Doulas & COVID-19

The last two weeks have been such a whirlwind, taking us from our normal routines to a full shelter-in-place order. With this post, I hope to share information and strategies to support you in the weeks ahead.

Memorial Hospital, St. Joseph’s/Candler, and Winn Army Medical Center hospitals here in the Savannah area are currently only allowing one support person to accompany someone in labor. Unfortunately, this person cannot return to the floor if they leave, and can not switch out with other support people. The Midwife Group & Birth Center is allowing one support person, but includes a doula as a part of the care team in addition to that support person. These policies come from the best intentions of protecting families and their babies, but present challenges of their own.

My greatest concern at this time is postpartum mental health. We know that when we are in times of high stress, our bodies produce more cortisol. When cortisol levels are high, we are more likely to perceive events as traumatic. Birth trauma arises from real or perceived trauma in birth.

So what can we do?

There are a few ways your doula can help support you in your birth experience, even when they cannot be physically present in the delivery room.

1) Prenatal Support

So much of a doula’s work is in the prenatal period, where we help educate and empower our clients about their options in their care during pregnancy and birth. These meetings are used to answer questions, help you decide your birth preferences, learn comfort techniques, process fears, and so much more! The great thing is, these meetings can happen virtually! Your doula is a birth encyclopedia, cheerleader, and listening ear for you. I personally also offer standalone prenatal consultations to provide this support to any pregnant individual, even outside of my service area.

2) Labor Support

Wait, you just said you weren’t able to be in the delivery room? While this may be true, most labor support begins at home! In fact, medical professionals are encouraging families to labor at home as long as possible to reduce your risk of exposure. Doulas are of course experts in labor support, but what many people do not realize is that we can tell how far along someone is in their labor journey based on their emotions, coping strategies, and sounds - meaning that we can help you decide when to head to your birth location.

3) Virtual Support

Once you are at your birth location, your doula can continue to provide support via text, phone, or video chat. We can provide verbal, emotional, and spiritual support, as well as instructing the people who are with you physically in comfort measures to support your labor.

4) Postpartum Support

Similar to prenatal support, your doula is available to answer questions, educate on postpartum life and baby care, provide emotional support, provide encouragement, and referrals to other resources. Your postpartum time can be challenging, especially in this time of uncertainty and social isolation. Your doula can help you build a support network for you and your new family to help you thrive!

BONUS: Childbirth Education

In addition to being a doula, I am also a childbirth educator. I am now offering the same award-winning, evidence-based childbirth education series I teach in person as an online course! The course consists of podcasts, videos, a course journal, and live sessions with me to answer questions and learn comfort measures. Your course also includes access to Prepared Feeding, an infant feeding course taught by an IBCLC (International Board Certified Lactation Consultant). Learn more here.

I hope this post serves to soothe some anxieties, and explains how your doula can still support you in this tumultuous time. If you have any questions or concerns, please do not hesitate to contact me!

For further information, visit:

Evidence Based Birth: Coronavirus COVID-19

Birth Monopoly: COVID-19 and Doula Support

My Doula Bag - Updated

A few years ago, I posted about my doula bag and it’s contents. Things have changed since then, and I wanted to re-write the post to tell you about it. I’m still using my ZUCA bag; it’s compact but has plenty of room for my supplies. The double wheels make it roll easily and quietly, and handle steps and curbs with ease. Also, the top of the bag is a seat, that I’ve found very handy at the side of a hospital bed or sitting behind a laboring person on the birth ball.

I purchased the organizing pouches that fit in the ZUCA to keep things neat and accessible. First up is the largest pouch that sits on the bottom of the bag. This one isn’t too exciting, it’s my personal bag. These items come in handy for long births when I need to freshen up.

Personal Pouch

*Full Change of Clothes

*Brush & hair ties

*Toothbrush, toothpaste, mouthwash

*Wisp toothbrushes

*Deodorant

*Medications

*Saline spray & artificial tears (hospitals are very dry!)

Fairly self explanatory, the next pouch is my Snack Pouch. These are mostly for me, but sometimes are helpful if the family didn’t pack any or labor is moving quickly. This pouch also holds mints and hard candies, to freshen breaths and soothe dry mouths. I also like to have Awake Chocolate for a caffeine boost when I can’t get a cup of coffee or tea.

Now we get to the fun stuff, all the doula tools and tricks! I’ll explain each of these as we go.

Environment Pouch

*Battery operated candles - these are a great way to calm the room, turning down the lights increases melatonin, which has a synergistic effect with oxytocin!

*Washcloths - hospital washcloths are scratchy and sterile white. I bring soft, colorful ones for my clients. These little touches make a big difference!

*Ice bag - if cool cloths aren’t enough, or the laboring person wants cold on their back or hips

*Contact solution & lens case - again, hospitals are very dry and this is an item easily forgotten by clients and their support people

*Honey sticks - I use these to give laboring people or a woozy support person a quick boost.

*Acupressure bands - these are great for points in the wrists, especially P6 for nausea.

Remedies Pouch

*Rescue remedy tincture & pastilles - these are a great way to soothe an anxious laboring person or support people!

*Calm, Focus, and Tummy drops from Calm-A-Mama - I don’t use these often, but I have them for my clients to use at their discretion.

*TENS unit and accessories - this is a great tool for early labor! Read more about it in this post.

*Essential oils, carrier oil, and gauze squares - there are a few oils that are useful for labor when used with discretion. I rarely put them directly on the laboring person, as their sense of smell is very sensitive, and I want to be able to get the smell out of the room if needed. These are in the clear packing pouch and sit on top of the other items in this pouch.

Labor Tools

These are the items I use at nearly every birth I attend, so they reside in the small pouch right on top.

*Unscented lotion - I use Lubriderm since it is so lightweight and non-greasy. and I am not allergic to it. My clients tend to want a lot of massage, counter pressure, and/or acupressure, so this gets used quite frequently! I also have a little tube of magnesium lotion, which is great for leg cramps.

*Tennis balls & massage tools - these help me save my strength when moms want massage or counter pressure for long periods of time.

*Saline spray & artificial tears - another set, this one for my clients! Hospital air is so dry, and dry eyes or noses are annoying in day-to-day life, but even more so in labor!

*New chapstick - dry lips are really common in labor, especially when laboring people are coping with deep breathing or moans and groans.

*New hair ties and clips - a flyaway hair is a nuisance, especially in labor!

*Bendy straws - a doula staple! It’s so important for laboring people to stay hydrated, but it is hard to drink out of a cup in some labor positions.

Whew! We made it through all the pouches! Lastly, I have a few items that ride loose in my doula bag, or in the interior pockets.

*Rebozo - an incredible tool! Rebozos have an amazing history and have been used for centuries to comfort pregnant people and those in labor. If you want to learn more, come to a class! The wooden spoon goes along with this in order to make hip squeezes easier!

*Phone charger - I have to stay in contact with my family, and occasionally other clients. I also use my phone to look techniques or positions up when I’m out of ideas!

*Reference materials - these are great when I want to share a technique with a nurse or support person before trying it, or when I need new ideas.

*Thank you notes - I love to give a little note to great nurses and providers! Personal connections matter, and I’ve made friendships with nurses from this small gesture.

*Business cards - always good to have on hand!

*Lactation keychain - the bead on this keychain represents the stomach of a newborn. It is a great tool to help encourage moms who are concerned about babies’ small, frequent feedings.

That’s it! I hope this blog was helpful to you. I would love to know what your favorite tool or trick in your bag is, so leave a comment below!

Acupressure for Birth

I just completed a wonderful course on acupressure for birth. I learned a few useful acupressure points in my doula training, and have found them helpful in some labors. I jumped at the opportunity to expand my knowledge with this course! I really enjoyed learning more about how my hands can be used to support a laboring client, beyond simple touch and massage.

Using acupressure for nausea on a client in transition. Photo courtesy of Tara Ruby.

First, let’s briefly discuss how acupressure works. Acupressure and acupuncture are age-old therapeutic modalities, originating from ancient China. When using acupressure, we are focused on certain points of the body that correspond to certain conditions. Research shows that using these points stimulates the parasympathetic nervous system. (The autonomous nervous system controls our ‘fight or flight’ responses, while the parasympathetic controls our ‘rest and digest’ functions). We know it is essential for the birthing person to be as relaxed as possible during labor, and the parasympathetic nervous system helps by slowing the heart rate, increasing gland activity, and relaxing sphincter muscles. (Remember, the cervix is a sphincter!) Evan, one of the instructors of the course, summarizes it this way: “acupressure gives us a direct line of influence into the most basic functions of the nervous system’s control over the birthing process.”

I think the most helpful things I learned in this course were how to use acupressure for postpartum and cesarean births. In the postpartum period, we can utilize points for fatigue, uterine recovery, and lactation. When supporting a cesarean birth, we can not bring things with us into the OR, and many of our comfort measures that we use in labor are not appropriate. Using acupressure allows us to help the mother to remain calm and be present during their surgical birth. It can also help alleviate some of the discomforts common to cesareans, such as headache and shortness of breath.

Acupressure is useful for many situations in labor, birth, and postpartum; everything from anxiety and nausea, to bleeding and lactation. For most conditions, there are multiple points that can be stimulated to increase the effects. It is important to be trained in acupressure, as some points can induce labor, and should not be used without permission of one’s care provider. On the other hand, using inappropriate points will not bring about the helpful effects we desire.

Further Reading:

www.acupressureforbirth.net

Acupuncture or Acupressure for Pain Relief during Labor

Acupressure to reduce labor pain: a randomized controlled trial

Acupuncture or acupressure for induction of labor

Standards & Scope

There is no one, single definition of the scope of a doula. Each doula training organization defines these for themselves. These are the standards, scope, and other information from the organizations I have trained and certified with. I am proud to be a part of these organizations, and honored to hold myself (and be held) to these standards.

 

New Beginnings

Statement of Professionalism

Scope and Standards

Code of Ethics

Stillbirthday

Principles of Service

 

Rebozo Workshop with Gena Kirby

I am so happy I finally got to do this training! While I was at Stillbirthday Homecoming, Gena posted on Facebook asking if anyone would want to come to a workshop in Tampa. That's only 4 hours away (the closest she's been to Savannah), and I knew she was taking next year off! So I contacted a colleague and we decided to split the gas and drive time and go!

We learned more than just rebozo techniques, we learned about truly connecting with and loving a woman in labor. I recommend this workshop to anyone working with pregnant and laboring women.

Gena is an amazing, passionate teacher. When explaining what true undisturbed birth is, and what birth can look like, her voice cracked and tears welled up in her eyes. That moment, I knew this was the woman to learn from. This is a woman making a difference in the birth world. This is a woman I can look up to, and want to learn every possible tidbit from.

I had a blast and made some truly amazing friends! I can not wait to use what I have learned with my clients.

Also, Gena's books, Rebozo Me Mommy and How to Sell Your Client a Bridge are incredible and so worth reading! Learn more about Gena, her books, and workshops at: http://genakirby.com/

Male Doulas, Pt. 4

Wow! I really had no idea we'd make it this far. I hope you all are enjoying reading these as much as I am putting them together.

Next is Louis Maltais, student midwife in Montreal, Canada. This post was edited, with permission, as English was not his first language.

-Tell us a little about yourself and your work.

I am a student midwife at the half of my third semester of the program. I study in UQTR (Université du Québec à Trois-Rivières) which is the only university in Quebec thats offers this program. I started to study when I was 27 years old. Before, I was a gymnast-acrobat-dancer and I worked in some companies for different shows. I also did a one year course in massage therapy. After a few experiences with pregnant women, I knew that I wanted to learn more about pregnancy and midwifery.

-What led you to become a birth-worker?

It’s hard in few words to explain all the feelings and the thoughts that led me to want to become a midwife. I really like to work with the limits of the body, with the intensity, with the natural medicine and with the essential things in life like love, health, emotions, birth and death. Since I began working with midwives I love this job more and more.

-What do you like to be called?

In french, which is my first language, we call a man midwife a 'sage-femme' (midwife) or a 'homme sage-femme' (man midwife) and I really appreciate to be called like that. For me I don’t think that it’s necessary to say man in front of midwife, but it doesn't really bother me. But a lot of people think that we call me 'sage-homme' (kind of midman). Sometimes, I say nothing but I often prefer that they call me midwife even though I am a man. I explain them that 'wife' is attribuated to the pregnant woman [not the provider] and people are positively surprised, and usually understand why we don’t have to change the name of this occupation.

-People don't hesitate at the thought of a male OB/GYN, but often scoff at the idea of a male birth-worker. Why do you think that is?

The job of an OB/GYN is very different of a midwife. First, they are specialists with complicated pregnancies, while midwives work with low risk pregnancies. A sepcial part of the job of midwives is to support the physiology of the labour and the delivery. Now, we all know sides that less interventions during a labour increase the chances of the woman to have a physiological delivery, which is the most secure way to give birth. I think that it’s necessary to be comfortable to do nothing but support [the woman] in all the normals steps of a labour including pain and all the difficult emotions. For this reason, socially, we are more comfortable imagining a woman to feel confident with a woman in labour because she has to be very empathic with her. Even if one needs more 'feminine' qualities to be a midwife, I think that men can also be empathic and good supporters with a woman in normal labour. In fact, general practitioners also work with low-risk pregnant women, and some of them practice the midwifery model of care. So I prefer to be compared to a general practitioner who chose to only work with pregnant women. An OB/GYN has to do interventions in front of abnormal factors during a pregnancy, and it’s "less important" in these situations to support women. [An OB's] goal is to keep them alive, and we can thank them because we can save women that a midwife probably couldn’t. In this kind of job, we can easily imagine a man because we know that they can be comfortable when they have something to do.

-Are dads uncomfortable with hiring a male birth-worker? / Do men ever feel insecure about having another man support their wife or girlfriend?

Most of dads are comfortable with a male midwife, but they have different reactions. Some are very surprised, most are open and curious, some are suspicious. Some men of different religions don’t want another man seeing their wife intimately.

-Do you have a hard time finding clients comfortable with a male birth-worker?
In Quebec, midwives only work for public services, so people don’t really choose their midwife, but they can refuse a man, exactly like with doctors. Most of the time, women and men are very enthusiastic to meet me.
-Do you feel that you can offer something different from a female birth-worker?I feel that I can offer something different from a female midwife which means that sometimes it will be easier and sometims harder, and most of the time it will be similar. I also think that being a man show to the women that it’s them, the women, who give births, and not the midwives. In all the ways, everyone will learn from each other. The most important thing that really helps me to learn how to be a good midwife is the openmindness of the women. They are generous, confident and very powerful!
-Do you provide hands on help with breastfeeding?It’s a very important part of the job to help with breastfeeding, so yes I give a hand in that. For the moment, I don't give much advice to the women because I’m still studying, but I feel very comfortable with this part.

Find out more or contact Louis here: maltais_louis@hotmail.com

If you could ask a male doula any question, what would it be?

Male Doulas, Pt. 3

I have to say, my readers are awesome. Thank you all so much for the great feedback.

Next up is Jacob Engelsman, aspiring doula in Athens, Georgia. He is currently the owner of Engelsman's Finest Ferments and Local Cook at Earth Fare - Athens.

-What led you to become a doula?

I believe that everybody has a super power. Some people play music by ear, some are natural cooks, some are really lucky, etc. I call mine baby-magic. I've always been one of those people, even when I had spikes on my jacket and a big pink mohawk, that babies just love.  

About 2006, before I even knew that male doulas were actually a thing, I was living in Asheville, NC. Doulas and midwives are pretty common there, and I've always felt a connection to babies but it seemed to me like being a midwife or doula was somehow "off limits" to men. A lot of research and conversations I had did not dissuade me from this feeling. So the idea was put on the back burner. Then life happened; I met my future wife, ended up moving back and forth across the country 4 times (long story), married her, and helped put her through grad school. Finally, we decided to settle down in Athens, GA, and I got to thinking about what I actually want to do with my life.  

All that bouncing around the country led to a lot of different jobs, but pretty much all of them were food service, with which I have lately been growing weary. I started thinking about what, when I'm older, would I regret never having done with my life. That's how I decided that 2015 will be the year I decide, once and for all, if I really want to be a doula. If I do, fantastic; if I don't, no regrets. I've been reading books and articles, watching documentaries and talking to many people about it. The world definitely seems to have opened up to male doulas in the last 9 years, and now it really seems like a feasible goal.

-What do you like to be called?

I'll just go with, "doula." I'm fairly certain that I hate the word, "dudela" but I have a complex relationship with puns :)

-How does your spouse feel about your work?

My wife, Liz, is very supportive of me in this endeavor. She knows that I've always felt a connection to babies and, since we've decided not to have children ourselves, does everything she can to encourage me.

-People don't hesitate at the thought of a male OB/GYN, but often scoff at the idea of a male doula. Why do you think that is?

I'm sure you could write a whole essay on this question alone, but I think a good short answer is: sexism. Historically, when people think of doctors they think of men and when they think of caregivers, they think of women. While women are breaking down barriers to become doctors and OB/GYNs, fewer men have become professional caregivers.  

-Do you have a hard time finding clients comfortable with a male doula? / How much of the time are you sought after *because* you are male?

Since both of these will be purely conjectural for me, I elected to combine the questions.

I don't foresee a time when there will be so many male doulas that we will be the only option for a woman (or couple.) I imagine that anyone who hires me will do so specifically because of who I am (which may or may not include my gender,) and not despite it. 

-Do you feel that you can offer something different from a female doula?

I have met some women who feel more comfortable with men as opposed to women. I could be helpful with those new mothers. Other than that, any doula offers something different from other doulas. I don't necessarily believe male doulas offer something different from female doulas, on the whole.

You can contact Jacob here: finestferments@gmail.com

If you could ask a male doula any question, what would it be?

Male Doulas, Pt. 2

Wow! The feedback from part one of this series has been AMAZING! Thank you all so much for taking the time to read it.

Next is Ray McAllister, doula and massage therapist in Barrien Springs, Michigan. Something that also sets him apart is he is totally blind.

-Tell us a little about yourself and your work.

On an airplane, the pilot directs the plane, while the flight attendants see to the comfort of the passengers.  The midwife or OBGYN is like the pilot, getting the baby born, but the doula is like the flight attendant.  I see to the comfort of the client and her family.  I do everything from instruction in good labor management skills to massaging the aches and pains of pregnancy, labor, and post-partum existence.  I am a licensed massage therapist, and trained as a “massage doula.”


-What do you like to be called?
Doula. Nothing else. A female president of the USA is not a female president, but the President.

-What led you to become a doula?

Turning 40, no children, totally blind, want to witness the miracle of birth. 


-How does your spouse feel about your work?

Very supportive, getting up at any hour of the night to drive me to the hospital.  She is an aromatherapist, and made a special labor oil blend as well as a pregnancy blend.

 

-People don't hesitate at the thought of a male OB/GYN, but often scoff at the idea of a male doula. Why do you think that is?

Doulas are more of a relational role with the mom, and people don’t think a man can do that. 

 

-Are dads uncomfortable with hiring a male doula? / Do men ever feel insecure about having another man support their wife or girlfriend?

In more conservative areas, dads are more uncomfortable with another male, although I’ve talked with men who would rather the balance of another man in the room.

 

-Do you have a hard time finding clients comfortable with a male doula?

Yes. I’m finding I do best, not in my own area, but reaching out to the less fortunate, those who don’t have much support and are open to any helping hand. 

-Do you feel that you can offer something different from a female doula?
I can offer strength, and the position of a male role model, which for many of the less fortunate single moms out there, it’s important to see how a man is supposed to treat a woman with respect.  I have also resolved small conflicts with boyfriends causing problems in the delivery room by being rude.  I am not certain if another female would have done as well as a “man-to-man” communicator.


-Do you provide hands on help with breastfeeding?

I have given verbal counsel concerning breast feeding which did help a woman increase her milk production. 


Find out more or contact Ray here: https://www.facebook.com/HealingsRaysMassage

If you could ask a male doula any question, what would it be?