My journey to becoming a DONA certified Doula has been a long, enlightening process.  Since being exposed to pregnancy and childbirth it has been something I have been so passionate about.  I have seen and experienced first hand how amazing and powerful birth can be and my goal is to help other women experience birth in the same way that I was able to.  I have been attending births since 2007 but didn't start my formal DONA training until 2012 and did not complete my DONA certification until this year.

I have had the privilege of attending births all throughout the lower mainland and also up in the Cariboo region of BC.  I have driven in snow storms, flown to births, and done hospital transports.  I have seen completely natural births, medicated births and assisted births and worked with both high-risk and low-risk pregnancies.  No matter what the circumstances or the outcome I always come out feeling so grateful for the journey I was able to be a part of.  I am grateful for everything I have learned from the DONA trainers, to the care providers to the mothers themselves as I feel they have the most to teach us about self worth and perseverance.  

My DONA training got off to an amazing start with Kathie Lindstrom as my instructor at Douglas College, the group of Doula trainees were all such amazing women and made the experience that much more rewarding.  On day 2 of Doula training things got a bit more exciting as I got called to go to my first birth as a somewhat trained Doula.  Kathie my instructor was more than happy to have me go to the birth and I ended up getting to make up the day I missed with a new group of amazing Doula's so I felt my experience got enhanced that much more because of this.

With two young kids of my own I really had to count on family and friends to help me attend births for certification and I am so grateful to them for their contribution in me accomplishing my goal of being certified.  I attended births of friends and strangers, first time moms and experienced moms, confident moms and hesitant moms, with OB's and with midwives.  The biggest challenge I felt was filling out the labor charts during the labor as it meant I did have to take a moment away from the mom, the other challenge was approaching the nurse or OB to have them sign the forms too as I felt I was being a pain sometimes.  But I powered through it.  I loved writing birth stories after each birth (so much that I would write two; one for certification and one for the mom I was working with) and I still write birth stories for the births I attend now.  Reading all of the books was awesome too as I learned so much and was able to build my library which I am very proud of.  Although I completed all of my births for certification in 2012 I still took 18 months to complete all of my paperwork for certification.  Being a mom of two young ones was my priority but I got to a point where I felt something was missing and I sat down over a weekend and finally put it all together.  I felt so amazing afterwards and was so proud of what I had accomplished and could not wait to send it in.

6 weeks later I got a call from DONA and got to do my phone interview with this amazing lady named Penny who went over my birth forms with me, shared some wisdom and congratulated me on becoming DONA's latest certified Doula!  I got a bit teary eyed and was beaming with pride.  A few weeks later my package came with my certificate and my name tag and I saw my name in lights...on the DONA website :)  It was a journey well worth the time and the effort.

You know those times where you feel like the hurdle is just too big to overcome…well I have found myself in this little predicament lately and I am working really hard to alter my view point.  My goal is to become a midwife and I hope to apply to the UBC midwifery program in the not too distant future.  This is a very competitive program and there are some hefty pre-requisites that take a lot of time and money.  I have been working toward these pre-requisites for a while and recently found out the second course of a 2 course pre-requisite may not be offered again in the near future which means I need to start from scratch for this pre-requisite.  So I had a little pity party for myself but now I have to just say to myself; that’s life. 

Our minds are so powerful and have the ability to bring us to such highs and such lows.  This is also so true for labor.  I personally believe that so much of pain perception comes from our thoughts and our minds ability to run with them and make them bigger than they might actually be.  I believe this to be true because I have seen so many different versions of labor and find that women who learn to control their thoughts and go within themselves and have this unwavering faith about their body and its ability, have (what appears to be) an easier time birthing.  The big problem here is that it takes a lot of practice and training to be able to go within, to be able to harness those thoughts and to have faith in yourself.  As women we can be quite hard on ourselves and do not always give ourselves and our bodies the credit we deserve.

In labor it is great if you can have a quiet mind, it is great if you can go inward and just focus on the amazing journey you are on.  Try to focus on the power and not on the pain as it will pass but the power of motherhood will live on forever.  Trust in yourself and trust in your body.  Practice meditation and self-love and you can help foster an amazing birth experience.  That’s life, it’s full of highs and lows and it is how you handle the highs and lows that counts.

Sometimes when you are pregnant it feels like everyone has an opinion and it is hard to weed out the good from the bad and what will really help you in the end.  Well here is my list of “What I Wish I Knew Then” that I hope can help you on your journey to motherhood.

1.       All bodies are not created equal – Okay so to some of you this is common sense but to some it may not be.  Let’s be realistic here, some women get that beautiful glow about them and some women spend their entire pregnancy green and ready to blow at any moment.  Some boobs grow to the size of watermelons while some barely grow at all, some women have the cute baby bump and some feel like the bump is all over them, their butt, their thighs, just everywhere and it can be hard for some women, so to all women I say: All bodies are not created equal

2.       Your due date is an estimate – Yup it’s called an estimated due date for a reason but so many of us put so much faith into this date and if it comes and goes we can be just crushed by this and may rush to get the baby out.  It is so important to know again that all bodies are not created equal; some women ovulate near the beginning of their cycle, some in the middle and some near the end yet the way we estimate a due date is the same for all so it is going to be normal for some of us to delivery early, some deliver on or near our due date and some past our due date and all 3 of these options are very normal.  Anywhere from 36-42 weeks can be considered a healthy time to give birth naturally, you will be observed throughout your pregnancy and it is so great if you can trust your body and your baby to be ready when they are good and ready.

3.       I Can Do That? – We have this image in our heads sometimes of what we can and cannot do during labor; well it is time to clear that up.  First and foremost you can wear your own clothes during labor and birth should you choose, you do not need to sport that hospital gown if you choose not to.  You can also eat during labor if you feel like it and you can bring things from home to make the room more comfortable, bring your pillow, your slippers, some flameless candles, some music, anything you think might help relax you (use common sense as if you are in a hospital as you have to be respectful of others around you).  And probably most importantly you can get out of that bed; that’s right you do not need to be bed ridden during labor, so get up and walk around, go in the shower if you feel like it, walk through the halls, get on the birth ball or the rocking chair, dance with your partner, movement is amazing during labor as long as you don’t overdo it and exhaust yourself so get up and let gravity do some of the work for you.  You can be vocal while moving around too, using your voice can be amazing during labor but try to use low tones that are pushing down toward your pelvic area and not high pitched tones coming up through your mouth as you want the baby to come out the other end J

4.       Diaper Please – When you see on some of those lists of what to bring to the hospital and it says oversized pads; believe it!  For the first hours and days following labor you will feel like you are wearing a diaper as much as your baby feels they are wearing one.  It is normal to bleed the first few days after labor and it can be quite heavy, you should be under observation from your care provider to ensure it is not too much but you will need those big pads that feel like they stretch from your belly button to your lower back for at least a few days, it is also a good idea to bring a towel for the car ride home just in case you leak through your pants on to the seat of your car.

5.       More Contractions? – Just when you think you are done with contractions; you have pushed out your baby, you have pushed out your placenta (your what you say? your placenta which yes needs to come out too, it was nourishing baby these 9 months but it gets evicted shortly after baby and requires a little pushing and the help from some contractions) and now you think you are done with contractions.  Well maybe you are and maybe you aren’t, many women who breastfeed experience light contractions or heavy cramping during breastfeeding, again this is normal, your body is still producing contractions which help your uterus go back to its original size and location and the oxytocin that releases during breastfeeding stimulates contractions and will generally speed up overall recovery time

As pregnancy nears its end all you will likely think about is the upcoming birth of your baby.  It is so great to inform yourself ahead of time of some great positions that can help you during labor and birth.

Since labor can last from a few hours to a few days it is really great to have a great array of positions to try at your fingertips.  Some caregivers are really good about encouraging you to change positions throughout your labor and during the pushing stage as well.  If your labor is quick there is less need for this.

Below I have summarized some positions that can help you through your labor, the image is also a great tool.

Positions to Relieve Back Pain

• Any leaning forward position will help to alleviate back pain as gravity will pull baby toward your belly as opposed to your back.  If you are experiencing back labor going on all fours or having your bum up in the air with your hips wide and your head resting on a pillow can be helpful (many children instinctively sleep in this position when they are young)
• Movement can also help with back labor, walking, being on all fours and swaying your hips, using a birthing ball and rocking can also help

Positions to Stimulate Contractions

• Sometimes labor can slow down, ways to help keep it going are by using gravity in your favor; stand up, walk if you are able, hold on to your partners neck and sway back and forth doing a little dance
• Try doing some gentle squats and lunges to help encourage your baby further into your pelvis which should help contractions along, I have done stairs with some of my clients which can help too (do not overdue it or tire yourself out)

Positions to Help Baby Along

• Gravity is your friend in a long labor, gravity is also baby's friend and helps baby move further into the birth canal, movement during labor is key to helping your baby meet you sooner
• If you are told your baby is not in the most optimal position (occiput posterior or sunny-side up with their spine against your spine is quite common and ideally you want baby to be occiput anterior where their spine is against your belly) you can again get on all fours to try to promote baby to flip, hip swaying and hip circles in this position can be beneficial as well

Positions for Pushing

• Pushing can last for a few minutes to a few hours, the longer it lasts the more I would encourage you to change positions if you are able and see if one yields greater results, when you are pushing you want to create as much room for baby as possible
• Squatting will provide the most space in your pelvis for baby to pass through, you can ask about a birthing stool which supports you in a squatting position so you do not strain your legs
• Kneeling or being on all fours can also help with the position of your pelvis and gravity is still working for you rather than against you

Positions to Slow Labor

• Some of you might be reading this thinking why on Earth would someone ever want to slow down labor, well if labor comes on very quickly you may be at home, in your car or somewhere else you might not wish to be giving birth.  You could also be in the hospital and for some medical reason they want to slow things down.  You can lie on your back with your bottom elevated and your feet in the air if possible (almost like the position you see women give birth in in the movies so if you do not want to slow your labor down I would suggest not birthing in this position)

To recap there are plenty of positions you can labor and birth in, being open to trying new positions and changing it up will benefit you during this last step on your journey to parenthood.  Talk to your care provider during prenatal appointments about positions and ensure they are happy to support you in whatever position you feel is best for your baby (as long as there is no medical reason suggesting this position is not good for you and/or baby).

Happy Pushing :)

So maybe you have already had a positive home pregnancy test (if so congratulations) or maybe you are just thinking about starting a family.  Either way this is a must read.  I hear all too often about women not being well educated on their options for care providers while pregnant.  Many times women think there is only one option and when they hear about other options it is generally quite challenging to switch care providers.  

I am going to outline the 3 types of care providers you can have in BC and what they can and cannot do for you.  I am also going to explain the difference between a midwife and a doula – did I lose just lose you?  If so you are not alone, many new mothers do not know what either are or many think they do the same thing, fear not I will clear it up for you.

When you are looking for prenatal care you can look to an obstetrician, your personal family doctor or a midwife.  It is important to note that they are all covered by MSP so you do not have to pay any out of pocket expenses and they all offer very different care models.

Let’s start with an obstetrician (OB); you can get a referral to one from your family doctor or likely even by going into a walk-in clinic.  They are highly trained professionals who have gone to med school and then completed an additional 5 year training program to become an OB.  They learn how to manage high-risk pregnancies and in many countries the only women they care for are considered high-risk.  They are the only care provider of the 3 we will talk about that can perform a cesarean.  When you go to an OB you generally have your appointments with them at the hospital but some do have offices as well.  During your visits you can expect to have your weight checked, they will likely ask you to give a urine sample so they can test for sugar and protein in the urine, they will check your blood pressure, listen to your baby’s heartbeat, and measure the size of your belly.  This all takes about 5 minutes, then you can ask a question or two but they will likely want to have you be on your way due to the large volume of patients they see on a daily basis.  You will generally see the same OB throughout your pregnancy but when it comes time to deliver you will get the OB on call and generally there are 5-8 of them on a rotation depending on how big the hospital is so you could be looking at a 1 in 8 chance of seeing the OB that cared for you during your pregnancy.  When you are in labor your OB will pop in and out of your room to check in on you and generally will not stay with you in the room until you have started pushing, they will assist in delivering your baby (you are really the one doing the hard work) and shortly after they will leave.  They will follow up with you after you are discharged by having you come to see them and you will be discharged at 6 weeks and at that point your care would return to your family doctor.

So on that note you may have the option to have your family doctor be your primary care provider for your pregnancy, it is becoming more and more rare to have a family doctor that will do full prenatal care and deliver but if your family doctor offers this then you have yet another option.  Your family doctor has gone to med school but has not normally done specialized training centered on pregnancy.  Your family doctor can refer you to specialists along the way if needed and will oversee your care throughout your pregnancy.  Your appointments would likely be at the family practice and would follow the same basic outline as with an OB but you may have a little bit more time for questions and the appointment will likely last around 10-15 minutes.  As far as who will deliver your baby; this would have to be a discussion had with your doctor as some will promise to attend your birth while others share a rotation with other doctors and whoever is on call that night would deliver.  Similar to an OB your doctor would pop in and out during labor and be present when you are pushing.  Your doctor would continue your postnatal care and beyond.

Another option would be to have a midwife look after your care.  Midwives are highly trained in prenatal care and must complete a 4 year specialized program before becoming certified in Canada.  Midwives are best suited for low risk pregnancies and would normally transfer care to an OB should any major concerns arise during your pregnancy or birth.  The most important thing to do if you would like a midwife is to call a clinic as soon as you get a positive home pregnancy test as midwives are limited in the number of patients they can take on and they normally have a waiting list of 10-30 people per month depending on the practice.  You can search for midwives practicing in your area by going to http://www.bcmidwives.com/find-a-midwife  Midwives are known for their women-centered care, your appointments will be in their office, will include everything that would have been covered with an OB or family doctor but your appointments will range from 30-45 minutes so you have more time to go over any questions you may have and become better informed about the journey you are on.  Midwives do take a more natural approach to childbirth but you are able to have medication with a midwife should you choose to.  With a midwife you may choose to birth at the hospital, at home or at a birth center whereas with an OB or family doctor your only option would be the hospital.  Your midwife will order all of your prenatal tests needed (blood work, ultrasounds etc.) and can also write you prescriptions for pregnancy related issues.  When you go into labor you would call your midwife and they would likely come to your home to assess you and see if it would be a good time to go to the hospital if that is your choice.  Your midwife will likely stay by your side for your entire labor and birth.  Your midwife will deliver your baby and can give you stitches should you need any.  After delivery your midwife will come to your home for your first 2 postnatal visits, the balance of your postnatal visits will be at their office and you will be discharged at 6 weeks postpartum.  Many midwives work in a shared practice where there are multiple midwives working at the same practice sharing the care, you will see all of the midwives throughout your pregnancy at different appointments so you know all of them, when you go into labor you will be taken care of by the midwife on call, to whom you have already met during your pregnancy.

So what is a doula?  A doula is a labor coach who would meet with you during your pregnancy to go over your birth preferences and work with you to prepare for birth.  Your doula will attend your birth and be with you throughout your entire labor supporting both you and your partner.  They will offer massage, allow your partner to have a break to get something to eat or go to the washroom and make sure you have support the entire time you are in labor.  Doulas are trained with knowledge on childbirth through various training options.  Doulas are not medically trained and cannot offer you medical advice nor can they perform any sort of medical exams for you, that is what your midwife or OB/doctor would do.  Doulas are for hire and can generally range from $500-$900 and you can find a doula at http://www.bcdoulas.org/find-a-doula

So who is the best care provider for you?  Only you can answer that question.  Each option is unique and has it perks and drawbacks.  It is important you are cared for in a way you feel most comfortable and confident.

Imagine its 2am, you have been in labor for quite a few hours but you are happy because the moment you have been waiting for, the moment you get to meet your baby is drawing near.  Your care provider did an internal exam 3 hours ago and said you were 2cm dilated and 20% effaced.  You keep going, your baby is coming, and you are doing it. A few hours go by and you grow excited again as your care provider tells you it is time to do another exam, as you wait patiently while your care provider completes the exam you can’t help but have a number in your head like I think I’m at 5cm, yes definitely 5cm and then your care provider gives you a blow, you are at 3cm and 50% effaced.  Now your head starts getting to you, if it is going to take me 3 hours to go 1cm and I need to get to 10cm I might as well give up now, how am I going to handle this.  Hopefully you have a great support system that encourages you onward telling you how great you are and you keep laboring on.  Another 3 hours goes by and you have been trying to stay positive in hopes of a good ‘number’ the next time.  So here it comes, the big number you have been waiting for after another exam and you are 3cm dilated and 100% effaced.  WHAT?  How could this be?  I have been in so much discomfort, going through so many contractions and nothing has happened in the entire 3 hours, what is wrong with me?  

This is where I say STOP!  The biggest disservice a care provider can do to a pregnant woman is not explain what I like to call the 1, 2, 3’s of labor; there are 3 number systems you will hear about: dilation, effacement and station.  They are all equally important and yet you normally only know about one of them – dilation, there should be a prenatal appointment strictly on the importance of these 1, 2, 3’s and how long they can take.  Effacement (image 1.1) is the softening, shortening and thinning out of the cervix and needs to happen before your baby can be born.  When a woman is not pregnant her cervix is quite hard, is generally 3-5cm in length and is quite thick.  During early labor your contractions are working to soften your cervix, shorten it by pulling it back and by thinning it out all to make way for baby and further dilation.  With this new found knowledge let’s think about what has happened so far; at the initial check you were 20% effaced, another 80% to go so still lots of work to be done, at your second check you are now 1cm further dilated and 30% more effaced so things really are happening down there, more than you had originally thought as you were focused only on how dilated you were.  At your third check, although you have not dilated any further you are now 100% effaced, this means that the contractions have done all that they can do when it comes to the cervix with the exception of dilating it, that is all the contractions have left to do right now, that is now their sole job, they have nothing else to focus on.  Now here is the best part; generally speaking once you are completely effaced you dilate quicker and get into rocking and rolling active labor.  During this time your contractions will become more intense, become closer together and last longer.  These contractions are working hard to get your baby further down into your pelvis and dilate you further.  

Don’t get me wrong, once you are completely effaced it does not necessarily mean you will have your bundle of joy in your arms in the next couple of hours, every labor is different and you never know what you’re going to get until after you got it.  As you get further along in active labor a whole new word will be introduced and that will be the station (image 1.2).  So let’s say another 3 hours pass and you are now 6cm dilated and baby is at 0 station which tells you where babies head is in position to the pelvis.  This number will generally range from -3 which means babies head is still high up in the pelvis to +3 which means babies head is fully engaged.  So now your contractions are really working hard on getting you to 10cm and getting baby further into the pelvis so you can start pushing.  So now you can keep laboring on with your support system by your side and be confident that your body is doing something and it knows exactly what to do.  At your next check you are 9cm and baby is at +1 station, you are so close, keep laboring on and you might start to feel some sensations near your rectum which may make you wonder if you have to have a bowel movement, you are normally welcome to try but it might just be that your baby is further into that pelvis of yours.  Your care provider notices your sounds during contractions are different and you explain that you are feeling pressure, they do one last check and HOORAY you are at 10cm and you may or may not have the urge to push, if you do then go for it, if not you might get a small welcome break from the intense contractions to build up some energy before that urge comes and you get to start birthing that baby.  Congratulations you got through all of your numbers and baby will be with you before you know it.