Something Stinks!

Do you have a super sniffer during pregnancy? Why? How do you cope with it?

Pregnancy can be really challenging when all of a sudden your sense of smell seems to be supercharged. For many people, super-smell is one of the first symptoms that they notice in their first trimester. When I was pregnant with my first child, I had an immediate reaction if anyone in my midwife’s waiting room was wearing perfume. YUCK! All of a sudden my husband smelled like he was a bathing in sausage water and walking into our pantry would instantly make me run to the sink. When my husband brought me a beautiful bouquet of stargazer lilies that I used to LOVE, I couldn’t even walk into the house with them there. Your sense of smell makes a huge difference in what you eat and how well you can keep the contents of your stomach inside of you too.

Why??

I found this article that reviewed all the scientific evidence about pregnancy and the sense of smell. What we know from science is that most people (90%) report having a sudden repulsion to certain smells, while only 10% find any smells better than when they weren’t pregnant. There are several theories as to why, the leading one which seems to be that it possibly helps you avoid toxins to protect the growing baby inside of you. They even gave people pregnancy hormones to try to see if it was hormonally related, and the results weren’t very conclusive. Another study summarized there didn’t find any heightened sense of smell in their participants between first trimester and postpartum. The author of course also adamantly notes that an abundance of anecdotal evidence exists to support increased olfactory senses during pregnancy, and suggests further research into the phenomenon. There are plenty of other theories, but no true abundance of evidence points to one simple explanation why 2/3 of people report super-smellers during pregnancy.

What Can You Do?

Stink happens, but how can you really deal with ALL the smells that make you want to hold your nose? I personally took a page out of the Victorian era playbook: I kept something good smelling in my pocket. This could be a favorite lip balm, a handkerchief with some essential oils on it, or even a vapor inhaler if that menthol smell is still appealing to you. Wearing a tight fitting N95 mask is another option that we should all be familiar with now too. I knew one friend who suffered so much with Hyperemesis Gravidarum that she actually kept alcohol wipes in her pocket in case a wave of nausea overtook her. Trying to keep track of all the smells that are terrible isn’t honestly worth your time though, because they could change and you’re sure to encounter some unexpectedly. Be prepared, and don’t be shy about keeping emesis bags in your car and purse in case you need them. Maybe your super sniffer would feel better going to somewhere that will 100% smell good, like a spa?

Rest assured, most people report that their super sniffer skills fade when they aren’t pregnant anymore. I promise you that my husband doesn’t still smell like he’s sweating sausage water and grandma perfume doesn’t make me instantly hurl anymore. Some aversions might stick with you, like I still can’t smell stargazer lilies, despite the fact that I really do think they are beautiful. I also can’t eat saltines anymore, but that has nothing to do with smell and more to do with the memory associated with eating far too many in my first trimester. You may be too busy changing diapers to even notice when your sense of smell goes back to normal, but you will 100% appreciate that fact when your baby starts eating solids and their poo changes smells again.

Our Non-Negotiables

Since 2014, I’ve been working here in Evansville, Indiana as a birth doula. That was the year that I formed the Doula Group of Evansville with a few other doulas. Though we’ve been through several different forms since then, the core values that we started with have always remained the same. I recently realized that we’ve never really publicly declared them, though they definitely come up in every conversation I have with potential doulas who want to join the team. We want you to know our values, because they are very important to us as a group. We come from a place of learning and acceptance, and aren’t trying to force anyone to think or do anything with these. The thought behind making these public is so you can know us better as a group. We want you to know where we stand and how we approach things, including how we do business and how we put our values into action in our services. 

(Side note: Documentaries are one of my favorite things to watch. I recently watched a documentary on a cult, and the leader made all her insiders sign some document that detailed her non-negotiables. Let me tell you, that list scared me, especially as I’ve been using the term “non-negotiables” for a few years with regards to our values. I promise, this short 3 item list is nothing like that.)  

1. Science is Real

I LOVE science! One of the reasons that I wanted to become a doula was because I was so upset about the gap between what we know and how maternity care is practiced. I read Henci Goer’s The Thinking Woman’s Guide to a Better Birth during my pregnancy and my mind was blown. One of my favorite things about science is that it changes; with new information comes new ideas and eventually, new practices too. We learn all the time that new doesn’t equal better either, and that can be hard, especially as techno-loving Americans, but I digress. 

When I say that we love science, what I don’t mean is that we believe there is one right way that works for everyone. I’m a social scientist with a PhD and I’m pretty sure they’ll come take my degree away if I say something so absurd as that. I’m also not saying that science has all the answers. What I am saying when I state that one of our core values is that science is real, is that we believe the scientific method is the best framework for understanding what is going on in reality. When we “do research” we’re looking for scholarly articles and trying to understand what the scientific consensus is, and we’re being picky about our sources. We know that anecdotal evidence is one source, but we want you to show us the numbers behind the assumptions. We ask questions like, “what is the absolute risk” instead of being persuaded by “the risk doubles” type of relative numbers arguments. We know that a scientific understanding can help us make more rational decisions based on actual evidence and not coercive language. Feelings are important, and knowledge can be powerful. 

2. Anti-Racism

We work to actively proceed from a place of anti-racism. That means understanding that some of us have privilege in this world because of our presumed race, and racism is a massive problem. This holds especially true in healthcare, and everyone on this team has committed to learning about the effects of racism and how to affect change by working in and through an anti-racism framework. If you’re unfamiliar with anti-racism, this community curated bibliography is a great starting point for learning. We know that being “not racist” is not enough, and we are attempting to do better. 

We also know that people deserve to have a doula on their team that understands their perspective from the inside and not from any sort of savior perspective. We have very intentionally built a team of doulas who reflect our community and the communities/families that we want to serve. We take that service very seriously, especially for BIPOC families who are at risk of experiencing medical racism that increases their morbidity and mortality as they welcome new babies into the world. We see you and are here if you want support and resources.  

3. LOVE the Rainbow

We are cognizant of the ways that some businesses seem to want to capitalize on their lip-service to the LGBTQIA2S+ community, and that is not us. Some of us identify as part of the “rainbow community.” Several of us have children who identify with the LGBTQIA2S+ community. Everyone on this team is an ally/accomplice, and will ask you your pronouns. We approach our doula work with LOVE and know that LOVE is what makes a family. We will always do our best to make sure all our client families feel seen and heard by us. All the doulas on this team LOVE our LGBTQIA2S+ community, family, & friends, and that goes so much deeper than tolerance. We also specifically seek out learning opportunities to better understand how to be/do better at using inclusive language, Supporting Queer Birth, & how to be better allies/accomplices. 

Who We Are

We are a group of doulas working to help make our community a better place for all families. We do that by helping families go from expecting through beginning. These 3 non-negotiable values are the starting points to everything that we do as a group, and how we choose to focus our working energy. You don’t have to believe the exact same things as we do, and we promise we have served all types of families who don’t believe these things at all. These are not a dogma that we are attempting to force on anyone; we just want to be transparent about our values. Most of all we approach this work with curiosity, love, and hearts for service. We seek to understand our clients so that we can better serve their specific needs. These non-negotiables are unapologetically part of who we are.   

Becoming a Doula

Way back in 2014, a mere month after walking the stage to receive my PhD in Medical Anthropology, I traveled to Louisville, KY to attend a birth doula training with the brilliant Robin Elise Weiss. Since then I’ve attended more than 200 doula client births and learned so much along the way. This is the story of how I became a doula.

When I got pregnant during graduate school (not something I recommend btw), I voraciously read everything I could about pregnancy, birth, and postpartum. I could not get enough, and I even had professors sending me articles about how babies learn language before they are born. Naturally I scheduled my German conversation course for the spring semester while I was pregnant. By the time I neared the end graduate school I’d had 2 children and wasn’t sure I wanted to be an academic. That was when the idea to become a doula really started to take hold.

I started in 2013 by networking with other doulas in Evansville, and oh my goodness they were all soo nice to me. They invited me to a “doula night” at one of their houses where they talked business, trainings, & all things doula. One of them even had a placenta in their freezer, and I knew these were my people. I was hooked. I went to the training in June 2014, and have been taking clients ever since then. None of those doulas I met that night are still taking clients, which speaks so much to how challenging this job can be, especially the unexpected bits of it.

The Unexpected Bits

I didn’t expect to need to run my own business. I know that sounds naïve, even to me now, but it is the truth. I wanted to help birthing families sure, but finding clients, building & maintaining a website, setting up the proper legal paperwork, social media, paying taxes, networking, and all that jazz were not part of the thought process of getting started. I may have had a PhD, but I had much to learn about business. I’m happy to say that I feel much more confident now, though the imposter syndrome does sneak in occasionally.

The challenge of life on call was not something I was wholly prepared for in the beginning. As a birth doula, I have to be ready to leave my life for a couple days with sometimes not much warning. I have to be willing to miss holidays and plays and family events to go be with my clients. When my kids were little, the biggest challenge was having childcare ready at any moment of the day for possibly an entire month of 24/7 on-call time. This is the part that I always talk to people thinking about becoming a doula about, because not everyone has the resources to be able to do that. The reality of how much energy being a doula takes also almost always has new doulas re-thinking how much they charge for their services, though that is a topic for another time.

The best unexpected bits have been the amazing connections that I’ve been able to make with clients and their families. I’m forever grateful to be a part of some of the most memorable moments of their lives. There are so many families that I’ve had the chance to meet and be part of that I would never have met otherwise. That is something so beautiful about this job and I’ll never take it for granted. Though it does sometimes make it challenging to walk through a crowd without someone yelling my name and getting random hugs. (BONUS!!)

Learning

I’ve continued learning from some of the best doulas around the world, and I’m going to keep learning probably forever, because that’s just my style. I’ve gotten amazing doula agency business advice from Jessica English. I took a brilliant postpartum doula training from Jen Chandlee. I continue to learn from Ann Grauer, who also trained the 2 other postpartum doulas on my team. I am learning about leadership in the doula world from Melissa Harley & Nikia Lawson all the time too. I’m sure this year will be a huge one of learning, as I step into the role of President at DONA International.

I’m asked all the time about how to become a doula. This is my story. I started with DONA International, and have worked hard to keep learning and growing as a doula. I have an abundance mindset, and I honestly feel like that has helped bridge so much learning and connection for me. It is also why I’m passionate that more people in Evansville should learn to be doulas too! I love talking to new doulas and am HAPPY when more doulas are trained here. I started Doula Group of Evansville so that more families could be supported by doulas and more doulas could feel supported by each other.

Ever thought of becoming a doula?

Becoming a doula has been one of the best decisions that I’ve ever made. It hasn’t been easy, but it has honestly been more rewarding that I ever could have imagined. If you’re thinking about becoming a doula, please feel free to reach out to talk to me. I will continue to pass on the kindness shown to me by the doulas here back in 2014 by always being willing to share my experience with others who might be interested in traveling this path too.

The Latest Local Maternity Statistics

Statistics reflect the culture of a hospital and the institutional priorities. What has changed here since 2017?

Anyone who has met me can tell you that I’m a huge fan of data! Words and images can hide a multitude of things, and opinions can be influenced by those too. But basing ideas and approaches to things on DATA is honestly my jam. Seriously, I get very excited about this stuff. Every year, Leapfrog Group publishes data they collect from hospital surveys about standards of practice. They measure all kinds of things, but naturally as a doula I’m the most excited to learn about the maternity care statistics. I’ve been collecting this information for our area hospitals since 2017, which is exciting because we’re definitely seeing some changes in the data. If you’d like to read my previous posts, you can do so here, here, and here. Please note, I did not collect the 2019 statistics because they were published in April 2020, and well, you all remember that year right? Without further fanfare, here are the 3 data points I’m always interested in seeing for our local hospitals.

Episiotomy

data from https://ratings.leapfroggroup.org/

I’m REALLY excited to see the episiotomy rate in serious decline because the evidence has been telling us they aren’t an evidence based routine procedure since the late 1980s!! It shouldn’t take this long to change, but at least it is changing. Don’t take my word for it, this paper concluded that, “Our systematic review finds no health benefits from episiotomy,” in 2005. Despite that scientific fact that has been repeatedly proven, as a doula in 2021 I heard a provider at a local hospital say that cutting an episiotomy would help prevent my client from “tearing too much.” I’m not naming names here, but I will if you call me. I have heard that the hospital this doctor works at requires all their physicians to provide explanation for every episiotomy they cut, so this particular doctor must be quite busy with those reports.

Early Elective Induction

Defined as scheduled cesarean sections or induction of labor prior to 39 weeks gestation without a medical reason, early elective induction can happen for a lot of reasons, but there are definite consequences to it. Here is what the picture looks like in our local facilities:

Hospital Goal: 5% or less2017201820202021
The Women’s Hospital Newburgh, IN1.4%1.7%6.8%4.1%
Ascension St. Vincent Evansville2.1%.8%0%0%
Owensboro Health2.1%1.4%.7%1.6%
Memorial Hospital & Healthcare Center Jasper, IN0%5.9%6.3%
Daviess Community Hospital Washington, IN1.9%0%Declined 
Deaconess Henderson Hospital2.4%0%0.0%
Good Samaritan Hospital Vincennes, IN4%0%
Local Statistics for Early Elective Induction

Cesarean Rates: what everyone really wants to know

Before you look at this chart, I want you to know what the data is telling us. An NSTV Cesarean is defined as first-time low-risk mothers giving birth to a single baby at full-term in the head-down position delivering their baby by C-section. Hospitals should have a rate of C-sections of 23.6% or less according to Leapfrog Group. Some people will argue that this rate should be 10% according to the WHO, but honestly that isn’t true. So what does this data tell you then? This chart shows you how many people pregnant for the first time with a low-risk pregnancy with one head down baby delivered their baby via cesarean surgery. This is also retrospective data, so it really isn’t predictive of the future or exactly what will happen to you either, but it does at least give you an idea of the culture of a place and what their staff sees.
The actual NSTV Cesarean Rates for 2021 are as follows:
  • 36.6% Ascension St. Vincent
  • 30.5% Deaconess Henderson
  • 28.9% Owensboro Regional Health
  • 24.5% Deaconess The Women’s Hospital
  • 17.6% Good Samaritan
  • 17.5% Memorial Hospital in Jasper
  • Daviess Community Hospital declined the survey this year.

What I Wish We Knew

As a doula, I always try to make sure my clients have the best most up-to-date information about their decisions. There is of course such a thing as having too much information, but I don’t think we’re anywhere near that right now with regards to choosing providers and birthing locations. These numbers honestly hide sooo much in the aggregated hospital data. How do I know what my provider’s rates specifically are for these things? They know them, but I have yet to find any providers willing to share that information readily with us. In fact, I’ve encountered a bunch of providers willing to say they don’t know them, when they get monthly reports from the hospital about their own statistics. What are they hiding & why? Why isn’t that information made public so that we can make more informed choices? I’d love to know about VBAC rates, induction rates, & percentage of high-risk vs low-risk deliveries. What about NICU admissions percentages and average length of stay in the NICU? Are there numbers you wish you could see when deciding on a provider and birthing location?

I’m going to keep watching to see how and if things change. I’m going to keep asking questions, as annoying as they might be. I’m a data geek after all. Transparency helps build accountability. Accountability can help push change and improvements. We’re all about improving the way things are done in our area, because seriously it is past time.

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