This week we are thrilled to feature licensed midwife Maria Iorillo as she discusses the transformative power of birth.
When I became a professional midwife 23 years ago I had an idealized version of transformation and how wonderful birth is. I just thought that birth was groovy and becoming a midwife was a wonderful way to change people’s lives. I didn’t have much experience with midwifery and hadn’t had a child then, either. 23 years later, I think I can finally answer that question based on what I’ve seen – it’s no longer just a philosophy.
I’ve seen it over and over again, women and their partners are telling me the same words after they have a really good, satisfying and empowering birth experience. They say, “that was the most incredible moment of my life”, “that was the most powerful moment of my life”, “I feel so different”, “I feel so changed”, “I never knew that I was so strong, I never knew that I could do that”.
Pregnancy and birth are a process of growth and self-awareness, that’s where the transformation comes. Especially the first time; this woman who has never been through birth before comes out the other end as a mother. Birth prepares us for everything that comes after. Suddenly, a mother is thinking, “I can do this – I can change a diaper. I can deal with a crying baby, I can work through the challenges that lay ahead of me because I went through pregnancy and labor and now I know how strong I am.”
I will also say that someone asked me recently to describe my birth philosophy. It was a great question. My birth philosophy is simply that women deserve to birth with respect and kindness and honoring. The baby has the right to be born gently. I believe that this kind of birth support is what allows transformation to take place. If you encourage each women to honor her own unique experience of birthing – then birthing is the teacher. We don’t have to add anything to that.
Just honor birth for what it is. That’s where we learn about ourselves, that’s where we learn about our partners, that’s where we learn about our community, we learn about our babies. You learn so much just being in the process. Just being present in it.
Women are smart and they can make their own decisions. It’s important that a mother can honestly say, “I was never manipulated along the way”, “I was never pressured into doing anything that I didn’t want to do”, “This was my experience, I own this, I own the way that I went through this experience.”
Maria Iorillo, Licensed Midwife Catching babies at home and assisting hospital births in the San Francisco Bay Area since 1986.
This is an excerpt from an interview conducted by Mindful Mama and is re-printed with permission from Mindful Mama.
Do you wonder how comfortable your husband will be with your doula? Good news: this week we brought back Micky Jones, an LLL Leader, doula, lactation trainer, conference speaker, IBCLC, Hypnobabies instructor, and author to guide you through her doula “cheat sheet” for Dads.
“I’m just not sure if he’s going to be able to handle it. That’s one of the reasons we wanted to hire a doula.” If I had a nickel for every mom who said this during an interview for doula services, well, I would have a lot of nickels. Moms often wonder if their birth partner will truly be able to fulfill the role set before them in childbirth classes or birthing books. So much to remember. So much pressure for someone who is also deeply invested in the well-being of this special baby and mother.
The presence of a doula can free a father (or other close emotional support people) to experience and enjoy the birth without needing to be a perfect “birth partner”. I suggest that the partner also must be free to be present, vulnerable and primal. One dad might get in the birth tub with his partner and catch the baby while another might sit in a chair in the other side of the room and just try not to loose his lunch. Both can benefit from the encouragement of a doula’s support. It is the right of the couple to determine the level and type of involvement he should give. Insisting that all fathers participate in a certain way is just as judgmental as assuming all women should birth in a particular way.
Obstetrician, Michel Odent has suggested that the influence of the father’s participation during the birth is far more complex than we have considered. In a Midwifery Today article from 1999 entitled, Is the Participation of the Father at Birth Dangerous, Odent raises questions including’ “Does the participation of the father aid or hinder the birth?” and, “Can all men cope with the strong emotional reactions they may have while participating in the birth?”. Most of us would say, “Of course!”
But after witnessing the interactions between many couples during birth and postpartum, I believe we have put fathers in a position they were never meant to be in.
Make no mistake, I believe in women AND men attending childbirth classes. The father/birth partner needs to gain information, understand how the mother plans to labor and discuss options during pregnancy in order to be very connected and in agreement concerning plans for the birthing. Information given ranges from anatomy to the stages of labor to the smorgasbord of interventions and choices available today. That’s a lot of information to tuck into one’s brain cells. Not to mention that this is a pretty big day for dad too as he rides his own roller coaster of birth.
So, how can a doula help dad? Here are just five of the ways the support of a doula can free dad to offer support in a way that is comfortable and effective.
Doulas live, breathe, eat and sleep all that stuff from childbirth class you (dads) can’t remember. Doulas who have been through training and certification have a basis of information about pregnancy, birth and newborns that is more than most men know or want to know about birth. While a really smart doula knows her main job is to just “hold the space” (provide emotional and physical support to mom) and assist her in gathering information from her care providers. A doula has a knowledge base of “birthy stuff” that takes the pressure off dad (and mom) to remember it all.
Doulas give dads a teammate. Birth is often compared to a marathon. It is important to keep the birthing mother hydrated, fueled and even rested periodically during her birthing event. Same goes for dad. Dads need to eat, drink, stretch, take naps and refresh themselves during labors that last more than a few hours. A doula gives dad someone to tag to come in the ring when he needs to bow out for a break. Dads often feel tremendous relief leaving mom with the support of someone who he knows will not leave her side and will support her choices.
Doulas allow dads to perform super-human feats they could never achieve on their own. Okay, perhaps I’m overstating a bit but have you ever tried to be there for a mom to lean on while simultaneously providing counter pressure to her hips? It’s pretty much impossible. With a doula, one person can be there for mom to lean on while another person can provide massage, counter pressure, hold warmth or cool on her back while she sways. A doula/dad team are able to put into practice a lot more of the techniques and tips learned in childbirth classes.
Doulas help dad know what she really means when she asks, “Do you think it might be time to go to the hospital?” Babies often like to get things started in the middle of the night. When mom rolls over for the 5th time to nudge you and whisper, “Honey, I think my contractions are getting closer together!”, you will want a doula to call so you can gauge whether or not to get up or attempt to close your eyes and pray there won’t be a 6th nudge. While a doula can’t tell a mom that she is definitely in her birthing time, she can offer her professional opinion as to what mom’s current signs might indicate. A doula can help get past those, “Holy macaroni, this is it!” feelings and relax knowing that someone experienced with birth is supporting them as a couple.
Doulas let dads relax and enjoy the birth of their baby. In Hypnobabies, the childbirth class I teach, birth partners are given a special CD that helps them feel relaxed and confident during the birth. Occasionally, dads are resistant to listening to this. It’s as if they don’t feel as if they have the right to be relaxed and confident during the birth. Having the continuous support of someone who knows and understands birth, can help dad relax and let the process unfold. Dad is free to get in sync with his partner, be there for her without worrying and experience his emotions.
It’s important that mom AND dad have the support they need during labor and birth. And trust me, with the help of a doula you will both be able to handle it!
Resources
Odent, Michel, (1999). Is the Participation of the Father at Birth Dangerous? Midwifery Today, Issue 51, Autumn.
Micky, a team member with 9 Months & Beyond, LLC http://ninemonthsandbeyond.com/ (hyperlink) in Nashville, Tennessee, has experience as a breastfeeding mother, LLL Leader, lactation trainer, conference speaker, and IBCLC. Her mother-baby experience includes a degree in child development and family studies, teaching as a Hypnobabies Childbirth Hypnosis Instructor, being a certified birth doula with two organizations and DONA Approved Birth Doula Trainer. She also trains for the COPE Program with Commonsense Childbirth based on the JJ Way developed by Jennie Joseph, LM.
Author of, Keep the Fires Burning: Conquering Stress and Burnout as a Mother-Baby Professional (available at www.ibreastfeeding.com ), Micky is passionate about encouraging other professionals to understand that who they are is more important than the work they do. Learning to value themselves is a vital part of being able to serve women and babies for years to come. Micky is also the wife of 14 years to her amazing hubby KC and the mother of three energetic school-age kiddos. She wanted to become a doula as soon as she found out what the word meant and had a doula for two of her three births.
Are you experiencing too much stress during pregnancy? Not sure how much stress is too much? To answer your questions we are proud to feature Laurel Wilson, Injoy Birth and Parenting Customer Advocate, Executive Director for Lactation Programs with CAPPA, doula, childbirth and lactation educator, prenatal yoga instructor and board certified lactation consultant.
During my first pregnancy, my husband and I moved to a military base in Guam, which had just been struck by the worst typhoon in a decade and looked like a warzone. This is what we would call an “acute life stressor”. And yet, terrified as I was to be 5000 miles from my family, I had a deep sense that my baby was counting on me to remain calm and peaceful – my inner life affected how he would grow.
For the sake of my baby, I braved broken glass in the streets and smiled kindly to the worn-out looking locals in Guam. I went to the beach almost every day. I held my belly, sang to my baby, breathed deeply and focused on trying to be as present and connected as possible. I focused on the things that were grounding and comforting – cuddling with my husband, looking at pictures from home, and baking banana bread.
Today there is a body of evidence to show that my gut was right. Stress impacts the health of the baby, the pregnancy and the mother. While short term stress that is relieved quickly is proven to have benefits for the growing baby, the type of stress that most mother’s encounter today (including those who spend their entire pregnancy in familiar surroundings) is not normal and can change the way the baby reacts to its new world when she is born.
Short bursts of stress that are quickly resolved tell the baby that life has bumps in the road, but it’s all going to be okay. In the right doses, stress makes our babies hardy. In fact, the slight normal increase in the mom’s stress hormone cortisol in the last two weeks of pregnancy actually prepares the baby to come into the world. It accelerated the baby’s brain development and is associated with better motor and developmental skills at age two.
What is not healthy for the mother and baby is unrelenting, chronic stress. Unfortunately, many mothers today are chronically stressed. They live their lives constantly on the go, jumping from task to task, engaged in activity from sun up until they drop in to bed in state of exhaustion well past sun down. This environment of stress impacts mothers’ ability to sleep (which also effects their risk of developing postpartum mood and anxiety disorders), the blood flow to the placenta, and increases the risk of preterm delivery.
There is plenty of documentation now that both chronic and severe/acute stress change baby’s brain development. The Children of the 90’s study has shown that children exposed to chronic stress prenatally have significantly more behavioral problems and emotional disturbances as children.
So what is today’s mom to do? With the increasing pressures of today, how do we lighten our load? The good news is that it’s actually quite simple to help the body relieve stress. Below is a list of proven techniques that ANY pregnant mother can use to relieve the effects of stress:
Yawn. Yes, yawn. Repeated yawning resets the brain, releases our “happy” hormones and helps the body process cortisol. Ever notice how you feel the need to yawn when you need to pay attention but just can’t find the energy? Yawning is like a natural, gentle boost to our brain. It helps us feel better.
Move! Talk a 10 minute walk, swim for half and hour, dance to your favorite music in the living room after you get home from work, take a prenatal yoga class! Movement improves circulation, releases beta-endorphins and releases stress! What? You are on bed rest? Do deep breathing. Circle your ankles and wrists, do some static stretching.
Smile and laugh. Have your best friends over for tea and giggle! Better yet, ask them make the tea and have you over, you are the pregnant momma after all! Watch your or favorite funny movie with your partner. Do things that make you HAPPY!!!! Laughter is one of the best antidotes for stress.
Nap. Allowing yourself to get at a minimum of 5 hours of uninterrupted sleep at night and having just one 10 minute nap a day helps everyone deal with stress better. Getting the brain into the delta state of relaxation allows for body rejuvenation and improved immune functioning. Take an eye mask and your iPod to work and instead of talking at the water cooler during your break, lean back, close your eyes and rest deeply for ten minutes.
While you may not be able to remove your stressors during pregnancy, you can help remove their effects from your body. My Rx for a happier, healthier, cooing baby: yawn a bit, take two bursts of laughter, nap for ten minutes and call me for tea in the morning!
Laurel Wilson is the Customer Advocate for InJoy Birth and Parenting. She has been working with families during the childbearing year for over sixteen years as a doula, childbirth and lactation educator, prenatal yoga instructor and board certified lactation consultant. She is also the Executive Director for Lactation Programs with CAPPA and is the co-author of upcoming book, The Greatest Pregnancy Ever: Keys to the MotherBaby Bond due in the fall of 2011.
This week we are delighted to bring back Cole Deelah to shares the second part of her insightful story of birth from her point of view as a Doula. Cole has over 10 years of birthing experience and has created her own independent childbirth curriculum.
The atmosphere in the birth center was fabulous: dim lighting, candles by the tub, inspirational music softly playing when I wanted it, and temperature controlled to my liking…I truly don’t know how anyone achieves a natural birth in a brightly lit hospital. The half-darkness helped me to stay calm. In fact, for most of my labor, I kept my eyes closed and just wanted to be left alone with the comfort of the select few members of my birth team.
The midwives took turns monitoring my progress. Every 15 min or so they were listening to the baby’s heartbeat with the Doppler. I was so glad I was not restricted in my movement in any way by an electric fetal monitor or by an IV. They were also checking my blood pressure and my temperature often. Everything was normal, which was very reassuring. I also remember how vastly important it was for me to have someone’s hands to hold during each contraction.
My husband was the best support I could have ever asked for. He was calm and reassuring. He held my hands and gave me water to drink. When he needed a break, my doula was there, holding my hands, massaging my hands, telling me I was doing great. I am forever grateful for the hands I held during each contraction.
I think the atmosphere in the room started to change around 3:00am (24 hours after my water broke), when I still was not pushing. I remember Jackie telling me that another hour or two and they’d need to take me to the hospital. I was so scared. I did not want to end up with a C-section. I’m not sure if the thought of going to the hospital motivated me or slowed things down, but soon after that I began pushing. I felt an urge to push, but it was not an uncontrollable urge…I think I was rushing it because I was scared.
We encouraged you to tune into your body and push only when you couldn’t not push. You became very introspective at this point, totally tuning the world out and listening to your body. You moved your hips back and forth, side to side, and began lots of loud vocalization. We could all hear the slight push that began to appear at the peaks of some birthing waves. You were not quite ready, though, and chose to return to the warm water of the birthing tub.
At this point, I know I was in transition. I was afraid I would not be able to push the baby out. Later, my doula told me a conversation I had with my husband during this time. Me: “I’m scared.” Him: “The baby is coming.” Me: “The baby will come any day now.” Him: “You are doing great. The baby is going to come.” Me: “The baby will come any hour now.” Him: “You’re right. The baby is coming.” Me: “The baby is going to come any moment now.”
I also remember telling myself (silently) that I was NEVER going to have another baby again. Then I said a prayer out loud, and I thought about all the people who cared about me and the baby. It gave me strength and at that moment, I chose to surrender to miracle of birth.
Shortly afterward, we started to really hear pushing noises from you for longer durations. You moved to the edge of the bed and squatted… really feel more pressure and starting to ‘wish push’ with each peak. We reminded you to conserve your energy until you had no choice but to push. Like magic, within the next two contractions, your pushing changed, your body had taken the reigns and you were submitting to the power of bring your baby forth.
Now I was definitely feeling the urge to push, and push I did. For pretty much the whole time, I remained in a full-squat position with my arms supported on the edge of the bed and my hands squeezing my husband’s hands. I was beginning to feel progress, and I continued to be encouraged by the midwives and my doula saying “Great job Lynnette.” “This is normal.” “You’re doing great.”
Then, the midwife got a mirror and placed it under me to see if she could see even just a little part of the baby during one of my pushes. I was elated when I heard that the baby was crowning. The whole atmosphere of the room changed, and I knew in my heart that I would indeed be willing to have more children and I would definitely choose this same route. I was going to have this baby at the birth center after all!
This indeed was the most painful part of labor, but without a doubt the most joyous. I had been so afraid of this part, but it was the best and easiest part (mentally and emotionally) of labor. Real progress was being made and my baby was coming into the world.
I was impatient at this point and was trying to wait for a strong contraction before pushing, but I just pushed and pushed, wanting my baby to be born. Looking back, I should have taken more time with this part and waited for the peak of contractions to push…I think this is why I ended up with a tiny first degree tear requiring 2 stitches).
Before I knew it, my daughter’s head and then shoulders emerged from me. And with one final and amazingly awesome feeling, her body came forth. She was born at 8:05 am (29 hours after my water broke). I was told, reach down and take your baby, which I did!
Your eyes popped over, you cooed ‘oooh!’, broke into a smile, and took your baby by the arms, lifting her out of your body and into your loving embrace.
I brought her to my chest and smiled and looked in her beautiful eyes and knew that I was blessed beyond measure. She was perfect. Her skin was amazingly pink and she looked into my eyes and let out some beautiful baby sounds. She weighed 7 pounds 2 ounces and was 20 inches long.
I cried with joy and exclaimed, “Oh my gosh, she’s my baby! Oh my goodness. Hi sweetie. Hi sweetie. Oh my goodness. I love you so much. I love you so much. Hi sweetie. Hi sweetie. She’s so cute! My baby girl; I love you.”
The midwives and my doula all helped me with breastfeeding within 20 or 30 minutes of the birth. My baby latched on right away with no issues whatsoever. She never left my arms. This was the most amazing bonding time, completely uninterrupted by the routine things (bath, shots, baby warmers, etc.) that would have been done at a hospital. Instead of all these procedures, I got to hold my baby skin to skin and bond with her.
The placenta was birthed and then my family came in to see the baby. My husband played his guitar and sang a beautiful version of “Somewhere Over the Rainbow”. Our baby stayed awake and alert for a good 2 hours after the birth, staring into our eyes. Afterward, we were left alone with her in the peace and quiet of the birthing room. We were told to nap, but I was so happy, so high on life, that I could not sleep a wink. I did rest. I did smile.
Our journey into parenthood had begun.
Beautiful family! What a blessed event! The laughter in that room, the joy and triumph, love and peace! It was an honor to attend you during the birth of your beautiful baby girl!
Cole Deelah is the mother of 5 beautiful, home schooled children and the wife of one feisty entrepreneur. She resides and works in the Houston area as a birth doula, childbirth educator, and midwife apprentice. She has over 10 years experience in the birth field and has written an independent childbirth curriculum and head’s up a local cooperative of doulas. Cole has authored articles in such publications as Midwifery Today, the International Doula magazine, and others. She has plans to become a practicing midwife and travel the world with her husband and children, supplying basic life skills and maternal and neonatal healthcare to underdeveloped and developing countries.
This week we are delighted to introduce Cole Deelah, who shares an insightful story of birth from her point of view as a Doula. Cole has over 10 years of birthing experience and has created her own independent childbirth curriculum.
Lynnette and Doug, you are a wonderfully delightful couple! Your beautiful daughter is so lucky to have such amazing parents. Your journey began long before your daughter’s birth day and, on that journey, you made so many amazing choices.
You chose to take an independent childbirth class, to hire a doula, to attend the play “Birth”, to interview midwives, and to change your care from a hospital-based midwife to a birth center midwife.
Saturday, January 29, 2011: Doug and I went to Laura’s house on the eve that my labor began. Laura and some of her friends were planning on running the Houston half-marathon the next day, so we “carbo-loaded” for dinner by having spaghetti and meat sauce, bread, salad, Girl Scout cookies, and ice cream.
Little did I know that this would be the last full meal I ate before my baby was born. Good thing it was full of carbohydrates for the long, hard work ahead.
When we lay down to sleep around 10:30, I felt my baby moving inside me rather wildly. The movements were huge and you could see their impression from the outside. Doug fell asleep with his hands on my belly, feeling our little girl dance. He was in awe of the miracle inside me, and so was I.
I feel asleep with a smile on my face.
Sunday, January 30, 2011: I woke suddenly at 3:00 in the morning and waddled as quickly as possible to the restroom, but my underwear was completely soaked by the time I got there. Then I sat on the toilet and felt a gush of fluid. Is this my water breaking? The fluid was clear and odorless and my heart started racing as I contemplated the possibility that my water had broken, but I still wasn’t sure.
I had read that only 1 in 10 women start labor with their water breaking and was not expecting my labor to start this way. I changed clothes and went back to bed. 30-minutes later, the same exact thing happened. Now, I was 99% sure that my water truly had broken. I lay in bed after this, feeling surprised.
I tried to go back to sleep. I knew this was important because labor could last a long time. But then I started feeling very mild contractions. I remember that they were only about 20 seconds long, but would happen every 5 to 10 minutes.
I read through some material from the childbirth class we had taken with Cole Deelah (my doula), just to try to figure out what was going on. I then realized I really needed to rest, even if I just lay there and couldn’t sleep. At 6:00am I called my midwife and told her what was happening. She advised me to let her know when my contractions lasted longer (at least 1 min) and were 5 min apart consistently.
Early on, you called to let me know that your water had broken in the early hours of the morning. You were patiently waiting for your contractions to begin and, in the mean time, you went for a walk and carried on as normal.
Doug and I went to the Stevenson park at 8:00 am to go for a walk. It was a drizzly, dreary looking day. I contemplated how appropriate it was that the marathon was going on that day and I considered how I had run a marathon 7 years ago and how if I could do that, then surely I could handle whatever lay ahead of me for labor and birth.
Sometime after 10:00am, I went to the birth center to check my vitals. My blood pressure and the baby’s heartbeat were fine. My midwife gave me an herbal tincture of Cottonwood bark extract to take every hour with a little orange juice to try to speed up labor since my contractions still had not gotten any longer or intense.
In the afternoon, you went to visit your midwife, who prescribed Cotton Root Bark to hopefully establish some contractions. Around 3 in the afternoon, you called to find out my thoughts on it. I reminded you to let your body start labor when it was ready, to not worry, and to take the cotton root if you felt comfortable with it.
I began taking the herbs immediately, knowing that there is some random “time limit” in which doctors and nurses want the baby to be born in after the water breaks. Jackie told me she was comfortable with a long amount of time as long as mom and baby are doing fine, but that her referring physician has a real issue if a woman goes past 24 hours after the water breaking and the baby is still not born.
Into the evening, my contractions still had not changed and I notified my midwife. She suggested I take some Castor oil. I was starting to become emotionally drained and I doubted that I should take the Castor oil. This conversation with Cole was pivotal in the progression of my labor.
Around 6:30pm, you called discouraged and worried. You were still not feeling much in the way of labor and talked about the use of castor oil. We also talked about the fact that, though your midwife was comfortable waiting on labor, her back-up OB wasn’t. I knew, in my heart, that your body was in protection mode. I encouraged you to go on a date with Doug, forget about what your body ‘should be doing’, and allow it to start in it’s own time.
She assured me that many women have given birth to completely healthy babies even DAYS after their water had broken. She explained to me the risks, but also reassured me: I was not Group B strep positive, so infection from that was not an issue, I was healthy, I was staying very sanitary, and I was not running a fever. All good things were on my side.
So, we completely cut off communication with our family and friends for awhile. We took a walk, held hands and played cards. And you know what? By the end of our card game, my contractions were actually requiring my attention. I began sitting on the birthing ball and holding onto Doug during contractions. After a few “big” ones, I was certain I wanted to make the car ride before it became more intense, so we headed to the birth center.
At 10pm that evening, I received the call that you were heading to the birthing center, your labor pattern was well established and you were in good spirits, but really working at labor.I arrived at the birth center within 40 minutes and found you in the bathroom, nauseous, and working through a strong labor pattern about 4-5 minutes apart.
You came from the bathroom and sat on the ball, rocking through contractions, moving your hips in a figure 8, and grasping the hands of whoever was nearest to you. Doug held your hands most often, praying with you, brushing the hair back from your eyes, and whispering strength and encouragement to you.
I had a ton of nausea at the beginning of active labor, making frequent trips to the bathroom with diarrhea and vomiting (really, really glad I had not taken castor oil…these issues would have probably been worse). I also had a lot of uncontrollable shaking in my legs and sometimes arms throughout the remainder of labor.
It was more annoying than anything, especially between contractions when I was trying to rest. I was able to drink water and Gatorade but did not have an appetite.
It was not long before you were active again, moving through your contractions and beginning to vocalize in deep hums and open ‘aaah’s. You asked for Doug to play for you and he brought out his guitar, weaving beautiful melodies throughout the room. You both sand a duet – Lynnette in the melody of birth, and Doug, in the melody of praise.
The first day ended with Doug playing his guitar and singing to me while I labored.
Monday, January 31, 2011: I labored in all sorts of positions: side lying, sitting on a birthing ball with my arms draped over the footboard of the bed, a modified sort of hands and knees position on the bed with my arms resting on a stack of pillows, standing, squatting, birth stool (which was uncomfortable to me so that didn’t last long), and in the water mainly on my hands and knees.
I remember thinking how important it was to me to be able to constantly change positions. I would get in a position during a contraction and then rest in sidelying or stand and sway between contractions. My body knew what it needed and I was constantly reassured by my midwife and doula that I was helping the baby get in the optimal position.
When the contractions truly began to come on you with insistence, you walked for a short bit, tried sitting on bed, but ultimately moved back to the ball after a short trip to the bathroom. You asked for a bath, which we drew for you, and soon you were lowering your beautifully ripe belly into the warm waters of the birthing pool.
You stayed in frog squat/kneel mostly, although sometimes you moved to all fours. Blissfully, you and Doug were both able to rest for short periods, and your body continued working toward the moment of birth.
Cole Deelah is the mother of 5 beautiful, home schooled children and the wife of one feisty entrepreneur. She resides and works in the Houston area as a birth doula, childbirth educator, and midwife apprentice. She has over 10 years experience in the birth field and has written an independent childbirth curriculum and head’s up a local cooperative of doulas. Cole has authored articles in such publications as Midwifery Today, the International Doula magazine, and others. She has plans to become a practicing midwife and travel the world with her husband and children, supplying basic life skills and maternal and neonatal healthcare to underdeveloped and developing countries.
This week, Mother’s Advocate discusses the warning-signs and indications of postpartum depression with Jodi Selander — activist, mother and Director of Placenta Benefits.
MA: What is the difference between the “baby blues” and “postpartum depression” and how common are they?
JS: Postpartum depression is a very real and physiological occurrence that can begin anytime between birth and twelve months postpartum. It is generally experienced as a series of symptoms, which are identified along a spectrum of severity — ranging from baby blues (which is the mildest and generally corrects itself in the first three to four weeks postpartum), all the way to postpartum psychosis. Postpartum psychosis is incredibly serious and often leads to hospitalization.
The majority (80%) of women experience some sort of post-natal mood instability, mostly in the “baby blues” range. Baby blues shares many common symptoms with full-blown postpartum depression, but is not technically considered a “disorder” by the medical establishment unless the symptoms extend longer than 3-weeks. Symptoms may include: weepiness, mood instability, mood swings, feelings of anxiety, not wanting anyone else to hold the baby, unwillingness to be alone with the baby, or fear husband or partner going back to work or even leaving the house.
15-20% of women who experience the baby blues will go on to experience full-on postpartum depression. When depressive symptoms last for longer than 6-8 weeks, a doctor may prescribe an anti-depressant.
MA: What causes mothers to feel depressed or sad postpartum?
JS: Aside from the physiological factors (hormone re-balancing and physical recovery), I believe postpartum is largely cultural. There is a lot of emphasis on building confidence during pregnancy and empowering the birth experience, but there is a real lack of practical support once the baby is born. Those first few weeks are filled with visits from friends and family and interaction with a care provider. But once the flurry dies down, the changes that come with a new baby can become overwhelming. It’s hard to have confidence as a mother, especially if you’ve never done it before — and the job is so important. Every decision you make feels like a life and death situation, and women tend to internalize everything.
It’s not just “oh the baby is crying again” — it’s “why is my baby crying again, what am I doing wrong? Why can’t I not stop this? Does this mean I’m not a good mother?” Women place a lot of pressure on themselves, and I think there’s a lot of pressure that society places on mothers as well. We elevate motherhood as a noble and worthy institution, which is fabulous, but we don’t give any sort of structure to support that pedestal. In my own personal experience, this leads to an incredible lack of confidence — and that’s very unfortunate.
MA: When should mothers seek medical support?
JS: This is really where the husband and/or partner comes into play. He or she should be aware of the symptoms of postpartum depression and notice when a mother is showing signs. Often a mother will not seek help for herself, and her partner should not be afraid to seek help for her — before it becomes a serious issue. If you notice that your wife or partner is still not herself after 6-weeks, suggest that she make an appointment so that she can be seen for treatment.
MA: What is the preventative measure, especially for women who have the baby blues?
JS: Most women who have just given birth are going to have depleted iron stores. The placenta is packed with iron and has a lot of vitamins and minerals that your body needs postpartum. I advocate that mothers utilize placenta encapsulation — whereby it’s completely dried and then ground — to restore the body’s natural balance.
Placenta is used in traditional Chinese medicine to treat fatigue and to enhance lactation, and it has been scientifically shown to increase milk production. The hypothalamus is part of the brain that regulates the endocrine system and studies show that it takes about two weeks for the hypothalamus to receive the signal that the baby’s been born. The placenta capsules help the body to maintain homeostasis during this period, until her body would normally regulate itself.
I’ve had hundreds and hundreds of clients, and everybody calls the placenta capsules their “happy pills”. It’s nature’s perfect gift.
Jodi Selander, Director of Placenta Benefits, started researching placentophagy in 2005 during her second pregnancy. She found substantial information documenting the benefits it offered. Having dealt with depression for many years, Jodi had many risk factors for developing postpartum depression. With a B.S. in Psychology, she understood the devastating effects depression could have on women and their families. As a natural health enthusiast, she wanted an alternative to pharmaceuticals that might help avoid those issues. Jodi continues to work toward her mission of making placenta encapsulation an option for every new mother with the launch of the Placenta Encapsulation Specialist Training & Certification Course in May 2008. As a member of the placentophagy research team at the University of Nevada, Las Vegas, Jodi has helped develop and perform several research studies on placentophagy. She traveled to New Orleans in November, 2010 to present the findings at the annual meeting of the American Anthropological Association. This research is incredibly important to her mission of validating the use of placenta for postpartum recovery. Her goal is to have a qualified person in every city offering encapsulation services, so that women everywhere can enjoy a happy, healthy postpartum experience – the way Nature intended.
This interview was originally filmed for Mindful Mama Magazine and has been transcribed with permission from Mindful Mama Magazine.
As any pregnant women with a burgeoning belly can attest, there are a preponderance of frightening birth stories out there, and little apparent reluctance in sharing them. Birth is perhaps the one unequivocal commonality we all share; everyone on earth today was born. It is a completely normal physiological process with generations of proof of efficacy and yet many, if not most couples in our culture today approach their births with some degree of fear. And yet, the mere word- BIRTH- seems to have the power to conjure fear in western women. Men, too.
So where does it come from? In previous generations, women had a healthy reverence for the intensity of birth. Compared to women today, they were much more familiar with the sights, sounds and smells of labor, but had a very limited understanding of why some women survived child labor and others did not. First time mothers also struggled to grasp how something that looked so intense, would feel.
With technological advances, antibacterial soap and more prevalent hand washing, the possibility of death has become as remote as our direct experiences with childbirth. Very few people actually experience a birth other than their own, but we are inundated with conflicting and scary representations of birth. Thus, we fear what we think we know. Our collective understanding has shifted from a very real concern for life and safety to a second-hand anxiety.
A woman has merely to suspect pregnancy, and suddenly find herself overwhelmed with information — from ‘reality’ birth on numerous television programs and its more humorous Hollywood caricature, to an endless stream of products and contraptions marketed to parturient women claiming to ease, soothe, simplify, (read: correct) her birthing process. Taken separately, each of these influences has the potential to undermine a woman’s confidence in her inherent capabilities; the cumulative effect can corrode it entirely. It is in the absence of this confidence that fear absolutely thrives!
But, how do we heal this pervasive cultural influence?
The simplest answer is that the antidote to fear is faith. It matters not wherein the faith is placed; be it a Most High entity, or basic physiological science, it simply boils down to how deeply a woman believes in her ability to give birth to her child. Whether she borrows her faith from a greater spiritual practice and views her experience as merely an extension of this greater understanding, or whether she simply studies the facts of the body’s process in labor and the statistical likelihood of safe delivery and is duly assuaged by belief in her own body’s capabilities, a woman coming to the experience with a trust fortified in fundamental understanding is much more likely to have a successful birth. She’ll enjoy her birth more.
Happy birthing is completely subjective, but it’s probably safe to say that not spending the entire experience in terror is more pleasurable — and more conducive to surrender, which is critical. Armed with a fundamental belief that birth can be achieved or that whatever takes place will lend to a higher purpose, a woman can more fully give herself to the process. This is the shift of faith. The entire spectrum of variables — prenatal care model, childbirth education methodology, labor support, etc — cannot overcome the significance of the role that sheer faith plays in the labor experience.
So perhaps the most important preparation for birthing is bolstering faith; cultivating a sense of independent, sustainable trust. Of course, we must also embrace fear as part of the gift, in that it teaches us how to better connect to and prepare for the process and we can also participate in a paradigm supportive of birth (choosing the best support team possible) – but these things cannot supplant a woman’s core beliefs. Only she has the power to choose faith.
In time, each woman empowered by her a pleasurable birth experience contributes to a shift in the collective consciousness — gradually reframing fear. Every woman within herself, and all women within their communities. Men, too.
Piper Sunshine Lovemore is a Certified Doula, Organic Birth participant and consultant, Lamaze Certified Childbirth Educator, Placenta Encapsulation provider and all-around natural childbirth advocate. Her core belief is that an informed experience is empowering, no matter the particular outcome. To that end, her goal is to educate and support families through their birth experience primarily through reconnecting them with their own embodied wisdom. Piper believes deeply in the importance of community and the richness of a diverse support network. She strives to nurture her community by organizing and attending activities with her family in her free time. She and her partner, Chaz, live in Hawaii with their three children: Che’ Pax, Plum and Rocket, and they look forward to expanding their family further. Take a moment to be inspired by Orgasmic Birth. Watch the trailer… www.orgasmicbirth.com.
This week, Mother’s Advocate speaks with Sarah Proechel, a Certified Professional Midwife working in Guatemala on Fulbright Scholarship. In this inspiring interview, Sarah discusses her perspective on hospital interventions in Guatemala, preservation of Mayan culture, and her own endeavor to open a midwifery school in the Guatemala highlands.
MA: There are a lot of women in the United States who become involved in the birthing community because they feel compelled in a in some larger way – as though supporting mothers through the birthing process is a part of their life purpose or destiny.
SP: For me that’s very true. I had things like this happen to me when I was very young but it was never confirmed. It was a big struggle for me to own that calling as an adult – until recently. If I had had somebody saying “oh yeah you’re supposed to be a midwife and that’s why you’re having all these dreams and these feelings”, I think it would have made a difference in my life.
Things are different here in Guatemala. Most women who become midwives are aware of their calling from a very young age. One of the typical stories you hear is that a woman was born “in the caul,” which means with the bag of waters intact at birth and that is sign of destiny, that she will be a midwife. She grows up with that story and that begins to live into it as life presents its opportunities. She may also or alternatively experience a series of dreams involving babies, pregnant women, dolls, or coins. There are many things associated with pregnancy and birth that show up in dreams that can point to a calling. She is therefore validated and called “comadrona” before she has any experience or training whatsoever. I find this so beautiful and life-affirming. A boy who is born in the caul is said to be a “curandero”, or healer.
There was a doctor in the room at the first birth I attended here, and he wanted to break the bag of water. I asked the mother if she wanted the bag broken and she said “no”. Eventually the doctor was asked to leave. That day, the baby was a boy and he was born in the bag – so it was meant to be. What if we had intervened? It would have literally changed the course of that boy’s life.
MA: You are working with a group of midwives and activists from Guatemala and the United States to open a midwifery school. Tell us about your vision for this school.
SP: Our vision is to have a training center/midwifery school that will serve the local women who are chosen as midwives — and also provide a unique educational opportunity for student midwives from the United States, Canada and beyond. The philosophy of the school is one of leadership and collaboration – this is not a top down model. It is the vision of Ester Pop Tuch who is a traditional midwife from San Pedro – a really competent midwife who has attended hundreds of births. Jumping off from Ester’s original vision many talented people have joined the project and it is becoming a truly visionary model that has the potential to really shift the discourse and the direction of midwifery in developing countries, beginning here in Guatemala, where home birth is still the norm.
The school curriculum will combine the midwifery model of care with Mayan healing traditions – herbal medicine, spiritual cleansings, spiritual guides and birth wisdom. We can really help this community by training the midwives in the midwifery model of care and emergency medicine so that the midwives know how to handle complications and when to transport to the hospital. They Mayans have a rich tradition of midwifery and home birth, which has been eroded away. There’s a long history of discrimination and abuse and colonialism and war; and midwives during the war were picked off because they were community leaders, so they were the targets. We want to scoop that tradition back up into a container where it can be passed on to future generations, ideally in a way that is healthier, stronger, and more sustainable than it has been.
MA: How will this project improve birth outcomes and lower intervention rates in Guatemala?
SP: I came here to research high maternal mortality rates in Guatemala. On the surface it looks like women are having their babies at home and that’s why they’re dying. There is a relationship there, but it’s much more complicated then it would appear on the surface. Here’s what I’ve seen:
People in this area, on the whole, prefer home birth. It’s culturally expected – anyone who comes to the clinic to visit me for a prenatal is expecting to have a baby at home. They don’t have any desire to go to the hospital and deal with the scene there or be operated on. You don’t see people who are like “oh just cut me open, that will be easier.” They really value home birth; they really value their midwives.
However, women are being told that they must visit the health post during their pregnancy – which is outside of the midwives sphere of influence. Theoretically that could be OK, except for the fact that the health centers uphold a medical model of care. Women who go to the health post – I’ve seen this over and over – are much more likely to be told, for one reason or another, that they need to go to the hospital for the birth. They reasons given are things U.S. midwives would balk at, like being over 40 weeks, being diagnosed with a “narrow pelvis,” or a baby that’s too big, being told that the baby won’t come out because the cervix is posterior or because the baby is posterior, to name a few. All of these things are utterly absurd and the sad part is that most of them do not seem to make it out of the hospital without a c-section.
When mothers end up at the hospital, they have to be alone – no partners, no midwives allowed. No support person. Absolutely none. That’s hospital policy across the board. This is problematic on many levels. There was this really fantastic study that was done my Nicole Berry, which correlates high death rates to a fear of going to the hospital (among other things) – women don’t want to go even if they know they need to go. They wait too long, so it’s a last-ditch effort going to the hospital, and then it’s too late. I have definitely seen this playing out but I have also seen almost the opposite. I have seen many women that are easily convinced that they should go to the hospital even though the reasons given to them are bogus. They just don’t seem to have enough knowledge about their own bodies and normal birth to know otherwise and often times the midwives don’t know any better either. It’s not that different than in the U.S. actually, where women are given umpteen reasons why they need a c-section and they don’t really protest.
There are also situations where the midwife doesn’t know her stuff, but this environment makes it especially challenging for a midwife who might say “this is outside of my parameters, we should go to the hospital”—because then the family has a big discussion about whether to go or not, knowing that they will be treated very badly once they get there. Then the question becomes, at what point is it worth it to go?
I have also experienced the loss of a beautiful baby boy due to the utter incompetence of the health care system I dutifully referred the family to. Instead of being treated, the situation was dismissed (by the local health post doctor) as a result of the evil eye. A few days later the baby died. I am still grieving over the recent loss of this baby, my first as a midwife, and dumbfounded at the whole situation. Healthy women with healthy pregnancies are being told there is something wrong and a sick baby, who needs urgent attention, is dismissed. It makes no sense.
On a more positive note, I have attended some really triumphant home births, where women have had their babies at home with me and a “comadrona” attending, against all pressure to go to the hospital. The depth of gratitude I have received from the women and their husbands, often the most from their husbands, makes everything I am doing worthwhile. I can really, really feel how deeply important it is to these people to have their babies at home with their families and their midwives. It’s deep stuff.
For me, I care deeply about woman and babies surviving the birth process. But the point I want to get across is that birth, and life, for that matter, is not just about survival. All of life is here to be cherished. Birth is one of life’s most exquisite experiences, or I should say it can be. For some women, maintaining their dignity and freedom is more important than staying alive. Others are willing to sacrifice the home birth and endure the hospital experience in favor of what they believe is their safety. They should not have to make that choice. They can have their babies in safety, dignity, and freedom, all at the same time.
The goal of the midwifery school is not only to equip midwives with knowledge; it is to elevate the status of midwives so that we can improve birth outcomes and lower intervention rates. Ideally, we would like to offer a comprehensive three-year midwifery education to younger midwives just starting out so that there can be a group of professionally trained midwives who are well-steeped in the midwifery model of care as well as their own culture. These midwives would fill a huge void in the community between birth with a traditional midwife, or “comadrona,” who has minimal training, and a c-section in the hospital. These women could serve as bridge builders with a valuable knowledge base of normal birth and the ability to communicate in both the indigenous communities and the medical world. We hope our students will be the leaders of the future of midwifery in Guatemala.
MA: You have described this project as a dream-come-true. It is inspiring to hear. Tell us about that.
SP: The more this project develops the more I have deep faith in the process and what will be the product. It feels to me like there is a spiritual force that has created an energetic blueprint of what it wants to create. Each of us holds a piece of the manifestation of that blueprint and have joined the effort because we are somehow aligned with it. For myself I feel like I’m just following instructions. I just feel like I trust everything that shows up and the more I do that the more I see results that blow my mind. Every meeting is productive, every action moves us forward. Every door knocked on is opened. It’s crazy and awesome.
Sarah Proechel is a Certified Professional Midwife from the U.S. She has had a private home birth practice in western Massachusetts since 2005 and is currently working in Guatemala as a 2010-2011 Fulbright fellow. Her project, a cultural exchange with traditional midwives in San Marcos La Laguna, Guatemala, has rapidly evolved into a joint initiative to create an international professional midwifery school. Sarah holds a bachelor’s degree from Goddard College in Health Arts and Sciences with a focus on Mayan midwifery and herbal medicine and is currently enrolled in a Master of Midwifery program at Midwives College of Utah. She is author of Voices of Maya Midwives: Oral Histories of Practicing Midwives from the Mam Region of Guatemala, Lulu press, 2005. When she’s not in Guatemala, she lives in the Hudson Valley of New York State with her husband, two young children, and one teenager.
Michel Odent, MD, is known as the French obstetrician who introduced the concept of birthing pools and home-like birthing rooms to hospitals. He has published 21 books over his career, including The Scientification of Love, The Farmer and the Obstetrician, and The Cesarean. This week, Dr. Odent shares his personal insight about creating an ideal birth environment.
The best advice for an easy birth is for the parents to have nobody around except for an experienced mother figure, a midwife and a doula. We have to re-discover what is simple. Privacy matters during labor.
During the twentieth century, many schools of childbirth were based on theories that today are unacceptable. We make things so complicated. I learned this with my very fist experience of childbirth as a medical student in 1953. At that time, a midwife had nothing to “do”. She was spending her life knitting – knitting while waiting for the baby, knitting while there was no woman in labor – she had nothing else to “do”, and in that respect I realized the value of this tradition and attitude.
At Cambridge University, some scientist explored the physiological responses to repetitive tasks. As an example of a repetitive task, they studied knitting. When you are doing a repetitive task like knitting you reduce your level of adrenaline and that’s the key for an easy birth – when the level of adrenaline of the midwife is low, it’s contagious. This helps the woman in labor to be in a state of relaxation and the birth is easier.
And today, I’m still learning what is simple. I have been attending homebirths accompanied by a doula. Yes, I am a doctor, but this doula is the mother of four children. I generally stay in the kitchen keeping the man busy, the baby’s father. Finding topics of conversation, different things to do – leaving the two women together in another part of the house.
The doula does most of the work. She has an incredible capacity to remain silent – to keep her mouth closed – and that’s how I’m re-learning again what is simple. I have come to understand – again and again – that the best possible environment for an easy birth is when there is nobody around the parents but an experienced midwife, doula, and experienced mother figure who can remain silent.
How did you ensure birth went according to your plan?
Choosing the care providers who will be present and support you through your pregnancy, labor and delivery is key to achieving the birth you desire. This week, Deb Flashenberg, a Mother’s Advocate Blog veteran, joins us to clarify the difference between obstetricians, midwives, labor and delivery nurses, and doulas.
As a doula and Lamaze certified childbirth educator, I’m often asked:
“What is the difference between a midwife and a doula? “
“Does my obstetrician work with my midwife?”
“Why would I choose a midwife over an obstetrician?”
“Isn’t a nurse like a doula?”
I finally realized that the best way to educate the women I work with was to create a comprehensive resource that covers what each does, how each might help her through pregnancy, labor and birth, and then attempt to demystify the world of birth professionals.
First, it’s important to understand the definitions of these terms, what each profession is ultimately responsible for.
Obstetrician (OB/GYN): A physician (doctor) who delivers babies, and is in the practice of obstetrics — the art and science of managing pregnancy, labor, delivery and the puerperium (the time immediately after birth).
You will see your OB/GYN or members of his/her practice throughout pregnancy, although exactly who your care provider will be at delivery ultimately depends on who is on call during your labor. During labor, the obstetrician will come in and out to check on your progress and, as the definition above states, “manage” your labor. Obstetrics is also a surgical field, so in the case of a cesarean, your OB/GYN would perform the procedure.
Midwife: A midwife is a trained professional with special expertise in supporting women through a healthy pregnancy and birth. Midwives also work with each woman and her family to identify unique physical, social and emotional needs. When the care required is outside of a midwife’s scope of practice or expertise, the woman is then referred to other health care providers for additional consultation or care. Midwives operate from The Midwives Model of Care, which emphasizes the fact that pregnancy and birth are normal life processes. Midwives statistically have lower rates of interventions, and provide the mother with individualized education, counseling, prenatal care and postpartum support, as well as continuous hands-on assistance during labor and delivery.
Midwives, like doctors, may work in a group that rotates who is on call and who will see you for your prenatal visits. Some midwives work alongside doctors in their practices, while some work individually or outside of the hospital setting. There are different types of midwives: direct entry midwifes, certified professional midwives, and certified nurse midwives. Depending on their credentials and training, some midwives work in hospitals while others solely attend home births.
Labor and Delivery Nurse: Nurses in this field provide care to women who are in labor, women who have recently delivered, and women who may be having complications with labor. They also work with doctors to develop a plan that aids in the safe delivery of healthy babies.
Labor Support Doula: A trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth. Some doulas also provide emotional and practical support during the postpartum period.
Unless a doula has additional training, she is not a medical professional, and will not perform medical procedures on the laboring mother or deliver the baby. However, she most likely will be one of the most consistent elements of the labor experience. She does not change shifts and only deals with one client at a time. A doula will also labor with a woman at home, before the transition to a hospital or birth center is made.
Now, back to the original questions:
What is the difference between a doula and a midwife?
As described above, the doula acts as emotional, physical and informational support for the mother. While the midwife may offer many of those same qualities, it is the midwife who will actually deliver your baby and perform necessary medical examinations throughout your pregnancy, labor, delivery and postpartum period. Midwives are also available to work with a woman outside of pregnancy, and can perform “well woman” yearly exams throughout a woman’s life, as well.
Does my obstetrician work with my midwife?
Yes, sometimes a practice has both obstetricians and midwives. But if your current OB/GYN does not work with midwives, you cannot have both as care providers. If a midwifery practice does not have an obstetrician as part of the group, there will be an outside doctor who backs up that group.
Why would I choose a midwife over an obstetrician?
Choosing your care provider is a very personal choice. It requires a long, hard look at the model of care you would like for your pregnancy and delivery. While both professions try to offer the best care they can to women, the path in which that support is offered differs. The model of care that midwives subscribe to reflects the idea that pregnancy and birth is a natural physiological process that should be inherently trusted, while the medical model focuses on the pathologic potential of pregnancy and birth. They both have the same desired outcome, but use different routes to get there.
You should also consider the style of care you personally prefer. Midwives will tend to be more present during labor; moreover, they will be more holistically based, and allow more space for the labor to unfold naturally before moving to medical interventions. Obstetricians are not as likely to give you as much personal care and time, and may move to medical interventions more quickly.
Isn’t a nurse like a doula?
Many labor and delivery nurses (L & D nurses) I have worked with are wonderful, and can offer a lot of helpful advice for the laboring mom. However, I would not advise depending on your L & D nurse to provide the same comfort and assistance as a labor support doula. The L & D nurse often has several women they are monitoring at the same time, and cannot offer consistent support since they work in shifts and breaks. You may also find it appealing to choose your labor support doula, and have the opportunity to previously discuss your birthing preferences with this person.
I hope that laying out this cast of characters makes it easier for you to make decisions about your birth — including the model of support you will receive, and who you would like to be present. After all, it is your birth.
Debra Flashenberg CD (DONA), LCCE is a graduate of the Boston Conservatory of Music. She spent most of her life performing, and was introduced to yoga through a choreographer in 1997. Soon after embarking on the path as a yoga teacher, she founded the Prenatal Yoga Center in New York City, where she continues to instruct prenatal yoga and train prenatal yoga teachers. Debra decided to also take her skills and passion for supporting normal birth outside of the yoga room, so she became a certified labor support doula with DONA and a certified childbirth educator with Lamaze International. For more information, please visit the Prenatal Yoga Center online.
This week we are thrilled to feature licensed midwife Maria Iorillo as she discusses the transformative power of birth. 
