Mourning During Labor 

Denise Bolds, MSW CD(DONA) November 12, 2017

I am always fortunate to have amazing clients whom always teach me something new in my doula practice. Awhile ago, I had a client who was a VBAC getting ready to give birth to her second child. My client comes from an affluent lifestyle; her first born son is 2 and a half years old. Her VBAC successful, her birthing room was filled with family celebrating the birth; however the mother was not celebrating the birth of her beautiful baby girl. In fact, her demeanor was one of anticlimactic, bordering upon disinterest. It was evident something was amiss. 

This mother was despondent over the change in her routine with her first born son now that her newborn daughter had made her arrival. For over two years this mother focused all of her mothering upon one child; there was a routine, a lap, a hug for her first born. With the birth of her second child, this mother did not process the addition of another child entering her life. Many parents of multiple children express anxiety over affection, routine and family structure. 

This mother hired support so she could try and maintain the routines she and her firstborn had before her daughter was born. She became frustrated and anxious; she was the perfect candidate for mental health support from a provider who specializes in post-partum issues, including managing siblings. Luckily this mother was receptive to receiving the support. 

Fast forward 18 months later. Another client, Kathleen was giving birth for the second time. Her first born son is two years old. During Kathleen’s labor, she began crying to the point where it evolved into hysterical sobbing. Kathleen’s hysteria had nothing to do with her labor, in fact, her hysteria was so pronounced, it shut down her labor.

I immediately stepped in to find out what was happening. John, Kathleen’s husband tried to console her to no avail. Before leaving the house, Kathleen forgot to kiss her sleeping son good bye. John did his best to rationalize with Kathleen; her sudden bleeding in her labor resulted in the couple rushing to the hospital with a potential emergency. Kathleen did not accept this reasoning; she continued to sob about how much she loves her son; she forgot to kiss him and touch him for the ‘last time.’ 

I remembered my client of 18 months prior; I knew what Kathleen was experiencing; she needed validation if we were going to move forward in the current birth. I went to Kathleen and I explained that I understood how she was feeling; I validated her, I saved space for her to mourn the loss of having an only child. I validated this mother’s anxiety with a simple statement: “Your lap and your heart are big enough for two.” Kathleen is an only child. She hugged me breathing a sigh relief. I was able to identify what Kathleen could not immediately express. 

As doulas, we are on the front line witnessing what our clients experience. As part of prenatal support having a conversation about parenting multiple children and having a resource of mental health specializing in maternal health is very beneficial. Having this topic as part of the doula prenatal intake is something to consider in empowering your client and the family. 

Here are some tips for the client and the growing family: 

 Have a sibling visit at the hospital. 

Have a gift for the older child. 

Have a ‘celebration’ of the newborn’s birthday. 

Have the eldest child be a helper to the newborn sibling. 

At home, set aside ‘Mommy & Me’ time with the oldest child while the newborn is with dad/mommy/partner. 

Find a job in the home that the eldest sibling and Mommy can do together like setting the table for dinner or getting the mail from the mailbox. 

Identifying and saving space for our clients when they cannot fully understand their own feelings brings trust and empowerment that affects the family as a unit. Many parents experience anxiety of having enough emotional resources, time and energy in parenting multiple children. This can be especially evident if the parents themselves are from single child families. 

Kathleen and John used some of my suggestions from above; Kathleen is both empowered and confident in her motherhood of her two boys. Post partum, she sent me a lovely thank you gift and card commemorating the space I held for her in her labor where she mourned before giving birth.

There’s a satirical storybook sold on Amazon on this subject. It’s a very serious subject: parenthood and sleep. As a certified birth doula and an experienced single mother, I can relate to this subject from both professional and personal levels. 

Human beings need sleep. When a pregnant woman sleeps, her body relaxes; allowing for the amazing science of the body to preform functions that benefit her and her unborn baby. 

Sleep rejuvenates the body and uses less energy to do so. It is scientifically based; the human body’s temperature decreases during sleep. A woman in the pushing stage of labor falls into a deep, resting sleep in between contractions allowing her body to rest before pushing again. This is the true essence of a ‘power nap’. 

After the birth, the new mom’s adrenaline is still going strong. A few hours later, she will feel the exhaustion of her labor. With the support of her partner, labor and delivery staff and her doula, she can get some rest… maybe. If the mother has a Caesarean- section or any other complications from the birth such as excessive bleeding, she will continue to be closely monitored by the labor and delivery staff every 15-30 minutes for her blood pressure, temperature and to check her uterus. Once stable, the new mother will be monitored less frequently. Many women say they cannot sleep in the hospital after the birth no matter how the medical staff implores her to rest. This can be the result of the environment (bed, lighting, noise, room co-sharing) or policy (frequent vitals checks). 

Once the parents go home with the new baby, there is a transition of assimilation to the environment for the baby who just spent the last ten months in the mother’s uterus. The new mother also adjusts to her hormones reverting back to non-pregnant, normal self. This will include hot flashes, restlessness, hair loss, etc. The new mom is also adjusting to breast/bottle feedings, counting wet/poop diapers, bowel movement, stitches, moving around and more. Family and friends come to visit, everyone is excited to see the new baby. Everyone has a gazillion questions and photos. It’s smart for the new parents to ask for cooked meals from the visitors; it’s a great help. The mother needs something else: sleep.

Sleep deprivation is used as a training tool from the military to medical school. Sleep deprivation is defined as a condition of not having enough sleep; this lack of sleep affects organ function and cognition. It is also known to cause clumsiness and poor judgment. Having a lack of sleep can cause high blood pressure, weight gain/loss and heart disease. Lack of sleep in addition to giving birth places the mother’s body in a no-win situation. Many fatal accidents involving infants are the result of parents not having enough sleep. 

Sleep deprivation and the new mother equals a higher incidence of postpartum depression in the new mother. Mothers are usually hesitant to disclose their fatigue; society projects the “suck it up” and “the rite of passage for the mother” attitude. Many new mothers are reluctant to admit to sleep deprivation for fear of being labeled as ‘weak’ or ‘complaining’ this social expectation can kill. Every year there are fatalities of infants where the exhausted parent fall asleep holding them. 

Many new parents experience insomnia from anxiety; there is fear present that something may happen or go wrong with the baby if parents go to sleep. Post Partum Maternal Anxiety is real. This is anxiety that something like SIDS will happen to the newborn if left unattended. The new mother experiencing this anxiety will watch her newborn constantly, be reluctant to put the baby down, and more. Sleep deprivation, the lack of sleep/rest places the body into ‘overtime’ with major organs such as the heart and brain suffering the most. Mothers will often forgo sleep to complete chores, tend to pets, other children in the home and of course be the perfect hostess to the constant flow of visitors. Many moms simply cannot go to sleep unless someone is up watching the newborn. This new mom may also have trouble sleeping if she hears her baby crying even with the other parent taking care of the baby.

There’s a solution. For the first 45 days after birth, limit the amount and duration of visitors to the new mom/baby. Delegate household chores and responsibilities in advance to those who are willing and reliable. Hire a postpartum doula to support the family with sleep solutions for newborn care while providing security to the family (especially Mom) the baby is well cared for while they sleep. Teaching new parents about newborns safely sleeping on their back, in a clear crib/bassinet and no co-sleeping.  It’s vital to acknowledge Post Partum Maternal Anxiety by working with the new mom in her sanctuary (home) building trust, comfort and reasonable goals as a new mother. Fathers and partners can also experience Post Partum Parental Anxiety.  Successful motherhood is not just the birth registry, the shower or the birth; success continues with postpartum support that provides security for the family to enjoy the miracle of life.    

Mother’s Need Sleep

Denise Bolds, MSW CD(DONA) 

January 9, 2017

Here’s A Scenario: A pregnant woman is faithful to her obstetrician care she currently receives. This mother-to-be has an awesome relationship with her prenatal provider: the medical professional is aligned with this woman’s beliefs and approaches to birth. The obstetrician recommends the prenatal woman to take a tour of the local hospital labor and delivery unit where the obstetrician has privileges; the mother-to-be will give birth at this facility. After taking the tour of the labor and delivery unit, the pregnant woman is distraught; she cries all the way home in her car. The hospital tour she just participated in is the complete anthesis of her obstetrician’s care and service. The pregnant woman also finds out after doing research the hospital the obstetrician has privileges in is not baby friendly; it also has a high cesarean-section rate. The pregnant woman is now faced with a dilemma; she’s 27 weeks into her pregnancy; she must accept her current provider and facility or start over with a new provider and facility as well as building a relationship from scratch. She goes to her obstetrician’s office and requests her medical records to be sent to a new provider… The current obstetrician only sends appointment dates. The pregnant woman calls her doula for guidance on how to navigate this scenario efficiently and correctly. As a certified birth doula, I have several of my clients face this very same issue every year. It is immediately assumed that if the OB provider works well, the hospital will fall in the same line as well. This is a huge fallacy and a stressor for pregnant women. 

Can Get There From Here… 

Every woman who becomes pregnant has choices. It is the diligence that is often neglected. The obstetrician maybe completely likable and even wonderful; however, the institution where he/she has privileges to deliver at is also vital. What does privilege mean? Medical practitioners have to be approved by a hospital before treating patients there: there is a credentialing check that takes place as well as malpractice coverage, and of course insurances accepted. It is a lengthy process. In the sanity of business, obstetricians usually support births at a local hospital where they provide prenatal care. It’s like an accord (agreement/understanding) between medical groups and practitioners not to encroach upon one another. It is territorial; most times the doctor has no say or influence in the hospital they attend births at. 

Baby friendly is a designation a hospital’s labor and delivery unit applies for: it is a lengthy process that involves policy change and training of staff. A baby friendly hospital supports rooming-in of mother and baby, no formula, breastfeeding support and the labor policies allows the laboring mother more flexibility. It is imperative the mother-to-be is aware of the polices and practices of both the prenatal provider as well as the institution she will birth at; same approach applies for midwives who support births at hospitals. If the pregnant woman utilizes an OB/GYN group for her prenatal care, there is a strong possibility she will not have her OB she likes when she goes into labor as the OB staff does take call on rotation. Keep in mind having a c-section is major abdominal surgery with increased risks, interventions and recovery than a natural vaginal birth with little interventions. A birth doula who is skilled can provide education support in this area as the pregnant woman makes her decisions with her partner. Having a birth preference is also a tool of empowerment. (more on that in another blog)

Know Your Rights! 

A patient has the right to change providers. A patient has the right to request their medical records and have access to them. All that is required is a signed release giving the office permission to release records and it is up to the pregnant woman to collaborate the prenatal care team she wants. It takes some diligence… Always know the cesarean section rate of any hospital and practitioner. There are several ways to research this on the internet:

 http://www.consumerreports.org/doctors-hospitals/your-biggest-c-section-risk-may-be-your-hospital/

 http://www.cesareanrates.com/2015/01/what-is-my-hospitals-cesarean-rate.html 

Do take the time to research c-section rates. Also, make sure you contact your insurance provider to inform them of your change in prenatal providers. You do have the right to make that change. No pregnant woman should have to face giving birth with a provider or facility that they are uncomfortable with or uncertain of. This stress will have an impact on the woman’s labor and birth.

Building A Supportive Team. A supportive team for the pregnant woman is more vital than her birth registry and the size of her baby shower combined. Having a birth doula that supports and understands the pregnant woman and her partner’s beliefs and wishes is also part of the team. The doula also has resources and considerations that the parents-to-be may not have ever considered. It is also vital to have your prenatal practitioner and institution where the birth will take place also be a part of the team. Having a supportive team positively impacts the birth and bonding of the baby and parents. It also provides respect for the doula to provide education and resources while respecting the policies of birth professionals/institution. The pregnant woman is never to feel trapped and voiceless. There’s nothing more beautiful than witnessing a pregnant woman’s confidence in her birth.