Doula Skills

“If a doula were a drug, it would be unethical not to use it.” – Dr J. H. Kennell

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 Doulas

It is well known in the birthing community that doulas are a unique and vital part of the
birth team. Evidence clearly shows that having a doula decreases a woman's chances of
experiencing complications - making pregnancy, birth and the first weeks with her newborn
easier.

“In spite of all the modern obstetrical methods to speed up labour – which include the
artificial rupture of membranes, augmentation of the strength of contractions with oxytocin,
and the use of forceps or delivery by caesarean section – the mothers with the shortest
labour in our study were again those women who had a doula present throughout their
labour.” - Mothering the Mother

There is such value in having a trained doula as part of a woman's birth journey. Studies
consistently demonstrate very impressive benefits for the mother and baby, including:

 a reduction in caesarean section by 50%

 a reduction in forceps use by 40%
 a reduction in epidural requests by 60%
 a reduction in the use of synthetic oxytocin for inductions or augmentation of labour
by 40%
 a reduction in the use of pain medication by 30%
 a reduction in the duration of labour by 25%
 increased rates of breastfeeding at 6 weeks postpartum
 decreased rates of postnatal depression and anxiety at 6 weeks postpartum

“I couldn't and wouldn't practice obstetrics today without doulas. They give me the
confidence of knowing the labouring mother is not frightened or alone and is always in the
capable hands of a professional doula. The quality and continuity of care should not be
regarded as a ‘fringe benefit,’ ‘an extra,’ but as an essential and irreplaceable part of the
birthing experience.” Harlan Ellis, M.D. quoted in Special Women by Polly Perez

6 weeks after birth, mothers who had doulas were:

 Less anxious and depressed, experiencing higher self esteem

 More confident with their baby and their ability to cope
 More satisfied with their partner
 More likely to be breastfeeding easily
 Experiencing improved mother/baby bonding and wellbeing

“The evidence for doulas comes from more than eleven carefully designed studies: Quite
simply, hiring one cuts in half the odds of you having an unnecessary caesarean…In the
typical birthing unit, the doula you bring with you may be the only person whose sole
responsibility is to make you more comfortable and to help you labour as effectively as
possible.” - Ina May Gaskin

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 Philosophy & History of Doula Care

Doula care, like birth, cannot be scripted. It should be organic in nature; free to flow with
the changing needs and desires of the birthing woman. An experienced doula is able to
respond to the unique needs and desires of each woman and each birth using her intuition,
training and knowledge of the birth process, and ability to identify the birthing woman's
philosophy and emotional needs, both spoken and silent.

"Birth is a rite of passage of women. Their journey should be honoured, their rights should
be fiercely protected, and their stories should be shared. " - Marcie Macari

“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

“Doulas are self-effacing. They become as steady as a rock if the client needs physical
support and then melt away into the background when the woman has no need of them.
For the doula, the woman takes ‘centre stage’ and the doula is the prop, or the resting
place, attuned to the woman’s needs, ready to serve.

Doulas are energised by the process of labour because they are women who are drawn to
the birth process and because of this they never seem to tire. I think Doulas are natural to
birth. I’m sure a great many ordinary women have felt drawn to supporting birthing women
since the beginnings of humanity… these are doulas – but when the focus of birth went into
the hospital system these women were no longer able to offer their support.

I truly believe that the work of a doula is a vocation that many women have. I also believe
that the doula is essential to birth.

Part of the problem with the medicalisation of childbirth was the weakening of the role of
the midwife. However, a bigger problem was the divorce of ordinary women from helping
each other during the birth process. This created generations of childbirth disabled
women… women who had never been near a birthing woman and who feared the process
of childbirth, women who still believe they need medical interventions for birthing their
babies.

The doula is the ordinary woman who is reclaiming her place besides other ordinary women
who are birthing their babies. It is true – she now has the advantage of undertaking training
to gain insight and skills, but she remains an ordinary woman.

For me the proof for the need of the doula lies with birthing women if they find them
invaluable at their births then they will continue to ask for them. And this, they do.”

*This article was written by Dr. Chris Vose (doctor, midwife, and doula), who has been a
midwife for over 20 years and is also trained as a teacher.

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Throughout human history women have always helped other women give birth. Virtually all
non-industrialised, hunter-gathering, and agricultural societies offered, and still offer
mothers the continuous support of other women during labour and birth.

As childbirth moved from home to hospital, however, this vital ingredient in childbirth
began to disappear.

While efforts to involve fathers and introduce other humane practices into hospital births
have done much to improve this situation, an important link remains missing.

Although the introduction of fathers into the birth room brought the couple together at this
momentous time, this practice tended to reduce the sensitive and experienced care of the
obstetric nurse during labour.

Childbirth tended to become lonelier and more psychologically stressful for parents. More
recently, concerns have been raised about rising rates of caesarean sections and the highly
technological and impersonal nature of childbirth.

These trends have led us, together with colleagues, to study the effects of restoring the
women helpers in the childbirth experience.

Our research has now demonstrated that continuous labour support from an experienced
labour companion can be dramatically beneficial. In studies of over 16,000 women
comparing outcomes with and without such support, we have seen a major reduction in the
length of labour, a greater than 50% drop in caesarean sections, a remarkable drop in the
mothers’ need for pain medication, and several other important and measurable benefits.

This continuous support is provided by caring, experienced women we call ‘doulas’.

*Excerpt from ‘The Doula Book’ by Marshall & Phyllis Klaus & John Kennell

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 Holding the Space: A Doula's Best Gift
by Pam England, CNM, MA

Once, there was a hospital midwife in Albuquerque who earned a favourable reputation
among parents for her unusual form of labour support: she sat in the corner of the room
and knitted. Initially I anticipated mothers would feel the knitting-midwife was not really
present to them, but in fact, every mother I spoke with said she was comforted by the
midwife knitting. One mother recalled her experience:

"I would finish a contraction, open my eyes and look to see her knitting in the corner. That
let me know everything was fine, I was fine, and I could do it. In fact, it was when she got up
to do medical checks, I began to wonder a little bit if something could be wrong—so long as
she was knitting, I knew nature and I were still on course."

This kind of presence in labour non-verbally communicates a felt-message of trust in the

mother and the process; this is known as "holding the space."

When I was pregnant the second time, what I wanted most from my doula was her
unhurried presence. I asked Janie, my doula, to do three things:

• To wear boots to "kick ass" on my behalf, if that was what was needed;
• To make a chocolate cake from scratch; and
• To “hold the trusting space” whilst being patiently present.

In labour, Janie arrived wearing her cowgirl boots. She made the chocolate cake from
scratch. She "held the space" for me to do whatever I needed to do. She didn't do or say
that much. I was contained by her calm presence and unconditional support for me.

From Janie I learned the power of a doula's presence. And her gift to me is the gift I try to
give other labouring mothers – and the mindset I want to pass on to new doulas.

As a teacher of doulas, I am searching for words to describe what genuine labour support
means. Sometimes it is silent; it may be expressed in a firm voice, a smile, through teaching,
or a skilful, timely intervention.

Whatever its form, genuine support comes from a positive-intention to ‘hold the space for
the mother’ in the belief that she is, moment-by-moment discovering how to birth.

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 Social Conditioning

“Social conditioning is the process of training individuals in society to have certain beliefs,
behaviours, desires and emotional reactions, which are approved by society in general or by
certain groups within it.”

Manifestations of social conditioning are vast, but they are generally categorized as social
patterns and social structures including nationalism, education, employment,
entertainment, popular culture, spirituality, and family life. The social structure in which an
individual finds him or herself influences and can determine their social actions and
responses. Parents, teachers, family, friends, co-workers, peer groups, books, media,
advertisements, radio, and leaders of any sort, all mould and influence us in terms of what is
normal/abnormal, right/wrong, acceptable/unacceptable. Some implicit social conditioning
directives include:

 Go along with the majority (the herd)

 Don’t stand out from the herd
 Don’t challenge or rock the boat
 Don’t question ‘authority’
 Go along, get along – or face ostracization
 Best be quiet and blend in
 Believe what you’re told by your leaders and media
 Who are you to question anything?

How might social conditioning impact women’s beliefs and approaches to pregnancy,
birth, breastfeeding, and motherhood?

Some examples of how social conditioning can affect our fears.

A classic example of social conditioning is mysophobia – the fear of germs. This was an
unknown disorder before the advertising profession started marketing disinfectants and
bleaches etc. The message contained in the adverts was so strong that in some cases the
viewers became irrational about the consequences of invisible germs.

Behaviourists argue that phobias develop as a result of inappropriate learning, primarily

with children being subjected to various fears by their parents being role models. This type
of learning can be very powerful and even unconscious. Small children are very receptive to
emotional states in adults and respond very strongly if they see a parent react in a terrified
manner at the sight of a spider or mouse. This can have a very deep impact on a child and
can result deep-rooted phobias later in life. Role modelling was seen to be a very sensitive
stage of development for children, and in most cases this was based on imitation rather
than understanding (Bandura & Walters 1963; Mead 1934).

A further example of learned phobia was the experiment by Watson and Rayner (1920) with
“Little Albert” which involved systematically terrifying the nine-month-old child by striking a

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steel bar every time he played with a white rat. Very quickly the child would show every sign
of fear of the rat, crying and attempting to crawl away from the animal. For all intents and
purposes, Albert had been trained into a full-scale phobia, which then went on to be
generalised to similar objects, like a furry white rabbit.

Core Beliefs

Core beliefs are developed throughout our early lives. They impact us from many avenues
and some are established very early in our existence.

When we come to be with other people, there are many things that get in the way of us
being able to be fully present.

These core beliefs will bring feelings up for you in your personal life and as a doula. They are
better known as triggers or patterns.

Working with birth is an extraordinarily powerful self-reflection tool and gives us the
opportunity to challenge our core beliefs and realise what makes us ‘tick’.

Acceptance of these triggers and knowing how they affect you is an important part of this
course. It is a huge task for most, but one that must be worked on if we are to whole-
heartedly support women in birth, remembering that it is THEIR experience, not OURS!

The following is an exercise to help you to examine some of your core beliefs regarding
childbirth.

Give each a score between 1 & 5 – and then go through your answers and ask yourself the
question, ‘why’?

1 = you completely agree & 5 = you completely disagree.

o Giving birth is generally a completely natural process that needs little intervention.
o Giving birth is generally a risky process that needs to be monitored closely.
o An Obstetrician is the safest caregiver to choose when giving birth.
o Midwives are caring, respectful, trustworthy, and supportive people.
o Women should give birth in hospital.
o Women are more than able to give birth at home safely.
o Birthing women should always listen to their caregivers and do as they are told.
o I would be completely comfortable to have a homebirth.
o I would be completely comfortable to have a hospital birth.
o Interventions are often used unnecessarily although they have their place.
o Interventions should be used on most women as a prevention method rather than
waiting until when a problem is eventuating.
o Healthcare professionals always have birthing women’s best interests at heart and
that of their babies.

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 Effective Communication

Effective communication helps us better understand a person or situation and enables us to

resolve differences, build trust and respect, and create environments where creative ideas,
problem solving, affection, and caring can flourish. As simple as communication seems,
much of what we try to communicate to others—and what others try to communicate to us
—gets misunderstood, which can cause conflict and frustration in personal and professional
relationships. By learning these effective communication skills, you can better connect with
those around you.

What is effective communication?

In the information age, we have to send, receive, and process huge numbers of messages
every day. But effective communication is about more than just exchanging information; it's
also about understanding the emotion behind the information. Effective communication can
improve relationships by deepening your connections to others and improving teamwork,
decision-making, and problem solving. It enables you to communicate even negative or
difficult messages without creating conflict or destroying trust. Effective communication
combines a set of skills including nonverbal communication, attentive listening, the ability to
manage stress in the moment, and the capacity to recognise and understand your own
emotions and those of the person you’re communicating with.

Effective communication skills #1: Listening

Listening is one of the most important aspects of effective communication. Successful

listening means not just understanding the words or the information being communicated,
but also understanding how the speaker feels about what they’re communicating.

Effective listening can:

 Make the speaker feel heard and understood, which can help build a stronger,
deeper connection between you.
 Create an environment where everyone feels safe to express ideas, opinions, and
feelings, or plan and problem solve in creative ways.
 Save time by helping clarify information, avoid conflicts and misunderstandings.
 Relieve negative emotions. When emotions are running high, if the speaker feels
that he or she has been truly heard, it can help to calm them down, relieve negative
feelings, and allow for real understanding or problem solving to begin.

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Tips for effective listening

If your goal is to fully understand and connect with the other person, listening effectively
will often come naturally. If it doesn’t, you can remember the following tips. The more you
practice them, the more satisfying and rewarding your interactions with others will become.

 Focus fully on the speaker, his or her body language, and other nonverbal cues. If
you’re daydreaming, checking text messages, or doodling, you’re almost certain to
miss nonverbal cues in the conversation. If you find it hard to concentrate on some
speakers, try repeating their words over in your head—it’ll reinforce their message
and help you stay focused.
 Avoid interrupting or trying to redirect the conversation to your concerns, by saying
something like, “If you think that’s bad, let me tell you what happened to me.”
Listening is not the same as waiting for your turn to talk. You can’t concentrate on
what someone’s saying if you’re forming what you’re going to say next. Often, the
speaker can read your facial expressions and know that your mind’s elsewhere.
 Avoid seeming judgmental. In order to communicate effectively with someone, you
don’t have to like them or agree with their ideas, values, or opinions. However, you
do need to set aside your judgment and withhold blame and criticism in order to
fully understand a person. The most difficult communication, when successfully
executed, can lead to the most unlikely and profound connection with someone.
 Show your interest in what’s being said. Nod occasionally, smile at the person, and
make sure your posture is open and inviting. Encourage the speaker to continue with
small verbal comments like “yes” or “uh huh.”

Effective communication skills #2: Nonverbal communication

When we communicate things that we care about, we do so mainly using nonverbal signals.
Wordless communication, or body language, includes facial expressions, body movement
and gestures, eye contact, posture, the tone of your voice, and even your muscle tension
and breathing. The way you look, listen, move, and react to another person tells them more
about how you’re feeling than words alone ever can.

Developing the ability to understand and use nonverbal communication can help you
connect with others, express what you really mean, navigate challenging situations, and
build better relationships.

 You can enhance effective communication by using open body language—arms

uncrossed, standing with an open stance or sitting on the edge of your seat, and
maintaining eye contact with the person you’re talking to.
 You can also use body language to emphasise or enhance your verbal message—
patting someone on the back while complimenting them on their success, for
example, or placing your hand over your heart when you are communicating a
genuine heartfelt message.

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Tips for improving how to deliver nonverbal communication

 Use nonverbal signals that match up with your words. Nonverbal communication
should reinforce what is being said, not contradict it. If you say one thing, but your
body language says something else, your listener will likely feel you’re being
dishonest. For example, you can’t say “yes” while shaking your head no.
 Adjust your nonverbal signals according to the context. The tone of your voice, for
example, should be different when you’re addressing a child than when you’re
addressing a group of adults. Similarly, take into account the emotional state and
background of the person you’re interacting with.
 Use body language to convey positive feelings even when you're not actually
experiencing them. If you’re nervous about a situation—a job interview, important
presentation, or first date, for example—you can use positive body language to
signal confidence, even though you’re not feeling it. Instead of tentatively entering a
room with your head down, eyes averted, and sliding into a chair, try standing tall
with your shoulders back, smiling and maintaining eye contact. It will make you feel
more self-confident and help to put the other person at ease.

Effective communication skills #3: Managing stress

In small doses, stress can help you perform under pressure. However, when stress becomes
constant and overwhelming, it can hamper effective communication by disrupting your
capacity to think clearly and creatively, and act appropriately. When you’re stressed, you’re
more likely to misread other people, send confusing or off-putting nonverbal signals, and
lapse into unhealthy knee-jerk patterns of behaviour.

How many times have you felt stressed during a disagreement with your spouse, kids, boss,
friends, and then said or done something you later regretted? If you can quickly relieve
stress and return to a calm state, you’ll not only avoid such regrets, but in many cases, you’ll
also help to calm the other person as well. It’s only when you’re in a calm, relaxed state that
you'll be able to know whether the situation requires a response, or whether the other
person’s signals indicate it would be better to remain silent.

Quick stress relief for effective communication

When stress strikes, you can’t always temper it by taking time out. By learning to quickly
reduce stress in the moment, though, you can safely face any strong emotions you’re
experiencing, regulate your feelings, and behave appropriately. When you know how to
maintain a relaxed, energised state of awareness - even when something upsetting happens
- you can remain emotionally available and engaged.

To deal with stress during communication:

 Recognize when you’re becoming stressed. Your body will let you know if you’re
stressed as you communicate. Are your muscles or your stomach tight and/or sore?
Are your hands clenched? Is your breath shallow? Are you "forgetting" to breathe?

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  Take a moment to calm down before deciding to continue a conversation or
postpone it.
 Bring your senses to the rescue and quickly manage stress by taking a few deep
breaths, clenching, and relaxing muscles, and saying a prayer (dua) that calms you,
for example. The best way to relieve stress rapidly and reliably is through the senses:
sight, sound, touch, taste, and smell. But each person responds differently to sensory
input, so you need to find things that are soothing to you.
 Look for humour in the situation. When used appropriately, humour is a great way
to relieve stress when communicating. When you or those around you start taking
things too seriously, find a way to lighten the mood by sharing a joke or amusing
story.

Effective communication skills #4: Emotional awareness

Learn to recognise & accept your emotions

Emotions play a key role in the way we communicate. It’s the way you feel, more than the
way you think, that motivates you to communicate or to make decisions. The way you react
to emotionally driven, nonverbal cues affects both how you understand other people and
how they understand you. If you are out of touch with your feelings, and don’t understand
how you feel or why you feel that way, you’ll have a tough time communicating with others.
This can result in frustration, misunderstandings, and conflict.

Emotional awareness provides you the tools needed for understanding both yourself and
other people, and the real messages they are communicating to you. Although knowing
your own feelings may seem simple, many people ignore or try to sedate strong emotions
like anger, sadness, and fear. But your ability to communicate depends on being connected
to these feelings. If you’re afraid of strong emotions or if you insist on communicating only
on a rational level, it will impair your ability to fully understand others, creatively problem
solve, resolve conflicts, or build an understanding connection with someone.

How emotional awareness can improve effective communication

Emotional awareness—the consciousness of your moment-to-moment emotional

experience—and the ability to manage all your feelings appropriately is the basis for
effective communication.

Emotional awareness helps you:

 Understand and empathise with what is troubling other people

 Understand yourself, including what’s really troubling you and what you really want
 Stay motivated to understand and empathise with the person you’re interacting
with, even if you don’t agree
 Communicate clearly and effectively, even when delivering negative messages
 Build strong, trusting, and rewarding relationships, think creatively, solve problems,
and resolve conflicts

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Effective communication requires both thinking and feeling

When emotional awareness is strongly developed, you’ll know what you’re feeling without
having to think about it—and you’ll be able to use these emotional cues to understand what
someone is really communicating to you and act accordingly. The goal of effective
communication is to find a healthy balance between your intellect and your emotions,
between thinking and feeling.

Emotional awareness is a skill you can learn

Emotional awareness is a skill that, with patience and practice, can be learned at any time of
life. You can develop emotional awareness by learning how to get in touch with difficult
emotions and manage uncomfortable feelings, including anger, sadness, fear, disgust,
surprise, and joy. When you know how to do this, you can remain in control of your
emotions and behaviour, even in very challenging situations, and communicate more clearly
and effectively.

Questions for Mothers & their Care Providers

BRAND! Remember this word.

 What are the benefits of what you are suggesting?

 What are the risks of what you are suggesting?
 What are the alternatives we can consider?
 Does it need to be done now?
 May I have some time to make a decision?

Tips for doulas communicating with care providers:

 Ask their name, introduce yourself and address/refer to them by their name
thereafter.
 Encourage the building of the relationship between your client and the caregiver, by
initiating a conversation with the permission of your client – mentioning your client’s
wishes/concerns and ask the care provider how they would suggest you can work
together to help her achieve/avoid what you have mentioned.
 Thank them – by name.
 Smile 
 Use indirect reminders when situations/suggested interventions arise, while
reassuring your client. E.g. “Anna understands that you are hoping to avoid an
induction and she is very supportive, let’s ask her what other suggestions she might
have and what your options are.” “Dr. Sing understands the importance of
immediate skin to skin with your baby and knows that is your main concern in this
situation; let’s ask him how he is going to make sure that happens for you.”
 Be calm, frank, and honest. This is especially useful if you are facing any hostility.

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 Understanding what kind of birth is desired – Understanding the best course of action to
best achieve this desired birth – offering complete support thereafter.

After receiving brief information on birth and birth related options, find out what kind of
birth the woman wants.

o What is most important to her?

o What are her birth priorities?
o How does she feel about her birthplace & options?
o How does she feel about her support people & care providers?
o What are her previous experiences?
o Does she have any fears?
o How does she feel about going post-due date?
o How does she feel about induction of labour?
o How does she feel about pain relief?
o How does she feel about interventions?
o How does she feel about caesarean section?
o How does she feel about antibiotics?
o How does she feel about breastfeeding?

Depending on the kind of birth desired, we can provide relevant information and
suggestions, so women can make informed decisions that are right for them.

Consider your thoughts in relation to these examples:

o A woman desiring a natural, drug-free intervention free birth with a strong

intention to breastfeed exclusively is thinking of hiring a private obstetrician in a
private hospital.
o A woman desires a natural birth, is open to drugs for pain relief, however wants
to avoid interventions at all costs.
o A woman is open to induction and drugs for pain relief, would like to avoid too
many interventions, however she is adamant that wants to breastfeed
successfully and exclusively.
o A woman is having a scheduled caesarean; her main concern is bonding with her
baby and is determined to breastfeed successfully.

With each woman and each situation – we need to meet them where they are at. Some
need more information and support on aspects of birth in comparison to others. It all
depends and so we must treat each woman and her birth wishes individually.

It’s important for doulas to understand it is not always easy to help a woman achieve
her desired birth wishes when they have been coupled with choices that conflict with
the desired outcomes. However, the most important aspect of a positive birth
experience is the woman feeling she had choice, was treated with kindness and
respect, and was supported in her choices.

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 Antenatal Birth Classes

Why are antenatal birth classes so important?

It’s not that women need to be taught how to give birth, because women's bodies are
designed to birth babies, and for the most part, women birth their babies without any
help from anyone else. Yet these classes are important ... vital, even. This is because all
pregnancies and births involve choice.

And to exercise our choices responsibly, we need to have knowledge.

It is that simple.

If we do not know what choices we have, we do not have any.

If we are aware of our choices but lack any information about the implications of each
path, we may not make responsible choices that lead to a healthy positive birth.

We have choices around care providers, place of birth, testing in pregnancy,

interventions in birth, type of birth, methods of feeding a baby, postnatal care issues
and early parenting choices.

Labour and birth and early parenting are not the times to be learning new information
for the very first time: these are times in our lives when we are not in a state to take in
new information and assimilate it. This learning is best done in pregnancy, so during the
time we labour, birth and mother our baby, we are already aware of our options and our
preferred choice.

Independent childbirth education classes cover more than basic hospital classes. They
will teach everything from late in pregnancy to labour, birth and caring for your new
baby. They will provide all of the content of hospital-based classes and much more:
more time, more resources and more attention.

Women who have attended prenatal birth classes usually come away feeling relaxed and
calm, confident and knowledgeable. The classes help enormously with birth planning,
preparing for birth and motherhood, and with choices and decision-making.

List birth education classes available in your community:

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 Books on Childbirth – An Excellent Resource for Mothers

Well-Adjusted Babies by Jennifer Barham Floreani

Give Birth Like a Feminist by Milli Hill

Mindful Birthing by Nancy Bardacke

Birth with Confidence by Rhea Dempsey

Birth Journeys

Ina May’s Guide to Childbirth by Ina May Gaskin

Birthing from Within by Pam England

Gentle Birth, Gentle Mothering by Sarah J Buckley

Childbirth without Fear by Grantly Dick-Read

The Wonder Weeks Book by Frans X. Plooij and Hetty van de Rijt.

Please add some books to this list!

Following is an example of one of the exercises used in the ‘Mindful Birthing’ book to
help mothers learn to deal with the sensation of pain.

Get a towel, a bowl of ice, a stopwatch, and a cushion to sit on the floor.

To begin, get someone to time you. Pick up the ice, and for one minute, hold it in your
hand. Feel free to complain, whine, and express whatever thoughts come to your mind.
This is the first part of the exercise. After one minute, drop the ice, and feel the relief.

Second time around, pick up the ice in the other hand and hold it for one minute. This
time focus on your breath and focus on the sensations you are experiencing. Do not try
to resist the sensations, instead move into it, and try to move past the hurdle of
resistance into acceptance. Drop the ice after one minute and reflect on the difference
between the two experiences.

What did you notice?

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 Your Fear Clearing Worksheet

Use these questions for each of your fears. Note down your answers on a separate paper.

Name Your Fear:

What would you do if this worry or fear happened to you and your baby?

What do you imagine your support people /care providers would do/say if this happened?

What would it mean about you (as a mother) if this happened to you or your baby?

How have you faced crisis in the past?

What, if anything, can you do to prepare for, or even prevent, what you are worrying
about?

What’s keeping you from doing it?

Write out several steps you can take to prevent it:

If there’s nothing you can do to prevent it, how would you like to handle the situation?

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 Debriefing Births

“The transformation that takes place when a woman becomes a mother is one of the
greatest changes that can take place in her life. The journey from the maiden to the mother
is one that touches us, emotionally, physically, psychologically, and spiritually. All that
shaped us before is now given over to the total surrender of the caregiver and the needs of
a helpless baby.

The shock that many women experience as they venture into motherhood for the first time
can have an enormous impact on their relationship with their spouse, their family, and their
baby. Many women comment that what they experienced at their birth was 'unexpected',
'traumatic' and 'not how they had planned', which leaves them asking many questions and
often feeling unresolved about their birth experience.

In today's age of highly interventionist birthing, many women are feeling residual trauma,
pain, and emotional scarring from their birth experience.

Birth de-briefing for women offers the opportunity for a greater understanding of what
happened at the birth, along with the opportunity for the story to be heard and counselled
with a woman that understands the birthing world and the impact of unmet expectations.”

Important Points:

 ALL births should be debriefed – most women do this instinctively, retelling their
birth story many times to process it. Debriefing with a birth professional ensures the
woman will begin to process her experience with a better understanding of what
happened/didn’t happen and why.
 Doulas should first debrief their OWN birth experiences.
 All births that have been attended MUST be debriefed with another doula – this
includes births you may not have physically attended that had an emotional
tie/effect on you.
 The most important question to ask is ‘How do you feel about the birth experience?’
 You may use the following questions as a guide or devise your own questions to
prompt.

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 Birth Debriefing Guide

o What did you love about your birth experience?

o What happened that you expected or ‘planned for’?

o What happened that was unexpected or ‘unplanned for’?

o What was the hardest thing emotionally during the birth?

o What was the hardest thing physically during the birth?

o Hindsight is a wonderful thing! Is there anything you would do differently if you were
to have another baby?

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 Doula Debriefing Guide

o What did you love about the birth?

o What happened that was expected or ‘planned for’?

o What happened that was unexpected or ‘unplanned for’?

o What did you find to be the most challenging?

o What did you do to deal with it?

o What did you learn?

o Hindsight is a wonderful thing! Is there anything you would have done differently?

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 Courtesy of the Mama Birth Blog – mamabirth.blogspot.com.au

Natural Birth Isn’t a Big Deal

Seriously folks, natural birth ISN'T THAT BIG OF A DEAL.

Sounds silly, dumb, even self-damaging coming from a gal who makes money teaching
people HOW to have this natural birth. But in the end, it is simply TRUE. Natural birth is
something that almost all women are perfectly capable of in almost all situations.

Yes, having a natural birth in a negative or unsupported environment can be very difficult.
(This is why your choice of birth place is SO important.)

Yes, you should take a birth class to "learn" how to give birth. (Really you are simply RE-
LEARNING what you always knew but have forgotten from years of listening to negativity,
misinformation, and fear. You are re-creating what once was common women's wisdom
about their innate power and ability.)

Yes, birth can be hard, overwhelming, and even the big P, "PAINFUL". (Maybe we need to
re-think what exactly the word "pain" means when it comes to life and birth.)

Yes, giving birth naturally can be triumphant, empowering, awesome and a VERY big deal to
the woman who accomplishes it. (It was for me and millions of others, in fact, I believe that
birth is divinely designed to be transcendent.)

Yes, all the above may be true, but still I insist that natural birth is not that big of a deal. It is
something you can do.

Your body as a woman was designed to give birth. Your spinal cord was designed to allow
you to FEEL your labour. Your legs exist so that you can walk, move, and sway.

Your contractions naturally come in brief spurts or waves. Rarely will they last longer than a
minute. Even if you had days of labour if you added up all the time that was spent having
just the contractions, it would amount to merely hours. You can do anything for a mere
minute. Very little of even a hard or long labour is spent in "pain" or enduring contractions.

Your uterus contracts and squeezes to move your baby down and out and to prepare you
mentally and physically for a monumental arrival. Your uterus does not do this simply to
punish you or overwhelm you. It serves a unique purpose and accomplishes it well.

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We fear the unpredictability of labour. How long will it be? When will it start? What will it
be like? Why should I experience this? But all these unknowns serve to prepare us for the
task of motherhood and the patience, humility, flexibility, and grace it requires.

"But the pain, how do I handle the pain?" women ask. Pain, though something we often
fear is not in fact deadly. Sometimes things that kill us can cause pain. Labour and birth
however are not meant to kill us. Their purpose is quite the opposite- birth exists to bring
life, not take it. Maybe you don't want to feel your labour, but you are perfectly capable
experiencing it. The sensations of labour exist to prepare us, not hurt us. You may be
surprised the confidence that can be gained by doing something you didn't think you were
capable of. In fact, sometimes the hardest labours teach us the most about ourselves and
what we are capable of.

"Will it hurt? Can I handle it?" we ask as we contemplate the coming birth. The answer is a
resounding, "YES." Yes, you can do it. Yes, you can handle it. You were made for this.

Your baby's birth will be a big deal to you no matter how you experience it. It is awe
inspiring and larger than life.

Birth though is also every day, common, possible, normal, natural, and no more than you
are capable of. It is the way women have been giving birth for a millennium.

In this way it is true. Natural birth isn't a big deal. You don't need to fear it. It is not bigger
than you or stronger than you. Birth is simply a very normal part of life.

Despite all the hoopla and studies and classes and worries that surround modern childbirth,
let's never forget one thing: birth is not a big deal. I fear we have become so caught up in
the how and the why and the techniques and the knowledge that we have forgotten the
simple truth; Birth is normal.

So, what do you think of this article? Please share a few words expressing your thoughts!

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This article was written by a
Christian - may Allah guide her to
Islam - I have altered it to better
suit Muslims.

In this day and age, childbearing is

often considered a thing to be
feared. There is this overarching
anxiety that we won’t be able to
manage the pain of it all. We fear
the baby being too large, or too
small. We fear losing control. My
desire here is to stop this train of
thought that birthing is a thing to
fear, encourage us to step back, and
reflect on the beauty of the birthing
process.

Childbirth is certainly work. But like

any work, it is doable. Allah’s Mercy
is extended to sustain us through it.
What we often overlook is the fact
that birth is a beautiful process, as we embrace the work and strive to get through the
labour in hope of receiving forgiveness and purification. He has created the female body to
be able to give birth. We were designed to give birth. This is what you were created to do!
Allah has specially designed this child, conceived in your womb, to be born into this world.

Please note, there can certainly be a place for interventions as it may not go as naturally as
desired, but ultimately if our heart is trusting in Rabbil Alameen, it will be a beautiful
experience, and should not be a thing to be feared. If you had a rough first experience, may I
inform you that - Allah knows best, and is capable of covering your past experiences, you
can try again, and you should trust Allah's divine plans with whatever the results.

Understanding the purpose of pain is essential for being able to conquer fear in our hearts.

Increases Endorphins = pain management: “Pain, by its very nature, is a call to action…Pain
has a physiological purpose in childbirth. The increasing intensity of the pain or discomfort
increases your body’s production of endorphins. Endorphins are natural opiates that are
responsible for ‘runners high’. They are also produced during sexual intimacy. Endorphins
are at peak levels near the end of the labor helping you manage the pain of the
contractions.”

Increases prolactin = breastfeeding success: “What is even more amazing is the endorphins
your body is producing in response to the pain of labor are preparing your body to care for

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your child. The high endorphin levels cause your body to increase prolactin levels. Prolactin
is a hormone necessary to breastfeed.”

Pain = movement = proper alignment: “Another important reason for discomfort or pain
during labour is the way you naturally move your body in response to pain. It is very difficult
to hold still while in pain, which works just perfectly for labour since movement is necessary
for your baby to properly align in your pelvis. Without proper alignment, either you or your
baby could suffer damage. Pain serves as a method of protection against a bad birth
position.”

Pain = Tawwakul: It is a beautiful process for a woman to see this pain as a means of helping
her refocus her attention on her Creator, who is her Provider and Source of Strength.
Therefore, focusing on remembrance and prayer during labour are appropriate responses to
the process. I believe this is all a part of the purifying process of childbirth. This does not
mean a perfect pain-free labour, but rather the ability to embrace your faith as your
strength.

Peace is letting go of control, and letting your Creator lead you through… Only Allah knows
to what extent you will need to work during labour. You may give birth painlessly, or you
may struggle through many challenges. You are only in control of how you respond to these
challenges. It is how you handle yourself, where you turn for strength, which is important.
Allah will give you the strength to manage whatever labour suits He has decreed for you.

Tips for Decreasing Pain:

 Keep your bladder empty.

 Stay upright during labor.
 Keep moving! Changing positions regularly.
 Learn as much about labour as possible. Understand the process and the way your
body works.
 Choose n birthing environment where you are comfortable, safe, and relaxed.
 Choose only people to surround you that you are comfortable with. Don’t be afraid
to say “no” to all the in-laws.
 Learn simple relaxation techniques: visualization, listening to Quran/Nasheeds,
relaxing each muscle in your body, deep breathing, and hydrotherapy. Practice these
frequently before labour begins.
 Keep your vocalization in labour low and deep. When we scream or yell in high
pitched tones, this tightens the uterus. When we groan, we allow the cervix to open
and relax.
 Let go of fear. The more fear you have the more pain you will experience. Don’t hide
it. Acknowledge it and turn to Allah to help you with it.

Responding to Fear

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It is important to first acknowledge your fear. We all have them. It is naturally a part of
being human. But the important thing is to acknowledge and address your specific fears
prior to labour. Labour is controlled by your sub-conscious mind, not your conscious mind.
Fear in labour produces excess amounts of stress hormones in our body that can lock up
your muscles and limit the supply of oxygen to your uterus and baby.

Don’t worry about anything; instead, pray about everything. Tell your Creator what you
need and thank Him for all He has done. Then you will experience His Mercy, which exceeds
anything we can understand.

One of the true blessings of labour is that Allah designed it to progress naturally and slowly
(in most cases, as some births do go extremely fast). It takes days to weeks to go through
the process (not all of it we are aware of!). Contractions gradually increase in duration and
intensity rather than all at once. And we are given total breaks of pain-free times in between
contractions. These points of rest, though short, help you to breath, relax, and take in fresh
oxygen and energy, all of which are essential for you and your baby’s health and wellbeing.

Focus on the new precious life that will soon be entering your arms. Focus on the beauty of
new life that is being birthed from your womb. Treasure that moment.

When we let go and allow our body to flow with the contractions, we experience a unique
empowerment that is hard to describe. When we focus our minds on embracing the pain,
the pain somehow becomes less severe. When we get up, move, and allow our body to flow
with the contractions, we embrace the design of our bodies.

The 3 R’s in Childbirth Preparation:

Relaxation, Rhythm and Ritual
By Penny Simkin, PT

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The 3 R’s approach to childbirth preparation is a simplified approach based on observations
of labouring women and how they cope with pain and stress in labour. Some cope well;
others are overwhelmed in labour. There are three characteristics common to women who
cope well:

1. They are able to relax during and/or between contractions. In early labour
relaxation during contractions is a realistic and desirable goal; later in labour,
however, many women cope much better if they don’t try to relax during
contractions. They feel better if they move or vocalize during the
contractions, or even tense parts of their bodies. It is vital, however, that
they relax or be calm between contractions;
2. The use of rhythm characterizes their coping style;
3. They find and use rituals, that is, the repeated use of personally meaningful
rhythmic activities with every contraction.

While women draw heavily on the coping measures they learned in childbirth class, those
who cope well usually do more than that; they discover their own rituals spontaneously in
active labour. If disturbed in their ritual or prevented from doing the things they have found
to be helpful, labouring women may become upset and stressed.

Women are most likely to find their own coping style when they feel safe and supported
and are free from restrictions on their mobility and their vocal sounds and are also free from
disturbances to their concentration, such as other people talking to them or doing
procedures on them during contractions.

Watch: https://www.youtube.com/watch?v=Mo4VmgpHmxs

Reflect on your births or the births you have supported. Do you recognise the three ‘R’s?

Waiting to Inhale: How to Unhurry the Moment of Birth – Mary Esther

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I am a mother of two children and am now expecting my third child. Both of my sons were
born into the hands of midwives and passed directly to me. I will never forget those crazy,
slippery, stunning moments in which I first held each of my sons. At the time, I couldn’t have
imagined wanting to meet my children in any other way. And while I fully honour and
appreciate the victory and beauty of the quick delivery of my babies onto my chest, I am
now thinking rather differently about this typical midwife-passes-to-mom moment as I
prepare to birth another baby in the coming months.

As a woman who supports other women in labour now—a doula—I have been witnessing
something lately that has given me pause. And literally it is a pause, a birth pause, if you will.
I have been deeply affected by what I have been seeing with a simple shift that allows a
baby and its mother to find their own way to each other, unhurried, through the moment of
birth and the minutes and hours following.

I first observed this pause at a home birth last year in the Bronx, where I helped first-time
parents Laura, 30, and Neil, 35, work through a rather zippy labour. Neil’s eight brothers and
sisters had all been born at home in Ireland, and home birth had made immediate sense to
Laura when I raised it as an option months earlier as she mapped out elaborate plans to
arrive at the hospital as late as humanly possible.

But now, after 5 or so hours of strong, active labour on a cold, January morning, Laura’s
contractions changed, and it was clear that she was pushing. She climbed out of the birth
pool and soon she was pushing, hanging off the edge of a table, and even walking up and
down stairs. Finally, Laura birthed her baby on her living room floor. She was on all fours,
kneeling in the warmth of a brilliant, winter sunlight. Valeriana Pasqua-Masback, her
midwife, and Neil crouched behind her to catch the baby. I knelt in front of her, her arms
wrapped around my thighs, her camera in my hands.

Laura pushes on all fours as her husband and midwife prepare to catch the baby.

As I photographed the moment Riley was born, I realized I was capturing something I’d
never seen before. What I witnessed would forever change the way I view birth. After Neil
and Valeriana caught the baby, Valeriana did not hand the baby directly to Laura. Instead,
she passed the baby through Laura’s legs and laid the baby on soft pads covering the floor
below her. As Valeriana guided the baby onto the pads, Laura’s eyes were still closed and
her head lowered as her whole body seemed to sigh from the effort she’d just made to birth
her baby. For an impossibly long breath, she paused and hung her head even lower in a
gesture that spoke to a deep exhaustion.

Neil came up close behind Laura. She opened her eyes and quietly sat back on her heels.
Together they knelt above their baby, studying their child below. Time passed slowly. They
stared down at their daughter, mesmerized, taking in this new being. Laura turned toward
Neil and kissed him. She then reached out to touch her newly born child. She felt her baby’s
hands and then slowly touched her baby’s legs and arms. She stroked her baby’s sides and
then wrapped her hands around her child’s body.

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Carefully, but with a clear confidence and readiness, she brought her daughter up to her
chest, embracing her for the first time. As I observed Laura, I thought that each move
seemed to have its own kind of integrity: She took a moment to pause and catch her breath
after the momentous effort she had just made to birth her baby; she then studied her
daughter visually and reached out for that exquisite first touch. Finally, she gathered her
daughter in. Within the space of these impossibly slow, sweet moments that added up to
barely a minute or two, Laura and Neil arrived on the other side of birth in what appeared to
me to be a very special way; they arrived, in their own time, as parents. They claimed their
child.

Carefully, but with a clear confidence and readiness, she brought her daughter up to her
chest, embracing her for the first time.

THE SEQUENCE OF BIRTH

What I saw at Laura’s birth made sense to me in light of a workshop led by midwife Karen
Strange in which she invited us to view the classic 1979 Brazilian film, Birth in the Squatting
Position (Paciornik, 1979), with new eyes. As the women in the film birthed their babies
down onto pads below them and took their time to pause, study, touch, and pick up their
babies, Karen described what she called “the sequence of birth,” a sort of blueprint for what
happens when we do not disturb birth. She spoke of it as one of Connection—mother and
baby connected in pregnancy; Rupture—the moment of separation at birth; Rest—the
pause as the baby lies before its mother, the mother seeing and touching her baby for the
first time; and Repair—the trip the baby makes to the breast, thus completing the sequence
of birth.

The beauty and normalcy of the Rest and Repair struck me. With the Rest, there is no rush
to get the baby onto the mother’s chest. The baby is gently guided down where it is born.
The mother has a moment to take a breath, to come back, as it were, from the work of
birthing her baby. “This pause,” says Karen Strange, “allows the mother to integrate this
moment of transition” (K. Strange, personal communication, April 14, 2010). The mother
now turns her attention to this next deliberate moment, the moment in which she discovers
her baby.

Neither is there a rush to “get the baby to latch” on the part of eager helpers (K. Strange,
personal communication, April 14, 2010). There is a tender, gentle time as the mother rests
from her own hard work of birth where the baby, when ready, begins its search, as all
mammals will do, for the breast. The baby is helped as needed, but given the time and
opportunity to exercise this age-old, instinct-driven ability to find the breast. In fact, a new
and exciting body of research demonstrates how beneficial it is for a baby to be allowed to
take the lead in breastfeeding in the special hours after birth (and beyond!; Colson, Meek, &
Hawdon, 2008; Righard, 1995; Righard & Alade, 1990; Smillie, 2007; Wiessinger, 2004),
something that is dramatically shifting many parents’ experience of breastfeeding.

But just as we are now appreciating what occurs when we respect a baby’s ability to find its
mother at birth, what I am seeing with Laura and other mothers is heightening my respect
for and understanding of our own abilities as women to find our babies at birth.

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When we do not rush through the moment of birth, but honour the pause that marks the
centre of this sequence, what happens, in my experience, seems to be nothing less than a
paradigm shift of equal significance. For we are not only finding our babies, we are also
finding ourselves as mothers, and finding our way into a new state of being.

For we are not only finding our babies, we are also finding ourselves as mothers, and finding
our way into a new state of being.

THE BABY

For the baby, there are many benefits to landing (gently, of course) below its mother and
waiting a few moments to be claimed. Laura’s midwife, Valeriana, points out that a baby
born down onto pads on the floor or bed is kept warm because it rests in a pool of amniotic
fluid released with the baby at birth (V. Pasqua-Masback, personal communication, January
19, 2010). When a baby is birthed down, Valeriana sees the baby stretch out its arms, which
in turn expands its lungs for those first few breaths. “The Moro reflex makes such sense!”
she adds, referring to the “startle reflex” where an infant throws open its arms (V. Pasqua-
Masback, personal communication, January 19, 2010). Additionally, this pause is an
important time for the placental transfusion, the return of the volume of blood that has
backed up into the cord and placenta with the squeeze through the birth canal, a function
that also aids in the transition to lung breathing (Mercer, 2001; Mercer & Skovgaard, 2002).

THE MOTHER

Although each woman’s experience is of course hers and hers alone, mothers like Laura,
who find their babies at birth, seem to respond in a near universal sequence, observation
and research are telling us (Klaus, 1998; Klaus, Kennell, Plumb, & Zuehike, 1970). Midwife
Valeriana takes the fact that she is repeatedly seeing this sequence as strong evidence that
something deep and instinctual is at play here (V. Pasqua-Masback, personal
communication, January 19, 2010). Karen Strange says, “We all carry this blueprint within
us. When we follow it, it turns on the brain in a certain way. It is amazing!” (K. Strange,
personal communication, April 14, 2010).

Indeed, if the archaeological record of birth is anything to go by, we can safely assume that
upright birth has played a significant role in the evolution of human birth. There is a high
probability that many a woman throughout human time has birthed a baby down onto a
surface below, taken a much-needed moment to recover, and then inspected and gathered
up her child. When I have observed Valeriana support a woman who births in an upright
position, this seems a very reasonable supposition. And when a woman gives birth on her
side or back, I have watched Valeriana simply guide the baby onto the bed where it
emerges. Others will gently help the mother to sit up so that she can—in her own time—
look at, touch, and embrace her child.

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A MOMENT TO EXHALE

When a baby is delivered directly to a woman’s chest, many—certainly not all—women are
somewhat overwhelmed when the moment they finish the work of birth and the moment
they take in their baby are one and the same.

Sometimes, there will be a sense of disappointment on the part of new mothers who
expected the very moment of birth itself to be something along the lines of, “Oh my God,
baby! I love you more than anything I have ever loved in the world. I feel great! The love
hormones are surging!” When I ask pregnant women what they envision the moment of
birth will be like, I usually hear a version of the previously mentioned lines. But, you’ll say,
isn’t this high one of the reasons we work so hard for our births? Isn’t this our reward? Yes,
by all means. And that is exactly why this high deserves to be parsed.

As a witness to the birth process and a mother myself, the words, and phrases I feel
describe most mothers’ first moments after giving birth include a stunned kind of relief,
bewilderment, and shock. Of course, the mother is eager to see her baby at long last, but
she is still very right brain. The tears I most often see at the time of birth are the father’s.
The mother is not there yet. But then, like a cruise ship changing course, coming now into
port, her attention shifts. There is a coming back, a return, a shifting of focus to this new
child who is also experiencing its own coming into port. This changing of course will happen
at more of a clip for some women than for others. But it is with this turn of attention that
the high begins to swell, and it will continue to swell over hours and days, weeks and
months, parenting effort after parenting effort, until one day, it is the tidal wave of love that
we have for our children.

When a baby is simply guided down at birth, and mother and baby pause, it is not that the
moment of birth itself will now be the realization of the all-consuming lovefest that the
mother had imagined. Rather, it is that a woman will very naturally have her moment for
the stunned relief of delivering her baby. This part of the birth process will be accorded its
own respect. A woman will exhale from the work of birth before she begins to inhale the
presence of her child and her new identity as a mother. There is no rush to initiate her as a
mother.

A woman will exhale from the work of birth before she begins to inhale the presence of her
child and her new identity as a mother.

The wisdom in doing so is profound and parallels other times in our lives when we pass from
one state of being to another: One moment we are girls, but with the first discovery of
menses, we are young women; one moment we are high school seniors, and with the
moving of a tassel, we are graduates; one moment we are not married, and with the
utterance of a few words, we are married. We move from one state to the next.

But isn’t there always a moment between these two states? A moment of transformation or
movement from one thing to the next? A kind of slow recognition of the transformation?
With death, for instance, isn’t there a moment of leaving between the states of being alive

29 | P a g e
and not being alive? With birth, isn’t there a moment of arriving between the states of being
born and being fully here?

I have watched many babies through this process, including my own. Similarly, for the
woman giving birth, isn’t there a moment between the state of giving birth and the state of
being a mother? Isn’t there a moment of arriving?

There is. And yet, this moment is so often hurried. Such business at the time of birth! So
much going on at the same time. We all get there eventually, but what if we were to pause,
consciously, as our babies are born and claim this moment between states? What if, with a
simple shift in business as usual at the moment of birth, we were to slow the process of
arriving, receiving with slowness our babies into this world and finding our own way, with
awareness, into our new state as mothers?

A MOMENT TO INHALE

As a doula who has witnessed the moment of birth more than a hundred times, I am now
finding a deep pleasure watching newly minted mothers have the opportunity to truly see
their babies in their full newborn glory moments after they are born. In my experience, it is
a near-constant variable that when a baby is delivered directly to the mother’s chest,
especially when a woman is reclining, everyone in the room will have a clear look at the
baby long before the mother sees her child’s face and body with any clarity. The mother will
get a quick peek at the baby on its way to her, but once the baby is on her chest—
depending on the baby’s and mother’s positions of course—mainly, she will see the top of
the baby’s head. Often, her first clear view of her child’s face and body is when the baby is
taken away for newborn procedures.

When a baby is delivered directly to the mother’s chest, everything is fine. After all, she has
her baby’s warm, just-born body on her—surely one of life’s most unforgettable experiences
—and there will be plenty of time to get to know the baby’s face and body in the days to
come; plenty of time to absorb the presence of this child and digest this new state of being.
Everything is just fine, too, when a baby is taken to the warmer at birth, no matter whether
the child was born vaginally or by caesarean. The time for seeing, studying, and claiming the
baby may be delayed a bit, but it will be found in the coming hours and days. But, as I have
observed mothers like Laura who are discovering their babies in their own time in the
moments following birth, suddenly, remarkably, having my babies delivered straight to my
chest feels a lot like an intervention to me. If intervention feels like too strong a word, at
least, it now seems like an interruption to what I might have done if no one had told me
what to do.

There are a million ways to slow it down: Babies are born in so many ways, and we arrive, as
mothers, in so many ways. For instance, just this morning, I was at a birth in Manhattan
where a baby was born at home in water, making a surprise breech entrance into the
birthing pool. The midwife, Tioma Allison, skilfully caught and placed the baby on its
mother’s backside (the mother was on all fours), as she massaged the baby into its first
coughs and sputters. The mother, Christine, later told me that that period of time felt so
good. She said she was so happy to do nothing, just resting her head quietly on the side of

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the pool, feeling grateful to be done, feeling her baby’s body on her bottom, and listening to
her child’s first squeaks and squawks.

Really, no matter how a baby is born, there is nothing we have to do, but slow down. Karen
Strange says, “In fact, we can’t do it perfect. There is no perfect. All we can do is slow down
for the connection” (K. Strange, personal communication, April 14, 2010).

I am not suggesting that a baby doesn’t belong on its mother’s chest at birth. When a pause
is experienced, the trip to the chest is simply slowed. It is still the baby’s ultimate
destination, the completion of the sequence of birth. This morning, after Christine’s longish
pause—it had, after all, been a very long labour—she of course turned, when ready, to
embrace her daughter. I am simply suggesting that just as many of us no longer hurry our
babies onto the breast but allow them time to exercise their ability to find the breast,
trusting their inborn knowledge and instincts, why not allow ourselves to slow down at the
moment of birth itself, trusting our own inborn knowledge and abilities in this moment to
find our babies, and ourselves as mothers, on the other side of birth?

As I think about birthing this new child on its way to me, I hope to remind myself of
something very simple at the time of birth. No matter how this baby might come to me,
resting first below me, appearing almost magically from a pool of water, or after some help
with start-up from my midwife, I will tell myself very simply: Exhale and then inhale. Exhale
the magnitude of the experience of birth and then inhale the unfolding moments in which I
am receiving this child. Life is not one big inhale, one big gulping in of experience. It is the
symmetry of exhale and inhale. Just as we breathe this rhythm through our labours, present
to one contraction at a time, we can also breathe through our transition to motherhood,
finding that moment between states and passing through as slowly as we need. This is what
I am learning from mothers like Laura: Exhale and then inhale.

POSTSCRIPT

On November 4, 2010, after submitting this article to The Journal of Perinatal Education, I
met my third child in what I can only describe as the most ecstatic of ways. After an
unexpectedly long first stage and a shockingly speedy second stage, I birthed my baby on
my bed in the all-fours position. As my midwife guided my baby down below me, I did
indeed exhale with a deep sense of peace at the completion of a labour that had seemed to
last an eternity. But the next moments are the images forever seared in my memory. As I
saw my daughter below me, as I touched her meaty little arms and legs, took in her red hair,
watched her first breaths, felt her cord pulsing with the life force we had shared for so long,
and finally—when I felt I had really seen her—picked her up, the experience was nothing
less than euphoric. After watching other women give birth, I knew that not hurrying a baby
onto its mother’s chest leaves the moment open to be what it needs to be. But I had no idea
that being upright for this precious first meeting with my daughter below me, with no one
hurrying her or me, would feel so powerful. I don’t think I have ever looked so intently at
another human being. I feel that I now understand, in a visceral way, what we mean when
we talk about the imprinting that takes place at birth. It was an extraordinary gift to be able
to truly see and take in this brand-new person at the moments in which she arrived.

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 Prodromal Labor, from a Doula’s Perspective

Rachel is a doula. Recently, she attended a prodromal birth. She posted her story—along
with any thoughts she had as a doula on what may have been helpful or otherwise. Many
women having prodromal labor make the same mistake: that of trying to get labor going
early-on. This works fine if you go on to have an 8-hour labor, but there is no telling how
long your labor will be, so take it from someone who just witnessed how things go when you
choose that route: if you find yourself in early labor, don't get too excited or try to make
things move along faster. (Especially if it is bedtime!) Prodromal labor is notorious for
kicking in at night.) Take labor as it comes. It will not leave you behind.

Here is Rachel's story:

Amanda started ctx-ing a week before her due date. Thinking that it was time, she and Brian
headed to the hotel. Yes, hotel. They live further out of town and were about a 45-minute
drive from the hospital, so they went to a fancy hotel about three minutes away from their
hospital to ensure comfort as well as being able to wait until the last possible minute to
head to the hospital. Really, really long story short. Amanda would get consistent, intense
contractions for a few hours and then just stop. Oddly enough, once I would get to the hotel
to check on her, she would putter out. Thankfully, she says it was because I made her too
relaxed. Ha. Good problem, I guess. (I had suggested to Amanda while she was still at home
to try and lie down to see if the ctx's would stop, thus showing us if it was active labor or
not. She was convinced that labor has to be "helped" along with constant movement, so she
never lay down. Thus, the frustration when she got to the hotel and I got her to lie
down...they stopped. Please understand that real labor will continue whether or not you lie
down or stand on your head.)

She did this for 44 hours. Off and on ctx's that were intense and longer than a minute, 3-5
minutes apart. When the last time that I went to check on her came around... (around 2 am)
I went to the hotel and the ctx's were more intense and all we could judge, consistent.
(Because they continued as she was in a side lying position for several hours). After about 4
hours mom was complaining of pressure and felt it was time to head to the hospital. (The
ctx's were off and on longer than a minute, but that part wasn't consistent. I made the
mistake of telling mom what we were looking for as our sign to head to hospital. Please note
fellow doulas: do not tell a laboring mom what you are "looking for" when trying to
determine her progress. The mind is a powerful thing and if you tell her you are waiting for
her to feel pressure, her mind will tell her she is having pressure, no matter how slight the
pressure is. I felt it was still too early to head to the hospital, but because she started
complaining of pressure, we had to go to be on the safe side).

Once we got there she was 4cm, 80% effaced, -2 station. I had told her not to get
discouraged no matter what we found out at the hospital, but it was hard not to, only
because I agreed we should go because she said she had "pressure."

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But at -2, and water still intact, I'm not sure what pressure she was feeling. (Exactly why you
don't tell the mom what you are looking for. It's not that mom wanted to head to the
hospital that early, rather she just wants to believe it is going faster than it may be at that
time. And for whatever reason, lots of moms believe that just being at the hospital will
make it all "go faster." That is no guarantee.) Either way, anything we can do at the hotel,
we can do at the hospital. Her doc was AMAZING and fully prepared to let her do whatever
she wanted and even to leave her alone. Because mom was exhausted from 44 hours of
prodromal and 4 hours of active labor, she needed some rest. However, Amanda is a…
ahem… stubborn woman. (Again, we were constantly battling this false belief that you have
to help a labor along. Nothing could be further from the truth. When dealing with a long
labor you must REST. As in, get in a side lying position and get your full "break" in between
contractions. But Amanda did not see the benefit in that and therefore wore herself out
completely.)

After several hours of the same thing… (*again, condensing things*) It took another six
hours to go one cm… and then another four hours to go one more cm. In that time, mom
was giving up. She was exhausted. And I knew that without some rest, she would not make
it to an unmedicated birth. After phoning a doula friend who suggested (thank you Virginia...
yes like a game show, "phone a friend") we get mom some narcotic (I would not
recommend this for the average long birth. In this case I believe it was necessary only
because mom refused to get rest on her own. It was for the purpose of slowing things down
so that she could get some rest in between ctx's. This worked like a magic show... she rested
for about an hour and a half...as her ctx's slowed to more than 10 minutes apart. Once the
meds wore off, she was renewed mentally and physically, enough to endure what would be
the last two hours of her labor. However, the same thing could have been accomplished
without the narcotics if she would have rested long before this point.)

After an hour of walking and pacing, she was checked and found to be at 6cm's. However,
she felt discouraged and was ready for the epidural. (*I think it is important to note
something here. After the birth was over, Brian informed me of something that I was
clueless about. He and Amanda made an agreement before the labor ever started that if
Amanda asked for the epidural at any point, she would get it. This is important to note
because in my opinion if you are planning on that option at any point, you WILL ask for and
probably get that epidural. This is an issue of philosophy of labor. Because the mind is a
powerful thing, if you give your mind an "out" it will take that "out." I wholeheartedly
believe, also, that her decision to put the epidural in play affected her labor. To me, it
seemed she never fully embraced her labor as what it would take to have her baby. I think
because she never fully embraced what one friend calls, "labor-land," her body responded
with a fight... taking 10 hours to go 2 cm's. Yes, I believe that is connected to her
mental/emotional state).

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After much back and forth with the two of them, I conceded (*keep in mind, I knew nothing
of their agreement, only that I had told them I would use every resource available to move
away from an epidural because that is what they communicated to me that they wanted).
The nurse was to call for the epi but the doc was stuck in a c-section and Amanda would
have to wait. So, as we are dealing with each ctx… she has a big one and then has a good
amount of discharge on the floor during the ctx. At this point… we get her in the bed to get
some narcotic until the epidural can be done. At that moment, her water breaks (on its
own), immediately her ctx's hit 2 min apart, 90 seconds in length. I pull Brian aside and say,
"I know she wants an epi… but I believe all of these things are pointing to transition and I
think very quickly you are about to hold your baby. If you can let me get her through each
ctx, one at a time, I believe this birth can happen the way you guys originally wanted it."

He agreed to work with me until the epi arrived. About 20 minutes later, Amanda shot up
and yelled, "RING OF FIRE." Surprised, I said, "okay honey… are you feeling pressure?" to
which she looked at me like I was crazy and said, "NO… ring of fire." So, I took a peek and
baby's head was definitely crowning. About 10 minutes later, Amanda had her sweet baby
girl.

No epidural. And even though they had their agreement… they both assured me that they
were glad that I persisted like I did and that she "went all the way.” Later the next day she
told me how wonderful she felt and how happy she was that it went the way it did... except
for the whole "length of labor thing." ha! I don't blame her. (I define a natural birth as one
that you embrace even if it is long, and you do what your body needs. You have to be
mentally prepared that things don't always go the way you expect them to or that they will
be anything like they were in your other births.).

NOTE: Some of Rachel’s comments were removed from her story however I find her story
one that is quite common to women and it is encountered by doulas often, and one can
learn a lot from her candid thoughts.

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 Isambard’s Home Birth Story – A real, raw insight into a home birth.

I knew this baby wanted to come to us fast, but I didn't expect to go into labour before forty
weeks. I felt a trickle just as I was falling asleep about 1 am on Saturday 7th May, exactly
thirty-nine weeks! After mopping the bathroom floor, my mind was racing, and I found it
hard to get to sleep. Where are the contractions, if this is it? And what about being Group B
Strep positive?
Waking up on Saturday morning, I expected to feel contractions, but no, nothing. We
bought a thermometer as Robyn asked that I monitor my temperature, given the GBS. I
wasn't concerned about it, knowing my body and how it works. I rang my mum and she said
the same thing had happened to her - waters broke. Nothing happened for ages. That was
heartening.
After nearly twenty-four hours without contractions, I didn't think I'd ever have one, l found
myself wide awake about 6am, although this wasn't too unusual as I'd been waking up in
the middle of the night for the past week. I finally began to feel contractions steadily six
minutes apart. The contractions stayed steadily six minutes apart most of the day. We
decided a walk might help get things going, and we went along the coastal cliff top walk to
the Macquarie Lighthouse and back. I sat on a bench and looked out at the ocean,
wondering if baby was ever going to come.
Contractions strengthened and got closer together at four minutes, and I became a little
more serious, not wanting to talk through them but still being able to hold a conversation.
My mum and friends arrived but nothing happened, we just chatted, and the energy was a
bit flat. The minute I laid down to sleep I had a massive contraction, followed by another,
ongoing at four minutes apart. I spent the night in and out of the shower and eventually
woke Andrew about 4:30am.

About 10am Andrew got the pool blown up and after a problem with the hose and running
out of hot water, I got in. It was bliss and the contractions came and went in smooth waves
rather than rough peaks. Skye and Jess arrived back, and Robyn arrived and immediately
checked the baby's heart rate which was solid as usual. I wanted her to tell me, 'This is the
way you should do it' or 'You're at this stage' or 'if you do this, the pain will go', but she was
just there. This was the beginning of my fight against the contractions. I grabbed Andrew's
arm during each pain, not in control in the slightest. He breathed and made noises with me,
without coaching, I began to say, "No, no, no" as each one rose, Robyn was amazing, she'd
say, "Yes, yes, yes" over the top of my ‘no's’. I was annoyed, thinking, 'But why would I say
yes to this pain!', but she was right. Eventually Robyn said that given the GBS risk we needed
to think about transfer for antibiotics. She talked as though I could just cruise over to the
hospital, have an IV of antibiotics, and cruise back home to give birth, even changing
position seemed insane, let alone getting out, dressed, into a car... But none of that was a
consideration: I wasn't having antibiotics. I'd read and prepared: antibiotics would give me
and baby thrush; they wouldn't kill all the bacteria anyway; and I naturally have lots of
bacteria in my vagina, and I don't want to muck about with It. I didn't want to inhibit the
formation of healthy gut flora in the baby, and I didn't want my baby to have antibiotics,
especially when the risk of toxaemia from GBS is 1 in 1000. So, I said, "No way in hell!"
Robyn was genuinely concerned, and I heard her ring another midwife, and then Randwick
hospital. I also heard her ask Andrew, who stuck by what I wanted.

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Again, Robyn mentioned transfer and by then I was thinking transfer myself, but not for
GBS. I was thinking about drugs, the pain was all-consuming, and I wasn't getting breaks in
the three to four minutes between contractions any more. There was pain in the front of my
pelvis. I asked Robyn if I needed to transfer because the baby wouldn't come out and I
couldn't handle the pain, and she said so firmly "Oh of course you can birth this baby here,
there's no doubt about that." I was a bit annoyed; I wanted someone to tell me my escape
from the pain was justified.
All sorts of crazy thoughts began to cross my mind. I had to get a break from the pain. How
would I get drugs? No, not hospital! There are pain killers in the kitchen cupboard … I could
just take lots. I pictured it. I wondered how I'd ask, how I'd get it, because I knew people
might not take me seriously. I didn't voice any of this. Andrew had gone for a short walk to
take a breather. I was roaring through contractions and Robyn was reminding me to keep
noises low and guttural. I'd done no prenatal classes of any sort, and I'd found a lot of the
birth preparation things I'd read, especially 'Birthing from Within', frustrating and 'not me'.
There was complacency in the room, another day was ending. I sensed that everyone had
retreated, given up on me, like I was never going to get there. I was despairing. But I never
voiced this, although I felt this way for so long. People had left the room. Robyn
miraculously appeared at key moments like a fairy, and regularly checked the heart rate
which remained strong and steady. She'd check my temperature, which never really varied, l
got the sense my moaning was getting repetitive, it was not only tiring me out, but I felt like
it was draining on everyone else too. Everyone needed a break.
My mum was somehow next to me. I don't remember her coming there, she just was there.
At first it was annoying. She has a very light touch and it can be irritating. But then she did
something I don't think she's ever done. She began to tell me I could do it. And with each
contraction she told me it was 'a good one'. She repeated the same things over and over,
and in my head, it was a bit annoying, but I began to believe it after a while. She made the
noises with me, in a steady way, and it was just the two of us, breathing and making noises.
She was the only one still sticking by me, and she wasn't going to let me get out of this.
She's never done this; she's always let me get off scot free, give up halfway through, take
the easy way out.

Everyone began to migrate back into the room, hanging around the edges watching and
noticing the atmosphere changing. I was only vaguely aware of this, but everyone
commented on it later. Twice I vomited pretty violently. Most of it went on Andrew! He took
it all in his stride, didn't even change his shirt, just stayed with me. Robyn was excited by
this, recognising it as a sign of transition. I'm not sure that it was, but things did change
when it happened. Robyn wanted me to get out of the pool. Things were happening, but not
enough, even I knew this. I wasn't getting a break between contractions because of the
pelvic pain. Robyn suggested this might be the last bit of cervical dilation happening while
the baby's head pushed against it. I managed to sit on the toilet then lie on the couch, then
stand up for a few contractions, but it felt awful, and I begged to be let back in the pool.
I think standing up must have helped somehow, but eventually I began to feel my body
push. It was overwhelming, like something taking me over, and my whole body convulsed.
Despite the intensity, I was glad. I expected to feel the baby moving down the birth canal,
getting closer, but nothing. It just felt like my body was pushing against a rock. After pushing

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a while, Robyn offered to check my dilation. I was silent, thinking to myself, what good is it?
Let it just happen.
It seemed like so long that my body had been pushing, and Robyn had even said that I
should try pushing on top of the involuntary push. Finally, the pain in my pelvis eased, but
was quickly replaced by another debilitating pain, all around my waist. Robyn said this was
the uterus fatiguing, which made sense given I'd been having contractions for over thirty-six
hours now. I changed position to my knees, leaning forward over the edge of the pool and
Andrew was there again. This gave me a bit of renewed energy, but I soon remembered I
didn't want to birth on my hand and knees, so turned back round to semi-reclining.
Eventually Robyn said to try and feel for the head and it felt like a centimetre of silky
smooth opening. I pushed so hard, it was very empowering! There was a moment of relief
towards the end of each push. I remember Andrew saying to me I sounded like I was
enjoying myself at one point (I wasn't, but I guess he was probably thinking of 'Orgasmic
Birth'!). Robyn said I should feel for the head again and this time it felt a quarter to a third
out. I thought about all those people who breathe their babies out and couldn't understand
how that is possible. I felt the perineum stretch so easily. It didn't sting, just stretched like a
piece of tight elastic. It did sting at the front, and I was convinced I was tearing around my
clitoris and urethra, but I didn't care, I was almost there!
At crowning, everyone was oohing and aahing, standing around the bottom of the pool. I
think I waited for the next contraction before I pushed out the shoulders, and then the body
slid out with a rush and everyone gasped and cheered, and I heard Jess burst into tears.
Someone said it was 7:57pm. It was an intensely emotional moment. Robyn lifted him from
the water and began unravelling the cord which was twice around his neck and once around
his body. I helped pull it away and held him as he cried almost straight away. His body was
purplish, his head slightly paler because of the cord, but he cried robustly and loudly. I
messaged his little hands as I remembered that might help stimulate him, not that he really
needed it.

As I looked at him and said hi for the first time, I realised he was a complete stranger. I
didn't know him, yet he had come from me. Andrew was overwhelmed, and we looked at
him and he said how proud he was of me and all sorts of other things, it was amazing. We
realised we didn’t know the sex – yes, a little boy, not what we expected but perfectly fine.
We could see that the top of his head had the imprint of the cervix on it, and also some lines
that Robyn said could be my ribs. She speculated he had been breech and turned during
labour, which would explain why it took so long from when the contractions ramped up.
The placenta was huge! We all checked it out, and Andrew cut the cord. Isambard fed
about an hour after birth. He was 4kg exactly and measured 50cm long with big hands and
feet. I had no tears. Not even a graze, which was amazing because I'd felt such stinging at
the front. Everyone eventually headed off and I was finally tucked up in bed with my little
boy and my amazing husband.
I don't remember much about that first night, I don’t know if we slept, having little sleep
over the previous thirty-six hours or more. I still can’t believe I did it, I actually had my baby
at home with no intervention, I stood my ground, I know what was right, and I made it,
perfectly.
This story is a particularly interesting insight into what can go through a woman’s mind
during labour. Thoughts?

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 Advice for Women on Promoting the Breast Crawl

Your baby is born ready to wow you with a miracle: She can crawl to your breast and
begin nursing all by herself.

Did you know that if your baby is placed on your tummy immediately after birth, and left in
undisturbed skin-to-skin contact with you, she will naturally have the ability to move on her
own toward your breast, latch on and begin her first feeding?

This no-less-than-miraculous continuation of the mysteries of birth is called the breast

crawl, and it’s far more common when moms and newborns are kept together, undisturbed,
after birth.
Sadly, expert healthcare assessments often get in the way of nature’s preferred method of
starting breastfeeding, despite recommendations otherwise from UNICEF and WHO.

How newborns come to feed

A remarkable sequence begins when your newborn rests on your tummy post-birth. Leading
expert Marshall Klaus observed that your baby will begin to salivate and chew on her
fingers. Then, she’ll use her legs and arms to move to your breast.

At your sternum, she’ll bounce her head to reach the nipple. And then, with her mouth
open, and it may take several attempts, she will finally latch on and begin to nurse.

To help this process happen in today’s busy birth environment, it’s important to let your
care providers know in advance that you plan to let baby initiate breastfeeding post-birth.
This means newborn assessments, vitamin K injections, and swaddling can all wait, unless
immediately medically necessary.

In fact, it is currently recommended that “all healthy infants should be placed and remain in
skin-to-skin contact with their mothers immediately after delivery until the first feeding
occurs.”

Bonding with your baby

Your baby is born with an amazing sense of smell. Research has shown babies can find and
prefer maternal odours, particularly an unwashed breast with milk versus other smells.

When babies self-attach to their mothers and start breastfeeding on their own,
breastfeeding is more effective than if the mother tries to show the baby how to nurse. As
baby snuggles skin-to-skin, her body releases the feel-good hormone oxytocin, calming her.

Babies who initiate nursing post-birth also tend to be more relaxed, sleep longer and have
less fear or anxiety than an over-stimulated baby.

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As your baby nurses, her temperature, heart rate, breathing and blood sugars will quickly
and naturally stabilise.

Initiating Breastfeeding Post-Birth

You can help your baby’s first feeding begin post-birth by:

 Requesting immediate skin-to-skin contact.

 Avoiding routine procedures or assessments unless immediately necessary.
 Observing baby go through the breastfeeding crawl sequence, assisting, but not
leading, as necessary.
 Remaining reclined and relaxed, allowing baby to take the lead in starting
breastfeeding.
 No visitors immediately post-birth and until breastfeeding is going well.

https://www.youtube.com/watch?v=OMUzOo11L90

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 Baby Bath is a Care to Share with your Baby

IS BABY BATH SO IMPORTANT? WHY?

As far as I remember, baby care has not evolved, especially the baby bath. Do we wonder
why newborns cry while they are in their bath whereas it’s the environment they know the
most? Yet, to us, this moment is synonymous with well-being, relax etc. We could even
make it last hours.
It’s not hard to make this baby bath go better, nicer. I will give you a few tricks (some of
them will be more important; we will call them “Golden Rules” and try to forget some
clichés).

TRICKS AND RULES OF BABY BATH ACCORDING TO SONIA ROCHEL

Golden rule n°1: We don’t give a bath to a hungry baby. When babies are hungry, even the
best baby bath ever wouldn’t calm them down. You’d better do this 20-30 minutes after
feeding.
 Generally speaking, babies sleep better after a bath. As a result, it would be preferable
for parents to schedule it in the evening.
 You need to know that baby bath is a care that will last for a while, that is to say
before starting, be sure that you’ll be physically and mentally available (no phone etc.)
 Bathroom will have to be heated to 23-24°C.
 We get prepared everything that will be necessary for the baby (clothes, towel,
products) before starting the baby bath.
Golden rule n°2: Let your hands, your heart express themselves. Tiny waves and swaying
will be appreciated.
 We barely think about this option: it’s definitely possible to bath your baby in the
basin if it is deep and big enough. It will be even more comfortable to you, since it is
at your height, and to baby, since it is at their size. If you pick that option, make sure
that your baby doesn’t get hurt with the tap/faucet.
 You can start by playing soft/slow sounds that will get both baby and parents relaxed.
 Run water at 38°C (temperature will have decreased by one degree Celsius when you
have finished taking your baby’s clothes off).
 Finally ! You can start bathing your baby, put your baby in the bath progressively.
Let’s start with the legs, then the back etc., immerse them with belly facing down to
avoid stimulating their startle reflex – or place a washer wet washer over their tummy
and hold both their hands together! Have a good time with your baby, he or she will
love this baby bath for sure.

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Golden rule n°3: hasty baby baths that come down to anchoring, soaping, rinsing, drying are
over! If you manage to keep the water at a good temperature, you can leave baby there
between 5 and 10 minutes (without taking your eyes off him/her!) ; for example, you can
leave a trickle flow at 37°C.
 With the water of the bath, keep your baby’s tiny body and head warm so he/she
doesn’t get cold.
 Soaping on a daily basis is not necessary, once every 2 days is enough, it’s even better
for the health of their skin. Do not use neither wash cloth nor sponge: baby will prefer
way more your soft hands.
Golden rule n°4: Some water could get into your baby’s ears or eyes. Do not worry, it
doesn’t harm them! However, ensure baby’s nose is clear of water at all times. Baby’s are
automatic nose breathers.
 At the end of the baby bath, wrap your baby up quickly in his/her towel; pick a big one
so he/she is warm; if he/she is crying, take your time to calm him/her down with a big
hug. It’s nice neither for your baby nor for you to do this under pressure.
Golden rule n°5: Baby Bath must be as good to give as to get, so … ENJOY it with your baby!

Baby bath video - https://www.youtube.com/watch?v=OPSAgs-exfQ

Important note! Do not attempt the extent of bathing techniques in this video – the woman
in the video is renowned for her baby bathing technique and skill. The purpose of this video
is to demonstrate the effects of relaxation techniques during bathing.

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 The Doula Bag!

This is what is in our doula bags, we started with a lot less and built it up with time. Start
with the basics and see what you feel suits you personally and what you find useful during
births.

 Make sure you have what you need to be away for 24 hours! (Even though this is
rarely the case, it does happen, so you should always be prepared!)
 Change of clothes, toothbrush/toothpaste, unscented deodorant, pads/panty liners
etc!
 Snacks/drinks for yourself.
 Charger and earphones.
 Packet of dates – for yourself and for the mother, also for tahneek after the birth if
the mother has forgotten to pack her own.
 Zamzam water.
 Aromatherapy oils – massage blends, pure lavender, clary sage, and anti-nausea.
 Electric oil diffuser.
 Gel heat packs (no wheat/hot water bottles as hospitals won’t allow).
 Face washer to use with cool water on mother’s face/neck.
 Lip balm – labouring mums get very dry lips!
 Rescue remedy pastilles! Great for everyone – including nervous fathers/support
people.
 Electric/battery operated lights/candles.
 Battery operated hand-held fan.
 Birth book/Acupressure guide.
 CDs with Quran/MP3 player with Quran.
 Birth affirmations.
 Clients birth plan – laminated!
 Plastic prayer mat – make sure you have a Qibla App on your phone or take a
compass.
 Pair of plastic thongs.
 Small change – for parking etc.
 Rebozo
 Bendy straws
 Honey sticks
 Combs for acupressure points and/or stickers
 Eye pillow
 Paper and pen for birth timeline

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 Visualisation/Guided Imagery

What it is:

Visualisation is like seeing a movie being played on a movie screen on the inside of your
forehead when you close your eyes. The mother either imagines a scene as she thinks of it,
or she imagines a scene as another person directs her.

How it works:
Visualisation can be a powerful tool for women giving birth. This is a technique commonly
used by athletes. You learn to visualise the whole experience of birth-from early labour to
delivery. In your mind, you picture all aspects of your birthing - from the smells around you
to the background noises and even the lighting - and how you will react to each new
development. When we see ourselves successfully giving birth naturally, we are better able
to trust our bodies when actual labour begins.

Visualisation will help to keep the mother relaxed by keeping her mind focused on one
thing, and preferably, a relaxing thing. It can be very difficult to relax your body when your
mind is jumping through thoughts of worry and fear.

Rather than thinking, "Did I pack everything I need? I better call my mother. Why does that
nurse keep coming in here? When will this contraction end? Oh No! We left the cat inside!”
the mother will remain focused on one image throughout her contraction, or through
several contractions.

How to do it:

When the mother is in a comfortable position, have her close her eyes and begin to describe
to her a scene. The more detail you give the easier it will be for her to visualise. Lead her
through the description of the surroundings and describe the activities in the scene.

Integrating it into labour:

One of the most common visualisations is a day at the beach. Describe the feel of the sand
on her skin, the sound of the waves and the sea gulls in the air. Describe the smells, and the
heat from the sun.

Some women find visualising their cervix opening helps them to remain focused on what
they are doing. Others find visualising their favourite flower opening from a bud to a full
bloom is an easier way to visualise opening.

To really encourage relaxation, describe to the mother that her body is melting into the bed
(or couch, or floor, or whatever she is resting on). Go into detail about her body becoming
liquid and sinking, deep into her foundation.

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 Creating Your Birth Visualization

Here is a list of questions to get you thinking about your ideal birth. Go through this list and
use it to get your imagination going. I recommend that you consider your ideal birth and
visualize it vividly. Try and close your eyes and do it daily. As you visualize
this birth over and over in detail, your mind will think you’re literally “practicing” for birth. It
will be like getting to practice over and over before the actual event!
Imagine your birth from the first-person point of view – so actually see the scene through
your eyes. Imagine the sights, sounds, smells, tastes – and what you’re feeling. The more
vividly you “daydream” the better. It’s OK if it changes a bit throughout your pregnancy as
you discover more about birth, yourself, and your baby.

A Checklist for Your Consideration

 Where are you at when you go into labour?

 How does it happen? Quickly? Slowly and growing more regular? Water breaking?
 What do you do when you realize labour is starting?
 What do you do throughout your early labour?
 Do you go somewhere different?
 Do you make any preparations?
 Do you call anyone?
 Will you eat or drink anything in early labour?
 Do you have a birth tub set up? Is it getting filled yet?
 Do you welcome labour, urging it to get stronger?
 Or do you wait on it to establish its own rhythm?
 Who is there with you as labour gets stronger?
 Are you preparing your home, or preparing to go to the hospital or birth centre?
 Are you moving around as labour gets stronger?
 Or have you found a position that’s effective?
 Do you have a labour partner?
 Are they assisting you at this point or are you more alone?
 What are you wearing? (if anything?)
 What is the lighting like?
 What sounds do you hear?
 What do you smell?
 What is your baby doing?
 Are you talking to him or her?
 How are you working with your uterus and baby?
 Are you using any techniques you’ve learned in your birth classes?
 Have you gotten into a birthing tub?
 Have you been in the shower?
 On the toilet?
 What positions are you using?
 How can you tell pushing contractions have begun?
 How do they feel?

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 How do you work with them?
 What does it feel like as your baby begins to move down?
 How does it feel if as your hips are spreading and your body opening for your babe?
 What position are you pushing in?
 Are you changing positions, or have you settled into one?
 Are you relaxing between the contractions?
 How many pushing contractions come?
 Are you watching your baby crown with a mirror?
 Feeling your baby’s head ease out?
 Reaching down to feel your baby?
 Are you kneeling, standing, squatting, on hands and knees as your baby crowns?
 Does your baby come out just after crowning or do you push again?
 Do you pull your baby up? Does your partner catch your baby?
 Does your baby come right up to your chest?
 Does your baby nurse quickly, or spend some time just being with you?
 Does the placenta come quickly?
 Imagine your uterus clamping down cleanly and easily, with little blood loss.
 What time of day was your baby born?
 Who was in the room during the birth? (Or perhaps outside with you?)
 How do things go after the birth?
 Who is there with you now?
 What’s it like?
 When do you go home if you’re at the hospital or birth centre?
 Where do you settle in to enjoy your “baby moon?”

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 Aromatherapy

Aromatherapy uses essential oil extracts from flowers, herbs, and trees to treat various
physical and mental conditions. Aromatherapy has been used for thousands of years in the
Far East and is now one of the more popular natural therapies in western countries.

Essential oils are highly concentrated, with dosages measured in drops. They are usually
administered by adding them to hot water in a bath, vaporised for inhalation, adding them
to plain carrier oils for massage or as compresses applied to the skin. They can also be
diluted in a hydrosol spray. Aromatherapy has been used for stress, anxiety, headaches,
fatigue, insomnia, depression, infections, aches and pains, addictions, circulation,
respiratory problems, nausea, digestion and as an aphrodisiac.

Essential oils are pure oils. They are usually quite expensive and sold in small, dark, coloured
glass bottles. They are different from scented creams or oils that can be purchased.

It is recommended you seek the advice of a qualified aromatherapist for specific treatments.

Brief guide to the best oils for use during birth

Clary Sage oil - strengthens the respiratory and muscular systems in labour while facilitating
regular, effective contractions to speed up the process. This essential oil also relieves pain
and tension.

Neroli oil - brightens the mood and brings clarity to the mind. This essential oil improves
circulation throughout the body and reduces anxiety.

Jasmine oil - dulls uterine pain, strengthens contractions during labour and promotes
healthy production of breast-milk.

Clove oil - stimulates contractions, facilitating the birth process. This oil is useful for its
antiseptic and pain-relieving properties and will also prevent nausea and vomiting,
sometimes experienced during labour.

Lavender oil - is good for pain relief and helps to strengthen contractions and is calming.

Peppermint oil - helps to ward off nausea and act as a pick me up. Great as a compress on
the back of the neck and forehead during the transition phase.

Rose Geranium - enhances circulation and is good for labour management techniques which
focus on breathing.

Lime - great for mental clarity and focus. Relieves exhaustion and fatigue. Reduces anxiety
and regulates blood pressure.

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 Birth Affirmations

Each contraction produces a healthy,

productive sensation that is not stronger
than I can handle.

I will relax and let birth happen.

I am completely cooperating with my body.

My body will give birth in its own time.

I can do it one contraction at a time.

My body is strong and healthy. Even when me

mind is afraid, my body knows what to do.

Courage, faith, patience.

Keep breathing slow and even.

Inhale peace, exhale tension.

My body has a wide-open space for my

baby to descend. There is nothing in the
way.

My body knows exactly what it is doing.

My body is made to give birth, nice and easy.

The strength of my uterine contractions is a

sign of my strength. I can do it.

I surrender to the contractions

and relinquish control to the forces within
my body.

I trust in my ability to give birth.

Baby feels my calmness and confidence.

I believe my baby's birth will come quickly and

easily.

Birth is an easy and natural occurrence for

which my body has been perfectly designed.

My body is completely relaxed.

Birth hurts, it is hard work, and I can do it.

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 I can’t rush birth. I will embrace each phase
for what it is in the moment.

I surrender my birthing
over to my baby and my body.

I am not afraid.

My body knows how to have this baby

just as my body knew how to grow this baby.

I am confident in my ability to birth

naturally and easily.

Some free printables!

https://hypnobirthing.com.au/birthing-affirmation-printables/

https://babylovebirth.weebly.com/blog/birth-affirmation-cards-free-printable

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 Some beautiful quotes, comments, tips, and articles reflecting labour!

"If you are privileged enough to have witnessed a woman giving birth unaided in a place she
has chosen, what will you have seen? You will first have been in awe of her strength. Her
thighs stand strong and mighty like those of a warrior as she stands, sways, and squats to
find the best position to ease her baby out. Then you will hear the deep primal cries she
makes as she does her work, sounds that come not from her throat but from her belly as
she grunts and moans and roars with exertion. Maybe you will notice the glistening river of
mucous tinged with blood and waters that run down her thighs unheeded; she is beyond
noticing such things, moved as she has gone into another plane of existence. And then
finally perhaps you are struck by her beauty: her face softened with the flow of oxytocin, her
eyes wide and shining, her pupils dark, deep, and open. And you will think - for how could
you not - what a phenomenal creature is a woman." - Ed Soo Downe, "Normal childbirth:
evidence and debate."

“I have to admit, I didn’t always think of birth as beautiful. There are no pictures or video
clips that captured my first labour or my daughter entering this world. Honestly, I didn’t
know what to expect. Not to mention all the information out there about what’s “ugly”
about birth-you know, bodily fluids and looking at the placenta, oh dear!

Maybe it’s the births I have had the privileged of attending, or my own impending labour
and birth. But there is very little about the whole process that I don’t see as beautiful now.
It’s in the labouring woman the entire way through, even when she is at her “worst”
because of the instinctive way she’ll choose to do everything, even talk or move.

The beauty is in the entire house as it gets ready for birth, with supplies here and there
intermingling with everyday items. The awesome fact that no one is watching the clock, but
instead the weather outside to remember what happened when. And definitely in the
husband or kids who have no choice but to be part of the moment that has seized the room.

And I don’t see the birthing woman as separate from her body now, as I used to think of it.
It’s not about her uterus pushing her baby out, or how far dilated her cervix is. The beauty is
in gleaning that information from the woman herself, as she unknowingly does exactly what
she needs to do to make birth possible for her baby. There is nothing as beautiful to me as a
woman left alone to hear the own voice in her head that tells her exactly which way to
swing her hips, or exactly what sounds to make when she doesn’t care who is listening.

I suppose, in short, that there is nothing as beautiful as birth to me because there is nothing
more glorious than seeing someone be exactly who they are. I thought a while ago that the
“goal” of birth was to handle it quietly, or efficiently. It wasn’t until recently that I realised it
is beautiful when it is handled just as it needs to be handled.

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For some that means focusing quietly on the contractions, and for others that means primal
moaning and groaning. It is so rare and infrequent to see someone being themselves to the
very core of their being, so much so that it is uncontrollable for them not to honour this.

It’s also a thing of beauty to see the woman in labour transition so easily back and forth
from being in a contraction to coming back to earth, even just briefly. It reminds me that, as
natural and normal a process as birth is, it still is this amazing, incredible, mysterious thing. I
see beauty in the unknown, the unpredictable-ness of labour and birth, and this beauty
commands my respect. “– IndieBirth

“High pitched screaming is fear in many cases - some women get to the point where they
feel out of control and need help to breathe, calm and focus - but often there is no-one in
the birth room who can help her do that (so she tends to opt for drugs to 'escape' the fear
and feeling out of control). The birth environment in hospitals isn't optimal for birthing.
Think of a cat going to have her kittens - she hides somewhere dark, warm, and safe, where
she knows no-one will bother her. Hospitals are full of lights, strange smells, strange people
(who want to poke, prod and 'measure' you, and the support is not nurturing, continuous
(shift changes etc.) or experienced. A good doula is an awesome option for women in
hospital who want to bridge the gap and feel more safe and nurtured.” Kelly Winder

“Giving birth should be one of your greatest achievements not your greatest fears.” - Jane
Weideman

“When you change the way you view birth, the way you birth will change.” - Marie Mongan

“There is a secret in our culture, and it’s not that birth is painful. It’s that women are
strong.” - Laura Stavoe Harm

“Birth should not be feared. It is only to be understood. “- Marie Curie

“The power and intensity of your contractions cannot be stronger than you, because it is
you.” - Unknown

” Rain, after all is only rain; it is not bad weather. So also, pain is only pain; unless we resist
it, then it becomes torment.” - I. Ching

“A healthy woman who delivers spontaneously performs a job that cannot be improved
upon.” - Aidan MacFarlane author of The Psychology of Childbirth (1977)

“All natural birth has a purpose and a plan; who would think of tearing open the chrysalis as
the butterfly is emerging? Who would break the shell to pull the chick out?” - Marie
Mongon

“It seems that many health professionals involved in antenatal care have not realized that
one of their roles should be to protect the emotional state of pregnant women.” - Michel
Odent, M.D.

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“Fear can be overcome only by Faith.” - Grantly Dick-Read, M.D.

“The effort to separate the physical experience of childbirth from the mental, emotional
and spiritual aspects of this event has served to disempower and violate women.” - Mary
Rucklos Hampton

“No other natural bodily function is terrifying and childbirth should not be an exception”. -
Grantley Dick-Read, M.D.

“Muscles send messages to each other. Clenched fists, a tight mouth, a furrowed brow, all
send signals to the birth-passage muscles, the very ones that need to be loosened. Opening
up to relax these upper-body parts relaxes the lower ones.” - William and Martha Sears

”The wisdom and compassion a woman can intuitively experience in childbirth can make her
a source of healing and understanding for other women.” - Stephen Gaskin

”Part of birthing without fear is trusting your instincts!” - Brande Holm, BWF mama

“It is not only that we want to bring about an easy labour, without risking injury to the
mother or the child; we must go further. We must understand that childbirth is
fundamentally a spiritual, as well as a physical, achievement. The birth of a child is the
ultimate perfection of human love.” - Dr. Grantly Dick-Read, 1953

"Birth is a rite of passage of women. Their journey should be honoured, their rights should
be fiercely protected, and their stories should be shared. " - Marcie Macari

“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

"Just as a woman’s heart knows how and when to pump, her lungs to inhale, and her hand
to pull back from fire, so she knows when and how to give birth." - Virginia Di Orio

“Remember this, for it is as true and true gets: Your body is not a lemon. You are not a
machine. The Creator is not a careless mechanic. Human female bodies have the same
potential to give birth well as aardvarks, lions, rhinoceri, elephants, moose, and water
buffalo. Even if it has not been your habit throughout your life so far, I recommend that you
learn to think positively about your body.” - Ina May Gaskin

“There is no other organ quite like the uterus. If men had such an organ they would brag
about it!” - Ina May Gaskin

“The way a culture treats women in birth is a good indicator of how well women and their
contributions to society are valued and honoured.” - Ina May Gaskin

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 Poems written by mothers, about their caesarean birth experiences. Please read and
reflect, realising that for some women it can be quite a traumatic experience. These
poems are included so that we can gain some insight and understanding.

WORDS!

Walking out the door - my waters break -

What timing!
Gush of excitement - I can hardly wait...
I've never done this before!

The hospital is very busy.

I'm rather inconvenient, I discover.
The timing might be good for me, but it seems
It's good for too many others!

Up the stairs and down the stairs...

'Sorry - There's no room free!'
Up the stairs and down the stairs...
Mind you - I'm doing what's best for me!

Into the delivery room - look at the bed!

I'd just like a chat, but I'm shown how it works instead.
The midwife seems distant and soon she really is,
As we're left on our own in a bit of a tizz.

The hospital is busy

The midwife's not 'with me'
My husband doesn't know what to do
I'm feeling panicky!

Contractions come, contractions go,

I hear feet in the hall
At last the midwife's here again -
But she's standing by the wall!

As soon as I can get off the monitor

I'm crawling on the floor
For the earthy-birthy business
I was designed for!

Burrowing into myself

Things really moving on
Pain is here, but that's alright
Inside I'm feeling strong

'You're doing really well'

Into my heart they creep

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 Four words of encouragement
(words I'll choose to keep)

But later... 'your contractions are not strong enough...'

Good God! They feel strong enough to me!
(I wish you'd just said that things were always hard,
with a babe placed posteriorly!)

Does that mean my uterus isn't up to this?

That I can't do it after all?
Some syntocinon might be needed -
(It's bound to hurt more)
A flash of doubt starts cutting,
cutting through my mind
An Epidural! - I'll go for that -
A needle in my spine!

The "mobile" epidural

I'm 8cm.
When it's done
I'm unmoving still.
Yes - The pain is gone, but I've lost more than I thought.
This 'heaven' is suddenly still and silent.
Baby - Where are you?
Still there? I can hear your 'beep beep beep'
Something has ended... but it had only just begun!

Lying on the bed - near flat on my back

There I was, in no position to change anything
And progress - at a halt.
Not surprisingly - still.

It was circumstances -
Though I think I asked for very little
On my maiden voyage into motherhood.
I wanted you my midwife.

A mother/sister figure, who is sure and strong and keen

Who'll help, suggest and if I'm weak
Who'll lovingly be mean!

You stand near the wall, like a shadow,

Your face has changed into one of many.
Like ships people come and go.
Hours slip by and all is slow
Motion without emotion.

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 At least the pain was happening.

At last... a sweet face drawing closer

Good news! Baby's coming down
(and turning around!)
my clever baby! (How did you do it?!)

Then... DOOM! Fills the room!

How can it come so close to such lightness?

Another doctor is here now,

And he thinks it's been too long
14 hours and syntocinon,
to hurry thing along

The operating theatre's free soon

And he thinks he'll give me a hand
My disappointed face
He doesn't understand.

He doesn't think to ask me

What I would rather do
And though baby is fine and me
Tired, but ever pulling through.
He thinks he's doing me a favour
and is totally unaware
as he voices his concerns
that he's growing fear in here
and growing doubt
and growing doom
and growing expectation
that the only answer in the room will be..
YES!
To a major operation!

'You have been on syntocinon for quite a while

and I'm a bit worried about the possibility
of your uterus rupturing.'

Oh God! Am I about to burst?

Is that what he is saying?
Like a juicy grape, I'll split
His steady words are slaying
Any hopes of carrying on
I just can't wait and see
If the drugs they've put me on
Will prove too stimulating for me!

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 Just add a bit of self-doubt
A touch or two of fear
You white ruler of my universe
I wish you were not here!

You must know what you're doing

You must know more than me
Or is it fear that haunts you too
And makes you feel less free?

Just in case... of complication

Just in case... of litigation
Just in case... It's too hard for me.

But you might have asked?

'It's very unlikely they'll let you try

for a normal delivery next time!

Oh... I see
My destiny, is sealed already
- well fine
I obviously do have something wrong with me.
I think my boat is sinking!

I see, from a distance now,

Things that then there was no way to know.
In black and white (without the fright)
I was simply just too slow!!

3/4 hour later;

Ah... The show begins.

The theatre curtain is green
My husbands in a funny hat
Everything is scrubbed and clean!

A lot of people, looking on

A spectacle to see
I wonder what they are showing now
Or rather... which part of me!

'Look at those fibroids

they're the whitish parts'
(I'd almost like to see them too!)

No, seriously...
It's really awful here, you know

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 I've really lost it all
What a spectacle to see
Looking at the wall.

But when they lifted you up high

My little babe, it was worth it.
My little star!

What is the message of this tale?

(I know it went on and on!)
Now I find, with a caesarean smile
that time was the short end of long!

We are all subject to circumstance

to overwork, we self-protect.
Ignorant at times of each other’s feelings...
Human beings!

But do hear this...

Little things can mean a lot.
Tiny words at times like these...
Forgiven, yes, but not forgot.

What are your thoughts after reading this? How can gaining insight into a woman’s
experience help you as a doula?

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 Poem from a mother who lost her baby.

Please read and reflect. This poem is included so that we can gain some insight and
understanding.

A Mother's Grief

You ask me how I'm feeling,

but do you really want to know?
The moment I try telling you
You say you must go

How can I tell you,

what it's been like for me
I am haunted, I am broken
By things that you don't see

You ask me how I'm holding up,

but do you really care?
The second I try to speak my heart,
You start squirming in your chair.

Because I am so lonely,
you see, no one comes around,
I'll take the words I want to say
And quietly choke them down.

Everyone avoids me now,

Because they don't know what to say
They tell me I'll be there for you,
then turn and walk away.

Call me if you need me,

that's what everybody said,
But how can I call you and scream
into the phone,
My God, my child is dead?

No one will let me

say the words I need to say
Why does a mother’s grief
scare everyone away?

I am tired of pretending
as my heart pounds in my chest,
I say things to make you comfortable,
but my soul finds no rest.

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 How can I tell you things
that are too sad to be told,
of the helplessness of holding a child
who in your arms grows cold?

Maybe you can tell me,

How should one behave,
who's had to follow their child's casket,
watched it perched above a grave?

You cannot imagine

what it was like for me that day
to place a final kiss upon that box,
and have to turn and walk away.

If you really love me,

and I believe you do,
if you really want to help me,
here is what I need from you.

Sit down beside me,

reach out and take my hand,
Say "My friend, I've come to listen,
I want to understand."

Just hold my hand and listen

that's all you need to do,
And if by chance I shed a tear,
it's alright if you do too.

What are your thoughts after reading this? How can gaining insight into a woman’s
experience help you as a doula?

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