Jodi the Doula

Choosing Your Doula

25 Jul 2012 1 Comment

by Jodi in Most Popular

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. Choosing to birth with a doula is a wonderful way to support yourself in having a positive birth experience.  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.

A good doula is an asset to your care team.  She will accompany you in labor and birth as a support person, helping to gather information and facilitating communication with your birthplace care providers.  She will provide reassurance and perspective, suggestions for comfort and labor progress, massage, and help with relaxation and positioning.  She will be continually present throughout your labor until after your baby is born.

There are as many styles of doula care as there are women who are doulas. Each doula brings her own talents and experiences to your birth.  Finding a doula who is a good fit for you can go a long way in helping you create a birth that you feel really good about, so choose wisely. Ask your doctor or midwife if she has worked with a doula that she might recommend, and then schedule a few interviews to choose the doula who is just right for you. 

The following questions may be helpful for you to ask in the interview process:

Why did you become a doula? What is your philosophy about birth and supporting women and their partners through labor?

 Hearing a doula’s reasons for choosing her career will help you get a feel for who she is and the style of care that she provides.  You may not agree with every word she says, and that’s ok. Hearing her philosophy of childbirth will help you get a feel for whether she is someone with whom you can work comfortably.

What training have you had? Are you certified? If so, by what organization, and what was required in order to receive this certification?

If a doula is certified, you might consider checking out her certifying organization.  Looking them up online  might give you a stronger understanding of the kind of training that they offer, or the standards of practice that their certifying doulas are encouraged to uphold.  Some training organizations are very hands-on, and others may be more textbook-based. Each also has different standards that must be met for certification.

How long have you been in practice?  How many births have you attended?

 An experienced doula is a wonderful find.  Her wisdom and years of experience can deeply enrich the support she provides for your birth.  In the birth world, having a wide range of experiences can help a doula maintain a calm and steady presence throughout your birth.  Do not, however, automatically rule out a doula  who is a newbie, especially if she has had good training.  A new doula’s energy and enthusiasm might make her an excellent fit for you. Ask if she is working with a mentor – you might benefit from having her mentor’s experience in the advice a newer doula offers.

Do you have education and experience providing any other type of care for childbearing women, such as childbirth education, midwifery care, nursing care, breastfeeding support, or postpartum doula support?

Many doulas also have experience teaching classes in your local community, helping new mamas with breastfeeding issues, or providing in-home care for new mothers and babies. Your doula might have a wide variety of experiences and services to offer that will enrich your work with her.

Do you have anyone else due near the time I’m due? Do you know of anything now that may cause you to be unavailable around the time of my birth?

Most doulas limit the number of clients they accept to two to four per month, and consider carefully the commitments they are making when agreeing to attend your birth. Doulas who work full-time in doula service have lives that are structured around being on-call for your birth.  Doulas who work part-time might have other commitments, such as other jobs or small children at home, that they take into consideration.

How do you view your role at the birth?  How would you work with and involve my partner?

Most doulas are comfortable including partners, family members, and other non-medical support people on your team to the fullest extent that others are willing and able.

How do we get in touch with you when labor begins?  When do you prefer to join women in labor? Do you come to our home or meet us at the place of birth?

Some doulas regularly meet you at home in labor, when it’s too early yet to go to your birthplace. Others typically meet their clients in the hospital or birth center after labor is well established.  It’s important to learn what your doula’s standard practice is, and to know if this is a good fit for you.  Some women prefer to have support at home at the first twinge of labor, while others who may have given birth before are more comfortable going through their typical daily routines until labor is too strong to continue to do so.

What services do you provide during labor and birth? What do you bring with you? How do you help women cope with labor?

Doulas may be trained in many different modalities of labor support.  Some offer massage or reflexology, some may know hypnotherapy techniques, while others are well-versed in using different labor positions for comfort and labor progress. Your doula is a valuable resource – learn what she has to offer!

  What is your view on the use of pain medication in labor?

The point, here, is to know that your doula is realistic.  It is important that she offers your support unconditionally, regardless of your plans, and irrespective of anything unexpected that may happen in your labor.  Medication is a tool – as with any other tool in labor, there are appropriate times and places for its use.  A competent doula will likely assure you that her interest is in your satisfaction with your birth experience.

Which labor coping techniques do you think tend to be the most helpful?

Here is where a doula’s training or special interests may again come into play. Most doulas are knowledgeable about many different childbirth methods and comfort techniques, and can offer valuable input on their effectiveness, in her experience.  If you have a particular method in mind, ask her about her experience with it, so that you know her ability to support you in this choice.

How long would you stay after the birth?

Some doulas have a set time frame, such as one or two hours, that they continue to provide support after your birth.  Others use guidelines such as “when you’re cleaned up and ready to rest”, or “when you’d like to be alone with your partner and baby, I’ll ask you to send me home.”  Others have their own guidelines that fit within your birthplace’s policies.

Do you offer any special services?

Some doulas may provide massage, photography, aromatherapy or other add-on services — such as writing out your birth story — for no extra charge. 

Do you provide any services in the postpartum period? What about reviewing my labor and birth experiences or helping me with breastfeeding? Are you available by phone? In person?

Some labor doulas also work as postpartum doulas and offer care after the birth. This may include breastfeeding support, light housekeeping, errands, and help caring for older children as well as the new baby.

Do you have a backup arrangement with another doula or group of doulas in case you’re not free when I go into labor? May I contact them?

Doulas are real people with lives of their own.  As responsible and committed as even the best doula may be, there may be times when she is unavailable.  Knowing that she has a solid backup arrangement will help put your mind at ease.

May I please contact other women who have recently worked with you as their doula, to ask about their experience with you?

 It’s  a good idea to check a few references. Ask what they liked most about the doula and whether there’s anything they wished she had done differently.

 Are you familiar with my doctor/midwife/hospital/birth center? What have your experiences with my practice/facility been like?

It can be especially nice when your doula and other practitioners know one another and have a harmonious relationship.  Your doula may have valuable insight on what it may be like to birth with the practitioner you have chosen.  If the doula you choose does not know your practice, ask if she is willing to have her contact information shared so that your doctor or midwife may contact her if they would like.

When will we meet again to address any concerns or questions I have and to review our birth wishes?  How often are we in contact with one another between now and the day of my birth? May we call you with questions or concerns before and after the birth?

Good communication with your doula will help her provide the best possible care for you. Find out now how and when she prefers to be contacted, and how to best remain in contact with one another between now and the time of your birth. This will help avoid any confusion or missed communication down the line, and will help your confidence in your doula to remain strong.

What is your fee, and what does it cover? What is your refund policy?

Doulas’ fees range from about $400 to $1,600.  Some charge a flat fee that covers all prenatal visits, phone support, and labor and postpartum.  Others charge an hourly fee, and still others  charge an hourly rate that is capped at a maximum point. Refund policies may vary widely – know in advance what your doula’s policies are, so that you are clear with one another.

Do you have any experience with reimbursement from health insurance plans?

As more and more insurance companies are providing coverage for doula service, this may be another area where your doula has experience that can be a big help.  Some doulas have standard receipts and letters that will be provided for you, and others may have their own Insurance Provider Numbers (the same sort of code used by doctors and nurses). She may even be able to help you learn about how to be reimbursed, even if you are not sure what your insurance company will cover.

Do you accept alternate payment arrangements, such as sliding scale, time payments, or barter?

If finances are a concern, many doulas are able to accept alternate payment arrangements, or may be able to help you find another doula, such as a doula in training who is working for reduced fees.  It can’t hurt to ask!
After the interview, try to imagine the doula at your birth with you and see if you feel good about that.

 Ask yourself:

Do I feel comfortable around this person?

Is she warm, enthusiastic, and knowledgeable?

Does she communicate and listen well?

Will she support my choices or does she have her own agenda?

Your doula will support you in feeling safe, secure, heard and included in the process of your birth. Your own empowerment is her priority. Finding the right doula for you is an excellent step in having a happy birth.

Good luck, and blessings on the journey.

Choosing Your Birth Attendant

15 Jul 2012 1 Comment

by Jodi in Most Popular

 
If your desire is to create a positive birth experience for yourself, and a gentle birth for your baby, finding the right birth attendant for you is essential.  Your birth attendant, whether you find a doctor, midwife, or a group of doctors and midwives, are the people you choose for your birth team who will monitor the medical wellbeing of you and your baby in pregnancy and birth.  When seeking out the right practitioner for your team, it is key to ask good questions.   Hearing responses that feel compatible with your preferences, and having clarity in your understanding of your chosen practice’s style of care will ensure that you are working with a well-chosen birth attendant.  This will contribute significantly to your feeling safe and secure at the time of your birth, and will support your ability to trust and be open to the process of labor.  It is of the utmost importance to know that you have chosen a practitioner in whom you are comfortable placing your trust.  You will find security in knowing that your birth attendant is respectful of your wishes, and willing to include you in the decisions necessary for yourself and your baby.  Following are some sample questions that may help you make your decision in choosing the right doctor or midwife. 
 
At what facilities do you have privileges?
Some doctors and midwives practice at more than one facility, and where you are to deliver may depend on where the person on call is at the time you go into labor.  Be sure to interview each facility as thoroughly as you do your doctor or midwife, as birthplace policies may vary widely.  Some homebirth or birth center midwives also have hospital privileges in the event of an emergency, some may work alongside doctor practices that are willing to provide hospital services when necessary, and some do not, making it necessary for you to make your own contingency plan. 
 
 
 What will happen during a typical appointment?  What tests or procedures do you normally recommend in pregnancy?

Every practice has different guidelines and recommendations for standard procedures during routine prenatal care. It is important that you know what will happen in typical appointments.   Regardless of what testing your practice may recommend, it is important that your practitioner is willing to thoroughly explain each test to you, discuss with you the risks and benefits of each, and explain which tests are considered optional.  Now is the time to feel out what your practitioner’s response may be should you choose to decline testing or seek alternatives. 
 
How much time do you allow for each prenatal visit, and how long is a typical wait in the waiting room?

This may not be a question you even need to bring to your practitioner. Look around the waiting room and ask women who are well into pregnancy how long they usually wait. If your stress level rises at every visit because the wait is making you late for the next part of your day, your pregnancy will not be enhanced by this experience.  Knowing also that you have adequate time to ask questions and understand what is going on with your body and your baby will increase your satisfaction with how you feel about your pregnancy and your provider.  Office schedules vary widely, with some docs allowing seven minutes for each visit, and others allowing as much as an hour.  Find out what your practitioner’s policies are. 
 
 
What pregnancy books or websites do you recommend I read?

Educating yourself about your birth options is a necessary step in creating an empowered birth. Practitioner’s styles may vary widely when it comes to advocating that his or her patients educate themselves. Some have lending libraries in office, while others may believe that a mother is best off doing as she is told.  Your doctor might have a recommended reading list that is readily available.  If so, look it over and see if he suggests any books or websites that you have already found and like. 
 
 Do you recommend any specific childbirth classes?

There are a myriad of choices available to consumers when it comes to childbirth class options.  Some doctors and midwives insist on only one method, and if so, it is important that this is one that one that feels right to you.  Some practices advocate hospital-based classes only.  Some hospital or birth center classes are supportive and informative, taught by certified childbirth educators,  and others are classes taught by hospital staff on “how to be a good patient”.  Others may suggest out-of-hospital classes that they consider good, and may even know instructors in particular that they recommend.  Knowing that your practitioner speaks the language of whatever method you choose will help ensure that everyone is on the same page at your time of birth.
 
 
How regularly do you attend births with doulas?  Which doulas have you worked with? Who would you recommend?
 
Using the services of a professional labor doula has been shown to significantly reduce the likelihood of a mother having a cesarean birth. Women who use doulas report experiencing less pain in labor, and typically express greater satisfaction with their birth, regardless of the use of necessary interventions. A good doula is an asset to your support team, and if you are choosing to birth with a doula, then finding a doula-friendly practice is essential.  If your doctor or midwife has a doula that they work with often, or even have a doula on staff with their practice or their hospital, this is even better! You may wish to avoid practices that discourage doula care.  Some practitioners have been known to say that doulas are unnecessary, or that your doctors and nurses will provide the same services as any doula would. This is not possible.  A doula’s training and expertise is specifically in the non-medical support of the physical and emotional experience of labor and birth. She is trained to work alongside – not in conflict – with the medical care providers on your team.  Find a practitioner who will support your right to have excellent labor support.  You might consider asking your doula who she recommends. 
 
 How will you encourage me to manage and cope with the intensity and discomfort of labor?
 
 Doctors and midwives can offer a host of options for pain relief including medication such as narcotics and  epidural anesthesia.  Some may be very supportive of keeping you up and moving to ease birth, and are willing and able to provide access to a shower or tub.  Others may advocate partner and doula support for massage, encouraging words, and effective non-medical relaxation techniques. (As a doula,I have a fond birth memory of a doctor who sat on the bed next to a laboring mama and said, “I’m your doctor. I know medicine. If you’re asking me what to do for pain, I’m going to talk to you about what I know. I’m happy to do that, but you’ve told me that you don’t want that, and that’s ok with me. You have a doula and your partner here who can get you through this without medication, and I think I’m going to step away now and let you have this conversation with them.”)
 
 
What role will my birth partner play?

It is standard now for a father or partner to remain with the laboring woman throughout labor and delivery, although the amount of participation varies. Ask if he or she is welcome at prenatal visits and whether he or she can stay with the mother in the event of a cesarean, or if they may stay with the baby in the event that nursery care is needed. Some hospitals consider doulas to be visitors, and others may not, allowing your doula to remain with you in addition to your partner. Find out what the boundaries are at your birth facility for having your doula remain with you. 
 
What do you recommend for normal pregnancy aches and pains?

There are many common discomforts associated with pregnancy, and many can be relieved with simple non-medical remedies.  Perhaps  you have found a practitioner who is willing to talk about these comfort measures.  She may recommend chiropractic care, homeopathic remedies, and common-sense solutions, or her answer may be written on a prescription pad. If limited medication is important to you, it is significant to learn where your practitioner’s style of care falls, as well. 
 
 Will you be my attendant at the time of my birth? If not, who will be there with me? Who are your back up practitioners? Will I meet them before my birth?

It is important to know who will be in the room with you at the time of your birth. Even if the possibility of another practitioner is remote, you may be more at ease knowing who might be there during your birthing time.  Some practices share on-call schedules with all doctors in the practice, some have one-on-one relationships between doctor and client, and others share their responsibilities with other practices.  Some hospitals have laborists who attend all births, regardless of what practice you have seen during pregnancy. If you should choose to hire this practice, will you know who will be at your birth? 
 
 
What interventions do you routinely recommend in labor?

There are no routine interventions that have been proven to be necessary in every labor or birth scenario.  There are practitioners who may have preferences for some interventions to be used routinely, and it is important to learn this long before having this conversation in your birthing room.  (I once heard a doctor exclaim to a mama, “But hardly anybody’s water ever just breaks on its own.”  This was hardly a surprise, given that rupture of membranes is typically the first thing she does routinely at the time of admission into the hospital.) Informed consent is a must in any birth situation, with each intervention being considered on an as-needed basis.  By having these conversations in advance, you may be sure that you have found a practitioner who will involve you in your own care.
 
 At what point do we talk about the artificial induction of my labor?

Induction of labor may be necessary when the medical facts show that your baby would now be safer on the outside than on the inside.  However, induction for a myriad of reasons may vary widely from one practice to another. Some doctors will recommend induction if you are one day past your due date, while others are willing to wait a full two weeks past that point as long as mother and baby are healthy and well. Some will suggest induction after one minor concern, while others will insist first upon further testing to confirm that all is well before going the induction route. Your doctor or midwife should also be willing to discuss their recommended method of labor induction, taking the time to explain the options you have and the reasons for each step along the way. 
 
 What are your vaginal birth rates? At what point do you recommend a cesarean birth? For first time moms? For moms who have had previous cesarean births?

Let your doctor know that you are committed to having a normal birth, and ask questions about the likelihood of this happening.  Be sure to ask specifically about Vaginal Birth After Cesarean (VBAC) if you have previously had a cesarean birth. This is another area where standards of care vary widely. Some practices are willing to allow for a trial of labor only if labor occurs spontaneously before a specific date, such as “before 39 weeks.”  Some doctors advocate for a c-section if labor progress seems to have paused for an hour or two, where others are willing to allow more time as long as mother and baby are fine.  Some practices or birth centers or hospitals have specific time limits for pushing, allowing “two hours for a first baby, one hour for a second baby” before a cesarean is ordered, whereas others are willing to continue as long as mother and baby are doing well. It is important to know in advance what your practitioner’s guidelines are. If you are planning a home birth or a birthing center birth, knowing at what point transfer to a hospital would be considered necessary is also important. 
 
What is your rate of episiotomy?  Forceps birth? Use of drugs and anesthesia? What percentage of births in your practice are unmedicated?

 Many practices keep their own statistics on these aspects of birth. These statistics can help you in comparing practices by indicating the amount of intervention during a typical childbirth with this midwife or doctor. Some may avoid answering these questions directly, by saying that they do the procedures only as necessary – the definition of necessity, however, can vary widely. There’s no harm in asking for specific numbers or a “best guesstimate”. Remember, you are the consumer choosing to pay for these services, and you have the responsibility of knowing what to expect. What are your chances of beating the odds if half of their births are cesarean, or if most births “require” episiotomies? On the other hand, there are many practices who no longer use routine episiotomy at all, and perhaps you have found one. Don’t wait until your baby is emerging to find this out – ask now. 
 
 
 If  I have a question, who do I call?

Some practices have a dedicated “warm line” that their mamas may call any time of day or night.  Some have nurses in the office who will return calls during the day, and some doctors and midwives have a “phone hour” planned into their daily schedule. It is important to know what you can expect your experience with your practice to be. 
 
Are there any special risks that I should be aware of with this pregnancy? Do you recommend that  I change my diet?  Are there other lifestyle changes that I need to be making?

Your doctor or midwife can be a treasure trove of information that will assist you in having the happiest and healthiest pregnancy that you can.  The more you ask, the more she can offer. Don’t just ask the internet – ask your doctor!
 

 It is unlikely that all of the above will be answered in one fell swoop on your first visit.  I encourage you to ask the questions that are most important to you at your first appointment, and if you are reasonably comfortable choosing this practice for your care, continue asking more questions at each appointment. If you feel rushed or intimidated asking questions, or if you get the sense that asking questions is unwelcome, it would be unwise to think it will be any different several weeks down the road when you want to know about concerns regarding your pregnancy or wish to discuss your hopes for your birth. Remember that you deserve to be treated with respect as an active participant in your own pregnancy and birth.  A good practitioner will welcome and encourage this.  Even if you are just now learning this later in your pregnancy, there are many good practices who are willing to take on a new patient, even if you are quite far along. Find one! Ask your friends, your doula, your childbirth class teacher,  and your community members who are happy with their births who they chose and why.
On the other hand, if you find yourself getting more excited about the pregnancy as you speak with your midwife, and if your doctor inspires your confidence and trust more at every visit, congratulations! This will be an excellent care provider for you! With this step, you can have the confidence of knowing that you are well on your way to creating a positive birth experience.

A Better Birth – Cole’s Birth Story

05 Jul 2012 1 Comment

by Jodi in Most Popular

Cole is my second child. You can find the story of my first birth here: Zack’s Medical Birth and the stories of my learning and preparing for a better birth experience here: Part 1 and here: Part 2

It was Easter weekend, 1998, and I was a week past my estimated due date. I had already talked with my doctor, and let him know that I was comfortable with waiting a while longer, as long as my baby was ok and my body remained healthy. I started having erratic contractions on Friday evening.  Taking my doula Kathy’s advice to “just do life until labor gets too strong for that”, I played with 21-month-old Zack, and spent the evening at the park with take-out food for our dinner.  We brought stale bread for feeding the ducks. The spring in Texas hadn’t gotten hot yet, and the bluebonnets were out in gorgeous full bloom. I pushed Zack in the stroller down the bike path by the lake, went home for a bath, and went to bed.

On Saturday afternoon,  my then-husband (who denied being in his mid-thirties by playing basketball with college students) had yet again managed to injure himself enough to require medical attention. By this point, my contractions were a steady ten minutes apart, and still light enough that I could “do life” in between. So, I drove us all to the emergency room. When we walked through the doors, the person attending the desk was surprised to hear that we were there for him, not me. For the next four hours, I walked the hospital hallways with Zack in the stroller, chatting and singing to keep my bored and highly active toddler entertained, and pausing to breathe through contractions which were getting stronger.

It was a holiday weekend, which meant that the ER was incredibly busy. By the time the sprained (again) knee had been tended, it was after midnight. My contractions were a good 6-7 minutes apart, but still bearable. So, what did we do? Go to the hospital across the city where I would have a baby?  No, we went home so I could dye Easter Eggs. The following morning was Easter, and by golly, my little guy was going to hunt Easter eggs if I had anything to do with it. Spending the afternoon in the ER was not going to stop me. So, I put both of them to bed, and got busy with the egg dye before turning in sometime in the wee hours.

Contractions, steady but still manageable, woke me up in the morning. I called Kathy to check-in, and reached out to my friend Julie to ask if she would be willing to take Zack to church with her before taking him to her house during my birth. I wasn’t in labor enough to head out the door yet, but I was past the point of sitting quietly in church. I continued to feel calm and unhurried, just “doing life”. We had Zack’s Easter Egg hunt, took pictures, got him out the door, and pseudo-napped (as close to napping as one can get between contractions).  We walked around the park. I got a shower, baked banana bread, and and watched a movie while I rocked on the birth ball. Closer to evening, I was pretty tired and my body knew it. My surges had fizzled and spaced much farther apart. I called Kathy to check in – I was having a moment of fear, worrying a little that this was like the time before, when things had stopped and needed help getting going again.

Bless my doula, who talked me down from the ledge. She reminded me that my body was wise, had been doing a lot of work for two days now, and knew that I needed rest. Things were likely slowing down so I could catch a break before the next leg of the journey. So,  I decided to go out to dinner, figuring that spicy cajun food couldn’t hurt.   The waiter’s eyes grew as big as saucers when I told him I was in labor – our order sure was handled quickly. After dinner,  I called Kathy again from home, told her I was having a glass of wine and going to sleep, which I did.

The following morning, steady five-minute-apart waves woke me again.  This time, there was blood (just a little) and I could tell that the baby had changed positions. “Ok, here we go”, I thought. I called Kathy, who stayed on the phone with me long enough to have our conversation interrupted by my moaning. She decided then to head right over. In the next few hours, I got in and out of the shower, and paced around the living room. Kathy took beautiful pictures, reminded me to eat and drink, offered me encouraging words, helped me keep my hands relaxed and breathed deeply with me. Sooner than I had expected, she told me that my last several contractions had been only three minutes apart, and that we should leave for the hospital. I could hardly believe it – this was already farther along than I’d gotten without an epidural for Zack’s birth, and I was still feeling pretty good.

We drove the half-hour to the hospital uneventfully, with Kathy following behind.  Walking into the hospital at 3pm, I was offered a wheelchair, and respectfully declined, though they reminded me that the birth suites were on the third floor, and a long walk. Up in the elevator we went, and down the long and winding hallway to the adjacent building, pausing and grabbing the handrail every few minutes to stop, sway, and breathe. When I finally arrived at the desk and smiled and told the nurse that I was in labor, she asked if I was sure, and commented that I looked “too happy”.  I just laughed. I was happy! Kathy commented that laughter is good for labor, and that I could just laugh the baby right out.

Kathy dropped off banana bread for the nurses, and I was soon settled in. My favorite music was playing, I had the birth ball set up to sit on while being monitored, and my aromatherapy oils were sprayed around. I stayed in the clothes I had chosen to wear – my favorite comfy long t-shirt. A heparin lock, not an IV, was put in place so that I could continue to move freely. My doc came in for a quick exam, and found that I was dilated to 6cm. He mentioned that my membranes were still intact, and offered to break them for me.  I made quick eye contact with Kathy, and asked him if he had to. “No”, he said, “It can just help things move along, but I don’t have to. We can talk about it later if you want.”  There was no argument, no conflict – I had asked a question, and gotten a reasonable answer. This was, in itself, a victory.

The first two and a half hours passed quickly. I wasn’t in the bed for even a minute. I was only monitored for ten minutes out of each hour – another compromise that the nurse made willingly. In between, I sat on the ball, rocked in the hospital rocking chair, and walked the hallway with Kathy offering encouraging words and putting pressure on my hips, which helped so much. Kathy looked into my eyes and breathed with me. The nurse noticed and commented, “You two are really good at that.”  Occasionally, I would  dance, slowly swaying through the surges.  Suddenly, I was so very tired, and had to rest. I climbed into the bed, lying down on my side.  Kathy covered me with a sheet and began stroking my back. The nurse popped in to ask if I was ok. Kathy answered, “She just had a huge oxytocin rush and is feeling a little sleepy, so she’s just going to rest a minute.”  At that moment, my water broke, just as it had in my first birth, soaking the bed and everything I was wearing. The nurse helped change the sheets, put me in a dry gown, and then… meltdown.

“Kathy, this hurts.”

“I know”, she said softly.

“No, Kathy, this really hurts.”

“I know, and you can do it.”

“No, no, I don’t think I can”

“I know you can. Skip knows it, too.”  She motioned for him to come stand in front of me, to give me his eyes, for comfort.

“No, no more. I want drugs.  I want drugs RIGHT NOW.”

A few more minutes passed in this way, and at last I said, “You don’t understand.  This really hurts, and I’m really tired. I don’t want to do this anymore.  I don’t even want to have a baby today!  We are getting back in the car, and going home!  We can all come back later, and I WILL HAVE A BABY TOMORROW!”

My doula, bless her, wisely nodded her head, paused a moment, and just said, “OK”.

A silent minute passed.

“I think I need to push.”

She laughed. “Ok!”

The nurse was called in, and I was checked – complete with a just a tiny rim of cervix. Kathy’s smile beamed. The squat bar was brought in and attached to the bed. The nurse told me that my doctor had been called, but that he wasn’t on the floor yet, and I’d have to wait a minute.

I looked her square in the eye and growled, “You… have GOT… to let… me PUSH.”  Then I looked at Kathy, and said, “I’m going up and over”, and I flipped onto my hands and knees. Kathy stayed by my ear. “If your body is pushing, I know you can’t stop it”, she whispered, “but don’t push hard. Just blow. Let your body do the work.”  One surge passed. I blew. Another, and I blew. Then, I gave a warrior’s cry as I felt every muscle in my body get behind a mighty heave. Why this is called an urge to push, I cannot understand. This was an imperative. My body was pushing, and nothing in the world could have stopped it.

A second nurse came into the room and saw me on all fours.

“What is she doing?”, she whispered to my nurse.

“Having a baby”, answered my nurse.

“Well, shouldn’t we tell her to turn around?”

“No.”

Another powerful heave, and out came the baby’s head! I could feel it, there touching my thighs. I reached down with my fingers. Oh, so soft! A moment later, and out the rest of him flew, right into the waiting hands of my nurse. The doctor hadn’t even made it down the hallway yet. I don’t remember the cutting of his cord, or turning over, or exactly who laid him on me, but I know that my son was immediately placed directly on my naked belly. No nursery, no NICU staff, just my baby skin-to-skin on his mama. Seconds passed… minutes, maybe. And then, my baby began to crawl. He pushed with his tiny feet up the length of my belly, found my breast, and latched on, all by himself. Watching human instinct in action was one of the most amazing moments I’ve ever known.

He was here. Nicolas Wesley was here. My baby was here. All was well.

My doc made it in, minutes later. My placenta came out easily on its own. I had a tiny tear, just a little bit, where my scar from Zack’s birth had been. My newborn never left my arms. There was no question that he was mine. This was exactly the birth I had wished for. I did it. With the birth of my son, I felt as if it was me who had been reborn.

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A Better Birth Story – Finding the Way

05 Jul 2012 Leave a Comment

by Jodi in Most Popular

While preparing for the birth of my second child, I had hopes for a different experience for the second time around. Don’t get me wrong, I knew I got a great kid out of the deal the first time, but somewhere in me, I knew that it was possible to have something… different. I just wasn’t exactly sure how.

From my son’s birth a year before, two moments stood out in my memory that gave me an inkling of possibility and hope.  I remembered the few minutes after my membranes released, in which I suddenly felt peaceful and calm, and wasn’t in pain. I remembered thinking clearly, “hey, maybe I can actually do this.”  I remembered also the words of the wonderful nurse who let me know in no uncertain terms that she could not tell me what to do, but that I could let her know my wishes. I remained grateful to her for giving me the words that brought my newborn son to my arms for even just that five minutes.

I wondered if it was possible to connect more deeply and intentionally to that place within myself; if there was a way to get to that feeling without it being fleeting, and birth without fear. I believed that, even if it were necessary to face every intervention from my first birth for a second time, if I could be in that place of knowing what was happening and not being scared, I would feel completely differently about my birth.

Having already found comfort in Dr. Sears’ The Baby Book, I looked into The Birth Book to learn more about my childbirth options from his medically-balanced perspective that also honors intuition and instinct. It was there, in a small sidebar on the right-hand margin of a page, that I first came across the word doula. It was just a brief snippet about a doula being a person trained in labor support to take the anxiety out of the birth process. Given that this was the pre-Google stone age of 1998, I called the 800 number given, asked for a list of doulas in my area (snail mail!), and began my search.

Finding my doula Kathy was one of the best decisions I have ever made. Her brilliant smile and her passion for birth put me at ease. She listened to my birth story, helped me uncover my fears and desires, provided reassurance and perspective, and encouraged me to believe in myself. She pointed me in the direction of good educational resources, provided information about different options available to a laboring woman, and helped me know what questions to ask my doctor long before we were ever in the birthing room. She was available as a sounding board throughout my learning. I would call her to ask questions, like “Hey, Kathy, I read today that when you reach the point of saying ‘if it gets harder than this, I can’t do it’, that’s as hard as it’s going to get. Is that true? Because if that’s true, I think I can do this.” She didn’t do the work for me, and held me completely responsible for my own choices without judgement. What she did do was ask good questions and offer unconditional acceptance and support.  She helped me discover the pieces that I had been missing. She shared with me in the “a-ha” and “oh, wow” moments along the way.

I chose a different hospital that was farther from home, but smaller and more intimate, with a birth center environment and more non-medical options available to laboring mothers. I found a different doctor; one with privileges at this smaller facility. I took an out-of-hospital childbirth class, which helped me learn about how natural birth happens. I learned about alternative comfort measures that I could use, and how to reprogram my own negative self talk with positive affirmations and belief statements. I began to integrate the belief that the body growing my baby would know how to get my baby born. I began to believe that I was strong. I was still scared sometimes, which is normal anytime someone is dealing with the unknown, but I was not terrified.

To be honest, I wasn’t completely sure yet that I would have an unmedicated birth. I was ok, though, with taking myself as far as I could go, and then taking just one more step. That was all the expectation I had, and I knew I would have the support to take it.

Learning from Experience

02 Jul 2012 2 Comments

by Jodi in Most Popular

Zack’s birth was a highly medical experience. My recovery – physically, mentally, and emotionally – was very slow, but it did happen.  I share my story and his not to gain sympathy, but to say clearly that I know what this experience feels like. I have been there. I’m not there anymore. I’m not, as doula,  asking any woman to go with me anywhere I haven’t also been. A better experience is possible. I know. I’ve lived it.  I’m not saying that the details of my lessons are the same as anyone else’s; only that there are lessons in every life experience, and that this was mine.

In the year following Zack’s birth, I began to ask questions. I joined a mothering support group at my church, and an online community, and a playgroup. I asked every women I knew  – and even some I didn’t know – about her birth story. I wanted to hear the details of the births that were different than mine. I wanted to know what they did to make it easier, or what happened that made it difficult.

I want to be clear that I don’t blame my doctor for the experience I had. In fact, I’ve said many times in the years following that I wish he were now in the state I live and serve in. I wouldn’t hesitate to send any mama to a doctor that knew my body was strong, my baby was fine, and that natural birth is completely do-able. He’s radical enough in his field that he’s affectionately known as Dr. Cowboy by his colleagues. I know I’m lucky that he was patient with my progress, and that with many other practitioners, I’d have had a surgical birth.

I don’t blame the hospital nurses for my birth experience, even the ones who were snarky or “just being honest”. They were just doing their jobs. They worked in a hospital that continues to have over 4000 births a year, very few of which are unmedicated. They were doing what they knew to do, working with a frightened woman with the skill set they had to offer. They didn’t do anything wrong.

I don’t blame my now-ex-husband, who slept through most of my labor. He, too, was doing what he could with the knowledge and skills he had.

I don’t even blame myself. I was young, and scared, and clueless. I was doing the best I could with what I knew, which in hindsight I realize wasn’t much. The problem was that not only that I didn’t know, but that I didn’t know that I didn’t know. I thought I did. I had read things, took classes, listened to the stories of my family and friends (not one of whom had had a low-intervention birth, except for the friend who had her baby two weeks before me). I didn’t know that it was ok to ask questions. I didn’t know that it was ok to ask what my options were. I didn’t even know that there were options to ask about. My birth was culturally normal. There are many stories like mine.

I felt powerless, and I was. I did as I was told. I was polite to a fault, and didn’t make waves. I surrendered to powerlessness. I surrendered to medically managed labor. I had no trust in my body, my baby, or the process of birth. That’s nobody’s fault – it’s just what was. Realizing that I had the responsibility to be an active participant in my own experience was the first step in what would be a long path to knowing birth in  a different way. That’s where the journey began.

Many midwives share the opinion that women birth as they live. In the same vein, Buddhists say that how we do anything is how we do everything. Our births are not exempt from who we are. It’s true – in my life, I didn’t know the value of the work of inner growth. I expected myself to always know everything I needed to know. I expected that I would be taken care of by my husband, my doctor, and my hospital. I put the opinions of others over my own, always, and trusted that experts who surely were wiser than me would tell me what to do, and how. I didn’t know the difference between asking questions to seek information for informed choices, and being rude and de-valuing their input. I thought that being a “good” patient was all that was necessary to have a good birth.

The change within me began with breastfeeding. Dear Dr. Cowboy was, in fact, a great source of support in the weeks following my birth, telling me that he knew I would succeed at breastfeeding. His wife breastfed all four of his children, and he required that all of his office nurses were trained in lactation support. I happened to check out Dr. Sears’ The Baby Book from my local library the week before Zack was born, and this was the beginning of my learning about a whole world of birth and parenting that was beyond what I had known.  I had a baby that ate every hour, didn’t sleep when he wasn’t in my arms, and cried when anything touched his feet.  I learned that there were ideas that worked in theory, and then there was what really worked for myself and my son.  I learned for the first time to listen to my body and my baby, rather than watching the clock. I learned that some experts, even well-respected ones,  might give information that wasn’t actually right.  I learned how and where to seek out sound, medical-fact-based information about the choices I was making with my child. I learned that the experts didn’t always agree – not even with each other. I learned to respectfully disagree, rather than go along with, friends and family and even <gasp> nurses at our pediatric doctor’s office, and that I could choose practitioners willing to have a conversation with me instead of telling me what to do. I began to learn that I had a voice, and a powerful mind,  and that I had the right and the responsibility to use it for the good of my child. I learned to say “I’ll consider that. Thank you.”  In short, I woke up.

In time, it became clear to me that while I had always wanted to be a mother, I had looked to the process of becoming a mother itself to fix something within me that had longed to feel whole, secure,  and “good enough” in the world.  I was longing for a sense of completion that I hoped existed somewhere, that I thought would magically happen with the birth of my own child. I began to see that parenting a child could not mend life’s wounds, or magically fix where I was broken.  I learned that, no matter what life challenges I went through, I couldn’t run away from ME.  I began to listen closely to my own mind, noticing my own harsh self-criticism. Some had come from my childhood, and some from the world around me, and I had willingly taken them on as my own. I began to understand that my own mind – the critic who would call me a wimpy, foolish girl and would remind me that I was surely doing everything wrong – was like a machine that had been programmed to destroy me, and that I was the one allowing it to happen. I began to practice deeper compassion, gentleness, and love for myself, and healing my own fears and doubts.  This powerful shift – from needing to be told what to do to accepting guidance and taking it into consideration  – began a profound change in my view of the world as I knew it.

What this experience taught me most of all is that I had to be my own inner advocate for my mind, my body, and my child so that I could make informed choices that felt right and good to me. I couldn’t expect my own wholeness to come from outside of myself by way of approval for being a “good” daughter, or a “good” patient, from having a “good” pregnancy, or being a “good” mother, or being in a “good” marriage. While I could – and did – learn to reach out for help, I was going to have to begin to trust myself.

This journey was long and hard (and continues to be ongoing), but rewarding. As I grieved the loss of the positive birth I had hoped for, and my losses past and present, my outward behavior changed. I began to stand up for myself and set healthy limits. I began to feel ok with stating what I needed and didn’t need in my daily life. My prayers shifted from “help me, help me” to “thank you for giving me the strength to do this”. I was becoming my own internal mother, taking care of my own internal child, and being my own friend as I was mothering my own child. My presence in my own life began to feel stronger, and my interactions with others became more grounded. These were not just birth lessons, but life lessons. Along the way, a year to the day after Zack was born, I learned that I was having another baby.  I knew that this time would be different. I was right.