Thursday, August 11, 2011

Monday, August 1, 2011

Send Me Your Birth Story!

To celebrate A Mom Is Born’s new logo and website, I’d like to honor women and their amazing power in birth. Something that is generally done in private in a hospital, birth is a secret, and it is not uncommon for pregnant women and their partners to have never seen an actual birth themselves. What is more frightening than the unknown? It’s tough to feel confident when navigating new territory – no wonder women’s expectations of themselves are that they are powerless. What we do see of birth on TV confirms that – women crazed or hysterical, narrowly averting death and danger, women lying down in bed under a tangle of wires and tubes with the soundtrack of beeping and flashing medical equipment.

Do you have a transformative birth story to share? Tell us your story of how YOU gave birth to your baby, not how your baby was delivered by the doc on-call. These stories should be real. Your story may include pain, but tell us about your perseverance. Your story may include fear, but tell us about your bravery. All kinds of stories are welcome.

You did it. Tell us the amazing story of how A Mom Is Born.

I will publish your birth story on my blog as a Birth Story of the Week, using only your 1st name.

Wednesday, June 1, 2011

About Doulas Behaving Badly

I was thrilled to see this resurface from Mother Wit Doula Lesley Everest. I, too, have been told by nursing and OB staff that I'm one of the only doulas they like -- those "other ones" have hidden agendas, or think their wishes are more important than the mother's, or are argumentative. 

In my professional support network, I don't have colleagues who see their role as agitator. And most of us have a preference for what  the mother in the room is showing us, so much so that we don't use information from the fetal monitor, let alone tinker with the machinery.  Do those doulas really exist? Who knows?  Everywhere, but particularly at the larger hospitals where I work and may not be a familiar face to the enormous staff, I mind my place within the hierarchy of hospital culture, and exercise my greatest skills in grace and diplomacy while still meeting the emotional and physical needs of my client. In the eyes of hospital staff, I am only as good as the doula they met before me, whether she is real or a stereotype, and so I am careful. Not only do I love my job, I also care deeply about my profession and the visibility of my professional community, and I envision a day when doulas are a valued, readily accepted part of maternity care

But sometimes it is tricky. As a doula, I have the benefit of a prenatal relationship with my clients, whereas the nurses and OB/midwives don't. There's a lot that I know about what sorts of meanings a woman has associated with her pregnancy, labor, birth, and post-partum. A few weeks ago, my client gave birth to her beautiful baby girl. My client had had a breast reduction some 15 years prior, and it was a goal for her to have as much of a breastfeeding relationship with her baby as she possibly could. She'd done so much reading about Breastfeeding After Reduction, perhaps even more than she'd read about birth.

She knew about the benefits of immediate, uninterrupted skin-to-skin, and it's correlation with higher breastfeeding rates. She reviewed it with her OB, who assured her that skin-to-skin was preferable also from the hospital's point of view, and that as long as there was no need for the baby to go to a warmer or be evaluated by pediatricians, skin-to-skin was the plan. And it did happen. Immediately after the baby emerged, she was placed right on her mother's naked, warm, receptive chest.

For seven minutes.

At seven minutes of life, definitely not an hour, and certainly not before the OB was done even repairing the perineum, the nurse said "Let's weigh her. Of course you want to know what the baby weighs, right?"

A doula's best advocacy tool is to remind her client about choices. If it isn't feasible for the mother to absorb that in any moment, then the next best person is her partner. My client's partner, her husband, was within my reach at that moment. I tapped him on the back and whispered in his ear -- "Do you want to know what the baby weighs, or do you think they'd like more skin-to-skin time?"  He moved quickly from behind his camera and asked the nurse, very politely, for more time, since mom and baby seemed so cozy,  and the nurse agreed.

At 20 minutes of life, so 13 minutes later, the nurse indicated that she needed to weigh the baby  in case she was over 9 lbs and needed blood sugars tested. Baby weighed in at 8.13, and the nurse began to diaper the baby, cover her sweet head with a hat, and then laid out swaddling blankets.

This time the dad was out of my reach, so I couldn't whisper a reminder of all that the mother had read and wanted. It is usually my last option, but I had to exercise it -- and I asked my client in my normal voice, "You can hold her again. Do you want her swaddled, or do you want her naked on your skin?"

The mother's eyes lit up with excitement. "Oh, naked for sure!"

The nurse's jaw stiffenened tight as she began to undo the swaddle. She was definitely displeased and looked at me sternly as she said, "Just be sure the baby is warm enough."

So is that the equivalent of taking a patient off a monitor? Is that the same as undoing an IV? Am I a doula behaving badly? That nurse probably thinks so, and I don't think I've done much to advance my field in her eyes.

But I can live with that.


Friday, February 11, 2011

Less is More

We all know the black and white, or red and blue, of politics. As we quarrel our polemics, so much rich grey gets lost in-between. Birth politics is no different.

Consider this article which appeared in yesterday's news: less is more. It's not all or nothing, one way or the other. It's actually more sophisticated than that: Less Is More. Not only the quantifiable Less Is More, in that when women are in control of their anesthesia doses, they will use less. But Less Numbness is More Satisfaction. Imagine the larger implication: women who have epidurals can also have satisfying birth experiences.

It silences all the propaganda, from both sides: "Why feel pain in an age of modern medicine?" and "Women must completely relish all the sensations of this most natural rite of passage into motherhood!" 

There is such vastness between those two corners into which we paint ourselves for the sake of a sound argument. And who gets to explore that vastness? With this finding about Less is More, the laboring woman gets to explore it for herself, and she gets to define her own world amidst those corners. Even if she has an epidural.

I have attended to women who were certain they would approach their birth in one singular way, they prepared for it, practiced, and knew -- just knew -- that this was how they wanted to give birth. And when labor came around, things changed. It wasn't what they thought it would be. And they found themselves facing decisions they didn't think they would encounter. And they find that they are not actually black and white, they are a whole spectrum of color and shades and textures -- and a whole birth experience exists that is so much more layered than what they thought.

Central to this experience, of course, is autonomy. Mom can choose if Less is More. Or she can choose if More is More. She can decide if None is Bad. or if All is Good. She can circle all those option if she wants, because there is no single right answer, and no one way to give birth. And when she makes her choices from an informed and educated place, with supportive caregivers and loved ones holding her hand, then she can define Satisfaction, as she sees it.


Thursday, December 30, 2010

Affirmation for a New Year

Having been nearly two years since I purposefully exercised, I went to a sunrise yoga class. Pre-sunrise, actually, so that my sacrifice is clear. Twenty-five degrees and dark, and I willfully got up out of bed and dragged my creaking 40-yet-feels-like-90 year old body to a yoga studio.

And like the sun rising over the horizon, I eased right back in. Years of practice and teacher training came back seamlessly. It wasn't easy, for sure. But I did it.

And the one thought that kept coming to me as I moved from one pose into another was: Always have faith in your body.

I felt like one of my laboring moms, realizing the strength and depth of resource that we all have within ourselves to give birth -- to a child, or to our new and improved selves.

Happy New Year, to all my friends and family, to my Facebook and blog readers, and most of all to the women and couples and children who have allowed me to participate in the birth of their families. May I never lose sight of the privilege I've been given.

Tuesday, October 5, 2010

To Empower...? Maybe not!

Recently, a friend (not a birth professional, because I do interact with a whole slew of people out there who have fairly normal jobs with predictable hours!) was discussing her work with me. Part of her work, she felt was "to empower people" as much as she could.

It's not the first time I've heard the word empower used that way. But I look at it the way I look at women who say their OB's delivered their babies -- Who is empowering whom? And with whose power?

As a doula, I don't have any special powers or magic dust. I am not a supernatural force field against a c-section or traumatic birth. And I don't have the ability to empower. I relish helping women feel safe, relaxed, and informed; and it's within that framework that I hope they can tap into a strength and faith that is all their own. I can't empower them any more than I can push their babies out for them.

Tricky stuff, language. And words often reflect our cultural, social, or ideological beliefs, as seen in the fact that many women don't refer to giving birth to their babies, but their babies are delivered. Delivered by whom? By the doc on call.

Doulas, in their websites or marketing strategies often state that one of their jobs is to empower women. I feel very strongly that this is not what I do.

Sunday, October 3, 2010

--An Unmedicated VBAC? Really? --Yes, Really!

My client was underneath a heated blanket, her naked newborn boy snuggled on her naked chest. She was marvelling at how special the immediate skin-to-skin experience was, particularly because she had delayed skin-to-skin with her first, as she was born by c-section. This was one of her largest motivators in aiming for a VBAC.

"That was amazing," she said. "I can't believe I did it."

"Not only did you do it," chimed in the attending OB from where she was counting instruments, "but you did it unmedicated. Almost no one can say that."

My client's VBAC certainly is a personal victory; given today's VBAC climate -- despite the NIH findings that a trial of labor after a c-section is actually safer than a repeat c-section -- it is a political victory as well. But the OB's comments are sticking with me because my witnessing of unmedicated VBAC seems to be the direct opposite of hers. I have attended about a dozen VBAC's in the past year, and all but 2 did it unmedicated (and those two had c-sections, one after a trial of labor, the other with no trial of labor).

Looking at older (2005) statistics from the MA Department of Public Health, epidural use was between 60-70 percent at the hospitals I frequent the most. Whereas those who work on L&D have seen probably thousands more births than I ever will, I think I have been a part of more unmedicated births because I am trained and experienced in specific, non-pharmacological, emotional and physical comfort measures that provide pain relief, and because I provide home support -- where that is the only option available.

My client had been admitted at 8cm, and was showing some of the "classic" signs of transition. All kinds of things were coming out of her mouth. Her sentences, all stream-of-consciousness and irrational, generously peppered with various forms of the word "f*ck," were basically amounting to the fact that she didn't want another single contraction, and that she wanted to put on her clothes and go home. When she said she couldn't figure out if she needed to pee really badly or if she needed to have a bowel movement, she began asking for an epidural.

When the OB said she was dilated to "9 and a lip" (a lip is a bit of remaining cervix that has not dilated), all my client heard was that she wasn't 10 cm, and her request for an epidural turned into a demand. Feeling the arc of this birth unfolding, I did exactly as I had promised her I'd do if she asked for an epidural -- talk her out of it. I explained to her that all the pressure she was feeling was the baby moving down through her pelvis. She resisted, saying again that either she wanted to put her clothes on and go home, or get an epidural. The nurse said, "OK, if you're sure an epidural is what you really want." She said it with great hesitation, probably because she knew this baby's birth was not far off, and because by the time anesthesia would have gotten there and placed the medication, the baby would have been born already. And probably because she didn't know what else to say, other than the words she needed to order an epidural .

Knowing that pushing would be a relief, as it is for many women, I said to her, "Pushing and getting this baby out is the best pain relief you can get." I asked the OB quickly, "Can she push past the lip?"

The OB took a deep breath and carefully considered my question, and I wondered if she'd ever been asked that before. I could practically see the light bulb going off in her head before she said, "I don't think that pushing past the lip will interfere with her progress at all."

My client needed convincing to push, so I suggested she push just to try it, and see if it helped any. The lip was anterior (towards my client's pubic bone), so I suggested she get back on hands and knees so that the baby's head would finally press out that lip. She pushed with the strength of an army of men, and 20 minutes later, my client was holding her baby in her arms.

What would have happened if my client had gotten the epidural, assuming that there would have been time to place it? Her baby was coming with such force that it is doubtful an epidural would have slowed the contractions, especially at 9+cm. For the same reason, I can't imagine it would have drawn out the pushing stage into anything long and exhausting, as can also happen with an epidural. She would have had a happy and healthy baby, and she would have done so via VBAC. And retrospectively, perhaps she would have been just fine with getting the epidural, especially when she'd get to the part of the story where she would describe the amount of pain she was in. It all would have been fine, probably, but I am thrilled that my client does not need to reconcile her goals for her birth with its outcome.

Lesley Everett, a doula in Montreal, just led a doula training for L&D nurses. The snippets of what she shared from that experience are encouraging -- many of the nurses who attended expressed some layered frustrations; not only do they not have the knowledge on how to support women who are laboring without an epidural, they have too many patients at one time to provide the focused and concentrated work of unmedicated labor support. Combine that with the fact that the spectrum of emotions and behaviors that unmedicated women present with can be pretty darn intimidating if you are not accustomed to it. What results is a lack of practice, which leads to lack of confidence, which leads to a lack of practice.

I am heartened by Lesley's work, and I'm hoping that my client's birth experience prompted some out-of-the-box thinking for the hospital staff involved, a gentle reminder that babies are born in hundreds of ways, as long as the mothers have knowledgeable support.


Tuesday, September 28, 2010

See What You Can Do? (And you're not even in labor yet!!)

I have a client due now-ish, someone whom I've felt a sweet connection to from the beginning. The stakes are high for her, as she wants to have a VBAC, and she deeply questions the necessity of her c-section a few years ago.

This client, like many VBAC women, has a "supportive" OB -- who has scheduled her repeat c-section for one week past her due date. And like many VBAC women, is under a tremendous amount of pressure to go into labor spontaneously and has spent many hours fretting, losing valuable sleep as she worries about how to get labor started.

She has armed herself with tons of information, so she knows that VBAC theoretically has less inherent risks than repeat cesarean. She understands that a healthy, spontaneous labor can begin at 42 weeks, which is 2 weeks past a due date. She understands the details of her own c-section and why she is particularly low risk for possible VBAC complications. In fact, a lot of this information came from her supportive OB -- the one who scheduled her repeat c-section.

She understands that hospitals have administrative protocols, so perhaps that is the sole reason why her surgery was scheduled. When the hospital sent forms for her to sign, her OB said, "Oh, don't worry about those things!" But her due date is approaching, and the supportive OB is now saying "Hopefully we won't get to that date, so let's not worry about it now."

But she is starting to worry, because that repeat section certainly becomes more possible with each passing day.

And then yesterday she had high blood pressure. She's a pregnant woman at 39 weeks, moving triple her usual blood volume and supporting another life inside her own body. She's working hard. She's also caring for a toddler. And she's anxious about her baby's upcoming birth. Of course she's got high blood pressure.

Her OB's solution to high blood pressure is to make her not be pregnant anymore (and notice that what my client has is high blood pressure, not pre-eclampsia, and it is important to know the difference). She has swept her membranes, and wants her to return in 24 hours for another blood pressure check and for another sweeping "if this doesn't work." And then the next step would be for an induction, if her cervix is favorable. And if not, c-section.

Between now and then, I gave her a few suggestions. She has been avoiding salt, but I explained to her why the body actually needs salt and so suggested that she use a little sea salt on one small thing on her plate. I also suggested soaking in epsom salt baths, maybe 2-3 times before she returned for the blood pressure check. I also suggested that she reach out to her ever-loving network of family and friends who have offered to help her when the new baby comes and tell them she needs their help NOW, to care for her daughter, to cook up a few meals, to run some errands -- because nothing is more important right now than putting her feet up, resting, drinking lots of water, and putting to use those very same meditation and visualization exercises for labor that she's been practicing for weeks.

She returned to the OB, and guess what. Her blood pressure was down. Not only that, physically she felt better. She thanked me for the suggestions, but I told her it was her body, and that she had done it. Just wait till she's in labor.

Thursday, May 13, 2010

What's a Good Doula to Do?

Recently, one of my clients went in for a c-section after a trial of labor. The nurses could see how much support I was providing my client, who was definitely more than panicked by labor. I'd say she was bordering on hysteria at times, but with guided visualization and breathing exercises led by me, she would calm down.

When the nurses brought scrubs for the husband to wear into the OR, they gave me a set, too. "She needs you in there," they said.

I went into the bathroom to change, and I could hear the anesthesiologist saying no. Rather than put the scrubs on, I came back out. I asked the nurse "No go?"

The anesthesiologist looked at me directly -- and not unkindly -- said no, I could not go in. She even said she was sorry, then explained to my client "There's just so little space in the OR, and with both your husband there and your doula, it will be too crowded."

I have to admit that I was disappointed, having never been in the OR yet, but I readily accepted her decision. Doulas almost never go into the OR. More importantly, I felt like my client had no expectation for me to be there, and she was fine with it. I told her I'd wait in her room, that I'd be there as soon as they brought her back in, and that I couldn't wait for her to introduce me to her baby.

Soon it was just me in the room, and I was tidying up my client's belongings. Another nurse came in. "Do you still have the scrubs?" she asked. "Put them on, because I think you should go in there."

I told her that the anesthesiologist had already refused me (what I learned in training was that it was the anesthesiologist's call, since doulas and partners would need to share the same space with that doc).

She shook her head. "I'm the OR charge nurse" (or whatever her title was...), "and it's no one's decision but mine, and your patient needs you."

"Is she having another panic attack?" I asked.

"No," said the nurse, "but if she does, you're the one she responds to."

Truly, I felt that my client and her husband were fine, even relieved to choose a c-section (and they did choose it). I said to the nurse, "The anesthesiologist looked right at me and told me no."

"But it's my call," she insisted. "They won't give you a hard time, they'll give me a hard time."

Had my client been unravelling, perhaps I would have reconsidered -- perhaps. But doulas walk such a tough line in the hospital; I'm only as good as the doula the staff has dealt with just prior to me, and whatever I do sets the mood for the doula they encounter after me. And doulas have to work hard to earn the respect of OB's, more often than not. Ultimately, I decided not to go.

What would you have done?


Sunday, May 9, 2010

Happy Mother's Day! (Or What Goes Around, Comes Around)

Often I've heard people scoff at Mother's Day, calling it a "Hallmark" holiday, just another opportunity to increase sales.

But on a personal note, having lost my mother when I was only 14 years old, I spent many, many years yearning to send my mother a Mother's day card. I did send cards to the mother-figures in my life, and thankfully I've had many of them, including my mother-in-law; but nothing ever truly filled the void.

My mother died when I was so young, and consequently there are many things I did not get to experience as a daughter. As I grew older, I had to rely on my imagination as much as my limited memory to know what it was like to have a mother.

But then Soledad came into the world, and I knew -- the overwhelming love, the sudden obligation, the inextinguishable need to protect. This is what it is like to be the daughter of a mother. This is how my mother loved me; there are no more doubts.

And magically, (and perhaps coincidentally, since I was gone for the better part of 4 days attending births this week) these are the paintings my daughters made for me on Mother's Day.

The one on the right was made by my oldest daughter. On the back, she wrote: "I remember being in your stomach!" The one on the left was made by my middle daughter. She handed it to me, and I assumed she was following her sister's lead as she often does, painting herself in my belly. "Mama," she said, "this is you inside your mom's belly!"

What goes around, comes around.