Coping At All Stages - Early Labor

"For my first I was set for an induction at 7am. I woke at 2:30am with period like cramps. I didn't know what labor would feel like, my doctor didn't give me any information and I didn't know about childbirth classes. Around 4am, I figured out I was having mild contractions. We went in at 7am and I told my doctor this. I still got Pitocin, though, and he broke my water and away we went. They were fast, intense and back to back. 

For my second, I woke at 3:30am to go to the bathroom, when I sat up I felt a trickle. I went to the bathroom and there was more fluid leaking. I was so excited. I was having mild contractions. 

For my third, I woke at 12:15am. As I opened my eyes I couldn't move because I was having such an intense contraction my whole body felt paralyzed..."~ Allison

"I woke to a pop and a gush - so there was no mistaking that I was going to be in labor - although, from what I hear, only about 10% of women's labors start with the water breaking. When my contractions started about 30 minutes later, I was in the shower rinsing off and my husband was putting the laundry in the washer. They started out subtlety, like a nearly continuous menstrual cramp. It was all under my belly button and all dull and achy. Within a few hours, the continuous dull menstrual cramp had spaced out to full belly hugs that wrapped around from the sides, the top, and the bottom, lots of water balloon-like pressure the full size of my uterus; like this giant water balloon being blown up inside, at the same time that this flat wide band wrapped around the water balloon and tried to pop it from pressure alone. The dull menstrual cramp of my lower belly was still there. As the day went on, the menstrual cramps got bigger, and the pressure got stronger...." ~ Amili

"I first considered that I might be in labor when I started experiencing crampy-like contractions at regular 6-7 minute intervals...." ~ Chelsea

"My contractions were confusing - I think everyone else knew I was in labor before I did. I woke up about 4am to a backache. It would start as a pulling on my lower back that would intensify, last for awhile, then go away. I woke repeatedly in the night to this sensation and I thought it was just a muscle strain. After I got up, my husband asked how I slept and I told him. He noticed I said 'about every 15 minutes I woke with a nagging backache; so no, I slept like crap'. He kept that observation to himself, which I'm happy for. The backache waves got closer and closer - until about every 7 minutes apart, before he said 'Do you think this is labor'? Until then I had no idea. I thought I needed a massage or a chiropractor. Luckily I had a chiro appointment for that morning..." ~ Liv

"With my first birth, I woke up to brief light cramps every 10-15 minutes. It took 24 hours for them to meet the "every 5 minutes" criteria my OB had given me, and even then they were still light. 

With my second,  I was induced gently. Acupressure and nipple stimulation worked to bring a light contraction pattern to around 7 minutes apart. 

With my third birth, I was in a meeting at work and I started having period cramps. They were probably every 7-10 minutes at first and lasted that way until dinner..." ~ Terri

"With my first pregnancy, I never had cramps or Braxton Hicks. I felt my insides twist up all of tha sudden. Then ten minutes, again. I knew right away. For my second, I'd been feeling crampy since the morning. I didn't know if it was worthy of mention since I'd been crampy for a month. My mom picked up my three year old for her usual weekly babysitting gig. As soon as he was gone the cramps became what I'd most certainly call contractions. Purposeful, dynamic, big, moving. I felt my uterus lifting up like a skirt with each one. I felt relaxed knowing this was probably "it", and suddenly very feminine too..." ~ Holly

"I had a midwife appointment at my house at 38 weeks and I asked her to check my cervix. This was around 4pm. We went out to dinner and called it an early night; going to bed at 9:30. I was glad because I woke at midnight. I had contractions that felt like cervical tickles. They would come for about 20 second every 3 minutes. I woke my husband after a few hours of this. At that time I got up to go to the bathroom (diarrhea) and saw I had pink discharge and my mucous plug in my panties. I called my midwife because they were so close so soon. She said to wait until they felt more intense OR got longer OR they spaced out to match the intensity and length. I called my doula hoping she'd say it was going to be a fast birth. She said 'it might be or it could be [midwife] touching your cervix' and then told me the same thing my midwife did. So I put on a pad and went back to bed. I woke intermittently, never fully rousing, and slept for a good part of the night." ~ Trinity

"I started having mild cramps after a doctors appointment. He said to go on a walk. My doula mentioned eating dinner and heading home to settle in early for the night. I went on the walk. We went to dinner, then I walked more. I didn't want the cramps to stop and they only stopped or spaced out when I stopped moving. So I kept moving. I checked in with my doula and said they were getting stronger, but were still short and only picked up in frequency when I walked. She again suggested I go to sleep. I really didn't want them to stop though, so I kept walking. About midnight I was thoroughly exhausted and had to go to bed. So I got a shower and we tucked in for the night. I woke up to nothing the next day. That evening, we repeated the events of the prior evening and night. Again, I tuckered myself out and went to bed only to wake up to nothing. The third night, I didn't go walking, but instead just hung out at home and went to bed early. Around 2am I woke to a different contraction. I can't explain it but it was more... encompassing...." ~ Kelly

Early labor is a time when your body is working, but you usually don't need to actively adjust your activities to accommodate the sensations. A textbook early labor would last around 10 hours and start with contractions far apart (10 minutes or further apart), lasting for a short time (30-45 seconds each), and be crampy, light, and not very intense. Over time, these contractions would get CLOSER, LONGER, and STRONGER (all three). 

But we all know that our  bodies didn't read the medical textbooks and every body has a mind of it's own, so early labor can last a few hours (or less) or a few days. Some women have labors that skip early entirely, and others have early labor patterns that don't follow the 'early labor patterns'. 

Sometimes early labor contractions will start out close together, but the intensity (strength) isn't there and the duration (how long they're lasting) isn't there. In those cases, your birth team would be looking for the strength and duration to pick up to match the spacing...  or for the frequency to space out to match the other two. This pattern is very common when your cervix is checked or stretched/swept at a prenatal appointment and you have contractions afterward. 

Sometimes early labor contractions are far apart, but the intensity is quite strong. This can sometimes be the result of baby being in a different position than on your left side or lined up with your belly button. If this is the case, call your doula or midwife to help you get some ideas for how to get the intensity to match the frequency and duration. 

Some Pro Tips from birth workers who have been around the block a few times with laboring mamas: 

• Make sure you're taken care of - sometimes practice labor, UTIs, bladder infections, and dehydration can look like early labor. Make sure you're well hydrated, if you were walking, try lying down (and vice versa), and make sure it doesn't hurt or burn to pee. If you've been spending a lot of time doing physical activities and that's what started everything, try getting on all fours and swaying your belly back and forth to make sure baby isn't playing with the braxton hicks button.
• Don't pay attention too soon - if you think you're in labor, let your team know, but then try to ignore the sensations and do what you would normally do during that time of day or night. If you'd normally be sleeping - SLEEP. You never know how long your labor will be and there will come a time you will probably want to sleep and can't. If you had plans for lunch, keep them - it's probably a good distraction, there will come a time when your labor won't let you be distracted from the work your body is doing. 
• Don't get hung up on timing contractions - try timing them in sets of 3-5 contractions, update your birth team, then put the app (or paper and pencil) away. When your labor sensations change (more intense, markedly closer, or markedly longer) time another set and send them to your birth team. 
• Don't try to walk your baby out during early labor - it rarely works and usually only serves to exhaust mama. Then when she really wants to sit or lie down, active labor kicks in and she can't sit or lie down. Walking your baby out is best reserved for active labor. 
• Eat and Drink - again, you have no way of knowing how long it will take. Eat when you're hungry or during your regular meal times. Drink water often. Pee often. 
• Greet labor with patience - you have been waiting for this moment for around 9 months. Remember it might be fast, but will probably take time and patience. Clocks have no place in the labor room and the more you can disconnect from worrying about how long it is taking or going to take, the more seamlessly it will evolve. 
• Change things when labor changes - when your labor says 'no more side lying, I don't like that' listen to your body. If you suddenly feel like you need to get rinsed off, take a shower. 

This is an overview of early labor.. next up is active labor, the time when we need to actively participate in the process. 

Doula 2 Doula - Why I Don't Offer In-Home Consults

I've had potential clients get miffed from time to time over me not offering in-home consultations. Sometimes they've even compared my practice to other local doulas who do offer in-home consultations.

I get it, it's more convenient to the potential client, especially if they have children. It's more private, intimate, etc...

But let's talk about the other side of things.

As a human, and a female human, I would like to think the best of people. But there's no denying that we live in times where we need to be considerate of our safety. If I were to meet a complete stranger in their home without any prior knowledge except an email and possibly a phone call, I have no idea what I am walking into.

There are a number of stories in the birthing community of doulas who found themselves in scary, and even dangerous, situations because they trusted the strangers that they were going to meet. In one, the woman backed out last minute and said 'go ahead and meet with my husband at our home, I have to go to an appointment.' (this was when the doula was literally on the front step knocking on the door). In another, someone blocked her ability to leave the home when she had to leave for another appointment. In yet another, the home was abandoned and a car pulled up to block her leaving the driveway, but then her husband (who happened to be with her for that day) stepped out of their car and the other vehicle drove off.

So please know, potential client, it isn't because I think badly of you. It's because I am thinking safety for all when I say 'let's meet here'. And doula to doula - staying safe in our field isn't difficult with simple boundaries and safe business practices.

Judgmental Doulas

Recently I've been noticing a theme in the doula community. The majority of doula websites state they provide "unbiased and judgment-free" doula support. Now that sounds marvelous, and I've never batted an eyelash at it.. until a recent discussion got me thinking...

I would love a doula who's unbiased, but I sure hope my doula has judgment. 

I'm going to start by saying that I bet 99.9% of the doulas who have this on their website agree with everything in this post, and never meant anything by their statement. But let's break it down (because we all know I love definitions and semantics). 

There are different types of judgement. There's good judgement and bad judgement. Positive judgement and negative judgement. 

Positive Judgement: 

"the ability to make considered decisions or come to sensible conclusions. synonyms: discernment, acumen, shrewdness, astuteness, sense, common sense, perception, perspicacity, percipience, acuity, discrimination, reckoning, wisdom, wit, judiciousness, prudence, canniness, sharpness, sharp-wittedness, powers of reasoning, reason, logic;"

Negative Judgement: 

"having or displaying an excessively critical point of view. "I don't like to sound judgmental, but it was a big mistake" synonyms: critical, censorious, condemnatory, disapproving, disparaging,"

Here's a little secret: No doula is non-judgmental. And I'd hope you'd want a judgmental doula too. 

I'd hope you'd want a doula who makes choices for our own business practices that show discernment, wisdom, prudence, and sense. I'd hope you'd want a doula who makes choices in the way that we serve the women we've been entrusted to attend that show discernment, wisdom, prudence, and sense.

I equally hope you wouldn't want a doula who was a Wesley - (think Princess Bride), one who simply said yes to everything, because then you'd miss out on the educational portion of doula work - the options and choices and personal experiences and head space of doula work. Doulas should give non-biased resources and education to their clients so that they feel good and positive about their choices, whether they go 'according to plan' or not, and no matter what those choices are. As I have said time and time again, how can we hope to make mothers out of women when we treat them like children? 

And then, on the other side of the coin, I would hope (for all doulas) that none of us would be judgmental in the fact we make choices for our own business practices or ways we serve women that are excessively critical, condemning, disapproving, disparaging, or censorious... to their clients, their clients choices, or their peers.

It would do us well to remember the difference between good and bad judgement, and bias; I hope none of us provide biased support, but I hope we all show good judgement. So let's be doulas who use wisdom, prudence, sense, logic, reason, astuteness, and perception to benefit our clients through education, resources, support, and community. 

Things clients say...

Entitlement and Luxury

There is an old concept in the doula community that simply won't die... this concept is that, just because a woman deserves a doula, that implies that every woman is entitled to a doula.

And this simply isn't true.

Let's go back to some of my earlier posts...

Much Ado About Gratis
History of Birth Workers

Doulas/godsibs, were always servants and loved ones. Historically they were women who weren't paid for their expertise and assistance during your labor and birth, and historically they had all had birth experience themselves so that they could be considered competent help for the midwife and mama.

Fast forward to today - a doula is now a profession. A profession means that we need to get paid so that we can continue to offer this service to women and don't need to go get a 9-5. We no longer live in an age of indentured servants and a strong local community of women who have experienced normal, natural, physiological labor and birth. So we who have embraced the profession and calling of a doula have had to learn the art of doula work. See here for more information .

I receive around 4 requests a month of women looking for free or reduced cost doula services. Most of them are not because a woman truly cannot afford our services; most of the time it's because they believe that, just because every woman deserves a doula, she is entitled to a doula. That, m'dear, is simply not true.

You're not entitled to a doula any more than you are entitled to a mechanic, or a chiropractor, or a college education. You deserve all of these things, but you are not entitled to them.

Entitlement is to have a right or claim to something, either by virtue of who you are within a certain social or professional network, by law within a given society or organization, or simply being human (i.e. basic human rights).

Deserving is to do something or have or show qualities worthy of a thing deserved. To be worthy of. 

Yes, every woman is worthy of deserving a doula. And every doula is worthy of getting paid for her work.

Now there's also a new concept going around the doula community recently. This concept irks me to no end just as much as the entitlement concept does... it's that our profession is a luxury. This concept stems from the ProDoula campaign to 'elevate the profession of the doula'.

Now, while I commend their vim, and agree that we are professionals and should treat ourselves as such (see earlier posts), we cannot lose sight of what our profession is historically and in terms of the current childbirth climate.

Let's break this bad baby down, shall we?

Luxury is the state of great comfort and extravagant living. Opulence or extravagance. Lavishness.
Profession is a paid occupation, especially one that involves prolonged training and a formal qualification.
To Elevate is to raise something to a higher position. To make it more important or impressive. 

We need to be careful of our words - because our words will exclude or include, promote or reject the heart of our profession and the women we serve...

Yes, a doula is a profession. By merit, so that we can provide this service, it is a paid one, and rightly so. Times have changed and it is a necessity.

No, it was never meant to be elevated. Being a doula isn't about how important and impressive I am... It's about how important and impressive the women we serve are. 

And finally, I am damned well not a luxury item. 

Doulas are a safety measure. It's helpful to look at doulas in terms of value, rather than cost. They put in many hours with each client, doing their best to help them have the healthiest and most positive birth experience possible--keeping you out of surgery and your baby out of special care. It's hard to put a price on that kind of experience. - Improving Birth

As I pointed out in prior posts, and specifically in the history of birth partners, doulas and midwives were not only meant for those women who could afford them. A doula was never a luxury item, although the term we use for our profession is one of luxury.

Doulas and midwives, godsibs and sage femme, historically went to every woman - not only those who could afford one. We trudged through hell and high water to ensure she had a good, supportive birth because we believed in a woman's worthiness to have it - not because of what she could provide us.

I love how Doula Speak puts this:

Well...Depending on what camp you sit in, either could be true. If you narrow your opic to the individual business level you may experience confirmation bias and for your own purposes define doula support as a luxury. With this perspective it makes it easier to be more "hard nosed" about your business model and putting earning before anything philanthropic. After all luxuries should be paid for. But this falls apart when you widen the optic and look at birth outside of your own business goals. The research is clear. Continuous Labour Support is vital to achieving better outcomes for mothers and babies.

Vital. Necessary. Not a luxury. 

So what can we come away with from all of this?

FACT: every woman is not entitled to a doula
FACT: every woman deserves a doula
FACT: the role of a doula is a profession worthy of compensation
FACT: our profession is vital and necessary to achieving better outcomes for health of moms and babies

I love Cassandra Jiminez' response below:

" I think it's a deeper issue of women appreciating their intrinsic value as human beings and we deserve to be taken care of and safe. My safety & well being are worth the cost of a doula and vice versa, my work as a doula is both necessary and valuable and I deserve to be compensated for my services."

What camp do you fall into? Do you consider yourself a Jaguar or a Louis Vuitton handbag; awesome but totally unnecessary?  Do you see your business as something that should be put on a pedestal for women to fawn over because of how great your role is? Or do you feel your work is worthy of compensation, completely important, relevant, and necessary, and have a heart of servitude for the women that you are given the honor of attending?

Thanks in Birth

I love the Greek language.  It is so expressive and complete. Whereas we might say 'love', the Greeks have different words for different types of love. And whereas we might say 'thanks', the Greeks have different types of thanks.

In my 13+ years of birth work, I can tell you that this one thing can make all the difference in the birthing room - whether you are thankful for the sensations of birth or not. If you're not, you might find yourself using these words:

• (at the beginning of a contraction) "NO!"
• (at the beginning of a contraction) "not another one..."
• (at the end of a contraction) "it's horrible, this is horrible".
• (between contractions) "I hate this, this is not good."

Think of it this way, if you have been asked to do a task that is very difficult, attitude will make all the difference. You still have to complete the task, but it's up to you if you do it grumbling and complaining or if you do it in thanksgiving and joy. Joy and thanksgiving doesn't mean it's not still going to be work, even hard work - it's just the difference between a dance and a dirge.

Ok - back to the Greek forms of Thanks. There are at least 7 forms that I am aware of. I am going to break down four of them for you here, and how they can apply to birth.

• YADAH - This form of thanks means to 'throw'. It literally means to thank with total surrender - like a child jumping into the arms of their parents in total surrender and gratitude.
• TEHILLAH - this form of thanks is audible - to sing or laud verbally. An unrehearsed and spontaneous new song or recitation from the heart. 
• TOWDAH - is physical thanks, such as extending your hands palm up in gratitude. This is also a form of adoration or agreeing with what has been done or what has been promised. 
• EUCHARISTIA - feminine form of giving thanks. This form means to actually feel thankful. 

Labor that is thankful is a change of mindset. When the mind changes, the heart follows. Practical ways to practice thankfulness in labor and birth can include: 

• YADAH - surrendering through your body language, completely letting go.
• TEHILLAH - using your voice positively and using positive words, such as 'yes', 'I am safe', 'this is good', and 'one step closer'. Nodding your head or rolling it in circles rather than shaking it 'no'. 
• TOWDAH - practicing deep surrender by releasing tension in your body. Keeping your mind set on the goal of birth - the baby. Being thankful for that baby and the work that comes with getting to baby. This would include keeping your mind set on the fact that labor is bringing you closer to baby. 
• EUCHARISTIA - if you are practicing the above thankfulness, eucharistia normally and naturally follows. 

Happy Thanksgiving everyone! 

Let It Go...

So, right about now, many of you have magically transformed into Elsa and are singing with gusto.

Yeah, that's kind of what I'm talking about. During labor and birth, your support team will be encouraging you to let it go... all of it. Physically, emotionally, and mentally. Labor and birth is an event unlike any other in your life - one which challenges you in all three of these areas, providing an intensity that brings you to a very primal place of reckoning within yourself.

For that reason, let's look at some practical and concise ways to encourage letting go during pregnancy, and in preparation for birth. 

First off, be sure to protect your bubble of peace during pregnancy by letting only positive and empowering stories and words into your heart and mind. Women love to give advice and tell 'big fish' birthing stories to each other. One simple thing you can say to stop negativity in it's tracks is, "please only share positivism with me, my baby is listening."

Read books that encourage education and preparation in a non-threatening and positive way. Books will give you education and tips/skills to help you through the labor and birth process. 

Practice physically letting go through conscious recognition of tension. An easy exercise for this is when you have to use the restroom, either #1 or #2.. .in fact, getting used to the sensations of both is actually helpful. When first sitting down on the toilet, remain in tension for a moment, notice how your pelvic floor is clenched. Then, take in a deep breath and, on the exhale, release the tension in your pelvic floor, allowing you to go to the bathroom... this exact sensation is what you need to accomplish during labor with every single contraction. You can do this as often as you like, and I recommend practicing this a ton in the last 6 weeks of pregnancy. 

Practicing progressive relaxation will condition you to physically release tension - which is a helpful tool for labor and birth. Find a good one, either through Hypnobabies, Hypnobirthing, or even YouTube, and practice it at least 3 times a week. 

And finally, practice being open and honest with your partner and birth team about any anxiety or worries that you have while preparing for birth. Two things are accomplished with this simple practice. One, you may be able to let go of some of these before your birthing time even begins. And two, if you can't, you are at least practicing honest self-evaluation - which will come in handy during your birthing time in the event any of these worries or anxieties come up during it. 

During labor and birth, there are some key tips and tricks to help you remember to let it all go...

First off, use words that help you let go. These words might be "limp and loose", "release and relax", "soft and open", or even "let go...". Your partner and birth team can help you by repeating these to you at the start of every contraction, and use reminders throughout the peak of each contraction as well. 

Now speaking of words (pun intended) let's touch on your own vocals. Prior posts have spoken extensively on the power of your labor sounds. More specifically, you can practice prenatally, and use in labor, the HA breath. Open your mouth and let your jaw hang throughout. Make what noises sound loose and limp, roll your head on your shoulders in broad sweeping circles. If you feel your jaw and neck muscles resisting, blow "horse lips". 

When you feel a contraction begin, shake out any tension in your hands, arms, hips, or knees before it climbs to it's peak. This will help you set your body into a state of 'no tension allowed' and wipe the slate clean during each contraction. 

Remember that toilet training from earlier? Practice that same 'letting go' during each and every contraction. Check in with your buttocks and pelvic floor and make sure it is in a state of looseness. If you pass gas or pee a little, that's fine. It means you are completely relaxed in the area it matters most. 

If you are in a position that you aren't using your hands to support you, place your hands palm up. This keeps you from referring tension to your hands. 

Remember to voice any negativity or anxiety/worry that comes into your mind and heart. Talking it out allows you to move over that hurdle instead of stepping onto a hamster wheel of negativity. Remember, your birth team can only help you as much as they know what you need. 

And that, my friends, is my list of practical ways to let go during labor! 

Scapegoats and Birth Teams

Dear Nurse -

"I don't like doulas. Just in case my actions didn't make it obvious enough, let me spell it out for you - 'your presence isn't welcome. You complicate my job and my relationship with the doctor."

I'm sorry that you have been bullied by the hospital contractors enough that you feel the need to treat doulas like that. I get it, I do. A doula's presence can sometimes make your job harder, no matter how hard we try to make it easier.

A doula's presence should allow you more freedom to focus on the details of your job - like charting, other rooms where women don't have additional support, and supporting mom in the medical aspect of her care. A doula should be able to focus her attention on physically and emotionally supporting mom during her labor, changing out linens, helping mom to the bathroom, helping her into different positions, cleaning up her messes, and getting her fluids and nourishment.

Sometimes, though, our presence can complicate your position. Sometimes, when we see a medical provider attempting to coerce mom into interventions or medications for the sake of the providers comfort, schedule, or personal bias, we might have to put on our advocacy and educator hats. This can place you between that proverbial rock and hard place.

Please remember though, we aren't the bad guys. Bad policies, medical advice for the doctor's best interests, and convenience sake are the culprits for the position that you are in. A doctor who bullies mom most likely also bullies nurse when nurse doesn't follow through with their orders - even if it is mom's refusal of those orders that made it so that you cannot fulfill those orders.

But let's call a spade a spade, shall we?

The provider wants you to do xyz to mom. Mom asks educated questions about xyz, and you repeat what you have been told to repeat; that it's 'necessary and non-negotiable'. I remind mom of her rights as a consumer and patient and offer, while attempting to include you in the conversation, other possible options.  

You update doc that mom has opted for abc and will be forgoing xyz. Doctor doesn't like this answer and puts the pressure on you to 'finish the job' that he wanted you to do in the first place. You are put in a hard place. It would've been so much easier if I wasn't there so that you could do xyz. 

Whose fault is this awkwardness really? Mom's for being a proactive partner in her own healthcare? Your's for not assaulting mom to complete what mom has refused? Mine for educating her so that she can have the best chance at achieving a birthing experience that is both safe and fulfilling? Or the provider's for attempting to manipulate both you and the mother?

Your anger and frustration is misplaced. I get it, it's hard to properly place blame when the blame rests on someone who can make or break your career. But to remain silent when you're being mistreated by your superiors is simply enabling them to continue mistreating you. And displacing that blame onto my shoulders only perpetuates the cycle of mistreatment. In essence, doulas become the scapegoat for your dissatisfaction for the way you are treated by your boss.

Did you know that a doula would be happy to back you up if you were to report a provider for mistreatment? Did you know that a mom would have your back in an instant if you had hers? And did you know that, if we began to demand more ethical treatment on all levels of healthcare, and worked together instead of offering up scapegoats for sacrifice, we could really make a difference?

So make your statement earlier or a little more honest and a little less enabling... "Cole, your presence complicates things. I was taking it out on you earlier because it's difficult to stand up to this doctor. Having an educated patient with a solid support team that advocates for her options ticks this doctor off... and he takes it out on me."

Additional reading:
https://www.amsn.org/sites/default/files/documents/practice-resources/healthy-work-environment/resources/MSNJ_Murray_18_05.pdf

It's Just Going To Hurt - And I'm Sorry

eventful.com

My husband and I went to a local comedy joint, as we often do, and had the privilege of watching the act of inspirational comedian, Darryl Lenox. Darryl is a man who's personal struggles, both physical and emotional, have provided him with the substance needed to bring his audience to chuckles and tears, motivation and amusement.

At one point, while talking about his eye surgery, he begins to explain how his cataracts were extensive enough that his pain medication wasn't touching the discomfort he was feeling. 

His doctor offered to stop the surgery, or to put him out with general anesthesia. Darryl replied that he didn't want to be put under general anesthesia because, in the event the surgery went awry and he lost his sight completely, he wanted to 'watch the lights go out'.

So his doctor made a very profound statement:

"This is just gonna hurt, and I'm sorry." - Darryl Lenox, 'Blind Ambition'

How many times in our lives would that statement have been helpful? Darryl expounds upon this by giving us a bit of humor.. It would be helpful to have this advice in high school, during our wedding vows, and so many other times... 

And what about birth? There are times when I hold a woman's hands while she is piercing me with the 'look beyond the birthing room' stare. She breathes heavily on my face and gasps, "but it hurts!"... and I do, I hold her gaze and earnestly say, "this is just going to hurt, and I'm sorry." 

Sometimes labor's just uncomfortable, but sometimes it hurts. I'm always honest with my mamas, but sometimes my best tool is to give her this type of honesty.  Breath awareness, counterpressure, massage, mantras... sometimes they all fall to the wayside and we are left with the root of it. 

This is just going to hurt, and I'm sorry.

Acceptance

and Surrender

How much freer could some mamas be, could we all be, if we were given that raw honesty so that we could accept, and surrender to, it? 

Small-Minded Birth Workers

Some of you might know, or it may come as no surprise to you that don't know, that there are a number doula support groups on Facebook.

The intent of these pages are many-fold. Some are intended to help you grow your business, others are on ethics and peer review, while others are for mentoring and local/community support. Most of these are a combination of some sort.

Now, recently a doula friend of mine, who is a member of one such board, sent me a screen shot of a current conversation.

The focus of this group is outlined as such:

" We are strong business women. This group was formed because _____ saw a need in the doula industry.  ____ trainers wanted a place where doulas could discuss the business side of doula work.

This is a forum where we will be sharing marketing ideas, business strategies, answering questions and facilitating discussions. The purpose and intention of this group is to spread the  _______ message.  _______ is dedicated to helping women turn their passion into a paycheck.  _______ believes that Doulas should be paid for the services they provide and believe it is counter-productive to the industry when other Doulas provide these services for free or low cost."

Ok, duly noted that they don't promote or believe that doulas should offer their services for free or low-cost.

And duly noted that they say in their description that they are a group about the BUSINESS of doula work, But... 

But what I don't understand is how these 'professionals' can pretend that they are professional when they make disparaging remarks and ridicule others in the same profession for having differing business practices.

If we lose site of the heart of what a birth worker is, even/regardless to how it pertains to being a 'business', we cease being community changers. 

Now a side note, many of my fellow doulas and friends, both IRL and online, are a part of this group. Just because they are a part of this group does not mean that they partook in the very unprofessional behavior that you will read herein, or that they support this type of ethic. 

Another aside, I received these screen shots from someone not a part of this conversation - so none of the doulas involved sought me out - I sought them out for their side of the story.

Along the left hand column of this post, you will see a conversation that has since been deleted from the group (per an individual involved in this conversation). Also, since this conversation began, at least two of the women ganged up on have been forcefully booted from the group.

Yes, it's a closed group. Yes, it's a moderated group. And yes, they are allowed to keep whomever they want in the group. That is not the point. The point of this post is the unprofessional, unethical behavior and bullying that occurred in this thread. 

The conversation started with an innocent enough question: "do you see doing a discounted or free birth here and there as your business 'giving back to your community'? I don't."

From one individual who was a part of the conversation, there was some conversation immediately after that initial post that talked about how free and discounted services discounts the work we do as a doula. To which a doula came on and said, "It's making a difference.. it's impacting the community."

The next doula who came on replied a little more directly: "['discounting the work of a doula' poster's name], just because someone has the desire to give freely of THEIR services, THEIR skills and knowledge, THEIR time - does *not* mean that they do not value doula work as a 'profession'. 

That is just small-minded to say, I'm sorry but it is. I see is as less likely for someone who *only* does doula work to be able to do low-fee/free births than someone who offers various services/has another source of income. But those birth workers who *choose* to do that work, shouldn't be put down for it."

Snarky, derisive, rude, and condescending comments begin at that point and blossom into a conversation that is almost too painful to read. These remarks are made by both members and admins of the group, alike. Always lobbed at those who support the right of a doula to choose to give free or discounted services, regardless of their reasons for offering.


I have posted before on my feelings about people asking for low cost or free doula services, but I don't care what side of the fence you are on regarding free and low-cost doula services, the behavior of these moderators and members is completely unethical. 

Ethics: moral principles that govern a person's or group's behavior.
synonyms: moral code, morals, morality, values, rights and wrongs, principles,ideals, standards (of behavior), value system, virtues, dictates of conscience"

It is never professionally ethical to treat someone so disparagingly. Never.

One person asked what principles and basis a dissenter to the 'popular opinion' might be referring to when she said "I cannot disregard the principles and basis of what a Doula was meant for."

Let me expound on that dissenters response... As I pointed out in prior posts, and specifically in the history of birth partners, doulas and midwives were not only meant for those women who could afford them. A doula was never a luxury item, although the term we use for our profession is one of luxury.

Doulas and midwives, godsibs and sage femme, historically went to every woman - not only those who could afford one. We trudged through hell and high water to ensure she had a good, supportive birth because we believed in a woman's worthiness to have it - not because of what she could provide us.

The moderators and contributing members have completely missed the point of this calling. From their own words, it is easy to see that, to them, it is only a business. To them, the 'principles and basis' for what we do for women and why we do it has been lost.



I get wanting to be valued in the community. I get wanting to be seen as a professional in the community. I get it because I wrote about it and continue to write about it. But the militant, aggressive, close-minded, and callous version that they believe? No way, I don't get that.

Hell, midwives in this area take state insurance and, as a default, offer reduced-fee services. Doctors do as well. Chiropractors and massage therapists in this area give reduced fee services and do community services and classes for those who cannot afford it.

Restaurants give free food to the homeless and grocers give food to the food pantries. A local man I know offers car services for the price of parts only on certain Saturdays for single mamas and spouses of deployed partners.

It takes a special kind of business owner to not see the merit of giving back to their community through their services in some capacity. And one I wouldn't want to do business with.

Shame on you, moderators and others involved in this disparaging and bullying thread. Shame on you for doing the very thing that you claim to be avoiding: making the doula profession unprofessional in every regard.

I will think of you next time I spend my time sending packets of information and resources and free samples to the 18 year old who is working her ass off trying to graduate with her class at the end of the year regardless of the fact that her mom and dad have all but disowned her and her baby's daddy is nowhere to be seen.

I'll think of you when I send her the name and number of an amazing midwife in the area that does offer her time and services free of charge just so that she can get out of the care of the only provider that her state insurance will cover that is within walking distance of her home because no one will drive her to a better doctor further away.

I'll think of you when I send her to a stellar up-and-coming doula who has a heart for these situations and plans on, someday, getting her midwifery license and traveling to third-world countries to help train birth professionals in every village.


And I'll think of you when she births her baby, on her own, into her own hands, surrounded by women who cannot disregard the principles and basis of what a Doula was meant for.

- actual situation in my professional past

*edited to black out their pictures ;) after receiving numerous 'requests' (well, threats) from a number of the women involved,. Only one woman contacted me and actually asked. Most of them cited Exploitative Law. But this doesn't fall into that category as seen here. As I told them, my intent was to draw attention to unprofessional behavior in our profession, not to individuals... As is apparent through my blacking out of the offenders names (insert roll eyes).. so I obliged. 

Some said it was yellow journalism. Some said I was muckraking. Some said I was unprofessional for calling them out. But here's the thing: I didn't sensationalize or exaggerate it in the least. Hence the screen shots. It's only muckraking if I a) SOUGHT it out (which I didn't seek out this information b) it's considered 'scandalous'... to which I asked if they thought their behavior was scandalous? and c) they'd have to be famous. :/ 

And would you consider me a bully if I stood up against bullying? That's what's happening here. So there you have it. 


So...

Rather than end on that note, tell me birth workers, how are you giving back to your community. Mamas, what are you doing to give back to those in your sphere of influence. 

5 Reasons You Don't Need a Doula

You hear me tell you a lot about why a doula is a great choice in any birthing setting... what I haven't told you in awhile is why you don't need a doula. Let me take this opportunity to do just that. This isn't a long post. It's short and concise - as truth often is - and without explanation. So here you have it. 5 reasons why you don't need a doula:

1. You are strong. You are. You don't need a high pain tolerance or be a marathon runner to be strong, you only need a uterus and a humble respect for it. 
2.  You are capable. You are. Your mind is sound and your body is able, the last part of that equation is to allow those two things permission to do what they need to to give birth. 
3. Your body contains ancient and primal wisdom. Cellular memory, your mother's mother's mother's mother's birthing wisdom and knowledge, they are coursing through every fiber of you.
4. Your body contains immeasurable power. Only a female body can create, grow, and birth. 
5. You have everything you need within you. Tap into that innate wisdom, power, trust, honor, respect, and knowledge. 

This is your birth. 

B.I.R.T.H. Fair 2014

Every year, Houston birth workers, education professionals, infant and young child professionals, and parents converge in one location to share information and support with their community. Picture this: hundereds of women, their partners, and their nurslings milling about. There are fashion shows, children's craft and learning areas, keynote speakers, workshops, movie screenings, and educational booths for everything from midwives and doulas to baby wearing and homeschool co-ops. 

Every year, the Houston Doula Co-Op and Sage Beginnings (me) are there. Every year, we speak to our community during the workshops. Every year, we meet hundreds of amazing women and their families - will you be one of them?  

Join us for our 13th annual BIRTH Fair as we celebrate natural parenting and pregnancy. Get the latest information about vaccines, birthing options, breastfeeding, babywearing, VBACs, and more! We will have overstuffed goody bags for our guests, activities for children. Birth Fair will be held on October 4th from 11 a.m. to 4 p.m. at the United Way Center on 50 Waugh Drive. Check us out on Facebook (www.facebook.com/houbirth) for our latest giveaways, or visit www.houbirth.org or call 832-499-6029 for more information. This event is free and open to all ages.

Bended Knee

I walk across the threshold into your room and see that you are swaying in the arms of your lover. Candlelight provides the backdrop for this sacred moment, and the scent of sandalwood and lavender waft from the warm water basin at the foot of your birthing alter.

As I step into your birthing space, I slip out of my shoes and quietly and humbly approach you. Your midwife sits on the couch to the left, her feet folded beneath her. Your photographer kneels on the floor at the foot of the couch, and your sister is cross legged on the hearth. Every knee is bowed and bent in reverence to the sacred work before us.

At first you dance to the rhythms of of your body - swaying and undulating your hips - while we silently hold

vigil. Soon, though, you move to all fours upon the ground as even you, the conduit of this powerful work, are brought to your knees in awe and deference of your bodies power and work. 

This is what we do. Every birth worker, whether she be hand maid, photographer, doula, midwife, or mother herself, should approach the sanctity of the power of birth on your knees; in humble reverence of the miracle of birth.

http://usthreebirds.blogspot.com/2011/08/elliottes-vbac-birth-story.html

Go to her blog to read a beautiful recounting of her VBAC birth story

Not placing ourselves above the birthing woman's powers - placing ourselves above her diminishes her power and resolve. This is the manner of obstetrics (from the root obstare - to stand in the way of). Adopting the attitude of bent knee is a mere reflection of the inner heart and mind. A servant to the ancient rhythms provide us the proper perspective to watch a miracle unfold. Following the conduits lead in a dance of ebb and flow, the perspective of 'with woman' is always on bended knee.

A Risk Analysis' Review of Her Own Births

This is a mamas review of her own birth experiences, cesarean and two VBACs. Thanks for sharing mama C! 

To those whose c-sections were for "failure to descend" (stuck baby) who are seeking a VBAC but having doubts about your ability to push out a baby, I hope my story (and data) will encourage you.

My first OB said she'd support my first TOLAC but she didn't see why I bothered trying as I probably just have a "small/heart-shaped" pelvis and probably can't push out babies. Which is funny because she didn't even attend my first birth that ended in c/s (she had an ear infection). So how would she know anything about my pelvis? Luckily by then I had read enough to know the necessity for my c/s was probably caused by position (baby's and mine) and preparation (mine). So I fired her. Clearly not supportive. I interviewed 6 OBs and finally hired another, much more supportive, OB who delivered both of my VBAC babies.

Some data which may interest you, in order of birth (c/s, VBAC, VBAC):
Birth weight - 7 lbs 2.3 oz, 7 lbs 0.2 oz, 7 lbs 0.8 oz
Birth length - 20.5", 19.8", 20"
Head circumference - 32.5 cm, 34.5 cm, 33 cm
(So, clearly it wasn't a size issue...)

Baby's position - stubbornly OP and asynclitic, OA, OA
(Figured out first was OP due to 24 hrs back labor, slow dilation, contraction pattern, head shape post-partum, and ultimately OB had to reach in and turn her for a final pushing attempt - she then flipped back to OP prior to surgical delivery)

My position - flat on my back, seated squat, flat on my back
(Delivering my 3rd on my back was unplanned and probably only successful due to SPD during pregnancy and/or my pelvis having opened before and/or preparation (see below))

Preparation -

For my first delivery I took the hospital childbirth and child care class which taught Lamaze. I did not however practice the Lamaze on my own between classes or after the classes were complete. I assumed I had learned it, and would use it when the time came. I didn't understand that when your body is under stress the only response you can count on is one that is INGRAINED in your psyche, not one that is simply understood by your brain. So it didn't work when I went to try and remember it during my birthing time. In addition I didn't prepare well when it came to my birth team - I had my husband, who had no birth experience, and my 3 best friends, who had no birth experience. I have no local family, and we all tried real hard, but no one knew how to recognize poor baby positioning, no one could advise on how to reduce discomfort, no one had a clue about how to calm me down and get me to release and let my body do what it needed to. I saw 4 shifts of L&D nurses of varying quality, and the least helpful was unfortunately who I had at the most critical time. The OB wasn't there much at all but was very encouraging when she was (again this was not the OB I had prenatally but the on call I met when I was admitted).

For my second delivery I took Hypnobabies (HB) and I practiced between classes and practiced after the classes were over right up until delivery. I wasn't perfect, I didn't practice every day, but I did it enough because I made it through delivery using those tools. For me HB was essential in preventing panic, which is what locks me up, in response to discomfort. My husband took the class with me and became a great L&D coach, more confident in how to support me, how to help me get through it. And I hired a doula, (Cole), who supported me through both shifts of L&D nurses (yay for consistently great support no matter who's on shift!!), and also specifically used her tools to help move labor along and help move baby down, in addition to taking the time to learn all my HB cues to help me use it successfully. My second birth was a GENTLY induced VBAC - yes it can be done when medically necessary and still end with a vaginal delivery!!

My third birth I credit HB for allowing me to be in denial about being in my birthing time most of the day. I practiced HB from week 30 up until birth, most nights, just listening to my tracks and practicing finger-drop. The day I entered my birthing time I was just uncomfortable and felt crappy. So I took the opportunity to "practice" HB for some relief but never believed I was actually in my birthing time. Suddenly late that night I knew we had to go to the hospital. I gave birth 42 minutes after arriving at the hospital, using HB the whole time. Everything happened so fast that my OB didn't make it in time, but my doula (Cole) did and she and my husband again gave me exactly the support I needed. Even with birthing flat on my back I pushed her out in under 15 minutes.

My point with all of this, ladies, is that POSITION and PREPARATION are far more important than perceived body capability and baby size to achieve the birth you want. Body capability and pelvis size CANNOT be determined by an OB by any method of examination, just educated guess! Baby's size doesn't matter as much as you'd think because FAT SQUISHES! Baby's position on the other hand can be encouraged (see SpinningBabies), your own birthing position can be controlled (particularly if you have a trusting relationship built with your care provider), and your preparation is entirely in your control as well. Find a childbirth class/method that you can COMMIT to and PRACTICE, and build your birth team based on your birthing NEEDS, not necessarily the PEOPLE you simply love.

You CAN do this, and don't let anyone - including well-meaning family, friends, or care providers - tell you otherwise!!!

My Doula Suggested

If you haven't noticed, I am taking a bit of a comical relief break in my blogging.. This blog post is no exception. So, without further ado, I give you, "My Doula Suggested" (a compilation of suggestions made by doulas that I know and trust, or me).

I Be Like...

Being a birthworker is such a rewarding profession. The ups, the downs, the in-betweens - all equate to one thing = my job is an adventure.

That said, there are ups and downs. This is my unprofessional view of birthwork through a birthworkers eyes.

What I feel like I look like at consultations

What I really look like at consultations

What I look like when I nail the consultation

What I feel like when someone tries to pop a pregnant mama's 

bubble of peace

How I feel when a mama I'm working with switches out of the care of her 

unsupportive provider and into the care of one I have worked with, 

trust, and supports her choices

How I feel when a mama I'm working with says, "I really want a natural

birth" but is unwilling to do anything I recommend to prepare for it or chooses to 

birth at a hospital notorious for cesareans 

How I react when a provider asks a mom if he can strip her

membranes at 36 weeks, 'just to see what happens.' ... 

and she consents

What I look like when a new report, study, or review comes out

regarding pregnancy, birth, or parenting options 

What I feel like when a provider ignores all of those same research, studies,

reports, and reviews for their 'own policies'

How I look while getting ready to head out to a birth

When the on-call steps in the room and says they 'don't do VBACs'

even though mom is ready to push

The face I make when a mom calls me to tell me she ignored

my advice to rest while she could in early labor, instead she

went for a walk, and now she is exhausted, wants to nap, and

labor just kicked into high gear

What it feels like when nurse and I work great like a team and rock it out

with our superstar skills 

The look I give a nurse in triage when

mom is making 9-10cm noises and she says, 'let me just go

get your chart' and leaves the room

What I do when an OB, who has made their first appearance in 

the room for the whole labor, says, "better start preparing for the

possibility of a cesarean. You aren't progressing and I don't see this ending vaginally."

What I do when, 2 hours later, mom is pushing so "well" that the

same OB barely makes it in time 

What I feel like when a mom has been been 'stuck' at 7cm for a millennium

and her baby is floating high in the pelvis and there's rumors circulating
in the room about "plan C"

What I feel like when, 30 minutes after the Parrish Maneuver, fear releasing,

and Walcher's Technique, mom is crowning

My face when I hear a midwife say, "a doula isn't helpful

or necessary at a birth outside the hospital."

What I do when a provider meets me at the door to a laboring

woman's room and says, "I don't like doulas, they are irrelevant

and I have had very bad experiences with them in the past."

What I think of other doulas and midwives who are unethical
(talking trash about other birth workers) and territorial with potential clients

What I do when a mom calls me to tell me she thinks her water

broke, she thinks she's having contractions, or she thinks 

she 'did something to her back' because it's aching

What my face must look like when a provider says they 'can't let mom',

'don't do ___', or tell her she "can't ___'

How daddy and I look when nurse goes to bat for mom's choices

and mom get's the birth she wants

The look I give an OB when they transform into a

midwife before my eyes...

What I probably look like when a provider or nurse takes 

the time and opportunities to teach me something

new and 'above my pay grade' 

What dad and I look like when a mom finds her voice during

labor, becomes empowered, and stands up for what she knows 

she and baby deserve

What I know I look like when a nurse or doctor says that babies

can't be born in any position but on a woman's back

What I do when an OB says for mom to pick whatever position

feels most right for her to birth in

What I do when someone gives advice that is neither medically sound

nor evidence-based on an online forum

What I do when a nurse says, "epidurals are completely safe

and have no real risks."

What I do when a midwife, mom herself, or partner ask if I will help mom

to do nipple stimulation

What I feel like for every. single. VBAC mama

What I feel for every single mama after she birth

What I look like when I get off a 32 hour shift and stumble into my home

And why I would do it all again after just a few hours rest