We Make Plans and Babies Don't Follow Them

That moment when you're headed to your first doula prenatal visit with a first time mom who is 35 weeks, and she calls you and says "So, it has been an interesting day... My water broke and I'm being admitted. Do you want to make your way to the hospital instead of my house?"

....WHAT!?

Luckily, despite our not having spent much time together, this mama was very calm and collected. And funny. I explained that she should do nipple stimulation to get contractions going (and avoid pitocin), I said "I know it feels weird to get sexy right now, but as they say, sometimes 'what gets baby in gets baby out'!" And she replied, "Maybe we shouldn't have had sex this morning!" And we both laughed.

Did you know BabyCentre UK has a bunch of safe sex positions for pregnancy images? Now I do!

I was nervous about a preterm baby, and any changes this might cause to the labor management plan, but everything turned out great. We did end up with pitocin to start contractions but mom labored with no pain meds and pushed her baby out in 6 quick hours.

It was one of those labors where I left work, doula-ed all night, and then returned to work in the morning, with no one realizing that while they slept and went about their routine, I was having an extraordinary night!



You learn something new every birth:

• The doctor told the mom that she couldn't start with cervidil instead of pitocin because her membranes had ruptured. 
• The nurse said the mom could use nitrous oxide during pushing if she wanted it (which she didn't). I've never seen it used during pushing. I feel like that would be hard to do both!
• I've never heard a nurse so insistent on the use of drugs for stitch repair on a non-epidural mom. She said mom could use the nitrous during stitch repair, but she couldn't hold her baby. Mom declined. She then told her she could give her stadol in her IV, and didn't even tell her the pros and cons. I said "that will make her loopy, right?" the nurse finally said, "yes." Mom agreed and regretted her decision when she felt totally out of it and couldn't do anything about it for an hour. 

I Am Not the Doula For Everyone

At the beginning of our doula-in-training journeys, I think we all want to be the world's doula. We say yes to every potential client who comes our way -

"Yes! I WILL be your doula!"

- No matter who she is. We want those experiences so badly! And we know or recognize everything that we will come to know and recognize.

I am grateful when I interview with someone who asks me numerous questions that are only going to lead her to be disappointed in what I say, and she does not hire me.

I am grateful when I interview with someone who says they want an intervention-free birth and a doula because their friends did it or they saw it on TV, but don't really know what a doula is and just do everything their doctor says, doesn't hire me.

I would be grateful to not be hired by the woman who wants a cesarean section for convenience (though, thankfully, I've never encountered this), or a woman who has no interest in breastfeeding, or something else I believe in.

I am getting better at recognizing a doula client who will not be a good match for me. Luckily, I've had to say "I don't think I'm the right doula for you," only once. Sometimes I say I am unavailable (often true) and refer her to other doulas. Sometimes the client simply hires someone else (I assume)...

When a woman who I would like to hire me doesn't hire me for any number of reasons -

• I'm too young and don't remind her of her mother 
• I have not birthed a child of my own
• Because I don't do aromatherapy/TENS/etc. 

She is grateful that she has not hired a doula that is not right for her. 

And I recognize that it is OK, because I do not want to be hired by a client that is not right for me, and am grateful. It comes from both sides...

I am not the doula for everyone.

Doula Re-Certification

This month marks 5 years since my DONA International doula training workshop, where I began my doula journey. Just a couple of months ago I renewed my CD(DONA) certification!

There are many doulas who choose not to re-certify, or to certify in the first place, for that matter. Certification is the effort to professionalize and legitimize the doula profession, to have it be recognized by health care providers and consumers as a trained role backed by a regulating body and a code of ethics.

There are some who say that doula work does not need to be professionalized or legitimized. Many doulas say they have no issues finding clients or doing their work as non-certified doulas, so it is not worth the cumbersome paperwork and cost of staying affiliated with the organization. I completely understand this perspective.

Others say that DONA's code of ethics and scope of practice are too narrow - they do not allow you to speak for the client, do not allow you to contradict the medical advice given by the provider, do not allow you to say that you are providing aromatherapy/other therapeutic techniques as a doula (you can do so as a trained aromatherapy practitioner, though). I personally think it is right that there be some boundaries that you do not cross in the role of a doula. The doula training is not medical training (if you have medical training, that's a different situation) and it does not make a professional with essential oils. I strongly believe that in order for doulas to remain allowed to come into the delivery room, we do have to play nice with the doctors and nurses (its common courtesy, anyway - just be friendly not combative)! Also, we shouldn't ever presume to put words in someone's mouth, especially someone who is about to become a mother (one who we hope will be a strong and confident mother, which often starts with birth).

DONA is ensuring that no doula ever oversteps her bounds, for the safety of the woman and her family.

I respect any doulas choice for certifying or not certifying. I will not judge you for doing so or not, as I hope whether or not you spend the time and money for the credentials that you still follow a scope of practice and a code of ethics that only helps women and other doulas, and does not hurt them. Doulas need to make sure that we build a positive reputation and never make any bad press for one another.

I chose to re-certify, and it really was not too rigorous. I started very soon after I became certified initially - I brought some papers to clients for them to sign to prove that I was at their birth, or had them fill out evaluations on me. I took my CLC training, and that knocked all of my continuing education credits out in one fell swoop. As my re-certification date neared, I did realize that I was missing a signature from one more mom, and asked a recent client to sign a form for me. Piece of cake! Submission wasn't too hard, and a couple of months later I received my new certificate.

I have clients ask me if myself and my back-up doulas are certified. I've had clients say they don't want a back-up doula that isn't yet certified. I've had clients specifically ask me about DONA.  Being certified proves that you are trained (not just calling yourself a doula), and therefore can associate yourself with all of the research-proven benefits of having a doula!

I am thankful for DONA International because the organization has:

1. Legitimized the profession of the doula, leading many childbirth educators to refer parents to DONA's website to find a doula, and hospitals to allow doulas in the labor room,
2. Worked hard to get doulas the ability to have an NPI number so we can help clients submit for insurance reimbursement,
3. Spoken and written (Penny Simkin and colleagues) on numerous topics that are now growing in evidence-base and popularity for the good of the mother and baby (e.g. the positive impact of the doula on labor experiences, delayed cord clamping, etc), 
4. Celebrated doulas and provides resources for both parents and doulas all over the world.

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? 

3 Years In: Reflections on Birth and Being a Doula

There are many instances in which a blogger says exactly what I've been feeling in a way so perfect that I could never have said it so well.

Recently, Gina (aka The Feminist Breeder) wrote a post reflecting on being a doula after 20 births. I'm almost to that number myself, but I haven't taken the time to actively reflect on how my outlook has changed. But reading her post, as well as Kristen's (Birthing Beautiful Ideas) recent post "I Don't Think You Should," makes me think of how being a doula has made me feel over the past 3 years.

Gina writes that she purposely doesn't mix her doula work with her blog. I feel the same way - I don't tell my clients that I have this blog and I don't use this blog to find clients. Some people have said I should - "but you have great information on there for your clients!" or "a blog helps people find you and want to hire you!" But I have always enjoyed having this as a place where I can say what I think and feel without worrying about past or potential clients wondering if it is about them, if my opinions might change what they think of me, or thinking that I'm going to bring all of my extreme activism into my relationship with them. As Gina puts it: "I do not bring my unfiltered self into the births; I bring only my experience, my knowledge, and a big heaping helping of empathy"

What a woman and her partner need during birth is freedom of choice and lack of judgement. The number one thing that a birth partner must learn (and perhaps say over and over to herself in her head) is "it is her birth, not mine."

A lot of my opinions about birth have changed over the few years that I have been attending births in hospitals, birth centers, and at home. In 2010 I wrote a post reflecting on how my mindset about epidurals had changed, based on a post written by Rebecca (Public Health Doula) on the Stages of Birth Thinking. Click over to read the entire post, but here it is in a shortened version:

There is Pre-contemplation:

This generally means that birth education comes from mass media portrayals of pregnancy and birth, as well as personal stories from friends and family that may vary greatly, but are usually filtered through the prism of our culture's main messages about birth: Painful and pathological; done in a hospital, with doctors. You might prefer a vaginal delivery or a c-section, but there's little you can do to control the outcome, and all hospitals/doctors practice more or less the same way,

then Initial learning and Revelation:

 "Wow! Nobody ever told me that birth could be amazing, not scary! These home births are beautiful. I didn't realize that my/my friend's/my aunt's c-section could have been prevented. I didn't know about all these harmful complications of interventions - I've only heard good things. And it's so clear how once you start one intervention, you get a cascade of them. Doctors don't have the best outcomes - midwives do! Breastfeeding has benefits I didn't know about, and they are so important."

then Validation (or not) through Experience:

A year of attending births nudged me yet farther away from my starry-eyed novice doula perspective. Not all c-sections can be avoided, even if you do everything "right". Sometimes epidurals are the best tool you have. Pitocin isn't fun, but it's not the end of the world. While it might be difficult to accomplish, you actually can have a great low-intervention birth in a hospital. This tempering is slow, and less personal - it's not happening to you, and it's happening over a multitude of experiences.

and finally Integration: 

You recognize that every situation is individual, even though there are patterns and large-scale effects that are likely, because you have a chance to see many [births].

I think this is exactly it - every situation is individual. Gina writes that 20 births later, she no longer feels the same way about a certain provider over another, free (unassisted) birth, cervical checks, and inductions.

She has found that there are no 100% guarantees when it comes to providers - not all doulas are perfectly supportive of all mothers, not all obstetricians are the devil (some are great!), not all midwives follow the Midwive's Model of Care (some do not practice patient-centered/evidence-based medicine). I would agree with this. I have heard wonderful stories of OB's who are amazing, nurses who go to lengths for their patients, and even seen some myself. I have also seen some terrible midwives (I've had some say my client isn't following the correct dilation curve, gah!). I still get excited when a client has a midwife as opposed to a physician, because on the whole I think they are still more likely to follow the Midwive's Model of Care, but every situation is individual. And you're more likely to receive excellent supportive care from a doula rather than not. But as TFB writes, "there’s no more “All” or “Always” to me anymore. What matters is a provider’s own philosophy, and the letters behind their name may not tell you what that is."

On the topic of UC (unassisted childbirth), I have to agree with Gina. I've spoken to doulas around whom I know I have to keep my mouth shut on this topic. There are some very strong supporters of UC in the natural birth community. But I have enough reasons as to why I would not birth unassisted, and also why a knowledgeable care taker should be present, to argue against it. This is just my personal opinion, but I have seen and heard about situations where a trained care provider was absolutely essential. I still think it is perfectly safe to birth at home, I just think that a midwife trained to respond to postpartum hemorrhage or use her emergency oxygen supply is more likely to save my life or the life of my baby than my partner.  I know why people do it, and I know that most of the time births are normal and low-risk. But when I'm in labor land I don't want to have to be responsible for being mentally and emotionally level-headed (which I probably couldn't be, especially if I passed out). And I don't think doulas should attend UC's either. (For more on the topic of doulas at UCs, click over to this post on Navelgazing Midwife's blog)

One point that I wholeheartedly agree with is that cervical checks in labor are almost useless! I've blogged about this before, but I will reiterate: A cervical check will not tell you how long your labor is going to be. That baby is going to come no matter how much you are dilated at a certain time. It does have several side effects: 1. disappointment and discouragement in the laboring mother, which can stall labor 2. disappointment by the medical staff, who then want to medically intervene to speed up labor in potentially unsafe ways, 3. higher risk of infection if the amniotic sac has ruptured.

There are some pros: 1. If the mother feels it will help her to know. For example, if checking before receiving an epidural can tell us whether mother can or should wait to receive one (it can stall labor before 5 cm, or if mom is about to be complete!) and 2. If the labor pattern indicates very advanced active labor but mom isn't dilated past 3 cm. This can be an indication of a problem to be worked out, for example, massaging cervical scar tissue to help the cervix dilate, or a baby being held up off the cervix by a cord and may need emergency intervention. For when you would like to know "how far along" you are, you may not even need a cervical exam - there are ways of assessing labor progress without an internal exam.

Gina makes a point in her blog post about sometimes inductions being necessary. My thoughts on this are: there are instances where some medical interventions are necessary, but they should be evidence-based and right for the patient. An induction because the mother and baby are medically at risk of eclampsia or because the mother is well past her 42 week mark are some. A truly emergency cesarean section is another.

I'd like to add one more reflective point of my own: VBAC and repeat cesarean section (RCS).
Though I believe that VBACs have been proven by scientific research to be a safe option for women, I do think that a woman has the right to make the personal decision whether to attempt a trial of labor or have a RCS. Maternity care needs to be both evidence-based and patient-centered. I fully respect a woman who weights the pros and cons of both options and makes the choice that is right for her. There are different risks for the moms and for the babies, and it is important to take into account past experiences, varying needs, and  emotions.

I agree with the way Kristen puts it:
I think you should give birth in a setting where you feel respected by your care providers.
I think you should be given every chance to have the safest, healthiest mode of birth for you and your baby.
I think you should have access to accurate and transparent information about your birth options, and that no one should use scare tactics to dissuade you from your choices.

But I also think that the way to achieve these goals is to go about things a certain way. So I do think that you should educate yourself as much as possible (take a childbirth education class, read books) and shop around for the best care provider and birth location (consider a midwife and a doula). But this is because I want you to have the very best birth, your ideal birth, and for you to not have any regrets.

I think the key to improving maternity care is not about everyone birthing the same way, but lies in removing any obstacles that impede women from having their best possible birth.

How have your views about birth changed over time, if at all? Do you agree or disagree with any of my outlook? 

You Learn Something New Every Birth

artwork (c) Amy Haderer mandalajourney.com

I'll admit, I don't usually back my doula bag until my client's are 40 weeks. I know this isn't perfect doula practice, but there are two reasons: 1. My bag stays almost entirely packed with my doula tools all the time anyway (I just have to add things like toiletries, snacks, medications, phone charger, sweater, etc), and 2. My clients never seem to go into labor before 40 weeks.

This is another reason that I find the whole "40 weeks is your due date and then after that you're late" thought-process to be completely flawed. Nearly all my clients have gone into labor AFTER their 40 week mark. There is no timer to go "ding!" that means you are "done" at 40 weeks! (but for more on estimated due dates, see this other post, or this one)  And not just first time moms!

Back when I was a brand new doula, my bag used to be packed at exactly at the 38 week mark. I was also more paranoid in general - not a single drink during my on-call period, no foods with onion or garlic (so my breath wouldn't smell bad), obsession with checking my phone all the time and with every single plan I made (can I go to the movies?), and so forth. I remember each birth that occurred prior to the due date:

I had a first time mom go into labor before 40 weeks, but that was an effort on her part - she asked her midwife to sweep her membranes at around 39 weeks (see bottom of post for an explanation if you don't know what this is), and it worked the very same day. I knew in advance why she wanted to go into labor earlier than her due date and she kept me informed of her techniques.
A third time mom went into labor at 38 weeks, a week after I met her and she hired me.
I also had a first time mom go into labor on her exact due date, which is so rare that it was shocking.

And then just recently, with no warning at all, I got a phone call in the middle of the night from a mom who had no major warning sign that she would give birth before 40 weeks (other than the fact that she really didn't want to be pregnant anymore, which is like most women), and had to scramble around and pack my bag! I found out that she was taking evening primrose oil capsules, on her midwife's advice. I'm not sure why she was taking them, or why the midwife advised her to take them, prior to her estimated due date. Perhaps the midwife always prescribes it. Perhaps the mom was incredibly impatient and so that's why the midwife suggested it.

Evening Primrose Oil is a supplement that can ripen the cervix because it is high in prostaglandins. Prostaglandins are sometimes administered directly in the vagina by a doctor to prepare for a labor induction. Semen also contains prostaglandins, which is one reason why they say sex can start labor! Evening primrose oil doesn't exactly induce labor; it helps soften the cervix in preparation for labor. I don't know much about EPO so I asked about it on twitter.  Respondents said that it can have side effects and should not be used routinely and perhaps not unless an induction is looming for post dates, and that there is not a lot of research on EPO. Apparently side effects can include upset stomach and headaches.

A quick survey of the literature came up with a retrospective quasi experimental study of 108 low-risk nulliparous women that found:

Findings suggest that the oral administration of evening primrose oil from the 37th gestational week until birth does not shorten gestation or decrease the overall length of labor. Further, the use of orally administered evening primrose oil may be associated with an increase in the incidence of prolonged rupture of membranes, oxytocin augmentation, arrest of descent, and vacuum extraction.

Another article on midwives' use of herbal preparation for stimulation of labor found that there were no reported complications in the use of evening primrose oil or red raspberry leaf tea and that evening primrose oil was the most efficacious herbal preparation for cervical ripening. Most else of what I could find just says that there is a lack of evidence. Basically, that more research is needed.

Anyway! She went into labor prior to 40 weeks and the labor and the birth went well. I always tell my clients that I will come when they feel they need me. Sometimes in the middle of the night I really hope that even though they're calling me, they'll see that their contractions are still "early labor" contractions and they won't "need me" right now. With this one, I did end up getting to her house a bit before an active labor pattern was established. This has happening to me a couple times. This is hard for a couple reasons: First, now everyone feels like we're in active labor mode and it's hard to not feel rushed once the doula is there and you feel like everyone is waiting on you and watching you labor. Second, it would be nice if everyone (mom, partner, and doula) all got some more sleep, but now sleeping arrangements are awkward. And third, several other things are also awkward - instead of needing active help all the time, we're hanging around at home watching TV and making lunch, etc. But the second ones are more about me, and so... see number one!

But it is also highly beneficial for me to come early in several instances. Once, it was because mom and dad had me meet them at the hospital and mom was only about 4 cm dilated. They walked around trying to decide what to do: Be admitted and be in the hospital the entire labor, being pressed for time and to adhere to the ridiculous "1 cm per hour" rule? Or go home and try to sleep, and hope that in their own environment labor would move along at a comfortable, un-stressed pace. Perhaps if I hadn't been there at the hospital to discuss things they wouldn't have gone home (and ended up having a great labor!)

Most recently, I was glad to sacrifice my time/comfort/sleep/whatever to be with mom and dad early in order to reassure them and keep them at home. This is a big one. I have been told so many times, "if it weren't for you, we would have just gone to the hospital at [2 am, 4 am, etc]!" And mind you, this is JUST after labor contractions start. You really shouldn't go to the hospital at the start of labor, for a multitude of reasons. 1. they might send you home if you're not 4 cm or more anyway, 2. hospitals can be stressful places where labor actually slows, 3. if you want a natural labor, the longer you are in the hospital the more likely things will be done that make this harder (i.e. stay in bed the whole time, pressure to get pain meds, you aren't allowed to [eat, drink, pee, use the shower for pain relief, etc], let's manage this labor a bit more with drugs, etc), 4. you will be rushed for time (it's been ___ hours since ___ so we need to do ___) even though there is no medical reason to do so, and 5. I could probably think of more if I wanted but I'll stop there.

Several times if I hadn't showed up right away mom and dad would have just listened to some direction (that always changes) like, "come in when contractions are 5, 1, 1" or "come in when your water breaks" or "come in so we can see how far you've progressed" which have no basis other than they just want to manage labor. I have been told a million times, "I am so glad we labored at home," and "this is really great laboring at home," and "I'm glad we didn't go to the hospital right away." And even from hospital midwives, who are impressed that the mom comes in at 8 cm or 10 cm because that is so rare for them (and I've even got a "way to go, doula!"). But it is hard, especially for first time parents, to want someone there with them to can reassure them about what is normal and answer a million questions about labor positions, eating and drinking, whether or not they should try sleeping or walking, and of course the big one - when should we go to the hospital? [And in this instance, interestingly, many a question was answered along the vein of "is this going to make the contractions worse? Such as "Is a cold beverage going to make the contractions worse?" and "Is a shower going to make the contractions stronger?"] I have witnessed many many more labors than they have and I know what a contraction pattern or mom's temperament means.

Just as an aside, I always let the couple decide when it is time to go to the hospital. I give advice if asked, but if they feel it is time, we go. The only instances in which I say "ok it's time to go now" are when mom says her first "I feel the urge to push"! And I should also add, here, that we've left while mom felt like pushing many times and always made it to the hospital in time (even with a third time mom); They have all still had to actively push for a period of time in the hospital. This is always a big worry, but the stories you hear about babies being delivered in the car are rare (though I'm not denying that is possible to wait too long to go, or to have an exceedingly fast labor).

Talking about doula self-sacrifice - my body was really aching after my last doula labor! Whoever thought that becoming a doula was all fun and babies, you should really recognize how hard being a doula can be, sometimes.

I also wanted to mention that a recent labor was attended at a Baby Friendly Hospital. I want to share this experience, because it wasn't quite what I thought it would be. Firstly, the nurses asked the mom immediately after delivery if she would be bottle feeding or breastfeeding. This is interesting in two ways:  1. I did actually think it odd that a hospital with the highest support for breastfeeding there currently is is even asking a mom if she is breastfeeding, instead of assuming that she would do the norm (and yes, wanting to breastfeed is the 'norm' - 75% of women in the U.S. initiate) and only require formula in case of complications (which is what formula should be used for), but...  2. For the people who say that going baby friendly hurts moms who want to bottle feed because it pushes breastfeeding on everyone, clearly if they are asking moms, this isn't true.

Secondly, I was under the impression that BFH's do uninterrupted skin-to-skin and make sure mom has help in trying to initiate breastfeeding in the first hour after birth. I was under that impression... (Perhaps you see where I am going with this?) This mom had her baby on her maybe 20 minutes of the entire first hour and twenty minutes of baby's life. They were doing the usual - weighing, measuring, drawing blood, eye ointment, letting dad take photos, etc in the baby warmer instead of letting all that wait and giving mom the chance to warm and feed and bond with the baby, all of which is good for both the baby's blood glucose levels and the breastfeeding relationship. Oh, and they did the typical swaddle the baby and we had to un-swaddle him to put him back on mom, and then they took him off a second time. And the entire time no one was helping with breastfeeding but me! Until finally a baby nurse came back in and then repeated EVERYTHING I had just been saying and doing. Grr. So frustrating. I do think this nurse was trained in lactation, luckily, but I don't know if all the nurses are, because all she said is "you can ask any nurse for help with breastfeeding." Which is what they all say everywhere, even if the nurses aren't trained in lactation.

The point of all this is... you learn something new every birth. Or many somethings. For instance, I also learned that if a mom is GBS+ she should really get the IV antibiotics in her system at least 4 hours before delivery (so don't wait too long to go to the hospital with a GBS+ mom).

Or sometimes, many things are affirmed. For instance, you really can't tell if a mom is going to take one hour or several hours to go from ___ cm to 10 cm. Or like how sometimes L&D nurses are all the same. And sometimes they're idiots (Sorry, just really annoyed at an L&D nurse who told my client to tell her if she had a continual urge to push,  even in between contractions, which is NOT how it works. And then wouldn't let mom stand beside the bed when she felt pushy because she was afraid she'd have the baby on the floor, even though she had just checked her and she was only 8 cm and was not going to push a baby out that fast. Ok, rant over).

Ok, POST OVER! Thanks for sticking with it til the end :)


--> A membrane sweep, or stripping the membranes, is not the same as breaking the bag of waters (amniotic sac). It is done by inserting a finger between the membrane that goes around the amniotic sac and the wall of the uterus to loosen the membranes from the wall. Sometimes this stimulation of the uterine wall can help to start labor. It doesn't work for everyone, may or may not be uncomfortable, and can sometimes cause the water to break.

Third Blogaversary: It's Time to De-Lurk

Well, it's about that time again! Happy Blogaversary to me! Or, Happy Birthday, Anthro Doula Blog!

Every day hundreds of people visit my blog from various places around the globe (amazing!) and I have no idea who you are! Some people come stop by once, but some of you stick around or return again and again. I really appreciate that! I know most of you don't comment, and that's OK. I'm not a big blog commenter myself, unless I really feel like I have something I need to say.

But on this, my third blogaversary, I'd really love it if you would de-lurk (or in other words, say hello!) Let me know a little about yourself. Why do you read? How did you find me? What are your favorite topics? What would you like to see?

I really appreciate the feedback!

Photo source

When I started this blog three years ago, I really didn't know that I would keep it up this long. I also had no idea that so many people would come to follow it! I really appreciate you, whether you follow on Facebook, twitter, or directly to the blog.

At the moment, I am excited to have more than 170 Google Friend Connect followers, 680 Facebook fans, and 2,443 twitter followers.

I am averaging 255 page loads per day, and I had about 1,154 first time visitors this past week. Recently, you have come not only from the United States and Canada, but also Singapore, Malaysia, Philippines, Cambodia, India, Brazil, Portugal, Sweden, Ireland, Germany, Spain, Iraq, Pakistan and the UK.

A lot has happened in the past year. I've gotten another year of grad school under my belt, and the end is in sight. I've worked on community projects related to the March of Dimes and to also breastfeeding. I've met some amazing people in MCH and public health. I've been a certified doula for over a year now, and added CLC!

I've also had a real life local doula client hand me a print out of one of my blog posts at our doula interview (completely without knowing that it was my blog)! That was pretty thrilling. It's kind of like coming full circle, in a way. And makes me feel like the information I put on this blog is helping women!

It has also been a great way for me to share the things that I learn, read, and experience.

Thanks for celebrating with me!

- Anthro Doula

What's going on in my world

If you're a doula, do you compensate/get compensated for being back-up on call? A while back I agreed to be back up for another doula and she paid me a small amount just for being on call, even though she attended the birth herself. In the past my back up arrangements have just been a pay-if-you-go type thing. I think everyone has a different system for this, and I'm just curious! Please share :)

I recently attended a birth where we labored at home until the mom felt an urge to push. We made our way downstairs, into the car, and all the way to the hospital and mom was doing great. We entered through the emergency room entrance, which is always how I've entered with clients at this particular hospital. When we entered, the woman at the desk asked "how far apart are her contractions? does she feel like she has to push?" So I calmly replied, "her contractions are about 2 minutes apart, and she is feeling a little bit like pushing." For some reason the emergency room (guy? tech? nurse? doc? I don't really know) decided that this meant she was about to have her baby, and wheeled the mom in her wheelchair over to an empty room and put on a face mask and gloves. I thought perhaps they were just going to check her dilation down there and then we'd go up to labor and delivery, but I realized that he had thought the baby was coming NOW. He turns to the mom as she's standing up from her wheelchair and says "do you feel like pushing?!" and she calmly says, "every now and then I feel the urge to push with a contraction, but not every one." And he's like "oh." And everybody stands down, and we are handed over to someone and taken to L&D. haha. I found it highly amusing. Have you ever had this happen before?

I've been analyzing my thesis research data lately and I keep thinking of one mom who described breastfeeding as "animalistic." Interestingly, exactly 1/3 of the women I interviewed had a cesarean section birth (the exact same as the entire United States).

If you're a spanish-speaker, what word is most often used for "breast pump"? sacaleches? bomba? pompa? I say pompa because I've heard it used, but when I actually look it up I get the first two.

A month ago I received a phone call inquiring about my doula services. The woman started the phone call out with "is this... the doula?" Apparently she forgot my name as the phone was ringing. But it didn't seem she paid much attention to my website anyway, since she apparently had no idea what a doula is or does. She proceeded to ask me whether I go with her to all of her doctor's visits with her throughout her pregnancy, and if I do ultrasounds. I sure hope she figures it out sooner rather than later. I haven't heard back from her!

The Summer I Ate Clay because I am a Birth Junkie

I ATE CLAY. Literally.

Curse my Anthropological curiosity!

This summer has been a whirlwind for my graduate program. I completed my IRB and began my research for my master's thesis on breastfeeding. I am also interning for the community organization who provides women with breastfeeding assistance. Doing participant observation has been harder to arrange than I thought, and recruitment for interviews wasn't able to begin until much later than I had wanted. But I am in the full swing of things! I am learning a lot about women's breastfeeding experiences. More on this project down the line :)


So why did I ate clay? Well, here is the story:
I interviewed a woman who was from Africa, and she told me all about the postpartum practices of her country. She was explaining that after women give birth there is a huge celebration, people whistle, and the children make these things that they bring to the woman. I asked her if it was food and she said "No. it's... mud. Is that the right word? It's edible." I thought perhaps there was a language barrier... how could mud be edible? Then she pulled a bag out of her kitchen pantry and said, "Here I have some that someone brought for me after I had my baby." And asked me if I wanted to try it.

Now you would think that since she had described it as "mud," that perhaps I would hesitate. And perhaps a normal person would. But being obsessed with all things birth and culture-related, I was fascinated by this different postpartum practice. What was this food that the women of her culture eat postpartum? I had to experience it.

It looked like a dark colored ball with white powder. I asked her if it was sugary and she said No. Then she broke one into pieces, picked up a small piece, and put it in her mouth. So, I picked up a piece, put it in my mouth, and started chewing. And quickly realized I was eating CLAY. And she said, "oh! you're not supposed to chew it!" And I'm trying not to be all, "AHHH Get this out my mouth its dirt!" Thankfully she said, would you like a paper towel? And I spit out as much as I could, rinsed my mouth out at the sink, and was still given a toothpick and a bottle of water on my way out so that I could continue to pick the mud out of my teeth. BLECH!

It wasn't until later that I realized that someone probably brought it to her from her home country, meaning I most likely ate the dirt of another country. And am now probably going to get all sorts of diseases. But I feel fine so far! :) In case you're curious, this is called geophagy, which is a condition where people crave and eat non-food items like clay, chalk, etc. Pregnant and postpartum women are known to crave clay. It is tradition in Africa, maybe because of cravings caused by dietary deficiency (lack of nutrients). It also helps you feel full.

Really interesting radio story about this here.

There has been a lot going on since I last did a "personal doula update" of sorts!

In biggest news, this blog was reviewed in this summer's SQUAT magazine! So cool!
Sarah wrote, "Overall, I've found that Emily's sharp, thorough intellect and clear writing style makes each blog post a learning experience, which keeps me (this non-blogger) coming back again and again." Thanks, Sarah and SQUAT!

I am also taking a course this summer on global women's health. We have focused on a lot of the topics that were covered in my anthropology reproductive health class, with a few others thrown in that are not related to reproduction (chronic diseases, violence, and so forth). This is the first time this course is being taught, and I really like how interdisciplinary it is, and how we talk a lot about human rights (and even feminism!) As part of this course, we are traveling to Panama to explore these health issues in this particular country. I am very excited to visit a new country! And to reflect more on women's health issues from an international perspective.


I had a few doula clients have their babies. I mentioned in my last update that one doula client was going to attempt a red raspberry leaf tea chugging method to make her labor super short. Well, her labor was very fast and intense! Of course, we'll have no idea if that is because of the red raspberry leaf tea, or the chiropractor/acupuncture she tried when her water broke and contractions didn't start, or just if that's how her labor would have been anyway. Once her contractions actually started in earnest, she was dilated at super lightning speed. I honestly didn't even believe that it was possible for her to be ready to go to the hospital when I got the call that went, "actually, don't come to the house, just meet us at the hospital!" But when we checked in she was fully dilated. The urge to push took longer to come, and the actual pushing phase was also longer than my average, which is interesting. I'm not sure what that means, but it was interesting to note. Every birth is so different! This birth had a fabulous in-hospital midwife attending, and I was so incredibly pleased to see that.


I had another new experience with another doula birth this summer. Client had a beautiful and relaxing birth center birth, labor not too long, and pushed her baby out into the water. I even had a doula-in-training friend working with me for that birth, which was fun! Unfortunately, she had the toughest postpartum period I've ever seen. The baby was the most frustrated baby I have ever seen. Would not stop crying, even when she had the breast in her mouth. Baby was not latching, and mom's milk didn't come in for a week. And then the poor mama felt she couldn't take it easy, didn't have a lot of help at home, and she had a lot of trouble with her perineal stitches. Apparently in my state, midwives aren't supposed to touch you 48 hours after the birth, so she was simply told to "go to the emergency room." With a newborn! My heart really went out to her :( I don't have a lot of practice with the postpartum end of things; I was never trained as a postpartum doula, and my newborn knowledge is really centered around breastfeeding.

Also, it has been a while since I talked about the objects from my doula bag that I use, so here is what I have realized that I use most:

- A fan. I realized the battery-operated one was just too intense (and loud) for moms, so I carry an old fashioned hand-held one (that I actually bought in China). I use it at every birth. Most moms have temperature swings, and get very hot during pushing.
- Wet wash cloth. Either my own or the birth center/hospital ones. For the same reasons as above!
- Breath mints. I eat a lot of these during a labor. Long hours without teeth brushing, or I just ate and want to clear that food scent away, or because I'm doing a lot of breathing and my breath probably just stinks. I offer to dad, too. 
- iPod and speaker. You would not believe how many times mom and dad don't bring their own (forget it at home or don't think of it). All my clients have liked either the classical music or the guided visualization tracks. I have a ton of ocean and nature music sounds, too, but these end up sounding annoying and weird in a hospital room.
- Birth ball. For laboring at home. Most of the birth locations in my area have some of their own.

Things I use often, but not every time:
- Rice sock to heat up
- Straws for mom to drink with
- Peppermint oil on a cotton ball for nausea.
- Preggie pop or other lollipop to keep mom going (sugar, anti-nausea, something good tasting)
- Lanolin ointment for when mom's forget their lip balm
- Tennis ball for back massage


I'll update you on Panama and women's health later! 

Happy Birthday, Doula Baby

Today is the 1 year birthday of one of my doula client's birthdays. This is clearly not my first doula baby birthday, but today I was feeling really happy about seeing pictures of a 1-year-old who has gotten so big that I saw born one year ago today!

I like e-mailing or calling my clients on their first birthdays. Not all of my clients have kept in touch, and I don't always hear back from them all, but I like to reach out. I put the date of their birth in my calendar and have it repeat one year later to remind me. And it makes me think about how time passes, how children grow so fast, and where I was exactly one year ago. It's also a reminder of the part I played in the lives of others, and how they have touched and shaped mine.

So, I am just taking this post to reflect on all of these things, and to say Happy Birthday to all my doula babies out there in the world!


Do you say happy birthday to your doula clients and their babies? How do you keep in touch?

Anthro Doula, CLC!

I passed my CLC exam and competencies! YAY!

Now that myself and my colleagues have all passed, we have been entrusted to start up breastfeeding peer-support groups in our community. We are thinking of starting one at my university since it doesn't have one, and the needs of student moms might be different than other populations. Plus, it will be convenient!

It took nearly 8 weeks for my results to get to me, which was frustrating. I already had a doula client say, when I suggested she call an IBCLC, "Well you took that training right? Aren't you certified?" And I had to explain 1. That I was trained, yes, but couldn't call myself certified yet... and 2. Not at all the same as an IBCLC! And she said, "What is that - an IBCLC?" Which just goes to show that the lay person has no idea that there are different certifications for lactation assistants out there. 

As I mentioned in my post about my training, even though I felt like I already knew most of what was taught at the training, it does feel nice to know that others will BELIEVE ME when I say I know it! :)

Now I get to celebrate!!

Certified Lactation Counselor Training

A couple weeks ago I did my training to become a Certified Lactation Counselor. I knew probably about 80% of it already (since I am a voracious reader of birth/breastfeeding blogs and academic studies on evidence-based practices, and I have worked with breastfeeding moms), but I also learned a lot, too.

Some of the new and awesome things that I learned in CLC training:

1. Babies can detect breast cancer (WTF): There is something called Goldsmith's sign, which is when a baby might be detecting undiagnosed breast cancer. The baby refuses to nurse on one breast. If other reasons such as ear infection, teething, birth trauma, etc are ruled out, breast cancer might be a possibility! And cancer may be diagnosed as late as 5 years after this sign from baby.

2. Breastfeeding provides protection for LIFE: When mothers who breastfed their baby donated a kidney to their adult child later in life, the adult child had less organ transplant rejection (compared to mother-child pairs that had not breastfed). The same protection was afforded when there was a sibling --> sibling organ or tissue transplant, if they had breastfed.

3. Powdered formula is not a sterile substance:  It must be prepared at a temperature of at least 158 degrees F (and then cooled) before being fed to an infant, and you should not prepare a large amount ahead of time. A powder cannot be sterilized, and formula has been found to contain harmful microorganisms from time to time.

4. Colic = crying for more than 3 hours/day for more than 3 days/week, for greater than 3 weeks. I didn't know that definition!

5. Great resource! How to Safely Co-Sleep: The UNICEF UK Baby Friendly Initiative have a helpful pamphlet on how to safely sleep or co-bed with your baby. This is more than the U.S. provides, as they just say "don't do it," but people do it anyway, and do it unsafely.

Of course I learned a lot of other things, too, but less new and less awesome (and thus not worth sharing here). But in case you're interested in what the training covered...


On the first day we covered: International and national breastfeeding policy context, evidence-based practice, lactation credentials, examination of factors influencing success at breastfeeding, national perspectives on breastfeeding rates, anatomy and physiology of lactation, hormones of lactation, composition of human milk, gastrointestinal hormones of lactation, distinct weight gain patterns of breastfed babies, and myths about milk supply.
On the second day we covered: The effect of substances and objects on milk supply, the effect on milk supply of hypoglycemia, jaundice, latch-on, engorgement, implants, effect of milk supply of discrepant breast size, breast surgery, inverted nipples and others, counseling women with fears about milk supply, approaches to use in patient education with different types of learners, health outcomes associated with infant feeding choice, safer use of infant formula, and donor milk banking.
On the third day we covered: Application of social psychology theory to lactation counseling, influencing the infant feeding decision, men's concerns about breastfeeding, enhanced effectiveness through lactation counseling skills, supporting the mother's desire to breastfeed exclusively, the impact of maternity care practices on breastfeeding outcomes, parameters of feeding assessment, and strategies that have been found to be effective in assessing breastfeeding.
On the fourth day we covered: Strategies for dealing with the challenge of breast problems, milk expression, milk storage and handling, supplemental feeding methods for the breastfed baby, working women and breastfeeding, strategies for building or maintaining a milk supply under challenging conditions, galactogogues, strategies found effective for assisting babies with special challenges, effect of breastfeeding on amenorrhea and fertility, the effect of foods in the mother's diet on the infant, the effect of alcohol, caffeine, and environmental contaminants on mother's milk, the impact of medications on the infant, and contraindications to breastfeeding.
On the fifth day we covered: Early support in the "zone of professional unavailability," common concerns after the early weeks - ages and stages, vitamin supplementation, complementary feeding, weaning, nursing older babies, nursing strikes, ethical issues in lactation care, and the Baby-Friendly Hospital Initiative


A lot of people in my course were new to working with breastfeeding moms - many people from the community, some people in public health, a few from Healthy Start-type positions, a handful of doulas, but only one nurse. I have realized this is not the normal audience for this type of class, which is generally mostly people from medical backgrounds. Elita at Blacktating writes about her course, which had a different audience, but was structured similarly to mine.

The organization that runs the course, The Center for Breastfeeding, has claimed that the CLC certification is equal to the IBCLC training in that both are "entry level." You can read more about their opinion here: Position Paper on the Comparative Roles and Training of the IBCLC and CLC. Basically they believe that since the CLC course has not only an exam that must be passed, but also several competencies, that it is just as good a training as the IBCLC, where "anyone can take the exam" and there are no competencies. I beg to differ. The IBCLC certification requires over 1000 clinical hours, in addition to certain pre-requisite education on anatomy/physiology, etc, and the CLC training does not require any. I imagine this is all part of a political rivalry between the two certifying organizations.

I'm glad to have added this training to my skill set, and anxiously await the results of my exam!

The Learning Never Stops

Happy May! I meant to post more than I did in April, but the end of my semester completely overwhelmed all my time! The good news is that I've been doing a lot of doula prenatal visits for my clients who are due this month and next month. Prenatal visits are so great! I love talking birth. This is why I should really become a childbirth educator, so I can just talk birth all the time.

In one of my recent prenatal visits my client taught me a few new things. First, she pointed out that the longer she is pregnant, the more her fundal height matches her gestation length! Fundal height is measured from the top of the pubic bone to the top of the fundus which is the top part of your uterus (the highest part of your baby bump, under the breasts) Fundal height is measured in cm, gestation length in weeks. So, for example, when she was 25 wks 5 days, her fundal height was 26 cm, and when she was 30 weeks, her fundal height was 30 cm! I had no idea that this occurred, but it is so cool. Unfortunately, it's not an exact science, but it does give a good indication of fetal growth. If for some reason the measurement was not as expected, an ultrasound may be useful!

The second thing, which I have been exploring a bit more on my own, is that she wants to drink at least a pint of very strongly brewed red raspberry leaf tea once she is in labor. It is known that raspberry tea has an effect on the uterus, by relaxing the smooth muscles while it is contracting, and many women drink it late in pregnancy to "prepare" their uterus for labor by toning and strengthening it. Anecdotally, women have said that it can ease labor or even make it shorter. This is why my client wants to try it. She has heard that just drinking it leading up to labor is not enough; some women have noted that when they downed a large amount of it in early labor that their labors were shorter. Since there have been no noted side effects for the woman or the baby with raspberry leaf tea late in pregnancy, we all agreed she can go ahead and try it if she likes! So, I will let you know how that goes ;)  When I asked some doulas on twitter what they thought about this, many different responses came up. Some said red raspberry leaf tea is good to get contractions going, some said it can slow them out and make them more regular, that it strengthens contractions, and that she shouldn't be disappointed if it doesn't work exactly as she was hoping. What do you think? Do you have any experience with raspberry tea for labor? Would you try this method? 

Additional good news is that next week I'll be doing the Certified Lactation Counselor (CLC) training. Has anyone taken that before? I am wondering what CLC's go on to do after they become certified. In addition to working with a local non-profit that supports breastfeeding, or just adding it to my doula services repertoire, what else can I do with my CLC? Do CLC's do independent work that they charge for? Do you run peer support groups, La Leche League style?

Personal Update

A lot of this blog is about sharing information that I find that's new or interesting, and not as much about personal doula updates anymore. I used to do a lot more back at the beginning of the blog when I was just starting out. I even posted some or my doula birth stories! But when I got some flack about sharing too much personal information, I sort of stopped.

Also, as I'm in grad school, I don't take on a lot of clients. My semesters have really been ramping up the longer I am in this program, and I just haven't felt like I could handle being on-call.  As a result, I don't want to come on here all the time and write about my meetings or births or impressions just in case my professional identity can be linked to this blog, and my clients get upset about something I say on here. Also, because I don't take on a lot of clients, there's less to share in general!

But since I haven't done a personal doula life update (or a "doula journey" post) in a while, I thought I'd take the time to write one down.

I've recently taken on some fabulous clients that are due this summer. One client interviewed and hired me at only 10 weeks gestation! So it has been an interesting experience having a client that long. I worried about the potential for having to go through a miscarriage with her (which thankfully didn't occur), and also about how to keep the relationship over such a long time (I'm used to the meetings all occurring in the last trimester of pregnancy - sometimes even the last month only!). So far it has worked out. I went on a hospital tour with them, so it was great to see them and chat then. She has kept up with e-mailing me with photos of her baby bump, the baby's sex, and lots of questions, so that's been great, too! They also invited me to a baby shower, and we will soon start our prenatal appointments together.

Two additional clients are both due in the same month, so I am glad to have some back up support from my wonderful back-up doula. With the first, the husband seems very concerned that he will have a highly active role to play, that I will just be there to give him reminders of what to do. Until I spelled that out multiple times in several different ways, I didn't see his smile. Dads are always all-business, while moms do most of the talking. My other client is of an older age, and I always find that the older moms who are pregnant for the first time do a LOT of talking. She tells me everything! I think it is really great. She is also delivering at a birth center that I haven't been to, yet, so I'm excited to meet the midwives there and have that experience.

Recently my doula friend who is still certifying asked me if she could shadow me on one of my births. She has already asked the permission of my client and gotten it. I have never had a doula shadow me, and I'm not sure how that will go! I almost don't feel like I'm seasoned enough to provide guidance for a doula-in-training, and I'm wondering how it will change the way I doula. Can anyone give any advice on this?

Once my semester ends I'll be taking a 5-day Certified Lactation Counselor (CLC) training. I'm very excited for this, as I've wanted to add additional breastfeeding training to my skill set, and also because I'm hoping it will provide hours for my birth doula re certification requirements with DONA.  If you're a DONA doula and you'd like more info on re certification requirements, they recently made a webinar on this topic! Additionally, serving as a preceptor at a birth with a doula-in-training counts as an alternative method to obtain continuing education contact hours!

In other news, I am officially Certified in Public Health, now that I've found out that I passed my CPH Exam!

Another Semester Down

Another semester down...

So I've found that I can hold down 2 part time jobs, doula work, a full grad course-load including 3 group semester-long projects, and not go totally insane. I still managed to get all A's and see my friends at least once a week for dinner. My wonderful SO was there to help me through the emotional breakdowns (I didn't say there weren't any!), and I managed to come out alive. I'm quite proud of myself! This semester was very hard and I'm so glad its over.

I had two fantastic doula clients give birth in the same week. Though it totally messed up my sleep and homework life that week, I thoroughly enjoyed helping both these wonderful families. Here is some of what I experienced and learned:

One was a primip who had switched to a birth center birth during her pregnancy. The birth center was big and beautiful and totally empty while we were there. I was with her and her husband for 24 hours at home and the birth center before the decision was made to transfer to a hospital so mom was able to get some pain relief and some sleep. She had been awake for nearly two days! First time moms never follow this advice which I always give, but you really have to sleep in early labor! She was such a trooper - she would have kept on going if she wasn't just so tired. Really such a sweet couple, great midwife and midwives' assistant at the birth center, and a seamless transfer to midwifery care at a nearby hospital. The transfer was very upsetting, and she did reverse some in dilation. I've heard of this happening before and I'm very sure this is what happened here. It was a beautiful labor that ended up being an asynclitic occiput posterior baby giving her so much trouble! (I learned at this birth that the baby can be OP and the mom might not have back labor). 

The second labor was the fastest dilation I've ever seen - another primip who I didn't end up laboring at home with because her husband was very nervous in early labor and insisted they go to the hospital. I met them there and the labor was great - very quiet, calm, peaceful. Very few nurses or doctors bothered us the whole time. Mom, dad and I slept on and off in between contractions. There was also some salsa dancing! I really think this may have been partly responsible for such a quick labor - She actually dilated 5 centimeters in about 2.5 hours. I was definitely jaw-drop shocked when I heard she was complete. I've never seen that before!

Recently I've been contacted by two potential doula clients who are very early in their pregnancies. I've never been hired by someone so early in a pregnancy! So I'm having a lot of doula firsts recently.

Next year I'm going to begin earning my continuing education credits for eventual re-certification... Best to start early! Next year will also be the year I start my internship, data collection and thesis writing. Whew!

Happy Holidays, everyone!

It's my Second Blogoversary!

HAPPY TWO YEAR BLOGOVERSARY TO ME!

It's my blog's 2nd birthday! Whoa! I can't believe it has been two years since I started my doula journey! 

A year ago I was averaging an average of 170 page loads, and now I'm averaging about 200 per day. In the past week I've had 1,580 page loads. I've also added a new popular post:

• Chimps Give Birth Like Humans but Don't have Midwives

I've had visitors from the United States, Canada, the UK, India, Australia, Indonesia, Latvia, Portugal, Greece, South Africa, France, Malaysia, Czech Republic, Switzerland, Norway, Hong Kong, Singapore, Croatia, Netherlands, and Mexico. 

Also, in the past year, I've met Robbie Davis-Floyd, Penny Simkin, and Jill Arnold from the Unnecessarean! 

If you are one of my regular readers, thank you for sticking by me! I really appreciate all comments and feedback. I'm still learning as I go!


I think Ricki Lake and Abby Epstein timed their release of More Business of Being Born DVDs perfectly with my blog's anniversary - Don't forget that MBOBB officially comes out tomorrow! And it is definitely going on my wish list :)



(And if you weren't around for last year's blogoversary, I encourage you to check out the awesome doula comic I posted a year ago!) 

Writing Client Birth Stories

A former client in the state I moved from a year ago, and one of my first doula moms, said: "I have been thinking of you because I know like 6 preggo people! I'd be giving you lots of business if you were here!" Awww :)

She also said that she showed some people the birth story that I wrote for her, and it made them want to hire me just from that! This is interesting, because I wrote birth stories for all my first clients, and since moving have stopped doing so. You can actually read a couple of the ones I wrote, with names removed, here: Doula Double Header Part 1 and Doula Double Header Part 2. There are many ways to write one - to the parents, to the mom, to the baby. You can say "you" or "I" or "mom."

There are differing opinions on the alldoulas.com forum about whether or not writing a birth story for your client is a good idea. Many doulas do it, but others don't think its a good idea.

The reasoning is that writing a birth story may alter the mom's perception of the birth, while it is not the doula's story to write. Many doulas say that writing it down from our perspective tells our story, not the mom's, and that's not the point.

The doula may write that the mom was powerful, or the caretakers were kind, and the mother may see it entirely differently.  And what to do if it was an incredibly difficult labor and delivery? Can you write the story in a positive light, if the mother doesn't see it that way at all? Or what if you felt it was difficult, but the mother thinks everything went well? It would be terrible if we negated a mother's experience of joy or trauma based on our own perspective of it.

Many get around this by writing only simple timelines of the things that happened - when contractions began, when the doula was called, when they left for the hospital, when vaginal checks occurred, when the baby was born, etc. This removes all emotion and makes it not technically a story at all.

Since doing my certification births I have stopped writing birth stories for my client. One reason was because I read the forums and was confused about how I felt about it all. Another reason was because I liked writing the stories for my blog, but then realized that I shouldn't be posting another person's birth story with my opinions on my blog, in case the mother found it. A third reason was because I had my first birth where I felt a little bit like a failure in some aspects of my doula work - it was so different from previous births - so how should I write it down for the mom? So I just didn't. And I didn't want to write birth stories only for the births I thought were perfect, because that didn't seem fair. So now I don't write any at all.

I still talk about the births with my moms afterward, at the postpartum visit. I ask them how they felt about it, what they remember, tell them funny things people said, or what time things occurred. I tell my opinions if asked, which is hard to do sometimes. And I've learned a lot! Things that I'd feel terrible about they didn't think was a big deal, and things I thought were good choices they felt really upset about.

It's hard to not want to write birth stories for the parents, sometimes, though. Especially when my former client tells me that her husband loves reading the story I wrote for them because it makes him cry, or she shares it with all her pregnant friends. I love to be able to continue to make a happy difference in people's lives for years to come through the story, but I'm still not sure the benefits outweigh the possible risks in other situations.


Do you write birth stories for your clients? What are your thoughts on all this? Please share!

Banned from Baby Showers

Haha, I'm not really banned from baby showers. But that is the title of one of the blogs I like to frequent, and the phrase sure ran through my head a lot this past week.

Last weekend I went to my first baby shower for a couple that I consider my friends. Compared to the baby showers I've attended in the past, which were for moms who weren't in my friend circle, this one was a little bit different. This was the first one where I signed a card "Auntie Em"!

So, here I am at this baby shower, as a doula, but not as the pregnant couple's doula, thinking things that would surely get me banned from baby showers if I were to express them out loud.

The whole time I was suppressing the urge to get into pregnancy, birth and baby talk with the people at the baby shower. For one thing, I wanted to keep these friends, and you never know when one piece of unwanted information or advice could really piss someone off. Secondly, a lot of the family members in the room were either from a previous generation (which comes with its own beliefs and experiences and knowledge of how things go or should go), or from a younger generation that hasn't yet been exposed to the birth world beyond the fiction portrayed on television.

I think that its a fine line to walk, and probably why the blogger, Donna, decided to name her blog "banned from baby showers" in the first place. As someone who eat, sleeps, and breathes childbirth education and has numerous, recent, firsthand experiences in a variety of settings, (not to mention that I read about birth in my free time for fun, and I study maternal and child health in graduate school), I find it difficult not to share everything I've learned with everyone I encounter! I want to shout it all from the rooftops!

Now, don't get me wrong, I do not want to force anything on anyone, and I certainly respect someone's choices, but I respect them more if they are well-researched and well-considered. I would never ever openly judge a doula client or a friend for the choices they feel are best for them. But I am passionate about spreading knowledge, and I am of the opinion that pregnant women and their partners are severely under-prepared for childbirth these days.

Donna writes on her blog:

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.

And that's how I feel, too. So, for now, all I can do is refer them to websites that they may not go to, lend them books they may not read, but otherwise keep my mouth shut at baby showers.

I promise I will! Please still invite me to your baby showers, friends!

Being a Doula is Hard

I don't think I've ever found a blog that talks about how hard being a doula is, but I think I'm going to be the one to do it.

Most doula blogs talk a lot about why they love being a doula, as I've done before myself, but don't always get into just how difficult the lifestyle can be. And since I've recently inspired someone to begin their doula training, I've been thinking lately about whether or not the doula life can seem too romanticized (at least to birth junkies).

Now, don't get me wrong, I really do find doula work rewarding. But I think its important for doulas to understand that the reality is you're probably going to lose sleep, have physical aches and pains, miss events you were looking forward to, and cry.

What are some of the potential worst parts of the job for a doula?
Nervousness about being called at inopportune times, being woken up at all hours of the night, working on very little sleep, having to be in hospitals all the time, dealing with difficult care providers, being emotionally and physically supportive to someone else in their most vulnerable time, and having to be the most attentive you've ever been.
There's also the fact that doula work is not always steady, many people don't always want to pay a reasonable fee (under-appreciated), having to find childcare, and sometimes you're just treated like crap by people.

In my case, I think its the extremely emotional nature of the job that has affected me the most.

There are some truly wonderful, magical births out there that will make you feel like you're floating on a cloud. And then there are some truly agonizing and stressful births that will leave you upset, angry, and possibly traumatized. To quote a good doula friend of mine, "We become collateral damage."

Women can have post traumatic stress from birth experiences, and doulas can have it from attending births. And sometimes, the doula is hit hard emotionally, while the mother feels OK. Its not always clear what is going to upset you.

You will have births that will keep you awake at night agonizing over how it could have gone differently if only you had done ____, the mother had done ____, or the doctor had done ____. Or you may not know, and spend weeks wondering why and how. 

You will have clients who frustrate you to no end for a multitude of possible reasons, such as 1. they refuse to take childbirth education classes or read the books, because they are simply relying on you/the nurse/the doctor to get them through it, 2. read everything there is to know about the risks and complications of induction/cesarean section/whatever and choose it anyway, 3. will soak up everything you say about how they can make their own, refuse any procedure, and what is evidence-based, but then ignore it all and agree to everything their doctor says anyway, 4. get upset when you do or don't do something even though its clearly stated in your contract that they signed, and so on.

Doula work has been the most emotional work I've ever done. It has made me feel elated - "I'm making a difference!" and completely depressed - "I'm not making a difference at all." I think the hardest thing is that doula work is usually done because of the doula's passion for improving women's birth experiences. And for me, in particular, its about making a positive change in maternity care. And many times I feel myself losing the fight.

How can a doula deal with all this emotion so that she doesn't get too burnt out? Some doulas turn to things fixes such as only taking out-of-hospital births. For me, though, the only things that help are:

1. Have a doula friend or two to vent to! Bitching and moaning about U.S. maternity care or just crazy clients, or simply discussing a birth and getting help processing what happened is really the best thing you can do for your emotional health.
2. Getting online or picking up a book and reading inspirational ways in which change is being made and can be made in maternity care, and birth stories of women who had beautiful, empowered births.

What are some of the hardest parts of the job for you, doulas? And what are ways that you like to process and decompress after stressful doula-related events?

Officially Certified!

Dear Readers,

It has been almost 2 years since I decided to look into becoming a birth doula, registered for a training workshop, and started my doula journey. And now, after the completion of 9 births, I am finally a DONA Certified Doula!

Despite the great debate over whether it is necessary or worthwhile to certify and disagreements about the merits of various certifying organizations, I am glad to be a certified birth doula. I am glad to have made it this far, coming from zero background in healthcare or motherhood. My interest in culture and women's rights combined with a desire to learn and improve the health and lives of women has brought me to my passion and I am grateful for all the training I have received along the way. And there is much more to learn!

I feel like myself and this blog have reached a great milestone, and I thank you for following along on my journey :) Whether you are a doula, doula-curious, a mother, a scholar, or everything wrapped into one, I hope reading my blog has been worthwhile, and that we can continue on together as I continue my lifelong learning.

Cheers,
Emily, Anthro Doula