Showing posts with label doula. Show all posts
Showing posts with label doula. Show all posts

Developing Your Inner Doula

This is a copy of my notes (polished up a bit and put into sentence form) from the doula conference this weekend.

I was VERY nervous, but received overwhelmingly positive from feedback from most of the people who were there, as well as encouragement from the PR Director of DONA (who was in attendance) to submit this article for publication in DONA's industry publication, International Doula. This in itself is quite flattering, as I have had the cover story in this magazine before, and I would nearly burst with pride to have it again.

So please post your comments or questions, and I will consider them all in the writing of my final draft of this article, before I submit it for publication to DONA. Thank you, and happy reading!

And to those of you whom I met at the conference-- it was lovely to meet you all, and I wish you nothing but the best in your pursuit of being the best doula you can be!

__________________________________________

To develop your inner doula is to become a gatherer.

Picture a squirrel, constantly seeking out small nuggets of nourishment, and savoring each little bit, treating it as if it were gold. This is how we nourish our minds, and our creative skills for our clients. Their nourishment is food, and ours is information. We should constantly be seeking new perspectives, and new information. It may not be useful in this moment, but tuck it away, and when you need it, it will be JUST THE THING, and nothing else will do.

Developed doulas teach classes.

To teach, even if once a year, you put yourself in a position to gather unique information. You can learn a lot from others. Perspectives and vulnerabilities you can’t see from any other vantage are visible in the nuanced interpersonal connections between teacher and the nervous expectant parent. Pay attention to how different people make you feel, and ask why they make you feel this way. This is a great way to test yourself for your own preconceived ideas about people and birth. Ask yourself if you feel effective in reaching your ‘problem students’, and what you could have done differently for them. The answer will change you.

What you can learn about yourself by teaching is invaluable. Seeing yourself through the eyes of the expectant family can help you fine tune the image you want to portray, and your communication skills. So, Tell the world who you are, and what you believe in, and you’d be surprised who is listening.

I think it’s important to note-- Teaching is not just for our cleints, we can teach one another as well, in meetings large or small. Topic oriented meetings are best, I have found, as doulas LOVE to talk birth! And if we don’t have an agenda, we will generally fill the allotted time and barely finish up the introductions! So make sure you have a goal or topic in each setting, and reach for it.

Developed Doulas attend/volunteer for Non Profit Organizations dedicated to new moms

To help a mother with BF issues, you need to know what the most common issues are in the first weeks and months of life. La Leche League is the best place to go to hear about these issues, and the multitude of women with variations on each issue and how to handle it. This group is an amazing resource for finding ‘alternate ways’ to look at common problems, as well as other methods of coping. The main points of the more common breastfeeding obstacles can be read in a book, but the tips, pointers, and life skills are passed from mother to mother, and if you go to the meetings, they will pass on to you, as well.

In one meeting your inner doula may learn enough to help a woman continue to breastfeed up to or beyond her original goal, and we all know this makes all the difference in the lives of that mother and baby. These same rules apply to meetings for ICAN, and other groups related to birth and parenting. They all have a unique point of view or group of mothers in need that YOU could learn something from.

In order to grow, we need to learn, and meetings like this will stretch our brains beyond our own experience and allow us to be a better doula to women with the specific issues these groups cater to.

Developed Doulas contribute to their community. And not just with money.

Do a BOLD Red Tent Event, startup a Trust Birth Initiative, sign up as a guest speaker at ICAN, LLL, or at different types of birth classes. As doulas, with each act of giving, we get so much in return. So let us give, for the betterment of others, for the betterment of ourselves, and the betterment of our doula community.

You don’t need money to invite women into your home to learn and talk about birth. There is more to giving than dollars—we can give our sense, too!

But please donate something, as it develops our roots in the community as doulas, our connection to the people we serve, and an awareness of doulas in the cultural consciousness. Donate your time so that women know how to find a doula on the day they decide they need one.

Developed Doulas are aware of the mainstream and cultural forces in their field

We should spend two hours each week reading industry materials. And no, I don’t mean blogs. Blogs are a FABULOUS WAY to keep your head and your name involved in the goings on of your field, but reading a blog on someone else’s opinion is reading an editorial. Newspapers differentiate between news, which is fact based, and editorials, which are opinion based—and you should, too.

While these outlets may serve to reinforce your opinion, or get you motivated, it is not to be confused with following the research or literature of the industry we work in.

Developed Doulas check their sources and ask hard questions. Developed Doulas don’t accept anything as fact because of who posted it on Facebook.

Check your sources, and make sure they are reputable, consistent, and fact based. Emotion-laden media serves a lot of purposes for doulas, but please don’t confuse it with fact seeking. Developed Doulas know their stuff. J

Developed Doulas do not indulge the negative media surrounding birth on television.

This is not the good for our professional self-esteem, and in most cases just gets us riled up and frustrated. So turn them all off (unless you know an amazing midwife or doula on a particular episode, and then you SHOULD watch—because those are the shows that we hope will change the rest of them).

Instead, we can read a book, or watch a reputable DVD to expand our knowledge base, so our personal wisdom grows. And with wisdom, comes confidence, grace, and a greater ability to conduct yourself in a relatable manner to your audience, no matter who your audience might be.

Developed Doulas make friends with people whose professions compliment theirs

Visit the offices of professionals who serve the same clients you do. Get to know them, how they work, and their side of the birth story—as we don’t all see it from the same point of view.

Get to know a massage therapist, a physical therapist, an acupuncturist, a lactation consultant, a postpartum therapist, a chiropractor, a midwife, a nurse, an Obstetrician *gasp*, a medical biller, etc. This will create a great referral base, and make you more knowledgeable about birth and pregnancy as a whole.

Developed doulas know their fellow doulas.

Make an effort to meet all of them, and not just the ones nearby. Know the other options, and opinions that help to shape birth in your area.

Developed doulas have backups, and lots of them.

Create a backup program with doulas from the four corners of your ‘workzone’. Meet with them quarterly. Develop a backup fee structure, as well as a ‘finders fee’ for referrals so no one loses when we’re not a good fit with someone.

Developed Doulas ‘Mother each Other’

Share birth stories, and the emotionally difficult parts of working birth for you, and for your family. Share where you felt inadequate, and where you felt strong. Share your general impression of yourself, and who you hope to become. We need to share these things with our backups, to create an intimacy, and a loving trust.

Offer them the opportunity to do the same, and tuck away the seedlings you see in them and hope to see more of in you. This builds us up from the inside out. When we allow ourselves to be mothered, we become more comfortable mothering others. We need to receive nurturing in order to do it well.

We love our clients with the same hearts we love our families, our fellow doulas, and ourselves with. So spread the love, and share your journey.

Developed doulas refer to others.

When a client isn’t right for us, or we can’t take their EDD, the responsible thing to do is to refer the mother on, so she doesn’t have to go back to square one. We need to lovingly, and gently hand that mother to the waiting arms of other trusted doulas we know. Who better to help them than the women we know best?

Those local doulas whom we’ve sought out relationships with, and whom we trust and understand deeply are waiting with open arms to help the people you can’t. Now we have already acted as doula to that woman and her family by mothering her, and sharing the love with the doula we referred her to.

And her new doula, has a mother who is pre-loved, and comfortably nestled within a community of confident, caring women, and already knows she is home. This mother has already benefitted from the gifts a doula has to offer before she even chooses one—and THAT is good for business, it may not hit our pocket books just now, but it will catch up in time.

Social Media can be amazing. Developed Doulas use it.

There are legions of people out there with interests like yours, who are passionate about your passions. Social media is a tool you can use to keep motivated and forward thinking. There are also people who need to hear what you have to say. Some of them don’t have access to a doula, or are unsure that you even exist.

So get on Facebook, get on twitter, speak your mind, spread your words, and get people interested. It will keep you interested as well, and that will make you better at what you do. So after you read this, friend me!

Developed doulas Blog about their experiences.

It is important to maintain client privacy, but you can still blog about your thoughts, and issues you perceive to be important.

We should share tiny things we learn over time that can improve someone’s postpartum or prenatal period. These are the small nuggets that the other doulas will seek out, and hold onto as treasure until the moment that your experience can improve the life of one of their clients.

Sharing your tricks makes us all better, and community success means individual success, as well. Blogging will make you create the time you need to really think about your true feelings on each aspect of birth. This will also clarify your thoughts and make the information you share with clients more concise, and thoughtful.

This is how we learn, how we assimilate new info, and how we share what we’ve learned with others. This is how we create a community of women, all coming together to feed their inner doulas. This is also how to create a better world for women to grow up in, and mothers to birth in.

And in this way, developing our inner doulas will make the world a better place.

And you just thought we made the world better by creating fabulous birth experiences for as many women as we can reach! But we’re so much more! Especially when we grow as a team.

Let’s develop ourselves into a mighty presence of confident women who are in the business of sharing our wisdom to change the experience and culture of birth for this and all future generations.

Lets support change by supporting one another, and spend our time being purposeful and dedicated so we can change the world!

I am a developed doula—and everyone reading this and seeking more information is, too!

Give yourself a hand for pioneering a field that is so unique and so needed, and let’s work together to create a powerful movement, and an enormous lobby. Let’s change the world one birth at a time, and by leaps and giant feminine steps!

Let us leave in imprint on the birth community in the shape of our high-heeled shoes (or our birth crocs). Please join me in the reshaping of birth in America. I look forward to sharing my journey with so many amazing, and powerful women. Thank you.

The BAD Labor and Delivery Nurse, and what to do about it...

Today Facebook is abuzz with the blog post by a personal friend and soon to be student of mine. She was privvy to a VERY inappropriate conversation on Facebook that was also very public between an OBGYN and a nurse working in the same facility. To protect her privacy, I will simply post the text of her post here:








So-called compassion for c-sections from L&D doctors and nurses?

On Facebook, I have one particular friend from grade school who happens to be an OBGYN. Last night, she posts this status update (name removed for obvious reasons):

OBGYN - Waiting on a delivery.... Baby please come soon. I'm getting tired. 10 hours ago via Facebook for iPhone ·
To which her friend, a labor and delivery nurse responds:

NURSE - Ahh just cut her. Fuk it!
10 hours ago


I was infuriated to say the least and sickened to my stomach. I honestly felt like I was going to throw up. I couldn't sit there and let it go:

ME - wow NURSE - that's about the most insensitive thing i've ever heard in my life.
9 hours ago ·

ME - and this is coming from someone who had a doctor cut her baby out of her, never followed up on her care, didn't know her baby was transfered to another hospital in critical condition, left her with a festering infection for two months and could care less that i was stuck to a wound vac for another month after that. so yeah, just "cut her" sounds like really great advice.

8 hours ago ·
If you think any of that was enough to make you toss your cookies, these are the responses I woke up to this morning:

OBGYN - NURSE is an amazing labor and delivery nurse..., who knows me well and knows that I don't do inappropriate sections. I'm sure she was joking.
8 hours ago


NURSE - Relax MOTHER all that wasn't necessary. I am sorry u had such a bad experience for such a joyful moment. And thank you OBGYN I truely love my job and I know how to relax and joke! Hope the delivery went a bit quicker and MOTHER I hope you found a new doc....try dr ####!!
5 hours ago


ME - Out of curiosity - I wonder
what the mother of that delivery would have to say to you if she saw what you wrote...what do you think her reaction would be?
about an hour ago ·


NURSE - im sure she would have a laugh with me instead of being so uptight like certain people on facebook. The problem with patients is they try to control their own deliveres so much for example "birth plans" that they set themselves up for failure. Than they dont actually look into their doctors history they just randomly pick an OB and thats how things go so terribly wrong. Patients need to have a true advocate if they feel they cant do it for themselves. So its always nice to not treat ur nurse like shit and she can be your advocate.
40 minutes ago


I'm still debating what route to take next. With the skyrocketing Cesarean rate in this country, and people finally looking at those numbers - calling it unacceptable - I'm still shocked that two "professionals" would retort in such an ignorant manner. I am 100 percent open for suggestions on this one.


---
To begin, this may have been a VERY callous and in poor taste joke between two overworked birth workers. The hospital environment is a hard working and exhaustive one, and I don't think anyone would believe that having a family and being up all night delivering babies is easy. I would like to state for the record, that I do not indulge in 'doctor bashing', or 'nurse bashing', and that I do try very hard in all of my classes and exploits to show consumers what birth looks like from the other side. Each side/perspective of birth has it's own share of pressures, inequalities, and points to consider. I always seek to understand the differences facing each side of a birthing issue, and try to bridge that gap. I spend a lot of time in my classes explaining how birth works for the hospital worker, as well as the added pressures faced by OB professionals and Midwives that people may not be aware of. This awareness creates understanding and sensitivity, and can make all the difference in the feeling and function of the 'team' at a birth.

So all of that out of the way, what this nurse said online is heinous. It's irresponsible, it's insensitive, it's rude, and worst of all, it's ignorant. It's ignorant of what kind of ramifications a surgical birth can have on a mother and family. It's ludicrous that a birth nurse could be so naive to these things, especially with all the news in the last month about cesarean. First, there was the NIH VBAC conference, which called into scrutiny womens' lack of access to VBAC births, and noted that repeat and initial cesarean rates were too high. And just this week the CDC released the 2007 statistics on the American cesarean rate, and it's at an all-time, all-world high. I won't be surprised if this bumps us from 28th in world rankings for maternal and fetal outcomes to dead last, so it's not an insignificant piece of news. A piece of news you would expect a birth worker like her to have heard about.

Clearly, there is a problem in our country, that this nurse doesn't see to understand, but more than that, she seems to be unaware of the massive efforts to change the problem, and even the current events on the subject. Add to this, that she seems UNCARING about the problems our country face, which can only be addressed one birth at a time. This is regrettable, to say the least.

It is repugnant that someone would be so unthinking to post an exchange like this in a public place, and with the attention this is getting, I sincerely hope her administrators are made aware of it and some sensitivity training and cesarean prevention education is put in place for not just her, but her entire workplace, as attitudes like this tend to fester in overworked and overstressed work environments.

Another point I'd like to make is her commentary on consumerism in birth and birth plans. We've all heard the rumors that nurses 'don't like them'. I have my students write their 'birth preference lists' very carefully, taking care to say things like, 'I trust your judgment, and these are my wishes in the event of an uncomplicated labor/delivery'. This nurse's experience is right in saying that women need to choose their providers more carefully if they want certain things to happen or not happen at their birth. Our biggest assurance for the birth of our choice is the questions we ask and the provider we choose.

However, many people stick with their teenage ob/gyn and don't look into their options, or choices. Women DO need to get educated and make better choices. This is our responsibility for our own health and our own experience. And again, this is something I cover extensively in my classes. HOWEVER.... this nurse seems t o go astray of reality when she starts assuming that women write birth plans as a mechanism to control their births because they do not have a supportive provider. This is where her personal prejudice takes over, and this is unfair to all the women under her care who do their homework.

To make the assumption that anyone with a birth plan is a 'control freak' a 'difficult patient', or 'bound for a cesarean' is a personal prejudice that does exist that I'm not sure what to do about. This nurse talks about parents needing an advocate in the birth process, and I agree. They need a DOULA, someone whose role is nearly the definition of what she is describing. But when this nurse suggests that a woman's advocate should be her nurse, I must say that I thoroughly disagree, and I do so with the utmost respect to nurses.

I have worked with some WONDERFUL women , and not every nurse is guilty of these kind of personal prejudices-- in fact, I think and I hope that most aren't. To rely only on the advocacy of your nurse, who will be working with several other patients and doctors, and whom you will meet only after labor has begun, and whom you know nothing about is not a good idea. A doula, on the other hand, will meet with you and offer support and education from early in pregnancy, and offer a continuity of care and personal attention throughout your labor that a hospital nurse cannot. You can get to know your doula and choose someone who 'click' well with your personality-- but the nurse you get is luck of the draw, so personal prejudices and opinions about birth won't be discovered until labor is in full swing, which is not the time to realize you're lacking support from the only source you planned on.

I also want to address the idea that is expressed by this nurse that women need a 'buffer' between themselves and their care provider. The sentiment here is that it's 'us vs them', which I could not disagree with more sharply. I emphasize choice and consumerism to my clients and students, and together we construct a personalized birth team based upon their wishes, goals, and specific medical concerns. The idea of advocacy in birth is wonderful, as labor does put a woman in a vulnerable place. For the laboring woman and her partner to feel 'safe', having the continuous presence of a doula who acts as an emotional support, an educational resource, and another pair of hands is only natural. But some women don't feel threatened when they are vulnerable, and some partners are well equipped to care for their laboring mothers. Educated consumers will have a provider who is aware of their wishes, and on bo ard with their goals. They will have assembled a birth team that is supportive and loving and of the same mindset, and they won't need to be protected from the 'snipping scizzors' that this nurse perceives to be always at the ready. It's also important to note that the most supportive nurse in the world cannot sway the decision of the medical care provider, or 'protect' the laboring family from intervention if its the opinion of the caregiver that it is needed.

I love nurses, and I really don't want this to be a tirade on nurses, even this particular nurse, who is largely guilty of misinformation and insensitivity. I teach my students and clients to befriend their nurses, and write down their names so they can ask for them with the next birth. I do believe that being nice to your nurse WILL give a better birth, and in many ways, the nurses are the gatekeepers and keyholders to smoother and kinder birthing experiences. But I think it's a real shame that there are nurses out there like this one, whose view point is so skewed that even on her best day, the care she provides will have an undertone of intolerance and impatience for 'that certain type' of patient who writes up a birth plan, even in the most respectful of ways.

I try to foster good relationships with the nurse s I work with so that we will remember one another and have a bond to build from with each birth we work together. We are both birth workers, there for mess and glory of birth. We are both away from out families for nights at a time, and we are both there to support a woman through a challenge that will stretch and shape her into a new kind of woman-- a mother. We should be working together. We are not so different, and this is why I am so upset by what I have read from this nurse's point o f view.

This whole issue is not new, but rather a barometer for an existing problem. This is not a setback, but an opportunity to raise awareness, push for education, and to think about our own prejudices about the birth workers we stand next to when we work. I would like to see some media coverage on this, as well as something done at the administrative level of hospitals to curb this kind of finger pointing an d negativity.

Let us seize this opportunity to ask for change. Let us use this moment to become better, ourselves. Let us turn a very ugly exchange int o a better experience for women to come. Please pass this on, and please consider your own personal prejudice and how it may be devaluing the experiences of the laboring women you serve.

Patience, patience, patients...

I was at a birth that was over 30 hours this week, and WHEW it was hard work for all of us-- obviously less for me than the laboring mother, but you get the idea. I just wanted to say KUDOS to those women who carefully choose their providers, and THANK YOU to those providers with enough confidence in 'normal' birth to not mess with things.

This was for my 'anonymous' mom who switched to my FAVE midwives at 35 weeks. What a brave, but sensationally brilliant move. I know a lot is said about how offices are supportive (or unsupportive) of VBAC moms, but I want to point out that AVOIDING cesarean should be applauded, as well. And this was certainly done.

They exhibited NOTHING but patience, despite the midwife being well into her third trimester herself, and despite an all hands on deck showing by the staff in the office, I really really fell strongly that she got the BEST care possible, and a beautiful vaginal birth.

I learned from one of these midwives that last week they let a different mother push for 6 hours. SIX HOURS-- she obviously had an epidural, but the point here is that most people would have cited 'failure to progress' or CPD and sent her to the OR after 2 or 3 hours. But baby looked fine, and this office let her go for 6. God bless Midwives. I know where I am having my next baby!

Ducks in a Row (the Aflac kind)

I just got my ducks in a row to be able to bill insurance! Most carriers won't have caught up to the new code yet, and I don't know how many of them will recognize it, or pay for it. But I can give you the code and you can call and check on it with your carrier.

Then, after the birth, I could provide you with an invoice and you can fill out a claim for and submit it to see if you're reimbursed-- isn't that DANDY???

The only thing really holding us back is that doulas are not state licensed, so we won't be recognized as a legitimate 'provider of service' so I don't think I can 'get on' anyone's plan just yet. Hopefully in the future this will change, but for now, I'm happy to offer my clients some form of reimbursement, however small!

Good luck and I hope you're covered!

The Doula's Ripple Effect

Recently, I blogged about the importance of finding the right provider, and how that's not always easy. This is made more difficult if your needs change, or if you overlook a small detail in your discussions, only to learn late in your third tri that your one missed point is a deal breaker with a doctor or CNM you thought you loved. This is very stressful position to be in, when moms are often 'nesting' and needing to know they are in good hands, and all is ready.

I recently helped a client in this particular situation get a new office whom she and DH are VERY happy with, and now things are smooth as silk again. There was a one question deal-breaker, that was somehow overlooked, and when it came to light, we were 33 weeks or so, and not happy. I am pleased, though, that she stood her ground, and found someone who could offer her more, because I know it will make her birth day much better. Well, this mom emailed me again this week to let me know that her late term switch inspired her friend to do the same.

This friend of hers walked into her OBs office with a 'birth plan' or something like it, and the doctor refused to even look at it. He then went ON about how OFFENDED (yes, actually offended) he was that she would bring something like this in to him. He has been delivering babies for (blah blah blah), and what does she know about it as a first time mom? How DARE she question 'his majesty'. Thankfully, this woman had a very level head, and said, 'thanks but no thanks', and walked.

She is now on the search for her new obstetrical mr. or mrs. right, and has told my client that her last minute search's success gave her the strength to stand up for what she believed in and get more for herself.

Now it upsets me to the Nth degree that there are ACTUALLY medical professionals out there who behave this way. God Complex, much? Since when is informed consent a frivolity, and since when does a woman not have a right to ask questions and make requests about what's done to her body when she's in labor?? Those outdated people who see birth as 'frought with danger... but we have the technology to save you from these perils', and who see it as a 'medical procedure' and not a life-changing, spiritual, beautiful right of passage, well, they make me ill. But all we can do is say NO, and go to someone who will respect us.

We need to be educated consumers, and to vote with our dollar.... and it is my hope that more and more women will do this, after hearing stories like my clients', and being encouraged by their doulas and other support professionals, that these outdated control freaks will soon step aside-- forced into early retirement due to public pressure for an open-minded, respectful physician.

I take this as a good sign-- that someone I don't even know is going to get the birth she wants because of encouragement I gave to someone else. So while this is a job that comes with many frustrations, it's important to take moments like this revel in the ripple effects your empowerment has on the community you live in. Personally, I couldn't be happier with my small role in the outcomes for these two women. And it has me pumped up to keep going, and to change the world a bit more each time!
Go Doula!!! Go Women!!! Go Birth!!!


RAH! RAH! RAH!
I hope the sidelines are always this powerful!

Interviewing a birth provider, and making the tough calls.

Recently I have had to help a client get a new provider four weeks shy of her due date, and also had a friend who is trying to conceive talk to me about options for birth providers. This got me thinking. I have this HUGE three page list of questions I give to people to give them a general idea of what ask and why, but it's too cumbersome, and too detail oriented... I thought, there has to be a way to make this simpler....

So I came up with this.

1. How can help me to achieve the kind of birth I am looking for (un-medicated, intervention-free, etc)

This question is open ended enough that you can hopefully gauge their REAL opinion on what you're hoping to do, as well as their level of comfort talking off the cuff about the topic. Stammers, and side topics are a good indication the doc you're looking at doesn't know much about it, or doesn't do it much.

2. How do you feel about doulas?

Now, obviously, I think everyone would benefit from a doula. But that's not the point of this question. Some doctors don't like doulas, and I have found that those doctors are the ones with high rates of intervention and cesarean rates. Not to mention that closed-mindedness is not helpful when it comes to healthcare providers! Some people may have had a bad experience with a doula, just like doulas sometimes have bad experiences with doctors-- the goal here is not to judge by those terms, but to gauge open-mindedness, and intervention rates.

Many doctors who straddle 'the line' of medical/natural have told clients of mine things like, 'well if that's the kind of birth you want, you would definitely be better off with a doula'. Meaning, if you're calm and under control and I don't have to worry about you, you can do whatever you want. But if you're NOT, then I just might throw the book at you. And this is not necessarily a bad thing, but can be a point of concern and warrant more questions on your part.

3. What is your cesarean section rate?

The US average (mind you we're 37th in the world when it comes to maternal and infant mortality, which is ABYSMAL) for cesarean sections is 31.8%. The World Health Organization states that there is no reason the number should be above 10-15%. Don't rest until you get the real number! They have it, or they can get it.

This can also be a good spot to segue and ask if they accept VBAC births. Even if you're not a VBAC, the answer to this question says a lot about the open-mindedness of the clinic, as well how much power the legal department has over the medical decision making.

4. What is your epidural/narcotic usage rates?

Some places give a combined stat, and some keep them separate. Either way, if it's over 60 or 70%, it's not LIKELY that the provider has seen the ebb and flow of many un-medicated deliveries, and may overreact to a situation that is normal, but 'could' be abnormal. Only someone who sees a large number of natural births will be able to adequately monitor support and gauge a mother who is un-medicated. This is where the science and the practice of medicine seem to really split. They learned about normal birth in college (theoretically), but may have not attended enough of them to be comfortable with them. Practice makes perfect-- find a practice who regularly supports natural birth, and you'll be in much better hands!

Also keep in mind that you need to have some symbiosis with ALL the providers in the group, because if you end up with the one OB who does not support the birth you are looking for, that can be a problem. Though, having been in this situation once, we did got mom through an all natural, un-medicated delivery without so much of an IV (which he was not happy about), but afterward he told us that was his first natural birth, and he was very impressed and learned a lot. So who knows... maybe we converted him. :)

Next, you need to ask about their office/hospital policies on the following things:

1. monitoring.

What kind and how often? All the studies show that too much monitoring can be really detrimental to the process of natural birth, so we like intermittent, external monitoring, or even doptone. And 'intermittent' can mean different things to different people, so be sure to ask what that entails for them. Another great question is if they have telemetry units. These report the results on radio waves, and therefore, have no cords. They can also be used underwater and in the shower. Not many places have them, but those that do are worth searching out.

Clearly, if the situation warrants a closer look, you can change your 'wish list' on monitoring, but if your office has a standard 'break the bag and insert the internal fetal monitor' policy, you may want to run screaming.

2. IV/hep lock usage

Is an IV standard? Is it possible to used a saline/heparin lock instead? Many doctors express concern over the skipping of he IV, and I can understand why. Many of the medications needed for emergency situations kept on the floor are meant to be administered directly through an IV-- so if you injected it, it could be all kinds of horrible for you, and probably wouldn't work either. So, there is a safety risk for women without IVs in unexpected situations, HOWEVER, there is no reason that a heparin lock IV start/access point isn't good enough. they can hang the saline, and literally have you connected and medicated with only a few extra moments. For most women, those extra moments are not critical, and the freedom of movement gained from not being tied to a pole, and going pee all the time is invaluable.

3. pushing positions

If they tell you supine with your legs up is best, run screaming. This has been proven time and time again to be THE WORST delivery position possible-- though, doc can see much better this way.

While many women do prefer to climb into bed to deliver, there are many options for positions even while in the bed that can help the mother use gravity, and help her use her body for leverage. Not having a choice here dictates that the doctor has not delivered in other positions often enough, and I wouldn't want to be their first case out of their comfort zone!

4. what kind of 'clock' can I expect to be put on?

Do I have 24 hours from when my water breaks until baby NEEDS to be born? 48?? In other countries women go days, and sometimes even weeks with broken waters before active labor sets in. It is not necessarily harmful at all, however, the legal-political climate in this country allows little room for situations like this. If your labor isn't 'fast enough' to beat the clock, you will be looking at pitocin at the least, and a cesarean at the most. So, the answer to this question is quite important.

5. food and drink in labor

The ACOG has recently come out in favor of food and drink in labor. A mother's blood sugar needs to be able to keep up with the marathon events happening, and allowing no food or juice is very detrimental to that process. There is really no reason to keep a mother from doing what comes natural, especially if she is hungry!

6. What are your 'standing orders'?

Standing orders are what doctors have on file at the hospital to do to get every patient ready for laboring. It often includes blood work, some monitoring, an IV, and in many cases, AROM, an internal exam, and pitocin. These orders are going to tell you a lot about how they practice, and how much patience they have for longer labors.

And lastly, ask WHY a lot, and use your gut! If you get a funny feeling, stick with it, and interview some other people. And remember-- charisma and charm are for getting the baby in there, they don't help get the baby out! Some doctors are very personable in the office, and turn out to be abrasive, short, or different in the hospital, so knowing their policies will tell you a lot about what you can expect when 'the going gets rough'.

I hope this list is helpful-- and remember to choose wisely!

Planning Your Postpartum Period

After having this conversation with almost client I've ever had, I think it's time I put it to paper. It seems most everyone is afraid of PPMD (post partum mood disorders). I can understand why, they're really scary, and who wants to be incapacitated when you have a new child to look after?

Well, here's some information that may or may nor be new to you. Postpartum mood disorders are NOT limited to depression. It can surface as any type of common mood disorder people can get when they're not postpartum as well, such as PPD, anxiety/panic disorder, OCD, PTSD, and psychosis. These diseases look and act EXACTLY the same as your standard disease by that name, except that they are linked to a 'specific onset' of childbirth, or being postpartum.

This said, they have the same treatments as standard mood disorders do. Keep in mind though, that once a mood disorder is triggered, it may stay with you for life. In may cases, the mood disorder was not caused by having a baby, but there was a strong predisposition, and childbirth was just the right circumstance to set it off. In these types of cases it is likely the symptoms would have been set off later in life, regardless.

Some of the reasons cited for PPMD are changing hormone levels, the massive physiologic stress of childbirth, and the stress associated with adapting to your family's 'new normal' once the baby is home. I can't get my hands on it, but Sarah Fields, an author on PPMD has a GREAT article on this in Mothering Magazine from May/June 2007. Other respected authors on the topic are Heather B. Armstrong, and Susan Dowd.

A great test you can take to objectively assess whether or not you have PPMD is the Edinburgh Postnatal Depression Scale. Though it is important that if you have any of the risk factors for PPMD, you discuss them with your care provider, and intervene earlier rather than later.

The risk factors for PPMD are*:
-a history of severe PMS or hormonal troubles
-family or personal history of mood disorders
-assisted fertility treatments previous to pregnancy
-prior or current perinatal loss, miscarriage,or stillbrith
-personal history of violence rape or abuse
-a complicated pregnancy or delivery, or a cesarean delivery
-early or prolonged separation from baby
-difficult infant temperament
-poor social support
-lower socioeconomic class
-single marital status or a troubled marriage
-having multiples.
*list taken from multiple sources on PPMD, and hospital handouts on the topic

The things we can do to PREVENT PPMD are as follows:
-breastfeed your baby exclusively for 9-12 months
-have a doula present at your birth
-avoid interventions at birth
-have baby on your chest and nursing right away
-do lots of kangaroo care
-eat well for you and your baby
-exercise moderately

How you can make a plan for prevention before the baby comes:
-Either have dinners by design, or a whole freezer worth of food-- not worrying about lunch and dinner takes a large burden off a new family, as well as making sure you are eating healthy food. Have healthy snacks and water on hand as well.

-Have planned visits from friends and family that break the monotony of he day, and to provide support in the immediate postpartum period.

-If overburdened by visitors, simply don your robe before answering the door. No one will stay long if you're in your robe-- it's a subtle hint that this is family time.

-Let people help you! When they ask if you need anything, have a grocery list ready or ask them to change laundry or do dishes. This is the one time in your life people are really willing to help, so please let them. It makes them feel helpful as well.

-Don't worry about acting as 'host' when people come to see your baby. They can fend for themselves. Your ONLY job is to rest, eat, nurse, and snuggle. Let the mess be messy, and DO NOT feed your guests!

-Have a calender where each day you rate how your mood was on a scale form 1-10. Make sure you fill it in at the same time of day every day. This is to help you and your partner monitor any changes or worrisome behavior. If your partner notices you are not filling it in, s/he should check in on you and why that isn't happening, as it could be a sign of emotional issues.

-Remember that the baby blues are normal, PPMD are NOT. Seek help if you feel you need it and don't wait too long.

-Continue taking your prenatal vitamins, and consider supplementing with B vitamins, folic acid, or fish oils.

-Have things on hand that are simple pleasures for mom, like favorite candles, bath salts, movies, etc, and have them all set up with easy access for a mom with one arm dedicated to holding infant to breast.

-Find a moms group and go to it.

-Find a La Leche League meeting and go to it.

-Plan time to talk to your partner about things every day, or a special night once a week where you do a special activity to stay connected through all the changes in your life.

I also think it's important not to dwell on the possibilities here, there is every likelihood that you will be fine! There are memoirs out there, written by women who have survived PPMD, and they can be great help if you do find yourself with a little more than the blues. But take care of yourself, take care of your baby, let people take care of you, and in time, things will feel right again.

A SIGN of the Times

So, here we are, back at the sign that everyone is up in arms about. Do I like it? No. Do I think it's hateful and ignorant and arrogant? Yes. But there's a deeper issue here I'd like to discuss.

The fact that the sign is UP us a victory for doulas and natural birthers everywhere. There are enough women asking for a birth of choice to upset someone who is not accustomed to giving them-- which means, we're mainstream. Of course, it's not good news that this doctor's office felt it necessary to say 'we are not like them and do not accept them', but I DO find it encouraging that our natural birth/doula/vbac movement is strong enough, and has enough interest generated by it that this office felt it necessary to say 'we're not like them'.

To be a 'them' is to be recognized as the 'other party' in a conflict, which means our side has gained enough public respect to be bothersome and common for this office. It's too bad they don't like us, progress takes time, but it does happen. Little by little the old school will be overturned, and the liberals win out. Progress is just that, what happens over time. Progress never stops, and to me, this is great sign that acknowledges our presence and prevalence in the mainstream birth communbity.

This makes me angry, but gives me hope. In 20 years, many women will either leave this office in disgust, or the sign will be taken down by a 'new management' who isn't so bothered by women's choices. You can't stop progress, not even with nifty green engraved signs in your waiting room that are full of spelling and grammatical errors.


Preparation for the big day (at war)

There have been some intense conversations going on on Facebook the last few days about the sign put up by one doctor’s office in Colorado. I am not going to address the sign exactly, other than to say ‘Thanks for letting me know so soon, so I can get a provider who has my best interests in mind’.

What I am going to talk about here, is doing your homework, and preparing yourself so that 1. You don’t have an unsupportive provider like this one, and 2. You can deal with him if the event of a last minute substitution at the hospital.

Unfortunately, there is quite a chasm in the world of maternity care, with natural childbirth acting as the polarizing factor. This includes the heated debates on the cesarean epidemic, policies on VBAC deliveries, doula care, labor medications, and much more. It seems there are thousand points to disagree on, and none that we can all say ‘okay, I can meet halfway on this one’.

In my debates over this sign, it was gently inferred by a fellow birth activist that perhaps my inexperience with all things ugly in the delivery room was the reason I was not up in arms, and that perhaps with time, I would change, and become more angry and jaded. Now, I am not taking words out of her mouth, here, nor am I going to tell you her name—but this is the impression that I got from our chatting.

I suppose to some, I am an inexperienced doula. With less than 20 births, and not one cesarean, one could assume I have had nothing but great births, but this is simply not the case. I have seen all sorts of things that have upset me to my core, sent me home crying, and swore me off my profession. It’s not always an easy job. But regardless of this, I believe the reason I can remain optimistic when birth has become such a battlefield has to do with the classes I teach, and the way I prepare my students and clients so that their births CAN be beautiful.

My birth classes are intense. I am a certified Bradley Method instructor, and I teach a pretty hard line on reality. Many of the births I attend have been my students (or come from other Bradley instructors), and therefore, they chose the right birth professional, made the right decisions, and did not allow themselves to fall victim to a terribly flawed system. Some doulas I know with 50+ births can’t do this. So I say the claim that experience makes your eyes more open, or makes you more aware of the problems at hand and what to do about them, is not a valid one.

Birth is not something that happens to my students, it is something they learn to embrace. The births I have been to have not all gone perfectly, in fact, some have gone horribly wrong. But my students are able to make good choices no matter what hand they are dealt, and are able to communicate well with their birth team, and feel confident that THEY have a choice. This said, I know many women do not have choices, and have been on a large handful of volunteer births that illustrated this for me in way that is more visceral than I can explain to you.

The system is flawed, and it seems that some of us are at war. My classes empower my students to make good choices, and not become victims in this war. The importance of being an educated consumer has never been greater, and you can’t be an educated consumer without an education. So find the BEST class you can in your area, and if you’re like me, take two. Learn about red flags, possible interventions, cesarean rates, and your provider’s comfort level. Don’t let this battle be fought in your uterus. And with my classes and me as a doula by your side, there’s very little chance this will happen to you. We may be at war, but this does not mean we can’t find peace on our big day.

Doulas and Dads


A common theme I hear about when a couple chooses to not use a doula, is that the Dad wants to have an active role in the birth of their child. I’m here to tell you that these ideas are not mutually exclusive. Doulas can actually enhance the experience of the father as well as the mother, especially when the father has taken an active role in the childbirth preparation and labor.


First let me explain to you what doulas do NOT do, which I think might be widely misunderstood. Doulas do not ‘take over’, nor do we step inbetween you and your wife, or advocate for your medical decisions with the doctor. We don't perform vaginal exams, or monopolize the birth room in any way.


Doulas do not have decision making power, are not disruptive to the process or labor, or the connection between mom and dad. A good doula will know in the interview that Dad wants to be very involved, and only step in help him when he needs it. There is nothing sweeter than watching a laboring couple love one another through contractions, needing no assistance at all.


Doulas are there to serve you both, protect your interests, and divert the power to the couple that is laboring. This means, if mom is being coached beautifully by dad, we stand back and let that happen, offering a hand to hold, a position change, or a straw to sip from as time goes on. In this sense, we can work as a team, offering two voices of reason, two hands to hold, and two levels of experience to comfort her with.


On the practical side, it is important to note that there will be at least two other people in the room during delivery, and it would be nice to have met a few of them before push time. Also practically speaking, doulas can offer dad a moment to go to the bathroom, get something to eat, or get off his feet for a few minutes, which is SUCH a blessing in the longer labors. Doulas also come with a wealth of knowledge on what positon helps what, when to walk and when to rest, and many other things that only experience can teach, which can make both parents feel more proactive and capable throughout the labor.


We can also provide a sounding board for fathers who need to make a medical decision and don’t want to decide ‘on the spot’ with the doctors and nurses watching. A doula can offer information on the risks and benefits of procedures and confirm the situation that warrants that procedure, so that Dad can decide more easily,whether he thinks this intervention is right for them.


I think the most important piece, is that we understand how hard it is to protect the one you love most when you have no control. We are there to help reframe these feelings of helplessness, and create a subtle support network to aid in decision making, and the process of labor. We can take a stressful moment and turn it into a good memory. We can reassure dads who have not seen the face of a laboring woman that ‘yes, this is normal, yes, we are doing the right thing’. As well as supporting dad throughout the labor as a significant piece of the family we have been hired to support.


I cannot speak for every doula, just for myself. But I can say that doula dads seem to walk away with a higher confidence in themselves, and are much happier in their outlook of the labor, even if it contained some less than ideal circumstances. Dads and doulas are SUCH a good team, and it would be a real shame to have to labor without either one of them.


Here is a video of Taye Diggs (very funny) talking about the birth he and his wife used a doula for.