2021 Reviewed

31 births

29 hospital births, 2 home births

24 vaginal, 7 Cesarean

1 VBAC (vaginal birth after Cesarean)

14 unmedicated, 17 epidurals

9 inductions

20 with midwives, 11 with OBs

Smallest baby: 4 lbs, 6 ozs

Biggest baby: 9 lbs, 1 ozs

Shortest labor support time: 2.5 hrs

Longest labor support time: 35 hrs

Average labor support time: 9 hrs

Longest gestation: 41 weeks 5 days

First birth: 17

Second birth: 12 (4 were repeat clients)

Third birth: 1

Fourth birth: 1

Location of births: Baptist Health Lexington 6, Clark Regional 1, Ephraim McDowell Regional Medical Center 2, Frankfort Regional Medical Center 2, Home 2, UK 18

Individual provider who caught the most of my clients’ babies: Hayden Meza, UK Midwife Clinic (5 babies)

Practice whose providers caught the most of my clients’ babies: UK Midwife Clinic (17 babies)

Professional development: Body Ready Method

My house is quiet and still as I write this- my children are at school, my husband is at a job site, my dogs are asleep on a rug. Outside my window, it is also still (and bare and cold). It feels like such a heavy contrast with the way I would describe this year in birth work. I’ve had more clients than the previous four years due in large part to situations related to the pandemic. So many of my clients’ labors and births were unique and unpredictable. Because of that, I’ve grown quite a bit in this work. The never-ending learning as a doula continues to challenge and amaze me.

Three of my clients had preterm births, meeting their babies at just over 35, 33, and 32 weeks of pregnancy. One had IUGR (intrauterine growth restriction) and severe preeclampsia that required induction of labor and the other two went into preterm labor. Two of the three had Cesarean births and all of the babies spent weeks in the NICU.

Due to the pandemic, I supported two clients virtually. One was at Baptist Health Lexington which was not welcoming doulas at the time and the other was COVID positive (on her last day of isolation- so close!). I was also unable to attend two of my clients’ births at Baptist Health Lexington because they had C-sections and the current policy does not allow doula support in the OR, in recovery, or on postpartum. I was able to support some of my clients in the OR at both UK (unplanned Cesareans) and Ephraim McDowell Regional Medical Center (planned Cesarean). I also had to call a backup doula for the first time this year because I was at another birth down the hall. I walked in shortly after their baby was born; they had wonderful care from my backup and I’m so grateful she was there for them.

While my clients’ induction rate was lower this year than the past two years at 29% (9 of 31), some of them happened suddenly/urgently, which I think made them take center stage in my brain. Six were medically indicated (e.g. preeclampsia, IUGR) and three were elective or unclear on the medical indication.

I’ll end with some interesting situations and highlights of the year:

• Supported a client during the worst ice storm of the year. We drove around downed tree limbs on the way to the hospital.

• A home birth client had a vaginal birth after having a Cesarean with her triplets about 2.5 years prior.

• Two of my clients were in labor at the same time in rooms right next to each other. With permission, I was able to leave one client to support the other’s precipitous labor, then go back to the first client.

• Two of my clients are best friends and they gave birth less than two weeks apart.

• Attended my first birth at Clark Regional in Winchester.

• Supported two 40 year old clients, one having her first baby and the other her second. They both had spontaneous vaginal births.

Reflecting on the year, the theme that comes to mind is team building and collaboration. One obvious advantage of attending more births is that I met and worked with more nurses and providers. I’ve said it many times, but learning nurses’ and care providers’ styles and approaches to different types of situations and developing collaborative relationships with them is so valuable to folks who choose me as their doula. I have now seen 40 providers catch/deliver babies! I feel like I have a pretty good understanding of what to expect from different practices, individual providers, and hospital staff.

I was also fortunate this year to team with Bundle Birth Nurses and cover tuition for five L&D nurses in their Physiologic Birth Training. Nurses from Baptist Health Lexington, Ephraim McDowell Fort Logan, Frankfort Regional, and UK claimed the spots. I know that the pandemic has been extremely taxing on nurses and this small gesture was a way to show how appreciative I am that they’ve continued to show up the way they have for my clients.

Birth work has not been easy this year. 2021 was harder than 2020, in my opinion. We’ve seen loss, illness, hospital staffing concerns and changes (compensate these L&D nurses and hospital midwives fairly, please, NOW!), and almost everyone I’ve known has felt burnout at some point this year. I’ve witnessed so much community support, though, which has provided some solace. I hope that this spirit of community care and collaboration continues and grows in the new year.

2020 Reviewed

21 births

15 hospital births, 6 home births

20 vaginal, 1 Cesarean

1 VBAC (vaginal birth after Cesarean)

14 unmedicated, 7 epidurals

9 inductions

15 with midwives, 6 with OBs

Smallest baby: 5 lbs, 9 ozs

Biggest baby: 9 lbs, 1 ozs

Shortest labor support time: 3.5 hrs

Longest labor support time: 34 hrs

Average labor support time: 13 hrs

Longest gestation: 41 weeks

First birth: 10

Second birth: 9 (6 repeat clients!)

Third birth: 1

Fourth birth: 1

Location of births: Baptist Health Lexington 1, UK 9, Ephraim McDowell Regional Medical Center 1, Frankfort Regional Medical Center 2, Norton Women’s & Children’s 1, St. Joe’s East 1, Home 6

Individual provider who caught the most of my clients’ babies: Sarah Hood, Home Sweet Home Midwifery Services (4 babies)

Practice whose providers caught the most of my clients’ babies: UK Midwife Clinic (7 babies)

Professional development: Became an NRP Provider (Neonatal Resuscitation Program) and started childbirth educator training with Birthing Advocacy Doula Trainings

2020 ended up being my busiest year yet. It started off beautifully, with my first repeat client giving birth at home (her first baby was born at a hospital) under the care of a midwife. Three more babies came before the pandemic, with one being born the week before everything started shutting down in KY. I had planned off call time in April due to a spring break trip (that got cancelled), so thankfully I was not dealing with the initial insanity caused by frequently changing hospital policies and had time to prepare for the possibility of supporting clients virtually. Thankfully, I was able to support ALL of my 21 clients in person. I had one client switch from hospital to home birth because of the pandemic, but others considered it.

My clients’ induction rate went down to 43% (9 of 21) after last year’s 50%. Not surprisingly, my longest continuous support time of 34 hours was at an induction. Even though I tell clients to expect inductions to last days, it’s hard to wrap your head and body around what that feels like until you’re in it; exhaustion is typically a huge factor in the process. Out of the nine inductions, there were only two that I would consider elective (although I don’t know that that is how they were labeled by the providers).

Some other stats that I want to highlight are that one of my clients had a VBAC (100%) and that six were born preterm (2) or early term (4). Both of the preterm births were originally planned home births, but transferred to hospital care- one for hypertension/preeclampsia and the other for imminent preterm birth at 35wks 1day. Not surprisingly, I had a COVID exposure at one birth (that I know of). The hospitals stopped rapid testing at some point and unfortunately, we found out that a client was positive two hours after baby was born. Thankfully, I did not get infected and the mom and her baby are healthy! Also, I had a Leap Day doula baby this year! He was born at 12:48am on February 29, 2020.

The year was hard for lots of reasons, but I feel that it was the one in which I’ve grown the most as a doula. It no longer feels difficult to share confidently about my value when talking to potential clients; I’m really good at doula work. Thank you to the providers and nurses who provided over-the-top excellent care to my clients during some seriously stressful times. Thank you to the six families that allowed me back into their birthing spaces this year and to the fifteen others who welcomed me for the first time. You all have provided some of the brightest moments of 2020!

In birth, ignorance isn't bliss

The exact path your birth will take is unpredictable. With so many variables in the process, it can feel overwhelming to attempt preparation for all of the possible twists and turns you’ll encounter during pregnancy, birth, and postpartum. While it may seem like the best (only?) option is to go in without expectations and follow the lead of your care providers, I want to encourage you to take the reins on your body and your birth experience. You absolutely cannot control every aspect of your birth, but you can educate and prepare yourself for the experience.

When meeting a potential client, I always ask what your plans are for childbirth education. I want to know what you’re going to know about labor and birth. I provide informational support during pregnancy and birth, but that does not replace childbirth education. And not all childbirth education courses are created equally. If you haven’t already booked classes, I’m happy to provide referrals to instructors/courses that will meet your needs.

One of the advantages to preparing yourself for childbirth is that you’re more likely to have an empowering experience when you feel confident about your decisions. You’re in a totally different state of mind during labor, and having to learn about an intervention for the first time when you’re laboring can be distracting and unnerving. It’s hard to really take in the information that’s being shared (or ask for it if it’s not being shared) when you’re laboring. If you’re prepared for what may come, you’ll be clearer on what’s best for you in the moment and in the long run. And all of that education and preparation will hopefully lead to a more positive birth experience and a stronger start into parenthood.

She’s a human, not an incubator

Many expectant parents make comments along the lines of, “…as long as the baby is healthy” when talking about their upcoming birth. As a mother of two, I wholeheartedly understand wanting healthy babies, but somehow we have created such a babycentric culture that not only friends and family, but also mothers themselves, believe that their mental and physical health have a lower value than that of their child’s. It starts when a woman is pregnant and complete strangers think it’s okay to feel her belly. She’s treated like a vessel instead of a human who may be totally uncomfortable with you touching her body.

Then, as the women thinks about how she might want her birth experience to unfold, she may weigh her options in terms of what is “best for baby.” These sentiments may be echoed or strengthened by her care provider, family, or even her own partner. Of course the baby’s health is important, but did the mother’s lose its value the moment the baby was conceived? There are two lives to consider, and a person shouldn’t be treated as though they are selfish or heartless if they take their own body into consideration.

The postpartum period seems to be a time when a mother’s mental and physical health gets most neglected. It pains me when women who’ve recently birthed are treated as though they’ve served their purpose in delivering this new life to the world, that they’re now an empty incubator, and all of the attention turns to the newborn. New moms need care. They need to know that they have support as they focus nearly all of their energy on caring for their baby. And while mom’s eyes are on the newborn, close family and friends need to remember to keep theirs on the new mom. Is she eating well? Is there something you could do around the house for her so she can feed and rest with the baby? Does she seem overwhelmed or anxious? Does she know that you have her back?

New babies are squishy and adorable and exciting. Feed them and hold them and talk to them. Respect when they’re upset or tired, revel in their joy, and celebrate their milestones. New moms are awesome. Feed them and hold them (if they want to be touched) and talk to them. Respect when they’re upset or tired, revel in their joy, and celebrate their milestones. These are two lives, two humans who are equally important to each other and to the world.

Intuition in pregnancy and birth

In my experience, as the baby grows and your body changes in pregnancy, so does your intuition relative to the wellbeing of yourself and baby. And while many people seem keenly aware of and reactive to what their gut tells them in other aspects of life, some find it hard to do so when they’re pregnant. I think part of this may stem from the fact that everything is so new with a first pregnancy, so you tend to rely on books or others’ advice to decide if what you’re experiencing is normal. I strongly suggest trusting your gut and bringing any concerns and questions, no matter how silly they may feel, to your care provider. Of course, you can also run them past your doula first if you feel like you need a filter for all of the questions that may arise. Your care provider should be willing to listen to your concerns and answer questions. If you feel like you’re not being heard, it’s never too late to consider interviewing and possibly switching providers.

During labor, being in tune with what your mind and body are telling you is also important. For example, maybe you’ve been on your back in the bed, but you feel like you should get up and change positions. It could be that your baby is trying to move to an optimal birthing position and your body wants to help the baby along. Listening to your body comes into play during the pushing phase of labor. ACOG states: “In the absence of an indication for expeditious delivery, women ... may be offered a period of rest of 1–2 hours (unless the woman has an urge to bear down sooner) ...”* This means that some people will rest before they begin the pushing phase, and there are cases when it is okay to do so. Most of the time, you can also listen to your body in terms of how you push. Again, from ACOG: “When not coached to breathe in a specific way, women push with an open glottis. In consideration of the limited data regarding outcomes ..., each woman should be encouraged to use the technique that she prefers and is most effective for her.”*

So while books and Facebook groups may be your first stop when you have questions, don’t forget that each pregnancy is unique. Your intuition is important and you should always feel safe sharing information with and asking questions of your care provider and birth partners. You know best how and what you’re feeling- it is your body, your pregnancy and your birth.

*https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Approaches-to-Limit-Intervention-During-Labor-and-Birth