Wednesday, June 16, 2010

Decommissioning My Doula Bag

I have been dancing with leaving the doula profession for a while now. There was a period of nearly a year when I didn't take clients, then I was back in for several. Then off again for six months, then pulled back in. Looking at this blog, I see that pattern repeated. Like with a cat at the door, all this coming and going becomes frustrating and confusing.

The reasons I keep coming back are the same ones that led me to this work in the first place. Birthing women are amazing. In a world where so many things are disappointing, overwhelming, discouraging, it renews the spirit to work with pregnant and laboring women. Every one of my clients has been smart, strong, inspirational. Even when the circumstances of the birth were not what they had hoped for, these women shone. They triumphed. Who can resist being around that?

In the past few years many of my clients were women and families whom I'd served before. That, too, was a pull. It is such a to have witnessed a woman's prior labor(s) when heading into a new one. It is a blessing to already have a bond with the family. I have yet to say "no" to a repeat client.

And yet. Life has become more complicated. I don't know how. My children are older and more independent. But I find myself busier with them after school than I used to be. In part there is more shuttling -- to piano lessons, soccer practices, friends' houses, etc. There is also more emotional need. I am more exhausted helping my adolescent navigate friendships and self-discovery than I was helping him learn to read or ride his bike.

More and more there are no "good" nights to be called away to a birth, no weekends I can afford to miss in my family's growth.

Dabbling in doula work doesn't work either. This spring I had two clients, my first in more than 6 months. With each of them there were things I forgot (e.g. offering to drop off postpartum herbal bath mixes) that used to be reflexive. Hospital policies had changed and I didn't know. I felt out of shape.

Hard though it is, I need to embrace these many signs that it is time. I am not saying I'll never return to being a doula. But for now I need to stop.

I am so grateful to each woman who shared her birth with me, and to each birth for what it taught me about life, mystery, knowledge and faith.


Thursday, January 07, 2010

She's back!

I've lost my voice -- my blogging voice -- I've been away so long. Zoinks.

As I work to find it, let me offer a little explanation for where I've been (and where I may well run off to again). It's several places, really:

1. Facebook. Nuff said.
2. New job
3. Family life
4. More Facebook (Scramble will be the death of me)
5. Lack of inspiration

If I can reconstruct the past year or so correctly, the end of my blogging was brought about by wanting to keep the focus of this blog on birth, but not having much to say about birth.

Nothing bad has happened, I wasn't distracted by, say, a personal health crisis, or marital troubles. Thankfully.

But I took a new job in October, 2008 and did not take on any doula clients for the first year I was there. It's a good job, for me and my family. I did not want to jeopardize it by running off to the hospital with little or no notice. "You were where? With whom? Why?" It can be hard to explain a doula's life to people.

At the same time, I became, inexplicably, less interested in birth topics. The fodder of this blog has been as much my reflections on our birth culture as actual births I attended. In theory I could keep thinking and writing about birth even if I wasn't observing it.

But my physical leave from birth coincided with (or caused, or perhaps was caused by) a general apathy toward the whole topic. I took "The Farmer and the Obstetrician" off my To Read list. I recycled my DONA magazines the day they arrived.

I can't say why I replied to an inquiry last July from a pregnant woman due in October. Before I knew it, I had a client. Then another -- expecting twins in December. Then a friend asked me to be her doula for her November birth. I had 3 clients and still wasn't sure how I felt about my relationship to birth work.

I plan to write about these births. They each, as always, taught me something. They each have larger take-away lessons. I am planning to be the doula for two women due this spring. Both are repeat clients.

At the same time, I have let my DONA membership and certification lapse. I haven't written here -- about birth at least -- in over a year.

Could it be that I'm moving into a different life phase, one that is enough removed from my own pregnancies and births that I no longer have the same emotional response to reproduction? Is birth "just" an interest -- like knitting, Wilco or professional hockey -- that captured me completely for a period of time and left me burned out? Maybe I'm just flaky.

Time will tell.

I wrote today. I have several things I hope to post about soon.

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Monday, March 02, 2009

The Gynecological Exam: Physician versus Midwife

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.

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Tuesday, December 09, 2008

Cervix Photos

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.


Monday, December 01, 2008

Assisted Reproduction

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.


Thursday, November 20, 2008

Individuals can make a difference after all

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 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.

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Tuesday, November 11, 2008

More personal recriminations

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?