I got the following email and although it's a quick reply, I thought I would share it with y'all (with Stephanie's permission), since some others might be curious too.
Hello!
I have been a stalker on your blog for a while now, and I am just now getting the courage to write you. My name is Stephanie Fritz. I am currently a senior in the Sociology program at the University of Indianapolis. Over the past two years I have become increasingly fascinated with the reproductive rights of women, and alternate services provided to women during the pregnancy process. I have become increasingly fascinated with the concept of home birth, midwifery, and doula services. I am far from becoming pregnant or even considering having a child, but I have begun considering doula training. I have looked into the different programs for Doula training out there (particularly DONA), but I wanted your opinion on where I should start to find out if this field is truly for me?
I guess my main concern is the viability of it as a career. How are you faring? Also, how did you fall into this?
Thank you!
Stephanie Fritz
Why did I bold that one sentence? I wanted to respond to this part first and foremost. The biggest piece of advice I have for Stephanie, far more important than sorting through the various programs and certifications and reading materials, is to ABSOLUTELY go for it now! The fact that you haven't given birth, in my opinion (I'm curious to hear others' opinions too), is really not much of a disadvantage at all. Doulas attend all kinds of women having all kinds of births, even if they are mostly in the hospital, realistically speaking.
I have had one birth of my own, and even if I only attended all natural home water births, they would still all be different. Mine was 13 hours in active labor. Very different than a 29 hour labor. Very different from a 5 hour labor. Yes, I know what 'a' contraction feels like . . . but that means I only know what MY contractions felt like. I have no idea what a a posterior baby and thus the dreaded "back labor" feels like from the inside. I didn't have to transfer, no resuscitation was necessary, I had an extremely long pushing phase, there are all kinds of things I didn't experience firsthand. You catch my drift: having had ONE birth isn't all that different from having NO births, in a weird sort of way.
But my main point to you, Stephanie, is that having no children at the moment is actually a huge, HUGE advantage, logistically. It might not seem like a big deal to you now, because you've never had to think about it, but trust me, having to arrange for child care in order to attend births can be a massive, stressful undertaking. There are work and class schedules to deal with, and I've so been there and know what a whopping headache that can be, but it's still more workable than a doula with kids (unless she's independently wealthy, I suppose). To illustrate that, I should remind you that I'm actually still IN training for the labor support portion of my doulahood, largely because figuring out how to attend the necessary number of births for my certification is ridiculously complicated due to child care issues.
I could kick my twentysomething self for not having started this process years and years ago, when I first became aware of the concept of a doula. DONA itself was newish, and within a year. three of my closest friends all got pregnant. I had always been fascinated by birth, and now my interest kicked into high gear. I learned along with them, reading the Searsbooks and "Natural Childbirth the Bradley Way" by Susan McCutcheon. I had plenty of dancing left to do, but definitely felt a strong pull towards birth even then, and one of the mamas-to-be was the first to suggest doula work. I considered it, and ultimately decided against it for the time.
I hate to say I regret the decision, since regret is such a waste of energy, and it's true that I did have all kinds of other experiences . . . but it really would have been a good choice. So I say if you're feeling that same kind of pull - go for it! Especially now.
Which organization? I can't say enough nice things about toLabor's workshop. I did DONA's postpartum training and have been working through CAPPA for my childbirth ed, and I think they all have their strengths, but toLabor was truly a transcendent experience. Do consider it! Reading recommendations: there are of course tons of great books out there, my favorites of which are over there on the right, but I'd prioritize the latest edition of "The Birth Partner" as well as "The Doula Book" by Ananda Lowe.
As for making a career out of it? I'll . . . have to get back to you on that. (See above re: logistics and childcare.)
Best training EVER. (Okay, it was my ONLY birth doula training so far, but I can't imagine a training being more awesome than this. This was our group, and I'm second from the right, perched on the birth ball.)
I'm fortunate to have now had the opportunity to "sample" three of the most significant doula & childbirth education organizations out there. My postpartum doula training was with the big guns, DONA International. I've been doing the distance learning program for childbirth education through CAPPA. And it's now been five days since I finished the toLabor (formerly ALACE) Birth Doula Workshop in Chicago.
I genuinely have enjoyed aspects of all three. DONA's postpartum training was thorough, enjoyable and efficient, run by wonderful veteran Susan Martenson. The CAPPA training is a little tricky to get a feel for since I'm doing the work independently, but based on the written materials included as well as the video portion of the distance learning (consisting of footage from an actual workshop), I think this is a very worthwhile program as well; quite challenging, as it should be, but well-structured. And I was lucky enough to convince The Feminist Breeder to be my study buddy as we worked through the manual and videos, Skyping once a week to talk about our progress and bounce stuff off each other. (Yo Gina, have you gotten to those essay questions yet? Ay caramba! Buzz me to vent when you do.)
But this has been the zenith of my experiences so far. First, it was the culmination of a process I began about a year ago, in fact, when I applied and was approved to sponsor this workshop in my own area; in exchange for coordinating, promoting and otherwise acting as local contact people for the training, sponsors are then able to take the workshop for free. I was thrilled and enthused, and set about doing everything I could to make this happen. Alas, after months and months, the deadline drew nigh and in this arid birth climate (more on that in a moment) we only had two - TWO - people signed up (there was a minimum of 12), and toLabor had to make the difficult decision to pull the plug. Fortunately for me, they were generous enough to invite me to attend a workshop in another area. As I have a few friends in the Chicago area and it was a reasonable drive away (well, moreso without a toddler, but such is life), I signed on with the Chicago group.
My arrival at the location of the workshop itself was like walking into an oasis from two years of wandering the desert. It was held at Mother Me, a collective space where doulas, childbirth educators and other birth professionals pool their resources to serve the needs of pregnant women - birth preparation classes, massages, prenatal yoga, and more; it all happens here. What really blew my mind? This isn't even the only place like it in the area. There were even other collectives like it IN THE SAME BUILDING. And this is just one area in Chicago proper. It's all over the place - travel a bit outside the metro area and you can also find places like Birthing Babes (which happens to be TFB's latest gig, but it's just one example).
You must understand where I'm coming from. In my area, there is ONE independent childbirth education teacher - a truly excellent teacher (I sat in on her class and had a ball), but still. One. The only other options are the hospital's own class or the 4 week series taught by a "crisis pregnancy center", where for ten dollars people can take the series and get (I am not making this up) a free car seat. What's truly amazing about that $10 plus a car seat series? They are having trouble filling their classes.
There is a small but dedicated local chapter of ICAN, comprised of fabulous women who I not only consider good friends, but care deeply about birth and do everything they can - but in this climate, where there are only a handful of active doulas and even those doulas are being challenged by some OB offices' policies, their battle is mighty indeed.
The local cesarean rate, you ask? 37.6% as of 2008.Some L&D insiders estimate that it has easily risen beyond that in the last two years. I'm sure that's just a coincidence.
So yeah. To walk into this space was a glimpse of paradise, of the way the world CAN BE. Everything being relative, I am positive that the local birth pros could tell me quite a bit about the challenges they face in their own area, and I don't mean to discount that. But seriously, Chi guys, take just a moment to appreciate the fact that your community exists and thrives to ANY degree, because it could be so much worse.
So back to the training! Where to even begin with how amazing this was?
There was plenty of material that one would consider standard and expected; a thorough breakdown of the stages of labor, a risk/benefit analysis of every standard current intervention, discussion and practice of positions and techniques used to support laboring women, and much conversation of the way to walk in the world as a doula, supporting women's choices with information yet without judgment. All well-organized, all as thorough as can be in an 18 hour training; the time constraints were my only criticism, but it's an unavoidable given in this setting.
There are some features that are unique to toLabor's training, however, features which are controversial, and I'm going to address them and share my own feelings about them.
Since its inception, toLabor has included two unique hands-on experiences in the workshop. The first is the palpation of actual pregnant bellies, provided by volunteer mothers-to-be on the second day of the workshop. We also used fetoscopes (not Dopplers) to listen for fetal heart tones. There were four women who graciously offered themselves, and we divided into four groups, each group getting to work with two of the mothers. It was amazing to really have a chance to take our time really sensing and feeling a baby in utero other than the quick, cautious feel of a friend's kicking action - typically the only experience we ever get outside our own bellies, if we're had them. We took turns locating each woman's fundus, at first gingerly and then with more confidence, then worked at identifying anatomical landmarks - not quite as formally as using strict Leopold's maneuvers, but as accurately as we could, with continuous feedback from the mother (and the occasional commentary from the baby, too) and help from our classmates.
The fetoscope was also a revelation, truly a shame that they are used less and less often. It IS much quieter than the blaring of a Doppler, true, but it is also so much clearer without the associated static (Rixa writes about this here), not to mention risk-free (exactly how much risk is associated with Doppler use is a matter of some debate, which I won't get into here). It looks like this, in case you haven't seen:
And you use it either like this:
Or like this:
Therese, our fantastic and intrepid instructor, explained that this was absolutely, positively NOT about learning to palpate pregnant abdomens in order to do so on our clients. She was crystal-clear about the limitations of our scope of practice all weekend long, on this and other matters. This was an experiential, well, experience, simple as that. She described it as learning to touch, and while I agree with this, I also saw it as an opportunity to get some practice communicating with and just plain being around pregnant women, period, getting more comfortable talking with them about their lives and bodies and babies. To an experienced birth pro, that probably sounds so basic as to defy a need for practice, but I would argue that some of us still have nerves about it, and want to make sure we're both confident and respectful.
The second experience is the one that triggers the most raised eyebrows, and understandably so. If you're a part of this birth pro community, you might have heard about it, and yes, it's true. In this workshop, under extremely careful guidance, we had the opportunity to give and receive a very brief vaginal exam. All volunteer, working as partners with one another - no one had to participate, and indeed, we did have a few women sit out (though I'm not even sure who did, as we were all just focused on what we were doing ourselves).
Let me make this clear as can be: This, like the palpation of the pregnant bellies, is a learning experience ONLY. This was not instruction on how to perform pelvic exams on our clients, EVER, and it could not have been made more clear that doing so was strictly prohibited (unless this is something that is already within one's professional scope of practice; if an RN were participating in the workshop in order to learn how to give better hands-on support - but even then, it couldn't be clearer that a vaginal exam would be done in his or her capacity as an RN, anyway, not as a doula). A pregnant pelvis would feel completely different anyway, as would a cervix that was in the process of dilating - the assessment of which is a different skill altogether.
Those participating paired up, donned sarongs and slipped off their underwear, grabbing gloves, chux pads and tissues. The women receiving first lay in a circle with their heads together, a configuration which preserved modesty completely. We had learned the sterile technique for donning gloves, and once they were in place, we sat with our dominant hand raised in a fist, awaiting a touch of lubricant from Therese. She then guided us through what was ultimately a very short exploration; not rushed, but not terribly lingering either, with lots of feedback from our recipients. We first felt for the cartilaginous tissue of the cervix itself, then upward for the pubic symphysis and on each side for the ischial spines, giving us a tactile understanding of what the pelvic outlet comprises. Finally we felt for the downward slope of the sacral curve, and we were done. (No speculums, by the way, just gloved fingers, straightforward verbal instruction, and respectful caution.) We efficiently switched off and repeated the process in opposite roles.
What was this about, for me? First and foremost, it was about context, about taking the discussion of the baby's journey out of descriptions, diagrams, vinyl models of the pelvis and even 3d animations, and just for a moment giving us live, real, conscious, flesh and blood experiences. It also (unexpectedly for me) demonstrated the subjective nature of what we're discussing. Sometimes I hear birth stories where there is a discrepancy about how dilated a mother is, or how a position was misread, and my initial reaction definitely included a bit of "What? How could they, the PROFESSIONALS, not get that right?" And it's so much clearer now. So increased understanding for the care provider's perspective was an added bonus.
A third and more nebulous purpose of this exercise has to do with our culture's vaginaphobia, as Therese aptly put it. Does participating in this solve the problem, does it instantly cure us? Probably not, but it sure goes a good way towards demystifying the area, which is certainly apropos for those of us who care enough about birth that we were in the room in the first place. Which leads into addressing the controversial-ness of this part of the workshop.
The controversy DID come up, though not at length or with any specificity. We were not given details of debates past or identities of accusing parties, but it is clear that there are those out there who disapprove of this part of the workshop. I'm willing to listen to anyone's thoughts on this, if they take issue. Everyone has a right to their opinion, and I'm certainly willing to concede that there may be a POV that I have not considered.
But if the argument is (as it does seem to have been in the past) that toLabor/ALACE, by including the palpation and the vaginal exams in their workshop, is tacitly approving of doulas performing either one as part of their professional service, I wholeheartedly, emphatically disagree. I would even go so far as to say that suggesting that the inclusion of these exercises might be interpreted as permission to do so professionally is a bit of an insult to the intelligence of the participants. Anyone making this argument is simply not listening to the explanation and detailed description of the exercises, and has certainly never taken part in the workshop, since as I stated previously, it could not have been made more clear that this was never, EVER to be done on clients. Some toLabor participants are interested in becoming midwives in the future (i.e. me), as toLabor definitely appeals to the midwifery-minded (being explicitly based in the midwives model of care) so perhaps there's some legitimate confusion out there.
Is there a chance that some doula out there could go rogue and start doing so anyway? Sure, it's possible. But that is an irresponsible act by an individual, and in no way reflects on the training organization. It's just as likely that a CAPPA doula would turn off a fetal monitor, or a DONA doula would take it upon herself to start removing IVs, or turn down the Pit, or even simply start answering for the family regarding their decisions. ALL of which are terribly irresponsible, ALL of which reflect poorly on us as a community, ALL of which are repudiated by the major organizations. None of which means that the rogue doula's training organization has approved of their individual ethical breaches.
Now, on the flip side, none of that is to say that if you haven't been through these exercises at a toLabor training, you therefore aren't a good enough doula or that an organization's training isn't adequate without them. Not at all. It's not for everyone! It's not even for everyone who attends the toLabor training itself - I mean it when I said there was no sense of judgment at all. But let's please recognize, as a larger community, that there is a place for a variety of experiences, just as there is a place for a variety of doulas, and for some, this is going to appeal greatly to their learning style and if it does (not that it has to), it will only serve to enrich their work and thus their service to women.
There, I feel better.
Suffice it to say, I can't recommend this training highly enough. I would happily do the whole weekend over again, and in fact, I just may get to in the spring, if I'm lucky enough to be selected as a sponsor when I move to my new location in Portland (from a desert to an oasis to the freaking rainforest). In closing, here's a bad camera phone shot of my own workshop, followed by some quality shots from the toLabor site itself.
This is a bit of a "round-up", but I couldn't let the hot (read: infuriating) items that have been circulating in our circles the last few days go without mention - especially since this very issue was brought home to me yesterday in a client meeting, live and local and in-our-faces.
Before I get to yesterday's incident, here's a little background from a while back.
Once upon a time (last November), this sign prohibiting Bradley Method and/or "doulah"-assisted births from a practice in Utah was shared on The Unnecesarean, and everyone had a semi-good time roasting it in appalled mockery:
This came on the heels of one OB's disclosure to his patient, who fortunately took it for what it was and RAN FOR THE HILLS, as of October. Excerpts:
* Home delivery, underwater delivery, and delivery in a dark room is not allowed.
* I do not accept birth plans. Many birth plans conflict with approved modern obstetrical techniques and guidelines. I follow the guidelines of the American College of Obstetrics and Gynecology which is the organization responsible for setting the standard of care in the United States. Certain organizations, under the guise of “Natural Birth” promote practices that are outdated and unsafe. You should notify me immediately, if you are enrolled in courses that encourage a specific birth plan. Conflicts should be resolved long before we approach your due date. Please note that I do not accept the Bradley Birth Plan. You may ask my office staff for our list of recommended childbirth classes.
* Doulas and labor coaches are allowed and will be treated like other visitors. However, like other visitors, they may be asked to leave if their presence or recommendations hinder my ability to monitor your labor or your baby’s well-being.
* IV access during labor is mandatory. Even though labor usually progresses well, not too infrequently, emergencies arise suddenly, necessitating an emergency c-section. The precious few minutes wasted trying to start an IV in an emergency may be crucial to your and your baby’s well being.
* Continuous monitoring of your baby’s heart rate during the active phase (usually when your cervix is dilated 4cm) is mandatory. This may be done using external belts or if not adequate, by using internal monitors at my discretion. This is the only way I can be sure that your baby is tolerating every contraction. Labor positions that hinder my ability to continuously monitor your baby’s heart rate are not allowed.
* Rupture of membranes may become helpful or necessary during your labor. The decision as whether and when to perform this procedure is made at my discretion.
* Epidural anesthesia is optional and available at all times. The most recent scientific data suggest that epidurals are safe and do not interfere with labor in anyway even if administered very early in labor.
* I perform all vaginal deliveries on a standard labor and delivery bed. Your legs will be positioned in the standard delivery stirrups. This is the most comfortable position for you. It also provides maximum space in your pelvis, minimizing the risk of trauma to you and your baby during delivery.
Amazing. Trust me, it goes on and on, I just had to crop it for length.
So just the other day, this letter from an Ohio practice came to light, courtesy of Birthing Beautiful Ideas. Same crap, different zip code:
The team at Kingsdale Gynecologic Associates is so pleased that you are expecting. We look forward to helping you enjoy your pregnancy and hope to provide a meaningful and safe birthing experience.
Because of concerns for increased risk to you or your baby, the doctors at KGA have made a thoughtful, unanimous decision not to allow doulas to participate in the birthing process. It has been our experience that they may serve to create a state of confusion and tension in the delivery room, which may compromise our ability to provide the safest delivery situation possible for you and your baby.
Again, with safety in mind, we have created a Kingsdale Birth Plan (which can be viewed in the obstetric packet provided at your initial visit), outlining the philosophy of our doctors with regard to labor and delivery. It is our opinion that other birth plans are unnecessary. We feel that our many years of obstetric experience in a setting of modern day challenges (larger babies, more difficult deliveries) enable us to provide sound judgment with regard to each woman’s particular needs during her course of labor.
Thank you for your understanding in our hopes of facilitating a safe pregnancy and birth process.
Patient’s signature
________________________
She goes on to post a revised version of this letter (make sure to check it out, it says everything I would have said and more), and then, the next day, shared a copy of the actual "Kingsdale birth plan" this practice offers. Click over to read it itself in all its chocolately paternalistic glory.
To top it all off, The Feminist Breeder had JUST posted this unknowingly prescient piece the extremely revealing chart found in Marsden Wagner's book "Born in the USA", exposing the downright contempt many (of course not all) OBs have for patients who dare to think for themselves. It both precipitated and underscored the garbage from the Kingsdale practice that hit the net the following day.
So, with all this buzzing in my head, I went to meet with a really wonderful young mother and prospective practice labor support client. She's very interested in having doula support, as there's not a lot of other support in her life, and has several pressing reasons of her own that she'd like to pursue a natural birth if at all possible. Hasn't read a whole lot yet but is very eager for information (I lent her "Your Best Birth" to start with) and is starting a childbirth ed course next week. All sounds good, right?
Well, she's also slowly figuring out that she may have to change care providers, as they recently informed her that she is allowed to use one of two pre-approved specific doulas - anyone else would be prohibited. I would have been more stunned if I hadn't just read and re-read all of the above, but as it was, I just had to sigh and shake my head.
If I were one of the two approved doulas, I wouldn't know whether to be flattered or appalled. (I'm not at all insulted at not being included, as I literally haven't even gotten started attending births in the area yet.) Frankly, I'm leaning towards appalled. I'd want to know WHY I was kosher and others weren't - was it because I was most likely to go with the hospital ride and not make waves? It's also possible that some other doulas had been too confrontational, perhaps, and gone beyond our scope of practice. Could it be a combination of the two?
Regardless of the reasoning, I'd so frustrated by all of this. It seems like we've been making progress with educating the public about doulas, and improving doula training, and increasing access - but then, what good does it do if more and more OB practices are issuing official kiboshes on us when it comes time to actually go into action? The bottom line probably does fall to the consumer.
Readers who are appalled at the Aspen Women's Health Center, the Kingsdale Gynecologic Associates, the doctor in Texas, and the group practice here in Erie - don't assume it's not also happening in your own backyard. We advocates can blog about this stuff until we're blue in the fingers, and we will and do, but it really comes down to the individual women themselves. Mothers who care about their births (no matter what their own goals are), have to stop patronizing care providers like this, and let them know why.
P.S. This was one of my entries for the Unnecesarean's Photoshop contest:
P.P.S. But wait! There's more! The Feminist Breeder and I basically simulposted today, and in her latest, she shares YET ANOTHER doctor-generated mandatory "birth plan", this time from the Chicago area practice WomanCarePC. I can't even be buggered to quote it here - click on over to read, it's exactly what, by the end of this post, you'd expect. But I will quote TFB herself, echoing my sentiment on using our power as consumers:
We all want to believe that it’s just angry women making hostile accusations toward well-meaning OBs and hospitals. Calm down honey, it’s all in your head. However, it’s pretty hard to ignore when the obstetricians are the ones sending out their patriarchal beliefs in writing, and then asking pregnant women to sign it.
There is a solution. Fire them. Take back your body. Refuse to be treated as a wombpod. Let them know that we ARE consumers in this process, and if they won’t treat us with respect, then by golly we’ll get our birth attendants elsewhere, thankyouverymuch.
*****
In medical billing courses, you’ll learn about the birth process.
This is the brainchild of a Facebook conversation between myself, the fabulous woman behind Thoughts From A Doula. She had commented about her unique requirements for a rental car: "Happy I could find a last minute sitter and a rental car with backseats big enough to fit my balls and gear!"
A friend replied: "The 12 year old boy that resides inside of me just giggled."
Colleen agreed: "I know! So did the 17 year old boys at the rental place who had to measure the doors to backseat to see if 'my balls' would fit! LOL!"
And I chimed in: "I'm seeing classic bumper sticker potential: 'Doulas Do It With Enormous Balls'."
By the next day, an entire line was set up, thanks to Colleen as well as Kelly Book, Tricia Fitzgerald and Amy Robinson Owen Doula. Check out all the gear! Didn't the designer do a kickass job? I know I need a babydoll T, tote bag and, of course, a sticker, at the very least!
And with that, I'm off for a few days, as I'm finally visiting some friends in Connecticut! Hope everyone out there gets to enjoy some warm spring weather.
Yes, right here in Erie! ERIE NEEDS DOULAS. I am both delighted and fortunate to be making this training available to women right here in town. The workshop takes place over the course of three days, from June 4-6.
ToLabor is the professional organization formerly known as ALACE, providing the same woman-centered training and certification which has exceeded national standards, bridging technical knowledge with a compassionate personal touch. So here's the scoop:
Is there a desire in you to:
• Help pregnant women and their families recognize what options there are in pregnancy, labor and birth? • Provide evidence based information for the healthiest maternity care? • Provide practical suggestions to help pregnant women relax during labor including physical and emotional support? • Help a woman find her voice in order to advocate for herself and baby? • Encourage an environment of calm within her team of care providers? • Offer follow-up support in the postpartum period?
A toLabor Professional Birth Doula provides support for the pregnant woman and her partner, continuous care throughout the labor and birth to help them fully experience their birth.
The workshop includes: an introduction to physical assessments, adding an aspect of experiential learning unavailable in other training programs; these experiential exercises serve to enrich and empower all those who attend our workshops.
Tuition includes: the entire training and certification process, the training workshop, processing your work, the exam, the certificate itself, and activates membership. Before discounts, the total cost is $425. Payment plans are available. Enroll for the workshop 30 days in advance & receive a discount of $30. Past graduates of our training who are current members, may attend a workshop again for only $200. Previous doula training discounts are also available.
Erie PA Birth Doula training June 4 - 6, 2010 Contact Anne 860-922-6439 annetegtmeier[at]yahoo.com or www.tolabor.org 804-320-0607 tolabor[at]gmail.com
“DOULA!: THE ULTIMATE BIRTH COMPANION” is a NEW 65 minute documentary film that follows three BIRTH DOULAS as they support three couples before, during and after their births.
The film features actual footage of doula supported births.
We also see POSTNATAL DOULAS providing practical and emotional support to new mums after their babies are born.
Here's a statement by the director and producer:
Hand on heart, I wish I had known about doulas when I gave birth two years ago. I had quite a difficult birth experience (failed inductions followed by a c-section) and I now know that with the help of a doula, it would have been a completely different and much more positive experience.
I found out about doulas after I had made REAL BIRTH STORIES, a documentary series telling the birth stories of five couples who had just become new parents (myself and my partner were one of the couples featured in the series!) None of the parents in Real Birth Stories had hired a doula and in fact, before this point, I had never even heard of a doula and had no idea what doulas do.
I did some research and started to meet some doulas. Every single one was incredibly enthusiastic, caring, warm-hearted, intelligent, knowledgeable and all were absolutely committed to giving expectant parents the best possible experience before, during and after the birth. Then when I filmed my first birth, something clicked. I saw with my own eyes the difference a doula can make. The doula made the birth magical.
The doula prepared the birth environment, made tea for everyone, massaged the mum’s feet, supported the dad, suggested labour positions, reminded the mum to breathe, soothed, comforted, encouraged, phoned the aunt and grandma to come immediately for the imminent birth, took photos and then when the baby came, she made sure the mum, dad and the beautiful new baby spent their first precious few minutes quietly together, uninterrupted as a new family. Then the doula helped the mum deliver the placenta before making up the bed for the new parents to sleep in.
The doula never told the mum or dad what to do but was just absolutely there for them the whole time, doing whatever needed to be done and I believe she was instrumental in giving the parents the birth they both wanted and deserved. The doula made all the difference. And in those few hours, I totally “got” what being a doula was all about.
And that’s why I wanted to make this film. So that other people “get” doulas. To help spread the word about how amazing having a doula can be.
Birth Plans. Normally, they're a collection of things to do or not do in order to give birth the way you prefer, and a major component of that for most women is avoiding a c-section. Same goes for a doula, right? In addition to helping create a birth that is as close to your ideals as possible, moms choosing to birth in hospital settings hire doulas to get their best chance at avoiding a cesarean.
So why would you even want to think about cesareans during your pregnancy, when you're focusing on visualizing your birth as positively as you can? And why would you bother with a birth plan if you know you're having one? Once the plan changes to surgery, whether it's in the heat of labor or in advance, isn't the whole raison d'etre for birth plans and informed choices out the window? Isn't it basically all the same?
Not at all. There are absolutely choices you can still make, choices that can make a huge difference in the experience for both your baby and yourself.
Hypothetical Reader: But I don't have any indication for a scheduled c-section, and no reason to think that I will be more likely to have an emergency arise during labor than any other low-risk mom. I want a natural birth if possible, or at least a low-intervention one. Are you saying I should write a backup cesarean plan? And doesn't thinking about this stuff risk manifesting it?
I remember all too well when I was facing the very real possibility of a cesarean, and a scheduled one at that - the very antithesis of the home birth that I had been planning and yearning for. Over the course of my pregnancy, my placenta moved from complete to partial to marginal, to finally, finally just over 2 centimeters (the minimum required to be in the clear for a vaginal exit) away from the os, at my 34 week ultrasound.
That whole story is a post unto itself, again, but I want to talk today about how I dealt with the possibility. Or rather, how I DIDN'T deal with it. Because I was intensely focused on doing visualization to help my placenta move upwards, I deliberately avoided reading anything at all about cesareans. I'm a pretty voracious reader, especially when it comes to this subject, and I read quite a few pregnancy books. But I confess to you all now, right here in virtual public, that I skipped right over everything that had to to with cesareans. I covered my ears and sang "Mary had a little lamb . . . (at home in her birth pooooool)".
Yes, it's true that I was able to dodge this bullet by the skin of my teeth, but in hindsight, I think this kind of willful denial was really not the best thing to do. Now, I'm not talking about turning it into a fixation that becomes a self-fulfilling prophecy, investing your energy into fear and anxiety. And as I said, I can relate. I understand not wanting to think about it too much. But I have read enough birth stories now where the mothers, in their admirable preparation for a natural or low-intervention birth, wind up heading into surgery for one reason or another, having absolutely no idea what was in store for them.
So to go back to our Hypothetical Reader, on the first question, "Are you saying I should write a formal backup cesarean plan?" No, not quite going this far (unless you have reason to schedule one, in which case, definitely yes; keep reading below), necessarily, but it is worth taking a deep breath, looking over some information on cesareans, and thinking about what your preferences would be if this were to arise. Perhaps write them down based on the examples to follow, if writing works for you. Take a few minutes to talk to your partner, doula, and anyone else on your birth team about these wishes. Confront it calmly, and then put it away. On the second question, "Doesn't thinking about this stuff risk manifesting it?" Again, this isn't about fixating on it and creating a self-fulfilling prophecy, this is acknowledging it and letting it go. Again, confronting it calmly, and then putting it away.
I want to share with you some really eye-opening and helpful information I've culled so far on the matter, most notably from Morgan of Adventures in Diapering and Beyond. (By the way, in case it's not already clear, let's assume for the purpose of this post that we're talking about necessary cesareans, both scheduled and unscheduled. You all know how I feel about unnecessary ones, and there's much to be said on them. But not today. Today we're talking about the ones that really do save lives.) First, Morgan herself gives a great explanation for using a birth plan for a cesarean here. An excerpt:
Why bother with a birth plan if you're having a c-section because you don't really have any say in what happens, right? Wrong. Even when you are expecting a c-section, there are still choices that you can make during and/or after the birth. Knowing what your options are can help you feel more a part of the birth experience rather than just an observer. While researching your choices, you will become better informed on what your doctor and hospital's expectations are and what you can/cannot do in a hospital setting.
*Catheter put in AFTER spinal (this is standard procedure at many hospitals) *Volume down on heart monitor beeping *Husband will photograph c-section *One of the staff members from my dr.'s office will video tape Baby's birth
*I'm allergic to (x drug). Please make sure I am not given this drug.
*Warm blankets during surgery *No sedatives after birth. I want to remember my Baby's first day of life. *Please reinforce my uterus and use dissolvable stitches for closing me up [Note from Dou-la-la: I would recommend making sure that your doctor uses a double suture, as this increases likelihood of a safe VBAC. There is also evidence supporting sutures over staples - this is important to discuss with your doctor as well.]
Baby:
*Please hold baby up for me to see as soon as Baby's born *Husband to announce Baby's gender (or maybe not announce gender at all and allow me to see for myself) *Keep cord long for Hubby to cut *No Eye Gel, No Hep. B vaccine. I will sign the waiver ahead of time. *Please bring Baby close to me during measuring & weighing.
*If Baby is doing well medically, please bring Baby to me as soon as she is suctioned, weighed, and measured. Please do not worry about cleaning her up much before bringing her to me.
*I would like to hold Baby while Baby is being foot printed, getting bracelets on, and while the paperwork is being filled out.
Recovery:
*Once back in our room to recover and been checked as stable, we would like to be alone with Baby to nurse. *We would like to keep Baby with us at all times. If Baby must go to NICU due to medical reasons, my Husband will follow. *If someone arrives to visit, please check with my husband or I as to whether we are up for company before allowing them in our room. *Delay Baby's bath until the evening after Baby is born rather than bathing Baby right after birth. *I am willing to be up and walking as soon as possible so I can get leg compressors off sooner *I would like my Catheter out early the morning after surgery *Baby will sleep with me in the hospital bed. While I am sleeping, there will be another adult in the room with Baby and I. *I will be nursing on demand and whenever Baby is fussy to help stimulate my milk to come in and to soothe Baby.
Excellent, right? I think she has done a wonderful thing in providing all this information. make sure to also check out her post on Things I Wish I Had Known Before My 1st C-Section. It has lots of firsthand information about possible side effects, descriptions of some of the strange sensations and hospital protocols you MUST be aware of if you want to avoid them (like taking baby to the nursery while you recover). Morgan, my hat is off to you.
I also want to address some possibilities that may be outside the realm of most OB's experience, but if you have a really good one, they might very well be willing to try something new. If you poke around in the birth spheres on the internet as much as I do, you may have run across the term "gentle cesarean". Dr. Nick Fisk in the UK has been a proponent of this approach, pointing out that "while couples having normal deliveries have been given more and more opportunities to be fully involved in childbirth, very little has been done to see how we could make the experience more meaningful for those having caesareans."
The scent of lavender fills the air and classical music is playing quietly. On the bed, Jax Martin-Betts, 42, is calm, focused and in control. With the birth of her second child just minutes away, the midwife, Jenny Smith, is giving her a massage. Her husband, Teady McErlean, is whispering words of encouragement: just a tiny bit longer, and our baby will be in our arms!
It could be a natural birth at any maternity unit in Britain, but we are in an operating theatre at Queen Charlotte's and Chelsea hospital in west London, and the birth we are about to witness sounds a contradiction in terms: a "natural" caesarean section.
Jax has been on the theatre table for half an hour, and the obstetrician, Professor Nick Fisk, has almost completed the incisions through her abdominal wall and into her uterus. "OK, the baby is about to be born," he says. "Let's prop you up so you can see him coming out."
Smith removes the blue drape between Jax's head and her belly, and the head of the bed is lifted to give Jax a clear view. Fisk cuts into the amniotic sac and a fountain of fluid rises into the air before he rummages around to locate the baby's head. In a few seconds it comes into view, covered with the milky-white vernix that has protected it in the womb. For the next few moments, the atmosphere in the theatre is electric: Jax and Teady gasp in wonder at their new son, who is now looking around, although his lower body and legs are still inside his mother's uterus.
The "gentle cesarean" tried to make the environment more soothing and slows the pace of the entire process down, making the baby's entrance more gradual and thus, hopefully, more peaceful. It may even help in squeezing the lungs out, the way vaginal birth normally functions, and one of the distinct disadvantages of surgical birth for the newborn's respiratory function. The parents can see the birth if they wish, rather than being walled off by drapes, and the baby is given immediately to the mother, instead of whisking him or her away just because of protocols/habits.
This may or may be your cup of English Breakfast, so the specifics are up to you and your doctor, but if a necessary elective cesarean is required, you could think about incorporating some or all of this into your birth. I encourage you read the whole article - you might want to consider printing it and bringing it in to your doctor to discuss it. In a similar spirit, Radical Doula featured a story on what was termed an "assisted cesarean", where the mother was able to catch her own baby! Check out this image:
A far cry from the usual image we see of someone holding the baby next to the face of the mom, who is strapped motionless to the table, unable to touch her baby. Radical Doula raises a very important point here, commenting, "But is this just an attempt to make an entirely medicalized process seem more mother-friendly? Luckily both the mother and doctor in this situation don’t want this procedure to encourage c-sections:"
But women should not consider assisted caesareans ahead of vaginal birth. “I still think a vaginal birth is the best way to birth your baby,” Ms Chapman says. “I don’t want women to choose to have a caesarean because of this,” [Dr. Gunnell] says. “We need to be very clear that this is not a good alternative to a vaginal birth; the caesarean section rate is very high . . . "But for those of us who don't necessarily have that opportunity [for a vaginal birth], this is a way of making an intervention experience a better experience.”
The original article also acknowledges that this certainly isn't going to appeal to everyone. Many women would shudder at the thought of seeing their own incision, for one thing. But if you look at the picture above and think this is a pretty amazing thing under the circumstances, why not at least ask your doctor? It's worth a shot. Even if he doesn't go for it, hey, maybe your other preferences won't seem like such a big deal anymore, by comparison. A nice bargaining chip, at the very least.
One final thought from Dr. Michel Odent. He was asked for his thoughts on how to make the best of the situation if a cesarean is inevitable, and he makes a case for allowing labor to begin on its own (hey, one of the Healthy Birth Practices, even if the context is a bit different) even if the end result is known.
Q: We now find ourselves preparing for a cesarean birth. We are wondering what things would be helpful to keep in mind/plan for/request in order to have the gentlest birth possible considering the circumstances.
A: The best way to deviate as little as possible from the physiological model of birth would be that the medical team is comfortable with the principle of an elective in-labor cesarean. In other words, the medical team would accept to wait until the day when you are in labor to perform an "in-labor non-emergency cesarean." This way it is a guarantee that the baby will have given a signal indicating that his or her lungs are mature. We know today that the baby participates in the initiation of labor. Furthermore, during labor contractions, the baby is exposed to hormones that make more complete the maturation of his or her lungs. This is why, as all pediatricians know, there is an increased risk of respiratory problems during the days following a cesarean performed before labor starts.
I think that's a pretty strong case, whenever the situation allows for it. Logistics would have to be managed, especially in terms of making sure your own doctor is available, or that his or her partners are also on board with whatever your plans are, but the effort is likely to be well worth it.
All efforts to reduce cesarean rates aside (and you know I'm all about that), a cesarean birth is still a birth, and is worth all the TLC you can possibly give to it, for both mom and babe. It IS possible to make it a healthier, less traumatic, and gentler experience. They both deserve it.
*****
Hypothetical Reader: Wait, isn't one character glaringly absent from this whole picture? What about having . . . a doula?
Indeed, what ABOUT having a doula? This is addressed in a future post.
This is actually from back in October, but if you haven't seen these clips, I thought they were well worth sharing, since we were discussing fathers and doulas just the other day. Here, Taye Diggs discusses the recent birth of his son on Jimmy Kimmel. I just love how amazed and reverent and loving he sounds about the whole experience. He even discusses placenta encapsulation! (Or, as Kimmel hilariously calls the placenta, "the big gross follow-up baby".)
Side note: NOW I remember where I learned that they use cream cheese for vernix on in TV births! I was racking my brain on that one the other day. Also note: Taye and Jimmy were confused as to the origin of the word "doula". It's actually adopted from the Greek, meaning, simply, "woman who serves".
And a similar, shorter appearance on Ellen. (When he refers to a "midwife lady", he actually means the doula, it was just a slip.)
I think he deserves major credit for talking about all this openly, and also for managing to do it with humor but WITHOUT resorting to a lot of the lazy, hackneyed, husband-disgusted-by-childbirth cliches we've all come to take for granted in the media over the years. Congrats again, Taye and Idina. Hope little Walker is doing stupendously!
He had a few arguments I tried to take into consideration: 1. Doulas are for rich people. 2. I want to help, I want to be your doula (or my "dulla oblongata," as he jokes).
The first argument, while I can see his point isn't necessarily true. To him, if we can make it through labor like many of our family and friends have without one, why spend the money? "Having someone you pay there to help is something rich people do." Well... Many doula's I've found in my area don't have rates on their sites because they work with people to set the right price on an individual basis. Most I've found prices for seem to range from the $200-$1500s but I hear some are in the $2000s, depending on location, experience, services, etc. Most of my friends seem to either have a friend and get one for free, or paid about $300-$600. Everyone has said it's worth every penny.
Now, looking at those numbers my husband says no way. He's rather use that money on things for the baby, or classes, books and material we can take together to be prepared for labor. But I heard you can get doula's who are getting certified and need live births to help you for free! I wrote to my local DONA lady to get the list of women in my area who will be certifying over the next year so I can contact them about helping me out. I told my husband this and he was a little hurt that I was so insistent on this. Which brings me to the next point... Him wanting to help.
I've read great articles and posts here and there about doula's helping husbands know how to help their wives, but he really wants to be the primary support. He really hasn't had a strong opinion about too many things in this pregnancy process unless I pry, so having him out and tell me how he really feels about it made me think again. He told me he wants to take classes with me and learn how to help me through it, but he doesn't want someone with us 24/7 and "taking his place." I can even picture him shying away because there's an extra woman there, and not wanting to help as much... If I had other help.
This is something that comes up for other women, too, so I thought it was worth addressing at some length. I started out just responding to her blog, soon realizing it was definitely a reply-turned-post, and then I couldn't get my comment to appear on her page at all due to some bogus HTML issue, so I just threw it all up here, period. Hope this is helpful to FutureMama (as she goes on Twitter) and to any other mom out there with a reluctant partner.
Again, kudos for taking such a thoughtful approach. I can already sense that this might be a reply-turned-post . . .
I want to briefly echo what Mommy Bee said about epidurals: I completely respect your right to make an informed choice, but do be aware that just because you've decided you want one does not guarantee that you will get one, or that when you do get it it will work, so the need to be prepared and to have support is just as valid even if you feel an epidural will likely be part of your birth experience. There are all kinds of benefits to laboring for quite a good ling time without one, reasons having less to do with the effects of the drugs on the baby and more to do with the effective progress of dilation and with optimal positioning of the baby for birth. As you'll learn when you go through childbirth ed classes and/or read further on your own, the baby's position in your pelvis is key, and the more movement and versatility of position you can bring to your labor the better. Doulas are experts here.
And let's say you labored a good long time without an epidural, and then decide to go ahead and get one. It's not like it's just Game Over at that point: there are still so many decisions to be made, and you have a say in every. single. one of them. Are you going to receive Pitocin as well? If so, how much and how quickly? What about AROM? What about episiotomies? There are so many choices to be informed about. (Do read "Your Best Birth" if you haven't already! It breaks the whole cascade of interventions down masterfully and easily. Immensely readable.) Due to her experience and education, a doula can be vital in keeping abreast of your goals and preferences, and help you ask all the right questions. She helps you advocate for yourself.
As for whether a doula is desirable if you aren't necessarily going for a 100% natural birth, my honest opinion is absolutely. Even if you have a c-section, a doula can be a godsend in dealing with hospital personnel and procedures and protocols. Marfmom's experience is a good example of this. I actually have an upcoming post planned for my own blog on exactly this topic, as inspired by a Twitter conversation the other day: how doulas benefit cesarean birth experiences.
Anyway, I can understand why your husband feels so strongly that he wants to be the primary support - and he ultimately will be, either way! But others here have given good examples of situations where, for all their good intentions, their partners were unprepared for the reality of the hospital setting. No matter how much they read (and if he does do a lot of reading, that is AWESOME and all the better, I don't mean to discount that; some husbands can't even manage that) and how attentive they are in a childbirth ed class, many of them become deer in headlights when faced with the White Coat of Authority suggesting something you both know you don't really want. At those moments, mothers sometimes lose their former allies to fear, and suddenly the man who had been their rock and their solace is now saying "Well, honey, maybe we should just do _____ after all; he IS the doctor . . ."
I'm not saying this WILL be the case with your husband - he really does sound like a peach. But some of the other husbands caught off-guard were wonderful guys, too - it's just a completely foreign experience for them, navigating the thorny maze of hospital protocol.
And this is where doulas are trained and experienced and prepared. It's not just about knowing back massage techniques, offering sips of Recharge, repeating affirmations with you, helping you walk around, bounce on the birth ball or relax in the tub, though those are all useful too. It's about helping both of you make your way through this sterile, high-tech, foreign land.
That brings me to the other point I wanted to mention. You are becoming a mother that day, and that, along with bringing this new being into existence, is the main attraction, of course. But your husband will also undergo a transformation that day. He is becoming a father. As much as he intends to be there for you, he is, by definition, also having his own experience of birth. This is a good thing! And he can still support you, and can still make attending to your needs at the top of his priority list. But the fact remains that a doula is the only person who is 100% there only for you and your support. This takes some of the pressure off your husband. Space has now been created for him to both share this experience with you AND have his own experience of transformation. He will still be your rock and your solace - and he can now breathe a little easier, knowing that someone is there to help you both advocate for your needs.
I hope that came across with compassion - it was meant to. It's truly hard for men to admit that they need help sometimes, especially when it's help in an area that they feel they SHOULD be responsible for. Often they insist on being the sole supporter simply because they think they should be, when in reality they might not feel comfortable once they're actually in the situation. When this is questioned, they can feel their authority threatened, even when they know, rationally, that this isn't really the case. I say let's give the guys a break!
As for the notion that doulas are for rich people, I wholeheartedly disagree that good care and support should only be reserved for the wealthy. This is why doulas have been fighting to be covered by insurance, and are finally starting to succeed, and why many doulas will work on a sliding scale, and why there are organizations providing doula support to low-income mothers in some areas (this is not available everywhere YET, obviously, but you'd better believe we're working on it). And even when none of the above apply, doulas in the certification process will work for free or close to it.
One final question: Labor can last a long time. Ask him how long can he go without using the bathroom. If for NO OTHER REASON than filling in for him so you won't be left abandoned when he needs to pee, you deserve to have this.
:^)
To wrap up: I second (or third, or whatever) the notion of interviewing a few to see who you mesh with, and I agree that it's a good idea to let them know of your husband's ambivalence in advance. If they're experienced doulas, they've addressed this before, I assure you.
And one last idea on cost: if you don't find someone who is in the process of certifying (which I am SURE you can, if you decide to go that route), you could also consider putting it on your registry, so to speak. I can think of no better shower gift, myself (unless it's a postpartum doula). There just might be someone in your life who would be happy to provide such a boon to you. Why not put it out there?
Seems like a no-brainer for me to weigh in on, no? Well, you see, I am but a young padawan doula. Number of births I have attended in person thus far: one (mine). Much as I aspire to not only start attending births as a doula but eventually train as a midwife, I'm still very much inexperienced in the real birth world despite my book and web-learnin' on the matter. I am sure this Blog Carnival will offer up scores of excellent posts by birth veterans, detailing the benefits of that incredibly important continuous support during labor, as well as birth stories in which that labor support person (whether a pro or a family member or otherwise) plays a vital role in healthy, satisfying birth experiences, and I look forward to reading them.
But here's something that's been on my mind as a newbie doula (which I recently realized makes me a 'doubie'): I'm starting to feel that even within the midwifery model of care, the amount of support a woman gets drops off dramatically after the first few days postpartum. Forgive me if I'm playing Captain Obvious here, but I'm currently witnessing the impact of this firsthand, as well as starting to see this pattern in the birth, breastfeeding, and postpartum depression stories I read so voraciously, both in print and online.
Nowhere is this more apparent than in births that have taken place in hospital settings, of course. Let's take the matter of nursing for just one example of the value of postpartum support. A woman heads home after a birth which may or may not have gone smoothly, where she may have received terrible breastfeeding advice, where she may have been separated from her baby, where her baby may have been given formula from a bottle with or without her consent or even knowledge. She may have even been given a "gift bag" containing you-know-what. Think about this mother headed out of the hospital has been really been set up. She may already be on a downward spiral.
Let's say, though, for argument's sake, none of the negatives in the hospital scenario above have happened. Let's say that in every instance, she experienced the best case scenario: no artificial nipples, no separation, a good birth, and so on. The environment at home can vary WILDLY in terms of what kind of support she has, in terms of both quantity and quality. The father most likely only has a few weeks of paternity leave, if that. She may have extended family living nearby, but this is becoming rarer and rarer in contemporary society, so she might have her own parents or in-laws coming to visit and help out for a while. She may or may not have friends in the area who can help out here and there; sometimes a meal rotation has been set up for the first week or two.
Within whatever existing support system she does have, there may be experienced, knowledgeable breastfeeders - and there may not be. If many of the less desirable variables are present, any difficulty she experiences can be exacerbated. So many nursing relationships can be sabotaged by well-meaning but ignorant advice. If the mother had hired a birth doula, a few postpartum visits are typically included, which is a help, but is it enough to make up for regular, quality help from the rest of the mother's support system?
Even if we take the hospital out of the picture, continuity of postpartum care can be lacking. She might have even had a home birth. Midwifery care does provide for MORE postpartum care than a hospital birth provides, typically scheduling a visit for the day after, then the third day (often a day of reckoning), then a week later. It's definitely an improvement, but I feel that a lack of regular support at home, and lack of accessible and timely lactation support, can still be devastating. Midwives who attend home births (primarily CPMs but also some CNMs) may or may not be skilled in lactation support. I think it's fair to say that most know the basics, and the type of sabotage that sometimes occurs in hospital settings is highly unlikely, but when serious issues come up, the variation in skill becomes much more crucial.
When more lactation help is needed, then, outside help needs to be called for, creating a new set of variables in terms of skill and accessibility, as not all lactation consultants are created equal, and the best ones may not be in the area, or may be out of a price range. Days or even weeks can go by before help arrives, time during which the breastfeeding relationship can be damaged in a number of ways.
I don't know if there are existing studies comparing the connection between breastfeeding success rates and better postpartum support, but from what I understand, many developed countries which have universal health care also provide for home health care visits for all new mothers. Here's one glance at different countries and their breastfeeding rates from the State of the World's Newborns Report 2001 via Kellymom:
Breastfeeding Rates Around the World
Country
% of mothers who start
% who continue 6 months or longer
Sweden
98
53
Norway
98
50
Poland
93
10
Canada
80
24
Netherlands
68
25
Britain
63
21
United States
57
20
Is it asking too much of midwives that they also be well-versed in breastfeeding support, and that they spend more time devoted to postpartum care? I don't mean to ask this as an accusing rhetorical question. It really may be too much, given the depth of their expertise in birth and the devotion it takes to acquire their skills, not to mention the considerable existing demands on their time - and if that's true, then we need to start thinking about finding ways to pass that baton to another support provider much more regularly and smoothly than we currently often do.
There is La Leche League, if you have an active chapter in your area with good leaders who will do phone consultations, which is not a guarantee, and honestly not a substitute for one-on-one help from a trained professional. Speaking of, then there are the lactation professionals, the gold standard of which is the IBCLC. Fantastic people, most of them are - if you have access, and even still, there is a break in the continuity of care, a disconnect, a stranger stepping in.
Another factor in postpartum support of the friends & family variety: it tends to peak within the first few weeks, which is when such support IS most needed (particularly in terms of breastfeeding), true, but many mothers find that they really could use help beyond that initial period. Suddenly, dad is back to work, family returns home, friends have gotten their fill of the novelty of the new baby, and the meal rotation comes to a close. Suddenly mom finds herself more alone than ever, which brings me to another area where postpartum support is vital: postpartum depression, or more accurately, the spectrum of postpartum mood disorders.
Isolation is a huge risk factor here, and feeling 'abandoned' once the baby is 3 or 4 weeks old can feel devastating to a mother. In my DONA postpartum training, listed within the services that a postpartum doula provides, right alongside education in newborn care, aid in mom's emotional and physical recovery, light housework, and breastfeeding support, is "companionship". Simple as that. This is not an insignificant or trivial thing. Having another adult around to relate to can really be a lifeline to a mom who is sleep-deprived and struggling, especially if that adult is trained in recognizing the symptoms of postpartum mood disorders.
You can see where I'm going with all this. My bias as a new and eager postpartum doula is showing, I know. But I think there's a case for shifting our view of the journey to motherhood. The moment of birth IS profound and amazing and deserves the most devoted support throughout that experience as possible - but can we start to see that this is just one part of the journey, climactic though it may be? Can we start to see it as more of a continuum? What would it be like if something resembling continuous support (though obviously not as intensive or constant as labor support) lasted throughout what has become widely recognized as the "fourth trimester"?
After the long buildup of pregnancy, and the transforming apex that is birth, with much societal (not to mention medical) attention paid to both, many women often get the relative equivalent of a handshake and a "good luck!" Women and babies deserve more. WE as a whole deserve more. I'm not sure what form this would take. I like the concept of reframing care as, perhaps, perinatal, rather than divided into prenatal, birth, and postpartum. I absolutely think postpartum doulas are one way of finding a solution, of course, but I don't mean to make this post one big sales pitch for them (especially, again, as a novice). I'm open to more solutions. Maybe the concept of Freestanding Maternity Centers, as Rixa of Stand and Deliver recently pointed mentioned recently. and as Dr. Stuart Fischbein has endorsed, could include more extensive postpartum support that flows out of existing relationships, and could thus move towards more of a continuum concept, to twist a phrase.
I've focused here on breastfeeding and to a lesser degree on postpartum mood disorders, but even if neither proves to be a problem, mothers still deserve to have much more support during their "babymoon" than they often get. These were just examples of postpartum needs - there are so many others, too. Adjusting to our brand-new identities as mothers is an world-shattering experience - hopefully mostly in the best possible ways, but in the event that challenges arise, I think mothers with newborns deserve to have the equivalent of counterpressure on their sacrums, cool cloths held on their foreheads, and strong, caring hands to hold when the going gets tough.
