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.
Wednesday, December 16, 2009
Wednesday, December 2, 2009
Respecting the Toes
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...
...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...
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
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
Monday, November 23, 2009
Clients, they're everywhere!
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.
Sunday, November 15, 2009
A weekend wedding, and a conversation about c-sections
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 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.
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.
Wednesday, November 11, 2009
The World is Emblematic
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:
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:
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.
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.
Sunday, November 8, 2009
The lovers, the dreamers and me
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!)
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
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
Saturday, November 7, 2009
Exploring Your Options
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
Friday, November 6, 2009
Baby...wise?
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.
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.
Thursday, November 5, 2009
Follow your inner compass
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 journey2. a normal journey3. 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.
Wednesday, November 4, 2009
Do you have a good relationship with your care provider?
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.
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.
Tuesday, November 3, 2009
Words, words, words.
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.
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.
Monday, November 2, 2009
In the beginning...
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!
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!
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