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

Jan 26, 2017 by

-To Heal And Protect-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 – but not at the expense of hijacking the learning needs of the larger group. My primary purpose is to teach the skills that lead to doula success, not to lead a counseling group.

When you think about it, people who want this kind of healing have few opportunities to get these needs met. Where else can you go in our culture where you can get this level of understanding and compassion? Where can you get the information to assess what you actually needed at a significant time? It isn’t just emotional support but information and context that is often lacking when people are making sense of their births. An effective birth doula training can offer all of these things.

What we need to understand is that doula trainings are about training doulas – and part of that is teaching them to all the skills that come with compassionate listening, boundary setting, and putting clients at the center of their own decision making processes.  We have to be aware of and responsible for our own emotions at someone else’s birth or postpartum. The participants who need to heal offer trainers the opportunity to model compassion for ourselves. Further, they offer a living example that to be of service to another birthing family, we need to leave our own attachments outside the door.

Lastly, with these participants we are able to confront the thought that we can protect our clients or keep bad things from happening. We are not omnipotent nor are we the decision makers. Human beings, which includes our clients, are also notorious for learning best from making poor choices and living with the consequences. So doulas may find themselves second guessing a client’s choices or being judgmental. Participants who are processing their births may voice negativity about their choices or themselves during that past birth. When this situation arises in a workshop, it gives trainers a ripe opportunity to model kindness and tenderness towards oneself and others, and the personal empowerment that comes from owning one’s past choices.

As birth doula trainers, our job is significantly more complex than it looks on the surface. While we think we are there primarily to teach strategies to prevent labor dystocia, we are really there to help a whole society heal from damaging birth experiences and learn a greater sense of compassion for one another as we stumble through life.

Gilliland, Amy L. (2016) “What Motivates People To Take Doula Trainings?”Journal of Perinatal Education Summer 2016, Vol 25, No. 3, p. 174-183.

This is the third in a series of posts interpreting this journal article.  The first reflects on people who don’t want to be doulas but want birth knowledge, “Take A Doula Training, Change The World.”  The second focuses on “Career Minded Participants In Birth Doula Trainings“.

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Doulaing For Friend’s Births

Feb 25, 2016 by

DoulaingForFriendsIt’s so thrilling to imagine being a doula for your friend’s pregnancy and birth! For some doulas this is what draws them to the work from the beginning. They want to make sure family members and dear ones have the best experience possible and to help make that happen. But underneath these altruistic desires is the reality of what going to our friend’s births really means. Sometimes it’s a harsh learning.

Ever since I started doulaing, I wondered what was different about it. I thrashed the topic over with my fellow trainers and experienced doulas for years, and then I started asking about it in my doula interviews. Eventually I had enough data to analyze (stories to pick apart!) to get to some core truths. Author Julie Brill, in her compilation book, “Round The Circle: Doulas Share Their Experiences” graciously invited me to write my findings for a chapter in her book. Along with 22 other experienced doulas, we offer advice on unexpected home births, surrogacy, encouraging the mother-baby bond, self-care, and supporting religious belief that is not your own, as well as many other topics. But here is a sample of what I learned:

1. Despite your best efforts, you have an agenda. Pregnancy and birth are times of tremendous life change and shifting of identity. When you walk alongside your dear one, you are attached to them. You want things to go well and you will do what it takes to get a positive outcome. Contrast this with your clients. You care about them and want the best, but our role is to support their efforts and not be invested in their choices. You will likely see them a few times after the birth, but your role is to see them through this transitional period. With your friends, you expect to be in their lives and their child’s lives and to see them grow up. This attachment to a particular outcome shifts and changes your support and you can’t get around it.

2. No matter what happens, you will be associated with that birth and its outcome. Forever. Because of your expertise, you may be blamed if something does not go as expected. In order to get distance from the birth, the family may need distance from you. This need may be expressed by the partner or grandparent, not your friend. However they need to honor those feelings. That may mean not being invited to gatherings or even not having casual visits. It’s so easy to blame the doula, which is not a problem when it’s a client. We shrug it off. But when it’s your friend, you want to explain or work it out, but some feelings you can’t work out. They just are. Often it’s a big surprise to the doula when this happens.

If something goes really well, you may be assumed to have “magical powers” that you know you don’t deserve, which can also be disconcerting. What really matters is how closely the laboring person’s labor and birth expectations meet the reality. If expectation and reality are a close fit, then it is usually a positive for your friendship. If they don’t, it can have negative consequences.

3. Your relationship will change and neither of you can control it. Beyond the rollercoaster ride of many friendships, which have ups and downs and varying levels of intensity, birth does not bring out the best in us. It isn’t supposed to. It brings us face to face with who we are – our strength, our weaknesses, our fears, our beliefs about the world and our place in it. When a stranger is with you, you are able to be intimate, understanding that knowledge is held in a special private place and will not have repercussions for your future relationship. When your close friend sees you, they will know you that way forever. That knowledge and intimacy can make some people really uncomfortable afterwards (including you).

You will also see their partners and family members in a new light, which may or may not be a favorable one. As doulas of friends, we have a much greater emotional load to bear. When we care deeply, it’s very difficult to hide our feelings about a partner’s actions or a care provider’s options. We are more transparent. They aren’t used to our doula mask, and they know when we’re upset or hiding resentment. It can be done, but it’s darn hard.

So what’s a doula to do?

First, buy Julie Brill’s book and read the two chapters on attending the births of friends!  (BTW, I get no money from the sale or promotion of this book. I just think it’s a great resource so you should know about it.)

Second, contribute your baby shower, birthday and holiday gift money towards a doula’s fee and encourage other people to do the same thing. Your friend or family member still needs a doula, just not you! Imagine what a fabulous supportive friend you can be: a sounding board for feelings, an extra resource for information, and all without the full burden of responsibility. You get to show your excitement and your disappointment honestly, offering an extra set of hands whenever they’re needed.

Lastly, as an older woman I want you “youngers” to know how precious your friendships are! Having people in your life who knew you from decades ago doesn’t happen without conscious effort and cultivating compassion, caring, and humility in each relationship. As doulas we often have a leg up on those qualities – but sometimes not with our friends. There’s you, and your friend, and your relationship that all need tending – make sure that you’re looking after each one before deciding to be their doula.

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The BFF You Need To Meet: Pelvic Floor Physical Therapists

Jan 20, 2014 by

You’ve never heard of a pelvic floor physical therapist?  You are not alone. Obstetricians and gynecologists are often unaware of the help PFPTs can offer their patients.  As a sexuality and birth professional pelvic PT’s are one of the most important referrals I make.  Women should not have to suffer sexual, urinary, rectal, or pelvic discomfort or pain!  A legacy of shame about our genitals may keep women from discussing postpartum and sexual problems.  When she does seek help, a woman may also be told nothing can be done, it is in her head, or just a part of having a baby.  Because of the easy intimacy of our relationship, clients are likely to discuss pelvic discomfort or pain issues with their birth or postpartum doula.   We are an important link in offering women information about pelvic PT.

When is a referral to a pelvic floor PT a good idea?  If your client mentions she…

Wets her pants when she coughs, laughs, or sneezes

Has to pee every half hour

Has to run to the bathroom frequently or daily

Can’t use a tampon because it hurts

Dreads sexual touching or intercourse because it is no longer enjoyable and is actually painful

Experiences pelvic pain when picking up her baby or with common daily movements

Things “just don’t feel right down there”

Has orthopedic problems with the pelvis/sacrum/lower back/feet have not improved with traditional treatment

While most of us might think that too “loose” or laxity in the pelvic muscles and ligaments is often the problem, too much “tightness” or stability of the muscles is an equal problem.  The muscles and ligaments of the pelvis work together as a dynamic system, which may need treatment postpartum to perform optimally.  When you recommend Kegel exercises to your clients, make sure they are spending equal time deliberately tightening and relaxing their vaginal muscles. 

Pelvic PT’s specialize in maximizing the function and remedying the dysfunction of the muscles, ligaments, and soft tissue areas of the pelvis.  They work with both men and women although the keyword “women’s health” is often used when searching for this specialty.  Common referrals to pelvic PT’s are urinary, fecal and flatus (gas) incontinence, getting up at night often to void, constipation, pelvic pain after childbirth, nerve damage, abdominal muscle separation, internal or external cesarean scar pain, and pain with urination, bowel movements, or sexual intercourse.  Somatic pain (pain with no known physical cause) that may be the result of emotional, sexual or physical trauma can also be successfully treated.  A woman who feels her childbirth was traumatic – even one without obvious physical trauma – may feel somatic pelvic pain.  PPT’s may also specialize in sexual problems such as severe genital or pelvic pain and muscle spasms that prevent sexual pleasure and intercourse.   Anything less than a feeling of wellness and optimal function in these areas may benefit from evaluation and treatment by a qualified pelvic physical therapist.  Even after years with a particular problem, pelvic PT may help.

While we might think that women with lengthy or problematic labors are more likely to have problems postpartum, this would be misleading.  Even women with ideal pregnancies and normal labors may have problems postpartum.  In my practice I make it a point as my two or three month check in to ask about these issues.  “Is everything in your pelvic area back to normal?  Are you peeing and pooping okay?  Other than needing lubricants when breastfeeding, is your body functioning so that you are without pain or discomfort?  If it isn’t, I have some recommendations for you.”   Sometimes I just send a “thinking about you” email or letter with local PT information.  If my client had any complications whatsoever – cesarean delivery, operative delivery, lengthy second stage, posterior presentation, epidural, episiotomy, or 2nd degree or greater tear, I will inquire specifically and directly about pelvic problems.   Every one of my clients who received PPT found out about it through me.

What can a person expect from an evaluation and treatment from a pelvic floor physical therapist?  The PT will take a complete history including any pregnancy issues, birth events and feelings, and past or present sexual, urinary and continence problems.  The PT will likely do an internal pelvic exam when the patient is ready.  This may be at the first visit or several visits later.  Understanding exactly where the pain is, pelvic tone and response to different exercises can help the PT focus on the correct therapy.

PFPT’s utilize a variety of therapies depending on the patient’s issues.  For postpartum patients, therapy may include exercises, recommendations for changes in daily movements, abdominal binders, TENS units, and education about positioning and posture.  If there are issues from an operative delivery (vacuum extraction or forceps), there may be nerve damage.  Manual (hands on) therapy techniques can address myofascial restrictions of the pelvic floor and remodeling of scar tissue.  PT’s also use biofeedback to help clients become more aware of sensations and to develop controlled responses.  For sexual problems, education about optimal sexual functioning and maximizing pleasure and arousal can also be helpful.

As doulas, we are in a place to encourage women to seek high quality and compassionate treatment.  We may need to gently coach clients that they not accept pain or altered circumstances as part of having a child.  This is not normal.  Our reassurance that their condition can be treated by specialists can make a vital difference in the quality of women’s lives for years to come.  We can also learn a lot about the pelvis and birth from PFPT’s.  When you add your local PPT to your referral list, ask them to make a presentation to your local birth group too.

Resources:

Good first stop:  The Pelvic Guru Explains What PPT Is

 Case history example with diet

Pelvic Pain and Rehab on pudendal nerve entrapment

 Managing Pregnancy and Delivery in Women with Sexual Pain Disorders

Physical Therapists As Sexual Health Professionals

Find a Pelvic PT  (choose women’s health even though PPTs work with men too)

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Another Reason Why Birth Is Sacred

Jan 1, 2014 by

Long ago I learned that rescuing people from their own actions is often a trap, one that ensnares us as well as the person we are trying to help.  When it comes to my client’s birth it can be really hard as she makes decisions that are not going to take her in the direction she previously desired.  As a doula I want to grab her and say, “No! Nooo….No!”  The more attached I am to her personally the harder it is…until I shift my thinking.  Once I remind myself to respect the transformation and challenges of pregnancy and birth as a sacred path it becomes much easier to support and serve this mother.

Several decades ago there was a lot of interest in vision quests* and understanding the deeper spiritual nature of existence.  These journeys of challenge and hardship were entered into to discover one’s strengths, weaknesses, inner nature, and relationship to the Divine.  For some groups it also involved the risk of death.  Joseph Campbell wrote extensively about the “hero’s journey” and the meaning and interpretations of this myth in contemporary society.  (Today we have Frodo and Harry Potter.)

Early on in my path as a doula, I saw the potential of birth to hold these same meanings for today’s women.  Women faced these same challenges by gestating, giving birth, and nursing – they didn’t always need a vision quest in the wilderness.  While our culture has not adopted the idea of a ritualized journey, the experience of childbirth still holds this potential for women.

If we appreciate a woman’s birth story as her own personal myth it has the potential to reveal to her deep truth and knowing about herself.  It can be a mirror of who she is.  Within her birth story is how she deals with challenge, how she deals with authority, how she supports herself, what strengths she brings forth that she didn’t know she had.  It reveals her relationship to what is unknowable and undefinable in human existence.  She must give herself over to a process that may be unknown to her that she is not in control of.  How does she respond?  What allies does she call upon?  When the crisis comes, what does she do?  How does she deal with her deep fear as it faces her in the mirror?  How does she experience pain and what does she want to do about it and what does she do about it?  How does this mother see the world?  How does she see her place in it?

To me, every laboring woman I am with is traversing this terrain.  My role is to guide her to finding her own way not to show her which way is right.  There is no way I can know her inner experience or how her history has shaped her to act in these moments.  I don’t need to know – I just need to trust that this journey is unfolding as it should for her.  Women have taught me to trust them to find their own truth.

This doesn’t mean it’s easy.  This doesn’t mean I don’t speak up; it means I trust her to let me know she wants me to.  It means I have developed an automatic questioning in response to my “No! No!”: “Is it about me or about her?”    It means I trust that when she whispers, “I think I want an epidural.”  I whisper back, “Do you want to talk about it some or do you know that’s what you want?”  If she nods “yes”, I get the nurse.  I believe she KNOWS and I do not rob her of that power of choice.  To dither about her birth plan is to diminish her as being able to know what is best for her in that moment.  My service is to trust her unconditionally as the heroine on her own quest.  She will find herself whether she wants to or not.

In my decades of doulaing I have found that many women come back to me and say that their birth taught them so much about themselves.   They learned who they were.  They faced their fears and lived the consequences of their choices.  When a woman has support, true support without an agenda, she finds her voice.  We amplify it so others can hear it too.

Women change their lives based on their births.  They end bad relationships, become fiercer mothers, move across the country, yell at their obstetricians, yell at their midwives, hug and cry with their obstetricians and their midwives, grieve for not knowing.  They grieve for the woman they left behind and embrace the woman they now are.  Who am I to know what is best for that woman in the midst of her birth?  I know nothing!

This acknowledgement of the deep spiritual nature of birth and the risks it contains for crisis and change, keeps me humble.  It also frees me.  I am a chosen companion for the journey, an ally who will respond as needed. Sometimes offering wisdom but always offering patience and calm.  I follow her lead because this is Her Story, the myth she is living and creating with each breath.  I trust Her and I trust my service to her, which is why birth and the path of doulaing when practiced this way is sacred.

 

“It is by going down into the abyss that we recover the treasures of life.  Where you stumble, there lies your treasure.”   -Joseph Campbell

 

* The term “vision quest” has different historical and cultural meanings in Native American or First People cultures.  I’m using a popular culture definition of the term.

 

If you wish to explore these ideas further:

The Women’s Wheel of Life, Elizabeth Davis* and Carol Leonard, Penguin/Arkana, 1996     (*midwife and author of the midwifery textbook, Heart and Hands)

The Wholistic Stages of Labor by Whapio Diane Bartlett    http://www.thematrona.com/apps/blog/the-holistic-stages-of-labor-by-whapio

The Woman Who Runs With The Wolves: Myths and Stories of the Wild Woman Archetype by Clarissa Pinkola Estes, Ballantine Books (1993)

Joseph Campbell and the Power of Myth DVD Documentary, PBS, 1988, 2013

Transformation Through Birth, Claudia Panuthos, Bergin and Garvey, 1984 (still being published!)

Birthing From Within, Pam England, Partera Press, 1998

 

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Doulaing With A Disability

Sep 16, 2013 by

Often becoming a professional doula is an achievable goal.  But for others becoming or continuing as a doula with its physical demands is extremely difficult.  In my thirty years of doing labor support I have met several doulas who were able to maintain their careers.  After thirty years, I have had to make adaptations myself.  As my colleague Cory Silverberg once said, “If you live long enough you will end up with a disability.”  Here are some helpful steps if you receive a diagnosis that will significantly change your abilities.

  1. Feel your feelings.  Anything that is significant enough that you will have to adapt your life around it will bring up a mix of feelings.  Relief, fear, anger, anxiety, sadness, and other emotions are all important.  Take some time to grieve – your body and your life are no longer the same.  It is when you push away your emotions that they control you.
  2. Adjust to the diagnosis.  Will any medications or health care regimens have unknown affects?  Are there any procedures that need to be planned for?  Remember you are a person with an illness or disability, not the disability.   Utilize your doula skills:  seek out resources, confide in those your trust, enlist others in your support circle, and advocate for your own needs.
  3. Be realistic about your circumstances.  How does your condition affect your ability to fulfill the doula’s responsibilities?  How do your changed circumstances affect your client and her labor support experience? How do they affect you?  Examples:  If you have a joint ailment, you may not be able to support a larger mother in her positioning or while walking or dancing.  As a cancer survivor, you may tire more easily.  With multiple sclerosis, you may have a flare that requires a cane or wheelchair.  Perhaps an endocrine condition requires at least five hours of sleep each night.  A benign tremor may mean your pictures are usually out of focus.  As a postpartum doula, arthritis may mean it is unwieldy to pick up a baby.
  4. Brainstorm possible solutions.  You might not be able to pick up the baby, but you’re fine if someone hands you the baby.  Maybe it is time for you to take on an apprentice doula who can do the more physical tasks.  Perhaps attending births together or in overlapping shifts with a doula partner would work for you.  Maybe you just don’t take photos.  When you look at your solutions, which ones would you need to choose and which might be up to your client?  For example, maybe your client would get to choose the second doula from three you like to work with.
  5. Readjust your marketing. You want to emphasize the positive while not misleading potential clients.  On your web site show a photo of you holding a client’s baby at a postpartum visit with your cane on the chair. At the introductory visit, state the adjustments that are required and how you intend to address them.  Focus on what you uniquely offer and don’t apologize for yourself!  Emphasize that prenatal planning affects birth outcomes tremendously and is not affected by your disability.  Maybe instead of three prenatal visits, you offer four.  Maybe you can turn a problem into an opportunity –  offer an incentive for a particular birth photographer which benefits both businesses.  It may be that if you work with an apprentice or a partner, no explanation is needed.  Your potential clients will choose based on your business model and feelings of safety with you.  Depending on what you are asking of clients and how open they are to your solutions, business may stay the same or even pick up.  “Two experienced doulas for the price of one – that’s great!”
  6. What if my business drops off?  Birth and postpartum doula support are market driven businesses and also relationship based businesses.  It may be that potential clients prefer not to make adjustments to work with you.  May be your confidence has declined or your grief over these changes is coming across.  Mothers may decide you are not the best fit because of your disability.  It always feels bad to be rejected  – and this may be your worst fear.  Less or no business may stimulate the grief process all over again – which is entirely appropriate.  In thirty years there have been many times I could not attend births even though I wanted to.  This was due mainly to my life circumstances and needs of my children. But eventually it was due to a health condition.  I swore a lot and then went through the process I have outlined here.
  7. Shifting your doula energy.  Maybe you can’t attend client’s births or postpartums anymore.  Notice I did not say, “can’t be a doula anymore”.  You’ll always be a doula – it is a way of being in the world.  Maybe you’ll open a mentor doula business:  attending a few births with novice doulas, and have monthly educational and support meetings.  There is a huge need for this type of additional education and support for emerging doulas.  Some birth doulas become postpartum doulas.  Some become childbirth educators, birth activists, support group leaders, parenting educators, home visitors, or run doula programs.  Some go back to school and get certificates and degrees that enable them to affect birth in a positive way.  There is still a place for you at the table it just has a different setting.
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