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.

One of the things that drives my linguistic study of the birth environment is that so little has been done in this area so far. In situating my contribution to the literature, I've had to go back a few decades to find relevant books. So here's this beauty: published in 1984, Birth Stories, edited by Janet Isaacs Ashford, is a collection of birth stories (bet you couldn't have guessed that!).

An interesting feature of this book, though, is that the stories collected range from 1915 to 1983, so it really gives a big picture of a variety of obstetric practices and childbirth tendencies over several decades. You may have heard of some of them: overuse of forceps due to complete unconsciousness of the mother during delivery; "Twilight Sleep;" women being left alone, without friends or family, to labor; routine shaving, enema, and episiotomy... Unfortunately, the list goes on. I'm so grateful to be mothering in an era when most of these have faded into the past. I watched many of them fade as I turned the pages of this book.

Throughout the decades, themes persist. There are women who feel there must be a better way, who seek alternative care. Some of these women find it. They deliver at home or birthing centers with the care of experienced midwives. Some are treated with respect in the hospital and voice their preferences and are listened to. Birth empowers them. Some go without care and face unfortunate consequences. Some feel that they can't find it, and end up being subject to the interventions they were hoping to avoid, even though they vocally protested. These women feel a loss of control, and birth is a severely disempowering experience. Their stories are told in this book.

After reading this book, I believe more strongly that birth is a story we must keep telling. We must tell our experiences, good and bad, and seek to make birth better and better for our birth-giving posterity.

Now to close, I have two questions for you, dear reader: 1) Would you be interested in also reading article reviews of the journal articles I'm reading about language and childbirth? and 2) Do you know of any books I'm missing out on that talk about language and birth? If so, comment below!

In September, I'll be presenting at the Evidence Based Birth Conference in Kentucky. (Can I just pause to say about how thrilled I am to be able to present at this amazing conference!?) I'll be leading a workshop about the critical role that our words play in shaping the birth environment. I can't wait to share how my passion for birth converges with my passion for linguistics and give other birth workers tools to use their language for good!

In preparation for my workshop, I'm familiarizing myself with any other texts that are relevant to this topic. It turns out that there aren't a ton of super-relevant texts, but I'm reading what I can about the overlapping spheres of language usage and childbirth. Enter Women Writing Childbirth: Modern Discourses of Motherhood by Tess Cosslett. It's an older book (published 1994) that synthesizes and analyzes literature of the 20th century that addresses the topic of childbirth. While it's well-done and thorough and has a few good themes, it's not a book I would widely recommend. If you're curious about what (mostly female) writers have written about birth in both fiction and non-fiction works and want to read one critical interpretation of those texts, it's a worthwhile read. It's certainly got its own biases (which the author acknowledges), and I disagreed--either in part of in whole--with several things Cosslett writes. However, she does uncover a few worthwhile themes in her analysis. Here are the ones that stood out to me:

• Like others, Cosslett finds that there are two contrasting ways people tend to write about birth: as a medical occurrence vs. a natural process. However, the two discourses are often blended much more than you might expect.
• Loss of control during birth comes up as a negative theme across many of the stories analyzed.
• Some discourses emphasize the objective portions of childbirth, focusing on the body and its functions, while others tune in more to the subjective nature of childbirth and the experience of the birthing woman. Women's perspectives can pull from both the objective and subjective sides of the experience.
• Childbirth is a fascinating place to consider themes of identity, as many people's perspectives vary regarding the unity or disparateness of mother and baby. Through birth, two identities are created or shifted: both child and mother. 

Cosslett teases out these themes as she examines several works of literature, both fiction and non-fiction. This book certainly provided food for thought and insight into potential themes in the language that surrounds birth.

Stay tuned for more reviews of the birthwork/linguistics literature and a preview of my EBB workshop!

I've read more than a few books about pregnancy, birth, and the rest of the journey. But this one, my friends, is my favorite.

I was introduced to this beautiful book by a dear friend when I was struggling with infertility before conceiving my twins. She shared a few essays about patience during infertility with me, and I was touched by them, but didn't read any of the rest of the book.

Then, years later, when I was pregnant with my son, I rediscovered this book and read it cover-to-cover. Reading it was one of the critical parts of my preparations for his birth--an unmedicated VBAC--and the beginning of the path that lead me to becoming a doula. The book is a compilations of essays and birth stories about pregnancy and birth, written by birth workers and many other child-bearing women. The common thread among the authors is that they are all members of my faith (The Church of Jesus Christ of Latter-day Saints). The unique perspectives offered by the authors invited me to reconsider stereotypes and paradigms about pregnancy and birth that I'd inadvertently and unknowingly observed and absorbed. The writings brought to light some beautiful truths that had been hiding in shadows for me and gave words to powerful beliefs that have become personal pillars. It sparked in me the desire to invite other women on this journey. In short, reading these stories and thoughts changed my life.

The Gift of Giving Life is divided into topical sections, including patience, preparation, fear, and many others. Among my favorites is the opening section, "Our Legacy," which begins with an essay titled, "We Are Each Eve," and continues with the faith/birth/motherhood journeys of many women who have faithfully and wisely chosen to bear and mother their children, following in the footsteps of Mother Eve and Mother in Heaven. From this potent beginning, the book carries the reader through women's thoughts and experiences about the importance of giving life, personal revelation, the spirit-mind-body connection, the atonement, and others. The book ends with a section on the fourth trimester, or the newborn/postpartum phase, inviting new mothers to go forward with a sense of divine purpose as they continue on the path of motherhood.

I feel it's not possible to do justice to the beauty and power of this book. So I encourage you to read it for yourself! If you're looking for a copy, I have one you can borrow. :)

​Before I'd learned much about HypnoBirthing, I had some negative associations with it. Whenever I heard about using hypnosis for birth, my mind went straight to the cartoons: one character swings a yo-yo back and forth in front of an unsuspecting victim, whose eyes then turn into crazy swirls. (I mean, if you do a web image search for "hypnosis," you get dozens of iterations of crazy swirls.) I thought that hypnosis meant being totally outside of and separate from the birthing experience, and that wasn't something that appealed to me. I want to be present and an active agent while giving birth, not a hypnotized object.

Then, as I learned more about it, I realized that (as is normally the case with stereotypes), these perceptions were wrong.

Speaking of terrible stereotypes, let's think for a moment about how birth is often portrayed in the media: mom, confined to a hospital bed, screams and looks completely out of control. Her husband is completely helpless to do anything useful, and looks rather terrified himself. Even the birth attendants are often portrayed and frazzled and behave more like they're managing the victims of a fire or another emergency than joyfully welcoming a baby to the world.

Addressing these sorts of stereotypes and their effects is ​one of the main tasks of HypnoBirthing​. If a woman has grown up in a culture that emphasizes pain, panic, and pandemonium in birth, it affects the way she thinks about it and approaches the birth of her child. Even if well-educated about birth, she probably expects a significant amount of pain to be involved in labor. And her body expects that, too. Mongan explains Grantly Dick-Read's fear-tension-pain cycle that affects many laboring women: They come to birth fearing pain, which causes the body to tense up, which makes laboring painful. Having once experienced pain as part of the childbirth process, the body tenses up in fearful anticipation of each contraction and feels more pain.

As I learned more about HypnoBirthing, I realized that a lot of it ties in with my interests in linguistics. HypnoBirthing takes many of the negative terms that are associated with a painful, clinical birth experience and  reframes them as more positive terms: contractions are called surges; rather than pushing baby out, HypnoBirthers speak of breathing baby down; cervical dilation and effacement is instead called opening and thinning. The terms help the process be perceived more as an natural process than a medical procedure. A natural process that the woman's body was created to do and is perfectly capable of doing! What a freeing paradigm shift!

To help laboring women overcome the fear they may have of pain during childbirth and to help the body be relaxed and relieve all tension, Mongan introduces a variety of breathing, relaxation, visualization, and ultra-deepening techniques for use during labor. Many of these reminded me of similar techniques I'd used to relax and relieve tension when birthing my son, though I didn't use the HypnoBirthing method.

In summary, reading this book taught me that HypnoBirthing is not nearly as "out there" as I perceived it to be. I am hooked and interested in learning more about HypnoBirthing, and I'm grateful for Marie Mongan's work in helping many women reclaim their birth experiences as peaceful and empowering! 

On December 1st, 2018, Sara's Birth Services became Summit Birth Utah. This post contains the blog archives from www.sarasbirthservices.com/blog.



Book Review: "The Healthy Pregnancy Book" by William and Martha Sears
11/21/2018
 
This post is the second in a series of related posts: book reviews of the titles in my lending library. Stay tuned for more!

As you can tell from the sticky notes, this book is packed full of good information!

I appreciate the Searses' well-rounded and positive approach to pregnancy they take in this book. They begin with detailed information about how to have a healthy pregnancy through wise nutritional choices,  movement, sleep, and self-care skills. This starts the book off on a great foot for helping women be the responsible agent in their pregnancy and birth, which I believe is critical! They list helpful nutrients for pregnant women and their developing babies, the foods that offer them, and even recipes to incorporate them in your diet. In the section on exercise, they emphasize the importance of moving healthily and the wide range of activities that pregnant women can do to stay in shape and help their bodies and their babies be as healthy as possible.

The next section of the book details the month-by-month changes that occur in the developing baby and the pregnant mother's body. They address concerns and discomforts that may arise by offering helpful tips and solutions. In the section on birth, they offer a detailed explanation of the "hormonal symphony of birth" and beautifully describe how mom and baby's bodies work together to bring baby into the world. They address common interventions and when they can be helpful and when they'd be better avoided.

In the final section, uncommon pregnancy complications are addressed. The section begins with the directive to read only those sections that pertain to a complication you have, as there's no need to worry about things that could but likely won't--wise advice for an expectant parent! I especially appreciate their re-framing of the term "high-risk pregnancy." They explain that this term is necessary for doctors to be aware of women whose pregnancies and births should be monitored more closely, but invite women in this category to instead consider their pregnancy as "high responsibility":

"Instead of resigning yourself to the high-risk label, becoming a passive patient, and leaving all birth decisions up to your doctors, become a high-responsibility mother. Take an even more active role in your birth partnership; cooperation between you and your care providers is essential. You need to be more informed and more involved in decision-making than the average mother, and you need to take better care of yourself. The first question you should ask your doctor after you are classified as high-risk is what specific things you can do to lower that risk."

I especially appreciated this advice because both of my pregnancies have been "high-responsibility," the first because I was carrying twins, and the second because I have a blood-clotting disorder and was planning on a VBAC. In my first pregnancy, I resigned myself to the "high-risk" label and stopped asking many questions and taking personal responsibility for my pregnancy, and I ended up with some complications that I believe I could have avoided if I'd been a more active participant in my health care. In my second pregnancy, I made sure I was well-informed and the responsible agent for caring for my extra needs, and I had a very positive experience as an active birth-giver!

In all, I definitely recommend this book as a comprehensive guide to having a healthy and positive pregnancy. It's the best book of its kind in that category!


Re-Branding Giveaway!
10/29/2018

On December 1st, Sara's Birth Services is getting a makeover and a new name! I'm really excited to unveil my new brand, but I'm still working on perfecting all the pieces. :)

So... in the meantime, while my new website and business cards and such are baking, I need to get rid of some Sara's Birth Services swag. And to sweeten the deal, I'm throwing in a FREE BIRTH PLANNING VISIT. 

This mini package offers a two-hour birth plan visit to help prepare you for labor and birth and access to my lending library. During the visit, we'll discuss your birth plan and preferences, and we'll practice several comfort measures for use during labor, such as:

• Creating a comfortable birth environment
• Comforting touch
• Music therapy
• Helpful positions for labor
• Aromatherapy
• Rebozo use
• Relaxation/visualization exercises

By the end of the visit, you'll be equipped with several tools to employ during labor. (Please note, this package does not include by-your-side labor support. If the giveaway winner would like to book the complete package, I'll discount it by $75, the value of the birth planning visit.)

To enter the giveaway, just click the button below. It'll pull up an email to me (sarasbirthservices@gmail.com). Just write "Giveaway" in the subject line and hit send!
ENTER GIVEAWAY!

Book Review: "Gentle Birth, Gentle Mothering" by Sarah Buckley
9/12/2018

This post is the first in a series of related posts: book reviews of the titles in my lending library. Stay tuned for more!

Ah, this book. It’s such a great read. Sarah Buckley, an Australian family physician, expertly walks the line between instinctive/super-crunchy/holistic and scholarly/super-well-researched/academic. It’s just brimming with quote-worthy snippets, so I’ve sprinkled them throughout this post for your reading pleasure. Enjoy!

“Birth is women’s business; it is the business of our bodies. And our bodies are indeed wondrous, from our monthly cycles to the awesome power inherent in the act of giving birth. Yet in our culture I do not see respect for these extraordinary functions: instead we diet, exercise, abuse, conceal, and generally punish our bodies for not approximating an unobtainable ideal. This lack of trust in and care for our bodies can rob us of confidence in giving birth. Conversely, an experience of the phenomenal capacity of our birthing body can give us an enduring sense of our own power as women. Birth is the beginning of life; the beginning of mothering, and of fathering. We all deserve a good beginning.”

The book begins with a few chapters on instinctive birth and trusting your inner self, and how healing birth can heal the earth.
 
 “We cannot birth our babies through sheer force of will. We need to learn the more subtle—yet equally powerful—path of surrender.”

“In surrendering to birth, we also learn about our role on the Earth: we are neither the rulers nor the architects of creation. Life comes through us, simply and gracefully, when we allow it.”
 
Buckley then gives a step-by-step guide to sound personal medical decision-making. She calls this the BRAN method, and encourages her readers to consider the Benefits, Risks, Alternatives, and possibility of doing Nothing when they are faced with a medical decision. She then applies this method to common pregnancy and birth procedures (Gestational Diabetes, Group B Strep, Going “Overdue”), outlining the research as she discusses each option.

“If the baby is truly large, it is likely that the mother’s body will have maximum pelvic softness and flexibility (due to peak levels of hormones such as progesterone) on the day she spontaneously goes into labor, giving her the best chance to accommodate and birth her large baby.”

In subsequent chapters, Buckley thoroughly reviews the research on common birth interventions, such as ultrasounds, epidurals, and cesareans. Each chapter has literally hundreds of footnotes—it’s clear that Dr. Buckley has done her homework!

“On average the first stage of labor is twenty-six minutes longer in women who use an epidural, and the second (pushing) stage is fifteen minutes longer.”

“The combination of epidurals and Pitocin, both of which can cause fetal heart rate (FHR) abnormalities and fetal distress (reflecting a critical lack of blood and oxygen), markedly increases the risks of operative delivery (forceps, vacuum, or cesarean delivery).”
 
She also peruses the evidence on gentler birth and mothering choices. With great detail, she describes the beautiful hormonal cocktail that accompanies and enables undisturbed birth.

“When birth is undisturbed, our birthing hormones can take us into ecstasy—outside (ec) our usual state (stasis)—so that we enter motherhood awakened and transformed.”

“Birth is a peak bodily performance, for which our bodies are superbly designed.”
 
She shows the safety and beauty of home birth for low-risk mothers; she tells the story of how love and attachment can be naturally and gently formed in the baby’s early days.

“One study showed that newborns who experienced “kangaroo care”—that is, uninterrupted skin-to-skin contact with the mother—in the first hour after birth were less stressed and more organized in their behavior, cried less, and slept longer, compared with babies who were routinely separated.”

She examines the vast research supporting breastfeeding and the many benefits it offers mom and baby, and she goes over the benefits of co-sleeping and how to safely practice it.

I’d highly recommend getting your hands on a copy of Sarah Buckley’s Gentle Birth, Gentle Mothering. It will open your mind to new ways of thinking and fill your mind with evidence-based information. As I closed the book, I felt energized, empowered, and grateful for Buckley’s great contribution.

“A recent review of satisfaction after childbirth found that personal expectations, support from caregivers, the caregiver-patient relationship, and involvement in decision-making are the most important factors in determining satisfaction with the experience of childbirth.”

Have you read Gentle Birth, Gentle Mothering? I'd love to hear what you thought of it!


Labor Lessons from Long-Distance Running
9/3/2018

“Like a marathon runner, a woman’s task in birth is not so much to avoid the pain—which usually makes it worse—but to realize that birth is a peak bodily performance, for which our bodies are superbly designed.”
-Sarah Buckley, Gentle Birth, Gentle Mothering

About two weeks ago, I ran the Run Elevated half marathon in Little Cottonwood Canyon. Near the end of my training, I came across this quote from Sarah Buckley, and it got me thinking: what lessons can be learned from comparing labor and long-distance running?

One at a time
Mentally, I didn’t run 13.1 miles. I ran one mile, 13 times. As I would pass each mile marker, I would think ahead to the next mile, and not focus too much on those beyond. Similarly, in labor, it’s a good practice to focus on one contraction at a time. A helpful affirmation can be, “I can do anything for 60 seconds.” Thinking of all of the contractions that have already happened and the unknown number still coming can be daunting. Focusing on one at a time feels much more manageable.

Preparation Makes all the Difference
I couldn’t have run the half marathon without the significant training I put in. The (increasingly-long) three-four short runs and one long run I put in each week made it possible for me to run the 13 miles on race day. My body was prepared through incrementally-more-difficult runs each week. Similarly, you don’t grow a baby in a day. The body stretches and prepares over nine months. The uterus has practice Braxton-Hicks contractions in later pregnancy. Early labor often lasts for quite a while. All of this is your body preparing to birth your baby.
Preparing yourself mentally with quality birth education and fining the right support system also makes a huge difference. I personally noticed a huge difference between my two birth experiences, and much preferred the one I had better prepared for!

The Body is Amazing!
It was so exhilarating to realize that my body is capable of running 13.1 miles! This was my second half marathon, and I even shaved off a couple of minutes from my last time (which was eight years ago, before two pregnancies, three babies, and with chronice venous insufficiency to deal with)! The human body is amazing. More amazing that that, though, is the woman’s ability to grow and support and birth a baby. Labor is awe-inspiring.

Chiropractors Help with Back Pain!
Seriously people. I mean, maybe this is obvious, but chiropractic care was so helpful in nearly eliminating lower back pain in both late pregnancy and at the end of my training. I prefer a chiropractor who incorporates deep tissue massage as well. I feel like some sort of magic has been worked when I get up from the table and can walk freely without pain!

You Can Have Pain without Suffering
During my training runs, I passed another runner wearing a shirt that said “Pain You Enjoy” from a previous race shed run. Immediately, I thought, “can’t that apply to labor, too?” While many women may say that the word enjoy is a stretch, I do think it’s important to differentiate between pain and suffering. (Rebecca Dekker does that beautifully in this podcast, which, coincidentally, I listened to on one of my training runs!) A few women experience painless births, but for most women, childbirth is some of the most intense pain they’ll ever experience. Rather than try run away from it (which tends to just make it worse, as Sarah Buckley points out in the opening quote), laboring women are most successful when they learn to work with their pain. They realize that the pain has a purpose and is an indication that the body is doing what it needs to be doing. Labor is a “peak bodily performance”!

It’s Worth It
Crossing the finish line was so fulfilling, and being able to say “I did it!” was so empowering. This is true one million-fold in pregnancy and birth. The nine months of pregnancy and hours of labor and birth bear a priceless fruit: a new baby, complete with snuggles and perfect baby smell and a beautiful cocktail of hormones that help you fall in love with each other.

Take Time for Recovery
For two or three days after my race, I was super sore. Going down stairs was especially difficult, since the majority of my half marathon was downhill and my quads burned! My awesome husband was understanding about doing a little more of the up-and-down childcare and housework while I mended. After giving birth, recovery time is critical for the new mother. It takes six to eight weeks for the uterus to return to its pre-pregnancy size, and the perineum takes time to mend. Baby’s frequent need for feeding during the early weeks encourages mom to be sitting or lying down much of the time, a welcome position for a body that has just grown, carried, and birthed another human being!

​Happy Labor Day, everyone!

A Peek into My Lending Library
7/31/2018

One perk I offer in my birth doula package is access to my lending library about pregnancy, birth, and newborns. My library is still growing and I plan to add to it forever (because you can never have too many book!), but here’s a look at my top three on my shelf right now:

1. Ina May’s Guide to Childbirth by Ina Many Gaskin
Ina May Gaskin is a midwife genius with piles and piles of wisdom born of experience. This book is half birth stories (gotta love ‘em!) and half explanations of physiological principles related to birth. Here’s a favorite: Sphincter Law. Sphincters are ring-shaped muscles that occur in a few places in your body, notably your throat and cervix. And it turns out that relaxing one set of sphincter muscles helps others in the body to relax and open! So blowing out with “horse lips” and making low, loose vocalizations helps your cervix to relax and dilate. This and other gems are found in Ina May’s Guide to Childbirth!

2. The Gift of Giving Life: Rediscovering the Divine Nature of Pregnancy and Childbirth by Felice Austin, Lani Axman, Robyn Allgood, Heather Farrell, and Sheridan Ripley

This book is a beautiful collection of essays and birth stories written by LDS mother and birthworkers. In it, the authors faithfully discuss the divine role that women play as co-creators with God. It addresses topics from infertility to the role of agency in birth to infant care. It’s an empowering, thought-provoking, and life-changing read!

3. Mothering the Mother: How a Doula Can Help You Have a Shorter, Easier, and Healthier Birth by Marshall H. Klaus, John Kennell, and Phyllis H. Klaus
Did you read that subtitle? A shorter, easier, and healthier birth—how awesome is that? This one’s an oldie, but a goodie! Referencing evidence collected in studies around the globe, the authors explain in depth the way that having a doula can positively affect your birth experience.
 
Here are the other titles on my shelf:

• Baby Catcher: Chronicles of a Modern Midwife by Peggy Vincent
• Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers by Nancy Mohrbacher
• Easy Labor: Every Woman's Guide to Choosing Less Pain and More Joy During Childbirth by Kathryn Alexander
• Gentle Birth, Gentle Mothering by Sarah Buckley
• Healthy Sleep Habits, Happy Child by Marc Weissbluth
• Our Babies, Ourselves by Meredith F. Small
• Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health by Toni Weschler
• The Thinking Woman’s Guide to a Better Birth by Henci Goer
• The Womanly Art of Breastfeeding by La Leche League International
• When Survivors Give Birth by Penny Simkin
• Your Amazing Newborn by Marshall H. Klaus
• Your Vegetarian Pregnancy by Holly Roberts

Do you see any of your favorites? Do you have other favorites to recommend? I’d love to hear about it in the comments!

Why Hire a Doula?
6/15/2018
 
Birth is an exciting, joyous time! It’s also unpredictable. Having a doula by your side ensures that there will be at least one person at your birth who knows you and your preferences and has an in-depth understanding of labor and birth. When nurses and midwives/OBs come in and out, your doula will be there from the moment you need her until your baby is born.
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Here are some other awesome perks to hiring a doula, as shown in numerous studies (see References).

​You may be thinking, “How is that even possible? How can having a doula at a birth make that much of a difference in so many ways?” The studies I cited don’t attempt to answer the questions of how or why, but here are some possible explanations.

Women labor differently around sympathetic women. Ina May Gaskin, one of the nation’s foremost midwives, is huge on this point. Women are able to progress more quickly, feel more comfortable, and better do the work of labor when they have another familiar woman in the room.

Doulas know stuff. Stuff that can make a real difference! We know a variety of labor positions and can recommend helpful ones throughout your labor: early labor, active labor, stalled labor, pushing, positions for when baby is having trouble descending, positions for when labor is coming waaay hard and fast, positions to help mom continue to progress when largely immobilized due to an epidural, and more!

Doulas give constant positive support. Throughout labor, doulas give moms positive feedback, leading to further confidence and renewed energy and focus.

All of this means that mothers who labor with a doula have a higher likelihood of shorter labor, fewer interventions, and a more positive birth and postpartum experience. You still won’t be able to predict the twists and turns that your labor may take, but you’ll have someone in your corner every moment!

​Have you had a doula at a birth? What was your favorite part of the experience? I’d love to hear about it in the comments!
 

REFERENCES

(Apologies for my stylistic inconsistencies.)

Katy Backes Kozhimannil, Rachel R. Hardeman, Laura B. Attanasio, Cori Blauer-Peterson, Michelle O’Brien, “Doula Care, Birth Outcomes, and Costs Among Medicaid Beneficiaries”, American Journal of Public Health 103, no. 4 (April 1, 2013): pp. e113-e121. 
 
Will Chapple, MPH; Amy Gilliland, PhD, BDT(DONA); Dongmei Li, PhD; Emily Shier, MSEd, CD(DONA); Emily Wright, RN, BSN, CD(DONA) “An Economic Model of the Benefits of Professional Doula Labor Support in Wisconsin Births”, WMJ : official publication of the State Medical Society of Wisconsin. 112. 58-64.
 
MH Klaus, JH Kennell “The doula: an essential ingredient of childbirth rediscovered”, Acta Paediatrica. 86:10. (October 1997): 1034-1036
 
MH Klaus JH Kennel, PH Klaus Mothering the Mother Addison-Wesley Publishing Company Reading, Massachusetts: 1993

Campbell, Della A., et al. “A Randomized Control Trial of Continuous Support in Labor by a Lay Doula.” Journal of Obstestric, Gynecologic, & Neonatal Nursing, vol. 35, no. 4, 2006, pp.  456-464.
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Katy B. Kozhimannil, PhD, MPA,1 Larua B. Attanasio,1 Judy Jou, MPH,1 Lauren K. Joarnt,1 Pamela J. Johnson, PhD,2,3 and Dwenda K. Gjerdingen, MD4. “Potential benefits of increased access to doula support during childbirth”, The American Journal of Managed Care. 2014 Aug 1; 20(8): e340-e352. 
 
“Benefits of a Doula Present at the Birth of a child”, Pediatrics. Nov 2004, 114 (Supplement 6) 1488-1491.



My Journey to Doula-Hood
5/29/2018
 

Doula? What's that?

If you’re asking, you're not the only one.  A few years ago, I was asking that, too. And now I am a doula! Here's my story.
 
I love pregnancy. No, not the nausea or the joint pain or the fatigue, but the baby kicks, the hiccups, and the wonder of having another person (or two) inside my body! Breastfeeding, too, amazes me: my body, without my conscious thought, can produce all the necessary nutrients and even protective antibodies for my babies! With all three of my children (and two pregnancies), I've loved bonding with my babies through pregnancy and breastfeeding. My two birth experiences, however, were drastically different.

My first birth experience felt like a medical emergency. After five weeks of bed rest to hold back preterm labor, I returned to the hospital in active labor. I got an epidural because I'd read that's what you "should" do with twin pregnancies. Then I laid in bed and waited for this labor thing to happen. 
 
After about four hours, I was told, "you've stopped progressing, so we're going to start Pitocin." I thought, "I've been lying in bed for five weeks trying NOT to have these babies, and now you're telling me my labor's moving too slowly?" I wanted desperately to do whatever would keep my babies safe and healthy, but I wasn't educated enough to know which procedures were recommended for safety, and which were offered for convenience or hospital efficiency. Not confident enough to ask, and being just generally compliant, I didn’t say anything.
 
The Pitocin didn't effectively accelerate my contraction pattern, so a few hours later, the doctor told me he was going to break my water. Again, I consented, not really knowing I had another choice.
 
Forty short minutes later, I was all but fully dilated and ready to push, when baby B's heart rate dropped. Giving me oxygen didn't help it rise, so an emergency cesarean was called. The second dose of my epidural hadn't quite kicked in, though, so I was given IV anesthesia that made me "a little loopy."
 
In just minutes, I was the proud mother of two tiny, beautiful, perfect daughters. But I didn't really remember their birth. I remembered swirling blue and white ceiling tiles and taking several minutes to recall my own name, my husband's name, and what was going on. I remembered trying to pucker my heavy lips to kiss my first daughter on the cheek, and the nurse writing a birth time on her arm.
 
When I became pregnant again two and a half years later, I knew I wanted this birth to be different. I'd always wanted an unmedicated birth, so I started planning for my unmedicated VBAC. I looked around for a birth class that fit me, and found Birth Boot Camp. They didn't have instructors in our area (at that time, Boston), but offered a ten-week online class that worked perfectly for our situation. Over the ten-week class, I learned about my body, how it was made to carry and birth babies, the benefits and risks of various interventions and procedures, and how to relax and work with my body.
 
 “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.”
-Ina May Gaskin

 After my little boy was born, friends asked me how the birth was. "It was awesome!" I would say, and their faces would say, "no, Sara, I mean the part where you gave birth. How was that?"
 
Awesome. Amazing. Incredible. Knowing what my body was doing and that I was working to give life to my beautiful son, I labored in various positions, sounded out each contraction, listened to my body, and was flooded with natural oxytocin as he was brought to my chest. I couldn't get over how perfect this little person was, how amazing he smelled, and how hard we'd worked to meet each other. And I was just overcome with awe for the birthing mother's body.
 
I should mention, lest I'm misunderstood, that his birth wasn't amazing because it was easy or ideal or because I didn't feel any pain. I passed out and threw up in labor. I had a third-degree tear that took an hour of stitching to repair. But that didn't change my perception of the labor and birth process. What was different this time? To paraphrase Ina May Gaskin, I had been the agent in the process this time. Birth wasn't something that happened to me; I was a birth-giver.
 
I should also clarify that I don't believe that unmedicated vaginal birth is the only way to be a birth-giver, nor does having an unmedicated vaginal birth necessarily make a woman a birth-giver. A woman with a cesarean can be a birth-giver. A woman with an epidural can be a birth-giver. A woman with unforeseen complications, even medical emergencies, can be a birth-giver. Birth-givers have an active role in the work they're doing. They ask questions to gain understanding and make decisions. They are in awe of the beauty of birth.
 
A little while after my son's birth, Birth Boot Camp sent me an email advertising their doula training program. I archived it without much thought. A little while after that, I had a weird dream that I was with a friend as she was having a baby. When I told her about it, she said, "Were you my doula? You would be a great doula!"
 
Doula? Doula! I would be a great doula!  I fished out that old email and started making plans. I chose a workshop, registered, started reading and watching and learning, and continued to feed my love for birth.
 
I believe that birth is beautiful. I want to help other women feel that way, too. So I became a doula.