Recently for the Bakersfield BirthNetwork, I was presenting on comfort measures for birth. Expectant families, as well as doulas, come to these gatherings, and I love being able to offer information that is not only helpful to parents, but also information other professionals can take to their clients! As a Lamaze-certified Childbirth Educator, I am always putting together ideas in an unusual way to help make learning about birth fun!

The inspiration for this started when I had a few ideas I wanted to squish together into an activity:
1. Update the stages of labor to reflect an additional pre-labor phase at the onset of the first stage
2. Scaffold the stages/phases of labor by choosing and practicing supports meant to intertwine with the key emotional and physical events occurring
3. Provide a handout which not only helps visualize the opening of first stage, but also serves as a cheat sheet to labor happenings, timing, and ways to cope

What I came up with, I call the "Spinning Circles of Womb." Just kidding, I don't. But I think it works, and it's pretty simple, and that's all that counts -- no frilly title needed. Basically, here are the supplies: 

• items/ideas that comfort
• items that encourage art
• non-negotiable for this activity are 4 circles measuring 3cm, 6cm, 8cm, and 10cm, tacked together with a metal fastener 

I can't remember a time when I sat participants at a table, but for this activity we did, indeed, sit at a table. Surrounded by Mr. Sketch Markers, paper circles, and stickers, I began to share the stages of labor by tacking three sheets of (laminated) paper onto the wall. There is relief when an expectant parent realizes there are only three stages of labor (I did have a dad once who suggested there were 14, but that was his lucky number, and I asked him to take a guess!).

Three. That's not hard to remember, right?

​Then I tack up two more papers, which you can see below, right. I share how some genius decided to break the first stage of labor up into phases, which is another word for, let's just insert more stages into this stage and call it good. 

On the front of the circles we write things like average length of that phase, approximate cervical dilation achieved, contraction action, and more (note: I don't show all of that in the picture). The pinnacle of this is affixing the face sticker to the appropriate phase​, as a handy visual reminder of what a laboring person might be feeling in that moment. 

While we are moving through the phases with markers and stickers, we are also brainstorming what comfort measures might be beneficial at what time, and those are added to the back of that circle. We practice these comfort measures as we go. If we expect people to feel comfortable with different physical ways to counter the strong sensations of labor, we can't expect them to get there from a picture alone! Would you step into a ballroom, ready to dance in front of judges, simply from pictures you saw in a book? We need to actually show families what these positions and movements look like, how they feel, and when they help -- or they are of no help at all.

​At the close of this activity, families walk away with their concentric circles of information, a piece of pool noodle, and an information sheet which shows about 20 different physical positions of a laboring person and partner working together.

Not a bad way to merge my three goals! A handy takeaway that can be utilized easily during birth.

​I find childbirth to be an absolutely beautiful event. It is certainly not at all glamorous by any means, but it is such an amazing experience to view not only as a bystander, but also as a participant. I have had 4 children, all girls, with 4 completely different experiences. All 4 birth experiences, in addition to my losses, have shaped me into the woman I am today.

My youngest daughter is now almost 4 months old, and she was conceived the same month I had a miscarriage. The pregnancy went very well, but I was very afraid that my labor and delivery would mirror the delivery of my third daughter, Spirit, which was extremely traumatic. This led to a lot of anxiety and fear, despite my knowledge on the subject. It was for this reason that I hired a birth doula.

My due date was Saturday 11/21 and absolutely NOTHING was happening, only slight Braxton-Hicks here and there. My older kids were at my parents’ spending the weekend, so I figured it was the perfect time to put together my bed frame and make sure the room was arranged for baby’s arrival. So I took everything out of our room, and with a little help, put the bed frame together. My boyfriend Jermaine wasn’t too happy about it, but it needed to be done so I had access to our bedroom closet and I could start setting shit up. That probably should have been my sign that something was up since I was so determined to get it done RIGHT THEN, lol. Mind you, I had already partly cleaned my kitchen (still had dishes to do, but had cleaned the floor by hand and had already done enough dishes to fill the dishwasher and dish drain by the sink), and had cleaned my bathroom the day before.

Once I was done, I wanted to start putting everything back in our room, but Jermaine was hungry so we ordered food and I went to go get it. By that time it was about 8-8:30p, and still nothing was happening. I was exhausted and my back was starting to hurt a little, which I chalked up to it being from bending over to clean and work on the bed frame. We started getting ready for bed and I left the place a complete mess thinking “Oh, I’ll just get up early and move everything back, etc etc”.

So around 12:45-1a, the back pain was still just annoying and then suddenly got really intense. I posted on Facebook in a pregnancy group I was in asking if anybody had experienced back labor and what it felt like, and called my OB as I had began feeling some pressure as well. He told me to wait it out a little since I wasn’t having any contractions at all, but said he would call the hospital just in case I decided to go in so they knew to keep me. Right after I got off the phone with him, I used the bathroom and then went to bed. I woke up at about 3:45, 4a because I had to pee again (had been drinking tons of water to see if it would help the pain, which it had) and began feeling the intense back pain and pressure again. Still no contractions at that point, but I just couldn’t move much anymore so we decided to head to the hospital.

Because of the pain, it took me awhile to get dressed and then at about 4:30a, BAM! First contraction hit! And the back pain and pressure literally stopped and I was cool. Started timing the contractions and they were 3-5 min apart straight off the bat and lasting from 30-45 seconds each. So, through all the mess I had made, we grabbed my bag, got as dressed as I could, and we were out the door. In the hurry, I tried calling my doula, Sam, and couldn’t get in touch with her since my phone was acting screwy so to keep my anxiety down I just texted her what was going on and updates as they happened.

When we got to the hospital, we were immediately taken to triage after they verified my documentation and weighed me. In triage, they hooked me up to the monitors and checked me. I was a stretchy 4-5 cm dilated, had bulging membranes, and was almost completely effaced, this was at about 5:15a. They moved me into my room, which had a relaxation tub, and immediately started filling it up for me. That tub was AWESOME!!!!!! Definitely consider laboring in a tub of warm water if you can, it feels ABSOLUTELY AMAZING!

​So, my doula comes and having her there was so relaxing and completely made the difference between a good, stress-free experience and a stressful, anxiety filled experience. I labored in the tub for about 2 hours and only got out to use the bathroom. At about 7:50, the contractions that hadn’t been bothering me suddenly felt different and I was feeling much more pressure so I asked to be checked. I told them that if I was a 7 or less, I wanted the epidural but if I was more than 7, I would tough it out. As soon as I stood up, I got hit with the most intense contractions back to back that I had EVER felt. After about 5-10 min of contractions where I couldn’t move, I finally made it over to the bed. I couldn’t sit, it was unbearable so I was on all fours moaning through the contractions. 

​The nurse checked me and I was at a 7, so they hooked me up to fluids and called the anesthesiologist for my epidural. My Dr. and a midwife came in and right then I got the unbearable urge to push and couldn’t stop, so they helped me roll over, my water broke, and in 2 pushes (about 2-3 minutes), my little rainbow was Earthside and super alert! 6lbs, 19.25in long, no stitches or repairs needed, and the anesthesiologist walked in not even a minute after she was born to give the meds, lol.

​Oh, and did I mention that this was my second VBAC!

I must admit, I hate math, and following close behind, is interpreting research. Have you ever noticed, many views are given when it comes to "studies" -- often "data" can be found to support opposing views of the same argument. It's enough to avoid a subject entirely, because who knows what to believe? Not feeling confident in one's ability to understand "the facts" as presented by a study can be a real weakness for a doula (and a parent!). Joyce takes this on in two parts, sharing her knowledge of the subject as she offers a primer on how to read, mark, and question a study, to really look at it critically. 

​My journey to becoming a doula makes plenty of sense in retrospect, but it is a winding journey. I entered college as a pre-veterinary science major, ultimately switched to a Psychology major, hated counseling but fell in love with animal behavior research, and graduated with a BA in Psychology, Biology minor, and Biology Honors. I then entered a PhD program at the University of Nebraska-Lincoln in the Biological Sciences with the intention of becoming a research professor. I actually completed my coursework for a PhD, but cut my research short to graduate with a Masters when I decided a career in academia was no longer what I wanted. After graduation, I became a homemaker and mom when our son was born 5 months later. When he was 10 months old I completed my doula training with DONA International, and attended my first doula birth one month later. Now my husband and I have three children, I am a certified birth doula with DONA International, a Hypnobabies Childbirth Hypno-Doula, co-leader of ICAN of Lincoln (International Cesarean Awareness Network), and have attended more than 55 births. I have a passion for teaching others, empowering women and families to love one another better, birth, birds, and chocolate.

I wanted to write a guide to other doulas and to parents-to-be on how to find, read, understand, and use primary research literature. There are excellent, free resources where the public can read the full text of research studies, although you may need to ask your physician for papers they can only access using their professional subscriptions. Reading and understanding the scientific literature is a learned skill, and I've given a crash course here. Finally, when you have found, read, and understood the research, using the information will be a highly individual decision that only the patient themselves is able to make, based on their intuition, desires, trusted counsel, and circumstances. Today in Part 1, I address how to find and read research papers, and tomorrow in Part 2, I walk you through a short research article, and discuss how to understand the paper and use the information.
 
How do you find research literature? I won't reinvent the wheel here, Understanding Research and Evidence Based Birth are great places to start. If you find a title that you cannot access without a subscription, sometimes you can search the title on Google Scholar, or even just Google, and find the full text for free. If you only have access to the abstract, use caution. The abstract is the very last piece researchers write before submitting their article for publication, and they may accidentally include incorrect information in their haste. Scientists are human too, remember? So, if you cannot read the whole paper, use caution in using that information to make decisions.
 
Once you've found a paper that interests you, how do you know if it's a good one? The best way is to read it and understand it. The research methods will clue you in to the robustness of the research. The gold standard of medical research is a double-blind randomized controlled trial, in which the individuals receiving the treatments, and those collecting the data, do not know what treatment was received, the treatments are randomly assigned to each individual research subject, and there are appropriate controls against which to compare the treatment effects. However, this is really difficult to do, so it is rare. When you read the methods, do you see any holes in the procedure? Anything that could have an alternate explanation? The fewer alternate explanations of the effects, the better the study. If you have found a review article, or a metastudy, this is gold. These are not primary research articles, but rather they summarize an entire field of research. Metastudies actually take the data from multiple similar studies, group them together and reanalyze the data as if it were one huge study, a powerful method. The Cochrane Database of Systematic Reviews is a great place to find these. While the review may be missing pertinent data, and only includes research conducted prior to submission for publication, these types of papers are wonderful sources of good information, when they exist.
 
Those five years of graduate school were largely devoted to training myself to read and understand the primary literature in my field efficiently. While the average science-literate citizen need not undertake this intense training, a guide to research articles is still necessary, as reading research is not the same as reading other materials. This has been covered well and more extensively by others, so I will summarize my advice here.

• Skip the abstract completely.
• Do write in the margins, underline, write questions. Read it once, and then read it again.
• First read the introduction/background section. Look up any words you don't understand before moving on.
• Identify the author's question, what have they identified is missing in the previous information, and what are they going to investigate? This may be explicit, as an "objective" listed in the article, or you may have to search for it in the text.
• Once you understand the question(s) the authors are investigating, read the methods. Do you think this effectively asks the question the authors want to answer?
• Once you understand what the researchers did, look at the tables, graphs, and charts.
• Once you understand those, read the results section.
• Then read the discussion section. Do you understand the author's conclusions? Do they make sense? Can you think of any alternative hypotheses the authors did not address? Do more questions come up for you?

 
Want more? www.understandingresearch.com, www.sciencebuddies.org, and www.violentmetaphors.com have wonderful guides to reading research articles.
 
Join me again tomorrow for Part 2 where we walk through a short article together and learn what to do with the information once you understand it! This is a short, less than one page, write-up of some preliminary research. Here is the paper:

Afshar, Y; Wang, E; Mei, J; Pisarska, M; and Gregory, K. 279: Higher odds of vaginal deliveries in women who have attended childbirth education class or have a birth plan. American Journal of Obstetrics & Gynecology, 2016;214(1):S162.

Go read it, following my instructions as best you can, and come back tomorrow!

​Joyce Dykema, MSc, CD(DONA), HCHD, became a certified birth doula in May 2012. She is also a trained Hypnobabies® Hypno-Doula, and volunteers as  leadership for ICAN of Lincoln, her local chapter of the International Cesarean Awareness Network. Joyce is a woman-focused doula. While passionate about natural birth and what research shows is the best for moms and for babies, the goal she strives for with every client is for women to have empowering and positive births, as the woman defines it. In addition to her doula credentials, she holds a BA in psychology and an MS in biological sciences. She breastfeeds, uses cloth diapers, uses baby sign language, babywears, and homeschools because these choices made sense for her family; she encourages others to explore and find what makes sense for their families. Joyce and her husband have three children, and live in the Lincoln, Nebraska area.

​You have just grown a tiny person,
You are Wonder Woman,
Stand up and be proud!
 
OK, so you may or may not feel like adopting the Wonder Woman stance for your entire labour and birth, but here are 7 great benefits to being upright during labour:

 1. Do You Know the 3 Cs? Feeling Calm, Confident and in Control!  

• Mums who choose their own position during labour will rarely lie on their backs, and they report more feelings of confidence and being in control.  
• Stress hormones are lowered when adopting an upright position, allowing oxytocin and endorphins (birth hormones) to flow.  
• Women feel more a part of their birth team and less like a patient when they’re not lying in bed.

You can imagine it could be difficult to feel confident being the only person in the room on your back with no underwear on. ​

3. Less chance of Distress to your Baby!

• Getting off your back allows maximum circulation (blood flow and oxygen) between you and your baby.
• Your baby is 54% less likely to have abnormal fetal heart rate patterns.
• It reduces the risk of aorto-caval compression.  

You know how you’ve been told not to lie on your back during pregnancy?It usually gets quite uncomfortable from somewhere in your second trimester anyway. The reason is that the main abdominal artery and vein can be compressed by the uterus and the weight of the baby, limiting blood flow. This can result in low maternal blood pressure, feeling faint, sweating and dizziness, and it may also effect baby’s heart rate. It doesn’t sound like a good idea at the best of times, never mind when you’re in labour. This does not occur when a woman is in a side lying or upright position. 

More Information:
Whole, Healthy and Intact - Avoiding Perineal Trauma, by Tracy Donegan 
What is the Evidence for Pushing Positions?

References: 
​2012 Cochrane review, Gupta et al., de Jonge and Lagro-Jansenn 2004; Green and Baston 2003; Green et al. 1990. ​Lawrence et al 2013

Bernie Burke is a GentleBirth Instructor and DONA trained Birth Doula, with a background in Holisitic therapies.  Bernie found GentleBirth during her second pregnancy and fell in love with the program, it transformed how she felt about birth.  She is passionate about all things birth and she has seen first-hand the positive change in her clients and their partners while using the program.
​
Bernie believes that when women and their partners feel empowered to make decisions about their birth, no matter what path it takes, they step into parenthood feeling confident and secure.  Bernie is looking forward to assisting families as a Doula in 2016.

Music is an accessible, adaptable, and valuable tool for comfort during birth because music is a whole-brain- whole body experience. A holistic resource like music can reach the many needs of a family in labor: physical, neurological, spiritual, emotional, social -- even environmental by shaping the birthing space. There are so many reasons music for birth is just.so.awesome! And the music we choose for birth can be really impactful and powerful. As leaders in health care, music therapists have demonstrated how accessible and enriching music can be for improving quality of life, rehabilitation and healing. As a doula  and music therapist, I’m entrusted to bring the music to the birth environment and I use it as therapy -- a prompt for change, discovery and self-expression. To be clear, music therapy for birth comes in many forms. I use my voice, my body, and at times various instruments through live musical interactions whenever appropriate. Yet, most often during the labor and delivery stage, music enters the space as pre-recorded playlists. Music is more portable and higher quality than ever before. So every time my phone beeps or buzzes in the middle of the night, I make sure my speaker is charged, my client’s custom birth playlists are downloaded, and that I am ready to help deliver one of my favorite birth bag resources: the music.  

So for the birth workers and parents out there who are considering using music as birth support, I’ll share my top three reasons why the music you choose in childbirth matters.  

​1. Music can support comfort and relaxation during birth to reduce pain perception, optimize hormone release and steady breathing.  I was privileged to attend a birth where the mother, so calm and so peaceful, took deep, slow, controlled breaths and did not need to push her baby into this world. Instead, the power of her breathing and the rhythm of her pulsing contractions, very simply, very gently, guided her baby out. Her vocal and guttural instincts were validated through the singer and supported by her beautiful lyrical mantra. The rhythm of the music helped the mother’s body entrain and progress, to open and release her baby gently into this world. Music has been shown to support, entrain and influence many dimensions of childbirth. So if there is music out there that will support this, do you think there is music out there that might work against the birth process, making birth more painful, longer and unsteady? Most likely there is, but this will be different for every person. This is why it’s important that doulas and birthing families recognize how every song you plan to use makes the birthing team feel, move, breathe and think -- tall order and a big responsibly. It is important to know favorites and to know what music typically is not preferred. It’s also important to know the difference between just streaming any “birth” playlist, and using carefully chosen songs to purposefully impact birth.  

2. Music supports ANY type of birth.  Regardless of what type or style is preferred, music can be incorporated into any birth plan and pairs nicely will ALL childbirth techniques. I collaborate with couples to create the most customized and comfortable playlists for birth no matter what type of birth they have planned. Many of my tips for using music work no matter how families plan to birth; active breathing, passive hypnosis, partner supported, even planned surgical deliveries. Everyone’s birth rhythm is different. This is why the music should reflect the goals for birth and the stage of birth. Feel like movement will make a difference? You’ll need a steady rhythm or a beat. Need to sleep? Try a single instrument or vocal tone to help lull the brain to deep relaxation. Epic contractions? Why not try that romantic soundtrack for support of vocal moaning? As a music therapist, I provide guidance in making the best song choices from preferred and familiar music to shape birth playlists to suit birth plans and personalities while maximizing the therapeutic potential of the music to support birth at home, in hospitals or during cesarean sections. In fact, music in the operating room and a doula by your side can make cesarean births calmer, more memorable and family centered.   

3. Music will create unforgettable bonds with baby before and at the time of birth.  As a whole brain stimulus, music is a window into great realms of creativity, self-awareness and healing. I’ve witnessed families experience the importance of prenatal sound together in music, making art, moving through the stages of grief and life and love; all initiated by a song. At the moment of birth the music can become part of the baby’s and parents' permanent memory landscape, a neurological imprint if you will. A carefully chosen playlist of songs can help families revisit the memories at any time, rejoicing in the happiness or healing from difficulties that were faced in labor. Along with supporting the biological imperative of bonding after birth, music can also etch the vibrations of your family birth song in your minds and on your heart, forever. Parents are always reporting back to Creative Childbirth Concepts® that they continue to use their custom playlists as they transition into the reality of raising a baby. Together they continue to explore and use their favorite music as a resource for parenting. Parents report music was an integral part to their therapeutic prenatal preparation.  Their music playlists were magical in how they connected them as a team, shaped their environment and created lifelong memories as a soundtrack to their birth. The music helped heal their past birth experiences.  The music helped them anticipate their fears and anxiety and work through them by supporting imagery and reflection. The music was “theirs” and the music was therapeutic. It CHANGED their births. This is why I believe the music we choose for childbirth matters.  

​I believe in the power of music at the moment of birth. I believe in the power of music for supporting the prenatal experience. I believe in the power of music bonding, to process fears, to address anxieties.  And I believe in you: I trust that those of you who use music, make music, and incorporate music into birth already are capable of making awesome choices and using intuition when working in the moment. I trust that those of you who are invested in learning more will seek knowledge and integrate it into the best music choices possible. But I also believe it’s important for you to know that there is a growing number of perinatal music therapists out there who are here to guide you whenever advice is needed. We really do want to help make birth better through music. Connect with me and I’ll share my favorite birthing music with you!  

​It’s your birth.  Be Creative.™

​Kate Taylor, MA, MTBC is a birth doula, board certified music therapist and owner of Creative Childbirth Concepts® in Chicago IL.  Kate provides perinatal music therapy services and assists families through labor and delivery as a birth doula.  Kate provides creative supervision for music therapists and mentors birth professionals around the globe.  She is passionate about educating others about music for childbirth and helps empower families through music, movement and other creative arts during infertility, pregnancy, birth, even during new parenting adventures.  Visit www.birthmusic.net for more information or connect on facebook with:  Creative Childbirth Concepts® Music Therapy & Doula Services.  In depth YouTube interviews, blog radio interviews, and audio podcasts of Kate are also available for you to learn more about her music therapy assisted childbirth practices, doula work and personal journey as a birth worker.

I have been a doula for 18 years. I began after the birth of my third child who was born at home with a direct-entry midwife. My midwife asked me if I would help her at births, and that launched me into being a home birth doula for seven years. She eventually moved away, and at that time, it was too far for me to travel to be a doula for her clients. I decided to start attending births at hospitals, and I have been an in-hospital doula for 11 years now.

When I was a doula at home births, I never saw myself in the position of midwife. I think at that time in my life, I wasn’t ready for that kind of responsibility. My children were all very young, and I wasn’t yet done having children. I was a lot younger, and I felt I wasn’t quite qualified and didn’t have enough experience to be in that role. So, I’d occasionally tell the midwife with whom I worked, that I didn’t want to be a midwife. I also thought that midwifery was not for me. After all, I had been pregnant while a senior in high school, barely graduated (attended a California’s continuation program to finish high school) and I had five children by the time I was 29 years old. By the time I was 38, I had eight children. Life was busy enough with homeschooling, church, helping my husband with his business, and being a doula. I couldn’t possibly add anything else to my over-flowing plate.

Well…that all changed in 2014. I noticed a trend in homebirths not only in the nation, but in my own community. I noticed no midwifery care was being provided to Spanish speaking women in my community. While English speaking women at least had the option of receiving midwifery care from a midwife who spoke their language if they so desired, Spanish speaking women in my county do not even have that option. “Someone should do something about this!” I thought. I still didn’t think that person would or could be me.
I became friends with a doula in a nearby city. She also has a large family, AND she was studying to be a midwife. I was excited for her! A doula-turned-midwife was a great journey. As the months and years of our friendship developed and grew, she eventually finished midwifery college, passed the NARM exam, and became a licensed midwife. During this time, I began being moved to pursue midwifery. I think it was always in me to become a midwife, but I just couldn’t imagine how I would pursue a midwifery degree. Watching my friend inspired me, so I began asking her questions about midwifery school.

My friend patiently answered all my questions, provided me with links, and fully encouraged me to go this route. I talked to my husband, I prayed about it, and I -- finally -- knew this was the next step for my life.
After looking at different schools, I chose Midwives College of Utah (MCU). MCU offers continuing education classes and these classes are a non-committal fashion to figure out if a distance education platform works for a person. After one semester of continuing ed classes, and getting a feel for how MCU operates, I knew, for sure, this was the school for me. I began the process of enrolling, and I was accepted into the Associates of Science in Midwifery at Midwives College of Utah in August, 2015. It will take me three years to complete the academic portion of the associate’s degree, and possibly another year to complete the clinical portion, totaling four years before taking the NARM exam.

Changing careers at the age of 45 has been an exciting and stressful adventure. My whole life, and how I operate, changed drastically. I went from having plenty of time to do all the things household, to doing school work 6-8 hours per day, including the weekends. I had to adjust my way of thinking, accept that going to school is the same as having a full-time job. When deciding to take vacations or weekend trips, or even day trips, I look at my calendar. I may have to do extra school work to make up for days I won’t be able to get any work done. I may have to take some school work with me, and get some studying done while on vacation. I have had to adjust everything around my education, and it has been difficult to make that transition.

Everything, right now in my life, is all planned around my schooling. In case any of you might by thinking, “Well there are summer breaks.” No, actually, there aren’t any summer breaks. MCU operates on a trimester schedule. That means, school runs all year long. We have four – fifteen week semesters: fall trimester, winter trimester, spring trimester, and summer trimester. Between semesters, we get a two-week break. That’s it, folks! So, no summer breaks! Now, if I plan it just right, I can finish up about 3 weeks early, and have about a 5-week break, but that means doubling up on assignments to get done early. It’s doable, but not an easy task!

​Currently, I am in the assist phase and working with a preceptor (a licensed midwife who has been approved by MCU to be my supervising midwife). Being in an apprenticeship is such a blessing, but such a huge change for me! I have been accustomed to being in the doula role (education, information, and labor support – which means, never any medical advice is given and no medical procedures are ever done!). Being in the midwife apprentice position is completely different. I get to check blood pressure, pulse, and feel the abdomen for the baby’s position (Leopold’s maneuvers). These are things which are out of the scope of practice for doulas, but within the scope of practice for midwife’s apprentice while under the supervision of a licensed midwife. It’s amazing and exhilarating to be in this new role!

Another big change, for me, is that I now call meetings with my preceptor’s clients “prenatal” appointments. As a doula, I never felt comfortable calling meetings with clients a “prenatal,” because that, to me, is a term used to describe an obstetricians or midwife’s appointment to receive prenatal care. But, now, I am in the midwife’s apprentice role, and can call these "prenatal" meetings.

Going from doula to midwife is completely polar opposite. Doulas provide one to three meetings before birth, provide education, information, and emotional support, provide labor support, some breastfeeding support, and one visit after the baby is born. Doula support is invaluable! Doulas do not, however, provide any medical services, whatsoever.

Midwives provide one prenatal visit once per month from 4 weeks – 28 weeks of pregnancy, one prenatal visit every 2 weeks from 28 weeks – 36 weeks of pregnancy, and one prenatal visit from 36 weeks – 40 weeks and beyond if needed. That’s a total of approximately 15 prenatal visits. These visits include blood pressure, pulse, weight, and fundal measurements. They include lots of information on pregnancy health, nutrition, exercise, and things to expect. They make sure mom and baby are well, and that there are no medical issues. If there are issues, they refer them to an OB. Each prenatal visit typically lasts an hour, sometimes more…Postpartum, they provide approximately 3-4 visits…

​So, for me, going from the doula role, to the midwife assistant role, has been a huge transition. Being part of the care a woman is receiving during her entire pregnancy is a completely different role from the doula role. I am in transition. As we know, transition is a hard place to be -- and I am eager to make the changes to get to my dream of becoming a midwife. ​

The most important thing that I learned from Stacie was that I had choices for this process. I could be in charge. There were productive ways to communicate with hospital staff to facilitate the birth that I wanted, and decisions that I could make to affect my birth, like the decision to stay home and labor for a while instead of going straight to the hospital when my water broke. I didn’t have to be merely a participant in my labor, I had choices and a voice. In our prenatal courses, we had talked extensively about my birth plan, making 2 or 3 drafts before we were satisfied with it. I also made a gift basket for the nurses and doctors in the hospital, to thank them for their hard work, and partly to schmooze just a little bit! The birth plan would help to communicate what I wanted in the heat of labor, and the gift basket would help them to remember me in a positive light.

​I called my doctor’s office. When I told them my water was broken, they told me to go straight to the hospital. I explained that I wasn’t ready yet and that I wanted my doctor to check me first. Fortunately my doctor was working and agreed to see me at 11:15 am. I took a shower, which was the best shower I have ever taken in my life, so relaxing! And my husband and I departed for the doctor. We pulled into the parking lot shortly after 11 am and I knew in my heart that we weren’t going home. My pain level had increased significantly since 9 am, but I was still unsure whether or not to go straight to the hospital. In my mind, I was clinging to the 4-1-1 rule (contractions every 4 minutes, 1 minute in length, happening for at least 1 hour) and I wasn’t’ there yet! My contractions were only about 30-45 seconds long, and I didn’t think they were long enough for me to go to the hospital.

Once in the doctor’s office, I had trouble disrobing from the waist down and getting up onto the exam table. When my doctor arrived and checked me, we were both surprised to find that I had already dilated to 5! It was time! I was going to the hospital! I was put in a wheelchair to go across the parking lot. I texted Stacie: “I am at 0 station and 5 centimeters dilated, I need you here ASAP!” “I’ll be there as soon as I can!” My husband accompanied me to the room and I sent him back out to the car for the hospital bag. The desk nurse gave me a hospital gown and asked for a urine sample. I got into the gown but the urine sample wasn’t going to happen. I was in too much pain, and I curled up on the hospital bed in the fetal position instead.

When my husband got back from the car, I was crying. “I need an epidural, I can’t do this, I’m going to die!” Cue the theatrics! He went for help. The nurse checked me and immediately ordered a birth kit; baby was coming faster than any of us anticipated. I asked for an epidural. My husband asked if I was sure, and in that moment, I certainly was! The nurses told me it would be at least an hour before I could get one; in retrospect I am sure they knew there simply wasn’t going to be time. The baby was going to be there before the anesthesiologist anyway! Stacie arrived around noon I believe, and everything became a blur. I was very lucky that my doctor was on duty and was there for the birth. Between her, Stacie, my husband, and the nurses, everything seemed to happen at lightning pace. Almost immediately, they had me pushing, I had plenty of help and support. My dear husband, who had pledged to stay by my head during labor to avoid the potentially traumatizing show, found himself holding one of my legs up while I pushed, after a nurse said “here, help her." Before I knew it, baby was crowning. Doctor Blair asked if I wanted to touch the head? “No! What are you talking about?! We are wasting time, let’s get her out of there!”

One thing I will always remember about this birth: It was an intense and fast birth in Bakersfield, CA, and soon the room was filled with voices offering suggestions and helps to work Tegan out. While I listened to the voices of incredibly caring and wise nurses, and my client's amazing (I cannot say that enough!), AMAZING doctor, I heard them calling my client by her given name, and not her preferred name. It struck me in that moment, what an advantage I had as her doula, with the benefit of many hours of time together before birth! I was able to get to know this family, understand their desires and needs, and offer them the education and tools they would use to shape their birth experience. I knew them, and to me, that really means something.

Before working as a doula in Bakersfield, Visalia, Hanford, and the lower Central Valley, I was in Chico, CA -- up north. This mother was a client of mine, and here she is shown having her second baby at home, after a very medicalized first birth due to her baby's health issues. This time around she labored all night, with erratic but strong contractions. When she finally realized they needed the midwife, it was just in the nick of time! The joy and ecstasy she experienced by this fast, healing birth shows in her body language, and of course her face! For this woman, being left undisturbed to labor was a huge part in the emotions and feelings that helped her have an ecstatic experience. It is a day she will always remember and have pride in -- and no matter how a woman's birth experience goes, with support from her team and knowledge of her choices, she can also be left with these good feelings. 

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). 

Expectant families often ask if they can do anything for their nurses, not only to show appreciation for the long, hard hours nurses work, but also gain a happy member of their birth team. I was impressed when a client showed me the basket of goodies that would accompany her and her husband to the hospital. Knowing nurses often get gifts of yummy (but not always healthy) food, she wanted to be different. Her basket was thoughtfully packed full of hand lotions and sanitizer, Propel packets, pocket-size tissue packs, gum, Chapstick, Jolly Ranchers, and tiny chocolates. This woman had a fast labor, and she didn't go through as many nurses as she expected, but every nurse that walked in -- even her doctor and I -- were encouraged to pull things from the basket we wanted. "Now I don't want to take any of that home! I brought it all for you!" she told everyone, happily. The nurses were tickled at this sweet gesture. Her doctor, at first reluctant, did finally concede, "I do always need Chapstick."

Some might say this is unnecessary, that nurses are being paid at their jobs, so why are "gifts" necessary? One L&D nurse I know shared, "I love the thank you cards. I am shy about gifts and food. It's very nice though, but not necessary." A second one told me: "I absolutely love when patients bring in something special for the unit. We are there for joyous occasions and heartbreaking occasions. When patients acknowledge our work it makes us all feel good about the job we are doing. It lets us know that we made a difference during a very important time in their lives."

Isn't that what a true thank you is about? Acknowledging someone's good work? Isn't that something we all want? To know someone noticed, someone cared, it mattered to someone what we did? It's not a hard thing to do, and it can mean so much. I dare you to care enough to say "Thank You." Two little words.