I heard a doctor say once, when presenting a pivotal intervention to the family I was working with, "If you were my wife, this is what I would do." It truly does offer the feeling: "He really cares about me." This is actually a fallacy -- faulty emotional appeal. It isn't based on science, or evidence, or the unique needs of mother and baby. It is simply an opinion said with feeling, and it can be swaying. Maddie McMahon hits the nail on the head here, and she offers sage wisdom to those of us who work with families -- families who may be vulnerable to the words we say and feel with emotion, that may not exactly be the truth.

These are the kinds of things I hear parents saying quite a bit, and they always remind me that being kind is just not enough. Meaning well is just not enough. Smiling and speaking gently is just. not. enough.

​There is a lot of talk in health care about compassion. And so there should be. It should pretty much be a core quality of anyone working in a caring role. Compassion means having a deep understanding and sympathy for another’s suffering. It also means wanting to do something to fix that suffering and take it away.

The problem is, compassion on its own can be a problem. If we believe we can make this all better, if we believe we know better, if we can’t bear to see present or potential future suffering, if even the idea of risk is frightening, then compassion can be dangerous.

Compassion needs to be tempered and balanced with empathy. The ability to enter into another person’s feelings, to see the world through someone else’s eyes. It is this ability that allows us not to get caught up in our own emotions and not get swayed by our own assumptions as to what might be right of wrong for this person. It is empathy which allows us to step outside of ourselves, just a little, and make space to really listen – and more than listen, understand WHY someone might feel the way they do.

So my plea to you wonderful, compassionate practitioners out there, whether you are doctors or midwives or nurses or lay supporters like doulas: Please try not to coerce with your kindness. Is this mother doing as she’s told because you’re so kind and she doesn’t want to upset you, or is she making a fully informed decision? Are you laying YOUR stuff on her or are you truly holding the space while she looks at the benefits and risks of all her options then follows her heart? True kindness and care means trusting that those we care for can make safe, appropriate decisions for themselves, even if we disagree with them.

My New Year resolution this year is to pour a cup of Alongsideyou Tea and strive to listen harder and longer and deeper, whenever I can to everyone I meet and give my empathy muscles a workout.

I had a doula client once who was struggling to breastfeed her baby. Nikki's baby was on her breast about 50 minutes of every hour, 24 hours a day. We were in contact daily, either by phone or in person. I kept connecting her with IBCLCs to troubleshoot the issue.
 
The first IBCLC was Ashley. She was very experienced, and a friend of mine. She suggested Nikki pump after each feeding and then offer the baby breastmilk in a bottle – in addition to feeding him at the breast. Nikki tried this and quickly realized it may help her make more milk, but it was not helping her stay sane. Ashley had to go out of town, so she suggested we meet with another IBCLC, Brenda.
 
Brenda was a very new IBCLC, having just passed the exam -- and she was also a friend of mine. Without regard to Nikki, Brenda created a plan to have mom weigh baby before and after every feed and record this information on a sheet of paper that looked like a chart with about a hundred boxes on it (read that sentence a few times so you feel overwhelmed -- that was the intent). Nikki didn’t even get so far as to try this – she said, sadly, “I can’t imagine being able to do all this without having a full-time nanny.”
 
Alone, Brenda and I discussed the situation. “What do you think?” I asked.

“I don’t really think there’s an issue – I think it’s in her head.”
 
I was hurt by this statement! I had wiped this mother’s tears, sat with her and listened to her share her fears that she was starving her baby -- that she just knew something was wrong. I didn’t realize how damaging it is to hear a care provider state she doesn’t believe her client/patient.
 
Compelled to say something, I responded quietly: “Whether it is real or not, it is real to her. How can you help someone if you don’t believe them?” This was real bravery on my part, to tell Brenda how I felt. Embarrassed and feeling vulnerable, I changed the subject. In a couple of minutes, I made up an excuse to leave.
 
I didn’t say anything to Nikki about this exchange, but she chose to discontinue seeing Brenda. Working hard to keep breastfeeding, she continued to nurse her baby as often as he needed, leaving time for just about nothing else. Exhausted is not even a word to use here – Nikki barely had time to use the bathroom, eat, or shower – forget about self-care, healing, meaningful time with her partner, or just stopping for a minute. Everything was rushed, and what was accomplished was accomplished with a baby crying in the background.
 
I was able to finagle one more meeting with a third IBCLC, Carly. She was very experienced, and also a friend of mine. Normally Carly wouldn't have been an option because of insurance issues, but as I discussed the situation with her, she agreed to see Nikki.
 
I was so excited to share the news with Nikki! I called her immediately and said, “Guess what? Carly can see you! She said to just call and set something up!”
 
Then came a long pause, and, “You know Stacie, I think I may be done.”
 
Oh, my heart fell. I knew how hard she was working. I knew for Nikki these early days were not about bonding and enjoying her new baby, but about feeling scared and always feeding, all-around-the-clock. I wouldn’t fault her for moving on and putting the breast to rest. Who could? And knowing what I did about this woman -- as we had been building a relationship for months -- and witnessing the strength and power she built and held during her birth, I was concerned she might look back and regret not having tried just one more thing.
 
I didn’t want to press her, and I resigned myself to one last sentence on the matter before leaving it all alone: “I would hate for you to look back and wonder if this might have helped.”
 
And then I changed the subject.
 
After we had been talking for about 10 minutes, Nikki interrupted the conversation with – “Okay, I’ll see her.”
 
This mother had PCOS, which we all knew, but as her milk came in promptly after birth, we mostly put that on the back burner. Baby was gaining 4ish ounces a week, nothing terrible enough to raise a red flag with the pediatrician. And like I previously mentioned, her baby was on the breast almost constantly.
 
At this consult, Carly suggested Nikki ask her doctor for a Domperidone prescription, to increase her milk supply. Carly felt Nikki could stop pumping (more like, stop feeling guilty about not pumping). Carly suggested if the baby was nursing that often, there should be adequate stimulation to keep up Nikki's supply. Nikki finally felt her needs were being taken into account as this plan was created and shaped -- that meant it was more likely to be followed. 

And things got better, quickly. Nikki got the medication on a Wednesday. She and her husband and baby were going out of town for a weekend wedding. She called me, overjoyed on Saturday, saying she was already making more milk, and her baby was happy and satisfied. “He has been eating every couple of hours instead of every hour for 50 minutes! For the first time ever!”
 
So what’s the point here?
1. I knew all of these IBCLCs well and continued to trust and refer moms to them. It wasn’t that any one was better than the other. No one made a mistake or mishandled the situation. It’s just that something different came into each lactation consultant’s mind first, and that is part of being human.
 
2. When we are in a helping position and a mother tells us the plan we have created isn’t going to work, we need to let go of our egos and the feeling of wanting to discount the mother and her experience. She has a better picture of what is happening in her life than anyone else, and we need to trust that.
 
3. If you are presented with a plan that doesn’t seem workable to you, that doesn't mean you are stuck. A care plan should be made with you in mind, not absent of your specific needs and unique challenges. Seek out a second opinion. Even a third. Because you never know  -- sometimes the third time’s the charm. 

Just a few end notes:

• All names have been changed.
• This happened 10+ years ago, when Domperidone was easily available through compounding pharmacies.
• Just as Carly "saved the day" here, I know for a fact Ashley and Brenda have had instrumental roles in stories just like this.
• PCOS is a very complicated issue, and women aren't always aware it might affect breastfeeding. In my opinion, one of the best sources of information about PCOS and breastfeeding for moms is "The Breastfeeding Mother's Guide to Making More Milk," by Diana West and Lisa Marasco.

I think it is important to tell you the story of how baby Graeme (pronounced grey – UHM) came Earthside because the more we hear about birth the less we fear birth and that is a catalyst for the continuing change towards mother centered birth.  This is his birth story.

My mother had lived with us for several months before Graeme made his entrance. This was because I have Rheumatoid Autoimmune Arthritis or as it is now called Rheumatoid Autoimmune Disease (it does NOT have me. :)) and it was actively flaring during pregnancy. I was unable to keep up with the demands of a household and our high-spirited toddler. This made for a unique environment with both good and bad points. By the end I believe we had become weary of the dynamic so you could feel the sizzle of anticipation in the air both from waiting for the baby, waiting for my disease levels to subside, and waiting for the end of our situation. I was told during pregnancy that having another child would be a very bad idea because of the many mounting health problems so having mourned that and come to terms with that I was very very ready to be done. When you come to terms with something, accept it, and move on and you have to wait several months for the moving on to come to an end it gets tedious. You are just waiting and pulling forward one day at a time to see a goal. It’s like closing the chapter to a book but you are watching the two covers come together in slow motion and it catches your breath. Ready to be done. 

I had followed the pattern like my daughter’s labor I had labored off and on for 2 weeks. Real bouts of labor followed by several days of nothing. I thought this was Braxton Hicks, but my doctor once again told me otherwise. Graeme was born on a Monday morning. The Thursday before I had my last prenatal appointment and my doctor who has practiced over 30 years said “You are a 7 and you are 78% effaced. See you at the birth center this weekend or Monday.” Having seen it all he is never wrong. He told me with my daughter “see you in the next day or two” and she was born the next day. Yes he sent me home. He is one of the few doctors out there who trust the natural birth process completely. Trusts a mother’s body to do what it is intended to do. He only intervenes when it is absolutely necessary. I am fortunate to have had him as my doctor for the births of my children. 

On February 10th, 2014 at 3:35 am I went to the bathroom. I felt a ton of pressure and was unable to go to the bathroom. This felt different to me. I had felt pressure sitting down for weeks but it became clear to me that this was different. I literally could not contract the muscles to go to the bathroom. This was a lot of pushing down. It didn’t feel like contractions to me but I felt “opening” and so I continued to sit as the half squat was helping that action . I was 39 weeks 4 days pregnant so I wasn’t sure if this was “it” or not. Then I began to feel the pressure come and go. This hadn’t happened this intense before. I started timing these “pressure “waves”. Before I could even get the timing app started I felt my body lurch forward. Labor is like that. You feel yourself being pulled and pushed down from inside. It is a powerful, earthy, painful and at once strange feeling. I texted my husband and said “Hey I’m stuck on the toilet in labor. Finding pants now.” He said “Ok. Waking Nana. FYI Blowing snow”.  It was blowing snow across the highway and there was an advisory to avoid travel if possible. I feel very fortunate that we had my Mom living with us and we could just go, no having to wait or anything. We would ordinarily stay home until later stages of labor but my contractions STARTED at 3 minutes apart and we didn’t want to end up on the evening news as that couple who gave birth on the side of the road in blowing snow. (Congrats to those who do. You have bigger balls than I do.)

3:40 am Got in the car. Contractions 2 1/2 minutes apart. Cascading one on top of each other. Couldn’t breathe. I texted our doula/longtime friend that I was “going to the hospital now” and off we went. 

White knuckle driving in the dark on an icy highway with no lines, high wind, and snow. 

Growl at husband “No” when he attempts to put music on. Growl at him “No” when he attempts to turn it off. Poor fella couldn’t win. Yell at him “IF YOU COULD ATTEMPT TO NOT HIT POTHOLES THAT WOULD BE GREAT! THANKS!!!” with my eyes shut breathing through the wham wham wham of hard fast labor. Didn’t realize that we were two blocks from the hospital when he hit the pothole and this car trip was almost over. Laboring in the car sucks butt. I don’t recommend it at all. 

4:10 am. Arrive at hospital.  Nurse Stacey comes out. She is pretty great, she recognized me because she had talked to my doula. Nothing like being recognized to bring the walls down. My amazing doula had pre-arranged many of the nurses and people who were a part of our team. One was a homebirth midwife in another state, my post birth nurse who cared for us was a doula for many years and was wonderful.  RN Stacey has many children herself. I had a 180 degree experience from last time. I am a sexual assault survivor so this was all pre-arranged to preserve my mental health and command the respect my body needed to do what it needed to do without the anxiety. This time no one asks me to do intake paperwork. My contractions are still 2 1/2 minutes apart. I am trying to keep cool through the pain. Fast labor is no picnic. It is like taking the entirety of regular long labor and smashing it into a few hours. Intense, overwhelming, terrifying and at times makes you doubt yourself and your ability to do it. 

We get into the room and I had to sit on the bed because we needed to get antibiotics in. I don’t want to but I have to. I tested positive for Group B Strep during pregnancy and despite measures to get rid of it at home we didn’t succeed. 

They get a line in and get antibiotics going. They try to get a heart beat on baby. This time manually. I am not strapped to the machine thank goodness. 

Doula Lindsay arrives around 4:30am

They want me to stand to get a heartbeat on the baby. Husband steps out to get water. My doctor has arrived and he is sitting with his feet up on the front desk chatting up the nurses. Typical for him. He’s a character. 

I HATED standing. I had to rest my head on my doula’s chest to get through it. I kept moaning/half-crying “Get me in the water. I want the water now.” “I can’t do this without the water.” Water reduces pain levels greatly and it is SO MUCH EASIER to labor in water. 110% easier. A nurse is running the water while we try to get a heartbeat. In fast labors sometimes the baby gets squeezed so much, so hard that the heartbeat isn’t consistent at all. Fast labors are hard on mom and hard on babies; they aren’t completely “normal”. 

About 5 am Graeme finally cooperates and I can get in the water. Thank the Lord! At this point I was in so much pain that I didn’t even realize my husband still wasn’t there. I was so hyperfocused breathing through the pain. Contractions are on top of each other. I can hardly breathe. My doula says “breathe.” I breathe in. 

As I sit in the hot water I lean back. Worst idea ever. I almost throw up it hurts so bad. I lean forward into almost a squat. Doula pours hot water on my stomach. It doesn’t help much. These contractions are so much more painful than with my daughter. My husband comes back. I cry “I can’t do this. I need pain medication” My doula says “you are doing this. You can do this.” I didn’t know that I was so close to having the baby. This was transition. I wish someone had told me, in retrospect, because I know the stages of labor. I thought this level of pain was going to go on for hours and I started crying. I started to not know what to do with my limbs. Almost flailing from the level of pain. 

“I need to stand. I can’t sit here any more. I have to stand.” 

6:15 am I stand and get out of the tub supported by my husband and my doula.

Yanno how they say when your water breaks it is never like it is in the movies? This was like the movies. WHOOSH it splashes everywhere. The bathroom floor is coated in amnion. Sorry about the shoes guys! (Never wear shoes to a birth if you can help it. Feet are washable.) 

As soon as I stood up I started to push. When natural labor is unencumbered and progresses on its own a beautiful thing happens. The body pushes on its own. No orders. No instruction to push. I have to stop every foot on my way to the bed to push. I half-squatted every time and groaned that gutteral, earthy groan, down into the floor using my husband and doula for support. 

I reach the bed. I feel I need to sit up with my breasts right against my knees. I begin to push and the team gets ready. No one counts this time. I push as the contractions tell me to. Which is a wonderful thing.

My son was a big boy so the nurses and our doula keep saying “pull those legs wider” I do. I hear my hip pop slightly out of socket and feel the pain of that. But I know this is the end of it so I keep going. I push that pain to the back of my mind and focus on the goal. 
Something crucial happens. My doula tells me to “relax”. When a person tenses while pushing she tears. If she relaxes then the baby does their work and they don’t tear. That tissue is supposed to stretch and it will if you relax it. This was the ticket for me. Every time she said “relax”, I did. I am ever grateful for that. My son slowly corkscrews out. On his way out, I didn’t know it, but he split a vein with his shoulder. There was a lot of blood. And my doctor, being the calm man he is, says “Don’t look down” even though there was a lot of blood. My husband retained composure holding my hand even though he said it was a lot of blood and freaked him out a bit. He said nothing. That is an amazing gift he gave me so I wouldn’t panic.

6:37am Graeme is born. He cries and they place him skin to skin on my chest. He latches like a champ. I cry tears of joy at the instant ability of my eager baby to nurse. We had a long trial with my daughter and his gulping noises fill  my heart to brim.  I rotate my hip back into place after my doctor stitches my vein and minor tears. We wait for the cord to stop pulsing before cutting. I deliver the placenta which turns out to be huge and my doctor says “I’m sorry” as it comes out because it is folded over on itself. It’s like birthing another baby. Kudos to you twin moms out there, you rock. The placenta weighed in at just over 6 lbs. This is not uncommon for moms with active autoimmune disease during pregnancy. The placenta had to work extra hard to keep my baby boy safe. I am grateful for this organ and what it did for my son. 

 He is here. He made it. Hello baby boy. 

When we got pregnant with my daughter, I knew that I wanted an unmedicated, natural birth. We prepared the best way that we knew how -- took a crash Bradley Method course, went to classes, read books and listened to other mothers. But nothing you read or hear prepares you for childbirth and I distinctly remember my inner voice telling me that all my tenseness and anxiety was making my labor pains worse and less effective. I knew it, but I could not relax myself - I was making my own labor harder and it ended in a c-section. 

Even before we were pregnant with my son, I decided I would have a VBAC, and I can say with 100% certainty that having a doula was how we achieved that goal. My doula, Lisa Lute, helped us actually enjoy our labor. My husband hated the experience we had trying to labor alone - he felt helpless to help me. He felt like a huge weight of need was on his shoulders without the experience to know what to do. With Lisa there, she facilitated everything I needed from him. He was still my laboring partner, but he didn't have to figure out what I needed. She gently made suggestions - using her experience and knowledge to help me relax and have productive contractions. She knew exactly what to do and just her presence removed a great deal of stress. 

During labor, she was such a blessing, but even so, beforehand. If you listen to certain doctors or read things from the ever-dreaded Dr. Google -- you can be scared out of a VBAC. You can decide a repeat cesarean is less risky. But Lisa addressed all my fears -- all my anxiety -- with a library of good information. She had the VBAC success statistics to give me, she had the history of attending many successful VBACs already in her arsenal. She had the reassurance that helped me VBAC. The doctor on-call when we arrived at the hospital was not overly supportive of our VBAC plan. It was a blessing to have Lisa with me and my husband. It was a blessing to have my very own experienced team member facilitating a wonderful birth experience. I would never choose to have a baby without a doula again.

"This is my favorite photo of my labor. Look at how relaxed my husband looks...he loved having Lisa there with us."

I knew I wanted a doula even before I became pregnant. The support that comes from being surrounded by a community of supportive women is unparalleled. But just who would that person be? Could that person be the one woman who has been there my entire life?

I knew my mother has long aspired to become a doula, to support mothers in birth. Not long after I told her we were expecting I asked the big question, will you be my doula? I was nervous and excited. She was too. She signed up for training right away.

The day of my son’s arrival finally came. I called her in the wee hours of the morning to let her know that this was the day. She drove three hours from her home to mine to be there for me. She came prepared, ready to put her newfound knowledge to work. I had been laboring for hours through the night by myself, pacing back and forth. It was so nice to have a familiar hand to hold to keep me grounded.

When I was ready to go to my birthing suite, to get the relief of the big Jacuzzi tub, she helped me call my midwife and made sure all of my bags were ready. She packed up the cars along with my husband and followed behind us as he drove us to the hospital.

When we arrive in our room, she carefully and quietly surveys the room to make sure my birth plan wishes are being honored. She assists me in communicating with the nurses as the contractions already a couple minutes apart come and go. We begin to move around the room with a rhythm. She follows me wherever I go. Holds my hand, offers her body for support. She runs her fingers through my hair or just sits quietly as I rest when my body allows.

As the day wears on I know she must be exhausted, her body must be tiring. But she never shows it. She just keeps offering herself to me. She supports me as only a mother can.

The following are the words I wrote about our experience just days after my son’s birth:

“How can someone perform so many roles and perform them so well, so seamlessly? Every touch radiated love and care. Every look raised my confidence. When I thought I couldn't possibly go any further, her presence told me I could. She did it. I can do it. She is here to support me in every moment. She is here through every contraction. She is here through every second of pure exhaustion. She is nervous and anxious but she never shows it. She is strong. She is strong for me. She labors with me. She pushes me through. She shares in my joy. She shares in my love. Our bond only grows stronger. I now know how she feels, what being a mother really means. It can't be described, only felt, only lived.”

I can’t imagine my son’s birth without her. I can’t imagine becoming a mother without my own by my side. It didn’t stop there, though. She stayed with me through the toughest time of my life. She had planned to stay a few days while we settled in to our new routine. But something wasn’t right. My son wasn’t nursing and he was losing weight rapidly.

She urged me to see a lactation consultant and went with me. At the consult he was weighed and I was told I should see his doctor immediately. The lactation consultant made an appointment for us and we went straight there. After the visit with a doctor we ended up in the NICU. They had to transport him to another hospital when he became unstable. My mother, my doula, held me up as I walked down the hallway and out the doors of the hospital without my son.

This was the hardest moment of my life. I felt like my everything had been ripped from me. She drove me to the NICU hospital and held me as we waited to see my son again. She held me in the NICU room as I stood there staring at my son hooked up to machines. She held me and her grandson while I struggled to nurse him. She was there through it all. 

They made her leave after hours. But as soon as those visiting hours started she was there. Even waiting outside the door for the clock to strike so she could come give me the support I so desperately waited for through the long nights. 

After we returned home so did she. I was so sad to see her go. But I knew with her encouragement and love that she had given me over the last few days that I could do it. I could be the mother I needed to be. And of course I could call on her during those quiet moments of doubt when only she would understand what I was going through. For only she was there to feel it all with me.

When my daughter asked me to be her Doula, I was so honored and excited. Not only was I going to be able to finally be a doula, something I had only dreamt of, I was going to be there to assist my daughter. I better get to work, I thought. I had to learn all I could. I wanted to be at my best, after all, this was MY daughter and MY grandson. To say I was overwhelmed is an understatement. I did my best to listen to my trainers. I also read every book I could get my hands on. One of the most important things I think I did was to talk to other Doulas and Midwives about their experience.

The day finally came. The three-hour drive in the wee hours of the morning was the longest ride of my life. I was on the hands-free phone with her most of the time, checking contractions, praying that it was God’s will for me to be there when she needed me. As I arrived, we went over her home plans and realized she was in active stage and could get some relief from the big Jacuzzi in the birthing suite, so off we all went. On the way to the hospital I thought, am I doing this right, am I saying the right things? As we arrived I went over her birth plan. Was the room dark enough, was it quiet enough? Making sure every support staff had copy of her plan.

Her labor was long and at sometimes it seemed that way. In other ways it seemed to go by so quickly. She received relief from the Jacuzzi. Finally I was able to see my daughter (yes, she is my daughter and client all at once, but my heart said daughter at this moment) calm and relaxed. I remember running my fingers through her hair as I did when she was young, thinking my baby is having her own baby. Holding her hand as we had millions of times before, but this time was different. 

The hours went by and I assisted her in about every laboring/pushing position you could think of (if you’re a doula you know what I mean). She was exhausted, I was exhausted, but she pushed through. And then finally her baby crowned, and she pushed through the head. Part of her birth plan was that she had wanted to be able to touch the head and that she wanted her baby to hear her voice first. Her midwife placed her hand on the baby’s head and with a finger to my lips I reminded everyone to be silent (what my daughter didn’t know is, that she had pushed the baby's head all the way out and the baby was looking at us with great wonderment). It seemed like hours as we all waited patiently in silence. Then when she was ready, the last push, and he was here!

I can’t explain the emotions I was going through. The love that I had for my daughter at that moment was like no other time before, the bond that I already felt for my grandson, and the pure physical exhaustion. I was a Mother, a Nana, and a Doula.

Our lived-in houses say so much about us -- from the paint colors, to the furniture, the pictures on the walls – even the wear of our carpets which reveal paths like game trails on a hillside. However lovely the décor or the price of the art within, a potential buyer has to be able to shape your home into her home and envision her life and experiences there.

I am pretty keen on watching HGTV. What happens time and time again is a person or couple's inability to see past the décor, dated furnishings, popcorn ceilings, and linoleum to make that space theirs. I am constantly shouting at my TV, like the enraged football fan yelling at the ref: "You can paint over that!" or "You can buy new appliances!" or "You aren't keeping their furniture!" It seems simple to me, so I take for granted it would be simple for them -- and once in a while, there is someone who sees the potential of a house so drenched in someone else's life and style, but that is not the norm.

Potential. How I love that word! What amazingness it comes with -- growing fat with ideas and hopes and hard work -- ready to push into shaped reality! But it can be hard to see potential...it hides inside, where there is no light.

Do we help our childbirth students, our doula clients, our friends and family we love, see their potential when it comes to birth? Many of us have our own stories -- our own incredible stories we wear like badges of honor or turtle shells. As we carry these parts of us, are we able to share them without offering them as a template to others? 

Planning for birth is like buying someone's house. There are many tools needed to renovate and personalize the space so it feels right. There are many tools to offer moms -- amazing tools we have read about, learned about, practiced, and have extensive experience using. As doulas and educators, time and time again, the most important tool we have to offer is trust -- we can simply offer trust.