This past weekend, thousands and thousands of people watched April The Giraffe give birth at the Animal Adventure Park in New York.  After months of watching and waiting, many of us woke up on a beautiful Saturday morning with the news that active labor was confirmed and that hooves were visible.   In our household, of course, we had to live stream it up on the big screen; first when the live cam went up in Feb, and then as soon as we knew it was the big day- for real this time.

 

Why were people so enamored with this majestic creature and her ability to birth her baby into this world you ask?  Maybe it was the uniqueness of the event or the ability to watch it live that drew us all in, similar to how many people watched a bald eagle nest earlier this year for the signs of a new baby bird emerging from its egg.  Or maybe it’s just the miracle of birth and the ability to watch it unfold in a way that we as a society don’t get to see very often.

But, what I want for people to take in was the very beautiful, very important lessons April The Giraffe demonstrated about birth.

As a Lamaze Certified Childbirth Educator, I am versed in what we call the 6 Healthy Birth Practices.   Basically, Lamaze has collected the research-based data and put out 6 recommendations for families to plan for when giving birth to promote the healthiest, most evidence-based birth possible.   These birth practices include:

• Let Labor Begin On Its Own
• Walk, move around and change positions throughout labor
• Bring a loved one, friend or doula for continuous support
• Avoid Interventions That Are Not Medically Necessary
• Avoid giving birth on your back and follow your body’s urges to push
• Keep mother and baby together – It’s best for mother, baby, and breastfeeding

As I watched April birth the lanky giraffe into her stall, I was struck by how many of the 6 birth practices are just mammalian nature.  The parallels with animal birth and human birth are a plenty, let’s take a deeper look.

Let Labor Begin On Its Own (HBP 1)

So, for many folks, waiting for April to birth was hard…and LLLLOOOOONNNNNGGGGG.  If you were anything like me, you watched a lot on day 1 and thought, “Oh, this is it.”  And then day two came and you thought “Oh thank goodness we got through the night and I didn’t miss it.”  And then day 3 came and you thought “TODAY! Is the day.”  And then, it was weeks which turned into months of waiting.  Your patience was tested to the max, and some days you may have given up hope and wondering if something was wrong or if the veterinarians should intervene in some way. But they didn’t.  They waited patiently for labor to begin on its own, and they encouraged us to do the same.

The end of pregnancy is hard for many women.  Sometimes it feels like you’ll be pregnant forever and ever and ever.  But, there are so many great physical and hormonal reasons(barring no medical complications) to wait for your sweet baby to say- “Hey mom, it’s time, let’s go!” The wait is worth it.  Check out this article from the March of Dimes about induction of labor and their campaign to wait until at least 39 weeks gestation.

Walk, move around and change positions throughout labor (HBP 2)

Did you notice how April The Giraffe walked and moved in the days preceding her labor and birth? I even noticed some swaying back and forth.  At one point my youngest child (teen #2) walked into the room and exclaimed, “I know what she needs to do, she needs to SQUAT.”  It was utterly amazing to watch this creature do exactly what she needed to do throughout the process to meet her very instinctual needs.  From walking to swaying to resting and sleeping, she was a fine example of patiently waiting and working with her body.

If you’ve been a part of my childbirth classes or doula trainings, you know that the cornerstone to much of what we teach about labor progression and comfort is movement and position changes for labor.  I like to say, the more you move, the less you hurt, the quicker the baby comes out. The process of labor is so smart that the body intuitively signals the mother to move in ways that are beneficial to both labor progress and for pain management. It’s such an amazement to me that some moms often begin swaying side to side instinctually in pregnancy, and then in labor, and then continue to sway to soothe a newborn.

Have you ever seen a woman in the checkout line at the grocery store swaying at the sound of a baby crying nearby?  Yup, it’s instinctual.

And the design of that instinct is paramount to helping the baby move deeper into the pelvis while also providing comfort for the mother.  Rhythmic movement is a coping strategy, and movement lessens pain!

Bring a loved one, friend or doula for continuous support (HBP 3)

Okay, so this one is near and dear to my heart (for obvious reasons).  How special sweet was it for us to watch April The Giraffe supported through the process by her companion, Oliver.  Did you notice her mate paying much attention to what was happening with her throughout the experience?  He was kept close by because giraffes are herd animals and the park experts knew that she needed support through the process. Because Oliver is a bit of a rambunctious boy, he couldn’t be IN with April most of the time, but he watched in the next stall and at times they would nuzzle or eat from the shared feeder. During the birth- he sure was pacing, just like a lot of dads out there.

In addition to her fellow giraffe, April had the park attendants on watch 24/7 for over two months, as well as regular check-ups from the park veterinarian. Her lead keeper, Alyssa would show her some love and support and you could tell that the two had a bond.  April was loved and supported throughout the process. In some ways, Alyssa, and all of the park attendants were her doulas.

Support in labor is important.  Really important.

Research shows that when women are attended by a professional labor support person such as a doula they experience:

• 31% decrease in the use of Pitocin
• 28% decrease in the risk of C-section
• 12% increase in the likelihood of a spontaneous vaginal birth
• 9% decrease in the use of any medications for pain relief
• 14% decrease in the risk of newborns being admitted to a special care nursery
• 34% decrease in the risk of being dissatisfied with the birth experience

The 2012 Cochrane review by Hodnett et al. concluded that “continuous support during labour has clinically meaningful benefits for women and infants and no known harm. All women should have support throughout labour and birth.” 

In 2014 and 2017, ACOG (The American College of Obstetricians and Gynecologist) endorsed doula support stating “evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support is associated with improved outcomes for women in labor.”

The bottom line- emotional support in labor matters, and is significantly meaningful to maternal physical, Emotional, and mental health.

Melissa with her own sister, after the birth of her third child.

The founders of DONA International knew this all the way back in 1992 when they founded DONA International (then Doulas Of North America), the education and certification organization for training up the next generation of doulas. The basic tenants of the importance of labor support are now finally starting to get the recognition that they deserve!

Avoid Interventions That Are Not Medically Necessary (HBP 4)

I got a really big chuckle reading many comments across the web about the speed of April’s “labor.”  It seems that we’ve become a society of intervening in the natural process, sometimes just because it’s hard to wait.  The very smart professionals at the Animal Adventure Park were quick to keep us grounded in the natural process that was unfolding.  As a matter of fact, they said that they couldn’t actually confirm labor until they saw the hooves!  They held fast and waited, knowing that when the time was right, we’d know. And, boy did we know.  It was such a joy to watch the facebook live video from park owner Jordon Patch as he was racing to the barn as it was baby day!  Wasn’t he just like any excited dad!!  If you haven’t seen it yet- take a quick look.

Okay, so are all interventions bad?  In a word NO!  Interventions in labor can be life-saving for both mom and baby. 

Let’s say that out loud again.  Interventions in birth can be life-saving.

With that said, we know that in the United States, we have a tendency to overuse…well just about everything.  Recently, ACOG published an opinion piece with new recommendations for OB/GYNS and the public titled Approaches to Limit Intervention During Labor and Birth.  The piece listed many ways for practitioners to promote healthy birth and reduce interventions in healthy pregnancies including awaiting hospital admission, reducing amniotomy(artificially breaking the water), providing continuous one to one labor support, encouraging non-pharmacological pain management support and so much more. The recommendation piece which was endorsed by ACNM and AWHONN was a huge step forward in promoting healthy, safe, birth for low-risk childbirth.

Additionally, this Huffington Post piece from March 2017, highlighted the difference an hour can make in our overall cesarean rate- and it’s substantial.  Basically- more time, more patience, and only medical management when medically necessary is healthier for moms and babies.

Isn’t it great to see the data and evidence support what many people feel instinctually! Birth and the bodies ability to give birth is simply amazing.

Avoid giving birth on your back and follow your body’s urges to push (HBP 5)

Wasn’t it completely fascinating how April the Giraffe gave birth while standing up…tall?  It’s estimated that the newborn giraffe falls six feet to the ground because of how tall the mother stands off the ground.  In perfect design, the fall enables the cord to sever and gives the new baby a little jolt to inspire breathing. For the sake of survival, in the wild, the newborn giraffe must be up and on its feet very quickly, so the fall to earth helps encourage the process along.

Using upright positions and following one’s body for pushing is one of the most passive things a laboring mother can do.  We have a celestial gift in the form of the gravitational pull that makes it all the more important for mothers to use upright positioning during birth.  Just like April The Giraffe, the human body knows exactly what to do and when to do it when it comes time for pushing, sometimes there’s just no stopping it.  The body will take over, and the uterus will do its job!  Using upright positions and working WITH the urges you feel will make the process more expedient, and less complicated. And, the squat gives you a significant amount of extra room for baby to pass through, so get upright and follow the bodies urges when the time comes!

Keep mother and baby together – It’s best for mother, baby and breastfeeding (HBP 6)

One thing I absolutely love about watching animals give birth is that almost always, mama mammals and baby mammals are NOT separated.  It just makes sense to keep moms and newborns of any kind together!  In keeping with this form, the Animal Adventure Park stated many times before the birth that the mother and baby would be together until the time of weaning.  This allows the young one to get nutrition and guidance from their mother.

Several years ago, when birth moved from home to hospital, we introduced the idea of the newborn nursery after birth.  The role of the nursery was to look after the newborn and to allow the mother to rest, and while well intentioned, research shows that keeping newborns with their mothers has many health benefits. I, myself remember that just 17 years ago after I held my little blanket wrapped burrito, he was taken to the newborn nursery for his bath and other newborn procedures and didn’t return back to me until FIVE HOURS LATER.

Skin to skin contact after birth has been proven over and over again to be optimal for healthy babies.  Additionally, Kangaroo Care has also been proven to benefit sick babies in the NICU.  There are many documented health benefits of keeping mom and baby close, and I’m thankful to say that many hospitals have changed their ways.  My local hospital Tallahassee Memorial Healthcare has begun to pursue Baby-Friendly Status, and the quest for this designation has affected many newborn routines(*hand clap* for TMH).  For instance, rather than giving newborns an immediate bath after birth, our hospital initiated a “Wait the first eight” policy, and after several successful months, that transformed into- wait until the next day!  Something so small makes such a big difference for the health of the baby as well as the transition for both mother and baby!

All in all, watching birth is magnificent. And watching April The Giraffe birth was inspiring and majestic.

While I watched her intuitively follow her instincts and birth her new calf into the world, I was reminded of the normal, natural process that birth can be, and struck how the six healthy birth practices support a birth similar to Aprils.  Prepared and supported but also with clinical care available as needed.  A hands-off approach until something showed that it needed to be different- which thankfully, it never did.

In birth, we sometimes say that the pendulum swings, and it seems that we as a society are swinging to more intuitive, hands off approach right now.  I’m seeing practitioners take a slower stance, and offering more and more communication with patients about their care.  It is encouraging.  Medical management of complications of pregnancy can be life-saving and can be beneficial to mothers and babies, and it seems that we may be re-learning how to use the tools and the expertise we have at our fingertips, only when necessary.

Change takes time; and while organizations such as Lamaze International, DONA International, ACNM, AWHONN, and ACOG often advocate for change based on best evidence, data shows that it takes a bit longer for those changes to reach regular practice.

Communication between patients, families, and health Care providers, is key to working together for the most healthy, safe, births possible.  

 

Always growing, ever learning, much loving,

Melissa Harley, AdvCD/BDT(DONA), LCCE is an advanced certified birth doula, approved birth doula trainer, and certified childbirth educator.  She is the owner of Capital City Doula Services (CCDS) and this blog.   While working as a doula led her to the childbirth profession, mentoring families and professionals is one of her greatest joys.  To contact Melissa, please visit our contact us page.

 

 

 

 

 

 

 

Editors note:  Hillaree Merck came through my DONA International doula workshop earlier this year.  In this post she shares a bit of what led her to becoming a doula, and how her previous career supports her new role.  I’m excited to see Hillaree begin her doula career and offer support to local Tallahassee, Florida families.  She’s going to be a great doula!  On a side note, I’ve seen over and over the light bulb moment when people who have a background in social work or counseling realize the cross-over between their skill set and doula work.  Read on to learn more.  – Melissa

By: Hillaree Merck, Doula, pursuing certification with DONA International

In a previous life, I was a social worker at an inpatient psychiatric facility, got my BSW and was hired on a couple months later. Working in mental health had been my passion for the better part of ten years and this new position was equal parts exciting and stressful. I worked closely with clients that were in crisis due to mental health disorders, trauma, and addictions. Mental health care is a broken system and I was devoted to being an advocate; this was my dream job and the ideal stepping stone to achieving my goals.

I forgot to mention one thing though, I was six months pregnant at the time I was hired. 

Before becoming a mother, I thought that I was going to be the working mom who was able to balance both a career and a family. Fast forward to a few months later, and I sat looking at my tiny newborn asleep in my arms, thinking to myself “how can I leave her?”  The career that I worked so hard to achieve and that I had such a passion for, suddenly didn’t seem as important anymore. I couldn’t even be in a different room from my new baby without having anxiety. There was just no way I could go back to working a traditional 9-5. Especially not in the environment of the psychiatric facility. Who would have thought my life would turn out this way?

After talking to my husband, we decided that I would stay home full time. The decision led me to a question that I kept asking myself, what do I do now?  I had a degree I was not going to use, a new baby (that I had a wealth of researched knowledge about) and all I had to show for my educational and career accomplishments was a degree and some student loans. The one thing that was decided was that I wasn’t going back to work full time.

Around the same time, I had a few local friends who also were pregnant,  so I surrounded myself with play dates. Over the course of the next few months I  had several other moms reach out to me to ask me questions about pregnancy and childbirth. I was talking about my labor story and my experiences almost everyday, it seemed. As I was engulfed in the pregnancy/childbirth/postpartum world I began to hear labor stories that included trauma and fear, and resulted in postpartum depression. Story after story of new moms feeling that they were not involved in the decision making process for their own births, so many women who felt a true lack of support.   After connecting with various pregnant women, I realized that there were great needs within our current and sometimes broken pregnancy/childbirth system.

THE SAME JUSTIFIED ANGER THAT MOTIVATED ME TO PURSUE SOCIAL WORK WAS RISING IN ME ONCE MORE.

“Why don’t you become a doula?”  I heard one day by a fellow new mom. This simple question led to a time of research on my own.  I talked to a local doula about her experiences, and she told me about DONA International.  In exploring the organization, I realized that the mission and values of DONA International spoke volumes to me.

The Quote “HOW WILL SHE REMEMBER THIS?”  BY PENNY SIMPKIN ECHOED IN MY MIND OVER AND OVER AGAIN.

This was an organization I could stand with. 

Childbirth is one of life’s greatest experiences and that memory should not include trauma, fear, and disappointment. It should be filled with accomplishment, empowerment, and joy. Doulas stand in the gap for moms in labor and open doors of communication so that their voices are heard.

All of this exploration brought me to this conclusion: my love for advocating for mental health translates seamlessly into doula work. In addition, the career affords me the ability to take as many or as few clients as I choose and still be able to stay home with my new baby. Next thing I knew, I found myself signed up for the DONA workshop. 

From the other doulas attending to the videos we watched, to the physical support techniques we learned, it was exactly where I needed to be. The similarities between my social work background and the doula profession are astonishing.

Emotional support, reflective listening, connecting with resources. As a social worker that was my job description, and now as a doula it remains the same.

Through working as a doula I can combine my passion of supporting people with my newfound devotion to childbirth. While I am still learning and in the process of becoming certified, I am confident this is what I am supposed to be doing.

 

Hillaree Merck, BSW is in the process of obtaining a DONA International birth doula certification. A former social worker, she has experience in counseling individuals and families in crisis. She has now turned her attention to working with mothers during pregnancy, labor and postpartum. A resident of Tallahassee, FL she can be found going for walks at local parks, sewing, or spending time with her husband and six month old daughter. Find Hillaree on Facebook at Rosehill Birth Services or on Doula Match. 

One of my childbirth education colleagues once stated a sentiment that went something like this: as many women as there are in the world, that’s how many different kinds of birth experiences there in the world.

Something about this statement really stuck with me as a young educator and over the years, I began to shift my thinking about what I believe makes for a really good birth experience into a place of admiration for the uniqueness of the individual birth experience. For example, some like yoga, while others like gym workouts, and others still prefer to not workout at all! Rather than put women in a “box” so to speak, I began to be intentional at looking at pregnant women as individuals, people who may or may not fit any kind of community or cultural norm surrounding their pregnancies.  This thought process then began to extend beyond pregnancy and birth; into infant feeding, parenting, education, family values..and on, and on, and on…

Recently, I’ve been looking at my work as a doula trainer in the same spirit. Just as there are many different birth experiences, so too are there many different kind of doula career experiences. From what led us to doula work, how we practice, where we attend births, who we receive our education from, and even what our circles of support look like- it’s all unique. No two doula journeys are exactly the same, and while there may be some similarities, at the end of the day, we’re all developing into the doulas that we are meant to be. My story is different than your story, and I feel empowered to make it what’s right for me!

To highlight our similarities and differences; our pathways that mirror one another, and our walks that seem completely opposite, we’re starting a series on The CCDS Voice Collective Blog named Doula Journeys: Challenges, Joys, Experiences.

Through this series, we’ll explore guest posts from doulas; stories about what brought them to doula work, their journey through education, and even their walk through the DONA International certification process. You’ll see some similarities, but mostly, I think you’ll see some uniqueness.

We’ll start the series with a beautiful post by CCDS doula, Emily Geyer on what brought her to doula work.   After that, Emily (and others) will take you on her journey through the first days of her life as a doula and share some of her experience about the certification process with DONA International.  

The goal for this series is to celebrate the fundamentals of our work, the essence of choice.  There is no one right way to birth. There is no one right way to doula. We have guidelines a “rule book” in our scope of practice and code of ethics, but in reality outside of that, we are all empowered to start, work, and succeed in our doula journeys as we see fit.

What works for one, may not work for another, and much like I tell my birthing moms, let’s find that pathway that works for YOU!

I hope you enjoy the series!

Always growing, ever learning, much loving,

 

Melissa Harley, CD/BDT(DONA), LCCE is a certified birth doula, approved birth doula trainer, and certified childbirth childbirth educator.  She is the owner of Capital City Doula Services (CCDS) and this blog.   While working as a doula led her to the childbirth profession, mentoring  families and professionals  is one of her greatest joys.  To contact Melissa, please visit our contact us page.