I help breastfeeding moms with lactation support in the Bakersfield, Visalia, Tulare, and Hanford areas of California's Central Valley. So often when I answer the phone to a mom looking for breastfeeding support, somewhere in there I hear the voice-cracking and the tell-tale pauses that show she is working hard just to reach out and share her story. We are often not prepared for how hard breastfeeding can be, and the toll it can take on our hearts. We hear of the joy babies bring, the bonding, their smell, their sweetness -- maybe someone out there mentioned being really tired or not showering easily in the first weeks. We are culturally conditioned to worry more about birth than breastfeeding.  

When a mom is struggling, what can we do to lift her up? What words and actions can scaffold her, infuse her with strength? I asked women to think back to what was encouraging and motivating, that anyone (not just a breastfeeding helper) could do, to make the journey a little easier. Here is what was shared:

1. "Keep the focus on me." Many of us have had issues with breastfeeding, and often the inclination is to quickly get to our own story and how we survived. "I cracked and bled for two weeks. I didn't have enough milk so my friends gave me donor milk. I locked myself in a room and said, 'we will figure this out,' and I never gave him a drop of formula, even though my doctor suggested I was starving him -- I just powered through." This is not helpful. It isn't that on a normal day Mom can't appreciate your experience, it's just that right now, it takes away from her very-current state of being vulnerable and needing support. If you can relate, say something simple that doesn't turn the whole subject back to you, like, "I remember that." It's okay to reaffirm you have felt something similar; it's not okay to shift the focus so now you can talk about yourself. In this moment, it needs to be all about Mom and Baby. It takes acute awareness to stay in the present with her, and this truly is your gift to give.

What is not helpful: Launching into your own tale of triumph, terror, or failure, especially with the intent of showing Mom you had it worse; the same holds true if you feel compelled to share your grief, your anger, or what you would do. Apply Susan Silk's "Ring Theory," which I have adapted. The idea is, the person facing the crisis (Mom) has the center spot. She is allowed to say whatever she wants or needs to, to anyone else. As the rings extend, others are assigned positions according to how close they are to the center. So Mom's partner is next. Again, he or she is allowed to vent in an outward fashion. Family and friends will have their own feelings, and it is appropriate to dump those outward as well. Advising, sharing your worries or coping methods, explaining your exasperation with the situation, etc., is never done inwardly, because this adds to the load of those dealing most directly with the crisis. 

2. "Use those active listening skills we hear about." Rephrase what she says: "It sounds like you are scared that breastfeeding is not going to work." By restating what you heard, you aren't going to tell her something she doesn't already know, and it lets her know you heard her. If it isn't what she's feeling, she can clarify by offering more information: "No, I feel like it is working, I just think maybe it will never end up being a smooth, easy process, like I imagined." It's okay if you don't get it right -- she will understand you are trying to listen to her feelings. Acknowledge her struggle -- you can never go wrong by saying something like, "I see how hard you are working." Don't ever  under-estimate the therapeutic power of being a good listener. 

What is not helpful: "Maybe it's not meant to be." "Haven't you tried hard enough?" "Formula/ bottles are here for a reason." "Your cousin Jill wasn't able to breastfeed, and everything turned out fine for her."

3. "Don't be afraid to touch me." When the dam holding back the tears and feelings breaks, she can feel cracked open and raw, and having an audience can make those feelings even worse. You can touch her shoulder, take her hand, or offer the comfort of a hug. Sometimes touch can give more solid support than any words can. When a baby cries, he is letting us know he needs something, and that gives us the opportunity to respond and help him feel better. When adults cry, there is the same opportunity to help someone feel better while also creating a bond of love or friendship. You may not know what to say when you see her like that, but you can't go wrong by showing her physically that you care. 

What is not helpful: Staring at her, pretending she's not showing emotion, visibly looking uncomfortable, or telling her not to cry. 

4. "Share in the loss I am experiencing." Whether breastfeeding will ever work for Mom and Baby, in the middle of the crisis, it is a loss -- a loss of hopes, a loss of dreams, a loss of what she thought would be an "easy and natural" way to feed her baby. It is okay to treat this as any loss a friend might face. This isn't the same as having two choices for dinner -- chicken and rice or beef and potatoes -- and then having the choice made for you. Breastfeeding comes with many overwhelming emotions. When she feels like she can't feed her baby, in that moment there is nothing that can feel worse, and it feels like loss. We can accept and value that, even if we can't understand it. 

What is not helpful: "It could be worse." "At least you have a healthy baby." "I don't understand why this is affecting you so much, it's not like someone died."

5. "Let me decide when I am done." Well-meaning friends and relatives who are concerned about Mom's physical and emotional well-being may try to convince her that she's worked hard enough. Mom is the only one who can judge that -- she knows her options. Wait for her to tell you where she is in this journey. One woman, a neurologist, shared: "If you say you are suicidal, people don't say, 'yeah...you should probably just go ahead...' They figure out how to help you, they talk you off the ledge." It obviously isn't the same thing, but in the storm of hormones, emotions, life changes, and struggles, the very-real feelings of hopelessness and loss of control can be strong and similar. Keep encouraging her. This is her marathon to run -- she decides the pace, the route, when to take a break, or even when to stop -- you cheer her on from the side no matter where she is in that loop, no matter how you are feeling about her situation. As another woman put it: "It's cruel to try to take someone's hope away."

What is not helpful: "It's unlikely by this age your baby is going to figure out how to breastfeed." "Just try X, Y, or Z -- it fixed our issues." "Not everyone can breastfeed." " I just can't bear seeing you so upset." 

6. "Do something for me that will save me from having to do it myself." Rabbi Harold Kushner is the author of, "When Bad Things Happen to Good People." When asked to share what he's learned in his years supporting people in the midst of suffering, he said it could all be summed up in this statement: "Show up and shut up." Anything you can do for Mom that gives her more time to be with her baby and concentrate on self-help and healing, is priceless -- and ANYONE can help. "My husband has always been supportive. He always left it up to me to decide what I wanted to do. And when I decided I wanted to continue to try, he helped me pack up the baby and drove me to LC's and LLL several times a week. He washes bottles and pump parts, he's a pro at freezing, thawing, making bottles, hooking up my pump. His labor of love is so important at continuing exclusive pumping, because I alone have logged about 3,000 hours of work towards pumping and pumping-related activities for the first year of my baby's life." Further out of the ring, family and friends can take care of pets or outside responsibilities, bring meals or snacks, run errands, make phone calls, drive Mom and Baby to appointments, and always, always there is housework and laundry. 

Ronald A. Rasband shared: "If you come upon a person who is drowning, would you ask if they need help -- or would it be better to just jump in and save them from the deepening waters? The offer, while well-meaning and often given, 'Let me know if I can help,' is really no help at all." It can take energy, effort, and humility for a person to list what she could use help with. In the movie "Robots," one of the characters, Bigweld, had this motto: "See a need, fill a need." Jump in and do what you can -- when there seems to be nothing else, there is always service. 

What is not helpful: Service with conditions; making the job seem too complicated to take on, or making it too complicated for Mom to delegate; rushing in to offer babycare when Mom and Baby could be bonding; expecting a thank you card. 

Society says feeling bad when breastfeeding is hard is not appropriate or okay. We don't want to make anyone feel bad if they can't breastfeed, so when a woman struggles to continue, her hard work is not always encouraged or even noticed. To really help, though, we need to suspend this judgement and be willing to accept her feelings and her reality. Becky Bailey writes: " Acceptance means recognizing that people, situations, and events are what they are. Each moment simply is as it is. Acceptance doesn't mean that we approve of the moment, only that we recognize that what is happening at a certain moment is, in fact, happening." 

Two women in particular said they couldn't remember anything helpful or hopeful that was said to them. This lack of acceptance is apparent when they shared what they wished they had been told:

Accept her struggle. Accept her feelings. Open yourself to her reality and you increase her willingness to accept your help. When she comes out the other side (whatever that other side looks like), it can be with positive memories of the support and care that was shown to her and her baby.

I value your comments and stories, and I am appreciative of the time taken to share them <3. 

Titles and terms can be confusing when it comes to assessing a doula's experience, training, and certification. Did you know:

• The title, doula, can be used by anyone who works with women during pregnancy (antepartum), birth, or in the postpartum period; one does not need specific attendance at a set amount of births, training, or certification to work as a doula.
• What I have seen regarding doula fees is, often a doula'a fees are commensurate to her experience and training; doulas with less experience generally have a lower fee, while those who have been serving families longer are on the higher end of the spectrum. 

Below are explanations (according to my experience and understanding as a DONA-certified Birth Doula -- I do not officially represent DONA) of what some of these terms mean. There are many, many other doula programs out there, and I would hope doulas trained and certified through these other organizations would chime in to offer additional information where I am very lacking. 

I am the first to admit, you don't need experience, training, or certification to be an incredible doula and make a difference -- we all start from a desire to serve. I value the doulas in my community and I honor the differences in our personalities and styles, interests and specialties. This is a work of the heart, and by following our instincts to care for a mother and family during birth, we offer unique support that helps build them up for the start of their parenting journey. 


Why certify? Read what doulas and moms have to say about it.

I once had a life-size, cardboard cut-out of Captain Jean-Luc Picard. I was 18, in college, and I spent every night at 11pm watching reruns of "Star Trek: The Next Generation" (or "TNG," as we Trekkies call it) at someone's house -- it capped off every day. For reals, I wish I had a picture of me with my paper Picard -- Flat Stanley's got nothing on Jean-Luc. 

When I first started with TNG, I was immediately pulled in by Wesley Crusher. Wil Wheaton had been a favorite of mine since the summer I watched "Stand by Me," 500 times between 7th and 8th grades. So imagine my surprise and sorrow, in the 13th episode of the first season, Datalore, when Captain Picard yelled, "Shut up, Wesley!" to my favorite teen in space. In this scene, it can be heard uttered by three different people, including his mom, Dr. Beverly Crusher:

I love to make memes -- they are a fun way of offering a small spark which might ignite one's full curiosity. 

For this meme, I extrapolated what I knew of Wesley and what people think of him -- both on and off the screen (the characters and the fans). Although brilliant, he didn't always escape the naivety of childhood -- hence his smiling face and eagerness to believe the professional who states, under no circumstances, can a tongue tie affect breastfeeding. Of course the insinuation here is, the professional hasn't been trained to properly assess, is likely choosing one or two pet methods of "examining" a tongue tie (one being simply looking at it, the other perhaps seeing it extend over the gum line), to decide -- despite the mother's and baby's issues -- it isn't the tongue's fault. If you are told your baby has a tie but it isn't causing your feeding issues, you may want to seek out a professional who knows proper assessment and evaluation requires more than just taking a peek into the baby's mouth.

The best list I can suggest is held within the files of Tongue Tie Babies Support Group on Facebook. These are often called preferred providers, but that term is inaccurate; these are professionals who have received enormous amounts of positive feedback from families. TTBSG goes on to research these providers in-depth before choosing whom to add to the master list. This doesn't mean there aren't other capable providers out there -- in fact, if you know of someone who is not on the list, contact an admin to let them know. And if you still don't see someone near you (and by near, let me share we traveled 4 hours away to see a listed provider, and I am counting that as "near"), be sure to see if there is a local state/region tongue tie group for your area. With the addition of these smaller, more specific groups, families have more precise information to share, and often they know of providers who haven't gone through the review process to be added to the TTBSG file. There are often suggestions for IBCLCs, body workers, and other professionals who can help you with the assortment of problems that surround tongue tie. UPDATE 12-30-15: TTBSG will no longer be maintaining and updating this list of providers. Instead, ATTE will be responsible for keeping lists of local providers in the State/Region groups. 

I am so grateful in my area we have an incredible dentist in Bakersfield who treats tongue and lip ties -- thus eliminating the lengthy travel some families have to make (she wasn't offering this service back when we had our baby treated). Dr. Dana Yeoman has studied under two excellent doctors experienced in tongue tie issues and utilizes that knowledge to help families in the Central Valley. 

The addition of the face-smacking captains is just a bonus. 

This week I received notification that I, once again, passed the Lamaze International certifying exam (making me the only listed LCCE in Bakersfield, one of two in Visalia). In light of that, I was curious to know why as doulas and educators, we choose to extend the extra effort and resources to gain and keep these initials after our names? Sharon Muza offers her thoughts to this topic. Additional quotes follow from not only doulas, but also mothers. And my answer? Grievance policy, as strange as that sounds -- I appreciate DONA offering this, as it protects my clients, and it protects me.

I am both a certified doula with DONA International, CD(DONA), and a certified childbirth educator with Lamaze International, LCCE. I am very proud of the fact that I hold and maintain these certifications. I worked hard for them and it means a lot for me to have these credentials. Here are my top six reasons for certifying AND maintaining certification with well-known, long-standing, internationally recognized organizations:

1.      Demonstrates my serious commitment to being recognized as a professional doula and childbirth educator.

2.      Assures my clients, students, my colleagues and the health care providers that I work with that I have successfully completed the requirements for certifications as set forth by my certifying organizations.

3.      My clients, students, my colleagues and HCPs are assured that I abide by and practice according to the standards of practice and code of ethics that have been established by well-known and well-respected certifying organizations.

4.      It allows me to support the organizations that I believe in, with my membership and certification dollars, allowing them to work toward improving maternal infant health outcomes as a serious player on the national and international level with my support.

5.      Maintaining recertification shows my commitment to receiving continuing education that is current and applicable, and demonstrates my desire to remain up to date with best practices.

6.      Provides a grievance process for clients, students, colleagues and HCPs who might have concerns about my practice standards, actions or ethical behavior.

I am very proud that I am a certified birth doula with DONA International and a Lamaze Certified Childbirth Educator.  I look forward to continuing to maintain these certification in the years to come.  I encourage you to seek out reputable and well-respected organizations to align yourself with and pursue certification in a professional manner.

One of the jobs of a doula is to provide resources to pregnant women and their families. We may provide a list on a piece of paper, or provide verbal information regarding different resources in the community. It could be anything from where to find a childbirth educator, a lactation consultant, an IBCLC, or even where to locate other new moms. Often an area that is forgotten or which is not known is information regarding milk sharing. What is milk sharing and how can doulas offer this as a resource to new mothers?

On page 10, paragraph 18, in the “Global Strategy for Infant and Young Child Feeding” by The World Health Organization (WHO) and Unicef (2003), it states the hierarchy for infant feeding. If a child cannot be fed directly from the mother’s breast, first the child should be fed the mother’s expressed milk, secondly the child can be fed donor milk through a wet nurse or milk bank, and then finally a breast milk substitute can be fed (WHO & UNICEF, 2003). There is caution to be taken when feeding a breast milk substitute, though. WHO and UNICEF (2003) state, “Infants who are not breastfed, for whatever reason, should receive special attention from the health and social welfare system since they constitute a risk group.” In this hierarchy of infant feeding options, donor milk is often neglected, but should be considered before a breast milk substitute is given.

Milk sharing is a centuries old tradition. Centuries past there was a process called wet nursing which utilized the services of a mother, with or without her baby, to feed another woman’s baby (Thorley, 2008). Sometimes this was done forcibly by slave owners, and other times there was compensation given to the lower class women who provided this service to those in the upper class (Thorley, 2008). In modern times, wet nursing is sometimes confused with cross-nursing which is the feeding of another woman’s baby out of a sincere desire to help without compensation. With time, these traditions began to fade away, and soon it was close to non-existent (Thorley, 2008). Oh, that’s not to say it wasn’t happening! It just wasn’t widely practiced anymore, because it was much harder to find someone who could cross nurse a baby. However, in the last four and half years, there has been an increased awareness of the benefits of peer-to-peer milk sharing also known as: informal milk sharing.

Currently, informal milk sharing is the process of donating excess, expressed breast milk to another baby in need of breastmilk without going through a milk bank. A mom who is producing enough milk for her baby, may choose to pump additional milk over and above what her baby needs in order to donate this excess milk to another baby. Many woman have chosen to save their milk to donate it to a baby whose mother is not able to produce enough for their own baby. A breastfeeding mom will generously donate her milk in an altruistic fashion. There is no monetary compensation during this milk DONATION. The compensation is knowing that her milk is feeding another baby in need.

There are many reasons why a baby would need donor milk. The baby’s mother may have health issues like cancer, insufficient glandular tissue, may be on medication that is not compatible with breastfeeding, or a host of other health issues too long to name, here. The baby may have been adopted, and the new parents want to provide their baby with the biological normal sustenance, breast milk. The mother’s milk may have taken a dip, and she is no longer producing enough to fulfill the baby’s nutritional needs. The mother may be returning to work or school, and does not have enough of a supply stored away. The baby’s mother may have passed away, and the family seeks out donor milk to continue feeding the baby breast milk. This blog post could be pages long with the myriad of reasons why families seek out donor milk. The simple and hard fact is that there are babies who need donor milk to meet their dietary needs in a manner that is consistent and compositionally the same as their own mother’s milk.

The growth and accessibility of social media has facilitated the exponential increase in the availability of donor milk. In Oct. 2010, in a grassroots efforts which opened up the doors to thousands of babies in need donor milk, Facebook was utilized as a platform to create Human Milk 4 Human Babies (HM4HB). This was the beginning of reaching scores of moms who had an excess amount of breast milk. Donor families used HM4HB to find recipient families who had a need of donor milk and vice versa. Years ago, it would have been difficult, if not impossible, to find someone locally who was breastfeeding and could provide a baby with donor milk. However, using social media, there is now a much faster method of reaching out to people in the community when there is a need. Informal milk sharing, although it had been happening on a much smaller scale, exploded. Volunteers generously committed hours to the creation of HM4HB public Facebook pages. These pages were set up all over the world to facilitate a place where families could search for other families willing to donate their breast milk. 

The process of informal milk sharing is completely dictated and handled by the families who are donating or receiving breast milk. While there are risks involved both in breast milk substitutes and informal milk sharing (Gribble & Hausman, 2012), families must weigh these risks, ask any questions, including health questions or concerns, and make an informed choice. Informal milk sharing on HM4HB is the sole responsibility of each of the individual families. Administrators of the pages do not get involved in any manner other than to post requests/offers, or delete off topic information. Because of this, HM4HB does not have statistics showing how many people on their sites are sharing their milk and receiving donor milk. HM4HB operates much like a bulletin board. People post offers/needs, admins keep the place tidy.

What about milk banks, you might ask? A non-profit milk bank, like the Human Milk Banking Association of North America (HMBANA) receives donor milk from families who have excess breast milk. This milk is reserved for the most vulnerable from our communities, preemies and ill babies. So, a healthy six-month old whose mother has had a decrease in milk production, would not be eligible for milk from a milk bank. While we NEED milk banks to provide milk to an extremely needy population, they cannot provide milk to all the babies. Additionally, there are restrictions for who can donate breastmilk. For example, a mother on herbal remedies would not be eligible to donate. Milk bank donor milk is being served to extremely delicate babies who have fragile immune systems and their donor milk must meet the strictest of standards. Hence, informal milk sharing is a valuable resource for families who don’t meet milk bank requirements for donor or recipient.

As doulas, we can offer much in the way of support to families. An additional way to offer that support is to provide information to clients regarding informal milk sharing. We can share HM4HB with families. We can let them know that informal milk sharing is an option available to them. Now, with this blog post, you will be able to direct them, here, so your clients can read for themselves what informal milk sharing entails. Or you can send them directly to HM4HB.

Had you heard of informal milk sharing before this reading this post? Have you been a donor or recipient? What are your experiences? Will you share this information with your clients? 

Gribble, K. D., & Hausman, B. L. (2012). Milk sharing and formula feeding: Infant feeding risks in comparative persective. The Australasian Medical Journal, 5(5), 275-283. doi:10.4066/AMJ.2012.1222

Thorley, V. (2008). Sharing breastmilk: Wet nursing, cross-feeding and milk donations. Breastfeeding Review: Journal of the Australian Breastfeeding Association, 16(1), 25-29.

WHO & UNICEF. (2003). Global Strategy for Infant and Young Child Feeding.

I believe I’m the youngest doula in my area at just 20. I have two young babies of my own and I’m learning to balance work life with mommy life, along with being married and having my own home. This last week has been crazy with two births back to back -- six long days of trying to get my footing and figuring things out. I learned five key facts this week that will help me get through many more times just like this one!

1.      Have stable childcare! I’m serious. I wasn't expecting two clients to have babies so early so I still hadn't set up childcare. I was rushing around like a mad woman trying to find people to keep my two while I ran off at odd hours to births. My dad and my best friend ended up taking the blunt force of my lack of planning. Random calls of “Can I drop them off right now?” and having to answer the question of, for how long with, “ I HAVE NO IDEA." So this is definitely of primary importance as a doula and a mom of 2.

2.      Remember you need to eat too! We are constantly encouraging moms and dads during births to eat and stay hydrated. Well I forgot that I needed to, too. I got home from day one of births this past week and realized I had eaten a pack of mini donuts and a Dr. Pepper -- and that was it all day! I suggest having small snacks in your bag like granola bars and a bottle of water that can be refilled.  How can you care for mom and dad if you, yourself, have no energy whatsoever? 

3.      This one is super difficult. Balancing sleep/work/ motherhood. I was coming home from nights at the hospital at 3 and 4 am.  I would come home to my very lived-in house and shudder, knowing that I needed to do housework. I would go and lay down in my bed and fall asleep doing none of it. My husband, I’m one of those super lucky women by the way, would get up with the kids in the morning allowing me a few extra hours in the bed. I would then get up, still exhausted, to spend time with my kids, not knowing when I would need to rush off again. You have to find a balance between them all. I know its hard, but it's a necessity!

It’s Sunday afternoon and I am just enjoying a lazy day, knowing that any day it will change very quickly with a phone call.  My daughter is 39 weeks pregnant with her first baby.  After many years of wanting a baby more than anything, she is finally going to be a mother at the age of 38!  She had really wanted a home birth (all those stories of me birthing her at home had really soaked into her psyche), but she finally came to terms that, due to her financial situation, she would be birthing in a hospital.  She did a lot of research, spoke to some midwives, and had found an OB who would support her dream of having an intervention-free, natural birth.   The phone rang and I could immediately hear a bit of concern in her voice.  “Mom, how do I know if my water broke?”  She had stood up and felt warm fluid trickling down her leg.  After our conversation she was convinced it was not urine, but the leaking seemed to have stopped.  I suspected that she may have had a small leak of fluid from the space between the amnion and chorion.  She was not experiencing any further leaking or contractions so she decided to just ignore the occurrence.  I, on the other hand, saw this as a sign that things may be happening and asked her if it was OK for me to go ahead and make the 2 hour drive to her home on Monday to accompany her to her doctor’s appointment on Tuesday.  She was very pleased at the idea and told me to just pack to stay until after little Reyelle came earthside. 

I arrived at her house and got settled in (as much as you can settle in when you are sleeping on the sofa!).  On Monday we just hung around the house and tried to organize all the cute baby stuff.  Well, maybe we played with all those cute little cloth diapers a bit too much!  But it was a fun day just talking and dreaming about her future.  It was a very special time of mother/daughter bonding.  Tuesday came around and it was time for her appointment.  She decided to tell the doctor about her “leaking” on Sunday.  Needless to say he was not happy that she had not called him when this happened.  And, yes, even her absolutely fabulous, natural-friendly doctor, pulled the “dead baby” card (which, of course, left her in tears).  He did check for the presence of amniotic fluid in the vaginal canal and did an ultrasound to check fluids and did finally say that all was fine.  He did not see any signs that it was amniotic fluid (although I still suspected it may have been a small leak). 

On Wednesday she and I decided to do some shopping.  She was 39 weeks 5 days at this point. She had a few last minute items she needed to purchase and/or exchange and I knew that walking would do nothing but positive things for her.  At 5:15 PM we were at home and relaxing after our long day of shopping.  Jessica went into the restroom and suddenly hollered out “MOM!  Oh my goodness, my water just broke for sure!”  I went into the bathroom and found her standing next to the toilet, straddling a large and growing puddle of clear fluid on the floor.  I grabbed a feminine pad and a towel and got her into the living room.  I had a pack of PH test strips ready for just such an occurrence (yes, I know it is “out of scope” for a doula, but this was my daughter and I thought I could take some liberties!) and went back into the bathroom to clean up and test the fluid.  It was clearly 7.5 to 8.0 on the ph scale so I knew that it was definitely her amniotic fluid this time.  I reminded her that her doctor had told her to call him or go into the hospital if her water broke.  He had also told her that, absent a rupture, he was fine with her laboring at home as long as she wanted, even waiting till she felt the urge to push to make the 5 minute drive the hospital.  She decided that since she was not contracting at all, she was just not comfortable with moving to the hospital at this point.  My advice to her was that, if SHE did not want to go in yet, then the best thing she could do was for her and her husband to try to get some rest until things picked up.  She decided that that was what she wanted to do and got her hypnobirthing audio going on her phone and went to bed to rest.  She said that around 6:00 PM she began to experience very mild contractions but she could completely relax and even sleep through them.  I periodically went in to check on her but she seemed to be resting quite comfortable and did not want to disturb her peaceful state. 

A little after 9:00 PM she called me into her room and told me that she felt it was time to go to the hospital.  She had decided that she did not want the drama of waiting too long before arriving at the hospital and would rather go now and get settled before things really picked up.  She got dressed and just kind of casually got her stuff ready and packed in the car.  At times I was unaware that she was even having contractions, although she did sometimes have to stop walking and talking to focus on her script and relaxation.  Parking and getting into the hospital proved to be an adventure.  We had to enter through the ER and check in with a security guard.  He offered to get her a wheel chair but she declined.  I am sure he must have been wishing she would have taken him up on his offer when twice, on the way to L&D, she had to get down on all fours on the floor of the corridor during a contraction! 

We arrived in L&D at 10:00 PM and were admitted to triage.  Of course she got the scolding again from them about the fact that she had been leaking fluid for almost 5 hours now and was just now arriving to the hospital.  They examined her and found her to be dilated to 6 cm.  But now, my baby who had been handling her contractions so incredibly well, was forced to lie on the gurney in triage, on her back while they hooked her up to the monitors.  She now was having a hard time coping with her contractions.

The orders from her OB were for her to have intermittent monitoring (15 minutes out of each hour), a hep lock instead of IV, minimal cervical exams, no offers of analgesia, for her to be allowed mobility to labor in any position she desired when she was not on the monitor and, lastly, for her to allowed to push and deliver in whatever position she found the most comfortable and effective (unless, of course, there was an emergency situation that negated it).  The nurse in triage was an absolute angel.  Even though she had to make Jessica uncomfortable with the contractions during the exam and monitoring, she spoke nothing but positivity to her about her ability to birth her baby naturally if that is what she wanted.  However, the nurse actually assigned to her once she was moved to a labor room was a different story (I will refer to her as “Nurse Sour Puss”!).  We had to keep reminding her of the orders.  The lovely nurse from triage even came in and backed us up!  They were having a difficult time keeping the monitor on the baby and kept insisting that Jessica stay in positions that were very uncomfortable for her.  She managed to do as they asked and, finally, at 11:00 PM, they were able to get the monitors off.  

After that, I immediately suggested Jessica get into the shower.  You could tell that Nurse Sour Puss was not happy with her patient being out of bed with ruptured membranes, but I just reminded her of the doctor’s orders, and Jessica told her that she was doing it anyway.  Jessica spent the next 45 minutes in the shower and was doing very well.  You could tell when she was having a contraction, but she coped quite well with them.  At various times she would have me running the stream of water over her belly and at other times she wanted it on her lower back.  She was making very little noise, just a low moan during the contractions.  I noticed a couple of times that Nurse Sour Puss would be standing at the bathroom door just observing.  I got the impression that this was the first time she had had a mother use the shower as a pain management tool and actually found it fascinating (hopefully she learned something!).  

At 11:45 PM she insisted that Jessica get back into the bed for more monitoring.  Again, my daughter (who had been managing her contractions quite well) started struggling with control.  About 11:55 she was kind of thrashing in the bed and I thought that perhaps she was wanting to try another position.  I asked her, “Honey, what are you trying to do?  Do you want me to help you into another position?”  She kind of whimpered and said, “I don’t know what I want!  I am just trying to get away from it!”  I leaned down and whispered to her that it certainly sounded like transition and that those feelings were just proof that she was making good progress and would be holding little Reyelle soon!  The nurse kind of looked at me as if to say “How can you possibly know that without a cervical exam?!”  She did not believe that this first time mom, who had just been 6 cm less than 2 hours ago, could be close to the pushing phase.  

With the very next contraction Jessica began making some grunting sounds at the peak of the contraction.  I asked her “Are you pushing?”  She said that she wasn’t sure.  But with the very next contraction (it was now midnight) she looked at me and said “Oh yeah, I need to push!”  The nurse, still being the naysayer, told her to not push, wait for a few contractions to pass, and IF she still felt like she wanted to push then she would check her for dilation.  Around 12:15 AM she did a cervical exam (only her 2nd exam since arriving at the hospital at 10:00 PM) and seemed quite surprised to announce that Jessica was complete and could push.  Jessica was just experimenting with a couple of positions in the bed for pushing .  At 12:30 the nurse just abruptly said, “Ummm, I will be gone a few minutes, stop pushing till I get back!” and abruptly left the room.  Jessica was really struggling with the whole “don’t push” thing, so I gently reminded her that this was her baby, her body, her delivery and for her to do what she felt comfortable with.  When, after several contractions, the nurse had not returned, I pushed the call button and asked when her nurse would be returning.  The charge nurse came in and told us that Nurse Sour Puss had gone to lunch and that she would be helping us.  While I was appalled that the first nurse decided to take off for lunch without so much as informing us what she was doing, it actually turned into quite a blessing that the charge nurse took over.  This woman was convinced that Jessica (who had been struggling with moving the baby down at all) could and would push this baby out. She made some suggestions on positions/techniques and finally Jessica appeared to be making progress.  

I remember pushing for almost 2 hours with my own first baby, and, as a doula, had seen many mothers push for long periods so I was not really surprised when things did not progress quickly.  The new nurse was very encouraging though.  She cheered for the tiniest bit of progress!  What none of us realized was that the slow progress was due to an asynclitic baby!  Mommy ended up pushing for over 3.5 hours.  During that time there were numerous times when they had trouble keeping the baby on the monitor.  While this nurse was obviously concerned with monitoring the fetal heart tones, she also was equally concerned with keeping mommy as comfortable as possible.  Several times Jessica would say something like, “I don’t think I can push her out!” but the nurse was always encouraging to her. This phase was where I was so happy to have my doula training and experience to rely on.  It was really hard to see my daughter trying so strenuously to bring her baby down and getting so discouraged!

Finally, after over 3 hours the baby was crowning.  Because of the long pushing phase and the difficulty in keeping the fetal heart tones monitored, they called in the pediatric team in case there was a problem with the baby.  The room was full of various personnel who were all in their little corners, chatting casually with one another, and just waiting for the baby to arrive so they could do their job.  In the midst of this the doctor arrived and observed the atmosphere (discussions were going on about what they had for dinner, where they went that past weekend…).  He announced to the crowd “I want the lights dimmed and everyone to be quiet and respectful!  This mom wants a natural, peaceful delivery of her daughter and we are going to give her what she wants!”  You could have heard a pin drop in the room!  The lights were dimmed, the doctor asked for some warm oil and he started massaging the perineum.  With the very next push Jessica made tremendous progress and within 3 pushes the baby’s head was out.  It was at that point, upon seeing her lopsided cone head,  that it became clear that her asynclitic presentation was probably the cause of her slow descent.  With the next contraction the doctor instructed mom to reach down and grab her baby.  Jessica was literally shaking with exhaustion and said “I can’t, I am afraid I will drop her!”  The doctor assured her that he would NOT let that happen and to just grab her baby. 

There could never be enough words to express the swelling in my heart when I watched my exhausted daughter reach down and pull her daughter out of her body and up to her chest!  I had a new level of respect for my daughter!  The pediatric team was quickly dispatched out of the room as it was immediately obvious that the baby was doing great.  All she needed was a little skin to skin time with mom.  Thankfully, this was at a hospital that has already obtained the “Baby Friendly” certification so they were not trying to hasten the separation of mommy and baby. 

At this point I was able to kind of take a back seat and just observe the new mommy and daddy reveling in their new roles.  Baby stayed on mommy’s chest while the doctor waited patiently for the cord to stop pulsing.  It was quite something to observe.  This long awaited baby was here and being loved on by her new parents.  I could not help but think back to the births of my own children 40, 38 and 33 years ago.  So much has changed since then, but so much is still the same.  My daughter had managed to achieve a hospital birth that was very close to the home birth that I had experienced at her own birth 38 years prior.  In my job as a doula, I know that the birth of the baby usually signals the beginning of the end of my relationship with this new family.  This was so different.  I knew that this was just the beginning of a lifetime of love that I would be able to shower on this baby and her parents!

PS:  Some of you may question the fact that I do not mention dad much during the labor and delivery.  Let me assure you that dad was very much there and involved in the process.  This family has a unique circumstance where daddy has some severe disabilities in his legs due to burns he suffered many years ago.  He is very limited on the amount of standing he is able to do.  So, while dad was there and contributed very much to the emotional support of his wife, I was the one who provided most of the physical support to my daughter during her labor and the birth of her baby.  

Karen is a mother, grandmother, and doula. She had a home birth in 1975 with a chiropractor attending. Karen is a Christian who doesn't think God made any mistakes with the way He designed women's bodies. Ever the caretaker, she has an adult, adopted developmentally-disabled brother who she helps care for. Karen loves to sew and cook, but she hates to clean up after both!  Reyelle is her 5th grandchild. Find her on Facebook to learn more about her doula services.