Almost as soon as I got the positive pregnancy test with my third baby, I started having panic attacks. I would wake up, anxious and scared, from a dead sleep. This was a surprise pregnancy that I did not plan. In my mind, the timing wasn't right.
I dealt with these panic attacks as best I could. They came in the day and in the night. When I found myself begging my husband to come home from work and help me cope, I realized I was dealing with more than just a little bit of scared feelings.
I opened up to my midwife. Being a doula and childbirth educator in the community, I felt utterly embarrassed to divulge my secret. Even though I could tell other women this was a common struggle pregnant and postpartum parents experience, I still held a deep shame that I did something wrong, that I made this happen: I felt this was my fault. Despite having a negative bias against medications used to treat emotional health issues, I must admit I was hoping my midwife would have some magic pills for me.
Instead of medication, she offered me coping strategies to move through the panic attacks. I had a ritual I was already embracing -- I would move to the recliner and begin rocking. I had a paper fan I would use to cool myself down. The TV would turn on to some benign TV show I could have to focus on, or just use as background noise. I had a blanket nearby for when I inevitably would cool down and get cold. As most of these occurred at night, I would rock and fan myself. Soon I could stop rocking and recline back into the chair, putting my feet up. Next would be the blanket, until finally sleep would come. The whole process took about an hour. My midwife offered me strategies to shorten this process, and over time, it really seemed to work.
When I say I shared with her what I was feeling, I have to say I half-shared what I was feeling. Like a half-truth, I didn't tell her the full extent of what was going on in my mind. So while my panic attacks got better, I was living with a daily truth that caused me worry without end.
I said this was a surprise pregnancy. My first two babies I planned. In my "perfect timeline of life events," I thought we would wait longer before adding a third child to our family. I spent a lot of time feeling sad about this accident. I got to the point where I was afraid to be happy, because in my mind, that was opening the door to fate -- I would be punished for my bad feelings and something would happen to my baby. I had this mental math equation in my mind always, and this is what it looked like:
I did grow happy about this new baby, and my panic attacks stopped being so present. And sure enough, as excitement and joy built up inside me, so did the knowledge that something was going to happen to my baby. My everyday reality told me, he would not be born alive. This is a hard fact to live with, and this is what I never shared with my midwife.
At every check-up, I would search my midwife's face, looking for clues she knew something was wrong. I would dwell on random words she chose, or mentally extrapolate on nil what-if's. Alone with him in my belly, I waited, knowing someday those swirling movements and gentle rumblings would stop and my reality would be borne out.
Today is November 11, 2018. Twelve years ago today I stood in my kitchen as silent tears mixed with soapy warm water, convinced sometime in the next 14 days my baby, not yet born, was going to die.
That never happened. My 12-year-old just got out of the bathtub (ordered there under threat of me scrubbing his dirty feet myself). Right now he is getting ready for bed.
Nothing happened to him in those two weeks. So what happened to me?
Cognitive distortion. There are many cognitive distortions we humans fall prey to, and the one I was living with was "emotional reasoning." Pregnancy is a time when hormones make many changes in the body, and these hormones can also make changes in the mind. In my situation, my hormones ramped up my anxiety and fear, and I interpreted these feelings as fact -- they were my truth. And I lived with them, alone, everyday for 9 months. I never told a soul what my mind was telling me.
It makes sense that hormones would influence us to prepare to be parents -- to collect together the things our babies will need, to secure a safe place to birth, and to confidently care for our little ones once they are here. Sometimes these normal feelings go into overdrive. Of course we fear something happening to our babies when they aren't near us, but needing to check on them over and over and over -- to the point that it is inturruptive to other activities -- is a normal feeling gone into overdrive. Babies come with lots of "gear," and no one wants to be caught away from home without a spare bottle or a diaper -- but choosing instead to avoid leaving the house at all, citing this as the reason why, could be a normal feeling gone into overdrive.
Cognitive distortions can come hand-in-hand with anxiety and depression. I encourage you to check out the link above for excellent information about how these look and what they do. Weekly I hear from pregnant or postpartum (which means after the baby, it's not a specific mental diagnosis) parents who are reaching out for help. Just today I had a conversation with a former doula client, friend, and new mother telling me she has finally recognized she is stuck and she cannot fix herself alone; she made an appointment to see her doctor to start the process of meeting with a therapist.
I cannot say how much strength this takes -- to reach out to someone! It can feel like the hardest thing in the world to do. As a Volunteer Support Coordinator for Postpartum Support International, I try to link families to resources. I am not a counselor or therapist, but I do have a listening ear, and I care about what families are facing. I believe PSI's mantra: "You are not alone. You are not to blame. With help, you will be well."
We hear so much about "postpartum" mood disorders, but these can actually occur during pregnancy. In fact, they do so at a higher rate. While the graphic above states 1 in 7, during pregnancy it is actually 1 in 5! Have you heard that before? I would guess sometimes mood issues in pregnancy go ignored, and then are labeled "postpartum" caused when a person shares them with their doctor or therapist after birth.
Keeping my secret was not positive in any way, shape, or form. It held me in an alternate reality where my mind was free to ignore the facts and instead, formed around emotions. Shame kept me from confiding in my very-trusted midwife. I know now she would never have wanted me to be stuck in that place alone. I know, too, she would not have blamed me in the least.
But I was afraid to tell her because then, my emotions told me she would judge me, and that judgement would last forever.
You are not alone.
You are not to blame.
With help, you will be well.
It's not easy, I know. And you can feel so much better than you feel right now.
When someone says, "At least I have a healthy baby," how do you interpret she feels about her experience? Birth is a transformative experience, and women can be transformed for the better, or for the worse. How can we, as doulas, help support someone who has had a traumatic experience? Abby gives excellent ideas which remain within our scopes and roles as doulas.
When you look at the probability of trauma in the course of a woman’s life, the statistics are high. One in three will experience sexual abuse in her lifetime, one in four will perceive her birth as traumatic. So, if you’re a childbirth or postpartum professional, you are regularly working with women who have experienced trauma. And keep in mind: a woman who has previous trauma or a history of abuse has a much higher chance of being triggered in birth and experiencing trauma again.
What is birth trauma? It’s all about perception. When a woman perceives her birth as traumatic, she has felt one or more of the following in an intense and damaging way:
Birth trauma will have immediate effects on a woman and change her experience of birth, postpartum and motherhood. As birth professionals, our goals are to prevent birth trauma by providing support, information and guidance for laboring Mamas. Some of the things you can do during your time together are build trust, tune in to Mom’s behaviors to establish safety in the labor room, and speak to her in a calm, affirming voice. But unfortunately, we can’t always prevent birth trauma.
Women who have experienced a traumatic birth can develop PTSD (posttraumatic stress disorder). It can be misdiagnosed as postpartum depression or anxiety but the symptoms are actually different. Some signs of PTSD in a new mother are:
There are some important things to keep in mind when dealing with a Mom who has birth trauma. Your support will be critical to establishing safety, support and eventually healing from this difficult time.
Here are some things you can do to support a Mom with trauma
The exciting and encouraging thing to hope for is what’s called post traumatic growth. With proper self-care, nutrition, sleep, and exercise she will begin to feel better. Suggest to her that some women find healing through yoga, body work, trauma therapy and groups. Post traumatic growth provides women the opportunity to heal from trauma and become stronger, wiser and more compassionate because of it. With adequate support, education and care, new Moms can fall in love with their babies and leave the shame and pain of trauma behind.
Abby Bordner’s background is in medical settings, community education and entrepreneurship. She currently has many online and in person projects for the non profit sector and her private business. She is a Cappa Doula Trainer, Labor Doula, and Lactation Educator. She is a certified ICEA Childbirth Educator, as well as an author and entrepenuer, creating such projects as Yoga Born, Birthing Tree Cooperative, Relationship Based Parenting, and Modern Motherhood. She travels around the US providing certification training for future Cappa doulas, and Yoga Born Childbirth Preparation classes – trainings for prenatal yoga instructors which integrate yoga and childbirth education.
I am a lover of doulas and what they do for families. We need to hear how we are doing, how we are being perceived, if we ever want to improve! When we get those bits of negative feedback, it is an opportunity for us to change and be better, not shrink and get resentful. We are all just people, trying to do the best we can. Communication is an important piece of the doula-client relationship -- the more we can communicate, before and during a birth, the better satisfied we can all be.
I hate to be Debbie Downer, that is not in my heart at all. I hired a doula for what I thought were realistic reasons. Like so many others, I read the statistics: shorter labors, lower uses of epidurals, happier feelings after the birth; those were the ones that stuck in my mind. I just didn't expect things to go the way they did, and when they went, they went fast. I felt like my doula went along with that, while I was left behind feeling alone.
I know one admirable quality of any doula worth her salt is good working relationships with the nurses and doctors at the place of birth. I was impressed by the stories I heard from my doula, the goings out to lunch with nurses, the sittings next to doctors at conferences. I will admit, it made me feel like she integrated well into the hospital process. What I didn't expect was that she might need to maintain that balance. When push came to shove in my situation, I did not feel she was with me, on my side. I felt like she was on their side, and it was her job to get me to feel good about coming to their decisions and preferences.
In a way, this was the beginning of the isolation. I had heard hospital doulas who are provided by the hospital or volunteer/work for the hospital sometimes have a hard time being neutral. I did not worry about this, because my doula was independent and nonaffiliated with the hospital. She did have a family member who was high ranking on the infrastructure of the hospital board, but again I saw this as a bonus, not a deficit. In reality, I think it aligned her with the hospital's way of doing things. It made it seem like her job was to help me buckle to that agenda in a less threatening way than if it came from a staff member.
I had a complication when it came time to push. Suddenly I was being rolled over, yelled at urgently, and told to push, even without a contraction. Extra people came rushing into the room. I was hearing all kinds of instructions at once. I closed my eyes and tried to do what they told me. My husband was no where to be seen or felt. My doula was also lost in the haze. I had no clue what was happening. I needed the tiniest bit of an explanation. The one person I would have expected this from was not there. My doula.
After the baby came out there was an audible sigh of relief. She was taken to a flat table to be given air and make sure she was breathing like she should. I felt the smallest touch from my husband's hand, and I wanted to gobble it up and have it take me away. He was scared too. We watched as our baby was being poked and prodded, mask on her face, lights flashing and alarms beeping. I looked for my doula and she was talking to the nurse about how frightening that was, and how she was sorry the nurse had to get up on the stool to help move me because the nurse was pregnant.
I could have used the emotional support my doula was giving my nurse.
It took a while before anyone explained what happened. It took even longer before our baby was brought to us. I felt pretty insignificant. I felt alone and afraid. Soon after the bustle in my room went down and I was considered recovered, my doula announced she needed to go move her car before her meter ran out. She said she would be right back.
"That's ok. I think we are ok now." She looked at me with a puzzled expression. "But the baby isn't back from the nursery. Do you want me to wait and see if we can get you nursing?" I let her know I was really tired, and I would ask for help from the staff if we needed it. She came over, gave me a hug, and said, "Thanks for having me as your doula."
Really I just felt sad. I felt let down. I wanted more mothering, and I got what seemed like a bubble gum teenager who was only with me until the cooler kids came (her friends at the hospital). I am not writing off doulas forever. I still can't deny those statistics. But next time, I am going to ask different questions, and remember to be impressed by different answers.
Lindsey is a high school math teacher and new resident to Harrisburg, Pennsylvania. Her husband, daughter, and Shar-Pei, Bluto, are expecting the arrival of a new baby around Thanksgiving. She is just starting to reach out to potential doulas.
Veronica's piece reminds me of a quote I received from a dad: "Hiring a doula was the best decision we made. It turned out to be way more important than what color we painted the nursery, what kind of crib we got, or cloth or disposable diapers. Stacie helped us so much the day Joshua was born. Whoever you are, wherever you are, unless you have had 16 kids, your mom's a midwife, and you're an obstetrician, you need a doula (and maybe even if that does describe you, you still need a doula!)." As doulas we recognize partners are in all different places, and the ability of a doula to make up the difference is her unique addition to the birth team.
This month is International Doula Month, and as such, I’ve been thinking about what I really wanted to say about doulas that I maybe haven’t said before. There have been a few interactions I’ve had lately that really got me thinking, although this is nothing I haven’t thought about before or even mentioned in classes.
We expect FAR too much from dads during birth.
So, here’s the deal:
Back in the day, like 130 years ago or more, when a woman went into labor, the local midwife would come into her home. The mom’s female friends and family would come to help– they would prepare her a birth space, soothe her, help keep her fed, hydrated, and reassure her. Birth was a normal part of life, something that most woman would be familiar with long before it came time for them to give birth as well.
I’ll say this again: Birth was a normal part of life.
The role of a birth doula is to try to bring into the picture those women who were very experienced when it came to birth. Unless you’ve been around a couple of women as they give birth before, birth is a pretty weird process that no amount of videos can ever prepare you for. So while I’m not saying we should go back to the time when it was considered “improper” for men to witness births, I’m saying that the idea of a partner having to bear the responsibility of caring for emotionally and physically supporting a mom through birth is unfair to everyone– it’s unfair to the partner, it’s unfair to the mother, and it’s unfair to the baby.
We have mounting evidence of dads (there is no info out on same-sex partners) experiencing PTSD as a result of being at the birth of their babies. Even if there aren’t ANY complications, while we should try very hard to prepare partners to be active participants at birth, there’s nothing to really prepare anyone for the twists and turns of birth. Doulas can’t predict how a birth will go, but they are prepared to walk the journey with families, no matter what that ends up looking like. Doulas provide that reassurance to EVERYONE during the process, no matter what, helping reduce trauma.
Doulas aren’t emotionally attached, nor do they have to bear the responsibility for the medical care being provided.
Hiring a doula isn’t a value judgment on the state of your relationship; in fact, having a doula can help provide the space and time for those critical moments during labor and birth that can bring couples closer together.
Hiring a doula will not take away from a partner’s role at birth; having a doula present will give him more confidence to be involved in a way that he’s comfortable with.
Hiring a doula means that the laboring mother will have what’s very biologically normal– the care and support of an experienced woman who will stay with her through the whole process.
Hiring a doula isn’t a luxury. Hiring a doula should not be a status symbol. Hiring a doula should not be political. Hiring a birth doula is a logical, critical, SMART choice that can help ensure that no matter what happens at a birth, everyone in the room was able to benefit from the professionalism and reassurance and care that a birth doula provides.
I believe in birth doula care SO MUCH that I have created a non-profit that, in addition to providing mental health services, provides doula care on a free and sliding-fee basis.
Hire a doula. It’s important.
Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE, Owner, BabyLove, Executive Director, The BabyLove Alliance, Ltd.
Veronica started with a B.A. in English and a Certificate in Asian Studies from Saint Anselm College in Manchester, NH. After the birth of her daughter, she attended the training to become a doula in November 2006, and became a certified doula through DONA in August of 2007. Veronica was so in love with helping families with birth that she became a Lamaze Certified Childbirth Educator in December of 2007. In April of 2008, she trained to become a Certified Lactation Counselor, and earned the designation of a CLC by the Academy of Lactation Policy and Practice. Veronica taught childbirth, breastfeeding, and sibling classes at a small hospital in Rochester, MN. She has also worked as a volunteer birth doula and still provides support to mothers who are experiencing a suspected miscarriage through a local hospital program.
“I take great joy in helping mothers with traumatic or disappointing birth experiences that require extra support and understanding, and I love to help every family through this wonderful journey!”
As doulas, we must plow through and process our own birth experiences -- and those we have grown up hearing -- before we are able to help other women face theirs. Although Denise is not technically a doula, as a counselor, she surely has felt this weight. Her thoughts and experience on this are too valuable not to share. It is our responsibility, as doulas, birth workers, and professionals serving women, that we take the time to process our experiences of birth or they can easily get in our way, making themselves known to all those we try to help.
I had all the tools I thought I needed to overcome my fears, my doubts, and my worries about my first child. I researched everything I could about natural birth. I enrolled in an expensive birth education class, and, obsessively, I read everything I could get my hands on. I was determined to make my birth different from what my mother experienced. I would be the natural-birthing, breastfeeding, attachment-parenting warrior I often criticized my mother of not being.
To be fair, my mother had the chips stacked against her. She was from Puerto Rico, spoke very little English, and had little support from my father. A mixture of mental illness and lack of family support made for a scary experience bringing her first child into the world. When my mother told me my birth story, it was filled with fear of the unknown, being in horrible pain, being drugged and knocked out for the “main event”, and ending in my mom only having vague and indistinct memories of the process of my arrival. “This will NOT be me!” I declared triumphantly. But inside, the fear turned over and over in my stomach. I rehearsed my birth plan in my mind and told the father of my children to do the same. As a therapist in training, I was engaged in my own therapy, and discussed in depth with the therapist my fears related to the baby. My therapist gently reminded me that I was not my mother, and that I was not doomed to repeat her mistakes; but the ghosts of my mother’s “not-so-perfect” birth lingered inside of me. What if things didn’t go as planned? What if one of my choices caused me to experience exactly what my mother had been through? I couldn’t enjoy my pregnancy fully thinking about the potential hazards that may or may not lay ahead.
Anxiety can suck the life out of you. Worse yet, many people fail to understand how a person suffering with anxiety feels. Hearing someone tell you, “Oh, stop it”, or “Just stop thinking about it,” or my personal favorite, “Relax!” can actually cause more anxiety. Anxiety disorders can cause distressful emotional and physical symptoms, and can be severe in intensity. It can range from a general uneasiness and worry that won’t go away, to feeling an intense amount of fear that causes you to believe you are going to die. With the ebb and flow of feelings one has during a pregnancy, anxiety can be easily exacerbated, especially if you have struggled with it in the past.
After the birth of my daughter, I was severely traumatized. Things did not go as I had planned. My midwife and husband stood by me as my “perfect birth plan” unraveled. I got an epidural after 2 days of slow labor at home, followed by Pitocin at the hospital. After my baby was born, the doctor cut the cord right after birth, and I didn’t get to hold the baby very long after she was born. Then, my uterus would not contract and the doctor had to manually and painfully stop me from bleeding out. I almost died giving birth; after the birth, the thought of this would not leave me alone. Looking at my baby would cause a wave of fear to flow through me, and I fought tooth and nail to keep close to her at every moment. Truthfully, there were times I wanted to be away from this “little reminder” that everything I had planned went wrong, and I had almost lost my life because of this. I felt a tremendous amount of guilt because I blamed myself for what had happened. My dark fear was that I had missed out on attaching to her, just as I believed my mother had.
To add insult to injury, I tried to get my daughter to breastfeed; after days of trying on my own, I tearfully gave her a bottle full of formula. I must have cried every single time I filled that bottle with formula for at least two weeks after that day. After all that planning and prepping, I felt the ghosts of my mom’s “not-so-perfect” birth were haunting me. I started berating myself; telling myself I had failed. I would look at my child every feeding and think how much of a failure I was, and how much she would suffer because of it. I imagined gloom and doom for both of us, because I had not achieved the perfect birth.
Weeks later, in therapy, a thought struck me. What if the “not-so-perfect” birth could be a way to exorcise the ghosts from my mother’s experience? If I made an active choice to walk a different path after the events I had been through, maybe the ghosts wouldn’t control my emotions and actions the way they had for my mother. Instead of living in fear that I had done some incredibly damaging things to my child, maybe I could believe that despite the “not-so-perfect” start, I could have a “pretty-damn-awesome” motherhood. Maybe I could learn to hear the ghosts’ voices and gently reply, “Even though I hear you, you will not be as loud as before, and I don’t have to follow you.”
I won’t pretend doing that was easy. It has probably been the hardest thing for me to do in my life, and still have to do it every day. Because wish though I might, the ghost lingers. Albeit a whisper, it is there. I don’t believe it will ever go away. What I do know is, it no longer holds me the way it once did. I faced the nightmare and the fears it contained, and it served to birth a stronger, more vibrant birth story for myself and my daughter. Not one of being a victim to circumstances, but one of taking adversity and transforming it to fit my life, my vision, and my version of motherhood.
Two years later, I found myself in the same situation, ready to give birth to my son, with a plan in hand; but this time I held the loving intention in my heart that “even if things don’t go the way I plan, the birth will still be good.” I cried as my midwife told me we couldn’t have the water birth I wanted, and as I got the epidural and Pitocin once more, I grieved because I knew this was my last child, and my vision of a “perfect birth” was lost. The voices rose up in a chorus, yelling to me of impending doom, and of critical insults; but I moved forward. My son, to everyone’s surprise, was born in the caul, which brought many a nurse out from behind the nursing station. My midwife exclaimed that this was indeed a special birth. “Take that ghosts!” I thought to myself.
Since these events, I have felt a pull to work with women who have been through similar situations, and describe the birth of their child as traumatic. Some have a great sense of fear surrounding their upcoming birth because of what they have heard about birth in the past. I hear them filled with resentment towards well-meaning people who, trying to help, do more harm than good by minimizing their fears or telling them to “relax.” They suffer silently at times, not wanting others to call them crazy, and they feel a deep sense of shame, guilt, regret, pain, worry and fear when things don’t go exactly as planned. Birth can be a wonderful, orgasmic, enjoyable, life changing event for most. It can be a traumatic, scary, life changing event for others. In my opinion, no matter what the circumstances around the birth are, it is life changing. You have the choice of how you will move through the events that shape your birth. The ghosts of the “not-so-perfect” births of our mothers, our sisters or even ourselves may try to lead you down a dark path, but remember the steps you take regardless of where you are on your walk into motherhood are yours to take. And if your birth was “not-so-perfect”, there is support, counseling, and a sisterhood of other women out there that have heard the ghost’s voices, and can help you lower the volume to a whisper.
So, how do you transform a “not-so-perfect” birth into a “pretty-damn-awesome” motherhood? It’s a long journey. It’s a different journey for everyone. Some women can say they walk it on their own. Others need to walk with a professional counselor. Some need medical interventions, natural or pharmaceutical. Some need to process the past, and learn to live in the present. Some must come to terms with the trauma they survived and walk a path towards healing. None of the paths are easy or short.
You may be trying to keep positive, and I encourage you to hold that warm intention in your heart for your birth; but if outcomes don’t occur as planned, the ghosts of trauma, guilt and shame may be screaming in your ears. Instead, voice the fears but welcome the possibility that things will go well. Hold the possibilities of the good and most positive birth experience possible while holding the knowledge that what will be, will be. Most of all, love yourself and accept the birth for what it is – a transforming, movement into motherhood full of excitement, joy, hardship, disappointments, courage, strength, awesomeness, sleeplessness, feminine power and a little of all of the above – regardless if it is an ideal birth or a “not-so-perfect” birth.
Denise Varela, a Licensed Mental Health Counselor in New York, has been in the field for over 14 years, and has worked with clients from infancy to age 101. Denise is the founder of Nurture We, a team of professionals who desire to help women find the fun in life again in easy and healthy ways. Nurture We is dedicated to providing classes, blogs, life coaching and counseling on mental health and related issues. Denise understands depression, anxiety, stress and other issues drain our joy and our childlike desire to have fun. When we address these issues, we can take back what we were born with -- the ability to enjoy life through its ups and downs, acknowledge all of our feelings, and still have fun in our daily lives! Our joy and laughter and fun will be contagious to those around us and our loved ones will be nurtured by our well-being.
I love how Liz is thinking outside the box here. She truly shows the progress in her beliefs as life has shown her more. As doulas, it is pretty easy to become disenchanted with doctors -- on a surface level we see and hear things -- and often judgements are held. Liz's world shifted when she looked deeper into the issue to see what women physicians face. Think of what it might be like if these physicians were offered physical, informational, and emotional support during the child-bearing year? And how it could help to improve not only their health, but also the health of those they serve?
It is okay, stay with me. I know you are saying, what? Why would we talk about Doctors during doula month?!!? Doctors are the reason women need doulas in the first place! I would agree, wholeheartedly, that women need doulas, in part, to help navigate the maternal health care system. But I would also agree that part of the reason that women need doulas is that doctors desperately, desperately need doulas too.
I became a doula nearly 14 years ago in my twenties, and I’m not going to lie, I didn’t last long. I had some births that resulted in healthy babies and the mom was…not disabled at the end of it. Even with a doula, these moms did not receive mother-centered care. For a long time I thought I was just unlucky to get some bad birth situations, but now I know, they were all pretty routine. A male doctor telling me in the middle of a baby crowning that most women urologists would much prefer to have Cesarean births because it preserves the pelvic floor (is this really the time? While this patient is purple pushing her baby out in a lithotomy position that only benefits you?). That time the doctor was in tears because she had agreed to induce at 37 weeks because winter holidays were coming up, and no, to keep it short, it didn’t go flawlessly. I don’t doubt she was crying because she was tired, and maybe a bit raw, and dismayed that the baby needed resuscitation and extended procedures to make the transition to independent breathing. And yeah, her medical malpractice insurance was about to get tested. I certainly had views on the doctors in these births!
So in my thirties I went to school for a Masters of Public Health with the goal of changing birth outcomes through public health, and if that meant throwing the doctor out with the bathwater, so be it. It was no more than they deserved for being such out of date, out of touch jerks.
But now I’m in medical school in my forties. I see classrooms nearly half full of 21 year old women being called “Guys” by every lecturer and attending, being erased by every lecturer and attending. I see course curriculum that includes nothing on breastfeeding, and when asked a question about normal breastfeeding, an obstetrician says she knows that answer because she has breastfed for three months! Not because as an OB she has extensive and comprehensive training on breastfeeding (they don’t get any), but because she has beaten the odds as a breastfeeding physician (66% of physician mothers do not meet their breastfeeding goals, most don’t make it to three months). She is also the one that told the class vaginal delivery was a procedure done by a surgeon.
Physician mothers have nearly a two-times increased relative risk of birth complications, because they are doctors, and if anecdata is anything to go by, can anticipate having every medical intervention in the book -- evidence based or not -- thrown at them (perhaps accounting for that increased risk?).
After birth? For the 30% of women residents that are pregnant, they have minimal leave; it may be paid -- or not; they may get to finish the program on time -- or not. There is no required minimum maternity policy for residencies. Even if leave is allowed, many won’t take the whole of it because pregnant physicians are considered a burden on the residency program by attendings and male residents. Most are expected to return within six weeks, if not sooner. Maternity leave for practicing doctors isn’t much better. On paper they may have 6 weeks of paid leave, but in reality? Maybe their partners have made it clear that the business will not tolerate that much time away. Don’t even think about taking time to pump! Their employees and staff have better maternity leave.
So get to the point already, you say, why am I advocating doulaing the doctor? Because if ever there was a group that was high-risk for all the bad outcomes of birth and postpartum, while simultaneously seeming to have all of the protective factors, it is women doctors. They set out to become doctors when they are 18, start medical school at 21, and spend the next 4 years being erased as women and indoctrinated into the medical system's way of maternity care. They often have minimal exposure to safe alternatives to standard medical maternity care because of their training, and even if they want something else, the systemic pressure on them is nearly crushing. They are shift workers as residents, they have no protection under the law for breastfeeding because they are salaried, and sure, they have lots education but also lots of debt and not much income. If they are part of a private practice, they struggle to balance breastfeeding and bonding time with the need to go back to work immediately in order to become a partner and thus-financially secure.
And yet they do not utilize doulas, because they KNOW about birth, they’ve been TRAINED, their OB is the BEST, the nursing staff will help. The research is pretty clear on this too -- doulas improve birth outcomes, increase breastfeeding rates and reduce postpartum depression. Also, research tells us that doctors are frankly the worst patients in the world, because they are doctors. They literally refuse to ask for help because they shouldn’t need it, they have the training, THEY know what to do. So a high-risk group that would clearly benefit from doulas isn’t using them, doesn’t realize they need them, and I’d like to see that change.
Great, so I want to see that change. What is the big deal if they don’t use a doula? Most women don’t. True, although that is changing as doulas become more available and the research on their benefit expands. But the big deal is this: Women physicians have the highest suicide rate of any profession, 250% higher than the rest of the population (men physicians are 100% higher than the population rate), and 400% higher than women in other professions. We are doing something so profoundly wrong in our profession that women who should be healers and leaders and colleagues and parents are killing themselves.
Suicide has many causes, but here is one I think we haven’t talked about enough: physician mothers are providing care and getting none. Maybe if we nurture our physician mothers through their intense times of change and challenge, support them during their births, help them bond with their babies, meet their breastfeeding goals, maybe we could change that suicide rate. Birth can be transformative, or traumatizing. Doulas can help shift the balance for women, and women physicians need this as much as any other high risk group. Time to doula some doctors and change the world.
Liz Langthorn, Master of International Maternal Child Health from Tulane University, current medical student at University of Oklahoma College of Medicine. Once a birth doula, always a birth doula.
I help breastfeeding parents with lactation support in the Bakersfield, Visalia, Tulare, and Hanford areas of California's Central Valley. So often when I answer the phone to a parent looking for breastfeeding support, somewhere in there I hear the voice-cracking and the tell-tale pauses that show they are working hard just to reach out and share their story. We are often not prepared for how hard breastfeeding can be, and the toll it can take on our hearts. We hear of the joy babies bring, the bonding, their smell, their sweetness -- maybe someone out there mentioned being really tired or not showering easily in the first weeks. We are culturally conditioned to worry more about birth than breastfeeding.
When a parent is struggling, what can we do to lift them up? What words and actions can scaffold them, infuse them with strength? I asked parents who experienced these hardships to think back to what was encouraging and motivating -- things that anyone (not just a breastfeeding helper) could do, to make the journey a little easier. Here is what was shared:
1. "Keep the focus on me." Many of us have had issues with breastfeeding, and often the inclination is to quickly get to our own story and how we survived. "I cracked and bled for two weeks. I didn't have enough milk so my friends gave me donor milk. I locked myself in a room and said, 'we will figure this out,' and I never gave him a drop of formula, even though my doctor suggested I was starving him -- I just powered through." This is not helpful. It isn't that on a normal day this parent can't appreciate your experience, it's just that right now, it takes away from their very-current state of being vulnerable and needing support. If you can relate, say something simple that doesn't turn the whole subject back to you, like, "I remember that." It's okay to reaffirm you have felt something similar; it's not okay to shift the focus so now you can talk about yourself. In this moment, it needs to be all about Parent and Baby. It takes acute awareness to stay in the present with them, and this truly is your gift to give.
What is not helpful: Launching into your own tale of triumph, terror, or failure, especially with the intent of showing this parent you had it worse; the same holds true if you feel compelled to share your grief, your anger, or what you would do. Apply Susan Silk's "Ring Theory," which I have adapted. The idea is, the person facing the crisis (breastfeeding parent) has the center spot. They are allowed to say whatever they want or need to, to anyone else. As the rings extend, others are assigned positions according to how close they are to the center. So the breastfeeding parent's partner is next. Again, they are allowed to vent in an outward fashion. Family and friends will have their own feelings, and it is appropriate to dump those outward as well. Advising, sharing your worries or coping methods, explaining your exasperation with the situation, etc., is never done inwardly, because this adds to the load of those dealing most directly with the crisis.
2. "Use those active listening skills we hear about." Rephrase what the parent says: "It sounds like you are scared that breastfeeding is not going to work." By restating what you heard, you aren't going to tell them something they don't already know, and it lets them know you are listening. If it isn't what they're feeling, they can clarify by offering more information: "No, I feel like it is working, I just think maybe it will never end up being a smooth, easy process, like I imagined." It's okay if you don't get it right -- they will understand you are trying to understand. Acknowledge this struggle -- you can never go wrong by saying something like, "I see how hard you are working." Don't ever under-estimate the therapeutic power of being a good listener.
What is not helpful: "Maybe it's not meant to be." "Haven't you tried hard enough?" "Formula/ bottles are here for a reason." "Your cousin Jill wasn't able to breastfeed, and everything turned out fine for her."
3. "Don't be afraid to touch me." When the dam holding back the tears and feelings breaks, the struggling parent can feel cracked open and raw, and having an audience can make those feelings even worse. You can touch their shoulder, take their hand, or offer the comfort of a hug. Sometimes touch can give more solid support than any words can. When a baby cries, they are letting us know they need something, and that gives us the opportunity to respond and help them feel better. When adults cry, there is the same opportunity to help someone feel better while also creating a bond of love or friendship. You may not know what to say when you see the parent like that, but you can't go wrong by showing physically that you care.
What is not helpful: Staring at the parent, pretending they're not showing emotion, visibly looking uncomfortable, or telling them not to cry.
4. "Share in the loss I am experiencing." Whether breastfeeding will ever work for this dyad, in the middle of the crisis, it is a loss -- a loss of hopes, a loss of dreams, a loss of what the parent thought would be an "easy and natural" way to feed their baby. It is okay to treat this as any loss a friend might face. This isn't the same as having two choices for dinner -- chicken and rice, or beef and potatoes -- and then having the choice made for you. Breastfeeding comes with many overwhelming emotions. When a person feels like they can't feed their baby, in that moment there is nothing that can feel worse, and it feels like loss. We can accept and value that, even if we can't understand it.
What is not helpful: "It could be worse." "At least you have a healthy baby." "I don't understand why this is affecting you so much, it's not like someone died."
5. "Let me decide when I am done." Well-meaning friends and relatives who are concerned about the parent's physical and emotional well-being may try to convince them that they have worked hard enough. The breastfeeding parent is the only one who can judge that -- they know their options. Wait for them to tell you where they are on this journey. One woman, a neurologist, shared: "If you say you are suicidal, people don't say, 'yeah...you should probably just go ahead...' They figure out how to help you, they talk you off the ledge." It obviously isn't the same thing, but in the storm of hormones, emotions, life changes, and struggles, the very-real feelings of hopelessness and loss of control can be strong and similar. Keep encouraging this parent. This is their marathon to run -- they decide the pace, the route, when to take a break, or even when to stop -- you cheer from the side no matter where the parent is in that loop, no matter how you are feeling about the situation. As another parent put it: "It's cruel to try to take someone's hope away."
What is not helpful: "It's unlikely by this age your baby is going to figure out how to breastfeed." "Just try X, Y, or Z -- it fixed our issues." "Not everyone can breastfeed." " I just can't bear seeing you so upset."
6. "Do something for me that will save me from having to do it myself." Rabbi Harold Kushner is the author of, "When Bad Things Happen to Good People." When asked to share what he's learned in his years supporting people in the midst of suffering, he said it could all be summed up in this statement: "Show up and shut up." Anything you can do for this family that gives them more time to be with their baby and concentrate on self-help, connection, and healing is priceless -- and ANYONE can help. "My husband has always been supportive. He always left it up to me to decide what I wanted to do. And when I decided I wanted to continue to try, he helped me pack up the baby and drove me to LC's and LLL several times a week. He washes bottles and pump parts, he's a pro at freezing, thawing, making bottles, hooking up my pump. His labor of love is so important at continuing exclusive pumping, because I alone have logged about 3,000 hours of work towards pumping and pumping-related activities for the first year of my baby's life." Further out of the ring, family and friends can take care of pets or outside responsibilities, bring meals or snacks, run errands, make phone calls, drive the parent and baby to appointments, and always, always there is housework and laundry.
Ronald A. Rasband shared: "If you come upon a person who is drowning, would you ask if they need help -- or would it be better to just jump in and save them from the deepening waters? The offer, while well-meaning and often given, 'Let me know if I can help,' is really no help at all." It can take energy, effort, and humility for a person to list what she could use help with. In the movie "Robots," one of the characters, Bigweld, had this motto: "See a need, fill a need." Jump in and do what you can -- when there seems to be nothing else, there is always service.
What is not helpful: Service with conditions; making the job seem too complicated to take on, or making it too complicated for the family to delegate; rushing in to offer babycare when the parent and baby could be bonding; expecting a thank you card.
Society says feeling bad when breastfeeding is hard is not appropriate or okay. We don't want to make anyone feel bad if they can't breastfeed, so when a parent struggles to continue, their hard work is not always encouraged or even noticed. To really help, though, we need to suspend this judgement and be willing to accept the parent's feelings and their reality. Becky Bailey writes: " Acceptance means recognizing that people, situations, and events are what they are. Each moment simply is as it is. Acceptance doesn't mean that we approve of the moment, only that we recognize that what is happening at a certain moment is, in fact, happening."
Two people in particular shared they couldn't remember anything helpful or hopeful that was said to them -- nothing came to their minds when looking back at their struggles. This lack of acceptance is apparent when they shared what they wished they had been told:
"This is the hardest thing you will ever do, but you will get through it. You are getting through it. One day at a time. You are amazing and strong and this will be worth it. It does matter."
"I support you and will be here to help you if you decide to keep trying or you want to stop. I value you and think highly of you as a mother and person, no matter your decision."
Accept this person's struggle. Accept their feelings. Open yourself to their reality and you increase their willingness to accept your help or be buoyed by your efforts. When this parent comes out the other side (whatever that other side looks like), it can be with positive memories of the support and care that was shown to them and their baby.
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It is hard to admit, staying home with a baby can be a lonely time. It is ironic that, on one hand, you have a baby that needs you all.the.time, and yet we can still feel alone. Sarah shares some great ideas in this feature. As doulas, we can work to create space for new moms to make friendships, and we can offer support for their changing emotional needs. As moms and women, we can look for opportunities to build and nurture friendships. And it's all good for growing families.
So you find yourself sitting at home, looking at your new baby who has finally settled into a sleep after feeding for what might seem like the last six hours continually. Your home might be a little untidier than usual, the washing is piling up, you have given up on the idea of bothering to iron anything (flat clothes are slightly over-rated anyway!) and you can’t remember the last time you got to have twenty minutes of “down time”.
Your partner is spending long hours at work (still trying to catch up on the backlog from his paternity leave) and the influx of visitors that wanted to greet the baby have slowed to zero as everyone else returns to their day to day lives.
And here you are… coming to terms with your new “normal”.
During Birthability coffee mornings we always try and have a “topic” of conversation which people can dip in and out of as they wish. We have always been so humbled that our mums don’t “play pretend” with each other. They don’t sit there and dress up their weeks to show off how brilliant parenting is. Instead they are brutally honest and share their experiences openly, offering a realistic perspective that sometimes it is hard to cope, and gain solace that they aren’t the only ones feeling that way.
One week I asked the mums to share how they felt emotionally. Of course a few people said they loved being with their baby. A couple of mums felt that they would take time to adjust to their new roles, and were wondering if they could ever accept that this was “the future” for them. But worryingly, the most common feedback was that our mums felt “lonely”.
Lonely despite always being in contact with another human (albeit a baby!)
Lonely despite seeing their partners every day and often seeing pre-baby friends on a weekly basis.
Lonely despite being part of a new network of hundreds of other mums that have recently gone through their experiences .
And Lonely despite visiting coffee mornings each week.
Since we set up our weekly Bumps and Newborn support sessions, we have had many mums telling us that we provided the most important service that they accessed. Mums feel that we provide an “anchor point” in the week – and if they can just make it through to that day then they can come along, chat through any issues, sit down and be waited on with a cup of tea and a biscuit, and feel like an individual again, rather than just “babies mum”. Don’t get me wrong – our small team loves to coo over their babies as they come in – but actually we are really more interested in offering the mums a listening ear and hearing about their week. Our group has organically grown into a peer support session, where new mums are always identified, welcomed and introduced to another set of mums with the same age baby. We often choose a “buddy” mum that we know is comfortable chatting with new mums and able to help them feel part of the group quickly. In truth we don’t know how we achieve a “non cliquey” group – but somehow we do!!
So, we could pat ourselves on the back for running a great session – But what happens at the end of a coffee morning? Well, the mums pack their stuff up – put their babies back in their car seats – and drive back home where some of them will feel lonely again until next week.
So as I stand watching my mums sitting around the room and freely chatting, I have to wonder why it is that women are often unable to continue those friendships with strangers outside the room, and it strikes me that we are pretty useless at being forward! How easy would it be to say to another woman that you have met at a coffee morning “Hey, you know its been great to chat with you, it feels like someone else really understands my perspective – would you like to meet up during the week for a coffee?”
Scouting has a wonderful motto – “A stranger is just a friend you haven’t met before”
So, if you are feeling lonely, afraid, overwhelmed or just a little bit bored by the monotony of parenting, why not look into your local groups? When you go in just ask to speak to the leader and explain that you don’t know anyone and would really appreciate it if they could introduce you to a couple of mums.
I can tell you that a number of our mums joined us like that – and have gone on to form lasting firm friendships.
Some of our more experienced mums invite new people to join them after in the pub for a quick lunch – and a couple of them have even grabbed unsuspecting mums walking past the venue with a new baby in a pram and said “Hey, why don’t you come in and join us for coffee? It’s a great group and they would love to meet you!”.
Women need to start loving each other. We all have lonely days. Be brave and reach out to “strangers” around you – it could be the beginning of a lifelong friendship.
Sarah is a co-owner of Birthability. She has been teaching antenatal courses in Warwickshire, England for over 7 years, and has taught over 3,000 couples across the region. She trained as an NCT birth companion in 2010 and received certified accreditation from the University of Worcester. She loves to meet couples in early pregnancy, watch their journey through labour and birth and offer support at coffee mornings until mum is feeling confident enough to move on. Sarah has 4 children, and in her spare time is often running around to Hockey matches with her boys, and walking their dog “Luna”. You can find Birthability on Facebook as well.
I love Sejal and her way of thinking. As a postpartum doula, she understands and appreciates what our new mothers need to take root and blossom. It is unrealistic to expect a new mother to confidently handle her new role independent of support, friendship, and practical help. If you take nothing else from today's post -- reach out to a new mom you know, and see how you can lighten her load.
I teach a newborn care class at our local Babies R Us store every month. One of the few points that I mention while I am teaching, that has nothing to do with newborn care, is how a partner, a friend or a family member can support the new mother. My love for the work I do as a postpartum doula does not just come from being able to care for the newborn -- it comes from caring for the mother. When a mother’s recovery is given priority, the impact of that support goes a long way for the entire family.
A mother who feels loved and supported can be a better mother and a better partner. The more I work in the postpartum world, the more I realize that for mothers in our country, being independent and rugged is considered the norm. I strongly disagree with this practice. Having support from the partner, friend, family, or a postpartum doula can prevent the challenges of future health issues, whether they are physical or psychological. In this case, prevention is better than cure. The increase in incidence of postpartum mood disorders is a big red flag that tells us that something needs to change in the way we care for our mothers.
A partner can provide support, understanding, organization and patience for the mother who is recovering from birth. This also applies to partners who have the privilege of supporting adoptive or surrogate mothers. We need to remember that there is invisible healing that takes place along with external physical healing that all new mothers go through in the first 6 to 8 weeks postpartum. A new mother’s mind and body are as fragile as her new baby. A new mother needs to rest and digest, to keep the stress level down. A partner can bring her snacks and make her a plate of healthy food. A partner can remember to keep her water cup or bottle filled. A partner can bring her a cup of hot tea. A partner can hold the baby while the mother takes a shower or a nap. Did you know that a partner who believes in breastfeeding is a marker of how successful a new mother is going to be at breastfeeding? The faith and energetic support of the partner is vital for the new mother.
A friend who is planning a baby shower for the new mother can communicate with the people on the guest list about organizing for postpartum support. Some of the best gifts for a new mother are not toys or things for the baby. Instead, if a new mother gets postpartum doula hours, housekeeping service gift certificates, massages, meal deliveriesl or even a friend or family who can come and do laundry once a week, she will find that more helpful than any gift. Trust me, I know this because my clients have told me so! Instead of investing heavily in the care and relationship of the mother and baby, we are investing in fancy toys and decor for the baby.
Postpartum doulas can provide emotional and physical support to a new mother. They can also educate new parents and provide targeted breastfeeding support. 92% of new mothers report at least one breastfeeding concern three days postpartum. When a mother has the support of a postpartum doula, she can be rest assured that her postpartum doula will try to find the best resources to help the mother if she cannot take care of it herself. When a partner needs extra sleep, a postpartum doula can make that happen, too. Meal preparation, running errands, baby’s laundry, light housekeeping and newborn care are just a few things that are on a postpartum doula’s to-do list. I have been fortunate enough to work with some of the most wonderful families who trust my knowledge and experience. I have only become more convinced about the value of the work I do as a postpartum doula.
Without good postpartum care practices, new mothers in the developed world will be, just like babies who aren't gaining and growing well, “Failure-to-Thrive."
Sejal is a postpartum doula whose career was inspired by a lactation consultant and the birth of her niece. Her need to care for people has been fulfilled in this career. She comes from a family of healthcare professionals and grew up with babies being born around her. She is from India, a culture that is known worldwide for its heritage and hospitality. Sejal feels strongly when you help a mom you are helping the entire family. Her primary goal as a postpartum doula is to empower new parents with all the skills that are needed to raise their child while also promoting healing through evidence-based information. To connect with Sejal, visit her website, or find her on Facebook.
For today's post I collected an assortment of comments from moms who had doulas.
Amanda, second birth, first time with a doula: I knew I wanted a doula after my first birth did not go as planned As a labor nurse I thought I would be able to handle labor, especially with a very supportive husband. Boy was I wrong. I know I could of had the birth I wanted had I had a doula, so when I got pregnant with my second I had to have a doula! The loving care and support a doula provides is priceless! The encouragement and reassurance through out the whole pregnancy was so important to me and knowing that a knowledgable woman would be at my side to support me and my wishes for the labor I wanted was what my heart, soul and mind needed to have a completely natural birth! Ending my birthing journey with Kim Humble at my side was a perfect ending! I admire all doulas for their dedication and love of the birth process and for giving up time with their families and lives to help empower woman during their birth process.
Wendi, doulas with her second and third babies: Having a doula was the only difference between my first and second birth and wow what a difference it made! The counter pressure on my lower back during contractions was a godsend. It was so helpful physically but also emotionally to have someone there to focus on me. Avary and Evie, doula-assisted births. Avary: 1-03 with Erin Romrell in Clearwater, FL. Evie: 5-11 with Jarynna Chua, Chico, CA.
Jenny, birth with a doula after a loss: Like many people I didn't think I needed a doula. My husband is an excellent helper and I had never had problems with relaxation and delivery. However, after having a stillbirth my very good friend who is a doula gently offered advice that it may be helpful to have someone not as emotionally attached to the experience in the room to help us both. She was so very right about that. We were more anxious than we knew going into our birth experience post stillbirth. Our wonderful doula/friend/sister was there for the both of us to keep us calm and focused. My husband still did most of my support and coaching, but she was there to run interference with hospital staff and convey pertinent information in a calming way from our midwife. It also turned out to be a huge blessing in that our midwife had 5 women delivering at the same time so we had the extra attention we needed at a time when we were both immensely happy and in a bit of mourning that we didn't know we hadn't yet done.
Rebecca, first birth, doula support for birth, and postpartum depression: My doula helped me through post partum depression. She was invaluable during my birth but the support we got later was what kept me from cracking. We had her come in two nights to take the baby and let me sleep after 6 weeks of insomnia. It got me on the right path to recovery and I trusted her more than anyone else to take the baby at night while we slept.
Kari, first baby with a late decision to get a doula: The prenatal support given was invaluable. My doula helped me not only with the obvious stuff like practicing relaxation techniques and different positions, but with building confidence to have the birth I wanted. I went ten days past my "due" date but never questioned my decision to not be induced, as we had talk about the cascade of interventions that often follow. She helped me trust my body and backed me up when my gut instinct told me to switch providers at 37 weeks pregnant.
Our preparation allowed me to labor at home as long as possible, and then my doula advised when to head to the hospital. I'm grateful to have been fully in active labor when admitted, and didn't have any issues with stalling. I attribute this to how safe I felt. While in labor, my memories are mostly touch and hearing, and feeling cocooned by the women present - my doula, midwife, and midwife in training. Birth was a very female centered thing for me. My doula helped me stay centered when I hadn't even notice that my efforts and pushing were less controlled and therefore less productive. I'm happy to have had a non medicated hospital birth, and felt very empowered by the experience. I can't imagine childbirth without a doula! [Kari's doula was Avira Wenn in the Visalia Area.]
Katie, second baby though adoption, first time with a doula: We hired a doula for a pretty unique reason. My husband and I were adopting a baby, so we hired a doula for our son's birth mother. I had gone to her child birth classes with her, and was going to be with her during her labor (though I had never given birth myself). But I knew that once the baby arrived he would be my priority. I had an awful image of this amazing young woman who was giving me the most precious gift going home from the hospital with no one to check up on her, navigating a difficulty time alone. She had some specific desires for how she wished her birth to go, and we needed an advocate who would be there for her before, during and after her birth. One reason we chose an open adoption was because we feel strongly about a birth mother's rights. But we were also realistic; we wanted a baby badly. The emotions surrounding a birth and adoption can change the best laid plans, and it seemed a conflict of interest for me to be her advocate during that time. Our adoption facilitator suggested we hire a doula. I am so happy we did! Thank you, Stacie! I know initially the adoption element was a bit out of your comfort zone, but you were amazing!
♥ four young boys and a boy dog (offspring)