The Doula As Witness

A baby’s first breath

by Jess Helle-Morrissey, MA, MSW, LGSW, LCCE, CLEC

Doulas serve a multi-faceted role in a birthing family’s life: supporter, encourager, normalizer, educator, guide. We rub backs, we squeeze hands, we stroke hair, we breathe, we hold space.  We press cool cloths to a birthing woman’s head as she brings her baby (or babies) forth from the warm, wet womb to the bright spinning world.

One role that is often overlooked, but is perhaps most sacred to my own doula heart, is that of witness. As doulas, we witness over and over again that unique and unparalleled moment in a woman’s life when she becomes a mother. Whether it’s a first birth, or a seventh, a mother is born each time she births a baby.

When a woman has a transformative birth experience (and really, what birth isn’t transformative?), she deserves to be fully seen. And that role is often uniquely the doula’s. Partners are witnessing, but they are most often deservedly caught up in their own personal experience of the moment. Midwives, doctors, and nurses are present, but they have medical tasks to attend to. Doulas are able to attend wholeheartedly to that moment.

We witness the joy of birth. We witness mamas finding their true selves for the first time in their lives as they birth their babies. We see the look on a mama’s face when her baby is five minutes old as she tells us, “Everyone said I couldn’t do it, but I knew I could.” We witness the hilarity of birth – I’ll never forget one mama who turned to me after birthing her twins and exclaimed, “That was f*cking AWESOME!” We get to see the way a partner looks at the birthing woman in complete awe as she makes her way through contraction after contraction. We get to see him or her wipe a tear away as this new little person makes that first yawling cry.

We witness the disappointments, too. And when things don’t go as planned, we can remind her that she is strong because we have seen it with our own two eyes, and we have felt it in our own doula souls. And we remember in a way that she might not.

So as witnesses to those moments, we begin to help her reframe:  Last summer, one of my doula mamas had a surgical birth after a long and difficult labor. In a case like this, it is easy to go to a place of dwelling in what went wrong. I go to my postpartum visit. We talk about all that happened, and I validate the disappointment. I sit with the pain.  But I also tell her, because I need her to hear, “I have never seen anyone work so hard for so long. I have never seen anyone fight so hard for what she wanted. You. Are. Amazing.” And she begins to feel it is true because I have seen it and I know it to be true. She knows I was there. She knows I saw her fully. And as I write this, I remember her fierce birthing spirit as if her baby was born yesterday, and I feel the hair on the back of my neck stand up a bit. Because I will never forget her strength, and the gift she gave me by allowing me in.

Above all, it is that sheer strength of birthing women – no matter how they give birth – that we doulas are witness to. The strength to carry on when it feels like all the reserves have been depleted. The strength to make a choice to go a different direction than we’d dreamed. The strength to joyfully claim a place in the history and lineage of birthing women.

And the repercussions of that witnessing can last a lifetime. I spent a good part of my own life feeling like I was not a very strong person. When I gave birth to my twin boys, I found strength I never even dared to imagine I had in me. Today, more than two years later, each time I see one of my two wonderful doulas, I still stand a little taller and feel that swell in my heart – “SHE has seen my strength! She knows the amazing things I am capable of!” A bit dramatic? Perhaps. But life-changingly, soul-stirringly profound for this mama? Most definitely.

So when you invite a doula into your life for some portion of the nine months of your pregnancy (and a couple months after), know that the benefits don’t end there. We not only witness, but we also remember. I tell my mamas, “If you ever need to be reminded of how incredible you are, call me and I will tell you as many times as you need to hear it to believe it.” So on behalf of all doulas,  thank you to birthing families everywhere who invite us to witness your incredible journey. Thank you for giving us the best job in the world.

Jess Helle-Morrissey is a birth and postpartum doula, a Lamaze-Certified Childbirth Educator, a Lactation Educator Counselor, and a clinical social worker in private psychotherapy practice. She teaches classes for families planning VBAC and for families expecting twins and more at Enlightened Mama, and lives in St. Paul, MN with her husband and her identical twin boys, born in January 2011. 

Ask a Doula: How can a doula assist my family during a planned, medically necessary C-Section?

We are excited for our first “Ask a Doula” post to have responses from not one, but two of our Collective doulas! On the heels of April’s International Cesarean Awareness Month, a mama on our Facebook page asked, “How can a doula assist my family during a planned, medically necessary C-section?”   Women having a necessary surgical birth still have choices for this important day! If you know you’ll be having a surgical birth, interview several providers and find one who can help you have the cesarean birth experience you want.  If you’re interested in learning more, check out this video on the  Natural or Family-Centered Cesarean movement being implemented in the UK. 

Our first doula response comes from Karrie Nesbit CD(DONA), CLC, HCHD: 

When considering a planned surgical birth, getting the information you need to make informed decisions is critical.  A doula will ensure you understand all of your options, and because a doula is not accountable to your provider, she will provide you with unbiased information to help you make the decisions that are best for your family.  With such a wide variety of birthing options available nowadays, it can be comforting to speak with a doula about her experiences with different birth techniques, providers, and birth places.  In short, if you are not completely comfortable with the options you are getting from your provider, a doula can help you find more of what you are looking for with other providers or birth places.

Once the decision to have a surgical birth has been made, your doula will prepare you for what you are going to see, hear, smell, and feel during the birth.  I find that for most families, just knowing what to expect takes away a lot of the anxiety.  Sometimes the  hospital staff forget to explain the details, or they explain them in a way that is not calming or easily understood.

In the operating room, your doula will explain procedures as they happen to reassure, comfort and calm everyone throughout the process. She will help you understand the circumstances immediately following the baby’s birth. If the partner needs to leave the operating room with baby, the doula will remain with momma. Whether in the operating room or recovery room, your doula can help facilitate skin to skin and breastfeeding.

Above all, doulas encourage and help you to speak up for what you need and want for your baby’s birth.  No matter how your baby comes into the world, the presence of a doula will help you to look back on your baby’s birth as a positive and empowering experience.

Our next response comes from Gina Picht with Partners in Birth: 

Sometimes when a family finds out they need or chooses a planned Cesarean birth, they stop thinking of it as a birth.  It becomes a procedure, a ”section”.  Something that the doctors do to them, not them birthing their baby.  A doula’s role becomes the keeper of the birth, bringing the focus back to the family and how they can best work with their circumstances to welcome their baby is a gentle, interactive way.

Your doula will likely meet with you before the day of surgery to review options, which some families are surprised to learn they still have!  Cesarean birth is more and more viewed as an experience that can be tailored to a family’s wishes.  Hospitals and even doctors themselves handle the surgical experience in their own unique way.  It is worthwhile to ask questions beforehand to better understand what options may be available to you.  Your doula can arrive early with you and help keep you relaxed through the preparation process, giving massage, using scented oils, dimming lights, and offering guided visualizations, just as in labor.  As questions are asked of the family by the medical staff, the doula can help give context for those questions, and help get more information when needed.

When the mother goes into the OR to get anesthesia, the partner is usually left alone outside the room.  Your doula will stay with your partner during this time and can be a calming presence in an unfamiliar time and environment.  Most often, the doula is allowed to join the family in the OR where she continues her support, using massage, her calming voice, and maybe a scented oil to mask any surgical odors.  If desired, the doula can narrate the procedure to some extent, letting the family know at what stage the surgery is and when the birth is close.  The time it takes to get to the baby can seem incredibly short, and the doula helps the family participate emotionally in the process, anticipating that moment when the baby is born.  She can encourage the screen to be lowered so the family can see the baby when it’s born, and advocate for the mother’s hands to be unstrapped so she can touch and hold her baby.

In certain cases the mother will feel ready to attempt nursing while the surgery is being finished.  If not, the doula can assist with this in the recovery room.  If the baby needs to leave the OR for any reason, the partner usually goes with the baby so the doula will stay with the mother.  She can help the mother process the experience, and go to get updates on the baby’s condition, maybe bringing back photos to help the mother stay connected.  Of course as soon as possible, the doula will encourage the mother and baby to reunite, facilitating skin-to-skin contact and breastfeeding.  And lots of photos!

A Cesarean section is still a birth.  In the end, a family is born, and a doula can help bring the focus back to that family.

Karrie Nesbit is a doula and lactation counselor who recently relocated to sunny Southern California. Find out more about Karrie at Birth, Etc.

Gina Picht has been a birth doula since 2001 after the birth of her second (and last) child. She is Treasurer of The Childbirth Collective and lives in Eden Prairie.  She believes all women already know how to birth.  www.partnersinbirth.com

The Childbirth Collective by the Numbers

by Liz Hochman, CD(DONA), LCCE

The Childbirth Collective doulas attended over 700 births in the Twin Cities in 2012.  We took some time to compile some year-end stats, and came up with what we think are very interesting numbers that offer a snapshot into the Twin Cities birth community.  These statistics show the varied settings, providers, types of families, and types of births attended by Childbirth Collective doulas.

Two-thirds of the births Collective doulas attended were for first-time families and over 200 births were for mamas expecting their 2nd, 3rd, 4th, or even 5th baby!  We believe there is a special role for everyone in the birth space as we don’t just support the mother but also the family as a whole. Nearly all (97%) of the births we attended last year included a partner in attendance and almost 20% included another family member as well.

Hospital births made up the majority of our births last year, with 90% taking place at Twin Cities hospitals.  We feel strongly that mamas need doulas in home birth (7%) and Out-Of-Hospital Birth Center (3%) settings as well.  Although we’ve had one of our doulas at every single hospital in the area for at least a handful of births, we spend the majority of our time at Abbott, St. Joe’s, Methodist, HCMC, Fairview Riverside, and Woodwinds (15%, 14%, 12%, 8%, 8%, 9%).

No matter what type of provider you are birthing with, chances are we’ve been there!  While 50% of our births took place with a Certified Nurse Midwife (CNM) in attendance, we attended births with OBs (37%), Certified Professional Midwives (CPM) (9%), and Family Practices Doctors (5%).

Whether you are seeking a natural birth or a birth with pharmacological pain management, a doula is valuable and can support you in ways that are unique to your needs.  Collective doulas report that 55% of their clients used no pain medication, 31% used an epidural for pain management, and 14% used other pharmacological methods.

Even if you are planning a cesarean or NOT planning one, but end up having an unexpected surgical birth – we are trained to change our support and comfort skills as your birth unfolds. Last year, families using a Collective doula had a 12% unplanned cesarean rate. Collective doulas also attended a handful of planned cesareans. When an unplanned cesarean birth was the ultimate outcome, our doulas were allowed into the operating room to perform continuous support for those families 67% of the time.

Liz Hochman is a birth doula and Lamaze-Certified Childbirth Educator who teaches at Blooma in Minneapolis, MN. She is the mother of two adorable girls. Read more about Liz at minneapolisdoula.com

Intuitive Birthing: A Doula’s Role

by Julie Colby, LAC, BD

As a birth doula, mother of three, and a feminist, I view birth as a journey of self-discovery.  The birth journey is an opportunity to travel deeper into one’s being and explore all aspects of it.  Ask any woman who has birthed and she will confirm that the birth journey compels her to fully embrace every aspect of her being. Having witnessed multiple births, ranging from unmedicated home births to surgical hospital births, I have deep reverence for how birthing mothers hold their own space during this journey.

The role of the doula is to serve birthing mothers and their partners physically and emotionally during birth as well as being a resource and supportive influence in the prenatal and postpartum phase.  One advantage of having a doula present, of the numerous reasons, is that doulas are there only to serve, which allows partners or other family members to actively engage in their respective role of partner, sister, mother, friend, and so on.  With each birthing experience that we, as doulas, get to witness, we fine-tune our own awareness more and more precisely.

I have come to know that women honor their strength and challenges in birth and labor differently.  Some women want their partners to be actively involved while others prefer less physical involvement from their partners and lean more heavily on the doula to support them.  Some women like massage, touch, verbal affirmations, while others yearn for no physical touch, stillness, and absolute quiet.  All of these preferences all completely valid and normal, and as doulas, we will protect a birthing mother’s wishes with every thread of truth in our being.

To support families as a doula means that we allow them to birth intuitively.  We acknowledge their own wisdom and power while offering continual support during their birth journey.  While we do not influence their decisions, we sense when they are struggling or need more information about their birth.  We truly act as a birth team to form a solid and trusting relationship prenatally.   If and when questions or concerns arise, families know we are offering wisdom based upon their birth plan and of the multiple meetings that have transpired prior to birth.

Another important attribute of the doula’s role is to honor a birthing mother’s wishes regarding her body, her pregnancy, her birth, and her amazing newborn.  Our intention is to promote awareness of the choices that are available along the journey from a nonjudgmental perspective.  Just as we believe there are no two births or pregnancies exactly the same, no two women are the same and we all have our own unique opinions.  It is impossible for any woman to know how she will feel during her birth journey, what noises will please or disturb her, what aromas will appeal to her, or what comfort measures will feel just right until that moment arises.

That is why, doulas have grown to become observant, aware, and mindful of the present moment when serving families.  It is because we have deep reverence for the transient nature of the emotional, physical, and spiritual aspects of birth and we trust that women know their bodies better than anyone else.  The role of the doula, in the words of a very wise midwife, is of the utmost importance to all birthing families!

Julie is a birth and postpartum doula, a Licensed Acupuncturist, and teaches Sacred Pregnancy. She is mother to three incredible boys and she loves her Circle of Women.  Find out more about Julie at ladysslipperwellness.com. 

 

Your Doula: Personalized Comfort for your Birthing Time

by Hope Lien, CD(DONA), PD

You’ve practiced the hip squeeze and your breathing techniques in your childbirth education classes. You’ve even been to the Comfort Measures parent topic session. You (and your labor support) feel ready for your birthing time. And, you really should be proud of yourselves for preparing so well. But journeying through the birth process is a big deal, and there are lots of emotions going on. It can be a lot of pressure (especially on a partner) to have to recall which comfort technique is going to help at the right time, and if that is going to help move things along in your labor. What if the birthing mom doesn’t really like the way that the partner massages her or presses on her back? Then what?

If you have hired a doula, you have covered your bases. Your doula knows the various comfort measures backwards and forwards. She is, for the most part, freed up emotionally to just be there without having to go through the process of becoming a mother or a father. She is like a chameleon, quietly changing into the type of support person you need her to be when you need it. Perhaps things are going smoothly– your doula can be available to get you or your partner food, or just step in if your partner needs a nap. She can offer gentle reminders in early labor which comfort techniques you might enjoy, and suggest alternative options in active labor. She can be as much or as little as you need her to be.

She can subtly help your partner get the feel of things so that he or she can support you just right way, and the only thing you remember afterwards is that your partner was “just the best“ at supporting you in your labor. She can help your partner stay hands on, or not, if he or she prefers. Doulas are wonderful at filling in the gaps so that you get what you need, while allowing the partner to participate to their comfort–in a very loving and supportive way.

Your doula may also have specialized training in hypnosis techniques, acupressure, healing touch or spinning babies techniques. This is a great question to ask when you are interviewing doulas, as many doulas have done specialized training in other areas.

The doula can support you in your labor differently than anyone else on your team, because you have met with her before the birth. You know her, and she knows you. When your birthing time comes, she already knows the types of touch you like or don’t like. She knows your greatest fears, your strengths and your weaknesses. She uses that kind of relationship to be a very unique support person for you and your partner.

She knows the kind of environment you would like in your birthing space, and will create that for you seamlessly, so you can have peace of mind knowing things are like you want them to be, without having to say anything. She knows the hospital room well, and has never ending ideas to try to keep things moving along. She even knows creative ways to put that bed sheet to work! She can magically make the birthing ball, warm or cold compresses and warm blankets appear without having a big discussion about it.

Your doula is an abounding resource of different things to try– who wouldn’t like that kind of additional support for their birth? She will work with you and your partner until you find that technique that is just right for you. She will be there with you through the toughest moments you come up against, until you are over that hurdle. And she will be there waiting, cheering you on, as you (and your partner) cross that finish line.

Hope Lien has been working as a DONA-certified birth doula for 3 years,

and also serves families as a postpartum doula. She is passionate about helping each family find their unique path to parenthood. You can learn more about her by checking out hopethedoula.com

Doulas Make a Difference: Meghan and Julie

by Meghan R.

From the beginning of our pregnancy, I knew I wanted a doula to
support our birth. So, the decision was not “if” we were going to have
a doula, but “who.” Through my yoga community I was recommended
several doula names. Also, I heard about the Childbirth Collective
parent topic sessions through Blooma and had been encouraged to check
out the All About Doulas night. My husband was on board with hiring
a doula but didn’t really understand what a doula would provide so
we decided to attend the Childbirth Collective night to gain a better
understanding (besides hearing it from me). My husband was sold. We
hired a doula team and felt instantly connected and supported.

The doulas we selected offered prenatal home visits to discuss our
pregnancy and birth preferences. The home visits were a nice time to
casually get to know each other and build rapport. Our doulas educated
us on choices that may be presented in the hospital (pain management)
and shared resources to support our pregnancy and journey to
parenthood.

Our doula (Julie Colby) was available as soon as our journey began
and attended our (very long) birth. During this time, she provided
great support for my husband and myself. Because my labor was not
progressing, she helped educate us about our decisions along the way
and feel trusting in the process. This was huge for me. Many things
came into our birth experience that we were not anticipating and
our doula helped us to be OK with our choices and trust the hospital
staff. This positively influenced my labor and delivery because I could
surrender to the process, trust, continue to breathe, and remain calm.
Julie helped remove the fear, doubt, and unknown as it bubbled up
throughout our birth. She always used positive and encouraging words.
She honored the mantras, images, and sounds I chose for our birth.
There was absolutely no judgment and she was instrumental to our
successful vaginal delivery and arrival of our precious son, Nolan.

Writing Your Birth Plan

by Karen Bruce, AAHCC, CD(DONA)

A birth plan, or care preferences document, is a statement of your preferences for your birth and it demonstrates to your birth team that you intend to take an active role in the decision-making process of your labor and birth.  Your doula can help you prepare this document, and you should share it with every member of your team in advance in order to address any questions or concerns in advance of your birth or to catch any preferences which cannot be accommodated at your birth place or in your particular medical situation.

Keep in mind that your audience is your care team (OB or midwife, nurses and other medical staff, and your labor support people), and be specific to your birth place — it shows you did your research when you are familiar with specific hospital or birth center protocols.  If you are planning a homebirth, you might have a plan for home with a back-up birth plan in case of hospital transfer.  These two documents should look radically different because of audience and options available in each setting.

Consider the specific options available to you in your birth place and do your research as to the risks and benefits of each option.  What does your intuition tell you is right for your family?

Once you have explored your options, you have an opportunity to communicate your hopes and dreams for the labor, birth, and immediate postpartum period.  What should you include in your birth plan and how should you organize your thoughts?  I recommend you find a few sample birth plans to get you started — ask your doula or childbirth educator for an example or two, or find some online, keeping in mind that online birth plans may not reflect the practices in your birth place, and should be edited carefully.

Here are some basic guidelines for preparing your birth preferences document:

• Make it personal — use your own voice and language whenever possible, and include information or photos that reveal something of your family’s personality.
• Keep it to one page.  If you really can’t keep it to one page print it back to back.
• It’s OK to plagiarise.  If you find a well-put statement on a sample birth plan and like how something is stated, don’t reinvent the wheel.
• Be succinct.
• Say it clearly and get specific — don’t be vague.
• Bullet, bold and highlight your priorities.  It should be obvious what is most important to you.

Whenever possible, make positive statements of what you do want to happen rather than gathering of list of “don’ts”.  Birth plans that demonstrate a cooperative attitude and flexibility will be well-received by your birth team and show your willingness to work together.  Your birth plan does not replace your conversations for informed consent/informed refusal, but can remind you and your partner of your preferences when decisions must be made.  If the circumstances of your birth take you down an unexpected path, writing a birth preferences document will have been a valuable exercise in educating yourself as to the risks and benefits of various birth options, even if you change your mind along the way.