Happy World Doula Week!

WDW

I can’t let this week go by without a shout-out to all of the wonderful women I know personally, and professionally, who’ve taken up the call to become a doula. A doula is a woman trained to assist other women in childbirth and/or to support a new family following the birth of their baby. And this is the week we are celebrating women all over the globe who do this incredible work!

Over 20 years ago, I was working as a temporary office monkey between jobs and wondering what it was that I wanted to do with the rest of my life. Across my desk one day came the company’s monthly newsletter and on the front page was an article about “doulas.” I’d never heard of this word before, and the concept intrigued me.

A few days later as I drove home during my lunch hour, there was a story about doulas on NPR’s show, “Talk of The Nation.” I had a “driveway moment” and couldn’t get out of the car until the story was over. My curiosity was growing. 

But it wasn’t until my best friend announced her pregnancy and asked me to be at the birth that I got serious about this idea: “Maybe I should become a doula!” I’m not an overly woo-woo person, but all of these things seemed to be pointing me in the direction of birth.

After some searching, I found out that The Seattle Midwifery School (300 miles North of my home in Portland) was offering a doula training that would conclude before my friend’s due date. Everything seemed to be lining up – so I signed up. I was hooked on birth immediately, and the rest, as they say, is history.

I never went so far as to complete the work of being certified as a doula. Finding scheduled evening and weekend hours as a Childbirth Educator kept me in the world of birth and allowed me to focus on having my own family. But every now and again, I’ve had the honor of being a doula at the births of friends, neighbors, or women who had no support or financial ability to pay for a doula.

It is such a gift to be with a woman when she’s giving birth. Helping her find her inner strength and witnessing the parents and the baby lock eyes on one another for the first time – it’s one of the most awesome experiences ever (that word is so overused in our culture, but this is one area where it’s completely appropriate)!

So,thank you to all of the women who’ve answered the call to become doulas. You are very special women, indeed. You have an immense capacity for nurturance, calm, strength and advocacy. You’ve got incredible stores of flexibility, skills and knowledge and you’re somehow able to continue to do the hard work of labor support on little sleep and not a lot of food. You are the best example of how continuous physical and emotional support can make all the difference as this couple transforms into a family.

I have nothing but the utmost respect and praise for the work that doulas do in the world of birth. But don’t just take my word for it. Google “benefits of doulas” and you’ll get 359K hits in about a half of a second. There aren’t any studies that I know of that show anything other than positive results of having a doula with you in birth. If you’d like to read more about the benefits of doulas, read this article written by Rebecca Dekker on Evidence Based Birth.

Having a doula at your birth can be linked to:

  •  Reducing the incidence of c-sections      
  •  Shortening the length of labor      
  •  Reducing epidural and analgesic requests      
  •  Increasing breastfeeding initiation and continuation     
  •  Increasing mother’s satisfaction of birth experience      
  •  Reducing the incidence of postpartum mood disorders     
  •  Increasing new parents’ confidence in the care of their newborn

There’s really no downside to having a doula with you in birth or postpartum! A doula is worth her weight in gold. If you’re interested in finding a doula for your birth or for postpartum, one place you can look is the DONA International website. Other places to look would be your friends and co-workers. A lot has changed in 20 years! Many more women are using doulas in their birth and postpartum and personal recommendations can give you so much more than a website directory! Many CBEs also have referrals they can provide, if you ask.

My tips for hiring a doula: Don’t get stuck on how many births they’ve attended, or what “extras” they might provide (photography, massage, etc.) These might be wonderful additions, but I think it’s more important you feel you can hang out with this person for 24+ hours. A professional doula won’t have an agenda for what your birth “should” look like. She’ll be willing to support you, and your choices in birth. Make sure your doula and your partner can work together. If you’ve chosen well, your doula will help your partner feel like they had just the right support so they could be involved in the birth at the level they were most comfortable with.

Doulas can be an amazing support when a birth goes really well, but even more so they when a birth goes rogue. Your doula can help you remember what matters most to you in this birth experience and help you get as close to that as possible. On the other side of giving birth, you’ll share a bond with this woman forever and she’ll be an important part of the birth story you’ll remember for the rest of your life.

Doulas are amazing women and I’m happy to publicly honor them in this way! A special shout-out to Liesl & Kathie (doulas) and Beth & Marilyn (midwives) for all of the doula-ing they provided me and my husband during the birth of our four children. I mean this honestly when I say it – we couldn’t have done it without them!

If you know a doula, please take time to honor them in some special way this week!

Empty Nest

It takes a torrential rain or windstorm to blow the last remaining leaves off the trees revealing what was so well-hidden in the uppermost branches throughout Spring and Summer: one, two, sometimes up to three bird’s nests. They vary in size and shape, and I have no idea if these nests were constructed just last year for a whole community of birds to share some space together, or if they’ve been there for years and yet are so sturdy as to withstand several winters. But one morning, after dropping my kids off at school I looked up from my parked car and this is what I saw:EmptyNest

Instantly, I thought of all the families who’ve been preparing in excited anticipation for their babies arrival only to end up with an empty nest. Whether it be through miscarriage, infertility or infant death, these families don’t get to celebrate all they’d hoped for when they began their parenting journey.

Truthfully, I’ve been sitting on this post since early Fall, wondering if I’m the “right” person to talk about this. After all, my husband and I have been extremely lucky in our personal parenting journey. But, despite writing dozens of other posts, this image of the empty nest and what it represents won’t quit me. And since I first made that connection I know several people who have experienced miscarriage and infant death personally. While I may not have experienced these things directly, I do know something about the pain of it – at least, vicariously.

Working in this field, miscarriage, infertility and infant death are realities. And after 17+ years and thousands of couples, I know families I work with who have experienced all of these things. Sometimes I’m privy to this information – a family will choose to share the details of their parenting journey with me. But oftentimes, I’m not.

As their Childbirth Educator, they might not feel comfortable sharing with me (or anyone else in class) their history of miscarriage as we’re just getting to know one another. So they remain silent about any struggles they might be having with their current pregnancy. Despite feeling especially vulnerable about the health and welfare of their baby, they might not be willing or able to reach out for support.

And even if I might have played an important role in their preparation to become parents, if a family has experienced infant death, this might be just too painful to share with anyone outside their immediate circle of support.

I respect a family’s desire to maintain their boundaries and privacy around such intensely personal events. Families should never feel pressured to share their parenting journey with anyone other than whom they choose.

I’m dedicating this poem/post to all of the families I’ve known, personally and professionally over the years who have suffered through miscarriage, infertility, or infant death as a part of their parenting journey. I’m not sure how often these realities are acknowledged. But I think they should be.

Empty Arms

“We’re pregnant!”
We want to scream it from the rooftops
But, we’ve done that before
And remember what happened last time
Parents and siblings trying on their new identities:
Grammie and Pops, Auntie Jen and Uncle Matt
Friends joking, “You’ll never sleep again!”

So,

Instead we check the test results over and over again
Like a nervous tic
“Is that a plus sign?”
“Do you see one line or two?”
And we keep the news to ourselves
Locked away
Silent, mute, anxiety-excitement
Heavy in our hearts
We won’t tell anyone

Until…

Morning sickness becomes all-day sickness
The baby starts moving –
A lot
We’re past that day, that week, that month

Because…

We need to feel the weight of the baby in our arms
The emptiness has been almost too much to bear
We can’t go through it again
Everyone else’s excitement crashing down
Heavy, crippling us under their collective grief

So,

We wait
With the breath of hope caught in our throats
We wait
For the right moment to whisper
Only to a select few
“shhhhh – we’re pregnant.”
Please keep our secret – don’t tell anyone
Don’t get excited – don’t believe it
We don’t – we can’t

Not yet

~~~~~~~~~~~~~

Every time I see a baby
My heart somersaults in my chest
And I wonder

“Why can’t that be me?”

If her baby is crying and she is frustrated, or angry, or too slow to respond
I wonder
How much better I would be at this:

Mothering

Because –
Why, exactly?
Because – I want it more
Because – I deserve it more

These are not rational thoughts
I’m not proud of these thoughts
But it is completely irrational that I’m not a mother
That we’re not parents

We’ve made the decision to stop trying
But we never decided that we didn’t want to have a baby
That was decided by someone – or something – else

And no matter what bargain we tried to strike
No matter what promises or prayers
We whispered long into the dark nights
Our arms remain

Empty

We still long to be parents
That desire doesn’t just go away –
That desire to be a family
Never goes away

Not ever

~~~~~~~~~~~~~

When I came into this place I was a mother
Because my baby was still alive
Not of this world, yet
But alive in the world created inside me

I could feel my baby’s every movement
Stretching my belly skin taut like a drum
Pushing my ribs out of place
Tap dancing on my bladder
Beautiful pain and exquisite discomfort
Now only a ghost memory

How can we leave this place now?
Arms empty
Breasts full

We have a car seat, a stroller, a bouncy seat
And there is a room in our home
A room with a dresser, a crib, a changing table, a diaper pail
All of the trappings of what was supposed to be
Our new little family

Intolerable cruelty
How will we ever get through this?

The pain is hot and sharp
It pierces and stabs
The pain is cold and dull
It throbs and aches

A constant reminder of how much
We were willing to love

How will we
How can we
Ever allow our hearts to love this way again?

Know that I grieve deeply with you if you’ve ever experienced miscarriage, infertility or infant death. And while these are such painful realities of many parenting journeys, they deserve to be shared and talked about – if and when you are ready to do so. These experiences are important chapters of your parenting story.

One national resource that might help you process is Share: Pregnancy and Infant Loss Support.

I’d also encourage families to consider individual and couples counseling. There are many therapists who specialize in working with families who have experienced pregnancy and infant loss.

Lastly, I’d like to remind all those who work with families to be aware that the parenting journey may include these painful issues and our families deserve our full support and compassion wherever they are in telling their stories.

Making Predictions During Birth – About as Magic as the 8 Ball!

Magic 8 Ball

Did you ever have a Magic 8 Ball? I did. I loved that thing. I loved being able to ask a question, any question, and have the almighty oracle predict my fate. Inside the little window floated a single die, with twenty possible answers to life’s biggest questions. Some of which included: “Signs point to yes” and “My sources say no.” When the Magic 8 Ball was certain, yes or no, then that was it. But sometimes there would be the confounding response of “Cannot predict now.” That always meant another hard shake of the ball and the search for a more straight forward answer. No matter how many times it took to get one!

I think too many of us are looking for straight forward answers to one of the biggest questions of all time. We want so badly to be able to predict what is by it’s very nature unpredictable – birth.

Today, I want to speak directly to those of us who work with pregnant and birthing couples.

Could you stop setting them up? Stop making predictions? Please, I’m begging you!

I recently had a reunion with some of my families. More than once I heard the report that someone on their birth team tried to make a prediction during their birth experience. I groaned and asked, “Why do they do that?”

One new Momma said, “so then, the nurse said to me “You’re really cooking! I bet we’ll have a baby before lunch!”

A second Momma said “the doctor came in and told me to get ready for a really long night, because he didn’t think I was going to have the baby until the next afternoon!”

Guess what really happened with these two women?

The first Momma’s labor came to a complete standstill about thirty minutes after her nurse had predicted a late morning baby. She started watching the clock and when the lunch hour came and went unceremoniously, no baby to be found even considering entering her birth canal, she became despondent and discouraged. She started to freak out that something was wrong with her body – with her baby. Given the strong connection between the mind and the body of a birthing woman, it’s no wonder all of this extra anxiety shut her body down for hours! It took an incredibly long time (and a new nurse at shift change!) before this woman’s labor started moving again. She ended up giving birth close to midnight – twelve hours longer than had been “predicted.”

The second Momma and her partner settled in for their “really long night.” But soon after she started second guessing her ability to handle the contractions that felt like they were right on top of one another. Instead of recognizing that her labor had kicked in big time and she was almost fully dilated, she thought that she was “just wimping out.” She was feeling very disappointed in herself and her ability to cope with what she’d been told by her provider was supposed to be early labor. Imagine the surprise when her husband had to run out of the room to grab someone to come catch the baby! It had only been about ninety minutes since she was last checked. So much for their marathon labor!

Birth is unpredictable. It can slow down, and appear as though it’s stopped altogether. It can speed up in the blink of an eye. The issue is not the unpredictable nature of birth, it’s our intense desire to make it predictable that’s the problem! There are way too many unique variables in every labor experience to make it impossible to predict consistently what will actually occur.

But we all still do it! Why?

Pregnant Mommas and their partners hear the due date and create an expectation that this is the day the baby will arrive, instead of recognizing their due month as closer to the reality of when the baby will actually be born.

As a Childbirth Educator, I’m guilty of it as well. I teach, as most do, textbook averages for birth. But do I explain that as a first time Momma, it’s completely within the range of normal to have a birth go super fast? Do I adequately prepare them for an ultra marathon labor experience? We all need to be more on top of this, so our students understand it is possible to have active labor begin almost immediately! And it’s also possible to be in early labor for three days before any changes in their cervix occur. As Childbirth Educators we need to provide our students with realistic expectations of the unpredictable nature of the birth process itself.

But once they’re at the hospital, too many nurses and providers think they’re doing a service for these women when they try to predict what will happen next. I know that this is not born of ignorance. These are professionals who have been at this job for a long time – decades in some cases – and they’ve seen an awful lot. The laboring woman in front of them is presenting as many have before her. The mind just wants to go there. “Here’s a pattern that I’ve seen before. So I’m going to predict what will happen next.” And in a lot of other areas of life, this might not be a bad policy. But not when we’re talking about birth.

This unpredictability of birth (and our refusal to embrace it) is what trips all of us up when it doesn’t have to. In fact, I would argue that we’re missing out on the most important aspect of birth while we’re busy trying to predict what will happen next.

As expectant couples, you go into birth with a rock solid Birth Plan that you wrote a month before your first contraction. But due to circumstances you could never have predicted, your birth has gone rogue. If you’re still clinging to the plan of your ideal birth (as opposed to participating in your real birth) you’re setting yourself up for disappointment instead of moving through your birth as it unfolds. When you’re able to adopt this attitude of flexibility, you’ll be surprised at what you’re really capable of! “Wow, this is not at all what I expected, but look at us and how we’re handling this completely unpredictable experience together!” It matters how you respond to your birth in real time, as it really happens. Not based on what you had predicted (hoped, wished, or expected) would happen.

As Childbirth Educators and Doulas, we are hurting ourselves and our couples when we try to make predictions about how we think our couples will move through their births. Let’s not prejudge how the people we work with will cope with their labors. Let’s give them all the benefit of the doubt in that they will have births that are, by nature, unpredictable. Let’s try our best to prepare them better for that reality.

As for the L&D nurses and providers who encounter these women in labor and try to make predictions about what will happen next, please understand how much that undermines a woman’s confidence in her ability to know her own body. For the woman before you, it doesn’t matter one little bit how many times you may have witnessed what she’s currently experiencing. She doesn’t need predictions from you about how much shorter or longer her birth might be. She just needs your support and your listening ear – right now. Even the least experienced laboring woman will be able to provide you with clues about what is actually happening in her body. And this is so much more valuable than what you think might be happening in her body.

I completely understand why we do this whole thing of planning and discussing averages and making predictions – all of us are wanting to avoid vulnerability. But vulnerability and birth are inseparable. They have to be. Birth without vulnerability lacks the key ingredient that’s necessary for deep and lasting transformation to occur.

All of us who work in this field should be experiencing that transformation on a regular basis. That’s why most of us got into this whole thing in the first place – the beauty, the mystery, the surprise, the unpredictable nature of birth stirs something in our soul. After each encounter, we should leave that new family feeling grateful we were once again able to witness their transformation – and be transformed ourselves at the same time. This is how we can continue to best serve our families, when we recognize the sacredness of our own work with them and strive to preserve that sacredness for our families no matter how unpredictable their birth ends up being.

There is magic in birth – it’s just not of the 8 Ball variety.

Experienced parents: Did you try and make predictions about your pregnancy, birth or parenting? Did any of them come true? Did anyone on your birth team try to make a prediction about your birth? How did his make you feel?

Words Matter.

Words Matter

This past week, I had the chance to talk with two different Mommas about their births. Even though their births were very different from one another, there was one aspect that they both felt compelled to share in the re-telling of their birth story. Each of them stopped and dwelled on it long enough for me to recognize how important it was to their overall experience. So, I’m sharing it with you all here just as a gentle reminder to those of us who work with birthing women: Words Matter. A lot. More than you realize. In the context of giving birth, some words will take on deeper and greater meaning and have such emotional impact that it can change a woman’s whole perspective on her birth. These same words can spark negative memories for her for years to come when they retell this story – to others, or just to themselves.

The two examples I want to share might not seem to include very harsh words or over the top comments, which is why I want to highlight them. You see, it isn’t enough to not be cruel with our words when a woman is giving birth, we need to realize that she is filtering everything that is being said to her through the lens of vulnerability. She is fully exposed, physically and emotionally. And the words she hears have more meaning, more weight. These words which normally might not offend at all, can be taken as judgement in how she is “handling her labor” or “conducting herself” while trying to have a baby. It’s not just our words that we need to soften, we need to create an atmosphere where a woman feels safe and secure while giving birth. Then words, maybe even the same words, would be received differently.

One Momma said that she felt like there’d been little to no encouragement when she started to push her baby out and to her, pushing felt like it was never-ending. She had no idea from her nurse or provider if she was making any progress and she was getting really tired and frustrated. So, as they asked her to give them yet one more push, she started making some pretty loud noises to help her get through her tiredness and frustration. And that’s when her nurse shushed her.

In the retelling of this story, this Momma stopped and we talked about this detail for a pretty long time. She said that she remembered thinking in her mind, “Did you just tell me to be quiet? Are you kidding me? I’m trying to give birth here and I need to do it quietly? What, am I embarrassing you?” She, of course, didn’t voice any of this – which is a shame, because this will be a detail that this woman will play over and over again and she might feel like she was silenced during her birth. Whether or not this Momma actually quieted down makes little difference. In her memory, she was shushed by this person – at a moment when she needed to roar.

Had she felt some level of encouragement and support during her pushing, her memory of this part of her birth could be very different. If this same nurse had taken the time to tell her what great progress she’d been making or even validating for her that pushing can be tiring and frustrating but that she was actually getting somewhere, she would have established a relationship with this birthing woman. Then, if she’d started to make a lot of noise with her pushes that same nurse might have been able to lean in and whisper in her ear, “Take all of that energy and put it straight into your pushing! Channel that noise and grunt your baby down and out. You are doing such a great job!” And even though, effectively she would still be quieting this birthing Momma, it wouldn’t be received that way. This same Momma might have told this part of the story differently: “I was getting super frustrated and making tons of noise with each push, but when she told me to grunt my baby out and let me know I was doing a great job I just got really serious after that – and then the baby was born! She totally helped me get focused on my pushing.” Or something to that effect.

The other Momma I talked with had gone through and incredibly long labor – close to 70 hours – and when pushing finally started to happen, she reported that one of her nurses kept telling her, “You’ve got to grab your legs and pull them back if you’re going to be able to birth this baby!” Now granted, this was maybe their 4th or 5th nurse because of the length of the labor, so she might not have been fully clued in to everything this Momma had already gone through. But in the re-telling of her birth story this Momma stopped as well and said that she wanted to tell the nurse “Why don’t you get up in this bed and pull your legs up after 60+ hours of labor? And then you can tell me what to do!” This Momma said that she couldn’t stand this woman standing next to her and wanted her to shut up and leave the room. Again, she questioned whether or not she had actually said any of this out loud (she hadn’t).

As birth workers we might not realize that what we say and how we say it matters so much – and it’s not limited to the actual birth itself.

I feel like I owe an apology to a new Momma from one of my recent classes. She ended up having a very fast and furious birth – 8 hours total from start to finish. And her partner told me her story just yesterday. She said that in the midst of giving birth the Momma felt like I’d lied to her! I had said that I didn’t enjoy my first pregnancy much, but that I loved my first birth. Of course, I had a typical long and slow-to-rev up labor with my first, and she felt like she’d gotten no breaks. Her partner told this to me kind of jokingly, but I take it to heart. My experience is only that – my experience. And I need to be aware that my words matter.

How and what I say in my classes will come back to women in the midst of their labors. Have I really prepared them as best I can for variables in birth? Have I encouraged them to ask questions and use their voices when and where they feel they need to? I don’t ever want a woman to feel silenced while she’s bringing her baby into this world.

We need to understand that women must be extraordinarily supported while giving birth. They are already doing so much! Everything else they perceive during their birth must be supportive, encouraging, respectful, kind and loving. During birth, this window of vulnerability opens wide and it’s our words and actions that will have the most impact. She’ll never forget this day. But what will she remember? Each of us who do this sacred and most important work of birth need to remember that we will continue to live on in her memory and in the retelling of her birth story.

How do you want her to remember you?

If you work with laboring women, does this ring true? Have you ever witnessed, or unfortunately found yourself speaking, words that now you realize to be less than positive or helpful? What words do you use that seem to have a lasting, positive impact?