Early on in my doula career, I wrote a blog giving a breakdown of my fees. Since then, I have gained a great deal of experience, attended several workshops/trainings, read a countless number of books, articles, studies, and blogs, and moved 1,000 miles away to a bigger city with a different market. So, today, I’d like to revisit that topic.
I love doula work. I really really love it. Really. I feel so incredibly blessed to be able to do something I love so much while making a small financial contribution to our family. I spend a lot of time and energy immersed in the doula world. And my time is valuable. Especially when it's time away from my husband and three young, homeschooled children. Some feel that a doula's fees are overly expensive. I'd like to show you a breakdown of those fees and why I charge what I charge.
Total fee - $1500
Childcare - $100/client
Gas and car maintenance - $50/client
Printed materials/handouts/marketing/website - $25/client
Bag and Supplies (includes snacks and toiletries for myself during the birth, massage tools, etc) - $15/client
Phone and internet costs, PayPal fees - $20/client
Lending Library - $5/client
Spinning Babies DVD - $20/client
Training, education, certification and organization/membership fees - $25/client
Remaining fee after subtracting expenses - $1240
Average amount of time spent with client (Initial consultation, 3 prenatals, the labor and birth, and one postpartum visit ) – 30 hours
Average amount of time spent driving to and from meetings and the birth place – 10 hours
Average amount of time spent reading, researching, creating and printing handouts, continuing education, and doing other prep work – 2 hours
Average amount of time spent answering phone calls, texts, and emails – 5 hours
Total average amount of time put into each client – 47 hours
Average amount of money I make for each client - $26.38/hour
Yes, that is considered a well-paying job at $26.38/hour. You get what you pay for here. I haven’t always made this. I charged $275 for the first births I attended. But, as I gained more experience and more knowledge, I raised my fee.
This fee doesn't include time spent marketing and networking (doula speed dates, birth/baby fairs/expos, and other events), time spent keeping up with my website and social media and the time I spend on call for each birth, which can be as long as 5 weeks. This also does not include taxes, which I do file and pay yearly as needed.
It's hard to place a value on needing to be packed and ready to drop everything and leave at a moment's notice (even if I'm at a birthday party or a wedding or having a date night or just fell asleep for what I thought would be the night just an hour ago) for weeks at a time. But, just for fun, let’s add in time spent on call.
Average time spent on call for each client – 3 weeks/21 days/504 hours
*New* total average amount of time put into each client – 551 hours
*New* Average amount of money I make for each client - $2.25/hour
Doula work is time consuming, physically exhausting, and emotionally draining. I often need at least one day, but often a few days to recover and feel like my normal self after a birth. I love every minute of what I do. I love to serve birthing families. I love witnessing a mother and father working together to bring their child into the world. I love making a difference in the lives of growing families. And if I want to continue to do so, I have to charge a fee that fairly compensates me for my time and sacrifice from my family.
I hope you enjoy this blog from Jaimie Schrock as much as I did. She is a dear friend and a treasure in the birth and VBAC community.
Fears. The what if's.
It would be one thing if all we had to worry about was ourselves.
But, there's this precious baby. This fresh new life. That deserves the best. And we love this little one more than our mouths can form the words to say.
You know this love, if you have had a child before. It's unspeakable and it grips your heart in ways you would have never imagined and could have never understood before.
When you choose a VBAC, it's choosing to do something different.
Most doctors, most mothers have been familiar with 'once a c-section, always a c-section."
No one really remarks if you choose this.
However, for those of us who have or will choose to do something that's outside of the norm, many can question us and we can question ourselves. Especially if you have had two or more c-sections.
I can't do it.
Or worst case...I rupture?
But I'm here to tell you...YOU NEED TO GET RID OF FEAR.
Well, we know that fear can be good. It can alert us to dangerous situations. That part of us is a good fear that was created in us to protect us. But this attacking fear that can strike our minds day and night, that is not a good fear.
Can I explain further? If you have chosen to birth by VBAC, I am assuming you have researched, you have thought. You have thought deeply. At one point in time, you decided this was the best thing for you, and for your baby.
And if you are like me, you prayed about it. You asked God what He wanted for your birth. You waited for an answer and when you received it you had peace. That passes over your mind and understanding.
Why Do We Need To Get Rid of Fear?
But what can we do when it prowls around us, wanting us to succumb to its temptation?
They promise us control. That if we believe them and worry with them, somehow we may prevent something from happening or if it does, our being afraid may make it better.
But those, dear readers are lies. Lies we were never meant to believe. They steal from us and nag at us. We were created to live in freedom and be at peace. When we do our best, making our best choices in childbirth and most especially when we ask God and pray about our situations, we can in fact have that peace that passes all understanding. That we have a loving God. That He is there for us. And we can trust Him in whatever we face. In birth. And in everyday life.
I am unashamedly pro-life. I am unashamedly pro-woman. I am unashamedly pro-child. I am unashamedly pro-man. And I am unashamedly pro-Jesus.
Friends, I am not marching today. It is my understanding that a woman with my beliefs is not welcome at this march “for women.” Oh the irony. A group claiming to be marching for me, as a woman, will not allow me to march with them because I am also pro-life, pro-child, pro-man, and pro-Jesus along with being pro-woman.
I really do understand and empathize with a lot of the beliefs on both sides of all of this. It is the truth that women are often undervalued and mistreated not just in the U.S. but around the world. And that’s so hard. Sometimes, it’s terrible, despicable, even evil. But, our government is not at fault there. There are no more laws protecting the rights of men than there are of women. In fact, women have one more “right” than men do in this country and that is the right to have their unborn children killed while the paternal rights of the fathers of these unborn children are completely disregarded. This undervalue and mistreatment of women is part of our culture. The culture of living in a fallen, broken, and cursed world. Genesis 3:16 states. “To the woman He said, "I will greatly multiply Your pain in childbirth, In pain you will bring forth children; Yet your desire will be for your husband, And he will rule over you." Nowhere in there does it say that we will be given the “right” to not give birth if we don’t want to by killing our unborn babies. It does say, however that He has multiplied our pain in childbirth. Nowhere in there does it say that if it is inconvenient, or painful (or even dangerous), or not in the timing we have decided for ourselves for us to have a child, that He will give His blessing in the decision to have that child killed within our womb. It does say that that we will bring forth children in pain. And nowhere in there does He promise that we will be treated as the beautiful, wonderful, adored creation that we are (“You are beautiful for you are fearfully and wonderfully made.” Psalm 139:14 “You are loved more than you will ever know by someone who died to know you.” Romans 5:6 “Whenever you feel unloved, unimportant, or insecure, remember who you belong to.” Ephesians 2:19-22) by the men around us. It does say, however that our desire will be for our husband(s) and that he(they) will rule over us. Later in the bible, men are instructed over and over again to love us well and the bible is absolutely filled with instructions for us all to love each other. But, because of sin entering this world, making every man and woman a sinner and bringing on this curse, it is a very nearly impossible thing to achieve. So men fall short (some incredibly, severely so) of treating and loving us well. We women fall short of what we have been instructed to do and be, also. We are all sinners. We all fall short. That’s the beauty of a salvation relationship with Jesus. We don’t need to be marching in the cities, demanding better treatment and protection of our rights. We need to be living in the light and freedom of the love and salvation of Jesus; walking our neighborhoods, loving and serving, valuing life of all sexes and at all ages and stages.
WE NEED JESUS. And that is why I am not marching. I love and value women; that’s why I serve them in my work as a doula and in other roles within my church and community. But, I am not marching because I believe demonstrations such as this will cause further division; emotional walls will be built; hearts will harden. And I don’t want that. I don’t think any of us do.
And I will continue to be pro-life, pro-women, pro-children, pro-men, pro-Jesus even if that means I will be unwelcome at events such as this Women’s March.
Yesterday, my oldest son turned 9. It’s now a thing for some moms to post play-by-plays of what their labors and their child’s births were like on their birthdays as a way of honoring the work that they did, the transformation they undergone, and celebrating their child entering their life. I love reading them. Especially one a former client posts one. It’s fun to revisit the births I have supported as a doula.
I felt a little bitter yesterday. I can’t write a post like that for my oldest child. At least not one that would be socially acceptable. It wouldn’t be nice, or exciting or funny. It wouldn’t be precious or beautiful. But, you know what? I feel like I need to share that story. Not just for my own heart, but because I believe it may be encouraging for other moms to know they’re not alone. It may bring hope to some moms to see what we have overcome and how we are doing 9yrs later now. And I hope that it would bring awareness to moms, obstetricians, midwives, doulas, nurses, and other birth pros of the reality of a cesarean and of the repercussions of our high rate of unnecessary cesareans. I’ve shared the story of the day my son was born on my blog before for CAM 2015 (Cesarean Awareness Month). Today, I want to share the story of the day after my son was born with you.
I was awoken at 7:00am by my night nurse and my new day nurse as the shift changed. My son was born at 5:38pm the day before by cesarean for a breech presentation. There was no labor. I had been 36 weeks, 5 days pregnant. He was a tiny 6 lbs 1 oz and was losing weight quickly due to all the fluids that had built up in him from my receiving IV fluids for so long before his birth (I sat in the hospital receiving IV fluids and being told I wasn’t allowed to eat for 6 hours before he was born). He had what is now known as “inflated birth weight,” but it was not something that was known or recognized then, at least not where I was. Sometime in the middle of the night, around 4:30am I think, a couple nurses had come in and helped me out of bed for the first time in 12 hours so that I could brush my teeth. There was a sink just a couple feet from the bed and it took two nurses to help me take those wobbly couple of steps and support me while I stood at the sink for a minute. I had to get the taste of vomit out of my mouth. The pain medication made me terribly nauseous and I had spent much of the first 14 hours of my son’s life vomiting. They asked if I’d like to try and go to the bathroom to pee. I wanted to, but I was unable to walk that far so had to return to bed and was catharized instead. My son and my husband weren’t there. My husband had slept in the room with us during the night some, but he quickly realized that I was unable to do anything for the baby needed to just “sleep it off.” (“It” meaning all the medication that had been pumped into my body….terbutaline to relax my uterus, spinal anesthesia, morphine for pain, antacid, pitocin, antibiotics to avoid post-op infection). My body hurt. I quickly realized that I had to keep track of when I could have another dose of pain medication (now oral pills) and ask the nurse to bring them to me every 8 hrs. If I didn’t “stay on top of the pain,” I was unable to function. My husband brought my son in to see if I was awake. I tried to nurse him again. It was not going well and I desperately needed help. It was so hard to nurse him. The pain in my incision made it hard to hold him correctly. I was secretly grateful that it was Friday and nobody would be coming to see us until that evening at the earliest. As the day went on, I got more and more help nursing (some of it I now know was actually bad advice and perpetuated the problems) and was able to make it to the bathroom. It was really hard for me to stand up all the way as the staples in my incision pulled on my skin and it felt like a really sharp pinch. I felt no connection to the baby. I *knew* he was my baby because his ID band matched mine and the pain of my body being cut open and organs removed and then put all back together now replaced the kicks and rolls I had felt just 24 hours before. But I didn’t feel the instinctual desire to protect and mother and nurture the baby like he was the child we had spent the past 3 years praying for and seeing fertility specialists to receive. I now know that the reason for that is because neither of us received the benefit of the hormone oxytocin that comes with labor and is responsible for mother-baby bonding. I ended up having a 4 day hospital stay as my son had lost “too much” weight and they wanted me to receive an extra day of lactation support. So we didn’t go home until mid-morning Tuesday. My hospital room was full of family and friends all day, all weekend. I appreciate them wanting to see and celebrate our long-awaited and hoped for baby so much. But, I also know now that what we really needed was quiet and privacy and a chance to rest and bond with our baby. So we went home on a cold, snowy day in December. We bundled our little bundle up in his carseat and nerbously drove the 10 minutes home. I was still in a great deal of pain and had no idea what I was doing, especially when missing all the motherly instincts that we are meant to have. They came, though. Slowly but surely, they came. Breastfeeding was rough for the first two months, but we made it and he nursed until he was 16mo old. My incision healed without any complications, thankfully. My pain decreased. I wore him in a wrap almost all day every day. And today I contribute breastfeeding and babywearing to saving our relationship. We are connected now, 9yrs later and when I looked at him on his birthday, I wish so much that he had had a better start. I wish so much that I knew then what I know now. And I don’t want other moms to feel that way on their child’s 9th birthday. That’s why I do what I do. That’s why I’m so passionate about evidence-based care; decreasing fear surrounding birth; empowering, encouraging, and educating families.
December 2007. I was pregnant with my first child. (Who is about to turn NINE!) We had endured three years of heartbreaking infertility and were ecstatic to be so close to having our baby in our arms. I truly thought I was doing everything I could and should to ensure a healthy pregnancy, healthy birth, and healthy baby. I really had no idea, though. I knew I loved this baby beyond measure and couldn’t wait to look into his eyes and count his tiny toes. I also knew that after all we went through to get pregnant, I wanted a natural birth. I wanted to feel every contraction. I wanted to fully experience giving birth. At the time, I had no idea, absolutely no clue just how much the experience of his birth would impact me. Wow. It has left an imprint on my heart that is hard to describe. And it was hard. It still is hard sometimes, even nine years later. I needed a guide, a research assistant, a cheerleader, a resource, another woman to support me. But I didn’t know that I needed it until after he was born. I needed someone to look me in the eye and tell me that I should not ignore the nagging little warning signs I had seen from my OB that she wasn’t actually supportive of the birth that I wanted. I needed someone to point me in the right direction of finding factual information about my options and teach me about evidence-based care. And when my baby turned breech at 36 weeks, I needed someone to tell me that I had more options than what were given to me by my OB.
I was not just pregnant with my first son. I was pregnant with anticipation of the incredible joy that birth holds within it as a woman transforms into a mother. And that joy was stolen from me. The imprint that was made on my heart was a painful one. We had a rough start, my son and I. But we overcame. And that experience is why I do what I do today.
Friends, a doula is not just a luxury. It is something you deserve. It doesn’t have to be me (although I would love for it to be!), but please do everything you can to receive the support of a doula and ensure that the imprint left on your heart after your birth is a good one.
Give yourself the gift of a doula this holiday season.
I am overdue for sharing another Pro Tip!
The days are short this time of year. And this abundance of darkness reminds me of a great tip to share with you all. There are some great benefits to laboring in the dark.
Melatonin. The first of these is melatonin. It has been discovered that myometrial tissue, the muscle in the uterus, is responsive to the presense of melatonin. And studies have shown that the majority of labor occurs at night. We’ve also found that pregnant women, especially those near term have increased levels of melatonin present. Read more specifics about the role of melatonin in labor and birth here and here. Oh! And watch a great video from Michel Odent on the same topic!
Privacy. The second is privacy. A sense of privacy is really important to laboring women. Birth is an intimate event. Feeling watched can come with a feeling of pressure to perform or act in a certain way and can negatively impact the hormones her body produces and that are needed for labor to progress. Feeling disturbed or interrupted or even exposed or vulnerable can cause stress hormones to rise and even shut down or significantly slow labor. Laboring in the dark is an easy way to gain a sense of privacy even if you are not alone. Read more about the importance of privacy in labor here and here.
Wow! The chemistry of our bodies is pretty cool.
Don’t keep this tip to yourself, friends! Here is a graphic a created to share on your own social media and let others in our secret of the benefits to laboring in the dark!
Dear mothers of Houston,
If chosen as your doula, I promise to:
*Inform you of all of your birthing options
*Help you gather all of the information you need to make the best decisions for your growing family.
*Support you in your decisions.
*Refer you to other needed and/or wanted professionals in the area.
*Encourage you to trust your own intuition.
*Believe in your ability to birth and mother your baby.
*Connect with you emotionally, mother to mother.
*Engage you in discussions and activities for a healthy pregnancy and birth.
*Empower you to take responsibility for and control over your care.
*Comfort you with expert labor support.
*Serve you with loving, intuitive, knowledgeable, professional doula care.
For your birth in 2017, choose Amber Piller.
Choose to be Stronger Together.
Choose to Make Birth Great Again.
It’s time for another Pro Tip!
It’s normal to feel afraid when thinking about what lies ahead of you…..what will labor be like? Can I do it? What if something goes wrong? Will I be a good mom?
These feelings will affect you, your baby, and your birth. But, I have good news! There is a way to keep them under control! Having a provider that you trust is a good start. Taking a quality, independent childbirth education class is another big step in the right direction as is hiring a doula to support you. Having a team around you to support and educate you will help relieve some of your anxieties of what labor and birth will look and feel like. Staying active and eating well is good insurance that you will have a healthy and satisfying birth with a healthy mom and baby at the end. Spending time practicing self care and nourishing and preparing your soul for motherhood is also important. Pray, meditate, talk to friends and family, create art, journal….find whatever it is that works for you and do it regularly.
Oh friends! Don’t keep all this information to yourself! I made a little graphic below for you to share on your social media and let all your friends and family in on these pro tips! And be sure to check out the other tips in this series!
Welcome back for my latest edition of my blog series: Pro Tips! This will be a series of short, simple, but incredibly helpful tips from a birth pro….me.
Cesarean rates can vary greatly by hospital. I’m still learning about the hospitals here in Houston, but I can tell you that one large teaching hospital with a maternal-fetal-medicine (high risk OB) department, and level NICU has an overall cesarean rate of 22%. And just a few miles away, another large hospital also with a MFM department and high-level NICU has an overall cesarean rate of 35%. Wow. And that’s not just Omaha. It’s everywhere. Do your research, mamas. Learning the cesarean rate of your birth place will tell you so much about how the providers within that system practice and the policies that hospital holds that may hinder normal birth.
Don’t keep all this great information to yourself! I made a nifty graphic for you to share on your facebook, Instagram, twitter, and whatever else you’d like so you can let all your friends and family in on these awesome pro tips!
I don’t often get so personal on this blog, but I think this topic very much ties into birth so it’s going here. And I am interrupting my Pro Tips series to get something off my chest that has been weighing me down for a good long while.
I am sick, sick, SICK of being ignored, friends. As I chatted with a couple new doula friends a few weeks back, one brought up this topic and she mentioned a personal experience of her own. She said that when she had moved to Houston and needed to get a Texas driver’s license, she looked up what she needed online and brought everything to the DMV. She waited and waited in a long line only to be told she was missing something once she finally got her turn. She asked if there was some way they could help her so that she didn’t have to go back home and gather what was needed and wait in that awful line again and was told no. Then she cried. And you know what happened next? They helped her. Why did they not just help her in the first place?
And since that conversation, I have been paying attention to my interactions with both my kids and my husband here at home. And you know what? The vast majority of the time, I am ignored the first time I say something. And often even the second and third. It is not until I either get crazy mad or really upset and cry that I am taken seriously. WHY???? I am not into the business of husband-bashing. Truth is, my husband is incredible and I love him dearly. But, he doesn’t often take me serious the first time I tell him something. Actually, he doesn’t often even hear me or register that I have said something to him the first time I say it. And it’s not that he’s insensitive or mean or whatever. It’s a strange phenomenon, really. He truly has no recollection of me telling him many of the things I say until I’ve said them two or three or four times and often not until I make a big fuss about it. And you know what? My three kids do the very same thing to me. Just now, as they were doing their chores in the kitchen after lunch and I was doing some work at the computer in our bedroom, I hear the younger two arguing. I listen for a minute and finally call out “What’s going on out there?” Nothing. So I try again, “What’s the matter, kids?” Again, nothing. This time, I just burst. I am MAD. And I go flying out to the kitchen and shout “EVERYBODY STOP WHAT YOU ARE DOING NOW!” They all stop and stare at me and I calmly say “Raise your hand if you heard me calling from the bedroom asking what was going on out here just now.” Friends, all three of my dear children raised their hands. And then they all three confessed that they did in fact hear me call out not just once, but two times. And I. Lost. It. Whatever “it” is, is now spattered and sprayed all over my kitchen as I turned into a screeching and screaming monster exclaiming that I am DONE with everyone ignoring me and will not be ignored any longer. Then I took away their screen time indefinitely. Now I have their attention. They’re all crying. But not because they feel bad for ignoring me all the time. Nope, they feel bad for themselves because they can’t watch their favorite TV show today. But I’m going to talk to them once I cool off and explain the very important lesson that I want them to learn here: Everybody’s thoughts and feelings matter and you need to pay attention to them, especially when it is a loved one.
And this is where I can relate this to birth. How many pregnant moms out there sit in the OB’s office with a birth plan only to be refused some of the things they want for their birth? How many expecting moms out there feel like their provider brushes off their concerns, isn’t really listening to or understanding them, is rushed, disconnected, or just too busy? How many pregnant moms out there feel that their OBs talk down to them and treat them like children when they express their desires or concerns for their birth?How many expecting moms out there feel that their husbands just don't understand why some things are so important to them? I am not a betting woman, but I bet it’s a huge number. And I bet it’s a pretty large number of these expecting mothers that just politely shut up at that point. Why? Why is our culture devaluing what women have to say about an event that is so incredibly important and sacred, an event for which we were given the ability to instinctually know what is best for us? Why does our culture generally encourage women to always be quiet and polite and not make a fuss while simultaneously conditioning everyone else to not take women seriously if they are being nice and quiet and polite?
I am telling you that I have had enough. And I’m asking you to join me in that. That doesn’t mean we have to get mean or lose “it” all over the kitchen every day. But, be firm. Don’t just shut up when you’re ignored or talked down to or brushed off. Especially when it’s about your birth. Who cares if everyone around you thinks you’re crazy and doesn’t understand why you want what you want? If it’s important to you, get it! And if you need help in that, or need to have someone totally on your team, who will support you in what you want even if everyone else thinks you’re crazy….hire a doula. That’s what we do. I will support you giving birth hanging from the chandelier if that’s something that’s important to you. You are worthy of being listened to. Your thoughts and feelings are important.
Make yourselves be heard, mamas.
Welcome to my new blog series: Pro Tips! This will be a series of short, simple, but incredibly helpful tips from a birth pro….me.
Today’s topic is that of your physical health. Moms, I’m going to level with you here. Pregnancy is not an excuse to put your feet up and eat whatever, whenever you want. Absolutely listen to your body, eat when you’re hungry and even give into those cravings sometimes. But, you need good, nourishing food while your body is working hard to grow and nourish your baby. Get plenty of good protein, fruits and veggies. You also need lots of water; at least one ounce for every two pounds of your body weight. And remember, that as your pregnancy goes on, you will gain weight, therefore you will need to increase your water intake. Lastly, keep moving your body. It doesn’t have to be super strenuous or intense. Take a walk while enjoying the company of your husband, go for a swim, try out a yoga class with a friend. The act of labor and giving birth is often likened to running a marathon. Would you stand on the starting line of a marathon without having done any training at all and after having eaten nothing but junk food for the last 9 months? Not likely. Take care of yourself, mama. You deserve it. Learning and practicing self-care now will be a valuable skill for the rest of your life. You will not be able to take care of your family well if you are not also taking care of yourself.
Don’t keep all this great information to yourself! I made a nifty graphic for you to share on your facebook, Instagram, pinterest, twitter, and whatever else you’d like so you can let all your friends and family in on these awesome pro tips!
sHey friends, glad to have you back for part three of this series! If you stumbled across this post first and haven’t yet read the first two parts, you should go back and read them now. In part one, we discussed that there is more to contractions than dilating your cervix; contractions are also about building your fundus. And in part two, we talked about the pushing, specifically feeling the urge to push and/or what is called the fetal ejection reflex. Check them out!
Today, we are continuing our discussion about the second stage of labor, otherwise known as “pushing.” Yesterday, we covered the uncontrollable, involuntary, powerful urge to push, the fetal ejection reflex. But, what about those moms who reach complete dilation and then don’t experience that urge?
If mom has an epidural, she either begins to feel a lot of pressure “down there” and then her cervix is checked and if she’s found to be completely dilated, will be coached in pushing her baby into the world. Or, mom may have her cervix checked during a routine check (usually scheduled for every hour or every couple hours) and is found to be complete but, mom’s not feeling any pressure so she is left to “labor down” for another 30min or even more than an hour before the pushing commences. If mom does not have an epidural, either that uncontrollable, involuntary urge to push takes over and the fetal ejection reflex kicks in and she births her baby, or she is found to have a completely dilated cervix during a routine check. In that case, most providers will coach mom to push her baby out. But some providers….the smaller few will wait. They will grab a chair and wait patiently for the fetal ejection reflex to kick in. The main factor to remember in all of those scenarios is that some moms experience an urge to push/fetal ejection reflex soon after their cervix reaches full dilation and some do not, regardless of whether an epidural is being used or not.
So what is the difference? Does it matter whether you feel the urge to push and just go with it or whether you are coached to push before/without feeling that urge? I believe it does matter. You see friends, our bodies know how to birth our babies. There is this phase of labor that is often not recognized or talked about and not every mom experiences it. It’s called the “rest and be thankful” phase. This occurs when a mom’s cervix has fully dilated but she’s not yet experiencing an urge to push. This is when she should REST AND BE THANKFUL. Labor is seriously hard work. And sometimes our bodies need to take a little break between doing all the work of dilating the cervix (and building the fundus!) and pushing our baby out into the world. This phase is good. Its purpose is to build up energy to finish its work. It may also be allowing baby some time to rotate to better fit through mom’s pelvis. But, mom isn’t allowed that rest (and baby the time to rotate) very often. Our maternity care system is impatient. Providers are taught that there is something wrong if anything takes "too long." And the results of not allowing that rest are that it then takes mom much longer to push her baby out that it would have if we had waited for the urge to push. And because our maternity care system is impatient, mom may even end up with a cesarean after doing all of this work and going this far because of that training that something is wrong if it takes "too long." Or mom just ends up being much more exhausted and sore than necessary once baby has emerged, making recovery harder. Also, it has been shown that coached pushing often results in more occurrences of tearing and more severe tearing than in mom-lead, instinctual pushing (aka the fetal ejection reflex!) which also makes recovery more difficult than it needs to be.
With my first VBAC, I experienced a rest and be thankful phase. My midwife knew I was complete. It had been a very very long labor (54 hours) and my baby was possibly, probably not positioned perfectly. I am so thankful that she trusted the birth process and my body’s ability enough to just patiently wait for my body to begin uncontrollably, involuntarily pushing on its own. While we waited, I actually fell asleep. Contractions faded and I napped for I believe around 20min. Then I pushed my daughter out in less than 20min, without any coaching and only experiencing a small tear. With my second VBAC, my water broke as we were on the way to the hospital and then the very next contraction, my body gave a little heave downwards at the peak. He was born just 8 min after we pulled up to the front doors of the hospital. I’m very thankful for that midwife as well, who trusted the birth process and my body enough to just stand back and let me push my baby out without making me submit to a cervical check first. She knew that if I was pushing involuntarily, then my body was ready to birth my baby. And that time, I experienced no tearing. They were both wonderful births.
I’d love to hear about your experiences, too!
I'm glad your back for part two! If you haven't read part one of this series, you should hop over and do so real quick. We talked about how contractions have more of a purpose than to just dilate the cervix.
So what happens once the cervix has opened fully at the bottom of the uterus and the fundus has built into this beautifully thick an strong muscle at the top of the uterus? Pushing! The baby will be born!!!
Pushing is what is known to be the second stage of labor. Some refer to this as the fetal ejection reflex. I can certainly understand why it would be considered a reflex. I like to compare the urge to push as sort of like throwing up, but backwards. It is an involuntary, uncontrollable, heave downwards that your body does all on its own (if left alone). It is that strong fundus that has been building up as your cervix has been opening, pushing downwards and expelling the baby. Have you ever known of a woman’s body to begin involuntarily, uncontrollably pushing and then mom’s cervix was checked and found to not yet be 10cm so she was told not to push? I have. I’ve watched it as a doula. And I really don’t like it. And I won’t participate in coaching mom not to push. I used to, but I won’t any longer. I have full confidence that our bodies are not making a mistake when that pushing urge kicks in. Now, if mom is feeling a lot of pressure in her bottom and is reacting to it by forcefully pushing with that pressure during a contraction, that is different. That can mean things like a swollen cervix. And we don’t want that. In those instances, we (her birth team) help mom to find other ways to cope with that pressure than by bearing down and pushing. But, if that fetal ejection reflex has kicked in and it is truly an uncontrollable, involuntary, and strong pushing urge, I believe in letting her body do its thing, no matter what her cervix dilation was at her last cervical check. I think that telling moms to resist and try to control that urge (although, as I said, it really is not controllable…her body still pushes on its own whether she is consciously pushing along with it or not.) is detrimental to the process. To explain my thinking on this, let’s visualize a baby learning to walk. You notice your baby standing next to the couch and trying to take a step away and then successfully taking two whole wobbly steps unassisted. Now let’s imagine that the “experts” have declared that babies should walk at 12 months old and not any sooner or later. So when you see your baby that is “just” 11 months old taking these couple steps, you decide to not allow him to be free to move about any longer, because babies simply cannot begin walking at any time other than 12 months old; they are not ready! You now confine your baby to a small playpen or a crib all day to discourage him from walking. He will still stand and take tiny wobbly steps in that crib. You can’t stop it, you can’t control it. His body is ready. But, you’ve slowed it down and he is not free to just do what he is ready to do. A few weeks later, after that baby reaches 12 months, you declare he is ready to walk now and let him freely move around again. But, suddenly he’s not interested. He’s lost the confidence he had a couple weeks ago. He’s now scared and unsure of himself and his abilities. His muscles have been temporarily stunted in their growth and development. And then it takes him months to gain that back. He is 16 months old before he is able to walk unassisted. And in those 4 months since his first birthday, everyone has been fretting and worrying and wondering what’s taking so long and offering advice and interventions and help of all kinds because this is not normal.
Can you relate this to the mom whose body was involuntarily and uncontrollably pushing and then told that it wasn’t yet time and she’s not allowed to push yet? What happens to that mom? She loses confidence in her body. She becomes scared and unsure of what to do or how to do it. That beautiful and strong fundus at the top of her uterus that is pushing her baby down and out has been stunted in it's growth and development. And then pushing can take much longer and be much harder than it needs to be, than it would have been if she had just been left alone.
And let’s explore another facet of this. What if……just what if not everyone dilates to exactly 10cm before their body is ready to push their baby out? What if all of our cervixes were not created perfectly equal and alike? What if our babies’ heads were all different shapes and sizes and had different abilities to mold and squish? Can you imagine? Perhaps this one-size-fits all definition of completely dilated being 10cm is a bunch of phooey because we were all created differently.
So now what about those moms that are fully dilated and then that fetal ejection reflex doesn’t kick in? Those moms whose cervixes are 10cm yet they are not feeling an urge to push? Let’s talk about that Thursday.
*Updated to add a link to Part 3.
What happens during labor? Your uterus contracts. And what is the purpose of those contractions? To open your cervix.
Well yes, but no. Contractions are less about a hole opening up and more about a muscle being built. Stay with me, here. I’ll explain. Let’s start with the fundus. The official definition of fundus is “the part of a hollow organ that is farthest from its opening.” So the fundus is the top of the uterus, farthest from the opening, the cervix, at the bottom. Got it? Good. Now, the uterus is an organ made up of muscle fibers. It is a big mass of muscle fibers all crisscrossing over and under and between each other; some running up and down and some running around it side-to-side. During a contraction, these muscle fibers…..well, they contract, pulling the cervix up and out causing the cervical tissue to thin and then open. As this happens, these muscle fibers start building up at the top of the uterus, the fundus. They are slowly moving from the bottom of the uterus, to the top with each contraction. As they do so, the cervix thins and opens at the bottom while the fundus is thickened and strengthened at the top of the uterus. And with each contraction, the fundus pushes down on the baby. As the fundus gets bigger, the push gets stronger. Once the cervix has finished opening, the fundus has also finished growing and now is a very large, very strong muscle that expels the baby from the uterus.
Pretty cool, right?
Let’s not stop there, though. Let’s talk a bit about pushing.
But, let’s do it Tuesday. I’ll see you back here Tuesday.
*Updated to add links to Part 2 and Part 3
Happy Independence Day! How blessed we are to live in this free and great country!
I am also a homeschooling mom and this week’s lessons have included lessons about what it means to be a Patriot and famous patriots during the American Revolution. I suppose, one may even consider me a patriot when reading yesterday’s blog and now today’s. I taught my kids that a patriot is someone who loves their country very much and defends and protects it. I do love my country and I love our rights and freedoms as citizens of America. This Independence Day (and many other days throughout the year), I am hoping to cause you to think about one question: How free are pregnant and birthing moms in America?
In my blog yesterday, I discussed the language that care providers use with pregnant and birthing women, the (false) belief that providers have authority over their patients, and encouraged moms to exercise their right of informed consent and refusal and to truly understand what it means to be a consumer of maternity care. Today, I want to bring awareness to something I believe is a right that every woman should have, but many do not: The right to choose where and with whom she gives birth.
In Nebraska, where I was born and raised and lived most of my life until our recent move to Texas, it is a felony for a licensed care provider to attend a birth at home. It is not illegal for a woman to give birth at home, but the state has taken away her ability to have an educated, trained, licensed professional there to care for and support her while she does so. Nebraska is one of only two states that has such restrictions on home birth (Alabama is the other).In many other states, although it is legal for midwives to attend homebirths it is illegal for them to attend the birth of a woman planning a VBAC (vaginal birth after cesarean) or a mom welcoming twins whether at home, in a birth center, or in a hospital.
Such restrictions are meant to keep moms and babies safe. But, they are infringing on women’s rights and there is no evidence that they are improving outcomes. I don’t care the intentions behind it, it is not OK to legislate and restrict where and with whom women are “allowed” to welcome their babies into the world. I want to encourage everyone to get involved with legislative efforts in your communities to increase access to out of hospital maternity care and birth. The medical community strongly opposes most efforts and they hold much of the money, therefore the power, so it will take a lot of families to stand up against it. Even if you are done having babies, or you have no interest in an out of hospital birth, I hope you recognize how important it is for this to be a safe, viable option for those that want it and will support it. When we all work together, we can do big things.
As many of my fellow Americans, I have spent a good amount of time these last couple of days feeling grateful for my freedom in this great country. I am also a homeschooling mom and our lessons this week have talked about the American Revolution, the Declaration of Independence, what it means to be free, and our rights as citizens of the United States. And while doing so, I am seeing things being written by expecting mothers in several facebook groups that is unsettling and leaves me asking: How free are pregnant and birthing moms in America?
These moms are saying things such as “my OB won’t let me…,” “my midwife says I have to…,” “I won’t be able to...,” and “they are making me…,”. And this both breaks my heart and makes me a little angry. Pregnant and birthing women must understand that medical professionals have no authority over them. Somewhere along the line as birth moved out of the home and into the hospital, the view of pregnancy and birth has shifted. What was once a normal, healthy life process that was supported and revered as sacred and miraculous has now become at best an illness, at worse a catastrophic emergency. And during that shift, medical professionals have become an authority over pregnant and birthing women. But, that is a FALSE sense of authority! Yes, they went to school for a long time. But, they are human. Their emotions and social and family lives can make things messy. The science and research and latest guidelines behind pregnancy and birth are ever evolving and can be hard to keep up with. And our culture views of fear surrounding pregnancy and birth shapes how many practice. Please remember that this is your body, your baby, and your birth. You are the expert of your own body and of your baby. And you are smart and capable and have the right (thank you America!) to make informed decisions about your care and the care of your baby. Please don’t allow a provider to speak to you in the ways I used above. Don’t allow them to talk down to you, leave questions unanswered, scare you, lie to you, or otherwise coerce you into doing something you do not want or need. Don’t allow them to be an authority over you. They are not. You are paying them to provide a service for you. They are an educated and trained expert consultant. You are funding their paycheck and that makes you the boss. You are a consumer of maternity care just as you are a consumer of food goods, clothing, and other products. If you are not receiving the care that you desire and deserve with your provider, stop giving them your money and your business. Do not fatten the wallet of a provider that does not respect your bodily autonomy. Seek a provider that will give you the care that you desire and deserve.
This is America. We are free. Growing or birthing a baby does not change our freedom status or rights as citizens of this great country. If we do not stand up and claim that freedom and those rights, we will lose them.
Be sure to check out part two of my Independence Day blog series!
I spent Monday afternoon watching debates/talks from the ACOG (American Congress of Obstetricians and Gynecologists) 2016 annual meeting. And I am sharing some highlights of those talks as well as my own commentary with you all.
The first debate was titled “Is There a Place for Outpatient Pre-Induction Cervical Ripening at Term?’ and there are just a couple things with this debate I want to highlight. Dr. Anthony Sciscione argued the pro side of this and one thing he said as he was introducing himself sent off alarms in my head. “We do about 7,000 deliveries a year. We are about the 15th busiest DELIVERY SERVICE in the country.” These two sentences give so much insight to the opinions and beliefs of the people at ACOG, the people setting the guidelines and making statements as to what the standards of OB practice should be. They do not see women birthing babies; families growing. They do not see the sacred event of a new life entering the world. These two sentences are undeniable proof that to so many, the practice of obstetrics is not about the woman, the baby, or the family, but is about the OB. And at the core of the practice of obstetrics is the belief that the OB is the knight in shining armor saving (delivering) the family’s tiniest member from the toxic mother’s womb and the dangers of birth. At the core of the practice of obstetrics is the belief that OBs act as fairy godmothers, magically retrieving and presenting the family with their new baby. Obstetrics is a delivery service. And ACOG is a place in which the OBs gather to stroke each other’s egos and brainstorm ways in which to make their jobs easier, not discuss what is needed by and best for the mothers and babies of America.
This debate was about whether or not women should be “allowed” cervical ripening medications and procedures to be administered and performed in her OB’s office and then sent home the day before her induction date or if it’s best for these things to be done in the hospital. Both Dr. Sciscione (who I quoted above and was debating the pro side) and Dr. William Rayburn, who debated the con side said repeatedly that it was important that outpatient cervical ripening only be done patients that have been “cherry-picked” with pregnancies that are low risk and at term. My question is, why are women with low risk pregnancies being induced?
A few minutes later in Dr. Sciscione’s argument for outpatient cervical ripening, he stated when this is done the day before an induction is scheduled, that “93% of people deliver before midnight which is very attractive to our folks.” Because what’s most important here is that the OB is able to “deliver” the baby to its family with enough time leftover to get a few hours of sleep before the next day begins.
My last highlight about this debate comes from Dr. Rayburn. During his argument of the con side of this topic, he discussed the cost of outpatient cervical ripening vs. cervical ripening being done under hospital admittance. He was encouraging OBs to consider the cost to the patient when deciding how they will practice when he said, “Have you looked at patients’ hospital bills and tried to make any sense out of it? I really find it to be difficult.” If a highly educated obstetric physician is unable to make any sense of the hospital bills of his own patients, there is a big problem with our maternity care system.
Let’s move on to the other debate that took place at the 2016 ACOG annual meeting Monday, “If No Elective Inductions Before 39 Weeks, Why Not Induce Everyone at 39 Weeks?” Frist of all, this was not a debate. This was two OBs convincing the other OBs in the audience that all women should be induced at 39 weeks. There was nobody debating the con of this ridiculous and dangerous idea. Both Dr. Errol Norwitz and Charles Lockwood were both “debating” for it to become standard practice.
Dr. Norwitz opened by explaining that their talk would not be a debate with one arguing the pro side and one arguing the con side. He said that “We [OBs] al read the same literature but we often come away with very different takes” so they decided to instead explain their individual reasons for both being pro mandatory induction at 39 weeks for very pregnant woman. The absurdity of this all still makes me want to vomit. As he was introducing himself, Dr. Norwitz announced with smirk that he himself was born at 39 weeks. He explained that he primarily works with high-risk pregnancies and boasted that “By the time my patients get to 39 weeks, the baby has been delivered, been circumcised, and is on its way to college.” The arrogance was palpable. (And let’s just overlook the fact that circumcision is no longer recommended by many health organizations).
He went on to quote a professor he had once had, Sir Alec Turnbull as saying “Nothing good happens after 39 weeks.” *sigh* I didn’t have the time to research any studies that may be out there on this. But, I very strongly feel that if that were true, God would have designed pregnancy to last 39 weeks. He’s not a careless creator, a sloppy artist, a mad scientist. I also know that it is a common belief in the birth world that labor is triggered by hormones that he baby’s lungs produce when s/he is ready for life in the outside world.
Dr. Norwitz justified his strong belief that all pregnant women should have their labor artificially induced at 39 weeks by saying “If a baby is born at 39 weeks, it is not at risk of still birth at 40 weeks.” This statement is so loaded, I’m not even sure I can appropriately convey all of my thoughts. And I have to be honest here and say that I would like him to say that to my dear, sweet friend who recently lost her baby at 39 weeks. (There is much more colorful language than that running through my mind, but I’m a lady and will leave it in my mind.) First of all, here is a glimmer of some good intentions with all of this madness. He wants to save babies. OR. Is he playing on other people’s fear with that statement? Does he say things like that to his patients to coerce them into interventions that they don’t’ want? That’s a common manipulation technique used in this profession. And lastly, once we start inducing everyone at 39 weeks and don’t see a big dent in our rates of stillbirth but see our cesarean section rates rise even further (and the rates of serious complications associated with cesareans like accreta become out of control), will there be debates about inducing everyone at 38 weeks? 37 weeks? He went on to say that although it is believed that elective labor induction is believed to increase risk of cesarean, he doesn’t think that is true. And he believes this because he looked at cesarean rates of women induced at 41 weeks. I’m not a doctor, or a scientist, or a mathematician. But, I’m not so sure that’s good science. A woman at 39 weeks of pregnancy is very very different than woman at 41 weeks. And a baby (not a fetus, but I digress) at 39 weeks gestation is very very different than a baby at 41 weeks.
To close, Dr. Norwitz told the audience to “Think like a fetus!” He said that if “you” (meaning the OBs in the audience, I presume) are a fetus just swimming around in the amniotic fluid with nothing to do but play with the cord and “you’ve read the literature” (But it’s a fetus! Obviously, not a baby, so how in the world can it read?!? *eyeroll*) and you are not smart enough to induce labor at 39 weeks, the OB care provider needs to step in. Wow. Just wow. Could this man be any more arrogant, insulting, and absurd? He then stated that he thinks the question posed at the beginning of the debate (If no elective inductions before 39 weeks, why not induce everyone at 39 weeks?) is a “No Brainer” and he doesn’t even know why it’s a debate at all.
To drive home his point, he cued up a slide with a photo of two newborns and the words “39 weeks and out!” along the top and, “…rescued by birth” under the photo. What exactly are you rescuing these babies from, Dr. Norwitz? I’m trying to give him the benefit of the doubt and remember that he mostly works with women who have high-risk pregnancies during which it DOES become safer for the babies to be out than in sometimes. But, this statement drives home my point that the OB believes s/he is a knight in shining armor, whisking the baby from imminent danger in its mother’s womb and “delivering” it into its mother’s arms.
Dr. Norwitz was followed by Dr. Lockwood who explained his reasoning for thinking mandatory standard inductions at 39 weeks are a good idea. In his “debate,” he stated that “Elective Induction of labor at 39 weeks is ALWAYS a better strategy,” using phrases such as “exposed in utero.” It absolutely blows my mind that these doctors sincerely think a mother’s womb is so dangerous compared to the outside world. Dr. Lockwood also explains that with his research, he has determined that the “optimal maternal age for delivery is about 29-30 years.” After instate mandatory “elective” inductions at 39 weeks for everyone, maybe they can further better our lives by only allowing women to birth babies around the “optimal maternal age” that they have determined for us.
During the rebuttal time, Dr. Norwitz said “I happen to think nature is a lousy obstetrician.” And then explained how midwives think it’s best to sit back and watch and let nature takes its course but he very much disagrees. Dr. Norwitz, you are a disgrace.
Before and after the debates, they polled the audience about their opinions on the topic being discussed. When asked the question, “Do you agree that it would be best to deliver most al women at 39 weeks gestation?” 63% of the audience answered “no” or “strongly no.” After this “debate” the audience was asked again and this time, only 9% answered “no” or “strongly no” while 70% answered “yes” and “strongly yes.” 81% of the audience answered “yes” to the question “Did the debate cause you to change or reconsider the view you had prior to the debate?” And the facilitator of this discussion responded to this with “Excellent. People are reconsidering their practice. Very good. We absolutely changed a lot of minds.” Disgusting.
The conclusion I have come to after spending two hours of my time watching these debates is that the mothers and babies of America are in a heap of trouble. We need to take back birth, mamas.
ACOG, the possessive, authoritative, demeaning, and insulting way in which you speak about women and babies is disgusting. Your failure to recognize the sacredness of the event of birth and that mothers are deserving of respect and bodily autonomy is alarming. Your dismissal of the centuries-old wisdom of midwives who are exceptionally skilled and trained in the design of birth is ignorant. And your efforts to play God are dangerous. Shame on you.
If you follow my facebook, either personal or professional, you’ve probably noticed that April is Cesarean Awareness Month (CAM). I’m pretty sure there are some of you out there, thinking things like “What’s the big deal? People have cesareans all the time. They’re safe.” Or “A healthy baby is what matters, not the way in which the baby arrived.” Or “So-and-so had a cesarean and it saved her/her baby’s life!”
I want to start out by being clear about one thing. I am thankful for cesareans. They can save lives. They are needed and I am glad we have them. But, and this is a big but….we are doing far too many of them. Ever hear the saying that there can be too much of a good thing? That holds true for cesareans, and all birth interventions. For example: we can all agree that drinking water is good for you. It keeps you hydrated and your body working as it should. Have you heard of water poisoning? It’s a thing. You can actually get really sick or even die from drinking too much water. America’s cesarean rate has risen 500% since 1970. And our maternal and infant mortality rates have been rising right along with it. Today, 32% of babies are born by cesarean. Are we slowly giving ourselves cesarean poison? Hmmmm…..I think we are definitely giving ourselves birth intervention poison.
Interfering with the process of pregnancy and birth has consequences. The medical model of maternity care, although well-intentioned, is slowly poisoning and killing normal, physiological birth. And our high cesarean rate is a symptom of that. The term “cascade of interventions” is something well known among birth workers. Once you introduce one intervention, often another is “needed” and maybe another and another and so-on, often until the point of needing a cesarean has been reached. What would have happened if that first intervention was never introduced?
Birth is a complicated, intricate process with an incredible cocktail of hormones, and body changes (for both mother and baby) that all work together. Every hormone and change in this process has a very specific purpose. And many of those have several purposes, not just for the event of giving birth, but also for the days and weeks, even months after baby is born. They are responsible for mother:baby bonding, for feelings of love, protection, and attachment. They are necessary for the production of breastmilk. They also play a role in whether or not mom will suffer with postpartum depression. They will ultimately affect how mom will parent her baby. If we alter one of those hormones by introducing an intervention, it changes the process, no matter how slightly we alter it. If we do things like bypass the process altogether and cut babies from their mother’s wombs before the process of birth has begun or any of the birth hormones have been released, it drastically changes things. So when doing so, we better be sure it’s for a good reason. When moms labor for a while and then baby is born by cesarean, it also changes the process as mom and baby both are then not exposed to as much of the birth hormones. When we force the process to begin before mother and baby are fully ready by introducing synthetic forms of our hormones, it drastically changes the process. When we use these same synthetic hormones to “speed up” labor, it changes the process. If we use medications for pain, it changes the hormones, thus changing the process. And we are interfering with normal, physiological birth so often now that we are forgetting what normal birth looks like. We are becoming fearful and defensive. We are misinformed about how our bodies work and what is involved in the birth process. We are no longer trusting birth, but trusting the medical maternity system. Fear affects our hormones, including and especially those involved in the birth process.
The way in which we meet our babies matters in so many ways. Mothers and babies feel the consequences of our birth intervention poison when these necessary and purposeful hormones are interfered with. And there are many out there that don’t even realize it because our poisoned state is what is becoming accepted as normal. They don’t realize the potential that is there. They have no idea how amazingly beautiful it can all be because so few (if any) around them have experienced it. The medical maternity system doesn’t realize that it’s poisoning us, it’s just doing its job…methodically, systematically, poking, prodding, testing, monitoring, and delivering “healthy” moms and babies over and over and over again, trusting it’s interventions much more than the birth process, forgetting what is normal, natural, and truly healthy. Like an axe, clearing a piece of land for a beautiful, new neighborhood, full of gorgeous homes and a pretty park with freshly planted trees and flowers. The neighborhood is not bad. The axe is not inherently bad, it is doing its job. But what about the old trees and plants and animals that lived there before? New trees and flowers and bushes will be planted, new animals will move in eventually. The axe will continue doing its job, unchanged, unaffected. But we cannot ignore the fact that that piece of land will never be the same again.
The axe forgets. The tree remembers.
Unless we start speaking out and changing how we currently do birth, birth will never be the same again; we will never be the same again.
I know you have all been waiting for a big announcement with the new year. So here it is: Agape Birth Services is moving to Houston! That's right. My husband has accepted a position there so we are packing up and heading south in a few short weeks. I am excited about the opportunities that Houston holds, for my husband, for my kids and for myself professionally. But, my goodness I will miss the people of Nebraska! I have so enjoyed working with all 49 families I have served during my time as a doula here. It has truly been a blessing to be involved in such a sacred, intimate, life-changing moment in your lives. If you are currently pregnant or trying to conceive or find yourself pregnant in the upcoming months please know that I will be happy to help you find a doula to meet your needs. We will be holding a going-away party on the afternoon of Sunday January 24th that all of my doula families will be invited to. I would love to see you before we leave! Be looking for a fb and/or email invite to that. And if you think of it, we would very much appreciate prayer as we go through this big transition.
Blessings and Happy New Year, friends!
Your pelvis feels so loosey goosey that you’re afraid that when you get out of bed in the morning, you will land in a big pregnant heap on the floor, completely unable to support your weight any longer.
You pee every 12 minutes during the day and every 54 minutes during the night.
Everyone wants to tell you horror stories of their own births or tell you what you should and shouldn’t do for your birth.
You have hot flashes.
Getting dressed makes you short of breath.
Strangers try to make small talk and ask about your “due date.” You are not a library book.
You are always hungry but yet always full.
You cry over big things, small things, and sometimes nothing.
Fluids are leaking from places they usually don’t.
Your back hurts.
Your feet are swollen.
You have heartburn.
You don’t sleep.
I know, mama. I know. This pregnancy stuff can be HARD, especially at the end. It is doubly hard at the end.
But you know what? You can do hard things. I believe in you. You are strong. You don’t need to be rescued from this pregnancy with an induction. You can get through this. Plan some fun things to distract yourself. Seriously, spoil yourself rotten….massages and pedicures and haircuts and shopping. Eat good food, drink lots of water, rest when you’re tired…take naps! Cherish these last days of wiggles and kicks and bumps and hiccups in your belly. You will be missing them soon. Trust. Trust your body’s design. Trust the process of birth. Fear has no place here...only joy, love, peace and trust. Know that waiting and letting your baby choose his/her birthdate really is the best for both of you. Know that both your body and your precious baby were fearfully and wonderfully made. Trust that there is a purpose to every part of this process...that it was designed by a God that loves you more than you can fathom.
Hang in there, mama. Your sweet baby will be in your arms soon, I promise. You are amazing. You were made for motherhood.
As I was scrolling through my facebook feed while my kids played outside after lunch today, I ran across this cartoon. It seems absurd, doesn’t it? Who in the world would think of trying to induce a chick hatching? But that scene right there is reality in our maternity care system and our culture, friends. And that leaves me wondering: Where has our faith gone?
When God took that rib from Adam and formed it into Eve, breathing His breath of life into her, she become the finishing touch to His beautiful masterpiece. When He created her, He intended for her and every woman after her, to be the vessels of all future new human life. He built within our bodies everything needed in the complex process of bringing forth new life. Does that give you goosebumps? It does me. Women, and only women have the great privilege and honor of taking part in creating life. God uses us to create a miracle. Again, goosebumps.
Now, look again at that little comic after reading that and let me ask you: Why do we trust the design of animals more than our own? Do we not think our Creator is capable enough to get this one thing right? Do we not believe that we are more important to Him than any other creature? Are we not told over and over again in the bible to trust God and to not be afraid?
There is great joy and freedom to be found when we know and understand our value, worth, and unique design on this earth and place our faith and trust fully in the Lord...in every area of our lives, including childbirth.
Dear Sisters, you were made for motherhood.
For fun, I sat down and figured up my stats for several birth interventions today using every birth I have attended in the last 3+ years. And then I compared them to the national rate of that same intervention for the most recent year I could find. Doulas really do make a difference, folks. Just see for yourself.
National: 61% (2008) (http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_05.pdf)
Agape Birth Services: 22.7%
National: 23% (2012) (http://www.cdc.gov/nchs/data/databriefs/db155.htm)
Agape Birth Services: 9.1%
National: 25% (2004) (http://jama.jamanetwork.com/article.aspx?articleid=2089343)
Agape Birth Services: 2.3%
♥Assisted Vaginal Birth (forceps or vacuum)
National: 5% (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672989/)
Agape Birth Services: 4.54%
National: 32% (http://www.cdc.gov/nchs/fastats/delivery.htm)
Agape Birth Services: 4.54%
♥VBAC (Vaginal Birth After Cesarean)
Agape Birth Services: 100%
“My doctor won’t allow me to go past 40 weeks.”
“I can’t labor in the tub at my hospital.”
“My doctor says I have to be in the bed for pushing.”
“I’m not allowed to eat during labor at my hospital.”
“I have to do the gestational diabetes/Group B Strep test at my next appt.”
“My doctor says I have to have IV fluids during labor.”
“My midwife says I have to have my labor induced.”
“I’m not allowed to walk around during labor because I have to be monitored.”
“My midwife says I have to have a flu shot.”
Do those things sound familiar? I hear them ALL THE TIME. Friends, I have another quote for you.
“How can we hope to make mothers out of women when we treat them like children?” ~ Cole Deelah
Please do not think for a minute that your provider or the hospital staff have any authority over you. In fact, the words “won’t allow,” “I can’t,” or “he/she/they won’t let me” do not belong in maternity care. You are not a child, you are a pregnant/birthing mother paying the members of your birth team to provide you with a service. You are the boss of your birth team. This birth team works for you and you are free to fire anybody at any time if they are not providing you with the service you need/desire. Hospital policy is not law. If your hospital’s policy is to not eat during labor, I promise you that you will not be arrested if you munch on an apple and cheese cubes between contractions. You don’t even have to be sneaky about it. Just do it. It’s your body. It’s your baby. It’s your birth. YOURS. If you are told during pregnancy that you are not allowed to labor in water and that is what you’d really like, tell your provider that. And if s/he is insistent that you will not be allowed to, find a new provider/hospital. If you can’t do that, petition the hospital administrators with your request and take along plenty of research and evidence for its safety. Consider driving to a provider/hospital that will allow it. Don’t give your money and business to providers and hospitals that will not support your desires and your role as a decision maker for both your and your baby’s care. Remember, as long as your baby is still on the inside, it is not too late to fire your current provider and find one that will support you. When choosing a doctor or midwife, refer to my post about choosing a maternity care provider for a list of questions to ask potential providers.
I’ve been thinking a lot about my business and my services lately. Really meditating on the quality of services I provide and want to provide and the reason for which I do this work. As I was telling a friend yesterday, I think I can safely say that all doulas begin this work because of a strong desire to serve other women during pregnancy and birth, helping them achieve safe and satisfying birth experiences and often to help push the pendulum in the direction of normal birth becoming more of the norm. We understand just how very important it is to be loved, supported, encouraged, and empowered during our births. We understand the imprint birth leaves on the heart of mothers. And we want to make a difference. We want to be world changers, pendulum pushers. _
I can’t think of a single person who started in doula work with the desire to make a lot of money doing it. Many families may see the price tag of doula services and think “Gosh, that’s a lot of money!” And I get that, $700 is a large amount of money. But, once you subtract all of our expenses of childcare, gas, website, printed material, education, certification and training, and supplies for our doula bag then divide the remainder out over the amount of hours we spend with the average family during prenatal visits, answering emails/phone calls, supporting the birth, the postpartum visit, and all of the time spent with our own lives sort of on hold during the on-call period, that large amount of money is suddenly not so large.
Doulas are constantly trying to balance their personal with their professional lives and being fairly compensated for the time and energy they give to their clients while still being affordable enough for as many families to be able to hire a doula as possible. And of course to be charging a fee comparable with other doulas in the area who have similar levels of training and experience.
A few weeks ago, I was introduced to the H.E.A.R.T. doula pledge. And it really touched my heart that was already thinking something needed to change with my practice. I am now proud to say that I am officially a HEART doula business. And with that, I have decided it was time to make a change to my services offered and their fees. A year ago, I introduced 3 packages of doula services in the hopes that I would be more accessible and affordable to more families. But, after much prayer and thought, I have decided it is now time to simplify and pear down those packages. So, as you will see by visiting my services page, I have made some changes. It was time to simplify and “get back to my roots.” The core of my doula work has been and will remain to be the things the HEART doula pledge stands for. Honest. Ethical. Accountable. Reliable. Thoughtful.
It is truly my desire to lovingly support families during pregnancy and childbirth.
Several things have happened in the last week that just absolutely have my head spinning. A couple of them are undeniably big deals, and others seem like minor, harmless little nothings. But, they have all come together in my mind and now I’m feeling dizzy.
I took my 5-year-old daughter to the grocery store with me last week. Upon hearing my conversation with her in the check-out line, the lady in front of us turned around and asked how old she was. The lady then went on to say that she has 4 kids of her own and she has a daughter about to turn 5. She also said that she cannot wait for this almost 5-year-old daughter of hers to go to Kindergarten in the fall. “I’ve done my time, it’s someone else’s turn now!” she exclaimed. As we were loading our groceries in the van, I looked at my daughter and I just couldn’t imagine feeling that way about her. I homeschool and one of the reasons I do so is because I like being around my children. I don’t want them to be away from home all day, five days a week, 10 months a year. I’m not saying this to start a homeschool vs. public school vs. private school debate. Nor am I wanting any working mothers or mothers that do not homeschool out there to feel guilty. I am saying that the number of parents out there that prefer their children being in the hands of someone else most of the time is quite alarming. My sister is an art teacher at a K-12 school in a small town. She has told me things that are equally sad and concerning. At parent-teacher conferences, she only had 6 parents come speak to her. And with the art show she put together with her students….the only parents that walked through were ones that were already at the school for another event. The eagerness to ship small children off to school as early as possible, and the lack of parental involvement in the school their children spend the majority of their waking hours in, is sad, alarming, and eye-opening. And it’s just getting worse. Parents seem to be preoccupied with their own lives…their careers, their hobbies, etc., and very uninterested in their children’s lives. Now, I know I am making broad generalized statements here. I know there are still many involved, attentive parents out there (whether in public/private school or not.) But anymore that really seems to be the exception rather than the rule.
One big thing that happened recently, something that has made national news….a 12-year-old child was just arrested for murder here in Omaha. I’ve been reading news stories about his home life, interviews with his parents, fb posts from friends of ours that lived a few houses down from him for a few years and got to know him and...... ohymygoodness. How very sad. His father is in prison in another state, serving a sentence for murder. His dad was involved in gangs and is now saying how much he regrets being so open about it around his children. He says that he should be blamed for the path his son has taken because he was an awful example, and absent most of his life. It’s said that people often get involved in gangs because they are looking for a sense of belonging, and gang members are getting younger and younger. These young children are searching for love and belonging. How heartbreaking is it that they’re not getting what they need where they should be….at home with their families?
Close to half of the 40 births I have attended have been with his practice. He bucked the system frequently, and now the system has flexed its muscle and shut him down. It is sad to realize what this means for birth here in Omaha.
OK….now bear with me. I realize at first glance it may seem like a stretch to tie all these things together. But I’m going to tell you how I believe that they are all connected.
Oxytocin is known as the “love hormone.” It is produced with a hug, a cuddle, a kiss, while breastfeeding, and lots of it flows during an orgasm. Oxytocin is a key player in birth, also. It is what keeps the uterus contracting, opening the cervix and moving baby down and out. Throughout the labor process, oxytocin levels steadily incline and then reach their peak at the time of birth….a climactic reward to the hard work of labor. Oxytocin is responsible for feelings of bonding, nurturing, and protection. I don’t believe this is by accident, friends. This climax of oxytocin at the time of birth and the steady stream that keeps flowing as mom cuddles and nurses her newborn….that solidifies their bond. Because human babies are born so dependent (when compared to other mammals), it is crucial that new parents feel a strong bond and desire to protect and nurture their baby. This hormone is important. And we’re only just beginning to understand the depths of its importance.
Now that you know a bit about what oxytocin is, let me explain to you how it ties these things together. The problem is that not many women experience normal birth any more. When we interfere with the birth process….even with seemingly minor things like IV fluids and monitor belts, and especially with things like epidurals and Pitocin (a synthetic form of oxytocin used to induce and/or augment labor), it changes the production of natural oxytocin and the body’s sensitivity to the oxytocin that is produced.
My theory is that the first three of these problems … the lack of parental involvement with their children’s lives and rush to start them in school and let someone else “have a turn” raising their children, the general view that children are burdens rather than blessings; and these kids, even young children seeking love, acceptance and belonging from violent gangs because they’re not getting it from their families … this all stems from the 4th problem. Physicians that provide evidence-based, gentle, supportive, attentive maternity care that support and respect the physiologic birth process are becoming harder and harder to find. And the few that do exist are being challenged and run out of business by the medical world. Normal birth is birth that is free of unnecessary interventions, tests, procedures, and policies that interfere with the physiology and keep the oxytocin flowing as it should. And normal birth has become the exception, not the norm. The process of labor and birth was designed by the Creator of creation Himself. Every little detail of it has a significant purpose, including oxytocin as I explained above. And in our desire to control and manage birth (even with the good intentions of decreasing bad outcomes), we have made a mess. As we have added more and more interventions to the normal birth process, our country’s maternal mortality rate has doubled in the last 25 years, our cesarean rate has steeply increased since the 1970s (the WHO states that a cesarean rate over 10% does more harm than good – the US rate is 32%!), and our infant mortality rate is one of the worst in the developed world.
My theory is that if we reverse this, if we make normal birth the norm, if we surrender control of this process to the One who created it, rather than trying so hard to manage and control it ourselves, we will begin to see less of these problems. Families will feel more bonded, protective and nurturing towards each other. Fathers will feel more bonded with their children and their children’s mother, which would lead to fewer absent fathers and/or broken homes. I believe that we will see an increase in attentive, involved parents and in turn, a decrease in a variety of problems like ADD/ADHD, teen pregnancy, young gang members, teen drug use, school/mass shootings. Some of this may seem like a stretch to you but, think about it for a second. How many of these problems can be traced back to the root problem of kids needing attention and a feeling of belonging, love, and safety and seeking it out in the wrong places/with the wrong people because they’re not getting it from their families? I believe that our culture vastly underestimates the power of birth and the importance of not interfering unnecessarily. The more I experience birth and see such a wide range of situations and outcomes, the more I believe this.
Normal birth, birth as designed by God is worth fighting for.
Reversing this trend will not be an easy task, but it is not impossible. We all have to work together to make normal birth normal again. Be watching my friend, Kate Sorenson of Time to Be Born’s blog, for more posts about normal birth. And be watching for my next post that will include practical, easy steps that both moms and dads can take to make normal birth the norm again.
P.S. I wanted to add one more thing to this. While I do believe that the points I bring up here are valid and fixing some of these issue could have far reaching impacts on society, I need to make one thing very clear. What would make an exponentially larger impact is for people to come to know, love, and follow Jesus. As Dave Ramsey says, “Remember, there's ultimately only one way to (financial) peace, and that's to walk daily with the Prince of Peace, Christ Jesus.”
Amber Piller - Professional Birth Doula and owner of Agape Birth Services. Serving Northwest Houston including Jersey Village, Cypress, Tomball, Spring, and Katy Texas.