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

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

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

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

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

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

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

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

In my classes, I have an activity I am pretty sure I learned in my Passion For Birth training where parents are encouraged to draw their ideas for birth. Taking left-brain concepts (hospital stays and medical procedures) and using right-brain-directed activities (drawing and coloring) blends our thinking and enables us to synthesize ideas, versus analyze them. What's the difference? When you analyze something, you have a singular focus on it and it alone.

​Imagine being worried about having an unneeded, unwanted, unwarned-about episiotomy. Analyzing this can lead to worrying it might happen to you, without much recourse or thought into the bigger picture of how to prepare to avoid it. Synthesizing takes many pieces of information and plugs them into a bigger picture. In the case of episiotomy, you can learn when they are medically necessary, ways to prevent them during labor (for example, avoiding getting over-hydrated) and second stage (avoiding purple pushing and being more upright), your doctor's opinion and habits, and your birth location's statistics.

Here are pictures from students in my Chico, CA classes (I currently offer Lamaze childbirth classes in Bakersfield, Visalia, Hanford, Tulare, and many places in between and beyond). 

I help breastfeeding moms with lactation support in the Bakersfield, Visalia, Tulare, and Hanford areas of California's Central Valley. So often when I answer the phone to a mom looking for breastfeeding support, somewhere in there I hear the voice-cracking and the tell-tale pauses that show she is working hard just to reach out and share her story. We are often not prepared for how hard breastfeeding can be, and the toll it can take on our hearts. We hear of the joy babies bring, the bonding, their smell, their sweetness -- maybe someone out there mentioned being really tired or not showering easily in the first weeks. We are culturally conditioned to worry more about birth than breastfeeding.  

When a mom is struggling, what can we do to lift her up? What words and actions can scaffold her, infuse her with strength? I asked women to think back to what was encouraging and motivating, that anyone (not just a breastfeeding helper) could do, to make the journey a little easier. Here is what was shared:

1. "Keep the focus on me." Many of us have had issues with breastfeeding, and often the inclination is to quickly get to our own story and how we survived. "I cracked and bled for two weeks. I didn't have enough milk so my friends gave me donor milk. I locked myself in a room and said, 'we will figure this out,' and I never gave him a drop of formula, even though my doctor suggested I was starving him -- I just powered through." This is not helpful. It isn't that on a normal day Mom can't appreciate your experience, it's just that right now, it takes away from her very-current state of being vulnerable and needing support. If you can relate, say something simple that doesn't turn the whole subject back to you, like, "I remember that." It's okay to reaffirm you have felt something similar; it's not okay to shift the focus so now you can talk about yourself. In this moment, it needs to be all about Mom and Baby. It takes acute awareness to stay in the present with her, and this truly is your gift to give.

What is not helpful: Launching into your own tale of triumph, terror, or failure, especially with the intent of showing Mom you had it worse; the same holds true if you feel compelled to share your grief, your anger, or what you would do. Apply Susan Silk's "Ring Theory," which I have adapted. The idea is, the person facing the crisis (Mom) has the center spot. She is allowed to say whatever she wants or needs to, to anyone else. As the rings extend, others are assigned positions according to how close they are to the center. So Mom's partner is next. Again, he or she is allowed to vent in an outward fashion. Family and friends will have their own feelings, and it is appropriate to dump those outward as well. Advising, sharing your worries or coping methods, explaining your exasperation with the situation, etc., is never done inwardly, because this adds to the load of those dealing most directly with the crisis. 

2. "Use those active listening skills we hear about." Rephrase what she says: "It sounds like you are scared that breastfeeding is not going to work." By restating what you heard, you aren't going to tell her something she doesn't already know, and it lets her know you heard her. If it isn't what she's feeling, she can clarify by offering more information: "No, I feel like it is working, I just think maybe it will never end up being a smooth, easy process, like I imagined." It's okay if you don't get it right -- she will understand you are trying to listen to her feelings. Acknowledge her struggle -- you can never go wrong by saying something like, "I see how hard you are working." Don't ever  under-estimate the therapeutic power of being a good listener. 

What is not helpful: "Maybe it's not meant to be." "Haven't you tried hard enough?" "Formula/ bottles are here for a reason." "Your cousin Jill wasn't able to breastfeed, and everything turned out fine for her."

3. "Don't be afraid to touch me." When the dam holding back the tears and feelings breaks, she can feel cracked open and raw, and having an audience can make those feelings even worse. You can touch her shoulder, take her hand, or offer the comfort of a hug. Sometimes touch can give more solid support than any words can. When a baby cries, he is letting us know he needs something, and that gives us the opportunity to respond and help him feel better. When adults cry, there is the same opportunity to help someone feel better while also creating a bond of love or friendship. You may not know what to say when you see her like that, but you can't go wrong by showing her physically that you care. 

What is not helpful: Staring at her, pretending she's not showing emotion, visibly looking uncomfortable, or telling her not to cry. 

4. "Share in the loss I am experiencing." Whether breastfeeding will ever work for Mom and Baby, in the middle of the crisis, it is a loss -- a loss of hopes, a loss of dreams, a loss of what she thought would be an "easy and natural" way to feed her baby. It is okay to treat this as any loss a friend might face. This isn't the same as having two choices for dinner -- chicken and rice or beef and potatoes -- and then having the choice made for you. Breastfeeding comes with many overwhelming emotions. When she feels like she can't feed her baby, in that moment there is nothing that can feel worse, and it feels like loss. We can accept and value that, even if we can't understand it. 

What is not helpful: "It could be worse." "At least you have a healthy baby." "I don't understand why this is affecting you so much, it's not like someone died."

5. "Let me decide when I am done." Well-meaning friends and relatives who are concerned about Mom's physical and emotional well-being may try to convince her that she's worked hard enough. Mom is the only one who can judge that -- she knows her options. Wait for her to tell you where she is in this journey. One woman, a neurologist, shared: "If you say you are suicidal, people don't say, 'yeah...you should probably just go ahead...' They figure out how to help you, they talk you off the ledge." It obviously isn't the same thing, but in the storm of hormones, emotions, life changes, and struggles, the very-real feelings of hopelessness and loss of control can be strong and similar. Keep encouraging her. This is her marathon to run -- she decides the pace, the route, when to take a break, or even when to stop -- you cheer her on from the side no matter where she is in that loop, no matter how you are feeling about her situation. As another woman put it: "It's cruel to try to take someone's hope away."

What is not helpful: "It's unlikely by this age your baby is going to figure out how to breastfeed." "Just try X, Y, or Z -- it fixed our issues." "Not everyone can breastfeed." " I just can't bear seeing you so upset." 

6. "Do something for me that will save me from having to do it myself." Rabbi Harold Kushner is the author of, "When Bad Things Happen to Good People." When asked to share what he's learned in his years supporting people in the midst of suffering, he said it could all be summed up in this statement: "Show up and shut up." Anything you can do for Mom that gives her more time to be with her baby and concentrate on self-help and healing, is priceless -- and ANYONE can help. "My husband has always been supportive. He always left it up to me to decide what I wanted to do. And when I decided I wanted to continue to try, he helped me pack up the baby and drove me to LC's and LLL several times a week. He washes bottles and pump parts, he's a pro at freezing, thawing, making bottles, hooking up my pump. His labor of love is so important at continuing exclusive pumping, because I alone have logged about 3,000 hours of work towards pumping and pumping-related activities for the first year of my baby's life." Further out of the ring, family and friends can take care of pets or outside responsibilities, bring meals or snacks, run errands, make phone calls, drive Mom and Baby to appointments, and always, always there is housework and laundry. 

Ronald A. Rasband shared: "If you come upon a person who is drowning, would you ask if they need help -- or would it be better to just jump in and save them from the deepening waters? The offer, while well-meaning and often given, 'Let me know if I can help,' is really no help at all." It can take energy, effort, and humility for a person to list what she could use help with. In the movie "Robots," one of the characters, Bigweld, had this motto: "See a need, fill a need." Jump in and do what you can -- when there seems to be nothing else, there is always service. 

What is not helpful: Service with conditions; making the job seem too complicated to take on, or making it too complicated for Mom to delegate; rushing in to offer babycare when Mom and Baby could be bonding; expecting a thank you card. 

Society says feeling bad when breastfeeding is hard is not appropriate or okay. We don't want to make anyone feel bad if they can't breastfeed, so when a woman struggles to continue, her hard work is not always encouraged or even noticed. To really help, though, we need to suspend this judgement and be willing to accept her feelings and her reality. Becky Bailey writes: " Acceptance means recognizing that people, situations, and events are what they are. Each moment simply is as it is. Acceptance doesn't mean that we approve of the moment, only that we recognize that what is happening at a certain moment is, in fact, happening." 

Two women in particular said they couldn't remember anything helpful or hopeful that was said to them. This lack of acceptance is apparent when they shared what they wished they had been told:

Accept her struggle. Accept her feelings. Open yourself to her reality and you increase her willingness to accept your help. When she comes out the other side (whatever that other side looks like), it can be with positive memories of the support and care that was shown to her and her baby.

I value your comments and stories, and I am appreciative of the time taken to share them <3. 

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 been a couple of days ahead of these 31 days' posts. Yesterday, on day 8, I was ready through Tuesday, including a special Mother's Day post for day 10. All I needed to do upon waking up today was hit "publish" for day 9's post. 

I was called to a laboring mom in Tulare at 2 am, yet I knew I could use my website's mobile app to publish from the hospital -- but not so, I kept getting an error message (while mom was being triaged in a Visalia hospital and I was in the waiting room). I finally gave up and focused on this birth, knowing I could figure it out later.

This birth! This birth was amazing. My friend and fellow doula, Denise, asked me to support her during her surrogacy birth. Her husband, Chris, was a huge helper -- after all, he has supported her through her natural births before. That left me wondering, what would my place be when the partner is already doing great? I did doula the dog while we labored at their house; poor Buddy had been hiding under the bed until I arrived. I walked in to lay my hands on Denise's back to let her know I was there, and from under the bed, something began licking my feet. Buddy!

What we couldn't predict was, once we got to the hospital, Chris started feeling very sick to his stomach. He needed to go to the car and rest for a while, and he was kind of in and out of the scene. When he was present, he was very present, offering everything he could to support Denise (and the way they worked together was inspiring). And when he needed to step out, he knew things would be okay. 

Denise had an amazing midwife, Rita. Rita is a powerhouse. She had five children of her own, and when she enrolled in a midwifery program Stanford offered for three years back in the 80s, she was pregnant with her 4th baby. Many doubted she would finish, but Rita is nothing if not relentless! And this shows when it comes to supporting her patients. Not only did she go to bat for Denise's comfort and preferences, she also knew how to talk to Denise to keep her courage up and help her move forward when she hit emotional and physical walls. 

The intended mother was at the birth, and she quietly witnessed the whole thing, very concerned for Denise's safety and comfort. When this little baby girl was finally born, she was laid on Denise's chest, with her mom right there, awestruck and deeply moved. I don't think any one of us in the room had dry eyes. Soon the mother sat down in a rocking chair and baby was placed skin-to-skin with her. We all watched this new mother interact with her baby -- the sweet words, the lilting voice, the facial expressions and the snuggling; it was an amazing peek into the private world of a mom and her infant. Soon the new dad joined mom and baby, and again, the tender voices and touches were sweet affirmations to those present that this new gift was one worked hard for, one cherished. 

I didn't intend for this to be anything more than a short Day 9 post to stay on track, but it is hard to withhold the beauty of birth -- every birth. I am amazed at Denise's strength and her generosity. She truly went through one of the hardest physical and emotional experiences in her life to grow and birth a baby for a family who did not have this ability. Four hours or so after the baby's birth I finally left, but one of Denise's last comments to me was this: "I am so grateful I could do this for them."

And I am amazed.