Category: Thoughts

COVID-19 & Pregnancy

Keep Calm! Wash Your Hands! Make a Plan. I am too.

You might be worried. Wash your hands. Maybe you are freaking out and wondering what is coming. Wash your hands. Who knew you touched your face so much? Wash your hands! We don’t need panic, we need to have plans for what to do. I have some advice for you, and want to tell you what I’m thinking about as a doula. Also, if you see me, give me an elbow bump!

Keep Calm

What we know is that it seems that pregnancy and birth doesn’t seem to be a big risk factor with regards to transmission of this virus. Special precautions may need to be taken to avoid contracting the virus, so take this time to stay home if you can and be very health conscious. It’s not a bad idea to socially isolate & generally stay away from huge groups of people.

Wash Your Hands

This may seem like a no-brainer, but seriously, do it, and do it well. Test out some new songs to sing for 20 seconds or more. Be thorough & keep your hands away from your face as much as you can. Wash your hands!

Doula Concerns

There are currently no restrictions in place at local hospitals with regards to a doula’s presence at births that I know of, but there are elsewhere. I have contacted all clients close to their due window about this. I have contacted my local professional contacts at the hospital to let them know about my concerns with COVID-19. Doulas should NOT be considered a visitor, but I can’t control if they let me in or not. Pregnant people need to contact their providers and birthing locations. My certifying organization has put out a toolkit for dealing with this COVID-19 issue for doulas. It includes a letter for hospitals & links to other important statements, like this one from the Association of Women’s Health Obstetric and Neonatal Nurses on 3/11/2020.

I will be doing my normal precautions for staying healthy. I am certainly open to being extra cautious when I go to a birth. Some doulas have had to wear masks, hair nets, gowns, shoe covers, and gloves. I would be fine with that. I will support clients virtually via Zoom or something else if necessary, but I sincerely hope it doesn’t come to that.

Bottom Lines:

Keep calm. Keep growing that baby. Make some contingency plans, and hope you never have to use them. Wash your hands!

3 Reasons to Hire a Doula

There are a million reasons that people hire a doula, and I’m only listing three here. As I have written before, families deserve support and doulas know a few things that can help you along the way. I love winning over the skeptics. I honestly find that many of the partners who were skeptical in the first place become the doula’s biggest fan when they meet us and see us in action. Birth and postpartum can be challenging; doulas are here to help.

1. Personalized Care

When you hire a doula you are getting a pregnancy, birth, and postpartum BFF who knows all kinds of great information and resources to send you. Doulas get to know you and what you want for your birth and the beginning of your life with a new baby. Sometimes you scour the internet and ask in parent groups online only to find conflicting and confusing advice. A doula can help you sift through that information for what you really need, what is evidence-based, and what will help you toward your own personal goals. We know about about pregnancy, birth, and postpartum.

2. Navigation

Navigating the healthcare system is challenging, and doulas can help with that too. When you hire a doula you get a professional person who knows the trail and can help you navigate the twists and turns. We have worked with many of the local providers in Evansville and Owensboro, and I always joke that we know all the stuff on the secret menu too. What I mean is that knowing the right things to request at the hospital can be extra helpful.

3. Zero Judgement

Hiring a doula means you have a completely non-judgemental person with professional support training and zero personal interest, because that is good and important thing. Doulas are there to serve you without agenda. We know our opinion is irrelevant and we are there to serve the birthing person and their partner. So no matter if you are planning to get an epidural as soon as possible, birthing at home with a midwife, or planning a scheduled cesarean, we can help.

Don’t take my word for it…

“Couples often wonder if they should hire a doula. Maybe your friends had wonderful births and didn’t hire a doula, why should you? All I can say is that doulas are like guides for the trek of labor. They know the landscape, are familiar with the people, sights, and sounds, and know special tricks that just might help you over a peak or through a valley or help facilitate that magical experience that lands firmly in your memory forever. And doulas are there for the whole family. They support partners, too, helping them understand what’s going on, get food, rest, and much needed breaks, and they can also guide partners in better ways to support the laboring parent. You do not have to go it alone. There are others who have trekked before you and know the way. Ask them for help.” (Transformed by Birth by Dr. Britta Bushnell, p136)

The path may be well worn, but sometimes having a doula can make it more enjoyable. Hire a doula to help you move around and suggest position changes. Hire a doula so your partner can go to the bathroom without leaving you alone. Maybe everything medical makes your partner nauseous. If you want someone there to go through it all with you, hire a doula. A doula works for you and nobody else, and that can be invaluable on one of the biggest days of your life.

15 Doula Lessons from 2019

As an experienced birth doula learning is important to me, and I grow with each birth I attend!

Every single birth I attend is an opportunity to serve a family. I am always honored to be invited into that space. With more than 5 years under my belt as a birth doula, I still feel like I learn things each time. Even as I inch closer to 150 births attended, I am always in awe of the process and my amazing clients. I will never feel like I have seen it all, and this year definitely brought some surprises. Instead of posting statistics about how many births I have attended, I prefer to post about doula lessons that I have learned this past year. Some of these have reinforced things I learned previously, and others have challenged me in new ways. This year has been interesting in so many ways, and I love that I keep growing and learning along the way.

Here is my list of 15 doula lessons in no particular order:

1. In childbirth, faster is not always easier.

2. I don’t have to agree with all of your decisions to support you.

3. A little determination goes a very long way for labor and delivery.

4. Communication and trauma informed care are not taught to all medical providers.

5. Rice socks smell like burnt popcorn if you microwave them for too long.

6. Home birth can be beautiful beautiful beautiful! Make sure to remind people to PRACTICE with their birthing tub at home!

7. Things I may view as traumatic, may not be viewed the same as my client. Don’t project my views onto other people’s memories. Recovering from a challenging birth is really important for me, physically AND emotionally.

8. Sometimes I burst into tears at the magnificence of it all, and that is ok.

9. Repeat clients are seriously, just the best! VBACs are pretty amazing too.

10. Watch the partner’s face; those glimpses of true joy and love are amazing!

11. LISTEN to the birthing person; their opinion matters.

12. Sometimes clients still surprise me with their ferocity, and I LOVE that!

13. Amazing providers who give individualized care and continue to consider experience and preference over standard operating procedure give me hope! All the preparation in the world cannot make up for an unsupportive provider.

14. Trusting my doula gut when it says GO is still the right thing to do.

15. Patience is undervalued and wholly necessary.

2019’s doula lessons were not easy, and this is certainly not going to be a year that I will soon forget. As I grow in my doula knowledge and skills I am also constantly reminded of how much I really don’t know. These doula lessons all help to increase my confidence and capacity to deal with new situations, hopefully with grace and humility.

2019: Connection & Growth

A year for transition has been excellent for growing and connecting with so many new people.

Every year I pick a focus word, and for 2019 I chose: connection. It has felt like a year for transition for my business for many reasons, and I am looking forward to some exciting new connections and growth in the new year. Before we get there though, I think it is important to look back and recognize what was accomplished in 2019.

I started the connections of 2019 by orchestrating an entire blog series connecting with other great local businesses! This even included 2 giveaways to local businesses, and I am looking forward to hopefully coordinating more in 2020. I taught a new class this year on natural coping techniques for labor and delivery, and it seemed to go over really well with the students. I did not teach any group childbirth classes, but I did teach some private childbirth education courses. I had a few speaking engagements as well at Common Grounds connecting and growing with fellow entrepreneurs and at Central High School with students too!

Making connections and growing with fellow doulas and childbirth professionals was also an important priority for me in 2019. I hosted a certified lactation educator training, a birth doula training, and a TENS training for doulas in 2019. I helped plan a meet the doulas evening where we hosted potential clients who came to ask us all kinds of questions. Some of my favorite conversations happened around my kitchen table at our doula gatherings too, and those connections are always extra special. Additionally, I became a member of the Southwest Indiana Breastfeeding Coalition, and that has been really great way to learn, connect, and grow with all kinds of local lactation professionals too.

I made connections and grew through learning and the wider profession a priority in 2019. I continued serving on the data collection subcommittee of the advocacy committee of DONA International, my certifying organization. I attended and received continuing education at 5 online conferences through GOLD Learning. I presented and attended the Evidence Based Birth Conference in Lexington, KY. I reviewed three books for the Lamaze International blog this year too. I also cultivated connections with the whole wide world through the launch of The Birth Geeks Podcast with my friend and doula mentor Robin Elise Weiss.

All of these connections and growth, local to international, doula to client, brain to information, face to face, they have all been so very special to me. I am proud of the work I have done this year, and I haven’t even started talking about my connections with my amazing clients. (That’s for my next blog post.) 2019 has been a special year as I have stepped whole-heartedly forward and grown with each new connection that I have made. These connections have sometimes been hard won, but I would not trade them for the world. Thank you to every single person whose connections have been invaluable to my amazing year.

Families Deserve Support

The continuous support of a doula is supported by science!

The continuous support of a doula is an evidence-based approach to improve outcomes, decrease intervention, & increase satisfaction. Multiple scientific studies and committee opinions have concluded that doulas make a difference! This is an easy to read summary of the evidence if reading academic text isn’t your thing. As a birth doula, I believe that all birthing families deserve support, and not just on the big day.

These are the kinds of support that I have been able to provide for my clients in the past:

Prenatal

Knowing what all the local options are for prenatal care and planning for birth. Calming fears is another thing I do to support my clients in the prenatal period, and this comes in many forms, but most often through education. I also find myself supporting clients prenatally by connecting them with trusted professionals. This can be for all kinds of things including prenatal massage, chiropractic, and more. I also am happy to share my shopping tips when clients are looking for specific things!

Birth

As a doula, during birth I am giving physical support by helping my clients move around. I give hand massages and help keep their gown closed as we walk the halls. I also like to say that I help clients ask more questions about their care. This is part of helping them know what all their options are as well. I like to say that sometimes I help them order off the secret menu of options that aren’t necessarily the norm, but are perfectly fine to request.

One area that I wish I could support birthing families better here is during cesarean surgeries. All families deserve support, and it can be so hard for families when their plans go sideways. In many other places in the United States, they allow doulas in the operating room as a second support person. Doulas are even trained in how to behave inside an operating room, and how to support clients having a cesarean. Doulas are not currently allowed in operating room of all our local hospitals, but maybe we can change that in the future.

Postpartum: direction to proper resources & support!!

The most important thing that I can do for birth doula clients is to direct them to the people who are actual experts in the things that they are dealing with in the moment. If they have questions about breastfeeding, I make sure I send them to an International Board Certified Lactation Consultant. That is just one example, but knowing WHO to ask questions is really important. Breastfeeding is a great example because so many people don’t really understand how little training most physicians have in breastfeeding science, and they end up getting non-evidence-based advice despite best intentions by everyone involved. Part of my job as a doula is helping clients connect to the right people for whatever questions they might have. I don’t always have the answers, but I do make it my business to know who to send you to.

I have not had the capacity to serve postpartum clients this year, but VERY soon, I am going to have an announcement coming, so be on the lookout for that in early 2020!

All families deserve the support of a doula. Part of my job is helping insure you get the right support at the right time from the right people. I’m constantly learning, so I can continue to know the best local and online resources for my clients.

What was the most helpful resource you found to help you after you brought your new baby home?

Midwives in Southwest Indiana?

Evansville needs midwives to support healthy birthing families!

Southwest Indiana needs midwives, and the lack of them here is surprising. It is frustrating for me as a doula for several reasons. Our area deserves to have midwifery options, especially as midwifery care has proven benefits for patient satisfaction, cost, and birth outcomes.

What does the landscape look like for people searching for midwifery care here? We currently have two Certified Professional Midwives that travel here for home births, one from Bedford and the other from Bloomington. However, home birth is not an option for everyone. In 2019, we only have one Certified Nurse Midwife catching babies at one Evansville area hospital.

So what is the big deal? Midwives are experts in normal pregnancy and birth. According to the Midwives Alliance of North America “all midwives are trained to provide comprehensive prenatal care and education, guide labor and birth, address complications, and care for newborns.” Midwives are not surgeons, and all obstetricians are, which fundamentally changes the way that they approach your care. The Midwifery Model of Care “whether practiced in clinics, private homes, hospitals or birth centers, has at its core the characteristics of being with women, listening to women, and sharing knowledge and decision-making with women” (MANA). Midwives expect pregnancy and birth to be normal and watch out for signs that pregnancy, labor, and delivery might need intervention. That is not the same approach as an Obstetrician, and if you want to read more about the comparison or some social science research about this I highly recommend this book and especially this article and this one too from Robbie Davis-Floyd. She is the most renowned anthropological expert when it comes to this stuff!

Midwives have also been proven time and time again to be linked to better outcomes for their patients. People who use midwives for their care are THREE TIMES more likely to be satisfied with their care when compared with obstetrician-led care. Midwifery care has also been shown to be the most cost effective care in the hospital setting.

Who cares? Well, I do, and I’m not alone. I chose midwifery care for myself when I delivered my babies in Cleveland. As a doula, I regularly get asked for recommendations about providers, and I can’t even count the number of disappointed people I have talked to when I tell them that there is only one midwife here in town available to catch babies in one hospital. There are plenty of factors that go into choosing a provider, including insurance, location, practice style, personality, and so much more. While one midwife is certainly better than none, people choosing to birth here surely deserve more options. We need more midwives in Southwest Indiana.

For a little comparison, just down the road in Owensboro, KY there are 4 Certified Nurse Midwives catching babies at the hospital. Owensboro has a population of around 60,000. Evansville has a population of >115,000! If we include the populations of the surrounding 5 counties (Gibson, Posey, Spencer, Vanderburgh, & Warrick) We have a local population of over 320,000 people, and we know that there are people traveling here from Northern Kentucky, Eastern Illinois, and even further counties in Indiana to give birth, and they aren’t even included in that population count! Not every pregnancy and birth here needs to be attended by a surgeon. Yes, family practice physicians are also an excellent option, and there are some great ones here, but midwifery care is more specialized and has a different approach than the medical model of birth.

Southwest Indiana needs midwives, and we have some currently working to complete their training. As I sit writing this I know three midwives who are currently in school and planning to practice here when they graduate. Two will be Certified Nurse Midwives who catch babies in the hospital and one will be a Certified Professional Midwife who attends home births. Growing families deserve options for their care, and these midwives will be an amazing addition to our community when they are finished with their training. I can’t wait for the day when birthing families in Southwest Indiana have more midwives to support them as they grow.

Have you ever considered hiring a midwife instead of a physician for your pregnancy, birth, and postpartum care?

I Remember

October 15th is National Pregnancy and Infant Loss Remembrance Day.

I remember the overwhelming feeling of gut-wrenching sadness that washed over me when I saw your parents faces knowing that they were not going to get to meet you because you were already gone.

I remember being so worried that I would say the wrong thing to them, when holding space for their experience and pain was really the most important thing I could do.

I remember seeing your sweet face that looked like them, counting your toes, and learning words I never wanted to need to know.

I remember crying right along with your parents and almost every single other person in that room as the pain of wondering what could have been leaked out of our eyes.

I remember that you were so LOVED. We all couldn’t stop looking at your beautiful face.

I remember the sobs that followed when you left the room so the nurse could get you wrapped in a blanket. Bless those amazing nurses for walking this path with families far more often than I ever have had to and with exemplary grace and reverence.

I remember realizing that birth and death are so much more closely linked than I ever realized before you were born sleeping, and I will always feel bonded to your parents in a way that we never would have wished. You were love and abject sorrow wrapped in a tiny baby blanket, and we were all changed by you. Your footprints will forever be on my heart.

October 15th is National Pregnancy and Infant Loss Remembrance Day, and today we remember all the families who have suffered one of the most tremendous losses imaginable. As a doula, I am honored to hold space for you.

I remember RG & DT!

1 in 4 pregnancies end in loss.

October is Pregnancy and Infant Loss Awareness Month.

Who do you remember?

4cms is NOT Active Labor

Active labor starts at 6 centimeters

Many moons ago, we thought that once you reached 4cms, you were in “active labor” and the pace of your labor should start to pick up and keep going no matter what. In 2010 Zhang and colleagues published a groundbreaking research study that re-examined labor patterns and redefined the beginning of active labor as starting at 6 centimeters! This was a HUGE academic smack-down of the 50+ year standard of Friedman’s curve that defined active labor as starting at 4cms.

Why does it matter? The BIGGEST reason physicians were recommending cesarean section in 2011 was “arrest of labor” or “failure to progress” and apparently they were making the call far too early! You can read more about that whole thing here. After this study was published, the American College of Obstetrics and Gynecology (ACOG) came out with this position paper saying, whoa, let’s slow down this trend in the rise of cesarean births, and even outlined why and how. That position has since be reaffirmed multiple times by ACOG, BUT, I am still not seeing all local providers using this evidence in their practice and I still hear some providers and staff telling people that they are in active labor when they are 4cms. Look, your Aunt Becky might not know the evidence, but you surely hope the people taking care of you are up to date on best practices from 5+ years ago right?

The evidence is clear: If you are 4cms dilated, you are NOT in fact, in active labor. Your labor still has a chance to stall out or even stop. While that is frustrating news if you are in that position, it is also good information to have in case someone might suggest that something is wrong because labor stalls and that you need to DO something about it. Labor takes time and patience. If you are not in active labor yet, leaving is actually an option. (And no, your insurance will not refuse to pay, that is a myth that has been debunked many times over including here.) As long as everyone is safe and healthy, asking for more time to allow your labor to progress without unnecessarily intervening with medicine you might not need is NOT an unreasonable request. Remember to use your B.R.A.I.N (Benefits, Risks, Alternatives, Intuition, & Nothing or Not Now), sometimes that N of NOTHING is important to remember to request!

As your doula, it is my job to know that 6 centimeters is when active labor begins and to help you remember to ask great questions about your care! Getting to 6 cms is typically what takes the longest time, and I help people cope with getting there physically too. I promise I do try not to geek out too much while hanging with clients in labor, but it does happen.

So remember 6 centimeters is when active labor begins!

My Goals as Your Doula

As a doula, I listen and follow your lead.

  1. Support you and your family how you want to be supported.

End of list.

Yes, seriously.

As a doula, I listen and follow your lead. If you want information about anything pregnancy or birth related, I am happy to help you find great and unbiased information about all your options. I love answering pregnancy and birth questions, but make a big effort not to inject my opinion into any of it. That is because my opinion about what you should do is pretty much irrelevant. I do not tell people what to do, and completely understand that there is no one right way that works for every birthing family and every situation.

Most people only think of the physical support a doula can offer, and that is certainly part of the job description, but it definitely is not all of it. I hold space for my clients to give them room to think things through and listen to their gut without an audience. I talk through tough decisions and help you get to the root of your desires for your birth. I am an empathetic ear when you are frustrated, excited, anxious, worried, elated, exhausted, etc. I also don’t have ALL the answers, but I am really great at helping people wade through the sea of information out there to find excellent sources and resources too.

In my 5+ years as a doula, my practice has certainly changed, but my #1 goal has always been steadfast, and I don’t ever imagine it will change! I have no agenda for your birth; I only want your family to feel fully supported as you would like to be. I truly strive to check any bias I might carry and leave it outside of the space of your blossoming family.

Would you like to have an extremely knowledgeable, experienced, and compassionate person in your contact list and at your birth? If you said yes, then I would love to talk to you about birth doula services!

Doula? A do what now?

Midwives and doulas have very different jobs!

One of the most common misconceptions that I run into as a doula is that people think that we are the same as midwives. While I have worked with some really great midwives in my time as a doula, and LOVED having midwives catch my own 2 babies, I do not want to be a midwife or be confused for one. Doula care can compliment midwifery care very well, but we certainly do not replace a midwife.

As a doula, I do a whole lot of things that can improve your pregnancy, labor, delivery, and immediate postpartum. I help you ask more (and sometimes better or more specific) questions prenatally and think through all those decisions about what you want for your delivery before it is actually the big day. I help you practice different comfort techniques and even help you know exactly what things you actually need to have for your birth and immediate postpartum period either at the hospital or home. I hold hands and help people move around, sometimes with all kinds of wires attached to them. I push on your lower back, squeeze your hips, and massage your hands during labor. I help you to the bathroom and comfort you through the challenges of labor and deliver with all kinds of affirming words. I will let you squeeze my hand and listen to the changes in your voice and demeanor for clues on how I can better help you. I do not doula the same for any two births, as each one presents its own unique set of circumstances.

Midwives provide care for healthy pregnant people prenatally, during labor and delivery, and postpartum. They approach birth differently than an Obstetrician, but essentially do all the medical things an OB can do other than surgery. Midwives view birth as a normal process and often practice watchful waiting while expecting everything to be perfectly normal and fine instead of trying to prevent things from going wrong through action. It can seem a very subtle difference in philosophy, and not all midwives take this approach, but this is the midwifery approach generally to pregnancy and birth.

  • A short and completely non-comprehensive list of things a midwife can do that I do not as a doula:
  • Check your vital signs like blood pressure and temperature
  • Order labs
  • See you for in-office prenatal visits (monthly, biweekly, then weekly)
  • Check your cervix
  • Catch your baby
  • Give you stitches
  • Check your fundal height after delivery
  • Order and administer medication

If you want to learn more about midwives, this link is a good place to start.

If you would like to learn more about doulas, you can read about us here. I would also LOVE to talk to you about my services! You can contact me through this website, via email, phone, or message me on social media–whatever you are comfortable with is fine with me. You can read reviews from previous clients and check my availability at this link as well if you would like.

I love helping my clients navigate pregnancy, birth, and postpartum, and have more than five years of experience as a doula at both hospital and home births. I have worked with some amazing midwives and OBs too. I have been to 8 different hospitals as a doula and learned all about their policies and who has which equipment. I know which cabinets have the towels and where to find the emesis basins. More than that though, I support my clients however they want to be supported, because each one is different and each situation demands different techniques and approaches.

Someone once asked me what the #1 most important quality is for a good doula. That was easy for me to answer: EMPATHY! What I may lack in midwifery clinical skills, I make up for in compassion and listening skills. Midwives and doulas can work really well together and there is definitely room for both in your chosen birthing space!