An important tool: relaxation

When we work together, we'll do a lot of talking about the importance of creating a relaxed environment for labor... and about remaining relaxed throughout. I feel that it is the most important strategy you can employ to improve both birth outcomes and your perception of the experience.  

The idea is a mind-dumbingly simple one, although sometimes challenging to execute.

When a birthing mother is experiencing fear and tension resulting from her own emotional state or something created in her environment, her body can tense up. She might crank up her shoulders to her ears, screw up her face, clench her fists or even toes, start making sounds that escalate in volume, pitch or tone. She may brace herself for the pain of each contraction as she senses it starting. 

But consider the goal and the mechanisms involved. Successes during the active stage of childbirth includes an opening and softening (cervical dialation) as well as productive movement of the baby (rotation, dropping, engagement with the pelvis). A mother has to allow these things to happen. Generally speaking,  more she resists, the longer all of this takes and the more difficult it becomes. 

With these goals in mind, clenching and tightening don't play productive roles. Resisting or bracing for contractions doesn't help. Best case scenario involves a mom deciding to relax, trust the process and allow each contraction to do its important job... to welcome the intensity, knowing that it won't go on forever and that it all ladders to an incredible result in the end. 

This is one of the areas in which it is sometimes hard for a partner to be as effective as he or she wants or needs to be. Frankly - the partner may not feel relaxed, either! Having a baby can be stressful for partners and -- despite training and reading -- they may not be prepared to provide what the birthing mother needs or wants, know how to help, understand what's normal, etc. 

As a doula, I encourage relaxation by creating an environment in which a mother can feel comfortable and supported. This can include setting up a space with familiar ambiance, items, music, lighting, etc. Some moms like to have music in the room, other's don't. I remind the mom to keep a loose jaw and shoulders, help her use breathing to stay on top of the experience of each contraction, apply hot/cold as needed to regulate temperature, employ visualization and vocalization strategies. We may use movement and distraction to both aid progress and pass time. We do goal setting - getting through 5 more contractions, 10 more minutes, 1 more centimeter. We talk about establishing a rhythm, and about how that rhythm might include something the mother invents on her own and can't be taught. And so much more. 

There are lots of good end results that stem from the activities above... but the big one, to me, is relaxation. 

(Ina May Gaskin (known as the mother of modern midwifery) talks about this a lot in her publications and travels. A nice summary can be found in this TED Talk - "Reducing Fear of Birth in US Culture" - have a listen.)

What's the best way to give birth?

Sorry... that was a dirty trick of a headline. You probably already know the answer....

There's no "right" or "best" kind of birth. People who are happiest with their births tend to characterize the experience with words like peaceful, confident, relaxed, informed, supported. They feel listened to and involved in the process. They understand their options and the risks/benefits of any changes that are necessitated. They've taken steps to try (to the best of their abilities, if they've never been through birth before!) to anticipate the experience they'd like to have, to enable this experience through all available tools and then to remain flexible if the path takes another course.

I believe that birthing moms meet their full potential when they are prepared, trusting of their chosen birth team, supported in the right environment and allowed to learn their way into and through it. And that, sometimes, what a mother thinks she wants initially isn't what ends up being the case during birth (hence the critical need to maintain flexibility). 

As a doula, I'm a non-judgemental, emotionally uninvolved support system who's there for the entire process. I bring calmness and insight and the ability to help you learn what "birth normal" looks and feels like, so that a woman in labor can remain confident and relaxed. 

I'm there to help navigate... but I'm not calling the shots and it is not my journey. In the end, I'm satisfied if the outcome includes a healthy baby and mother PLUS a family that is proud of their birth experience.

The importance of breastfeeding support

One of the things I'm most passionate about is supporting other women in reaching their breastfeeding goals, whatever those may be. This is why I'm so excited to have just completed a peer lactation counselor course.

Both of my babies were born in winter months, and so I feel like I've experienced firsthand how isolating having a newborn can be (in general)... let alone when you're trying to develop a brand new skill that requires almost your full attention and that you've rarely seen demonstrated. We don't live in villages anymore where there are other women around to model, to ask questions of and to lean on for support - I often wish we did. 

(According to The Surgeon General's Call to Action to Support Breastfeeding, among children born in 2007 about 75% of mothers initiated breastfeeding, 43% were still nursing at 6 months and only 22% at 12 months. The numbers are even lower when you look at exclusive breastfeeding (33% at 3 months, 13% at 6 months). BUT... good news... according to the CDC, the numbers were up across the board in 2011: 79% of women initiated, 49% still going at 6 months, 27% at 12 months... 40% exclusive at 3 months, 19% exclusive at 6 months.)

Some people choose not to breastfeed, or to stop earlier than they planned, and they are totally at peace with their decision, and that's awesome. But stopping because you chose to is different than stopping because you felt you HAD to, didn't have support, ran into a speed bump, etc. I bet a lot of people fall into this latter camp, and I bet a lot of these moms are left feeling disappointed, frustrated and sad.

Enter more good news: Professional lactation support is a vital tool in helping mothers initiate and continue breastfeeding, and the numbers of helpers are increasing annually. Also from the CDC: 2006 through 2013, the number of IBCLCs (board certified lactation consultants) increased from 2.1 to 3.5 per 1000 live births. And in 2013 there were 3.8 CLCs (certified lactation consultants) per 1000 live births, up from 2.5 in 2011.

My training didn't make me either one of these types of professionals, but it provided a great base of knowledge to supplement my personal experience with nursing, as well as opportunities to hone my counseling skills. It also allows me ongoing access to moms who need help. I can use my knowledge to troubleshoot issues, provide empathy, impart confidence and connect them with the pros if necessary. I'm so excited to become part of the solution.

Advertising Doula

My professional life to date has been spent largely slumming around ad agencies, trying to get interesting ads over the line while also satisfying clients' needs (and let me tell you, these two things rarely co-exist).

I was an account exec: a role that I sometimes compare to a translator. The agency people and the clients speak two languages and someone has to play go-between, making sure the two groups stay synced and work gets done on time, budget and strategy. (I'm overgeneralizing... the best agency people, across departments, care about clients and the best clients know how to elicit great work from agencies... but these trusting relationships are the exception.)

On any given day, my role involved:

• helping clients articulate and clarify their goals;
• working to develop a "brief" - a succinct document written in plain English that conveyed the assignment to the agency team; 
• leaning on subject matter experts for wisdom (production people, creative experts, strategists, analytics gurus, media mavens)... and not being dumb enough to pretend I knew as much as these people about their crafts;
• working behind the scenes with the agency team to make sure the work (media plan, creative idea, whatever) delivered on the brief;
• hand-holding everyone through the process... which involved a lot of feelings and art and science and late nights and glasses of wine and the proverbial blood, sweat and tears;
• developing trust with clients, and understanding their perspective well enough to represent them back at the agency; 
• actually representing the client's (sometimes unpopular) POV without pissing agency people off... or with the least possible pissed-offedness involved;
• coaching teams of junior account people toward flawless delivery of client service.

Anyone who has worked in advertising knows that producing an awesome, effective campaign is analogous to birthing a baby. There is a fragile, vulnerable little being (in this case, an idea) involved that gestates for about the same length of time as an actual baby, and sometimes with almost equal levels of physical and emotional investment from the creative parent(s). Birthing it (or, concepting, testing, producing and editing) is stressful and exhausting and often very emotional. 

The skills I acquired during my advertising years are transferrable to the work a doula does. I envision myself helping clients articulate their goals, hopes and concerns. I anticipate talking to them about how to then reach the goals and developing nimble birth "plans" (in pencil, with flexibility built in!). I will lean on and foster deep respect for on the experts (midwives, doctors, nurses). I know that the process of getting a baby out draws upon wisdom from both art and science. I will develop trust and the ability to advocate for, coach and hand-hold my clients through whatever comes at them. 

After any major advertising effort, my hope was always that the brilliant, hard-working people involved were PROUD of the work and accepting of the decisions made along the way. We weren't always satisfied, but darned if I didn't work hard to try to get us there. Another good parallel.

Ultimately, an ad is not a human baby and of course there are lots of ways that the work of creating advertising looks nothing like childbirth. There are usually not ACTUAL blood, sweat and tears involved in ad-making. But it is incredible how many skills from my former career apply!  

Baby Brain or Superhero?

Working on textbook reading for my lactation counselor course and just came across this little wonderful gem:

"When we think and act we use both sides of our brain - left and right - which are joined by the corpus colosseum and, therefore, work together. However, certain modes of thinking are more associated with one side of the brain than with the other.  For example, the left brain is associated with planning ahead and the logical, sequential and analytical.  The right brain, on the other hand, is associated with relationships, being in the moment, the intuitive and the holistic.  Newborns use their right brains because their left brains are not yet well developed. Some suggest that during early postpartum, a mother's right brain may become dominant to make it possible for her to connect better with her baby (Simille, 2008).

During the early weeks, many mothers report difficulty following instructions, remembering facts and keeping track of time, all primarily goverened by the left brain. Some researchers have referred to this phenomenon as a 'cognitive deficiency' (Eidelman, Hoffmann, & Katz, 1993). 

However, for the survival of the species, mothers must want to care for their newborns, and it is the right brain that governs a mother's emotions. This may explain in part why the right brain appears to take a more active role in the early weeks. Rather than referring to this as a 'cognitive deficiency', it may be more accurate to say that new mothers have 'enhanced right brain function'."

I love this! I felt totally disorganized and... to use their word... deficient in the postpartum periods after both of my babies.... when in fact I may have been intuitively responding to my children, prioritizing those attentions and activities that were most necessary to their survival. 

What a great way to reframe the experience into a positive and make a new mom feel powerful instead of strung out and crazy.

Coxswain Doula

In college and for several years after graduation, I was a coxswain. Most people have no clue what that is.  Every once in a while you get someone who says "Ohhh, that person who sits in the back of the boat and yells 'ROW'." Uhhhh, no.

From Wikipedia: "In rowing, the coxswain sits in either the bow or the stern of the boat... and verbally controls the boat's steering, speed, timing, and fluidity. The primary duty of a coxswain is to ensure the safety of those in the boat. In a race setting, the coxswain is tasked with motivating the crew as well as steering as straight a course as possible to minimize the distance to the finish line. Coxswains are also responsible for knowing proper rowing technique and running drills to improve technique."

I stumbled into the role when I arrived at Bates College in Maine... and looking back I realize what a fateful, lucky and smart decision it was to join the crew team. I know now how much the experience taught me about leadership, motivating and influencing others and really about just being a functional human.

Let's pick it apart.  The coxswain:

• Ensures safety and carries the full trust of the team (none of whom, it is worth pointing out, are facing the direction in which the boat is headed);
• Motivates the crew to push through pain and find levels of achievement they didn't know they could reach;
• Steers a straight course, adjusting to create efficient and effective responses to natural and man-made obstacles;
• Advises on technique to ensure, for instance, that every one of those eight oars enters the water at precisely the same time (otherwise the boat lurches around and dumps from side to side, upsetting the rhythm and speed).

(Seeing the parallels to being doula yet?!  I sure as heck do.)

Anyway, I spent a lot of time sitting in that tiny little coxswain seat, hooked up to a microphone, learning how to be confident in my own leadership and intuition. And I got to be pretty good at it.... earning myself two Head of the Charles medals and a literal boatload of friends who trusted my leadership. (Oh, and a husband, who happened to row on the same team. But that's a story for another day.)

One of the things I loved about being a coxswain was getting into a boat full of novices and helping to impart skills, confidence and enthusiasm. In that setting I was able to help people who had never set foot in boat achieve goals they'd only been able to talk about. I consider myself a novice in the childbirth arena - my experience at this point is limited to my own two births, a litany of reading and stories from friends - but in the coming years I hope to gain enough experience to confidently advise,  help and coach laboring mothers through what may be for them a totally uncharted experience. 

Coxing taught me a few things about what it takes to gain the unquestioning trust of another human, and how much that trust matters when real pain comes into play and stakes are high. 

The power of expectation setting

A few months back I took my two little girls into the pediatrician for their annual check-ups and vaccinations.

My four year old was due for a boatload of shots. Four, to be exact. She's got a dramatic streak and isn't super big on pain, so I was bracing myself for a scene.

My husband and I did our best to prepare her. We talked with her before the appointment about what vaccinations do. We told her there would be more than one shot and that each would hurt momentarily, but then it would be fine. We practiced taking a deep breath and counting slowly to three... by which time the shot would be over.

Right before the nurse came in, and with her consent, I gave her four tiny pinches - two on each arm - and told her that's what the shots would feel like. She seemed unfazed and crawled up into my lap, remaining there calmly through all four injections. Not a flinch, not a tear, not even a hint of the epic freak-out I had been expecting.

(The nurse sort of just stared at me as if to say, "Is your child a robot?"  For a moment, I wasn't sure.)

I think we did right by little J in telling the truth, helping her develop a frame of reference and teaching her a couple of ways to cope.

I've heard of people having painless childbirths, and I hope I witness that someday. But mine weren't painless... in fact, they were far from it. I wonder whether it is better to expect pain and practice coping strategies than to ignore and avoid it. Although you will not know what childbirth (or breaking a bone for that matter) feels like until you do it, ask yourself some questions. Does expecting pain stress you out or cause anxiety? Or, would you rather go into a potentially painful situation without your expectations set, without a basic set of coping skills? Would you rather do some work to help get your head in the game? 

I don't know the answer... I suspect that each person's experience and preference is different. Part of the role of a doula is to help a soon-to-be mom work through some of this and think through what might be most comfortable and effective for her.

"You can't go around it"

My second baby was helped into the world by a skilled and hilarious midwife (Ronni from Womanwise Midwifery), my husband, a wise and supportive doula (Christina from Well Born Baby) and a tough but lovable L&D nurse who took great care of me well into recovery. You could say it was sort of a dream team.

When we arrived at the hospital on a Friday evening, I was almost 8 cm dilated and in the throes of transition (not a fun car ride, let me tell you). When it was time to push, I gave it what I thought was my best try. Ronni took one look, stared me right in the eyes and in her signature matter-of-fact tone said "Honey, this is a thing with second timers. You can't trick it. You can't go around it, you can't go under it. You have to decide to go through it." Christina chimed in with words of support and encouragement and for a moment time stood still.  To me it felt like we were the only three people in the whole hospital, maybe the whole world.

And then it became clear. Dammit... they were RIGHT. I'd sort of blocked out the pushing part from my first birth, but all of a sudden I remembered vividly and I wanted OUT OF THERE. Fight or flight at its best.

I can't describe how important it was, in that poignant and fearful moment, to have those two women there telling me that they understood what I was feeling, they'd seen it before and they had confidence that I was going to get through it. They knew how I wanted that birth to go and they were helping me get there. I know that if I'd expressed a preference for a different type of birth, they'd have helped me toward that outcome, too.

A moment of panic and doubt was met with what felt like the midwife/doula equivalent of a locker room halftime pep talk and I gave it another go. I will spare you the glamorous details, but less than a half hour later my beautiful 8lb 13oz baby was in my arms. I am acutely aware that it might not have happened as ideally without the support and attentive care of the professionals in that room, especially at that pivotal moment, and I will be forever grateful. I seek to bring this same level of steadfast support, personal attention and deep understanding to other moms during their birth experiences.