We don’t talk about more than just postpartum

In recent years, women have become empowered to make decisions about the birth of their child. We write birth plans and hire doulas – which of course, I’m more than a little biased in favor of.

As expecting couples, we educate ourselves and prepare for the future as best we can. The lists of recommended strollers and car seats are kept and reviewed. Moms often discuss the six to twelve weeks of maternity leave as if it is a lingering vacation where they can recover and get to know their baby. Spoiler alert: you may be sleep deprived and just recovering and learning how to breastfeed half awake.

And then, the reality of childcare sinks in like a blanket of dread. This particular dread comes with a sticker shock that rivals your wedding venue’s cost.

As women, childcare seems to be the last frontier of taboo topics. The cost, the stress of choosing the perfect place and the realization that you may need to delay having a second child solely based on the financial impact.

Its not “just” financial. The decision is highly emotional and comes with incredible weight. Rarely does a family take dropping a newborn off at a care facility with the levity of dropping off your family pet for the week.

As women, we seem to have put this topic in the same “don’t ask, don’t tell” bin as the feeling of looking down at your sagging belly during the first postpartum shower. Why? Is the conversation taboo because we don’t want to walk the line of the infamous “Mommy Wars?”

Let’s have the discussion.

Childcare is the hardest part of being a parent. Balancing the need to be yourself and have alone time without a baby strapped to you in a trendy carrier, no matter how many good mom points that wins you, is essential to being a happy person. You deserve to be you, solo, alone, with friends, without a baby in your arms and still feel emotionally at peace that your child is safe and content.

This scenario comes at a price. A price of checking your super mom cape at the door and realizing that another human  being has the same goal of keeping your child safe and content while you are away being yourself. It also comes with a hefty financial price as well.

Girls Nights Out are not the only emotional mom guilt causing experience regarding childcare. If they were, well, pass the mojito. It’s your career,  if you have chosen to return to work, or life has chosen for you to return to work, that can cause this guilt. It hurts. It’s hard. It’s scary, but sometimes your a better mom because of it. Sometimes, we may need Xanax and a hug I get through it.

As women, we seem to talk a lot about whether we went natural in childbirth or whether we  breastfed and forget to warn an expecting mom in a gentle way that even though the laws say otherwise, you may not be the same employee after you have had your child as you were before. You definitely won’t be the same six to eight weeks after having your baby, despite what FMLA insists.

Having vacation time for actual vacations  may be a thing of the past. That time will be used for ear infections, check ups, broken bones and hand foot and mouth virus (yep, that’s a thing).

You will be a good employee but, your heart may be somewhere else. Your fear will be that you have chosen subpar childcare. If you happen to be on a tight budget and can’t afford the premiere childcare center, your heart will ache with a feeling of”what if”.

I often said, “the worst part of having children was needing childcare.” I wanted Mary Poppins. I wanted to know my childcare provider would love my child the same way I loved him. In retrospect, I realize that this was a tall order.

I had wonderful care for my kids. I owe my care provider so much respect. I also feel we need as women to talk about it more.

Subsidies could help a single mother find better care and be more focused at work. Paid family leave would mean we could spend more time enjoying healthy kids instead of using all of our leave sitting in the doctors office praying the hacking child next to us won’t mean we need to be home sick in a week. At the end of the day, policies and subsidies may not eliminate the guilt and difficulty of removing a clinging two year old from your leg to head into the office.

Women, don’t be afraid to speak up. Tell your expecting friends to look early and hard for childcare. To expect to go through the stages of grief when leaving their babies for the first time. To also realize that in the journey of motherhood, finding out you are happy being a career woman is just as valid and admirable as finding out you want to be home with your children full time.

And as a final note, no one will ever take care of your child like you do. No one. If they are safe and content, they will appreciate the fact that you, alone, are their mom. And a strong, willful mother who loves and cherishes her child can be an example of a hard working woman too.

Talking about the decisions regarding childcare without judgment  is an important support for a new family. Birth plans are great – new family plans are almost better..

 

 

 

 

 

 

 

 

 

Due Dates: The hidden curse of pregnancy

When are you due? A pregnant woman typically hears this question in almost every conversation when meeting a new person or talking with a stranger.  The due date. The date the careprovider focuses on, your family anxiously awaits and the date you count down to in excitement.

What is a due date? Let’s be honest, it’s a guess. It’s a guess based on the best science we have on how long a human gestational length is for the median of women. Is it an exact science, nope. Is it an exact date, absolutely not. Is it the worst most depressing day when it passes and you are still staring down at your swollen feet over the hump of your overly active baby, most likely.

As doulas, we hear many first time moms who are convinced they are going early. How can I possibly get much bigger? Why wouldn’t I go into labor at 37 weeks, baby is mature then, right? Let’s clear up some myths and then help you avoid the inevitable feeling of, “AAAAAHHH” which happens when the text messages ring in every hour on the hour when you are 40 weeks and 2 days — and still pregnant.

The median length of gestation is 40 weeks. Median. Average. There are many women on both sides of that median, who are perfectly normal and their babies are perfectly safe and comfy inside still. In certain countries, they have now changed the average gestational period and due dates to 41 weeks. Are their babies growing differently or more slowly? No. The care providers are realizing 40 weeks is a guess and 41 weeks may be a better guess.

Doctors guess your due date. It’s an educated guess, but its a guess. You due date is based off of the perfect woman’s 28 day cycle schedule where one ovulates on day 14 and gets pregnant on that day. In reality, this is far from the average scenario that plays out. Many women can attest to having average cycles of 30 days or more and many many women can attest to those swimmers lasting for a few days before finding paydirt in a ready egg to fertilize.

When you are given the due date and the sonogram and the dates don’t match, women tend to choose the earlier date. Choosing the earlier date does not mean your baby will choose it too! Choosing the later date will allow you and your care provider the leeway that you may need in case your baby was actually conceived on the later date. Many unnecessary inductions have been carried out because the due date was up to a week off because women choose the earlier 28 day, perfect scenario date and their care providers don’t seem to feel the need to explain the consequences.

First time moms love to share their due dates with everyone. Why not? They are going to deliver early at 37 weeks, right? So, when the actual average pregnancy length of 40 weeks and 4 days hit, they have been answering the question, “Still Pregnant?” one million times which can be emotionally disturbing and downright depressing. Veteran moms tend to lie a bit about the due date or give the impression that the date could be anytime around the date since practice makes perfect and dealing with the calls once is enough in a lifetime.

Subsequent pregnancies do not mean going “early”. They do mean  your body has been in labor before and you do often get a break in certain parts of labor which are more difficult or longer in first births – but the timeline can often be exactly the same. Don’t bank on going two weeks early the second time either, it may be the same or more than your first in gestational length. Bigger uterus because of a previous pregnancy can sometimes mean more space for a baby to get super comfy.

Bottom line: Due Months are your friends!

When are you due? March. Just March. Not March 2nd, not March 14th, just March.

The other method, April..and surprise them with an “early” baby,

Breastfeeding: Bonding or trapped by your baby?

I’ll admit it. I didn’t enjoy breastfeeding. Gasp! I’m a doula. I’m a naturally minded birth educator that believes a woman’s body is perfectly made for birthing and caring for her baby. I feel strongly against ignoring the natural instinct to snuggle your baby in the name of making a newborn “independent”.  How could I not enjoy the most maternal and primitive thing I can do for my baby: provide food and nurturing.

Well, breastfeeding for me was just plain difficult. I had a colicky 9lb baby who was born hungry and was never satiated. I was blessed with an abundant milk supply which, while wonderful for my ever hungry child, would cause my breasts to feel like balloons filled with rocks. They would leak so strongly that I would soak every shirt I wore even while wearing multiple pads.

i was miserable. I wanted to love it. I wanted to feel maternal. I wanted to bond. I didn’t want to cringe at the thought of having to sit in the rocking chair again for the tenth time in one day.

Then one day, i had a revelation. I didn’t have to love it. Feeding my child didn’t have to be an all encompassing experience of joy. It was food. I was trying my best to give him the best start.  Thats it. I didn’t have to enjoy the leaking porn star boobs. I didn’t have to set a goal of nursing until my little angel self-weaned. I just needed to take it day by day and feed my baby.

I decided I wasn’t going to feel trapped by the rocking chair anymore. I was going to take advantage of the quiet time and do something for myself. I starting reading while I nursed.  I planned vacations, I searched the Internet and stopped counting down the minutes until I could wean without being shamed by the moms group.

To my surprise, I began looking forward to the quiet breaks in my day. My boobs returned somewhat back to normal and so did I. My son grew out of the colic and I made my way out of my postpartum funk. I never had the nursing experience with rainbows and unicorns. I realize now, that is perfectly normal and definitely okay. We found our own way.

Feeding your baby is the most nurturing and parental duty you have as a mother. If it is breastfeeding or bottle feeding, it is still a loving, nurturing act. Be kind to yourself as a new mother. Not everything is rainbows and unicorns.


Continue reading Breastfeeding: Bonding or trapped by your baby?

Water birth Isn’t Always the Birth Pinnacle to Reach



As much as the natural birth community and a million beautifully edited natural childbirth YouTube videos would like to suggest, a water birth is not the “gold medal” of natural childbirth.

Water is an amazing tool for coping with labor. As doulas, we highly recommend spending an inordinate amount of time during early and active labor in the shower, tub or birthing pool. The water and floating helps alleviate the tension and pressure caused by contractions for many moms. An amazing tool for coping has unfortunately been confused with the “best” way to give birth.

Unmedicated and low intervention birth has many benefits to both mom and baby. Having the unexplainable rush of endorphins and oxytocin as you hold your baby for the first time, knowing you have ran the marathon of childbirth and reached the prize at the end, is truly magical.  Somewhere, along the way, we forgot that although low intervention is better, it comes in many different variations and none of them are the most natural. They are all natural childbirth.

I have had more than one doula client insist on staying in the birthing pool, despite obvious signs that they are not comfortable in the water, but feel it’s the most natural birth. It is the goal which they have shared with their friends and have watched touted on the  videos as the most beautiful type of birth. We have traded one type of forced position and setting for birth for another externally driven expectation or culturally forced position for birth.

Your birth should be an empowering experience based on your needs and wants during your labor. What you believe will be comfortable during waves of labor, may not end up what helps you cope through them. Looking inward to find your perfect type of birth is the goal to reach for during labor. Having the strength and support to make informed, empowered and personal decisions about where to birth, how to birth and what tools you use to cope is what makes your birth experience positive.

Empowered birth comes in all shapes and sizes. As doulas, we support women have their best birth – not just the “natural” water birth we have grown to love in the birth community.

Birthing in Annapolis


After seven years of attending births in Baltimore and thirteen years as a Baltimore City resident, I moved to the Annapolis area. I began attending births locally at the medical center and two birth centers which we are blessed to have within 5 miles of downtown Annapolis.

The culture shock of transitioning from City life to suburbia was difficult.  Yes, that is “City” with a capital “C”.  I firmly believe “City Life” is a universal being and can be personified.

As any city person can attest to, a well knowing nod or shoulder shrug whilst muttering the words, “well, that’s the City” will pretty much excuse 99.9% of any shortcomings of civil services in thr 20 miles radius called, “Baltimore”. For some unknown reason the phrase also keeps a person like myself hooked to the beauty of Indian take away and a metal walking cart to schlep home from an urban farmer’s market.

The transition for my family was difficult. I miss the diversity of the “City”.  I miss the vibrant and unique community.

Even though my love for suburbia and a grocery store with a garage and elevator has been growing slowly, my love for the birth centers, local birth community and medical center has been a instant and “love at first birth” experience.

I birthed my babies in Baltimore with an amazing midwifery practice. I was a younger, naive newly pregnant woman and followed a friend’s recommendation to bypass the larger hospitals in the area and make an appointment with one of the only midwifery practices in the area. And a mother, baby and doula was born.

In the Annapolis area, the choices for midwifery care are amazing. The local birth centers offer wonderful respite from beeping monitors, hospital beds, white coats and the all encompassing, hospital smell.

When a client chooses the midwifery  model care, my heart sings a little happy jingle.  I have attended beautiful, informed, and empowered births with Ob/Gyn groups at the medical center. There are a few groups in the area who I absolutely love as OBs, but a dimly lit room, adorned with candles and a mom quietly lifting her baby from the water into her arms – well, my heart sings a little happy song.

So, if the OB births are empowered, informed and beautiful, “Why do you like births at the birth centers? Why the happy jingle?” Honestly, because a laboring woman and a supportive family which doesn’t need intervention, doesn’t need to refuse it. The stress of a birth plan or the need for advocacy for the normalcy of birth is lessened. And I love it. Save the energy for pushing and the marathon of newborn nights instead of using it for mitigating the policy regarding continuous fetal monitoring.

Birth is normal. We are blessed in the suburbs of Washington, D.C. and Baltimore to have two freestanding birth centers offering a model of care which treats pregnancy and birth as normal until proven otherwise.

Is midwifery care for everyone?  No. Can you have an amazing  birth at the hospital with beeping monitors? Of course! An amazing, empowered birth is the one attended by a trusted care provider and supported by your trusted birth team.

I found my transition from the entity that is, “City life” to the quietness of the suburbs was made less stressful by being welcomed into an incredible, evidenced based  birth community.  A community allowing women to birth without the constant beeping sounds of monitors and the comfort of dimly lit rooms and lavender scents – and many times, a comforting tub.

Pregnant in Maryland? Check out the birth centers. Ask yourself, do I want to advocate for the things I truly hope for my labor or do I want to match my hopes and vision to my model of care? Birth is unpredictable and plans change – but policy and protocols rarely change because you have it written on a birth plan.

If you aren’t into birthing out of the hospital, you aren’t alone. I once had a client tell me she would tattoo the word, “epidural” on her chest so if she couldn’t say it, she could point to it.

She had an empowered and informed birth. It was one that matched her vision and was beautiful. The medical center is amazing and with the evidenced base practices in Annapolis, a low intervention birth is more than possible.

So, my point? Even though I readily shrugged my shoulders and excused many shortcomings with the words, “That’s the City”,  the shortcomings of antiquated interventions and protocols should not be excused. No shrugging allowed.

Two beautiful birth centers, one beautifil medical center with many evidenced based providers, just ask questions and be informed.

And as a doula, I would suggest being supported by a birth team that includes a local, experienced and certified birth doula…who may or may not be slowly transitioning into life which includes a drive way out front and a grocery store instead of a farmer’s market.

You may have Dr. Wonderful but Hospital Policy Doesn’t Care

As doulas, we often hear how great and supportive our client’s doctor is during their monthly prenatal doctor appointments. As experienced doulas, we have worked with many of the doctors in the area and usually the one our clients are discussing with us.

Sadly, we know that Dr. Wonderful is saying all of the right things to his patient who is preparing for an unmedicated, low intervention birth, but his words do not match hospital policy. Hospital policy will win out in the end. Whether Dr. Wonderful believes that a ruptured water bag is not a valid reason for bedrest during labor means little when he is not in the hospital when your water breaks. The nurse will inform you that the policy is bedrest and monitoring once your water is broken. It’s not bait and switch, but rather, you were asking the right questions to the wrong people.

Your birthplace is the element of your birth plan equation which holds the majority of the power. Hospitals which hold to antiquated policies regarding monitoring, bedrest and clear fluids/ice only during labor can make or break the natural, low intervention birth plan.

How does a woman avoid finding out about these policies too late to remedy the situation? Ask the right questions to the right people. Go on the hospitals labor and delivery tour early in your pregnancy. Call the labor and delivery floor and ask the charge nurse about their policies. Ask other women who have delivered their babies at your birthplace recently about the “must have” items on your birth plan.

Don’t assume because you have a different doctor than your friend that the hospital will change its policy or routine for you or your doctor.  Every woman wants to believe they are special or have a special bond with their doctor which will trump hospital policy, but sadly, it usually doesn’t.

A positive, empowered birth is different for every woman and family. Determine which requests you have are the most important. Do you want to labor in a tub? Do you want to eat during labor? Do you want to have your baby room in? Match your birthplace to these desires and look for a doctor or midwife who attends at the best fitting birthplace.

Also, if you want to avoid a surgical birth? Check out your birthplace on consumerreports.org. The reports now include hospitals-section rates. Often, hospital policies can lend themselves to a high surgical birth rate.

As always, doulas are wonderful resources for the scoop on local birthplaces and careproviders. We have attended births in nearly every hospital in the Annapolis, Baltimore and DC area. We are know and are prepared for each birthplace. We can also empower you with the knowledge and support to choose a birthplace which matches your birth vision. So, when in doubt, find a doula and ask away! We are professional birth workers who want to see women achieve an empowered birth. Matching your plan to your birthplace is essential.  Let us help!

Modern Doula Care of MD

www.moderndoulacare.com

 

So, how do I interview a doula?

Modern Doula Care

As doulas, we go on a significant amount of interviews. The interviews can take place at a coffee shop, the clients home, our office or even a mall or park. The location may be diverse, but the questions seem to inevitably be the same.  As experienced doulas, we try to give an overview of our services and experience and cover the questions that we know are running though a potential client’s mind. We hope, by the end of our conversation, the client’s neatly typed up questions or ones printed from the internet have been answered in a much more casual and comforting way.

But, what should you be asking that maybe the internet doesn’t even know about? Sure, certification is a good place to start. Number of births attended, although this one is subjective in many ways and doesn’t necessarily indicate whether a doula is skilled or even ‘good’, and finally, the fees.  There are other important, almost deal breaker items that don’t seem to be listed on the pregnancy forums.

The hard questions which should be asked are not about quantity of births, certifications, birthplace experience or even what ‘tools’ are in their birth bag. It can be business practices alone which can be the most important to an expectant couple.

“So, what happens if I labor for a really long time? Over 24 hours? Does your fee change? Do you leave? Do you share shifts like the nurses? is there continuity in care?” 

For many DONA certified doulas, continuous labor support means just that…continuous. Your present for active labor.  As a business owner, we have to manage the long labors and the short labors in our own business plan, but the continuity of care should not be broken because of the need for business profit. We are running a business, but let’s face it, the woman whose labor just hit the 24 hour mark isn’t exactly excited about being the woman who is making you work overtime and, quite frankly, may be the woman who needs doula support more than others.

Some doulas do have clauses to switch out or charge extra after a certain amount of time. Ask this question. Think about the answer. Mull it over. You may be comfortable with the risk and feel like overtime pay is appropriate. You may not. It’s a question that needs to be asked to avoid last minute feelings of resentment.  Let the doulas, who run their own small businesses, handle the details of their profit margin. As the expectant family, be comfortable with your choice of support and budget in any situation that may arise. In our practice, we don’t feel that a woman should be charged for a long labor simply because we need to cover our expenses for being at work longer than expected.  We don’t  believe we handle this issue the only right’ way, but we are comfortable with our business practice.

When do you come to me in labor?

Labor is unique. I have yet to attend two births that are exactly the same in the way labor begins, how a woman reacts, or even how quickly it progresses. As experienced doulas, we can typically tell from the ‘birth song’ of a woman through contractions or the partner’s voice on the phone and description of the laboring mother where they are in the stages of labor. If a doula’s business practice is that they arrive during early labor and stay throughout the birth and after or whether they come to you during active labor (4-5min apart contractions), is an important question to ask and feel comfortable with the answer.  You need to feel supported during your labor. Doulas are, by definition, servants to laboring women. Feel comfortable with the answer.

Can I meet your backup? Do you have backup? What are you plans for my birth window as of now?

Many women ask the question, “how many clients do you take a month?”. While this is an important question to gauge how busy a doula may potentially be, it doesn’t gauge what will happen if, by chance, those 2 or 3 clients go on the same day. Collisions happen. Not often, and in doula collectives or partnerships, they are handled much easier. Whether you take 6 clients a month solo or 2, mother nature sometimes just throws a doula a curveball.  So, as a client, you need to know the game plan. What if it happens? Will I know the doula who walks through the door? Will they have the same pieces of experience or philosophy that you have that I feel comfortable with? Meet the backups. Talk to the backups. Even if a doula has never used a backup, there is always a first time.  And most importantly, ask about your birth window. Even through we try not to, we tend to look at a first time mom and think, well, she will probably go a little overdue since that is extremely common. Do we plan vacations on your due date? Of course not! But, ask a potential doula anyway. They may not have the same business practices.

What Else?

There are many more questions that can be asked. Philosophy, connection, the all important feelings of ‘clicking’, but business practices and the details of the contract you sign will definitely matter when the first contraction strikes. Make sure you understand the way your doula handles her business and the protocol for a laboring woman.  We all do things differently, and that’s the great part of being a doula business owner. Connecting and supporting women with clear cut expectations of our roles in their birth village is an amazing job.  What better way to spend the day than to welcome a new baby earthside……

 

World Doula Week

handsAndKneesBed

This week is “World Doula Week”. In celebration, I have a client a week overdue and was honored to attend a wonderful, textbook labor for another client who was first time mother.
I love being a doula. Being a doula means supporting a woman who is just “d-o-n-e” with pregnancy and understanding from personal experience as well as professional experience the heartache of postdate pregnancy. It is also giving balanced advice regarding the current research about induction without mixing in personal or past client experiences in the conversation.
The role of a doula is many times seen as the woman in the birth pictures leaning behind a laboring mother. Maybe rubbing her back or doing the favorite, “double hip squeeze”,  which is the go-to move for all doulas supporting a client. Being a doula is so much more.
We are birthworkers. Women with experience with local careproviders and birthplaces. We know so much more than the “double hip squeeze”. We know the risks and benefits of induction when you are postdate in a pregnancy. Maybe we even know the risks catered to your personal careprovider, if we have been a doula long enough in the area. We also have a pretty limited scope of practice that we agree to with our certifications. A doula isn’t a medical professional. We aren’t allowed to give medical advice or direction. We can support and guide a woman to make her own decisions, but we have balance our own inner voice. An inner voice which may be shouting, “Stay home!” when a client insists she must go to the hospital upon membrane rupture because her doctor told her that she must. It is almost as though she has seen an episode of ER and believes that once your water breaks, the baby is just two commercial breaks away.
In the doula world, a rift has been building as doulas strategize on ways to validate the role of the doula in the birthplace. As the role of the doula becomes more widely accepted or mainstream, the rift grows amongst doulas on how to represent ourselves and our role and how to run our businesses accordingly. No longer being hired by only rich or crunchy expecting families, doulas are being hired by average expecting couples who want a guide to help navigate the hospital experience. Doulas need to adjust their mindset and professional path to meet this demand and to define our role.

Although some define their value by hourly wage or by the goal of running a small business aimed at higher income clients, there are still doulas who see their role as invaluable  support. The support of a mother and father through their birth experience cannot be quantified by an hourly wage. Doulas need to be fairly compensated. We deserve to support our families with a decent living wage for our professional  services, just as any working professional. The rift is based on the philosophy that this value or living wage is the only reason why we are birthworkers and the only way to be compensated is by money or profit.

For “World Doula Week”, I am wishing for another perfect textbook labor for my postdate mama who is ready to meet her baby. I am hoping for the worth and value of the doula role to become as mainstream as the belief that when your water breaks, you must go to the hospital immediately. I am also hoping for the doula community to come together as one in order to solidify our role as valid members of the birth community.

I am hoping that the rift between doula sisters regarding fair wage and how to run our businesses fades and we realize that we are invaluable to the clients we represent. Our worth as professionals is not defined by our profit margin. Our worth as birthworkers is defined by the incredible work that we have chosen to do as a profession and the gratitude and respect of the families we support.  Whether they pay us well to show their gratitude and respect with money or with karma, as small business owners, it is our choice to balance our budgets however we choose. I hope as we end the week, we can embrace our fellow doulas and their philosophies and decisions just as easily as we hope that hospitals, ob/gyns, nursing staff and the average expecting couple embraces our presence and support that we provide.