Pregnancy and Birth Outcomes...

...are influenced by a variety of factors, but cannot be controlled by planning.

Let me rephrase that.  Parents have an idea (fantasy?) of what it will be like.  Moms and dads get organized, read all the 'right' books, take classes, write their birth plan, hire a doula.  And the reality is nothing like they expect:

Just getting through a contraction blocks out everything mom has learned and read.

 
The parents expect to be at home with their doula in early labour and end up in the hospital for 18 hours instead. 

 
Mom says she will never get an epidural and after 30 hours of labour, gets it and wonders why she didn't get it sooner.

Most of us have a fundamental belief (whether we acknowledge it or not), that if we prepare in a certain way and do all the right things, we will have the 'good' birth.  If the birth we have does not match the fantasy, we make an assumption that we have done something wrong and judge ourselves as failing.

Part of what Birthing from Within is about is acknowledging this belief and shifting the idea of a 'good' birth. External factors (what happens) are not as important for parents feeling good about their birth as internal ones (what parents do in the moment).  Some people have unexpected cesarean births that they feel great about, because they know they did everything they could.  Others have a rapidly progressing vaginal birth with no interventions that they perceive as being completely traumatic.

Birthing from Within is not about laying down a plan to follow to the letter.  It is about preparing by putting out into the universe what we would like for ourselves, without being attached to what actually happens.  We are prepared to accept what is happening in the moment and do the next best thing, when necessary.

This is a huge departure from most of what is out there about birth preparation.  It can be scary to let go of the busy work that we do to get the 'right' plan.  And it is good to be a little bit scared, especially when we are stepping into the unknown.

Please check out www.birthingfromwithin.com and www.elliedoula.com for more about this unique birth preparation.

Fathers and Partners Help Best as Birth Guardians...

...and/or loving partners, not as coaches; they also need support.

In honour of Father's Day, I decided to write about this Birthing from Within principle.

In our birth culture, we have moved from dads not even being in the room, to an expectation that they are responsible for supporting the mother in every aspect of pregnancy and birth.  This is not fair to either parent.

Birthing from Within Classes and doula support recognizes that fathers are also going through a rite of passage and major life change that is parallel to, and different from, the mother's experience.  Birthing from Within Classes provide a special class for fathers,that address their different needs. Read more about how Birthing from Within helps fathers...

The main role of the father during birth is to simply be present for the mother, to focus all of his attention and love on her.  Many dads learn that their role at the birth is to 'do something', whether that means negotiating with hospital staff, getting ice chips or doing a certain kind of massage for the mom.  While there are times during the birth that specific tasks may be required, the thing that moms remember most is a sense of their partner being present emotionally.  The father's preparation is sometimes about unlearning -- letting go of the instinct to solve a problem or fix something and instead learn to let the mother experience the intensity of labour, simply being there for her and recognizing the birth as the transformative experience it is.

Birthing from Within pain-coping practices (learned in a class) can help the parents stay connected to each other and gives the father something 'useful' to do that maintains and intensifies their emotional connection.

Having a doula or other female support person present is an excellent way to allow the parents to focus inward on the birth, while the doula gets the ice chips!  Doulas can also help direct dad if he is uncertain about what might help the mother and give him a break if he needs to leave for a few minutes to centre himself. Read this article about how doulas help...

Mothers

Julie and Ellie - Early Days

Happy Mother's Day.  What a lovely opportunity to take a few minutes to reflect on ourselves as mothers or mothers-to-be.

How do we let go of the judgement that we feel from the world around us, and more importantly the self-judgement?

Learning to say: "I am doing the best I can with the resources and knowledge I have and moving forward."

Learning to let go of the organic quinoa falafel cakes we saw on Pinterest, but never baked. Let go of the parenting book we didn't have time to read.


Let go of feeling guilty about yelling at our 3 year old for digging up the section of the garden we just planted and putting pine needles in the watering can -- eventually even letting go of the yelling (maybe).

Instead, how do we learn to embrace the early morning request for a group hug with mommy, daddy and 6 stuffed animals and hold on tight for an extra minute, instead of rushing off to make breakfast?

How do we give in and relax at the idea that our 3 week old needs to nurse for six hours straight, put up our feet and read a juicy novel, while he lies on our chest?

Julie and Ellie - Today

During pregnancy, how do we prepare for birth and motherhood in ways that nourish us, whether it is preparing a special place in our home for our baby, or in our hearts.

I am off to enjoy my daughter's company.  I hope that everyone has a wonderful day.

Pain and intensity are an inevitable part of birth...

...yet much can be done to ease suffering.

Often during pregnancy, people share stories of their birth experiences.  Sometimes these stories give us a sense of how exciting birth can be, of the amazing accomplishment of bringing a baby into the world. 

Unfortunately, sometimes people who tell these stories had a birth that was scary for them, where they suffered.  Hearing these scary experiences, the pregnant parents naturally look for a way to avoid something similar for themselves. 

One Birthing from Within principle is to help parents recognize that pain and intensity are inevitable during birth, and to focus on what we can do to ease suffering, which is the story that we tell ourselves about the pain.

Learning ways to cope can change a scary experience into an awesome one.  It is not about removing the pain, but about seeing it differently and being able to handle it. Some of the pain-coping methods we practice in class are extensions of what women will naturally do when in labour.  The reason I teach them is allow both parents a chance to understand how they work and to practice them, so that they come naturally, even in difficult situations.

Tips on pain-coping during labour:

·         Sometimes mothers are exhausted and might find it helpful to be ‘talked through’ a couple of contractions.

·         Partners - DO NOT tell her to ‘breathe’ or ‘relax’.  Birth is not relaxing.  Encourage her to rest in between contractions.

·         Parents practice together before the birth and find out what works for her.

·         If nothing is working, do something completely different!

What about epidurals?  Many women get epidurals and some will tell about how the birth was terrible until they got the epidural.   When epidurals work properly, they provide almost complete pain relief.   However, there are potentially major risks involved.  In my Birthing from Within Class, we discuss the epidural as one pain-coping tool.

Unexpected events happen during birth and the more preparation you do, the better you will cope.   Labour is painful, and getting through may or may not include an epidural.  Sometimes, even if you plan to get it, the epidural is not available or it doesn’t work correctly.  Having a variety of strategies to cope with pain will help you adapt regardless of the situation and to feel more positive about the entire birth experience.

In my classes, we spend at least 5 hours on pain-coping (1/3 of class time).  This article is intended to give some generally help, regardless of whether you take a Birthing from Within Class.  Practice of pain-coping and integration into your daily life will great increase how effectively you are able to use it during labour.  Hiring a doula who understands pain-coping can help too!

This article originally appeared in the Nuturer, Mommy Connections Lethbridge (March 2012)

January Newsletter

Read the Birthing from Within Lethbridge January Newsletter for lots of great info about our classes and doula support, plus community events and discounts for pregnant women and families.

Pregnancy & Birth Information Session

The first step in birthing (and living) in-awareness is to turn your attention inward each day. One of the important tasks of pregnancy is to consciously tune in to, develop, and trust your own, new, maternal intuition. 

www.birthingfromwithin.com

Are you pregnant and interested in learning practical ways to improve your pregnancy and birth experience?

Dr. Amy Heilman, West Lethbridge Family Chiropractic, will offer some practical ideas about easing some of the common discomforts of pregnancy as well as answer any questions about how chiropractic care can help many of these problems.


Ellie Colver, Birthing from Within Mentor and Doula, will begin to help you prepare for emotionally and mentally for your birth and parenting experience. She will also tell you about her classes and doula support.

Saturday, February 4
2:00 – 4:00 p.m.
West Lethbridge Family Chiropractic - 888 Heritage Boulevard W

For more information and to RSVP:
Contact Ellie Colver
Birthing from Within Mentor & Doula

elliedoula@gmail.com
403-360-7878



Birthing from Within Lethbridge on Facebook

Good Nutrition is the Number One Thing You Can Do to Ensure a Healthy Baby

Throughout pregnancy, many women receive numerous tests to ensure that their baby is healthy.  While these tests can sometime be helpful in detecting problems, in most cases knowing something is potentially wrong does not actually provide a solution.

The best thing you can do to take care of your baby and yourself is to eat well and stay physically active.  There is no guarantee that if you do all the 'right' things, your baby will be healthy, just as some people do things that research has shown to be harmful and end up with perfectly healthy babies.  Nevertheless, eating well and exercise have been proven by research to improve outcomes for babies overall.  Also, the habits that you form around your diet before and during pregnancy will be passed on to your children.  Babies actually develop a taste for the food that mothers are eating through their amniotic fluid (and later through breast milk) and like those foods themselves.

Here are some specific suggestions (businesses are all Lethbridge-based):

Yoga is great for helping you feel good during pregnancy and preparing your body for birth. Theresa Spencer at Terra Sol Yoga offers classes and workshops for pregnant women and their partners. www.terrasolbodytalk.com

Eat whole, unprocessed food. Avoid processed soy, sugar, corn syrup and artificial sweeteners whenever possible. Many grocery stores have a 15% discount on the first Tuesday of the month, so stock up on healthy, organic food. Look for local produce and meat, as it is often free of pesticides and hormones and it supports local businesses.

Eat as much as you need to of healthy, nutrient rich food and you can expect to gain 28-40 pounds (or more) during your pregnancy. Perfect Fit – Pre & Postnatal Fitness offers classes specifically tailored to pregnant and new moms to help you stay physically active. www.perfectfitness.ca

Taking a DHA (or fish oil) supplement improves your baby’s brain development. Naturistas (424 7 St S) sells prenatal DHA, other prenatal vitamins and many other high quality pregnancy and baby products.

Receiving chiropractic adjustments can be a great way to relieve many of the common discomforts of pregnancy. Many women under chiropractic care report feeling better during the entire pregnancy, better quality of sleep, less morning sickness and a more comfortable labour and delivery. Contact Dr. Amy and Dr Elliott at West Lethbridge Family Chiropractic for more information. 403-327-0070.

Birthing from Within® Childbirth Classes help you prepare for the healthiest, most stress free pregnancy, birth and new parenthood possible. Contact Ellie at elliedoula@gmail.com to learn more about these unique classes.

Take time every day to relax and connect with your baby, even if it is just a few minutes. When you are eating, pay attention to the food, how it tastes and remember that you are nourishing yourself and your new baby.

Join ‘BIRTHING FROM WITHIN LETHBRIDGE’ on facebook for great articles and information to help you in pregnancy, birth and new parenthood and chances to win prizes.

Getting Postpartum Support - A few ideas

Below are some ideas for support with a new baby.  Most of the resources are local to Lethbridge, but the ideas apply to everyone.


When you have the baby, change your voicemail to say:“{NAME} was born {DATE&TIME}, weighing {POUNDS}. We are busy getting to know our baby and we will get in touch when we have all rested a bit.” You can also put a sign on the door if you expect people to stop by.

 Make a list of things that people can help with: Groceries, Meals, Chores, Errands.  This way when they ask what they can do, you can put them to work. Check out www.mealtrain.com to set up an online meal request calendar.

Hire a postpartum doula (if you haven’t already).  A postpartum doula can help you with practical baby care, emotional support, babywearing and anything else you might need.  See www.elliedoula.com for more on postpartum support.

Connect with La Leche League Lethbridge for breastfeeding support.  Meetings are the first Tuesday or Wednesday of each month at the downtown library.  Join the facebook group to get reminders about the meeting or call 403-331-1003 for phone support.  www.lllc.ca.

Find a group of new moms you can connect with.  www.mommyconnections.ca offers postnatal programs for moms in Lethbridge.

If you think you might have postpartum depression, get help.  www.thesmilingmask.com has lots of resources including the Edinburgh Postnatal Depression Scale.  Alberta Health Services offers in-home counselling for women with postpartum depression, free of charge.  Contact Bree Elliott, Mental Health Therapist at 403-388-6666 for more info.

Get a baby carrier and wear your baby as much as possible.  www.ecobabycanada.com is a local business selling great slings, wraps and soft structured carriers, along with help learning how to wear them.  Also join the facebook group for Bridge City Slingers – Lethbridge Baby Wearers, to get support on babywearing and info about meetings.

DADS: If mom is breastfeeding the baby for hours every day what does dad do:

o   Everything else! – find ways to give mom a break (even a short one)

o   Wear your baby in a carrier around the house or go for a walk

o   Change diapers

o   Give the baby a bath or take a bath together

o   Take a nap with the baby (make sure to follow safe co-sleeping practices)

o   Make a meal, or go out and pick up healthy takeout or nutritious snacks

o   Sweep the floor, do a load of laundry, change the sheets on the bed...

o   Support breastfeeding by caring for your partner, so she can care for the child.

Active, creative self-expression...

... is critical to childbirth preparation.  And it is really beneficial for life in general.

Making art slows down fleeting images, allowing us to really see and know how we see things. People who discount or dismiss the importance of art-making in prenatal preparation are probably people who feel uncomfortable making art themselves. They often argue that millions of women have given birth without ever having made any art during pregnancy. That is true, but it doesn't mean it is "right." Birth Art is a vehicle that brings parents from their outside knowing to their inner knowing. It is an organic and enjoyable form of learning, unsurpassed by any other method. - Birthing from Within

Birthing from Within Classes allow parents to engage in creative self-expression through birth art.  Birth art is a part of the class that people are often either intrigued by or terrified of.  First, let's clarify what we are talking about with birth art.  It is:

• For the purpose of learning about yourself, finding new ways of thinking about yourself and your birth.
• Not art therapy.  The only person who looks at your art is you.
• Different for everyone.
• Not supposed to be pretty.  It is not 'supposed' to be anything.  
• Helpful in preparing for birth and parenthood, because it usually doesn't go the way you planned it in your head, but even more marvelous things happen than you could have imagined.

Even though I am not pregnant, I get to do lots of art in preparation for mentoring my Birthing from Within classes.  The idea is that everything I ask parents to do, I am doing twice as much of.  So if I ask parents in my class to draw their 'Strongest Image of Birth' as the assignment for a class one week, I am drawing that assignment or something similar twice.  

Doing the same assignments several times allows me to let go of some of the associations or 'stories' I am telling myself about certain aspects of pregnancy and birth.  Every time I draw something the images are different and new questions come up.  Sometimes little questions about what to ask parents in my class after a certain art assignment and sometimes big questions that help me to understand and put aside my own judgments and biases.

The Birthing from Within book has some of the art assignments in it, but the best way to experience the art is in a class setting.  Whether you draw and paint on a regular basis, or you haven't picked up a crayon since kindergarten, the birth art process will teach your something about yourself.

This belly cast is not something that we do in a class, but it is something you can experiment with.  It is decorated with henna, which women around the world have used to decorate their bodies in order to celebrate major life events such as birth.

My friend Kim Strom did the henna decoration.  You can find her on facebook under 'Henna by Kimberley'.  She does blessingways, baby showers and plain old henna parties.

Parents' Individual Needs and Differences Determine Class Content

Birthing from Within Classes are designed as gourmet meals, where parents can 'order up' different dishes  depending on their needs and appetites.

In a six week series, each class is a meal, which includes:

• APPETIZER: some type of introduction to whet the appetite
• BREAD BASKET: this is the pain-coping.  1/3 of each class is spent on learning practical skills that parents can use during labour.
• MAIN COURSE: the 'meat and potatoes' or practical information.
• SIDE DISH: enhances the main course.  It can include birth art, role plays or other activities to initiate parents - moving from the known into the unknown of birth and parenthood.
• DESSERT: closing the class by celebrating the pregnancy and upcoming birth.

A weekend class is designed the same way, with three complete meals on the Saturday and three more on the Sunday.

I have at least 50-60 hours of potential content and 15 hours of class time.  So while I follow this menu, and I have a general idea of what types of things might come up, the same class from one series to another can be very different depending on what kinds of questions parents ask.

I always begin the first class by asking:  "What would need to happen during this class to make it worthwhile for you?" and I use that in my preparation and delivery of class content.

The one thing I don't spend too much time on is providing a lot of obstetrical information.  I find that people who are interested in medical information usually have a lot of it by the time they take the class.  I am always happy to recommend books to parents and there are some suggestions on my website and this blog. Birthing from Within is really about learning what birth might be like from the parents point of view and to prepare them for their own birth experience.

Topics covered in a typical Birthing from Within Class:

• How to cope with pain in labour (what it might look like, practical non-medical and medical ways of coping)
• Nutrition and physical health for pregnancy and postpartum, including breastfeeding.
• Labour itself:  early signs, a 'map' of labour, things that help labour progress, what might a 'normal' labour look like.
• Unexpected events: Induction and Cesarean Birth are covered
• Special class for dads:  dad's role as the main support person; special concerns of dads
• Life with Baby: includes expectations, practical information, where to get help
• Ways to celebrate birth and new parenthood
• And lots more....

Please get in touch with me to register for the classes I am offering in Lethbridge and check out www.birthingfromwithin.com to find Birthing from Within Mentors in other parts of the world.

Like my Birthing From Within Lethbridge Facebook page for interesting information and connection to community resources.

The Teacher is "Midwife" to the Parents' Discovery Process...

...not the expert from whom wisdom flows.

This is the fourth Birthing from Within guiding principle, and one more thing that sets Birthing from Within apart from some of the other prenatal class options that are out there.

I realized how true this is when I mentored my first group class last weekend.  My regular class series (whether weekend or six week series) is 15 hours of class time.  Last weekend's class was 6 hours total.  At first, I was concerned that I wouldn't be able to cover 'everything' in 6 hours.  Then as I explored further, I recognized that there is no 'everything'.  There is simply the process of introducing parents to new ideas and ways of thinking about birth and themselves as parents and trusting they will take what they need from the class and learn more on their own.

There is so much 'information' about birth:  telling people where to go, what to do and presenting potential scenarios for parents depending on the decisions they make.  The reality is that parents will not really be able to understand in advance exactly what will happen and instead need to understand that each birth is a different and intensely personal experience for everyone (even a mother and father at the same birth or a mother from one birth to the next).  This is one of the reasons that we use the Labyrinth to look at birth.  The labyrinth has one pathway in and out, but the path is full of twists and turns.  When I taught this at my class last weekend parents really responded to it.  One mother said that she only really understood how useful it might be for labour and birth once she explained it to her own mother.  This is a really good example of how the Birthing from Within Mentor (teacher) introduces a concept and parents take it, explore it further and make it their own.  She bought the Labyrinth of Birth book, which includes history of labyrinths, how to make them and ways to use them in preparation for labour and during labour.

What I do as a Birthing from Within Mentor can be hard to explain.  In our society, we are accustomed to looking for the right answer.  Many people feel inclined to make judgments about pregnant women and give them advice, and sometimes that advice seems helpful, especially if it reinforces what we already believe about birth.  As a Mentor, it is not my job to tell parents what to or tricks on how to have the 'right' birth.  My role is to help them understand what might be right for them and to truly accept that the unexpected is inevitable.  From there, parents take responsibility for their own birth preparation.  Sometimes, it seems to make the classes more challenging to 'sell' to people, since I am not offering a magical solution.  Instead, I am offering the opportunity to discover things about yourself, your relationship with your partner and presenting new ideas that may help you in birth and as a new parent.

I have a six-week series starting on November 2, for those in the Lethbridge area.  please contact me for more information:  elliedoula@gmail.com

Childbirth Preparation is Also Parent Preparation

This is the 3rd guiding principle of Birthing from Within.  People spend a year preparing for a wedding day, how much time do we spend preparing for married life?  Similarly, most prenatal classes spend most of the time preparing for the day of birth itself, how much time do we spend preparing for actual parenting? The Birthing from Within perspective is that you are a parent while pregnant, and we use the terms parents, mothers and fathers to refer to our class participants.

One great thing about Birthing from Within Classes is that the way the classes are taught, prepares you for both birth and parenting.  We learn that birth is unpredictable, unexpected events occur, we cannot plan for or control every aspect of it.  We may feel frustrated, exhausted or uncomfortable.  Welcome to parenthood!

I think about the ideas I had about both birth and parenting before I had my daughter, and I have to smile at myself.  The expectation that I could control so many things, that if I just figured out the magical equation she would sleep, calm down, nurse the way I expected her too.  Even now, she is 2 and a half and I still sometimes want to make things happen in a certain way, that is easy or convenient for me.  I would have loved to take a Birthing from Within class, and maybe it would have helped me understand that holding a baby for hours on end to get them to sleep was not a problem to be solved, but what I signed up for as a parent. Now, in the rare event that she wants to snuggle or has trouble going to sleep, I do my best to use my Birthing from Within breath practices (used for pain-coping during labour), to be present in the moment and enjoy it or at least accept it.  It works (sort of) for temper tantrums in the grocery store too.

Connected to the topic of parent preparation, I participated in a workshop in my community this week, from the creators of The Smiling Mask:
The purpose of The Smiling Mask is to create awareness, understanding, and acceptance of postpartum difficulties; to bring peace and validation to mothers and fathers by engaging and empowering families, and communities in the life changing and natural experience of parenthood.


The three women who started it all experience postpartum depression after the births of their children, and they were not prepared for it.  Our society and media barrage us with images of happy mothers and peaceful babies, and if we fall outside of that there is some kind of deficit in us.  Really the deficit is in an understanding of parenthood as a major rite of passage and the reality that we feel all kinds of things as new parents.  Consistently, new parents feel exhausted, but other than that it really depends on the individual. If we do meaningful preparation before birth, the more resources and coping skills we will have.  The more that we create a community of support, whether it is family, friends or professionals such as postpartum doulas and counsellors, the more we can call on them when we need help.  Everyone who had a new baby needs help, the difference is whether we allow ourselves to accept the help.

I would highly recommend The Smiling Mask website, dvd and books.

Childbirth is a Profound Rite of Passage...

...not a medical event (even when medical care is part of the birth)


This the first of Birthing From Within's 14 guiding principles.


I have been talking to lots of people in my community lately about Birthing from Within® and how the childbirth classes I mentor offer something completely different, and it seems like the principles are a gateway to that explanation.


So I am going to look at the principles over the next few weeks and give you my interpretation of them.


A Rite of Passage
a significant event in a transitional period of someone's life


Sometimes it feels like birth in our culture is really polarized between a medical birth and a 'natural' birth, with value judgements about one 'type' being better than another.  Many of us who work in birth recognize how destructive it is for women to categorize their birth one way or the other.  To me the piece that is important is understanding that all women who become mothers undergo a significant life change and that acknowledging and respecting this truth brings us together and allows us to support each other through this rite of passage.


Regardless of where we are giving birth or what expected or unexpected thing happen during the birth, every women experiences this life changing event.  Birthing From Within childbirth preparation validates the understanding a mother has about her own birth, motivates the parents to make the choices that are best for them, educates that birth is hard work and it changes you as a person, initiates the parents into the birthing experience and celebrates the strength and resilience of all mothers and babies.


Please contact me for more information about these amazing classes and check out www.birthingfromwithin.com

Happy Mother's Day

I just wanted to take a minute to wish everyone a Happy Mother's Day.

I am very fortunate to be a mother of a lovely two year old.  

I also am lucky to have a profession as a birth and postpartum doula, where my job is to 'mother the mother'.  Simply put, that means I get to play a role in women becoming mothers by supporting them (and their partners) through the birth experience.  I also get to come to their homes and encourage them as they mother their new children and help their older children adjust to a new baby (or babies) in the household.

Clearly I have the best two jobs in the world.  As a mother and a doula.

I planted part of my garden today as a treat to myself.  I hope all the moms out there treat themselves today.  And a little bit everyday.  If you are pregnant or have a newborn, you can treat yourself by hiring a doula.  If you know a special mother (or mother-to-be) who could use this support, doula services can be given as a gift.

Recommended Reading

Check out (literally!) my list of recommend reads for pregnancy and childbirth.

All these books are available at the Lethbridge Public Library and other libraries in the Chinook Arch System.

Stay tuned for reviews of some of these books in upcoming weeks.

The Role of the Birth Doula - Realities and Misconceptions

I regularly get asked what a doula does and people sometimes mistake me for a midwife.  I have covered the difference in other posts, but basically a midwife is a medical professional who is trained to deliver babies.  As a doula, I work alongside your doctor and nurses to provide emotional support and offer suggestions for comfort measures such as: positions, massage and pressure techniques.

In my last post, I reviewed the book Your Best Birth: Know All Your Options, Discover the Natural Choices, and Take Back the Birth Experience.  The authors of this book are big fans of the doula and there is an entire chapter devoted to how a doula helps.  Because they are such promoters, I am wary of being critical of the contents of this chapters, but I felt like some of their explanations could be clarified.

DOULA vs. CHILDBIRTH EDUCATOR
First, I just wanted to clarify that a doula and a childbirth educator are different things.  Some doulas are trained as childbirth educators, but not all.  Many childbirth educators will teach classes, but will not attend the birth of your baby.  In the book, the distinction is not made clearly.  I am trained as a doula, not as a childbirth educator.  As a doula, I do offer information and resources about birth and I certainly will recommend books and dvds to clients, but I don't offer in depth classes.  There are options in our area for Lamaze and Hypnobirthing classes and I will connect clients to these (and might even attend the classes with them).

I hope to become a childbirth educator for Birthing from Within in the next three years and I am taking the first training in June 2011.  This will enable me to help couples better prepare for their birth and eventually offer classes that compliment my birth doula services.

DOULA TRAINING
In Your Best Birth, Ricki Lake and Abby Epstein say that doulas start by doing a course and then apprentice (attend births) with more experienced doulas before becoming certified.  Maybe this is the case for some doulas in some communities, but in my community the hospital only allows two support people, so it is difficult for more than one doula to attend a birth.  Also, there are very few experienced doulas here who are able to act as mentors.  I think an apprenticeship for new doulas is an ideal scenario, but do not be surprised if your doula has not had the opportunity to work with a more experienced doula.  I am trained through DONA International. For more information about their certification process click here.

DOULAS and DECISION MAKING
Lake and Epstein understand what doulas do, but they don't always explain it well.  The statement: "Doulas can help you make the decisions you're faced with during childbirth" is a good example.  I help couples prepare before the birth and provide them with information that they are interested in, so they can make decisions during labour.  One of the tools I use to do this is the B.R.A.I.N. acronym.  Couples can ask these questions of medical professionals about suggested interventions:

Benefits - what are the benefits of this?
Risks - what are the risks to mother and baby?
Alternatives - is there anything else we could do instead?
Instincts - what do the parents' instincts tell them?
Nothing - what happens if we do nothing?

This allows couples to ask questions and the medical staff to respond directly to them.  As a doula, it is important for me to maintain a good relationship with the caregivers and not be viewed as confrontational.  Also, as I mentioned in my last post, it is important that parents educate themselves and learn to advocate for themselves.

DOULAS HELPING your SUPPORT PEOPLE
This is an area that was covered well in the book.  You are the star of your birth and everyone else is the supporting cast.  As a doula, I want to help the pregnant woman feel confident and powerful and to help her partner (or other support person) do the best job they can to help her.  Often, the most important thing a doula can do for couples is to reassure them they are doing well and that this is what labour looks like. Most people have not seen anyone in labour (TV doesn't count), and don't know what to expect.  If they are fearful or in a really medicalized environment, anything that happens can be seen as potentially dangerous.  Labour is very intense and sometimes the role of the doula is to remind the support people (and the mother) that birth is not an illness and what is happening is normal.

I hope this post helped clarify some of the more complex questions of what a birth doula can help you with.  Please feel free to contact me for more information or an initial interview.

Your Best Birth

I have recently finished the book Your Best Birth: Know All Your Options, Discover the Natural Choices, and Take Back the Birth Experience by Ricki Lake and Abby Epstein, who made the filmThe Business of Being Born, which is a documentary about birth in America.  I watched the film more than two years ago when I was pregnant and I really enjoyed it.

Overall, I enjoyed the book too, although it was not as clear and well written as some other books that provide an overview of birth options, such as Ina May's Guide to Childbirth.


TAKING BACK THE BIRTH EXPERIENCE
"This book will serve as a reminder that giving birth is something that women instinctually know how to do, and that you can tap into your own innate sense of power to take back the birth experience."

This idea of taking back the birth experience is central to this book and central to what I try to do as a doula.  Instead of being passive consumers, pregnant women and couples are actively preparing for birth, researching options, educating themselves about childbirth and preparing emotionally as well as physically for the experience of giving birth. A doula can help you with this, but ultimately the responsibility for preparing is that of the pregnant woman.

FEAR AND STRESS DURING LABOUR
In Your Best Birth they talk about the role the fear plays in undermining labour.  Mammals will stop labouring if they feel threatened and this is also true of humans.  In a hospital setting, with bright lights, medical procedures and interruptions, some women will find their labour slowing down or even stopping completely.  They experience a spike in catocholamines (such as adrenaline and cortisol) and this inhibits their ability to produce their own oxytocin (which creates strong contractions).  So artificial oxytocin (pitocin) can be used, which results in extremely intense, sometimes painful contractions that can cause fetal distress.

Another way that fear can affect labour is if there are unresolved issues or concerns the mother feels going into the labour.  Some questions they suggest asking include:

• What was your initial response when you realized you were pregnant?  Have their been any changes in your attitude or feeling since then?
• How has this pregnancy affected your relationship with your partner and other family members?
• If you have given birth previously, what was it like for you? Is there anything you would change if you could? Is there anything you do similarly the next time you give birth?
• How do you envision the birth of this baby? What is important to you? Who will be present at the birth?

While this book does a good job of addressing potential fears that could affect labour, I think they could be more careful with the writing as sometimes their comments could increase potential fears.  For example they mention choosing between an episiotomy and a tear, without talking about ways to avoid tearing for another 100 pages.

CHOOSING YOUR 'TEAM'
Lake and Epstein comment that women are people pleasers by nature, and this sometimes means that we will worry about how everyone else feels before meeting our own needs.  In birth, we must put ourselves first in order to make sure the birth is what we want.

This is key when choosing our support people.  The authors suggest having people at the birth who you trust completely, who approve of your birth plan and who you won't be self-conscious being naked around.

At the Lethbridge Hospital, woman are usually allowed only two support people, including their partner/husband.  What that means is that pregnant women need to choose between having their mother or a doula.  This can be a difficult choice, as a doula has all kinds of tools that a family member might not have.  Then again, a mother might know her daughter really well, or maybe her sister had a great birth and could be extremely helpful.  I think this something where a pregnant women should trust her instincts.  As long as the person they choose will be able to really support them, that is what matters the most.

What about partners or husbands who are afraid for their spouse or not supportive of her choices?  It is so important that the role of researching and preparing for the birth is a joint role.  Also, a doula can really help the father, both in preparation and during the birth experience.  As a doula, I hope the partner will be the primary support person, with me providing suggestions, reassurance and comfort techniques that he can use.

Your Best Birth cautions that we have realistic expectations of our support people (whether a partner, family member or doula). Although we can expect them to share our preferences with health professionals during labour, we can't expect them to argue against necessary medical procedures or body block the anesthesiologist.  I am preparing another post to further address the role of the doula as it laid out in this book.

LOCATION OPTIONS
This book is a strongly slanted towards natural birth and especially home birth with a midwife.  It can be frustrating to Lethbridge mothers, as this is not currently an option in our community.  The are no licensed midwives based here and the midwives working in Calgary have waiting lists for Calgary clients and are not usually willing to take clients from Lethbridge.  Hopefully that will change in the near future.

The most important thing to remember is preparation.  Knowing what you want your birth to be like and having a team (possibly including your partner, family members and/or doula) who are on the same page with you.  It can be important to have a doctor that you trust, but it is also important to remember that your doctor will likely be present only at the very end of your birth and many doctors (both family doctors and obstetricians) take turns being on-call, so your own doctor might not be at your birth.  You need to ask your doctor about this, if it is important to you.

From the last paragraph of Your Best Birth:
"...when women feel safe and empowered around their own births, they are able to bond with their babies and enter motherhood from a place of strength and security.  We have a long way to go toward making this a reality for every expectant mother, but through sharing information that will support woman through this journey, we are moving closer.  Our babies will thank us."




Overall, an inspiring book and well worth the read.  I also recommend the film, especially for couples to watch together.

Healthy Pregnancy, Healthy Baby(ies)

I just finished reading Having Twins And More: A Parent's Guide to Multiple Pregnancy, Birth, and Early Childhood by Elizabeth Noble.  It is part of my required reading for my DONA Postpartum Doula Certification (which I will have all the requirements completed for in the next couple of weeks).  I loved this book, and much of the information it provides is useful for  parents of 'singletons' (as they are called in the book), as well as parents of multiples.

My only complaint about this book is that it was published in 2003 and I hope that a new edition will be published soon.  It is very much based in research and I am certain that even more research has been done in the  past eight years to support some of her points of view.

The book is extensive and covers everything from health in pregnancy to bonding with your babies to coping with infants with disabilities and even the death of a baby (which is more common in multiple pregnancies).

For the purposes of this post, I will pull out just a few of the ideas that struck me as interesting and that are useful to me as a doula, supporting pregnant women and families with new babies.

Pregnancy
Noble shows that the single most important factor that results in a positive outcome for twins (and more) is the health of the mother.  Good nutrition, hydration and moderate exercise are the most important things pregnant women can do to ensure the delivery of full term, healthy babies.  Certainly, this is also true for single babies.  This is great news, because it is something that pregnant women have control over. We can decide to eat well, drink lots of water and go for a walk around the block once a day.

I have recently started taking yoga again, which I previously did when I was pregnant, and I am amazed at the effect it has on me physically and emotionally.  I would highly recommend prenatal yoga classes for all pregnant women.  If you can't afford classes or they are not available in your area, check the online Prenatal Yoga Centre for free videos on yoga to do during pregnancy.

Birth
One of the reasons that taking care of yourself during pregnancy is important is to avoid preterm birth, meaning birth of your baby(ies) before 36 weeks gestation.  According to Having Twins And More preterm birth is by far the major cause of complications and infant deaths.  In fact, 75% of all infant deaths in the U.S. are babies born before 36 weeks.  Some babies are born premature regardless, but good health and nutrition does reduce the chances of preterm birth and therefore can improve outcomes for babies.

Another thing that was interesting to learn from this book, is that prolonged bed rest during pregnancy, does not reduce the chances of premature birth and it greatly increases the potential for health issues in the mother. A NASA study shows that one week of bed rest results in the equivalent of one year's worth of ageing on the skeleton!

Often with twin or higher multiple pregnancies, doctors will recommend elective cesarean section.  Mothers agree to this because they believe it will result in better outcomes for their babies.  But the research shows that multiples (and singletons) delivered vaginally have lower mortality and morbidity overall, as do their mothers.  There are certain situations where a c-section is necessary, but most pregnant women (regardless of how many babies they are carrying) should be able to deliver vaginally.  Also, taking care of newborn babies is much more difficult when recovering from major abdominal surgery.

Parenting Multiples
Having Twins And More has great information about bonding with twins, their relationships with each other and with their parents and other siblings.  One interesting thing that Noble points out is that with more than one new baby the number of new relationships within the family increases. She provides suggestions on how the parents can help foster those relationships.  There is a lot of focus on the importance of recognizing the twins as separate individuals, rather than as a unit.

Overall, I would highly recommend this book for anyone expecting multiples or anyone who works with multiples and their families.

New Year - New Endeavours

Over the past weekend, I put together a small website at www.elliedoula.com.  It is a start.  I want to keep posting new information to my blog, hopefully more often this year, but a recent promotions workshop I attended said that it is essential to have a website, so there you are.

I am also doing a presentation on Friday, January 28th at the Family Centre here in Lethbridge, as part of their 'Parent Talk' program.  The purpose of this presentation is to let more people know about birth and postpartum doulas and that we are available here in Lethbridge.  

'Doula' is still not a word that most people know, at least in this part of the world. I want people to understand that a good doula will be interested in supporting you to have the birth that you want. What we do see, both anecdotally and through research, is that mothers who had a doula present at their birth consistently report a more positive birth experience and have a better self-image (DONA Position Paper: The Doula’s Contribution to Modern Maternity Care).  

As doulas, our role is to ensure mothers feel they had the birth they wanted and that they felt confident and empowered during the birth.  Doulas should not be promising women: “If you hire me, you will not need a c-section, epidural, etc.”  We should be doing what we can to ensure women feel positive about their birth experiences regardless of the outcome. The doula provides clients with information and helps them advocate for themselves, she must not make judgement calls about what kind of interventions a client might need.

DONA Standards of Practice are very clear: DONA International Standards and Certification apply to emotional and physical support only. The DONA International certified doula does not perform clinical or medical tasks such as taking blood pressure or temperature, fetal heart tone checks, vaginal examinations, or postpartum clinical care.  I love this work because it is not medical.  I believe that birth is 90% emotional and psychological and maybe 10% medical.  

There is a huge need for emotional support in women giving birth, which is not being met in hospital settings in my community.  This is not the fault of nurses and doctors, their role is different and broader than a doula’s, and it is not realistic to expect them to provide continuous support the way that a doula can. Professional doulas who understand the scope of their practice are able to meet this need, in a way that is complimentary to the role of medical care providers.

I look forward to the future, when women in my community have the option of a safe home birth with a licensed midwife, and I know doulas will be just as valuable in this situation as in the hospital. In the meantime, I am happy to help clients give birth in a hospital setting, maintaining good relationships with hospital staff, the majority of whom greatly appreciate my role as doula.

Practice as a Post-Partum Doula (Part 1 of 2)

“A post-partum doula is trained and experienced in meeting a new family’s needs for household help, meal preparation, advice and assistance with newborn care and feeding, and allowing time for the new mother to rest.” (From Pregnancy, Childbirth and the Newborn, 5th edition).

Me as post-partum doula, holding the baby while my sister-in-law takes a shower.

On February 24, 2010 my brother Ben and his partner Abigail had their first baby, Anne. She weighed a healthy 8 lbs, 4 oz at birth and was born in the Kamloops hospital, naturally, with few complications.

This was great for me, because along with becoming an Aunt and having a new cousin for my little one, Julie, it was one of the first times in my life that I got to be the one in a position of support. As the little sister, growing up I was always used to doing things second. But in this instance I was able to use the experience I gained by having Julie last year to be in a position to help.

I am calling this post ‘Practice’ as a post-partum doula, because although I am a trained birth doula, I have not yet been trained as a post-partum doula. I am hoping to take the training in Lethbridge at the end of May.

It strikes me that, like a birth doula, training is not necessarily the most important element in providing post-partum support. Like a birth situation, being able to read the environment, and helping the mom in the way that she needs to be helped is the key. It is all part of preserving the space. This is just as important after the birth as during the birth process.

Sometimes family members can be in a great position to support the new parents (as I was in this case), but what about when there is no family available, or if the family and the new parents have different philosophies about how to parent? That is where a doula can be extremely useful. A good doula should be concerned with helping the parents to have the environment that they want, allowing them to rest and helping to increase their confidence (if they are first time parents).

In my next post, I will write about what specific kinds of things I help Abigail and Ben with.

All information used with express permission