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.
“Although this moment is bittersweet, it’s one of my favorite photos and I’m glad it was captured. Just before I was taken into surgery, after 24 hours of hard labor at home. My #doula, Faith, never left my side.”
— Ottawa County client, after a homebirth transfer to hospital
“[Faith] provided me with many resources, and I also really appreciated the teas she made me. Her evidence based approach was very unbiased and nonjudgmental. I felt like I could be honest about my needs with her… She really proved herself when the birthday came. She was my knight in shining armor! She made me feel so confident and comforted through my labor. Her knowledge of a birthing woman’s body and need for support was obvious. I credit my smooth labor and delivery to her…”
— Norton Shores mom, of her homebirth with Birth Quest
When I tell people that I’m a birth doula, the most common response I get is, “Oh, so you help women having their babies at home?”. To which I reply, “Yes, doulas support women at homebirths, but all of the women I’ve supported have given birth in hospitals”.
Because the word doula is not a part of everyday vocabulary for most people, I think many confuse a doula with a midwife. This is usually the second thing I have to explain to people about my job. I don’t catch the babies; I hold space for mom and support her through the process.
The next question usually revolves around why doulas attend more hospital births than homebirths. Several factors impact a woman’s decision on whether or not to hire a doula. For the woman choosing to give birth at home, the biggest factor is likely financial. Homebirths are generally paid for out-of-pocket, as are doulas. Since doulas don’t provide the clinical support a pregnant woman needs and they don’t catch babies, women who desire a homebirth are often faced with the decision to choose between hiring a midwife or a doula. In this scenario, the midwife is usually chosen because of the necessity of her services.
But what if having a doula AND a midwife were an option?
It’s true that your midwife will spend more time with you while you labor and provide a different model of care during pregnancy and delivery. It’s also true that she will likely have assistants who can attend to some of your needs. However, with their focus primarily on the clinical aspects of care, there are other elements left unaccounted for.
Generally, a doula will meet with you in your home at least a couple of times before you have your baby. She’ll be familiar with you and your surroundings. It’s during these meetings that doula and mom become acquainted and comfortable with one another. If there are pets, the doula will get to know them. If there are other children or family members, the doula will get to know them, too. This process is vital in developing a safe relationship as the mother will depend on the doula to cover the non-clinical elements that are a part of the birth process. It’s during these visits that mom can share her hopes and her fears. While she’s probably also done this with her midwife, the doula provides more time for mom to process and plan. The more informational and emotional support a woman receives during her pregnancy, the better.
And in the event of a hospital transfer?
Your doula will be with you. Your midwife probably will be, too, but if your doula is the one you’ve been leaning on emotionally during your pregnancy and labor, her presence is vital. Odds are, she was with you earlier in your labor than your midwife was, as well. That’s the beauty of a doula: no shift changes and present with you from the beginning to the end. Another benefit is that a doula is likely to be very familiar with the hospital environment and maybe even some of the staff, so she can help to explain what is going on and bridge the gaps between a homebirth and a hospital birth.
Regardless of the outcome, whether you had your baby at home or had to transfer to the hospital, your doula will be there postpartum for you to process the experience. Your midwife will, too, but depending on how the birth went compared to how you had envisioned it, your doula provides added space and opportunity to share things that you might not wish to share with your midwife. I know for me, I’m no good at confrontation and had I been upset with my midwife or disappointed, there’s no way I could have told her that (fortunately, that wasn’t the case for me!). A doula is trained to listen to your grievances and your joys. Validating your feelings and helping you to pick through the pieces and put them together, a doula can offer perspective, encouragement, and reassurance.
Birth is one of the most unpredictable events in nature. No matter how much you know about it, curveballs often appear in the form of all the little things that surface in the midst of the limbo of labor that no one had planned on.
I think back to my last pregnancy, when I had finally planned the homebirth I’d always wanted. It honestly was an amazing experience to labor at home and push my baby out the way I wanted with a supportive group of women (midwives, assistants, my mom and mother-in-law) and my husband. All of it was golden. I was even doing “doula talk” in my head, like focusing on the words soft and open. You see, I’d had my birth doula training through DONA only a few short months before the birth. So at the very least, I was able to focus and feel pretty in control during the more intense moments of labor. Super proud of myself for that!
However, the entire day leading up to my precious little one’s arrival, my anxiety and the negative self-talk going on in my head was relentless. Fourth baby, longest labor. Why? Was I not moving around enough? How long was it going to take? Why were the contractions that woke me in the wee hours of the morning that were 4 minutes apart and very uncomfortable spacing out to 15 minutes and not as painful? And there went my thoughts for the better part of an entire day. It’s the one part of my labor I look back on and wish I’d had a better attitude about. As helpful and supportive as my husband was physically for me that last time around (so grateful for the counter pressure and back rubs!), I needed someone to help ease my mind. I needed someone to remind me that every labor is different and that what I was experiencing was normal. I’d fed my fear of waking in labor and things moving quickly, as they had in the past (with my third baby, I went from 5cm to holding my baby in under a couple of hours after painfully relentless contractions). Instead, I spent the better part of the 24 hours that I was in labor anxious, discouraged, and feeling guilty for having sent my kids away first thing in the morning because I was sure “this is it!”. I wasn’t mentally prepared for a long labor. I’d never had one.
Don’t get me wrong; my birth team was incredible! I’d depend on them again in a heartbeat for their care and support during pregnancy and birth. Looking back, though, I know I needed more in those long hours before my little guy finally made his arrival.
Doulas meet so many needs that are maybe overlooked or not considered.
I know when my son was born, my house was a mess. Pretty sure there were dishes and laundry that needed to be done. I didn’t feel like cooking and no one brought food while I was in labor. It was a long, lonely day. I struggled to find distractions. There were so many things during that entire day of early labor that a doula could have helped me and my husband with. We were both so tired.
When I was in active labor and pushing, I soaked up every encouraging word and touch my birth team provided me. They were tender, attentive, and confident. In hindsight, I realize I had needed that all day to better cope with my apprehension about the imminent arrival of my baby. I needed someone to hold that space for me and remind me that everything would be okay. I needed someone to tend to the things my husband and I couldn’t get to while I tried to rest.
My other children were born in the hospital, where food and laundry weren’t an issue. While the hospital environment is not my personal favorite for giving birth, those two things ended up being huge oversights for me with my homebirth. I don’t have sisters or super close girlfriends that I would have felt comfortable having with me while I labored; and I wanted my mom and mother-in-law present for the birth, not running around my house cleaning and cooking. While having my son at home was truly a dream, waking up the next day to the reality of…well, real life, wasn’t. Looking back, I hadn’t planned for how to handle those seemingly tiny details. Who knew that while I did the hard work of bringing life into the world that my house wouldn’t clean itself or cook a meal for me! Or take care of my other children when they returned home the very next day (totally needed a postpartum doula, too).
My business partner and Birth Quest founder, Faith, also had her last baby at home. Her labor, which was the complete opposite of mine, was quick and intense. Despite her doula training, she found herself in need of one and speaking the words women the world over often say when it’s become too much…“I can’t do this! Make it stop!”
I needed a doula; but even if I’d wanted one, I couldn’t have afforded one anyway.
At least, that’s what I thought. I know better now. I could have asked family to help with the expense or sought a doula out that would take my finances into consideration and work with me to make it affordable. Our vision is to increase access to doulas for every person who wants one, so please contact us if you have a financial hardship, especially if that is due to the unreimbursed expense of an out-of-hospital birth. Everyone deserves a doula!
As one Birth Quest client of her having a doula for her homebirth said, “My parents paid for my doula as a gift for our Homebirth. If they hadn’t, cost might had been an issue but I definitely would choose to hire a doula again. Their knowledge and support are so priceless if you can find one you love!”
My story and Faith’s are just two of many stories. Doulas do so many things. If any one part of your labor and birth could be considered customizable, it’s who you choose as your doula. With you from the moment you feel like you need her, she’s the one you’ll have expressed your desires to about labor and birth. Whether you need someone behind the scenes – doing your dishes, folding laundry, or getting a meal ready – or someone to be a part of the action – holding your hand, taking pictures, or showing your partner where to apply counterpressure – your doula is the one person attuned to your wants and needs. And if at any time you want what your doulas doing to change, just say the words…that’s what she’s there for.
What does a doula do at a homebirth anyway?
At a homebirth, a doula is going to do everything she’d do for you in a hospital, except that she is in your space where there are more personal elements that might need tending to. Because the list could go on and on, here are a few examples:
- Ideally, she arrives earlier in your labor to provide support (informational, emotional, physical, etc.)
- Support for your partner (in the form of breaks, encouragement, direction on how to apply pain management techniques, etc.)
- Support for others present during your labor and birth (friends, relatives, children, etc.)
- Light household chores (dishes, laundry, etc.)
- Meal preparation
- Tending to the needs of pets
- Taking pictures
- Crowd control (making sure mom has the space and privacy she desires)
- Immediate postpartum support
- Assistance with breastfeeding
- Preparing a place to rest postpartum
- Meeting needs specific to the individual
- Hold space for the woman in labor
- Create/maintain a peaceful and calm environment
Who could use a doula at a homebirth?
There’s no denying that as a doula, I feel the benefits are universal and for all women. With that being said, specific reasons a doula is perfect for a homebirth include:
- Women whose family/friends are not near enough to provide support
- Women without a partner or whose partner might not be available for support
- Women with anxiety or other health issues that might impact their confidence in their ability to give birth
- Women who want to be prepared in the event of a hospital transfer
- Women who know they need a lot of support
- Women who don’t want to worry about meals or cleaning during labor and after birth
- Women who know their partners will need additional support
- Women who want support but aren’t comfortable with family/friends present
- Women who have specific wants and needs
- Women who have other children that will be present that need support
- Women who want someone to promote and maintain a calm, peaceful environment
- Women who want a safe person to hold space for them
Since doulas aren’t as commonly present at homebirths as they are for hospital births, we did a little investigating into why.
Thanks to the women who took part in our Facebook poll (@birthquestservices) to find out why they, women who’d had homebirths, didn’t have a doula. Not surprisingly, the leading reason was cost. A close second were women who felt they already had enough support while the third reason was a desire for privacy.
However, because women were allowed to choose more than one option, some chose both cost and sufficient support as their primary reasons for not hiring a doula. This leaves us to wonder…which was the biggest factor?
— Blog written by Beth Singleton, DONA-trained Birth Quest birth doula and photographer,
who had her fourth child at home in Muskegon
Serious Side Effects for a Common Concern
Urinary tract infections are extremely common in women, and even more so among pregnant women. During the second and third trimesters of pregnancy, women are at an increased risk of developing a UTI. Treatment for this infection typically includes antibiotics, some of which can leave life-threatening adverse reactions for mom and baby.
A urinary tract infection is a bacterial infection of the urinary system. It develops when bacteria comes in contact with the urethra, ureters, bladder or kidneys. Women are more susceptible to UTIs because they have shorter urethras, providing bacteria quicker access to the bladder. Symptoms include:
- An intense urge to use the bathroom while your bladder is empty
- Burning sensation while urinating
- Lower back and abdominal pain
- Pelvic pain
- Bloody urine
- Fever or chills (which indicates the infection has spread to the kidneys)
Other contributors to urinary tract infections include sexual activity, a suppressed immune system, certain types of birth control, menopause and any other blockages in the urinary tract.
Treating Urinary Tract Infections During Pregnancy
Bacterial infections need to be treated with antibiotics to ensure the infection completely goes away. Although some antibiotics pose certain risks to unborn babies, not using an antibiotic to treat an infection could cause more harm. For that reason, doctors will recommend the safest option and most efficient treatment. Doctors even use the U.S. Food and Drug Administration’s list of Pharmaceutical Pregnancy Categories to help prescribe antibiotics that are safe to use during pregnancy.
These Pharmaceutical Pregnancy Categories rank in five letters — A, B, C, D and X — to indicate the level of safety of drugs for pregnant women. The most unsafe rankings are X and D, and are strongly advised against. The safest rankings are A and B. Drugs and antibiotics with a C ranking are somewhat safe, but it is important to know they may cause a level of risk. Some of the common antibiotics used during pregnancy include:
- Amoxicillin — B ranking
- Nitrofurantoin (Macrodantin) — B ranking
- Erythromycin — B ranking
- Ciproflaxacin (Cipro) — C ranking
Whenever taking antibiotics, it is important to only take what is prescribed. An excess of any drug, especially while pregnant, can prove to be dangerous to a mother’s health and her baby’s growth. Pregnant women are at an increased risk of developing bad reactions from drugs, specifically from fluoroquinolones. Studies have found these drugs can be toxic to a growing fetus, especially when taken in excess and not as a physician prescribed. Pregnant women taking fluoroquinolones should take only what is prescribed and with a level of caution.
How to Prevent UTIs
It is common for urinary tract infections to resurface over time. However, there are ways to reduce the likelihood of developing another infection. To prevent a UTI, you should:
- Wipe from front to back after using the bathroom.
- Stay hydrated! Increase your water intake while treating the infection, and drink at least 6 – 8 glasses of water regularly.
- Drink unsweetened cranberry juice, which can eliminate the presence of unwanted bacteria in the body.
- Avoid sexual activity while being treated for an infection.
- Wear cotton underwear to wick away moisture and maintain good hygiene habits.
Kiara Anthony earned her undergraduate degree in Mass Communications from Towson University, and her graduate degree in Communications from Trinity Washington University. She regularly contributes to Drugwatch.com, along with other publications.
My VBA1C Story.
So here it goes! I am a little late but I just finished up with school and having a newborn baby, and her being baby number two with a 5 year old boy at home has been quite the adjustment for me, but things are really coming along great and he is an amazing big brother to her!!! I had my amazing VBAC! I gotta say, my story is one of these stories you mommas trying for a VBAC MUST READ. I read stories like mine everyday during my pregnancy and they gave me so much encouragement. Because after what I had been through with my son, I honestly had a lot of doubt deep down. I was 17 when I got pregnant with him. I did not educate myself, I thought having a baby was nothin! I figured everyone else seemed to have a baby no problem, so why can’t I!? But as we all know birth can be very unpredictable. So as far as what happened with my son I will try to make a long story short, I went in for my last OB check up, which was a day before my due date and my blood pressure was extremely high so I got an ultra sound to check my fluids, everything seemed fine, but they did schedule me to be induced for June 13th. Hours after pitocin started I was making little progress even after they broke my water, ended up getting the epidural and after 24 hours of labor and 4 hours of pushing I ended up with a c-section. My son was posterior and was showing signs of stress. I just remember, after being told that I was going to be having a c-section, all I kept telling my sons father is “I feel like a failure, why can’t I do it!?” It was all very traumatizing. The anesthesiologist was a complete smart ass when came time to bring me in for the c-section, cuz I mean there was so much to joke about, right!? Afterward I was shaking so bad, I couldn’t hold my baby for nearly a half an hour after the c-section, not to mention I was so doped up on morphine and whatever else, I could barely function. I will say my son was absolutely perfect. 8 pounds 2 ounces and 21 ½ inches long, and very healthy. When the surgeon paid me a visit in the recovery room he informed be that I would HAVE to have the rest of my children a c-section in the future. I was highly upset. I was upset about the outcome of my birth, I felt everything had went wrong, and that I failed. Recovery was also very painful and lengthy!! But, my recent experience with my daughter was very healing. I feel empowered, strong, hopeful, blessed and so many other beautiful things that birth can possibly make you feel, but most importantly, I got my baby girl, who arrived healthy! And I was healthy! But enough rambling and on to the best part!
Ok, so I found out I was pregnant March 1st of this year. I guess I wouldn’t say it was planned, but we weren’t necessarily trying to prevent it. At first I was just like ok, I guess I’m going to have another c-section, that really sucks. But then my stubborn bitch side kicked in and I was like wait, no, they can’t make me do s***! I mean they can’t really force me to have surgery, I’m not doing it, I refuse. Most people thought I was crazy and I heard a lot of “oh but you have to” and “you’re not allowed” but I was determined. I was also determined to breastfeed which I was unsuccessful with my son as well. (which has been going great as well ) But anyway, I told my midwives that I really wanted to have this one natural and they told me I better go in when time to push or the more safer route would be to go to Spectrum, so that is what I planned to do. But then I was actually talking to my stepmom and I was explaining to her that I really wanted to have this one natural and she told me to look into hiring a doula. I heard of a doula, but didn’t really know what they did or anything about them. And then a few different people referred me to Faith Groesbeck. What a real kind hearted, and genuinely beautiful soul she is. So explaining to Faith what I wanted as far as birth and telling her about my first experience she suggested I go to Gerber Hospital in Fremont. I made my appointment to meet with the VBAC supportive provider for the first time and when I got there I couldn’t meet with her because she was in delivery with one of her patients. I could have rescheduled but I wasn’t going to be able to meet with her until closer to the end of my pregnancy. I was a little frustrated, understanding that things happen and it wasn’t her fault, I just decided I would go to Hackley. It’s right down the street from my house, yes they are not as VBAC supportive as I would like, but I just kept in mind that they can’t force me to do anything and that I CAN DO THIS. And I did eventually accept that, if I HAD to, if there were extenuating circumstances that required me a c-section, than I would because my daughter and my safety was number 1. But unless it came to that, I was determined to have my VBAC, at Hackley Hospital. No matter the risks (because I did an extensive amount of research and there were risks, yes, but very unlikely considering my circumstances. I was not high risk.), the paperwork I had to sign or the attitude that was given, because honestly, no one’s attitude was going to be bigger than mine, and paperwork..??? Give it here!
Other than all of the morning sickness I had at the beginning of my pregnancy, it went really well. I had a little bit of preterm labor scare at about 25 weeks, but was most likely due to lack of water. After that I would have Braxton-Hicks here and there but nothing to get to excited about. I was very patient up until the last 3 weeks of course. The anticipation really started killing me. On Halloween though, I lost part of my mucus plug. I did feel some excitement because I knew my body was making changes, but my due date was in 10 days so I also knew that it didn’t necessarily mean anything. I could have been pregnant for another 10 days, or longer!! So I went about my week as normal, but was definitely trying to get last few things done around the house in case she decided to come a little early. I was supposed to go visit my grandma in Grand Rapids that Saturday but I called her Friday because I was having Braxton-Hicks very consistently and had a feeling the baby would be here soon so I wanted to spend my weekend doing the final last touches to the house and the kids room. So Friday morning I woke up feeling fine, I had sex about 11 am-ish I think it was and about noon I started having the Braxton-Hicks. I went to the grocery store, came home and was hanging out with my son for a bit. He was supposed to spend that whole weekend with his dad but I didn’t want him to because I knew when the baby came he was going to go with his dad for about a week or so so I could recover a bit (my kids have different fathers, so you’re not confused lol) I didn’t want him to go though because I was sad that it was my last little bit of time left with him being my only child. So I told his dad that he could go that night but I wanted him back Saturday if I could so that I could soak up the time with him. So anyway, my son went with his father that evening and I got this huge burst of energy and cleaned everything. I mean everything. I also cooked dinner and made brownies! Meanwhile the contractions were starting to be more consistent and somewhat uncomfortable, they weren’t anything unbearable. It was about 9 pm when I noticed they were at about 10 minutes apart. I was not concerned though because I was still in minimal amount of pain. At 10:30 I lost the rest of my mucus plug and then I thought, ok my body is making more changes, GREAT! I think I may have somewhat been in denial. As I’m communicating with a good friend of mine, she’s all like “baby time, you’re going to have her tonight watch” and I’m all like yeah right, I wish! Although I did feel she was going to come soon I just didn’t think it was going to be that night or anything in the near-near future. Lol. Anyway I decided that jusssst in cassse the baby came that night I decided I Should take a shower and do my eyebrows lol. So it was about midnight and my daughter’s father showed up, he works second shift and gets out of work at 11. I told him I wasn’t sure, but I thought labor may be on its way. Lol denial at its finest…and at 12:30 I crashed really hard, so I laid down. I woke up at 2am from the sharp pain of a contraction. It wasn’t anything excruciating, but enough to wake me out of my sleep. I sat up and just dealt with them as they were a little uncomfortable. I texted my grandma and told her I thought I might be in labor. She called me immediately and asked me how far apart my contractions were and I told her about 3-4 minutes apart. She told me to go in, I told her that i didn’t want to go in because they would send me home. Yeah my contractions were close together but I wasn’t in that much pain yet. You would think if you were in real labor you would be in a great deal of pain right? So I called a close friend of mine and asked her how much pain she was in when she decided to go in and she said she was in so much pain but they kept sending her home. So Brandon, (my daughter’s father) said we should go in, and here I am like no I just don’t really want to get sent home… but with him and my grandma hounding me I said okay, I’ll go in, but watch me get sent home. Right before I left my house the heat turned up a notch! It was about 2:45 when we arrived to the hospital and when I got out of my truck I knew then it was real labor because I couldn’t walk through the contractions anymore. I could still talk, and was breathing through them, but they had me hunched over. They got me checked in and the Nurse checked me and said “okay they will probably be keeping you but the Doctor will be coming in shortly to check you again, now I understand you had a c-section with your first” I told her I wasn’t having a c-section and she says “Well, do you know our policy here at Hackley on VBAC’s?” Of course I went in there with my diehard attitude and I said, I know you guys are going to try to make me have a c-section and its not going to happen. She says “Well we aren’t going to make you do anything, but we do have to let you know the risks” Her name was Lauren, She was awesome and I will never forget her. I won’t forget any of those residents there that night. I also reminded all of the residents that I did not want an epidural or any other form of pain medication. The Doctor that came in, his name was Dr. Thomas Duncan, and right away he checked me and told me that they were going to do what they could to help me have a successful VBAC and went through the ricks with me and that it was going to be either him or Dr. Gale-Butto that would be helping me deliver. So wait am I dilated though? I asked him. “Yes, you’re dilated to 9, your water is bulging and I can feel baby’s head” he says. I got scared. It was really happening, I was about to have this baby, SOON! I was in a good amount of pain by this time but was breathing through the contractions and felt I was doing okay. I was scared mainly of what was going to come when my water broke. As they moved me to the room where things were getting much more intense I suddenly felt the urge to push and my water broke. They wanted me to hold off a little bit because I tested positive for group b strep but its kind of hard to hold off when your body is taking over. At one point i asked if it was too late for the epidural, and Lauren the sweet nurse I will never forget, encouraged me that i was so close and she believed i could do it without, along with my daughter’s father and one of my Doulas Elizabeth (Unfortunately Faith was not able to make it due to important life events in which I do not hold against her for we were communication the entire time, and she was very encouraging as well) . You can do it they kept telling me. One of the other nurses came in and wanted to check me again but I refused firmly. I was in so much pain by this point, hands feeling in my vagina is the last thing I wanted! And besides when they checked me last i was at a 9, what do you need to check again for!! I thought. I told them I wanted to push when I felt ready and that I wanted to listen to my body. So after my water broke I could not fight the urge to push any longer. It was time to start working that baby out! I would say when I first started pushing I didn’t feel like anything was happening but i was in all this pain and i felt like I was trying my hardest. So after a number of pushes and feeling like it would never end I got fed up with the pain and decided I would take in that deep breath and push with all my might. The harder I worked, the sooner I could hold my baby girl in my arms. It’s truly amazing what you body can do. When she was crowning I reached down and felt all of hair and it was almost relieving and it made me so happy to just be able to touch her and know it was almost over. Unfortunately there is no picture of me touching her head, but Brandon, her father did say the look on my face was priceless and he will never forget it. What’s also crazy is pushing your baby out, and wanting the pain to end so badly, but having the doctors tell you to push, but don’t push so hard, because they were working her head out and her shoulders. Lol That took some control, but had I not listened I may have tore worse than I did. But after pushing for an hour and enduring that great amount of pain that I had no idea I could handle, my beautiful baby girl arrived at 6:12 am weighing 6 pounds 8 ounces and 19 inches long, HEALTHY and PERFECT. It was instant relief and all I could think about was how perfect and beautiful she was and that I DID IT. She came out eyes wide open and sucking on the back of her hand. She was ready to nurse and latched on right away, no problem! I feel like a momma lion!!! I knew I could do it, and the encouragement i received from those around me helped so much!!! I will never forget the residents that helped me deliver at Hackley hospital. I am truly blessed and I hope you mommas who are trying for a VBAC get some encouragement from this, you CAN do it!!
“It’s so great to be around friends. The work we do is so hard.”
— Participant, 2016 Society of Family Planning’s North American Forum
In November of 2016, I had the honor of attending to the Society of Family Planning’s North American Forum, a life-changing experience, not so much because of what I learned, but because of what it made me feel. I knew this conference was going to be different from any other I had attended when I went to register and realized that I needed two personal references to even complete the online form.
This was heavy. It’s heavy because healthcare providers are risking their lives every day to provide comprehensive reproductive healthcare services to women. It’s heavy because by being in the presence of so many abortion doctors at one time, I was myself at risk for being murdered. Every conference attendee received a name badge, with a photograph that had to be scanned every time we entered the conference area. We were to turn off the location-finders on our electronic devices. We were to take off our name badges if we left the conference area. We were not to take photographs with other attendees and share them.
I’ve been to a lot of conferences before, but nothing with this level of security. One might think that I would be afraid for my own safety, but the measures taken were reassuring. A lot of people don’t understand the sacrifice people make to perform abortions. Often, it is the only work a doctor can do, due to stigma. This can result in social isolation. Going into the work is not taken lightly and is often the consequence of life-changing experiences, some of which were shared with tears and great conviction at the microphone. Sharing space with such brave people opened my heart to a small taste of what they experience daily. I can read about statistics and danger, but this experience brought me closer to a more personal understanding.
Doctors weren’t the only ones in attendance, though. There were also attorneys, researchers, academics, students, and advocates, but I think I was the only doula and childbirth educator present. I’ve shared a lot of the resources I gathered, but I haven’t written about some of the things that I learned that may be useful in my work. Here are some highlights:
- Catholic Healthcare:
- Although there are over 600 Catholic hospitals in the US, over 1/3 of women surveyed did not correctly identify the hospital where they sought care in terms of religious affiliation.
- Most women believe that hospitals should never be able to restrict care.
- Residents who graduate from programs at Catholic institutions report dissatisfaction with their training. Although they may not be able to provide abortions, they can still be taught how to do them, through online modules and off-site collaborations.
- Zika Virus:
- Many of the countries affected by Zika also have some of the most restrictive abortion laws in the world.
- Zika is not transmitted through breastmilk
- Men should wait 6 months after potential exposure before trying to conceive. Women should wait 8 weeks.
- We don’t yet know what the outcomes will be for infants who were exposed, but are “normal” at birth.
- Vertical (mother-to-fetus) transmission is less likely in the first trimester, due to the impermeability of the placenta, but if contracted, outcomes are worse. Later in the pregnancy, the fetus has a more mature immune system and the mother has transmitting immunity, so the outcomes are better.
- Affected countries are advising that women avoid pregnancy, without giving them access to contraception and abortion, which is an unfair and unreasonable expectation.
- Immediate Postpartum Long-Acting Reversible Contraception (LARC)
- LARCs can be inserted immediately postpartum.
- 50% of women ovulate and 60% resume sex before their 6-week postpartum visit
- Up to 35% of women never attend their postpartum visit
- Subdermal implants inserted 1 to 3 days postpartum have shown no negative impact on infant health or breastfeeding.
- Male Contraception
- There are 3 options for male contraception:
- Acceptability determines if men will use available options.
- Surveys show 44 – 83% of men would use, if available.
- Lowest acceptability is in Indonesia; highest is in Spain.
- Women play a role in acceptability – men are more likely to participate in studies when encouraged by their spouses.
- A barrier is that men don’t have a designated healthcare provider for birth control, but family planning clinics may be the most logical place for them to go.
- Methods exist, but are not yet labeled for use as male birth control.
- LARC methods exist for men, but are hindered by lack of precision and research.
- There is likely to be less of an environmental impact with male hormonal contraception methods than female methods because those are excreted into the waste-water and impact fish reproduction.
- There are potentially non-contraceptive benefits to male hormonal contraception, such as an increase in lean mass, decrease in fat mass and decrease in bone loss.
- There are 3 options for male contraception:
Overall, I left the conference feeling that the training of most doulas in family planning is inadequate. Doulas and childbirth educators play a role in reducing infant mortality, poor birth outcomes and perinatal mood disorders when we have knowledge of family planning to decrease unplanned pregnancies and increase interpregnancy intervals. We can also help educate clients about the wide range of birth control options and their potential impact on breastfeeding and future fertility. As a full-spectrum doula, it’s important to provide information and support that is respectful of the values of the families I serve, across the wide-range of reproductive health decisions they face.
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