Category: Thoughts

Ask Questions!

As humans, we like to ask questions. As patients, we are often not encouraged to do so. That is a problem. You are in charge of your body. You are in charge of what happens to it. That means that nobody gets to do things to you without you saying yes; that’s bodily autonomy. You deserve to be given true information to make the best decision possible for you and your family. As a doula, I encourage my clients to inform themselves as best they can and find a provider that they trust to be able to have open and honest conversations about your care.

Misinformation can spread like wildfire, and you have to be mindful about who you are getting your information from, even when you might trust the source for other things. Just because your mother gave birth 25 years ago does not mean that she is up on all the latest evidence regarding birth practices. Just because your neighbor had a fantastic planned cesarean does not mean that committing to major surgery is what is right for you or guarantee that you will have similarly easy outcomes. The point is this: question the source and motives of anyone giving you information!

This is a short list of things I often hear about that are NOT TRUE:

  • Once a cesarean, always a cesarean. (VBAC is an option!)
  • Everyone should be induced at 39 weeks. (Nope)
  • If they think your baby is big, you have to schedule an induction or cesarean surgery. (Nope)
  • Induction is no big deal. (Not always)
  • Laying flat on your back is the best pushing position. (Not according to the evidence)
  • You are in “active labor” at 4cms. (Not since 2010)
  • There are no risks to getting an epidural. (Not true)
  • Doulas are judge-y jerks who only help people who want to go without medication! (not me) I could honestly write a whole post about ideas about doulas that are wrong, but that is for a different day.
  • Home birth is not a safe option. (There is plenty of evidence to say it is.)

The truth is that everyone you ask for their advice is informed by their own knowledge and experience. Your great-grandma may have LOVED being asleep for the birth of her children, but that just isn’t how most people choose to birth anymore. Your doctor may have had a string of 3 traumatic deliveries that they attended in the week before your appointment. Your sister may have had a medical condition that necessitated her induction. You need to make sure to temper any opinions you get with unbiased information too, and then figure out what you would like to do using the BRAIN method:

  • Benefits–Why are you suggesting this intervention?
  • Risks–Is there anything negative that could happen?
  • Alternatives–Are there other options available?
  • Intuition–What is your gut saying you should do?
  • Nothing–What happens if you do nothing?

That last one is REALLY important to remember. If nobody is in danger, it is perfectly prudent to ask for more TIME! Sometimes doing nothing is a perfectly reasonable option, and you are well within your rights to say no to interventions being offered in a non-emergent situation. Even when a non-emergent intervention such as a cesarean needs to be done, it is also perfectly ok to ask for a few moments to gather your thoughts and prepare your mind for what is to come. Though some do, not all necessary cesareans need to RUN to the operating room, and a massive shift in plans can be a bit easier to stomach if you have a moment to wrap your head around it before it happens.

The Rights of Childbearing Women is a great place to start when thinking about what you might want to question. You are not a bad patient for asking questions! Some people prefer to have a provider who tells them what to do, and that is ok too by the way, but if you prefer to have a provider who is open to communicating with you and explaining their reasoning for recommendations, I HIGHLY recommend checking out your options and knowing that you may have the option of switching providers for any reason and at ANY time. Providers all have different styles, and finding one who fits with your style is a GOOD thing. Not all providers are created equal, and sadly there are providers who are less than honest in their recommendations. Trust your gut! Don’t be afraid to speak up, ask questions, and switch if you feel like your provider is trying to push you into something you are uncomfortable with and isn’t necessary, including using coercive techniques to persuade you.

If you want to do research, here are some trusted sources for good information that I send to my clients:

If you are a childbirth professional and you want to learn more about your clients’ rights in childbirth, you can check out Birth Monopoly’s Know Your Rights course designed specifically for us in mind.

Dads Doulas Love

Some dads are just the best.

Father’s Day is this weekend, and I want to give some special shout-outs to some of the amazing dads that I have had the privilege of working with in my time as a doula. Before I go there, let me just say that as a doula I ADORE working with some fathers, and not always for the reasons that might be so obvious. There are some rumors out there that doulas replace dads, and frankly that is insulting to both of us in my opinion! First it is insulting to fathers, as it assumes that I am sooo good at my job as a doula that I can possibly get to know a birthing person better than the father of the child they are about to bring into this world. While, yeah, that *might* be possible in some odd constellation of circumstances, for the most part, that is just not true. Secondly, it is insulting to me as a professional, because I am in no way ever trying to replace anyone’s partner for any amount of time.

I LOVE all kinds of fathers for different reasons, and these are 3 types of dads that I think they are ever so special for bringing what they do to the birthing room, wherever that is!

  • Super-involved & helpful fathers are really easy to love as the doula. These are the guys that step into the situation that they may never have been in before and step-up to help as much as they can. These are the guys that ask me pointed questions about how to do better hip-squeezes and where exactly on their partner’s back they should be pressing. They unflinchingly grab a towel to sop up the amniotic fluid that dripped on the floor and watch me like a hawk to see what angle I’m holding their partner’s leg at so that they can do the same. They are enthusiastic, very much present in the moment, and do everything they can to help the process. But these are the easy dads for a doula to love for so many reasons, the biggest reason being that they help make my job easier.

This next one might be a bit more surprising:

  • Dads who made sure I was hired to help because they know they can’t are also big on my list. The fun part for me as the doula, is that I often don’t know that this is why I was hired until we are actually in the moment. This includes one dad that everything medical made him nauseous, so he stayed flat on his back on the couch in the room with his eyes covered the whole time we were at the hospital and kept apologizing to his partner. Seriously, it was the sweetest thing ever and I felt so bad for him throughout the entire birth. These dads know their own limitations, whether they are spoken to me or not prior makes zero difference to me as the doula. I LOVE that they ask for what they personally and their partners need, and honestly wish more people would.
  • Skeptical turned overly appreciative dads might be my favorite though. These are the guys that weren’t sure that they should be hiring me to help at the birth, and it is sometimes clear that they are really just humoring their partners when they agree to spend the money on hiring a doula. These are the dads that eventually become my biggest cheerleaders afterwards. It isn’t that they think they know everything about birth and how to help their partner get through it, rather they are more typically skeptical about spending the money on a doula that may or may not actually be helpful when it comes to the birth. I appreciate the skeptics especially, probably because I tend to be one myself.

As a doula I work with partners to see how they want to be involved. I NEVER want to replace a partner, and always want to help encourage that relationship in this most amazing moment of change. Fathers are special, and there is no possible way I could replace one, even with all my expertise and experience. I help partners participate in a way that they are comfortable with and without requiring them to become experts on childbirth.

Happy Father’s Day to all your amazing dads out there! I hope your day is full of relaxation and appreciation for all you do for your families!!

If you want to read a little more about Dads and Doulas, here is a blog post from DONA International on the subject that debunks some of the myths.

What is your favorite pro-tip for all the new fathers-to-be??

Bridges

May is International Doula Month, and I am all about building bridges right now in multiple different directions!

Doulas are ALL OVER the news lately for lots of reasons, but definite thanks goes to Amy Schumer & Meghan Markle for bringing doulas to the forefront! Go Doulas go! I am sooo happy to see this profession grow!!!

That picture above is one I snapped while driving to a client’s house and I really just loved the view because I had never been there and I could not see the other side of the bridge as I approached. I am a bridge builder by nature. I want to connect people with each other and with the information and resources they might need. That is most definitely part of my job as a doula!  

As I mentioned here before, I like to pick a word for the year to help guide me, and this year’s word is: CONNECTION! Locally, I am trying not only to create greater connection among businesses that also help serve growing families, but also between new doulas and potential clients. I worked with other local doulas to hold a Meet the Doulas night, and we are already working on the next one!

I am cultivating connections between professionals who focus on pregnancy, birth, breastfeeding, and postpartum. I have been trying to expand my network of not just providers of medical services, but also with other businesses that I have featured here on this website. I have a few more connections coming up on the blog, so keep your eyes peeled for those! I keep reaching out to new businesses that might be interested in collaborating on different projects, so if you are interested, please feel free to reach out to me!

I am working to try to figure out how to bring a barrier-free doula training here to Evansville! I have held two DONA approved birth doula trainings here, but I know there are more people who would like to be doulas but may have just had trouble figuring out how to make it happen for whatever reason. This would mean that people who wanted to become a birth doula, but have barriers in their way (finances, childcare, etc), could have access to this training. This is probably the biggest project I am working on at the moment, fueled especially by the messages and advocacy work of the March for Moms and 4Kira4Moms. I’m not afraid of big projects, and I really believe that the more doulas we have locally, the more people will want to use doulas. Hooray for the abundance mindset!

Another local project that I would really like to help move forward is to facilitate greater continuity of care between people who are seeking home births and their parallel care providers who hopefully can be waiting to help just in case and in the open. The lack of continuity of care currently is a true disservice to people who choose to birth at home, and I know that the lack of transparency is not good for ANYONE!

I’m also trying to help the newly formed Southwest Indiana Breastfeeding Coalition develop and grow, and we have a really cool new project that we are excited about where we are collecting survey data to hopefully recognize businesses that really support breastfeeding parents with their policies! If that sounds like your employer, you can answer the survey here.

On a much grander scale, I am in the middle of developing a bigger project for childbirth professionals, and you should check it out if you are interested! It’s called The Birth Geeks! There’s a podcast and more coming!

Bridges connect people. Bridges bring two places together. Bridges are helpful. Bridges are carefully engineered and crafted. Bridges are not easy, but are VERY needed, and for the record I’m not allowing any trolls under mine!

A Doula’s Price

When you hire a doula, you get so much more than just a professional attending your birth! From the time that I am hired by my clients, they essentially have access to all the resources and information I have for them, with my cell phone number to call or text. Pregnancy and birth can be stressful, and part of what I do as a doula is help mitigate that stress with answers to your questions!

There are all kinds of costs to the doula for both being a doula and for attending your birth. A few that come to mind right now are training and continuing education, professional memberships, childcare, gas money, supplies for your doula bag and office, software, website, etc. The BIGGEST costs to me as a doula are ones that many people don’t think about though: my TIME and my FREEDOM!

What does it mean to be on call, really?

Being on call means that I have to be ready to drop my life and go help my client at any moment. I have to have childcare lined up for my children at all hours, and honestly that is one of the biggest barriers for many people who want to practice as a doula. Let me illustrate with a story.

Recently my husband had to leave town for a work trip. It was a last minute meeting at an office 3 hours north of where we live, and he was going to be gone from 6:30am that morning until 10pm that night. My children are in elementary school, so I have the ability to take them to care at school at 6:30am and I can pay for them to stay there until 6pm. I knew that if I was at a birth, my husband could drop them off at school before he left, but what if I was at a birth past 6pm and couldn’t pick them up in time? I made arrangements for a babysitter to come to my house from the time my children get off the bus at 3:20pm until my husband came home at 10pm. Then my babysitter had to cancel at the last minute, and I had to call someone else to babysit but she could only be there until 7pm when she had a meeting. I had a gap in childcare from 7-10pm that I had to get covered. Thankfully we have family here in town who was willing to be on call just in case I needed help, but please trust me when I say that I know how lucky we are, and that not everyone has that kind of help available to them. All of this childcare was completely contingent on whether or not my client went into labor. I didn’t even know if I was going to need it, but I certainly had to have it in place just in case I needed to go help my client.

Childcare isn’t the only barrier that people who want to work as a doula have, and it certainly isn’t the only stress I have as a doula, but it is most definitely one of the hidden stresses that clients don’t even realize doulas have to navigate all of the time. Contingent childcare is also not free for everyone by the way; I know many doulas that pay a retainer fee for babysitters to be at the ready at all times. Not everyone has family members that they can call just in case they have to go to a birth. What happens if my husband has to travel out of town over night? In that case I have to have a babysitter who is able to come to my house at ANY hour to watch my children so I can leave them and help my clients.

I have to be available at any time for my clients. Please appreciate the fact that yes, that does mean that I get phone calls at 3am to leave the house and go meet my clients wherever they are. When I leave the house to meet a client, I have no idea when I will be coming back or how long I will be working. Birth is unpredictable like that. Sometimes I barely make it to a precipitous birth and sometimes I am there for 2 days. There is absolutely no way I can know how long I will be gone before I go!

I am on-call for my clients from the time that they are 38 weeks pregnant until they have the baby. Sometimes they have the baby before 38 weeks and I still go help them. Sometimes they don’t have the baby until 42 weeks and 3 days, and I still go help them. I can’t travel more than an hour away from home during that time period. I can’t flit away for a weekend trip with my husband. I can’t go anywhere where I don’t have a cell phone signal for my clients to be able to contact me. Every single plan I make ends with the phrase, “as long as I’m not at a birth,” and my friends all know that. It is NOT easy!

Can’t I just call someone else to help?

Yes, that is a possibility, but again, this is a stress on a doula that many clients don’t understand. Calling someone else means that I have made an arrangement for that person to help my client during a specified time period. Maybe I have concert tickets and will be out of town for 12 hours to attend the concert. Calling in a backup doula means that I not only pay part of my fee to that doula to be on call for me for that specified amount of time, but I’m also making sure my client has met the potential backup doula before I even go and trusting my client with that doula if they happen to have a baby during that time period that I am unavailable–no matter how short. There have to be doulas available in the area, during that time period, who I unconditionally trust. How many people do you trust to do your job?

I have yet to meet a birth doula that is raking in the money. Yes, my fee can give some people sticker shock at first, but I am confident that it is the right one for my services, knowledge, and experience. I have done market research and even taken a class about how to set my fee. I know what I am giving up as a doula when I take on each client. I know that I sacrifice my time and freedom to help others, and I choose to continue doing it because I love my job helping families bring babies into the world. I also know that all of my work isn’t done in the room where birth happens. I have prenatal meetings with clients, answer all kinds of questions during pregnancy, during birth, and in the postpartum period. I bring all of my knowledge and experience to each encounter I have with my clients. I love my job, but I really wish that more people understood what all goes into the price of a doula and the price that we pay to be doulas. Don’t feel sorry for doulas because of how hard our job is, but DO try to understand where we are coming from when we set that price.

Cesarean Awareness Month

I took that picture above at Indiana University many years after I graduated and I was walking around campus with my family, and I saw the statue with new eyes–with my doula eyes. I had never seen the low-transverse incision mark on her abdomen before that day. It made me smile in admiration and wonder if it was intentional. I’ll probably never know for sure, but I like to think that it is.

April is Cesarean Awareness Month. This was started by
ICAN (International Cesarean Awareness Network) to direct attention to the fact that the cesarean rate in the United States is too high.
32% of American babies in 2017 were born via cesarean section according to the CDC. That number actually hides quite a bit though. That is the number for TOTAL cesarean births, as Jill Arnold explains on cesareanrates.org, and looking at the low risk first time cesarean data gives us a more accurate picture of what we should be targeting to change, especially given the lack of access to and support of VBAC in many places in the country. There are some amazing people working to try to reduce that first cesarean, including the American College of Obstetricians and Gynecologists with this statement originally published in 2014, and Neel Shah and his team at Ariadne Labs who are working to reduce medically unnecessary cesarean surgeries. Shah says that as many as HALF of all cesareans may actually medically unnecessary, and he is not the only one working to reduce that number!

Sometimes cesarean surgery IS necessary. Sometimes surgery saves lives. NOBODY is suggesting that there should be ZERO cesarean surgeries! I join the chorus of people saying that perhaps we should question the efficacy and long-term health consequences for individuals all the way up to the population level.

I’ve never had a cesarean section surgery personally, but I have been in the operating room as a doula for some. Cesarean surgery can be scary, especially if you don’t know what to expect and your support person doesn’t either. Many times you weren’t expecting to be in that operating room, or are questioning whether you should be there right then. Learning about what to expect before you go into the operating room is one of the things I talk about in my childbirth classes. In my first prenatal visit with my clients, we talk about birth preferences, and I always make sure to talk about cesarean birth preferences with every single client no matter what their plans are. Plans sometimes go awry, and knowing what your options are if everything else is going sideways is a great way to mitigate fear as well.

Cesarean birth IS birth, and great medical staff can make a world of difference. There are even some hospitals that will allow a doula into the operating room as a second support person, which can be extremely beneficial for parents who can often feel like strangers in a strange surgery land. I know I have learned so much each time I have been in the operating room, including how best to support a person undergoing surgery, what is normal and expected, what exactly happens in that surgery, which staff is in charge of what action, where to stand, what not to say, and soo much more.

I sincerely hope that more doulas will be allowed in the operating room as a second support person for people undergoing cesarean surgery! I hope that it becomes just one more way that doulas can support the rest of the 32% of births in this country!


Photo by Chris Ensey on Unsplash

Birth is amazing, no matter how it happens. I seriously believe that! The bravery of having your body literally sliced open to bring a child into this world is not lost on me at all. I honor and respect all cesarean parents, and know the sacrifice you have made for those tiny humans.

2018 Local Hospital Statistics

Progress!!

You can tell a lot about the culture of a hospital by their statistics.  Statistics tell us part of the story, and we should listen to them. Leap Frog Group collects voluntary data from hospitals all around the country and publishes them on their website.  You can put in your location and compare the hospitals in your area. I did exactly that 2 years ago, and so I wanted to revisit the information and see what kind of progress, if any, the hospitals I visit as a doula have made since I originally looked.

Photo by Piron Guillaume on Unsplash

In the below chart, I’ve compiled three maternity statistics for better understanding a hospital’s culture. Here are some things you should know before you see the numbers:

  1. Early Elective Deliveries are defined as elective induction or cesarean sections before 39 weeks.  This does not include medically indicated early deliveries. 
  2. This Cesarean Section data  is for NSTV (research speak for 1st time parents, 38+ weeks pregnant, with a single head-down baby) cesarean rates and does not include repeat cesarean deliveries. This is an important distinction. Leapfrog Group uses the Healthy People 2020 goal of 23.9% for primary cesarean deliveries in this category.
  3. Episiotomies are a cut made to the perineum during the birth process.  While sometimes necessary, routine episiotomies are not evidence-based practice.
  4. The numbers in (parentheses) are the previous numbers reported in 2017. I only looked at three hospitals that year, so apologies for not being able to compare for all the hospitals listed here.
Hospital Early Elective Deliveries Cesarean Sections Episiotomies
The Women’s Hospital 1.7% (1.4%) 22.9%
(24.3%) 		14.8% (18.5%)
St. Vincent’s* Medical Center of Evansville .8% (2.1%) 27.2%
(37.2%) 		6.8% (8.4%)
Owensboro Health 1.4% (2.1%) 29.7%
(30.7%) 		12.7% (19.5%)
Methodist Hospital of Henderson 2.4% 26.1% 2.4%
Memorial Hospital & Healthcare Center Jasper, IN 0.0% 12.8% 9.8%
Daviess Community Hospital Washington, IN 1.9% 15.2% 13.1%

*Listed as St. Mary’s Medical Center of Evansville on the website, but they have since changed their name to St. Vincent’s Medical Center of Evansville.
-Good Samaritan in Vincennes declined to respond
-IU Health in Bloomington, IN declined to respond

What a difference 2 years made!! Yes, there is always room for improvement, but these numbers give me serious hope that the needle is at least moving in the right direction. I take ZERO credit for these statistical improvements, but will most definitely celebrate these hospitals’ achievements.

The numbers certainly do not tell the whole story. As an anthropologist and doula, of course I would think that right? Qualitative data would be especially helpful for better understanding, and these are not the only numbers we as consumers should be discussing. I also want to know about quality of care and how people feel like they are being treated, including reports of obstetric violence.  

What about access to VBAC and hospital level data for VBAC? I can find state level data for VBAC, but nothing looking at the smaller and more specific picture. And in case you were wondering:

VBAC Rates by State, 2017

State Births after previous
cesarean as a % of all births 		VBAC rate of reporting state
Indiana 13.9% 12.8%
Illinois 15.6% 14.7%
Kentucky 16.9% 8.3%

What about physician specific statistics as well? I used to be able to find that data, but after much searching gave up. Where did it go? I’m also wondering why some hospitals chose not to report their data, though I can think of many innocuous reasons why they might choose not to such as deadline issues, personnel, etc.

Want to learn more? Start here:

Compare Hospitals at Leapfrog Group: http://www.leapfroggroup.org/compare-hospitals

Cesarean & VBAC specific information: http://www.cesareanrates.org

My Birth Matters by CMQCC: https://www.cmqcc.org/my-birth-matters

Do any of these numbers surprise you? Will this information influence your choice of birth location? Have you asked your provider anything about their statistics or those of the location where they work?

As Your Doula

I work for you.  I will give you all kinds of information about your birth options.  I will talk to you about your goals for your birth.  I will do research about anything I do not know, and come back to you with all the evidence I can find.  I will be there for you if you need to ask any questions during your pregnancy.  I will be almost as excited about your impending labor as you are.  I will wait anxiously by the phone for the call that might come in the middle of the night to come and join you while you are in labor.  I will come to your house, if you want to keep laboring at home or are birthing there.  I will follow you to the hospital or meet you as you arrive. I will hold your hand and tell you that everything is going normally, if it is.  I will decode any medical-speak you don’t understand and make sure that you are making informed decisions about your care.  I will squeeze your hips and try all my tricks to help you stay as comfortable as possible during your labor. I will call the nurse to give you your bolus of fluids for your epidural if that is what you want.  I’ll suggest position changes and help you move into them.  I will make you go to the bathroom every hour during labor. I will be there with you the entire time.  I will help guide you through the entire process, and I will love every minute of it.

I want for you to have the birth that you want to have.  I don’t care if you get an epidural; I still have ways that I can help you. If you don’t want an epidural, I know how to get you there too.  I want you to leave your birth feeling fulfilled.  I want you to feel like you accomplished something, because having a baby is a MAJOR accomplishment no matter how it happens.  I want you to feel like you were supported in every decision you made along the way, and that you had all the information to make each one.   I want for you to be happy with your birth, exactly how it happened, no matter if it was to plan or not.  I want so much for you to completely exhilarated and excited about your birth, so much so that you can’t wait to tell the story to anyone that will listen.

I believe that birth is amazing.  There is nothing more exciting than getting to watch a new baby come earth-side.  Getting to be a part of that process is what makes the job of a doula so rewarding.  I believe in this work and its value.  I believe that this job makes a difference not only in the lives of the women we serve, but also in all those that we touch through our service: the nurses and other hospital staff, the physicians, the midwives, the family members, and the friends. I believe that one birth at a time, I am making a difference in the way that birth is viewed and approached.  Most of all, I believe that this work is my passion.

Doulas make a difference.  Doulas everywhere want to change birth one mother at a time. Doulas are evidence-based.