Welcome back. Many people ask me about insurance coverage for doula care. Right now insurance does not cover doula care. The closest we have gotten is Flex/FSA reimbursement which does have a good track record for covering doula care. 
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"The most important thing you bring to the birth is yourself."

I wanted to be a professional doula but I sat on the idea for about 10 years before I really pursued it full-time. One obstacle was having two small children. I went to a couple of births when they were little and it was really challenging being on-call with little ones. But that wasn't the only reason I wasn't ready to do it.

My other challenge was that I didn't know if I could do it with a disability. Stuttering may not seem like a disability, and its a tricky one because you can't always see it and most people might not see it as a disability. But look it up, it is. 

So of course my stutter gets more challenging when I'm tired, rushed and on W's, M's and D's.  Just perfect when I want to work with women and mothers as a doula! Oy, does God have a sense of humor or what?! So I thought that I just couldn't do it. That I would just keep this passion quiet and accept where I was. I had a great job in an office. I did stutter there but its no rush so no worries. I'm not embarrassed by it at all, it just seemed like too much to have in the high stress situation of birth where communication is key. And I did work in communications in my office job anyway, how ironic.  

Then comes summer 2010, and my aunt Marcy, who is a homebirth midwife, calls me up and invites me to go to births with her as her assistant. I was hooked immediately and I knew I had to face this head on to get myself where I wanted and needed to be. I started researching speech therapy. I had had it for 8 years as a kid, it helped somewhat, well, a lot. I can get by now. But I felt it was time to polish it up and get rid of the these last bits so that I could be a doula. I found some options but they were all really really expensive. So then, after seeing so many homebirths, I considered maybe I can find home-speech therapy.

I looked up a bunch of stuttering self-help books in-between my studies for my doula certification I had started working on at the same time. It was hard to do so much reading but I really wanted it done in time. I found this really great book that had me laughing to tears. It described the stutter's mind so well, it was me, it was hilarious and so true. It explained that stutters see words as three dimensional objects. And I'm like, They ARE three dimensional objects! And then the stutter tries to push them out and then they activate the pushing reflex with closes the throat and that does not work because words are not 3-D objects. Wow, a tie in to pushing that I was just reading about from my doula certification reading list as well. The book explains the anatomy of pushing in great detail to try and explain the physiology of stuttering and pushing out words, so that we don't do that. It was great to read an in-depth analysis of pushing, both for speaking and for births. The book also has exercises to remember to not push, to do the opposite of push. But the real work is to rework the mind to really believe that words are not 3-D. Words are only a combo of breathing and mouth movements. This is really hard for me to accept, while I know it intellectually, I never realized before reading this that I was treating words as three dimensional. So all these exercises are very helpful, when I do them, like exercises always are.

The other important piece of advice this book gave me was that it said, don't wait to do what you want to do waiting for your stutter to go away first. Do what you want to do, work on it, stutter if you have to, but don't shy away from life. And it was such an ah-ha moment. Yes, I'm just going to have to jump in, imperfections and all. Now.

Its true for so many things in life. You don't have to wait for perfect. You just have to jump into life, challenges and all, and live. And I bring this to your birth. Yes as a mother who gave birth twice, and a doula who has been to many births, but also as a person with a life-long struggle of finding what I needed to have the life I wanted to have. I bring an in-depth understanding of feeling blocked. Stuck. Of feeling judged. So like labor! Of not believing or knowing that the tools to get to where you want to be are within you. I have learned how to come from having a disability, and redefining it into a different ability. I have to work with what I have and make it work well. A MacGyver intuition and skill set has actually been a great asset to my doula work.

So if you are feeling weak, or scared, intimidated, or maybe pure confidence coming into this birth, I'm here to support you. I'm here to help you find what you need inside yourself and from the support team around you. I have your back, front and sides and I am here to support you. And you don't need any prerequisites. You can find yourself amidst those contractions and may think you're not strong enough or the right type or whatever. But you are. If you are a woman, you are the right type to deliver a baby. That's all you need. You. 

So now coming up on my 160th birth, I'm feeling so very grateful. I know I have helped so many women and their families, and shared and received soooo much love its amazing. I am living the life I always wanted. And you know what, some days I still stutter. And that's ok. I still talk to the doctors, the midwives, the nurses, and of course my clients and their families and its just not a problem. It's me. And its OK, we're all OK, just the way we are. 

*****

Also on this note, I love this piece from Ted Talks from a differently abled woman, and I really like that term, differently abled. I find her inspiring and I like to remind myself if I ever start feeling too challenged to look for the advantages instead of the disadvantages of our lives.  
http://www.ted.com/talks/aimee_mullins_prosthetic_aesthetics

I'm a NYC native and I was a Brooklyn teen. We went to Coney Island every day all summer to get numbers and dance to the house music the DJs hotwired to the street lights. We leaned on parked cars and watched the boys do tricks on their bikes. High school we went to Dewey, Midwood, Erasmus, Lincoln, Stuyvesant and St. Ann's. We had school shootings 6 years before Columbine that never made national news. We spent an hour prepping doing hair and makeup before our 2 minute walk to the corner bodega. I went to college in the SUNY system, and when we went to Albany to protest the tuition hikes and they called out all the cities, when Brooklyn was called I joined the loudest "Brooklyn's in the House!" roar the state has ever seen. Then cafe poetry slams, I remember my older friends buying apartments in Fort Greene when it was still affordable as we watched the Biggie Smalls funeral procession go by when I worked at Moshood. My Brooklyn is gone and found only in memories and fb threads of old NY.  I've now lived in 4 of the 5 boroughs, I've moved a total 32 times, across the country and in and out of the states, and I'm back in the Borough of Manhattan where I was born. Its convenient and gives me easy access to clients all over the city. Besides, there's like 1000+ doulas in Brooklyn already! 

When I was 15 and said I wanted to be a midwife, I was envisioning what most people envision. The wise woman who comforts, protects and guides the laboring woman. The one who is wrapped around her, or holding her hands, swaying with her, looking deep into her eyes, whispering knowing words in her ear, and guiding her loving to the other shore. And as much as I love midwives, this is not what the modern midwife is. I think most of us have the mythological fantasy of what a midwife is, but it's not quite accurate. A modern midwife in NYC is usually a CNM, certified nurse midwife, CM certified midwife, or CPM, certified practical midwife. They go to medical school after their undergrad, popular programs here are at NYU, Columbia, Yale and SUNY Downstate. Its a very intense training that prepares you for midwifery in hospitals, birthing centers and homes. Yes, midwives work in hospitals, they can be your primary care provider even if you want a hospital birth, even if you want an epidural, but I digress. Midwives today are great, and they are medically trained, which is also great. They often provide a more personable bedside manner, but they do not do what many of us fantasize they do. 

In a hospital setting, most midwives work on shifts as part of a group practice. Just like OBs. They will meet you at the hospital and most likely have other patients in labor at the same time. They will not stay in the room with you while you labor, they come in periodically to assess your labor and make any decisions needed. The nurses will be responsible for your vitals and administering most meds if indicated. They will be more present at the end for catching the baby, again, just like an OB. They do have better outcomes statistically and you do have a better chance of a non-medicated vaginal birth with a midwife, but they're not doing what we often fantasize they do. 

I learned that the hard way when I didn't have a doula for my first birth. I thought that because I went with a midwifery practice, I didn't need a doula. I thought that the midwife would be draped around me, supporting me, helping me ride those crazy contractions. Nope. She just caught the baby. I learned later that she did nothing wrong. I learned that what I really needed was  a doula! For my second birth when I had my doula I got all the hands on, and the support, and the words, and the touch and massage and calming presence....yes I realized, I want to be a doula! ...not a midwife. That was what I was envisioning for over 20 years since high school but I didn't know the word, nor did I know such a profession existed! 

Signed, 
Your NYC Doula
Maiysha

This is my longest blog entry to date. This thought and the need to explain it kept me up till 4am writing it out. If shorter blog posts are more your speed, just scroll past this one as all the rest are quite short.

My greatest tool in my doula “tool box” is my ability to help you regulate your emotions. Regulation is our ability to maintain stress within a window of tolerance. Its often referred to as being calm, being connected, being present, essentially its when your body mind system is in a balanced state. When you are you are thinking clearly, you’re engaging, your interacting, because your stress is maintained within a window. We all have a window for how much stress we can handle. Once we eclipse that and our experience exceeds that window, we move into dysregulation. Commonly referred to as stressed out. When you are in a state of dysregulation, you feel irritable, withdrawn, depressed, defiant, aggressive, you can’t think clearly, your short term memory is repressed. Its the state of road rage, losing it, seeing red. We all vacillate between these two states all the time. With the right support and understanding, a person, and specifically a woman in labor, has the essential tools to regain a calm state of regulation. 

Labor can be an intensely stressful situation. Doula care is spefically intended to address the emotional needs of the laboring women to help her deal effectivly with the stress of labor. To work with her contractions, to work with however her birth unfolds, to help her have the birth experience she desires, and/or help her manage an unexpected labor that is far from what she had expected or hoped for, in a positive way.

Stress is normal to experience during your birth. But balancing that stress with calm is a vital balance to help you adjust to the huge transitions of labor and delivery. Not finding the balance can be pathologically harmful. The abstract below addresses the effects of stress on the body’s ability to function.

Chronic Stress, Immune Dysregulation, and Health


In the past 40 years, a growing body of literature has shown that chronic psychological stress can lead to immune dysregulation. Notably, these stress-induced immune changes are large enough to be clinically relevant. Chronic stress has been associated with a state of chronic low-grade inflammation, delayed wound healing, poor responses to vaccine, and increased susceptibility to infectious illnesses. Activation of neuroendocrine and sympathetic systems provides physiological pathways linking stress and these immune outcomes. Behavioral changes under conditions of chronic stress also contribute to immune dysregulation. Behavioral and pharmacological interventions may attenuate stress-induced immune dysregulation. 
(Jean-Philippe Gouin, MA, MPs, Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois  http://ajl.sagepub.com/content/5/6/476.abstract)

My role as your doula is to help you regain calm and return to regulation from state of dysregulation. 

To help someone find their calmness, you must first be calm within yourself. As a doula, a mother and a calm energy person, I stay in a deeply regulated state during your labor no matter how stressful the scene may be. I feel most calm when I am at births. Births regulate me (why? I don’t know, thats why its called a calling) and in turn, I get the privilege of helping to regulate you. In addition to bringing you my calm energy, there are additional tools to help you. These techniques interweave with hypobirthing and yoga birth and are essentially bringing about the same desired results. All of the effective childbirthing techniques are essentially just ways to practice the following principles. 


Regulating the environment. 

Dimming lights, hydrotherapy, selecting specific sounds, music, or just silence are some examples of how I help affect your environment to help support you. Also practicing and modeling a calm, slow speaking voice to partners and others present.


Directed breathing techniques are an extremely effective tool in helping laboring women regain regulation. When you create that dynamic of breath, you can bring regulation back to your system.


Touch is another amazing tool for regulation. 

Lymphatic massage is a very gentle type of massage therapy used to flow off redundant fluid from the body and build up the general performance of the lymphatic (immune) system. This type of massage is easy to learn and a great technique for partners to learn as well. It can be done on isolated body parts or on the entire body. This kind of massage helps to bring about the proper direction of the lymph flow.
(Lymphatic massage definition from: http://www.yogawiz.com/massage-therapy/lymphatic-massage-techniques.html#continued). Counter pressure is a more intense form of massage. Counter pressure is the firm application of hands and/or other hard objects such as tennis balls, massagers, etc to help alleviate the intense pains of contractions. This is most often done on the sacrum, hips and buttucks. 


Positions

Changing and suggestions positions can help a woman feel like she has choices. Some positions are for the comfort of the woman, some are for aiding progress, many of them overlap those two things. Choices in labor are a useful calming and empowering tool for her. Some positions can also bring the desired affect of centering, like child's pose. Childs pose helps a woman quiet down the outside and regain calm. It puts her in a power position with her body as well as being great for opening and widening the pelvic outlet. 


The next piece of helping a woman regain and keep regulation is hydration and nourishment. 

A women needs to be well hydrated yet not over hydrated. Dehydration will zap her energy and decrease the efficiency of her labor. Advanced dehydration is of course a very dangerous condition. Over hydration can have adverse affects as well. Beyond swelling, we don’t want to overly dilute her oxytocin either. For nourishment, I am carefully monitoring her emotions and labor progress, or lack thereof, for signs of deficiency in calories, protein, sugar, carbs and/or sodium. Preparing highly nutritious yet low volume foods that don’t require much chewing or effort to eat and beverages to the laboring woman whenever possible helps regulation and labor progress.


Speaking up in the labor room and advocacy

As your doula, I do not address your health care provider on your behalf. I cannot speak for you, nor do I desire too. My goal is for you to find your own voice. But why is it sometimes so hard for women (and many men) to find their voice? Why are doctors sometimes so intimidating? Beyond their medical expertise that may make some feel less confident to voice their opinion, there are stress hormones affecting our abilities to cope with and react to the environment as we would like to. When people don’t find their voice during their births, they can then have a sense of failure, regret and/or other negative emotions. This is not your fault or failure to be strong and assertive. It is our survival mechanism in the face of stress. The flight or flight response mechanism we all learned about, which yes inhibits oxytocin (hormone responsible for contractions) and can inhibit contractions, and then necessitate the need for augmentation, ie pitocin, is more complex than we used to understand. And stress has a different reaction in women than in men. Stress in women does necessarily not cause the “flight or fight” response we all learned about. More recent research has shown that when under stress, women “tend and befriend”. Tend and befriend is not standing up to authority. But she is protecting her young and herself. Women need to realize it is a normal response to stress and nothing to be ashamed of.

" Human Stress Responses

The human stress response coined, "fight or flight" by Walter Cannon in 1932 is a hormonal response characterized by the release of epinephrine and norepinephrine. This hormonal cascade is caused by the activation of the sympathetic autonomic nervous system in response to a potential threat or danger. These threats can range from a predator attack to natural disasters threatening the survival of the individual and species such as earthquakes, fire, or even flooding.

Up until 1995, research investigating the fight-or-flight response had been done primarily with males, females only constituting 17% of the participants. Researchers have rationalized this inequality because of an inconsistency in the results obtained from female subjects due to fluctuations in hormone levels during menstruation cycles. Taylor et al. (2000) suggest that the primarily male based research may have caused many to overlook a unique female stress response which they term "tend-and-befriend."

Taylor et al. (2000) argue that due to differences in parental investment, females may have evolved their own stress response in order to protect themselves while they were pregnant, nursing, or caring for offspring. The male fight-or-flight response would not have been advantageous to the survival of females and their offspring because often the female would either be unable to fight or flee during pregnancy, or unable to protect their young if they were nursing or taking care of their young. Evolutionarily the tend-and-befriend stress response in females would have been selected for and the fight-or-flight response would have been selected against in females.

Unlike the fight-or-flight response which allows one to fight against a threat if overcoming the threat is likely or flee if overcoming the threat is unlikely, the tend-and-befriend response is characterized by tending to young in times of stress and befriending those around in times of stress to increase the likelihood of survival. Since a group is more likely than an individual to overcome a threat, this response is a protective mechanism for both the female and her offspring. Basically, befriending other females is inherently necessary for the protection of offspring since pregnancy and nursing make a female even more vulnerable to an outside threat. Forming a network not only allows the female to have added protection and help with the raising of offspring, but also serves to secure resources such as housing and food. Although the threats mentioned are assumed to be external to the female home environment, this female network also serves to protect the females from the males even within the home environment. Studies even show that females who emigrate and are unable to form a female network, characteristic of female befriending, are more likely to become victims of abuse than women who are able to form these ties (Taylor et al., 2000). "

(Quote from: http://www.personalityresearch.org/papers/mccarthy.html)

When women are with women, they are better able to manage the vulnerable state brought upon through the care for their offspring during and before birth. When women are under attack with their babies, they will try to deal the aggressor with kindness. It goes with the saying, ‘you can get more bees with honey’. And when you are in vulnerable state, such as having contractions, and if you are in a hospital with an incompatible staff to your expectations, and you maybe didn't have any other support, it might just be the wise decision in that moment to be nice to your care providers. So women should never feel like they failed if the didn’t stand up to a hostile person. They were surviving and protecting their young in a way that felt the most effective and safe. As your doula, I am your “other females” that help calm your nervous system from the “threat”. And that “threat” may not necessarily be your doctor. It could just be your pain of labor. Maybe the threat is that you are confused by what is being said in the room and I can put it into simple terms so that you have a genuine understanding of the options and you can make confident informed decisions. By taking away the feeling of threat, your nervous system can calm down and you can release your fear. When you release your fear you are not afraid to express yourself, you are not triggered to go into tend and befriend. You can speak up confidently without fear of attack to you or your baby.


Expressing emotion

Emotional issues, past and present, can be an additional challenge in labor. When you have fears and anxiety and you can express it in a healthy safe way, you can begin to let it go and move on. Simply put, it feels good to talk to a trusted friend about it. When you don’t have someone to express your feelings to, or you do have an ear but they don’t listen, understand or respect what you are expressing, it can make the feelings worse. A doula uniquely understands the stresses and emotions of labor, so that when a woman needs space to express them, we are appropriately acknowledging those emotions and fears and complaints. As your doula I am listening to you. It can be your stress of labor you need space to let go of, or it can be something else. It can body issues relating to food, abuse, losses. It can be a stressful family history, fears about becoming a mother, finances, fears about what this baby will do to your body, your relationship with your partner, your parents, and yourself. If a woman doesn’t have her fears and anxiety and feelings being heard, then the experience becomes trauma. When a woman feels heard, understood and respected, the pain may not disappear, but the fear and despair can begin to dissipate and no longer govern the experience.


How the doctor/midwife work together with the doula

We need a medical provider to safeguard the health and safety of the mother and the baby. Their mindset needs to be focused on maintaining that clinical safety while simultaneously looking out for pathology and treating it if detected. Some medical personnel work from a place of stress and fear. When caregivers have stress and fear, they are unable to help the laboring woman return to a regulated state herself.  And sometimes that kind of stress and adrenaline is a useful emotion to make sure they can activate the needed parts of their brains to think clinically and quickly to keep the woman and baby safe. But that stress energy is only beneficial on that one level. On the one hand its helping them act quickly, but if it dysregulates the woman’s emotional state, it can worsen whatever the emergency is. Even if a woman needs an emergency c-section, she and her baby will have a better outcome if she remains calm. A doula is still helpful for the emotional and clinical outcomes in that scene because she can help the mother regain calm even if the rest of the room isn’t. Keeping her breathing and regulated is also keeping the baby regulated. Which is a much better state for them to enter surgery. And before any c-section is performed, the medical staff are first trying to avoid a c-section by various means depending on the situation. If the mother is regulated and therefore helping her baby to be regulated, there is a better chance that the medical interventions to avoid a c-section will be more effective and an c-section can hopefully be avoided altogether. Professionally trained doulas work very well with doctors and midwives complementing each other helping moms have better outcomes. Some women worry that their doula’s presence may make their doctor uncomfortable. That is only true if the doula doesn’t respect understood doula boundaries. The boundaries are not limiting to a doula, but actually help a doula. Defined along clinical lines, by excluding clinical tasks from the role of the doula, she can focus on the emotional and informational needs of the laboring woman. When done right, doctors and midwives love having doulas present. I enjoy working with obstetricians and midwives and have never had conflicts because I show them respect for their importance and role in the birth. I respect their medical expertise and responsibility and at the same time I am confident in my expertise in supporting the woman in the doula role. In addition, the doula and the obstetrician may sometimes have very little interaction at all because many are rarely present in the room until the end of the pushing stage.


With this understanding of doula care and its effects on the emotional state of the laboring woman we can see how essential it is for better birth outcomes. Research has proven the benefits of doula care on birth outcomes:


Numerous clinical studies have found that a doula’s presence at birth;

• tends to result in shorter labors with fewer complications
  
  
• reduces negative feelings about one’s childbirth experience
  
  
• reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans
  
  
• reduces the mother’s request for pain medication and/or epidurals
  
  

Research shows parents who receive support can:

• Feel more secure and cared for
  
  
• Are more successful in adapting to new family dynamics
  
  
• Have greater success with breastfeeding
  
  
• Have greater self-confidence
  
  
• Have less postpartum depression
  
  
• Have lower incidence of abuse
  
  
  

(list from http://www.dona.org/mothers/why_use_a_doula.php)

After births, women often tell me they were most appreciative of my calm presence during their births. It is this calmness that helps women regain control and awareness of self and body. It is this calmness, along with an in-depth understanding of birth and the needs of laboring women, that I bring to your birth. Your birth experience is something you will be replaying over in your head for the rest of your life. I am forever honored by every family who chooses to include me on their sacred passage into parenthood!

I run to keep up. I run to have the stamina to be able to endure labors. I've always worked out here and there, but since I starting doing this work full-time a few years ago, I work out way more than I used to. When I work out I recover so much faster from births. This work is so physically demanding, I feel like an athlete in training. But since working out is not my first nature, I need a lot of inspiration to get myself out there. First I need music. With the right music, I feel like I can do anything. Next, I'm thinking about my work. I'm thinking about the fact that I need to be strong. For myself, for my moms, for my family. Then I remind myself that I am a woman. I make people, and I stand strong for other women when they make people. If I can do that, if we can do that together, then I can run another lap. 

My run this morning was beautiful. Snow melting on the track, music pumping in my headphones, a new mom about to call me any second, and I'm running. There's a couple of young guys on the track this morning trying to show off their stuff, but they have nothing on the strength and stamina I see when I get the privilege of attending births. And yes, I can run yet another lap. With my sun, with my body, and all those birth miracles in my heart. This run goes out to all my moms, all my marathon labor moms, all my did it natural moms, all my epidural moms, moms who had to accept what they hadn't planned and rocked it anyway, and moms who had to come to motherhood through surgery, you all rocked it too. You all had to cross that bridge with faith and strength and courage. You all had to surrender to the day, the night and the next day too. You all had to let go and hold on simultaneously, and bring forth these beautiful souls. This run is for you, this run is for us. My heart and spirit grows daily thanks to all of you!