A Doula as Your Witness

Doulas are witnesses at births.

by Beth Singleton

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

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

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

Why doulas make great witnesses

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

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

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

Special circumstances

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

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

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

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

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

Crying During Pregnancy and Labor: Breaking Through Barriers with Tears

Crying pregnancy labor

Person crying

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

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

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

Possible Hang-Ups About Crying

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

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

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

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

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

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

The Benefits of Crying

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

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

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

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

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

Practice is the Key

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

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

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

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

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

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

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

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

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

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

Facing Obstacles

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

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

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

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

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

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

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

Cooperative Childbirth Education: Class Descriptions

Cooperative Childbirth Education classes in Muskegon

Birth Quest’s fall 2017 and winter 2018 childbirth education classes can be taken a la carte.

Interested in attending childbirth education classes, but don’t have the time to research your options, travel outside of Muskegon or attend a full series?

Busy families like yours want to be able to make the best use of their valuable time when expecting a new addition. That’s why Birth Quest offers a la cart classes so that you can seek out knowledge according to your unique interests and circumstances. I have taught a wide variety of classes privately, in group settings, for non-profit organizations, and as a guest presenter in classrooms. Since 2014, I have taught classes in the following settings (places in italics were as a volunteer):

Please contact me if you would like to host a class!

Are you having trouble deciding which classes to attend? Check out the class descriptions below:

  • Choices in Childbirth: Providers and Settings — Did you know that the choice of where and with whom to give birth best predictor how it will turn out? The purpose of this class is to educate you about all of your choices are so that you can give birth where you feel safest and the most supported.
  • Self-Care for Your Changing Body — This class is for those who are motivated to optimize their health during pregnancy through diet, movement and tending to their emotional needs. Strategies for alleviating common pregnancy discomforts will also be shared.
  • Holistic Pregnancy Care Options — Many families are turning to less invasive and more natural solutions during pregnancy and birth. This class will look at several different complementary and alternative medicine options, along with where to find practitioners in the Muskegon area.
  • Birth Plans: What Parents Need to Know — There sure are a lot of choices to be made when having a baby! You will leave this class confident, knowing what the available research says about birth plans, staff responses and birth outcomes. Parents will be provided with multiple templates for creating a birth plan, as well as advice for forgoing a birth plan altogether. Whatever families decide, they will learn all the key decision-making points from early labor to common newborn procedures and everything in between.
  • Labor & Delivery: Prepared & Informed — Birth is unpredictable, full of unexpected twists and turns, making it something families anticipate with both excitement and apprehension. Highlights of this class include indications for, risks and benefits of and how to prevent common interventions, such as inductions, episiotomy and cesarean. Childbirth education does not guarantee an outcome, but it can lead to empowerment: knowledge is power!
  • Essentials of Labor Support: What Birthing People Need — This class is for the birthing person and whoever they choose to support them during labor and delivery, including spouses, partners, friends and family members. Topics include communication skills, practicing massage comfort techniques and so much more!
  • Pain-Coping Strategies: A Smorgasbord of Options — Pain relief during labor is a primary concern for many pregnant people. Some believe that they must choose between no pain relief or an epidural. Fortunately, we’ve come a long way since the days of a one-size-fits-all approach. We will explore a full spectrum of both pharmaceutical and natural ways to lessen and cope with the pain of childbirth.
  • Postpartum Wellness: The Fourth Trimester — This class is focused on the physical and emotional health of parents after a birth. We will cover recovery from a vaginal or a cesarean birth, movement, nutrition and mental health with lots of resources for further exploration. This class is appropriate for any expectant or new parent.
  • Newborn Care — Babies aren’t born with an instruction manual, but the good news is that you are the expert on caring for your baby! We will cover what to expect from newborns in terms of appearance and behavior, as well as bonding, development, diapering, bathing, safe sleep and more!
  • Breastfeed Successfully with Knowledge & Support — This class is for anyone interested in learning more about the benefits of breastfeeding how it works, and how to avoid common pitfalls, as well as community resources to support breastfeeding families.
  • Childbirth After Cesarean: Making Informed Decisions — With about 1/3 of West Michigan moms delivering their babies via cesarean, many are faced with limited future childbearing options. This class seeks to inform and empower families before and during pregnancy to make the best decisions for themselves and their families.
  • Introduction to Birth Work: Doulas & Childbirth Educators — This class explains possible career paths for doulas and childbirth educators, what they do and how they positively impact birth outcomes. The presentation concludes with a sample childbirth education class.

You can find out about upcoming classes on my calendar or under “events” on Birth Quest’s Facebook page.

Classes can be tailored to suit the needs of any setting or population, like youth, maternal and infant health professionals, homeless shelters, or places of worship. Presentations can also be developed to cover other specific topics, like pregnancy complications, anger management during pregnancy, substance abuse prevention or parenting. What topics would you like to see Birth Quest offer?

Childbirth After Cesarean: Lakeshore Women Have Options

From module 12 of the VBAC Education Project (VEP).

From module 12 of the VBAC Education Project (VEP).

Women in Muskegon and elsewhere along the West Michigan lakeshore have several options for childbirth after cesarean. What are some of these options?

Repeat Cesarean

The majority of women in Muskegon County who have a prior cesarean have a repeat cesarean section (RCS). This may be because they decide this is the safest option for them based on their medical history, while others prefer the certainty and convenience of scheduling their birth. Other times, women don’t realize that they have other options or don’t have the support to access them.

Vaginal Birth After Cesarean (VBAC)

I’ve heard Muskegon birthing people being prepped for surgery be told that they can deliver vaginally in the future, but that they would have to go to a Grand Rapids hospital. That’s only part of the story. While currently, all three of the hospitals in Grand Rapids, Spectrum Health Butterworth, Metro and Mercy Health St. Mary’s, offer VBAC, distance makes this option a challenge for many people. Holland Hospital also offers VBAC as an option.  Others are intimidated by the prospect of receiving prenatal care and delivering with a large practice and facility, which feels impersonal compared to the care they are accustomed to in their community. Despite the challenges, some Muskegon people will travel out-of-county for their VBAC.

Another option that appeals to some families is to deliver in a community hospital that has a VBAC ban, or policies that discourage VBAC, but is known to have supportive providers. Dr. Michele and her colleagues at Spectrum Health Gerber Memorial have an excellent reputation for supporting those who choose to have a VBAC. Others receive their prenatal care locally, put off scheduling a RCS or do not show to appointments, with the plan to show up in labor at their local hospital. Local community hospitals include Mercy Health Hackley in Muskegon and North Ottawa Community Hospital (NOCH) in Grand Haven. I have heard of people having VBACs at Hackley, despite the ban, but not at NOCH.

Free-standing birth centers are an option for women who want to deliver with a midwife in a home-like atmosphere outside of, but close to, a hospital. There is some evidence that choosing midwifery care through a free-standing birth center increases VBAC success rates. Simply Born Birth House is the only free-standing birth center in West Michigan. Sara Badger, a Certified Professional Midwife (CPM) is the provider there. Birth centers have criteria they use to screen women to see if they are good candidates for this type of care. If this is something you are considering, I recommend scheduling a consultation before pregnancy to learn more.

The final option is to plan a home birth after cesarean, or HBAC. In the event of a rare complication, like a uterine rupture, this may not be the safest option, but some people are willing to take the risk to birth on their terms, in the privacy of their own home, with a provider who believes in their body’s ability to birth. As with birth centers, home birth midwives have criteria for screening clients who are candidates for HBAC. You may have to interview several in order to find the right one for you.

As with any birth, there are many decisions to be made. Since providers vary a great deal in their support of VBAC, it isn’t a bad idea to do some research prior to your next pregnancy. A provider may also have good advice to increase your chance of having a successful VBAC, like the amount of time to wait between pregnancies and how to optimize your health.

While those in Muskegon and along the lakeshore may not have all of the options available to birthing people in large, metropolitan areas, they do have possibilities. Knowing what those are is the first step to choosing the course of care best for you and your family.

Honoring Women’s Childbirth Choices

freedom

I’d like to honor women who make childbirth choices that make them vulnerable to judgment in their social circles, like planning a repeat cesarean or a home birth.  While no one is obligated to defend any of their family’s personal healthcare decisions, I’d like to open the conversation about the complexity and diversity of individual situations that create the context for such an important decision as how to give birth to one’s child.

1.)           Support: While it may be easy for an outsider to say, “Screw your family member or provider,” most people rely on support within their relationships long after the birth of their children.  For some women, it may be worth it to avoid conflict around their birth decisions knowing that they will not have to heal wounds in the future.  Relationships are complicated and based on a history that predates this event.

2.)           Timing: Babies arrive on their own schedule, paving the way for the unpredictability of parenthood.  Unfortunately, modern life is not always so flexible and accommodating.  Wanting to schedule the birth of a child around the availability of the one person you cannot imagine not having by your side at the moment of birth or in the weeks to follow is rational.

3.)           Tradition: Some choices are normalized in a family.  Other times, we seek to not fall into the footsteps of our foremothers.  Carrying on or rebelling against a historical family pattern are both common and natural reactions.

4.)           Economics: What a family can afford is often the driving factor behind their reproductive decisions.  When the top choice is not feasible, compromises are inevitable.

5.)           Experiences: Our individual experiences with birth are unique.  Negative past memories, whether personally or vicariously lived, sometimes impact us more than facts.

6.)           Values: What each parent holds dear will influence their decisions around birth.  Filtering our options through our values helps us move from knee-jerk to more conscious decision-making.

From the outside, someone’s choices may seem completely irrational or even self destructive, but under the surface lays the foundation for their actions.  For example, many people will judge someone who chooses to stay in an abusive relationship without trusting them to best know how to stay safe in the face of adversity. Imposing strong opinions or even facts that dispute another’s choices does not honor our diversity. Instead, we can strive for confidence in our own decisions while respecting the choices of others.

Have you every felt frustrated by the choices or judgement of others?  What helped you reach a greater understanding?