Sunday, May 11, 2014

Random Doula Tip #1: TALK to Your Labouring Clients

Happy Mother's Day, Sweet Mamas!  I haven't blogged in a long while, and have missed it.  So I thought every now and then I'd throw out some random doula tips that have helped me along the way, just to throw y'all a bone.  Please know that these are my personal opinions and stories and in no way are meant to tell you what you should do if what you are doing in your practice is already working for you.  I certainly don't have all the answers.  Keeping in mind that Birth is a great Mystery which shifts every time you get cocky enough to think there is a formula, and that every vessel Birth moves through will express the energy uniquely teaching you something every time you witness it, my musings are simply ideas and shared from my heart to yours.  This will in no way replace your own knowledge and experience.

So, RANDOM DOULA TIP #1: TALK TO YOUR LABOURING CLIENTS:

"Well, duh, Lesley," I hear you all saying.  Hear me out for a sec.  I'm not suggesting I think doulas are busting out their best mime gestures to communicate or playing  rousing games of charades.  What I am suggesting is that you need to rely on your client's voice as much (or more) than you do her words.

Just to segue in to the meat and potatoes (or tofu and yams if you prefer) of this tip, let me share that my last "real" job was as a pastry selling, coffee making counter-girl at a restaurant called La Tulipe Noire in 1991.  After having a baby and beginning my La Leche League journey, I did my doula training in Boston with what was then Informed Home Birth/Informed Birth and Parenting (IHB/IBP), became ALACE, and is now ToLabor.  Then I hung out my "doula" shingle, and have been going strong ever since, having a few more babies, gathering many more skills along the way, and teaching lots of students to "do the doula".

All this is to say that I did not begin my career in "the communication age".  We did not have a home computer with Internet until  about 1999, like many people. So there was no information on line at your finger tips (Effective Care in Pregnancy and Childbirth by Chalmers and Enkins was the doula bible at the time), nor emailing clients to schedule. I had no cell phone.  If I was on call, I would have to check my phone messages from a PAY PHONE every hour or so.  These were the days you had to keep pockets full of change to use them.  Soon I got a pager, but I discovered that when I went on the Metro, I would not receive a page, so I had to check in via public phone every time I travelled around the city.

Now that I have revealed my dinosaur status and you can envision me rocking on my porch and shaking my head at you crazy kids and your electronic gadgets, you can imagine that it still amazes me that we can communicate by text.  Doulas receive intimate communications via invisible connections.  When I stared out, photos were still captured on film, so when I receive images of mucous plugs or poopy diapers within seconds of the image being taken, I still get little jolts of, "Wow, I never imagined this would be a possibility back when I started out!"  It is wonderful stuff.

And, we have to be careful.  Hence the name of my random doula tip.

You see, when we rely on text communication, especially when our birthing client is in labour, we miss the subtle cues the voice can reveal.  I emphasize this even more with women having subsequent babies, as their psychology can be different.  People having contractions for the first time are generally keeners. Everyone is different, which is why I say "generally", before people bombard me with how this was not their personal experience.  It wasn't mine either...my second birth was way harder and way longer than my first. So, "generally", meaning not ALL people, but enough overall to take notice and make preparations for the possibilities thereof.  Not having experienced contractions before, and not really knowing what to expect in terms of intensity, first time contraction-ers often go to their place of birth (or call in their support) early on in the process.  Ladies birthing again tend to be much more laid back.  They have done this before, and their experience has usually told them that it is intense for a fair amount of time before a baby comes. They know that just 'cuz it hurts, doesn't mean the baby is coming. They often don't want to jump the gun. And while this is wonderful, there is often a very predictable state of denial which settles over the subsequent birther.  I see this again and again, enough that I put forth this random doula tip: TALK TO YOUR LABOURING CLIENT.

The last few births I attended, for example, were of mamas having second or third babies.  Texts revealed that contractions were far apart, that the contractions felt strong. But no no, it wasn't REAL labour, it was more that they were probably just feeling scared by the fact that the veil of partial amnesia about the reality of sensation of childbirth had lifted and were smacking themselves in the head a little bit for deciding this might be a good idea to do again.  It was all fine, just being a little wimpy, no worries, go off and do your thing and I'll call you when I think I need to go to the place of birth/call the midwife.  Doulas, this might be denial.  It is not intentional, it is not anything weird.  It just very often is a reality.  Enough that I feel it worthy to mention to newer doulas.  You veterans know exactly what I'm talking about.  After my long and hard second birth, having already been to nearly 100 births as a doula and being an experienced mama, lo and behold when I went into labour with my third, I did the very same thing.  I did not realize I was in REAL labour until ten minutes before the baby arrived.  Accidentally unassisted.  So even if your client is a birthworker herself, pay attention.  I have doula-ed doctors who themselves catch babies for a living, and they can fall into this trap too.

The last birth I attended, had I not actually called the mother to check in and relied only on her texts, she would have very possibly birthed in her car.  And I can't imagine that being very fun. The texts said that contractions were about every ten minutes, lasting maybe thirty seconds.  If you take that information at face value, as a doula you're thinking, "Oh, that's gonna go on all day, and we are just beginning," and perhaps not be on alert. Given that I don't find timing contractions very helpful when it comes to figuring if labour may be progressing, and given she told me the contractions were feeling like they were kicking her butt, I knew texts were not going to serve our purpose. I had to hear her voice to satisfy me. So we chatted on the phone, old school.  Her voice revealed right away that oxytocin and endorphins were flowing (far away and sleepy sounding between contractions), that contractions were way longer than she thought (she was only counting the peaks as worthy of notice, cuz you're often more badass the next time 'round and aren't fussed by every sensation), and were actually quite close together (she had only been counting the BIG ones, and as we doulas know about some active labours is that often Nature gives you a "butt kicker" contraction, followed by a little "cool down" contraction).  Well, those "cool down" contractions COUNT!  They do stuff.  But since they are not not as challenging, they are often reported more as just "twinges" between the "real" things.

If this had been a person experiencing contractions for the first time, it wouldn't have felt as urgent to me, but because it wasn't, and because my job is to lay out information as best I can so clients can decide what to do, I did have to let her know that while I certainly couldn't know for sure, I felt perhaps labour was more advanced than she thought.  Given a reasonably long car ride, taking that into account would be prudent.  Let's just say it was a good thing we talked.

And in my experience, though I realize other people's experience may be different, this happens SUPER frequently.  Experience has taught me (and I am a believer that it is all academic until you've actually witnessed it a few times and grounded the knowledge empirically), to be on the ball with moms who have previous experience with contractions, and to let your mouth and ears do the communicating instead of your thumbs.

Happy Sunday, and Happy Mother's Day!

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