#196 | The Toughest Part of Being a Doula with the Dynamic Doulas of London, Ontario

January 18, 2023

Sarah Hutchison & Lara Martens are the Dynamic Doulas of London, Ontario. Doula work is a delicate balance of keeping a "soft front and hard back", stepping-in and and not overstepping.  The fact is, doula burnout is high, the emotional work can be heavy, and the lifestyle is challenging. But as any doula knows, those who are called to the work can't imagine doing anything else and the rewards of supporting mothers in achieving their birth goals are tremendous.

Today's episode is an "off-the-record" kind of conversation between us and this "dynamic" doula team, where we get into the heartfelt anguish of being a doula. In today's discussion we explore: What do women really want from their doulas? What's the hardest part of keeping a client happy? Should doulas take on any client who's willing to hire them, or should doulas be selective about whom they choose to work with? How can doulas avoid burnout? How far should a doula go in advocating for their clients and how do doulas manage a client's unwillingness or inability to speak up for herself when faced with an unwanted intervention? How can doulas support women whose birth values starkly differ from their own, and what should doulas do when they suspect the woman's chosen birth location has firm policies in contrast to physiologic birthing? Should doulas speak up more or less, and to what extent do women expect doulas to go beyond birth support and assume the role of protector and advocate? Whether you're looking to be a doula or hire one, today's episode gives you a behind-the-scenes scope into the demanding lifestyle of providing emotional, mental and physical labor support to birthing women and their families.

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They felt like they made an informed choice. And then when they comb through it later on, then they realize, Oh my gosh, there's so many things that were traumatic. And I did have a doula there. So how did that go? So wrong?

That Yeah. And then they'll say what you knew? And it's right. We didn't know. And so then this becomes this super difficult place where, what is stepping in, and what is overstepping?

I think that's a huge part of the burnout is, I tell myself, yeah, I can go support this obstetrician birth in the hospital, and maybe it goes well, for the first little bit goes great when you're at home, and then you get to the hospital. And then you see a few too many aggressive cervix checks in the course of eight hours, and then you start questioning all your life choices.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Hi, we're Sarah and Lara, the dynamic doulas of London, Ontario. Sarah here I am a kinesiologist. I came to birth because I was pregnant with twins and I started down the midwifery path. And then after I had my boys, I just was obsessed with it. I wanted to know more. I loved my doula and I wanted to be her. So here I am. I have two 11 and a half year olds and an eight year old and and became a doula and between them and then Laura and I've been working together for four years.

And I am Lara. I started out as a massage therapist still am. I got really into doing prenatal massage. And then that kind of trickled into doula work after I had my first baby. I had a doula for that birth. And it was a very fast, intense birth. And I would have paid my doula a million dollars if I could have and I decided that's what I needed to do and add to my practice. So I also have an 11 year old and a nine year old and I'm a girl mom, Sarah's a boy mom. And I love working with a partner. It's amazing. It really is. We think so? Absolutely. Do you guys tag team, all your births? Do you go to together?

We don't know. We go individually. Our clients would love Yeah, that's gonna say that's like, wow. I've said for years, you're already the hardest working and lowest paid women in the industry. So tag teaming doesn't exactly work with the numbers.

That's true. There is a price for everything though. Somebody wants that. I'm sure we would make it happen. He would just charge for it. Of course, of course. Okay. So, one reason I was excited to talk to you guys today after we were emailing a bit, and I was hearing your thoughts on some things is, when I got into the work that I do, I started working really closely with a lot of doulas, and it was very eye opening. Because I was a mom who had a doula. I had one at my first birth. And I had my notions of doula work. But then when I started becoming extremely close friends with doulas, I thought, oh, my gosh, the burnout rate is high. We need a doula support group. And a lot of my own clients who had beautiful births became so moved and inspired by birth that they themselves became doulas. And I always saw that within time, many of them would just get a little, I don't know, discouraged, just emotionally beaten, they just ended up experiencing second hand births that I guess they didn't want to believe were happening. And they themselves didn't experience. So they were going into it looking to relive their own birth and experience more and more beautiful births in their lives. But they, they experienced this whole other world of birthing out there. So I'm wondering if we can start by you commenting on that?

Absolutely. We love to go into birth with this idea of having a soft front for our client and a hard back to watch for what's coming. Because the reality is, as much as some training bodies tell you you're not there to advocate and that you're just there to provide the hand holding and the soft skills, you know, to in to stop some of the trauma that's going to happen. You need to be able to say what you're seeing is about to happen and to articulate it and then ask for a decision and decide with your client how you're going to approach that. But that is exhausting. I don't think the majority of doulas get into this work because they want to be an advocate. And then that's three ality of the work and advocating is exhausting and experiencing secondhand trauma. I mean, it takes you out. And I would say that's one of the best parts of being in a partnership. We always tell doulas, like don't try and do this alone, there be many times that I think we would have burned out if we didn't have each other to, you know, talk each other down when we've had a really hard birth. And they do say like burnout is three to five years. So I mean, we've been doing this for more than that, but together in a really big way, where we're doing over 20 births a year each. That's really only been the last four or five years.

Yeah, yeah. I think that a lot of doulas get into this work because of the glorified picture of birth that we're seeing now on Instagram on tick tock of twinkle lights and beautiful photography, and that that's what this work is like. And yes, sometimes it is. And we are blessed with attending these beautiful births that are twinkle lights, and tubs and beautiful music. But there's also a lot of very, very hard emotional work that goes into it as well as a doula and to I don't think that you can teach anybody that I don't know if you can prepare anybody for that. It's really just comes with the experience.

And I think in the beginning, when a doula gets into this, they really are bought into the idea of a doula for every woman. And that I am here to support all births. So whatever you want, you want a Syrian great, you want an epidural, great, whatever you want, I'm here for it. I think for us, now that we're this far into it, when we have a consultation with a client. I mean, we're really looking at, you know, here's your values, here's what I'm hearing. And here's what we're offering. And, you know, if someone says to me off the hop, you know, I've hired an OB, they're really great, I trust them. And I'm just happy to go with the flow. Like, that's a red flag for me. Right. And so, while we think as women, that that's a beautiful trait to go with the flow, I mean, really, what that says to me is that you're gonna go for every single intervention that comes your way, and that you're going to think it's in the best service of you and your baby. And so when an induction is suggested at 39 weeks for no good reason, you're gonna be like, Sure, that sounds great. And then when I would maybe ask the question, that I've now determined already from the console that you're not open to have, you know, do Do you feel like an induction is the best choice for you or for your birth? Is that what you're desiring? Is that feel like you understand the medical necessity and consequences for that? And they're like, well, ob suggested it. And so obviously, you know, it must be right.

How do you handle clients like that? Do you screen your clients and an initial consult and pick and choose who you work with, based on whether your values align?

I think that a lot, we're pretty lucky in the sense now that we do have a really great presence on Instagram, and we have a lot, presence, a lot of information out there in terms of our website. So I think a lot of people are almost pre screened for us. And then by word of mouth, we're getting a lot of referrals from people who want birth, that usually sounds like people saying, you know, if I'm gonna get an epidural, it's because I'm many hours in and I'm exhausted, but I really want to try without like, there's, there's not as many clients coming in that are like, I want one right away. And I'm open to all the interventions and and then I think we would even ask that question like, What are you hoping for in terms of doula support? If we're in the hospital with you while you have an epidural? And what does that look like to you? And what are you hoping from this package? And we I think, in the beginning, we had a harder time asking that, you know, like, really just blank, what are you expecting from this relationship? What are you hoping for? You know, and so we say that now and yeah, we we definitely screen in terms of like, who we think you'd be best fit for on our team? And I'm pretty Yeah, I'd say so.

What do you think people are looking for when they hire a doula? I think that many women now feel that it's just like, like a box, they have to check like, it's, I should have a doula. This is what I see. This is what I hear. Everybody has one. It's supposed to make my birth better. But what do you think people are really looking for when they hire a doula?

I totally agree. I think a lot of times that they don't really know what they're looking for. Usually, the first question they ask is, what is it actually that you do? So in those intakes, a lot of times if they are planning an epidural, we can talk through like, what our support looks like during an epidural, and what our support looks like when you're trying to avoid one and that we're kind of a Sherpa, a personal trainer, a wedding planner, but for your birth. And also the other question that we get asked all the time is do you replace my partner? So that's always a fun one to talk through how we know birth and you know each other and our goal is to bring more intimacy for the two Have you and help your partner be a better support person as well.

The very notion that most partners can be birth support is a little bit funny because like in some birthing programs in HypnoBirthing partners are called Birth companions. But I mean in the Bradley method, which certainly has its merits, but they've called it like husband coached. And first of all, the husband part is problematic, because that's not always the case. But the coach part is problematic, and we can joke about it. But I, you know, said to a lot of men over the years, it's like, you are the last person who should be telling anyone how to give birth. So I hope you feel a weight lifted, because it's not my job to teach you how to tell someone else to give birth. This is a mother led experience. This is an intimate bodily experience, just like sexism, intimate bodily experience, no one has to like come out of that experience, and engage with someone else to describe or be coached through what they're experiencing. So what is the birth companions job is to be lovingly present, it's just be present. Like I always say to my clients, I hope she looks up in, in birth, I hope she looks up in childbirth, and sees your loving eyes looking right back at her and, you know, talk amongst yourselves about what you really want. But I mean, it's my personal hope she doesn't look up and see you looking bored or watching movies on your iPhone, unless she tells you, hey, go ahead, but I wouldn't have wanted that from my husband. But that's a very different role, from the person who's rolling up their sleeves and giving you that saying just the right words to support you through it, stroking your head or squeezing the hips or helping you into another position. I love how you said it. We're preserving the intimacy of your relationship because that partner is now relieved from having to physically coach her through childbirth. I've seen doulas go through some extremely difficult experiences in our work over the years, and some of them come to mind as I'm speaking. There was one friend of mine was called in the middle of the night, put on her scrubs. That's what she used to wear to her clients. And she was working with a single mom who said, I'll text you when I'm ready for you. I'm not ready for you yet. And she was sitting in her car on a pounding raining night, in her scrubs in the car just waiting to drive waiting for the Go ahead, like okay, come now. And after a very long while, the woman texted back, I've changed my mind. I don't I don't want you anymore. And she just felt so defeated. And that was that was also when she learned to collect all of her money upfront before the labor because she ended up going through that experience and learning a very valuable lesson as far as the sport she lived through pregnancy and what she went through that night and didn't get paid for it. And that was a shame.

No, it's just very hard work. I think it is. And I feel like that's the beauty of having a backup like in an ideal scenario, she would have been able to send the backup.

I mean that sometimes we've had clients who were disappointed with backup, postpartum and birth clients who the person that they wanted was not the one who showed up and even that's a discipline treatment and then need to have a healing discussion after the fact it's a lot of pressure, when really the service that we're selling is our self. Like our clients get bonded to us as almost like a stuffy, like a support animal who they're very attached to a lot of the time. I think it helps Sara and I that we have a presence online together so that our clients see us together and often. So if they do follow us on social media, I do find that that helps specifically our clients. know both of you, you're saying, Yeah, I do. And I think because we do so much together, it does feel like our support is fairly interchangeable. Because even if I take a course, I'm talking to Laura about it, if I started changing the way I feel about something, and I'm talking about something differently. We say things like even things like when we say you know each other we know birth together, we make the perfect triangle. You know, that's something that like, I don't even know who said it first at this point, we just both say it now. So that feels like we're more interchangeable. Whereas for some of our backups, there may be not showing up on screen as much as we are if at all, which is fine. That's not their energy. But it means that they're in the 5% chance where you get a backup and not your primary. It can feel to feel like a letdown. Yeah, this happens in midwifery homebirth. Yeah, exactly. Just just the same. But I think the important thing is that when you take on a client, you let them know that that's a possibility. And they must understand and agree that if you are not able to be at their birth, that there will be a backup. Who they may or may not know. I mean, look at my experience. Attending Cynthia spur. She had never met me. She was coming. The other birth assistant wasn't available. And so it was me. And but you have to have that conversation at the start of care, so they understand that that's a possibility. Because you're one person and you can't be in two places at one time. Yeah. And we tell our doulas all the time, like our postpartum and birth teams like life happens. Kids get sick families get sick and have to cancel at the last minute. Flat tires happens. Vacations happen. Someone goes four weeks early. Yeah, we had one of our doulas have a miscarriage this month. And she had to cancel a bunch of bunch of her postpartum shifts like, we need humanity to have a little bit of compassion for each other. And I think for that doula, I think you're right that if she had shared with them what she had been going through, I mean, I hope that that client would have been a little bit more understanding, but who knows who can't make assumptions about what people's behavior will be?

Totally back to the question you had at the beginning about why do people hire us in do Are they just checking a box? And absolutely, I think so. The other part though, there is attaching an outcome to what they think will happen when they check that box. So thinking that when I hire a doula, then I'm not going to have to change myself or do any work on myself. I've now hired a doula This ensures that I don't have a traumatic birth and this ensures the birth I see on Instagram with like Laura said, The twinkly lights, the home the home birth, maybe the birth in the tub, or maybe they think I've got the doula with me. So now I can just circumvent skip the home birth part. I can just have that birth in hospital, which I love how I think it's Rachel Reid says, you know, we should be more surprised that any physiological birth can happen in hospital. So when you're taking your doula with you thinking that she is the key to your physiological beautiful birth, and then the outcome doesn't happen because you've now outsourced your power to a doula. You think that that checkbox means you don't have to do the hard grimy work of learning what the system of birth actually is, like, learning about what those interventions are, and learning what it is that you need to avoid and how to protect yourself protect your oxytocin. I mean, we obviously talk about all this in our prenatal class, but to really get that sometimes I feel like people are like, but that's what I hired you for, right?

The one key to any woman's best possible birth is the degree is responsibility. Yeah. I think that this is the first lesson every woman needs to understand. But I do want to ask you, um, I think what would be hard for me is this. In your work? I think everything about it would be hard for me. Honestly, I think it's our doulas do their work. But what do you how do you support people when they're very values are at odds with yours? Yeah, what I mean, you obviously no one goes into this work without feelings and opinions. And that's okay. I mean, I don't teach my childbirth class like a computer. I have passionate feelings about things. I believe they're rooted In evidence, but I'm also entitled to my feelings. I'm entitled to say that doctor is abusive, and he doesn't deserve to work with you. That's your opinion. But what do you do when you're supporting a woman who is in the hands of such a doctor? Do you feel your? Do you feel it's a self betrayal? Do you feel you're betraying her? Do you go home and with a feeling of conflict or guilt? I feel like that part would be extremely difficult. So what do you do about it? Or say no to those clients?

Yeah, right. I think that's a huge part of the burnout is, I tell myself, yeah, I can go support this obstetrician birth in the hospital. And maybe it goes well, for the first little bit goes great when you're at home, and then you get to the hospital. And then you see a few too many aggressive cervix checks in the course of eight hours. And then you start questioning all your life choices. And then you go home and you cry for a few days. And you talk to your doula team. And maybe you don't take on a hospital birth for a few weeks, a few months, and then you find yourself there again, it's really, it's really complicated.

It is because you can have that intake where you feel like you're on the same page. And then for various reasons, you know, maybe becomes a transfer of care. And then it becomes an induction, and then it becomes a 36 hour induction. And, yeah, and then you're in it. For all of it. I will say we spend a lot of time texting each other and our doulas so that they feel supported when they're mired down in the birth, dust the fog, right where you think you're doing nothing of value, you feel like you're just sitting there contributing to the gross SNESs that to be reminded that you know what, you need to go out and get a drink and go to the bathroom and wash your face and come back or even let's take out for five hours. Because sometimes you're just stuck in it, and you just have to get through it. Because there wasn't a way to prevent getting yourself into it. And it is exhausting in that. The I think you've hit the nail on the head. That is the burnout, for sure. Yeah.

What do you do? Do you ever say you do you ever say to the client, you have the right to stop getting these cervical exams? Oh, yeah. Oh, and so is the difficulty in not saying that to her. But it's the difficulty in when she says, Well, I'll just It's fine. I'll just let the doctor do what they're doing.

Yeah. And then and then they years later you hear from them when they're about to have their second. And all of those things that you saw that you know, were, you know that were going to cause trauma they consented to in the moment, they consented to having a cesarean when they had been pushing for a few hours, they consented to getting that epidural at 10 centimeters like all of these things have been consented to. They felt like they make it made an informed choice. And then when they comb through it later on. Then they realize oh my gosh, there's so many things that were traumatic. And I did have a doula there. So how did that go? So wrong?

That Yeah. And then they'll say what you knew. And it's right, we didn't know. And so then this becomes a super difficult place where, what is stepping in? And what is overstepping, right, I can't say to you in the moment. You know what, Cynthia, you're gonna register these cervical checks as trauma traumatic in two years from now, even though right now they feel like it's just a nurse who wants to know how dilated your cervix is, like I I can say, you don't have to have these you can turn them down. But in the moment, do they even know it? Let's say even they're not particularly uncomfortable. I think it's only in retrospect, when they're like compounding them. They're like, wow, I had eight cervical checks or 12. And, and I did I really need those. And yeah, that's such an obstacle for us to know how much especially because we run a baby group. So we're sitting down with eight to 12 of our women afterwards, and they're all telling their birth stories. And I often wonder after that, when they're sitting there, listening to a birth story, looking at us and thinking, Hmm, you see this over and over again? What are you thinking, how can you not prevent this? And why is this happening into women? And then there's the, you know, two out of the 12 that are what seem like the unicorn births. And those women even feel shameful telling their beautiful stories, because they're like, Oh, mine was so simple and easy. I don't have any trauma to share.

I don't want to cause hurt. Yeah, I feel like I feel like if I were in your shoes, and all I can do is speculate, I feel like as long as I said to her, you have the right to decline. You don't have to get these. I feel like if I said that, at least her future feelings about it really wouldn't be my responsibility. And many women aren't traumatized by cervical exams, but I think as long as I'm not going home feeling of self betrayal, but if I were quiet, and didn't say something when I might have been able to help her or influencer, I think I wouldn't be able to do that. I think the self betrayal would be the first thing that would, that I couldn't tolerate. But if you're true to your values and your, your, you're reminding her of her rights, it is in her hands what she chooses to do with that information. And she may change her mind later and regret it. But you're doing art, which is all I can do. That's it like, that's all you can do. But some doulas stay silent and watch the abuse. Yeah. And I think that must eat them up on the inside. I just think that's, I think that's the thing. A doula is for a lot of people, we have to remember that hindsight is always 2020. And that people don't know what they don't know until they know better. And, in some cases, people have to learn for themselves, it doesn't matter how much you tell them in advance. It doesn't matter in the moment that you tell them that they have the right to decline. Many people have to go through experiences for themselves before they embody the change of mind.

I've sat with so many clients who even though I'm sitting there being like, please eat like, Yes, I know the hospital is telling you you can't eat Yes, I know. They're telling you you're going to ask right when you have this scenario and under General that they're dangling in front of your face. But like, please, if I could just know what the difference would be if you just ate and they still won't do it because they don't want to break the rules like that stuff is what keeps us up at night.

The one that keeps me up at night is the the speed with which everything happens in the end. So they're pushing, there's fingers in and holding tissues apart. And there's manhandling of the baby's head. And you've got this OB who's got 15 years of school and 20 years experience just doing their thing. And then babies on the chest we know maybe after an episiotomy or not, which I mean, again, we will be saying they're they're picking up the scissors, they're gonna give you an episiotomy Do you consent to this, and then baby's on their chest and they're scrubbing the snot out of this poor baby. And I'm saying you know, touch your own baby, talk to your baby. And you know, then it becomes like, how much fight do I have in me to to go up against this OB to say my clients and I have talked about the fact that she would like it to be her hands on this baby but everything's happening in such a rush. And the OB is trained to stimulate tactile stimulation for the baby immediately. And they're looking at you like, oh, cool, so you want the baby to die. Like, you're like you're set, you're psychotic. And there's no understanding of the physical, physiological approach that we're trying to talk through. And that's the ones where I feel like I go home. And I think, you know, how could I have said more? How could I have stood up more? And actually, what is the expectation of some of these? I mean, we're talking about hundreds of births. And how does a doula who's gone for a couple weekends of courses, stand there with OBS, and we have, we're in a teaching hospital here in London. So you've got a ton of residents standing there. And then you've got a pile of nurses, and especially if you get wheeled into the OR, and, you know, even if you're allowed into the or, you know, and so then you're supposed to be this person who all of a sudden chimes in and says all the things that your client, oh, like, Well, the interesting, that interesting thing that I have never done a doula course, but from what you're describing, it sounds like doulas have done the courses. Maybe not that extensive. And maybe it's really just about learning how to support a woman emotionally through labor. But now doulas have taken on this huge role of advocacy in birth, and they're self educating. And just the same way, you know, pregnant moms are, so many people are learning for themselves about their birth rights and what is acceptable in birth and what is not. And now you're sort of in this role of taking on this extra level of service to them. Yet, it's difficult because if you're up against the midwife or the obstetrician, like you said, you have this small little segment of education, but emotionally, you're taking on so much more. Because you know, you know, better you have you, you have the knowledge. So, that in itself just sets you up for a challenge. And I'll be honest, like we took our, our training 10 and 11 years ago, so I can't say with any accuracy, what doula training bodies are training today, other than the fact that we've had a number of doulas go through it, they've shown us kind of or talk through what they've been taught. So I can't say whether they're explicitly saying your role is not to advocate or you can advocate a bit. I've heard both sides of the fence have on that for sure. But yeah, it just seems like a daunting and impossible task to feel like you've done a good job when you've stood by and watched these things happen and not said anything. But also, to go in there as someone who especially if you're in the beginning, and you're your first five to 10 births, you know that these people are seeing four to six births in a shift, and you're in your first five births. And you're apparently supposed to go in there and know all of the without medical training all of the outcomes and reasons. I mean, we're still learning and it's wild, the amount of things that you have to unpack and the amount you could even read on things like evidence based birth, like its unending really, I think you're taking on so much more responsibility than your education has initially given you. But it's very similar in midwifery, it takes many, many years and you become the best midwife and you become the best doula over time, after you've seen things time and time. Again, that's the same for obstetricians too. I mean, they come out of school and yes, they have many, many, many more hours of medical training and you guys get or even some midwives get, but it's the hands on practice that really teaches you It's you get that you know, those experiences or you can't learn that in the textbook. You know, being with a woman and being there is really the only way you become the most qualified.

Yeah, absolutely.

I knew a doula who told women that she won't go to a certain hospital. She refused. And I can't help but respect that. I don't think she owes it to the public as a doula to go to every single birth facility. She's a human being she's a mother, she's got her own life and family and I think she has the right when you're when you're when you're in business for yourself. The one great thing that comes with it and should come with it is you choose who you work with. You don't have to open yourself to every single opportunity in the entire world you have the right to say this client makes me uncomfortable. This one makes me feel However, I'm not going to that hospital, I don't support births in that hospital and she doesn't and I thought, well, you know what, you have to have boundaries in this work. This of all kinds of work, you need to have boundaries in this work. Because no one will perceive a boundary. You have to establish that we've also heard from a number of doulas who actually say that they won't do hospital births. They only support home birth. Yeah. And then, on the flip side, we get people asking us also frequently, if you're planning a home birth with a midwife do you actually need a doula? Yes, definitely a bit less of the advocacy. Right? Let the doula a doula can take on so many roles. If a doula is at a home birth, you she would really do a lot less advocacy, she's gonna see a lot less typically, of the things that make her uncomfortable. But she still does her traditional to blood work. It's like the role has changed because of things that are going on in hospitals and doulas now are expected to be advocates. I do think it's a valuable doula who reminds a woman always of her rights. But the woman does have to speak for herself. You don't have power of attorney over these people?

Exactly. I will. Now that we're through a pandemic, we have seen a bit of a shift in midwifery. And even in the way, like here in Ontario, the language in 2021, changed for the College of midwifery Ontario to be able to fire a patient and for turning down tests. No, yeah, so you can look that up. It's on their their website. So there's a different flavor there in terms of, you know, a bit more midwifery medical midwifing. And so there is some, some advocacy to that that happens at home. But you're right, not as much. One of the things that we often tell people when they're saying that, like, do you think we should have a midwife and a doula Does that make sense is that midwives have a lot of they are clinically responsible for you, they're medically responsible for you and your baby. And they have a lot of paperwork to do. And the emotional support is not something that they have capacity for to do both in a really great way where it's for us, our only job is to be emotionally present, and holding space for you in every moment. And I will say over the last 10 years, there was a there. In the beginning, I felt like a lot of midwives, even my own, be 12 years ago said to me, I will be everything you need. And it turned out, she wasn't able to come to my birth because she was at her wedding shower. But I think there's been a shift where we've worked with enough midwives now who know like, Okay, this is your role, this is my role, and we actually can work really well together. And the one of the benefits this is maybe not to the client, but to the midwife is that they often get to show up a bit later because we help them decide if they're still in early labor, and do they actually need their midwife yet?

I think one of the like both of us have considered only doing home births for sure crosses our mind after every hospital one that's a mess. I think the part we struggle with is because we are especially me, not so much Sara, inherently a people pleaser. It's like how do I say that I only support home births, and not put shame upon those people that are planning hospital births. Or how do I say I only support home births. And then when that client decides they need to change where they are and go to the hospital and get an epidural, or some sort of transfer of care happens. I'm like already managing a situation that didn't even happen and how that's going to hit on them that they think that I don't want to be at the hospital.

I remember the first I used to say to people, this is gross. So this was years and years ago, I had an experienced client having an epidural in my first 10 births. So anyway, I had said this to a client in a prenatal visit, like you know, I haven't had a client had an epidural yet. And of course, she was then my first epidural. And she asked makes me still feel so gross. She apologized to me. Like, I'm so sorry, I'm getting an epidural. And I was like, oh, no, this is absolutely the opposite way this is supposed to go and I have never seen anything like that ever, like stats are not ever coming out my mouth. But so much of this stuff. You have to learn the hard way. It's so girls, thank you for sharing that. I know that wasn't easy to share. Thank you for sharing that. You feel, of course, I mean, you learn. And back to what Lara was saying. I think that you would have the right to say to a woman, I don't do hospital births. If you ever went that route, I don't do hospital births. And it it isn't that you're judging hospitals or her choice. Really it comes down to I don't do hospital births because I need to feel at peace with the work I do. I know what I can do well, and my hands are tied in the hospital and I don't want you to hire me for me to feel later that I wasn't able to support you in all the ways that I want to be free to support you. And I think that's a very authentic, legitimate reason not to do a birth In a certain setting, I knew a doula who only did his Aryan births Believe it or not, wow, yeah. What if why shouldn't everyone have the right to do the births where they love giving support, I do want to bring up the elephant in the room. And somehow this just doesn't ever come up. Sexual assault, sexual, sexual assault statistics are through the roof. And women are expected to go give birth without it now being triggered of assault and lay back for cervical exams. I mean, it's not just a matter of cervical exams being incredibly uncomfortable, potentially risky. And potentially risky. But this, this is a really big deal. I mean, when you we talk so openly about how some people are traumatized, just going to the dentist, it's like really someone who has suffered sexual assault and having them go to to their birth to you as doulas feel that it's your responsibility to ask a woman if she has anything she wants to share with you? Or how do you approach seeing if she wants to talk out any past trauma and talk through some of her fears? Or what she really wants for her birth? Without getting triggered? Again? Do you bring that up?

We talk about it a little bit in our prenatal class, like we'll say scenarios that we've seen, like you may want to sit back and think about as the partner and as the woman giving birth. What would it be like for you to have seven different people's fingers checking your cervix over the course of your labor? With people watching in a brightly lit room? What would it feel like to have a strange man who you've never met, come in and introduce himself, and then very swiftly, put his fingers inside of your vagina. Like, these are the things that people again, when they're thinking about birth, because this isn't what we're seeing in the movies, or on social media, they're not thinking about what effect that could have on them, even just physiologically, whether they're consenting to it or not like our body knows what's going on. So we try to talk about it.

The other piece we say is, you know, what, gets the baby and gets the baby out. And so you know, safety, sensuality, and a partner that you're comfortable with. And we often say, you know, the hands that you are physiologically comfortable with are your own and your partners. And mentally you will tell yourself, this is fine, this is safe, this is good. This is right. To have this professional care provider who I met one minute ago, maybe gave me their name or not hands inside me, that is fine. But physiologically, your body is saying no. And that might manifest itself down the road as vaginal Summize. And all of these things are true for people whether they're walking in with previous sexual assault or not. I do remember having this conversation with myself as I do. You know, is it something that you ask ahead of time? Do you have sexual assault that you want to tell me about and I think I was a bit more explicit about it in my earlier births. And what I found was that it didn't have a lot of translation ultimately, into what should or shouldn't be allowed at any birth, right? Like we all should be given a level of respect and autonomy and consent, that is really no different or exception. If you are coming in with sexual assaults are not previously, the new rules for the midwives being able to fire a client had me thinking about this and thinking, okay, so if I'm supporting a client, who does have a history of sexual abuse, who's turning down cervical checks, and now a midwife can fire that client for turning down cervical checks. So now that clients in a position where they have to disclose their history of assault, in order to hopefully convince the midwife to not fire them, like that is just blowing my mind that that is something that will possibly now come up.

It's not a no or all of can. Yeah, it's not as explicit as that. I think there's so it's an eight page document. I was rereading it this morning. And one of them is about how do they phrase that like, less for having desiring less than what the midwife can offer basically less than the standard of care? Right? So my assumption was that was that was more around things like turning down say a GBS swab or a diabetes test or say an ultrasound for positioning or for breach or for placenta location, that those would be reasons those would be the main three that I was assuming, was an insinuated, but it wasn't clearly explained what it meant by saying, you know, if you aren't basically saying yes to what the midwife is suggest stating that they can let you go. So if I don't know if that falls into that category or not, it's interesting, because it really isn't your business if someone has a history of sexual assault, so you really can't come out and ask, yeah, but you want to open the door for the conversation, if she does want to talk about it. And I think Sarah made a really good point. And I don't want it to get lost on us that she was saying, Well, why don't we just treat all women a certain way where no one's going to get traumatized? And no one will get triggered? If they have had a history like why? Why should we seek to create a gentler experience just because some women have already been traumatized want to just treat everyone that way to begin with, that should be certainly be the standard. And then in a healthy patient provider relationship, whether that's an OB or midwife, that should be part of an initial patient intake. I mean, a midwife or an OB should know that history for a woman that that question should be asked, and every woman should be treated in labor, respectfully, and nobody should feel threatened by cervical exams or any way a provider touches them. But you need to be exceptionally sensitive. In the case of somebody who has that kind of history. So before we, before we wrap this conversation, could you guys share with us like, Do you have a few top reasons or tips for women about why they should choose a doula? Regardless of where they're giving birth?

Why should you hire a doula? The quote that we've been going to lately has just been, we will help you have a better birth. So whatever your current goals or knowledge or education is leading you towards, we can make that even better by having a doula present, we can increase that intimacy with your partner, make it a less stressful situation, help you navigate the system. And the earlier that you hire a doula, the better that is the question we get all the time is when do you hire a doula, the earlier you hire your doula, the more value they are going to provide, we start in the very beginning with education. And that is the foundation when you lean into your intuition, coupled with your education, and then you get that self responsibility. And then you just put a doula cherry on top to make sure that you're taking care of we often tell people like we can be your Google and the reality is when you Google things your your made depending on the question you put in, you're gonna get kind of a lot of generic information and the the most the bulk information rises to the top and is that the information that aligns with who you are, and aligns with the physiology of birth? And I do think we do a good job of explaining upfront in that initial intake, that our bias is physiology, anatomy and biology, and we will help you unlearn what you need to unlearn from Hollywood will help you relearn how to get out of your own way and how to help yourself in birth. And so that's really what we want to do is help you to move your baby through you in the best way possible.

Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.

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About Cynthia Overgard

Cynthia is a published writer, advocate, childbirth educator and postpartum support specialist in prenatal/postpartum healthcare and has served thousands of clients since 2007. 

About Trisha Ludwig

Trisha is a Yale-educated Certified Nurse Midwife and International Board Certified Lactation Counselor. She has worked in women's health for more than 15 years.

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