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[amlikam]

 (or wanna be's :-)

Thought I would start a thread for those of us who currently work as doulas, midwives, IBCLC, OBs, RNs... and so on, with a primary focus on pregnancy, labor or postpartum.

Wondering how your training might be influencing your birth this time and just generally be a good place for us to chat knowing "both sides" of the experience as to be mamas and care providers.

I am a certified doula, ceremonialist and overall birth/family/community advocate. I have not taken clients in the last year due to my father's illness and passing. Now with pregnancy I am happy to have to time to love and dote on me as a pregnant mama! I have been trying to really embrace the "my body was made for this" mentality this time around but sometimes my training makes it hard for me to shut down the frontal cortex when it comes to thinking about my pregnancy, birth and PP.

Any others out there? 

[pokeyAC]

I am a newish doula.  I have worked with 3 clients and been to 2 births.  I have been studying and interested in birth for many years.  I have already read quite a few books on birth and such, so I don't feel like I need to do a lot of reading during my pregnancy.  I let my wife choose the childbirth class because it is more for her than me since I have already attended a few classes on my own.  I have been pretty laid back through my pregnancy.  I have normal worries and anxieties, but I feel pretty good about everything that is going on.  I have heard so many stories about what can go wrong that it's hard to completely ignore them, but I am doing my best to not think about worst-case scenarios.  I found out recently that I have placenta previa.  There's a great chance it will move, but it was the first thing I really had to worry about.  We plan on planning for any outcome so we are prepared.  I would be very disappointed if I had to have a c-section, but I know how important it is to process that so I don't have a traumatic birth experience that I regret later.   

The births I have attended were both in the same hospital and they have taught me that you can't predict what kind of birth experience you will have based on the care providers.  One was a quick birth with a very chill OB, and the other was a long labor with a more aggressive CNM.  The second birth reinforced my feeling that I don't want an epidural because it seems to slow things down and lead to many other interventions, some because you just can't move around.  The first birth showed me that if you can wait to go to the hospital, they don't have time to offer any interventions.  I live 2 blocks from my hospital so that may be an option for me.

The funny thing is, I don't know if I want to have a doula at my birth.  I think I would be ok with someone I already know and trust, but bringing in someone new I'm not so sure about.  I kind of want as few people there as possible so I can feel more relaxed.  It's strange to be on this side of it in that way because I can see why someone might say they don't want to hire a doula when I think we are so valuable.  I have learned from experience that it is handy to have a third person there if only to take pictures, bring mama drinks and keep her company while her partner is out of the room.  I'm honored that my clients trusted me to be there to help them as such a vulnerable time.

[womenswisdom]

I've been a doula for over 6 years and on the midwife path for over 2. I also have had a cesarean, vbac and a loss (last pregnancy). So I'm a complicated bundle of mess around here, lol. I think some of what I've learned as a midwife has helped me be more relaxed about this pregnancy and some has made me a little more anxious. On the one hand, I'm more afraid of loss than I was before and I hope that as the pregnancy progresses, that will abate some since the chances of survival increases as time goes on. OTOH, I was very emotionally invested in my hbac last time, which was a wonderful experience. This time, I'm more at peace with however this baby is born, although I have no reason to think that it will be anything other than according to plan. I've got a good midwife team and a good backup OB team but I know that stuff happens. My experiences dealing with unexpected complications with clients and my own loss really put things into perspective and all I want out of this pregnancy at this point is a healthy baby. I know I would be disappointed if I would up with a transport or cesarean, but I don't think I'd have regrets, which is all I can ask for.

[bearandotter]

I am a family nurse practitioner (whole lifespan) but my career has focused on women's health and antenatal/perinatal health. I am now doing a PhD in nursing with a focus on women's experiences of health and illness. I like to think I work under the umbrella of a midwifery model of care, providing families with solid information about what is known/suggested and then supporting them in their decisions. Having been a provider for a number of years providing prenatal care and catching a few babies... I came into pregnancy feeling pretty comfortable with the 'evidence' and a lot of the reasoning behind suggested interventions/protocols. I start each appt with my MW telling her what I want (Blood work or whatever) and then we spend the rest of the time chatting. Some of the standard care in North America doesn't have a ton of evidence to support it - so I am not as 'by the book' as people might guess. As an individual I lean toward crunchy, so this influences my personal decisions too. 

I was in active labor with my first until I walked into the hospital - then nada. I think my self-identity as a provider completely over rode what my body was going through. That labor ended up being augmented (argh). My second was a speedy, unanticipated home birth (though the MW walked in minutes prior to delivery). I felt a lot of anxiety in that birth knowing what could go wrong and I had a postpartum hemorrhage that really scared me. We will try for a natural hospital birth again this time and I am doing a lot of visualization/planning for how I can let my body do what it needs to in a hospital setting. 

I like your reference to shutting off the frontal cortex amlikam - I agree. It is why I refuse weights at my appts. I cannot find any solid evidence that that monitoring wait is a good indicator of anything, and I know I would obsess (should I eat more/eat less/am I retaining fluids... etc...). I will do one at 36w ish so that my MW has it in case of emergency. 

On the doula topic, interesting you bring this up pokeyAC. I think doulas are a great asset for many women. However I have NO desire to have one. I go somewhere deeply personal/internal during labor and cannot imagine anyone there that didn't have to be. The entire idea of being surrounded by a community or circle of women, as some people write about so eloquently, icks me out. I think it is amazing how different we each are as to our desires and needs in labor. 

[pokeyAC]

Originally Posted by bearandotter 

On the doula topic, interesting you bring this up pokeyAC. I think doulas are a great asset for many women. However I have NO desire to have one. I go somewhere deeply personal/internal during labor and cannot imagine anyone there that didn't have to be. The entire idea of being surrounded by a community or circle of women, as some people write about so eloquently, icks me out. I think it is amazing how different we each are as to our desires and needs in labor. 

I'm glad it's not just me!  I just want to be left alone.  I'm an introvert, and I don't yet know how I will be in labor, but I imagine I will want to not want to spend my energy relating to other people.  However, I think a doula might be good for DW to keep her calm and remind her that what's happening is normal.  I have a lot more empathy now for women who say they just want their partner with them. 

[boolery]

I am a CNM (and up at a birth right now!) and have given a lot of thought to how experiencing my own labor and birth will be different from managing someone else's labor and birth. I too hope that I can turn off as a midwife and just be a laboring lady. I am hoping for a homebirth, but am not dreading a transfer, in part because it would be to the hospital where I attend births. The birth of my son, who my partner carried, was about as far from our dream birth as possible (induction, thick mec, c/section, NICU) but we still got this totally awesome baby at the end, which was really all that mattered. I find that I'm much less focused on my "birth experience" and much more focused on the goal of a healthy baby- by whatever birthing means necessary.

[amlikam]

The deeper I go in pregnancy the less I want a doula. I have committed myself to one who is also a close friend and apprentice midwife. (and unconventional RN). I thought she would be good to have since my midwives are 1.5 hrs away (assuming they got right in the car and started driving). Plus she knows my daughter, has seen me naked, has seen me pee on the trail when hiking..... Basically we are familiar in a a way I don't have to feel awkward about (not at this point anyhow). :-D
There was another friend which I recently said yes to but feeling now overwhelmed by another person. Plus my sister keeps commenting on how she won't make any flights because she knows I will want her at my birth. Really I am just not sure about that. With DD my whole family (ok most, 2 sisters, my sisters boyfriend and his brother, my dad, my niece, MIL and my BIL...) showed up to the hospital while I was in labor uninvited and I felt like a fish in a bowl. Mostly all tried to give me space but my sister who wants to come this time kept making comments of how I should just have drugs and when I finally did she was happy I was "comfortable". My other sister was good though and kept telling me that I could do it and she believed in me. But really no one offered any physical support except the hand and leg holding during the purple pushing Phase....
I'm conflicted because Sis could be helpful with DD but it can also be a way to push DH out of the picture and I really want him present. (emotionally).
So much to think about. As a doula I wish for every family who wants a doula to have access to one but I am understanding more and more why many people go it alone with just a care provider and DP. Such an interesting flip.
FWIW I can totally see myself surrounded in a circle of women and that actually helps me walk through my fear, but I think more in terms of a metaphor right now during labor. I'll have a juicy ritual beforehand bc during I don't think I want all those women blocking the hormones from DH and DD. after this pregnancy they deserve to see momma blissed out and loving them. :-) not distracted by visitors.

[amlikam]

I've had both losses and a not well infant as well. However I feel a lot of my DD newborn issues wouldn't have been so severe at home. As for the losses, I have started to trust the process a bit more and worry more about preterm labor than loss at this point. Though each day I spend time being in the now moment as well because you never know. Life is so precious.

[JNajla]

I'm a peds clinical nurse specialist, but worked as an MCH RN before I went back for my masters.  I would say that having this additional experience/ training has made me more 'stressed' during pregnancy- because I know all about the 'statistics' of what can go wrong.... sometimes you're better off not knowing!  It is a blessing and a curse, I guess.  

[JNajla]

Quote:

I like your reference to shutting off the frontal cortex amlikam - I agree. It is why I refuse weights at my appts. I cannot find any solid evidence that that monitoring wait is a good indicator of anything, and I know I would obsess

I love this!  I've been weighing myself everyday during pregnancy and all it has been doing is causing me to stress out....

[pokeyAC]

Even though logically I know I should not be worried about my weight gain, being weighed still makes me nervous.  I was overweight and don't need to gain much. I downloaded a pregnancy app and according to it I am right on schedule anyway so I should stop worrying.  I think next time I will close my eyes so I can't see the number.

[Sweet Huck]

I'm not a professional, but my mom is! She's a high risk Maternal/Child Nurse as well as a lactation consultant. She also spent many years as a maternal/child grieving nurse.  Ironically, she herself became a high risk patient when she delivered my little brother at 25 weeks. I've grown up with her amazing and sobering stories from the field, as well as the experience of a very sick micro-premie brother.

The world of high-risk and micro-premies is pretty different from low-risk birth, but these experiences have definitely informed my pregnancy and thought... and, yes, my fears. I am very thankful that all is progressing well. Also very thankful for a mama who knows all the technical world! She's very good, too, about not wanting to influence my own decisions and opinions, only offering advice if I ask specifically for it.

[amlikam]

Are any of you planning on taking a "childbirth" class? Tonight we start a 4 week series which I am mostly taking to support the hubby. Also the instructor is a friend of mine who does the class more mmmmmm how do you say.... ritual-ish kind of way- with lots of great information.

[pokeyAC]

We are also going to take a class.  I couldn't convice DW to take the more expensive one I have taken before and really like because she doesn't see the point in paying for it when I've already taken it.  So I let her choose since it is mostly for her.  We will take the one offered at the hospital.  I talked to someone the other day who took it and had a homebirth, and she said she liked the class more than she expected to.  That raises my expectations a little bit.

[bearandotter]

No class for us. We did the hospital tour with #1 and it included a 90min class on labor/delivery. The RN instructor recognized my DH (a physician) and became super nervous and akward through the whole class. I felt so bad for her that we will stay away this time. I taught prenatal classes for a number of years so I'm feeling OK with the 'knowledge' part. 

With my first I really was hoping for DH to come to a more natural/ritualistic class, but no dice. He trained as a physician in a province before MW was legal, so until 2009, and our first pregnancy, didn't know the difference between a doula and a MW (eek). And unfortunately some horrible experiences with some crazy 'doulas' (who were practicing illegal, untrained midwifery leading to some poor outcomes/deaths) he was very against the whole idea. It took major work to get him to agree to using a MW (helped our first MW had a PhD in medicine). He is now a total convert and refers all his normal-risk pregnant patients to a MW instead of an OB (!). 

Turns out I could care less about 'support' during labor. I spent most of my first labor alone in the hospital bathroom (my choice) and my second was so fast there was no time for anyone to support me though anything. I think if I was more 'normal' in my preferences/lengths of labor I would  force DH to take a class/read something to become more aware of massage/etc techniques. 

How sad is it that my DH trained as a physician and caught more than a hundred babies (before we moved somewhere where it didn't make sense to practice to do maternity care) - that I was the first intentional drug-free delivery he saw (if you don't count my pit augmentation). He was never exposed to the idea that it could be done and the women in our old community were similarly ill-informed. I have RN friend worked full time in obstetrics for a year before she had a patient deliver without an epidural. Because as an NP, who used to work in a remote area, all my catches were accidental (precipitous births that couldn't handle the 2-3h transfer to a hospital) - all of them were as natural as you could get (and luckily- easy wonderful births). 

[ABNYLON]

I'm a CNM, but have been teaching midwifery students instead of practicing since I moved to the UK 2 years ago (I have to retrain for a year and a half to work clinically here). My husband is a NICU attending. We're taking a childbirth class and it's been really helpful in getting us out of our clinical brains and into the role of people who are about to become parents.

Having the excessive amounts of knowledge about birth and newborns that we do has been both good and bad. Husb has intentionally had himself taken off the NICU schedule and is only doing research these last 2 months before the baby comes, otherwise he just sees too many of the 1% of horrible things that can happen. 

We're planning a homebirth with an independent midwife we really like and are looking forward to that. I'm pro socialized healthcare but after my first few NHS appointments here realized that I really need to know who I'm going to deliver with and trust them in order to fully turn myself over to the birthing process and just be a person in labor instead of trying to manage things.

[JNajla]

I'm a peds clinical nurse specialist, working with kids aged 4k- 5th grade. My experience is mostly population health/ public health so I'm definitely not an expert in OB content. In fact, a lot of what I learned about OB in nursing school 12-15 years ago is outdated anyway. Experiencing pregnancy is a much different experience than learning about it from books!