Journey to Becoming a Midwife

I’m on the path to becoming a midwife and consider myself still very much an apprentice. The first birth I ever attended was my nephew’s when I was 16 years old. My sister had a long, difficult birth that involved a cascade of interventions that she had not at all understood. My nephew was delivered with a shoulder dystocia that resulted in a serious birth injury from which he still suffers today. This is not when I felt the call to midwifery. Instead it left me terrified of birth. 

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A decade and a half later I attended a prenatal yoga teacher training and it was there that I learned about the physiology and importance of birth and just how different an experience it can be. For years I worked as a crisis hotline volunteer for our local sexual assault resource agency and at the time I was taking psychology courses at UVA with a view to pursuing a graduate degree in psychology. In that prenatal yoga training it became clear to me that the confluence of my interests were calling me to midwifery and that my passion for counseling would continue to blossom on this new path.  

As I was seeking the right route and program for me, I learned about a school in West Virginia and considered moving there to study. By some turn of fate and good fortune, within months of my seeking it out,  the school’s founder happened to move to Charlottesville and started a school in 2014. I was among the first cohort of students. That same year I met my doula partners in that setting, joined Bright Birthing and continued to learn from and assist at out-of-hospital births.

Much of what I’ve said so far has more to do with my journey than my reasons for why I am a rising midwife. I want to be a midwife because birth is on a continuum with sexuality and I believe that a woman’s sexual experiences are sacred and matter deeply to her sense of self and to her well-being. As a result of my own personal sexual experiences in life and my education, I have come to care strongly about sexuality, respect and consent. There is a lot of mystery in birth and a lot at stake. Women are both at their most vulnerable and most powerful during the transformational passage into new motherhood. I consider it the highest privilege and honor to learn the art of how to listen, how to respectfully inform, and how to help a woman safely navigate that mystery.



Locals we love: Dianne Bearinger

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Each time I adjusted to the transformation of becoming a mother to a new little person I was so lucky to have the support of the great teacher, spiritual guide and postpartum doula Dianne Bearinger. This weekend will wrap up my fourth trimester and we had our final postpartum doula visit with Dianne last week so this feels like the right time to compose a more formal message of gratitude and endorsement than the little note card I jotted for her personally.

Dianne holds circles for women exploring crucial and deep questions through storytelling. She reflects and writes as introspective practices. She tutors children and leads parents to trust their own instincts through not only postpartum doula support but also parent-child classes that bridge from babyhood through toddlerhood into childhood.

It certainly put my partner’s mind at ease knowing that we had Dianne’s visits in the weeks when he first went back to work after each baby’s birth. In the past couple of months she was with us two mornings a week and on those days (at least) my partner knew he could be at the office on time as she helped out so he could escape!

Since Dianne was our postpartum doula after my eldest was born they’ve had a really beautiful relationship - I am not sure whether my daughter would put it this way, but I think of Dianne sort of like a fairy godmother. When Matilde was a newborn Dianne set me up with wonderful arrangements of pillows to literally hold me up while I figured out nursing with my tiny mighty baby. This time around often when Dianne came she spent one-on-one time with Matilde so I could focus on our new baby. Together with my daughter, Dianne baked bread, folded and put away laundry, took care of all our dishes, kept our fridge in tidy order and always left me feeling more confident than when she’d arrived.

Locals we love: midwife Debbie Wong

One of my first friends in Charlottesville, a professional mentor, a remarkable craftsperson, adventurer, scientist, world traveler and exemplary midwife: Debbie Wong (of Nine Moons Midwifery) supported me in personal transformation, healing and creating my family.

If that sounds heroic it's because that's how I think of Debbie. She keeps a notable poker face when it's serving to do so, and when I ask for advice she offers it with love and no bullshit. My partner said a while ago, "I really like how Debbie can tell you things I wish I could but with her you never get defensive." For me she was the perfect care provider, holding space for my fears to surface and then sublimate.

Debbie has a tastefully appointed, sunny office that's a pleasure to visit, and she makes some client visits at home. My daughter was excited every time we saw Debbie for care during my second pregnancy and she was sweetly integrated into the team listening to the baby's heart, measuring my fundal height and massaging my belly. It felt like such a perfect circle to watch my nearly three year old help Debbie with the newborn exam after my son was born at home.

A tremendous gift Debbie offers to childbearing people in Charlottesville is meeting us where we are. She consults with other practitioners in town who may be simultaneously caring for clients; she works as a birth and postpartum doula in addition to her home birth midwifery practice. Debbie teams with wonderful assistants and collaborates seamlessly. In our case what that looked like was a planned home birth with our first, a transfer to UVA for the birth, which she attended; then, all of our care through my second pregnancy including home birth and first rate postpartum care for the baby and me. I trust Debbie deeply and will live my life in gratitude for the encouragement and authentic empowerment she instilled in my process of becoming a mother.



Locals we love: photographer and doula Zoe Krylova

I met Zoe at a housewarming potluck with a bonfire soon after we moved from the Bay Area, where she'd also once lived. As I settled into Charlottesville and the birth community here I got to know Zoe as a poet, a mother who shares her stories openly and richly, an artist, and someone whose presence always shines golden light. It was an honor to have her with us for both Matilde's and Gideon's births and after she visited us this week I just had to break my blog hiatus to share some praise.

Zoe Krylova (Windflower Doula) was quite literally the doula of my dreams. When I was pregnant with my first child I got up the nerve to let her know that I’d thought for years about her as my ideal doula and it was a pleasure to go through the other side of the doula-client relationship (prenatal appointments getting to know one another on a deeper level; practicing birth support positions with my partner guided by Zoe; checking in when things were difficult along the way) with someone I had long admired. She was with us for the epic weekend when my daughter was born and she took photos we will always treasure.

In March I had my second baby and I sent a message to Zoe in the middle of the night, after my labor had begun. This time she was going to join us to take photos in a less formal role than that of doula, and I knew the time commitment would be significantly less since honestly I’d been reading about unassisted birth and wanted to wait until pretty well into labor before having even our midwife join us. Zoe saw my message when she woke up in the morning, called my partner and zoomed to our place as I was pushing. When she came into the room I absolutely lit up - her energy is warm, balancing, peaceful, confident and so strong. She set up her tripod and took incredible photos. I could not more highly recommend her as a doula and/or photographer!

Postpartum Support

In the weeks after my baby was born, I was floored by just how debilitated I felt physically, but also by how beautifully supported my family was by the community around us. Lucky for us I had been working in the birth world for six years already at that point and among our friends there are lots of doulas. Knowing that washers and dryers were three floors below in our apartment building, one friend picked up dirty laundry and brought it back clean and folded. We had a steady stream of meals prepared with care. Brand new babies bring a whirlwind of upended rhythms and exploded expectations and so the adults who care for them need all the TLC they can get.

...newborns are ever so sweet but equally exhausting!

...newborns are ever so sweet but equally exhausting!

With that in mind, the Bright Birthing team is excited to expand our support in the postpartum weeks and months. This spring Sara and I attended a postpartum doula training with Cynthia Jordan Fisher and Dianne Bearinger of Month 10 and Nearby Baby. We’re now offering postpartum support hours as an add-on to our normal birth packages or a la carte to families that don’t necessarily hire us as birth doulas.

Our training was informed by the Montessori and Waldorf backgrounds of the two great teachers, as well as the excellent resources they gathered and the expertise of lactation consultant Valerie Goodman, who came to speak about early breastfeeding support. Postpartum doula work can include listening to and validating a birth experience, doing laundry and preparing meals, tending to older children or pets, coordinating meal trains and delegating tasks to family, friends and visitors, supporting baby’s first bath, and almost always making referrals within the community for activities, care providers and/or groups that can further be of benefit to anyone with a newborn. If you or anyone you know may need a postpartum doula, please be in touch!

Kids & Nature Festival

We had such a fabulous morning at the Kids & Nature Festival! Ix Art Park is one of our favorite places in Charlottesville and this event brought out so many Bright Birthing families, such fun activities, wonderful puddles for jumping and splashing and it was a fundraiser for our friends at Little Planets, with plans to build a permanent structure at Ix including a yurt, mud kitchen and so much more. 

Rain or shine we love this community so much!

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Fourth Annual Truck Touch

We had so much fun at the bubble station collaboration between Bright Birthing and Debbie Wong of Nine Moons Midwifery!  We're excited to add this bubble machine to our event tool kit - watch for it next at our Yoga Picnic on May 12 and then at the Kids & Nature Festival on June 3. 

Spring!

There will be no village circle this month as we gear up for our annual May Yoga Picnic (date TBD). Below is a scene from two years ago - our practice that day, led by Sara, was designed for pregnant and postpartum participants and the weather was perfect! 

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What Doulas Don't Do (and why doing the DON'Ts made me a better doula)

What's the T on what doulas DON'T do?

What's the T on what doulas DON'T do?

One of the most meaningful ways that I can show respect to my clients and ensure that I maintain a reputation of professionalism and safety is to adhere to a very clear SCOPE OF PRACTICE.  I love this work!  I am so excited to further my training as a midwife and continue caring for birthing people!  As a doula and future midwife, I find that it is important for me to be very clear about how I function differently in these two roles.

In preparation to write this blog post, I have realized that I find myself in very few conversations about scope of practice.  We talk about the things we DO as doulas during our interviews.  Surprisingly few people ever ask about what we DON’T DO!  It seldom comes up in discussions with other doulas.  I assume that this is because there really isn’t much to talk about.  From my perspective, the boundaries are so very clear there is not a whole lot left to explore amongst the Bright Birthing team or in professional gatherings with other doulas.  

I LOVE the Evidence Based Birth article about the evidence on doulas.  I share the article with all potential clients to provide research to back up what we already know: having a doula can make for a better birth experience!  This blog post, however, is focused on what doulas don’t do.  Knowing our limits is just as important as knowing how to use comfort measures and positioning, create a calm environment, and provide emotional support.  Perhaps we will elaborate on what doulas DO do in a future blog post?! Because what doulas DO and DON’T DO is so clear in the Evidence Based Birth article, I’m gonna use their words instead of my own to clarify the boundaries of our work -- efficiency for the win!

Here’s an excerpt from the article Evidence on: Doulas, taken from https://evidencebasedbirth.com/the-evidence-for-doulas/

What is NOT included in doula support? Doulas are not medical professionals, and the following tasks are not performed by doulas:

  • They do not perform clinical tasks such as vaginal exams or fetal heart monitoring

  • They do not give medical advice or diagnose conditions

  • They do not make decisions for the client (medical or otherwise)

  • They do not pressure the birthing person into certain choices just because that’s what they prefer

  • They do not take over the role of the partner

  • They do not catch the baby

  • *They do not change shifts (although some doulas may call in their back-up after 12-24 hours)

*YOUR TEAM DOULAS DO CHANGE SHIFT, but you don’t get a stranger, you get your caring, compassionate, skillful OTHER doula.  YAY!

Seems pretty simple and straightforward, right?!  NO cervical checks, NO monitoring heart tones, NO medical advice.  Of particular importance to me is that I do not see my role as BEING the voice of my client.  I believe it is my role to AMPLIFY the voice of my client.  I am very clear within myself, with the Bright Birthing team, and with potential clients that I am not in this work to project my own ideals about birth onto anyone else’s experience.  My job is to educate and empower.  My job is NOT to make decisions for birthing people.  

Now, I think there’s a lot to be desired in modern maternity care.  So, for the record, choosing to support my clients, empower them to make decisions, encourage them to be educated consumers, and walk with them through the maze of machines and medications in no way means I’m giving a high-five to the madness of hyper-medicalized birth and our country’s very not evidence-based approach to all things labor, birth, and child care.  But I REALLY, REALLY so very strongly believe that healthcare consumers will be the drivers of change.  And I REALLY, REALLY so very strongly believe that birthing people will drive change when they are informed, educated, empowered and having their own experiences that make it so very clear that the system IS NOT SERVING THEM.

Ok, so why am I on about this?  Well, it occurs to me how VERY important it is that birthing people understand that a doula who might be offering services such as cervical checks and fetal heart tone monitoring has stepped outside of the boundaries of doula work.  If you’re interviewing a doula who offers those services, it would be important to ask what other qualifications and experience allow the doula to perform those tasks safely.  Then, it would be necessary to clarify that those still ARE NOT things that doulas DO, so it would be important to hash out exactly in which capacity that provider intends to serve you.  See where I’m going here?  INFORMED CONSUMER-VILLE!  When birthing people, doctors, midwives, doulas, and whoever else is involved as a pregnancy support team are all on the same page about who does what, the whole system works better!  AND clients are safer!

A couple of years ago, I learned that an organization based in Richmond, ToLabor, was including vaginal exams and fetal heart tone monitoring in their doula training.  I was shocked! Alarmed!  Concerned!  How could they?!  Then, I read their website FAQs (http://www.tolabor.com/about-tolabor/faqs/) about the training and it made so much sense!  On the surface, this was so contrary to everything I understood about the doula role.  But ToLabor wasn’t teaching doulas to perform vaginal exams so they could send them out into the world of doula work to harm clients and put themselves at risk for some serious loss of credibility within their communities.  ToLabor offers student-doulas the VOLUNTARY opportunity to perform vaginal exams and listen to fetal heart tones so that they can become more comfortable with touch, better understand pelvic anatomy, and get a real sense of their clients’ vulnerability.  I actually kinda think it’s brilliant.  They also have anyone who comes through their workshops sign a scope of practice agreement and make it completely clear on their website that performing vaginal exams and checking fetal heart tones is NOT part of a doula’s work.  

I never attended a doula training workshop.  When I became pregnant with my first babe, I turned into a bit of a self-study maniac on all-things pregnancy, labor, birth, and parenting.  I read so much.  I was never without a book on one of those topics, well into my son’s first year.  Then I started midwifery school and began the process of becoming a Certified Professional Midwife.  So, I learned to be a doula by learning to be a midwife and through my own yearnings to learn about pregnancy, birth, and child care.  I’ve participated in voluntary vaginal exams.  I’ve measured fundal height.  I’ve checked fetal heart tones.  I’ve assisted with something like 75 prenatal appointments, during which I checked urine screens, checked the pregnant person’s vitals, and palpated pregnant bellies.  But learning to do these things as a midwife, did NOT ever give me the impression that they were part of my work as a doula.  

As a result of participating in voluntary vaginal exams, I understand the importance of talking to pregnant people about what is happening during pelvic exams and why the information gained might be helpful.  I understand pelvic anatomy because I have felt the ischial spines, and the ovaries, and the pubic arch with my very own short little fingers.  I’m more comfortable with touch because I’ve measured, palpated, and assessed.  Really, it is hard for me to imagine my doula practice without the deeper understandings I gained from being a midwifery student.  So, I can appreciate ToLabor’s approach.  I see the value in learning about things that are OUTSIDE of the scope, to better inform the work that is done WITHIN the scope.  And I trust the people doing the work to know the boundaries.  

If you ever have questions about the limits of the doula’s role, feel free to give us a shout!  You might also check out the DONA (very credible doula organization) statement on the doula scope of practice, which can be found at https://www.dona.org/wp-content/uploads/2017/08/COESOP-2017-FINAL-Birth.pdf.  

We’re also happy to answer questions about our training and experience any time-via email, fb messenger, or at our regular gatherings!