The phone rings at 7:30 – I am still asleep. A midwife-friend asks if I can come help a couple birth their baby. I shower, grab my bag, kiss my baby and husband, and head up the hill.

I see him first. “Alan?” I introduce myself as he applies counterpressure to the heap of a person lying in front of him. She is the beautiful Audra. Her face glistens with sweat, sticky long strands of hair cling to her cheeks. In the throes of labor, she looks Snow White-ish and other-worldly.

This work is intense. She cries out. Her own mother comes, bringing soft hands and sweet words; she did this for her daughter, and now her daughter does this for a son. As connected as they were through cord-to-organ are they now head-to-head, their noses mirrored. One face reflects pain while the other projects protection.

Alan has her now, cradled in his arms as she rocks toward him. I press, press, press on that bulging place on her back that signals a baby's passing – that upside-down triangle which starts where flesh dips and thins at the top of her warm buttocks. I smell her – the smell of life – spicey, earthy, and hot, and tinny. Alan's fingers graze mine and for a blink we connect with this woman's power. It won't be long.

Her baby emerges in a bag of egg-drop soup, wearing his cord as a scarf. The midwife gently unwinds his traveling clothes and hands him to his mother. He squints his eyes and searches, following his hands like a blood-hound on the trail. The force that expelled him caused her breasts to force out shiny beads of honey. As he suckles, mother and baby are brought back to their circle of symbiosis.

With my first child, I had no idea there was such a thing as a doula -- I had never heard the word.  With my second, we moved while I was 7 months pregnant, and I had since learned what a doula was; as I was away from home and family, I thought about finding a doula to help me through that birth, but in the end, the fear of the cost left my husband and I on our own again.  With my third child, I finally decided I deserved a doula!  As a doula, I knew I needed to put my money where my mouth was and be sure I had a doula present to help me through my labor.

And do I ever love her!

Once my contractions began and we headed for the hospital, we called two people:  My mom (who was three hours away), and my doula.  My doula, Tracey, met us soon after at the hospital.  She came ready to serve with her doula bag, her calm demeanor, and her gentle smile.  I felt instantly better as she walked into my room, like "now I can do this." 

My husband had been with me through two other labors and births -- he wasn't a newbie.  But Tracey could intuit what my needs were without even asking.  She was so good at helping me, she was almost like a fixture in the room -- the one handing me cold wash clothes to put on my hot belly, the one adjusting the bubbles in the Jacuzzi tub, the one giving the soft physical and verbal encouragement when I hadn't even realized I was struggling. 

From my husband I had love and security; from my doula I had nurturing and normalcy.  Now I know, if I ever have another baby, I absolutely will have a doula.

I attended a lovely waterbirth last week.  Mama+Daddy=Chloe.

I was recently asked how women in general have the courage to go through birth more than one time.

My response:  Are you kidding? When I think over my last birth experience (11-05), I keep wishing I could go back to that last hour of most intense, hard, full-on kill-me-now labor. While it was hard and intense, what I remember and long for is the closeness that was in that room with my mom, husband, doula, and midwife. The quiet support they offered me. The jokes in between contractions. The anticipation of knowing the baby would be here soon. There was such a special feeling shared amongst us all -- like there was absolutely nothing else happening anywhere else in the entire world, or universe, for that matter.

Yes, during that intense time I said two funny things I 150% meant. 1) I told my midwife, "I'll let you pull him out with a vacuum, you know." 2) I told the room, "I don't think I can do this again."

My first baby was pulled out via vacuum after three hours of pushing. I felt let-down and insignificant, like my doctor could not help me push him out by suggesting another position, or just letting me take my time -- it was more like she wanted to get home. My dh knew I would be so upset if I actually did have this baby pulled out that same way, so he knew he would not let me do that (if it were not needed). My midwife laughed, too -- she recognized it as a cry for help and plea of desperation, but not what I really would have been happy with in the long run.

When I said the second thing I meant I could not have another baby after this. My midwife looked at my husband and said, "Do you want to get this in writing?" I held strongly to this until day 6 postpartum -- and then I remember thinking, "I would do it again."

There is just something so incredible about being on the cusp of that life-changing experience. I think I would have 5 labors/births to not have to go through 9 months of pregnancy, that's really where the draining experiences come in my opinion!

Before my first baby, I didn't have so much fear simply because I had no idea what to expect.  After my first, and seeing how things went and knowing more, yes I was pretty scared to have another baby. After my second I was even more scared -- they say the third birth is a wild card, and I also had this cognitive distortion that, well babies and I were safe the first and second time, so something bad is bound to happen now! 

After my third birth I felt like, heck -- they are just starting to get good! Having my third baby made me want to have another one, and I never felt that way before.

I am often approached by women who feel a pull towards this work.  A common comment in situations like these is:  "But you know so much!  I don't know nearly enough -- how could I do what you do?"

There is a secret.  I learned this though years of personal observation and experience.  I would love to share it with you if you have come here in the hopes of figuring this out for yourself.  Are you ready for it?  Now, pay attention, because if you understand and embrace what I am about to tell you, you may gain a boost of confidence that can buoy you up in times of self-doubt and personal conflict.

Imagine this:  You are shopping in your favorite grocery store.  You notice the refried beans are no longer in their spot on the shelf.  You ask a passing employee for help.  She confirms visually they are missing and says, "Oh.  I don't see them.  I don't know what?  Sorry."  Then she leaves.  How are you feeling?  Frustrated, mad, let-down, unimportant?

Imagine now the same situation.  You see garbanzo, kidney, white, black -- but no refried beans.  Again an employee walks by and you ask about the beans.  She looks, sees their place on the shelf has been taken over by other beans, and turns to you to say, "I don't know, but let me find out for you."  Now how are you feeling?  Cared-for, worth it, appreciated?  That employee took more time to help you, admitted she didn't have the immediate information you needed, and in the end, she helped you solve your problem (the beans had been moved by the tortillas, salsa, and canned peppers!).

Women are coming to us for information, yes, and often they are needing comfort, reassurance, affirmation, compassion, an ear to hear and sometimes a shoulder to cry on.  It is so much more important that we encircle that woman in our attention and our care versus offering her the precise answers to her questions and then sending her on her way.  The surface problem she presents may be just the tip of the iceberg, and without skills like active listening, seeking clarification, reacting with appropriate body language, we can miss what's under the water.

When does a woman feel cared-for?  When she knows you are focusing on her and that you care about her.  The way to show this is by being present with her.  It is okay (and appreciated!) to tell her you aren't familiar with the issue, and you will aid her in finding helpful resources.

So the answer to the question, "Am I smart enough?" is this:


"Stuff" can be pulled out of books -- facts, statistics, information; this comes from without and slowly takes root within.  It can be sterile, static, and cold.

"Stuffing" is what you have to offer,  what makes a teddy bear comforting; this comes from within and (often, not slowly!) makes its way without.  It can be calming, assuring, and warm. 

One makes you a smart doula; the other makes you a great doula.

The Birth of Leah

Debbie called me at 8:30 am to let me know contractions had started.  I joined her and her best friend Lisa at the hospital – Debbie was 2-3 centimeters.  Debbie and I worked through the contractions.  She would really have to focus.  Lisa  and I would stand on either side of the bed rubbing Debbie’s arms and shoulders, smoothing her hair, and giving her space to focus.  Lisa  was not quite respectful of Debbie’s need to focus and go within herself to endure, and Lisa  would ask Debbie questions about unimportant things while Debbie was trying to concentrate.  I kept redirecting Lisa  respectfully, reminding her that Debbie needed space to focus, and could we wait until the contraction is over to get an answer?  A vaginal exam at 1:15 revealed Debbie to be 100% effaced, 4-5 centimeters dilated.  Debbie had AROM followed by her epidural at 2:00.  The contractions spaced out to 8-10 minutes, and Debbie’s blood pressure dropped dangerously low.  Debbie’s nurse, Mary, stayed with us in the room for almost 2 hours charting and watching Debbie and her monitors.  Debbie’s blood pressure did eventually increase.  At 4:30 pm Debbie was checked and found to be complete.  She started pushing at 6:00, and baby was born via Mighty Vac at 6:52.

Debbie is a single mother and she felt a doula would help her feel supported and informed.  My primary goal for Debbie’s birth was to make her feel special, strong, and empowered.  I knew Debbie wanted an epidural.  Debbie had a severe knee injury which happened about the time she became pregnant.  That, coupled with her being very overweight, greatly reduced her options for movement.  I helped a lot before Debbie got the epidural with coping techniques such as counting backwards through contractions, and massaging her hands, which grew tired from gripping her bed rails.  Debbie’s situation reminded me of something Penny Simkin wrote of a client who left an abusive relationship:  I think Debbie did not need to feel any pain on this birth day.

Debbie reacted well to her labor!  She really had to focus from about 11:45 until 2 pm.  She seemed to leave for a minute and find someplace in her mind where she could cope, and once the contraction was letting up, she would slowly open her eyes and release her grip on the bedrails.  When I would say, “Debbie, that was great.  You have found a place and you are really doing a wonderful job focusing and relaxing,” Lisa  would discredit what I was saying by replying with, “Yeah, Debbie’s thinking ‘Whatever,’” or “Debbie’s thinking, ‘Shut-up already.’”  I don’t think Debbie was thinking any of those things.  It really felt like I was being undermined.  When I would ask Debbie the, “What was going through your mind…” question she would usually reply “I just wanted to get through it.”  She never had a panicked or scared reaction.  Debbie reacted very sweetly to her new baby.

I learned some good people-coping skills.  Lisa  is a tough kind of gal.  When Debbie’s blood pressure fell, and then her legs went numb, Lisa  was upset and wondered why they didn’t stop the epidural?  Lisa ’s personal experiences left her to believe the numbing aspect of an epidural was abnormal (“That did not happen with my epidurals”).  I tried to explain how epidurals worked, but she got very defensive.  I finally said I did not know, and she should ask the doctor about it (he was also Lisa ’s doctor).  I learned sometimes it is better to “not know.”  I learned sometimes I need to stand away and be useless, like while the baby was being delivered and I was not by Debbie (Lisa  was to her left, doc at the end, nurse at her right).  After Leah's birth, I was able to help more practically.  Lisa had left, and Debbie was alone.  I stayed longer helping with breastfeeding and ensuring Debbie got a nice meal as well.  Debbie’s father arrived about an hour later, and I was able to help him hold his granddaughter for the first time -- he swayed and shooshed her right to calmness.  I learned even though a person only thanks you for bringing them dinner, that can mean a lot.

I have been working hard for months to bring a doula training to Chico.  Why, some might ask (my husband included!)?  Why would I want to bring in more competition?  I guess my reasoning there would be, so women in my community have more options about the doulas they are able to select from.

I often hear things from people like, "I would love to be a doula, but ___________."  The answers that fill that blank are things like, I have never given birth, I already have a full-time job, I have little ones at home, I am too old, I am too young, etc.

At the end of the doula training yesterday, as a closing exercise, the women were asked to say why they would be good doulas.  The very last woman, who was also tending her on-the-run baby for just the few last minutes of the training, said  -- very passionately -- "Because I want to!"  This wasn't an answer we might expect from a toddler who is asked why he is kicking the dog, but instead, it was a woman's firm, known, felt desire surfacing as she examined what it was within her that would allow her to be truly present for a woman during labor and birth.  And I cannot wait to work with her!

Self-examination is a good tool.  This can come in handy when looking at why you might want to start down the doula path.  Visiting the DONA site gives many answers to the common questions women have when they consider what it would take for them to become a doula.  Other great places for answers can be online doula websites, real doulas already working in your community, and books, such as "The Doula Book," and "The Birth Partner."

I have heard this before:  "I can't hire that doula, she has never had a baby."  While this can be a very important to a family as they are selecting a doula, upon further examination, it is not hard to see where the logic can breakdown:  Simply, a woman who has never had a baby is potentially bringing less baggage to birth than a woman who has experienced birth and formed personal opinions about what makes it good and bad.  Also a bonus, a woman who has not given birth likely has less entanglements at home which might complicate her life as a doula.

Of course you can be a good doula no matter what your background -- no babies, cesarean births, or 10 kids all born at home -- because essentially, helping a woman through her own experience of birth has nothing to do with me.  This is not my show, these aren't the choices I would make for myself, this is not the baby I  will raise and love for the rest of my life.  This is her experience, and my job is not to judge -- my job is to offer her information, support, and caring as she makes the decisions that are the best for her, her baby, and her particular labor/birth.

So, it doesn't matter who you are and what you have experienced, it only matters that you want to help, and that through training, intuition, and instinct, you know how to provide that help without imposing or inserting your own agenda, but that you have the ability to care for this woman, walking alongside her and her partner, as they navigate their road together.

A few places you can find more answers:

DONA's FAQ
So You Want to Be a Doula?
Mothering Magazine's Forum for Birth Professionals

Q.  What is your feeling about taking clients that have the same due date?

A.  I would actually prefer to have two clients with the same due date, as opposed to having clients with a two-week space between due dates.  It is speculated that only 5-10% of babies are born on their actual due dates -- that is maybe one out of ten women, so the chances of two women, with the same due date, having their babies at the same time is even less than that.  On a personal note, I have only ever had back-to-back/same-day births with clients where I thought there was a safe distance between due dates, but babies come when babies come -- they don't often get the memo about due dates.

Once a client of mine had a cesarean two weeks early for a medical issue (about 2 pm), and another client had her baby the same day (her due date), 6 minutes before midnight.

Second time I had a client go two days early; my back-up doula had a client go 18 days overdue (my back-up had to leave on day 16).  My back-up's client (whom I was now the doula for) was in the hospital working on day 2 of an induction.  My client went into spontaneous labor, and actually had her baby at about midnight.  Before I left, I went to pop into the other family's room, but their nurse assured me they were sleeping.  I geo home (35 minutes away) and barely fell asleep, when the phone rang.  I ran back to the hospital, very sleepy!  Baby was born about 12 hours later around 3 pm.

Third time I had a client go 16 days past her due date, and another client went a couple of days early.  Over-due mama delivered at about 10 pm; early mama called me at 1 in the morning stating her water broke.  Back to the old grindstone!

A few things you should know about due dates:

-What Goes in a Due Date?
-When is that Baby Due?
-ACOG Guidelines for Induction

Or...

My first Root Canal!

I was ushered into the exam room, and an assistant came in, touched my arm, and said, "Hello. Can I get you anything?" She held her hand on my arm for more than a second before she moved across the room. I had the thought, "She could be a doula."

She was my mom's age, shortish, roundish, with long brown hair. For reading material, I packed an article on "Non-Pharmaceutical Pain Relief." She saw what I was reading and asked about it, thinking it pertained to my dental visit. I shared that no, I was a childbirth educator, and my class that evening was on comfort measures and pain.

The dentist walked in and she, too, thought the article looming in my lap was the signal for someone petrified of all-things-dentist. That was when I remember some people really are very frightened of the dentist, like I am frightened of throwing up. I assured her, too, this was just job-related. I told them both I felt my class on comfort measures and pain was getting a little stale, and I wanted to refresh my memory and increase my knowledge.

"You know, it's funny," I started, while these two dental professionals were gathering things together for my wonderful procedure, "Often women say, 'I wouldn't get a root canal without anesthetic, so why would I have a baby without pain medication?'" The dentist asked, "What do you tell them?" "I tell them birth is normal, someone drilling into your tooth isn't." They both laughed -- the assistant with her birth wisdom, and the dentist with her root-canal/tooth-drilling wisdom.

As I laid practically with head in the dentist's lap, she slowly and methodically started shooting my gums up with anesthetic. "Oh, you are doing great. If anyone should be able to relax for this, it's you. Excellent work." She continued to brag to the assistant about me and how wonderful I was coping. I thought she may have been yanking my chain a bit, but I still felt good -- if she was trying to distract me, it worked!

She left to give the anesthetic some time to work. The assistant and I started chatting. She said she had 6 children, and that she was something of a legend: She was the first woman in our county to have VBAC after 3 cesareans! She told me she has been with her daughters when they have birthed, and then she sheepishly added, "They have had their babies at home." I smiled as much as my half-numb face could smile (a half-smile?) and shared that if I had another baby, it would only be at home.

We had a lovely chat. She shared her VBAC story with me. Her family and extended family -- friends and children-of-friends -- commonly ask her to help support them through labor. "If I had to do it all over again, I would get into the birth-world." I agreed it was an amazing place to be.

I left with a temporary filling, an appointment for next month, and a renewed appreciation for the awesome opportunities I have as a doula.

Some link-y-poos promoting positive dental health during pregnancy, 'cause I am aabout the good here -- trying to help you avoid a future root canal, folks:

-Is that Advice ADA-Recommended?
-Did You Know this Stuff?  I Didn't!
-Common Myths Debunked

I had a doula birth this weekend. This family was having their second baby; I was with them during the hospital birth of their first daughter almost two years ago. This time they planned a homebirth with our community midwife (whom I love).

I was struck by this couple's groundedness during their first birth. Mom labored for about 5 hours, and then had her baby, with no interventions or medications. She never complained, even when it was within her rights to do so. She never said, "This hurts," or "I want this to be over," or "It's hard." She did not utter one complaintive word during the whole birth. It really got me thinking: There are people out there who never complain; they just deal with what life offers them and move through it. Wow.

After their baby's birth, Mom started losing a lot of blood. Her placenta would not release from her uterus and come out. Because of this, her uterus could not clamp down, the process which normally shuts down the full-force of that bleeding. Her midwife tried quite a few tricks before she had to call her supervisory physician for advice. Now, I don't think she really needed "advice," but the way the laws work here, she had to inform him of the situation and see what he recommended. They discussed manually extracting the placenta, and the doc agreed the midwife could try it -- that would keep him home for the time being.

This experienced, well-respected-in-her-field midwife then slowly reached her hand into this new mother's birth canal in hopes of bringing the placenta down and out. This mom was stoic. With her midwife's hand in her uterus, she did not cry, scream, or make any "normal" sounds one would associate with this very painful procedure. She knew this was work that had to be done. Her husband watched as what her called "rivers of blood," ran out of his wife. After a second attempt at this and still no placenta, the midwife administered narcotic medication to help the mom relax and feel markedly less pain. She also called the doctor back, and he was on his way. The third attempt did not look promising. "Visualize your placenta letting go -- visualize it releasing." Just as the doctor opened the door to the room, the midwife came out of this new mother's uterus, placenta in hand.

21 months later this mother is laboring again. I joined them at about 8 in the evening. We went for a walk, stopping every few minutes to "honor the contractions," as the mother put it. Around 10 the midwife and her assistant dropped by, fresh from another birth. This mother guessed she was about 2-3 centimeters, still in early labor. The midwife suggested we all go home and let Mom and Dad get some rest.

I watched a movie when I knew I should have gone to bed. Then I dawdled around a bit more, getting to bed at 1:15 am. I placed the phone on the windowsill so I could reach it if they called, then I snuggled into my pillow. Just as I shut my eyes, the phone rang. I was back at their house at 1:30.

Mom still wasn't quite in active labor yet, but things were picking up. We moved from a hands and knees position over the couch, Dad holding both her hands and me pressing on her back, to the birth tub, to the bathtub, and then back to the couch. She laid on a mattress on the floor for a while, still being diligent enough to get up and go pee every 30 minutes or so.

At about 5 am Mom decided she wanted to lie down in her bed. She crawled up into the middle, facing her husband, and I laid facing her back. For the next hour, the three of us moved into place when her contractions would start -- I would press on her back, Dad would offer his hands to be squeezed, and Mom would make the noises to cope with the sensation. As her voice tapered off, slowly I would lighten my touch, and Dad would claim his hands back. Then we would sleep. Dad laughed at one point that it was a good thing they had a kind-sized bed. Mom and Dad (can't say for myself!) would both snore between contractions. I knew I was dreaming because I would wake up with other thoughts deep in my mind. But we would shift into action to help support this woman as she moved through this experience of labor.

At about 6 am, Mom said the sensation had shifted, and she felt, at certain points during a contraction, a little like she wanted to push. Although she had a longer latent phase than with her first birth, I imagined once she got close to complete, she wouldn't have to push for very long. I made the call to the midwife, and she was there by 6:30.

Mom was checked and found to be 4 centimeters, almost fully effaced. She decided to "do laps," around the circle of her living room, dining room, and kitchen. This helped the intensity and regularity of her contractions. By 8 she was feeling the urge to push, and the midwife found her to be without any cervix. After a few different pushing positions, the mother eased her baby out sitting on a birthing stool. She was asked to, after the birth of the baby's head, breathe through contractions so the midwife could suction the baby's airway as there had been some meconium in the water. Baby came out, right to Mom's chest, Mom was leaning against Dad and we were all struck by the beauty of such a simple birth.

But only for a moment.

What was said not to happen again did indeed happen. The placenta was not coming out. Through nipple stimulation, herbal tinctures, and finally a shot of pitocin, the placenta stayed tight. This midwife also tried to manually extract it. One, two, three times -- to no avail. Mom was losing blood. It was not critical, but the midwife feared if we got Mom up and out the door to the car, she would likely lose a lot of blood by the time she arrived at the hospital. The decision was made to transport by ambulance. Mom and Dad were calm. They knew this must be done, so they simply got down to business and made the best of it.

Mom went in an ambulance and her midwife followed behind. Dad dressed and diapered the baby, I threw together essential items for Mom and Baby, and then we headed to the hospital, too. The midwife's assistant stayed and began the clean-up.

The doctor-on-call tried to manually remove the placenta twice, and he was going to try one more time, before Mom said, "No, I will go to surgery." They took her back and gave her general anesthesia, and then they were able to fully remove the placenta; the placenta that did its job so well -- too well. Mom and Baby were reunited, and aside from a delay in breastfeeding that seemed made up for later, are doing just fine now.

On the way to the hospital, Dad shared with me, "Having been through this before, I knew what to expect. I also knew she did not lose as much blood this time as she did the first time. I wasn't worried at all."

I asked Mom later, are you still glad you planned a homebirth? "Absolutely. I had a wonderful birth at home and aside from the placenta thing, I wouldn't have changed a thing."

Birth doesn't often go as we plan. We can be in-tune with our bodies and our babies and understand sometimes physical need has to take priority over envisioned ideal. Even if we are caught sleeping on the job.

A few relevant resources for further exploration:

-Homebirth Safe for Low-Risk Women
-Choosing the Right Sized Bed
-Bedsharing with Your Baby (couldn't find anything about bedsharing with your doula, sorry!)