A Doula Story

I just heard about a moving film, "A Doula Story," and can't wait to watch it! The film's website described it this way:

A Doula Story documents one African American woman’s fierce commitment to empower pregnant teenagers with the skills and knowledge they need to become confident, nurturing mothers.

It's available to watch for free here.

I love doulas. :-)

She is a SUPERWOMAN!

I wanna turn the whole thing upside down
I'll find the things they say just can't be found
I'll share this love I find with everyone
We'll sing and dance to Mother Nature's song
I don't want this feeling to go away
-Jack Johnson, "Upside Down"

I couldn't keep the tears from coming as I read Holly's birth story. Warm fuzzies up the wazoo! I'm so happy for you, Holly! I knew you could do it! (I hope you don't mind the photo snagged from your post.) :-)

Birth Faith

This pregnancy has tested my faith in so many ways. But my deepest fear has definitely tested it most of all.

At our doula training two weekends ago, we did an introspective exercise. We were all given a piece of paper and a marker. Then we took the marker into our non-dominant hand and drew or wrote something to represent our deepest fear about our actual or hypothetical upcoming birth. For me it was very actual... very real. It was a limp and lifeless baby with his arms and legs hanging down below him. A dead baby.

I have never needed to face that fear before. I never worried that my daughters or I would die in childbirth. I worried about other things... logistics... would the staff pressure me to have interventions I didn't want? Would I be able to handle the contractions? Would I tear? I never asked, "Will my baby die?" This is the first time I've asked myself that question. And what a heavy question!

Of course my daughters could have died... even in the hospital. Babies sometimes die. I suppose the difference now is that I don't have the other logistical worries to occupy my mind. I know there will be no unnecessary interventions. I know I will be surrounded by support. I know I can handle the contractions. But I also know that, if something bad happens, those who have questioned our home birth will shake their heads and point their fingers at ME. No one would ever think to point their finger at a mother whose baby died in the hospital... even if it was her own ignorance of the risks of interventions or poor choice in doctor that led to the death. It would be absolutely unheard-of to blame the mother. Home birth mothers don't get that kind of courtesy... even when their babies' deaths have nothing to do with their birth location and would have died in the hospital anyway.

So I do think about it. And I know I wouldn't be able to handle facing that deepest fear in real life... without my faith. When that fear starts wrapping itself around my heart, it is my faith (and my husband's even stronger faith) that slowly eases the panic.

As we did the fear-facing exercise at our doula training, we went on to contain our fears with the internal and external forces/influences that would be at our disposal. I contained that frightening image with my husband, my midwives, preparation, and God. I suppose you could say, I contained that fear with my faith in them.

I had a really reassuring chat with my midwives this morning at my appointment. It was reassuring that they can't even remember the last time they had to transport a woman who'd given birth before (to the hospital). And their confidence that they could get to my house in 20 minutes put my "what if the baby comes too quickly?" fears to rest. They've never lost a mother or baby. They have seen it all when it comes to birth... over and over again (Mary, for 30 years!). And they're not afraid. So why am I?

My husband, who was always afraid of home birth in the past, has no doubt in his mind that everything is going to be fine. He isn't the least bit worried. At all. No matter how many times I ask him, in my weakness, "Our baby's not going to die, right?" He always responds with the same steadfast assurance and peace, "No. Everything is going to be fine." He has total faith in our path. So why can't I?

More importantly... God has never let me down. I have no reason not to trust Him. He guided us to this particular path and urged us not to fear. So why do I?

I suppose it wouldn't be called a "test of faith" if it wasn't hard. :-)

Sometimes I like to imagine that moment when my son emerges and I take his slippery little body into my arms... you know, that moment that always makes me cry in birth videos... I like to imagine hearing him take his first breath and use his lungs and vocal chords for the first time. And I imagine the overwhelming relief that will wash over me with each breath, each sound, each vigorous movement of his arms and legs... he is alive! That imaginary instant may be just in my mind, but it feels so real every time it presents itself. So real, in fact, that I think I just might have enough faith to believe I'll see that moment happen.

My new toy

I got a birth ball, baby! I think my husband was even more excited than I was to blow it up last night and try it out. He's a runner and general fitness-lover, so he was trying out push-ups and sit-ups and various moves on it. Then he laughed at me while I bounced on it, smiling from ear to ear like a little kid. :-)

In other good news, we also bought most of the supplies for the birth last night! You can see some of them piled in the background of the picture... lots of plastic drop cloths and shower curtains to protect the floor and furniture, loads of cheap towels and wash cloths, diapers, batteries for the camera, nursing pads, etc. I feel so much less anxiety now that we're stocked with what we need! Yay!

And, speaking of getting prepared, I'd love your help creating my "birthing playlist." I'm looking for soothing and inspiring music. So far I have a lot of Enya and Sarah McLachlan on my list. Any ideas??

2009--The Year of Birth Trauma Awareness!

I love this idea and this photo at Joyous Birth!They urge us:

Kick off Birth Trauma Awareness Year 2009 by standing proudly with your sisters.

We are all in this together.

What is done to one woman, is done to us all...

Enough is enough.

We will no longer stand by while our sisters, partners, friends and babies are mutilated and traumatised.

The silence ends now.

YES! Let's do this, girls!

It's about TIME

How cool is this... Time Magazine is raising awareness about the problems with repeat cesareans! I knew it was going to be good when I read the opening line: "For many pregnant women in America, it is easier today to walk into a hospital and request major abdominal surgery than it is to give birth as nature intended." I love that birth issues are popping up more and more in the mainstream media! Click here for the article (Pamela Paul, "The Trouble With Repeat Cesareans").

Ask Busca: Dads and Doulas?

I think I'm going to start a new feature: Ask Busca. If you have a question related to childbirth, pregnancy, or breastfeeding, ask away, my friends! I'll work on getting an email address created for this purpose. In the meantime, here's the first "Ask Busca" post.

Fig asked:

My husband only wants the two of us to be present for our first baby's birth. (No friends or relatives or anything, just him, me, and the people who are delivering the baby.) So ... do you think I can convince him a doula would be one of the baby-delivery personnel? I have no idea what the dynamic is like in a delivery room. No idea what to expect. But here's what I know about my husband: he is extremely private. He doesn't like big fusses, or loud craziness, and he's very uncomfortable with profound emotions/pain. He also doesn't like to be bossed. I guess I just can't figure out how the husband and doula work together without the husband feeling a little bit weird. Am I worrying about nothing?

Busca's babble:

My husband and I had some of the very same concerns with our first pregnancy. We felt that we only wanted just the two of us at the birth. But God knew better. So he gave us Eve--my saint of a nurse, who was really basically a doula. I could NOT have done it without her help. I thank God almost daily that Eve was my nurse. But the truth is... most nurses aren't like Eve. So, most women labor alone with their extremely overwhelmed husbands trying, often futilely, to support them.

We talked a lot about this at our doula training. One of the studies we discussed (click here for the abstract) showed that 12 out of 20 husbands take on the "witness/observer" role in their wives' births. Only 4 out of 20 filled the "coach" role. The remainder were "teammates"--taking their lead from others' suggestions (which requires someone to actually be present to make those suggestions). We discussed how important it is for couples to discuss which of those roles the husband feels comfortable filling. Some men just aren't comfortable taking on the "coach" role, but so many women have the expectation that they will (or MUST) fill that role. Then they're disappointed when their overwhelmed husband can't be that support during labor. Some husbands plan to fill the coach role but find themselves blind-sided by the intensity of birth (think: deer in headlights).

It's completely OK for a husband to be a witness/observer if that's what he's comfortable being. He shouldn't be expected to be something he's not. Based on your description of your husband ("he is extremely private. He doesn't like big fusses, or loud craziness, and he's very uncomfortable with profound emotions/pain"), I wouldn't be surprised if he would be most comfortable as a "witness/observer." Birth (by its very nature) is a big, huge fuss! It is LOUD. It is intense and RAW and emotional and painful. It just is. And it's OK if he needs to withdraw from that intensity and just observe. It's totally OK.

BUT... if you're serious about wanting an unmedicated, non-interventive labor and delivery, you absolutely must have support. And a "witness/observer" will not be enough. And you can't guarantee that your nurse will be helpful. They're generally busy and overworked and used to the standard assembly-line approach to birth. I understand the desire to experience this sacred event privately. But I'm telling you now that, if I'd had any other nurse, I would have been cranked through the birth machine just like everyone else. I would have buckled, no question. Continuous emotional and physical support are crucial!

Here's a quote from one of the articles in our doula training binder:

"Women in labor have a profound need for companionship, empathy, and help. Those responsible for her and her baby's clinical well-being (doctors, nurses, midwives) even if capable of providing support, must give it a lower priority thatn their clinical duties, and in some cases, their personal needs (for breaks, sleep, and to go home). Labor support is so intense and demanding that few can do it forty hours a week. Some well-prepared partners are admirable labor support providers; most are not.

"Without a labor support person, the women's emotional needs will probably be unmet, and she will not cope nearly as well as she might with good support. Copstick, et al. (1985), found that women were unlikely to use techniques learned in childbirth classes beyond early labor unless their partners were trained and willing to help and coach them" (Penny Simkin, "The Labor Support Person: Latest Addition to the Maternity Care Team," 1992).

I just can't stress enough how important continuous support is. If Eve hadn't been there to show my husband how to put counter-pressure on my knees or to suggest other ways he could help, he wouldn't have known what to do. And I wouldn't have known either. Eve had given birth without meds before. She knew how to help. She knew that the noises I was making were normal and OK. She reassured both of us. And she never made my husband feel uncomfortable. They worked as a team.

For more info, check out DONA's "Dads and Birth Doulas Brochure."

Still high

What could be better than gathering with 50 fellow "birth junkies" in a 3-day birth-binge? Oh my. The doula training was awesome.

I tell you what... the oxytocin in that room was palpable. In part because of 5 or 6 breastfeeding mommas with their babes. Compound that with the massages and comfort-measures we were practicing. (Massage and loving touch promote the release of oxytocin.) And then the 6 or 7 birth and breastfeeding movies we watched. I think, in fact, that watching a birth (particularly when physically present) can promote the release of oxytocin. But that's just my theory based on some interesting tidbits from this weekend...

1) The Zone
Our doula trainer, Mary, talked about the way a pregnant woman's hormones can affect those around her. For instance, Mary told us about a study showing that men sharing a home with a woman in late pregnancy will experience a reduction in their testosterone levels. I suppose it's nature's way of preparing the male for fatherhood--promoting less aggression and more sensitivity and decreasing his libido in preparation for his wife's postpartum recovery period. Then Mary discussed how there can be a chemical chain reaction at birth. The people surrounding the laboring woman can enter into a kind of "zone" in which their bodies start producing hormones in response to the laboring woman's hormones. A woman in labor is radiating oxytocin like nothing else. And I think the people around her--if in-tune with her through their consistent presence--will also experience a surge in their own oxytocin levels. It makes complete sense. Of course God would prepare such a chain reaction... He knows the laboring woman needs the people around her to be supportive and nurturing--exactly what their elevated oxytocin levels will promote.

2) The Tears
If you know me well, you know that I'm not a crier. I once told my husband there are really only two things that will get me to cry. The first is emotional agony, the second is God. And I think God touches us quite often through our own body's chemical impulses. God is LOVE. Oxytocin is the hormone of love. I was brought to tears with just about every birth we watched this past weekend. Here are people I've never met giving birth to children I've never met, and I can't help myself... I cry every time I see those babies birthed and brought into their mothers' and fathers' arms. During one video, the combination of the music and the images of women being supported in labor had me wiping away fat tears streaming down my face. I'm convinced that you don't even have to be physically present with the laboring woman to experience an oxytocin rush in reaction to her labor/birth.

I think my oxytocin levels may have even gone a little too high, actually. It didn't even occur to me until after I got home last night that oxytocin may have been responsible for the excessive number of braxton-hicks contractions I experienced during the training. I know, from past experience, that I often have more frequent and intense braxton-hicks contractions following oxytocin-producing activities (use your imagination). Those contractions came over and over and over all weekend. Some of them were quite intense... almost painful. And I thought more than once that if I was going to go into pre-term labor, there couldn't have been a better time/place--at a hospital with doulas and a midwife present in the room! Thank goodness my baby is still safe inside though.

With the bonding hormone so plentiful, it's no surprise I formed friendships over the weekend. I sat next to these lovely ladies on Saturday and Sunday...That's Jessica and Cassie. It was so fun spending the weekend with them and holding Cassie's cute baby boy. And I'm thrilled that they have both offered to be my doulas. Plus Cassie's a photographer and said she'd take photos at the birth for us too! :-) I look forward to laboring and birthing my baby surrounded by loving, supportive women as well as my fabulous husband too.

Here I am with our doula trainer, Mary, after I got my certificate for completing the training workshop...Yay! Now on to fulfill the other certification requirements...

But, in the meantime, I'm doing some serious nesting. All of a sudden I've got the urge to clean and organize the entire house and purchase everything we will need for the birth and have it all gathered and ready. In fact, I spent several hours this morning cleaning my bedroom (one of the rooms I plan to labor and possibly deliver in), putting away baby clothes, vacuuming, and starting a birthing playlist in iTunes. I've never nested so literally before... I'm actually preparing the place where my child will be born. Cool!

Stay tuned for posts with tips and tidbits from the doula training workshop!

The emperor has no clothes

This is fantastic. :-)

You never forget the first time

"How will she remember this?" -Penny Simkin

I got a packet in the mail from my doula trainer a week or two ago. It included info about our upcoming workshop as well as some pre-workshop homework and readings. One of the items is a reprint of Penny Simkin's research published in 1991 in the journal Birth: Issues in Perinatal Care--"Just Another Day in a Woman's Life? Women's Long-Term Perceptions of Their First Birth Experience. Part I." So I sat down and read it last night, with pen in hand, of course.

And I just gotta say... wow... I learned so much for this piece. The points that struck me most...

1) We've come a LONG way, baby! Penny Simkin's research reports her findings from interviews conducted with women who participated in her childbirth education courses between 1968 and 1974. So she gives a list of typical features of intrapartum care in that time period to develop a context for her research. For example... no private labor rooms, enemas/pubic hair shaves, restriction to bed, fathers rarely present, formula feeding (fewer than 20% of women breastfed), baby in nursery except for daytime feedings, and 4-5 day hospital stays for vaginal births. Wow. We still have a long way to go, but, man, I'm glad so much has changed.

2) 5% ?! There is ONE thing I'm NOT glad has changed. The cesarean rate at this time was a mere 5%! Good heavens. So in the past 40 years doctors must have figured out that they could avoid malpractice lawsuits and sleepless nights best if they just played the "hero" card and sliced babies out of their mothers rather than letting nature take its course. Then, of course, placing the blame on the women: "Your body just wasn't built to handle birth," or "Your baby would have died if I hadn't cut you open," or "More women are asking for cesareans." Whatever helps them sleep at night, right? Clearly there are cases when cesareans are warranted, but 5% to a whopping 31.1%?! Unfortunately, just as the cesarean rate has increased, so have the rates of serious complications associated with them.

3) Even highly-interventive births can be highly satisfying. This one was a shocker for me. Simkin divided her research participants into two groups based on how they rated their level of satisfaction with their births--high satisfaction and less satisfaction or dissatisfaction. I was surprised to see that more women in the "high satisfaction" group were given Pitocin, episiotomies, and forceps deliveries than in the less satisfied group! How could it be?! Simkin concludes that what really makes the difference for women is not necessarily what happens to them during their births but how they felt throughout the process. The women in the satisfied group remembered their interactions with doctors and hospital staff as positive. The women in the less satisfied group all reported negative interactions with doctors and staff. How women are treated makes an ENORMOUS impact.

4) When will they listen?! I became livid when I read one woman's account of her negative experience: "Anyway, the doctor wanted to give me a spinal. And I was just sure I could push this baby out if I could just get up there and get some leverage, I could squat and push the baby out. 'Nope, not that, couldn't do that,' so about it seemed like 20 or 30 minutes, he said that I should have a spinal. So I had a spinal. . . . I was no only put down by the doctor and the supporting staff, but by that point there were a couple of other doctors that had come in and some interns, and I felt like this guy partly wanted to show off."

$*#&^*&%^@^@%#&!^&@^!! The sad thing is... this could have happened yesterday. In fact, I'm sure it's happening somewhere right now.

5) This sounds familiar... Another woman's account brought back fond memories of my own first birth experience: "One nurse had been there the whole time, and then when she was off shift, she still wanted to stay with me. She seemed like she was really interested and involved, and that she really cared. I thought it was neat and it made me feel very special." I will never forget my nurse, Eve. In fact, I like to call her Saint Eve. Heaven bless that woman and all the other nurses like her.

To close let me share Simkin's own conclusions:

"The way a woman is treated by the professionals on whom she depends may largely determine how she feels about the experience for the rest of her life. A woman in labor is highly vulnerable. Her most private body parts are exposed; she is in pain; she sweats, trembles, moans, and cries out while among strangers; she is in a strange environment. If she is treated without respect, if her efforts to maintain dignity and control are rebuffed, or if she is taken advantage of, the negative impact is permanent. If she is nurtured, treated with kindness and respect, and feels like a participant, the positive impact is permanent. . . .

"Because the woman may remember her caregiver forever, the question, 'How will she remember this?' should be in the caregiver's mind at all times. . . .

"[M]uch more is involved in the outcomes of 'a healthy mother and healthy baby' than coming out of it alive with no permanent physical damage. The potential for psychological benefits or damage is present at every birth. . . . In addition to a safe outcome, the goal of a good memory should guide their care."

Oh, I love you, Penny Simkin. I've loved you ever since I first opened The Birth Partner nearly four years ago. If you don't already love her, my friends, you will. Especially after you read this.

I'm so excited to join the doula ranks Penny spurred into action. :-)

Turn off the lights!

Last night I heard about a study that reaffirms what our mammal cousins have known instinctively for thousands of years... birth should happen in a dark, comfortable place! It also helps explain why most women go into labor in the middle of the night (which is, of course, why doctors find inductions and cesareans so much more convenient). And why so many labors slow down or stall in a hospital setting....

Read the rest of this post over at my new website!

Would your OB...

...never keep you waiting more than a few minutes?

...or say, "It's okay!" (and mean it) when you apologize for arriving late (because you've got two little kids in tow and couldn't find a parking place).

...tell you how beautiful you look?

...take your blood pressure, look at your urine sample stick, or draw your blood him/herself?

...spend time just chatting with you and/or your children?

...give you a hug at the end of every appointment?

Have I mentioned I love my midwives? Even if the birth experience itself wasn't superior with midwives (and it is), the personal and genuinely interested prenatal care midwives provide makes them so beyond worth it! Once you've been cared for by a midwife, there really is no going back!

Just in case you're wondering, my glucose levels were great this morning. Yay! And I was relieved to find out that I only gained about 2.5 lbs since my last appointment (definitely easier to swallow than the 10 lbs I gained over the holidays)! And the little munchkin is head down... good to know, 'cause I've been wondering. (A little breechling would definitely throw an enormous kink in our plans!) So everything's going fabulously. Except that it's going too fast! I've only got about 9 weeks to go! Ah!

Douladom

I'm finally doing it, my friends. It was the summer of 2005 when I first started exploring the world of doulas and felt myself being called to join their ranks. I've continued longing for it ever since, but it just never felt like the right time and the trainings were cost-prohibitive. Well, the time has come.

Fortune smiled on me a few months back when I was interviewing home birth midwives. One of the midwives I interviewed happened to also be a doula trainer, and she mentioned to me that she was offering a free doula training in February! She decided to offer it as a service to the community and only asked that the participants promise to use their training to give back to the community as well. She was also offering it as a way to spread the word about a really cool group she was involved in starting: the BEEP Movement. BEEP stands for "Better Educated and Enlightened Parents." It's "a grassroots movement founded by mothers, fathers, and professionals dedicated to guiding families to the best information regarding pregnancy, birth, and parenting" (according to the Yahoogroup page). I was totally excited to find out about the training workshop as well as the BEEP Movement.

So, over Valentine's day weekend, I will spend all day everyday learning the doula's art. And I can't wait to start using the skills I learn to help other moms experience beautiful births! In the meantime, I'll be spending some time on the DONA website refreshing my memory about the certification requirements, etc.

P.S. Tomorrow morning I eat jelly beans. :-)