After being a doula for 20 years, I got the calling to become a midwife. I didn’t accept the calling haphazardly. About a year passed by, lots of contemplation, discussion with my husband, and then the application process, before I became an enrolled student in a MEAC-approved school. Now I’m in my third year, and things are getting hectic.

I have a circle of doulas around me, though! And do you know what these doulas do best? They doula me through this midwifery journey. Some of the best times I have is when we get together for doula lunches, and we just hang out together around a good meal. It never fails that they ask me how school is going, and encourage me with their kind words. It’s like I have my own support team, and they are wiping the sweat off my forehead with a cool rag.

I sent several of them a message a few weeks back, including Stacie. Just knowing that I have these few doulas, surrounding me, giving me encouragement, and simply being there, is a huge boost to my morale. They are helping me get through this active stage of labor! I don’t even think they know that they are doing this for me. It’s such a part of the fabric of being a doula, that it comes naturally for them.

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.
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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.
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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.

Have you ever shadowed an experienced doula or asked to be shadowed?  Did the experience match your expectations? 
 
I think one of the greatest challenges new doulas face once they’ve finished their initial training is learning how to put their knowledge of textbook labors into practice when so very many labors are not textbook.  I remember walking out of my initial training excited, feeling ready to jump in as a knowledgeable support person, only to find myself at a 56-hour complicated and confusing labor both for me and the couple I was supporting.  It wasn’t following any of the textbook rules.  Neither did the next 2 births I attended, which were equally complicated and confusing for entirely different reasons. 

Many certifying organizations offer only a short introduction to the labor process in person in which there isn’t much time to get over the natural and normal variations of labor.  While there are many books, articles, and websites available for further study into the various reasons why a labor might look active when it’s not or why it might not progress in a linear fashion, it takes time for a new doula to start putting those puzzle pieces together.  I had to learn as I went.
 
Often on the fly, little by little, we learn as we go.  I sort of took those early difficult labors as a test of my will to be doula.  Wouldn’t that be so much easier, wouldn’t it be so much faster though, if there was a mentor to help in those situations?  This stress over feeling not well enough prepared is what leads many doulas to try find someone to shadow or another doula they can call while at a birth.  But it’s not always so easy to find or implement.  I often hear from doulas that they asked around but no one was willing, or that they found someone but then their client don’t want someone sitting in the corner watching, or that they were afraid to wake a mentor at 2 A.M. to ask questions about a situation unfolding.  While many certifying organizations encourage finding a mentor, few formally arrange for it. 
 
As someone who comes from a strong teaching and mentoring background, I really wanted to offer shadowing situations for new doulas.  But I found that the shadow concept didn’t work well for me or for my clients for a lot of different reasons.  It might be a new doula that I didn’t personally know very well, the connection with the client might be awkward, or often the case, the new doula might reach out once and then never follow up.  The energy output for a mentor is high.  When it’s not reciprocated, it can be frustrating and discouraging.  I needed a different solution, which luckily presented itself as most great ideas do, like a light switch coming on. 

​I’m fortunate that I often get to work with licensed midwives, and an important part of becoming a licensed midwife is be an apprentice.  An apprenticeship has all the things I was looking for: It addresses that most people learn best by watching and then doing; it’s a formal relationship with clear expectations; it’s long term so you get to know each other well; and, clients know we come as a package. 
 
By this time, I was already working in a group practice.  We had already worked through the logistics of our business model, things like work load distribution, call time management, money management, and most importantly communication requirements.  It was relatively easy to slip an apprentice into the mix, what remained was deciding what was required of the apprentice and how to select one.  This process has evolved and been refined over the years and includes the obvious things, such as attending prenatal sessions, active labor, and postpartum follow-up with the client, but also now has requirements about reading, advanced classes, and hands-on experience.  When our group turns a doula out into the world, we want to be confident and we want that doula to feel confident that they have the skills and experience to handle any situation.  The birthing people and families in our community deserve excellent doulas.  We really enjoy being a part of helping to make that happen.  It’s an honor and a privilege.
 
In case you’d like the do the same, here are a some tips to you started:
 
In working with an apprentice, I believe that it’s very important to know yourself before you can know what you need from an apprentice (it’s not all just you giving, it’s a reciprocal relationship). For example, what are your core values or what makes you tick?  Your values help you to stay focused and keep on track, make appropriate decisions, connect with like-minded people, and be inspired. 
 
Some questions to ask yourself (answer truthfully!):

​Week 4 of our childbirthing classes, our instructor said, "Next week, we will have a doula come talk to us about doula support. A doula is like a coach and you parents are a team. She coaches you through birth." I was curious! Well, as a junior high school teacher, I have coached a lot of different sports, from volleyball, to track and field, football, softball, and baseball. I am a sports-lover, so that term had me excited to learn more. 

As promised, the next week me met Renate, the doula. Renate was a confident-looking woman, in her mid-forties. She knew about birth, that was clear. Renate shared about meeting with couples before birth to learn about them. She walked us through a typical doula/couple relationship from before the birth to after the birth. She told us about a few things she carries in her bag. When you add that all together, it looked like the perfect playbook to help a team win a game. I wanted in!

Convincing my wife, Shelly, that a doula would be good for us was a different story. Shelly was more inclined to let things happen on their own without a lot of preparation or planning. "I just want a healthy baby," is what she would say to me. Everyone wants a healthy baby. Everyone wants to finish the game. As a coach, I wanted more. I wanted to feel good about the effort we put in as a team in this birth "sport," and I wanted to feel like we won.

Where was the turning point in this? Our doctor. At one of our appointments, Shelly shared with our doctor that I was making a little book filled with information I would need to help her cope. In this "playbook" were things like, 4-1-1 (when to go to the hospital), labor stages and signs, the Take-Charge Routine, what happens in the hospital's mandated "Golden Hour." When our doctor heard this, she asked, "Oh, have you thought about hiring a doula?" I nodded my head yes. "What's the hold-up? Often it's the dad who doesn't want one." I pointed at Shelly. Maybe that wasn't the most mature thing to do.

"What do you think, Mom?" our doctor asked. Shelly replied: "I hear birth stories all the time. I have so many friends who had ideas about their births, and then their plans went out the window. I don't want to set myself up for some special experience, and then feel let down." Our doctor said there are no guarantees in birth, but that doulas can help couples feel better about their overall experience. She handed us a list of local doulas, starred a couple she thought we might get along with. Shelly still wasn't convinced, but she agreed to meet with a couple doulas and see what she thought. 

We recognized one name on the list: Renate! We arranged a meet-up. 

When it came down to it, Shelly and I liked Renate and we felt she could help us both achieve our birth goals. She was an amazing help. My father had an accident a few days before our baby was born, and he was in Intensive Care Unit of the same hospital where we were having our baby. He actually had a surgery planned for the day Shelly went into labor! Because of Renate, I could run between these two important people in my life to make sure they were all okay. I could know about where things were with Renate texting me, so I could be with my dad for a few minutes before his surgery. I was also able to stop by once he was out of recovery. The most exciting thing was, when I could come back to my dad and step-mom with a picture of our baby, Stuart Henry, to his grandfather, Henry Stuart.

With Renate by our side, I didn't need to clutch my playbook to my chest. I could relax and trust her coaching abilities. When I say coaching, I say she supported Shelly, and she helped me support Shelly. But she absolutely coached me! And that was just what I needed.

Evan is a middle school teacher from Des Moines, Iowa. He, Shelly, and their daughter can be found screaming their heads off at Iowa Wild Hockey games, or cruising around their neighborhood on their tandem bike (with a baby seat). 

​You don't see the countless times, crying alone on the floor, scared we are harming our unborn babies with the medications that don't stop the sickness, but just help keep us both alive.

My family had to see me so sick I wanted to die, more then once. They had to see me pale and withering away. They had to see me cry, day after day, because I just didn't feel good ever.

I've thrown up in more public bathrooms and parking lots than I care to count. I've had to buy new shirts while we were out because I threw up all over the one I was wearing.

Did you know that toilet water has a distinct smell? We do. We smell everything. Your perfume. Your lunch you ate. It all makes us sick.

The smell of my kids when they played outside made me extremely ill.

I took the highest dose of zofran a person is allowed to take. I had to rotate meds. I had to fight to not get a PICC line IV. At the end I battled to keep a feeding tube out of my nose and a hospital admission out of my family's life. I had to tell my doctor no, because I had nowhere for my kids to go for such a long period of time.

I've done 4 HG pregnancies, my first and my fourth being the hardest. My last one, I lost 45 pounds and was sick the entire pregnancy. I never made it back to pre-pregnancy weight with him.

So please. I beg you. The next time you see a woman clearly suffering from HG, take a second to consider what she's going through. Don't try to force ginger, crackers, and natural remedies down her throat. Just love her and try to understand that her life at that moment is hard. Try to pitch in and help. Bring a meal for the rest of her family. Bring her a good book or movie. Maybe some comfy pajamas. I can tell you for certain, she'll appreciate your efforts.

​​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.
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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.
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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.
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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. ​

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.
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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!

​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.
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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."

I love Sharon and her creativity, and what an idea machine she is! She is great to brainstorm with -- I lay out all my half-baked imaginings, and Sharon helps plug the holes into a complete activity, or she offers an additional use of something I came up with. When I asked her to share in this year's 31 Days, I had a vague idea I tried to (poorly) convey: "...something about motivating yourself to write when it's the last thing you want to do. How do you come up with creative content, over and over and over?" Well Sharon has figured it out. She took that seed of an idea and grew this amazing, inspiring post, sure to help any new or blocked-blogger out there.