The Power of Milk - DONA International

The Power of Milk - DONA International

16th AnnualDONA InternationalConferenceAugust 5-8, 2010Albuquerque, New MexicoComplete ChildbirthEducation & HypnosisGreetings, wonderful doulas!Here at Hypnobabies, we recommend DONA to our Hypno-Moms and we serve womenwith the same love and dedication that you do. We are on a mission to help the motherswho have chosen natural childbirth to have the best and safest birth experience possible,so we would like to let you know more about Hypnobabies:Hypnobabies is:• A complete childbirth education program including all aspects of laborand delivery, nutrition, exercise, comfort in pregnancy, staying healthy andlow risk, avoiding back labor, birth empowerment, optimum fetal positioningand much more.• A complete childbirth hypnosis program which includes pregnancy andbirthing affirmations, birth visualizations, many different relaxation techniquesand cues, and medical hypno-anesthesia, which greatly lessens andsometimes eliminates labor pain. This allows natural childbirth to be theloving, positive, empowering experience that it can be.Please see the full article on Hypnobabies by visiting our website at,in the “Hypno-Curious” section of our menu. If you share our goals of serving and helpingbirthing mothers and would like to bring Hypnobabies to your community, we would alsolike to have you join our loving, dedicated team!714-952-BABY (2229)2009 Hypnobabies Instructor Trainings:Bend, OR: March 20-23 ~ Richmond, VA: May 15-18Cypress, CA: July 17-20 (near Disneyland!)HYPNO300673_1-2PgAd_FINAL.indd 12 International Doula Volume 17, Issue 31/27/09 1:01:27 PM

CONTENTSFeatures228 The Power of Milk10 Self Discovery in the Postpartum Phase,Part II13 DONA International Founders' Awards14 2009 Conference Photos16 Successful Pregnancywith Autoimmune Disorder18 Trust Issues20 How Your Doula Training and ExperienceApplies to Nearly Any Occupation21 Appreciating the Slower LaborDepartments186 Poem — So, What Does a Doula Do?7 Book Review — Labor of Love7 Book Review — Brought to Earth by Birth24 Tricks of the Trade — The Doula InterviewColumns4 Letter from the President5 Letter from the Director of Publications6 Member Letters23 Essay — Sight Unseen26 Essay — Postpartum Doula Misconceptions30 Ask Penny / Pregúntele a PennyMember News & Benefits27 2009 Conference Report29 Postcard from Home28 Doula Services AddedForms3033 Network Communications34 Membership & CertificationCover 3

from the presidentHello Wonderful Doulas,Did you get to go to the fantastic conference in Atlanta? I hope you had aterrific time. We had such challenging and professional speakers. Whichone did you like best? If you missed this conference, start saving yourpennies for next year in Albuquerque, New Mexico in August 2010. Thehotel is so authentic to the area and we are going to be the only group, taking up thewhole hotel. Be sure to register as soon as the conference info comes out next springto be sure you get a room! Also, special savings are available on early registrationconference fees. 2009 conference attendees are eligible to save 15 percent off theearly registration conference fee with a non-refundable deposit of $50, and those whowere unable to attend the 2009 conference can still save 10 percent by reserving theirregistration now. Information is available on the DONA Boutique.This will be my last letter to you as DONA President. I have enjoyed the experienceand the last eight years I spent on the DONA Board of Directors in various positions.If you have an inkling to work with such wonderful, forward thinking women, watchthe web site for open positions. You can start on a committee or as a SPAR too!So this is a happy and yet sad letter. I am going to sleep for a month and thendecide what other exciting adventures my life holds. But I am going to miss writing toyou and working with the Board. I plan to be around because DONA is in my heart.So if you see me in Albuquerque, be sure to say “hi!”When we became an international organization we wanted to take it slow and getit right. Since that time we have done workshops in other countries and have alwayshad international doulas at our conferences. We are working on getting some of ourmaterial translated into Spanish, with other languages in mind for the future. But I amespecially excited that this year we brought doulas to our conference and workshopsfrom various countries on a fellowship to become doula trainers. They will be able togo back to their own countries and start training doulas in their own languages. Weare so excited about this project.I bet that you work with a variety of families, from different neighborhoods, fromdifferent countries and from different cultural or religious backgrounds. I am alwayshonored to learn new things from the families that I work with. My horizons arecontinually expanded by supporting families in their own style. A couple of times Ihave worked with women or families who cannot speak English and I was not fluentin their languages. At first it seemed daunting but then I realized that birth andpostpartum transcend language in many ways. Demonstration and pictures work well.I hope you get to learn and grow from the women and families you work with.Keep up the good work! Have fun on your doula journey.Warmly,BOARD OF DIRECTORSPresidentdebbie youngPresident Electsusan toffolonTreasurerkirsten rohlDirector of EducationOPENDirector of Certificationbrenda laneDirector of PostpartumJacqueline KelleherDirector of PublicationsSunday TortelliConference DirectorNicole WocelkaDirector of Int’l Developmentnicole heidbrederDirector of Membership Supportyana katzap-nackmanDirector of Public Relationsstefanie antunesMulticultural Directormichelle-nicholle calaresoREGIONAL DIRECTORSNortheastern USnatashia fuksmanSoutheastern USJennifer Rokeby-MayeuxMidwestern USDani JohnsonSouthwestern USCindy HodgesWestern Pacific USheathergail lovejoyEastern Canadajulia macneilWestern CanadaJalana GrantMexico/InternationalopenFoundersAnnie Kennedy · John KennellMarshall Klaus · Phyllis KlausPenny SimkinInternational Doula TeamDirector of PublicationsSunday TortelliPublications@DONA.orgManaging EditorLoree SiermacheskyIDEditor@DONA.orgP.O. Box 626, Jasper, IN 47547Associate EditorsNicole Stoller · Vicki HedleyPlease send all contributionsto the editorDESIGNWISE GROUPnatasha Fletcher, Art Directorwww.wisegroup.com4 International Doula Volume 17, Issue 3

Amy Wright Glenn, MA, in Religion and Educationfrom Teachers College at Columbia University, is aKripalu Yoga Teacher, DONA certified birth doulaand hospital chaplain. You can learn more abouther work at letterspoemFEATURE STORYPrenatal YogaMBy Amy Wright Glenn, MA, CD(DONA)any pregnant women our more difficult parts and use the energyknow that the practice locked in such patterns to affirm life.of prenatal yoga Prenatal yoga is an amazing preparationasanas (postures) is for birth where focus and attention tohelpful for staying in shape throughout breath help women ride the waves ofpregnancy and in preparation for birth. sensation and relax through the first stagePrenatal practiceIn reference to “Prenatal Yoga,”Volume 17, Issue 1, CristinTighe, MEM, MA, CD(DONA),PCD(DONA), RYT writes:For healthy women who have an activeyoga practice prior to pregnancy, a fewmodifications are needed. Perhaps themost obvious change is to avoid belly-In fact, the benefits are numerous. During of labor, helping the body ease the baby down postures after the first prenatal yoga teacher training, we into the birth position. Finally, depending Some are surprised to learn that pregnantwere told that “it’s never too early or too on her interests, a pregnant woman can yogis can safely go into inversions (e.g.late” to begin a prenatal yoga practice. benefit spiritually from the practice. In headstands) even into the last trimester if …here’s a different perspective onWhatever kind of birth is hoped for or taking the time to hold the belly, share a inversions had been a part of their practiceplanned, the practice of calming the mind, class with the baby within and marvel at the before pregnancy. However, most womenpaying attention to the breath and relaxing wonder of becoming a vehicle for life, the find they prefer to spend less time in morethe body aids women through the rite of heart is opened to great mysteries. strenuous postures and use a wall to helpinversions. I am a Kundalini Yogapassage into motherhood and helps with Because tension and emotional stresses with balance. Based on my training, thepostpartum in our tissues, we all benefit by moving mantra to offer is “trust your comfort.”mindfully and with breath awareness. The majority of women in a prenatalBenefits aboundMany of our clients may ask about the yoga class are new to the practice.teacher (,benefits of yoga. It is helpful for us to Advanced postures are purposely notA pregnant woman benefits physically be informed about these benefits and taught at this time, taking a more gentlefrom yoga as she supports her body in offer information to our clients regarding approach. In my teaching, I focus onthe transformative months of pregnancy. prenatal yoga practice. As doulas, our own connecting to the baby and postures thatLower back pain, sore muscles and general connection to our bodies and breath helps will be helpful through labor and birth — with advanced Conscioustensions ease through the birthing women in their connection to opening the hips, release of shoulder/backpractice. Furthermore, body and breath. The Sanskrit root of the tension, freeing the voice to make helpfula woman benefits word yoga signifies union or connection. sounds through labor and strengtheningemotionally to make Women who support women through pelvic floor muscles.Pregnancy Yoga training, andspace for the positive birth are practicing a form of yoga,While it’s true that many good textsenergies found in even if they have never practiced yoga and DVDs are now available to use atpregnancy as well as asanas. We practice what Nel Noddings, home, nothing replaces the power ofthe concerns, fears, a feminist care ethicist calls “motivational a class in real time with a teacher whoalso studied with Judith Lasaterdoubts and anxieties displacement.” By setting aside our own can personally interact with students.also common in personal interests, we focus intently in Practicing with other pregnant womenpregnancy. An creating a deep connection to the birthing creates a warm community of support atessential skill woman in the spirit of sisterhood and a time in our culture where communitiesof yoga is service. Specifically, doulas practice what are far more fragmented than those our ( fromto befriend is traditionally called karma yoga or selfless grandmothers knew. Pregnant womenservice. This is particularly true for those throughout time have sought out onewho offer services without charge. another to prepare, share stories, offersupport, learn from each other and, most Iyengar yoga. There are noimportantly, celebrate pregnancy.doulas practice whatis traditionally calleddouble-blind studies provingkarma yoga orselfless servicethe benefits for pregnancy. In16 | International Doula | Volume 17, Issue 1Kundalini Yoga, women do notpractice inversions at all after the120th day. Judith doesn’t teach inversions because (1) first trimester is atime of implantation; (2) second trimester the baby can move/get wrappedin the cord; (3) third trimester inversions mean all the weight puts pressureon the women’s diaphragm, heart and lungs. There may be real risks toinversions during pregnancy, so it is worth questioning their value whenthere are so many other yoga poses beneficial to pregnancy.Author Amy Wright Glenn’s reply:… There are quite a few perspectives with regard to the skillful use ofinversions during pregnancy. … there are accomplished and thoughtfulyogis who disagree as well. I suggest each pregnant woman take the time toread, research, and trust her comfort as she moves through her pregnancyand birth intuitively. I agree with the following insights provided by Iyengartrained teacher Karen Allgire.“… In general, the recommendation is that the inversions may continueif they are already a regular part of a woman’s yoga practice. If she doesnot know the inverted poses, this is not the time to learn them. Even if awoman does practice inversions regularly, she should stop them if they feellike a strain. How far into the pregnancy they can be done is an individualmatter. Senior Iyengar teacher Patricia Walden says the inversionsshould stop as soon as the woman experiences heaviness in the pelvis orbreathing becomes difficult.”At the 2008 DONAInternational Conferencein Vancouver, BritishColumbia, I participatedin a study comparing American andCanadian doulas by answering a survey.One of the last questions read: “Qualities/actions you bring to laboring women/families that make you a good doula.”I know from studies that just the presenceof a doula or a supportive person isassociated with better outcomes. I knowthat I don’t have to do anything to bea good doula. My presence and energyalone are enough. I felt compelled,however, to try to pinpoint what exactly Ido at a birth because I struggle with thisevery time someone asks me, “So, whatdoes a doula do?” This was my response.So, WhatDoes aDoula Do?By Kat Hickey, CD(DONA)I love. I listen.I empower. I massage.I believe. I whisper.I rock. I touch.I breathe. I thank.I witness. I praise.I soothe. I dance.I encourage. I hope.I laugh. I cry. I dream.I love.correctionThe article, DONA International and Third Party Reimbursementin Volume 17, Issue 2 of the ID, contained a typo. It should read“Ninety-five percent of the mothers served by the program had Medicaid[not Medicare] in one form or another and it seemed reasonable thatinsurance should pay for the services they received, including childbirtheducation and interpreters.” We apologize for this error.Kat Hickey is a DONA certifiedbirth doula, Reiki practitionerand birth photographer. Inher life before children, shewas a professional actor andmusician and is trying to find opportunities touse those talents in her daily life. She lives in FortWayne, Indiana with her husband and four childgurus,age eleven, nine, seven and three.6 International Doula Volume 17, Issue 3

Surrendering thismost feminine part of mebecame a source ofpride, wonder and aweon a Pitocin drip with an epidural I didn’tneed or want and lots of issues abouthow my body had failed me. I needed adoula but didn’t know any better! I alsohad a very difficult pregnancy, sufferedfrom hyperemesis gravidarium and lost 42pounds in the first weeks of my pregnancy.I had scarcely controlled vomiting forseven of the nine months and at the timeof birth was still 20 pounds lighter thanbefore I became pregnant. These issuesonly served to compound my feelings ofresentment for my body and I felt as ifit didn’t work and never would—I hatedit all the more for these reasons.It was very difficult for me to surrendercontrol of my body on someone else’sterms and someone else’s schedule, evenif it was a tiny, helpless little infant. Ireally struggled with my baby’s seeminglyconstant need for my breasts in the firstdays. I called La Leche League for supportmore than once and cried to my husband.It was so difficult for me to let go of thecontrol I had maintained over my bodyfor so many years in order to feel safe as aresult of the violence I had been through.Slowly, after a few more weeks ofnursing, the soreness and engorgementwent away and I began to treasure thetime my baby spent nuzzled and sleepingat the tap, as my husband would say.The resentments I had harbored againstmy body for years as a result of violence,mistreatment and my pregnancy failingsmelted away as I began to realize that mybody was doing the most amazing was nourishing my son with the milkand love he needed to learn, grow andbond to me in those critical first days. Isuddenly stopped resenting the seeminglyconstant need for him to nurse and fellin love with my son and my breasts.Surrendering this most feminine part ofme became a source of pride, wonder andawe as my son nursed early and often andestablished the most intimate connectionI have ever felt. This changed my life, andmy relationship with my body—somethingthat ten years of therapy could not do.My breasts have always been large andI felt they were a target to attract sexualpredators; and when they ballooned out toa 36G as my milk came in I was appalled,embarrassed and very nervous. With time,however, I came to know my body in a wayI never had, and as my son continued tonurse with vigor, I learned how remarkableit is to be a woman and that my breastswere the most amazing gift I had everbeen given. For me, breastfeeding hadredeemed all acts of violence and failureand allowed me to love my body andrealize its power for the first time.For my son, breastfeeding providednutrition, love, protection and the feelingthat he was the most important littleboy on this earth. For me, breastfeedingprovided self-love, acceptance, safety and aconfidence I have never felt. This has trulychanged my life and shaped my future.Breastfeeding alone was the mostpowerful instrument of healing I have feltin all my life. Who knew that feeding thistiny baby would bring the most profoundjoy and sense of accomplishmentin my 30 years? I feel strong, I feelpowerful and I have overcome so much.Breastfeeding is so much more powerfulthan I ever imagined and I sure amglad I stuck with it to find out!Editor’s note: Breastfeeding may not beregarded positively by all abuse survivors.Compassionate birth professionalscan provide the framework for eachsurvivor to make choices that feel rightfor her and her particular situation.Colleen Curry is a DONA certified birth doula,childbirth educator, La Leche League leaderand mother to the adorable Mr. FinneganDanger. She focuses her energy on supportingand empowering both parents through thepregnancy, birth and postpartum periodsand thinks she has the best job on earth!Illustration: Susan Kirk. See page 29 for 9

aby phase and had no idea what it meantto be a mother. For her, it was a huge lifechange. In her case, the doula acted like a“social worker” who helped her accept hernew identity.The theme of isolation and lonelinesscame up for quite a few of the mothers,as did the feeling of vulnerability. Onemother stated, “no one talks aboutthis—the resentment, the loneliness.”For many mothers this isolation wasaccompanied by feeling “brain dead”and “overwhelmed” as well as “unsure”and “nervous.” One mother said, “Thereis no empathy for new mothers. It doesseem like everyone around the new momhas forgotten how overwhelming it is” tobecome a new mother. This same motherfelt as if all the attention given to herwhile pregnant disappeared and the focusshifted from her to the baby. Additionally,she felt that the attention given to her wasthe wrong kind because it required her tobe a hostess. For this mother, the doulakept the attention on her by providing forher and not making demands, and in sodoing, gave her the energy and calm spaceto focus on her baby.A majority of women in this samplefound the postpartum phase to be difficult.Many of them expected that they wouldneed practical help in this phase of life, butthey did not know that they would needemotional support. They did not knowhow vulnerable they would feel inside. Alot of them disliked the feeling of not beingin control or not having command of whatthey needed and found it hard to allowothers to take care of them.The doulas concurred with the mothersthat the overarching goal of the doula is tomother the mother so that she can motherher baby. The doulas stated that the kindand amount of support given to the mothersvaried from mother to mother but thatit encompassed three categories also identifiedby the mothers as follows: emotional,educational and physical support.A cultural set-upThe doulas commented that the problemsof the postpartum phase are a culturalissue and that there needs to be moreacknowledgement of what actuallyhappens to a woman in this phase. Theyadded that the mainstream individualisticculture of the United States leaves womenthinking that they cannot ask for helpand that there is no empathy for newmothers. One doula stated that “it is a setup for them to feel like they are failing.”She continued, “Mothers don’t know thatthis is a time when they can stop beingthe hostess, house cleaner and cook.”They will sacrifice bonding and nursingfor keeping the house going and guestshappy. One doula stated that women,even those with financial means, ask, “DoI deserve this doula care?” She addedthat she often hears new mothers say thatthey “hate to ask for help.” Accordingto the doulas, this leads women to thinkthat they should be able to “do it all” inthe postpartum period. As a result, aneducational part of what doulas do is tolet mothers know that it is OK to ask forwhat they need. They support the motheremotionally in understanding this andthen model it in physical ways.New mothers needto be in-relationThe number of mothers in this study whomentioned feelings of isolation duringthe postpartum phase speaks to the ideathat new mothers do best when theyare in-relation in the postpartum phase.The doulas interviewed had observedsimilar reactions in their work acrosssocioeconomic lines.Yet the majority of mothers in thisstudy also found it hard to accept 11

Feature StoryVolunteer on theBoard ofDirectors!• Director of Education• Latin America RegionalDirectorFind requirements andapplication proceduresfor all open positions atwww.DONA.orgEmailNominations@DONA.orgfor detailed information2011 DONAInternationalConferenceBoston, MAWatch forDetails!doula’s physical support. One motherexemplified this when she spoke about herdoula bringing her a meal in bed:“There was some awkwardness for memaybe around being taken care of and…served. I certainly didn’t think of her asa servant at all…I felt sort of privileged…Iremember she and I talking about that, itmade me feel like this is the most powerfulintervention any one could have.”Because of the mothers’ awkwardnessat being taken care of, the doulas oftenfound themselves re-contextualizing thepostpartum phase through a self-inrelationmodality, allowing the mother toreframe for herself what it means to bedependent at this time and to realize that itis not a negative.It is interesting to note that a lot ofthe women in this study were stronglyidentified with being independent anddisliked needing to rely on others in thepostpartum phase. While Jordan, et al.(1991) and Jordan (1997) saw women asbeing in-relation, the mothers in this studystill seemed to be strongly identified withbeing independent. On the other hand,their postpartum doula’s support broughtthem tremendous relief. In effect, thenew mothers in this study seemed to becaught between the need to be in-relationand the need to be independent and selfreliant.This tension was amplified by thefact that they were coming to terms withtheir baby’s reliance on them. These newmothers seemed to be discovering andadjusting to their newfound identity asmothers, leaving behind their independentadult identity and facing their newfoundstatus as being in-relation to their child, toother women and to themselves.The mothers in this study were alsosurprised to find such a strong need foremotional support at this time. Most ofthem were very grateful to receive thiskind of support from their doulas. Mostcame to understand that they do nothave to become mothers in isolation.Accompanying this was the recognitionby some of the mothers that they feltcomfortable with being in-relation. Assuch, the postpartum phase can be anopportunity for women to experiencehealthy dependency.Women thriveon connectionWomen should not be expected tomother their newborns alone. Instead ofbeginning life as a mother in a state ofisolation and anxiety, new motherhoodcan begin in a state of connection. Apostpartum doula can be the catalystfor a shift in a woman’s experience ofthis phase of life. The doula does this byhelping a woman come into contact withan important facet of her womanhood,one that is about fostering connections toothers. It is these connections that give themother the emotional room to discoverher baby and herself in a new way. Thus,she is given the tools to work toward asmooth transition into matrescence.Binda Colebrook worked as a postpartum doulain New York City for three years before decidingto obtain a Master’s Degree in Social work. Sheis currently working in Massachusetts as a socialworker in the field of early intervention supportingchildren aged 0-3 with developmental delays andtheir families. In addition she is part of a programthat offers support to women who are pregnantor in the postpartum phase. Binda applies thesame principles outlined in this article to her workwith new mothers and their families. She can bereached at, J.V., Kaplan, A. G., Miller, J. B., Stiver,I. P. & Surrey, J. L. (1991). Women’s growth inconnection, writings from the Stone Center. NewYork: Guilford.Jordan, J. V. (1997). Clarity in Connection: Empathicknowing, desire and sexuality. In Women’s Growth inDiversity: More Writings from the Stone Center. J. V.Jordan (Ed.) New York, Guilford Press.12 International Doula Volume 17, Issue 3

2009 ConferenceDONA International Founders’ AwardsBy Ann Grauer,CD(DONA), PCD(DONA)The DONA InternationalFounders’ Awards wereestablished to honor the workof the men and women whosevision was the beginning of DONA. Eachyear the Founders’ Awards committee seeksnominations. Awards are given when thereare outstanding nominees who representthe spirit of the founders. The foundersdo not participate in the selection processbut are pleased to present their namesakeawards to the deserving recipients eachyear at our annual conference.THE PENNY SIMKIN AWARDfor doula spirit and mentoring—presented to Carolyn Ogren,CD(DONA)Carolyn has spent 40+ years workingwith pregnant and new families in thegreater Boston area. For the last 15 orso years she has volunteered her timewith an adoption agency and now theBeverly Hospital Doula Program. She alsocontinues to nurture not only new doulasbut also new doula trainers. Carolynserved on the DONA Board of Directorsfor more than eight years and continues tovolunteer for DONA International.THE ANNIE KENNEDY AWARDrecognizing excellence in a doulagroup—presented to LexingtonMedical Center Doula GroupFounded in 1994, this doula programprovides no-cost doula services to womenbirthing at Lexington Medical Center.Most of the doulas on staff have beenwith the program for 10 or more years, atestament to the strength and integrity ofthe program. Since its inception the LMCDoulas have provided 6,500 families withlabor support and are now expanding intopostpartum care as well.Back row: Lexington Medical Center Doula Group, Annie Kennedy. Front row: Sally Riley,Phyllis Klaus, Judith Fry McComish, Marshall Klaus, Penny Simkin, Carolyn Ogren.Not pictured: John KennellTHE JOHN KENNELL ANDMARSHALL KLAUS AWARDrecognizing excellence in research asit relates to the effects of doula care—presented to Judith Fry McComish,PhD, Wayne State UniversityDr. McComish’s study, “Domains ofPostpartum Doula Care and MaternalResponsiveness and Competence” waspublished in the Journal of Obstetric,Gynecologic and Neonatal Nursing,Volume 38, Issue 2. Along with her sisterresearchers at Wayne State University shelooked at the main areas (domains) inwhich a postpartum doula functions. Herdesire to learn more about postpartumdoulas and what makes them tick is aneducation to us all.THE PHYLLIS KLAUS AWARDhonoring doulas who make a positiveimpact on parent-infant bonding—presented to Sally Riley, CD(DONA)With over 30 years experience workingwith birthing and new families Sally hasleft her mark in the Kansas City area.A founder of Doulas of Greater KansasCity, she has given much volunteertime to affect policy for pregnant andnew families on a local, state and evennational level. She has been a tirelessvoice for them with the Mother and ChildHealth Coalition, Postpartum ResourceCenter of Kansas, The March of Dimes ofKansas City, Kansas Health Commissionand the Coalition for ImprovingMaternity Services.Ann Grauer, CD(DONA), PCD(DONA) chairs DONA International’s Founders’ Awards Committee. A pastpresident of DONA International, Ann coordinates Wisconsin’s only hospital-based doula program at theColumbia Center in Mequon and spends a lot of her time thinking about doulas and DONA 13

2009 ConferenceAtlanta, GeorgiaLeft: Theresa, Sara and MickyBottom: Silent auction benefitingthe Doula Spirit FundTop:Penny Simkin'sexhibit tableTop:Midwestern Region doulasCindy, Katie and CharleneLeft: NortheasternRegion doulas, The DoulaCooperative14 International Doula Volume 17, Issue 3

Right: International TrainerFellowship Recipients withPenny (Birth Doula Mentor),Nicole (Director of InternationalDevelopment) and Pat(Educational Chair)Top: Multicultural DirectorMichelle-Nicholle and ConferenceVolunteer Coordinator RosemaryRight: Dr. Robert Sears and doulasfollowing a sessionLeft: Ayla, Kai (GA SPAR) withher baby and TracyHappy 15

Feature StorySuccessful Pregnancywith Autoimmune Disorder:A Story of Loss, Hope, Love and New BeginningsBy Sheila M. Cameron, CD(DONA)Shecould nowconsiderherselfto be in anormalpregnancywith ahealthybabyEditor’s note: Story and names used withpermission.On February 10, 2007 at 35weeks plus five days, Sabrinawent into labor and herdaughter’s foot came out ofher. She gave birth 25 minutes later atthe hospital to little Samantha who wasstillborn. Samantha was 4 lbs. 1 oz. and17 inches long with beautiful light brownhair. Sabrina couldn’t see or hold her,it was just too painful. It was the rightdecision for her at the time and she doesnot regret it. She waited while her husbandand family said goodbye to her little girl.The emotional journey to living withoutSamantha to love had begun.A year of what seemed to be infertilityissues ensued in their quest to conceiveagain. She had a hysterosalpingogram tocheck her fallopian tubes and passed thetest with flying colors. Visits with geneticspecialists concluded that Samantha’sdeath was a fluke. Still Sabrina was notsold that this was the reason. She had toknow why Samantha died so that futurechildren would not die as well.In January, 2008 she had an infertilityappointment with a reproductiveendocrinologist (RE) and learned that shewas pregnant and didn’t even know it!Sabrina and her husband were overjoyed,but she had a miscarriage at 11 weeks.She had a low progesterone level, butSabrina was not convinced this alonewas the reason for her losses. Later shelearned she had a blood clotting disorder,lupus anticoagulant, which was morethan likely the reason for her recurrentpregnancy losses.The RE started her on an aggressiveaction plan for conceiving with Clomid,progesterone and baby aspirin. Threemonths after the miscarriage, Sabrinafound out she was pregnant again.Determined to do whatever she needed todo, she took on the challenge of this newpregnancy.Under the care of her RE, herperinatologist, her obstetrician andme as her doula, she made this veryemotional journey. In addition to thedaily progesterone and baby aspirin,she took Lovenox shots once per dayand progesterone shots weekly through36 weeks and heparin shots twice a dayduring the last month. She had non-stresstests and biophysical profiles every weekat the same hospital where Samantha wasstillborn. In her mind this hospital was amorgue and she relived that experiencewith every new nurse, every week. Shecalled me after every appointment to letme know how it went and to discuss howhard each visit was. I was only able tohear and support her feelings and wouldcall her again the next day to see how shewas doing.Through the next five months of ourcontact Sabrina went through manyemotions concerning Samantha’s stillbirth,her miscarriage and the possible lossof this new baby. Sabrina would say, “Idon’t believe, at this point, that this babyis going to be born alive.” I suggested shetake one moment at a time, understandingthat taking it even one day at a time couldbe too much for her to bear.Finally, Sabrina passed the two mostdifficult milestones—Samantha’s birthdayand the 35 week plus five day gestation16 International Doula Volume 17, Issue 3

Top: Author and baby.Right: Author with a laboring client.period. Following her 36 week obstetricalappointment she sent me an e-mailupdate and said the doctor came into theroom simply glowing! He told her thatshe could now consider herself to be in anormal pregnancy with a healthy baby.Although not emotionally convinced thather baby girl would be born alive, she waseven more hopeful than before. She wasscheduled for an induction at 38 weeksplus six days.At 38 weeks plus two days at 8:00 on aSunday morning, Sabrina called to tell meshe was having regular contractions andwas on her way to the hospital, where Isoon met them.Advised not to get the epidural she hadhoped for because she had been takingheparin and baby aspirin during herpregnancy, Sabrina coped well during herseven hour labor and the baby was strongand vital. Even when it was time to pushshe couldn’t quite comprehend that thisbaby would be alive at birth.On that final push, baby Sydneypopped out squirming and, with a pout,she began to cry. Sabrina said, “Is shealive?” Sabrina is hard of hearing, soshe may have not been able to hear thebaby’s cries, or perhaps she just could notbelieve what she was hearing. She askedmany times if Sydney was alive and wehappily repeated, “Yes! She is strong andbeautiful!” When they placed 5 lb. 6 Sydney on her breast, Sabrina justcouldn’t believe she was finally holding thisprecious little miracle!I am forever bonded with this family.My role was rewarded a thousand timesover when I heard Sydney’s cries and sawa mother’s and father’s tears of joy. Wherethere was once heartache and loss, thereis now pride, joy, love and fulfillment.Sabrina reminds me though, “Having asubsequent living child after stillbirth doesnot cure or fix the death of Samantha forme.” She believes that Sydney was sent bySamantha, and the two sisters will share aspecial bond forever. It is a new beginningwith Sydney, the daughter here on earthshe cherishes. Samantha will always live inour hearts and never be forgotten.Sheila Cameron has been a DONA certified birthdoula since November 2007 and has attendedmany births since then, but she feels that helpingwomen through labor and watching new life enterour world is a brand new experience every time.She thrives on those phone calls saying, “It’s time,please come!” She also gives free presentationsto teens.Midwifery Workshopsat The Farm Midwifery Centerwith Ina May Gaskin and partnersMidwife Assistant WorkshopsMarch 7-13, 2010 • April 11-17, 2010May 2-8, 2010 • June 20-26, 2010Aug 1-7, 2010 • Sept 19-25, 2010Neonatal Resuscitation - April 19-20Advanced Workshops• Common Sense and Tradition:Workshop for MidwivesMay 23-27, 2010• Advanced Midwifery WorkshopAugust 22-28, 2010• IV Therapy WorkshopAugust 28-29, 2010CEUs awarded for all advanced workshopsHerb WorkshopMay 19-22, 2010 ACNM CEUs awardedFor more information and curriculum, write:The Farm Midwifery WorkshopsP.O. Box 217Summertown, TN 38483e-mail: 17

Feature StoryTrust Issues:How to Help Women Find Trusted Information On-lineBy Nancy Ripton, BScWhile pregnant with myfirst child my husbandactually placed an Internetresearch ban on all thingsmom and baby. The tipping point waswhen I collapsed on the floor in tears—convinced I was having a miscarriage.At 16 weeks I had been having somecramping. After typing in my symptomsto a variety of search engines I feared theworst. A trip to the emergency room andaccompanying ultrasound showed that Ihad a small benign cyst that was causingthe problem—nothing to worry about.On-line self-diagnosis is never a goodidea (no matter how tempting), but thiswasn’t the only bad web informationI received during my pregnancy. As ajournalist I became concerned over theamount of random, unsubstantiatedadvice out there for moms-to-be. Idecided to co-found a web site,, with wellresearchedarticles and an extensiveexpert panel so other moms wouldhave a place they could trust (outsideof government sites) for information.Here are some ways doulas can helpdirect moms to the best information on-line:Take the easy routeIf you don’t want to research a lot ofsites, the best choices for information areaccredited medical schools, governmentagencies and professional medicalassociations. If you are using a commercialsite, look for experts from top schoolsand associations on the advisory board.Look out forcatch phrases thatdon’t deliverJust because a site says “DoctorRecommended” doesn’t mean you cantrust it. “What you don’t know is howmany doctors recommended the site orhow long ago the recommendation wasmade,” says Dr. Jennifer Shu, editorin-chiefof the American Academy ofPediatrics’ Baby & Child Health: TheEssential Guide from Birth to 11 Years.A panel of experts or an advisory boardis a much better way to judge the qualityof a site than medical catch phrases.Look who’s talkingAuthors and contributors should beidentified for each story. Look forcredentials and a reason to trust who isdelivering the information. “You shouldalso do some of your own research,” saysDr. Shu. Do a web search of the writersand experts to see what else they havedone. Lastly, you should be able to contactthe site’s founder(s). Be wary of any sitethat doesn’t offer contact information.Blog rolesBlogs have a role in offering informationto new moms, but you shouldn’t blindlytrust everything you read. Consider blogsthe equivalent to talking to a friend.They’re great for getting helpful advicesuch as, “This is what worked for me whenmy toddler threw a tantrum.” They’reequally good at providing a voice youcan relate to and making you feel likeyou’re not alone in your new experienceas a mom. What they’re not good for issound medical advice. Most blogs are notwell researched; rather they’re opinionpieces of the host. Look to blogs for aconfidante and a way of getting cool momtips, not any serious health information.If they do offer the latter, only take noteif a link to the study is provided so youcan do further research on your own.18 International Doula Volume 17, Issue 3

Due dateArticles should post a date when theywere published. You don’t want totrust something that was posted 10years ago and may be out of date.Mind your privacyDoes the web site clearly state its privacypolicy? This is important because there isfraud on the Internet. Take time to readthe web site’s policy before signing up.If the web site says something like, “Weshare information with companies thatcan provide you with products,” that’s asign your information isn’t private. Neverprovide your social security number. If youhave any doubts about how your personalinformation may be used, contact the website sponsor via the “Contact Us” feature.Decoding the DotThe last three letters in a web site usually tell you what type of organizationor company has set up the site and can most likely help you determine howreliable the site’s information is. Here’s how to decode what’s behind the agency. Generally speaking you can trust theinformation these sites have to offer.Non-profit and professional organization. Not a guarantee forreliable information; don’t be fooled by the title. Do your research.Academic or education-based. The top medical schools are agreat resource.If it’s too good tobe true, it probably isDoes the web site make claims that seemtoo good to be true? “Lose all your babyfat in days.” Be skeptical of sensationalizedwriting or dramatic cures. It’s also agood idea to do your own fact checkingand make sure you can find other websites with the same information..comCommercial sites. This advice is all over the map. Do yourresearch before you trust what you read.THE LAMAZE ® INTERNATIONAL2009 ANNUAL CONFERENCENancy Ripton is a pregnancyand parenting journalist withover a decade of experience.Her work appears regularlyin Pregnancy, Fit Pregnancy,Mom & Baby and CanadianFamily magazines. Sheis also the co-founder,a pregnancy and parenting site for new momsthat offers trusted advice. She is mother totwo-year old Bode and two-month old Beckett.Look forcredentials and areason to trustwho is deliveringthe informationOctober 1 – 4, 2009Disney’s Coronado Springs ResortWalt Disney World ® , FLJoin doulas from all over the world for anunforgettable conference experience. Togetherwith Lamaze, you can:• Discover the latest research insafe and healthy birthpractices;• Learn how to bettercommunicate withpregnant families; and• Meet peers who share yourbeliefs about pregnancy,childbirth and earlyparentingRegister now! 19

Feature StoryHow Your Doula Trainingand Experience Applies toNearly Any OccupationBy Elizabeth Petrucelli, CD(DONA)As much as we all want tobelieve that once you startin the doula professionyou will stay there, not allof us do or can. With the trying economy,changes in family life or lack of supportfrom friends and family, some of us maymove on to different professions althoughour heart still lies with being a doula andeverything it encompasses After all, that’swhat brought us to being a doula in thefirst place.Presenting myselfconfidentlyBy the time I realized I had to look for anew job I had better communication skills.Interviewing was much easier for me thenit had been in the past. After all, doulasare always meeting with new people andtrying to sell ourselves to them. I wasactually quite shocked at how easy it wasto interview. I found myself talking aboutbreastfeeding in nearly every interview.One of the main things that I learned from my work asa doula was compassionI recently had to slow down my doulapractice tremendously. After nearly fouryears and a little over 75 clients, I hadto get a full-time job when we could nolonger support ourselves on one salaryplus what I made as a doula. It is a hardtransition and I do what I can to stayin the field, such as attending seminarsaround town and teaching about doulas ata local community college.I had studied for a few years to becomea police officer before I had my son.When he was born, my passion changedfrom law enforcement to birth and Ibecame a doula. My new job is every bitas interesting as my doula work, but whatI did not realize is how much of my doulatraining could be applied to my new job.Can you imagine? I sat on a police oralboard in front of five men. Two wereSWAT officers and one was a Lieutenantand there I was talking about helpingwomen with birth and breastfeeding. Isucceeded in selling myself despite the factthey knew little on the subject. I knew it sowell that I came across as very confident.Of course, I also had to submit resumesand I had to dress appropriately. Thiscame easy as well since I always includedinformation about me and my experiencesin my packets when I met with potentialclients and I would dress appropriately forthose interviews.Once I was offered a job, myexperiences as a doula really helped. Iaccepted a position as a security officerin a hospital. One of the questions duringthe interview was, “Are you comfortableworking in a hospital environment?” Yes!That was easy. Other questions wereabout hospital procedures and beingcompassionate to people I don’t know andthose who would make decisions I maynot support. Amazing! Could there be anymore parallels?Once a doula,always a doulaSo I started my job at the hospital withease. I felt comfortable there and knewmy way around despite the fact that I hadnever attended a birth at this particularlocation. One of my past clients actuallyworks in the emergency department! Wecontinued on page 22, top20 International Doula Volume 17, Issue 3

Feature StoryAppreciating the SlowerLabor—It’s Not a Race!By Marianne Donch, CD(DONA), CCESix couples sit in a circle withme; all of us a little nervous,filled with apprehension aswell as curiosity. It is thefirst meeting of a six-week childbirthpreparation class series and everyoneknows that individual introductions arenext. The first round of personal info toshare is kept very safe—names, due dates,choice of local doctors or midwives. ThenI prompt an open-ended question: “Howdo you envision your ideal birth to be?”It’s like casting a fly rod into the stockedkiddy pool: I always get at least one strike.“Fast—a fast labor would be nice!” Othersnod their heads in agreement. Whowouldn’t want a fast labor?I have wondered many times whenand why the birth process has becomea race in people’s minds. Most pregnantwomen hope for the blitz birth; and innew mothers’ circles you will invariablyhear some women proudly announcethe lightning speed of their labors, whileothers seek compassion for the long hoursthey endured endless contractions. Bothreinforce the culturally shared belief—fastis better than slow. Don’t we all share inthis ideal? Faster cars; faster service; fasterfast food. Faster is definitely better. It is soingrained in each one of us that we don’tstop to think about it.Well, my own 36 hour posterior labormade me stop to think about it. Thegreatest teacher in this experience wastime. It taught me patience, doing the bestI could with what I got, how strong I reallywas, responding to my baby’s needs andthe value of excellent support. All greatparenting lessons, yet I know that this typeof reflection is not meaningful to parentsexpecting their first baby. They do notcome to childbirth classes for a parentinglesson; they come for strategies to dealwith the challenges of labor.Fast labors are usually very challenging,contrary to popular belief. How can Icorrect the common misconception andinstill in pregnant parents an appreciationfor the slower labor? Here is a thoughtthat first-time parents can relate to easilyand that has effectively changed manyan attitude.Look at it this way: giving birth is a setamount of work for each woman. Theactual amount of work does not change,whether one has a fast or a slow labor.A fast labor only means that the work isdone in less time—it is not less work! Forexample, if a woman’s labor from start tofinish is six hours, she would have to workthree times harder than if her labor was 18hours. Suddenly 18 hours does not soundso daunting. It means longer breaks, moretime to adjust, the opportunity to pampermom with massage and music and more,often fewer requests for pain medication,possibly quiet time and intimate momentsfor the couple.Of course, no woman can choose herlabor. Provided that there are no medicalconditions, the task at hand is simply toappreciate and work with what is actuallyhappening instead of wishing, hoping,continued on page 22, bottomMost pregnant womenhope for the blitz 21

Feature Storydid youknow?Valuable informationis gleaned from everybirth YOU attend!Complete aDATACOLLECTIONFORMfor each and everybirth YOU attendas a DONA traineddoula and mailor fax it tothe DONAhome office:P.O. Box 626Jasper, IN 47547FAX: (812) 634-1491How Your Doula Training—continued from page 20would chat and people thought it was oddthat a security officer knew so much aboutbirth and breastfeeding.One of the main things that I learnedfrom my work as a doula was compassion.I am often ridiculed for being so compassionatewith the patients. The staff andmy fellow officers claim that I cater tothem. It is hard to refrain from getting abin for someone to vomit in even thoughthey overdosed on drugs or alcohol. I tellthem it’s going to be alright now that theyare here. I also run to get blankets, coolcloths, food, ice chips and the nurse whenthey need assistance. Am I doulaing thepatients? I think so, but I just can’t help it!Compassion is so hard to come byand I don’t want to lose that compassion.I am so grateful for the training I had asa doula. I was an extremely shy personbefore becoming a doula. I wasn’t sure Iwould be able to talk with people I hadn’tmet before let alone sell myself to them sothey would hire me. The skills I learned inmy DONA International workshop helpedin all aspects of my life. Serving as a doulahelped me learn patience, compassionand empathy; it was there before but it’smuch stronger now. I have confidence inmyself that I never had before, even afterspending four years in the Marine Corps!I hope all of you can get through thesetrying times. If you have to step away foreither a part-time or full-time job, the skillsyou learned from your experience will bemore helpful than you could ever realize.Bottom line is, even though I had to slowdown my practice to almost non-existent, Ican still be a doula even if I am not helpingpregnant women like I used to. The skills welearn in doula training and from runningour own businesses can be applied toalmost any job. People often say to me,“Being an officer is so far from being adoula.” I tell them, “No, the jobs are verysimilar. I just want to help people and I cando it better now because I am a doula!”Elizabeth Petrucelli, CD(DONA) lives in Parker,Colorado with her husband and son whose birthwas her inspiration for becoming a doula.Appreciating the Slower Labor—continued from page 21worrying or intervening to change thenatural pace of a labor. This is in essencethe doula approach to birth. Doulas areby definition the antidote to the racementality. Amazingly, the act of givingunhurried time to the mother and familyhas a welcome side effect—shorter labors.It is absolutely critical that parentsadjust their attitude about labor lengthbefore going into their birth journeybecause it affects their expectations anddecisions during labor. Doulas see upclose how powerfully parents’ expectationsand feelings shape their birth. The momwho appreciates the longer breaks of herslower labor stays positive, relaxed andconserves her energy. The mom whoexpects to dilate one centimeter per hourright from the start will be disappointedwith her slow progress, start to worrywhether her body is doing it right, doubther ability to give birth and begin torelease high levels of stress hormones(catecholamines), which can slow or evenstop contractions altogether—a selffulfillingprophecy.Here is a couple who appreciated theirslow labor, a whole week of it. Melissaand Scott (not their real names) came tothe childbirth class reunion with a uniquelabor story. Shortly after her due dateMelissa started to have very light contractions,building over a few hours. At thehospital Melissa was found to be onecentimeter dilated. She labored a few morehours and reached three centimeters. Atthat point her labor slowed and essentiallystopped. Melissa and Scott consulted withtheir doctor, a family practitioner, anddecided to go home to await the return oflabor. They were surprised to have to waitthree days until contractions started upagain. This time Melissa was four centimetersat admission and progressed to sixcentimeters, when again labor came to ahalt. With membranes still intact and inagreement with their doctor the coupledecided against labor augmentation andagain went home. Two days later Melissaand Scott showed up at the hospital sevencentimeters dilated and proceeded tohave their first baby swiftly and withoutneed for any medical intervention. Eventhough this labor would not have won atrophy on the race track, the parents werepositively glowing as they recalled theirbeautiful birth.Marianne Donch lives in Bozeman, Montana,with her husband and two daughters, ages 12and 14. She is a birth doula, childbirth educator,lactation counselor and a DONA approved birthdoula trainer. Besides her love for all things birthand breastfeeding, she enjoys gardening inthe short mountain season and traveling to hernative Germany.22 International Doula Volume 17, Issue 3

essay — multiculturalSight UnseenBy Marianna Terhune, CD(DONA), CMA, LS, CBEIalways try to make sure every This time during their second birth atmother and father feels like the same hospital the staff was extremelythey had control of their respectful of the couple’s impairmentbirth and that their voices and wishes for their baby’s birth. It waswere heard. When working with a couple important to them that the baby’s fatherwith impairments, this becomes even be very involved. The midwife introducedmore challenging. Their basic needs are herself and said she understood that thethe same, but the little details become husband was her assistant, getting him theextremely important. This includes making scrubs he requested, which made themsure that items are not moved without smile. The parents had full control of theletting them know, announcing who birthing process, with the staff’s respectfulis entering or leaving their space and guidance. The birthing woman touchedmaking sure that they are fully aware of herself as often as she needed to so thatany touching. The why, who, where and she could truly feel the progress and knowhow are even more pertinent and crucial where her baby was at all times. Whenin this situation for them to feel in control. the baby was crowning she rubbed thePart of a doula’s responsibility is to protect head and talked about the ring of fire. Thethe birthing environment. It is important midwife helped the father guide his babyto create a birthing space that invokes out into the world and he placed the babyall of the senses: sight, sound, taste, on the mother’s tummy. Both parents heldsmell, touch, balance and acceleration, the umbilical cord until it stopped pulsingtemperature, kinesthetic sense, pain and while talking to and stroking their newother internal senses to be girl. The midwife helped the father toRecently I attended my second birth with clamp and cut the cord.a visually impaired couple. The womanis completely blind and the man only hassome vision at extremely close range. Theyare an amazing couple. He is studying forhis bar exam and she is on sabbatical fromher job as a counselor for the blind.During their first birth three years agoI was constantly reminding the staff thatthe couple was visually impaired despitethat it was noted on their chart and birthplan and posted on their door so anyonewho entered their space would know. Thestaff did not announce themselves whenentering the room, they did not explainwhat they were doing, they asked them tosign on the “X” and gave only visual clues.It was a bit challenging!As the new baby snuggled and wasloved by her mother the midwife explainedin great detail about the placenta andamniotic sac, letting the parents explore itwith their hands so they could understandwhat supported their baby in the womb.They identified the tree of life, placentaand sac.Baby self-attached with a little gentleguidance and nursed on both breasts withthe full support of the staff, where sheremained for two hours before newbornprocedures were done.It was an incredible experience towitness the birth journey as a part oftheir world. I now truly appreciate thelittle things that we sometimes take forgranted.Marianna Terhune is a DONA certified birth doula,certified midwife assistant, certified lactationspecialist and all around birth advocate who lovesthe process of birth and making a differencewhen a new life comes into this world. A goodfriend describes her as being a guardian angeland guide for newborn babies.It is important to create a birthing space thatinvokes all of the 23

essay — tricks of the tradeThe Doula Interview:Important Components of the First MeetingBy Jennifer Johnson, CD(DONA)The interview is the initialcontact a doula has witha potential client, and herdemeanor and level ofprofessionalism are crucial to the successof this first interaction. Though the clientand the doula are both deciding whetheror not to work together, the potentialclient is looking to the doula’s behaviorand responses to determine whether shewants the doula to support her duringher birth or postpartum period, a veryimportant time in her life.Elements of the interview includewhere to meet, what to bring, answeringquestions and signing the contract. Beingprepared for the interview questions canmake the difference between a tenseexperience and an enjoyable appointment.Where to meetAfter initial phone or e-mail contact,an in-person meeting is advised so thatthe doula and the potential client candetermine whether they are compatible.The location of the meeting is generallyflexible and each has advantages anddrawbacks.Some doulas have an office or othercomfortable place to hold a discussion,while others may welcome the client intotheir home. The benefit of meeting in thedoula’s office or home is that she will nothave to spend time and fuel traveling andthe potential client can get to know herand her style a little better. On the otherhand the client may be dismayed that shehas to travel to interview the doula; or shemay feel more comfortable meeting in herown home, office or a neutral location.Both the client and the doula mayfind meeting at the client’s homeadvantageous. The doula gains insightinto the potential client’s lifestyleand personality (since she is likely tobehave more naturally in her ownhome) and the client may appreciatethe investment of time and thedoula’s effort to accommodate her.This option is especially beneficialto the postpartum doula whowill be serving the client in herhome. The main disadvantage tohaving the initial interview in the client’shome is to the client. The doula, whomshe may not ultimately choose to hire, isessentially a stranger so the client may feeluncomfortable disclosing her address andwelcoming her into her home.Meeting at a neutral location, such asa coffee shop, may seem safer and morecomfortable to all parties involved andcan work out well if the doula and clientlive a distance from each other. The maindisadvantages of a public meeting placeare a lack of privacy, potential discomfortin the surroundings and an inability tocontrol distractions.There may be many more reasonsto meet or not meet with clients inthese suggested locations. It is alwaysbest for the doula to carefully examineeach situation with respect to her andher client’s comfort levels and needs todetermine the most appropriate andsatisfactory location for an initial interview.What to bringMany doulas create a folder of informationto give the woman. Information aboutpregnancy and postpartum issues, copiesof the letter of agreement and contract,a business card and brochures arecomponents of a standard folder. DONAInternational has many publicationssuitable for distribution to potential newclients, including the Position Papers andWhat is a Doula? and Dads and Doulasbrochures. When aware of her situationahead of time (i.e., first-time mother,VBAC, multiples, etc.) a personalizedA doula’s birth philosophiesshould reflect both her passionnd her professionalism24 International Doula Volume 17, Issue 3

folder can show both your breadth ofknowledge and your willingness to supporther. Include handouts from trustedprofessional organizations as well ashelpful items you have created yourself.Answering questionsMany people ask similar questions whenthey are considering which doula to hire.Having well-considered responses to thesequestions will make the interview processeasier.Typical questions asked of doulas are:• What is your birth or postpartumsupport philosophy?• How many clients have you attended?• What did your training involve?• How long have you been a doula?• What do your services include?• What are your fees?A certified doula is a professional inher field and she should be able to answerthese questions as well as others posed bythe client. Many items may be addressedin the letter of agreement, a documentthat details the doula’s training andbackground, services provided and fees.The refund policy and the doula’s backupsituation should also be discussed.Perhaps the most important partof the conversation is in regard tophilosophy. This will be a critical aspectof the relationship between doula andclient, and it is essential for a doula tohave considered her own philosophy andbe able to articulate it. Among a doula’sgreatest challenges is remembering thatthis experience belongs to the womangiving birth. A doula’s birth philosophiesshould reflect both her passion and herprofessionalism and likely incorporate thedeeply personal factor of why she becamea doula and how she practices.The interview is an opportunityto get to know each other a bit,making the decision to worktogether multi-facetedThe doula is also interviewing theclient. The interview is an opportunityto get to know each other a bit, makingthe decision to work together multifaceted,including professional as wellas personal aspects. It is helpful to askabout her previous birth and postpartumexperiences, if any. Find out if she andher partner were satisfied with theprevious experience and how you maybest serve her needs in this pregnancy,birth and postpartum period. Clarifyingher expectations of the doula’s role willalso help determine if working togetheris feasible. Be prepared to record heranswers to questions as the interviewprogresses.Signing the contractOccasionally upon meeting each other, allinvolved know right away that the matchis a good one and the contract/agreementcan be signed at the initial interview. Thisbegins the official relationship betweenclient and doula. Often, however, it willnot be clear whether the client wants toinvite the doula to her birth or postpartumexperience. Some women would like theopportunity to have a private discussionwith their partners or interview otherdoulas to make certain they are choosingthe right support person. Offering a timeframe such as ten days to two weeks tomake a decision gives both the doula andthe client enough time to consider thisimportant decision. The client can thenmail the signed contract and deposit backwithin the allotted time.The initial consultation is a time for thedoula and the client to meet and find outmore about one another. Being preparedfor this crucial first meeting will enhanceconfidence and allow the potential clientto experience the doula’s professionalismand warmth and to understand the doula’sbusiness practices and her passion for herwork. As her doula business continues togrow, routines will also evolve. Refiningconsultations is a fundamental part ofenhancing a busy practice.Jennifer Johnson, CD(DONA) is a birth doulain St. George, Utah and a member of the UtahDoula Association. She is pleased to be a pioneerin Southern Utah, helping to educate anddemonstrate to both mothers and care providersthe benefits of labor support. Jennifer could donone of this without the love and support of herhusband and two 25

essay — postpartumPostpartum Doula MisconceptionsBy Beth Youmans, BA, PCD(DONA), ICBEIcame to the postpartumdoula occupation somewhatthrough the back door. Istarted in the birth industryas a childbirth educator and have beenteaching since 1990. After teaching forseveral years and attending the birthsof my students, I officially becamecertified as a DONA birth doula in 2002.Bottom-line, I was a total birth junkie!Looking back, I remember having aconversation with a local midwife in whichshe asked if I had “ever considered beinga postpartum doula?” My response was apolite, “no thanks!” Little did I realize thata seed was planted in my consciousness;and although it would be years beforeanything would come of this conversation,this midwife, through her intuition andwisdom, left a profound impact on me.For a little over two years I have servedour community as a postpartum doula. Tomy surprise and delight I discovered beinga postpartum doula was a great match anda whole lot of fun! Needless to say, I ampassionate about helping families duringthe postpartum season or fourth trimester.In this article I hope to dispel what I believeto be some common misconceptions,maybe even some I had myself, of whatpostpartum doulas really do. I will alsocandidly share that like being a birth doula,being a postpartum doula can be exciting,challenging and extremely rewarding.Misconception No. 1A postpartum doula is onlyfor women in crisis.True, there are times when a postpartumdoula is hired to help someone copewith a difficult situation, such as feelingoverwhelmed, coping with postpartumdepression or working through abreastfeeding issue, but the vast majorityof postpartum doulas are hired beforethe birth. If so, the postpartum doula canmore effectively help the parents gentlytransition through the fourth trimester andin most cases avoid postpartum difficulties.I have encountered situations whereit was likely that women might sufferfrom postpartum depression or havebreastfeeding issues, but the support ofa postpartum doula right from the startaided in avoiding serious issues. Just ashaving a birth doula does not necessarilyinsure the desired birth outcome, thechances of achieving certain goals aremuch more likely with the right support.Misconception No. 2A postpartum doula is aglorified housekeeper.If this were true I would make a terriblepostpartum doula! The majority of mytime is spent helping with breastfeeding,giving the parents a break to nap, makingsure they are nourished and hydrated,teaching baby basics including how tocarry their infant, fielding questionsand concerns and making referrals toprofessionals and support systems in thecommunity when appropriate. Yes, someof my time is spent tidying, however,the majority of my time is spent indirect support of the family—educating,empowering and encouraging.Misconception No. 3A postpartum doula is a babysitter.This is anything but the truth! I donot take over the primary care of anewborn or other children, rather Iam there to coach the parents duringthe postpartum season; to encourage,nurture, educate and empower themto a place of steady confidence.Yes, I do care for the newborn orother children for short spells of timeallowing parents the opportunity to napor shower, but I do not solely care forthem for hours on end. The postpartumdoula’s motto is to work her way out of ajob. I am there to help mom and partnerbecome independent not co-dependent.Misconception No. 4A postpartum doula supportsmom and baby; she is oflittle value to partner.While many partners are back to workwithin a week or two, whenever homes/he can count on encouragement andsupport from the postpartum doula whois often of help to grandparents and otherfamily members that may be visiting.Some specific ways of supportingpartner during the postpartum seasonmight be showing him/her how to bathe,diaper, swaddle, wear and/or soothehis/her new baby. Preparing a snackor meal, offering beverages, makingsure s/he’s getting sleep, giving him/her time to reconnect with mom andrunning errands are ways to providepractical support. Checking in withhim/her and listening with a nonjudgmentalear to his/her joys andconcerns is a way to provide emotionalsupport. It is important to rememberthat this is a season of adjustment foreveryone; the postpartum doula isthere to support each family member.In summary, postpartum doulas helpthe new or growing family by providingemotional, educational and physicalsupport in the weeks and possibly monthsfollowing birth. Hiring a postpartum doulaallows parents to rest, bond with their newbaby, enjoy greater breastfeeding success,interact with older children and gentlytransition into life with a newborn.Beth Youmans previouslyserved the Washington DCmetropolitan area as a DONAcertified birth doula andBradley Method® childbirtheducator and is currentlyserving her community as aDONA certified postpartumdoula. She also enjoys teachingchildbirth education as an independent instructor.Beth resides in Northern Virginia, is married to aterrific man and is the mom of three amazing kidsranging in age from college to elementary school.26 International Doula Volume 17, Issue 3

2009 conference reportOur Annual Conference, Atlanta 2009By V. Nicole Wocelka, CD(DONA)Our conference planningthis year was put to thetest when Passion for BirthLamaze trainer Teri Shillinghad challenges with her travel and firstgeneral session speaker Shafia Monroewas unable to join us at the last minute. Iam happy to report that the doula spiritshined through when Pat Predmorestepped into the Lamaze pre-conferencesession until Teri could arrive safely andDeb Gauldin, with hearty laughter andtender songs, opened our conference inan unexpected but thoughtful way. I don’tthink we even realized we were actuallylearning! Sharon Storton led us throughtouching stories and skill building forhelping our clients and us through andout of birth trauma in her general session.Friday ended with the DONA membershipmeeting, Sharing Circles in the Ballroomand private get-togethers that lasted intothe wee hours.In Saturday’s general session we heardDr. Robert Sears speak on vaccinationsand the evidence-based informationthat doulas can use to help the familiesthey serve as they make those importantchoices. Postpartum doulas stated thatvaccination questions are almost alwaysasked of them. In Saturday afternoon’sgeneral session Dr. Susan Ludington-Hoewent to presentation extremes to provideus with information about kangaroo careand attachment…certainly educationaland hilarious enough to keep us awakeafter that hearty lunch! Saturday eveningincluded another fun opportunity to spendwith Deb Gauldin. The laughter wasfollowed by dancing…sort of!On Sunday, we were delighted by AmyGilliland’s general session presentationon the attachment needs of the laboringwoman. Amy is one of the few researchersstudying doulas and is one of our own!The last general session of the 2009conference was a timely presentation byFounder Penny Simkin on “Eco-FriendlyBirth.”Please don’t think the concurrentsessions are not worth mentioning; therewere just too many good ones to referencein detail. As one attendee stated, “It wasvery difficult to choose concurrent sessionsthis year – so many great choices…thisis info that is vitally important to all birthdoulas.” Of course, attendees loved theunique opportunity to hear FoundersMarshall and Phyllis Klaus during theirconcurrent presentations.There were a few changes this year. Aswe plan to go green with our conferencemanual next year, in this transitionalyear we offered general session handoutsprinted and concurrent sessions ona CD in the back of the manual. Theplated breakfasts were commented onappreciatively and attendees said theyliked the lunches too. One doula wrote,“The food was very good, but it wouldhave been better with cookies.” Wait, did Iwrite that?At the end of the conference, whilesinging “Dona Nobis Pacem” holdinghands with women I did not know,but who are my sisters, I was struck bythe most beautiful feeling. You see, forthe past two years the board and theconference committee have worked hardwith me to make this conference happenand I received praise and gratitude fromthose present. But I truly know that thisis OUR conference, every single memberof DONA International is a part of it. IfDONA were a person, she would standin that circle, feeling the melodies andharmonies swirl around her and knowingthat she was in the presence of greatlove. To all the official and unofficialvolunteers who took care of pregnant orfrail attendees; to all of you who dancedwith abandon and laughed until tears felldown your face; for all of you who madesomeone feel welcomed; it is now my timeto thank you. Truly, with all that I am, andall that I have, I honor you.Please join us! We are in Albuquerque,New Mexico on August 5-8, 2010 and inBoston, Massachusetts in 2011 and weneed you to make our conference andannual membership meeting complete.You might: a) get your picture takenwith Founder Annie Kennedy, b) learnsomething new, c) teach something toanother doula, d) remember why beinga doula is so great or e) all of the above!How’s that for a post test?V. Nicole Wocelka, Conference Director lives inMinnesota or Wisconsin depending on the dayand is one of those tree-hugging, hippy doulaswhen she’s not dressed up for conference. Sheis stupid in love with her husband Anthony andworks at a free-standing birth center with CPMs,woo hoo!Are you ateamplayer?Join the DONAPublicationsCommitteeas anInternational DoulaAssociate EditorVarious editorial positions areavailable for you to consider!For more details, 27

member newsDoula Services Added to theUniform Insurance Claim FormThird Party Reimbursement is Becoming a RealityBy Jessica Atkins CD(DONA), ICCE, DONA Third Party Reimbursement ChairAsignificant achievement physical, emotional, and informationalfor U.S. families andsupport to a mother before, during,doulas occurred in May. and just after birth and/or provideNancy Spector, Chair of emotional and practical support to athe National Uniform Claim Committee, mother during the postpartum period.released the following statement:Source: National Uniform ClaimCommittee, 2009The NUCC has completed its reviewand approved the addition of ataxonomy code for Doula. The newcode will be included in the Julyrelease of changes to the code set andwill go into effect on October 1. Thefollowing is the definition of the code.Doulas work in a variety of settingsand have been trained to provideYou could be apublishedauthor…artist…photographerSubmit your feature articles,research, poems, bookor video reviews, douladoings, questions for Penny,letters to the editor andphotos or artwork.Contributor’s Guidelines andspecifications available on request.E-mail your submissions toIDEditor@DONA.orgThis is truly an amazing milestone forDONA International and families acrossAmerica. Beginning in October doulas willbe able to use an official code assigned fordoula care to assist our clients in pursuingreimbursement for doula services.One of our own doulas, Pat Burrell,spent a great deal of time working toachieve this major accomplishment ingaining reimbursement for doula services.Through her former work in public healthand professional connections she soughtan invitation to the annual review ofclaims processes where she introducedthe need for a universal code system.There was some opposition at first. Shefielded arguments against approving acode and declarations that the need wasnot warranted since publicly-funded andhospital-based doula programs alreadyexist across the country.Pat was able to justify that “womenneed a doula who is there just for them.”When a doula works for a publiclyfunded agency or hospital, she canhave a different role than a doula whois hired by a family; and public doulaservices are not universally availablefor all families. As proof Pat utilizedDONA International published statistics,the DONA International Scope ofPractice and Code of Ethics and DONAInternational’s reputation for being thepremier professional doula organizationfounded by highly educated and informedindividuals including physicians.This means that families will havegreater access to doula services for bothbirth and postpartum care regardlessof the type of insurance they have. ThisUniversal Code applies to both privateinsurance and Medicaid. The details ofhow families will access this payment areforthcoming but DONA Internationalencourages the continued use of theThird Party Reimbursement forms withall clients. It is through continued demandthat consumers can change the landscape.What is next for DONA International?We are mobilizing our forces to beprepared for October 1st when the codewill go into effect. The newly formedThird Party Reimbursement Committeewill begin to define the scope of doulaservices with the intention of creatingguiding principles so as not to risk havingthem defined by an external party. DONAInternational is releasing nationwideannouncements informing the public ofthis exciting news. A special informationalgathering was held during the DONAInternational Conference in Atlanta,Georgia. Also watch for newly revisedThird Party Reimbursement packets thatwill be available through the Boutique onthe DONA International web site soon. Ifyou are interested in participating thereare several ways to help this effort. Pleasecontact for moreinformation.Jessica Atkins isa DONA certifiedbirth doula, DONAapproved birthdoula trainer and acertified childbirtheducator. She assistsorganizations in theirnonprofit programdevelopment. She is currently serving as theDONA Third Party Reimbursement Chair. Sheresides outside of Austin in the Texas Hill Country.28 International Doula Volume 17, Issue 3

Postcard from HomeThe 2009 DONA International Conference is now history! We were so excited to see somany of our doulas in attendance and hope that all who attended found the conferenceto be informative and fun. Hopefully you were able to connect with doulas from yourarea and also from around the world.We work very hard to bring you the best conference possible each year. Weappreciate your attendance and also your comments and suggestions to make the nextconference even bigger and better.Now is the time to start planning to attend the16th Annual Conference in 2010. We have alreadybegun making preparations for the conference tobe held in the beautiful city of Albuquerque, NewMexico, August 5-8, 2010.We appreciate you and your commitment to thebirthing community! Please let us know if there isanything that we can do as your office staff to helpwith your doula needs.Sincerely,Kathy, Angela, Terry, AmyP.S. Don’t forget to look at your mailing label on the outside of this issue to see whenyour membership expires. You wouldn’t want to let it lapse and miss any of the greatissues of the International Doula magazine!International Doula is aquarterly publication ofDONA International, anonprofit organizationregistered in the stateof Indiana. All rightsto the content ofthis publication arereserved. © DONAInternational 2009.Articles published inInternational Doulado not necessarilyrepresent the opinions of DONA International.Authors are responsible for the accuracy of allcontent. The names of people mentioned inInternational Doula are fictitious or appear withpermission. Nonmembers may receive theInternational Doula for $20 (U.S.) donation. In theinterest of education and the dissemination ofcurrent and correct information, reproduction,in part or in whole, of individual articles withinthis publication, is encouraged unless otherwiseindicated. Reproduced articles must haveproper accreditation and must not be sold. Thispermission to reproduce is limited to numbersless than 100 unless prior permission is obtained.Moving? The post office will not forward theInternational Doula magazine. Send your addresschanges to DONA International, P.O. Box 626,Jasper, IN 47547, or e-mail inquiries should be addressed to the Editorat or mailed to P.O. Box 626,Jasper, IN 47547. Unsolicited manuscripts arewelcome but will not be returned.Quotes~“Work worth doing,that’s all you reallyneed.”~Justice Sandra Day O’Connor”When your workspeaks for itself,don’t interrupt.”~Henry J. Kaiser“You’ve achievedsuccess in your fieldwhen you don’t knowwhether what you’redoing is work or play.”~Warren BeattyThis Issue's Cover ArtSusan Kirk is the creator and owner of Mother Art.I have been creating art ever since I was a small girl.When I was pregnant for the first time I was fascinatedwith this life growing within me. At the time, I wasmeeting with a group of women working with clay andI was inspired to create a vessel that would hold thisexperience, empowering and honoring the upcomingbirth. This also became the birth of Mother Art. Thiswork connects me to my own experience as a mother, through birth andnurturing, and connects me to the entire life process.My art celebrates the mystery of life, the incredible beauty of birth and thebond with our children and the whole family. Rounded, graceful, flowinglines capture the beautiful feminine form through her growth of life andspirit in pregnancy, birth and breastfeeding, creating art that connect uswith family and friends in sacred ceremony and joyous celebration.I have exhibited my Mother Art line at Lactation Consultant and Midwiferyconferences for many years. I have enjoyed the responses that I receiveabout my work and I deeply respect the work of these professionals. Mycreations may also be purchased online at have worked as an art educator and substitute teacher for nearlytwenty years after graduating from UCSB with a B.A. in art in 1979and CSUC with a teaching credential in 1986. As a member of theChico Art Center, I have been included in several group shows andhave participated in COBA in 2004 and 2006, and in Open Studiosin 2005 and 2006. I’ve also had three solo shows at the Upper CrustBakery in Chico, CA, my home town. My work has been purchased forprivate collections and I have completed many commissioned pieces,including 3 large murals for Circus Circus, Reno in 1984 and 29

ASK PENNY | PREGÚNTELE A PENNYIs a “Perfect Storm” Brewing in Maternity CareBy Penny Simkin, PT, CD(DONA)Dear Readers,I don’t have a specific question toaddress with this issue, but rather, Iwill discuss something I am frequentlyasked about (and that I frequently askothers): “Will we ever see an attitudein obstetricians and policy-makersthat reflects the normalcy of birth?”I recently read a most enlighteningpaper by Lawrence Devoe, MD, theoutgoing President of ACOG, titled,“The Future of Intrapartum Care:Navigating the Perfect Storm — AnObstetrician’s Odyssey” (AmericanJournal of Obstetrics and Gynecology,April 17, 2009 [Epub ahead of print]).This honest, thought-provoking articlerevealed the troubled thoughts of theleader of the most influential group inmaternity care. He describes the “perfectstorm” brewing in intrapartum care,caused by the simultaneous occurrenceof many problematic elements, leadingto disastrous outcomes. Any oneelement, by itself, is far less likely tocause disaster. Using this analogy, “aperfect storm in the labor environmentcan lead to perinatal injury or death.”Dr. Devoe takes the reader on “anobstetrician’s odyssey during which we willencounter the ‘perfect storm’ of currentintrapartum care.” He first describes themany “advances” in maternity care thatwere intended to make birth safer formothers and infants, but when subjectedto scientific evaluation were found notto provide expected benefits, not tobe practical or, in some cases, to domore harm than good. He cites theseexamples: electronic fetal monitoring;fetal scalp blood sampling; fetal pulseoximetry; the growing cesarean deliverypandemic; cesareans for all breeches;repeat cesareans for all; cesareans onmaternal request; increased use ofPitocin and cesarean delivery for slowlabor progress; increased inductions forlogistical, not medical, indications. Someof these practices have been abandoned;others are constantly being tweaked inhopes of creating improved outcomes.The repertoireavailable to him asan obstetrician islargely limitedAlong with the harms and lack ofbenefits of the “advances” listed above,Devoe names other non-clinical factorsthat further contribute to the “perfectstorm:” the unpredictability of thelabor process and accompanying risks;shortcomings in teaching obstetric staffin the intended use and interpretation ofintrapartum assessment tools; growingusage of induced and enhanced laboralong with growing ignorance of itsmanagement; shortages of experiencednurses; the adverse medicolegal climate.Then, Dr Devoe offers his “modestproposals to…navigate this perfect stormsituation and arrive safely in port.” Indeedthey are very modest proposals, whichessentially continue what they are doing,but try to do it better. Among otherthings he advocates: better teaching andrecurring certification for all providers inthe use of EFM and oxytocin; frequentclinical drills to prevent and deal withobstetric disasters; recognition thattechnology has limits and cannot replacehuman vigilance; addressing the issue ofcesarean delivery on maternal request;introduction of “laborists”—in-housedoctors who cover the hospital and freeprivate doctors from having to attendtheir patients in labor; and preventionof medical errors through improvedcommunication about patient care.All this seems quite basic, and toolittle too late, or as Amy Romano said,“rearranging deck chairs on the Titanic,”an apt analogy that goes along with theperfect storm analogy (in “ImprovingEFM: Rearranging Deck Chairs onthe Titanic,” Science and Sensibility: AResearch Blog about Healthy Pregnancy,Birth, and Beyond from LamazeInternational, June 5, 2009). I appreciateDr. Devoe’s honest concern and desireto improve care of mothers and babies.It is clear, however, that the repertoireavailable to him as an obstetrician islargely limited to even heavier relianceon and improved application oftechnological interventions. His deepfaith in technological obstetrics (despitethe lack of evidence of benefit) seems toprevent him from thinking outside thebox. Surprisingly (or not), he did notmention midwifery care as a safe, costeffectiveway to avert the perfect storm,nor preventive care and health educationof women before and during pregnancy.Shared decision-making between womanand caregiver was not mentionedas an innovative way to increasecommunication and respect and removethe defensiveness that characterizesour litigious maternity care climate.I have left the best for last, however.There is one outstanding exception inDr. Devoe’s technology-based proposals.He sees a place for doulas in preventingthe perfect storm! As a way to address“the cumulative shortage of skilled andexperienced obstetric nurses, …the useof properly trained patient care assistants30 International Doula Volume 17, Issue 3

and doulas is a stopgap measure thatshould not be dismissed out of hand.”Not exactly a ringing endorsement ofdoulas but, considering the source, it is awelcome acknowledgment of our value.Imagine that—doulas as a way toavert the perfect storm! What aboutit, doulas? Are you up to the task?In the doula spirit,PennyPenny Simkin, PT,CD(DONA), has specializedin childbirth education since1968 and is one of DONAInternational’s founders.Her practice consists ofchildbirth education, birthcounseling and laborsupport, combined with abusy schedule of conferences and workshops.Penny and her husband Peter have four grownchildren, eight grandchildren and a pug.Please e-mail your questions forPenny to with“Ask Penny” in the subject line.¿Se Estará ElaborandoUna “Perfecta Tormenta”En La Maternidad?Por Penny Simkin, PT, CD(DONA)Queridos Lectores,No tengo ninguna pregunta en específicode la cual hablar en este artículo, peroquiero discutir algo de lo cual siempre mepreguntan (y que yo siempre pregunto aotros): ¿“Veremos algún día una actituden los obstetras y los políticos querefleje la normalidad del nacimiento?”Hace poco leí una gran informaciónque escribió el Dr. Lawrence Devoe, elpresidente saliente de ACOG (ColegioAmericano de Ginecología), titulado“El Futuro Del Cuidado del Intraparto:Navegando la Perfecta Tormenta — UnaOdisea del Obstetra” (Diario Americanode Obstetricia y Ginecología, 17 de abrilde 2009). Este sincero artículo pone a unoa pensar y revela pensamientos negativosdel líder del grupo de más influenciaen el cuidado materno. El describe la“perfecta tormenta” elaborándose en elcuidado intraparto como algo causadopor los sucesos simultáneos de muchoselementos problemáticos que solo causandesastre. Usando esta analogía, “unaperfecta tormenta en el ambiente delparto puede llevar a gran daño o muerte.”El Dr. Devoe lleva al lector en “unaodisea del obstetra durante la cual él chocacon ‘la perfecta tormenta’ del cuidadodel intraparto en la actualidad.” Primeroél describe los muchos “avances”en elcuidado materno cuya intención es hacerel parto más seguro para las madres ylos bebés, pero cuando esto es 31

ASK PENNY | PREGÚNTELE A PENNYcientíficamente no se encontró ningunbeneficio, no se determinó que fueranprácticos esos “avances”, y en algunoscasos, hicieron más daño que bien. Elcita los siguientes ejemplos: monitorfetal electrónico; muestra de sangrefetal del cuero cabelludo; oximetría delpulso fetal; el gran incremento global enel número de cesáreas; cesáreas paratodos los bebés que no están en posición;cesáreas repetidas por cesárea anterior;cesáreas pedidas por el paciente; aumentoen el uso de pitocina y cesáreas parapartos lentos; aumento en induccionespor razones no médicas. Algunas deestas prácticas han desaparecido; otrasson constantemente modificadas conmiras a crear mejores resultados.Junto a los daños y falta de bienestarde estos “avances,” Devoe mencionaotros factores no-clínicos que contribuyena “la perfecta tormenta:” el no poderprever el proceso del parto y los riesgosque conlleva; defectos en la educacióndel equipo de obstetricia en el uso delas herramientas para interpretar elproceso del parto; el aumento de lospartos inducidos que van a la par conla ignorancia del proceso; escasez deenfermeras con conocimientos; y laadversidad de la legalidad médica.Entonces, Dr. Devoe ofrece su modestapropuesta para…navegar esta perfectasituación tormentosa y llegar segurosa puerto.” De hecho, son propuestasmuy modestas, las cuales continúan loque están haciendo, pero tratando dehacerlo mejor. Entre otras cosas que élaboga: mejor educación y certificaciónrecurrente para todos los proveedoresen el uso del monitor fetal externo y laoxitocina; frecuentes ejercicios clínicospara prevenir y tener que bregar condesastres obstétricos; reconocer quela tecnología tiene sus límites y que nopuede reemplazar la vigilancia humana;exponer la situación de las cesáreasque son reclamadas por el paciente;introducción de “laboristas”—doctores—dela casa que cubran el hospital y liberea los médicos privados de tener queatender a sus pacientes durante el parto;y prevención de errores médicos a travésde mejor comunicación sobre el cuidadodel paciente. Todo esto parece básico,muy poco muy tarde, o como dice AmyRomano, “rearreglar las sillas en lacubierta del Titanic,” una muy buenaanalogía que va a la par con la “perfectatormenta” (en “Mejorando MonitoreoFetal Externo: Rearreglando las sillasen la cubierta del Titanic,” Ciencia ySensibilidad: Un Estudio Interactivo sobreEmbarazo Saludable, Parto y Más Alláde Lamaze Internacional, 5 de junio de2009). Aprecio la sincera preocupación ydeseo de mejorar el cuidado de las madresy sus bebés. Está claro, por supuesto,que el repertorio disponible para élcomo obstetra está limitado a todavíamayor confianza y mejores aplicacionesde las intervenciones tecnológicas. Suprofunda fe en la obstetricia tecnologíca(a pesar de la falta de evidencia encuanto a los beneficios) parece que nole permite pensar fuera de esa premisa.Sorpresivamente (o no), él no mencionóel cuidado por comadronas como algoseguro, más económico a manera deprevenir la tormenta, ni el cuidadopreventivo y la educación de salud delas mujeres antes y durante el embarazo.La decisión compartida entre el médicoy la paciente no se menciona comouna manera innovadora para aumentardicha comunicación y respeto y remuevela defensiva que caracteriza los litigiosen el clima del cuidado materno.He dejado lo mejor para último, porsupuesto. Hay una gran excepción enlas propuestas basadas en la tecnologíadel Dr. Devoe. El ve un sitio paralas doulas en el tratar de prevenir laperfecta tormenta! Como manera debregar con la escasez de enfermerasobstétricas, menciona el uso de asistentescorrectamente adiestradas y doulas. Noexactamente un endoso resonante paralas doulas, pero considerando la fuentede información, es un reconocimientomuy valorado y bienvenido.¡Imagínense esto—las doulascomo manera de prevenir la perfectatormenta! ¿Qué tal eso, doulas?¿Están ustedes listas para eso?En el espíritu de las doulas,PennyPenny Simkin, PT, CD(DONA), se ha especializadoen educación prenatal desde el 1968 y es unade las fundadoras de DONA Internacional.Su práctica consiste de educación prenatal,consejería y apoyo sobre el parto, combinadacon un ocupado programa de conferencias ytalleres educativos. Penny y su esposo Metertienen cuatro hijos, ocho nietos y un perrito “pug.”Traducción por Augie Rigual, BA, CD(DONA),LCCE, CLC. Augie ofrece clases prenatales enespañol para dos Departamentos de Salud enOrlando, Florida, tiene grupos de apoyo paramadres lactantes a través del hospital WinniePalmer y trabaja para el hospital como educadora.Tiene cuatro hijos, y reside en Orlando, Florida.32 International Doula Volume 17, Issue 3

Network CommunicationsNetwork Communications Proudly Presents Audio Recordings of the2009 DONA International Conference — August 6-9, 2009, Atlanta, GeorgiaAudio CDs $10.00 each (Buy 6 & the 7th is FREE!)Qty. Order # Description CircleDN-T00D Full Set of Audio CDs of Recorded Sessions in CD Storage Holders (Includes a 20% Discount) $232.00DN-T00M MP3 CD of All Recorded Sessions in the MP3 Audio Format $169.00DN-T00U USB Drive Containing All Recorded Sessions in the MP3 Audio Format $169.00DN-T00L MP3 Download Library! After we process your payment we will send you a link to download all recorded sessions$129.00in the MP3 Audio Format!DONA INTERNATIONAL GENERAL SESSIONS (Audio CDs $10.00 each, CD-ROMs $15 each)DN-101 GS1 — DONA Music and Humor — Deb Gauldin $10 CDDN-T02 GS2 — Birth Trauma: Lessons from Solace for Mothers — Sharon Storton $10 CDDN-T02R Synched CD-ROM: GS2 — Birth Trauma: Lessons from Solace for Mothers — Sharon Storton (PowerPoint and Audio Track Synched as $15 CD-ROMPresented at the Conference)DN-T03 GS3 — Vaccines: Making an Educated Decision for Your Child — Roberet W. Sears $10 CDDN-T04 GS4 — Birth Kangaroo Care and Beyond: The Science of Hormones, Pain Control, Hypoglycemia, Thermoregulation and Breastfeeding — $10 CDSusan M. Ludington-HoeDN-T04R Synched CD-ROM: GS4 — Birth Kangaroo Care and Beyond: The Science of Homrone, Pain Control, Hypoglycemia, Thermoregulation $15 CD-ROMand Breastfeeding — Susan M. Ludington-Hoe (PowerPoint and Audio track Synched as Presented at the Conference)DN-T05 GS5 — The Attachment Needs of the Laboring Woman — Amy Gilliland $10 CDDN-T05R Synched CD-ROM: GS5 — The Attachment Needs of the Laboring Woman — Amy Gilliland (PowerPoint and Audio track Synched as $15 CD-ROMPresented at the Conference)DN-T06 GS6 — Eco-Friendly Birth — Penny Simkin $10 CDDN-T06CR Non-Synched CD-ROM: Eco-Friendly Birth — Penny Simkin (PowerPoint and Audio track Synched as Presented at the Conference) $15 CD-ROMDONA INTERNATIONAL CONCURRENT SESSIONS (Audio CDs $10.00 each)DN-T07 101 — From Crowning to First Latch: Integrating Research, Realities and the Doula Role — Teri Shilling $10 CDDN-T08 102 — Part 1: Give The HUG: An Innovative Approach to Explaining Newborn Behavior to Expectant and New Parents — Jan Tedder $10 CDDN-T31 103 — The Three Year Itch — Stefanie Antunes $10 CDDN-T10 104 — Welcome to My Home — Marilyn Hildreth $10 CDDN-T11 105 — How a Doula Can Help a Mother Take Advantage of the Sensitive Period — Marshall Klaus $10 CDDN-T12 106 — Healing the Doula: Recovering From Our Clients’ Losses and Disappointments — Miriam Maslin $10 CDDN-T13 201 — Breastfeeding: A Partnership — Eva Bild $10 CDDN-T14 202 — Part 2: Using The HUG with Young Families — A Skill-Building Workshop — Jan Tedder $10 CDDN-T15 203 — The Seduction of Induction — Penny Simkin $10 CDDN-T16 204 — How Obstetricians Think: Barriers to Evidence-Based Family-Centered Practice — Marjorie Greenfield $10 CDDN-T17 205 — Recognizing and Healing Birth Trauma and Burnout in Birth Professionals — Sharon Storton $10 CDDN-T18 206 — Integrating Self-Hypnosis with Other Pain Relief Methods — Phyllis Klaus $10 CDDN-T19 301 — The Big Squeeze: Doulas Designing and Delivering Individualized Childbirth Education — Teri Shilling $10 CDDN-T20 302 — The Mother-Baby Love: Bonding and the Roots of a Thriving Society — Suzanne Arms $10 CDDN-T21 303 — Attachment Parenting: The Science behind the Style — Robert W. Sears $10 CDDN-T22 304 — Transparency in Maternity Care Project: The Birth Survey — Getting the Word Out — Nasima Pfaffl $10 CDDN-T23 305 — Safe Sleep: How Location Affects Breastfeeding — Lysa Parker $10 CDDN-T24 306 — Part 1: How the Miraculous Transition of Birth Occurs — Inside to Outside — Karen H. Strange $10 CDDN-T25 401 — Doulaing the Pregnant and Laboring Father — Amy Gilliland $10 CDDN-T28 404 — Dual Development: Working with Pregnant and Birthing Teens — Nancy Sinclair and Nick Wechsler $10 CDDN-T29 405 — Step-by-Step Birth Kangaroo Care — Susan M. Ludington-Hoe $10 CDDN-T30 406 — Part 2: When Things Do Not Go as Planned — Simple Tools for Doulas to Support Integration and Healing — Karen H. Strange $10 CDSHIPPING: U.S. Orders: $2.00 Per CD up to a maximum charge of $10.00. All Other Countries $3.00 USD Per CDTOTAL ORDER $SALES TAX $(MO RESIDENTS ONLY! .05780%)SHIPPING CHARGE $TOTAL DUE $CUSTOMER NAMECOMPANY NAMEADDRESSCITY, ST/PROV, ZIP/POSTAL CODECOUNTRYCREDIT CARD # CVC# EXPIRATION DATEPhone Orders (800) 747-1426 Mail Orders P.O. Box 378, Cedar Hill, MO 63016On-Line Orders 33

Membership & CertificationBecome a member of DONA International today. Your membership includes such benefits as referrals; a subscription tothe quarterly magazine, the International Doula; a discount on DONA International’s Annual Conference; and access tothousands of doulas around the world who support DONA International’s mission to improve the physical and emotionalhealth of childbearing women and families. Furthermore, your membership in DONA International is the first step on thepath to becoming a DONA Certified Doula. Act now and enjoy immense rewards as a member of DONA International.All materials can be ordered from in the DONA Boutique or complete this form and mail or fax it to the DONA International Home Office.membership optionsMembership fees in u.s. fundsFor current fees in other countries, check the International Fee GroupIndex in the DONA Boutique at or call the Home Officeat 888-788-DONA (3662).Membership in DONA International includes a subscription to theInternational Doula magazine and eDoula newsletter.One Year $50.00 USD (U.S.)One Year $41.50 USD (Canada)Two Year $85.00 USD (U.S.)Two Year $70.50 USD (Canada)Three Year $125.00 USD (U.S.)Three Year $103.75 USD (Canada)One Year $34.00 USD (Mexico)Two Year $57.60 USD (Mexico)Three Year $83.75 USD (Mexico)group membership informationI wish to receive information on the cost-saving groupmembership option (minimum five group members).certification informationcertification packet in u.s. fundsFor current fees in other countries, check the International Fee GroupIndex in the DONA Boutique at or call the Home Officeat 888-788-DONA (3662).The Certification Packet contains all the necessary information andforms for certification. The packet must be completed within two years.(Allow 2-3 weeks for delivery.)birth doula certification packetpostpartum doula certification packet$35.00 USD member (U.S.)$28.00 USD member (Canada)$22.75 USD member (Mexico)$45.00 USD non-member (U.S.)$36.90 USD non-member (Canada)$29.25 USD non-member (Mexico)miscellaneousdoulas—making a differenceA video collaboration by Douglas College and DONA International. Newparents share how doulas made a difference to their birthing experiences.Featuring Penny Simkin, PT, Michael Klein, MD, Pauline Clare, CD(DONA).DVD: $20.00 USD memberDVD: $25.00 USD non-memberVHS: $10.00 USD member/non-memberintroducing the doulaA video by Penny Simkin, PT, CD(DONA)DVD: $22.00 USD member/non-memberVHS: $12.00 USD member/non-memberInternational DoulaQuarterly magazine—one year subscription (membership includes one subscription)$15.00 USD member (additional subscription)$20.00 USD non-memberPlease check the options you want above, then complete the form below.NAMEADDRESSCITY STATE/PROVINCE ZIP/POSTAL CODE COUNTRYPHONEE-MAIL addressI do not wish to have my name included in the DONA International rental mailing list______ (initial here) As a term of agreement to become a member of DONAInternational, which includes my choice to receive referrals, I hereby consentto abide by the DONA International Code Of Ethics and Standards of Practice.(See for the Code of Ethics and Standards of Practice.)Please give my name to consumers as a (check all that apply)birth doula postpartum doula______ (initial here) As a term of agreement to purchase aBirth or Postpartum Doula Certification Packet, Ihereby consent to abide by the DONA International Codeof Ethics and Standards of Practice. (See www.DONA.orgfor the Code of Ethics and Standards of Practice.)i have enclosed a check for $_______________in us funds made payable to dona internationalcharge my mc, visa, am ex, or discover on CARDSIGNATUREReturn form and payment to: DONA International, P.O. Box 626, Jasper, IN 47547 USA; fax (812) 634-1491; or order on-line at www.DONA.orglast updated 3/0934 International Doula Volume 17, Issue 3

Expand Your Birth HorizonsBrought toEarth by BirthHarriette HartiganThis stunning collectionof black and white photographsby one of the world’smaster birth photographerscelebrates giving birth andbeing born. Here is creation,lived by each of us.Whether you have not yet seen birth or have seen it manytimes, gaze upon these eloquent moments lived with power,courage, love and grace. They are worthy of your sight.Experience the power of women in labor. See the joy offamilies with their newborns.Through the poetry of photographs and the weaving ofwords, experience what birth means to you.To read more about this book, Press, paper, 96 pages MB03BE $25.95Do you want to be a midwife?Paths to Becoming a Midwife:Getting an EducationAre you thinking about becoming a midwife, but you’renot sure what kind of midwife you should be, or whattraining options would be best for you? Paths toBecoming a Midwife was designed to help you answerthese questions and to help you make sense of thevarious options available. This edition includes 11 newarticles, 20 substantially updated articles, plus adirectory of over 150 schools, programs and other resources.Paper, 328 pages C514PM $29.95Paths to Becoming a Midwifeand Education Issue ComboSave $5 when you buy Paths to Becoming aMidwife and Midwifery Today Issue 78 at thesame time.PM78 $34.95Survivor MomsWomen’s Stories of Birthing,Mothering & Healing after Sexual AbuseMickey Sperlich, MA, CPM,& Julia S. Seng, PhD, CNMWhether you are a survivor, a midwife, a mentalhealth provider, or you know a survivor who is on thispath, you will learn from this book about motheringand the ongoing journey of healing and surviving.To read more about this book, visit Motherbaby Press, paper, 245 pages MB02 $34.95Placenta: The Gift of LifeThe role of the placenta in differentcultures, and how to prepare and use itas medicineCornelia EnningLearn about placenta rituals from around the world and thehistory of placenta remedies used throughout the ages.You’ll also find 15 recipes for use of the placenta inointments, essences and other remedies. Included are true stories ofsuccessful uses of placenta remedies by new mothers.Motherbaby Press, paper, 80 pages MB01 $21.95Here’s a Place to start…Midwifery Today Issue 78 onMidwifery EducationRead this issue for articles on traditional midwifery, nursemidwifery,apprenticeship, and direct entry midwifery, aswell as a listing of current direct entry programs availablearound the US.Articles include •Midwives as Educators: Teaching in the21st Century •Traditional Midwifery, a Traditional Vocation •Pathways to Midwifery:ACNM •Why Accreditation? MEAC and Midwifery Education •US DirectEntry Midwifery Programs •North American Registry of MidwivesMT78 $10.00The Beginning Midwives PackageThis package includes a one-year subscription to Midwifery Today magazine,Paths to Becoming a Midwife and 4 single audio tapes regularly priced at $9each:•Realities: Midwifery and the Profession, by Mabel Dzata 961T450•Realities of Being a Midwife, by Ina May Gaskin 981T762•Realities of Being a Midwife, by Valerie El Halta 981T809•The Art of Midwifery, by Elizabeth Davis, CPM 981T807P04 $105.00 (U.S.)Save $21.90P04x $110.00 (Canada/Mexico)P04xx $125.00 (All other countries) Price includes shipping.www.midwiferytoday.comMail: P.O. Box 2672, Eugene, OR 97402 USA Tel: (541) 344-7438 or (800) 743-0974 US/CANFax: (541) 344-1422 E-mail: Web site: 35

P.O. Box 626Jasper, IN 47547Shop for all your doula needs!Logo itemsDoula toolsGifts for clients or for yourselfBooks for certificationPosition papers and brochuresCheck out our new 788-DONA (3662)ALL MAJOR CREDIT CARDS ACCEPTED!SECURE ON-LINE SHOPPING! FAST SHIPPING!

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