Shame and guilt appear to be accepted aspects of motherhood. There is very little a mother can do that doesn’t make her susceptible to being shamed into feeling like a ‘bad mother’. If you formula-feed, you are denying your child a healthy start. If you breastfeed past the first year, you are a hippie attachment parent who can’t let their baby grow up. If you go back to work early, you are abandoning your child. If you stay home, you have no ambition (I have done ALL these things by the way). The list goes on…
Shaming also extends into the birthing world, and birth shame is personally something that I have carried with me for some time now. When I was pregnant with my first son I had planned the birth that many doulas dream of. I had the midwifery team, the doula, my home birth supply list, and even a spot in my backyard picked out for planting my placenta. It was going to be a peaceful, primitive and undisturbed birth experience, complete with rainbows and unicorns. Well, it turns out (in case you didn’t know) that things don’t always go as planned, and I ended up in the hospital at 36.5 weeks facing an induction.
Induction is a bad word in the birthing community. It should be avoided like the plague! And I was a doula, so shouldn’t I know better? Shouldn’t I be ‘informed’ enough to know the risks? Against what I was taught I went ahead with the induction. After 12 hours of labor my son was born, and was immediately whisked away to the Neonatal Intensive Care Unit (NICU). Instead of making memories of our first gazes, or taking pictures of his tiny feet, I was left in the birthing room without a baby. Were my choices the reason that my baby was in a cold incubator all alone? Was I the reason that we missed out on those first precious moments together? My shame convinced me that our mother-child bond was compromised by my failures. All I could see was that I hadn’t been good enough, that I hadn’t tried enough, and that I hadn’t been smart enough. Maybe if I had refused Pitocin, the birthing process wouldn’t have been so hard for my son. All the things that I could have done differently swirled around in my head.
As a doula, I felt somewhat like an imposter for not having the intervention-free birth that I had envisioned. I would share my birth story with other moms and doulas, but I felt the need to justify all of my actions and to explain all the medical reasons that led to an induction so that I wouldn’t be judged. Luckily, with time, the shame simply morphed into disappointment. I was soon pregnant with my second and I had convinced myself that I would do things entirely different this time around. But unfortunately many of the same problems that plagued my first pregnancy started creeping up again, and it looked like my rainbow-coloured home birth was just a fantasy.
After 37 weeks of a very emotional second pregnancy, I made the decision to be induced before my medically necessary 'deadline date' (cue audible gasps). I was exhausted and worn down by a difficult pregnancy. And I was sick of being treated like a ticking time bomb. I was done with the blood tests, the ultrasounds and the non-stress tests. I was just done. I knew it was the ‘wrong’ choice to make, and I carried a lot of shame over it. I didn't tell anyone about my choice (until now!) because I was afraid that I would be judged by other moms, and by other birth professionals. But after some self-reflection I have realized that it wasn’t the wrong choice to make, because it was the right choice for my family in that moment and it involved so much more than simply weighing the medical benefits and risks of an induction. My fears, my hopes, my past experiences, my knowledge, my insecurities, and the information I was given were all factors in my choice to be induced. And people can judge my birth choices all they want, but I am no longer going to let their judgments cause me shame. I am proud of myself, and I am proud of my births.
Being a mom can be the source of so much guilt and feelings of failure. Let’s not make birth one more thing that we fail at as moms. Let’s support each other and the decisions that we make, even if they were ‘uninformed’, or based on fear or pain. Let’s watch our words and our thoughts, because they can have a big effect on how a woman remembers her birth experience. Let’s not project what we feel is an ideal birth onto someone else…it may not be what they consider ideal at all. And let’s focus all of our 'judgey' energy on making the maternity care system better, and not on shaming the women within the system.
Aztec elders taught that women who died in childbirth go to the same level of paradise as men who died in battle. After attending over forty births, I fully understood why. Men die in battle from intense wounds. They bleed as they sacrifice for a greater cause. The same holds true for women who die in childbirth. They bleed as they open to life. The juxtaposition of beauty and pain in each birth astounds me. Each story lives in me.
Amy Wright Glenn in “Birth, Breath, and Death—Meditations on Motherhood, Chaplaincy, and Life as a Doula”
At 9:35pm, my first doula client called me in active labor.
“I’ll see you soon,” I told her. “You can do this Amanda. Just one breath at a time.”
Thirty minutes later, I had everything I needed to begin my doula career. I kissed my husband good-bye. “I’m not sure how long I’ll be gone,” I said holding him close. “Wish me luck.”
It was December and the New Jersey winter air filled my lungs. I drove to Amanda’s address. After parking the car, I looked up at the stars and prayed. I vividly remember walking to her apartment door.
I had successfully completed my doula-training workshop, read many birth books, and seen a multitude of videos and images of birth. Yet, nothing compared to the honor of being asked to support a woman through labor and delivery.
Over the course of the next 17 hours, I held Amanda’s hands, massaged her back, shared encouraging words, kept silent vigil, and even at points laughed with her as she rested between the waves of contractions transforming her being. Then, the time came. Amanda stood up, fiercely held onto her loving husband, and pushed her daughter into this world. The midwife joyfully caught the infant from below. I marveled at the wonder of birth.
My first birth as a doula transformed me as did the dozens more that followed – each unique and beautiful, each a testament to a mother’s courage.
I’m deeply drawn to the doula path. I love offering my time to women as they open their hearts, souls, and bodies in childbirth. As a doula, I stay up for hours on end holding, nurturing, and making space for a laboring woman to find her strength. As a doula, I hold the hands of women as the next generation enters our world.
The word “doula” comes from a Greek term meaning “woman servant.” Historically, doulas were servants skilled at attending women in labor. Today, doulas continue to serve birthing women.
Doulas are not midwives, OBs, or nurses. But together with these professionals, doulas work to support a woman through birth. While the focus of the medical team involves analyzing data and safeguarding the physical health of both mother and child, a doula focuses on the holistic wellbeing of the mother. Doulas teach comfort measures, offer loving touch, speak encouraging words, and serve as a spiritual support at a most transformative time in life. In today’s hospitals, doulas work from a place of softness in an obstetrical world of hard edges.
Most modern women have never personally witnessed a birth. So often, the first birth they experience is their own. When contractions begin, the majority of pregnant women embark upon one of the most transformative experiences of their lives without first hand knowledge of what awaits them. This fact stands in stark contrast to the birthing practices of our ancestors. For the vast majority of human history, women have always surrounded each other in labor and delivery. This aids birthing women and emboldens future mothers with the first-hand knowledge of female strength. Today, doulas reconnect birthing women to the powerful legacy of female support in birth. A doula’s presence also impacts the quality of the birth itself.
According to Christine Morton, a Stanford-based research sociologist and co-author of “Birth Ambassadors: Doulas and the Re-Emergence of Women-Supported Birth in America,” more and more American couples are hiring doulas. Morton argues that this is because midwifery care isn’t widely available and a doula’s presence at birth can lead to many of the same benefits found in a midwifery-based model. Morton writes, “Doulas are the birth ambassadors for the midwifery model of care in the US.” Such a model empowers women to be fully involved in the birth experience. Many studies confirm that the presence of trained labor support shortens the length of labor, minimizes the use of interventions, and reduces the use of pain relieving medicine. As Dr. John H. Kennell famously stated, "If a doula were a drug it would be unethical not to use it."
But, what about the husband or partner? Does a doula replace the birthing mother’s most intimate labor companion? No. While a doula “mothers the mother” through the birth process, the husband or partner also deeply benefits from her presence. Often husbands or partners become more involved in supporting a birthing woman as they learn and adopt many of the doula’s comforting techniques. A doula’s presence frees the husband or partner from feeling like s/he must be an expert support in an entirely new and challenging situation. If the labor is particularly trying, difficult, or emotionally charged, a doula’s presence soothes scared nerves and buoys a birthing couple’s confidence.
The Practical Level
There are two kinds of doulas: birth and postpartum doulas. A birth doula meets with a pregnant woman, is present throughout the birth, and helps the couple process the experience in a postpartum visit. A mother doesn’t need to be planning for a natural birth to hire a doula. Indeed, the majority of woman delivering in a modern day hospital setting would benefit greatly from the continuous labor support that a doula provides. For women birthing at home, a doula’s presence offers added support and loving energy to the wisdom that skilled homebirth midwives bring to the table. Birth doulas usually charge a flat rate and often ask for a portion of their fee to be paid prior to the birth.
In contrast, postpartum doulas help new mothers with breastfeeding and responding empathetically to a newborn’s needs. They understand a mother’s need for rest and support in the postpartum period. In a world where families are often separated by days of travel, the presence of a postpartum doula can provide a new mother with essential loving kindness and insight. Postpartum doulas charge per diem.
When seeking out a doula, I suggest interviewing at least two women. An expectant couple needs to find the right fit. Some doulas are closer to the mother’s age and bring a sister-like energy to the birth experience. Other doulas are older and bring a matronly energy to the birth or postpartum care. Most importantly, an expectant couple should feel very comfortable with the doula’s presence. After all, birth is one of the most intimate experiences one can share with another human being. Deep emotions and a great deal of physical touch are involved in most births – and much of this carries over into the postpartum period. A couple needs to feel confident that the doula will be a trusted, nonjudgmental and compassionate presence as they undergo the crucible experience of birth and welcome their little one to this world.
A doula holds the memory of each birth as precious. While she protects the confidentiality of her clients, her very presence also helps protect the mother’s own memories of birth. This matters.
Protecting a Mother’s Memory
“I am a protector of birth memories,” I often tell my clients. “I want you to look back on this experience and remember being supported, heard, and loved. I want you to feel proud of yourself.”
When women feel silenced, helpless, and dismissed in the birthing experience, their trust in both their own body’s wisdom and in their baby’s instinctive energy is eroded. This is true even if the birth experience fits the classic, textbook rendition of “normal.” If the emotional tone and energy surrounding the birth is negative, an unnecessary harm has been done. The impact of a negative birth experience -- sometimes called birth trauma -- can disrupt the secure attachment bonds linking generations and deeply impact a woman’s sense of self.
When women feel emboldened and supported through the birth experience, their abilities to trust their maternal instincts and bond with their newborn are deeply enhanced. This is true even when birthing preferences or plans unfold in ways unexpected. If the energy surrounding a birthing woman is positive, inspiring, and kind the mother internalizes these qualities as she nurtures her child.
The way we approach birth as a society can either empower or disempower women. According to Aviva Romm, a Yale trained medical doctor and former homebirth midwife, “Women can be partners in their care, not subjects of it.” Doulas support women to be fully informed and empowered in their birth experience. Doulas are the ambassadors of change in a culture bereft of the birth’s wisdom present in ages past. Doulas help protect a birthing woman’s memory of her strength, struggle, and accomplishment.
I’ll always remember my first birth as a doula. When the time comes for me to leave this world, I take with me many treasured memories. Some of the most precious involve being present for the wonder, pain, love, and beauty of birth.
In celebration of doulas, I bow.
Originally published in Holistic Parenting Magazine, Issue #3 May-June 2014
Once you've found a doula whose availability, area, and available information looks like it might fit, Your next step is making contact. What follows are some rough guidelines for how to do that in a way that will help you gauge early on if you’re a good fit for one another.
Most of the time, your initial contact with a doula will be through a contact form, by e-mail or phone. In either case, you want to cover your basics—usually focusing on availability and setting up a consultation. Your first contact isn’t about whether or not you want to hire them. It’s about whether you want to set up an interview to get to know each other further.
E-mail gives you a little bit more room to explain what you’re looking for than a contact form, but your first e-mail should usually still be fairly concise. I personally find it difficult to have in-depth conversations by phone in a world where mobile reception on both ends is often a very real barrier to communication, so I often ask that people who’ve contacted me by phone first follow up with me by e-mail.
Things to Include in Your First Contact by Phone, Contact Form, or E-Mail:
Leave These Topics for Your Consultation
Although most doulas will happily answer the following questions, they’re usually best left for a time when you have an opportunity to discuss them at length, with time for follow-up questions as they arise naturally. They’re important questions you’ll probably want answered before you hire her, but they’re not usually the best for your very first inquiry. You'll also be better able to evaluate what the answers mean to you after you've spent some time together.
Whether you are pregnant with your first child or your third, your birth story is important. Each birth is unique and the day that your baby enters the world is an event that you will never forget. Though it is impossible to completely plan your birth, it is vital to be prepared and know your options. As a labor and delivery nurse, it often strikes me that so many of my patients enter the hospital without any real knowledge or idea of what to expect. Others check in to deliver with a specific plan for how they want childbirth to happen, and cling to this plan even when things do not unfold the way they had hoped. Childbirth requires a delicate balance between planning and surrender. Here are a few great ways to prepare for your ideal childbirth and remain open to a change in your birth plan.
Reading other women’s birth stories is one of the most important ways to prepare for your best birth experience! Even if this is your third pregnancy and you feel that you have it handled, there may have been some parts of your previous births that did not go as planned. Perhaps you ended up with an induction, a long labor, or an unwanted cesarean section. It is important to heal any parts of the experience so that you don’t enter into the next childbirth with fear.
Birth with Balance (plug in site http://birthwithbalance.com) is one of the best websites available to share your birth story or read birth stories of other mothers. If this is your first pregnancy the website provides empowering birth stories that will offer advice and alternatives to keep you up to date. If you have already given birth the site is a great place to share your own birth story in order to reflect, heal, or teach other mothers. Birth with Balance is a place where women teach women through first hand experience. This site was created to give women a forum to share their stories in any language, read the stories of others, and learn more about the incredible, inspiring, and always personal phenomenon of childbirth. This beats a book or a doctor any day.
Take Child Birth Education Classes
There are so many options when it comes to childbirth education classes. The pain of labor is what most women worry about and choose to take a course which will best help them get a grip on this. If you are preparing for a natural childbirth here are short descriptions on a few options.
Lamaze supports natural labor and birth through controlled breathing and progressive relaxation techniques (which the mother should practice daily). This system believes that labor should begin on its own. The woman is encouraged to walk and move around. There should be continuous support with her throughout the process.
Find more info on Lamaze: http://www.lamaze.org/p/cm/ld/fid=1
The Bradley Method
This method encourages the father or partner to be involved and aims for a natural birth with minimal interventions. The class runs up to 12 sessions meeting weekly. Focus is on a well-balanced diet, exercise, taking responsibility during pregnancy and birth (remaining informed), education through healthcare providers and books, and relaxation. Nearly 90% of mothers who use the Bradley Method do not use pain medication in labor.
Find more info on The Bradley Method: http://www.bradleybirth.com
Hypno-Birthing believes that with the absence of fear or tension, labor and delivery can be relatively pain-free. The method doesn’t promise to put you in a trance, but more of a dreamlike state. Anxiety is reduced and confidence is increased through continual application of the technique at home before birth.
Find more info on Hypno-Birthing HERE http://hypnobirthing.com
Birthing From Within
Birthing from Within courses are custom-tailored to what the parents want to learn and discuss. They encourage the release of fear through birth art and journaling.
Find more info on Birthing from Within: http://www.birthingfromwithin.com
Look into Hiring a Doula
It is difficult to research how deep the human need for caring and nurturing is, but during labor it is a priority. Dr. Marshall Klaus, M.D. and Dr. John Kennell, M.D. have done a substantial amount of research on doulas. They found that for first time mothers the presence of a doula shortened labor by an average of two hours and reduced the rate of cesarean section by 50 percent (Northrup 460). It was also noted that doula support could save the healthcare system an average of 2 billion per year by reducing epidurals, fevers, surgery, and interventions. A doula reduces the need for anesthesia by her continuous presence. She will help you plan your best birth and be at your side even if the plan changes.
It has not been long that I've been a doula. My training is nearing completion with a few more births to be evaluated. I take great pride in my training efforts; read far more than required, watch every film and documentary, listen earnestly to other birth workers and other mothers like myself who have experienced a birth trauma, only to redeem their experience with a subsequent birth. I think I can confidently say "I know the basics" just as confidently as I can say "there is so much to be learned".
As a training doula, I often focus my learning on techniques to be used: massage, Rebozo, essential oils, memorizing positions and their uses. Important stuff, as in most descriptions of a doula these are the highlights of our work. We know how to help you cope, physically. We know the process, and believe in the process, of natural childbirth. We also know about the interventions and how to work with them so they don't fall into the "cascade" we birth workers fear will take away from the childbirth experience. Ask any lay person what a doula does, and if they know anything about us at all, they will know that we can help you deal with the pain of labor.
But despite all the wonderful uses and intentions of those techniques, I fear I have left out focus of a key factor of my work. As a doula can tell you, the most beneficial part of having a doula at your birth is the CONSTANT SUPPORT. I knew this. I believed this true. And yet I still didn't understand the extreme impact that statement has.
Not "doing it with woman", not even "helping a girl out". WITH. With? Such a simple implication of a word. Defined easily, categorized simply.
Not until the last birth I attended did I truly understand the full weight of importance of "with" in my role as labor support.
Although, I should have as I experienced it in my own birth of my second child. In my personal experience of a rather quick labor/birth (6 hrs total), I did not want coping techniques to be used on me. I was fighting off the panic of how quickly my birth approached. I holed myself up in the smallest room of my house and made a small nesting area reminiscent of the way the dogs my family bred in my childhood did. I was offered a simple, and known to be quite effective, hot water bottle; but the presences of the gentle, loving, midwife's apprentice and the trying of that physical ease made me loose focus. I did not like either, and so I stayed alone in my safe place listening to the conversations of my husband and midwife, my mother crushing ice for me in the kitchen, my father retreating to another area of the house so not to disturb the process; alone and content working internally to handle my labor.
And then, eventually, I came out of my nest because I honestly felt a little out of the loop. I wanted to be near the people. I entered the hardest of my labor there, with them. I needed them there. I did not need them to assist my labor and frankly they couldn't have anyway. No, I just needed them. After a unfavorable positional change I remember grabbing my midwife's knee suddenly as a heavy contraction hit before I was ready. Her face was shocked by my sudden grasp as I up until this point had labored within myself, not reaching out for help. And then her eyes told me what I needed to know:
"I know it's hard. I know you're working harder than you ever have. I know."
After that moment I felt a new level of trust. Not because she helped ease my pain or even because she said some scholarly fact about transition being the hardest but shortest part, but because she empathized and validated my experience..... all in a look.
Yes, a doula can offer you many helpful things to deal with your labor but not all who labor want a massage or a positional suggestion. Some just need you to be WITH them. To hear them when they cry out that they don't want to do this or that they don't think it can be done. To know they are suffering. To somehow with your presence tell them you understand. Perhaps a word of "but you are doing this" or "your work is paying off" or even "you are further than you realize and doing more wonderfully than you think" but mostly just WITH.
The last birth I attended was a mother's 3rd and first attempt at a totally natural and un-augmented childbirth. Much like my own, quickly moving. She fought her labor until she couldn't fight anymore. She voiced her retreat of intent for this birth so I could hear it, not because she really meant she wanted to give up but because someone had to know how difficult it was. And I did. I knew. It was hard and it was fast and it wasn't exactly how she pictured herself laboring. Once she had told me and I agreed that it was hard, she stopped fighting it. She danced beautifully the dance of a laboring woman, drawing her baby further through the pelvis. And when her dance was sufficient she found herself a bed to rest in. And when her rest was sufficient, she pushed the baby out in 2 waves without voicing to anyone that it was happening (in fact, in that dark hospital room, we nearly missed that the baby was being born, let alone a doctor to be present for its entirety!). Her birth was beautiful and it was hers. She was strong, even when she tried to say she wasn't. I did not help her with counter pressure or positions as I so often do. No, instead I was simply "with".
To sum up the whole, the best part, the most important part, is that I, and all the striving birth workers in our present, past and future, are WITH you, woman. Every mother that has ever been is WITH you, birthing goddess. And if you need to be validated while you work to bring your baby earth-side, just look to the woman at your birth-she is WITH you in this momentous right of passage and that, I hope, will sooth your soul.
Before I begin I should confess I am a bit biased about doulas. I am trained as a doula, but got pregnant immediately after finishing my training and have yet to attend a birth.
Even so, when I first got pregnant I thought I might be okay without a doula. My husband would stay up for three hours after every three hour doula class and learn everything I had just learned: my voice high, words fast, spouting about this intervention and that idea. I told him early in our relationship that I wanted my children born at home, and he had gone from thinking I was a crazy hippie to fully understanding and embracing my thoughts and feelings about birth environments.
And then I realised that my partner's love for me and his baby would send everything we had learned in training right out the window. Yes, I needed a doula.
A doula is a fascinating creature. When a woman invites a doula to attend her birth, she invites someone into the most intimate parts of her soul, into her marriage or partnership, into her life. You are hiring someone to love and protect you and she does it without reservation. I sat on my own couch at home while I watched another woman coax my husband into confessing his fears, worries, hopes and dreams for his first born child. I didn't feel threatened: I felt loved, I felt trust.
Megan helped us do everything from navigating midwifery protocol to practicing ideal birthing positions to coaching us spiritually to reminding us to keep things going in the bedroom. She loved us wholeheartedly.
My due date came and went and I was eventually facing a hospital induction for reasons I believed in my heart to be complete nonsense. My doula reminded me of my options. I opted for acupuncture treatment and a herbal induction in an attempt to protect my wishes for a home birth. By the next morning my contractions were in full force. Megan came to our home and the three of us labored together. My husband and my doula worked as a brilliant team to ensure all of my wishes were met while I labored. My midwife and doula were a cohesive unit, each making certain to respect boundaries and scope of practice. Each of them making beautiful sacrifices in their own life to serve me.
The first twenty four hours of my labor was beautiful, painful, amazing: it was the party I had imagined. But I had made very little progress. My baby was OP and deflex: sunny side up and her chin wasn't tucked. Her positioning promised me an exceptionally long labor and a slightly riskier vaginal delivery. When the sun rose on the second day of labor, I somehow knew that my sweet baby wasn't going to be born at home, and I knew that at the hospital my cervix would not cooperate. Megan sent Kirk to tell me that it was time to go. I told them that I couldn't, that I knew they would cut me at the hospital. My husband was a mess, too, and all of his biggest fears were bombarding our peaceful home birth. Luckily, Megan was there to stand in a gap I wasn't even aware of.
Megan's back up doula met us at the hospital. I had two midwives, two doulas, and my husband standing at my bedside cheering me on. I watched as a resident OB with an attitude came in and my birth team made a human wall between her and my exhausted body. Of course, she reigned supreme. Things went exactly as I expected – epidural, pitocin, birth rape, failure to progress, heartrate deceleration: Cesarean Section. Thirty nine hours after the onset of labor I had my baby girl in my arms. Forty two hours after the onset of labor, my doula was finally able to go home to bed.
Because of my doula I know how to love my surgical birth. I can say with certainty that we tried everything to get my sweet baby out and to honor my original birth plan. Megan had me walking, dancing, squatting, lunging, screaming – everything! - even when I was ready to give up. Without her, I would have regrets. I would be left wondering why I hadn't tried any number of things. But we gave it everything we had. She protected my emotional and spiritual well-being. She gave my husband the tools to support me when he was broken too. She reminded me to be selfish.
One of my initial reservations about hiring a doula was cost. I'm not poor, but I don't have an extra few hundred dollars kicking around. I'm glad I set that worry aside and cut personal costs to have the cash. I had kept track of the time Megan spent with us and worked out what she made by the hour: a whopping $7.95. I didn't include supplies she provided, mileage, or child care. She didn't get paid overtime, she didn't collect holiday hours, she has no benefits. She has specialized training that needs to be worked into what she makes. She probably needs a chiropractic adjustment and a couple hours of massage therapy after providing a day's worth of counter-pressure to my sacrum. She would make better money working in a fast food restaurant. She would make better money babysitting on evenings and weekends. Nobody enters the birth world as a get rich quick scheme (or get rich incredibly slowly scheme, either): it is a labor of love, a calling of the most intimate kind, a sisterhood. Megan continues to provide postpartum support to my family. She has helped me see the beauty in the way I had to birth. She has inspired me as a birth advocate and doula. I still believe in every woman's ability to birth in whatever way she sees fit.
Hiring a doula doesn't make a woman immune to interventions or surgical birth. A doula reduces your chances of unwanted interventions, and helps you overcome the waterfall of emotions when things go off course. She doesn't take the partner's place, she educates, empowers, and inspires connectedness. Hiring a doula helps to educate a woman, helps a woman to see her options. A doula breathes life into a solemn and terrified hospital room. A doula sneaks your partner a delicious submarine sandwich and brings her labouring mama a cup of broth and a sip of coconut water. A doula reminds you to be strong and believes in the innate wisdom of a woman's body and her unborn baby. A doula knows how to be firm or gentle or whatever she needs to be. A doula knows how to love.
Yes, I needed a doula.
You’re pregnant! Congratulations! Maybe you’ve been trying for a long time, or maybe you’ve been taken completely by surprise, but either way, there’s a lot to do! We’ll trust you to handle the fun stuff like shopping and showers; here’s the low-down on the logistics:
First Trimester (conception through week 13)
The first trimester is all about making sure your body is a good one to live in for both you and your baby. It can be tough to keep up with it all, especially when common early pregnancy symptoms make doing healthy stuff like eating well and exercising really hard. Just remember that small steps are bigger than no steps, and even small victories are victories! Places to begin:
- Pick up something to use to record information and ideas throughout your pregnancy. You don’t need the fancy baby book just yet, though. Just start with a notebook and use it to keep track of anything you experience: test results, things you want to ask your doctor about, ideas for names, etc.
- Start taking a prenatal vitamin, if you aren’t already. Even if you’re just a few weeks along, there’s already some crucial development going on in the nervous system, and it’s important to have adequate amounts of things like folic acid to make sure this development gets off on the right track. This is important for most pregnancies, but especially so if your diet doesn’t have a good variety of fresh fruits and vegetables. If you’re just planning to get pregnant, it’s a good idea to start taking your prenatal vitamins before you start trying. If you’re not sure what you need, your doctor or pharmacist can point you in the right direction.
- On that note: start trying to eat well. You probably don’t feel too great, either because the nausea has set in or because you’re exhausted, and both of those things make getting a balanced diet difficult, but do your best. Eat frequent small meals to keep your stomach calm (having an empty stomach makes the nausea worse) and try to make those snacks the healthiest thing you can tolerate. If the healthiest thing you can tolerate is “well, plain toast has grains in it, right?” don’t worry, but do your best.
- If you’ve been smoking, drinking, or consuming other drugs, it’s time to work on quitting. If you’re worried you won’t be able to do it on your own, talk to your doctor or an addiction center for a plan that you can stand by. Try not to worry if you were doing any of these things for several weeks before you found out you were pregnant. Just know that the sooner you quit, the more you reduce your chances of harmful side effects for you and your baby.
- Exercise: Birth is hard work, and apart from that, recent studies have shown that regular exercise, even if not especially rigorous, leads to better birth outcomes and healthier babies. If you’re new to this, chat with someone about working out a healthy and realistic exercise plan throughout your pregnancy. Your medical caregiver is a goodplace to start, but other options include nutritionists, personal trainers, or workout instructors, as long as their practice specializes or has some training in pregnancy (ask for credentials, though—there are special considerations for different stages of pregnancy, and it’s important that whoever gives you advice knows what they are).
- Doctors, Midwives, and other Medical Care: regardless of where you live and what kind of birth attendant you’re planning to have, you’ll probably need what’s known as confirmation of pregnancy to start going through the next “official” steps, like getting a provider referral, handling insurance, and getting services if you need them. Your family doctor or general practitioner can usually do this, but if you don’t have one, any walk-in clinic should also be able to help. If you’re worried about the cost, sliding-scale clinics like Planned Parenthood offer reduced fees to uninsured patients (in both the US and Canada) and may even be able to provide your early prenatal care while you look for an OB or midwife. Your first prenatal visit may also involve a pelvic exam and PAP smear, a breast exam, and some blood work to test for STIs and other potentially harmful conditions. If you need a referral for other providers, they can usually offer this as well.
- If your usual doctor doesn’t provide maternity care or you’re hoping to work with a midwife or other provider, you’ll need to start looking right away. This is true whether you’re planning on an OB, a family doctor, or a midwife. In some areas, people find themselves wait-listed even when they’ve started making contact in the first weeks of their pregnancies, so don’t put this off, especially if you’re looking for care from a practice that’s in high demand or want to give yourself more than one option. This is especially true if you’re seeking midwifery care.
- Find out what your insurance will cover in terms of prenatal care, your birth, and postpartum. You may need to add to your current plan to get full pregnancy and birth coverage, which can take time. If private insurance isn’t for you, find out what your options are for government-funded prenatal and birth care. In most cases, having some amount of coverage will save you money on the overall costs.
- See the dentist, especially if you’ve had dental concerns prior to pregnancy. Pregnancy can weaken your teeth, so good dental hygiene and regular check-ups are especially important during and just after pregnancy.
- If you know you're going to take a prenatal class, don't worry about taking it at a specific time in your pregnancy. Although some programs ask you to wait until a particular point in your pregnancy, if you feel like you need more information now, look for a class you can take now. Knowledge matters, and there is no wrong time.
Second Trimester (weeks 14-26)
The second trimester tends to be the easiest on the symptoms front for most people, so take a breath and catch up! Once you've gotten a few good meals down and are feeling a bit more energetic, it's time to tackle the next set of tasks:
- If you haven’t already, start researching your birth options. Pick up a few books and start thinking about the kind of birth you’d like to have. Ask your friends if they have any favorite books or if they had a prenatal class they just loved. If you aren’t sure where to start, I highly recommend books by Penny Simkin, Ina May Gaskin (especially if you’re hoping for an unmedicated birth) and Ann Douglas (who writes good guides in both US and Canadian editions). Unless you’re very comfortable with the medical model of birth, skip the What to Expect books. They’ve got good information, but tend to assume you have a doctor that you trust completely, which doesn’t suit everyone.
- Consider meeting with a financial adviser—this may be a service provided by your bank, or you can find a private adviser. They will help you set up your budget to make sure you save enough to get through on reduced incomes during parental leave, help you redistribute your existing income to meet the expenses of a new baby, or discuss how having a baby will fit into your other plans for your financial future. This can be a stressful step, and it’s one most people put off, but in the end you’ll probably be better off with some professional advice.
- Talk to your employer about parental leave plans as soon as you feel comfortable (if you're worried, know that it's usually best to tell them before someone else does), and look into your government-provided options for leave and benefits. Now is the time to figure out the timeline for applying for benefits, even if you don’t have to do the actual applications for a while.
- If you’re planning to hire a doula, start looking now. This will give you time to interview several options and plan together, as well as leaving some flexibility if you are worried about costs. You generally want to finalize these plans sometime near the end of the second trimester or beginning of the third.
- Start thinking about your birth plan. It’s perfectly ok to start with a checklist to guide you through your research and information-seeking phase, but your final document should be more personalized. Talk about your plan with all members of your birth team, including your medical caregiver. Include some details about what you’d like to have happen if your plans change: how you might make a cesarean a better experience, for example, or what accommodations would make it better for you if your planned home birth needs to be transferred to the hospital. Discuss these plans with your team, as well.
- If you are living abroad or your baby will have dual citizenship, contact your embassy or consulate for information about this process. It is often time-sensitive, and if you don’t live near the embassy, you may need to plan for a visit.
- Find out what you need to do to set up your baby’s health insurance, whether government-issued or private. Some plans cover baby’s first few weeks of well-baby care under your coverage; others require baby to have their own coverage once you’ve left the birth site.
- If you're having a home birth, ask your midwife or doula for advice on finding supplies. Either or both of them may have some items they can provide, but most of the time, you'll need to stock up on at least a few supplies, and if you're hoping for a water birth, you may need to arrange a tub rental. Give yourself plenty of time!
Third Trimester (week 27-birth)
You've made it to the home stretch! You're probably getting ready to meet your baby, but there's still just a little left to do:
- If you haven’t taken a prenatal class yet, do it now. If you’re going with a private prenatal class, arrange a tour of your birth location or your backup location, if you’re planning a home birth. You don’t want the first time you walk through the doors to be when you’re in the midst of labor. If a traditional class doesn't suit you, know that there are options for online classes, individualized classes, and other options, but I strongly advise against neglecting this important step. Even if you're perfectly content to go along for the ride and do what your caregiver thinks is best, knowing what to expect makes a big difference. A good prenatal educator will take input from the class on what their information needs are and will help make sure they're met. As an added bonus, keeping in touch with other members of your prenatal class means you'll have a built-in group of parents who are going through the same stages you are. That support will be important later on.
- Make your postpartum plan. Talk about it with your partner, family members, and other supportive roles. Build up your network, and talk with family and friends about who can help you and how they can help. Consider tools like MealBaby or the services of a postpartum doula, nurse, or other support person, and make a list of resources in your area that you can turn to for support if you have issues. Key points for this are breastfeeding (both peer and professional support options), 24-hour nurse hotlines for help with questions, a few support options for if you face postpartum mood disorders, and support for any special needs you anticipate you or your baby might have after the birth. Tack the list of phone numbers, websites, and/or email addresses on the fridge to have handy if you need them.
- Find a pediatrician for your baby. If you already have a family doctor, they may also be able to take on your child. If not, you’ll want to look for a pediatrician or a family doctor soon. Many states and provinces have systems in place to help connect you to providers. Also ask your pregnancy caregiver if they have any advice.
- Talk to your provider about your finalized birth plan, and update it as needed if anything changes in your pregnancy. Leave a copy to be kept with your records, and have extra copies on hand to take with you to the place of birth. Even if you are planning a home birth, it’s good to be prepared in case you need back-up care.
- Get your car seat installed properly so it's ready when you need it. If you're not sure about your installation, have it checked. There are many local resources for this. Consider baby stores (the store where you bought the seat might be a good option), public health and safety offices, or even your hospital. If they don't have seat check programs of their own, they can almost certainly refer you to somewhere that does.
Ever heard of tocophobia? It’s a term used to describe the fear of childbirth. Researchers in Sweden have found that when expectant fathers experience tocophobia, it may have negative effects on the birth experiences of their partners.
The study, titled 'Psychoprophylaxis - Antenatal preparation and actual use during labour', by Malin Bergström found that many of these men were fearful not only of the process of childbirth, but in their roles as parents as well. There have been some signs to indicate that tocophobia contributed to an increase in cesarean sections, pointing to the need for birth professionals to address these fears with expecting parents.
Since the study, the Swedish Medical University has begun providing childbirth preparation classes featuring the use of psychoprophylaxis (relaxation techniques) for all expectant parents with good results.
Childbirth educators encourage both mother and partner to participate in class discussions to try and address these common fears about labor and early parenting. Educational models such as the Bradley Method, Hypnobirthing, and Birthing from Within place a great deal of emphasis on the partner as a strong yet calm source of strength for the woman in labor by teaching the partner relaxation techniques like massage and affirmations.
In another study on childbirth education classes from Lamaze International* the researchers discovered the rate of attendance for childbirth courses, and particularly courses lasting more than one session, has been decreasing over the past several years. Couples are encouraged to take lengthier courses, independent of the hospital preparation courses to get a more complete training in birth support.
Additionally, hiring a doula can help parents receive one-on-one training in these techniques and a sense of security in asking questions concerning any anxieties in an intimate and supportive setting. Doulas also help the partner to feel comfortable that everything is going well in labor, knowing that the mother will never be left alone and that there is a constant source of guidance and expertise by their side.
For a list of childbirth educators in your area, visit the International Childbirth Educators Association website.
*Contemporary Dilemmas in American Childbirth Education: Findings From a Comparative Ethnographic Study, Christine H. Morton, PhD and Clarissa Hsu, PhD, Journal of Perinatal Medicine Fall 2007
The word doula comes from an ancient Greek word that literally translates “woman’s servant.” That is great for an anthropologist, but it doesn’t really explain much about the modern women who attend birth. Some people confuse the services of a doula with the services of a midwife, yet some doulas are also midwives. Each doula brings a unique set of skills and attitudes to her clients, but all labor doulas support laboring women and their partners during birth.
Doulas are often (though not always) specially trained and certified by organizations. Doulas of North America (DONA), Childbirth and Postpartum Professional Association (CAPPA), and Childbirth International are three of the largest certifying groups in the US. To become certified, a doula must educate herself through research and required reading, attend a training workshop, and submit positive evaluations of her performance during 2-3 births. Some doulas have chosen not to become certified, but may have completed any or all of these steps and possibly more.
Doulas are not medically trained, however, some doulas may wear more than one hat. Some are also registered nurses, massage therapists, or midwives. The role of a doula doesn’t require any of that. Doulas can provide information, suggestions, and support, but not diagnosis or treatment. They place an emphasis on service and caring for parents both physically and mentally. Doulas are appropriate in any birth setting, but are especially effective in hospital births.
Early research about supporting women during birth found that simply having a more experienced woman in the room with a laboring mother reduced her anxiety and pain. Doulas start there and expand, often meeting women prenatally to address concerns and provide education. During labor, in addition to being a comforting background presence, doulas provide suggestions and support on a wide array of topics.
A doula can recommend positions to help speed up a slow labour. She can apply techniques for reducing pain and positioning baby. For example, if a baby is sunny side up (posterior), a doula will encourage a mother to be on her hands and knees so that the baby is more likely to spin around to a better position. If a mother is experiencing a lot of back pain, doulas can massage and use counter pressure to help her deal with labor.
Doulas support birth partners as well. They can prepare Dad ahead of time with what to expect and provide suggestions during labor about how he can best help the mother. Possibly her most important role is someone who brings water and snacks to tired parents while frequently reassuring them that they are doing well. Especially for parents who are new to birth, just being reminded that everything they are experiencing is normal comforts and reassures them enough to walk the twisting road of labor with confidence. Women who are undergoing a cesarean can also benefit from the knowledge and experience of a doula.
Occasionally, doulas are called upon to act as mediators between hospital staff and clients. Though doulas don’t speak for parents, they often help them to understand procedures and suggestions as well as act as ambassadors between clients and care providers.
Most doulas remain present with the new family after the birth to make sure that their needs are met and that breastfeeding gets off to a good start. Many doulas follow up with clients in the early days of postpartum recovery to provide advice about breastfeeding and baby care. Studies suggest that women who receive this kind of early support have more successful breastfeeding relationships and lower rates of postpartum depression.
If you think a doula is a good idea for your birth, meet one and learn more.
A friend of mine was a business tycoon before becoming the victim of a terrible fire. One night while sleeping in his motorhome, propane gas leaked and filled the vehicle. Once ignited, his body was burned and forcefully ejected. Upon arriving to the scene, rescue workers found him dead. Against all odds, they revived him.
My friend remembers watching the ensuing drama from a calm vantage point above his body. He remembers an all-enveloping peace surround him. This peace extended beyond words or comprehension. This peace transformed his very being. We spoke at length about his near-death experience and the profound changes it inspired. Today, material gain is no longer his primary goal in life. Relationships, connection, and service stand as center points of focus.
“It all boils down to choosing between love and fear,” he told me.
This choice is particularly stark when we stand at the doorways of birth and death.
There is no love like a mother’s love. While the hard work of labor can evoke fear, love sustains. Love encourages. As a doula, I know that love is stronger than fear. I watch women bravely move through the challenges of labor when they focus on the love felt for their precious little ones. Particularly while working with laboring women who have survived sexual abuse, I stand in awe at the transformative power of love. We can choose to focus on love. Through this choice, fear is transformed. Through this choice, healing comes.
While we can’t change the scars we carry from the accidents and traumas of life, we can change our perception. We can choose to live with a love that brings healing to wounded places
Consider the work of Dr. Joan Borysenko, well known for her contributions to the field of mind-body studies. In a weekend workshop at The Kripalu Center for Yoga and Health, Borysenko describes her own healing from the chronic headaches, backaches, and panic attacks she experienced while on “the rat race of overachieving”. She mentions how integrative practices like yoga and Tai Chi helped her see the vital connection between the negative movies she was running through her mind and her physical stress.
Borysenko draws a Vin Diagram showing three interconnecting circles to symbolize a person’s state of ease or disease. One circle represents biology/genetics. Another circle stands for a person’s environment. The third circle symbolizes the power of a person’s will and the impact of chosen behavior. These three circles interlock and interact. For Borysenko, all three rest in “a sacred mystery.”
My friend profoundly encountered sacred mystery. His life was out of balance before his accident and deeply transformed because of it. “Even though my body was burned, love revived and healed me,” he told me. A peaceful calm took the sting out of his fear of death. Today, he chooses to focus on the memory of this peace when fear arises. He chooses to remember this event as he moves through this life.
As a doula, I’ve worked with birthing women who have suffered sexual abuse. While they face challenging obstacles in childbirth, love can guide them in their journey to motherhood. I’ve witnessed first hand the transforming energy of love as a woman faces her fear and chooses to embrace the new life emerging from her body. These examples remind me of the power found in Borysenko’s third circle symbolizing our ability to choose.
No matter what one is given, agency sets a person free to experience the transformative power of love.
Austrian psychiatrist and Auschwitz survivor Victor Frankl’s wrote, “We who lived in concentration camps can remember the men who walked through the huts comforting others, giving away their last piece of bread. They may have been few in number, but they offer sufficient proof that everything can be taken from a man but one thing: the last of the human freedoms -- to choose one's attitude in any given set of circumstances, to choose one's own way.”
It all boils down to choosing between love and fear.
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