Catching Our Babies

Seattle Channel Video can be played in Flash Player 9 and up

The Pediatric Airway - Guest Blogger

Terri is a newer blogger over at RN Perspective. She has been a pediatric nurse and wants to share her insight with new parents. She initially contacted me to share her awesome post about Why You Should Choose a Birth Center, and I invite you to go read it, as she is looking for feedback from people who have used a birth center instead of a hospital.

Terri also offered to write a pediatric piece applicable to the Spring/Summer season. I invite you to read it as I learned something new and hope you do as well.

The Pediatric Airway

As a pediatric RN, I’ve worked with newborns and adolescents. One of the most common problems I encounter among pediatrics regardless of the age group is an issue with breathing/reactive airway. The term reactive airway and asthma are often used interchangeable, but I’m here to tell you that they are not necessarily the same condition. 

With reactive airway disease (RAD), there is not really a specific diagnosis, it’s a term used to describe symptoms such as coughing, wheezing and shortness of breath with an unknown cause. On the other hand, asthma is a chronic inflammatory disorder of the airways, which causes attacks of wheezing, shortness of breath, chest tightness, and coughing. So as you can imagine, there are times when kids with asthma are mistakenly diagnosed with RAD and vice versa.

Though some people think there is only one main cause of asthma symptoms, there are actually two main causes: airway constriction and airway inflammation, when the airways of the lungs are swollen and irritated (click for a look inside your lungs)

So what should you do if your child is diagnosed with asthma?

My Advice: Be a partner with your healthcare provider is finding the right combinations of medications. Be informed and reinforce education about the diagnosis with your child. Emphasize with your child that this condition is treatable and once there medication is under control they can do the same things as other children. Believe it or not, participating in sporting activities will help strengthen the lungs, so don’t limit your child. Asthma is not a shameful disease so encourage your kids to share their condition with their friends. For instance, you can have your child tell his/her friend in order for me to breathe better I need to use my inhaler before we play sports. No one wants to stand out or be different so find ways to remove the stigma.

I’m a pediatric RN on a surgical floor so I’ve seen lots of interesting procedures. The best thing about my job is that I’m able to give sick children and their families hope. I’ve learned that the most important thing in caring for a child is listening to their parents. No one knows their child better than a parent, so when a parent tells me they notice a change in their child’s behavior that’s a huge clue. I’ve always known I wanted to work with children and I could not be happier with my career. Follow me at RN Perspective to learn more.

For additional reading on alternative treatments to discuss with your care provider, see here, here, and here. Course of treatment should be decided on specific to the individuals needs, as there is no one treatment for every child.

Progressive Parenting Radio

Gina Kirby is on Progressive Parenting talking about doulas! :)

This is the first installment of a three week series covering the last weeks of pregnancy for first time parents.  Host, Gena Kirby, who is also a Doula, will share (over the air) what actually happens between a pregnant couple and the guardian of their journey.  This is reality radio at it's best!  In the third installment (if baby cooperates) we will be discussing the birth and how these new parents feel about their experience.

Listen to internet radio with ProgressiveParenting on Blog Talk Radio

Additionally, they have a great show up on out-of-hospital birth options.

Her guest on this show is be Kaitlin Rose Parmenter of Bring Birth Home. BBH is a great resource for parents wanting to learn more about their options outside a hospital or birth center. Hospital birth is fairly new to us, as far as the history of man is concerned. To put this in perspective name the first US president who was born in a hospital. More and more women are choosing to have their babies at home. Later in the show she is joined by Mrs. Birth Without Fear!

Listen to internet radio with ProgressiveParenting on Blog Talk Radio

Opening

Labor is not about dilation, it is about opening. Opening of the mind, to invite yourself to new horizons. Opening of the heart, to love another life even moreso than your own. Opening of the spirit, to walk in a faith that may require sacrificing everything. And opening of the body, to willingly surrender control of the life it contains.

A Chance To Make a Change

I just finished up writing a quick post on the FDA seizing birth pools that arrived in the U.S. and were slated to be delivered to home, birth center, and hospital birthing women around America.

Since the original notification, and as passion and frustration continues to mount, I ask that we take a moment to consider the implications of our words and actions. 

How can we help?

• First off, let me say that the best help we can be for the business owners and companies who are being impacted by this action is not to bombard them with questions, phone calls, and emails. They are, no doubt, working hard to try to find resolution to this issue while also helping to maintain women's options and access to water birthing pools. This is undoubtedly a frustrating time, and our impassioned words should be tempered (myself included) with prudence and wisdom.
• Second, until there is resolution, we should not stoke the fires of panic. Instead, reduce, reuse, recycle. Have a birth pool in the attic? Consider offering it to other women in your community who are planning on a water birth. Have extra liners? Share. Run out of liners? Use California King mattress covers as liners. :) Until this is resolved, we know that our access to birth pools will be limited, so let's rally support for one another. 
• Third, write NON-HOSTILE letters to our state representatives and on our own social media sites encouraging positive change and support for these companies and the women they serve.  
• And last, if you KNOW someone who has had a water birth in what might be able to be considered a water birthing POOL/TUB before 1976, PLEASE have them contact Barbara Harper so that she can get you both in contact with those who could use the information to attempt to grandfather the birthing pools in.

Our focus should be to elicit positive change, while also influencing the powers that be to consider the implications of limiting women's birthing options. Just as midwifery that was outlawed simply forced midwives underground... and outlawing home birth just forced home birth underground, so would, ultimately, strictures on birth pool availability.

The goal, then, should be to make sure that we don't allow it to get to that point.

Taking a cue from the Big Push and other organizations that have much experience in birth option government limitations, I recommend that we begin a letter writing campaign to the state legislatures that can lobby on our behalf to reign in the FDA, release our birth pools, and start a positive discourse for resolution to this issue so that it does not come up again.

This might mean that we have to come up with a classification of approval in order to retain active access to our birthing options. But, in the mean time, let's get our birthing pools back into the hands of the women who they benefit.

"The use of water as an option, a choice, a way of receiving comfort in labor, has always been for me, a platform upon which I stand to have a conversation about birth - all aspects of birth.  I don't really care what pool one uses, or where that birth happens, as long as the birth AND the baby are respected.  Do I have personal preferences?  Of course, but there is a joy that happens when I see waterbirth introduced into a hospital and the cesarean rate drops or when other practices change in the hospital after the staff witnesses the power of undisturbed birth.


I firmly believe we can continue to use this platform to talk about all the issues that plague us today and stop the polarization of home versus hospital, CNM versus CPM, OBs versus midwives.  All women deserve the choice of undistrubed birth and how we come together to make that happen will be the deciding factor.  Let's use this current confrontation to our best advantage and form a united movement to insure that waterbirth, midwifery, home birth, and undistrubed birth in any setting by any provider remain options for all women, all babies and all families throughout the US and around the world." - Barbara Harper

The Letter
Please see the letter below and feel free to cut/paste/modify as you see fit.

Then, send it..

send it to your local representatives, Tweet it, FaceBook it, and email it to your friends, peers, and coworkers.

Dear ______________________,

I’m writing in response to the recent FDA's hold on a shipment of birthing pools destined for pregnant women who were looking forward to using them during their labors and/or births.

The FDA has placed a detention on incoming shipments of portable birth pools and have given the distributors/manufacturers various deadlines for compliance. The FDA claims that these pools are unregistered medical equipment, but they are, as of yet, not providing a way or means to get them registered.

The FDA is requiring a 510(k) – PreMarket Authorization – to be turned in for each Inflatable Birth Pool. The problem is that there is no Pre-existing Medical Device – “Predicate” – already approved by the FDA. Hence, we are potentially looking at of years of clinical trials and legal fees that can cost up to a million or more.

While a new classification is being drafted, outlined, and implemented, numerous women around the United States will be without birthing pools, a very valid means of labor pain management utilized by many of the home birth community and some of the birth center and hospital community.
As taxpayers and as mothers, we find it unacceptable that our choices are being limited by the restrictions and detention of these pools as set forth by the FDA.

The option of water birth has been shown in numerous medical studies to decrease the use of medical intervention, which, in turn, reduces the incidence of cesarean and iatrogenic risk, resulting in healthier and safer labors and births. Additionally, with health care costs rising, the use of something as simple as a birthing tub can drastically reduce the costs associated with childbirth.

By limiting, even short-term, women’s access to inflatable pools used in labor and birth, the FDA is seeking to limit access to a safe and effective means for reducing risk during the process itself.

Additionally, the very definition of medical equipment is debatable. Should toilets, rebozos, couches, and physical therapy balls be subjected to FDA approval for the act of birth? Like birth tubs, these are all routinely used in healthy, normal pregnancy and births. Should these also be considered durable medical equipment and be regulated?

The term, medical, is defined as: relating to the science or practice of medicine. Likewise, the definition of medicine is: The science or practice of the diagnosis, treatment, and prevention of disease (in technical use often taken to exclude surgery), or a drug or other preparation used for the treatment or prevention of disease.

As such, medical equipment would be defined as: equipment related to the science or practice of the science, or practice of the diagnosis, treatment, and prevention, of disease.

The use of birth tubs are, in most cases, reserved for the healthy and low-risk birthing woman. As such, her care does not automatically fall under the classification of a medical event and birth pools should not be denoted under the classification of medical equipment.

We urge you to advocate for the women within your communities; women who are giving birth and who have a right to safe and effective health care.

Please support us in allowing the birthing pools that have been confiscated by the FDA to be distributed to their rightful owners. Help us also then to work with the FDA, the manufacturers of these pools, and the caregivers who assist us during our labors, to come to a consensus as to how to move forward, without putting restrictions on our safe birth practices in the process.

Sincerely,
Cole Deelah
Supporter of Women’s Birth Options
and mother of five beautiful children

You can send this letter by email, by mail, or by hand to your local representatives.

• If you are in Texas, reach out to your legislatures here. 
• If you are in Michigan, see here. 
• If you are in Tennessee, see here.
• If you are anywhere else and need help finding out who your representatives are, see here.

Remember, this is time sensitive. Change is inevitable, let's make sure that it is good change.

UPDATE: please note there has been an update on everything! The pools have been released to the company that had them shipped in, but the FDA has told them they are not to sell them. The companies are still working with the FDA to be able to reach their personal deadlines of compliance and are attempting to work out a reasonable solution for the future of water birth pools.

Our letter writing campaign is still very important! Please continue to contact your local representatives, but consider changing the verbiage to reflect these updates.

Please read Laurel's follow up post here for more information.

The FDA is Having a Pool Party

www.richmondmidwife.com

And we weren't invited.

This morning I got onto Facebook to read that Barbara Harper posted a note. The information within it floored me.

The FDA has confiscated a shipment of birthing pools and is holding them.

These pools were destined for a company that sells many home birthing supplies that are medical and non-medical, where they would then be distributed to the women who purchased them for a water birth..   

The directives are clear: they will be destroyed or shipped out. Their reasoning? They are stating that birth pools are medical equipment.

The FDA says that birth pools are unregistered/unapproved medical equipment... really? REALLY?

"Got a kiddie pool in your house?  Watch out!  The FDA may be coming after you!   No… seriously, they might be knocking on your door to seize your unregistered medical device! No joke!" - Danielle from Being Pregnant

I think we should flood the FDA with requests to approve all other 'medical equipment', including: birth stools, my kitchen chair, washcloths, regular baths, shower heads, fish nets, submersible pumps, toilet, breast pump, bed, dining room floor, kitchen floor, rocking chair, sofa, ice maker, rice sock, Tingler, rebozo and husband... oh, and let's not forget ME! (not really, but this is my knee-jerk reaction).

"And therefore since one arm of the U.S. government believes that pregnancy is an illness and birth is a medical event and anything that is used during this time is considered a device that needs to be approved by the FDA, what is the next option/choice to go?" - Childbirth Today

This just fumes me... and I hope it does you too!

So, the federal government now consider birth a medical event... As far as I knew, it was state by state whether legislature considered childbirth a medical event or not (i.e. midwives practicing medicine without a license or simply providing a service).

Additionally, the very DEFINITION of medical is: Relating to the science or practice of medicine...

Likewise, the definition of medicine is: The science or practice of the diagnosis, treatment, and prevention of disease (in technical use often taken to exclude surgery), or a drug or other preparation used for the treatment or prevention of disease...

So MEDICAL EQUIPMENT means: equipment related to the science or practice of the science, or practice of the diagnosis, treatment, and prevention, of DISEASE!...

uh... childbirth is NOT A DISEASE!

Laurel Ripple Carpenter quickly got a blog post up and running, seeking to inform others about this issue and to rally support.

According to Barbara Harper, author of Gentle Birth Choices and founder of Waterbirth International, the FDA has seized a shipping container of AquaBorn birthing pools at a dock in Portland, Oregon, and have ordered agents to “inspect and destroy.”

“They claim they are unregistered medical equipment, but they are not providing a way or means to get them registered. In other words, if the medical authorities can’t stop waterbirth, then just have the FDA take away the birth pools,” she explains in a lengthy discussion that began yesterday.

While birth pools are imported to Canada under the category “paddling pools” and some are imported here in the U.S. under the category “sitz baths,” they have no legal standing as medical equipment at this time.

But why would they?  They are purchased or rented for personal use in private homes.  Barbara’s conversation with an FDA official may shed some light on this as a clash of perspectives.  She explains that she was told, “Pregnancy is an illness and birth is a medical event. Therefore, a pool that a woman gives birth in should be classified as medical equipment.”   So what about our toilets, our bathtubs, our showers?  Kiddie pools, horse troughs, hot tubs?  Oh, and what about the fact that pregnancy is *not* an illness?

What the FDA Wants
Martha Blackmore Althouse, owner and manager of Waterbirth Solutions in Beaverton, Oregon, has been interacting with attorneys and the FDA on the issue.  She explains:

The FDA is requiring a 510(k) – PreMarket Authorization – to be turned in for each Inflatable Birth Pool. The problem is that there is no Pre-existing Medical Device – “Predicate” – already approved by the FDA. Hence, potential of years of clinical trials and legal fees that can cost up to a million or more. Obviously not feasible.

One potential loop hole is a “PreAmendment Status” product. If there was anyone in the US using birth pools (yes, troughs, tubs of any kind) prior to May 1978, we can get “Birth Pools” grandfathered in to the FDA as an approved Medical Device. Waterbirth would have permanent legitimacy and could not be questioned any further.

So it seems that there could be a solution to this, but not before enduring a long process full of red tape and bureaucracy.

How to Help
Martha and Barbara need help – specifically, a high profile attorney and support from any midwives who were practicing waterbirth before 1978.

“If you know of anyone practicing waterbirth prior to 1978, please let them know we could use their help,” Martha pleads.  That would be the only way to establish birth pools as eligible to be grandfathered in.  Also, “We need a high profile attorney to highlight the ludicrous nature of this attempt at taking away women’s choices for comfort in labour,” explains Barbara.

This whole thing seems pretty baffling, and I still find myself wondering if it could possibly be real.  But evidently, according to several trusted names in the birth world, it is.  So let’s get on it–Facebook, Twitter, and your whole Rolodex full of powerful connections.  Hit ‘em up.

See the original note here. See the follow up here, then go to Enjoy Birth's Blog to vote on if birth pools should be considered 'medical equipment'.

UPDATE: Here is the followup post. Please help us take what positive action we can to get these birth options back into the hands of the women who need them.

Our Own Worst Enemy

Lesley over at MotherWit wrote a post last year on Doulas Behaving Badly. This post returns to mind often, as I am seeing an increasing number of doctors and practices in my area refusing to ‘allow’ patients to have a doula attend them during their birthing time.

I love her post, it resounds so true, and is a great jumping off point for my own thoughts on the subject.

“... my purpose and my goal is to ensure women get the best possible care within the system they choose. This is not by control, but by support.” Lesley Everest

When I speak with women during labor and birth, it is never with bias or coercion, This is an important one – all doulas start their businesses with passion; a passion for things to happen the ‘right way’ or the ‘best way’… but, through experience and personal growth, we should all come to the realization that, as our name implies, our job is not to give every woman the ‘right’ or ‘best’ way to birth in our own eyes..

Our job is, as doulas, to give every woman ‘her right and best way to birth’ to the best of our abilities.

Much of this is accomplished prenatally.

We have all have encountered the women who want a doula to ‘save’ them from the experience of a hospital birth, and yet, they are choosing a hospital birth. My role, every doula’s role, is not to save a woman from the situation that she places herself in, instead it is to educate her prenatally on how to be an empowered and educated consumer within the system that they choose.

If a woman chooses a doctor whom I think it paternalistic and controlling, I will be sure to point out the inconsistencies in what she says she wants and the type of care giver she is choosing. If she persists with that caregiver, though, she has chosen that caregiver.

My job is to support her choices.

I cringe so hard when I read reports and hear stories like the ones in Doula Makes Four. In this article, a doula ends up walking out on a family who, prenatally, wanted a natural birth but, because of her particular labor situation, chose to have an epidural. In another example, a LC encourages a mom to take her preemies off of formula and only IV nourishment until mom was able to nurse.

I know doulas who have:

• Grabbed doctor’s hands to stop them
• Walked out on families who deviate from their birth plans
• Coarsely and rudely ‘call doctor’s out’ in front of their patients
• Turned off pitocin
• Yelled at nurses or spoken down to them

Again, my job is to support the woman’s choices, not make them for her.

Don’t get me wrong, I work my butt off to keep her on track with her prenatal choices and desires, but I, like any wise woman in the childbirth field, will tell you: labor and birth is organic, unscriptable, unknown.

It is best supported knowing what you want, doing all you can prenatally to ensure that the goal is feasibly accessible, and then working hard to achieve it.

That means, while in the birthing room, my job is to make communication between her caregiver and herself fluid and open. It is not my job to grapple with the medical staff, inhibit their care of our mutual client, or make choices for the couple I am working with.

If the mother has given me expressed desires, though, I will be sure to remind her of those throughout the birth journey so that she can make her own choices while traversing her own organic experience.

I do not give medical advice; I supply women with many options and recommend that she talk with her provider about which would be appropriate, through analysis of the risks and benefits, for her particular case.

I do not unhook a woman from IVs, encourage her to check herself out of the hospital AMA, or take women off of EFM. Though, I will remind a woman of how long she has been on them, ask the nurse if mom can get off the monitors, and be truthful with a mother about the ability to refuse any treatment at any time.

Doulas who create an atmosphere of tension, a power struggle, with the care providers whom the woman has chosen are stepping outside their role as a doula.

Doulas who tamper with medical equipment without notifying the medical staff or otherwise inhibit their care of the client are stepping outside their role as a doula.

Doulas who openly argue with nurses and care providers, contradicting them or openly and hostilely confronting them are doing their clients a disservice, not supporting the client’s choices, and stepping outside their role as a doula.

And the long term consequences of these actions are becoming evident: doulas are getting banned from doctors clients, offices clients, and even whole hospitals.

Now, I won’t place all of the blame on doulas…

Sometimes women choose to have a close female friend attend them at their birthing time – acting as their doula. This is a great option if you have a wholly supportive and educated female friend.

If you are one of those women and your friend does attend you during your birth though, please don't refer to her as your doula, call her your friend. I have been privy to a few occasions where a friend calls herself a doula, acts outside the standard of practice of a doula, and, as a result, taints the name of doulas to that particular doctor or practice.

The result could mean doulas being banned from that particular practice or hospital.

Bottom line, all of you Doulas behaving badly: cut it out. We have worked hard, as professionals, to create a standard of practice. If you want, consider it working within enemy lines, but the truth of the matter is this: in most situations we are all on the same team. We all want what we see is best for the women we serve.

Just as a mother hires her provider to provide her a service of childbearing care, so is she hiring you to provide her a service of educating and empowering her… not robbing her of that empowering opportunity by taking that power into your own hands.

You work for her… as a woman’s servant.

“You may justify yourselves all you want by making snide remarks about brown nose diplomacy. I would rather wipe off the occasional stain than have my spotless snout shut out entirely and responsible for leaving vulnerable women unbuffered in that system”... “Instead of healing this birth culture through your angry, righteous approach, you are going to get doulas, the very ones who hold the power to heal it, barred from hospitals entirely.” - Lesley Everest

Birth Movement

I have been sitting and hemming and hawing and procrastinating on this e-book review for quite some time. Don't get me wrong, I was excited to do it, but life has been so busy lately, I had little time to stop and read for leisure (yes, my leisure reading consists of birthy books too).

Well, this past month I have been doing a lot of catch up reading, and Birth Movement has been one of them.

Jun-Nicole Matsushita, MA, CD (CBI), is a Certified Labor Doula and owner of Bamboo Birth Services. She lives in Iowa City with her husband and two sons, both born without intervention at the University of Iowa Hospitals and Clinics.

As a doula, Matsushita, uses her training and background as an instructor and scholar in physical education and health to help women prepare for and experience their births as empowered and active participants. She considers birth to be the ultimate physical event and firmly believes in the benefits of physical, mental, as well as emotional preparation for the labor and birth process.

In addition to her role as a doula, Matsushita is the founder of the not-forprofit tsunami relief organization, HUGS: Help Us Give Slings, babywearing instructor, and co-leader of the Iowa City Doulas.

Birth Movement is a quick and easy read that shows wonderfully detailed pictures of different positions for laboring and birthing in the hospital environment through the use of a birthing ball, birth bed, squat bar, and birth sling.

Although there are many positions that I, as a doula use, that were not shown in this book, for the conciseness and ease of reading, there were plenty of positions that I do employ the use of.

The pictures were well described and the positions were well represented. The booklet is small enough that I believe it to be a great asset to the families that I work with (especially the partners/men who don't 'like to read') that I will definitely be recommending this booklet from now on.

It is easy to see that Matsushita is a well versed and knowledgable doula, and I think that her book will be a wonderful addition to many a doulas birthing bags. All in all, I thought this a great downloadable book worthy of noting for the Month of May, International Doula Month.

Much Ado About Gratis

Lately, there has been a slew of women contacting doulas, myself included, about free or reduced doula services. I understand that this is a financially difficult time for many people, and, although many women have good reason to be asking for help with the cost of a doula, I know that some do not have good reason.

I know, I know that some of you out there are booing me right now, but let me make myself clear before you bring out tomatoes and rotten eggs.

Some of the many reasons I have been given recently for why women are seeking free or reduced services include:

1. "I had a cesarean previously and don't know if I will wind up in a second. I really don't want to invest that type of money into a service that I may or may not use."
2. "My husband is not sold on the idea of a doula and I am not sure if we will call you when we are in labor. We would rather play it by ear and call you if we decide we need you... and we can't see putting that type of money into a service that I may or may not use."
3. "We don't have insurance/are on state assistance."
4. "We are at a financially difficult time right now. I cannot/don't work because of _____ and my partner's hours are _______"

I, like most doulas, believe that every woman deserves a doula. For this reason, if she cannot financially afford a doula but truly wants one, I make every effort to work on price, to barter if she has a service or skill I could use, or to help her find a doula who can provide services for free. So, please understand this as you continue reading.

Something to remember is that a doula will turn away paying clients who are due around the same time as the the gratis or low-cost clients. This results in a loss of income for our families, which is part of the reason I make the process so much more stringent.

An additional concern that I have is that the emotional, physical, financial, and mental investment that we make has no return. Basically, if I make the effort to go to a woman's house, provide her with educational and physical support throughout the prenatal period, but yet she makes no commitment other than to be at her home for our allotted prenatal meetings, she is less apt to make the emotional, physical, financial, and mental investment necessary to ensure that she 'gets' the birth that she states she so desires.

It even happens, at times, that women who seek out free services without a valid reason will simply not call when she is in labor. These scenarios don't occur as often when a woman has a valid financial reason for not being able to afford doula services, as they truly value our service, but cannot give us the financial value of our services.

With all of that said, I would rather save my free or reduced fee services for women who will make the necessary sacrifices to ensure the best birth possible for her and her baby.

Now let's take a look at the reasons I have been recently given and my reasoning for my responses (by the way, these are the actual last 4 requests for free or reduced services that I have gotten):

1. "I had a cesarean previously and don't know if I will wind up in a second. I really don't want to invest that type of money into a service that I may or may not use." 
1. My friend, another doula, calls this occurrence the FreeBAC. I can understand the reasoning. But, on the same token, you have to understand that I depend on the income I receive for doula services for my family. I also will be paying out of pocket for print-outs, supplies for clients, and gas to and from your home and place of birth. 
2. Also, if you have a TOL but still end up in a cesarean, your doula is still with you during labor, putting in time and work for your birthing time. And also, even if you choose or medically need a CBAC, doulas are very instrumental in helping these go as well as possible. 
3. Likewise, if you really wanted a VBAC, you would passionately and whole heartedly pursue it, making some difficult choices that will better ensure that you get the TOL or VBAC you deserve (such as switching providers). Unwillingness to make such a small choice/financial commitment is an indicator of willingness to make the bigger choices/commitments 
4. And finally, women still benefit from using a doula when they have planned or unplanned cesareans. 
2. "My husband is not sold on the idea of a doula and I am not sure if we will call you when we are in labor. We would rather play it by ear and call you if we decide we need you... and we can't see putting that type of money into a service that I may or may not use."
1. Again I depend on the income I receive for doula services for my family. I also will be paying out of pocket for print-outs, supplies for clients, and gas to and from your home and place of birth.
2. Another thing to think about is 'who will be laboring'? Of course we are there for partners as much as the laboring mom, but ultimately, a woman deserves to have what and whom she wants for birth, after all, she is the one birthing.  
3. A doula will turn away clients who want and will commit to using a doula if they take on a woman who may or may not call based upon her partner's desires. This is not a fair trade off, IMHO.
3. "We don't have insurance/are on state assistance."
1. This might be a valid reason, which is why I require they show proof of this along with proof of income. The reason is, if you don't have insurance (self employment, smaller company, etc..) but have income, women are often still eligible for state assistance during pregnancy, birth, and the first 6 weeks postpartum.
4. "We are at a financially difficult time right now. I cannot/don't work because of _____ and my partner's hours are _______"
1. Ok, show me that you are in financial need and I will be happy to work something out with you. 
2. I have a form that they must fill out and documentation that they must provide (proof of state assistance, pay check stubs, etc..).
   

Some times, when there is a little financial need, but I can see where families could find the money to pay something for a doula, I might state something to the effect of "well, what do you think a doula's services are worth?" This way, they can name a price and we will work around that.

Other times, if I know the family has a specific trade, skill, or life choice that I am interested in, I offer to barter services; I give them a service that they need/want, and they return the favor. From bartering, families have received doula services, and I have received in return:

• organic produce from their garden for 6 months
• knitted uteri and a few newborn caps for postpartum visits
• babysitting while I was gone to prenatals
• website design
• website optimization
• a weekend at their family time-share

Yep. I love bartering. :)

Like I said before, if I cannot help by providing free or reduced services (either I am booked, I already have a gratis or reduced fee client, or I simply don't think your reason is valid enough to influence my income for that month), I can always refer you to other doulas who do offer free or reduced services all the time.

These doulas are either doulas-in-training, doulas who offer less services (not as many prenatals, have the clients come to them, etc..), newer doulas, doulas who are financially set/not dependent upon the income for their families, or who over-book themselves and cannot give reasonable assurance that they will be at your birth. When I refer you to doulas who offer these discounted or free services, I ensure that my recommendations fall into the categories of newer, in-training, or financially-set doulas. 

Beyond this, though, many people wonder just how, exactly, a doula sets her fees. Well, let me tell you how I have set my fees (adapted from Big Belly):

• Driving - a doula has a lot of wear and tear on her car. She must ensure that the tank is always full and that it is in good running order.  Likewise, she must pay for gas to and from prenatal visits, postpartum visits, and labor/births. With gas prices like they are, this can equate to a large chunk of her income from clients.
• Consumables - there are some supplies that we use during labors/births that we need to restock on. These can include: high protein snacks for the families (no matter how many times I remind them to pack snacks, I cannot recall how many times I feed the families, and happily), massage oils and lotions, homeopathics, emergency childbirth kit supplies, and birth balls, sea bands, and ribozos (that sometimes get ruined at births)
• Self-Employment - self employment means we have to deduct income for vacation and sick time, self-employment taxes, insurance, marketing, promotional materials, lending library materials, and the handouts that we provide to our clients. Our communication expenses are quite large, when you consider we are on-call 24/7, and with business phone lines, unlimited plans on cell phones, and internet connection. We also have general office expenses such as printers, paper, computer equipment, maintenance, ink cartridges, folders, business cards, and more.
• Hours - Couples having a first baby may imagine that their doula will only be spending a few hours with them during the labor and birth. In reality, an eight-hour labor would be considered pretty fast; most first labors last at least 24 hours; the longest continuous time I've spent providing labor support is 41 hours. The average time I have spent with a woman for her labor and birth is about 13 hours. I spend another 10 hours in prenatal and postpartum visits, another hour or two in phone calls or email, and up to six hours travel time. Using those averages, my fee translates to an hourly rate of about $25/hour, before expenses and self-employment taxes.
• Experience and Education – When you are looking for a doula, you want one who has experience and education - a wise woman to attend you during your birthing time. This means that your doula has continued education expenses from conferences, peer review, association dues, recertification costs, and CPR and NRP recertification costs. We keep up to date on current research, procedures and policies, and spend a number of hours making sure that we bring a current and competent doula to every birth. Additionally, many doulas, myself included, make sure to tour their area facilities, schedule meetings with area doctors and midwives to talk about personal policies and practices, and generally make sure that we know the ins and outs of our birthing community better even than most of those who work within the profession as doctors and nurses (who are usually only well versed in their particular way of practice).
• Clients - When I commit to being available for a woman's labor, that means that I have to limit the number of clients I take on per month so as to ensure the best chance that I will be available for her birthing time and not have to use my back-up. When providing in-home services (unlike those who work a shift in a hospital or job-share) one client per week is a very full schedule.
• Personal Commitment - Being with a woman in labor means that I might be gone from my family for anywhere from a few hours to a few days. Beyond that, when I return home, I require about 24 hours of recuperation time to be back to my regular and completely alert and competent self. This means that my family makes this commitment with me with every woman I take on. Additionally, this means that family vacations, celebrations, and holidays are often missed out on, rescheduled, delayed, or cut short. If I want to ensure that I can go on a trip, to a conference, or be at an event, I have to add 2 weeks on either side of that date wherein I cannot accept clients.  

Doulas commit to being willing to work up to 56 hour shifts away from their own families, functioning on 1 hour of sleep after being gone for an indeterminable length of time, and living the life of someone on-call, all the time. We are willing to be conferenced during dinners, during birthday parties, and during vacations.  

South Bay Homebirth Doula

We have carefully woven our own support system (babysitters, spouses, peers, and friends) so that we can support you in the way that you deserve during one of the biggest events of your lifetime. 

And we love it! We love it and are passionate about it, please don't misconstrue all of this to say that I am not happy or fulfilled with my calling. We all wish that we could do this work as a community service to every single woman... but the truth is, we are self-supporting professionals that have had to choose to either run our businesses very judiciously in order to ensure that those who truly want this service can have it, or to leave our callings and go back to a 9-5 job that will pay much more and take much less from our lifestyles.

This is all to say that, before you ask for free or reduced services, please make sure that you really need the financial assistance. Although I am fully dedicated, fulfilled, and joyful of my calling, this line of work, the life of a doula is not glamorous, it is not easy, and it is not for everyone. It is also not something that I will give away freely without a good reason.

Pregnant in America

If you haven't had the chance to see this movie yet, it is available in it's entirety on hulu right now (see below). It is good at showing some of the limitations and failures in American birth practices, as well as gives clear information on what we can do to make our outcomes better.



The downside is that it is militantly anti-hospital and the producer is a little far on the conspiracy tail. :) Worth the watch, though, IMHO, if you can take it all with a grain of salt and a critical eye.

Power of The Tongue

Where do my blog posts come from? Sometimes it's from a question from a reader (yes, I answer all questions sent to me), sometimes it is from an article I read, and sometimes it is from a recent experience or conversation I have. And sometimes, like this post, it is from a seemingly unrelated event.

My daughter was on Facebook when she saw a video that she wanted to share with me.



And herein is the birth of a post. As workers in the field of birth, we must understand that we have power. Power to kill and destroy, tear down and disempower... or we have power to raise up, encourage, enlighten, and enliven. This power comes from the same source.

The Tongue..

The power that words play in our births is tremendous. Don't believe me? What does the term 'ring of fire' tell your perineum? What about the difference between calling a contraction strong and good versus calling it hard or big? Our words impact our perceptions - our perceptions impact our experiences.



Our tongues are a double edged sword; our words can slay dragons, or can raise the dead in spirit.

Learning to wield this sword with wisdom and prudence is one of the best tools a doula can master. To whisper, to direct, to encourage, or to reprove. To command, to bless, to educate, or to placate.


And, when necessary, to learn when to bridle your tongue, and speak without words.

“Ask me for strength and I will lend not only my hand, but also my heart.” - Unknown

I am not going to elaborate on the benefits of using certain words, I have done that in past posts.

I only want to encourage you, while speaking today, use your words for life and health. Let them be words of honey and milk to the souls of those whom you are speaking to. Let your words be a fount of refreshing wisdom and truth. 

Anticipating a difficult or tumultuous meeting today? Perhaps you will be knowingly encountering a person who seeks to harm your healthy place either as a person, a mother, a doula, a midwife, or a spouse?

Remember, a kind word turns away wrath, and a soft word is like salve to the wounded heart.


For more reading, check out:
Perpetuating Fear

The Story of You, My Baby

This is a lovely unassisted birth story, as shared by Mama Wise, and presented to you with permission.

bound by love; my husband and our son

... as told by your by graceful papa:

AG, you were born in our hearts before you arrived to this world of joy and
strife. As any two people sharing lives, we had our struggles, your mom and I, but never with you coming to our lives. We watched her belly grow, amazed at the biology, at the miracle of you in there getting ready to live a human life with us in this mad and beautiful world. Just the vision of your little face and hands, of your smell and cooing baby sounds always made us smile, and sometimes even cry... not something I do very easily. And then, when you finally arrived, well, my heart cracked open wide as I cry now and forever in sweetness for you... that which I only feel for you and your big brother, Brandon.

We really wanted to have you born in the softness of our own gentle home. I was nervous about this, to do this without experienced help, but not your mom; she knew what all women know but most forget, that we would have the collective help of all the women who have ever lived, that giving birth is what she is made for, and that you would come to us like water from morning air.

We tried to be patient as your due date arrived and passed, but as you’ll know soon enough, waiting is a lifelong treasure. We went to a museum that night, and something in the air felt different, kinda dreamy for me, and kinda constipated for your mom; We knew you were coming.

She knew it would be hard... or she thinks she knew it would be hard because people tell us this and she was reading about it for nine months; I knew she had no clue what she was in for. It started slowly and softly, around ten o’clock. We lit candles and played mellow music; I scurried around making sure everything was in easy reach, while she tried to find comfortable positions for the surging waves that would eventually build to be an earthquake in the air... really, she was making sounds that made the air shake. The most primal and true force of nature had enveloped our home through your mom. It was late at night and, though I knew the neighbors were understanding of what was happening on the other side of their wall, I hoped nobody had to get up early for work or church. At one point I was certain the police would come pounding at the door, guns drawn, demanding my surrender for murder.

In the bathroom, really? That’s where she wanted to be and nothing would be better, not the warm water tub, nor the propped pillowy bed. On the toilet, really? I just had to figure out how to maneuver her and you and me all in that small space, and I really hoped you wouldn’t land in the bowl. Our sweet puppy Oso was curious all night, seated right outside the bathroom door... trying to get a few times to see what the ruckus was all about. Between the throes of her thundering, I tried to massage her, give her water, or whatever she wanted, but of course, little I did could ease the pressure of the next swelling wave. She wanted to be alone for some of this, to focus, to surrender into this rolling ride, in and out of here and now, off into some other place you nor I will ever know. I thought it would go on for many more hours, so I laid in bed to rest and listen to this tribal superwoman scream and vibrate the walls. Around three a.m. her contractions were very close together and very intense, and I mean out of this world

Intense; there’s no way anybody who hasn’t done it before can be ready for this kind of intensity, no matter what people tell you or what you read. And that’s about when I saw the top of your head inside your momma’s vagina... “whoa, okay, here we go, now I can do something. First of all, it was really cool, you had dropped in for the final descent, and I could see that you had lots of dark hair. I could see the amniotic sac intact... hmmm, should I break it, how do I break it, when do I break it? Your momma kept wailing as her body pushed you closer to the world... it wouldn’t be long. I was nervous about what I didn’t know, but calm and ready to do what ever needed to be done to take care of you and your momma. The top of your head came closer, more of it showing, and your momma’s cootchie stretching unimaginably. I decided to touch the sac with my finger to feel it’s texture and thickness, and when I did this it just popped like a bubble and thankfully clear fluid poured out. I rubbed your hair... another pushing and you were closer, and then another... I could see you were facing downward, your head more than halfway out, WOW, this is amazing to watch and hear and smell, your momma, still on the toilet, pushing your small body through a yet smaller opening, like squeezing a watermelon through a garden hose, as they say.

She lifted her hips with each pushing surge as I gently guided your head further and further, until suddenly your whole head was out and you turned your head to the side and I saw your face... Oh my god, your face, buddha like with eyes wide open gazing about. I slipped my finger inside to feel your neck... smooth and clear, no cord, pheeew. Here comes a shoulder, and whooops, quickly here comes the rest of you like a wet eel... I had to hold your head with one hand and catch your slippery body with the other, clutching you to my chest so you wouldn’t slip away from me... no, I did not almost drop you.

You had a blue-ish tint to your pink body, normal and healthy. You weren’t crying like I thought you should be, but I could tell that you were breathing. Your momma lay down on the bathroom floor, towels underneath, and I put you right to her chest, your lifeline cord still inside on the placenta. I could feel momma’s heart beat still pulsing through it to you. I suctioned your nose and mouth, rubbed your back and legs and feet... I really wanted you to cry, to take big gulps of air to hear your lungs open wide, but you didn’t; you just cooed and gurgled a little, gazing about the candle-lit bathroom... okay, he’s still got good color, he’s breathing, his reflexes are wiggly and strong, his face is expressive, his heart rate is strong... the cord stopped pulsing, so I clamped and cut, for you to forever have your own blood supply. Where’s the placenta... c’mon... this isn’t over yet... the baby is okay... now the momma... more painful contractions and after about 25 minutes it came out looking like a big piece of liver spilling onto blood soaked towels. The quaking noise stopped and I wondered if the world knew you were here, or at least maybe the neighbors.

We moved to the bed... everything seemed okay, though the bathroom looked like a scene from Dexter. You were perfect, relaxed and dazed. Your momma was perfect, relaxed and dazed... but I was still in there, monitoring, watching everything. At the least, for the re-assurance that you and momma were safe and healthy, I’m glad we went to the hospital. I’m really glad we went after our own home birth, by ourselves, just our family right from the start; nothing will ever change what the three of us did together.

 Through the night, I was indeed focused on the business of birthing you,
keeping you and momma safe, but I was also above the whole scene of us, watching from somewhere else. I’ve always been somewhat of a living contradiction, so to say I’m a “spiritual atheist” makes sense, and it feels right to say that the god-who-doesn’t- exist lifted the curtain that night... gave us a live back-stage participation in one of the greatest forces in the universe, the creation of a new life-force... You...AG, may you always take big gulps of air with wide open lungs, and gaze about the world... buddha-like.

Natural Childbirth - It’s like playing cards!

This guest post was written by Patricia Harman, the author of Blue Cotton Gown and Arm's Wide Open. I do hope you enjoy it!

There’s something about childbirth pain that frightens women, as if they aren’t man enough to take it. That cracks me up.

Though, I’ve given birth three times, twice naturally and once with a pain shot, a stubbed toe will make me cry. And the part about not being “man enough” is a good joke, since pretty much all women, think God made females have the babies because males couldn’t take it.

As a midwife, I’ve witness thousands of natural births and I have to say there’s something to be said for making it through labor un-medicated. It’s not just that most pain meds mess up your labor, but making it through the circle of fire is rewarding in itself, a transcendent experience. It does hurt, but with good support and a normal labor, most women can make it.

When I had my babies in the 1970s and 80s it was a big deal to take charge of our childbirth experience. The alternative was revolting. To be trussed on a metal delivery table, legs elevated in stirrups, arms spayed and tied down like Jesus, given gas whether you wanted it or not, the baby pulled out with forceps over a large episiotomy.

No bonding afterward; the baby was smacked on the butt and taken away. No father’s present, either, non-negotiable. You can see why we rebelled. Lamaze childbirth breathing wasn’t a joke then. It was the only weapon with had. “Look, Doc, we said with every breath. I can do it. I’m a woman not a child. I’m not going to scream my way through labor or kick you in the face.”

Things are little better in hospitals now, but not much. Women who opt for medicaliized childbirth are just tied down to different things…the birth bed and monitor belts or an internal fetal scalp probe, the IV needle and pole so she won’t get dehydrated, the ever handy Pitocin if her labor slows down, the epidural catheter in her back for continuous anesthesia and, subsequently, the urinary catheter because she can’t feel to pee.

Sounds almost as bad as the 70s, right? But not quite. At least the mother’s awake, the baby’s father can be involved if he wants to, family members can be present and if the woman’s lucky she’ll hold her baby before the nurses put antibiotic ointment in his or her eyes.

So, pain is a big consideration…and it’s scary if you’ve never done it before, kind of like jumping off a cliff into Lake Superior! You know it will be cold, but how cold? And will you be able to swim or will you freeze up?

I tell my patient, the most important choice she has to make, if she decides she wants a natural birth, is who will be her care provider and where she’ll have it. She needs to be in a setting and with people that make her feel relaxed, cared for and confident. 

Some women feel most secure in a high-tech OB Medical Center where they have all the bells and whistles, not to mention specialists and access to a C/section in minutes. That’s where they’ll do their best. Others feel safer at home and then there are the places in between, small hospitals and birthing centers.

Some people have utter confidence in physicians. Others are scared to death of anyone in a white coat. For the later women, a midwife would be a good choice or maybe a doc along with a doula…if they can find a doctor who cares as much about normal physiologic birth as he does about getting home for supper. I shouldn’t be so sarcastic. My husband is an OB and he’s the best! A midwife doc. But you know what I mean. There’s a reason so many C/Sections happen around 5 PM.

Not everyone can get through labor without medication. There are multiple factors that are unpredictable and out of our control. The position the baby lands in, the size of the baby, the shape and the size of mother’s pelvis, how and when her labor starts, the state of the bag of water, how much sleep she’s had when the contractions start….The list goes on.

It’s like a game of cards, you do the best you can with the hand you are dealt. The important thing is a healthy baby and to feel you did your best. Then everyone is a winner.

Patricia Harman is mother to 3 grown men and wife to Thomas Harman, OB/Gyn. Patricia Harman has spent over thirty years caring for women as a midwife, first as a lay-midwife, delivering babies in cabins and on communal farms in West Virginia, and later as a nurse-midwife in teaching hospitals and in a community hospital birthing center.

Patricia Harman still lives and works with her husband, Ob/Gyn Thomas Harman, in Morgantown, West Virginia at their clinic, Partners in Women's Health Care. Though she no longer attends births, she provides care for women in early pregnancy and through-out the life span. She brings to this work the same dedication and compassion she brought to obstetrics.

Jolene

In case you aren't a regular follower, you should check out The Feminist Breeder, one of the awesome blogs that I read.

She had her baby recently and both compiled a slideshow of the birth (below) and did a live stream during the actual event.. you can read up on the post-event details here. Enjoy!

Neonatal Resuscitation

I believe that a key component that every doula should have is Neonatal Resuscitation. See how to get formal training here.

Even if a doula chooses to not get NRP certified, I highly recommend that she read through the course material and then test that knowledge through the printables here and the additional information found here:

MTB neonatal res Nicole

Uploaded by LISA on WizIQ Tutorials

Why do I think we need to know this information as doulas? Consider that we work with women during childbirth. Consider also that many of us encourage the mother's that we work with to stay at home as long as possible or comfortable.. consider finally that some labors progress very rapidly and, for that, many of us are also learned in emergency childbirth.

Wouldn't it stand to be reasoned, then, that we should also train ourselves and be prepared to help in the event that one of the babes that we *might* help birth *may* need extra help to initiate respiratory efforts? Consider becoming NRP certified, or at least educated, as part of your celebrations during the month of May, International Doula Month.

"Arm's Wide Open" - Review and a Giveaway

 

I am a sucker for Midwife Memoirs, and I just finished "Arms Wide Open: A Midwife's Journey".

Oh my goodness, my husband looked at me like I was off my cracker, the way that I was sobbing at one point, then yopping with laughter the next! I'm guessing that you can tell, from that alone, that I simply loved, adored, gobbled up, marinated in, (gush gush gush) every single word that Patricia Harman wrote.

She writes a simply stunning, funny, heartfelt, candid, emotionally torquing memoir about her journey to, and through, midwifery. I recommend it whole heartedly - to every childbirth educator, midwife, midwife apprentice or aspiring midwife, doula, and mother. On the other hand, if you are expecting a baby and are working to maintain your bubble of peace, I would recommend waiting until your baby is here before reading it. ;)

I am not sure how many of you have read The Blue Cotton Gown: A Midwife’s Memoir, Arms Wide Ope, but Patricia expounds upon this earlier work by bringing her readers face to face with the trials, tribulations, triumphs, tears of a midwife's life.

Her readers find themselves reliving her early commune days, her self-induced poverty days, her fears of not knowing enough, the joys of catching babies, her delights of her own children and lovers, and so much more.

We get to know the young hippie living in a rustic log cabin deep in the secluded woods of Minnesota. She gives us a taste of the joys and heartaches that accompanied the rough winters, solitude, and young parenting years.

We grow with her as she moves to a communal farm where she and others seek to live a self-sustaining, completely peaceful lifestyle, while also realizing, more fully, her love of working with women and babies.

We watch her birth her own children, then hold our breaths while she catches her friend's babies.

And then, we get to know the older, wiser, somewhat more jaded and anxious middle-aged ex-commune, hippie-at-heart Patsy as she navigates life as a mother of 3 grown boys and a CNM, with her supportive, but harried OB/GYN partner.

Harman fashions a tale of love, hurt, fear, courage, political activism, pacifism, feminism, midwifery, and motherhood. She speaks to the woman, lover, and mother in all of us, giving us a painfully candid glimpse into her emotional life.

She molds time and space in her hands, as easily as a potter at the wheel, pinpointing those moments in her life that acted as catalysts, shaping her future self, her career, and her personal life. As a time traveler, the reader is able to move seamlessly from the naked hoe-wielding, farming hippie on a commune in Minnesota to the grown mother waiting with bated breath in her expansive home in the middle of the night on her cordless phone.

I invite you, the reader, to discover the bear chasing, childbirth education revolutionary.. the sun-kissed, baby wearing, earth toiling minimalist.. the family rescuing, fire-fighting lioness... the midwife, the mother, the social worker, the with-woman.

Her's is a love story. A love for her partner, her children, her work, her women... a love for herself, and life... for humanity and the earth we live in. This is the heart and soul of "Arms Wide Open".

If you are a woman, a mother, a sister, a daughter, a midwife, a mentor, a wife, or an educator; if you are a servant to women, or simply a servant of life, Patricia Harman's latest book will speak to the innermost you, that part of you that you hold secret and safe - and will entice you to take a long look at the world and people around you.

I recommend this book wholeheartedly and with abandon, and I want to give my copy to one of my readers. If you are within the U.S., the rules are simple: just share in some shape or form (online message board, FaceBook, TheBump, Blog, etc...) then comment below with how you shared and how I can reach you. 


Giveaway ends and drawing will be done on the weekend of May 28th.

Bamboo Magazine Online

Open publication - Free publishing - More children

Talk It Out - Part 4

This post is for Kimberly, who requested I write a follow up post to Talk It Out, with examples of positive communication and what to look for when talking with your provider about your wishes. This is the final installment from the Talk It Out series. Parts 2 and 3 can be read prior to this.

Hopefully, by the time you are in labor, you will know how supportive your provider is. Your responsibility to ensure full and informed choice, though, doesn't end prenatally.

Positive communication with your provider has 4 main intents/purposes:

• To keep your relationship with your provider positive
• To give you full information so that you can make a full and informed choice
• To facilitate more/open communication with them in the future
• To keep you in the position of control - this one sounds harsh, but, remember, YOU are responsible for your health care. You are in control of your health care decisions, and, trust me, you don't want to give that power to anyone else

Now that we know what tips us off, ahead of time, to a provider that isn't supportive of mom and her autonomy, we have reviewed some examples of positive communication, and we know what our goals of positive communication are, let's talk about how to maintain that communication during labor and birth.

When you are in labor, anticipate that you will be your most vulnerable and easily influenced. For this reason, it is VITALLY important to have the previous conversations beforehand; this sets the stage, allowing you to, prenatally, assert your autonomy, as well as your patient's rights - which are both inherently connected to one another.

The Educating Acronym
While in labor, I am sure that you have heard of the BRAIN or BRAND acronym. If not, let me explain them both herein:

Benefits - "what are the benefits of the procedure or intervention being suggested?"
Risks - "what are the risks of the procedure or intervention being suggested?"
Alternatives - "what other alternatives can be considered?"
Interventions - "what other interventions accompany this procedure or intervention?"
Nothing - either "what could vs what will happen if we choose to do nothing at this time?"

Benefits - "what are the benefits of the procedure or intervention being suggested?"
Risks - "what are the risks of the procedure or intervention being suggested?"

Alternatives - "what other alternatives can be considered?"Nothing - "what could vs what will happen if we choose to do nothing at this time?"
Decision - either "how much time do we safely have to make a decision?" or "We have decided to _____."

My preference? BRAIND.

Benefits - "what are the benefits of the procedure or intervention being suggested?"
Risks - "what are the risks of the procedure or intervention being suggested?"

Alternatives - "what other alternatives can be considered?"

Interventions - "what other interventions accompany this procedure or intervention?"

Nothing - either "what could vs what will happen if we choose to do nothing at this time?"
Decision - either "how much time do we safely have to make a decision?" or "We have decided to _____."

We can write the best birth plans possible, but, in the end, labor is organic and cannot be scripted. Thus, making sure you have BRAIND each possibility before making a decision will ensure that you are making careful, competent, and fully informed decisions.

An example of this can be found with the commonplace conversation of pain medication for labor and birth. We will use our fictitious mom, Kirsten, and her nurse midwife, Brenda, once again, for example.

Kirsten: "I want an epidural"
Brenda: "ok, I will tell the anesthesiologist, he will come in to talk about benefits and risks, and then you can have the epidural".

This is usually the end of the conversation for most care providers and their clients. A fully informed patient would continue:

Kirsten: "what are the benefits of an epidural at this point in MY labor?"

Brenda would then have an opportunity to share Kirsten's specific labor and the benefits she might gain from it (i.e. long labor might mean she could get some rest, a tense laborer might be able to finally release her pelvic floor allowing dilation to complete, creeping blood pressure can sometimes be brought down by an epidural, etc..).

Kirsten: "what are the risks of an epidural for MY labor?"

Brenda would then have a chance to discuss implications such as babies position and how an epidural might influence babies chances of moving into OFP, her lack of dilation or near complete dilation (not much dilation might mean labor might slow or become ineffective, necessitating pitocin whereas nearly complete dilation might mean she might not choose to have an epidural), her medical history (i.e. if she has a history of low blood pressure).

Kirsten: "What things could I try other than an epidural?"

Her care provider may have some great suggestions like walking, the tub, the birthing ball, and others. Her nurse might also. It would also give her doula, if she chose to have one at her labor, a chance to give more suggestions... the more minds working for you and your birth, the better.

Kirsten: "What other interventions will be or might become necessary?"

Brenda would have a chance to tell her that an IV will have to be ran, a catheter will most likely be used to urinate, she will most likely not be able to get up from the bed from that point on, and continuous fetal monitoring will be used.

Kirsten: "What could vs what will happen if I decide not to get the epidural?"

Brenda would have a chance to point out that many women ask for epidurals during transition, the time between 6-9cm, that usually culminates with the urge to push within an hour or two. She would also have a chance to talk about the fact that most anesthesiologists need around 45 minutes to get there and get the epidural placed and that Kirsten can take that time to decide if she really wants it, which leads right into the D of BRAIND - making a decision or taking time to make the decision.

Putting The Proverbial Foot Down
Now, unlike before labor and birth, your birthing time necessitates quick thinking and leaves little room for 'conversation'. In truly emergent (not necessarily emergency) situations, where your care provider may be requesting you to make a split second decision (i.e., about to cut an episiotomy, about to deep suction baby, about to break your water, etc..) politeness will come second to refusing or accepting an intervention or procedure.

For this reason, I am going to give you different scenarios and how one might work within them. I like to call this the Stop, Look, and Listen approach

Your care provider is doing a vaginal exam and wants to break your water. Without asking consent, (s)he picks up an amni-hook:

STOP: Get your providers attention... in whatever way time permits. This is usually a hasty and/or direct order, so as to stall their hand/the procedure. Sometimes, it warrants raising your voice.

• "Wait!" Alternatives of this can be "No!", "Stop!", or "Dr. ____" .

LOOK: Note what is happening, what you are worried about, what you are witnessing, or what you want clarification on.

• "I see that you are trying to break my water." Alternatives might include "I see something in your hand", "what are you doing?", or "what do I see in your hand?"

LISTEN: This is two-fold, first, to get your provider to listen to your wishes and second, to listen to theirs.

• "I don't want my water broken." Alternatives to this might include "I expect/hope you will discuss any intervention with me before applying it to my health care." This will allow them to express their reasoning, hopes, and expectations of the procedure they want to complete.

Again, Stop, Look, and Listen are best used when you have to make something happen right then and have to, for the most part, do away with the pleasantries, but still allows for open communication. If your provider does not respond to the first Stop, Look, and Listen, you may have to repeat the Stop part until they do.

In truly emergent situations, "Look" can be omitted:

• an example would be episiotomy - STOP: "Don't cut me(her)!", LISTEN: "I/she would rather tear."
• another example would be deep suctioning at the perineum - STOP: "Wait!", LISTEN: "use the bulb syringe."

If you are not in the place to use Stop, Look, and Listen, your advocate (partner, husband, or other family member) should do this for you. Your doula can remind you or make you aware of something that might be about to happen, but they cannot make these choices for you.

In Closing
Remember, at all times, you have the right to refuse or request any procedure or intervention. This includes IVs, monitoring, discharge from the hospital, pain medications, surgery, and any and all touch, including vaginal/cervical exams, blood pressure readings, AROM, and the like.

Your goal should be to make your wishes be known and to have them be followed throughout your prenatal and labor/birth/postpartum care with the best, most open communication possible with your care provider. Open, honest, and unhostile communication will ensure the most pleasant care and empowering experience, which is why we have discussed all scenarios, those which we can be thoughtful of our words, and those when pleasantries may take a back seat.

Here is to hoping for open communication and honesty between providers and the women they serve!

Conscious Family WINNERS

Ok - slightly belated, but here are the winners for the Conscious Family Giveaways :)

Winners of giveaway #1 - MamaVee and Jenn D.
Winner of giveaway #2 - Kim Through the Looking Glass
Winner of giveaway #3 - Salty Mama Ruth
Winner of giveaway #4 - Hakima Midwifery, Shannon
Winner of giveaway #5 - Alisa
Winner of giveaway #6 - Jennifer P
Winner of giveaway #7 - Jennifer P
Winner of giveaway #8 - Jessica Fischer

Please contact me within 56 hours so that I can forward your email and shipping address to the vendors. :)