A Day in the Life of a Doula: Baby Parties!

Every culture has their customs. Some are dictated by religion, some by superstition, or just plain wanting to have a good excuse for a party. In many cultures that have come out of primarily Third World Countries, the infant mortality rate is high – higher than ours, so you have more babies than you planned for, often as many as you can manage to make, because statistically, a certain percentage will not survive. A new report by Save the Children finds that India leads the world in the highest number of babies dying within the first 24 hours of their birth, more than 300,000 a year. The international non-governmental organization sounded the alarm this week with its annual State of the World’s Mothers report, which says India accounts for 29 percent of all global first-day deaths. The three major causes of newborn mortality are pre-term birth, severe infections, and complications during childbirth. Save the Children said these three conditions alone account for 80 percent of all newborn deaths worldwide. (And I cannot help but wonder if reports of killing unwanted baby girls is not being added officially to these numbers.)

As of this writing the best countries to have a baby in (and ensure its survival) is Finland, Sweden and Norway. The worst are the Democratic Republic of the Congo, Somalia and Sierra Leone (Save the Children’s Mother’s Index.) Tibet isn’t far behind with not only its high infant mortality rate but rates highest or number one on the charts for maternal deaths. Many studies have been done in Lassa, Tibet at the

hospital there on high blood pressure, anemia and altitude considerations as the possible cause, but according the Tibetan diaspora in Minneapolis, which is the 2^nd largest next to New York in the U.S. when asked, they universally site the cause as the calculated Chinese genocide on the Tibetan population: A family brings a woman into the hospital because of complications during labor and the all-Chinese staff does little or nothing – intentionally. (Does anyone want to fund a watch-dog trip to Lassa? Let me know!)

A recent CBS report reveals that the United States has the highest first-day infant death rate out of all the industrialized countries in the world. About 11,300 newborns die within 24 hours of their birth in the U.S. each year, 50 percent more first-day deaths than all other industrialized countries combined, the report's authors stated. The 14th annual State of the World's Mothers report, put together by the non-profit organization Save the Children, ranked 168 countries according to where the best places to be a mother would be. Criteria included child mortality, maternal mortality, the economic status of women, and educational achievement and political representation of women. Worldwide, the report found that 800 women die each day during pregnancy or childbirth, and 8,000 newborns die during the first month of life. Newborn deaths make up 43 percent of all deaths for children under five. Sixty percent of infant deaths occur during the first month of life.

So I was not surprised when my friends from Laos explained that they will not celebrate the birth of their new baby until she reaches her 1^st month birthday. We are not supposed to mention that she is cute, or adorable or strong, much less her name which the parents have not said out loud even once yet, lest the bad spirits hear of these things and come to spirit her away or make her sick, which is basically the same thing in

their history. The Ethiopian family that I recently was doula for asked me to attend their new daughter’s Orthodox baptism when she reaches 40 days of age. Boys’ baptisms take place on day 30. They could not tell me where that comes from, but I can only guess that in their experience in the past girls babies were stronger than boy babies, so they chose to move up the date for boys to somehow absorb a little extra grace so they might have a better chance at survival. In many cultures the baby won’t receive gifts until the proscribed ‘wait-and-see-if-he-lives’ period is over.

Adam Katz-Stone writes in an article in The Jewish Federations of North America newsletter: “In Jewish tradition, baby showers were taboo. Neither Halakha or Jewish law forbids gifts for an unborn child, but custom effectively prohibits them. Such gifts once were thought to draw the attention of dark spirits, marking the child for disaster. To this day, many Orthodox Jews will not so much as utter the name of a baby until that baby is born, for fear of inviting the evil eye. In liberal Jewish circles, however, attitudes are more relaxed.

"I don't think there is anything wrong with giving gifts," said Rabbi James S. Glazier of the Reform Temple Sinai in South Burlington, Vermont. In his view the traditional reluctance to hold a shower "is based more on superstition than anything else. It's all Ashkenazik medieval superstition. I don't denigrate it, but on the other hand I don't put a lot of stock on it either."

While the rabbi and his wife had baby showers for both their children, they deferred to tradition in so far as they did not decorate the nurseries until after the babies were born. Like many modern rationalists, Rabbi Glazier said he respects the psychological imperative behind the custom of not holding a shower – a custom that arose in a time when infant mortality was high.

"I can see where you don't want to have a whole room waiting, in case something terrible should happen," he said. "Today people have concluded that since infant mortality in childbirth is so infrequent, they think every child will be healthy. I don't agree with that. In our case we didn't want to be faced with a complete room before the baby came home healthy."

At the Conservative Temple Beth Shalom in Mesa, Arizona, meanwhile, Rabbi Bonnie Koppell said her mom warned her against buying "so much as a receiving blanket" before her first child was born. The rabbi went shopping anyway, but she agrees that full-scale pre-natal nursery design may not be appropriate.

"My sense is that preparing a whole suite of furniture and decorating the room might be a bit much," she said. "However, a few receiving blankets, onesies, and diapers--G-d forbid, if the infant does not come home, these few things won't make terribly much difference in the face of such overwhelming grief." Yet there are many in the observant community who will not buy so much as a sock. Some say that the tradition of shunning the baby shower is not just ancient superstition: it serves a deeper communal need.” It's not just about the couple having the baby, they say. It's about all the other couples that can't. Rabbi Jay Yaacov Schwartz and his late wife wrestled with infertility for years before adopting. When they did begin the adoption process, "we didn't even tell people when we had an adoptive opportunity, because we were afraid of ayin hara -- of bad energy," said the rabbi, a spiritual leader at the Orthodox synagogue Young Israel of Oceanside in New York. Rabbi Schwartz was not literally afraid of demons. He feared waking the cosmic wheels of action and reaction that he believes return to us just what we give out. In this case, he knew that his happiness might cause pain for some childless couple, and their unhappiness would someday come back to bite him.

I have also been to Hmong baby parties for my friends from Laos. One time I was told to come to a certain address by 8 a.m. It was a good thing I didn’t have any other obligations that day. We didn’t eat until 7p.m. or later. Really. The pig was still running around in the basement when I arrived. He would be ritually sacrificed sometime during the day to drive away all bad spirits from the baby and his family. A shaman sat on a sawhorse upstairs and played his bamboo raj nplaim or tsaaj nplaim flute and communicated with the Other World, asking the bad spirits what they would require in order to vacate the premises.

More often than not, they would request a pig feast and the family would butcher the animal that just happened to be in the basement that day. A host of relatives (meaning up to 200 minimum) would be invited and the preparations would begin. The men would prepare the meat and bring it to the kitchen where all the aunts and grandmothers would be squatting at large round cutting boards that looked like small tree stumps, each wielding a huge machete or knife and would proceed expertly hacking and chopping it. Periodically during the day, a large dishpan would be brought around with the ‘appetizers’: whole scrubbed cucumbers or hard boiled eggs or apples and oranges. Thick, sweet syrupy hot instant coffee would be passed around, too. This would suffice to stave off starvation until we could feast later that night.

I usually had one or more of my children with me when I did home visits, always at least one or two was still nursing (See: Twin Birth on The Farm with Ina May Gaskin at this blog under the April posts.) So I would wander around the house visiting with the other moms, or talking with the grandmothers. One of the favorite activities among the girls was taking turns brushing my hair. Unlike their straight black hair, mine is brown and kinky curly (a true ‘Jew-fro’.) So I sat on a couch and submitted to the ordeal while nursing a baby or two just to pass the time. Then I would wander into the kitchen and watch the cooking. It was fascinating watching Grandma Moua Lee hacking perfect little broccoli flowerets for one dish with a giant machete and Great Aunt Mee Thao slicing pigs ears into what looked like long rubber bands. Fresh pig liver was frying on the stove and ground meat was being mixed with hot peppers and cilantro in another giant pot (see: http://hmongcookbook.com/main/.) Cauldrons of rice were steaming on the stove while another auntie was pounding raw, sweet rice in a mortar for sticky rice cakes or Hmoob Jiang that would be wrapped in aluminum foil and steamed in an electric rice cooker. Cases of Mountain Dew and Coke were piling up as each new car pulled up to the building in the housing project. Teenagers were visiting out on the lawn smoking cigarettes while the oldest grandpas shared a hookah in the back yard.

Finally, the dirty dishes and cutting blocks would be cleared away, the floors all swept with little handmade brooms and babies collected from all the mats on the floor. We all gathered around the new baby and her parents as the shaman began the ceremony with prayers and good wishes for a long, prosperous life. He burned some gold paper called joss or jin (below) which represents money to placate the ancestral spirits.

He tied a cotton cord onto one of the baby’s tiny wrists as he spoke the last blessing and announced her name. Then all of the grandpas and uncles tied their white cords onto the baby’s wrists with a blessing, also repeating her now-public name. Little Pah (which means ‘a flower’) slept through most of the ritual. Another uncle continued to pass out more pre-cut white cord to all of the guests down to the children. After a while both of Pah’s arms were full of strings and I noticed that some relatives had started attaching them to her ankles too. Some of the guests also pressed large bills into the parents’ hands, more often than not 50s and 100 dollar bills. Perhaps the money would be saved for her dowry, but it was explained to me that this way her extended family was ensuring that she and her parents would never have to go hungry. The strings would be left on little Pah until they literally fell off, at which time she would be much stronger and not in need of the prayers that had been attached to her arms and legs with the strings.

Next, all of the men and boys in attendance sat at the many card tables that had been brought in or stood around those sitting at them and ate from the communal bowls stacked around the center. Little children were already smacking their lips on sticky rice cakes. Meanwhile, the women kept their eyes on the bowls of stews and soups, refilling them

as soon as they emptied. When the men finished and roamed back out to the hookahs, all of the cracked Melmac dishes were snatched up and washed in the kitchen and the tables set once again which us women and girls descended upon.

Hmong etiquette requires one to eat until you are ready to burst. Perhaps this grew out of years of wars and occupations where you never knew if this might be your last meal for a very long time. And hostesses make sure you are told at least three times, “noj kom txog rau thaum koj muaj tag nrho” (pronounced: naw-maw choe-PLAH!) or literally, “eat your stomach FULL!) When my husband came along with me to these parties he had no trouble complying. He loves Hmong food. The Hmong grandmas and grandpas would sit around him, watching in awe as he filled his bowl over and over with food, commenting that they thought Americans didn’t like their food; after all, none of the doctors or social workers they had invited to a meal since they first arrived in the U.S. had ever once come to their homes to eat with them.

At one party we were at a young Hmong dad had sat down next to David with two cold beers, handing my husband one of them. At the previous party this father had noticed and obviously admired David’s boots and had gone out shopping until he found an exact replica. As they sipped their beers in anticipation of the meal, 

Jou Zhe Yang pointed out his new boots to David while grinning from ear to ear. He could not speak English yet.

I went to a Vietnamese Coming Out Party last weekend. It was amazing! The mom is required by tradition to stay in her room for a month. This is a tradition in many cultures suggesting that she needs time to once again become ‘pure’, or recover, (or I like to think establish a good milk supply.) It gives the family a chance to ‘mother’ the mother, which we could do a whole lot more of in our society in the U.S. She gets to rest for a whole month and doesn’t have to shop, cook, do laundry, care for other children, or think about her partner’s needs. She is waited on hand and foot!

Tuyen’s* midwife hosted the party at her home, inviting family and friends of the new mom and also quite a few of her own family. Her interpreter from the birth attended with her husband too. This was a first for me, so I wasn’t expecting to being invited to help with the cooking when I arrived. Maya,* the midwife, with the help of a niece had already shopped for just about everything listed in their Asian cookbook and were half way through a recipe for Green Papaya Salad when I arrived. I have seen this in Hmong and Thai restaurants and love it, so I was glad to see it here, too. It is a very spicy salad made with julienne slices of peeled green papaya mixed with cabbage, tiny dehydrated shrimp, raw green beans, fish sauce, sugar, carrots, red Thai chilies and a host of other ingredients.

While we were tasting that and adjusting the spices, turmeric-coconut rice was simmering on the stove, ground shrimp Pops on sugar cane sticks were cooking on the barbeque, catfish in caramel sauce was bubbling on the stove in another pot, and Maya was finishing up the rice and peanut sauce for the Pops and

a sweet chili sauce for the fried egg rolls. Spring roll ingredients were arranged on the buffet: rice ‘skins’, warm water for dipping them into, rice vermicelli, fresh mint, basil and cilantro leaves, lettuce, shredded carrot and cucumber slices.

All this time, little Ngoc was being passed around as she slept, oblivious to the festivities. Tuyen had dressed her in a tiny plum colored satin dress with matching booties fit for a princess. Finally when all the cooking was done a couple of hours later, we all sang Happy Birthday for Ngoc and then dove into the meal. It was

exquisite! Tuyen had brought all of the ingredients for quail egg drop soup and had been making that on the stove while we were all finishing making the last of the other dishes. I have eaten some very interesting things during the past 30 years that I have worked with refugee and immigrant communities, but this was a new one. I hesitated, thinking back to my son's little pet quail who died of a heart attack one evening as Isaac was holding him and a huge truck backfired as it passed our house, scaring the little guy to death. Literally.

After the meal, at which Tuyen ate more than any of us had ever seen her eat before -- all 85 pounds of her -- we opened presents. Baby clothes have gone to a whole new level since I had my babies in the early 1980s. She received the cutest little dresses, sleepers and shoes. She was given checks with which to buy things she may need for herself and her baby. It was a wonderful party, and a real encouragement to her in her new country.

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

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 21^st 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.

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 21^st 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!” 

(see: http://enlightenedmama.com/contact/)

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 6^th 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 entrée 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 21^st 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.” 

― Thich Nhat Hanh

On Birthing Books: Or, How does a book get born, anyway?

I don’t know about other books, but this is how this one was first conceived. I was trained as a midwife, but not to deliver babies, mind you. My primary instructor in 1989, Valerie El Halta, who supposedly retired a few years ago, but who is now ‘catching’ babies for Mormon mommies in Utah, made it clear from day one in school that midwives don’t deliver babies. In fact, we actually don’t ‘catch’ them either.

What she wanted to teach us first was to learn so well what Nature already knew how to do very well. Then she wanted us to see that babies and mothers knew what to do also, if we let them, and that we could approach birth with respect. We saw birth after birth after birth until we learned -- and some of us had to un-learn quite a bit, too -- what normal birth really was, and what natural birth really was. Only then were we trained to know when we were seeing something that didn’t fit in the picture. Then we were trained to know when it was time to take charge or how to help, but not with instruments. Instead we learned to use our hands, and ears and eyes, or perhaps a mother’s body in a different position, to get things back on track. Sure, we studied all the obstetrical pathology and I am still fascinated by new discoveries, but normal came first. Always.

I did not realize how well I had internalized Val’s lessons until over 30 years later when I was getting to know the Somali refugee community in Minneapolis. My husband and I had worked with refugees since just after the Vietnam War when our family had sponsored Hmong families as they arrived in Minnesota back in the 1970s and ‘80s. (Over 50,000 Hmong eventually came to Minnesota.) We got to know several extended Hmong families and became close friends, staying in touch for all these years, attending births, giving their babies American names when they asked us to, attending weddings, and translating for funerals, as I learned to speak Hmong. My children actually spoke Hmong before English, having been with Hmong children as they grew up and being watched by various grandmothers while I worked with their moms.

David and I had gone into mission work after our children were grown and found ourselves  in England. At one point we returned to the States on a sabbatical to visit our now grown children and grandchildren in Minneapolis. The civil war in Somali had continued to escalate and displaced families were flooding into Minnesota by the early 2000s. As I write this there are over 70,000 African refugees in Minnesota, the majority Somalis, trying to start over and live in peace once more. I was as curious, it turned out, about them as they were about us. I didn’t have regular work, so I began hanging out every day at the Somali women’s bazaar. I’d give an English lesson here and there, and they would paint my nails with henna and ask about life in the U.S. We’d compare everything: what we were each making for supper that night, where we bought our skirts, where our kids were going to school, what natural remedies were better than prescriptions. But the longer I was there, the more troubled I felt about … something.

I could not put my finger on it at first. I knew that the Somali immigrant community had the highest incidence of autism in the state compared to every other ethnic population. I started snooping around and found out that the Hmong had the lowest, lower than the average for us other Americans which is about 1 in 110 to 150 infants.  The Somalis had 1 in 28! and rising, according to SAAF, the Somali American Autism Foundation. This is unacceptable! As I listened and observed I became more and more convinced that my mind was switching into the ‘Valerie mode’ I had learned in 1989; in other words, what is wrong with this picture? There is something very not normal here. I puzzled and wrestled with it from every angle I could think of until it dawned on me, one of those little ah-ha! moments: they weren’t bonding with their babies! Since I began observing Somali mothers I had seen only 1 baby being worn in a baby carrier or wrap on the mother -- in 8 years! They had been all worn back in Somalia. However, I continued to see strollers, cell phones, blue tooth phone ear attachments, Walkman with ear plugs poking out of every other hijab I saw; mothers driving cars (Hmong women did not drive until much later assimilation), and already owning their own businesses. 

The babies in the strollers were wearing new clothes, using pacifiers, drinking formula from propped up bottles, and playing with toys from local department stores. Many of these women were so economically successful that as of this past October 2010, they had already attracted the attention of a delegation of businessmen and women, led by Dr. Benny Carson from Sweden, who flew to Minneapolis (where Somali women own a shopping bazaar called Karmel Square) to learn from them how they had become so business savvy so soon, with the hope of replicating this in Sweden where there is also a large Somali population who have not been as successful there, though they blame the Swedish business laws for much of the delay. And I found out also that Sweden has identified the Somali population there as having a similar autism epidemic. I believe I am seeing a group of fiercely independent, assertive women, but, unfortunately, by adding our 21rst century, technological culture to this mix, we have women unconsciously multi-tasking during the earliest bonding opportunities, eager to rejoin or compete with other Somali women in their new-found freedom, social status, and economic independence. I have even had nurses at the University Hospital ask me how they can get the moms to room-in with their babies.

To top this off, in 2007 the Women’s Coalition on Breastfeeding in Minnesota declared breastfeeding a “disaster in the Somali community with no one nursing past 3 months”. In the same year, neither WIC nor the La Leche League in Minneapolis had been able to identify a Somali woman who had nursed past 6 months and thus could act as a breastfeeding peer. (WIC has done a phenomenal job since then in educating and supporting immigrant women to successfully nurse their babies.) 

To me, at least, it was critical that someone compare the Hmong and the Somalis and figure out what was causing the problems, not just with autism, but with the many emotional and developmental problems that they told me they were dealing with and had never heard of in Africa. As I waded further and further into this puzzle it became very clear that many of the doctors and people doing research were forming several ‘camps,’ some thinking vaccinations were the culprit. Others were sure it was genetic, and would not be swayed by any other arguments. Still others were already treating children with diets devoid of wheat and dairy, often prescribing and replicating the foods their parents ate in their home country. A lack of vitamin D is being investigated, and hotly debated, too. Then it also became apparent that there were different sides even within the Somali community: political, religious, medical. It was getting so very complicated with different factions blaming the State, or the U.S., and demanding compensation from the government, and then even the universities and hospitals here in Minnesota were vying for the research money that began trickling in. But the children continue to suffer. The National Institute of Health, Washington, D.C., in collaboration with Autism Speaks, New Jersey, is finally tackling the research needed here in Minneapolis in collaboration with the University of Minnesota.

I am continuing to meet with Somali mothers and fathers and sharing, where I am able, the need to bond with their babies right from the time before birth. Together with a Somali grandma, Fadoomah, and a Somali mom, Fatima, both who have become close friends and fierce bonding advocates, we have produced a DVD in Somali about bonding which Somali TV, radio, and newspapers have expressed a great interest in.

But back to my book, which is still very pregnant and waiting to deliver. I still felt that the biggest disparity between the refugee groups that I have worked with over the past 30 years, and more recently in many American moms I see also appears to be in maternal-infant bonding. I blame our fast-paced technology, rampant consumerism, and our perception of evolution that includes materialism and the death of the extended family for our present levels of bonding and non-bonding behaviors that have become acceptable to an entire generation. I cannot blame any one individual mother. Without seeing examples of good bonding in past generations, is it any wonder women haven’t learned how to bond, do not recognize their instincts and have become so out-of-touch? So I continue to hope that a book about bonding in the 21^st century will address a much bigger problem than just autism in Minneapolis, though that remains paramount. This book is actually the culmination of years of observation, friendships, research, study, and just plain wondering. Some answers are given, others remain elusive. I am hopeful that this book will encourage all new parents everywhere and those who help care for them to bond deeply with their children in our modern age of technology and materialism. Something must change and I believe it begins with the recognition that we are producing instinct-driven newborns who have not evolved along with modern technology, even though we treat them as if they have.

"Women today not only possess genetic memory of birth from a thousand generations of women, but they are also assailed from every direction by information and misinformation about birth." ~ Valerie El Halta

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

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 21^st 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.

All in a (Doula’s) Day’s Work

“Waking up this morning, I smile. Twenty-four brand new hours are before me. I vow to live fully in each moment and to look at all beings with eyes of compassion.” 

― Thich Nhat Hanh 

First babies are often slow in starting when it comes to labor. I tell moms that their muscles know they must practice ahead of time because they’ve never done this before. So even two or three days of prodromal labor is normal. It can come on gently and then stop. Or labor comes on strong and then stops. And tries to start again, only to stop again. The trick is not to worry. (Yeay, right!)

The traditional midwife believes that birth proceeds in a spiral fashion: labor starts, stops, and starts while the baby goes down, up and down, and the cervix opens, closes and opens. Nature has no design for failure; she holds her own meaning for success. 

~ Sher Willis

From the expert, Gail Tully, See http://www.spinningbabies.com

She writes: There are variations in early labor patterns. Early labor is from 0-3 cm dilation by common childbirth education descriptions. Next comes active labor from 4-10 cm, including contractions, or rushes, that come on stronger and more frequently and last longer.

            Prodromal labor is when the uterus contracts somewhat frequently, may be strong or mild, contractions usually aren't occurring with regular intervals, but can keep a woman on alert, can keep a woman awake, and certainly can keep everyone wondering when active labor will establish.

            Typically, primipara (a first time mama – ‘primip’ [PRIME-ip] for short) women are told that labor begins gently; contractions may be 10-20 minutes apart and gradually grow closer and stronger. Once the cervix begins to change, to dilate and thin out, labor is considered to be starting.

            Women may be told that ~

Early labor can stop without it being a matter of concern. In fact, it is often considered

quite normal. Interruptions in location (going from home to hospital, for instance) or people (the nosey neighbor, stressed family member or unfamiliar medical person) walk in or leave (partner, doula, supportive nurse, doctor, or midwife has to leave for some reason or end of shift). These can be thought of as psycho-social reasons for early labor to stop. These reasons are well known and talked about in childbirth classes, for instance.

            Prodromal labor may start with the night and stop with the day. Non-dilating contractions seem more common with approaching storm fronts when the barometric pressure drops. With or without contractions, a woman is considered to be early labor if a woman's waters release (Spontaneous rupture of the membranes, SROM).

            Women aren't usually told that  ~

Early labor can stop when the uterus gets tired after trying to fit the baby into the pelvis.

Which may be because baby isn't engaged yet; often because baby is posterior and, in this case, the head may be deflexed (extended, chin up) and the forehead is resting on the pelvic brim, and not engaged. Early labor with a breech baby can stop/pause when the baby is trying to tilt his or her waist to get the hips into the pelvis. The labor may stop at any point with any fetal position if the baby can't fit further down the pelvis and the uterus gets tired. Rest and food may also help solve any problems.

            
             Hormones increase at the end of pregnancy helping prepare for actual labor. A rhythm of coming on at night is often hormonally related. These "practice" contractions are often called Braxton-Hicks. They can be painless and thought to be the baby moving or "balling up," or they can be quite intense making a woman feel that she will have having the baby that day. The thing is these don't change the cervix. Don't be shy about checking in with your provider. Better safe than... surprised! 

            Labor comes on strong and then stops. And tries to start again, only to stop again.

Sometimes these are simply warm-up or practice contractions as described above. But when they begin in the daylight or after fetal movement, and don't change the cervix, then consider if the baby is 

•  Trying to change position, from posterior to anterior or breech to head down, for instance
•  Successful at changing position (though it may not be the position you hoped for, so check it out)
• Trying to engage in the pelvis

            Zoë* is a very courageous single mother. She called me sometime during the night on Friday. I don’t look at the clock any more when the phone rings. My night is over no matter how much or how little I’ve slept, so I let the adrenaline take over. I am being blessed with being asked to attend yet another miracle. I am grateful and a bit in awe each time, even after 30 years. It is actually the most important event at this moment in the entire universe, and I get to see it! Rather, I look to see whether or not I laid out a clean set of clothes on the chair the night before and that my bag is packed and standing by the door.          

Her contractions were strong enough that she couldn’t sleep but nothing else was going on. Her water had not broken yet. Zoë’s visit with her midwife the day before confirmed that she was starting to dilate a little and was at 1 centimeter. The midwife was concerned that the baby didn’t appear to be very big and may not have grown in the last couple of weeks. She ordered an ultrasound at which the technician guessed the baby was about 6 ½ pounds. She sent her report back to the midwife saying that all looked well in there. There was also some worry that Zoë’s blood pressure was slightly higher than they would like. The midwife had already started talking about inducing her should the blood pressure stay too high, or baby appear to have stopped growing and might do better outside rather than in at this point.

            I told her that it sounded like this might be the night. It was 1 day past her guess date (no longer called a due date because too many pregnancies were being induced when in fact babies weren’t ready to be born and sometimes 1 or even 2 more weeks was needed for this particular baby.)

            I encouraged her to try to sleep, even if she just dozed. I told her that if she slept and the rushes went away then we would know it was just early labor. I said that if they picked up and became more regular or her water broke that then we have the real thing. I also advised her to let her midwife know and to let me know if she wanted her to come in yet. I went back to sleep and didn’t hear anything from Zoë the rest of the night.

            I assumed that things did settle down. I texted her about noon and got a reply that the rushes were still very sporadic but she was visiting friends and walking a lot. Later that night she called asking if she might be seeing the mucus plug, or bloody show, which I confirmed. I told her it was all completely normal and that she should try and nap and to keep eating.

           

 Finally at 10 p.m. Zoë called to report that the rushes were about 5 minutes apart and that she couldn’t keep it together alone at home any more. I suggested she call her midwife and let me know if she would be going to the hospital. I offered to hang out with her at home, too, if she wanted to do that.  She called back within minutes and said they wanted her to come in. She suggested calling me after she got there to see if they really were going to keep her or send her home. A bit later she called again and said she was at 3 centimeters but that her blood pressure was high and they wanted to keep her and monitor that. I was on my way.

            During the night the nurses had her stay in bed hoping the blood pressure would come down. It did for a little while, but then when the rushes got more intense it rose back up. We tried different positions in bed that might help the baby labor down even if she is not able to walk around. Sitting up in bed cross-legged, on all fours or on her knees with her arms resting on the raised head of the bed, or lying down with a peanut ball between her knees all encourages the baby’s descent. 
            Finally she got to 8 centimeters at about dawn. We were able to move to the tub at this point which Zoë said felt wonderful compared to the bed, but even after more than 2 hours, we were still at 8 cm. The midwife suggested breaking her water to help the baby’s head press against the cervix, hopefully encouraging the last 2 cm. There was some meconium in the water, so at the midwife’s insistence, we went back to the bed and the monitor to see if baby was OK. The fetal heart tones were not ideal, so they watched that for a while. The blood pressure was still too high for comfort, but the midwife was quite relaxed and didn’t suggest any interventions yet, which surprised me. Most of the other hospitals I have worked at would be talking about a C-section by now if that had not already happened.           

The shift changed. New nurses fluttered in and out of the room. We were still at an 8. By 8:30 a.m. Zoë had been up two nights and three days and announced that she was done in. She asked for something for pain or something that would let her rest for a while. The nurse called the anesthesia department and set the room up for an epidural. I got Zoë up to the bathroom and suggested she stay there for a bit. It is an ideal position to labor in on a toilet and she felt better being up so we hung out there. When she returned the anesthesiologist ran through his list of dire side effects, had her sign the consent form and then sped through the screening questions. He asked at one point, “normal blood pressure?” and since Zoë was in the middle of a rush, the new nurse answered for her, “Yes.”

            I was surprised and hesitantly added, “Um, NO!” He turned to the nurse who explained that it was high when she came in but it was fine now. I was shocked, knowing that it was higher than any protocol that was in place when I was still a practicing midwife, so I ventured out again and said, “Well, actually, it is not normal. It has not come down. The last one was in the 150s.” The nurse huffed; the doctor looked at her and back at me, quite befuddled. Then he said, “OK, let me see the (monitor) strips then.” He carefully unfolded the strips from the previous night and noted the elevated numbers and announced, “No way!” The nurse looked too and said, “But no one told me!” This obviously got missed at the report at shift change. She should have been alerted but wasn’t. I wasn’t overly upset; I knew we were all part of a team wanting the best for Zoë and we need to look out and cover for each other. So, the doctor ordered a blood test that would tell him if she was indeed pre-eclamptic or where she was at. I knew she wanted some pain relief so I asked him if he could recommend something while we waited for the blood tests to come back, which I knew could be quite a while. He suggested fentanyl which the nurse ran to get. She gave that to Zoë who was still trying to work with the rushes and trying to follow my breathing but was very impatient at this point for some kind of a break.           

          The fentanyl didn’t do anything. Zilch! I had never seen that. It usually helps women relax almost immediately and some people actually feel rather happy or even goofy on it. I tell them that I promise not to repeat anything they say from here on out, since it is known for its somewhat drunk-like-inducing properties. It doesn’t take away the pain, but it does take the edge off for an hour or sometimes two and then can be given again if needed. But we had to work with each rush just like we had been doing. This was a first for me. I didn’t say anything to her, but concentrated on staying connected and reminding her to rest between each one. While we kept on dealing with each rush and then resting the doctor left, the lab people left and the nurses all filed out, leaving us alone.

            I look back and wonder if her full bladder had slowed things at 8 cm. or if just getting up and sitting on the toilet at that particular moment did it, but as soon as the room was cleared (taking with them all the concerns and negative vibes) Zoë announced she wanted to push! I completely trusted her instincts on this one, even though she was only 8 cm. five minutes ago. I suggested just some tiny nudges on the next rush. She tried that and I could see baby’s long black hair. I called the nurse who hit the “COME ALL” button on the wall as soon as she saw it too. Two more pushes and baby was on the bed. Zoë was reaching for her, crying and overcome with joy. Baby’s cord was too short to let her be lifted up to Zoë’s chest, but as soon as it stopped pulsing the midwife cut it and baby was with her mama. She nursed shortly after, without even showing her how. Little Jazelle was 6 pounds 5 ounces, and 19 inches tall -- not overdue at all. No long fingernails  and plenty of vernix, the creamy coating that prevents babies from turning into little prunes from being in the water for the last 9 months. It is a waxy white protective substance covering the skin of a fetus, short for vernix caseosa. Her little ears were still stuck flat against her head, another sign of prematurity, or in this case, not being ‘overdone’. Overdue babies’ ears often stick out and the placenta will also show signs of aging if truly overdue.

              We had worked out a birth plan ahead of time and stipulated that we would like baby with her mom for at least 2 hours after the birth and after that any care would be done on the bed and baby would not be removed to the warmer or nursery. I find that nurses actually like this plan as it gives them more time to pick up the room and not feel the pressure of having to finish every last item on their to-do list before they can leave after that shift. They can simply note in the chart that the mom ‘refused’ all the routine

procedures after birth like weighing, measuring, eye drops, vitamin K shot, etc. It lets the nurse off the hook and the next shift can fit it all in at their convenience instead. So that is what we did. Just hang out and get to know Jazelle. And order Zoë a big breakfast. She wasn’t able to eat during the night – standard procedure for labor and delivery units, especially when they have concerns like meconium or high blood pressure. This puts the mom on a fast track to the possibility of a C-section and you can’t have any food in your stomach for that, so it is pretty common to have to switch to ice chips and water when interventions first appear in the conversation. Needless to say, she was ready for a couple thousand calories, after all, she had just consumed as many calories as she would have running a marathon! We called down an order for just about everything from the breakfast menu which arrived shortly after.

            I finally got ready to go. I packed up the tea lights, massage tools, snack boxes and juice bottles and hugged Zoë goodbye. I whispered in her ear, “You got the natural birth you wanted in spite of everything! I am so very proud of you, sweetheart!” We agreed to get together as soon as she got home for a postpartum visit. Another happy motherbaby couple. We are actually beginning to write 'motherbaby' as one. Stop and think about it: they have been one all these months, and that bonding continuum should be ongoing during the next weeks and months. Our babies are not born mature enough to be without us at all. They are totally helpless, far more vulnerable than any other baby mammal at birth.          

Have you ever wondered why we as humans have such large brains? This one is obvious: we are smarter than any other animal. But our babies are more helpless than other mammals at birth. Have you ever wondered why? Part of the reason is that, yes, we are the most intelligent species, but our babies are born unprepared for survival. Our brains grow so fast before we are born, and into the first year, however, that if they kept growing until the rest of the body caught up and was as mature as, say, a calf is at birth, their heads would be far too large for the birth canal they must pass through. Since our brains are so advanced, they grow faster in the first year than the brains of any other species. If we waited another 4 - 5 months or until they could crawl, to deliver our babies their heads would be too big to fit our frames. So Mother Nature had a toss-up: make mothers’ hips even bigger than what we have now (Horrors!) or have babies born sooner than they are in reality ready for. So, this makes it clear that they are not as mature as other little mammals and do need us constantly, even more than the offspring of other species. Nature knows this. Babies know this. Do we? We don’t act like we know it. Nature knew also, by the way, that baby elephants would not survive if they couldn't walk and keep up with the rest of the herd shortly after birth, and would likewise be eaten if left behind, so elephant mamas are pregnant for 2 years or until baby Babar can walk! And we complain about our 9 months' gestation. (A MUST see: The Dramatic Struggle for Life - Bali, on YouTube)         

         

     It is actually an illusion to imagine that our man- or woman-made time machine should likewise affect our babies, but we in fact do believe this. The truth is our babies are just about as immature at birth as our fore-mother Lucy’s were 3.18 million years ago. Consider Lucy (who currently resides at the Ethiopian National Museum in Addis Ababa, Ethiopia), whose babies had to be carried, and in constant contact with her, 24 hours a day, day and night, for at least 2 years or until they could walk. He (I am just guessing it was a firstborn son) had constant skin-to-skin contact; was in constant proximity for eye contact with his mother or whatever member of the clan his mother was interacting with throughout the day – at an adult’s eye level, incidentally, and not lower as in a crib or stroller where faces suddenly appear to loom above his and just as quickly disappear.  He nursed on demand.  He had no need to cry. A grunt or his reaching for a breast would be enough of a sign. His mother had enough time connected to him that she could already easily ‘read’ any signals coming from him. He listened to his mother interacting with others all day long. We don’t know when she began speaking directly to him, though. Perhaps it began when he spoke first, having listened to adult speech and figured out how it worked.

          We now know that bonding is reciprocal.  Even into the 21^st century, however, we can read some authors who are still considering bonding a mother-led phenomenon, whereas it is actually reciprocal. When a baby searches his mother’s face, he is seeking her gaze in return. If her gaze is not there more times than it is, she has also given him a clear message: this is not how we humans interact, though she gives him no alternative solution. When he reaches out to touch her, he expects his hand will be held or caressed. When he first coos, a rewarding sound from his mother will encourage more early speech. If parents are engaged elsewhere either mentally or literally, while interacting with a cell phone or texting, for example, and those overtures from your baby are ignored, that, too, is a message: he isn’t being answered. Perhaps his voice may not be the best way to communicate after all. He’ll have another try at it first: cry louder, perhaps, to get the needed response. Or do something, anything, to get your attention. Sounds familiar? But back to Lucy. Bonding was the way to survival. Had she put her babies down, they would have been mauled or eaten. And we would not be here today.

           I got home that afternoon to a flurry of activity. A dear friend had called my husband while I was at the hospital in Minneapolis asking us to go to South Dakota as soon as possible as a friend of ours was in intensive care in a coma from spinal meningitis. A young father in his 40s -- we couldn’t imagine what his wife and 15 year old daughter had been going through. We didn’t even know yet if he would make it through this. We packed up, I showered and changed, threw some food in a bag and we left, driving non-stop till we got to Sioux Falls. He had come out of the coma while we were driving, though he was very confused and still critically ill. He turned a corner later that day and has been improving little by little ever since. He is not out of the woods yet or the ICU, but he seems to be mending. We are all so grateful.

          We returned a couple of days later and I could finally visit Zoë. I didn’t recognize Jazelle – I had only seen her while she was still nursing and had not been cleaned up at all yet after the birth. They both looked so good. Zoë had support from her family and friends and was still floating on cloud nine. She could not believe how intense and how incredibly amazing her birth was. With your first you can watch dozens of videos about birth and read all sorts of books but nothing really prepares you for the experience. I told her I knew she could do it and that now she knows too, that she can do anything. It was a very empowering experience for her. She will need that inner strength now to raise her baby girl on her own.

“People usually consider walking on water or in thin air a miracle. But I think the real miracle is not to walk either on water or in thin air, but to walk on earth. Every day we are engaged in a miracle which we don't even recognize: a blue sky, white clouds, green leaves, the black, curious eyes of a child -- our own two eyes. All is a miracle.” 

~ Thich Nhat Hanh

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

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 21^st Century,© pending by Stephanie Sorensen