Most Birth Quest clients deliver at Hackley, Gerber, Spectrum Health Butterworth, or home.
Here at Birth Quest, a lot of people ask Beth and I where we most often support birthing clients for their deliveries! Here is the answer with some reflections on each from a doula’s perspective:
1.) Mercy Health Hackley: Over 1/3 of our birth doula work is at Hackley. Beth and I were both born at Hackley and we both live less than a mile from the hospital, so this shouldn’t be a surprise. It also makes sense because we strive to serve our community and this is our community hospital! Being located near downtown Muskegon means there are some good food options, like Ryke’s Bakery, near-by. Design aspects we like about the hospital include having separate bathrooms in the hallway for visitors, a waiting room with an ice machine and being able to enter and leave the floor without having to pass through a security door. We’re not crazy about the separate Labor, Delivery & Recovery and Postpartum floors. Hackley is the only hospital on the lakeshore where midwives still deliver and I like how the nurses treat me like an equal. We’re curious to see the new labor and delivery unit that opens in summer of 2019.
2.) Spectrum Health Gerber Memorial: Many of our lakeshore clients travel to Fremont to have their babies at Gerber because of their reputation for supporting natural and patient-centered births. This support is backed up by Certified Nurse Midwives and their Perinatal Nurse Educator and blogger, Samantha Kauffman, who is both Hypnobirthing and Evidence Based Birth certified! Their Director of Clinical Nursing, Beth Coulier, and I worked together on the FIMR Case Review Team when I worked for Public Health – Muskegon County. She brings a lot of experience and compassion to Gerber and this is reflected in the quality of care her staff provides. Gerber gained a national reputation under the leadership of Dr. Tami Michele, who was innovative in overcoming an official ban in order to support trial of labor after cesarean (ToLAC) and vaginal birth after cesarean (VBAC). Dr. Michele currently works at the Butterworth campus. We like that birthing people can labor, deliver, and recover postpartum all on the same floor. Negatives include being located in a small town with few food options, especially late at night, having to be buzzed in and out of the unit by staff and not having visitor bathrooms on the unit. Although the staff are accommodating, it would be nice to have coffee, ice water and a fridge available without having to ask. You know, like a doula station? A doula can dream!
3.) Spectrum Health Butterworth: Although I would love to assist someone in the Natural Birthing Suites, we have not yet had the opportunity. When women we serve plan to deliver at Butterworth, it’s usually because they are high risk or planning a VBAC, making them ineligible for this option. In these circumstances, all of West Michigan is fortunate to have access to the state-of-the-art care provided there. There are pluses and minuses to being in such a large hospital. On the one hand, most of my clients have no idea who is going to be there when they deliver with a practice. On the other hand, when a woman’s care is transferred, there is a good chance that the care she seeks is available. Some of my favorite birth memories as a doula at Butterworth involve supporting women who want to do something that is met with staff discomfort and do it anyway!
4.) Home: There is nothing like the flexibility and comfort of home, even someone else’s home! Whether small or large, the gathering is always intimate, peaceful and festive. When present, I love spending time with other family members, friends and pets. There is never a struggle to support a natural birth plan, especially when it pertains to newborn interventions, at a home. Cost is the biggest barrier to home birth for those who desire it and fit the criteria. I also hope for a future with more diversity among midwives, to help increase access for all women.
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.
For information about resources in the area or to inquire about our services, please contact us.
From: My Philosophy on Birth, revised
Birth is amazing.
Birth is beautiful.
Birth is a journey.
Birth is unpredictable.
Birth is challenging.
Birth is unfair.
Birth is a miracle.
Birth is magical.
Birth is spiritual.
Birth is a rite of passage.
Birth is the only way.
Birth is inevitable.
— From a brainstorming exercise for my Birth Arts International (BAI) certification, “What is Birth?”
A couple of years back, I wrote a blog based on a question that often comes up in interviews, probably because some doula organizations include it in their list of questions to ask potential doulas: what is your philosophy on pregnancy and birth? What I wrote instead was my approach to my profession: evidence-based, trauma-informed and prevention focused. While I still hold to these practices, I think holistic, individualized care best defines my current practice.
When I was first asked this question, I felt like I knew the correct answer, which would be something like, “Pregnancy and childbirth are normal, healthy processes that are best left untampered with so nature can do its job.” The problem is, that’s not necessarily what I believe. In another blog, I addressed how the concept of “natural childbirth” isn’t inclusive enough to take into account couples for whom childbirth is a very technological process. Birth and pregnancy are only natural processes when circumstances and preferences allow.
After having supported a couple dozen families through birth, I feel like I have more of a grasp on what my philosophy actually is. Like my partner, Beth Singleton, who shares her approach to childbirth in another blog, I think the needs of the birthing person are paramount! I also think that my role is finding ways to balance their needs with the sometimes opposing needs of their support team, healthcare providers, partner and family.
As an advocate for reproductive justice, I identify as a full-spectrum doula, meaning I am here to support the pregnant person or parent as they make their choices, within the context of their sometimes complicated lives, regardless of the outcome. As I’ve written before, one’s reproductive decisions are impacted by many factors. There is no one right answer, but the best answer for that individual, at that time, in that situation.
There is a myth that doulas take the place of or override the needs of partners. Oftentimes, it is the partner or a family member who pays my fee. Regardless, the primary client is the pregnant person. When there is conflict, such as with the choice of a birthplace, it is still important to listen to all sides. Opinions that are in opposition to the desires of the birthing person are still valid and must be met with compassion and understanding. The process by which families overcome conflict around birth ideally strengthens them for the challenges of childrearing that lie ahead.
Which brings me to the choice of “Birth Quest” as my business name. Pregnancy, birth and parenting are unpredictable events. They force us to challenge our deeply held beliefs, our concepts of who we are and our purpose in life. Good support helps us to emerge stronger, more convicted and well-prepared for the lifelong journey of parenting and beyond. We are the heroes and heroines of our own stories that become woven into the foundations of the families we are creating.
I came into birth work with a good deal of dogma. Growing as a doula has been the process of shedding that in exchange for an openness and sense of wonder. Yes, doulas impact outcomes. This is a fact supported by research. I try to keep good track of the outcomes in my practice to see where I can improve my services to better support the needs of clients. My role is not to control variables, though, but to provide information and support along the journey.
Having a midwife attend your labor and birth increases the chance of having your baby naturally and without drugs!
In a prior blog, I wrote about how North Ottawa Community Hospital (NOCH) closed their midwifery practice in 2014. At that time, I contacted both federally qualified health centers (FQHCs) in Muskegon to ask them if they would be willing to have me interview them to help spread the word to expectant women in the area about their remaining options. Hackley Community Care (HCC) got back with me and we were able to videotape an interview with their collaborating physician, Dr. Danielle Koestner.
I have been at several births with the HCC midwives and have always been impressed by the way they respected and supported the wishes of my clients. The good relationship we had benefited our mutual clients because we were able to communicate concerns to better coordinate care.
When I learned that the HCC midwives were going to stop catching babies, my initial response was, “Not again!” Like others, I am still upset about losing the option of midwife-attended deliveries at NOCH. Still, I wanted to wait and find out more information. Earlier this week, I received the official letter from HCC, stating that the midwives were going to continue to provide pre- and post-natal care and that they were officially certified as a Centering Pregnancy site. Now, however, the obstetric laborist and residents at Mercy Health Hackley would be in charge of their pregnant patients’ labor and deliveries.
The laborist comes with a wealth of knowledge and experience. While many women include avoiding residents in their birth plans, I have found them to be on top of the latest research, open to patient preferences and supportive of evidence-based care. For some women, this will be an acceptable option. During their prenatal care, they will benefit from an evidence-based group prenatal care model, the individualized care characteristic of midwives and access to a host of other services offered on-site. However, for women specifically looking to benefit from the better outcomes research shows continuous care from a midwife during labor and delivery offers, this change will be unacceptable. The research shows that interventions are lower and outcomes improve when midwives provide care throughout the pregnancy, labor and delivery.
For women who seek a midwife to provide their prenatal care and attend their birth, Muskegon Family Care (MFC), Muskegon’s other FQHC with a midwifery program, recently hired new midwives and are now fully staffed. In July, I had the pleasure of meeting with one of them, Katie Van Heck, CNM, to discuss how to improve their services by increasing their patients’ access to doulas. I now have a couple of clients who are seeing the midwives there for care and I am excited to work more with this practice in the future!
If you live along the West Michigan lakeshore and you wish to deliver in a hospital, with a Certified Nurse Midwife (CNM), the only midwives who can practice in Michigan hospitals at this time, these are some of your remaining options:
- Muskegon Family Care – With three midwives on staff, this practice is located in a federally qualified health center in Muskegon Heights. This means they primarily serve low-income people, but they can serve anyone.
- Midwifery Services at Advanced Women’s Ob/Gyn – If Muskegon-area women are willing to travel to Spectrum Health Butterworth in Grand Rapids to deliver, this private midwifery practice has an 6% c-section rate, which speaks for itself.
What will be the next news for midwifery options along the lakeshore? Hopefully, something positive, like a new private practice or free-standing birth center opening up!
Did you have your baby with a midwife in a hospital? Please share your experiences in the comments!
Sandall, Jane, et al. “Midwife‐led continuity models versus other models of care for childbearing women.” The Cochrane Library (2016).
There is a general understanding that the term “natural birth” means unmedicated childbirth with minimal medical interventions. For the purposes of communicating with like-minded folks about our birth plans and experiences, “natural birth” works pretty well. While I have supported women with no interest in natural birth, most clients seeking doula services are in search of support that will help them achieve a more natural pregnancy and birth.
Despite its convenience and universality as a term, I still have problems with some of the underlying assumptions of natural birth. There is so much about modern lifestyles that veers from what is natural that in order to achieve health, some unnatural habits are often used, such as supplements. Even when natural components are used, there is nothing natural about nutrition in the form of a pill. Perhaps if I were running around nude in the tropics, I wouldn’t need to tan or take a vitamin D pill. During long Michigan winters, however, I need to compensate for what I lose by living in an inhospitable climate.
Family planning is another unnatural choice for most modern families. While I don’t judge women who spend their fertile years pregnant or breastfeeding, I am grateful for the wisdom and technology of all the forms of family planning I have used over the years to control my fertility and limit my family size. Supplements and family planning are just two examples of how modern life leads me to make choices that are not natural.
I question the idea that to live naturally, one must reproduce and have children. Many people struggle, even today, with societal pressure to pair up, settle down and start a family. Those who choose not to parent often are made to feel like they have missed a rung on the ladder toward emotional maturity. This is ironic to me, as my childless friends have been one of my biggest sources of knowledge, inspiration and resources to me as a parent!
Even for those who do choose to reproduce, not everyone is able to achieve pregnancy through natural means. I think anyone who has ever been through the grueling process of in vitro fertilization would agree that there is nothing natural about it! Turkey basters have helped many lesbian, gay and single people become parents. From the beginning, some families need a little creative assistance.
So, while I am passionate about natural birth for myself personally, it is not something I promote. I’m uncomfortable generalizing about birth in a way that could exclude so many diverse families in my community. If you sense this discomfort, please know that it isn’t due to a lack of support for what is natural, but out of a desire to celebrate all families.