Doula Life

Extremes

2008-03-07T12:43:00.000-08:00

Oh, the many ways I struggle to compose a thoughtful and coherent post. This is the reason I post so infrequently, if you wanted to know. My thoughts on birth, doula-hood, life, just seem so nebulous and contradictory at times that I could surely sit here for hours in the effort to explain even a small portion of these thoughts with any clarity.

This week has been particularly interesting in several ways.

On one afternoon I was driving my car, feeling the warm sun through the window, completely content with my role in birth and my experience of doula-hood over the years. Today I am frustrated, cranky, and frankly weepy over exactly the same things.

I have twice tried in the last two days, with likely imperfect results, to explain my philosophy of birth - once to potential clients who want a doula dedicated enough to unmedicated birth to enthusiastically invest in their birth plans (I am!), and once to a convince a new doula-to-be, who seemed initially to misunderstand me entirely, that I recognize the need for medical intervention when necessary (I do!). Over the years I have in one moment thoughtfully explained the merits and safety of homebirth with a midwife to folks who think the very idea is suicide or homicide or both, and then turned to defend both elective cesarean and unassisted homebirth to some of my fellow birth professionals.

I feel it is my very lack of judgment for others and their choices, my empathic tendency to emotionally walk in another's shoes, that has always been my greatest strength as a doula. This has been no small feat for me as I grew up in a very black and white world, theologically speaking, and found great comfort and superiority in the belief that I was right and other people were wrong. Having worked through the process of changing that belief system, I am now seemingly presented with people who want to make sure I'm judgmental enough (in either one direction or the complete opposite direction) to align with their world view. With so many areas of weakness as a doula (and believe me I have those), why is this one strength giving me so much grief at the moment? Today that question is totally bringing me down.

What I'll Do Next Summer

2007-10-12T14:09:00.000-07:00

I'm taking an Introduction to Midwifery Class with local Certified Professional Midwife Lynnette Chambers of North Colorado Midwifery. For the first class she wanted us to write a paragraph on our plans for our next 5 years in birth work. I didn't really cover 5 years, and I didn't get it to her in time for the first class (oops!), but here's what I did come up with.

What I'll Do Next Summer

So, it worked out well for me that I didn't get this written in time for our last meeting, because my thoughts on my future in birth have now coalesced slightly from “no clue whatsoever” to “the faintest vision of a clue”. I guess I shouldn't say I had no vision, just that my vision has mostly consisted of more of the same, only ideally with more clients and students. When I initially had my career crisis more than 5 years ago and decided I really wanted to work with women in birth, my first thought was to become a nurse-midwife. I didn't pursue that for a number of reasons at the time, and good thing, because being educated and providing care in a conventional medical setting is not the right thing for me at all. Being a doula offers me two very appealing things in terms of my role at birth. First, the Big Decisions regarding health and safety of mom and baby are not mine to concern myself with. Second, I am able to offer support with a clear conscience knowing that I am never torn between instinct and information, or between the care I give my client and the forces of the law, insurance or politics. (This is all going somewhere, I promise. I told you I was feeling philosophical about this whole thing.) So I am and will be pondering these things as they relate to my future in birth care, particularly as they relate to a possible future in midwifery. I may resolve these in my mind and at some point also be struck with a feeling that I must be a midwife, and if so I will move forward in that direction. If not I may keep doing more of the same, or change it a little, or change it a lot, or put the whole thing aside and have 26 children (okay, that last one is unlikely). I don't really know at this point, but admittedly the lack of some answers and a plan is making my brain itch a little. But I'm resisting my inclination to pursue additional education and credentials just because it seems like the next logical step (yes, yes, I know, the perpetual student). Whatever changes I make I would like them to come about because I feel I must do this, which is how I became a doula to begin with.

After all that about what I don't know, what I do know is that I would like to actively pursue gaining some experience in out-of-hospital birth. If my future is in that arena, I don't think I will ever know it without experiencing that environment directly. If the opportunity arises locally, that will be wonderful. Whether it does or does not, I have recently learned about some other opportunities, the possibilities of which are very exciting to me. The first opportunity is the internship program at the Northern New Mexico Midwifery Center in Taos. I've been obsessing on it a little over the last couple weeks and I think it would be very doable for my husband and I to go to Taos together for a month or so for me to do this. So at the moment I'm anticipating applying to participate in that program in the next year or so. The other opportunity, if the program restarts, is the Mexico Midwifery Program through the National College of Midwifery. It's two month classroom + clinical observation immersion program in Tepoztlan, Mexico. I just about died when I found out where the program is held because Matt and I spent our honeymoon there and I would go back in a second. It feels just meant to be except that the program is on indefinite hiatus due to health problems withing the program director's family. Anyway, either of these opportunities mean I should get crackin' on my Spanish, so that's in the plan as well.

Okay, there it is. You know, I wondered how some of the other people in the class had written a whole page on this, and here I am. I'm just wordy.

The Business of Being Born was great!

2007-10-06T13:57:00.000-07:00

Last night was our doula group "date" for seeing The Business of Being Born, and it was a great success on many levels. The movie itself is very well done in terms of editing and cinematography but also in terms of content. It touched on so many issues relating to the modern birth experience in the US, including:

safety of birth location
maternal and infant mortality rates
health insurance
malpractice insurance
training and belief systems of care providers
empowerment of women
cultural fear of birth
medical and midwifery models of care

It also did a great job of following the human stories of several women who chose non-conventional births and their reasons for doing so. I do hope that the film is going to be released to DVD because I would love to have it for loan to my clients and students.

It was also tremendously fun to watch the film in an audience primarily composed of doulas and others who work in the birth field. There was lots of clapping and laughing (the film was surprisingly funny as well) - hopefully we didn't completely overwhelm the other audience members, several of whom were pregnant. A post-show dinner of sushi (the Heart Attack roll at Jeju - you must try it, people!) was a perfect way to finish the night. And perhaps best of all my previous email was lucrative in that I was able to draw out some previous students and their babies (who are always so much older than my mind thinks they should be). I hope we can do something like it again in the future!

"The Business of Being Born" is here!

2007-10-03T14:25:00.001-07:00

An e-mail I sent to more than 50 women I know on October 2, 2007...

Hello all,

I am casting a wide net with this email today - friends, family, students and clients both past and present - because I am eager to tell you all about an exciting and important event taking place in our community this week. The Lyric Cinema Cafe in downtown Fort Collins will be showing "The Business of Being Born", a documentary examining the state of modern maternity care in the United States. From imdb.com:

"Birth: it's a miracle. A rite of passage. A natural part of life. But more than anything, birth is a business. Compelled to find answers after a disappointing birth experience with her first child, actress Ricki Lake recruits filmmaker Abby Epstein to explore the maternity care system in America. Focusing on New York City, the film reveals that there is much to distrust behind hospital doors and follows several couples who decide to give birth on their own terms. There is an unexpected turn when director Epstein not only discovers she is pregnant, but finds the life of her child on the line. Should most births should be viewed as a natural life process, or should every delivery be treated as a potential medical emergency? 'The Business of Being Born' is a must-see for moms, dads and anyone even thinking about having a baby."

I would be thrilled if each of you were able to take the time to attend this film, for yourselves or even only as a favor to me. The issues of belief, safety, and choice in healthcare for women and babies impact us all, whether we have had our children, may or may not have children in the future, or are in the midst of our childbearing years. The schedule of showings is below. I will be attending the 5 pm showing on Friday with a group of my fellow birthworkers. I would love to see you there, or if you would like some company for a different show time, please let me know and I will join you then as well!

Dana

***

The Lyric Cinema Cafe
300 E Mountain Ave, Fort Collins
www.lyriccinemacafe.com
Adult: $8
Student: $6.50
Matinee: $6

"The Business of Being Born"
84 minutes
Wednesday October 3, 2007; 3:00 pm; 7:15 pm
Thursday October 4, 2007; 5:00 pm; 9:15 pm
Friday October 5, 2007; 5:00 pm; 9:15 pm

New Growth Charts

2006-08-24T13:20:00.000-07:00

The World Health Organization (WHO) has issued new growth charts that use breastfed babies as the norm rather than formula-fed babies as was the case for the old charts. Because breastfed babies are leaner than formula-fed babies, for many years some breastfeeding mothers have doubted their ability to successfully breastfeed based on their babies' "insufficent growth" according to the old charts. Rather than rehash what others have written (professional journalists at that, no doubt doing the subject more justice than I could), I'll just pass along some good links.

Mothers Got Wrong Advice for 40 Years - out of Britain, but pertaining to the same charts
Read about the new charts - from WHO
Get the new charts - also from WHO

Playing Catch-up

2006-08-24T12:16:00.000-07:00

So it turns out that this blog is one of those ideas that I really, really love then tends to get overlooked for long periods of time. As a result I have quite the backlog of posts on the brain.

First I'd like to give a little review of my experience of this year's DONA International conference. This was all the way back in July (did I mention I'm behind?). The conference was in Denver this year, meaning a relatively short drive (yea!), but through the Tech Center (ugh!), and I was abloe to visit with many other Colorado doulas who I haven't seen in a long time. Here are the highlights:

* The first of my two favorite presentations was on the subject of baby-led latching, given by Christina Smillie, MD, FAAP, IBCLC, FABM. Dr. Smillie's presentation focused on the newborn baby's ability to find and latch onto the breast, requiring only skin-to-skin contact with mom and some physical support as the baby manuvers, on its own, into the ideal breastfeeding position. This is in stark contrast to the current approach, even practiced by most postpartum nurses and lactation consultants, in which the baby is put into a breastfeeding position and brought onto the breast, sometimes rather forcefully, by the caregiver. I absolutely must contact her to see if I can get files of the video she shared of babies self-latching and am most excited to incorporate these principles into my breastfeeding classes and doula work.

* My other favorite presentation came as a total surprise as it was on the subject of co-sleeping. I thought I was plenty current on the subject, with a good understanding of the "Rules of Safe Co-Sleeping". Certainly these guidelines do, in fact, exist and when taken into account, allow for very safe sleeping arrangements of babies in close contact with their mothers. The speaker was Dr. James McKenna, and in addition to his sarcasm-infused humor (my kind of guy), he did an amazing job defining exactly why babies are less prone to SIDS when sleeping in the same room as their mother and what we can take from the newest American Association of Pediatrics statement on co-sleeping. He also showed great video of how moms are very in-tune with and responsive to their babies while co-sleeping.

* I also had great fun helping staff a booth with Sheri Menelli. Sheri is a former hypnotherapist and Hypnobirthing& #0153; instructor, author of Journey Into Motherhood: Inspirational Stories of Natural Birth, and now birthing business expert. She has helped me hone my understanding of marketing and I look forward to great results as I continue to implement her ideas. (And her book is on my pregnancy "must-read" list - I loan it to all my doula clients.)

Midwives Day/Doula Month Picnic

2006-05-08T12:48:00.000-07:00

We all had such a wonderful time at the first annual Midwives Day/Doula Month picnic last Saturday. The weather finally cleared after an unusual pattern of rain lasting several days, leaving the ground moist but suitable for sitting. A little sun was all it took and I would guess around 50 people turned out to celebrate, including local doulas, midwives and client families. Can't wait to do it again next year!

Neonatal Resuscitation With Karen Strange

2006-04-25T21:29:00.000-07:00

Today I attended a fabulous training with Karen Strange, retired certified midwife. She's becoming quite renowned within the midwifery community for teaching neonatal resuscitation as it applies to homebirth. I have heard rave reviews from many local midwives and wondered what could be so fantastic about what I thought was basically a CPR class for neonates. Karen's class is so much more! I was rivited by the detailed description of the physiologic transition that takes place as a baby is born and takes its first breaths. Karen is so in tune with the experience of the baby during transition and how birth attendants can help babies process a traumatic birth or a resuscitation. I learned so much that will help me even when working "just" as a doula that I would absolutely recommend Karen to any birth worker, even those who are not required to certify in this area. Fantastic!

Those of us in Colorado are very lucky as Karen has just moved to the Boulder area. However, she also travels frequently to other states to teach this class and is always looking for people to sponsor one of her trainings. You can contact her directly for more information at: karenmidwife@yahoo.com.

Beyond "Healthy Mom, Healthy Baby"

2006-02-05T09:37:00.000-08:00

There is a sort of game doulas sometimes play with clients as they work to discover the client's plan for their birth. The doula prepares index cards listing various birthing preferences and outcomes and the clients select several from the stack that are most important to them. Always amongst their selections is a card that says, "Healthy mom, healthy baby". And if the clients are asked to give up their cards one by one, with discussion along the way of choices, circumstances, and alternatives, when there is only one card left, it will be that card.

This is a position I see frequently among doctors, doulas, and mothers alike - a healthy outcome is the only thing that matters, and anything that must be sacrificed along the way has been given up for a worthy cause, the only cause. But what about those who do it all "right", perhaps give up their birth dreams for the sake of the cause, only to have a sick baby or worse, or a sick mother or worse, what is left? Surely something must remain. There must be a goal beyond the external that can be achieved no matter the outcome. True partnership with our partners, reliance on faith, life without fear, or living each moment to its fullest are all choices that are available to us and will always remain.

A day late and a birth short

2006-01-17T17:56:00.000-08:00

For the first time ever as a doula, I missed a birth! To make a long story short, both the mother and I were lulled into believing she was not a far along as she was, and 20 minutes after I received a call to come because her water broke, their new baby girl was unexpectedly born at home into her father's hands.

While not technically my fault, as I had conferred with the mother frequently only to jointly decide that it would likely still be awhile, I feel terrible that I was not there for them when the baby arrived. I think all doulas look back on the births they attend and wonder what they may have done better or differently, and this is no exception. "I should have known she was getting close. If only I had left earlier. I should have... If only..."

My own frustration aside, I am just thrilled about their birth. I believe this was a wonderful healing experience for the mother after her difficult first birth, and the dad is rightfully proud of himself and has a great story to tell the guys at work. And of course their baby girl is their greatest reward.

The Birth Plan "Jinx"

2006-01-06T11:04:00.000-08:00

I participate as a online helper on the Hypnobabies yahoo group, and yesterday one of the members reported hearing the following as part of her hospital tour:

"...birth plans are jinxed here so think twice about bringing one."

Sadly, this a common perception among some hospital staff. In my opinion, the notion that "women who have birth plans don't get what they want" is a sort of half-truth that can be accounted for by several factors:

1. The majority of women who have birth plans want less- or non-interventive births. One only needs to look at hospital intervention rates to see that unplanned interventions are overwhelmingly the result of modern maternity care, not the presence or absence of a birth plan.

2. The beliefs of the nurses have a tremendous effect on the outcomes of births they attend, which can lead to a self-fulfilling prophecy of sorts if the nurse believes that "birth plans never work out". I think this belief also reflects the fact that hospitals are accustomed to seeing highly compliant patients who don't bring a list of requests with them upon admission.

3. In a small number of cases I do see women who's birth plans are a reflection of their tremendous need to control a birth environment that they perceive to be hostile. In this case, fear can indeed derail a birth and ideally she would choose another birth setting or care provider.

All of that said, all of my doula client prepare birth plans and the vast majority go on to have unmedicated births. In fact, after my first Hypnobabies birth, the postpartum nurse was wheeling my client to her new room and when she saw the chart said, "Most women who have a birth plan end up with a c-section." I kindly pointed out that my client got everything on her plan, just as she wanted. So don't be deterred from making your wishes known!

In the News

2005-11-27T12:23:00.000-08:00

Ah, some interesting material for my first "real" entry. Last week I was interviewed by Kevin Darst, a local newspaper reporter from the Fort Collins Coloradoan, regarding the recently released c-section statistics. Nationwide the c-section rate has risen to 29% and our local Poudre Valley Hospital is reporting a rate of 30%. Kevin was looking for local comments on this trend toward higher c-section rates and I was more than surprised to get a phone call asking for my input. At the time my cell phone rang I was running low on batteries and made arrangments to get in touch with Kevin later in the day. I'll admit that I considered declining the interview for fear of how my comments on such a controversial subject would be used in the paper. But I made a conscious decision not to be ruled by fear and called back to move forward with the interview. It was a great personal lesson on moving through fear in search of the reward on the other side, something I hope to support in others when I am their doula. And appropriately, it was my comments about the consequences of our cultural fear of birth that made the paper. And in the end I was mostly pleased with the content of the article and my comments therein. I had given Kevin some statistics that were not included but I believe they speak volumes about the state of birthing care in this country so I will include them here:

The World Health Organization states that c-section rates should not exceed 10-15%
The United States has a higher infant mortality rate than 41 other countries worldwide, including Taiwan and Cuba.

Getting Started

2005-11-18T17:44:00.000-08:00

After much thought (read: a spur of the moment decision), I'm getting started with a doula blog. This will be a great place for me to ponder all things birth and will hopefully give others a peek into the doula life.