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!

Response to Birth is Natural

Several days ago, I read an article in my Facebook feed-”Ten Things I Always Tell Pregnant Women” by Joanna Goddard.  For the most part, I wholeheartedly agreed with much of what was expressed.  She interviewed Erica Cohen, clearly a seasoned doula, who deeply understands the art and science of birthwork.  However, there was one thing Erica said that really stuck with me.  “All birth is natural.”  I read and reread the paragraph in which she expounded on this idea.  I thought about it for days.  I attempted to try on that concept, as if I agreed, to see how that would feel and just could not get there.  Nope.  I very strongly disagree for so many reasons.  You can imagine my surprise when I saw it pop up on the Bright Birthing Facebook page with Gwen’s comments “Love this!”.  

Henna design by Hannah Bukowski

Henna design by Hannah Bukowski

I found myself distracted for a couple days.  I love and cherish the Bright Birthing team members and always hope to demonstrate the value I place on their perspectives.  Yesterday morning, I finally decided to send a bit of a rant to Sara, Gwen and Stephanie via email to share my conflicting views and open up a conversation amongst our team members.  One of my favorite things about working with these amazing women is that we often have differing perspectives.  We’re not always on the same page about everything.  But we care enough about each other to talk through our disagreements.  That is golden!

The group consensus was that we should share my thoughts  in a blog post.  I’ve edited a little, just to make it more of a blog and less of a rant, but content is completely intact!  Here ya go!....

Here's a link to the article for those who may or may not have read it...

https://cupofjo.com/2017/10/erica-chidi-cohen-pregnancy-advice/

Here's the excerpt I'm referring to...

Natural birth. We need to stop using the term “natural birth.” The concept of natural birth is divisive and inherently competitive. All birth is natural. It’s as simple as that. If you want to have the intense sensations of labor and you’re coping well, go for it! If you have a hard time with pain or you have bad associations from trauma, that’s totally okay. You have the inherent right to choose how you want to navigate your birth experience, and those choices should be free of judgment. You should be celebrated for moving through the process of pregnancy and birth, however it unfolds, unmedicated, medicated or cesarean. THERE IS NO UNNATURAL BIRTH. It’s not Westworld. It’s all natural.

I love the spirit of her comments.  I agree that much about birth has become divisive and competitive and find that to be a sad reality of our society.  I agree that NATURAL is an inaccurate term that may mean different things to different people.  We know with certainty that many products labelled "natural"  are full of harmful additives, for example.  When I think of NATURAL in relation to pretty much anything, I reach out to connect with the essence of the human experience spanning millions of years on this beautiful earth.  I think of the time we've spent with our bare feet in the mud;  the time we've spent huddling next to fires, made with our own energy and intelligence;  our reliance on the stars, our animal brothers and sisters, and each other.  My vision of a NATURAL human is  someone who knows how to live in harmony with the earth;  some who not only survives, but THRIVES in the natural world, with no need for modern entrapments.  Perhaps because my definition of NATURAL is already so far from the picture that is painted by corporations, the media, etc..., I am especially sensitive to this particular application of the term?

The crisis of women being disempowered and devalued by our society is something I care deeply about and hope to address throughout my life as a birth worker.  I absolutely agree that each birthing person has the right and responsibility to choose how they want to navigate the experience of giving birth.  I hope that someday every person who gives birth will be celebrated for that beautiful act of strength, grit, love, and vulnerability-regardless of method, medication, or location.  I hope that every single thing I ever say or do throughout my life and career will contribute positively, whether directly or indirectly, to the mission of creating true equity for women in all facets of life (i mean, world domination , really...but, I'll take equity I guess for now!).  

However, I think by applying the term NATURAL BIRTH to ALL birth, we undermine the importance of speaking accurately about what happens in hospitals, homes, and birth centers.  I don't see any way to possibly address the many, many problems with the modern maternity care system if we allow ourselves to placate women by generically applying the word "NATURAL" to all births.  I find it incredibly condescending to birthing people.  I don't believe that much of what happens in doctors' offices and hospitals surrounding birth (and many other "medical conditions") is anything like NATURAL.  I don't think the interactions feel natural.  I don't think the environment is natural.  And it seems like it should go without saying that being hooked up to monitors and medications, while someone looks at a screen to make decisions about your well-being is not natural.  I just can't get there.  I don't want to get there.  I think without speaking clearly about augmentations and interventions, we miss an important opportunity to truly empower women.  I don't agree that women will be more empowered if we all lie to ourselves and each other about the realities of modern maternity care.

I believe women will be empowered when they are educated healthcare consumers.  

I believe women will be empowered when they are informed decision makers.

I believe everyone will be better off when we address the unfathomable inequities and inconsistencies in maternity care.

I believe there is an enormous amount of work to be done, so that, eventually, the FACT that birthing people are being duped, dismissed, and steamrolled by the system becomes so evident that they just won't fucking tolerate that shit anymore.

I hope that I live long enough to BE the change and SEE the change when educated, informed, empowered women are DRIVERS and DETERMINERS of what maternity care looks and feels like in the this country.  

Lastly, I hope that our fears of judgement will not prevent us from having the hard conversations that will be required if we ever want to put a dent in this mess.

 

Crappy Dinner

This year in addition to village circle each month (stay tuned here or on our facebook page for dates, speakers, themes, etc) we are excited to open our homes in 2018 for irregular, occasional Crappy Dinners!

A meme that totally speaks to busy parents, Crappy Dinners may be absolutely scrumptious and indeed not super crappy at all, the point being we will not go to great measures to clean our homes, we will not be showing off or entertaining. We plan to pull out frozen meals, request attendees show up with something to share, order pizza or something similarly casual. 

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Commensality - sharing a table, eating together - is an intimate and enlivening thing to do. We laugh, make a mess, nourish ourselves on so many levels when we eat together with other beloved grown-ups and kiddos. We may discuss our day, our concerns, what we've been binge-watching on Netflix, or just touch base with one another. We are looking forward to a year of deepening connections with each other and with you - if you are interested in hosting a Crappy Dinner at your place, let us know! 

*Thanks to Sarah Struckmann and the Moms and Babies group at the Women’s Initiative for reminding us of the notion of Crappy Dinners, and this article from Mothering!

Making the Most of Prenatal Appointments

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Oftentimes prenatal visits feel like a whirlwind. Pee in a cup. Blood pressure check. Fetal heart tones. Measure your belly. “Any questions? No? Great! See you next time.” Often after such visits, we leave the appointment feeling flustered, unheard and vaguely disoriented. I am completely certain that healthcare providers  (who worked incredibly hard to obtain their education in obstetrics and midwifery) intending to support people and couples in pregnancy and birth do not intend to leave them feeling unsure and unsettled! And yet many excellent and very caring doctors and midwives get caught up in the system. It’s not the fault of these amazing humans! The system is set up this way. They are forced to see so many patients and do so much in an incredibly limited amount of time. Because, over time, it becomes so routine for them, healthcare providers may forget that this pregnancy is certainly among the most special experiences the expectant couple may ever have.

Here’s the thing: I believe that these professionals truly want to connect with their patients. I’ve seen them in the birthing rooms. They are present. They care. They slow down and talk to their patients. So how can we ask them to bring this presence of being into their prenatal appointments? There are a few ways we can let them know how important it is to us, as their patients that they slow down and connect – and, I believe, it’s important to them as well.

It’s fine to simply say, “I’m feeling like we need to connect. Will you take a moment to talk with me?” So, that’s a great approach if you’re a person who is comfortable with that. Now, for those of us (me included!) who aren’t comfortable with being quite so direct, just ask questions. All the questions. It doesn’t actually matter if you care what the answers are. You may find, though, that once you start asking questions you do in fact care an awful lot! Less Google, more conversation with these incredibly experienced, wise, caring professionals!

The more you chat with your healthcare providers, the more comfortable you will be seeking the information through them. Sit down before each appointment and take a moment to write down a couple of open-ended questions. Your doula can help guide you in which discussions can be most helpful throughout your pregnancy. As birth support professionals, we have found that, when given an opportunity to connect, most of our wonderful local doctors and midwives really jump on it! Charlottesville is so fortunate to have so many amazing doctors and midwives and we make our choice because we believe them to be the best fit for us. Shall we give them ample opportunity to live up to our (and perhaps their own) expectations?!  

Nearby Grandparents

For the first several years I was a practicing doula in San Francsico, I lived across the country from my mom. As I attended a couple dozen births, my own intention to become a parent solidified, but my partner and I knew we wanted to be closer to family before having our own children.

We moved to Virginia at the end of 2012, about an hour and a half from where my mom lived at the time. I re-established my doula practice here and became part of the sweetest community - including the other doulas of Bright Birthing. We welcomed Baby Bright in 2016 and as her first birthday approached, my mom found a home even nearer to us.

Our home is a cozy apartment, so it's especially pleasant to have Yaya's farm within an easy driving distance. She has dogs, chickens, quail, doves, a vegetable garden and plans for an orchard. There's a playhouse and a sandbox, a wrap-around porch for shade and fields for romping. 

Wednesday October 18 we're excited to share the love of having a nearby grandparent with folks who are able to join us at the Farm Picnic! 

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