What we're thankful for.

Today I am thankful for my family. My wonderful, patient, kind husband, and our beautiful, spirited little boy. I am thankful for Tom's support, his selflessness, his work ethic, his intelligence, and his sense of humor, and I am thankful for Finn's tenacity, persistence, creativity, and endless joy. I am thankful for our health, for having a warm home to live in, and plenty of food and fresh water to eat and drink. I am thankful for indoor plumbing.

I am thankful for my mother, for giving me life, trying to teach me things I didn't want to hear about, and for her good health. I am thankful I had a father to raise me and love me, even though I don't have him any longer. I am thankful for my Gram, who had strong hands, great cookies, and silly names for all her furniture, even though she has left us as well.

I am thankful for my sister, for being my best friend, beautiful, strong, and compassionate. I am thankful she has found the man to spend the rest of her life with, and I am also thankful for him. I am thankful for my brother, who is disciplined, and selfless. I am thankful for his happiness and good health.

I am thankful for my inlaws, for loving me from the moment they 'got me', and for their support. I am thankful for Grandma and Poppa and how much Finn adores them and his cousin Soupie. I am thankful for my cousins, aunts, uncles, and other family members as well, even though I don't see them all nearly enough, and sometimes we don't get along.

I am thankful that I still have two healthy dogs, and that we have the technology to keep Murrey alive with minimal effort.

I am thankful for those that have reached out to us, and who help us. You know who you are, and you have changed our lives. Thank you for such amazing opportunities.

I am thankful for my friends. They support us, they love us despite our flaws, they listen to our bad jokes, and cry with us when we need consoling. I am thankful for the deepness and the strength of the bonds we have, and with so many. I am thankful for each person in my life, their health, and their good fortune. I am thankful that all of our victories are shared.

I am thankful we live in a country where speech and thought and free, and I am thankful to those in our government and military who work to keep it that way. I am thankful for fireman and local law enforcement, and all their work to keep everyone safe. I don't always agree with many of the decisions my government makes, but I am thankful to live here, and to know that I have an opportunity for my voice to be heard. I am thankful that change is possible, and I am thankful for democracy. I am thankful for Barack Obama, and the change he inspires.

I am thankful that we live in a country that is not war torn, or so corrupt that people are sick or starving, and I am hopeful that the future will show us a healthcare reform to change the lives of those in our country who do suffer. I would like all our citizens to have the access to care that my diabetic dog has.

I am thankful for medicine, and medical technology, and for all the lives it improves and saves. I am thankful for healthy babies, innocent smiles, and big, round, pregnant bellies. I am thankful to have an awesome job that allows me to touch people in very big, significant ways. I am thankful to those who have supported my studies and work to get me here. I am thankful for the opportunity to get here, and the people who let me scrub their toilets to pay my way.

I am thankful that our country tolerates all religions, and the lackthereof, and that our lawmakers will support our right to diversity, since many of us have questions, and few of us have answers. I am thankful that people in my country are learning to tolerate homosexuality and same sex adoption, and I hope there is more to be thankful for in the near future.

I am thankful for our oceans, and the vast beautiful wildlife on this planet. I am thankful for those working to research, conserve, and defend our natural resources and wildlife habitats.

I am thankful people are going green.

I am thankful for so much more.... and hope for more to be thankful for next year.

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!

Patient Abandonment Video from NBC 5

This video deals with a woman who was dropped from care by her OB at 40 weeks gestation (full term). Her ICAN leader Gina Crosley-Corcoran did a lot of work to try and find her some help, but she ended up delivering (safely, mind you) in the ER. And she got the VBAC she wanted.

My point in posting this article is not to say that 'This OB is a DOUCHE BAG', though that's pretty inarguable at this point. My point goes back to previous postings on communication and the importance of provider selection.

Too many women are waiting until the end of their pregnancies to ask the tough questions, and learning too late that they are incompatible with their provider's general operating procedures. At this point you will either need to give up on what you wanted, switch providers (which can be hard to do late in the game), or WORST CASE, you stick to your guns, and get dropped from care like she did.

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A joke to sweeten your Friday!

The OB, the Anesthesiologist, and the Midwife...

An anesthesiologist, an OB, and a midwife walked into a bar. The anesthesiologist ordered a pitcher of stout and a double burger; the OB ordered a Reuben and a bottle of red wine; the midwife ordered their biggest plate of steak and fries with a margarita. They all sat in a booth and shared war stories.

A long time passed, and the three realized something had gone wrong
with their order. They decided to find out what the problem was. They
found the bus boy just behind the swinging double doors to the kitchen.
He was struggling to get their overloaded cart from the tiled kitchen
to the carpeted dining area. The wheels kept catching on the bump.

The anesthesiologist kneeled down and examined the tires. You just need to inject something here in the back he announced. Then everything will go better.

The OB leaned down to look at the carpet. This part of the carpet is blocking the cart, he announced. Give me a knife and I'll just give it a little cut to help it along.

The midwife leaned over to the busboy and whispered loudly in his ear, "You can do this!

Just PUSH!"

Now THAT's FUNNY!

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.