doulicia

The Gynecological Exam: Physician versus Midwife

2009-03-02T21:14:00.002-05:00

I had my annual gynecological exam today. For the first time in a dozen years, I saw a physician instead of a nurse-midwife. My reason was convenience. Our family practice doctor's office is about 2 miles from our house. The CNMs are more like 13. And they're usually running way behind.

Since finding them for my obstetrical care, I have stuck with the nurse-midwives for my gynecological needs for three reasons. First, being a believer in the midwifery model of care, I wanted to support CNMs with my business and my insurance dollars. Second, it was a way to stay connected with practitioners that I would encounter at births (the only births for which I've been a doula at the smaller-volume hospital in town have been with this nurse-midwife team). Third, I liked them. At least one I consider a friend.

But in this busy year (hence the pathetic blogging record of late), I am trimming time where I can. Cutting an hour and a half experience in half won out. I will write an apology note to the midwives soon.

Long back story. What I wanted to write here were my observations about what was different with my physician exam compared to the midwives. By and large previous exams and this one were very similar. I felt comfortable (physically and emotionally) at all of them; I had my breasts palpated, my cervix scraped, my uterus and ovaries squeezed between a finger in the vagina and one on my abdomen.

But there were a few things I noticed that were different about this exam.

My doctor did not ask about my calcium intake. The midwives always ask about my diet generally and calcium in particular. Each year I leave their office with a photocopied list of foods high in calcium.
My doctor did not examine my labia before putting in the speculum. Typically my midwives look at the exterior before diving in for the pap.
My doctor did not ask me to do a Kegel. The test I fear at every exam is the midwife's request that I do a Kegel squeeze on her finger. Let's just say it is always clear I do not regularly squeeze and release. Every year I vow to practice nightly -- at least weekly -- and forget as soon as my pap cramping goes away.
A nurse was present. I might attribute this to the fact that my doctor is a man. But my previous OB/GYN was a female and she always had a nurse assist, too. Midwives do it all for themselves.
I was not asked for updates on my family. Usually I spent at least 5 minutes telling the midwives about what my boys -- the ones they caught -- are up to.

Is there anything to extrapolate from this? I doubt it. I still felt like I had a thorough exam, that my whole health was considered. But maybe these differences are telling. I can't think of anything my doctor did that the midwives do not. It was all loss going from them to him, not a trade-off of some questions or procedures for others.

The differences were small. Small enough that I suspect I'll return to my doctor next year. But that is not to say that other things being equal -- namely the distance from me to health care -- I wouldn't choose a midwife over a doctor.

Cervix Photos

2008-12-09T10:30:00.003-05:00

I'm guessing anyone who visits hear is already more in the loop than I and has already heard of My Beautiful Cervix. A student midwife and doula took (actually had her partner take) daily photos of her cervix. THEY ARE AMAZING!

I have seen cervices, including my own. But I never saw or imagined the variety of fluids that are continually exiting the uterus. My image was of an organ that bled a few days a month and was otherwise quiet. I mean, yes, I knew about vaginal discharge and have observed its changing textures. But LOOK AT THESE PHOTOS. There's creamy, there's milky, there's bloody. Every day a different combination.

Women, we are marvels. Truly.

Assisted Reproduction

2008-12-01T11:57:00.002-05:00

I read an account, in yesterday's Times magazine, of the author's decision to hire a gestational surrogate. It nicely illustrated the kind of circumstances that can lead to surrogacy: protracted infertility on one side; financial and altruistic benefits on the other.

Coincidentally, a solicitation for the Smile Train ran alongside part of the article. It reminded me of a news item I saw last week linking assisted reproduction (ART) -- particularly in vitro fertilization (IVF) -- with increased incidence of certain birth defects. Among these was a more than doubling of the risk for cleft lip with or without associated cleft palate.

The magazine showed photos of the author's healthy baby. My friends who have used IVF share similarly joyful results. It seems like it would make the decision to pursue IVF much more difficult if you suspected something in the process itself made your baby more at risk for certain defects. On the other hand, any choice to conceive, let alone raise, a child is fraught with risk to that child's health and well being.

Perhaps it is the case that parents going the ART route have considered scenarios and answered hypothetical questions before meeting with a doctor or employing the proverbial turkey baster that the rest of us avoid altogether simply because we can. That does not mean the "unassisted reproducers" don't face risk of loss and complications. Rather, because our initial investment is so low (semen is free), we have the luxury of hoping for the best.

Individuals can make a difference after all

2008-11-20T21:24:00.003-05:00

I was pleased when Ricki Lake released "The Business of Being Born." But I had more reservations than many of my birth colleagues, who seemed to think the movie would spark a renaissance in attitudes toward labor and delivery in the U.S. Surely the movie would draw a crowd of converts like myself instead of women unsure about or wholly skeptical of non-medicalized birth paradigms. Surely an Obama rally would draw only the Democratic faithful.

Or would it? We have a liberal president for the first time in 8 years. And apparently home birth rates are up in New York. Not only that, they're appealing to new classes and cultures of women. Says the article, "Home birth professionals in New York City have been struck...by the fact that the increase is coming not so much from the dyed-in-the-wool back-to-nature types as from professionals like lawyers and bankers."

Moreover, "One reason for the change, it seems, is “The Business of Being Born,” a documentary produced by the actress and former talk show host Ricki Lake, which ran in only a few theaters during its theatrical release in January but has become an underground hit among expectant parents since coming out on DVD. "

I stand corrected. Ms. Lake, I apologize for my cynicism. You made a movie to "educate[ ] people and empower[ ] them to really know their choices in childbirth." Darned if it doesn't appear you did just that.

More personal recriminations

2008-11-11T12:52:00.004-05:00

Last Friday I went to a fundraiser for our local volunteer doula program, Doulas Care. It was very nicely done. I am hugely impressed by the amount of work that went into it. I know most of the employees and volunteers, so my gratitude is quite specific.

The evening was a delightful mix of socializing with birth colleagues , browsing silent auction items, and tasting wine. They had live music and a caterer. There were twinkle lights everywhere in the renovated barn where the fundraiser was held. It was quite enchanting.

I left with a high, great feelings for the increased awareness I've seen about doulas and birth in the last 5-6 years. I felt a sense of unity with these women and men who are committed to the same cause. I was affirmed by shared stories of births gone well, and women empowered.

By the next day, I was thinking again of this article a friend posted on his Facebook site. It's about maternal mortality and the persistence of high death rates among women in poor countries. The article has an accompanying slide show.

Between the images of spartan delivery rooms and descriptions of deaths that would be so easily prevented in developed countries, I realized how different the global issue of birth is from what I confront here in this little corner of Michigan. Yes, we have poor women here. Yes, women start labor without a minute of prenatal care. But there are places where they can be brought for safe delivery and recovery.

Insurance is, of course, its own issue. But if someone is hemorrhaging in this community, she will be given a transfusion at a hospital.

I was reminded again of a midwife friend who left the area saying she was "tired of these Ann Arbor women and their fancy birth plans." It sounded so cynical at the time. These were the women who were seeking her out for the amazing birth experiences of which she was so often a part. We needed desperately needed her and her birth philosophy here. How dare she leave.

She went on to work in rural Latin American countries and on American Indian reservations. Her patients were not concerned with whether or not they could birth in the squatting position. They were hoping, especially in Central America, simply to survive the experience and return home with their child.

I've thought about this before and come down hard on myself. On doulas generally. Aren't we all just birth junkies fortunate enough to have found this mechanism for getting to be present at birth?

Hopefully the answer is no. I think it is no. I think we want women to have a positive birth experience. Thankfully, in much of the developed world, fundamental questions of survival are largely taken for granted. We doulas arrive on a scene that has the luxury to focus on the smaller details: informed choice, minimal psychological trauma, enhanced bonding. But I suspect that if we were in a culture where birth was a dicier proposition, we would do what we could to assist on that level: lining up blood donors for each woman in advance of birth, helping women get to care, providing care to families in the event of loss.

It is a spectrum. We are fortunate to be on the more luxurious end of it. But we would serve even if we were not. Wouldn't we?

Paying a Premium to be Female

2008-11-03T20:51:00.002-05:00

An editorial in today's NY Times called attention to the fact that women often pay more than men for the same health care insurance coverage. They are also excluded from eligibility by conditions that are uniquely female: having had a c-section for example.

The editorial mentioned that women fortunate enough to obtain coverage may find that maternity care isn't covered. I would add that even those policies that cover maternity care do so only when it's provided in a hospital. Ixnay on the omebirthhay.

This type of information is rarely surprising. Last week our office was buzzing about a study that said heterosexual marriage added seven hours a week of work to the woman's load and decreased the man's by two hours. My colleagues appreciated confirmation of what they felt to be true, but no one found the study enlightening.

Similarly, are we surprised health care is a little harder to get or pay for by the women in our society? Sadly, no.

More grounded, no less busy

2008-11-02T20:56:00.002-05:00

Time flew. My self-imposed hiatus is over. I found four items to flag for my "doulicia fodder" favorites folder. I got my legs under me at the new job (and what a pleasant new place it is!). I saw a doctor about my sore Achilles tendon and received a diagnosis of tendonitis, for which I begin physical therapy this week. I spent a gorgeous evening passing out Halloween candy from our front step and watching bats swoop over our house.

Now, November. A work colleagued had a baby, her first, last week. She called to say everything went "really, really well." I haven't heard the details of what that meant to her, but I am glad for her happiness.

Another colleague told me she was pregnant last week. We have in common a friend, who is also a former client. Small world.

This Friday I'll be going to a fundraiser for the Doulas Care program, our local volunteer doula service for low income women. I'd like to say I'm generous enough to be one of the volunteer doulas. I'm not. At least not for now. But I have served on the board of Doulas Care's precursor organization, and provide what financial support I can.

I'm eager to post and reflect on the issues I flagged. For now, I'm just getting back in the groove. Hi.

Where I've Been and Where I'll Be

2008-10-08T21:05:00.002-05:00

I've changed jobs since I last wrote. By which I mean my regular, non-doula employment at the U. It's a great change, but time consuming.

This move, coincides with a planned break in my doula work. I am not taking on any new clients until 2009.

I have not spent a lot of time lately thinking about birth. Which is not to say I haven't been thinking about it at all. I have.

But the other things pushing in right now make me think I'll extend what is already a 3-week break from blogging a little longer. Assuming things settle back into a routine around the house, I look forward to resuming in another month or so. And whether or not things settle, a new batch of clients will no doubt bring new fodder for posts.

So the few of you who check in from time to time might want to just make a note to wait until November.

Enjoy your October.

Is Breast Really Best?

2008-09-17T09:43:00.003-05:00

Let's take a stick to the hornet's nest, shall we? Let's call into question the tenet, the slogan, the moral high ground. Could formula be okay? Might it not really matter to babies if they are breast fed or not?

One academic thinks so. Joan Wolf is going head to head with La Leche League on the website Opposing Views (a neat concept in itself).

Before villifying Wolf, read what she has to say. She raises excellent questions about biases and omissions in the studies that have been used to label breastmilk the preferred baby food.

Better yet, read her complete article, "Is Breast Really Best? Risk and Total Motherhood in the National Breastfeeding Awareness Campaign." It will likely make you uncomfortable. It will challenge your fundamental assumptions about breastmilk, mothers, and public health campaigns.

The author and I were randomly assigned college roommates. She was a feminist, an honors student, a spitfire. I was not at all surprised she became an academic.

I read and commented to her on an early draft of the breastfeeding article. It shook me. I was surprised to learn how little is really known about the benefits of breastmilk over formula. So many of the studies that compare groups of babies who are breast or formula fed cannot control for other confounding factors.

I do not think Wolf is trying to undermine breastfeeding. Rather, she is saying that before we launch a national health campaign, we should make sure there is sound science to support it.

Obviously, I am a breastfeeding supporter. In part this is because of the very research Wolf questions. But it is also because I have a fundamental faith in the superiority of evolution over chemical engineering. I do not believe a feeding system that has sustained mammals for hundreds of thousands of years could be improved upon or even equalled by a few decades of tinkering in the lab.

I also find it more cosmically "right" to have mothers feeding babies from their bodies than from bottles.

But these things are arguments of faith, not reason.

Read for yourselves. Keep an open mind. Whether you end up persuaded or not, it is good to know the rational and scientific arguments for and against.

Even if in the end you return to faith.

Does Vaginal Birth Help Hardwire the Maternal Brain?

2008-09-10T19:30:00.004-05:00

According to this article, the brains of women who birth vaginally show more activity in response to their baby's cries than those of women whose babies were born surgically. Says one of the investigators,

Our results support the theory that variations in delivery conditions such as with caesarean section, which alters the neurohormonal experiences of childbirth, might decrease the responsiveness.

Yes, perhaps. But empirically, do we really see this? I would be curious what demonstrated behaviors, if any, correlate to the increased or decreased brain activity?

Obviously, I like any research that supports caution in using Cesarean sections. But this one seems especially primed to make women who have a C-section, including those true emergency C-sections, feel guilty. And that is the last thing any new mother needs.

update: Interestingly, a list of headlines related to this research, all cast it in negative terms (e.g. "C-Section Poses Risk to Bonding"), except one: "Natural Childbirth Makes Mothers More Reponsive to Own Baby Cry." This is my concern. The latter headline affirms vaginal* birth, while the others criticize surgical birth -- and, indirectly, the women who experience it.

*note: I, too, share the pet peeve of labeling all vaginal birth, "natural!"

Further Clarification on the Role of the Doula

2008-09-02T09:38:00.001-05:00

A few weeks ago I posted a link to an article about a local couple whose baby was born in their front yard. It was a great birth story, but worried me because the couple's doula reverted to her midwife training when the baby came early. What if the article made people think all doulas check for dilation?

Apparently I wasn't the only person who heard alarm bells. Local midwife and doula trainer extrordinaire Patty Brennan wrote a to-the-point editorial in the same paper last Friday. I couldn't have said it better myself.

Damn Creepy Guys

2008-09-02T08:40:00.004-05:00

I was greeted by this in my e-mail this morning:

SECURITY BULLETIN from
Department of Public Safety

BULLETIN DATE: Sept. 1, 2008

OFFENSE: Attempted abduction

LOCATION: South of campus near Packard Road and Independence Street (near Fraser’s Pub)

An unknown man reportedly approached two young women in separate incidents after dark Aug. 31 and attempted to push each one into a nearby minivan, the women told the Police Dept. One woman reported she was jogging in the area about 9:40 pm when she was approached and the second female reported an incident one hour later. In each case, the woman fought off the man and succeeded in escaping without injuries.

Just last night I was complaining how I hate it that I can't run where and when I want without fear. As any road runner (or cyclist) knows, traffic lights are a pain in the rear. Your rhythm is thrown off, not to mention any consistent measure of your time. And every intersection bears the risk of a collision, flesh with metal.

But traffic lights are at intersections of major roads. This runner keeps to major roads because of visibility. It's going to be harder to pull me into a van if you have to put on your hazards to pull over, and cars are regularly passing in both directions.

I run on major roads.

Now I see that a major road, in a "good" part of town, was the site of two attempted abductions last night, an hour after I was out running. And these were bold attempts. Dragging a woman off the street into a van!

I already avoid the public bus in the afternoon, to no small personal inconvenience, because of one particular creepy guy. I'm starting to think I may need to become a gym rat for the same reason.

It really is enough to make one want to carry a concealed weapon. This from Ms. Peace and Love.

Random Birth Thoughts

2008-08-26T11:13:00.002-05:00

I spent last night perusing my birth blog links (midwives, doulas, etc.). There's so much inspirational stuff out there. It reminds me I should spend more time reading when I'm on-line and less time playing WordTwist in Facebook.

And I should spend more time writing when I'm on-line than browsing groups on Ravelry.

But then hasn't many a therapist said we fill our lives with too many "shoulds?" The kinder approach to oneself is to be forgiving, especially of small vices and transgressions (Mountain Dew, buying more yarn than one could possibly use, Scramble...).

Anyway, I wonder how many of you have heard about this reported link between surgical birth and the risk of Type I diabetes for the baby? They don't seem to understand the mechanism yet. Still, another reason to birth vaginally if you can.

I do not have any clients for the fall. At the moment I'm appreciating the break from call and visits. My guess is that will fade by October and I'll add someone before the end of the year. I am still in touch with my most recent two clients, one of whom just went back to work, the other of whom will go back in about two weeks. Neither was ready. Why do we rush our mothers back to work so soon?

My recent insight was that as much as I dread long births (like, 20+ hours long), those are invariably the births at which I feel most useful and from which I form the closest bonds with clients. A special bonding happens when you cover epic birth ground together. It's just not the same when you're with a client two or three hours and the baby's born. NOT that we complain about those births. And not that I've had so many of them on which to base my judgment.

Knitting Doldrums

2008-08-13T13:13:00.004-05:00

I'm adrift. Casting about from feeble project to half-hearted swatch. For everything I think to knit, I lack either the right yarn or the right pattern.

It could be the post-sweater let-down. Since finishing Snorri in June, I just haven't been able to pick up anything else meaty. This often is the case when I finish a book I've really liked. I can't jump right into another one. I read periodicals or children's fiction instead.

The new house also could be to blame. My knitting time has always been in the evening, on the living room couch, while my spouse watches a ballgame on the other side of the room. In our new house, the TV is in the basement, the couch is in the living room and my evenings are filled with the seemingly endless tasks of getting settled. There are no routines or physical prompts conducive to knitting.

Regardless, the result is this:

and -- yawn -- this:

Do these not scream knitting apathy? "What the hey, give me some yarn...any size needles...leave me alone here to garter stitch..."

The first project is really just playing. A log cabin progression in Noro Kureyon. The second project is some cotton dishcloths using the tried and true pattern and my random balls of 1824 Cotton.

I've also swatched for the start of a sweater for my spouse. But I tried Addi Turbos for the first time and would rather not remember the experience. Needless to say I returned them for some Clover Bamboos the next opportunity I had.

I don't worry this will pass. It just disappoints while it's here.

nightly blood sucking or monthly metamorphoses?

2008-08-07T09:36:00.003-05:00

I know: what's up with 3 posts in the same week? Am I getting back in a groove? Wouldn't that be nice?

I have to share with someone this conversation from last week. We were at the home of friends having some beers (well, I wasn't. I hate beer. I was having a Smirnoff something or other, which is flavored beer, but works for me).

These were Molson (or Labatt?) beers with "conversation questions" on the label. A kitchy idea with just enough genuine merit that we found ourselves reading and answering them. The one that divided us and nearly started a marital spat or two?

"Who would you rather be, a vampire or a werewolf?"

We all rolled our eyes. Easy. No question.

Vampire, right? Except, no! The men said werewolf.

Looks of shock and outrage were exchanged. Then we settled down and explained ourselves. It was clear that sex appeal drove those of us in the vampire camp:

vampires are seductive
they are drawn to that most scintillating of areas, the neck
they have orgies or group somethings (who saw the movie with Tom Cruise?)
they're attractive, if undead

The men werewolf contingent thought it obvious that the appeal came from having that animal strength and general reprieve from symptoms except for the monthly full moon. Never mind that we are subject to our own monthly symptoms, the strength argument held little weight.

And that was without taking THIS phenomenon into account, which will no doubt persuade me even more (and is already working on fellow blogger Peacock Chic).

My random Thursday question to you is if you're with me in the vampire camp? If you vote, please include your gender, so I can test my hypothesis that this is very much a men are from Mars, women are from Venus thing.

The Sweetest Little Face

2008-08-06T10:08:00.005-05:00

No matter how often you've seen it, the appearance of the baby's head in the birth canal is exciting. Encouraging comments ("you're doing so well," "what amazing work you're doing") take on a new level of sincerity and intensity when non-maternal skin shows up.

Many partners become emotional at seeing this first glimpse of their baby:

Oh my gosh! I can see her! You're doing it! Yes...pushpushpushpushpushpushOmigod! Sweetie, She's right there. She's coming! Again? O.K. Pushpushpushpushpush. OH! I can see her little face [sniffle]. She's beautiful! She looks just like-- O.K. YES! PUSHPUSHPUSH. She's so close now...

I've been there. I've ridden that climaxing wave of emotion. It is a big part of the payoff for us doulas, that high.

However, after a few births we learn to take a second look when someone announces they can see the face. Face presentations are rare. In fact, when they occur, the face can become so swollen, that it is mistaken for a bottom! And because it takes the brunt of the friction and force, face presentations often aren't pretty (at first).

Nor is the "face" in the canal pretty. On closer inspection, it seems rather disfigured, often with lots of dark lanugo.

What's going on?

It took me a while to realize I and all these thrilled (or horrified) parents were seeing not a wee face, but a wrinkled patch of scalp.

As the baby comes down the vaginal canal, she usually does a two-steps-forward-one-step-back progression. Overall each push moves her down, but she slides back up a little once the pressure is off. At that point, her skin is pressed tight against the vaginal wall. It doesn't slide all the way back. As the skull bones pull back and slacken the scalp skin, it folds and wrinkles. Try this with your arm: grab it a few inches below the elbow and push toward your hand. See the wrinkles near your grip?

Put those wrinkles under some mucus, down a narrow tunnel, and they could be anything. Especially when all the thoughts of love and anticipation are projected onto them. They could indeed be a face.

When the baby truly crowns, when the perineum is stretched to snapping and the head is moments away from fully exiting, the scalp is stretched taught. There are no wrinkles and no mistaking what is face and what isn't.

Unless they look upset, I don't explain to a partner what that "face" really is. When they are so happy to see it, so full of affection for it, who am I to get in the way? I try to see a face, too, as they are seeing it. Their sweet baby's face.

Front lawn birth

2008-08-04T12:28:00.003-05:00

This has probably made the rounds already -- the baby born in an Ann Arbor front lawn. If you haven't read the story it's really a fun one. The doula on-hand, Beth Barbeau, is a local homebirth midwife, doula, and breastfeeding educator. And a delightful soul on top of all that.

Says the article,

Barbeau arrived at 10:50 and found that Jennifer was still in the early stages of dilation, but her water broke as she was getting out of the shower. By the time Jennifer was helped out to the car, she could feel the baby coming. "We won't make it!" she shouted.

Barbeau needed to examine her. In the dark in the front yard, she mistook Jakary for her daughter.

"She grabbed my mom's crotch," said Jennifer.

I can only imagine how crazy things were there for a few minutes.

The one potential negative I can see to the story is that it perpetuates the common misperception that doulas are involved in the woman's medical care. As a doula, I am not permitted to check for dilation. In the situation above, I would have (as my partner T$ did at her client's unplanned home birth) called for an ambulance and helped catch the baby if it arrived before the ambulance.

The DONA Standards of Practice actually say, "If doulas who are also health care professionals choose to provide services for a client that are outside the doula’s scope of practice, they should not describe themselves as doulas to their client or to others." I don't read that to mean that you CANNOT use your skills in an "emergency" situation that calls for them. It seems Barbeau should be able to use her midwife skills if a client is delivering a baby.

I just don't want people to think, "I'm not going to have a doula because I don't want one more person with her hand up my hoo hoo."

Quid pro Quo (Part II)

2008-07-22T11:07:00.005-05:00

The thought of trading a sweater for art filled me with joy. It meant my knitting was not only a hobby I enjoyed, it was something other people found value in, too. (I will spare the whole side reflection on whether a hobby should be more than enjoyed, whether my need for others to find value in it means it's not a hobby, but another performance arena, etc. That thought is there, though.).

I poked around on-line, sent images of different styles (cardigan, pullover, bulky, slim silhouette, cabled, gansey, etc.). He settled on Snorri, from Reynolds. I'd never knit cables before, but why not start with this? Actually, it gave me a welcome excuse to jump in.

Six months after I finally "got gauge," I finished the behemoth. The friend is six feet tall with even longer arms. Thank heaven the yarn was bulky.

Without further babbling, I give you my "will knit for art" sweater, modeled by the recipient:

Pattern: Snorri from Best of Lopi.

Yarn: 12 skeins Cascade 128 in colorway 7633 (brown tweed). This is GREAT yarn. All the Peruvian softness of Cascade 220, but in a beefed up size. I will use this again.

Needles: Clover bamboo circulars, size 9 and 10.

Notes/Thoughts: I couldn't be happier with how it turned out. The knitting went quickly, cabling was a snap, and the pattern read well. I was a bit intimidated by sewing the thing together and let it sit in pieces for about two months. When I got down to it, even the assembly went well. I added 4 inches to each arm to make sure it would fit the ape-armed recipient. It ended up with just a little extra length in the arm. Whew!

This barter equation:

=

Quid pro Quo (Part I)

2008-07-18T11:22:00.007-05:00

I realized the other day that I have been a runner for more than 25 years now, starting with middle school track. I was never a standout, but ran, even then, for other reasons: wellness, the feeling of air moving past my body, beginning to know my physical limits. Also all my friends ran track.

Never a sprinter, I moved from track to cross country in high school. I didn't fare any better in the races, but the workouts were better. We practiced in the park and ran our long distances on the various unpaved or skim-shouldered roads around my small hometown.

To this day, a pleasant and deep memory is of running in the country when the corn was at its full height on both sides of a narrow road. It crowded in and provided physical relief in a midwest landscape otherwise unbroken except for remnant forests.

One particular stretch of road had a tree that I loved for its loneliness among the corn. Some years ago I started wanting to capture its image and something of my sentiments about it. I took photographs with my small digital camera, but only when I happened to remember it on a trip to or from my parents' house. In short, the photos weren't great:

Last summer we were at the home of some friends. He is an amateur painter (in addition to a very useful furniture mover, as he proved this past weekend). I had a brainstorm. He could PAINT my tree. Then I would not only have it memorialized, but also have some original artwork for our house.

He was very open to the idea. Within a few weeks of my sending him the photo above, he produced this canvas, much to my delight:

We're not in the position to buy art, which meant the issue of payment had to be negotiated. I thought about barter. They are done having kids, so volunteering doula services was out of the question...what else? What else? Knitting of course!

Up next: the knitting commissioned by the artist.

What did I tell you?

2008-07-16T21:34:00.002-05:00

The mantra, the mantra, the mantra. You gotta say it, you gotta believe it.

For this doula, the mantra is, "This will all work out."

Say it with me, 'cause you KNOW I was saying it Saturday morning when, as I did my final walk through of our new house, my client called to say she was in early labor. We'd already picked up the moving truck. Our friends were showing up in 1/2 hour to start helping with the move. But did I freak? Nah. I just said the mantra and finished the walk through.

And wouldn't you know, her partner called me just as we were finishing unloading the last items from the last truckload to say they'd like me to come over. My spouse was about to order pizza for the moving crew. All I'd miss was dinner. And bedtime. And unpacking.

Still, I had faith. "This will all work out," I said, as I changed clothes, put on fresh deodorant, brushed my teeth and jumped in the car.

When I got to my client's house, she was just deciding it was time to go to the hospital. I was only at her house 15-20 minutes before we left. She was at the hospital less than an hour when she pushed out her precious little one.

It was a great birth and she's written a great account of it that I'll see if I can share. In the meantime, I couldn't be happier that my fastest birth to date kindly happened on a day when I most appreciated it. It really all worked out.

I'd Rather Give Birth...

2008-07-11T10:16:00.004-05:00

...than move. But as with labor, the time comes eventually. Inevitably. For me, that time is now.

Tomorrow will find doulicia loading that moving van and hauling her possessions to a new house. Don't get me wrong. I'm excited to be in the new space. I just hate moving.

Plus, my births were pretty darn easy. So it's not saying much to prefer birth to moving. If it weren't for having to keep the baby and raise it, I'd "do birth" over again in a heartbeat.

Which leads me to another insight I've developed the past few months. Realty should have its own doulas. House selling doulas. Wouldn't it be nice to have a reassuring presence by your side as you meet with your agent and learn what your house (that you paid X for) is likely to sell for in this down market (X-Y)? A house selling doula would tell you what to expect and give tips for making things go smoothly. For example, "Don't wipe down the bathroom for an open house until after the boys have peed and been banished to the yard for the remainder of the morning."

When an offer finally comes in on your house, you'd first call your doula to share the flood of emotions -- excitement, disappointment, anxiety -- before meeting with your realtor. And your house selling doula would suggest ways to stay distracted (go to a movie! take a walk!) while the inspector is going through the house and itemizing all the things you have to fix before closing.

I know I could've used someone reminding me to take deep, slow breaths, to keep focused on the end goal, to remember that thousands of people do this every day and have been for years.

Then the doula would come when we're finally in our new house and coo over it, make sure we're taking time from unpacking for self-care, and bring a meal.

Anyone?

p.s. Have I mentioned I have a client due Tuesday?!! Cosmic vibes, please encourage her baby to hang in there just a bit longer!

Spreading the Good Word

2008-07-07T11:30:00.003-05:00

This past year our family has been host "Aunt and Uncle" to an AFS exchange student from Japan. I never knew that if you were not able to make the commitment to be a host family, you could still connect with and exchange student in the Aunt/Uncle/Cousin role. The involvement is minimal -- one interaction a month.

Our "niece" taught us how to make rice balls (onigiri). They remain a favorite with the kids. In return, I taught her to knit! Actually, she initiated it. She went to one of my son's indoor soccer games and asked what all the women were doing. We have lots of knitters among the soccer moms. I told her it was knitting and she said, "You show me knit?" BINGO!

She was a very quick student. One lesson and she was off on a garter stitch scarft. The next lesson and she was purling. Our third meeting, I escorted her to the hallowed halls of a yarn store and bought her her own needles, tapestry needle, and yarn. Showing excellent taste, she chose a divinely colored ball of Misty Alpaca.

Being talented and ambitious, she asked to make mittens. Great. Except that she couldn't read patterns, and I only saw her every month. I quickly had her knit a gauge swatch, then calculated a cast-on for her to knit a flat square. My thought was that at our next meeting we'd seam the squares up the side, leaving holes for thumbs, and pull a string through the top to tighten like a hat closure. Not perfect, but the best I could do.

We met for the last time in June. She brought her squares and I showed her how to sew a mattress stitch. She seamed the sides and I picked up stitches to start the thumbs. She took over (her first time on DPNs) one thumb, while I started the other.

She finished the mittens, I snapped a photo, and returned her to her host family an hour later than I'd planned. But she took a finished pair of mitts back to Japan with her, and a few balls of yarn to keep busy with on the plane.

Each one, teach one!

Where did the month go?

2008-06-29T20:48:00.002-05:00

It's almost July and I've only posted once in June? Not for lack of thoughts, news, etc. Mainly time.

We just returned from a wonderful week's vacation in Michigan's Leelanau Penninsula. I knitted lots (more on that in a future post), read a satisfying amount, and enjoyed my time with the family.

I return to what promises to be a full, challenging month. If all goes as planned we close on the sale of our house and purchase of a new one this next week. Two weeks later we're scheduled to move. Just a few blocks across town, but an emptying of domicile nonetheless.

That would be challenge enough, but it just so happens I also have a client due the same week of our planned move. Who would have guessed when we listed our house in March and I accepted a client in April, that the (most welcomed) forces of relocation would pinpoint the same time frame as the labor godesses.

As always, I'm putting my faith in the "this will work out; it always does" mantra we birth tenders cling to.

Which reminds me. Two nice twin stories to pass along. The first from someone I know through work, whose twin boys arrived roughly a half hour apart in early June. They were her second and third children. They, like their sister before them, arrived vaginally, without any pain meds in their mama. Between them, they weighed over 11 1/2 pounds.

The second is from a former client who left the area about a year ago. She, like the work colleague, was young, not on fertility medication, and completely floored by the announcement of twins on the way. Hers, too, arrived vaginally in a birth she would not have wanted to go any other way.

It is reassuring to hear that hospitals are still letting multiples, at least in some situations, arrive in their own time, through the birth canal.

Professional Hazard: Friendship

2008-06-03T08:33:00.004-05:00

Yesterday, after having lunch with a former client, and a week after having coffee with a different former client, I was reflecting on the wonderful friendships I've made through my doula work. This includes, of course, my friendship with my backup/co-doula, T$, as well as the other amazing birth professionals I've gotten to know over the years.

It also includes the growing number of mothers and families I count among my friends. When I became doula, I hoped I would occasionally get to serve as a doula for a friend. I did not anticipate that I would often become friends with someone I served as a doula. It happens.

In large part this reflects the fact that most of my clients are similar to me: college educated, mid- to late-30's, partnered, Caucasian, liberal, middle-class, etc.. I admit my practice is not as diverse as it could be, despite my sliding fee scale and willingness to work with low-income clients.

It was therefore heartening to read this news story about a doula and client who became friends despite differences in their socio-economic, marital and educational status. Their respect and inspiration runs both ways.

There is a place in all doulas that hopes for this: that we may learn from our clients and they may learn from us; that we mutually raise each other a little bit from where we were. In a profession where the hours are long, unpredictable and intense, it is a pleasant perk to meet women one enjoys being around. It is likewise satisfying to have women want your company.

Yet unspoken in the article are those boundary issues we doulas need to keep in mind. Anyone who has worked with women in crisis, transition, or just a bad situation knows the "rescues" are few and far between. It is not the doula's job to help new mothers set up housekeeping. Nor should we assume emotional responsibility for the family's welfare. The doula heart wants to make everything better. It rarely can.

The doula-client relationship is a different thing from a friendship. Sometimes the former evolves into the latter. More often -- especially in cases of need -- the former masquerades as the latter.

Fortunately for the women in the article, their friendship appears genuine and balanced. Both of them draw from it and contribute to it. Things have worked out nicely for each of them.

Part of a doula's work is maintaining self-awareness. One must recognize when the urge to help or simply spend time with another woman exceeds the doula's professional scope. When that happens, it is either time to begin closing the doula-client relationship or to embrace the newly budding friendship. Both actions, when honestly motivated, keep us invigorated and rewarded in our work.

Iaterogenic prematurity

2008-05-28T13:05:00.002-05:00

The New York Times reports the fastest growing segment of premature babies is in the 34-37 week gestational age group. Moreover, researchers suspect unwarranted Caesarean deliveries are "causing" many of these early births.

"It is often hard to tell from medical records exactly why a Caesarean was done," reports the article. Amen.

My only client to have a scheduled C-section did so officially because of "suspected macrosomia" -- big baby. That is what is in her charts. What is NOT in her charts is that she had professional experience dealing with babies who had aspirated meconium, most of whom were post-dates, and did not want her baby born any later than her due date. When she had not started dilating by week 39, her doctor told her induction would end in a C-section anyway, "diagnosed" and scheduled her.

Fortunately none of my clients have been pushed to induce or deliver before their babies were full term. Nor have they pushed their doctors to induce or deliver early. Sadly, this does not appear to be the case for the U.S. in general.