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Posts Tagged ‘midwife’

There are several cultures where childbirth is understood to be a rite of passage. Beliefs surrounding this transformation are important because they inform the way in which women give birth.

The first culture that jumps to mind would be the Kung of the Kalahari Desert, where young men and women practice rituals that bring them into adulthood.  The most significant right of passage for the Kung men is to hunt and kill their first large animal. For women, the right of passage is giving birth. The Kung is a very subtle tribe who don’t honor bragging.  For example if a young man comes back from a hunt and boasts about making the big kill they will be ignored.  Instead they will quietly start passing out meat, indicating that they accomplished this feat.  For women to gain the same kind of honor, they go off on their own to give birth in the bush without saying anything to anyone. Once the child is born, they very quietly come back and start nursing their baby under a tree.  At this point everyone notices and comes by to congratulate her.  She is then honored for her stoicism and her warrior like abilities in her right of passage.

Another great example is Japan.  Most births still take place in the hospital, however there are maternity homes with live-in midwives where women go for pre-natal care and birth.  The Japanese and the midwives who work in these maternity homes have a specific saying about labor pain; they call it “metamorphic”.  They say that going through labor is a metamorphosis because it changes the woman into a mother the way that crawling out of the cocoon changes the caterpillar into a butterfly.  They adhere to an old story that states if you help the caterpillar out of its cocoon it will die.  It has to emerge by itself in order to survive and to be strong.

Japanese midwives approach birth with great patience.  They believe that the struggle and pain of labor helps the mother to grow and transform herself. The mother must look deep down inside herself and find out who she is.  The baby also needs the struggle of being born; the work is what transforms both the mother and the baby into separate beings with the power and the strength to go on and to be the mother-baby pair that they need to be.

The babies muscles will get exercised during birth which will prepare the baby to be ready to breastfeed.  This will also enable the baby to be aware of the smells and hormones needed to latch on.  If it’s born by cesarean section for example or if there are drugs at birth the baby’s consciousness will be reduced as well as the flow of necessary hormones.

The mother’s metamorphosis releases massive doses of oxytocin while she’s in early labor. Late in labor a flush of adrenaline gets her on a high and gives her the power and strength to push the baby out. Right after this stage comes another flush – the biggest flush of oxytocin she’ll ever get in her entire life.  This will transform her and the moment of suffering, pain and pushing.  If you watch women’s faces at this moment there’s a suffusion of joy and ecstasy in their expression.  Then the milk lets down, the prolactin comes and the hormones all work together to make the caterpillar turn into the most beautiful butterfly.

This excerpt is part of a video interview with Robbie Davis-Floyd and is being re-published with permission from Mindful Mama.

 

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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.

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.

How did you build your support team?

 

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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.

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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.

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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?

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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.

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Mickey Sperlich, well-known midwife and childbirth advocate, speaks about post-traumatic stress disorder (PTSD) in sexual abuse survivors this week. Mickey shares with us her experiences with “survivor moms,” and provides hope that post-traumatic stress can become post-traumatic growth with a safe, healthy, fulfilling birth.

MA: Many women who experience sexual abuse suffer from post-traumatic stress disorder, or PTSD. Can you tell us about your experience with PTSD?

MS: I’m a semi-retired midwife. I had a home birth practice for 20 years, and my interest in working with what I call “survivor moms” really grew out of my practice. So, some very powerful experiences that I had with my clients caused me to realize that survivor moms were bringing particular issues to the whole childbearing process, and needed care and attention that I wasn’t necessarily educated to give them [at the time].

I can give you the example of working with a woman who was pregnant for the fourth time. I’d helped her with three babies prior to that, and they were all boy babies. Everything had been super smooth for her first three pregnancies. This time around, she intuitively sensed that she was carrying a girl. We ended up having an experience late in pregnancy where I was examining her, and she suddenly flashed back to being a little girl. I was no longer her supportive, loved midwife that she knew really well — I was her abusive mother. And, that was a really challenging experience, not only for her obviously, but for me too — to be cast in that role where it certainly wasn’t my intention. Thankfully, I had enough trust established with her that we really worked on this and what had happened. … What she had experienced, that re-experiencing or flashback, that’s one of the hallmark features of post-traumatic stress disorder — which I found out later, in the process of trying to educate myself about this. This happens quite frequently to women, so I just determined — I’m going to find out everything I can.

MA: Speaking of survivor moms, tell us a little bit about your book, “Survivor Moms: Women’s Stories of Birthing, Mothering and Healing After Sexual Abuse.”

MS: I started a survey project around the country where I began asking women, “How do you feel that your history as a survivor of sexual abuse has affected your pregnancy, or your birth, or the post-partum period, or how you feel about yourself as a mother?” I got hundreds of responses, and then I invited those women to write their story in a narrative form, and eventually published a book on that — which is the result of their stories. More than 80 women reported their life story to me within this context. … I was [then] fortunate to hook up with my co-author, Julia Seng, who is a certified nurse midwife, and got her Ph.D. looking at post-traumatic stress disorder and its affects on childbearing outcomes.

For more information on “Survivor Moms,” please visit Midwifery Today.

MA: How would a pregnant woman or her care provider recognize PTSD?

MS: One of the hallmark features would be the re-experiencing … it may be that they feel as if the trauma is happening all over again. A classic example during pregnancy might be if a woman has to have an internal examination for some reason, and in the midst of that, feeling as if she’s triggered back to a rape scenario. And even some of the terminology we use, like telling her to relax and all of that — it seems like a good thing for us to say, unless you consider the [possible] context. When was she told that before? So, some of the language we use can really be triggering. Women, when they’re pregnant, can [also] feel sort of invaded by the baby — out of control. One of the features of having been traumatized, especially sexually traumatized, is feeling like it [the situation] was out of your control. Being pregnant for some women is just a very wonderful, rosy situation, and for other women, they feel like: “Here’s my body — not under my control again.” That would be an example of the re-experiencing.

Then you also have the numbing — that’s another feature. So, feeling like you’re not there, like you’re not connected to what’s going on. Some women might report, “I don’t really feel pregnant,” or just feel really disconnected from their bodies. … Also, just anxiety, fear, anger, irritability — those things come along, as well.

MA: In the wake of PTSD, how can women empower themselves to move forward — specifically during pregnancy and birth?

MS: Something that I’ve found while practicing midwifery is that pregnancy is a wonderfully gestating transformative time — just in its very nature — so it actually is a really good time to work on your psychological issues, and to seek help. Many women reported to me in the narrative project that they saw a great opportunity to stop the cycle of abuse. They were like, “Oh my gosh, I’m going to be a mother. I know that I don’t want to be this kind of a mother — that’s real clear. I know what that looks like, so how can I envision how I do want to be?”

And they’re going to need a lot of support, so reaching out — that’s where maternity care providers can really be helpful, by modeling healthy relationships, listening to women — that’s key, being listened to. When you look at the data about who is resilient or not growing up in an atmosphere of abuse, a little girl or a little boy needs to have one adult in their life who they trust, and who they know really deeply cares about them and wouldn’t harm them. And it doesn’t have to be a parent. It can be a teacher, it could be a friend — it doesn’t matter, but we have to be able to connect in that way. And so, being able to connect in that way is one of the things that allows us to connect with the infant, to be able to attach with the infant.

MA: Is it actually possible to move beyond PTSD?

MS: Absolutely. There’s a lot of talk now about post-traumatic growth. One very cool thing is that many women have reported to me how utterly healing becoming a mother was. Especially for women who had been sexually abused, and that’s how they developed PTSD. To take this space that was formerly violated — a violated space — and to have this beautiful transformation of the baby coming through. Growing a baby, and then birthing that baby, and then having this precious life that you fall in love with — that that in and of itself was transformative, and healing, and fostered their growth — their post-traumatic growth in ways that they had never dreamed possible, actually. And that’s a wonderful opportunity we as midwives have, to foster that, to protect that space for the woman so she can have the kind of pregnancy and birth experience that would allow for something like that.

This interview, originally video-taped for Mindful Mama, was transcribed and re-purposed with permission from Mindful Mama.

Mickey Sperlich, a certified professional midwife with nearly 20 years of experience, helps women on the journey of pregnancy and birth. Mickey is the mother of two grown children, and has been married since 1980. She appreciates being a midwife and mother, and learning so much from the women and families she has served, and also from her own children. Mickey is recently retired from full-time midwifery, but continues to focus on women’s health issues. She currently manages various research projects that look at the effects of post-traumatic stress on childbearing at the University of Michigan’s Institute for Research on Women and Gender. Read more on Mickey’s blog, Survivor Moms Speak Out.

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