One Of These Things

For those of you who watched Sesame Street in the 1980’s you’ll remember the song so often included in the show:
 

“One of these things is not like the other,

One of these things does not belong.

Can you tell which things are not like the other?”

 Refresh your memory with this quick little clip.    https://www.youtube.com/watch?v=6b0ftfKFEJg

This jingle always comes to mind when I’m getting ready to leave my childbirth class. It’s easy to spot my red pea coat from the pile of black coats and sweaters. Picking up my red loafers, again from rows of paired black sneakers, it hits me- I am different than them.

“As a birth worker serving the Amish, I receive a certain amount of reverence and respect. As a non-Amish woman I am always just on the outside of inclusion; if that makes any sense. No matter how much time I spend serving, living and working among them I will never be one of them. Of course I don’t want to be Amish. Still a little part of my heart hurts knowing that my sacrifice of comfort and time, the gift of quality culturally sensitive care will never win me full belonging. I will never be inside the circle.” 

As I wrote these words last week tears came to my eyes.  The passage is part of a novel I am currently working on. When I started writing the paragraph they were just fiction.  As I sat back to read it I realized it to be my truth. And I cried.

Fourteen years ago when my husband and I bought our house we wanted a rural location and school district. Little did I know how I would become immersed in serving the Amish families in my neighborhood.  Literally my neighbors. I attended a birth just this morning for the family whose farm shares a property line with mine. And I love it. 

They appreciate and respect me and my professional wealth of knowledge. They call, send letters, flag me down when I am out running, stop me in the middle of Wal-mart. Together our children ride the bus, learn at school and play at home. It is a rich life.

Raised in a family, church and community where diversity in culture is embraced it has become a defining value for me. Both personally and professionally, I am comfortable and drawn to relationships with those different than myself. I find myself drawn to vocations that serve people from other cultures. Running a food pantry and financial assistance program, interpreting English to Spanish during a surgical operation, childbirth classes with the Amish-I have loved the diversity of each one.

And for the most part it works well. Culturally competent care stretches my muscles of compassion. Challenges me to look at life from outside my own view and appreciate the differences. I enjoy learning about other people’s experience of life. Being in their homes, eating their food, learning their language. I’ve learned so much and I am a better person for it. 

Now after all that would you believe me when I say that I still feel on the outside at times? And that that last bit of space between our worlds can really be a splinter in my palm. What would it be like to be one of them? Not to actually BE Amish, but to be the same? I don’t feel this way all the time. The tiny bit of hurt surfaces now and then. Mostly when I’ve been in on an intensely emotional experience. Like a baby dying, like a victorious birth hard won.

Sometimes I just want to belong.  Really belong.  Am I alone in this flip side of appreciating difference? Alone in my longing to be the same? 

When your client lives with abuse....

Within minutes after stepping through her front door, I felt it.  Stifling static tension, he sits in his leather LazyBoy watching soccer, not taking his attention from the game as I enter. She noiselessly, gracefully moves around the room as to not disturb him.  Ushering me into her bedroom for our prenatal doula meeting, no mention of her husband stoically sitting in the other room. 

She didn’t reveal and I didn’t ask at that first meeting. I knew something was amiss between them.  I didn’t get it all put together until my postpartum visit in that same bedroom 5 weeks later.  Mari’s husband, hits her, belittles her, shames her and ridicules her.  His abuse is as long lasting as it is painful.  Mari has three daughters with him and this birth brings their fourth child, first son into the family.  She is in the midst of a long and secretive process of getting protective immigration status so she can free herself from her husband’s control.  In the mean time she endures his abuse.

Once Mari is settled into the labor and delivery room he begins to complain about how cold his feet are. Five minutes pass, and he is excusing himself stating his feet are just too cold- he’s headed home to change out of his sandals and will return soon.  He lives 3 miles/10 minute drive from the hospital.  His son entered the world 15 minutes after the cold footed father left the hospital.  Aamazing considering she was 4 cm with “lazy” contractions every 7 minutes when he left.  It was the fastest labor I had witnessed.  The OB nurses were quite surprised.

It was as if her body hurried to birth the baby while he was gone.  Maybe he left on purpose as to give her this space? I’m not sure he is that sensitive or perceptive.  Was her body tuned into some kind of instinct that protected her birthing from his intimidating, dominating, demanding presence? I’ll never know.

Yessica is a client I met through the neighborhood clinic I worked for as a contract doula.  Prenatally the clinic informed me that she having a baby with an abusive boyfriend.  Yessica and I spent lots of time prenatally discussing her relationship with her boyfriend and her wishes for his participation (or lack of) during the birth.  She was clear, he was not to be present.  The physician agreed with Yessica that it would not be safe for him to be present for the birth.  The plan was to alert security once she was laboring at the hospital as to keep him from entering the labor room, all parties agreed this was the safest and preferable plan.

After three hours of active labor at the hospital, Yessica begins to give up on herself.  I am pouring myself into supporting and encouraging her.  With each passing contraction she grows more and more pathetic.  The physician enters the room to observe her status.  Noting her distress, he stays to provide support.  It becomes clear Yessica has decided that she cannot and will not do this.  She wants help, is crying for help, begging really.  But not accepting anything we offer.  It reminds me of my toddler throwing a fit.  She is rude, loud, demanding and dramatic.  All her energy goes into her protesting and fighting her labor, making it all the more painful.  At one point she is combatant, swinging and clawing at me when I try to hold her hand and encourage her further.

As things escalate, a nurse informs us that her boyfriend is waiting outside the room and wants to enter.  He has charmed his way past the front desk and is pleading for a chance to enter the room.  The physician quickly exits to talk with him outside the door.    As I anticipated there is drama that distracts us all from the process of this labor and birth.  As a doula I am concerned for my safety.  

Stepping back from the scene, I realized she is playing the role she always does.  She made herself the helpless, victim to be pitied and rescued.  Miraculously her body continued to labor effectively opening and pushing even despite her best effort to fight it.  Within minutes of the baby’s birth the boyfriend entered the room, as agreed upon.  Yessica became a different woman.  She nuzzled into him, glowing with accomplishment and hungry for his affection.  It turned my stomach.  I felt so much sadness for this little family. 

What is a doula to do in cases where abuse is suspected/confirmed? Ignore or inquire?  Pity or probe?  The social worker in me wants to get the details.  I want justice. I want her to be protected, for her to heal and to know her worth and stand up and leave.  And it is not just her I worry about, but her children as well.  Leaving an abusive relationship is a move that takes time, support, resources and planning.    

There is a cross cultural element to be considered.  Culture and religion can make it even more difficult for a woman to break out of an abusive relationship.  For so long they accept his control, his power over them.  They feel shame, blame for their situation.  Religion tells them to trust, pray, forgive and forget.  Not addressing the need for protection, healing and separation.  Culture tells them he has the right to be controlling, to treat her how he wants.  She must be an attractive, attentive and passive mate; or he will mistreat her or stray.   

To answer my own question I think it is responsible of the doula to report any abuse she witnesses if there is physical evidence of abuse (bruises, scars etc).  Often it is not that clear or reportable.  Start with asking her questions, build on the rapport gained through the labor and birth. Don't ask if you aren't willing to do something with her answers. Follow up with her health care provider.  Give her information on resources, community counseling, woman’s shelter etc.  If nothing else, use the moments of empowerment and victory from the birth to reinforce her strength and power.

Both Mari and Yessica were already connected to services in the community.  They knew there was a problem, looked for support, and connected to professionals that can help them.  Unfortunately, even with education, support and counseling they still are in ongoing relationships with men that treat them horribly.  Abuse is a bondage that is challenging to break free of.

As I write this I realize that with Amish women there is a huge barrier to accessing these same services.  The Amish church’s patriarchal system handles transgressions internally.  There is a process of confession, repentance, and forgiveness- then silence.  There is no divorce; there is no leaving unless conditions are proven to be severe or highly dangerous.  I am frustrated at the lack of protection for the abused women and children in the Amish church.  Is there opportunity for counseling, sorting out the abuse and healing?  A chance for a fresh start, and new self-worth?   Where does the cycle of abuse end when children grow up with it?  How does it carry on to the next generation?

When it comes to abuse, I wonder is my little bit of love and encouragement enough?  Does an empowering birth where a woman is respected and protected make a difference?  I’d like to think it can. So doulas, midwives, doctors, nurses, model respect for her and birthing power. Give her a safe place to bring forth life.  Pay attention to her needs, work to earn and keep her trust.  Empower her in every little detail and pray that it will ripple into her life beyond the birth.

Ten years since that first birth...you are invited to my party.

Evening is settling into the neighborhood.  Families are finishing their outside chores and gathering around the kitchen table to share a meal.  I sit at the stop sign exiting my cul-de-sac.  My daughter is sitting beside me.  She’s layered in a light pink hooded sweatshirt with her orange softball team t-shirt on top, her mit rests in her lap. We wait for the oncoming buggy to pass before I pull out.  A large gloved hand lets loose of the reigns and gives me an energetic wave.  His wife quickly peeks out of the side window, a 4x6 inch opening.  I can see her young eyes behind petite glasses and pointy nose.  She recognizes me and leans past the 7 month little boy sitting on her lap with a big grin and wave. 

“Another couple from your class?” my daughter sighs with slow exasperation.  “Yup” I say while returning the buggy greetings.  I glance over at my daughter, whose game I will miss tonight.  “They really like you mom, you must do a good job.” She comments.  In that moment I am reminded all at once, the price I pay each time I leave to do birth work and the gain in each new couple I connect with.  The cost and the reward.

Tomorrow is my ten year anniversary from that first life altering birth I attended as a doula,  May 7, 2004. Every year I pause to remember.  Writing it now it seems unreal.  Ten years.  I kept count for a while of all the births I attended.  By year three I’d lost track exactly.  If I had to guess now I’d say its anywhere from 150-200 births I’ve attended as a doula or midwife’s assistant.  I have only been teaching for three years, but I am closing in on 200 couples in my classes. 

This trophy is a treasured gift from a family that
 I was able to doula through both of their daughter's births.  

Last night as I waited for the caffeine and teaching induced adrenalin to drain from my body. I imagined- what would it be like if I could gather all these families together for one big party?  What would that look like?  Where are they all today? Do they remember me?  I decided there would be three distinct groups of people in attendance. 

*Disclaimer these are generalizations and not every family fits just perfectly into my categories*

The First Year Families: 

These are families I met through my work with Maple City Health Care Center, a low income health clinic in Goshen.  The clinic gave me as much doula work and I could stand those first few years of my career.  The families were Spanish speaking Mexican immigrants, living in a new place and far from their family support system.  It was such an honor to usher them through their births, buffering them from the healthcare system, comforting them when their mama or sister could not.  All these babies are now grade school students, ranging from third grade to Kindergarten.  I bump into these families at community soccer games, the county fair, chess meets and shopping at the mall.

Usually the mother and I exchange some shy glances trying to figure out “Is that who I think it is?”.  I am the first to make the move, to introduce myself again, sometimes I remember their names or the name of their child, but not always.  Recognition flashes in their eyes and a warm smile spreads across their face.  We are quickly reminiscing; she calls over her child and introduces them.  The timid and irritated child not fully understanding what the big deal is all about, flashes me a smile and “hey” and is back to the activity at hand.

The Mainstreamers:

This group of families is sprinkled through the years of my work. As much as I love working with people in other cultures, it is enjoyable to be with families “like me” as well.  Living in and around Goshen, alumni of the same school, enjoying comfortable midwest lives I feel an ease with them.  They drive family vehicles shuttling their kids to sports, the park, and school; balancing work and home life.  These families have means, strong partnerships and resources.  They are self-empowered, informed consumers of birth.  Working with these families allows me to utilize a different skill set.  During the labor and birth I work to honor their specific birth plan.  Partners are more informed about the process and participate intentionally in it. This informed and intentional aspect draws deeper meaning to the victory of the birth and welcoming of a new life.  Doula babies born to these families pop up in my Facebook feed- growing up before my eyes.    

The Amish:

If the Amish families I work with came to my imaginary party, they fill the parking lot with their family size “minivan” model buggies.  There would be several van loads dropping off the couples from the same neighborhood or same family.  A small herd of three and four year olds run about while their mothers bounce their still-in-arms siblings.  In reality, I encounter my Amish families throughout my daily life, neighborhood walks, local grocery store, weddings, and funerals.  Last winter I was on call for a very important homebirth 5 miles from my house.  On the verge of a huge blizzard, the forecast had me sleepless at night.  I soothed myself to sleep by counting in my head all the families between my house and hers that I knew from birthwork.  Families that would open the door if I knocked, families that would buggy me the rest of the way to the birth if I got stuck in the snow.  Would you believe it was 12 places between my home and hers? Twelve families who knew me, “Betsy Black, the lady that helps at births”.  What a blessing to know and be known by those around you.

Writing this impresses upon me that this is quite an accomplishment, this web of relationships.  This way of belonging to my community, to my neighbors; it is valuable.  Lately, I struggle to know where my professional life is taking me. The insecure question, “Am I doing enough with my life/with my gifts and abilities?”  creeps into my mind in quiet moments.  I struggle to defeat that insecurity.  Today as I celebrate at my imaginary party I am overwhelmed with the richness that birthwork brings my life and the value of my work. I am important just as I am.  My work matters. I am enough.

Part One: Two years ago and about 30 births into my doula career I witnessed my first Cesarean Section.

Two years ago and about 30 births into my doula career I witnessed my first Cesarean Section.  Since then I think I’ve attended about 10 more Cesarean births and about 150 births all together.  It is an amazing ratio 1:15 births, much different than the statistics a mother delivering in today’s US hospital setting faces 1:3. My amazing stats are due to the caring providers and facility in which I served.  So before I delve into the story I have to give some background on my set up.  In the early years of my doula career I worked for Maple City Health Care Center (MCHCC), a low-income neighborhood based clinic that provides doula care to all of their pregnant patients.

My Set Up:  Maple City Health Care Center circa 2004-2006

The providers at MCHCC were a general family physician and a certified nurse midwife (CNM).  Both the doctor and midwife worked tirelessly to educate their clients about what kind of birth experience was available to them here in Goshen.  All clients delivered at then Goshen General Hospital, now IU Health Goshen, a facility with caring nursing staff and dedication to honoring a supporting mother/baby experience.

MCHCC recruited me for doula training.  I still remember the conversation with Ellie the prenatal care coordinator.  She pulled me aside one day as the clinic was closing up and wondered if maybe I’d consider training as a doula and attending births with the clinic’s pregnant patients.  The majority of OB patients during this time period were undocumented women from Mexico.  These women lived in the states for less than one year, isolated from their mothers/sisters/friends back home and speaking only Spanish. Their circumstances made a good match for the labor support and translation services of a doula.

It was 2004 and there were 5 or 6 doulas each attending least one birth a month for the patients at the clinic.  We were each individually contracted with the clinic, but supported each other through regular meetings, backup coverage and a general listening ear.  It was ideal for my novice self.  There were so many layers to the work.  There was labor support and navigating hospital birthing, but also the language and culture were a challenge.  Understanding my client’s expectations and needs took intentional effort.  And I loved it.  I thrived.  I was passionate about it enough to scramble to find a sitter for my 3 and 1 year old children each time the labor call came.   

At the clinic all pregnant patients were encouraged to attend prenatal care in the Centering Pregnancy groups. The Centering Pregnancy group was adapted a model to enhance the mother’s experience of her pregnancy and improve health outcomes for her and her baby.  More information on this program is available online at Centering Pregnancy.

This format was perfect for women who were new to our area and living far from their maternal support system.  Educational topics included nutrition, pregnancy discomforts, labor support, VBAC (Vaginal Birth after Cesarean), and breastfeeding.   Ten sessions in total were all presented in English and Spanish.  This information helped women discuss their questions and concerns, process the culture of the US medical system and enable them to feel more confident in the care they were receiving and the birth they anticipated. 

The Outcome:

The effort that the providers and clinic put into offering this service demonstrated each woman is valued and respected in the healthcare setting.   The care provided by the doctor and midwife went a long way to decrease unnecessary cesarean deliveries and increased VBACs (vaginal birth after cesarean).  Doula support was utilized by many of the patients, this support didn’t always mean the birth was short and easy, but it was an experience where women felt cared for and supported.  This is the lesson I learned as I doulaed (this is a word in the birth world) Leticia through Caroline’s birth.  See my next post to read that birth story.

Ordinary

If you look in the dictionary you’ll find Ordinary is something considered to be normal, routine, regular, the customary course.  In my opinion Ordinary doesn’t get the respect it deserves.   We live in a culture that values the above-average, over the top, best it can be kind of experience.  An unrealistic way of living and birthing.  Now don’t get all worked up that I’m not gushing about the beauty and mountain top moment that birth can be, hear me out.  I observe plenty of beauty, holiness and all together awesomeness at births.  I love those moments.  But I value ordinariness just as much as the once-in-a-life-time-ness of a child being born. 

It’s possibly a loaded word, this ordinary, when it comes to describing a woman’s labor and a child’s birth. Depending on where you are and who is providing care- the regular routine may not be desirable.  I’ve been in those places, seen those births.  Heck, I’ve had one of those births.  And that isn’t quite what I’m getting at.  It’s not the “normal” defined by the hospital or provider you choose.  Its “normal” as defined by nature, the regular old ordinary natural process.  Muscles contracting, hormones surging, baby descending through bone-this is the Ordinary that I watch for.

Over the course of my birth work I am convinced that there is a piece of this ordinary in every birth.  Yes every birth.  I can go back through each birth I have attended and find the Ordinary.  Sometimes it is a glimpse- one naturally occurring contraction, an uncoached urge to push, a baby that cries and pinks despite an operative birth, a mother’s swelling oxytocin as her babe suckles for the first time.  The moments are there, and I’ve started looking for them, counting them almost.  Because ordinary is the goal, ordinary means it is working. Despite our efforts to control it, to manage it, even if it has to go undercover, Ordinary happens.  

It is easy now for me to break down those moments in a birth.  Like my son taking apart his Lego creation, each moment a brick. Each brick a part of the whole no matter the size. As a childbirth teacher I explain the workings of the female human body during pregnancy and childbirth on a monthly basis.  Perhaps that repetition in presenting the birthing process has made it seem so obvious and normal to me that it IS simply ordinary.  So entrenched in my mind are the sequence of events, so many times I have seen it, that is Ordinary.

Let me give you an example:

The first birth that comes to mind is Sarah.  Sarah labored for 3 days, the first day a slow starter after her water broke.  It wasn’t painful so much at first but she was restless and anxious.  And those early contractions were close enough to keep her from sleep.  By the second day her contractions had picked up- they were closer together and stronger. She made the 1 hour drive from her home to the birth center where she hoped to give birth.  Sarah missed another night’s sleep in the course of labor unfolding.  She was getting tired and so was her uterus.  

Along with her midwife’s counsel Sarah and her husband decided to transfer to a local hospital for services the birth center couldn’t offer.  Leaving her birth plan behind was hard.  But she needed some sleep.  At the hospital she transferred care to a different midwife who ordered an epidural and some medicine to keep Sarah’s contractions coming. 

This is where I met them in the process.  Sarah hosted a childbirth class at her house two months prior and I was the teacher.  Her original midwife called me and asked me to doula them as she was not able to care for them at the hospital.  I was glad to go, it was my own son’s birthday and I felt a special connection to Sarah from our first meeting.

When I arrived Sarah was just waking from a few hours of sleep.  She was smiling and chatty.  The epidural had given her just want she needed.  Sleep.  While sleeping her body continued to work and she was ready to push.  Her anxiety resurfaced and insecurity, “Is this going to work?  Can I push out my baby?”.  The fresh midwife cheered and encouraged Sarah through the first pushes.  And she did do it, Sarah pushed.  Uterus contracting, baby descending, mother opening.  She pushed, the baby moved, one bit closer to birth.  Sarah didn’t believe it would happen, she couldn’t even feel it happening because of her epidural.  Her plans for this birth had already changed so much, she doubted she could do it.  And then she did it.  A squawking pink baby girl in her arms she washed over with relief less than an hour after her first push.  

Betsy, get to the point here.  You are waiting for the Ordinary part right?  So Sarah’s hoped for natural birth center water birth did not happen. Regardless, her body started labor on its own water breaking then gradual contractions.  Pretty ordinary stuff.  I observed Sarah work hard; muscles straining, sweat rolling, gazing into her husband’s eyes for support. Plain hard work. And then the emergence of her daughter. It happened, it worked.  And it was very Ordinary.  Remember that definition I mentioned earlier? Something considered to be normal, routine, regular, the customary course.  

And Ordinary really is quite nice.