Onwards and Upwards

1 08 2012

A new title for my blog, and a new phase in my life. “On Birth and Life and India” is now “On Birth and Life and the World,” for you see, my clinical birth work has made it to America. In just a few weeks, I start my nursing and midwifery education at the Yale University School of Nursing.

While I am thrilled beyond belief for the start of my midwifery training, it’s also sad to say goodbye to my phenomenal doula program in Brattleboro. I completed my doula training at Brattleboro Memorial Hospital in October 2010 with Dawn Kersula, a birthing center nurse, lactation consultant, Lamaze instructor and master of all things perinatal. It was a whirlwind of a training, and I felt completely overwhelmed afterward. It’s scary walking into a labor for the first time! But Dawn believed in me, and I’m so grateful for her confidence, which got me started on this path.

Last summer, I came home from India and found the BMH doula program revamped. Debbie Partrick, the nurse manager of the BMH Birthing Center, and Carol Schnabel, one of the original doulas, had redesigned the doula program to encourage more doula assisted births in our community, while continuing to offer emotional and educational support to the existing doulas, and offering training for aspiring doulas. In the last year, we’ve met monthly, with a different educational focus during each meeting. We’ve had visits from the local midwives, a staff anesthesiologist, a physical therapist, childbirth educators, and Brattleboro Area Hospice. With other BMH doulas, I’ve attended workshops on lactation, infant led attachment, skin-to-skin, and a Penny Simkin webinar on trauma. And then, of course, I’ve also been the doula for seven women and their families in the past eleven months. I’ve seen natural births, Pitocin inductions, epidurals, and adoption. I’ve been at birth that kept me up all night, and births that have gone so fast I’ve been home in a few hours. I’ve mopped amniotic fluid up off the floor, cut an umbilical cord, and had two moms tell me that my massages are so good they’d pay me to do it when they weren’t in labor (yeah, I’m bragging). It has been an educational, motivating year, and I am so lucky to have been a part of this incredible hospital-based doula program. For a small town, Brattleboro is truly fortunate to have such amazing birth support.

This weekend I attended what might my last birth as a doula. It was an absolutely beautiful and inspiring birth (though really, aren’t they all?). It was my first birth in several months, and as such was the perfect reminder of why I’m embarking on this crazy, intense adventure to midwifery. Everyone in the room knew of my midwifery plans, and took the time to do extra explaining. When I visited the family the day after the birth, the new parents gave me the usual thanks, but also told me how they believed I would make an incredible midwife, how grateful they were to be matched with me, and wished me luck on my path. It was awfully sweet.

On Monday night, the doulas had a gathering to celebrate the year anniversary of the rejuvenated program, and to say goodbye to me and another doula, Jesse, who happens to also be starting the same program at Yale (how nice to go with someone I know!). Debbie, the nurse manager, surprised Jesse and I with gifts, and cards signed by the doulas and the midwives. It was incredibly moving to read the messages of support and belief. Two of the midwives attended the celebration, and wrote me notes as well, offering their confidence and help with whatever I need (and their jobs, though I think that’s at least 50% a joke…). It has been such a comfort and a blessing to hear from so many people who believe in me as a midwife, and who are—already—willing to help me any way they can. Women with children who say they wish I could have been their doula or midwife, and women without children who hope that I will be. College professors who see exactly how my academic background would have set me up for a career in midwifery. Friends I haven’t spoken to in years, who hear that I’m starting the nurse midwifery program at Yale and simply say, “of course you are.” The nurses and midwives I’ve worked with, who can see my potential and are hoping to see me come back with a plethora of acronyms attached to my name. Just as Dawn inspired my own confidence when I started as a doula, all these people in my life have led me to believe that I’m prepared to be a student midwife.

Now I’m here, sitting at my kitchen table in New Haven, ready to begin my next great adventure. I’ve got my stethoscope, my bandage scissors, and a big tuition bill with my name on it. The Yale shuttle rolls up my street every fifteen minutes, ready to take me to the medical campuses. And I’m ready to go.

my latest doula family (shared with their permission)


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Unbound Birth

22 01 2012

A few months ago I connected with Jennifer Yarbrough, a trained childbirth educator and the mother of three children, all born naturally in the hospital. On January 31st, Jenny’s first e-book, Unbound Birth: How to Have a Natural Birth in the Hospital, will be released. Yeah, Jenny! As a hospital-based doula, I was excited to read it. She was kind enough to send me an advanced copy and I whipped right through it last weekend.

Unbound Birth is a good introduction to unmedicated birthing in the hospital. At fifty-nine pages, it is far shorter and a much quicker read than other books about childbirth. Most of my favorite go-to birth books as a doula and childbirth educator are 400 plus pages! Unbound Birth is a great read for mothers-to-be who are just starting to consider the idea of birthing naturally, or parents who haven’t done much reading, and are in a hurry to soak in some tips before the big day arrives. For those who hope to learn more, Jenny makes excellent recommendations for other books and internet resources throughout Unbound Birth. Jenny’s tone is casual and conversational. She intertwines the stories of her own births with information about how other moms-to-be can do the same. Unbound Birth feels like sitting down with a friend for a chat about the birth experience, rather than listening to a sermon. It’s refreshingly casual.

Jenny emphasizes that natural birth can be for everyone with the right preparation, and that it is an empowering experience. Jenny points out that many women choose epidurals and then plan unmedicated births during subsequent pregnancies, but few woman have unmedicated births and then opt for medicated ones later. Having a natural birth is a powerful experience that profoundly effects women. Jenny acknowledges that many women desire natural births, but are uncomfortable with the idea of birthing at home. Unbound Birth helps bridge the gap between medicalized hospital birth and al naturale homebirth. There is a place for everyone woman to have the kind of birth she desires, and Unbound Birth will help women achieve it.

Unbound Birth comes with a blank template for creating a birth plan that I would tell my doula clients and childbirth education students is just about perfect. The cost of the book is worth it just for this template alone! Having an unmedicated birth in a hospital is often challenging due to poor or miscommunication. Having a birth plan is a great idea for communicating desires for labor, delivery and postpartum, but if mothers come armed with a long, detailed list of want they want medical staff can view this as over the top, threatening, condescending or ridiculous. It’s great to talk with your partner and your caregivers about what you hope for, and to find comfortable compromises should things go awry, and to have all this written down. Sometimes though, it’s counteractive to over plan. A birth “plan” should really be a simple list of preferences and ideas. Things rarely go exactly according to plan, in birth or any other scenario, so find a way to hope for the best without absolute rigidity. I encourage pregnant women to have two birth plans: one for themselves, their partners and their doula that lists many ideas and preferences (“I would like to try being on a birth ball”) and one more simplistic birth plan to give to the medical staff at the hospital (“I am planning a natural birth; please don’t offer me pain medication”). The Unbound Birth birth plan template is a great tool for helping women to boil down their long list of great ideas into something more productive for hospital staff.

Unbound Birth: How to Have a Natural Birth in the Hospital will be available January 31st, and can be purchased for $4.99 through Amazon.com or on Jenny Yarbrough’s website, www.unboundbirth.com. You can also connect with Jenny on Facebook or Twitter!


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Big Bird Thinks Breast is Best

6 01 2012

I’ve said it before, and I’ll say it again: Sesame Street has gone way down hill. (Damn you, Elmo!) Back in the day, Sesame Street was truly wholesome and worked hard to foster acceptance, caring, learning and hundreds of other good principles. So why does a discussion of Sesame Street belong on the reproductive health blog of a doula, childbirth education apprentice, and breastfeeding research assistant? Because throughout the 1970s and 80s, Sesame Street included frank, warm and fuzzy discussions about breastfeeding on the show. Even the popular Maria, played by Sonia Manzano, who has been on the show since 1974, breastfed her baby on the show. As the Huffington Post recently reported, breastfeeding on Sesame Street abruptly stopped in the 90s. They’re still showing feeding infants, but those feedings are all from the bottle. I, for one, am bummed. I thought they did an amazing job of tastefully showing breastfeeding as a healthy, normal way to feed a baby.

In my favorite clip, a woman named Buffy breastfeeds her baby in front of Big Bird. The segment’s sole purpose is apparently to establish the act of breastfeeding as normal. Here’s the transcript for the clip (embedded below):

Big Bird: “Whatcha doin’ Buffy?”
Buffy: “I’m feeding the baby. See, he’s drinking milk from my breast.”
Big Bird: “That’s a funny way to feed a baby.”
Buffy: “Lots of mothers feed their baby this way. Not all mothers, but lots of mothers do. He likes it because it’s nice and warm and sweet and natural. And it’s good for him. And I get to hug him when I do it, see.”
Big Bird: “Oh. Well is that all he ever needs to eat?”
Buffy: “Well, at first, when he was just born, and very tiny, this is all that he wanted and all that he needed, but now that he’s getting bigger, see, I mash up fruit and vegetables and sometimes a little bit of meat, and as he gets older he’ll need more and more different kinds of food to eat, but for right now, this is just fine. He’s drinking his milk.”
Big Bird: “You know… that’s nice.”

I love that Big Bird, who is developmentally aligned with a five or six-year-old, asks the same honest, curious questions that a real kindergartener might ask a breastfeeding mom. Just as children aren’t inherently racist, sexist or any other “ist”, children don’t view breasts as sexual or gross unless we feed them that idea. But they may not have seen breastfeeding before, and they might be curious!

Buffy answers Big Birds questions so gracefully, honestly and smartly. I like that she doesn’t shy away from using the word breast– there is nothing inappropriate about teaching children proper names for body parts. I love that while she’s clearly a breastfeeding advocate, she explains, in simplest terms, that not all mothers choose or are able to breastfeed, and without vilifying them. Buffy succinctly explains the benefits of breastfeeding: that the baby likes it best, that it’s healthy for him, and that it comes with skin-to-skin contact, in a clear, easy to understand and developmentally appropriate way. She explains how he’ll eventually be weened, and take on a healthy, balanced diet.

I imagine myself as a five year old being somewhat bored with this segment, but I think that’s fine! No one is forcing young children to be interested in what adults (or babies) do, just laying a foundation so that children will grow up imagining this healthy habit as a normal one. Sesame Street could make a huge impact if they’d return to this format of education, and away from the chaotic, grammatically incorrect world of Elmo. Educational television can be more than just numbers and letters. It can be about inclusion, friendship, hope, honesty, and promoting a multitude of healthy habits, like breastfeeding. And in the words of my childhood hero Big Bird, you know… that’s nice.


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Perspective and Mantras, for Birth and Life

30 12 2011

I can tell that I’m in the right line of work by the way the lessons I learn in life inform my birth work, and the lessons I learn in birth inform my life. In this year of my first twenty births I’ve learned a lot, but it all boils down to this: everything is all about perspective.

Last winter I began an experiment, and decided that I was going to truly enjoy every yoga class I went to. Somehow I had fallen into a rut of going to class with excellent intentions, but finding myself discouraged and uncomfortable and wishing I could see a clock. I wasn’t going to let this happen anymore. Yoga is something I do for myself, something I pay to do, something I’m good at, something that I want to enjoy, that I do enjoy! And so, whenever I felt crappy, I took a deep breath, told myself I was stronger than I thought, and forced myself to actually smile. It was a bold move. By smiling I was sure that I was aligning myself with the yoga crowd who openly moans and farts and places their mats uncomfortably close to others. I may live in Vermont, and I may not always shave my legs to go to class, but this is not a crowd I want to be associated with.

At my first class of “smiling through it,” I felt like a phony, but I noticed that the class felt more enjoyable. After my second class, it started to feel more natural, and I really started to enjoy the difficult moments in practice, and to be able to embody the reasons I do yoga. After my third class of smiling through it, I felt like a rock star and apparently I looked it too: a complete stranger in the class told me how beautiful my practice was! (Surely a true yogi wouldn’t glow in the compliment the way I did.)

“Smile through it” was my first mantra. I’m usually apt to associate mantras with the moan/fart in yoga crowd, but it’s actually incredibly helpful to have one little thought to focus on; a phrase to help re-frame our whole attitude. Women in labor often have their own ideas of thoughts, words or phrases to think or say, but it is also my duty as doula to come armed with some others in case they need a spare! I started jotting down mantras that I thought of, or read in books, or came across on the internet. A quick note turned into pages in my journal. Here are some of my favorites, for birth and life:

“Pain is just sensation.” This was given to my by a massage therapist almost ten years ago, and I have held onto it ever since. I had somehow worked my neck into such a tizzy that I couldn’t turn my head more than one inch in either direction. As she worked on my spasming muscles, I tensed more and more, and she repeated “pain is just sensation; relax into it.” It’s easy for us to equate pain with harm, or even death. That’s its job, to get our attention so we can fix the problem! I was already working on the fixing, and needed to get on top of the pain mentally, remembering that a biological nerve response does not necessarily mean harm. With practice, mind over matter really can conquer a lot!

“Pain is temporary.” Even when pain becomes too great to process cerebrally, it’s valuable to remember that it will eventually stop! This is helpful for emotional pain too. Yes, it’s terrible to hurt, it really is, but when you can imagine a finish line, it makes pain much more manageable.

“Feel what you’re feeling.” I use this a lot Sure, I think it’s important to try to manage physical pain with a positive attitude, but handling emotional pain is different. Not letting pain hurt isn’t healthy when it comes to emotions, and allowing ourselves to really feel something is helpful for processing those emotions, and moving on. We’re all human, we’re all emotional beings, and there is no point to pretending that we’re not. It’s normal to be angry, sad, frustrated,  confused, or insecure and it should be normal to express those feelings in addition to our joy! I’m a huge advocate for having a good cry. Kelly Kravitz, a doula on Twitter, recently put my thoughts on crying into great, succinct thought: “Crying doesn’t indicate you are weak. Since birth it has always been a sign that you’re alive and full of potential.” Even if crying isn’t how you feel your feelings, let ‘em rip when you need to!

“Inhale peace, exhale tension.” And then there comes a time when all that cathartic crying needs to pass, and we need to move back into controlled, calm life. Good, deep, breathing is the original epidural and the original Prozac. It’s amazing what fresh oxygen does for pain and frustration, and important physiologically in birth. In order to properly and fully contract, the strong muscles of the uterus need a steady supply of oxygen, and the baby, who is also working hard, is (of course) reliant on the deep breaths of the mother to fuel his own journey. Sometimes a reminder to breath is enough, but other times it’s nice to have a thought to focus on to keep the pattern going. In with the good, out with the bad.

“Take a deep breath and blow that last contraction* away.” [or terrible commute, long day, disagreement, etc.] Related to the above, breath is cleansing. As a doula, this mantra is probably the one I use most frequently. It’s often difficult for women to relax between contractions during the pushing stage with all the excitement and energy and sometimes anxiety or fear in the room. They hold their breath while pushing, and then forget to resume a normal pattern for their time off, holding on to all that emotion, and depriving themselves and their baby of vital oxygen. And we all fall into this trap in our daily lives too! Take a deep breath, blow the tension away, let the past be in the past, and focus on how you’re feeling now.

“Trust the wisdom of your body.” There are thousands of stories out there of women who felt they were about to push their babies out, only to be told by a medical professional that they were wrong. What happens then? Birth, of course. We know ourselves better than anyone. Regardless of how much training someone else has, they are unable to know for certain what is going on in your body or your head. We spend all day, every day with ourselves. We know when something is amiss. Trust that, whether it be physical or emotional. We know what we know; no one else can.

“I am in charge of my own experience.” Ultimately, it is up to us and us alone to create our own life, or birth experience, or vacation, or career, or whatever else. Sure, things come up that are out of our control, but we are the captains of our own experience and we can steer it in whatever direction we choose and choose how we handle any obstacles in our path. Take ownership!

smiling through yoga


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And the World Spins Madly On

15 12 2011

Tonight I am trying to internalize how truly grateful I am for the life I’ve made for myself, for the experiences I’ve had, and for the people I surround myself with. I was thrown a big, unexpected curve ball last night, and after hours of sadness and defeat I found myself searching for something positive to focus on. I needed to stop feeling like I was trapped, and remind myself that I am not my circumstances; I am a strong, capable, independent woman who is capable of creating happiness for myself.

My thoughts are filled with India, and the moments I had that made me feel more alive than ever before. I stood barefoot, in a temple many centuries old, face-to-face with a beautiful, enchanting elephant, who focused her brown eyes on my blue ones, and laid her trunk across my head and shoulders in a blessing. I felt the bristles of her trunk, and it’s heft and strength and power, and happiness poured out of me. I felt whole. I waded ankle-deep in a monsoon-swirled Arabian Sea, with an umbrella over my head and the clouds wringing out over me. I was completely alone in nature, in life, in my travels, and far away from everything I knew. The horizontal rain and agitated waves washed against me, salt and sand scrubbing me raw. I felt small and insignificant, but in a powerful way that cleansed me: I might not influence the universe much, but I had influenced my life considerably, because I had taken myself out of my comfort zone, thousands of miles out, and I was still okay. I witnessed my first nineteen births in India, and became intoxicated by the powerful emotions that come with birth. Most evenings after a birth, I would sit on the rooftop of my home in Madurai, looking up at the starlit sky and the moon, taking in the universe for the newest member of our planet, feeling overwhelming hope for this new life.

I have been physically and emotionally home from India for months, but now I am reminded to bring the ethereal of my experience home as well. To surround myself with people whose arms, when around me, carry the same power of profound love and support as an elephant’s trunk. To allow the feeling of being insignificant to be a positive force, because it means I have made myself vulnerable, and allowing space for vulnerability means that I am strong. To accept that I have complex emotions and can be bruised, but to let new beginnings be full of hope and light, just as in birth.

Births keep on happening. The rain comes and washes away old perspectives. We meet souls that shake us to our core and change the fibers of our beings. When we’re in life– really and truly there– nothing else matters. The world spins madly on.


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Shy Sphincters and Orgasmic Birth

2 12 2011

I avoided Orgasmic Birth for a long time. Despite my rapture for all things birth, I assumed that this documentary was a bit too marginalized for me. I rented it last night, and discovered that I was terribly wrong. I absolutely loved it, and I daresay Orgasmic Birth might be my favorite birth film.

I wouldn’t say that Orgasmic Birth  is about orgasm in birth, though it is mentioned late in the movie. Instead, Orgasmic Birth emphasizes that the most positive birth experiences are paralleled with sexuality: allowing the experience to be physical and sensual, to create a space filled with love, and to find intimacy in the process of birth, with yourself, your baby, and those around you. There are many similarities between birth and sexual experience. Physically, the same organs are involved. Likewise, the same hormones are produced in sex and in birth, and they are incredibly powerful positive hormones that trigger not only the physiological processes, but also intense feelings of love and bonding between parents and their baby. Birth, when properly supported, sounds like sex. The terrified screams we hear in the media are not the realistic sounds of a woman who was prepared for childbirth. And, just like in orgasm, birth cannot easily happen if there is unwarranted pressure or audience. Women and their families should be given the time and privacy to “get in the zone,” just like they might if they were having sex.

Ina May Gaskin, who appears as an interviewee, is always good for a chuckle when it comes to sexuality in birth. Her great line in Orgasmic Birth refers to sphincters being shy, and how they can slam shut if their owner gets nervous (for review, a sphincter is a circular muscle that ordinarily maintains high levels of constriction… in this case, it would be the cervix). If some people can’t even relax their urethral sphincters to pee when someone is in a stall on the other end of bathroom, how can we possibly expect a woman to get her cervix to ten centimeters while lights are beaming down between her legs while a team of doctors and nurses stare and prod? All physiological and psychological evidence points to allowing a woman intimacy in birth. It is ultimately her experience, and she needs to make it her own to feel comfortable and yield the best results. While few women actually achieve orgasm in birth and most women still classify it as a painful experience, many women who are well prepared to manage the discomfort of labor are able to cope in a way that allows them to classify their birth experience as a pleasurable one. As for the actual orgasms, the film does show the birth and an interview of one woman who had two orgasms during labor, brought on by the labor itself. Ina May also talks about an unofficial survey that she did about orgasm in labor. She discovered that a surprisingly large percentage of women orgasmed at some point during their labor, though she doesn’t mention how they were achieved. I wouldn’t be surprised if all of them (or close to it) were the result of run-of-the-mill sexual experiences with a partner during early labor. The hormones produced during orgasm can speed labor, after all!

Despite my love for the angle of Orgasmic Birth, I wish the producers hadn’t selected such a radical title. If I, a birth junkie who hoards birth-related materials, avoided this movie for so long, then certainly many women and expectant parents shy away from it based on title alone. The preview emphasizes the orgasmic side of the film in a way that made me expect the whole film to be about hippie moms trying to orgasm during their births. I wish it had been edited to truly show the colors of the film!  Sure, there are a few crunchy expectant couples. A film about birth isn’t the same without a half-naked pregnant woman dancing while her husband chants and play a djembe. But most of the featured couples seemed extraordinarily… ordinary. You don’t have to be a hippie to have a magical birth outside on your deck, you just have to be open to the idea.

Perhaps what I loved most about Orgasmic Birth was that it preached truthfulness instead of propaganda. While I am a huge advocate for natural birth, midwives, doulas, homebirths, breastfeeding and all those other “liberal” birth topics, I’m also wary of a subset of fellow advocates who are militant about their views, and combative towards anyone that has a different view. It gives the whole movement an ugly face, which many are apt to shy away from. Orgasmic Birth  is clear in it’s pro-natural childbirth stance, but it doesn’t demonize other options. It shows that yes, epidurals mess with the natural physiological process of birth, and this leads to much higher rates of intervention. But yes, there are some women who absolutely need some sort of relief. If birth is too stressful and the mother is absolutely panicking, this isn’t good for the baby either. Orgasmic Birth also shows that with support from providers, childbirth educators, doulas, and families, a huge percentage of women who would self-elect themselves to the “absolutely needs an epidural” group would be able to cope with natural labor just fine with non-medication options of pain relief, like hydrotherapy or massage. The film shows that yes, there are many risks to giving birth in a hospital, and yes, the cesarean rate is way too high. But also that a cesarean can also be a lifesaving procedure. And no, not all hospital births end with a cesarean.

I also loved the story of a survivor of multiple sexual abuses, which highlighted the absolutely transformative power of birth. This woman knew that she needed to have a birth where she felt safe and loved, so she planned a homebirth with the support of a midwife and her husband. She discussed learning how to surrender her body to a greater force– a difficult process for everyone, but especially for someone who has been so traumatized in the past! “My son’s birth became the most powerful thing that had happened to my body.” Such a moving statement by this particular woman, and generally about the power of birth!

Birth has the capacity to deeply change a woman. She realizes that she is capable of absolutely amazing things. She is proud of herself. She loves the ability of her body to bear a child. She loves the baby that was the result of such determination, work and raw love. Birth is the physical, emotional and spiritual highlight of many women’s lives. Orgasmic Birth definitely emphasizes that all women should have access to this kind of experience. A powerful film, indeed.


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Finally… the BMH Doula Podcast!

20 11 2011

One of my fellow BMH doulas just tipped me off that the radio show I did in October with the lovely and amazing Jesse DeVries and Carol Schnabel is finally available online! Since it was a live segment and I missed the re-broadcast, this was my first chance to hear it too– I was actually slightly less awkward than expected… a rare feat! And so without further ado, here’s the link to the piece from Steve West’s Live and Local, focusing on the benefits of trained labor support, and the Brattleboro Memorial Hospital doula program! LISTEN HERE.

And I totally get more eloquent as time goes one, so be sure to listen to the whole thing!


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