Almost as soon as I got the positive pregnancy test with my third baby, I started having panic attacks. I would wake up, anxious and scared, from a dead sleep. This was a surprise pregnancy that I did not plan. In my mind, the timing wasn't right.
I dealt with these panic attacks as best I could. They came in the day and in the night. When I found myself begging my husband to come home from work and help me cope, I realized I was dealing with more than just a little bit of scared feelings.
I opened up to my midwife. Being a doula and childbirth educator in the community, I felt utterly embarrassed to divulge my secret. Even though I could tell other women this was a common struggle pregnant and postpartum parents experience, I still held a deep shame that I did something wrong, that I made this happen: I felt this was my fault. Despite having a negative bias against medications used to treat emotional health issues, I must admit I was hoping my midwife would have some magic pills for me.
Instead of medication, she offered me coping strategies to move through the panic attacks. I had a ritual I was already embracing -- I would move to the recliner and begin rocking. I had a paper fan I would use to cool myself down. The TV would turn on to some benign TV show I could have to focus on, or just use as background noise. I had a blanket nearby for when I inevitably would cool down and get cold. As most of these occurred at night, I would rock and fan myself. Soon I could stop rocking and recline back into the chair, putting my feet up. Next would be the blanket, until finally sleep would come. The whole process took about an hour. My midwife offered me strategies to shorten this process, and over time, it really seemed to work.
When I say I shared with her what I was feeling, I have to say I half-shared what I was feeling. Like a half-truth, I didn't tell her the full extent of what was going on in my mind. So while my panic attacks got better, I was living with a daily truth that caused me worry without end.
I said this was a surprise pregnancy. My first two babies I planned. In my "perfect timeline of life events," I thought we would wait longer before adding a third child to our family. I spent a lot of time feeling sad about this accident. I got to the point where I was afraid to be happy, because in my mind, that was opening the door to fate -- I would be punished for my bad feelings and something would happen to my baby. I had this mental math equation in my mind always, and this is what it looked like:
I did grow happy about this new baby, and my panic attacks stopped being so present. And sure enough, as excitement and joy built up inside me, so did the knowledge that something was going to happen to my baby. My everyday reality told me, he would not be born alive. This is a hard fact to live with, and this is what I never shared with my midwife.
At every check-up, I would search my midwife's face, looking for clues she knew something was wrong. I would dwell on random words she chose, or mentally extrapolate on nil what-if's. Alone with him in my belly, I waited, knowing someday those swirling movements and gentle rumblings would stop and my reality would be borne out.
Today is November 11, 2018. Twelve years ago today I stood in my kitchen as silent tears mixed with soapy warm water, convinced sometime in the next 14 days my baby, not yet born, was going to die.
That never happened. My 12-year-old just got out of the bathtub (ordered there under threat of me scrubbing his dirty feet myself). Right now he is getting ready for bed.
Nothing happened to him in those two weeks. So what happened to me?
Cognitive distortion. There are many cognitive distortions we humans fall prey to, and the one I was living with was "emotional reasoning." Pregnancy is a time when hormones make many changes in the body, and these hormones can also make changes in the mind. In my situation, my hormones ramped up my anxiety and fear, and I interpreted these feelings as fact -- they were my truth. And I lived with them, alone, everyday for 9 months. I never told a soul what my mind was telling me.
It makes sense that hormones would influence us to prepare to be parents -- to collect together the things our babies will need, to secure a safe place to birth, and to confidently care for our little ones once they are here. Sometimes these normal feelings go into overdrive. Of course we fear something happening to our babies when they aren't near us, but needing to check on them over and over and over -- to the point that it is inturruptive to other activities -- is a normal feeling gone into overdrive. Babies come with lots of "gear," and no one wants to be caught away from home without a spare bottle or a diaper -- but choosing instead to avoid leaving the house at all, citing this as the reason why, could be a normal feeling gone into overdrive.
Cognitive distortions can come hand-in-hand with anxiety and depression. I encourage you to check out the link above for excellent information about how these look and what they do. Weekly I hear from pregnant or postpartum (which means after the baby, it's not a specific mental diagnosis) parents who are reaching out for help. Just today I had a conversation with a former doula client, friend, and new mother telling me she has finally recognized she is stuck and she cannot fix herself alone; she made an appointment to see her doctor to start the process of meeting with a therapist.
I cannot say how much strength this takes -- to reach out to someone! It can feel like the hardest thing in the world to do. As a Volunteer Support Coordinator for Postpartum Support International, I try to link families to resources. I am not a counselor or therapist, but I do have a listening ear, and I care about what families are facing. I believe PSI's mantra: "You are not alone. You are not to blame. With help, you will be well."
We hear so much about "postpartum" mood disorders, but these can actually occur during pregnancy. In fact, they do so at a higher rate. While the graphic above states 1 in 7, during pregnancy it is actually 1 in 5! Have you heard that before? I would guess sometimes mood issues in pregnancy go ignored, and then are labeled "postpartum" caused when a person shares them with their doctor or therapist after birth.
Keeping my secret was not positive in any way, shape, or form. It held me in an alternate reality where my mind was free to ignore the facts and instead, formed around emotions. Shame kept me from confiding in my very-trusted midwife. I know now she would never have wanted me to be stuck in that place alone. I know, too, she would not have blamed me in the least.
But I was afraid to tell her because then, my emotions told me she would judge me, and that judgement would last forever.
You are not alone.
You are not to blame.
With help, you will be well.
It's not easy, I know. And you can feel so much better than you feel right now.
In my experience, many pregnant people FEAR THE BIG BABY! I myself fell prey to this when pregnant with my first child. I went to an OB visit that happened to be on my due date. My doctor said to me, "Are you ready to get this over with? Because I think he's getting kind of big." In my mind, there was nothing scarier than THE BIG BABY! I didn't want THE BIG BABY! I had read in "What to Expect When You're Expecting" (or as I refer to it, "What to Expect When You're Paranoid"), that doctors don't induce unless it's medically necessary. At that time I figured if it came from my doctor's mouth, that meant it was medically necessary. And because I was afraid of THE BIG BABY, I agreed.
What can we keep in mind about THE BIG BABY?
1. Many professionals agree it is more about the position of a baby rather than the size of a baby. Babies who are face-up (posterior) can make labor longer and harder. For more about this, check out the Spinning Babies website.
2. Ultrasounds measure the length of bones, not the squish of fat. You can't tell from bone length how much your baby will weigh. There are actually different formulas for measuring and each formula produces a different estimated weight -- do you know what your doctor is using?
3. Ultrasounds have about a 15% margin of error. This could be a pound and a half either way. That pound and a half number also changes the smaller your baby is. For example, if you were told your baby would be 9 and a half pounds and your baby was 8 pounds, that's about a 16% margin or error. If you were told your baby would be 8 pounds and your baby was 6 pounds, that's a 25% margin or error.
4. The size of a baby does not tell us if the baby's lungs and other systems are mature enough to be up and running on their own. It's actually the baby who decides when to be born by releasing a hormone the placenta responds to, and then triggering labor. Read Kim James' "Close to Due Date" for the breakdown on how all of this works.
5. My experience as a doula and childbirth educator tells me most women are afraid of having THE BIG BABY! This fear is often used by professionals to get us to agree to be induced, even though this is not recommended. The American College of Obstetricians and Gynecologists states inducing for a "suspected" large baby is not evidence-based. "In cases of term patients with suspected fetal macrosomia, current evidence does not support early induction of labor. Results from recent reports indicate that induction of labor at least doubles the risk of cesarean delivery without reducing the risk of shoulder dystocia or newborn morbidity."
My first baby was induced. And he wasn't small -- he weighed 9 pounds, 8 ounces. But was he more than my body could handle? With my next baby I passed over an OB for a Certified Nurse Midwife. I remember wanting desperately to go into labor on my own, but I was also petrified of having THE BIG BABY MARK-II. In a conversation with my midwife at around 38 weeks, I said to her, "You know, if I go over my due date, I'm just going to stop eating." She looked at me wisely and replied: "His HEAD is not getting any bigger. He's just putting on fat. And fat is very squishy."
Wow. As that sank in, I had an amazing realization that more often than not, our bodies know what they're doing. My second baby kick-started an 8-hour labor at 41 weeks and 2 days. Not only did he weigh 9 pounds, 9 ounces, he came out fully face-up and with his head tilted to the side (posterior and asynclitic). Granted my doctor was right about THE BIG BABY, and then THE BIG BABY MARK II came along next. But baby three (8 pounds, 4 ounces) and baby four (8 pounds, 1 ounce) proved I could have smaller babies. Either way, there's no need to fear THE BIG BABY.
Sometimes a cesarean is necessary and a family knows this before labor begins. This gives them a chance to prepare in ways they may not have thought of during a regular labor-turned-cesarean birth.
1. Bring easy carbs to snack on -- fruit, cheese, crackers -- bring what you and your partner like to eat. Aside from the surgery aspect and the fact that you usually can't eat until you pass gas (to ensure everything is moving as it should), I suggest you just take care of yourself like you do every other day of your life -- pretend you are staying at a hotel; what would you bring food-wise to eat when you weren't able to go out? Like that 2 am snack?
2. While none of my local hospitals have mini fridges for patients and family, it is possible to bring a small ice chest for things like yogurt or drinks that you'd like to keep cool.
3. More often than not people bring too many things. Bring your own pillow, pajamas (maybe nursing night gown so no waistband to put pressure on your belly). Bring small comfort items that help you feel better -- again, things you would bring on a trip. Most hospitals provide you with a belly binder after a cesarean birth, but you should call and find out for certain. This would be a wise purchase ahead of time if you don't get one from the hospital.
4. Some families like to dress their babies in the hospital, others keep babies in the hospital shirt/diaper and just do lots of skin-to-skin...that choice is yours. Everything your baby needs during the stay will be provided. If you want your baby in special diapers, then bring those (if they are cloth, bring the necessary wet bag to store the used diapers in).
5. I suggest packing in levels -- everything you will need before your cesarean birth in one bag, everything you need for your stay in one bag, then everything you need for going home in one bag. This way you don't have to dig through the going-home outfits to find your slippers, etc.
6. They will not take your baby to give you a break, even if you request it. I had a mom who had twins and had to stay at the hospital alone as she had other children dad needed to stay with. She was exhausted and asked if a nurse would just take one baby for one hour, and the nurse said sorry, babies only leave mom if they are ill and need to be in the NICU. You can have your partner stay the night if you wish. If your partner can't stay the night, some families arrange to have a grandma stay with mom.
7. Although there are TVs in all the hospital rooms, many families do well with a tablet, phone, and/or laptop. This way you can share baby updates and pictures with family and friends, and you can watch movies or listen to music if you have a spare moment.
8. Advocate for yourself. This is a day you will never forget -- if you are receiving care that isn't up to your standards, address the situation or ask for a new caregiver. You are paying the bill and you deserve cheery, positive, helpful support, even if you choose to do things a little differently or decline traditional procedures. You can decline ANYTHING if you don't want it. Don't feel pressured, and be sure to start a conversation that is centered around shared-decision making. You are the expert of you, while your doctor is the expert regarding the medical issues. You have equal say and power in what is going on.
Women rate their birth experiences on 2 things: How in control they are, and how much support they get. This can happen in ANY kind of birth. I have seen women walk away from what looks like an amazing vaginal birth traumatized with PTSD, and I have seen women walk away from unscheduled cesarean births beaming with pride and happiness. It is mostly about how you are treated and how much say you have in how things go. Even in a cesarean birth you have options -- ask what those might be (things like listening to music during the birth, no outside conversation that doesn't relate to your baby's birth, having the drape lowered as baby is being born, etc.). Often families find they can have greater say in something because of FOMO -- the things they feel they might be missing out on during a vaginal birth. Bring these concerns up ahead of time with your provider and ask what accommodations can be made to shape this into the birth you dreamed about!
Day 11 brings us a poem from a mom of 3 who recalls her first baby's birth. She didn't want share her personal information, she simply wanted to share her poem.
Sitting still, baby kicks
Belly squeezes, baby stills
Mind races, breathing slows
The waiting time is over
The waiting time has just begun.
Ready partner, strong support
Doula helping, steady hands
Midwife present, eyes bright
The storm is calming
The storm has begun.
Eyes closed, sound within
Mother loving, triumphant face
Baby grimaces, seeking the breast
The journey is over
The journey has begun.
With my first child, I had no idea there was such a thing as a doula -- I had never heard the word. With my second, we moved while I was 7 months pregnant, and I had since learned what a doula was; as I was away from home and family, I thought about finding a doula to help me through that birth, but in the end, the fear of the cost left my husband and I on our own again. With my third child, I finally decided I deserved a doula!
And do I ever love her!
Once my contractions began and we headed for the hospital, we called two people: My mom (who was three hours away), and my doula. My doula, Alicia, met us soon after at the hospital. She came ready to serve with her doula bag, her calm demeanor, and her gentle smile. I felt instantly better as she walked into my room, like "now I can do this."
My husband had been with me through two other labors and births -- he wasn't a newbie. But Alicia could intuit what my needs were without even asking. She was so good at helping me, she was almost like a fixture in the room -- the one handing me cold wash clothes to put on my hot belly, the one adjusting the bubbles in the Jacuzzi tub, the one giving the soft physical and verbal encouragement when I hadn't even realized I was struggling.
From my husband I had love and security; from my doula I had nurturing and normalcy. Now I know, if I ever have another baby, I absolutely will have a doula.
Sometimes it's fun to hear what people think we do as doulas. Often we get the same kinds of answers. In Day 9 Kelly Bolerjack shares a great top 5 list of misconceptions related to doulas and the work we actually do.
I’ve noticed a lot of confusion from the general public about doulas. And it’s understandable. Doulas aren’t portrayed in television or movies. You don’t hear about us on the news. Most people will never even meet a doula; and if they do they may not ask any questions. (I’m pretty sure my dad thinks I’m a doctor of some sort.) So, I thought I’d spend some time today clearing up the five most common misconceptions I hear about doulas.
1. We’re essentially midwives. Umm, no. Not quite. Midwives handle the physiological aspects of birth. They monitor the health and status of mother and baby, diagnose and treat problems, and are medically trained in healthcare to some degree. Midwives are essentially OBGYN-replacements. Doulas give emotional, physical, and informational support as well as advocate for the rights and wishes of the birthing woman. As a doula, I offer knowledge (from training) and experience (from practice) in an attempt to normalize birth. There are many unknowns in birth and women can feel scared or threatened. A helpful and familiar doula who can offer advice or encouragement, without the burden of (midwife/OB) responsibility, can help the woman achieve the birth she desires.
2. We’re all patchouli-loving hippies. I actually hate the smell of patchouli. And while I admire hippie women who live free and uninhibited lives, I like my medications, Iphone, high heels, and smooth legs. Doulas come in many varieties. This misconception is based in a (sort of) truth in that modern doulas arose in response to the medical births of the early and mid 1900s. Our first doulas (and midwives) were a group of hippies in the 1970s who began the natural birth movement. Hospitals were putting women under so many medications during labor and birth, they were unconscious, also known as Twilight Sleep. But while hippies may have started the movement, options in birth has become a mainstream idea. I know medications can be successfully used in some birth situations. I simply advocate for a woman’s right to choose where and how she gives birth.
3. We only attend natural births. In my personal practice, this couldn’t be farther from the truth. I attend far more births where the woman is utilizing some sort of medical intervention, be it pain relief or induction. Some doulas may choose to decline medicated births for personal reasons. But not me. Don’t get me wrong, I certainly have (very) strong opinions on what I believe are the best ways to give birth. But I’ve already had the pleasure of planning and experiencing my own births. As a doula, I help other women with their births. If my client wants medicine, I want it for her, too. If she wants to be induced, I support that fully. If she wants to schedule a cesarean, I will stand by her side.
4. We replace the partner in the birth room. That would be a terrible thing, indeed. I am constantly including the partner in whatever I am doing for the birthing woman so that the partner can be a part of the experience. The truth is that this birth is their memory, not mine. I won’t be invited to the child’s birthday parties or high school graduation. I am in their life for a short, yet sacred time. I strive to be an addition to the birth team; to be the part that seemed to be missing. I cannot replace the loving bond that connects the woman to her partner and their new child.
5. What we do is easy and should be offered for little or no cost. It’s not easy. It’s hard work. Doulas must create their own small business and run it. We network with perinatal providers in the community to attract clients and spend a lot of time and energy in letting pregnant women around us know that we are available. We must build an intimate relationship with our client (akin to a counselor) in a very short period of time, while tailoring our services to their specific needs. We study, learn, and grow constantly in our knowledge so that we can hopefully be of help in every sort of situation. We put ourselves on-call and contract to drop everything else (family, friends, commitments) when our clients go into labor. We support women (physically and emotionally) on little to no sleep with the diet of coffee and adrenaline. Most importantly, we hold space. We witness birthing women and see them without making any judgements. All the while, we sometimes witness hard and scary things during birth that can make us question just what the heck we’re doing. But we love it. Doulas are compelled to join women during labor: to stand with them and support their choices. And in valuing other women, we must value ourselves: our time, our knowledge, our strength, our service.
I hope that this has been informative for you in clarifying the role of the doula. If you have any questions or comments, please write them below. I’d love to hear from you!
Kelly is a DONA-certified birth doula living the dream in Austin, TX. A mother of 3 daughters and a lover of exercise and taco food trucks, Kelly incorporates a modern and urban dynamic into her work as a doula. She serves women of all backgrounds and identifications, with all types of care providers and in all settings. Kelly's clients value her honesty and relentless desire for informed decision-making. Kelly also provides trauma-informed care and helps each woman she meets screen for Perinatal Mood and Anxiety Disorders. Find her on Facebook as @kellybolerjackdoula, Instagram as kelly_bolerjack_doula, or her website www.kellybolerjackdoula.com to find out more.
Today's feature brought out mixed feelings in me. I don't want to give it away, so please read Deena's ideas and see how they make you feel. Is she right? Is she wrong? Is she somewhere in between? What kind of doula are you and can you support anyone's birth choices, truly? Is it time for doulas to "science up?"
On my third date with my boyfriend, we were at a local pub, having drinks and consuming mass quantities of greasy but tasty loaded fries, he suddenly became nervous and sincere. He leaned across the table and looked into my eyes. I was curious because we were only causally dating, and this seemed rather serious to me.
He started to speak, caught himself, and then spoke again. “I know you teach yoga, childbirth education and I understand what you do as a doula.”
I nodded, waiting for the rest of his statement.
He asked me, “Ok, I have to know, what’s your thought on vaccines?”
The look of relief on his face was measurable when I said, “Vaccines are a public health issue. It’s irresponsible not to vaccinate your kids or yourself.” He assumed, erroneously, since I wore all of those job titles proudly, that I must be anti-vaccine.
He replied, with a huge smile, “Good, because it would have been a total relationship deal breaker if you were anti-vaccine.” More than a year later, here we are, still together.
Fast forward to last week, I had an initial consultation with a new potential doula client. She asked me a question I’ve never been asked before in a consultation appointment in my almost ten-year career. “There is this stereotype about doulas”, she said, “It’s that doulas are, well, all-natural, hippie, alternative medicine people. I’m not any of those. Are you like that?”
The question gave me brief pause. I smiled and her and said, “I like my science. I will never try to fix your health issues with essential oils, or for that matter, try to sell them to you.” She smiled back and said, “Oh, thank god!” We discussed the topic a bit further and then moved back into the rest of the consultation.
Her question was a valid one, and so was that of my boyfriend.
The perception of doulas in the greater community is how this pregnant mother described. It’s one of placenta encapsulation, essential oils, earth-mother figures, natural birth, and anti-medical establishment attitudes. Thus, it becomes an exclusive club, leaving behind those who wouldn’t touch a placenta, let alone ingest it in any form and those who trust their doctors and want their epidurals. Yet, these women want, and sometimes need a doula too. The public perception restricts these women’s desire to reach out to us for an interview, let alone to hire us.
Yes, I know what we all preach. A doula for every birth! We support what you want and need, my personal bias is shelved for your birth!
However, that’s not how we always practice and that’s not the perception of many pregnant people out there of what we doulas do and how we do it. Perception is reality. Those women seeking the holistic, anti-medical establishment but still in a hospital birth are the ones who often find us and the mothers who are comfortable with the system, may not seek us out at all. So, we end up filling the role that fits the stereotype because of how we’ve presented ourselves as doulas. It becomes a circle, belief leads to practice and practice leads to belief.
I have no answers here, with regards to how to amend the public perception of who we are and how we practice. I know that there are doulas who are very natural oriented and that suits them and their clients. I also know there are doulas, and other birth professionals, who like me, are firmly grounded in science and evidence-based medicine with a healthy dose of doula compassion and TLC for their clients mixed in.
We can serve more birthing people, better, if we can change the perception and move more into the mainstream. It makes me wonder too if we’d be more likely to be successful at having health insurance companies cover our services if we can amend this perception.
My question to the readers is thus: How do we better show to the public, those who don’t know us, that there is no one way to doula? How do we show that some of us are science based and some of us lean more holistically? What about those of us who straddle both worlds of alternative therapies and evidence-based medicine?
Deena Blumenfeld ERYT, RPYT, LCCE, FACCE is the maven behind Shining Light Prenatal Education. She has been working with women since 2008 as a prenatal yoga instructor, doula, childbirth educator and teacher of teachers. She specializes in women’s health for all phases of reproduction: fertility, pregnancy, childbirth, postpartum and pelvic floor health. Her two children put her on her path to serving other women throughout their childbearing years. She can be reached through her websites, shininglightprenatal.com and
Shining Light: building empowerment, self-confidence and connection through candid education and compassionate advocacy for all families before, during and after pregnancy.
Today Sharon Muza shares one of her most embarrassing moments as a doula. We can all recall our missteps -- those times we wish we would have done something a little differently, said something else, or held that poker face a bit more tightly. We are human, and these things will happen. All we can do is laugh at ourselves when appropriate, and try to do better the next time!
As a doula, I always try to do my best. And sometimes, doing my best results in funny outcomes. I am sure that we all could share a funny story or two about our birth work. This is one of my favorites.
I had been at a birth of some clients. I was with them for about 15 hours. It was a perfectly normal birth, things moved along as they should, and a baby was born. I took my leave at the appropriate time, said my goodbyes and made my way home to rest and return to the rest of my life, which as you know, had been put on hold. It was mid morning, and I took a quick nap, thinking I would just go to bed early that night.
Another baby had a different idea. I received a call from a client about four hours after I got home from that first birth and soon joined another family at a different hospital. This birth took a bit longer and I was with family number two for about 24 hours, including through what was now my second consecutive night of missed sleep.
This baby arrived and once again, after providing post birth support, I began to say my goodbyes with baby number two and its family. It had been a long 24 hour birth (after a long 15 hour birth) and I was now officially and totally wiped out and ready to throw myself in bed for a long sleep.
As I was heading for the door, I looked back over my shoulder for one last goodbye. I called out “Goodbye Samantha, goodbye Jason, I will talk to you tomorrow.”
Before I could open the door and go through it, the dad called out to me. “Oh Sharon, by the way, my name is Kyle, not Jason.”
I stopped dead in my tracks. What?!?! I had been calling him Jason for the past 24 hours. How could his name not be Jason. Then it hit me. Jason was the name of the dad from the first birth I was at, the day before. This indeed was Kyle. I had called him the wrong name probably a 100 times over the past 24 hours. On the day of his child’s birth, the doula had called him by the wrong name every single time.
I was mortified when I realized what I had done. But why did no one correct me. Not the birthing person, not the partner, nor any hospital staff. Not one person questioned why I was calling Kyle by the name Jason. I had never realized my mistake due to my exhaustion and back to back births with Jason.
I did not know what to say. I mumbled some apologies and rapidly shuffled out the door. I was stunned and ashamed. What a fool.
When I saw them next at the postpartum visit, we laughed, sort of, at my mistake. They told me not to worry. I worry about this to this day, probably ten years later. I wonder why he never told me that I was using the wrong name? Why wait till I was walking out the door? I can laugh at it now, but I am still completely curious why I was not corrected. Strange but true.
Have you had strange or funny things that have happened at the births you have attended? Please share in the comments below while respecting client confidentiality.
Sharon Muza, BS, CD(DONA) BDT(DONA), LCCE, FACCE, CLE has been an active childbirth professional since 2004, teaching Lamaze classes and providing doula services to more than a thousand families through her private practice in Seattle, Washington. She is an instructor at the Simkin Center, Bastyr University where she is a birth doula trainer. Sharon is also a trainer with Passion for Birth, a Lamaze-Accredited Childbirth Educator Program. In September 2011, Sharon was admitted as a Fellow to the Academy of Certified Childbirth Educators. In 2015, Sharon was awarded Lamaze International’s Media Award for promoting safe and healthy birth. Very active in her community, serving in a variety of positions that promote maternal-infant health, Sharon enjoys active online engagement and facilitating discussion around best practice, current research and its practical application to community standards and actions by health care providers, and how that affects families in the childbearing year. Sharon has been an engaging speaker at international conferences on topics of interest to birth professionals and enjoys collaborating with others to share ideas and information that benefit birth professionals and families. To learn more about Sharon, you are invited to visit her website, SharonMuza.com.
I always love Joyce's contributions to the 31 Days Project -- and today's does not fail to represent her heart and her mind. If we, as doulas, cannot see ourselves here in this vulnerable position of admitting we know nothing, I would suggest some introspection take place to balance pride with humility.
This month, I celebrate eight years since my DONA International birth doula training! In those eight years, I have had the privilege and sweet responsibility of supporting more than 70 births. My husband and I have added two more babies into our own family in that time. I have achieved and maintained certification through DONA, completed certification as a Hypnobabies Hypno-Doula, volunteer with the International Cesarean Awareness Network (ICAN) Lincoln chapter, volunteer with DONA as the Nebraska state representative, and serve locally with Doulas of Lincoln. I have completed training and taught other birth professionals as an Evidence Based Birth(R) Instructor. I have completed training on Rebozo techniques, Spinning Babies, techniques to alleviate back labor. I have brought new doulas with me to births for hands-on training. I have read and read and read some more. And yet. On some level. Despite all the knowledge. I know nothing about birth.
I understand the physiology. I understand the anatomy. I understand the symphony of changes that must happen in birth, at least as much as is understandable. I understand the emotional changes that birthing parents go through as their birth draws nearer. I understand the physical needs common to birthing women. I understand the psychology. I understand the medical considerations. I understand the medical system and its power structure. I understand that my clients will make choices that I would not, and I accept and honor that. I understand how to support women in childbirth, from the early stages to the first weeks postpartum and beyond.
Yes, I have lots of knowledge about birth. And birth surprises me. Regularly.
In those 70+ births, I have seen a woman go from 3cm to pushing out her baby in an hour. I have witnessed a mother going through the emotional signposts of labor during her pre-op for her scheduled Cesarean. I have held space for a woman to process her fears of becoming a mother while her cervix waited at 9.5cm for over 1 hour, and then cheered as she pushed out her healthy baby. I have supported women through inductions, natural births, epidurals, Cesareans, and more. I have been present for external cephalic version. I have experienced the stillness of breath, the concentration, the skill, the hope in the caregiver while resolving shoulder dystocia. I have held my own breath waiting for that first cry of life, and sighed in gratitude and relief when it comes. I have been astounded. I have been afraid. I have been amazed. I have witnessed miracles. I have had prayers answered moments after I prayed them. I have had prayers answered in a way I did not want. I have been allowed into sacred space. I have witnessed the moments that will live within a family forever. I am grateful.
I have made mistakes.
I had a client who was negatively impacted by seeing the clock, and I wished I had taken it down. I then had a client who was paying close attention to the clock, so I took it down. She lost her focus, and needed me to put the clock back up. I know nothing.
I had a client who was bothered by me explaining things in detail during her birth. I then had a client who wanted more detailed explanations during her birth. I know nothing.
I had a client who loved the bathtub. I then had a client who hated the bathtub. I know nothing.
I had a client who needed to smell peppermint oil to alleviate her nausea. I then had a client who found the smell of peppermint nauseating. I know nothing.
I had a client who needed her support team to be extremely quiet to feel safe. I then had a client who felt safer when her support team was chatting and talking around her. I know nothing.
I have lots of knowledge about childbirth. But when I go to a birth, my only hope to do my job well is to listen to the birthing mother. To read her. To ask her. To trust. To let go of my knowledge and myself and simply serve. I know how birth works, but I cannot know this birth before me.
Only the birthing mother knows birth. It is my duty, my joy, my honor, to serve her.
Joyce is the oldest of four children, and her birth experiences began when she watched her two younger brothers being born, med-free in hospital settings, when she was 4 and 8. When she and her husband discovered they were expecting their first child, she began researching everything she could about natural childbirth. That is when Joyce first learned about doulas. Labor support is her calling, and she is overjoyed at the opportunity to serve women in this way. In addition to being a doula, she is wife to her high school sweetheart and mother of three amazing children! Joyce holds a BA in psychology and a MS in biological sciences.
Joyce breastfed all three of her children to at least one year of age, used cloth diapers, baby sign language, babywearing, use natural remedies in conjunction with Western medicine, and homeschools. She doesn't think of herself as an "attachment parent," a "green parent," or any other parent label, she just does what makes sense for her family, and she encourages others to explore what makes sense for theirs.
Her website, Doula Joyce, and her Facebook page are where you can learn more about her.
BRAIN is one of my favorite examples of an easy way parents can get more information and ideas about different interventions they face. What I have not brought with that is the HEART Megan shares in Day 5's post. I love the combination of the two and am going to print them both out on business-size cards for my next childbirth classes!
One of the most crucial things we do as doulas is help parents make decisions. It's not as glamorous or often discussed as giving massages, squeezing aching hips, or whispering words of comfort and encouragement (not that any of those things are particularly glamorous). But it's one of the most important things we do.
Decision-making happens frequently during pregnancy. Choosing a care provider, a place to birth, which breast pump to buy through your insurance, what kind of birth preparation class to take, what sorts of things to register for, and so on...the decisions to be made sometimes feel endless.
But during labor, things are different. No longer is there a stretch of weeks or even months before baby is on the way - things are happening right now. Add to the urgency of time the fact that most laboring families are not necessarily calm, cool, and collected the way they might like to be when making decisions. Parents often don't even understand the implications of the options their care team is presenting.
That's where we come in.
In our prenatal visits and birth classes, we often use a tool well-known in the birth world. In fact, it's a tool now used by many who encourage healthcare literacy as a helpful way to approach decision-making with care providers. This tool comes in handy no matter where you're birthing, but we find it's often especially helpful for clients who are having their babies in a hospital setting.
The tool is an acronym: BRAIN. When a question comes up in labor, or a procedure or medication is suggested as the next step, our first suggestion is always to stop and take a breath. Sometimes these situations can be nerve-wracking in labor. So give yourself a moment rather than responding quickly and impulsively.
Once you've gotten a nice breath or two under your belt, take some time to go through the acronym letter by letter and ask some questions.
B: Benefits The first question to ask is what the benefits of the suggested procedure, medication, or change to the situation would be. Remember to consider benefits both for you and for your baby. We've found that usually care providers answer this question even before you have to ask it, because their suggestion is made with the intention of giving you and/or your baby a certain benefit. But if you have any additional questions about the benefits, ask them!
R: Risks Next to ask is, what are the possible risks to you? To your baby? Usually in a medical setting the answer to this question reads more like the side effects listed on a drug label. While this is good information to know, there are other indirect considerations to think about which sometimes fall outside the realm of the care provider's role in that moment.
For example, sometimes our clients ask their nurse or anesthesiologist about the risks of an epidural. Usually we hear care providers mention things like the possibility of a drop in blood pressure, headaches, nausea, itching, etc.
However, I've never heard a care provider mention the increased risk of a longer pushing phase, the increased use of medication to augment a labor slowed by epidural (pitocin), or the increased difficulty of breastfeeding after births involving an epidural (probably due to the IV fluids that accompany the administration of an epidural). These are things we discuss with our clients if they're considering an epidural, along with the benefits including "therapeutic rest" if labor has been long and hard.
If you ask about the risks of your care provider's suggestion and receive information from the drug label, also ask if there are any other indirect risks they know of. (And check in with your doula too, to see if they have any other information that might help you as you make your decision.)
A: Alternatives Ask your care provider if there are any other alternatives that can be tried first before proceeding to the suggested procedure or medication. There may be something less invasive or more temporary that might help address the issue at hand.
Often care providers and medical staff are much more comfortable with medications and medical technology in birth than parents are - primarily because they're around those things all the time. They see highly medicalized care help families every day. But most expecting parents aren't in that boat. Our clients are often surprised that their care providers suggested something more invasive when there was a less invasive alternative. Understanding where your care provider is coming from can be really helpful in this case. And of course, if your care provider suggests an alternative or two, make sure to use your BRAIN when exploring those options as well.
I: Intuition What does your gut say about this? How are you feeling about the situation at hand and the proposed next steps? Studies have actually shown that the intuitive, ancient part of our brains (the part that gives us those gut feelings) often works faster than the more analytical part of our brains. Here is a fascinating article on the subject.
It's important not to discount the sensations in your body we refer to as a gut feeling because what it can mean is that some part of you already knows the answer. It may just take a while for the rest of your mind to catch up and figure out the "why." Pregnancy, birth, and parenting involve a LOT of intuition. Don't leave your intuition at the door when you enter the birth room.
N: Nothing Also known as, "What if we wait an hour?" This question can help you determine whether your care provider feels the situation is an emergency or not. If the answer to "Can we wait an hour?" is "Sure, I'll come check in later," you know you have time to think things over. But if the answer is, "Waiting isn't an option - we need to make a decision now," obviously that gives you a different picture.
If the care provider's response to waiting an hour is positive, sometimes parents are surprised they were being asked to make a decision earlier than necessary. It's important to keep in mind that care providers are often on a schedule and juggling multiple patients at once. Sometimes the timing of things has more to do with their patient load than with your particular situation, which is another reason why it's important for parents to be asking these questions. This question is especially powerful for parents who want to minimize medications and medical technology in their births.
You should be able to take your time in making your decision unless there is a medical emergency at hand.
After you've had a chance to ask your questions, request a few minutes alone without your care providers in the room to consider your options. (If you have a doula, it could be beneficial to have them in the room with you as you talk things over. But if for any reason you'd be more comfortable having the conversation alone, by all means let your doula know.)
Once you're ready, let your care providers know you've considered your options and made a decision. If you are choosing to accept your care provider's recom-mendation, often the conversation will be fairly straightforward. But if you're choosing instead to try an alternative or wait a while before trying anything else, sometimes care providers can feel that their expertise is being undermined or that someone is convincing you not to accept their recommendation. This is a very human reaction!
To help diffuse any tension if this happens, speak from your HEART when communicating your decision to your support team.
H: Hear "I hear what you're saying and I understand why you recommended this..."
E: Empathize "...and I know you want the best for me and my baby..."
A: Affirm/Assert "...but I intend to wait a while longer before considering x, y, or z." OR "...I would rather try this alternative instead."
R: Reassure "I will let you know if anything changes."
T: Thanks "Thank you so much for your time and for taking good care of us."
These kinds of conversations can be difficult, especially if any medical concerns are present. These tools will give you an anchoring point when making decisions in labor and beyond.
Remember to use your BRAIN and HEART!
Megan has been serving growing families since 2014. She is an Advanced Birthing From Within Mentor and doula based in Orange County, CA. She is passionate about providing holistic guidance for her clients, helping them cultivate resilience and openness on their journeys to parenthood. In addition to offering birth doula support, she also teaches birth and parenting preparation classes. Megan practices in partnership with her wife, Marlee, who is also a birth and postpartum doula, childbirth educator, and lactation counselor. Together they serve families of all shapes and sizes with respect and compassion. Find out more about her by visiting Hero Birth Services, or her Facebook page.
♥ four young boys and a boy dog (offspring)