Oh blank page, how you haunt me.

Respect birth.

Home from a birth with a lot on my mind.

I recently attended an event where Carla Hartley from Ancient Arts Midwifery Institute spoke about trusting birth and her message of Trust Birth, the Trust Birth conference, etc. She was a warm and loving speaker and I reserve a little seat in my heart for her and what I've learned through talking with her, being challenged by her, and the little connection I believe we made while she was here.

I told her then that I struggle hard with this message of "Trust Birth"; I fear that it comes across too simply. Birth is not simple. Well, it is, and it isn't. Babies are born, they come out one way or another. The myriad ways that occurs and what must happen for a child to emerge from their mothers, those things are complex.

I have been sitting with my discomfort with these statements and exploring what felt so challenging to me about it when it hit me- I don't 'trust' birth, I respect it. By having respect for birth, I acknowledge that it's something I can influence but not control with my presence, that if I am going to respect birth I must also respect the mother, the father, the baby, the "Birth Fairy", and the Divine aspect. Out of respect, I listen carefully and with my heart, I tune in my intuition. I speak honestly and from the heart. I put away routines. Out of respect, I ask birth to be birth, I don't ask it to be a performance, or to be a healer.

Let's consider Birth and her many facets- Birth is always accompanied by Death who must ALWAYS be respected as well. They are married to each other, one can not appear without the other. Let's consider birth's many moods - playful and light, intense and focused, frustrated, surprising, so many personality aspects that have a heavy influence on the experience of all of us walking through it.

We approach wild animals with respect, honoring that we walk the planet at the same time and that if cornered, sick, or injured, one might lash out at the other. Approaching birth without that same deference is a huge mistake. We can't forget that despite our best plans and full commitment and best birth team and everything lining up behind green lights, that a sudden change can happen that shift the whole experience. Sometimes those experiences 'bite'.

I think approaching birth as if something is bound to fail is the wrong attitude. I heard nurses say to my client recently that continuous monitoring was required after they broke her water (no other meds or anything going on) that the monitoring was needed 'in case something happened' during those 40 minutes when she'd be off the monitor. I was angered by this, how dare they approach her with their fear messages? I 'trust birth' and so should they. I felt like I knew something they didn't, and I felt just a little bit superior for about a second. 30 minutes later her baby had a five minute long decel and validated their concerns and left me reeling. I still 'trusted' birth but in some way they were right- the decel would have been missed and then what? Maybe the baby recovered on her own and maybe not. I didn't respect birth in that moment, I was busy being in my head about how birth 'should' look. If we trusted birth, we wouldn't need all of this monitoring! Maybe in this particular instance this mom DID need the continuous monitoring her doctor was asking of her.

The issues aren't with what happened, but rather what they triggered within me. I wondered what would have occurred if we'd been at home with a midwife several times. I knew the outcome would have likely been the same but so many variables would have colored those lines in with myriad different colors, painting a very different picture.

I wanted to believe in trust being enough and I don't now. I struggled because "Trust Birth" felt like such an ideal, I just struggled to push through to get there. It felt more like a goal. Someday, I will 'trust birth'.

Today I realize that it isn't the truth for me, trust isn't correct. Trust leaves the impression of safety. We trust our grandmothers, we trust our parents. Respect works hand in hand with trust but also adds that element of caution that we accept some risk as a part of the relationship. We respect the mountain we must climb, we trust in our ability to climb it. We prepare for outcomes we may not expect and do not hope for.

Conversation

This was my response to an inquiry about a conversation I had recently, just tossing it out to the masses for discussion.

All my own opinion and practice here...

Meeting clients where THEY are at is the first step. It can't be done with your head, it has to be done with your heart. Hearing their fears, hearing their concerns, and standing behind THOSE while keeping the long view- the shadow is where their fear lives and that is often the guiding force of their decision making. What right do we have as professionals do DIMINISH that?? What right do we have to qualify their experience? It's one thing to say that it's frustrating to see that parents are not getting the information they need to understand how common a nuchal cord is, or to discuss the larger culture of birth, and it's another to diminish their experience because it seems silly, or even because the families just don't know any better.

For me, this reeks of the stories I hear of my friends who pursue nursing and have to stand at the L&D nurses station and hear the nurses criticizing and (this kills me) *laughing* at the mothers because of how they want their labor to go, or how they're handling it. Laughing at them!!! Now I realize that this is not what was happening but this is the seed of it- thinking we have something that they don't have, just because we are experienced and knowledgeable.

The judgment of parents puts us on the other side of a wall, not next to them which is where we desire (and they desire for us) to be. It's the shiny new doula with her ideals about how she's going to convince every client how amazing a natural birth is and to want it (that was me, 7 years ago). It's the birth professional who isn't truly listening with her heart, but processing with her head and the 'shoulds and should nots' that are just not helpful.

The client should do *exactly* what they're doing. They invite us in to help guide them and that is our role, to do that, to *serve*. This service requires the ego to step down, our encylopedic knowledge to take a back seat to a loving touch and a caring word, sometimes.

If one is going to make a lifestyle change, they must make it 24/7 a day until it becomes normal. They can't just do it when people are around. If we are going to TRULY elevate parents and hold them higher so that they might see themselves higher, then we must do it 24/7, with every word as well and this is what I strive for.

The beauty is that we are all exactly where we are supposed to be, wonderful teachers to each other! The call was a wonderful teacher for me, hearing the conversation and noticing my reaction to it- your inquiry was the next, because I had not formed these thoughts fully into words until now and it feels good to see it clarified. :) Thank you for inviting me to share!

Your Best Birth by Ricki Lake & Abby Epstein

I'm currently reading Your Best Birth by Ricki Lake and Abby Epstein, a pleasant surprise from my local library. I love that they're getting current birth books; occasionally I'll forward them a list of books I think they should have on hand and I've had good luck with seeing them on the shelves before too long. It helps that I tell them that I'll be referring my clients to the library to find the books.

Oops, went off on a tangent there- hope it's helpful to someone anyway. :)

So I'm reading this book finally- I did see the Business of Being Born and I know that I will eventually own a copy and lend it to clients. I'm enjoying the book thoroughly; it tells the story that as of yet, I've not seen another book explore. Ricki and Abby do a brilliant job making the complex maze of maternity care in our country seem to make some kind of sense (even if it's not what you wanted to hear), without vilifying anyone. The maternity system is what it is - it's easy to point at everyone else as the reason but the reality is that we have all brought it to this place, and now we must keep shifting.

One thing I read that I thought had a great foundation (if only needing a few tweaks, for my taste) was talking to women about what questions to ask when you visit the hospital where you will give birth. Rather than asking questions that are easy to gloss over, "Do you have birthing tubs?", asking something more specific to what you want to know, "What percentage mothers use the tub for pain relief in labor?" It's easy to hear "Yes, we have tubs," and then run with the idea that if they have tubs, it must mean that they use them- but it may not necessarily be true.

This book isn't about what your uterus is going to do in labor, it's more like a handbook for navigating the political side of birth to get what you want. I know birth professionals have been quietly coaching our clients with this information, how to talk to your provider to find out what you really want to know, how to avoid routine procedures you don't want, how to ask for what you do want, how to craft a birth plan that will communicate effectively for you... it's a huge boon birth professionals to be able to point clients to this book - easy to both read and comprehend - and it's a boon as well to the women who will see a familiar face in Ricki, and pick it up just to hear what she has to say.

Birth Activism

Especially now since being on Facebook and seeing that explode, and having been a doula for as long as I have, I've seen many birth activism efforts over the years. Every single one has passionate, fierce people behind it, and each one, in their own way, thrusts the movement toward informed consent and true choice for women and babies a little bit closer to the target.

I was 20 when I had my first child and I was nothing if not ferociously passionate! I couldn't imagine why any woman wouldn't want to breastfeed her baby. I couldn't even speak to women who wouldn't try without feeling disgusted and superior. All my passion was mixed up in judgment but it was there! (Another post about judgment is forthcoming, methinks.)

I see these amazing orgs and groups with their machetes, chipping away at the dense, prickly and predator filled jungle that is American birth - and I no longer feel pulled to be alongside. I'll walk behind them, lifting women up to sing their birth songs and find their own machetes. I suppose maybe this is my own way of chipping away at American birth, by helping women, wide eyed, yelling, laughing, bawling, sweating, but every single one SURGING in her own way, to discover where they want to stand on this path. We all choose, even if we choose not to choose.

I sometimes feel guilty that I'm not writing letters at every opportunity, attending every conference (or any, for that matter, but it's solely due to cost), staging protests - I feel the urge to do it but realistically, it's just not realistic for me.

My heart, love, and pride is with every person out there who is working hard, every day in action and in spirit to make things better for families in our country - and soon enough my hands will be alongside yours. Is being a doula enough? Is telling women they have options, standing beside them as they tell their truth in shaky voices, and witnessing them discover the Mother Warrior within themselves - is that enough? For now, it will have to be.

Confessions of toddler nursing

My daughter is going to be 2 next month and while she's still small-ish for her age, I'm feeling that familiar sensation of discomfort nursing around other people. I'm rather fierce in real life, I really don't let other people define how I should parent in order to fit in the 'good' category- I do what's right for my own family and I don't ask what anyone thinks about it. I try to meet situations with compassion, especially those which do not reflect my own values. I do feel strongly that we don't nurse long enough in this culture and that it hurts us in obvious and subtle ways, as individuals and as a culture.

I nursed my oldest until he was 3, my middle until he was 4, and I felt strongly since I started having babies 12 years ago that babies should get to have the milk their mamas make for them. I've worked with countless women in person and online who were nursing babies and young children of many ages - at some point it stopped phasing me.

And then my own children would hit about 2 and I would become suddenly sensitive to what I perceive was the outer judgment of my decision to continue to put my wee one to my breast. I would have met any reproach with either stinging rebuke, recitation of the laws protecting my right to do what I was doing, or 101 reasons why breastfeeding was best- I was armed and ready. Inside, I was a little embarrassed, a little uncomfortable, and wishing that there was something, anything the child would accept in lieu of the breast at that particular moment.

Now my daughter is reaching that age where my comfort level goes down, but my values stay steady- even if I am uncomfortable, she has a right to her milk. This shows me so clearly the inner workings of other moms whose scales might tip the other direction - knowing the babe should ahve milk but feeling so terribly uncomfortable nursing around others that other 'reasons' begin to manifest to justify weaning. I feel that, I really do.

I've been on many forums where any opportunity to wean was jumped on, and I've been on others where discussion of weaning was considered almost abusive if mentioned before the age of 3. I've seen women be told to 'suck it up' when they were in my shoes, and others be encouraged and reassured that if they weaned, they did a good job and were still good mothers (as if when you wean defines your quality as a mother!)

When I think about weaning my daughter I feel a small little sense of relief, to be finished, to be able to put away the nursing bras I don't love, or having to deal with how to nurse her and keep her in a shopping cart simultanously without fully exposing my breast, or how to not have to pull over while driving because she is tired and insists on 'meelk', even a top off to help her fall asleep.

And then I look at her face and wonder how I could ever break her little heart by taking away something so integral to our relationship, to her day - the one thing that allowed me to feel like a mother to her in her first week of life when I could only hold her in the nursery and hand her back over to the women who mothered her the rest of the time.

I nurse her to sleep for her nap and I feel no reservation, no desire to wean us from nursing, to say goodbye to those milky laughs and her sweet breath - it's all about me and the stories I tell myself about how other people view me for nursing her.

Every day, I just choose to get over myself and give her what she needs, give her what I need to give her.

Back to work!

Woo hoo, I'm back to work! A friend re-invited me to her birth which I think is coming up in September, I was hired by another friend for her birth in March, and then a new client tonight due in October!

It feels wonderful and new and strange and exciting to be back to doula work, FULLY present and back. Am I ready with all my papers and processes? No - but am I ready? Yes!! Yes, oh yes, I feel like a newlywed!

Recommitment

My 10 year wedding anniversary is coming in March and we're in discussion about what to do to mark that special milestone. We got married with just two friends in attendance and then didn't even tell our families until three months later - so there was never any party or hooplah where we could celebrate together and I feel called to consider doing something like this.

In cycle with this, I feel renewed in my commitment to birth work, refreshed and ready to look at what I do, and where I want to go, with fresh eyes and an invigorated heart. I do still toss back and forth the idea of being an OB/GYN - I don't know that any birth professional has inspired me more than my own OB, despite the many areas in which we disagree, he has shared so many incredible experiences with me (having to do directly with me and my own care, or with a client we shared) that I feel almost guilty when I think of not following in his foot steps. I think sometimes too about midwifery, I am always questioning myself on that- am I a midwife?

I feel that I don't know the answers to these questions because truly, all paths are open to me. What I do know, deeply and in my core (the way I wish I knew about being a doc or midwife), is that I want to move forward to being a great childbirth educator, a great doula, a connected henna artist and to teach couples and young women about natural family planning. I can claim that dream with clarity. I'm part way there, or there and needing a little housekeeping, on some of these, and no where near others, and that's part of this journey I suppose.

I have let the mechanisms of my doula work fall to the wayside as I a) got burned out, b) got pregnant and decided not to work through the pregnancy and after she was born, c) started attending births before I had picked up the ball, d) pursued a partnership -- and again, never went back 'home' to rekindle my relationship with my own practice. I LOVE my practice. I LOVE my methods, I love how I have things organized, I love that the client and being sustainable (in an energetic sense) are built in as the priorities. I love the confidence I have when I am organized.

I just haven't been organized in a very, very long time!

I want to just throw out everything I've collected over the years and start fresh with new things. I want to use things I've chosen rather than things I've inherited - and so I will.

Shifting a culture

I know we're doing it, and the momentum is building. Is there a way to go about consciously and intentionally shifting the culture of birth? It really does happen on the grassroots level doesn't it - the masses must shift before the powerful minority will follow.

I wonder what that will look like as the wave starts to crest.

Pit to Distress

There's been a hubbub of late over Facebook on the recently outed term, 'pit to distress', wherein a provider will amp up Pitocin until the baby goes into distress (or shot across the room) so that a surgical birth can be performed, and the LDRP room turned over.

I think back over my time as a doula and I can't say any of my clients stick out to me as having experienced this but I'd have to go through my records because honestly my memory sucks. (Trust me, there's nothing worse for me as a doula than to run into a client who knows me but who I don't remember.... DOH!)

There's a follow up to the initial article here - and after reading it (also check out the links at the bottom of that page) I got to thinking about this looming wall that women and defenders of Birth (with a capital B, as in, unhindered, supported Birth) throw ourselves against.

I have stated many times (probably not in a recent enough post here that someone could pull it up but if you know me personally you know this about me: the current state of maternity care (if you can call it that) is NOT the doctor's fault.

Ha! Yes, yell at me, I can handle it.

It's not the doctor's fault. It's not the mother's fault. It's not the insurance company's fault.

Every one of those facets are looking out for their own interests. Women are looking to get through birth with the least amount of trauma and the highest illusion of safety. Doctors are looking to get women and babies through birth with the least amount of potential liability and insurance companies want to save money and not get sued either.

Blaming doctors is convenient and easy. And that is not to say that they bear no responsibility - in fact I am saying that we ALL do.

It is the culture of birth that must be shifted.

The culture where the number at the bottom of the spreadsheet bears more weight to us than the safety of women and babies, of preserving families.

I am not saying I have answers on how this has to happen and I know it is happening in myriad ways - every country and culture has their successes and failures where it comes to birth/maternity care. Some have more successes and others have more failures.

One of the fundamental things holding us back from progress in my opinion is the absolute unwillingness for doctors to converse with the many other facets of care that arises in birth. Long have I fantasized (and I know I'm not alone here) about a summit of people who cared primarily about providing the safest and highest quality care for women.

We can develop these questions and grow our outrage but at the end of the day our platform is the childbirth class - the quiet meetings of women at playdates discussing their birth stories - and in conferences where women reveal and are revealed in their own stories.

After reading this insanity about 'pit to distress' and how it is not an accidental consequence of events but an intentional sequence set to force women and their babies down a path without their consent or knowledge - I want women to stand in the streets! I want families to write articles to newspapers and blog for the revolution of maternity care- that the compass always be pointed toward true north - safety balance with compassion - and that no entity, group or individual, be allowed to sabotage that course.

I adore my obstetrician- I want so much in so many ways to follow in his foot steps. When I hear about things like 'pit to distress' I suddenly feel pain in my ovaries that require me to make an appointment with him wherein I can pepper him with questions about his practice, things he's seen, the right-ness and wrong-ness of it and how women can avoid it in the future. I also recognize that he is wonderful but not infallible and a part of me does not want to find out that he has consciously participated in this.

I think I've been hearing about the cesarean rate for so long (and now, being one of those numbers), that it just doesn't fire me up anymore. I know there are incredible organizations and individuals that are watching, recording and performing their many brands of activism around that.

For me, this fires me up- not the term or the fact that it's happening but that it has come to this at all. So where do we go from here? We've learned that women, while under anesthesia, were having their vaginas invaded without their explicit consent by students, we've learned that in some states the cesarean rate is approaching 50%, we've learned that women are being systematically lied to by providers (midwives are not without dirty hands!), that women were being given medications that were causing their uteruses to burst and their babies to die despite the outcry, and now we discover 'pit to distress'.

Enough is enough.

Let the games begin!

I haven't written in ages. I haven't felt inspired whatsoever. I've been experiencing many things in other planes of my life that I have just not wanted to share, and not a single one had anything to do with birth.

I actually spent a few days thinking that maybe my season as a doula had finally waned- that after about 7 years, maybe it was time to 'move on'. I had fantasies of what it would feel like to leave the birth community, leaving this sense of responsibility I have to birthing women and to myself, and to the many colleagues I've learned from, loved and even lost over the years. I thought, maybe this is where this ends, and it's not on a bad note. I can move on. I will admit to even having some sense of relief.

I was invited to do henna (my new venture) at a local birth meeting and I told a few of my colleagues who have known me a long, long time about the thoughts I'd been having. I saw a few looks of shock and other looks of commiseration, which in turn shocked me!

Listening to these wonderful midwives strategize the best care for women, the most impactful with the least intervention, and the magical subtleties that happen in that birth space between the child and its new environment, between the mother and child, within the mother herself, between the mother and her partner, the partner and child, and all the myriad finer points in between, I felt something stir... a little spark jumping inside of me.

I left that meeting feeling excited and stirred up once again and I realized that I have been starving the flame of birth work inside myself- I have had a few clients since E was born but they were largely friends or people who just wouldn't take no for an answer, toddler strapped to my back or not, I would be at their births! (By 18 months E had attended 4 births with me!) Beyond that, I have had no interaction with colleagues, the local doula discussion lists have been quiet and hard to wake, I've been to no workshops or seminars or conferences.

I realized that even though I might have a passion for what I do and I KNOW deeply in my bones, within my Spirit, that I am doing what I am supposed to be doing on this earth, that those fires can become starved when they aren't fed. Attending births isn't enough, it is the sharing of ideas, the feedback on interesting clients and births, the outrage at the current state of things, the comraderie with my sisters who are all fighting the good fight in their own ways - that is what fuels me!

So after a long hiatus and some hard questions within myself about who I am as a birth professional, what my boundaries are, and what I am willing to risk to do this work, I return to my blog and hope that the wonderful people who challenged me, held me, and helped me to become the professional I am today, will still come along for the ride. :)

Trying it on

Had an urge to write a post about birth - no real topic in mind. Maybe I'll write about discovering ourselves in the space of the birth profession.

This is a topic that is alive for me right now as my partner and I discover that we are in need of discover/rediscovery of our own identities as doulas and birth professionals before we engage as partners. We talked tonight about the initiation that occurs as we enter into this work and yes, when I look back I see many stages of initiation for which I'm grateful, but didn't necessarily love experiencing.

I forget sometimes that while I am one of the witnesses and guardians of the space as parents are initiated by their birth experience, that I am also experiencing my own along the way as well. I can't remember the exact moment that I realized that it wasn't about the OUTCOME. Thank goodness it was early on, but what a huge weight it was off my shoulders to not feel that I had to perform in a pass or fail way with my clients, but that I could be a part of their experience in each moment, and remind them to BE in that very moment.

I remember when I first started out, wanting to keep track of statistics and after just a few clients I realized how fruitless that was, and how skewed it caused my focus to be.

I think it's time to start writing again! Woo hoo. :)

Getting fired

Oh the joys of getting fired. I wasn't going to write about it because I was a little embarrassed but I'm not anymore. I've learned a lot from the whole experience- having a doula client also take classes and then fire me from both. It wasn't as all together painful as I thought it might be, the communication through the process was really open and relaxed, and her feedback was really valuable to me.

I knew I'd learn something big and I did, and something really fundamental too. People need to feel safe, and bringing the energy of safety isn't enough sometimes. I created a class environment where upon arrival I felt frazzled and stressed, mildly concerned about how this class would work in this new space which didn't really serve my needs. I jumped right in as I always do, not thinking that if *I* didn't feel comfortable, how could I ask my clients to feel comfortable? I learned several things:

* Introductions aren't just fluff. Take the time to do them.
* People want to have some idea of what to expect even if the structure is loose.
* The space should feel safe and receiving, and easy to be in. It doesn't have to be fancy to accomplish this.
* Arrive to the space early enough to set up and feel relaxed before people arrive, rather than rushing around sweating when people start arriving.
* Ice breakers should be very basic in the beginning until trust is established.
* People don't want to do art if they don't feel safe.

Lessons learned.

Partner and I are looking to rent our own space, which will be such a glorious coup! Something small enough to not be expensive but large enough to accommodate classes - something we could rent out to other teachers or use for meetings if we want... ahh!! I don't know how we'll accomplish this honestly, a doula/teacher's income is so sporadic. I think we'd have to really step up our marketing rather than passively taking clients as they contact us. It's something to talk about, for sure.

Settling

I've felt so stirred up for so long, weeks and weeks, that now things are starting to settle and it feels like my brain actually gets a chance to rest once in a while.

Yesterday I started my class series and it definitely went directions I wasn't expecting but I think at the end it shook out to be beneficial for everyone. Interesting how that happens sometimes, my ego was a little bruised but I think I recovered well and offered what was needed in the moment.

When I got into the BFW program and started learning about mentoring I didn't get it. I guess I did get it to a point, but now that I've gone through this gauntlet these last few weeks and had this opportunity to clarify my values and where I want to go as a doula and educator, the mentoring appeals much more to me. My partner agrees and this is the energy we are taking into our work. Personally I think BFW relies a little too much on it and isn't quite as balanced as *I* needed, but yeah, I think they're definitely on to something.

Gah. This makes me nervous but...

The first five people to respond to this post will get something made by me! My choice. For you.

This offer does have some restrictions and limitations:

I make no guarantees that you will like what I make!

What I create will be just for you.

It’ll be done this calendar year.

You have no clue what it’s going to be. It may be a story. It may be poetry. I may draw or paint something. I may bake you something and mail it to you. Who knows? Not you, that’s for sure! However, I *do* promise that it will be more than just a handmade card!

I reserve the right to do something extremely strange.

The catch: You have to put this in your journal as well. We all can make stuff!

** I have a goal this year to procrastinate less (I'll get around to it.. lol) so this will be a good challenge for me. **

Peer review again

So I'm going to do it, I've put the word out to local folks who are interested in peer review. I've polled the greater community and I feel like I understand better now after talking with a few close mentor-friends about why this idea isn't sweeping the community. That's fine. I feel like I want to go to the next level with my services, and really take ownership of the consequences of my decisions in a different way from what I previously did.

It's been hard to stay involved in lists and boards where people are throwing medical advice around - it's one thing to refer someone to information so that they can choose for themselves or take that information to their provider (or whatever they want to do with it), and it's another entirely to be telling women online what lies to tell their provider, or what herbs to use to start labor when the doula has no training, etc. It goes on and on. It's not black and white, the medical system is fucked, it lies to women more than anyone else- I think I've seen good informed consent once or twice, once at an abortion I attended where the risks associated with Cytotec took two pages which she had to SIGN (rather than "it's just a little pill" women hear in the hospital when they're being induced), and the other with my own OB/GYN. I do think I'm starting to understand informed consent a little more though and have some understanding of where docs come from when they don't feel they have to educate their patients - a lot of patients either don't want to know, don't care, or can't understand it. That doesn't excuse the provider from helping the client to understand before decisions are made though- but our system isn't set up to allow the provider in a busy clinic more than 3 minutes or whatever per patient. I mean, this system is fucked. It needs a serious overhaul.

Back to my original point (I think I had one)... I am having to really look at my connections and see if a) they're feeding me and b) if I am giving something back. I'm feeling right now that I'm more of a bur in the sides of those who like things just like they are, and that's not so bad, but it's pointless unless it drives discussion and it doesn't seem to be. So I'll just sit on my hands in public and come here (you know, my "private" blog.. hardy har har) and say what I need to say.

My friend said, "Tell the truth." I'm really intent on doing that - the truth as I know it is that the doula community has become so expansive and the definitions of doula work so broad that standards of practice (unless you're in a certifying body who tells you the SOP) are almost impossible to nail down. I frankly believe and have said many times that this HURTS our profession more than it helps us. Doulas are non-clinical care providers, but then we have midwifery students who are also doulas blending the lines... or doulas who want to be midwives going outside their scope... or doulas who think they are shields for clients and need to protect them from a birth the *doula* doesn't want her to have.

Doulas are not heroes. We aren't the protectors of women from the 'big bad provider'. It *disempowers* women to be their voice for them, we are no better than the providers from whom they think they need protection! For me, this means teaching my clients how to discern whether this provider/birth space/decision is right for HER, not for me, not for her outcome, but for this moment, right now, with the information and intuition and resources we have in THIS moment. If my client says she wants a 'natural' birth, what does that mean? "Natural" birth is just a word with a really nebulous definition. Does it mean no pain meds? Does it mean narcotics are okay but not epidural? Does it mean no Pit? Does it mean no vaginal exams? Does it mean homebirth? I might think my version of natural birth is what she's trying to achieve but if I don't listen and really hear my client, we might be moving in two different directions.

Doulas are not quasi-providers. One thing that drives me up the freaking wall is the 'doula as herbalist/homeopath/nurse/midwife'. Wear one hat, girlfriend, you only have one head. I don't know how to word this without sounding bitchy and I'm only half worried about that, so I'll just say it. *Doulas have no place giving medications, herbal or otherwise, to their clients unless they are herbalists!* Oh, and this one... *Doulas have no reason whatsoever to have their hands in a client's vagina!* Even in an emergency situation (unless the doula is the only one present), a father/partner can catch their own baby, there's no reason for the doula to get involved except to continue to provide support and encouragement. Of course there are exceptions, maybe dad fainted or something, whatever, but it's safer for everyone if the doula errs on the side of letting the mother's body do what it needs to do and helping dad to stay calm and present. Is a doula trained to manage a dystocia if it happens? Sure, we've all read/heard about the Gaskin maneuver but do we all know how it works, or what signs to look for that it's working or not? And what happens if we think we know what to do, try something and screw it up worse? Whose responsibility is that?

I don't think that we need to practice in fear at all. I think if doulas stick to what we're there to do, love and support the couple, share resources so that they can make decisions, we really don't have much to fear with regard to the law, or overly controlling doula policies in hospitals.

So what do I say when I see doulas bantying medical advice between them trying to clarify what to tell a client about the risks of something? Right now, I say nothing. I'm too fired up about it, so I'm just holding my breath until I can be settled in myself and calm. It feels good to write, though.

What is a doula, anyway?

After six years I find I'm rediscovering it. It's not (for me now) what I thought (it was), and I'm not moving in the direction I feel is right anymore. I used to identify myself as the 'knowledgeable' doula and now I find that I want to learn more about mentoring, working alongside my client in a very different way. I think this is what attracted me to Birthing From Within (even though the love got lost along the way, I retained that value), the idea of mentoring and growing and learning alongside clients rather than being the keeper of the knowledge.

I don't like, nor agree with the perceived authority that comes with being the knowledgeable one. When a client looks to her doula and asks, "What are the risks of this decision?", the doula becomes the authority figure and the energy shifts from the client being in charge, the provider being responsible to distribute information, benefits and risks. Suddenly the doula is pitted between the client and provider as the 'trusted' person. No wonder providers don't like doulas! When did our role shift from being loving heart and hands to being the extra encyclopedia that clients could bring to their births?

What if we put the onus on the client to hire a provider she trusts, choose a space in which she feels safe, instead of hiring a doula to act as her encyclopedia, lie detector, advocate and defender? How many potential clients have I turned away when their inquiry was around me telling their provider NO if necessary? No wonder providers look at doulas as potential witnesses in lawsuits. If clients are trusting their doulas over their providers, who is legally responsible for a bad outcome? No wonder these waters are so muddy, and the bridges almost impossible to cross.

I'm learning to ask more questions than answering them. Even my teaching involves asking questions and helping them find access to answers (with a foundation of basic knowledge). I think the whole point of my classes is not so much to teach them about the benefits and risks of every possible thing they might encounter, but rather give them the tools with which they can get the information they need in the moment to discover that information for themselves. I really believe that that is where the power and strength lies in this work, because these are tools that the parents can take with them as they go forward and parent their child.

I have several goals this year - I want to be profitable at the end of the year (and that can be $1 into the black, that's fine!), I want to teach four class series (at least), and I want to have clients every month that we're accepting clients. So far we have clients in March and April; I am holding the door open for clients to fill slots for the rest of the year. I just ordered a business license so I'm looking forward to taking that next step to organizing my business as a business and not just an expensive hobby.

I feel concerned at growth of this profession in numbers without the growth in integrity and clarity. I raised the issue of peer review and I am really shocked how no one seems to have any feelings around the idea, supportive or challenging. The assumption is that their needs are met by talkign with a trusted partner or their own doula collective - but where are the lines of confidentiality drawn THEN? Doula orgs have standards but doulas can be certified for years and unless a client were to complain the certifying body would never know if the doula was breaching confidentiality or not.

One doula organization says that the concept of peer review challenges their ethics and they would not support it because confidentiality for the client couldn't be guaranteed (as if midwives or doctors can guarantee it?). Another org supports the idea as a positive one and is looking at ways to create a space for their doulas to participate in this in some way online.

For me, this feels like a 'taking it to the next level' thing. This feels like it could develop into a way for doulas to be taken much more seriously than we are, and for us to take ourselves more seriously than we do. I can't even fathom the types of things we might learn about our profession, our motives, our methods of delivering our agendas (which do exist), our diplomacy within the birth space, etc.

What hesitation do we have to go to the next level, to deliver better services, and to take more responsibility?

Paying the bills

I received payment from a couple of clients in the last few days and when the check arrives I feel really excited! Five minutes later when it hits me that I have to split some with my partner (whom I love!), pay for teaching space, buy materials, etc., I wonder if there will enough left for a trip to Starbucks.

I had to buy a business license so that I can bill the insurance company of another client who is trying to get them to reimburse for my classes. I have never done this before - I really can't afford to take on a student for less than my fee if I don't absolutely have to, so assuming the insurance company pays me, will they pay my full fee? Now that I've paid out money to get paid, will I even break even? Gah!

Peer review

My first post back. Baby's sleeping and this has been floating around my mind for the last few days. It's just an idea at this point but it's already raised some big questions and solid answers in my own little community, so I thought I'd toss it out here for mastication by a larger crowd.

Doulas have networks, we have organizations that train us, certify us, promote a code of ethics and offer a grievance policy. We have networks that offer preceptors, apprentices, business training, networking opportunities, and referrals. We have online forums where we can ask questions to doulas all over the world about every topic we might come across.

What I've never seen is a peer review process. I know that medical providers have such a thing- using midwives as the example, this is a link to their standards as put forth by NARM. I envision something very similar for doulas- a round-table environment where the facilitator is neutral and not involved in the content of the meeting but holds the container of organization and safety for the participants. All participants would agree in writing to standards of confidentiality and these standards would be read before the meeting (maybe?). Everything said within the PR process would remain there. The doula bringing forward a case would have permission from her client to do so, but would respect the anonymity of the client by discussing only the most pertinent details to the issue at hand.

* The client's decisions would not be under review (as they obviously are her own)
* The medical decisions and behavior of the provider would not be under review

The facilitator would be on watch for discussion that tended to lead toward either of these topics (as it is very difficult sometimes to not ask WTF someone was thinking when they ____), and keep everyone focused on the doula's process.

The doula would then ask for feedback, support, and suggestions and would be able to hear back from the group.

Is there a need for something like this? I've heard some passionate desire to have this sort of thing and I've heard some dissent as well, but nothing that struck me as weighing so heavily as to make this impossible or even a remotely 'bad' idea.

The more I've Q&A'd this, the more it flushes out in my mind and the more I think that this process might be valuable to doulas as well. It's another way for us to develop our profession in a more complex and meaningful way. I'm becoming more and more supportive of the idea as it gains in complexity. :)

Feedback anyone?