Almost three years ago, I packed up my four children and drove to Oregon to help care for my father. His melanoma had metastasized to his spinal fluid, and everything that could be thrown at it to kill it, had been. There was nothing left, but to wait. Probably only weeks were left.

His decline was gradual, over the course of about three and a half months. During that time, I discovered another purpose to my doula training and work.

The end of life is much like the beginning. It is mainly about waiting, comfort and support. There isn’t anyone who can do the dying work, except the dying. Those in attendance find themselves with not much to do but wait. At the most, we bring comfort through physical touch, slow conversations, and just quietly being present. It is so much like waiting while a woman labors. The main difference being that we are on the wrong side of the veil. We do not get to see our loved one birthed into the next life. It is all darkness on this side.

I have never been so grateful for my training as a doula. Everything I learned is very nearly directly applicable to the dying process. Here are 5 things I learned while doulaing my dying father.

1. Pain can be a normal part of the process.
Granted, the pain of death was not something I believe that we were ever designed for. It is often pathological, but it is also a natural part of dying. As in labor, it is a signal that something needs to change. Perhaps a massage will alleviate it. Perhaps a dose of morphine will help the man laboring to die to rest a little easier. Pain also allows and invites loved ones to minister to the dying simply by being present, holding a hand, or stroking the hair.

2. The same comfort measures used in labor often work well for the dying.
Massage. Gate control. Supporting the five senses. Medication. Acupressure. Essential oils. Music. Bathing. Hydration. Light snacking to their level of hunger if it exists at all. The dying, much like the laboring woman, do not need much food if any. It’s important to follow their lead. All these techniques we learn in our doula training are applicable to the dying one. Of course, some causes of death render certain massage strokes unbearable, much like transition may do in a laboring woman. It’s all about trying different things, and allowing the dying to accept or refuse it without taking it personally.

3. Holding space is the foundation for dignity.
We know as doulas that a mother’s pain level, or even the kind of birth she has will have little bearing on how satisfied she is with her experience. What matters most to her is that she is the decision maker and that she feels supported throughout the process. We as doulas hold the space for that to happen. We are constantly directing attention back to the laboring mother: “How do you feel about adding Pitocin to the plan? Would you like time to talk about it?” It’s the same with the dying. They often struggle to decide, and just need the space to settle in with what they want. This gives them the dignity they deserve as a human being while they go through an undignified, and often painful process.

4. Writing an end-of-life plan is much like writing a birth plan.
It’s written before the active dying really begins, much like a birth plan is written prenatally. It outlines the dying person’s desires, wishes, and medical decisions ahead of time, so that if and when they become incapable of decision-making, those who are caring for him can use it as a guide to know what he would most likely want to do. Unlike a birth plan, it is a legal document, and only power-of-attorney can override it. The principle is the same, though. And as a doula, upholding these desires came naturally to me.

5. Dying doesn’t look at all like what is portrayed in the media.
Birth in the media is always an emergency, there is a lot of screaming and hating of husbands, and demanding of drugs. It’s almost never clinically accurate or true to life. It is the same with death in the media. Death in the movies is always grand or gory or like watching someone fall asleep. Watching my father die was none of those things. There is no way to portray the sights, smells, sounds, or the heaviness of the room where the dying man lies. There are as many ways to die as there are to give birth. As beautiful as Dad’s final moments were, as dignified and peaceful as it was, I found death itself to be ugly. Just as I find birth to be beautiful, in spite of the “mess” and the pain and the noise and the smells. Death and birth are studies in contradiction. They are each a paradox. And both are sacred.

I loved being with my dad while he lay dying. I felt honored, privileged, and blessed to witness a man’s leaving of this world to enter the next. For Dad, to live was Christ, and his death was gain. Every time I enter the sacred birthing space of another woman, I am reminded of the gravity of life, and how important it is to have dignity at both birth and death. As a doula, I now know that I have the skill and compassion I need for either. If I weren’t a doula, or pursuing midwifery, I think I would want to be a hospice nurse. But that is an entirely different post for a different day.

Thanks for sticking with me. I know this is a tough subject, but it’s close to my heart, and it was time to write about it. How have you experienced death or birth in your life? Have you seen both? Are there other parallels you noticed?

Grace & Peace,
Tiffany

It’s been awhile, birthy world! Thank you for your patience. I’ve had quite the interesting summer so far, how about you? Anyway. Today’s post.

Go ahead and go read this short article before you proceed here: Fear Makes Labor Longer, Study Finds.

So, they’ve “discovered” that fear slows down labor. Really?

This is something women have known innately for thousands of years, and something that natural birth professionals have been preaching for decades.

We cannot make labor happen faster than it should. However, there are things we can do to slow it down – and harboring fear is one huge one. It’s called the Fear-Tension-Pain cycle. A phrase coined by Dr. Grantly Dick-Read, a pioneer in natural childbirth.

Essentially, it works like this: Mom feels the pains of her first contractions, and fear creeps in that she will not be able to cope when it gets harder. This raises her stress hormones, which ready her for flight, and she tenses up. At the peak of her contraction, her carried tension leads to a greater sensation of pain, and she again begins to fear what comes next. She fears she will not be able to cope, and the cycle begins all over again. Not much fun, I’m afraid.

How do we break that cycle?

1) Hire a doula.
I address a mother’s fears by listening to her, and helping her work through them verbally ahead of time if at all possible. This can even be done in labor. Even small fears have the potential to become big ones in the right environment, so never dismiss any fears you have as “silly.” Address it, work through it, and let it go as best you can.

2) Take an evidence-based childbirth class.
In class is where you can find all kinds of practical tips, tools, and techniques (hooray for alliteration!), for coping with any kind of pain or discomfort you may have during labor. It’s a chance for your support person to learn how to best help you, and you can prioritize ahead of time what techniques you would like to try first.

Also, the more you know about the basic anatomy and physiology of normal birth, the less likely you are to fear it. It kind of takes away all the mystery, and sheds light on an aspect of your womanhood you may never have really understood before. I know that very understanding was a huge help to me as I labored with each of my children.

3) Consider home birth.
No, really. Do it. Look into it. Especially if you have a strong aversion to hospitals and doctors normally. What better way to minimize fear than by being in your own space? Where everyone caters to your needs in labor. Where no one crosses personal boundaries “for your own/baby’s good.” Where you have the most control over the environment. Midwives almost always offer a free consultation, and it never hurts to ask questions! (Visit my home birth & midwifery link at the top of the page if you have more questions.)

4) Learn effective stress management techniques.
These don’t just work for labor – they work for life. They are practical things you can even teach your young children to do when they are feeling stressed. We all know that stress can make us sick, so learning to do this is paramount to all of us in the crazy-fast-paced world. Incidentally – many of the basic relaxation techniques taught in childbirth classes are great stress management tools!

Among many other tools, you can use prayer, physical relaxation techniques, massage, warm compresses, breathing, essential oils, and herbs.

Once the cycle is broken, and you are relaxed, your labor will progress much more quickly and bearably. You may even enjoy many parts of it! It’s not as overwhelming when you know that it is all perfectly orchestrated to bring your baby earthside as safely and effectively as possible. Eliminating fear from the equation allows a better cycle to work: Rhythm, Relaxation, & Ritual cycle (Penny Simkin).

Well, it’s not so much a cycle as it is a principle at work.When you are able to get into a groove of some kind, to find your rhythm, you are able to relax more effectively. You will create little rituals that mark time and space for you in a place where time and space mean almost nothing. It sends you to your primitive brain (a.k.a. “Labor Planet”), and helps you handle your labor as you were intended to handle it: one contraction, one rest period at a time.

When you are relaxed well, you are able to handle everything your labor brings forward. You can crest your contractions like waves, accepting them and holding realistic expectations of your own ability to continue working as long as you need to.

A woman relaxed in childbirth is a woman of power, strength, and faith.

A woman relaxed in childbirth allows her labor to work as quickly and efficiently as it was designed to. There is nothing to slow it down when fear is out of the way.

The beauty of it is that it also has a physiologic effect on your labor! Women, relaxed and uninhibited, will MOVE in labor. They will move a lot. And every movement of mother encourages the baby to move, which in turn encourages the cervix to move, which encourages mom to move, and on we go. The beautiful cycle of relaxation and courage!

Embrace it by educating yourself and taking nothing for granted.

If you have had children before, what was the one thing that helped you cope with each contraction the most? What led you to try that? What fears, if any, did you confront in your childbearing year?

Grace & Peace,
Tiffany Miller, CLD, CCCE

“Labor will hurt. Probably a lot. But whether this is negative is another matter… A laboring woman can be in a great deal of pain, yet feel loved and supported and exhilarated by the creative forces flowing through her body and her ability to meet labor’s challenges.” ~ Henci Goer

Pain in general is not a good or bad thing, in and of itself.

Pain is simply a message from our body to our brain that something needs to change. It tells me when to move my hand away from a hot surface. Pain tells me to lie down and rest for awhile. It tells me to take a bath.

In labor, pain is part of that creative process moving through my body. It does more than just tell me to get moving.

It empowers me to take what control I can in an otherwise uncontrollable event; it places me squarely on the crest of each contraction wave, where I can ride it out in some measure of peace. It tells me to seek comfort – in a warm bath, in the arms of a loved one, outside in the sun, in a dimmed room with soft music, in the motion of walking, and even in the simplest relief of emptying my bladder.

Pain signals the release of huge amounts of endorphins, bringing me to the brink of ecstasy as I feel the baby slip out of my body and into my arms.

Pain experienced in loneliness or perceived isolation is excruciating. Pain experienced in an environment of peace, comfort, and perceived safety is empowering and moving. It is life-changing and educational. It is powerful, intense, and sometimes indescribable.

The pain of labor is not suffering.

In life, as well as in labor, I find that it is often only through pain that I can experience pleasure at its fullest.

The agony and the ecstasy of labor and birth often go hand-in-hand. They are experienced in the same moments. Even at the height of a contraction, there is knowledge in my mind and heart that I will soon forget my pain at the joy of my child being born into the world. In my face, one can see unbounded joy, awe, and underlying it all – the pain of motherhood that never really goes away. We carry it with us as we agonize over every mothering decision.

Motherhood and its inherent pain is a baptism unlike any other on earth.

Being immersed to a depth we did not know we had, to emerge in the clear air of a role we somehow know without being expressly taught.

Pain in labor is what teaches us, and proves to us beyond all doubt that we have what it takes. We can rise to any challenge.

“You can’t scare me. I’ve given birth!” is our rousing, unarguable cry!

The pain of labor and birth, no matter our experience of it, or how we choose to manage it, tells us in a voice of authority: “We CAN be mothers.”

What is/was your experience with pain in your labor(s)? How did you use the various tools available to you (everything from natural methods to medication is welcome to be mentioned here) in order to meet the challenge of your labor pain? Would you change anything about how you managed your pain? Why or why not? Did you experience a painless birth?

Grace & Peace,
Tiffany