Doulas Archives - Childbirth Collective

The Doula As Witness Copy

A baby’s first breath

by Jess Helle-Morrissey, MA, MSW, LGSW, LCCE, CLEC

Doulas serve a multi-faceted role in a birthing family’s life: supporter, encourager, normalizer, educator, guide. We rub backs, we squeeze hands, we stroke hair, we breathe, we hold space. We press cool cloths to a birthing woman’s head as she brings her baby (or babies) forth from the warm, wet womb to the bright spinning world.

One role that is often overlooked, but is perhaps most sacred to my own doula heart, is that of witness. As doulas, we witness over and over again that unique and unparalleled moment in a woman’s life when she becomes a mother. Whether it’s a first birth, or a seventh, a mother is born each time she births a baby.

When a woman has a transformative birth experience (and really, what birth isn’t transformative?), she deserves to be fully seen. And that role is often uniquely the doula’s. Partners are witnessing, but they are most often deservedly caught up in their own personal experience of the moment. Midwives, doctors, and nurses are present, but they have medical tasks to attend to. Doulas are able to attend wholeheartedly to that moment.

We witness the joy of birth. We witness mamas finding their true selves for the first time in their lives as they birth their babies. We see the look on a mama’s face when her baby is five minutes old as she tells us, “Everyone said I couldn’t do it, but I knew I could.” We witness the hilarity of birth – I’ll never forget one mama who turned to me after birthing her twins and exclaimed, “That was f*cking AWESOME!” We get to see the way a partner looks at the birthing woman in complete awe as she makes her way through contraction after contraction. We get to see him or her wipe a tear away as this new little person makes that first yawling cry.

We witness the disappointments, too. And when things don’t go as planned, we can remind her that she is strong because we have seen it with our own two eyes, and we have felt it in our own doula souls. And we remember in a way that she might not.

So as witnesses to those moments, we begin to help her reframe: Last summer, one of my doula mamas had a surgical birth after a long and difficult labor. In a case like this, it is easy to go to a place of dwelling in what went wrong. I go to my postpartum visit. We talk about all that happened, and I validate the disappointment. I sit with the pain. But I also tell her, because I need her to hear, “I have never seen anyone work so hard for so long. I have never seen anyone fight so hard for what she wanted. You. Are. Amazing.” And she begins to feel it is true because I have seen it and I know it to be true. She knows I was there. She knows I saw her fully. And as I write this, I remember her fierce birthing spirit as if her baby was born yesterday, and I feel the hair on the back of my neck stand up a bit. Because I will never forget her strength, and the gift she gave me by allowing me in.

Above all, it is that sheer strength of birthing women – no matter how they give birth – that we doulas are witness to. The strength to carry on when it feels like all the reserves have been depleted. The strength to make a choice to go a different direction than we’d dreamed. The strength to joyfully claim a place in the history and lineage of birthing women.

And the repercussions of that witnessing can last a lifetime. I spent a good part of my own life feeling like I was not a very strong person. When I gave birth to my twin boys, I found strength I never even dared to imagine I had in me. Today, more than two years later, each time I see one of my two wonderful doulas, I still stand a little taller and feel that swell in my heart – “SHE has seen my strength! She knows the amazing things I am capable of!” A bit dramatic? Perhaps. But life-changingly, soul-stirringly profound for this mama? Most definitely.

So when you invite a doula into your life for some portion of the nine months of your pregnancy (and a couple months after), know that the benefits don’t end there. We not only witness, but we also remember. I tell my mamas, “If you ever need to be reminded of how incredible you are, call me and I will tell you as many times as you need to hear it to believe it.” So on behalf of all doulas, thank you to birthing families everywhere who invite us to witness your incredible journey. Thank you for giving us the best job in the world.

Jess Helle-Morrissey is a birth and postpartum doula, a Lamaze-Certified Childbirth Educator, a Lactation Educator Counselor, and a clinical social worker in private psychotherapy practice. She teaches classes for families planning VBAC and for families expecting twins and more at Blooma, and lives in St. Paul, MN with her husband and her identical twin boys, born in January 2011.

A year of supporting birth adventures: A Doula’s reflection

by Samantha Chadwick

So this week is World Doula Week. And I am just a few days away from celebrating the birthday of the first baby whose birth I attended as a doula. I am so grateful to have been invited by families this year to support them on their adventures.

And OH how far I have come! I remember nervously peeking around the corner of the wall in my house to try and watch the birth videos on my yoga DVD while I was pregnant. Now, I cry and laugh and breathe and moan alongside laboring women sometimes for hours (or days) on end and I really enjoy it. It’s strikes me as sort of an odd thing to love doing, but I do! This week my toddler has been asking to “see a baby get born” so I finally downloaded The Business of Being Born and showed her some. She loved it.

I know firsthand that pregnancy and birth can be simultaneously amazing and very difficult. As a doula I help families find resources, prepare for labor, and help work to ensure they have a positive birth experience. I see my role as supporting the birthing mother (and her partner or other companions), playing the role desired by that particular family. A lot of times that means providing information and resources during pregnancy and preparing for birth, being a good listener and helping the mother/couple discern their own wishes for the birth, and then providing emotional support and physical comfort during and immediately following labor and birth. I can assist the family in getting information that the mother and partner want in order to make choices.

Sometimes I’m in a hands-on, very active and physical support role or occasionally more hands-off, background role depending on what is needed. I take pictures and write down key moments and refill water bottles and hand out Tic Tacs and chapstick. I give the partner a thumbs up or confident head nod and swap in when they need a rest from squeezing their partner’s hips. I tell it like it is. This is probably the hardest thing you are every going to do, and it’s a amazing thing you are doing for and with your baby.

I see myself as working to create a positive, encouraging, and supportive environment for the mother and her family to birth a baby, recognizing that this is an experience she will probably vividly remember for the rest of her life, and it matters how she is treated, supported and believed in.

I believe that birth works – that women’s bodies are meant to carry and birth their babies safely, and in many cases nature works best when a laboring woman is comfortable, feels safe and loved, and is allowed to follow the wisdom of her own body without much interference. As a doula I can help facilitate this kind of environment and preparedness for what to expect and how to cope. That said, birth is unpredictable and different for every mother and baby. Just as important for me as doula is to support the mother/family no matter what comes up, to affirm the choices she makes, to listen to her and help her process what happens, and to help her remember how amazing and strong she was during her birthing time.

“There is a secret in our culture, and it is not that childbirth is painful. It’s that women are strong.” –Lisa Stavoe Harm

I am in on the secret. It’s true.

I am Your Doula: A Poem

I don’t work a typical 9-5 shift
I am on call 24/7
It is not uncommon to spend a day away from my own family
I get to witness your special moments and see you become a family
When you are happy, I am happy
When you are sad, I feel sadness too
I live for that next surge and the next phase of labor
I live to see the moment when you meet your precious child
I put all my energy, time, tears, and joys into your special day
I am overjoyed to be a part of your birth story, no matter what path it takes
I love to learn and see what changes the birth world will bring us
I love the passion I feel when I am working and connecting with new families
I do all of this, because I am your doula

-Danielle Cincoski

Danielle Cincoski is a certified birth and hypnobirthing doula. She also does placenta encapsulation. When she is not “doulaing”, she is Mum to 2 crazy and cute toddler boys Charles (3), and Graham (1).She lives in Forest Lake with her Husband Joe who is a veterinarian. And yes, they have 4 animals.

Journeying with mothers when you are not: Reflections from a doula without children

Doula Support

by Karen Schultz, CD(DONA)

In pre-natal meetings or in the early hours of labor I learn a surprising amount about my clients, and they about me. Inevitably, our conversations turn to family, the birthing stories of our mothers, and the dreams for our own babies.

There is always a thoughtful pause in the conversation when they ask, “Do you have children?” I smile and always offer the same response: “No…not yet.”

It is often the case that a woman comes to work as a doula after experiencing her own labors and realizing what a benefit that extra support was or could have been. She either didn’t have a doula and wished she had, or did have a doula and was inspired to follow in her doula’s footsteps. But for some of us, the call to doula comes without our own transformative birth journeys.

Doula Support

I am the only daughter in a family of six. My mother birthed naturally in hospitals and breastfed all of us for two years apiece, an oddity at a time when breastfeeding, for any length of time, was frowned upon. My mom’s influence was subtle over the course of my childhood, but by her example I slowly came to the conclusion that 1) birth is sacrificial, sacred, and beautiful, and 2) women are strong enough to labor well, to breastfeed well, and to nurture well.

I had always been interested in childbirth (I think most women intuitively are) but I hesitated in considering it my life’s calling. What could I, a woman who had never experienced labor, offer a women in the throes of childbirth?

I considered nursing school for a time, but I didn’t want to be bogged down in charting and paperwork when my real love was building up the bonds within families and communities. Science was also a passion of mine, and eventually I did teach high school anatomy & physiology, along with biology and a host of other subjects. Inevitably, when the time came for classroom lessons about fertility, fetal development, and childbirth, my female students would moan about the anticipatedpain of birth, while my male students would acknowledge the fear they had of simply supporting their future wives during their labors.

I thought, “Is this how our young people should face one of the most transformative experiences of their lives?” Surely not! It just didn’t seem right that our society was priming them to believe in the weakness of the female body, rather than in its strength!

It wasn’t until I left teaching and returned home to Minnesota that the doors to birth work began to open. With a bit of nervousness but firm resolution, I attended my first birth on New Year’s Eve of 2012. It was remarkable! In every birth I attended since then, I’ve been struck by how comfortable I’ve felt in the birthing room, how confident I was in the mother’s ability to birth well, and how touched I was by the love between parents. I also became more practically aware of the advantages of my singlehood: I didn’t (yet) have to juggle the responsibilities that come with motherhood–no worries about getting a sitter for a long labor or finding a back-up doula when a little one catches a fever! My responsibilities, in large part, are to myself only.

I also realized that being a doula who hasn’t birthed carried another benefit: I am not burdened by my own “birth baggage”. I don’t have, for instance, the memory of an epidural followed by regret of that choice, or a c-section that I felt could have been avoided. I can pretty safely say that I don’t have any expectations of how labor “should” go because I can’t judge based on my personal experience. I know that every labor is different because every mother is different and every baby is different.

Of course, I hope it goes without saying that I know dozens of “doula-mothers” who successfully leave their own birthing experiences at the door of the birthing room and only retrieve wisdom from them if it is of benefit to the mother and her particular need. I also know with certainty that there are doulas who, having not personally experienced the intensity of labor, might struggle to have compassion for a laboring woman in great need. There are strengths and weaknesses of both states in life.

So what is it, then, that makes for a stellar doula? Is it simply a matter of knowing what labor feels like? That seems far too simplistic; having a baby isn’t just about getting through contractions or learning how to push. It’s about realizing the gift of our femininity, discovering a deeper bond with our partner, and trusting in the strength of our created bodies. It’s about relying on those whom we love and trust for a firm and steady hand and the unfailing reassurance that we can do it.

For many expectant parents, I think it’s quite natural to ask the question, “Will my doula know what to do if she hasn’t had her own children?” But I would urge these parents to instead think of the qualities necessary for an exceptional doula: Compassion. Understanding. Presence. Wisdom. Joy. Having birthed or not having birthed, it is these qualities that are most important.

Karen Schultz, CD(DONA), is happily settled in the Twin Cities after a hiatus in Washington, D.C. where most recently she taught science to high schoolers. Read more about her at http://filiabirth.com.

Cesarean Awareness: A Doula’s Humble Reflection

by Erin Stertz-Follett, CLD, LCCE, HBCE

My journey into birth began 10 years ago after the birth of my first nephew, Micah. I wouldn’t fully embrace birth as my calling until many years later, after the birth of my own two girls and the ‘birth’ of the passion inside me to bring services of meaning to pregnant women and their families.
I will never forget that moment. After an induction that lasted more than 24 hours, and “arrest of descent” of the baby during pushing, my sister was told that she would need a cesarean section. I watched as her face turned from determination, to disappointment, to resignation, and to sorrow. As my mom and I left the room while they began the surgical prep, I said to Mom, “That’s not what we wanted.” With tears trickling down her cheeks, she shook her head, “No.” The grief for what Sarah so badly wanted – a vaginal birth with minimal interventions – was palpable.

A few years later, as I was pregnant with my first child and wanting to learn as much as I could to avoid my own surgical birth, Sarah invited me to an ICAN (International Cesarean Awareness Network) meeting. At that time, the group was small and had just begun reforming here in the Twin Cities. I happened to attend on a night when a wise midwife named Gail Tully was on hand to provide information and practice in ‘optimal fetal positioning’ for birth. I didn’t know anything about birth halls or Rebozos, or the side-lying release. I just knew that it felt so good (and kind of funny!) as I was used as the ‘pregnant model’ for Rebozo belly sifting.

Two babies later, both of which included my sister’s attendance and support, I began the true path to birth work as a Lamaze Certified Childbirth Educator, doula, and HypnoBirthing Certified Educator. Again, my journey was largely inspired not only by Sarah’s first birth, but also by her successful HBAC (home birth after cesarean) her second time around.

To offer full disclosure, I dreaded as a doula the first time I would need to step into the surgical suite and witness a mama experience a cesarean birth. In some small way, I was traumatized by my sister’s experience. Now with several under my belt, I can say that my perspective has changed. Yes, it is still difficult. But, with my doula hat on, I enter the experience with an open heart and an open mind, with nothing but how I can best support that mama in that moment as my focus. It is at that time that we turn our trust over to the trained surgeon whose job now is to safely bring the baby forth from the mother’s womb. I offer a grounding hand on the forehead, an explanation of what to expect and what is happening, sounds and smells that calm the mother, words of reassurance to the partner, and pictures if mama desires.

I have seen mothers who view their surgical births in many different ways: From full-on acceptance (even requesting one at the end of a long, stalled labor); to complete devastation (offering my doula hands to wipe away tears); to somewhere in the middle (perhaps with resignation and a resolve to process the experience later). I have seen cesareans that are completely medically necessary, and those that fall in a grey area.

Look, the cesarean rate in this country (32.8%) is too high. There’s no way around that. We can do better. For women, for babies, and for their families. It may feel daunting to tackle this subject on a grander scale and I know many of us birth workers often feel at a loss. But here is what we can do:

Approach the subject with mamas (clients, patients, friends, family) with gentleness, understanding, an open heart; and, when needed, the statistics.
Remember and value the fact that not all mamas view their cesarean as traumatic or unnecessary. Don’t assume that all mamas do and meet them where they are, especially as they plan a subsequent birth.
Educate. Educate. Educate. Knowledge truly is power. Whether it is ways to more optimally position baby for birth, or methods for deep relaxation, or just knowing all options and all places of referral. Education is key. The ability to ask questions and have them honestly answered is tantamount.
Refer to birth providers who offer options for mamas in pregnancy and labor; and who understand normal, physiologic birth… Those whose rates of cesarean birth are on the lower end (including out-of-hospital options if the mother desires).
Refer mamas who have experienced cesarean birth, especially those that view their births as traumatic, to resources such as ICAN and Homebirth Cesarean groups.
When a surgical birth becomes truly medically necessary either before the birth or during the laboring process, we can offer support and guidance for having a more family-centered experience.
Put our time, our money, and our voices behind organizations that support mamas in having births with low interventions.

And finally, as doulas and as friends or family, we can hold hands. Wipe tears. Validate fears. Lift them up. Walk down to the lowest lows with them. Remind every mama how strong they are… that they brought their baby into the world; that they can do it again with love.

Erin Stertz-Follett owns Flutterby Birth Services, located in Burnsville, MN. In addition to doula services, she offers HypnoBirthing, Lamaze, and Breastfeeding classes as well as other workshops and events. She is the mother to two lovely and lively little girls.

Editor’s Note: This post first appeared on the Flutterby Birth blog. Photos credited to Stephanie Ryan Photography. All birth stories used with the permission of the mothers.

Eat, Pray, Doula: A Doula’s Journey in Bali

by Karen Bruce, AAHCC

I am writing from a hotel room in Ho Chi Minh City, Vietnam, awestruck by the experiences of the past 10 days, still overcome with emotion at the intense connections formed among a group of strangers in that time, and brimming with anticipation for my future birth work. I just attended Eat Pray Doula 2014 in Ubud, Bali Indonesia with 27 of the most beautiful birth keepers you have ever met.

What better place to celebrate World Doula Week than in SouthEast Asia with such a diverse group of women? We represented at least 11 countries and spoke numerous languages. We included midwives and teachers, translators and nurses, small business owners, and, of course, doulas. Some brought their families on this adventure, some traveled alone. All of us converged in this beautiful land they call the Island of the Gods for a DONA Birth Doula Workshop taught by Debra Pascali-Bonaro, chair of the International MotherBaby Childbirth Organization and creator and director of the film Orgasmic Birth, Ibu Robin Lim of Bumi Sehat International and CNN’s Hero of the Year 2011, and Katherine Bramhall, co-founder of Bumi Sehat and homebirth midwife.

Katherine Bramhall, Karen Bruce, Debra Pascali-Bonaro, Ibu Robin Lim

I traveled with my partner from Minneapolis along with two fellow Childbirth Collective members, Angie Posine and Angie Sonrode and their families. We all knew this was something special and were eager to share and learn with so many experienced doulas and world-famous birth gurus. Our Twin Cities contingent had much to offer by way of practical suggestions for natural pain relief, position changes, communication with families and staff, etc. I am proud to say that the Childbirth Collective was a shining example to our peers of how birth keepers can work together to support one another and provide best practices with an evidence-based model of doula care. We loved sharing how Minnesota is at the leading edge of a revolution in well-supported birth thanks to the many legislative efforts of Susan Lane and the Minnesota Better Birth Coalition. Our community enjoys many options in childbirth that are sadly not widely available.

But Eat Pray Doula challenged me in many ways to move beyond the comfort zone I have created in my doula work – I know very well the culture of birth in the Twin Cities and my place in it, and my toolbox is filled with ideas to support the physical and emotional needs of the birthing families I serve. However, I may not have been fully prepared for the deeply spiritual transformation I experienced at this workshop. Our facilitators were skilled at creating the conditions that allow true connection with other people, and they lit a spark within me that has inspired me to create sacred space in birth, to preserve and protect the spiritual as well as the physical and emotional.

My first DONA Birth Doula Workshop with Gail Tully in 2006 prepared me in very practical ways to be a birth doula, and she certainly speaks to the spiritual, but I may not have been ready to hear it. The 8 years of experience at over 200 births in between have prepared me to receive this new perspective in order to develop that part of my practice which is so critical to the mystery of life and love on this planet.

Not to be confused with religious expression, the spiritual aspects of creating life in our womb and birthing our babies into this world are simply related to the human spirit or soul. Simply by choosing my words or silence more carefully, by being fully open to the MotherBaby mystery as it unfolds, and, when I have my activist hat on, by educating and encouraging gentle birth practices by other doulas and care providers – I know I am making a difference. I remind myself that it is not necessary to understand this mystery in order to honor it and create space for its expression during this profound transition from pregnant to parent, from MotherBaby to mother and child.

Eat Pray Doula workshops are appropriate for new/aspiring birth doulas, but even the most experienced will learn many new ideas to breath new life into their important work. I would especially encourage nurses, midwives, and obstetricians to consider registering for a future workshop as a gift to yourself and all birthing families you will hold sacred in the future!

Karen Bruce is a certified Bradley Method(r) Instructor and Birth and Postpartum Doula in the Twin Cities. She serves as the Vice President of the board of the Childbirth Collective. Her website is karenbrucedoula.com.

Celebrate and Share World Doula Week 2014!

March 22-28 is World Doula Week! Did you know that just recently, ACOG and SMFM (American Congress of Obstetricians and Gynecologists & the Society for Maternal Fetal Medicine) named doula support as one of the most important and most underutilized tools in preventing cesareans in first-time mothers? This is just one of the amazing, research-based benefits of doula support.

So if you are a doula, used and loved a doula, or just want to shout the doula love from the rooftops, feel free to comment here and share these graphics on social media! We here at The Childbirth Collective are so proud to do what we do. Happy World Doula Week!

3rd Time’s a Charm: The HBAC Waterbirth of Bryce

by Robyn Hustrulid

Before starting this birth story, I feel the need to mention my 1^st and 2^nd births. They are the beginning of my journey and very much effected how I gave birth to my 3^rd child. My first came a couple weeks early with my water breaking in the middle of the night. I went to the hospital before contractions started and after walking around a bit, they started me on Pitocin. It took the whole day for contractions to get strong, and after 2 hours of strong contractions, an epidural and a cervical check resulting in little progress, the OB recommended a cesarean. Besides asking if we could wait, I didn’t know enough to fight this recommendation, so my first baby came to me via an unplanned, and what I have come to realize, an unnecessary cesarean. The reasoning was “failure to progress,” or maybe we could call it “failure to wait.”

The cesarean wasn’t easy for me to accept. I was happy I had a healthy baby, but not happy with how things went. Breastfeeding started off rocky and recovering from major abdominal surgery was not what I had planned for. I knew I wanted something different for my second birth. I started asking about VBACs (Vaginal Birth After Cesarean) at my 6-week postpartum visit. And then two and a half years later when I got pregnant, I read more books, watched the essential movies, attended some parent topic nights, became a regular at Blooma, switched to a midwife, and hired a doula. I felt prepared and knew that I could accomplish a safe and rewarding VBAC. My labor started at 41 weeks, again with my water breaking in the middle of the night. I stayed home and waited for contractions to get intense, and then went to the hospital. There were a few hiccups of back labor, stalled progress and an epidural, but eventually I welcomed my 2^nd baby into the world via a VBAC!

After that experience, I fell in love with the role of the doula, because I knew my first birth would have been different if a doula had been with me. I decided becoming a doula was the right path for me and dove in headfirst. After 2.5 years of witnessing strong mamas welcome their babies into the world, I decided it was time for me to do it again. But again, from all that I had learned and witnessed, I knew this time would be different. I decided to have a homebirth. I hired 2 midwives and 2 doulas. I focused on eating healthy, working out and doing yoga. I also went to the chiropractor regularly to make sure my pelvis was balanced and my body was in alignment. After hearing amazing reviews, I decided to give Hypnobabies a try as well. I was very committed to doing all of the homework and listening to the tracks daily. I was a believer but wasn’t sure if it would work for me until my birthing time came.

On Mother’s Day 2013, my guess date, I decided I wanted to have a low-key day and spend some time with my own mom. I took a nap and listened to the “Come Out Baby” track from Hypnobabies. Then I went for a walk in the afternoon with my mom and a movie after. I had been having Braxton hicks daily for weeks, but started to notice some waves (Hypnobabies term) coming more regularly during the movie. Later I realized this was my early birthing time, but during I dismissed them because they didn’t seem to be getting stronger. These waves continued on through the night as I ate dinner with my kids, did the dishes (while listening to Birthing Day Affirmations) and then put the kids to bed. I went to bed thinking nothing was happening, but decided to listen to my “Deepening” track. I wasn’t able to fall asleep because the waves were getting a bit stronger. Around 11:30, I felt some fluid leak a couple times and thought I was peeing, so I decided I should go to the bathroom. When I stood up, I felt a gush between my legs and knew exactly what was happening. I sat on the toilet and felt a bit stunned, excited, anxious, and in disbelief. I called to my husband that “my water broke.” It took him a bit to wake up, but then he got up, and we started getting things together.

I made my phone calls; told my mom to come over to sleep, and I let the midwives and doulas know that it was happening, but I didn’t need them yet. I could feel the waves but they weren’t very strong, so we decided to get everything ready and then go back to bed. David set up the birth tub and got me some water. I got the camera, some snacks, the Hypnobabies scripts and my iPod out. My mom got to our house around 12:30. I told her “this one is sure different.” I had a few waves in the kitchen and leaned over the counter while breathing through them. They still felt somewhat mild to me or just like pressure. I was sure there was a lot of time left.

Around 1am, after we felt like things were gathered and set up, I asked David to do the rebozo for a bit. I was feeling some of the waves in my back so we wanted to encourage baby to get in a good position. After a couple waves, I got up and sat on the ball and David turned on the “Fear Clearing” track. The waves started to get a little more intense, so I decided to call my midwife around 1:30am. She asked how close they were, and we had no idea. So she asked that we time a few and call her back. After timing them and seeing that they were 3 minutes apart, I realized that things were moving faster than I thought, but I still felt like it was early in my birthing time. My midwife decided they should come, so I also called my doulas to come. My midwife also suggested we do an initial fill of the birth tub, because it would probably take a couple, and we would need time for the water heater to heat more water.

With every wave, I was leaking a lot of fluid, so I decided to get in the shower. I let the hot water run on my breasts in between the waves and drew peace signs and hearts on the steamed up shower door. During the waves, I leaned over and let the hot water run on my back. My mom got me my water bottle, and I put it in the shower with me. I could hear some of the Hypnobabies in the background, and I was saying, “Open, Open, Open.” After the waves I would burp, and I smiled as I remembered my midwife telling me that was a sign of active labor. I loved the shower and the routine/rhythm I had created. But sadly, because we were also filling the tub, the hot water ran out. I got out and sat on the toilet around 2:25am. My mom started to boil some water just in case. I didn’t realize it at the time, but my mom and David started to get a little anxious for the midwives to get there. My mom asked David if he could deliver the baby if need be. He just grinned and put his hands out like he was catching a baby.

One of my doulas arrived around 2:30. She took note that waves were about 2 minutes apart, and I was listening to Birthing Affirmations. I remember using my peace cue during waves, and feeling like it was really helping. My doula said relax, and I could feel my shoulders melt and my body soften. Around 2:45 one of my midwives arrived, so my mom was able to relax. My doula suggested I eat something, so David went and got me some yogurt and an Emergen-C drink. The midwife in training arrived shortly after, and then my other doula. One of my doulas came and put her hands on my shoulders and forehead and told me to relax.

My midwife tried to hear the baby with a fetoscope but wasn’t able to get a good angle while I was on the toilet. My other midwife arrived and also tried to listen to baby while I was on the toilet, but it wasn’t working, so they asked me to stand up. I stood up and leaned over my sink. My doula did some double hip squeezes and massaged my back, which felt wonderful. My midwife was still unable to find the baby with the fetoscope, so she asked if I wanted to get in the bed or use the Doppler. I couldn’t imagine lying down, so I said Doppler. She found my baby’s heartbeat, and it was perfect. I remember hearing on the Hypnobabies track, “say your baby’s name.” And I said, “I don’t know your name.”

At 3:24 I asked if I could get in the tub. It wasn’t ready yet, so one of my doulas went downstairs and helped my mom bring the boiling water up to fill the tub. David and my other doula were checking to see if the water was warm enough to start filling it with the hose. Around 3:30, I started to feel like I needed to poop; my doula mind knew what that meant, but I wasn’t ready to admit it out loud yet. As the pressure built, I asked again if I could get in the tub, but it still wasn’t ready. One of my doulas suggested I sit on the toilet while I waited. When my first wave came while on the toilet, I felt my whole body start to push and I couldn’t resist it. I had about two waves like that, and heard my midwife say, “she is going to have that baby on the toilet.” I said, “I NEED to get in the tub.”

Around 3:40 I got in the tub, and my mom was still dumping hot water in it. When the first wave started to build, I got into a froggy squat position. It felt like the rise of a roller coaster, excitement, nervous, anxious and joy in the anticipation. I knew once I got to the top there wasn’t anything I could do. This baby was coming down, and I was just along for the ride. I felt my whole body start to involuntarily push. It was such an unusual feeling, and I knew I had no control and needed to surrender. The “Pushing” track was on, and I remember sending peace down and out in front of my baby’s head. After the wave, I leaned over the side of the tub, rested my head on the edge and asked for cold washcloths. David held one on my forehead and someone put one on my neck. While pushing I could feel the baby’s head moving down and then rocking back up in between waves. My midwives told me I could reach down and feel the head during the next wave, and it was then that I finally believed I would meet my baby soon.

Just before 4am, one of my doulas asked if I was ready for the kids to come in. I said I didn’t know and asked if they thought the kids could handle it. Everyone said yes, so I said ok. My mom woke up Kyle and Jolie and they came around the corner sleepy eyed and smiling. They got pillows and blankets and lied in the hallway. They would sit up and watch as they heard me making grunting and pushing sounds. Kyle asked my mom, “What’s all the drama?” Apparently I was making more noise than the women in the movies I had showed them. In between waves, I asked Kyle if he was ok and he said yes and didn’t look the slightest bit scared.

My midwife suggested I tilt my pelvis during the next wave so the baby could get past my pubic bone. What a difference that made, I could feel the baby move down even further and stay down. During the next wave I sat back and thought in my head I’m going to keep pushing even if I feel burning. I reached down to feel the head coming out, and then the wave stopped. I asked, “is this ok,” even though I knew it was. My midwife assured me it was just fine and the baby’s color looked great. During the next wave, I could feel the shoulder come out and then the rest of the body slide out. I brought my baby up on my chest and felt the most incredible rush of emotions. “Oh my God, oh my God, oh my God, this was awesome! Everybody should do it!” And then I heard my son say, “it’s a boy!” My sweet little man, Bryce David Hustrulid, came into this world in such a beautiful way at 4:04am and changed our lives forever!

Bryce David Hustrulid born May 13, 2013 at 4:04am

8lbs 14oz, 21 inches

Sweet Moments in OOH Birth: A Doula’s Perspective

by Anne Ferguson, CD(DONA), HCHI

A homebirth mama is comforted by her partner and her doula as her midwives look on.

Amazing, beautiful and empowering birth can happen anywhere, that’s for sure. But there are some special things I’ve witnessed as a doula in out-of-hospital birth that you really don’t see in a hospital setting. Here are just a few of the amazing things I’ve had the honor to be a part of in some of the birth center and home births I’ve attended as a birth doula.

The doula waking the older children in the middle of the night just moments before their Mom pushed their new sibling out in the world so they could witness the birth, and the children announcing the sex of their new baby sibling.

The entire birth team and family enjoying chocolate cake and pink champagne at 6 am after a beautiful home birth.

A strong Mom pushing her baby out into the world just as she envisioned, in the birth tub in her backyard as the sun rose on a beautiful summer morning.

Enjoying Pizza Luce for lunch while sitting around the dining room table in a comfortable and cozy birth center with a Mom in early labor, waiting for her body to move into the next phase, without any expectations around timing or a need to rush the process along.

A beautiful, quick birth during a power outage, because it turns out you don’t really need power to have a baby!

In general out of hospital birth offers the following perks:

Taking a bath or shower in your own bathroom and then climbing into your own warm, comfortable bed not long after giving birth.

A homemade meal made just for you, right in your own kitchen or in the birth center kitchen, made just to your needs and tastes.

Midwives who you know and trust because you’ve been meeting with the same people for months, and you know who is going to be there when the times comes for your baby to be born. (This happens sometimes in hospital birth with small groups of care providers.)

Moms being able to trust their bodies completely, knowing when it’s time to push their babies out without any cervical checks.

Control over who comes in to your postpartum space, instead of the constant flow of traffic that usually happens in the hospital setting.

Out of hospital birth is a safe and wonderful option for low risk mothers wanting a low-intervention birth. In the Twin Cities we are incredibly lucky to have three free-standing birth centers and many, many wonderful, skilled home birth midwives. If you are planning to have a low-intervention birth, it is well worth your while to consider your out-of-hospital options!

Anne Ferguson, CD(DONA), HCHI is a birth doula, Hypnobabies instructor and placenta encapsulator who has two sons, one born in the hospital and one in the comfort and safety of her own bedroom. You can find her at www.bywaterbirth.com.

The Lowdown on Out-of-Hospital (OOH) Birth

by Kate Saumweber Hogan, CPM, LM

A homebirth mama gets support from her midwife.

What is OOH Birth?

Out-of-hospital (OOH) birth refers to births occurring outside of a hospital, such as at a home or a free-standing birth center that is not connected to a hospital.

Planned OOH births can be in a house, townhouse, apartment, trailer, hotel, friend’s house, birth center, or even a back yard! Most homebirth midwives are pretty flexible with space needs, and can make almost any “home” work. Ideally, there should be running water, electricity, and a phone (or cell phone service), but even those can be negotiated!

Weighing the baby at a homebirth

What do all of those letters mean after midwives names?

There are two general kinds of midwives in our country. There are nurse midwives who are primarily trained in a hospital setting and most often attend births in the hospital; they are called Certified Nurse Midwives (CNMs). Some CNMs gain additional experience to offer OOH care as well.

The second type are direct entry midwives; these midwives are primarily trained in the home birth or OOH setting and provide care in this setting. Some direct entry midwives earn the national credential of Certified Professional Midwife (CPM). In Minnesota, CPMs also have the option of becoming licensed by the state, which also gives them the title of Licensed Midwife (LM). It is a good idea to ask your midwife what her credentials are, especially in Minnesota where there are so many possible combinations!

A homebirth midwife helps a mama welcome her baby earthside.

It is safe to birth at home or at a birth center outside of a hospital?

Midwives are experts in normal. So for normal, low-risk, healthy moms and babies, YES, research shows that with a trained care provider, it is as safe or safer to be OOH than being in a hospital setting. However, OOH birth isn’t for everyone. Your midwife will help determine if you are a good candidate for OOH birth, and will continue to monitor you and your baby during pregnancy, labor, and delivery to ensure that it is still safe to be at home.

If you would like to read the research available regarding home birth, a thorough review is available through Midwives Alliance of North America.

The question is often, “is homebirth safe?” but rarely, “is hospital birth safe?” This article looks at the other side of the coin.

What equipment do OOH midwives bring?

Each midwife will have a little variation in her birth bags, but in general, most midwives are certified in neonatal resuscitation and CPR, and will have equipment pertaining to those certifications. She will have medical supplies such as oxygen, suction for baby, medications for hemorrhage, a fetoscope and doppler to monitor baby’s heartbeat, a baby scale, and equipment to check mom’s vitals (blood pressure cuff, stethoscope, thermometer, a watch).

Some midwives carry IV equipment, suture and lidocaine for perineal tears, a pulse oximeter, a variety of herbal and homeopath remedies, and a birth stool. Some midwives also rent birth tubs and have additional equipment relating to the tub. Be sure to ask your midwife what you can expect her to bring to your birth.

Most midwives have families purchase a birth kit, which will have all of the disposable things that are needed for the birth, such as underpads, gloves, gauze, and a peri bottle. Families will also be asked to gather a list of supplies to use at the birth, such as towels, baby blankets, and extra pillows.

A new family snuggles in their own bed just after birth

Is homebirth messy?

This question comes up a lot! Surprisingly, birth is not at all like it is portrayed in the media and it really isn’t very messy. Your midwife uses supplies from your birth kit to help protect your bed and floor. She will start the laundry and clean up any sign of your birth before she leaves your home so your visitors won’t even know where the birth happened! There isn’t even very much trash, often barely enough to fill a kitchen sized garbage bag. You may have a second bag of trash if you are using a birth tub with a large plastic liner.

A mama meeting her baby in her own home.

What about labs, ultrasound, and newborn care options?

When you interview potential midwives, it is good to ask if they offer routine labs, ultrasounds, and newborn care options (vitamin K, erythromycin, newborn metabolic screening, hearing screening, CCHD screening). Some midwives offer them as part of routine care, and others would refer you to your primary clinic for these services. Informed consent and shared decision making is at the heart of midwifery care. Prenatal visits will be an opportunity to discuss the pros, cons, and alternatives, and make a decision together about what is the best choice for you and your family. If you’d like to decline testing or newborn options, you can! It is your choice and it shouldn’t be a fight! But it can be nice to know what options will be available to you, since there may be some that you want for yourself or your baby.

If the midwife you choose doesn’t offer the newborn screening options (metabolic screening, hearing screening, and CCHD) most midwives who offer these options are willing to see babies outside of their practice for these screenings. You can find providers who offer these services here: http://minnesotamidwives.org/MCCPM/Newborn_Hearing_Screening.html

Does insurance cover it?

Sometimes! There isn’t an easy yes or no answer, since it is really plan dependent. Most OOH midwives are out-of-network and will be covered based on your out-of-network benefit levels. Many of the birth centers are in-network and are covered at that level. Some midwives bill insurance, and others don’t. Midwives who offer insurance billing usually can do a benefits check to give you a better idea of what you can expect to be covered. If you have an HSA or flex spending plan, those funds can go towards paying for your midwifery care. The vast majority of the time, even paying 100% out-of-pocket for your home birth is less expensive than the out-of-pocket costs for a hospital birth after insurance processes the claim. The Childbirth Connection is a good resource for comparing costs by birth place from a national level.

Brand-new homebirth family.

Can I have a doula and a midwife?

Yes! Many out-of-hospital midwives encourage each woman to consider having a doula at her birth. Doulas provide continuous emotional, physical, and informational support before, during, and after birth. Many midwives offer this kind of physical and emotional support as well. However, unlike midwives, doulas don’t provide any medical care. Doulas are great at offering comfort measures and supporting both the laboring woman and her partner from early labor until after baby is born. Be sure to check out the Childbirth Collective for free parent topic nights and ample opportunities to meet with and interview doulas.

How do I find a midwife who works in a home birth or birth center setting?

Check out the midwife listings on the Childbirth Collective, view members of the Minnesota Council of Certified Professional Midwives, and check out this comprehensive list of midwives from Minnesota Families for Midwifery. Most practices offer a free consultation to see if the midwife and family are a good fit, that is a great opportunity to ask any additional questions you may have about out-of-hospital midwifery and birth!

Kate Saumweber Hogan is a certified professional midwife and licensed midwife, serving Minnesota and Wisconsin. She is the owner of Twin Cities Midwifery where she provides prenatal, home birth, newborn, and postpartum care. She sees families at clinic spaces in Minneapolis and White Bear Lake, and lives in south Minneapolis with her husband and nursing daughter, born at home in the water in December 2012.