Monday, May 9, 2016

A Doula's Love Letter to Nurses

Having worked with obstetric, postpartum, and NICU nurses over the last couple of decades, I can honestly say that aside from the birthing/new mothers, nurses are the hardest working folks in the hospital.  I have developed amazing relationships with many of my local nurses over the years.  Honestly, having seen many a nurse catch a quick baby with skill and compassion when a doctor didn't get there in time, I know the whole system would fall apart without the skill and compassion of nurses.

These are my top reasons for wanting to shout out my love and appreciation to nurses this National Nursing Week.

1)  Nurses tend to REALLY understand birth

Because OB nurses spend far more time with a woman in labour than other medical folks, they usually have pretty developed Spidey senses when it comes to birth,  While a new medical resident may be apt to say things like, "You were 4 cm dilated only twenty minutes ago, so according to the progress of labour charts, it's not possible you want to push now," a nurse will rush around preparing the room for delivery, knowing that the sounds the mother is making means Baby isn't waiting for any chart.

I have seen doctors walk into the birthing room brusquely to ask questions of the birthing mother, and witnessed the nurse put up her hand and say, "Wait, she's having a contraction...let it end first before talking to her."  They get it.

2) Nurses set the tone

Nurses have immense power in the birthing/postpartum/NICU room.  When oxytocin flows in a relaxed way, birth and motherhood often unfold more smoothly.  When a nurse has respect for the birth/early parenting process and the family, no matter how the situation unfolds from a medical perspective, women often remember the FEELING of being tended to by a caring nurse. They carry that feeling in their hearts forever.  Even if the doctor on call that day is busy and doesn't take the time to connect while they do their medical tasks, the parents don't take it personally as long as the nurse meets the basic love and connection needs of the oxytocin besotted family.  Nurses have the opportunity to serve as the crucial emotional anchor,

Years after birth, reflecting upon their hospital experiences, my clients will go all melty and gooey when they speak of the nurse who was a kind presence in the room.   They will call her by name and use adjectives like "angelic" and "saintly" when describing her.  If nurses could only fathom the amount of love their happy patients carry for them, based on the few hours they spent together during the peak transformational experience that is the creation of a family, they would glow brightly with that beautiful sense of meaningful service.

3) Nurses are some of the hardest workers in town

Where I live, we generally do not have one on one nursing care when a woman is in labour or with her new baby.  A nurse may have two or three patients with intense needs at the same time. When things get really busy in their department, you will literally see nurses jogging from room to room.

I'm always quite amazed to see the nurses, some of them far older than I am, break apart the delivery bed and set things up with remarkable strength and speed.  As a doula, I know that supporting women in birth is a very physical job, and nurses do this ALL the time.

A nurse, in the midst of dramatic birthing or new parent/ baby moments, manages all her clinical tasks at the same time as listening to and supporting her frightened patient.  This is no easy feat.  To have head and heart engaged at the same time in the unique way nurses do, takes a level of skill I bow to.

I have also seen many nurses stay at a birth or with a tiny new patient an hour beyond their shift, because they knew their patient or little patient's parents were attached to them.  They committed to seeing them through until things settled.  In the throes of labour or worry, many parents don't notice their nurse is there after her shift has officially ended.  But I notice.

4)  MacGyver has nothing on nurses

If you want to be really impressed at the comfort measures that can be whipped out of thin air for in a pinch, come see a nurse in action.    I learn really cool tips from nurses constantly, like how to make a super efficient heating pad out of a wet towel and a placenta bag, or an ice pack out of an examination glove, or a peanut ball out of a stirrup and a pillow.  The fact that as a doula I carry very little with me in my bag besides  mouthwash and a change of clothes is because nurses have taught me the art of comfort measure innovation.

Where I live, supplies can often be low.  I have seen Baby's first diaper be made out of a Chux pad and medical tape by a savvy and apologetic nurse.  I have even seen nurses think to place a blanket near a sunny window (if the blanket warmer is busted) so it will be toasty and cozy for Mom and Baby after birth.

5) Nurses are Grace under fire

When a hospital staff runs smoothly as a team and everyone gets along, this is obviously the ideal situation for everyone. But I have witnessed shabby treatment of nurses sometimes by other staff members, or by those who manage them.  And, let's face it, not all patients are easy going and appreciative. Or, a nurse at any given moment may be reeling from a recent tragedy. As professionals, most nurses don't let on to their patients that they've experienced something crappy.  They dive into their work, and hopefully process it all later. I have sometimes walked out of a birthing room to get a coffee and beheld a nurse having a private teary moment in a stairwell.

Nursing can be a high stress, high drama job at times. It can be common for people to lose their tempers when challenged.  In my experience, it is usually the nurses who do the best job of keeping their cool.  They usually manage to continue their compassionate care of their patient no matter who is acting out that day.

The moments that have touched me most as a doula in regards to nurses are when their Grace comes through in the most human of ways.  When a birth is clearly traumatic to a mother, or if a mother has experienced less than glorious treatment by other staff members, or if there is a tragedy, I have sometimes witnessed nurses enfold their patients in their loving arms and share tears of sorrow with them, honouring their patients with their silent acknowledgement of sad truths.

To all the nurses who work with birthing and new families, I bow to you in honour for what you do.  I see you as you go about your jobs, and you have my respect and regard.  May all of you be plied with wine, chocolate, massages, and love this week.  I am grateful for you.  I celebrate you.  We at MotherWit Doula Care say THANK YOU!


Friday, May 6, 2016

5 Ways a Doula Can Help When It's More than the "Baby Blues"

Are you Pregnant?  Have you given birth within the last few months?  I want to ask you a question many people, your doctor included, may not think to ask:  how are you REALLY doing?

Recently I spoke to a lovely pregnant mama in a doctor's waiting room.  As a doula for 22 years, my Spidey senses told me something was up.  I initiated some general conversation, and after a while asked her mom-to-mom about how she was feeling . A shadow fell across her face.  "Well, you know, okay I guess."

"Yeah?" I responded, and waited.  And breathed.  In a small voi
ce she said, "Not so good. Everyone keeps telling me it's just hormones, but it's not passing.  I'm unhappy.  If it's like this now, I'm afraid of what will happen when the baby comes.  Can you get postpartum depression BEFORE the baby is born?"

The woman agreed to my gentle encouragement to speak to her care provider about getting a referral to a mental health professional, just for a check in.  If we have blood pressure or blood sugar issues in pregnancy, we get checked out.  Mental health care should be as easy and accessible to perinatal women as a childbirth ed class.  It sadly isn't, but that's another blog.

In honour of Mental Health Week here in Canada, I want to shed light upon the fact that up to 20% of women experience anxiety and/or other mood disorders like depression in the time surrounding the birth of a baby, making mental health challenges among the most common complications of childbirth.  It can happen postpartum AND in pregnancy.

When a woman experiences feelings of sadness, overwhelm, panic, intrusive thoughts, obsessive-compulsive issues, and/or anger (among others), she may be reluctant to share what's going on for her.  She can be afraid people will think she's about to harm her baby or herself, and take the baby away from her.  She often thinks her feelings are a character flaw, and that if she were a "better" person, she could pull it all together and be a "good", happy mom.

While in some cases thoughts of self-harm/harm to the baby turn into reality, the vast majority of women will not experience this extreme. But left untreated, mental health crises can and most certainly do arise, which make life feel unmanageable.  While maternal death is very rare in developed nations, suicide remains among its leading causes.  Any time someone feels at risk of harming themselves or their baby, this is an EMERGENCY, and must be treated as such.

Many women feel shame for being overwhelmed or apathetic when their pregnancies/babies are healthy.  There is a stigma around mental illness in general which deepens when it comes to motherhood.  If there appears to be nothing to complain about, many women feel guilty about expressing their pain.

But there is good news.  To quote Postpartum Support International, "You are not alone.  You are not to blame.  With help, you will be well."

A doula, being a trained, experienced birth/parenting support professional, spends ample time with her client, and can often recognize some of the signs that something is amiss. She can ensure the mother gets the help she needs as soon as possible.  Because the sooner the mother feels better, the more space she has to enjoy her pregnancy and her baby, which is healthier for the family long term.  We want to ensure a mental health professional can intervene before a downward spiral potentially happens.  Even though wait times to see one can be inappropriately long, feeling like something is done can be a relieving first step.

These are five ways doulas can help when it's beyond "the blues":

1) Doulas Listen

As a doula, I get to know the people in my care.  I listen deeply not just for the words said, but for the feelings behind the words.  I'm not afraid to ask, "Hey, how are you really feeling today?"  and am comfortable not glossing the spaces over with chatter.

If the mother is receiving messages from her friends and family that her feelings will pass, that it's "just pregnancy hormones" or "just the baby blues" even though her anxious/depressed feelings are persistent, we may be the only ones to speak up and say, "maybe this requires further investigation.  Why don't we call your midwife and you can tell her what you've been sharing with me?" Or, "I have the number of an amazing psychologist who specializes in perinatal mental health.  Why don't we call her right now for an appointment?"

A diagnosis made by a qualified mental health professional is important to get the ball rolling in the exploration of treatment.

2) Doulas Provide Resources

Professional doulas tend to be very community minded folks, and are well connected to the available maternity support resources.  A doula can share information about the importance of the woman contacting her care provider, and then help her follow up on the doctor's referrals to the appropriate mental health professionals.  A doula herself will often have a list of psychiatrists or psychologists who specialize in perinatal anxiety and mood disorders, and can share these resources with her client.

A doula will also have resources for extra support while the mother is waiting to see her mental health professional, or is in treatment.  The mom may be interested in seeing a massage therapist, nutritionist, or joining a support group for other moms going through similar things.

3) Doulas Provide Respite

Many doulas are trained/experienced in providing respite for struggling families, throughout the day or the night.  Feelings of isolation and inadequacy can make mental health struggles worse, especially when they're compounded by the exhaustion of the postpartum period.

 A postpartum doula can help mothers feel like they have a handle on things while she supports feeds, keeps the mom company, and tucks her into bed where she can rest secure knowing the doula is keeping Baby happy.  Or, perhaps Mom might need time with her baby and a little tidying or meal preparation done while she relaxes and bonds.

A doula always seeks to support bonding and to foster a sense of confidence and mastery in new parenthood. Occasional respite care can make all the difference when the mother is getting treatment or waiting to.

4) Doulas are on the Family's Side

Unsolicited advice is the bane of the pregnant/new parent's existence.  Everyone wants to tell them where it's at.  Your baby should sleep through the night at birth, you should be planning an all natural delivery, you should have an epidural, you should start your baby on a bottle right away, you should breastfeed exclusively.  Parents can feel like they'll never do anything right, which can weigh heavily on a person experiencing mental health challenges.

Doulas are there to provide parents support for their choices.  Period.  A family's life isn't played to the tune of any personal doula agenda.  Doulas most certainly provide parents with evidence based information, giving them more tools with which to make informed choices, however, they know that things must work for the ultimate health and well-being of the family.  When parents have explored their options and made a decision that contributes to the family's happiness (which generally contributes to Baby's well-being too), the doula will support them.

5) Doulas Honour Mothers

In our fast paced Western culture, we are often so busy trying to do everything "right" by finding the best information, we often forget to slow down and pat ourselves on the back for growing/birthing/parenting a new little citizen as best we can.  We are all already whole.  It's just that when things feel overwhelming, we forget.  Your doula will not forget.

As a doula, one of the things I try to do for people is uplift them with the honour I have for them.  Sometimes I will look at a mama with a new baby, tears of overwhelm streaming down her face, and I will hold her gaze for a while, seeing her in her wholeness (even when she can't see it herself). I see her tender vulnerability as well as her wild mama strength .  "I see you," I'll say.  And I will smile at her with my whole heart to show her that I uphold her as worthy an beautiful, letting her know that I believe in her.  Reflecting someone's wholeness back to them helps them to remember who they really are.

You are not alone.  This is not your fault.  With help, you will be well.

With love,