Archives

Book Review: The Doula Guide to Birth

Apr6

Book Review: The Doula Guide to Birth

The Doula Guide to Birth: Secrets Every Pregnant Woman Should Know
By Ananda Lowe & Rachel Zimmerman
Bantam Books, 2009
Softcover, 270 pages
ISBN: 978-0-553-38526-7
www.thedoulaguide.com

Reviewed by Talk Birth

The Doula Guide to Birth is written for pregnant women, though the title may suggest that it is for doulas. It also has a chapter and sections specific to birth partners. However, doulas will also find the book to be a friendly, enjoyable read and may pick up some fresh perspectives for their work with birthing women.

The book also includes (short) sections for often-ignored or marginalized segments of the birthing population such as same-sex partners, parents using a surrogate mother, and women planning for adoption.

The first five chapters of The Doula Guide to Birth cover benefits of doulas, the role of fathers/partners and the complementary nature of the doula role to other support people, general overview of labor, childbirth education options and medications, and finding a doula.

The later seven chapters delve deeper into less typical subjects such as doulas and medical providers, when should you really go to the hospital, labor techniques, unexpected interventions, birth plans/birth essays, and what really happens postpartum.

Though not a criticism per se, I did feel like the first half of the book reads very much like an extended “commercial” for doulas. The second half of the book really shines. My favorite chapter was “labor is not about dilation”: “Although there is currently a heavy emphasis on dilation, vaginal exams, and timelines for giving birth, labor is not about dilation. Your body knows how to give birth whether or not you ever have a pelvic exam during labor. Birthing women need encouragement to trust their bodies, and to be the stars of their own labors. Doulas help provide this encouragement. And the confidence a woman discovers in labor can help carry her through the demands of parenting and future challenges in life.” (emphasis mine).

The Doula Guide to Birth is supportive of the midwifery model in philosophy, but only includes very brief mentions of midwives, the assumption being that most births will be in the hospital.

The book has extensive endnotes and an appendix with a birth evaluation form.

–

Disclaimer: I received a complimentary copy of this book for review purposes.

Review previously published on Citizens for Midwifery

Guest Post: Mothers Matter–Creating a Postpartum Plan

Dec12

This guest post is part of my blog break festival. The festival continues through December, so please check it out and consider submitting a post! Also, don’t forget to enter my birth jewelry giveaway.

I connected with today’s guest post author, Rachel Van Buren, via Facebook. Rachel has a passion for postpartum support and so do I. When she mentioned that she was teaching a postpartum planning workshop, I asked if she’d consider writing up her notes into a post to share and she did!

“Mothers matter” – Creating a postpartum birth plan
by Rachel Van Buren

The Neighborhood Doula

I feel compelled to state the obvious: Society fails to meet the needs of the laboring, birthing, postpartum woman. Because these women lack the support that seems obvious for those around them to give, they assume their feelings are not normal. I am here after having birthed 4 children over the last 13 years to reassure you that your needs are normal. So normal, that I can read ten thousand threads in one afternoon of women who are crying out for support during the postpartum months. Why is it that we dismiss our feelings, and label ourselves as “ungrateful, needy, or weak” because we read one perfect looking blog, or Facebook post? Don’t misunderstand…the 4th trimester is beautiful. It really truly is. But it’s also life changing. Have you ever experienced a life change without experiencing anxiety? Of course not.

My message here is this: Women need to plan for the postpartum time period. It is essential. We get so wrapped up with birth, we forget about what happens when we bring baby home.

There are 3 areas of importance to explore before you bring baby home: Dealing with friends and relatives, how to delegate without guilt, and the importance of self-care.

Let’s explore these topics together.

How to deal with relatives and visitors during those first few weeks:

  • Have a clear vision of what your postpartum time will look like. If you aren’t sure, have that discussion with your partner now. Do not wait.
  • Set clear boundaries: Everyone does better when they know what to expect.
  • Set phones to go directly to voicemail.
  • Change your outgoing voicemail greeting. For example: “You have reached the _______ family, we are sorry we can’t take your call right now, as we are busy enjoying some quiet time together as a family. We are all doing well, and really appreciate your thoughtfulness in calling. We will return your call when we have the opportunity to talk, or are ready to expect company. So good to hear from you, and have a great day!”
  • Stay in bed.
  • Stay in pajamas.
  • Do not offer beverages. Visitors will be less likely to overstay if you are not in the entertaining mode.
  • Have partner or Postpartum doula mediate and advocate to well-intentioned but pushy friends or family. A BFF, parent, or close relative shouldn’t serve in this capacity. Prepare with them an “elevator speech” regarding visitors “Their Doctor/Midwife has encouraged the family to take a postpartum “Baby Moon” and they are really taking that advice to heart.”
  • If mom is breastfeeding: A gentle reminders to others, that she is nursing the baby about every hour(maybe even more) and are spending lots of time skin to skin, so visitors are just not practical right now.
  • Use social media to the fullest…

Update your Facebook status as a way of giving a “heads up“.

Delegating without the guilt: I find it interesting to meet a lot of women that perceive themselves as feminists; they have no problem advocating for a natural/intervention free birth, defending their right to an elective Ceserean, or advocating for their future right to nurse in public. However many of these women come home after birth, and suddenly find themselves struggling to find their inner voice. Suddenly things become sticky because we’re now dealing with people that we have relationships with on a personal level. Boundaries can be tough to establish and maintain because our desire is really to our loved ones. Here’s when guilt creeps in. Perhaps guilt over losing exclusive relationships (first child, partner, or even self). Guilt of not living up to our mother’s example, our friend’s example, or the “perfect” mother on Pinterest who is sewing her own postpartum maxi pads and cloth diapers.

I’m a believer in learning to delegate. It decreases levels of guilt from not being able to be Mrs Cleaver. It lightens our load. Whether it’s with our partner, or our children, we need to do it. The days are gone where we can “do it all”.

Here are some simple steps to practice in order to delegate without feeling guilty:

  • Set your ego aside: There is more than one right way of doing things. Yours is not the only way. Invite the possibility that they might even do the task better or faster than you.
  • Stop waiting for people to volunteer: It is your job to communicate your needs. Partners are not mind readers. Just because they don’t offer, does not mean your needs aren’t normal.
  • Ask and you shall receive: Get to the root as to why you struggle with asking for help (shame? guilt?). Learn a different way. Learn to ask for help.
  • Delegate the objective – NOT the procedure: Dignify the person helping you by allowing them to do it as they choose, but make clear what your desired end result is. This will stop you from being the ever annoying micro-manager. After all, you are not training a robot, but a human being who can adapt and improve.
  • Be patient: The person you delegate will make mistakes, it is part of the learning process. Work consciously to keep a positive and realistic attitude.
  • Recognize your helper: Make sure they hear you brag about them to your friends or family. Everyone loves praise, and when they are appreciated they will be more apt to tune into your needs and want to help. Say THANK YOU! Let partner know that it makes you feel so special that they are working so hard to meet your needs.
  • Avoid controlling partner’s feelings. It doesn’t build up the relationship, and only adds resentment. (“I won’t ask partner to load the dishwasher because I don’t want to hear complaints. I’ll just do it myself to avoid the argument”) Partner has feelings, and is entitled to them, whether you perceive them as “good or bad”. Feelings are not facts. They are interpretations of the facts.
  • It’s OK to feel guilty. NO ONE has ever died from guilt!! (excellent mantra during particular moments of delegating)
  • Avoid saying “yes” when you really mean “no”.
  • Change your “normal”. Embrace the fact that the next 3 months are truly a time to expect the unexpected.

Self care:

Postpartum self-care is an absolute necessity. Get in the habit now of taking care of yourself. I firmly believe that how we take care of ourselves is learned behavior. Surround yourself with women who value their physical and mental health. Watch them, and copy them.

Here is a list of self-care ideas for your physical postpartum recovery:

  • Ice packs for perineum
  • Postpartum massage
  • Belly binding
  • C-scar massage
  • Herbal bath (with baby too!)
  • Lots of sleep
  • Ask for help
  • Eat nutritious living food
  • Stay hydrated
  • Listen to your favorite music.
  • Avoid any negative television.
  • If you are already caring for a child with special needs, make sure that support is already in place to continue caring for them during those first few months until you are back into somewhat of a routine.
  • Create a network. Women want intimacy. Do not isolate. Isolation breeds anxiety.
  • Stick to your spiritual routine (whatever that looks like) Feed your soul daily.
  • Avoid stress triggers (if overbearing mother in law is coming by, let partner and baby spend time with her. Go take a shower, or get some rest)
  • Hug your partner. A lot
  • Avoid alcohol and caffeine. These both will be very tempting, and can be OK depending on your circumstances. If you are feeling blue, or have a history of depression, I recommend avoiding during the 4th trimester.

And most of all, listen to your instincts. Don’t compare yourself to others. Believe in yourself. Postpartum is a special time in which we evolve, allow yourself to be transformed.

Be empowered: create a postpartum plan today!

Rachel Van Buren is a birth and postpartum doula living in Charlotte, NC with her husband and four children. Visit her online at The Neighborhood Doula.

Originally posted at The Neighborhood Doula,
Dec 6, 2012

—

You can read past Talk Birth posts about postpartum here:

Planning for Postpartum

Lann’s Birth Story–Baba Style!

Sep21

Today my firstborn son turns NINE! I can hardly believe it. I mean, I remember being nine. What happened?! And, as I thought about his birth and planned to share his birth story link as I always do, I suddenly remembered…I have his birth story from my mom’s perspective too! And, I’ve never shared it here (I also have my friend’s version and my doula’s version—this could keep me going for a while!). In our family, we call my mom Baba as her grandma name, so here is the tale of Lann’s birth, Baba Style:

The time for Lann’s birth was rapidly approaching, and I felt like I was fairly well prepared. My bag was packed, and I had been studying my labor support information. I needed to honor my commitment to demonstrate lace making at the Potosi Bisonfest, so I had driven a separate car, and had my newly purchased cell phone handy – I even made a test call to Molly and Mark to be sure it would work from that location. It was a long day – up at 5:45 a.m., drive 2 hours to Potosi, demonstrate for 6 hours, drive 2 hours home. I made it through without receiving “The Call”, and thought I’d go ahead and check in with them to see if the watched pot had begun to boil before falling, exhausted, into bed.

What a surprise it was to have Mark answer at about 7:30, and tell me that they thought something was happening. I couldn’t believe it, even though this was the moment we’d all been waiting for! Molly got on the phone, and expressed her concern that perhaps this was false labor. I tried to reassure her that it didn’t matter to me if I had to make 10 false trips, as long as I didn’t miss it. Her contractions were coming regularly and close together, but even so, she seemed reluctant to call in her support team without feeling more confident about what was happening. We decided to wait a little while, and see what developed. I used that time to change out of my demonstration costume, and begin gathering supplies I thought I might need (book, project, birth art, extra clothing, etc.). The phone rang within 45 minutes, and this time Molly said she wanted me to come. She told me that during contractions, she kept thinking it was time for me to come, but that between them she felt she was doing fine. I took that to mean it was time for me to get to Jefferson City!

I listened to soothing music in the car as I tried not to speed on my trip. I repeatedly visualized how the evening would progress, even though I knew that anything could happen, and that I needed to be open to whatever occurred. No amount of imagination could prepare me for I was about to experience.

I arrived at the Remer home at about 10 p.m., where Mark let me in and told me Molly was in the shower. When I got upstairs, and unloaded my belongings, I could hear Molly humming “Woman am I” from behind the bathroom door. When she came out, wrapped in a green towel, she was so adorable that I had to take a couple of pictures. She said she’d had 7 contractions while in the shower, and was glad I was there.

It’s hard to remember the exact chronology of events. After a while, we called the doula – but when she wanted to know the timing of the contractions, both Mark and I were vague. It was never clear to us if we were timing things correctly. What was clear was that the contractions were coming close together, and seemed intense to me. We called the birth center to give them a head’s up, but had to leave a message, and realized that we weren’t sure what the after hours procedure was supposed to do. We called S again to ask her how to contact the doctor, L, directly. It seems like around that time, L returned the call from Molly’s message, so apparently that’s their procedure – just leave a message and someone calls you back!

Meanwhile, Molly continued to have regular, intense contractions that barely ended before the next one began. She commented that she never seemed to get a break, and was a little fretful about things getting worse. I tried to let her know that she only needed to deal with each contraction as it came, and not to “suffer what she feared”, because maybe this was as heavy as they would ever get. I felt like I should be the voice of wisdom, even though I couldn’t really tell what was going on with her. My job was to soothe and support, and I had schooled myself carefully to remain cool and calm!

Throughout the contractions, Molly continued to hum “Woman am I”, and sometimes, as the humming began to speed up and get louder, I would hum along with her, hoping this would help to center her. We had various tricks that we had planned, like a foot massage, counter pressure, squeezing combs (hah!), but none of them seemed desirable or necessary. Occasionally, she would begin to question her ability to continue if it became more difficult, so I brought in her list of affirmations and read them to her between contractions – they were all familiar to her and seemed marginally helpful. Watching a woman labor makes the support people feel rather helpless, so it was good to find something that she could focus on, if only for a while. We also offered frequent drinks and food. Mark was extraordinarily in tune with her.

We tried various positions to ease her comfort. One mistake was suggesting that she lie down on the bed for a while. She said it made her feel terrible and trapped. She was amazingly calm and serene, otherwise. I had expected her to be irritable with me, or Mark, but she was very internal and focused. I had also expected to feel more protective than I did. I thought I’d want to take away her pain, and be the “mom” who fixes the hurts, but she was so in control the entire time that I didn’t feel the need to go into mom mode. Her strength was inspiring.

Around 2 a.m., we decided it was time to call S, who arrived in record time. It was a relief to have a more professional opinion available. Molly was in the bathroom at this time, and had quite a bit of pre-birth matter (to put it politely) that had been discharged into the toilet. To me, this looked like far more than the mucus plug and seemed to indicate that birth was imminent, but S didn’t seem to think so. I still don’t know, but it was definitely an indicator of big progress being made! Also, the contractions were very heavy and close together. S took us aside, and said that first-time moms take a really long time, and that we shouldn’t be jumping the gun – hindsight reveals that Molly was further along than any of us realized.

S altered the room lighting with little gentle lamps that gave off a dim blue light, very much like candles. She whipped out rice socks, and offered various suggestions for position changes. It was good to have someone else to offer support, although we were doing pretty well without her. Molly kept saying that she felt different inside, like something was happening, but she wasn’t too clear on what it was. She said that during contractions, she wanted to race to the birth center, but between them she didn’t. I remembered her saying something similar about my arrival, earlier, and wondered if maybe we should heed this and get straight in the car……

S suggested another shower, but Molly was quite resistant to this, and then announced that we should go to the birth center. I was glad to be at this point – in the hands of professionals! The original plan had been to transport in 3 cars – Molly and Mark in theirs with the carseat, me, and then S. It became obvious that Molly would be much more secure if she could have Mark’s attention during this 40 minute drive, so we switched the carseat to my vehicle, got everyone loaded, and sped away. It must have been at about 3:15, because we got to the birth center at 4. By this time, I was running on adrenaline, having had no sleep, and having already driven nearly 6 hours, but I felt charged and clear. My grandson was on his way, and I was the driver. This was an important task! I tend to drive a tad fast in ordinary circumstances, but this event led me to be a regular lead-foot. I kept it at about 75 mph, although S says I went faster. The road between JC and Columbia is very “swoopy” – there are lots of dips, and then bumps that the car sort of chunks over. Molly was moaning, and seemed especially agitated as we bumped and swooped. I don’t think slowing down would have helped, so I just kept the pedal to the metal and got her there as fast as I could.  I couldn’t tell what was happening in the back seat at all, and just concentrated on my driving.

We pulled into the parking lot of the center, and there was nobody there! As I began to question this, a car pulled in, and out stepped V [midwife], very calmly, carrying a cup of coffee. She opened the door, asked a few quiet questions, and then casually went off to brew more coffee. We unloaded some things, including Molly, who seemed a little confused and tired. Mark called friend Kate, who we had called before, leaving a message. Little did we know that she was standing by waiting for the follow-up call for hours! She arrived about a half hour later, beaming and fresh. It was good to see another caring face. We all wanted to do something – anything – for Molly. However, Molly was in complete command of herself, so it was left to us to stand quietly by.

We were placed in the room Molly had hoped to have, and I came in, no doubt thinking we had plenty of time. She checked Molly and said that she couldn’t find a cervix. I found this unnerving. Did she mean no progress had been made? How could that be?!? Did Molly have some bizarre disorder that caused her cervix to disappear? I was working hard on being quietly serene, so I finally just asked what she meant. V said Molly was fully dilated, and could begin pushing whenever she felt the urge. I’ll never forget Molly’s face, disheveled hair, and wide eyes as she looked questioningly at V and said, “Are you telling me the truth?” Well, she was telling the truth, and Molly soon began to push. At this point, I remembered the car ride, and realized that Molly had gone through transition while swooping along the highway.

At one point during the pushing, Molly was standing by the bed with her arms and elbows supporting her. She gave a tremendous grunt, and her water broke with an audible report, splashing Kate and lots of the floor. It seemed like a lot of fluid! At this juncture, V said she’d better call the doctor, so we helped Molly into the bathroom.

Molly was concerned about making huge messes, so she was fairly comfortable in the bathroom – that way, everything just dropped handily into the toilet. The age-old concern about excreting a wee amount of feces was there, so being on the toilet alleviated that problem. Mark was with her all the time. I should take a moment to mention how wonderful Mark was throughout this entire event. He never left her side, and was completely attentive to every move she made or word she spoke. He never lost his calm demeanor for a moment, and was a pillar of strength and support.

Dr. L was now present, and she added to the overall feeling of having a competent team in place. It also helped to know that things were moving right along, and Molly would soon have her tiny son.

I had made sure to bring along Molly’s birth necklace from the Blessingway, as well as her needle felted birth art. I took a moment to hang the necklace at the foot of the bed where she could see it, and I place her felted ladies on the table where they could look on. Molly was wearing a cotton-knit nightgown, and had on an amulet bag with the fused glass touchstone a friend had given her. We all knew that things were happening, and became very energized by the birthing energy.

While in the bathroom, as we stood outside the door, I could hear Molly humming her song – I hummed along with her so that she would know that I was still with her, even if I wasn’t in the same room. I didn’t know if she could hear me (she could), but I thought it might help.

Molly and Mark were still in the bathroom when L came out and told us that they wanted some privacy, and ushered us all out into the lobby. Before I left, I told everyone that Molly didn’t want to give birth on a toilet, and they seemed to hear me. We sat there – V, Kate, S and I – chatting a bit, and wondering what was going on in there. I voiced my trepidation that maybe I wouldn’t get to see the birth after all, but that I also realized that I wanted it to happen the way they wanted it. That meant they might not want me (or anyone) there, and I knew I needed to be at ease with that. V had some stories to tell of her own children not needing her. I wasn’t comforted, but was fully aware I needed to get over it! I later discussed this with Molly, who told me that L had asked if they wanted privacy, and when they said yes, she took it upon herself to move us out.

Not too much time elapsed (maybe 30 minutes), and L came out to invite us back into the birthing room, but that no talking was allowed. It was really hard to not utter any words of encouragement to Molly, who was now lying on her side on the bed. It was very dimly lit, so L shined a flashlight to show us the tiny tuft of hair emerging as the baby began to crown. Once again, I later found out that Molly had not requested complete silence – but at the time, I was afraid to make a peep for fear they’d kick me out and I’m miss everything. They had us place a mirror so that Molly could see the baby, and shifted her position so that she was sideways on the bed. If I’d been allowed to speak, I would have suggested placing something under her heels to give her purchase for pushing. Instead, I moved around a bit, and put my leg under her foot to try to help. Then, I had to move to allow room for L and V to get ready for the Lannbaby.

Molly expressed amazement that she was “really doing this” and repeated that it didn’t feel real. She kept saying things like, “This is really me! I’m really doing this!” She was astoundingly together the entire time.

Molly pushed and pushed, still serene and still in command. There was a great deal of stretching discomfort that alarmed her, but L put her mind at rest by telling her that her body was made to stretch like that. After a few more pushes, and Lann’s head emerged, crying loudly, and spluttering. Before this, I was recalling a birth support video that I’d watched, in which the baby wasn’t breathing and was shockingly limp and white. I was girding my loins to be calm and supportive if this happened – but no need! A very vibrant and squalling head greeted us! His body slithered out directly afterward, and we had a whole, crying baby boy in the room with us. What a miracle! The joy was intense. Kate and I burst into tears.

Just born!

L handed the baby to Molly, who immediately, with Mark behind her throughout, began crooning and talking to her tiny son. She instinctively put him to her breast, and he calmed as he began nursing. They cut the cord, and then needed to take him from her for checking, and diapering – it was time for the placenta, which slid out as nice as you please. They told Molly that she had a small tear, and didn’t recommend stitching it.

There was an uncomfortable follow-up moment, when some blood clots needed to be manually removed to that the uterus could properly contract. Mark had the baby, and it was hurting Molly, so she called to me. S got there first, but I soon took her place, and we went through a few more rounds of “Woman am I”.

We also joked with Molly about getting an A+++ on labor and birthing. I’m not sure what the staff made of that. They probably thought I was some pushy, overachieving home school mom that insisted on academic excellence. It was definitely an A+++ event!

This is about when I got a chance to hold my peacefully sleeping grandson – what a perfect little guy! It was such a wonder and an honor to be present at his birth. I’ll forever be grateful to Molly and Mark for allowing me to share this experience with them. It forged a new bond between us, and made me understand the reality of life everlasting. Little Lann is my immortality.

Baby Lann with his Baba!
(I couldn’t find a newborn one with Baba. Surely I have one?!)

With Baba nine years later! (and Aunt Nancy too!)

Thanks for being there, Mom! :)

–

Related posts:

My First Birth

Alaina’s Birth Story–Baba Style!

New Birth Skills Workshop!

Sep18

Active Birth and Labor Support

Saturday November 17, 6-9:00

Location: Tara Day Spa in Rolla, Missouri

Cost: $35 for the pregnant woman + one support person (husband, partner, relative, friend…)

Workshop description: First, practice active birth techniques and learn about working with pelvic mobility. Next, spend some time learning labor tips and tricks and practicing comfort measures with doulas! Then, enjoy a friendly Q & A session all about what you most want to know. You will have access to three birth professionals for the price of one! We will close with some relaxation skills practice and a guided visualization.

Interested? Please email me and I’ll send you the registration form!

The lifelong impact of breastfeeding support

Aug5

I’m on a roll with breastfeeding-related posts during World Breastfeeding Week. Why stop now? This essay is an older story that was previously published in Leaven, LLL’s publication for Leaders.

Nursing Zander at our 2006 WBW picnic.

In 2006 I was in the post office — 24 weeks pregnant and holding my sleepy two-year-old, three packages, and my purse. An older woman in front of me offered to hold my packages so that I could hold Lann better. We chatted for a minute about how crowded the post office was. She glanced at my necklace then and said, “I like your necklace. Is that La Leche League?” (I was wearing my logo pendant.) I told her it was, and she said, “LLL saved me about 32 years ago.” She proceeded to tell me her story.

Her baby had weighed seven pounds, 13 ounces at birth. At his two-week checkup, he weighed seven pounds, three ounces. The doctor watched her nurse, weighed the baby, and then decreed that she wasn’t making enough milk for him. He “ordered” her to give the baby formula. She said she is someone who always follows orders. He had previously ordered that she feed the baby only every four hours and never wake him when he was sleeping. Wanting to nurse before it was “time,” her baby had been crying himself to sleep; she wouldn’t wake him to nurse when the prescribed four hours had passed because she had been ordered not to wake him. So, he was “starving to death.” She went to the store, got all she needed for formula feeding, and went home crying.

When her husband came home, the woman was still crying. He had seen a poster for La Leche League and told her, “Before you give him that stuff, call that La Leche person.” She called, and the Leader encouraged her to nurse the baby as often and long as he wanted; so she did. The baby started to perk up and gain weight, and they had no more problems. When she went back to the doctor, he said it looked like his plan was working. She said, “No, I know what really works!” and told him that she was nursing the baby anytime he wanted and that everything was going great. (The doctor then told her that his office could no longer help her and she would need to find a new doctor.) “He never did have a drop of formula!” she reported with obvious happiness. Then she told me that her daughter-in-law is expecting a baby and is going to breastfeed and that she had told her about LLL.

One of the things that stood out to me about this story is that the woman had never gone to any LLL meetings, met the Leader she talked to, nor had any further contact with LLL…and yet she still recognized the logo and felt so positively about her experience that she wanted to tell me about it 32 years later. These seemingly little contacts we make with mothers matter. They have a lifelong impact. As birth advocates and breastfeeding helpers, we may never know the potent impact of our words on a woman’s life, but someday, perhaps 32 years in the future, someone may be sharing the legacy of our own words to another stranger in the post office. Choose carefully, choose consciously, and make a difference!

Conscious Agreement and Informed Consent

Jul28

This post is part 2 of my CAPPA Re-Cap series.

During their general sessions at the recent CAPPA conference, Laurel Wilson and Tracy Wilson Peters both advocated a process called “Conscious Agreement” in working with pregnant couples. The basic steps are as follows:

  • Separate yourself from external influences
  • Get quiet and pause
  • Listen in (including mentally checking in with your body and how it feels)
  • Choose and commit

I especially appreciated Tracy’s observations that this process of conscious agreement goes beyond informed consent and, as birth educators, we need to make sure to “marry the two every time,” rather than focusing solely on informed consent. Why? Because there are several things wrong with informed consent as it is practiced today:

  • It fails to address the importance of conscious decision-making
  • Informed consent is made with the mind or intellect (and ignores feeling and intuition)

And…

  • You can “consent” all day long and not feel good about it.

The last point is the crux of the issue to me. When I cover informed consent in my non-birth classes, I always emphasize that the corollary is informed refusal. If “consent” as it is practiced by your hospital means saying yes and there is no option of saying no, it does not qualify as consent! A choice without the option to refuse is NOT a choice at all (see The Illusion of Choice). My students have almost never heard of the notion of “informed refusal” and seem shocked to even consider the possibility! Since I’ve had a special interest in this topic for a long time, I really connected with the idea of conscious agreement, especially when paired, as Tracy suggests, with informed consent information.

Another handy tip offered by Tracy during her presentation was to use HALT before entering into any agreement (or confrontation). Check in to see if you are…

  • H–Hungry
  • A–Angry
  • L–Lonely
  • T–Tired

(Also, consider whether the person you are trying to communicate with is any of these things. This is especially good to remember with children.) And, she shared this little poster:

This little sign may have been made especially for me. I have a terrible problem with getting crabby and snappish and plain old hangry (hungry + angry)—and then having to apologize. You’d think I’d have it figured out by now! (though, I do think nursing exacerbates it)

The Rest and Be Thankful Stage

Feb26

During my first labor, I experienced what Sheila Kitzinger calls the “rest and be thankful stage” after reaching full dilation and before I pushed out my baby. The “rest and be thankful stage” is the lull in labor that some women experience after full dilation and before feeling the physiological urge to push. While commonly described in Kitzinger’s writings and in some other sources, mention of this stage is absent from many birth resources and many women have not heard of it. After writing recently about the spontaneous birth reflex, I received a comment stating the following: “I was particularly interested in the idea of resting after full dilation before pushing. This makes sense if you are only following your body’s urges to push, but never something I had seen (or remember seeing?) spelled out before.“

I always make sure to tell my birth class clients about the possibility of experiencing a lull like this, because it is during this resting phase that labor is sometimes described as having “stalled” or as requiring Pitocin to “kick it off again” or as requiring directed or coached pushing. Also, think of the frequency of remarks from mothers such as, “I just never felt the urge to push.” When exploring further, it is often revealed that what the mother actually experienced was no immediate pushing urge instantly following assessment of full dilation. Depending on the baby’s position, this can be extremely normal. The way I explain it to my clients is that the lull represents the conclusion of the physiological shift happening in the uterus—the transition between contractions that open the cervix and the contractions that push the baby down and out.

As I wrote in a previous post from several years ago:

Your uterus is a powerful muscle and will actually push your baby out without conscious or forced effort from you–-at some point following complete dilation your body will begin involuntarily pushing the baby out. Many women experience the unmistakable urge to push as an “uncontrollable urge”–-but, in order to feel that uncontrollable urge, you often have to wait a little while! Though some care providers and nurses encourage you to begin pushing as soon as you are fully dilated there is often a natural lull in labor before your body’s own pushing urge begins. Some people refer to this lull as the “rest and be thankful” stage. It gives your body a chance to relax and prepare to do a different type of work (in labor the muscles of your uterus are working to draw your cervix up and open. During pushing, the muscles of your uterus change functions and begin to push down instead of pull up). If you wait to push until you really need to, you will often find that your pushing stage is shorter and progresses more smoothly that pushing before you feel the urge.

In the book, Our Bodies, Ourselves: Pregnancy and Birth they share the following important point:

“Research suggests that the length of time before the baby is born is the same if you allow one hour of ‘passive descent’ of the baby (when you relax and don’t consciously try to push) or you start pushing immediately after you are fully dilated.”

via Waiting before pushing… « Talk Birth.

That’s right, the length of time between full dilation and baby’s birth is the same, whether the mother waited one hour before pushing, or started pushing without the urge immediately following full dilation. I know which one sounds easier and more peaceful to me!

In my own experience with my first baby, I found that I felt like I should be pushing after full dilation and thus began to do so before feeling the full urge. I ended up pushing for about an hour and fifteen minutes. I suspect if I’d just continued hanging out for 45 minutes to an hour, he may have flown out in 15 minutes. Prior to pushing though, I did experience a rest and be thankful stage of about 30 minutes in which I sat in a rocking chair, joked about feeling “trippy,” and talked about being an A++ birthing woman. I describe it in my son’s birth story:

After finding out that I was fully dilated, I started to feel very odd and I really think I had to go through a sort of emotional/psychological transition to adjust myself to the fact that I had “missed” the physical transition point…I sat in the rocking chair for a while and kept saying things like, “am I dreaming? Is this real?” I also made a joke about feeling “trippy” like in Spiritual Midwifery. We also joked about what an A+ + + laboring woman I was (a family joke–I was a 4.0 student throughout college and grad school and so we always say that I like to get an A+ + + on everything I do). Those pressure feelings I had been having for a while, got a little more intense and I started pushing kind of experimentally. I was on my knees with my head on the bed on my pillow again and during one of the little pushes my water broke with a giant, startling POP and sprayed across the room including all over my friend. At this point, the midwife left saying, “I think I should call the doctor.” via My First Birth « Talk Birth.

The blog Birth and Baby Wise has some great thoughts to share on resting and being thankful (note the blog is from an educator in London, thus the use of the term Syntocinon, rather than the U.S. based brand Pitocin):

… it seems that there is little appreciation for this well documented pause amongst health professionals working in the consultant-led units of hospitals. Any stop in action once the magic ’10 cm dilatation’ is reached is met with almost instant medical intervention to get the contractions back up and running, ie a syntocinon drip. Women experiencing this are already on a consultant-led unit, where a higher level of medical intervention can be anticipated, but it is strange that there seems to be such a rush to use a syntocinon drip to get the contractions going again, providing mother and baby are both coping well.

One reason the contractions may ease temporarily is in order to allow the baby’s head to get into a better position. If this is the case, then artificially speeding contractions up is hardly likely to have the benefit of a faster birth for the woman – if anything, a slower and more complicated birth as she tries to push out a baby that is not quite in the right position. In addition, she has to cope with stronger contractions that she might find difficult to deal with, necessitating further medical help in the shape of an epidural – which in turn makes pushing the baby out even harder…

…At this stage, the woman and her partner are incredibly vulnerable to this well meant ‘help’ from midwives and obstetricians and are unlikely to question the requirement for additional medical help. It is also unlikely that the calm and relaxed environment so important for a peaceful birth can survive the worries of the health professionals, which will affect most women and their partners. via Rest and be thankful – or panic and have a drip shoved in? | Birth and Baby Wise.

I agree. In my own personal experience with my first birth, I was very vulnerable to just the perceived expectation of it being “time to push.” With later babies, it was intensely important to me that I have very few people present at the birth, knowing how sensitive I am to the expectations of those around me. It is truly only my husband and my mother than I trust to not disrupt my “birth brain” and the freedom of my birth space.

I’d love to hear more from readers about their experiences with the rest and be thankful stage.

Did you experience this lull between full dilation and pushing out your baby?

Was the lull recognized and respected by your birth attendants?

If you pushed without feeling the urge, was the pushing stage fairly long?

With subsequent babies, I had no internal checks during labor, so I never really knew if I experienced the rest and be thankful stage with them. I just pushed when my body started pushing—I have no idea how long after full dilation that was. So, I also am curious to know if women find they experience this stage with all babies, with only the first one, or with only some of their babies?

I suspect I did experience it with Alaina, because I remembering feeling concerned that contractions were suddenly “far apart.” I started talking more and analyzing myself and the labor and this was probably part of a lull in the intensity of the contraction action while my body prepared for a powerful spontaneous birth reflex.

Book Review: Doulas’ Guide to Birthing Your Way

Jul27

Book Review: Doulas’ Guide to Birthing Your Way
Authors: Jan Mallak & Teresa Bailey, 2010.
ISBN: 978-0-9823379-7-4
$15.37 – $21.95, 188 pages, softcover
Hale Publishing: http://www.ibreastfeeding.com/

Reviewed by Molly Remer

Geared towards pregnant women, Doulas’ Guide to Birthing Your Way is written in a simplistic manner using short, direct sentences. While in some ways this approach makes the information readily accessible, it can also feel unsophisticated in places. However, while the writing style is basic, the content is not. The Doulas’ Guide is a book that really “goes beyond” the information traditionally offered in birth preparation books, covering topics many parents typically may not have considered prenatally such as natural birth vs. birthing naturally, physical comfort preference styles, visualization, being a savvy consumer, blessingways, and taking pictures of the placenta. The information is refreshingly practical and hands-on. Chapters cover the critical importance of the human environment, “five arms of doula support,” birth preparation, one chapter for each stage of labor including separate chapter for immediate postpartum, a section about cesarean birth and VBAC, and a breastfeeding chapter.  There is an excellent section on postpartum care including a PPD symptoms chart. I was a little taken aback by a blithe comment, “Just think of it as an alternate birth route!” regarding cesareans.

Doulas’ Guide contains good, helpful snapshots throughout the text. Dads will like the plethora of labor support skills and ideas and the accompanying photographs. The book advocates preparation of a “birth vision” and includes examples at the end of the book (including cesarean birth options).

The variety of checklists, key questions, tables with reference information, bullet points, and pictures keep the pace of Doulas’ Guide to Birthing Your Way snappy and digestible. This book covers lots of ground and packs a lot of information into under 200 pages!

—–

Disclosure: I received a complimentary copy of this book for review purposes.

Birth Witnesses

Dec30

Birth Witnesses

Guest post by Bonnie Padgett

In this so-called Age of Information, we have iPads and smart phones, mega computers and micro chips, and a world of knowledge at our fingertips.  We are not limited by the resources in our community when we can reach out to virtual communities that span the globe with the touch of a button – forums full of ideas, innumerable news sources, websites for all schools of thought and up-to-the-minute research from leading experts in every field.

So why, then, are new and prospective mothers still so naive when it comes to the act of childbirth?  Why, despite our best efforts to educate ourselves, are we still in the dark about the whole process until those contractions hit and we begin the journey through labor ourselves?  I, myself, was included in this group, although I did everything I could think of to educate myself prior to my daughter’s birth.  I read books on what to expect, took classes hosted by my hospital, toured the birthing facility, joined an online forum of moms, and Googled everything I could think of related to pregnancy and birth.  I spent months practicing Hypnobabies for a natural birth, discussed my wishes in detail with my doctor, and, after studying ample examples and recommendations, formed a ‘birth preferences’ list for the doctor and hospital.  I knew what I wanted and what I didn’t want when it came to birth.  At the same time, I knew my “plans” would likely not go as expected, but was prepared to make informed choices along the way.  I had ideals and contingencies, preferences and plan Bs.

However, when all was said and done, I found myself totally unprepared for the experience of labor itself.  I had read about contractions, witnessed videos of women in labor, seen and practiced techniques for comfort and relaxation.  None of that prepared me for the anxiety and unknowns that flooded my mind as my body began its natural next steps.  I realized just how little I knew about the hours ahead.  How uncomfortable I would feel with nurses and midwives going about the “day to day” routines of their jobs, and by doing so how secondary I would feel to the process.  How defenseless I would feel to contradict or decline an expected treatment, especially under the medical staff’s disapproving glares, and with no one to support clueless me and my equally unknowing husband.    While a doula certainly would have helped in easing my fears and strengthening my resolve, I think my inability to grasp what I was a part of, indeed, the central part of, would have still left me bewildered and terrified in those hours.

After my daughter’s birth, I found myself struggling to comprehend what had just happened to me.  Although everyone assured me this was a fairly ‘normal’ labor, I had no point of reference on which to base that comment.  I realized the short video clips online and in class captured only key moments in a much longer, more complex and nuanced process.  Those huge gaps left in my knowledge of labor are what left me so unprepared to defend myself and my baby against treatments I didn’t want, didn’t need, and had previously decided against but found myself, in the moment, succumbing to.    I tried discussing it with my mom, who explained that she’d felt the same way when she had me (her first child).  She concluded the only way to truly understand birth was to experience it yourself.

The only way to understand birth is to experience it yourself.  The ONLY way?  That comment stayed with me, haunted me.  I became a doula after my daughter’s birth because I wanted to be able to provide women with support and knowledge that could give them a different experience, a better memory than what I had.  I just couldn’t believe that there wasn’t a way to understand birth at all except to experience it firsthand.  Certainly there wasn’t always this fear and unknown around birth that we each face today.  Not always.  I began studying that idea.  What about other cultures?  What about our culture, historically?  What about The Farm?  There wasn’t always this myth and mystery about birth!  I realized there was a time (and in places, there still is) when women banded together for births.  Mothers, sisters, cousins, daughters, aunts, friends.  They came together and comforted, guided, soothed, coached, and held the space for one another during birth.  These women didn’t go in it alone – they were surrounded by women who had birthed before them.  Women who knew what looked and felt right, and what didn’t.  Women who could empathize with them and empower them.   In addition to that, girls and women were raised in a culture of attending births.  Daughters watched mothers, sisters and aunts labor their babies into this world.  They saw, heard, and supported these women for the long hours of labor, so when they became mothers themselves, the experience was a new, but very familiar one for them.  Birth wasn’t a secretive ritual practiced behind the cold, business-like doors of a hospital.  It was a time for bonding, learning, sharing and sisterhood.  Girls learned how women become mothers, and mothers helped their sisters bring forth life.  It was a sacred and special part of the birthing process that has become lost in our institutionalized, over-medicalized, isolating and impersonalized system today.

While I certainly don’t expect us to throw our entire system out the window in favor of simpler times, I think the rush to technology and medical advances certainly left some essential elements of birth in its wake.  Elements such as women supporting women.  Listening to one’s body.   Intervening only when necessary instead of as a matter of protocol.  And perhaps, most importantly for us all, the community aspect of birth.   This has lead me to believe that in order to truly educate ourselves about birth, to improve the way we birth, and the way we prepare for birth and prepare our sisters and daughters for birth is that we need to provide the women we love (especially those of childbearing years) the opportunity to witness and participate in our births, because only when you are present for a labor and birth can you begin to fathom the process, the emotions, the physiological changes that one goes through. If we can allow women the chance to witness and share in our births – the way it was done historically – and how it is done now at sacred places such as The Farm – we can give them a chance to prepare for birth in a way we were never able to. They can see firsthand the role of a midwife or doctor (and the roles those care providers don’t play). They can observe the benefits of a doula, they can have the opportunity to doula themselves – caring for and soothing a woman in labor.  They can observe the power of changing positions, the instinctual side of birth that leads each woman to listen to her inner voice to bring forth her child.  They can witness the time, energy and atmosphere it takes to birth a baby. I truly wish that more women were invited into the birthing setting by close family or friends so they could witness normal birth and understand it as best they could before they do it themselves. This is one of the keys, to me, to normalizing birth for every woman.

As a ‘birth survivor’ myself, I understand the trepidation some women feel at including more people in this personal and – unfortunately for some – traumatizing event, and I respect that, but I would like to offer a few thoughts about opening your birth to ‘birth witnesses’.  First of all, my initial reaction to the way my daughter was birthed was “that was not how it was supposed to be!” followed shortly by “I don’t want anyone I know to have to suffer through that humiliation, degradation and pain!”  Those sentiments led me down the path of trying to discover a way to share with the women I love what childbirth could be, and what it should not be.  My best answer is to let them witness a birth experience and let them form their own opinions about what works for them and what won’t, so that they can be better equipped going into the experience themselves – empowerment!

My second thought for you is to think of those women you would want to share this experience with – do you have a younger sister? A daughter, niece, or friend who may one day become a mother?  Don’t you want to offer them the best opportunity for a great birthing experience?  Think of the presence they will bring to your birth, in turn.  These are women whom you love the most in the world.  They are going to be calming, happy, supportive presences in your birthing place (and if they’re not, I recommend they not attend).  These women want to see you succeed. They want what is best for you and your baby.  They are going to know you better than any doctor or midwife or doula, making them naturally better able to comfort you and support you.  Their love and warmth will be a welcome and helpful addition to your birth, as well as an educational experience for them.  And, if you, like me, were scarred or traumatized by your first birth, that type of love and unconditional support might be just what the doctor ordered, so to speak.

Like all things in this life, I don’t believe there is a universal approach to anything.  I don’t think that inviting birth witnesses into one’s labor is right or necessary for everyone, nor do I think that every woman must witness a birth to be adequately prepared.  For most women in our country today, though, I think there are many benefits – to the laboring mom and to her support team.    If you do want to invite birth witnesses into your experience, I recommend you consider the following as you prepare for your birth:

  • Think about where you are birthing and how many people are able to attend.  Many hospitals have limits on the number of people who can join a woman in a delivery room, but you may be able to rotate some of them in and out, giving a few women a chance to participate. Some birthing centers are more flexible, especially if you explain your intents, and your home of course is the an ideal option for including birth witnesses.
  • Think about who will best help you as well as who most will benefit from the experience.  This is YOUR birth after all.  Your needs must still come first.  If there is someone whose presence may cause friction or tension, you may not want to include them.   Birthing mothers need calm and relaxation.
  • Consider inviting witnesses no matter if you’re planning on a natural birth, an epidural, induction, or other intervention.  There is something to be learned from every birth experience, so don’t discount your ability to help because of the way you choose to birth. It is the physical presence at a birth that offers more to women than the type of birth.  They will form their own opinions about what they are comfortable with while watching and learning from you.
  • Talk to your witnesses beforehand.  Let them know you’d like them at your birth and why.  The idea of being present with birthing women has become a strange one for many people since it has fallen out of vogue, and explaining that they can help you by being present, and that you’d love for them to be there to witness your birth may warm them up to the idea.
  • Consider hiring a doula.  The doula can become a support for you, your partner and your other attendants, offering explanations and information, ideas for support, and helping to control the atmosphere and activity in the room so that it is ideal for your birth.

In the end, do what is best for you and your family.  Remember, the point of including birthing witnesses in the experience is to help you and to help someone else.  Even if you invite just one friend, a sister, or a niece to join you, you are helping to transform that woman’s view of childbirth and offer her an experience and education that she will carry with her for the rest of her life.  If we all became birth mentors for just one woman, think of the tremendous change we could affect for the next generation of birthing women.

Bonnie Padgett is a proud mother and wife, and an active member of the birthing community in Atlanta.  Bonnie is the owner of La Bonne Mama, which offers labor doula services, childbirth and newborn care education, birth art and placenta encapsulation services.  For her next birth she is planning a homebirth and her sister, sister-in-law, and niece will be invited to share in the experience. You can visit her online at www.labonnemama.com, or www.facebook.com/labonnemama.

Pictures & Doulas

Dec10

I am buzzing with topics to write about, but this week is finals week and I have been really busy with grading papers, tests, and dealing with last minute student issues and requests and blogging keeps slipping down in my possible options for the day. I also have two more giveaways to set up! So, I thought I would share some more pictures from my recent photo session. You may also notice that I have a fabulous new header for my website :)

And, here is the one I chose to use on my Talk Birth Facebook page:

I’m pleased as can be with them :)

Today I had a visit with my doula for this birth. I am completely confident in my birthgiving abilities and prefer to be nearly alone while birthing my babies (husband only), but I do also feel a deep need for immediate postpartum support. I am very capable at birthing my babies, but afterwards I am wiped out. Indescribably so, really. I’ve toyed with thinking that maybe this is an issue I can “get over” and I could take a mind over matter approach to dealing with, or, is planning for the wipe out I’ve experienced three times before just good, practical, realistic sense? So, my plan with her is for just that—for her to arrive shortly after I’ve had the baby and to quietly walk around in the background washing the bloody towels. This sounds like a good plan to me :) I also have “blood” issues that I’ve touched on before and so I made a “don’t look down” plan for post-birth trips to the bathroom. With each baby, when I go to use the bathroom, I look down to wipe/clean up and then become woozy/light-headed/ringing in my ears/can’t see any more and start to “go under” (though I’ve never actually fainted in my life). But, then when I get back to my “nest,” I feel okay again. (Same thing happens if I get my blood drawn or get an IV, so it doesn’t seem to literally be related to blood loss, but to a mental issue with seeing blood.) So, this time I’m going to make a plan not to look down! It felt really, really nice to have someone paying exclusive attention to me, my baby, and my birth plans—the focused, concentrated time that is hard to find space for in the midst of other kids and responsibilities.

Tomorrow I am going to a mother blessing ceremony for a friend. I’m looking forward to it—they are always special!