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.

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.

I finished another project I am so excited about! I wanted to put to pictures these 20 ACOG statements that came out in March with the goal to avoid a woman's first cesarean. Now some asked why the images didn't exactly match the recommendations. All I could reply back with was, some of these things, you wouldn't want to see in pictures, either because they would be boring, or because they would be graphic. But more to the truth is, I wanted the pictures to represent patience...we need to be more patient with labor. We need to give moms and babies more time to perform this task. 

I am so grateful to all the families, doulas, and photographers who shared pictures with me -- the response was overwhelming. Because the focus is on preventing the initial cesarean birth, I am pleased that some of these moms are shown laboring toward what ended up being successful VBACs!

Patience is the key. Many of these are based on evidence that shows with more time, a woman can birth vaginally. And speaking of time -- research shows it can take 10-17 years before new evidence is implemented into practice. If we familiarize ourselves with these new recommendations, we can be the driving force behind ensuring the care we receive is current when our caregiver might still be doing things out of habit, comfort, or custom. Let's spread the word!

Pin these! Help raise awareness and get this information out there into the hands of the families that need it. The goal is to educate families, so they can enter into their providers' offices knowing what ACOG now recommends. 

Stay tuned for August's adventures in celebrating World Breastfeeding Week and Breastfeeding Awareness Month. Like my Facebook page for resources that can be used by educators, doulas, and of course, breastfeeding mothers!

Every April is Cesarean Awareness Month.   Cesareans of course are sometimes necessary and in some instances can be a lifesaving procedure for the mother, baby or both.  In my work as a doula I have attended a number or Cesarean births and one of my favorite clients to work with are moms who are planning a VBAC (Vaginal Birth After Cesarean) birth.

A lot of people assume that because I am a doula that I am anti-intervention and therefore anti-cesarean.  Believe it or not I am personally very thankful for Cesarean’s because my mother and I would not be here today without them.  I was born by an emergency, lifesaving Cesarean.

While my mother was pregnant with me she experienced a complication called placenta previa.  Placenta Previa happens when the placenta is low in the uterus and either partially or completely covers the cervix.  In her situation it completely covered the cervix.  This complication is a true medical indication for a Cesarean birth.  It’s dangerous for the mother to even go into labor.

My mother was told she wouldn’t go into labor but would start bleeding first and to come immediately into the hospital when that happened.  She had been hospitalized earlier in the pregnancy for bleeding.  On June 3rd (due date was July 14th ) she started experiencing contractions, as a first time mom who was told she wouldn’t go into labor she didn’t realize what was happening.

She was staying with my grandma while my dad was at work and in the afternoon my grandma noticed her stopping to breathe through contractions and took her straight to the hospital.  Upon arrival she was checked and was fully dilated.  Things really got busy at that point as the doctor came in to do an emergency cesarean on her.  The doctor yelled at her for eating lunch while in labor because they needed to put her to sleep.  The nurse insisted that I had no heartbeat as my mom was being wheeled into surgery.  She was put to sleep right after the nurse said “I don’t know where that doctor thinks he’s hearing a heartbeat at.  This baby is already gone.”

Needless to say we both made it though.  I was a preemie but did great.  I didn’t even need oxygen.  My mom still talks about what a frightening experience my birth was.  She woke up assuming that she had lost her baby.  She had a really rough recovery after and woke up many times asking what happened to me and being reminded that I was ok.

Now for what I learned from my mom about birth.  My mom was never afraid to talk to us about her birth experiences.  I’m thankful for that.  Even with the dramatic way I entered this world I was not fearful of giving birth when my time to birth came because of her.  She talked to us about her disappointment in never getting to birth her babies.

She went on to have two more children both scheduled cesareans.  With my brother the youngest she was thankful for being able to have a spinal and be awake to hear his first cries.  She searched for a provider to have a VBAC with my brother but due to the fact that she had a classical uterine incision they felt it was too risky for her to attempt.

She always talked to us about what birth was supposed to be like.  Empowering, amazing and beautiful.

She was present for 4 out of her 5 grandchildren’s births.  She says it was healing for her to experience those births.  With the births of my children she was so supportive and helpful I can’t imagine not having had her there.

My dream is that my daughter and someday maybe my granddaughter’s won’t fear birth and that they will embrace it as a life affirming, empowering event that my mother taught us it could be.

I first became aware of the rebozo eight years ago when I visited a border town near Weslaco, Texas, called Progresso, Mexico. The women and young girls were carrying babies and toddlers on their backs with a fabric. After showing an interest in that cloth, my mom, who had taken me to visit Mexico, took me to a small store to purchase one. My first ever rebozo was a beautifully woven white rebozo. 

Fast forward six years, when I see an advertisement for a rebozo class for doulas and midwives. After reading the information on what the workshop offered, I signed up. That day, was the first day that fell I love with the rebozo for the use in pregnancy, labor, and birth. The Rebozo is a shawl or scarf which is long enough to wrap around a woman's body and has been used for centuries to help women find comfort and support during the birthing process. There are several other uses for the rebozo such a baby wearing, using as a shawl on a cool day or evening, or using it as an accessory to an outfit. These are only a few of its uses; there are many other methods to use the rebozo.  In this blog post, you will read about its use in pregnancy, labor, and birth. A rebozo comes in different lengths. For the purposes of pregnancy, labor, and birth, the ideal length is 9 ft long X 2-3 inches wide. The shortest it should be for optimal labor support is 6 ft.. Rebozos come in a variety of textures and colors. My favorite rebozos are the handmade ones from Laos because they are thin, long, and have some beautiful hues. 

As a doula, one of my goals is to integrate the partner with the laboring woman. The majority of my clients are husband and wife relationships. The husbands desire to have a very active role in supporting their wife's labor. Where as before, all I had to offer were the use of the hands as a tool, I can now offer the use of the rebozo. Most men like tools. Having a tangible item to use in labor, can help him feel connected to his wife. I have found that the rebozo is a great tool to facilitate the bond between partner and mother. The rebozo can be used to engage the partner in the birth process and is an extension of the labor partner's arms.

There roughly more than 30 different ways that a rebozo can be used for pregnancy, labor, and birth. You will be introduced to five in this post. If you would like to discover other uses for the rebozo, taking a rebozo class or workshop for either pregnant families or professionals would be extremely beneficial. You will gain knowledge and hands on experience in the use of this traditional shawl.

A rule of thumb when using the rebozo, and any other comfort method, is to always ask the laboring woman if she is comfortable with what is being done. If she likes the way it feels, the partner should continue with the comfort measure. IF at anytime the woman feels discomfort the partner should stop what he/she is doing. The partner can readjust the rebozo or discontinue its use altogether. Always measure continuing the use of any comfort method based on how it feels to the laboring woman. Since doulas do not diagnose nor treat their birth clients, the rebozo is meant only for comfort, support, and extension of the arms. The rebozo should never be used as a treatment. 

The following are five ways to use the rebozo to give comfort while performing the hip squeeze. The hip squeeze is one of the most desired labor comforts. The partner uses his or her hands to squeeze the hips together to alleviate some of the pelvic pressure from contractions. Hip squeezing can last up to a minute or more during a contraction. Although the partner would never voice this in labor, it can be a tiring job for him or her. If her main support is her husband and he has any wrist injury, he would be unable to perform the hip squeeze with his hands alone. The rebozo can take the place of the hands, thus allowing for longer and stronger hip squeeze support.

3. Hands and knees 
The hands and knees position is great especially if the laboring woman is having back labor. This position relieves some of the pressure from her back. If she isn't having back labor, it could still help take some of the baby's weight off her back. Help mom get on hands and knees. Wrap the center of the rebozo around the woman's hips paying attention to that it is not on her abdomen. For the hip squeeze, we want the rebozo around her hips. The partner holds the open part close to the woman's buttocks, and tightens the hips. A knot can then be made in the rebozo to assist with the squeezing of the hips. Once the knot is in place, the partner can use one free hand to put pressure on the sacrum. Continue as long as mom desires. 

5. Leaning over the bed
This position can be done similar to the above mentioned hands and knees. If she is in a hospital, the bed can be raised  to a more comfortable level for the woman's height. She can then lean on the bed and hug a pillow or two for comfort and to support her upper torso. The center of the rebozo is wrapped around the woman's hips making sure not to wrap on the belly while she is leaning on the bed. The partner holds the opened side of  the rebozo (fringed side) and tightens the rebozo around her hips. Make a knot at the end close to her buttocks as tight as she likes. The partner will have a free hand to add some pressure on the sacrum.

The use of the rebozo can free a partner's hand to give him or her the ability to use an additional comfort measure such as massage and a gentle anchoring hand on the shoulder. It can assist in longer durations of comfort measures to the laboring woman because the partner is not too tired from using his or her hands. This is beneficial to the laboring woman because she will feel fully supported by her labor team. In all, the rebozo is an amazing tool which can enhance the labor and birth experience. 

When I am being interviewed by families seeking a doula, I often get this question: “So you do have any children?” I smile sweetly and give my standard answer, “No not yet.” I know this question will come at some point during most interviews.

It used to be a question I dreaded. I used to have this nagging voice in my head “Why would they want to hire you? You’ve never given birth, and there are plenty of other doulas who have that experience.”

These days, though, my internal chatter has stopped. I know that regardless of whether or not a woman has given birth herself, she can still be a phenomenal doula. In fact, I think I have a couple perks to offer, since I don’t yet have children.

#1 I don’t have to worry about childcare. This is a big one! Many, many doulas out there that have children need to coordinate who’s going to watch little ones, drop off and pick up from school, or take care of a sick kid, if they get called to a birth or postpartum situation last minute. Being on-call can be challenging in and of itself, and not having to worry about kiddos yet may mean that I am more immediately available to families.

#2  I don’t have any baggage from my own births. Many doulas that have given birth are able to put their own birth experiences, joys, and struggles aside and simply focus on the family they are serving. But this can be challenging. Perhaps a doula wishes things had gone differently during her birth, and she may subconsciously steer her clients toward birth choices she herself made or didn’t make. Without any previous emotional ties to my own birth experience, I can fully hear families’ wishes and support them in their ideal birth or postpartum time.

Many women take an interest in doula training after they themselves have given birth. Maybe their birth was a life-changing ecstatic and empowering event, and they want to share with other women the potential for birth to be wonderful. Or maybe they had a challenging birth or postpartum time that they wish they could go back and do differently. As I do not have children yet, I come to doula work with a different background, although I share the same passion all doulas have for making birth and the postpartum time as empowering, positive, and supported as it can be.

My first experience with birth was witnessing my mother giving birth to my little sister when I was 13 years old. She had Maryann in a nice hospital in Southern California. I was at the hospital while my mom was in labor, but I wasn’t much interested in it. I remember she was in bed, on her back the whole time (or so it seemed). I was in the room when an epidural was placed, and I remember her vomiting a lot. All in all, labor looked like the pits. I remember there were a few family members in the room, but no one seemed to really be helping her. I remember everyone sitting around chatting, knitting, doing crossword puzzles. I remember thinking if I was in my mom’s shoes I would yell at everyone to either get out, or to get off their butts and do something like give me a massage!

After seeing enough of what looked like a hellish labor, I went out to the waiting room until my aunt came and got me when my sister’s arrival was imminent. The birth went by quick, and I don’t remember many details, other than holding my little sister soon after she was born. It was the labor that stuck with me; I was convinced that I never wanted to go through what my mom went through.

Fast forward to when I was 21 years old. Some of my girlfriends started having babies, and when I asked them about it, they all had horror stories. Most of them had cesareans, and seemed to think that if not for their cesarean/OB/other decision, they would have died or their baby would have died. I started adding these stories up, along with the memories of my mom’s birth, and it just didn’t make sense to me.

If birth was so exceptionally awful, how had all the generations of our ancestors made it through? This little idea started to develop in the back of my mind that maybe birth didn’t have to be so scary and dangerous, and gut-wrenchingly painful. 

When I was 22, I had just gotten out of a yucky relationship and was kind of in a rut. Being close to my mom, she was privy to my interest in my friends’ birth experiences, and she suggested I complete a doula workshop that was coming to town. When she first sprang the idea on me, I wasn’t convinced it would be neat. I thought doulas were like woman shamans who attended births and oversaw the spiritual aspect of birth; was I up for that?

But by the first hour after my doula training began, I realized doulas were not old-lady shamans, we were the reclaimers of the potential for positive birth experiences!

I’ve been a birth doula for six years now and a postpartum doula for one year. It truly is my life’s passion to help every family have their best birth and postpartum experience as they define it.

When we got pregnant with my daughter, I knew that I wanted an unmedicated, natural birth. We prepared the best way that we knew how -- took a crash Bradley Method course, went to classes, read books and listened to other mothers. But nothing you read or hear prepares you for childbirth and I distinctly remember my inner voice telling me that all my tenseness and anxiety was making my labor pains worse and less effective. I knew it, but I could not relax myself - I was making my own labor harder and it ended in a c-section. 

Even before we were pregnant with my son, I decided I would have a VBAC, and I can say with 100% certainty that having a doula was how we achieved that goal. My doula, Lisa Lute, helped us actually enjoy our labor. My husband hated the experience we had trying to labor alone - he felt helpless to help me. He felt like a huge weight of need was on his shoulders without the experience to know what to do. With Lisa there, she facilitated everything I needed from him. He was still my laboring partner, but he didn't have to figure out what I needed. She gently made suggestions - using her experience and knowledge to help me relax and have productive contractions. She knew exactly what to do and just her presence removed a great deal of stress. 

During labor, she was such a blessing, but even so, beforehand. If you listen to certain doctors or read things from the ever-dreaded Dr. Google -- you can be scared out of a VBAC. You can decide a repeat cesarean is less risky. But Lisa addressed all my fears -- all my anxiety -- with a library of good information. She had the VBAC success statistics to give me, she had the history of attending many successful VBACs already in her arsenal. She had the reassurance that helped me VBAC. The doctor on-call when we arrived at the hospital was not overly supportive of our VBAC plan. It was a blessing to have Lisa with me and my husband. It was a blessing to have my very own experienced team member facilitating a wonderful birth experience. I would never choose to have a baby without a doula again.

"This is my favorite photo of my labor. Look at how relaxed my husband looks...he loved having Lisa there with us."

I must preface this by stating, it is not an uplifting tale of birth. I know in our culture we hear more birth horror stories, and it is not my intention to perpetuate that. This is the beginning of my birth experiences, and although I take credit for my missteps, I hope 1-it can serve to help get you thinking about your birth options, and 2-you will read my other experiences of birth to see the evolution which came through my personal education and faith.  

When I was pregnant for the first time, I fit the typical American mom-to-be stereotype. My older sister was three months behind me pregnant with her first, and she was planning a homebirth with a midwife. Not me, I wanted a hospital birth, and the cherry on top was, I chose a female obstetrician just knowing she would "get me."

My appointments were a lot of waiting, waiting, waiting for her to show up, and then her rushing me out in important-doctor fashion. One time I was made to wait so long, naked bottom on the papered-table (in a very hot, windowless room) that I sweated through the paper -- how terrible was that? But I was a good girl, and I did as I was told. "Take off your pants and sit here, she will be here soon." How humiliating. (Please, if it is not too late for you, keep your pants on until you practitioner arrives, and just sit in the chair while you wait -- it's allowed!).