Category Archives: Women’s Health

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.

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“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.

African-American Women and Breastfeeding

I’ve read the standard books on breastfeeding that outline the benefits to both mother and baby. My most recent read is Black Woman’s Guide to Breastfeeding by Katherine Barber. Barber writes an amazing guide that details why it’s so important for Black women to breastfeed.

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Barber states, “African American infants are twice as likely to die before their first birthdays as white infants…have the highest rate of asthma, severe asthma, and mortality caused by asthma than any other race…have a 20 percent higher occurrence of childhood obesity than white children…[that] African American women are 2.2 times more likely to die from breast cancer…[and] are 30 percent more likely to die from ovarian cancer than white women.”

So, what do these stats have to do with breastfeeding? The numbers drastically decrease when mothers share what nature intended for their children. Before downloading this book for my Kindle on Amazon.com, I read through some of the reviews. One woman threw her two cents in by explaining that this book promotes separatism, because all moms need support when it comes to breastfeeding, not just Black women. This reviewer was quickly schooled, thankfully, by other moms who explained that African American women do, in fact, have special needs when it comes to breastfeeding.

Almost half of African American mothers choose not to breastfeed their children, and the health repercussions of such a decision usually aren’t discussed in mainstream breastfeeding books. Often, women choose against breastfeeding because they’re afraid of pain or discomfort, have been convinced that formula is just as good as mother’s milk, or a host of other reasons that attest to being unaware of both the benefits associated with breastfeeding and the risks of not doing the same.

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In addition to being a great resource that breaks down why it’s so important that Black women breastfeed themselves, this is a book that belongs on every reading list for birth workers throughout the United States. As birth workers, we must understand the challenges that Black women face when it comes to breastfeeding, and be armed with facts that help us inform mamas about the benefits of breastfeeding. If you haven’t read Black Woman’s Guide to Breastfeeding yet, what are you waiting for?

Your Child is What You Eat

In my childbirth education classes I speak with families about the importance of maintaining a balanced diet. We talk about all the goodness and gold awaiting us in vegetables and herbs, and go over the importance of understanding what we put in our bodies to stay healthy. However, where I – and many educators – fall short is in not discussing the implications on our children of how we eat.

Often, care providers will monitor a woman’s intake to make sure that she isn’t put at risk for labor and delivery. However, there may be possible risk to the lives of our children when we aren’t aware of the effects of the foods we eat. For example, most pregnant women are told to avoid salt to reduce the chances of preeclampsia or other pregnancy related illnesses. However, pregnant women who consume excess salt may predispose their unborn children to adult high blood pressure. Likewise, a woman consuming too much sugar may alter her child’s possibilities of being diagnosed diabetic.

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In the natural birth world I feel like we do a great job of helping parents understand the effects of manufactured medications used during labor on unborn babies. Parents often know THAT they should eat better, but often don’t understand why. We must do a better job of helping our families make better food choices when possible. I read an article in The Huffington Post titled, “To Eat Artificial Dyes or Not?” It would be a great follow-up to this blog to understand how dangerous something as common as an M&M can be.

Preconception Planning III: More Trying and Less Conceiving

TTC can be the most emotional time of a woman’s life, especially when trying for several cycles. The moment your uterus begins to shed its lining you feel that nature has betrayed you. For some, it feels as deeply as the loss of a child.

We’ve all memorized Taking Charge of Your Fertility, and know by heart which links to click on Mayoclinic.com. We can read basal body thermometers in the dark, and chart temperatures with our eyes closed. And when we realize that we touch our cervixes more frequently than scratching our noses, it’s clear that we’re experts in knowing what’s going on with our bodies to recognize ovulation signs.

There’s advice about the best time to take your temperature, how often you should check cervical mucus (CM), how to interpret your charts, and the best time of day to use an ovulation predictor kit (OPK). But what happens when these things aren’t coming together like the beautiful celestial chart that they’re supposed to form? Shouldn’t these methods be fool proof?

Here’s what you don’t get along with the advice: not every woman has egg white cervical mucus (EWCM), and the OPK may not detect your hormone levels clearly.

I can’t stress enough how important it is to begin charting your temperature months before you begin actively TTC, especially if your cycle isn’t very predictable (I hate to think of my cycle as irregular!). Become comfortable with analyzing your charts, and seek expert help when things don’t make sense to you. Pay attention to the moistness of your vulva the days following menstruation, and try to notice whether or not you feel any slight cramps the more moist you become (without stimulation). Before you know it, you’ll be able to feel your body releasing an egg (or two!).

Learn to differentiate between your own CM. Recognize that as your body matures your CM can change (I haven’t had EWCM since my early twenties!). Some women go from dry, to watery to creamy and never experience sticky or EWCM. Some women go from dry, to watery, to EWCM, to creamy then sticky. Some women’s bodies may do something different all together. If you’ve been paying attention to your body for months before trying, you’ll know your cycle and won’t be waiting for EWCM when watery may be your ovulation sign.

Practice peeing on different brands of OPKs. You may notice that as you approach ovulation a faint pink line appears, grows darker over the course of the next 3-4 days, but never quite matches the test line. Does that mean you’re not ovulating? It could mean a number of things, and you should speak to a specialist to help you understand what’s going on. Some women never match the test line, and the faint line is their ovulation sign. I’ve only tested positive once with an OPK, and the positive result appeared after my temperature had already spiked. Go figure!

Sometimes we end up trying so much (unsuccessfully) because we aren’t interpreting our signs accurately. Sometimes we don’t trust our bodies enough to believe what they’re telling us instead of an OPK or someone else’s assessment. There are also times when this isn’t so cut and dry, and that may be a sign of something else going on. It can be hard to stay positive when you try cycle after cycle, especially when it seems like people around us get pregnant without even trying. But staying positive is a must!

Here’s to more conceiving after so much trying.

Bargain With Your M.D About Fees?

One of the longest standing battles in the birthing community is over ducats.  Should we charge, and if so, how much?  Are we obligated to do volunteer births, and if so, how often?  Health insurance in the United States doesn’t cover doula services (although you may be eligible for reimbursement, find out more here) so these discussions will never go away.  One strong argument from experienced doulas draws a parallel to sexism when it comes to doulas setting fees.

Our profession has historically been and is currently largely made up of women.  We’ve been socialized to meekness, to always seek acceptance, ever offering apologies, and not wanting to rock the boat.  We give of ourselves before giving to ourselves, leaving us burned out too fast and too often.  Pregnant women are comfortable asking doulas to lower their fees (or to provide free service), or to throw in a few extras; seldom do women (or men, for that matter) ask this of men who provide services.  No one expects their mechanic to voluntarily change their oil because they’re going through a rough patch.  In fact, people would run away from a volunteer mechanic thinking, “Something’s gotta be wrong!”  Part of the paralleled sexism argument is that we don’t haggle with our care providers.  At least we didn’t.

According to Dr. Jeffrey Kullgren, we should try!  Dr. Kullgren is, “an internist and clinical scholar at the University of Pennsylvania, [and] specializes in research on the impact of consumer-driven health care.” Now that insurance companies are cutting back on what they cover (not to mention the increase of uninsured in the US), more folks are left paying for health care out of pocket.  Dr. Kullgren suggests that patients be upfront with their care providers about their financial situations, and ask for the discounted rate whenever and however they can.

Where does this leave women during the perinatal period?

Some care providers are so used to ordering tests and writing prescriptions without thinking about cost because 1) their assumption is that insurance will pay, and 2) they’re not trained to even think about the business aspect of medical care!  If you have to pay a portion (or all) of your health care out of pocket, ask your provider if each ultrasound that’s ordered is necessary; or ask to be checked with a fetascope or doppler if possible.  If your provider is prescribing prenatal pills, ask for the generic brand.  You can also ask which over-the-counter prenatal pills or herbal supplements are recommended.  If you’re facing an induction or surgical birth, find out what your insurance covers and what it doesn’t; some companies are refusing to cover elective cesarean surgery because it is so expensive.

You can also seek a midwife during pregnancy.  Midwives aren’t just for home birthing families; midwives work in hospitals and birthing centers as well.  A midwife’s fee is far less than an OB/GYN’s fee, and their care tends to be holistic more often than not.  So there you have it, ladies – grab your ovaries with gusto and don’t shy away from speaking about finances with your OB.  If you’ve come to expect volunteer or low-cost doula services, don’t let your care provider off the hook for billing you up the wazoo.

Read more from The New York Times here.

Do Pregnant Women Lie About Smoking?

I’ll never forget the day that I walked by a student of mine who was about 6 months pregnant, yet smelled of fresh cigarette smoke.  I asked her if she had been smoking before coming into the building, and she honestly responded that she had been.  However, she assured me that she was trying to quit for the sake of her baby.  It became an unconscious habit of mine to inauspiciously sniff her each time we came into contact; she hadn’t quit by the time she went on  maternity leave.

These days, smoking is highly stigmatized.  I remember being in elementary school and buying cigarette gum from the ice-cream truck, or pretending that pretzel sticks were cigars on the school yard during recess.  I smoked my first real cigarette at age 12.  The tide slowly began to change, and adolescents began to see smoking not just as a health risk, but as simply not cool.  Throughout my twenties I struggled with quitting; I could go a few months here and there without buying a pack.  And, I must admit that New York’s no-smoking law kept my habit from spiraling out of control.  Even still, as a non-pregnant woman, I did everything I could to hide that I was a smoker.

A recent study shows that 13% of 994 surveyed pregnant women were active smokers, and 23% of that 13 reported that they didn’t smoke.  Researchers tested levels of cotinine, “a biological indicator of tobacco exposure,” in pregnant women revealing their exposure to cigarette smoke.  The sample is nuanced, however, because there’s no way to distinguish between first and second hand smoke based on levels alone.

One thing is clear, there’s definitely help for smokers trying to quit – pregnant or not.  Smoking while pregnant isn’t a crime (at least not yet!), so lying about it does no good.  If you’re pregnant, addicted, and struggling to quit reach out for help.  Many (all??) states have free cessation programs, so seek support not just for your baby, but for you!

Read more here from The New York Times