Debbie called me at 8:30 am to let me know contractions had started. I joined her and her best friend Lisa at the hospital – Debbie was 2-3 centimeters. Debbie and I worked through the contractions. She would really have to focus. Lisa and I would stand on either side of the bed rubbing Debbie’s arms and shoulders, smoothing her hair, and giving her space to focus. Lisa was not quite respectful of Debbie’s need to focus and go within herself to endure, and Lisa would ask Debbie questions about unimportant things while Debbie was trying to concentrate. I kept redirecting Lisa respectfully, reminding her that Debbie needed space to focus, and could we wait until the contraction is over to get an answer? A vaginal exam at 1:15 revealed Debbie to be 100% effaced, 4-5 centimeters dilated. Debbie had AROM followed by her epidural at 2:00. The contractions spaced out to 8-10 minutes, and Debbie’s blood pressure dropped dangerously low. Debbie’s nurse, Mary, stayed with us in the room for almost 2 hours charting and watching Debbie and her monitors. Debbie’s blood pressure did eventually increase. At 4:30 pm Debbie was checked and found to be complete. She started pushing at 6:00, and baby was born via Mighty Vac at 6:52.
Debbie is a single mother and she felt a doula would help her feel supported and informed. My primary goal for Debbie’s birth was to make her feel special, strong, and empowered. I knew Debbie wanted an epidural. Debbie had a severe knee injury which happened about the time she became pregnant. That, coupled with being very overweight, greatly reduced her options for movement. I helped a lot before Debbie got the epidural with coping techniques such as counting backwards through contractions, and massaging her hands, which grew tired from gripping her bed rails. Debbie’s situation reminded me of something Penny Simkin wrote of a client who left an abusive relationship: I think Debbie did not need to feel any pain on this birth day.
Debbie reacted well to her labor! She really had to focus from about 11:45 until 2 pm. She seemed to leave for a minute and find someplace in her mind where she could cope, and once the contraction was letting up, she would slowly open her eyes and release her grip on the bedrails. When I would say, “Debbie, that was great. You have found a place and you are really doing a wonderful job focusing and relaxing,” Lisa would discredit what I was saying by replying with, “Yeah, Debbie’s thinking ‘Whatever,’” or “Debbie’s thinking, ‘Shut-up already.’” I don’t think Debbie was thinking any of those things. It really felt like I was being undermined. When I would ask Debbie the, “What was going through your mind…” question she would usually reply “I just wanted to get through it.” She never had a panicked or scared reaction. Debbie reacted very sweetly to her new baby.
I learned some good people-coping skills. Lisa is a tough kind of gal. When Debbie’s blood pressure fell, and then her legs went numb, Lisa was upset and wondered why they didn’t stop the epidural? Lisa ’s personal experiences led her to believe the numbing aspect of an epidural was abnormal (“That did not happen with my epidurals”). I tried to explain how epidurals worked, but she got very defensive. I finally said I did not know, and she should ask the doctor about it (he was also Lisa ’s doctor). I learned sometimes it is better to “not know.” I learned sometimes I need to stand away and be useless, like while the baby was being delivered and I was not by Debbie (Lisa was to her left, doc at the end, nurse at her right). After Leah's birth, I was able to help more practically. Lisa had left, and Debbie was alone. I stayed longer helping with breastfeeding and ensuring Debbie got a nice meal as well. Debbie’s father arrived about an hour later, and I was able to help him hold his granddaughter for the first time -- he swayed and shooshed her right to calmness. I learned even though a person only thanks you for bringing them dinner, that can mean a whole lot more.
Connie was my own doula trainer, and she has been mentioned a lot in the last few 31 Days project, as she was Monalisa's and Amber's doula trainer as well. I can't say enough kind, incredible words about Connie. From day one of me meeting her, she has championed me on in not only the doula world, but also the related world of birth. Connie brings her heart to all she does, and that has made her an excellent mentor and a dear friend -- we should all be so lucky to have someone like Connie in life.
23 years ago, when I started my work as a doula, I experienced some of the greatest highs of my life! After a birth I would sit on the phone for hours, processing this and that with my other new doula friends. I was excited to carry a pager, to know I had a prenatal visit coming up, to be thinking about my doula bag. My learning curve was steep and I was devouring every piece of information I could find. Newly married, my husband delighted in how happy I was. He said, “when I married you I knew I was getting a great woman. I didn't know I was getting a doula as well!”
The years have passed. I usually don't need to process a birth for several hours. Usually I come home happy, but not always high. I often feel pressure to get to bed at a good time, be sure my cell phone is charged, know that my childcare is perpetually lined up. The weight of being on call 24/7 sometimes feels heavy. I feel frustrated with marketing my work on social media because really, marketing is not what I love to do. Neither is social media.
And yet, the joy of this work continues to fill me. I feel honored to be trusted and invited into what is surely one of the most powerful experiences a woman will ever have. I am humbled as I witness her strength, his kindness, their love. I learn as I watch women make very hard decisions. I help her gather information. I act as a sounding board as she talks through her options. I am present for miracles.
Perhaps there is a selfish part of me as all this occurs. I learn so much from these birthing women and from these powerful experiences. When I return from births I try to write down what I learned from the experience. This is part of what keeps me thriving as a doula – it's the learning. While my learning curve about the labor process is not as steep as it once was, my learning curve about life still is. These women are my teachers.
One woman I labored with for a few days never once complained. Trust me – if I had been in her shoes, I would have complained. As we walked the hallways for the millionth time I told her that I was so impressed at how she kept a positive attitude. She told me her story of growing up watching her brother who was very ill. At some point she realized she could complain about their lifestyle, in which regular trips to the hospital were a part of her life, but when she considered what her brother was going through, she felt that to complain would be an unnecessary indulgence. She had developed a mantra in her life: I will not indulge in complaint. Listening to this I began to realize that, in fact, I sometimes did indulge in complaint. The hours we spent together taught me a valuable lesson about myself. I still complain, but maybe just a little less. And my life is better for it.
Then there was the mother who had everything stacked against her, but she just kept making these great calls for herself as she labored toward having a much desired VBAC. After two sleepless nights of non-progressing contractions, her doctor told her that even though her labor was very mild and she wanted to go home, she couldn't advise her to do so because there had been a few dips of her baby's heart rate in the last several hours. The mother listened to what the doctor had to say, asked a few questions, and then made a decision to leave despite her doctor's advice. This was not someone I thought would ever even consider signing out AMA (Against Medical Advice), but she said she dug down deep and just knew it would be worse to stay. She had never heard of signing out AMA but described doing so in her own words to the doctor. The doctor said she completely understood what the mother was asking for and that she only was telling her the hospital's policy. As I followed the mom out of the hospital, her nurse whispered into my ear that she would have made the same decision for herself. The laboring mom left the hospital, got some much needed rest, but went on to encounter many other obstacles. Despite them, she and her baby had a very healthy VBAC. The lesson to watch for miracles was reinforced for me at this birth.
I have learned that slow and steady progress often makes big changes. Not just in dilation! But even in birth advocacy. I have encouraged and watched as women kept asking for their babies to be taken out of the warmer and placed in their arms. Now it's standard for babies to be placed in mom's arms after birth. I have suggested to women that they might consider delaying their baby's first bath. Now I attend births in hospitals that post that they prefer not to wash babies for 24 hours. Episiotomies were routine. Moms complained. I haven't seen one in 6 years. I've learned that health care consumers really can make change if they are supported.
When I think about why I keep doing this work, it is because it fills me up. It makes me smile. This work helps me to learn and grow. The highs are not always as high as they once were – but the lessons are so much richer. Where else could I receive these powerful life lessons than at a birth?!
Connie Sultana, BA, CD(DONA), ICCE, LCCE has been a doula for over 20 years. She is a DONA-approved Birth Doula Trainer, and a Lamaze-approved Childbirth Educator Instructor. Connie is a former Director of Certification and Board Member of DONA International. Connie is forever grateful and appreciative to the over 700 families who invited her to provide support during their labors and births. She lives in Santa Rosa, California with her family and her two dogs.
Some doulas strive to venture into the world of birth as no-frills and intervention-free as it can happen. Other doulas, like Julia, offer their experience and knowledge to help families considered "high-risk." Julia and I agree -- we need both kinds! Julia also is passionate about mentoring doulas through the certification process, so virtually and on the phone she is able to provide support, feedback, and heart to help grow new doulas. If this is something you are curious about, contact your certifying organization and ask how you can help as a volunteer, ultimately helping your fellow doulas.
Around a year ago, I was hit by a drunk driver. While I recovered, I was unable to do what I loved most, parent. But secondarily, unable to also do the work I loved, doulaing! So, I decided there was one thing I could do, help doulas who were certifying. So, from my bed, I sent out my resume and letter of intent to become a volunteer certification packet reviewer for DONA, and so began a journey that has taken me on a fantastic ride with a organization I’m proud to be a of.
When I certified, I felt overwhelmed by the process, it felt daunting, and the organization felt large, with seemingly nowhere to turn… and so as soon as I was approved to be a reviewer, my goal became clear, and the doulas spoke this to me… I needed to help make certifying accessible, smooth, straightforward and personable for every doula. So, I set my sights on doing just that.
This year, as a reviewer, I started the “Tips from your Friendly Certification Packet Reviewer,” a Monday post on the DONA Facebook Boards where I bring frequent “bump in the road” items I come up against in the packets I review. Some of the tips I’ve covered include:
The conversations that have emerged from the posts have been insightful, and I’ve started to see cleaner, more organized packets since these posts. As a result of having cleaner packets, I’m able to really sit back and relish the best parts of the packets, the birth stories. One of the best parts of packet reviewing is that I’m basically part of a doula birth story sharing circle every single day. I get to read how doulas experience birth, their tips and tricks from all over the world, and glean their knowledge. And let me tell you something, as someone who is “seasoned,” I’m learning from them every single day. I’ve certified close to 200 doulas in the past year, and every birth story I learn something.
Just today, I called a doula to let her know I had her packet to review. She told me that she had an acting background and how it played into her doula career. I couldn’t quite picture how, and she explained that if she had to meet a client for the first time in birth, she needed to improv into the role, and read the room immediately. GENIUS. In another birth story, a client was having a hard time focusing because of the people in the room, but still wanted them there. The doula pulled out an eye mask for the client to wear, and it worked like a charm. GENIUS. This is what I get to be a part of.
I’m proud to play a small part in the big world that is DONA, and to hopefully continue to show that certification can be a straightforward, personable, welcoming experience. If you are certifying, or mid-process, please feel free to reach out to me if you have questions that I can assist you with! I would love to help you along the way!
Julia has been a practicing Birth Doula since 2013. Her passion is supporting families prenatally. Her main goal is to make sure that each birthing client (and partner) feels that they are well prepared for birth. Julia specializes in high-risk births and families expecting twins or triplets. She is confident and knowledgeable when it comes to navigating the medical system and helping families feel informed and empowered to participate and lead their own birth story. She has written a twins-doula curriculum that she has subsequently taught to doulas around the country.
She is currently certifying as a Childbirth Educator as well in addition to her work as a birth, fertility, postpartum and bereavement doula. In her free time, she volunteers on the Birth Doula Certification Committee for DONA International.
You can learn more about Julia on her website at www.northwestbirthservices.com, on her Co-Op page, www.doitalldoulas.com/julia/ or by emailing her at firstname.lastname@example.org!
I recently had a family reach out to me looking for a doula in the Bakersfield area. I knew I was not available for when they were due, so I offered the names of three other doulas, with reasoning as to why I thought they would be good matches. I also shared the resources area of my website, where I try to keep a running list of doulas in the greater Bakersfield and Visalia areas. I kept in contact with this family for a while, to ensure they had their doula needs met.
A couple weeks ago, after coming away from a prenatal with a current client, I noticed I had a Facebook message, and a text message. I thought, wow, someone has been looking for me! I opened them both to see it was one of these three local doulas, thanking me for the referral, as this family hired her. I was tickled with surprise and appreciation for this small act! We are all busy, and I am sure we often think, that was nice of her, I should let her know; the reality is, we don't always follow-through. I know I will remember this doula faster the next time I have a referral, and I also know I will rush to thank the next person who offers me a similar favor.
When working towards my certifying births for DONA in Chico, CA, there was one experience where the doctor left before I could ask for an evaluation. Hoping for the best, I wrote her a note and included an evaluation form and a SASE. Honestly, this doctor wasn't my favorite...but she didn't have to be my favorite to provide good care to my client. I thought of authentic statements I could share to show I valued her place in this birth.
"Dear Dr. Doe,
I had the privilege of helping Jane and John Person during the birth of their baby, Baby. Jane said nothing but good things about you during our prenatal contact -- it is clear to me she felt you two truly connected. I appreciated the way you cared for Jane throughout the pregnancy and birth, helping her feel confident about the experience...."
The next paragraph explained the certifying process, a bit about DONA, and that an evaluation from her would be helpful. I closed with: "Thank you for taking the time to do this for me."
Guess what? She sent it back, and I was able to use it for my certification.
Once at my pediatrician's office, I was telling my friend (nurse manager of the clinic), how much I appreciated the woman who worked at the registration counter. Every time we came in, she knew our names. She always asked how we were doing. She even remembered things we had talked about before. She felt like a friend, and I noticed this was not just how she treated us -- this was how she treated everyone in this clinic, which had a high rate of patient appointments where many families had Medicaid. She never seemed annoyed, she never acted like people were an inconvenience. As I was sharing this with my friend, she handed me a paper and pencil and asked me to write a note to the hospital which oversaw this clinic, sharing my feelings with them. I thought nothing of it -- it took less than 5 minutes of my day, and then honestly, I forgot about it.
The next time we visited the clinic, this woman came rushing toward me, arms open wide, and she thanked me heartily for what I shared. She said it meant so much to her, to be acknowledged and praised for the work she does daily.
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.
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.
Sharon Muza, BS, CD(DONA) BDT(DONA), LCCE, FACCE has been an active childbirth professional since 2004, teaching Lamaze classes and providing doula services to hundreds of couples through her private practice in Seattle, Washington. She is an instructor at the Simkin Center, Bastyr University where she is a birth doula trainer. Sharon is also a trainer with Passion for Birth, a Lamaze-Accredited Childbirth Educator Program. Sharon is a former co-leader of the International Cesarean Awareness Network’s (ICAN) Seattle Chapter, and a former board member of PALS Doulas and Past President of REACHE. In September 2011, Sharon was admitted as a Fellow to the Academy of Certified Childbirth Educators. Sharon Muza has been the community manager, writer and editor for Science & Sensibility, Lamaze International’s blog for birth professionals, since 2012. Sharon enjoys active online engagement and facilitating discussion around best practice, current research and its practical application to community standards and actions by health care providers, and how that affects families in the childbearing year. Sharon has been a dynamic speaker at international conferences on topics of interest to birth professionals and enjoys collaborating with others to share ideas and information that benefit birth professionals and families. To learn more about Sharon, you are invited to visit her website, SharonMuza.com.
Many of us are excited about these new evidence-based findings ACOG released in March. There are almost 20 statements that show how we can better support laboring moms to work in preventing a woman's first cesarean birth (knowing once she has had a cesarean birth, her chances of obtaining a vaginal birth after cesarean, or VBAC, are extremely low due to our climate). Basically what these statements boil down to are, women need more time in first and second stage, and we should not rush to cesarean delivery if mom and baby are doing well. Please share these.
I love Lamaze's amazing infographic which states it can take up to 17 years for medical practices to change when new information becomes available -- and Lamaze goes on to emphasize, as pregnant women, we don't have 17 years for our providers to catch up. It is all of our responsibilities to inform ourselves and present these best-care practices to our providers and see that we are treated accordingly.
"A prolonged latent phase (eg, greater than 20 hours in nulliparous women and greater than 14 hours in multiparous women) should not be an indication for cesarean delivery."
We have learned women don't line up with Friedman's Curve like we thought they should. So basically this new data tells us: dilation from 4-6 cm can take 4-6 hours longer than we thought! Patience is what we need -- give moms and babies more time when everything is going okay with them both.
♥ four young boys and a boy dog (offspring)