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.

5 Ways to Prevent the Need for Induction of Labor – A Response to the ARRIVE Study

— by Faith Groesbeck, BA, CCCE, CD (BAI)

This month, the results of the ARRIVE study, or A Randomized Trial of Induction Versus Expectant Management, were presented at the Society for Maternal-Fetal Medicines annual meeting, called the Pregnancy Meeting™. This study is explained in more depth on the Evidence Based Birth® website, in the article on due dates.

The research showed that in over 6,000 women, inducing labor at 39 weeks without any other medical indication, reduced the overall risk of cesarean, developing pregnancy complications and harm to the baby. While advocates warn that this may mean that we face a future in which all pregnancies will be forced to end before reaching their due date, I’m a little more optimistic. In my experience, I’ve found it more likely that the pregnant person will choose an induction once this becomes an option for them rather than their healthcare provider imposing it on them. Provider practices vary greatly across the country, so I’m not sure this is the case everywhere, but to date, no professional organizations have said that this should become the standard of care (SMFM).

This research brings attention to two sides of the coin when it comes to the induction debate between those who advocate for physiologic birth versus those who seek better outcomes through technology. On the one hand, birth is a normal process, best left unhindered when possible. On the other, the longer a person remains pregnant, the more likely they are to develop pregnancy complications and the more time the fetus has to grow inside the uterus. I’m not saying our bodies are not marvelous and capable of birthing babies much larger than average, which is around seven and a half pounds.  I’m sitting somewhere in the middle of do nothing and intervening thinking, is there a way to prevent the need for induction and still have good outcomes?

While I realize the tremendous pressure parents are under to do everything “right,” I’ve also spoken to a lot of women who have said that if they had known that there was any chance that they could have possibly prevented the need for an induction or a cesarean, they would have gladly made changes in their lifestyle to at least reduce the risk.

So, here are some tips that may help to reduce the need for induction. I’m not saying that if everyone follows these ideas that they are guaranteed the outcome they desire or that women who do not do these things are at fault if intervention is necessary. I am saying that we may have some control over outcomes if it is our desire and within our means to explore these options. As always, please consult with your healthcare provider before making dietary or fitness changes during pregnancy.

  1. Hire a doula. Having a doula present at your birth increases the likelihood of having a spontaneous vaginal delivery (Hodnet). A spontaneous vaginal delivery is when the pregnant person goes into labor on their own, without the use of drugs and that the baby is born without the use of forceps, vacuum extraction or cesarean.
  2. Eat Dates. Several studies have shown that eating dates at the end of pregnancy, can reduce the need for an induction (Al-Kuran; Jadidi and Kordi). The general recommendation is to eat 6 dates per day, starting at 36 weeks.
  3. Practice Yoga. While yoga has many health benefits throughout a person’s life, a study done in Iran found specifically that doing one hour of yoga, six times per week, starting at 26 weeks, reduced the need for induction and resulted in fewer cesarean births (Jahdi).
  4. Quit Smoking. Smoking is a risk factor for having a smaller than expected fetus or having the amniotic sack, or bag of waters, break before their due date. Both may, under certain circumstances, be indications for induction of labor.
  5. Eat a Low GI Diet. While early induction for those who develop diabetes in pregnancy is not evidence based, gestational diabetes does increase the risk of developing other complications which may then make induction the safest choice. Eating a low glycemic diet during pregnancy decreases the risk of developing gestational diabetes and thus the risk of developing further complications (Brand-Miller).

As a doula, I’m here to support families, often with otherwise healthy pregnancies, who face decisions around inductions. I’m also glad that through childbirth education, families can adopt healthy lifestyle practices that may be able to prevent the need for an induction in the first place.

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Al-Kuran, O., Al-Mehaisen, L., Bawadi, H., Beitawi, S., & Amarin, Z. (2011). The effect of late pregnancy consumption of date fruit on labour and delivery. Journal of obstetrics and gynaecology31(1), 29-31.

Brand-Miller, J., Marsh, K., & Moses, R. (2013). The Low GI Eating Plan for an Optimal Pregnancy: The Authoritative Science-Based Nutrition Guide for Mother and Baby. Workman Publishing.

Hodnett, E. D., Gates, S., Hofmeyr, G. J., Sakala, C., & Weston, J. (2012). Continuous support for women during childbirth. Cochrane Database Syst Rev10.

Jadidi, M. Y., Sang, S. J. B., & Lari, H. (2016). The effect of date fruit consumption on spontaneous labor. Journal of Research on Religion & Health1(3).

Jahdi, F., Sheikhan, F., Haghani, H., Sharifi, B., Ghaseminejad, A., Khodarahmian, M., & Rouhana, N. (2017). Yoga during pregnancy: The effects on labor pain and delivery outcomes (A randomized controlled trial). Complementary therapies in clinical practice27, 1-4.

Kordi, M., Aghaei Meybodi, F., Tara, F., Nemati, M., & Taghi Shakeri, M. (2014). The effect of late pregnancy consumption of date fruit on cervical ripening in nulliparous women. Journal of Midwifery and Reproductive Health2(3), 150-156.

Society for Maternal-Fetal Medicine. (2018, February 1). Induced labor after 39 weeks in healthy women may reduce the need for cesarean birth: More information is needed before changes to clinical practice are made. ScienceDaily. Retrieved February 16, 2018 from www.sciencedaily.com/releases/2018/02/180201115718.htm

Dimming the Lights: An Aid for Helping Labor Progress

Getting out of the bathtub at Spectrum Health Butterworth, after laboring under the light of LED flameless candles.

— By Beth Singleton, Birth Quest birth doula and photographer

I still remember my last labor like it was yesterday. Waking in the wee hours to discover I was in labor, only to have it stall during the daylight hours and then ramp back up after the sun set. When pushing, the room was dimly lit and to make things even darker, I had my face buried into the couch.

What is it about darkness that seems to ease and promote the progress of labor? A very common desire among laboring women, I thought it’d be a great idea to look into this.

The need for darkness is observed in nature.

If you’ve ever had the experience of witnessing a cat during labor, you probably noticed her need for a safe, dark place. When my cat had her kittens a few years back, that’s exactly what she did. In a box under my bed, our proud momma cat gave birth to her babies. This need stems from the mammalian brain, a commonality that affects cats, dogs, mice…and humans! I mean, we’re mammals, too, so regardless of the countless ways in which we’re nothing like our pets, the biological event of birth reaches deep to reveal that our needs are ultimately very similar.

Bright lights can make a laboring woman feel exposed.

Birth is a very private event for a woman. During such an intimate moment in her life, bright lights shining down can cause her to feel like she’s being observed or like she has no privacy. In nature, laboring animal mother’s will stop mid-labor if they think they are being watched in order to find safety. In a hospital setting, though, a woman can’t follow in the footsteps of her fellow mammal mothers and relocate if she feels like she isn’t safe.

Bright lights stimulate the neocortex of a laboring woman’s brain.

This increases brain activity during a time when labor progress relies on a woman’s primitive brain instincts. This stimulation can interfere with a woman’s ability to produce the hormones necessary for labor to progress and to help with pain. Some sources of bright light include:

• overhead lighting
• windows
• computers
• cell phones
• tablets
• televisions
• monitors

In particular, electronic devices affect the body’s ability to rest. Blue light, the light produced from items like cell phones and tablets, interferes with the production of sleep-promoting hormones. So even in a room where the lights are off, it’s important to consider the effect of having the television on or staring at a phone if relaxation is the goal.

How does darkness aid in relaxation?

When the lights go down and the room darkens, this signals to the brain that it’s time for rest. One of the hormones produced is melatonin. Also known as the “hormone of darkness”, melatonin promotes relaxation and sleep. When a laboring woman is better able to relax, she will probably rest better and more deeply between contractions. Her contractions might also be less painful if she isn’t holding so much tension in her body.

There are numerous ways to labor with the lights down low.

Whether laboring at home or in a hospital, there are several ways to create a dimly lit setting.
For a home birth, consider some of these ideas:

• night lights
• LED candles
• string lights
• votive and/or pillar candles
• dimmable lamp
• blackout curtains
indoor light projector

For a hospital birth, most of the above options aren’t as feasible. For example, a hospital probably isn’t going to permit burning candles; they will, however, allow LED candles. And items like string lights or lamps are bulky and may not be allowed, either. Night lights and indoor light projectors, on the other hand, are small and the room will likely have at least one outlet you can use to plug them in.

Sometimes, though, darkness isn’t the best option.

While it makes sense that many women desire to labor in darkness or a space that is dimly lit, there are
circumstances when the issue shouldn’t be pressed. Examples include:

• women who are afraid of the dark
• women who might become anxious if they feel the darkness would interfere with their care
• women with a history of trauma who feel safer with the lights on
• women who simply object to having the lights off

In the end, it all comes down to a woman’s preference.

Whether she chooses to labor with the lights on or off, the point is that she gets what helps her the
most. Ultimately, it’s the support she receives from those around her that will have the biggest impact
on her birth experience.

If you’ve already given birth, did you dim the lights? Why or why not?

We’d love to hear your feedback on this!

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.