Category Archives: Labor

Natural Disaster Labor

In the wake of hurricane Irene, the US’s East Coast is riddled with anxiety and fear. It’s been a tough week for us, given that natural disasters really aren’t our thing. The last hurricane to threaten the eastern seaboard was over 20 years ago when Gloria gifted us with a tropical storm in 1985. Add to that Virginia’s earthquake earlier this week that sent risidual tremors along the East Coast and many southern states, and we’re in panic mode here. News reports tell us what we should have on hand in the event of an emergency, but what about women who are full term in their pregnancies?

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Lakeisha Dennis, of Lighthouse Birth Services @DoulaonDuty, brought natural disaster births up on Twitter this morning. What happens to a mom if she goes into labor during an earthquake, hurricane or snowstorm? What does she do if she can’t get to her support, or if her support can’t get to her?

Here are a few things you should consider including in your emergency birth kit in case you go into labor without the ability to head to your birth place (or have your team come to you).

1. 3 gallons of water – mom will need to stay hydrated during labor, and will need extra water for cleaning both during and after the birth if she desires. Keep an additional gallon of water for each person present.

2. Canned fruit, nuts, vegetable chips, and other non-perishable healthy foods to last at least 3 days.

3. Disinfectant – in the event that you have no running water, you don’t want to waste your drinking water washing your hands.

4. Dental floss – you can use dental floss to tie off the umbilical cord once it stops pulsating if you choose to detach it.

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5. Large garbage bags – aside from their normal use, plastic bags can be used as lining for your furniture or floor as a protective layer against fluids.

6. Sheets that you don’t mind ruining – you can use these on which to labor, in addition to staying dry and warm. Old sheets are also great for cleanup, because you can toss them when it’s all over!

7. Towels – have several on hand for cleanup and staying dry/warm for both mom and babe.

8. A few sets of clothes – there’s nothing like searching through a dark, flooded or otherwise damaged home to find clean clothes in an emergency. Keeping protected, clean sets with your emergency birth kit will help you greatly in your time of need. Remember to include baby clothes and diapers

9. A mirror to go with the flashlight you’ve already got in your emergency kit. During labor, you may need to see what’s happening around your vulva, especially if you are birthing alone. With a 40-week belly, a mirror will help you get a handle on what’s going on down there.

10. An extra fully charged battery for your mobile phone – in the event that you have service, but no electricity, you’ll be happy that you set this aside to be able to reach out for help!

Although these are some great things to keep in your kit if you can, you’ve also got to be prepared to use them! Check out Penny Simkin’s Birth Partner; she’s got great advice for what to do during an emergency birth.

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Also, speak with your provider about a contingency plan. If you’re birthing at a hospital or birthing center, what happens if disaster strikes if you are either already there in labor or in labor at home en route to your birthing place? Speak with your midwife about what to do in the event that neither she nor her backup can make it to you during a disaster. Ask your doula about how her services might change during an emergency.

What Not to Ask Your Doula

There are many lists and resource guides about what to ask your prospective doula when you interview her. I’ve even included a post here about asking whether or not your doula can help you apply for reimbursement from your insurance company for her services. I can’t say that I’ve seen any lists advising parents what not to ask their doula, however. I’m happy to have the honor (grin).

Every woman comes to her birth filled with experienes that have gotten her to this point. Because of her experiences, she expects her birth, and conversely, her birth team, to pan out in a particular fashion. Birth plans are an important part of birth that are often overlooked, and I can’t think of one doula that I know that doesn’t promote them in some way. Women also want the members of their birth team to have a certain level of experience, whether professional, personal or both. For some women, that means being surrounded solely by other women. For others, it means hiring a doula that has attended a certain amount of births. Still, there are many women who prefer to hire a doula that has labored and given birth herself. These are all valid desires. Birth is an extremely vulnerable situation, and a woman absolutely deserves to have her needs met during labor.

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Part of our training as doulas includes effective communication. We learn to be aware of our facial expressions so we don’t offend clients as they share personal information. We learn to be active listeners so that, even if we have given birth ourselves, we allow our clients to have their own experiences. We even learn to keep our own tempers under control when something happens that would, under different circumstances, drive us crazy.

So, why this post? It’s been my experience that women who are TTC form bonds and support each other through the turmoil. However, it’s also been my experience that women with successful pregancies sometimes forget (and rightfully so!) the ups and downs they’ve shared with their sisters in the struggle for what, for some, has been years. Pregnant women have graduated TTC college, and have every right to enjoy their pregnancies with other pregnant women. Along with that, they have every right to want a doula who has experienced pregnancy and labor herself. But mamas, please consider the following.

A childless doula may not have children because she simply doesn’t want any. The doula you’re interviewing may not be able to conceive. The lovely woman sitting across from you at the coffee house as you feel out her qualifications may be overcoming the heartache of a miscarriage. She may be a single woman who wants children, but can’t afford artificial insemination or IVF. The woman who scores high in every area on your checklist except for whether or not she has children may have given birth to a baby that didn’t survive.

Does this mean you should stop caring about whether or not your doula has children? Absolutely not! Your desires are yours, and you deserve to have your needs met by all means. Do continue to ask ask, “Do you have chidren?,” as you interview. Please do not ask, “So, why don’t you have kids?” It may seem like a harmless question, but it’s one that could have devastating effects on a doula who planned to have a lovely afternoon chatting with you.

“Mother is Worthy to be Praised”

This Memorial Day Weekend I went to see Dance Africa at the Brooklyn Academy of Music.  As usual, the dances were amazing.  What stood out to me most, though, wasn’t the dancing at all.  Through the clapping, shouting and audience participation, I noticed the stretchmarks on one of the dancer’s bellies.  Things suddenly began to move in slow motion for me, almost like when Maria and Tony see each other at the dance in West Side Story.

I realized that I was watching a mother, and suddently felt some cosmic connection to her.  I began to wonder whether her children were in the audience, how old they were, or if any were possibly sharing the stage.  I wondered how she was able to find time to do something so magnificent with herself while conducting a family.  I wondered whether or not she raised her children, or if they knew how talented their mother is.

At the end of the show I stood in applause. Of course, the round was for all of the dancers, musicians and singers who graced the stage.  There was, however, a special beat in my heart in praise of the woman I had identified as a mother.  I’m sure she wasn’t the only mother on the stage.  In fact, the audienced was sprinkled with mothers holding small – and not so small – children.  If I was surrounded by mothers, what made this one so different?

During a time where it’s almost impossible to watch television for an hour without a cocoa butter or other stretch creme commercial promising to help women either prevent or erase their stretch marks, I found it amazing that this mother proudly bore the marks of her birth(s).  Just as waist beads, hair style, or jewelry denote status and rites of passage for women in traditional African cultures, so, too, do stretch marks. 

Watching this mother’s belly flap to and fro across the stage brought me back to the precious moments immediately following birth where a woman bonds with her baby face to face for the first time, and took me to the moment that I observe in so many women when they realize their bodies have undergone an amazing change; she not only birthed her baby, but she birthed her motherhood as well.  So, I stood and clapped that Monday afternoon in praise of motherhood.

These last few days I’ve been in reflection mode.  In reviewing both business and personal goals, the one thing that keeps coming back is the Yoruba proverb that’s the inspiration for my doula practice:

Oria bi iya ko si, iya la ba ma a bo

There is no Orisha like mother, it is mother who is worthy to be praised.

Praise mothers.  Praise them for the weeks they carry and nurture their children in waiting.  Praise them for the sleepness nights they endure for so many years of their lives.  Praise them for the decisions they make that often leave them holding the shortest stick in the bunch.  Praise mothers, simply because they are worthy to be praised.

Don’t Give Your Voice Away, Not Even to Me

Every once in a while during a consultation a mom will ask me, “…and you’ll be able to speak to the hospital staff for me, right?” In response, I smile and tell her that I do not speak for her, but rather show her how to advocate for herself and her baby.

Communication is key in everything we do. Sometimes, as women, our voices have been silenced – by our families, society at large and even by our partners. Someone often thinks they know better than we do, and can show us the best way to handle a situation. A lifetime of learned helplessness doesn’t vanish when we become pregnant. If anything, our insecurities are multiplied. We learn to distrust our instincts and our bodies.

What does mom need to speak up about?

I always tell moms to research any information they’re given, even when it’s coming from me. All too often, we listen to “experts” without using our critical minds to question what’s being said. We spend more time researching the kind of car we want to buy than we do research regarding our health and wellbeing. It’s important for moms to question and ask for more information from their care providers, because care providers often turn questions into statements or commands.

For example, “I’m going to break your water now, because this will really help things get going.”

This should be a question: “You’ve been at 7 centimeters for 5 hours now. I think breaking your water will help to speed things up. What do you think about that?”

See how the latter asks mom for her input? She even has a chance to decline. The former, on the other hand, leaves no room for discussion. This is where mom has to feel empowered enough to advocate for herself. She could stop and ask for more information – risks vs. benefits. She could also ask what other interventions, if any, the recommended intervention may lead to. Breaking the sac before mom is 10 centimeters often leads to a fetal scalp monitor, an intrauterine pressure catheter and a foley catheter to channel urination. These interventions are often left out when the care provider walks in with a smile ready to rupture your membranes.

Why can’t the doula ask these questions?

There are some doulas who offer to speak for their clients. I think that’s just as much of an injustice as the rest of the world taking away a woman’s voice. The issue with asking or expecting your doula to speak for you is simply that she isn’t you! You run the risk of turning your experience into someone else’s when you give up your voice. You may be opening the door to allow your doula to relive her own birth experience through you. You create an atmosphere where it’s possible to not have your best birth when you give up your voice. If you relinquish your voice during labor, with what voice do you plan on raising your child?

So what do I do?

During your prenatal visits with your doula, ask her to help you role play different scenarios. Start simple with things like drinking and going to the bathroom, to more complex like negotiating interventions and holding your baby. Create code words with your doula so she knows if you need help making a decision (and by help I don’t mean the, “What would you do?” kind of help – but asking the doula for more information about a topic to help you make your own decision). Write a birth plan so you can see on paper what you’re expecting from your birth. Use your birth plan to ask questions of your care provider during prenatal appointments so you have clarity before you go into labor.

Don’t be passive-aggressive about your desires, discuss them upfront. I’ve seen too many moms simply email their birth plan, or bring it to the hospital while in labor; these types of plans often go unread, and mom is displeased with her birth experience. Your care provider works for you! Have the necessary proactive conversations before you go into labor. You should also register for an out of the hospital childbirth education series to help you resolve communication issues.

“Birth is powerful, let it empower you.” author unknown

Preconception Planning II – spiritual understanding

As soon as I completed the previous article, “Preconception Planning,” I remembered a great story that a sister doula – Amadoma Bediako – shared at a Health Conference. She recounted:

There are a people in West Africa where a baby’s birthday isn’t the day she’s born, but rather the day she became a thought in her mother’s mind.

The story continues:

Very Early Parenting: An African Model
A Child’s Song

There is a tribe in Africa where the birth date of a child is counted not from when they’ve been born, nor from when they are conceived but from the day that the child was a thought in its mother’s mind.

And when a woman decides that she will have a child, she goes off and sits under a tree, by herself, and she listens until she can hear the song of the child that wants to come. And after she’s heard the song of this child, she comes back to the man who will be the child’s father, and teaches it to him. And then, when they make love to physically conceive the child, some of that time they sing the song of the child, as a way to invite it.

And then, when the mother is pregnant, the mother teaches that child’s song to the midwives and the old women of the village, so that when the child is born, the old women and the people around her sing the child’s song to welcome it. And then, as the child grows up, the other villagers are taught the child’s song. If the child falls, or hurts its knee, someone picks it up and sings its song to it. Or perhaps the child does something wonderful, or goes through the rites of puberty, then as a way of honoring this person, the people of the village sing his or her song.

And it goes this way through their life. In marriage, the songs are sung, together. And finally, when this child is lying in bed, ready to die, all the villagers know his or her song, and they sing–for the last time–the song to that person.

You can read more about the author, Sobonfu Somé, here.  I thought this was so amazingly beautiful, and made perfect sense to me.  The moment we begin thinking about TTC, a connection is made.

As she told this story, it made me think of traditional Yoruba concepts of preconception.  Two key principles of Yoruba traditional religion are the beliefs in reincarnation and destiny.  It’s believed that, before we are born, our souls reside in heaven with a spiritual twin.  When we are born, so enters our soul into the world with the first breath we take.  The spiritual twin, however, remains in heaven awaiting our return (death).  During gestation, our souls are in heaven completing specific tasks and rituals to seal our destinies before taking the journey to earth.  You can read more about this process here.

What does this have to do with preconception planning?  For those following the Yoruba spiritual path, it’s important to remember that our pregnancies are joint journeys.  Understand that your baby chose to reincarnate into your family, and is experiencing spiritual development throughout your pregnancy.

I often tell moms that I believe birth is spiritual.  No matter what your spiritual or religious tradition is, wouldn’t it be cool to know the beliefs around pregnancy while you’re TTC?  We watch our health to prepare our bodies to house, protect and nourish our babies, but it’s equally important to watch our spirits.

 

Purple Pushing: Just Say No.

What’s purple pushing (PP), you ask? It’s the moment in labor when care providers instruct you to hold your breath and bear down as hard as you can until they tell you to stop. Often, women are given just a few seconds to catch their breath in between bouts of PP. Some moms, depending on how light skinned they are, will actually turn purple during this stage.

So, why say no to PP? One of the things that we teach moms during childbirth preparation is to breath deeply, but not too quickly, to avoid hyperventilation. Mom’s breathing is the baby’s oxygen supply, and one of the last things we want during labor is for the baby’s access to air being compromised. Why, then, would we want moms to literally stop breathing during the most stressful moments of birth? No coach would ever tell their star athlete to hold their breath before making a play, I’m not sure why we think it’s a good idea for laboring women.

On second thought, PP isn’t about the woman at all! PP is part and parcel of managed care and the belief that someone outside of our bodies knows our bodies better than we do. PP usually happens in hospitals, where care providers have been trained to “deliver” babies of medicated mothers. In the hospital, things must be done as quickly and safely as possible. It fits perfectly into the equation when moms are instructed to push as soon as they dilate to 10, because the process will be over quickly once the episiotomy has been performed and your baby “delivered.”

During natural birth, a woman will feel the urge to push. It’s a natural, normal feeling that lets you know that something needs to exit your body. She will usually feel the urge when she’s fully dilated, but I’ve labored with some women who felt the urge as early as 4 centimeters. However, a mom who is numb due to medication won’t feel the urge to push. She will need to be told what’s happening to her body – when she’s having a contraction, when and for how long she should push. Doctors are taught to work with these moms, and so most moms are treated as though they’ve been medicated when it’s time to push. A natural birthing mom who has been educated and prepared for birth doesn’t need to be told when and for long to push. She will feel and be in communication with her baby.

Imagine, for a second, a comparison. You’ve had a meal, and 45 minutes later someone tells you it’s time to poop. You don’t feel anything, but you head to the bathroom anyway. 5-10 people crowd around your toilet bowl, and instruct you to push under bright lights. Not only are you uncomfortable, but now you’re working against your body that hasn’t yet given you the signal that it’s ready. You will have a traumatic bowel movement, and may even tear your anus due to excessive pressure. On the other hand, you can wait until you have the urge to go, head quietly to the loo on your own terms, and simply breathe out your waste without as much effort. Granted, a baby isn’t exactly the same, but the logic is.

When a mom is on her back, and being coached to PP, the baby is put in danger. Gravity keeps weight down on the baby, and increases the risk of compromised oxygen to the baby by creating pressure on the umbilical cord. This is true before mom even begins to PP. Add to that a mom who is holding her breath, and it’s no wonder that hospital born babies (those born to healthy, low risk mothers) are so closely monitored after they’re born.

Now, if I’m saying, “Say no to PP,” there’s got to be an alternative, right? You betcha! Left to her own devices, it’s extremely rare that a birthing mother will naturally bear down. She may grunt, scream, moan or simply breathe – all perfect ways to push. I’m reminded here of a mom who beautifully groaned throughout her labor, and finally pronounced, “I have you push,” to which her midwife responded, “You’ve been pushing.” The media, even when we think we’re beyond it, shapes our understanding of birth. Mom was expecting someone to tell her to hold her breath and count to 10. Realizing that PP isn’t the only way to push is half the battle.

We can take back our power! If you’re birthing in a hospital, there’s nothing that says you can’t take the initiative and get on all fours if you want, or that you can’t ignore the care providers when they tell you how to push. The key is having a great support system during labor – your cheerleaders who know exactly what you want the experience to be like for you under normal and safe circumstances. Hire a doula, take independent childbirth education/preparation classes, and have a plan for yourself.

The Magical Properties of Hugs

View the story here

There are so many mysteries to life that I doubt we will ever truly understand them.  As a doula, I believe completely in the power of touch.  I’ve seen time and time again how a simple brush of the brow, holding a hand or stroking a back can be all a person needs during a tough time.  After reading this story of a mom who birthed a baby that was pronounced dead brought him back to life simply by holding him for two hours.  She didn’t intend to bring the baby back, but absolutely intended to shower the baby with love.  How beautiful that she was able to be with her baby for so long!  I wonder what would happen if we slowed down a bit in the States and paid less attention to the clock.  Happy Birthday, Jamie Ogg!