I always love Joyce's contributions to the 31 Days Project -- and today's does not fail to represent her heart and her mind. If we, as doulas, cannot see ourselves here in this vulnerable position of admitting we know nothing, I would suggest some introspection take place to balance pride with humility.
This month, I celebrate eight years since my DONA International birth doula training! In those eight years, I have had the privilege and sweet responsibility of supporting more than 70 births. My husband and I have added two more babies into our own family in that time. I have achieved and maintained certification through DONA, completed certification as a Hypnobabies Hypno-Doula, volunteer with the International Cesarean Awareness Network (ICAN) Lincoln chapter, volunteer with DONA as the Nebraska state representative, and serve locally with Doulas of Lincoln. I have completed training and taught other birth professionals as an Evidence Based Birth(R) Instructor. I have completed training on Rebozo techniques, Spinning Babies, techniques to alleviate back labor. I have brought new doulas with me to births for hands-on training. I have read and read and read some more. And yet. On some level. Despite all the knowledge. I know nothing about birth.
I understand the physiology. I understand the anatomy. I understand the symphony of changes that must happen in birth, at least as much as is understandable. I understand the emotional changes that birthing parents go through as their birth draws nearer. I understand the physical needs common to birthing women. I understand the psychology. I understand the medical considerations. I understand the medical system and its power structure. I understand that my clients will make choices that I would not, and I accept and honor that. I understand how to support women in childbirth, from the early stages to the first weeks postpartum and beyond.
Yes, I have lots of knowledge about birth. And birth surprises me. Regularly.
In those 70+ births, I have seen a woman go from 3cm to pushing out her baby in an hour. I have witnessed a mother going through the emotional signposts of labor during her pre-op for her scheduled Cesarean. I have held space for a woman to process her fears of becoming a mother while her cervix waited at 9.5cm for over 1 hour, and then cheered as she pushed out her healthy baby. I have supported women through inductions, natural births, epidurals, Cesareans, and more. I have been present for external cephalic version. I have experienced the stillness of breath, the concentration, the skill, the hope in the caregiver while resolving shoulder dystocia. I have held my own breath waiting for that first cry of life, and sighed in gratitude and relief when it comes. I have been astounded. I have been afraid. I have been amazed. I have witnessed miracles. I have had prayers answered moments after I prayed them. I have had prayers answered in a way I did not want. I have been allowed into sacred space. I have witnessed the moments that will live within a family forever. I am grateful.
I have made mistakes.
I had a client who was negatively impacted by seeing the clock, and I wished I had taken it down. I then had a client who was paying close attention to the clock, so I took it down. She lost her focus, and needed me to put the clock back up. I know nothing.
I had a client who was bothered by me explaining things in detail during her birth. I then had a client who wanted more detailed explanations during her birth. I know nothing.
I had a client who loved the bathtub. I then had a client who hated the bathtub. I know nothing.
I had a client who needed to smell peppermint oil to alleviate her nausea. I then had a client who found the smell of peppermint nauseating. I know nothing.
I had a client who needed her support team to be extremely quiet to feel safe. I then had a client who felt safer when her support team was chatting and talking around her. I know nothing.
I have lots of knowledge about childbirth. But when I go to a birth, my only hope to do my job well is to listen to the birthing mother. To read her. To ask her. To trust. To let go of my knowledge and myself and simply serve. I know how birth works, but I cannot know this birth before me.
Only the birthing mother knows birth. It is my duty, my joy, my honor, to serve her.
Joyce is the oldest of four children, and her birth experiences began when she watched her two younger brothers being born, med-free in hospital settings, when she was 4 and 8. When she and her husband discovered they were expecting their first child, she began researching everything she could about natural childbirth. That is when Joyce first learned about doulas. Labor support is her calling, and she is overjoyed at the opportunity to serve women in this way. In addition to being a doula, she is wife to her high school sweetheart and mother of three amazing children! Joyce holds a BA in psychology and a MS in biological sciences.
Joyce breastfed all three of her children to at least one year of age, used cloth diapers, baby sign language, babywearing, use natural remedies in conjunction with Western medicine, and homeschools. She doesn't think of herself as an "attachment parent," a "green parent," or any other parent label, she just does what makes sense for her family, and she encourages others to explore what makes sense for theirs.
Her website, Doula Joyce, and her Facebook page are where you can learn more about her.
BRAIN is one of my favorite examples of an easy way parents can get more information and ideas about different interventions they face. What I have not brought with that is the HEART Megan shares in Day 5's post. I love the combination of the two and am going to print them both out on business-size cards for my next childbirth classes!
One of the most crucial things we do as doulas is help parents make decisions. It's not as glamorous or often discussed as giving massages, squeezing aching hips, or whispering words of comfort and encouragement (not that any of those things are particularly glamorous). But it's one of the most important things we do.
Decision-making happens frequently during pregnancy. Choosing a care provider, a place to birth, which breast pump to buy through your insurance, what kind of birth preparation class to take, what sorts of things to register for, and so on...the decisions to be made sometimes feel endless.
But during labor, things are different. No longer is there a stretch of weeks or even months before baby is on the way - things are happening right now. Add to the urgency of time the fact that most laboring families are not necessarily calm, cool, and collected the way they might like to be when making decisions. Parents often don't even understand the implications of the options their care team is presenting.
That's where we come in.
In our prenatal visits and birth classes, we often use a tool well-known in the birth world. In fact, it's a tool now used by many who encourage healthcare literacy as a helpful way to approach decision-making with care providers. This tool comes in handy no matter where you're birthing, but we find it's often especially helpful for clients who are having their babies in a hospital setting.
The tool is an acronym: BRAIN. When a question comes up in labor, or a procedure or medication is suggested as the next step, our first suggestion is always to stop and take a breath. Sometimes these situations can be nerve-wracking in labor. So give yourself a moment rather than responding quickly and impulsively.
Once you've gotten a nice breath or two under your belt, take some time to go through the acronym letter by letter and ask some questions.
B: Benefits The first question to ask is what the benefits of the suggested procedure, medication, or change to the situation would be. Remember to consider benefits both for you and for your baby. We've found that usually care providers answer this question even before you have to ask it, because their suggestion is made with the intention of giving you and/or your baby a certain benefit. But if you have any additional questions about the benefits, ask them!
R: Risks Next to ask is, what are the possible risks to you? To your baby? Usually in a medical setting the answer to this question reads more like the side effects listed on a drug label. While this is good information to know, there are other indirect considerations to think about which sometimes fall outside the realm of the care provider's role in that moment.
For example, sometimes our clients ask their nurse or anesthesiologist about the risks of an epidural. Usually we hear care providers mention things like the possibility of a drop in blood pressure, headaches, nausea, itching, etc.
However, I've never heard a care provider mention the increased risk of a longer pushing phase, the increased use of medication to augment a labor slowed by epidural (pitocin), or the increased difficulty of breastfeeding after births involving an epidural (probably due to the IV fluids that accompany the administration of an epidural). These are things we discuss with our clients if they're considering an epidural, along with the benefits including "therapeutic rest" if labor has been long and hard.
If you ask about the risks of your care provider's suggestion and receive information from the drug label, also ask if there are any other indirect risks they know of. (And check in with your doula too, to see if they have any other information that might help you as you make your decision.)
A: Alternatives Ask your care provider if there are any other alternatives that can be tried first before proceeding to the suggested procedure or medication. There may be something less invasive or more temporary that might help address the issue at hand.
Often care providers and medical staff are much more comfortable with medications and medical technology in birth than parents are - primarily because they're around those things all the time. They see highly medicalized care help families every day. But most expecting parents aren't in that boat. Our clients are often surprised that their care providers suggested something more invasive when there was a less invasive alternative. Understanding where your care provider is coming from can be really helpful in this case. And of course, if your care provider suggests an alternative or two, make sure to use your BRAIN when exploring those options as well.
I: Intuition What does your gut say about this? How are you feeling about the situation at hand and the proposed next steps? Studies have actually shown that the intuitive, ancient part of our brains (the part that gives us those gut feelings) often works faster than the more analytical part of our brains. Here is a fascinating article on the subject.
It's important not to discount the sensations in your body we refer to as a gut feeling because what it can mean is that some part of you already knows the answer. It may just take a while for the rest of your mind to catch up and figure out the "why." Pregnancy, birth, and parenting involve a LOT of intuition. Don't leave your intuition at the door when you enter the birth room.
N: Nothing Also known as, "What if we wait an hour?" This question can help you determine whether your care provider feels the situation is an emergency or not. If the answer to "Can we wait an hour?" is "Sure, I'll come check in later," you know you have time to think things over. But if the answer is, "Waiting isn't an option - we need to make a decision now," obviously that gives you a different picture.
If the care provider's response to waiting an hour is positive, sometimes parents are surprised they were being asked to make a decision earlier than necessary. It's important to keep in mind that care providers are often on a schedule and juggling multiple patients at once. Sometimes the timing of things has more to do with their patient load than with your particular situation, which is another reason why it's important for parents to be asking these questions. This question is especially powerful for parents who want to minimize medications and medical technology in their births.
You should be able to take your time in making your decision unless there is a medical emergency at hand.
After you've had a chance to ask your questions, request a few minutes alone without your care providers in the room to consider your options. (If you have a doula, it could be beneficial to have them in the room with you as you talk things over. But if for any reason you'd be more comfortable having the conversation alone, by all means let your doula know.)
Once you're ready, let your care providers know you've considered your options and made a decision. If you are choosing to accept your care provider's recom-mendation, often the conversation will be fairly straightforward. But if you're choosing instead to try an alternative or wait a while before trying anything else, sometimes care providers can feel that their expertise is being undermined or that someone is convincing you not to accept their recommendation. This is a very human reaction!
To help diffuse any tension if this happens, speak from your HEART when communicating your decision to your support team.
H: Hear "I hear what you're saying and I understand why you recommended this..."
E: Empathize "...and I know you want the best for me and my baby..."
A: Affirm/Assert "...but I intend to wait a while longer before considering x, y, or z." OR "...I would rather try this alternative instead."
R: Reassure "I will let you know if anything changes."
T: Thanks "Thank you so much for your time and for taking good care of us."
These kinds of conversations can be difficult, especially if any medical concerns are present. These tools will give you an anchoring point when making decisions in labor and beyond.
Remember to use your BRAIN and HEART!
Megan has been serving growing families since 2014. She is an Advanced Birthing From Within Mentor and doula based in Orange County, CA. She is passionate about providing holistic guidance for her clients, helping them cultivate resilience and openness on their journeys to parenthood. In addition to offering birth doula support, she also teaches birth and parenting preparation classes. Megan practices in partnership with her wife, Marlee, who is also a birth and postpartum doula, childbirth educator, and lactation counselor. Together they serve families of all shapes and sizes with respect and compassion. Find out more about her by visiting Hero Birth Services, or her Facebook page.
It can be daunting to try and show the world how you differ from other doulas -- and this can often set us up for competition. In Day 4's selection, Natasha Longridge shares her feelings about the race between doulas, and how we can realistically shape our ideas about competition.
I've been a doula for over 10 years. I've seen a lot of doulas come and go in this profession for many reasons, but the one reason for leaving doula work that always hits at my heart, is when other doulas say "There's too much competition". I wish to flip that perception.
Take a step back, and think of where you heard the term doula. Was it from a friend? You're own birth? In the news? Chances are, it wasn't a common discussion, no matter where you heard it.
Statistically, in the US (because nothing is coming up for Canadian doula stats) only 6% of birthing families chose to have a doula. If we are talking about over saturation in the job market, that number would be a lot higher! It also goes on to mention that another 27% would have liked to hire a doula.
I like to look at that as a challenge. Obviously, we know that the word doula is still relatively unheard of in most mainstream circles. For as long as I've been a doula, I still run into people that say - I don't know what that is.
How do we change this? How do we get the word doula to roll off the lips of every beautiful birthing person? This is the challenge; to make it part of everyday conversations. The way for it to make it into more conversations, is if it becomes the norm, and a way to make it the norm, is if there are more doulas! Abundance.
I often share fellow local doulas info, blogs, etc on my business page. I have people ask me all the time why I do this. Why should I share and promote the "competition". To that I say, until every family on this vast planet knows what a doula is and does, I will keep sharing. I share because I'm not the right doula for everyone. I share because my doula sister has some great info, I share because even if I don't get the client, I know they are getting who they need and now one more family has doula support. One more family can now share the word doula with honour and love. Abundance.
I'd like to change the word competition (rivalry for supremacy) to abundance (overflowing fullness). If we believe that we do this work out of love, then we need abundance. The world we raise our children in, that we bring future parents into, needs more love. By believing in abundance of love and support we all win.
When we flip the idea that other doulas are competition, we lose the fear, we start to see how strong we are. We start to see the tribe of support that stands around us, holding the space for big things to come. That there is strength in numbers, and with those numbers, we have the power to create a birth world revolution.
Natasha is the mother to 4 spirited children who, along with their dogs, cats, and reptiles reside in Spruce Grove Aberta, Canada.
Natasha has been a practicing doula for over 10 years, and has worked in all Edmonton area hospitals, along with the local Lucina Birth Center and home births.
She takes her role as doula very seriously, and in doing so she is forever upgrading her skills. Natasha has taken training through DONA, Stillbirthday University, and GK University. She is currently enrolled in The Cultured Doula Program, and has recently completed her Masters Rebozo with GKU. As a placenta specialist she trained with PBiU.
Natasha can be found at Supermomma Doula & Placenta Edmonton, and her Facebook page.
Pursuing your passion once you've found it isn't easy. Often a lot of time and growing pains come with becoming a doula. Most of us have gone through this, or are going through this, or have to go through it again and again when other life changes occur, such as a move or having a baby of our own. Darby Morris shares her struggles in Day 3's post -- and I'm sure many of us can relate.
I sat next to one of my closest friends from college in the hospital room. Her husband and I were desperate to help. The nurse came in to the room: “you seem to be in pain, you should really get some pain medication,” she said for the fifth time with one glance at my friend. It was only a few more hours until my friend agreed and the nurse sent us out of the room while an epidural was administered. Her husband and I went to get some food from the cafeteria. He returned to the room with her mother for the birth of his firstborn. I spent the first few nights postpartum at my friend’s home doing all I knew to help her and her newborn. I was obsessed. In love. Infatuated. Though my friend would go on to be buried in postpartum depression, she saw my passion and suggested I become a doula.
I took as many classes as I could possibly find and attempted to create my own company. My first potential client was excited to hire me. I was petrified. How could they put me in charge of their birth? I had never attended a birth before. Was I crazy to want to be a doula? What if I just wanted to be a mom?
With that thought, my career as a doula ended. The answer was a resounding: yes. I did want to be a mom. With that I turned my back on the birth world and continued my pursuit for a career path, eventually getting two masters and starting my journey towards a PhD. In 2015, I had to drive two hours round-trip to get to work every day. My boyfriend had recently introduced me to podcasts and, in an attempt to find a new podcast to listen to, I decided to punch “birth” into the search bar. The Birth Hour, Birthful Podcast, Longest Shortest Time, and Mom and Dad are Fighting. (Today I have some new favorites: Fourth Trimester Podcast, Informed Pregnancy Podcast, Sprogcast, and All Things Breastfeeding Podcast.) I would come home from a full day spent collecting field notes only to spout birth facts -- until my boyfriend begged me to stop talking about birth.
A year and a half later, in November of 2016, my boyfriend found a job in California, we moved across country, and I decided to be a volunteer doula instead of immediately starting my own company. Volunteering as a doula is a unique opportunity. There are not many hospitals nation-wide that have volunteer programs. What I did not realize back in North Carolina in 2009 was that the University of North Carolina had its own volunteer doula program. Had I decided to volunteer the first time around my life would have taken a very different path.
San Francisco also has volunteer programs at San Francisco General Hospital (SFGH) and St Luke’s. SFGH’s volunteer doula program is well established. It took me five months to get into the program after applying and another month to get my badge so I could work there.
SFGH is primarily shift-based doula work. We were required to do one twelve hour shift once a month at the hospital’s labor and delivery ward. I did not enjoy it. There were times when I would sit for hours in the staff break room with nothing to do, staring at a screen trying to decipher the abbreviations that at the time meant nothing. When I was asked by the nurses to help a patient out I would find myself in a situation like this: a woman had barely acknowledged her desire for the epidural that was administered. It was explained by several hospital staff how it worked. Once we were alone she turned to me, “what is this?” she asked, pointing to the epidural button.
If I had been there earlier, I could have helped her understand all of her options, cope with her pain, have the birth she wanted, or at least explained to her the confusing birth hospital system she had been thrown into: all things I was able to do while on call with families at St Luke’s. Instead, the women we serve in shift-based work at SFGH only get support from a doula midway through their births, and at that point I was little better than the drugs the hospital had set her up on: another unexpected, confusing intervention to a natural process that modern medicine has somehow turned into an esoteric exercise for medical technicians.
I no longer do shift-based volunteer work and no longer volunteer at St Luke’s. Instead I work at San Francisco General Hospital for their small on-call program where I help with high-risk births: substance abuse survivors, rape victims, women whose babies will need surgery immediately postpartum, etc. I also started Sweetbay Doula as a doula who works to nurture the relationship between birthing individual and their partner that I believe is so important. And I love my job.
Since May 2017, Darby Morris has been serving private clients, and volunteers at both San Francisco General Hospital (SFGH) and St. Luke’s Hospital as a birth and postpartum doula.
Darby believes in providing doula experiences based upon continuing education and spreading that knowledge to families. Her business, Sweetbay Doula, is named after the Sweetbay Magnolia tree. Magnolias are known for their strength, flexibility and beauty. They can be found in both warm and cold climates, and are either deciduous or evergreen, depending on the environment. Their blooms are not affected by frost so they are able to bloom into late spring.
In short, Sweetbay Doula, like its namesake, is highly-resilient, flexible, and open-minded in all of the ways an expectant parent needs.
Being a US-based doula, it is easy for me to assume the general ways we practice as doulas are similar around the world. This 31 Days project gives me a dose of reality and shakes up my US-centric thinking when I read stories from doulas like Nicci. I wish Nicci and everyone like her the strength to keep supporting families, the courage to continue the uphill battle, and the heart to handle so much pain. The title for her post is also the motto for her bereavement training program -- thank you, Nicci, for allowing me to share your powerful words here.
My name is Nicci and I am a Bereavement Doula from Pretoria (Gauteng Province, South Africa), dealing exclusively with miscarriage, stillbirth and infant loss. I have been a "death doula" since 2015 and I am currently one of the most experienced bereavement doulas in the country.
Death humbles you. It leaves many wounded and scared (and scarred!) but also just as many people are awakened to the miracle and the fragility that is life. It opens your eyes to the absolute gift it is to breathe (and have those you love breathe) every single day. I deal with indescribable pain and heartache. My job is not an easy one, in fact, it’s probably one of the most emotionally challenging professions out there. But it is made bearable by knowing that I could help a mommy or daddy carry the load, even if it’s only for a little while. There is something unique about child loss. Because you don’t only lose a child you love, you lose the promise of that child’s life. You lose the "could have beens". You miss their first day of school. You miss their 16th and 21st and 30th birthdays. You miss out on every little thing that would have made that child "yours".
Like the character in the book The Shack, I carry The Great Sadness with me every single day of my life. Sometimes The Great Sadness is quite satisfied to sit in the corner of a room or on the roof of my car and just leave me alone – sometimes even for a day or two. Other days, The Great Sadness would just not let go of me. It will cling to me whilst I brush my teeth, when I feed the dogs, when I pray, when I speak to a telesales agent and decline a cellphone contract for the umpteenth time. It will rear its sad head when I walk in a shopping centre and see something or someone that triggers a memory. Sometimes when I walk passed a baby store The Great Sadness would hug me so tight that I struggle to breathe. But the Great Sadness and I have come to an agreement: Whenever I am with a client, it will not show up for a while. But sometimes The Great Sadness breaks its word and all that I can do is be sad with them.
The parents I assist and I usually have a lot of time talk and cry and yes, even laugh. Sometimes it’s much easier to talk about your pain to a stranger – somebody that you don’t feel guilty over because you are "burdening" them with your pain. Someone that won’t judge, just listen – who may shed a tear or two with you but who will not fall apart.
As a bereavement doula I am learning more and more about life, death, loss and everything in between every day. I have seen that parents feel guilty because they are experiencing deep grief over the death of their child. Statements made by well-meaning friends may cause them to question the validity of their deep feelings of sorrow – statements like the following: “Just be glad you didn’t get to know her. This way you won’t have to suffer the grief.” Or “The woman down the street lost all her children in a fire, you are lucky compared to her.”
The fact is that grief cannot be compared – not even between parents. Grief will not lessen just because the grief of another person is perceived to be greater. Also, they may have given birth to another child. But this will be another child, not a substitute for the one who has died. I always say babies aren’t puppies who can fulfill a general need. And to be honest, not even a dog can be replaced, how on earth can people expect parents to "replace" their baby who has passed on with another!
Although primarily my focus, I don’t just assist with baby loss but also with other losses. I have assisted a mother who gave birth via c-section to a healthy, beautiful little baby boy. The reason she needed me though, was because her husband was brutally shot and killed in front of her. This woman was shattered and tears jumped in my eyes when I looked into hers. It was almost unbearable to look at her. But she needed a calm, collected and professional person to assist her during the birth. In hindsight, I was none of the above. I may have appeared calm and collected, and yes, even professional to the untrained eye. But I was falling apart on the inside. The moment the doctor lifted that precious little boy from his mommy’s tummy I had such a huge lump in my throat I couldn’t breathe. The Great Sadness won that day…
Because there is such a huge need for bereavement birth workers in South Africa, I have written an Online Bereavement Training Program to enable as many people as possible in South Africa with a heart for bereavement to assist parents going through loss. Students are equipped with the right information, tools and coping skills to guide families in South Africa going through the unimaginable.
It is my dream that my profession will be formally recognized and acknowledged in South Africa and that bereavement doulas’ services will be covered by all medical aids. The motto of the bereavement doulas trained by Nicci.doula Bereavement is “to serve with love in loss” – I hope to be able to do this for a very long time to come.
Ever since the traumatic birth of her firstborn, the subsequent birth of his brothers, 6 infertility 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 the former director at Voice of the Unborn Baby, and Managing Director of 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. If you would like more information on the work Nicci does, please visit www.niccidoula.com or visit her Facebook page. For international bereavement training please visit www.stillbirthday.com.
Nicci lives in a leafy suburb at the foot of the Magalies mountains, in the Pretoria area of Gauteng Province, South Africa.
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.
Recently I was watching The Labyrinth, that incredible movie of my early teenhood. I watched that VHS tape so much it started to warp. I know just about every line, I sing every song, and I am ALWAYS ready for it to have a different ending, even though I know that never really happens.
I was struck by the opening credits -- when the words "It's only forever," play. This one day, when we birth our babies, stays with us forever. Shouldn't we do all we can to improve our experiences so the memories bring us happiness instead of disappointment? Enter, the Labyrinth...
The basic premise: Sarah is an imaginative girl who loves to dress up and pretend play. She has to baby-sit her half-brother, Toby, and she dreams her story to be that of having a wicked stepmother and she being forced to work and have no life. Her brother begins to cry from his crib. She accidentally sends Toby off to the Goblin King, Jareth. She then has to rescue him, through the maze of a huge labyrinth, or he will be lost to her forever. Ultimately she has a few choices -- live in her pretend world forever and forget about Toby, become Jareth's queen and live happily ever after with him, or fight to get Toby back -- and of course, that's what she does.
But did I mention who Jareth is?
Um, yeah -- that's why I was always Team Jareth...but I digress.
1. This is a piece of cake!
Often labor starts out so small, we work up confidence and think, like Sarah after making a good choice, "this is a piece of cake!" That's right before she falls into a hole with nothing to stop her except a bunch of "helping hands."
While early labor is often something we can handle on our own -- occupying our minds, resting, bouncing on a ball, relaxing in a tub or shower -- as things progress, our bodies will demand more from us. Instead of worrying that this is a predictor of how hard labor may be (at some point in the future -- I call this 'catastrophysing,' and in real life, I am pretty good at it), we need to enlist support from those around us. This is where partners, doulas, midwives, mothers, nurses -- whoever is there to fill that role, come in.
Labor WILL get more intense -- that's the nature of the process. With support, we can be lifted up by those caring people on our birth team, those helping hands.
2. There can be a lot of waiting!
There is an average amount of time women will labor. For first time pregnant people that is 12ish-24ish hours. Be mindful of that when you start telling people you are in labor, people forget birth is a marathon, not a sprint. It may only be an hour of time that has passed and well-meaning friends and family can start to ask if your baby has been born yet!
Some families consider sitting with this information for a while until there is something more exciting to report. Often the invitation (or expectation) that people will wait happily in the lobby can be a lot of pressure to the laboring person! I have been at more than one birth when a guest pops into the laboring person's room, unannounced, and either there was nothing going on, or the person had to be shooed out quickly because it was pushing time or naked time or toilet time -- this doesn't have to happen to you! You can decide where your loved ones will bide their time, and it doesn't have to be at the hospital.
3. It may help to lose your head
Whether it comes as a loss of control, or a needed suspension of reality, staying in our left brain where logic and reason try to make sense of things isn't always productive in labor.
As labor progresses, we need to move to our right brain and listen to what our bodies are saying. Linear flow of time, labor math, and trying to make predictions according to what we know and what has happened all need to go by the wayside. Our team should help protect this state of mind by moving with us, going at our pace, finding another place for their fears besides our ears, and knowing how to help if we are truly lost -- like getting into take-charge mode. Labor is challenging, and we are working hard enough to keep our own heads straight -- partners and others can respect this and flex to it as long as we are feeling safe and moving forward.
4. Ultimately, birth isn't fair
We learn. We read. We immerse ourselves in information and do our best to plan for our births. But in the end, there are so many things that aren't in our control. Does this mean we shouldn't even try?
What can we really plan about birth? We'd like to think we can plan a lot -- hospital, support team, safety. But we've all seen videos of women birthing unexpectedly in their cars (as a doula I had that happen once). So what's a pregnant person to do? I'll tell you: take a comprehensive childbirth class where you'll learn your options in a nonbiased way. Understand the labor process, how to cope, and what to expect. Build your dream birth on a foundation of sound evidence-based information -- this will ensure if your Plan A becomes a Plan B, you will know exactly what your new set of choices are -- because you ALWAYS have choices. Birth, like life, may not be fair, but you can adjust the scale in your favor with knowledge and options.
5. "You have no power over me."
I recently had a conversation with a pregnant woman who shared: "I know no one can make me do anything I don't want to do. I can always say no or ask for other options. That's my right."
Not sure what your rights are? According to the American College of Obstetricians and Gynecologists (ACOG), pregnant people:
This is what ACOG is laying down that many physicians aren't picking up: no one can guarantee the outcome for you and your baby -- and because of that, the choices we make during pregnancy and birth are ultimately our own. This doesn't mean you have to be contrary out of the gate, this simply means when you have researched, thought over, pondered, prayed about a decision which may differ from that of your medical provider, no one holds more power than you.
On December 18, 2014 I wrote this with a sick baby in my lap. Ezra was 8 months old and had his first doctor-worthy illness -- croup. I had been talking to a former doula client about her second birth, which I wasn't able to attend as her family had moved. After that phone call, coupled with the inability to leave the house or put my baby down, The 12 Hours of Labor was born. I made some visual updates because I was never happy with the quality of the print -- hopefully this helps!
This is my step sister's story of her first baby's pregnancy and birth. Noah touched down and lifted off sooner than any of us wanted. And I am so amazed to see how this family has pulled every good thing from that painful experience.
We were expecting our first baby and we were very excitedly awaiting the upcoming anatomy scan so we could get another peek at our baby and give them an identity. The appointment finally came. We sat anxiously in the waiting room. Finally, it was time to go to the back. I had invited my cousin to come along and witness the appointment with us. I got all set up, pulled my shirt up and the jelly was squirted onto my belly. We were finally seeing our baby.
We asked questions as the technician took pictures. “what’s that?”, “Is that a leg?” I recalled that a friend who went to the same office for her pregnancy had gotten 3D pictures at the anatomy scan. “Will we get some 3D pictures of our baby?” Silence. And then, “Normally we do that, but there’s not very much fluid so we won’t be able to.” Collin and I exchanged nervous glances and squeezed each other’s hands. I decided to be positive and not let what the technician said worry me.
Then she attempted to get the gender. That took our focus off of what had been said. Our baby was not cooperating. So the technician told us that she believed it was 70% chance a boy. Then she said that the doctor needed to come in and talk with us. Again, Collin and I exchanged nervous glances and squeezed hands.
Our doctor came in and said that after reviewing the images taken by the technician, it did not appear that our baby had developed kidneys. However, he wouldn’t say anything definitively. He instead referred us to a specialist for us to be able to get the final word. He briefly explained what it meant if our baby did not have kidneys. “Not compatible with life”. We were numb. I nervously looked at my cousin, who had tears in her eyes.
After that, we went out to lunch. Before going into the restaurant, I swallowed the lump in my throat and made a phone call to my aunt, my sister and my in-laws. I told them what was going on. We agreed to all pray and fast before the next appointment, which was scheduled for a couple days later. Then we went into the restaurant.
Collin and I were talking about what the doctor had said. I realized that my sweet husband had still not connected that our baby could not survive birth without kidneys. I gently told him. I watched the realization hit him. Then I quickly began talking again about the things we would do in the meantime while we waited for the appointment.
It was an agonizing couple of days, full of tears. I recall saying “There’s no way I could lose a baby. I can’t handle something like that.” The day for the next appointment came. We felt positive that morning. A sense of peace for whatever was going to happen in that appointment. The doctor used fancy ultrasound tools that gave him a clearer picture of our baby. First, he got the gender for us. We were due to have a baby boy! After about 45 minutes, and several different ultrasound tools, the doctor finally confirmed that our baby had not developed kidneys.
We were devastated. We tightly gripped each other’s hands for strength. Our doctor began to explain what to expect. Our baby would swallow the amniotic fluid, which is meant to stretch the lungs. Then it’s supposed to continue a cycle where it gets filtered through kidneys and peed back out. However, without the kidneys to filter the fluid, it wasn’t able to finish the cycle. Eventually he would get to a point where there was virtually no fluid around him. As a result, he wouldn’t be able to swallow any fluid to stretch his lungs. This meant that his lungs would no longer be developing and as a result, he would not be able to get a sufficient amount of oxygen upon his first breath after birth and he would pass soon after.
This was difficult for us to hear. We both put on strong faces as the doctor continued to talk. At this point, he said that as a doctor he has to go off of the facts and those were that there was no way for our baby to survive. Then he said that as a person, he believed that there was absolutely room for hope. He said that he had seen many things in his career that could only be explained as miracles. He told us that he had to ask if we wanted to continue the pregnancy. Without hesitation, we both agreed to carry him as long as possible.
After the appointment ended, we went back to our car in the parking lot and we both lost it. We were both crying and hugging and holding each other. I remember this feeling of “why me?” and I felt like it was so unfair. I had already been through enough hard things in life, right? We composed ourselves enough to start making the phone calls to update family. Those were very hard. We called my aunt and uncle, Collin’s parents, and my sister. We cried more with each phone call. We left 2 hours later, once we felt composed enough to travel home. It was about a 30 minute drive back home.
A few days later, I remember feeling like I needed to do something. I had heard about a Washington senator who had experienced the same diagnosis with her daughter. They ended up finding a doctor who would inject saline into her uterus for her baby to swallow and develop her lungs. When her baby was born, she was put on dialysis and had to wait at least one year to get a kidney. I did not feel like this was what I needed to do. One reason being that most doctors did not find it to be ethically okay, so it would be hard enough to find a doctor that would agree to do it for us. And another being that dialysis is already hard on an adult, so it would be even harder for an infant.
As I tried to figure out what to do, I came upon another story of a woman who had a similar experience. She had been told her baby did not develop kidneys and would not survive. Well, near the end of the pregnancy, the baby suddenly had kidneys. It was a miracle. That baby survived. After reading that story, I realized that the best thing I could do was have hope. To believe in my son’s ability to receive a miracle. I started talking to my husband about it and trying to raise his hope. We decided to continue shopping for our son as if he would survive. It was very therapeutic for us.
Here’s where people began to misunderstand our choice to have hope: Family and friends that we shared our son’s story with began to think that we didn’t recognize the reality of the situation. They confused our hope with denial. They thought that we fully believed our son would survive birth and that there was no chance of losing him. This was false. We absolutely understood the reality of the situation. We knew it was more likely that he would pass than survive, but focusing on that did not uplift us. We did not want to look back on our time with him and only see ourselves gloomy and waiting for him to die. We wanted to look back and see the hope and see that we did SOMETHING to cherish that time with him.
This misunderstanding made things awkward. I had a sister who was pregnant at the same time as me. I would hear family excitedly talking about her baby and her pregnancy, but when I brought up our baby and my pregnancy, it usually was a short and awkward conversation because nobody wanted to focus on the baby that was going to die. It was an incredibly lonely feeling. Collin and I could only talk to one another about it.
About 2 months before my due date, we decided to move back to home so we could be near family when our son was born. We got a new doctor set up quickly and got a tour of the hospital that recently had upgraded it’s NICU to a level 4. About a month later, I went to my 34 week appointment. I asked the doctor what to expect when I went into labor. I wanted to know if I would even have a “water” to break since there was virtually no fluid left around our baby. He assured me that I would not experience a “water breaking” moment because of the lack of fluid.
A couple days later, my water broke. I had noticed earlier in the day that my tummy seemed to have “dropped’ quite a bit. My husband was working potato harvest, so when he came home that evening, he commented on how low my belly looked, too. We went on a date that night since he wouldn’t be working the next day. We went to Red Lobster for my first time and then we decided to do some more baby shopping. We bought a car seat, and a baby chair.
When we got home, I sat down to snack on some pineapple. When I got up, I felt a pop. I told my husband to continue to the bedroom without me and then I went straight to the bathroom. Fluid was flowing out of me. I quickly went downstairs to my husband and said “We have a problem. I think my water broke.” He went into a panic and told me to call my sister and ask her if that’s what was going on. I laughed and told him we could just go upstairs and ask my aunt, who had delivered 7 babies herself. We were living with my aunt and uncle during that time.
My heart was pounding. I was so worried about our baby. I needed to hear his heartbeat, I needed to know he was still alive. I had bought a Doppler for this very purpose, weeks before we found out about his diagnosis. I quickly grabbed it and started searching for that familiar thump thumping. After a few quiet seconds, I finally located it. So we went upstairs to let my aunt know what was going on.
Things got exciting at home. Collin gave me a blessing. Then we headed to a 24 hour urgent care. We wanted them to test the fluid and confirm if my water had broken. I found myself continuing to worry about our son. I was so nervous as they set things up for an ultrasound. I was terrified I wasn’t going to see his heart beating. I didn’t want to ever have to experience that. As soon as I saw the flicker, I breathed a huge sigh of relief. He was doing just fine.
The litmus paper test for the fluid was inconclusive, but the doctor at the urgent care had talked to my doctor and they both had decided that I needed to go to labor and delivery. At first they were going to send me in an ambulance, but then we were able to talk them into letting us go in our own car. They just made us promise that we would go right there and we would not stop for food on the way.
It took us about 20 minutes to get to the hospital. There was a security guard waiting for us at the ER entrance. He took me in a wheelchair through the maze of the hospital to Labor and Delivery. I was put into a triage room. A nurse came in and did a more official test to clarify if my water had broken. We waited about 45 minutes for the results. It was positive.
They moved me into an official delivery room. A doctor came in to speak with me and to start going over all the details. My sister in California began getting her things together so she could quickly make the drive to Washington to be there for me and my husband. We were told that I could have a day to let my body naturally go into labor. The next evening they would induce me if I didn’t start labor.
One thing that sticks out the most to me is that as soon as I got checked in as a patient, I was told that I wouldn’t be leaving the hospital until our baby was born. All of this happened on a Saturday. The next day, Sunday, we played the waiting game to see if I would go into labor. We also had to make some big decisions regarding our son. I still was very hopeful at this point, but I also had the weight of reality pushing down on me. We had to decide if I would have a heartbeat monitor for our baby during labor, and if we were going to sign a “Do Not Resuscitate” order for our son in the event that he would pass away. We took some time to discuss these important matters. We chose to not have the heartbeat monitor and we signed the DNR order.
Signing that paper felt like one of the worst things I could do as a mother, but I knew that if he did pass away, it would have been torture to watch them revive him again and again only to watch him pass again and again. The rest of the day we mostly talked with family that stayed at the hospital with us, but I also walked the halls and tried to do whatever I could think of to help my body. No luck! So I got induced with cervadil.
They told me it probably wouldn’t be enough to throw me into full labor, but they would evaluate things as we went. Well, 2 hours after administering the cervadil, I was in full on labor. Contractions on top of contractions. I did nothing to prepare myself for that misery! I did my best to keep moving since that seemed to help. I sat at the end of my bed with my legs apart, my hands on each leg, and I rocked back and forth with the contractions. It seemed to help the most, but I was still miserable.
My nurse kept giving me pain meds to try and alleviate the pain. I think she didn’t believe I was in as much pain as I was. After the second dose of fentanyl and the second reaction to it of throwing up, she finally checked me and decided to offer me an epidural. I gladly accepted it. Once I got the epidural, I could finally relax and go to sleep.
I woke up hours later, with the urge to poop. I told my nurse. She checked me and told me I was fully dilated. The current doctor on call made me very uncomfortable, so I pleaded to the nurses to not let him deliver our baby. They said that because of the circumstances we were in, they would do their best to get the other on call doctor for the next shift to come in earlier to deliver our son. So we played the waiting game as the nurse worked hard to get the other doctor in.
Family started showing up to the hospital so they could be around once our baby was born. The nurse was successful in getting the other doctor to come in early, which was a huge relief for me. Everything went so fast after he showed up. The bed was broken down for delivery, the doctor gowned up, and everything was set in place. Finally it was time to start pushing.
We actually had a pretty pleasant conversation while I pushed. I was so relaxed because of the epidural. The doctor had to be extra careful because our son was breech, so he was delivering our baby butt first. This was only allowed because of our son’s chances for survival. They said that it made no sense to perform a c-section on me and put me at risk, if our son’s chances of survival were non-existent. I was very comfortable having a breech, vaginal delivery.
At 7:48, our son was born. Noah Austin Pound. As they brought him to my chest, I heard my little boy struggle to take a breath. And then he quietly passed. In my head I was begging him to come back to me. Then I felt a peace overcome me and I knew that my little boy had completed his life on earth.
The next several hours were spent taking him in. Looking at his sweet little body and how perfect it looked. You wouldn’t have known there were no kidney’s in that little body. I gave him a sponge bath, we dressed him, we took pictures. We cherished the moments. Then there were the tears. Lots and lots of tears shed. Lots of thinking “This isn’t fair. He’s so perfect”.
We stayed another night in the hospital. Anytime I wanted Noah, the nurses would bring him to me. When they took him back, they put him somewhere that made him very cold. They would always wrap him up in a warm blanket when they brought him to me.
Each time I would hold him again, I would lose it. I would experience all the emotions again until I landed on acceptance.
The next day, I dragged the day out as long as I could. Then came the time to have the mortician come take Noah’s body. That was very difficult for me. I never wanted to stop holding him. I knew our time together was coming to an end. After spending every moment with someone for months, especially someone who was inside you, it makes a difference when they are suddenly gone.
Noah was the best thing to happen to me and to us. I would never wish this experience on anyone, but I have seen so much growth in me and in mine and my husband’s relationship as a result. I continue to learn things from this experience.
I love to talk about Noah. There is a new stigma we face where people get uncomfortable when we mention him or tell them his story. That makes me sad. The best thing anyone could do for me is say his name and acknowledge that he lived and that he meant something to us. I know it seems difficult to talk to somebody about the child they lost, but you will not hurt them by mentioning their child. Ever.
Noah would have been 3 this year. He has 2 sisters now, Lucy who is 2 and Ellie who is 8 months. They will always know they have a big brother looking over them. I will always cherish our memories with Noah. I’m a better mom today because of him. Happy birthday, buddy!
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!
♥ four young boys and a boy dog (offspring)