Vacation

Yes, even a doula takes a vacation.  I have been involved in attending births for 26 years now.   How have I kept myself from getting burned out from my stressful job?  I plan two vacations a year.

I have found that it is not enough to just be off-call because if you are in the vicinity and a labor starts, you will still want to attend.   if the phone rings with a new inquiry, you are going to take it. mif a client has a question, you are going to respond.    So twice a year I call in a backup, make plans with different friends and have a "change of pace" in my schedule.   This also gives me something to look forward to, especially if I have attended several very long births in a row.

When I'm entering hour 30 of a labor that still has time to go, I start remembering i have an upcoming trip.

Living life on call 24/7 for months at a time can wear on you, and cause a lot of stress.  But having a brief time away with no worry about the phone ringing at 2am can have a refreshing effect.  A friend and I recently went to Kauai for 5 days.  Not a long trip but many hours were spent just staring at the waves and sand crabs.  A definite change of pace!

Of course it is costly to take time off but the other downside can be that you worry you have forgotten how to work through a labor.   Tonight I had my first birth after six weeks and was delighted to see that I had not forgotten what to do....and also it was the 795th birth I have attended.
So I guess I have no excuse not to remember how to help.

The next time you are finding yourself in a rut, follow my plan.   Have a vacation! I highly recommend it.

Storms vs Full Moon

We have often heard moms looking at the calendar and declaring their birth will no doubt come on a certain day because there will be  a full moon.

Although I'm sure there is some scientific evidence to prove that this may be true, i.e., barometric pressure changes, I have been in labor floors before with the place empty on the night of a full moon.  I've had moms who were almost 42 weeks and the night of the full moon passed with no labor beginning. I have actually seen more labors start during storms.

Of course this seems very inconvenient since the doula is racing through the rain and wind on wet streets  in the early morning hours to reach the laboring couple - but such is the nature of the job.  And then we can be in a lovely labor room enjoying the birth while the rest of the area has to deal with the storm's fury.

I really don't mind the rain - what I like the least is fog.  There is nothing more scary to me than navigating the causeway at 2am with the fog so thick that you can barely see a foot in front of the car.  I can still remember getting a frantic call from a client at about that time - obviously labor was proceeding rapidly - and I'm trying to get to Davis in a thick fog - quickly but safely - and half asleep.  I'm happy to report I did make it before the baby arrived - but barely.

It would be so handy to be able to predict when a labor is going to begin by looking at the weather report or the full moon listings on the calendar.  But it just isn't that simple.  Babies don't seem to have those at their disposable to use to coordinate their appearance.

So the next time you are starting to drift off to sleep with the rain and wind pounding outside, imagine the doulas navigating the storm to get to a birth.  And rest assured your doula is willing to meet the challenge of dealing with all these situations to be at your side as quickly as possible to welcome the arrival of your little one!

When Your Doula Is Away

As I'm finishing up a well earned vacation, I'm reminded of a common question I am asked.  "What happens if you are not available for my birth?"

Good question.  Having supported families for decades I can say that having to bring a back up doula  into the process is rare.  All hard working doulas take their responsibility to be available very seriously.  That means any plans we make are always "tentative".   We know we are on call 24 hours a day, 7 days a week.   Dental appointments, parent teacher conferences, giving family a ride to the doctor, special dinners out..all have to be cancelled if a family has a need.

But this continuous schedule can be stressful after a long period of time, a break is needed.  I try to get out of town twice a year.   When I return, I'm happy once again to be on call for the families who have chosen to have doula support.

But while away, I make sure that I have a dedicated doula on call for these families.  So what happens if I'm not available?   Another hard working and qualified doula will be available to support them.  

I'm back on call at midnight and continuously until the next great vacation is planned. Thanks to all those wonderful doulas who provide backup so I can get away and regroup! Thanks to all the families who have chosen doula support but also support my getting away for a vacation!

Induction

The word "induction" can strike fear in the heart of many expectant moms.  There are two main fears - that the pain will be unmanageable and that starting with an intervention will lead to many more.

So when is induction a good plan?

No matter how wonderful our plans can be for an intervention free birth - sometimes a mom's health or a baby's health dictate a change in plans.  So when either mom or baby are compromised, an induction can be a good plan.

In working with your medical team, make sure you understand the details.  How will the induction start?  Are there several options in beginning this process?  If one doesn't start labor - what is the next step?  Will this be a slow process allowing labor to kick in - or are there medical reasons that it needs to be moved along more quickly?

Will you be allowed to eat up to a certain point, if labor does not start by evening, do you have the option to turn everything off, shower, eat and sleep before starting again.

What will your limitations be with the method of induction chosen?  Will you be able to move around? Will you need constant monitoring?

These are all questions to discuss to come to a medically sound, safe process of induction.

I've seen many families go through an induction unmedicated and with a happy ending. There are definitely inductions that don't lead to many more interventions.  But if that happens, just keep asking questions so that you feel informed of the choices made.

Having a doula to support you through this process can be a great help.  But in any case, be well - and try not to fear that induction can lead to a bad memory of your birth.

PATIENCE

All parents know how important the quality of patience is needed when raising children.  But where does that lesson start?  Soon after conception.

Are you not sure you are pregnant?  Perhaps you have to have patience in having this reality verified.  Then patience on having the pregnancy become well established.  Patience on telling family and friends may be needed.

Patience on learning if you are expecting a boy or a girl - or even more patience if you decide to delay that information until the birth itself.

But the most patience has to be exercised when the due date is approaching.  Allowing labor to start on it's own can be so helpful to having a safer, easier delivery.  Each day may seem like a year - the phone may be ringing off the hook from family and friends who are just "checking" on you.  This can make it more difficult to be patiently waiting. 

When labor does start - being patient in allowing it to increase at it's own pace is important.
But this can also be difficult.  This can be difficult on the doula also - to be on alert but not needed yet.
But in the end, the more labor is allowed to set the pace, the better the birth can turn out. 

So learning this lesson of patience in pregnancy/labor can be a great starting point for your new life as a parent.  Take a breath - enjoy the lesson - and have a great day!

The Sounds of Labor

In the movies, labors are very noisy with moms screaming at her support people, the medical staff or to no one in particular. But is that an accurate depiction of a labor?  No.  However, labor does have it's own unique sounds.

Some moms find it best to stay very quiet during contractions and just sink into a quiet world while their body and their babies do the work.  Some use rhythmic breathing patterns to focus during contractions. Some find low moaning to be comforting.  And some are more vocal with loud expressions.

I feel all the above are fine.  A mom in labor has to figure out what works for her - and in some cases their own sounds have to give them some type of a platform to stay above the "noise" of their labor going on inside.  The down side to this is that they usually notice a throat that feels a little raw once the baby is in their arms.

How should support people react to the sounds. First of all - allow her to do what feels best to her. But there are times when added direction can be helpful.  If a mom's sounds are in the high, nasal range, I encourage her to bring them low and deep - describing it like a "mama bear in a cave"..  Upper range has a more hysterical feeling whereas the lower range has a more powerful feeling.

If a mom is making sounds that are heading in a more "desperate" direction,  describing that she is feeling "lost", "scared", "in pain", then I try to direct her in a more positive direction of sounds.  When she is saying "no", I encourage "yes"....when she is saying, "this is painful", I may suggest, "this is working" and if she is expressing feelings that she is scared, I acknowledge her fears but then suggest that she is surrounded by support and that she has the ability to do this.  That she is okay.

So - whether you are at a birth that is very quiet - or in a room filled with sounds, remember to respect laboring moms' right to make sounds.  And enjoy the end result - the sound  of a newborn baby!

Medical Team

I was attending a birth yesterday and it reminded me of the contribution a good nurse can make to a great birth outcome.  This nurse was friendly, helpful and loved to support natural births.  She really brought a sense of teamwork to the room.

This birth, as noted by the doctor who caught the baby, was such a peaceful birth.  It was so quiet in the room during the pushing (and there were about 6 members of the medical staff present) that it was funny when someone's pager suddenly announced "low battery".  In the end, everyone was able to share a wonderful birth.

The laboring mom and dad contributed the most to this working process.  But having such caring support from doctors and nurses can make such a difference to how the birth feels. 

So if you are delivering your baby at a hospital, bring the nurses a gift (they love food) and invite them to share their experience and knowledge with you to support your birth.  I always view the nurses as a wealth of information and creating a cooperate team for the laboring mom is so important.  Don't view them as someone to keep out of the room - but someone who can help give you the experience you are working to achieve.

Is this Labor?

As the due date approaches and anticipation builds, an expectant mom is looking for any signs of labor.  It is not just due to her own anticipation, but all the many friends and relatives who are calling, stopping by, and asking, "Are you in labor?"

Don't dare bend over and hold your breath - the onlookers will be quickly dialing "9ll".  Expectations are high.

But labor is a combination of many factors.  It is typically not just contractions.  And as it progresses, the reality that "this is labor" usually becomes very clear without the insistent questions.

Sometimes one of the signs that things are loosening up is the loss of the mucous plug.  Although exciting, does it mean labor is imminent.  Unfortunately no.  I had one client who didn't go into labor for a couple of weeks after losing it.  And she was having her 4th child.  I've also had clients who did go into labor that same day.

So although it doesn't clearly tell you "this is labor", it is none the less a fun sight to share with others in the house (oh yes, many dads have been subjected to observing this progress),  and a topic to share with all the many anxious family and friends who are asking "is this labor?" 

Hang in there - a day will arrive soon when you can answer "YES". 

When Storm Clouds Form

Pregnancy is an emotional time.  There seem to be many moments when things don't appear to be going in the right direction.  Are you dealing with nausea for days - or weeks?  Are the many bathroom breaks starting to wear on you?  Sleep is becoming a distant memory.

Bigger issues are dealing with doctor's appointments, what will the hospital policies be and how will you cope with everything?  The expenses climb - the anxiety climbs - storm clouds forming on the horizon.

But I was thinking about literal storm clouds tonight.  I see many labors start when there are big storms. The change in the barimetric pressure can cause the water to break - so during some of the worst storms - families and doulas are heading to a hospital.  But it also makes for a great story. 

Just as a storm passes and clears the air - emotional times of pregnancy pass and settle into a calmer time.  So literally as the "sun will come out tomorrow", keep moving forward, have a confidence about the future.  When storm clouds form - a bright sky is in the future!

When A Doula Misses A Birth

This might seem like a strange topic, but in almost every interview I've attended, one of the questions is "Have you ever had two moms in labor at once?"  After over 750 births, the answer is a resounding "yes". A few times,  3 moms in laboring stages at once.  What does a doula do?

We have to have qualified backup to make sure that families who are expecting doula support for their birth - have doula support for their birth.  So a doula's backup is a very important person.  She allows a doula to take more than l birth a year - or a vacation once in awhile.  Or even to get through something like a bad cold.

Expectant moms understand that even though they may have a primary OB, many, many times they are uncertain that the doctor doing the delivery will be their primary or even perhaps a doctor they have never met.  It will be the doctor on call that day.  That is one reason some families look for a doula - to have a person in the room that they know, have developed a trust in before the birth.  It is a privileged responsibility that doulas take seriously.

In many years of attendiing births, I have a very small amount of times I have had to use a backup.  Thankfully. But it can happen and having someone who is willing and able to run to an unexpected birth, of a family that they've not met, is amazing.  And in my experience, families love the backup and are grateful for the support.

But how does the doula feel when she has to send backup.  Sad.  After months of preparing to support a family through their birth, it is so disappointing to be somewhere else and get the messages of the progress of the birth.   That has happened to me twice in a month and I have to say it has been hard to miss the births.  Of course the families have loved their birth and their doula support - which tells me that the wonderful doulas I use as backup are well qualified - and great!  But it has been so disappointing to not be the person in the room sharing the journey.  I'm just glad I'm the disappointed one - not the clients.  I'm looking forward to many more exciting birth journeys - and to hopefully making the rest of my births this year without need for backup!  But if I do need to send someone else, know that it will be  a wonderful doula.

Re-framing A Birth

Birth memories can leave us with a smile on our face - or we could be left with a sense of trauma that we don't want to remember.  I began this journey of supporting families through labor to help a family "re-frame" a birth.  Since birth, like life, has ups and downs, how do we re-frame it?

During a labor, there are usually moments of frustration, concern, tears....when a family's memory highlights those moments, it can damage their birth memory.  There are usually also moments of laughter, joy, excitement.  Though these may be momentary (such as between a contraction), what if that is your overall memory of the birth.  This feels valuable to me.  We carry our birth memories the rest of our lives.

So I like to remind families of those light moments - even sharing in them during the birth.  I have found over the years that moms are so powerful when working through labor - and dads are so supportive and concerned.  Why not emphasize these characteristics?  What if a couple who had to make very tough decisions during the birth, still came out of it with a sense that they made good decisions for this particular birth and this particular situation?  Would that not "re-frame" their overall view of the outcome?

Birth memories are important - not as important as your healthy child in your arms - but important still. So if you want help in "re-framing" your birth, I hope you'll consider adding a doula to your birth team.

A Female Voice

I've always felt the most important support person in a room is the dad.  But one thing they can't bring to the support is a "female voice".

Why does that seem so important?  Moms in labor can feel very isolated and although they need reassurance and guidance, there are times when they need a female voice.  Your husband saying "you'll be okay" does not have the same impact as a woman who has been through labor who says "you'll get through this - it'll be okay". Could be compared to you and your husband backpacking on your own into an isolated area - versus having a trained guide helping you navigate the path.

This does not discount the need for reassurance from the dad - not at all - but having a female voice can be that added support that helps a mom over the rough spots.

Does it matter who the female voice is?   Henci Goer in "The Thinking Woman's Guide to A Better Birth" put up a comparison chart of labor support from a female relative or friend or a doula.   One of her comparisons is that a female relative or friend "may have beliefs and experiences with labor that may color her behavior and bias her advice".  However, a doula "knows you but the fact that you have no ongoing relationship means you don't have to perform for her or worry about what she might think of you."  Also a doula "knows about labor, techniques to promote good progress, and comfort measures. She can help facilitate communication between you and your caregivers.  She too provides a loving touch."  Of course, some relatives or friends can provide great support, and a female voice. You know best who you want to provide support during this journey.

So when you are planning your birth team - give consideration to a female voice, along with your husband.  And talk to other families who have added a doula to their birth team and listen to their experiences.   Here's hoping the voices you hear in labor will guide you to a wonderful experience.