Posts Tagged ‘childbirth education’

So It Begins.

Monday, December 22nd, 2014
Image credit: knowyourmidwife.com

Image credit: knowyourmidwife.com

In November, The North American Registry of Midwives accepted my application into the PEP program.

That should really have about eleventy-one exclamation points behind it. After all, it is the ripening of a long-blossoming fruit. The result of  a dream hatched over seven years ago, when my youngest was just a baby. I called the midwife who had walked with me during my last two pregnancies, Merrie, and asked to meet with her in order to discuss becoming a midwife. In her wisdom, I remember that she said to me, “You don’t want to be a midwife,” and proceeded to tell me all the reasons why it was not something to just walk into.

It was at that meeting when I first heard the word, “doula.” A what-a? Her assistant at the time was one, and Merrie encouraged me to meet with her. She assured me that if I could hack it as a doula, then midwifery might become an option later. That is how I was born into the life of a birth professional. I took my training in the fall of 2007, when my youngest was only two months old. A lovely babysitter came with me, and I nursed him through sessions, and she played with him in between. I worked slowly through my training, taking the maximum amount of time CAPPA gave me to finish my certification, but it was worth it.

Through it, I gained experience outside my comfort zones. I learned that I can live on call, and work around my family.

Soon, it wasn’t enough. I wanted to teach. So, I trained through CAPPA (of course), under Desirre Andrews (who was a doula, lactation educator, and a dually-certified childbirth educator at the time), to become a childbirth educator. Teaching has always been at the heart of who I am. I often find myself teaching, even when it isn’t wanted or needed–a character trait I hope is being shaped into a far better tool than it has been in the past. At this point, it became obvious that I needed a place to teach, but not having a regular income, nor a family budget to pay for a place, I sought help from Desirre again. She had a lovely office and classroom space, and was wanting an educator to help her as she began to assist a midwife (the same one mentioned above, in fact). I approached her, and asked that she become my professional mentor, and allow me to work with her to grow, teach, learn, and have space and time to build Birth In Joy into whatever it needed to become.

I haven’t looked back since. It has been a wonderful working relationship, and I have been blessed with a treasured friend whom I feel is my “big sister.” Working with her has challenged my perceptions, my biases, my experience, my emotions, my mind, my heart, and my very character.

Soon, even that was no longer enough for me. I have always taken a light client load, because my family needed me to. So, I knew I wasn’t beginning to burn out. Far from it! My passion and love for this work has only grown, over the years. Thanks mostly to my fabulous, beautiful clients and students, who have shown me quite a cross-section of birthing women and the strength they each have in common. What a world we live in, and what a privilege to have walked with so many through such a sacred, intimate time in their lives!

Desirre declared to me, when she started assisting Merrie, that she only wanted to gain insight and skills she could use as a doula. She wasn’t going to become a midwife.

Ahem.

She is now a Certified Professional Midwife, registered in the state of Colorado. Ahhhh, life. We never really know, do we?

Except that I do know. Midwifery has always been my goal. My dream. What I want to be when I grow up.

So, as soon as Desirre became a preceptor with NARM this past September, I started my paperwork. Phase 1 has been accepted by NARM, and I am working on both Phase 2 and the 43 pages of skills I must master and prove. (No, shaking chicken bones and chanting are not on the skills exam. Just so you know.)

So it begins.

My journey to becoming a midwife. “With woman.”

I didn’t know I was ready until one day, I was.

What is your passion? What dreams are you pursuing?

Grace & Peace,
Tiffany

A Weighty Responsibility

Monday, August 4th, 2014

Image credit: longdrivejourney.com


Finishing up a class is always bittersweet, triggering a time of self-evaluation, reflection, and a desire to do better next time.

Childbirth education is not a job where I can just show up, punch a card, and go home. It is filled with challenges as unique as each student who walks through the door. Each student requires some customization of the curriculum, and will invariably ask a question I don’t know the answer to. There will be rabbit trails every so often, and bringing class back on track in order to cover the essentials adequately is critical. It is also just as critical to know when it is time to abandon a few of my slides in order to acknowledge and travel down a rabbit trail with purpose.

It requires constant research, reading, and learning on my part. I cannot recycle the same information over and over, and expect to meet the needs of an ever-changing population. Every class series I teach, while built upon the same foundation, will be a little bit different.

As I work toward finishing my re-certification process as a CAPPA Certified Childbirth Educator, I am overwhelmed at the amount of new information permeating the atmosphere surrounding the perinatal year! I am required to choose and read ten complete studies relating to my field that were published in the last five years. I thought it would be a challenge to find new research. I was wrong. The information is out there. It is accessible, if you know where to look, and I am astonished and excited at how much I still have to learn!

I am so glad I chose to certify with an organization that has such rigorous standards for its members. If it weren’t for the constant challenge of re-certification, I think it would be too easy to fall into a rut and stay there, becoming more and more irrelevant in the community. More and more useless in effectively navigating the changing state of childbirth in this country.

When I am up front teaching, I am viewed as an expert, and even an authority on childbirth. Shame on me if I fail to strive to live up to such labels by maintaining a steadfast continuing education. While I know I can never impart everything I know to every student who walks into my classroom, it does not excuse a lack of evidence-based, current knowledge driving and directing my passion. All the passion in the world means nothing if it isn’t paired with a working knowledge of current evidence, applied realistically, and presented in a way that is easy for students to integrate into their own real-world experience.

A discerning childbirth educator changes with the times. Changes with each new group of students who choose their class. Incorporates new information into curriculum as quickly and accurately as possible, enabling students to apply the new knowledge to their own circumstances and worldviews. A wise childbirth educator strives to get a little better each day, understanding that people are making decisions based (at least in part) on what they have said in class.

It is a weighty responsibility.

And I love it.

How do you continue to learn, grown, and change in your own work? What drives you to keep reaching for the next step?

Grace & Peace,
Tiffany

Childbirth Education Myths 1

Monday, January 27th, 2014

Over the next several weeks, Team Preparing for Birth will be debunking some common myths surrounding childbirth education classes. Check back every Monday to see the newest post.

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MYTH #1: “I’m having a homebirth, and my midwife will do all my education.”

Home birth families often see childbirth classes as an extra, rather than a valuable and necessary tool to help them have the birth they are hoping for. The most common objection they have is that they will be able to get all the education they need from their midwife. While midwives do educate their clients to some extent, this perception that they can (or should) cover everything is a myth, for several reasons.

1) Education is not a midwife’s job.

Just as obstetricians are not childbirth educators, neither are midwives. Just because midwives are more likely to do more education than an obstetrician, does not mean they give comprehensive education, and they should not be expected to. That is not their job.

Rather, a midwife’s primary job is to maintain the clinical safety and health of the mother-baby dyad. This will involve some education, yes, but only as a by-product of good midwifery care.

A good midwife will encourage her clients to be active participants in their care by reading, taking classes, and educating themselves proactively, instead of passively relying on the lack of intervention common to home birth. Midwives want clients who are thinking women, who take responsibility for their own care, and who can integrate what they learn in practical ways.

 

2) The reality of transport.

Another downside to relying solely on your midwife for childbirth education is the preparation for hospital transport. Realistically, around 10% of women and babies need something that cannot be offered at a homebirth, for whatever reason. It is not a midwife’s job to prepare you for the hospital.  Her job is to prepare you for birthing safely at home. Therefore, an expert on the hospital system is needed to prepare a birthing woman, in case of a transport. Most midwives spend very little time in the hospital, due to the low transport rate, so their expertise on local practices may be limited.

On the other hand, childbirth educators work very hard to stay up-to-date on all policy changes, protocols, and the general attitude of the staff in local hospitals. They often work (or have worked) as doulas, and have regular opportunities to interact with staff in the local hospitals that midwives simply don’t have. (This is not a criticism, merely a reality.)

While a midwife can go over what a typical transport looks like in her practice, a good childbirth education class will be able to prepare the client for what a hospital birth will look like. She can help the client to understand how to navigate the environment, and teach her how to communicate with the staff effectively.

 

3) The birth tool belt.

Midwives know that most women need a wide array of pain management techniques available to them, since an epidural is not an option at home. While a midwife will teach her clients the importance of stress management, emotional health, and relaxation, there is no substitute for a good independent childbirth course where you can actually practice tried and true techniques from all kinds of sources. This creates a solid foundation of knowledge, provides varying perspectives, and allows the birthing pair time and space to learn or review valuable tools for labor.

 

4) Prenatal appointments can only cover so much.

Even though midwifery appointments are much longer than typical obstetric appointments, it is still a very limited amount of time for a woman to learn all she needs to know about birth. Not to mention the birth partner, who may not be able to attend very many of the appointments. Childbirth education can fill in the gaps, empower a birthing pair, and provide opportunity to practice valid techniques in a real-world environment.

It is never wise to assume that your care provider will simply take care of everything, no matter who they are. Leaving the decision-making and responsibility solely in your midwife’s hands is not fair to her, to you, or to your baby. You owe it to yourself to take a proactive approach to childbirth education.

 

What You Need to Know About Birth Plans

Friday, September 27th, 2013

As a doula, I require all of my clients to put together a birth plan, discuss it with their care provider, and to provide me a hard copy. I make very few exceptions to this requirement. I believe firmly that a birth plan is a critical piece of the puzzle in good perinatal care.

As much as we want to believe that our prenatal care is individualized, it often is not. Even home birth midwives can get into a “this is how I always do it” habit, though that is far less likely. Still – I have learned to never take anything for granted when it comes to care providers.

I spend a good amount of time with each client in helping them form their own unique birth plan, and provide them with role-playing opportunities that teach them how to have open, honest, and clinical discussions with their provider about their individual needs. If I am hired late into the third trimester, that is almost all I end up doing prenatally – birth plan work.

It’s that important.

That said, I don’t particularly care for the term “Birth Plan,” and I use it only because that’s the common vernacular. I think the word “Plan” conjures up images of precise blueprints and/or legally binding documents. A birth plan is neither of those things, and the sooner we understand that, the better.

Instead, I believe that birth plans are tools designed to help you, your care provider, and any staff you encounter to communicate effectively about your individual needs and expectations regarding your care.

It provides a basic framework that helps your care provider and staff to better care for you, but it does not legally bind them to your every whim and wish.

Instead, a birth plan gives you and your care provider an opportunity to pursue individualized care together, and to be on the same page before you go into labor. It has the potential to build rapport, trust, and respect between you and your provider–a critical factor in enjoying a positive, healthy birth experience, no matter what the circumstances end up being.

For this reason, I really prefer the term “Birth Preferences,” “Birth Goals,” or even “Birth Desires.” Those make a lot more sense to me. When a birth plan is viewed this way, it is often much easier to mentally and emotionally process anything that derails those plans.

Birth is still unpredictable, and there are no guarantees, no matter how safe we have made it. The reality is that birth is like any major event we plan: There will always be at least one thing that does not go the way we expect it to, for good or ill.

Mommas get sick. Babies get sick. Babies get into funky positions. Mommas get exhausted. Heart rates get wonky. Side effects of drugs happen. Things stretch on longer than we thought, or go far faster than we anticipated.

Stuff happens.

Overall, birth is a safe and healthy process, but it has a lot of variables within a very wide range of Normal. Accepting that fact, and writing a birth plan with flexibility in mind is key to processing those funky things that happen during our births.

I find that the most flexibly written birth plans get the most respect from staff. They see clearly that my client has done her research, and has realistic expectations. Frankly, I find that my clients are more likely to get exactly what they want when their language is open and flexible.

I also find that when things get weird in a birth, staff and providers tend to bend over backwards to keep the spirit of the plan intact. They seem to view themselves as being on my client’s side, and try very hard to make it work within the parameters this particular labor has laid out for them.

My clients come out of these births processing all of it in a very healthy way. They understand that they don’t have to like what happened, but if they felt respected, understood, and as though their choices mattered, they are often okay in the long run. They understand that it’s okay not to be okay for awhile. They grieve the stuff they didn’t like, but are grateful for the support and good care they received within the circumstances their birth chose for them.

Care they might not have received had they not communicated clearly what they hoped for, ahead of time, via their birth plan.

So, when writing your birth plan, be careful about the language you use. Really examine how it comes across, and how you view your relationship with your care provider. Some basic tips:

  • Open with a sentence like: “We understand that circumstances may arise that preclude the following desires, but we expect to be fully informed before consenting to any procedure that may be proposed, and we appreciate your help in achieving a healthy and pleasant birth.” This lets them know you understand that birth has a lot of variables, and that you are willing to work with the staff.
  • Have a short introductory sentence or two explaining your overall desires. (Natural birth? Well-timed epidural?) The staff will automatically know what requests will go along with that, and you can eliminate a lot of specifics. For example: If you know you want an unmedicated birth, and state that fact right away, you won’t have to tell them you’ll want to move around, have dim lighting, etc…
  • Keep it simple. It shouldn’t be more than one page long.
  • Use bullet points and clinical language.
  • Tailor it to your provider’s practices, as well as the protocols at your place of birth. If you know they do rooming-in, you don’t need to request it.
  • Do your research. Take an independent childbirth class. Hire a doula.
  • Take your first draft to your provider and ask specific questions. “Under what circumstances might you do an episiotomy?” This helps you know if something needs to be added or taken off the plan.
  • Have a cesarean plan. Look up “Family-Centered Cesarean,” and choose your top 3-5 items you think might be important, and add those.

Be decisive and clear in your desires, but remember to stay open as well. Choose carefully your hills to die on, and let everything else go if it becomes necessary. Ask questions. Even if all you can think is to keep asking “Why?” That one word can gain you a lot more information when a decision becomes critical. Open your eyes, and walk forward confident in your desires, your ability to birth, and your ability to make good decisions for you and your baby.

You are already a good mother. Go for it.

I could write mountains of information on this subject, but this post would get too long. Did you write a birth plan? Why or why not? Do you feel your desires were respected? Do you feel it created a sense of cooperation with the staff who cared for you? Why or why not?

Grace & Peace,
Tiffany

New Happenings!

Tuesday, June 12th, 2012

Image from: homeandgardenideas.com

My business is beginning to thrust up little green shoots of growth, and I am deliciously excited with the doors that are opening for me in this privileged line of work! My responsibilities in my work grow, and I find myself considering each and every commitment in my life, my list of priorities, and my dreams as a birth professional in a new light as I experience growth and learning through change.

It seems to be a bit of a bumpy ride, but like birth, it will all be worth it in the end! The hard work, prayer, and rearranging I am committed to in order to keep growing is a lot to digest, and is a little bittersweet. It means that my life will not be the same. That’s great though – it was time for a change!

This summer will be a time of transition for me, as I begin to phase out a lot of personal outside commitments, and focus on more family and birth work commitments. By the fall, there will be a lot more birth work, if all things go as planned, and I am working hard to make small, daily changes to give my work a greater chance to thrive.

I cannot do otherwise. Every time I turn around, I’m receiving “random” confirmation from the God I serve that “this is the way, walk in it.” It’s exciting and scary and new and so very, very right.

One of the changes I am implementing is committing to real-live, genuine office hours as a part of Preparing For Birth! They are short, but they will be expanded come fall. These hours will allow me to keep my word to a few friends who need me over the summer, but still initiate the growth in birth work that is on the horizon.

I will be in the office from 1:00pm to 5:00pm every single Tuesday. I will reserve the mornings for home visits and postpartum work, while the afternoons will be open to interviews and prenatal office visits. It’s also a time that anyone who would like to can stop by, borrow a book, ask a question, pick up supplies, register for classes, etc… Preparing for Birth is growing, and I get to be in on it!

Another change is that, in addition to being a private practice doula, and a contracted educator, I will also be offering my doula services under contract with Preparing for Birth. There will be benefits to my clients whether I am hired under the Birth In Joy name or the Preparing for Birth name – I feel strongly that this will be the best way for me to give greater access to my services to a wider range of women and their families.

Also, I will become the official “librarian” for Preparing for Birth. Over the next few weeks, I will be collecting and cataloging all the books we have at our disposal, and implementing an easy system for our clients and students to check out books and videos. To be honest, this sounds fun to me. My natural bookworm tendencies has me excited about this!

As I sit in the office, typing this post, I smile. I know that there are challenges coming up, and there will be some inner conflict as I work to change some deeply ingrained habits, but I know that I am strong to meet them, by the grace of God. I’m sure that there will be a few stumbles as I unlearn a lot of things, and open my heart and mind up to learning new things, but I am also sure that I am not alone. I have an incredible community of support, and I am truly as excited and happy as I am nervous about it all.

I cannot wait to see those small green shoots grow into lovely shade trees – perhaps kind of willowy – stable and richly green in season. I am willing to work and wait, water and weed, protect and persevere to see it all come to fruition. To rely on the grace and wisdom of Jesus as I walk.

I can do this.

I was made for it.

Grace & Peace,
Doula Tiff

Intangible Reasons

Tuesday, May 29th, 2012

Image from imdb.com

My husband and I watched “Away We Go” last night. It’s a movie about a pregnant couple’s quest to find the place where they want to give birth and raise their baby. Along the way, they meet up with a lot of old connections to try and get a feel for where they belong. During the obligatory “hippie-tandem-nursing-birkenstock-wearing-freaks” scene, one line really stood out to me, and bothered me.

As filled as the scene was with exaggerated stereotypes, it wasn’t those that bothered me, because all of the families in the movie were portrayed in a way that was a bit over the top. (Except the infertile couple – THAT was one of the best movie scenes I have ever witnessed. Ever.)

John Krasinki’s character explains why he and his girlfriend don’t need a doula. He says something along the lines of “Doulas are for women who are clueless, or have a partner who doesn’t want to be involved, and since I am involved and educated, we don’t need one.”

While he is right in the fact that a doula can be a great asset to a couple who are “clueless,” the quote illustrates the common misconception that doulas replace fathers in the birth room. That if the father is involved and supportive, a doula is just an extra. It’s simply not so.

For one thing, “clueless” clients have more potential to drive a doula crazy! We try to teach our clients to take responsibility for their own births, and encourage them to educate themselves as much as possible about everything relevant to their situation. Some do, and some don’t. The hardest births to be on as a doula are ones in which a mother has not educated herself much at all, and has unrealistic expectations of both birth and her doula. That is a problem that is usually easily remedied. However, not really the point of this post.

Moving on. Sorry to slow you down.

The truth is that men in the labor room is a recent phenomenon. For eons, it’s been women’s work. Birth is what women do. And we do it well. We did not “need” our men in the birthing room – we could handle it pretty well, thankyouverymuch.

However, we began to want our men in the birth room, and welcomed them. Super-cool! We felt it only made sense for the one who helped create this child, be there to help bring him into the world. And we were right. Men should have the chance to see the women in their lives be so strong.

We then threw the baby out with the bathwater, and banished everyone else in favor of the men in our lives.

No one – and I mean no one – can replace the father, husband, lover in the labor room. However, neither can the father bring the shared connection all women have. They can’t bring the “girl power” women thrive on when they are laboring.

Birthing women need both.

For example, I had both my husband and my mother at all of my births (this was before I’d ever heard the word “doula” – my mom essentially filled that role). I could not have done what I did with either of them missing. It is hard to explain tangibly the reasons that this is so.

When I tried to explain it to my husband, I told him that when Mom said I could do it, she was the one I believed.

It’s not that I didn’t believe anyone else, it’s just that it was her energy, faith, and connection to me that helped me put feet to my own belief in my ability to birth. I believed my husband when he said he believed in me, and I appreciated his confidence, but when my mom looked me in the eye and said “You can do this,” something inside me responded, and I could not doubt that she was right.

That is why even the most educated, proactive, emotionally-healthy, bonded couple can benefit from having a doula – and I would even venture to say, needs a doula.

I hear it all the time from my clients: that they just believe me when I tell them they can carry on. They tell me that they love and appreciate the safety and security of their partner’s presence; the love that radiates from his eyes when he holds her hand or brings her water gives her a comfort that cannot be matched. She blossoms under such romance (which is exactly what it is).

But when the doula speaks, moms listen, and their faith in their own ability to birth is given wings.

The truth is this: She cannot do as well as she wants to do without either.

Nearly every client tells me, “I couldn’t have done it without you!” then immediately turns to her partner, “But I couldn’t have done it without you either!” Both statements are as true as true can be. I feel the same way about my mom and my husband.

Of course, there will be exceptions to this, and only you can decide if you are one of them. There are also many situations in which a mother doesn’t have a partner at all, or her situation varies from the norm in some other way. Her need for a doula who will walk alongside her, hold her hand, and support her unconditionally is even greater! I have supported several such women, and stepping into what is essentially a dual role is tough. I could never do that for all births!

My point is that just because factors, A, B, and C all line up for you does not mean that you don’t “need” a doula. Sometimes, it’s the most educated clients that need me the most when push comes to shove. (No pun intended.)

Never say never. Talk to doulas in your area, gauge your needs well, and make the right decision for you and your family. Don’t let anyone – especially a care provider or Hollywood – tell you that you don’t “need” anything when it comes to your birth. Only you can decide that. And take what the media says with an extra-large grain of salt.

Grace & Peace,
Tiffany

Do Moms Planning an Epidural Need a Doula?

Friday, May 25th, 2012

This question was posed on her facebook wall by my mentor, Desirre Andrews. I appreciate the thought that her questions provoke, and the way she challenges me to dig a little deeper and search out what my answer would be to this question.

I think, overall, there is an assumption in our country that an epidural is a panacea. The concept of labor with an epidural on board is one of passivity and a desire for separation from the experience because of fears about the process of labor. Whether those fears are well-founded or not really does depend on the individual, and is not the subject of this post. I would very much like to see a more realistic, knowledgeable view of epidurals begin to take prevalence in my community, and the world at large.

As a doula, I know that I can bring my community closer to that vision, one mother at a time. So, here is my answer to the question posed in the title of this post:

I usually tell someone that they don’t “need” a doula (if they want to get all technical), in that they can definitely have their baby without one. Yet, I would never say that a doula is a luxury, either. There is too much benefit to the presence of a doula, supported by scientific evidence, to label them luxuries. Not to mention the fact that women, for all of our world’s history, have always supported women during birth. Women need women who believe in them at their births. Period. Again – a subject for another lengthy post.

Moving on.

In the specific case of a mom planning an epidural, a doula can really help to optimize the use of this particular tool — maximizing its benefits, and minimizing the risks associated with it — if that’s what she wants.

A doula can help a mother stay calm through the procedure, and prepare her ahead of time to have realistic expectations of what epidurals do and do not do. Contrary to popular belief, epidurals are not a panacea. They vary in effectiveness for many women, and come with some side effects that are common enough that every woman who wants one should know about them.

A woman with a doula who has educated her ahead of time who experiences, for example, the drastic drop in blood pressure that can go along with an epidural, will know that the nurse will come in, place her on her side, put an oxygen mask on her face, and give her medication to raise her blood pressure immediately. The nurse will act, she will not ask. This prepared woman will be less susceptible to fear as the nurse takes quick action. The unprepared woman may end up scared out of her wits, and experience fear for her baby because of this process, if she did not know ahead of time that it could happen. A doula can prevent the latter circumstance. Doulas can help take fear out of the equation for women.

Along the same lines, a doula can assuage the fears of a woman’s partner, and reassure him/her that what’s going on is common, normal, and that mom and baby are likely to be okay. Partners who love these women so much often forget all they learned, as their gut takes over, and having a doula there for reassurance can really bring a sense of peace to the partners, freeing them to be fully present in their relationship to the laboring mother.

Doulas can also give women tools to cope with labor up until the time the epidural is placed. Mom is having a natural birth up to the point the epidural is in place, after all! A woman and partner equipped with basic labor coping skills and techniques will be able to handle whatever their labor throws at them up to the point the epidural can be placed.

Many moms, without the presence and preparation of a doula, may not know that the timing of an epidural is critical in avoiding some of the risks (both for herself and her baby), and maximizing its benefits. For one thing, an epidural placed too early can cause labor to slow down enough that Pitocin will be needed, beginning the lovely “Cascade of Interventions” all of us in the birth community are familiar with.

Without a doula, a mom may not have the confidence to believe she can handle labor beautifully until the time comes that an epidural would be more to her and her baby’s benefit than a risk. A doula can bring a strong sense of “I can do it” to the labor room, and help a mother to gauge when the time is right for her epidural.

Once the epidural is in, a doula will help a mother assume multiple positions that can keep it working well, keep her pelvis moving, and encourage progress. Progress in labor is directly linked to the amount of movement mom is able to do, and a doula knows this. She can help a mother and her partner work to keep an active role in her labor by maneuvering mom into alternating positions. Since epidurals are gravity-based, this also helps keep the pain relief on a more even keel, and minimizes uneven sensation.

A doula can also walk moms through what pushing with an epidural might be like, and teach them about different options for that stage. She is equipped to help them advocate for the option to “labor down” (a technique that can help preserve mom’s energy for more active pushing when baby is much further into the pelvis/birth canal), instead of beginning active, hard pushing as soon as she reaches full dilation. She can help mom assume different positions every few contractions, to maximize baby’s ability to descend and rotate well. This can also minimize the risk for forceps or vacuum extraction being needed.

After the birth, during the postpartum visits, a doula can help walk moms through any after effects she may be experiencing. She will have prepared the mother to recognize signs of a spinal headache (one possible side effect that is fairly common, but not overly so), and to get help quickly for it. She can help moms understand the back pain that may come along with it; the longer recovery time often associated with it; and – if it was on board for more than four hours – the side effects that her baby may experience. Usually, a baby might be sleepy, and have trouble latching on for the first time.

Once a mom is fully equipped with all the information about an epidural, she is equipped to take any side effects in stride, without fear. She knows that they may happen, and she accepts and owns her decision. She can come out on the other end still satisfied with her experience, even if she has experienced some negative side effects, when she is fully informed and fully supported in the way that only a doula can really do.

So, do moms planning an epidural need a doula?

You tell me.

This is just the tip of the iceberg regarding the knowledge a doula can bring to an epidural birth. If you are a birth professional, what would you add to this? If you are a mother who chose an epidural: Did you have a doula? If so, how did she help you? If not, would you want a doula the next time? What was your experience – doula or no doula?

This is a safe place for you to share – so, please do!

Grace & Peace,
Tiffany

Top 10 Things I’d Do If I Were Pregnant Again

Tuesday, April 10th, 2012

Image from decalsground.com

We all have things we’d like to hit the rewind button for. Today, I thought I’d share the top ten things I’d do differently if I were to miraculously find myself pregnant again. Why not? It’s not something I’ve shared before on this blog. I don’t often get very personal, but I’d like my readers to see me as a real person, who has made real decisions about birth.

So, without further ado, and in no particular order:

The Top 10 Things I’d Do If I Were Pregnant Again:

Image from richmondmidwife.com

1) Have a water birth.

The first time I’d heard of water birth was at our group tour of the birth center where DS #1 was born. In answer to another mom’s question, the midwife leading the tour said something like “No, we don’t do water births here, because we don’t think babies were meant to be born that way.” They did allow moms to labor in tubs, and I tried it. My labor practically stopped. I didn’t know then that if you get in the tub too early, the water can slow/stop your labor. I never thought twice about it all the time I was birthing my four children. Now that I have seen several water births, I would definitely choose to have a pool set up in my house for that purpose.

2) Have my placenta encapsulated.
This is an option I had no earthly idea about when I was having children. I think it could really have helped me with a whole slew of issues. I never struggled with baby blues or a PPMD, but I did have pretty roller-coaster-y emotions in the immediate postpartum days. Also, I have never been able to say that my milk supply was abundant, and I think the reassurance of the placenta pills’ ability to boost supply would have been a welcome comfort to me.

3) I would take a comprehensive, independent childbirth class.
Since I am a certified childbirth educator, I don’t think I’d actually take a full course, but I would probably take a refresher workshop of some kind, just to see if there is any new information out that would be important for me to know, and to give my husband a chance to internalize information he has heard at random since I became a doula. There is always room to grow, and I think we would both benefit from additional education.

One more thing. If I found out that I had to birth at the hospital, for some medical reason, I would definitely take a full, comprehensive course. Since I have never birthed at a hospital, I would really need to fully equip myself for the big differences I would face.

4) I would take a breastfeeding class.
Breastfeeding, for me, though a beautiful experience, was a struggle. I never had cracked, bleeding nipples. I never had to overcome hospital “booby traps,” because I never birthed in a hospital. I had the full support of my husband, my friends, and my mother.

Still, I was never able to meet my breastfeeding goals. When I look back, I know it was simply a lack of basic knowledge of how breastfeeding works. I hadn’t even read a book about it. I think that, if I were pregnant now, that is the first class I would sign up for, and would make sure I had the phone number to some good lactation support.

Image from portlandplacentaservices.com

5) I would make placenta prints.
Before I had it encapsulated, of course. I would frame them and hang them in my living room. They’re gorgeous when done correctly.

6) I would exercise.
Now that I have started trying to take care of my body, and can see the immediate benefits to my emotions, my confidence, and my overall well-being, this is something I would do during pregnancy. Though I did eat well, I never officially exercised with any of my kids, except for the occasional walk with a friend. I know that if I kept up a good exercise routine, I would probably enjoy my pregnancy more.

7) I would try a few different baby-wearing carriers.
For all four of my babies, I had a trusty ring-sling. One was a hand-me-down, and one was custom-made for me by a dear friend. I loved my ring sling, but there were some definite downsides to it. I had no idea there were any other carriers out there that would be properly supportive of my babies (Snugli’s and others like them are not ergonomically correct for a developing baby). So, if I were pregnant again, I’d hook up with the local “baby-wearing lady” in town, and try something new.

Image from hottopic.com

8) I would YouTube/Facebook/Tweet my birth.
I wasn’t on any kind of social media during my other pregnancies, but this time, all my friends would be hearing from me regularly! I’d probably try to facebook/tweet pictures and thoughts as I labor, and be able to announce my little one’s arrival as soon as he got here!

9) I would have professional prenatal photos taken.
This is something I really wish I had done before. I look at all the adorable baby bump photos around me, and sigh a little, wishing I had done the same.

10) I would have a professional photographer at my birth.
There is nothing as powerful as positive birth images. Images that reflect the intimacy, the intensity, the power, the strength, and the sacredness of birth.

There, that about covers it. I can come up with a few more, but I’ll leave that up to you! What would you do if you were pregnant again? If you’re already pregnant, what kinds of things are important to you? What are you doing to enjoy your pregnancy this time around?

Grace & Peace,
Tiffany

Tips to finding the right “childbirth” class

Friday, October 14th, 2011

If you were my best friend, I would tell you there is not any one-size-fits-all “childbirth” class.  Education can be foundational to informed decision making and better outcomes for both mother and baby.

I encourage you to go about choosing a class series in the same way you would choose a provider or birth location. Do some investigating and even interview the educator.

In the search:

  • Get referrals from:
    •  Women who have had or wanted the type of birth you are desiring
    • From local birth groups or doulas
    • Your provider
  • Do a web search for classes in your area. There may be many offerings of differing methods and philosophies outside and within the hospital setting.
  • If  you are thinking about a hospital sponsored course, find out if it is a comprehensive series or a what happens to women once they get to our hospital class? This is otherwise known as a good patient class.
  • Check out the course website, then call or email the instructor to get a feel for her style and philosophy. Even a hospital based educator should be able to call you back or email you.

Before paying and registering:

  • How long is the series?
    • A comprehensive series is between 12 and 24 hours of instruction and a minimum of  4 class sessions up to 12 class sessions. The condensed express classes of one or two partial days are not designed for good retention or appropriate processing. It IS worth the investment of time.
  • When is the class? Day of week and time of day needs to fit into your lifestyle. Again, I encourage your investment over a period of time versus a one-day class. If you cannot find a fit, consider a private class. It is important to have classes finished by 35 or 36 weeks pregnant.
  • Where is the class held? Classes may be held in like-minded businesses (chiro office, yoga studio, doula office), in home, care provider office, birth center or hospital.
  • What organization is the instructor trained and certified with? Though certification is not required, it can be very important what training and background an educator has. If instructor is certified, check out the organization’s philosophy and beliefs.
  • What does the instructor’s experience involve?
  • What is the instructor’s philosophy and style?
  • What is the cost of the course? Classes can cost anywhere from free through a hospital to a few hundred dollars. It really can be a wide range. Find your comfort level. Though expect to invest in a good class. Free or low cost classes are often not comprehensive in nature.
  • What is the course content? A comprehensive class should include a variety of topics, such as, pregnancy basics,  common terminology, normal physiologic changes, emotional health and connection, exercise, nutrition, prenatal testing, birth plans, informed consent, communication skill building, overview of spontaneous labor and birth, labor milestones with comfort and position strategies, overview of all options in labor and birth, labor partner role,  immediate postpartum, navigating first weeks postpartum, overview of infant feeding, infant norms, medications and interventions, cesarean, unexpected events, role-playing scenarios, relaxation practice and local/online resources. It is usual to expect homework on top of class time as well.
  • What are the birth outcome statistics for class participants? It may be difficult though to get true data whether a philosophy-based or method-based class.
  • What is expected of me as a class participant?
  • What do I need to bring?
  • Who may come with me?
  • Is there a lending library?

Could this be labor?

Wednesday, September 21st, 2011

For first time mamas, previously induced mamas or those who have loads of prodromal labor, getting a handle on the nuances of when labor is going to start or if it is lasting labor can be really confusing. There is no way to know exactly when labor is going to start, but there are many things to look out for that can give clues and signs that onset of  labor is sooner rather than later.

Here are my favorite categories to look at and simple ways to decipher what is going on with your body at the end of pregnancy.

Remember to take a look at the whole puzzle picture not just one piece.

  • Vaginal Discharge:
    • Loss of mucous plug (after 38 weeks);
    • Steady mucousy output;
    • Thin and watery mucous;
    • Blood tinged – similar to the beginning or very end of a menstrual period. This means there is effacement and ripening of the cervix going on and even a bit of dilation happening.
  • Contraction Characteristics:
    • Longer and more intense contractions that most often find a pattern;
    • They do not stop or even increase with activity change;
    • Sudden increase or onset of regular Braxton-Hicks;
    • Low period crampiness, pelvic heaviness, off and on backache, thigh achiness.
  • Other symptoms
    • Increased nesting;
    • Insomnia or excessive tiredness;
    •  Flu-like symptoms;
    • Intuition/Instinct;
    • Loose bowels;
    • Weight Loss in the last week.
  • Testing out contractions for possible labor:
    • Change activity level – if resting get up and move, if moving sit down and rest;
    • Drink a large glass of water;
    •  Eat a snack, preferably higher protein;
    • Take a bath or shower.

After doing these things if contractions continue and increase in intensity over another hour or so likely labor is becoming established. Congratulation! As always, contact your care provider at the agreed upon time.