Thursday, January 16, 2014

The Female Form

On my way home from the gym today, I was chatting with my friend about body image.  Both of us being mothers of four breastfed children, we shared in the laments over our stretched out bellies and breasts.  We shared with one another our own struggles against body confidence, how our mothers' words and actions had affected the ways in which we viewed ourselves and our hopes and dreams for our own daughters.

It is hard to feel comfortable with your own female form in this day and age.  When we are constantly being bombarded by images of what some person somewhere decided was the "ideal" female shape, it is hard to find acceptance in a body that cannot fit that mold.

I grew up with a lot of inner confidence, but sadly lacking the outer confidence that I needed.  I felt confident in my knowledge and abilities, but was scared of how I might appear to other people.  It has taken many years to accept this body, this shape, these genes, this skin that cocoons the very essence of who I am.

When I started birth work, I was given the opportunity to see a wide range of female bodies, and I was blown away with how beautiful they were.  No matter if a woman was short or tall, tiny or large, this pregnant mother was breath-taking in my eyes.  Because pregnancy and birth were not about focusing on what was wrong, but rather on focusing on what was right with the female body.

These bodies of ours, they are amazing.  These stripes of stretched skin bear the mark of our having a hand in the creation of another human being.  This extra fluff on the belly belies the fat that was stored for transporting extra nutrients to a child if need be.  These not-so-perky breasts mark the wisdom that has been gained through patiently nursing, nourishing, nurturing these four children now half grown.  This body is an outward reminder of the inner changes that have occurred in my life.



This female form is not beautiful because it is firm and toned and polished and perfect.  This female form is beautiful because it has worked hard in its feminine role of growing, bearing, nourishing, and loving these little people in my life.  Why hide these accomplishments?  Wear them proudly because you earned them.

Monday, October 21, 2013

Birth is Universal

We sat around my living room, the three of us.  We laughed about the ridiculous things we had seen and heard in hospital birth rooms.  We gushed about the awe and wonder of a woman giving birth in all of her glory.  We opened up to one another and shared our concerns and asked for input on how to be better - in both the hands on and business aspects of birth.  We ate scones and hummus and thousand-layer cake and chocolates.  We nursed babies and re-directed school-age children, and sent them upstairs to find their own entertainment.  The three of us, though not knowing one another well, we clung to one another's words, experiences, souls.



Three different women, three different continents, three different cultures.  Together we represented a very broad range of beliefs and ways of life.  But we convened for the purpose of discussing something universal.  Birth.

I have found that this profession - the profession of being with a woman through her birth - is one that is unlike any other.  While bankers, mechanics, graphic designers can all gather together and talk about their lives, their work, their difficulties and successes, nothing can compare to the sisterhood that is created in sharing this work. 

No matter where I go in this world, no matter what ethnicity or culture or continent I am with, I have found that birth is universal.  Every child from the beginning of time has come from a woman's body, and to witness this everyday miracle is such an honor.  Everywhere on earth, from the beginning of time, other women have gathered around the laboring mother to help her, love her, cherish her through the transition of motherhood.  It is an amazing privilege to be able to share this experience with women all over the world and throughout time.

After the get together at my house, we all went our separate ways.  Three different religions, three different lifestyles, three different households, and yet this love of birthing women connects our souls and leaves us with a feeling of unity that cannot be described.

Friday, May 31, 2013

Inversion - Going Upside-Down to Make Things Right!

For years in my childbirth education classes I would joke with my students about how the only position worse than laboring on your back would be laboring upside down.  We all laughed and thought it was hilarious to imagine a women doing handstands in labor.  Funny how perspectives can change.

I was originally introduced to inversions by my chiropractor, who specializes in pregnancy and pediatric chiropractic care.  I often invited her to come to my childbirth classes to talk about the importance of posture, optimal fetal positioning, and chiropractic support in pregnancy.  Since many of my doula clients also saw her, we have always had an open relationship about ways in which to help laboring mothers.

The first time I went to her office with a client in early labor she had my client put her knees on the adjustment table and her hands on the ground.  I thought it was a bit odd, but I have seen a lot of odd things in this job that end up working!  It didn't make sense to me at first, but the more I asked, the more I pondered, the more I practiced it, it began to make perfect sense.

The Baby Entering The Pelvis


Think about driving a car into a parking space in a crowded parking lot.  You turn the wheel of your car and try to ease in to the tight fitting space when you realize, uh-oh!  I don't have enough room to maneuver my way into this spot!  Do you then keep driving your car forward?  No way!  That would result in crushing cars parked in the adjoining spaces.  So, you back up, take a different angle and try again.

 










This can also occur in pregnancy and labor.  As mentioned in my previous posts, there tends to be an optimal position in which babies best fit through the mother's pelvis.  Sometimes, babies start to move down into the pelvis in a manner that makes an awkward fit.  This can result in a stuck baby who does not make much forward progression.  In these cases, getting baby to first back up and then come in at a different angle is what will help baby best to realign and enter in a more suitable manner.

 

How Do You Do It?


Inversions can seem a bit scary at first.  And it's okay if it is a bit awkward.  You have a large belly and it will be awkward! 

What you'll need:

 
 

- A support person
- Stairs, a low table, a couch, or chair

Step One. You should begin by starting on your hands and knees, facing away from the furniture that will be supporting you.

 

Step Two.  With your support person helping, crawl backward and lift one knee up onto the furniture.
 

Step Three.  Pull up your other knee onto the furniture.
 

Step Four.  With your support person supporting your shoulders, push off your knees, up onto your feet, lifting your bottom farther up into the air, and attempt to make your body into an angle of 90* or less.  Make sure the mom releases her belly, letting it fully relax.
 

Step Five.  Hold this position for a minute at a time.  (Notice how the support person uses her knees/legs to support the shoulders while holding/shimmying the hips).  Make sure mom is keeping her belly relaxed.


 

Step Six.  Alternate onto elbows if needed.

Step Seven.  If desired/necessary, have the partner shimmy your hips to help disengage baby.

Step Eight.  Take a break on your hands and knees/elbows and knees but do not stand upright.
 

Repeat steps 1-8 twice if in late pregnancy, in between each contraction if in labor.

Now this is important!!  Before the mother gets into an upright position, it is incredibly beneficial to sift the mother's belly to help baby rotate into a better position, or angle him/herself into a better position.
 

 

Why This Works

 
The Uterus - If your uterus has any type of twist or imbalance to it due to uneven ligaments holding it to the pelvis and back, the inversion will be incredibly helpful at releasing those ligaments.  We humans tend to spend all of our time in an upright position.  In this position, the heavy uterus hangs down in the same manner day after day.  When a pregnant woman inverts, her uterus then hangs in a completely different manner.  This allow the ligaments to be gently pulled on and balanced on both sides of mom's body.  This will help the uterus to become aligned, allowing more room for a baby to move around.

The Baby - This technique can be incredibly effective at getting a baby to find it's best position through the pelvis.  Once the baby has started to engage into the pelvis in late pregnancy, it is much more difficult for baby to maneuver his way into different positions.  If his hand is up by his head, his head is extended, he's come down oblique, or posterior (to name a few predicaments), getting him *out* of the pelvis will be a much more effective technique to realigning him than just trying to move him in an already tight space.  Like that car in the parking space, backing up out of the pelvis before correcting the position of the baby will be much easier than trying to reposition him while he's hedged in.
 

In Labor


The inversion is most effective if done prior to the onset of labor.  This allows the repositioning to be done without the counter-acting forces of contractions.  Since contractions forcefully push the baby into the pelvis, trying to disengage the baby from the pelvis during labor can be difficult.  The contractions act as an additional force to gravity, like a bulldozer pushing that car into the parking space.  But, it can be done!

In labor, assume the inversion position as often as you can in-between contractions.  It can be difficult to hold the position through a contraction, but see if mom can do that as well.  The contractions will feel very odd in this upside down position, and mom will need a lot of support.  If mom is laboring in a hospital, you may need to work around a lot of wires and lines.  Having an i.v. or hep lock in her hand will cause some difficulty in leaning forward on her hands.  Helping her on to her elbows will be a better position if this is the case.

 

 

Signs That An Inversion Would Be Helpful

In Pregnancy:

* You are in your third trimester of pregnancy
* You have round ligament pain
* You have pressure in your back or bottom
* You have pressure in your hips
 

In Labor:

 * You are having prodromal labor
* Your contractions are sporadic or spaced out
* You are feeling the contractions mostly in your back
* Contractions are strong but baby is not moving down
* Contractions are irregular - coming at varying lengths, piggy-backing, or double peaking
* You are feeling a lot of pressure in your back or in your hips
* You have an urge to push while only 4-6 cm dilated
* You seem to be "stuck" at a certain dilation
 

Warnings!!

 
Please reserve the inversion for women with intact waters.  Once the waters are released, there is the added risk of a cord prolapse.  A mom can go to knees and elbows at this point, but a full inversion may add to the risk.
 
Please reserve the inversion for women with normal blood pressure.  Make sure mom feels okay with this position, can support herself with her arms and does not get a headache from being upside down.
 
 

Tuesday, March 12, 2013

Trauma, unexpected

Many times as doulas we are called to support a mother through a birth that doesn't go the way she expected.  Like the wedding we plan since childhood, our birth experiences are something we often dream of, plan out, idealize.  And sometimes it goes just so.  Perfectly.  But more often, there are things that go awry.  Sometimes in little ways, other times in large ways. 

These unexpected births can be difficult for the mothers and difficult for the doulas to know how to process, to support and help the mother through.  We've all had those births - the ones that encompass an unplanned epidural, a transfer from home to hospital, or an unexpected cesarean.  When mothers encounter resistance at the hospital, we know to pour on the love and support.  When mothers suffer through the agony of back labor, we know to keep our hands pressed firmly and endlessly in counter pressure.  When labors tend to go on and on with little progress, we persevere ourselves with endless encouragement and optimism, utilizing every possible tool we can find.  Those difficult hairpin turns in the labor can take a moment for our actions to support our ideas of taking everything in stride and readjusting our expectations.  But we keep on supporting, loving, tending.  And we know that these mothers will often need more time to process their births afterward, and that we need to be available and open for listening to the mother share her experience, her feelings, her grief.

But many of us have the idea that it is only those births that were intended to be natural births and ended up being medicalized that are the ones which mothers need longer support to process.  When we see a birth go quickly and naturally, we tend to rejoice and applaud the wonders of such an efficient birth process.  We often think, that was easy!  She got her natural birth, she must feel great!  This is not always the case, and we really need to be careful to not assume that any birth outcome is exactly what the mother intended.

My most recent client's labor started out slow and steady, easing into contractions, gradually building up in length and intensity.  And then, all of a sudden things changed so quickly, we barely had time to blink before we were rushing off to the hospital.  This mama's body switched gears so fast that her baby was born in the car in the hospital parking lot.  At first I was so pleased for this mama, who was fearful of encountering resistance to her natural birth plan in the hospital.  She didn't have to fight for a single one of her wishes!  Her baby came without any interference!  But I knew.  I could see it on her face.  That look of shock and trauma.  I knew how that felt. 

There is no place in another woman's birth experience for our own feelings.  There is no where in her own perception that we need to place our own feelings, or the way we think she should feel.  Mothers get that all the time from outsiders.  "You should be happy that you have a healthy baby!"  "You are fine."  "Just focus on the relief of this being over with!"  Why do so many press upon the mother how they need to be feeling?  We do this often in the obviously traumatic births.  But we also do this with those births that are unexpectedly traumatic.  "Wow!  That was fast!  You must be so happy!"  "How exciting that your baby was born in the car!"  Why must we assume that a mother feels a certain way just because we would feel a certain way, or because we expect her to feel a certain way?

Those births that seem great from an outside perspective are those that we, as doulas, need to be very aware of.  Never assume that a mother feels great, or doesn't feel great about her experience!  Check in with her.  Look her over, holistically.  How is her emotional state?  How is her mental state?  What is she presenting physically?  Touch her and look at her.  Quietly assure her that you are there for her and that she can feel safe to tell you her story.  Many times women are afraid to tell the truth of how they feel.  When everyone around them expects them to feel one way, why would they feel safe in countering everyone?  If even her doula expects her to be happy, then how does that impact the mother who is, in fact, not happy with her experience?
 

So doulas, listen up!  Make sure you are not overtaken by your own feelings.  Because, while they matter to you, they don't matter in the experience of the mother.  Only her feelings matter there.  Save your own feelings for your debriefings and reflections, but tuck them aside and open your heart to see and hear the story that the mother tells.  You may find yourself quite surprised that it is a very different story from the one in which you feel you just took part.

Wednesday, July 18, 2012

Life and Death

For the first time in 9 years of doula'ing, I had to step out and let someone else take over my roll of doula for one of my clients.

It was not due to my inability. Nor my lack of desire. In fact, I grieved over having to leave my laboring mother. But I knew that I left her in good hands, and I felt some peace with that.

In late April, as my client frantically nested, setting everything up in the nursery just so, cleaning bathtubs and refrigerators, and feeling the first little twinges and changes of impending labor, a dear friend of ours was on a drastically different journey. On a rescue mission to fly wounded soldiers to medical help, his helicopter was brought down, and his life with it.

While I cleared my schedule to focus on being available for my client, we heard about a helicopter crash and pilots who were KIA, and we prayed it wasn't one of our pilots. One of the ones we had travelled with through aviation school.

And after my last prenatal meeting, having talked through all of the mama's fears, her desires, sifted belly and baby to coordinate in mama's womb, we got the news. Our fears were brought to reality. It was Nick. And he was being laid to rest in five days.

The first day was spent in shock and utter disbelief. The second day in sobs of grief. We purchased plane tickets, booked hotels, and arranged for my mother to come and watch our kids. And then I remembered my client. A woman on the verge of welcoming life. Surely new life could wait while I honored a life already spent. Surely birth could hold out while we experienced death.

In the last days before our departure, I quickly coordinated a back-up plan, naively believing that my client would hold out for my return.

And on that night before we were to leave, we had our alarm clocks set to awaken us at 3 a.m., our funeral clothes pressed and hanging in travel bags, my client informed me that life could not wait. So, I went.

As this mama worked and walked and struggled and sipped, I imagined my friend, Julie, and how she labored that same evening in preparation for her husband's funeral. I rubbed and sifted and gentled and supported, and this mama praised Jesus for the new life about to unfold. And I wondered, is there someone with Julie to rub and sort and gentle and support her tonight? To praise Jesus for the life that was well spent? Is there a doula for death as there are doulas for birth?

And baby Jacob took his time. Like his name implies, he struggled to make his way out. My back up came in the wee hours of the night to take over as welcoming committee, and my husband and I flew off to make up the farewell one for our friend.

Jacob took his time coming. He struggled his way through his mother's pelvis, slowly moving toward his exit, and his mother struggled her way with his movements. It was not an easy birth, but at last he emerged, vigorous, healthy, crying. And I, so far away now, also struggled. I was torn between two worlds. I had left a mother transitioning into a new role, and was now present to witness my friend relinquishing a role she so loved. We also struggled our way through this ceremony of exit. It was not easy. We struggled with the right movements. We cried. And as my client said, "Hello little one! How I love you!" We said, "Good bye, dear friend. We love you."


 Life and death, they go hand in hand. They are events in our lives that change us forever. They help us to learn and to grow and sometimes take a lot of time to understand. Both events need to be covered in love and support, to be surrounded by strong and gentle arms, and tears that express what cannot be said through words.

And we need to remember, just as the new mother doesn't stop her journey at the birth, the bereaved do not stop their journey at the death.

Friday, July 13, 2012

A New Role Unfolds

I show up again today, armed with, well, my arms. And my heart. And my experience. But mostly my presence. This new role unfolds before me - a lot less telling, a lot less movement, a lot more quiet listening, a hug, a reassurance. This pace is much slower than I'm used to, and lengthier. But the benefits are amazing. To not end with motherhood, but, instead to begin there. When I teach childbirth classes, parents often become so focused on the childbirth aspect, they sometimes forget that the birth of their baby is not the end, but merely the beginning of their journey. Walking with women as they emerge from their own re-birth into mothers, wet around the ears, tender and vulnerable, this is an amazing blessing and honor to be here. To share. Babies, they are amazing. We think they are helpless and clueless and must be taught so much, but watch and learn. They have more to teach us than we have to teach them. Babies are not logical creatures. They are fully right-brained, instinctually powered individuals with so much inner wisdom. Us mothers, we tend to fear our right brains, afraid that we won't sound intelligent, that we'll let things get out of control unless we keep track of the numbers and facts. We have our books and our computers and our experts, but look! Your expert is in your arms. Your expert is in your soul. Mothers and babies, they are already experts. The hardest part of becoming a mother is what should be the easiest. Trust. Trust yourself. Trust your baby. You know already! And this is just the beginning. If you can open yourself up in the beginning to learn from your wee little teacher, you will soon find that they will teach you everything along the journey of parenting.

Saturday, January 28, 2012

It's Not Always Easy

I recently had a couple from my childbirth classes go through two full straight days of back labor. Because I have spent so much time studying optimal fetal positioning, and apply it extensively in my doula work, it can be very difficult for me to stand back and not try to jump in and "help".

The mom and dad both remained in touch with me throughout the labor via phone calls and text messages. They kept me updated with what was going on, and asked for input every now and then. I offered to come over and help them periodically, but I was not hired as their doula. They wanted to do this on their own.

And I thought over and over, if only they'd invite me over! I could help them out so much! At a difficult moment for the mom, dad asked me to come over and lend an extra set of hands. This was on their second night of intense back pain. I did a ton of rotational techniques, getting mom in all sorts of various positions. But I could only encourage mom to do what felt right to her. I could not take control over her body or her labor. As much as I'd like to have, this was her labor, and she needed to make the choices.

I went home after an hour of being with them. Left them relaxing in their bed, hoping that something I did had helped, but not knowing whether it had.
A few days later I received an email from the mom, and it really struck my heart what she said;
I feel like our labor experience really created and set the foundation for our family. I've had so many reflections on the beauty of it all. So many times we try to run from suffering at all costs and miss out on the amazing, redemptive power of it all. That was the hardest thing we have ever experienced, but it brought us closer together than we could imagine and because of that the pain was the best gift. Michael was an excellent coach and I admire him so much more now that we have been through that, and he has seen my strength by what we were able to do together.

If I had insisted on going over there earlier on in their labor, when I knew that I could make things easier for them, what would that have accomplished? It probably would have made for a faster, easier labor, yes. But did you hear how that labor has shaped these parents? A quick, easy labor was not what these parents needed. A long, difficult labor is what they were given, and they excelled with it. They learned from it. And they are wiser and stronger because of it.

As childbirth educators and doulas, we give our clients all the information and tools ahead of time, but then it is up to the couple as to how they will use it.
We are not to be their guides on the journey. Even if we know for certain a better way, an easier way, how a different decision will create a better outcome. We are not to guide them along the pathway to parenthood. The parents are the guides, learning some of the most important things they'll need to know as parents - how to make decisions on their own.

We are not the guides, we are the observers of this journey. A presence along the way to witness the strength and the transformation of these parents, emerging from self into selfless.