Precipitous Labor- Communcation is the Key

Recently I received an email from a client of one of our doulas. She was unhappy that her doula did not come earlier to her induction. I reviewed the timeline that the doula had from the numerous texts she had had with the partner of the pregnant woman and even the phone calls she had had with her. The truth is an induction can take days to get going and can turn and get going quickly. No one knows what will happen.

I have worked with moms who were gently induced over several days before they were having any significant contractions. Our agreement states that we will come when you need us. But not being present when your labor induction begins does not allow us to hold a magic 8 ball that tells us when that will be. So, we rely on your communication. Here is a timeline of a recent birth:

12:19am text from dad that mom’swater may have broken. Doula suggested that she call midwives. She texted them at 1:30 to hear if they had heard anything yet. Midwife suggested resting and calling back at 7am to give them an update.
7:32am text that she had talked to midwife and she had wanted them to come in for antibiotics and see if they could get labor going. She was off to take a shower. Doula suggested walking and using a breast pump once she got there. 8:38am on their way over via text. Doula suggested getting something to eat and made a reference that today may be his birthday!
11am text that she was waiting on pharmacy for her GBS meds and they had just drawn bloodwork. She was up walking since she was having mild contractions. Midwife said that the contractions could be actual labor beginning- and guessed her to be maybe 3cm, and she said she is still having discharge coming out. Doula agreed that vaginal exams would not be good and told them she was sitting on ready- she would stay tuned. Doula asked where she was feeling these little contractions.
Mom said that she was feeling it mostly in the front. Midwife said maybe there would be an exam at 1pm which would be 12 hours since her water had broken. It is now noon and she just finished her first big dose of antibiotics. Doula suggested during that exam to ask midwife the position of the baby. But based on what she is feeling, it sounded like a perfectly positioned baby.
Vaginal exam at 1:37pm and she could not even feel the cervix since it was so posterior. But the baby’s head is down. Due to the GBS and her water having broken, midwife needs to give her Pitocin to get things going. 1:40pm a text to dad asking when they started the Pitocin. There is no response.
Next text is at 3:13pm saying that midwife feels she is having a rapid start and it is time for the doula to come. He tells her they are in room 7. 3:17pm doula says she is on her way.
Next text at 4:07pm from dad says they are getting close. Doula responds that she is parking at 4:08pm. Baby boy was born at 6:17pm.

The mom of this baby contacted me telling me she was upset that the doula did not come earlier. She is upset that the doula was only there for a few minutes ( more than 2 hours actually). But when the mom contacted me, I talked to the doula and got the actual text times for this timeline. So what is really going on here?

Sometimes moms have a squeded idea of who the birth actually unfolded. Fast births can be traumatic. Perhaps the dad did not share the texting that had been happening between the doula and the mom. This is why although I appreciate communicating with the dad or partner, communication with the mom directly if at all possible is best. Sometimes depending on traffic, it can take a while to get to the mom in Atlanta. This doula had been sitting on ready and was able to walk out the door immediately- but it still took 50 minutes to arrive.

As doulas we have no idea what is happening if you do not communicate with us. Every labor is different. But we want to be with you when you desire for us to be there. Know that. But you will need to communicate with us to let us know what is happening.

I recently had a birth where the mom was what we lovingly call a “park and push” Here is their timeline:

I met with them on Tuesday night for four hours. I shared some optimal positioning exercises and rebozo techniques. The baby was beautifully positioned but tucked deep into her right ribs. She was barely 37 weeks.
I received a call that night regarding some cramping and more mucus. I encouraged her to drink a let of water and try to rest. I later find out the cramps had awoken her at 4pm and she was now seeing some pinkish red show. She was also having loose stools, a release of prostaglandins.That morning she said the baby had dropped into her pelvis.
I heard from them again on Wednesday evening. they called me at 4:45…to give me a heads up. We discussed how this could be early labor. I suggested calling the midwife to see if she could come by the office for a check. The midwife said she would be leaving soon but would ask the in call midwife to call…should get a call within the next 2 hours from midwife. She told her maybe early labor.
I received a call at 5:27. They heard back from the midwife. She suggested they come to triage. They decided to get dinner before doing so.
I called at 6:01, they are headed to hospital. will call me. Dad said mom is not doing good. She sounded very different than the time I had spoken to them only a half hour ago when she was barely having contractions. I asked if he wanted me to meet them. He said they are close and will call me ..don’t come yet. I was in Midtown on 85 in heavy traffic.
I called at 6:09 after thinking about how she sounded but it was not a good connection. I thought he said he would call me back.
6:13 I called to say I was going to meet then there…I was downtown in rush hour it sounded like she was in very active labor. Dad was so calm. GPS was sending me onto Freedom Parkway. So I took at 2 minute detour to drop off the things I had for the meeting I was headed to. But there was so much traffic once I got off the highway and onto the streets to the hospital.
I called at 6:57 only 1 mile away. I was on high traffic surface streets to the hospital. Dad told me that they were in room 2004 but that their baby girl was here.
He had dropped her off at the hospital. She had waddled in. The ride over had been hard. She eventually took her seat belt off after trying to lay the seat back but not being able to do so since the birth ball was in the back seat. She turned around facing the seat with one knee down, feeling nauseous at the traffic stop she had opened the window fearing she would be sick, head out the window!
Once in the labor area, she went to the public restroom where her water broke. She managed to open the door for her husband. A nurse attempted to get her in a wheel chair but she could not sit. She instead knelt in the wheel chair and someone got a towel to cover her now bare bottom. She was immediately wheeled down to room 2004.
Dad had to hang up with the midwife who luckily was in the hospital. She heard them call overhead for any doctor in room 2004 and she realized that was her patient. She entered the room and four contractions later this speedy little girl entered the world at 6:44. Her placenta came within 5 minutes.
I arrived at 7:08. Mom was resting with her hubby by her side and her baby girl on her chest.
I stayed until it was family time and baby had nursed at 9:30
I was glad to have been a small part of this labor of love. The dad said it was my voodoo the night before that had started everything!

Although the dad did comment that the hourly rate for all involved had been a good one, never did they state they were unhappy with the way their birth unfolded or my services. I went to visit them on day three and offered some soothing baby guidance while sharing the pictures I had taken when family arrived to meet the new little one and congratulate the family.

Both of these couples had a precipitous birth. Both had doulas who very much wanted to be there to support them. Both doulas had been communicating along the way. Both families had been supported by their doulas.So why are the stories so different on how they feel about their doulas support? I am unsure. What I do know is time some time helps to bring peace to the situation. But the key factor is communication.

Call your doula along the way. She will offer guidance. If at any time you desire her to come, invite her to do so. She wants to be there. We have no idea what your needs are unless you call us. We often hear that fast labors are like roller coaster rides, but without getting your seat belt buckled in. We want to be there to help buckle you in for the fast ride when it happens. Call us.

Lean Into Birth

Debra Pascali -Bonaro recently spoke in an interview about birth imperatives. One of the things she said was that women needed to “lean into birth.” This phrase resonated with me. I wanted to elaborate on her thoughts and my thoughts regarding this comment. First think about what the opposite of lean into is… it is to pull away and resist. This is not the way we need to approach birth. We all know that in order to move forward in a positive way, leaning into something without fear is ideal.

To lean into birth emotionally means to not be fearful- but instead to actually lean into it– embracing it fully. When women are afraid they hold back in that fear. How will that help them in labor? How will it hold them back? When you just let the waves roll over you, not fighting the sensations, you allow your bodies to let go and open. This is a radical concept in our society. Women often think that pain is isolating and so intense that they do not like the idea of not getting an epidural early on in their labors. But I have seen moms lean into their births by preparing ahead of time.

They address their fears instead of being hesitant to discuss them for fear that doing so will give that fear power. I feel not discussing it gives it power.
They begin to work through those fears with tools to help them lean into them and find ways to turn their fears around to feel empowered.
They surround themselves with a team that fully supports them.
When they feel empowered and supported, they are able to let go and lean into their labors without the paralyzing effect of the fear.

It is like the first time I zip-lined- I was afraid but after considering the safety techniques the canopy company used, knowing others do this and survive, having a team leader who knew what she was doing and being with friends who encouraged me, I was able to push through those fears and lean into the line and zip across the cavern below.

To lean into birth physically means just that. Instead of laying back into a bed resisting our bodies’ natural response to gravity for birth, which makes birth more difficult, leaning into birth makes birth easier. Having a mom upright, on her own feet or kneeling, allows the baby to align beautifully. The mom feels empowered when she is using her body and instinctive movements for birth. Leaning forward and allowing the baby to be in the hammock of the uterus helps the baby to line up for an easier movement through the pelvic outlet.

So as you approach birth, considering ways to allow yourself to lean into birth rather than resist. Acknowledge your fears, address them fully, gather tools to work through them. (We offer classes to help you do this.) And in labor, stay upright and listen to your body.

Birth is In Your BODY

There are so many classes and books about birth today. But women fixate on the techniques or the set information about when they are due, how to time contractions, methods of induction, etc. They worry about if they will poop on the birth bed or in the pool, whether they will “loose it” in labor or whether they will need medication. All of these things are keeping women in the heads, not their bodies. But birth is in your body!

I often say 98% of labor is in the shoulders up- meaning in the head. But what I mean by that is if you get out of your head- let go of all those fears and thoughts on how birth should be and just let birth be, your births will be much easier. Our bodies already know how to birth- we just have to get out of the way and let it do it!

How do you do that? First take the calendar down- quit worrying about your due date. Due dates are guesstiments at best. Second, when you go into labor remove the clocks and watches. Labor has not time limits. It just is. Third and most important really- get into your body. Learn to listen to what it is telling you to do. Move when you need to move. Listen to your heart and intuition. This is what we teach in BOLD. When you are pregnant, learn to do these things so that it comes natural in labor. Stay fit – swim, walk and dance. Write down in your journal your thoughts and dreams about your birth. Let your body lead you- not your head.

My advice to you is to get out of your head- get into your body to birth! Take a movement class to learn to let go! Letting go is essential to birth.

When a Doula Says No

Lately on many private doula pages I am on, there have been doulas discussing watching their clients being abused and what the role of a doula is when that happens. And it is a difficult situation. We can not give medical advice nor be disrespectful to a care provider, but when we see abuse and have to stand quietly out of the way it is very difficult. What many doulas have done, and I personally have chosen to do is to step away from taking clients who have abusive providers.

Recently I had to decline being the doula for a client whom I have been the doula for twice before. She continues to go to the same provider although she is not listened to and is even abused in my eyes. I wanted to be there for her but I can not enable her to continue on the path she chooses. And I am not going to get into why women allow this to happen to them… the vulnerability and issues behind it are outside of my understanding.

We watch women being lied to…outright lies. They are told things that are not evidenced based and are totally biased. We watch women have their cervix stripped after asking to not have it be done. We have women have rough vaginal exams in labor only to be told that is why they need to choose an epidural. We have women have their amniotic sac broken without consent and sometimes even after telling the doctor they did not want that to be done. We watch their perineum being sliced without consent. We watch women get bamboozled into inductions that are not warranted and into medication they did not desire. And for some of us we see worse. When we see women shut down- not listened to- not being heard when they speak- not having a say in their births, we want to yell STOP! But we can’t. We can stand by her side and remind her of what she desired and try to help her find her power. But some women give their power away. They know what they wanted but they are quick to give it away. It makes us go home and cry for that woman and that baby and that birth experience.

I have attended over 600 births and I realized after the first couple of hundred that I had to put my foot down and protect myself from burning out. I had to say, no I will not be party to watching that abuse, that birth rape occur in my presence again, feeling powerless and being damaged emotionally by watching it. So there are providers that if a mom chooses that provider, I have to decline being her doula. There are only a few- one at Gwinnett Medical and two at Northside. I am reminded of something an OB told me years ago, “ObGyns are either one of two kinds of people. Those who hate women and want to control them, and those who love women and want to support them.” I have found this to be true.

Recently our local hospital that does more births than any other facility in the country came out with a form that is required by the patient and doula to sign. It is attached for you to see it. It must have come after doulas stepped outside of their scope of practice. I only did one birth there in 2014, so I have not heard the scuttlebutt of what caused this to happen. But it is a shame. The scrutiny of the doula in the support team is sad. If I go as a friend or family member I am not held to signing this agreement. But it seems that although the parents want a doula to accompany them, a nurse can decide that that doula has to leave. How do you feel about a hospital that can control that aspect? And this form is not about overstepping medical advice- it is about support – things your family members do and most nurses prefer for us to help with- but someone decided to make doulas sign it- controlling your choice in having a doula.

I have only been asked to leave by a doctor once- when he wanted to control the mom and dictate who she could have in the room, inviting some who were not invited and then saying too many were in the room and I had to leave. The mother watched in horror but without her voice. Later as she clung to my neck and cried about the horror she had just experienced at his hands, she broke my heart. I had a midwife decide the room needed to be cleared once and ask everyone to leave. She thought that was best. But again, the mom was voiceless. It breaks my heart when care providers feel the need to control the birth room without regard with the mom’s desires. That is about as dis-empowering as it gets.

I think women need to have their voices heard in labor and birth- but I also feel doulas have to know when to say no. I have cried many tears for women who allow their births to be taken away from them. It is always about control. And watching women give their birth choices away to someone else to control breaks my heart.

Here is the form that is now required to be signed if a doula remains in your labor room at Northside Hospital. If you can not read it from this pic- let me share some of the verbiage:

The role of the doula is to provide labor support, which may include emotional support and coping strategies for your labor and birth. The role of the labor doula does not include performing clinical task such as assessing your medical needs for those of your baby, diagnosing medical conditions affecting you or your baby, offering medical advice, operating any monitoring or medical equipment, removing or applying monitors, assisting you out of bed to the bathroom, making decisions regarding your care and treatment or providing instructions or information that would be required by a licensed professional registered nurse or medical provider.

If at any time your doctor midwife or nurse believe that the doula is not adhering to his or her role in providing you with labor support or if your care providers believe that you’re doing is intrusive in the care and treatment provided to you during your stay at the hospital, we reserve the right to instruct the doula to leave the hospital. You may dismiss your doula as well.

So although a doula should not be giving or providing medical advice or treatment, the document seems to possibly restrict us helping our clients get informed consent. The words like “being obtrusive in the care” and we are told all of the time to unplug a mom to help get her up to the toilet… and when we ask about this we are told of course we can- but if we do- this is grounds to have us dismissed… could be treading on tricky waters. So be aware of the situation your doula may be being put in by supporting you at this facility.

The Clock is Ticking…

There is an idea being supported within the birth professional community that a doula needs to charge more after a set number of hours of labor support. The theory behind it is the doula needs to call in a back up substitute or be paid extra for longer hours. How do you feel about that? There are doulas who after 12 hours are then taking on an hourly rate above the fee originally charged.

If the average woman is in labor for 19.5 hours, that means some will go over that time frame and others will go quicker. A doula does not usually attend a mom as soon as labor begins as it is often very manageable and erratic. The doula is usually called when labor is established and she needs more pain coping management. But how about the mom who has a longer labor and needs her doula for more than 12 hours?

Do you think that having the added pressure of having to pay the doula for more hours offers a sense of comfort to the mom? I do not think so! Do you think it may cause her to delay in contacting her doula for fear that the fee would then escalate?

We personally feel it holds the mother hostage. If you want further support in the deep throes of labor, you must be willing to pay more! We will not be party to this new idea. We are there for the long haul of supporting you throughout your labor.

If you need labor support for an extended period of time and we are exhausted and do not feel we are at our best, we may call in a back up to assist you while we take a power nap. We pay that back up out of our fee. We do not feel it is up to you to pay more money due to our fatigue and the need to call someone in to help.

Where did the arbitrary time of twelve hours come from anyway? Can I doula support for longer than 12 hours and still be fine? Sure! Now of course it depends on what time you called her. Yes if you need her at 11pm and you did not give her a heads up so she could take a nap, it may be difficult to be up all night. So, please give your doula a heads up so she can perhaps prepare for an all nighter and maybe an all day the next day too. In early labor, consider resting a lot and allowing your doula to do the same- waiting for things to pick up later and have a refreshed doula. If possible sometimes the dad and doula will tag team and take power naps when possible and still support the mom fully.

We have been known to support moms for days- yes I said days! We have been with a mom for 50 to 70 hours before- more than one of us has done so. And our fee remained the same. Sometimes we have been tipped. Sometimes a tip was offered if a back up was called in since they knew the doula was sharing her fee. But never was it expected or demanded. It will not be happening in our company.

A laboring mom feels so much pressure on her already to perform in such a way to keep intervention at bay. Increasing our fee after a long labor will not be one more added pressure. We will not be a party to this unfair idea.

How to Choose a Doula

doula bierman

You know your girlfriend may have loved a particular doulas, but that does not mean she is perfect for you.

You know your midwife or doctor may suggest a particular doula, but that does not mean she is the right choice for you.

You will know who is the best doula for you if you do a few things:

Read their bios on the website
Give the doulas you are drawn to a call and chat a bit
Come to the Mingle to meet them all in person
Or set up an interview if you did not make the mingle with the ones you feel may be a good fit
Sit and be mindful of which doula you are most drawn to- and hire her!

So many times a woman will tell me about herself and ask me to tell her who would be the best fit.

I do not presume to know who is the best doula for you. I believe you will be able to figure that out for yourself.

I think you will not go wrong with any of our doulas. We are all very different in personality and experience. But we are all the same in regards to our hearts for birth and families. We all offer the same services as doulas.

So trust your instincts and heart when choosing a doula who is the best fit for you!

Shelia Shares Her Recommendation for BOLD

Recently I posted about our upcoming classes and Shelia Matthews responded with this generously sweet recommendation. I wanted to share it on our blog!

I very highly recommend this class for all parents-to-be. My husband and I were well-informed and very prepared for our son’s birth as a direct result of the BOLD classes. This course taught us a variety of laboring techniques, very important early decisions we would make regarding our newborn, and most importantly- this course provided a channel for us to comfortably explore each other’s expectations and perceptions so that there were no misunderstandings during my birthing experience. Seriously, just take the class because it covers so much more than that and you’ll both enjoy it!

Meet Our Birth Professionals

Want to investigate hiring a doula and want to meet a bunch in one location? Want to hear about classes from the instructors before making a commitment to one? Have questions regarding birth and need answers? Want to meet birth pros that can help after the birth?

Our Mingles are the perfect way!

In 2015 we are switching things up a bit to offer different times within a month to have opportunities to meet the birth professionals of Labor of Love. Our location stays the same, centrally located in the Toco Hills Lavista location and same time.

The dates for 2015 include January 13th, February 24th, April 14th, May 19th, June 30th , August 11th, ,September 22nd, November 3rd and December 15th.

mingle pic

We hope this gives you ample opportunity to come and meet us all. We provide a short video, some details on our services and classes and time to talk to each of us to find out if we are a good fit. This meeting is often in lieu of an interview but it is also a great way to meet potential back up doulas in the rate event that is needed. Come out to meet us! We would love to meet you and share about our birth passion!

Meet and Mingles 2015

What We Will Not Do…

We will not give you medical advice.

We will do our best to not catch your baby.

We will not make you feel guilty if you deviate from your birth plan.

We can not guarantee you will not get an epidural.

We can not make sure you do not have a cesarean.

We will have opinions about things like vaccinations and circumcision, but we believe it is your decision, not ours.

We will not take your partner’s place.

BUT

We will help you find your answers by helping you find your questions to get those answers.

We will offer guidance on when to head to your birth location and if things go quickly, we will help you.

We will help remind you of your birth ideals and your options.

We will provide you guidance in more than 25 pain coping techniques.

We will be one piece of the gentle birth pie, helping you have a vaginal birth.

We will encourage you to do your research and make informed decisions.

We will support you along side of your partner and support them too.

Anjli Offers Her Recommendation of BOLD

We have taught nurses and even medical physicians and gotten recommendations from them. But today when I opened up my email and found these kind words, I asked if I could share them with you. They are so kind.

I routinely recommend the BOLD weekend with Teresa and Charlotte from Labor of Love, and knew well before I got pregnant with my first that I would want to attend one of these weekends myself. Being a midwife with a deep trust in birth and the journey of motherhood, I still felt that this weekend was a gift that I was giving to myself and my unborn child. It was an empowering time to get connected with mind, body, soul, and a community of women sharing something special. Women lead busy lives with much to do, and don’t often get the opportunity to discover, or re-discover the sacredness of this time with child. Different than any partner/couple based birth classes, which I also think are helpful, the BOLD weekend can really help women reveal their deepest wishes and innate desires, not just for birth, but for life. We never know what the future will hold, but we deserve to live life without fear, and further, to welcome it with eager joy and anticipation. I have been quite impressed with the peace and power women come away with after they attend this weekend. I cannot recommend it enough. Thank you Teresa and Charlotte for all that you do for families.

Anjli Aurora Hinman

Co-Founder/Certified Nurse Midwife at Atlanta Birth Center, Certified Nurse Midwife at Intown Midwifery and Provider/Volunteer at Community Advanced Practice Nurses, Inc.

It was a pleasure being her guide as she increased her BOLDness with our BOLD Women’s Weekend. Thanks Anjli!