This week I received notification that I, once again, passed the Lamaze International certifying exam (making me the only listed LCCE in Bakersfield, one of two in Visalia). In light of that, I was curious to know why as doulas and educators, we choose to extend the extra effort and resources to gain and keep these initials after our names? Sharon Muza offers her thoughts to this topic. Additional quotes follow from not only doulas, but also mothers. And my answer? Grievance policy, as strange as that sounds -- I appreciate DONA offering this, as it protects my clients, and it protects me.

I am both a certified doula with DONA International, CD(DONA), and a certified childbirth educator with Lamaze International, LCCE. I am very proud of the fact that I hold and maintain these certifications. I worked hard for them and it means a lot for me to have these credentials. Here are my top six reasons for certifying AND maintaining certification with well-known, long-standing, internationally recognized organizations:

1.      Demonstrates my serious commitment to being recognized as a professional doula and childbirth educator.

2.      Assures my clients, students, my colleagues and the health care providers that I work with that I have successfully completed the requirements for certifications as set forth by my certifying organizations.

3.      My clients, students, my colleagues and HCPs are assured that I abide by and practice according to the standards of practice and code of ethics that have been established by well-known and well-respected certifying organizations.

4.      It allows me to support the organizations that I believe in, with my membership and certification dollars, allowing them to work toward improving maternal infant health outcomes as a serious player on the national and international level with my support.

5.      Maintaining recertification shows my commitment to receiving continuing education that is current and applicable, and demonstrates my desire to remain up to date with best practices.

6.      Provides a grievance process for clients, students, colleagues and HCPs who might have concerns about my practice standards, actions or ethical behavior.

I am very proud that I am a certified birth doula with DONA International and a Lamaze Certified Childbirth Educator.  I look forward to continuing to maintain these certification in the years to come.  I encourage you to seek out reputable and well-respected organizations to align yourself with and pursue certification in a professional manner.

I have lots of fun goodies I use as an educator and doula. Sometimes these look like toys, and sometimes they are purchased in the toy section, but I promise, they are not toys, they are props.

What's the difference? How do Hot Wheels track pieces change from toy to prop once absconded from my kid's room and placed in my childbirth ed supplies? What changes a kitchen utensil to an educational model? Dollar Tree junk to demonstration delight? 

One word:

Here is a sampling of toys, and how I use them!

One thing's for certain, it isn't going into the toybox at home! I let my little guy (21 months old) play with it, heavily supervised, for about 30 minutes, before I packed it up and put it back in its box.  I know, I've got problems, you say -- it is, after all, a kid's puzzle! I own my issues. Just like we encourage when it comes to precious personal objects:  it's my special toy and I don't want to share it.

I added links to similar posts...

As I compose this, my washer is going full-steam-ahead with a vomit-covered, king-size comforter in it, my 8 year old lies on a well-protected couch (his bowl on the towel-covered ottoman), and Kipper -- a long ago forgotten, feel-good kid show -- streams on the TV. 

My little guy is sick. 

Standing vigil with him last night, I was reminded we can make our pain worse or we can make it better, and a lot of that power lies in our brains. Like many of us, he doesn't enjoy being sick. He tried to rest, but when his stomach started to rumble, he grew restless, rocking his legs back and forth with anxiety and anticipation. Not wanting to wash any more linens, I encouraged him to move to the bathroom, where he would pace back and forth in front of the toilet in his attempts to avoid the inevitable. 

"I don't like to throw up," he said, tears sliding off his cheeks. 

"I know." I gently rubbed his back. I wasn't sure how much of his pain was from his stomach, and how much was from his brain. Sure, he was coping, yet he was also masterfully avoiding his body's natural impulses to move through this illness. Fear -- he was scared.

"When you worry so much about being sick, it can make your body feel worse. I think if you can take deeper breaths and try to let your arms and legs be lazy and heavy, then you can really hear what your stomach is saying." We both sat on the edge of the bathtub as I mirrored the deeper breathing and lazy legs while continuing with my fingers on his back. 

We repeated this ritual many times in the night, and a shift occurred: knowing he could calm parts of his body and mind led him to feel more secure in what was actually happening in his tummy. He was able to better feel the illness, as it would come and then go, and this helped him rest in-between.

See any similarities to labor here? 

Really what this describes is the fear-tension-pain cycle. In my classes we demonstrate this with a very long piece of elastic tied in a knot -- like a very, very long piece (10 yards?). I offer it to three different participants, so when held, it makes a giant triangle in the middle of our classroom. I then assign each of the three to be either "fear," "tension," or "pain," and have them relax their arms so the elastic falls to the ground, and we read over a few situations. As one trigger point becomes activated, that person pulls back on his or her piece of the triangle, then the next trigger is activated, and we see the result when the third person has to hold his elastic tightly to prevent it slipping from his hands. As we get to the problem-solving part, that person relaxes his or her part of the triangle, until it is loose and dragging the floor again. 

What's going on here? And how can we short-circuit the fear-tension-pain cycle? The biggest difference is, Mary's coping strategy has changed -- she is no longer upright and mobile, being comforted by her partner's hands. Now she is sitting, strapped into the car, and on her way to the hospital. 

A change in the level of PAIN, brought TENSION to her body, and FEAR about the future. Mary's partner can help her through this verbally -- reminders to relax and release tension, seatbelt caused hindered mobility,  labor not necessarily picking up but changing sensation from changing position, etc. Relaxing can reduce the TENSION, while knowing this information can speak to the FEAR, thus helping to change the intensity of the PAIN, interrupting the cycle.

Let's look at another situation (without the pictures -- as a side, I am currently reading Unfolding the Napkin, and I decided to follow the author's advice about processing visual information and creating my own pictures :)). Mary is now in the hospital. She is coping well by sitting on a birth ball and rocking through her contractions. She hears a scream down the hall and suddenly she has a FEAR response; consequently, she TENSES, and her PAIN increases. What can help here? 

Address the FEAR with words. Remind the woman, just as she has a birth team taking care of her, the lady down the hall also has professionals aware of her situation. The screaming might not actually have anything to do with a level of pain or danger -- it may just be how that lady chooses to cope, maybe she is just a screamer? Hands-on touch can offer physical reminders to relieve TENSION in areas of her body, and her PAIN level can go back to where it was before her scare.

My little one is on the mend, the laundry is done, and I got a nap this afternoon. Watching him struggle was intense as a mom, just as it is when we are with laboring moms. It was an amazing tool to offer him, navigating through his own experience of the F-T-P cycle, by helping him recognize ways to make himself feel better in his body, by simply using his head. 

The Cascade of Interventions is a typical topic covered in childbirth classes. I don't want to say it's like the Domino Theory of Communism,a logical fallacy known as "slippery slope," but it...it kind of is. As moms, doulas, educators, and birth workers, we often can recall someone's "cascade of interventions" story. The important thing when it comes to teaching is to help students understand that the use of an intervention doesn't mean a woman is fated to the "next" likely step -- with education and awareness, she and her partner can be work to avoid the common pitfalls a specific intervention might bring. Basics:

• I like to use story-telling in many childbirth education activities. Roger C. Shank, a cognitive scientist, said: "Humans are not ideally set up to understand logic; they are ideally set up to understand stories." I feel this is an effective way to help participants relate and remember bits of information, versus throwing factoids at them. 
• I have a set of 12 boxes, that when stacked reach over my head (and I am 5'5"). I bought them at Costco about 7 years ago with this activity in mind.
• I have a 12-step story with each step written on its own slip of paper. The first part of the story is in the smallest box. Step two is in the next size up box, etc. I put these under students' chairs before class.
• Parents offer their boxes as size/story dictates, read their part of the story, then stack their box. In reverse-size order we see how even though the small box was no big deal, as the stack increases, it starts to teeter, and it might even fall. I ask a partner to be in charge of holding the stack up while we finish the activity.
• This story starts with the tiniest box in my nesting collection, and it is a benign "intervention," one we might not even consider when looking for offenders: external fetal monitoring. The story ends with breastfeeding being interrupted -- of course the worst thing we generally think of within the context of normal birth situations is cesarean birth; I felt that was an obvious choice. When it comes to cesarean birth, I feel it can be easy for participants to think, "That won't be me," whereas breastfeeding interference seems an idea we can open our ears to.
  

The story I use:

1. EFM: Jamie arrives at the hospital at 3 cm woth contractions about 5 minutes apart. Jamie's coping method is bouncing/swaying on the ball. Once in her room the nurse wants to get a reading on her baby and requests 30 minutes of EFM to get a 'baseline" on baby.
2. limited mobility; increased pain/anxiety Jamie's limited mobility means she is no longer able to sit on the ball through her contractions. Her contractions become more intense, and this starts the F/T/P cycle.
3. pain medication request (Stadol) Jamie is scared about how she can cope with labor if it is going to get worse. She decides she wants to try an analgesic pain medication, which can be given as a shot.
4. labor stalls Jamie finds although the medication takes away some of the pain, her labor has stalled.
5. pitocin to speed things up; IV Jamie now needs pitocin to get into an active labor pattern. This means she will have an IV as well.
6. epidural request As the pitocin increases the strength of her contractions, she experiences F/T/P cycle again. She requests an epidural.
7. blood pressure drops Jamie's blood pressure drops in response to the epidural.  
8. medication for blood pressure Jamie gets meds to counter low blood pressure.
9. maternal fever Jamie has a fever, which could be from the epidural.
10. OFP affected; baby born via vacuum Since Jamie was not able to be more active, her baby has not had help moving and rotating into an optimal position and needs the vacuum to be born.
11. baby has fever; sent for observation, possible septic work-up Baby has a fever at birth and needs to be taken to the nursery for observation and possible tests. Jamie and her baby are separated for 6 hours.
12. separation/breastfeeding affected Breastfeeding is affected.

The bolded statements are being recorded on a large sheet of paper as we read along. After the activity with the boxes, we go through the list and discuss what can be done to avoid or minimize the effects from a specific intervention. This is also the time I hand out basic info sheets about common interventions. 

I hope I included everything? If you have questions, ask! And please "like" my Facebook page to stay up-to-date on the teaching tips I share.

In celebration of getting my DONA recertification in the mail, I decided to challenge myself to see if I could make this creatively and frugally. 

This morning I went to Wal-Mart to peruse the Halloween decorations, thinking there had to be a usable pelvis from a skeleton I could use. I found one I thought would work -- and only one, really, out of all the decorations. I live in a small town, and Wal-Mart is just about all we have; I would have checked other places if I lived with more options, because although this one worked, I would have liked to see more samples. That was the only thing I purchased -- everything else I had around the house.


Materials List:
skeleton with a pelvis
embroidery floss
orthodontic rubber band
needle/thread
fabric
baggie
tape
baby that fits the pelvis
baby sock for uterus

I would use something else for the amnion, but I was grabbing things I had in my house -- nylons might work? Also I would use a newborn's sock, not an 18 months old's sock, for the uterus...you could also knit one. 

If you have questions, let me know! It took me about an hour from start to finish! And it could save you 70+ dollars! Sorry the order is off -- putting them in order this way on the computer makes the mobile version easier to view.

I'm an educator that calls pain "pain." I think that is how most people perceive it. I used to feel the "p" word was bad, and I used all manner of euphemisms to avoid saying it. When you teach almost 2000 hours a year, you hear back from a lot of families. When more than one former student came back asking me why I didn't just call it "pain," I decided to adjust my viewpoint.

I do have an activity where I "break down the pain" into sensations, involving a bucket and water. The intent is to dissect each sensation, that when clustered together, we call "pain." I find it makes the physical sensations we experience more recognizable and less scary. But I digress!

I begin this activity before class, really, when I bring out the Hot Wheels track pieces absconded from my sons. When the first couple arrives, I ask them to put the track pieces together. Once finished, they are laid on the ground, the starting line by me, the finish line at the back of the classroom. 

You would be surprised how happy it makes people feel to see Hot Wheels tracks and cars on the floor of the classroom where they are learning about how to have baby! This is generally class 3 of our 6, when we discuss pain theories and comfort measures. This is how I share the Gate Theory of Pain, essentially, that we can make pain worse (turn it on) or make it less (tune it down) by what we think, feel, and do.

To start, I lift up the end of the track near me, the starting line, and I let a few cars loose. Unobstructed, they zip down the track like greased lightning (hello, Grease fans!). Then I ask, "What have you heard about, in books or from your friends or family, that helps with labor pain?" People start shouting things out. "Water!" Okay, get your Post-It notes out and write "water" down on one. Choose a partner to come and place his or her shoe under the track, and stick the note on the shoe. 

Ask again. "Massage!" Same thing. Have a partner come, place his or her shoe under the track at a different point, and slap that Post-It note on the shoe. How many people you have here depends on how long your track is. Pretty soon you have something that looks like this the top image, above (except I have them continue to stand while we do the next part -- I was home alone when I made the pictures here and I opted for empty shoes). 

Now repeat the exercise with the cars. Start sending them down (I use 5-6 cars). Some will make it all the way to the end, some will slow, and some will get knocked off the track. What you will see, though, is that the undulations made by the shoes (interference, right? Comfort measures) will compete with the "sensation's" ability to get to the end (the brain). We can make sure the road is clear for those sensations to fly straight up and tell us we are in pain, thereby triggering the fear-tension-pain cycle, or we can "congest" those nerve pathways by throwing in other sensations to confuse our brains about what we are really feeling...enter comfort measures and emotional support! Voila.

One other thing about me: I love things that nest. Whether they are baby toys that stack together, measuring cups, boxes, or even Matryoshka dolls -- if it nests, it's the best. I have three different nesting toys that I actually don't let my kids play with...I keep them in the closet with all my childbirth education supplies. 

One shopping trip, probably 8 years ago (I could look in a catalog to see for certain!), I found these boxes. I was attracted to the nesting, of course. But as I looked closer, I wondered the measurements? Might they be in centimeters, oh maybe, 2ish to 10ish? I went to a handy pencil/map/paper-tape-measure station to check it out. The smallest box was about 2ish centimeters, the next box was 3, 4, 5, and so on, until finally the last box was 10ish. Woo-hoo! I bought about 6 sets!

The bad news is, IKEA doesn't make these boxes anymore. The good news is, maybe you have an affinity for things that nest and there is a set in your possession? Maybe unlikely. But it gets the wheel turning, doesn't it? To be on the look out for what might work? If you are truly motivated, you could make your own, perhaps out of duct tape? I would love to hear your ideas -- let me know what you come up with! And don't forget to "Like" my Facebook page to keep getting ideas!

I cannot even pretend this was my original idea. I got this from Linda J. Smith's book, Coach's Notebook: Games and Strategies for Lactation Education. In "Who's Glad You're Breastfeeding," Smith offers a list of family and community members who see the benefits of breastfeeding. 

I came across a pack of adorable thank-you cards at the Goodwill for $.99, so of course I picked them up with this activity in mind! I took 10 of Smith's suggestions and hand wrote thank-you notes for moms in the group to read out loud. As a modification, I had them withhold who the note was from and the rest of the group had to guess based on the information shared.

For example, the one I shared in the picture says: 


"Dear Breastfeeding Mom,

Thank you for breastfeeding. Your child's athletic ability gets a boost from better eye-hand coordination and motor development.

From,

Future Sport's Coach."

Smith has a list of 21 people "glad" a mom is breastfeeding, including her partner, her accountant, er dentist, her OB, her garbage collector, etc. After we read through the 10 I created, I asked what other benefits moms knew about that we hadn't covered. We also, tongue-in-cheek (but maybe not?) composed a letter from a mother-in-law to her breastfeeding daughter-in-law -- maybe as an attempt to  imagine what we might appreciate hearing? Nevertheless, it was a fun group activity!

I said before I am frugal. If I had all the money in the world, I am still not sure I would buy supplies if I could get away with making them. 

In my first class of six, we go over the different changes in the pregnant body. I found these paper ladies at an educational supply store, and immediately I knew how I was going to use them!

I am not an artist, but you don't have to be! I broke down the pregnant body into 9 different regions or topics. In my own interpretation, I drew. Then I glued or taped the baby doll form on the mom. On the back of each lady are the common issues associated with each topic. 

In class, each person or couple gets a lady (depending on class size), and I have an order I like to go in. One by one, participants read from the back of their paper ladies. I check in with the moms, asking if anyone has experienced certain ailments, how she has coped, etc. 

In my curriculum I have extensive back-up material for each of these changes, in case a family wants more information about something. An alternative to the paper ladies but still using the research information is one that always gets people giggling. Once I forgot my paper ladies at home and I wasn't sure how I could offer the information without just lecturing. I decided to have each couple draw their own pregnant lady, and label the issues themselves. Then they shared with the rest of the class. Hilarious -- I have kept some of those drawings. You wouldn't believe how much grown-ups can have drawing stretch marks or hemorrhoids!

The basis of this activity is finding the current information about the physical, emotional, and hormonal changes that happen in pregnancy, and going from there! Get out your markers, tape, and scissors, and start having fun!

Pictured here are nine babies I use in my childbirth classes. I am cheap -- I mean, frugal. I could have purchased very expensive dolls from a company that specializes in education materials for this purpose. I could have eve gone to Toys R Us and bought them brand new. But being as I love saving money and find it a challenge to see how little of it I can spend and still have a useful item, I decided to scour my local thrift stores. It didn't happen in one day, it took time and persistence, but one by one I acquired these dolls. 

See the one on the top shelf, middle position, with the tattoos on his head? He's my favorite, and I bring him out every week to show a baby's position in the womb, or how a baby's head appears when crowning, or how to breastfeed in a laid-back position. The other dolls only come out in the breastfeeding class.I also purchased newborn clothes from thrift stores so they wouldn't be cold and naked. 

I bet I paid no more than $25 for the whole set. After the class when they are used, I clean their hard surfaces with a Clorox wipe and return them to their cupboard. Once every 6 months I wash their clothes. In "Coach's Notebook," by Linda J. Smith, she cautions about handling dolls as carefully as you would real babies, to model positive behavior for your participants. I have a habit of sitting my little model baby in my lap, facing outward, with his feet crossed at the ankles in a comfy, watching-TV-in-the-recliner position during class. It makes people smile, although a real baby wouldn't sit like that for long.

I have a fake uterus I use as well, also purchased at a thrift store -- but I will save that for another post (hint: it was repurposed from something else). There are some things you will just have to buy, like your favorite DVDs or copyrighted printed materials, so anything you can creatively recycle leaves you more in your budget for the things that just won't budge.