Monday, June 10, 2013

From the Diary of a Doula: 8 a.m.

The whole point of woman-centered birth is the knowledge that a woman is the birth power source. She may need, and deserve, help, but in essence, she always had, currently has, and will always have the power.Heather McCue
My Ethiopian mama will be here any moment. She is taking the bus from St. Paul for our last appointment. I usually see ladies four times before their guess or due date. I will go with her to her birth or help her labor at home first and then see her at home for the final postpartum visit usually 2 days later. Farhia* is expecting her first baby, a girl. She says her iron has been low in spite of iron pills so I take the opportunity to discuss nutrition. Her diet is very good and full of fresh fruits and vegetables, but I remind her that liver and red meat is also good; beans and dark leafy greens are just as beneficial. I talk about a recent study that found that even if you are eating an iron-rich diet, that you might need to include some dairy at each meal which in turn helps the iron bond and be better assimilated.
Yogurt, kefir, milk, cottage cheese and ice cream are good choices. I suggest prunes and prune juice, which she has never heard of, so we stop to have a snack and I get out the prune juice in my kitchen which she discovers she likes very much. Then we watch the movie “Everybody Loves… Babies.” Without a lot of words, this award-winning film clearly shows the benefits of maternal-infant and parent-infant attachment. The babies shown in poorer countries actually seem happier and become more confident little people without toys or early educational programs compared to the babies in the Western cultures who have every advantage but appear bored, frustrated and whiney. Not exactly your happy campers. I use this film in my childbirth education course to point out the blatantly different styles of parenting across cultures and the resultant levels of bonding.

Filmmaker Thomas Balmes offers a glimpse at the first phase of life in this film following four newborn babies through their first year of life. Ponijao, Bayar, Mari, and Hattie were born in Namibia, Mongolia, Japan, and California, respectively. By capturing their earliest stage of development on camera, Balmes reveals just how much we all have in common, despite being born to different parents and raised in different cultures. What is not said, however, is that all the toys, gadgets, enrichment classes, numerous choices presented by parents and attention – or lack of it -- actually doesn’t make our babies more self-assured or more prepared for life.
The converse appears true: babies in the so-called ‘Third World’ are simply part of the family or society’s ongoing continuum of daily survival and work. They aren’t singled out for special baby activities or coddled and seem to have greater self-esteem and are more independent earlier than Western babies (and less work!). Likewise, in her recent book, Parenting Without Borders: Surprising Lessons Parents Around the World Can Teach Us by Christine Gross-Loh (2013 Penguin Group) repeatedly points out how our Western views and models of parenting actually undermine the self-esteem we are hoping to instill in our children. This will be explored more completely in my forth-coming book, Stone Age Babies in a Space Age World:§ Babies and Bonding in the 21st Century© pending.

We finish the movie just as my next client arrives. She folds up the final draft of her birth plan that we have composed together and gets up to leave. A couple expecting twins heard about me from another couple who have hired me as their doula that they had recently met at a support group for parents of multiples. I haven’t met them before, so this is just a consultation or information session with no obligations. Couples actually should interview several doulas before they find one that is right for them.


I like to start a first appointment with a beautiful little DVD that the Childbirth Collective in Minneapolis recently made called “Doula: A Documentary” by Emily Rumsey, 2012. (See: www.emilyrumsey.com)  It tells better than I can what a doula is and what she isn’t. It presents a look at water birth, home birth, hospital birth and C-sections and as my friend/mentor Liz Abbene of Enlightened Mama says in the video, “I tell them about all of their choices because if they don’t know what their choices are, they don’t have any!” 
Since this couple is expecting their first babies I offered to show the DVD of my twins’ birth with Ina May Gaskin at The Farm filmed in 1982 called, “Twin Vertex Birth.”                Twin belly here, above right.
See:   http://www.inamay.com/natural-delivery-vertex-twins-dvd They had lots of questions, actually the same questions I had 30 years ago when I found out I was carrying twins and realized that the whole land of birth as I knew it with a singleton two years earlier had suddenly changed. We visited for over an hour and I suggested they talk it over and perhaps interview other doulas before making their decision.

My next appointment is with a Somali mom at her home in the housing projects that they have dubbed “the Cages.” Thirty floors of tiny airless apartments with only one elevator as access, which is known for frequently breaking down. I have never tried walking up 30 flights of stairs. I hope I never have to. It is like a scene right out of Rachel and Her Children by Jonathan Kozol. Fatima was one of my earlier clients last year when she birthed her 6th little girl. She only makes girls, she has decided, and they are beautiful, too. Her littlest, Hikmet* is now 8 months old and the continuum bonding that her mother has practiced is obvious. A bright, inquisitive baby who is never far from her mother, little Hikmet is enjoying life as it was meant for babies. She has no need to cry for what she wants. Her earliest cues are noticed and answered, whether it is for food, affection or the need to be changed or kept warm. I don’t reach for her to cuddle her, but instead let her initiate a visit to my lap when she is ready to explore beyond her mother’s safe bubble. Continuum babies will tell us when they are confident enough to wander beyond the safe place that is their right. Then they will venture farther and farther away, secure in the fact that a parent will be there when they have the need to check back in again. Continuum babies actually become very independent little people earlier than babies who were separated shortly after birth and forced to sleep in a crib or cradle and self-soothe themselves during intervals throughout the day. I drop off her breast pump that I ordered and show her how to use it, though I hope she is able to put off going back to work for a little longer.

When I get home after my last appointment, I remember I have to call a client’s clinic. I saw her yesterday for a prenatal doula visit and was rather shocked at the enormous amount of swelling that wasn’t there the week before when I saw her. She assured me she was having an appointment with her doctor later in the morning, but I want to let her provider know that this is a concern. As a doula I don’t do anything clinical that her provider does, but I can let her know when I notice something that may have been lost in the translation. She speaks some English, but Amharic (spoken in Ethiopia) doesn’t always translate well especially with medical terms. And she wears an ankle length hijab or robe that completely covers her legs. She also told me she stopped taking her prenatal vitamins and extra iron because of constipation. I told her to be sure and let her midwife or doctor know this too, so that they can discuss it. I suggest making a list of questions before she goes to the appointment so that all of her concerns are discussed.

My last appointment of the day is with a first-time mom, also a recent immigrant to the U.S. who couldn’t make it to our breastfeeding class at Everyday Miracles (the non-profit I work out of – see: http://www.everyday-miracles.org/) so I have offered to do a home visit and go through the material with her. I enjoy this class very much. I wish I had even half the information we now have when I was having and nursing my babies back in the 1980s and ‘90s. We didn’t have a clue what we were doing. La Leche League was available for support groups or by phone, but we didn’t know then what we know now about latch, positioning the baby(ies), cracked nipples or really any of the basics.

First I like to show “Breastfeeding: the Why-to, How-to” videos**. Each one runs about 20 minutes. It is packed with information that is presented in a confidence-building way. I have made my own demo breast out of an old white T-shirt. I dyed one piece of cloth in tea water overnight, and another piece in a brew of cocoa and coffee. Without rinsing them I dried and then ironed the two swatches to set the colors. I sewed and stuffed the main tea-dyed breast and then hand sewed on the darker coffee and cocoa dyed nipple. It didn’t cost me anything, and I think it looks as good as the commercial ones if not better, compared to the $50 ones in the educational catalogs. Other teaching supplies that I cannot make are available at: http://www.1cascade.com/Category.aspx?CategoryID=10032

My cloth breast comes in handy when demonstrating things like how to make a ‘sandwich’ of your nipple to help a newborn latch on. It also shows clearly what Nature had in mind: the darker nipple and areola is actually a ‘bull’s-eye’ that your baby can see and is therefore directed toward as his/her first destination after birth. I can also demonstrate massaging and expressing that will come in handy should you become engorged. 
Next I bring out Tofiq, (pronounced: toe-FEEK) my anatomically correct 7 pound boy baby doll that I use to have parents practice nursing positions with. When we were having our babies 2 and 3 decades ago, we did not know that they should be lying on their sides to nurse and not flat on their backs with their heads craning around to reach the nipple. We didn’t know how to keep them nursing when they fell asleep or how to burp or not burp them. We didn’t know about the side-lying position, cross-over hold, cradle hold or football hold. I can also demonstrate baby-led or baby-initiated breast crawl and latch (see "Breast Crawl UNICEF" on YouTube) with Tofiq. He has also been bathed (see ‘The Best Baby Video Ever!’ at this blog under the March listings) at homes and classes at women’s shelters.


Time to go home and make some supper. I like to make extras of whatever salad or entrĂ©e I am making so that if I get a call and have to leave for a hospital in a hurry there is food in the ‘fridge for my husband and I can quickly put some in a container that I can have later at the hospital. I refuse to eat vending machine food. More and more hospital rooms have little refrigerators in them for their patients’ use for storing food and also any breast milk that they have pumped. 

Time for a nap. I follow my own body’s cues on this one. If I am tired, and I am at home I nap. I never know how long or short the coming night will be. Rather than drinking another cup of coffee – I will do that during all-night stints -- I take a nap. When I get up it is time for a hike down to the river and back. Then I need to put in a couple hours of writing. This discipline does not come easily, but the prospect of a book is terribly exciting so I have made it a regular daily activity. It is getting easier, but I still have to consciously make time to do it. For so many years I was busy with children – 6 in all, and could not have dreamed of free time to write. LOL! But now after all those years I have that luxury. I figure it is time to share some of the wisdom those years taught me with younger moms. It was not meant for me alone. We need to pass it along.

*all names, dates and identifying characteristics have been changed.

**Vida Health Communications www.vida-health.com

STAY TUNED... This and other stories will be appearing in one of the books, Call the Doula! a diary© or Stone Age Babies in a Space Age World:§ Babies and Bonding in the 21st Century,© pending by Stephanie Sorensen

§This phrase was first coined by Dr. James McKenna, used here with permission and gratitude for his work. A world-renowned expert on infant sleep – in particular the practice of bed sharing, he is studying SIDS and co-sleeping at his mother-infant sleep lab at Notre Dame University. He is the author of “Sleeping With Baby: A Parent’s Guide to Co-sleeping,” 2007, Platypus Media, Washington, D.C.

"The most precious gift we can offer anyone is our attention. When mindfulness 
embraces those we love, they will bloom like flowers.” 

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