What Does a Doula Do?

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Doulas are great, right? You’ve heard that a friend used one and loved her birth. Maybe your doctor or midwife suggested that having a doula would be good for you, too. Even the most reputable medical authorities (here’s looking at you, ACOG!) recommend birthing with a doula to decrease your chances of having a cesarean birth. But what exactly is a doula, and what do they do?

If you’ve been looking online for information about doulas, you’ve likely seen a hundred versions of something like this:

A doula is a woman trained in the physiology and psychology of birth, and in the art of providing labor support to birthing mothers during pregnancy, the birth process, and immediate postpartum period. It has been well-researched and documented that women who birth with doulas have shorter labors, are far less likely to have a cesarean birth, are less likely to use pain medication during labor, and report being much happier with their births.  Women who have birthed with doulas are typically more likely to describe their birth in positive terms, and feel more attached to their babies.

Ok, good. People who birth with doulas are happier and are likely to have fewer medical interventions. That’s great news. Doulas are non-clinical professional labor support prople who work as a team with you and your doctor or midwife. Doulas provide a wide range of services to families of all sorts, in a variety of birth situations. But the question remains – what is it, exactly, that a doula will do for you? Provide support for birth, yes, but what does that support look like? Here are ten answers that you might not find in the standard “doula blurb.”

We get to know you. Before your birthing time ever arrives, and even before you choose to make the doula/client relationship official, we meet face-to-face. If you are inviting someone into a setting as intimate and vulnerable as your birth space, it’s important to first make sure that your doula feels like a good fit for you. (Not sure what questions to ask? Find some suggestions here.) I want to know how you function and express yourself in your daily life, when you aren’t in labor, because that will help me gauge the intensity of what you are experiencing when you are laboring and working hard. I want to know what you’ve heard about your own birth, about your partner’s thoughts on what his or her role will look like, and all about your hopes and preferences for your birth. We’ll talk about what we can do as a team to help your wishes happen.

We help you decide what to pack for the hospital. Have you seen some of the “what to bring” lists on the internet? Some are five pages long! (What exactly will you need a rolling pin, a blindfold and a deck of playing cards for?) Others are more like, “maybe bring a toothbrush, but the hospital might provide that, too.” We talk through all of the options that are available at your hospital or birth center. (Do you really need to bring your own pads and newborn diapers? Do you need to bring your own birth ball, or will your hospital provide one? Your doula knows the answer!) We’ll talk about what you might want to pack for yourself, your partner, and your baby, and what I might bring with me or be able to make out of what the hospital has on hand. (Think of your doula as your personal Birth MacGyver!)

We talk a lot about pain relief. Are you intending to have an unmedicated birth? Are you already certain that an epidural is right for you? Or are you somewhere in between, and want support in making the best decision for yourself when the time comes? The more I know about your preferences and priorities, the better I can support you in making them happen. I will recommend classes, books, and other educational resources that are a good fit for you. We can practice laboring positions and coping techniques together to help you prepare. I want to know which ideas really appeal to you, and which ones are not of interest to you at all. (Are you a guided meditation/self-hypnosis sort, or is dancing/moaning/swearing more your thing?) This helps me know what to suggest when you are in labor, and eliminates the need to try to have a discussion about it between contractions.

We help you know what to expect in labor. Long before you are ever in labor, we talk through what the day of your birth might look like, step-by-step. We discuss when to call your midwife, and when to call me. We’ll talk about things like what to do if you think your water broke, how to know when it’s really labor, and how to know when it’s time go without getting to the hospital too early or too late.

We listen. Doulas are professional non-judgmental listeners. I want to know what you are feeling, what you are thinking, and what you are going through. Whether you need to talk through something you are worried about, share your excitement, or vent to someone who will understand that you are feeling tired and done when you still have a couple of weeks to go, your doula is only ever a phone call away. Reach out as much or as little as you need to.

We answer the embarrassing questions. Did your mother-in-law tell you that eating too many spicy foods in pregnancy will make your baby rashy, and you want to know if it’s true? Want to know if eating your placenta is really a thing? That’s what I’m here for. Doulas are walking “birth wikis.” If I don’t know the answer, I know who will, and I won’t hesitate to say “call your doctor” when it’s appropriate to do so. Nothing is too embarrassing, random, weird, or icky. Really, asking me questions about sex in pregnancy or about your mucus plug is way less gross than Googling it, I promise. (But about that mucus plug – maybe just hold off on sending me pictures of it unless I ask.)

We provide continuous labor support. No matter which doctor or midwife is on call, or how many people are in labor in your hospital at the same time, or whether shift change happens for the nurse a time or two during your labor, you can count on your doula to provide one-on-one support from the time you are admitted to your hospital until the time your baby is born. We’ll suggest position changes and comfort measures. We’ll rearrange the furniture and break out all the tools it takes to help your labor progress. We’ll get you in and out of the shower or tub, and remind you to breathe. We hold the vomit bowl, and keep the cold washcloths coming. We know where the extra towels and blankets and chux pads are hiding. We keep your water bottle filled and remind you to hydrate. We tell you, as many times as you need to hear it, that you are strong. You can do this. All is well. We talk through your choices as they arise, and help you have confidence in your decisions.

Support is for partners, too. A good doula combined with a supportive partner makes for a real Dream Team in labor. A doula never replaces the role of a loving partner or family member. We encourage partners to be involved and included to the fullest extent possible. I’ll also make sure that he or she stays nourished and rested, so that he has the strength and energy to support you.

We help you feel safe. Birthing with a doula in a hospital is a lot like traveling to another country and bringing your own interpreter. As a doula, I’m fluent in the language of normal birth, and in the language of “hospital.” I help you know what’s normal and what’s not, and provide encouragement and reassurance when you need it. I’m protective of your privacy and modesty, if that’s important to you. I make sure the door to your room stays closed when someone enters or leaves. I am mindful of each little detail that makes you feel more comfortable in doing whatever you need to do to get your baby born. I pay attention to what’s going on around you that might not be said out loud, and gently bring things to your attention as needed. I facilitate conversations with your care provider, explain what’s going on and keep you focused if something unexpected comes up. I support you in the process of asking the right questions to get the information you want in order to make your own best choices. I provide a calm presence to sustain you and your support people through what might be a mentally, physically and emotionally intense experience.

We help you adjust to new parenthood. Doula support doesn’t end when the baby is on the outside. We’re also trained to provide support with infant feeding, newborn care, postpartum self-care and early parenting. Some doulas are even available to provide in-home postpartum care for several hours at a time in the early weeks. Your doula is part of your village. Nobody needs to feel like she is alone as a new mom. Reach out – support is exactly what doulas are there for.

Now that you know more about exactly what doulas do, you are ready to take the next step. You can email me at jodithedoula@gmail.com, or begin a search for a doula in your area by popping over to CAPPA’s website.

Best wishes, and happy birthing!

What Your Doula Wants You to Know

This Spring marks the 14th year that I have been serving families as a doula.  In attending many births and in networking with other doulas during these years, it seems there are a few things that every doula would like for her clients to know. So parents, if you are using a doula for your birth or are considering hiring a doula, here are some thoughts to keep in mind.

Keep me in the loop. You have hired me to attend your birth, and I’m really looking forward to that. It’s important that you know that a big part of the support that I am able to offer you begins long before labor does. Please don’t hesitate to reach out to me. I’m here to be your “walking birth wiki”. I’m way less scary than Dr. Google, and I love to talk about birthy stuff. Pick my brain. Ask me questions. I will offer you information, share my resources, give you encouragement, and lend an empathetic ear to your concerns.   I especially want to know if you go to the hospital for any reason, or have something happening that you are worried about. It’s good for me to know what’s on your mind as you prepare for your baby, because this might come into play with your birth experience. Keep me posted about what’s going on with your prenatal care. Even if it’s just a note that says “Hi, we’re all great!”, I want to hear from you. It’s never “bothering me” to call. No apologies or guilt necessary. I’m going to let you set the pace for our communication; call me once a day, or call me once in pregnancy – that’s up to you. Everybody’s needs are different. I’m going to trust that you know that I’m here, and that you are reaching out as much as you need to.

Understand my role. You are the boss of this birth, and you have hired me as your doula.  This means that I don’t get to tell you what to do. You tell me what’s right for you. As an experienced doula, I might have relationships with your doctor, midwife, nurses, or hospital. With any luck, they are good relationships, and our being on a birth team together is something that will enhance your experience.  Providing non-medical labor support is my role on the team. I will do all I can to help you give birth the way you want to, while respecting the medical professionals and the rules of the birthplace you have chosen.  I am not there as a bodyguard or a bouncer. I don’t arrive prepared for combat.  I cannot throw myself between a woman and the doctor who is about to break her water. If I tried that, they would throw me out and never let me or any other doula come back. I want to support your birth, and I also want to be able to show up for the next mama who plans to birth there. So, I won’t speak to your doctor on your behalf. I don’t get to tell them what you will do. You certainly may, though. What I will do is remind you of your goals. I encourage you to ask questions that help you gather information, so that you have clarity to make your own decisions. I stand behind you in exercising your right to use your own voice to speak up about what you will accept or refuse.

Set yourself up for success. If you really want to have a low-intervention unmedicated waterbirth that’s “as close to a homebirth as possible”, then the big teaching hospital with a 95% epidural rate and no tub is probably not the best place for you. Chances are pretty good that if you choose to give birth there, the birth you want isn’t going to happen. Make sure that your birthplace and your birth attendant are a good fit for what you have in mind. You, as the consumer, have a choice. Look into the facilities that are available to you. Ask what options they provide, and find out what they offer to support you in creating the kind of birth you want to have. The same is true for choosing your doctor or midwife. The practitioner who says, “Ugh, I don’t like doulas” isn’t very likely to be into the idea of other requests you make, either. Take personal responsibility for learning the rules of your attendant and your birthplace. Though I, as doula, may wish the highest and best for you, my being present will not protect you from factors that come with the territory of the location or practitioner you have chosen.

Prepare yourself for your birth.  It is up to you to take charge of readying yourself as fully as you can for birth in body, mind, and spirit. Participate in good classes, educate yourself about birth options and coping skills, and take excellent care of your body and your mental and emotional health. Seek out the support that you need to do this. Your power is already your own, whether you choose to claim it or not.  It  is not mine or anyone else’s to give to you or to take away from you. I do not empower your birth. I do not advocate for you.  I support you in learning to empower and advocate for yourself. Likewise, I know a lot about having a baby, but I am not having your baby. I can make suggestions for positioning or comfort measures, and help you remember all of the ways that you have learned to cope with the intensity of labor. I can encourage you to ask for what you want. I cannot guarantee you that your birth will be easy or uncomplicated. Labor is hard work, whether you have a doula or not.  Birth is unpredictable, even when you’re well-prepared. When all is said and done, you are the one responsible for your choices. You are the one who will go through this process to become your child’s mother. Prepare yourself to surrender and release, and let your mind, your heart, and your body be open.

You have my unconditional support. This is your birth, not mine. My priority is to see that you know what your options are, and that you are informed in making your own best choice. I want to understand your hopes, fears, and goals for this birth, so that you feel seen and heard. When I ask about these things, I want your deeply honest answer. Please don’t concern yourself about the “right” answer, or what you think I want to hear.  I will offer comfort in whatever way I can to help your experience happen in the way that you hope for. I will remind you of the wishes you have shared with me, and give you encouraging words and hands-on support if you want to have a drug-free birth. I believe in you, and I know you can do this. I will not leave you if you change your mind and decide that pain medication is the right option for you. I will not judge you for the choices that you make. This is your body, your baby, and your birth. I trust you to make the best decisions for yourself. If something happens differently than what you had hoped or planned for, please don’t apologize to me. You have my support when you are scared. You have my support when you think you can’t do it anymore. You have my support when you are crying. You have my support when you are angry, or irreverent, or unglued, or unlovely. You have my support in your joy.  This is your birth. I’m here for you.

Our relationship will change. I love being your doula. I love the whirlwind courtship of getting to know you well in a short time. I love hearing your stories about your life,  the births of your children before this one, the story of how you met your beloved, the story of your own birth as your mother told it to you. I ask intimate questions that perhaps you hadn’t even thought about before, about your hopes and fears, and how you cope with overwhelm, and what makes you feel safe. More than anything, I listen. Toward the end of your pregnancy, we may be talking once a week. In the last few days, we might be checking in every day.  I might not ever know the names of your siblings, or where you grew up, or any of the other things your friends would usually know, but by the time your baby is born, we have forged a bond that is close, and real, and beautiful. Then, after your baby is here and you are settled in as a new mother, I don’t see you much anymore, and we hardly ever talk.  Please don’t take it personally. Know that I still care very much, even if I probably won’t make it to your child’s birthday party. Our relationship as doula and mama happens for a finite period of time. I miss you. I still love you. I cherish the memory of the time I have shared with you, and now I’m offering that same support to my next mama. I’m just as busy with her as I was with you. This is what doulas do.

I will always be grateful. Thank you for allowing me to serve as your doula. I would say thank you every day, if I could. Thank you for inviting me into your life, your home, your birth space.  Thank you for trusting me to witness the birth of your child. Thank you for the honor and the privilege of caring for you through this part of your life. Every birth touches my heart. Every birth brings a lesson, and I am grateful for the learning that comes from your birth. I am grateful for this place where our paths crossed, and our life stories are woven together for this short while.  Thank you always, and blessings on the journey.

 

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It All Started with THIS

I’ve had a whole five days now of THIS:

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And it all started with THIS:

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An empty coffee cup on a Monday morning is a terrible thing. So, I walked off in search of THIS:

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In my own kitchen, in the house where I live, where I have walked at least a thousand times, my toe collided with THIS:

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THE STEPSTOOL. Which has lived without incident on the floor in the kitchen for as long as it has been our kitchen. The thing I’ve stepped up on every time I’ve needed to reach into the upper cabinets, because SHORT PEOPLE PROBLEMS, Y’ALL.

And because two solid pbjects that have both have weight and mass cannot occupy the same space at the same time (and I told my ninth grade science teacher I’d never need to know this stuff!) my toe did THIS:

Nope, not gonna show it. Some things just have to be imagined. Ew, and then unimagined. Just think of puppies, envision the calm blue ocean… it’ll be ok.

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So, I went to the emergency room, right? WRONG.

Eventually, yes. But first, I did THIS:

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Texted my backups. Both of them. Because WHAT IF SOMEONE GOES INTO LABOR RIGHT NOW? Break a bone, break a water bag. I’m pretty sure that’s a real saying that I maybe just made up right now. But when you’re a doula, that’s what happens. Ninth grade science teacher didn’t cover why that’s true, but I believe a certain Mr. Murphy may have.

Waiting for the Uber to take me to ER, took care of THIS:

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Because what else would a doula do besides focusing on a distraction (like answering a question about which chiropractors I love) while lamaze breathing and texting a neighbor for a ride to the emergency room?

So, now my view is a whole lot of THIS:

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And I can’t wait for this fat purple foot to fit back into THESE:

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I’m bored. I’m a little frustrated. I’ve watched a lot of TV and done a lot of phone time this week, rescheduling classes and clients. I’d like to get up and drive or throw in my laundry or even THIS:

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Hi, vacuum cleaner! Miss me?

But if a baby should need to arrive today, I’m not worried. I’m grateful for a strong team of professional and reliable colleagues. If someone went into labor, I knew that my clients would be in excellent hands as I rest and continued to heal. A good doula knows to prepare for the unexpected. “What if you were suddenly unavailable” and “Who is your backup?” are important questions to ask your doula, and even more important for your doula to have a solid answer for!

Because life can happen, just like this!

How Many Doulas Does It Take to Change a Lightbulb?

One, but only if it’s her own lightbulb. Otherwise, I’m not the homeowner or the electrician, so it isn’t my call. However, I am familiar with the process, and would be happy to talk you through.

First, do we know that the light bulb must be changed right now? Are there more urgent matters at hand, like fire or glass on the floor? Is everyone safe? Do we have time to talk this through? OK, good.

The benefit of changing the light bulb would of course be having more light in the room. Is that your preference? Great.

The risk of changing the light bulb would be falling off of a ladder, but that’s relatively low in this case because the lamp is on the table and the likelihood of your needing a step ladder is minimal.

Of course, it’s another option to use a camping lantern, or light a candle or use a string of twinkling Christmas lights as long as that’s appropriate and safe for the space it’s in. What ideas might you have about that?

Or, you could choose to do nothing right now. It’s still daylight out, and the lamp is decorative, and perhaps you aren’t planning to keep it. I remember you’ve said that Aunt Mildred meant well when she gave it to you, but it really isn’t your style. It’s entirely up to you.

If you are worried even a little, call your contractor or an electrician. They may assure you that this isn’t an emergency, or they might want to talk with you in person to let you know of ways that they can help you make a plan for this. They might recommend installing overhead canister lighting fixtures, but I’m really not the person to ask about that.

What matters most is that you are making the decision in this that is right for you. I want you to be content with your lighting choices. Let me know how I might be of support.

There’s no pressure to make a rushed decision, take some time, mull that over, talk to your partner, and let me know what you think. And if you change your mind about it later? That’s ok too. It’s your lightbulb. You can do that.

When “Rare” Becomes Real

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If you’ve been following recent news at all, you’ve no doubt heard the hubbub about the new documentary Vaxxed, which was pulled this week from the Tribeca film festival in New York, where the film was scheduled to be shown. Robert DeNiro is under fire in recent media, both for pulling the film from the festival and for stirring up the ongoing controversy around vaccine safety. Vaccine controversy is hardly anything new – it’s a question that parents have been facing for the last twenty years.

As a doula, I hear “the vaccine question” from many families I work with. My answer is always, quite simply, “It’s not ever my role to give medical advice. This is, however, an important topic to learn about and have an informed conversation with your child’s doctor about the right decision for your own family.” I will gladly recommend evidence-based resources to support parents in educating themselves. Professionally, I’m Switzerland – as neutral as can be. I typically don’t even mention my own point of view, because it’s irrelevant to the decision another family may make.

A quick Google search would have us believe that there are only two extreme schools of thought. One side of the fence says “All vaccines are bad, the general public is brainwashed” and the other states just as clearly that “all scheduled vaccines are necessary, and only the misinformed Tin Foil Hat Brigade thinks otherwise” There is, however, an often-unmentioned middle ground. This is one parent’s story of what living in the invisible no-man’s-land really looks like.

Eighteen years ago, when my son was three months old, at his standard well-baby checkup he received three shots. Having been through the usual routine with my older child, this was nothing new. What happened in the aftermath, however, became a completely different story. My son had what is generally referred to as an atypical reaction. It’s nothing unusual for babies to run a slight fever and be a little cranky the day after shots. In the wee hours of the night, a few days later, however, my baby wasn’t just fussy, he screamed. I don’t mean he cried very hard – this was a high-pitched, piercing wail that lasted for hours, unending. He ran a high fever. The soft spot on his head began to bulge. The membrane that surrounds his brain was swelling. This is called encephalopathy.

The Center for Disease Control, the same CDC that advocates for routine scheduled vaccination, notes that this encephalopathy is a real, though rare, known possible side effect of one of the three vaccines he had received. Our doctor provided excellent medical care, and access to solid information. The US government has a Vaccine Adverse Event Reporting System in existence since 1990, and a VAERS report was filed about my child.

I am acutely aware that this is unusual, though the exact statistics of specifically how uncommon are harder to pin down. The Center for Disease Control (CDC) states that “approximately 30,000 VAERS reports are filed each year. About 85-90% of the reports describe mild side effects such as fever, arm soreness, and crying or mild irritability. The remaining reports are classified as serious, which means that the adverse event resulted in permanent disability, hospitalization, life-threatening illness, or death.” The probability of serious adverse effects is minimal, with only 3000-4500 serious adverse effect reports per year, out of the over ten million vaccines adminstered per year to infants under the age of 12 mos. This statistic can be reassuring to some parents. However, when your own child becomes the statistic, the viewpoint changes.

The challenges we have faced were only beginning. My baby stopped smiling and cooing. His milestones, like rolling, crawling, and walking were delayed. Other developmental delays began to follow. Speech delays caused him to be only minimally verbal until the age of six. He didn’t develop a dominant hand (become left- or right-handed) until seven. He was in physical and occupational therapy until the age of eight. A visual disability thrown into the mix meant that learning to read at all was delayed until the age of nine. Writing with a pencil (illegibly, but intentionally) wasn’t obtained as a skill until age 11. He didn’t sleep through the night until he was 12 – years, not months – when it was finally accurately diagnosed that an existing neurotransmitter deficiency requires medications that tell his body when to wake up and when to fall asleep. He has moderate multiple sensory processing challenges, and an autism spectrum diagnosis. It has taken many qualified and dedicated professionals to figure out how my kid learns, working as a team to ensure his success. He was homeschooled or tutored at home until fifth grade, when he was mainstreamed into school with a 504 (a document that provides exceptions for children with disabilities) and an Individual Education Plan (IEP.) This is the reality of living with a special needs child.

So, do I believe that vaccines cause autism? Put simply, no. Current evidence bears proof that most reactions, if they happen at all, are mild, and the benefits outweigh the risks. Most children who receive them will be fine. My child, however, will not receive another one. With no explanation for why the extreme reaction happened, it’s not worth the risk to his health and safety. I’m grateful for herd immunity that occurs when most children are vaccinated against disease, because that’s what keeps my child safe from these diseases.

On a positive note – he’s come a long way. In a month, he’ll be graduating high school with honors and will attend college on an engineering scholarship. He’s in the National Honor Society, plays on the football team, loves to act and sing, and has a fondness for really corny jokes. Social skills have had to be vigilantly taught in baby steps, and he’ll never be neurotypical, but he’s going to be ok. He’s a little awkward, perhaps, but given that he’s going to be an engineer, it’s possible nobody will find that strange.

I don’t blame “modern medicine.” I like aromatherapy and all, but if my kid has appendicitis, we’re going to the hospital. I’m aware that the highly-publicized “MMR Causes Autism!” Andrew Wakefield study from 1998 has been debunked. I don’t think our pediatrician was participating in any sort of conspiracy or “cover up” when he recommended vaccinating our baby. While I do also believe that diet and lifestyle are important factors in everyone’s health, I work within the health system. I’ve witnessed lives being saved by modern medicine with my own eyes. I run an evidence-based doula practice, and I believe in science. My son has been seen by numerous specialists, including heads of department in a reputable children’s hospital.
All of that said, the missing piece here becomes glaringly obvious. We still don’t know why this happened, and we are not alone. Parents across the country, another 3000-4500 serious VAERS reports per year, are telling their stories of similar events. Their babies were fine, got vaccines, and weren’t fine anymore. Some have serious illness, and some are no longer living. With 23.2 million children under the age of five living in the US at the time of my son’s birth, even being one in 10,000 is no longer a small number, and it’s only growing larger.

Most children will be fine. A small percentage will have reactions that are classified as severe. That small percentage happens to a few thousand children a year. Unfortunately, none are born with stickers on their foreheads that say, “I’m the one who’s going to be injured,” but there is hope that perhaps there are other clear signs that we can learn to see. This is worth attention. We need to learn more.

There are many theories currently being suggested by respected medical authorities. Is there a genetic component that makes some children more vulnerable to adverse events than others? Maybe. I have multiple autoimmune diagnoses, and my son’s father had severe mental health issues. In fact, at the age of 40, my son’s father had an adverse reaction to a routine Hepatitis B vaccine, developed a lesion on the cerebellum of his brain, and was hospitalized for a week.

Were environmental factors involved? Maybe. We do live in New Jersey, where the autism rates in the US are at their highest, along with our air and water pollution levels. Or, on the other hand, perhaps our early autism screening system just works more effectively in New Jersey than it does elsewhere. The thing is – we don’t know. Science can’t tell us yet how to discern who will be fine, and who is more likely to not be fine. “Why did this happen?” is a question that my family, and many others like mine, still have unanswered.

This is where research is leaving a gaping hole. Studies are being conducted left and right to prove that vaccines don’t cause autism. What isn’t being focused on, however, is the answer to WHY, exactly, these serious reactions happen to some children and not others, and what we can do to make it safer for everyone.

What’s being brought to light, here, is that research needs to be done on the “maybes,” so that they become answered. When we know more about the facts, when we learn the “why,” we can make a more effective plan than “It probably won’t happen to you.” This happens. It’s rare, but real. I’m not angry, but I am aware. The parents who live with this reality are simply asking for answers. All we’re looking for is the truth. No tinfoil hat required.

Jingle Balls

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When I never know what tomorrow may bring, getting holiday baking done can require some juggling. Jingle Balls to the rescue! These are super easy, and can be done in short bursts of activity. They store well in the fridge throughout the holiday season, and are always a hit.

I’ve been asked for the recipe, and i have to confess that there really isn’t one. It’s too simple to be called a recipe. There used to be one, somewhere, and it was called something else entirely, and I’ve changed it to suit myself.

Here’s how it’s done.

Step one: Bake one boxed cake mix, any flavor. I like chocolate.

Step two: As soon as the cake is out of the oven and still very hot, scrape it into a big mizing bowl, dump a tub of frosting in it (chocolate again,) and stir it all into moosh.

Step three: Put it in the fridge until you have time to deal with it – could be a couple of days. Snitching occasional fingerfulls of the lovely moosh straight out of the bowl is suggested.

Step four: Roll moosh into walnut sized balls, put them on a cookie sheet, put them in the fridge.

Step five: Promptly ignore them until the moment you say “Oh, geez, I have people coming over, and I could get called to a birth tonight, I’d better get these done.”

Step six: Melt a bag of chocolate chips (I do about a third of the bag at a time, and use a cereal bowl in a saucepan as double burner, because who has room for a double burner in her cabinets anymore?) Throw in four or five balls at a time, swish them around until they’re covered in melted chocolate chips (Oh, I also throw in about a tablespoon of coconut oil, just to mnake the glaze a bit thinner), use two forks to lift them out, and put them back on the cookie sheet.

Step seven: Chill until the chocolate is firm, and ta-dah! Jingle Balls!

There you have it! A totally simple and impressive holiday treat, compatible with busy lives and procrastination! Enjoy, and Happy Merry from Jodi the Doula to you!

What Should I Buy for the Baby?

At prenatal visits, I’m often asked what the necessities are for bringing baby home. The lists offered by most baby registries are long and overwhelming. Keep in mind, too, that the more “stuff” you register for, the more profit the store makes when your friends and family come to shop for you there. What’s a new family to do?

In short, as long as you have your breasts, your arms, and some diapers, you’re going to be ok in the beginning. Tiny babies don’t need much. Here are a few things that, as a doula, I see most families use and enjoy.

1) A Carseat. Don’t skimp here. Get the best one you can afford, and please make sure that it’s correctly installed. Call your hospital and ask if they offer carseat safety checks, or if they know who does. According to the National Highway Traffic Safety Administration, although most parents believe that theirs is installed correctly, seven out of ten carseats are improperly installed. Get it checked by a professional. I’m serious about this part.

2) Onesies, newborn gowns, and sleep sacks. Tiny babies tend to be leaky at one end or another several times each day, and require changing of diapers and clothing. It’s amazing how much laundry one little person can generate in the course of a week! Onesies are easy because they’re simple, soft, and low-fuss. If a diaper is a real blowout, the folds on the shoulders of a onesie allow the whole thing to be pulled straight down toward the baby’s feet – no need to take a messy thing off by pulling it over baby’s head. Newborn gowns, which have long sleeves and simple elastic at the bottom, are the best invention ever when, at 3am, you can’t keep your eyes open when your little one needs a diaper change. They pull up and pull down – easy to do one-handed, and no tiny snaps to fuss with in the dark. Sleep sacks are a warmer version of nightgowns, for when the temps are cooler. Remember that your babe will only be in newborn sizes for about five minutes, so don’t buy a ton. Half a dozen onesies and gowns, and a sleep sack or two is a good place to start.

3) Light, thin blankets. These are great for covering baby and parent for skin-to-skin time, which is so important for bonding and breastfeeding success in the early days. They’re also great for throwing over Aunt Irene’s shoulder when she asks to hold the little one who has just been fed, so that she doesn’t get blurped on. If swaddling is your baby’s thing, light blankets are just the right weight. Remember that babies don’t need blankets for sleeping, though. That’s what nightgowns and sleep sacks are for.

4) A safe place to sleep. In the “Safe Sleep Seven” handouts written by Sweet Sleep author Dianne Wiessinger and published by La Leche League International, guidelines are given for the safety of babies who cosleep with parents. The American Academy of Pediatrics, in their guidelines for safe sleep, recommend room sharing, though not necessarily bed sharing, in the early weeks. Whether bed-sharing or room-sharing, newborns need to be close to their parents, and aren’t ready for cribs in separate rooms just yet.

5) A sling or soft carrier. Very small babies tend to be happiest when they are in-arms and at-breast. How is a parent to get anything done that requires two hands? Babywearing is a great solution to keep parents and babies both happy. There are many soft carrier options to choose from. Babywearing International has good safety guidelines on their site, along with great information on how to choose the carrier that’s right for you.

6) One safe place to set baby down. There are so many options – bouncy seats, swings, rocking seats, and the list goes on and on. Really, it’s not necessary to have one of each. No need for your house to look like you’ve decorated in Early Fisher Price. Just one thing will do. Pick one. Will your baby like it? Probably not, at least in the beginning, but in a few weeks, the beloved bouncy seat may be the one thing that allows you to get a shower.

7) A way to get baby fed. If you are planning to breastfeed, hold off just yet on the bottles, pacifiers, sterilizers, and warmers. Breastfeeding has a bit of a learning curve in the first month. It’s best to get really good at breastfeeding before adding other things into the mix. That can come later.

8) Diapers and wipes. Whether disposable or cloth, you’re going to use a lot more of these than you might think you will.

9) SUPPORT. Whether you have a postpartum doula or family and friends who can pitch in, let someone else do the laundry, the errands, the cooking and the housework. It’s Mom’s job to take care of the baby, and it’s everyone else’s job to take care of Mom.

That’s it – the “Doula’s List” of what you really need. What would you add? What did you use more than you thought you would? What did you have that didn’t get used at all? Leave your thoughts in the comments below.

Knitting With Ugly Yarn

20150323_154752Once, several years ago, I decided that it was time to learn to knit socks. I couldn’t tell you why, now, except that I’d already knitted blankets and handpuppets and doll clothes and stuffed animals and diaper covers and an instrument case, but never socks, and all of my knit-witted friends seemed to like making them. Peer pressure never ends – it just changes forms.

So, I bought sock yarn and a set of five spaghetti-strand sized double-pointed needles, and got to work. Oh, was it tedious. I had no patience for the pattern. It required way too much counting. The stitches were tiny. The yarn, which I first thought would work itself into a watercolor blending of blues and greys, turned into ugly black and blue stripes. Even my mother, usually my biggest fan, said, “Tell me you aren’t making those for me.” And the worst part? I lost count of how many people saw my work in my hands and said, “Socks? You know you can buy those in a six pack at K-Mart these days, right?”

But, perseverance being my middle name, I did it. Though it took about forty hours over the course of months, I finished one sock. I felt accomplished for all of about ten seconds. Know what I discovered? There is no joy, none at all, in knitting one sock. Finishing one sock only means that it’s time to start the second sock, and do the whole thing over again. The whole thing. Every single tedious stitch, just like the first one. So, tenacity being what it is, I started the second sock, and developed a terrible case of Second Sock Syndrome. I didn’t like the yarn. I didn’t like the pattern. I didn’t even like the first sock, already finished, sitting in the bottom of my knitting bag. Knitting was now a drudgery instead of something to enjoy. I resented every stupid “knit two purl two” in every single stupid row.

And then…

I went to a wool festival with my mother. I love the annual wool festival. (I realize that I have lost all hope of ever being cool when I could say “I went to the wool festival and I had a great time!”) It’s where I stock up on enough yarn and enough patterns to last me through the year. While there, browsing through the hundreds of vendor booths, a little grey-haired granny walked past me. On her canvas knitting bag were the words, “Life is too short to knit with ugly yarn.” I paused. I thought of the horrid black and blue wool sitting in the bottom of my own bag, with half a sock left to go. Then, something clicked.

“I DON’T HAVE TO DO THIS!”

Yes, I said I would. Yes, my friends all had cute handmade socks that they loved. Yes, I had shown fierce determination, even in the middle of my resistance. Yes, I had invested in the yarn, and the needles, and endured the teasing, all in the name of starting what I finished. And guess what? I could change my mind! So I did. I stuck the whole project in a handpainted bowl and called it art. Done. Looking at it now makes me happy in a way that horrible handmade socks never would have. It’s a completed thing, and I can let it go, and move on to making things that I actually like. The outcome didn’t match the original vision, but I like it so much more!

What do my ugly unfinished socks have to do with being a doula? It’s pretty simple, really. “Knitting with Ugly Yarn” is a life lesson that stays with me. It’s true of leaving behind things you do because your peers say you should, and deciding what’s right for yourself. It’s true of a birthing person changing the plan, and deciding to make the best choice in the moment. “Don’t knit with ugly yarn” is all about knowing when to look at something from a different perspective, and listen to your gut.

Sometimes, you’ve just gotta stick it in a bowl and call it art!

What’s your “ugly yarn” story? Where have you let go of one idea, to have a much better one take its place?

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The Real Truth After Having a Baby

We do so much to prepare for having a baby, right? We read the books, take the classes, choose the right attendant, choose our birthplace, and buy all the right the cute fuzzy pastel-colored “stuff.” And then we learn that the gorgeously decorated yellow-and-sage green gingham-covered room with the hand-painted tree mural on the wall is really only used for changing diapers for the first year, and that the crib can hold really a lot of laundry. Really. A lot. Which is great because really, who has time for laundry anymore, and have you SEEN how much laundry a seven pound human can generate in a week? Ahem. I digress.

The point is, no matter how well we prepare for childbirth, and no matter how much we think we’ve prepared for the arrival of a new little human, the aftermath of baby-having can be shocking.

The books say things like:

“Sleep when your baby sleeps.” (And do laundry when the baby does laundry, too?)

“With a proper routine, things will be flowing smoothly for everyone in no time.” (Babies are lousy at telling time.)

“Breastfeeding is easy, natural, and free!” (And leaky!)

We’re prepared for all of the warm-fuzzy, soft-focus moments that the magazines are full of. Somehow, we think, with the right amount of preparation and the proper accessories, new motherhood can be just like this:

newmotherbaby
“Oh, yeah. I’ll totally have time to dress noodly little newborn legs in pants with a button and zipper, and my white shirt won’t ever have leak stains on it. Plus earrings.”

And then, reality hits. Fact of the matter – being a new parent includes a lot of weird, bewildering, or just-plain-gross parts that the books don’t tell you, your friends are too embarrassed to share (because they think they were the only ones it happened to), and your mother doesn’t remember. But, hey, this is what doulas are for! (Sidenote: Don’t invite doulas to dinner parties. We forget that most people don’t talk about placentas in polite company.)

So, here are the REAL things to be prepared for.

THE SEVEN B’s of NEW MOTHERING

1) The Baby

Babies are beautiful, but sometimes they’re a little funny looking. Their heads come out in strange shapes, and it can take several days for it to look properly head-shaped. Also their eyes are puffy and their faces look squishy. That’s ok. Some babies get newborn acne worse then any teenager. That’s normal – it’s your hormones leaving their body. Their skin may look flaky and dry in the first couple of weeks, which is also normal. It’s because they were soaking in water for a long time before they came out. It doesn’t need to be treated with lotions or oils – it’ll pass. Also, they cry. Sometimes, they cry a lot. Three hours a day of crying is normal for a three-week-old. It doesn’t mean that you’re doing anything wrong if you can’t figure out why he’s crying. It’s not your job to make sure that he never cries. It’s your job to be there and let him know that he doesn’t have to cry alone.

2) Bonding

Some women have “OMG I Love you so much and I’ve waited for you my whole life!” feelings about their babies immediately. Some don’t. That’s ok. Sometimes it takes time for those so-in-love feelings to kick in. Sometimes it takes a little time to get to know each other. It’s also normal to feel overwhelmed by the thought of being entirely responsible for another human being. If you are having thoughts of doing harm to yourself or your baby, then do reach out to your practitioner for help. If, however, you’re feeling like one new father voiced so well when he said, “I don’t even really know what to say when I’m talking to a baby,” that’s normal. Babies don’t keep up with current events much. It’s ok to talk about what you’re doing while caring for the baby. “I’m changing your diaper now. First, we take the wet diaper off, and then we’ll put this clean one on. Please don’t pee on me, ok?”

3) Your Bottom

Your lady-parts may be very sore. This is true if you tore a little, it’s true if you tore a lot, it’s true if you had an episiotomy, and it’s true if you didn’t tear at all. In the first few days, ice packs are your friend. If you want to be really clever about it, soak some pads in water and then freeze them to make the best ice packs in the whole world. Just maybe don’t post pictures of the process to Pintrest. (You won’t have time for that anyway.) It helps to keep your knees together when you’re sitting down, and to keep them together when you’re moving from sitting to standing. When getting up from lying down, bring your legs, knees together, over the edge of the bed first, and then sit up and rise to standing. This keeps the delicate healing tissues from being stressed the way they would if you were sitting cross-legged. (I don’t really know what that’s called anymore. When I was a kid, it was “indian style.” When I taught preschool, we called it “tailor sitting.” My daughter’s teacher calls it “applesauce,” which makes no sense at all. Anyway, don’t sit that way in the first week if you have stitches. It hurts.) Some women feel a lot better in a couple of weeks, and some take a good six weeks to feel back to normal. It’s normal to worry that your bits might never be the same again. Don’t worry. Everything will eventually settle back to the way it was pre-baby. The first time you are ready to even think about having sex again (the guideline is six weeks, but I’ve heard of women offering to bribe their doctors to not say that within earshot of their partner) you might be really nervous. That’s normal. Go slow, and remember that Astroglide is your friend.

4) Bleeding

Most women bleed for at least a couple of weeks, and sometimes off-and-on for up to six weeks post-birth. For the first few days, it’s heavier than the heaviest day of your period, which is a polite way of saying that you might pass a clot the size of a goose egg and flip out because clearly you are dying here, only to have someone with medical knowledge tell you that it’s no big deal and totally cool. You will laugh and roll your eyes at the ridiculous mesh underwear and mattress-sized pads that the hospital gives you. That is before you discover that they are awesome and you want to steal some and stash them in your bag to take home. Remember “spanky pants” – the unders that you wore when you were five? The cotton full-coverage kind that nobody wears anymore? Unless you want to use your maternity underpants for just a while longer, get some before you have a baby. You’ll be wearing big pads and you’ll still have a belly for a little while. More on that later.

5) Breasts

If you are breastfeeding your first child, your milk will come in around day four or five. Before that, your breasts will feel soft – about the same as they did in pregnancy. Your baby will be getting all of the nourishment he needs from colostrum, which is what you are producing before you make milk. Colostrum is very concentrated, and comes out in tiny amounts. It’s very thick and fatty, and ranges in color from light yellow to deep gold. You likely won’t see it dribbling out of the corners of your baby’s mouth while he feeds. You may not see it at all, and that’s normal. You might leak, or you might not. Either way is ok. As long as your baby is having adequate wet and poopy* diapers, you’ll know that he’s getting what he needs. He’s not starving. If your midwife or pediatrician have concerns that your situation has some unique factors that make supplementing necessary, they’ll talk with you about that. It’s a good idea to find a good lactation consultant in your area who can talk with you by phone or do a home visit, if that’s necessary.

(* While we’re on the subject of poop, it’s important to mention that newborn poop looks like tar. It’s black and sticky. That’s meconium. It will only be that way for a couple of days. It stains everything it touches, though. Don’t use your cute cloth diapers just yet. And don’t wear white. After milk comes it, it starts to look like dijon mustard, and smells like buttered popcorn. Truth.)

Breastfeeding, while normal and natural, might qualify as the weirdest-feeling normal-and-natural thing you’ve ever done. Lots of women find the “learning curve” of the first few weeks to be challenging. You are not alone in that. Most of us, before having children, haven’t been around very many breastfed babies, at least not in an up-close and personal enough way to see how it’s done. Learning to breastfeed when you’ve only seen pictures and videos of breastfeeding is a little like learning to ride a bicycle when you’ve only seen pictures and videos of people riding bicycles. Seek out a local support group. Call a lactation consultant. Call your doula. Ask for help, sooner rather than later. It shouldn’t hurt unbearably – don’t suffer and grit your teeth to get through it if it does. Problems that cause pain can usually be remedied, some very easily.

On the day that your milk comes in, your breasts might feel hot, and sore. They might swell a little (and by “a little,” I mean that you might look like the Dallas Cowboys Cheerleaders plastic surgeon got ahold of you in your sleep.) This might be especially true if you had IV fluids during your labor. More fluids in your body make for more swelling. If you run a fever, call your provider. This is another time when ice packs are your friend. Bags of frozen peas are great. Some women say that heat feels better than cold. Find what works for you. Some of this swelling if from milk, but most of it is from lymph, extra fluids, and swelling from the milk ducts as they are being put to work for the first time. It should pass, usually in a day or so. Don’t pump to try and make your breasts empty again. Milk works on a supply and demand basis – the more milk that is taken out, the more your body will make to replace it. Nursing your baby and pumping “all of the extra milk” out tells your body to make lots more. Basically, you’re sending the message to your body that you’ve just had twins! (Or quads, if you really did have twins.) Gentle massage may help, if your breasts are feeling hard. Hand express a little, just enough to relieve discomfort, if you need to. There are good how-to videos for this online.

6) Body

After your baby is born, you might still look about seven months pregnant, even if your weight gain was not any more than average. It takes time – a few weeks, usually – for your uterus to shrink back down, and for all your muscles and organs to go back to where they started.Breastfeeding helps burn the baby weight off faster. It took nine months for your body to reach your full-on-pregnant shape, and it may take another nine for it to all go back to where it was. Be gentle with yourself. This is not a time for crash-dieting or hitting the gym. It’s normal to feel like you don’t really recognize yourself for a little while. Some things may return back to their pre-baby state, and some may not. Remember that this strong body is the same one that grew and birthed an entire new person. Working on a better relationship with your body is never easy, but now is a great time to start.

7) Blues

Remember when we talked about the day that your milk comes in? Wait, there’s more. Day four or five, women turn into rivers. This is when everything that CAN flow, is flowing! Your breasts are leaking, you’re bleeding, you’re peeing every ten minutes, and having night sweats (all that extra fluid you’ve been toting around has to come out somehow!) And then, the tears come! There’s the “pastel blues” – You might be staring at your baby, and out of nowhere, the waterworks start up because he’s “just so beautiful!” There’s the “midnight blues” – when you cry because you’re “just so tired.” You might have the “moody blues” when your moods may swing like a trapeze from one moment to the next. Happy/sad may feel like the on/off of a lightswitch. You might also have the “peacock blues” – happy moments of realizing that you DID it! Your baby is here! This is all normal, normal, normal. Most of it is your hormones sorting themselves back out. Some of it is fatigue. You just did a lot of work to grow and birth this baby. Also, babies aren’t the most predictable sleepers, and you may be feeling the effects of that. Some of it is adjustment. Becoming a new parent FEELS like something! It’s a major life transition, and that comes with an emotional process, just like any major life change.

Gentle self care helps. Lower your expectations. In the first two weeks, if you have brushed your teeth by noon and have changed your shirt by dinnertime (and by “shirt,” of course I mean out of your pajamas and into other clean pajamas), then you’ve had a great day. This is the time to let everyone else do everything else that needs doing. Let your mother, your partner, and your friends who have offered to help take care of you, so that you can take care of your self and your baby. My great-grandmother, who lived through the Great Depression, once said, “Be grateful for your dirty dishes, because they mean that your family is eating well. The dishes don’t mind being dirty. Just walk by the sink and wave to them, and then go sit down and nurse that baby. The dishes will be there later.”

Remember that this time in your life is temporary. This will pass, and all will be well.

What would you add to the “need to know” list? Please comment below.

My Least Favorite Doctor

For years, I’ve had a very strong personal policy about not speaking out against other professionals. Harmonious professional relationships are one of the biggest assets of my practice, and I work hard to keep it that way. Even in the rare occasion when personalities may not make for the best fit, I will respectfully defer to a professional judgement call. Most of the time, I genuinely love the doctors I work with. I’ve seen them offer boundless patience and encouragement in the longest of labors, and I’ve seen them offer wise advice in times of need. A few, I’ve witnessed handling true emergencies with admirable grace. With every encounter, my respect grows deeper and my gratitude for them is stronger.

However, sometimes a woman gets fed up. Sometimes, things just need to be said. Sometimes, a relationship just isn’t working, and needs to be let go. This is one of those times. I confess now, there is a doctor I can no longer stand.

He is reactive in the face of the smallest concerns – every mysterious bump or blemish needs to be tested for cancer. Every strange hiccup might be an emergency, and an immediate trip to the hospital is warranted. More than anyone I’ve ever known, he loves to trot out the words “this could be fatal.” And yet, his inconsistency is equally maddening. In times of true concern, he’s just as likely to say, “Ignore it, don’t do anything. This is probably nothing.” For second opinions, he’s abysmal. More than answering with anything evidence-based, he loves to contradict whatever advice someone has already been given.

People love him for his availability. I’ve heard stories of his answering questions at the oddest of hours – 10 am, 10 pm, 4am, whenever. He exists to hear himself give answers, without it mattering in the least whether they’re actually right. It seems he never sleeps.

His bedside manner is horrid. Not only does he completely ignore an individual’s unique circumstances or test results, he has no compassion whatsoever for anyone’s feelings, or what a family may be going through. It’s either “You’re going to die” or “Stop being a baby.” He’s calloused and completely unresponsive to feedback.

The worst part is that there’s not a chance of his being fired. As far as any state boards or governing organizations are concerned, he’s untouchable. His license is bunk. He’s a quack. And just as frustratingly, though this reputation is well-known, people ask for his input anyway.

So, the most I can do is refuse to work with him anymore. From here on out, I will tell people to ask someone else that they (and I!) can trust. I will not encourage listening to his advice. Don’t contact him, don’t listen to him, don’t give him your attention. And, I will say it here for everyone else to see:

DOCTOR GOOGLE, I HATE YOU. WE ARE THROUGH.

Doulas and Nurses – A Mighty Team

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In the birth world, whether on message boards, at a nurses station or in a doula meeting, it’s not uncommon to hear tension on either side of the story. “UGH! This nurse! She kept saying ‘You can get an epidural anytime, you know. It’s not like you get a better baby without one.'” “Oh, this doula, OMG. She kept taking the monitors off, and every time I came in the room, she was on a mission to keep me from doing my job!”

Both have tough jobs, to be sure. A nurse, in her twelve-hour shift, might be attending to three people at a time, assisting with who-knows-how-many deliveries in the course of a day. She’s watching Room 5, who has an epidural and is sleeping, on the monitor screen when the fetal heart rate goes wonky. Then she’s helping Room 3 push, then assisting Room 7 in getting an epidural. Room 4 is admitted with ruptured membranes, having no contractions, and has seventeen people camping out for her in the waiting room for whom the nurses will be playing diplomat for the next thirty hours. Room 10 is having a panic attack, and Room 8 is using self-hypnosis and doesn’t want anyone to talk to her in any way, shape, or form. That’s just in the last two hours. Who even knows what the rest of the day will bring? If she’s lucky, she’ll get five minutes to pee. Forget about lunch.

She’s fluent in the communication style and preferences of each of the eight doctors on shift that day, and can turn on a dime as needed. Dr. David loves it when everything is ready for delivery, gloves and all, when he comes in the room. Dr. Wendy doesn’t like questions, and will ask for everything she needs, so just do as she asks when she asks for it. Dr. Zen is going to be calm if her patient takes all day, and Dr. Zip is going to order pitocin in the next hour if her patient doesn’t get moving. Dr. Fortissimo is a yeller. Dr. Brown likes to be called in after pushing is well underway, and Dr. Green always does her own internal exams and wants an update at least once an hour, please. Dr. Shiny, the brand-new Resident, is eager to overmanage and hasn’t yet learned the art of patience and diplomacy. No problem – this nurse can handle it all with style and grace.

She makes the transition from one scenario to another countless times in one day. She goes from the blissful welcoming of a long-awaited firstborn to the fear-filled room of a teen mom laboring alone. Then she enters into the room of the grieving parents whose preemie baby isn’t handling labor so well, and from there to the exhausted mom who has been laboring with her third for two days. In each room, she smiles. Each one, she asks about comfort and how needs can be met. Each interaction must be accurately documented (with the software that is different this week than it was a week ago,) meaning that she must find the balance between interacting compassionately with her patient and facing a screen. Meanwhile, in her head is the ongoing chess game of which patient’s need is greatest in this moment, and hoping that the charge nurse, who is the air traffic controller of all nurses who sees that all of the tasks get done, will let her be where she thinks she is most needed when she needs to be there.

The doula works just as hard, in a somewhat different way. Her focus is on one birthing person at a time, for as long as this birth takes. She, too, provides long hours of support. She tends to comfort measures, position changes, counterpressure, and talking through fears. She keeps the birthing person informed about her options, and encourages her in her decision making. She has the time and availability to answer questions, and explain each step of the process of labor, in a way that others on the team may not.

When doulas and nurses work together in harmony, the outcome can be spectacular. The nurse is free from worry that her patient is being well cared for. Her stress level is lower, and her time in the room can be more focused on providing high-quality care, and less on housekeeping and getting more juice. When doulas and nurses work in conflict, the consequences can be stressful for all involved. So, what can doulas do to ensure a happy birthing team?

First, remember that we’re all human. Communication skills and styles vary widely from person to person. For some, it’s a strong suit, and for others, not so much. However, what one nurse lacks in “warm fuzzy” she may make up for in knowledge, or patience, or strong clinical skills. Remember, too, that everybody has an “off” day now and again. Take nothing personally.

For every one nurse who makes a snarky comment, there are surely ten more who are going the extra mile, staying fifteen minutes after the end of her shift because the patient she had bonded with was delivering and she didn’t want to leave. And, you know what? Nurse Snark probably did that yesterday for somebody else, but today, she witnessed something really intense at the beginning of her shift, and now she’s exhausted. Maybe another patient just bit her head off. Perhaps she just got called out of a room with someone who really needs her, and she is worried that the person taking her place now won’t be a good fit for the patient she just left. Maybe her kids were whining this morning because she’s working today, on her day off, because someone else called in sick. We’re all going through more than we reveal out loud. Be gentle in your judgments.

Second, if you want to be on a harmonious birth team, act like it. Introduce yourself. Look the nurse in the eye and smile. Let her know that you’re happy to help in whatever way you can. Remember to say “please” and “thank you,” and call her by name when you do. She changed soggy bed pads? Say thank you. Said something really encouraging to your client at just the right time? Thanks again. Brought extra towels into the room for the third time? Thank you. Brought you the birth ball and the rocking chair, and has the tub room all ready for your client? Thank you, thank you, thank you!

Let her show off her skills, too. Doulas and nurses both come into this line of work as compassionate people with a desire to serve others. Chances are, just like you have, she’s learned a few things along the way. When she’s in the room, let her do her thing. If she wants to share a few of her precious and limited minutes doing some of the good stuff – taking a few moments to breathe with your client through the contraction, rubbing her back, making a comfort suggestion – welcome it. Take this opportunity to learn from her, and expand your own repertoire.

Stay within your own scope of practice as a doula. Remember that you are a guest in the hospital staff’s workplace. If you have questions about the hospital’s rules and protocols, ask in a way that communicates respect and a desire to work within their guidelines. Refrain from offering medical advice, and support your client in making her own choices. Let your client speak for herself. It’s seldom a good idea to start with,”But her birth plan says…” Ask all of the questions you need to in order to help gather information, let the nurse share what she knows as well, and leave the decision-making part up to the client and her partner. Don’t speak to the doctors or nurses on your clients behalf. Remember that you are responsible for fulfilling your support role, and the client is responsible for making her own choices and letting her own wishes be known.

When all is said and done and the birth you’re attending is complete, share your good thoughts. In a job full of intensity, when laboring women are often seen at their most raw, it means the world when someone else notices something that was done well, and says so. Did you notice her gentleness? Was she great with an anxious mama? Did she sit on the floor and contort her own body to hold a monitor in place for ten whole minutes so that your client could stay in the comfortable position she’d found? Let her know that you noticed, and that you appreciate it. If she was really fantastic, perhaps even consider writing a letter to say so, and sending it to her boss.

We’re all in this together. A great team makes for a great birth experience. When doulas and nurses work together well, everybody wins.