Sariah knocked on my door at 12:10 am and said “It’s baby time!!” Her face was so hyped up. I was immediately thankful that I was feeling better. “Ok,” I said, “I’ll be right up.”

I went into the bathroom and got my ziplock bag of a mini-version of my doula kit. I had good feelings all along that it was going to be a fast birth so I didn’t feel like I had to bring very much. I went upstairs to their apartment. Charlotte greeted me with a big grin. She said “I’m having lots of contractions and I can’t talk through them.” We were all excited.

She phoned the doctor, as she was standing on the second step. She began having a contraction so she handed the phone to me. I heard a beep and I wasn’t sure if it was an answering machine so I just started talking.

“Hi, this is Amanda, Charlotte's doula. Charlotte is in labour and we are going to head to the hospital.” Then I heard a very groggy voice say “Ok, Charlotte…. right…. ok how long until you are at the hospital?” 
“45 minutes,” I said.
“Ok, I’ll meet you there.”

We phoned Oscar, our taxi driver who was going to be on call for her birth. Charlotte had a few more contractions and then Oscar knocked on the door. Eric grabbed the bags and we were headed upstairs.

As we were gathering our stuff, Cora woke up. She hadn’t woken up in the night for over a year, Eric told me later. She woke up, sat up in bed and said “Baby sister is moving.” Charlotte went over to her and said “Yes, baby sister is coming.” Cora said, “Um, yes. I’d like some milk.” Sariah and Charlotte laughed. “Yes, Cora. You can have some milk.”

We went upstairs and got in the cab. Charlotte was on her hands and knees in the back seat of this huge van that Oscar brought. We all got in and Oscar tried his first attempt at the very steep driveway. The tires squealed in protest. He reversed and tried again.

Oscar’s friend who was with him hopped out. Then Eric got out too and they were trying to figure out how to get the van out of the steep driveway. Charlotte was getting anxious as she didn’t want the van to roll back and squish Eric. She was yelling at him a bit from inside the van. Then they reversed and tried going up the other side of the driveway. (The driveway was a circle.) No luck on the other side either and then Charlotte said, “Oh, my water just broke!”

I yelled at Eric that Charlotte’s water broke. It was clear the van was not getting out and the bumping and jostling was really hard on Charlotte as she barely had any time between contractions.

Finally she turned and yelled at Eric out the window, “We need to get out of here!” He said “Ok babes, I got this! I will get us out of here!”

By this time the taxi drivers were talking to this other woman at the top of the driveway. Eric walked up to her and asked “Can we get a ride to Puerto Vallarta please! My wife is in labour and her water just broke.”

The lady said “Of course. Jump in!”

The lady, who introduced herself as Georgina, and her English husband Danny owned the smallest car in existence. And in the backseat was a carseat. Georgina wedged herself into the carseat. Charlotte was in the front seat on hands and knees. I was in the middle, leaning forward, rubbing Charlotte’s shoulders and whispering encouragement into her ear. Eric was beside me in the backseat.

Danny was an excellent driver. Between he and Georgina, they knew every bump and pothole along the way. He was careful and he was very fast. Charlotte worked on keeping her moaning low pitched to allow her cervix to Open Open Open. I would count on her ear when the contractions came, to give her something to focus on. We would come up to a red light and Georgina would look and say “Ok, Danny. Just skip in. We have to keep moving!”

Outside of Bucerius, there was a police car going the same direction as us, we pulled up beside it and Georgina, sitting in the child’s car seat, yelled out the window to them, asking for a police escort.

They pulled ahead of us, lights and sirens going, and we went very very fast behind the cruiser. He pulled off as we got to Nuevo Vallarta, and waved us onward. Charlotte was doing so well through all this stress. The contractions were strong and very frequent. She concentrated on her noises and said “Open open open.” Her ability to remain as calm as she did through all this uncertainty and near-disaster impressed me to no end.

The epidural was in place and Dra Laura said “I have to move the baby’s head just slightly. I am going to stick my hand up and when I tell you to, I want you to push just a little and I can tip the baby’s head.”

Dra Laura did just that and Charlotte looked at me with wide eyes and said “I can feel the baby coming down the birth canal.”

They decided it was time to move Charlotte to the delivery room. They told Eric and I to go put our stuff in her postpartum room and then come down and get in our scrubs. He and I got into the elevator with all our stuff and were just told a room number. The doors shut as we saw Charlotte wheeled down the hall and Eric looks at me and says “And this is when we steal your baby!” And I laughed. But we both felt a bit uneasy.

We dumped the bags and headed back down. The hospital was entirely empty so we weren’t sure where to go. We saw someone and asked. They gave us scrubs and we were changing and trying to figure out a one-size-fits-a-mammoth scrubs. Eric’s head bandana looked like a nun’s hat until he tied it. Then he tilted it to the side, real gangsta’ style.

We got in the delivery room, as Charlotte’s baby was starting to crown. She said “The baby will be here any minute!”

Within 10 minutes, the baby’s head was clearly going to come out. In between contractions, Eric started telling me a pirate joke, which I honestly can’t remember a word of. Then suddenly, out came the baby! They cut Lyra’s umbilical cord and lay her on Charlotte’s belly. Charlotte cried and said “Hello, welcome baby!” Eric too was making joyful exclamations of being a dad again. 

They took Lyra to the warmer, and checked her out. The pediatrician suctioned out her nose and she put her hands up to fight him. She was immediately alert and looking around. Charlotte quickly delivered the placenta so that no one but the doctor even noticed.

The staff put Lyra in an incubator and took her to the nursery with Eric following closely behind. He was clear and confident in his role of dad. I mean, he’s done this all before!

Charlotte and I stayed in a corner of a hall for more than an hour while we waited for the effects of the epidural to wear off a little. Then after a few times asking the nurse, they moved her upstairs to her room. Soon they gave her baby Lyra and Lyra latched on immediately.

Mom and baby safe and happy. After such an adventurous and fast labour, they were home from hospital that very afternoon.

It was such a privilege to be a part of a whirlwind Mexican birth experience. Charlotte, I am extremely proud of you at what you accomplished. Eric, you were a fantastic and assertive father in exactly the role you needed to play. You together make a great team and I am nothing but grateful to be included in such a momentous day.

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

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

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

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

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

Doula work is hard! Let's just get that out of the way! Planning life, working another job or going to school, taking care of family needs -- and knowing at any minute you could be called away to a birth -- that's stress!  Burn-out rates can be high for doulas, and if it doesn't send you away from the work permanently, it can leave you reeling in chaos and discontent while you try and regain your doula spirit. Find hope in these 13 ideas to keep yourself grounded and satisfied.

1. Be picky about what clients you accept. It is normal, in the beginning, to take every client that seeks out your services without thought to how you might work together. This can be draining, though. You have ideals, and while we know the mantra, "it's not my birth," it would be unrealistic to say you need nothing out of the experience simply because you are the hired help. If, for example, you feel useless sitting by your client while she gets an epidural at 2 centimeters, then it is okay to ask yourself: What would my ideal client look like? As doulas, it is rewarding for us to work alongside the client. That doesn't mean we stand in condemnation of the mother who wants an epidural as fast as she can get one, that simply means, be true to yourself and honor your feelings. During your interview, ask how she envisions her birth. If that is the information she shares ("I want an epidural as fast as I can get one"), there may be a doula that fits her better than you fit her. 

2. Find something else that fills your doula cup. I taught childbirth classes for a midwifery practice. I remember sitting across the desk from one of the midwives, having a breakdown, because suddenly my doula life felt like it was crushing me. I am grateful for her words: "If you keep going when you feel like this, you may lose your love for doula work -- it can be hard to come back from a burn-out. See if there is another way you can get those feelings -- like teaching -- and then come back to doula work when your heart feels ready." In the midst of this career crisis, I felt like a failure for wanting to just walk away. This was my passion! This is what I worked so hard for, and yet, I was ready to trash the whole thing in a time of severe stress. I am grateful for the wisdom of a sister birth worker and her words of love that day. There is no shame in stepping away for a while and rebuilding your faith and restoring your energy, so you can serve better in the future. 

3. Take on a partner. I remember exactly when my first burn-out occurred. I was at an especially long and difficult birth. I stepped out of the room in a moment of calm and called my very good friend, who is also a doula. "I hate this!" I cried. "I would leave right now, give them all their money back, if I never had to see them again!" I had been piling on more and more and more. I probably took this birth sooner after the birth of my own baby than I should have. The mother was not responding to any of us. The hospital put her on the clock. And nothing was working. I realized if I had a partner, I wouldn't bear the full weight of this -- I could call in support after so many hours awake and apart from my baby. My same friend and I agreed to begin working in a partnership. We didn't change our business names or websites, instead we just created an agreement between the two of us (we didn't know how long we would work like this). When a phone call came for either of us, we would explain we were working in a partnership with another experienced doula. We would attend all prenatals together, and then we generally had agreements about which client we would be on-call for (simply taking turns worked), barring another birth or life event coming up. We split the deposit, and then the doula who attended the birth kept the remainder of the fee (and she also did the postpartum visits). It was amazing! Unlike simply having a back-up, where I often feel I am spending money to keep her around "just in case" I need her (but I really try to never have to call her), with a partner it feels easier to share the births, and the guilt isn't there if I am not able to attend, because the clients know they will have support from one of us. 

4. Offer gratis service to someone. When you are paid for your services, it can be a nice break to find a mama who really could benefit from having a doula. Contact pregnancy crisis centers, womens' shelters, churches, OB/midwifery offices -- someone is bound to know a woman who could use birth support. This is a way to get back to the basics of why we became doulas in the first place -- to mother the mother so she can mother her baby -- and a mama struggling is in need of that scaffolding so she can be at her best for her baby.

5. Raise your fee. The flip of that is, it may be time to raise your own fee. Feeling undervalued can lead to resentment. When I first began working as a doula, I offered clients a sliding scale. This worked well for me, and I found that clients preferred to pay my top fee. Something I noticed: the clients more likely to pay the bottom end of my fee were, in my eyes, the ones who most could afford to -- double-income professionals, in owned-homes with brand-new cars in the garage. The clients who had noticeably less more often paid me from the top end. After two births in a row where I felt I was being taken advantage of, I raised my fee and kept it there -- no more sliding scale. 

6. You're stressed, so destress. In one of his lectures, Tal Ben Shahar shared "stress is not the problem, lack of recovery is." He offers a way to regain ourselves through three different ways of recovering:  micro=15 minutes of every hour, mezzo=good night's sleep, macro=vacation. Realistically this may not seem practical -- we can't often walk away for 15 minutes of every hour while at a birth. But we can find small moments, even if it is just going to the bathroom. Sharar also said, "To create, you need to (re)create." Find your recreation. Do what you can as you not only care for the clients, but also as you care for yourself. 

7. Work with a doula group. My third burn-out resulted in creating a doula group with 5 other women. It took a lot of time to put this together, is wasn't just a random grouping of doulas who decided to work together. We had to hammer out a lot of agreements and policies before we were ready to hang our shingle, but once things came together, this was an amazing way to work as a doula. In addition to sharing call by picking 4-5 days a month on each calendar (which clients were given so they knew who to call), we also held free mini-workshops every other week that were open to the public. Those lasted about 45 minutes, and then we excused our non-clients and paired up as doulas to work with our clients. This was a great way to attract clients, as well as devote specific time to our contracted families. Although I moved away, this doula circle is still up and running. 

8. Let go of someone else's experience. We all walk away from births where we think, "What just happened???" In your prenatals, mom sounded so sure she wanted her birth one way. She seemed confident in her ideals, you felt she had done her homework and had prepared herself to have the birth she talked about. Then at the hospital, it all comes undone! It can be easy as a doula to feel you failed -- you were going to help her achieve her perfect birth, then you watched as she continued to make choices that led her further and further away from that possibility. "I can't want it more than she wants it." I say that to myself a lot. This is her experience, and for whatever reason, it didn't stack up to her before-labor plans. IT IS NOT YOUR FAULT. In order to help the clients understand they have the control, you might phrase your statements with words like, "Choosing (intervention) can lead to (side effect); are you sure that is your decision?" It is not that you are blaming her, you are helping her see she has the liberty of choice. This is assumed, of course, after gentle reminders from you about alternatives, trying 3 more contractions, etc. It is a fine line between helping/advocating, and then staying silent and happily continuing to support her once she has veered from her birth plan. She makes her choices, and you continue to support her efforts. 

9. Say no. Just because you are a doula, that doesn't mean you have to answer every pregnant person's questions. Once in a while doulas get locked into conversations with women who act interested in hiring them -- the doula is hoping for a client, and the woman is hoping for free help. Decide how far you will get entangled in this before you let the woman know you would be happy to meet with her for an hourly fee (you are being her free research assistant!), or as her doula, but her requests are demanding more of your professional time than you are able to give her.

10. Set limits. As doulas we want to make ourselves available to our clients. While the average client may not need an excessive (or annoying!) amount of care, once in a while we encounter a client who is always in need of some advice, information, or help processing things. It's okay to set guidelines on when you are available and on what topics. I have a friend who is a breastfeeding counselor, and she let's families know they can call her "during daytime hours," meaning, when the sun is up. Communicate to your clients how best to contact you and regarding what topics, with the exception of when labor may be beginning. 

11. Refer, refer, refer. It is too easy to get pulled into wanting to be EVERYTHING for a family. We are only as capable as our professional skills and training deem us. For issues out of your scope as a doula, if you have no additional trainings or certifications, a client's issues are best supported by the professional made for the job. For breastfeeding problems, know your IBCLCs and LLL groups. If she is having mood disorder issues during or after pregnancy, find out who helps mamas in those situations. Who are the postpartum doulas in case she needs after-birth help in that way? As her doula you offer physical, emotional, and informational help related to labor and birth. Brush up on your local resources if she needs more so you can help her get the continued support she needs. 

12. Pay your back-up. When I began teaching childbirth classes twice a week, I knew I could not leave my group if I had a client in labor. This was a huge stress for me, even though it was only 4 hours a week that I was unavailable. I wasn't sure how I could take clients until I realized, with a solid back-up, I would have no worries. She could step into the doula role while I was at class and manage things until I returned. For this peace of mind, I would pay her half the deposit, and she would attend one prenatal with us, as well as be on-call for me. 

13. Find your support community. Doulas support families, but who supports doulas? Although like anything, a real-life group of fellow birth workers is ideal, that isn't always practical, so online groups are also an option. There is something that runs through our veins and our hearts, and it bonds us. There are some things it seems only other doulas can understand. Gathering together with others when you are feeling disappointed is a way to be buoyed up, and we all take our turns being the one lifted, as well as being the one doing the lifting. Turn to you doula sisters when your heart hurts and your mind is telling you you aren't making a difference.

So my boyfriend recently related a story to me in which he ran into an old friend of his from high school. She has two kids, and when he told her that his girlfriend is a doula, she had an interesting reaction. She said that doulas are all about natural childbirth, and she wasn't into that at all. For both of her births, she utilized medicinal pain relief. 

Now, I have no idea what this woman's history or story is, but I wanted to take the opportunity to clear up this misconception. Over half of the women I have supported during labor and birth have decided either on the spot, or beforehand, to use a medical intervention to decrease the intensity of their contractions. I am proud to say that most of these women had already planned to use this option, and only one time, in a prolonged labor, did a client of mine, who was planning not to use any, end up with an epidural. When a woman gets any kind of medicinal pain relief, there is still a lot a doula can do to support her during her labor and birth.

Sometimes, when a woman no longer has to focus on the physical aspects of labor, her mind will start racing. It is not uncommon for a woman to start thinking things like "Is my baby ok?" "Is everything going all right?" or even "I feel like I can't breathe." A doula's role is then to support the mother emotionally and assure her when everything is going along normally. She can help point out when the mother is having contractions, and in this way, she can still connect the mother to the fact that she is in labor. 

It is a good idea to have mothers move at least every 20 minutes, to help the baby become engaged in the birth canal, and move labor along. Sometimes this can be a challenge when the mother is numb and/or unable to move her legs. The doula knows specific positions to help the mother get in, which are appropriate in this scenario. 

Sometimes, care providers will want to let the epidural or other drug wear off a little before the mom starts to push. This makes it easier for her to feel when and how to push her baby out. A doula will then jump right in with the physical comfort measures she has been professionally trained to provide.
And lastly, sometimes pain relief, for whatever reason, doesn't work out. Sometimes a woman may still have 'windows' of pain where the drug doesn't numb her. Or, if her labor is moving very quickly, she may not have time to utilize the pain medication she was planning on.
 
Doulas are not here to judge or impose on your birth story. We support women in whatever choices are right for you. Childbirth is intense and filled with a myriad of physical and emotional ups and downs. A doula will help navigate the waters of labor and birth for any mother who desires her support.

"I come to this field as a woman,  and as a daughter. I am a teacher, and also a student. A former aspiring elementary school teacher, I was drawn to this work after hearing stories from my young mother friends who had less than ideal birth experiences. I truly know that a positive and empowered pregnancy, birth, and postpartum period is integral to creating a more compassionate species."

Find Amber online at her website or her Facebook page.

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

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

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

You know how they say, “Wear sunscreen? Well, let me be your cautionary person-writing-this-blog-post and say, up front, WEAR YOUR SUNSCREEN. On that note of “The more you know” (did you just hear the music?), let me also share that we need to watch our skin for more than just those changing moles we always hear about. Yesterday I had a Mohs procedure on a superficial basal cell carcinoma on my face (yes, skin cancer). My only clue this was something that needed attention was the fact that, all summer, I had this spot on my nose that would scab up for a week or so, and then heal.  Scab, then heal. Scab, then heal. It was a shiny piece of flesh-colored skin that maybe looked a bit callused – no pigmentation, no mole appearance, just a regular area of skin that looked and behaved a little differently. A visit to my dermatologist revealed it was problematic, and that leads us to the Mohs procedure.

In order to fully get the root of the tumor, a Mohs surgery can be lengthy.  The skin is numbed, the surgeon draws, and then they cut. They take that piece of tissue and essentially put a cross-hair on it,
mapped to match the area from where it was removed. This is examined to see if all the bad cells are gone (I never said I was an expert). If they see anything remaining on the sample, they know exactly where the offending tissue lies; my surgeon had to come back one more time in true, if-at-first-you-don’t-succeed fashion. There is a wait time of 30 minutes between each sample, which is why this isn’t generally an in-and-out procedure.  

After this was all taken care of, I expected my doctor would just swab some antibiotic ointment and slap a cutesy Band-Aid on and that would be it.  But I was wrong.  I actually had to go to a different part of the building. “I’ll meet you over there, “ my handsome, thirty-something, Mediterranean (Middle-Eastern? Spanish? Who knows) hunky doctor said. Then a nurse walked me through some doors, shoved some things into my arms, and said, “Go ahead and put your clothes in the bag.” Um, what? I am just getting my nose bandaged!? What’s going on?

In the shock of suddenly realizing I needed to strip down, I couldn’t remember if the gown was to open in the front or the back. I tried it one way, spun it around, then twisted it back the first way.  Finally with it half on, fabric clenched in my hands to cover my behind, I stuck my head out to call, “Hey, what’s the story on the gown?  Open in the front or the back?”  The back, definitely the back.   

I continued with my booties and the ever-lovely surgical hair-net thing.  I was placed in a bed and my nurse brought me a warm blanket -- other accoutrements included an automatic blood pressure cuff, and a pulse ox on my right index finger.   My nurse sat and chatted with me for a bit, over such everyday topics as allergies to any drugs (none), was I supposed to take my bra off, because I did (there are so few places outside of one’s own home where I can do this, so why not?  But no, it was not required), and the fact that we both were breastfeeding mothers (can’t remember how that came up). 

I was actually wheeled, wheeled, I say! into the surgery (that sounds so Doc Martin, but unlike the European definition, this was the place in the surgery center where they do surgeries, not the office where docs do visits). When my doctor came in, I was kind enough to remind him that it had been a couple hours since last my nose was bee-stinged beyond feeling, so I would love some more drugs to numb that region. Here is the comment that started it all: “I think I have a pretty high pain tolerance, but I don’t want to feel this if I don’t have to.” His response was, “Oh, why do you think that?”  I shared I had 4 babies with no pain meds. He and the two nurses all gasped. Oh, I had one more coming, “And the last one was born at home.”  My nurse fainted to the floor.

Okay, not really. But I they were still abuzz with a lot of questions, that all sounded like “Why?” (Let me come down off my high-horse now.) “I wasn’t planning to have my first without pain meds.  In fact, I said, ‘I have seen women give birth naturally, I think it’s pretty crazy; I am totally getting an epidural.’  Well fast-forward to an unneeded induction, and I wasn’t able to get an epidural. My fear of throwing up won out over my fear of having a baby, so I somehow was able to give birth to my first baby without an epidural or narcotics. It took some time to work through mentally, but eventually, I was happy about it.”

By this time in the surgery, my bed has been lifted up, the doctor has cleaned the left, upper quadrant of my face with iodine, my eyes stinging from the closeness of the fumes, and my face has been covered with a piece of paper with a circle cut out of it so only my nose is exposed.

I continued on…“With my second baby, I wondered what could birth be like if I actually planned to not use any medications?  I got a midwife who delivered in the hospital, and I waited to go into labor on my own. Third baby, the same.  Fourth baby, we moved here, there were no hospital-based midwives, so I found a licensed midwife who came to our home to help us have our baby there.”

“Why would someone choose to not have pain medications?  It is painful to have a baby!” he stated, with much authority (at this point, I did question how he knew this, had he ever experienced it?  To which he conceded, no, but he had seen it a lot).  So I asked him this:  “Why would someone choose to climb Mt Everest?”

“That’s different,” came his reply, “I can understand that.  You want to see what you are able to
accomplish physically.  You are challenging your body, working toward a goal...”  My pulse-ox’d finger interrupted him, pressing, pressing on its imaginary quiz-show buzzer – or maybe it was my voice -- “DING DING DING! You got it!”

I couldn't see him because my face was covered, but his hands paused in their stitching.  “I…could see that,” he came around, slowly. The hands resumed their stitching.  “I am not sure what the big deal is about drug-free birth though.  There is so much pressure to have a natural birth, but we don’t have the longitudal studies that show epidurals, or even c-sections, have life-long health risks.” On the spot, under the cover of plastic-y-paper, I couldn’t think of anything incredible to counter with.  I did cite that babies born via cesarean birth have higher levels of allergies, and that was about all I could think of.

I joined him, then, because I do feel it’s the truth, “There is a lot of pressure for women to go all natural, I see that. It is very similar to the pressure we put on women to breastfeed  -- ”  Okay, this is when he cut me off!  

“ – But those stats are there, we know breastfeeding is beneficial, we have that information.” Interesting!  Super, hard-cord breastfeeding advocate, not so much on the normal birth platform! I decided, since I couldn’t present any compelling evidence-based studies or data from Cochrane, I would just keep it simple and stick with his line of thinking. “We are humans, though, and we know as mammals, breastmilk is the optimal, species-specific diet for our newborns.” He agreed.  "Doesn’t it stand to reason, then, that vaginal birth, as unhindered as possible, is the norm for us as well?  And even though we have the option for epidurals and cesarean births, that vaginal birth would provide the most optimal way for our babies to be born?” Honestly, I can’t remember what he said after that, only I know he wasn’t trying to refute anything.

The cover was lifted off my face and it was time for the nurses to step in and dress my wound.  As he stepped back to let them take over, he asked, “Are you a medical professional?”  I paused before my
answer, and then said, “No, I am a birth doula, a childbirth educator, and a La Leche League Leader.” He shook my hand, nodded his head to me, and then departed to fill out my discharge papers.

What fun!  It made all those 5 bee stings to the nose worth it. I can actually say, due to that conversation, I rather enjoyed my day at the dermatologist. The staff was incredible and attentive (and I am assured my scar will be minimal).  You never know where great birth conversations will happen! But the opportunity to have 20 minutes, one-on-one with a surgeon (albeit a derm surgeon), was pretty darn fun.

I had a cavity filled today.  I like my new dentist, he is a funny guy and his
staff is friendly -- they remember my name.  My dentist was chatting today about when he was a kid, he was always building things.  He decided he wanted to be an engineer, but once in school, a fellow engineering-turned-dentistry-student talked to him about becoming a dentist, and he changed his mind.  "I like being a dentist, but sometimes I think I should have stuck with engineering."  From my stand-point, or chair-point (lounge-point?), I see the fields of dentistry and engineering as pretty similar -- bridges are built in both, right?  He seems to think we should write a book together, about something important, I guess -- the topic is still undecided.  

I had a lower cavity filled, and my dentist made sure I was good and numb -- actually, my whole tongue was numb and half of my lower jaw, including the right side of my lip.  After he injected the medication, he asked me to keep my mouth open for a couple of minutes and to stretch the muscles, and also tilt my head to the right so the anesthetic could gravitate downward to provide better coverage.  Once he came back, and I could take the spit-sucker out, close my mouth, and then open it to talk, I shared with him that when a woman receives an epidural a similar anesthetic issue can occur.  After epidural placement, a woman is propped on her left side, and if everything is going well, she is left in this position indefinitely.  Gravity causes the medication to pool into that lower left side, leaving the right side less-anesthetized.  Have you ever heard from a woman, "My epidural only worked on one side"?  This could
be why.  My dentist agreed this made sense. 

There are ways to prevent this, something called "pancake-flipping," where we have the woman lie on her left side for a few contractions, and then we help her move to her right side for a few; next we facilitate a forward/hands and knees position, usually with lots of bunched-up pillows.  As mom keeps "flipping," it helps to evenly distribute the medication through her lower body.

I wanted an epidural with my first birth -- I had voiced that request loud and clear for months before I even had a hint of what labor would feel like.  In my case, I never received one.  In hindsight, I am glad for that, but at the time I was bitter.  Regardless, today I felt like my tongue had epidural anesthetic. (I realize, just as there isn't a specific "epidural" drug, it is a cocktail of different medications that can be changed according to an anesthesiologist's preference and a patient's needs, "epidural" refers to the specific spot where the medication is placed -- the epidural space is the sac of fluid that surrounds the spinal column.  Obviously this doesn't apply to my tongue.)  My dentist requested I move my tongue to the left so he could drill on my tooth a little.  I tried to move my tongue, but I was unsure if it was actually going anywhere!  "I can't tell ith I am moothing it or not!" I half-mumbled, half-dribbled.  I was instantly reminded of being with a past client who had a heavy epidural, during her pushing phase, and the doctor demanding, "Push!  You need to push!"  To which her confused reponse was, "I can't tell if I am pushing!?"

I do like my dentist, he is gregarious and puts me at ease; I think I will, however, give him six months to ponder over what we could collaborate on -- I am in no hurry to return back to the chair to get an epidural for my tongue.
 

My step-sister, Michele, had her first baby via cesarean birth. She was set up for an induction, and after many hours she heard the label "failure-to-progress." To the brain, induction sounds good -- let's get this show on the road. The  body doesn't always have the same plans, especially when a woman hasn't had a baby before. Even with the medications and procedures offered, the body may not make fast enough progress for the medical establishment. In these situations, a cesarean birth can become necessary.  

With her next baby, Michele wanted to try a VBAC. She chose a doctor who was comfortable with vaginal-birth-after-cesarean (although it required her to travel to a bigger city an hour away), and dreamed and planned for her son's birth. As Michele's confidence grew in her body's ability to birth her son vaginally, her fears of the pain and work of labor didn't ease. In order to cope with these intense feelings, she made the decision to get an epidural pretty early on in labor. 

Last summer Michele learned her family would grow yet again, and this time she was determined to step it up even one more level -- try for a VBAC with no pain medications. Although she chose her same doctor, she did make one change - she decided she wanted a doula to accompany her and her husband during this birth. That's where I come in!

Every baby and every birth is different, and this was no exception. Michele's labor seemed to drag on and on and on this time. I ended up at her house at about 3 am. It felt a lot like a slumber party, and we let her incredible husband take a nap in bed while we laughed and swapped gossip and stories. I knew we should try to get some sleep, seeing as how any time labor could pick up and we would all be exhausted, but we were truly having too much fun. We finally decided to try resting, but Michele wasn't really able to get any sleep.

The next day (or later that day) found us still puttering around their house, playing with the kids, watching movies (Puss in Boots, Toy Story, something else, I think, and then Baby Mama!). We were still waiting for labor to start rolling...we really had no way to plan for the baby-sitter, or my mom to travel to the hospital -- oh, and Michele's little sister just happened to be flying in that night, of all nights! And my mom was going to pick her up in the event we were off having a baby (Murphy's Law!). 

At one point during Baby Mama I had Michele stand through a contraction in a deep lunge position, and I asked her to switch to the other leg during the next contraction. It seemed after that, Michele's contractions really started to pick up. That silent energy that so often comes when the invisible switch flips on inside the mama was humming around us.  Michele was buzzing around, calling the baby-sitter, pulling together the kids' supplies, finding her shoes!  It was finally time to go!

We climbed into the car, Michele in the back seat and her hubby at the wheel (I had shotgun) and we hit the road. After about 75 minutes we walked into the hospital.There was a woman ahead of Michele in line, but the receptionist could tell Michele needed to be the priority! They quickly got us a room and let Michele start doing her thing. After an intense 90ish minutes of labor, Michele was holding her new, sweet baby girl!

And it was intense!  Michele was amazing. She coped in many effective ways. She moved around and changed positions. She verbally told us what she needed. She even prayed outloud (although she said at the time she thought she was praying in her head). I know it is hard to prepare for the unknown urgency of how labor feels, and Michele was able to take each contraction one at a time, focusing her attention on her loving hubby or me -- sometimes both! so she could keep her head above the water of the labor-waves instead of being tossed and turned about in the surf.  

I can't say how proud I am of this mama and her decision to seek something different in our not-very-supportive VBAC society. The fact that she challenged herself even more by deciding to work toward a birth free from pain medications is something I am also impressed by. It is scary to do something you have never done before, and armed with support and education, she not only set the goal, she achieved it. Michele, you are amazing! I admire and love you tons, and I will always remember the power and beauty you shared on the day your sweet little Reese was born.