Thursday, September 18, 2014

Keeping My Doula Mouth Shut

Recently I feel as if everyone around me is getting pregnant. It started a few years ago and was just a trickle on my facebook page. Now it is more and more frequent, back-to-back newborn photos on my newsfeed, and more immediate, with more people I actually know in person getting pregnant!

And it has become a problem.

Why would this be a problem for a doula and maternal and child health professional?

Well, it is not a problem if it is someone seeking me out for doula services! Then it is great. I can feel free to help them to my fullest extent - send them articles, answer questions, give them advice, etc. They came to me for information and wisdom, and I share it.

The issue occurs is when it is a friend or colleague.

It is very hard to talk to an acquaintance about their pregnancy. Do they want me to give them more information, knowing I'm a doula? Do they want me to keep my mouth shut, as they have not indicated any interest in hiring me? Should I discreetly post things on facebook and hope that they see it?

If I ask the questions I ask doula clients about their pregnancy and birth wishes, if I give advice that has not been solicited, will they pull away? Will they not want to be around me anymore? Will they actually choose something opposite of what I've recommended because I've turned them off? Is it more information than they want to hear (often the case, where most women put all their trust in their OB and rarely take childbirth education)?

It can be so hard to want to tell them how wonderful birth can be! But I know that pregnant women hear a lot of unsolicited advice, and I don't want to be part of the annoying crowd. I want them to know that I am here as an option if they feel comfortable approaching me. I never want to come across too strong (it is like dating)!

If I tell them that the hospital they are going to has the highest intervention and cesarean section rates in town, they will most likely feel judged and angry at me, rather than thinking they should switch providers. I struggle with this with my doula clients, as well.

Do I want my friends and acquaintances to hire me as their doula? Absolutely. I want all my friends to hire me as their doula. I want them to be with someone they feel comfortable talking with, and to receive the benefit of a doula. I would not even be bitter if a colleague hired another doula and not me (I know I'm not the exact perfect fit for every woman!), because I would be glad that they'd have a great source of support and information.

Even though I am approaching the 5th anniversary of my doula training, I still cannot say that I've figured this aspect of being a doula out.

I actually wrote about this 3 years ago in a post called Banned from Baby Showers (inspired by another blogger). In this post I wrote,
I find it difficult not to share everything I've learned with everyone I encounter! I want to shout it all from the rooftops!
But I try to follow the wise advice that I quoted:
I decided a couple of years ago that it was probably more important to have friends than to educate them about why they shouldn't believe everything their OB says.
So for now I wiggle and squirm internally, watching friends post on facebook that they are reaching their due date and "why isn't baby born yet?!" Or listen to people say that their baby is too big. And I can't send them the information that pregnancy is not postterm until 42 weeks (especially in first-time moms), and that suspected macrosomia is not a medical indication for induction. And I feel sad when an acquaintance is induced with a healthy first time pregnancy and ends up with a C-section for failure to progress, as can be expected.

The activist part of me wants to say to everyone that they need to know this, because it will affect every future pregnancy, but I don't want people to shut me out. So I continue to share everything on my Anthro Doula facebook page and my doula services page where those who want to see it, can.

I know some birth professionals who would not cover their mouths - they would still talk to everyone and anyone about what they think. The thing is, I've seen people recoil from them. I don't want to lose potential people to help. Sometimes people ask for help in their own time and we have to let them. Others are more independent. Research has shown that women do not think that there is an issue with modern maternity care. I might talk like there obviously is and turn someone I am trying to help away, thinking I'm crazy.

I won't keep quiet in my professional life. I will still continue to be a birth activist and work towards improved maternity care and better births for all women. But around friends, I have to let them live their lives as they will. Friends who I don't want to unfollow or avoid me will continue to not be hit with unsolicited information or advice. I am here if they need me.

Has anyone else figured this out in their lives? Do you have any advice for birth professionals who struggle with this issue? 

Wednesday, July 23, 2014

Choosing Your Pregnancy Care Provider and Birth Location

You're Pregnant? Congratulations! You're full of excitement and love, and your family is already planning your nursery and picking names and buying toys and clothes.

You know you need to see a health care provider. You think, "I guess I'll just go to my regular gynecologist."

WAIT! There's a lot more that goes into your pregnancy and birth care provider choice than what goes into your gynecologist choice. You have a lot of options when it comes to your pregnancy care that most women don't know about before they are pregnant.

Why is this important?

1. Because women remember how they were treated during their birth for the rest of their lives. Choose someone who will make you feel respected.
2. Because it will affect the amount of information you receive, what options you have during birth, and the degree to which you are involved in decisions about your care.

So, here is a guide to finding and picking a care provider and birth location.

Your Options: Hospital, Birth Center, or Home

Most of us assume that birth will be done in a hospital, and that's that. Truly, everyone feels safer in different environments. Find the best match for you:

Hospital: A great option for high risk care for you or your baby; No need to transfer to a different location if something goes wrong in labor; Medical pain relief and other medication is immediately available; Care is standardized ("cookie cutter") rather than individualized; Interventions are used routinely whether or not there is a clear medical need; Technology is relied on to make decisions rather than a woman's body or intuition; Staff are not always available to provide continuous emotional, informational, and physical support; Requires transfer from home to hospital during labor.

Free-standing Birth Center: Greater emphasis on individualized care; Rely on your body's physiology rather than technology; Staff are available to provide psycho-social support; Requires the need to transfer from home to the birth center while in labor; Requires transfer to the hospital in an emergency; Some birth centers do not have medications available for labor; Avoid routine interventions and rely on medical need.

Home Birth: Highly tailored to your individual needs and preferences; Completely avoids use of routine interventions during labor and delivery; Continuous psycho-social support is available; Does not require transfer from home to a different birth setting during labor; Does require transfer to hospital in the case of emergency.

Your Options: Obstetrician or Midwife

The typical American woman has an obstetrician as her care provider. It is the doctor that we are used to, and it is all we have seen on TV, in movies, and our relatives do. Obstetricians are the default option for women who want to give birth in a hospital.

A midwife, to the general populace, is what our great grandparents used for birth, or what they use in primitive tribes. The thought is that they are for people who don't have doctors. Or, maybe they're just for the hippie types who don't use health care.

In reality, a midwife is a great option for your pregnancy care provider. They are highly trained and licensed, come in all shapes, sizes, ages, and from all political backgrounds. You can be with a midwife for hospital birth, a birth center, or at home. I like to share more information on midwives because many people don't realize it is an option. There are a few types of midwives:

  • Certified Nurse Midwife (CNM): Trained in both nursing and midwifery, and work in hospitals, birth centers, or sometimes attend home births.
  • Certified Professional Midwife (CPM): Certified by the North American Registry of Midwives. Requires knowledge of out-of-hospital birth settings. 
  • Licensed Midwife (LM): A direct-entry midwife who is licensed in her state to attend out-of-hospital births.
The number of deliveries attended by midwives in the United States is growing. Numerous research studies show that midwives provide equal or sometimes better care to patients with low-risk pregnancies. To learn more about midwives, check out this great video series.

An obstetrician is a physician and trained as a surgeon. They are great for pregnancies that require a bit more medical care, and they generally supervise or "back" midwives in the hospital. Because midwives do not perform emergency surgical procedures, midwives always "risk out" a patient who may need additional care. An obstetrician is a medical doctor.

Differences in models of care
The medical model of care that a physician provides focuses more on a hierarchical system of care where the woman is a patient, birth is meant to be managed by experts because it is potentially pathological. Some obstetricians are great and spend personal time with patients, but many are authoritarian, depersonalized, and do not provide emotional support. The midwives' model of care respects birth as a normal part of a woman's life and involves her more in the relationship. Decision making is ideally shared, and information is shared during more in-depth prenatal visits. Some midwives are more medical model, and some obstetricians are more midwife model. It all depends, and that's why its a good idea to interview your provider.

Other care providers
You can also have a MFM (maternal fetal medicine specialist) as your care provider for high risk pregnancies, a family physician, or ARNP, but these are generally less common than OB or midwife.

Choosing a Care Provider

One way to start choosing a care provider is to see which providers your health insurance covers. Another is to pick based on where you want to give birth - home, birth center, or hospital. A great way is to ask around among birth professionals in your area, including doulas and childbirth educators, who know the local "birth scene."

If you've started reading books, blogs, or signed up for a childbirth education course, you'll learn what your options are for birth and decide what is important to you. Is it the freedom to move around during labor? To avoid medication during labor? To have a VBAC?

Once you make an appointment with a care provider, it is important to take a tour of where they deliver. Find out what the birth experience will be like. Does the hospital have a certain reputation (e.g. high c-section rates)? Interview moms who have worked with that particular home birth midwife. Call and ask what hospital or care provider statistics are on intervention rates that you might like to avoid (e.g. induction).

Questions about the Birth Location

  • Are there restrictions on who is allowed in the room?
  • Do they allow intermittent monitoring, birth balls, laboring in the bath tub, walking around during labor, etc?
  • Can I eat and drink during labor?
  • Are they supportive of doulas attending labors? (if your provider says no, it may be that they do not have your best interests in mind. Doulas are evidence-based!)
  • What are the hospitals c-section, induction, epidural rates?
  • Are mom and baby kept together after birth? Does the hospital support immediate skin-to-skin? 
  • How does the hospital support breastfeeding? 
  • What if I choose to decline a certain intervention for myself or my baby?
  • (If at birth center or at home): Under what scenarios am I risked out of your care?
  • Do I feel comfortable here?

Questions for the Care Provider:
When you have a chance to sit down with your care provider, here are some questions to ask to gauge whether they are a right fit for your desires:

  • What is your birth philosophy? How do you feel about natural birth?
  • What do you consider "full term" or "past due"?
  • How much time will be spent with me during each appointment?
  • What routine tests are there during pregnancy?
  • What are your intervention rates? (induction, artificial rupture of membranes, episiotomy, epidural, c-section, etc)
  • How do you feel about my hiring a doula?
  • Can I push and deliver in different positions, including hands and knees, squatting, side lying, etc?
  • Is there an on call rotation?
  • What if I want to refuse a procedure for myself or my baby? Are there any procedures that are non-negotiable?
  • How do you feel about my birth plan to avoid [continuous fetal monitoring, an episiotomy, pain medication, pitocin augmentation, etc].
  • Do I feel respected by this care provider, and like my wishes will be granted?
  • Are his/her practices consistent with evidence-based medicine?
  • How much responsibility do I want to take for my pregnancy and birth?

Switching Care Providers

After you've begun to receive prenatal care from a provider, you may notice that he or she is not as supportive of your wishes as you'd like them to be. Or, you've learned that the hospital they deliver at has the highest cesarean section rate in the region! Everyone deserves respect in health care. Ideally, you should have shared decision making and be able to ask them anything. They should respect your plan for your ideal birth. If you find you might like to switch, it is a great time to get feedback and advice on providers from others in your childbirth education course, or do some research and call up a new doctors office, birth center, or home birth midwife. You need to make sure that you "click" with the person providing your care during this very emotional time. 

I've heard switching stories lots of times. It seems difficult (you're already invested in your current provider, they have your health records, you think its too late to switch, you don't want to hurt their feelings, etc). but it is generally an easy thing to do.  If you are very near the end of your pregnancy, you may have to call a few people to find someone who is willing to take on a new client so late. Again, ask your local birth community on advice on how to ask to switch (they can help you say the "right things" to get you in)!

For more great information and resources from an excellent national resource, check out Choosing a Caregiver and Choosing A Place of Birth from Childbirth Connection.

Friday, May 23, 2014

What Pregnant Women Google Worldwide

I encountered a post on the New York Times of a Google word analysis of things people search about pregnancy in different parts of the world. I found this fascinating from a cultural perspective. In our globalized world, many of the (male or female) googlers inquiring about pregnancy are concerned with much of the same things.

For instance, the top five keywords searched, in several countries, for "How to ___ during pregnancy" brings up, as the NYT notes, issues of vanity and sex.

Pregnant women (and their family members) are seemingly preoccupied with how to not gain too much weight, not have too many stretch marks, and how to have sex. Even in non-"Western" countries (the ones represented here by the NYT, at least), pregnancy Googlers focus on the same issues. This reflects a desire for the mother to maintain normalcy while pregnant: The typical appearance of ones body (not as the large, stretch-marked person pregnancy often creates), a good amount of sleep, and their regular sex life. A few "stay healthy/fit" items are thrown in, as well, which brings the focus back to the baby.
Click to enlarge

When it comes to pregnancy worries, there a lot. No surprise there, with doctors, family members, and strangers alike telling us what we can and cannot do with our bodies while pregnant. But the number one question about what pregnant women can do has to do with... FOOD!

This could reflect 1. The high level of importance of food in our lives (on an hourly basis, in some cases, but at least daily); 2. A high level of rumor and confusion related to whether certain food items are "ok" while others aren't (stemming either from bioscience "rules" or from cultural taboos); 3. Lack of dialogue with care providers not providing enough information about what is safe/unsafe or what might have side effects.
Click to enlarge

Interestingly, though, are the ones that stand out -- Brazil's has nothing about food, but wonders at riding a bike, and Spain's women don't know if it is all right to sunbathe.

Important to keep in mind that it may not be the pregnant women themselves who are googling (could be the dads or grandparents-to-be)!

NYT interprets "Can pregnant women _Fly_?" as  flying in an airplane, but if that was really the Google search, I'm thinking:


Now that would be a neat superpower to obtain while pregnant! ;)

Tuesday, April 22, 2014

Happy Earth Day, Babies!

Today I am thinking of all the babies who will come into the world on Earth Day. I am thinking of all of the babies who will grow up in a world with less and less clean water and clean air every moment. I am thinking of all the garbage and waste that will one day take up more room than humans.

What mother or father wants their child to grow up in a world where there is no more clean soil to play in, clean water to bathe in, clean air to breathe, space to run around? We all imagine our children running and playing, healthy and happy. 

On this Earth Day, if you are conscious of your children's futures, and your children's children, take the time to conceptualize how much of an impact you have had on the Earth's health, and how much impact you can make to improve it.

Here are 4 easy ways to start today, on this Earth Day, to improve the planet for your children:

  1. Breastfeed, encourage your wife/sister/friend to breastfeed, and support breastfeeding in all its forms.
    • Breastfeeding reduces the amount of bottles and plastic and trash required to feed babies
  2. Cloth diaper
    • This is a growing trend that is going to seem a lot less weird to all of us down the line. Obviously, this is a lot less wasteful, as you wash the diapers and re-use them, rather than throwing each dirty diaper into a landfill.
  3. Recycle children's toys
    • Sure, we all love a brand new shiny toy, fresh from its packaging. But if you can stick to already-loved toys, you'll give that toy a longer life, save yourself money, and save the environment. Less packaging and plastic waste, fewer perfectly good toys not biodegrading in the landfill. Garage sales, freecycling, craigslist, or friends - Toys can be used for generations before they need to be thrown away! (and while we're on it, wooden toys!)
  4. Buy local
    • Not just for baby! Although going on is easy, purchasing local means less fuel is used to get the product to you. You can even get creative and make baby items yourself - clothing, wraps, nursery decor, etc! 

Friday, April 4, 2014

Doulas for Death

Have you ever thought about how birth, the beginning of life, and death, the end of life, are similar? I've philosophized about this a few times with friends and fellow doulas, and found that these important transitions have a lot in common. The need to have someone near, for emotional reassurance, information (what is going to happen? is this normal?), and a loving touch. 

This thought occurred to one of my blog readers, who contacted me with this e-mail:

Last night as I midwifed my cat through her dying hours I thought about how comforting the touch, soft voice, and warm breath would be for people who were dying and wondered if there was a niche for doulas for dying.  Of course it’s important to have loved ones with you when you are dying but sometimes those loved ones have all passed on or are too far away to be there during the dying hours.  And most of us know from seeing fathers and other family members at births that they often need as much doula care as the woman giving birth.  The same is likely to be true for dying – their presence is important, but they may not be able to provide the gentle caressing and soft voice that a trained doula can provide. 

My husband and I don’t have children and we often discuss our concerns that the second one to die won’t have someone with them for their dying hours.  I know I would feel better if I knew there were people trained to comfort the dying in a hands-on way who could be hired at the time of death to provide needed emotional care.  Certainly hospice provides wonderful and necessary comfort to the dying, but I’m talking here about someone who works along side a hospice team and who serves at the end of life the same function as a doula at the beginning of life.   It would be someone who was paid for his or her services, just like a birth doula usually is.  Maybe it seems a heresy to suggest that birth and death could both be supported by a doula, but don’t we need as much love and help at the end of life as we do at the beginning?

Though not too common, there do exist "End-of-Life Doulas" or "Death Doulas," if you will. Actually, googling will turn up a couple of programs that include doulas in their care for the dying.

It seems the role of the doula can have an impact in many areas of life. More and more popular these days are doulas for the full spectrum of birth experiences, for example, stillbirth or abortion. 

What do you think about the concept of "doulas for dying"Have you encountered an End-of-Life Doula before? 

Wednesday, March 19, 2014

Back As a Mrs.

Hello, blog! I'm back!

I apologize for my long absence; I was unprepared for how much your life gets sucked up by wedding planning. But, now I am back, and happily ever after married to the cute boy who encouraged me to become a doula. How could I not marry the man who drew me an adorable doula comic?

There have been some interesting occurrences as we've planned, wedded, and been married that have chafed my feminist sensibilities.

When I made the reservation at the hotel we'd be staying at the night of our wedding, the hotel automatically put it in my husband's name. This really irked me because 1. I made the reservation, 2. I was paying for it with my credit card, and 3. I was the one checking in before the wedding (without him). Why would you change it to the man's name? So you could say that it was the "husband's-last-name" newlyweds? Well, that is presumptuous for multiple reasons. What if I'm not changing my name? The whole thing rubbed me the wrong way, and I asked them to change it. Unfortunately, it had not been changed the day that I checked in, and I gave the concierge a piece of my mind.

Anyone who refers to us as "Mr. and Mrs. Husband's First and Last Name." I. will. kill. you.
I am a separate person and I am not his property! Just go ahead and erase my entire individual existence, why don't you!?

The fact that because I have chosen to have one family surname that matches my husband's (and future children), that I have to change my name with social security, the bank, my passport, the DMV, human resources, my work colleagues, my health insurance... the list goes on. I come home and fill out and fax tons of paperwork, and my husband doesn't have to worry about it at all. The only easy part of this is that these institutions are so used to it, that it is a piece of cake. If my husband had decided to change his name with me to a new name (which we were contemplating), he would have had a very hard time doing so, since it is not the "norm."

We went to the bank to open a joint checking account to officially begin our shared fiscal future. When the bank associate was telling us the details of our account, she told us that my husband was the primary account holder and I was secondary, "because he's the husband" and she smiled. He and I looked at each other and said to her, completely seriously, "That's unacceptable. Is that really the reason?" She thought it was all fun and told us, "Ok, how about it is because his last name starts with a B which comes earlier in the alphabet?" We didn't want to make a big deal out of it, since it sounded like it really didn't matter whose name was first, but it irked us that that was the default. After we left my husband actually offered to go back and change it to me, but I told him I really didn't think it meant anything in terms of the account's operations.

The fact that when we file taxes, we have to file "married but withhold at single," because the IRS still considers the married/joint tax brackets to be only one person working, or one person making significantly more money than their spouse. Because this is not the case, if we file as married, we would suffer from being taxed at a higher rate than if we file single, AKA the marriage penalty. I actually just read a story this morning about how the IRS Supports the Gender Pay Gap.

I'll probably come up with more as time goes on, but that's just what I've encountered in the past 2 weeks!

What non-feminist societal occurrences irked you when you got married? What else have you experienced that I haven't, yet?

I am grateful for my feminist husband, and super excited to call him my husband after 8 years together. Thanks for reading!

- Mrs. Anthro Doula
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