Chapter 1
~Daring to Doula
Not all Septembers are this hot, but this September felt different. It seemed almost poetic to Sarah. She was sipping the one margarita that she would allow herself while on call as she pondered the last three years of her life. She never expected to become a doula and yet here she was. Just three years in, and she felt more confident and certain of her career choice than ever. Awareness had increased significantly since a new federal law was passed to mandate doulas be covered by insurance. The law, which highlighted that doulas correlated to a decrease in cesareans, took longer than hoped to pass but now that it had, the US began to focus on a better, more mom/baby centered experience. Thanks to this change, families were seeking out assistance more often and Sarah was doing well. A kind-spirited, animal-and-nature-loving person, Sarah enjoyed getting to know her clients. She felt genuinely honored to be included in their journey and that thought brought a small grin to her lips. As she sipped her drink, she continued to reminisce about this past year and the progress with the project at the hospital. The huge influx of requests prompted a working partnership with her and she began guiding new interns through their certification. The hospitals now regularly staffed midwives and doulas so Sarah worked closely with Seifts Medical Center to allow training doulas to shadow her during births at their facility. Glancing down, she realized that her glass was empty and considered it a sign to turn in early so she could get as much sleep as possible. She checked on her twins, who just turned 10, and gave them each a kiss on their forehead before making her way to the bedroom. she slipped into some PJ's and slid into bed but not before checking her ringer for the third time to be sure it was not on silent before drifting quickly to sleep.
Chapter 2
~Admiring an Apprentice
She was a clever quick-witted woman with an infectious smile and Sarah was so happy to be working with Danielle. Today she would be taking her to an in-home prenatal with a repeat client who was pregnant with her second child. While carpooling to her clients, the Andersons, Sarah and Danielle talked a bit about why she decided to become a doula
" Really, it has so much to do with the lack of knowledge and resources in my own community. I want to help women of color break down those barriers and really remind them how powerful and in charge they are. I want to start by really focusing on the knowledge end and plan to work on handouts and packets that really highlight the many resources available to us."
Sarah was filled with hope as she watched her new friend gush about all the information she had just recently learned.
"I mean learning about the 'harsh environment' theory was definitely an eye opener to me!" a serious look etched into her brow as she continued. "Like this for instance, Evidence Based Birth says, "'ever since birth moved out of the home and into the hospital, laboring people are frequently submitted to institutional routines, high intervention rates, staff who are strangers, lack of privacy, bright lighting, and needles.' Which as you know effect progression of labor by causing the birthing person to release fight or flight hormones, essentially stalling it until they can establish that they feel safe again..." she trailed off. "I am just happy we are starting to really listen to families and especially the birthing person, they deserve to be listened to and their emotional health should be protected as well."
Sarah nodded enthusiastically. She listened as Danielle continued on a bit more and began to talk about stress during pregnancy. She explained about how she had recently read a book, Parenting for Peace which indicated that stress was absolutely a teratogen. "You know they usually reserve that word for things such as drugs or chemicals that could effect and deform fetal development, but I am starting to believe that stress is something that we don't address enough." She sighed as she closed her eyes for a brief pause "This rabbit-hole led me to an article which tries to explain "Why Black Mothers and Babies Have the Worst Birth Outcome in the Nation" her head fell as her gaze met her knees, "I found it most interesting that a Dr. Braveman believes, 'It is absolutely plausible, scientifically, that the chronic stress of being treated unfairly or viewed unjustly because of one’s race—or even just worrying that this may occur—could cause physiological changes in a woman’s body that can in turn put her infant at a disadvantage,'"
They pulled up to the Anderson's and collected their bags then began to walk to the door
"That sounds like it could seriously hinder her health, chronic stress can even weaken the immune system and should be closely watched through the pregnancy and postpartum period ." Sarah shook her head with a look of indifference. "It’s why I know this work that we do is so important! This new bill has really shined a light on the psychological aspects of birth and how it can also seriously affect labor, birth, and postpartum. I think you're certainly looking in the right places and I am excited to hear more about your research as time progresses!"
They both stepped up to the door...
KNOCK KNOCK KNOCK
Chapter 3
Power of Prenatals
They were quickly greeted by Mr. Anderson and were directed into the living room where Mrs Anderson was sitting. Eating a bowl of fresh berries as she painted what looked to be a solar system but upon closer inspection was shown to be a uterus and ovaries.
"Oh, hello!" Mrs. Anderson chirped as she looked up. Realizing she was being watched, she quickly stood up.
"I am Alisha Anderson; you must be Danielle!" she exclaimed as she pulled her in for a hug. "Please call me Alisha."
"And Sarah! I am so happy to see you again."
"Hello Alisha" Sarah said warmly. "I am delighted to see you again too! Are you ready to get started?"
Danielle sat back to watch as Sarah got to work. Starting first by asking Alisha some questions and filling out a short questionnaire with her, she then followed it up by talking with both Alisha and her husband about how they envision their roles in the birth and how they envision hers as well. What Danielle noticed was that Sarah listened to the Andersons. She did not interrupt them and always repeated back to them what they said before providing evidence-based information regarding their questions and concerns. Sarah came prepared with a small packet of information, and additional inserts which she handed to Alicia to allow her to choose from.
"Let's see what you have selected" Sarah said. "Cord Clamping; this is an excellent handout. Do you have any specific questions about it?"
"Well, I wondered about possibly waiting until the placenta was born," Pondered Alicia.
"That is a great question, and there are many different parts to that equation."
"Will it be allowed?" asked Alicia
"Because my support is not clinical in nature, it's not my place to say. This is something that you can always do some research on and then speak with your midwife about your findings. I can also put on your birth plan that you wish to delay until such time as long as circumstances allow it." Sarah continued, "Would you like to go over a great way to work through these questions with your midwife, Alicia?"
"Sure! I always have a hard time saying exactly what it is I want. I get all these ideas and sometimes I feel a bit crazy but other times I feel like my gut is telling me to go with it." Alicia paused "I just feel a bit judged sometimes is all"
Sarah placed her hand over Alicia's, "You should never feel this way, and I'll never judge you." she said matter-of-factly "This is how it works; you can remember it by the Acronym B.R.A.I.N"
"B..R..A..I..N?" questioned Alicia
"Yes, and it’s pretty clever, I promise! I have also had to use it when I was pregnant with my daughter" Sarah giggled, as she flipped through her handouts. "Here it is," she said as she placed the page on the table in front of them.
Informed Decision Making
Benefits - What are the benefits?
Risks - What are the risks?
Alternatives - Are there alternatives?
Intuition - What does my intuition say?
Nothing - What happens if I do nothing?
"Oh, this is pretty simple, I can try to use this for sure." Alicia smiled
"You can even keep a smaller version in your purse!" Sarah encouraged "Now that we have talked a bit about your preferences, I am going to start putting together a sample birth plan. Is there anything else you can think of that you would like for me to include? " Sarah continued to make notes as Alicia visibly searched her mind’s eye for all the wonderful questions that just floated about. Yesterday she could hardly escape all the questions and thoughts as she attempted to fall asleep, but today it seemed she could not find them.
"Well..." Alicia trailed on, "I can't think of anything at the moment but can I text you later if something comes to mind"
"Absolutely." Sarah stated rather quickly - She smiled "Sorry, I just mean to say that as your doula I am available to you each day between 8am and 5pm so please feel free to text, call, or email me. Then once you are 36 weeks, I am on call 24 hours"
"Now, Mr. Anderson"
"Really, call me Peter! After your help with our first little, we really are thrilled that you will be helping us again."
"Thank you Peter" She smiled and nodded kindly. "Now don't you go thinking you are off the hook Mister!" her voice stern while she grinned. "Here is an info-graph on some ways that you can help Alicia in early labor. I would really love for you to look over it and try a few things before our next prenatal and definitely before labor," Sarah chuckled
"I will!
"Well we really must be off! Thank you for allowing us in your home. I look forward to our next visit!" Sarah picked up her bag and signaled for Danielle to head out.
Chapter 4
Loving and Labor
Babies do not own calendars and have no use for a clock. Inside their home they are fully sheltered and food is on demand. Although toward the end space is a bit more limited, they seem content to stay for as long as possible. There are really no actual ways of knowing. Sure, dilation is an indicator, but just as surely as it is, another person can have no dilation and still go into labor.
Sarah was no stranger to calls that wake her from her dreams and tonight would be no different. The call came in the wee hours of the night, Sarah woke as she fumbled around her nightstand for her phone.
"Hello, this is Sarah"
"Hey Sarah, this is Peter. I think Alicia may be getting close. She asked me to call you and let you know."
"Does she want me to come now or will you be calling me back or texting with more updates?"
"She said that she could really use your calm, soothing, guidance."
"What are the contractions looking like? How long and how close together?"
"They've been about 45 seconds long on average but sometimes a full minute and they are about 5 minutes apart."
"Okay you called me at a great time. I will get ready and be with ya'll shortly. Does she need to speak with me?"
"No, she is just happy you will be here soon. We are still at home, is that okay?"
"That's fine. If anything changes please let me know!"
Sarah took the next moment to call Danielle and let her know to get ready as well then got in the shower. For birth days she always made sure she was a clean slate. As part of her contractual agreement, she was required to arrive within 2 hours of being called and this gave her the time she needed to take a shower, eat a small meal, and brush her teeth. Once she finished her pre-birthday ritual, she was off. Because she was on call, her doula bag was already in the car and she was ready to take off.
She was met at the door and led to Alicia who was in the shower. From the look of the curtains she must have been swaying around a bit.
"Alicia?" Sarah paused and after a moment, she continued, "Would it be alright if I opened the curtain a bit?"
"Bbbbbbbb," Alicia blew out like a horse then took a deep breath before saying, "Ooooo... Yes, that's fine."
Careful not to open the curtain too much as to disturb the mood that Alicia seemed to want and need at the moment, Sarah opened the curtain just a foot or so and began watching Alicia. As if she was trying to time the rhythm of the ropes while they turn in a game of Double-Dutch right before finally taking the plunge and jumping in, she gave 100% of her focus to this moment. Sarah was getting a feel for the contractions, their timing, how long they were, and Alicia's facial expressions throughout to gauge which parts were the toughest for her and where she could apply a bit of her assistance. Some people needed physical support while others only needed her to just be present. There is never two births that are the same. Knowing this sustained her in this life path. She watched Alicia with a keen eye, carefully studying her movements, tone, and posture. There were moments where she would watch a bead of sweat drip down her brow and without thought she wiped it. There were few words exchanged and this often worked best for labor. Concentration and relaxation are often the key to opening up quickly and in these moments her intuition had to do the work. She would not dare speak unless it was to ask for consent in touch, but otherwise, she handed Alicia her drink, wiped her brow, and sat in silence as she watched another Mother and Baby work together to be born that night. Not here of course, but Sarah could tell it was about time to head to the hospital, so she suggested it to Alicia.
As if to say yes, she waved her hand up and down and began to step out of the shower. Sarah advised that she would take off ahead of them and would let the hospital know of their arrival.
A wheelchair was at the ready when the Andersons pulled up to Seifts Medical Center. A nurse greeted them kindly and with haste they made their way to the birthing suites.
At the suggestion of the midwives and doulas, the hospital had equipped their rooms with various things that could be leveraged and used for a more natural birth. The bed was pushed off to the side and in the center was a mat on the ground, a small birthing chair, and a birth ball. Toward the back of the room a set of bars were installed on the wall and a rope was tied to them while another hung from the ceiling. To the left was the bathroom which had a shower and toilet. This suite did not have a birthing tub, as a few of the others at the hospital did, but it was otherwise equipped perfectly and was the one that Alicia had hoped to get after seeing it on a tour. She and her husband made their way to the birth ball and he slowly guided her to it then stood near her so that she could rest on him when she needed. Sarah noticed that each contraction sent Alicia's hands to her back so he began to apply counter pressure through the contractions for her. After a bit, the waves slowed and Sarah asked Alicia if she would like for her to try some belly lifts to help ease the back pain. She agreed that she wanted to try something new so through each contraction, while standing behind her, Sarah would lift up Alicia's belly using a piece of fabric that was wrapped around her belly. After doing this through several contractions the back pain seemed to ease up a bit so Sarah found some mood boosting music and Alicia and Peter began to slow dance between waves. The energy in the room quickly changed however as Alicia began to become overwhelmed by the coming waves. Each felt stronger than the last and she knew that her baby would be here soon.
Chapter 5
Patience in Postpartum
A beautiful baby girl was born just after 1am and as requested, Alicia and baby both enjoyed their first hour of quiet together. Alicia was able to delay the cord clamping until after the placenta was born and thanked Sarah for giving her the B.R.A.I.N method as a means to discuss her questions with her midwife. It was now about 4 days postpartum and Sarah and Danielle are with Alicia for her first postpartum visit. Sarah quite enjoyed these visits, but they could sometimes bring about big emotions as well.
"So, Alicia, how are you feeling?" Sarah paused then clarified, "Let's start with physically; do you feel like you're healing well? Are you still in any pain?"
Alicia shifted a bit, "Well, thankfully I did not have to be stitched this time around, but none the less, it's pretty tender still."
"Stitches can make it a bit more uncomfortable for sure, and tenderness is common. I have some helpful information on healing if you want it for later use." Sarah shuffled through her bag and took out a small collection of sample items and teas. "I know it isn't much but these can give you a great idea of what you like and what works and what doesn't."
Alicia winced as she reached for the bag and then laid it on her the side table.
"Having a midwife this time around really empowered me, I think," Alicia seemed strong in spite of her healing body. "I am still processing everything of course, but the process, the atmosphere..." Alicia trailed off as she attempted to recall moments from the fog of Labor Land. "I just felt more involved this time. I enjoyed being asked, instead of told, and I really felt calmer without the constant monitoring."
As Alicia and Sarah talked, Danielle helped out by doing some small chores followed by filling up a therapeutic bath with fresh lavender and candle light. Danielle joined them back in the living room and held out a hand.
"How does a nice warm bath sound Alicia?"
"Amazing!" She exclaimed as she visibly perked up. Emily, her newborn, was fast asleep, so Alicia laid her in the bassinet before making her way to sweet sweet relaxation.
As she stepped into the bath, she reminisced on her birth experience. Not everything went as planned but overall, she felt like Emily came Earthside in her own perfect way. Having Sarah and Danielle there was a great relief for her and her husband. It's difficult to be in multiple places at once, so when he had to go to get food or to use the restroom, she still had them. Even being able to take this short bath without worry was such a reprieve that Alicia felt like she could conquer the world after. Before leaving Sarah and Danielle cooked her the most splendid lunch from the foods in her pantry.
"Well Alicia, please call us if you need anything! We will be back by for your final postpartum visit of course so we will be in touch to settle on a date and time."
"Thank you so much for everything." said Alicia as she waved to them. "Until Next Time..."
Interested in having a doula on your birth team? Contact me today, let's chat!
..::*~While doula care is as described in this fictional story, there are currently no federal laws in place that mandate insurance coverage for our services. Want to be a part of the change? Reach out to your representatives and tell them your story! SC.gov