Between the Path and Pyxis

Waiting for the lights to change

2012-02-06T07:47:00.000-08:00

This morning, on my way to work, a traffic light right before the interstate exchange turned yellow, then red. I slowed to a stop, and watched the cars flow through the intersection. Then, an unusual thought crossed my mind: What do I do when stopped at a light?

My usual behavior at lights is to watch for signs that my light will be turning green. Cross-walk signals are good indicators; one can usually see the cross-walk when it starts to blink and count-down the remaining walk time for pedestrians. On streets lacking cross-walks, sometimes the light for the opposing traffic is peripherally visible.

I think this is a way to pass the time. Having something to do while I wait is a benefit; my mind prefers to be engaged. Also, I'm proactive about remaining consciously aware at lights, because I don't want to be that person who "zones-out" and doesn't realize that the light has turned green and it's time to go again. My immediate opinion about this behavior is, I just think it's more responsible to be alert in that situation.

One thing I noticed while I was waiting and watching is the physical effect of this activity. There's a definite feeling of anticipation, followed by a surge of tingles when I've received some indicator of the impending light change; finally, I feel a release of tension when the light is green.

As I drove forward, I contemplated this observance. Pause-surge-release is a repeating pattern in other places in my life. I could see it in stress reactions I've experienced in the past. And in conversations: I listen; there's a build-up of words in my mind as I processed what I'm hearing; then, at the appropriate time, I speak those words.

There's also a parallel, here, with watching the ocean's tide, an activity I find mesmerizing. Sitting on the beach while the waves roll in and out again is so relaxing for me. It also puts me into a state like hypnosis.

Watching a woman labor, I see pause-surge-release. There's a moment when her body, after resting, pauses its movement; then her body language shows me the first grip of her contraction, which builds and peaks; finally, the squeeze releases and she rests again.

This reminds me of the Hypnobabies tracks - the hypnotherapist says something along the lines of, We slip into self-hypnosis all the time, like when we're driving home on 'auto-pilot' and thinking about other things as we do so. In true multi-tasking fashion, I have experienced instances when I've 'awoken' from my drive hypnosis to realize that I'm watching for light change signals. That behavior has become part of my drive process.

The more I think about it, the more drawn toward hypnosis for childbirth I become.

Hello again, blog!

2012-01-22T18:04:00.000-08:00

It's been a while since I posted, and a while since I've doula'd. I had a client in the fall of 2010, and then didn't take another one until recently. 2011 was the year of the "day job," and it didn't slow down until I had to take some vacation time which I was at risk of losing.

Fortunately for me, 2011 wasn't devoid of things to keep my doula wheels greased. There was a Spinning Babies workshop. And I'm still helpling my friend Kim with her website and classes as I'm able. I also got some new books, and I won a "Motherload" drawing and received a free copy of More Business of Being Born.

So, I'm going to try to get these bloggy gears turning again now that it's 2012; this is the Chinese Year of the Dragon, and a turning point in history according to the ancient Mayans. If nothing else - it'll be interesting! (-:

Here's a shout-out to Dale Lund for inspiring me with his stories to begin blogging again.

Birth Models That Work: The Netherlands

2010-11-28T07:11:00.000-08:00

There was some internet buzz about Birth Models That Work, edited by Robbie Davis-Floyd, and since I wanted to get a copy of Birth as an American Rite of Passage, I went ahead and got them both.

I started the latter book, and am thoroughly enjoying it, so much so that I've broken my cardinal rule about finishing one book before beginning another and dug into Birth Models.

The first birth model described is the one practiced in the Netherlands. Danish midwifery has been a model that American midwives have marveled since the 70's, when the first renaissance of physiologic birth happened in the U.S. One of the primary driving reasons of the why's of birth management in that country is explained by a unique cultural perspective on the role of the birth attendant. The authors of this chapter explain, "In marked contrast to the U.S. [OBs] - who are inclined to heroic interventions, rescuing a laboring woman from protracted pain and life-threatening complication with surgery...or medication - [OB/GYNS] in the Netherlands shun the role of hero... The cultural disinclination toward obstetric heroism is sustained by a system that minimizes competition among [OB/GYNS] and between [OB/GNYS] and midwives. In market systems, [OB/GYNS] have an incentive to sell their 'superiority' as the heros of birth."

A Danish OB was quoted as describing the cultural character of the Netherlands as "emancipated" and "self-assured." Individuals have a culturally-instilled view of themselves as capable, which promotes a healthy sense of "mistrust," a kind of suspicion that proves how much one values oneself and compels one to ask a lot of questions before taking action.

I spoke with a pregnant mom recently who is having her first baby; she explained how happy she was when she was diagnosed with PIH, because suddenly, the quality of care she received was different. "Everyone [at the doctor's office] seems to actually care about me all of the sudden. When I didn't have any problems, no one took any time to explain anything to me."

I asked her, why didn't she ask them to take the time to explain things to her? She replied, "Oh, I ask questions, but sometimes I have to wait until the following office visit to really get answers." When I pointed out that she was often saying how she planned on asking questions at office visits, but put them off till the next visit, and how she'd been hoping to ask a particular question for about six weeks but it had yet to happen, she said, "They're just so busy, you know? That's why I'm happy to have their attention, now!"

This particular mom has also voiced to me her love of medical technology. "It makes me feel safe. I would have an ultrasound every day if I could." When I asked her why, she explained, "When I can see the baby, see him breathe and move, I feel like everything is okay, my baby is doing fine, look at him being active." I asked her if she has any faith in how her body works to grow and protect her baby, and she said she did on some intellectual level, but when a qualified medical professional tells her she and her baby are doing well, it makes more of an impact on how she feels than any self-possessed assurance.

Her deep desire to confirm her health through outer, technological means makes me wonder about her inner faith in herself. From the Netherlands, we have an account in Birth Models which tells us the cultural demeanor of its people is one of self-reliance. Where is the American woman's positive sense of self?

Full Moon Musings

2010-03-30T10:17:00.000-07:00

It's a full moon tonight, and I'm feeling a fizzy sensation in my body. Last night, I dreamed I was laboring alone in an unfamiliar hospital. It was like I wasn't me, in a way, like I was experiencing someone else's sensations. I was wearing a hospital gown, and my contractions rushed over me, making me feel high, like that spinning euphoria I used to get when I was a little girl and would turn in circles until I fell down giggling. I think I was laboring by myself, but strangely, in what seemed like the most unfriendly and intrusive laboring environment I could imagine (bright, florescent lights; blinky machines; unfamiliar bed and clothing), the hospital staff left me alone.

I woke before the dream labor reached any conclusion, but the impressions I retain were unforgettable, and possibly important. I've heard labor described by those who's experienced it in much the way it happened in my dream. Maybe it was my body's way of giving me something close to empirical to take with me to labors I attend as a doula.

Much of my time preparing for a labor is spent pouring over research and laboring techniques. When I'm in research mode, I have a hard time switching gears - for example, I can't seem to finish Birthing From Within because I get so distracted by a desire to go back to reading research studies and articles on evidence-based care.

There's something comforting in all of that science-based knowing in a world which demands that I be grounded, realistic, and factual. Sometimes I feel awkward when faced with the draw of something deeper, an intuitive sense which urges me to pay attention, become emotionally expressive and not rely so much upon words and numbers.

This reaction is probably because I was told by all of the people and influences in my life for so many years that my emotions aren't as important as making choices which are grounded in logic. Rein it in, said my culture, my teachers, my parents.

I never stop growing. All of these things, all of the four cardinal directions in which a human grows (physical, mental, emotional, spiritual) are always changing as we learn, and we learn constantly. So, I decided not to stress it - if I feel like it's time to grow in an emotional and spiritual direction, to honor the moon and feel a little fizzy, well... Nothin' wrong with that. In fact, I think I'll honor those parts of myself by cross-posting some of my birth poetry, which was featured over at the BirthActivist blog:

Birth Reflections: Clare

Spear

Security

2010-03-22T08:03:00.000-07:00

Birthing Beautiful Ideas recently posted a transcribed copy of a "patient safety update" sent to all patients at an OB practice in her area. The letter focused on VBAC, and essentially served as a notice to that practice's patients that VBAC was not an option offered by some of the practice's providers.

BBI was concerned about the flawed information being sent to those patient about the safety of VBAC. I can't blame her. Read her explanation and you'll see.

For the better part of last year, I found myself thinking about the mothers who choose to allow someone else to control their birth experience. I was baffled. Why are some moms more at ease in a 'technocratic' birth environment, and why are some moms afraid of it? So, I set out to have as many conversations with moms as I could about birth experiences, a sort of informal poll, in an effort to understand their decisions. All of my talks with moms have been interesting and enlightening.

The constant theme in these conversations was this: everyone wants a healthy baby. That may seem like a 'duh' statement of the obvious, but it was actually a very important fact. Remembering this helped me keep their decisions in perspective. Some mothers look back on their birth experience and point out things that could have been better, but as long as their child benefited (or at least, wasn't harmed in any perceivable way), then the choices made were just fine.

Another theme was the way moms returned to the value judgement, 'Does this choice bring me a sense of security?' For some moms, there's a sense of security gained from working with a care provider who calls the shots. I had women express how much they liked their care provider because s/he seemed to always know what was best for her, and following his/her advice resulted in a healthy baby.

A very close friend, whom I consider one of my three heartsisters, discovered recently that she's pregnant again, and is now facing the challenges of deciding whether or not to pursue a VBAC. I'm watching from the sidelines as she's faced with the same situation that's been posed to the patients of the OB practice who wrote that letter, because the provider she used for her last birth has a no-VBACs policy. Her choices are even more limited due to another set of policies followed by nearly all of the care providers in our area which label women of size as high risk mothers. I know she'll weigh her options carefully, but in combination with the level of struggle she believes she can endure to get what she wants, these policies may cause her to choose an elective repeat cesarean.

Dr. Bradley wrote, in Husband Coached Childbirth, about his observations of laboring mammals on the farm where he grew up. Animals need specific things to make them feel safe, and engage in behavior which ensures safety. They often hide in darkened barn stalls, and need to be undisturbed; their instincts tell them that any disruption of the birth process could be an opportunistic predator attacking. For humans, our understanding of what security means can be influenced as much by our personal experiences and the cultural collective from which our experiences stem as by what's written into our genetic code as instinct. And we're social animals who rely upon our interactions with others of our kind in order to function and evolve.

Mothers are put into a unique decision making position by our culture and individual care providers who exist today. Mothers are asked to trust everyone and no one at the same time, to make decisions based on the consensus while appeasing their individual and instinctual needs. What an overwhelming expectation to have to fulfill. Is it any wonder, then, that some mothers find security in placing the safety of themselves and their child in the hands of something or someone else?

I understand that sometimes, the decision is more about what is safest than what seems safest. No one can argue with a choice made to save a life or prevent irreversible harm, especially one which is made in an emergency situation. That being said, in cases where the research evidence says that certain options are reasonable and should be available to mothers, it's concerning that care providers will not support their patient's decision. If you read the evidence report from the recent NIH VBAC conference, it's clear that the risks of cesarean section (which is a major abdominal surgery) are higher than the risk of uterine rupture during a VBAC attempt.

I have so many other thoughts about this, I may have to do another post.

"Welcome to the Last Three Weeks of Being Pregnant."

2010-02-27T21:51:00.001-08:00

So sayeth the midwife to my March client, who called her tonight to tell her about the wild and wooly Braxton-Hicks she's having.

This client has been a fun one; she's a feisty go-getter who's been a research hound since day one of her pregnancy. She had a loss several years ago, which she mourned; this is a very welcomed pregnancy and baby, and she's done everything she can to improve her physical life and educate herself, working toward the goal of a birth that's as un-medicalized as possible.

Her text messages tonight have been making me grin - "Am I just being silly and blowing this out of proportion??" she asked me when her body decided to practice squeeze just one section of her stomach. I replied that it's her first time around this block, and anything new and unknown can be frightening, then suggested that she try drinking some juice, lie on her left side and do some kick counting to reassure herself that her little one is okay in there. She did, and he's moving just fine.

Carry on, mama - you're performing a miracle!

The Weight

2010-02-24T19:51:00.000-08:00

My first paying client had her baby about a week and a half ago, and I'm 99.9% certain her little guy was posterior. She had all of the typical signs, and it was a really hard labor. In second stage, she pushed for literally hours, and it was like there was no end in sight.

I've been anxious and worried about her ever since; some things she said after the birth really concerned me that her lasting birth impression was a negative one. I feel like this is the first birth where I didn't do a good enough job as a doula, and now my client has a terrible opinion of her birth experience. I keep replying the birth in my head, looking at all the points where I could have done something and didn't - for example, I should have urged her to have her midwife palpate her belly to try to get a better understanding of the baby's position. Signs said she was experiencing a posterior baby, but her water wasn't broken until she got to about 8.5 cm's and finally asked the midwife to break it in hopes that it would bring the birth to a faster conclusion. Before that, when we asked the midwife if she could help us figure out baby's position, she said she had no real way of knowing until she could do a vaginal exam after the release of membranes, when she'd be able to feel the fontanels of baby's head.

A fellow doula (whom I'm working with in a dual-doula birth next month) tried to help me keep it in perspective by pointing out how difficult and painful it can be to labor with a posterior baby. "Does she realize how amazing she is for giving birth without any medication in that situation?"

I tried to tell my client exactly that, but I don't think she was very receptive at that point, which was less than 24 hours in the wake of the experience. She said she'd call me when they got home, but I haven't heard from her. I'm acquainted with friends of hers, and they've been kind enough to let me know how she's doing - I won't go into detail, but this poor mom has her hands full, so while I'm respectfully waiting for her to call me since that's what she asked me to do, I can't stop worrying about her.

The Weight - The Band made famous a song by that title many moons ago, and my favorite interpretation of the last verse is so very appropos right now in my doula life:

And what's all this "take a load off Fanny" riff? The whole thing becomes only a little less cryptic when we learn, in the very last lines, that the pilgrim is traveling under instructions, has, in fact, been sent by the mysterious Miss Fanny. The "weight" of the title is the load of her obligations the pilgrim has been sent to discharge. The irony, of course, is that he leaves with a heavier load than the one he brought with him - "my bag is sinkin' low."

I went into that birth thinking I had the message right - that I was educated and experienced enough to help her - but I left it carrying a heavy load of doubt in my abilities and concern that I didn't give enough. Since her birth, I've been pouring over posterior labor resources, especially Spinning Babies, in hopes that I'll be more proactive and better prepared for a posterior labor in the future.

The one thing positive I can say about my assistance was that they would probably have been worse off without me if for no other reason that no one could be expected to rub a mom's lower back continuously for the entire length that her labor ran - so at least I was able to help her husband alleviate her pain in that way.

Oh, Baby.

2010-01-31T11:20:00.000-08:00

Flipping channels, I came across a show about some famous socialite named Kendra. I have no idea who this person is, and I really don't care - then, before I clicked to the next channel, I notice that this woman, Kendra, is in the hospital, and obviously pregnant. Like a train wreck, I couldn't look away as I watched the program's presentation of her labor, watched her lie in bed for 24 hours with Pitocin and an epidural, only to end up with a c-section.

Smiling doctor telling her the day before she was induced, "We've given her something to help her get some rest, since she'll have a big day tomorrow..." Every time marker in the footage, she's still lying in bed, in the same position... Smiling doctor reappearing at the 23 hour mark, saying "You've been a trooper, and baby looks fine on the monitors, but it's time to go have a baby..." Wheeling her to the OR five hours after that... Kendra saying, "9 pounds, 5 ounces, no wonder I needed a c-section!..."

I get so angry, sometimes, the way the medical system can manipulate parents into doing things their way. The calm, rational part of me reminds me that this is an example of parents who's birth experience was peripheral to the fact that a baby was born. I understand, and I respect that. But... I feels a deep sadness for the lost and beautiful experience they missed out on.

To bring myself back to a happy place, I came across news that Gisele Bundchen had her baby at home in the water. (-:

Some More Perspective

2010-01-26T13:03:00.001-08:00

Recently, I wrote about Samantha Burton being forced to submit to bed rest and a c-section, and I basically said that both parties probably made some poor decisions, and maybe it would have been better if both mom and OB had quit their working relationship and mom had found another care provider.

Then, Mom's Tinfoil Hat made a comment-turned-post in her blog, and had a point I found interesting: just because a woman is smoking doesn't necessarily mean she doesn't care about herself or her baby, or even that she's headed for disastrous consequences. I particularly like when she said,

"We all have our priorities. Exercise has also been associated with pregnancy loss. I wonder what you think of women who are selfish enough to take epilepsy meds."

Whether Samantha was making the right decisions or not isn't the focus of the court; the point to her case is that she was barred from exercising her right to choose her own course of action. The writer of another article about Samantha's situation (which I can't put my fingers on right now) said something to the effect of, "At what point do women's decisions render them incubators and wards of the state?"

I've been thinking a lot about smoking in pregnancy, and a client of mine recently let me know that she was smoking through probably about her 20th week of pregnancy, tapering back slowly until she had quit altogether. My personal decision to not serve women who are pregnant and still smoking seemed to dissipate suddenly when she told me this - I had been offering her support through her pregnancy already, and her smoking status didn't change the fact that I've helped her thus far by providing research, information and resources to her. Maybe she needed my support in these ways while she worked through her decision to quit smoking, and maybe without my support she wouldn't have made it to the point of quitting. And even if she didn't quit, she still needs me at her birth, I'm her primary point of support (after her medical care provider).

This is all very thought provoking. I think I'll go ruminate upon it all some more.

Movers and Shakers

2010-01-26T12:17:00.000-08:00

There are two hospitals in my city, and the larger one has a birth unit called the Women's Pavilion. This weekend, that hospital put on a baby and family fair. When we doulas initially found out about it, we discussed it at our monthly meeting and were all like, How do we get in on this action!?

We had a few challenges to overcome... Not only were we trying to figure out how to pony-up $250 for a table at the last minutes, but also, in the past, this hospital has denied a table to the local ICAN group (the leader of which is a doula), and we were concerned that we'd be barred, too.

Then, a light bulb went off over the heads of one of the doulas at the table. She works with a government program and managed to secure a table (on the last day of registration - we got lucky, and got one of the last two tables available). So while the major theme of our booth was the services offered by that program, we were also able to slip-in information about other local resources (such as the doulas!) and stuff about informed consent, avoiding a c-section, nutrition, breastfeeding, and more. A whole booth-ful of doulas, dispensing lots of great info, laughing and talking with moms - it was awesome!

We doulas got together at the end of last year and applied for a Lamaze mini-grant to start a birth network - and they awarded one to us. Again, a last minute effort, but it paid off. At this point, I'm thinking, the sky's the limit - imagine what we could do if we weren't operating on the last-minute protocol...

It'll get better, as we figure things out and get a structure going. It's always a little bumpy in the beginning of any endeavor, but with so much talent and skill among us, we're slated for success. It's very exciting.

Perspective

2010-01-25T12:07:00.000-08:00

Everyone's shaking a finger, either at Samantha Burton or her OB.

Ms. Burton experienced something many of us would consider a worst case scenario: she lost her baby at 25 weeks gestation. And as if that isn't terrible enough, she was held against her will at the hospital when a court ordered her to comply with her OB's recommendation of bed rest. Finally, her OB performed a cesarean in hopes that her baby could be saved - only to discover that fetal demise had already occurred.

A big question echoing in many conversations about this situation is, at what point does a pregnant mom become incapable of deciding what is best for herself and her baby? Ms. Burton was smoking during pregnancy, which is acknowledged by pretty much every care provider out there to be a bad thing. But even if she was making a bad decision, isn't it still her decision to make? That's the crux of the arguements against her OB's decision to initiate a process to hold this mom against her will: freedom to choose.

Last year, I interviewed with a potential client who had two older children, both born premature and with physical and mental abnormalities, who was also a smoker. I didn't contract with this client, simply because I knew, after our interview, that I was not the right person to help her. There were a few reasons why, but the second most important one was because I'm so utterly opposed to smoking, whether one is pregnant or not. Cigarettes are laden with chemicals that are not supposed to be in the body in any amount.

This became a deal breaker for me; my personal feelings about smoking aren't something which can be negotiated around, I can't support someone who wants to continue to smoke when I believe it's a bad decision which puts the lives of both mother and child in danger. I wonder why Ms. Burton's OB decided to go through all of the effort to keep her in the hospital and eventually perform surgery - was it not an option to refer her care to another doctor?

Maybe it's not that simple, I don't know.... The Hippocratic Oath does basically say you can't refuse to help someone when you become a doctor. I know there's probably many more details about Ms. Burton's situation which caused her OB to steer her care in the direction it went. It was a bad situation for both mother and care provider, and maybe both of them could have made better decisions along the way. I find it difficult to take sides with either the mother or the care provider (providers, really, both the OB and the hospital) when both acted in ways with which I don't agree.

I think it's worth noting that this sort of thing is rare, and as frightening as it can be to have something like this happen practically in my own back yard, it's important to keep things in perspective. A pregnant mom in preterm labor is a challenge to any care provider; and a care provider who doesn't agree with a mother's choices during pregnancy is a challenge for that mother. It seems a little paradoxical, but rising to the challenge sometimes means walking away.

Making the Best Decisions Possible

2010-01-12T09:10:00.000-08:00

I recently posted about being called to a birth-in-progress on New Year's Eve, and mentioned that mom was admitted for low amniotic fluid based on an AFI of 4.5 (0.5 of a point below the 'low' assessment rankings).

It's sort of been bugging me, and I wanted to see what research was out there about this kind of testing. So, I pulled out my handy A Guide to Effective Care in Pregnancy and Childbirth and did a little reading.

Effective Care mentions the AFI somewhat obliquely in chapter 12, section 5.5:

5.5 Fetal biophysical profile
The ‘biophysical profile’ was derived from a study of serial ultrasound examinations and antenatal cardiotocography (non-stress test) in high-risk pregnancies. Combining five biophysical ‘variables’ considered to be of prognostic significance (fetal movement, tone, reactivity, breathing, and amniotic fluid volume) into a score, reduced the frequency of false-positive and false-negative results compared to the non-stress test alone. An additional advantage of the biophysical profile over the nonstress test is that it permits assessment of the possibility of major congenital anomalies. This may be important, as detection of a serious anomaly may on occasion help to avoid a cesarean section when the baby is clearly abnormal.

Only two controlled trials of biophysical-profile testing have been performed. Both were conducted in women referred to units specializing in fetal biophysical assessment. They compared care based on biophysical score results with that based on non-stress test results, following a management protocol. In both studies, the biophysical profile score was a better predictor of low 5-min Apgar scores than the non-stress test. The biophysical profile was both more sensitive and more specific in predicting overall abnormal outcome than the nonstress test.

Despite the better predictive value of the biophysical score than the non-stress test, its use did not result in any improvements in outcome for the baby. Outcomes measured included perinatal death, fetal distress in labor, low Apgar score, and low birth weight-for-gestational age. Compared with cardioiocography alone, biophysical-profile testing showed no obvious effect (either beneficial or deleterious) on these outcome measures. The available evidence provides no support at all for the use of biophysical profile as a test of fetal well-being in high risk pregnancies. However, the number of women included in these studies is so small that any estimates of effect are extremely imprecise.

Basically, what I took from that was, researchers believe the biophysical profiling approach is an effective means by which to see how mom and baby are faring, but the research may be flawed or incomplete when one reviews it, and so Effective Care authors believe it's difficult to say whether it's an effective method or not.

I think this is another instance where care providers try to lump all women into categories, like making an IF/THEN/ELSE statement. (Well-Rounded Mama is dealing with a similar situation with her health care, so it's not unfair to say that this sort of thing happens all the time in other instances of health care.) It makes me wonder what my last client's experience would have been like if she had made different decisions, and decided to place her trust more in her (very healthy) body than in (uncertain) risk assessment testing.

Humanity is on the search for "true indicators", but life isn't always consistent in its outcomes and occurrences. So, here's the approach I'll have when I'm a pregnant mom: I'll make the best decisions possible with ALL of the information available and won't forget to listen to intuition and feelings as well as intellect.

More Catch-Up: Links in Review

2010-01-08T12:21:00.000-08:00

The Case Against Reasoning, by Morgan Gallagher

Morgan sums-up something I've been struggling to explain to others: formula is suboptimal. She says,

There is less in formula milk, than there is in human milk. There is less physiological growth in bottle feeding, than there is in breastfeeding. Combine the two, and add in that modified cow's milk destroys the natural flora in the new born gut.. and you have an activity that increases health risks in homo sapiens: formula feeding.

She also expresses aptly the way business drives culture, and how advertisers manipulate us so effectively into believing that something that is suboptimal is normal, and something normal is achievable only if you're Superwoman. It's a cleverly devious bit of psychology: breastmilk is "best" so formula is "okay" claim the formula companies - but it's not true!

Yoga for Hip Discomfort: Eka Pada Rajakapotasana (One-Legged King Pigeon Pose)

BirthActivist recommends this pose for hip pain during pregnancy. Those loosening joints are sometimes uncomfortable, so this may help.

I interviewed a client several months ago who was experiencing hip pain, and I wish I'd known about this back then!

Clean Eating Magazine: Recipes and Meal Plans

I am quickly becoming a BIG fan of this magazine. Wholesome food recommendations, awesome recipes, informative nutrition articles... The meal plans alone are worth the price of the magazine - each day's meal plan has a sum of total calories, fats, fibers, sodium and proteins consumed.

There's a link between eating well in pregnancy and avoidance of eclampsia and HELLP syndrome. Most pregnancy nutritionists recommend eating between 80 and 100 grams of protein daily, among other guidelines - and these meal plans could be a big help to the mom who doesn't regularly track her food intake.

Calm Birth, by Dr. Robert Bruce Newman

I ordered both the Calm Birth book and CD recently. The book is more or less a review of stuff I already knew, but I found the history and research-backed information about the effects of meditation very interesting and potentially helpful for my clients. I've been recommending the Hypnobabies "Relax Me" scripts to my clients, but for those who think hypnosis is hooey, I think Calm Birth may be more approachable.

Two new blogs on my blog feed: Kayce's Doula Journey and Doula Momma

Doula Momma is a DONA doula and Lamaze childbirth educator; Kayce is a self-described birth junkie and future midwife. Both offer lots of stories and data worth looking at.

Playing Catch-Up

2010-01-08T08:34:00.000-08:00

Ach, I've been so out of touch lately. It's been a whirlwind since the beginning of the holiday season, and I've been struggling to keep up.

New Year's Eve, I found myself hanging out at my buddy Kim's house. It was around 1:00 PM, and she was telling me how one of the couples in her last class (which I attended) was in labor, and called her very early that morning to talk through some stuff. In the middle of our gossip session, my phone rang - to my surprise, it was the daddy of the couple we were discussing! Our conversation went something like this:

Dad: Well, we're in labor, and have been for a long time...
Me: How are things going?
Dad: Honestly, I'm not sure... I mean, we've been here since Wednesday, and [Mom] is having a hard time managing her pain."
Me: How are YOU holding up?
Dad: I'm exhausted. All of us are.
Me: Do you need some help?
Dad: [big sigh of relief] I would be grateful for anything you could offer us.
Me: I've gotta run home and get my bag, but give me 20 minutes and I'll be there. What's your room number?

(Mom told me later after the birth, "That was the shortest phone conversation I'd ever heard.")

When I got there everyone looked deflated, and the room was in chaos, stuff was everywhere. How could anyone be comfortable laboring in this environment? I thought to myself. While I helped clean up, I explained that we had a plane to catch to go to my cousin's wedding in another state, and I would stay as long as I could, but I might not be able to be there for the birth. They said it was okay, and any help was better than none!

I immediately started the work of assessing the situation; mom, dad and baby's grandmother filled me in on what I'd missed. At 41 weeks and 2 days, mom went to an appointment with her OB and never got to go home. She was admitted for oligohydramnios (based on an AFI of 4.5), induced with Cervidil (which was removed after she reached 4 cm), membranes released (SROM) at around 5:30 AM that day, and she'd been laboring for around 24 hours without any other medical interventions. The Cervidil induction was painful and frightening, and mom was happy to have it removed - but since that time, her contraction patterns were sketchy, and her tone and demeanor were like that of a woman condemned to Sisyphus' fate. "I feel like it's never going to end," she confessed.

I got mom out of the bed; dad fell into it and immediately went to sleep. Baby's grandmother went out, brought back food for the family, and went home to get some rest.

After some dinner, mom seemed to be getting her energy back, so I started to pep talk her, during which we changed positions, tracked contractions together, and focused on approaching labor one rush at a time. I knew she was still in early labor because she was able to talk easily between her contractions. Every time a contraction was nearing or had ended, she would affirm, "Contractions are good..." And I would reply, "Contractions make a baby come out," or, "Contractions go away and then we can rest." As we talked, it became clear that the intensity of her pain was due to her fear of that pain, and her feelings of inadequacy about herself as a laboring mother.

When dad woke, he was amazed by the change that had come over his wife. "You're a new woman," he said, and hugged and kissed her.

The hospital experience was a mixed bag; while the majority of the attending staff was supportive of their decisions (to varying degrees of approval and disapproving forbearance, though mostly the former), interruptions easily knocked mom out of her labor, and slowed her contractions. At one point, during a heavy discussion with the attending OB, her solid 1:00-1:30-minute / every 3 minutes contractions stopped altogether for 20 minutes. An encouraging nurse recommended that we try nipple stimulation, which helped get her back into the groove of labor, but mom would stop doing stimulation cycles (2 minutes on, 2 minutes rest with a contraction in between) and labor would slow again. Dad mustered himself long enough to convince the attending OB to get her off of continuous EFM, which he felt was interfering with her ability to relax and wasn't proving helpful (baby had a textbook perfect heart rate for the entire labor). After his confrontation with the doctor, his physical exhaustion and emotional stress got the better of him, and he was a little shaky. But the pay off was time in the tub, free from monitoring.

16 hours later, it was time for me to go. I felt terrible about it, but they were very understanding. Before I left, mom decided to try a small dose pain medication, but it was largely ineffective, so she asked to be prepped for an epidural. (For the second time, I missed a potential opportunity to witness an epidural being placed! Drat.) Even though this family was seeking an unmedicated birth, after 32 hours of labor, mom was just too tired to manage labor sensations anymore.

Baby's grandmother arrived a little while after I had to go, and 12 hours later, mom birthed her baby - vaginally!! Interestingly, they set her up with an push button epidural; she was able to chose when to have the next dose of the medicine, and she hit the button only once after the initial dose. She later told me that the rest she got during the first dose helped a lot, and then after that just having the option of pain relief was comforting.

All's well that ends well. Baby had 1/5 minute Apgars of 8/9, mom had minimal tearing (not even a 1st degree), and they're breastfeeding really well. Three days after the baby was born, they moved to another city so dad could start a new job - I wish them all the best on their new adventure, and thank them for letting me share in their happy day. (-:

What's Goin' On

2009-12-16T18:17:00.000-08:00

I taught Kim's Bradley class, cycle 4 class 11, while she was in Williamsburg, VA; it was the "Are you ready?" class, so we finished watching Orgasmic Birth, went through the workbook materials (especially the Bradley Energy Saving Techniques article), and talked about what to pack for the hospital. Today was class 12, so cycle 4 is over, now. I'm sort of sad. Of the five cycles I've attended, even though each one is unique, this one was so inspiring. All four couples started out reluctant to speak up in class and brought with them a general air of confusion. By the end of the cycle, their final labor rehearsal was incredible - each couple was in tune with their partner, moms were relaxing beautifully and everyone left their final class with a quiet air of confidence.

Two of the four couples are due in February; both of them have approached me about doula services, but only one actually contacted me after the class ended. I'd love to attend all of their births, I think they're all going to have beautiful labors, but I'm trying to stick to one client per month. So, it'll be interesting to see what happens if both February couples want to hire me...

Oh, and I busted my ankle again leaving Kim's house - it was really dark on her front step and I couldn't see - but fortunately, it was a light sprain. It's almost healed, just a little bruised, now.

My March mom and I went to Molly Shaker's prenatal breastfeeding class, which was great. What I don't get is: why would you pay $35 for a class and then not ask any questions at the end?... There were a lot of people who just looked clueless and scared in that room; all of them were first time parents. (After Molly took that poll to see who was a first timer, I wished she would've polled the dads and other support people to see how many of them had attended a birth, that would have been interesting.) One of the great things about Molly is how her communication style is so matter-of-fact but doesn't sacrifice tact. She and Melissa are both really good at that, and I try to emulate them when I talk about birth-related stuff.

Respecting the Toes

2009-12-02T12:52:00.000-08:00

A doula recently posted this link in a yahoogroup I read from the BBC News site about doulas entitled Doulas: holding hands or stepping on toes?.

The gist of the article is pretty much that medical care providers in the UK are agitated because they feel doulas are intervening in a negative way during the course of medical care provided to moms across the pond.

There's been a lot of criticism locally about doulas, too. A DONA doula was asked to speak at a monthly meeting held by the OBs in our area, because the doctors are worried about the effects of a non-medical person in a labor room, advising moms. Our representative made sure those doctors understood the DONA scope of practice for birth doulas states the following:

Whenever possible, the doula provides pre- and post-partum emotional support, including explanation and discussion of practices and procedures, and assistance in acquiring the knowledge necessary to make informed decisions about her care....The doula advocates for the client's wishes as expressed in her birth plan, in prenatal conversations, and intrapartum discussion, by encouraging her client to ask questions of her caregiver and to express her preferences and concerns. The doula helps the mother incorporate changes in plans if and when the need arises, and enhances the communication between client and caregiver.

She also explained that there's a process for issuing a complaint with our certifying organization if a care provider believes a DONA doula has acted in a manner that's outside of our scope or ethics.

It seems like everyone feels like they're being attacked. Care providers feel like their patients have no confidence in their services when a doula is brought in; doulas feel like the care providers refuse to recognize the validity and benefit of their services. Caught in the middle are mothers who want to have the best births possible.

The issues that arise among birth team members are ultimately no different than any other team's issues. A corporate guru named Patrick Lencioni wrote a book called The Five Dysfunctions of a Team, and named the cornerstone of most team's problems to be an absence of trust. When team members don't trust one another, actions on the team's part are foundationless and fall apart; the team's mutual goals degrade into self-serving motivations.

So, when...

care providers try to convince moms to have interventions that make the care provider feel better and no one else;

moms hire doulas to "run interference" and make sure the care provider doesn't do what mom doesn't want during labor;

doulas try to countermand care providers' directives in offensive and emotionally-charged ways;

...then you know there's an absence of trust on the birth team.

The unifying goal and reality of birth teams is this: everyone wants mom and baby to be healthy, and while there are common aspects to all births, all of us are working with a unique mamatoto (that's the Swahili word that describes mother and baby as one entity) who has idiosyncratic feelings, needs, and expectations to be addressed. But without trust, no one sees the unifying goal in one another's actions.

So, how do we promote trust on the birth team? If we follow Lencioni's model...

Ask for help. It's not an admission of incompetence to say, "I don't have the resources. Can you help me?"

Don't conceal weaknesses and mistakes from one another. Anyone can say "I don't know" when asked a question - it's when that admission of weakness is followed by, "but I can find out!" that trust blooms. Then it's important to sustain that trust with follow-through by obtaining and providing the information requested.

Provide constructive feedback. No one can make improvements who doesn't know there's an improvement to be made. If your care provider is rough during exams, say something! If your patient is always late, say something! If your doula has bad breath, say something! Just remember: the best way to make sure a criticism is received and change is implemented is to communicate constructively. Be kind, be tactful, be empathetic.

Offer help. No one is an island. We all need to feel connected in order to create the necessary buy-in that links team members. If when you're talking with your care provider and she seems distracted, ask what's up; maybe she'll mention how her house painter quit and apologize for being only half there, and maybe you happen to know a good house painter - that's your opportunity to say something!! Even if they decline your offer for help, you'll be remembered as someone who's altruistic, and who cared enough to ask, "What's up?" Furthermore, you won't leave your care provider's office thinking, jeez, I have a crappy provider, I was so rushed through my appointment, she didn't listen to me at all...

Don't jump to conclusions about the intentions and aptitudes of others without attempting to clarify them. This one is SO important. It's up to each of us to communicate effectively, but sometimes we unknowingly blunder when trying to verbalize our ideas. (There's a whole blog dedicated to the things care providers say badly.) Try to further communication efforts by repeating back those words, or rephrasing them and asking, "Is that what you meant to say?"

Building a team requires effort on each team member's part. When everyone is on the same page, we all sing beautifully together!

---
Edited to add: here's another article - this one's an opinion piece with an interesting take.
The mother of all rows breaks out over doulas, Doctor questions benefit of female supporters at births

Clients, they're everywhere!

2009-11-23T15:21:00.001-08:00

Lately, I've been wryly examining what pre-doula Erinn conceptions about doula life compared to what present-day Erinn has experienced. My top three unforeseen things about being a doula are:

1. Women want to tell me their birth stories. Admittedly, I regularly solicit birth stories during conversations - but even when someone else initiates the discussion, the mom telling the story always ends up looking at me, whether she knows I'm a doula or not.

2. I've become a conduit for information to everyone. A few weeks ago, a friend whom I was helping pick out a new computer laughed at me and said, "I feel like you're doula'ing me through this purchase."

3. The way I offer my opinion in any situation has changed dramatically. I used to just speak my mind; now I choose my words extra carefully, and always make sure I round-out the discussion by pointing out opportunities for individual choices and bringing up variances that might not have been mentioned.

I have two more potential clients, one couple from Kim's Bradley class and another who was referred to me by a local doula, Melissa. Both are planning on a birth center birth with CPM's, which is exciting - I haven't done a birth over there before, so it should be very cool, and very educational. My Bradley couple are still in the middle of pregnancy, and I don't expect them to commit for a couple of months, but the referral mom I spoke with tonight said, excitedly, "I can see we're going to be a great match," after our phone conversation today, which made me think she was ready to sign the contract!

I'm constantly amazed at the way being a doula has changed me, and how it's made my life so exciting. It truly is a gift to me when mothers and families allow me to serve them during pregnancy and labor.

A weekend wedding, and a conversation about c-sections

2009-11-15T07:49:00.000-08:00

My fiance took me to a wedding this weekend; one of his childhood friends got married, and there were a lot of old friends from his hometown there. I got to meet some very nice people, including a couple who are high school sweethearts, got married several years ago and have had two sons in the past few of years. The conversation turned to birth (surprise, surprise), and these two little boys' petite, dark-haired mom with a perfect figure and complexion told me she "had to have two c-sections."

I nodded slowly, thoughtfully, and asked, "If it's not too personal to talk about, why did you chose surgery?" Here's what she said.

"During my first pregnancy, my doctor said, with my family history (my mom and my sisters both had to have c-sections with all of their children), that my baby wouldn't descend. I'm just too small, and so are the other women in my family.

Care providers sometimes diagnose moms with a small pelvis, known in medical terms as cephalopelvic disproportion. CP is listed in the A Guide to Effective Care in Pregnancy and Childbirth (Oxford University Press, 2000); Table 5 of this well-respected publication on maternal care states that "diagnosing cephalopelvic disproportion without ensuring adequate uterine contractions" is a form of care "likely to be ineffective or harmful."

Diagnostic tests, such as an ultrasound, are used to calculate the approximate size of the fetus, and care providers compare these approximations to the size of the mother's pelvis (usually also an approximation, since most women don't have x-rays of their pelvises done before becoming pregnant and x-rays are no longer used while mothers are carrying a child due to negative health implications of exposing a developing baby to radiation). Effective Care's authors go on to state in chapter 12, page 83, "...controlled trials show that routine ultrasound measurement of fetal size in late pregnancy results in an increased rate of antenatal hospital admission, and possibly of induction of labor, with no evidence of substantive benefit to the baby."

If a 'small pelvis' is one side of the coin, the other side is 'big baby,' also called macrosomia. By medical definition, a macrosomic fetus is one which weighs more than 4,000 grams, or 8 pounds and 13 ounces. But there's a problem with the macrosomia diagnosis, too - research says, "[Care providers'] ability to predict macrosomia is poor [and] management policy of suspected macrosomic pregnancies raises induction of labor and cesarean delivery rates without improving maternal or fetal outcome."

"My doctor scheduled my c-section on my due date. When she, my doctor I mean - well, when she cut me open, sorry to be so indelicate about it, but I guess that's what happened - she said after the birth that my son was really high inside me. She said, 'There's no way he would have descended - he would never have come down so it's a good thing you chose the operation.' I guess it's a good thing I knew my family history, you know? That way, I was able to tell my OB, and everything worked out for the better."

During the third trimester, baby is carried higher in the body, to the point where mom's diaphragm is unable to pull down as far as it can when she's not pregnant and taking a deep breath can be difficult. One of the things a mom's body does in preparation for labor is allow the baby to descend. Simply put, if a baby hasn't descended at all, then mom's body hasn't initiated this particular part of the process of labor preparation, and baby isn't ready to be born.

In labor, some moms experience arrest of descent, when the baby stop its birthing progress and labor slows or stalls. Usually arrested descent happens because the baby isn't positioned well; and most of the time, helping mom change positions or move around causes the baby to re-situate and continue being born. However, I think it's worth noting that arrest of labor isn't applicable until a mother is actually in labor. If a c-section is performed before labor begins, there's no labor to diagnose as arrested.

I would like to say that the experience of the mom I spoke with was an uncommon one, but in fact, the exact opposite is true. The World Health Organization recommends a c-section rate of between 10%-15%; but the U.S. national c-section rate is around 1 in 3 women.
Jill at The Unnecesarean put it like this:

One of the results of this mass over-diagnosis of labor dystocia is that many women are left feeling inadequate about their bodies, telling friends “I’m just not good at birth” or “My babies just don’t descend on their own” or “My labors just don’t keep going on their own without Pitocin.” While it may be true in some cases and I refrain from passing judgment about individual situations, I remain highly skeptical that labor dystocia is the epidemic that obstetricians are making it out to be by operating so frequently.

I asked mom why she chose a c-section for her second baby, and she said her doctor advised her that a trial of labor after having a c-section for a previous child would result in uterine rupture. The second baby was another scheduled c-section, just like the first. This is fairly routine; many care providers are hesitant, if not outrightly opposed, to a mother attempting to vaginally birth another baby after having one by c-section due to a risk of uterine rupture. It's up to the mother and her care provider to weigh these types of risks, so I like to make sure my clients know that research says "[the] risk of losing the baby because of a scar rupture is in the range of 1-4 per 10,000."

Mom was very intrigued that I'm a birth doula. All of the research I've studied flitted through my heard while we talked, but instead of voicing what I know from books, I shared some of my experiences attending moms who chose vaginal birth. She said, somewhat wistfully, "I'm not unhappy with either of my births, but... I'll always wonder what it feels like, you know...to give birth the usual way." I said maybe she could try for a third, and she smiled, and her husband laughed - both of them had a hopeful gleam in their eyes.

We turned the subject to the joys of raising children, and left childbirth topics behind, but I think our conversation sparked something. Later, as we were leaving the reception and saying our goodbyes, mom gave me a deep and thoughtful look. One never really knows which butterfly wingbeat will incite the monsoon on the other side of the world - maybe I was part of an important moment in their lives. I hope I was able to pass on a sense of empowerment to this mom during our conversation while also respecting her feelings of satisfaction about her birth experiences.

The World is Emblematic

2009-11-11T05:29:00.001-08:00

The title of this post if a quote by Ralph Waldo Emerson, and the prefacing statement in a book by one of my favorite poets, Dr. Nick Bozanic.

I took two semesters in high school of literature classes taught by Dr. Bozanic. Of the many incredible class offerings I had the opportunity to take or choose from at my school, his classes were probably some of the most meaningful ones to me. I made a lot of mistakes in that class, and discovered that my personal best wasn't good enough, and cried when I failed a test. Me, the one who floated by in school and didn't ever seek to excel academically - I was devastated by that failure. In the end, though, the grade I received (I passed, barely) couldn't possible measure what I had learned.

I discovered that my ability to learn was a chain of interconnected and simultaneously occurring processes that I had yet to truly explore. And probably even more importantly, I found that I wanted to explore it. School was never a priority to me, but those classes changed my perspective about education and allowed me the place and time to find out more about this key part of my personality.

Learning occurs at many levels for most of us. While some learn best theoretically (in the mind), others are more suited to hands-on and experience-based learning (through physical acts). One of the things that seems to bridge the gap between these two modes (mental and physical, or internal and external) is a constant theme documented by anthropologists in every culture: symbols. (Dr. B, forgive me, I know you dislike that word, but I'm using it in its absolute form, here.) A symbol is an idea or concept encapsulated by an image - the mental made physical, so to speak. Dr. Bozanic preferred Emerson's word choice, emblems.

I could get into detail about the symbols all around us, but the point I really want to make in this entry is this: we create symbols for ourselves, and actualize the potential inside us by focusing on the meaning being imbued in those symbols. I offered some ideas on vision boarding in a previous post - that's a way of finding symbology that works for you. You might also try this:

Write down your ideas about birth. (This is an exercise recommended by Pam England in her book Birthing From Within.) Don't overthink anything, just get it all out on paper.
Then, simplify the main themes of your writing into one or two words each.
Cut out some card stock or construction paper into about 6 rectangles (or make 4 squares, which ever works for you). Make as many cards as there are themes you've come up with.
Draw an image that represents each theme on the cards you've made. Don't be afraid of any lack of artistic skill - the graffiti on ancient cave walls wasn't elaborate, but it still got its message across! You might want to stick to one or two colors, or maybe one color per image. Try using big, bold marker strokes; or maybe get some pastels or charcoals.

The results are ideas made tangible - you've worked art's alchemical trick to make mental objects into physical ones! You can use these symbols in a variety of ways:

Like with a vision board, you can put the symbols someplace where you'll see them every day - your fridge, your bathroom mirror, your dashboard, your desk...
Strategically place positive or 'antidote' symbols on top of or next to the symbols of your fears, or put the fears in a box when they overwhelm you.
Showcase positive symbols in pretty picture frames.
Got a particularly nagging fear? Photocopy the symbol and cut it into pieces while you think about all of the reasons that fear doesn't control you. Or find research studies about your fear and paperclip them to the symbol - you won't have to read the studies more than once or twice to know, when you glance at that stack of papers and the symbol, that your fear is either reasonable or unfounded.
Build a diagram of how you're going to cope with a concern with its symbol at the center and the coping mechanisms surrounding it. You could write-out the coping ideas, or you can make a symbol for each one.
Celebrate the things you're experiencing and looking forward to by dressing up your symbols in party hats and streamers.

Connect with your inner compass (your alethiometer, if you prefer). The world is full of words and images that are our emblems, and that can be sign posts on the path if we know what to look for. Making that connection is a learning process; even the cells of your body, which are programmed by genetics to know what to do, have those first moments of being bathed in new chemistry during childbirth and need time to adjust to the changes. Whether you're expecting your first child or your 19th, you can facilitate that process by learning and observing your patterns, working within them and pushing their boundaries as necessary. Symbols are a tool you might find useful in this process.

The lovers, the dreamers and me

2009-11-08T19:03:00.000-08:00

There are a lot of fantastic blogs out there written by people who have scads of years and experience over my paltry one-year-and-three-births as a doula. Those wonderful people are sharing their knowledge and processing their experiences in front of us all so that we, all of us reading, can get something out of those events, as well. Sometimes I wonder if my thoughts have a place out there, among those gurus, when I'm such a greenhorn.

The reality I come back around to when I think I'm out of my league is that what I know about birth, as little as it seems in comparison to other professionals out there blogging, is still more than the average Gen X'er. The basic sex ed we got in 7th grade barely scraped the surface of what I eventually learned in my childbirth education classes and my DONA birth doula training.

I started this blog because I spend my free moments thinking about things birth-related - even more to the point, a lot of the time, I worry. I worry about those moms and new families out there who have no idea that they have options. They need good sources of information. One of our local childbirth educators recently told me about how one of my 'classmates' (one of the moms in the Lamaze class I audited) approached her after the class ended to thank her. She was profoundly moved by the simple statement that educator offered her: You can give birth. No one up to that point had ever said or done anything to instill confidence in her and her body - every care provider, friend, loved one and perfect stranger had only told her that they were happy she was choosing to surround herself with medical staff and interventions. Don't get me wrong - medical interventions can be good, in some cases - but research studies show that there are interventions and treatments being used which have drawbacks that don't justify the benefits of their use. (For more information about treatments and interventions, just check out the appendices of A Guide to Effective Care in Pregnancy and Childbirth. I actually own a physical copy of this book and jumped up and down when I found out there's an online version!)

It seems like those who end up with credible, honest and truly compassionate care providers, ones who actually listen and help women find the best birth experience possible, are usually more lucky than resourceful. (Not that luck is bad - thank goodness for luck!!) Then there are those moms who just pick whatever care provider their sister-in-law recommends, wander mostly obliviously through 9+ months of pregnancy, maybe read What to Expect When You're Expecting (NOT a book on my recommended reading list, by the way)... They show up at the birth place when they're told, go through all manner of indignities and eventually go home with a baby. Doesn't sound anything like a 'magical' birth experience to me.

Mostly, I write to offer positive encouragement to those who are setting their sights on a birth that they are in charge of, one where options are known and choices are made. People who hire doulas usually do so because they either know what they want or are trying to figure it out and want help, and because they want to ensure that there's a labor support professional at their births who's only role is to help them. (Sidenote: at a hospital birth, nurses can be wonderful. But most of the time, they have 6 - 8 other laboring moms to provide medical care for, plus paperwork, not to mention many other important duties. Nurses are normally not available to provide consistent labor support, although there are nurses who relish the opportunity to do so.)

On the other end of the spectrum, the dark end, are the moms and families who suffer because they had no advocates and didn't know their choices. They are the ones who emerge from a birth experience and call it rape. I haven't experienced first-hand a birth that falls into that category, but I have dear friends who have, and my heart goes out to them. Their stories put the "iron in my soul," to quote British midwife Mary Cronk.

Sundance aired a documentary about the musical theater show Hair on last Thursday night. One of the cast members of the show expressed, in an awed tone, that he believed the propelling energy behind the show was the hope for a new tomorrow, one held in the hands of the peace- and love-makers. He said something to the effect of, We were expressing a utopian ideal, and we changed people's perspectives through beauty.

Being a doula is important to me because I, as a doula, am important to families. (The research says so!) In my ideal world, we would all learn doula skills, and it would be at least as commonplace for someone to be a trained doula as to be CPR certified. We'd all be respectful and compassionate toward mothers and families. Everyone would witness a birth at least once in their lives. Women would become mothers by laboring confidently, surrounded by the loving touch and supportive voices of other women who have labored or will labor to birth a child.

Who said that every wish
would be heard and answered
when wished on the morning star?
Somebody thought of that
and someone believed it
Look what it's done so far
What's so amazing that keeps us star gazing
and what do we think we might see?
Someday we'll find it, the rainbow connection
The lovers, the dreamers and me

- from The Rainbow Connection, by Paul Williams and Kenneth Ascher

Exploring Your Options

2009-11-07T07:01:00.000-08:00

Our friendly, neighborhood Birth Activist blogged recently about how some future moms tell themselves (or are told, in many cases) that, at the end of labor, the manner of birth is not as important as having a healthy baby in arms. She goes on to make an analogy about how planning for big events allows us to reap the best from the event. (It's a good read, go check it out.)

Telling oneself or a new mom, "At least you have a healthy baby," is a sticky thing. Yes, the desired result for anyone who chooses to give birth is for a baby with all the appropriate working parts. But that's only one part of the equation. If mom births a healthy baby but her care provider convinced her to have an intervention she felt was unnecessary or that she feels she was coerced into, how will that affect her interaction with care providers in the future? How will the experience shape her ideas about birth and about herself as a mother?

Using the compass rose as a model, imagine that each cardinal direction represents the four major parts of our human experience: physical, mental, emotional and spiritual. Bearing a child is an intense experience which shapes all of these aspects of ourselves. The body changes; the mind is challenged to make decisions for the benefit of a new being; emotions are finely-tuned and sensitive. And birth can be influential to those for whom spirituality is an important part of life.

Planning means exploring one's options. Families have choices in childbirth. They can pick where they give birth, who will attend them, what interventions (if any) are acceptable. The design of a birth experience is farther reaching than just the day a baby emerges from its mother's body; birth is a touchstone experience, and can shape our ideas about what life is and means in a long term way.

In childbirth, there's a balance to be achieved between what can and cannot be planned. Sometimes the way things turn out doesn't match the hopes or expectations of the family - and even if the birth was its absolute ideal, often moms feel that their lives are in upheaval from the act of bringing life into the world. Being at peace with a birth experience can take time; it is an act of respect to be gentle with a mother while she processes her experience.

For more information and different approaches to crafting a birth plan:

Melissa @ the Bradley Babies blog, Tips for Creating a Birth Plan, part 1 & part 2
Chapter 17 in Pam England's book, Birthing From Within
Janine DeBaise's Birth Plan (published by Midwifery Today)
Christine Kane's guide to building a vision board
Birth plan tips from an (awesome and supportive) L&D nurse, part 1 & part 2

Baby...wise?

2009-11-06T12:00:00.000-08:00

Woman to Woman Childbirth Education recent posted about the book Babywise, and offered us this attachment parenting article entitled Babywise Advice Linked to Dehydration, Failure to Thrive. The writers of the Babywise book, however, believe that the needs of a child, in infancy and beyond, should be determined by the parent and not the child.

Last week, a coworker (at my 9-to-5 job) expressed that "babies can be easily spoiled" by too much holding and feeding, and then urged me to warn all my clients about the dangers thereof! I confess, I momentarily lost my usual cool. I stamped my foot (yes, I did, it's a shame but it happened), and stuck a finger in her direction while I proclaimed, "That is NOT a statement founded in sound research, and I can send you at least five resources based in science that say otherwise!"

I'm a little ashamed because as a doula, it's my job to discern when it's the right time to share information with others, and to communicate good information about childbearing/rearing, not sling it at people whom I feel are being willfully ignorant and/or rude. Two wrongs don't make a right!

There's a forum post floating around out in cyberspace somewhere that I can't put my fingers on which sums-up my feelings perfectly - a doula expressed how she chose her words poorly back in her "cage days" of being a new doula, armed with information and angry like a tiger being poked with a stick through cage bars. I feel that way some days, too. It's not that my coworker's chosen parenting style was bad - I'm just irked when people feel compelled to push their choices on others through unsolicited advice.

I can understand why Babywise might seem like a viable option for some. I'm sure the Ezzos, who wrote Babywise, aren't trying to hurt families. This parenting style most likely worked for them, and they just want to pass it along. The parenting choices of my coworker that are so similar to the Babywise method may seem strange to me, but it worked for her and her family.

It can be a struggle as a new parent to being home a baby who can't communicate with you by any other means than crying, and who's little body demands food, sleep and alertness in no discernible pattern. Ultimately, the parenting choices that help everyone in the family adjust and grow in the healthiest way are the best choices.

Follow your inner compass

2009-11-05T08:46:00.000-08:00

I love, love, LOVE this post from Enjoy Birth entitled Birth is a Journey: Does it have to be life changing? As she so aptly puts it:

If you simplify different birth experiences I think they could fall into these 3 categories.

1. a traumatic journey
2. a normal journey
3. a magical journey

You know that old saying, One man's trash is another man's treasure? Well, similarly, there are times when one mom's trauma is another mom's magic. I've had a client who loved her epidural, and another one who would have considered an epidural to be a total defeat. I've read birth stories where a c-section was a horrible, frightening and emotionally scarring event, but in another story, the act of having a baby via surgery was totally peripheral to the fact that there was a baby born!

The reason birth is such a complicated and emotionally-charged topic for many people is because all of us have unique needs and expectations. Even though all of us have a mother and a navel to show how we were once a part of her, that's often where the similarities end! There is no one-size-fits-all approach to birth.

That being said, because each of us needs something different, I've been asked so many times this question: how do families prepare for the birth journey?

Here's what I recommend to my clients.

Be informed. Knowledge is one of the most powerful tools at your disposal. Knowing how your body works and what to expect during pregnancy, labor and postpartum is empowering in a way that nothing else can be. If you're the kind of person who learns best independently, look for literary resources recommended by credible birth institutions. DONA International, one of the oldest and most respected organizations of birth and postpartum doulas, has a required reading list for birth doulas (PDF) that's been approved by professionals for the purpose of preparing birth attendants. Or, if you prefer being educated in a group setting, find a childbirth class in your area. CAPPA and Lamaze are great places to start if you're looking for professional educators with solid classes based in research evidence. There are also methods that can provide the same research-based education that are geared toward specific birth philosophies, such as Bradley, Birthing From Within, and Hypnobabies. There are lots of different kinds of childbirth education, but no matter what educational 'flavor' you pick, I recommend selecting a class taught by a trained and certified instructor.

Thoughtfully choose medical care and other support providers. The great thing about all of the personalities in the birth community is that there's a care provider out there for everyone. I urge my clients (and potential clients) to interview more than one of care provider. It's important to have the right people on your team! Also, interviewing more than one care provider means you have a back-up plan in the event that one of those providers cannot attend your birth.

Research your birth place. If you're using a hospital or birth center, choose the one with the best care practices. The Coalition for Improving Maternity Services has a list of birth place principals which may help you ask in-depth questions when you tour facilities. If you've chosen a home birth, talk with your care provider to plan the details, such as supplies you'll need to have on-hand and transport procedures in the event of an emergency.

Follow your inner compass. I believe we're all capable of having a magical birth experience if we listen fearlessly to the inner voice inside us. Be centered, focused. Be open to the best experience possible.

Do you have a good relationship with your care provider?

2009-11-04T13:00:00.000-08:00

It's interesting to me that often, once a mom has decided upon her care provider, changing providers doesn't seem to be an viable option, even when it becomes clear that the patient and care provider aren't well-matched. For example, if you were pregnant, and your care provider handed you a birth plan that limited your choices, would you stick with them, would you feel they were acting in your best interests?

I wish all care providers were held to the same emotional and cultural selection criteria as doulas. Current literature guides on hiring a doula recommend that families interview between 3 and 5 doulas before making their selection, and there are lots of great suggestions on what questions to ask a doula before hiring her.

The same approach can be used when looking for an obstetrician or midwife - don't be afraid to ask questions - suss out their approach to care provision! And remember: it is never too late to change providers.

Words, words, words.

2009-11-03T11:17:00.001-08:00

I just adore this post on the etymology surrounding the constellation Pyxis. It's fascinating to me how words can be so influential on how we think.

Back in June, Rixa Freeze mentioned an article in the NY Times entitled Letting the Patient Call the Shots, in which Dr. Donald M. Berwick, president of the Institute for Healthcare Improvement, discussed the idea of "patient-centered" care and effects of words like "noncompliance" on the patient. Compelling ideas!

I did a lot of thinking before I settled on the name for my doula service, because I wanted to find the words that best described the core of what I can offer a pregnant family. I knew I wanted it to describe or relate to the idea of pathfinding. As a doula, I offer myself as a partner on a mother's journey toward childbirth; I help her find information and research, and I hold her hand when she needs support that's less logical and more emotional in nature.

I'm not so much a leader as a partner, not a guide but a traveling companion. And I don't call any of the shots - the choices are up to my client, and it's my job to stand in her corner and help her achieve what she has determined to be the best birth possible. Once my client has found her guiding birth principals, we build upon them and use them as a compass.

The compass rose grabbed me, then - what a wonderful image. It represents all of the directions in which one can travel, and the empowerment of knowing where one is going.

Just like my clients are on a path, I'm on one, too. Their births are a gift to me; because they share their experiences by allowing me to be part of their support team, I'm better informed for the benefit of future clients and myself as a potential parent. I've learned a lot through independent study and my DONA training, but putting that education into action by serving women during pregnancy and birth gives meaning to all of the words I've absorbed.

In the beginning...

2009-11-02T16:33:00.000-08:00

A long time ago, a voice teacher told me to always introduce myself as "I am," and not "My name is..." Of the two phrases, she said, I am is more powerful, more resolute and present. The lesson has always stuck with me, and so, here's who I am:

I am a woman who became a doula without knowing what the word meant, or that there was even a word. In 2008, a friend asked me to be her labor coach, because her husband, who's in the US Army, would be stationed elsewhere when she gave birth. Being an intimate part of her pregnancy, labor and birth experiences transformed us both. After her daughter was born, I found myself still researching things birth-related. I thought, This is over, why am I still neck-deep in websites and books about mothers and babies? Then, I came across a site for a doula service in Ann Arbor, MI: Center for the Childbearing Year, LLC. I read the explanation posted to the Center's website describing the doula's role, and a steeple bell sounded in my head. I wanted to be more than a one-time labor coach - I wanted to be a doula.

I am without children of my own. Before witnessing birth, I never thought of myself as a potential parent - being a mom was the furthest thing from my mind, because I didn't see my parenting potential. Practicing a doula's skills has shown me otherwise - by becoming invested in others, as a doula or a friend or a loved one, those parts of me that are mothering come forward and flourish. Being a doula makes me more me. And that's a big part of my personal philosophy: I believe I'm here on earth to reach my potential through experience.

I am deeply concerned about the state of our birth culture in the United States. Typically in my country, women are advised at every turn by doctors, family members, friends - complete strangers often have some opinion to offer, whether it's solicited or not. Even after a baby is born, the influx of opinions, facts, falsehoods, and well-meant anecdotes don't stop, until parents can feel incapable in the face of a mountain of other people's words. I think it's time to let parents chart their own course toward becoming a family by allowing them the opportunity to ask questions and seek truths for themselves. I believe a woman's birth experience doesn't begin with a medical care provider's office - it starts when she becomes invested and involved in the experience of her birth.

I am a DONA-trained doula, working toward certification. (As of this post, I'm only one birth and a little bit of paperwork away from being certified, yipee!!) Being a member of the world's largest certifying organization of doulas is something I'm proud of; anyone can be a doula with the right experiences, but I think experience partnered with my DONA training gives me something extra, makes me more ready than your typical 'newbie doula.'

I am Erinn, and I'm very excited to be opening this blog!