ChicagoDoula

Who Is ChicagoDoula?

Rachel Dolan Wickersham — Fri, 04 Jun 2010 06:31:38 +0000

So Amy is trying to get me to blog. I have to say, I have never considered this and am not so sure how good I’ll be at this. I’m only here because she has the smarts and the drive to get us both here. Maybe I can start by giving you the back story. For the past 15 years, I’ve practiced as a childbirth educator, doula, doula trainer and occasional midwife’s assistant. I’ve used the web since the beginning and have always used the screen name identity “ChicagoDoula.” But as the web developed, I remained a very basic user – email, the occasional instant message, web-browsing.

I always thought I should make more of it. I even took a website design class. I created a draft version of a very pretty website. And it sat there on my computer for years. I had no idea how to get it published. Two years ago I finally figured out that I needed to purchase a domain name. So I did. But that sat there too. When Facebook came along, I figured it out to some degree, though I only have personal pages – no business page.

Then along came Amy, a new doula on the block, with some really neat ideas. She hoped to develop a website and call it ChicagoDoula.net. I agreed to this because after all, though I’d been using the name for years, I did not yet have a website and thought I would never get around to it. Amy began building the site and after a time we realized it was something we could work on together. We began to think of ChicagoDoula as a concept rather than a specific person and several months later, here we are.

Who is ChicagoDoula? She is a little bit of everything, just like the city she serves. She is an activist, a doula, a mother, a midwife (of babies or ideas or communities), a mentor and a student. She is experienced and wise, yet she is fresh and enthusiastic and full of new ideas. She is knowledgeable about a variety of childbirth preparation techniques and is comfortable working with them. She believes that life is precious and she also believes in a woman’s right to make a full range of decisions about her reproductive health care – whether that means choosing to terminate a pregnancy, choosing an epidural for labor, or choosing a homebirth with an underground midwife. She strives to help women understand the full implications of their choices and help them find their innate power, so their choices are not driven by fear. She understands that there is no single right answer for any given situation. She is willing to support women in whatever choice is right for them.

ChicagoDoula loves her city and the people in it. She joyfully serves families from all walks of life. She is ever-hopeful with a strong vein of cynical, anti-racist, queer-friendly, working on recognizing her privileges as well as her own internalized oppression, challenging others and herself to see and understand things differently. When faced with obstacles, she looks for creative solutions rather than struggling to achieve particular outcomes.

She envisions a world where all women get the support they need across the spectrum of pregnancy, labor, birth and parenting – a world where every woman in every community has access to the information and support she wants and needs so that she can be affirmed in her choices.

She envisions a world where women are respected, safe, honored and empowered.

In short, ChicagoDoula is many things. We invite you to get to know her, us, as we continue posting here and continue building our websites.

Thirty Years Too Long

Rachel Dolan Wickersham — Fri, 26 Mar 2010 19:37:07 +0000

Journalist Amanda Robert’s story highlighting the homebirth situation in Illinois, says it all in the tag line: “Thirty years later, Illinois midwives fight for birth rights.”

For 30 years the state of Illinois has been aware that some 800 – 1000 Illinois women per year choose home birth and choose the care of a midwife especially trained to attend home deliveries - a direct-entry midwife (entering the profession directly rather than through nursing – sometimes also called lay midwife).

Thirty years ago midwives and families lobbied the state to license such midwives and were turned down. Every so many years they went back and were turned down again. Yet home birth persisted. It did not go away.

Since the year 2000, home birth and midwifery advocates have gone to Springfield for every session under the banner of the Coalition for Illinois Midwifery. As the Coalition, we’ve developed the language of the licensing bill to reflect the standards of the time. Instead of talking about lay midwives we are talking about CPMs (Certified Professional Midwives) – women (or men) with years of training, who have passed a national exam administered by a credentialing organization that is accredited by the very same organization that accredits the nurse-midwives organization.

We’ve gained the support of the Illinois Public Health Association, the Illinois Society of Advanced Practice Nurses, the Illinois Maternal Child Health Coalition, and even the AFL-CIO. And most importantly, we’ve set the highest level of educational requirements for state licensure of CPMs in the nation.

House Bill 226, the Home Birth Safety Act, is currently is gaining momentum in the Illinois House.

Home Birth STILL persists and rates are climbing –increasing 5% from 1990 to 2006, according to the CDC. It is time for our state legislature to take action and finally license and regulate the midwives who are out there attending it. Thirty years is a long time to stay underground.

Birth Story of a Doula’s Doula

Amy Catania — Fri, 26 Mar 2010 16:00:51 +0000

Holly Barhamand is a mother, doula and childbirth educator in Chicago and is also one of my real life, everyday heroines. Holly was one of the doulas at my labor with my second baby and has since become a wonderful mentor and friend.

Whenever I need to work something out about teaching childbirth classes or have a complicated labor to get pointers on, she is eager to listen and help – and always seems to have the right thing to say.

This week Holly gave birth! Oh and did I mention that she is a fantastic writer? I love a good birth story and am delighted to pass this one on.

Congratulations on welcoming your newest baby, Franklin Darius, into the world, Holly! And thank you for sharing your incredible story. Much love and light to you.

Postpartum Support Just Got a Little More Organized

Amy Catania — Tue, 23 Feb 2010 21:09:46 +0000

I am excited about this new tool making it a bit easier to get and give postpartum help. If you are about to have a baby (or know someone who is), check out this new organizational tool called meal Train. According to co-founders, Michael and Kathleen Laramee, it’s aim is to simplify the process of receiving and giving meals after the baby arrives.

I have been both an organizer and a recipient of postpartum meals and I know what a daunting task it can be. Yet, the payoff is always worth it. The parent advocate and community organizer in me LOVES this idea and I am looking forward to seeing how it works for new parents and communities.

Upcoming Events

Amy Catania — Wed, 17 Feb 2010 23:39:37 +0000

Saturday February 20, 2010

BirthNetwork Chicago presents a film screening of two short documentaries: Laboring Under and Illusion: Mass Media Childbirth vs. The Real Thing and It’s My Body, My Baby, My Birth.

2:45 pm – 6:00 pm at Mother Me, 3717 N Ravenswood Suite 213 Chicago, IL Directions and Map

Following the films, all are invited to stay for discussion with panelists including Jennifer Gagnon, homebirth CNM with A Woman’s Place, Sherri Reurup, CNM and director of Swedish Covenant Hospital’s Midwifery Group.

The event is free, and if you are able a suggested donation of $10 is welcome.

For more information email birthnetworkchicago@gmail.com

Sunday February 21, 2010

ICAN of the South Suburbs – The February Meeting

This month’s topic is Childbirth Education Choices. Hear from local childbirth educators in Bradley Method, Birthing From Within (presented by your’s truly!) and HypnoBirthing.

There will also be a presentation on the potential benefits of chiropractic care during pregnancy, including Webster technique.

Health on Earth Wellness Center

7711 W 159th St. Suite 102 Tinley Park, IL View Map

Sunday February 21, 2010 from 2-4 pm

The event is free.

Wednesday March 10, 2010

Film Screening and Panel Discussion: The Chicago Maternity Center Story

6-8 pm UIC School of Public Health Auditorium Room 109 1603 W Taylor Street Chicago, IL View Map

Panelists:
• Sabina Dambrauskas, Chairperson, American College of Nurse- Midwives, Illinois Chapter
• Stacie E. Geller, PhD, G. William Arends Professor in Obstetrics and Gynecology and Director, Center for Research on Women and Gender & National Center of Excellence in Women’s Health, UIC
• Suzanne Davenport, filmmaker, “The Chicago Maternity Center Story”

Chicago Maternity Center provided safe home deliveries for mothers including one woman followed in the film. Funding from Northwestern University declined and the center was closed. This film portrays the history of the center and the center’s fight to stay open.

Co-Sponsored by:
Chicago Community Midwives
American College of Nurse Midwives
Women and Children First Bookstore
UIC School of Public Health

Accessible entrance: Rear door to Auditorium
CTA: Pink line Polk Street stop
Parking: On the street and in the Paulina Street parking structure

For more information, please contact Jaime Klaus at 312-996-0724 or jaimkl@uic.edu

This event is free and open to the public.

CNMs, CPMs and DEMs…Oh My!

Rachel Dolan Wickersham — Tue, 26 Jan 2010 06:36:20 +0000

Note: This is a first post by doula extraordinaire, midwife-in-training and legislative advocate, Rachel Dolan Wickersham. Amy and Rachel are thrilled to begin our work as a team to bring ChicagoDoula to you in its new format as a collaborative birth blog. Enjoy!

I’ve had a lot of requests for a basic primer on the different types of midwives available to home and hospital birth mothers and families. Generally, everyone understands that midwives have a more holistic approach than MDs, spend more time with their clients, and get better outcomes for both mother and baby. However when it comes to figuring out which type of midwife is best for a given situation, the devil is in the details. Here is my best shot at sorting out who’s who.

CNMs and CMs (Certified Nurse-Midwives and Certified Midwives)

CNMs receive a degree in nursing and then go on to get a master’s degree in midwifery in most cases. There are a number of CNMs who have a bachelor’s in nursing and a certificate in midwifery, rather than a master’s, but basically, it’s nursing plus midwifery training. Starting in 2010, a graduate degree will be required for all CNMs and CMs.

CMs receive midwifery training alongside CNMs. They are part of the same program, however before the midwifery training they do not receive an RN. They do however, have to receive a bachelor’s before the midwifery training because they will be receiving a master’s in midwifery. Those who already have a master’s degree in a related field, may earn a certificate.

Both CNMs and CMs sit the same midwifery exam to receive their credential. The exam is administered by the AMCB – American Midwifery Certification Board. One is not required to prove out-of-hospital experience in order to sit the exam or receive a CNM or CM credential.

CNMs can practice in all 50 states. CMs can practice in 3 states – New York, New Jersey and Rhode Island. The vast majority of CNMs- or CMs-attended births occur in hospital settings. Less than 5% are outside of the hospital in homes or free-standing birth centers.

DEMs and CPMs

DEMs are direct-entry midwives - midwives who do not enter the profession through nursing. They learn through a variety of pathways. Possibilities include but are not limited to formal midwifery schools such as Seattle School of Midwifery, exclusive apprenticeship, or a combination of the two. These midwives may or may not use the same textbooks as CNMs and CMs. They may or may not be legal within their state. They do not carry a national certification unless they choose to become a CPM (see below). They may or may not have education equivalent to that of a CNM/CM. Whereas the CNM/CM proves her entry-level competence by passing the AMCB exam and earning her CNM/CM credential, the DEM who does not become a CPM has no such designation.

It is up to the consumer to discern their DEM’s level of education and expertise through asking questions, contacting references, and examining any evidence their DEM provides (such as certificates of training in neonatal resuscitation, etc). In some states, licensure is offered to DEMs who meet certain requirements. Often, but not always, the requirement is to earn a CPM (certified professional midwife) credential.

Some DEMs wish to prove their competence by meeting certain criteria and then sitting a national exam. These DEMs become CPMs (certified professional midwives). They may still receive their education through a variety of routes, (see DEMs above) but it is almost guaranteed that they will learn from the same textbooks as CNMs and CMs because the national certification exam draws questions from materials in these textbooks.

The national certification exam for CPMs is administered by NARM (North American Registry of Midwives). NARM’s exam tests for the same body of midwifery knowledge as the AMCB’s exam. It does not test for advance practice nursing skills and knowledge (such as knowing how to calculate and prescribe narcotics doses for pain relief in a hospital birth) because CPMs are not nurses and are intentionally, out-of-hospital providers. In addition to passing the exam, in order to receive a CPM credential, the applicant must prove documented out-of-hospital experience (something CNMs and CMs do not need to do).

CPMs are legally allowed in 26 states and are selectively ignored in other states. Only 11 states actively ban them. In some states they even get Medicaid reimbursement, as can CNMs.

CNMs, CMs and CPMs have all earned certificates demonstrating competence in midwifery. Consumers should be able to verify proof of their certification. In the case of CNMs in all 50 states and CPMs in some of the 26 legal states, one can verify their state licensure. Where licensure is not available, it is up to the consumer to ascertain proof of education. To see a list of legal states for DEMs and CPMs, go to www.mana.org and click on the resources tab.

Illinois

Since I live in Illinois, I can comment on our situation here.

In Illinois we have no CMs. We have many CNMs. Most practice in hospitals. At this writing, there are no free-standing birth centers for them to practice in, though a law establishing a pilot project of such centers passed in 2007.

Five nurse-midwifery practices offer homebirth services in the Chicago area. Two practices offer homebirth services downstate. Altogether, these practices are based in only 5 out of 102 Illinois counties.

Currently in Illinois, DEMs of all kinds, including CPMs, are illegal but there is a bill before the Illinois House for licensure of DEMs requiring the CPM credential as proof of competence. Licensure would also require an associate’s degree with specific science-based coursework in addition to the CPM.

There are DEMs all over the state of Illinois. Some are in the open. Some are underground. Here in the Chicago area, we have only a few CPMs.

CPMs are legal in some neighboring states (Wisconsin and Missouri). They are generally allowed/ignored in Michigan. Iowa and Indiana are working on licensure for CPMs, as is Illinois.

For more information on Illinois Licensure, go to www.illinoismidwifery.org
For more information on CPM licensure nationally, go to www.thebigpushformidwives.org

Birth Day Appreciations

Amy Catania — Sat, 23 Jan 2010 17:12:48 +0000

I came home late tonight to a quiet house after spending the last 26+ hours providing labor support. Partner and kids are already tucked in bed for the night – so my birthday has passed by here for my family without me. And I am kind of sad about that. We will have to make it up later.

But instead!… Instead, I got to spend it doing something I love! Something that is truly an honor. And I was rewarded by witnessing the birth of a completely posterior (and asynclitic!) baby. For those of you who don’t speak “Obstetric”, that can be a very tough birth and frequently results in a cesarean rather than vaginal delivery. Anyway – it was simply a miracle. I do love my job.

And now I am enjoying one of my favorite meals after a long day (and night) of doula work: Thai food (Panang noodles that were waiting for me in the fridge) and a dirty gin martini.

But the especially cool thing is that along with it, I got to read through so many birthday wishes from such a fantastic group of people. I got a little weepy (either the sleep deprivation or the gin or both) and thought I’d write a bit just to say: “Thank You!!” I am so glad I get to stay connected with each and every one of you.

I feel very blessed this January 23rd.

…And in case you want to know more about preventing posterior positioning – or ways to try turning a baby who’s already there. Check out spinningbabies.com!

Why a Doula is Better Than Your Best Friend

Amy Catania — Mon, 23 Nov 2009 09:20:55 +0000

When we are pregnant, most women “know” on some more or less abstract level that this will eventually end with a birth. Chances are good that around 30 weeks or so, the thought that you will actually have to go through this birth yourself and that you will have to open and push this baby out of your body becomes clear in a much less abstract way. This is when many expectant parents begin to more seriously prepare and gather their resources and support people around them, including making a plan for how they would like birth to go, who will be there and what their roles will be.

In my first pregnancy, this part of my preparation included taking a Birthing From Within class, chatting with my midwives about when they would be there and asking my best friend if she would come as well. I never considered hiring a doula because, in addition to my partner and my best friend, I had not one or two, but three midwives. I figured I’d be set for support. I learned through first hand experience why, even with five loving, supportive people in the room, that a doula to offer continuous labor support might have been a good idea.

A doula is someone who is knowledgeable about normal birth and familiar with possible medical interventions in a way that most family and friends are not. She gets to know you and your desires before birth so that she can better help you when you are in the thick of it. In labor she can be a buffer or bridge depending on the need. She can translate from “obstetric” language to everyday language in the event that parents misinterpret doctors, nurses or midwives.

On the day of your baby’s birth your doula is someone who will remain with you continuously and whose role is unique. She is someone who will not be having a baby that day (or grandchild, niece or nephew). She won’t be watching a loved one in pain and isn’t likely to be overwhelmed by the resulting combination of high running emotions and exhaustion common for laboring parents. She is someone who will be on-call for you, get to know you, who will accompany you through the whole process and who will not be attending dozens of other births that week or that month.

Even if your midwife or doctor can be on call for you, your doula will be there to attend to your emotional and spiritual well being in a way that your midwife or doctor simply will not.

The beauty of continuous labor support from a doula is that it can look however a laboring mother needs it to look. For one woman this might mean a constant companion there to hold her hand and speak words of encouragement and reassurance through each contraction, then wipe the sweat from her brow, and stroke her hair in between… and for another it might mean a trusted presence knitting in the next room, holding the space, listening and keeping watch, at the ready if needed, but out of sight and earshot in order for this woman to have the privacy she needs to birth in her own body. Both are forms of continuous support. For many mothers, the support they instinctively want and need shifts through the course of labor depending on where they are and what else is happening around them and, ultimately, may include a combination of a little bit of both of these ends of the spectrum.

For yet another woman, the term continuous labor support could mean having a person there solely for the purpose of backing up her husband or partner – offering reassurance, water, and suggestions to her partner as he or she stays physically and emotionally in contact with the mother. Sometimes a team approach works best and a partner can remain in front of a laboring mother maintaining eye contact, while a doula provides massage and counter pressure on her back or hips from behind her. It’s the mother’s facial expressions, body language or directly spoken requests that tell her doula what support she needs in any given moment.

On the day your baby is born, your doula will most likely be the one and only person in the room in that in between space who can understand what is happening from multiple perspectives. She will work to get to know you to get a sense of who you are emotionally and spiritually as well as what fears and hopes you have for your labor, birth and postpartum period.

A doula is also familiar with terms of midwifery and obstetrics. She knows her way around a labor and delivery room and can be trusted to explain medical terms or proposed procedures. Yet she isn’t a part of the medical staff and influenced by the powerful force of a hospital’s or particular practice’s work routines and day-to-day rhythms and expectations for birth. Most importantly, she is someone who is comfortable with and knows birth and knows the value and benefits of the unique kind of continuous labor support she offers.

Midwives and doctors must focus on fetal and maternal health and safety and may not be able or inclined to consistently attend to a mother’s emotional needs – especially if she wants more support early on before “active labor” has begun.

Friends who offer loving support but are unfamiliar with or at all wary of birth, can miss how important it is that support begin early in labor and be continuous. They can also be unprepared to help parents make difficult decisions along the way – during active labor and pushing as well as in the immediate postpartum period.

And partners who remain present throughout with no one else to back them up can get exhausted or emotionally overwhelmed.

Each of these possibilities were in fact realities in my first labor and birth. It seemed fitting then, that at my second birth, in addition to loving family and friends, I had not one, but two doulas (and just one midwife). My doulas offered me what I now understand was the invaluable benefit of continuous labor support.

Local Cesarean Rates Vary Widely by Hospital

Amy Catania — Fri, 06 Nov 2009 07:37:57 +0000

In my birth preparation classes I often discuss the concept of “entrainment“, or the phenomenon that takes place when two forces influence each other so that, over time, they move in the same way or with the same rhythm. When one force is stronger it more easily pulls the smaller force in line with itself.

One of the ways this can happen at birth is in the way that the attitudes and beliefs of all who attend may influence the decisions parents make “in the heat of the moment”, as well as influencing the final outcome. Even when parents have an express desire to birth a certain way, and truly believe in this as the “right way” for them, if the collective force of all those present at the labor (including doctors, midwives, residents, and the nurses in triage, labor and delivery, and the nursery) differs with this belief, it may well steer parents in a different direction than they planned to go before labor began.

The overall birth culture in a hospital should be at the top of the list when considering whether the forces that will be “entraining” your labor are in line with your own beliefs and attitudes about birth. One indicator of (and influence on) the birth culture and routines in any given hospital is the rate of cesarean births that take place there.

The types of labors and births that are more commonplace (e.g., unmedicated labors, induced labors, labors with epidurals, and cesarean births) can impact the way that hospital staff is inclined to view normal birth and may lead parents to want to ask more questions to find out if the hospital and the care providers there feel like a good fit.

Here is recent coverage from the Chicago Tribune that includes a link to data reported to the Illinois Department of Public Health for Illinois hospitals in 2008. The report cited in the link provides a range of information, including the total number of births and the number of cesareans for each facility in the state. It is a good starting place for finding out more about a hospital you or someone you know may be interested in for giving birth.

A Labor and Birth Story

Amy Catania — Mon, 21 Sep 2009 17:55:28 +0000

I have been a reader of the extremely popular dooce.com since I was pregnant for the first time six years ago. A coworker suggested the site to me during my first trimester because of my ever-so-regular complaining and sharing of entirely too much information. She thought I would like the blog not just because the author, Heather B. Armstrong, was also pregnant for the first time, about 3 months ahead of me, but because she had a delightfully candid and deeply funny take on the joys of pregnancy. And I do use “joys” loosely.

While I approached so many aspects of birth and first time parenthood very differently than dooce (I had a home birth, she had a hospital birth. I used Pantley, she used Ferber…), I never let that stop me from reading. So much of what she was going through in pregnancy and postpartum reflected my own reality – and as it turned out, that of thousands of other women. In fact, speaking of tmi, when I was working full time and away from my baby during the day, I reserved my breastmilk pumping time for reading dooce. Her touching stories of her own postpartum struggles – and plentiful, gorgeous pictures of her baby girl – increased my let down!

I checked in on her daily and was grateful for her willingness to share her life with millions of strangers. When she was hospitalized with Postpartum Depression I remember telling a good friend how shaken I was because I saw so much of myself in her writing.

Fast forward several years, I had a second child, was working on becoming a doula and birth mentor, and was still reading dooce as she got pregnant again, suffered a miscarriage, and then happily carried her next pregnancy to term.

In her first labor story five years earlier, she’d had several “standard” medical interventions beginning with Pitocin to augment her labor, an eventual epidural and an episiotomy as her baby was crowning. I wondered and looked forward to seeing how her story would unfold the second time around.

So when she finally wrote it- in three installments – I was absolutely delighted that attending another mama’s birth, hiring a doula and reading Birthing From Within were part of her story! It was dooce at her best: hysterically funny, heartfelt, grounded – and open to an amazing transformation. Labor and birth stories can have so much power and I am thrilled that I can share this one with you:

Part I

Part II

Part III