Nicole and Barry welcomed their third child, Silas Asher, on January 8, 2021. Nicole had experienced epidurals with her first two births but wanted to try for a different experience this time. She desired to feel her body’s cues, particularly during second stage so as to facilitate the pushing progress by listening more to her body and less to other people’s voices. Her body did some early ripening in preparation for birth, dilating 2 cm and 50% effacement by 37-weeks. Then a week later she was a “loose 3 cm”, so taking baby steps towards birth, no pun intended. And to make things a bit more exciting and confusing, she was up in the night with contractions off and on that eventually dissipated. Her uterus was busy doing things, just not yet going into labor.

Then nearly a week later Nicole was having regular contractions that were steady at 5 minutes apart. It was a sensible time to head to the hospital so Nicole could labor without the children underfoot. She knew she would be more able to tune into her body knowing her kids were taken care of. Nicole and Barry were in the car by 6:00 am and contractions had moved closer to 3-4 minutes apart. Nicole was dilated 5-6 cm and admitted. It happened to be shift change but Barry’s stern advocacy for his wife helped speed the process of moving to a room by 7:15.

Nicole labored about the room in positions that felt right to her. She was very calm and instinctive as she labored, and Barry was her constant companion through it all. I remember telling her she was strong and controlled, and she would look up and smile. Between her contractions she was peaceful, not anxious or scared. And this is not often the case when a woman has experienced multiple labors with epidurals. She found a trust and the desire within herself that she could labor through the contractions without pain medications. And she did not let the surges overwhelm her.

Nicole’s water broke on its own at 7:27 am as she sat on the edge of the bed. She told us it had happened, there was no need for anyone to declare it. The puddle gave it away! She felt her contractions intensify soon after and found that leaning over the birth ball upon the bed gave her a sense of power and also happened to be a great position to encourage her baby’s descent to birth. Barry and Nicole locked eyes and their connection was a beautiful part of Nicole’s labor. We placed cold cloths on her forehead and back and she heated them up quickly with her body. But she stayed focused and soon her body signaled that it was time to push.

Nicole labored her baby down and then pushed intentionally with the contractions she felt. Her baby’s heart rate dipped at times, which is not uncommon during the second stage of labor. But he always recovered with variability between. She followed her body and stayed focused. Again, her trust and commitment to her natural birth was astounding, and made even more so by the serenity of her countenance during this birth. Her midwife and OB encouraged her, and Nicole was able to hone in on what her body and baby needed her to do, especially at the end when her baby’s heart rate dipped even more. 

Silas Asher was born at 8:51 am on January 8 and placed in his mother’s waiting arms. Barry was beside himself with pride and joy, and Nicole’s beautiful smile was all we needed to see to know of her bliss. Those postpartum hormones are real and they do mighty work to encourage loving bonding. There was so much love overflowing in that space, such gratitude from everyone just for the privilege of being there, and gratitude from Barry and Nicole to all of us as well. It was a veritable love fest. The nurses and midwife were in awe of how Nicole handled herself in labor. Her confidence and trust in the process and her body were truly remarkable. She was the epitome of serenity. Honest.

Silas weighed 7 lb. 7 oz. and measured 20.5 in. long. But those stats weren’t determined until after the magic hour with his mommy and daddy for snuggling, breastfeeding, and getting to know each other. This birth was another reminder that every birth is new and different, and always presents the opportunity to see beauty in its uniqueness. From start to finish, Nicole was in labor for just 5 hours. With the craziness of a pandemic pervading so much of what we do, I am extremely grateful and hopeful that the simplest yet profound miracle of birth remains a constant. Thank goodness for that mainstay of optimism. New life, new hope, new possibilities, new love.

Lindsey and David welcomed their sweet baby girl, Delilah Moon, on December 18, 2020. Their birth was a great example of how unpredictable birth can be. It always keeps us humble. At a routine prenatal appointment and NST, it was noted that Lindsey’s amniotic fluid levels were low. Since she was already 10 days beyond her due date and had an induction just days away, they felt it best to err on the side of caution and begin induction that evening. Plus, Lindsey’s cervix was still closed so there was some groundwork to be laid.

She was admitted that evening for some cervical ripening overnight on December 16, 2020. A Cook Balloon was inserted along with some low dose Pitocin and Lindsey and David settled in for the night. But Delilah didn’t respond well to the combo as her heart rate fell low. The Pitocin was turned off and the balloon removed and the midwife was very pleased to learn that Lindsey was dilated 5 cm. The plan was for Lindsey to eat a breakfast, monitor the baby and resume Pitocin in an hour. Slow and gradual was the name of the game and the day consisted of increasing Pitocin and gauging baby’s response as to whether to raise it or turn it off. Just after 4:00 that afternoon, Lindsey was dilated 5-6 cm and the midwife broke her water. The hope was that her body would respond with contractions that moved to active labor. Their intensity escalated quickly, and with the Pitocin at 18.0 mu, Lindsey was coping with her strong contractions well. She labored beside the bed, slow danced with David, used a heat pack on her back, and continued to move.

Another bout of decels had the Pitocin turned off again, however. Lindsey was dilated 5 cm and 80% effaced but had not made a lot of cervical change since the morning. Her uterus would need more time, but it was anybody’s guess whether her baby would be able to tolerate labor for a long time. A fetal scalp electrode provide the reassurance of baby’s true heart rate in response to contractions and seemed a good compromise to keep the induction plan moving forward. Lindsey labored upright in the bed, hoping to get gravity to help. The Pitocin was still turned off based on her baby’s prior response to it. And the hope was that she might not even need it. She continued her labor dance drifting through child’s pose, slow dancing, dangling with the rebozo from the squat bar on the bed, and even lunges. And Lindsey’s hard work paid off because she went from 7 cm dilated at 8:20 pm to 8-9 cm dilated just past 10:00! In the throes of transition, Lindsey still found the confidence to say, “This shit is crazy!” followed by “I’m a badass bitch!” And indeed she was!

Hands and knees over the peanut ball provided some back relief and encouraged Delilah’s heart rate to recover from an earlier position that caused another drop. Valor essential oil gave an emotional boost as Lindsey edged toward pushing, and by 11:21 pm she was fully dilated. Her baby remained high at 0 station however, so there was still some work to be done. Lindsey reached out for Davey’s hand, something she did time and time again over the course of her labor. Their connection was a beautiful thing to witness. In the midst of a complicated induction, they were tethered to each other providing ballast through unchartered and choppy waters.

At 12:15 am on December 18, the Pitocin was resumed at a low dose in the hopes it would encourage Lindsey’s baby to move deeper into the pelvis for a vaginal birth. An hour later at 1:30 am and 4.0 mu of Pitocin, Lindsey made the difficult decision to get an epidural. She was exhausted after being up for two nights and laboring through contractions for the whole day, but also to salvage some rest before pushing. But soon afterward, the baby’s heart rate dipped lower and longer than it had before, bringing the OB on call to her room for a conversation. After palpating the baby’s location, he determined that an amnioinfusion might provide enough of a cushion to free up the cord and allow baby more room to fine tune her position for a vaginal. Birth. The plan was to rest, resume Pitocin (again), and then to push.

But then as if in answer to that plan, Delilah’s heart rate dipped again, this time even deeper and longer than the other ones. And the OB looked Lindsey in the face and said very gently that her baby was choosing a different road. There were concerns about the baby’s ability to handle hours of pushing, especially with decels happening that were already so significant. And Lindsey and David agreed that a c-section birth was the safest way to meet their baby. After laboring all day and dilating to 10 cm without pain medication, Lindsey opted for a complete change in plans for the safety of her baby. I have such admiration for moments like that, when a mother has to relinquish control and reframe her birth experience in such a vastly different way than what she had originally envisioned. 

And at 4:29 am on December 18, 2020, Lindsey and Davey met their sweet Delilah at long last. She weighed 6 lb. 12 oz. and measured 21 in. long and was every bit as perfect as they had imagined. And you would think this was where the birth story ends. However, Lindsey took a turn for the worse, and after receiving blood products her vitals weren’t improving. So she was rushed back to the OR for what they initially expected to be a quick fix. But it wasn’t. The doctor discovered some internal lacerations that required swift attention. Lindsey was put under general anesthesia and underwent emergency surgery that lasted several hours. Davey and Delilah had some quality daddy-daughter bonding time, while Lindsey spent the night in the ICU recovering.

At the time of this writing, Lindsey, Davey and Delilah are settled nicely at home getting to know each other and their new family dynamic. Lindsey is navigating early motherhood day by day, trusting her mommy instincts to do what feels right for her daughter. Davey is a constant support, helping and available just as he was during the birth process. Even in the midst of a downright birth odyssey and complicated postpartum, these new parents are thriving and moving forward confidently and full of love and patience for each other. They were adamant that their story be shared. Birth can look so very different from one person to the next. And even when you think you’ve made it through the most difficult part, there could still be a surprise lurking around the corner. And it is in this way that birth is the perfect training ground for parenting. You just never know what the journey will look like. You only know that it is a journey you must take. Flexibility, compassion, patience, and resilience, much like what Lindsey and Davey demonstrated, are incredible attributes for parents to have. They are definitely starting on the right foot.

At first glance, this may appear to be the opposite of what a doula would write about. But hear me out. Support and advocate are two words that have been erroneously linked to the doula profession but do a disservice to doulas and to the women they serve when used to describe what we do. Let’s break the words down separately. 

Support. I had never considered this word as inappropriate for doulas until hearing Michel Odent speak of it. Don’t doulas support? Isn’t that the end all, be all of our work? Well actually, it’s not. Stay with me, and Michel, for that matter. If we support someone, we insinuate that they require our assistance. To support means “to bear or hold up; serve as a foundation for.” It can also mean “to sustain (a person, the mind, spirts, courage, etc.) under trial or affliction.” While the second definition is closer to what we do, it’s still not correct. When a woman gives birth, she is the one doing the birthing. It is from her body, her mind, and even her spirit, through which her baby comes forth. She does not need her doula’s support to make this happen. Sure, I hear from many clients following the birth that they “couldn’t do it without my support.” But this makes me feel a bit self-conscious and it is simply untrue. It’s very important to check your ego at the door here and remind your client and yourself if necessary, that it was from her own determination, actions, and choices that she birthed, not because of you.

Looking at the root of the word, doula, can lend some further insight. Doula is a Greek word that means servant. And a servant is someone who is employed by another, or in service of another. Ah yes! Service. THAT is what a doula does for her clients. She serves them. She does not support them, a word that connotates she is required for her client’s success, in the same way a building would crumble without the support of its foundation. A doula is invited into a sacred space to perform humble work in service of another. A doula SERVES.

Advocate. This word has rubbed me the wrong way for about as long as I have been a doula. While it is true that doulas are champions of a woman’s agency, choice, and respect in pregnancy, birth and mothering, it is not the doula’s role to advocate for her clients. Unfortunately, the lines get muddied here, spreading misinformation about the correlation between doulas and advocacy far and wide. We see the word “advocate” listed all over the place in affiliation with doulas—on tote bags, t-shirts, stickers, even in the job description. But at the heart of what we do, we do not advocate for our clients. At least we shouldn’t. Our appropriate role as the doula is to facilitate our client’s ability to advocate for herself. And if she is not able to (i.e., in the throes of labor and unable to focus or communicate because she is too overwhelmed), then her partner can advocate for her. As the doula I will not rob my client of the opportunity to harness her own power and advocate for herself and her baby. The doula empowers her clients to do this for themselves. She is not to strip that power away by seizing it from her client.

There is an important caveat to this. When a doula advocates for her clients by speaking for them, she becomes the one communicating with the provider, further blurring the line between doula and provider. If we are to maintain separate roles, then our place on the birth team should remain one in service to the birthing woman and partner. If she seeks more information, we can help her to get it by encouraging her to ask questions and communicate directly with her medical care team. But it is not our place to discuss her care with the provider. There have been situations in which the provider talked with me about ideas for furthering labor’s progress, i.e., various labor positions and comfort measures, but they did not consult with me regarding medical decisions. There is a big difference here. Our clients must be the ones advocating for themselves. Not us.

If we are to stay true to the call of our profession as doulas then we are to serve our clients by facilitating their own process. There is no room for our ego in their birth. We are tasked to come to her side without judgement or preconceived notions, free of self-importance, agenda, and pride. Instead, we are to accompany her, bear witness to her, listen to her, and humble ourselves to her. Remember that as doulas we are servants. Our role is small in reference to the task of the birthing woman. We are mere satellites encircling her as she brings forth life from the depth of her power. She is the one to be elevated, celebrated, and in the simplest and most profound of words, served.

Avery and Davey welcomed their first child, a son, on December 17, 2020. This labor was quite the story and just goes to show that anything goes, even for a first-timer. Avery’s cervix laid some groundwork ahead of time, dilating to 2 cm by her 37-week appointment. While this can be exciting to some, Avery appreciated that it would not predict anything except that she had 2 less centimeters to dilate. And so she remained at 2 cm for the next couple of weeks, but continued effacing to 75-80% by the last week. 

Then a few days later, on her due date, Avery reached out to tell me she was having consistent contractions. It was 2:29 am at the time of the text, which was a clue that it must be something! She first felt the pain around 4:00 that afternoon but figured it was just gas. She ate dinner, took a bath, and went to bed at 8:00. But she was awakened around 10:30 that night by more consistent waves of pain that were oscillating 5-6 minutes apart, albeit short at 30 seconds. She wasn’t feeling pain radiating from her back at all like she had assumed she would, and the pain was focused low in her uterus and not as strong as she expected. I reminded her to hydrate and rest, saying all of the doula things typical to a first-time mom in early labor. And she reached out about 45 minutes later to tell me the contractions were getting closer but staying short, and certainly not strong enough to require her to stop and focus. We left it at that and she would update as things developed.

Around 6:45 am, over three hours later, Avery could tell that the contractions were definitely stronger and longer, lasting 55-60 seconds, and coming every 6 minutes. Rest was still a prudent plan so she would try to continue that. Then just before 11:00 am, the contractions were no longer tolerable in bed. But when she stood up they jumped close to 2-3 minutes apart and short again. What was going on? The inconsistent nature of her contractions hinted to her baby’s position being a bit off. So we thought the Miles Circuit was in order. Avery began the regimen and Davey texted to ask about when they should leave for the hospital around 11:30. That was another good sign things were progressing—Davey was the one texting, AND that he was beginning to think of the logistics for the drive to the hospital. An hour later, with contractions at the 5-1-1 range (thanks to the Miles Circuit), that quickly jumped to the 3-1-1 interval, it was time to head in. We would meet at the hospital.

And somehow in the process of decoding contractions, resting, taking a shower, and doing the Miles Circuit, Avery arrived at the hospital dilated 9 cm!! Oh my word! Clearly, Avery had mastered the art of laboring at home. The room was swirling with activity as you probably know—they were getting the delivery table setup and turning on the baby warmer, and taking their places. But Avery did a great job laboring beside the bed as she felt led, knowing her body would soon tell her when it was time to push her baby out. She tuned into what she was feeling and did not let the flurry of activity distract her. Then her water broke as if in answer, and she was thrown headlong into pushing after that.

As you might have guessed, Avery pushed well and was not afraid of the hard work it required. And after just about an hour of pushing, her sweet baby boy, David Thomas (the third!) was born at 3:12 pm on his due date! Avery grabbed for him between her legs and brought him instinctively to her chest. He was embraced with such love and elation, we all couldn’t help but revel in it as we watched this new mother so self-assured and grateful for the gift of birthing.

Little Davey weighed 6 lb. 13 oz. and measured 21 ½ in. long. He was perfect and adorable and he latched eagerly and fed for 25 minutes at his first go. For a little guy, he was healthy and strong, and had a fair amount of hair, and lots of rich vernix coating his skin. He was at home in his mother’s arms. And why shouldn’t he be? It’s nature’s proven method of keeping babies warm and secure.

Instinct was the name of the game in this birth and it translated to something quite beautiful all around. While COVID restrictions have affected some aspects of modern hospital birthing, births like this are such an important reminder of what is true and real and permanent. Women are strong. Babies know how to be born. And birth is natural. Welcome to the world and welcome to parenthood!

Amber and Eric welcomed their second child, a son, on December 17, 2020. Amber found herself growing anxious as her due date came and went. And the logistical details of getting her daughter situated during delivery didn’t help. So she opted for an induction with her provider’s blessing.  She had also had the unsettling news late in pregnancy that her son was in the breech position. Thankfully he drifted into transverse and ultimately head down, thanks to his mother’s diligence with positioning and maneuvers. Suffice it to say, she was ready to meet him. She had high hopes for a birth free of pain medication this time, but she also understood what she was signing up for with an induction. So she remained open-minded.

Her doctor was very patient and supportive and we are all so grateful for that. But by that evening, Amber was ready to move forward with pitocin. After a break for dinner, the pitocin drip began. It was around 6:45 pm, December 16. Slowly the level was raised. Amber was blessed with amazing nurses both shifts. But her overnight nurse was something special. A champion for natural birth, she was all about leaving Amber alone and giving her space and options. Although she was working harder with her contractions by 10:00 that night, her cervix remained 2 cm. Amber, who had been a trooper through it all was beginning to feel discouraged. We used essential oils to literally breathe new life into her labor. Lavender for tension and anxiety, peppermint for an energy boost, raven to help her breathe deeply, and valor for the hard work that was to come.

Shortly after midnight on December 17, we hit the official birthday and Amber hit active labor! Eric pressed a heating pack on Amber’s lower back and she labored in a variety of positions, breathing deeply all the while. Just past 1:00 she expressed her doubts about continuing on with her plan of avoiding pain medications so we suggested she labor in the shower. Amber did amazing work in there! Eric and I took turns spraying her with the shower nozzle and she faced each contraction with a renewed sense of courage and determination. And at 2:00 am she was dilated 8 cm!

Amber was so strong and mighty as she opened fully to 10 cm. It was a 40-minute process and the intensity was powerful. Amber labored down beautifully until it she could no longer resist what her body was telling her to do. And she pushed mightily and quickly brought her baby out. The doctor arrived with just a few minutes to spare and Charlie Keith was born at 3:00 am on the dot! And oh the tears! Eric and Amber both cried, overjoyed and elated by how everything unfolded. Charlie rested against his mother as his umbilical cord pulsed a full 5 minutes to completion before Eric cut it. Charlie spent time in his mother’s arms but she was quick to offer him to daddy for a snuggle. It was so precious and shows how sweet and generous Amber is. Eric melted as he looked into his newborn son’s eyes and Amber melted at the sight of her boys taking each other in.

In the minutes following the birth we heard joyful songs like “Celebrate” and “Happy”, perfect soundtracks for the happy ending of Amber’s labor. Charlie weighed in at 7 lb. 4 oz. and measured 21 in. long. He was just perfect. 

 At a time when the world is more aware of the medical side of things (aka COVID), it was a lovely juxtaposition to watch a natural process unfold and for it to happen with minimal medical intervention. It gave us hope for something better, something different in the grand scheme of things, but also reinforced that for Amber on a personal level. I know a natural birth was Amber’s wish in the beginning, but often it’s not until you look back from the other side of the experience, that you truly get the chance to ponder it. Everyone in the room was blessed to be there. It was good for us to see that birth works and that women are strong, and in spite of history, there is always the opportunity to move through a new and different experience. 

I am given such gifts by my clients every year—their trust, their willingness to include me on an intimate family journey. I am given the gift of seeing strength, vulnerability, courage, fortitude, patience, and love. And I am always learning and growing alongside my clients. I am also grateful to the couples who have trusted me to assist in their preparation through my childbirth education classes. You are also gifts to me.

So in return, I would like to offer you this gift of a slideshow retelling some of those memories shared. The images you’ll see are only those that had previously been posted on social media with permission. So not every single family is represented.

While it is no secret that 2020 was a struggle for all of us, some more than others, it still had some special moments. While my family came through the year rather unscathed, I’ll still admit some of the brightest spots were when I was standing alongside my clients as they held their babies in their arms for the first time. You are all so dear to me. Thank you, thank you from the bottom of my heart. Here’s to 2021 and hopefully an even brighter year for us all.

I am thrilled to announce the arrival of Juliet and Bill’s fourth child, a rainbow baby in fact, and my fourth time to serve as their doula. Mary Charlotte Lee arrived on December 2 at 6:13 am, the perfect end to a crazy year. Of course, there was the tailspin brought on by the COVID-19 pandemic, but we had developed a coasting approach to the new normal in regard to hospital requirements. But Bill and Juliet had also purchased a new home and were still unpacking and getting settled at the time of our prenatal visit, just weeks before Mary Charlotte’s birth. These parents took it in stride though. With three kids age 5 and younger, they were used to having a lot on their plates. 

Juliet followed her providers to their new location since they had taken such excellent care of her through every pregnancy. And she waited those last weeks for the signs she would recognize. But her body had contractions in fits and starts, so she was really unsure whether she needed to pay attention. Those contractions were doing something though, because she dilated to 3 cm before labor even began. One night she thought it was the night, but the contractions faded and she was able to sleep. In fact she overslept which would turn out to be a blessing since the following night the cramps returned and they didn’t go away. It was finally go time! Bill texted me at 3:00 am to let me know Juliet was going into labor. There was a drive and friends on the way to watch the little ones, so we decided to meet at the hospital. We got there around the same time, 5:20 am. 

Juliet walked through the front doors of the hospital and was immediately hit with a contraction. She clung to Bill and breathed through it and resumed her walk to labor and delivery. Her midwife met up with her and confirmed Juliet was 6 cm dilated. She had done good work in the past couple of hours. She was also 80% effaced and her baby was at -1 station so things were sure to move along quickly. 

Juliet politely answered the questions, and tolerated the monitor, and even the COVID test, and by 5:45 am she was moving into transition. “This is so hard,” she said and then moved and breathed through the next contraction. Bill kissed Juliet between contractions and always had an encouraging word to say. He held her hand and stayed right beside her. Once off the monitors, Juliet chose to sit upon the birth ball. We placed cold cloths on her forehead and back and she warmed them so quickly with her body that we had to circulate them after nearly every contraction to keep them cold against her skin.

Juliet’s water broke at 6:05 am which brought some excitement, immediately followed by a strong pushing contraction. Her nurse wanted to check her cervix to confirm but the signs were all there. Juliet was fully dilated and pushing. And her baby was coming! (Her nurse did do an exam and stated the same.) Then she called out for support. She called for anyone since the baby was already visible. The room quickly filled with several people but the one that mattered most to Juliet was her midwife. She came in behind the others and in no time was gloved up and ready. Juliet didn’t push long, maybe two contractions, and her sweet baby girl, Mary Charlotte, was born gently surrounded by loving support.

Juliet rejoiced with squeals to know her daughter was born and Bill looked right into his baby’s face and was wrapped. Juliet hugged her baby close and following her Mary Charlotte’s cues, had her latched by 6:30 am. We commented on how chunky she looked in the arms and legs and sure enough, Mary Charlotte weighed in at 8 lb. 2 oz. and was 20.2 in. long. She already had rolls and by the look of things, she was intent on growing more.

In a time that feels crazy and uncertain, it’s wonderful to have a job in which I see beauty, strength, wonder, and innocence regularly. It’s a beautiful opportunity to focus on the important things and to find my center. This family is a wonderful example of those things and I will forever treasure the memories we have shared in birth. 

I’ve been doing some soul searching the past few months in regard to birth, and the transition into a new year has brought the feelings and intention for change welling up inside me so much that I need to express them. So here I go. Those who are involved in the birth community of Hampton Roads as birthing families or birth workers, are aware that right before the pandemic hit our country full force, a beloved labor and delivery unit which included a midwife staffed birth center, closed its doors. This was a huge loss for our birthing community, one that was felt acutely by countless people locally but also spanned the globe as previous birthing families had moved away. After all, it had been in operation for over 25 years, and with our highly mobile military presence, their influence on birth and the beginning of parenting has spread far and wide. The Midwifery Center had tubs for laboring and birthing, which were a huge draw for many families. But more importantly, those who were intended to birth in the Center were met with openness. Their midwives listened and gave options, and trusted in the birthing woman and the innate safety of birth. And since there is always the potential for risk, the collaboration between midwives, OBs, and pediatricians, and nurses created the best of both worlds. As risk factors developed the elevated level of medical support was available. However, by and large, birth was safe and low risk, creating the opportunity for women to welcome their babies with minimal intervention. Options like intermittent monitoring, eating in labor to their comfort, laboring and birthing in a variety of positions, and even the option of laboring and giving birth in a tub were the norm. 

The pandemic hit like a tidal wave right as so many were adjusting to ache of such a loss. The OB practice reestablished itself in a different facility, and with change come growing pains. To be frank, there was some resistance from staff in part due to lack of information or understanding, but also because the expectations of birthing women were significantly different than the status quo of birthing the staff had grown familiar with. Women who had come to expect a certain sort of care from their providers, were having to conform their wishes to the hospital rules and protocols, all while navigating the fear and panic brought on by COVID-19. To be fair, the pandemic affected the labor and delivery units of all of our hospitals. They struggled to balance safety and choice, all while incurring the additional responsibilities like COVID tests, enforcing mask wearing, and a higher level of PPE for the safety of all. However, many thought some of the COVID protocols were extreme with the risks and benefits balance questionable. Doulas were excluded from the birth space physically, relegated to virtual support at all hospitals, except one. Only one support person was allowed, leaving laboring women to make difficult choices about who would attend them. Babies were separated from moms with positive COVID tests, and masks were required by laboring women until a negative COVID result was confirmed. Women who tested positive would be required to mask up for the duration of their births. Many families chose to give birth at home where they still had a sense of agency in who would be present and how they would birth. This was a very good thing for our homebirth midwives as well as the families served, for it gave them a higher level of recognition and appreciation, while shining the light on birth as a natural process. Our homebirth midwives had more work than they could handle. And many in the birth community were very excited about it.

Yet here we are nearly 10 months later, still adjusting to this new normal. Some restrictions have been lifted, like virtual doulas and separation of moms and babies, with others in place to maintain a reasonable level of protection from transmission of the virus. But it is possible to normalize, embrace and accept low intervention birth even in the midst of the pandemic. It does not require a huge overhaul in policy, except perhaps the addition of birthing tubs. The change would involve a change in thinking. The time has come. ESPECIALLY in light of the pandemic. Birth is the same as it always was. The way we approach it has changed. At a time when fear for our health and safety has overhauled so many of our daily routines, we need to remember that birth for most continues to be normal and safe. 

Collaborative care, evidence-based practices, and listening to birthing families, really hearing them out and having a dialogue with them, are what it will take to change the mindset of staff. And above all, trusting the birth process is absolutely essential. Childbirth education, in-depth thorough education about the process of birth brings a confidence to women—confidence in their bodies and their ability to tune in to it. And they also feel more comfortable laboring longer at home. But education and trusting the process must also happen from the hospital side. Childbirth education that goes beyond a standard medicalized birth is just as important for the hospital providers and staff serving laboring women. Yes, the interventions are there if needed or requested, but they should also learn how to serve a woman who does not desire those things.  The care is quite different. Education is crucial to change mindset. For example, when a woman arrives at the hospital in labor, why not trust that they are actually in labor and skip the triage room? Triage brings with it the assumption that a woman might not be in labor, as if she must prove she is in labor before soiling a room. Why not assume she’s right and commit by admitting her to a room? If she has prepared for her birth with an in-depth childbirth education class series, she is much more likely to present in active labor. Education is a win-win scenario.

Things like dimming the lights, while seeming superficial, can do a lot to allow a woman to follow to her instincts and limit distractions. Music can also have a wonderful effect on the birthing environment and the temperament of the laboring woman and her support team. Aromatherapy is another way to do this, creating strong emotional responses that can relax and empower the birthing woman during key points in labor. As she nears delivery, that is not the time for lights to be switched on, a crowd to gather, and lots of rushing about. Late second stage is precisely when a minimal number of necessary support people enter quietly (without loud side conversations!) and take their places. This will better enable the woman to continue to birth in the way she had been up to that point, with limited distractions and the support of her core team. Only a nursery nurse is necessary unless elevated risk requires the presence of a pediatrician. All others are extraneous and very distracting.

After baby is born, and the baby is transitioning well—this does not have to involve aggressive rubbing of the baby for many minutes—the initial birth cry and subsequent movements and color changes are indicators that baby is transitioning. Evidence shows that babies transition best against mom’s skin. Mom can rub the bottoms of the feet to keep baby crying and alert just as well as a stranger can. The trained medical staff can glean a lot by looking and listening to baby. Intervene if necessary, but in most cases it’s not. Covering baby with a towel against mom skin-to-skin is the best way to maintain baby’s body heat. Rubbing the wetness off (and the valuable vernix!) doesn’t amount to much. Keep that towel still on baby she they can remain warm against mother’s skin and also benefit from the microbiome being established in part by that vernix.

And when it comes to breastfeeding, the first hour, deemed the magic hour in birthing vernacular, is for mom and baby to explore each other. It is not the time to rob a mother of her power by grabbing her breast and the baby’s head and show her how to feed her baby. There is plenty of time for that. Remember, one sustained feed in the first 24 hours is a normal expectation, even after presenting the breast every 2-3 hours during the day, and 3-4 hours overnight. Keep the lights dim to encourage baby to open eyes and take in mom, and try to limit lots of extraneous noise and side conversation. This hour is magical, remember. And it is made more magical by empowering mom and baby to learn and discover hunger cues and smells. The help is there if they need or ask for it. But don’t jump to intervene at the slightest delay of a latch.

I would love for women to have the option of laboring and birthing in tubs again. The evidence shows that it is safe and an excellent comfort measure for women in the most active part of labor. It’s a shame that it feels a bit elusive right now, but I know it can happen again with proper planning and exploring resources. Birthing families want options and that is an option in high demand but very limited availability.

I have seen midwives and OBs work side-by-side to insure the best outcomes for mom and baby. But I have also seen these same providers trust birth and trust a mother’s instincts when conditions are right and all is well, to birth how she wishes. I have been welcomed and respected as a member of the birth team, working alongside the medical staff and my clients as a valuable part. I have watched women feel strong, empowered, and trusted to know the best decisions to make for themselves and their babies. And I have seen women move forward into motherhood with the best possible start because of such agency in their birth and the respectful support received. Let’s come together to create normalcy in birth for options, less intervention, and trusting moms, and most of all for trusting birth. It can revolutionize not only the way birth looks, but the way birth feels, and the way mothering begins.

Isabella and Corey are parents! They welcomed their sweet ray of sunshine, Callie Lucille, on November 21! It was such an honor when Isabella shared the secret of her pregnancy because I had been lucky to work by her side at many births. She is a nurse! But being a nurse can make it more challenging to be the patient, and Isabella knew this to be true. Her body dilated gradually and she felt waves of contractions come and go for weeks. Nighttime was the hardest because that’s when her uterus would gear up. She did Miles Circuit and was mindful of being restful, knowing she would need energy when those contractions organized themselves into active labor. Then on Saturday evening I got a text at 5;25 with a contraction pattern and the comment that “the last three have gotten really strong. I’ll let you know in another hour.” Isabella had felt the familiar bout of contractions 10-15 minutes apart, but they picked up in intensity around 4:30 that afternoon. I reminded her that she had been feeling contractions for weeks and unless they were different they were likely more of the same. And this was when Isabella assured me she really thought they were different. She would keep me posted and continue various positions as she was able.

Two hours later I got a text that Isabella and Corey were going to the hospital. And Isabella said, “I’ll let you know if we are staying.” So I waited to hear back. Wellllllll, it was definitely labor because when Isabella arrived her midwife did an exam and confirmed she was 8 cm dilated! Thank goodness I live close and was able to be there a few minutes later. I walked in the room at 8:20 to find Isabella working hard to stay centered during her contractions as well as in between. She was answering questions even as her contractions intensified, trying in earnest to help her fellow nurse complete her admissions tasks. Corey and I circulated wet cloths on Isabella’s head. She was generating a lot of heat from her transition labor! “I can’t do this,” did escape Isabella’s mouth, along with other things like, “I want an epidural,” but Isabella was rocking it and facing each contraction with courage and determination when they came. We recognized it as transition talking and knew she would have her baby in her arms very soon. Isabella was pushing by 8:55 pm.

Isabella welcomed her midwife’s offer to break her water, she was already pushing and we could already see birth was imminent. “Out, out, out, come out, baby, you hurt!” was Isabella’s mantra to Callie. They were working so well together every step of the way, as if Callie heard her mom’s words and obeyed. Isabella reached her hand down to confidently feel her baby’s head. I just love that moment of connection and awe so much! It doesn’t matter that Isabella had witnessed hundreds of babies being born. She was so captivated you never would have known. Isabella connected with her baby again and again in this way, and it spurred her on to keep pushing.

Isabella brought her baby to a crown and sighed and stretched as she gently eased her out. And Callie was born at 9:18 pm with her amniotic membranes around her waist like a skirt. She was such a girly girl from the start! Isabella grabbed Callie up to her and noted right away she did not have a tongue tie. And she also told her nurse she was comfortable with postpartum Pitocin if she felt it necessary. Yes, Isabella was definitely a L&D nurse. She smiled at her midwife and thanked her for catching her baby and graciously allowed her coworkers to pop in and congratulate her. I imagine they were jockeying for position to be in that room for delivery, knowing it was their friend, Isabella giving birth! Membership has its perks, because her midwife brought her some pizza and cookies from the staff room saying, “You get the reward for the hardest working nurse on the unit today.” No one would argue that! Callie was 19 ½ in. long and weighed in officially at 6 lb. 4.4 oz. But I have to give Isabella credit for her estimated weight of 6 lb. 5 oz.! Truly, mommy knows best.

Isabella had a greater challenge before her simply by being a nurse herself. She even finished her shift the day her labor got going. But she managed to take care of her husband’s needs—making him mac and cheese during labor to keep HIS strength up, assist her nurse—she helped her with proper ice pack placement, and even thanked every member of her birth team for being there. But don’t let her sweetness mislead you because I can vouge for the fact that when it comes to birth, she is a downright warrior with unfailing strength who is not afraid to let a few adult words slip from her mouth. It was such a joy to accompany this couple to parenthood. Well done!

Haley and Kent, repeat clients of mine, welcomed their second son on November 12. Her pregnancy journey was different than her first. Preterm labor was a concern based on her previous birth, so a cerclage was placed rather early on. It was removed that final month and we were all pleasantly surprised that Haley’s cervix held on and she didn’t go into labor until a day past her due date! I got a text at 7:40 am that Haley’s water had broken a couple of hours earlier. Verifying whether water has broken can be confusing even for a woman who has previously given birth. Thankfully Haley’s body began contracting and by early that afternoon she was heading to the hospital. We met up at the hospital right around the same time and I could see that Haley was forced to stop and breathe through her contractions. Walking up to labor and delivery, and knowing an exam was coming, Haley just hoped she wouldn’t be dilated only 4-5 cm. She wanted to be further along. And she was! Her midwife confirmed her dilation at 6 cm and felt membranes in front of the baby’s head. So perhaps the amniotic sac had not yet broken.

Haley was patient as they admitted her, including strapped monitors around her belly and doing the requisite COVID test. Once done however, when Haley got up out of the bed, she felt a lot more pressure. And the next contraction that came brought her down to her hands and knees upon the floor. Now, things had taken a significant turn. The shower was her next destination, for she knew the warm water would help her to relax and continue to cope with her growing contractions. She labored in several positions under the water flow and we saw some bloody show that hinted of further cervical change.  

Haley emerged from the shower nearly an hour later and her cervix was dilated to 8 cm and her baby’s head was at -1 station. She was vocalizing louder and longer through the contractions, and even paused between two to say, “I’m less chatty now.” Haley was entering transition, the hardest but shortest phase of labor. Her midwife chimed in with, “The smiles between contractions are gone.” But the greatest joy was coming soon! Haley squatted, clutching the rebozo anchored on the back of the bathroom door. She faced the physical demands of her labor with stamina and a willingness to do demanding things. This would soon be invaluable for soon after Haley began to push, her baby’s heart rate dipped. An oxygen mask was placed over her face and she pulled from her inner strength to push with all she had. She pushed with great effort, but once her baby’s head was born, the shoulder’s weren’t coming. There was a delay, but the staff mobilized and worked together with Haley’s strong pushes to bring Emmett Jesse out into the world in spite of a rather scary shoulder dystocia. He weighed 8 lb. 10 oz., by the way.

Emmett was a bit stunned at first and needed some respiratory support. But he transitioned well and was back in his mother’s arms as soon as possible. After working so valiantly to birth her son, poor Haley was left waiting and asking if he was okay since she didn’t hear his cry. We assured her he was fine and getting the support necessary, and in time he did cry on his own which brought tears to her eyes. When he was declared just fine and returned to her, Haley gathered her son in her arms and held him close. After putting forth such great effort she looked into his eyes and was lost in time and memory, seeing all she needed in that moment right in her son. Mothers are such warriors and goddesses, bringing forth life from painful and raw places that leave them so open and vulnerable, and yet strong and ready. Haley is definitely one of those. It was amazing to serve beside her through yet another dramatic birth journey.