Waiting for the lights to change

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!

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

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

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

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."

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

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.