In the past two days, a lot of buzz has been going on about a study that linked labor induction to increased rates of Autism.   The response to this has been interesting. There are those who say that this simply means that more research needs to be done, and those who say that suspicion has existed all along that labor induction and augmentation are perhaps higher risk decisions than originally thought.

I’m also seeing, within the natural birth community, a lot of feedback about using herbs and essential oils for “natural labor induction”, promoted as though these options are much better or safer. Here’s where I part ways with the pack.

Induction is induction is induction. Making labor happen before mother and baby are both ready is, in and of itself, a risky procedure. These studies aren’t just showing us that Pitocin is risky, or that Cytotec or any other labor-inducing medications carry risk, but that forcing a baby to be born before the baby has initiated labor is a procedure that carries risk.

Though medical science has developed ways of getting the baby born when a concern is present, science has as of yet found no explanation for exactly what makes labor begin on its own. What we do know, from studies in recent years,  is that the last stage of fetal development happens in the baby’s brain, and that this triggers the cascade of events that leads to baby being born. The most recent study, released yesterday, shows that induced labor may increase the likelihood of  a child later developing autism.

Going past a predicted due date is, for many, a problem with impatience far more than it is one of medical safety. Science has shown that the length of a normal pregnancy varies by up to five weeks.   Going past a due date by two weeks is perfectly normal. Being “tired of being pregnant” is not worth the risks involved with forcing labor before the baby and the mother’s body are ready. This is true whether the agent used for induction comes from a plant purchased at the health food store or a chemical carried in a hospital pharmacy. There is no such thing as a “natural” induction – forcing the process of labor is, itself, not natural.

As both a doula and a practicing herbalist, I’m often asked if there’s anything one can do to get labor going. My answer is to rest and hydrate. Store up your strength. Eat well. Laugh a lot – laughter releases oxytocin and makes you feel better. Snuggle with your partner. Cry if you need to. Do whatever needs to be done to get to an emotionally ok place with being in the temporary “in between” space of growing a baby and becoming a mother.  Getting comfortable with the discomfort of the unknown is just one of many life lessons that carrying a baby brings the opportunity to learn. Babies come when babies are ready. Don’t push the river – it flows all by itself.

Have you ever heard a “bad doula” story? Chances are, if you’ve been in this field any time at all, you have at least once. She crossed a line, rubbed somebody the wrong way, didn’t do what was expected, things didn’t go as planned… In her own version of the story, the doula may have put her best foot forward. Sure, sometimes we all make mistakes. That’s part of learning and being human. It might also be true that, no matter what she did or didn’t do, this story was not going to have a good outcome in the end.  Not every doula is a good fit for every mama.

As we learn, grow, and hone our skills, a really important lesson comes in the form of knowing when to say, “I’m sorry, I’m not the right doula for your birth.” It’s not easy, especially in the beginning. A new doula is excited to have an opportunity to serve as many as she can. She’s eager to meet with new clients, and willing to stretch herself as much as possible to make her mamas happy. The thought of turning a client away is fear-provoking. She needs the experience, wants the income, and has in her heart a desire to be helpful.

Eventually, the lesson comes that we, as birth workers, are responsible only for our commitments. We are not responsible for our clients feelings, or the choices she makes, or her struggles. We are not responsible for whether her birth meets her own expectations. Nor are we responsible, though our egos love to think so, for her joy. We are accountable for our integrity – for doing as we say we will, when we said we would. Nothing more, nothing less.

A big part of showing up in integrity is knowing ahead of time what we can and cannot do. Saying, “That’s beyond my ability”, especially the first few times, is terrifying. The hamster wheels in our head get to spinning. We may think, “What if she doesn’t like me anymore?  What if she doesn’t hire me?  What if she tells her friends, and then I get a bad reputation? What if she doesn’t find someone who is right for her?” We worry about creating stories of abandonment, or hurting feelings. Doulas are, at the heart of the matter, compassionate people. But, if we truly long to help not just this mama, but the many who may come after her, knowing when to say “no” is truly an act of service within itself.

If we take on the responsibility for the journey of a woman’s pregnancy and outcome of her birth, we have robbed her of the opportunity to claim her own responsibility in creating her birth story. Denying a woman the power of using her own voice and strength is the greatest disservice we can do. The “bad doula” that you’ve heard about?  Chances are that she was speaking for the mama instead of encouraging the mama to speak for herself. It’s likely that she was holding herself accountable for this birth, instead of holding herself responsible for support. She showed up in combat gear to do a peacemaker’s job.

On my own doula path, I’ve come to recognize a few red flags that let me know clearly when I’m not the right doula.  Other doulas may have their own signals. A few I’ve come to recognize are:

If a mama is…

hoping that hiring a doula is all she needs to do to have an unmedicated birth

not interested in taking childbirth classes or reading books (at least one or the other)

learning all she needs to know from watching birth shows on TV

suffering from unresolved trauma, panic attacks, or debilitating anxiety for which she is not seeking other professional help

working with a doctor she hates and is unwilling to change practitioners

working with a practitioner who has made it clear that he or she doesn’t want to work with doulas

delivering in a facility that has strict policies against what she wants, and she’s unwilling to go somewhere else

planning to accidentally have her baby at home without qualified support

wanting to have uninterrupted hands-on doula support from the time her first mild or erratic contractions begin (even when it’s clear that birth may be days away)

truly terrified of giving birth at all, with or without medication

wanting to be told what to do, rather than given her options and asked for her decision

wanting to be protected from an abusive spouse or family member who will be present for her birth

… then I’m not the doula she’s looking for.

This doesn’t mean that I don’t care. Rather, it means that in knowing my own limits, I’m in a much better position to say “here’s someone else who might be able to really help you”. Maybe I send her toward a great therapist, or a support group, or even another doula who specializes in exactly what she’s looking for. Sometimes, saying “I’m sorry, but no” is the best support that I can offer. Is it easy?  Heck, no. My hands sweat and my knees shake, every time. But in the end, I know that in the temporary disappointment for us both, I’ve offered her far greater support than I ever would have if I’d have made a commitment I knew I couldn’t honor. I sleep with a clear conscience, she has the opportunity to get the support she really needs, and all will be well.

 

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Almost every mama I talk to says that she wants to have an unmedicated birth, or at least wants to get as far as she can without medication. Most of the time, that’s exactly what happens. My epidural rate is less than ten percent. As part of the support team, I give my word that I’ll pull out every tool I can to help. The question I am always sure to ask, though, is: “How will you let me know if you’ve changed your mind?”

Sometimes, this will catch someone off guard. Why would I ask about her changing her mind if I believe in her and will support her through her birth? The answer is simple. I ask so that I can be fully supportive. I want her to have the power to make her own decisions with this birth. Deciding to use or not use medication is her decision, not mine. I want her to have the freedom to say whatever she wants to, and do whatever she decides is right. Do I think she can do it without an epidural? Absolutely, I do. If natural birth was impossible, the human race would have died out long before now. But, when all is said and done, I want her to know that she did it for herself, not because of anything I said or did.

Every mama who has ever had a baby has reached that moment when she says, “That’s it. I’m done.” It might happen out loud (very loudly), or it might be only a passing thought in her head, but it does happen. It’s a very charged moment – it’s usually when she’s in the most short and intense part of the labor process, often right before her body begins to push. Physically, this is when contractions are the strongest, longest, and closest together they will be. Getting through them one at a time requires a lot of focused effort. Neurologically, this is when rational thinking part of the brain has shut down, to allow the hormones of labor to do their work. Emotionally, it’s the moment when she has reached the threshold of the only life she has known, and is at the no-turning-back point, stepping into the foreign territory of life as this new person’s  mother. That’s a huge step, and it’s normal to have strong feelings of resistance, doubt, insecurity, and fear come up. I want a mama to have the safety and freedom to express her doubts and fears, to know that she is seen and heard, without holding back because she’s afraid that her desires for natural birth will no longer be supported. I want her to know that she can experience and release these feelings however she needs to, without anyone doubting her strength by offering drugs.  If that means that she becomes silent and centered within herself, that’s wonderful, and if she instead chants, “Give me drugs!” and “What was I thinking?” through every contraction, so be it. Coping comes in many different forms. She is free to do whatever works for her.

I want every mama to have the autonomy of knowing that a natural birth is something she chooses to do. Nobody is forcing this on her. Knowing that this is her choice allows her to believe in herself and experience her own strength. Yes, it’s hard. It hurts, and it’s work. She can do it – she already is. Nothing she can say will make me doubt her ability to get through this. For me or for anyone else to say, “You know, you can have an epidural if you want to” undermines her own power. I won’t do that.

I also want her to know that she has the right to change her mind, and that if she does, she will not be judged, shamed,  or abandoned. There are situations in which medications or anesthesia are exactly the right tool. That’s not all of the time, certainly, and probably not even most of the time, but there are circumstances when an epidural has made the difference between having a vaginal birth or having a cesarean.

Likewise, I will not stand in the place of telling someone that she cannot have anything she is asking for. I don’t control anyone else’s choices with her birth, ever. It would be nothing short of abusive to say, “No, you told me to tell you ‘no’ if you asked for medication. You said you didn’t really want it.” That would be my taking on a power that doesn’t belong to me in her birthing space.

So, we come up with a plan. I ask, “What do you want me to do if you say, ‘Give me drugs right this minute’? I already know that right now, that’s not the choice you prefer, and I will support you through every moment. I know you can do it. So, if you tell me that you’ve really changed your mind, what do you want me to do?” We talk over the possibilities.   I can go get the nurse.  I can offer to step out so she can talk it over with her partner. If she’s very close to giving birth, we might talk her through the necessary steps of making that decision, with the awareness that by the time all is said and done, her baby will likely be here.  (That might sound like “ok, first the nurse will need to hook up your IV, and that will take about 20 minutes to complete, then they’ll call anesthesia. It’s about another 20 minutes to get the epidural in place…”) Would she like for me to empathize that this is hard, and tell her that she’s doing it just right? Would she like me to suggest something else? (“Let’s get through this one first, and get you in a better position. Then we can talk through it if you still want to, you just let me know.”) We might decide in advance on a way that she will let me know – a code word, a phrase – that she has 100% changed her mind and there’s no conversation to be had. (If a mama tells me “I’m at red”, it means “we’re not even talking about it, call someone in here now.”)

The benefit of having this conversation in advance is that once we’ve come up with this plan, we hardly ever have to put it into action. There’s a clarity that comes with the knowing that this birth belongs to her, that she’s calling the shots with her own body, and that her desires will be taken seriously. Thinking through the possibilities and having a contingency plan in place allows her to have the peace of mind that comes with knowing that she can change her mind if she wants to, and that will be respected. Then she is fully able to release, surrender, trust in the process, trust in her body, and get through it in the way that feels exactly right to her. As her doula, that’s the best I could wish for her.

 

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I am a doula. I have worked with over 400 families.

I have known  mamas who breastfed easily, who cherished their nursing relationship.

I have known  mamas who struggled with babies who wouldn’t latch or wouldn’t gain weight, and breasts that never produced milk.

I have known mamas who chose to formula feed out of medical need.

I have known mamas who chose to formula feed from the beginning.

I have never known a mama who didn’t care that her baby was fed.

I support you.

I have known mamas who have birthed peacefully with no medication or intervention.

I have known mamas who struggled with labor that didn’t go as planned or hoped for, changing their course of action in the moment.

I have known mamas who have had cesarean births out of emergency.

I have known mamas who have chosen cesarean birth.

I have never known a mama who didn’t care that her baby was healthy and safe.

I support you.

Breast or bottle, vaginal or cesarean, co-sleeping or crib, stay-at-home or work-outside-the-home… It’s time to end the Mommy Wars. You love your children. Your heart swells with joy when they smile, and breaks when they cry. You worry, I worry. You toss and turn when all is not well, just like me. You hope that you’re doing it right. So do I. You care deeply that he or she is healthy, strong, loved, compassionate, and a functional adult who is an asset to the world when all is said and done. You’re doing everything in your power to make it so. Me, too.

For this, I support you.

Join me in supporting the I Support You movement. Find out more from Mama By The Bay, here.