EnCouragement

Encourage

Interview with Jennifer Fisher of EnCourage Doula Care

(NOTE: While I hope that this post will provide information and be a positive resource for women and families, it’s important to note that the subject matter of this post involves pregnancy loss and bereavement.)

B: Jen, I’m so glad that you agreed to an interview for Birth Happens. There are lots of things that we could discuss, but I wanted to interview you about your latest venture into the world of Maternal Health as a Bereavement Doula. This idea might be something that’s new to my readers, and an important offering that people might not even know exists.

First, tell us a little bit about yourself and your family. When, how and why did you begin working in this field?

J: When I introduce myself, I say that I’m working in this field because of my family. My career started when I became a mom, with a great birth. I began volunteering with Nursing Mother’s Counsel when my oldest daughter was 6 months old. She’s now an ambitious freshman in high school!

Motherhood allowed me the time to volunteer additionally with Birthright of Vancouver, Washington where I listen to women while they take a pregnancy test or come in seeking resources. I always qualify my work at Birthright, while listed as a pro-life organization, as simply pregnancy support. I have no more ability to make a mom keep her pregnancy than I have to fly to the moon. I support moms wherever they’re at. The nurturing that I learned there, encouraged me to reach further in my career to become a certified childbirth educator over a dozen years ago, and now more recently, to become certified as a doula.

Baby number two came along two and half years after big sister. She taught me patience and that pregnancy and birth goes the way it wants. That birth also showed me how women working and supporting women during labor can be life altering! I had a doula, I had a nurse who believed in my goals, and I had a partner who was willing to watch me dig deeper and fight harder for this unmedicated birth. That support broadened my expectations of what we can do for each other.

Our miscarriage occurred less than two years later and I knew at the time, while we wanted and loved this little angel, his or her birth was there to teach me compassion for other women. It was then that I learned birth is not all rainbows and unicorns. While I knew this from a Childbirth Educator’s standpoint, it was in experiencing it myself that I really understood. Our baby’s name is “Eliti” which means “gift of the sun,” and I’m so clear in my work that this baby was a gift to us.

My sweetie and I were brave a few years later and got pregnant again. And this is where support from other women who had walked similar paths carried me through the pregnancy. I distinctly remember a conversation with my good friend Mary, who had experienced numerous miscarriages, when I asked, “When will I feel safe?” And she answered, “Maybe not until you hold that baby in your arms.” Our shared stories helped build up my courage.

My last kiddo was born at home as the sun came up, his 7 year old sister there to welcome him, and his almost 4 year old sister dragging her blanket into our room wondering what all the cheering was about. My family story is so intertwined with my career, it’s hard to tell where one starts and the other ends.

B: When did you start considering doing something “extra” in this field, in addition to your work as a Childbirth Educator?

J: Expanding my career to midwifery came while pruning the heather in my backyard! Heather is one of the flowers that struck me while I was on my pilgrimage in Spain, the Camino de Santiago, and I had planted some to commemorate that experience.

I realized in Spain that my career was intended to be about the babies. While pruning the heather in my backyard, the realization was it’s about the babies… and their mommas. So midwifery became the plan. Last year, I had to let that dream go as balancing school, tending to 3 acres, and my work as an educator did not equate to me functioning at my best, for everyone involved.

B: So, how did you make the move from midwifery to what you’re doing now?

J: Well, at the same time, a beloved friend endured a pregnancy with a fatal diagnosis. It was heartbreaking. I just kept racking my brain with the question, “Who is supporting her through this?!” She had a loving partner and family, but they were in the midst of dealing with their own grief. Who was supporting her?! That marked my transition to becoming a bereavement doula.

B: Why does this work matter to you personally?

J: I have always said that if I was not in the “beginning of life work” that I would be in the “end of life work.” Both have incredibly spiritual, profound moments that our culture as a whole does not recognize. I’m now able to do the work of witnessing both – and support the family whose world has been transformed by pregnancy and death.

B: How do you think your work as a bereavement doula will impact women and families?

J: When women and families acknowledge life and death, they can integrate these experiences and begin to process the emotions around them. For some, this may be more simple than others. I’m not here to judge women and families on how they do it. I’m here if they want support doing it. Yes, family and friends will be there, but even than that does not constitute best care practices. Maya Angelou says, “When you know better, do better.” By being trained to be a doula for both birth and death, I can assist families moving through their mourning and grief. Inevitably, when we are grieving, we seem to turn on those who are closest to us. With concerted support from a professional that sits outside the circle of family and friends, maybe the blow to ourselves and our loved ones can be lessened.

The other aspect of this work is integrating subsequent pregnancies and births. When we’re mourning, and we begin to assimilate the experience and move on from the loss, that has its own set of emotions. If, and when, we get pregnant after experiencing a loss, guilt can flood in and override our emotions. As a doula, being at the next baby’s birth, even with an expected positive outcome, is as important as the prior birth. This family may have a spectrum of emotions that need to be understood and they need to be reassured that what they’re feeling is normal. Experiencing happiness is okay – it doesn’t mean we love any less.

B: How do you envision working with families in this way? What does the model of care for EnCourage Doula Care look like?

J: EnCourage Doula Care was developed this year to offer birth and bereavement doula care in the Portland/Vancouver area. I’m happy to attend births wherever this family is ready to meet – home, hospital or birth center. It’s such a privilege to witness the birth of a baby and, a new family. My philosophy is, whoever can love this baby is the perfect parent. I’m happy to support any birth and family combination.

As typical for a doula, I would like to meet first, have a conversation about birthing ideals, then attend the birth and follow up with a postpartum visit. However, in loss, especially when it is sudden, attending birth to provide emotional and physical support is my first priority. Then we would meet postpartum as well.

EnCourage Doula Care is a community resource. I see working with families, maternal fetal medicine clinics and family birth centers as my primary focus. I envision my role as a bereavement doula as backup for the nurse who may have many additional jobs that need to get done when a family is experiencing loss – and I can be there to provide the emotional and physical support to help this family as they try to make sense of what has happened.

B: What are the next steps for EnCourage Doula Care?

J: The next phase is grant writing, so I can be paid for on-call bereavement care. I’d like to try and roll this out at a local family birth center so women who are having unexpected loss have bereavement doula support as an option. Lastly, I want to design a study to look at the impact bereavement doula support can have on the birthing family. Can we lower stress? Can we integrate care to lessen the negative postpartum impact such an experience can have on a family? Can we increase options of support for this mom and family so the processing of their birth and loss are complete?

B: What do you know for sure about the work you’re doing as a bereavement doula?

J: What I know for sure about this work is that I have no inhibitions about it. When midwifery was the end goal, I spent quality time stressed out about how I would manage school/work/kids/family. Now with this doula work, I feel completely at ease, that all needs will be met and that this is the path I was meant to be on. When we discussed it as a family, my husband and kids were so supportive that this work needs to be done, and thankfully – they believe I have the courage to do it.

B: Jen, thank you so much for taking the time to provide my readers with this information. I really believe in this work and in you! I also think this is the path that you’re meant to be walking and I’m thrilled to be able to refer my families who have experienced loss to you so they can better process and integrate this experience into their lives.

How can readers get in touch? Where can they find you?

J: I’m happy to answer any questions or meet to discuss care options. Please call, text or email me at Jennifer@encouragedoulacare.com 360-241-0277. You can look me up at www.encouragedoulacare.com or find me on Facebook at EnCourage Doula Care where I share all sorts of birthy things!

Being Present

Being Present

Or, “The True Gift of Labor Support”

I got called out of retirement and had the privilege and honor of being the doula at the birth of Baby M born just over two months ago.

I’ve been asked by many couples over the years if I would consider being their birth doula. It’s always a bittersweet moment for me, as I love being a witness to birth almost more than anything else in the world. But with four kiddos, two part-time jobs, a relationship with my hubs that I like to see flourish, and this writing gig of mine – I have ZERO time to attend births.

So, when M & A asked me if I would be their doula at the end of the first night of our 4-week series, I told them what I usually tell all of my students making this request: “Oh, that’s so sweet – but I’m not really doing births. My life is just a little bit too full to consider this a realistic option right now…”

They were a little bit disappointed – but said they understood and they’d see me next week. I promised I’d send them an email that included thoughts on hiring a doula, what to look for, what questions to ask, and a few referrals for local doulas that I thought were really great.

The next week, I asked if they’d decided on a doula yet.

“Ummmm, no. We only want you.” This flattered me, but I knew when their due date was and not only would I be teaching a ton of classes around that time, I was also scheduled to leave town to go to my niece’s wedding. There really was no way.

“I really wish I could be your doula – but it’s just not going to work out. I think you should contact some of the people that I’ve referred you to and we can chat more about this next week.”

I’m guessing you’ve figured out what happened next.

Every week they’d come back and say that they hadn’t talked with any of the referrals and finally they decided that if I couldn’t be their doula, they’d be just fine on their own.

Now, I think couples can do really well on their own, but it’s hard to deny what the evidence shows about having the continuous presence of a doula during labor and delivery – statistically better outcomes for both Mommas and babies!

On the last evening of class, M & A gave me a book and a thank you card which read, in part: “We would be remiss not to formally ask you to consider if you would attend our birth. We completely understand your busy teaching schedule and travel plans and if it relieves any hesitance or pressure, we wouldn’t plan to rely on your presence. In our minds, the structure would be that if it worked out such that you were free and available, we’d love it if you would join.”

I mean, really, how could I say no to that?

This was a couple that I believed would be just fine if I wasn’t able to be there on the big day – I didn’t for a second think they were trying to say the right thing to get me to agree. They were being completely sincere and were speaking my language… I’ve always felt that when labor begins, the people that are supposed to be there to witness the event somehow end up being there. If I was meant to be at their birth, I would be there.

So, we came up with a really interesting split-fee set-up: one amount for the pre-birth “Phone Doula” work that I would provide for them which included: a formal interview about their birth wishes, some assistance creating a template for what really mattered for them in their birth experience, some questions to spark discussion with their provider, and the availability to answer any questions and advise them as they came ever closer to the birth of their baby. And if I ended up being able to be at the birth, there would be an additional fee.

The real gift of labor support is being fully present to an expectant family.

And for me, that began when they hired me. It wasn’t as if I dropped everything I was doing, but we had some regular text check-ins and a few phone calls to see how M & A were doing as the due date drew ever closer. I slept with my phone on and next to my headboard at night (I usually have it turned off, far away from where I sleep and covered up as any “Ping!” noises or even the battery light is enough to keep me awake!)

I kept my phone with me at all times and was checking it much more often than is usual and I’d get back to M & A as quickly as possible after receiving any contact from them.

And on Saturday, April 8th, I began my formal “it could happen at any moment” doula-watch. M called to report that A was having contractions and that “It might happen tonight!” While I appreciated his excitement, after hearing that they were both scarfing down Mexican food at 11 o’clock at night, I encouraged them to get some sleep as I didn’t think that they were going to have a baby anytime soon.

I received word from M in the early morning hours that A had slept soundly through the night – confirming what I thought was happening… Great early labor, but nothing to be getting too worked up about.

Over the next several days, I was in pretty close phone contact with M & A as they navigated what seemed to be prodromal labor. They were handling it so well and really only needed quick check-ins for reassurance that they were on the right path and that everything they were experiencing was normal and good work for what was to come.

On Thursday April 13th, the call finally came: A’s water had broken! I think they were both excited for this very positive sign of labor finally happening, although the contractions hadn’t progressed enough to call it “active labor” yet.

I was excited for them as well – I’ve had prodromal labor myself and I know just how frustrating it can be if it continues past a couple of days – and we were closing in on six days at this point! I was also thrilled they’d gone into labor before I left to go out of town – but, I was scheduled to teach a class that evening and I hadn’t arranged for a sub yet.

It took some finagling on my part (and a small bribe of chocolate and beer) to enlist my friend and colleague Jen to take my class for the evening – but the details weren’t figured out until about 4 pm that afternoon. During the day, M & A made their way into the hospital and I continued playing Phone Doula for them, encouraging them at one point to try some exaggerated marching through the hallways to see if they could get the labor to pick up speed. Apparently, this was a hit with all of the nurses – they loved it!

I finally arrived at the hospital around 6 pm and after saying hello, A had what was, by the reaction, her first real-deal contraction, saying “Whoa! That one was really different!” I laughed and said, “Well, now that your whole birth team is here we can get serious and have ourselves a baby!” And, in fact, about eight hours later that’s exactly what happened!

I won’t give a play-by-play of the entire labor, other than to say that, I fell in love with this couple as I watched them work together to bring their baby into this world!

The act of giving birth, watching partners support the one they love giving birth, and witnessing the birth of a family is sacred work to me. And in this sacred space, time stands still as we are all present to one another, living only in this moment together.

And while it’s nice to know a few things about breathing, and positions and other comfort measures – the real gift of labor support is in being present.

Some people might doubt how having continuous labor support can make such a difference in positive labor outcomes for Mommas and babies – but in our ever-increasingly-barely-ever-present culture, I think it makes more sense now than ever!

As a birthing woman settles into her rhythms and rituals, making claim to the strength she might not have been aware of until this moment, she’s able to ask for whatever she needs – RIGHT NOW – to realize this act of co-creation. She opens herself, both figuratively and literally, to bring forth this new life from within.

And in this moment-by-moment experience, everyone focused and working for one purpose, a miracle occurs: it’s not just a baby that is born, but also a mother, a father and a family. These people are now connected to one another, and they will be, for their whole lives! To witness this in whatever role – doula, nurse, provider, friend or family member – is also a gift that connects all of us in this one moment in time.

I was really exhausted after this beautiful birth! And I couldn’t figure out why at first – I mean, I was only there and working hard from 6 pm until about 2:30 in the morning. In the world of birth, that’s not a lot of time! And then I realized why… It had been awhile since I’d been so focused and present in a continuous way for such a long period of time. And it’s intense to be truly present to the sacred for any period of time.

But oh, what a gift!

I dedicate this post today to M & A and Baby M. I’m so honored to have played a small part in witnessing the birth of the three of you as a new little family! Thank you for your persistence in hiring me, and for giving me the idea of being your “Phone Doula.” I’m so happy to be connected to you in this way.

PS – We’re also connected in one other very important way… Baby M and my son, Alejandro, share the same birthday (only 15 years apart)! I’m pretty sure that this is another sign that I was meant to be fully present at this birth.

In My Humble Opinion…

bees

So, the world of birth is abuzz this month as ACOG (The American Congress of Obstetricians and Gynecologists) has released their newest Committee Opinion: “Approaches to Limit Interventions During Labor and Birth.”

This opinion might have left some scratching their head and saying, “Duh!” But I want to jump up and down squealing with joy! I think this is a fantastic step in the right direction from the OB/GYN leaders of America. They’re asking their members to consider: “If a pregnant Momma is low-risk, how can we keep her low-risk?”

The answer is: “Don’t intervene unless it’s medically necessary!”

I’m going to break down the recommendations and conclusions section of this Committee Opinion for you here, because there are lots of big, fancy words – and you might appreciate my attempt at a simpler translation. Also, we know that when information comes from people who wear white coats and carry stethoscopes around their necks, it sometimes carries more weight – even if we’ve already heard this same information from different sources. Just saying… In our culture, there’s a hierarchy when it comes to medical advice and opinion – evidence or bias, be damned!

So, this is not a perfect translation (and my editorial comments are included in italics) but in a nutshell here’s what the ACOG has stated in it’s Committee Opinion, Number 687 for February 2017: Approaches to Limit Interventions in Labor and Birth.

  • If a woman is between 39-41 weeks, and is in labor that’s started on its own, and has a baby that’s head down, the use of intermittent fetal monitoring and unmedicated comfort and coping techniques is a good idea. (Full-term according to ACOG. Intermittent – the fancy word that means there are breaks in between periods of monitoring.)
  • If a woman is still in early labor, she doesn’t have to come to the hospital right away as long as she and the baby are doing okay. It’d be great if she was offered frequent contact and support, as well as unmedicated comfort and coping techniques. (See what I wrote here, here and here (It’s a 3-part series!) about how to stay comfortable and pass the time of early labor at home before coming into the hospital.)
  • When women come into the hospital in early labor due to pain or exhaustion, they should be offered education and support, water to drink, encouraged to try various positions that might provide more comfort, and other unmedicated comfort and coping techniques like massage and how using the shower or sitting in warm water can be very helpful. (Hydrotherapy – the fancy word for drinking water, showering and/or sitting in the tub – are great ideas for comfort and can also help labor progress!)
  • OBs and other providers should inform those women whose water has broken at the onset of labor about any risks associated with waiting for labor to start on its own. If there are no other reasons to be concerned for the baby’s health, an informed woman can choose, and should be supported in her choice, to wait for labor to start on it’s own. The exception would be if a woman has tested positive for Group B Strep – antibiotics shouldn’t be delayed, and there may be a preference from both the provider and laboring woman to induce labor immediately, rather than wait for it to start on its own. (Many providers already use “expectant management of labor” – the fancy word for “watching and waiting,” but more providers might now be encouraged to wait before inducing immediately if water breaks at the start of labor.)
  • Evidence suggests that in addition to regular nursing care, continuous one-to-one emotional support is associated with improved outcomes for women in labor. (YAY DOULAS! And partners, and Grandmas, and BFFs and… DOULAS! You can read my post here about how a doula can be a great addition to your birth team.)
  • For women with a labor that’s progressing and a baby that’s doing well, routine breaking of the bag of waters is not necessary unless needed for internal monitoring. (Amniotomy – the fancy word for breaking the bag of waters before it has broken on its own – is often suggested as a way to “speed things up” but can be associated with more interventions and increased risk for Cesarean Birth if it doesn’t work.)
  • In order to promote intermittent monitoring, hospitals should adopt protocols and train staff on how to use hand-held Doppler monitors for low-risk women who would prefer this type of monitoring. (This one even surprised me! I thought they would suggest using the external monitoring belts less frequently, but hand-held Dopplers would be a fantastic improvement over current practice. So much easier and comfortable for laboring Mommas!)
  • Using a coping scale and the use of medicated and unmedicated coping techniques will help providers tailor interventions to meet the needs of each woman. (Some hospitals have already adopted the use of a coping scale instead of a pain scale, but this little tool can be very helpful in changing the mindset of a laboring woman from focusing on the level of pain she’s feeling to whether or not she’s coping well.)
figure-1-the-pain-intensity-scale-0-to-10-adapted-from-wong-baker-faces-pain-rating

Figure 1. The Pain Intensity Scale: 0 to 10. Adapted from “Wong-Baker Faces Pain Rating Scale”

coping

Figure 2. The Pain Coping Scale: 10 to 0, developed to assess coping during labor and birth. Adapted from “Wong-Baker Faces Pain Rating Scale”

  • As long as there are no complications and fetal monitoring is still possible, a woman should be encouraged and supported to change positions often during labor – it will make her feel more comfortable and will help move the baby into the best position for birth. (Being upright and changing positions as often as possible, for as long as possible, allows babies to make all the twists and turns necessary to be born.)
  • Women should be encouraged to use whatever kind of pushing technique she likes and is most effective. (Gone are the days of telling women to assume certain positions and hold their breath for ten seconds! Yeehah!)
  • Unless it’s medically necessary to deliver quickly, women (especially those with an epidural) can be offered a period of rest before pushing – unless she feels a strong urge to push sooner. (“Laboring down” is a really nice way to allow your body to catch up with your labor. Your contractions might have already opened your cervix all the way, but until your baby moves down into a better position for birth, pushing just because “You’re 10 cm dilated – let’s go!” might not be as effective and could lengthen the overall time of pushing, causing undue exhaustion.)

Can you see why I’m so excited about this Committee Opinion?! It aligns so beautifully with what I know to be true for women in labor. Interventions are not “bad” and can be life-saving in certain circumstances.

But if we limit the routine use of these interventions and only use them when medically necessary, we are protecting the normal physiology of birth. And this will result in better outcomes for Mommas and babies.

I am so heartened by this statement from the ACOG and excited to see the impact this will have for laboring women and birth in this country. My sincere hope is that members of ACOG will review their own personal practice based on this Committee Opinion and see where they might step back from intervening too soon or too often. I also hope that pregnant women will read this and know that they should talk with their provider about limiting the use of intervention in their own pregnancy and birth.

Knowledge is power. Be informed.

(You can access the entire ACOG Committee Opinion here in all of its medical terminology, further explanation and extensively cited form. It’s a great read, in my humble opinion…)

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!

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?