by Carl Sandburg

Being born is important
You who have stood at the bedposts
and seen a mother on her high harvest day,
the day of the most golden of harvest moons for her.

You who have seen the new wet child
dried behind the ears,
swaddled in soft fresh garments,
pursing its lips and sending a groping mouth
toward nipples where white milk is ready.

You who have seen this love's payday
of wild toiling and sweet agonizing.

You know being born is important.
You know that nothing else was ever so important to you.
You understand that the payday of love is so old,
So involved, so traced with circles of the moon,
So cunning with the secrets of the salts of the blood.
It must be older than the moon, older than salt. 

The beautiful picture that accompanies this poem is done by artist and mother, Cary York.  I came across her work on Etsy.com, of course.  She kindly allowed me to use her picture here in my blog.  Her lovely pictures truly envelope the spirit and heart of motherhood -- they are a joy to look upon.

As an educator, I am pretty easy-going.  My main goal is to offer accurate, evidence-based information and trust the expectant family to make the decisions they feel are right for their situation.  I don't give a lot of "you should do this" kind of advice -- it's just not my style, and I don't think it lends well to a woman learning to trust her inner wisdom.

One place where I throw this out the window, though, is when it comes to "rules" a partner absolutely must follow.  These rules are not covered in a particular class, rather they come up according to what topics we happen to be discussing.  In class last week we happened to touch upon quite a few of these rules, and I told my families, "I should write these down."  Enter, the blog!

These are for partners, so the "you" in the sentence is not the woman who is pregnant, but her direct support person...I think you know who you are.

1.  You are not allowed to have bad breath.  Her breath will probably be less-than-optimal -- she is working hard, breathing through her mouth, it could have been hours since she last brushed her teeth, or she may have thrown up her last snack.  None of this matters.  She needs support, often in a very close, in-your-personal-space kind of way.  If her breath causes you to recoil, you can muster up your strength and remind yourself of the awesome events unfolding within her body.  If your breath causes her to recoil, she may, very bluntly, tell you so, or maybe she will just involuntarily vomit in your lap.  You have been warned.  No chili cheese fries with extra garlic for you, partner.  Breath mints, gum, and mouthwash are your friends.

2.  You are not allowed to comment about anything else that might come out of her that is NOT a baby.  It is very common for a woman to have a bowel movement during the second stage of birth -- it is actually a good thing -- not only does it provide extra space for a baby, it also shows she knows how to push.  If a woman asks later, “Did I poop?” be careful, this question can be as loaded as, “Do I look fat?”  My best answers to this question:  “Hmm, I don’t remember,” or a solid, “No.”  One situation, kids, where honesty doesn’t pay.

3.  You are not allowed to try and have a conversation with her during a contraction.  Commonly, partners pick this one up pretty quickly, so it is kind of a freebie.  But, there is a second part:  While this seems like a simple idea to you, others coming and going may not remember to “respect the contraction.”  Your job is to run interference so the laboring woman can focus -- remember her contractions are her body’s little bursts of working energy, and her concentration is needed.  If a nurse or friend tries to talk to her at this point, not only can it be a source of irritation to her, it can actually impede her body’s ability to unroll the red carpet that is the birth process.  "Let's wait and ask her when the contraction is over."

4.  You are not allowed to suffer in silence if there are people in the room that your partner is obviously not comfortable with.  This includes friends and family as well as hospital staff.  If the person(s) happen to be friends or family, and they just won’t listen to your kind requests of removal, enlist help from your doula or nurse or practitioner.  Get one of these fine folks alone in the hall and let her know your company has gotten out of control, and to save yourself the potential grudge at the 4th of July party and forever, could she please help you out?  These professionals have mouths like magic wands and they can easily clear a room with smiles on their faces and official-ness in their voices.  Your guests will never know what was at the root of their departure, and you have helped protect your partner and the space she needs to un-focus for birth.

If the unwanted guest happens to be working at the hospital, it is perfectly acceptable to ask for a replacement or a removal.  If you feel there is a bad connection with your nurse, you can talk to her about it, talk to the nurse manager about it, or talk to your practitioner about it, and see if the situation can be changed for the better, either with improved communication, or with a new nurse who better fits your philosophy and birthing plans.  If a nurse walks in with a group of students and your birthing partner does not want to be on the observation deck, this is a situation where you can ask for removal, in a nice way, of course.  “My-partner-the-laboring-woman and I discussed this beforehand, and she is not comfortable having students present.”

5.  You are not allowed to get upset if you catch the brunt of some unseemly comments.  When a woman is having a baby, some odd things happen in her brain and she may not be in the “polite” part of her mind – that filter of sorts – that “nice-izes” the things we say.  Imagine this:  your eyes are closed and you are listening to something you know is very important, but it is lightly garbled and it runs together.  Your job is to pick out the words and phrases and construct some logical instructions out of it.  The words are being whispered, and you are concentrating hard, trying to understand them.  At the same time, you are aware of a fly buzzing around your face.  You don’t know how long the fly has been there, but suddenly it seems like forever, and in a nanosecond, the idea of that fly just consumes you, and you pop open your eyes and start flailing your arms around like crazy, surprised by how you went from zero to medieval in no time flat.  That’s kind of what it’s like in your head when you are absorbed in having a baby.

6.  You are not allowed to complain about being tired, hungry, sick, or sore.  That just kind of goes without saying.  If you feel you might need someone to help you help your partner if one of these four physical conditions should arise, consider hiring a doula.  Not only does she help the laboring mother, she also ensures the birth partner is doing well, gets to eat, gets to rest, gets a shoulder rub, etc.

To sum up:  Labor and birth are intense times.  There is so much going on that it can be hard to know how to help.  A woman must go through this process herself – no one can do it for her.  But that doesn’t mean she has to be alone while she is doing it.  The most important rule a partner should remember is to be with her and remind her of the wonderful job she and her baby are doing together, and that she has your support, your heart, and your presence during the process.

Two weeks ago I sent this letter off to my local newspaper, Chico Enterprise Record.  This morning a friend called me to say it had been published.  They cut out a bit, but the main message is there.  This is a bad move for EnloeMedicalCenter -- it shows that despite the practices the facility is trying to implement, by losing their option for midwifery, they don't really care about patient-centered care and holistic alternatives to harsh (over)medicalization when it comes to their mothers and babies.  All I envision is, these new, beautifully spacious and accommodating rooms, with private bathrooms, tubs, and a nice place for a partner to sleep, while a woman does not have the option of a practitioner whose goal is to be "with women," during the birth experience.

Here it is:

Chico is losing a valuable resource. Soon, there will be no certified-nurse midwives delivering babies at EnloeMedicalCenter. Enloe has painstakingly taken the difficult steps toward becoming a baby-friendly hospital. This is an arduous process, and once achieved, it will place Enloe on a list of only 77 U.S. hospitals that can boast of such status. This program "promotes, protects and supports breastfeeding." The core tenets include avoiding artificial nipples and unneeded supplements, and keeping mothers and babies together during their stay. This is best for babies.

Enloe has recently adopted the Planetree Philosophy designed to treat patients in a kind, compassionate way, and to put their needs first. This is best for patients.

The midwifery model of care focuses on birth as a normal life event, not a medical crisis where a woman needs saving, perhaps from an iatrogenic intervention. All over the world midwives safely help babies into life, and it has been this way since the dawn of man. Midwives in our area provide safe, gentle, kind and compassionate birth options — whether a certified midwife at a hospital or a community midwife at home. This is best for women. It is unfortunate that Enloe will no longer have a place for families choosing midwifery care. — Stacie Bingham, Chico

For more information:

Health Care Crisis Claims Chico Midwifery

Enloe Addressing Provider Squeeze

Midwives Should not be Eliminated

Letter to Midwifery Patients and Supporters



If you are in support of women having the option of a midwifery-assisted birth at Enloe, please take a minute to let the facility know:

Patient Service Excellence

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.

A while back I posted about my own experiences visiting the dentist.  This experience involves my two-year-old.

In October, Jonas went to see our family pediatric dentist -- I knew he had a cavity between his two front teeth.  This dentist is awesome.  She is very low-key.  The child sits facing the parent in a straddle position.  The doctor then wheels her chair up really close so her knees are touching the parent's knees, and she eases the child into her lap.  This was just what we needed as the regular chair was not only too big for Jonas, it was way too scary!

Once the time came to do the work, the dentist had two assistants with her, plus me, holding his lower body in my lap (and keeping his hands restrained when needed).  One assistant was the go-to gal to get supplies, tools, etc., and the other assistant was purely there to help keep Jonas immobile.  This all sounds harsh, and being the mom of three, I quickly understand crying due to pain and crying due to not-wanting-to-be-somewhere; I don't seek out opportunities to torture my children, I just realize sometimes these things are necessary and needed for good health.

The first time I witnessed my child being inflicted with something that was uncomfortable (yes, even painful), was when my first baby was being treated for a septic infection following his birth (probably due to his hospital birth, as I was not GBS+ and germs do tend to hover in hospitals).  I was discharged on day 2, and he had to stay another 9 days without my full-time care.  I came every three hours to feed him.  One time as I was walking into the NICU, I heard Jacob crying.  I saw the nurses were trying to hold him down so they could place an IV into his head.  A nurse looked at me and said, "Mom, you can stay and help hold him, or you can leave until we are done."  I jumped right in and helped hold my baby while a bit of his hair was shaved and the procedure was finished; it did help to hear his crying was the same when they were shaving his head as they were when the needle went in :::shudder:::.  Still not a pleasant experience for a newly postpartum mother and her first baby.  I just felt, though, if I couldn't handle it, I would have left him all alone, and that was more heart-breaking to me than what needed to be done for him medically.

I guess I think of myself as a tough mom, because I learned early on if I let something get to me, I would be asked to leave, and I didn't want that.  So I am a let-me-help-hold-him-while-he-gets-his-shots-so-he-has-my-support kind of mom.

The one assistant that was helping keep Jonas still was on her knees on the floor.  I knew her pain!  As a doula I often find myself in that same position.  "You need a garden pad," I told her.  "What?" she asked?  Over the sounds of the dentist's tools, I explained I was a doula, and what that entails.  "I carry a bag full of things that often help a woman when she is laboring.  The one thing I ALWAYS use, though, is my kneeling pad.  Moms have used it, dads have used it, and even midwives have used it.  That's what you need."  She agreed, and slid another towel under her poor knees.

Jonas got through it all, and we left to go directly to the toy store to get him a special toy for his trauma.  Once I got a chance, guess what?  I dropped off a garden pad off to the office with a thank-you card.  

I want to empower her. I hear this a lot. I understand the idea. And yet, I maintain, you cannot empower someone. Where I think we often go wrong is, we say empower, but what we really mean is overpower.

Within the modes of discourse, I have often been a fan of The Essay of Definition. Coupled with this simplistic, overused style, I will add a little pet named, Compare and Contrast.

(Now, the obligatory introduction.) According to Merriam-Webster’s Online Dictionary, empower means to give official authority or legal power to, or to promote the self-actualization or influence of. Common use: I want to empower her to have a great birth experience.

Many of us would like to think we are such convincingly dynamic childbirth educators, doulas, empowered-women-who-have-had-great-birth-experiences – that simply through our shared thoughts and feelings, we can convince a woman to come over from the Dark Side and want to have something like we had or believed should be had.

To affect with overwhelming intensity the way a woman feels and interject one’s own agenda is not empowering, but overpowering. Likewise, to overcome by superior force her intended desires in regards to birth is to overpower her. When, overcome by passion, zest, zeal, and one’s own pre-conceived notions about the way a woman should birth, one may begin to provide…more power than is needed or desirable. Yet these are the ways we often try to empower.

This is just not reality-based.

Empowerment is not giving a woman your personal tools and teaching her how to build your perfect birth. Empowerment is opening the shed, allowing her to become familiar with all the tools held within, and then stepping back and confidently trusting she will build for herself the birth that is right for her, her baby, and her family.

  Q.  Why would we want a doula?  Wouldn't that be like having a stranger at our birth?

A.  Unless you know your doula before pregnancy, she does start out as a stranger.  During the course of your meetings, though, you get to know each other.  She gets a good feel for your needs and desires for birth, and you experience the way she cares for and nurtures new families.

What expectant families don't often realize is, the day your baby is born, your doula might be the only person in the room (aside from family and friends) who ISN'T a stranger!  The option of choosing your medical birth team is not always available.  In offices with many practitioners, you may meet with all who may potentially catch your baby, but rotation schedule is most likely the factor in deciding who will be there on your baby's birthday; likewise, a practitioner in a solo practice -- if unavailable -- has a back-up whom you may not have even met before.  In these situations, a doula can help remind you of your birth intentions, and she can support you and your partner no matter who is on your birth team that particular day.

Q.  My partner is planning to be my support-person -- what good would a doula be then?  Wouldn't she make my partner feel displaced?

A.  Most partners plan to be the main support person during birth -- and a doula doesn't interrupt this plan.  A partner's support is different than anyone else's on the birth team:  The partner is the only one at a mother's side because he or she LOVES the mother, cares about the mother, and has a great interest in the outcome and future for mother and baby.

Every partner is ready to participate in the birth process at varying levels.  Some are very comfortable with the scenes, sounds, and smells surrounding birth; others need a little more space to process the events going on.  Regardless of level, a doula supports mother and partner where they are at, and helps bring them where they wish to be.  Doulas allow birth partners to participate at the level THEY are comfortable with.

Q.  How else can a doula help besides actual birth support?

A.  All doulas offer prenatal support before birth.  This is a time to learn about birth options, birth planning, and expectations for becoming parents. In addition to this, many doulas also offer breastfeeding support, infant/mother massage, postpartum doula services, information about local resources, and a continued listening ear about the transition to parenthood.

Attention:  I personally authored these FAQs.  Please do not copy them without permission.

Many expectant moms find the last weeks before their baby’s arrival to be fraught with a rainbow of emotions.  The excitement builds as the due-date comes.  This date has been the goal.  Although realistically only 5% of babies are born on their due dates, we still cling to that date as if it means something bigger than it does.  Just as every fruit on the same tree reaches ripened maturity at different points in time, so do our babies.  Another survey suggests 7 out of 10 babies are born past their estimated due dates (as a birth doula, I can say this backs-up my experiences with mothers and babies). 

Babies aren't just hanging around after their due date filing their nails and looking at their watches -- they are still growing and developing, and important changes are taking place.  Babies at this late stage are storing up "brown fat," whose sole purpose is to generate heat -- this helps a newborn maintain his or her body termperature.  Other last week events include:  weight gain, iron storage, sucking and swallowing practice, and of course, lung-maturation.

There is new evidence that babies being born via elective cesarean birth are healthier and have less problems if they are born no more than 7 days before their estimated due date.  The New England Journal of Medicine published these results January 6, 2009.  According to this study, babies "delivered at 37 weeks were twice as likely to have health problems, including breathing troubles, infections, low blood sugar or the need for intensive care."  As far as complications went, the total breakdown (and know this study focused on over 13,000 women) was:

15% of those born at 37 weeks

11% of those born at 38 weeks

8% of those born at 39 weeks

From my limited knowledge, and my (weak!) math skills, I would throw out a guess that of babies born at 40 weeks, 6% might experience complications.  Although this study focused on timing of elective cesareans, the information applies to all babies -- and this is good stuff to remember if an induction of convenience is offered.

Mothers and fathers aren’t the only ones anxious to greet the new stranger; well-meaning family and friends can cause undue stress on the expectant family with their calls, visits, and inquiries as to whether the baby has arrived yet.  Some ways families have alleviated the pressure these loved-ones can unknowingly bring are:

·        Appoint a family member to field phone calls.  Update this family member as needed, and direct phone calls to his or her line.  Have family members call this person for the most up-to-date information. 

·        Leave a message on your machine that lets people know baby has not been born yet, the expectant couple (or family) is resting and gearing up, and you will share the news as soon as there is news to share.

·        Place a sign on your door which explains to visitors (if you do not feel like answering the door, or maybe you are catching up on sleep) that you are resting and wish to not be disturbed right now.  Assure them you will welcome a visit (and a lended-hand) once the baby is born, but for now focus is elsewhere and you are busy resting and nesting.

It is not uncommon for an expectant mother to start to go within herself at this point.  Her inner focus is being shifted from her environment, her house, her life-to-this-point, to her body, her baby, and the process which will unite out of the womb what was united inside those many months ago.  Often she will want time to meditate, journal, rest, enjoy her partner and their last days together before they greet, together, this new human they took part in creating.  Emotions can come freely, including fear, sadness, joy, excitement, relief, apprehension, with interminglings of feeling overwhelmed, unsure, and stressed.

Remember to take care of yourself; rest when you want to rest, work when you want to work, eat when you want to eat.  Pamper yourself – get a massage, have your nails done, visit your acupuncturist – whatever makes you feel special and taken care of.  Have your partner read books to your baby, share in this time together. 

Final words for mom and dad:  Rest, relax, and enjoy each other – strengthen your bond so you can welcome your new baby with love and strength.

Your heart pounds, your mouth dries, your ears begin ringing, and your face suddenly feels so hot!  You just got a call that a potential client wants to meet for an interview.  This often leads to a mad-scrambling of resources, or the paralyzing shock of sudden responsibility.

No need to fear!  First off, keep in mind these people have contacted you because they are aware of the services you provide, and they are wondering how you as a doula can help them as expectant parents. 

Place:  Where to meet?  There are many different ideas about this.  Many doulas feel there is nothing better than to meet in the expectant parents' space -- their home.  The advantage here is, you are able to show them you can fit into their home and life.  Pregnant women are traipsing to a lot of different places -- the doctor's office, the ultrasound office, the hospital to pre-register, their childbirth classes.  Nothing is really accomodating, so to be able to visit a mom in her home can help with the whole why-one-might-want-a-doula-in-the-first-place:  Having an advocate to help with physical, informational, and emotional support who is more just a random stranger on shift.

Sometimes a doula might feel meeting in one's home, without any prior meeting or credible information about a potential client can be a safety issue. I have personally had times where I did feel comfortable going to a stranger's home for an interview; there are also times I feel more relaxed scheduling an interview in a public place.  Going with your gut can be helpful here -- we encourage women to use their intuition to aid in their process of birth, we need to remember that and apply it to ourselves, as well.

There is another school of thought that says, this is an initial meeting where no commitment has been agreed upon yet, so the doula and the expectant family should try to meet in a public location about as in-the-middle as can be, which can be helpful if a doula lives a distance from the potential clients.  This saves her gas money and travel time.  Often if a doula is hired, she makes the full trip to the clients' home for her prenatal meetings.

A good alternative to meeting in a private home is a comfortable, public location.  I often meet clients at a tea bar I frequent.  The atmosphere is light and calm.  There are many different types of tea and drinks, plus food if the meeting is at a meal-time or if someone needs a snack.  I have met at coffee shops before, although I don't drink coffee.  I have found they are often bouncing with noise and turnover-crowd.  Other places I have had interviews are parks (good in the weather is nice or the interviewee has other children), restaurants, medical office waiting rooms (this helps streamline a woman's appoinments), her work place at lunch (then we went on a nice walk), WIC Office, baby store, and an apartment's recreation center.

It would be naive not to take some cautionary measures for your safety when going to an interview.

-Leave a note detailing where you are going, who you are meeting with, and how long you will be gone.  Information that should be included:  The names of the folks you are meeting, the address of the location, the email address or access to any online exchanges you have had with the person.

-Bring a cell phone with you, especially if you are meeting at a private home.

-If you feel something's fishy about the situation, choose a public place, and perhaps have someone come with you, incognito at another table, or as a doula-in-training learning the ropes -- saftey in numbers.  I know this sounds odd, and if you really felt strange about something why go at all?  There are times, however, where you aren't sure about the situation.  I have never had a "this is not right," kind of situation at or after an interview, but I have had those feelings from initial phone or email contact.  Proceeding with a back-up plan is just an added measure of protection in an uncertain situation.

It is important to note I have not experienced anything scary or dangerous as I have worked as a doula.  The point is not to strike fear into your heart, the point is to remember to listen to your gut and be mindful of your safety as you proceed down this road. 

Stay tuned for part 2:  No Need to fear...the Interview:  What to Talk About?