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Archive for the ‘doula’ Category

Like many of you who freelance, I spend a good deal of my professional time looking out for my next gig.  It is the invisible work behind all the actual work that I do. And it is takes up a decent amount of time and energy. All that effort is meant to lead up to the interview for my next birth doula client.

It is not uncommon for me to go to a job interview several times in a month. Many people are unsure how to interview some for a job.  This is probably because most of us don’t have much opportunity to practice.  I often walk people through it because I want to make them comfortable enough to speak their mind.  I ask them how they found me, what made them decide to interview me, what they are looking for from a doula. I reflect back what I heard from them – addressing any or concerns they may have.

There are a series of typical questions people ask me – how long I have been a doula, how I became a doula and how many births I attend during a month. Many people ask happens if they are in labor at the same time as another client or if something prevents me from being able to attend their birth.   This is a very important question and everyone should ask it.

Yesterday at an interview I was asked the best question I have ever been asked at an interview. It made me think back on nearly a decade of interview questions and consider which ones fostered the best communication between me and potential clients. I highlight them here not because I think I have the best answers but rather because I think these particular questions provide a window into any doulas personality, style and way of working. Open ended style questions give you a chance to find out if you can connect with particular doula.  If you believe your communication styles well work together and that the connection is established, then you can grow that into a trusting relationship.
Here are my top ten doula interview questions:

1. What is your relationship to my other caregivers? How will you help me make your presence as a doula work for everyone in the room?

2. What do we do if we, as a couple, decide we need some privacy during our birth, even from you?

3. How will you support me if my birth for any reason becomes more medical than we hoped? For example, what if I need a plan induction or planned cesarean?

4. What are the things you can do for me that no one else might be able to do, such as my partner, a friend, or family member?

5. How will you respond if I choose to have an epidural or other intervention that doesn’t fit into the “natural childbirth model” way of doing things?

6. What are the most important things you think I should be doing right now to prepare for my birth?

7. After the baby arrives, then what? How long do you stay? What are the ways you are helping us in that time period? Do you just go poof?

8. What is my labor is super, crazy long? How will you help me? How will you have the energy? When is too much, too much? Do you leave?

9. What do you know about postpartum depression?

And my all time favorite question to be asked at an interview,

10. What do you love the best about being a doula? What motivates you and excites you about this work?

 

I am sure there are hundreds more interesting, insightful, open-ended questions to ask when interviewing a doula. What would you add? What kinds of answers have you heard. Stick around to hear mine in the coming weeks. If you are a doula, share yours in the comment section.

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Just like that I’m working. A month ago I was feel rather gloomy about working  here in Northampton. I couldn’t quite find my feet despite all my skills, experience and training.  We moved. It was hard to start over. It felt for a while like my work didn’t come with the rest of our stuff. What turned the tide? Social media, prayer and hunger most likely.

So just like that, I’m moderately busy. The more work you have, the more work you get – and it must come from clients. There is no one like a satisfied client to send more business along.  I’m not quite as busy as I’d like to be, but busy enough considering that like most working moms I don’t have enough affordable, quality childcare and we are running full speed into the Holiday Season. As an aside,  we generally call it the Season of Croup for lo, as long as we have been parents (11 Christmas this year), there hath been croup at the holidays. We inevitably end up with someone sleeping between us with the windows open to the cold New England breeze in dark December because nothing is better for a swollen larynx than your own mothering’s teeth chattering as you sleep on her chest.

I find myself leaning into next fall as I scramble to keep my work life flowing with a 4-year-old in tow. He is in very part-time preschool. It is very nice and very affordable. The only three moves we can make are

1. Very unaffordable preschool/daycare

2. Very not nice daycare

3. Wait it out til all day public Kindergarten.

We are waiting it out. He is in the school’s preschool program. He will be happy at the Kindergarten is 10 months away. Summer will be a whole different animal – every working mother stares that beast down pretty hard right at the end of February break.Next September everyone will get on that bus and stay there til 3 – though 4 would be better.

Waiting it out has been our family policy on the day care conundrum though for 11 Christmases now we have doubted and reevaluated that decision. We’ve always ended up picking high quality, affordable part-time care. We are not alone in our confusion. I had a chance to hear Sharon Lerner, author of The War on Moms, spoke this morning at the MotherWoman breakfast here in Northampton. I learned that 62% of mothers report wanting to work part-time and 26% are actually working part-time. This means 36% of women are working way more or way less than they want to be working. We aren’t getting enough help here. I feel it everyday. I’m aiming for the 26% mark. It’s a teeny bulls-eye to shoot for from a great distance.

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Every day I think about Paula, the midwife who helped me birth my younger children. She wore a white lab coat with a big purple button that said Listen To Women. I think of her as I continued to be troubled about the rigidity within some corners of  the birth community. Today I was reading on the ICEA blog (International Childbirth Education Association).  The author was responding to a doula’s question that had through Facebook: How do you guide a clients who are not interested in breastfeeding?

Here are the non-answers that stood out the most to me:

I was very proud to respond that I have never had a client that was not interested in breastfeeding.

If I ever move from Santa Fe and start working as a doula elsewhere I am afraid I will be in for a rude awakening.

I use social media outlets like Facebook and Twitter to post articles about the benefits of breastfeeding.

I downloaded and printed “Thank you for breastfeeding in public” cards to hand out to women that I see breastfeeding in public.

As far as I can see, the author not only did not answer the question, but lacks the professional experience to even field it.  I have had this experience a few times. If the doula who wrote asking is anywhere out there, please allow me to respond. From time to time as a doula, you may encounter clients who are not interested in breastfeeding. The first thing I try to remember is that my primary role is birth support. Although I am a strong proponent of breastfeeding, the job I have been hired to do is help this mama labor and birth her baby. If I am able to ask my client some open-ended questions about her lack of interest, sometimes I can better understand her needs. I do believe that breastfeeding is a healthy choice for mother and child. However, I also acknowledge that while I might have stats at my fingertips about research and benefits, I have only known my client a short time. I don’t know how she came to her decision. I don’t know how strongly she feels about her choice. Keeping in mind that it is not my job to change her mind, I might say something like,

Can you tell me about your decision-making process?

How did you come to decide that breastfeeding was not for you?

Do you know any other moms who breastfeed? If so, what was it like for them?

If not, do you have questions you want to ask me mom-to-mom that you don’t feel comfortable asking anyone else?

Are you uninterested in feeding at the breast? Might you consider pumping colostrum and breastmilk for a few weeks?

When I ask these exploratory questions I might find out that she is on a medication that is contra-indicated for breastfeeding, or that she thinks is contra-indicated for breastfeeding, that no one in her family breastfeeds and she is not willing to try something that seems so foreign, that she is expecting to go back to work at 6 weeks postpartum when her paid time is up and has heard pumping is miserable and she may not have time for it anyway. I might learn that she tried breastfeeding before, did everything “right” and never made the milk she thought she should. She is still wounded over that and doesn’t want to go down that road again. I might learn that she is a sexual abuse survivor and cannot imagine sharing her body in this way. There are so many things I can learn when I ask open ended questions of my clients. Some of the obstacles face are ones that can be conquered with support. Others are conquerable in the best of circumstances but that may not be what my client is experiencing right now.

Many women who do not breastfeed or who breastfeed for a few months do know the benefits. They often feel quite guilty that they are not breastfeeding. The question for birth professionals must be how are you going to support women? If you take rigid stance on an issue and don’t open up for exploration and conversation, you may miss a beautiful opportunity to help a woman birth her baby.  You may or may not be able to help her decide to breastfeed. Can you be at peace, knowing your respect and openness are more valuable to her at this time?

 

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Trauma

(As always birth stories are told with time mysterious delays and details changed).

The birth looked lovely. We were in a mother friendly hospital with very nurturing midwives. The mother labored well. Her husband held her hand. Her sister pulled her hair off her neck and teared up. I was busy with cool cloths, juice and words of comfort. It was her second baby. The labor was quick and relatively easy. Her baby was born in perfect condition.

We were in a play. Everyone acted just as they should – and still, there was something not right. My client was unkind to her spouse, dismissive towards her sister, and distrustful of the staff, arguing her case for things that they were trying to give her. She was getting everything she wanted, but she was not able to access it. Communication lines were failing. The midwife was lovely, but too soft spoken under the circumstances. I was translating in both directions. They didn’t know each other – that happens sometimes with on-call schedules.

Everything went so well but felt so wrong. It wasn’t the pain. I’ve been with many women in labor so I’ve seen pain. This was trauma. It may have been a previous birth or it may have been abuse – I don’t think from the current relationship – or it may have been both.

She was more peaceful and herself in deep labor. Her anxiety abated but swept back over her after the first moments of her baby’s birth. They were healthy. The dad held the baby and took pictures. They’d be sent home in a few days. I went home painfully aware of statistics.

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All is Calm

Everything will sit quiet here awhile. I’m off to help a mama have a baby. When I get back, I am going to respond to some tags & challenges. I hope you will play too:
Telling a Story in a Hundred Words, from Slouchy
&
Year End Review, from Heather.

Go visit and play along!

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If you have heard of Henci Goer, it is probably because you have reading A Thinking Woman’s Guide to a Better Birth. Her other major work is Obstetric Myths Versus Research Realities, which is quite dense book, not exactly light fare pregnancy reading. I read this work as part of my childbirth educator certification. What I sensed intuitively, she has documented thoroughly: many of the most common practices in American obstetrics have little medical basis.

Working as a doula at hospitals here in Connecticut, I see in practise things that I know serve no purpose, that have no benefit and even can do more harm than good. I see different practitioners at the same hospital stating their preferences as though they were set medical truth which must not be questioned (No, you may not get in the hot tub if your water is broken. Yes, of course you can get in the hot tub if your water is broken. No, you may not get in the hot tub until you are 4 cm dilated. Yes, you may get in the hot tub, until you are 4 cm dilated.)
As a professional, I find this to be frustrating. As a laboring mother myself, I found it maddening. After Henry was born, I was very much in need of stitching; he had been transverse & the last moments of labor were just dreadful and messy. At some point after I had nursed him a bit and cooed him to sleep, the baby was whisked away to the nursery & I shooed Matt after him, as was always our plan. My own medical needs taking precedence at the moment. I hardly noticed his absence, wrapped up in my own pain and then transferring over to the maternity floor. By the time I’d gotten re-patched, cleaned and had my first dose of codeine, he was back. We nursed again and fell into a deep sleep.
Twenty two months later, I birthed Theo without a scratch. A hearty 9lb 3 ounce baby, after just a few hours of labor. They took him to the nursery after our feeding, to be watched for a whole hour (or was it 2?) – I was hardly tired, felt fine and literally watched the clock. I rang my bell begging for my baby to come back. I sent Matt in to be with him, but it all felt so stupid. We did not need the separation. It’s not ideal, though sometimes helpful or necessary, but in our situation, well, it was just dumb. If he had been on my chest, we would have slept. Instead, I stewed and got upset. I was told, of by huge baby with big old huge APGARS to match, that if “something” was going to happen, it would be within the first few hours. Oh, yes! They played the horrid “dead baby” card that I hate so much. I hate it because, sadly, sadly, babies do die. To me, the manipulative use of the “dead baby” card is a form of disrespect towards families who have suffered loss. Also, I see it as some form of terrorism for new mothers – who 48 hours from when you say that, you are going to ship off home with a 1-800 number, a few newborn pampers and a car seat check…with the seed planted, that “anything could happen.”
Damn it, people, we are all scared enough. Aren’t we?

So, where was I? Yes, Henci Goer, whose thoughts are much more organized than mine, led a seminar about the Illusion of Choice in Childbirth. It was a fascinating, interactive two hours at Yale – many midwives and midwifery students were there as well as local doulas. We went back and forth on what value information has in the obstetric setting of American hospitals. Knowing that separation from his mother was neither valuable nor helpful, did not keep my baby near me at Hartford Hospital, which is one of UNICEF’s 80 Baby Friendly Hospitals in the United States (Which seems to mean, I got a Whole Foods gift bag, instead of formula on my way out the door)

Birth doulas and childbirth educators have been working under the assumption, that if women have better information, they will have (and make) better (“better”) choices. It just doesn’t turn out to be that simple. Should I inform clients and students of options not reasonably available to them? There are no providers who will attend vaginal breech births here in CT. None, to my knowledge. So, hadn’t I better help them understand the procedures of a surgical birth and what the recovery will be like? When realities show me that choices are limited in scope, and in my ability to chose in a truly autonomous way

Yes, we birth junkies have our little illusion. I’ll tell you all about “natural” childbirth, and then you can go into the hospital and make your informed choice. Perhaps my own bias weighs too heaviliy there at times; perhaps I screen it out better on some issues than on others. We all have our non-negotiables. Maybe I have given you all the information in the world about the high risk of surgical birth associated with scheduled inductions, but it matters not one whit, your doctors are going to induce you, or fire you.

Hospitals have an alarmingly similar illusion – only it tends to translate into reality because in a hospital setting there are some big time power differentials at play. Their game is called informed consent. Its practice in the obstetrics department of hospitals is very nearly a laughing matter & usually goes something like this “it is time to break your water so your labor can move along, okay?” See, information and consent. The information is sparse, the consent is implicit. Informed refusal is hardly ever mentioned. Should you refuse that induction, you will have to find another care provider, late in your pregnancy. You could choose that, but your choice is now being made under duress, isn’t it? How free is your choice in that case?

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The baby was just 34 weeks. Her water had been broken for several days. He was a hearty little soul, quite fiesty – but tiny at just over 4lbs. To the NICU he went to be watched and cared for. Yesterday mom was discharged, and baby stayed, because we have no rooming in at the NICUs in our city hospitals. Nor is there any step-down NICU, for the babies being watched for potential problems, rather than being treated for problems. It was bittersweet. We were all so happy to see him doing so well. It was hard for them to leave their baby there. Yes, they may visit as much and as often as they like, but that is a far cry from coming home with a baby in your arms, a far cry from rooming in at the hospital. This baby is fine. His only requirements for discharge are taking all his feedings by breast of bottle (which he is doing), breathing on his own (which is he doing) and maintaining his body temperature (which he is not yet doing.) The crunchy doula in me wonders if he’d be just as well of rooming in with mom, sleeping at the breast, skin to skin under a blanket. The worried mother in me wants him and his mother to have the security of incubators and NICU nurses. Every part of me wonders, why can’t they have a little bit of both?

Next week I am going to join other caregivers in this area for a discussion with Henci Goer on the illusion of choice in childbirth. Tell me about it. No one plans for their water to break at 33 1/2 weeks. After that, choices are limited.

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