the birth of a doula

Doula Jenna "Families Reunion" 2012

2012-01-18T10:51:00.000-08:00

As I supported families throughout 2011, I had the idea to host a gathering at the end of the year. The main reason was to reconnect in person with the parents and babies that I had a chance to work with. I was also excited for many of them to meet one another and for my own family, my husband and daughters, to get a chance to meet my clients as well.

On a Sunday in January, we met up at a local park (my favorite one) and enjoyed lots of yummy treats and a few hours of talking, laughing and playing together. One of my dear friends and also a client of mine, graced us with her photography talent and captured some priceless shots. This is something I plan to do annually. If you are a doula, or anyone who works with people, for that matter, I encourage you to do the same. We need to take advantage of reasons to gather and celebrate. It's wonderful on so many levels.

some of the 2009-2011 babies

i get to meet and work with some of the coolest women

the best husband this doula could ask for (the man sans stroller)

sweet twin girls and their wonderful mama

so many amazing families!!

an attempt at a "chronological order of birth" shot... close :)

special family... babies number one and sixteen for me

* all photos taken and posted with permission by Katherine Nagel

A Day in LA with Ina May

2012-01-09T14:46:00.000-08:00

You know those days where you have a hunch that what you're doing and who you're interacting with seems like it very well might be a once in a lifetime opportunity? That was me on January 6, 2012. I found myself headed northbound to LA in the company of my dear friend and co-doula, Annely Allen. Our destination was BINI Birth, a unique space that's dedicated to offering support, education, and resources for families and birth professionals. I've been familiar with BINI for a few years and was thrilled to have the chance to see it in person. I'd received notice a few weeks earlier that Ina May Gaskin was going to be speaking there. Double hooray. I've read some of Gaskin's work and her book Ina May's Guide to Childbirth is one that I recommend to women often. She is someone who has had a deep influence in maternity care worldwide and the way childbirth is perceived. I wouldn't say that I am her #1 fan, as there are others who would rightfully claim that title, but I do have great respect for who she is and the work that she has committed her life to. Below are some photos and bits of wisdom I gathered from what she shared.

"We always think that paying more for something = better and typically, this is true... but not when it comes to the birth industry."
- Referring to the cost of maternity care and how often because hospital birth costs more (before insurance contribution) it is seen as the superior environment to give birth in

"Birth is not about making money... especially when the people making the most aren't the ones actually caring for the women and babies."
- Talking about insurance companies and policy makers

"When you don't have midwives, you don't have obstetrics either. You just have surgery."
- Voicing the need for midwifery to continue to play a vital part in maternity care throughout the world... the need for both midwives and obstetricians to care for women and babies. Not either/or. Both have a rightful place.

"Wouldn't it be amazing if our little girls grew up knowing that the place babies came out of went from little to gigantic?"
- Talking about the fear women often have of giving birth vaginally and not fully understanding that the vagina is created to expand and accommodate birthing a baby.

Ana Paula & Ina May

Following the workshop, Ana Paula Markel, founder of BINI and a childbirth educator and doula herself, graciously invited anyone who was interested over for dinner and more discussion time with Ina May. Annely and I looked at each other and without saying a word knew that the other was thinking "no-brainer." There were a handful of other San Diego doulas who were in attendance and had the same reaction. We headed to the grocery store and picked up some pasta, salad, and bread and made our way over to Ana's house. We arrived before she and Ina May got there. I LOVE how Dawn, one of the SD doulas, made Ana's kitchen her own and along with a few others, started working on preparing dinner. Over the next few hours, we shared a meal and talked more with Ina May, Ana, and the 20 or so other women who joined for dinner. It was a rich opportunity to connect with women who all have the goal of supporting and caring for women, babies, and their families.

San Diego Doulas & Ina May Gaskin

In closing, after spending the day listening to, talking with and observing Ina May, here's what I most admire about this woman...

She's one of those people who you know has so much wisdom and a wealth of life experience and yet is humble and quite unassuming.
She's approachable and engaging. I never felt like she was looking past the person she was talking with or that she was annoyed by the hundreds of requests to talk or take a photo with her.
She speaks very plainly and candidly. While she has great passion in the things that she shares, yet she doesn't get lost in the emotion, which would be so easy to do.
She's respectful and appreciative of many obstetricians and medical doctors. She calls many of them personal friends.
She's an avid reader and learner.
She appreciates the diversity and beauty of cultures throughout the world.
She's funny.
She's a normal woman, who early on in her life, saw that there was a need and rose to the occasion. She didn't assume that someone else was going to step in and do what needed to be done. Instead, she got her hands dirty (literally) and looked for ways to learn and grow and teach others.
She's a wonderful picture of someone who isn't slowing down as she ages.

Me, Ina May & Annely

Closing Remarks for 2011

2011-12-28T21:00:00.000-08:00

With the close of this year and a new one on the horizon, I naturally look back and find myself reflecting. I've decided to share these here. It may seem a bit scattered and a smattering of thoughts... I'm ok with that. These are thoughts I've had this past year-- take them or leave them.

As the EDDs of women I'm supporting approach and come and go, I find myself in a similar mindset as a doula to what I felt like waiting for my own labors to begin. "Should I schedule our car for service tomorrow, plan to go to the zoo as a family, host dinner with friends this weekend or will baby decide that this is the day and I'll be called to a birth?" It's easy for me to get antsy from time to time and to hear myself say "Well, it all depends on if there's a baby being born or not." What I'm trying to remember is that like all of life, we make our plans and then adjust accordingly. I encourage the women I'm working with to go on with life and to enjoy the moments and memories they have before birthing their baby... and I'm telling myself the same thing. Live today. Live now. Live.

I've seen doctors mention possible interventions to their patients (my clients), such as "cutting a small episiotomy because the perineum seemed short" and then changing their minds moments later, resulting in a woman birthing her baby just fine with very little natural tearing. I keep on hearing that "episiotomies aren't used all the often anymore," and while this may be the case, I can count at least five births where I've heard them be discussed or used in the past year. My advice here would be to ask your care provider under what circumstances they would suggest this procedure and then make certain that they know that you are wanting to avoid one unless absolutely medically necessary.

I posted this on my Facebook page in November and it's truly at the core of who I am as a doula. "I'm all for 'healthy mom, healthy baby,' as being of the utmost importance when it comes to birth... BUT I'm for 'HOLISTICALLY healthy mom, healthy baby,' meaning that mom's and baby's emotions and psychological state are of utmost importance too. Women giving birth deserve to look back on their experience and feel that they were heard, respected, and cared for on all levels and that they were an active participant in making decisions regarding their care." At the end of the day, whether a birth went along without a hiccup or a birth took unforeseen and surprising twists, my deep desire for the families that I support is that they know without a shadow of a doubt that they made the best decisions for their specific situation. This looks different for each woman and each situation. Whether a labor and birth are intervention-free or riddled with necessary interventions, my hope and prayer for the maternal care system is that women and their families have trusting and mutually respectful relationships with their care providers and that they have the information and space to make informed decisions for their individual labor and birth.

I'm convinced more and more that choosing a care provider is one of the most important decisions a woman will make. I want to shout from the rooftops that just because you've gone to a specific care provider for your gynecological care DOES NOT mean that they are necessarily the best fit for you when it comes to prenatal care. You might find that your OB/GYN is too medical for you and you'd fit better with a midwife or an OB/GYN who takes a more "midwife model of care" approach to pregnancy, labor and delivery. Before conceiving and then in the early prenatal period, it is vital that you think about what approach to birth you are more in line with. I go into this at length in this post. It's unlikely that you've been concerned with your OB/GYN's cesarean rate, their birth philosophy, or under which circumstances they'd recommend induction when only seeing them for gynecological care. However, these are of utmost importance to know and be on the same page with as you're figuring out what your values are for the birth of your baby.

This year I witnessed the following:

a medically necessary induction that went on and off for three days resulting in an otherwise unmedicated, vaginal birth
women overcoming deep fears they had about giving birth
women taking ownership of their care and switching care providers at the end of their pregnancies
an unmedicated, vaginal birth of twins
women showing up at the hospital complete and ready to birth their babies
babies born in their homes
women who were planning for an unmedicated birth choose an epidural and it being the very best decision they made... helping me shape my opinion that epidurals are not all good or all bad, but that it's key to be wise with when to have it, if you have it
women having uneventful labors and births and very eventful third stages (postpartum)... showing me again and again that birth is unpredictable
a baby being born en caul
women who go to the hospital thinking they are in active labor only to be sent home since they were not dilated 4cm yet, only to head back to the hospital a few hours later in very active labor, almost transition... showing me that letting go is everything
women laboring very quietly and women laboring very vocally... women birthing very quietly and women birthing very vocally
husbands and partners being AMAZING supports and anchors to the mothers of their children
women knowing what they want and what their rights are and in a firm-but-kind-manner, communicating their wishes to hospital staff
women who have rapid labors and make giving birth look like such a piece of cake (yet I know that it is intense for them, all the same)
women birthing with their families surrounding them- children, husbands, mothers, sisters, dads, in-laws, friends... all privileged to witness new life entering this world

Thank you to all of the families who invited me into their deeply life-transforming moments as their babies were born. I am so, so honored and grateful. Thank you to the OBs and midwives, doulas, L&D nurses, childbirth educators and others in the birth world who encouraged, mentored and taught me something new this year.

Here's to 2012 and all that it brings. I'm ready for it... eager to learn and grow and be shaped some more.

Birthing in the Hospital... What to Expect

2011-08-06T19:38:00.000-07:00

I often support women giving birth in hospitals. Birthing in the hospital means that there will likely be routine procedures and potential interventions that take place... it comes with the territory. It's important that women and their partners are familiar with 1) what these procedures and interventions are, 2) why and when they may occur and 3) what the risks and benefits are to each.

To be clear- the point of this post is not to list out the pros and cons, but to instead list the most common routine procedures and interventions so that they are all in one place. My hope is that clients of mine, fellow doulas, and parents looking for a list like this can use it as a springboard and do their own research. I want people to KNOW what can be expected when laboring and giving birth in a hospital. Follow the rabbit trails of links and suggested reading and be very familiar with what these common procedures and interventions are.

So without further adieu, I give you the list.

Amniotomy or Artificial Rupture of Membranes (AROM) aka "Breaking your Water"
This is often suggested as a way to help induce (start) labor OR to augment (speed along) labor.

Very detailed article on AROM at PregnancyToday

Information on AROM along with other induction measures at American Pregnancy Association

Routine IV Placement
Upon being admitted, it's routine for either an IV (Intravenous Fluids) to be started or for a saline lock sometimes called a "Hep Lock," a hold-over from when heparin was used, to be placed. IV fluids are administered to help with hydration. If an IV is not started, but the saline lock is placed, it's done so medical staff can have quick access to veins should the need arise. The jury is still out on whether routine IV placement is the best standard of practice among low-risk pregnant women. What is important for you to know and to discuss with your care provider is what your options are. Do you absolutely need to have an IV while in labor if you're not planning to receive pain medication and/ or not needing antibiotics because you didn't test positive for GBS? Do you need to have a saline lock placed at admission or is your care provider comfortable with waiting to have it placed until you need it? Once you know what your care provider and your place of birth require, you can plan accordingly for your labor.

Quick rundown on IV's during labor from the blog Suite101

Lamaze International's stance on IV use during labor

Denying Food and Water During Labor
For many years, it's been common procedure to restrict eating solid foods and drinking liquids during labor. Spoonfuls of ice chips have been the main "soup du jour" in many hospitals. This is mainly due to the concern that should a woman undergo general anesthesia for a Cesarean, she could aspirate anything she'd eaten or drunk while in labor, a condition known as Mendelson's Syndrome. However, in recent years, there's been much debate on the current likelihood of this happening since general anesthesia routines have changed over the years.

The Cochrane Library review on restricting oral food and liquid intake during labor.

ACOG's (American Congress of Obstetricians and Gynecologists) 2009 statement on food and water during labor.

Very, VERY informative article on NursingCenter site with LOTS of links to other resources on the subject.

Article on MedicineNet discussing food and liquid intake during labor.

Article on PubMed evaluating the debate on eating during labor.

Sheridan Ripley of the blog Enjoy Birth writes a post on eating and drinking during labor and links to previous posts on the subject as well.

Electronic Fetal Heart Monitoring (EFM)
Your baby's heart rate is monitored throughout your pregnancy and during labor and delivery. During pregnancy, this is typically done with either a fetal doppler or in the case of a non-stress test, with an external fetal monitor. During labor, the external fetal monitor is primarily used and in some instances, the internal fetal monitor.
EFM is heavily relied upon in hospitals. Most hospitals and care providers require continuous EFM, but a few allow for intermittent EFM. It's important that you know what is routine where you'll be delivering and to talk with your care provider accordingly.

WebMD takes a look at external and internal fetal monitoring.

Editorial piece in the American Family Physician (AAFP) online journal on why EFM is being used; very informative.

SUPER detailed article from the American Family Physician journal on the interpretation of EFM. More info than you'll likely want to know, but very thorough.

Article from 2011 in the American Journal of Obstetrics & Gynecology on the use of EFM and its relation to neonatal and infant mortality

Post from The Clinical Advisor on EFM vs. Intermittent Auscultation (IA)

Vaginal Exams, Cervical Checks, Pelvic Exams
It's not uncommon to want to know what your cervix is up to in the last few weeks of pregnancy and during labor. Many care providers will offer to begin checking at 37 weeks. It's important to know that it is YOUR choice to have a vaginal exam or not. This is true both during pregnancy and during labor. It should be noted that checking your cervix and reporting the findings cannot and will not indicate when labor will begin and/ or how it will progress. There are a few different things that can be measured during a vaginal exam

Well-written and thought-provoking post on the ICAN of Western Maryland site: "Routine Vaginal Exams During Labor"

Another thought-provoking post on Dare to Birth Naturally site: "The Vaginal Exam During Labor: Is It Necessary?"

Hospital Gown
To some, this may seem like a silly thing to list as a routine procedure and to others, this might be really important to consider. It's common for a woman to be encouraged to change into a hospital gown when she is admitted during labor. We've all seen them... the lovely open-in-the-back kind. There is absolutely nothing wrong with using the hospital gown. At the same time, there is absolutely nothing wrong with requesting to stay in your own clothes. For some women, the thought of putting on a hospital gown makes them feel like they're a sick patient vs. a healthy woman who's in labor and happens to be birthing in the hospital. If you want to wear your own clothes, this is something that you'd want to check out with the L&D at your hospital.
Some alternatives to wearing a hospital gown that I've seen are: a sports bra or nursing tank and loose skirt, a short tank-style, loose-fitting night gown, nothing at all, a custom made labor gown (see links below), or a sarong, to name a few.

Pretty Pushers

BINSI

Gownie by Baby Be Mine Maternity

B.Y.O.G.

I realize there are more procedures and interventions to write about and I plan to do so in future posts. These include the use of epidurals, Pitocin, Cytotec/ Misoprostol and Cervidil and various newborn procedures such as Vitamin K shot and eye prophylaxis (Erythromycin). The ones listed above are what I tend to see as the basic standards of care during labor at the hospitals in which I've attended births.

You might be asking, what now? I suggest asking questions and conversing with your care provider about what you've read. Take a tour of the hospital you're planning to birth in and ask questions of the tour guide and/ or the head nurse. The more you know about what it will be like when you are laboring and birthing in the hospital, the more informed you will be. The more informed you are, the easier it is to be ready for the routine procedures and possible interventions that will be offered. As mentioned earlier, the main goal is to be aware and have information so you, along with your care provider and birth team, can make the best decision for your labor and birth. It's important to remember that in choosing to give birth in a hospital, there are rules and procedures that come along with that choice. Some of those are flexible and others are not. In talking with your care provider, my biggest suggestion is to do so without an agenda and without an "Us vs. Them" approach. Instead, do your research and engage in an open discussion. If you feel you're not getting anywhere or coming up against resistance, remember you are the one who gets to choose who you're entrusting your care to. If you want to find a new care provider who might be a better fit, you can.

As you prepare to give birth in the hospital, keep this in mind, with any suggested intervention- use your BRAIN.

Further Online Resources on Routine Procedures and Medical Interventions
Lamaze Healthy Birth Practice #4
Common Medical Birth Interventions You Should Know
Routine Labor Care

Doulas at Home Births

2011-07-23T18:35:00.000-07:00

A majority of the women I support are giving birth in the hospital. I've been asked recently to support a few women who are planning to give birth at home under the care of a Licensed Midwife. As I've considered what my role might look like in the home setting vs. the hospital setting, I posed the question to a few birth focused communities that I'm a part of on Facebook. I thoroughly enjoyed reading responses that I received and thought that sharing them here might be beneficial to other women who are considering hiring a doula for their home birth team and/ or other doulas who are asked to provide support at a home birth. Feel free to comment below with any additional thoughts or experiences.

Thoughts from women who've birthed at home...

M- I did have a doula, yes. Her role was "whatever needed doing." She offered emotional support to the whole family, helped filling and emptying the pool, helped care for the kids, tidied up about us. I found her really good! I would suggest having a close friendship with your doula though, because women who don't bond well with them don't find them as helpful as I did!

S- Yes. I had my partner, a doula and 2 midwives (they come in pairs for safety reasons). It was extremely helpful especially at end with my long labor and pushing phase. My partner got really exhausted so I leaned on my doula for support. She also helped by taking care of all the little things like water/hydration, birth pool water temp, food, etc., so my partner could attend to me 100%. I would definitely have doula support at my next birth as well! Very helpful!

J- I know a lot of women that DO have doulas, even in home birth. I did not with any of mine. With my first we wanted it to just be us- private & intimate. It was perfect. With baby #2 we had more people there- my mother acted like an "assistant coach" & my husband was again in that main coach role. This worked out nice & we did have my mom back for baby #3. We did decide though to keep it private & intimate again with that birth & we are really glad that we did. I know that doulas are great & important & helpful no matter which setting you are in (hosp, home, birth center). But its ultimately a very personal choice. Don't let the $$ be the deciding factor. If you feel like you'd like that extra support, another womanly touch to the birth etc- GET A DOULA! :)

D- I've given birth at home AND I've been a home birth midwife assistant AND I'm a doula--so here's my two cents: If you have a midwife, she should have an assistant with her, maybe two. If she just has one, then a doula would be helpful. If she has two, you probably won't need another person there in a "doula" capacity.

K- I was lucky and had three midwives present for my son's arrival... The one who helped me catch him had been a doula for many years before training as a midwife, so I really had the best of both worlds! Having more than one of them there was wonderful because they were able to take turns applying counter-pressure with my intense back labor (had it with all four babies... The way I am built, unfortunately.), as well as working as a team helping me into different positions and such.... I can only say: The more: the merrier! I'm glad all three of them were there!!
I have heard of many women who've had doulas that are also photographing their births.... If you're considering it-- go for it!! I had a friend come take pics and she did an excellent job, but I bet the pics would have been even more amazing if it hadn't been the first natural birth she'd ever witnessed and she'd known more of what to expect... Like a doula absolutely would!!

J- When I was interviewing midwives, I asked about it. One flat out said they didn't provide that type of support and I would need to hire a separate doula. The one I hired said I could if I wanted, but she and all her assistants were former doulas and they would act as both. Sure enough, I got home from work with less than an hour until birth and one was pressing into my back during contractions, instinctively. It was lovely! Now that I am a doula, I will probably ask a colleague to attend my next birth so I can get the full experience.

A- I did. I wasn't originally planning to since I'd already given birth naturally & had a (long but) fairly easy labor & since I'd have 2 midwives & my husband present. So originally, I expected her role to be more photographer than anything else. But my labor turned out to, not only be long again but also ALL back-labor. Her presence was priceless & crucial. I'm SO glad that I had her there!

J- I did and thought it was great. My doula was there for the whole labor (midwives showed up once I was in active labor). She did a little bit of everything - support for me and my husband, calling people, talked me through pain, made sure I stayed hydrated and fed. I recommend a doula to everyone!!!

B- With my first, there was just me, my hubby, my midwife and her assistant. My midwife then was very hands off, and gave me a lot of space so my husband was front and center helping me the. entire. time. He was completely exhausted at the end... of the 12 hour labor. With my second, I didn't have a doula, but my sister-in-law came to the birth to fill that role. I just wanted someone else present that could help out. She ended up being absolutely fantastic!! She helped with the tiny bit of back labor I had, she knew just what to say and when to say it when I needed encouragement, she took pictures and video, and reminded me to drink enough water. I doubt I'll ever choose to go without an additional support person again. For my husband's sake and my own.

W- I did not and I wish that I had. Filling the tub, taking care of our 3 year old and trying to support me was a bit too much for my husband to handle on his own. He could have used more support to better support me. I will have a doula and at least one other attendant for my next home birth.

M- At my HB: midwife, her assistant (training midwife), doula & hubby. Midwife & her assistant were hands off too, doula was great. Basically, hubby stayed by my face encouraging me and talking to me, doula did lots of back/neck massages and she did more with helping & encouraging me to change positions, she also did things like grab the camera and snap some first family photos & she put a freezer meal in oven for me.

I- I did. My labor was so fast that my midwife made it there before my doula because of distance only. But in theory, I would have wanted my doula there before the midwife, to be with me and support me through all the laboring part. I know my midwife would be willing to do this for me, but I felt her job was to make sure that all my physical/medical needs were met and my doula was to make sure all my emotional/comfort needs were met. I would definitely recommend a doula, regardless of where you choose to give birth.

S- No we did not have a doula. I didn't see the point. My husband was my support. But I think next time we might hire a doula so she can take pictures for us because we were unable to take pictures till after our baby was born and we were cleaned up. I wish I had a picture of right when she came out and I was holding her for the first time

H- My midwife was working with an apprentice who was a doula. Also, my two best friends are also doulas so they came as well. I was really blessed to have so much support. There were more then enough hands to take care of me, my other children, my husband and the house too & get photographs/video. I never felt alone, never worried about my other children and my husband felt supported too. Even with a full house was still a very peaceful birth because they were all so respectful of the process.

J- Yes, her role was to be photographer and help with bigger kids. My doulas didn't make it to either of my home births though (nor did my midwife)... next time we'll try again. In fact, I just may keep having babies until my photographer and midwife make it to one.

A- I had two friends serving as doulas and they were invaluable. One documented a lot for us via photos and videos and did a lot of running around the apartment gathering things (supplies for the mw, water refills for me, etc.). The other was a primary physical support when my partner needed a break or, at the end, when he left my head space to catch our daughter.

E- Yes, she blended right in to the fabric of my birth experience in a very positive way. Not usurping anyone's role but offering patient and intuitive support. She was so respectful of the intimacy of our home birth.

M- I didn't have a doula but if I could go back and make any changes to our birth & preparation for birth, it would definitely be to hire a doula.

K- Yes! My doula was so wonderfully supportive, wise, and loving. She helped my husband with counter-pressure and hip squeezes, suggested position changes, and all the usual awesomeness that doulas do... but mostly, she was a solid, positive, reassuring presence. I HBAC'd, so it was also neat that my doula is the ICAN president!

E- I can't recommend a doula enough, especially for a first birth. My labor was very long and unpredictable. When my husband needed to rest, the doula could support me and vice versa. She was the quiet calm we needed in an unpredictable labor and delivery.

K- Yes I did. She was extremely helpful! She helped my husband, helped me with positioning, pressure, massages, drinks, cold and hot rags. She was invaluable!!!

K- I had a friend come and be a doula for me and I'm so glad! She didn't at all take the place of my husband for labor support-- I needed them both! The birth was a little complicated (face presentation!) and I was very grateful to have my wonderful midwife, husband AND doula-friend helping me at the end!

P- Yes I did. I invited a student doula to my home birth because I know how hard it can be starting out to get experience. She was also there to take some of the role of supporting me off my mother and husband. I wanted to have a nice tight team of people with different jobs so no felt overwhelmed (especially me). All I needed to do is sit back and birth my baby and feel every sensation of it. Having my doula and other team members there afforded me that ability. She was also charged with the task of taking pictures and she rocked it at it. She got great pictures

K- Yes, for a precipitous freight-train birth, and she was amazing. We converted to home birth while I was in early labor, and she and my husband cleaned my whole bedroom and turned it into a birth suite while I bounced on a birth ball and ate a sandwich. Then, after my water was broken and I went IMMEDIATELY into transition, she was right there with me, pouring her energy into me to keep me capable of keeping my head above water. I would not have managed that experience half as well without her. While I was pushing, I began to come unglued just a little bit, and she physically turned my head towards my husband so I could join his focus. She was amazing and I'm so grateful.

R- Yes, she was amazing. She was with us for 24 hours and the midwife for the last 12 hours or so. Will definitely have a doula for #2, too!

N- I had 2 midwives and 3 doulas. One doula was my photographer, one was my best friend and guide throughout my journey of birth and being a birth professional and one was a new friend in birth and was about to give birth herself (turned out to be 9 days later) They were all wonderful and I am so very grateful that I had them ♥

Thoughts from doulas who've given support at home births...
C- Doulas should be at every birth! I feel doulas allow the midwives a break - they don't have to spend as much time at the birthplace, allowing them to sleep and keeping it more intimate for the parents. The more undisturbed you can keep the birth, the better for the hormones to work and baby to slide out! :) I still come when mom needs me and do the same as I would at any other birthplace. I tidy up and assist the midwives as needed and have always worked as a team with them. Home births are so soft and safe for the parents. I look forward to the day when we attend more births here than at the hospital!

A- My goal and passion is to be involved in home births. I'm just patiently waiting for the awesome opportunity!

A- I loved my doulas when I was a home birth midwife! I got to show up while the moms were in transition or pushing, feeling ready to handle anything, having eaten & slept.

R- I have attended just one home birth and it was a fast one. I arrived before the midwives. When I arrived it gave dad the freedom to heat water for the tub. When the mw arrived they were busy setting up shop and paperwork, etc. I was comforting mom and heating up the rice pack, fetching drinks, taking pictures. After the very fast birth it was the same mw were attending to baby and paperwork. They actually commented, "how did you find a photographer who is also a doula? You are so lucky!" And I think they said that because they saw I was the only one designated for verbal/emotional encouragement, completely focused on mom. Grandparents were focused on food prep and childcare, etc. I was wondering if my doula role would be unneeded and I would just assume the photographer role but my doula role was huge. Especially during pregnancy. I am so grateful for the experience and look forward to my own home birth some day!

J- I'm going to be attending my first home birth in early Sept. I can't wait! Like CM said doulas should be at every birth. I expect I will get there before the mw but I'll let you know how it goes..

J- Yeah! More home births! Love being a doula in the home ♥

J- I'm doulaing at a home birth next month. I will do whatever she needs me to. Her 2 year old will be there and he knows me so I may just end up being his watcher for a while, I love doing pictures so I would do that too if needed. This is mama's 2nd home birth so I think she'd do great w/out me, but her needs are different this time w/ little guy there and new town, etc.

B- The difference between home and hospital birth is like night and day... night on earth and day in Euphoria, but *please* remember the masses of women who *need* doulas in the hospital. 99%. I encourage you to take what you learn at home and find a way to recreate the atmosphere for the 99%, begging you to please not abandon hospital birth like so many doulas who get a taste for home birth do.

N- I've only supported a few home births but have felt useful at every one. I have found that it's less common to just hire a doula for a home birth but it's more about picking people that have something specific to offer. I always feel an even deeper appreciation for being able to attend when I'm asked to witness a birth at home.

Giving the Gift of Food

2011-05-31T19:41:00.000-07:00

I firmly believe that one of the kindest things you can do for someone going through a season of life transition is to provide a meal. Whether it's moving into a new home, walking through illness, grieving the loss of a loved one or welcoming a new baby, nourishing people physically is such a tangible way to say "I'm here, I care, you matter." I've been on the receiving end and the giving end of providing meals and both ends are equally as wonderful. After the births of my children, it was such a gift to not have to think about what we were going to have for dinner in those first few weeks adjusting to the new normal of life with a newborn. On the flip side, it's quite fulfilling to help organize and prepare meals for friends who are in transitional times.

I responded to a post from a friend on Facebook who was asking for ideas of what to make for a family who'd just welcomed a new baby. I had a lot of fun reading through the responses and decided to do a little poll myself and asked fans on my Doula Jenna Facebook page for their suggestions of favorite meals brought to them or what they like to make for others. I thought it would be fun to share some of them here... WARNING- if you are hungry right now, do yourself a favor and grab a snack. This list is bound to make you salivate.

Soup & Salad

Creamy Chicken Noodle Soup, Bread Bowls & Salad
Bean Soup & Dill Bread
Chili
Tortilla Soup w/ all the Fixings (Sour Cream, Shredded Cheese, Green Onions, Avocado & Tortilla Chips)
Tomato Soup w/ Grilled Cheese & Ham Sandwiches
Tortellini soup
Spinach Salad w/ Roasted Chicken, Strawberries, and Veggies

Pasta

Spaghetti w/ Meat or Marinara Sauce and a Salad
Mac & Cheese.... the ultimate comfort food
Lasagna
Roasted Veggie Lasagna
Spinach-stuffed Manicotti w/ Salad & Bread

Variations of Chicken

Chicken Enchiladas
Swiss Stuffing Chicken and Rice w/ Vegetables
Roasted Chicken w/ Grilled Vegetables & Potatoes
Homemade Chicken Pot-Pie
Garlic & Rosemary Chicken & Roasted Veggies
Grilled Chicken and Brown Rice or Couscous w/ a Salad
Shredded BBQ Chicken, Rolls, Baked Potatoes & Baked Beans

Meat

Pork Tenderloin, Baked Sweet Potatoes, Green Beans & Rolls
Baked Ham & Scalloped Potatoes
Burritos w/ Ground Turkey or Beef (wrap individually in foil so they can be frozen and baked whenever)

Meals w/ a Spin

Lettuce Wraps
Breakfast for Dinner: Quiche, Egg Dishes, Creme Brulee French Toast
Steak/Mushroom and Chicken/Veggie Kabobs with a Side of Brown Rice & a Fruit Salad
Lunch Groceries- Turkey, Wraps, Veggies, Hummus, Chips, etc. (especially great if they have a lot of leftovers from other meals)
Quiche (in multiples... great for dinner, breakfast or a 3am snack)
Butternut Squash Enchiladas

Fun Extras

Bake a batch of brownies
Make some cookie dough and roll into balls, freeze, and bring so they can pop a few cookies at a time into the oven for fresh baked cookies
Bake muffins or a coffee cake and wrap them individually so that they can be frozen and thawed one by one
Ice cream w/ Hot Fudge or Caramel Sauce
Dark or Milk Chocolate
Bottle of wine and/or sparkling juice

Coordinating Meals for Someone
We're all busy, so the thought of organizing meals for someone may be daunting and not something you want to commit to... that's ok. However, there are GREAT websites out there that make it so easy and with just a little time spent, you can give one of the best gifts to a friend through coordinating meals. Below are three websites that I've used and found user-friendly.

MealBaby

CareCalendar
MealTrain

What's great about these websites is that you don't have to deal with "reply all" to a mass email that you send out and also don't have to be the one to remind people about the meal they signed up for. These sites track the sign ups and send out reminder emails to individuals and to you as the coordinator. They also make it easy for you to include any special dietary requirements, as well as the contact information for the person receiving the meals. Here are a few tried and true steps in the process:

Ask the person you're setting up meals for to provide you with a list of names and emails of people to email. If you know the person well and have mutual friends, you might not even have to ask for this information.
Find out how often the family would like meals. Some would like every night for a few weeks and others every other night and/ or only weekdays and not on weekends.
Send out an email (be sure to bcc the email addresses). It can read something like:

Hello friends of...

As you all know, little baby is here! This email is regarding setting up dinners for the family. There is no pressure of course, but if you would like to sign up to bring a meal, please visit the link below:
(Include link to online meal calendar and any password that might be required)

All of the details are listed on their calendar as to what kinds of foods are ok and not ok. If you have any questions, please feel free to email me.

Please bring meals in containers that don't need to be returned to you.
Thank you in advance for your help!

Things to Remember when Bringing a Meal
Keep in mind any food allergies or special dietary needs.
If you're not much of a cook or simply do not have time to prepare a meal, ordering takeout from a favorite restaurant is perfectly acceptable.
If you're not sure what to make, instead of asking the family "what sounds good," try to offer a few choices. When people are going through life transition, making decisions, even about what to eat can be overwhelming. There's a good chance they'll be thankful with anything you bring.
Plan to drop off the meal and don't expect to stay. If the family asks you in, keep the visit short.
Bring the meal in a dish that does not need to be returned to you.
Include any baking or reheating instructions.
Meals that can be frozen are an excellent choice.
If you're extra ambitious, bring a second meal that can be put right into their freezer for a later date. Write the baking instructions on the lid.

Things to Remember when Receiving a Meal

People love you and want to help. Allow others to serve you. Be grateful, but don't feel guilty.
You will be the one to bring meals at another point in your life.
Don't feel like you have to entertain. It's ok for you to let others know that you so appreciate the meal but can't visit right then.
Say thank you. Personally, I think that a phone call, text or email is acceptable.

Feel free to post in the comments any tips you have and/ or any favorite meals you've made or received. Bon Appetit!

Four Precious Babies, Three Incredible Women, One Unforgettable Week

2011-03-23T11:01:00.000-07:00

Never before have I experienced something quite like I experienced this past week... and I have a feeling that it will be a long time before I do again. Between Tuesday, March 8 and Tuesday, March 15, I had the privilege (and I mean PRIVILEGE) of supporting three beautiful, strong, inspiring women as they labored hard and birthed their babies. With their permission, I want to share some of their stories and give you a look at what this week was like for me.

The first couple I supported was one that I started working with late in their pregnancy. The mother and I were in touch via phone and email prior to us meeting for the first time and deciding to work together. This woman had one of the most physically draining and taxing pregnancies that I've witnessed. Severe hyperemesis followed her for 40 weeks and with it came non-stress tests and ultrasounds twice a week, along with an OB who was on high alert. She was unsure of what her physical strength would be like when it came time for labor and birth. We dialoged at great lengths about what the best option might be for her in her specific situation. She had valid personal reasons that I won't go into detail about, that made her really question if she wanted to deliver vaginally or by cesarean. Most of all, she really hoped to avoid being induced and avoid any pitocin use. Two days before her due date, we spoke again and she shared some very real fears and anxiety she had about her due date approaching and what that might mean when she met with her OB the next day.

It was no surprise to me when early that same evening, I got a text from her saying that she was feeling some labor sensations and that it was possible she was in early labor. As the night wore on, we kept in touch and I headed to bed for a little sleep. *Side note, her mother had fast labors with all of her children and while it wasn't a guarantee that it would be the same for this woman, I know from experience with another client who's mother had fast labors that it was a definite possibility.* I got the call around 10:30pm that they were heading to the hospital and we agreed that I'd meet them there. As I joined her, she was in the middle of being admitted (labs drawn, paperwork galore, etc). She'd been examined and was 8cm dilated. Wow. Labor moved very rapidly and was not giving her much of a break to catch her breath... but oh was she handling it beautifully. I was relieved when I found out that one of the CNMs was on call and would be working with her. At around 9cm, she chose to have an epidural placed. Personally, I think that this was such a wise and timely decision. For this mother, in this specific situation, the use of an epidural gave her the chance to rest, to catch her breath, and to wrap her mind around what was happening and what was to come. At 2:40am, she was complete and instead of starting to push right away, she opted to take more time to rest and continue to let her baby move further down. Early in the morning on March 8, this woman faced her mountain of giving birth vaginally, head on, and birthed her baby boy... what a joy-filled moment it was to share with her and her husband.

Four days later, a day after her due date, another mother I was supporting gave birth to her baby girl. This couple had a few interesting twists to their story. For starters, her husband traveled weekly for his job and it just so happened that he had to leave for training out of state on March 9 and would be gone for 6 weeks. Her EDD was March 11. As you can imagine, this was a big unknown for them and I was blown away by the way they took it all in stride. The situation was absolutely not ideal, but it was reality and they dealt with it the best they could. Another twist was that around 37 weeks, this couple discovered that their OB wasn't on board with supporting their wishes for labor and delivery like they originally thought. After talking with them, I suggested thinking about switching to a different care provider. It was important to them that they deliver in the hospital they'd been planning to deliver at, so I suggested a care provider accordingly. They were astounded at the difference between the two providers. Their former provider left them feeling anxious, stressed and not listened to. Their new provider, like they were all on the same team and that they were fully supported. They'd found the right fit.

In the week and a half preceding her due date, this woman had consistent contractions that often felt like they could be labor and her baby was very low and putting great pressure in her pelvic region. There were a number of days where she and I both thought that labor was imminent and it kept us guessing as to when things were really in motion or not. On Friday morning, March 11, she had an appointment with her doctor. She and her husband decided that they'd have the doctor sweep or strip her membranes. They knew this wouldn't guarantee that labor would begin, but they thought it was worth a try since the husband was home from his training for the weekend. Throughout the rest of the day, she experienced stronger cramping than she had been previously, but she wasn't sure that it was labor. As the evening wore on, she experienced stronger sensations and it seemed that labor had started. We agreed to keep in touch but that we'd all try to get some sleep if possible. A little after midnight, her husband texted me to tell me they were planning to head to the hospital and asked if I could meet them there. I met them and we had to wait for a room to be turned over before she could get into one. Within the hour and a half that we waited, I observed her through contractions and it seemed as though she was most definitely in labor. Finally a room was available and she got changed and waited for the nurse to examine her to see how far along she was. Much to her shock (and all of ours for that matter), the nurse told her that she was 2cm and 70% effaced but that baby was very low. This was exactly where she'd been 12 hours earlier when she saw her doctor. As you can imagine, this news was disappointing and very confusing. It didn't help matters that her nurse's bedside manner left something to be desired. The couple took some time to discuss their options which were to stay at the hospital and do some walking to see if labor might pick up or to head home and try to get some rest and to come back once labor seemed to be more intense. It was a tough call to make because at this point, it was just shy of 3am and the contractions she was experiencing didn't seem like the kind she'd be able to sleep through. A different nurse came in (with MUCH better bedside manner) and she suggested going home and taking some Tylenol PM to try to help her sleep. The couple thought this sounded like a good idea. I returned home and crawled into bed around 4am.

At 5:55am, my phone rang and it was her husband. Labor had intensified greatly and not only was she tired because she'd been up for almost 24 hours, she'd taken the Tylenol PM with hopes of sleeping and had no such luck. So she was dealing with some serious contractions and was way beyond tired. I hopped in the car and made my way over to her. I was there not even ten minutes before the decision was made to head back to the hospital. I could sense her reluctance and yet eagerness to get there. While she was really hoping to avoid having an epidural, with the exhaustion she was feeling, she was open to the possibility of having one if we got the hospital and not much seemed to have changed. I encouraged her that she was REALLY handling her contractions well... breathing deeply and steadily through each one. I followed them to the hospital and she was admitted to a room. The shifts had changed and new nurses were on. The new nurse (wonderful nurse, I might add) checked her at around 7:50am and she was between 6 and 7cm dilated and 100% effaced! AHHH! Sheer joy. Literally from that moment on, whatever fatigue she was feeling seemed to disappear and she just continued to take each contraction and breathe and move through it. Over the next two hours, her OB was paged and checked in on her and she progressed steadily to 9cm at 9:25am and then complete at 9:50am. She pushed for 30 minutes and delivered her baby girl into the world. Another beautiful birth I got to witness.

Monday, March 14 rolls around. There was one more woman who I was supporting that was due any day. Something special about this birth is that it was my very first twin birth. This woman met a client of mine while in line at the grocery store and got to talking about babies and birth and doulas. My client gave her my contact information. At around 37 weeks, this woman emailed me to see if I'd be interested in meeting and supporting her. I knew that she could literally go into labor any day and that I also had two other clients who were due around the same time. Once I found out who this woman's care provider was, I felt confident that she was in the very best care that I could hope for her when it came to honoring her wishes of having an unmedicated, vaginal birth of her baby girls. I also did some asking around to a few other doulas to see if they'd had any experience in supporting a twin birth. I quickly discovered that it was not something that many doulas had experienced, largely due to the fact that many care providers suggest cesarean delivery and/or at least an epidural.

Sometime that Monday morning, I got a text from her to say that she was experiencing some cramping sensations and that she was trying to rest. We kept in touch via text throughout the rest of the day and into the evening. Thing were feeling the same and she'd been able to rest, but contractions continued to come at regular intervals. She'd discussed with her care provider that she'd go to the hospital when they were 5-10 minutes apart lasting for around a minute. I checked in one more time before I went to bed that night and didn't hear back, so I fell asleep unsure of when I'd get the call. Around 4:15am, my phone rang and it was her partner. Contractions were consistently about 5 minutes apart and they were going to get ready to head to the hospital. I got up and prepared to leave. This was going to be my first birth where my husband was away. Amazingly enough, every other birth I've supported, he's been home. I let the women I had on standby know that I'd be needing help with my girls that day.

Around 5am, I left for the hospital. I wasn't able to join her in her labor and delivery room until around 7:30, as this hospital requires that patients go through triage first before being admitted to a L&D room. I waited downstairs and had the chance to talk with both grandmas-to-be, who were also going to be in the labor room. I got a text from her partner to say that she'd been examined and was 5cm dilated. Once we were all up in the room, the next few hours were no different when it came to supporting her than it would've been had she been carrying one baby. She had wonderful focus and a deep breathing pattern established and took each contraction as it came. She and her partner worked in harmony as he supported her. One of my favorite elements to this labor were the couple's two mothers, the grandmas-to-be, sitting very quietly, respecting the space and the environment that this laboring woman had established. She was on the fetal monitor intermittently and labored in varying positions on the bed and in the shower. Sometime around 11am, her OB arrived and checked her again and she was 9cm with a tiny bit of anterior cervical lip left to go. Her OB suggested changing her positioning a bit and to give her body a little more time to fully dilate. It didn't take very long before she was complete. She gave a few practice pushes in the labor and delivery room before she was transferred to the OR (twin births take place in the OR so that if there is immediate need for a cesarean, they're in place). It was standard hospital policy that only one support person be allowed in the OR, however, this couple requested that the nurse see if an exception could be made so that I could be in there as well. I assured the nurse that I was ok with surgical environments and also suggested that I could even be waiting to go in once the first baby was born so that I could be there to support this woman for the birth of her second baby, while the father was with the first one. The nurse checked with the anesthesiologist on call and I said a few prayers and held my breath. She came back and let us know that I could be in there for the entire birth, but if there was need for a cesarean, that general anesthesia would be used (since an epidural wasn't in use) and I would need to leave immediately. So with that, the father and I gowned up, I grabbed their digital camera and we followed her into the OR.

Once in the OR, she was transferred from the L&D bed that she was on to the operating table. In addition to her OB, there were about six nurses standing by. Two of them had been with her throughout her labor and the others were there to attend to the babies once they arrived. The environment of the OR was pretty different from what she had in her L&D room- the lights were understandably much brighter and there was much more medical machinery around. It was also colder and she requested to be covered with blankets over her chest. Another difference was that the sterile environment was in effect, so the mother wore a mesh surgical covering on her head- much like a shower cap. Everyone present wore surgical face masks and caps. She had the fetal monitors on throughout the duration of her pushing. As she pushed with contractions, I remained on her right side near her head for the most part. One thing that I wanted to assure her of was that the only reason that she was in the OR was that she was delivering twins. "There is nothing abnormal. There is no emergency. The only reason you're in here is because you are birthing more than one baby," I said softly to her a few different times. With each mention, she closed her eyes and nodded in agreement. Her partner was on the other side of her and frequently bent down close to her head and whispered encouragement and excitement that their baby girls were so close. Her OB was really encouraging and at one point, had her hold onto the end of a rolled up towel while he held onto the other end. While she pushed, she played tug of war with her OB and pulled on the towel and tucked her elbows close to her body. After using this technique for a few sets of pushes, he suggested that she go back to holding behind her legs and continue to push in that manner. After just shy of an hour, baby A's head became more and more visible and suddenly, was born. With one more push, out she came and was placed on her mama's chest for a few moments. She was handed to the proud papa so that he could have some skin to skin time with her while baby B made her way. Baby B was transverse and while typically, a baby in this position would not be given the chance to be birthed vaginally, because she was the second twin, the OB was willing and skilled in attempting to turn her. Baby B's amniotic sac was ruptured and the OB manually guided her to a head down position. Since baby A had come through the birth canal, there was room for him to do this. Within five minutes of baby A being born, her fraternal twin sister, baby B, was born. What an amazing sight. I count it such an honor to have been able to have been able to bear witness to an unmedicated, vaginal birth of twins.

This week had its fair share of interrupted sleep and days of not being totally sure if I was going to be able to do what I had planned for that day. In some ways, it reminded me of the days preceding both of my own births... not sure when it would be go time. This week was also very energizing for me. After every birth I support, I come home and jot down thoughts on a document on my laptop called, "Things Noted While Witnessing Births." I will share in a future post some of those things from these three births, as well as others. For now, I'll end with this... I am most certainly a better doula after supporting these three women, their partners, and their four precious babies. This week is one that I will cherish always.

Mama Knows Best... Thoughts on Switching Care Providers

2011-03-07T10:57:00.000-08:00

This post has been brewing in me for some time now. Let me start with a disclaimer... as a doula, I have enormous respect for the men and women who are medically trained to provide care for pregnant women and their unborn babies. I believe that most have the best intentions in mind when it comes to caring for their patients. I know that they pay one of the highest malpractice premiums out there. I think that many are doing the very best they can do.

That being said, I've had a number of women in my life, friends and clients alike, who've shared that as they got further along in their pregnancy, they felt uneasy about their relationship with their respective OB. For some of these women, as they brought up their hopes for labor and birth during a prenatal appointment, they found their OB not all that supportive or willing to really listen. When asking to discuss their birth preferences plan, their OB snidely responding with "It's the patients who come in with a birth plan who end up with an unplanned c-section." For others, they felt like their OB had a typical way of going about things (suggesting induction at 39 weeks and/ or urging induction at 40 weeks, performing cervical checks starting at 37 weeks, etc.) and when the patient questioned if this was medically necessary or just routine, the OB growing visibly frustrated and curt with the patient.

These women who've shared with me aren't demanding or inflexible in nature. They aren't trying to be difficult or suggest that their OBs don't know what they're doing. They've simply wanted to have a two-way relationship with their doctor- one where they can ask questions and share their wishes for their prenatal care and impending birth, without feeling belittled or like what they've researched is all bunk because they're not the one who went to medical school. They are hoping that the one they've entrusted with the care of themselves and their unborn baby would be open to conversing and making the best decisions for their care based on their individual situation. Some of these women have chosen to stick it out and remain with their OB despite not seeing eye to eye and others have chosen to look elsewhere for a care provider who is more in line with what they're looking for.

In reflecting on the conversations I've had with these women, I thought that sharing via my blog might help others who find themselves in similar situations. I think there is a proactive approach and a reactive approach that can be taken. For women who are not yet pregnant or early on in their pregnancy, be proactive. If you're not pregnant, do some research before you're "on the 40 week clock." You don't have to know exactly what kind of birth you hope to have, but begin to think about what values you have when it comes to giving birth and what type of care would be a good fit for you during pregnancy. Would you feel more comfortable with a midwife or doctor who practices from a medical model or a midwifery model of care? There are OBs who practice more from a medical model and others who practice more from a midwifery model. The same can be said for midwives. Another thing to consider is the care provider that you currently see for gynecological care. If you're seeing an OB/GYN for your annual, you may love them for GYN care but find out they're not the person you'd fit with best for OB care. Ask around if anyone you know has had them as a care provider during pregnancy. Google their name and see what kinds of reviews come up. If a friend has recommended her OB or midwife, feel free to call and ask to set up an interview.

If you are early on in your pregnancy, NOW is the time to begin the dialog with your care provider about the way they view labor and birth. Find a list of questions (online or in a pregnancy book) to go over with them. Get a feel for if this person is the best fit for you and your partner and your hopes for your care during pregnancy, labor and delivery. If there are red flags, don't ignore them. You have time to find a better fit. Ask for referrals from friends who have a similar birth philosophy to yours. Contact a doula in your area and see who they suggest.

If you are later on in your pregnancy, your approach is going to be a bit more reactive. As you get closer to term and you feel like you're seeing your care provider's true colors come out, don't assume that it's too late to do anything about it. There are OBs and midwives who are comfortable with accepting a patient late in their pregnancy. Depending on your insurance, you have flexibility to change to a different provider. One of my clients was 37 weeks and felt more and more like the OB she was with was not going to be as supportive of her wishes for labor and birth as she once thought. After discussing her situation with me, she decided to seek out another OB and switched to their care just shy of 38 weeks. She shared with me that instead of going to appointments with her guard up and on the defense, she finally felt like she could go relaxed and knowing that she would be listened to.

Hope-Filled Thoughts on Breech Babies

2010-10-21T19:38:00.000-07:00

I'm in an interesting place today and feel the need to process and write and share. I've been planning to post some thoughts on the incredibly varying road to pregnancy, pregnancies, labors and births that I've witnessed and will do so soon. This post is part of it, but is happening in real time, as I write. I received word late yesterday afternoon from a client that her baby is frank breech and her medical team thought it best to schedule her for a cesarean this afternoon. She has handled the "change of plans" so beautifully and with an open hand. I'm so proud of her and am thrilled that she will hold her baby in a few short hours.

As a doula, this is a big first for me... the first time that I've walked through pregnancy with a couple and am not getting to support them in person for their birth. Am I ok with that? Of course. Is there a sense of disappointment? Of course. NOT with the couple, NOT with their sweet baby, but with the situation... wishing that it were different. Wishing that breech babies were more commonly delivered vaginally, or at least attempted. The reality is that 90% of them are not and it's not the parents fault or the baby's fault, or I would even go so far as to say not the actual doctor's fault. It's because cesarean for breech babies has become the norm in the last 50 years, and therefore the training has nearly vanished from US medical schools. "... [vaginal breech birth] risks are reduced when an experienced, skilled caregiver attends the birth. There are few doctors with the necessary skills, however, since obstetric training programs have stopped teaching how to assist at breech births. Doctors who have the necessary skills are unwilling to use them, because the standard of care today requires that all breeches be delivered by cesarean." (from pg. 190 of The Birth Partner by Penny Simkin).

I HOPE that our maternity care system strives to give women in this situation the option when it's safe for her to try to birth vaginally. I know that it's a rare thing for an OB to be skilled in vaginal breech deliveries and that depending on the type of breech, that vaginal delivery most likely isn't an option. But there are OB's out there who have opened themselves up to this skill and I HOPE that they are allowed the freedom to offer this service to women who want to pursue it. I HOPE that breech deliveries aren't portrayed in the media as being the end of the world. I HOPE that when a woman finds out that her baby is breech, that her care provider is quick to offer her suggestions of possible ways to turn her baby into a head down position before automatically scheduling her for a cesarean.

I'm 100% in agreement that "a healthy baby & healthy mama is the most important outcome." I am not arguing against having a cesarean birth for a breech baby when that truly is the safest option. I'm just processing and writing from where I'm coming from today... hoping that things will change and women with breech babies will have more options.

Helpful sites on this topic:
Overview of Breech Presentation
Spinning Babies
External Cephalic Version
Version Prior to Labor
Study Finds Possible Link Between Genetics & Breech Presentation

Music for Labor and Birth

2010-10-12T14:03:00.000-07:00

As a doula, I try to be careful of suggesting things that seemed to work for me, personally, in my own labors and deliveries... mostly because it's not my place to share with clients what I did, etc. It's about that woman, that baby, that family and what works for her, for them... and as a doula, I want to respect that and to have a trust there.
I do want to share though, something that I found helpful and very integral in the labors and births of my two daughters. Music.
I put together play lists on my iPod for both births... and it played a role in both. With my first labor, I remember having the play list on repeat once I was at the hospital and labored through the night. I remember coming in and out of consciousness as contractions came and went, and certain songs being played that I'd be able to focus on. With my second daughter, most of my labor was at home, and I remember laboring and listening and focusing and letting the songs carry me through my contractions. The songs I chose were already special to me, in that they were among my favorites... but after going through labor with these songs, they became all the more special and meaningful to me. From time to time, I'll come back to both play lists and find them so calming and soothing as I listen to the music compiled on them.
I'm sharing my play lists below... some of the songs are repeated on both, but there are different ones as well.

ARA's Labor Play list
Hem: The Fire Thief, Lucky, Redwing, Hollow, The Beautiful Sea, Reservoir, Half Acre, Leave Me Here
Watermark: Holy Roar, Who Am I?, The Purest Place, Grace Flows Down
Sara Groves: Jesus, You're Beautiful, You Cannot Lose My Love, Every Minute
Enya: To Go Beyond (I) & (II), Portrait, Caribbean Blue, No Holly for Miss Quinn, Watermark
George Winston: Joy, Northern Plains, Sleep, Baby Mine, Longing/ Love, Variations of Kanon by Pachelbel
Once Soundtrack: Falling Slowly
Hillsongs: Let the Peace of God Reign
Jill Phillips: O God of Love
Something Like Silas: Spirit Waltz
Passion: Knowing You
Steven Curtis Chapman: Be Still & Know
Switchfoot: Learning to Breathe
Vineyard Music: Your Love Reaches Me
Norah Jones: Sunrise, Humble Me
Chris Rice: Jesus, What a Friend for Sinners

EMA's Labor Play list
Hem: The Fire Thief, Redwing, The Beautiful Sea, Reservoir, Half Acre
Watermark: Holy Roar, The Purest Place
Sara Groves: Jesus, You're Beautiful, You Cannot Lose My Love
Enya: To Go Beyond (I) & (II) Portrait, No Holly for Miss Quinn, Watermark, Shepherd Moons
George Winston: Northern Plains, Sleep, Baby Mine
Jon Foreman: House of God Forever, Your Love is Strong, White as Snow
Jill Phillips: O God of Love
Steven Curtis Chapman: Be Still & Know
Sting: Fields of Gold
Coldplay: Life in Technicolor
Alison Krauss: Baby Mine
Brooke Frasier: Hymn
Tim Hughes: Everything
Chris Rice: Jesus, What a Friend for Sinners, For the Beauty, Like a River Glorious, This is My Father's World, Savior Like a Shepherd Lead Us, How Great Thou Art, Great is Thy Faithfulness
Mindy Smith: It's Amazing

Interviews with Me on Being a Birth Doula

2010-09-15T19:57:00.000-07:00

I've had a few different opportunities to be interviewed on what it means to be a birth doula. You can find the interviews on these blogs:

Interview w/ Your Baby Booty
Interview w/ Ladies Lotto

Pack Your Bag(s)...

2010-09-10T20:14:00.000-07:00

If you're planning to give birth outside your home, you'll most likely want to pack some items to help make your labor and postpartum hours spent in the hospital or birth center more comfortable and as homey as possible. Take some time to think through what kinds of things you'd like to have around you and on you. Below are some suggestions... feel free to comment if you have other suggestions- I'm willing to add to this list :)

Things for Labor & Room

Pillows (think nest... hospitals have limited supply of pillows & they're typically plastic coated) use a pillow case that is NOT white and bring clean extras to put on your pillow for your postpartum stay
Hot water bottle (fill it before you leave home... if you need more hot water, ask your doula, labor companion, or nurse to get some from cafeteria or coffee cart)
Electric heating pad (keep in mind some hospitals don't want you to use outlets in the room... a hot water bottle solves that problem)
Birth ball (some hospitals have these... but again, limited supply. I suggest bringing yours anyway, that way you have one for the shower and one that is dry for the room)
I-pod & charger
Sound dock w/ batteries
Camera & batteries/ charger
Video camera (ask hospital's policy on recording... some require and some restrict use of tripod)
Cell phone & charger
Laptop & charger
Olive oil (instead of mineral oil for perineal massage... include this in your birth plan. A handy way to bring it is in a sterile urine specimen cup- grab one from your OB's office the next time you're there.)
Massage oil for yourself (if you're wanting massage during labor at all)

Clothes

Robe & slippers (may I suggest treating yourself to a new set?)
Night gown (WONDERFUL to labor and birth in your own loose-fitting, short tank-style nightgown)
Nursing tank (for postpartum)
Sleep nursing bra (for postpartum)
Labor bra (if you plan to labor or deliver without a gown on and don't want to be naked... but you can be naked too, it's ok)
Pants (for postpartum)
Underwear (for going home)
Swim suit for hubby or birth partner (if you'd like them to join and/ or help you in the shower or tub)
Warm clothes for hubby or birth partner (good chance you will want the room on the colder side while laboring... and YOU get to control the temperature)

Paperwork, Etc.

Photos of special people (other children, family, pets, etc.)
Any birth books, labor notes, birth class handouts, etc. that you might want to have with you
Copies of birth plan (more than one so that you can give to nurses if shifts change)
GBS (Group Beta Strep) test results
Pediatrician info
Driver’s license
Insurance card
Cash (some hospital cafeterias/ vending don’t accept credit cards)
Call list
Baby book (when your baby is getting foot printed, ask the nurse to print a set in your baby book as well)

Snacks (shhh… you can eat during labor)

Pretzels/ crackers (salty helps with nausea)
Nuts (PROTEIN!!)
Vitamin Water or juice
Peppermint or citrus candy (helps with nausea)
Snacks for hubby or birth partner (watch your breath though… DO NOT, I repeat, DO NOT get close to a laboring woman if you have strong breath… brush your teeth)

Toiletries

Shampoo/ Conditioner
Deodorant
Hair stuff
Head bands
Lotion
Lip balm
Toothbrush/ toothpaste
Make-up

Baby

Nursing pillow, if you have one... nice to use in the hospital
Coming home outfit
Bath soap for first bath (if you prefer to use something other than standard hospital soap)
Socks
Long sleeve onesies and/ or long sleeve t-shirts (side snap for both are the best)
Hat
Receiving blanket
Burp cloths
Car seat & base (already installed in the car and checked at your local Sheriff’s station)

You Have a Choice (short documentary)

2009-10-03T18:02:00.001-07:00

food for thought...
You Have a Choice

Things to Have on Hand for the Postpartum Weeks...

2009-09-22T18:42:00.002-07:00

We find copies of lists on "what to pack for the hospital" in the birth books and through childbirth classes... but have you found one on "what to have when you come home from the hospital?"

Here are a few key items I suggest picking up so that you don't have to run out in those first few days and weeks (or try to explain to your husband where to find them!!)

Feminine pads ranging in absorbency
My personal pick is a long super maxi w/ wings for that first week or so and then something in the moderate to regular absorbency category for a few weeks and then something light. Every woman is different- so the bleeding will vary and therefore how many you will need of each type of pad will vary as well. I'd pick up a package of each mentioned above... you can always give the extras to a girlfriend for after her birth :)

Tucks pads and/or Preparation H Cream
Ah yes, the "wild card" postpartum surprise... Hemorrhoids. Some women get them, some do not. For those who do, you'll find that you will want to treat them as soon as you can. These can cause more discomfort than other things you may be healing from and if anything, they are just annoying. I suggest buying but not opening a box of Tucks and a tube of Prep H and saving the receipt. That way, if you don't end up needing them- you can return them... hey- you'll need to get out for fresh air at some point!

Check out this link for some helpful hints.

Soft toilet paper
By this I mean splurge on the Charmin or Cottonelle if you typically buy the Kirkland brand at Costco. This is not the time where you want to be using anything other than the softest possible tissue known to mankind. The kind with aloe in it is especially kind to your bottom.

Nursing pads
Reusable ones are nice for the environment and for light leaking, but seem to not do the trick if you tend to leak more heavily. You can find all kinds of reusable options on Amazon.com and many other sites. If you go the disposable route, again, there are many options to choose from. My personal favorites are made by Lansinoh. Have a lot on hand and don't forget to stock your diaper bag and purse with a few for when you are out and about.
(I'll also mention that Lansinoh breast milk storage bags are my favorite, hands down. Leak-proof and BPA free.)

Nursing tank tops
Wait a few weeks to purchase a good nursing bra or two (it takes little time for your milk supply to level out). From the get go, I suggest having a few tank tops designed for easy breastfeeding. My personal favorites are from Target and the long ones made by GlamourMom (note- by up in size if you go with GlamourMom... they tend to run snug in the rib cage).

Water and easy snacks
I can't stress enough to have water readily available. Consider keeping water bottles handy wherever you tend to nurse and keep a supply in the refrigerator as well. Likewise, keep nuts, trail mix, granola bars, and other protein-rich foods in spots where you nurse, as well as in your diaper bag and purse. Hunger and thirst tend to hit hard during the postpartum weeks as your body is regulating and adjusting to a non-pregnant state. Keep cheese and veggies cut up and available in the fridge.

A comfy pair of pajamas or night gown
Treat yourself to something soft and cozy or even a few things... you'll be spending some solid hours in them.

Someone to check in on you
By this I simply mean someone that you have designated to check in on you throughout the day. This might seem silly... but with taking care of your new babe and nursing around the clock, it is SO helpful to have your husband or a family member or friend who's at your house make sure that you have 1) water 2) meals and 3) are comfortable.

My Best Birth Celebrity Webisodes

2009-08-06T10:56:00.000-07:00

I've enjoyed viewing these so far... hope you do to.

http://mybestbirth.ning.com/page/celebrity-webisode-trailer

A Doula's Role... great YouTube video snippet

2009-08-01T22:04:00.000-07:00

Thought this was well said...
From the Mindful Mama website... click here

So it begins...

2009-06-25T22:55:00.001-07:00

I've been thinking about starting this blog for a few weeks now. It's been an exciting and full spring with the opportunity to assist three women with their births... one in February- baby A, and two in May- baby E and baby I.

I'm left utterly amazed at each of these births... all three shared the commonality of an expectant mama who nourished and grew their precious babe for 9 months (give or take a little) and then lovingly labored to bring them into the world... but each labor and birth having a beautiful spin of it's own. As a student of birth- I had front row seats to three very unique births... a first time mama who labored and birthed much quicker than any of us expected... a second time mama who had a much more positive birth experience this time around... and a first time mama who labored long and hard and beautifully surrendered her expectations as complications arose.

I find myself now reflecting on these births and the lessons they hold for me. I'm humbled that I was allowed to witness and learn from these women and their stories.

I'm not sure exactly what this little piece of the blog world is going to look like... but I hope that it's a place where I can share what I'm learning and what I'm thinking about and invite others to do the same. Let's face it... we're all in the process of being born into something... we've been given lifetimes to find new things and to spend our days discovering and growing and asking and wondering. For me, I'm in a season of being born into birth and all the beauty and deep wonder it holds.