Speaking of Birth, this is the story of what I learned giving birth in a teaching hospital....
Some time before I became a childbirth worker but some time after I witnessed calves being born on a farm, I gave birth to our baby boy. It was a beautiful sunny day in May in New York City.
At the time I did not know about doulas and natural birth alternatives, but I knew I did not want any medications. I didn’t want medications because I’m a bit of a nature girl and I was concerned they would intervene and slow down the natural process. I figured if it was just one day I could bear it.
I did know enough to seek out a midwife at our hospital, however in my last trimester I risked out of using midwifery care due to gestational diabetes
I was using the local, public hospital at the time I became pregnant, I did not have health insurance and when I asked my Obstetrician how much it would be to pay out of pocket for the prenatal care and actual birth, the answer was around $20K. So I visited a public hospital just a few blocks from my apartment to see if they could help. I learned about the cost of medical bills.
Can you guess which New York City hospital it was? It was founded in 1736 and is the oldest public hospital in the US. Its psychiatric wing has a famous history and recently in 2014 it was in the new for successfully taking on ebola patient, and Doctors Without Borders’ MD, Craig Spencer. If you guessed Bellevue Hospital you are correct!
Bellevue took me in and I received medicaid, which I was embarrassed to tell my mother and family because they would not agree with going on medicaid, however I didn’t have a lot of options, so I did what I needed to do for the health of my baby. When my sister asked my mother who was paying for the healthcare, my mother told my sister, “You are, dearie.” (my sister was a New York resident). Thank you New York residents!
So the morning of, I was getting ready for my office temp job when my body produced a giant gush of fluids on the bathroom floor! Was it pee or was it amniotic fluid? I felt pretty sure it was fluids, so called the hospital around 8:00 a.m. and they said to come in, so naturally I postponed going in and opted to clean my apartment instead. This was pre-doula days so I didn’t know much, but I knew NOT to go the hospital right away, especially if your water has broken but you are not contracting.
Around 10:00 a.m., I waddled up and over the 7 blocks and 2 avenues from 20th and 3rd, on Gramercy Park South, to 27th and 1st in Kip’s Bay.
I went to buy some milk from a street cart vendor when I arrived at 27th and 1st, and he wanted to gift it to me. He actually got kind of offended when I paid. I should have let him gift it. I learned a lesson in grace.
In I went to the hospital with my milk, red medical card, and little overnight bag. Bellevue is a teaching hospital, affiliated with NYU and I can safely say the birth of my son provided lots of teaching opportunities for lots of residents.
In triage there was the intern who tried and tried to put the large gauge IV into my RIGHT hand only to find out about 30 mins later that he was supposed to put a smaller gauge IV into my LEFT hand, where he tried and tried again. That day, an intern learned where and how to put in an IV.
Around 11:00 a.m. someone must have checked me because they said I wasn’t contracting and I wasn’t dilated, so they wanted to give me Pitocin.
I called and let my fiancee, and now husband, know that I was at the hospital, but having a very strong work ethic (never misses a day of work type of guy), he thought nothing of saying he’d be there as soon as work was done. For some reason I didn’t really care as I was satisfied to labor without his presence - without a daddy either not knowing what to do (hire a doula if you want your partner to learn how to be more involved!), or seeing me such an intense state.
They admitted me to labor and delivery where I was watched over by nice nurse. I don’t recall her name but she helped me breath. Since I was not contracting, they wanted to give me some artificial oxytocin known as Pitocin or pit. Now as a birth doula, a labor support person, I know many other ways to get nature's oxytocin hormone to release (as well as the negative side effects!), but not having a clue about anything because we only took one parenting class at Bellevue, I agreed.
Next thing I knew, all I can see are my white knuckles gripping the bed rail and my nurse saying, "Ms. Rachel, you need to breath for baby! Breath for your baby!" It was a command and I’m glad she reminded me, because otherwise I definitely would have forgotten to breath for long periods of time. I learned about my own strength that day.
They kept offering pain meds but I was concerned they would slow things down and I didn't want the whole process spiraling downward (I later learned was called the "Cascade of interventions"). As it turns out, I was glad I didn’t have any pain medication because I could feel just how horrible these chemical induced contractions were. Pitocin contractions are much more forceful than a natural contraction, which is more of a wave – Pitocin ones are more of a strong spike.
Being able to feel the contractions made me realize how strong they were – much too strong – how could my baby breath? Now I understand more how it works and how during labor the baby and its cord (supplying oxygen and nutrients) gets kind of squished during contractions and the baby’s oxygen supply gets cut off until the contraction is over when the bay catches its breath again. If I’d had pain medication I would not have felt how strong the contractions were and know how my baby was not getting a break from being squished. I said, ‘turn it down, turn it down” I wasn’t getting a break, they were on top of one another!
After several hours of labor I said I couldn’t take it anymore and I wanted pain medication. A doctor came in – like a real doctor I think (not a student) - and told me I was all the way open and let’s do this. Okay. Let's do this.
It was close to 6:00 p.m. and my fiancee arrived around that time, but all I remember is his washed out red shirt with a constellation of little white bleach stains that he wore. I asked him to stand at my head and shoulders. (I secretly replaced this shirt with new one sans bleach stains after).
The local residents also arrived - in came, what seemed like no less than 15 residents and interns to see this crazy lady on pit with no pain meds deliver her baby (it was probably closer to 8-9 interns). It was a wall of white coats - short and long. They all stood there watching, framing the room. I didn’t really care how many people were present – I don’t know why. My mother, mother to 6 children, always used to say, all modesty goes out the window when you have a baby and I found that to be true - I really didn’t care who or what was in the room. As long as me and my baby could breath and my fiancee was at my head and shoulders, I didn’t care. I know this would not be true for many other women who desire privacy.
The attending was present and she was lovely and very encouraging. I don’t remember much from the pushing phase other than it was really exhausting. I was so tired from laboring all day and the pushing phase was so intense and required so much energy. I felt I could NOT do it! Now when I coach moms, I am glad I know just how exhausted they are when they need to push their baby out, so I can support them the right way. It is hard to imagine the exhaustion. I learned how it feels to have absolutely zero energy left and be told you have to bicycle up a giant hill anyway, on a hot day.
The attending told me I was a good mom and I hadn't even had my baby yet. She made me feel so good with just a few words of encouragement here and there.
Our baby boy was born at 6:30 pm. Our hearts completely exploded with love and joy upon welcoming our son.
Whisked away to nursery because I was “high risk” – I asked my husband to follow them as I didn’t want a switched at birth scenario or anything - haha protective mother I guess! They returned baby soon after and with it my fiancee brought a pint of Vanilla Swiss Almond ice cream, my favorite and something I’d gone without for months due to the gestational diabetes. Thank you Steve!
Baby took right to breastfeeding and soon after, my mom in law arrived and looked with such treasure on her new grandson – it was a site to behold! My parents came the next day and that will always be one of my favorite and most treasured memories is my mother and father coming to meet my new baby – my son and then 3 years later, my daughter. Now that my mother is gone, I treasure those moments even more. In my doula role, whenever a grandparent visits a mom right after the birth, I think how the parents will look back on that as one of their favorite memories and they will miss the grandparents some day. Of course, I cannot say that, but I try to do whatever I can to contribute to them enjoying the moment as much as they can.
So, to me and my Irish sense of humor, the birth was a comedy of errors. I could probably write the same story through a traumatic birth lens and getting poked with IVs, provided not comfort measure, having a classroom full of residents present, but I really don’t feel that way - I feel I had a pretty good birth because it was fast and positive and I could feel what was happening in my body. I learned each birthing woman writes her own story.
Speaking of Birth... here are some gorgeous moments captured from a recent birth I attended as birth photographer.
Sometimes you attend a birth and the air is thick with love. My last birth as an NJ Birth Photographer at Pascack Valley was just that type of birth. This is why I always encourage people to hire a birth photographer because you will want to capture those images of your partner supporting you, of holding your baby skin-to-skin for the first time, of the amazing birth team that accompanied you on this journey. It seems simple but when everyone is so busy on the day of, it is important to have a designated photographer. Here are some images from that birth to give you a sense. Please contact me today to chat about your spring or summer booking for Birth Photographer NJ.
All photos shared here with permissions. Thank you to the family for opening their hearts and sharing such an intimate, beautiful and empowering experience. I am forever grateful to be able to share a family's positive birth experience. (Midwife, Donna Tabas; Doula, Lexie Litvin)
Speaking of Birth... How about the fact that birth photography is going mainstream?
Every year The International Association of Professional Birth Photographers (IAPBP) host their annual image competition to recognize “excellence in birth photography". There are four categories: Labor, Birth, Postpartum, & Birth Details.
Subsequently, every year a (noisy) chorus of viewers respond “eww!” “yuck!” “why?” “how?” Too much. Too private. Too public. Too old. Too natural. Too medical. Too beautiful. Too upsetting.
Many responses are downright visceral - people get offended and find the images “disgusting” saying “birth is horrifying” and "Isn’t it awful that someone would share these photos,” and “We don’t need to see the photos.” “This should be personal between the family.” “This is a private moment.”
And every year photographers, families, mothers, and birth workers feel the need to play defense.
So when labels of prude and exhibitionist go head-to-head in a virtual shit slinging competition with a simple loving moment, what’s a birthing mama to do?
When I deliver photos to clients, the best response is that they love the photos and that I captured so many wonderful moments, that they don’t even remember. Icing on the cake is when they express that they want to share their photos.
Here are some feelings my clients are NOT experiencing when they choose to share their birth photos online:
- I want to upset a woman who is having trouble getting pregnant.
- I hope to encourage a person who doesn’t want to have children to tell everyone so.
- I want to force the image of my laboring body into someone’s newsfeed, so they get really angry and start abusing people in the comments section,
- I want to challenge all the people in the world who think birth should be kept behind a curtain.
- I am a millenial exhibitionist and want to share naked photos of my birthing body to the world, just because.
Nope, these are not the feelings a mom or family has when she wants to share her photos.
The feelings are more along the lines of:
- I want people to see how wonderfully supportive my partner was at the birth of our baby.
- I want to share an amazing moment in my life and just how joyful the moment of meeting baby was (or a miriad of other positive feelings around sharing birth photos).
- I want to share photos of my natural low-risk birth to provide images for viewing public to see, so we can see what "normal birth" is and thus become more comfortable with it.
Maybe other mothers want to show people how they moved around and were not in the hospital bed, so that anyone considering a natural birth or homebirth, can see the photos and earn an automatic invitation to learn more, and to see what resources are available in their area, to support the birth they want. Oh and why shouldn't a woman have the birth she wants and enjoy birth, so she begins motherhood from a place a strength and love?
Believe it or not, many people find the birth photos beautiful - whether it be the power of a woman birthing or the reception of a newborn baby into the family’s arms or just the beautiful sight of mothers, fathers, partners, baby (babies), siblings, caring providers, dim lights, the birthing scene. Its pretty a scene, ya’ know?
But beauty is in the eye of the beholder, yes? So it’s safe to assume that not everyone is going to think birth photos are beautiful, but why all the hate people?
Imagine birth is such a private and mysterious event that no one know or has ever seen anything about it.
Now imagine a photo of a woman in labor - lots of skin, maybe some fluids, big expression.
The reality is that people watch ridiculous birthing scenes in tv and movies all the time, but the scenes are made to be so short and such hyped-up ridiculous drama that it becomes entertainment (imagine your surprise sitting through a 12 hour birth scene during your favorite show?).
People say they want birth to stay private but what they are really saying is that they want real-birth, not media-birth, to stay private. They do not wish to know how a woman can moan and groan her way thru labor, or how her knuckles can turn white from gripping a nearby support, or the veins in her neck will pronounced with the force the blood pulsing within her body. They do not wish to know yes there is blood - not necessarily from a woman ripping apart as sensational media would like to think - but from amniotic fluids and bloody show that is a normally present in vaginal fluids at birth as membranes release and the nest of fluids that has been safely tucked away for months gives way to…. yes, a baby!
It is an incredible time in a woman’s life. Amazing birth of a baby and some people wish the share this experience the same way others share about big, beautiful, transpiring life events.
Too private? Yes, birth photos are voyeuristic by nature. This day in age when nothing is private and everyone shares everything - there is often too much oversharing, but it is accepted. Are we expected to have more personal and privacy boundaries with birth photos? This perception really shines light on our cultural perceptions of birth, and they are vastly negative. Society gives us a pass when share other stuff that shows just as much intimacy, just as much skin, just as much emotion but when it comes to childbirth we are scrutinized.
So the haters continue to hate and when large, main stream publications like Huffpost and People Magazine publish birth photos, as they have featuring IAPBP winning photos last year and again recently featuring a mother breastfeeding while in labor (which raised another of issues for those who feel a child should not breastfeed after a certain age) - the public responds in a big way.
See, another sad reality is that women feel they must keep a positive birth stories and images to themselves, because it is more acceptable to share about your horrible birth experience than your triumphant one. As a birth photographer or as a mother, am I supposed to hide my beautiful image because it might make someone feel badly about their birth experience or about their self-image as a strong woman? It is true that some viewers may have had a very medicalized birth or even a traumatic birth and viewing can evoke many emotions just by looking at birth photos featuring normal birth where mom is free to move and experiences only limited interventions. For some it is hurtful because maybe they cannot have children for biological reasons. Seeing the photos can be upsetting for some and hopeful for others. Some women have chosen not to have children and do not feel valued in their choice, or cannot related to the strong powerful woman in the photo, because their strong powerful self lies elsewhere. It is unfortunate that images and stories end up in our newsfeeds that we do not wish to see. It is true we want to be sensitive but does that mean we cannot share?
As a birth photographer, you can guess where I stand on the issue - I support birth photography and the mother and family are very capable, thank you very much, to share if they so choose and the viewing public is free to view or not to view. The problem lies in the responses - when an image shows up in someone’s newsfeed and they are disgusted and offended and then they choose to take time to comment, rather than just move on - it's confounding! Why such visceral responses? Why all the hate? IMHO, if you are offended by birth photography you need to be more honest with yourself about your cultural programming and media influence.
Check your preconceptions at the door, leave all your baggage behind, and meet mama in her moment, right where she is, not where you think she should be.
View this year’s entries and winners on IAPBP. No, it is not a competition for best birth by the way. It is a photo competition.
For mothers who are thrilled with their birthing experience, For mothers that are not, For mothers to be that have no clue what to expect.
Written & Shared by mother, Tanja Nenadovic Vasquez
This is the story about my pregnancy and natural, vaginal, un-medicated birthing and choosing of the team that helped me accomplish all that.
It was Monday night. We went to bed, but for whatever reason I kept getting these waves that would pull me out of my sleep each time I almost drifted into the dream land. I coped with it for some time, then texted Donna, my midwife. She suggested to take a bath, which would ease off waves and give me some time to rest. I jumped in the tub and took a shower. I have not realized at all at the time that bath and shower are not the same not only linguistically but medically as well for a birthing woman especially: bath is slowing the birthing process while shower is intensifying it. So, that is what I have got – intensified birthing waves (known as contractions in medical vocabulary). Around 1.30am I woke up my husband and told him that I think I am having pressure waves and they are kind of strong. He got ready and we worked together as a team and did all that we learned from Donna and Holly. Around 3am we called Holly to join us. She came ready, as always. Using her rebozo (special scarf, very sturdy and long), Holly guided me through different positions during my waves while she and my husband were either massaging me, or squeezing my hips, or holding me one way or the other. She also brought oil lamp with soothing oils, warm and cold packs to release the tension in my back, and different essential oils for the massage. As I said, Holly is a person of excellence who is always a mile ahead. ☺
Around 10am I was on the phone with Donna during one of the pressure waves and she determined that it is time for her to join us. She came to our home and examined me. “Six centimeters! Great! I am heading to the hospital to prepare everything. You get ready and we’ll meet there.” Donna said and stormed through the door. We got ready and followed her.
We arrived to the hospital around 11am where Rachel, our photographer, joined us. Journey to the hospital and the hospital procedure took some time, which disturbed my flow with the waves. But once it was over, we were able to concentrate on my birthing journey. Donna was directing us all what kind of position I should do next. Alex and Holly were helping me do all of them tirelessly, silently, without any flinch, while Rachel, invisibly for me, documented all that with her magic camera eye. Not to mention that all of them coped with my loud and constant prayers to God, singing, and my outbursts of demands and requests in occasionally unkind way. None of them ever answered back, they just did the best they could to accommodate each and every need that I had. That was tremendously important to me since it gave me all the space to concentrate on gliding through my waves that were slowly but surely intensifying and coming closer. There was a big clock in the birthing room, but God helped me not to focus on it, but rather stay in the moment and let go, let God, and go through waves with Him and my DREAM TEAM. I noticed the time was passing and it seemed rather long, but I did not care. I had one goal and one goal only – to birth our son safely, gently, naturally, vaginally, unmedicated.
Donna later explained to me and my husband what I was going through in order to accomplish that. Our son was positioned head down and started descending. He was on the right-hand side of my belly, which took him the longest way to come to the right position – down my belly button (baby moves clock-wise during birthing, another lesson from Donna ☺ ). This took about five-six hours to happened and for me to open from six to eight centimeters. My DREAM TEAM, led by Donna, had all the time and patience in the world for me and our son, because my goal was their goal too – natural, vaginal, unmedicated birth as long as possible! Once we accomplished the voyage, Donna realized that our son’s head is tilted in such a way that he is hitting one of my pelvis’ bones. He would not be able to come out by himself in such a position, so that would probably ended up being a c-section for me, shouldn’t I have my DREAM TEAM by my side. All their amazing knowledge helped me go into different positions during birth waves so that our son can come out of my pelvis just enough to change the head position and then slide back in. This took some time again and we were bound to infuse some oxytocin here and there to keep things going smoothly (should you ever meet Donna or Holly, they will tell you what that means ☺).
Around 9pm Donna finally said: “You got it, dear! Time to push! Would you like us to direct you or to push at your pace?” I was so focused on going through waves that I did not know how to switch now and I needed direction. So, Donna asked me to lie on the bed while she positioned herself at the bottom of it where my son was about to arrive. She positioned my husband to hold my right leg and Holly to hold my left leg. She directed me how to position my body, follow urges to push and just do it at my timing. This lasted for about an hour, and it took about five-six pushes according to Donna. In the midst of it, Donna asked me to touch my son’s head that was crowning. At first touch I just felt something soft and hairy. Second time when I touched I felt most of his head coming and I screamed the scream of COMPLETE JOY – MY SON IS HERE!!!!!!!!!!
It was 10.06pm on October 4th, 2016th, only about twenty-four hours after it all started. And folks just so you know, I WOULD NEVER MAKE IT WITHOUT MY DREAM TEAM!!!!!!!!!!!!!!!
T H A N K YOU, MY LOVE!!!!!!!!!!
T H A N K Y O U, D O NN A!!!!!!!!!
T H A N K Y O U, H O LL Y!!!!!!
T H A N K Y O U, R A C H E L!!!!!!!!!!
GOD BLESS YOU AND REWORD YOU FOR YOUR AMAZING WORK, DEDICATION, ALL YOUR LOVE AND CARE THAT YOU GAVE ME!!!!!!!!!!!!
"My Dream Team" Backstory:
At the beginning of February 2016th, we found out that I am pregnant. Thrilled with the news, I visited my obstetrician, but my appointment did not go how I expected. I did not feel informed enough about my pregnancy process and different testing that kept being required and never explained; my questions were at times answered in a tone “not a big deal” or “you should know that”; and I was slightly ridiculed when I mentioned that my job (teacher for 2 to 6 year old children) is getting a bit demanding for me in my new condition. It took me few months to admit to myself that I deserve better than that and to start the research for new care-provider, preferably midwife this time. My husband suggested to call each hospital affiliated with midwifes and ask them for their names and phone numbers. First on my list was Hackensack UMC Pascack Valley in Westwood, NJ. They gave me quite a few names so I called each and every one of them. My husband, who was helping with the research, said: “Check this one out, I think you will like her, Donna Tabas.” I did as he said and felt that she is THE ONE! And that is how I started forming my DREAM TEAM.
Now I will tell you more about each and every team member.
First and most important one is MY HUSBAND, of course. The one I took longest time choosing, only little bit over thirty years! And even that was not my choice, I believe, it was God’s preordained plan for us and I am so thankful for him in my life – the most loving, caring, kind, and gentle person that I know of. And he only confirmed all that through my pregnancy and birthing journey. He was by my side when I was doing the pregnancy test – we cheered in amazement together to my pregnancy and our parenthood that was starting; he was researching and letting me know each week what is happening with our baby and what parts of its body is developing at the moment; he supported me when I needed to stop working unexpectedly at three months of my pregnancy due to challenging requirements of my teaching job; he was by my side when I was changing from obstetrician to midwife and did research with me and helped me find the right person for us; he read the books that were teaching him how to help me during the pregnancy and birthing, he coped as a champ to my occasional emotional outbursts of tears and such; he loved me through each and every pregnancy or just womanly tantrum; he was there to not let me give into my sugar cravings at times; he was by my side at the ultrasound exams watching in wonder with me our son growing in my belly; he supported me when choosing the doula; he worked hard after work on our baby’s room fixing the walls with contractor, painting, putting the trim; he was kissing our son each and every morning and night for both of us with such joy and gentleness. He is the love of my life, my rock and my stronghold. I hope that most of the ladies reading this have such support, and that the men will be inspired to be such a support.
The most important medical support that thought me so much about everything that I ever needed to know about my pregnancy and birthing was DONNA TABAS, CNM. I still remember our first meeting and her gentle and calm, yet strong and confident demeanor that won my adoration. Even before we decided to work with her, my husband and I learned so much from her. “SHE IS THE ONE!” we agreed and our real pregnancy journey began. First thing that Donna did was give me the booklet of about two hundred pages that she created that covers all possible questions that a pregnant woman will ever think of asking: from dietary requirements and how much weight I should gain to all the changes my body and mind can possibly experience during this process, and more. She also explained to us what is the difference between medicated and unmedicated birthing and why the first one ends up with C-section in 40% of the cases when the real emergencies are actually only 10%. As I mentioned before, Donna is very gentle but very open and persistent as well - she will do everything in her power to help you birth in the most natural way without distressing you or the baby and only in the real emergencies go for other alternatives. In order to do so, her goal is to keep mother as healthy as possible. In my case that meant – stay away from sweets and watch your weight because it was high to begin with. When Donna faced me with that in her direct but kind way, I was a bit hurt deep down inside. “Well, I was not that much overweight anyways! I am doing my best. I am not even eating the whole chocolate bar a day!” deceiving justifications went on and on in my mind until all of a sudden I realized: “Donna is not my enemy nor will she gain one ounce of anything if I do listen to her or not. The only advantage from her advices will come to me and my child. So, what am I fussing about?!?! Donna is trying to help me and it is up to me if I am going to listen to her and now help myself! And I AM!” So, I took all the paperwork about food that Donna gave me and worked diligently on following the food chart and food intake that was suggested. Whenever I had sugar craving I followed Donna’s advice and took some protein (nuts, egg, piece of whole-wheat something) instead. Little by little my sugar-cravings eased of. Thanks to Donna I concord the reality and the myth of my cravings.
Donna also kept saying: “If you want to have natural vaginal birth you have to have doula, have to have doula, have to have!” Oh man! Coming from a country where that did not even exist yet and where just few decades ago my grandmothers gave birth wherever they happened to be around the house at the moment due to a lifestyle in the countryside, I thought that Donna is surely overreacting about doula. Nonetheless, I decided to find out for myself what that doula really is. After the research, I concluded: “Doula means having a private masseuse at the birthing, and this strong Serbian girl does not need that for sure!” And if Donna did not gently persist, I would live to learn how wrong I was. To find out more about Donna and her wonderful work, please visit her website www.northjerseymidwiferycare.com.
My husband and I decided to research still more the doulas in our area. Once we gathered all the information needed, I started contacting different doulas and I must say that I came across many nice ones. However, some were not available, some were over our budget, some were having clients at the same time as our due date… I managed to interview few still and things just did not feel right with them, until I met HOLLY GRAFF! She came ready in each and every way – she was present, very sensitive to my nature and needs, surprisingly knowledgeable not only about basics but about all different approaches, techniques, and exercises that I was interested in and she was able to do it with me on the spot. WOW! Thank you, God! I really liked her and felt comfortable having her in our birthing room, so I asked her to come again and meet my husband. She won my husband’s heart in a beat also with easy going conversation, but even more so with gentle instructions about his role before, during, and after the birthing process. It was very important that two of them bonded and had good communication, because they would work as a team in helping me go through my highs and lows at birthing. As a person of excellence, which Holly Graff certainly is, she came again to visit us and teach us how to properly do certain exercises that our midwife asked us to do during the last weeks of my pregnancy. Thank you, Holly! If interested in contacting Holly, please send email to firstname.lastname@example.org.
RACHEL CONNOLLY KWOCK is professional doula and photographer. She came unexpectedly into our lives, again through our midwife, Donna Tabas, and at the last minute almost, but we are so grateful that she did! I fell in love with her writing while browsing her adorable website http://www.speakingofbirth.com/ She shared her deepest self in many of the stories which I consider very brave and admired her before we even met. When we did meet, her calm and soothing demeanor, none intrusive but gliding curiosity, and gentleness in manner won both me and my husband and we agreed to have her on board of what is to become my dream team. During my birthing, I was ever grateful for that decision, because she was not only completely invisible and quite so I did not even notice that she was photographing me, but she was also invaluable part of the team contributing with the ideas for new positions during my waves, reminding the team that they need to eat to keep the strength, and keeping positive vibe. Thank you, Rachel! If you want to see more of her mastery, please visit her website and enjoy yourself!
Clients often ask if I can provide them with a receipt that they can submit to insurance. Yes, I can, but you will want a back-up plan. Doulas are not automatically covered by insurance although many people feel they should be. Choices in Childbirth (CiC) put out a big report on this topic earlier this year, Overdue! Insurance Coverage of Doula Care. Warning: it's complicated. In the report they say, “Private insurance plans should include services of a trained doula as a covered service, and state legislatures should pass legislation mandating private insurance coverage of doula services, as they have done for a broad range of services." Even in states where there are programs and the insurance companies are supposed to reimburse (the only states being Oregon and Minnesota), it is not a slam-dunk, “At this time, few doulas, if any, have actually received reimbursement in either Oregon or Minnesota.”
So some people try to get covered with some effort. For this, the doula needs to provide an itemized receipt. The theory is that there are insurance companies that cover support services that fall into a second tier of health options such as therapeutic massage, gym memberships, breast pumps, lactation consultants and doulas, and typically the companies require the insured to provide paperwork and receipts. As an example of how to submit, DONA offers this DONA 3rd party reimbursement manual, but keep in mind it needs updating as it still includes CPT code, which I will go into below: http://www.dona.org/PDF/3PRSampleLetter.pdf. As doulas, we can provide a detailed receipt including our National Provider Identification (NPI#) and a description of services. As per describing services - I have not heard of the insurance companies being impressed with doulas describing relaxation and pain-coping techniques or that doulas are preventive medicine and statistically reduce the need for expensive surgeries and epidural anesthesia. The companies seem to better respond to tangible services they are familiar with, such as childbirth education and breastfeeding support.
Anecdotally, I have heard of a doulas being reimbursed when the provider signs a letter of medical necessity, including a medical code, indicating labor support increases the chances of the patient having an unmedicated birth with no pain management (I guess if it's doctor's orders then it is taken more seriously). What is this secret code you ask? Midwives and Doctors can offer CPT code 99499, since they are medical, but since doulas are not medical we cannot offer this same code. Per DONA, “As of this date, there is no national CPT (current procedural terminology) code for doulas.” So doulas cannot sign-off on this type of letter/receipt because doulas are not medical therefore we do not have a diagnosis code. Having a provider sign-off on our services is not realistic option for most of us since we are hired by the client and not by the provider, but there are offices in my home turf of northern NJ that have doulas on staff, such as Wombkeepers and Midwives of NJ.
So what are the options? Some clients have been able to use their Health Savings Account (HSA) accounts and Flexible Spending Accounts (FSA), that can reimburse an individual or help one pay for eligible health care expenses not covered by one's health plan. Typically, the amount designated from your paycheck, that you put into your FSA, is taken out pre-tax. You will still need a receipt with NPI# and description of services for this purpose.
In closing... The insurance piece is going to take some time. Feel free to get involved by raising awareness via the CiC report or by contacting the rep at your doula organization who handles insurance questions. Personally, I don't recommend clients invest too much time with insurance. As for women who cannot afford a doula - recommend saving, offer a payment plan, request money for doula-savings at their baby shower/registry, ask a doula to barter services. Also, there are always student doula training and attending births, as they work towards their certification. To find these doulas just look on doulamatch and see how much they charge – rates often correlate with experience.
What is your experience with insurance reimbursement for doulas and what are creative ways you've heard of how people afford a doula? How do you respond when people ask if you provide insurance? I hope to read your response.
If you are interested to read the full report, visit Choices in Childbirth's Toolkit Overdue Medicaid and Private Insurance Coverage of Doula Care to Strengthen Maternal and Infant Health http://choicesinchildbirth.org/our-work/advocacy-policy/doulacoverage/.
Skylands doulas, a group that generates supports and advocacy for the role of doulas based in northwest New Jersey, periodically hosts doula meet-ups. This past year we had the pleasure of hosting 3 midwives as part of our meet-the-midwife gatherings. The 3 midwifes all came from different practices here in NJ.
Let's quickly outline the different license options for midwives here in NJ as there are 3: CNM (prescriptive and non), CM, & CPM.
According to American College of Nurse Midwives, "CNMs are licensed, independent health care providers with prescriptive authority in all 50 states, the District of Columbia, American Samoa, Guam, and Puerto Rico. CNMs are defined as primary care providers under federal law.
"CMs are also licensed, independent health care providers who have completed the same midwifery education as CNMs. CMs are authorized to practice in Delaware, Missouri, New Jersey, New York, and Rhode Island. CMs have prescriptive authority in New York and Rhode Island. The first accredited CM education program began in 1996. The CM credential is not yet recognized in all states." Read more on the ACNM Website.
A Certified Professional Midwife (CPM) "is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the Midwives Model of Care. The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings." Read more at NARM.org
According to NJ Homebirth Midwives "All New Jersey licensed midwives have undergone both clinical and academic training and have met rigorous standards set out by the NJ Board of Medical Examiners. For midwives certified as Certified Midwives or Certified Nurse Midwives, their training has been university based and usually includes a graduate degree. For midwives certified as Certified Professional Midwives, their training is community based, which means they’ve done extensive study under experienced midwives and have graduated from a MEAC-accredited academic program as well. CPMs are the only type of midwife whose training is specifically focused on out-of-hospital birth."
To learn more about the regulation of midwifery practice in NJ pls visit NJ Consumer Affairs Midwifery Liason Page.
Ok so, let's begin...
The first midwife who visited us was Kacey DiVine, RN, CPM who does homebirths with Babycatcher Midwifery & Motherlore Midwifery. Kacey shared about the experience, homebirth midwives sometimes go thru, of transferring from home to hospital and what to expect regarding: transport, continual support from birth team, choice of hospital based on location of medical back-up, reception of hospital staff, and more.... In the story she shared, all was well, but it was clear more communication and collaboration could be fostered between the homebirth communities and local doctors and hospitals. Kacey feels that having a good collaborative relationship with an OB practice (like the relationship they have with One to One Female Care) "makes transfer safer and less stressful for the mom. The goal that we homebirth midwives are working on is expanding those relationships to other docs and hospitals." What ideas do you have how to educate and inform regarding home to hospital transfer? Thanks to Kacey as we were very grateful she was able to come share about her experience with the Skylands Doulas.
What programs do you know of that help foster the relationship between #homebirth communities and local doctors and hospitals? Tweet
The second midwife, who we were honored to have visit, was Donna Tabas CNM, MS of North Jersey Midwifery Care, who currently attends births at Hackensack UMC at Pascack Valley. Donna has a solo practice and works as a "dedicated” midwife, meaning that she is the midwife you will have for all your prenatal care, the birth, and postpartum period. Donna shared about her journey to becoming a midwife as well as how we must carefully choose the words we use when speaking of birth - it's all on her blog, read more about it on Donna's blog. Donna also shared some of the exercises she does with clients including a meditation on cesarean surgery. The cesarean meditation released tension and emotions in the room for all the women present - both on a personal level as well as professional as it released tension we hold from clients and the stories we become vessel to. Thank you Donna for helping us find our way through this space, which is often traumatic, and helping us find new words and helping us reframe.
What is one of your favorite activities/exercises you do with #doula clients to help release fear and tension?
The third midwife, we were lucky to have visit, recently became credentialed at two NJ hospitals after working as a Homebirth Midwife for 24 yrs. Linda Perry CNM, of Lifelong Midwifery writes that she is, "So excited.....bringing my practice very soon to Mountainside Hospital and Hoboken University Medical Center. Have you heard bad things about Hoboken? Times a changing over there. They are bringing back many of the St. Vincent's crew across the river, renovating both the rooms and the outlook." Linda also shared with us about Hoboken's new Pampered Pregnancy Program, "A family-centered childbirth and parent education program emphasizes mother and baby wellness, information for all family members, and family autonomy." Through this program, all of Linda's clients will have their own Pregnancy Coach included in their care. Follow Linda at https://www.facebook.com/YourMidwife/ Linda is excited to be working closer to home where she is short drive to be with her mamas. She is also looking forward to collaborating with the hospitals to further enhance their motherbaby care.
If you are a midwife or a birthworker and would like to come speak to Skylands Doulas, please contact Birth Doula & NJ Birth Photographer Rachel Connolly Kwock at email@example.com or 917 676 7177. Thank you!
Thanks to all the midwives of the world!
Not everything comes naturally but that is no reason to be discouraged from pursuing something you want to pursue.
Sometimes we need to learn the basic skills first in order to feel comfortable enough to let our intuition really flow and to allow things to come naturally – to have the ability to “just know” something without any proof or evidence.
Take a chef for example – to be able to say “oh I just added a touch of this and stirred in a little bit of that” is usually from years of trial and error – from souring sauces and burning side dishes. Now they can play around with seasonings.
Or consider a businesswoman who says, “I followed my gut” or “I had a hunch about that deal” – it’s often from years of experience and observing behavior, analyzing metrics, and taking risks. They already know how far they can push things and what the likely outcome will be.
Intuition as a learned skill applies to business and creative pursuits as well as many of other vocations – and in my personal experience, it applies to working as a birth doula in northern New Jersey.
As a birth doula, a woman who supports and serves women in childbirth, it was frustrating when I started to have more-experienced doulas tell me – “just to follow your intuition”. I would think–I have no idea where this intuition, you speak of, starts or where it leads, so can you please provide me a little direction?
When I started as doula, I would always do a simple hip squeeze – placing my hands on either side of mom’s hips, applying pressure to relieve pain and tension. I did this repeatedly because neither my skills nor intuition was guiding me anywhere else. About a year ago I participated in a workshop where we learned in-depth information about positioning for mother and baby and am now able to follow my intuition more. The workshop changed by practice.
Knowing more helped me be more intuitive.
Now when I support a mother – I know to breath out any tension and let any thoughts go from my own mind – to leave the suitcase at the door. I listen to what comes intuitively - to the sounds of the birthing space and the birthing woman.
Tuning in helps me listen to the sounds of her movements – whether they be tired, tense, relaxed, imminent.
I can sense her clenched jaw and gently rub her jawbone to provide release. I can tell she is hold tension in her pelvic area by how she paces and positions herself during contractions – and can gently place my hands on her sacrum to offer her release and support.
Are her legs tired from standing all night? I can feel if her muscles are taught or wilted and go on to provide a gentle foot massage or little wiggle to shake out her lax limbs.
It took me years of building my knowledge and skills to get to the point where I felt I could follow my intuition but now I feel confident to enter the space of a birthing woman and close my eyes and listen to the space and to what her body is telling me – where her body is guiding my hands to go, to be intuitive. To “just know.”
So if this skill of intuition was there all along and is available to all of us - how can we hone it? How can we simply be more attuned and responsive to the subtle clues we receive?
Scientific America Magazine wrote that intuition is linked to the basal ganglia area of the brain – an area that controls fast, automatic, cognitive operations. So it would make sense that to hone our intuition we need to improve or maintain our brain health.
As many studies show – brain health can be maintained with good diet, exercise, plenty of sleep, and clearing the mental clutter. To be a good listener and more intuitive, it is important to turn off the chatter in our brains. We can do this using meditation or periods of silence and solitude where we focus on our breathing or something that brings us peace.
In order to be better listeners in our environments, we need to turn off the noise.
So intuition may not be a mystical thing for all of us. If we are experts or even very experienced in our fields – it may be a matter of just connecting the constellation of silent clues we receive in order to yield an intuitive response.
Being intuitive can be a wonderful, freeing feeling. I will never, ever say to a doula starting out – “oh just follow your intuition” as if they already have that roadmap. For some of us, it is only possible to follow our intuition after we have created a map that charts skills, knowledge and experience. Only then can we can paint with broad brush strokes of intuition over the charted ones.
As Picasso says, “It took me four years to paint like Raphael, but a lifetime to paint like a child.”
Fellow doulas, what helped you to follow your intuition more?
Photo shared with permissions. PC: Rachel Connolly Kwock. Feat.: Doula Holly Graff & Midwife Donna Tabas.
Capturing the labor and delivery (birth) is a constant adventure and I love it! This year has been great (for me) as I gain experience taking photographs at childbirths in New Jersey. I've learned Birth Photography is unique and is such an adventure in so many ways.
Here are 3 reasons:
- Focus! The homebirth setting, or hospital labor and delivery room setting, are often dark, so a flash and/or a wide lens is often needed. Also, everyone is constantly moving! The labor and delivery nurses, the doctor or midwife, the doula, the laboring mother, the partner and/or father, and anyone else in the room - everyone is always moving, so it makes it a challenge to focus on your subject in a dark space. I've gotten better over time so this has been rewarding.
- Birth space is a highly charged and sensitive environment. Depending on how one's birth is moving along and where one is giving birth, the environment can really vary. In my current work as a Birth Photographer, I am sooooo grateful to my DONA Birth Doula training and background to be able to understand what is happening in the room and to be able to play a role in protecting the birthing space for the family.
- Careful not to set-off mom's catecholamines and cortisol fight-or-flight hormones. Childbirth is a time mom needs to burrow into her shell so she feels safe and protected, so all her good birthing hormones will be released. When in my role as photographer, I work to be gentle and not probing with my photography, so as not set off a flight-or-fight response in mom and risk reversing or halting any progress she has made. I enjoy the challenge of capturing a moment while trying to be very quiet, gentle, and unobtrusive.
I truly love the work and adventure. I look forward to working with clients and families this fall and winter. I am currently booking birth photography clients who reside in eastern Pennsylvania (Lehigh Valley), in northern New Jersey, and in New York State (Rockland & Westchester counties), so please get in touch to set-up a free meet-n-greet.
Happy Birth Wishes!
Professional Photographers dedicate years of learning and experience to master their craft, invest thousands of dollars in camera bodies, lenses, and equipment and editing programs, create a legal photography business entity recognized by the state from which to conduct business....
My offerings are a little different....
I am birth doula certified by Doulas of North America (DONA), a (former) professional filmmaker, and hobby photographer currently merging my love for all the roles here in Northern New Jersey. So how does it work - how can I be your birth doula and photographer at the same time and what exactly is my level of expertise?
Well, to answer the first part of the question... If I am hired solely as your Birth Photographer then yes, 99% of the time I will capture everything that you would want captured. If I am hired in a dual role as your Birth Photographer/Doula, I can do both jobs at about 95%, as there will definitely be a few moments where I am not able to capture a photo or not provide the support needed depending on what you have expressed you want. At our prenatal visit, we can discuss what is more important to you, either the birth photography or the doula support, with the caveat being that birth is fluid, and oftentimes intense, so your needs may change in the moment and as a doula I am trained to respond to the woman's physiological needs.
Okay, so what is my level of expertise? I have been a lifelong hobby photographer, however once I committed to offering birth photography services, I invested in a new digital camera/lens/flash. editing system, etc... took a class to polish my skills, paid for pro membership and enlisted the help of a designer friend to create a watermark. Photographers are always learning, however I feel confident with my skills and equipment at this time. Please see my gallery page to see the progression of my work. I will continue to build my portfolio over the next year.
So yes, I believe a doula and a birth photographer can fulfill both roles simultaneously, but with limitations. I also feel a client can hire a professional birth doula photographer in just one role but feel secure knowing they have hired someone with doula expertise as their photographer or someone with photography skills (if enlisted) as their doula. I will always have the heart of a doula and the eye of the photographer whatever role I am in. Best wishes for you birth and props to all the birth doula photographers in the world!
It was such an honor to be doula to Matt, Megan, and Baby Atticus. It was humbling to see a husband and wife so dedicated to one another and to their baby. The endurance and struggle Megan went thru, to try and provide her baby the birth she felt was best, was immense. It was inspiring to be witness to her coping - to see her roaring her way thru labor humming and moaning, rocking and swaying side-to-side, back-n-forth on the bed, in the tub, in the shower- allowing herself to surrender to the power of birth. I will never forget the heartbreaking look on Megan's face when she was told she will need to have surgery. I know the end result is a million miles away from where they thought and hoped it would be, but personally I will never forget being amongst a circle of women in the presence of an incredibly powerful lioness who thundered her way thru every surge, and her devoted husband who provided incredible support, focus, assuring words, gentle touches, and constant devotion and attention. Megan, thank you for sharing your experience of challenge, healing, and love.
"Whatever birth you end up with or choose, becoming a mother is a strong and brave act – it’s the beginning of the selfless gift of unconditional love you give to your baby. " - Megan
By Megan Stark
I’ve been a doula since 2012, trained in both birth and postpartum support and I am obsessed with birth.
But let me start at the very beginning.
When I was born, I was diagnosed with pulmonic stenosis, which for me was a condition that required immediate emergency surgery. I was whisked away to NYC to have open chest surgery, which as a new mom, I can’t even wrap my head around how incredibly terrifying this must have been for my parents. I healed well, and became an avid rock climber in my teens. After college I completed an internship in Boston, and while there I suffered from a TIA (stroke). This alerted my cardiologist that perhaps something else was going on with my heart. She discovered a hole in my heart – which is a far more common condition than my pulmonic stenosis. After my internship I moved to the New River Gorge in WV with my future husband. I wanted to learn more about the hole in my heart and how it might affect future pregnancies, but the health insurance laws prevented me from obtaining health insurance for some time (pre-existing condition clause). Once I did obtain insurance, I had to wait a whole year to be seen by a specialist for my heart (again the pre-existing condition clause which has now been ruled illegal by the new health insurance laws). Finally – in 2010, I was able to learn more details about the hole in my heart and what it might mean to pregnancy and birth. I was told that the hole was of such a size that pregnancy would be dangerous – and so began my journey toward providing a provider that could close the hole without another open chest surgery.
My husband and I moved back to my home state of NJ, and in 2011 I had the ¾ in. hole in my heart closed via a cardiac catheter procedure. The most amazing thing happened after my procedure – I no longer felt like I was suffocating when I exercised! I had never quite realized I felt his way, since I never knew any differently.
In the summer of 2012 I finally got pregnant, we were excited and elated, and shared our news with my family in one of those adorable Pinterest worthy ways. At seven weeks we lost that pregnancy, and I was devastated. Miscarriage is a cruel and sad event, and one so many people experience but it is so commonly written off, ignored and covered up. If you have experienced a miscarriage (nearly 30% of all pregnancies end in miscarriage), please know that you are not alone, and if you are struggling with this loss seek support from your friends, family or a professional. It is a true and profound loss, and you are absolutely allowed to mourn that loss.
As I said, I was devastated. So I decided to re-focus my attention, and began my doula training in 2013. Training to become a doula was this incredibly intense and powerful experience – just like birth! I loved attending births, and was feeling positive and excited about becoming pregnant again. In the summer of 2013 I achieved that goal, and gun shy this time, told our family in the quietest way possible. This time, I was sick – soooo sick. I was bloated and hormonal, and miserable and scared. I was terrified we would lose this pregnancy, and wanted to keep it as quiet as possible. At 12 weeks we went for our ultrasound.
There was no baby.
Our pregnancy was a “complete molar pregnancy” and my sickness was related to my out of control pregnancy hormones. I lost my mind. As a doula, I knew about these types of pregnancies, but they are rare, and having made it to 12 weeks, I was so hopeful that this pregnancy would stick. A molar pregnancy is dangerous, so a D&C is necessary and follow up blood tests are required. Women who have suffered from a molar pregnancy must also hold off on trying to get pregnant again for some time. This is to be sure that if the pregnancy hormones go up again, that Doctors can be sure it is not from pregnancy and instead from the molar pregnancy. (While rare, molar pregnancies can turn into a form of cancer, so the blood tests monitor that the hormones are going down and not up.) Here's the link for support group I found: FB.com/groups/mymolarpregnancy/
Another year passed and we finally decided to try again, one last time.
And this time it worked. We were due in April 2015, and I had one of the most amazing pregnancies. I wasn’t sick, I felt great and I was so hopeful! I also began working from my doula trainer, Debra Pascali-Bonaro, and was greatly immersed in all things birth and babies. It was such an amazing time! I was one of the most over prepared mamas-to-be you could imagine. I hired my doula co-worker and friend Rachel Connolly-Kwock as my doula, prepped my husband with too much information, took Debra’s new childbirth class, “Pain to Power”, and found an awesome midwifery group “The Midwives of New Jersey” which have an incredible water birth record. I wanted providers that I knew I could trust. As a birth doula, I had heard and saw so many women who felt coerced or disrespected in their births, and I wanted to avoid questioning my providers motivations, after everything I’d been through, I needed to know that they too wanted to avoid a cesarean as much as possible.
I planned a natural, intervention free water birth and wanted to labor as home as long as possible with my doula and husband. When I went into labor early Saturday morning, I was sleeping on the couch (at 41 weeks, while still quite comfortable, I was having some trouble sleeping). I worked through the surges on my own for a couple of hours, but was suffering from (what I later realized was) really intense back labor, decided to wake my husband for more support. At 9am things were progressing so quickly, we decided to call our doula. Let me say, that when your doula shows up, there is an incredible feeling of relief knowing you now have the professional, knowledgeable, kind and understanding support of a trained doula by your side to support you and your birth partner. We labored at home until after noon that day, and then made a plan to meet up with my lovely midwife Chrisy at their office. The office was closed that day, so it was particularly peaceful to labor with my support team. I was encouraged by my midwife to hydrate, take some honey, and eat as we knew labor could still be quite a while. We decided to check my dilation and I was just about 6cm. After a couple of hours we decided to move to the hospital, as I was desperate to get into the tub!
I labored in the shower and the tub for hours, but I was not progressing. My contractions were not coming at a steady clip, my back was killing me, and I was becoming discouraged. My doula, husband, 2 midwives and midwife assistant were incredibly encouraging and supportive. We agreed that breaking my waters might help my contractions to become steadier, assisting me in progressing. At this point I was still only 6cm, nothing had changed.
Hours later, I was done. I mean done. I asked for an epidural, something I swore I would never do. My lovely midwives distracted me, suggesting we instead try a very tiny amount of Pitocin, to see if we could get things going. I did not want this, but was feeling exhausted beyond anything I had ever felt before. I knew if my midwives were suggesting it, they felt it was likely needed. The goal was a vaginal birth above all else, and I knew that I would not be able to go on like this forever. Along with the Pitocin, I agreed to another drug that would allow me to rest between contractions. A couple of hours later, I roared awake during an intense surge. I was DONE- and this time I meant it! We decided to check my dilation again, and I was fully dilated. After some time, the midwife asked if I wanted to push. I had absolutely no urge to do so, which I thought was odd. But, ready for baby to arrive, I got to it! I pushed in every position you could think of. On my bed legs up, legs down, on all fours, standing, squatting, up, down and practically inside out! I was falling asleep between surges, completely worn out – my strong and amazing husband was literally holding my sleeping body up. Two hours later there was no progress, the baby’s heart rate was decelerating, there was meconium present and I was making no progress. The backup OBGYN was called in, and I was told that a cesarean was now on the table. My wonderful midwives knew how much I did not want this. They gave me the time and space to consider my options. I knew when my midwife Cindy told me that it would be safe to try a little longer, but that she really felt that nothing was going to change, that she meant it from her heart.
Sometimes births take a turn from what we anticipated. When a woman has a cesarean, she often feels she has failed herself and her support team. This is so sad but the reality is that we end up needing to ask for self-forgiveness. For a mother, who dreams of natural birth, to be told that your dreams have been dashed is heartbreaking on so many levels... You wanted the experience for you and your baby, you wanted to know that experience other women speak of- of birthing your baby and holding them skin-to-skin, a moment when all time stands still. You are scared and don't want surgery. You are aware of the benefits of natural birth from reading studies that show the hormones released during the birthing phase may be critical to emotional development, the shaping and molding of the cranium can ignite cranial-sacral balance, the baby being exposed to microbiomes can provide a lifetime of strong gut health and improved immune system. It is not to say some of the health benefits of natural birth can not be nurtured over time in a surgically born baby, but when you are told you are going to have a cesarean these are just some of the thoughts that flood your mind.... and it is devastating. Most prominent and most upsetting is the sudden lack of control - you were in control of your body (sort of, right - as much as we can be birthing a baby) and you were looking forward to responding to your body and baby's needs as the birth process progressed, but then all of a sudden your body, your baby, your birth, became my body, my baby, their birth.
Defeated and exhausted, I apologized to my husband for not being able to do it, and agreed to the cesarean section. My husband of course thought that was silly, he was so proud of me for what I had accomplished - but at the time I felt like a lemon. My dream of my intervention free water birth had been lost earlier that evening, and now my vaginal birth was gone too. As I was rolled into the OR, I was mentally numb. The surgery is quick, bright, intense and bizarre. All around you are strangers, your partner isn’t allowed in the room for the prep, your doula isn’t allowed in at all, and after all those hours of intensity, your body is numb. I feel so lucky that my midwife Chrisy was in the room during the prep, which for me was the scariest part. She held my hand, talked to me, and kept me company as I prepared for the birth of my baby. Finally, my husband was ushered in, and what felt like seconds later, my baby was born. A quick flash of the baby over the curtain, screaming and purple and my husband was rushed over to the baby. He was able to bring the baby to me for a quick kiss before the two of them were taken to the nursery. Another dream, of immediate skin to skin time and delayed cord clamping was taken away.
Birth via cesarean in an amazingly quick process, but the closing up is tedious and lengthy. Without my baby or husband there, it was sad and lonely. Again my midwife’s presence was so comforting. She continued to hold my hand, chat when I needed to, and let me know what was happening when I asked. Everyone in the OR is concerned about your body, but my midwife was there for my emotional support, and I am so grateful for that, in a way I will never be able to express fully with words.
Finally, finally, I was rolled to recovery, and sometime thereafter reunited with my husband. This time when I saw my baby I was able to hold him and kiss him. He nursed immediately, was so tiny, beautiful and perfectly healthy. So much love was in the room as I was surrounded by my doula Rachel, midwives Cindy and Chrisy, and midwife assistant, Ashley. Everyone was exhausted, and the outcome was not what anyone had wanted or predicted. The OBGYN confirmed that the baby was OP, which confirmed what all had suspected and explained my back labor, lack of progress, and the fact that I never felt an urge to push. OP babies can be born vaginally, but Gail Tully of Spinning Babies explains that OP babies are unpredictable – some can be born vaginally “sunny side up”, some turn during labor and some get stuck and need to be born by cesarean.
So now, I heal. I forgive myself for not having a vaginal birth. I come to terms with my cesarean scar. I trust that my providers did all they could for my “dream birth.” I learn to not obsess about the health implications for a cesarean baby. I talk about my birth and my disappointment. And I nurse, like crazy, because I need a victory, I need to know that my body isn’t lemon, because it isn’t. Birth is unpredictable, cesareans can be necessary, and moms are strong. Whatever birth you end up with or choose, becoming a mother is a strong and brave act – it’s the beginning of the selfless gift of unconditional love you give to your baby.
I want to thank my midwives:
Cindy – for her wisdom and experience and because I knew I could trust that she had the same goals for my birth as me.
Chrisy – for her kindness, warmth, and comfort when I needed it most.
Ashley – the midwife assistant, for her beautiful photography and the way she told me I was strong when I needed to hear it most.
Rachel – my doula, for always knowing what I needed when I needed it, for supporting my birth wishes, my husband, and for taking care of me, even now as I heal.
To Matt – my rock, my strength. For literally and figuratively holding me up when I needed it most.
Photo Credits: Midwives of NJ & Matt & Megan Stark
I wish I wrote her the day before or the day of, I would have said something like: Hi Ma, It was great to see you at Phoebe’s graduation. We are really looking forward to seeing you this summer in Redding- should we plan a tea party? She probably would have been thinking about the tea party while on the tractor. Oh the burden of unfinished business. I think no matter how long the person is alive, no matter when they leave us or we leave them, it is never enough time. Or as I recently heard Alex Orbison say, in speaking of his late father Roy Orbison on the 25th Anniversary of Mystery Girl, "When someones gone, no matter how much longer they would have been with you, well it wouldn't have been long enough." But I will say, even if you are not getting along with your parent you can still send emails- I did force myself (since I wasn't feeling very loving on account of our relations) to send her a loving note and photos for Mother’s Day. One of my biggest regrets is not sending her email about Stephen Colbert’s video tribute to his mother who had just passed earlier in June. I knew she’d appreciate the video but I wanted to watch it again and send a note about why exactly I was sending it, to mask the elephant in the room of her impending death (atleast in my mind I feared she wouldn't be with us much longer). So I waited and wouldn't send it until I had time to watch it again and find the right wording. If I had sent it, I might have written something like, "Sending you Stephen Colbert's tribute to his mother since we both like him and since it is such a nice tribute to an amazing woman and a mother so dedicated to her children. Thought you could relate.," effectively blending my need to send her love and gratitude while feeling some resentment and a distance. Read more....
Courtney's story was so amazing because she had no expectations or desire for a waterbirth but when her midwife acted quickly to fill the tub yet and Courtney's veins responded slowly to iv fluids, she arrived somewhere she did not think she would be. Thank you Courtney for sharing your story....
I was due May 1st. This is my birth story: My contractions started at 5:30pm the evening before and they were very intense and strong but were not consistent or close together. 18 minutes apart, half hour apart, 12 minutes, 11 minutes apart. They never got closer together than 11 min apart so I called the midwife on call at 2 am (Lisa Milstein at Avalon Midwives) who said to call back when there 5 to 7 minutes apart. I called her again at 9 AM with the same news no updates and she suggested to set up an appointment for me to go to the office to get checked. She said we will just take it from there. I started using my TENS machine to deal with my contractions. Joanne Cunha was going to try to be available to deliver my baby but she was working in the office that day so she met with me at the office to check me. I told her that I lost my mucous plug yesterday and that my contractions are really intense. She said since the contractions are so far apart that this could be false labor and contractions can last for a few days like this. She wanted to do an internal check but basically suggested that we go home and wait until the contractions are closer together. I was so disappointed I really wanted to have my baby on May 1st- I love that date.
Joanne said before you leave let's just do an internal check, she said wow!!! you are 6 cm dilated right now!! She said you are going to have his baby today! She said if she breaks my water right now the contractions will be closer together and everything will start progressing normally. I was so afraid for her to break my water I was afraid it would hurt. She told me I wouldn't feel it, so she broke my water with a little pin prick on the end of a rubber glove. It didn't hurt at all but I started gushing water immediately and she put a giant chuck pad folded up in my pants lol so we can drive to the hospital without getting water everywhere. She said she wouldn't be available to deliver my baby today but Kim Kirby will be there and she is great. I love Kim I was so happy to hear that she was on call!! As soon as we left Avalon and walked out to the elevator the contractions started and they were five minutes apart the way they are supposed to be. My TENS machine really helped. We got to the hospital at 11am and I had to pee so bad. When I came out of the bathroom Rachel my Doula was in the waiting area with Rob! I was so happy to see her! I started telling her what happened at Avalon just when a big strong contraction came, she said don't worry about telling me the story let's just get through this contraction. Then I saw Kim with her iced coffee (which she never got to finish ) she gave me a kiss on the cheek and we were so happy to see each other. She said let's get you into a room! Do you want a tub? I said yes.
We were in the room that we saw during the tour. They sat me down on a yoga ball which was so relaxing and took away all the pressure. They were trying to put the belt on monitor on my belly but could not get it in the right position. Rachel was rubbing my back softly and using aromatherapy- citrus smelled so nice ! I told her I wanted an epidural and Kim said that they have to first flush me with Iv fluids for half hour and then they have to request the epidural. That takes a lot of time and Kim couldn't find my vein to get the IV fluids going I have black and blues all over my arms. She asked me if I wanted to get into the tub to get through the contractions more easily. I told Rob that they are tricking me I don't think I will be able to get the epidural. I wasn't panicking I don't think it really clicked in my mind what that would mean. Once I got in the tub I wouldn't be able to get an epidural quickly. Rachel looked at me and said think about the opportunity that you have right now you can do this! When I got into the tub it was so relaxing and warm it's unbelievable how wonderful it felt. The temperature was absolutely perfect. During contractions I would press the whirlpool button. Before I got into the tub I kept yelling that I feel pressure! I feel pressure! Kim said what kind of pressure ? I kept yelling I don't know I don't know I don't know I think it's the head.
Kim told me that she felt the head and that it was right there! She said there's no point in getting out of the tub the head is right there! She told me I could start pushing. I kept yelling I don't know I don't know I don't know I don't know how do I know when to push? I felt a contraction and I pushed and she said we see the head!! She said keep pushing I pushed again and I yelled I feel the ring of fire I feel the ring of fire! As I was pushing the head I felt my whole crotch stretch and burn. By that time the entire head was out I heard the nurse say okay shoulders are next. She told me to give a big push she said do it harder that's not hard enough! I pushed again and she said one shoulder was out I felt like my entire insides, my pelvic bones were separating as I felt the baby move through. I was yelling beastly sounds and started screaming get it out ! get it out! Why aren't you getting it out ?!! I don't know understand why you cant get it out!! I gave a long push, the push was so long I couldn't believe that the push lasting that long and the rest of the baby came out.
I went from intense horrific pain to complete bliss with no pain at all. The moment the baby came out there was absolutely no pain. Rob was crying because he said the birth was so beautiful just like on TV. He said the water was completely clear no blood, no poop! When the placenta came out that's when the tub turned red. She was born and they put her right on my chest in the warm water. She was beautiful 8 lbs. 13 oz. 20 3/4 inches. Rob cut the cord. We got to the hospital at 11 and I delivered at 1:06. I was really frustrated with how much pain is involved with the pushing the midwife said I only pushed for six minutes. She said stop complaining and can you just be proud of yourself? Look what you just did! You just had an unmedicated water birth- do you know how many people want to do that?! You are so strong and had so much control. You did an amazing thing today and you're still intact, no tearing! That's amazing!
Thank you for sharing your story Courtney.... It is so interesting the details of what we remember - for Courtney it was the words and the pain and the bliss :). Bring more bliss! I remember Courtney saying at our postpartum visit that she was so amazed how, with water birth, baby just went from being inside you to being on your belly - without interruption. Also, there were a few funny details... Courtney said thank goodness their wasn't a tour or something going on outside her door and I told her, there was- it all happened so quickly that the midwife needed to remind the nurse to close the door right as the maternity tour was walking by. It was also funny when Courtney said "This is orgasmic!' when they put the ice pack on her crotch or right after the birth when Courtney said "I feel so powerful, I feel like I could punch someone in the face!" I said okay Courtney - if that is how you want to use your power! May all postpartum mothers feel so powerful to want to punch someone in the face. Courtney tells me shops closed after baby #2 but I am secretly hoping to attend more of their births. To read Courtney's Tips & Tricks on early motherhood, visit her blog Angelic Treasure https://angelictreasure.wordpress.com/
Thank you Courtney (& Rob & Lucas & Rosa Lia!) for sharing your story! I of course wish for all women and, personally, all my clients to have such easy and uncomplicated beautiful births and if presented with more challenging births - I wish for safe and healthy motherbabies. May we all be happy and healthy at the end of the day(s).
Happy Birthday to my mother, who would have turned 80 today. She loved animals and kept one of each like a little petting zoo at our "farm" in rural Connecticut. We kids learned many life lessons from the resident animals- if you are a cute, little chicken, do not stand under the garage door or you will get squished; if you are a cute little duck, a mother hen may take you under her wing and you will grow up wondering why you waddle and do not strut; if you are a blind, old gander still running into things at full force with your beak and biting them, you can regain consciousness by vigorously shaking your head; a way to see if an animal is dead is to poke them really hard and see if they respond; if a 14.2 hand Quarter Horse wants to visit her boyfriend across the street, she is more powerful than a GMC van driving 35 MPH; if a 40 pound Springer Spaniel wants to visit his girlfriend across the street, he is not more powerful than a sedan; ducks can pair off male/female or male/male, female/female; and of course, there is not room enough for 2 males among the females... so off to the you-know-where with the ill-fates rams, bulls, cocks and ganders.
My first exposure to birth was (I believe) around the time this photo was taken and I was about 7 or so. Mother Heifer was pregnant and was going to give birth to her baby in the stall- i.e. in the garage turned "barn" housing two stalls padded with straw. I must have seen the scene a few times because I remember quite distinctly that when the cows were in labor they were so active. Normally the cows were very calm and moved very slowly but when in labor would pace and make sudden movements that they never made otherwise. After some time, calf's front hoofs would emerge and she Heifer would bellow - probably wondering what the heck is happening to her privates. You wish there was a Doula-Cow to reassure her, but no such luck! Slowly, very slowly the hoofs would emerge and mother cow would either be laying down on the ground or try to rise suddenly in the middle of the calf emerging, which didn't seem like a great idea, because I remember the calf emerging in one the sudden movements and squishing to the ground in a gelatinous, bloody sac - eek. Calf would start moving quite quickly making its way out the sac, mom would lick sac off baby, and then within no time at all, calf would attempt to stand on those little matchstick legs, wobbly, resisting gravity only by its attachment to its mother's teat. That is how I remember it - quite a site for a 7 year old but I wonder if that is played a part in being a birthworker in my adult life.
So Happy Birthday Granny Bunny- we think of you all the time and remember all the animal husbandry adventures you took us on while at Meeker Hill. Much love to you in heaven where surely you are seeing many baby animals be born since you forever possess a childlike curiosity and love for animals.
This video shows it pretty much exactly as I remember - adding one detail I must not have noticed, which was the Heifer virtually leaps up (or whips around) immediately after giving birth because she wants to check on the calf and start licking the sac off. So much for not tugging at the placenta! It just comes flying right out- not sure if this always works out for the heifer but I realized watching this that... they don't wait for it to expel. Their movements just remove it quickly. Watch only if you are Not squeamish!
Disclaimer: This is my blog and is my opinions - I am not a doctor and not a scholar- these are my opinions from what I see and from what I have experienced.
When and How much?
When my son was born - my water broke and I wasn't contracting. Ignorant to any birth choices I headed to the hospital where they put me on Pitocin to get things going. I didn't want an epidural because I didn't want to slow anything down, however I felt lucky I didn't otherwise I wouldn't have felt the hell the pitocin put my body thru. One contraction on top of the other- they never came down fully and there were no breaks in between. I just remember the vision of my hand gripping the bed rail while the nurse yelled at me, “Ms. Rachel you need to breathe for your baby!” and me pleading with her to turn the pitocin down. They did but I always wonder how that affected my son and if he suffered oxygen deprivation - fetal hypoxia and how many people are put on those high levels of pitocin where there uterus is hyperstimulated and they don't even know it because they can't feel it and it is only turned down when the baby's heartrate is decelerating and the contractions are too long- This is too late! This is reckless! There is a reckless use of Pitocin going on!
Where I live in the state of New jersey, it is basically protocol to use pitocin and if it not 100% it is safe to say it is about 90-95 % use either for induction to start labor or augmentation once labor has started.
Were you oxytocin receptors at peak levels when you received pitocin to augment labor or were you administered picotin to get labor started?
How much did you receive and for how long? All these may contribute.
If your uterus is hyperstimulated by pitocin, you may experience contractions that are right on top of one another and will not experience a break in between. Uterine Hyperstimulated definition - contraction more than 5 in 10 minute period. It is defined as either a series of single contractions lasting 2 minutes or more or a contraction frequency of five or more in 10 minutes. Typically a contraction last 60 seconds and there is a break in between each one of a few minutes. During the contraction the baby's oxygen is limited since everything is feeling pressure and baby is being pushed down into birth canal and everything is compressed. In between contractions, that pressure subsided, the cord is able pulsate delivering oxygen to the baby again. so what happens if your uterus is hyperstimulated by pitocin and you are experience one contraction after another? How will your baby get oxygen? Is it possible that there are a lot of babies being born who are not getting enough oxygen? And some by cesarean due to decelerated heartrate that was caused by administering too much pitocin? I believe more studies need to be done to learn the optimal time to first receive pitocin and the safe length of time to receive. According to Sarah Buckley, mother's oxytocin receptors have levels and when they are at peak levels, it is a more optimal time to receive induction because they will respond better. If not at peak levels then a greater amount and presumably length of time will be required. Think of it like sex- if you have experienced foreplay and are plumped and ready to go, then your chances of have experiencing climax will be sooner than if your body was not primed. Or a car - we must prime the engine folks. What else in life do we "prime" - shouldn't our bodies be primed for pitocin as well if it is going to work well?
Needlessly exposed to this drug? It can be helpful but with proper dosage and timing.
So if medical personnel are trained to turn off the pit or lower the pit AFTER the baby'e heartrate has already decelerated or AFTER the contractions have been too long- isn't this too late!? This may not be too late for the medical facility and staff to save baby from death or severe brain injury but we don't even have the studies to show if this is too late for baby in terms of long-term health and brain development. Do we know this isn't contributing to autism for example- not even the oycotcin factor but simply the oxygen? I just think it is interesting that NJ has extremely high-rates of pitocin use and autism- there I said it. How long is the medical community going to play reckless with our babies?
According to the recently published hormonal physiology of childbearing report synthetic oxytocin may impact maternal oxytocin and physiology. Possible effects include
- uterine hyperstimulation with potential fetal hypoxia, requiring monitoring
- body is deprived of adequate oxygen supply
The report goes on to say:
Physiologic principles, animal studies, and evolving human evidence suggest that perinatal synthetic oxytocin exposure may have longer-term impacts on offspring. While high-quality research is lacking, potential mechanisms include
- direct fetal brain-hormone effects from synthetic oxytocin transfer through placenta
- indirect signaling of maternal oxytocin to fetal brain
- indirect effects from subclinical hypoxia
And according to the 2013 ACOG report (American American Congress of Obstetricians and Gynecologists) “Induction and augmentation of labor with the hormone oxytocin may not be as safe for full-term newborns as previously believed…”
“However, we don’t want to discourage the use of Pitocin, but simply want a more systematic and conscientious approach to the indications for its use,” Dr. Tsimis said. Study Finds Adverse Effects of Pitocin in Newborns
There is a need for studies on the effects of pitocin induction and any correlation to fetal distress.
Let's stop this reckless use of pitocin! #skipthepit #talkpitover
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The day is my choice, I have the right to change my mind at any time, it is my right." - Brittany Maynard
Does that statement sound familiar to you birth workers out there?
More than anything, of course, I wish Brittany Maynard a miraculous reversal of her brain cancer within the next 48 hours, so that this blog is no longer relevant. If that becomes a reality, what will be remain relevant for years to come, is the work Brittany is doing for the Compassion and Care movement. For those not familiar, "This spring, 29-year-old newlywed Brittany Maynard learned that she had terminal brain cancer. After careful assessment of her prognosis and end-of-life choices, she and her family reluctantly decided to move from their San Francisco Bay Area home to Oregon, one of five states (including Washington, Montana, Vermont and New Mexico) that authorize death with dignity."
Brittany's experience, and the language she is using around it, runs parallel with many of the choices women make in childbirth. Doulas work to support these choices. A birth doula is a person, usually a woman, who supports a laboring women thru birth physically, emotionally, and by providing information to aid informed decision making. Occasionally, the birth doula acts as an advocate for the laboring mom (when called for). As birth doulas we support all the same choices for laboring women who are ushering in birth, as Brittany is exercising in preparing for death.
Saturday November 1st West Coast in her bedroom surrounded by those she loves — in her bed, on an upper floor of her Portland, Oregon home, with cherished music filling the room. We are all familiar with Brittany's Preferences for her gateway into death. She has gone to great lengths (moving to a different state for one) to be able to choose when, where, how, and with whom she will be born into death. She is doing this the same way we doulas support women to be able to choose when, where, how, and with whom they will birth.
When creating birth preferences, a doula encourages women to think about when, where, how and with whom they will birth and about the birth setting. What music will be playing, how the light will be set, what kind of medications they are willing to expose their bodies and babies to? Where will they be- at home, birth center, hospital and if in a hospital will they be in a bed or in a bath or holding onto a bar? Who will be at the birth- MD, Midwife, provider of your choice.
Unfortunately many laboring women do not have control over which hospital staff, and sometimes which Obstetrician in a revolving practice of MDs, will attend their birth. The laboring woman is expected to adjust and collaborate with this stranger (or someone they've met one time) at one of the most important events in her life. This can be very dangerous because if you don't know a person, you also don't know what will come out of their mouth, and the words and things people say to a laboring women will stay with her her entire lifetime. A doula can encourage supportive language at a birth by injecting positive words and phrases into the atmosphere. These are two of the most important aspects a doula provides- holding the space and providing continuity of care. At birth, if a woman is juggled by different nurses and even different doctors, they atleast have the continuity of care of their doula and a partner, when applicable. For Brittany to be able to choose her support team, her death doulas, is critical. Brittany understands this well and has chosen to be with her closest loved ones – her husband and her mother.
Brittany has my support in all her choices- and if she changes her mind, that is her choice too! Brittany can choose to continue staying alive past Saturday or she can choose to die as prepared for on November 1st or on another date of her choice. “The day is my choice, I have the right to change my mind at any time, it is my right." - Brittany Maynard
A laboring woman has the right to change her mind, too. I support Brittany the same way I support a laboring woman and if the woman changes her mind from 100% natural birth with no medications to wanting a epidural- okay! If she wants pain medication and then decides to go natural- okay! If she wants to question her provider's every step and then decides to just do what they say- okay! It's the woman's choice. If you change your mind from when, where, how, or with whom you want to give birth or cross over into death, you have my support! It seems silly to me to state such a basic human right but as we've seen, Brittany had to relocate states to make this choice a reality so evidently it is not obvious to all. Women preparing for a gentle birth also go to great lengths just to be able to have the freedom of choices. Brittany is a beacon for how to illustrate, outline, and expressing preferences in advance of death, while being fluid to the changes possible. Brittany is preparing herself for her best death, for a positive death experience, and open to change.
Doulas also support a positive birth experience and understand births can look very different from one another- medicalized, natural, home, hospital, surgical etc.. but as doulas we support the woman to have her best birth possible, whatever manifestation that may take.
Brittany.... I am wishing you the most amazing last few days with your loved ones, who are so lucky to have known you in your short life, and you them. On November 1st, may you feel all the love and light and support in the world as your husband and mother (your end of life doulas) and the universe hold your hand across the gateway of death. If you’ll let me I will hold your hand from afar too and will light a candle with my loved ones in your honor. You have support of so many across the globe, and I imagine we will all be holding your hand from afar on Nov 1st. Thank you for sharing your love and compassion with us. Wishing you love and light in life and death. We will forever feel the glow of your person as well as the light you have created around the issue of gentle death.
"And in the end, it is not the years in your life that count, it is the life in your years."
- Abraham Lincoln
Visit the Compassion & Choices site and sign the card and let Brittany know you support her bravery in this very tough time.