Sunday, May 24, 2015

Volume 2, Issue 4 - May 2015

Dear CBI Students,

Did you know that May is the Month of the Midwife?  5 May is the International Day of the Midwife aimed at supporting midwifery care around the world and educating the public on the midwifery needs of women world-wide.  If you want to learn more about what is going on with midwifery care, please check out the International Confederation of Midwives page.
Did you celebrate in your community?  I spent the day running around the island attending prenatal appointments with my senior midwife.  We celebrated each other with a hug and a kind word and then got back to work!
Look at this gorgeous preggo belly!
I hope that May has been bringing you many chances for learning and self-reflection.  I was able to attend my first birth as a student midwife and it was pretty incredible!  It's amazing how well a woman can labour when she feels so safe and supported.  I have a few doula births in hospital coming up that I'm trying to wrap my mind around now.  I'm finding it harder and harder to switch back and forth from hospital doula to homebirth midwife.  If you attend births both in homes and in hospital, how do you manage to switch out your mindset and support the women in the different environments?



In April, I attended a client at a hospital birth.  After that birth, it took me a week of self-care to stop having flash-backs to the trauma I witnessed.  My client desired a gentle hypnobirth but chose a care provider that I had never seen support anything other than an active managed birth.  We discussed the doctor's typical way of handling birth many times during our prenatal meetings, and explored the option of other care providers who were more supportive of a gentle birth.  But my client didn't want to change care providers and since her doctor assured her that her desires for birth were fine with her, she assumed that her birth would go the way she planned.  And the labour part (when the doctor was out of the picture) was beautiful!  

Once the doctor entered the room, everything changed.  And just as I feared, the gentle birth quickly turned into a very active managed birth.  I watched the doctor quickly cut an episiotomy without informing the mother and then lie to her and tell her that because she has a really short perineum, she had torn.  I watched her clamp the baby's cord straight away and then hold the cord up and tell the mother that it had stopped pulsing so it was okay to cut.

When the doctor cut the episiotomy and when she clamped the cord and lied to the mother about both things, what was my responsibility as a doula?  Was it my responsibility at the time to yell out "she's cutting you!" or, "she's lying, she cut an episiotomy!" or "she clamped the cord, she's lying!"?  In the moment it is so hard to know what we're meant to do.  

The political situation where I live is such that if I argue with the nurses or doctors I can easily be banned from the hospital.  We have to pass through an interviewing process in order to be able to provide doula services at hospitals.  So, the doulas are put in the precarious position of speaking up and no longer being allowed to support clients, or going along with whatever is done to their clients.

Afterward, my client, unaware of the lies the doctor told her, felt great about her birth.  And for the most part, it was an amazing birth!  And I wanted her to go with that, to focus on that.  But is it right for us as doulas to only focus on the positive?  To skim over the negative parts of the birth, to reframe our client's birth experiences so that they walk away feeling whole and strong?  What would happen if we told them the truth of what occurred to their bodies and their baby's bodies?  Is it our "mandate" as doulas to make a woman regard her birth experience as a positive one?  Sociologists Bari Meltzer Norman and Barbara Katz Rothman are quoted in Jennifer Block's book, Pushed, as stating, 
"the unanswered, fundamental question is whether (doulas) are making birth better for women, or just making women feel better about their births"(Pushed, p. 160).  

How much trauma can we prevent in our prenatal care with women?  In our reflective practice, we are required to address the actions we take which lead to the outcomes we experience.  If our clients are given the information we provide through the WIGWAM guidelines and still choose a care provider who doesn't align with their goals, what can we do?  If you understand what is likely to happen, do you feel right in telling a client that you can't support her if she chooses a certain care provider?  What can you do at a birth to help a client meet her goals while her care provider is not supportive and quick to do the opposite?

Such as the case with my client, often times it is those who are witnesses who end up absorbing the impact of the trauma and not actually our clients.  In Block's book, she states that  "there's no research to date on the secondary psychological effects to birth attendants who witness traumatic births -- partners, doulas, nurses.  But many report similar symptoms, nagging feelings of grief and loss and anger following a traumatic birth.  Ina May Gaskin calls these individuals the 'walking wounded'" (p.147).  When we witness the trauma, either with our client or for our client, we are left with the burden of what we've witnessed.  How do we process the experience?  For me, I have a group of trusted birth professionals that I can share with and receive loving care.  I journal about the experiences.  I find that until I write it out, I carry the heaviness of it around with me.  Writing it out on paper allows me to unpack the trauma a bit.  I focus on eating well, getting a good amount of sleep, and also getting out into nature.  These three things can often re-set my internal compass and help me find my groundings.

When we work with women who do feel the trauma of their birth or immediate postnatal experience, we need to make sure that we are not carrying our experience of the trauma into their stories.  Our experience will be different from theirs and we need to leave our baggage at the door before we enter into their space and listen to their story.  Doing on-going postnatal or breastfeeding work with a woman and/or partner who is processing her traumatic experience can be heavy for the care provider.  It can be hard to continually sit with a family experiencing trauma and not let it overcome you.  This is why it is important that we do work through the trauma.  Deal with the trauma we experience as it comes to us so that we don't bring it into our work space, and so that we don't become so overwhelmed with all the trauma that we can no longer effectively support these women and their families.

The Department of Anesthesiology and the Department of Surgical Intensive Care at Peking University First Hospital, Beijing, China are reporting that epidural anaesthesia during childbirth reduces the risk of postnatal depression.

Dr. Katherine Wisner, a psychiatrist at Northwestern University, Chicago said:
"It's a huge omission that there has been almost nothing in postpartum depression research about pain during labor and delivery and postpartum depression.  Pain control gets the mother off to a good beginning rather than starting off defeated and exhausted."

Read through the article and reflect on the who is doing the research, what type of birth is normal in their community, and how epidurals may help some mothers reduce the risk of postnatal depression.


We are so glad that you have joined us on your journey

  • Sarah D., USA - Postpartum Doula, Breastfeeding Counselor
  • Brandie C., USA - Postpartum Doula, Breastfeeding Counselor
  • Renee C., USA - Birth Doula
  • Bethany P., USA - Birth Doula, Breastfeeding Counselor
  • Kathryn B., USA - Birth Doula, Postpartum Doula
  • Jenny B., USA - Birth Doula

We wish you much love and success in your endeavors

  • Maggie E., USA - Certified Postpartum Doula
  • Andria P., Canada - Certified Postpartum Doula
  • Cathee J., Hong Kong - Certified Postpartum Doula

Saturday, April 18, 2015

Volume 2, Issue 3 - April 2015

Dear CBI Students,

What has been inspiring you lately?  As I wrap up my second term in my first year of midwifery school, I am finding that I need a lot of inspiration to motivate me to keep working toward my goals.  One of my inspirations to continue this work is seeing the world-wide caesarean statistics.  Did you know that April is caesarean awareness month?  What is the rate of caesareans where you live?  Do you feel that that rate is an accurate portrayal of how many women in your community need a caesarean?  What do you feel is driving the rate either up or down in your area?

As birth doulas, how can you help prevent caesareans, and how can you support a client through a surgical birth?  As postpartum doulas, what are some special techniques you might employ to help your caesarean-recovery clients?  As breastfeeding counselors, what are some of the effects a caesarean birth can have on the breastfeeding relationship, and how might you help that relationship?

The work you are doing makes a difference!  Studies show that continuous labour support significantly reduces the rate of caesarean delivery.  Women state that postpartum doulas significantly improve their post-cesarean emotional and physical recovery process.  Studies show that when women are supported in their breastfeeding attempts post-caesarean, they have long-term breastfeeding rates on par with their vaginal birth counterparts.  See how much difference this support makes?  Keep up the amazing work, birth workers!


 One of the biggest reasons I hear women become doulas is so that they can advocate for their clients.  Perhaps you had a beautiful birth experience and you hope to help other women experience the same thing you did.  Perhaps you had a rough birth experience and hope to save women from the same.  Either way, often times it's big feelings that drive women into this profession.  
While the idea of speaking up for our clients or empowering our clients is common in doulas as they start out, I would love to see you grow into a better understanding of your role in your client's experience.  The bulk of advocacy as a doula is best done in the prenatal time as you use your active listening skills to hear what your client really desires for her birth.  It is done as you help her explore her options and help her gather information on her choices.  Advocacy is walking a client through situations and practicing with her to enable her to speak up herself and use her voice. Advocacy is asking her in the labour room if she feels she has all of the information she needs to make a decision.

In the Communication Skills manual, it states that "enabling clients to make choices on their own is empowering and teaches them a skill that they can use in the future in many other situations.  Although it is tempting to want to 'guide' the process, this draws power away from the client -- it is the opposite of empowerment!" (pg. 75).

Megan Hendrickson, in her final communications paper, wrote so eloquently how CBI sees our work in advocacy and empowerment, I feel I need to share it with all of you:
"I no longer see it as my responsibility to empower women - but instead to help encourage them to find their own power that they've had all along.  I don't view myself as an advocate for my client - but rather as a support and reminder to advocate for herself.  I don't want to find myself in a position of authority or to be viewed as a hero - I want to serve women as they find authority within themselves and come out of their births inspired by their own strength and heroism and confident in their bodies and themselves." 
  In the visual above you see two people holding up another person who is speaking.  Where do you see the doula in that pyramid.  Is she on the bottom supporting the client as she speaks, or is she using the client as a stepping stool to voice her opinions?

In February, the Royal College of Obstetricians and Gynaecologists (RCOG), in collaboration with the International Federation of Gynecology and Obstetrics (FIGO) and the World Health Organization (WHO) published a paper in support of delayed cord clamping at birth.
"The National Institute for Health and Care Excellence (NICE) recommends that for healthy women at term the cord is not clamped in the first 60 seconds and that it should be clamped before five minutes, although women should be supported if they wish this to be delayed further."
To read what they've found to be the benefits and risks of cord clamping, read here.


We are so glad that you have joined us on your journey

  • Jennifer G., Arizona, USA - Birth Doula, Postpartum Doula, Breastfeeding Counselor
  • Hannah R., Victoria, AUS - Birth Doula
  • Elanor D., NSW, AUS - Birth Doula
  • Marlee M., California, USA - Birth Doula, Postpartum Doula, Breastfeeding Counselor
  • Charla G., South Carolina, USA - Postpartum Doula
  • Lucie K., California, USA - Birth Doula
  • Radhika P., Ontario, Canada - Postpartum Doula, Breastfeeding Counselor
  • Rachael B., California, USA - Birth Doula

We wish you much love and success in your endeavors

  • Heather B., Louisiana, USA - Certified Birth Doula
  • Paige D., California, USA - Certified Birth Doula
  • Cathee J., Hong Kong - Certified Birth Doula

Sunday, March 22, 2015

Volume 2, Issue 2 - March 2015

Dear CBI Students,

Happy March to you!  This month I was able to travel home to the States for a week and a half.  As much as I would like to say it was for pleasure, it was purely for school purposes.  Though I was able to see my parents and one of my brothers, it was hard to only be able to spend three days total with them, and the majority of my time at a conference center in Utah.
One of the things I did in Utah was attend Karen Strange's Integrated Resuscitation of the Newborn.  If any of you ever get the chance to attend one of Karen's workshops, I would highly recommend it!  This was the second time I've attended one of her classes, and I always walk away feeling more grounded and more determined to advocate for the unborn and newborn.  One thing that really stuck with me from her workshop was the idea that our personalities are formed in utero more than any other time in our lives, and that babies not only gestate in a mother's emotions, but *marinate* in them.  I went from this workshop to spending a day with my own mom and her sharing her experience of her pregancy with me.  These two events together were incredibly eye-opening to helping me understand parts of my personality that I've always questioned.  And to be able to forgive myself and my mom for things we couldn't control.
Now, how I can apply this knowledge to the mothers I work with, this will be tricky!

Karen Strange explaining the transition a baby goes through at birth


Communication Paper

As the largest assignment tasked to all CBI students, and the cornerstone to the CBI philosophy, writing your communication paper can seem a daunting task to many.  Different students approach this assignment differently.  Some like to tackle it straight away, and get it out of the way.  Others tend to put it off while they mull over their topic and focus on other assignments at first.

This assignment is the topic of the majority of the emails I receive from students, so I'm writing this to cover some of the most common questions and concerns.

First, it is important to understand that written communication will likely be a large part of your initial contact with potential clients.  Being able to address their questions and answer in a precise and professional way will lay the foundation of a potential client's first impression of you and whether they want to pursue a relationship.  Therefore, working on your written communication skills is important.  Please, carefully read through the instructions.  They are quite exact and answer many of the questions I receive.  Verifying information is understandable, but asking a question that is clearly specified in the instructions often indicates that a student hasn't taken the time to thoroughly read through them.  Think about if you asked a client for information they just presented to you.  How might they feel about your response?

Second, I always recommend that, before you begin writing your draft, you do some pre-writing and write out a narrative of the birth or other even on which you're reflecting.  This allows you to first tell your story.  From there, you can then start pulling and picking the story apart and separate the descriptive parts from the feelings, from the actions and learning.

Read the sample paper.  It is an excellent resource and a great way to get a feel for how the paper should be constructed with content, word count and flow.

What should you expect from the feedback?  Every paper turned in will receive detailed feedback.  You can expect 2-3 pages of feedback on your draft.  Do not lament over the amount of feedback as it is intended to help you deepen your reflective skills, rather than state any inefficiencies.

In The News:

I'm sure you've all heard of the latest breastfeeding study that came out of the Federal University of Pelotas, Brazil that states that babies who are breastfed for a year are more intelligent, educated and wealthier at age thirty than those who are breastfed for less than a month.

Because this has to do with breastfeeding and intelligence, it will, and already has, spark controversy.  What do you think?  Do you think the results have to do with breastfeeding, or with socio-economic status?  With breastfeeding, or the attachment of mothers and babies?  What are your thoughts on this topic?

Welcome New Students!
Welcome to all of our recently enrolled students from around the world:

  • Erica C., USA: Birth and Postpartum Doula
  • Stefanie M., Germany: Birth and Postpartum Doula, Breastfeeding Counselor
  • Paige D., USA: Birth Doula
  • Eleni Z., Australia: Birth Doula
  • Shawn K., Guatemala: Birth Doula
  • Joti P., France: Birth Doula
  • Nicole S., USA: Birth Doula
  • Tiffani N., USA: Birth and Postpartum Doula
  • Mandy J., USA: Birth Doula
  • Lorraine H., USA: Birth and Postpartum Doula, Breastfeeding Counselor
  • Andrea Z., USA: Birth and Postpartum Doula, Breastfeeding Counselor
  • Teena H., USA: Birth Doula, Breastfeeding Counselor
  • Shereen Z., Dubai: Birth Doula
  • Lisa S., USA: Birth Doula
  • Jennifer P., USA: Birth Doula
  • Camille C., USA: Birth and Postpartum Doula, Breastfeeding Counselor
  • Caro L., Australia: Postpartum Doula

Congratulations Graduates!
Congratulations to all of our recent graduates and we wish you luck as you pursue your passion.

  • Rekha, India: Birth Doula
  • Donna K., USA: Postpartum Doula
  • Katherine D., USA: Postpartum Doula
  • Natascha O., South Korea: Birth doula
  • Grace V., Canada: Birth Doula
  • Megan H., USA: Birth Doula
  • Kim M., USA: Postpartum Doula

Wednesday, February 18, 2015

Volume 2, Issue 1 - February 2015

Dear Students,

Gong Xi Fa Cai!!

In Singapore, celebrations are in full swing this month as we celebrate the lunar new year and welcome in the Year of the Goat.

My youngest and her schoolmate on a field trip to Chinatown
January was a super busy month for my family and I didn't get a chance to send out a new year newsletter, so I'm trying for the Chinese New Year date instead!  Along with some traveling, starting a new school term for three of my kids and myself and starting a new school year for my oldest, falling into new schedules and attending births, I'm starting to wonder if life will ever slow down, or will I just get used to this new "normal"?  Because the Chinese traditionally believe that those who are born in the Year of the Goat tend to be unlucky, perhaps the babies will slow down this year?  With my calendar already filled through August, it seems very unlikely!

I wish you all a happy and prosperous new year and look forward to hearing about your struggles and successes as you continue your journey toward certification.


Bringing Diversity Understanding to Your Practice
One thing that I'd like to address for my students is the idea of cultural diversity. CBI students come from all over the world and live in areas with practices that may not be fully familiar with everyone.  Even within our own countries there is great diversity in cultures and beliefs and it is important that you start your work with, not only an understanding of the diversity in your community, but with an understanding of to whom you are marketing yourself.  

The work we do is intimate, in the homes of our clients, and interacting often with their families.  It is so important that we know best how to work with our clients and how to show respect.  I encourage you to look into your community.  Who are the majority, and what other communities are present?  How are those in the margins being cared for?  Are you representing them in your marketing and your communication?  Who might you be leaving out?  How can you reach out to those under-served or underrepresented in your community?  You may not be the right doula for every one in your community.  You do not need to work with every client who seeks you out, nor do you need to seek out every women in your community who is pregnant.  But, it is the important act of a mature doula to know the community at large, to know the resources available, and be able to point women in the right direction.

In The News
I'm sure you all have heard by now the news that the National Institute for Health and Care Excellence (NICE) said home births and midwife-led centres were better for mothers and often as safe for babies.  While this is excellent news for the advancement of natural births in the U.K., it also has implications world-wide.  As more countries normalize out-of-hospital and midwife-attended births, the rest of the world starts to take notice and question their own practices.

In early February, the American Congress of Obstetrics and Gynecology (ACOG) along with Society for Maternal and Fetal Medicine (SMFM) released a joint statement that identified Certified Midwives, Certified Professional Midwives and Licensed Midwives as appropriate health care providers, in addition to those health care providers which they had previously recognized, for low risk women in out of hospital facilities. 

What do these statements mean to the women giving birth where you live?