Tuesday, June 20, 2017

Dr. Marshall Klaus, Champion of the Doula

Dr. Marshall Klaus, the world renown pediatrician, who with the late Dr. John Kennel, researched the power of a birth companion (doula) and followed other's research to discover the modeling that birthing women will sometimes even verbalize themselves!

Link to see this in YouTube to see Spinning Babies 2001 video of Dr. Klaus talking about the doula with doula Malik Turley.

Malik Turley: "Dr. Klaus, I was at your talk yesterday about "Sensitive Period" and I was wondering if you have a couple minutes to go over that again for me?"

Dr. Marshall Klaus: "Sure,... You know,  John Kennel had been working for about 30 years on the problem. One of the things that we saw in the beginning that made us wonder if this period was unusual is that if mothers got her babies just one hour after birth the mother was different for as long as nine days. We'd never seen this. They were much more responsive to their babies. They were more interested in their babies. Yet, we hadn't given them any more education.

And then when the new studies came up, related with mothers having more support during labor, and the South African group seeing that those mothers were less depressed 6 weeks later, we began to see that if mothers had their babies 6 hours on day 1 and 6 hours on day 2,  after birth, remember down South, in Susan O'Connor's data, there was less child abuse in the next 17 months and the study was randomized.

We think that because the woman is having a large amount of oxytocin, the love hormone, being secreted, and its going to the brain, that theres a major change in the brain of the newly delivered mother. And that this was placed in an evolutionary way so that women would be very sensitive to their new babies. So they have to begin to take the baby, because each baby is different.

And the mothers are staring at the babies and staring and staring.  They don't take their eyes off baby. When I asked some of these mothers years ago, they said they were taking in the baby.
And I didn't quickly realize what this meant. It means they are incorporating, by watching the baby closely, the needs of the baby.

What this means for physicians and nurses and doulas, is that you have a woman who is like a sponge [hence the Sensitive Period]. The more caring we are of this woman, she incorporates the care we give to her and it becomes the quality and the kind of care she gives her baby.

And I think that what stimulates this especially is the doula. Because when the doula holds the mother and rubs her back and even though the labor takes 6, 8, 10, 12 hours, you don't leave her. You're with her and even though you're exhausted you stay with her.

Very few people have ever been cared for like that.

She begins to feel very warmly towards ...you.
She takes in the way you cared for her, your gentleness and your caring, and then she applies this to the baby.

And the more caring we are, she rises. Six weeks later and two months later she is still different. So she incorporates your qualities and she applies it to her baby.

If you have your baby right after delivery, and it never leaves your bed those women in three different countries those women don't give up their babies.

In Sweden, there's a woman, Kerstin Uvnäs Moberg, who has an idea how this works. Right up to the time of delivery you have more receptors in your brain for oxytocin. And you get in a sense, an oxytocin high where you're open and you're open to new things.

When you're in a Sensitive Period, it means you're mobile, emotionally.

If you have a traumatic birth and you didn't have a doula, or somebody was mean to you, it could be destructive, hurtful to you. But if you're sensitively cared for, if have a difficult birth but a doula whose with you every minute, then you are able go up in
 your functioning permanently, I'm talking about.

So, the Sensitive Period suggests we have to change obstetrical care to make it as humane as we can.

The doula is an ideal person to model, not only to the mother but you can model for physicians such as myself, and you can model for nurses for the obstetricians, and when we see the kind of care you're giving her we're going to start to think about, why are you doing this, you know.

And if we start to have more papers on the Sensitive Period then everybody that works with mothers will realize they are very powerful, but hopefully in a good way.

What's good about the doula is you won't do anything for the mother unless you check with her.

Malik Turley: Right.

Dr. Klaus: You may want to rub her back but she may want you to rub her arms. She may not want any rubbing at all. So you're always checking with her. And we don't do that enough; I don't think doctors check with the mother enough. Give them choices.

The Canadians are ahead of us. The Canadian Royal Society of Obstetrics recommends that every mother have a continuous caring woman with them.

I would say every doula that we've seen is very gentle and caring. You have to remember you're a powerful person because she is in this unusual state of consciousness.

Malik Turley: What do you see as the primary benefits from this caring influence in this Sensitive Period?

Marshall Klaus: One of the biggest things is that mothers that are cared for in the way you are caring for women there's a chance she will be a lot less depressed. And there's data to support that. Less anxious. And I think that she'll take care of her baby using some of the care signals that you gave her.

I visited a close friend some years ago. I was surprised she did this well with a set of two active twins. And I asked her, 'How did this all work out? Cause I knew you like to keep things in order, and babies don't keep things in order.'

She said, 'You know when I had a doula, the doula was just wonderful with me. And when I got more upset she became more relaxed and helped me through it. Now, when the twins get upset I try to help them through it. But I don't get upset I become calm like my doula.'

Dr. Klaus looks at the camera, smiles, and says, "That's real, by the way."

More on oxytocin

Friday, June 16, 2017

Preparing strength with vulnerability

Lately I've been re-introduced to vulnerability. I don't mean I've been re-introduced to hurt. Actually I've been feeling stronger and more fluid than I have for a while within myself. I have more peace now with the process than I have had since the beginning of "my big learning curve" to give birth to Spinning Babies. And in the strength of this emergence, I add some thoughts about supporting birthing strength through the vulnerability involved with communicating needs.

Pregnancy is a series of decisions to give birth, or not, and to end the pregnancy (or grieve a too-soon end of pregnancy) or to "be delivered" and give that powerful transformation sometimes called giving birth to ones self.

One of the most treasured experiences of my doula or midwife life has been to serve women seeking again their power within to birth after a previous surgical birth. There is very often grief when birth is finished through major surgery.

Whether the cesarean was expected and accepted, or sudden after a long labor or discovery of a breech position or other issue, the message may linger than one's ability to give birth may not be unrefutable. The grief of losing the experience of birth continues even with the welcoming of a live, and hopefully healthy child. Especially when the baby is healthy. Especially when the reason for the cesarean is less than certain. Parent may then ask, who am I now? Who am I really in view of this event? Who are we? Who is he? Who is she? I thought I was (they were) the birth giver and that moment was taken, shaken or forsaken.

For many there remains a question, if I have a chance to give birth again, can I finish under my own body's power? Here the unknown is met with determination.

Life brings cycles of stability and instability, coasting and accelerating, learning and sharing. Opposite forces rotate around our lives bringing us opportunities that balance through opposing experiences.

Being pregnant and preparing for birth is a time of change. The unknown beckons while a need for comfort can bring about a want for comfort and surety. We are open in pregnancy to recreate ourselves even as we offer ourselves in empathy and hope to grow a child. In the depth of creative self, in creating self, we are in a sensitive period (as defined by Dr. Maria Montessori as a developmental period of absorbing information) where the behavior of the people we value becomes a model of social behavior.

The seeming dichotomy to achieve a powerful, strong birth may be through vulnerability. What I mean by vulnerability is the taking a risk to express the desire of what one wants to experience. Another vulnerability is trying when the result isn't certain. Giving your heart 100% to the cause and risking disappointment. But this is also giving 100% and experiencing 100% the portion of the process you are currently in. The process is the reward.

Sometimes women have told me that they choose not to tell their doctor what they want or don't want at birth because they don't want to make the doctor angry. The fundamental need is to protect access to the expert who will save your baby. Compromise is a coping skill to sustain a relationship with the person in power (the power to save the baby presumably), as well as to grow a collaborative relationship. But collaboration can only occur if communication comes first.

Vulnerable strength in communication
It's ok to say what you want to your birth professional.
Speak in a way that is mutually meaningful so that you can be heard. It's ok to agree to be rescued if something goes amiss while maintaining autonomy when the birth process is proceeding normally or near normal.

If your doctor or midwife disagrees with your request or birth plan its ok to ask them more about their  thoughts. Ask them if it's their personal opinion, medical finding or a recommendation from statistics rather than a medical finding of your specific situation.

Common questions to help you make an informed decision are:

  • What are the benefits?
  • What are the risks?
  • What are the alternatives, including waiting.
  • What if nothing is done for a while, or nothing different?
  • Is there any medical reason not to try something physiological first in a limited time frame

Of course, in my perspective, I'd like to try a physiological approach using techniques for balancing birth anatomy and positions for opening the pelvis if the issues are related to starting labor, strengthening labor or helping a long or painful labor progress.
When we pick a physiological approach we need to know safety limits (we need to rely on medical assessment and agree upon signs of infection, range of normal blood pressure or normal fetal heart rate, etc). We are often able to resolve a labor stall, for instance, without surgery, but would not attempt to do so if risk factors for mother or baby were severe.

And even as you agree to medical intervention, it's also ok to ask for the opportunity to try something you would like to include. Just as it's ok to sample the flavor of your labor and then accept a second surgery. It's just important to be ok with the process.

Finding determination within unknown elemental forces is the role of a ship's captain and a birthing person. Know what you are about. Set your course. Communicate it with your crew. Keep afloat. Keep fresh water and food available. The mast must be both strong and responsive and so must we.  Test the winds and don't hesitate to reset your sails. And let the stars guide you.

Spinning Babies member Alisa Blackwood offers these dynamic questions to assist your self reflection:

“What are the opposing forces in your life?" 
"What would you list as your uncertainties and your desires?"

Alisa guides us to Give voice to our vulnerabilities, rather than pushing them aside. By embracing our vulnerability we propose to find our inner strength as well as help us ask for the support of others to help us birth from our best selves.

Resolving Shoulder Dystocia in Europe

I just got to teach Resolving Shoulder Dystocia in Italy and in Amsterdam. The wisdom and experience of these midwife "students" is immense, humble, and inclusive to my perspective.

As midwives, we love to come together and learn from one another. Where else can midwives share insights and experiences unique to our experiences as midwives. This is particularly true about birth complications such as shoulder dystocia (baby's head is born but the shoulders remain stuck inside the pelvis). For those midwives who attend home births, we want to hear variations of experience and how other midwives "figured it out!"

Our fingers know that what they find is not always described in the medical literature. Learning from one another prepares us for the unique situations in which books can not contain.

Hear midwives stories and learn how to resolve five types of shoulder dystocia in Gail's video,

Changing the Earth by supporting Birth

Mothers bring forth life; medical corporations do not. Birth can be simple, powerful and loving. Fetal positioning, natural birthing and practical help for normal birth.