We’ve all heard the horror stories. The homebirth turned cesarean. The induction gone wrong. The horrible hemorrhage. Cracked and bleeding nipples. Breastfeeding sabotaged by circumstances. And more. There is almost a compulsion to tell these stories, and we are often left feeling a little dazed as we walk away.

These are valid experiences, but hard to hear. Even harder is our response. Smiling and nodding seems shallow and awkward. What do you say in such situations when it doesn’t seem like there is anything right to say? None of us want to be trite, or offer mere platitudes, but what else is there?

Some advocate for setting firm boundaries and asking that only positive stories be shared. This may work among our own circle of acquaintance, where people know us and can understand where we are coming from. However, that often doesn’t feel right to do with someone we don’t know well or have only just met. It just feels wrong to hold up our hand and stop someone from telling their story.

I would like to offer another option.

Listen to their story.

Then, validate their experience. “Wow, that sounds like it was really hard for you.” A simple statement that honors the fact that they have shared part of their life with you.

Go a step further and ask them one question:

“If you could go back and change anything about your experience, what would it be?”

No one has likely asked them anything of the sort. More than likely, they have only been told “At least you have a healthy baby, and that’s all that really matters.”

Imagine what that one question could do for someone struggling with a traumatic experience. Someone who has told her story dozens of times, only finding those who could one-up her story, or who spoon fed her “healthy mom, healthy baby” platitudes.

Imagine being the first person to open up the door in the wall between this precious woman and her own healing. Perhaps no one has confirmed her struggle. Perhaps she has not been allowed to grieve what she lost. Perhaps she has been expected to get over it, no matter how much it hurt, or how few answers she has about her circumstances. Perhaps her experience has only ever been marginalized, even by well-intentioned loved ones who are simply uncomfortable with trauma.

Imagine what you could learn from hearing the answer to such a question. The information that may be between the lines of her answer that can help you confirm or change the decisions you yourself are making. Perhaps her story will be the means of preventing your own traumatic experience, and make you better equipped to handle unexpected outcomes.

Imagine being the means of turning horror into healing.

How have you handled horror stories in the past? How might you handle them in the future?

Grace & Peace,
Tiffany

Yes, it almost sounds like a Dr. Seuss-ism – “Would you rather be a passenger or a driver?” Most of us would rather be the driver, I would venture.

In every other aspect of our lives, we exercise informed consent. We want to be involved, in control, and overseeing every detail. Take for example the research we do in buying our next car, cell phone, or home. Think about how much we invest in knowing our stuff, so we can avoid the sales pitch and just get exactly what we want because we desire to make a responsible informed decision.

Yet, when it comes to our health care–prenatal care in particular–we often content ourselves with being a passenger. We readily abdicate responsibility for our health by laying down our questions and concerns to take the word of a stranger. We leave our right to informed consent in the waiting room.

Why is that?

“But, they’ve gone to medical school for a million years! What do I know?” Of course, their expertise is invaluable. Their advice is often sound. While they have an intimate knowledge of the human body and its various pathologies, they do not have an intimate knowledge of your body in particular. Its quirks and signals that are all too familiar to you.

What many fail to realize is that, no matter which role we choose to play in our health care, the consequences of any and all decisions are carried by the patient. By you and me. For the physician, it is out of sight, out of mind, not because they are inhumane, but because they are human.

When it comes to prenatal care in particular, we see a unique dilemma, because the health care we receive has more to do with a physiologic process, rather than pathology or disease. This isn’t a broken femur, a tumor, or a chronic illness. It is not even a parasite, in spite of the tongue-in-cheek proclamations of many. It is something our bodies do naturally, without a lot of help. It is a process more in need of general oversight, rather than active management.

Pregnant or not, it is imperative to understand that the practitioner is hired for his or her advice. It is up to the patient to decide what to do with it. We have many options.

1. Follow the advice without question.
2. Question the advice, decide what to do.

• What are the benefits?
• What are the risks?
• What are my alternatives?
• How does this advice apply to my personal case?
• What happens next if it doesn’t work?

3. Get a second opinion.
4. Discard the advice in favor of an alternative outside traditional medicine.
5. And more…

Medical decisions are rarely black and white.

The key is to remember who it is that carries the weight of the risks. It is ultimately the patient. There are many factors that play into the reasoning behind your doctor’s recommendations–not all of which are health-related. (That’s another post for another day, however.)

In the end, all you have to do is decide which set of risks you are most willing to live with. That is true informed consent.

Only the driver can decide that. Not the passenger.

In which seat will you choose to sit?

Thanks for reading.

Our best to you,
Desirre & Tiffany

Why take childbirth classes anyway? You and baby are made for this process, so what is the big deal?  You go into labor, have many contractions, eventually become fully dilated and push out a baby. Bam. It’s nature! Right?

Not quite, I’m afraid.

In a perfect world, women would grow up around pregnancy, labor, birth and postpartum to soak it all in. Younger girls would assist the mother, participating in many aspects of her care, and would then gain valuable in-person true life experiences that give her encouragement, education, and confidence going into her own pregnancies, births, and postpartum times. Aunties, grandmothers, daughters, cousins, and friends all would participate in this womanly art of birth. If this were still the case, it would put the need for childbirth classes to an end.

Sadly, women in our culture are all too often discouraged, educated with fear, and lack confidence about all things related to pregnancy, labor, birth and early postpartum. It is a mystery to most women as they grow up, and very few have regular access to normal birth. Indeed, the body of a woman isn’t something that is expanded on widely in health classes, or talked about with any raw clarity. The female body, and what it can do, is shrouded in mystery from puberty to the end of life. So, we need good childbirth classes because women have been giving birth in a vacuum for a long time, and have lost the knowledge they once would have grown up with.

Women and babies deserve better. Women and babies deserve to have positive, foundational knowledge to pass down to the next generation. Women and babies deserve the care that can come when the veil is torn, and the mystery becomes clear.

Women learn in community. Quilting bees, canning day, and wash day didn’t really go away. It’s merely been replaced by play dates, mom groups, and social media. Childbirth classes are one more great way to bring women together over a common goal so that they can learn from each other. It serves the purpose of re-integrating the knowledge of generations of birthing women into the modern world.

A good childbirth class will help a woman and her partner to:

When I set out to be by my father’s side in 2012, I had no idea what to expect. My sister and I both lived in Colorado Springs, so naturally we caravaned to Oregon together. We talked about it a lot. What would we have to do? How would we help our mom? This was not a typical visit in any way. I felt ill-equipped and unprepared.

Once we arrived in Oregon, and we settled in, I began to discover just how similar labor and postpartum doula work is to supporting not only the dying man, but his family.

Here are 5 more ways I found that my doula work had prepared me for this in ways I did not expect.

1. Dying has a natural, typical process.
I will never forget the social worker who came to visit and explain the process of death to us as a family. It’s a lot like labor, where the signs of impending death get “longer, stronger, and closer together,” like contractions do. Like labor, the dying process is made up of stages, but they are not set in stone, and it looks different for everyone. No one can ever predict when or how the dying process starts, nor how or when it will end. You just have to wait and see. Like labor, when you are more familiar with the basic physiology of the dying process, caring for your loved one is a lot easier. It helps to have a general idea of what to expect.

2. The family needs support as much as the dying one.
Much like the expectant father, the dying man’s loved ones need education and support to help them navigate this painful, sometimes confusing journey. The social worker told us that we would all feel like we were going crazy, “but that’s okay–it’s normal crazy.” Pretty much everything we would experience would be typical of the dying process, but we would all feel as though it wasn’t. And that was normal. Dying is weird. So is birth. And for those who haven’t seen it, it helps to be able to hear an expert tell you that it’s all normal. This is a major role a doula plays. Supporting the father, partner, or family members through the birth process largely consists of smiling across the pregnant woman’s back and giving the thumbs-up to a dad who thinks the love of his life just might be dying based solely on the sounds she’s making. That calm professional presence meant so much to us as a family and enabled me to put on my own doula hat and love my family through the process.

3. Doulas are comfortable with bodily fluids and nudity.
My only regret in helping care for my dad is that I didn’t step up sooner to help my mom with the actual physical care. It took seeing my mom in tears, needing help to get Dad up off the floor for me to see the need for what it was. Dad was reluctant to let me help, because he didn’t want his daughter seeing him that way. However, Mom needed me. So, I gently insisted to Dad that he needed to let me do this for Mom’s sake. He agreed, and it didn’t take more than one trip to the bathroom together for him to feel okay about it. I happen to have a natural bent toward a clinical mindset, and I knew it wouldn’t bother me to help Dad get to the bathroom while he could, and when he couldn’t, to hold the portable urinal. It’s not much different than letting a pregnant woman lean on you while she’s on the toilet during labor, or hold her hair and an emesis bag while she throws up. It’s just part of life. And death.

4. Everyone involved has a vital role to play.
Part of a doula’s job is to understand the roles everyone involved in a labor and birth are going to fill, based on their gifts and what the mother needs. She assesses the expectations, then sees where she best fits in, and can enhance and help everyone’s roles. It’s the same at the deathbed of a loved one. Everyone has natural personality quirks and gifts and roles, and it is vital to let each play the part they are most comfortable with. Granted, we all have to step out of our roles once in awhile and make do, but generally, we each got to do what came naturally to us. Our kids even filled a role, keeping joy front and center even in the midst of our death watch. It was comfortable and seamless for the most part.

5. It’s not about me.
No birth I attend has anything to do with me. I am along for the ride, for better or worse. I am there to comfort, support, encourage, and anchor. I am not there to fight battles, rescue anyone, or to make a statement. My father’s death had nothing to do with me either. It was his journey, and I was there to comfort, support, encourage, and anchor as well as I could. I could have done a better job, I know, but I did the best I could with what I had, and I know that it was enough. It had to be, because I offered everything I had. We all did.

We each of us, my mother, sisters and I were utterly drained at the end of it all, but we had no regrets. Dad passed into his Father’s arms exactly the way he wished to: with minimal pain, at home in his own bed, surrounded by those he loved. We all of us were his doula team. And we didn’t even know it.

To read the first part, click HERE.

If you have lost someone, what would you add to this? Feel free to share your story in the comments.

Grace & Peace,
Tiffany

A mother waits patiently on the small triage bed while the nurse concentrates on what her fingers are telling her about the progress of this labor. After a minute, she pulls her fingers out, and chirps brightly, “You are 5 centimeters dilated!” She flips her gloves into the trash can and turns to the computer to chart.

It’s a universal experience going into a hospital in labor. The progress of labor is reduced to a number between one and ten, and nothing else. An hour later, after being admitted to her room, the mother is told she is “still only a 5.” Once again, she isn’t a mother, she is a number. She is left alone to contemplate that, and to deal with it as she may.

Most of us tell our birth stories in terms of this number. “I was stuck at 5 forever!”

What if I told you that this number means very little when it stands alone? What if I told you that your cervix does a whole lot more than just dilate? What if I told you that there are more ways to measure progress in labor than that ubiquitous range of centimeters?

Well, it’s true.

My preceptor and mentor, Desirre Andrews says:

“There is a mystery surrounding cervical dilation and changes prior to and during labor. I like to think of it as the jobs of the cervix. The cervix does so much more than simply opening.”

So, the next time you have a baby, and you are facing a vaginal exam, make sure you ask about what else your cervix is doing!

1. Effacement
Hold up your pointer finger. Touch the second knuckle. From there to the tip of your finger is about the length of your cervix. In order for the cervix to dilate completely, your cervix has to shorten, or “efface,” completely. This is measured in percentages. If your cervix only reaches from the tip of the finger to the first knuckle, you are about 50% effaced. This process must happen before dilation can even occur. In many women, it occurs at the same time or it overlaps dilation. In first time moms, we often see effacement first, then dilation quickly follows. What if our mother was told that, while she was “still 5,” she went from 50% effaced to 90% effaced? That’s progress, people!

2. Ripening
Touch the tip of your nose. (You didn’t know this would be so interactive, did you?) That’s about the texture of a closed, uneffaced cervix. That’s no good for dilation, and it has to soften, or “ripen” in order to do its other jobs. This primarily happens before labor, but can also happen throughout labor. The texture of your cervix must work its way to the softness of your relaxed lips, and then softer still to match the texture of the inside of your cheek. We call cervixes at this stage “soft like butter.” Yet another measure of progress. If our mother were still at 5, but her cervix was much softer and more difficult to feel, that’s progress!

3. Position
To protect your baby, your cervix points towards your tailbone (posterior) during pregnancy, and sometimes even early labor. In order to open and allow the baby to move through it, your cervix must shift its position until it is pointing directly into your vagina (anterior). If our mother were told that though she were “still 5,” but that her cervix was easier to reach, this job has been done, and she has made progress!

4. Dilation
Last, but not least we have dilation. Your cervix must open up from a tightly closed position, all the way up to “10 centimeters.” Really, it’s not 10, though. At this point, nothing can be felt except baby’s head. It’s often now simply called “complete dilation.” The thing to realize about dilation is that it cannot happen unless the cervix is doing all of its other jobs already. They often happen seemingly in tandem, but sometimes a mother will be “stuck at 5” while her cervix is effacing, softening, and moving forward. Once those jobs happen, dilation is a downhill race to the finish (though it may not seem like it).

So, the next time you consent to a vaginal exam in labor, make sure you get more than a number. Ask about effacement, softness, and the position of your cervix. Your cervix is amazing and has a lot more to do than just open. Make sure it gets all the credit it deserves!

Were you informed of the various ways the cervix works before and during labor? How might this change the way you approach your future pregnancy care?

-Tiffany

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