 “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.
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 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 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.”  Many women will at some point in their lives, find themselves staring at two pink lines on a pregnancy test. Positive. Pregnant. This can come with many emotions….excitement, fear, anxiousness, joy. And for many, there are a lot of questions. How do I tell everyone? When do I tell everyone? What do I eat now? Is it safe to exercise? How do I choose a care provider?
I’d like to address that last question. How do you choose a provider to care for you during your pregnancy and upcoming birth? You start by setting up interviews/meet-and-greets with several providers. You will want to ask lots of questions and take into consideration the type of care you desire and in the end choose the provider you feel is the best fit for you. Remember, that no provider can be perfect for everyone so if your BFF or co-worker loves a certain provider, you may not and that’s OK. Also, remember that you are hiring this provider to provide a service for you, so give this decision a lot of thought and don’t be afraid to switch providers at any point if you feel that the provider you had chosen is not/may not work for you after all. Here is a list of questions I’ve come up with to help you get started on your search for the right provider. ♥ How long have you been in practice? ♥ What hospital(s) do you have privileges at? ♥ What does a typical prenatal appointment with you look like? ♥ What prenatal tests/procedures do you require and/or recommend? ♥ What books and childbirth classes do you recommend for your patients? ♥ Is your practice a group or solo? What percentage of your patients’ births do you attend? Do all of the partners share the same philosophy/practice style? ♥ Do you have any time off planned around my due date? ♥ Please tell me about the “average” birth you attend. Are you usually at the hospital with patients as they labor? ♥ What percentage of your patients have their labor induced? ♥ What is your most common reason for inducing labor? ♥ What percentage of your patients have their labor augmented with either medication or procedures like breaking the water? ♥ What is your standard practice for women who go past their due date? ♥ What percentage of your patients birth with an intact perineum? ♥ What percentage of your patients give birth by cesarean? ♥ What percentage of your patients receive assistance from vacuum or forceps? ♥ What percentage of your patients receive an epidural during labor? ♥ How do you feel about other labor support people such as friends or family? How do you feel about doulas? ♥ What do you recommend for breech babies? ♥ What positions do most of your patients birth in? ♥ What are your and the hospital’s policies and thoughts about fetal monitoring? IV access? Eating and drinking in labor? Delayed cord clamping? Immediate skin-to-skin? Delayed newborn procedures and assessments? ♥ How do you help mothers that want to breastfeed? ♥ What if my baby is born early or has special problems? If you have already chosen a provider, but feel that you didn't ask enough questions, ask them now! Take these questions in and have a conversation with your provider at your next appointment. If you don't like the responses, go shopping for a new provider. Trust your instincts and remember, you are paying your maternity care provider to provide you with a service. Only give your money and your business to a provider that will give you the kind of service that you desire. As long as your baby is still on the inside, it is not too late to change providers if you have hesitations or second thoughts about the provider you have chosen. This decision is the first of many you will make as a parent and it is a hugely important one. Shop around, ask questions, trust your instincts. You know what (and who) is right for your family.  I’m going to stray a bit from my typical post about birth related topics and talk about myself today. As some of you may know from my facebook posts, I broke my ankle three weeks ago. My family and I drove to a campground two hours away and as we were setting up, I stepped out of the camper onto uneven ground and rolled my ankle. This resulted in breaking the very tip of my fibula off at the ankel joint and tearing a tendon. These last three weeks have been very hard for me. Not so much the physical pain, although there was some in those first days after, but emotional and spiritual pain. This week I have been wondering, what would God have me learn through these circumstances? And the answer is: so much! ♥My identity is in Christ, not what I accomplish. Ouch! I am a task-driven person. And I am guilty in seeking my worth and finding my identity in the things I accomplish. And now that I am forced to spend the majority of my days sitting and lying with this broken ankle, God has been speaking to me on this issue. I am not defined by my accomplishments, or my situation/circumstances. I am created in His image (Genesis 1:27, Ephesians 4:24). I am fearfully and wonderfully made (Psalm 139:14). I am a child of God (John 1:12, John 3:1-2, Galatians 3:26) He has chosen me, dwells within me and loves me (1 Corinthians 6:19, John 15:9, 1 John 4:9) And no person, thing, situation or circumstance can take that away from me (Romans 8:35-39). I am important. As I see the effect of my weeks of being limited on my feet, I realize how much my family does in fact need me. And through the outpouring of love we received with meals from friends and family, I realize that people care about me and my family.I know all of this in my head, but it’s hard to let it sink into my heart. ♥The Lord will provide. For much of the last 3 weeks, I couldn’t even tell you for sure what it is that I needed, but I needed *something*. I have been seeking the Lord and He has provided. (Philippians 4:19, Hebrews 11:6). I still having moments of frustration and feeling stir-crazy, but overall, I’m feeling more content and patient. And we have had so many people caring for our family by bringing meals. Seriously, we had an entire 3 weeks worth of dinners and many lunches brought to us….what a blessing! ♥ I need to have patience All of this sitting around waiting to heal is hard! I am learning patience and I pray that it will help me relate better to my husband, my children and my doula clients. (Romans 12:12, Romans 5:3-4, Colossians 3:12) And I trust that all of this will build character in me and will be used for good once I am through it. (Jeremiah 29:11, Romans 8:28)   Most of you have seen or are aware of the fetal monitors that are often strapped around mom’s belly while laboring at a hospital. There are two belts, one that monitors the baby’s heartrate and one that monitors mom’s contractions. But, do you know all of your options regarding fetal monitoring during labor? Do you know there are different types of monitors? Do you know what the evidence behind fetal monitoring says? You need to know these things. There are so many options and choices during pregnancy and birth.
You need to learn the pros and cons, risks and benefits with all of them. Yes, all of them. Because friend, you don’t want to be caught off guard and be unsure of what you want or not have enough information about your options at a time you may be faced with a decision in labor. You’ll be in labor…not a place or a time in which is best to learn the information, weigh your options and make a decision. And what’s more is that you want to learn of these things during pregnancy so that you have plenty of time to not only choose what is best for you, but discuss your preferences with your provider. You want all of those things hashed out and agreed upon before the big day. And you want to come up with a Plan B if something happens that would not allow you to continue with Plan A. This is just one of many reasons why it is so important to educate yourself…take a quality childbirth education course (a private, non-hospital class is recommended), read read read, hire a professional birth doula that will not only help inform you of your options and create a birth plan that is right for you, but support you in your decisions and remind you of what you want while you are in the throes of labor, and be sure that your provider is on the same page (and if s/he isn’t, find a new one that is!). "If you don't know your options, you don't have any." ~ Diana Korte
Since April is cesarean awareness month, I’ve decided to share with you the birth story of my oldest son, Nehemiah. He was born by cesarean a little more than 7 years ago. I often say that birth is transformative. And that holds very true for me. His birth made me who I am. His birth made me a mom. And the experience I had with his birth was the gateway through which I developed such a passion to support pregnant and birthing women and then ultimately became a doula. I feel very strongly about helping women avoid unnecessary cesareans and encouraging providers to lower the cesarean rates because when too many are done (our cesarean rate is double that which the World Health Organization has stated to bring the best outcomes for both mothers and babies), more harm than good is done. And for many years after Nehemiah was born, I grieved. I grieved the birth I had wanted. I grieved the birth that was stolen away from me. And while I still sometimes get sad and even angry about his birth, I am thankful for it. Thankful because it made me who I am today. It is my desire to help moms avoid that first cesarean and support moms who have already had a cesarean to achieve a successful VBAC. I wrote Nehemiah’s birth story while pregnant with my daughter, Roselynn. I knew it would be helpful to write it all out in processing my feelings. And I knew the importance of that processing to my success in having a VBAC. I did have that VBAC. It was very long and hard and full of emotional roadblocks. And I had a second VBAC with my youngest son, Abraham, which ended up being much shorter and easier. I’d love to share those stories sometime, too. I didn’t do any editing to his birth story. I’m sharing it with you exactly as I wrote it a little over 5 years ago.
On May 8, 2007, after 3 years of suffering through the heartache of infertility and losing our first child to a miscarriage, I stared at two lines on a pregnancy test and tried to catch my breath. I was convinced that my body was broken, but these two lines were going to prove me wrong. We were very cautious in the beginning. I was terrified of losing this baby, too. As we reached the end of the first trimester, we breathed a big sigh of relief and happily shared our news with all of our friends, family, and co-workers. I cherished every moment of pregnancy. I never felt more beautiful and feminine and alive. Feeling our tiny miracle dancing about in my belly was the most amazing thing I have ever, ever felt. Josh and I could sit for hours watching and feeling my stomach move and shift as our son moved, imagining what he may look like and eager to meet and hold him. Josh pampered and doted over me.
On Thursday December 13, 2007 I was headed to my OB’s office for my 37 week check-up. I was actually 36 weeks and 5 days into my pregnancy. I was feeling pretty good. The discomfort and pressure I had been feeling in my hips, pelvis and lower back for several weeks had lessened in the last couple days. I wondered if maybe the baby had moved further down into my pelvis. That morning, I had a pretty serious craving for a Burger King Croissan’wich. Josh and I were driving separately so that he could go straight to work after my appointment. He was running late, so I left with the intention of going through the drive-through and eating the sandwich while I drove. However, I missed my turn and didn’t have time to turn around. So, I went on to the doctor’s office. I was a little disappointed and pretty hungry, but my appointments were usually pretty short so I planned on getting my sandwich right afterwards. My OB checked me and said I was dilated to three. I was feeling so good. I adored being pregnant and was just so excited about the labor and birth, and finally looking into the eyes of the miracle growing within me. I told my doctor about the pressure and discomfort going away. She didn’t seem concerned, she reassured me saying that she had felt his head when she checked me. She was about to say “See ya next week” when I mentioned that my mother had had three breech babies. That caught her attention. She left the room and came back a few seconds later with a little ultrasound machine. “Breech babies aren’t hereditary, but I just want to be sure,” she told us as she squeezed some cold goo onto my belly. Our son, who had been hanging out so low in my abdomen for the last several weeks had flipped. Our doctor exclaimed, “That’s his butt I felt!” He was now breech. The next half an hour or so was a whirlwind of confusion. She worriedly explained to us that since I was dilated to three, she was afraid my water could break anytime. And if my water broke, the cord could prolapse. And if the cord prolapsed, we would have a “dead baby.” I felt sick to my stomach. She told us her plan, but I didn’t understand any of it. I just knew that I was supposed to go home, get my bag and go straight to the hospital without eating anything and that my precious son could die. I called my mom as we were leaving. Josh called his. My mom laughed and said “welcome to the breech baby curse.” I didn’t think it was funny. I was in a weird state of shock and denial. I called my boss as I was driving and told her that my maternity leave was starting that day. “Oh god, I’m having a baby…probably today,” I thought to myself. “But this isn’t right. What is going on?” Fear and desperation had a tight grip on my heart.
Finally, after a couple hours, a nurse came in to escort us down to have another ultrasound. I shuffled down the hall in my standard issue green hospital gown and the pink slippers I had purchased just a few weeks before specifically for our hospital stay. I had envisioned slipping them on in the middle of the night while I happily floated about our hospital room tending to our little blue bundle. Or perhaps as we walked a few laps around the mother-baby floor, proudly displaying our special delivery. The perinatologist confirmed that the baby was breech. He was a complete breech. He explained to me that our son was sitting sort of cross-legged on my cervix. He estimated him to be 6 lbs. 9 oz. Next thing I knew, they were preparing for an amniocentesis to check his lung maturity. The thing I remember most about the amniocentesis was that there were three staff there: the perinatologist who was a man, another man who was either a medical student or an assistant of some sort, and a nurse. The three of them were trying very hard to joke and put on a sort of comedy routine for us. I’m sure they were trying to keep me relaxed. I imagine it wouldn’t be good to insert a big needle into a uterus that is tense and hard with fear and anxiety. When my husband tells the story of the amniocentesis, he recalls feeling sick to his stomach as he watched the needle move onto the ultrasound screen next to our son. Afterwards, I had a hard time sitting up as my stomach felt hard and sort woozy. Once back in our room and strapped back down the bed with monitors, I felt a tight sensation run through my abdomen. The monitor showed that it was a contraction. The nurse then told me that it was normal after having an amniocentesis performed. Sure enough, there were only three of them over the next hour then they were gone. We were told that we would have the results from the amniocentesis in two hours…4:00. We waited and waited and waited. As it approached 5:00, I was tired, bored, worried, scared, and starving. A nurse came in to check my IV and I asked about the results of the amniocentesis. She responded with “Nobody’s told you yet?” That scared me. She said that someone was supposed to have told us that our doctor was coming in to speak to us personally. A little after 5:00, our obstetrician appeared in the door of our room. She explained to us that the results of the amniocentesis were good…that our son’s lungs were mature enough to be born. She then told us our options from there. Our first option was to take me over to a delivery room and attempt an external version to move the baby into a head down position. Once the version was complete, labor would be induced to insure that he would not flip again before he was born. I didn’t love that option as I was firm about my decision to not allow my labor to be induced as I knew it could lead to more interventions which could lead to a cesarean. The second option was to just have a cesarean. I was feeling as though a rug had been yanked out from under my feet. “Those are our choices?” I thought to myself. “But, he’s premature. How did we end up here, in this moment with these two crappy options about how our son will be born today…prematurely? Is there really no other option?” I desperately searched my scared, vulnerable mind for something….a question to ask, a tidbit of information about our situation I may have read during the last several months, a knowledgeable friend to call who could provide some guidance…anything. I came up empty-handed. With my doctor hovering over me awaiting an answer, I made the decision. I wanted to avoid a cesarean at all cost. We were going to do the version. There were a few risks involved with the version. They all would require an emergency c-section, so I was moved into a delivery room next door to the operating room. After I signed the consent form for the version and while Josh was gathering our belongings to be moved into the delivery room, I asked the doctor if the external version would be painful, stating that I would not change my mind about it no matter what the answer was. She told me it would be painful. It didn’t matter to me. I wanted our son to be born healthy, vaginally, and as naturally as possible. Josh hurriedly made several phone calls to update our friends and family on the outside. I noticed right away that the delivery room we were moved into didn’t have a Jacuzzi tub, which we specifically asked for in our pre-admittance paperwork as we were still pushing for a natural, medication free delivery. I asked about it and was told that we could use the “community one” down the hall later if I wanted. Then they began talking about the anesthesiologist coming in to give me an epidural. Wait a minute! Stop! “I don’t want an epidural.” I told them, while thinking to myself “Did you even read our birth plan?” They tried to talk me into it, but I was determined to have as natural of a birth as possible. They put something in my IV which I was told would relax my uterus. The external version was performed by three people: my female obstetrician, the male perinatologist, and his male student/assistant. There were also two labor and delivery nurses present….one of which I think was either a student or in training of some kind. As my OB emptied two entire bottles of ultrasound jelly onto my belly, she grinned down at me and said she preferred to use olive oil for versions. If it is possible to have an out-of-body experience, I had one during that version. The doctors briefly discussed their plan of action…which way they were going to “roll” the baby. Then, they braced themselves against the tables, and counters around them, looked at me and said “ready?” As I nodded, they began pushing, pulling, and twisting on my abdomen with all their might. My dear husband was by my side, holding my hand and one of the nurses was by his side encouraging me to breath. That’s all I could do. I stared into the light above me and breathed. Every second was excruciating. They stopped, but I could tell that the news wasn’t good. My OB turned to me and said, “Amber we’re going to try and roll him the other direction now. He didn’t want to go that way.” My head and body screamed, “No!” But I was holding on to my hope of a natural birth and nodded. Again, I looked into the light and breathed. They were able to turn the baby transverse, but he would not roll all the way. A cramp formed in my right hand as a result of the tension I felt during version. My fingers were twisted and curved in odd directions, unable to move. My sweet husband massaged my hand for what seemed like hours. I was told it was time for the c-section.
The devastation I felt at that point is beyond words. I felt such a loss of control…control over my body, my life, my family. With warm tears running down my face, the nurses began to “prep” me for surgery. I was exposed and shaved while the room was bustling with people. Nobody seemed to be concerned for my privacy. Although the nurse was gentle, I was humiliated. A cover was placed over my hair and my legs were put into some sort of inflatable blue bags. Josh was handed a set of scrubs and told to quickly change his clothes. I didn’t want him to leave me, even for a second. I was scared and so sad. I asked my obstetrician before she left to get herself ready for surgery if I would be able to have a VBAC in the future. Her response was “Well, we can try if you really want. But, you’ll probably find it easier just to schedule another section.” My heart crumbled. It was time. The nurses escorted me down the short, cold, sterile hallway to the operating room….the back of my gown open, exposing me. Again, there was no concern for my privacy. I felt defeated as I was assisted onto the table. There were so many people. The anesthesiologist was there, getting ready to play his part. I saw through a window into another little room that the perinatologist, his assistant/student, my obstetrician, and a couple nurses were scrubbing their hands. The anesthesiologist was rude to the nurses and made me feel very uncomfortable. I was terrified of the receiving a spinal block for the surgery. I did not want a needle in my back. What if they did it wrong and I ended up paralyzed? Once the spinal block was in place, I was told to very quickly lie down. Once lying down, my arms were pulled out from my sides and strapped to boards so that my upper half created a T. A large sterile drape was placed just under my bustline, blocking my view of the majority of the room and the people that it contained. The anesthesiologist who placed the spinal block was replaced by another one. This man was much nicer and he took his position at my head…slightly to my right side. They were about to cut me open and I began to panic. What if the spinal block wasn’t working properly and I felt the scalpel slicing into me? What if they cut into one of my organs? What if they accidentally cut my baby? What if I lost too much blood? I was terrified. I fought with everything in me not to have an anxiety attack on the table. Josh was my rock. He sat on my left side, very close to me and sweetly whispered into my ear. He was such a proud daddy and so excited to see his son. He tried to keep me focused on the fact that I would soon meet our little boy. I was told that I could look into the reflective light thing above me to watch my son being born. The thought of doing that made me sick. I couldn’t look at the bloody, gaping hole my stomach as they were pulling my premature son from my womb. I remember my OB asking me if I “felt that” as she made sure the spinal block was working before beginning. My mind was screaming “they’re cutting me open! My insides and blood are spilling all over this room!” The next thing I know, the anesthesiologist told me that now was the time to look if I wanted to see my son being born. I said “no.” He gently said, “Are you sure?” And I realized that I needed to be as involved in this as possible and that I should look. I didn’t want to regret it later. I looked. My son was being pulled out of me, butt first. There was so much blood. Nehemiah Mark was born at 6:40 p.m. Josh left my side to see our baby. After several seconds, it occurred to me that I hadn’t heard a cry yet. My obstetrician said from the other side of the drape that he was doing OK. Finally, I heard a cry. But, I felt nothing. It was just a baby crying. They do the initial assessment and weigh and measure newborns in the O.R., claiming that they can then stay close the mother and the mother can still be involved. However, I had no idea what was going on. I couldn’t see him or hear him and nobody was telling me anything. Josh came back to me, smiling ear to ear and exclaimed that he was beautiful and he weighed 6 lbs. 1 oz. I tried hard to feel excitement, but I just felt a pounding head and a heavy heart. Josh left my side again and came back several minutes later with a little bundle cradled in his arms. My hands were strapped down. I couldn’t touch him and all I remember seeing of him was his eyes and the tops of his cheeks. I was instructed by the nurse to kiss him and Josh held him close to my face so I could. They told me they were taking him to the nursery now which was on the floor below. I told Josh to go with him.
I was alone in the operating room. There were no friends and family cooing over our new arrival. I wasn’t able to count all his little fingers and toes or kiss his little cheeks. I was lying on a cold table under bright lights with my arms strapped down, and most private places exposed, unable to feel anything below my chest. I was surrounded by strangers wearing scrubs covered in my blood, hovering over the gaping wound in my stomach that they had just pulled my precious baby from and gossiping about their co-workers. I was mad and shocked at their total disregard to the major event that just took place for my family. But, I was too tired and sad to say anything. My husband and baby were gone. I closed my eyes and willed the throbbing in my head to go away. Now I had a terrible taste in my mouth, too. I told the anesthesiologist who was still at his station by my head. He gave an explanation, but I don’t remember what it was. Finally, I was wheeled into a recovery room. I chatted with the nurse almost non-stop as I was desperately trying to make the time move quickly so I could see my baby. I told her about my throbbing head and she told me it was because of the pitocin that was given to me to make my uterus shrink back down. She said I was given an unusually large amount for some reason…she didn’t know why. Josh came in and I began to feel some excitement. He informed me that our son was 18.5 inches long. He played me a video of my son in the nursery. As I watched the baby on the screen being handled by strangers, I felt no connection to him. He was cute. I sent Josh back to the nursery. Once he left, I desperately tried to muster up some sort of motherly feelings for the baby I had just watched a video of. I knew in my mind it was my son, but my heart was confused. I felt a deep love for the baby growing within my womb. I was having a very hard time forming the connection that the baby I was being shown was the same one that I had so lovingly carried within me and prepared for the arrival of for the last 36 weeks. At last, I was taken to our post-partum room on the “mother-baby floor” below and was told the baby would be brought right to me. It was approaching 8:00 and I was concerned about initiating breastfeeding as I knew the importance of beginning as soon after birth as possible. I lied alone in that room for 15 minutes before my husband finally came in, pushing a plastic box on a cart which contained a tiny baby boy swaddled in several blankets. Josh placed him in my arms as I was still unable to move my legs. Tears filled my eyes as I looked into his tiny face. Where were the fireworks? I felt very little for this child and was trying so hard to. He was beautiful and perfect, but was he mine? I was split in two as part of me still felt pregnant and the other part of me knew this was my baby I was holding. I was almost frantic about needing to nurse him. It had been two hours since he was born and I desperately hoped that nursing would help me feel connected to him. I had no idea what to do. I had read about it, watched videos, and received some instruction from our “Prepared Childbirth” instructor. But, I could hardly move and was lost. Josh paged the nurses’ station. When they answered, he told them I needed help breastfeeding for the first time. It was at least 10 minutes before a nurse came in to help. By this time, my son was almost two hours old. As she helped me try to get him to latch on, I began to feel sick. The nurse saw it and asked if I was going to throw up. I told her, “no.” I was really good at not throwing up and I was not about to do it while nursing my first child for the first time. I was wrong. In one smooth motion, the nurse handed the baby to Josh, and caught my vomit in a pink plastic tub. While I was being sick, there was a knock on our door. Our pastor and his wife had come to visit. Josh had asked them not to, but they were about to leave town for the weekend and came anyway. I don’t remember their visit.  Finally holding my son for the first time, a little over two hours after he was born. I was in such shock over what had just happened to us. I couldn't understand why the baby in my arms didn't spark any of the love that I had felt during my pregnancy and expected to feel once I saw his little face. Now I know that that's because I didn't labor at all. There was no oxytocin released, which is the "love hormone" and causes feelings of love and nurturing. I don’t remember much else of that night. It breaks my heart looking back now and realizing what I missed. I missed most of the first 12 hours of my son’s life. Josh took a video of his first bath for me. I was very sick all night. My poor husband held that pink tub for me over and over and over again. I hadn’t eaten in over 24 hours and was vomiting all night. I have no idea how many times I nursed the baby or even if he nursed well. He lay in the plastic bassinet next to me and we all tried to sleep. When he cried, I couldn’t get up to get him and I could hardly sit up in the bed to hold him when my husband handed him to me. Josh realized that I needed to sleep off the effects of the drugs and that I just couldn’t take care of our baby. He took him to the family lounge down the hall and stayed up with him all night, bringing him to me to nurse every couple hours. He remembers that night fondly. He spent all night cuddling with our tiny bundle in a reclining chair while I was in a deep drugged-out sleep down the hall. I remember the nurses waking me up in the middle of the night and making me get out of bed so they could clean me up some. They asked me if I’d like to walk the couple feet to the sink so I could brush my teeth. I wanted to, but only took one step before having to stop. I am so very thankful that my son had no major complications from being a “late pre-term baby.” We did suffer complications, however. He was small, and had a very hard time breastfeeding. He lost so much weight in the first three days after he was born that we were kept in the hospital an extra day so we could receive more help from the lactation consultants on staff there. Breastfeeding my son ended up being something I had to fight hard for.
I recently sat down with a friend from high school who is now working as a Women's Services Nurse Educator. The hospital she is working for is beginning to offer a natural childbirth session as an add-on to their prepared childbirth class and she was wanting to a little help in coming up with some content for this class. It was an honor to work with her!
And that meeting produced an idea for this blog post. Our time to talk was short and she only has two hours to give her students the best information she can. So, I tried to focus on what I believe are the biggest keys to being successful in one's desire for an unmedicated birth. And with that I give you: Keys to a Successful Unmedicated Birth:
2. Surrender Every mother who has an unmedicated birth has to find that place in which she is able to relax, let go, and surrender control to this beautiful process. This is pretty big. Absolutely essential, actually. No amount of reading or breathing techniques or squatting will override the inability to do this. And that can be hard for many reasons. Some don't learn how until they've labored for many hours. The earlier you are able to do this, the better it will be. If mom is fearful or anxious or is trying to control her labor, her body will be tense and working against itself. I wish that I could write out some simple steps to learning how to do this, but I can't. It's not that easy. This is something that I have worked through with so many clients. And it's something I'm only able to do in-peson, individulally as each mom's emotions and circumstances and reasons for being unable to surrender are unique. But, I can tell you that it is helpful to practice any and every relaxation technique you are able to throughout your pregnancy. There are many to choose from. Don't learn just one, try a few. It's also helpful to work through anxieties and fears with your spouse, a friend, your mom, a counselor, etc so that when labor begins you are more easily able to surrender. Something that falls under this category that I've noticed is helpful is mom's ability to ignore her contractions in early labor. I tell my clients over and over and over again: whatever you would normally be doing at the time labor starts (middle of the night=sleeping, noon=make some lunch, do a load of laundry, etc), do it. And ignore the contractions until you absolutely can't any longer. The moms that are able to do this during the early phases of labor, are typically in better spirits and much less exhuasted than those that watched the clock, analyzing duration and frequecy of every contraction and/or tried tricks to make labor faster during early labor. You can not control or predict your labor and birth. No amount of analyzing will allow you to predict who your labor will progress and what the outcome will be. No combination of activities or techniques or tricks will enable you to control your labor and birth. You need to educate yourself and surround yourself with a supportive birth team so that you are able to control how you are cared for during your labor and birth, but you will not be able to control the process itself. That's it. Two keys. Sounds simple enough, right? It is. But it really isn't. On a cold afternoon in late January, I arrived at my new home. I had been filled with anticipation for days wondering what my new home would be like and what sort of things I would be carrying. When I arrived, my new owner squealed with excitment which was a nice welcome. Then she began open up my many pockets and exploring everything I had to offer. Within a few minutes, she was filling me with some of the strangest things...things I had never thought I'd be carrying. The set of clothes and toiletries and snacks were not unusual. But, then came the the little bag housing a small plastic pelvis, tiny baby, amniotic sack, placenta, umbilical cord, and uterus. Next, she placed battery-powered candles, essential oils,a hand-held air pump, tennis balls, colorful socks filled with rice, a small speaker, and a long but pretty scarf thing that she called a rebozo in me. I was so curious as to where we would be going and what she would be doing. Much to my delight, I soon discovered that my new owner was a birth doula and I was her new, much needed and much loved doula bag that would not only be housing all of her wonderful doula tools, but also witnessing several tiny new lives entering the world!
I quickly learned that I had already missed her first three births of the year. But, I was able to attend 15 with her and I visited many families in their homes during prenatal visits where she proudly displayed my contents and demonstrated in what ways they may be useful during childbirth. My doula attended 18 total births this year; 9 beautiful girls and 9 precious boys were born. Of those 18 births, 8 were VBACs (Vaginal Birth After Cesaren). My doula talks all the time about how much she loves VBAC births because she had two of them herself. And of those VBAC births, one mom had had 3 previous cesareans, two moms had had 2 previous cesareans (and one of those had had a traumatic car accidnet which shattered her pelvis 2 years before!), and the last five VBAC moms had had one previous cesarean. Seven of those 18 babies born are the first/oldest in their families while the remaining 11 had sibling(s) eagerly anticipating their arrivals. There were 3 births this year for which my doula never even unzipped one of my zippers. She always says her most important tools are her hands, her heart, and her head. And I don't carry those, obviously! There was one birth this year for which I wasn't even taken out of the car. That tiny boy gave us all a surprise by arriving 7 weeks early at home just 10 minutes after my doula was called...what excitement that was! Two of the births we attended this year were ones we didn't have on the calendar, as we served as backup for doula friends. And then we had to call in those favors later in the year as we had three moms laboring at once this summer and then a few weeks later, two moms labored at the same time. Those weekends were long and a lot of work, but so very much fun! During the weekend in which there were three births at once, two of the moms were laboring in hospital rooms next-door to each other and we called in a back-up. During those births, I was in one room and the back-up doula's bag was in the other room and both doulas used both bags. My contents were practically strung all over the hospital at the end of that weekend!  I spent many nights packed up and ready, waiting by the front door this year. I had the privilege of going camping twice this summer with my doula and her family. No babies came during those weekends, so I ended up spending a couple days in a hot car, ready to go at a moment's notice. I imagine those won't be my last camping trips. Some new things my doula added to me this year are an essential oils diffuser, a foam gardening kneeling pad, a wooden spoon (you'll have to ask her what that's used for!), and a super cool and comfy new pair of purple shoes to wear to births. My doula mentioned a couple times this year how thankful she was that I have plenty of room for her tools and supplies, especially her extra set of clothes, toiletries and snacks. Some of those births we attended were really long and lots of work! But of course, worth it in the end! 2014 has been a wonderful year and I am happy to be so helpful in supporting families as they welcome a new baby and to have witnessed the miracle of birth 15 times over. I am looking forward to 2015 with much anticipation...it's looking to be a busy year! Blessings to you all in 2015!   I've said it before and I'll say it again: EPIDURALS ARE NOT EVIL. *Gasp* Are you shocked to read those words from a doula who has given birth twice without an epidural and has supported more than two dozen other moms who have done the same? It's the truth. Epidurals can be helpful and effective tools when used apporpriately. The same is true for IV pain medications used during labor and birth.
Sometimes, for many different reasons, moms who had chosen and prepared for an unmedicated birth decide during labor to get an epidural or have some IV narcotics. And that is OK. I won't leave. There is still plenty I can do to help. The list of labor positions I have in my head is huge and continuously growing. Several of those positions can be done with an epidural in place. I can still get mom and dad drinks and snacks. I can still give mom massages and whisper encouraging words. I can still show dad ways he may be comforting to mom. I can still gather information and answer questions that mom and dad may have. Sometimes, mom requests “something” or specifically an epidural and I know that if we can just get her over this “hump” she will do beautifully without one. In those instances, I begin making suggestions of other things to try first. Which leads me to...... 12 things to try before you get the epidural:
As I said before (and I'm sure I'll say again) epidurals are not evil. But, if you are hoping for an unmedicated, low-intervention birth, please try some of these suggestions if you find yourself asking for one. They just may get you through that tough spot and accomplish your goal.
 While interviewing with potential clients, I am asked a lot of questions. Some are sort of bizarre. Some are creative. Some are repeated often and asked by many. There are some questions that definitely have a common theme: “How will you work with my husband?” “Will you replace me?” (asked by the husband/father) “Will I have anything to do with a doula there?” (aked by the husband/father) “What about my husband? How will he be involved in the birth with you there?” “Will you support my husband, too?” See the theme? Both moms and dads are sometimes curious about how dads and doulas work together and worried about a doula taking dad's place in the birth of their baby. I'm here to assure you, I do not and will not take dad's place during a birth. I have no desire to do that. (Although I have supported a couple moms who did not have her husband/the baby's father at the birth.) I support BOTH mom and dad. What does that look like? How do I support both mom and dad? How do I work together with dad? I'm a list maker, so here's a list to answer those questions.  1. I am an extra set of hands. I can be a gopher while dad is with mom. I am able to refill mom and dad's water, grab a snack for mom and/or dad, warm up rice socks, get a cool washcloth for mom, run for a barf bag when mom feels naeuseous, track down extra pillows, shut the door, turn down the lights, turn on some music all while dad focuses uninterrupted on mom. I can support mom while dad uses the bathroom, takes a quick shower, gets something to eat, or takes a catnap. I can rub mom's back while she leans into/on dad. I can massage mom's feet while dad strokes her hair and whispers encouragement. I can apply counter-pressure to mom's hips/back while mom slow dances in dad's arms.
2. I can help dad be helpful to mom. Even the best prepared dad forgets what he learned in childbirth class once labor begins. I will remember what labor positions are most helpful for back pain. I will remember how often mom is supposed to eat and drink and pee. I will remember what is helpful when mom feels naeuseous. I will remember what signs to look for to know when it's time to go to the birth place. I can set the tone and hold the space with things like candles, essential oils and music, making sure the door is closed and everyone is speaking softly so that dad is able to completely focus on mom. And even better....I will know things that were not covered in childbirth class and make dad look like a genuious when I suggest that he does things that he's never heard of or seen before but are some how exactly what mom needs.
 4. I am experienced, educated, and trained in labor support. I am a birth professional. I have had two natural births of my own and have attended 29 births now as a doula. I've felt what mom is feeling, both physically and emtionally. I have read countless books, articles and studies about birth. I have attended several workshops taught by the country's top professionals. I know birth. If I don't know the answer to something, I have many resources and a large network of other doulas and professionals to turn to. 5. I am a calm, reassuring, intuitive presence. I often see a worried/concerned/scared look on dad's face for different reasons during some point in labor. And I can reassure him that what is happening is normal and that everything is OK. Sometimes, the sensations mom feels during labor can be a bit scary for her and I can assure her that everything is fine, and she is doing a good job birthing her baby. I have been told by many clients that I have great intuition and somehow know what mom needs without her saying it. I am not emotionally invested/connected to mom and baby in the same way that dad is and can offer an objective perspective when needed. I am able to remain calm and present in the rare circumstances that something may not go as planned and help mom and dad through difficult situations.  Dads and doulas play very different but equally important roles on the birth team. Dad knows and loves mom best. I know (and love!) birth best. I work for and with dad as he supports mom. And I love it.
Dads, what do you think was the most helpful thing your doula did for YOU? Comment below! *Photo credit: Traci Greve and Kara Holden In honor of International Babywearing Week, I wanted to share a few pictures of my babywearing family over the years. I am about to begin the process of becoming a VBE (Volunteer Babywearing Educator) through BWI (Babywearing International. If you'd like help with your carrier, I would be happy to do so during your postpartum visit!
 Pregnancy and birth have so many emotions attached to them. Excitement. Doubt. Anticipation. Love. Contentment. Discomfort. Happiness. Worry. Joy. Fear. Fear. There is a lot to be afraid of for any mom. And even more so for a first time mom, having never experienced all things motherhood before. It's normal to fear childbirth. Especially in our country, where women stop eachother in grocery stores to share their birth horror stories with eachother. Our country, where childbirth costs more than any other country in the world, but doesn't have the improved outcomes to show for all that extra expense. Our country, where many doctors and midwives practice based in fear. This fear is doing none of us any good. It's turned a normal, natural, God-designed process that can and should be beautiful and joyful into a cold, sterile, medical procedure wrapped in fear.
Sometimes, bad things happen. And it's awful and heartbreaking. But, letting fear of those bad things take over, steals the incredible potential there is for joy, beauty and love in childbirth. Fear is a dirty theif. Don't let fear steal that from you, friends. You deserve love and joy and beauty. But what about Eve? Didn't she ruin it for us? Isn't childbirth suppposed to be awful? Birth is supposed to be hard work. I will never tell a mom otherwise. It is powerful and intense and a lot of work. But, that hard work doesn't steal the beauty and joy. Fear steals it. Childbirth can be both a lot of intense hard work and incredibly beautiful and joyful. We just need to kick fear to the curb.
*Give your worries and fears to God through prayer. Ask for His peace to fill your heart. (Philippians 4:6-7 ~ Don’t worry about anything; instead, pray about everything. Tell God what you need, and thank him for all he has done.Then you will experience God’s peace, which exceeds anything we can understand. His peace will guard your hearts and minds as you live in Christ Jesus.)
*Claim the power you have through God to cast out fear. (2 Timothy 1:7 ~ For God has not given us a spirit of fear and timidity, but of power, love, and self-discipline.) *Trust God's plan, not only for you, but for your baby as well. (Jeremiah 29:11 ~ For I know the plans I have for you,” says the Lord. “They are plans for good and not for disaster, to give you a future and a hope.) *Stand on God's promise that you can do ALL THINGS with Him. (Philippians 4:13 ~ I can do all things through Christ who gives me strength.) *Support. Find a provider who does not fear birth. Hire a doula to guide, educate, and support you on your journey. It is my prayer that moms release their fears to The Lord, embrace their bodies' design, trust God's plan for them and their children, and reclaim their births.  As my business has grown these last two years (yes...I just celebrated the 2nd anniversary of the first birth I attended!), our life has had a shift, as well. I've gone from being on call sometimes to pretty much living on call.
I go on call for my clients at 38 weeks of pregnancy. And I remain on call for that client until a week after the baby is born. That means that I can be on call for a client as long as three or four weeks. And once, my on call period lasted five weeks for a client that had a baby who wanted to stay on the inside a bit longer. And because I have 2-3 clients most months, that means my on calls overlap. Occaisionally, I'm on call for four moms at once. What does it mean to live on call? It means always having my fully-charged phone near me with the ringer on and turned up. All the time. 24/7. It means that when we want to go camping for a weekend, we have to choose a campground within an hour's drive of home, drive two cars, take along my doula bag and business files and have a separate shower bag for me so that I can shower before I leave if I get called for a birth. It means that my doula bag is always packed and sitting next to our bedroom door (or front door if I know mama is in early labor) with my birth clothes neatly folded and sitting on top...waiting. It means adding the phrase “as long as I'm not at a birth” at the end of my RSVP for everything and then sometimes missing those things because I'm at a birth or recovering from a birth. It means having on call childcare and several back-up plans in place so that I can get to my clients when they need me, day or night. (Thank you, Chelsea!!!!!) It means if I'd like a glass of wine, I have ONE glass. It means being woken up in the middle of the night, getting dressed, quietly kissing my sleeping family and slipping out. It means not knowing how long I'll be gone when I get called to a birth. It sometimes means going many many hours without sleep. It means that at any time, I am ready to leave my three sweet children to witness a mircale. It means that at any time, I may be called away to support a woman as she finds her strength, learns to trust her capable body, and transforms from woman to mother. It means that at any time, I may leave my amazingly supportive and loving husband to watch a beautiful love story unfold between a new mom, a new dad, and the life they created and birthed together. It is sometimes hard living on call. I could say it's one of the hardest parts of my job. I've missed some thing's I'd rather not have missed. I've learned to go 40+ hours with no sleep. But, every second of it has been worth it.  To the mamas who breastfed for a week...
To the mamas who breastfed for a month... To the mamas who breastfed for six months... To the mamas who breastfed for a year... To the mamas who breastfeed into toddlerhood... To the mamas who pumped and bottle-fed their babies breastmilk... To the mamas who openly nurse in public... To the mamas who cover up to nurse in public... To the mamas who fought through tongue tie... undersupply... flat nipples... engorgement... MSPI... sleep deprivation... NICU stays... breastfeeding mulitples... tandem nursing... and so many other difficulties... To the mamas who fed their babies with donor milk... To the mamas that supplemented a little with formula... To the new mamas who wonder if they're doing it right... their baby's getting enough... when they will sleep again... how they will be able to leave the house again... To ALL the breastfeeding mamas... GOOD JOB! You are doing such a wonderful thing for your baby! It may not be easy all of the time. But, hang in there! It will get easier. You are not alone. There is so much support out there. Much love to all of you. HAPPY WORLD BREASTFEEDING WEEK!   For me, the story begins on Monday, January 20th around 5:00pm, when I would normally be getting off of work and heading home. However, I was in an extended meeting with my manager. I received a text from my wife asking if I was coming home soon. I replied, “No, why? What’s up?” She simply said, “Oh nothing. I just think I might be labor. No big deal.” NO BIG DEAL?! I quickly wrapped things up with my manager and left work as soon as I could and called Megan. She assured me she was okay, and that it was still early on. When I arrived at home, Megan was packing her “go bag” with clothes, snacks, baby gear, etc. The contractions were pretty far apart still, and not too strong. We both realized that we didn’t quite have everything we needed, so...we took a trip to our favorite place: Target :) We walked around for a while, stopping while mild contractions too place every five minutes or so. Eventually heading back home. Once unpacked at home, Megan said I could go ahead and go to bed since it could be a long night if things got more serious. I went ahead and got ready for bed, and was only laying down for a few minutes when Megan yelled my name from the living room. I went to her and she said her water broke while she was shifting on the couch! Wow! Here we go! We contacted our doula (Amber) to let her know what was going on. She told me to call the midwife to let them know we needed to come in for Megan to get her antibiotic for Group B Strep. We packed up the car and took the 20 minute drive down to the Midwife’s Place. It was around midnight, and a very cold, January night. Luckily no snow! Once we got to the Midwife’s Place, we brought everything in (thinking we were going to stay there the whole time). Megan got checked out by the midwife and hooked up to the IV. I thought I would be nice a strong and handle that simple thing okay, but I ended up getting pretty queasy and needed to go sit down before I passed out.  Megan’s contractions started getting stronger over the next hour or two. I stayed with her, helping her through contractions, until I was too weak to help out anymore (like I was doing anything near as hard as she was!), and went to grab Amber so she could step in and help for a bit. While I was laying down, I heard Megan throw up (a normal/good thing when in labor), and that normally wouldn’t bother me, but it did...so I followed suit and did the same sadly. Some strong dad I’m gonna be ;)  After a while, the midwife checked Megan’s progress and suggested we go back home to labor there since you’re generally more comfortable and relaxed in your own home and can progress better there. So, despite not wanting to pack back up and go home, we agreed and did so. It’s now just after 2:00am or so. Once home, Amber ran Megan a bath right away, while I went and laid down on the couch (sad, I know. I still can’t thank Amber enough for helping out. This is exactly what a doula is for!!) I rested while Megan labored in the tub for a while, and eventually they moved to our bed and continued laboring for a couple hours. By about 5:30am, Amber though Megan had progressed enough to the point where we needed to go back to the Midwife’s Place. So we got ahold of the midwife and let her know we were coming back. Funny story: As Megan and Amber were getting ready to leave, I knew I had to take care of our dog Millie (feed her breakfast, let her out, etc.) since we wouldn’t likely be back home for several hours. Megan didn’t see that as a very critical/important thing to do at that exact point in time, and shared some friendly, laboring words with me to let me know that we needed to go and that I shouldn’t be worrying about the dog :) You can use your imagination to figure out what may have been said. We get in the car and take the drive back down to the Midwife’s Place - again, still pitch black outside and below zero temperature. Megan was having some back-labor pain, so Amber placed her rebozo in a big knot behind her back to push on the car seat as we drove (so smart!) which helped Megan out. Once we got there, Megan felt like she was so far and was in enough pain that she wasn’t wanting to get out of the car! I told her, “we’re right here, just get out and have the baby inside.” We made our way in and the midwife checked Megan once more - telling us she was still only at about 6cm. We knew going in to this that we wanted to attempt to have a water birth. So, we ran a bath right away and got Megan ready. While she was sitting on the toilet, Megan said, “I think I’m ready to push.” Just a few minutes after the midwife told her she was only at about 6cm! Gotta love those maternal instincts :)  So we get her in the tub and Megan starts really pushing and the contractions are strong and very close together - barely giving Megan a chance to rest in-between. I had complete confidence in Megan the whole time. It was so exciting seeing her do this all on her own.
 Once Megan sat back I handed the baby to her and just sat there weeping with absolute joy and amazement. I knew my wife was a strong woman, but to go through the whole process from start to finish without any pain medication, drugs, etc. at all makes me respect and appreciate all that she just went through SO much more. An AMAZING accomplishment. Besides that, our daughter was just the most beautiful, sweet thing! What’s neat about a water birth is that the baby doesn’t really cry too much right away, because she goes straight from amniotic fluid to water, then air. So it’s a gradual thing. Megan just held her skin-to-skin, while I held the baby’s foot. We waited for the umbilical cord to stop pulsing to ensure all the cord blood got into the baby’s body, and then I cut the cord (another awesome experience). And then I took the baby so that Megan could get cleaned up and out of the tub. This is probably my favorite part of the whole experience, where I was able to hold the baby skin-to-skin with myself. It was such an amazing bonding moment right away. We went and laid down in the bed and waited for Megan to join us. Just such a sweet experience.
Happy 6 month Birthday, Lucy! There's no such thing as TMI for a doula. And we are known for being totally unaware of our surroundings while on a phone call with a client or discussing birthy stuff with doula friends. To those who have overheard these conversations, I'm sorry. Sort of. To my doula friends, comment with your funny quotes!
20 Funny Things I Have Said to Clients (Or my husband or a friend) “Was there blood too, or just mucous?” “You're throwing up?! Yay!!!” "Can I show you your placenta?" “Your butt is not ripping apart. I know it feels like it, but it's not.” “Most women poop. Poop is good!” “Stick your butt waaaaay out. Like this.....” “Your nipples are perfect.” “You were making noise when this baby got put in there. It's OK to make some noise while this baby comes out.” "Hey, babe. I just got home. There's a placenta in the fridge in the garage." “You can take it orally or insert it vaginally, whichever you prefer.” “You feel like you need to poop? That's what we're waiting for!” “May I touch your breast?” “Try holding your boob like this...” “Don't put the phone down next time. I want to hear the noises you are making.” “What did you see when you wiped?” “You should probably bring some towels to sit on.” “I promise you the baby is not coming out of your butt.” "I need to get going. I have a placenta in the van." "Pushing feels sort of like throwing up, but in the other direction." "Semen can really get things started. Orgasm is good, too. Oh! And nipple stimulation." And to balance it out..... 20 Things that aren't so funny, but that I say often during a birth. “You are amazing.” “You are such a good mom.” “I know it's hard, but you are strong and you can do this.” “Great job.” “You are doing so well.” “Take a couple big breaths for your baby.” “What a beautiful belly.” “I can't wait to see you holding your baby for the first time.” “Wow. You are incredible.” “Good, mama. You are doing so good.” “You were made to be the mother of this baby. Whatever decision you make is the right one. I will support you with whatever you decide.” “Let's have a birthday party!” “Your body is working perfectly.” “Listen to your body.” “This contraction will go away just like all the others have.” “Stay with it. Almost there.” “You will never feel that contraction again.” “You were designed to do this.” “Would you like me to pray with you?” “Can I get you something to eat? Drink? A cold washcloth for your neck? A warm blanket? Turn the lights down? Turn on some music? Draw you a bath? Massage your back/feet/hands? Try some counterpressure? Get you anything?”
 Let's talk more about a doula's fees. I sometimes get messages asking me to give a discount or take on a client for free. I understand that money is tight for many and I strongly believe that every woman deserves a doula. However, I just can't afford to do those things. 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 children. Some feel that a doula's fees are expensive. I'd like to show you a breakdown of those fees and why I charge what I charge.
Total fee - $450 Childcare - $75/client Gas - $25/client Printed materials/handouts/marketing/website - $20/client Bag and Supplies (includes snacks and toiletries for myself during the birth, essential oils, massage tools, etc) - $20/client Phone and internet costs and PayPal fees - $15/client Lending Library - $5/client Training, education, certification and organization/membership fees - $25/client Remaining fee after subtracting expenses - $265 Average amount of time spent with client (3 prenatals, the labor and birth, and one postpartum visit ) – 22 hours Average amount of time spent driving to and from meetings and the birth place – 3 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 – 2 hours Total amount of time put into each client - 29 hours Average amount of money I make for each client - $9.14/hour This doesn't include time spent in interviews (which are free of charge), time spent marketing and networking (doula speed dates, the baby fair, and other events), time spent keeping up with my website and business facebook page and pinterest page, and the time I spend on call for each birth, which can be as long as 5 weeks. 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) for weeks at a time. This also does not include taxes, which I do file and pay yearly as needed. Doula work is time consuming, physically exhausting, and emotionally draining. And I love every minute of it. 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. Stay tuned for my next blog in this 3 part series, The Luxury of Doula Care! In Part 1, I discussed The Value of a Doula. And coming up in Part 3, I will discuss just How to Afford the Doula of Your Dreams. **Update** My fees have changed since I wrote this blog to allow me to be more fairly compensated for my time, resources, and skills. And in an effort to meet the needs of families with lower incomes and/or different needs for prenatal support, I now offer three different packages of doula services and individual birth plan assistance and labor support training. Please see the services section of my website for more information. The number one reason I hear from parents for not hiring a doula is the cost. I hear and read things such as, “a doula isn't in our budget” and “a doula is a luxury we just can't afford” or “I'd love a doula, but they're too expensive.”
Bologna. If you see something as valuable, you will find a way to pay for it. I'm going to inform of you why a doula is not a luxury, but in fact a necessity. Let's start by just addressing the financial side of this. Bear with me as I go through some sorta dry statistics. I promise you these numbers are super mega important, though. You need to know them. In the Omaha area, the average doula costs $450 (price varies a bit by experience...$450 is the average and is my current fee, so we'll go with that.) According to a Cochrane review published in 2012 by Hodnett and Colleagues, women who receive continuous labor support provided by a doula experience: 28% decrease in cesarean *The average out-of-pocket cost of a cesarean in America is $15,000 31% decrease in the use of pitocin *I'm not sure of the average cost of pitocin, but considering that hospitals are notorious for charging a half a day's pay for an aspirin, I'm certain it costs more to have it than not to. Pitocin is administered by IV, so there will be costs associated with having the IV placed, as well as just the medication itself. 12% increase in the likelihood of spontaneous vaginal delivery *I'm also not sure of the cost of either vacuum or forceps assisted births (despite my amazing google skills) but would imagine it costs more to use them than not to. 9% decrease in the use of pain relief medication *The price of an epidural is in the neighborhood of $1,000-$2,000. 14% decrease in the risk of her newborn being admitted to a special care nursery *There are a lot of variances to this one. It depends on whether it is a level II special care nursery or a level III NICU, how long the stay is, and the reason for admittance. Have you ever heard of a $450 NICU stay? Me either. 34% decrease in the risk of feeling dissatisfied with the birth experience *The ability to be an active participant in my birth while feeling loved and supported by everyone around me coupled with the feeling of intense joy and empowerment after my two VBACs attended by a doula is priceless. Priceless. Doula care has also been shown to: Improve breastfeeding success *The average price of one can of infant formula is $25. One can per week for 52 weeks (one year) comes out to be $ 1,300. Decrease the risk of postpartum depression *We can't put a price on mental health. We could put a price on antidepressants and counseling services, though. Let's say you spend $10 a month on prescription antidepressants and see a counselor twice a month at a cost of $40 per visit (after insurance, of course) for six months. That comes out to a total of $540 for six months. My $450 fee can potentially save you tens of thousands of dollars. Now, let's look beyond the financial side of a few of these areas. Cesarean Nebraska's current cesarean rate is 32%. I said above that the evidence shows that doula support decreases a woman's risk of cesarean by 28%. That is a pretty big number. I also said above that a cesarean costs around $15,000 out of pocket. That's for an “uncomplicated” cesarean. A cesarean is major abdominal surgery, folks. So, of course it comes with risks. Things like infection, blood loss and damage to other internal organs like your bladder. It also increases your risk of placental abnormalities in future pregnancies like placenta acreta or placenta previa. Some of those abnormalities can be deadly to either mom or baby. Take a minute to let all of that sink in...the financial cost, the emotional cost, the health cost of a cesarean can be astronomical for some, especially those that experience some of the complications that I mentioned. Pitocin As I said above, doula support decreases the risk of mom receiving pitocin by 31%. Pitocin is a drug used to either induce or augment (speed up) labor. It is a synthetic form of oxytocin which is a hormone mom releases during labor. Oxytocin is referred to as the “love hormone” as it is the hormone released (in different levels) during hugging, kissing, orgasm, labor/birth, and breastfeeding. It is the hormone responsible for mother-infant bonding and those overwhelming warm, fuzzy nurturing feelings moms have towards their children. Pitocin effectively causes contractions, but does not have the same emotional effect that oxytocin does. A mother who receives pitocin does not make as much of her natural oxytocin as she would have otherwise. A price can not be put on all of this. But, think about the possibility of not reaching the full potential of bonding with your new baby. Pitocin also carries with it risks such as hyper-stimulation of the uterus. And moms receiving pitocin are required to undergo continuous fetal monitoring. No walking the halls. No baths or showers (which have shown to decrease mom's discomfort by up to 60%). Mom is now on a leash. Spontaneous Vaginal Delivery As I mentioned above, I'm not certain of the cost of births assisted with vacuum or forceps, but I would imagine it costs more than a birth without. And it certainly has more risks than birth without. There's increased risk of tearing for mom and increased risk of injury to baby, including some pretty serious things like bleeding on the brain. Doula support increases the likelihood of spontaneous vaginal delivery by 12%. Pain Medication Any intervention given during birth messes up the natural physiologic process. Birth was designed with an incredible cocktail of hormones flooding the mother's body as she works to birth her baby. Adding any kind of artificial drugs, whether it be pitocin or some kind of pain medication changes that cocktail. IV pain medications are narcotics. They do affect the baby which can cause difficulties with breastfeeding. They can make mom feel sleepy or loopy or even sick. I know that I'd much rather be fully present for such a milestone moment, not only in my life but in my husband's and baby's lives as well. Epidurals don't affect moms or babies the same as the IV pain medications. But, they severely limit mom's mobility. A glimpse at pelvic anatomy will confirm that women were not meant to give birth on their backs in bed. And of course, epidurals don't come without risk. There is a possibility of nerve damage and spinal headaches, which are awful. Imagine spending the first week of your baby's life with the worse headache of your life. And if you buy the epidural package, there are other things that come with it, of course. Things such as an IV, continuous fetal monitoring, a pulsox clippy thing, and a catheter. Mom will be stuck in bed, tangled up in all sorts of wires, belts, straps, lines, cords and machines, with no control over her bladder, needing someone else to empty it for her. And sometimes no control at all of her legs, requiring help to even roll over. AND, it has been shown that once mom receives an epidural, her partner and other support people sort of check out. Mom doesn't need help focusing or breathing any longer. Mom doesn't need counter-pressure or the physical support of certain labor positions any more. Plus, it's now hard to even get to mom through all of the straps, wires and belts to do just offer a hand to hold. Mom is often now laboring alone while dad gets a nap, facebooks from his phone or watches TV. Feeling Dissatisfied With the Birth Experience No monetary value can be placed on this, but let me assure you, it is of paramount importance. The birth experience will impact you more ways than you realize and for the rest of your life. Birth is the beginning of the mother-baby relationship. The way in which you birth your baby and the circumstances under which you first meet your baby set the tone for your postpartum period, and really your entire parenting journey. Imagine beginning that journey feeling as if you failed. You may be set up for failure. What impact would beginning that journey feeling as though you were trapped, cornered and had no options or as though nobody listened to you or took you seriously have on your parenting? Beginning that journey feeling as though the baby being healthy is all that matters can potentially set a new mother up for an incredibly emotionally hard postpartum period. That mama matters, too. This issue can piggyback off of the decreased risk of postpartum depression that mothers who receive doula support during their births experience. Birth matters. In my experience, dads have been particularly grateful for my doula services. It helps take the pressure off of them to do all and be all. Even the most prepared dad will forget some (or most) of what he learned in childbirth class once contractions start. Even the most calm, even-keel guy can panic once he sees his lady in discomfort. A laboring woman isn't always able to verbalize what she needs/wants. I've been trained in that area. I've given birth before. I've doula'd for many other mamas. I have been blessed with a motherly instinct and a servant's heart towards birthing women that I tend to follow more often than not. Mamas, you deserve the love, undivided attention, education, encouragement and support of a doula. Daddies, you deserve the help that a doula can give you so that you can be all you can be for the woman you love. Families, you deserve to have the best chance possible of starting your new relationship, your new family off on the right foot in a loving, gentle, educated, and supported way. You get one shot at this one birth. There are no do-overs. How can you afford NOT have a doula? This is Part 1 in a 3-part blog series about the cost of a doula. In Part 2, I will discuss a thorough breakdown of my fee and explain how I came that amount. In Part 3, I will discuss ways in which you can afford a doula for your birth. Thank you for reading! As a doula, I have the honor and pleasure of witnessing and participating in all kinds of amazing different birth experiences. There are a small handful of especially incredible things that are on my doula bucket list. These are things that I hope I am blessed to experience in my (hopefully many) births as a doula:
1. A baby born en caul. This is when the amniotic membrane is not ruptured prior to the baby being born, so the baby is born still inside the amniotic sac filled with fluid. I've seen pictures of this and it is an amazing glimpse inside the baby's world before birth. 2. A multiple birth. I would love to doula for the birth of twins or even triplets. Double and triple the joy! 3. A vaginal breech birth. My oldest was breech, but was born by cesarean. I would love to see a breech baby born vaginally. 4. A surrogate or adoptive birth. I'm sure a birth like this would be so incredibly emotional for all involved, but I would be so blessed to support a family through one. 5. Attend a homebirth. Sadly, Nebraska is not a very homebirth-friendly state. One of my recent clients blogged and shared her birth story yesterday. What a lovely birth that was. I'm so honored to have been a part of it. I'd like to share it all with you, too. Here is the story of Lucy's Day. Enjoy!
 The mission of the Omaha Doulas Association is to provide quality birth and postpartum doula services to expectant women and their families. We seek to provide information and support to empower birting mothers while working to promote public awareness of benefits of doula care. In addition, we provide support, companionship, and networking opportunities within the doula community.
I'm a member and co-leader of Omaha Doulas Association. I LOVE this group of ladies. They are so passionate about their work. And we're all friends and so supportive of each other. Next weekend, we will be working together to have a table at the Baby Love Essentials Baby Fair. Its such a fun time of interacting with new and expectant families. And we have big plans of doing more of this. World Doula Week is coming up soon and we are raising funds through shirt sales to raise community awareness of the benefits of doula support, network with healthcare professionals and provide our members with continuing education. These shirts are really great. It would mean a lot to me if you supported us by buying a shirt and sharing the link. Thanks, everyone! Omaha Doulas Association Shirt Fundraiser. The birth world has been a buzz about the newly released consensus statement on preventing primary cesareans from ACOG (American College of Obstetricians and Gynecologists) this week. And rightfully so. This statement includes things that the scientific evidence has been supporting for some time now, but that have not been widely practiced by maternity care providers. Some of the new recommended guidelines in the Safe Prevention of Primary Cesarean Delivery statement, and what I believe are the biggest game changers include:
These new guidelines offer great hope for lower cesarean rates and safer births for both mother and baby. But, it will be a big challenge to change the culture surrounding birth and obstetrician's attitudes about labor management. History has shown us that once new guidelines have been posted, it takes anywhere from 10-20 years before they are widely practiced. I don't want to wait that long. I'm afraid to wait that long. Our cesarean rate has been increasing steadily. Our maternal mortality rate has doubled in the last 25 years. We are ranked very low among developed nations in infant mortality and morbidity, yet we spend an obscene amount of money on maternity care...the most in the world. We need these changes to happen soon. How can maternity care consumers facilitate these changes?
There are a lot of things I love about being a doula. A lot. One of those things is the support and friendship within the doula community here in Omaha. We have so many fabulous doulas here. And we're all friends. Seriously. We don't view or treat each other as competitors, but as colleagues. I belong to a facebook group in which most (maybe all) of the doulas in the Omaha area are members. Most of the conversations in that group are doulas helping each other out....providing backup for a sick or exhausted doula, sharing handouts, resources, articles and studies, offering suggestions for those harder labors, helping each other with website design, sharing opportunities for continuing education, inviting each other out for doula dates, doula parties, and doulas' nights out, cheering each other on, and offering a shoulder to cry on after those particularly emotional births.
We all have one common goal: safe, healthy and supported births. We all understand that no doula can be the right doula for every mom and genuinely want every mom to have a great birth. We work together to raise awareness about the benefits of doula care and refer to each other to make sure that every mom who wants a doula, finds one that is a good fit for her needs, desires, and personality. We deeply believe in this work. It's not about the money or the number of clients on our calendars. It's about moms and babies. It's about love. Thank you, fellow doulas for your love and support not only for the mothers and babies of Omaha, but of your doula colleagues. It is a blessing to be a part of this lovely little community. |
AuthorAmber Piller - Professional Birth Doula and owner of Agape Birth Services. Serving Northwest Houston including Jersey Village, Cypress, Tomball, Spring, and Katy Texas. 
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Professional Birth Doula Services in Northwest Houston. ♥ Jersey Village ♥ Cypress ♥ Tomball ♥ Spring ♥ Katy
amber@agapebirthhouston.com
amber@agapebirthhouston.com