Aren’t Doulas Just for Natural Birth?

Aren’t Doulas Just for Natural Birth?

Every doula I know smacks her palm to her forehead whenever she hears or reads some version of the headline above.

But guess what?  We hear it a lot… so our foreheads are pretty sore.

And we must be somewhat to blame. It would seem that our efforts to educate are falling very short. Of course, this perception doesn’t come from nowhere. Definitely, doulas tend to relish birth in all of its raw, primal intensity. Witnessing a birth like that or experiencing it firsthand might be what brought a doula to her work in the first place. I, myself, never fail to enjoy supporting an unmedicated birth, but then again, I’ve never failed to enjoy supporting a medicated birth either. Supporting natural (unmedicated) birth is NOT the crux of what I do.

A am awed and impressed by the birthing mother*. Always. I don’t care what the birth looks like. The person giving birth is a complex human, with a complex past and complex feelings and motivations. Her partner or other support people are multi-faceted and her relationship with this person or these people is unique. Her pregnancy is one-of-a-kind. Trying to bring a healthy human in the world is hard and vulnerable work. It takes thought, guts, control, surrender, strength, vulnerability and so much more. And that is true for anyone giving birth. Whether a person gives birth with Pitocin (a drug that causes contractions), without Pitocin, with pain medication, without pain medication, by planned cesarean, unplanned cesarean or crash, emergency cesarean, none of it is easy.

The crux of what I do is support the pregnant person and the father/partner when present.

That support starts in pregnancy. Are you planning to have an epidural? Great! Is that alone enough to make you feel secure and confident about giving birth? Probably not…  Wouldn’t it be nice to have someone who is well-versed in birth (in all its forms) to whom you can ask your questions, who can send you information, and can listen to your worries and your partner’s worries and help you work through them without judging what you’re feeling? That’s just some of what I do as a doula.

As your doula, I  can help you learn what to expect from an epidural, talk to you about when you might want to get the epidural, how to cope with contractions until the epidural arrives, keep you massaged and hydrated once the epidural is in place, help you change positions, reassure you when you feel nauseous or shaky, apply cool washcloths to your forehead, and translate “medicalese” to you and your partner. I can talk to you in advance about how to isolate the muscles used to push, so that it’s easier to push when the time comes.

As your doula, I am your constant. When you plan to give birth at a hospital you won’t know the nurse that will attend to you–the nurses change with the shift–and it’s not uncommon to see your OB or midwife only at the very end, when it’s time to deliver your baby. With all of those variables,  wouldn’t it be wonderful to have your own, dedicated birth consultant at your side?

If in your pregnancy you begin to be faced with the possibility of induction or planned cesarean for medical reasons, you may need to change your “plan” drastically from what you imagined. What if you had a person who could help you process your emotions and talk out your options? There is such a person. You guessed it! It’s a doula.

I have attended planned cesarean births, in which I was allowed into the operating room with the mother and the father and I took pictures of the birth, held the mother’s hand or stroked her head when she needed it. I let the parents know what kinds of requests they could make of the birth team (for instance asking for delayed cord clamping or skin-to-skin contact soon after delivery). These mothers and fathers have told me how precious it was to have photographs of their baby’s first moments and their first meeting of their baby.

Perhaps I could try to list every different situation in which a birth doula could be a helpful addition to the birth team, but that could go on forever. Mostly, what I want to say is that giving birth is a profoundly physical and a profoundly emotional process. No matter how your baby comes out, that statement is true.  The medical members of the birth team can get caught up in the purely physical aspects of the labor (and this can make sense, since they are tasked with the job of keeping you and your baby safe), but it’s not the only aspect that needs tending to. You and your partner need considerable emotional support also. A professional doula’s focus is on support and comfort for you, both physically and emotionally.  This is something that all birthing families need.  For this reason I am not, nor will I ever be, just for “natural” birth.

*Mostly I serve mothers, but a birthing father, non-binary birthing person, or person who was not planning to parent the child is equally awe-inspiring.

Surrogacy: The Most Hands-On Professional Development I May Ever Get

Surrogacy: The Most Hands-On Professional Development I May Ever Get

For those of you that haven’t heard, I have some big news: Once again, I’m carrying a life. This life is a kicking, somersaulting little boy who, when born, will be handed back to his parents, two Dads who live in Utah.  He is due on May 3rd or thereabouts.

I might be crazy, I’m not sure. But this has been an amazing journey so far and one that is still teaching me.

One thing that everyone wants to know is what made me choose to be a surrogate. It’s a fair question, but one with an understandingly complicated answer.  There are a few parts to it.

A) I’m one of those women who liked being pregnant (and if I could skip the first trimester, I would like it even more) and I loved giving birth. I know that’s weird, but I absolutely loved the birth process. Author and anthropologist, Sheila Kitzinger, once said about birth, “Now this is a sport I can do!” and I completely relate to that. Besides that, I had my children at 23 and 28 respectively, so at 35 I’m totally done with my family, but have still felt the itch to go through the process again.

See! Here is how giant my children are now. There’s no trace of baby left in them.

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B) As a doula and childbirth educator I work with women that are pregnant and giving birth, and while some of these women had an easy time getting and staying pregnant, many of them had a long road of miscarriages or infertility before they got to the point of carrying a full-term pregnancy. Many women in my personal sphere have also had their hearts broken over and over in their attempts to have a child. Many times I have wanted to hand over some of my own fertility to these families.

C) Putting A & B together made me realize that I would be a perfect candidate for helping someone have their own biological child. I had no trouble getting pregnant or staying pregnant and had had uncomplicated pregnancies and births. In the end I was matched with a wonderful gay couple (rather than a heterosexual couple, with a mother unable to carry a child) and I wouldn’t change a thing. I feel lucky to be matched with these great guys and they say they feel the same about me.

D) Professional development- It’s no secret that I live and breathe fertility, pregnancy, childbirth and breastfeeding. Being a surrogate would allow me to experience IVF (crazy!), ultrasounds and hospital birth– all things I did not experience in my own pregnancies and births. What I got was even more than I bargained for. I went through the IVF process once, got pregnant, had the easiest first trimester I’ve EVER had and at almost 10 weeks found that the baby had no heart beat and had stopped growing at about 8 weeks 5 days. It’s hard to explain the shock of finding that out (I was supposed to be taking care of this baby!), but even after I had accepted that the baby was gone, I still wasn’t done because I had to deal with the reality of “birthing” this baby that was no longer with us. Too many of you have experienced this. For me it was the first time and I will never forget it or take for granted the difficulty of that piece of the process. Luckily, the second embryo transfer also resulted in pregnancy  and this one has stuck despite a rocky beginning with some scary bleeding (and this time the first trimester was much more like what I remember with my own children, namely, nauseous).

Here’s me just after the last embryo transfer in August.

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Here’s me after I’m pretty sure I’m pregnant, but before I’ve gotten a blood test to confirm it.

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E) Compensation- I really should mention that I’m being monetarily compensated for this pregnancy. For me that was important, though not at all the sole motivation. This “job” is a 24/7 endeavor and one I’ve been working on for more than a year. It has affected my work and my family, so it feels important that I’m not making those sacrifices for nothing. It’s giving our family a little boost, but really, if I just wanted to make some extra cash there are far less laborious ways of doing that.

I knitted some booties while on bed rest after the embryo transfer for good luck with this baby sticking:

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It’s exciting to be pregnant again. It’s also a little strange too to figure out how to be excited about a baby that doesn’t belong to our family. We’re figuring it out.

In the mean time, I’m totally back in the world of maternity jeans, round-ligament pain, slow digestion, you name it! And it’s reminding me of all sorts of pregnancy tidbits that I had long since forgotten. This is good news for my clients–it’s a refresher for me!  So while I’ll be off work for most of April, May and a little bit of June, I can already tell that I’ll be excited to take on more clients for the second half of the year.

I’m wishing you all health and wellness this winter and through the year!

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These are some ultrasound pictures from the anatomy scan at 19 weeks. I never did this with my own children!

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And here’s a recent picture of my growing belly. Babycenter.com informs me that my uterus is the size of a soccer ball now, which seems huge to me! But it’s only going to get bigger…

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Take Nothing for Granted: What it Feels Like to Come Home from a Birth

What do you feel like when you come home from a day of work? Tired? Energized? Cranky? Cuddly?

When I come home from a day (or more) of being with a laboring mom I feel like I’ve been in another world. A world where life and death hang in the balance. A world where lives are changed dramatically and forever. A world where women and their partners exhibit amazing feats of endurance and remain exquisitely beautiful as they negotiate decisions in the throes of great physical and emotional strain. I bond with these people as if we’ve been in a war zone together, hanging on to each other for dear life.

That may sound awfully dramatic, but in those moments it sometimes feels that real.

And given all of that drama, it’s impossible to just reintegrate to normal life.  I know that birth happens every day–it’s mundane in that sense–but when you have just witnessed The Miracle of Life it doesn’t shake off easily.

I was talking to a doula friend who said that she’s uncomfortable with this transition period. She wants to be able to flip a switch and go back to her normal routine. But she can’t. She’s working on how to reconcile this emotional dilemma of how she thinks she should feel versus how she actually feels. In the mean time, she just lives with that uncomfortable feeling until it fades away and things start to feel normal again.

For me, after 4 years of doing this work, the post-birth “syndrome” is predictable and recognizable. It has two sides. On one side I am in love with the world and everyone in it and truly grateful for the most important things in my life–my family. I live in the moment and take joy in things like baking a big batch of granola for the family or cleaning the kitchen. But on the other side I am incredibly vulnerable. I have a hard time tolerating grouchiness or bickering, especially if it is directed at me. Sometimes little things will make me break into tears. And I look around at people honking at a bad driver or venting about a co-worker and I think, “Why? Why spend your energy on this when there is so much to be happy for?” I appreciate this feeling. Sure, it makes me a little moodier (this is where I apologize to my husband), but it routinely humbles me, reminding me to take nothing for granted.

Death has the same effect on people that are close to it. Two bombs exploded yesterday near the finish line of the Boston marathon. Three are dead and many others are wounded. My heart goes out to the victims, their families, and those who just narrowly missed being in the path of the blast. I often feel powerless after events such as these. What can you do? But where I find my power is knowing that in the face of great pain we often find great strength. Those who survive will be reminded not to take their lives and their loved ones for granted. Those who have lost loved ones will hopefully find healing by finding ways every day to love, honor and remember the one they lost. Boston, pull your loved ones in close, give kindness, compassion and casseroles. Take nothing for granted.

And to all my doula clients past, present and yet to come, I thank you. I thank you for the chance to support you, for the chance to be a part of your life at such a critical time, and most of all, for the consistent reminder that life is amazing, fragile and beautiful.

Ripe for the Picking

Ripe for the Picking

It’s late summer now. Middays are hot, but the mornings are chilly. And the blackberries–my favorite berries of all– so ripe a few weeks ago, are starting to shrivel and go dormant until next year. Sure I have some guilt for loving this invasive plant, but somehow I can’t help myself. Ahhh… blackberries.

And the picking of berries makes me think of–what else?–pregnancy and birth, of course. Why, you ask? Because I’m an impossible birth nerd and I nearly always have labor on the brain. And also because they are both about nature, about the mystery of why one berry on the vine is ripe for the picking and releases easily with a gentle tug and others on the same branch resist the traction you place on them. The unripe berry might have good size, it might be nice and black (although if you turn it, you may find it’s still pale on the underside), but still it tells you, “Not yet. Give me another day.”

But while most people seem to understand and accept that not all berries ripen at the same time, they do not always feel the same about pregnant women and labor. Sometimes I think they view it more like baking a cake. When the timer goes “ding” the cake needs to come out soon or it will end up dry, or worse, burnt. Though any good baker knows to check the cake for doneness, in the baking world it’s always better to pull the cake out early (and put it back if underdone) than to wait too long. Often, this thinking pervades in the labor and delivery world even though you can’t check a baby for doneness without getting him/her out and you certainly can’t put the baby back in to “cook” for longer if s/he was born too early.

We just like to know when the baby is supposed to be done and in this day and age it seems impossible that we still cannot pinpoint a normal healthy delivery date to any smaller range than 4 weeks. But such is life. As annoying as it is, there are some good reasons to learn to live with it.

Consider:

a) When women are induced or scheduled for cesarean births prior to 39 or 40 weeks, providers sometimes discover that the due date was wrong and that the baby hadn’t yet reached “term” resulting in an accidental premature birth with all the resulting health risks (known as “accidental iatrogenic prematurity”).

b) Though we consider 40 weeks the average end-point to a normal pregnancy, a 1990 study by the Harvard School of Public Health showed that the average (median) length of gestation for uncomplicated first pregnancies (in which the mother goes into labor spontaneously) is actually 41 weeks + 1 day. For subsequent pregnancies the average length of gestation was 40 weeks + 3 days. (Note: This study applies to white women only. Weird, huh? There’s a lot to explain about this which I can’t get into here, but for those who are curious, here’s a short explanation: For reasons that aren’t completely understood [but may be related to the stress of institutional racism, not just in the woman’s lifetime but in the lifetime of her mother and grandmother] black women have a much higher rate of premature delivery even when they are highly educated, get good prenatal care and have higher incomes).

c) By studying other mammals, such as the mice in this study, we know that the presence of lung surfactant protein (which is key in making the lungs work after birth) acts to trigger the hormones which lead to labor. Though this has not been studied in humans, it has been studied in other mammals so it’s reasonable to guess that something similar occurs in humans. If this hypothesis is correct, it means that babies signal their mother’s bodies to go into labor when when they are ready to survive outside of the womb.

Everything seems to flow more easily when babies are ripe and ready to be born–while it might look early or late based on the calendar, often when labor happens on its own, it is right on time for the baby.

In my own experience, I’ve seen babies born at 38 weeks at 7.5 lbs and babes born at 42 weeks at 8 lbs and everything in between.  My own two little monkeys had quite different gestational times. My first child was born at 41 weeks exactly and my second was born at 39 weeks +1 day, weighing just a few ounces less than my first (they were 8 lbs 2 oz and 7 lbs 14 oz, respectively). For whatever reason, my younger child needed nearly 2 weeks less gestational time than my older child did.

Of course, nature does make mistakes sometimes. I would be a fool not to recognize that. Women do go into labor prematurely and some women do get to a point at which it is safer to induce labor. But this ought to be the exception, not the rule. Having a great care practitioner that you trust is key–one that recommends induction only if it is truly needed, not just because the clock is ticking.

Good things are worth the wait. Here’s to babies born ripe, healthy, plump and delicious!

Finding Your Voice

I was at a networking meeting for birth professionals recently and in small group discussions we asked a question: “What do you wish more people knew about pregnancy, birth, postpartum or breastfeeding?”

There are a lot of answers to that question, but immediately one doula said (and I paraphrase), “I wish more women knew… that they had options.”  Options*. Yes. You have tons of them. But often people don’t know about them–well, you can’t ask questions about something you don’t know exists–so they get swept along with the status quo.

Here’s how it so often goes: You already have an OB/GYN that you see for your annual Pap test and any other “feminine issues”. When you get pregnant you’re a jumble of emotions and new physical sensations.  The birth is, like, forever away.  You call your OB/GYN to see what to do next and you’re told that they don’t see you until you’re about 12 weeks along. And so you wait. And hopefully you’re not too nauseous as you’re waiting.

When you do go in for your first visit, you’ll spend short visit being weighed, measured and listening to the heartbeat (♥). You may do some tests to screen for Down Syndrome and Spina Bifida. (Do you have to do these tests? No. But then again, you probably don’t know that’s option. And you don’t know that the screening test is only about 60% accurate. The other 40% of the time, it gives you a false positive or a false negative, yielding either a lot of anxiety and more tests or a false sense of security).  And then… you make an appointment for the next visit in another month. Maybe you had some questions, but your doctor seemed pretty busy. Besides you’ve got tons of time before you have to talk about all this stuff (remember, the birth is forever away). You can cover it in the next visit. Or can you? (For an illuminating view on the differing amounts of time you spend with an OB vs. a Midwife, watch this 2 1/2 minute video)

Maybe you have a vague concept that there are other childbirth choices, but they all seem kind of out there, odd, or um, crunchy. You can’t really relate.

I can relate.

You might be the ‘respect authority’ type, or the laid back ‘I-don’t-want-to-trouble-anyone’ type. I know I was. Only because my interest in birth goes back pretty far, did I go for the “crunchy” option right away.  But I don’t like to inconvenience people, especially not doctors. They’re important and they’re busy. I’m not a diva. I don’t feel like my needs have the be the highest priority. No big deal, right?

Wrong-o.

There are all kinds of choices that need to be made in your pregnancy and birth (in your life for that matter) and if you are not making those choices, it doesn’t mean that there wasn’t a choice, it just means that someone else is making it for you.  Sometimes that’s nice. I hate making decisions. If it’s of little consequence, I’m only too happy to hand that responsibility off to someone else! (Thai food? Burgers and fries? I don’t care! Pick for me.) But the key word here is “consequence.” Who has to live with them?  You do.

Wrenching as it sometimes is to make big decisions (or little ones, even) there’s something immensely satisfying about being in the drivers seat when it comes to your care.

Women should be making decisions together with their doctors or midwives. Your doctor or midwife should know enough about you to understand your hopes, fears and peculiarities. He or she should listen, answer your questions fully and should have a genuine interest in you and your well being.

If you have a nagging feeling about whether your choice of provider or birth place is really right, my advice is not to push it away. Take that nagging feeling and look it in the eye. Are you confident that you will get all the support you might need? If not, it’s time to start researching your options. There’s that word again! Options. Research them. Ask questions. Read books. Read blogs!  It doesn’t mean you have to change your mind or your plans. In fact all your research might show you that, in fact, your first choice was the right one for you. But whatever you choose, it will feel better–more purposeful–now. And, really, one less nagging worry is always a good thing!

Congratulations. You’ve found your voice.

*Obviously, this post isn’t about specific options (too much to cover in one blog entry!), but about the value of exercising your freedom of choice. 🙂

Epidural: Friend or Foe?

Well, I asked for suggestions for a new blog entry and someone helpfully suggested one of the most controversial topics in maternity care: THE EPIDURAL. Is this too much for one blog entry?

I guess we’ll find out because I’m going to take it on. But don’t expect me to come down on one side or the other. I’ve never seen this stuff as black and white and I don’t support arguing over it.

What I do support is knowing what you’re getting into (as much as possible considering we’re talking about labor here, the essence of unpredictable), whether we’re talking about getting an epidural or “going natural.”

So let’s break it down.

Pros of an epidural:

  • Takes the pain away, but leaves you mentally still “with it”
  • Allows you to rest if needed (sometimes desperately)
  • Relatively little medication gets to the baby
  • The amount  of medication can be adjusted so that you can have some sensation and motor control in order to push and change positions (while remaining in the bed, of course). I have been able to help some moms maneuver into a squatting position (with a squat bar) or onto hands and knees all while under the effects of epidural anesthesia. 

Most of those pros are common knowledge. The cons of epidurals are less well known:

  • Getting an epidural means lots of other medical things have to be done also. You will need IV fluids, your BP will be checked regularly, you will have continuous fetal monitoring, and you will probably have a catheter and a pulse oximeter (measures your blood oxygen levels).  You will not be able to leave the bed (although, as mentioned, you may be able to change positions in the bed).
  • Sometimes an epidural doesn’t work. Or it only works on one side (if you don’t believe me, just Google “epidural only worked on one side” and you’ll come up with hundreds of thousands of hits). Or it leaves a “hot spot” where you can still feel pain.
  • An epidural can slow down your labor. (note: sometimes it can also speed up labor and sometimes labor stays at a steady pace). If your labor slows, you will likely receive Pitocin augmentation and it may be increased more quickly because providers are not as concerned about your pain since you are receiving pain medication.
  • Epidurals can cause fever in the mom, which means that she may be treated with antibiotics in case of infection. Baby may also be subjected to an invasive septic work-up to rule out infection and/or will be treated with antibiotics.
  • Epidurals can affect the initial breastfeeding. I’m not sure how much stock to put into this because some epidural babies latch just fine and some medication-free babies have trouble with the initial latch (and vice versa), but studies show that there is an increased risk of initial breastfeeding difficulty in babies whose mothers had epidurals.
  • Epidurals anesthesia can make your BP suddenly drop, which is risky for mom and baby. The IV fluids are given to head off this potential complication.
  • Reactions to the medication can range from the very common itchiness (usually starting at the chest and neck) to the much rarer severe allergic reaction to the anesthesia.
  • These actually aren’t all the cons, but I think you get the picture.  Getting an epidural isn’t always easy and breezy, although for many women it is. 

And you know what else is not always (or even often) easy and breezy? Yeah, you guessed it; unmedicated childbirth. I’m all for it, and I could list several items that were pros for me (but I can also see why someone would not relish this particular mode of birthing):

  • Allows your body to follow the hormonal “blueprint” that helps prime you for motherhood and your baby for life outside of the womb. 
  • Increased the bond  between my sweetie and I. Being able to trust that I could “lose control” and still have him there by me, supporting me was an immeasurable feeling and made me fall in love with him all over again.
  • Made me feel incredibly powerful. It’s incredibly powerful just to carry and grow a baby inside your body. Giving birth can intensify that feeling.
  • It was like a rite of passage. I came up against some big fears and I had to face them in order to move forward in labor. Though it was hard, it was also rewarding. 

But the cons are many as well:

  • It hurts (for many or most women).
  • You don’t know how it will feel or how you will cope. You may worry if you will be able to cope.
  • You may come up against some big fears that you are not ready or able to face (this could be especially true for survivors of abuse).
  • “Losing control” or surrendering to the process can be difficult and/or terrifying to do.
  • You may cope well at first, but if labor is long, it can severely deplete your ability to handle the rest of labor.

In the end though, it comes down to this: What are your needs? What can you do to help you meet those needs? Whatever that happens to be is A-OK.

One big piece of advice, though: Make sure you are not making decisions based on fear. Fear is fine and normal, but it is not your friend when making big decisions. Take these steps during your pregnancy:

  • Think about your fears. Are you terrified of tearing during birth? Are you scared of how you will act in labor and what people around you will think? Are you scared about being a parent?
  • Talk with someone you can trust about these fears (your partner, your childbirth educator, your doula, your friend, your counselor) or write them down. Often there actions you can take that will address your fears. Sometimes even, just getting them out can make you realize that maybe it’s nothing much to worry about after all.
  • Having your fears addressed and your priorities in order will help you proudly chose how you want to birth. And it will help you make choices during labor, too, if (when) unexpected things pop up.

Many blessings for your birth.

“There is a secret in our culture and it is not that birth is painful but that women are strong.” -Linda Stavoe