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It’s Your Turn to Make Doula History

Posted by on Apr 3, 2017 in Experience, History, Research | 4 comments

Lately I’ve thought a lot about what’s left after someone is gone – and who tells their story. It has made me really think about who is going to write the story of our movement. Traditionally history is written by people after events have happened, after the world has already changed. It’s written by people who have the power to write and disseminate information – which is why so many of our perceptions of history are distorted. What about us? What about our history? Who will write the story of birth and postpartum doulas across North America and the rest of the world? Who will point out the indigenous women who never abandoned each other under the pressures of western medicine? Who will write about the women in the seventies and eighties who said, “I will go with you and I won’t leave you”? Who will write about how we took care of each other when our own families would not support us in breastfeeding or avoiding another cesarean? The battleground of the doula revolution was not on a national stage. It was quiet, in every labor room across the planet, where one woman held another’s hand and said, “You can do this, I believe in you.” We made a stand for another person’s mental and emotional wellbeing in a system that had little room for it. We protected the space. We stood by her side when she said, “No.” We agitated the system with a smile on our faces. We kept doing it, over and over again, for years, until eventually those in power could no longer ignore us or their own research. That’s the big story. But what about the little stories? What about the doulas in Pueblo, and Springfield, and West Bend? How did birth change there because of the presence of those early doulas? All of our communities have little stories. Each weaves a thread into the tapestry of our great big story of doulas changing birth in the world. Where are those stories? Who came before you, person reading my blog? And what was birth like in your town? The time has come for you to seek out retired doulas and nurses and midwives and find out. You see, if we don’t write our own stories, someone else will tell a tale that serves their own purposes. Or they will be forgotten, seen as not being important. Much of women’s daily lives has been unimportant to historians. But doula history is significant. If any one movement will be singled out as creating change in our system of birth, it is going to be birth doulas. Mostly we’ve been like dripping water, slowly eroding rock, getting the system to change. Lots of drips lead to pitting a foundation, causing it to change in response or else collapse. So while we may not be at most births, we don’t have to be. Our impact continues to grow. We aren’t done yet. What is your community’s story of change? Starting in the 1990’s I was the Archivist for Doulas of North America (DONA). Doulas sent me articles from their hometown newspapers. Back then it was a rare occurrence. While we might have wanted to change birth, what we really wanted to do was make sure women didn’t...

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“To Heal and Protect”: Attending Birth Doula Trainings for Personal Reasons

Posted by on Jan 26, 2017 in Philosopy of Doulaing, Research, Self Care | 2 comments

A small but influential group of people attend birth doula trainings not to become doulas, nurses or midwives, nor to positively influence births in other jobs, but to help heal from their own birth experiences (Gilliland, 2016). In any 10 to 12 person training, one or two people are there primarily to make sense of their own births or to make sure their future births are better. Although small in number, their motivations influence the type of discussions that occur in a workshop which makes their presence a significant one. In this study, this group was defined in two ways. When forced to choose their top five reasons for attending a doula training, participants chose “understand my own labor(s) and birth(s) more deeply” or “make my future labor and births better” as one of their top two answers (n = 38; 8.2%). They also ranked professional reasons lower in their top five answers or omitted them. In the general question (“choose all reasons that apply”), members of this group also selected significantly fewer professional reasons for attending or none at all. There was a very clear demarcation between the “professional” attendees and the “personal” ones. However, this was the only difference. When these two groups were compared to one another on the other variables (age, births attended, parity, etc.) there were no significant differences. In addition to this well delineated group, about 20% of all attendees chose “understand my births” as reason to attend. So while it’s a primary motivating factor for 1 out of 10, another two people in that training group also have lingering questions. This is a when my knowledge as a trainer with twenty years experience takes over in interpreting the research results from the study. People who are in a birth doula training to gain healing from their own experience are not primarily invested in learning doula skills in order to use them with another person. They are there to figure out and make sense of their birth. By gaining information about what people need in labor and the components of support, they think they will better understand their own experiences. My hope as a trainer is that these people also develop more compassion for themselves. In exploring this theme with small groups outside of the published JPE research study, there were five repeated themes in our conversations. They viewed a birth doula training as an avenue for healing because they felt: People in the doula training will understand my story. I will be treated with compassion and not dismissed. I will be able to figure out what happened to me and why it happened. I’ll be able to figure out why I feel the way I do. I can keep what happened to me from happening again (to me or to others). People seeking healing from a past birth experience have been a part of birth doula trainings since they started happening. In the 1980’s, I took “introduction to midwifery” workshops as well as ones designed to help you become aware of how your own births and growing up in our culture shaped our attitudes. In my decades as a trainer, I’ve learned how to make sure that people with these needs have opportunities to reflect and make sense of their experience –...

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Career Minded Participants in Birth Doula Trainings

Posted by on Dec 29, 2016 in Experience, Research, Training, Uncategorized | 4 comments

  Its natural to assume everyone in your birth doula training was there to become a doula. Not so! Only about half the people are there because they want to do labor support as birth doulas. What else can my research can tell us about career minded attendees? In my Journal of Perinatal Education article, “What Motivates People To Take Doula Trainings?” (Summer 2016, Vol 25, No. 3, p. 174-183), “become a professional birth doula with my own practice” ranked as the fourth most popular answer out of eighteen possibilities. In the question where people were forced to choose only their favorite five reasons, 60% included “birth doula” but only 30% chose it as their number one reason. Hospital Based Doulas: What about “working for a hospital program”? Only 4% chose it as their top reason, but 20% selected it as one of their top five. Some participants expected to work both independently and for a hospital, as 24% chose both options. Hmmm…there are only a handful of hospital programs that employ doulas or pay them as independent contractors in North America. So this percentage made me wonder if some trainings in my sample were being conducted specifically for a hospital based program. However, these responses were not associated with a specific training, location or doula trainer. Midwifery and Nursing Students: Another significant presence in trainings was participants desiring to become midwives. “Want to become a midwife (or am considering it)” was the number one reason for 20%, and a top five reason for 43% of participants. For the most part, the midwifery and doula bound groups had little overlap. Only about a third of people who put “birth doula” in the top five also chose “midwife”. Midwifery bound attendees are different in other ways too. They tended to be younger, not have children, and only about half had attended a birth (not their own). Interest in midwifery was confined mostly to women in their twenties. It dropped off almost entirely in the 30-39 year olds, with resurgence in the 40-49 year old group (who had all had children and attended a birth). Another contributing factor may be that 64% of all nursing students (n=42) chose “midwifery” as one of their top five reasons, and nursing students in the study tended to be younger and childless. In my experience, midwifery students have always attended doula trainings. But only in the last eight years are many midwifery schools requiring that students take a doula training before being accepted. In this way, the training serves as a screening and preparation tool to ascertain whether people understand the importance of support skills. Nursing Students made up 9% (n=42) of total attendees and were more likely to attend to increase their birth knowledge (72%) and to explore midwifery (71%), as indicated in their top five choices. I found it very interesting that one quarter wanted to be in an atmosphere that “believed in women’s bodies and ability to birth naturally”. For the most part they were not interested in a doula career (only 7%) but many intended to volunteer their labor support services (36% of nursing students). In comparison, “birth doula” bound attendees usually have birthed or adopted children, tend to be more evenly distributed across the age spectrum, with about the same...

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Take a Doula Training, Change the World

Posted by on Nov 9, 2016 in Research, Training | 4 comments

Almost ten years ago I noticed many happy participants at the end of trainings but few people actually went on to become doulas. Being a researcher I decided to do a study, which was recently published as “What Motivates People To Take Birth Doula Trainings?” in the Journal of Perinatal Education, Summer 2016, Vol 25, No. 3. While I can’t repeat what was written for JPE because of copyright restrictions, the blog allows me to explore the findings of this research project in a more intimate way. This first post covers people’s desire for social change by taking open birth doula trainings; part two will focus on professional motivations; and part three will focus on personal reasons. From 1997 to 2007, most people came to my workshops to become doulas. They traveled hundreds of miles and most people set up practices or attended births in some way. Sprinkled in were attendees who’d had difficult births or were from related occupations. By 2008 I was convinced there was something else going on – why did it feel that fewer people were headed down a doula path? So, for three trainings I used my own participants for a pilot study. I had people brainstorm all the reasons why they were there until I stopped reading anything new. There were 18 unique reasons. Dang! Now, I wondered how popular each one was, and if this trend was happening outside Wisconsin. I tested on my own workshops again by making a survey to complete before the workshop began. I did that for a year, refined the survey, and then decided a wider investigation was possible. Next dilemma: Who would volunteer to distribute the survey, and be committed enough to do it correctly? How could I get a diverse enough group in order to generalize any findings? I turned to other DONA International doula trainers, who were willing to implement my persnickety procedures so that everyone was doing the same thing. I am grateful to the many trainers who helped. In the end, the survey was answered by 473 people who took one of 46 DONA birth doula workshops offered by 38 different trainers in 18 U.S. states and 3 Canadian provinces. Data was collected in Oct-Dec or Jan in 2010/11 and 2013. What I suspected all along was true: people were attending for many reasons and career advancement was clearly important to most attendees. But the proportion is what surprised me. No matter which statistic I cite from the study, what emerged is that only about half the people in those trainings were there with the intention of becoming a birth doula with their own independent practice. And only an additional small percentage intended to become a doula in another setting, such as volunteering or working for a hospital or other program. Remember, this is for trainings where registration is open to anyone[i]. I thought it would be about 70%, but here it was at less than 50%. The Survey: First I had people choose ALL their reasons for attending from the list of 18 reasons (ALL). Next, they had to choose their top five reasons and rank them in order. Then I could compare what reasons were popular with ones that remained important. “Becoming a birth doula” only ranked for about half the...

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What U.S. Birth Professionals Need to Understand About ICWA

Posted by on Oct 13, 2016 in Controversial Issues, Policy | 2 comments

The Indian Child Welfare Act – why is that relevant to my practice? The laws concerning children’s rights changed earlier this year. Although standards vary among the 544 tribal nations recognized by the United States government, some tribes consider a person with one drop of Native American blood as a member.  While only slightly over five million people have full or partial Native American heritage, the growth rate within the population is more than double that of other racial groups. At 26.7%, birth rates between 2000 and 2010 were almost triple that of the nation as a whole at 9.7% (U.S. Census, 2012). The average age of a Native American is 29 years old, compared to 37 years for all Americans (U.S. Census, 2012). This means most of the indigenous U.S. population is in their childbearing years – when they are most likely to be utilizing our health care services. Why should we care? Recognition of tribal status is important to the individual, the family, and for the continuation of the tribe. The child may qualify for different social programs because of their heritage, but the most significant impact occurs if they enter a Child Protective Services (CPS) system. Tribal status begins with correct information on the birth certificate. Even misspelling a name can interfere with identification. (The infamous Veronica case went all the way to the Supreme Court in 2013, which was caused in part by an error in spelling the absent father’s name on the birth registration form. Even though he was registered with his tribe, his misspelled name did not show up in a search. So the child was legally adopted by a White family until the father contested.) Since hospital staff are filling out the forms, it is important that parents and their support team ensure that correct names and demographic information appear on the birth certificate. In a recent briefing session, Oklahoma CPS social workers explained, “Even though we have a higher than average population of Native Americans in our state (Oklahoma), nurses still look at the baby to discern race and ethnicity. If the baby looks white or black, they check that off without ever asking the parents.” Parents may also not realize why it is important to categorize their child’s heritage correctly from the very beginning. It is difficult, but not impossible, to get that changed at a later date – but it must be done with a court order by a judge. Doulas can explain to families how ICWA affects their child’s rights, their ability to receive assistance or scholarships, and placement in the welfare system if those services are ever needed. How does a person become recognized as a tribal member? Heritage is not established by clicking a box; the person must be recognized by the tribe. Each tribe has their own standards and they are not the same. After applying, the first step will be genealogical research on the child’s relative, who may or may not be a recognized tribal member. Most tribes keep complex family trees. Some records are online and easily searched, while others have paper records kept in file folders. If the relative is already recognized, establishing heritage may be fairly easy. Why does this status change how a child is treated in protective services?  Native Americans are...

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Hospital Agreements: An Opportunity For Engagement [Part II]

Posted by on Jul 24, 2016 in Controversial Issues, Experience, Hospital Agreements, Philosopy of Doulaing | 0 comments

If a doula agreement is being waved in front of you, congratulations! It means that your doula community has gotten too large to ignore and is having enough of an impact that the hospital wants to exert some control. Now the real work begins, not with clients, but with the institutions where our clients are choosing to birth. You have an opportunity to create a collaborative atmosphere even if their actions seem hostile at the moment. This is politics, system change, and social change happening in your neighborhood, and I hope to give you concrete suggestions to co-create a synergistic relationship – even if it seems impossible now. Keep the focus on your long term goal: an open channel of communication between this hospital and the doula community. Your goal is not to get the hospital to eradicate the agreement but to build understanding and strong reliable communication channels between two groups of people. You are using the proffered agreement as an opportunity for greater connection, understanding and dialogue between the people most affected by it. It’s imperative that the doulas who are approaching this conflict negotiation realize that attacking the hospital’s solution, the agreement, is counterproductive.[1] Anytime you openly criticize something, you make that person defensive about it and more entrenched that they are right. Instead, you have to put the emphasis on the conflict and your mutual interest in resolving it. If you focus on the agreement and what’s ‘wrong’ with it, you will get into a power struggle and doulas will likely lose. If not this issue, how you handle this will set a precedent for communicating about any future conflicts. Sorry to increase the tension, but this is an influential time and needs to be recognized as such. So what can doulas do? First, have a leadership committee of the people who have the best communication skills as well as doula experience. Prepare yourselves. Read simple books on negotiation and conflict resolution (see below), or see what community or internet resources are available for continuing education. Being prepared and having skills will give you more confidence – but don’t wait too long. Contact the people in charge and set up a meeting. Make it clear that your goal is to generate solutions to their problem, and not to deny that a problem exists. Explain your perspective is rooted in concern for the long term health of the hospital’s relationship with its future patients and future doulas, and an ongoing relationship with open communication can work to both of your benefits. Doulas are not going to disappear, and trying to exert power over the doula community without seeking to get to know them will not work in the hospital’s favor. Someone in that problem solving group knows that, but their voice may have been drowned out by others. Doulas, there are allies in that hospital, and you will need to find them. Hopefully, you will also cultivate new ones through your sincerity and focusing on the long term goals. This will be harder to do if the atmosphere is hostile or the agreement is written in a way that delegitimizes a doula’s contributions to maternal-infant health or seeks to restrict the doula’s access to a client. However it isn’t impossible. Remember, they don’t understand our values...

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Hospital Agreements: The Wrong Solution for the Right Problem

Posted by on Jun 27, 2016 in Controversial Issues, Experience | 0 comments

Birth doulas are concerned about hospitals requiring signed agreements in order for them to practice their livelihood on the facility’s grounds. Some agreements outline scope of practice behaviors and even have vaccination requirements. My concern is that these agreements are seen by hospital leaders as an easy solution, without realizing that agreements without prior negotiation lead to greater conflict and tension, thus worsening the situation for their staff rather than alleviating it. They seek to save institutional energy and time, sidestepping the processes of defining the problem well or evaluating other possible solutions. It’s also possible hospital leaders do not understand the doula’s role. A few months ago a very experienced labor and delivery nurse asked me about a doula who “just sat on the couch” most of the birth, only “getting up to help them change positions or go to the bathroom”. Her perspective was that the doula’s role was to tell the mother what to do to make her labor more efficient. This also represents a clash in values. In the hospital system, members have been socialized to believe that their primary value is in doing something. Our emphasis is on presence, a state of being that helps to create a safe space where oxytocin can flourish, the laboring person’s body can open up and use it’s own wisdom to get the baby born. As someone who does frequent workshops and trainings for labor and delivery nurses, I can say that nurses gain their knowledge about birth from different sources; and often they do not know what doulas know. Nurses reading this blog very likely do, but they may not be the people in charge of solving the ‘doula problem’. Doulas read different research literature and have different conclusions. It is risky for doulas to assume that others understand our role or why we place value on physiologic birth[1]. When people don’t understand the doula’s approach to enhancing labor, they misunderstand our actions and motives as well. To me, the agreements and many doula communities’ reaction to them, are representative of a clash in values, misunderstandings about each person’s role, and short sightedness about the long term relationships that need to exist between birth doulas and hospital staff and administrators. Part of my reasoning comes from the hospitals and doula communities who have effectively worked through their conflicts and found solutions that work. Each group took the time to appreciate the other’s contributions, and develop a long term perspective that included a multifaceted communication network. In my next post, I’ll outline their achievements and share strategies to help get to that point in your own community. If an agreement is being proffered by your hospital, this means that you have a sparkling opportunity to engage with administrators to resolve conflicts and outline your working relationship. This is a critical time to define your relationship with one another as it has the potential to influence all future interactions. In a way congratulations are in order – the doulas in your area are being seen as a big enough force that they can no longer be ignored. You’ve got their attention and can use it to create positive change in the system that benefits you, your clients, as well as the hospital. The hospital staff just doesn’t know it...

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Doulas Are Paraprofessionals

Posted by on May 31, 2016 in Research | 0 comments

Encouraging professional behavior by doulas is one of the purposes of this blog, but it needs to be clear that the doula occupation is a paraprofession, not a profession. Community based, hospital employed, and independent practice birth doulas clearly fit dictionary and research interpretations and even the U.S. Department of Labor classification. However postpartum doula work is not such a neat fit. One of the definitions for paraprofessional is that they work alongside of or under the supervision of professionals. While they may work and make decisions independently, there is something about the nature of their work that is connected to the stronger influence of a professional. Profession vs. Paraprofession A profession is any type of work that needs specialized and prolonged training, a particular skill, or a high level of education; often a formal qualification or licensure is required. A defining characteristic of paraprofessional occupations is that training can be achieved with only a high school degree or its equivalent. While some programs may offer an associate’s (two year) degree, this is often done for financial aid reasons, not because it is essential for training purposes. Because there are no impediments to offering services (some people don’t even take a doula training before doing the work), we cannot define doula work as a profession. However, that does not mean that doulaing does not require a high level of specialized skills to perform well, nor does it mean that there are lower standards for professional behavior. In fact, several papers discuss the need for paraprofessionals in the family support services field to develop a professional identity as helpers of families, and to transform who they are and how they serve others as part of a successful training process (Behnke and Hans; Hans and Korfmacher). “Paraprofessionals frequently associate significant personal growth with their training and work experiences. They connect their training to higher self-esteem, greater personal and professional aspirations, and the ability to engage in more effective interpersonal relationships (p.10)…An emerging identity as someone who plays a valuable and valued role helping other individuals seemed to be a central experience of doula training for the women who successfully became doulas.” The women who did not complete this transformation [or become doulas] felt they gained “mostly technical knowledge” but did not feel personally changed by the experience. In fact they expressed “a resistance to change” and seeing themselves in a helping role.” –Behnke and Hans (2002) It also does not mean that the professionals we work alongside of can effectively do our job. This is not to say that the professional person can perform the paraprofessional’s duties.   The paraprofessional has specific skills and attributes that make it possible for the professional to accomplish more complex tasks and responsibilities. Several sources discuss that when paraprofessionals fulfill their role, they boost the effectiveness and relationship between the client and the professional. They are able do their job better because we do ours. I think this is true in the perinatal context for doulas because our core values are good communication, maternal involvement in decision making and maximizing positive memories. Even though the labor and delivery professionals we work with may not have the same values, our presence often contributes to meeting their medical goal of “healthy mom, healthy baby”. Doula Research The defining of doulas...

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Birthrape And The Doula

Posted by on Apr 29, 2016 in Controversial Issues, Experience | 18 comments

“At many births, while I have my hand on a woman’s arm reminding her to breathe, someone has their hand in her vagina digging around, her eyes are wide, she’s trying to get away, screaming STOP… What do I do? What do I say? How do I help make it right? I hate it. I hate it. I hate it. It seems so wrong.” [excerpt from one email among many I’ve received over the years] Dear Doula, I wish I could tell you that these kinds of things only happen to you, that they aren’t worldwide, that people aren’t suffering, that how one is treated during birth doesn’t traumatize a person, and that I don’t have multiple examples of this in my doula interview files. But that wouldn’t be true. I wish I could explain what the medical careprovider is thinking or understand more deeply the processes that lead this person to conclude that what they are doing is right or that it doesn’t matter to the person in the body that they are touching. But that compassion is hard for me to come by. What I can tell you is that the careprovider has somehow forgotten they are treating a person, not just a body. The medical detachment they learned to protect themselves has gone haywire, and so much so that they’ve forgotten that a real person is inside the body, and it is the person, not simply a medical situation they are treating. There is no detachment for the patient – and everything is experienced wholistically, meaning it affects their psyche and their spirit as well as their physical selves. Maybe the medical careprovider never learned this or maybe this knowledge has gotten buried. But our focus needs to be on our client, on the person in the body. We are their amplifier, their voice, their conduit, when others who are caring for them aren’t listening. We are the one reminding that there is a person in the body, and that person has value. So what do you do? Be the voice. State what is happening in clear language. “Dr. X, I hear [client’s name] saying “Stop” and “No”. Do you hear them?” “[Client’s name], do you want Dr. X to stop?” “Dr. X, is this an emergency or can you stop for a moment and let us all catch up with one another?” Christine Morton and Elayne Clift, in their book Birth Ambassadors: Doulas and the Re-Emergence of Woman-Supported Birth in America, discuss the “interactional wedge” when doulas ask physicians to stop doing what they are doing and talk about it. It’s one of the main reasons doulas are often disliked by medical careproviders. (My opinion is this an asset for informed consent, which I discuss here). When we interrupt a physician or midwife, we are vying for power, so it must be very clear that we are doing it on behalf of our clients whose voice is not being heard even though they are expressing themselves. If the medical careprovider does not stop, appeal to the nurse. “Nurse Y, I hear [client’s name] saying “stop” and “no”. Do you hear her too?” “[Client’s name], do you want Nurse Y to ask Dr. X to stop?” “Nurse Y, if this is an emergency, can you explain...

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The Time To Ask About Past Abuse or Assault is Never

Posted by on Apr 6, 2016 in Controversial Issues, Experience, Philosopy of Doulaing | 8 comments

One of the most upsetting questions I have read on a doula’s personal history form is some version of this: “Have you ever experienced sexual abuse or assault, either as a child or as an adult?” While I realize the doula is trying to be helpful, the attempt is misguided at best, and can actually create problems and stresses for the client that negatively affect the doula-client relationship. What the doula really wants to know is whether there are ways to help the client more effectively, even if what the client wants may seem odd or unusual. There are better ways to obtain that information that don’t create more problems. Asking the question automatically puts your client in a bind. They have to choose whether to be honest with you before they are ready to do so, or whether to lie. The issue with most survivors of abuse or assault is that the perpetrator took away their power of choice. Their body was not their own, it was the property of the perpetrator. The victim’s only choice was to submit or possibly face worse harm if they resisted. Part of offering healing is for us to allow self-disclosure if it is desired, and when the client initiates it. When we ask the question, it is to meet our own needs even though it is in the guise of good intentions. If our client does not wish to discuss these acts or even for us to know, their only other option is to lie. This dilemma is distressing for our client, which is not the doula’s intention. So don’t ask. The truth is, what you really want to know is how you can help them more through their birth or postpartum journey. There are ways to get at that information without knowing exactly why. In fact, knowing details about the story is not necessary to offering effective support. Here’s what you really want to know, and I suggest you say something like this on your last prenatal visit (after establishing rapport): Sometimes people have had life experiences that left them traumatized and that they had to recover from. Sometimes that involves assault or abuse, or even being in a car accident. There may be things that other people do or say that lead you to being instantly scared or startled or remind you of that original traumatizing experience. I just want you to know that I can help you best when I can help myself and others to avoid those behaviors, and what to do if they happen. You can also offer examples: Sometimes a person is easily startled and doesn’t want to be touched from behind without being asked first and waiting for a response. Another person didn’t want to be in the bathroom alone with the door closed. The door had to be open or someone needed to be with them. Another didn’t want people talking about her as if she wasn’t there. She insisted that they use her name and not call her ‘dear’ or ‘honey’ or ‘mom’. Another was concerned that breastfeeding would bring up negative associations with a past experience involving their breasts. This person needed assistance in being anchored in the present whenever the baby nursed in those first few weeks. Others don’t care...

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