Doulas are for Dad's, Too!

Yesterday we had a really good time celebrating Father's Day with Greg's family.  The weather was ideal, the kids were happy, and we just hung out at my in-laws doing nothing and being together.  (A day of doing nothing is bliss for this mama!)  It was also a good to to reflect on fatherhood; how my dad's love for me shaped me into the woman I am today and how my husband is such an awesome dad to our kids.  I also had fun reflecting on the proud new papas I have served as a doula!

It's always amusing to me that, at interviews, the dad is usually pretty apprehensive about hiring a doula, but after the birth he is almost more grateful than the mom!  I think that labor support, especially for first-time dads, is really hard.  They've typically never seen a birth before, so to see their wife or partner going through such an intense ordeal can be very taxing emotionally.  He often has a hard time knowing how to support her, especially if she starts asking for drugs when he knows that she really wants a natural birth!  I can't imagine what it must be like seeing the person you love most in the world experiencing the crazy ride that is childbirth.

This is why I love my job so much.  As a woman having gone through childbirth twice before, and as a trained birth professional, it is so rewarding for me to deduce what a laboring mom needs at a certain point, and gently instruct her loving partner to know how to best support her.

I remember at one of my very first births (this couple happened to be some of our best friends), they were working so well together, swaying and relaxing through some of her most intense contractions.  And I just stood in the corner, giving the dad an occasional calm smile letting him know that everything was going perfectly.  When she went into the bathroom by herself, I just gave him a little pep-talk on what to expect over the next hour or two (she was entering transition, so I told him she would probably get emotional and start having some self-doubt).  Within minutes after her coming out of the bathroom, she started crying and saying she couldn't do it anymore, and it was so beautiful to watch her husband calmly tell her that she could, and that she was doing great, and how they fell into their perfect rhythm together again.

And last week I was at a birth with a super sweet couple.  Young, newly-married, first-time parents, they hired me at the last minute because someone in their birthing class told them that they HAD to have a doula (yeah!).  The dad had been very quiet and reserved throughout our prenatal meetings, and continued to be so during the birth.  During her labor, I just did my thing, helping his wife, giving her words of encouragement and prompting him to do the same, telling them both what to expect through each stage of labor, and really just guiding them through the process.  Toward the end when things were getting quite intense, she really needed some eye-contact to keep her grounded.  So I did that for awhile and breathed with her.  Then she went to the bathroom, came back and was lying on her other side facing her husband, so I said, "During this next contraction, I want you to really focus on her eyes, and breathe with her in rhythm."  It think it was really hard for him--he was crying quietly from seeing his wife in such a state, and I could tell he wanted to withdraw from the situation because it was just so emotionally overwhelming.  But I gave him a tissue and prompted him to stay close to her.  And they both got into this amazing zone together, connecting in a deep and meaningful way.  What a privilege it was to have facilitated such a beautiful moment!  Afterwards, at their follow-up visit, she told me that her husband had been telling a pregnant relative of theirs how much of a help I was, and that they should hire a doula, too. :)

So as much as I am passionate about women and our amazing bodies and all things birth/mothering related, I think dads are pretty cool, too.  I love creating a space where a couple can really connect without worrying about outside distractions, assuring them of the normalcy of birth as they work together to bring their baby into the world.  Whether it's getting dad a coffee and a sandwich, or showing him how to put pressure on his wife's back in just the right way, my goal is to help him to be as integrated and as involved in the birth process as possible.

I Think This is Why I Love Birth So Much

It's totally unpredictable. And you can't control it, no matter how hard you try.

I got a call last Sunday morning from a client's husband saying that his wife's water had broken. And she wasn't due until the end of September. Surprise! Luckily, I wasn't in Chicago visiting my sister, or in another state visiting friends. We were in town, so I dropped everything, grabbed my doula bag and put my DONA pin on my shirt, got my family situated with basic instructions and frozen pizza, and headed out the door. And despite the many interventions used to get this baby out, I loved it. It definitely wasn't an ideal birth, but I loved that I got called when I least expected it, and stayed up all night when I wasn't planning on it, and witnessed the absolute miracle of a child being born on a Monday morning when I otherwise would have been sleeping.

When people ask me why I am a doula, or why I love birth so much, I usually say something like, "I just love to push my body--it's such an empowering accomplishment!" or "I love trusting that my body can do what it was created to do!" But last night I was lying in bed thinking about it, and I realized that the real reason I love birth so much is because you can't control it. Unlike almost everything else in this on-demand culture, labor and birth cannot be manipulated to happen when and how we want it to. Not that people don't try, but when they do, a less-than-ideal outcome usually results.

Labor connects us with our bodies in a very unusual way. It just happens, and it doesn't stop until the baby is born! It takes a great deal of determination, focus, and self-discipline to come to grips with this fact, to turn inward, and let your body do what it was made to do. No matter how little sleep you're running on. No matter what time of day or night. No matter if you had plans to go shopping that day. Birth demands that you drop absolutely everything and come face to face with who you are in your deepest, most intimate parts.

At the birth last week, the mom said, "I wish I could just take a break from labor for a little bit, go out and grab some dinner, and then come back." I totally empathized with her, but the reality is that she couldn't! And that's the beauty of it.

There is a power in being powerless. In trusting that someone much greater than you has you in his hands. There is a beauty in giving up the control that we so desperately struggle to have every single day--in joyfully submitting to the power of labor and the divinely inspired design for birth. It is so empowering to be free of fear, in spite of the pain and your lack of control, and to embrace every single moment with thankfulness and trust.

And this is why I love birth so much.

A Birth Story

Madeleine’s Birth, written by Kim
28 June 2010

I got a call at around 5:45 on the morning of June 27th, saying that you had been having some consistent, albeit not too painful contractions since 2:30! You and Rob were both taken off guard because you were expecting the contractions to be coming more like 20 to 30 minutes apart, as opposed to the 5-6 minutes apart that you were experiencing. Since it was obviously early labor (and would be for a long time!), you labored at home with Rob all day.

I got another call that evening a little after 5. You said the contractions were becoming more uncomfortable, and we decided that I should come to your house in a half-hour or so. Christina (the doula-in-training) and I arrived there at around 5:45, and your contractions became more spaced out—up to nine minutes apart! We had a hunch that the new people in the room caused your body to slow down a bit, so you and Rob went for a walk at around 6:30 to try and get things moving again. It seemed to work, because when you got back at around 7:30 you were saying that your contractions were “not fun.” You were coping very well, though, standing up and pacing through each one, sometimes leaning on Rob or against a wall. You also started experiencing nausea around this time. Rob offered to get a saucepan in case you had to throw up. :)

At around 9:00 the contractions were getting more painful and closer together, so we decided to head to the hospital. We walked into the emergency room entrance, and the guy at the front desk tried to make you sit down in a wheelchair to go up to the maternity ward, but your contractions were much more painful when you were sitting, so you fought it. He eventually gave in and let you walk. When we got upstairs, they checked you in to triage, and our nurse, Gina, checked your cervix. Unfortunately and surprisingly you were only 1 to 2 centimeters dilated. This was super discouraging news, but you took it really well. After talking it over with Rob, you decided that you wanted to go back home to continue laboring there.

Shortly after we returned home, your body decided it was time to get down to business. Your contractions almost immediately picked up in both intensity and frequency (though they were never a consistent amount of minutes apart). At around 11 pm you noticed some bleeding when you went to the bathroom. Rob called Dr. Kruskol, who reassured you that it was most likely from the vaginal check at the hospital. You continued laboring upstairs with a fan blowing on you, while munching on frozen blackberries—it was HOT! We placed the exercise ball, which Rob had thankfully blown up earlier in the day, on the end of the futon. You got into a rhythm of lying down on the futon between contractions, and standing up and leaning over the ball during them. You and Rob were both so very tired, since you had been awake and in labor for almost 24 hours. You wanted so badly to be able to lie down during the contractions, but the pain was just too much! You had to stand up in spite of your exhaustion. You were also struggling with nausea, but were never able to throw up and relieve the sickness you were feeling. This was definitely active labor, and you were handling it so well in spite of the heat, your tiredness, feeling sick, and the intense pain.

At around 1 am, I suggested a shower to try and help with the pain, and you reluctantly agreed, but because of the heat it wasn’t much of a help. You and Rob got out after a short 10 minutes or so, and your contractions were becoming closer together, averaging at 4 to 6 minutes apart. We headed back upstairs, but after a several minutes of very frequent and intense contractions, we decided it was time to head back to the hospital.

We entered the emergency room entrance for a second time, and this time you could not talk them out of making you use a wheelchair. So you sat down, but every time a contraction hit, you made the guy pushing you stop the chair so you could stand up and lean on one of us for support. At around 2am, we arrived in triage and Gina checked you again—you had progressed to 7 to 8 centimeters dilated!!! There was a lot of blood, and your very intense contractions were right on top of each other. Your body was quickly approaching full dilation!

We were sent to room 2606, and you were hooked up to a fetal heart rate monitor and a capped IV was put in your arm. You were feeling a lot of pressure and shortly thereafter you began to feel an urge to push. Gina checked you and you were at 9cm. She told you not to push, but you couldn’t help it! I helped coach you through those contractions with light breaths, and finally, at around 3am, you were given the go-ahead to start pushing! That strong urge to push had gone away, though, and you were unsure about how to do it. But after a few good tries you were really making progress. Gina was checking you during one of those initial pushes, and she said she felt the baby’s head move down over an inch! Despite your tiredness and the extreme pain, you had so much power and strength!! The pain of pushing actually seemed to frighten you, but the nurse and I assured you that it was normal, and you buckled down to get your baby out.

At 3:12am Dr. Kruskol checked you and confirmed that you were fully dilated, and the baby’s head was moving down through your pubic bone. We could see her hair and her wrinkly little scalp! You were so focused and determined. Finally, at 3:36am Madeleine was born into the world, and was placed on your chest right away. All the pain and pressure of labor was immediately gone, and you were completely enraptured in your new little one. “Oh my god, she’s so little!” were your first words after seeing her. Rob cut her cord, and you and Madeleine were both anxious to breastfeed as the doctor was stitching you up. When he was finally through, you and Madeleine settled in for a nice, long nursing session. She latched on immediately and nursed contentedly for at least an hour—the first hour of your family’s new life together.

The Big Essay

Down to the wire, I'm getting all my papers and documents in order to send in to DONA after my final birth, which is coming SOON!!! I co-hosted a shower for Chrissy this past Saturday, which was so fun and made me realize how soon her baby is coming!! We'll have our final prenatal meeting within the next week or so, and then we wait... I CAN'T WAIT!!! I'm so excited that my final certification birth will be for one of my best friends--I know she's going to do great!

So I started and finished my big essay today, which will be handed in with a plethora of other documents. Here is it:

The Purpose and Value of Labor Support

A. The benefits of labor support to the mother and her family

For the laboring mother, the advantages of having a doula are great. The mother feels more comfortable with her labor knowing that a kind and knowledgeable woman is constantly by her side. She is able to relax more freely and let go of fear, which decreases pain and speeds up labor. Statistics also show that having a doula present can decrease complications, such as the need for oxytocin and cesarean section.1 In one study, having a doula present showed an 11% decrease in the use of oxytocin and a 10% decrease in cesarean sections.2 Doulas can also greatly benefit the mother’s partner. Though he may love his partner dearly and want to support her as best he can, he has never been through anything like this and may not know what to say or do to help her best. When the couple chooses to have a doula, “the pressure on the father is decreased and he can participate at his own comfort level.”3 And astonishingly, having a doula even has benefits for the baby. In one study, 51% of babies whose mothers had a doula were breastfeeding at 4-6 weeks, as opposed to only 29% of babies whose mothers did not have a doula.4 Furthermore, significantly fewer mothers suffered from post-partum depression, and more reported a positive birth experience in the weeks following their baby’s birth.4 It is very clear that doulas are extremely helpful for not only mothers, but also for their partners and their babies.

B. The purpose behind providing labor support

The birth of her baby is arguably one of the most memorable and life-altering days of each woman’s life. Throughout history, women in labor have without question been supported by other women throughout the journey of childbirth.5 Sadly, the normalcy of this natural and beautiful support system has disappeared from the highly sterile and cold environments of American hospitals. The doula recognizes the need for women to be supported emotionally and physically during labor, and her goal is to provide this support to any woman who desires it. She also understands the need for families to experience intimate connection on the day of their baby’s birth, and her services empower them to have that connection.6

C. The doula’s responsibilities

The doula’s primary responsibility is for her client. She must do everything in her power to ensure that her client has all the support possible, and everything she needs for the most satisfying birth, according to that mom’s expressed desires. As a professional, she also has certain responsibilities she must abide by. She must possess a strong work ethic and sense of commitment to each client. For instance, she should return calls promptly, be committed to sticking to pre-arranged meeting times, and make every effort to assist the mother during the prenatal weeks, labor, and the first few weeks following the baby’s birth. She should have a respectful and courteous attitude toward her colleagues and her clients, and should respect each client’s privacy. She must also remain up-to-date with new developments in her field by continuing education, actively networking with others, and being involved in related organizations. Her fees must be fair, and she should strive to offer discounted or volunteer services when possible.7

D. The doula’s role

The role of a doula is very special and unique because of the intimate nature of the birth process. She offers a minimum of one prenatal meeting, though usually more, to get to know her clients, establish rapport, educate them on the birthing process, and to learn what she would like her birth to be like. During labor, she is with the mother at all times (except for short bathroom or food breaks), providing any support the parents need. This could be giving a massage, counter-pressure, hot/cold compresses, or instructing the partner on how to do these things. She provides reassurance that her body knows what to do, and encourages the mother to trust in the process. She could help with visualization or relaxation techniques that have been discussed at a prenatal meeting, or facilitate the spontaneous coping methods the mother may begin. The doula does not perform any medical tasks, but may guide the mother to ask questions or speak up to her care providers. She provides “support, information, and mediation or negotiation.”8

1. Table 1 in DONA’s Position Paper
2. Klaus ’86, Table 1, in DONA’s Position Paper
3. DONA’s Position Paper, page 2
4. Hofmeyr ’91 & Wolman ’93, Table 1, in DONA’s Position Paper
5. DONA’s Position Paper, page 1
6. DONA’s Position Paper, page 1
7. DONA’s Code of Ethics
8. DONA’s Standards of Practice

My First Birth: A 36-Hour-Long Lesson

Posted with permission.

"I will never give birth without a doula."
~Jennifer, after the birth.

Jennifer's water broke at 3am this past Thursday. 35 intense hours later, her son, Andrew, was born. Here is what I learned.

1. Doulas are crucial for not only unmedicated births, but also--maybe even more so--for births where interventions are used.

Jen and Keenon had been preparing for a natural labor and delivery, and Jen had been reading and practicing Hypnobirthing, which uses relaxation, visualization, and meditation to cope with the pain of labor. Many hours after the broken bag of waters, though, her contractions were just too weak and far apart to be helpful. But the doctor was very patient, and waited until 6:45 pm to start augmentation with pitocin. It took an hour or so for contractions to really get started up, but when they did they were pretty painful, continuing to get stronger and closer as time passed. Jen did an amazing job of staying focused and breathing through each contraction, and Keenon was such a strong support to her. I suggested different positions and tried to create a relaxing environment for them to labor in. When things really started getting intense, she settled in the bed for some concentrated focus and relaxing. I was reading a meditation script to her, which helped get her focused, and after that she came up with her own ritual (a sign that she was really coping well). She started repeating in her head, "in love, out pain" with each breath, as I stood by her side and repeated that mantra out loud. After about eight hours of laboring with pitocin, the nurse checked her and she was still only 1cm dilated. This was awful, disheartening news. The good news was that her cervix was 100% effaced, or thinned out, which is what we had been accomplishing for the past eight hours. This was probably a low-point in the labor--Jen was so discouraged, and in her discouragement expressed that she just wanted to get a c-section and be done. Keenon was also in a state of disbelief, and very concerned for his wife. I knew, though, that they were speaking out of pure emotion, and in the end would most likely regret it if that was what happened. The nurse (who had been rather prickly up until this point) really came through, and with me, encouraged an epidural, some rest, and to go from there. Which brings me to point number two...

2. Epidurals can be very, very helpful.

Under normal conditions, I believe that women have an innate strength to get them through labor, if they are well-educated, prepared, and have a strong support system around them. This was not a normal circumstance, though, and the options were either an epidural and some rest, or a c-section. Thankfully, they decided an epidural would be the best way to go, and this was given at 3:30 a.m.

3. It is impossible to sleep in the waiting room, no matter how tired you are.

Heather (Jen's best friend, who was also a part of the support team) and I left the room so Jen and Keenon could get some much-needed sleep. We begged the nurse for some hospital blankets and headed out to the waiting room. After 2 hours of twisting and turning from floor to chair to small-hard-couch-thingy, we headed back to the room to see how things were progressing.

4. When working as a doula, I hold up just fine on zero sleep.

I walked back in the room, bright-eyed and feeling like a million bucks (well, almost). The nurse came to check Jen at 6am, and she had progressed to four centimeters! The baby was also moving down. This was awesome news! We still had quite a ways to go, but we were making progress. Friday morning was less intense than the night before, but still required constant vigilance and attending to Jen. I felt totally awake and sustained by the prayers of friends who were praying for me and for Jen and Keenon. What a blessing.

5. The "24-hour rule" can be bent if both mom and baby are doing well.

Typically, after the bag of waters breaks, the clock starts ticking--doctors say they will have the baby out 24 hours later one way or another because of the risk of infection. But as we were well past the 24-hour mark and there was no talk of c-section, I was hopeful that her baby could still be born vaginally. (After the birth, I asked a nurse why they let her go so long without operating, and she said it was because the baby's heart rate was strong and Jen was doing really well. It would have been nice to know this was a possibility!)

6. Emotions are ten times stronger when running on no sleep and adrenaline.

We didn't know this at the time, but around 11:00 the doctor had told the nurse to get the papers ready for a c-section and to bring them in for Jen to sign, but to check her one last time just in case. So she came in, checked her, and said, "I don't feel any cervix!" I couldn't contain myself--I was so happy I started crying. They asked, "Is that good?" I said, "Yes, this is so good! We made it! You can start pushing!!" It was a beautiful moment. Our awesome new nurse started rushing around to get the room ready for a baby!

7. Women can be strong. So, so strong.

Before she was checked, Jen started feeling the contractions getting stronger. She started having a urge to poop, and I was suspicious that we were nearing the end (having felt that same sensation not too long ago myself). She started having to really focus on her breathing during each contraction, and soon, it seemed like she didn't have the epidural at all. She also started getting pretty emotional, and losing her focus (which we later discerned was a sign that she was in the transition stage of labor--between 7 and 10 cm). Thankfully, her friend Heather knew just how to calm her down and talk her through it. Then I informed her that the pushing stage was going to get very intense again, and that she was going to have to draw from all her inner strength. The room was ready, the spotlights turned on. Heather and I each grabbed a leg while Keenon stood by her head, and the nurse coached her on how to push. She was in so much pain, and could feel everything, but she was so strong for her baby. For two hours, I counted to 10 for each push, which was 3 or 4 times per contraction. She was exhausted, but so focused, and took advantage of every second between contractions to rest. After almost a day-and-a-half of no sleep and barely any food, I was blown away by her strength. She pushed Andrew out into the world at two o'clock pm.

8. The minutes after birth are the most beautiful, spiritual, and love-filled moments ever.

Their new baby was placed on Jennifer's chest. There were tears, kisses, and so much love between their new family. I was crying and taking pictures, doctors and nurses were bustling around attending to Jen and the baby as she held him. But they were in the zone. Nothing could distract them from the miracle of what was happening. I am so blessed and thankful to have been a part of this incredible journey.

The Doula: Who She is and How She Helps

"Doula" is Greek for "woman's servant." The term today has been adopted and changed a bit to mean someone who helps women in labor. She provides emotional support (caring words, encouragement), physical support (massage, gentle touch), and mental support (education) before and throughout labor and birth. She is well-educated about birth, natural pain-relief and comfort techniques, and how to make the laboring woman feel strong and in control of her body. Her calming presence during labor allows the parents to relax, knowing they have a caring friend who will not leave their side, and someone who will advocate for them throughout this new and often-times overwhelming event. She does not perform any medical tasks; her sole purpose is to be there for mom (and dad), and to make their birth experience as smooth and worry-free as possible.

When I was pregnant, I had a general idea about what a doula was, but I didn't feel like I needed one. None of our friends had had one, and I felt like Greg and I could do it on our own. Which we did, and it was amazing (see my birth story). BUT, looking back, I realize it could have been a lot better if we would have had that extra support-person. Greg was really busy while I was in labor, packing our bags, calling people to let them know this was the day, and dealing with hospital staff/procedures. Not to mention he was super nervous and--dare I say it--a little bit scared. I feel like it would have been a lot less hectic had a doula been there working with Greg to make sure everything got done and that I was being taken care of continuously (I spent a lot of time laboring by myself). Also, since we were only at the hospital for a few hours before Lucy's birth, we had the same nurse with us the whole time. Most of my friends, though, have spent many, many hours at the hospital and have had several different nurses who left them alone in the room so she could take care of other patients. One benefit of the doula is that she is always there, by mom's side.

There are also many very real, tangible, and actually quite astounding statistical benefits to having a doula. Studies have shown that doula supported women have:

Overall, a 25% decrease in the length of labor
50 % decrease in cesarean births
60 % decrease in epidurals
40 % decrease in the use of pitocin
30% decrease in the use of narcotics
30% decrease in the use of forceps*

Can you believe it?! I think that is just plain amazing.

Long-term, mothers with doulas breastfeed longer and with fewer problems, are less likely to suffer from post-partum depression, and in general have better feelings about themselves, their birth experience, and their new family. AND, their babies are more likely to have a greater appetite and fewer health problems at six weeks than their non-doula counterparts.**

*Mothering the Mother, How a Doula Can Help You Have a Shorter, Easier and Healthier Birth by Marshall H. Klaus, John H. Kennell, Phyllis H. Klaus
**The Doula Book by Marshall H. Klaus, John H. Kennell, Phyllis H. Klaus