Here at Birth Quest, a lot of people ask Beth and I where we most often support birthing clients for their deliveries! Here is the answer with some reflections on each from a doula’s perspective:
1.) Mercy Health Hackley: Over 1/3 of our birth doula work is at Hackley. Beth and I were both born at Hackley and we both live less than a mile from the hospital, so this shouldn’t be a surprise. It also makes sense because we strive to serve our community and this is our community hospital! Being located near downtown Muskegon means there are some good food options, like Ryke’s Bakery, near-by. Design aspects we like about the hospital include having separate bathrooms in the hallway for visitors, a waiting room with an ice machine and being able to enter and leave the floor without having to pass through a security door. We’re not crazy about the separate Labor, Delivery & Recovery and Postpartum floors. Hackley is the only hospital on the lakeshore where midwives still deliver and I like how the nurses treat me like an equal. We’re curious to see the new labor and delivery unit that opens in summer of 2019.
2.) Spectrum Health Gerber Memorial: Many of our lakeshore clients travel to Fremont to have their babies at Gerber because of their reputation for supporting natural and patient-centered births. This support is backed up by Certified Nurse Midwives and their Perinatal Nurse Educator and blogger, Samantha Kauffman, who is both Hypnobirthing and Evidence Based Birth certified! Their Director of Clinical Nursing, Beth Coulier, and I worked together on the FIMR Case Review Team when I worked for Public Health – Muskegon County. She brings a lot of experience and compassion to Gerber and this is reflected in the quality of care her staff provides. Gerber gained a national reputation under the leadership of Dr. Tami Michele, who was innovative in overcoming an official ban in order to support trial of labor after cesarean (ToLAC) and vaginal birth after cesarean (VBAC). Dr. Michele currently works at the Butterworth campus. We like that birthing people can labor, deliver, and recover postpartum all on the same floor. Negatives include being located in a small town with few food options, especially late at night, having to be buzzed in and out of the unit by staff and not having visitor bathrooms on the unit. Although the staff are accommodating, it would be nice to have coffee, ice water and a fridge available without having to ask. You know, like a doula station? A doula can dream!
3.) Spectrum Health Butterworth: Although I would love to assist someone in the Natural Birthing Suites, we have not yet had the opportunity. When women we serve plan to deliver at Butterworth, it’s usually because they are high risk or planning a VBAC, making them ineligible for this option. In these circumstances, all of West Michigan is fortunate to have access to the state-of-the-art care provided there. There are pluses and minuses to being in such a large hospital. On the one hand, most of my clients have no idea who is going to be there when they deliver with a practice. On the other hand, when a woman’s care is transferred, there is a good chance that the care she seeks is available. Some of my favorite birth memories as a doula at Butterworth involve supporting women who want to do something that is met with staff discomfort and do it anyway!
4.) Home: There is nothing like the flexibility and comfort of home, even someone else’s home! Whether small or large, the gathering is always intimate, peaceful and festive. When present, I love spending time with other family members, friends and pets. There is never a struggle to support a natural birth plan, especially when it pertains to newborn interventions, at a home. Cost is the biggest barrier to home birth for those who desire it and fit the criteria. I also hope for a future with more diversity among midwives, to help increase access for all women.
— by Faith Groesbeck
Some social scientists believe that human evolution is closely linked to the need for animal protein to meet the nutritional needs of gestating a primate with a very large brain. The nutritional requirements of humans during pregnancy has been studied over time as they relate to nearly every complication of maternal and infant health. Perhaps due to our origins as hunters and gatherers, vegetarian and vegan diets have received a lot of scrutiny as being unnatural and harmful.
The Western history of dietary recommendations during pregnancy has swung like a pendulum of extremes from starvation to overeating and for the moment has landed in the middle. In the 19th C., when maternal mortality was high and cesareans were life-threatening, pregnant people were cautioned not to overeat to prevent large babies. Starting in the 1920’s, maternal weight gain was recorded at every prenatal visit. As late as 1974, text books advised women to gain no more than 25 pounds during pregnancy.
Then, in 1977, Dr. Thomas and Gail Brewer published What Every Pregnant Woman Should Know. Their research showed that preeclampsia was the result of protein deficiency. Subsequently, they advocated for a diet containing at least 100 grams of protein per day. They provided lists of food combinations to obtain “complete” protein that were difficult to comply with for vegetarians and nearly impossible for vegans.
Although researchers who followed were unable to replicate their studies, their teachings became very popular among healthcare providers. The Bradley Method and Childbirth Education Association of Metropolitan New York, where I received my training, both advocated the Brewer Diet for many years. Despite the lack of evidence, many providers believe that a vegetarian diet is dangerous during pregnancy. In fact, I was eating a vegan diet when I became pregnant for my son in 1997 and was advised by my midwife to at least eat canned salmon with the bones!
I had been influenced by books like Diet for a New America, written in 1987. That book’s popularity was followed by the low-carb craze and the Atkin’s Diet. I was working for Dr. Ronald Hoffman at the Hoffman Center for Holistic Medicine in Manhattan in the mid-1990’s. Dr. Hoffman promoted his own diet, the Salad and Salmon Diet, which was a little less extreme, but still focused on increasing lean protein.
Today, the pendulum has swung back again toward a plant-based diet. Thanks in part to the many documentaries in recent years that explore the negative environmental and health consequences of meat consumption, more people in the United States identify as vegetarian or vegan than ever before. Not surprisingly, many of my clients abstain from meat during pregnancy. Unsure of the most current research, I decided to explore the issue to learn the health impact of vegetarian and vegan pregnancies.
I found a systematic review, published in the British Journal of Obstetrics and Gynecology in 2015, that got me up-to-date and answered my questions. What they found was that studies finding poor outcomes in pregnancy did not always distinguish between those that were vegetarian by choice and those whose circumstances forced it upon them. It also found that, over time, in developed countries, food options for vegans and vegetarians have improved, making it easier to eat a well-rounded meat-free diet during pregnancy. Other than cautioning vegetarians to pay some attention to preventing iron-deficiency anemia and B12 deficiency, they could find no other concerns.
Although I’m no longer a vegetarian or vegan, I am a conscious eater and appreciate those who also eat conscientiously in regards to their own health or that of the planet’s. I can provide herbal teas for my vegetarian and vegan clients to boost their intake of minerals, including iron. I can easily modify my lactation cookie recipe by substituting for eggs and butter. Since educating myself, I can also affirm the health of a vegetarian and vegan diet during pregnancy.
How about you – were you vegan or vegetarian during your pregnancies? Did you feel supported by your community and providers? Please share your stories!
“3 Historical Trends in Clinical Practice, Maternal Nutritional Status, and the Course and Outcome of Pregnancy.” Nutrition During Pregnancy: Part I: Weight Gain, Part II: Nutrient Supplements. Washington, DC: The National Academies Press, 1990 .
Brewer, Gail Sforza. What every pregnant woman should know: the truth about diets and drugs in pregnancy. Random House, 1977.
Milton, Katharine. “The critical role played by animal source foods in human (Homo) evolution.” The Journal of nutrition 133.11 (2003): 3886S-3892S.
Piccoli, G. B., et al. “Vegan–vegetarian diets in pregnancy: danger or panacea? A systematic narrative review.” BJOG: An International Journal of Obstetrics & Gynaecology 122.5 (2015): 623-633.
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.
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.
— 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.
- 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.
- 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.
- 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).
- 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.
- 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.
*** *** ***
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 gynaecology, 31(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 Rev, 10.
Jadidi, M. Y., Sang, S. J. B., & Lari, H. (2016). The effect of date fruit consumption on spontaneous labor. Journal of Research on Religion & Health, 1(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 practice, 27, 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 Health, 2(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
A year ago, I wrote a blog about how hospital bans against vaginal birth after cesarean (VBAC) limit options for Muskegon families. I used birth data from the Michigan Department of Health and Human Services to compare percentages of people with low-risk pregnancies who have a cesarean after a prior cesarean in Muskegon and surrounding counties. Not surprisingly, VBACs are more common where hospitals support them.
The data available that I used was from 2008 to 2014. Since then, 2015 data has been released. I wanted to update this information to see if there were any changes, explore what might be impacting this change and predict how this situation might change in coming years based on current developments in healthcare policy and services.
Statewide, there has been improvement. In 2015, a total of 2,006 people had VBACs, compared to 1,882 in 2014, an increase of 124. When we look at West Michigan counties, however, only Muskegon County and District Health Department #10, which includes Oceana, Newaygo and eight other counties, saw an increase. Kent county births included 40 fewer VBACs and Ottawa county had 3 fewer than the year before.
There are a few issues with this data and that make it difficult to draw conclusions from. First, the two-to-three-year lag time from when the year ends until the data becomes available makes it less useful. We can reflect on what may have happened two years ago to impact these changes, but it is less relevant than being able to access real-time data. Secondly, the online database only provides this particular piece of information by county. In a large county, like Kent, it would be interesting to see how being in an urban, suburban or rural area or proximity to a specific hospital may impact access.
When applying this information to our doula practice, we see clients make a lot of different choices when it comes to choosing a provider and location for their planned VBAC. While some Muskegon area families are happy to travel to Spectrum Health Butterworth in Grand Rapids to deliver, others prefer the intimacy of the small practice at Gerber Memorial Women’s Health, also under Spectrum, in Fremont. Still others have decided to stay in Muskegon and show up in labor at Mercy Health Hackley, while home birth after cesarean (HBAC) is a clear choice for others.
Things may change in 2018. Dr. Tami Michele, who has practiced at Spectrum Health Gerber Memorial for many years, is switching over to Spectrum Health Medical Group Ob/Gyn, with locations on 68th St. and on Mid Towne in Grand Rapids. Some say the move is to help increase the access to VBACs at Butterworth, which serves more patients. Dr. Michele is former doula, whose advocacy for those who wish to plan a VBAC has earned her a national reputation. What is less known at this time is how her moving from a small, rural hospital to a large metropolitan one will impact access to VBACs for those outside of Grand Rapids. Some will surely follow her, while others may feel that they lost a resource.
Another recent change on the national landscape was the publication of the American Congress of Obstetricians and Gynecologists updated guidelines on VBAC, which appeared in the November issue of Obstetrics and Gynecology. According to Mark Turrentine, MD, chair of ACOG’s Committee on Practice Bulletins-Obstetrics, the guidelines are meant to ensure delivery at the safest facility, “However, this absolutely should not result in women having limited access to VBAC.”
According to Jen Kamel, founder of VBACFacts.com, the guidelines are an improvement over those released in 2010. She quotes the new guidelines, “Available data confirm that TOLAC [trial of labor after cesarean] may be safely attempted in both university and community hospitals and in facilities with or without residency programs.” She interprets this to mean that if a hospital can handle deliveries, they should offer VBAC, because an emergency cesarean may be required in any birth, even a low-risk one.
How local staff changes and changes in the ACOG guidelines will impact local access remains to be seen. Will more people be able to access VBACs at Butterworth, or will support at Gerber decline? Will the 2017 ACOG guidelines result in a reversal of bans at Mercy Health Hackley, North Ottawa Community Hospital and Spectrum Health Gerber Memorial, or will the liability concerns prevail? Time will tell, but we won’t be able to see the data until 2020!
In the meantime, we will continue to support families in all their choices, whether they choose a repeat cesarean, a VBAC at a hospital or birth center of their choice, or at home.
— 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
• cell phones
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!
In May of 2016, I attended a postpartum mood disorder class in Grand Rapids. As someone who supports moms – and as someone who struggles with bouts of anxiety and depression – I was eager to learn as much as I could.
Navigating my way through the parking lot, looking for the entrance, I noticed a woman who I figured was probably doing the same thing I was. But there was something about her that stood out to me, and I gravitated towards her without any real thought. Her energy was warm and kind. We met in the parking lot and found our way in together.
There had to be at least a hundred people there for the class, probably more as they couldn’t all fit in the main room. We (Rachael and I) sat together and got acquainted. I was one among a handful of doulas in the room. Rachael, however, was one of a kind.
In the short time we spent there that day, I did my best to take in and understand what Hakomi was. We’ve even kept in touch since then; but to this day, I’ve wanted to know more. Thankfully, Rachael, who practices through her business, Making Space Hakomi, was kind enough to oblige my request for an interview.
I hope you’ll all enjoy what she has to share. As she is just getting started on this path, I also hope you’ll all welcome her and encourage her on in her calling to serve women and their families.
Beth: First of all, what is Hakomi? I know when I met you, it wasn’t something I’d ever heard of and I haven’t really met anyone else who has.
Rachael: Hakomi is a mindfulness-based, body-centered form of assisted self-discovery. It is also experiential. What this means is that we work to stay mindful and in the present moment to explore our underlying unconscious beliefs about ourselves and the world. Often we learn a lot when we pay close and respectful attention to the wisdom of our bodies. It is an extremely gentle, respectful and sensitive method that understands the client to be the expert of themselves; the job of the Practitioner is to assist the client to maintain mindfulness and help guide them toward a more complete awareness of themselves.
Beth: What was it about Hakomi that appealed to you?
Rachael: I knew from my experience as a client that it really works and it felt so much more elegant and respectful than anything else I had tried. I love the founding principles of non-violence, organicity, unity, mindfulness and body-mind holism.
Beth: What inspired you to become a practitioner?
Rachael: My own experience as a client. It was a truly transformative experience for me through which I realized so many things about myself that I hadn’t consciously been aware of before and I felt like I gave (with the help of my Practitioner) those wounded places within myself the healing they needed; that resulted in really knowing I could choose to inhabit my life differently than I had been before. The result is that I generally feel more resourced, more connected to myself and able to connect with others, more aware of my unconscious beliefs and more able to make more life-affirming and nourishing choices in my daily life. Of course, I have hard days and I forget all these things sometimes, but generally feel much more whole, aware and vibrant than I did before going through my Hakomi process. I continue to learn and struggle but am so grateful for what I continue to learn through this lovely method.
Beth: What kind of training did you have to complete in order to become a practitioner?
Rachael: I completed an 18 month comprehensive training program through the Hakomi Institute. I then completed the certification process, which is based on competence rather than hours, about 16 months after I graduated from the program.
Beth: How would you say Hakomi is helpful for women before, during, or after pregnancy?
Rachael: The transition into motherhood or transitioning from mothering one to two or two to three children, etc. is significant in all women’s lives. So much happens to women as we go through that process. It is a time when we can be particularly vulnerable and particularly in need of extra support to find our footing in who we are and how we want to embody our life as a person who is also a mother. The way that process unfolds is different for everyone, but across the board it is a unique time of life that lends itself to mindful self-discovery as we come face to face with a lot of our own wounding, fears, desires and the impacts of our personal history. Hakomi is such a lovely way of learning to be with and learn from those parts of ourselves that can arise during times of transition.
Beth: What are some of the reasons women might seek out the assistance of a Hakomi practitioner?
Rachael: I often see clients who are having trouble transitioning into motherhood, feeling stuck in behavior patterns that don’t serve them or interacting with their children in ways that feel triggered but not grounded or based on their truest desire for how to be in relationship with their child(ren).
Beth: Is Hakomi something that can help new parents adjust to the changes they’ll face as well? If so, how?
Rachael: Absolutely. Hakomi is based on the idea that when we are mindful and we have a skilled assistant on our side we can uncover our unconscious beliefs that often drive our behaviors and ways we live in the world. Hakomi allows us to gently make space for the wounded parts of ourselves that can become particularly activated upon becoming a parent as so many of our developmental wounds
are revealed as our children grow. Hakomi also provides amazing and individualized resources and skills that people can take home with them and practice using in their daily lives.
Beth: I see you have a Mindful Mothering Support Group coming up in November. Is this a little different than other support groups for moms and if so, how?
Rachael: Yes. This is a unique support group because it is founded in mindfulness. Mindfulness is slowing down, being aware and also cultivating a sense of non-judgement or curiosity. So we will engage in some guided meditation time and be able to study what arises during those times of mindfulness. It will be a highly facilitated group where participants will be encouraged to speak from their present experience rather than retell the “story” of their struggles. In doing that we can more easily access the issues UNDER the story and hopefully offer some healing to those places that need it.
Beth: Do you offer any other classes or provide private consultations?
Rachael: Yes. I provide one-on-one sessions as well as an eco-grief mindful support group which is designed to support people who deeply feel the pain of the earth and the damage we have done to it in this moment in time. The goal is to provide a safe space to share grief and pain and also allow those feelings to flow and move and see what else can arise through that process. This is inspired by the work of Joanna Macy and her book, “Active Hope.”
Beth: Is there anything else you’d like to share?
Rachael: Thank you for the opportunity to share about Hakomi. I am grateful. I have myself worked at a college for midwives, trained as a birth and postpartum doula, volunteered as a postpartum doula and experienced postpartum mood disorders. So I have a deep well of empathy, compassion, and resonance with the struggles that come with the transition into mothering and learning how to be who you truly are in the new and overwhelming role of parent.
Beth: Thank you so much, Rachael, for your time and help with this. I can honestly see how this is something everyone could benefit from, and I hope that services like yours continue to grow and help people heal.
On August 22nd, 2017, Sandy Parker from On the Path Yoga and I drove to the New Holland Brewery in Grand Rapids to hear Dr. June Murphy, DO, Maternal Fetal Medicine Fellowship Director at St. Joseph Mercy Oakland Hospital, talk about “Advances in Management of Preterm Labor: Achieving Optimal Practice.” The lecture was at an event that combined the journal clubs of obstetric residents at Mercy Health Hackley in Muskegon and Metro Health (University of Michigan) in Grand Rapids. The event was sponsored by Hologic, the makers of the fetal fibronectin test.
Understanding the ever-changing standard of care involving preterm labor is important for maternal and infant health advocates, like doulas and childbirth educators. People who experience preterm labor are often confused about why treatment varies so much between patients. Not understanding the standard of care can lead to anger when it appears that patients have not been treated equally. While unequal care can occur, protocols can prevent bias and reassure patients that everything possible is being done to protect them and their infant.
While preterm labor is the leading cause of infant mortality in the US, it is very common and often harmless. In fact, I learned that as many as 1 in 4 women will experience four contractions per hour prior to 32 weeks! However, 30% of preterm labor resolves spontaneously, without treatment. Only 1 in 10 women who are diagnosed with preterm labor will give birth within 7 days. In other words, uterine contractions poorly predict whose baby will be born too soon!
To complicate matters, steroids given to mothers with preterm labor improve newborn outcomes when given as late as 34 – 36 weeks, but can be harmful when given unnecessarily.
So, what are providers supposed to do? Fortunately, the March of Dimes created the Preterm Labor Assessment Tool (PLAT), an algorithm, or decision tree, based on the Rose et al study (2010), to assist healthcare providers in deciding whether to admit someone in preterm labor. Dr. Murphy explained how the cut-offs for cervical length combined with the fetal fibronectin results best predicted who would deliver early. Unfortunately, the protocol does not prevent preterm birth, but does save money, time and stress from unnecessary hospitalizations.
In addition to the lecture, residents reviewed two articles, one comparing the efficacy of vaginal progesterone to an injection. Studies in the last decade have shown that progesterone treatment to prevent preterm birth is effective. Barriers to this treatment include problems with insurance reimbursement and compliance with office visits to receive injections. Vaginal progesterone has the advantage of being cheaper and easier to administer. Although the study was small, it showed promise for an alternative, but effective, treatment to prevent preterm delivery and save lives.
Dr. Murphy said that if a woman presents to a hospital in preterm labor and there was a thought bubble above her fetus, if would say, “Follow the protocol!” The causes of prematurity are complex and interrelated. Clinical providers have a limited role in addressing the underlying causes of prematurity and the infant mortality that results. Standardized care based on the latest research can reduce treatment influenced by bias and help achieve equity.
According to Kids Count data, released August 9th, 2017, the Black infant mortality rate, or B-IMR, in the City of Muskegon has more than doubled in an 8-year time span. The infant mortality rate measures the number of infants who died per 1,000 infants born. This makes it possible to compare places with different population sizes, or groups within a population. The data in the report compares a “rolling average” or the average of a 3-year time span, 2008 – 2010 and 2013 – 2015. For a relatively rare event like an infant death, years are combined to get enough numbers to make sure the statistics are not related to chance.
The community report for Muskegon points to the Maternal Infant Health Programs (MIHP) at Muskegon County’s two Federally Qualified Health Centers, Muskegon Family Care (MFC) and Hackley Community Care (HCC) and several programs through Catholic Charities of West MI as examples of efforts. Policy recommendations in the full report include:
- Reducing disparities by race and ethnicity
- Protecting the Affordable Care Act and the Healthy Michigan Plan
- Expanding home visiting programs to support vulnerable women and infants
- Addressing the social determinants of health
Here is a timeline of some significant events that impacted reproductive, maternal and infant healthcare services in Muskegon during the time covered in the report:
These events may impact infant mortality in the following ways:
Despite promises by administrators that reproductive health services would not be impacted, the hospital system, now operating under the Ethical and Religious Directives for Catholic Health Systems (ERDs), eliminated insurance coverage for family planning under its health insurance plans. Although some providers violate the ERDs by prescribing birth control for preventing pregnancy, there is now institutional support for providers who, because of their own religious beliefs, refuse to insert an IUD immediately postpartum, prescribe hormonal contraceptives, or emergency contraception; or perform a tubal ligation during a cesarean, for example. The merger also meant an end to all abortions, except to save the life of the mother, which, as the court case Means vs. the US Conference of Catholic Bishops shows, is up for interpretation by the local Bishop. The ban on abortions includes terminations for fetuses known to have birth defects incompatible with life, even when the pregnant person has health conditions that can make pregnancy dangerous for them.
As I stated this past May, when I was invited to speak to congressional staffers by the National Women’s Law Center (NWLC) on the impact of religious restrictions in healthcare in Washington, DC, unenforceable policies open the floodgates to discrimination based on provider biases.
Muskegon’s Fetal Infant Mortality Review (FIMR) findings showed an increase in both unintended pregnancies among women experiencing an infant or fetal loss and a sharp increase in Black infant mortality following the loss of Title X family planning services.
The new Muskegon Planned Parenthood clinic reopens inside of Public Health – Muskegon County , providing services in Muskegon for the first time since the Peck St. clinic shut down in 2007. Title X – funded clinics are unique in that federal guidelines prohibit discrimination, religious refusals on the part of the provider and can provide more confidential services to minors than state law requires.
The Birthing Center at the former Mercy Hospital was a favorite among local women. As an in-hospital birthing center, it was physically detached from the hospital, but still run by it. During construction, some women who gave birth complained to me of noise and crowding. Some women who had given birth prior at the Mercy facility and then had to deliver subsequently at the new facility, preferred the later.
Centering Pregnancy is an evidence-based group prenatal care model shown to decrease the incidence of preterm births, with the best improvements among African American women.
- Jan 2013: Muskegon’s Only Abortion Clinic Closes
Regardless of the reasons of the clinic’s closing, Muskegon County women now must drive to Grand Rapids’ Heritage Clinic, currently the closest abortion clinic, to obtain an elective abortion. For those who lack transportation to Grand Rapids or the addition time for travel, this clinic closure creates an additional barrier to obtaining services. Research has linked increases in abortion access to declines infant mortality rates.
- Oct 2013: Public Health – Muskegon County (PHMC) Eliminates the FIMR Program
Despite successfully reducing the B-IMR in Muskegon County, PHMC eliminates the FIMR program after a “Know Your Rights” event is held at Muskegon Community College. The event, co-sponsored by the ACLU of Michigan was held to educate local women about how other communities had been impacted by mergers with Catholic healthcare systems.
Planned Parenthood takes over the job of STD testing, despite being open fewer hours, when PHMC decides to focus on partner notification. At the time, we had the third highest rate of Chlamydia among all counties in the state of Michigan. Chlamydia and Gonorrhea are major contributors to prematurity and infant mortality.
- May 2015: HCC Begins offering Centering Pregnancy
Now, both of the FQHCs offer Centering Pregnancy group prenatal care, although the midwives at HCC stopped catching babies that same year, leaving MFC the only place in Muskegon to receive continuous care from a Certified Nurse Midwife throughout labor and birth.
Research shows that racially inequities in incarceration rates are directly related to racial inequities in STD rates. When the former jail was being used, the racial disparities was 5.9, meaning an African American in Muskegon County was nearly 6 times more likely to be in jail than a White resident. Muskegon County FIMR participated in at least two efforts to address this injustice: The Disproportionate Minority Contact (DMC) Coalition and a Health Impact Assessment (HIA) on the funding of the new jail. The DMC Coalition, which was making some progress in collecting data to identify key points in the juvenile detention system where discrimination occurred, had its leadership derailed by a vote electing Judge Pittman as the new president and never again convened. The HIA was sabotaged by inadequate funding and refusal to approve a research project initiated by a professor at Grand Valley State University to inform service providers of the unmet psychosocial needs of current inmates.
Muskegon is about to have its second birthing unit in five years built away from the city center to be more convenient to out-of-town patients. According to the head of obstetric nursing, community input for the birthing unit was obtained, although the public was not invited.
While the causes of infant mortality and the inequalities expressed in rates are complex, one thing is clear, Muskegon stands out in Michigan as having the largest increase, 131%, in an eight-year time span at the same time as infant mortality statewide is decreasing. This is not an accident, nor are the multiple contributing factors a mystery. What remains unasked is why aren’t the home visiting and other programs in place not making more of a difference? And moving forward, if Public Health and Mercy Health aren’t doing a good job of ensuring the survival of our county’s Black infants, is anyone paying attention and will anyone be held accountable? Who will spearhead our efforts toward improvement? Whoever that is, I wish them the best of luck in their endeavors, will follow their lead and hope that they don’t become demoralized and without a job. The needed change will not come without stepping on a few toes.
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
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:
- 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)
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.