A Doula as Your Witness

Doulas are witnesses at births.

by Beth Singleton

This is kind of a tricky topic to write on, but one I consider quite valid when it comes to childbirth. When most people think of a doula and what she does (well, for those who know what a doula is!), the primary thing that probably comes to mind is her service and her support. Encouraging women through their contractions, reminding them to breathe, and using touch as a way to help ease discomfort are a few things that doulas are known for doing. But what about a doula as your witness?

During life’s most meaningful moments, we desire to be surrounded by people who care. Weddings, graduations, and funerals come to mind, where the support of others and the power of their bearing witness is paramount. Having people around to witness once in a lifetime moments goes as an unspoken desire that’s fulfilled because others care enough to be there. I mean, in order to get married, you have to have a witness!

Childbirth really isn’t any different. While it’s certainly a more private affair than the public vows of marriage, it definitely tops the charts of once in a lifetime moments. During my training through DONA, I remember hearing the word witness more than a few times by the other women there with me. I wasn’t the only one who viewed doulas this way or who knew the need was there!

Why doulas make great witnesses

A doula is with you continuously throughout your labor. That’s not to say that your partner, friends, or relatives (whoever you’ve chosen to be present) aren’t with you; but, more often than not, they need to take breaks. It’s also very common for people, if they aren’t actively supporting a woman in labor, to get involved in conversation or a good book. Not the ones faced with the demands of labor, people can’t help but find ways to pass the time. Books or phones in the hands of those who are with a laboring woman are a very common sight, and there’s certainly nothing wrong with it. Labor can take awhile! Your doula, however, knows things can change in an instant; so unless mom is taking a much needed rest and fast asleep, no book or phone will be in the doula’s hand. Her eyes, ears, and intuition are all focused on mom. In a hospital setting, shift changes mean that a new set of eyes, ears, and hands will be taking over care. It’s not uncommon for the nurse who cared for you in the early stages of labor to not be the one there when baby finally arrives. Your doula, on the other hand, is there for from start to finish. If you aren’t sure or can’t remember exactly what happened or when, just ask your doula.

A doula can help validate your experience and your feelings. This is HUGE for most women, regardless of whether or not they had a positive birth experience. As doulas, we are trained to pay attention. This really matters when it comes time for mom to process her birth, especially if it was traumatic for her. During a tender period of time afterwards, women need to go through and piece things together. When there are pieces missing, a doula can help fill them in. Sometimes women have questions about specific things that happened, like procedures or even something someone said. Was the nurse really being mean? Did my doctor really say that? Your doula can help you shake that feeling of “Am I crazy or did that really happen?” by either confirming or clarifying the moment in question. She can also help to paint a visual picture for parents. Pointing out relevant moments that were possibly overlooked because of the intensity of labor, a doula can provide insight on the experience by highlighting those details.

A doula works for you. They answer to no one else. Their focus is on you and what you’re experiencing, without letting emotions get in the way. That’s not to say your doula isn’t emotionally vested because she is; it’s impossible not to care! But your doula isn’t your partner, your mom, or your best friend…and that’s really important. The people closest to you are probably as emotionally involved in your birth as you are. They can’t help it! Needless to say, it’s reassuring to labor and give birth knowing someone was there attuned to you, your wants and needs, and paying attention. Your doula is filing everything away in her brain and in her notes about your labor and birth. She knows how much it matters to you to have this information later. Even if questions pop up months down the road, your doula is the one you know you can turn to for answers because she was there as your witness.

Special circumstances

For some women, having a doula present at their birth is critical because of special circumstances. Some of these circumstances include, but are not limited to:

• the absence of a supportive partner
• the absence of supportive friends or family
• women with anxiety
• women with previous trauma
• women with a fear of labor and/or childbirth
• women with doubts about their abilities to labor and give birth
• women who know they will need someone to process the birth with
• women who struggle with trust

On the flip side, some of these reasons might also apply to a woman NOT wanting a doula present. Depending on her specific situation, some of the reasons listed above may stand in a woman’s way of even reaching out for the support of a doula.

As with all things, any number of factors play into whether a woman wants support, to what degree she wants it and what her specific needs are. As doulas, we understand.

If you’re considering hiring a doula to support you throughout your pregnancy and birth, Birth Quest is
here to help. For more information about our services or to set up a free consultation, contact us.

Crying During Pregnancy and Labor: Breaking Through Barriers with Tears

Crying pregnancy labor

Person crying

I’ve wanted to write about this for years. The profound effect crying has on people has always fascinated me. How can something that must seemingly come from a place of hurt lead to what can only be described as relief?

Now, for some people, crying comes easily. Maybe they are just instinctively good cryers or were fortunate to have the support from others to cry; I’m sure there are many reasons. But for others, like me, crying doesn’t come so easily. For pregnant women, this makes breaking through barriers during their pregnancies and labors more challenging.

Crying has always been hard for me, even though I know I need to do it. I know how much better I feel, how much less cloudy my mind is. But I also know it takes a willingness to be vulnerable, something I seldom allow myself to do. I need privacy and safety, as many others likely do. Often, those two elements don’t come together and so the need to cry builds. At some point, there’s no moving past what’s causing the hurt and the only way out is to be honest and let the tears flow.

Possible Hang-Ups About Crying

I know what my hang-ups are when it comes to crying. As someone who was bullied all through school, I did my best to hide my tears because I didn’t want to be seen as weak or give them the satisfaction of seeing me hurt. Like many other kids, I also remember being disciplined or scolded at times for crying too much. It’s about safety for me; I’ll cry when I need to, but never in front of anyone…not if I can help it. I also fear that I’m “too much” when I do get emotional, and that’s embarassing to me. So finding the nearest bathroom, bedroom, or private place is a must if the tears are going to fall.

And doesn’t anyone else think crying hurts? I hate how I feel when I’m doing it. I also hate how sometimes, it’s like an earthquake with aftershocks that pop up out of nowhere in the hours after the initial round of tears. Despite how much I hate it, though, I can never deny how necessary it is. It’s freedom, it’s relief.

So, for women who are pregnant, what are some hang-ups they might have about crying prior to and during labor? Here are a few possibilities:

  • Fear of judgement
  • Fear of appearing weak
  • Fear of being vulnerable in front of others
  • A belief that crying is a sign of weakness
  • A belief that she’ll be “too much” for others to handle
  • Fear of being seen as overly emotional
  • Embarassment

The reasons for these hang-ups no doubt vary from woman to woman, based on her individual life experience. Some of these impactful experiences might include:

  • Abuse
  • Abandonment
  • Upbringing (cultural, religious, etc.)
  • Lack of privacy
  • Lack of support
  • Suggestion from others not to cry

The Benefits of Crying

 Believe it or not, even if it doesn’t always come easy, crying is good for you. The list of benefits include:

  • reducing emotional stress
  • ridding the body of toxins
  • improving mental clarity
  • moving past barriers
  • releasing tension

There is science behind the benefits of crying. One study found a difference in the make-up of reflex tears and emotional tears. While the reflex tears consisted primarily of water (approximately 98%), emotional tears included more chemicals. What I really thought was interesting is that one of the hormones found in emotional tears was prolactin, which is also associated with a mother’s let down reflex.

You can Google it all you want; the benefits of crying are real.

But what if you’re like me? What if crying doesn’t come so easily?

Practice is the Key

If you struggle to let those tears flow, consider the growing trend in Japan. I saw an article online that struck me a couple of years ago: Japanese men getting together to watch sad movies so they could learn how to cry. In a society where it’s considered a virtue to keep emotions in check, this trend is helping to “normalize” crying. Not to mention how much better the participants feel after a good cry!

Life is already stressful enough. Add to it the changing hormones, anxiety, and fears common in pregnancy. It’s very common for women to “get stuck” or plateau during pregnancy and childbirth. What isn’t so easy is giving in and letting it go with a good cry.

Any number of things can give a pregant woman reason to cry. From financial strain, physical changes, discomfort, to anxiety and fears surrounding birth and past trauma, it’s completely understandable to feel the need to cry. Pregnancy tends to be a time in the lives of many women where such issues emerge to be dealt with.

For a woman nearing the end of her pregnancy, it’s the perfect time to let the tears flow when she feels the need. Not only will it help her feel better, it’s great practice for labor. One of my favorite birth-related books, Natural Hospital Birth by Cynthia Gabriel, points out just how significant crying during pregnancy, and especially during labor, is. I was trying to come up with a good analogy to describe the way holding back from crying affects moving beyond barriers for pregnant and laboring women. All I could come up with was having to pee.

We all have to do it. We all know that if we hold it in too long, it’s all we can think about. There’s nothing else taking up residence in our minds when the need to pee has reached its nagging peak. Same goes for needing to cry. At some point, the dam will break.

I also think that Ina May Gaskin used a similar analogy that also applies here. She pointed out how most people have a hard time peeing in front of others. This, too, applies to crying. Having an audience, especially one that you aren’t sure supports you, is a real hinderance. Call it what you will (I think of it as a sort of stage fright), crying openly in front of others isn’t always easy.

As with just about everything else in life, practice is the key. Pregnancy is the perfect time to get in touch with your emotions and address any mental roadblocks you may be facing. Crying helps with this. A few ideas to help you with getting those tears to flow are:

  • Find time to be alone
  • Find safe people to talk to (your partner, a trusted friend, family member, counselor, or doula are excellent options)
  • Journal about your feelings
  • Watch a movie that makes you cry
  • Listen to music that helps you cry
  • Be honest with yourself about your feelings
  • Give yourself permission to cry

As challenging as it may be, even one good cry during pregnancy can help to straighten out jumbled thoughts and emotions. It also helps to set the stage for the transition to childbirth. If crying during pregnancy helped to move past emotional barriers, remember that it can do the same during labor. Physically and mentally demanding, childbirth is no time to hold back from crying, especially in the instance of a plateau or intense transition. Tips for crying during labor include:

  • Requesting privacy if there are too many people in the room
  • Letting your care provider know ahead of time you plan on crying as an aid to help labor progress
  • Making sure you have good support (your partner, doula, friend, or relative)
  • Shutting out negative comments or advice from others (a support person can help with this)
  • Practicing during pregnancy
  • Trusting that crying is purposeful
  • Reminding yourself of other times crying has helped you to feel better (a support person can remind you of this as well)

Facing Obstacles

There will always be obstacles to crying, though. Many people, even medical care providers (they’re people with feelings, too), are made uncomfortable by crying. It’s possible that they or others (your partner, friends, family, etc.) might tell you not to cry. They may or may not give you a list of reasons why you shouldn’t cry or tell you what to do instead. Odds are, they are simply just uncomfortable with it. Generally speaking, I don’t believe most people like to see others hurt. It’s also without question a learned response. I know I’ve heard it and hate to admit I’ve said it… “Don’t cry”. While no ill is likely intended by telling someone not to cry, it takes away from the validity of a person’s emotions.

But crying isn’t about weakness or defeat. So in spite of your own hang-ups, or what others might think or say about it, it’s important to remind yourself that crying is an essential release that leads to renewed strength.

It’s kind of like the difference between transition in labor and the pushing stage: considered the most intense part of labor for many women, transition is often the time women are pushed to the limits of what they think they can take. Those viewing on will inherently want to help. If a woman is encouraged and supported through this stage, pushing often yields a more focused and less distressed woman. With the pain and intensity of transition over, women can catch their breath and get ready for the purposeful work of pushing their babies out.

If, instead of receiving encouragement and support during transition, a woman is told not to cry or is offered other options, she may miss out on the relief and satisfaction that waits on the other side of safely expressing her emotions through tears. Anxiety, fear, and other pent up emotions that are not let out cause more physical pain, as well. This is often the point where women face decisions that will affect how their babies are born. This is a very tender period for the mother. Practice in supporting a woman in this delicate phase is essential. Not only does it reduce her risk of interventions, it increases her odds of reflecting positively on the birth experience.

Just like transition, crying is temporary. It’s simply a part of the process.

Seeking out the support of a doula is an excellent idea if you fall into the category of women who struggle to cry as a way of dealing with pent up emotions or who lack needed support. Trained to listen non-judgmentally, provide encouragement and a feeling of safety, doulas know the difference that positive support makes possible.

For information about resources in the area or to inquire about our services, please contact us.

Nitrous Oxide: Safely Taking the Edge off of Labor

One of the highlights of the American College of Nurse Midwives (ACNM) Michigan Affiliate conference this past January was the presentation on Nitrous Oxide. The presenters, Michele Amstutz, RN, c-EFM and Laura Bozeman, MSN, RNC, CNL, c-EFM, from St. Joseph Mercy, enthusiastically described how they overcame obstacles through persistence, teamwork and education to bring laughing gas to their hospital.

From an historical perspective, the presenters explained that nitrous oxide was available for pain relief in labor in the United States up until the 1980’s, when epidurals grew in popularity. In recent years, the number of US hospitals offering nitrous oxide for women in labor has increased. Currently, two West MI hospitals, Spectrum Health Zeeland and Gerber Memorial offer it. Mercy Health Hackley responded to me on Twitter in January that they don’t have a start date yet, but their goal is to have it available within the next year.

When considering pain relief in labor, many women are concerned about the impact on the fetus. Fortunately, nitrous oxide is metabolized in the maternal lungs and clears rapidly, so only 80% of 1% of what the mom inhales reaches the baby. Studies have shown that there are no adverse effects on fetuses, including effects on fetal heart rate or apgar scores.

When it comes to maternal outcomes, nitrous also has advantages over other forms of pain relief. It does not require moms to receive intravenous fluids, have the fetus be continuously monitored, or restrict mobility, as with an epidural. The units can even be used with women who are in the tub! Unlike narcotics, it is non-addictive, which may be of concern to moms in recovery.

Something that I hadn’t considered was the many ways nitrous oxide could be used during labor and even postpartum. Because it is anxiolytic, or a medication that reduces anxiety, it can be used during medical procedures that may make a woman tense, like starting an IV, a foley bulb placement, or a vaginal exam. Although it cannot be used in conjunction with an epidural, it may be used during the insertion of one. Furthermore, many providers prefer it to local anesthesia for repairing tears after delivery because there is less distortion of tissues.

Nitrous oxide isn’t for everyone. Some women prefer a completely unmedicated experience. A small percentage of those who use it will experience side effects, most commonly dizziness and nausea. There are a few contraindications, including vitamin B12 deficiency. Finally, if a woman wants complete pain relief, she will probably not be satisfied with nitrous alone.

What about you? Have you used nitrous oxide for pain management during labor?  I would love to hear about your experiences!