Doulas and their Boundaries

My job as a doula is to help you grasp all of this information as best as you can. When you endure a major life event, it affects your ability to remember previous conversations. A doula chimes in and helps you recall your initial expectations, and then gently helps you shift your perspective to the present moment. This is where boundaries play in a doula’s role.

It should go without saying, that a doula’s opinions should not play into any aspect of their client’s birth. As with any boundary, these lines blur depending on the context. I can attest to growing more opinionated as my experience has broadened. My education allows me the ability to offer unique suggestions, but how do we know when to push for a little more effort, or to step aside and allow for the birthing person to make their choice?

I certainly step aside more often than not. Maybe that is where I’m at in my journey, or maybe that is just how birth should be supported. Birth is many things; Strength, vulnerability, shedding of old ways, and transforming into parenthood. Of all those things, I work hard to be empathetic to my client’s needs. I have had moments in which I felt compelled to push. Some clients follow that guidance, while others push back. Either way they are informed of their options. I have even had clients ask me (and partners) to leave. While it may seem like a slight on my skills, it’s truly just what that birthing person needs. The art of “doulaing” requires a person to set aside their pride, and support individuals where they are.

This is definitely a processing point for me as a doula. Was I enough? Could I have advocated more for this? Should I have advised differently? Is this safe for my clients? Just like everyone else caring for these individuals, I have seen birth many times. Our ability to to draw a line can be compromised. Empathetic roles require a high level of self care. When implementing boundaries that allow me a proper amount of self care, I can continue to grow my knowledge, and still be sensitive to my client’s needs.

Like any fiscal position, I have individuals question my value as a caregiver. These boundaries in particular are the groundwork to maintaining my career. This generally takes place in the interviewing process, but sometimes within the early stages of a professional relationship. Questions arise such as, How are you helpful within a planned c-section? What if you aren't available for our birth? These are valid concerns. This is a place where we sort of web all of our boundaries into a safe space, and through contractual agreements. It’s incredibly important that every person involved in this experience feels heard, so that they feel confident in themselves throughout the whole process. This experience will affect every aspect of their parenting relationship, and doulas are very sensitive to that.

Putting it into words almost feels like a juggling act, which is how I imagine most business owners feel, but most especially us empaths.

Setting Boundaries in Public

Boundaries. This is a concept we learn overtime. For me it was through a slough of embarrassing moments in my 20s. No lesson is ever learned without a mess. I say this often when I’m attending births. In my role as a doula, boundaries are a large part of the discussion that I continue to have, even on the day of the birth with my clients. Placing such distinctions for your birth is paramount in delivering your baby. Remember. These preparations will not change any potential curve balls in your expectations of your birth, but having a clear idea of the environment you need to have in order to feel safe and vulnerable will give you a leg up in the process.

On paper, that all sounds pretty doable. Now, we add in your current lifestyle. Whether you planned this for years, or your caught by surprise, this is a major change in your individual lives. The stress of finances, the pressure of responsibilities in your work lives, and managing schedules in the hopes of spending a day or two together. This climate isn’t always cut out for the efforts it takes to really come to terms with expanding your family. Naturally we turn to others that have been through it before. How did they cope? Where did they give birth? How was there experience in comparison to their expectations? Most of the time pregnant individuals don’t even get a chance to ask. Pregnancy tends to draw people near you regardless of how you are feeling in the moment. This is a great place to implement those boundaries. It sounds silly, but I always recommend having a specific statement prepared for the unwelcome interactions. “I respect and appreciate your experience, but have to be on my way” Simple, respectful, and concise. How they take that is on them.

Next week we discuss boundaries in your birthing environment. How to decide who you want in your space, and taking the steps to set those standards ahead of time.

Catching up!

This year has been pure madness. Some good some bad, but all in all necessary. I haven't had a ton of inspiration on the blogging front, but my Instagram game is pretty steady. Check out my World Doula Week Birth affirmations, for some insight on my year so far. Thanks to my avid readers. Please feel free to contact me personally with any insight or questions you may have!

Bali, A Birth Story

I had the opportunity to visit Bali this year. I was there for 3 weeks working with a family and experiencing my surroundings when I had some time off. The streets in Bali are lively with motor bikes by the hundreds flooding the streets, even the sidewalks in times of congestion. The people smile, and busily sell their services to tourists on the streets. I had the opportunity to visit the city of Ubud, known to some from the book turned movie, “Eat, Pray, Love” by Elizabeth Gilbert. I did my best to live it up during this very unique experience. I haggled with men on mopeds for transportation services, walked, and prayed in a temple. I rode on the back of a motorcycle through the rice paddies, watching the flags and banners waving as we cruised by, the sun beating on my skin as the driver stopped and went with quick decisions through busy road ways. I’m not going to lie, I was concerned for my safety, but only a little. I spent an afternoon at a beach club drinking margaritas and listening to good tunes while meeting different people from around the world at a swimming pool bar. I even got to wash a grown elephant and feed a baby one. I mean, dream vacation, right? Funny thing is- none of those experiences topped the one I had at the Bumi Sehat birthing center.

While visiting Ubud, I had the opportunity to visit Bumi Sehat, a community birthing center started by Robin Lim. When I arrived in the city, I began asking around about Bumi Sehat, interested in hearing a story or two of births that had happened at the center. I was able to speak with two different gentleman who provided me with transport. The first gentleman in his 60s told me of his daughter who was receiving care at the center, and how grateful he was for the the facility as well as the staff. The other man was in his 30s. He and his wife in the process of trying to conceive. They attend fertility counseling offered in the center. He discussed how grateful he was for the affordability of the care. The center accepts whatever you can pay. How beautiful is that? Everyone receiving the same quality of care, for whatever they can afford.

I planned on getting there and simply offering my hands in any way. I was prepared to check in on postpartum recovery mamas and help them swaddle up a fussy baby, or establish breastfeeding. Heck, I was open to prepping food or folding some laundry, Wherever they needed me, I was ready to serve. The PR woman showed me around the center. Upon introducing me to the midwives on call that day, they immediately said, “Oh, you can support our birthing couple!!” I honestly did not expect this. I was floored. It turns out that this couple had wished for a doula, but were unable to attain one. The staff asked the couple if they would be ok with me providing doula services for them. They said, “Yes.”… I couldn’t believe it. Due to the nature of the work I was doing in Bali, I was only available to stay for 5 hours, so when I arrived I made it a point to make that very clear to them. It is important that boundaries are set, to not leave clients with disappointment. They still felt the time valuable, so I joined them in the room they were in, introduced myself, and got to work.

It was like a dream. The mother was originally from the Netherlands, her partner born and raised in Bali. She smiled at me with the glow of a laboring mother. Still talking and smiling in between contractions. It was a different dynamic than my other births, of course, as this was happening in a culture that exists on the other side of the planet from my usual domain. I get more time to get to know my state side clients before the birth. This birth support required a subtle dance between present, quiet support, and getting to know each other through conversation. One of my favorite aspects of international travel is the constant obstacle that language barriers provide. The art of communication is really chiseled down to the very raw details. Body language, eye contact, and listening. As a doula, I utilize these very aspects of communication in my work. As mentioned before, I make the time to meet with my clients a few times prior to the birth. However, there is still that aspect of uncertainty in the air. The unpredictability of birth permeates all aspects of the birthing room when the time comes. There is no way to know how one will react in that space, until we are actually there. I enter every birthing room with an open heart, ears, and eyes. When listening with all my faculties, intuition guides my hand and body where it needs to go. So, walking in here I felt virtually the same emotions as my state side births. The only difference is the comfort in imminent changes this community has. Imagine only having access to just what you need. No overabundance of materials or services to choose from, simply being comfortable with what you can have at that very moment. This couple welcomed me with trust and confidence. That confidence allowed me to just jump in and help, despite having just met at that very moment..

The environment was warm and muggy. The back door to the room open wide with curtains blowing in the wind.  The sounds of motor bikes, children’s voices, and generations of families housed together, thriving as their own village. I could not believe what an opportunity this was for me, and how enriching it felt to participate in this one of kind experience. Aside from her partner, she had some close friends present at her birth. Very relaxed with them in and out making sure mom and dad had everything they needed. Her girlfriend even snapped some of my only photos present at a birth.  

Applying counter pressure to mother's hips while she rest off of her feet.

Applying counter pressure to mother's hips while she rest off of her feet.

Mama was sitting on the bed when I came in, which was low enough to allow the space for her hips to ease open. As we were quickly getting acquainted, she began pacing the room. That is one of my most favorite aspects of birth. In staying present in that space, birth itself begins making certain choices for you. As a doula, this allows us the opportunity to get a sense of the mama’s rhythm. The last thing I wanted to do was walk in there and stand in the way of all the progress already done, so I just watched for a minute. I then began implementing some counter pressure during her contractions. She would beautifully float from bed to wall, placing her hands on it as a contraction came on. Her knees would weaken a bit allowing her to naturally squat into each surge as they came on. I acclimated her to my touch for about 30 min allowing her to brush the edges of active labor.

She asked for some relief for her hips and mentioned feeling sort of stuck. Feeling stuck can happen for all sorts of reasons, it could be the position of the baby, a nagging thought in your head, or maybe just an aspect of the waves of emotion you are feeling, keeping you from moving you forward. I got her on her hands and knees on the bed and went to my bag for my rebozo, calmly explaining to her how I would be using it. I wrapped the rebozo around her hips, tightening just enough to grip and gently shimmy them back and forth. This forced her muscle tissue to let go, easing baby lower. We stayed there a little bit after, swaying her hips back and forth while I applied counter pressure during contractions. We became a unit on the bed, with dad spotting us. She soon grew tired of this position, so I got out the birthing ball, giving her the chance to rest but still able to work her hips.

Applying counter pressure in an active labor position.

Applying counter pressure in an active labor position.

Before we knew if it, she mentioned feeling fluid leaking down her leg. This is a good indication of what we in the birth world refer to as SROM, or Spontaneous Rupture Of Membranes. For this mama it seemed more like a small tear, slowly emitting amniotic fluid with each contraction. This is can also be an indication of possible transition. When the waters break, the cushion between the birth canal and baby’s head disappears, which can intensify the birth considerably. This was true for this mama. She slowly stopped talking, and began pacing even more than before. Her close friend cut up some dragon fruit for the room and mama would stop and snack as often as possible. I was watching the clock pass time as she slowly drifted off into the most intense place she had been since the beginning of this journey. Her midwife, Robin came in to check on her. She was pleased with her progress, and without any intervention, other than some suggestions on birthing techniques, she took her leave to allow this birth to unfold. We got mama in the shower on a birth ball. She rocked her hips more intensely, dad and I taking turns running warm water down her back as she moaned beautifully. Her restless feelings grew bigger as she furthered her progress so she switched back to pacing, clearly her favorite method of laboring.

Her friends and husband spent some time observing me, and I teaching them some of my techniques so they could assist her closer to pushing. Soon, it was time for me to leave. Without taking away too much from their current moment, I gave them some words of encouragement and gratitude, and left knowing that they were soon to meet their little one.

Staying active in a supported squat on the birthing ball.

Staying active in a supported squat on the birthing ball.

The last couple of weeks there consisted of long hours as a babysitter, and quiet evening swims in the moonlight. It wasn’t long before I was packing my bags to return home. As beautiful as this island is, my heart belongs to Texas. The trip home is well over 24 hours, including an eight hour layover in Korea. I was exhausted by travel, my tummy sour with the acidity of my fourth cup of coffee, but I couldn’t help but smile at the joy I received in spontaneously supporting a beautiful mama through her transition from early labor to active labor. My life is forever changed for this experience and I will be forever grateful.