5. 2023 Year in Review: What I Learned from Supporting 19 Birthers this Year
In summer 2022, I decided I wanted to become a birth doula. My births have affected me in profound and startling ways, and I knew I wanted to be there with other people as they made their way through those journeys. I started my training in September of 2022 and got connected to the amazing Alycia Cullen at Advocate Birth, who allowed me to shadow her through prenatal meetings and a birth. I will never forget walking into that birth space — the first birth I’d witnessed in person other than my own. It was like walking into a different plane of existence. I could not stop crying when that baby was born. (I still tear up sometimes at births, but I don’t blubber anymore. Usually.) It was all so incredibly special, and I’m grateful to that mom for allowing me into her space.
I’m also so grateful to Alycia for giving me the chance to learn from her. She’s greatly influenced my ideas about advocacy and prenatal education. The absolute best thing I learned from Alycia is how common it is for providers to filter decisions about courses of action through their own values systems and then present the result to the patient as if it is the only option. Wow, that was a long sentence. I’ll do a longer post on this in the future (because it is FASCINATING), but let me break it down briefly here.
TW: discussion of stillbirth rates
Client A, whose had a healthy pregnancy with no complications, goes in for her 39 week appt where Dr. B tells her she can’t go past 40 weeks, and that they’ll be scheduling an induction in case she doesn’t go into spontaneous labor before then.
*RECORD SCRATCH*
Do you see how a decision has already been made with no conversation? Dr. B has decided what “the best” choice is without sharing her thought process and any research with the client and without taking into consideration the client’s own preferences and priorities.
Let’s magically teleport to a better world and try this again.
Dr. B: Hi A, I’d love to talk to you about some options we have as we get into these last weeks of your pregnancy.
A: That sounds great!
Dr. B: As you may know, the risk of stillbirth increases as your pregnancy continues. At 39 weeks, the rate of stillbirth is 4 in 10,000. At 40 weeks, it’s 7 in 10,000. At 41 weeks, it’s 17 in 10,000. At 42 weeks, it’s 32 out of 10,000. As you can see, the overall risk is very small, and it does also go up. [Source]
A: Thanks for providing those actual numbers.
Dr. B: Of course! I love giving you specific information so we can talk about what sounds best to you. Would you like to hear about what an induction would look and what the risks and benefits are at each gestational age? Then we can talk about what spontaneous labor would look like and the risks and benefits of continuing to stay pregnant.
A: That would be great! Thank you for treating me like a smart and capable adult and providing me with nuanced, accurate information.
Dr. B: Duh! Nuance is my favorite. Let’s go over your individual risk factors too, the things that make you more or less likely to experience a stillbirth. I’d also like to thank the insurance companies in this magical better world that reimburse for patient visits longer than 15 minutes so we actually have time to talk about all this.
END SCENE
(Side note: If you’re interested in how different people make medical decisions, check out Your Medical Mind by Drs. Jerome Groopman and Pamela Hartzband. It’s a great read that shows how people have different underlying medical philosophies that influence how they make care decisions. They don’t talk about birth specifically, but it’s incredibly relevant to the perinatal period, which, in my humble opinion, has a greater sense of perilousness because people don’t trust women and birthers to make decisions about their own bodies and babies. But that’s a post for another time…)
So again, thank you to Alycia for illuminating all that for me. It’s something I love to discuss with clients, so they can figure out which questions to ask providers in appointments to get the information they need to move forward.
Anyway, back to my year in review. I took my first doula client in February 2023 and have supported 19 births in total this year! Most of them have been at Northside Hospital Atlanta and Emory Decatur, and I’ve also supported at Wellstar North Fulton Hospital, Northside Hospital Forsyth, Emory Johns Creek, Emory Midtown, Piedmont Hospital, and the Atlanta Birth Center. (I would love to serve birthers at Wellstar Kennestone, Northside Gwinnett, and Grady in the future.) The earliest I’ve been interviewed by a client was as soon as they found out they were pregnant, and the latest I’ve gotten hired was when the client was already laboring at the hospital (yes, it happens!). I’ve supported clients through planned Cesareans, in-labor Cesareans, vaginal births with and without epidurals, inductions, and precipitous births.
What have I learned?
Every birth is different. I know, I know, this sounds so obvious. But it’s true on every level. I think it’s human nature to look for patterns in our experiences, and to some extent this is helpful. Every individual is so unique though that what happens at one birth isn’t always relevant to the next, even if it looks similar on the surface. I try to strike a balance between building my foundational knowledge of birth and birth support and always learning from past experiences while also approaching each labor with fresh eyes.
People will surprise you in good ways. The nurse who seems run down and overworked will stand up to the provider for the birther. The doctor who was frazzled earlier will come back kind and compassionate. The partner that was always quiet in prenatal meetings will step up in a huge way when the birther really needs their support.
Everyone has their own stories, past experiences, and values, and these will heavily affect what they do and don’t want when it comes to birth. I’m lucky in that I get to spend lots of time with clients beforehand, so I can get to know them deeply. Usually, providers don’t have the time to get to know them on a personal level, so my job is sometimes quickly providing context and background to the provider (with the client’s permission) to help the provider better understand them.
On that same note, a positive birth experience looks different to everyone *because* we all bring different things with us into birth. I try hard to recognize when my own personal thoughts on birth and my past experiences might affect the way I respond in different situations, and then I aim to deal with those thoughts and feelings in an appropriate way so that I can best support what an individual client wants.
Lots of things can get lost in translation in the hospital. Providers can talk next steps with nurses and forget to include the client. They can resort to medical jargon and forget to explain and clarify. Sometimes providers can even sound condescending (e.g. “You just let us worry about that right now.”) when I think they actually mean to be reassuring.
The challenges birthers face in labor (and the lead up) are often not what they expect. Inductions, long labors, short labors, getting to the hospital really early, getting there really late, deciding to get pain meds when they didn’t want them, etc. can all throw people for a loop. That’s why it’s so important to work on those skills that will help you navigate the twists and turns of birth throughout your pregnancy.
Trust moms and birthers. If they say the baby is coming, believe them! If they say they are in too much pain, believe them! If they say something doesn’t feel right, believe them! They’re more connected to their baby than anyone else. All the technology in the world can’t tell us how a birther feels, which is why it’s so important to ask good questions and listen to the answers.
I’m so honored I got to support each of these birthers, and they’ve taught me so much about resilience, courage, empowerment, and compassion. I learn new things at every birth I attend, and I carry those with me to better support my future clients. It’s no wonder my packet for the first prenatal meeting with clients is currently at 44 pages!
I’ve taken a break from supporting clients in December and am now eagerly awaiting all the wonderful births that 2024 will hold.