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.

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.

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.

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.

Why Natural Birth Isn't Beneficial...

Say, what??!! Isn't this blog titled, "Natural Birth In Kitsap"? Aren't you a propenent of natural birth?
Why, yes. Yes, I am.
What I want to share with you is something that has been spreading in the breastfeeding world for some time now, and I think needs to also spread to the birth world.
Natural birth does not hold benefits. It holds normalities.
As mammals, this is the normal way we were intended to birth babies. Moving, private, peaceful, freedom. As humans, this is the normal way we were intended to birth babies. Supported, loved, nurtured, unmedicated.
Natural birth doesn't add anything to the birth experience. It is the way the birth experience was intended to be. It doesn't benefit the baby. It doesn't benefit the mother. It doesn't bring short-term, nor long-term benefits. It is where we set our human standard. Anything other than this is deviating from the way we were inteded to be. Not birthing naturally brings risks.

Just as with breastfeeding, our bodies have a specific way to work. We have a specific birthing function, a specific feeding function. It is a correlation between the mother and the baby.
Any time we alter from that course, we increase risks of things going wrong, and causing harm.
Often times we are told that our bodies are not good enough. That, even though we are mammals, whose very defination is one who "gives birth" and "nurses their young", our bodies cannot do. We need help from man-made products. "Supplements".
We supplement with membrane sweeps, cervical ripenings, artificial oxytocin. Supplements lead to less of us, more of them, until we find ourselves unable to produce at all. Unable to produce milk, unable to produce contractions.
We are told our nipples are the wrong shape, our uteri are the wrong shape, our pelvises are the wrong shape. Our bodies will harm our babies. They tell us this, and they are wrong.
We are told that natural birth is dangerous, that it is impossible, that it is unrealistic, and that we are just trying to martyr ourselves. When did normal become such a big deal? When did we get so detached from ourselves that we can't fathom our bodies functioning in normal ways?
We have set the standard at medicated birth, just as our society has set the standard at artificially-fed infants. We have tests and procedures that are necessary for medical births, that have become routine and "normal". We have nurses trained to help medicated mothers but unaware of what to do for a naturally birthing one. We have doctors who have been trained to interfere and do so with such regularity, that we have to specifically state over and over that for *this* birth, we want to be left alone.
Shouldn't it all be the other way around?
Shouldn't we be wondering at the dangers of medicated birth? Of interfering with the natural bodily functions? Shouldn't we base our studies, not on how natural birth might lower risks, but how interference may increase risks? Shouldn't the burden of proof be placed on deviating from normal, rather than deviating from medicalized?
Why are we looking for studies and statistics which prove the worth of natural birth? Do we look for studies and statistics which prove the worth of natural breathing, natural urination, natural eating? Why don't we hear studies talking about the benefits of NOT catheterizing everyone? Or NOT putting everyone on a ventilator. Or NOT giving everyone a feeding tube? Wouldn't that be a ridiculous world to live in where everyone was made to believe that they could not eat, breathe or urinate without medical intervention?
And yet, with birth, we find a huge discrepency. A normal bodily function that is overseen by doctors, nurses, medications and machines. We are told that we can't do it naturally. And medicalized birth becomes the norm.
We need to stop setting the birth standard at medicalized birth. Any deviation from the normal way the body functions should be backed by a true medical reason. We should not be laughed at, rolled eyes at, scoffed at, annoyed at, or ridiculed for wanting to do what is normal. Normal should be supported and accepted. It should not be rare. It should not be so hard to attain. It should not be something we have to battle for!
The health benefits, bonding benefits, breastfeeding benefits, etc. associated with natural birth are not benefits at all. They are what every mother and baby were intended to have. They are the standard. And, yet, how many know this? How many are choosing risk because they believe that risk is normal?

Natural birth is not beneficial. Natural birth is normal.

A World of Safety Nets

“Differing definitions of safety also play a part. Doctors often feel unconcerned about side effects – even life-threatening side effects – provided they know what they will do to treat them and that the life-threatening ones occur reasonably rarely. So, two doctors writing for their colleagues can say reassuringly: “These [epidural] complications should not cause fatalities if trained personnel and adequate resuscitation facilities are available.” Loose translation: If a laboring woman develops a life-threatening complication from an epidural, she or her baby won’t die of it provided hospital staff are on the ball.”
From, The Thinking Woman’s Guide to a Better Birth by Henci Goer, page 127

“What has happened in the rich world is that, while removing the ideal food and feeding method, there has been progress in the elimination of other immediate risks. It is important to remember that it is still only a minority of the world’s population that can be artificially fed from birth without getting ill or dying.”
From, The Politics of Breastfeeding by Gabrielle Palmer

While these two quotes talk about two different things – medicated birth and artificial feeding – they are essentially saying the same thing about the world we currently live in. That those of us in first world countries live in societies filled with safety nets. And while that’s great for us, the rest of the world cannot manage to live the same way and afford the same healthy outcomes.

The switch from births happening at homes to hospitals and the rise of artificial milk for babies has followed a similar trend. They were at first disastrous. Dangerous. Doctors in hospitals and artificial baby food makers did not really know what they were doing. It was all trial and error, and many mothers and babies died as a result. With the awareness of germ theory, sanitation, and clean water sources, births in hospitals and artificial feedings improved. As the western world improved in wealth, it also began to take risks with its health. As long as they had a way of fixing the mistakes, it was okay to risk making them.

But living in a world of safety nets is a precarious world to live in. Walking a tightrope is risky, especially if there is not a safety net below. But even with the safety net, you will need to deal with the consequences of walking in a way that our bodies were not intended to walk. The feet of tightrope walkers tend to have many broken bones. Bodies react when we force them to do something outside of what they were intended to do.


When we interfere with the natural processes of labor, there will be reactions. Most doctors see these reactions as perfectly acceptable, since they tend to have plenty of safety nets set up in place – epidurals, pitocin, cesarean sections, drugs to bring blood pressure back up, resuscitation devices, and epinephrine. We believe that taking risks with our bodies while in labor is safe because we have become so accustomed to the safety nets. We have begun to forget what normal is meant to look like, and only what it’s like in a life of safety nets.



The same goes with artificial baby foods. A mother’s body is meant to breastfeed her baby, and a baby’s body is meant to breastfeed from it’s mother. When we alter this normal process, there are reactions. We have come to believe that ear infections, upper respiratory infections, and digestive problems are normal for infants because they happen so often. But these are reactions to altering the normal state of being. And this is only acceptable in our society because we have so many safety nets set in place. We have clean water to mix with formula. We have unbelievably easy access to fuel with which to heat the milk. We have easy access to transportation if our child becomes ill, and many hospitals, clinics and health care providers to offer care for our sick children. All of these are safety nets. Without such easy access to these things, feeding our babies with anything other than breastmilk would be dangerous.


But this alternate form of normal is acceptable in our society because a world of safety nets has become the new normal. And while I do not wish for these safety nets to stop existing – I am very thankful for them, actually! – I do wish that we would understand that safety nets are meant to protect us in case of emergency, not as a daily way of life. Normal labors should not routinely need to be induced or augmented. One third or our women should not need to have their babies removed from their bodies for them. Breasts should not be seen as so easily unable to provide nourishment. Ear infections and upper respiratory infections should not be common childhood ailments.

It does not take moving to a third world country to begin to understand the effects of a life based on alternatives without safety nets. What would we do in our comfy, wealthy society if these safety nets were suddenly sparse? It sounds unlikely, but all you need to do is consider Florida after the 2004 Hurricane Charley. Or the Gulf Coast after 2005’s Hurricane Katrina. We are not a country immune to natural disasters. And these disasters could easily wipe out all of our safety nets from beneath our feet.


In order for a medicalized birth to be above dangerous, there are many safety nets that need to be in place. Electricity, clean water, access to medications, availability of trained physicians, anesthesiologists, and surgeons. This may seem standard to many, but when hurricanes barrel through, earthquakes topple down, tsunamis wash away, or volcanos erupt around and upset all of this, we find that those must-have inductions and must-have cesareans become less urgent. We find that women can labor without being numbed, and that babies can come out without all the gadgets and gizmos set up in a hospital. And many see it as a tragedy that, because of a natural disaster, these women had to birth in a normal way!

In order for artificial feeding to be above dangerous, there are also many safety nets that need to be in place. How long does it take to boil water in order for it to be sterile? How many times must a mother do this in a 24 hour period for a formula-fed infant? How many gallons of water must she carry to her home? How much wood or other fuel source does it take to heat up the water for formula or for cleaning the bottles and nipples? How far is it to the nearest health care clinic, and how long would it take her to walk there with a sick child? How available is a health care provider in an emergency situation? During Hurricane Katrina, this is what formula feeding parents had to consider. In most of the world, this is what all parents have to consider.

I hear over and over again that formula feeding is perfectly safe ), and that breastfeeding really is not much better than formula feeding. What arrogance we have in our society! To take away the immunities and healthy digestive system our babies were intended to have, and replace it with a safety net of doctor’s trips, antibiotics, special hypoallergenic formulas, inhalers, insulin, etc. just because that is what is now normal, does not mean that it is safe. We can only claim it’s safety because we have all of the safety nets in place to catch our children when they fall. Those safety nets would not be as necessary if we followed the natural order our bodies and our babies’ bodies were intended to follow.

In our country, we have the ability to choose whether we want to have a natural or medicalized birth. We have the ability to choose whether we want to breastfeed or formula feed. But just because these choices are available, it doesn’t mean that they hold the same level of safety. At any moment we could be in a situation where our safety nets fail.

Reflection

The other day while waiting for my daughter's ballet class to finish up, I began chatting with a woman who was also waiting. During our chat, it came up that I am a doula. "A do-what?" this middle-aged Ukranian woman asked me.
Though the term doula is becoming more and more well-known, this is a question that I hear often. And I've noticed that older women tend to not understand the necessity of my role as do the younger women. And not knowing much about birth in the Ukraine, I was not really sure what this woman would think about the work I do.
"Are you more for the emotional support, then?" this woman asked me when I tried to describe my role at a birth.
"Yes! Exactly!" I responded.
This opened the door for this women to share her own experience, as often is the case when talk of my profession comes up.
I love that women feel that they can trust me to be a sounding board for them as they describe in great detail a part of their lives that is so intimate, and so personal. I love to listen and gain more insight into the beauty and pain of womanhood.
This woman told me of her first birth, thirty years ago at a Soviet hospital in what is now the Ukraine. She told me how she had no idea what was happening to her, that no one had explained how the baby would come out of her, and that no one bothered to inform her at the hospital. She told me how she was left alone to experience pain after pain, not knowing if she was dying. She asked me if I tell women what to expect before they go into labor. I assured her that this was a large part of my role as a doula, and that I teach entire class series on what to expect through my childbirth classes. "This is good," she told me. "Women need to know. And they need someone with them to help them through it. What you are doing, it is a very good thing."
I think that it is important for us, as birth workers, to hear not only the good stories of birth, but be reminded of the bad stories, and how our efforts must continue - that history must continue to change so that all women can experience birth in a safe and satisfying way.