Recently I was asked to doula a fellow doula for her upcoming birth. A close member of her family, who supposedly knows what doulas do, asked, "So Stacie is going to deliver your baby?" This pregnant doula was exasperated by the question, because she has explained many times to her family members (who have been her biggest supporters) what she does when she is hired by families -- and that is always punctuated by, "we don't deliver babies." Erica shines a new light on the answer to this question, and the idea to me is lovely and accurate.
Through almost a decade of discussions with friends and family, this has been the most frequent question asked: what DO doulas do? A loaded one. In the few instances where someone does know the word doula, I typically see generalized notions picked up from media, college, or that hippy-dippy aunt of yours that had her baby at home, such as labor and delivery support, birth assistant, maid, personal assistant, stand-in for unsupportive partners, etc. And while I could speak on the subject for days, I often find myself explaining over and over again how integral a doula can be in any birthing experience from a planned cesarean to an unmedicated home birth, even a high-risk pregnancy and loss of pregnancy. Doulas wear many labels, often times several: birth doula, postpartum doula, antepartum doula, bereavement doula, etc. This led me to find out what the leading experts say about the modern-day doula.
In the fourth edition of The Birth Partner | The Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions, Penny Simkin states:
"The [birth] doula is on call for you, arrives at your home or the hospital when you need her, and remains with you continuously, with few or no breaks, until after the baby is born. The doula is trained and experienced in providing emotional support, physical comfort, and nonclinical advice. She draws on her knowledge and experience as she reassures, encourages, comforts, and empathizes with the mother."
Ann Douglas, in The Mother of All Pregnancy Books, writes:
"[Postpartum doulas] offer a similar service [as birth doulas] during the postpartum period, providing hands-on assistance to new parents during the first few days or weeks of parenthood. Postpartum doulas are “jill of all trades,” who bring a range of different skills to the table."
The Doula Book, written by Marshall H. Klaus, MD, John H. Kennell, MD, and Phyllis H Klaus, MFT, LMSW, explains:
"…a doula needs specific skills and insights. A successful doula is comfortable with giving of herself and is not afraid to love. She also can enter another’s space and be highly responsive and aware of another’s needs, moods, changes, and unspoken feelings. At the same time, she is able to be flexible in this process, adapting herself to each mother’s needs, and has no need to control or smother."
Clearly, there are a wide-range of definitions available for a doula, and often times doulas vary in what they offer to clients and their families. I’m reminded of a term I learned while watching animated films with my husband and son: Inbetweeners. In animation, these are assistants to the animators that ‘fill in’ drawings around the key frames to maintain smooth evolution from one to another. Just like a doula, they do not control the story line (that’s left to the writers, directors, editors, etc.), rather they assist progression to accomplish the end goal of a successful film. In birth, doulas are the Inbetweeners.
Doulas do the inbetween work – applying counter pressure on mom while she leans on her partner, managing meal prep and household upkeep while mom, dad, and baby adjust to their new life together, offering words of encouragement during a challenging transition. She does not control your birthing experience. You may not see her in birth photos (just like we rarely notice credits for Inbetweeners), but she is there, assisting progression to accomplish the end goal of each mother.
Her face isn’t what you’ll carry with you. A birthing experience void of confusion, desperation, frustration, or regret is the ultimate service of a doula, and this is a passive one. She is dedicated to facilitating an experience as close to the wishes of the mother as situationally possible.
What DO doulas do? Everything inbetween.
Erica Verbeck, born and raised in Southern Indiana, is the owner of Doula the Damn Thing. She earned a Bachelor of Science in Communication and Culture with studies in Anthropology, Family Studies, and Early Childhood Education from Indiana University.
She values homeopathic restoration of our natural bodies through healthy diet, minimalism (work-in-progress), and unschooling her toddler. She works to balance her traditional upbringing with the ancient methods of our predecessors to enlighten her journey through pregnancy, birth, and motherhood.
When not playing with her young son or discussing birth and babies, Erica enjoys wire-wrapping jewelry and reading the latest research on pregnancy, birth, and parenthood. Through a mother's most intimate and primal journey, she hopes to build a trusting and informed birth experience for all who desire one. You can find her through her Facebook pagedoulathedamnthing.com, or her website, Doula the Damn Thing.
This woman had it all covered! Not only did she bring her own lighting to the hospital, she had a diffuser, and her own Tupperware rolling pin, the one you an put cold or hot water in! She was, in just about all ways, prepared. And she did it in a way that made sense to her.
Pink was the theme! She beautified my suggested birth plan template and framed it -- setting it on the counter in her room. Every nurse that came in stopped, ooohed and awwwwed over it, and took the proffered chocolate treats sitting next to the frame.
Knowing her husband might need important information to be easily accessed, she put a list of must-dos on the back of the front door, so nothing would be overlooked or forgotten before leaving the house. She also had a small photo album full of ways to support her, phone numbers, and small self-care steps he could take for himself.
A packing list was created so all items this woman wanted would be included. Then it was broken down even more to specific location, so others would be able to find what she was needing or wanting without digging into the wrong place.
Another photo album was filled with calming images the woman could look at during labor.
Does this seem like a lot of work? Or does it sound like your style? You don't have to be this thorough! The key is to make your plans in a way that speaks to your own sense of organization. In labor, we can utilize comfort measures that we are familiar with and turn to during times of stress or discomfort -- we don't have to learn a lot of new-fangled coping measures that might feel unnatural or hard to remember. It works the same way when getting ready for labor and birth -- rely on an organizational strategy that feels good and works for you!
Anne is one of my most favorite doulas in the world. I wish we still lived close to each other so we could work together. She has a different way of looking at things, which makes them more memorable and easy to understand. I thought this post was a great one to end on -- it shows how we can let go of the discomfort that might normally accompany us when it comes to being around and touching others -- as doulas, this is what we do. Enjoy, as Anne shares how she bursts her bubble.
I worked with somebody once that had a definite “bubble” of personal space. It was kinda fun to subtly test the limits of those boundaries. I finally determined, through months of occasional observation and experimentation, that the space was 3 feet. Step, even 1-inch, into that invisible 3-foot force-field, and my subject would move away to reestablish the 3-foot bubble.
I, too, have a bubble. When it comes to supporting a woman in childbirth, I temporarily deflate my bubble to support my client AND the rest of her support team. Conversely, I understand that my client may also have that bubble. So, how does that work in such a short amount of time and in such an intimate setting?
In a combination of ways. Conversation, empathy, care-taking, simply being, and sometimes, sleep deprivation.
Conversation and sleep deprivation Labor room conversations, at least the ones influenced by my quirky personality, can be hilarious. The people in that labor space learn things that –- well, let’s just say that things that happen in the labor space, stay in the labor space. Humans are social. Somebody has a story about skunks, everybody else has to share their story about skunks or some other wildlife interaction, which leads to some other topic like nudist colonies and the technicalities of furniture cleanliness in regard to naked rears. Sleep deprivation just makes it all that much more entertaining. People start shlurring theyr wors an mis..misum.... an people don hwere tings wite.
Empathy I have huge amounts of empathy. The people that have chosen, or have been chosen, to be in the labor space care about the mama in labor. We all want to make the experience easier in whatever way we can. We cheer her on, we give her water, we massage tense muscles, and tell her how beautiful she is. We acknowledge her perception of her experience and help her to see the big picture. We all get giddy when her efforts culminate in 10 glorious centimeters of openness. Pushing is the best. Everybody breathlessly tells her that is the way, just like that, good job…and we grunt and we hold our breath and we push too!
Care-taking The bubble slowly deflates with a soothing of a brow. Light massage. As labor intensifies, the bubble deflates completely. It becomes all hands on deck. Time for position change; one person holds IV lines, another person holds the blankets for privacy screen, another person changes the chux pad, another person physically helps mama roll, the person holding the IV line passes a pillow to the person helping mama roll, the person holding the privacy blanket then wipes mama’s brow with a cool washcloth, and the nurse readjusts the baby monitor-ducking under the person giving the mama a sip of water. All bubbles deflated, we are all up in one another’s business!
Simply being Probably the most important. The care team for my client become protective. We hold the space, her privacy, her concentration, her focus, her rhythm, her ritual, HER ever-evolving strategy for bringing forth her infant into this world. In the early stages of labor, a knock on the door is a welcome distraction. In the final stages, a knock on the door is met with looks of annoyance and protective aggression.
Birth is a short, intense, intimate journey. Some are “mush longer den udders.” Sleep deprivation joke, get it?!? Guffaw, snort! Emotional support begins long before labor begins. Physical intrusion into the bubble is typically a gradual process, becoming more involved as the intensity of labor calls for more support and the temporary removal of the bubble. Informational support never ends. Doulas aren’t medical experts, but we are quite familiar with the key terms to know in the chapter of life called the Journey to Parenthood.
Anne is the youngest of 6 children, which is probably why she gets along well with people. She also grew up on a dairy, which is probably why she gets along with animals. She has two daughters, and is a volunteer 4-H Community Leader. She was one of the original creators of the Chico Doula Circle, volunteered for a hospital-based doula program, and offers gratis support to expectant teen moms. Anne is currently waiting with bated breath to see if she passed the Lamaze Exam to be a Certified Lamaze Childbirth Educator. Find her at Happy Pushing or on Facebook.
This post was born from a Facebook comment Sejal made about not understanding why professionals are hesitant to share their knowledge. I asked her if she could think about it and share something for the 31 Days project. Sure enough -- she gives her back story, and then shares how fortunate she has been to be mentored by amazing, open IBCLCs.
A few days back while I was in the hospital visiting a friend of mine after their surgery, I saw a family with a brand new baby heading home from the hospital. As I walk past them, I see a lady walking next to them, pushing a hospital cart filled with a few balloons and flowers resting on top of a couple of Trader Joe’s reusable bags and a duffel bag.
This brought back so many memories of my own discharge from the hospital I gave birth at and how it was a cold December morning that we walked to the parking garage with our newborn daughter dressed in a red fleece dress and buckled up in her car seat. I don’t think we realized how cold it was for her tiny little feet to be outside in the breeze.
My baby girl was upset with the draft of the cold breeze and I was so upset with her crying as we tried to get her into the car. Fumbling through the seat belt and a bunch of other stuff to keep her warm, we managed to at least get out of the parking garage. I sat down in the front passenger seat (mind you this was the one time I hated sitting down because of the perineal pain). If I had known what I know about mother infant separation and how I could have been closer to her and kept her less stressed and more warm by being in the seat next to my daughter I would have been able to keep her calm. But what did we know as new parents, apparently nothing, but as they say ignorance is bliss and bliss we did feel when we had her in our arms after a long traumatic birth.
Here we were leaving the hospital, embarking on this journey as three of us instead of two of us, completely oblivious to what was ahead of us. The drive home was not too pleasant and every bump in the road was causing me pain. It felt like I was hanging on to the handle on the inside of car so I did not have to put any pressure on my perineum. At home my kind and loving parents were waiting for us to get home with our little nugget. I just wanted to lay down but the pain was too much and by the time I reached home, my feet had gotten half a size bigger. I still had no idea what was going on. I could not walk properly or sit properly and then the idea of breastfeeding my baby without any help from the nurses seemed daunting. My mom was really willing to help and she did try but somehow my daughter could not latch without a nipple shield. Also no one at the hospital had shown me how to breastfeed my daughter lying down and that was a completely foreign concept to me. Every time that my little girl needed to breastfeed I would sit upright in my bed, get my Boppy pillow ready, cover it with a receiving blanket to protect the pillowcase (mind you I was a clean freak back then) and have my mom bring my baby to me to feed, and every time she tried to latch, either the nipple shield would fall off or she would accidentally whack it out of place and then the whole saga of a screaming baby and flailing hands and crying mama would begin.
By Day 3, my breasts were getting engorged and my feet were super swollen. I could not walk to the bathroom, which was only 10 steps away from my bed. I called my OB's office and they said I needed to come in as soon as possible because they were not sure what was going on with my swollen feet. When my OB came in and saw my face, my feet, and my hands, she smiled and said, “You look like the Michelin Man”. I was unfamiliar with who the Michelin Man was but figured it was a character out of some movie. She gave me a script for diuretics and sent me home. She did not even tell me that the number of times I would need to get up to pee would be exhausting in and of itself. I came home and breastfeeding was still difficult for me and my baby. I kept using the nipple shield and having the struggles. I went to develop mastitis and had a really high fever which put me into a delirium. I kept telling my mom, that she should take care of my baby in case something terrible were to happen to me. The pain with breastfeeding was excruciating and I was feeling like I was going to die.
The doctor’s office called in a prescription for antibiotics and I started them immediately. They told me to use the manual pump that I had to relieve any engorgement. I ended up using the nipple shield for 3 months before I went in for a lactation visit at our local hospital where I met a lactation consultant who helped me breastfeed my baby for the first time without a nipple shield. I had never pictured myself not using the nipple shield.
Fast forward my life 10 years and now I was a veteran mom who has helped her friends through their postpartum journey, and my kids were growing up and I was doing the best I could to fit this mold of a supermom, partly created by the expectations of the society, the family and myself. Due to a life event, I had to make the choice of going back to school to get a vocational certificate that could get me a job and somehow I chose to go to nursing school. I became a CNA and then started taking my prerequisites to apply for nursing school. I was also working as a CNA at a private nursing home. I worked 4 half days and learnt so many things on the job as well. During my year as a CNA, my younger sister who was pregnant at the time sustained a fall and broke her leg. She could not move and had to have surgery. She had to stay in bed until her baby arrived and I left my job to care for her. She had her baby and I was there to help her during her postpartum recovery and so were my parents. She was having breastfeeding troubles, her baby was not gaining weight very well and had jaundice. The hospital lactation consultants came and helped as much as they could and then we went home.
The breastfeeding continued to be a struggle and she had to start supplementing with formula. We tried to look for someone who could come to her home for a lactation consult and finally found a lady who did. The lactation consultant started her visit and I was a mute spectator in the room, and all I could think was, who is this person who is so knowledgeable about breastfeeding and was able explain everything to us so clearly? Her name was Meg Stalnaker. Why did I not meet her when I had my first baby ? I absorbed and listened to everything she did and said, as did my sister and brother-in-law. I just had a lightbulb moment. I wanted to do what she does. That was it. I did not want to be a nurse. I wanted to be a lactation consultant. I talked to my sister and she told me that I should ask for the contact information for this angel who helped her. I don’t know why, but I did.
I kept doing my own research about what classes I needed to take and signed up for them at the local community college. I kept in touch with the Meg via email. After I finished my community college classes, I contacted her again and asked her if she could be my mentor. She said yes, but there was a caveat. I needed to wait until she finished mentoring two other students she had at the time.
I was really sad that there was not enough guidance on how to find mentors for the pathway I had chosen to become an International Board Certified Lactation Consultant. It also felt like there were a lot of negativity in regards to choosing to become an IBCLC as a career. I kept looking to see if someone would be interested in being my mentor and taking me on as a student.
During one of my lactation classes at the community college, we had a guest speaker by the name of Peggy Andrews, who was giving a lecture on the topic of jaundice and breastfeeding. I saw a tall woman with golden and white hair walk into our classroom with a smile. She had the brightest smile I had seen on someone’s face. She started the lecture and I was just mesmerized by her way of teaching and felt like I was back in India in my middle school, listening to my favorite biology teacher. At the end of her lecture she shared her email address with our class and something in my head said, “Sejal, you need to email Peggy and ask her if she could be your mentor.” I mean that was a spur of the moment thought and I acted on it by sending her an email asking if that was possible.
The next moment I thought, oh boy, have I made a big mistake by asking this guest speaker to be my mentor. I was hoping that I would get an email saying how inappropriate that question was. To my surprise, I hear back from Peggy saying she loves to mentor students. I was cooking and jumped up and down in my kitchen saying, YESSSSSS!! Wait that is not it, I actually got a call that evening from Peggy asking me if I wanted to go on a lactation visit in Washougal the next morning. I said, I most certainly would, but then I thought, where in the world is Washougal? Well it is in our neighboring state of Washington.
The next morning I meet Peggy at a designated location and she said to me that she will be driving me to the appointment since it is so far. I was so excited and off I went on my first official visit. I started learning about how to talk to a new mother, ask specific questions and give her plenty of time to tell her story. We were there for an hour and a half and I felt like I still made the right choice by asking Peggy to be my mentor. I have learnt so much about being a good listener from Peggy.
I never for one moment thought that Peggy was keeping any information from me when it came to lactation. I had asked a few other local lactation consultants and they said that they don’t mentor students and I was quite discouraged. I am sure other students like me were discouraged as well. Meg, also let me go on a few lactation visits with her and I kept learning from both Peggy and Meg.
One day I saw a class on hand expression at a local boutique taught by another lactation consultant named Bryna Sampey. I immediately signed up for it, and when I went to the class I was secretly happy that I was one of the two people in class, although I also felt sad that people did not sign up for this informative class. I felt like I had learnt so much about manual expression of breastmilk in this class and that little voice in my head said, “Sejal, ask Bryna if she would mentor you.”
After the class, Bryna asked if I wanted to have a bite to eat at the place next door. I jumped at the opportunity to hang out a few more minutes with this brilliant brain. I was practically salivating. We talked about what I did as a postpartum doula and how I was studying to be an IBCLC and she mentioned to me that she also mentored students. I almost wanted to give her a hug and say, where were you a year ago and why did I not meet you earlier. I did not want to be a total psycho so I did not hug her, but told her that I would love to be her mentee. She said that she would let me know as soon as a spot opened up.
What I learned from Bryna and her brilliance made me think critically about breastfeeding and the challenges that come with it and how she made breastfeeding a breeze with all the techniques and tricks that she shared with her clients. As I followed these three amazing women, as my mentors, each one of them taught me how to help with breastfeeding challenges in their own special ways. I feel blessed to have learnt from them and will be eternally grateful for them sharing their wisdom, knowledge and time with me.
I was talking to other lactation students like me one day, who were in the same boat as I was and one of them told me that when they asked a local IBCLC to mentor them, the local IBCLC said to them, and I quote, “Why would I let you shadow me ? You will take my knowledge and compete with me once you get certified.” I was so shocked to hear this. I have no idea who the IBCLC is and don’t even want to know, but it made me realize how fortunate I was to have mentors like Peggy, Meg and Bryna.
With the struggles I had in finding mentors, I had decided in my mind that if I ever become an experienced lactation consultant, I will mentor students. I am an IBCLC now, and I am a brand new IBCLC, but I hope to someday mentor students. I think it is our responsibility as professionals to mentor the future IBCLCs. My dad used to say, knowledge only increases by sharing. He is a brilliant surgeon and he has helped many other doctors become surgeons and I am certain he never thought this way.
So, why do some people have a hard time sharing their knowledge with others who are seeking mentorship in the field of lactation consulting ?
Maybe the experienced professional does not have the time or the resources to mentor someone. Maybe the experienced professional thinks that, sharing their knowledge with newbies will reduce their chance of personal success.
Maybe the experienced professional does not trust this newbie. Trust building does take time.
Maybe the experienced professional in the specific field is a knowledge hoarder.
Maybe the experienced professional wants to have monopoly in their field.
Maybe the experienced professional feels more powerful if they don’t share their knowledge.
Being a mentor and taking on mentees is also a huge responsibility and one that is not easy. I understand that it may be difficult to take on students, but in the field of lactation consulting, I wish we had more mentors. I wish students had access to mentors without having to wait for a long time. I wish experienced IBCLCs would be willing to share their knowledge and expertise with them.
Mentors are an inspiration. Mentors can connect you with opportunities. Mentors know ways to make you succeed professionally. Mentors keep you motivated. Mentors invest their time and energy in you to help you grow. Mentors teach you about finding a good opportunity. Mentors have been where you are and can empathize with your struggles and help you find your way through the obstacles and hurdles. I am so thankfull to have found such mentors who continue to be there for me and do not feel threatened by my success.
Sejal Fichadia, owner of Kindred Mother Care, is the first 31 Days participant to be featured four years in a row. In 2014 she wrote "Our Culture's Needs for Postpartum Doulas," in 2015 she added "Growing Happy, Healthy Moms." Last year she added "Hitting the Pause Button." She has a love for babies and mothers, and feels it is important to help families learn skills to help them on their parenthood journeys. Sejal works hard at expanding her education and working to improve her knowledge base so she can provide families with up-to-date, evidence-based information, which in turn gives them the tools to parent with confidence. This year she passed the exam to add IBCLC to her credentials. She has a caring heart, and as soon as she can, she will be mentoring others wishing to get to IBCLC.
What do you remember of yor births? Are there thing you would change? Things you are surprised you did that didn't follow what you learned about or expected? In this feature, a doula shares her birth story with additional hints and advice as seen through her professional lens -- what a great idea!
On my first born's 6th birthday, an idea popped into my head to share the story, but this version will be injected with Doula Tips and new discoveries I’ve made since being a natural health educator.
When you get to know me, you know that I’m a big planner. Fortunately, we got pregnant the first month of “trying”. I took the pregnancy test in the morning, saw the + sign and danced with delight. I brought the test into our room to share the news with my husband. We instantly prayed together to thank God that pregnancy happened easily, and asked Him for health and well-being. I didn’t experience morning sickness. There were a handful of times I needed to vomit in the morning, but as soon as it came up I was ready to rock ‘n roll. I figured out that I was taking my prenatal vitamin on an empty stomach, first thing in the morning. DOULA TIP: purchase a natural prenatal vitamin.
One issue I experienced was the increase in headaches around the beginning of the 2nd trimester. My midwife advised I needed to drink more water. I remember one day driving home from work, and I had to pull over and vomit in a plastic bag because my headache was throbbing. Ouch + ick. The headaches didn’t last long. DOULA TIP: essential oils can address head tension. I wish I knew about them when I was pregnant the first time.
I have fond memories of prenatal yoga. It was so fun being surrounded by other mommas and baby bumps. Another great experience was our antenatal childbirth education class provided by BirthCare. It’s a 6-week class and they structure it so you have a coffee group once all the babies are born. We met weekly for about a year (when we all went back to work). To this day, these mommas are some of my favourite people in the world and I miss them dearly. DOULA TIP: create your supportive group of peers while pregnant.
Her due date was Friday … but she arrived three days early on Tuesday.
I woke up before midnight to use the restroom and when I wiped there was a “bloody show”. Exciting! There were mild tightenings, so I went to the living room to watch the wall clock. Sure enough, those tightenings were coming and going every 10 minutes. I remember our midwife telling me to sleep at night and not wake my husband (if at all possible). DOULA TIP: let your partner sleep and you really need to sleep too!
Back to bed I went to try to sleep, but let’s be honest, this is an exciting moment. I laid in bed, took a nap, then eventually woke Brad around 3am. In his delirium, he started to pack and wanted to throw things into the car. I laughed at him and just told him to calm down because it would be a while before going to the birth center. Brad started to time the contractions. We got ourselves organized, packed the last minute items, made some toast and a smoothie, and walked around the house. At 7am, we called the midwife to tell her what was happening. She encouraged us to keep moving at home and call when the contractions got closer together. I got into the shower, washed my hair, shaved my legs. I had rented a TENS machine, so we tried that around 9am. This was not comfortable for me, so we ditched that. Bummer that we wasted over $100 to rent it. DOULA TIP: ask your maternity provider about TENS because this can be an effective pain management tool for you.
We put on a Grey’s Anatomy as a distraction… do you remember the theme song? When you play the DVD, that song just keeps rolling over and over again until you press “play” so that was on in the background as the contractions started to get more intense and closer together. My husband was amazing. We found a groove of him massaging my lower back during the contractions.
After talking on the phone again with our midwife, she agreed it was a good time to head to BirthCare. We arrived around 11:30am and she said I would probably have to leave because I was smiling upon arrival. When she did the vaginal exam, I was 6cm dilated. She filled up the birthing pool (huge, Jacuzzi style tubs in the birthing room). I noticed that she dropped a couple drops of something in the pool. Later on, I found out it was clary sage. She is amazing. I didn’t know of essential oils back then, but I was so glad she used it in the pool. We got settled into the room and kept moving/ massaging/ going in and out of the pool. My midwife provided a carrier oil (probably sweet almond oil) for my husband to use on my back. DOULA TIP: I always have fractionated coconut oil in my doula bag when I attend births. A carrier oil helps hands to glide smoothly on momma’s back, even in water.
Both of our girls were born at BirthCare, Auckland – a primary birthing center across the park from Auckland City Hospital. No doctors, no epidurals… just large birthing rooms with pools and midwives and oxygen/ gas if needed. My main motivation for birthing here was that if you birth here (instead of the hospital), you get to stay in a PRIVATE postpartum room for three nights. Everyone else has to share a room with another momma + baby, or pay a ton of money for a private room. Looking back, the other part I love about BirthCare is that there wasn’t anybody else coming and going (no nurses, no lab techs). It was just Brad and Christine as my birthing team. It’s like a home birth, just in a comfortable space with more tools (and the freedom to leak blood and fluids and water from the pool/ shower all over the place). DOULA NOTE: find a birth space your are comfortable with
At some stage, my water broke (but I didn’t feel a pop or gush). My midwife noticed leaking and some meconium coming down my legs. Darn. She did a great job of protecting me from this information. She mentioned it, but did NOT say it was an “issue”. She let me keep labouring comfortably. My husband kept massaging my lower back. He only missed two contractions during the whole labor experience. What a champion. His hands must have been so tired. My midwife was on the phone with the Charge Midwife up at Auckland City Hospital. She was checking in with her decision making to keep me at BirthCare as she monitored the meconium situation. There was potential that I might need to transfer up to the hospital since meconium can be dangerous for baby. Did you know that I didn’t need to be on the fetal monitor until towards the end of my time in the birthing room? We used a doppler to check baby girl’s heart rate while I was moving in the pool and around the room. Due to the meconium, I was hooked up to the electric monitors to make sure Madam Blueberry was safe. DOULA TIP: you can request intermittent, portably fetal monitoring if birthing in a hospital.
I started to feel the urge to push! A couple of deep growly grunts were let out because I could feel my body taking over. I wasn’t fully dilated yet. So my midwife gave me some oxygen to breathe deep and regain control. The entire birthing experience was very calm, quiet. At this stage, I was up on the bed being monitored. I was checked again and given the go ahead to push. Another midwife came into the room to assistant mine. They had my legs up and coached me to “bear down” to push. My midwife wanted to get baby girl out as fast as possible because of the meconium. I was still oblivious to this being an issue. I took deep breath and pushed so hard that I burst a blood vessel in my right eye. Yikes! DOULA TIP: I now suggest that mommas “breathe” the baby out and spontaneously push instead of “bear down” coaching that most nurses and care providers use. But every situation varies.
Because I was so internally focused, I wasn’t honing in to my midwife's voice. With the last push, baby girl’s head came out at the beginning and I didn’t hear my midwife telling me to stop pushing… so out came the rest of her body all in one fast swoop. Whoops. That’s how you get tearing. DOULA TIP: listen to your lead maternity carer’s voice right at this moment. They are there to protect your perineum.
Baby girl was instantly placed on my chest for skin-to-skin time. She was born at 4:50pm, about 16 hours after seeing the bloody show. Talk about love at first sight. Whew. I didn’t know I could love a creature so much. It’s like loving a pet only times a billion. Baby girl was breathing fine -– she did have some meconium on her, so they wiped that off. My husband cut her cord, then my midwife waited for the placenta (we took it home and planted it below a lemon tree) and started my stitches. We started breastfeeding right away. I was able to take a shower in the birthing room before waddling over to my private postpartum room. Stitches on your bottom are sore. DOULA TIP: I recommend a blend of helichrysum and frankincense essential oils to help with perineum healing.
I felt so loved and safe and cozy in our room after that epic experience. BirthCare is like a hotel with midwives. The food is delicious and plentiful, the midwives help you establish breastfeeding, and there are educational video streams on the TV in your room. It makes me so upset that mommas of O’ahu don’t have access to the same maternity care experience covered by insurance. You can hire a home birth midwife and pay out of pocket for a similar set up. I count myself monumentally blessed to have been living in that part of New Zealand with my incredible midwife and our amazing natural birth experience at BirthCare. After three nights there, we headed home with our treasure. My midwife visited us at home for the next 6 weeks to check on my stitches, help with breastfeeding, and track Madam Blueberry’s growth. We did well. My husband had two weeks off work, then Mom and Dad came from Hawai’i for two weeks. We cherish this birth story and are so grateful to our midwife and all the midwives at BirthCare. DOULA TIP: postpartum blues are normal and the American maternity system is NOT mom-centered. Ask for help. A postpartum doula can provide references to services and can support you with newborn care, routines, sleep solutions, etc.
Jenna Clarke is a doula in O'ahu, Hawaii. She is the owner of Malama Momma, where she shares "Mālama" is Hawaiian, and it means, "to care for, to protect." Jenna provides labor and postpartum doula services, as well as lactation support and education. She is the happy mother of two little girls, born in New Zealand. Jenna and her husband are passionate about natural health, the importance of reducing toxic load, the science and pathology behind illness, and how to treat illness with plant-based therapies, whole food, exercise, and reducing toxic exposure.
I once wrote how teaching about birth is like selling a house. I was happy to see Joyce's comparison here, and even happier how her points lined up with reality. We hear many analogies for the roles doulas hold. I think this one stacks up well -- what do you think?
Although doulas are increasingly popular additions to the birth team, not everyone is clear on what they do for a birthing family. There are several useful analogies out there, but the comparison of a doula to a real estate agent is less discussed. So here is my attempt, 10 ways a doula is like a real estate agent!
1. The doula's goal is the client's goal.
Just like your real estate agent is not searching for his/her perfect home, your doula is not pushing her perfect birth onto you. Your doula will get to know you before your birth as much as possible, so s/he knows what you want in your birth.
2. Your doula can help you navigate your options.
Your real estate agent knows her/his local real estate market, just as your doula knows his/her local birth market. Your doula can help you find the best birthplace to fit your desires, just as your real estate agent can help you identify your ideal neighborhood.
3. Your doula is up-to-date on the current market.
Your real estate agent will know how properties are selling currently. Your doula will be familiar with local maternity care.
4. Your doula knows what to look out for to help you have a positive birth experience.
Just as your real estate agent knows what items to ask for on your offer (the appliances!), and whether or not the cracks in the plaster walls are something to fret about, your doula will know what questions you need to ask in order to make informed decisions.
5. Your doula is trained and experienced in the field.
Even a brand new doula without children of his/her own has received extensive training in both normal childbirth and its variations and complications, and in caring for childbearing women. Just like a real estate agent has been trained in navigating the real estate market.
6. Your doula will support you if you change your mind about what you want.
Just as your real estate agent will continue to help you if you change your property search criteria, no matter your reasoning, your doula will support you if you change your mind about choosing that hospital, or planning an epidural, or having a waterbirth.
7. Your doula will offer his/her advice, but you are the decision-maker.
A real estate agent will offer her/his advice when pricing a property, or writing an offer, but you are still the one making the sale or the purchase. Your doula will remind you when you stray from your birth plan, but this is your birth, and your baby.
8. Your doula knows where to go for complementary pregnancy and birth services.
Your real estate agent knows the title companies in your area, the lenders, the exterminators, the inspectors, and has worked with them before. S/he can help you find a reputable professional in your property-selling/purchasing process. Your doula knows the chiropractors, the accupuncturists, the prenatal yoga instructors, the lactation consultants, the babywearing groups, the back-to-work support groups, in your area, and can help you find perinatal professionals in your area to help you.
9. Your doula will walk you through the entire birth process.
Just as a real estate agent will assist you through the entire purchase or sale, your doula will help you from the earliest inklings of Birth Day through the first couple of hours postpartum. Whether her support is over the phone, email, text, or in person, your doula is supporting you the entire time.
10. Your doula follows up with you after your birth and helps you adjust to your new family.
Your real estate agent will follow up with you after your sale or purchase to make sure everything continues to go well, and answer any last-minute questions. In the years after your property purchase, you can even contact your realtor for referrals on remodeling projects! Your doula is the same way. Just because your contract period has ended with your birth doula does not mean you cannot contact him/her again! For example, the definition of postpartum depression is any depressive symptoms in the year following the birth. Your doula wants you to be well, go ahead and reach out to her if you need anything.
Joyce Dykema, MSc, CD(DONA), HCHD, became a certified birth doula in May 2012. She is also a trained Hypnobabies® Hypno-Doula, volunteers as leadership for ICAN of Lincoln, and is an Evidence Based Birth Instructor. Joyce is a woman-focused doula. While passionate about natural birth and what research shows is the best for moms and for babies, the goal she strives for with every client is for women to have empowering and positive births, as the woman defines it. In addition to her doula credentials, she holds a BA in psychology and an MS in biological sciences. She breastfeeds, uses cloth diapers, uses baby sign language, babywears, and homeschools because these choices made sense for her family; she encourages others to explore and find what makes sense for their families. Joyce and her husband have three children, and live in the Lincoln, Nebraska area.
If there is one thing I love, it is helping other doulas get started. There are so many aspects of doula work left to individual preference and style -- it can be beneficial to watch and learn from other doulas as you discover your own shape. The first time I was able to shadow a doula, it was accidental. I was hired by a family, along with a second doula, because both of us had prior scheduled events near the due date that we couldn't miss. The offer was then extended: If you are both available then you can both come and support our birth. As luck would have it, we were! Although I had plenty of doula experience at this point, it was my first time in a new hospital; the other doula was generous with her knowledge -- I couldn't help but grow in many ways thanks to her openness to share all kinds of things with me.
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!):
Best of luck to you and your students! If you need a mentor, I’m here!
Teri Nava-Anderson, PhD, CD(DONA), ICCE has been assisting pregnant people and their families through their labors since 2008. She is the CEO and founder of the Harmony Doula Group and co-founder of the Modesto Doula Group, both private practices dedicated to community education, mentoring new doulas, and advancing “mother/baby-friendly” practices in local hospitals. She has been teaching advanced doula training classes since 2012. Teri is the Northern California Regional Representative for DONA International, and the Board President of Mt. Diablo Doula Community.
I'm sure we have all heard different myths about doulas -- whether it's thinking doulas catch babies like midwives, or they come together to dance beneath the full moon -- there are a lot of misconceptions out there. Becky amazes me -- not only is she a comic genius when it comes to doula humor, her graphic art choice is the perfect medium to convey her message. She addresses common myths about doulas, and leaves us full of happy feelings for the work we do.
There is often confusion over what a doula is. Many times I have talked with couples nervous about a doula possibly taking over their birth. They are afraid that a doula may guilt them into a certain type of birthing. To add a little silliness I have illustrated examples below with my subpar Window’s Paint skills. These show the differences between someone that will fight against your birth, a duel-a you could call her, and a doula, or birth support for your choices.
This may be new to you, but doulas are not just for natural birth. They are for anyone wanting more support for their birth. Doulas are helpful in cesarean births, medicated births, natural births, hospital births, home births, single parent moms, and so much more. Whether you have a plan or not, we are here for you, no light sabers involved. Note: In the odd case that you want light sabers at your birth, we can help you with that. We do not discriminate against nerds; we just won’t use them to stop your choices.
The next concern often had regarding doulas: "But I want my husband involved. I want him to intuitively know what I need.” If he helped start this baby business, then it totally makes sense to want him right there involved in the birth.
Can I tell you my secret? We LOVE it when dads are hands-on and involved. It is our biggest goal to facilitate the best connection between you and your partner. We know that dad helps get the oxytocin and birthing hormones going. Some men need a little direction along the way. They are new to this. Our job isn’t to replace dad, it’s to help him help you best. If dad isn’t there this works the same for grandmas and friends. We will not erupt in flames if someone else gives you counter-pressure.
I met with a doctor today. He was a little on-guard, and he felt the need to explain how he goes out of the way to help his patients. Sadly, too many providers have met some kind of duel-a, or have heard stories of them. All he knew was that I was a doula and he assumed that I had a negative view of him as a doctor. In reality, I have yet to meet a provider that did not want the best for mom and baby. Sometimes they have differing opinions on care, and different points of view, but they all care. Doulas are not out to defy anything medically related. We need the medical team so that we can focus on emotional support and comfort for mom and the family.
Doulas work with mom’s birth team to help her best reach her desires. Doulas will encourage you to choose a provider that you feel you can trust that you can work with together. They encourage mom to ask questions, find evidence-based information, think over benefits and risks, and if needed, help mom stand up for herself. Our job is not to have a show down with the medical staff. Our job is not to speak for you. Our job is to help you get the information you need to make choices, and to support you as you speak for yourself.
I am not a duel-a. I am not out to fight or prove anything. I am a doula -- a supporter of women, babies and families.
Becky Hartman serves as a birth, postpartum, and bereavement doula, birth and pregnancy photographer, Benkung belly binder, and energy worker. She has been shaped by her own births, and the realization that education factors into creating an empowering experience. Becky strongly believes women can follow their hearts and they will know the decisions that are right for their situations. She encourages families to learn, explore, develop ideas, and then go with the flow of their birth experience. Becky lives with her family in Clearfield, Utah.
When it comes to doulas and the support they offer, I'm a sucker for a good, old fashioned, positive birth story! Today's feature is just that. I also appreciate how Dorothy shares she did all she could to prepare herself for birth, yet she still credits luck and genetics for her experience, because when it comes to birth experiences, we don't always get to pick how things will go.
“Why are you still working?! Your due date is next week, what if your water breaks while you’re at work?”
“Oh that’s not going to happen to me, they do that in movies for dramatic effect. In real life, the water breaking in a gush only happens to about 8% of women, that won’t happen to me, I will be fine”
This was a conversation between myself and my good friend Jammie one week before my October 13th due date with my first child. I had an easy pregnancy, no morning sickness or vomiting, and I had not taken a single day of work off the entire nine months. I manage an office, it’s not physical work and since I had felt fine, I felt no reason to stop working even with my due date right around the corner. I wanted to maximize my time off after the baby arrived. Little did I know, I was about to be one of those 8%...
On the morning of October 14th, one day overdue, I awoke to my dog barking. She doesn’t usually bark at night unless she needs to be let out to answer the call of nature. I groaned internally. “Ugh, it’s 2:30 a.m., I don’t want to get up and let her out,” I complained internally. Then I thought, well I probably have to pee anyway, it’s only been an hour since last time I peed and everyone knows how often pregnant ladies need to pee. I heaved my big, pregnant belly up and began walking to the bathroom. "Oh, I guess I really had to go," I thought, as I felt fluid trickle. By the time I got to the bathroom, there was a gush and a lot of fluid. Apparently my water had broken, signaling that the arrival of my baby was imminent. I called to my husband and told him to get up and let the dogs out while I cleaned up.
The first call I made was to our doula. I had made the decision to hire a doula fairly early in my pregnancy, and she came highly recommended from a mother of 6 that I have known my whole life. I hired a doula because I was afraid of having a hospital birth, I was afraid of being forced into taking unnecessary medical interventions during labor, and afraid of being bowled over by a medical team that had never met me, knew nothing about me or my baby, and didn’t know what I wanted from my birthing experience. I envisioned an intervention-free birth, preferably at home, with a midwife. My husband, rightly concerned with my health and that of our unborn baby, objected to my home birth plan and preferred a hospital setting. The compromise came in the form of our doula, who I wanted to help me through an intervention-free hospital birth.
“My water just broke, should I go to the hospital?”
“How do you feel? Have your contractions started yet?”
“I feel fine, I am not in pain and having no contractions yet.”
“It’s up to you whether or not you’re ready to go to the hospital. However, it can take some time for the contractions to catch up once the water breaks. Since your water is broken, if you do go to the hospital, it's likely they won’t allow you to leave once you’re there.”
“Ok, well I don’t want to go too early, I think I will wait a while and go later. I should not go to work though, right?”
“NO!!! Do not go to work, and keep me updated.”
After getting off of the phone, I called my mother and told her the news. I told her I wasn’t going to the hospital yet and I didn’t expect the baby to arrive for several hours, probably not until late evening. I expected a long labor, everything I had heard and read said that most first time mommies have a long labor so I was prepared for a marathon. With this in mind, I decided to go to work. This decision was made because I knew I couldn’t get someone to cover me, I work at 4:30 am, and I just planned to go briefly to give a quick morning meeting and inform my staff that I would be out until the end of my maternity leave. My husband got dressed and drove me to work, and I was there for half an hour before we left and drove through McDonald’s for breakfast to be fueled up for all the work ahead of me!
At home around 6:30 am we both laid down, I wanted us both to try to get some rest for the long day ahead. I was having minor contractions at this point, 15-30 seconds long and 5 or so minutes apart. At about 9 am I sent my husband to drop our dogs off at a friend’s house. My contractions had increased in frequency and length but I was still not ready to go to the hospital. I was texting our doula and asked how long I could safely wait to go to the hospital? She said it was up to me how long I felt safe staying home, and she advised me to contact my doctor for an appointment to check my progress. If I had progressed enough, I could go directly to the hospital, but if I wanted to go back home, I could do that too. That sounded ideal to me, my doctor’s office was located in the parking lot of the hospital I would deliver at.
This is why I wanted a doula and why I decided to go with our doula specifically; she listened to me, asked me how I felt, and asked what decision I thought was best for me. Essentially, she helped me to decide for myself instead of just telling me what to do or what she thought was best. From our prenatal courses, she knew my concerns about having a hospital birth and advised me with that in mind. Our doula knew that I was concerned about going to the hospital too early in labor, and that I was concerned about having my movement in labor restricted by monitors and hospital rules.
The most important thing that I learned from our doula was that I had choices for this process. I could be in charge. There were productive ways to communicate with hospital staff to facilitate the birth that I wanted, and decisions that I could make to affect my birth, like the decision to stay home and labor for a while instead of going straight to the hospital when my water broke. I didn’t have to be merely a participant in my labor, I had choices and a voice. In our prenatal courses, we had talked extensively about my birth plan, making 2 or 3 drafts before we were satisfied with it. I also made a gift basket for the nurses and doctors in the hospital, to thank them for their hard work, and partly to schmooze just a little bit! The birth plan would help to communicate what I wanted in the heat of labor, and the gift basket would help them to remember me in a positive light.
I called my doctor’s office. When I told them my water was broken, they told me to go straight to the hospital. I explained that I wasn’t ready yet and that I wanted my doctor to check me first. Fortunately my doctor was working and agreed to see me at 11:15 am. I took a shower, which was the best shower I have ever taken in my life, so relaxing! And my husband and I departed for the doctor. We pulled into the parking lot shortly after 11 am and I knew in my heart that we weren’t going home. My pain level had increased significantly since 9 am, but I was still unsure whether or not to go straight to the hospital. In my mind, I was clinging to the 4-1-1 rule (contractions every 4 minutes, 1 minute in length, happening for at least 1 hour) and I wasn’t there yet! My contractions were only about 30-45 seconds long, and I didn’t think they were long enough for me to go to the hospital.
Once in the doctor’s office, I had trouble disrobing from the waist down and getting up onto the exam table. When my doctor arrived and checked me, we were both surprised to find that I had already dilated to 5! It was time! I was going to the hospital! I was put in a wheelchair to go across the parking lot. I texted our doula: “I am at 0 station and 5 centimeters dilated, I need you here ASAP!” “I’ll be there as soon as I can!” My husband accompanied me to the room and I sent him back out to the car for the hospital bag. The desk nurse gave me a hospital gown and asked for a urine sample. I got into the gown but the urine sample wasn’t going to happen. I was in too much pain, and I curled up on the hospital bed in the fetal position instead.
When my husband got back from the car, I was crying. “I need an epidural, I can’t do this, I’m going to die!” Cue the theatrics! He went for help. The nurse checked me and immediately ordered a birth kit; baby was coming faster than any of us anticipated. I asked for an epidural. My husband asked if I was sure, and in that moment, I certainly was! The nurses told me it would be at least an hour before I could get one; in retrospect I am sure they knew there simply wasn’t going to be time. The baby was going to be there before the anesthesiologist anyway! Our doula arrived around noon I believe, and everything became a blur. I was very lucky that my doctor was on duty and was there for the birth. Between her, our doula, my husband, and the nurses, everything seemed to happen at lightning pace. Almost immediately, they had me pushing, I had plenty of help and support. My dear husband, who had pledged to stay by my head during labor to avoid the potentially traumatizing show, found himself holding one of my legs up while I pushed, after a nurse said “here, help her." Before I knew it, baby was crowning. My doctor asked if I wanted to touch the head? “No! What are you talking about?! We are wasting time, let’s get her out of there!”
At 1:13 pm, Tegan Janine arrived. 7 pounds, 3 ounces and 18.5 inches of pure, healthy perfection. I remember seeing her for the first time, her arms outstretched. As they laid her on my chest, I was overwhelmed with emotion and disbelief. She had arrived so quickly, I was caught off guard and burst into tears, “I’m just so happy." Delivering the placenta was slightly problematic, it didn’t want to dislodge itself. The doctor massaged away at my abdomen for 20-30 minutes, and I cursed loudly…but it was eventually delivered. I was given a shot of Pitocin in my thigh because I was bleeding a little more than they would have liked, but otherwise everything was fine.
All of the preparation and planning were worth it. The decision to hire a doula and educate myself on my choices and decisions was crucial. I am extremely fortunate that I had an easy pregnancy and a fast labor, many mothers aren’t as lucky as I was. I recognize that genetics and pure good luck played a huge part in me having a positive labor experience. I hope that by sharing a positive story of birth, other mothers can feel more confident. There are so many terrifying stories of labors gone wrong, I feel that women need to hear that labor can be a positive experience.
Dorothy and her husband reside in Bakersfield, CA. Along with Tegan, they share their days with two adorable Daschunds. Dorothy is currently pregnant and getting her out-of-the-hospital birth wish: her baby will be born at a local birth center.
When Nicci asked if she could share how the loss of a baby can be in South Africa, I said, sure -- if you have a story to tell, we want to read it. As I began reading, though, I realized I had more questions than answers -- when she said "here in South Africa," she really meant it -- her work as a bereavement doula is nothing like any bereavement doula I have heard about in the US. I needed more clarification to see how things are so different, and what can be done to help change these archaic, thoughtless laws and procedures -- I am pleased to see Nicci is helping to make that change happen.
Except for different room numbers, the two doors looked identical. If you could have peeked inside, you wouldn’t have been able to tell the stories apart. Except for their age difference and the gestational age of their pregnancies, they were just two women waiting to give birth. And they did give birth, almost simultaneously.
Behind Labour Room 1 an 18-year old teenager was unsuccessfully trying to take deep breaths to ease the pain that threatened to overcome her young body. She was experiencing severe discomfort with each contraction, and as I held her hand I could almost feel her pain. Annah (all names have been changed) looked at me and asked, “Is this going to get worse?” I had to be honest because this is the one thing I promise my clients: Honesty. I looked at her and told her that yes; unfortunately it was going to get worse.
Her big brown eyes followed me as I walked around the bed and straightened her IV line. She asked again in a strong, clear voice, “How much worse, Nicci?” I took her hand and assured her that it was going to be painful, but it doesn’t last forever and she will forget the pain. I couldn’t tell Annah that while the physical pain would go away, the pain of the memories never leaves. It would have been cruel in the moment, so I just squeezed her hand.
Annah was a normal teenager who had just finished Matric [final year of high school] and she was celebrating the New Year and the beginning of new things with her friends. What happened is still a blur to her, but she fell pregnant the first time she was ever intimate with someone. It was devastating news. But the news was not as devastating as what they learned around 20 weeks along: according to her doctor, Annah’s baby had severe health issues, his condition being incompatible with life. At 22 weeks, Annah’s baby was going to be born.
Lisa, Annah’s mother, is who I spoke with about this birth. “Lisa, it’s Nicci, I am a bereavement doula and I was told that you want to make use of my services?” With relief in her voice she asked me to come immediately, as they were about to break Annah’s water. I rushed to hospital. After reporting to the nurse’s station, I was taken to the Labour Rooms. That’s when I saw the two identical doors...
When I was first introduced to Annah she seemed a bit hostile, but within five minutes we were chatting like old friends. After a while she told me that she was pregnant with a little boy she was going to name Zach. I was so relieved that we clicked. It is extremely difficult to assist someone who doesn’t want you there! In fact, it’s virtually impossible.
Annah starting talking about Zach’s funeral -- she said she wanted a particular casket and elaborated on her plans. Lisa and I both listened as Annah told us about Zach’s name, his casket and a few other details about saying goodbye to him. Annah was complaining about her contractions again and I demonstrated to her how to breath to make things a little bit easier for her.
I left the room to give Lisa and Annah a moment alone, and as I was waiting in the corridor, I couldn’t help to hear the familiar sound of a baby’s heartbeat in the other room. I could hear the nurse telling the mom in Afrikaans “Dit is nou amper tyd” (It is almost time now), and I could hear the laughter and buzzing excitement. The contrast to Annah’s situation was so stark, my breath caught in my throat for a second and I had to concentrate very hard to not let the sadness overcome me.
Lisa came out and we went around the corner to have a quick private conversation regarding the situation, but after five minutes she received a frantic phone call: Annah was ready to push! I was astonished that this woman went from 3cm dilation to full dilation within a matter of not even 20 minutes. We both ran to the room. We were just in time. The doctor arrived as we got there and the next moment Annah’s agonizing screams could be heard echoing down the labour ward’s corridors, surely made worse by the realization of her situation. Between her pauses to take a breath, I could hear a mini commotion next door as well. Unbelievably, both women were giving birth at the same time. Oh, the irony!
The next moment Annah was screaming so loud my ears were ringing, and with a soft push, little Zach was born. But contrary to the celebrations and exuberant exclamations next door celebrating the birth of a healthy baby boy, in this room there was silence as tears streamed down Annah’s face, Lisa barely coping herself. If pain were a picture, I saw it in that room.
The nurse delivered the placenta after the doctor cut the umbilical cord (and subsequently left straight away) and was gently cleaning Annah up. Lisa was standing with little Zach wrapped in a soft white blanket that was embroidered with a white silk bow. Lisa took the baby boy to his young mommy and I quickly grabbed my camera to snap a few photos. Lisa gently handed the baby over to his mom and I could see a thousand thoughts running through Annah’s brain.
“He’s beautiful. He’s so tiny. Look at his perfect little nose. He is so, so beautiful!” exclaimed Annah. I could feel the pesky lump in my throat returning to torture me, and I swallowed very hard to keep my composure. I took a few photos of him, especially his tiny little hands and feet. I wrapped the baby again and gave him to his grandma. Annah insisted to hold him and she stroked her baby’s forehead.
In South Africa, babies born before 26 weeks without taking a single breath, are considered medical waste and treated as such (incinerated with amputated limbs and used needles.) It is something the Voice of the Unborn Baby are trying hard to change. It is the greatest insult to families, during a time of such great loss, to not have their babies legally recognized. Because of this, a doula like me, who is Still Birth Day accredited and trained in perinatal bereavement, has to complete an affidavit (or assist a parent to do so), basically stating that a placenta is being removed from hospital – we just fail to mention that the baby is attached to the placenta...
The nurse motioned me outside and when I closed the door behind me she asked me when I was going to the police station to have the affidavit completed. I told her that the commissioner of oaths was actually coming to the hospital herself -- there was no need for anyone to go to a police station. She looked unsure of herself and then she asked me where the casket was. I told her it was in my car, but if she wanted to see it I would go and fetch it. She indicated that this was indeed what she wanted, so I quickly ran to my car. Our caskets are beautiful little woven baskets that look like a Moses basket and not like a casket at all, so luckily I didn’t upset anyone with it.
When I got back, Annah was sleeping and the nurse had taken the baby. Lisa’s eyes were red from crying, but she was calm and asked me a few questions, which I patiently answered. Luckily the commissioner of oaths showed up and we finalized the paperwork and chatted a bit about Zach’s funeral. Annah knew exactly what she wanted for the funeral -- I was impressed with how composed she was. I had to fill out a report for the hospital stating that I take full responsibility for the “remains,” and that I will dispose of it lawfully.
We put little Zach in a carry cot, and after saying goodbye to Lisa and Annah, we left. They both confirmed that they had said their goodbyes and that they didn’t need to see him again. In these situations we are absolutely led by what our clients want and we respect and carry out their wishes as far as humanly possible. Little Zach was snugly tucked into a comfy carry cot, covered with his embroidered blanket. He looked peaceful at last.
I so wished those two doors held the same thing inside: beautiful, lively little newborn baby boys. But we don’t always get what we wish for, and that is precisely why I do what I do. Because there is a family facing the unfaceable, because the government makes this even more painful by not recognizing these so-called ‘fetuses’ as babies, because someone needs to comfort, answer questions, and hold the hands of the people going through this excruciating pain – this is why I do what I do…because no one should have to walk through that door alone.
Ever since the traumatic birth of her firstborn, the subsequent birth of his brothers, 6 infertiliy treatments, 3 miscarriages and 1 adoption, it has always been Nicci's dream to make a difference in the lives of bereaved parents. She is Birth and Perinatal Bereavement Doula, and a certified SBD Doula®. Passionate about ensuring families of all kinds have the unique support they need, she is a director at Voice of the Unborn Baby, and also Doulas of South Africa. Nicci is an avid writer and has written many short stories on her experiences as bereavement doula. Nicci also wrote a book about her infertility struggles. Besides being a doula, she is also a professional stillbirth photographer. Nicci believes in the power of encouragement, and in building confident and empowered doulas to make a difference in South Africa. She also believes in dreaming big and working hard. She is passionate about people in general and more specifically about the doula profession.
Nicci lives in a leafy suburb at the foot of the Magalies mountains, in the Pretoria area of Gauteng Province, South Africa.
♥ four young boys and a boy dog (offspring)