The other thing I don’t know right now is what support you will want from a spouse, partner or friend and what support you will want and need from me. I can tell you a few things. When I am at a birth, there is plenty of work to go around. What you need from each person in the room becomes clear to me as I watch, listen and make adjustments to what is happening. I can also tell you that the same research from the Childbirth Connection website also indicates that women who have professional labor support – a doula – have lower intervention rates -yes, fewer cesareans, less pitocin, lower usage of pain medications. In addition to those benefits, women who labor with a doula are most likely to report having a positive birth experience.

Once I was at a birth that included – among other things – the doing double hip squeeze for about 9 hours. Apparently, I have the knack. (If you don’t know how the double hip squeeze helps during a contraction, ask anyone who has experienced back labor.) During this adventure, the laboring mom needed plenty of other support – juice, cool washcloths, and emotional encouragement – which she received from her husband and her midwife. At a different birth in the same hospital, I=important medical decisions were being made and I helped create a safe place for both parents to experience truly informed consent as they get all their questions answered from the care provider team.

So, what I do for you that perhaps your spouse, friend or sister cannot? So much depends on how your birth unfolds and what your needs are. One important thing I ask my clients to remember – I will be there, I will stay with you for whatever you need – not to rescue you, fix you or save you but to support and empower you during your birth.

There are several important conversations buried in this interview question. The most important thing I want to express that I value all births equally. No matter how your birth unfolds, you are becoming parents and welcoming your child into your arms. You deserve emotional, physical and practical support. I can provide that to you.

The informational support I offer can help you feel in control of your health care decisions. I will use all my resources as a certified childbirth educator and experienced doula to get you the evidenced based information you need to help you determine if a medical induction or cesarean section is in your best interest. Once you have made a decision with your care providers, we can create a plan together that you feel good about. It is okay to acknowledge that this might be your plan B. Even if parts of your plan B might be disappointing to you, we can create a plan that feels safe to you.

You deserve your doula’s best efforts on your behalf for a safe, supported birth no matter how your birth unfolds. If you want to talk more about this topic, call me. I’d love to sit down and talk in person.

This is a question that not everyone asks but it does sometime come up. Occasionally, inquiring families perceive themselves to be extremely private. They might feel that they are only considering inviting a doula into their labor and birth for “practical” reasons – the chance of reduced interventions, the chance to have comfort skills demonstrated to birthing woman and support partner, in case family members giving support need a break, and for knowledgeable decision making support. A doula can also provide emotional support and stability to both a labor woman and her team, but not all families feel certain they will want or need constant support.

One of the most common reasons people who are interviewing me for their second birth tell me they did not hire a doula for their first birth is they wanted to be alone together as a family. Birth can be a very bonding time for families. Everyone is leaning towards the experience with hope and joy.

As an experienced doula, I tell all the families that there are times when privacy might be the very best thing to help a labor progress. This is why time alone in a hot shower does wonders for some moms whose labor has slowed down a bit. Entering the cave-like atmosphere of a dark bathroom can feel like the safest thing for some moms as they get ready to push their baby out.

When I am with a laboring woman, there are times she may ask me to leave her some space. This means different things to different people. It may mean she feels most comfortable with me knitting in the corner while she finds her way to the best position to help her with contractions. She may want me just outside the bathroom door should she need me to wipe her face or move from one spot to another. She might even want an hour or so with only her partner and ask that I take a walk or a short break with my cell phone on hand.

Some families surprise themselves when they discover that their privacy circle widens to include their doula. By the time they are in labor, families have met with me two to three times at least. We have often spent several hours laboring at their home before moving to the more public sphere of the hospital. Their need for privacy is being met by the intimacy developed among us as a team devoted to a healthy, progressing labor and a mom who feels supported.

Since my only plan for your birth is to support you, you cannot hurt my feelings by letting me know what your needs are. I will ask just enough clarifying questions so that I know with certainty how to best serve you. Hopefully what this means to most families is that they can both have high quality labor, professional labor support and the just right amount of privacy for their birth. Rest assured that if you need some extra privacy, I will go enjoy a hot cup of tea and hold you in my thoughts until I re-join you with fresh energy and enthusiasm.

After a post went up from a Babble blogger that shamed mothers who breastfeed without a nursing cover, and piece over at Slate that indicated the simplest way for us to move forward as women in society would be for lactivists to care less and the market to over better nursing covers, I was invited to write a guest post for Annie at PhD in Parenting. I hope you will visit me over there and join our conversation about misogyny, the female body, judgments and the mommy wars.

What is your relationship to my other caregivers? How will you help me make your presence as my doula work for everyone in the room?

Prospective clients ask this question for a few reasons. Some come to a doula interview unsure of exactly what a doula does. Families are usually looking for concrete information about the different roles that are played in a birth setting. Some are unsure if obstetricians allow doulas. Some are wondering if there is a need for a birth doula when there is also a midwife. Others wonder if their partner will feel like an extra in the room.
One of the simplest ways to answer this question is to say that a doula is the only person at your birth who is there just for you, the laboring woman. Every other person in the room has layering responsibilities and experiences during your labor.
Your partner and fellow-parent:
Your partner is there to give you love and support but while also remaining present to the experience of witnessing the birth of their own child. I am happy to share to work and model the tasks of massaging your back, brushing your hair and offering you physical support. There are also ways I am able to help you because of my training and experience that include finding the best positions tow work with your body and techniques for counter pressure to help with back pain – and much, much more. Through all this I can provide quite reassurance to you and your partner that the noises, sensations and discomforts of your labor are normal. For loving partners, concern for their family can easily take over their ability to offer support. With reassurance from a doula, your partner can continue to enter in to your experience and help meet your needs.

Your nurse
Studies have shown that continuous support -the way a doula provides it – from hospital staff personnel can have benefits for laboring moms. There are a few potential problems about counting on a nurse to help you all the way through labor. The first is that your nurse’s primary obligation is to monitor the condition of the laboring mom and her fetus. At times and in some hospital settings, nurses will have the time and opportunity to provide high quality labor support. Many that I have worked with over the years have the experience, skills and passion for this work. However, labors do not follow the shift schedule of a hospital. Change of shift will happen at regular intervals no matter where you are in your labor.
At times your nurse will have to step out because of other patients, will have to update an incoming nurse about your condition, or will have to communicate with an OB or midwife. Your nurse’s job is a very important one because should you or the baby have a change in your condition having access to your history throughout the entire labor is a extremely valuable tool for how you and your medical care provider will decide if any medical intervention needs to be considered.
If you want to read a bit more about the evidence of doula support having an edge of support from a hospital staff or a family member you can find that at the always helpful Childbirth Connection.

Your midwife

Your midwife is highly invested in giving you quality support throughout your labor. If you are birthing in a hospital with a Certfied Nurse Midwife, you midwife will most likely meet you there for your entire labor. She may or may not have other laboring patients at that time but her goal is to help you progress through your birth to delivery feeling safe and supported. Women report a wide range of experiences with their midwives – it is important to know that some quality that may irk one person about a particular provider might be the exact quality someone else appreciates the most in that provider. Some midwives may appear to be more hands on than others with regards to labor support. Some of that is dependent on the standards of care and expectations in your care setting, as well as factors outside our control such as how many women are delivery babies the same day as you, and your CNMs on training and preferences.

One important fact that is often not immediately clear to expectant families is that a Certified Nurse Midwife must record and document your condition, your fetus’ condition and you care because all CNMs in the United States work under a supervising Obstetrician, who is available for surgeries and consults. Of course, you are hoping this will not be necessary for you, as is your midwife but it is her responsibility to make sure that all the information is available to the OB should any situation warrant consulting them. It has been my experience working at many births with CNMs that there is plenty of labor support to be done. The room simply does not feel crowded or chaotic when people are working together in harmony to support a laboring woman.

Your obstetrician

Even with both home birth on the rise and increased awareness about hospital based midwifery, the vast majority of babies born in the Unites States are born under the supervision of an obstetrician. Some obstetricians may have heard of doulas. Others may not have. Some may have reservations about doulas and wondering if adding an extra person in the room is beneficial to the birthing process, Or perhaps they have had little experience with natural childbirth and view it (and doulas) with some suspicion. Others have more varied and positive experiences and may welcome you taking some ownership of your care and hiring a doula. No matter the situation, if you hire a doula, she works for you. Whether you obstetrician is thrilled with her presence or wary, she is still there to meet your needs. Ideally you have a chance early enough in your pregnancy to talk about labor and birth. If you feel your current provider does not have the ability to support you through a safe, healthy,low-intervention birth, you have the right to look around for a new provider. One thing is for sure, obstetricians do not specialize in hands on labor support. Depending on the length of your labor you may see an obstetrician from your practice once or twice during your labor before you are pushing – and in some settings, not at all. For families seeking a low intervention birth a doula becomes a necessity to provide continuous labor support.

All this makes it sounds like I am anti-obstetrician, when I am not. I have worked with many wonderful OBs in the last decade. I have seen some completely changed their minds about the presences and value of a doula, about low intervention birth and even some some wonderful champions for woman-centered birth. I have even had a chance to congratulate new residents on attending their first non-epidural birth, or first birth with a woman not leaning back in the bed. Having meaningful, honest communication with your care provider is the most important thing.

Weaving it all together
As an experienced doula, I weave all these factors together when I come to you in labor. If you could be a fly on the wall at your own birth, you’d see me:
– squeezing over to make a little extra room near you if your partner is holding back
– stepping in close when your midwife has to stepped away for a moment
– listening along with you to something the nurse is suggesting and looking into your face so you know you can voice any concerns or questions you have about that
– showing your partner the exact spot on your hips to squeeze to provide the most benefit to you
– stepping out to refill my water bottle, and yours, and your partners.

You would also hear me:
- Asking you out loud, “Are you comfortable with that? Do you have any questions about what your nurse/midwife/OB just said?” Or “Do you need more time to decide?”
- Thanking your labor nurse by name each time she shuts down the lights, brings us a fresh cold cloth or warm blanket.
- At your request, updating any family you may have waiting for you -or by phone – so you don’t have to be distracted by this task and they can be well assured that you are doing fine.
- Checking in with you to see if your silence means you are feeling safe and calm or alone and needing more support.
- Encouraging your deep vocalizations sounds, letting you know that you have our support and are free to work with your own body to birth your baby.

As your doula, I hold the birthing space for you in tangible ways. I will make sure those lights are dim, that your door is closed, that your music in on if that is you desire. But you also need an emotionally safe space in which to birth. Many women are trained from an early age to be concerned and take responsibility for the emotions of others, the responses others are having to them and the ways that others are getting along. On the day you are birthing your baby, you do not need to take care of everyone in the room. I am there to take care of you and to work harmoniously with your team so that you have the safe space you deserve to have.

It is not uncommon for me to go to a job interview several times in a month. Many people are unsure how to interview some for a job. This is probably because most of us don’t have much opportunity to practice. I often walk people through it because I want to make them comfortable enough to speak their mind. I ask them how they found me, what made them decide to interview me, what they are looking for from a doula. I reflect back what I heard from them – addressing any or concerns they may have.

There are a series of typical questions people ask me – how long I have been a doula, how I became a doula and how many births I attend during a month. Many people ask happens if they are in labor at the same time as another client or if something prevents me from being able to attend their birth. This is a very important question and everyone should ask it.

Yesterday at an interview I was asked the best question I have ever been asked at an interview. It made me think back on nearly a decade of interview questions and consider which ones fostered the best communication between me and potential clients. I highlight them here not because I think I have the best answers but rather because I think these particular questions provide a window into any doulas personality, style and way of working. Open ended style questions give you a chance to find out if you can connect with particular doula. If you believe your communication styles well work together and that the connection is established, then you can grow that into a trusting relationship.

Here are my top 10 doula interview questions:

1. What is your relationship to my other caregivers? How will you help me make your presence as a doula work for everyone in the room?

2. What do we do if we, as a couple, decide we need some privacy during our birth, even from you?

3. How will you support me if my birth for any reason becomes more medical than we hoped? For example, what if I need a plan induction or planned cesarean?

4. What are the things you can do for me that no one else might be able to do, such as my partner, a friend, or family member?

5. How will you respond if I choose to have an epidural or other intervention that doesn’t fit into the “natural childbirth model” way of doing things?

6. What are the most important things you think I should be doing right now to prepare for my birth?

7. After the baby arrives, then what? How long do you stay? What are the ways you are helping us in that time period? Do you just go poof?

8. What is my labor is super, crazy long? How will you help me? How will you have the energy? When is too much, too much? Do you leave?

9. What do you know about postpartum depression?

And my all time favorite question to be asked at an interview,

10. What do you love the best about being a doula? What motivates you and excites you about this work?

I am sure there are hundreds more interesting, insightful, open-ended questions to ask when interviewing a doula. What would you add? What kinds of answers have you heard. Stick around to hear mine in the coming weeks. If you are a doula, share yours in the comment section.

What do we not know about skin to skin contact? Sometimes it seems like just another item to check off on a birth plan. How can we move beyond treating it as a ritual that lasts a bare minimum number of minutes before we start providing “real care” to the newborn. I spent some time at the Partners In Perinatal Health Conference learning more from Debbie M. Norris, a lactation consultant at Newton-Wellesley Hospital. She inspired me re-envision skin to skin contact as the best medical care for newborns and moms.

Skin to skin contact between mother and newborn has almost the same benefits as breastfeeding with none of the effort. Babies are often birthed onto the mother’s abdomen. Sometimes before we move them up to the vertical position between the mother’s breast, we cover them and wrap them with layers and layers of blanket. We take them away sometimes – just for a minute – and then bring them back bundle and ready to nurse. Then the babies are sleepy, and mothers are sleepy. Mothers are also hungry and sore. The first few days of motherhood are all about taking in the experience. Reva Rubin’s research on postpartum emotional adjustment shows us this time is for her meet her own needs, talk about her birth, and care for her body.

Often at the hospital we sit mothers right up in bed. In an effort to support her and the baby, we surround them with pillows and blankets. We want to get their babies as close to them as possible for a good latch. We want to prevent neck and shoulder injury pain. So we prop up more pillows. She sits on her sore perineum. 24 hours later she often complains that breastfeeding is uncomfortable and not going particularly well. Maybe she says, “I don’t know if I can do this.” Already feelings of failure are creeping into this sacred time. We might strip the baby down to the diaper for a few minutes, but visitors come and go. The door opens and shuts. Moms cover up their breasts. It is our system that is failing this nursing pair.

What are we missing? Skin to skin contact provides the newborn with temperature stability. The mother’s chest can cool a hot baby and warm a cool one. (It can even cool one warm one and heat one cold one if you happen to have twins!) This provides the energetic conservation. the newborn needs so he has more energy to feed. Skin to skin contact on the mother’s chest reduces incidences of dropping glucose levels, something that concerns hospital staff when babies are not yet feeding. The mother’s chest is the natural and safe habitat for babies. While the newborn receives this benefits, the mother can lean back and rest. We can take her own weight off her perineum.

Donna Norris, RN, IBCLC, sung her theme song of the benefits of skin to skin contact and helped a room full of nurses, doula, midwives and childbirth educators think creatively about how to teach new mother’s about it. We must stop acting like this is another intervention, another thing to check off our list of birth wishes. We cannot check it off. No one can tell you how long to do it. Your baby benefits for as long as you are establishing this breastfeeding relationship. The first 24 hours are for taking in, taking in your infant, taking in your experience, taking in the emotions.

When I help you breastfeed at the hospital, I will show you how to lean back and place your baby skin to skin on your chest and let him or her find the breast. You will see how your baby bobs his head up and down and latches on in his own time. When your baby’s body is prone on yours, feeling safe and connected to you, you will want to sleep – and you should. Your baby will latch on and nurse, probably in the first 24 hours. Your job is to create and maintain his natural habitat. It is your baby’s job to breastfeed. You should lean back and relax.

Postdate 10

I remember walking to the nurse with a friend. Did the teachers send you by twos at your school? In elementary school, they sent us by twos. Two little girls in navy tunic dresses, tights and matching shoes, asking permission to take the huge elevator down one floor. Friendship meant hearing someone say “May I walk her?” when you asked the teachers permission to go to the nurse?

When I wait with a woman for her labor to begin, I walk with her in my mind. I know I may be called at any moment. I care for my house, my children, saving one little space in my mind to simply wait with her.

I continue to take care of myself, stealthily carrying my phone with me and leaving it on while working out, in the sauna @ the Y, in a ziplock bag poolside while splashing around with the kids. It sits under a blanket during yoga. I meditate and tune in, hoping it only buzzes if someone needs me.

I eat well. I bake in the waiting time and keep reviewing my birth bag – caffeinated tea, minty gum, honey sticks, a clean t-shirt. I wake each morning thinking of how to handle the kids if today is the day. I go to sleep each night wondering if I will be called in the early morning hours.

There is nothing my client needs me to do. I listen. I take her calls. We talk about waiting. We kvetch about toddlers who won’t nap, back pain, and sleepless nights before a newborn is even trying to feed. She talks about some contractions that disappear. I walk with her. We wait.

Fun. Everyone agrees, but what is fun? How do we create fun as educators? I think the answer is engagement. We must engage ourselves with the material and with the community we create in each class. Participatory classes that engage adult learners with more than just a download of information will be fun and attractive.

Every time I have an opportunity to teach a group of adult learners, I ask myself, how can I mold my curriculum to engage not just the intellectual needs but the physical social and emotional needs of these soon to be parents. In short I am always asking, how can I make it more fun?

pregnancy affirmations for the holidays on the March of Dimes, News Moms Needs blog.