It has been 7+ years and 200+ births and I sit and write today and touch on what it is I do. What it is I see... and how I perceive the miracles of life through the minutes and hours before baby comes. I chose this profession for many reasons. I birthed my babies without a doula but with a supportive husband. With my mother passing away when I was 14 I felt an emptiness knowing I didn't have a "mother figure" with me in that time when I transitioned from woman to mother. I knew that nurses had other patients to look after and that the attention I wanted wasn't going to be given. I knew that mothers after me would want continuous support from a woman who was educated, sympathetic, and respectful of her needs and desires. Doula means "mothering the mother" it is a greek word. I certified as a doula through DONA approx 6 months after I took my doula training. I trained and read countless books, I attended conferences, and got NRP (neonatal resuscitation program) certified. My first year as a doula I attended many births and did most of them free. As other women feel called to do the work they do... I felt doula work was my calling. I was hired on by no less than 30 women a year for the first 4 years. Here and there I would take breaks and not take on more than a few clients. Being a good doula was hard work, it required my full attention, respect of clients choices (regardless of personal beliefs), countless time, and emotional energy. Every client I have had I cared about the outcome of how she would perceive her birth. It was my duty to aid in creating a space of comfort and peace for her and those present. I was hired on to be her advocate. It always surprised me when a woman called me and "chose" me to be her doula. I was going to be present for HER miracle and transformation to becoming a mother.... I was a stranger who made this expecting mother feel comfortable enough to HIRE and PAY me to be present at her birth and aid in making her experience better and one where her voice would be heard as it deemed necessary. In the 2-3 months before delivery I did prenatal visits with my clients. Some lasted 2 hours while others would last 5. I stayed with them answering questions til the couple's minds were full of only answers. We would laugh and get to know each other on a level that would make things even better for me to be present for their birth. We spoke of birth preferences and options for alternatives to what may or may not happen during labor and delivery. I laid out specific expectations of each birth facility and what hospital guidelines were. I worked with strong women, whom hired me to go epidural free and unmedicated. Through my work I was able to get to know women on a deeper level than their own mother's, sister's, or even spouse. I have now been told countless stories of women and sexual abuse histories. I too am a survivor and have intuition on specific happenings in ones' lives. I would go to bed at night wondering if this woman's history of abuse would play a role in her birthing process... my dreams would sometimes haunt me. Around her estimated due date my phone would ring, usually the father spoke and said: " it is time Tiffany!! You can head on over here now and help us through these tougher contractions." In a hurried frenzy I would gather my things together and head for my clients home. In my car late at night I would park it on the side of the road and before going in I looked at her chart to make sure I understood her wants and remembered here background and history. I lightly knocked on their door and the father opened it allowing me in the birth space. Each time I stepped in I would take a deep breathe look at those present and smile. Whether the mom be on the birth ball, bended knee or in the bathroom I got down on her level (physically) and rest my hands on her. With positive energy and light I then asked: "how are you doing"? My hands were the grounding anchor that aided the tension to melt away. I was doula-ing.... I was "with them", "mothering the mother", finding their needs and working towards completing them one by one. I witnessed a beautiful woman contracting every 3-5 minutes lasting 1 min and 20 seconds long. I witnessed a mother laboring FOR her child to come into this world the way that "she" wanted. There were numerous mothers who made me choke up in tears at the very sight of their discomfort. Call it innate or what have you but something inside made me want to take that pain away even if it be for a few moments... I knew even if I could take it away, that would be robbing her of the experiences that she was to bear and not I. Contraction after contraction, breathe after breathe, vocalizing through the discomforts she was ready to head for the birth facility. We would meet up at the hospital. Greeted by the nurse who would be accompanying her in labor, introductions would then take place. It wasn't long before I learned to greet the nurse: "Im Tiffany, her doula, I look forward to working with you as the birth team." Each of my clients have a birth chart that I write down specific details to give the mother a birth timeline afterward. Today is my lucky day the nurse likes me ;). I can go on a little easier with my doula duties. I get acquainted with the hospital and where things are stored. Looking through drawers and cupboards I find the basin in case the mother becomes nauseated, I find the washclothes to put cold compresses on her forehead and neck, or for hot compresses later for her perineum. I get my essential oils out that are common for labor and set them at the bedside. The mother is asked by the nurse to be put on the monitors: 1 to check the fetal heart tones of the baby, and the 2nd to check her contractions. She lays in the bed strapped to the monitors, she is uncomfortable and annoyed at the positions she is made to be in. "Every hour for 20 minutes the monitors must go on," she is reminded from her nurse. I have held and situated the monitors countless times to get an accurate tracing while the mother got herself more comfortable. Sitting or half laying in a hospital bed is not the optimal position for labor, most moms despise it. The nurse evaluates the patient and asks permission to do a cervical exam to check for dilation and effacement. The nurse situates the patient in the bed and tells her to relax and open her legs wide. With a high reach of the nurses hand the cervix is evaluated and the nurse announces: "you are 80% thinned and you're only 5 cm dilated." The mother then looks at me and starts to panic. I give her a look of great joy and say: "You are over half way done. You are amazing and wonderful, your body is doing this perfectly." The mothers face softens and she whispers... "I thought I would be farther along, how can I do this for hours more? How can I keep going on? It has been SO hard up til now and Im already tired." I rub out her tired sore thighs she has been tightening and say with ease: "you take 1 contraction at a time, that is how you do it. Your labor from here on out will be more intense but much faster than what you expect. You have everything within you to keep going. Im proud of you. I will support you in whatever choices you make, it's why Im here." I fill up the tub in the hospital bathroom and escort the mother to the toilet and offer her another drink of tea. It is then that another contraction takes over her being and she sinks back into labor land. I turn up the stereo that plays soft music to set the tone for the birth space. (A favorite CD of many birthing mothers is Liquid Mind series) The mother tenses her eyebrows just at the forehead and I remind her to let go and release. Instantly she does as I ask without hesitation. Her husband then helps her off the toilet, we help get her out of her clothes and into the warm tub. She sits down and lets out a happy sigh of relief and says: "Now why didn't we try this earlier? This is HEAVEN!!" She smiles and sinks down into the tub with another contraction. The father looks at me with fearful eyes and I give him a smile and nod that all things are ok and normal. I guide the fathers hand to his wifes tensed hand and tell him to be gentle and breathe in positive energy. I stand behind the father and place my hand at the middle of his back and feel his quick paced heart beating away, I slow my breath and wait for his heart to slow and I feel his calmness. For a brief moment she opens her eyes to look at who is holding her and smiles so angelically to her husband. The contraction ends and I ask her to take a cleansing breathe and give her red raspberry leaf tea. Time moves forward gently. The nurse comes and checks the mother vaginally again (in the tub) to tell her she is 8cm dilated. She is amazed it happened so quickly and has hope that she can make it naturally another 2 cm. The dad at this point starts tearing up as his excitement grows meeting the child he so anxiously is awaiting for. I hear a change in the mothers contraction as she starts unknowingly pushing or grunting with the pressure she feels against her cervix. I tell her to follow her body and listen to it's urges and go with them as they feel right for her. She moans through the next contraction and I moan with her to allow her to feel safe and unafraid. I tell her how perfectly she is at laboring and how moaning low open sounds will get her through. We work our way to the toilet again as she feels the need to go. She contracts again and I hear her bag of waters release and a small gush of fluid hits the bathroom floor. With a surprised look from both mother and father she looks up at me astonished and says: "I can't believe my water just broke on it's own." I remind her that her body is doing just as it was meant to do. After she urinates she feels some release of pressure from above her cervix due to her full bladder. I walk her back to the bed where she asks to for a squatting bar. I quickly ask the nurse who wasn't aware that she was ready to start the pushing phase of labor to bring the squatting bar to the bed. We place the squatting bar over the bed and get it settled in. Again the monitors are placed upon the mother as she rests herself upon the bed this time in a supported squat. Her feet sit perfectly on the bed as she holds her body weight upright and rests her armpits on the squatting bar. Her head is down with her hair covering her face, she looks tired but angelic. The baby's heart tones look perfect, showing variability and some signs that it is ready to be born quite soon. I ask the father to stand in place by the bedside at her head and give him the job of applying cold washclothes to her forehead and neck. I ask him to tell her of his undying love for her and give her all the encouragement he can. With a bucket of icewater at the fathers side he does as he was told by me. I place myself on the other side of the bed and ask her where she feels discomfort. With energy building up she frantically tells me her backside is having pressure and pain. I apply forceful counterpressure and she breathes a sigh of relief. Her body sinks into my hands further and again the contraction takes her to another place. With the next contraction she takes a breathe, and gives a full push. The nurse puts on gloves and calls the doc through the call button on the bedside. I look at the mom and tell her to let herself completely relax in between contractions and let herself go to a place of peace and comfort. The hospital room takes on a separate space of noise and chaos setting up birth equipment. Another contraction comes and this time with a primal growl mom pushes and we all witness a bulging at her vagina. Her baby's head is just barely inside, it stays within for moments, allowing the tissues to stretch. As a rose opens so does a woman's inner and outer labia as she pushes with another surge. She pushes and the baby rocks it's way down a few notches and rocks back up one notch. The OB comes in and gets robed in hospital garb. I ask that we get hot compresses on her perineum. (her wishes she stated in her birth preferences) Once the cloth is placed upon her bottom and the slight counterpressure is given she breathes a sigh of comfort and release. She opens her eyes to say a big thank you with her bright smile and closes them again to go to her peaceful place of relaxation. Within this next contraction I witness a good portion of the baby's head and I tell her she has made so much progress and if she wishes to do so she can touch her own baby's head with her fingers. She looks at me and starts her way down with her fingertips, I direct her hand to the appropriate place. With astonishment and glee she laughs and cries knowing she is seconds close to having her baby in her arms. Another contraction takes over and all the team is focused on her. It wasn't more than a few contractions later that the baby's head emerged. The OB checks for the umbilical cord around the neck and there is a loose one that she gently pulls over the baby's head. Mom pushes for the shoulders and the rest of the baby slides on out. A perfect wet baby with very little vernix says it's hello's to the world with a big cry. The nurse briskly dries off the baby and assess the baby to make sure it is breathing and perfectly pink in color. After the nurse is finished I direct the mom to enjoy her baby skin to skin and she then looks at the sex of her newborn and announces tearfully: " it's a girl!" Sobs of joy fill the room from daddy who is elated that he is now a father of a daughter. I get choked up but do my best to hold it together as I take pictures of the perfect moments of the newest addition to the family. The OB takes care of the placenta and checks for tears. Thankfully the mother didn't have any separation of her tissues. In just a few minutes time she was given an ice pack for her perineum and given warm blankets and left to enjoy her new daughter. I chart on her birth file all that happened and the stats of the baby's time of birth and APGARS. As I sit in the chair towards the side of the room. I witness the couple look their baby head to toe and coo and caw over their perfect creation. I hear a big sigh of relief from the mother who then says: "WOW, that was really tough, I totally didn't think I could do it. (she giggles through the sentence) I can't believe it's finally over and she is here, it's all soooo surreal!" I see dad shake his head from side to side in utter amazement and adoration for his wife. His love for her grew so much in the last few hours, his admiration was palpable. I see the baby girl suckling on her own hand and say: "it looks like a good time to try nursing your baby if that's what you want to try?!" The mom says: "I'll try, let's see how this goes!" I find pillows to put under her elbows and raise the bed to a comfortable nursing position. We put baby's tummy to mom's tummy, mom holds baby in a cross cradle hold. With a little teasing of the nipple at baby's lips the newborn opens her mouth and mom puts baby's head to her breast.....baby suckles and latches off quickly then tries again. SUCCESS!!! Mom gives me a look of intensity as the baby's latch is tight. Her husband and I giggle a bit at the sight, mom is happy and baby is happy. Dad sits and admires his wife and new baby girl they named Chloe.
This is an optimal birth as a doula that I have witnessed time and time again. I have also witnessed many homebirths as well as birth center births. I have witnessed other things as a doula that I must get off my chest:
-Over and over again I have seen the bait and switch from a OBGYN/CNM whom say before hand that they will support a natural birth with a doula. Once the mother is at the facility in labor the support goes where?? The provider asks the mother to get an epidural to speed things along and to do what is best for her. In my opinion it's about being a "compliant patient."
-I have had nurses despise what it is I do without knowing "me" or how I practice doula work. I have SEEN nurses do things rudely or harshly to the birthing mother b/c I was on "her territory" and these nurses did not want me there. To get even with me they do things to the mother that are uncalled for. **not all nurses but too many to count.
-I have witnessed an OBGYN lie to my face about a mothers condition at her prenatal visit that day, and the same day mother and baby lay in the ICU both in critical condition. I as the doula was called after the visit with the OB and got the stats of the visit (from my client) I instantly told the mother to go back to the facility and check in at Labor and Delivery, due to risks that could severely affect baby and mother.
-I have witnessed IV's being injected with Pitocin after labor, w/out mom's consent NOR verbally telling the mother. Now it seems it's just protocol to give every mother Pitocin after the birth. Im talking about when a mother isn't having any issues with bleeding or the uterus contracting down!!
-I have seen 3 episiotomy's that were given ONLY b/c the provider didn't want to suture a tear b/c it was "easier" for them to suture an episiotomy.
-I have seen 2 forceps births where the provider states that "no harm is brought to the baby." As I stand and witness (nauseated) the strength and visible shaking of the hands placed on the forceps as they PULL with force during a contraction and afterward. No harm to baby or it's spine or neck? What about the bruises on the babies face and head? Oh and let's not forget the 3rd or 4th degree tear it gives the mother?!
-Time after time I have heard the provider blame the mother for tearing her tissues and being angry with her b/c they have to suture her perineum up. Instantly the mother feels guilt over making the provider go out of their way for her.
-I have seen care-providers and nurses tell a mother she can push in whatever position mom wants to be in and when the time comes she is "made" to lie on the bed in "their standard semi reclining" position without other choices. We all know that this position is far more optimal for the catcher than the birthing mother. **That doesn't make it ok!
-I have called photographers to take pics of a a baby and mother whom both weren't supposed to survive. To this day those photos are a blessing to this mother and I believe it was the miracle of them bonding with each other for the 1st time that allowed them to live today.
-I have witnessed a mother in a coma and on ice and fans to keep her brain activity down...when minutes ago she was pregnant. With many unanswered questions. And not a sympathetic person in sight for this new father. I was the only one he trusted or grieved with.
-I have witnessed nurses "doing their job" and taking baby away after the cord is clamped to clean and assess the baby 10 feet away in a bassinet.... while the mother looks aching to hold her brand new infant. It is a shame the baby witnesses the nurses face before it's own mothers. We need to keep the baby skin to skin with the mother, and allow bonding to take place right then and there!! APGARS and all other duties can be done while the mother is holding her infant. I have seen it done many times and it works!!
-I have witnessed docs say that they will do a "husband stitch" on a mother so her husband can then enjoy her tight vagina after they resume sexual activity. **rolling my eyes as I type
-I have witnessed mothers tell providers of her history of sexual abuse and the provider thinks nothing of it, asks no questions and moves forward as if he/she heard nothing. Using words that can easily be "triggers", not asking permission before breaking her water with a amniohook, or scraping her membranes.... acting as if nothing was ever said.
-I have witnessed nurses telling a mother not to cry, that she should tough it out b/c this is what she asked for in an unmedicated birth. I quickly tell the mother not to listen to that nonsense and to let out her emotions as she sees fit. Even getting another nurse (if need be) who is supportive of this mothers choices.
-I have seen docs talk so sternly to a mother who is vocalizing during labor and tell her that she is making other patients in rooms nearby fearful, and that she must stop or she will need medication to calm her down. FYI: SOME mothers vocalize during pushing which should be perfectly acceptable.
-I have seen mothers who have been affected by abuse in their past who completely lose themselves during the birth of their baby. I have seen them grieve and disconnect completely from their body (as a safety mechanism) and their baby. As a doula to witness such pain and fear upon this mother has affected me so deeply it brings me to tears.
-I have been yelled at by the "grandmother" (to be) whom sternly states: "Tiffany you are a stranger in this room, who doesn't even know my daughter. How can you know what she needs? We are her family and she wants us here despite what she is saying right now." I generally ask the father to take care of the family who can wait in the waiting room as the mother wishes. I have been mocked and had rude stares as I pass the waiting room or give information on how mom and or baby are doing. With glaring eyes of distain for my presence.
-I have had to calm father's down who were irate at the docs for intervening without need due to wanting a compliant patient (the mother) or being home at 6pm for their dinner time.
-I have had countless nurses tell a mother NOT to push as the doc/CNM isn't there yet but is in the car on their way to the facility. They have yelled at the patient that it is not ok to push and have even left the room knowing that a mom won't tend to push when a hospital employee isn't present. *I've almost caught a few babies b/c there wasn't a nurse or doc present. FYI a nurse is trained to catch a baby there should be NO issues with a mom pushing if a doc doesn't make it... so be it!
-Lastly I have given birth twice now. Both times my babies whisked away quickly to the nursery. The docs acted as if my babies were too critical to hold and bond with. I had an episiotmy (completely unnecessarily) with my first. I chose to push hard with my 2nd baby knowing full well that I would tear. My doc was very upset with me for pushing when he hadn't stated I could do so yet. It was involuntary for me at that time b/c I was going natural. When it was time to sew up my torn perineum he gave me NO medication, topical or otherwise and sutured me up. I had no epidural, which he was FULLY aware of. This doctor also took his hand and went within my uterus and swept it out. My placenta was completely intact, I wasn't having bleeding issues and yet there was no reason to do the sweeping of my uterus.... he does it to every patient b/c that was what he was taught. Let me tell you that having a fist up your vagina going into your uterus was one of the most painful experiences of my life. I felt completely violated. I had a nurse tell me with my first that I shouldn't nurse my baby for as long as I did or my nipples would bleed and fall off and I was doing more of a disservice to my new son than anything. My 2nd baby was in the NICU for having low oxygen levels and the NICU nurses never asked me if I wanted to nurse. Nor did they give me privacy with my baby to try and nurse him. I had to be proactive and ask for curtains and ask for a breast pump and ask to have private skin to skin time with my infant. To this very day I wonder if my son would even need the NICU if he had been placed in my arms and talked to and held skin to skin with his mother!! Even if he hadn't had good O2 levels thereafter Im sure his NICU stay would have been shorter. I was without my baby for 10 days. Leaving that hospital without my new son was one of the hardest things I had ever done. And although my son never latched properly to the breast I pumped my milk every 3 hours for 6 months straight which fed my newborn and my 2 year old for an entire year. I had far more milk than 10 women would need. I suffered with mastitis over and over. I tried everything I knew to be a successful nurser... and I failed. I did all I knew at the time.
Why do I write my feelings today? I ask myself daily... WHAT IS MY JOB AS A DOULA?? Is it my job to be emotionally wracked with all I have witnessed? Is it to empower mothers whom shy away once docs speak over them? I can not be a witness to all I have seen and sit back anymore. The good births I have witnessed are fewer and far between than the bad that I have seen and heard with my very own eyes and ears. If there is anything I can say to all women out there it is this: TRUST YOURSELF, TRUST YOUR INTUITION, TRUST THAT YOU KNOW HOW TO MAKE CHOICES FOR YOU, YOUR BODY, and YOUR BABY! I beg you to ask the hard questions to your OB's, CNM's, midwives, ask ask ask!! Know what you are asking. Be educated, read books, take education classes, or hire a doula. Don't listen to all the BS that a woman can't go natural and why would she in this day and age?! Women have birthed babies for thousands of years and will for thousands more.... we can do it, our bodies know how to do it. The hospitals DO have their agendas for expectant moms. The things they do or say are NOT always in the best interest of the mother nor the baby. The hospital and staff have their protocols and when we deter from that it makes people question why they do what they do.... Choose a midwife or OB who will support you in your choices. If your friend or family member had a popular doc did they have the same wishes for their birth as you do? If not, they may not be the optimal doc for you!! Write what you prefer for your birth (keep it to one page maximum) and share it with your doc at each visit. Ask their c-section rate, episiotomy rate, epidural rate and so forth. Right this very second in my life I question why I am a doula. I have spent so many hours with women in labor and have seen it work without the interventions that hospitals proclaim to need. A birthing mother isn't sick she is having a baby and intervening will generally cause more issues than anything. I hope one day we will stop practicing continuous fetal monitoring as it has no benefits to mom or baby. If we all had the chance to visit women in labor in their own homes and be that "fly on the wall" we wouldn't choose anything else. Yes indeed I know birth can go awry and in those times hospitals are blessings. However, treating every woman as high risk or whisking 33% of women into the operating room for a c-section delivery is asinine. Look at the statistics of not only our country but other countries. We aren't doing things the right way. Docs are absorbed in doing things that won't get their asses sued. They follow those "guidelines" set by??? So today as I sit and still question it is what I do and whether I will continue this path.... I can only say those that are thinking of going this direction of doula-ing, it isn't a profession it is indeed a calling~ Perhaps my calling is changing and homebirth midwifery is my new chapter... that I don't know yet. I do know that doulas (educated doulas) are needed in the hospitals with these mothers. I just don't know if I have it within me to witness anymore than I already have....
