I Failed – I got an Epidural (um, no you didn’t, Mama!)

To all of those women out there who are upset with themselves for choosing an epidural, let’s get something straight – YOU CREATED, GREW AND BIRTHED A BABY!!! You, just like every new mother, are a ROCKSTAR! Whether a baby was born medicated, unmedicated or via cesarean, that simple fact remains the same. You rock! Celebrate your awesomeness and rockstar status!

First off, not every new mama wants to go unmedicated. Some mamas want an epidural as soon as possible. That is absolutely fine. For many others, however, the desire for an unmedicated birth is deep. (Please notice I didn’t say “natural birth.” I view all births as natural, therefore I choose to use the “medicated” and “unmedicated” adjectives.) The reasons for this deep desire to go unmedicated are varied. Some women want the empowerment of the experience while others are just “anti-drugs.” Whatever the reason, this choice is usually accompanied by a strong sense of purpose, determination and “will.”

Having that strong desire and preference is wonderful, as long as she remembers how uncertain labor and delivery can be. As a birth doula I like to encourage my clients to have a “tool box” with them during labor. (This concept of a “tool box” was taught to me by my teacher, and friend, Jacqueline Starkey, and I use it with her blessing.) An epidural is one tool in the tool box. Many laboring women want to try other tools before considering pulling the epidural out of the “box.” Some other tools to help get through the pain associated with labor are massage, counter pressure, focused breathing, position changes, a tub or shower, etc. Sometimes, though, those tools are simply not enough. If a labor is extremely long and mama is exhausted, other tools, like an epidural, may be desired or required. That is perfectly okay!! It saddens me to have women judge themselves harshly if they “give in” and have an epidural. It isn’t giving in, it’s choosing a different tool. Listen, even cesarean surgery is in the tool box should the provider feel it is medically necessary that the baby be born that way. Let’s be glad different tools exist as not every baby wants to make its entrance into the world the same way.

While preparing for the birth of your baby, make a birth plan. This is a written plan of how you would like things to go during labor, if you could write the script. Share that plan with your partner, doula and medical providers. All I suggest is that you bring along the tool box of options, so that you can go with the flow of uncertainties that may present themselves. Be knowledgeable about the tools so you can make a well-informed decision regarding their use. Ask questions so that you are part of the decision-making process. These steps, hopefully, will leave you feeling more positive about your birth experience no matter if it differs from your plan.

So, please, no mom-guilt or self-judgement. Remember, you rock!

What Does Mindfulness Have to do With Maternity?

I love the name of my business. It came to me naturally when I made the decision to become a professional birth worker in the roles of doula and childbirth educator. After studying mindfulness for several years and having a personal mindfulness meditation practice, I thought it would be a great idea to combine my two loves, meditation and all things pregnancy, birth and baby, together. That was the conception of Mindful Maternity Birth Services. However, let’s get back to the original question…what does one have to do with the other?

Let us step back and define what mindfulness is in the first place. In its most basic form mindfulness can be defined as the opposite of mindlessness, or “autopilot.” How often have you driven to work, for example, and then realized, upon arrival, that you didn’t even remember the drive? Or, maybe you are an avid TV watcher or Facebook user who goes through the motions of answering your child’s questions, but can’t really remember what they were talking about or wanted from you. These are small missed moments of your life. Does that sound dramatic? It should!!

Jon Kabat-Zinn, the creator of Mindfulness-based Stress Reduction (MBSR), defines mindfulness as “paying attention on purpose and nonjudgmentally, to the unfolding of experience moment to moment.” For some, that means simply stopping, noticing their inhales and exhales, feeling the warmth of the sun on their skin or even feeling their bottom in a chair and their feet on the ground. It sounds simple enough, but it actually takes practice. One’s mind may start to wander, which may frustrate the new meditator. That’s ok. Remember, Kabat-Zinn said “nonjudgmentally”- don’t judge what’s happening. Simply acknowledge the thoughts and then try focusing on feeling your breath again. It is an activity that really doesn’t have a “wrong way” or a “right way”, so you don’t need to carry any performance anxiety into mediation with you. Just sit and BE. It will take some practice, but eventually you will feel your inhales and exhales get longer, and relaxation will settle in your body. No “body” can benefit more from mindful meditation than the pregnant woman’s body. Let’s look at this more closely.

From the moment a woman finds out she is pregnant, her mind races with visions of her child’s future; in her mind’s eye, she envisions her baby’s milestones, successes, and mulls over fears for its future.  Her thoughts then come back to wondering the sex of the baby, what the name will be, what her family will think, when she will look pregnant, to worrying about the pain of labor and pushing a baby out. She wonders- is she even ready to be a mom in the first place?! You get the picture. Her mind, and her body, need to slow down so that she can enjoy the next 9 months and so that her body is relaxed and ready to do the work it needs to do. I think part of my job as a birth doula is to remind a mama and her partner to stop, relax, visualize their baby and their birth, feel all of the little (and big) things that are happening within her body, and to find a sweet contentment with the stage of pregnancy she is at and not rush through the months of preparation.

As Elisha Goldstein, PhD, co-founder of The Center for Mindful Living in West Los Angeles, said in an interview, putting focus on “the little things is where life happens.” I would hate for a mother to look back and say, “I don’t remember much of my pregnancy.” Even more important than living in the moment and being present during pregnancy, mindful meditation brings many health benefits to both mom and baby!

1. According to Brainwave Institute UK, endorphin levels are elevated during meditation. Endorphins are the pain-relieving and pleasure-enhancing hormones that you want as elevated a possible during pregnancy and labor.

2. Meditation also increases DHEA levels. DHEA is another hormone in our body that, when at optimal levels, helps prevent depression and keeps the stress-related hormone, Cortisol, at lower levels.

3. Meditation can also lower your heart rate and blood pressure. As deep relaxation through meditation takes place, stress levels decrease.

4. I saved the best for last! Quiet mindfulness enhances the connection between a mother and her baby. This is a beautiful opportunity to spend time visualizing your baby surrounded by love.

As if those benefits weren’t enough of a reason to practice meditation, research has also shown that all of those above-mentioned benefits can lower cesarean rates and lower use of epidurals in laboring women. It is a win-win!! Meditation is a free gift that I encourage all pregnant women to practice. If you practice consistently, and with honest effort, over time you will see its benefits. It is subtle yet powerful.

So, my bottom-line advice to all pregnant women? Hire a doula and meditate!! (Oh, and don’t forget to take a childbirth education class!)

Kathryn Malloy, CD(DONA), LCCE
Mindful Maternity Birth Services

What Does a Doula Do? – A Brief Overview

There is much evidence to support the idea that having a doula alongside a laboring woman, and her partner, is valuable and beneficial to the entire birth process. One aspect of having a doula that is not discussed at length in many publications is the fundamental simplicity and beauty of a woman helping another woman. It cannot be overlooked that more women need to hold space for other women in general. In our culture we seem to be moving away from generational connections between women. No place is this need of support more crucial than during the labor and birth process. As birth is the most intense experience a woman will experience, both physically and mentally, another woman beside her offering continuous emotional and physical comfort, will only serve that birthing mother in the most positive of ways.

Evidence shows that birthing mothers are more likely to have spontaneous vaginal births, have shorter labors and less medical interventions when a doula is present. As a continuous support, and, specifically, one who is knowledgeable about labor and delivery, a doula can suggest various comfort measures to allow a woman to endure the powerful surges of contractions and delivery. These comfort measures include, but are not limited to, position changes, breathing techniques, counter pressure and massage techniques, relaxation strategies and, when available, a warm shower or tub. The utilization of all, or one, of these measures often allow a woman to manage the pain associated with labor and, therefore, reduce the likelihood of an epidural. Long-term studies show that one medical intervention often leads to other interventions. Many women would like to try to avoid this string of events, if possible. It is important to note, however, that if a woman does choose an epidural, a doula will help ensure that she is fully informed and comfortable with her decision. A doula’s main goal is to ensure that a woman feels empowered, informed and a part of all decisions made in regard to her labor, especially when medical interventions are suggested or insisted upon by the medical team. (Obviously if an emergency situation emerges, the doctors may not have time to explain things in detail. The health of the mother and baby are everyone’s immediate concern.)

Most often, doulas visit a client and her partner, in their home, during the last trimester of the pregnancy. During these prenatal visits, the clients and doula get to know each other and develop a relationship. This ensures a sense of comfort for the couple (and the doula) at the birth. The home visits enable the doula to get to know the couple and what they want their birthing experience to look like if all went their way. A doula’s job is to meet the client and her partner where they are. Their job is not to judge or push their personal beliefs on them. This is their experience. The prenatal visits are also the place where the doula explains her role and scope of practice. It is made clear that a doula doesn’t offer medical services of any kind. It is always recommended the couple defer to their medical provider for specific questions regarding her pregnancy. What a doula does offer, however, is an overview of what to expect, suggestions of different comfort measures (as discussed above), help in writing a birth plan, suggestions of questions to ask their provider regarding interventions, etc. While a doula should never speak to the provider on behalf of the client, she can remind the client of her birth plan and ask her if she has any questions to ensure she is fully informed prior to any action taken by the medical provider.

Some couples worry that a doula will take away some of the experience for the partner. The doula is not there to take anything away, but, rather to support their relationship and work in conjunction with them as a team. Partners are encouraged to get involved as much as they are comfortable. A doula will assess how she will interact with the couple as she observes how they interact with each other. Partners often find comfort in having a knowledgeable and calm person along for the long ride of labor (even if hesitant to start with). A doula honors their relationship and what this birth experience means for both of them.

Labor and delivery is an experience one cannot fully predict. It can be a combination of thrilling, joyous, scary, painful, wonderful, and everything in between. One “constant “ a couple can count on is a doula. She will join them on the crazy ride of labor and be alongside them from beginning to end. This, in turn, creates a calm presence and continuity for the couple, which can allow them, hopefully, to greet their new baby with joy no matter how rocky the road was to get there. The goal for the doula is to have the couple have positive memories of the birth experience that will last a lifetime. This sort of positive experience not only affects that particular family, but, in a larger sense, society as a whole. Doulas simply hope to make each birth story a little bit sweeter, while, for themselves, having the honor to witness new life entering the world.

An Open Letter to my Certifying Birth Families

I want to take this opportunity to thank you for giving me the honor of serving you during the labor and birth of your sweet babies. Your trust in me as a new doula means so much to me. What I hope you did not realize was exactly how nervous I was!! I wanted to do my best for you as I know how significant the birth of a child is. It became all about you, and not about me, when labor actually started. It was no longer about achieving certification, but, rather, the deep desire to help you have a positive and satisfying birth experience.

To my very first client, you were a rockstar. This was your first child and your labor went so quickly. You labored very internally that it was hard to distinguish the difference between you being simply uncomfortable to you being ready for an epidural. Your direct stare and use of our pre-arranged code word (to know she meant business about the epidural) taught me a lot about differences in pain tolerance and expression. Seeing your boy born was the first time I witnessed a child coming into the world. What an absolute honor it was to be there. I was emotional as it was at that VERY moment I knew I was finally doing (at age 52) what I was meant to be doing. Thank you for allowing me to be part of your birth story.

To my mama whose labor was so quick that both your husband and I literally got to the hospital just in time to see you push your little man out. All I can say is, “WOW.” No, I couldn’t use your birth toward certification (as you labored overnight in the hospital and didn’t even call your husband, let alone me!). The joy I felt for you knowing that this birth was so dramatically different than your first (which you describe as “traumatic”) was overwhelming. I had nothing to do with making this birth more positive, but, it warmed my heart to see you birth him like a champion. It was all that mattered. My heart was full.

To my sweet cesarean mom, what a ride you endured! Your high risk status and experience with loss, made your pregnancy and delivery a delicate balance between hope and worry. You were so strong. I admire how you gracefully went month to month determined to birth this child. Even when a potential VBAC was changed to a scheduled cesarean, you maintained composure. Thank you for allowing to be the one to help ease your fears and calm your nerves. No, your birth didn’t count toward certification, as I wasn’t in the operating room, but you delivered a healthy boy. After what you had been through, could anything else matter? Absolutely not! Thank you for letting me join you on your birth journey.

To my sweet VBAC mama, I connected with you right away. I felt confident you were a great candidate for a successful VBAC based on the circumstances of your first birth. While there is never a guarantee of a birth going as planned, you labored and stayed focused on achieving your goal. We worked as a team to welcome your little girl into the world. There were hugs all around! Thank you for allowing me to part of your family for a little while.

To the new mama that came to me the very same day I found out I needed another birth for certification, thank you! I honestly feel like I was meant to know you. I felt like our meeting was a divine appointment. Your sweet nature and gentle spirit made you the right client at the right time. Hopefully you saw our new relationship as a win-win like I did. The confidence in your ability to birth your baby unmedicated, was the perfect way to approach labor. Maintaining a positive attitude can be difficult when hearing an OB mention the word “induction” before you were even 40 weeks along (with no medical indication one was necessary). I am glad I was able to help you see that the odds were your baby would let you know exactly when she was ready to meet you. You labored beautifully and delivered your sweet girl without an epidural. You knew what you wanted and you achieved it. I was so proud of you. Your birth, by the way, was my first unmedicated delivery. Thank you for the opportunity to be with you as you became a mom!

Finally, a note to the dads. Thank you, also, for trusting me enough to allow me to be a part of a very intimate moment in the life of a family. Thank you for allowing me to be part of the team that welcomed your children into the world. Your “thank you hugs” were often stronger than the moms’ hugs as if to say, “thank goodness you were here.” I took notice of that and treasure each of those moments.

Now I am officially a Certified Doula with DONA thanks to all of you. May your lives be full of joy (and sleep) as you raise your little ones into amazing people. As always, I am here if you need anything.

Love, Kathryn

“If a doula were a drug, it would be unethical not to use it.” John H. Kennell, MD

“Birth is not only about making babies. Birth is about making mothers–strong, competent, capable mothers who trust themselves and know their inner strength.” Barbara Katz Rothman