This woman had it all covered! Not only did she bring her own lighting to the hospital, she had a diffuser, and her own Tupperware rolling pin, the one you an put cold or hot water in! She was, in just about all ways, prepared. And she did it in a way that made sense to her.
Pink was the theme! She beautified my suggested birth plan template and framed it -- setting it on the counter in her room. Every nurse that came in stopped, ooohed and awwwwed over it, and took the proffered chocolate treats sitting next to the frame.
Knowing her husband might need important information to be easily accessed, she put a list of must-dos on the back of the front door, so nothing would be overlooked or forgotten before leaving the house. She also had a small photo album full of ways to support her, phone numbers, and small self-care steps he could take for himself.
A packing list was created so all items this woman wanted would be included. Then it was broken down even more to specific location, so others would be able to find what she was needing or wanting without digging into the wrong place.
Another photo album was filled with calming images the woman could look at during labor.
Does this seem like a lot of work? Or does it sound like your style? You don't have to be this thorough! The key is to make your plans in a way that speaks to your own sense of organization. In labor, we can utilize comfort measures that we are familiar with and turn to during times of stress or discomfort -- we don't have to learn a lot of new-fangled coping measures that might feel unnatural or hard to remember. It works the same way when getting ready for labor and birth -- rely on an organizational strategy that feels good and works for you!
Anne is one of my most favorite doulas in the world. I wish we still lived close to each other so we could work together. She has a different way of looking at things, which makes them more memorable and easy to understand. I thought this post was a great one to end on -- it shows how we can let go of the discomfort that might normally accompany us when it comes to being around and touching others -- as doulas, this is what we do. Enjoy, as Anne shares how she bursts her bubble.
I worked with somebody once that had a definite “bubble” of personal space. It was kinda fun to subtly test the limits of those boundaries. I finally determined, through months of occasional observation and experimentation, that the space was 3 feet. Step, even 1-inch, into that invisible 3-foot force-field, and my subject would move away to reestablish the 3-foot bubble.
I, too, have a bubble. When it comes to supporting a woman in childbirth, I temporarily deflate my bubble to support my client AND the rest of her support team. Conversely, I understand that my client may also have that bubble. So, how does that work in such a short amount of time and in such an intimate setting?
In a combination of ways. Conversation, empathy, care-taking, simply being, and sometimes, sleep deprivation.
Conversation and sleep deprivation Labor room conversations, at least the ones influenced by my quirky personality, can be hilarious. The people in that labor space learn things that –- well, let’s just say that things that happen in the labor space, stay in the labor space. Humans are social. Somebody has a story about skunks, everybody else has to share their story about skunks or some other wildlife interaction, which leads to some other topic like nudist colonies and the technicalities of furniture cleanliness in regard to naked rears. Sleep deprivation just makes it all that much more entertaining. People start shlurring theyr wors an mis..misum.... an people don hwere tings wite.
Empathy I have huge amounts of empathy. The people that have chosen, or have been chosen, to be in the labor space care about the mama in labor. We all want to make the experience easier in whatever way we can. We cheer her on, we give her water, we massage tense muscles, and tell her how beautiful she is. We acknowledge her perception of her experience and help her to see the big picture. We all get giddy when her efforts culminate in 10 glorious centimeters of openness. Pushing is the best. Everybody breathlessly tells her that is the way, just like that, good job…and we grunt and we hold our breath and we push too!
Care-taking The bubble slowly deflates with a soothing of a brow. Light massage. As labor intensifies, the bubble deflates completely. It becomes all hands on deck. Time for position change; one person holds IV lines, another person holds the blankets for privacy screen, another person changes the chux pad, another person physically helps mama roll, the person holding the IV line passes a pillow to the person helping mama roll, the person holding the privacy blanket then wipes mama’s brow with a cool washcloth, and the nurse readjusts the baby monitor-ducking under the person giving the mama a sip of water. All bubbles deflated, we are all up in one another’s business!
Simply being Probably the most important. The care team for my client become protective. We hold the space, her privacy, her concentration, her focus, her rhythm, her ritual, HER ever-evolving strategy for bringing forth her infant into this world. In the early stages of labor, a knock on the door is a welcome distraction. In the final stages, a knock on the door is met with looks of annoyance and protective aggression.
Birth is a short, intense, intimate journey. Some are “mush longer den udders.” Sleep deprivation joke, get it?!? Guffaw, snort! Emotional support begins long before labor begins. Physical intrusion into the bubble is typically a gradual process, becoming more involved as the intensity of labor calls for more support and the temporary removal of the bubble. Informational support never ends. Doulas aren’t medical experts, but we are quite familiar with the key terms to know in the chapter of life called the Journey to Parenthood.
Anne is the youngest of 6 children, which is probably why she gets along well with people. She also grew up on a dairy, which is probably why she gets along with animals. She has two daughters, and is a volunteer 4-H Community Leader. She was one of the original creators of the Chico Doula Circle, volunteered for a hospital-based doula program, and offers gratis support to expectant teen moms. Anne is currently waiting with bated breath to see if she passed the Lamaze Exam to be a Certified Lamaze Childbirth Educator. Find her at Happy Pushing or on Facebook.
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.
Connie was my own doula trainer, and she has been mentioned a lot in the last few 31 Days project, as she was Monalisa's and Amber's doula trainer as well. I can't say enough kind, incredible words about Connie. From day one of me meeting her, she has championed me on in not only the doula world, but also the related world of birth. Connie brings her heart to all she does, and that has made her an excellent mentor and a dear friend -- we should all be so lucky to have someone like Connie in life.
23 years ago, when I started my work as a doula, I experienced some of the greatest highs of my life! After a birth I would sit on the phone for hours, processing this and that with my other new doula friends. I was excited to carry a pager, to know I had a prenatal visit coming up, to be thinking about my doula bag. My learning curve was steep and I was devouring every piece of information I could find. Newly married, my husband delighted in how happy I was. He said, “when I married you I knew I was getting a great woman. I didn't know I was getting a doula as well!”
The years have passed. I usually don't need to process a birth for several hours. Usually I come home happy, but not always high. I often feel pressure to get to bed at a good time, be sure my cell phone is charged, know that my childcare is perpetually lined up. The weight of being on call 24/7 sometimes feels heavy. I feel frustrated with marketing my work on social media because really, marketing is not what I love to do. Neither is social media.
And yet, the joy of this work continues to fill me. I feel honored to be trusted and invited into what is surely one of the most powerful experiences a woman will ever have. I am humbled as I witness her strength, his kindness, their love. I learn as I watch women make very hard decisions. I help her gather information. I act as a sounding board as she talks through her options. I am present for miracles.
Perhaps there is a selfish part of me as all this occurs. I learn so much from these birthing women and from these powerful experiences. When I return from births I try to write down what I learned from the experience. This is part of what keeps me thriving as a doula – it's the learning. While my learning curve about the labor process is not as steep as it once was, my learning curve about life still is. These women are my teachers.
One woman I labored with for a few days never once complained. Trust me – if I had been in her shoes, I would have complained. As we walked the hallways for the millionth time I told her that I was so impressed at how she kept a positive attitude. She told me her story of growing up watching her brother who was very ill. At some point she realized she could complain about their lifestyle, in which regular trips to the hospital were a part of her life, but when she considered what her brother was going through, she felt that to complain would be an unnecessary indulgence. She had developed a mantra in her life: I will not indulge in complaint. Listening to this I began to realize that, in fact, I sometimes did indulge in complaint. The hours we spent together taught me a valuable lesson about myself. I still complain, but maybe just a little less. And my life is better for it.
Then there was the mother who had everything stacked against her, but she just kept making these great calls for herself as she labored toward having a much desired VBAC. After two sleepless nights of non-progressing contractions, her doctor told her that even though her labor was very mild and she wanted to go home, she couldn't advise her to do so because there had been a few dips of her baby's heart rate in the last several hours. The mother listened to what the doctor had to say, asked a few questions, and then made a decision to leave despite her doctor's advice. This was not someone I thought would ever even consider signing out AMA (Against Medical Advice), but she said she dug down deep and just knew it would be worse to stay. She had never heard of signing out AMA but described doing so in her own words to the doctor. The doctor said she completely understood what the mother was asking for and that she only was telling her the hospital's policy. As I followed the mom out of the hospital, her nurse whispered into my ear that she would have made the same decision for herself. The laboring mom left the hospital, got some much needed rest, but went on to encounter many other obstacles. Despite them, she and her baby had a very healthy VBAC. The lesson to watch for miracles was reinforced for me at this birth.
I have learned that slow and steady progress often makes big changes. Not just in dilation! But even in birth advocacy. I have encouraged and watched as women kept asking for their babies to be taken out of the warmer and placed in their arms. Now it's standard for babies to be placed in mom's arms after birth. I have suggested to women that they might consider delaying their baby's first bath. Now I attend births in hospitals that post that they prefer not to wash babies for 24 hours. Episiotomies were routine. Moms complained. I haven't seen one in 6 years. I've learned that health care consumers really can make change if they are supported.
When I think about why I keep doing this work, it is because it fills me up. It makes me smile. This work helps me to learn and grow. The highs are not always as high as they once were – but the lessons are so much richer. Where else could I receive these powerful life lessons than at a birth?!
Connie Sultana, BA, CD(DONA), ICCE, LCCE has been a doula for over 20 years. She is a DONA-approved Birth Doula Trainer, and a Lamaze-approved Childbirth Educator Instructor. Connie is a former Director of Certification and Board Member of DONA International. Connie is forever grateful and appreciative to the over 700 families who invited her to provide support during their labors and births. She lives in Santa Rosa, California with her family and her two dogs.
Amber is no stranger to the 31 Days of Doulas project. She wrote about the advantages of a doula who hasn't had children yet, how doulas help in all kinds of births, and her "labor" as she started nursing school. This year's addition gives us a peek inside Amber's life. Nursing school is not easy! And Amber's confidence was shaky -- until she realized the true value those doula skills held.
Doula training has a way of bringing out the best in people. Sure, before I was a doula, I was caring and compassionate, but I was also a wild 20-year-old who wasn’t always focused on others. When I completed doula training at 22 years old, my eyes were opened to the injustices that many women and families face as they meet their baby for the first time. I was made more aware of how much what we say matters, and how important it is to simply listen and respect people. During my training, I also learned physical skills to provide comfort. I didn’t know it at the time, but the knowledge I gained over my two-day doula training would stay with me, even when I wasn’t supporting women and families during the childbearing year. Most notably, my doula skills have all proved extremely useful as I’ve journeyed (yes, sometimes trudged) through my last 2.5 years as a student nurse.
Prior to starting nursing school, I absolutely loved being a doula. Being present for one of the most intimate moments in a family’s life was an immense privilege. The qualities that I already had were allowed to shine when I was a doula for a family. Once I started nursing school, I was immensely saddened that the magical relationships that I built with my doula clients would be a thing of the past. It was time to become a nurse, and my touchy-feely relationships would only be distant fond memories.
At the end of my first semester in nursing school, I was talking to one of my professors about how much harder nursing school was turning out to be, in relation to my expectation of what it would be like. Her response was one I vividly remember. She told me that you can be a nurse forever, and learn all these fancy technical skills, but that it is extremely hard to learn how to be truly empathetic, be good at listening, and have emotional intelligence towards your patient. She told me that it seemed I already had these skills. It wasn’t until she pointed this out to me that I had really stopped and realized just how much I had translated my doula training into my practice as a student nurse.
I hadn’t realized it, but I had been all of my patients’ doulas. The older folks who had dementia who just needed someone to talk to, the veteran who was depressed, the widow who was confused and scared because she didn’t know where she was -- these were now my doula ‘clients’. Except, they were my patients.
There was something that I brought to my practice that was slightly different than some of my classmates. Now, the other students in my cohort are amazing. We are all very different, and have very different skills. Some of them are fearless, they always jump at the opportunity to insert an IV or catheter. I, on the other hand, was sometimes almost petrified with anxiety just thinking about doing something I didn’t feel confident in. Some of my other classmates were really book-smart, they had memorized complex physiological processes and medications. I sometimes compared myself to these other students, and felt inadequate, that I would never be as good as them. But, once I realized that emotional support was my strong suit, I stopped beating myself up.
When it came to talking to patients who were depressed, needed someone to talk to, had just received bad news, had dementia and missed their loved ones, or were in pain, I felt very comfortable. It seemed that knowing appropriate yet comforting things to say came easily for me, and I didn’t shy away from using physical touch on my patients. With this knowledge in hand, the rest of nursing school has been different for me. Yes, I’ve had some tough days (and nights!) but I know that every single one of my patients felt emotionally supported, respected, and truly cared for. I know that if I were in the hospital, this is how I would want my nurse to be, too.
Now that I’m at the end of my nursing school journey, I feel confident that I’ve left a trail of cared-for patients in my wake. The unique set of skills that I will always carry with me as a doula can be translated into any area of life, and I am so happy that I don’t ever have to stop being a doula. I am especially grateful that I also had the opportunity to share some of my doula-ness with my classmates. I think some of the knowledge about providing comfort will stay with my classmates. Some of the doula wisdom I’ve shared with my class, which can be translated to almost any patient are:
I’m planning to start working as a labor and delivery nurse this summer, so I will truly get to put my doula skills to use on my patients. But, I also know that wherever nursing may take me, no matter a patient's sex, age, or whatever brought them into contact with our medical system, I will always be their doula.
Amber is a special soul to me. Years ago when I was bringing the first of many DONA-birth doula trainings that my former trainer, Connie Sultana, would offer in Chico, CA, I got a phone call. It was Amber's mom. She asked me questions about doulas, the training, what it would mean for someone like her daughter who had a fascination with helping people and a passion for birth. She passed along that information to Amber, and the rest is history! Amber and I became fast friends although we weren't exactly peers -- me with three kids, and she, college-aged and free! But we had a connection, and we built on that. Slowly we started finding more doulas, bringing Connie back for more trainings, serving families, and creating plans for better ways to serve families. Eventually we helped form Chico Doula Circle. All this time, Amber was set on getting into a nursing program. I moved away, and she got into a program -- and here she is, at the end of that schooling-journey, ready to jump into the world as a nurse! Amber will be an amazing nurse, in any field, although her heart is set on birth. I am so excited for what her future holds!
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 Nicci asked if she could share how the loss of a baby can be in South Africa, I said, sure -- if you have a story to tell, we want to read it. As I began reading, though, I realized I had more questions than answers -- when she said "here in South Africa," she really meant it -- her work as a bereavement doula is nothing like any bereavement doula I have heard about in the US. I needed more clarification to see how things are so different, and what can be done to help change these archaic, thoughtless laws and procedures -- I am pleased to see Nicci is helping to make that change happen.
Except for different room numbers, the two doors looked identical. If you could have peeked inside, you wouldn’t have been able to tell the stories apart. Except for their age difference and the gestational age of their pregnancies, they were just two women waiting to give birth. And they did give birth, almost simultaneously.
Behind Labour Room 1 an 18-year old teenager was unsuccessfully trying to take deep breaths to ease the pain that threatened to overcome her young body. She was experiencing severe discomfort with each contraction, and as I held her hand I could almost feel her pain. Annah (all names have been changed) looked at me and asked, “Is this going to get worse?” I had to be honest because this is the one thing I promise my clients: Honesty. I looked at her and told her that yes; unfortunately it was going to get worse.
Her big brown eyes followed me as I walked around the bed and straightened her IV line. She asked again in a strong, clear voice, “How much worse, Nicci?” I took her hand and assured her that it was going to be painful, but it doesn’t last forever and she will forget the pain. I couldn’t tell Annah that while the physical pain would go away, the pain of the memories never leaves. It would have been cruel in the moment, so I just squeezed her hand.
Annah was a normal teenager who had just finished Matric [final year of high school] and she was celebrating the New Year and the beginning of new things with her friends. What happened is still a blur to her, but she fell pregnant the first time she was ever intimate with someone. It was devastating news. But the news was not as devastating as what they learned around 20 weeks along: according to her doctor, Annah’s baby had severe health issues, his condition being incompatible with life. At 22 weeks, Annah’s baby was going to be born.
Lisa, Annah’s mother, is who I spoke with about this birth. “Lisa, it’s Nicci, I am a bereavement doula and I was told that you want to make use of my services?” With relief in her voice she asked me to come immediately, as they were about to break Annah’s water. I rushed to hospital. After reporting to the nurse’s station, I was taken to the Labour Rooms. That’s when I saw the two identical doors...
When I was first introduced to Annah she seemed a bit hostile, but within five minutes we were chatting like old friends. After a while she told me that she was pregnant with a little boy she was going to name Zach. I was so relieved that we clicked. It is extremely difficult to assist someone who doesn’t want you there! In fact, it’s virtually impossible.
Annah starting talking about Zach’s funeral -- she said she wanted a particular casket and elaborated on her plans. Lisa and I both listened as Annah told us about Zach’s name, his casket and a few other details about saying goodbye to him. Annah was complaining about her contractions again and I demonstrated to her how to breath to make things a little bit easier for her.
I left the room to give Lisa and Annah a moment alone, and as I was waiting in the corridor, I couldn’t help to hear the familiar sound of a baby’s heartbeat in the other room. I could hear the nurse telling the mom in Afrikaans “Dit is nou amper tyd” (It is almost time now), and I could hear the laughter and buzzing excitement. The contrast to Annah’s situation was so stark, my breath caught in my throat for a second and I had to concentrate very hard to not let the sadness overcome me.
Lisa came out and we went around the corner to have a quick private conversation regarding the situation, but after five minutes she received a frantic phone call: Annah was ready to push! I was astonished that this woman went from 3cm dilation to full dilation within a matter of not even 20 minutes. We both ran to the room. We were just in time. The doctor arrived as we got there and the next moment Annah’s agonizing screams could be heard echoing down the labour ward’s corridors, surely made worse by the realization of her situation. Between her pauses to take a breath, I could hear a mini commotion next door as well. Unbelievably, both women were giving birth at the same time. Oh, the irony!
The next moment Annah was screaming so loud my ears were ringing, and with a soft push, little Zach was born. But contrary to the celebrations and exuberant exclamations next door celebrating the birth of a healthy baby boy, in this room there was silence as tears streamed down Annah’s face, Lisa barely coping herself. If pain were a picture, I saw it in that room.
The nurse delivered the placenta after the doctor cut the umbilical cord (and subsequently left straight away) and was gently cleaning Annah up. Lisa was standing with little Zach wrapped in a soft white blanket that was embroidered with a white silk bow. Lisa took the baby boy to his young mommy and I quickly grabbed my camera to snap a few photos. Lisa gently handed the baby over to his mom and I could see a thousand thoughts running through Annah’s brain.
“He’s beautiful. He’s so tiny. Look at his perfect little nose. He is so, so beautiful!” exclaimed Annah. I could feel the pesky lump in my throat returning to torture me, and I swallowed very hard to keep my composure. I took a few photos of him, especially his tiny little hands and feet. I wrapped the baby again and gave him to his grandma. Annah insisted to hold him and she stroked her baby’s forehead.
In South Africa, babies born before 26 weeks without taking a single breath, are considered medical waste and treated as such (incinerated with amputated limbs and used needles.) It is something the Voice of the Unborn Baby are trying hard to change. It is the greatest insult to families, during a time of such great loss, to not have their babies legally recognized. Because of this, a doula like me, who is Still Birth Day accredited and trained in perinatal bereavement, has to complete an affidavit (or assist a parent to do so), basically stating that a placenta is being removed from hospital – we just fail to mention that the baby is attached to the placenta...
The nurse motioned me outside and when I closed the door behind me she asked me when I was going to the police station to have the affidavit completed. I told her that the commissioner of oaths was actually coming to the hospital herself -- there was no need for anyone to go to a police station. She looked unsure of herself and then she asked me where the casket was. I told her it was in my car, but if she wanted to see it I would go and fetch it. She indicated that this was indeed what she wanted, so I quickly ran to my car. Our caskets are beautiful little woven baskets that look like a Moses basket and not like a casket at all, so luckily I didn’t upset anyone with it.
When I got back, Annah was sleeping and the nurse had taken the baby. Lisa’s eyes were red from crying, but she was calm and asked me a few questions, which I patiently answered. Luckily the commissioner of oaths showed up and we finalized the paperwork and chatted a bit about Zach’s funeral. Annah knew exactly what she wanted for the funeral -- I was impressed with how composed she was. I had to fill out a report for the hospital stating that I take full responsibility for the “remains,” and that I will dispose of it lawfully.
We put little Zach in a carry cot, and after saying goodbye to Lisa and Annah, we left. They both confirmed that they had said their goodbyes and that they didn’t need to see him again. In these situations we are absolutely led by what our clients want and we respect and carry out their wishes as far as humanly possible. Little Zach was snugly tucked into a comfy carry cot, covered with his embroidered blanket. He looked peaceful at last.
I so wished those two doors held the same thing inside: beautiful, lively little newborn baby boys. But we don’t always get what we wish for, and that is precisely why I do what I do. Because there is a family facing the unfaceable, because the government makes this even more painful by not recognizing these so-called ‘fetuses’ as babies, because someone needs to comfort, answer questions, and hold the hands of the people going through this excruciating pain – this is why I do what I do…because no one should have to walk through that door alone.
Ever since the traumatic birth of her firstborn, the subsequent birth of his brothers, 6 infertiliy treatments, 3 miscarriages and 1 adoption, it has always been Nicci's dream to make a difference in the lives of bereaved parents. She is Birth and Perinatal Bereavement Doula, and a certified SBD Doula®. Passionate about ensuring families of all kinds have the unique support they need, she is a director at Voice of the Unborn Baby, and also Doulas of South Africa. Nicci is an avid writer and has written many short stories on her experiences as bereavement doula. Nicci also wrote a book about her infertility struggles. Besides being a doula, she is also a professional stillbirth photographer. Nicci believes in the power of encouragement, and in building confident and empowered doulas to make a difference in South Africa. She also believes in dreaming big and working hard. She is passionate about people in general and more specifically about the doula profession.
Nicci lives in a leafy suburb at the foot of the Magalies mountains, in the Pretoria area of Gauteng Province, South Africa.
The parallels of birth and death aren't unknown. They both require suspending judgement, supporting in the moment, and holding space to respect individuals' journeys and nature's timeline. Today's feature isn't as happy and joyful as many others in the 31 Days project, and yet every doula knows endings are inevitable. Hold on to your hearts.
There was a woman who named herself after the mountains where she had communed with other women and wrote poetry. In the end she went berserk with agitation, climbed out of her hospital bed in an attempt to lie on the earth again. We covered her in blankets as her community of friends took turns sitting vigil. Her strong body and spirit would not give in to disease without a great fight. Back in bed, she lasted for weeks like that, feeding off the fuel she had accumulated over a lifetime until one day, the flame burned all the way to the core and released her free at last.
There was a woman quiet and withdrawn, who only nodded yes or no. Yet when a dear one entered and approached, she open her arms to bring them in close. Her adult children had lost a father just two years before and her illness had mostly been a secret, a failed attempt at protecting her loved ones from pain. All we can do is be there to support and minimize suffering. The existential journey is their own. At a time when one can no longer deny death, loved ones gather with tears and smiles for all the healing that can finally begin. In the end, friends and family gathered in the chapel to acknowledge and honor her life. Then came a parade of flowers our way, grandiose bouquets perking up the solarium.
A volunteer angel drops in every now and again, effortlessly singing A cappella, opening the portal within the spirits of the dying, attempting to free them of blocked emotional meridians and move them forward on their individual path, on the labyrinth of existence.
An emaciated woman already a skeleton slowly turned to look at me and offer a weak smile, appearing to wonder about my treatment or judgement of a lifelong multi-drug abuser lying on her death bed before she was even old. She is estranged from all family. I offer reassurance that she will be cared for with kindness and respect. She replied "thank you". I suggest that she has experienced a lot of trauma in her life. She replied "scary". Perhaps at birth, or in the mother's womb, she was already addicted. Maybe now, in a time as vulnerable as birth, she can finally just receive love and care without having to do anything to earn it. She seeks to have her pain and anxiety resolved, just like any other human being. And in a couple days, after a week hiatus in the desert, I will return to this work, wondering if she survives still. As a death doula, I will either care for her with kindness and compassion, or if she is gone, I will care for the others who come next to this house.
It's no surprise to me that Christa's heart holds room for these monumental bookends we call the beginning and the end. She and I had the pleasure of meeting years ago when she moved to Chico, CA as a birth doula, wanting to connect. This was serendipitous, and she, four other doulas, and I went on to create the Chico Doula Circle. Christa was planning to attend nursing school in New York as soon as she had all her pre-requisite classes. Knowing her passion for mothers and babies, I was surprised to learn she was working as a nurse in a hospice home. She admitted she didn't imagine herself there -- life brought her to serving those on the other end. She holds a reverence for nature and its ways, and I know she is right where she needs to be.
What a pleasure to feature Yiska's piece on self-care! The longer I stay working as a doula, the more I realize the value in taking care of me -- and it seems to get harder each passing year. As a new doula, I bounced back from births more quickly, feeling like Super Girl. Now I drag myself around for a couple days as I try to fit back into the pace of my (still-running-around-me) life. Yiska has a gentle heart that is bursting with ideas and eagerness to help not only birthing families, but also those who support those birthing families.
The topic of self-care is an essential one for any care-giver. As doulas in particular, we’re always telling our clients to make self-care a priority, but do we listen to our own advice? There are some obvious and some less obvious ways doulas can take good care of ourselves. The following are the top 4 areas, in my book, for doula self-care…nourishment, body posture, recovery practices, and emotional self-care.
Packing healthy nourishing foods for births and staying hydrated is priority number one. Some great portable meal and snack ideas include protein bars, hard boiled eggs, yogurt, a thermos of bone broth or other soups, homemade nutrient dense smoothies, fresh fruits, trail mix, coconut butter packets, almond butter and jelly sandwiches, etc. A helpful tip here is to avoid peanut butter because it’s such a common allergen and keep stinky foods tucked away.
Emergen-C packets are a great way to keep your immune system boosted and I started mixing mine with CALM magnesium packets as well. Some use magnesium to help them sleep but the reason it works for that is because it calms the nervous system. I found myself feeling way less strung out and more grounded as a result of adding this to the mix. Both powders dissolve in water and you can nurse the drink anytime throughout the birth.
Bottom line is, staying hydrated is key to sustaining our well-being. Whether you’re a coconut water lover or into the vitamin c and magnesium mixture, keeping your own water bottle nearby will help ensure you don’t end up dehydrated, just like your clients. Hospitals are notoriously dry too!
2. Body Posture
When I first started doula-ing, I would get myself into all sorts of contorted positions trying to support my clients. Part of the reason I teach comforting touch for birth the way I do is based on what I’ve learned over the years around taking care of my own body even while I serve my clients.
Now, if I get twisted up trying to support a client, after the next contraction, I make sure we all adjust our positioning so I can face their back or hips head on, without compromising my own well-being. There’s always a way to find a win-win, but we need to be willing to include ourselves and our needs as well. It doesn’t have to be us or them.
One of my biggest tips in this vein is to use your body weight when offering comforting touch. Rather than muscling your way through a counter pressure or massage technique, lean your body into and onto your client, taking advantage of gravity. This approach tends to feel more enveloping, intimate, safe, warming and less effortful, all adding to the comfort value.
Watch this video from my Comforting Touch for Birth guidebook as an example of how to adapt your double hip squeeze so you’re straining your muscles less and leaning in more. Both you and your clients will appreciate the difference.
3. Recovery Practices
Taking time for recovery after a long birth, double-header or simply being up all night is crucial to keeping up with this work and life in general. Some approaches are as simple as a healthy meal, a bath or shower and a long, uninterrupted sleep. If you’re still on call, look into ways to program your phone to ring only for your “favorites”, and put those clients on that list. I also turn my text tones off and let my on-call clients know they must actually call me if they need me. This way I’m not woken up by unnecessary text message notifications.
The biggest thing here is to be kind with yourself and allow yourself the time it takes to recovery your energy and catch up. Some births will be more taxing than others. Many doulas feel the time they need to recover increases over time, so adjusting to what we need as we need it often takes self-compassion as we adapt our expectations. Just as you’d advise a client to be gentle with themselves postpartum and relax expectations, we could use the same advice in the days following a birth.
Additional practices I’ve found helpful in the days following a birth including getting a massage or acupuncture, taking a yoga class, a trip to the local Korean spa, and a magnesium float. Just like it helps to calm the nervous system when you drink it, flotation or sensory deprivation tanks can be found in most major cities. The intense concentration of magnesium salts makes you float while you rest for an hour in a dark, sound proof room, as if in the womb. I can’t think of a better way to recover from a birth than going back to the womb!
If any of these fee-based recovery practices appeal to you, the key is to budget for them just as you budget for childcare or travel expenses and include the cost in your doula fee. Self-care is including ourselves in the equation of care financially too.
Finally, for a great restorative exercise, visit my blog post on constructive rest here.
Emotional self-care is just what it sounds like. As we mentioned above, being kind with ourselves both after as well as during births is one way to care for ourselves. Doulas are drawn to this work for many reasons, but at the crux of it all, we care. We care about women and we care about birth. Sometimes, when there’s only so much we can do, it can be hard to accept the things that lie outside the realm of our care, responsibility, experience-level, or control. Births can stir up a lot.
Making time to talk about our experiences with friends or colleagues is often helpful. Whether we’re feeling uncertain about something we did or traumatized by something that happened, expressing it will always lighten the load. Journaling is another great way to process the emotional content of births. However we do it, giving ourselves space and time and permission to feel our feelings is hands-down one of the greatest acts of self-care there is.
I hope these suggestions help you add a few new things to your self-care tool-box or simply serve as a reminder, so you can continue to do your work feeling healthy and strong. You deserve it!
Yiska Obadia-Gedal is a proud, been-at-this-for-more-than-half-her-life massagapuncturist, oxytocin-fiending, Comforting-Touch obsessing, doula, wife, friend, writer, teacher, rockin’ Moroccan, dance-loving, wannabe-mama and one of the world’s best huggers (or so she's been told)! She has trained in Israel, China, Maryland, and New York, but calls NYC home.
Yiska is the creator behind Comforting Touch for Birth Workshops and the subsequent guidebook -- a comprehensive curriculum for doulas and expectant parents. These resources are designed as tools to give partners and doulas confidence, skills, and ease in offering hands-on labor support, regardless of experience level.
"Birth is one of those rare life experiences where power and vulnerability live side by side. That is all! To touch that. To touch others who touch that, is my great pleasure and honor."
Seeing mom working so hard to bring their baby out? Making noises that seem more appropriate coming from a howling monkey instead of a human? Watching things that maybe one has only seen on Discovery Health Channel through half-closed eyes? The blood, sweat, and tears of it all? Does that answer your question?
Birth is an amazingly transformative event in the life of the family. As a doula and an educator, of course I relish in the whole thing and view baby's emergence as a spiritual experience unlike any other. I am comfortable with the noises of labor and the sound of hard work -- the music which accompanies this great act. Not everyone is, though, and not everyone feels sure about the birth process and the safety of their partner, the laboring person.
My husband and I have been married 21 years. On our 11th wedding anniversary we found ourselves seated across the table from each other at a Chinese food restaurant. At this point we had three of our four boys, the youngest just a year old. I decided to start the conversation.
"I want us to think about our time together, and take inventory of our relationship, our family, and our lives." My husband suddenly looked like a he walked into a pop quiz. He didn't look eager to answer my probing questions. I was joking, but this did lead to one question that had been on my mind lately: "Well, answer this for me -- did you enjoy being at our babies' births, or would you have rather waited outside until it was over?" Being a birth-lover, I knew what answer I wanted to hear -- did I have it within me to hear the other answer, too?
"Honestly, I would have liked to come in when it was all over." I did kind of know this, I don't know why I was expecting to hear that other answer. I love my husband, and to his credit, he never left me needing or wanting more during labor; coupled with my doula's support, he was my main pillar of strength. I know he appreciated my doula's way of caring for me, of anticipating my next whim, of comforting not only me, but also him.
The realization set in that labor and birth is not everyone's cup of tea.
I have seen partners, unsure in the beginning, actually put a glove on and check Mom's cervix (with the help of a wonderfully encouraging midwife). I have seen a dad be the first to touch his baby's little head as it peaked ever-so-slightly out. I have even seen a baby tumble out into a dad's strong hands. But a partner does not have to do any of that to be involved and to show his or her love for the laboring person. Hands are important, but the location of hands is not. Hands on hair, hands on forehead, hands on back -- hands on hands -- can be accomplished by a birth partner at any comfort level. Touch is the goal -- touch and loving words.
In my husband's case, he held my hands during the most intense parts of labor, and he encouraged me with his voice; sterile gloves were not needed for either.
♥ four young boys and a boy dog (offspring)