In the last 5 years, I’ve attended around 50 births as a birth doula. Professionally I’ve grown and expanded in the way I approach this line of work, and I’ve learned so much. Each birth is totally unique and marvelous in its own way. Its truly a humbling experience to be present for each one. To commemorate the first 50, I give you this post. In my first 50 births, here is what I’ve learned as a doula.

1. Women are far stronger than they ever imagine or realize.
2. The design of birth is perfect and beyond wondrous. It makes me stand in awe of creation.
3. I’m always grateful to be at a birth. Always.
4. Midwives are the most amazing combination of personalized care and skill that exists in all of humankind.
5. Birth workers of all kinds really deeply care for their clients and patients.
6. Babies have a terribly underestimated strong intuition and intelligence about them.
7. Dads are amazing.
8. Medication is not evil. Sometimes it’s very important.
9. Home birth is not for everyone.
10. Neither is hospital birth.
11. Affirmations are powerful.
12. Doulas deserve to be compensated for their time away from their families and it’s ok for us to practice like that.
13. The more births I attend, the more I realize moms need more of my support and presence and less of my bag of tools.
14. Cesareans save some moms and babies.
15. Other times, they are terribly risky.
16. The mind / body connection in birth is unbelievably powerful.
17. Quality Childbirth Education is indescribably crucial.
18. No intervention, natural or pharmaceutical, is risk free.
19. I can summon energy from seemingly nowhere when I need to.
20. Similarly, I can sleep anywhere, in any position, when I need to.
21. Babies are full humans with emotional, physical and spiritual dimensions.
22. “Textbook” labor” only exists in the textbooks.
23. Women greatly underestimate their awesomeness, and it’s a crying shame that society does too.
24. A birth doula and a birth activist are not the same thing.
25. The role of a doula is totally unique to the support and care team.
26. Dads need doulas as much as moms do.
27. Sometimes I need a doula too.
28. Birth is very very very hard work.
29. It is equally empowering.
30. Alternative care in pregnancy really does make pregnancy and birth healthier.
31. Emotions and relationships play a woefully understated role in the way a birth plays out.
32. Birth needs to be private. It’s not a group event.
33. Every woman’s body responds to medication, natural interventions, and support in their own unique and unpredictable way.
34. Castor oil really does work to induce labor. So does nipple stimulation.
35. But nothing works for everyone every time.
36. If moms could see themselves through my eyes, they might just be frightened by their own power.
37. Doula work can be applied to many uncertain situations in life. For example I doulaed my dad in the months before he died. Being a doula prepared me for that in ways I could never have imagined.
38. Doulas can not do this without the support of their families. Mine is amazing.
39. There are two ways to look at birth: normal, or dangerous. The lens you see through will surely manifest itself in the way your birth turns out.
40. It’s equally exciting to know the sex of the baby before the birth as it is to learn it at the moment of birth.
41. I need to take care of me so I can take care of the family I’m serving.
42. When doctors and midwives work together in collaborative care, unbelievably amazing things happen.
43. Each woman has her own coping mechanism that is individual to her. She may not even know it but I recognize it.
44. The powerful stillness of the space where a woman rests between contractions leaves me speechless every time.
45. Natural birth is awesome.
46. So is medicated birth.
47. So is surgical birth.
48. The end of pregnancy brings a discomfort that makes women desire labor to start, even though they know what kind of intensity comes with labor.
49. Oxytocin is the world’s most powerful drug.
50. I love this work so very much.

Inspiration for this blog came from Tiffany Miler: my doula, midwife, and dearest friend.

Written by guest contributor, Rachel Madrigal. A birth doula since 2010 and childbirth educator since 2014, Rachel recently moved to the midwest from Colorado. She has since been a regular contributor to the A Woman’s Design blog. In her career, she’s served as both the President and the Treasurer of the Pikes Peak Regional Doula Association, and the coordinator for the Colorado Springs chapter of the Birth Network. A homeschool mom to her 4 crazy kids, she enjoys family time, a riveting book, movie dates with her husband, life in the country, snowboarding, travel, journaling, and a big glass of red wine after a long week.
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​    It’s of the utmost importance to find a compatible care provider that will support you in pregnancy, during birth, and in the postpartum period. Your choice of care provider will influence the direction your birth goes more than any other factor. Rarely do we think of “hiring” our doctor or midwife, but when we choose a care provider that is exactly what we are doing. We are paying them to provide us a service, so it stands to reason that we should ensure we choose someone who is going to be a good fit for us.

Women today have more options for their pregnancy care than ever in history. They have their pick of several doctors, a midwives, or family physicians. They can choose someone who likes a hands-off natural approach, someone who works in a high tech medical facility, or who prefers to actively manage more medical births. They can choose to birth at home, in the hospital, or in a birth center. There is no single provider for every woman - each approach will fit for someone.

Your provider should be compatible with your personality, but they should also be compatible with the type of birth you would like. For instance, if you would like an unmedicated birth in a hospital, it wouldn’t be prudent to hire a doctor who has a 90% cesarean rate. Perhaps he has a high cesarean rate because he takes a lot of high risk cases, and you do not fit the profile of the type of patient he sees the most. He may be very nice, but his practice may not be the best fit for you so it’s probably best to look elsewhere.

Many women question whether or not they can switch doctors during their pregnancy. Let me reassure you: it’s never too late to change your provider. Doctors and midwives are no strangers to taking on a client or patient at the end of their pregnancy. Their training has enabled them to thoroughly understand your charts from your previous provider, just as in any other practice of medicine. You do not need to stay with the doctor you have just because they have seen you since the first trimester.

Finally, it’s important in your interviews to ask questions that require more than a “yes” or “no” response. This is to ensure that you get as much clarification about that particular topic as possible. If you don’t understand the answer, ask for further clarification. It’s ok to press until you feel you’ve gotten the answer you need.

With that, here are some questions to consider when interviewing a care provider:

Logistics And Approaches To Care

1. What is your philosophy on pregnancy and birth?
2. What was your training?
3. How long have you been in practice?
4. How many births have you attended?
5. Where do you practice? Home, hospital, or birth center? Which one, and why is that your choice?
6. What is your cesarean rate?
7. Do you work solo or are you in a group practice? How many midwives / doctors are there, and will I get to meet them all prior to birth?
8. Do you collaborate with midwives (if you’re hiring an OB)?
9. Do you collaborate with OB’s (if you’re hiring a midwife)?
10. Do you take my insurance?
11. What are the costs involved with my care?
12. Are you supportive of integrative medicine? Would you cooperatively collaborate about my care with my preferred alternative support care providers?

Prenatals and labor

1. What will our prenatal visits look like? Do you provide any additional information or education during that time?
2. What prenatal testing do you require? How would you feel if I opted out of any of those tests? Would it change your plan of care for me?
3. What would you do if I became a “high risk” client / patient?
4. How do you feel about doulas? Are you comfortable with my hiring one for the birth?
5. Do you recommend that I take a childbirth class? Which one?
6. Can I have additional family members at my birth?
7. How would you feel if I chose to eat or drink during labor?
8. How many vaginal exams do you routinely do?
9. What is your policy for monitoring in labor?
10. How would you feel if I asked an alternative care provider to come to the birth? (Chiropractor / acupuncturist, etc.).
11. Are you supportive of my choice to labor in as many positions as possible? Can I deliver on my hands and knees, squatting, side lying, etc?
12. What do you do if labor slows down? Do you support natural augmentation techniques?
13. What are your preferred pain management techniques? How do you feel about medication for pain management?
14. What complications have you seen in your practice?

Postpartum

1. What is your preferred method for managing tears?
2. Do you practice delayed cord clamping? (The WHO suggests delaying cutting of the cord for a minimum of 3 minutes).
3. Can I breastfeed as soon as possible?
4. How do you support skin to skin for your patients?
5. Are the newborn procedures performed immediately or can they wait until I have had a chance to bond with my baby?
6. Do you do the newborn care or that the responsibility of someone else? If it is someone else, how can I communicate my desires with them?

​If you find out that there is a chance that your baby will need a NICU stay, it’s good to know at least a little bit about what the NICU is like. Nobody ever plans to have their baby in the NICU, but it is a reality for many families and some basic understanding about it can relieve some of the surprise since the NICU can feel very overwhelming. Of course each baby's medical situation is going to be unique to them, so we cannot possibly explain everything you will encounter in your situation. For instance, a baby born at 28 weeks is going to need far more intervention than the one born at 36 weeks. There are some things you will do well to know, however, if you are facing a possible NICU stay for your baby.

Sanitation is VERY important. Babies have underdeveloped immune systems, and premature babies are particularly sensitive to infection. The NICU has strict guidelines about hand washing and sanitation. Sometimes a face mask is recommended as well. It is critically important that you adhere to the guidelines about sanitation every time you visit the NICU, not just for your baby but for the others as well.

The NICU is busy. At any given time, there may be neonatologists, pediatricians, NICU nurses, RN’s, lactation specialists, other parents, and sometimes social workers or psychologists in the NICU. (A psychologist can help parents process the difficulty of having a premature baby.) It can feel very crowded and this is normal.

It's OK if you're scared. If being in the NICU with your baby feels scary, that is OK. You don't need to try to look at the bright side, try to see the good, or look for a silver lining. If you're intimidated and scared, it's OK to not like it and just be present in the situation as it is.

You can still breastfeed. Premature babies benefit greatly from their mother’s milk. While it may be difficult to establish a latch with a premature baby, you can still pump and slowly work toward a latch. If you need to supplement, many hospitals have donated breast milk that you can use for your baby. A premature baby’s stomach is particularly sensitive and breast milk is going to be much easier for your baby to process and digest than formula. Talk to your pediatrician and neonatologist about the options available to your baby.

In most situations, you can still do kangaroo care. Kangaroo Care is the term used to describe a mother and baby staying skin to skin as much as possible to support baby’s development. Kangaroo Care regulates the baby’s body temperature, helps establish regular breathing patterns, and generally contributes to baby’s overall well being and health. Even if your baby has a lot of tubes or cords attached to them, NICU staff can usually get the baby to stay on you. Remember, your baby knows you and they benefit from your presence  

You are allowed to stay with your baby as much as you want. That is your baby. You have a right to see your baby as much as you want, whenever you want. Don’t forget to do some self care, but do not be afraid to insist on staying with your baby if you want to.

NICU nurses are highly skilled, and they really care about your baby. It takes a very special type of person to be a nurse. It takes an even more unique type of person to be a NICU nurse. NICU nurses truly love babies and families. They do the best they can to make sure your baby is healthy and cared for. That being said, if you have an issue with a particular nurse for any reason, you can request that person not work with your baby and your request should be honored.

A NICU stay is never the plan, but a little extra medical support can mean a world of difference for tiny babies. With a little patience and help from a supportive staff, you and your baby will be discharged and snug at home in no time.

FULL-FAT DAIRY (OR COCONUT) PRODUCTS
Organic, full-fat dairy products are a great option for moms whose bodies aren't dairy-sensitive, allergic or intolerant. Same goes for coconut. 
During the postpartum healing phase, your body needs ample, healthy, whole fats to ensure production of the prostaglandins that facilitate cell, tissue + organ repair. Eating full-fat dairy or coconut products will rebalance your female hormones, energy + even help your mood (by stabilizing brain chemistry to stave off some postpartum depression!). In addition, full-fat organic rawdairy contains probiotics and enzymes that keep your gut + digestion in top shape.
If you're breastfeeding, your need for ample, healthy, whole fats is even higher -- and these foods help produce the rich colostrum + hind milk that your baby needs to grow happy + healthy.  
Here are some of the best "grab-able" full-fat dairy + coconut options:

• Greek Yogurt - Get full-fat Greek yogurt that's free of added sugar, sweeteners + flavors. You can always add a handful of berries and a dash of cinnamon!  (There's a few coconut yogurts out there, but unfortunately, most have too many sweeteners + additives to be healthy options.)
• Milk - Organic whole milk and/or full-fat canned coconut milk. Makes great smoothies (or mixes well with a tbsp of raw cocoa powder!).
• Cheese - Try organic string cheese, pre-cut cheese cubes or curds, or cheese blocks if you can manage slicing.

​Healthiest Option: Get organic, full-fat, plain dairy when possible. Raw is ideal. If you're dairy free, lean on plain, full-fat coconut milk.

NUTS, SEEDS + NUT/SEED BUTTERS
These convenient, portable healthy fat sources work wonders as nutrient + energy-dense snacks -- just a handful or smear can help nourish, energize + tie you over between meals (or feedings!). 

Healthiest Option: plain nuts, seeds or nut/seed butters without additives (except sea salt). Soaked + sprouted raw nuts ​ideal.

​Helping women achieve the optimal health, fertility + life vitality they deserve is Laura's life mission. She became a certified N.T.P. and instructor of nutrition after recovering from bulimia, binge eating + a slew of health problems. Laura now provides holistic nutrition + food therapy support services for women struggling with food, health + hormonal issues through her private practice Greener Farmacy. She employs use of natural, holistic + nutritional therapies to resolve chronic issues with weight, hormones, blood sugar, overeating, undereating, disordered food behaviors, fertility, energy + moods. She is also a trained yoga instructor + natural family planning expert. For fun, she authors Secrets of a Binge Eater, where she explores our common mental + emotional ties to food.
 
Follow her free health posts and learn more about how Laura can help at GreenerFarmacy.com and Facebook/greenerfarmacy or contact her at Laura@greenerFarmacy.com.

A few weeks ago it was determined that I would need a surgery that was long overdue. The recovery time for this procedure would be very similar to a postpartum period but not as awesome because I wouldn’t have a new adorable babe to remind me that it was all worth it.
 
During the consultation and planning of this surgery I was encouraged to start making plans for the recovery period for myself, my family and my business.
 
As a birth worker I have offered very similar advice almost weekly to expectant families during prenatal/postpartum visits and during childbirth education class. “It is important that you [mom] be taken care of so that you can focus on what is important during that time. Healing and transitioning your life with this new baby.”
 
I never thought I would be offered the same advice again since our family is complete. I also did not know what to expect as it can be challenging for me to hand over my other responsibilities and plan to just focus on myself for an extended period of time. I made this mistake during my own postpartum periods and during various times of my life when I really could have used a village…a community.
 
I started with making arrangements for my children. I am very blessed to have close family nearby and an older child who has acted as a second mother to her younger siblings. I make it a habit to not call on them often because I do not want to burn them out with last minute requests (when you are on call for a living this is not always an easy task).
 
One night during my planning my sister-in-law called me and said, “I want you to know that I have some vacation days available that I am planning on using. We can take the kids some days during your recovery.” There was silence. She said my name because I hadn’t responded in what felt like minutes. I hadn’t responded because I was overwhelmed with emotion. My sobs grew louder and as she realized what was happening she went on to tell me how much they loved me and my family and that they are there to help in any way they can.
 
I have amazing friends who have offered to make and bring over meals for my family, help with laundry and to make me laugh until I cry (which I love!)
 
A few days later I started to make arrangements for A Woman’s Design (which is my other baby). I contacted my team and had a few meetings to discuss the next few weeks and months. Not to my surprise these amazing women stepped up by taking on different roles and responsibilities even to the point of training if needed.
 
Collectively these people are doulaing me in their own ways. It is exactly the support I need to return and continue this amazing work with women and families. They think I’m driven and passionate now…
 
This Mother’s Day I encourage you…I implore you to not wait until you’re at the end of your rope to ask for help. Make it a habit to check in with yourself and reach out to those around you when you need. Don’t try to do this life alone…this parenting journey alone. It doesn’t have to be a big group of people. It can be women in your moms’ group, church group, the gym, close work friends, friends, family or the help of postpartum doulas.
 
They love you and want to support you in more ways than you know. They only need to be asked.
 
Love to you and yours,
Natalia
 

Sources:

Urinalysis: http://americanpregnancy.org/prenatal-testing/urine-test/

BP: http://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy/art-20046098

Pap Smear:  http://www.healthline.com/health/pap-smear

Gonorrhea culture: http://www.healthline.com/health/pregnancy/infections-screening-gonorrhea

Blood tests: http://americanpregnancy.org/prenatal-testing/blood-test/

Amniocentesis: http://www.webmd.com/baby/amniocentesis

Glucose test: http://evidencebasedbirth.com/gestational-diabetes-and-the-glucola-test/

Ultrasound: http://www.webmd.com/baby/ultrasound

MYTH: Only people with mental illness benefit from therapy.

TRUTH: Therapy is based in developing a relationship where you can feel safe to share your emotional experiences and life challenges. Many people seek out a therapist because they are struggling with stress, changes in life, or relationships. These are not necessarily issues of mental illness, and yet therapy can be extremely beneficial in providing essential support and a space to be heard without judgement. Often, we are concerned about “burdening” our friends and family members with our day to day stresses and worries. Working with a therapist allows you to share the weight of life with another person who is equipped to carry the load with you and help you figure out how to navigate life in a more manageable way. 

MYTH: I don’t need a therapist if I’ve got friends and family. 

TRUTH: Some people suggest that working with a therapist is like hiring a friend, and why would you do that if you already have friends? A therapist is there to support you like a friend or family member might, but they are also highly skilled in guiding you in progressing toward your goals, improving your quality of life and growing as a person. Unlike the other people you may have in your life, a therapist provides unbiased and non-judgmental feedback. A therapist is solely concerned with what’s in your best interest. They will not give you advice or tell you what to do, which is what our friends often do, sometimes leading you to feel conflicted if you don’t agree with their suggestions. A therapist does not judge you for the choices you make and cares about you unconditionally. They also carry hope for you when you can’t see it for yourself. 

MYTH: If I start therapy now, I will be going for years to come.

TRUTH: When you start and end with your therapist is your choice. It is your therapist’s job to be guided by your goals for therapy and to follow your lead, while also challenging you a bit and pushing you out of your comfort zone once in a while in order to help you grow. Most people spend a few months working with their therapist intensely to resolve the immediate issues that brought you in initially. After that, you will have likely formed a great relationship with your therapist, so you might take a break or drop down to only checking in once every couple of months. The great part about having established this relationship is that you can always return at any time if things come up in life that are difficult.


MYTH: A therapist gets paid to care about me, but I am sure I’d just be another number to her.
​
TRUTH: Therapists get into this work because they are deeply passionate about working with people in a meaningful and impactful way. Therapists are generally very empathic and compassionate people who genuinely care about and like their clients. Therapists do think about their clients outside of session because they truly matter to them. Many therapists spend much time when not with clients learning more ways to help, researching resources, consulting with other therapists about how to be most effective, and hoping that their clients are doing well in between sessions and after they have stopped coming to sessions. Our clients leave lasting impressions on our lives, too. 

MYTH: I had a bad experience with therapy in the past, so clearly it isn’t for me.

TRUTH: Finding the right therapist is like trying on shoes. Some might look great on the rack, but when you try them on, they pinch your toes, or just don’t fit quite right. Because the success of therapy is largely dependent upon a good relationship, it is essential to find a therapist with whom you feel like you “click” well. You’ll need to actually like your therapist if you’re going to building a trusting relationship and share details about your life that you might not have ever shared with anyone else. So, if you’ve tried therapy before and it did not work out, it left a bad taste in your mouth, or you did not find it helpful, give it another chance before you write all of us therapists off! Just like with people you meet in other parts of your life, you are not going to get along with everyone, and that’s ok. The right therapist for you is out there, it just might take a few tries before you find someone you feel like “gets” you and with whom you can relate. Therapy provides a sense of belonging, and in order to experience that benefit, you’ll need to find a therapist you like and by whom you feel accepted.