Monthly Archives: August 2012

“No” is a Love Word

“No” is a Love Word

All three of my kids could be described as spirited, high need, or intense. So am I, so they come by it honestly. 

 I have come to believe that my children are my mirrors. They show me, through the feelings I have in response to their action, the work I need to do within myself. Sometimes, this means pushing my buttons to show me where my buttons are, so that I can learn how to shift and work on them.

Case in point:  Cole, now 14, was and is my non-sleeper. At 3, he would go to bed, and get up endlessly for hours to ask for a snack, a drink of water, another hug, nursing, had a question, had another question. For a long time, my internal process would sound something like, “What kind of mother would send her child to bed thirsty? Hungry? In need of nurturing? Squelching his curiosity?” So I would attempt to redirect, or distract, or comply, and comply, and comply. In the retrospective wisdom that only hindsight can provide, I see now how my inner waffling (“I don’t want to do this”/ “What mother wouldn’t do this?”) contributed strongly to his tantrums. He felt the energy of my struggle and resentment, and it was confusing and overwhelming to him, as well. I didn’t want to deal with the tantrums. I’d silently resent the hell out of the demands on my time and attention, and was tapped out from my unmet need for alone time and rest.  No matter how much I tried to avoid it, most nights ended in meltdowns for both of us before anyone could get sleep.  He developed the mistaken core belief of “My role is to get this negative/undue attention”. He acted almost as if his thoughts were, “This is a confusing thing when I push this button.  What happens if I do it again?  And again?  And again?”  He was exploring his part in the dynamic as much as I was mine. 

  At the heart of Attachment Parenting is the knowledge that children are happiest and healthiest when their needs are met. As helpless infants, needs and wants are one and the same. As children grow, a new need – one of learning to live under the same roof in health and harmony as part of a community unit – begins to emerge.  When I gave myself space to sit with my own feelings of frustration, and was honest with myself about what my feelings were, and considered what I really needed, I realized that while I was responsible for meeting my child’s NEEDS, I was in no way obligated to gratify every WANT.  As a parent, it was going to be my responsibility to teach my children that not every want had to be fulfilled immediately. It was my job to help them learn patience. It was my job to help them learn that they did not need to be in the spotlight, with me at wit’s end,  to feel loved and accepted.

I learned (eventually) that it was my work to discover and communicate where my own boundaries were. Otherwise, I would use myself up, wear myself out, give more than I had to give, and be burned out.  It was part of the children’s work, as people learning how to function in the world, to be aware of and respect the boundaries of others. They might not like it, but really, they didn’t have to. There is NO RULE that says that children have to like an adult’s decisions. “It’s ok to not like things” is, in itself,  another valuable life lesson. Learning to discern the difference between dislike that is A Big Deal vs. dislike that is little enough to let go is another valuable lesson that I could help my children learn, as is the ability express their dislike in a respectful way. I learned to let go of my own expectation that others (including my children) would like and accept my boundaries with no resistance.  I learned that someone else’s approval of my boundary was not necessary.  I became aware that I could be compassionate to their experience of not liking it, and stay abundantly clear on what I would do. Deciding what I would do, I realized, is the only power I have in any relationship, including my relationship with myself.

My parenting mantra became and has remained “Decide what I will do”.  

 I decided that it was ok to communicate to Cole that I needed time  for rest. My self-worth was strong enough to be firm in meeting this essential need. We were done with today, it was bedtime,  there was no more time for snacks (he had a good dinner and a bedtime snack, and going to bed without more food would not harm him), there was no more time for questions (we would have all day tomorrow to talk about every thought that crossed his mind).  I was clear that setting the stage for sleep with a good bedtime ritual was in no way bringing him harm, even if it wasn’t his desire.  I decided that I would not stand at his door with endless explanations of WHY the answer was no (because I don’t owe him an answer that he likes, and that was just another way of engaging my time). 

   When I reached this place of clarity in myself, a powerful shift that happened. I was surprised to find that my children responded differently when they sensed that my own internal compass was clearly focused.  Affirmations I found myself repeating in my head were “‘No’ is a love word” and “‘No’ is a complete answer”. I never, ever wanted to tell my kids no. To avoid tantrums, I simply avoided saying the word. I was all about “Yes, as soon as…”, or looking for a distraction, or giving a longer explanation about what we would do. I realized that sometimes, I was contributing to the problem, frustrating them, and making it worse, as well as creating the belief within themselves that they could endlessly needle me until I gave an answer that they were willing to accept.  It was frustrating to me, and teaching them disrespectful behavior towards others. So, if my inner answer was a very clear NO, I actually started using that word.  I learned how to say it simply, without an emotional charge. I realized that “no” was going to be a part of their lives, and that I could teach them with love how to honor someone else’s clear “no”. This is a valuable life skill for the healthy adults (which I hope they will one day be) to have.

 In learning to communicate my boundaries with compassion, and sticking to them with love, I could be compassionate to my children without “giving in” and losing myself. I could say, “I understand that’s different than what you’d like, and it’s bedtime now.” I could be firm in the moment of conflict, and talk with them with kindness at neutral times (not in the middle of bedtime resistance!) about what options they had.  As a team, we got a lot better at problem solving. Cole learned to go to bed and stay in bed. Though he still needs less sleep than I do, we have harmony in our home because both of our needs are met.  Boundary setting with compassion continues to be a successful strategy with Cole to this day, and at 14, our relationship with one another is often respectful and easygoing because we both know that we’re in it together, and we trust that both of us will navigate to have our needs met in healthy and functional ways.

 I’m not intending to imply that this is exactly where any other mama is in her own learning.  There are no “shoulds” here. I share it because this is the story of the lessons I am learning in my mothering path, and it might resonate with someone else.  Blessings on the journey, for us all.

 
 

What’s in a Fee?

What’s in a Fee?

doula_money

 

Every doula has heard it at least once…

“So, if my birth is really fast, you’ll refund part of what I paid you, right? Because then you didn’t really have to work that much.”

“How can you be ok with charging so much?”

Or, my personal favorite, “You know, what you’re doing is an act of service. It’s really special. It’s like doing The Lord’s Work. So, don’t you think it’s wrong to not do it for free?”

The money questions… it’s enough to make any doula want to crawl under a rock, or wish we could go live in a yurt, in a nudist colony, on a self-sustaining  farm, so that our living expenses could be lower.

How a doula sets her fee is an unclear concept to many people who are seeking or offering birth services.  On the surface, it may seem like a doula’s fee is a lot of money for what amounts to one big day of work. I offer this so that new parents and new doulas have greater clarity of what a doula’s fee really includes.

A Typical Work Week:  Booking one “due date” per week is more than just one day a week at work – it’s a full-time workload.  Consider this – for every client I take on, I offer up to three face-to-face prenatal meetings, unlimited phone support throughout pregnancy and the first week postpartum, and an in-home postpartum visit.  This means that an average work week for me will have four to six home visits (about two hours each), six to ten hours of phone time, and eight to twelve hours of travel time. Throw in a couple of hours for recordkeeping, appointment scheduling, text and email support, and the extra hours it takes to call everyone and reschedule when I have a mama in labor. That’s typically a 37 hour work week, before I’ve spent even one minute at a birth. When all is said and done, each client, on average, has had the benefit of 30 to 42 hours of her doula’s time, and most of those hours have been when she hasn’t been in labor.

 Birth Hours: The average number of hours I support an individual labor, from the “this is it” phone call, through birth, and the first hour of recovery is 16 hours. Some labors are short and fast, and some are measured in days.  The shortest and fastest births have still had me returning home eight hours after I left. The longest I’ve spent at one birth is upwards of fifty hours. This unpredictability is why I do not charge an hourly rate. I make myself available to provide support for however long a birth takes, and know that on my end, things will average out in the long run.

Commitment and Availability:  When a due date is added to my schedule, I plan to be on-call at any time from 38 to 42 weeks – two weeks to either side of that due date. This means that if I plan a dentist appointment or dinner with a friend, or schedule myself to attend a training, the commitment I have made to my mamas is taken into consideration. I am responsible for making financial arrangements with my backup in advance when I know of days that I will be unavailable, or if I were to have an emergency.  No matter what I think my plan for the day may be, if I have a mama in labor, she takes priority over anything else I may have going on. Classes that I teach are  either rescheduled or another facilitator is paid to take over for the evening. I rely heavily on my on-call sitters to fill in the gaps when I’m not there to pick someone up at school or get dinner on the table. What this also means is that any fees I am paid for a birth cannot be counted toward my living expenses until after the birth has happened, since parts of this fee may need to go to my sitter, another instructor, or my backup doula. Even a doula who is consistently booked has a monthly income that is highly unpredictable.

The Cost of Self-Employment:   Doulas have typical professional and office expenses, required continuing education expenses every year, high transportation and communication expenses, website fees, professional organization fees, insurance expenses, and parking fees at most hospitals.  For a self employed doula, there’s no sick leave, no medical insurance, no benefits, no paid vacation, and no days off. The living income of any self-employed professional, after taxes and business expenses are factored in, is only about half of what they earn. So, the annual living income that a doula must live off of is half of her fee per birth, multiplied by her number of clients per year. For a doula  to earn the equivalent of the US minimum wage of $7.25 per hour for full-time work, she would need to charge $580 per birth. That is if she was willing to be on-call all year, no days off, no weeks in which she wasn’t booked, while taking on a responsible client load of one birth per week, AND if she did not miss one birth due to illness, emergency, or having two mamas in labor at once. That’s just to earn minimum wage!  Even with her years of training and experience,  your doula might be making a better living by asking if you’d like fries with that.

Though clearly no doula is likely to make a fortune from doing this work, it’s fair to expect that a doula should be able to take on a full-time client schedule and make a livable wage. The options are to charge a fair price to empower a doula to work for a living, or to leave birth work, as most ultimately do, to accept a conventional job with a predictable schedule, a decent wage and benefits.

If one looks for them, there are doulas that can be found who will attend births for free, or who accept significantly reduced fees for their services. These are often student doulas who have attended only a few births, or are women who are in a financial position to offer free services. Regardless of her reasons for asking for less than her services are worth, I strongly encourage any mama to pay her doula a fair price, so that the doula may continue to be available for the mama’s next birth and the births of others. I urge all doulas to consider asking for a fair wage, to treat our services as having value and worth, so that ours may be a profession known for attracting and keeping highly skilled and talented individuals.

Wisdom and Experience:  To every birth she attends, a doula brings her knowledge and the lessons that have come from each birth she has witnessed.  On a personal level, I have learned something new with each birth, over 400 times, in 14 years. I have worked in 15 different hospitals, and keep up-to-date on all of the latest research on birth policies and procedures. Having had the opportunity to work with so many different practitioners, I witness the wide variations from one hospital to another, and one practitioner to another. Studies have shown repeatedly that doula support helps lower the chances of a woman having a cesarean birth,  lowers the use of anesthesia in labor, shortens labor time, and results in mamas who are happier with their birth experience. A doula’s head, heart, and hands are completely committed to supporting each woman in creating the birth that feels exactly right for her. Her wisdom and dedication are valuable resources. Her fee is an investment made  toward creating a positive birth experience.

Burnout and  Balance:  Most people who become doulas stay in this field for less than two years.  Burnout runs rampant among birth workers. The unpredictability and demands on ones’ time and energy are more than most people can bear for very long. Balancing home and family connections with birth work takes mindfulness, flexibility, patience and commitment not only on the part of the doula, but from her spouse, her children, her family and friends.

Being on call requires a level of personal sacrifice that few are willing or able to offer.  I have left my own birthday party to spend the night at the hospital with a laboring mama, while my friends remained to celebrate without me. Each of my children’s birthdays and many holidays have been spent at births. I have rescheduled countless parent-teacher conferences. I have cooked Thanksgiving dinner at 4am because a mama’s water broke and I knew I’d be leaving soon. Vacations are few and far between. I go to bed every night with my phone by my head, not knowing how long I might get to sleep before someone is in labor.

I never know what may happen after the “come now” call. There are long days and nights without rest. I might catch a nap while sitting upright in a chair. I may go hours without nourishment, munching on the occasional granola bar.  My body gets tired and sore from supporting a woman through laboring positions and applying counterpressure. I’m usually the one who ends up holding the vomit basin. I go home with amniotic fluid soaking my pants, or blood on my shoes. When the day is done, I’m messy, and tired, and hungry, and fried… and happy – deeply, completely, truly happy.

I do it because I love it. I do it because I cannot imagine my life without attending births. It’s my calling and my life work. I hold space for women in a scenario more  intimate than others will ever have the opportunity to see. All facades melt away. There’s no pretense – just the genuine, intense, authentic energy of a woman giving birth. It’s raw and sometimes unlovely. I witness the transformation of modern civilized professional women into primal birth goddesses, and see the strong love that their beloveds hold for them. It’s an honor, always, to be a trusted caregiver in a space so sacred. It’s an honor, always, to offer love and affirmation in the face of such vulnerability, and to see it through to the other side – to witness the accomplishment and victory that happens when, after reaching the end of all that she thinks she knows, a woman stands toe-to-toe with her fears and chooses to take just one more step into the mystery, and emerge on the other side victorious, with her wet, squalling newborn naked on her skin, and her newly-born mother-self rising up as never before. This is what this work is all about.

I hope this has helped you in making your decision.  Happy birthing!

 

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10 Tips to Create a Positive Hospital Birth

10 Tips to Create a Positive Hospital Birth

As a doula, I am occasionally asked, “So, do you only attend home births?”  Far from it. Though I am a strong advocate of home birth, I believe that labor support is absolutely necessary wherever a woman chooses to birth, and that a woman has the right to choose to birth wherever she feels safest.  For approximately 98% of birthing women in the US, this means choosing a hospital birth.

What is also true is that, nationwide, our hospital cesarean birth rate is 36%, with my home state of New Jersey ranking the highest,  and our maternal mortality rate in the US ranks 50th in the world. 95% of birthing women are choosing to have epidural anesthesia for labor. These numbers don’t reflect a very high incidence of warm-fuzzy natural births. So, if this hospital setting is where the majority of women, including those who want a low-intervention natural birth, feel safest, then the question must be asked, how do we as mamas and papas and partners and practitioners create a sacred experience in the birthplace where we feel safest?

There may always be circumstances beyond our control. That’s a given, and making the best informed choice in that moment is a necessity. There is much, though, that can be done to create a natural, gentle birth while still being in a hospital setting. You’ve no doubt been told to take a good childbirth class, and that’s a great place to begin. The following suggestions are the “beyond the birth class” pointers that I have taught to expectant families and birth professionals for the past 14 years.

 

 

10 Tips to Create a Positive Birth in a Hospital

 

1. Hire a doula! If you desire a natural birth in a hospital then having a doula for support is essential. Doulas are the “Walking Wikipedias”  for all things natural birth. Experienced doulas know the doctors and midwives in their area.  They may also know your hospital staff, and have built harmonious bridges there. They can refer you to  good childbirth classes, lactation consultants, pediatricians, chiropractors, and are a wonderful resource for many other prenatal and postpartum services. They often have connections with support groups and other parents in your area.  Your doula will support you with every step along the way as you prepare for your birth, and will remember what is important to you when your birthing time comes. A good doula has immeasurable value!

2. Imagine your positive birth.  The part of the brain responsible for memory does not know the difference between something that actually happened, or something that is vividly imagined.  This means that spending time with imaginative visioning provides you with stored memories of positive birth experiences. Take time to picture clearly the details of yourself feeling peaceful and safe, your body opening, your baby emerging with ease.  Take in positive birth stories through books, film, and other women who feel satisfied with their births.  These positive stories will provide you with confidence and comfort. With good experiences now stored in your brain as a resource when you are in labor, it’s as if your brain says, “Oh, remember that time I had a baby and everything went easily and was just fine? If I’ve done that before, I can do that again right now.”  Oh, and stop watching  the Birth Story shows. Normal, uncomplicated  birth doesn’t make for good high-drama TV, and takes much longer than half an hour. Your memory is taking those in, too, and they won’t serve you well.

3. Figure out your fears. Name them, and if you can, take time to examine and re-write the core beliefs behind them. Our “core beliefs” are what we hold to be true about ourselves. They are the deciding factors behind most of the choices we make in our lives. A person with the core belief of “I am worthy, loved, and safe” is going to have a more positive experience than a person who carries the core belief of “I have to struggle to get what I need”, regardless of their birth outcomes. Preparing to give birth is an opportunity to not only understand the physical process of growing and birthing a baby, but also to explore the mental, emotional and spiritual aspects of preparing yourself for parenthood.  Now is the time when working with a childbirth educator, doula, counselor or therapist to heal the negative core beliefs that may undermine your ideal birth is an excellent way to support yourself.

 4. Know the policies and procedures in your hospital. Understanding your options in a hospital is critical in order for you to feel empowered and to create a safe space. Ask your doctor and your doula about their experiences with natural birth in your chosen birthplace. Call your birthplace and find out who can answer your questions about their policies. If the birthplace of your choice does not offer options that you find acceptable, find another one that does. They do exist!

5. Write a birth plan. Notice I did not say “Write a five page list of demands and make fifty copies and hand one to everyone you encounter”. People don’t typically like being told what to do in black and white before they’ve had a chance to show you their best. The process of writing a birth plan is a shared exercise between expectant mama, her partner and other support people who will be present for her birth.    Thoroughly considering all of your birth options via a mental “dress rehearsal” can help you understand your options and  clarify your wishes and intentions for your birth. This exercise then becomes a tool that will help you communicate clearly with your doctor or midwife.  If you do choose to put a birth plan into writing, keep it short and simple – a single page, with your top ten utmost priorities bullet-pointed, phrased in the positive (“Thank you for…” and “I would prefer…”, rather than “DO NOT EVER…”). Review it with members of your birth team prior to your birth, so that everyone is on the same page.

6. Thank the hospital staff upon arrival with a gift. Perhaps you bring the banana bread that you baked while passing the time in early labor, or maybe you have a basket of cookies ready to go. Stop for doughnuts on the way to the hospital, if that’s what works for you.  Attach a thank you note with your name on it, and a copy of your birth plan. Most hospital nurses work really hard.  It’s long hours, a lot of demands on their time and energy, and not a lot of thank-you’s to go around. People are nicer when you begin your interactions with showing kindness and gratitude. (They’re also nicer when you feed them.) This may not inspire anyone to bend the rules on your behalf, but it will certainly start things off on a positive note between the hospital staff and the laboring family in room 16. They will notice right away that this is a different experience for them, and that opens the door for your entire birth experience to be different than “the usual”.

7. Find subtle ways to make your hospital space your own.  Consider making a sign to hang on the hospital door that asks that people knock and enter quietly, or even just make one with your names – “Jane and Tom and BabyQ say thanks for your support”. Choose your own clothes to wear, rather than the hospital gown that looks like every other patient. Bring positive birth images to tape to the wall. Bring an aromatherapy spray that you like the scent of.  Anything that may lead someone who is entering the space to pause for a brief moment and notice that “Oh, this is different” helps create the space for your birth to be recognized as unique, and treated as such with respect.

8. Bring music into the labor and delivery room. This not only helps with making the space more comfortable, but serves a myriad of other purposes, as well.  Rhythmic music can be calming to your mind.  Rocking and swaying, often helped along by music, helps move the baby down more comfortably and with greater ease.  Singing along can help you use your voice in a powerful way to cope with strong surges (no matter how well you think you can carry a tune). Music creates a sound barrier between your room and the room next door, if the hospital walls are thin. This helps you have a greater sense of privacy, making it easier for you to let your own guard down so that you can surrender deeply to your birth process.

9. LOVE, LOVE, LOVE!  Ina May Gaskin says that the energy that created the baby is the energy that will get the baby out.  Oxytocin, the hormone produced during lovemaking, is the same hormone responsible for labor.  So, anything that would be conducive to good lovin’ is also going to make for an easier birth. Sweet music, hugs and kisses, loving words, soft lights – these are all helpful. Likewise, anything that would be a mood zapper can have the same effect on labor. Keep the hospital room door closed. Keep people in the room to a minimum. Turn the phones off.  Let love lead the way.

10. Practice meditation to invite calmness and well-being into your daily life. Meditation isn’t about learning to sit like your legs don’t have any bones. Meditation isn’t about seeking and finding peace and stillness. Rather, it’s about making room for the stillness that is already within you, under all of the layers of busy-ness. In that place of stillness dwells the part of you that already knows how to have a baby. Just like your baby knew how to grow the right number of toes without taking a class to learn how, your body knows how to birth, and your baby knows how to get born. In being able to tap into your own stillness, you will find your strength. Start now. It’s ok to start with a minute – just one minute – of sitting and smiling. Your thoughts may wander, and that’s normal. Just recognize this, and bring yourself back. Take a breath, in and out, and then another breath.  Take one minute to take a deep breath and name three things that you are grateful for today. Take one minute before sleep to replay a happy memory from this day. A minute here, a minute there – it adds up. Find your stillness. Trust your body. Trust your baby. You can do this.

It is my hope that you benefit from these pointers and share them with others. If you have any of your own suggestions  on what made your hospital birth positive, empowered, and sacred, please share them here in the comments.

 

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