All about Birth Doulas

doula artMany of our clients wonder what is the benefit of hiring a doula for a birth center or home birth.  After all, isn’t your midwife a lot like a doula?  Not necessarily.

We love it when our families choose to have a doula and believe it provides many benefits before, during and after birth.  In fact, we believe so wholeheartedly in the benefits of a doula that we have a doula internship program, which links newer doulas with families in our care.

In this post, we’ll explore what a doula is, how she* fits into your birth team, what support she offers, and what he training looks like. In our next post, we will talk about the many benefits of a doula

*While there are some male doulas, most doulas are female and thus the use of “she” here.      

What is a birth doula? 

A birth doula is a trained professional with knowledge of the physiology of birth and the emotional needs of laboring women.  She offers continuous emotional and physical (but not medical) support to mom and her partner throughout labor.

Doula as a unique part of the care team

While a midwife knows and supports a mom and her partner, she is chiefly responsible for the medical and clinical care of mom and baby during labor.  She may offer intermittent support and comfort as well.  A doula will offer continuous emotional support and comfort as soon as early labor, as a woman and her family desires.  Nurses are present to help with the medical and clinical aspects of birth and may not be familiar to the family prior to birth.  A family often knows their doula before labor.  A partner offers emotional support and loves the mom and baby like no one else on the birth team, but does not typically have the knowledge and experience that a doula can offer.

What does a doula do?

doulalaborpushSome of the specific support services a doula provides include:

  • Before birth, she often meets with an expectant family one or more times to get to know them, their wishes, hopes, and fears, and so come to understand how best to serve them in labor.  This also gives the family and doula an opportunity to develop a rapport and build trust.
  • A birth doula works to empower families through education and access to resources before, during and after labor.  She does not speak for a woman or her partner, but helps them make informed decisions and advocate for themselves and their desired birth vision.
  • In labor, a birth doula provides continuous support, meaning they will come to your side during labor when you wish (at home or in the birth center) and stay with you all the way through your labor and delivery and the first few hours postpartum.
  • A doula supports the role of the partner, and does not usurp his role in a woman’s labor; conversely she supports and enriches this bond and this support.
  • A birth doula can help suggest and facilitate physical comfort measures to help a woman cope through labor.
  • She offers emotional support to both the laboring woman and her partner.  She remains calm and objective throughout the birth process.
  • She facilitates communication between members of the birth team (professionals and kin).
  • After the birth, doulas often meet with families, offering breastfeeding and early postpartum support.

What does a doula NOT do?

A doula does not:

  • Provide medical information or clinical advice.  She will not perform clinical or medical tasks such as taking mom’s blood pressure or temperature, monitoring fetal heart rate, performing vaginal exams, etc.
  • Make decisions for a woman or her partner, or interfere with their care
  • Judge a woman or her partner for their wishes and choices in birth
  • Take away from the role of the partner or any other birth team member

What training does a doula have?

doulatrainingBirth doulas have a choice to become certified with a certifying body or not. The most common, though not the only, certifying body is DONA, or Doulas International (formerly Doulas of North America, hence the acronym).  Bear in mind that uncertified doulas may have the same level of experience and qualifications but have chosen, for one reason or another, not to become certified.  For this reason, it is important to ask prospective doulas about their experience.

To become a DONA-certified doula, a person must:

  • Read five selected books on childbirth and breastfeeding and additional materials.
  • Complete childbirth preparation (often a childbirth education series of at least 12 hours)
  • Complete at least 3 hours of breastfeeding training
  • Complete a doula training program of at least 16 hours
  • Attend at least 3 births (evaluated by the laboring woman and her care team)
  • Develop a resource list for clients
  • And more.

How much does a doula cost?

Doula services, which vary based on a doula’s experience, her included services, and other factors, can range anywhere from free to over $1000.  Some doulas have a set fee while others use a sliding scale.

While most insurance coverage does not cover doula services, the benefits of having a doula are so well demonstrated that insurance companies and the state are beginning to consider and adopt coverage for doulas.  It’s always a good idea to ask your insurance carrier if they cover doula care (every request for a service, even if not approved, is documented and is taken into account by the insurance carrier when determining covered services in the future).

Bear in mind that a doula has often completed a rigorous training process, makes herself available on call for a 4 to 5 week period around a woman’s due date, spends anywhere from a few hours to a few days with a laboring family (sometimes paying for childcare and other expenses while away), devotes hours to supporting a family before and after labor, and has professional expenses like any other independent small business professional.

How do I find a doula? 

  • Talk to us!  We have a list of a few doulas we know and recommend. We can also talk to you about our doula interns.
  • Childbirth Collective Parent Topic Night: All About Doulas.  This is a great event held monthly in Saint Paul and Minneapolis where doulas and expectant families gather to meet and talk about doulas. The Collective also has a list of doulas on their website.
  • Blooma.  Many of the yoga teachers and educators at Blooma are also doulas.  This may be a great way to make a connection.
  • Childbirth education classes.  This can be another possible avenue to connect with a doula.
  • Word of Mouth.  Talk to other mamas who have had doulas and find out who they recommend.

Check out our related post on the benefits of having a doula!

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The benefits of a doula

doulaIn our last post, we covered the basics about doulas—what a doula is, what she does, how she fits into the birth team, her training and how to find a doula.  Today, we talk about the many proven benefits of having a doula.

In 2011, an extensive study—the largest systematic review of continuous labor support—demonstrated the effects of having a doula for over 15,000 women who participated in 21 randomized controlled trials.  The study authors concluded from this extensive research that:

Having continuous labor support has clinically significant benefits for women and their babies and no known harm.  All women should have support through labor. 

Other experts have said that if the benefits of a doula could be bottled up in a jar and given to laboring women, it would be a crime not to use such a potent medicine.

Doulas mean better outcomes for mom

The best and most recent studies show that women with continuous labor support have:

  • shorter labors (by about 40 minutes on average)
  • a greater chance at spontaneous vaginal birth
  • fewer interventions, such as cesarean section or vacuum extraction with forceps
  • lower rates of epidural or analgesia to manage pain
  • lower rates of induction (via Pitocin)
  • more positive feelings toward their birth experiences, leading to a cascade of positive effects including
  • lower rates of postpartum depression

Specific studies have found that doulas help increase a laboring woman’s self esteem and actually can decrease her perception of physical pain during childbirth.

If we are just talking continuous labor support, wouldn’t a partner or a friend have the same effect?  Not necessarily.

The effects of continuous labor support are strongest when the person is not a member of the hospital staff or a person in the woman’s social network, and was present solely to provide one-on-one labor support (i.e. a professional doula).  With a doula, specifically, women were:

  • 34% less likely to view their birth experience negatively
  • 31% less likely to use synthetic oxytocin to speed up labor
  • 28% less likely to have a c-section
  • 12% more likely to have spontaneous vaginal birth
  • 9% less likely to use pain medication

Newborn in mother's handsDoulas mean better outcomes for babies

Research also shows improved outcomes for babies when doulas are present for a laboring woman.  These babies have:

  • better APGAR scores at birth
  • shorter hospital stays
  • fewer admissions to special care nurseries
  • have greater early breastfeeding success
  • have more affectionate mothers in the postpartum

In sum, the most important thing is for women to have continuous labor support from someone– a nurse, midwife, partner, or doula. However, with several birth outcomes, doulas have a stronger effect than other types of support persons.

For tips on how to find a doula, please see our post here. 

Interview: Welcome Baby Care’s Carey Lindeman

wbcWe had the pleasure of speaking with Carey Lindeman, founder of Welcome Baby Care to discuss postpartum care and her pioneering postpartum doula service in the Twin Cities.  Many people don’t know what a postpartum doula is or how they can help.  Hopefully, this interview will shed some light on this invaluable and unique type of postpartum support and what amazing doulas, like those at Welcome Baby Care, can offer.

What is a postpartum doula?

While a lot of people have heard what a birth doula is, not everyone has heard of or understands what a postpartum doula is.  Essentially, what a postpartum doula does is come into a family’s home after the birth. Our first priority is taking care of the mother and making sure that she is healing properly and bonding with her baby.  So our goal is to relieve her of the things that would normally be overwhelming her.  Whether that be laundry, changing the sheets, keeping the bathroom clean, cooking, maybe running errands.

So there is that piece and there is also the education piece where we educate on taking care of baby—you know, best practices, what’s normal, what’s not, as well as what is normal and what is not in her own recovery.  So a lot of the questions she may call the doctor about or wonder about, we are able to help with and so help her with the transition into a more confident parent and navigating all of the unknowns.

Having this support can speed up the process of becoming a more confident parent and bonding with your family, staying connected with your husband, all those things you are negotiating during this tremendous transition.

What does a typical doula visit look like? 

ppdoula

It could be two different things depending on whether it’s a day shift or an overnight shift.  A daytime shift is usually a minimum of 4 hours.  When the doula arrives at a family’s home she is going to assess what is going on—she may walk into a sink full of dishes,

piles of unfolded laundry, or mom may need some hands on help with the baby or with breastfeeding).  She is not going to ask, “what can I do” but instead will assess and do what needs to be done.  She may ask things like “Have you had anything to eat today?” to mom.  Usually what a doula will do is prepare snacks for the day for when mom is feeding, she’ll prepare food for later, she’ll clean up, and essentially her goal is to create a very stress-free environment.

And, you know many times a doula is walking into chaos, there may be multiples or other challenging situations.  A doula’s role is to put a “calm” on the situation.

She may be managing other people as well—maybe there are grandmas involved or aunts, cousins—she may have to say to them “This is where you can be most helpful right now.”

 What about if there are older children there, how does that look with a postpartum doula? 

With other children, what a doula will do is find a way to entertain and manage them while mom needs to be breastfeeding or napping or whatever she needs.  But she also finds ways to incorporate the family together.  So it isn’t just a separation of mom from partner and other children.  Sometimes, for example, the doula will make a snack and ask dad or an older child to take it to mom and sit with her.  We are always trying to foster family bonding.

Great, and what about that overnight postpartum doula service you mentioned?

Yes, going back to our overnight care, this looks a little different.  This is a separate service and definitely our most popular.  A typical overnight shift will begin at about 9 or 10 at night. Mom and partner are off to bed immediately and we take over from there.  We are with the baby.  Mom may choose to pump and have us feed the baby or maybe she wants to breastfeed.  In that case, we would console baby for as long as possible, then bring the baby into her, she can breastfeed, and then we will change the baby and put him or her back to bed.  So we are with the baby all night long while the parents sleep.  The doula will stay as long as the family wants them in the morning but a typical shift ends about 6 am or so.  A lot of times we leave when everyone is sleeping.  And mom can get up with baby whenever that is.

What does service typically look like for a new or growing family—how often do people need care, is it different for everybody? 

You know it is different for each family, depending on if there are multiples or not, if it is a first child, etc.  We do have packages offered on our website that give some examples.  And I would say that most people buy one of our packages.  Probably in the next few weeks people will be able to purchase these right from the website (as well as our classes).

twins

What does the training look like for a postpartum doula? 

We have our own postpartum doula training and certification program.  We have an excellent trainer formerly from Fairview and she has developed a certification program.  We felt that a lot of postpartum doulas coming to us as DONA-trained doulas (birth doulas with a piece of postpartum education) had great training but that it didn’t go far enough.  We wanted more extensive training.  So we developed our own specific postpartum training program.

People can go through it and not necessarily work for us, though there is always the option to interview with us, while other people will work independently or just want to learn this information for their own benefit.  We give people a max of 6 months to go through the program and there are 4 components: reading, classroom training, shadowing a doula, and pro bono work for moms in the community that need help.  The details of the classroom training content can be found on our website.

How did Welcome Baby Care come to be? 

One of the unique things about our service is that we also do senior care—so we are kind of a full spectrum in-home care provider.   How Welcome Baby Care started was with this senior business.  When my stepdaughter was having her first baby—and I have raised four children myself—I was there as a grandmother I thought, “I’m really rusty—I don’t really have all the answers to help out.” So what occurred to me at that time was, just like seniors, new moms need support, everybody needs a doula.  And its just one of those things, you know it’s the same type of care, the difference is the type of caregiver.  But it is still that turbulent time in people’s lives where they don’t know what they are getting into.  It’s so new.

So that is when we decided to have these two ends of the care spectrum (we split these into two sister companies).  And that’s how it came about.  Then I discovered that a doula with her expertise, the sixth sense they have…those were the kind of people that I wanted to do this care.  They are just so loving and caring and have such a heart.

Can you tell me more about the doulas you work with? 

The doulas are hand picked and multi-talented.  They all have their own gifts; they are all different in so many ways.  They are all doulas but they all have special additional gifts that they can offer.  So when we are interviewing with families, what’s great is that we have this whole team to pick from, not just one person.  So we can really assess what the family needs and hand pick the doula or doulas that are going to be the best fit.

Another great thing about having a doula team—and all of our doulas are our employees, none of them are contract—is that we have ongoing monthly training. So we may have speakers come in, and there is always a discussion session.  If there is ever something with a family that they maybe have a question or concern about, it’s all confidential, but they also have this team to talk with and get support from.  So they are not trying to figure things out all on their own.  And what’s really important is this ongoing training component.

When they go into a home, we always want that continuity of care.  So when you hire our doulas, you are not going to get someone different every time.  You are going to get the doula or two that are the best fit for you (# of doulas per family depends on # of hours needed).

What other services does Welcome Baby Care offer?

Through in-home care, lactation support, and classes, we offer:

  • Information for bonding techniques for new families (including adoption)
  • Breastfeeding support and counseling
  • Special care for preemies and multiples
  • Expertise in postpartum depression
  • Overnight care
  • Household care
  • Bedrest support
  • In-Home infant CPR

As far as our classes go, we offer a gamut of breastfeeding classes.  We have Breastfeeding 101, which is “the basics”.  The 201 class is not just breastfeeding or bottle feeding but also weaning, starting solids, and those types of things.

We also have a Grandmothers class, which is really popular.  This is where the expectant mom and her mother and/or mother-in-law come to class together.  And they talk about the differences between when grandma had the babies versus now.  A lot of new things that are happening, such as back to sleep and feeding and equipment, and all those things that may be new that grandma may not know about.

Kind of breaking down the barrier of her knowing what is important, and what mom feels is important, because often grandmas play a large role in raising the new child.  So with the help of this class, they are not going into it with preconceived ideas, barriers, and walls and not really discussing it.  And it’s learning on both ends—both the new mom and the grandma.  It’s a combination of education and facilitating communication between the generations.

gma

What if you are not sure during pregnancy whether you want or need a postpartum doula? 

I would suggest pursuing it.  We are here to answer all questions without any strings attached.  And maybe its not even postpartum services she may have questions about.  We also have a separate lactation service so maybe if she is feeling uncomfortable about breastfeeding and has questions, you know she can ask without being locked into in-home services.

I think that it’s worth attending one of our classes. We help provide a postpartum plan.  You know a lot of people make a birth plan, but not always a postpartum plan.  And we help you develop a plan, which covers things you should be aware of postpartum.

And again, consider calling and asking questions or even interviewing someone just in case, because again no strings attached ever.  People don’t always realize the importance of having that care.  You know, in other countries, people have their families and they have people helping them and we just don’t have that in this country.  The lesson is from second world nations that really know how important extended family care is.

What if you are sitting at home one week postpartum and you realize you need some help.  Is it too late to call a doula? 

It’s never too late.  We answer our phone 24/7.  I get calls during the night.  Calls come in when people are in the hospital or are feeling like they need to go back to the hospital.  You know, I got a call from a mom recently, I couldn’t even understand her.  She was so tired and so overwhelmed—it was four in the morning—and I was trying to get information and finally I just asked: “Do you need help right now?”  She asked if we could call her back in the morning at nine.  So we called her back and she was so overwhelmed.  But we were able to help her.

So anytime, we are available for new moms.  We want you to call us.

What advice might you have for pregnant mamas?

No expectations.  I mean, plan, but have an open plan for how the postpartum is going to look.  I think one of the most damaging things about our social world and the media is they put such high expectations on new moms and I think that is a mistake.  To buy into that and listen to too many people ahead of time and have all these expectations and lofty goals is a mistake.

You know, take things a day at a time and realize that, more than anything, you just want to have time for that baby, and give them everything they need.  But don’t have this idea of what its going to look like—like you’re going to lose weight, you’re going to look like this, you are going to have all the perfect equipment and clothes, and everything is going to look perfect and composed, and then buying into what all your friends are saying.

You know make sure you know who your support people are: get the support.  But don’t surround yourself with people who tell you how you need to be—just get that loving non-judgmental support.  And know, too, that we come in with NO judgments—mom can decide and parent the way she feels is right.  You know, we will guide and support but we will not judge.  That’s the biggest thing—you do not want judgment around you because it is just toxic.

What advice do you have for new mamas, who are maybe going through the postpartum period right now?

For them, I would say, the same information applies.  You need the support of other people.  Do not isolate.  Get the support.  Find those people that don’t have expectations for you.  Because you are the parent and you know your baby better than anybody and you need to be the one to make decisions.  You know, 10 or 20 years from now, it is going to be your decisions that matter, not anyone else’s.  So I think you need to really look at your own “mama guts” because you know.  And don’t think you don’t know because you DO know what is best.

And also, there are so many good resources out there, so take advantage of these great resources.

And plenty of rest and relaxation, and try not to put too many expectations on yourself.

You can contact Welcome Baby Care on their website or by calling 952-942-5676. 

 

Birth Story: “the single most amazing experience of my life”

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The birth of baby Norah

By Rebecca Barth

Everyone always says that you’ll know a contraction when you have one, but for the first hour or so I wasn’t sure that I was in labor.  I told my partner, Dylan, to start timing the squeezes to see if there was a pattern.  Sure enough, each squeeze lasted about 40 seconds and they were coming about four or five minutes apart.  Labor!

We called the midwife to let her know what was happening.  She encouraged us to labor at home for as long as possible.  “Call me back in a few hours,” she said.  I took a warm bath and tried to nibble on snacks and drink water.  The contractions were getting more persistent and requiring more focus.  I rolled on an exercise ball for a while, listened to Abbey Road on vinyl, but the thing that helped the most was to hold on to the back of one of our dining room chairs while swaying my hips and gently stepping my feet.  I let my whole spine undulate during contractions while trying to relax as much as possible.

By midnight I was sure that labor had progressed enough to go to the birth center.  The midwife asked to talk to me during a contraction, which was not easy but I could do it.  She confidently said that I was not ready to come in yet and that I should try to labor at home a little longer.  However, I was getting concerned that if we waited too much longer the 20 minute car ride to the birth center would be extremely uncomfortable.  She encouraged me to take another warm bath and meet her at the center in two hours.

Although I had been anxious about the car ride, my contractions actually slowed way down on the drive over.  By the time I waddled into the birthing suit in my jammies and slippers, my contractions were much more manageable than they had been at home. Even so, I was confident that I was at least four or five centimeters dilated.  I had heard so many women say that they too were confident about their progress only to find that they had not dilated at all, but I was certain I was not one of them.

The midwife asked how dilated I had been that afternoon.  “About two,” I replied, “How far am I now?”  The midwife maintained a cool composure and said, “You’re making nice progress and you have some work left ahead of you.”  I laughed, “No really, how far am I?”  She just reiterated that I was doing great and that I should keep up the good work.  I was able to translate her evasive language myself: I was pretty much exactly where I was that afternoon.

My lack of dilation aside I was really proud of myself.  I felt like I was handling my contractions beautifully; I was able to turn inward, tune out the rest of the world, and focus on relaxing and staying open and calm.  I swayed, rocked, and gyrated around the dim room.  I quickly shed all of my clothing and hopped into the glorious tub.  I kneeled in the tub for quite a while as my doula supported me through contractions.  (Dylan had ducked out for a quick nap, knowing that we still had a long night ahead of us.)

Although the contractions were getting intense, I remember being able to quietly talk with my doula during the breaks.  I had known ahead of time that I didn’t want a lot of talking or noise during labor, but in this warm, cozy room with just the two of us, our soft whispers were so comforting.

My midwife came and checked on me periodically.  I was laboring fine and Baby was doing well.  Thus far in labor I had almost exclusively been upright, either standing or kneeling.  Lying down, even being on my hands and knees or draped over something, was not comfortable.

The midwife got concerned that with so many hours of being on my feet I was going to get tired.  She asked me if I felt I could lie down to try and get some rest.  Rest?  Was she kidding?  I humored her and gave it a try, but just as the first contraction set in I jumped up and started my swaying dance.  No way was that going to work.

The contractions got stronger and I became more introspective.  The talking in between contractions stopped.  The nurse and my doula encouraged me to try and eat something.  Food sounded revolting, but I remembered from our birthing class that eating and drinking during labor were important.  I forced myself to swallow a bite of applesauce, and somewhat defiantly shoved the spoon back into the bowl as if to say, “There, I ate.  Are you happy?  Now stop bothering me.”  I remember the nurse chuckling and saying that one bite wasn’t going to cut it.  I think I later stomached a fruit popsicle which seemed to satisfy the masses.

Some time later the midwife was back and strongly suggested that I try to get off my feet for a bit.  I understood why she wanted me to rest–I needed to have enough energy to keep laboring at the birth center and to be able to push later–but I really didn’t think I could do it.  However, I remembered hearing about women who eventually needed to be transferred to a hospital for an epidural and a break because they were exhausted.  The one place I didn’t want to end up was the hospital, so off to the bed I waddled.

The second my contractions started in that bed I started to cry.  I squeezed my eyes tight and started to fight each contraction.  For the first time in my labor I started saying “Ow,” and “I can’t do this.”  I silently cursed at the midwife for making me lay down.  I felt lost.  Then, my wonderful nurse took both of my hands and ordered me to open my eyes.  She looked straight at me and said, in a calm but firm voice, “This is your birth.  You get to decide how you do this.”  I remember feeing like the words could mean anything, but her look said everything.  She was helping me find my way back.  She was telling me to work with my body, not fight against it.  I sniffled, nodded my head, and took a deep breath.

The next contraction came, and I let it.  I breathed, and I let it happen.  And then, I kid you not, I fell asleep.  My contractions slowed down and I remember waking up in a dream-like state for each of them.  I would make sounds, move, or even sit up during a contraction, and then I’d drift back off to sleep.  My partner told me later that he and the doula marveled in disbelief at the sleeping woman in labor.

After I had rested for a time I felt ready to continue laboring.  My contractions were strong and increasingly intense.  The midwife checked my progress again, but she still wouldn’t tell me how much I was dilated.  Seriously?!  I was sure that meant that I hadn’t made much progress and that the midwife felt it would be discouraging to hear how little change had occurred.  She tried to focus on the positive changes (my cervix was thinning, Baby was doing fine), but I “still had some hard work ahead.”

I tried to rally.  I gathered my strength and went on laboring.  By now my contractions were becoming relentless.  There was little and sometimes no break in between contractions.  I stood under the hot spray of water in the shower for what seemed like eternity.  I gripped the support bars with all of my might while I swayed back and forth under the water.

Talking was long gone.  I didn’t talk and everyone around me knew not to talk either.  I started making small, sometimes completely unrecognizable hand gestures to communicate.  I mimicked drinking from a cup when I was thirsty, I shook my head almost imperceptibly when someone asked me a question, and I held up one finger when I wanted people to wait while I was having a contraction.  If someone reached out to touch me during a contraction, up went my finger.  It said, “back off, I’m busy.”  If someone tried to take my vitals and I felt a contraction coming on there was the finger again saying, “hold on a second, don’t touch me.”  My partner and doula deserve so much credit for being able to give me what I needed during this phase.  I wasn’t speaking or letting anyone touch me and yet I still felt completely supported and cared for.

As the contractions got even more intense I found myself dismayed by how relentless the process was becoming.  I couldn’t call for a time out and my body didn’t listen when I wanted a break. I felt like I was a servant to the process.  I kept talking to myself, reminding myself to stay open, visualizing how the contractions squeezed from the top while pulling the cervix open at the bottom, but I started to surrender to the knowledge of my body.  I took solace in knowing that I didn’t actually have to do anything; my body was doing it for me.  I could help or I could hinder, but this baby was coming.

We learned many comfort measures in our birth class, but as I felt my body changing during labor I instinctually found my own comforting rituals.  For a while I had the urge to push against something with my head.  Somehow pushing with the top of my spine helped me free up the bottom of my spine and I was able to sink into more relaxation.  Dylan’s chest was the lucky recipient of my pushing head.  At the start of the contraction I would find Dylan, grab him by the arms and pull him toward me.  I would push him up against a wall and then sink my head into his chest and twist it back and forth as my lower body swayed and swung.

I also started to do more sounding in this phase of labor.  I had the urge to make a lot of “mmm” sounds, but I remembered our birthing instructors words: “open mouth, open sphincter.” I tried my hardest to turn every “mmm” into a “mmmaaah.”  I also started talking to the baby.  During particularly hard contractions I would mumble, “it’s okay, it’s okay…” over and over.  My partner and doula knew I was talking to the baby, but at one point the midwife came in and seemed to be concerned.  “It is okay,” she affirmed.  I wanted to tell her “no, I know that I’m fine, I just want the baby to know he or she is fine.”  This felt like my first real motherly act: the baby was going through this stressful and arduous process with me and I felt responsible to help the baby stay calm and to reassure him or her that everything was going to be okay.  And somehow, putting the needs of the baby before my own made the contractions more bearable.

The hours kept passing and the contractions got overwhelming.  At one point I said, “I don’t know if I can do this any more.”  Even as I said the words I knew they weren’t true.  I knew I could keep going, I just needed some reassurance that everything I was doing–all the movements, moans, and grunts–were normal and okay.  Later I learned that when my doula went to get the midwife and told her what I had said, the midwife simply nodded, stood up, and calmly walked into the birthing suite.  This was just a phase that most women went through.  She crept into the bathroom where I was laboring and said just enough calm, reaffirming words to help me continue.  I was fine; this was what labor was supposed to be like.  It was so much harder than I thought anything could be, but it was normal and that knowledge was comforting.

As my contractions got even stronger and the baby got even lower, I decided to try sitting on the toilet.  I had read that many women found that to be a comfortable place to labor and I was going to take any iota of comfort I could find.  Now, I didn’t just sit on the toilet, I laid on the toilet.  I went as horizontal as one could get while still sitting on a toilet.  My head rested on the wall behind me and my feet were out in front of me as far as they could stretch.  During each contraction I grabbed Dylan’s hand and pulled back as hard as I could having him counter my weight.  (He told me later that his thumb had turned purple but good man that he is, he didn’t complain once.)  The toilet became my labor station for some time.  If there was a contraction, I needed to be on that toilet and in my pulling-on-Dylan position.  At one point in the early morning the midwife suggested that she check me once again.  I tried to get up and walk to the bed but as the next contraction started I literally ran back to the bathroom to have the contraction on the toilet.  It was the fastest I had moved in months.

I tried again to make it to the bed so that the midwife could check on my progress.  I made it just outside the bathroom door before another contraction hit.  I remember grabbing Dylan and pressing my weight into his body while thinking “if there were drugs here, I would take them.”  But then I thought, “If I really want drugs, I’m going to have to put clothes on and get into a car.  No way in hell I’m getting into a car.  I’ll be fine.”  That was the only moment that drugs crossed my mind and I am forever grateful that they weren’t available and that no one offered me any.  I understand why people take them, but I was really committed to a natural birth and I am so thankful to have been a facility that encouraged and supported that choice.

During the most intense hour of labor I remembered another bit of wisdom from our birth educator: “When you feel like you can’t do it anymore, it’s probably the transition phase, and you’re probably almost done.” I told myself that as I got back into bed to get checked a third time.  While I had no sense of time, I could see the sun streaming in through the window.  I smelled coffee brewing.  I had labored through an entire night.  I felt a little surge of power.  I had made it at least twelve hours.  Then my midwife looked down and smiled at me, “Now I’ll tell you your progress: you’re at nine centimeters.”  Nine!  I really was almost done.  That little surge of power turned into a wave, a tsunami of confidence.

I went back to the toilet for the final lap of labor.  I started to feel unbelievable pressure getting lower and lower.  With each contraction I felt more and more like I was sitting on a bowling ball.  I just couldn’t believe that I could labor much more without this kid falling out.  I muttered “I think I might be ready to push.”  The midwives had a shift change in the morning, so the new midwife who had taken over filled the birthing tub.  My doula, my partner, the nurse, and I made a small processional to the tub.  I realized this was really happening.  My dream of having a baby was about to come true.

Suddenly the once quiet, almost empty room was all abuzz.  It was still incredibly calm, but it had a sense of aliveness.  My mother came in and sat quietly in the corner.  The nurses prepared instruments and post-birth equipment.  Dylan slipped away quickly to put on his swim trunks in case I wanted his support in the tub with me.   The midwife helped me into the tub and to get comfortable.  Everyone was in their places ready for the show to begin.

I wasn’t sure that I truly had the urge to push but once the midwife gave me the okay I gave a little test push during my next contraction.  With that little test push my body surged into a strong push.  It was a lot like throwing up in reverse: the second you start to push it just takes over your whole body and you can’t help but push.  I gave a few strong pushes and the midwife told me to reach down to see if I could feel anything. When I did I was astonished to have felt a tiny, quarter-sized bit of soft, squishy, wrinkled baby head.  I remember exhaling, looking up, feeling the sun shine on my face, and smiling.

I gave a few more strong pushes before I felt the baby’s head in the birth canal.  I remembered that once the baby had crowned I should stop pushing to avoid tearing.  As I felt the fullness of my baby’s head, I willed myself to stop pushing.  It felt a little like stopping a race car on a dime–nearly impossible–but I slowed the baby’s progress to a screeching halt.  My position in the tub didn’t allow the midwife to have the best view, so I don’t think she saw quite how far the baby’s head had come.  She told me again to reach down and touch the head.  “I don’t need to,” I gasped, “I feel it.”  In a flash her hands were down under me, supporting me as I gave another push.  I felt the head slide out and then in a wave, the rest of the baby slid out into the water.  Dylan scooped up our baby and handed her to me.  I was so surprised that she was out so quickly!  Wasn’t I supposed to push more?  I thought the baby’s head would come out and then I would have to give several more pushes to deliver the rest of the baby.  All I could muster for intelligent conversation was, “We had a baby!”

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Norah was born at 10:30 in the morning, weighing six pounds, ten ounces, and measuring 18 1/2 inches long.

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After Norah got some vigorous rubs and puffs of air, she started to pink up.  We got out of the tub and delivered the placenta.  Once the cord had stopped pulsing, Dylan clipped the cord.  Our family of three made it to the bed to cuddle.  We tried nursing, but Baby wasn’t super interested yet.  I was so in awe of this beautiful baby that I was completely unaware of the nurse and midwife monitoring Norah closely.

IMG_1297Not long after we got snuggled into bed the midwife told us that Norah wasn’t breathing well enough on her own.  If she didn’t get the hang of it soon, she’d have to go to the hospital.  While I was worried and disappointed at the idea, I remember feeling like “we made it through all of the labor and delivery.  If this is what we need to do, it’s what we need to do.”  The happy post-birth hormones were wonderful.

 Norah did end up being transferred to the hospital.  My partner went with her and spent several hours in the NICU holding her and telling her all about the family she had just joined.  I stayed at the birth center to get cleaned up and to rest.  My pulse rate was really high for hours after the birth so I too was transferred to the hospital.  I had great nurses at the hospital who let me sleep in the baby’s room in the NICU.  One nurse even came to me in the middle of the night to take my vitals so that I wouldn’t have to leave Norah.  I spent the night nursing and cuddling my new, perfect little baby.

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Although I was sad about being transferred to the hospital and especially about missing those several hours with Norah after birth, I’m glad that our midwife did what was best for us.  Neither of us needed any medical intervention aside from monitoring, and we were sent home the next day.  I am forever grateful that we were able to birth the baby at the birth center and not in a hospital, but I am also thankful that we were taken to the hospital when we needed it.  It will always be a somewhat bittersweet ending to our birth story, but luckily it is just the start of our lifetime with Baby Norah.

I am so grateful for the amazing and empowering birth experience we had.  Sometimes when I’m sitting and nursing Norah I start to daydream about her birth, about pushing her out, and about seeing her for the first time.  It is the single most amazing experience of my life so far.  The fact that I birthed a baby makes me feel fierce.  It makes me feel like I can be a good parent, because if I am strong enough to birth a baby, I am strong enough to face anything that life sends my way.