Visualization
(Photo by https://www.instagram.com/Didssph/)
This comfort measure doesn’t have to do with what you’ll actually see with your eyes, but what you visualize in your mind. Imagining calm, serene scenes, or places that are personally meaningful for you, can bring comfort during your labor. Sometimes, these visualizations will be guided my someone else, as your partner or doula reads aloud to you or describes a favorite place. But if you’ve practiced visualizing pleasant images before labor, you may be able to take yourself there without another person verbally guiding you through it.

I’ve found some fabulous visualization exercises in this book. And this podcast episode talks a bit more about the power of symbols and imagery that you can incorporate in your visualization.
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The Faces of Loved Ones
(Photo from https://www.pexels.com/@pixabay)
​It’s important, during labor, to surround yourself with those you love—people you feel comfortable around and supported by. Inviting people into the birth space who bring up feelings of discomfort or tension will likely slow your labor and make you less comfortable, both physically and emotionally. So, during this important time, surround yourself only with people who will create a feeling of warmth and love.

So carefully choose your birth team: friends and family you feel safe with, a care provider who respectfully cares for you, a doula that you feel emotionally connected to, a photographer who you feel comfortable with, etc.

Also, if there are loved ones who can’t physically be with you, you may want to bring pictures of them. Perhaps you admire a grandmother and her picture would bring you strength, or maybe you have young children that you don’t want in the birth space, but keeping their pictures with you will comfort you.

I posted a while back about how I'd be working in partnership with Mary Caplin during 2020--you can read here about how our partnership works. Now that the new year has arrived, let me take a minute to introduce you to her so you know why I'm so excited to be partnering with her!

I met Mary several months ago, shortly after she moved back to Utah county after spending nine months in Ghana with her family. I was struck at once by her gentle and kind nature. She is just the type of person you'd want in your birth space! She says this about her experiences serving women and their families:

"The mothers I’ve attended in Utah and Ghana have amazed me. I believe in the strength of women and the power of their love to change the world. Birth is intense, and the experience matters. It shapes us and our story."

As we got to know each other better, Mary and I felt that we could offer complementary and compassionate care for our clients, so we joined forces! I love talking with her about birth and benefitting from her ideas, insights, and perspectives.

One thing that I admire about Mary is what a great listener she is. I've watched her--in our conversations and with clients--take time to really process what the other person is saying and give plenty of time for them to express themselves. She is also skilled at recognizing and encouraging the father as an integral part of the birth experience. She says:

"You want the birth of your baby to be a beautiful, sacred experience. I do too. My goal as your family doula is to enable mother and father to have this through education before birth and providing continuous emotional and physical support during labor. I love to see a father more involved because of what they've learned, a woman reach to become a mother, and a family be born. It is incredible."

You can learn more about Mary at her website: 
https://caplinmary.wixsite.com/yourfamilydoula.

And if you reach out to either one of us, we'd love to schedule a free meeting so you can get to know us and see if we'd be a good fit for your birth team!

I first learned of Rebecca Dekker’s work at my doula training. That next summer, as I trained for a half marathon, I listened to episode after episode of the Evidence Based Birth podcast. I love and admire Rebecca’s work, as she uses her skills as a nurse and researcher to compile and review the most up-to-date research on important topics surrounding birth, and publishes them in ways that are easily accessible to the public through evidencebasedbirth.com. She’s covered topics such as natural induction techniques (I summarized a few in this post), the use of saline locks, circumcision, Vitamin K supplementation, doula support, and everything in between.

When I found out she was writing a book, I was thrilled! The title of her book, Babies Are not Pizzas: They’re Born, Not Delivered, also shows that she’s passionate about using language that empowers birthing families. So am I! (For more on that, visit www.birthwords.com or listen to the Birth Words podcast on your podcast app. I even had her as a guest on my podcast in October!)

Babies Are Not Pizzas is a fairly quick read for a book filled with as much information as it is. That’s because Rebecca interweaves her research findings about birth with her own personal narrative—the story of how she became interested in the evidence about common birth practices, why she started sharing what she found, and the repercussions that ensued because of her research.

The story was intriguing, and the research she uncovered along the way was just as fascinating. Through the book, she tells about what the research shows about birth practices that are the safest and most effective, and why they’re not always practiced in hospitals. Reading this book re-acquainted me with the research and also gave me a better understanding of why institutions work the way that they do and why change can be difficult and slow. But it also re-inspired me to continue to be a change-maker in every sphere I can influence so that birthing families can have safe, empowering, positive experiences as they bring new life into the world.

I don’t want to give away her story, but I will say that I highly recommend getting your hands on a copy of this book! (There’s one in my lending library!)

 For clients due in 2020, I've got great news!

Mary Caplin and I are teaming up to bring you the support and expertise of TWO doulas! Mary and I have been collaborating for several months, and we both feel like we're ready to synergize and work together for the coming year. Mary is an incredible support to the families she serves. She has a wide range of experience in the clients she's served, and she's especially good at helping learn how to work together as a couple during the transformative time of birth.

So, what will it look like?

You--the client--will reach out to one of us, and meet with us during a complimentary consultation. That gives you a chance to ask your questions and decide if the fit feels right. After the consultation, you can connect with the other doula before deciding to move forward.

Then, when you book, you'll have two doulas working together to make your birth journey positive! We'll work together to direct you towards helpful resources, answer your questions, and help you and your partner prepare for birth. During your two birth preparation visits, you'll get to know and be comfortable with each of us one-on-one.

When labor begins, the doula you originally reached out to will be your primary on-call doula to join you when you need extra support. Sometimes, though, labor is long. If that happens, you'll want a fresh, well-rested doula to join you so you can continue to focus on the incredible and unique work you're doing. Mary and I will switch each other out to make sure you're getting the support you need.

In the days following baby's birth, you can continue to reach out to both of us via text, phone, or email. One of us will also visit you in your home to discuss your birth and connect you with postpartum support resources.

The services unique to each of our businesses will now be available to you throughout the experience. We'll continue to offer grants for lower-income families, and you can borrow books (about fertility, breastfeeding, pregnancy, birth, and infancy!) from the lending library. Plus, Mary's unique touches of a birth memory letter and a loaf of homemade bread will help you settle in with your new addition.

I'm thrilled to offer this service to our clients! Do you have questions about the partnership? Ask them below!

I've blogged before about how, when I heard about doulas, we just weren't in a position to hire one. I'm passionate about making doula care accessible, and so today I'm so excited to announce that I know offer grant applications for lower income families. Find out all the details and submit an application here.

​But here's the low down:

If your annual household income is at or below the guidelines in the chart at the end of this post or are otherwise financially constrained, you can apply for a grant to help pay for doula services.

Just head on over to the Grant Application tab and fill in the required info, including your self-reported annual gross household income. You'll get an email response within 48 hours letting you know if you could receive a grant and the value of the grant. If you decide to hire me as your doula, that grant will go directly towards the total fee.

I'm happy to answer any questions you have! Email me at summitbirthutah@gmail.com or comment below.

-Sara

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The other day, I was talking with my daughter, telling her about the research I've been doing at the intersection of doula work and linguistics. I explained to her that linguistics is all about words: what we say, how we say it, why we say things certain ways, etc. And I told her that I was writing about words and why they're important in doula work: what are good, helpful things that we can say to "mommies having babies," and what things aren't helpful or good. I asked her if she had any ideas about that, and her response gave me lots to think about!

She said, "well, it wouldn't be good to say, 'I don't think this baby is going to come out. It's not going to come out. You better just stay here until it comes out.'" I then asked her about what would be good things to say, and she said she could only think of silly ideas. I pressed her, asking what ideas seemed silly that she had thought of. She said, "Well, you could say, 'Are you hungry?'" I assured her that this was not a silly idea, but rather a really important question to ask! A laboring woman may very well be hungry (especially in early labor), and it would be very helpful to check in about that need. I thanked her for her great idea and asked her if she had any other ideas about good things to say. "You could say, 'Are you feeling okay right now?'" When I asked why that was a good thing to say, she explained, "because you want to make sure she feels safe." I again thanked her for her very thoughtful and important idea and asked if she had any more. She told me she had one last idea: "Are you comfortable?" Again, I told her this was an excellent idea and that she would be a great doula! She told me she'd consider adding it to her future plans. :)

As I thought back on our conversation, I really was struck by the simple dichotomy in what she labeled as helpful versus unhelpful things to say to a birthing woman. Few people would actually say to a woman in labor, "I don't think this baby's going to come out; you better just stay here until it comes out," but what's the underlying message here? It's a lack of confidence in the woman and her body and an assumption that birth is something that just happens to a woman while she "stays there" and waits, without confidence that she can actually do this. Are there times when words uttered in the birth space have these unhelpful dubious underpinnings? Instead, let's aim for our words to share Ina May Gaskin's message: 

“Birth is something that women do—not something that happens to them. The birth-giving woman is the central agent in the ancient drama of life bringing forth new life.”

So let's turn to the second set of suggestions my daughter gave, of helpful things to say. The obvious similarity among all three suggestions is that they are questions. Rather than projecting a certain sentiment about the birth experience onto the laboring woman, these questions value the woman's role as an important individual with unique needs. The questions seek to discover those needs, with the intent of helping to meet them. I was especially struck with the explanation she gave regarding her second question, "Are you okay right now?" about how it's important that she feel safe. This is so true for a laboring woman! Her physical progress in labor can be impeded if she feels unsafe: physically, emotionally, or otherwise. This is a basic need that all in the birth space should be sensitive to! And attending to her other physical needs of hunger and comfort are helpful ways of showing support for her in the valuable work she's doing. As participants in a birth experience, let's always be mindful about the underlying messages our words send and thoughtful about sharing confidence and support.

I'm grateful for the wise words my daughter shared with me! What wisdom have the young people in your life shared with you?

When I first heard about what a doula was, my husband was in grad school, and our main source of income was his research stipend. I used most of my time taking care of my twin daughters, and I worked a variety of side jobs to (minimally) supplement our income: babysitting, tutoring, teaching voice lessons, cutting hair, and a couple of other random gigs. Money was tight, but we recognized that the sacrifices we were making as a family would pay off long-term and that education is invaluable. When I was pregnant with my son, my neighbor, who was pregnant with her third baby, told me about doulas and sang their praises. Then she mentioned the cost of hiring a doula, and the subject became completely irrelevant to me. It simply wasn't in the budget!

Fortunately, I took a comprehensive childbirth class, and my husband was a fabulous support. My obstetrician was respectful of my desire for an unmedicated VBAC, and I lucked out with a phenomenal nurse who stepped in and gave some awesome counter-pressure and words of encouragement.  I ultimately had a very empowering, amazing labor and birth.

Three years earlier, when I was pregnant with my twins, I didn't even know what a doula was. If I had know then, though, my reaction would have been the same as it was during my pregnancy with my son, "that sounds nice, but it's not relevant to me. It's just not in the budget." But in the case of their birth story, I sincerely believe that having a doula by my side would have made a world of a difference. I strongly believe that, with the help of a doula, my husband and I would have realized that we had the opportunity to make choices throughout my labor. We could have declined or delayed interventions, and I have a hunch I could have avoided the emergency cesarean that brought my twins into the world. Of course I'll never know, but I know for sure that additional knowledge and support during that pregnancy and birth would have been helpful. But it wouldn't have been in the budget.

So, if you figuratively find yourself in my old shoes, saying, "a doula sounds nice, but it's just not in the budget," please reach out to me. I offer a significantly reduced (40% off) student rate, and I'm willing to work with anyone (students or not) to make my services affordable to you. Everyone deserves a supported birth!

Here are some other ideas to help make hiring a doula a financial possibility:

*Consider this: A doula provides physical and emotional support that can help you avoid the use of pain relief medications during labor, such as epidurals. Not having an epidural on your hospital bill will significantly reduce your hospital costs!

*Ask for funds for a doula on your baby shower wish list.

*Some insurance companies will give partial or full reimbursements for doula services. Reach out to your insurance company to see if they'll offer that for you--it can't hurt to ask! To boost your argument, share this article from Evidence Based Birth. Your insurance company will see that when their clients have doulas, they are likely to save money! This blog post takes you through the step-by-step process of asking your health insurance company to reimburse doula costs.

I read an interesting article yesterday with some important implications for labor and birth. It was aimed at an audience of anesthesiologists, but it raises some important questions about how laboring women frame their own experience and how they're cared for.

The authors had conducted a study to determine the effect of language when checking in with post-cesarean patients. The assessors came into the room of the recovering patients in the first day after their cesarean. To half of the patients, the assessors asked the patients, "Do you have any pain at the moment?" 63 of the 116 patients (54.3%) responded that they did. To the other group, the assessors used more positive language, asking, "How are you feeling?" and "Are you comfortable at the moment?" In this group, only 28 of the 116 women (24.1%) reported that they were in pain. And these women were recovering from a major surgery!

For the most part, this study was well-conducted, although it did have a few limitations, which were acknowledged by the authors (like the fact that study's design meant that only the patients, and not the assessors, were blinded; and the difficult-to-define spectrum of pain and comfort affected the results). However, I think it offers important food for thought in the care of laboring women.

Imagine how a similar phenomenon might happen with a woman in labor. If asked how she's feeling and if she's comfortable, the laboring woman and her friends and care providers can work to help her find optimally comfort and find a rhythm with the work her body is doing. If confronted with the question of her pain, she may pause, get out of her body's natural rhythm, and focus more on the pain she's feeling. The authors of this article point out that, during pregnancy and the postpartum period, women are increasingly susceptible to the power of suggestion. This is acutely true during labor. We need to carefully consider how our language frames the mother's birth experience.

I certainly don't want to discredit women who have felt pain during childbirth. Although I believe there are ways to manage pain and increase comfort in labor, I feel that it would be more beneficial to reframe our perception of pain in labor. As the authors of this study pointed out, pain is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." This definition, and the common perception of pain, is that it indicates that something is wrong. Sometimes this is the meaning of pain in labor, as when the baby is malpositioned, or the mother is in an unfavorable position. This pain can alert the mother and her care providers to take action to correct this.

Often, though, the "pain" of contractions is a sign that everything is right, that the body is doing just what it needs to in order to birth this baby. For this reason, hypnobirthers have chosen to linguistically reframe many of the sensations of labor. Rather than "contractions," they refer to "waves" or "surges." These words are inspired by images of nature running its right and proper course, and help a laboring mother realize that her body, too, is doing what it naturally should. Many hypnobirthers speak of intense pressure, rather than pain, as they experience the sensation of the uterus working to open and thin the cervix.

Many women feel that hypnobirthing isn't for them. I still believe that these women benefit from linguistically reframing the sensation of labor and birth! If a mother says she's in pain, we should believe her and work with her to manage it! But if she hasn't said anything of pain, then let's not introduce the word into the vocabulary of the experience. Let's talk about optimizing comfort; let's compliment her for beautifully handling the intensity of the experience; and let's remind that her body knows what to do, and that she is doing just what she needs to be doing.

What terms or phrases have been helpful for reframing labor sensations for you?

Reference:
Chooi C. S. L., Nerlekar R., Raju R., Cyna A. M. (2011). The effects of positive or negative words when
assessing postoperative pain. Anaesthesia and Intensive Care 39(1), 101-106.