Recently I was watching The Labyrinth, that incredible movie of my early teenhood. I watched that VHS tape so much it started to warp. I know just about every line, I sing every song, and I am ALWAYS ready for it to have a different ending, even though I know that never really happens.
I was struck by the opening credits -- when the words "It's only forever," play. This one day, when we birth our babies, stays with us forever. Shouldn't we do all we can to improve our experiences so the memories bring us happiness instead of disappointment? Enter, the Labyrinth...
The basic premise: Sarah is an imaginative girl who loves to dress up and pretend play. She has to baby-sit her half-brother, Toby, and she dreams her story to be that of having a wicked stepmother and she being forced to work and have no life. Her brother begins to cry from his crib. She accidentally sends Toby off to the Goblin King, Jareth. She then has to rescue him, through the maze of a huge labyrinth, or he will be lost to her forever. Ultimately she has a few choices -- live in her pretend world forever and forget about Toby, become Jareth's queen and live happily ever after with him, or fight to get Toby back -- and of course, that's what she does.
But did I mention who Jareth is?
Um, yeah -- that's why I was always Team Jareth...but I digress.
1. This is a piece of cake!
Often labor starts out so small, we work up confidence and think, like Sarah after making a good choice, "this is a piece of cake!" That's right before she falls into a hole with nothing to stop her except a bunch of "helping hands."
While early labor is often something we can handle on our own -- occupying our minds, resting, bouncing on a ball, relaxing in a tub or shower -- as things progress, our bodies will demand more from us. Instead of worrying that this is a predictor of how hard labor may be (at some point in the future -- I call this 'catastrophysing,' and in real life, I am pretty good at it), we need to enlist support from those around us. This is where partners, doulas, midwives, mothers, nurses -- whoever is there to fill that role, come in.
Labor WILL get more intense -- that's the nature of the process. With support, we can be lifted up by those caring people on our birth team, those helping hands.
2. There can be a lot of waiting!
There is an average amount of time women will labor. For first time pregnant people that is 12ish-24ish hours. Be mindful of that when you start telling people you are in labor, people forget birth is a marathon, not a sprint. It may only be an hour of time that has passed and well-meaning friends and family can start to ask if your baby has been born yet!
Some families consider sitting with this information for a while until there is something more exciting to report. Often the invitation (or expectation) that people will wait happily in the lobby can be a lot of pressure to the laboring person! I have been at more than one birth when a guest pops into the laboring person's room, unannounced, and either there was nothing going on, or the person had to be shooed out quickly because it was pushing time or naked time or toilet time -- this doesn't have to happen to you! You can decide where your loved ones will bide their time, and it doesn't have to be at the hospital.
3. It may help to lose your head
Whether it comes as a loss of control, or a needed suspension of reality, staying in our left brain where logic and reason try to make sense of things isn't always productive in labor.
As labor progresses, we need to move to our right brain and listen to what our bodies are saying. Linear flow of time, labor math, and trying to make predictions according to what we know and what has happened all need to go by the wayside. Our team should help protect this state of mind by moving with us, going at our pace, finding another place for their fears besides our ears, and knowing how to help if we are truly lost -- like getting into take-charge mode. Labor is challenging, and we are working hard enough to keep our own heads straight -- partners and others can respect this and flex to it as long as we are feeling safe and moving forward.
4. Ultimately, birth isn't fair
We learn. We read. We immerse ourselves in information and do our best to plan for our births. But in the end, there are so many things that aren't in our control. Does this mean we shouldn't even try?
What can we really plan about birth? We'd like to think we can plan a lot -- hospital, support team, safety. But we've all seen videos of women birthing unexpectedly in their cars (as a doula I had that happen once). So what's a pregnant person to do? I'll tell you: take a comprehensive childbirth class where you'll learn your options in a nonbiased way. Understand the labor process, how to cope, and what to expect. Build your dream birth on a foundation of sound evidence-based information -- this will ensure if your Plan A becomes a Plan B, you will know exactly what your new set of choices are -- because you ALWAYS have choices. Birth, like life, may not be fair, but you can adjust the scale in your favor with knowledge and options.
5. "You have no power over me."
I recently had a conversation with a pregnant woman who shared: "I know no one can make me do anything I don't want to do. I can always say no or ask for other options. That's my right."
Not sure what your rights are? According to the American College of Obstetricians and Gynecologists (ACOG), pregnant people:
This is what ACOG is laying down that many physicians aren't picking up: no one can guarantee the outcome for you and your baby -- and because of that, the choices we make during pregnancy and birth are ultimately our own. This doesn't mean you have to be contrary out of the gate, this simply means when you have researched, thought over, pondered, prayed about a decision which may differ from that of your medical provider, no one holds more power than you.
Karen is one of my doula-friends in Bakersfield. She is reliable, knowledgeable, and serves families in a loving and caring way. I remember when she had this client, because she asked me what my experience was with cholestasis as a doula. One thing I realized was, information changes, and I had old information. Karen has recently been able to help me navigate a similar situation as I have supported a client through this condition -- doula sisters are always good to have! Sharing and integrating knowledge keeps us all informed and better able to help families as they whether their own storms.
Justine was a young woman, expecting her first baby when she asked me to be her doula. In a roundabout way she was family. Even though there was no genetic connection between us, I immediately felt bonded to her as if she was family. She and her husband, David, were so excited about welcoming their baby into their family. From the beginning she had a hunch that she was carrying a little girl, which was later confirmed.
She was appalled to learn that her regular OB/GYN had a policy to automatically induce a woman as soon as she hit the 40 week mark. Justine had done her research and knew that this was not an evidence based policy. She also really wanted an unmedicated delivery and knew that this policy would throw a road block up for that. Early in her pregnancy she discussed this with me, and we were able to get her under the care of another OB who had a much friendlier attitude towards her desires to attempt an unmedicated and intervention free delivery.
She had just formed an affinity for this new OB when life presented the first “storm” of her pregnancy. Within a week of each other, she and David both lost their jobs, which meant that she lost her insurance policy! I went to her next appointment with her to the doctor. Her plan was to tell him that she had lost her insurance, had applied for Medi-Cal (the California form of Medicaid) and ask him for a recommendation for an OB who would have similar practices and also took her Medi-Cal insurance. All this stress, combined with her pregnancy hormones, had kind of left her in a very fragile emotional state. She was crying as she explained all this to him. He gave her a big hug and informed her that, while he did not advertise it, he was actually an approved Medi-Cal provider! She could continue to see him! Not only that, but he worked with her husband (whose prior job had been in pharmaceutical sales) and helped him find new employment! She began to have faith that things were going to work out fine!
Things were going along quite well with her pregnancy. She found out that she was carrying a baby girl and they selected the name “Noah Grace” for her. Did you know that there was a female person in the Bible named “Noah”? I certainly didn’t! The story is found in Numbers 27. She was quite a woman for her day. You can read about her story here . What an amazing woman to be named after!
We did a private childbirth and breastfeeding education class in their home. They were both so excited about what they were learning about the physiology of birth and coping techniques for labor. Of course we touched on interventions (including inductions) and complications, but all of us thought that this info would be unnecessary in their actual birth. However, within a few days, the second “storm” arrived: she called me complaining about intense itching, mostly on her hands and feet.
I advised Justine to contact her OB right away. I knew that she had had a pre-existing condition with her liver and was quite concerned. Her doctor also suspected that this was being caused by an issue with her liver and she was quite quickly diagnosed with Cholestasis (a problem where the mother’s liver is producing excessive bile acids). This condition, in addition to causing the intense itching, can also result in a fetal death in the last few weeks of pregnancy. Justine was placed on medication to control the bile acids. Medi-Cal delayed in getting the prescription filled, and she told me that many nights David would place his hands on her and pray for her for relief of the itching just so she could get some sleep! She truly felt like his prayers helped her both physically and emotionally. She was also referred to a perinatologist for concurrent care along with her regular OB. Overnight, Justine’s and David’s focus switched from preparing for an intervention free birth, to a quest to just birth a live baby. She did say that one bright side of having to see the perinatologist on a weekly basis was that it also gave her an opportunity to see her precious baby girl on ultrasound every week. It was comforting to see that visual reminder that baby Noah was growing and thriving.
Her concern was compounded by the fact that her own mother had died at an early age due to liver failure, and Justine has had elevated liver enzymes herself in the past. The perinatologist explained to Justine (which concurred with the research she was already doing) that her baby would have to be delivered at 37 weeks to reduce the risk of stillbirth (a recommendation that is changing now to 36 weeks gestation). In a facebook post just a few days before her baby’s birth, Justine wrote, “Everyday I get asked when my due date is and and every time I have to explain that my baby will come early due to Cholestasis of Pregnancy. Most people assume I'm fine because I look okay and since the itching is gone they assume I must be better but the truth is that I constantly am concerned with my growing child and the closer to my due date I get the more I worry!”
Upon the recommendation of her perinatologist, Justine was admitted to the hospital at 37 weeks for an induction. At her OB appointment just prior to her admittance, the doctor declined to even do a vaginal exam. He told her that he was certain that her body was truly not ready for labor and so there was really no need for it. Instead he sent her to the hospital for the induction. This started her third and final storm of this pregnancy. She was admitted and they started the process. Justine was given a vaginal dose of Cervadil (a cervical ripening drug). When the nurse inserted the Cervadil, she informed Justine that she was already 2 cm dilated and 50% effaced! That was so comforting to her as she was certain that her cervix was not going to be anywhere ready for delivery yet! It was like her baby girl was telling her that everything was going to be alright with her coming at 37 weeks!
Justine gradually began dilating and effacing and having some contractions. This process was very slow getting started, but picked up over the next few hours. About 13 hours after the medicine was inserted, Justine was almost 4 cm dilated. She had a very painful moment, which she had a difficult time recovering from, when the nurse was having trouble removing the cervadil strip. She did ask for some IV pain medication to cope with that pain. At this point she, along with her doctor, made the decision to rupture her membranes to see if she would continue to labor on her own, without the need for Pitocin. This accomplished exactly what she had hoped for and her contractions picked up significantly. She asked for IV pain meds again. She was having a difficult time coping with the frequency and intensity of her contractions. She said that if felt like she was getting no break between them at all. About an hour later she made a decision to get an epidural for pain management. Finally she was able to rest and let her body do its job.
About 14 hours after getting the epidural, and after getting some much needed rest, she was ready for pushing! Soon after, Justine had her precious Noah Grace in her arms. Baby weighed a healthy 7lbs 6oz and had Apgar scores of 8 and 9! It was like she knew she was coming early and just developed a bit early to make things easier! Baby appeared to suffer no ill effects at all from her early delivery!
Justine said “Having you as a doula emplowered me to be brave when I was oh so scared, and helped me to have the knowledge so that I can now help other women!”Today, Miss Noah Grace is quickly approaching her first birthday! She and momma are both in good health, and baby is still nursing like a champ!
Working with Justine and David was such an honor! They were truly a team in every aspect of her pregnancy and delivery. Their love for each other, their faith in God, and their trust in their health care team got them through a very scary time in their lives. While they say that they learned from me, I know that it was truly I who learned the most from them!
Karen Berhow serves the greater Bakersfield, CA area. She has over 20 years experience supporting women through labor and birth. Although she started helping friends, she is now a professional doula, offering childbirth classes, breastfeeding help, and general support for new families. Karen has been on the Board of Directors for the Bakersfield Birth Network, and she loves her involvement with other professionals as they try to bring awareness of birth options to their area. The mother of three grown children, she recognizes her personal birth experiences shaped and motivated her to reach out and help others on their journeys.
I'm sure we have all heard different myths about doulas -- whether it's thinking doulas catch babies like midwives, or they come together to dance beneath the full moon -- there are a lot of misconceptions out there. Becky amazes me -- not only is she a comic genius when it comes to doula humor, her graphic art choice is the perfect medium to convey her message. She addresses common myths about doulas, and leaves us full of happy feelings for the work we do.
There is often confusion over what a doula is. Many times I have talked with couples nervous about a doula possibly taking over their birth. They are afraid that a doula may guilt them into a certain type of birthing. To add a little silliness I have illustrated examples below with my subpar Window’s Paint skills. These show the differences between someone that will fight against your birth, a duel-a you could call her, and a doula, or birth support for your choices.
This may be new to you, but doulas are not just for natural birth. They are for anyone wanting more support for their birth. Doulas are helpful in cesarean births, medicated births, natural births, hospital births, home births, single parent moms, and so much more. Whether you have a plan or not, we are here for you, no light sabers involved. Note: In the odd case that you want light sabers at your birth, we can help you with that. We do not discriminate against nerds; we just won’t use them to stop your choices.
The next concern often had regarding doulas: "But I want my husband involved. I want him to intuitively know what I need.” If he helped start this baby business, then it totally makes sense to want him right there involved in the birth.
Can I tell you my secret? We LOVE it when dads are hands-on and involved. It is our biggest goal to facilitate the best connection between you and your partner. We know that dad helps get the oxytocin and birthing hormones going. Some men need a little direction along the way. They are new to this. Our job isn’t to replace dad, it’s to help him help you best. If dad isn’t there this works the same for grandmas and friends. We will not erupt in flames if someone else gives you counter-pressure.
I met with a doctor today. He was a little on-guard, and he felt the need to explain how he goes out of the way to help his patients. Sadly, too many providers have met some kind of duel-a, or have heard stories of them. All he knew was that I was a doula and he assumed that I had a negative view of him as a doctor. In reality, I have yet to meet a provider that did not want the best for mom and baby. Sometimes they have differing opinions on care, and different points of view, but they all care. Doulas are not out to defy anything medically related. We need the medical team so that we can focus on emotional support and comfort for mom and the family.
Doulas work with mom’s birth team to help her best reach her desires. Doulas will encourage you to choose a provider that you feel you can trust that you can work with together. They encourage mom to ask questions, find evidence-based information, think over benefits and risks, and if needed, help mom stand up for herself. Our job is not to have a show down with the medical staff. Our job is not to speak for you. Our job is to help you get the information you need to make choices, and to support you as you speak for yourself.
I am not a duel-a. I am not out to fight or prove anything. I am a doula -- a supporter of women, babies and families.
Becky Hartman serves as a birth, postpartum, and bereavement doula, birth and pregnancy photographer, Benkung belly binder, and energy worker. She has been shaped by her own births, and the realization that education factors into creating an empowering experience. Becky strongly believes women can follow their hearts and they will know the decisions that are right for their situations. She encourages families to learn, explore, develop ideas, and then go with the flow of their birth experience. Becky lives with her family in Clearfield, Utah.
When it comes to doulas and the support they offer, I'm a sucker for a good, old fashioned, positive birth story! Today's feature is just that. I also appreciate how Dorothy shares she did all she could to prepare herself for birth, yet she still credits luck and genetics for her experience, because when it comes to birth experiences, we don't always get to pick how things will go.
“Why are you still working?! Your due date is next week, what if your water breaks while you’re at work?”
“Oh that’s not going to happen to me, they do that in movies for dramatic effect. In real life, the water breaking in a gush only happens to about 8% of women, that won’t happen to me, I will be fine”
This was a conversation between myself and my good friend Jammie one week before my October 13th due date with my first child. I had an easy pregnancy, no morning sickness or vomiting, and I had not taken a single day of work off the entire nine months. I manage an office, it’s not physical work and since I had felt fine, I felt no reason to stop working even with my due date right around the corner. I wanted to maximize my time off after the baby arrived. Little did I know, I was about to be one of those 8%...
On the morning of October 14th, one day overdue, I awoke to my dog barking. She doesn’t usually bark at night unless she needs to be let out to answer the call of nature. I groaned internally. “Ugh, it’s 2:30 a.m., I don’t want to get up and let her out,” I complained internally. Then I thought, well I probably have to pee anyway, it’s only been an hour since last time I peed and everyone knows how often pregnant ladies need to pee. I heaved my big, pregnant belly up and began walking to the bathroom. "Oh, I guess I really had to go," I thought, as I felt fluid trickle. By the time I got to the bathroom, there was a gush and a lot of fluid. Apparently my water had broken, signaling that the arrival of my baby was imminent. I called to my husband and told him to get up and let the dogs out while I cleaned up.
The first call I made was to our doula. I had made the decision to hire a doula fairly early in my pregnancy, and she came highly recommended from a mother of 6 that I have known my whole life. I hired a doula because I was afraid of having a hospital birth, I was afraid of being forced into taking unnecessary medical interventions during labor, and afraid of being bowled over by a medical team that had never met me, knew nothing about me or my baby, and didn’t know what I wanted from my birthing experience. I envisioned an intervention-free birth, preferably at home, with a midwife. My husband, rightly concerned with my health and that of our unborn baby, objected to my home birth plan and preferred a hospital setting. The compromise came in the form of our doula, who I wanted to help me through an intervention-free hospital birth.
“My water just broke, should I go to the hospital?”
“How do you feel? Have your contractions started yet?”
“I feel fine, I am not in pain and having no contractions yet.”
“It’s up to you whether or not you’re ready to go to the hospital. However, it can take some time for the contractions to catch up once the water breaks. Since your water is broken, if you do go to the hospital, it's likely they won’t allow you to leave once you’re there.”
“Ok, well I don’t want to go too early, I think I will wait a while and go later. I should not go to work though, right?”
“NO!!! Do not go to work, and keep me updated.”
After getting off of the phone, I called my mother and told her the news. I told her I wasn’t going to the hospital yet and I didn’t expect the baby to arrive for several hours, probably not until late evening. I expected a long labor, everything I had heard and read said that most first time mommies have a long labor so I was prepared for a marathon. With this in mind, I decided to go to work. This decision was made because I knew I couldn’t get someone to cover me, I work at 4:30 am, and I just planned to go briefly to give a quick morning meeting and inform my staff that I would be out until the end of my maternity leave. My husband got dressed and drove me to work, and I was there for half an hour before we left and drove through McDonald’s for breakfast to be fueled up for all the work ahead of me!
At home around 6:30 am we both laid down, I wanted us both to try to get some rest for the long day ahead. I was having minor contractions at this point, 15-30 seconds long and 5 or so minutes apart. At about 9 am I sent my husband to drop our dogs off at a friend’s house. My contractions had increased in frequency and length but I was still not ready to go to the hospital. I was texting our doula and asked how long I could safely wait to go to the hospital? She said it was up to me how long I felt safe staying home, and she advised me to contact my doctor for an appointment to check my progress. If I had progressed enough, I could go directly to the hospital, but if I wanted to go back home, I could do that too. That sounded ideal to me, my doctor’s office was located in the parking lot of the hospital I would deliver at.
This is why I wanted a doula and why I decided to go with our doula specifically; she listened to me, asked me how I felt, and asked what decision I thought was best for me. Essentially, she helped me to decide for myself instead of just telling me what to do or what she thought was best. From our prenatal courses, she knew my concerns about having a hospital birth and advised me with that in mind. Our doula knew that I was concerned about going to the hospital too early in labor, and that I was concerned about having my movement in labor restricted by monitors and hospital rules.
The most important thing that I learned from our doula 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 our doula: “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! Our doula 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, our doula, 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. My doctor 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!”
At 1:13 pm, Tegan Janine arrived. 7 pounds, 3 ounces and 18.5 inches of pure, healthy perfection. I remember seeing her for the first time, her arms outstretched. As they laid her on my chest, I was overwhelmed with emotion and disbelief. She had arrived so quickly, I was caught off guard and burst into tears, “I’m just so happy." Delivering the placenta was slightly problematic, it didn’t want to dislodge itself. The doctor massaged away at my abdomen for 20-30 minutes, and I cursed loudly…but it was eventually delivered. I was given a shot of Pitocin in my thigh because I was bleeding a little more than they would have liked, but otherwise everything was fine.
All of the preparation and planning were worth it. The decision to hire a doula and educate myself on my choices and decisions was crucial. I am extremely fortunate that I had an easy pregnancy and a fast labor, many mothers aren’t as lucky as I was. I recognize that genetics and pure good luck played a huge part in me having a positive labor experience. I hope that by sharing a positive story of birth, other mothers can feel more confident. There are so many terrifying stories of labors gone wrong, I feel that women need to hear that labor can be a positive experience.
Dorothy and her husband reside in Bakersfield, CA. Along with Tegan, they share their days with two adorable Daschunds. Dorothy is currently pregnant and getting her out-of-the-hospital birth wish: her baby will be born at a local birth center.
When living in Chico, California, and starting as a doula, I did not enter this work with a professionally-created business plan clutched in-hand – I walked in with my heart open and extended, ready to help families. The focus on business in the doula world has been huge in the last few years, and I absolutely see the value in that. When I started as a doula, there simply were not resources past the doula trainings we took. I did as many others did – made things up as I went along. With freedom and (eventually) experience, I made changes as needed to better fit how I wanted to do business. I have known all along that I do things differently than many other doulas, and I am perfectly content in that. In order for me to stay sane, happy, and sustainable as a doula, my business beliefs and practices have to match me. Take, for example, payment.
It is the norm for doulas to be paid-in-full before a baby is born – often by 36 weeks. The agreement generally is, if you have not paid your doula before your birth, she does not consider herself on call for you. I deviated from this years ago after seeing an uncomfortable situation with a doula friend and her client.
Anne was called to labor with a client at home. The client had not yet paid the second half of Anne’s fee, but Anne made the choice to attend her client. After a night spent working through contractions, labor stopped. Anne left to wait for her client to share when labor began again. But Anne’s client never called, and soon Anne learned the baby had been born. Expecting to be paid, Anne contacted her client to make arrangements. The client, though, expected that since she didn’t have direct doula support for the birth, nothing was owed. For weeks and months I saw this play out, and I felt bad for Anne. The amount of time and energy she put into trying to collect payment was painful to watch. I understood Anne’s side of things, and yet I could imagine a situation where her client felt good about birthing without a doula.
Anne never was paid.
I have since moved from Chico to serve the areas of Visalia and Bakersfield, yet my belief hasn’t changed: my true heart of this birth business lies in wanting families to have what is right for them – even if that means they change their minds about me. I cannot stress this enough! Thoughts come to me: what if a family finds that fee-remainder would be more important to them than doula support? What if I miss a birth? What if they are laboring confidently and a doula’s presence doesn’t fit the flow of their birth? What if a planned cesarean birth is needed and they feel well-enough supported? I wanted my clients to have an “out,” to be free not to call me, without worry of penalty.
My contract expectations are as follows:
There it is – all in place should a family find it useful.
This structure is worrisome to many doulas I have shared it with. What about being on-call and then suddenly having your time wasted by not attending the birth? Unless I block my calendar out for specific dates (and as my husband is a teacher, I block out some time in the summer), I am on-call a lot. When weighing this as an option for families (against my inconvenience), I want families to win.
Ultimately this has been more of a non-issue: I am getting close to 200 births as a solo doula, and I changed my contract to reflect this option around birth 30; in all of that time, I have never had a family NOT call me, and I have never had a family NOT pay me. So why keep it in my contract at all, if it isn’t going to be used? Because I believe birth is a time when your choices shape your outcome – and who is on your birth team should always be one of your choices.
Sometimes I feel like we don't hear enough about the benefits of being active and laboring/birthing in upright positions. Babies have to navigate the pelvis in a series of necessary movements. When Mom is sitting in bed, a baby must do this all on his own; if she is moving around -- sqautting, walking, climbing stairs, rocking on a birth ball, changing her positions from being active, to resting, her baby has more help to get into optimal positions. This is a true partnership between Mom and Baby -- she helps her baby in the race to meet the outside world. And as Bernie points out, this makes things better for birth.
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!
2. Shorter labours!
3. Less chance of Distress to your Baby!
4. More Comfortable Labour!
5. More Room for Baby!
6. Decrease Chance of Assisted Delivery by 23%!
7. Decrease Chance of Episiotomy by 21%!
Whole, Healthy and Intact - Avoiding Perineal Trauma, by Tracy Donegan
What is the Evidence for Pushing Positions?
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.
Supreme love and thanks to my friend Christine for allowing me to share her amazing pictures. She deserves to be a meme <3. Stacie
I have always loved music. I love when families incorporate music into their birth experiences. In fact, the other day I was at a postpartum visit where Mom and Grandma were asking all sorts of important questions about life with baby, and Dad interjected, seriously: "I have a question..." Long pause. "Should I be playing her country music around the clock now?" I laughed, and answered back with a question of my own, "Do you listen to country music? I wish I would have known that before I agreed to be your doula." They do listen to county music, and their baby's birth happened over the weekend of Stagecoach Festival, an important event in their lives as music lovers. As a Music Therapist and Birth Doula, Kate offers compelling reasons and creative ways to bring music to birth -- I know I can't wait to learn more.
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.
Day 2 brings us to a clarifying list about doulas! I will admit, just yesterday a friend from church said I was a midwife, and I had to explain the differences between the two professions.I had a great conversation with Becky, and I learned she has great taste in books and music! Fabulous to know there are doulas all around the world who believe in the importance of helping women achieve safe and satisfying births, despite the unique, local obstacles we face.
Yeah, yeah, we all know what a Doula is but there’s little information out there on what a Doula isn’t. I’m going to change that!
1. They are all Hippies who only attend natural births. Natural Birth? Let me scratch that one right away! Birth is natural. The End. If you are a human who births a human baby, that my friend, is a NATURAL BIRTH! Taadaa. We can categorise birth into vaginal, assisted, surgical ect but a human birthing a human is a natural event. Doulas attend all kinds of birth. Whether you plan on birthing at home in the water or in theatre with a surgeon, you can be assured there is a doula out there to support you and your family on the day you meet your little baby for the first time. Hippies? Yes there are some Hippie Doulas and I can hook you up with some if that’s what you need. I, however, shop at Tesco, dye my hair, wear business attire 99% of the time and occasionally feed my kids Mc Donalds!
2. They protect women from their care providers. Really, if you are attending a birth place where you feel you need protecting from your care providers then we’ve got much bigger fish to fry than simply hiring a doula. I’m very glad to publicly state that all of my clients have had a great relationship with their care providers and had amazing support on the day. I don’t believe women need protecting from care providers. I believe care providers are people who made a profession out of caring for people. I have had clients change their birth place, obstetrician or move to a more suitable model of care to suit their preferences for birth. We call it stacking the odds in your favour. I trust my clients to choose the best care providers for them, if they are happy with the team they’ve chosen then I am completely behind them and will support them 100% of the way.
3. Doulas are just like Midwives. Midwives are health care professionals. They have an impressive range of skills. Doulas also have an impressive range of skills but they are on very a different spectrum. The only similarities between doulas and midwives are that we both offer emotional and physical support for birth. Doulas do not preform any clinical tasks. We do not advise clients. We do not advocate for the woman. We are present, we offer continuity of care, we offer information, education, physical and emotional support. Support. We have a relationship with our clients that unfortunately, most midwives don’t have the opportunity to have. No, we don’t catch the baby but we will be right there cheering you on if you want to!
4. Doulas advocate for you. You are the advocate, your partner is the advocate, your midwife is the advocate. Your doula is an ever present support person. We do not advocate. See point 2. We trust you to have chosen the best possible set of circumstances for the birth you want so we trust that there is no advocating to be done on your behalf. This is YOUR birth. It isn’t ours. We don’t ever want you to feel pressured or swayed to have or continue on the path of one particular type of birth. This is where “unbiased support” comes into play. You can change your mind. That’s perfect. If we’ve done our job right at our antenatal visits, you and your partner will be ready and able to do all of the advocating on the day. We may offer gentle reminders of conversations and wishes we’ve spoken about prior to the birth but ultimately, our job is to help you find your voice and feel strong and empowered to use it!
5. Doulas will work for free range eggs! Seriously, there is a misconception out there that doulas will work for little or nothing…..or eggs. I am a person just like you. I’ve got a mortgage, a car to run and kids to feed. I don’t work for eggs and frankly, I wonder about trusting a person willing to work for eggs to support you on the most important day of your life to date! Yes, hiring a doula in an investment. You are paying for your doula to be within range, without alcohol, have childcare arranged and be willing to drop everything at the ring of a phone to come at be with you during your labour. All of that for up to 5 weeks, 24 hours/ 7 days a week. That’s not counting the hours spent on the phone, texting, emailing and having access to her wealth of knowledge for your entire pregnancy and post partum period until you part. So yeah. Eggs?
6. Doulas replace the partner. One of the most memorable births I attended was jamming out to Macklemore with the Dad while the Mum was “surge twerking” to the beat. It was FUN. Serious FUN! After the birth the Dad turned to me and said “Thank you so much for being here, I was dying to pee until you came and they don’t warn you how hot these wards are. You need to drink water, then you have to pee.” Doesn’t seem like a big deal but being able to run to the bathroom while your Love is in the throes of labour is a huge deal to a partner who maybe needed to pee, maybe not, maybe just needed a breather from how completely overwhelming birth can be when you’re experiencing it for the first time. I love attending births with a life partner present. The partners also love that they can relax, breathe and off load a tonne of the pressure. It’s win win to have us both there.
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.
Here is another take on a doula's experiences in nursing school. Amanda offers insight into what she has and hasn't learned in her different educational pursuits, and I, for one, was surprised by the results. These are excellent points to keep in mind as we work with families and with nurses.
Things that I learned in nursing school that I wish I had learned in doula training:
1. How hospitals work: Hospitals are complex systems that practically have a life of their own. Many different professions work together to create the beautifully synchronized dance that is a functioning labor and delivery ward. The various actors all have their own roles to play and each one is important. Nurses assess and monitor. Patient technicians take vitals and help with repositioning and other essential tasks. Doctors and midwives are responsible for the health and wellness of several mothers and babies at a time. Anesthesiologists administer epidurals. Even the housekeeping staff have an important role in keeping contamination risks at bay. This doesn’t even take into account nurse managers, case workers, social workers, scrub/OR nurses and the hospital administrative staff. If any part of the system isn’t perfectly coordinated, it can cause problems in many other parts of the unit. My presence as a doula should not be a hindrance to how the unit operates. In fact, it should add to the effectiveness of the whole team and knowing what everyone else is responsible for and keeping within my scope will ensure this.
In a large birth center, it is very easy to get lost in the hustle and bustle of so many people and so much activity. I highly recommend that all doulas take a tour of any birth center that they are not familiar with prior to going there to support a mother in labor. Ask questions about nurse to patient ratio and how many patient technicians or aids are usually on each shift. Ask about their intake and triage procedure. Ask if the labor and delivery unit is separate from the postpartum unit or if the mother will remain in the same room throughout her stay. Orient yourself to the floor, making sure you find the ice machine, the family lounge, the restrooms, and the vending machines.
2. What L&D nurses actually do: When I began my training as a doula, I had a false sense of what labor and delivery nurses actually did. I assumed that they would be “hands-on” with the patient often, either by taking vitals or doing vaginal exams or other “medical” things that I only vaguely defined in my head. In reality, most of their job consists of observing, assessing and documenting with a healthy dash of caring thrown in. Nurses are the primary eyes and ears in the room for the doctor, midwife, and laboring mother. She is the first one to notice if something just doesn’t look right and the first one to take steps to mitigate any problems.
As doulas, our job is to facilitate a good working relationship between the nurse and the laboring woman. Respect the nurse and the important job that she is doing. Advocate for the mother’s preferences regarding monitoring and assessments. Better yet, teach the laboring woman how to advocate for herself. Make suggestions on how to meet both the need for monitoring and the need for freedom of movement, such as moving the birth ball to right in front of the machine so the wires will reach, using a wireless pack, or using intermittent monitoring instead of continuous. Ask the nurse if there is anything that you can do to make her job easier. Above all, remember that very few nurses went to nursing school because they like to chart! These nurses chose to be in labor and delivery because they care about these women. These nurses may see you as a threat because you are taking the best part of their job away from them – being the shoulder to lean on and the person who gives reassurance. Let the nurse share in supporting the mother with you – that is a win-win situation for all parties involved.
3. The rationale behind “Policy”: The hospital, the doctors, the nurses, and doulas all have one common goal: the health and safety of all of the women and infants. The hospital’s policies are usually a source of grief for my clients. They are viewed as rigid rules that impose on their body’s ability to birth naturally. I am not going to address any one policy in this section, just the reasoning behind these policies. The hospital wants to ensure the safety of EVERY woman, not just one specific woman. They know that for every so many hundred births, something will go wrong. They address this by instituting policies on everyone to make sure that those few who will have something go wrong don’t get missed until it is too late.
Sometimes these policies are out of date or not applicable to a mother’s personal situation. If that is the case, the mother can always opt out. It is easier to do this if the mother knows the policies ahead of time and can talk to her caregiver about it, but it is never impossible. (I know a woman who didn’t just change doctors, but changed hospitals at 8 cm dilated in active labor to avoid a policy that she didn’t agree with.) For every procedure that is done in the hospital, the informed consent of the mother is required. Informed consent mandates that the mother understands the benefits of the procedure, the risks associated with it and how likely they are, any alternatives to the procedure, what happens if it is not done, and any implications of her decision. A woman always has the last say in what happens to her body! To best advocate for your clients, make sure that they know how to advocate for themselves by asking the right questions, knowing where to look for unbiased information, and ensuring they have enough information to give informed consent or informed refusal.
Things that I learned in doula training that I wished I had learned in nursing school:
1. What labor and birth look like without intervention: This may or may not come as a shock to you, but in the course of my Nursing Care of Women and Children class we did not once see an unmedicated labor. All of the videos that we watched in class were of women who already had an epidural in place. At my placement site for the clinical portion of the class, more than 90% of women had epidurals. The 10% who didn’t, were usually attended by midwives instead of obstetricians who didn’t allow students in the room. In a four hour lecture on caring for women in labor, we spent 15 minutes on managing labor pain with opioids, 45 minutes on epidurals and the nursing care involved, and less than five on all non-pharmalogical methods combined.
This seems to me to be a chicken or an egg type of a conundrum. Do we spend more time on epidurals because that is what most women choose? That makes sense to the practical side of me. Of course we need to learn how to care for women with epidurals, and if that is the majority, then shouldn’t we spend the most time on that? But what if, we as nurses, unconsciously push for more epidurals because that is what we are the most comfortable with?
Obviously, I can’t speak for anyone’s experience besides my own, but if I had not been a doula prior to nursing school, I would have never seen an intervention free labor. I am in the camp that believes that birth is not pathological and that we should not intervene unless there is something going wrong, so the idea that there are practicing nurses who have never seen one without intervention seems unusual at best. Therefore, I would like to see a more comprehensive nursing curriculum that covers non-pharmalogical pain management and an intervention-free labor more in depth, even if it is just a film.
2. The importance of the psychological state of the mother: Birth doula training focused on this topic extensively. Human women are just like all other mammals in that to give birth we need to feel safe and secure. That just makes evolutionary sense: a woman in labor is vulnerable and so is her infant. Any increase in stress during early labor can stall progress. Additionally, fear and anxiety are well known to be associated with tension. Tense muscles during this time when the mother’s body needs to relax and open up can increase the amount of pain that is felt during labor.
Birth doulas use this knowledge and spend most of our efforts trying to reduce stress. We create an atmosphere of peace by dimming lights and playing soft music. We empower a woman to feel like she is in control, even when her body is listening to more basic instincts. We are the gatekeepers for mother-in-laws and supporters of partners, so she is free to worry about a few less things.
Nurses could be a huge ally in this process. They are gatekeepers of a different kind. They can cluster tasks to minimize interruptions or space them out if the woman needs a distraction. They can knock before entering the room and insist that others do so as well. They can protect the space better than doulas can, by making sure that other hospital staff do not come in to refill supplies or empty the trash. Nurses also have the importance position of being the intermediate between the hospital and the laboring mother. Orientation to the room and floor is essential to feeling secure. It is amazing how much difference knowing where the family lounge, the bathroom, and vending machines can make. Listing the names of the nurse, the patient technician, and important phone numbers somewhere in the room can give the mother a sense of belonging and welcome.
3. Physical support of a woman in labor: The birth doula workshop is truly an amazing experience. I didn’t just learn about how to physically support a laboring woman, but also how to ask the right questions to figure out which skills would work best for that particular woman. From using eight pillows to ensure that every single joint was in alignment and supported, to applying firm counter pressure, to a cool wash cloth placed on her forehead, doulas have the market cornered on providing physical comfort.
This starts with a solid foundation, which nurses are already taught, the gate theory of pain. Simply put, a person’s brain is only capable of paying attention to so much information at a time. Overwhelming these nerve pathways with other stimuli, like cold or pressure, prevents some of the pain from getting registered. Nurses learn about this theory early on in their education because pain control is an important part of our everyday tasks. The application of this theory in labor is, however, as I mentioned above, taught in a very limited manner. Furthermore, reading a laboring woman to determine which of the comfort measures to try is not taught at all.
Things that I am grateful that I learned in both because I also have a uterus:
1. How I treat my body and my mind now matters: The thing that prevents complications from developing during labor more than anything else, is not who she chooses as a care provider or what doula she decides to go with – it is how she treated her body in the years before she became pregnant. Eat healthy. Maintain strong muscles and healthy joints. Keep your weight in a healthy-for-you range. Try to squat sometimes even before you get pregnant, just to get used to how it feels. Get enough sleep at night. Get help for your anxiety or depression. Learn what techniques help you to manage your stress. Yoga is amazing because regular practice will build strength, flexibility, decreases stress, promotes relaxation, and most importantly helps to develop a trusting relationship with your own body. You learn how to really think about and focus on your breath. You learn how to be in and feel your body, how it is positioned, and how to reposition it in a way that it is telling you to. These are all things that you can do now, even if you are not pregnant to ensure a healthy delivery later on.
2. The time to prevent interventions is at the prenatal appointment – not in labor: Talk to your care provider with an open-mind and realistic expectations. Tell them what matters to you. Ask them what the policies are. Try to compromise between the two ahead of time. There is no prenatal appointment that is too early to start discussing your birth plan! If your caregiver agrees with you to modify a policy, get it in writing in your chart and ask to speak with the charge nurse on the unit regarding it. The more the nursing staff knows ahead of time, the more smoothly it will go during labor and delivery. If your caregiver isn’t willing to compromise with you, hear them out. Try to understand if they have a different philosophy of birth than you or if it is a matter of safety and you should consider changing your point of view. If you can’t reach a compromise or you just don’t like your caregiver – shop around for a new caregiver. All of this is much more easily done before labor, than during and in between contractions.
3. The importance of flexibility: Things don’t always go according to plan. When making a birth plan, remember this. In fact, make two birth plans. Plan A: my ideal birth. Plan B: if it all goes to hell and I need an emergency cesarean birth. The fact is that even with the ideal caregiver, the best circumstances, the healthiest mother, and an easy pregnancy things can still sometimes go less than ideal. The world health organization recommends a cesarean rate of 10 to 15%. This means that for 10 to 15% of pregnancies, a cesarean birth is safer than a vaginal birth. So be flexible during labor, if things don’t go as you planned initially keep as many elements as you still can. Ask to be allowed to have skin to skin after delivery. Swab the baby with vaginal secretions to kick start his microbiome, if you are into that sort of thing. Make sure your partner still gets the picture of the baby on the scale. Talk to your doctor about how to still incorporate your personal customs and rituals into the birth.
Amanda currently works as a birth doula for Shining Light Prenatal Education to make birth better for the women in the greater Pittsburgh area. She is also a “second-degree” nursing student at Duquesne University and will graduate with her BSN in July of this year. She is passionate about informed decision-making and self-determination in the birthing suite and beyond. When not attending births or studying, Amanda practices yoga and takes long walks with her dog.
♥ four young boys and a boy dog (offspring)