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Friends & Family At Births

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This post might not be popular with some people, especially if you are a family member or friend who finds they resemble some of these descriptions. However, I work for my doula clients to make sure their birth experience is one they can cherish and this needs to be said:

If your pregnant daughter, friend, niece, granddaughter, cousin (or any imaginable relationship) requests that you not come to the place of birth while she is in labor — respect her wishes.

I can hear the excuses now. But we want to be there. But we want to see baby be born. But we want to be the first in the family to hold the baby. But she is my (insert relation). But the partner is (insert relation). But, but, but.

She said she didn’t want you there. Actually, she probably didn’t say I don’t want you to be there. She probably said something polite and nice like, please respect our privacy. I will be working hard to bring a child into the world. We would like our privacy. We will call you once we want you to come or once baby has arrived. It may take a long time and we don’t want you hovering. Please respect our privacy.

Please listen and respect her wishes. Please know this is an important day and if she has made any attempt to ask you to not intrude on her privacy and concentration, she has thought long and hard about how to convey this to you without hurting your feelings.

Let me tell you what happens in some scenarios when people don’t listen to and respect a laboring woman’s wishes. At worst, you can cause her labor to stall or completely stop or contribute to a dysfunctional labor that can put her at risk for interventions she has been wanting to avoid. This is especially true when a woman is attempting a natural birth, but it can happen even with an epidural for pain relief. On a less serious level you are disrupting her concentration and possibly creating a memory she would rather not have attached to the day her baby and your (insert relation) is born.

Why do I sound so harsh about this? Because after 16 years of being a doula I can tell you I have seen some family members behave in peculiar ways. Yes, I understand you are coming from a place of love and concern but it boils down to people making choices to disrespect what a laboring woman has requested. Here are some scenarios I have witnessed:

  • A laboring woman tells her family she is going to the hospital to be checked out and she will give them an update. Upon her arrival, she finds there is a room full of family eagerly asking private details she may not want to share and interfering with the staff assessments. Her labor stalls or stops and she is sent home, only to return a few hours later and this time to keep it to herself.
  • Despite clear instructions and a sign on the door that the laboring woman does not want visitors, family members continue to come in because they “just have to know what is going on.”
  • Family members falling down and wailing on the hospital floor when they hear a woman requires a cesarean for safety, disrupting the precise and necessary care from the medical providers.
  • Family members physically grabbing me and shaking me for updates.
  • A laboring woman finally getting a break from her labor either via a natural spacing in her contractions or some medicinal pain relief and taking a well deserved and needed nap only to have family members barge in wanting updates even though they had been told she is napping.
  • Family members bringing cheeseburgers and fries into the room of a laboring woman who hasn’t eaten in 12 hours.
  • Family members threatening to sue the staff if the baby isn’t here soon.
  • Family members accosting all staff, doulas, partners, and even the woman if any of them come out of the room and going so far as to be standing in the hallways eavesdropping with their ear against the door.
  • Family members making comments that they have never seen such a large belly, telling her to get an episiotomy, random myths and outdated advice, asking her why she is trying to go natural, telling their own birth horror stories, or one of the worst, saying I just don’t know what I would do if you or the baby died.

Are you thinking this is fabricated? It isn’t. This actually goes beyond a case of bad manners. These sorts of behaviors can be dangerous, especially if there is a medical situation going on. When an emergency cesarean is needed, staff needs to move fast. As a doula, I move out of the way and let them do their job when something becomes medical. Family members falling down in the hallway is hindering the staff and the well-being of mother and child, and possibly even other mothers and children. People expressing their love and projecting their fear by voicing that the process is taking too long or they are bored or that something negative will happen to the mother and baby is not only not helpful, it is harming the process and the persons you profess to love. Showing up at a hospital when you have been asked to wait for instructions is crossing a boundary of respect and can make a woman feel like she needs to hurry up. Speaking of, many family members actually say, can you hurry up and have this baby? I have had women hiding in their bedroom or hospital room and sometimes locking themselves in a bathroom simply to find the privacy she desperately requires.

Each woman is different on how she views the need for privacy during labor. In the early stages of labor, a room full of chatter and excitement may be helpful for some and unhelpful for others. As active labor begins, most women prefer a quiet and private environment. There are times I will step out and allow partners to work privately during labor. There is a reason nurses, midwives, and doctors do not sit and stare at their patients. We know that disruptions are disrupting, it is as simple as that. Childbirth is not glamorous and is usually messy. We have not arrived at a point in our society where it is acceptable or comfortable for women to ooze bodily fluids in front of others. Would you want someone to watch you moving your bowels? No, you would probably try to wait until you had a private moment and birth is much the same. Women need to feel supported and one way to support them is by listening to their wishes. If you have been asked to respect their privacy, please listen.

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As the mother of an adult daughter, I have often wondered how difficult it would be for me to know she is in labor and to have been asked to not participate in or view my grandchild being born. I understand it must be hard. I understand that our society has created much fear about birth. I understand that Hollywood makes it seem that a woman’s water releases/breaks and we have a baby born at the hospital mere minutes after a screeching ambulance races her there.

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That’s not how it works. That’s especially not how it works for first time moms. Average labor time is approximately 15 hours. Average pushing time is 2 hours for first time moms.The placenta may take several minutes or longer to be birthed after the baby.  Unless you live many hours away, there will be time for you to arrive. After a baby is born we want mom, partner, and baby to have a minimum of one hour for bonding and breastfeeding and that is after the clean up, physical assessment of baby and mother, and any repairs. Your loved one just birthed a baby into the world and needs that time to de-escalate and bond with and nurse her baby. You could be notified the moment the baby is born and if you live locally would still have time to be waiting to see the baby.

The baby will not grow 2 heads or horns or grow up and go to college before you get there. I promise. And you might be able to bring that new mama a wonderful favorite meal on your way to visit (don’t forget daddy or partner!).

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If you are anxious, excited, nervous, antsy (and who wouldn’t be) I have a list of suggestions for you.

  • If you are crafty, work on creating something for baby
  • Go grocery shopping or cook freezer meals for the new family
  • Clean their home (with permission of course)
  • Walk their dogs, do any errands they may need
  • Write a letter to your loved one(s) and the new baby arriving
  • Go shopping for last minute essentials or just for fun
  • Assemble any baby items that need assembling (swings, bouncers)
  • Make every attempt to send peaceful and positive thoughts, prayers, and vibes
  • Trust that her request for privacy is in her best interests and what she needs

If you simply must be at the place of birth, find the waiting area and occupy yourself with something and wait for more information. Family members can be a wonderful source of encouragement. I am in no way advocating that family and friends be kept out of the loop or prohibited from being at the birth if the mother wants their support and company. I have seen mothers, sisters, cousins, best friends, brothers, fathers, mother in laws, etc., be a positive and useful source of support and encouragement– but please be invited.

Kimberly Sebeck, AKA Knoxville Doula, 2016

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Important information for every woman, whether you have given birth by cesarean or vaginally, whether you have had no children of many. Hysterectomy is the most common non-obstetrical procedure for women in our country. Approximately 600,000 are performed each year in the U.S. 1 in 9 women will have one. It’s time for us to focus on our pelvic floor health.

August ICAN of Knoxville Meeting — Pelvic Floor Health

Please join us to hear our guest speaker, Autumn Synowiez, OT, speak to us about our pelvic floor health. Whether you are planning to get pregnant, are pregnant, or have birthed your babies in the past — we can all benefit from good pelvic floor health. Those with diastasis recti, perineal repairs, and cesareans will especially benefit from this information.

Meetings are FREE, however we gratefully accept donations for our local 501c Non Profit Chapter. (suggested donation $1-$3)

Partners and children are welcome for most of our meetings. We respectfully ask that if your child is needing a quiet moment that you step out if needed.

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Pelvic Floor Therapy Guest Blog

Please enjoy this guest blog from a Pelvic Floor Therapist in the Knoxville, TN, area.

This does not have to be your current or future experience.

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Hello! My name is Autumn Synowiez and I am a pelvic floor therapist.

A pelvic floor therapist (PFT) can help treat many different types of problems that women have such as:

  • urinary incontinence (it is not normal to wet ourselves)
  • stress incontinence (when we cough, laugh, exercise) or urge incontinence (always feeling a strong urge to go).
  •  pelvic organ prolapse (yes we can reduce prolapse without surgery by two stages!).
  • perineal/episiotomy scars, cesarean scars.
  •  diastasis recti
  • pelvic pain, pressure, dyspaurenia (painful sex)
  • preparing your pelvic floor for birth to reduce these symptoms after birth and help coordinate your pelvic floor for optimal pushing.
  • postpartum check ups to make sure you truly are ready for exercise and have sex again (if not we will set you up with all the exercises needed to get you on the right path, surprisingly most women are not ready for either).

    Countries like France and Sweden have women going after their 6 week postpartum check up with their OB as the norm to make sure women are healing properly after child birth. These countries have much better outcomes for women long term (fewer women suffering from incontinence, pelvic pain, organ prolapse, etc).

    Do you have to have had a baby to need pelvic floor therapy? No! Most of us are unaware of our pelvic floor and how it works with our everyday movement. A lot of women who run, heavy weight train, cross fitters, etc.,  are not coordinating their pelvic floor properly when exercising and actually causing injury and weakness in that area.

    Having chronic pelvis or back pain? No one can fix it? Could be in your pelvic floor! We have success stories of people seeing multiple doctorss and physical therapists with no relief and sometimes after just one visit with PFT they have relief.

    C section only? Yep! Pregnancy alone can weaken your pelvic floor muscles and with your abdominal muscles being cut into, that can lead to an even more weaker pelvic floor and core. They go hand in hand.

    PFT is amazing cutting edge stuff that most women know nothing about. Women in our country have been neglected in this area or are ashamed/embarrassed to talk or look down there! It’s time to change that! You are not alone I can promise you that! There’s a whole set of muscles that are very important that we need to be exercising regardless of our age or whether we have had kids or not. These muscles are our center and help hold our organs in! Can’t wait to discuss more about this soon and offer awesome workshops with Kimberly! Please feel free to ask any questions! I’m sure I left a lot of info out!

    Yours truly-
    Autumn Synowiez OTR/L
    Women’s Health Pelvic Floor Therapist
    asynowiez@gmail.com

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All Rights Reserved, Knoxville Doula, Kimberly Sebeck, 2016

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What Would You Tell Ina May to Include in a Book?

I stumbled across a fabulous podcast with Ina May. The interviewer did not have a natural birth and felt as if there was missing information in Ina May’s books — at first I thought this was going to be simply a critical viewpoint of Ina May.. but it’s not.

If you have ever struggled with disappointment or a feeling of failure because you didn’t have the candle lit, in a birth pool, 100% intervention free birth — please listen to this.

At the end you are given options of how to let Ina May know what you would like included in her current or forthcoming books.

 

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A Glimpse Into Postpartum Work

I have been doing quite a bit of postpartum doula-ing lately. More clients request my birth services but I really enjoy being hired to do postpartum work, too. Sometimes people are not as familiar with what a postpartum doula does, or doesn’t do.

My services are really quite flexible and dependent on what each family needs. Some moms have me come over and basically “pick my brain” about feeding the baby, newborn care, postpartum recovery, infant milestones,  etc., and that consumes the majority of my block of time. I choose to come over to a home for a minimum of 3 hours but it can certainly be longer. Other moms understand how important rest is and feel safe and relaxed enough with me watching over their new baby so they can go take a blissful long nap, with maybe a shower thrown in. Other families want to soak in every second of the newborn period with their baby and I do errands and simple household tasks. I also attend doctor visits like the first pediatrician appointment or a postpartum visit for the new mom.

I don’t do heavy cleaning. It’s far less expensive to hire a housekeeper than a postpartum doula. I do light tasks: loading the dishwasher, laundry, running errands, sterilizing breast pumps and/or bottles, putting together infant gadgets like monitors and swings, making a snack for mom or starting a meal for dinner. Speaking of dinner, I actually love to cook for my families especially if I am going to be there for a good amount of hours for the day. I give them a list of recipes that I am familiar with and good at and let them send me to the store or give them a list of ingredients to pick up. Imagine how good it sounds to have a knowledgeable person come over to answer newborn questions, perform household tasks, and then be able to enjoy my now famous chicken and dumplings or a refreshing summer salad. If the partner has already returned to work they can come home and focus on bonding and family time instead of working all day and then coming home to a list of things to do.

Frequently the question comes up of: what will we do for 3 hours? Once I am there and a mom sees how wonderful and valuable a postpartum doula is they often request more hours in a day. It might seem awkward at first to have someone in your home but that feeling quickly dissipates. I can be the person you confide in when you’re having some “baby blues” or postpartum mood disorders and I have the resources of where to get help. I can be the person who helps you ease into motherhood without any judgment. I can give suggestions about trying to get enough sleep, how to soothe sore nipples, and also dispel some of the misinformation given out by family, friends, and online sites. Having trouble figuring out your K’Tan or Moby? I will help you practice so you feel confident wearing your baby. Those sheets you have been sweating in, bleeding on, and leaking breastmilk into? I can change those out for fresh ones.

I will help you find your way to being the best parent in the manner that suits your lifestyle. One day you will be the one telling me what the baby needs and that is exactly how being a postpartum doula works. I work myself out of a job as you grow into parenthood and recover through the fourth trimester.

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All Rights Reserved, Knoxville Doula, Kimberly Sebeck 2016

www.knoxvilledoula.com

 

 

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A Cautionary Tale for Doulas About Giving Medical Advice

Doulas who attend trainings with a doula organization are taught to not speak against medical provider advice. We are told that we aren’t to get between the clients and the medical providers. Yet, it happens. Usually it’s a very subtle thing, like our client calling us first to ask what to do if her water is broken. The proper response would be to ask their provider, of course, but perhaps we first offer some helpful tips like putting a pad on and seeing if it’s urine or letting them know the smell and color of amniotic fluid. Perhaps their provider suggests a procedure and they call us to get more information about the procedure such as what it is for or if there is an alternative. I like to think that these conversations are about helping the client educate themselves and get evidence based information so as to go back and have an empowering discussion and decision with their provider. What I would choose to do is not relevant and not only do I say that but I encourage the woman to listen to her gut feelings and ask for as much information and clarification as she needs.

Have I seen things that have given me pause? Of course. Have I felt like I would make a different choice at times? Yes. But none of that matters — it is not my birth. I am there to support decisions and facilitate the birth process no matter the circumstances. Now I will tell you about a recent scenario, with some details changed and names left out. Even after 15 years of being a doula, I am always learning.

One morning I receive a text from the client’s husband saying the amniotic fluid is very low and baby needs to be born and an induction is going to happen immediately. I text back and say ok, let me grab my stuff, call me when you can and give me details and how low is the fluid. I am told the level of fluid is an 11.  I won’t go into great detail over what is considered low and the fact that many providers perhaps are a bit overzealous with inductions for low fluid. In my head I thought the level is an 11? That’s not that low — but I correctly assumed that I was missing vital pieces of information. After a little while another text comes that the OB is recommending a cesarean. This really made me pause — why not an induction and trial of labor first? Again, I remind myself that I must be missing information as I know this provider and truly do trust his opinion and judgment and the fact he is called the male midwife in our area. I receive a phone call from the clients and get a little more information as I am driving to the hospital. The fluid was so alarmingly low that the ultrasound technician said there was none and as the OB explained to them that with there being no dilation or effacement of the cervix even past the edd that he was leaning towards a cesarean to safely deliver baby, but it was their choice.

I am confused, I admit it, but I keep it to myself.  My client is being sent straight to the hospital for monitoring and to make her decision about induction or a cesarean that afternoon. I assure them I am on my way and we will sit and discuss all the details so she can make a decision. When I arrive we sit and talk extensively. I ask the client what her gut feeling is. She says to do a cesarean, for a variety of reasons. She cries, we hug, we grieve a bit. Then we sit and discuss what she can expect for a cesarean. She is concerned that she has to wait a few hours but I assure her she is being monitored and if anything adverse happens that she and baby will be well taken care of. We spend the next few hours making sure the father gets all their stuff from home and gets something to eat and just going over things.

When it is time for the cesarean we are all prepped. This OB happily allows doulas or birth photographers in the OR. I have never been in the OR at this hospital with this OB — this is how rarely one of my client’s under his care gets a cesarean. I talk to the father while we are not allowed in for those few moments and keep him company and give him some advice for post cesarean care. We go in and the cesarean begins and I snap photos. Mama looks gorgeous despite the circumstances and I take some photos of her and speak reassuringly to them.

Beautiful baby girl is born in minutes, quickly taken to the warmer, and then given to Daddy for skin to skin. In moments we discover why the cesarean was an excellent decision. The placenta has already previously torn away in a partial abruption. There is virtually no amniotic fluid. An infection is suspected. The OB graciously shows this to me and we nod at each other over our masks. The surgery goes well and baby is given to mama on the way back to the room and we almost immediately initiate breastfeeding.

I stay for a few hours and we discuss what a good decision was made. I know that it’s a whirlwind of activity at this time and I offer to come back the next day to help process and give cesarean care tips. Unfortunately we had a huge snowstorm that night so I speak to them on the phone and come the following day. All is going well. We discuss the partial abruption and later we find out that the amniotic fluid level was not an 11 but instead was declared a 0.

Would it have been possible to have a successful induction? Maybe. Maybe not. No one is concerned about that any more because the decision has been made and it was an empowering and successful birth even if it wasn’t an unmedicated vaginal birth.

I am reminded yet again why we don’t give advice counter to medical advice. Doulas are not OB’s or midwives. We are not even labor and delivery nurses. There had been no symptoms of a partial abruption — no bleeding, no pain, no contractions. There was no fever to indicate an infection. Baby’s heart rate was good on the monitors. The week before the amniotic fluid had been at over a 20 level, then went to virtually none. Sometimes you take the signs, symptoms, and trends and have to make a tough decision.

I am reminded yet again why it’s important to have a birth team that you trust and also for my clients to trust their intuition. As we discussed while she was making the decision — no one could give her a guarantee either way of the best call. You make the best decision you can with the information you have at the time. Hopefully you have an OB like hers who doesn’t unnecessarily frighten or make you feel you don’t have a choice. She had a choice and the risks and benefits of both were clearly outlined. Yes, mother and baby were both fine and healthy but the bonus was that my clients felt empowered in their decision and were supported all the way and their emotional health was considered and supported.

Being a doula is a precious role and one that should stay within the proper scope of practice of non medical advice while offering emotional and physical support.

All Rights Reserved, 2015, Kimberly Sebeck, Knoxville Doula