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According to Claudia

BOND/360

Claudia Booker is a doula, childbirth educator, breastfeeding counselor and homebirth midwife working in the Washington DC, Maryland, and Northern Virginia area. She has supported over 900 families and has been working in birth for over 12 years- So she has just a tad bit of wisdom on how to best support our birthing people (her website even has an “According to Claudia” section!) We thought we could learn a lot from her, so we sat down and chatted birth “According to Claudia.”

On the need for birth workers to provide culturally specific care:

I think it’s our responsibility [as birth workers] to let clients know of all their options and opportunities especially when it comes to cultural specificity- that culturally specific care is available.  For example, I’m an African American woman, been one all my life, born and raised in D.C.  I am not culturally specific to a Haitian woman.  She’s black.  I’m black.  She’s a woman.  I’m a woman.  But I am not specific to her culture.  She needs a doula and childbirth educator that are specific to her culture and to her lifestyle.  I don’t think the white birth community understands that. In all my practice I’ve never heard of a white midwife or doula say to an African American client, “I would love to work with you, but I need to let you know that in this community we have a wide variety of African American midwives and doulas…” I feel that not giving pregnant people full disclosure of all their resources is just like the stuff that doctors do.  How do they know they are making the best choice if they don’t have all the options?

Birth work is based on heart to heart; The client absolutely needs to find practitioners whose heart sings to her heart.  But we have to let our clients know of all of their opportunities and then hope that they still come back to work with us. I believe it’s our job [as birth workers] to take this on so that we can work to enable every group, culture, and society to have the best birth they can while we fight for universal change.

On how you empower your clients to be active participants and joint decision makers in their births: 

My clients and I spend a great deal of time going over how to best be joint decision makers (Because if you’re not driving the car, don’t be surprised where you end up), active participants (If you don’t understand say, “I don’t understand” and have them explain it until you do) and participate in full disclosure and informed consent (If you don’t understand, don’t say yes.)

To start, I always make sure that I am the right person to be working with that client because maybe there are doulas who are better at dealing with parents who are not interested in being active participants and joint decision makers in their births...Who can work with clients that say “I will never speak up. I’ll never ask a question.”  But that’s not me.

And parents need to start practicing before the birth.  You need to have conversations prenatally where you are counterpointing with your care providers so that you can get used to being in a position of power. Especially if you are working with a practice with nine million providers. You need to have this conversation with everybody so the providers get to know who you are, and you get to practice having a dialogue from a position of power with your clothes on.  It’s hard to start to have a conversation that has a power dynamic when you are sitting there with “the robe of disempowerment on”...The robe with your ass hanging out and your coochie almost showing.  It’s hard to stand up for yourself when you’re looking like that!  This is something that I really work on. 

And then I focus on ways to reinforce the messages that I am giving.  For example, I send all of my clients to this one yoga teacher because she’s reinforcing in her classes what they heard in their childbirth class and what they are going to hear from me.  They are getting the same message in like sixty different ways.  If they can’t hear it from me, or they can’t hear it from the childbirth education teacher, we’re going to keep saying this message until we find a way that really resonates with the client.

On the biggest challenges that come up while working in birth:

As a culture we have lost contact with what our bodies were meant to do and how they were meant to be because we focus our reality as women on what is presented to us in social and mass media. We wear tight jeans where we do get enough air in our bottoms and a nutrient deficient diet so we are getting yeasty.  We’re carrying huge $2,000 pocket books on our shoulders, which is causing our pelvis to tilt forward.  We’re absorbing xenoestrogens.  We’re not supporting our pelvic floor. Every year the shoe gets higher and higher tilting the spine... Our bodies were not designed for this and all of these things are external signs that we have decided are nomenclature for what a woman doesn’t look like, instead of taking any time to go back to the universal energy and recognition of our bodies, and how they function best.

And then there’s the fact that we’re all taking pills and people are choosing to focus on their careers so they are deciding to stop having periods altogether.  The internal biological and hormonal forces that we could have had our whole lives to adjust to, become attuned to, get to know, are being turned off.  We are not dealing with the internal pieces that respond to the universe, and to nature, and to who we really are because we have chemically turned off these systems. And it’s not always just turn it off, turn it back on. Because when we do decide we are ready for babies It takes the body some time to get back into rhythm.  And it may get back into rhythm, or it may not.  When we decide we all of a sudden want to be in tune with our bodies, it may feel like its not answering us. And then we start saying, Oh my god, my body’s not responding the way I want it to respond.  I can't trust my body.  My body’s failing me… But we haven’t been listening for the past however many decades! It may be answering us, but we don’t understand the language that it’s answering us with.  And even those who manage to conceive quickly, they have spent most of their adult life having no relationship with any part of their bodies except questions, doubts, and fears, and an overall idea that their bodies may fail them. 

And this is where we as birth workers meet them.  And it’s our job in what, 10 months? 8 months? 3 months? 3 weeks? to help them start relating differently.

My clientele that are gentrified come to me and say, Oh, I saw The Business of Being Born and I want a natural birth.  And so I talk about the birth preference plan at our very first visit becausewhat does “natural” mean? There’s no common definition. It’s like “free-range” “organic”.

I say, OK so what out of that movie do you want?  I make them really tell me what they are looking for. What kind of a birth they are prepared to work for.  Talking to them about who they really are and coming up with a birth vision that represents their lifestyle, their culture and their commitment. 

I always ask people, How do you handle pain? Frustration? Deadlines?  Because birth is the day all of those things come together at once.  If you were stressed, tired, hungry, your butt hurt, and you had to have your work in tomorrow, how would you proceed?  How would you handle yourself?  I have everybody talk about it.  I like them to write it down because it gives the couple a chance to really talk about it out loud and not just say, “Yeah Babe I really want what you want.” “ Well, no Babe I want whatever you want.” 

No.  What are you willing to bring to this party?  What are you bringing to the party?  What’s everybody bringing to the party? 

On the change you’d like to see for birthing people:

Respectful maternity care.  How do you get respectful maternity care? How do you get a medical system that will assist you and that will respect you?  I don’t yet think that we have made much progress on this, except for those who are lucky enough to have the finances to be real consumers. Also, there is this total lack of competence, lack of support and lack of access to accurate information.  There are families being sabotaged because they simply don’t have the correct information!  This isn’t okay.

We also need to figure out how to build pregnant people’s confidence that she can do it, help her to find peace, for her to appreciate the immense responsibility, the gift, of being someone’s mother.  I’m always saying to my clients, You’re already a parent.  You're just a parent with a baby inside.  You don’t need a stroller right now, but you are somebody’s parent. For everything you do, and everything you say, and everything you eat, and everything that goes on your child is watching you.  Let’s think of it that way- Think about this now.  There’s a kid who is absolutely relying on everything that you say and do now, not later, now.  If women are already thinking of themselves as mothers while pregnant, then they may start thinking about their choices a bit differently.

I would love to see women gathering more in small groups, intergenerational groups. I want people to talk and educate about menstruation in their homes.  Ask each other what these experiences are like. Create and foster dialogue from multiple perspectives and identities so that we can learn and share what it’s like to be a woman.  

Doulas and Nurses Collaborating at Cedars Sinai Hospital

BOND/360

Ana Paula Markel at Bini Birth

Ana Paula Markel at Bini Birth

At the end of September, BOBB Films Ash Spivak was invited to the 2016 Gathering of the Los Angeles Birth Community at Cedars-Sinai Hospital in Los Angeles; a collaboration between Cedars-Sinai staff and Ana Paula Markel of Bini Birth, to witness all of the change they have been able to implement by bringing together the doula and childbirth education world and the medical community.

Bini Birth is a staple of the LA birth community, and after Ash’s visit, it was immediately apparent why. The space is entirely unique both in aesthetics and in offerings. The building has stained glass windows, a grandiose staircase and chandelier- oh, and three whole floors (Which to a New Yorker like Ash was truly mind blowing).  Bini houses a yoga studio, home birth midwife, massage therapist, and psychotherapist office amongst other practitioners. Everything one can need in one place!

In addition to doula trainings, Bini offers a large variety of childbirth, new parent and newborn classes all with the emphasis on offering a variety of options (all from an evidence-based perspective) instead of promoting a specific method of parenting or childbirth. The message here is clear: There is no “right” way to birth or parent. The ultimate goal here is for parents to have a positive experience knowing that they are validated, supported and loved throughout the process.

For these reasons, you will often see medical professionals actually taking classes at Bini, and going to Bini for support. And this makes sense since collaborating with the medical community at large for enhanced maternal care is of extreme importance to Ana Paula. And she has really made some incredible strides on that front.

At the 2016 Gathering of the Los Angeles Birth Community. From Left to Right, Ana Paula Markel, Mykel LeCheminant, Hermine Hayes-Klein, JD. Below: Monica Lundry

At the 2016 Gathering of the Los Angeles Birth Community. From Left to Right, Ana Paula Markel, Mykel LeCheminant, Hermine Hayes-Klein, JD. Below: Monica Lundry

Ana Paula sits on two task forces at Cedars-Sinai helping to improve patient satisfaction and bringing her experiences as a doula and birth diplomat to the institution.

Some of the accomplishments of one of the task forces has been: skin-to-skin in the OR, creating birth plans for hospital patients with a doula's touch, aromatherapy in the hospital, and creation of a doula committee to address patient communication and quality of care.  This committee is called CDAC (Cedars Doula Advisory Committee) and allows for L and D nurses and doulas to report on what is occurring on the Labor and Delivery floor so that improvements and education can be provided when necessary.  In 2015 Ana Paula was hired to help improve Cedars-Sinai’s childbirth education curriculum and is now in full effect with new parenting and newborn care classes recently launched.

Wow, right?!

Ana Paula Markel with Abby and Ricki

Ana Paula Markel with Abby and Ricki

The theme of this years event was Shared Decision Making in Childbirth from Theory to Practice and was truly a celebration of all the they have accomplished together.The event was put together by Monica Lundry (an L and D nurse) and Ana Paula.  In addition to many staff members speaking on the importance of bettering maternal care, keynote speaker Hermine Hayes-Klein of Human Rights in Childbirth presented on our legal right to informed consent and refusal and how that can play out in the hospital system.

Even if Hermine’s presentation wasn’t as eye-opening and inspiring as it was (and oh man, it was!), simply the fact that this event was happening inside of a hospital and attended by doulas, L and D nurses, childbirth educators and OBs alike is a huge accomplishment in and of itself.

Ana Paula, along with former L and D manager Marle Shelton, Assistant Manager Mykel LeCheminant and Monica Lundry, some of the major players in this collaboration, have shown us that working together to provide cohesive, supportive, patient-centered care is both possible and fruitful. The system may not be perfect yet, but they are certainly onto something- something that hopefully soon, we can model at other hospitals across the country too.

First team of Ana Paula's nurses turned childbirth educators at Cedars Sinai. Mykel LeCheminant, first from the Left. Monica Lundry first from the Right.

First team of Ana Paula's nurses turned childbirth educators at Cedars Sinai. Mykel LeCheminant, first from the Left. Monica Lundry first from the Right.

We Went Back to The Farm!

BOND/360

It's been a while since we've been to The Farm in Summertown, TN but BOBB Films' Ash Spivak recently stopped by to chat with Farm midwife Deborah Flowers about all of their going-ons and recent successes.   

Entrance to The Farm

Entrance to The Farm

The Farm has really become a staple of the greater birth community, not only as a safe haven that honors and supports normal physiological birth, but as one that is willing to learn from and collaborate with the medical community at large so that birthing women can receive the best possible care. For example, a new policy was recently passed that requires an oxygen saturation test be performed at the time of the newborn screening to help prevent against congenital heart disease. In the past, newborn screenings were performed by the midwives, but the saturation tests were not.  So, local doctors actually invited the midwives to attend hospital trainings so that they were able to perform this test at The Farm. Additionally, The Farm receives infant resuscitation trainings from a local nurse, who also started an Angel Ambulance (like a NICU on wheels) that would come to The Farm (and other outlying areas) in the rare case a baby was in need so she could be treated while en route to the nearest hospital.  And, to even better build relations and trust, Deborah shared that she will sometimes go with a client to her doctor's appointment so that she can meet him or her face to face.  At times she'll even bring her resume to show them her license, experience, training and expertise. 

Exam room at The Farm Clinic

Exam room at The Farm Clinic

The midwives at The Farm have been instrumental in changing birth policies in their community and beyond. CPMs (Certified Professional Midwives) are now legally able to practice with licensure in Tennessee thanks in large part to Midwife Carol Nelson. (In some states only CNMs, Certified Nurse Midwifes, can practice.) Last year, they hosted a group of doctors, nurses and midwives from Alabama (where CPMs can't legally practice) so that they could learn more about how legalized midwifery works and to create a greater conversation and collaboration around working together.  And, at a nearby hospital, the midwives recently helped to make small doses of Pitocin available for VBAC patients. 

Ash Spivak and midwife Deborah Flowers

Ash Spivak and midwife Deborah Flowers

So, it's no wonder that women are still coming from all over the world to birth at The Farm.  Most recently, two women from Turkey come to give birth. One came because her doctor in Istanbul had a 90% cesarean rate and promised her she'd never be able to give birth vaginally because her baby was too big according to the ultrasound (She gave birth vaginally just fine and the baby weighed only 6lb 14 oz). They also had a woman from Senegal come (she came for all three of her babies) because at her very first prenatal her doctor told her she was going to need surgery.  She too gave birth vaginally.

Birthing room at The Farm

Birthing room at The Farm

So what's next for The Farm? Training more midwives!  In collaboration with The College of Traditional Midwifery, they have just launched a Competency Based Midwifery Education Program for aspiring midwives who want to become Certified Professional Midwives. Their first class of students started this month!

Want to learn more? Visit their site and check out this article about when the folks from Alabama came to visit.

And, don't forget to rent our past interview with Ina May Gaskin, the founder of The Farm!

Mural inside one of the birthing houses at The Farm

Mural inside one of the birthing houses at The Farm

An interview with Ashley Williams

BOND/360

You might recognize Ashley Williams from How I Met Your Mother and The Jim Gaffigan Show, but did you know she is also a doula and a mom who birthed her baby on her living room floor?!  We got to chatting with Ashley about how birth work has influenced her acting career as well as how it has colored her overall life perspective.

What made you become a doula?
I ended up being in town when my sister went into labor with her first child. She requested a “walking epidural,” and the nurse said they didn’t exist. I spoke up on her behalf and was removed from the room. She actually ended up having an amazing birth but I was angry. I told my husband I would never have a baby. He was actually the one that suggested we use a doula!  I read up on them and thought, “I actually think I could be really good at this.” I did the training, put in my time, and it’s the most fulfilling work I’ve ever done.  

What does the role of ‘doula’ mean to you?
We provide women and their partners with physical, emotional, and informational support prenatally, in labor, and postpartum. To me, that means providing options and empowering parents to make informed decisions, and helping them execute those decisions. I love the word ‘Ambassador.’ That word rings very true for me.  

What have you learned from your doula work that you apply to your acting work?
The root of doula work is all about empathy. I imagine myself in her place—If I were her, feeling pain where she does, what would I want? I listen to what she says as if it were research on cracking a character—what is she most scared of? I take into consideration her history, her hopes, the same way I do with a character. I’ve become a much better listener as an actress since becoming a doula.  

What have you learned from your acting work that you apply to your doula work?
Doula work is extremely rigorous, physically. As an actor my body has been put to the test – I once worked a 19-hour day with only one 30-minute break for lunch. BUT that is nothing compared to, say, an induction. It’s expected for me to be on my feet for a solid 24 hours, or even more, during an induction without so much as one bathroom break. I’m not exaggerating. My acting career taught me how to dig in and get lost in the work so I don’t feel fatigue or heat or hunger. It’s also taught me that once the birth is over, I need to let it go. I’ve still not perfected that… truthfully I usually have an enormous cheeseburger and cry in the car after a birth. Then I sleep for 12 hours. Actually I do all that after an acting job too…. I’m working on it!

What have you learned from the process of labor/birth that you find yourself applying to your own life regularly?
I continue to be inspired by the strength of women. Women are my heroes. I have stared into the eyes of women at their edge and have discovered the most fearless, resilient, patient, persistent, warriors who fight even at their most fearful and dark moments. I am honored to be a woman and don’t take my own power for granted.   

Does being around birth make you feel differently about your own body?
I think my doula work and research has taught me to trust my body. It knows what it’s doing, more so in pregnancy, labor and postpartum than almost anything else, I think. It’s rare to need procedures or medication when it comes to procreation. That idea really put me at ease throughout my pregnancy and birth.

What was your birth like?
It was awesome. We had a planned homebirth and I pushed my baby out on the living room floor. I remember several days afterwards saying to my midwives that I was actually a tough case for them because I may have said I was open to a transfer, but I actually would have been really upset about it. Luckily everything went beautifully.  For my next pregnancy I think I’m more open to going with the flow. I mean… I hope.

What was your process of deciding where and with whom to give birth?
The truth is I have a lot of fear when it comes to hospitals. I knew that feeling safe is paramount to labor progression, and I couldn’t imagine myself relaxing in a hospital.  We also lived so close to the best hospital in Los Angeles and I could have been there in less than five minutes in an emergency, which was a huge factor.  I trusted my midwives, Beth Cannon and Laura Monroe Burnett, implicitly and I am in awe of their expertise. They taught me so much about myself and I am forever changed by their guidance.  A home birth, surrounded by a team of my own choosing and on my own turf, was the only choice for me at the time.  

We would love to hear about your experience working on The Jim Gaffigan Show. We know Jeannie (the character you play) really had five home births with Cara, the midwife featured on The Business of Being born. How funny?!
Working on this show, at this time in my life, is a dream come true.  I was actually pregnant when we shot the pilot and every day thinking, “Please, please, please let this go.”  Miracle of miracles, it did.  There’s a killer playroom and Gus comes to work with me and plays with all the kid actors.  He’s in heaven.  AND it means that in between setups I can run up to the playroom and hang with everyone till they’re ready for me.  I knew no one in New York for prenatal care but Abby Epstein and Jeannie recommended Cara so she was my midwife until I got back home to LA.  I LOVE HER.  If I’m lucky enough to get pregnant again in the future at some point, I’d love to have her on my team now that I live in New York.