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.
​

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?!

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.

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.