Saturday, December 6, 2008

Baby Catcher

A friend of mine loaned me her copy of Peggy Vincent's book, Baby Catcher, last week and I read the whole thing in two days. It is so good!

One of the things I enjoyed most was how the reader can feel time passing throughout the narrative, simply by the types of clients that the midwife encounters. The stories in the beginning include hospital births, a nurse instructor with a bouffant hairdo, and married couples in Lamaze classes. Then the stories phase to hippie couples, lay midwives, Birkenstocks, and Leboyer baths. Then there are home births, midwifery school, Christian Scientists, and a psychic institute. And towards the end, lawsuits, soccer moms, and a young Muslim couple. You can really feel the culture of each of the decades in the details of Peggy Vincent's stories and I found that very engaging.

The other changes that she describes in the stories are those concerning the practice of midwifery in the United States - from the lay midwives practicing without licenses, to alternative birth centers within hospitals, to licensed midwives who were fully insured, and midwives working in the hospital culture of birth efficiency...

Peggy Vincent also shares a few very moving stories about her personal pregnancy experiences, including a difficult delivery and the conception of a Spirit Baby, as her son called it. All of the birth stories are very interesting and they cover a variety of people - different ages, ethnicities, and creeds. A few of the stories might be a little much for people who aren't involved in the birth culture or who don't enjoy pregnancy stories, but all of them have happy endings. :)

Wednesday, December 3, 2008

Experiencing a Spiritual Cesarean

Tonight I attended a two-hour workshop led by Lanell Coultas on the topic of c-sections. She is an excellent teacher and she could really teach a 6-week course on this topic. But we didn't have that much time, so we spent most of the session role-playing and walking through what the mom and dad and baby might encounter during a c-section and how the doula could best support them.

A few people shared stories and Lanell offered suggestions. More than any of her suggestions, though, I am always most impressed by how Lanell remains so calm and sensitive and genuine. She empathizes so deeply and seems to get to the root of issues in a way that makes me want to sit at her feet and soak up all of her knowledge and wonderfulness. :)

So, don't get caught up in the to do's or not to do's and definitely don't take them as rules, but consider some of these ideas that Lanell offered:

- Don't avoid talking about cesarean birth with your client. Sometimes doulas and other fans of natural birth methods act like they might jinx a birth by even mentioning a c-section. But by neglecting to talk about the possibility or to consider how you might respond in such a situation, you do your client a great disservice. It is a good idea to let her know that a c-section is always a (distant) possibility and it might be a good idea to bring a CD to listen to in the operating room or comfy socks, in the event that she has to walk from L&D to the operating room. It doesn't mean she needs to spend time worrying about a c-section. But she can be a little more prepared, just in case.

- If your client is having a planned cesarean, encourage her and her partner to establish a common vision that they can reflect on during the moments throughout the birth when they are separated. This might include when the mom is getting her spinal anesthesia or when the dad goes to the nursery with the baby. If the mom and dad are sharing a common thought about their home or their baby or their dreams, they can feel connected despite the temporary physical separation. This is also a great way to help them go inward, and not get distracted by all the noise and hustle and bustle of the operating room.

- When the anesthesiologist gives the mom the bolus, she might shiver or shake quite a bit. You can support her by gently and firmly holding the pressure points in the arches of her feet. This can help her to feel grounded and should help relieve a little bit of the shaking.

- Slow down. Help the mom to focus on her vision, her dream, and not get flustered by all of the adrenaline in the room.

- If she is concerned about the c-section being anti-climactic compared to labor and vaginal delivery, give the mom some ways to experience this as a rite of passage. She can go inward and speak the words her baby needs to hear. She can imagine the surgery that is happening and how her baby is emerging into the world. She can focus on the doctor's hands and pray for him. Lanell told about a client who was meditating to focus all of her love for her baby into the doctor's hands so that the baby could feel his mother's love that first moment when the doctor touched him.

- Suggest that the dad take lots of pictures so that the mother can fill in all the blanks in her birthing experience. He can ask the anesthesiologist to take some pictures of the surgery and of the new family, too. :)

- Tissues with a few drops of essential oils are a good idea for both the dad and the doula. The scent of peppermint or lavender can remind you to slow down and experience the moment and can also combat the unpleasant smell as the doctor cauterizes the mother during surgery.

- Affirm the mother in her pain. Not having seen the procedure, the mother may feel guilty for not being more resilient or for needing pain medication. Remind her that she has just undergone major abdominal surgery and her body has lots of recovering to do. It's okay to use pain medication if she needs it.

In light of my recent thoughts about supporting dads, I also thought Lanell had some particularly good ideas about the dad's role in all of this. She said the dad can assume that his place is always with the baby. If he ever needs to step back, a doctor or nurse will tell him. But he can know that he has a clear and significant role as he accompanies the baby while the mother is stitched up and goes to recovery. Also, it is completely natural that he wants to protect his child and reunite his family. It's okay for him to be like a broken record, asking if he and the baby can see mom yet... When they are all together again, he can tell her about the surgery and about everything that happened in the nursey. His words will contribute significantly to how the mother processes the whole experience.

Anyway, there was so much more, but I don't want to get caught up in little details. Basically, Lanell challenged us to think about the fact that once c-sections become necessary, they really are just that - necessary. Whether it's because of the mother's feelings, the father's thoughts, the doctor's experience, circumstances beyond anyone's control, or whatever, once they have decided on a c-section, it is necessary. Because at that moment, it's the best way. She compared it to this vortex that everything is flying around in, to bring about this one result.
And in the end, a baby will be born. and it is still amazing!

Tuesday, December 2, 2008

Supporting Dads

I just finished reading "The Father's Home Birth Handbook," compiled by Leah Hazard. I found it very easy to read and a manageable length, too. Although it is aimed to answer the questions and concerns of fathers, I am already starting a mental list of women that I'd like to give this book to. The author doesn't assume that the reader knows much about birth and addresses questions that might seem trivial to birth "experts." I think the basic, straightforward content and the question and answer format would be a great way to introduce the concept of home birth to friends of mine who find the idea unusual, dangerous, or extreme.

I think this book does a great job of presenting the benefits of home birth and of comforting the expectant father that a home birth isn't dangerous, without neglecting to address the fact that, if complications do arise, being at home doesn't mean the mother or baby will be harmed. The book includes testimonies from a few dads who had to call ambulances or whose partners were transferred to the hospital, without giving the idea that this is the norm.

The book ends with a quotation from a dad named Geoff, "Be sure to share your story. There is no shortage of fear-mongering and simply unhelpful advice when it comes to birth. As fathers, we need to make birth a part of the masculine dialogue."

This sentiment reminded me of similar statements from
Patrick Houser, who taught a workshop here in Austin last month. Patrick is trying to create more opportunities for fathers to share their stories and to support one another through the life-changing experience of a child's birth. Until I sat through Patrick's workshop, it had never occured to me how redundant a father might feel in the birthing room. He is surrounded by professionals who know what they're doing and a wife who is busy laboring and he may even be in an uncomfortable or unfamiliar hospital environment. He may feel unable to ask his questions and he may not voice his concerns for fear of distressing his wife or unnecessarily alarming the care providers. He may feel unable to protect his wife and saddened to see her in pain. For all of these reasons, it is important for doulas to take time to address the concerns and questions of dads, too. Perhaps there is even a local peer network that the dad can join.

Here are some things that Patrick mentioned:
- warn the dad of the variety of emotions that he may experience - nervousness, jealousy, helplessness, tiredness, joy, pride, etc.
- let the dad ask his questions
- welcome the dad to the experience and especially into the delivery room, do not allow him to feel unwanted or "in the way"
- trust the dad to do tasks and to hold the baby. If he does not feel needed, he may withdraw.
- impress upon the dad how his presence makes a difference
- encourage the dad to have skin to skin contact with the baby and to cuddle the mom and baby during nursing

Having attended births and felt unnecessary, I can imagine a little bit of what it must feel like for a dad to enter the birth environment and feel like a stranger. Hopefully I will be more sensitive to these feelings in the future and will be better able to support dads. I encourage dads to educate themselves and to voice their questions and concerns. And I definitely recommend reading "The Father's Home Birth Handbook," no matter what kind of birth you're planning.

Saturday, October 25, 2008


I just got home from a 13-hour visit to the hospital. My client was induced at 6:00 yesterday morning but wasn't progressing past 4.5 cm by 10:00 at night. So the doctor did a c-section and baby was here before midnight. It was a little emotional for mom because she didn't have a lot of time to adjust to the idea of a surgical birth. But everything went fine and the baby was safe and healthy.

This was another experience where I wasn't sure what my role should be. There were five support people in the room, including me, the laboring mom's mother, and three friends. :) Once the epidural was introduced, my comfort methods weren't necessary. And once the laboring mother was tethered to her bed by a catheter, epidural, blood pressure cuff, internal monitor, and IV, there wasn't much option for moving around. Basically, we all just sat and waited...

We never once glanced at the birth plan. The scheduled induction wasn't ideal was convenient for out-of-town family members... and then the c-section became unavoidable. I wonder how to tell how serious a mom is about her birth plan, in the future. It almost seems like some moms write these lists of birth preferences disconnected from the reality of their situation. It would be nice for me to be able to set my expectations somewhat.

I've also decided I will ask a few more questions when I interview with potential clients in the future. :) Like, "how many support people do you anticipate having in the delivery room with you?" It might help me to gauge what my level of involvement would be...

Wednesday, October 15, 2008

¡Numero Dos!

I attended my second birth as a doula this week. :)

This labor and delivery was different for me than the first one in a few ways. First of all, I was more familiar with the hospital environment. I knew how to read the monitors and I was familiar with more language and standard procedure. I was in a hospital that was unfamiliar to me, but I knew just enough to figure out where things were. I also had a better sense of the sounds and the smells, what an epidural is like, how often the nurse checks blood pressure, why they might use a cathater...

But, even knowing a little bit more than the first time, I wasn't necessarily a lot more comfortable, really, because I didn't feel quite so needed. The first mom I supported didn't have anyone else to share the experience with her. There was always plenty I could say or do to be of help. But this mom had a great support team in her husband and her mother. I tried to make myself helpful by doing little errands and chores, but the laboring mom was getting plenty of encouragement from her family.

Both she and her baby are healthy and happy. It was another great doula experience for me. But it also gave me something to think about, as I continue to try to understand the role of a doula and what I can bring to the birthing room. What can I offer that perhaps family members or friends do not?