The fantasy doula league

Fantasy football is ending. Sad? You won't be after listening to this podcast which envisions...a fantasy doula league!

These dads are obviously quite familiar with the doula trade and are fantasy doula league experts. They really pick up on the crucial skills and stats of doula practice. And, then of course, there's the placenta-kiwi foam.

Fantasy Doula Report - Comedy from Jon Cragle on Vimeo.

"With Rebozo moves like this, she will not be available long!"

A few links to start the New Year

Happy New Year! Here is a total mishmash (not even sorted! only sort of related!) of interesting links for your enjoyment. It feels good to start clearing out my starred list in Google Reader, at least!

Many perspectives on why to have a doula for your homebirth (and a few on why you might not have one).

Doulas serving the expat community (as well as locals) in South Korea

The Well-Rounded Mama posts a list of obesity and birth/breastfeeding research on her Christmas wish list. Any public health peeps out there want to get on it?

The amazing Cathy Genna has a page on tongue tie including pictures and posterior tongue ties.

One mother's struggle with getting her daughter's tongue tie (and lip tie) properly diagnosed and treated - she ended up traveling to Dr. Kotlow to get treatment. "My prayer is that it will not always be this difficult for tongue-tied babies and their mothers. It should not require so much time and so many resources to simply feed your baby."

Interesting and varied responses to the updated UK guidelines on c-section availability.

Knit your own baby-wearing coat extender!

A post on cultural issues and breastfeeding, specifically on diet. My preferred way to deal with this (right now) so as not to contradict any breastfeeding cultural traditions: when people ask me if there are foods they should eat/not eat, I say "Every culture seems to have their own foods that they say are good or bad!" and then I name some examples. Hispanic mothers are often surprised to hear that Americans think broccoli is bad, for instance. I say "If there are foods that your culture thinks are good or bad, then go ahead and do what is recommended. Unless you hate the food! Then you don't have to eat it."

Android apps for doulas

I got a smartphone for the first time in March of this year. I had wanted the iPhone for years, but was tired of waiting for it to come out on Sprint. (Of course, once I gave in, Sprint announced they were getting the iPhone. As much as I love Apple products though, I can't say for sure I'd switch to the iPhone once I'm ready for my next upgrade. I've gotten a little bit addicted to certain Android apps & features.)

I've found the phone mildly addictive in some ways (Google Reader on phone = bad idea?) and super helpful in many others - including doula work. I thought I'd do a post on a few of the apps I've found useful as a doula, and ask for app suggestions that others have discovered.

Navigation

When you're meeting up with clients at their houses, or various places out in the community, or driving to unfamiliar hospitals, navigation is wonderful! One of my favorite things about the Android is that Google Maps is your in-phone GPS. This is absolutely amazing, not just for the directions but for a lot of other little details. For example, when you arrive at your destination, it will show you the Google Maps street-level photo of the address you're looking for. I am using it constantly for both doula and non-doula navigational needs (I have a terrible sense of direction.)

Contraction Timer

I definitely don't spend a lot of time at births timing contractions (I don't spend a lot of time at births looking at the clock, period), since most of what you need to know about labor progress you can tell more from looking and listening than you can by timing. But there is the occasional situation where it's helpful to do a little contraction tracking, especially when getting ready to pass along information to the midwife or doctor. I found it helpful in dark, quiet room while the mom was resting with her eyes closed. There were no lights and no light-up clocks (other than my phone), but I felt like her contractions were lasting surprisingly long. I turned my screen brightness all the way down and was able to just hit the button silently whenever I heard her start or finish a contraction, and pass along the information to her midwife. This app is simple, free, and does exactly what you want it to: show duration and frequency of contractions.

LactMed

I've written about this app before, and now it's on the Android Market proper! Quick and easy look-up for medication safety & breastfeeding, from the comprehensive database maintained by the NIH. I make a point of using it and demoing it in front of the medical providers who should know about it - already got an ER doc to download it this way!

"Whitelist" call screening apps

The one holy grail app I am still searching for is a "whitelist" call screener. Especially since I work nights, I am at very high risk for getting phone calls when I'm sleeping. But when I'm on call, I cannot turn off my phone. All doulas face this problem in some form: you might be at movies, at work, in class, etc. You're willing to let your phone buzz or ring quietly for a client, (knowing it's highly unlikely they'll call during that time) but when the dentist calls to confirm your appointment it's kind of embarrassing. What you want is an app that screens calls, so that your clients' phone numbers are OK to ring through, and and all others will be sent to voicemail.

VIP Alert worked perfectly, but when the whitelist numbers rang through, the ring would just be a soft beep. That would work perfectly in a movie or meeting, but I needed something to wake me up! It now seems to have been updated so you can adjust the volume, but at the time I tried it, that was a no-go. I'd be curious to try it again.

I tried Profile Call Blocker, but it just did not work the way I wanted it to. No matter how I adjusted it, the blocked calls would still ring through briefly before getting blocked - long enough to wake me up. I e-mailed the developers and didn't hear back from them. It might work on a different model of phone than I have (HTC Hero) but I can't recommend it myself. Also, it had a lot of other features I didn't really need, just to get at the one thing I did need.

I haven't tried Semisilent since I just discovered it while doing research for this post, but it looks promising! Does anyone have experience with it?

Swype

OK, this isn't really a doula-specific app. Um, I'm listing it because it makes it faster to write e-mails to your clients? I'm just putting it in here because I love it so much. Seriously, it is the best typing/keyboard app I have tried, and I have tried multiple. Instead of tap-tap-tapping out each word, you just slide your finger from letter to letter and Swype magically guesses the word that you want (occasionally you have to correct it, but not often). I probably type 3-4x faster with this method than I ever did thumb-typing. You can't find it in the Market - you have to go to the Swype website. The trouble is worth it!

Other apps doulas have found useful? Feel free to list iPhone apps...maybe I can be tempted to switch!!

What every doula should know about breastfeeding: Tip #2: When to refer, how to refer

Preface: Often as a doula, before I became an LC, I would encounter situations in the hours after the baby was born, or at postpartum visits, where I wasn't quite sure what to suggest; or looking back, I realize I could have done something differently. I've decided to share some tips with other doulas about things that I wish I had known long ago! Today is Tip #2: Referring to advanced support.

Knowing when to refer and how to refer mothers to advanced breastfeeding support is a vital part of a doula's role in supporting breastfeeding.

WHY to refer:

As doulas, we spend hours, sometimes days with our clients through one of the most intense experiences of their lives. You often end up very bonded and very invested, and when breastfeeding issues arise you're ready to jump in and do everything to make it work.

Resist the temptation to solve everything for your client!

On doula listservs I sometimes see questions like, "My client's baby's weight is down 12% and she's having to supplement with formula. What can I do to help her?" or "My client's baby just won't latch, should I suggest she do a lot of skin-to-skin?" You can give so much to a client in this situation: compassion, practical support, a listening ear at 2 a.m.; but the most important thing you can give her is a referral to a lactation consultant and the encouragement to call ASAP. She has a problem that needs quick professional help; it will probably not be helpful to her for you to come back in a couple days with tips from people who have never met her.

A 3-5 day CLC/CLE/CBE etc. course is wonderful (as is years of experience breastfeeding your own babies, helping friends, etc.) but KNOW YOUR SCOPE and be careful about venturing slowly into deeper and deeper waters where suddenly you discover you're in way over your head. It is so easy to get drawn into helping beyond your expertise. I speak from experience! I have written about how the more I learn, the more I realized I didn't know. I say this knowing that I, myself, would sometimes get in over my head when helping clients in AmeriCorps; our supervisor was a midwife who could help out when we were stuck, but she wasn't always available and I was trying to fix things knowing the patients might not be able to come back for a follow-up visit. I honestly cringe at some of the advice I used to give! It wasn't terrible or harmful, but it was probably really unhelpful.

In general, think of yourself as a "breastfeeding emergency first responder". You should provide the same services as any emergency first responder - do what you can at the moment to help the patient, offer them comfort and support, and then get them to advanced care. So absolutely suggest that the mom whose baby isn't latching do lots of skin-to-skin - and then help her find an LC who can assess why this is happening and how to fix it.

In the meantime, support the mother and remember the rules:
Rule 1) FEED THE BABY (in whatever way is necessary; sometimes bottles and formula ARE necessary);
Rule 2) Protect the milk supply (through pumping and/or hand expression if the baby is not feeding effectively at the breast).


WHEN to refer:

Not sure if your client is having just some normal latch pain and things are going to get better? Not sure if the weight is a real concern or just a temporary dip?

Here's a (partial) list of situations in which your client should DEFINITELY be referred to an LC (do not pass Go, do not collect $200):

• Painful nipples throughout the feeding...
• ....especially with any signs of nipple trauma (cracking, bleeding, blisters)
• ....especially if the mother tells you she "dreads" feedings, that she cries from pain during the feeding, that she puts off feedings or limits their length because of pain, or that she is exclusively pumping because of latch pain
  
• Excessive weight loss or poor weight gain in the baby, or any concern for weight that leads the baby's doctor to recommend supplementation
• A mother who was sent home from the hospital supplementing the baby (via any method, not just bottles) without clear further instructions about when/how to stop supplementing
  
• A baby who refuses to latch or does not latch consistently; the mother may describe feedings as "battles" or "fights" that drag out, sometimes for over an hour

(Does anyone have additions or modifications for this list?)


HOW to refer:

To refer your clients, you need to know about the lay of the land in your community. Who are the lactation consultants? Where are they based - pediatric offices, hospitals, private practice? Does the mother have to go to them, or do they do home visits? What do they charge and how do they bill the mother's insurance? (For example, at our hospitals outpatients' insurance is billed for a nurse visit and the mother has a small co-pay; a private practice LC will generally be paid up front and the mother must apply for reimbursement.) For lower-income mothers, is there a WIC breastfeeding support program that has an IBCLC?

As you're getting to know the lactation support resources in your community, please read Best for Babes' Is Your Lactation Specialist an Imposter? Not all lactation "helpers" are lactation consultants; and sad to say, not all lactation consultants are supporting moms the way they should. This is true of every profession; hopefully, you would not refer your doula clients to a midwife just because she had "CNM" or "CPM" after her name, assuming she provided optimal midwifery care, because not all midwives practice in ways that are consistent with a compassionate, evidence-based midwifery model of care. You would want to talk with other doulas, mothers, and providers - or work with the midwife directly - to know that she provided the kind of care you were comfortable recommending. I have worked with midwives I would refer my clients to, and midwives I would warn them away from; the same goes for LCs. You help your clients by finding trusted people you can refer to.

Ask local La Leche League leaders, mothers, doulas, midwives, doctors, and other community resources who they trust and recommend. Listen for specifics of how they deal with different issues, and whether the mothers who use them found them to be sympathetic and helpful. And, while this is a little delicate, keep your ear to the ground for the people who are not recommended or who you hear about giving questionable advice. Of course, even the best provider will have some dissatisfied patients (again, you may have an absolute favorite midwife and meet someone who had a bad experience with her - maybe it just wasn't a good personality fit, or a bad day.) But when you hear the same poor feedback over and over about somebody, it could be a sign to have your ears perked if your client mentions working with that person. (And if you know a hospital doesn't have LCs on staff, and the mother says "But the lactation consultant in the hospital said her latch was perfect!"...be skeptical.)

If you develop a relationship with an LC, or a few LCs, that you consistently refer to, you may also develop a referral system. Many LCs will welcome a phone message or e-mail from a doula or other professional working with the mother, who can offer an outside perspective on what has been happening and why the mother is being referred. Talk to the LCs you work with about whether this would be helpful.

Even when you've helped your client find a great LC, your client may be hesitant to pay for a lactation consultant - especially since with a private practice LC they will need to pay up front. Help her think through the cost of formula, or even of exclusive pumping (which some women seem to regard as a quick solution for any breastfeeding problem, without understanding that it brings its own distinct challenges.) Talk to her about how she saw the value in hiring a trained labor support person; hopefully she will see the same value in finding professional breastfeeding support.

A lot of women seem to feel guilt or frustration for needing to turn to someone for help at what is supposed to be "natural" (I say "it might be natural, but it doesn't always come naturally!") You can discuss some women's need for lactation support with your client at prenatal visits, so your clients who need LCs know in advance that they're not "failing" or somehow strange for needing an LC. You can include information about LCs you recommend in your prenatal information packets.

If you can, follow up with the mother about the LC visit, how it went, and how things are progressing; or encourage her to call you if things are still not going well. If the mother did not feel helped by the first LC she sees, offer to help her find someone else, especially if you are not sure about that LC's qualifications. And of course, support and empower her in whatever challenges she is facing, and listen to and validate her concerns.

Note for community-based and/or volunteer doulas:
If you are working with low-income women, they may be in a very difficult situation. We confronted this issue a lot when I was working in AmeriCorps. Ask around for low-cost resources like WIC, LCs who are willing to do pro bono work (especially if it is referred by a doula who knows the mother's financial situation), LCs working at hospital-based clinics that may take Medicaid, and free mother-to-mother support groups that the mother would be comfortable attending (keep in mind some women may feel out of place in settings like La Leche League meetings). Be proactive about helping the mother get in touch with these resources.

If you are the only help available to a mom, ask around for LCs/LLLLs/other resources who might be willing to talk you through problems or offer suggestions, and again be very careful about not overstepping your boundaries. While it's hard to see a situation go down the tubes, and you want to throw every idea you have at the problem to fix it, it is actually better for a mother to give up breastfeeding than for her or her baby to be harmed by poor advice... and it's hard to know what's poor advice if you're stepping outside your scope of practice.

---

I loved the feedback on the last post, and welcome comments on this one! More tips to come!

July link party!

So many starred posts in my Google Reader! So much to share!

Science and Sensibility interviews Dr. Michael Lu on preconception care. Oh, does this warm my MCH public health heart! This man has done such amazing research and I am so excited to see his work getting connected to the birth advocacy communities via S&S:

Allen Rosenfield probably 30 years ago asked the question, “Where is the ‘M’ in MCH?” Where’s the “mother” in maternal and child health programs–because much of MCH has focused on children’s health and much less on maternal health. I think the question we’re asking today is where’s the ‘W’ in MCH—where’s the woman in maternal and children’s health? If we really want to improve maternal and child health in this country, we really have to start by improving women’s health. [Emphasis mine because this is SO IMPORTANT!]

I think it’s pretty much in alignment with what you’re saying; it’s not just about childbirth. If the natural childbirth movement is all about natural childbirth, it doesn’t have the kind of impact that it could have. The focus should really be on promoting women’s health over their life course continuum and how we would be a better society for doing that.

And he talks about reproductive life plans! Be still, my beating heart! Part One is here, Part Two is here, and I am eagerly awaiting Part Three!


The Gates Foundation did a blog series on stillbirth to accompany the publication of the Lancet stillbirth series.


From the Academy of Breastfeeding Medicine blog, a report from the Third Annual Summit on Breastfeeding.


Yup, US maternity leave policy really sucks.


Birth Sense talks induction for premature rupture of membranes when the mother is GBS positive - is it necessary? How soon does it need to happen?


Educational website on tongue tie, including a PowerPoint presentation to help train other doctors perform clips. The best part is lots of photos - there is nothing like seeing photos of tongue ties to help learn which type you are looking at and what are the more subtle signs of a tie. Crossing my fingers that this website helps more practitioners learn about and be willing to clip ties that are interfering with breastfeeding. I found the site via the Kellymom FB page where there are many stories of mothers struggling to find someone who will clip. (A post on tongue ties is coming soon in my breastfeeding-tips-for-doulas series.)


NPR's the Baby Project blogs about doulas! Check out the comments for stories from grateful moms who used doulas!


Another hand expression video. This one uses a similar although slightly different technique to the Jane Morton/Stanford technique, with the fingers slightly closer to the areola. It also shows breasts where the milk is in and engorgement is past. If you want to listen to awesome Norwegian, click on the first video; otherwise, scroll down for the second video with narration in English.

Weekend at the movies: TED Talk on "Love, Breathe, Just Doula!"

Really enjoyed this humorous and engaging Doula/Birth 101 by Ginny Phang, a doula in Singapore.




The only thing I disagreed with her on was she was maybe implying that first-time mothers can get a 3-4 hour labor by preparing and educating themselves...I think that preparation and relaxation can certainly help shorten labor, but I wouldn't want a mom who had worked hard to prepare for birth expect a 3-4 hour labor or feel like she had done something "wrong" because a first labor took longer. But she also talks about not knowing how long labor will take, being prepared for anything, and writing a comprehensive birth plan with Plans B, C, and D. It was a fun and inspiring little video, and I think will help people understand what a doula does and why it's important. (Also, catch the gasps when she talks about planning to breastfeed for a month, then mentions how long she actually breastfed her son!)

Short but sweet on why dads/partners should love doulas

Trying to convince a reluctant family member of your need to have a doula? Try this quote on them, from an OB-GYN I know who had a doula at her first birth: "I can't say if having a doula shortened my labor, but it definitely lengthened my marriage!"

100% real life, as seen by doulas

Gina at the Feminist Breeder posted a most excellent angry rant about the Lifetime TV show L&D reality show, "One Born Every Minute". She had some issues with the way a couple planning an unmedicated birth was portrayed in the documentary, but this is what she had to say about the medical staff's attitude towards them:

And now thankfully the show is over, and I never have to see that nonsense again. Except that I do — in real life — every time I attend a birth at a hospital with a high rate of unnecessary interventions. As a doula, I can tell you that Lifetime’s “One Born Every Minute” is 100% REAL LIFE, and the things happening on that show are absolutely representative of what’s going on in EVERY labor and delivery unit where the staff and providers do not practice evidence-based medicine or the midwifery model of care.

YES. YES YES YES.

You can read the post for a blow-by-blow of each interaction these parents have with the nurse Gina terms "Nurse Dread". In a follow-up post, Gina has a clip of one of their interactions with said nurse - or more accurately, their doula's interactions with the nurse. If you are planning to give birth in a hospital setting you suspect or know will be hostile to an unmedicated, low-intervention labor, you need to watch this:



This is what doulas want you to understand: as Gina puts it, this is 100% REAL LIFE. The nurse's tone, attitude, demeanor, were so intensely familiar to me.

This is how it is. Bleeding from a thousand passive-aggressive cuts. "I'm trying to take care of ALL of you, especially your BABY, and I can't do my job! Haha, I'm laughing, YOU'RE RISKING YOUR BABY'S LIFE. Here's the monitors laid out nicely [those are the belts she's messing with], why don't you get back in the bed now." And I guarantee you she'll be back every 10 minutes with a variation of the same speech. "You know, when you're making such slow progress, we just get very worried about the baby. We want what's best for both of you, you know that. Right?? Mommy and baby, we care about you both so much! We just really need to be able to know what's going on in order to do that." And on. And on. And ON.

This is not because the nurses are evil horrible people bent on ruining birth. I bet this nurse is a wonderful person and takes excellent care of her patients. But she is made so profoundly uncomfortable by a labor that goes off her standard script that she cannot handle the situation respectfully or gracefully. She is constantly trying to nudge it back to what she's used to seeing, so she can get back on-script and go on with her life.

And this is why you need a doula. In this clip, the the parents aren't even seen; the doula's the one to deal with the aggro, then go in to communicate the situation to the parents (and probably discuss with them how to negotiate the next steps). Listen to how the doula is working to defuse the situation, acknowledging the nurse's concerns, reminding her the parents' priority is a healthy baby, and offering her some alternative ways to think about the situation ("people have different pathways"). The mother portrayed talks in an interview with Gina about how the doula was, in fact, the person handling most of the stressful interactions with the nurse:

[talking about her disappointment with the way the show handled things]:

I wish two things: 1. that they’d portrayed our doula in a better light. She was incredibly supportive, and had to field the majority of our conflict with Pam. AND, she did everything on zero sleep, since she came directly from another long birth, and 2. that they hadn’t insinuated that Eleanor was in trouble, and that we were putting her at risk. Every time we were on the monitor (which was 20 minutes of every hour), she was tolerating perfectly well, and even when we were pushing, her heartrate stayed up. There was never any danger.

From now on, whenever I'm trying to explain to someone why it's important to have a doula when you're planning an unmedicated and/or low-intervention birth, I'm going to point them to this show. You need someone between you and those negative attitudes to absorb as much as possible for you, and to keep the comments that do hit home from sapping you of your confidence and energy. Please, please, don't try to do it alone - find someone who can help protect you, and keep you feeling in control and confident, no matter how things go.

Reply turned post, on a 360-degree view of the doula's role

Birthday Nurse wrote a post recently on, in part, the role of the doula in the birthing room:

One thing I always seem to struggle with when I have patients who have doulas is when they ask their doulas for "permission" before they do anything. The patient was thinking about getting an epidural after 10+hrs of backlabor and no real cervical change. She had been talking about it and going back and forth and I asked her if she wanted me to start her fluid bolus prior to her block. She looked right at her doula and said "what do you think?" When her doctor wanted to start pitocin a few hours later after she was comfortable and still not changing her cervix...again she looked at her doula and said "what do you think?" (after waking her doula up from the nap she had been taking on the pull-out mattress) HELLO!! This is not your doula's labor! This is your labor, your baby, your body, your experience! You don't need your doula's permission!!! Doula's are great support people, they're awesome, don't get me wrong. But (most of them...and especially not the one in the previous scenario) they're not trained medical personnel...they're not your doctor or your nurse...don't ask their "permission"!

My reply turned into a post of its own, here in somewhat edited form:

I have a couple perspectives to share on the "permission" thing. Sometimes as a doula I get clients looking to me for "permission". I understand what they're doing, they hired me in part to be a sounding board and an independent voice, and they want to know what I think. Because it's not my role to give them medical advice, I generally try to turn it around and talk them through the situation and ask what more information THEY need to make a good decision. I wouldn't want a client asking me for actual permission if her doctor told her she needed a c-section. But if she turned to me and asked what I thought, and it meant I could help her talk through the facts that baby was showing no distress and that her progress was slow but was happening, that might be a good thing for her having what she needs to make an informed decision about whether or not she wanted to consent to the section. If you have the independence as a nurse to give her the space, time, and support to potentially question her doctor's recommendation, that's fabulous! But many nurses don't, or won't, and I feel that's where the doula's ability to be an independent sounding board comes in.

And sometimes I also recognize that as someone they shared their birth plan with, and trust, they just need emotional validation for the path they're about to choose. It would be nice if they could get that validation from the medical staff, but unfortunately many people who hire doulas are doing so because they do not completely trust the medical staff - and sadly, with good reason in some cases (this brings us back to the need for an independent sounding board.) They need someone who they know is totally on board with their birth plan to affirm that it's OK to deviate from it. So in those cases I can be the one to say "You seem so exhausted, I agree an epidural sounds like a great idea", or whatever it is they need to hear to feel good about their decision. A doula friend told me recently that she actually asks her clients, "Do you need me to give you permission to _______?" as in, do they just need some help to feel OK about their decision?

I have experienced this from the other side (albeit less often) doing lactation support where the mom looks to her doula when I recommend, for example, a nipple shield. "Do you think I should try it?" And I get this flash of irritation - "Your doula didn't train for this work and take the LC exam and work with hundreds of breastfeeding dyads, why are you asking HER?" - and then I go "aha, this is what the L&D staff must feel like when my doula client turns to me!" So in that moment I remind myself that I have just met this woman - why should she trust me? She trusts the person who she met and has been working with for weeks, and just went through many hours of labor with, and she is trying to make an informed decision that (gasp) may not be what I recommend. She is going to consider her options and make a decision instead of just agreeing with what I suggest, which is a strange feeling for me but a good one to get used to. I may not agree with her decision but she will be the one who lives with the consequences, not me, and I have to make room for the possibility that I am wrong and she is right. That this is so uncomfortable for me to do has been an excellent learning experience and given me a lot more sympathy for all sides!

Take action to support federal funding for community-based doula programs

From Health Connect One (formerly the Chicago Health Connection, which piloted some of the most prominent and impressive models for community-based doula programs!):

"Help ensure continued funding for community-based doulas!
Email your elected officials today

We have received confirmation from staff with Senator Richard J. Durbin and Congressman Jesse L. Jackson Jr. that both Senate and House Appropriation Committee FY11 U.S. DHHS reports include funding for the community-based doula program at its current level of $1.5 million. The Senate Appropriations Committee specific language is as follows: “$93,999,263 for the Special Projects of Regional and National Significance [SPRANS]. Within that total, the Committee recommendation includes sufficient funding to continue the set-asides for oral health, epilepsy, sickle cell, doula programs, and fetal alcohol syndrome at no less than last year's level.” In addition, although the House Appropriations Committee has not released its report, we know the House bill includes funding for doulas.

It is anticipated that after the November elections, a Conference Committee, made up of members of the House and Senate Appropriations Committees, will create a final bill. We need you to contact your Senators and Representatives and encourage them to keep the doula funding in the final bill."

Click here to easily contact all of your reps + the president - it takes all of 3 minutes to write an e-mail and send it along!

"Help! My husband/partner/family doesn't want a doula"

If I had a nickel for every time I heard a mom say, "I would love to have a doula, but my husband [or partner, or mom, or whoever is going to be the primary support person] is against it" - well, I would be a much richer doula! In these situations, unfortunately, their support person's opposition usually wins out over mom's desire for a doula - and more unfortunately, I sometimes hear mom saying later that she regrets letting herself be overruled.

Much of the resistance seems to be based in the idea that the doula will take over the family's role. I think they envision the doula hovering around mom - getting her everything she needs, rubbing her back, talking with her - while her family sits in the corner watching, excluded from being hands-on.

What I try to express to people who envision that is that this is almost NEVER the picture you truly see at a doula-assisted birth - instead, it's what I see happening when I first walk in the room! Mom is often lying in bed, and her family/friends are lined up on the couch watching her like a TV show, wanting to help but not sure what to do; or slightly better, standing next to her as she vocalizes through a contraction but not sure what to say or how to help.

My goal is to change that picture, but not in the way the family is envisioning. In fact, my ideal picture is for the people who love the laboring woman the most to be the ones who are massaging her lower back, who are whispering encouragement in her ear, who she leans on during a contraction; if there's anyone sitting on the couch watching, it's me!

To get to this picture, there are a few key things I do as a doula that I think are so important: first, I help the support people understand what's normal. They may be very anxious about noises mom is making, or the length of labor, or baby's heartrate. I can help them understand that things are going normally, which gives them the space and confidence to reassure the laboring woman and keep her going. It sounds simple, but I think it's absolutely one of the most important things I do. You can watch a dozen birth videos and still find the actual process and presence of labor intimidating; it takes a little while to get comfortable with its rhythms and sounds and, ahem, bodily fluids. Just having a calm, confident presence frees up so much energy that is otherwise in anxiety and helps everyone enjoy the birth experience without fear.

Second, I know the ins and outs of the labor room. I know where the volume control is on the fetal monitor (and that it's perfectly fine to turn it down), where to find the birth balls (and how to get mom onto one without disturbing the monitors and IVs if she can't get them disconnected), how long that fetal monitor really needs to run before she can take it off and start intermittent monitoring (and I'll happily be the one to push the call button and ask the nurse to come in and take mom off).

Third, I remind and reinforce what they may already know. For example, I find more and more that there's some point in labor where I sense that mom needs to get in the tub or shower. She's starting to get totally overwhelmed and I can see incipient panic in the eyes of her support team. Sure, they learned that water can be helpful in labor; it's probably on their birth plan. But in the moment, they just don't think of it. Often, mom is reluctant to try it (remember, she's totally overwhelmed and even walking one step seems impossible), but I encourage her, get the tub all set up, she decides to give it a shot, and... aaaah. She relaxes into the water and gets her second wind. The bathroom is tiny, so her partner kneels by the tub to coach her through contractions and I retreat into the L&D room to just listen in case they need anything. This is often when mom is going through transition and I love getting to facilitate those last intimate moments between the parents before she starts to push and they get ready to meet their baby.

Finally, while I'm happy to sit on the couch and hang out if that's all that's needed, I should add I don't need to be hands-on to be busy as a doula! I can be running down the hall for more ice or to heat up the rice pack or getting snacks for mom/support people; bringing fresh washcloths for mom's forehead; catching medical staff at the door so if they've just come to "check in" I can update them without them having to interrupt the laboring woman's space; searching out birth balls, rocking chairs, squat bars, etc.; plugging and unplugging portable IVs, fetal monitors, etc. if mom is moving around/headed to the bathroom; and on and on. Again, these are things that the other support people might be hesitant to do or not know their way around well enough to do confidently; I can take care of that stuff and free the family up for focusing on mom and baby.

In short, a doula does not and cannot replace a woman's own family and friends - and doesn't want to! She is there to make everyone's experience better. Once your support team understands this, they're usually much more open to having a doula at the birth.

You could also try this quote on them, from an OB-GYN who had a doula at her first birth: "I can't say if having a doula shortened my labor, but it definitely lengthened my marriage!"

Do you have family and/or friends who are planning to be at your birth, but are resistant to the idea of a doula? Here are a few things for them to read to get educated about a doula's role at a birth:

From DONA: http://www.dona.org/PDF/DadsandDoulas.pdf

From Penny Simkin, doula extraordinaire: Myths about Dads and Doulas

Written by a dad: 5 Reasons Dads Should Demand a Doula

Do Doulas Replace Dads? includes a nice chart on what kind of support each person in the birthing room provides, and where doulas do and don't overlap.

(I apologize for the heteronormativity of all these links! I have tried in this post to use language that's inclusive of different types of family structures. Hopefully regardless of what label your support people fall under, they can find this information helpful.)

In the end, remind yourself and your support people - this is YOUR birth. Just as you have the right to say that no, your mother-in-law and all your second cousins are NOT welcome in the delivery room - you have the right to say that you WOULD like a doula there. If this is truly important to you, your support people should respect that and work with you to find a doula they feel confident will empower them, and you, during the birth.

You buy the hospital ticket, you go for the hospital ride, Part 235624

The Feminist Breeder posted a link today to a friend's blog post about an OB and an L&D nurse discussing c-sections on Facebook. The OB said she was up late waiting for a baby to come out, the L&D nurse recommended "Ahhh just cut her, fuk it!" and when called out for this both the OB and the nurse defended each other, with the nurse loading on some extra distaste for "birth plans".

I actually don't think the OB's original comment was so out of line. I've (obliquely) sighed over a long induction on FB, and I have friends in many jobs (including medical ones) who vent a little bit at the end of a long shift or a tough task. It was really the nurse's response(s) that I thought deserved the ire that's being generated.

And as I was scrolling through all of said ire in the comments, I came across a great comment from Navelgazing Midwife that I wanted to repost here in part. She is responding to many of the people asking why the nurse was hating so much on birth plans.


Doctors and nurses HATE birth plans. Have for years. (There are a minute few who accept them.) The reason the nurse said it sets women up for failure is because the hospital system is not equipped to permit/allow/encourage women to have an autonomous labor and birth. The hospital assembly line moves one way - through as much technology as possible. Asking a nurse to attend to a woman "wandering the halls" (as I've heard said many times before) is unfair because she has other patients to take care of, too. If the patient wants intermittent monitoring, wants to get up periodically, wants to eat and drink in labor, wants to push out of the bed, wants to do without an IV... all of these things cramp the hospital and nurse's (and OB's) style, making their jobs much more difficult... AND, in their eyes, opens them up for some serious liability. *We* can say, "Tough caca. They need to do what we want because we're hiring them and it's my birth," but they can be quite persuasive and manipulative, threatening women in the middle of what should be a glorious experience.

I use the phrase, "You buy the hospital ticket, you go for the hospital ride" because if you want a homebirth in the hospital, you will be sorely disappointed (the "set-up for failure" the nurse speaks of). If you want a homebirth, have a homebirth. Otherwise, acknowledge the limitations, choreograph what you can and don't be surprised if your birth doesn't turn out like you envisioned.

The same can be said about doulas; hospitals, nurses and doctors generally despise them. They get in the way of the care provider's directions, they "make" women question the status quo and rock the boat of misogyny and anonymity in the hospital's birthing assembly line. Some dislike doulas so much, they refuse to work with a client who has one -and some hospitals have banned them altogether.

If a woman feels like she's going into battle in the hospital, I would *highly* encourage her to seek out other options (new doc, new hospital, etc.) if at all possible. I do understand that not everyone has that luxury, but many do. I hope they exercise their power of economics to hire someone who respects them.


I will add the caveat that I don't think that hospitals, nurses, and doctors "generally" despise doulas, birth plans, etc. because I have now worked at multiple hospitals and I would say that generally I have been well-received as a doula - the haters have been the exception, not the rule - and I haven't seen much open disdain for birth plans although I could imagine it's taking place behind the scenes.

But apart from that I will say a big YES YES YES to the rest of this. I know I've posted about it before but I just had to do it again, because I've heard a little too much lately about people's basic dignity being disrespected in the hospital and/or by care providers. Some of these people can change and do, some can and don't, some are stuck with their "hospital ticket" and the ride that it entails.

In short: it's hard to fight the tide of people, like the nurse in the post, who put quotes around the words "birth plans", coming at you in the hospital who are used to getting things done their way, who have gotten things done their way with the 15 other women they've worked with this week, and at all of the 2,500 other births they've worked at in their career. If you think you can buck the tide, ask yourself, who has more practice getting births done their way, you or them? And then prepare yourself thoroughly for resistance, because at best you won't need it and more likely, you will.

(My goodness, all my posts lately have been not very positive, have they? I blame the deadline for my master's paper putting me in a negative frame of mind.)

Link party!

First of all, Happy Olympics! I am so excited. I love the Olympics. My department had an Olympics party last night - come as your favorite athlete, sport, or country. We had everything from Brian Boitano to bobsledding to several people all in white ("Winter") and one Olympic torch. I was Sweden, which is a good Winter Olympics country to pick.

I've been trying to come up with some kind of play on words with the Olympics starting, Olympic rings, the rings are linked, links...I think I'm trying too hard. So let's just say that my Google Reader starred list is becoming too long to contemplate, and that it's time for a link party. I've been saving some of these up thinking "I'll write a post on this!" but the truth is, I might or might not eventually, and in the meantime why let the starred list get longer?

Academic review article on the risks of not breastfeeding for mothers and infants, and the role of obstetricians and hospitals in breastfeeding promotion. A very nice summary.

Via Empowering Birth blog, an informed consent roleplay. Has anyone ever used this with a class? It seems like a great idea to get people prepared to actually advocate for themselves - it's easy to talk about it beforehand, and harder to actually do in the moment.

And another link from Enjoy Birth about choosing hospitals wisely.

A dad talks about his thoughts on breastfeeding.

At Guerilla Mama Medicine, HUGELY important questions and thoughts about race and the natural childbirth movement.

An article from RH Reality Check about The Doula Project, which provides doulas for women who are having abortions and who are relinquishing their babies for adoption. I'm proud to say that I know one of the co-founders, Lauren Mitchell, who has an awesome quote in the piece: "You can't speak for your client, even if what's going on is the opposite of what she wanted - you're not in control of the room. But you are in control of what you are giving your client, and that is an informed ally and a deeply empathetic presence. When you're a doula you have to acknowledge how to be 'human' even when you want to be more than that. What keeps me going is the feedback from the clients that the space that I've created for them is unique and extremely important." If I end up back in NYC I would LOVE to volunteer with them!

From Birth Sense, thoughts about manual rotation of the fetal head. I have seen this happen once, and it was very effective - baby went from making very little progress with pushes, to crowning within minutes. But the midwife writing the article reminds us that it's also extremely important to move the mother!

I've also been enjoying Birth Sense's series, "Your Doctor or Midwife Still Does WHAT?" Here's a sample: #5, Cervical Exams. Reading expectant mothers' blogs I come across so many sighing with frustration that they're still not dilated at all, when is this baby going to come, etc. etc. Since there are very few actual medical reasons to do a cervical exam, it starts to seem like a highly effective method of psychological priming for induction.

Navelgazing Midwife did a great series of photo posts called "Teachable Moments" about placentas, vernix, trailing membranes, etc. Here's a great one on being born in the caul. I guess I should put in a disclaimer that these photos involve vaginas and birth fluids and stuff like that, although I have such a high tolerance at this point I have to remind myself that somebody else might need a warning.

That's all for now - off to watch me some Olympics!