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"No."

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“No.” - A haiku

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No, thank you is nice

But nice is not required

Birth is not polite

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You do not have to justify your, “no.”

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You do not have to apologize for your, “no.”

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There is no true consent if there is no option to say, “no.”*

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There is no true consent if it is perceived there is no option to say, “no.”

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Consent to any medical procedure in any way is a basic human right in birth (not to mention in most other aspects of life as well...but I’m gonna try and stay on topic).

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*I think I am paraphrasing @cristenpascucci from @birthmonopoly there...probably...she’s a smart lady



 

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Birth Ninja

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I often wear black as a #doula when I am attending a #birth. If not black, I try and wear something plain and preferably dark (obviously pending what is clean...I'm still human). I want to be as stealthy as possible. I am a birth stagehand. My goal is for the show to go off without a hitch and without being noticed. I like to fill up water without the birthing person realizing I’ve left the room, I want to be squeezing her hips before she says she needs me, I want to have chapstick on her lips before she realizes her deep breathing have made them dry. I wanna be a #birthninja  #birthmetaphor

 

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Birth is all in the BRAIN

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My guide to making every decision in #birth and life.**

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BRAIN

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Benefits
Risks
Alternatives
Intuition/Inner Circle
Nothing

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My clients (and anyone who knows me for that matter) have heard me espouse the long and short versions of this acronym more than anything else, coming in a close second to, “drink more water.” (It’s a good thing I give one helluva hip squeeze or else the entirety of my doula work pretty much ends there)

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The first step in the BRAIN method of decision making is asking the question, “Is this an emergency?” If the answer to that is yes, then ideally my clients have a baseline level of trust in their provider and previous knowledge to guide them when time is of the essence. So let's go ahead and get that out of the way. Emergencies are a different conversation.

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After it is established that it is not an emergency, we look at what is referred to in the acronym as the Benefits and Risks of any given option. Though this is, in reality, a trixie shorthand. What we are really talking about are the facts and figures on the definite pros, the possible pros, the definite cons, and the possible cons given to you from sources that you trust - medical professionals, #doula, #evidencebased research, your faith leaders, etc. The point is it is information you trust to be true and people to help you interpret it and apply it to your individual situation. Also known as #evidencebasedcare.

Very few things in life have definite (ie guaranteed) pros. There is no guarantee an epidural or a tub will relieve your pain. There is no guarantee that a fully unmedicated or cesarean birth will result in a healthy Mom and/or baby. But there are possible benefits that you may deem worth the risk of all the definite and possible cons. The only definite pro is that you will know you tried the option that was best in the moment.

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Then we look at alternatives. Keeping with the coping example, what coping techniques have we not utilized or can utilize again? What about IV pain meds, sterile water shots, or a cesarean (and then we would go through the B/R of those)?

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Then it is onto intuition/inner circle, the most overlooked of the factors IMHO. Intuition, what does your gut say? It isn’t anyone else’s body and it isn’t anyone else’s gut. What say you, gut?

Inner circle, your and your partner’s* own VALUES and PREFERENCES.  No decision in birth belongs to anyone but you, the birthing person. You’re the boss, you’re in control of making decisions. Even if your decision is to let others make the decisions. That giving up of control is in itself, in your control. Despite the verbiage we hear in many birth stories, no one is allowing you or letting you do anything. This is the piece that can take a fully weighted scale and tip it the other direction, facts and figures be damned.

*many decisions are made as a team, but at the end of the day, it's the birthing person’s body and the veto power remains with them and them alone.

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Last in the acronym is nothing. What if we do nothing? What if we just give it a little more time? What if we revisit this decision in an hour? A half hour? Tomorrow? A few days? A week? Weeks? (You get the gist)

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I honestly believe that if you make decisions with this method, you can’t make a “wrong” decision. Sure, you can make decisions that you look back on with that good ol’ 20/20 hindsight and wish you had done differently. But IN THAT MOMENT, when you knew everything you could have possibly known at that moment and made a call based on your values and preferences, you can know at the very least that you made the best decision you could given everything you had at that moment in time. That is all we can possibly ask for.

Go forth and live an intentional and decisive life.

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**Now, don’t go all extremist and use this with what to make for dinner or appetizer versus dessert (both, clearly). If it’s reversible or not going to cost life or limb or a huge life changing experience like Birth, pick something and move on. Get the damn potato skins.

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Everybody Poops...In Labor

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Bear (down) with me here. This is not something to feel ashamed or embarrassed of. It is just plain physiology. Ya got a human coming out your V. Ya got some P in your B. Either it all comes out or none of it comes out. You wanna NOT poop in front of your midwife/OB/nurse/partner...or you wanna have a baby? Ya gotta let go and let gravity.

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Some people think that it will just be those with epidurals because you can’t feel the pushing as well...nope! Some people think it will just be the unmedicated ladies because of the positions and whole “natural” aspect of their labors...nope! (and wtf?)
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So, in case you didn’t know, birth is a bodily function. I personally think it is a friggin’ amazing bodily function, one that is worth any other bodily functions that come with it. Especially if those other things bring the baby closer...which they do. Not just pooping, but peeing (baby’s heads tend to have a hard time getting past the bouncy bumper known as a full bladder), farting (I mean...if you’re pooping…), burping, vomiting (hello hormones!), and making lots and lots of noise. #WooHoo
And yes, I stand by the “friggin’ amazing” part. Birth is not ladylike...babies don’t come out of crossed legs.

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Ok, so I know I shouldn’t make a claim like that because I am certain that *some* people don’t poop in labor. There are those who get out of the pooping-in-labor club on the technicality that they have c-sections before they get to that part of labor (but still totally part of the common, terrified-of-that-first-post-birth-poop club...#solidarity). And of course there are some who either don’t push in a way that makes them poop, they miraculously didn’t have any poop to poop at that time, or possibly they are magical princesses who don’t in fact poop because they don’t actually exist. But thanks for letting me riff off of the popular potty training book for a moment because I can’t read it without thinking my truth, Everyone Poops...In Labor.

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#BirthIsNotLadylike #Everyonepoopsinlabor #doula #birth

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Esmee's Orchard: Labor Environment and Hormones

Esmee's Orchard: Labor Environment and Hormones

This picture was taken in Esmee's orchard next to her house by her sister. She labored best in her home environment surrounded by people she loved and felt the most comfortable with. 

One of the biggest factors in birth is all about the hormones released in the birthing person's body in response to the environment. 

Oxytocin, endorphins (helps muscles relax, sends blood to the uterus, decreases sensitivity to/awareness of pain) and more flow when a person is in an environment that brings them comfort and calm. 

On the other hand, adrenaline (causes muscles to tense, sends blood to limbs, increases sensitivity to/ awareness of pain) flows when a person is in an environment that is unfamiliar and/or a disruption from their place of comfort. 

It is important to keep this in mind when choosing your place to labor and birth. Some people feel safest and most comfortable at home, so they either choose to labor and birth at home, or simply labor at home as long as they can before they go to the hospital. Other people feel most safest and most comfortable to go ahead and be at the hospital earlier so they know they are close to any medical intervention as soon as it may become necessary. 

There is no right or wrong choice. Both options carry their own pros and cons, risks and possible benefits. Each birthing person gets to decide what is best for them given where they feel they labor most effectively. 

Either way it is handy to have a doula :)

A doula can help you decide when to go the hospital if you are wanting to stay home as long as you can to decrease the likelihood of staying home too long or going to the hospital too early (its not an exact science, but can help you interpret the signs of early vs active labor). 

A doula can also help talk you through all the benefits/risks/alternatives/etc when you are in the hospital for any interventions that are offered in a non-emergent situation. (we help put the informed in informed consent)

While it is always true that there are things you cannot control about labor and birth, it is also true that there are things you can control in non-emergent situations. Stack the deck in your favor. Plan to labor in a place you feel safe and comfortable. If that means the hospital, you can alter the usually bright, unfamiliar hospital room in many ways. Doulas have lots of tools in their doula bag and tricks up their sleeves to assist in this. 

Remember, two of the biggest factors in birth are physiology and psychology.

Help your brain to help your body. 

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Where We're Going

“I wanna wake up and know where I’m going. Say I’m ready. I’m ready.” – Tracy Chapman

 

I take lots of deep breaths.

 

On this Monday morning I am trying really hard to get my mindset in check.

 

My weekend was a bit more of a rollercoaster than usual. A medicated (and NOT in a sedated way) toddler, an adorable and sweet toddler (it’s a Jekyll and Hyde thing with toddlers…even without medication), sleep hindering allergies/cold and subsequent medicine fog, the honor of talking to a group of doulas in training, a difficult conversation with a friend, an amazing prenatal with clients, and the fact that it was the weekend and therefore I had the ability to sleep in a bit to make up for the coughing fit at 3am.

 

Yet this morning I was still feeling physically pulled down in my gut. The first day of the mentor course that I have been putting together starts tonight. It is a very big thing that I have been working on both in putting the logistical parts of creating an online course and figuring out an action step I can take to get towards my bigger goal.

 

My bigger goal is to bring about systemic and multilevel change in our maternity care system.

 

A tendency I have that I am working on every day is a deeply ingrained reflex to be easily overwhelmed when it comes to conquering large tasks.  These can be actual large tasks…like making an impact on America’s health care system or things that seem large in moments of depression*…like cleaning the house.

 

This course is actually one of the first several steps I have been taking with a doula mentee, Riah. We have been talking for months about how as doulas we can make an impact on the ground level. And we are not content with throwing one starfish into the sea at a time. We decided that one thing that we could do was go one step up (to start). Instead of just supporting our clients, we would support other doulas. More doulas, more clients served, more consumers requesting evidence based care, more health care providers wanting to give potential customers what they want.**

 

In addition to bringing more people into doula work we also wanted to create a space for doulas of any certifying organization or philosophy to learn from each other in a supportive environment. While this seems like a no brainier in a community that is built upon supporting women, we found that while there are many communities we didn’t find the one that fit for us; one that both provided support without defensiveness, criticism, and judgment and also had at its heart the purpose of moving the maternity care system forward on a bigger level. We believe that the second, larger goal cannot happen without the first. If we are focused on the minutia of doula work where we practice differently than the doula next to us, we cannot focus on all the women who will be birthing in a system that has been conditioned to bypass informed consent and dismiss evidence based care in favor of tradition and habit.***

 

We created social media accounts. We took pictures and made videos. We speak daily about how we can reach people with the same goal.

 

Our next step was to think of a way to help the doulas we were hoping to reach get started out on the right foot. One of the big conversations I have always had with new doulas (and myself in my own head when I started) was how beneficial it would be to see a more experienced doula put all the things you learn in trainings into practice. This was driven home to me even more so this past weekend when I was speaking to the doulas in training. So much of what you want to know can’t be taught at a training. There isn’t time to have nothing but a question and answer session. There isn’t time for all the dialogue and curiosities that a new doula wants and needs.

 

As someone who has mentored new doulas (with great success if I do say so myself…my mentees are friggin’ amazing and while I can’t take all the credit, I like to think I made the process a little easier and less lonely), I loved the thought of mentoring more and more doulas by talking about my personal experiences and personal modus operandi. It does not feel authentic for me to talk about “how to be a doula” on a general level so I decided to speak to doulas simply from my perspective. The way I do it isn’t the best or the only right way, it is just one way. There is no ‘best’ way for a client to birth. There are too many variables chief among them (IMHO) being the client and their beliefs, values, and preferences based on their life. But we don’t just leave them with the childbirth education class or the books. As doulas we give them our time, our experience, our knowledge, the ability to ask us all the questions. Then we give them the support to empower themselves in making all their own decisions.

 

We value the support we give our clients. I want us to value the support we give each other.

 

We believe these are the first steps in our sphere of influence to bring about very necessary improvements to our maternity care system.

 

The first step may sometimes be the hardest, but that doesn’t mean that all the steps that come after are easy. It helps to know I am not doing it alone; it is less overwhelming.

 

So, getting all that off my chest was the first thing I needed to do this morning.

Onto the next thing…I haven’t decided what that is yet, but it will be easier to figure out with that bit out of my head.

 

Have a great week.

 

*I got the bipolar numero dos

 

**At the end of the day hospitals are businesses. The medical staff of doctors, midwives, nurses, etc who want to do best by their patients are not usually the once who write the policies, decide how buildings are built, but the tubs, decide how to teach the next generation of medical professionals. Those decisions are made by the people on the business side and as much as we know that each individual person wants what is best for patients, we also know the reality that legal worries and profit have over most any business.

 

***This statement is NOT to be confused with provider blame or an ‘us vs them’ mentality. This is a systemic, institutionalized problem. While there are always people that make poor choices out of high emotion when their identity as a professional is questioned, this is not about bad actors; it is about imperfect human beings attempting to operate in a broken, convoluted, fear-filled system. The goal of our work is to create a space for everyone, doctors, nurses, midwives, doulas, and especially birthing people, their partners, and their babies to benefit and focus on what each does best, consistently, and enthusiastically.

 

 

 

 

 

 

 

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Expectation Setting

*This post was originally written in May 2016. Clearly, it took me a little bit to actually do the thing. Here I am now, January 2018. I have also put most of these thoughts into my first video blog, so if you have seen that, this is mostly repeated info. I edited it slightly as, shockingly, I am a slightly different person than I was almost two years and 30 births ago.*

Most of my adult life I have been prone to rants. This is especially true on social media when things get me in a tizzy. And if you know anything about social media, you know that it can throw many a person into a tizzy. 

There have been a couple times in my non-professional life that I have attempted to "start a blog" as a place to put such musings or thoughts on one subject or another, but the focus was too broad and I would usually lose interest after an initial entry or two. 

Enter big life change of having a baby, quitting my desk job, and embarking on the journey of becoming a doula. This has involved many things, one of which being the social media aspect of having a small business in 2018. A blog is by no means required, but it is one of those pieces that is constantly recommended. And as someone with the aforementioned lean toward putting my opinions and thoughts of all varieties out for public view, I felt it was time to jump in and start typing. 

Seeing as I am planning on this being my first post, I wanted to start off with some good ol' expectation setting. 
First of all, I will be talking about pregnancy, birth, postpartum, newborn care, and things that relate to any or all of those things. I may at times drift into a tangent, but, as this blog will be a branch of my doula business it at least sets the parameters. If you do not enjoy hearing about things occasionally involving vaginas, you are in the wrong blog. (unless you are stretching your comfort zone, in which case, welcome and good for you) My personal tilt in the birth world is toward evidence based birth practices (go check out evidencebasedbirth.com if you haven't already), helping parents know all of their options so they feel empowered in their choices as consumers, and looking at birth, pregnancy, and parenting from an inter-sectional feminist perspective. If you don't think that is your thing, I invite you to stick around anyways and keep stretching that comfort zone thing. I always welcome the chance to further explore an idea through discussion.   

The second thing I want you to be able to expect from my writing is empathy and authenticity. I, of course, am speaking from my own specific life experiences. All we can do in life is speak our own truth and I will do so without apology, but I will try my best to always remind myself and anyone reading to look outside one's own circumstances. Pregnancy, birth, and parenting can be very touchy subjects with some thinking that what worked for them should work for everyone or that something that works in theory should always work in practice. This is just not the case and not something I will advocate. Each parent is different as is each child (as any parent of more than one child will tell you). This will not be a place for judgement or condemnation. 

That does not mean that this will be a space that does not challenge ideas. This will be a place that values facts alongside opinions with the caveat that we must recognize the difference between the two. Critical thinking about the many choices available to parents does not need to equate to judgement for someone's choices in parenting or their body. This is a very important distinction that I'm sure will be spoken of again. Making different choices does not make any choice "right" or "wrong." It means that each person has reviewed the pros and cons, weighed the evidence and its sources, compared that to their own personal life circumstances, and made a decision. Or it could mean that they skipped one or two of those steps and jumped ahead to decision, but the fact remains that it is their decision to make. It is possible to have mature, civil discussion while still coming to different conclusions. And thank goodness for that or life would be boring as hell.