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. ​

When you look at the probability of trauma in the course of a woman’s life, the statistics are high. One in three will experience sexual abuse in her lifetime, one in four will perceive her birth as traumatic. So, if you’re a childbirth or postpartum professional, you are regularly working with women who have experienced trauma. And keep in mind: a woman who has previous trauma or a history of abuse has a much higher chance of being triggered in birth and experiencing trauma again.
​
What is birth trauma? It’s all about perception. When a woman perceives her birth as traumatic, she has felt one or more of the following in an intense and damaging way:

Birth trauma will have immediate effects on a woman and change her experience of birth, postpartum and motherhood. As birth professionals, our goals are to prevent birth trauma by providing support, information and guidance for laboring Mamas. Some of the things you can do during your time together are build trust, tune in to Mom’s behaviors to establish safety in the labor room, and speak to her in a calm, affirming voice. But unfortunately, we can’t always prevent birth trauma.
​
Women who have experienced a traumatic birth can develop PTSD (posttraumatic stress disorder). It can be misdiagnosed as postpartum depression or anxiety but the symptoms are actually different. Some signs of PTSD in a new mother are:

There are some important things to keep in mind when dealing with a Mom who has birth trauma. Your support will be critical to establishing safety, support and eventually healing from this difficult time.

​Here are some things you can do to support a Mom with trauma

​The exciting and encouraging thing to hope for is what’s called post traumatic growth. With proper self-care, nutrition, sleep, and exercise she will begin to feel better. Suggest to her that some women find healing through yoga, body work, trauma therapy and groups. Post traumatic growth provides women the opportunity to heal from trauma and become stronger, wiser and more compassionate because of it. With adequate support, education and care, new Moms can fall in love with their babies and leave the shame and pain of trauma behind.

​This month is International Doula Month, and as such, I’ve been thinking about what I really wanted to say about doulas that I maybe haven’t said before. There have been a few interactions I’ve had lately that really got me thinking, although this is nothing I haven’t thought about before or even mentioned in classes.

We expect FAR too much from dads during birth.

So, here’s the deal: 

Back in the day, like 130 years ago or more, when a woman went into labor, the local midwife would come into her home. The mom’s female friends and family would come to help– they would prepare her a birth space,  soothe her, help keep her fed, hydrated, and reassure her. Birth was a normal part of life, something that most woman would be familiar with long before it came time for them to give birth as well.

I’ll say this again: Birth was a normal part of life.

The role of a birth doula is to try to bring into the picture those women who were very experienced when it came to birth. Unless you’ve been around a couple of women as they give birth before, birth is a pretty weird process that no amount of videos can ever prepare you for. So while I’m not saying we should go back to the time when it was considered “improper” for men to witness births, I’m saying that the idea of a partner having to bear the responsibility of caring for emotionally and physically supporting a mom through birth is unfair to everyone– it’s unfair to the partner, it’s unfair to the mother, and it’s unfair to the baby.

We have mounting evidence of dads (there is no info out on same-sex partners) experiencing PTSD as a result of being at the birth of their babies. Even if there aren’t ANY complications, while we should try very hard to prepare partners to be active participants at birth, there’s nothing to really prepare anyone for the twists and turns of birth. Doulas can’t predict how a birth will go, but they are prepared to walk the journey with families, no matter what that ends up looking like. Doulas provide that reassurance to EVERYONE during the process, no matter what, helping reduce trauma.

Doulas aren’t emotionally attached, nor do they have to bear the responsibility for the medical care being provided.

Hiring a doula isn’t a value judgment on the state of your relationship; in fact, having a doula can help provide the space and time for those critical moments during labor and birth that can bring couples closer together.
Hiring a doula will not take away from a partner’s role at birth; having a doula present will give him more confidence to be involved in a way that he’s comfortable with.

Hiring a doula means that the laboring mother will have what’s very biologically normal– the care and support of an experienced woman who will stay with her through the whole process.

Hiring a doula isn’t a luxury. Hiring a doula should not be a status symbol. Hiring a doula should not be political. Hiring a birth doula is a logical, critical, SMART choice that can help ensure that no matter what happens at a birth, everyone in the room was able to benefit from the professionalism and reassurance and care that a birth doula provides.

I believe in birth doula care SO MUCH that I have created a non-profit that, in addition to providing mental health services, provides doula care on a free and sliding-fee basis. 

Hire a doula. It’s important.

I have a son who was born with an aortic stenosis. This means his aortic valve is narrower than it should be. He just turned 14 and up until his cardiology appointment last month, there has never been an issue.
 
Before we found ourselves back in the office, we had been rescheduled twice, so I was already feeling on-edge. Walking into the waiting room, there was not one place to sit. This added to my feelings of annoyance. When we finally met with the doctor, I was relieved, until after placing the transducer on my son’s chest his first question was, “Have you had a growth spurt recently?” Not what you want to hear when your child has a heart defect.
 
The most recent reason we had been rescheduled was our doctor had a spider bite on his leg that needed treatment. I rolled my eyes when the receptionist shared this with us (good thing it was over the phone). I thought it sounded like an interesting excuse – who has to go to the hospital for a spider bite? But another part of me wondered: Why is she telling me this? Is that my business?
 
At this bad-news-appointment, we were told medication would be needed to lower my son’s blood pressure – not because it was high, but because the rate of flow through the narrowing could cause damage to the area where the blood comes through, like spraying a pressure washer constantly at one spot on your house. We were also asked if we had other children, and if they had ever been assessed by a cardiologist? We have 4 sons total, and no one has ever told us this before – that was jarring. The doctor was adamant my husband and I be checked, as well. Our heart-son’s health is monitored fiercely because there is a known issue – but if this were genetic, any of us could have an issue and not know. That was frightening.
 
We were the last appointment of the day and the office was shutting down. As the doctor was performing the echocardiogram, he kept sharing details of his spider bite, occasionally shaking his leg or letting out a sigh or “ouch” here and there – it was obvious he was not feeling well. He also said he couldn’t wait to get out of there that day and change the dressing.
 
So here’s us: bombarded with overwhelming information.
 
And here’s our doctor: trying to help us while being distracted with his own issue.
 
I left that day feeling sad, scared, and unsure about all his recommendations. Knowing we didn’t have his full attention added to my stress and confusion. I questioned our relationship with this professional, and again to my mind came: Why is his issue my business?
 
So how does this relate to doula work? Let me share another story. 

​A number of years back I had a couple I loved, and I think they loved me. We were so excited to work together. A week before they were due, my grandma passed away and the funeral was in another state. Of course I was going to attend – in the grand scheme of things, my grandma’s funeral is going to be more important to my health and memories than the birth of a client’s baby. So I let my client know my plans.
 
It was an emotional phone call, because she was one of the first people I told. I did cry when I let her know I was going out of town, and of course I would provide a back-up for her. I felt good about everything. I was gone for 5 days, and just as we hit the California state line again, I knew I would be home by nightfall and things would return to normal! I could still be there for her birth.
 
I was unprepared for the phone call I got within an hour of that feeling. It was my client. She said she didn’t want there to be any bad feelings at the birth, and they had decided to proceed without a doula. I felt confused because I knew I didn’t have any bad feelings – had I been clueless to their feelings?
 
The next day we talked it out more. I felt I had made it back and things would proceed as planned. But what I didn’t realize was, my business had become her emotional baggage, as she worried about my loss and whether I would be back in time for her birth.
 
At the time I remember thinking, “No one cares about me.” Meaning, clients don’t offer the same emotional support and empathy that doulas do. Our lives don’t get the same priority as the pregnant families we serve. It was an acutely painful realization made worse by the loss of my grandmother and exhausted nature of the trip. 
 
Of course, I was wrong. That’s how it should be when I am being contracted to provide a service. And once I was mature enough to realize it, I decided I wanted my clients to feel like I don’t have a life. Never again would I burden a client with my personal business. I want them to realize, when it comes to their expectations of me, there is nothing more important (even at the most inconvenient times), than their call of: “we need you.”

I have heard from many women over the years, words and situations that haunt them, where a professional’s business was made the mom’s business (which is really bad for business).
 
-A mom was waiting for her midwife to come for a postpartum home visit. The midwife told the mom she couldn’t find childcare for her little boy, so she would need to reschedule. The mom experienced a pretty traumatic birth, and she was eager for this visit and the need for someone to look over her baby again. She was so worried she took her baby to the ER just to have someone tell her the baby was safe and healthy (which she was).
 
-A mom who wanted a TOLAC (trial of labor after cesarean) ended up with a repeat cesarean birth. It was very emotional, everything leading up to this and ultimately, having an unexpected surgical birth with an unexpected provider. Toward the end of the birth, the doctor said, “Can someone take over for me? I have to get to my granddaughter’s piano recital.”
 
-A mom who experienced terrible postpartum anxiety and depression who was desperate for support. She sought out a therapist recommended to her by a friend. Once there, sharing her story in an uneasy fashion, with tears, and memories, and guilt, the therapist let this be an opening to share her own struggles with depression after her brother’s suicide. Suddenly "a little postpartum depression" felt minimal compared to this professional’s loss.
 
We pay professionals for a service. They should be taking care of us. When the tables turn and we are suddenly made aware of their personal lives, it can stir up feelings of empathy and sympathy. It can make us feel like we should be the caretakers now – we need to look out for this person and not bother them with our trivial matters. “I don’t want to load too much on her, because she has struggles of her own.”

But then, what are you paying that person for again?

Professionals need to leave their personal business out of their professional lives.
 
That’s not to say clients are rude or uncaring – they aren’t. And the focus still needs to be on them. What can we do when something comes up?

As a doula serving Bakersfield and Visalia, California, I strive to build families up and let them know I will be there for them, come hell or high water. I also contract personally with a back-up doula who attends prenatals with us, thus laying a foundation of support in the small chance I am unable to attend a birth (it rarely, rarely happens, and the cost of paying for a back-up’s time is absolutely worth my peace of mind). It shows a family: I am committed to you, and sometimes things come up; if that happens, here is my trusted back-up so you won’t be alone in this journey.
 
Ultimately, I believe me making my business your business is bad, overall, for business! ​

In my classes, I have an activity I am pretty sure I learned in my Passion For Birth training where parents are encouraged to draw their ideas for birth. Taking left-brain concepts (hospital stays and medical procedures) and using right-brain-directed activities (drawing and coloring) blends our thinking and enables us to synthesize ideas, versus analyze them. What's the difference? When you analyze something, you have a singular focus on it and it alone.

​Imagine being worried about having an unneeded, unwanted, unwarned-about episiotomy. Analyzing this can lead to worrying it might happen to you, without much recourse or thought into the bigger picture of how to prepare to avoid it. Synthesizing takes many pieces of information and plugs them into a bigger picture. In the case of episiotomy, you can learn when they are medically necessary, ways to prevent them during labor (for example, avoiding getting over-hydrated) and second stage (avoiding purple pushing and being more upright), your doctor's opinion and habits, and your birth location's statistics.

Here are pictures from students in my Chico, CA classes (I currently offer Lamaze childbirth classes in Bakersfield, Visalia, Hanford, Tulare, and many places in between and beyond). 

The first time as a doula I witnessed the consequences of sexual abuse on a woman's birth experience, two things struck me: 1-I was amazed at what we can carry around every day, having pretty good control over, stuffing down and away, that can come bubbling up during something as intense and consuming as labor. And 2- Who did this to her? I felt helpless in the moment, and I just prayed to help and not hurt her; I promised myself I would learn more. I am so grateful to Julia for sharing this with us.  And please, add your ideas and resources if you are aware of any not listed here. 

I am a survivor myself, living through an extremely violent rape that happened by knife point. I subsequently became pregnant and had the awful choice of deciding what to do, and living through an abortion procedure alone. I continue to work extremely hard to continue to process new memories that have surfaced, and live with PTSD. After my assault, my rapist moved out of state, and re-offended, his next victim being a 12 year old girl. He was prosecuted, and he served 7 years. He currently lives less than ten miles from me, and those I love, and I've seen him four times around town. Since I didn't prosecute, I can't get a restraining order, and the statute of limitations has long since run out for me. Since the rape, I've been a strong supporter of organizations whose main goals are to support survivors of sexual assault, and serving survivors as a doula... as childbirth brings up a lot of triggers for women.

Several friends have asked "how can we help" in the light of the recent sexual abuse scandals (most notably by the eldest Duggar son against his sisters, which then went unprosecuted, and of which he never received any punishment, nor rehab for.) So. Here's what you can do as an ally.

(Note:  In this post, I refer to survivors as female.  I do this only because I identify as female, and am speaking from my personal perspective.  I only use the female pronoun for ease in this context.  Male survivors especially have many more hurdles than female survivors and have a very hard time reporting abuse.  Furthermore, I refer in this story to rape as the general term for the crime committed. Again, as that is my own story and for ease of not listing every possible sexual abuse category.  All violations are egregious and deserve attention in the media and by law enforcement.)

Support local/national politicians looking to make a change. 
One such person is Wendy Davis. She has been a passionate advocate for eliminating the statute of limitations on sex crimes. Support her. Comment on her FB wall, write a letter, tweet support, sign ANY petitions on this topic that she brings to the masses.

Learn about some of the injustices out there facing rape survivors.
Mariska Hargitay is a part of an organization called Joyful Heart Foundation. One grave injustice are to the survivors who subject themselves willingly to a rape kit, and their kits NEVER GET PROCESSED. From first-hand experience, a rape kit is an extremely violating experience, especially after living through a violent sexual assault. It involved pictures, statements, they take your clothes and do intense exams. Women who go through this should never have to wait for their kit to get off the shelf. It says "there is money to fund other crimes (most notably not sex crimes) but you aren't important enough to follow up on." I have NO idea whether my kit got processed (I didn't prosecute, nor do they have my name, so there is no way to follow up on this) but I imagine it is still sitting there. In my hometown of Portland ALONE, there are nearly 2,000 unprocessed kits. You can donate to End the Backlog.  Only 39% of kits are ever submitted for crime lab processing. THIRTY NINE PERCENT. This is outrageous and unacceptable.

Find organizations that support survivors and support them.
RAINN (Rape, Abuse & Incest National Network) is an amazing organization who deserves every dollar they are given. Looking to give local? Find a local organization and give of your time or money.

Know a survivor? Ask them "Would you like me to ask about your experience?"
I can't tell you how healing it has been to have people ask me questions, bear witness to my story, and not look at me with a huge pity face while doing so. Just today I was able to share with a friend about some of the details, who has taken on a very challenging role to assist me in healing and honestly, just being asked is so affirming. My (their) story matters. Sharing and being acknowledged that I went through this is healing. Don't know what to say? "I'm sorry that happened to you." Or, "That sounds like that was a really hard thing to live through." Or, "I believe you." ALWAYS appropriate. (Not appropriate: anything that starts with "at least" or "what were you wearing?" or "Why were you in that part of the building?" I mention this from direct quotes.) Remember, I (we) can always say "I don't really want to talk about it," but know, nobody EVER asks. Imagine having a transformative event in your life that nobody ever wants to talk about. Know what's worse than talking about my rape? Not talking about it.

Understand #rapeculture. 
Society blames women for rape. What were you wearing, why were you at a party, why walk down an alley, why were you drunk? This stuff is real. We need to take society from a "No means No" to a "Yes means yes" POV. Educate your children about sex. About CONSENT. Yes, teach your girls how to keep themselves safe, but teach your BOYS to respect boundaries and talk openly about consent, and situations where lines are blurred.

Seek out resources for yourself!
Need more ideas on how to support a loved one? Check this site out! Band Back Together. 

As I compose this, my washer is going full-steam-ahead with a vomit-covered, king-size comforter in it, my 8 year old lies on a well-protected couch (his bowl on the towel-covered ottoman), and Kipper -- a long ago forgotten, feel-good kid show -- streams on the TV. 

My little guy is sick. 

Standing vigil with him last night, I was reminded we can make our pain worse or we can make it better, and a lot of that power lies in our brains. Like many of us, he doesn't enjoy being sick. He tried to rest, but when his stomach started to rumble, he grew restless, rocking his legs back and forth with anxiety and anticipation. Not wanting to wash any more linens, I encouraged him to move to the bathroom, where he would pace back and forth in front of the toilet in his attempts to avoid the inevitable. 

"I don't like to throw up," he said, tears sliding off his cheeks. 

"I know." I gently rubbed his back. I wasn't sure how much of his pain was from his stomach, and how much was from his brain. Sure, he was coping, yet he was also masterfully avoiding his body's natural impulses to move through this illness. Fear -- he was scared.

"When you worry so much about being sick, it can make your body feel worse. I think if you can take deeper breaths and try to let your arms and legs be lazy and heavy, then you can really hear what your stomach is saying." We both sat on the edge of the bathtub as I mirrored the deeper breathing and lazy legs while continuing with my fingers on his back. 

We repeated this ritual many times in the night, and a shift occurred: knowing he could calm parts of his body and mind led him to feel more secure in what was actually happening in his tummy. He was able to better feel the illness, as it would come and then go, and this helped him rest in-between.

See any similarities to labor here? 

Really what this describes is the fear-tension-pain cycle. In my classes we demonstrate this with a very long piece of elastic tied in a knot -- like a very, very long piece (10 yards?). I offer it to three different participants, so when held, it makes a giant triangle in the middle of our classroom. I then assign each of the three to be either "fear," "tension," or "pain," and have them relax their arms so the elastic falls to the ground, and we read over a few situations. As one trigger point becomes activated, that person pulls back on his or her piece of the triangle, then the next trigger is activated, and we see the result when the third person has to hold his elastic tightly to prevent it slipping from his hands. As we get to the problem-solving part, that person relaxes his or her part of the triangle, until it is loose and dragging the floor again. 

What's going on here? And how can we short-circuit the fear-tension-pain cycle? The biggest difference is, Mary's coping strategy has changed -- she is no longer upright and mobile, being comforted by her partner's hands. Now she is sitting, strapped into the car, and on her way to the hospital. 

A change in the level of PAIN, brought TENSION to her body, and FEAR about the future. Mary's partner can help her through this verbally -- reminders to relax and release tension, seatbelt caused hindered mobility,  labor not necessarily picking up but changing sensation from changing position, etc. Relaxing can reduce the TENSION, while knowing this information can speak to the FEAR, thus helping to change the intensity of the PAIN, interrupting the cycle.

Let's look at another situation (without the pictures -- as a side, I am currently reading Unfolding the Napkin, and I decided to follow the author's advice about processing visual information and creating my own pictures :)). Mary is now in the hospital. She is coping well by sitting on a birth ball and rocking through her contractions. She hears a scream down the hall and suddenly she has a FEAR response; consequently, she TENSES, and her PAIN increases. What can help here? 

Address the FEAR with words. Remind the woman, just as she has a birth team taking care of her, the lady down the hall also has professionals aware of her situation. The screaming might not actually have anything to do with a level of pain or danger -- it may just be how that lady chooses to cope, maybe she is just a screamer? Hands-on touch can offer physical reminders to relieve TENSION in areas of her body, and her PAIN level can go back to where it was before her scare.

My little one is on the mend, the laundry is done, and I got a nap this afternoon. Watching him struggle was intense as a mom, just as it is when we are with laboring moms. It was an amazing tool to offer him, navigating through his own experience of the F-T-P cycle, by helping him recognize ways to make himself feel better in his body, by simply using his head. 

first labors are longer. There are ways to help shorten labor length, such as being active and upright. In next week's class we will get into the stages of labor and talk more about that." 

And so it goes for every worry. If I don't have any information to offer off the top of my head (meaning it was more unusual), I take the break to dig something up. I offer my findings, and I make a promise to find additional sources of information in the coming weeks. My biggest caution is to never leave anyone feeling more worried when they leave than they were before they came. In fact, I ask that at the end of the first class, and I make sure we have about 7 minutes to debrief and digest.

How do I address worries that aren't found in a biology textbook? A worry that comes up almost every time is "money." While I don't have any segment of class dedicated to how a family can afford their baby, I do offer many tips on saving money in almost all my classes. Whether it's finding a doula on a budget (class 3), or skipping the expensive breastfeeding gear (class 5) or unnecessary baby supplies (class 6), I like to think (because I am a cheapskate!), if they are along for the ride, they will get some ideas about reducing their expenses a bit.

This Operation head is likely hard to come by. I don't know, check eBay. But I have seen two at thrift stores -- I bought one to give to my mentor doula and trainer, and I left the other one on the shelf, not realizing probably somewhere out there, it could be a valuable resource. If I ever see another one, I will buy it! In the meantime, I have seen at least two options that would work for creative minds:

I would cut a hole in the doll above's head, and probably carve out a hole in the wig forms's as well, and add a wig, of course! It's okay to be fun and silly -- it helps put people at ease and keeps them interested. If you have any questions or would like a more detailed outline of this activity, ask. 

Happy silly, effective, creative teaching!

My wide (oops! wife!) is the one suggesting doula in our house. I am the one who scoffs at this idea. Women and men have been having babies forever and I am obviously capable to be there to support her (like all the dads before me right?). When we have disagreements we have a system where we each right down 5 reasons for our point of view and we share these with each other. . . sometimes it ends up fixing our issue and sometimes it ends up a way for me to sleep on the couch. We tried it. I had some good ones.

1. Money factor when we would have lots of bills and expenses 
2. Stranger at the most (almost most) intimate time of our life
3. Doctor P. said he wouldn't recommend it
4. Hurt our moms' feelings since they both want to come and we told them no
5. I really think I will feel bad if you have someone else taking care of you. I am sure I don't need a doula to help me take care of you.

Well my wife decided to hit each of my points with her own points (she even used a red pen and underlined things twice. Did I mention she is a teacher?): 
1. Money factor when we would have lots of bills and expenses 
YOU AREN'T HAVING THE BABY. SO WE CUT BACK ON EATING OUT.

2. Stranger at the most (almost most) intimate time of our life
WE WILL MET HER AND HIRE HER, WE GET TO CHOOSE HER. YOU AREN'T HAVING THE BABY.

3. Doctor P. said he wouldn't recommend it
DR P. ALSO SAID HE DID HIS OWN VASECTOMY. HE IS NOT HAVING THE BABY EITHER.

4. Hurt our moms' feelings since they both want to come and we told them no
REMEMBER HOW MY MOM ACTED AT OUR WEDDING? AND HOW YOUR MOM ACTED AT YOUR NEPHEW'S CHRISTENING? WE DON'T WANT THAT CRAZY IN OUR HOSPITAL ROOM. AND THEY AREN'T HAVING THE BABY EITHER.

5. I really think I will feel bad if you have someone else taking care of you. I am sure I don't need a doula to help me take care of you.
I AM SCARED TO HAVE A BABY. I HAVE NEVER DONE THIS BEFORE. I WANT A DOULA. I AGREE YOU DON'T NEED A DOULA. YOU ARE NOT HAVING THE BABY. 

So in the interest of sleeping in my bed I agreed to meet some doulas. And guess what? I was right that I didn't need a doula. But my wife did. And I admit she knew what she as doing.