Summary: Results of a recent study to better understand modifiable factors such as physical activity that may affect a woman’s ability to conceive a child suggest that walking may help women to improve their chances of becoming pregnant.
Results of a recent study to better understand modifiable factors such as physical activity that may affect a woman’s ability to conceive a child suggest that walking may help women to improve their chances of becoming pregnant.
The study was conducted by recent graduate Lindsey Russo and her advisor Brian Whitcomb, associate professor of biostatistics and epidemiology in the School of Public Health and Health Sciences at the University of Massachusetts Amherst.
Russo and Whitcomb’s findings among healthy women ages 18 to 40 years old with a history of one or two pregnancy losses are based on their secondary analysis of the multi-site Effects of Aspirin in Gestation and Reproduction (EAGeR) study. It is led by Enrique Schisterman of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Results are in the current online issue of Human Reproduction.
Russo says, “One of our main findings is that there was no overall relationship between most types of physical activity and the likelihood of becoming pregnant for women who had already had one or two pregnancy losses, except for walking, which was associated with higher likelihood of becoming pregnant among women who were overweight or obese.”
Whitcomb, whose research on the determinants of fertility and pregnancy outcomes usually involves studying biomarkers at the molecular level, adds, “Lifestyle is definitely relevant to these outcomes because it can have an effect at the molecular level. What we eat and what we do are potential factors we can change to shape our health. So this sort of research is important because it helps provide information on the things people can actually do something about.”
Further, he says, “We were happy to be able to add scientific evidence to general recommendations about physical activity. This is especially true for the results about walking for even limited blocks of time. Walking has great potential as a lifestyle change because of its low cost and availability.”
For the 1,214 women in the study, the association of walking with the ability to become pregnant, known as fecundability, varied significantly by body mass index, the authors report. Among overweight/obese women, walking at least 10 minutes at a time was associated with improvement in fecundability. Further, in statistically adjusted models, women reporting more than four hours a week of vigorous activity had significantly higher pregnancy chances compared to no vigorous activity.
Moderate activity, sitting and other activity categories were not associated with fecundability overall or in BMI-stratified analyses, they add. Russo and Whitcomb say one finding that is still not clear is the different associations related to vigorous compared to moderate and low-intensity activities. Whitcomb says, “We don’t know what to make of the finding that high intensity physical activity may have different biological effects than walking, but our study doesn’t offer enough detail to get at why vigorous activity would work differently than other levels.”
Among a number of cautions the researchers point to in this work is that physical activity is related to other behaviors and lifestyle factors, and women who are more physically active may be different from women who are less active in many ways. Russo says, “We did our best to try to account for the differences and to address them statistically.”
The researchers also note that the overall generalizability of this work is limited because the study population may not be representative of the general population with regard to fecundability, and exercise habits may differ in women with prior miscarriage compared to those without.
Whitcomb says another way in which this study is distinct from other work in this area has to do with who was included in the study. The EAGeR trial focused on women with a history of one or two prior pregnancy losses. However, he adds, “We were happy to be able to conduct research considering women having the most difficulty getting and staying pregnant, and to provide messages about common lifestyle factors they may be able to address.”
The researchers conclude that “these findings provide positive evidence for the benefits of physical activity in women attempting pregnancy, especially for walking among those with higher BMI. Further study is necessary to clarify possible mechanisms through which walking and vigorous activity might affect time-to-pregnancy.”
Maryland Governor Larry Hogan (R) is expected to sign a bill Tuesday that will license direct-entry midwives and make it legal for them to attend to home births.
Maryland Gov. Larry Hogan (R) is expected to sign a bill Tuesday that will license direct-entry midwives and make it legal for them to attend to home births.
Maryland was one of six states that forbid midwives from helping mothers give birth at home unless the midwife is a nurse. Advocates have pushed for legislation to change this law for many years, but opposition from medical groups and concerns about safety had prevented it from gaining traction in the state’s Democratic-majority legislature.
Around the country, the number of births that take place outside of a hospital setting spiked by 60 percent between 2004 and 2012, according to the Centers for Disease Control and Prevention (CDC). Currently, somewhere between 1 and 1.5 percent of all Maryland births occur out of the hospital.
Proponents of changing the state’s law argued that these women and the midwives that help them have few legal protections. They believe that changing the law to allow for licensed certified midwives—as 28 other states have done—could enhance safety through education and regulation and give everyone involved legal protection.
Groups representing doctors, nurse-midwives, and nurses had previously opposed similar laws, as had the state’s health department, but the bill introduced this year included compromises on many issues that had been at the center of legislative disagreement. The bill set specific education requirements for certified midwives, noted which health conditions precluded home birth, and explained when and how midwives would transfer care to another medical professional if they encountered problems during delivery.
The sticking point this year was related to what is known as vaginal birth after cesarean section, or VBAC deliveries. It used to be settled science that once a woman had a c-section section, all future births would be by c-section to reduce the risk of uterine tearing.
New surgical procedures, however, have made this risk much lower and allowed some women to have a vaginal delivery with their next pregnancy or pregnancies. Fear remains that VBACs are more dangerous and many in the medical profession are against VBACs attempted outside of a hospital.
Pam Kasemeyer, a lobbyist for the Maryland State Medical Society and other physicians groups, told the Baltimore Sunin April that VBAC was “the one remaining very contentious issue.”
“We understand that women are going to make that choice and deliver at home, and that’s their right,” she said, adding that medical groups weren’t going to agree to the bill unless VBACs were excluded.
To get the bill to move forward, both sides agreed that VBACs would be prohibited for now. But the bill requires a committee to report on the safety of such deliveries and leaves open the possibility that the law could change.
Delegate Ariana Kelly (D-Montgomery County), who sponsored the bill in the house, was not surprised by the contention. She told the Baltimore Sun: “Medical licensing bills are brutal. They’re turf wars.” Once the last compromise was reached, however, the bill, HB-9, was passed unanimously by both the house and the senate.
Birth has become dangerously medicalized for them.
Aboriginal or indigenous midwifery is seeing a resurgence as conventional health-care policies in hospital and clinics perpetuate an environment in which most contemporary pregnant Native women are considered pathologically unhealthy.
“The mainstream medical narratives surrounding Native women depict moms who don’t breastfeed and don’t have partners. According to this portrayal, Native women don’t exercise, eat poorly, and have diabetes. We are seen as hopeless,” said Marinah Farrell, an indigenous Chicana certified professional midwife based in Phoenix.
“When I worked in the hospital, I saw so many Native mothers who would hemorrhage and have terrible outcomes during their births. It seemed so abusive; they were treated like they were sick already when they entered the hospital doors,” said Rebekah Dunlap, a member of the Fond du Lac Band of Ojibwe who works as a doula and is a registered nurse, bachelor of science nurse, and public health nurse in Minnesota.
What began quietly as the efforts of a few dedicated women has in recent years grown in size, scope, and agility. Today, Native women across the United States and Canada are putting their skills to work in challenging the status quo of mainstream medicine.
Birth has become dangerously medicalized for them. Cut off from traditional diets, support networks, and community midwives due to colonization and assimilation, many Native women have chronic health conditions that mean giving birth is a high-risk activity—and one that requires travel to well-equipped hospitals.
Many indigenous women in the United States and Canada give birth in governmental health facilities overseen by Indian Health Service (IHS) in the United States, and First Nations and Inuit Health Branch in Canada.
Health-care policies at IHS and First Nations and Inuit Health are comparable to those at conventional health-care facilities in both countries.
Aboriginal or indigenous women, especially those in the United States, are overwhelmingly classified as high-risk. In Canada, according to Statistics Canada, birth outcomes among indigenous peoples are consistently less favorable than among the non-indigenous population. Native American and Alaska Native women have higher rates of maternal morbidity or injury compared to the general population, according to the Centers for Disease Control and Prevention (CDC). The risk of maternal death for Native women is twice that of white women in the United States.
The infant mortality rate for Native American and Alaska Native babies is .83 percent, second only to rates for non-Hispanic Black American babies of 1.13 percent.
The practice of forcing Native women to travel to hospitals because their traditional ways of caring for pregnant people were outlawed contributes to an endless cycle of poor outcomes. Despite the public health industry’s best attempts at addressing Native women’s high-risk status, this cycle can’t be addressed by the same Western-style institutions that are complicit in perpetuating the problems in the first place, according to indigenous midwives including Katsi Cook of the Mohawk Nation.
For instance, governmental policies such as forced attendance at Indian residential schools in Canada and Indian boarding school in the United States were explicitly intended to eradicate and denigrate indigenous cultures, languages, and ways of healing and birthing. Many children in these schools were subjected to sexual and physical abuse and denied access to their families, thus creating generations of untreated post-traumatic stress disorder or historical trauma. After being cut off from families and traditional lifestyles and foods, which some suggest offer nutritional benefits, indigenous peoples began developing high rates of diabetes and poor health outcomes, such as high rates of lung, chest, and intestinal disorders.
Forcing Native women to birth in hospitals is another in a long line of colonial acts of violence, explained Kanahus Manuel, a member of the Neskonlith Indian Band of Secwepemc Nation in British Columbia, Canada. “Birth is the ultimate act of decolonization and resistance,” she said.
The efforts of indigenous midwives in Canada and the United States run a wide spectrum of styles and practices. However, according to Nicolle Gonzales, Navajo nurse-midwife, “Indigenous peoples share a worldview of connection to the land. We view birth and motherhood as ceremony,” she said.
“Traditional midwives took time to sit and talk with the mothers about their lives, families and challenges,” Dunlap noted.
“Our women were given time and support to have their babies; there was no agenda dictating the various stages of labor,” she said, drawing a clear distinction between birthing experiences at hospitals versus in Ojibwe communities. According to the American Pregnancy Association, there are three stages of childbirth including early labor when the cervix moves toward complete dilation of 10 centimeters, active labor when the baby is delivered through the fully dilated cervix, and third stage which includes delivery of the placenta. The first stage of labor is usually the longest period and can last from a few minutes to many hours.
Among indigenous peoples, as birthing women moved through the stages of labor, they were fed certain foods to provide physical, emotional, and spiritual strength.
When the baby was born, its feet touched the earth even before it was given to the mother.
“All of these ways had important meanings that are not yet completely lost,” she said.
“Woman is the first environment,” Cook said, echoing Dunlap’s sentiments. “With our bodies we nourish, sustain, and create connected relationships and interdependence. In this way the Earth is our mother, our ancestors said. In this way, we as women are earth.”
Cook has influenced and inspired generations of midwives to embrace their traditional Native ways. “I have a long tail in championing indigenous midwifery extending back to when I was first pregnant in 1973,” Cook said.
Cook has worked as an indigenous women’s health and midwifery advocate for many years. In 1983, she helped create a “Birthing Crew” of local elders and midwives on her home reservation of Akwesasne in New York and Canada. The crew provided midwifery services and health education to tribal members. In 1985, after the nearby St. Lawrence River was polluted by polychlorinated biphenyls (PCBs) from General Motors, Cook established the Mother’s Milk Project. A study found PCB contamination of breast milk of Mohawk women who ate fish from the St. Lawrence River.
Today, Cook’s many devotees and students continue taking up the challenge to revitalize indigenous midwifery.
Aboriginal midwife Kanahus Manuel is a self-proclaimed warrior, freedom fighter, and well-known indigenous land and water protector.
Manuel was pregnant with her first child while opposing the Canadian government’s plan to build facilities for the 2010 Winter Olympics on Secwepemc lands. When she learned that authorities had issued a warrant for her arrest for these activities, she fled to the Marble Mountain range deep in Secwepemc territory when her time came. “I knew I wanted an unassisted birth as my ancestors have done for centuries; I didn’t want to have my baby in a prison cell,” she said.
She educated herself in both mainstream and traditional birth practices and has since birthed all four of her children in the Secwepemc way, at home attended by family and/or midwives.
For Manuel, revitalizing indigenous midwifery is a declaration of sovereignty over women’s bodies and autonomy from colonial governmental systems.
Other advocates are finding ways to work within the systems to revive Native birth ways.
Gonzales is working within U.S. medical laws and regulations to create what will be what she describes as the first Native culturally focused birth center on tribal lands. Founder and executive director of the New Mexico-based Changing Woman Initiative, Gonzales received her bachelor’s of science in nursing and master’s degree in nurse-midwifery from the University of New Mexico and is a member of the American College of Nurse-Midwives and certified with the American Midwifery Certification Board. Although eligible to practice in a conventional hospital, Gonzales envisions creating a birthing environment that is friendly and welcoming and where Native women can have ceremony, eat traditional foods surrounded by family, and reclaim their traditional ways of birthing and healing.
According to the CDC, in 2015, 98.5 percent of births in the United States occur in hospitals. Out-of-hospital deliveries represented 1.5 percent of births in 2015. Of the more than 61,000 out-of-hospital births, 63 percent occurred at a home and 31 percent at free standing birthing centers. However, most insurance companies don’t cover home births and may only offer limited coverage at birthing centers.
Gonzales hopes she can establish Medicaid certification for the birthing center they are building and establish other ongoing funding in order to offer services for women who may lack other health insurance.
They hope to complete the birthing center, on the Pojoaque Pueblo, north of Albuquerque, this year.
Providing Truly Culturally Sensitive Care
Gonzales and her colleagues argue that although the Indian Health Service is tasked with providing health care to Native Americans, it is unable to effectively meet its mission. IHS is the federal agency within the federal Department of Health and Human Services that is charged with meeting treaty agreements between federally recognized tribes and the U.S. government, which promises to provide tribal members with health care. These promises have their base in Article I, Section 8 of the U.S. Constitution governing duties and powers of the Congress.
Criticism of the type of health care offered by IHS, however, could be lodged against other conventional health-care facilities in the United States that are also subject to the same limitations and laws regarding types of services that can be offered.
A statement provided by the Phoenix Indian Medical Center indicated that it employs ten certified nurse-midwives who provide culturally sensitive and relationship-based services. According to the statement, the health center provides pregnant people with therapeutic massage, hydrotherapy, and lactation support. Gonzales, however, argues that although IHS insists it offers culturally sensitive birthing practices, most of the midwives are non-Native and the facilities are still governed by the same strict hospital-style protocols as its mainstream counterparts. So no matter where a Native pregnant person might reside, their access to culturally sensitive care will be limited, if nonexistent. Birthing mothers are restricted regarding food consumption and the use of open fires, and ceremonial food preparation is restricted.
Aboriginal midwifery in Canada, however, has long been recognized by mainstream organizations such as the College of Midwives of Ontario. The college, responsible for registering midwives in the province, declared in a 2001 vision statement that midwifery care in Ontario, including aboriginal midwives, was defined by ongoing support for community-based midwives working in partnership with childbearing women. Aboriginal midwifery is seen as a valuable way not only to improve patient and infant health outcomes, but also as a means to help reverse overall health disparities among Native peoples.
In 1994, many Canadian provinces added a special exemption to the Canadian Midwifery Act. It allows aboriginal midwives who provide traditional midwifery services to tribal communities to practice without registering with the Regulated Health Professions Act. The act varies by province but requires midwives to complete a set of mandatory courses and abide by the rules of the act. Aboriginal midwives can practice legally without accreditation under the often-rigorous demands imposed by the act.
“Indigenous midwifery and healing practices are keystones in addressing reproductive health and longstanding problems in communities such as addiction, disease, shame and trauma,” said Cook, who helped create the 1994 exemption.
Preliminary data and evaluations indicate that birth outcomes have improved since the exemption was added. For instance, Inuulitsivik Health Centre’s Midwifery Service in Nunavut territory has provided care by traditional Inuit midwives to clients since 1986. According to research funded by Health Canada and published in Birth Issues in Perinatal Care, findings indicated low rates of intervention for births despite the high-risk designation of many Inuit mothers. Ninety-seven percent of births were documented as spontaneous vaginal deliveries; Inuit midwives attended 85 percent.
Midwifery in the United States, however, is not as accepted as in Canada. Laws governing its practice vary greatly from state-to-state. Only certified nurse midwives (CNMs), not other midwives, can practice legally in all 50 states. They are afforded hospital privileges in 30 states. After earning a bachelor’s degree in certified nursing, most CNM candidates also complete graduate studies in programs certified by the American College of Nurse-Midwives.
Some midwives may practice under other designations, including direct-entry midwives, certified midwives, or certified professional midwives, who may work in birthing centers and/or help with home births. Training for and attainment of these titles varies from state to state. In some states, many midwives run the risk of arrest for practicing medicine or nursing without a license.
For most women in the United States, the path to childbirth begins with a trip to a traditional hospital. Native mothers frequently must travel great distances from rural home communities and frequently can’t afford to bring along family or other support people. More insidious, however, according to indigenous midwives, is the impact of ongoing trauma from sexual assault as well as unresolved historical trauma created by U.S. federal policies designed to separate Native peoples from their lands, cultures, and languages. According to the Department of Justice, Native Americans are 2.5 times more likely to experience sexual assault compared to other ethnicities. One in three Native women reports having been raped in her lifetime.
The hospital environment with its rigorous, sterile protocols forbidding food; regulations regarding the number of visitors; agendas dictating when to induce birth or perform cesarean sections seem like another in long line of traumatic events.
According to Cook, Native peoples won’t be healthy and whole until Indigenous midwifery, which helps to combat trauma affecting poly-victimized people, is restored to their communities.
In that vein, Dunlap and a handful of other Native women in her area are creating a local effort to spend time with traditional midwives and healers and encourage expectant people to learn more about their Ojibwe birthing ways.
“Our Ojibwe stories describe how the fathers would keep a fire burning while the woman birthed so the baby’s spirit could find its way.” Having a prescribed role for the father provides him with a sense of connection and purpose with the birth.
“For Ojibwe, birth is a ceremony; baby is on a spiritual journey before they actually arrive,” Dunlap said.
“We have ancestral knowledge that Ojibwe women can share with each other,” she added.
The reclamation of indigenous women’s medicine is a true grassroots endeavor, Cook pointed out.
“In indigenous communities, health begins at home, at the kitchen table, using the everyday language of everyday people,” she said.
CORRECTION: This piece has been updated to clarify Kanahus Manuel is a member of the Neskonlith Indian Band. A previous version of the piece also listed Rebekah Dunlap as her online pseudonym R.A. Mackelberry.
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Demetra Seriki is a NARM registered Midwife and owner of A Mother’s Choice – Birth Options and Beyond
She is also a Midwife who serves the community of Colorado Springs, Colorado and is currently seeking Student midwives of Color who are interested in training to complete their education as midwives. With so many hospitals closing in many states across the country, the necessity for properly trained Midwives are seemingly increasing.
She recently shared some disturbing but much needed statistics about birth:
It is with a very HEAVY heart that I will report the 2016 birth statistics in El Paso County (Colorado Springs) for families of color. They do not separate the stats by birth location so these numbers represent total births and all birth locations.
Total births (all races) 9,499
1. Hispanic – 1,517
2. Black – 814
3. Asian – 468
4. Native – 92
Low Birth Weight (<2,500):
1. Hispanic – 8.8
2. Black – 14.1
3. Asian – 9.0
4. Native – 13.0
Very Low Birth Weight (<1,500)
1. Hispanic – 1.5
2. Black – 2.5
3. Asian -0.9
4. Native – 6.5
1. Hispanic – 10.4
2. Black – 13.5
3. Asian – 9.8
4. Native – 19.6
52 infant deaths
34 neonatal deaths
Unfortunately the data that I can see does not identify these babies (angles babies) by race. (I can’t imagine why)
If you are a student midwife or a women seeking health services in the Colorado Springs, Colorado area please feel free to contact her.
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At 2:33am her labor intensified and she was now in Trans. The look on her face was psychedelic. It was as if all of her fears had whispered away as she began to surrender to her godliness. In that moment she began her transformation into this fearless warrior whose body was no longer hers but belonged to all the women who once walked in her footsteps, crouched down on their knees, and birthed nations across the oceans.
THE DIVINE INTERVENTION
I met Arlene and Charlie through divine intervention is what I like to believe. Just days before Arlene’s predicted due date, her original Birth Doula, my former classmate who trained as a Doula with me; had to leave for Africa to embark on her 6 week journey of nursing and midwifery studies. Like any responsible Doula does; Ashlie decided to contact me and refer me to the couple as their back up Doula just in case the baby came after Ashlie boarded her flight. Ashlie and I did our Birth Doula workshop together and she believed that my philosophies of birth were parallel to hers and I would be a great stand in for her if the unfortunate situation happened where she would miss the birth of the Baby. In the beginning of the week Ashlie had us get acquainted via Group chat and email. I was briefly educated on the journey that the soon to be mum and dad had been through with Ashlie. I began to feel as though I was called into this birth for a reason. My spirit guides told me that I should meet with the couple as soon as possible because I would soon be the chosen Doula for their birth.
On a Friday night after a long week, Arlene and Charlie arrived at my Harlem office with Poppa Charlie’s mother and loads of questions and apprehension up their sleeves. I was so excited to meet them but felt a weight of responsibility to be ready at any given moment to support this couple as a Doula with knowing little to nothing about who they were, how they loved, and what I could possibly pull out of their souls to provide them with the strength they needed to get through this miraculous experience. I literally had 24hrs to meet them; their souls, their spirit, and the spirit of their unborn baby through the love they expressed towards each other.
THE INITIAL CONSULTATION
I left that consultation feeling inspired by Arlene, after conversations with her and husband about her fears and joys, anticipations and expectations. I learned that there were so many warrior spirits that surrounded and raised Arlene to be the woman she is today. I wondered to myself how I would gather all this power to assist her through what I knew would be the biggest transformation in her life. With much privilege I took on the responsibility of being chosen to be her gate keeper of life and death as she welcomed the new life of her baby onto this earth and departed from herself as a woman who was not yet a mother. I gave Arlene and her husband Charlie a few days to consider hiring me as a Doula, because after all; my belief is that the baby chooses the birth Doula not the parents. They went home that night, meditated on it and emailed me way before the 24 hours to inform me that I should be ready because the baby had chosen me.
THE CASUAL YET NECESSARY CONVERSATION
My practice as a Doula is based on how I can be this woman’s keeper. My goal is to dive deep into her psyche and learn her in depth feelings about the journey she is on as a woman. I often find myself asking mum’s who are fearful of labor if, “They are ready to be a mother to this specific child.” Through my observations I have gathered that all births are different for mums and that often times when a momma is worried about her delivery it is based on a fear of what life would now be like after the baby becomes a little human right before their eyes. Therefore, I tap into my client’s emotions with genuine curiosity in search for guidance on what will be needed of me as a Doula toensure this woman is empowered by this experience. I remember asking Arlene if she was ready to be a mum. This was Arlene and Charlie’s first baby. After our in person consultation, I went home concerned by Arlene’s fear of not living long enough to see past the birth of her baby girl. She expressed that one of her fears was not being able to see far enough into her future to witness her baby grow up. I wondered if her mentality sprung from a societal repression of the Generation Y2k, whom see the world for the scary place that the media makes it out to be. I wondered what made this strong, vibrant, and joyful woman hinder her own ability to believe in the hope she had for a wonderful future with her new family. As a Libra myself, I decided there were so many layers apart from strength and perseverance that made up Arlene’s character. I learned she was a Libra who was in the process of working tirelessly to bring both sides of her family together in love and unison before the arrival of her baby. Arlene was joyful about meeting her baby but was anxious about welcoming her baby into a safe and loving environment. I assured her that nothing happens as a coincidence and that baby would be what would remind her, her family, and all who are a witness of what love, life, and adventure is truly about; the unexpected and the inevitable.
FROM CONCEPTION TO CONTEMPLATION
Around 9:00am Arlene began to update me with what her body was undergoing. Charlie was more excited with letting me know every new phase Arlene went through in the beginning of labor. I asked Charlie to keep me updated. But also to go about their day as normal as possible. The two of them began their Saturday morning with loving vibes, a stroll in the city, grocery shopping, and even having a good ole slice of pizza at a local pizza parlor. As a Doula, I was 40 minutes away with my phone attached to my hand going along with my day working my 9-5 with the readiness to come up with an excuse for my supervisor if at any given moment I had to leave for the birth of the baby. I asked Charlie to track Arlene’s labor moods, and contractions as the hours went on in order for me to know exactly when I would have to leave for Harlem from White Plains NY. It is always better to be near the laboring mum. Not necessarily with her all day, but nearby just in case the baby wants to rush into this world without notice. By 1:00pm I decided to take the train ride into the city and hang out at a local coffee shop since the text messages from Poppa Charlie were getting more dramatic by the hour. Just as new parents would react in a situation not knowing what to expect; I wanted to assure them that I would be near them for whenever they needed the in person support. By 6:00pm, Arlene’s contractions were going at every 5 minutes, 30-40 seconds long. At 7:30pm I arrived to their home. My favorite part of my Doula career is the reaction of the parents, especially the mum the moment I arrive at their door. Like most mums in their homes during labor, I walked in to Arlene cleaning. It is almost an innate reaction that a woman has while laboring at home to begin cleaning to get her mind off labor and keep distracted from the process. However from a birth worker’s perspective; I know too well that this kind of behavior is anxiety manifesting its form of cleansing out the old energies in preparation for the new energies and new life coming into the home. Then again Arlene is Colombian; historically many Hispanic and African cultures the woman always cleans when they have a lot on their mind. Can you blame us? It is extremely therapeutic. A clean space equals a clear mind.
Upon Charlie opening the door, Arlene saw me and my bright cheesy smile that followed with a joke, “What are you doing? Cleaning? Why? Wheres the party? I asked. She smiled with joy. A spirit of peace came over her. It was such a privilege seeing her sweep the broom across the living room so calmly as if she had no care in the world because now her Doula was there. Little did she know she was going to be the one doing all the work; the cleaning included. It helps for a mum to be active during contractions and I wasn’t going to be the one to take that away from her. I made this very clear to her through many jokes. The night progressed smoothly as both mum and dad insisted in catering to me as if I was a guest of honor. I had to remind them that I did not need anything to drink or eat but that I was there to serve them and make sure they had everything they needed to be comfortable and Zen. During Arlene’s contractions, Charlie would tend to her like a Lion romancing his lioness, gallantly protecting and nurturing her yet secretly adoring her with all his gratitude as she labored their unborn baby.
THE EFFECTS OF AN UNEXPECTED GUEST
At around 9:40pm unbeknownst to me the unexpected happened. As a birth Doula and future midwife I have strong beliefs about who should be present at a woman’s birth. Most pregnant women don’t usually conceptualize how spiritual the birthing journey can be. Nor do they consider how powerful each individual presence involved during the labor can be. It is highly important for all of those who are in the presence of the laboring mum to be invited and to only be there to serve the situation with physical, spiritual, and emotional support. That being said, no one who is fearful of the processes of labor should ever be in the presence of a birthing woman. Energy is very real and while a woman is laboring she is literally in between two realms; the realm of life and of death and as she travels spiritually in and out of this dimension she gathers strength and purpose from all her ancestors and all her predecessors in order to birth her child.Therefore it is my duty as her Doula to protect the space for her to travel freely and peacefully.
Suddenly I heard a key turning in the door of the apartment and my heart dropped. I didn’t want to believe what I knew was already manifesting. After all, Charlie and Arlene made it very clear to me that Arlene’s mother in law; Charlie’s mother was not going to be in attendance during the laboring process of their baby. That she would only be allowed in the waiting room during the delivery as she expected her first grandchild. Arlene was doing so well during her contractions that we all found it so comical how she would be telling a story and sharing jokes but then in a split second she would close her eyes and disappear into a wave of energy that both Charlie and I could only imagine what kind of roller coaster ride it felt like. Like clockwork, Arlene was at a steady pace of 40 second contractions every 3 minutes by now but then the door opened.
It was Charlie’s mother. All of my attention was glued to Arlene when I noticed her shift in energy the moment she saw her mother in law come into the house. I quickly accessed the situation and realized that the couple was not expecting her arrival to the home before they went to the hospital. As I continued to look at my watch in monitoring Arlene’s contractions I became worried when I noticed that she was no longer contracting every three minutes. She had stopped contracting for 10 whole minutes now and I quickly decided she needed a change of environment away from her mother in law. I asked her to come with me to her bedroom and I brought it to her attention; how her energy became bothered and unsteady the moment her mother in law walked in. She shared with me how she loved her mother in law but that her cigarette smoke scent and the past week full of horrifying birth stories from her was what she feared having to experience at that moment.
FROM A WARRIORS BELIEF CAME BABY CHARLIE
It was in this defining moment that I realized how much value my work as a Doula truly has. As I paint this picture I wish for all to imagine for just a moment this beautiful yet chaotic energetic chain of events that led to the minutes that introduced baby girl Charley into this earth.
By 10:30pm mum had progressed in labor and the energies of the home felt a bit more peaceful. Mother in law was staying out the way by suddenly picking up the responsibility that every Afro-latina woman is graced with during any moment of anxiety and she began cleaning every inch of her son’s apartment. As I monitored Arlene, she began to not be able to voice her labor progression and the jokes were now one sided. It was then that I prepared mentally to schedule our next moves. My duty was to keep calm, and get poppa to order this Uber, make sure mom in law continued to scrub the floor somewhere in the back, and help Arlene feel safe every time she transitioned further and further away from her natural state of consciousness in order to bare the labor pains.
No surprise at all when I was approached with the duties of ensuring mum would stay mentally in the birthing zone. It almost became a game every time Arlene will have a 3 minute break between contractions and start asking everyone if they had everything they needed. She asked if we had her IDs, did we have the suitcase, did I have everything I needed. I was like, “Arlene, focus on birthing this baby and let us handle everything.”She even suggested we all take a selfie in the elevator on our way to meet the Uber. I couldn’t wait to tell the Uber driver about how important this ride was for him as much as it was for us. Shout out to that Handsome African Uber driver who was so impressed by Arlene’s powerful handle on the situation she was dealt. It made me so happy to be apart of a man from Africa witnessing an American woman labor so gracefully with no complaints. The whole ride to the hospital he kept affirming her ability to do it. We all became Doulas in that car ride!
Upon arriving to the hospital I had to mentally prepare myself for the worst. Being a birth Doula in hospitals can be very challenging when working to keep mum at peace in a very chaotic and stoic environment. Arlene was 4 centimeters when we arrived and the nurses suggested that she leave for two hours and come back when her labor had progressed. Imagine the disappointment when we hear this after thinking we did most of the work at home. It was game time for me.
My job was to make the best of the situation at hand which was the reality that Arlene and her husband would have to labor in this hallway waiting room with other expecting families staring. I quickly positioned her crouched over a big medicine ball, pulled out my headphones from my bag and activated her prepared playlist. She was officially gone. By 1am she had advance a few centimeters and her contractions were getting stronger. There were moments where I had to coach her like a sports player to get up off the floor or switch positions in order for her to keep her blood circulating and get the baby to move downward. I had to make sure she was comfortable and not cramping her legs by being on her knees for too long.
Charlie was so loving throughout the whole process and only wanted to ensure that she wasn’t in too much pain. Charlie kept Arlene comfortable the whole time and would kiss her and keep his hand on her to remind her that he will never leaver her side especially in their toughest moments. It was magical to bare witness to a poetic love story I was just beginning to read. Many moments occurred when I would look away from Arlene and see her mother in law right behind her rubbing her back the whole time, while we were on the floor, when we moved to the middle of the hallway against the wall. I realized that mother in law understood why I was there. Here was this 60 something year old lady whose had traumatizing births in the same city was now witnessing her daughter in law have an empowering experience with a dream team who was supporting her every time she moved, had to pee, or needed us to hold a cubby for her to throw up in while we stood in the middle of the hallway. It was in that moment that I knew my job was to be the Doula for this whole family who was learning the true beauty of natural labor.
By 2am Arlene’s moans made a roaring entrance into a very quiet scene. It was time. Charlie had Arlene come off the elevator after a walk alone together around the floor below us and as they stood in the elevator she had to step out because baby was coming. In the elevator hall way they stood and Arlene let out a roar like a warrior who had led all her people to the promise land but was tired as heck. Her body collapsed over the arms of her husband and her water broke. I stood watching everything from the glass doors confident that this was my place just making sure they knew I was close enough to assure them that all of what was happening was completely normal.
It took only 2 seconds after her roar for Mother in law to flee to the scene while asking me if she was okay. I explained that she was fine. Her water just broke and there is amniotic fluid on the floor and its time; but she’s doing great! Mother in law rushed to get through the door just like a momma bear wanting to protect and save all and anyone in distress. I almost had to box out mother in law from the energetic bubble the couple was in to make sure that her fears wouldn’t freak out Arlene or Charlie. I knew I had to watch out for mother in law the moment she rushed in asking if everything was okay which transmuted into Charlie taking all the napkins he had in his pocket and started cleaning the wet floor while trying to hold up his wife. I laughed. And quickly gave everyone a small speech in our hallway huddle, “Charlie leave that there, I am sure they are use to having women’s fluids everywhere around here. Mother in law, this is normal. She is now ready to deliver baby. Arlene, you did it! You are at the end of your marathon and your so close to meeting your baby.” Within minutes we get her admitted into her room and Arlene delivers a beautiful baby girl in which no one knew the sex of before meeting her.
They named her Charley in honor of her daddy. I never seen a love so quiet yet powerful between two people the way I have witnessed between Arlene and Charlie. That morning I had battled more negative spirits and transmuted negative energy into positive than I ever had in such a short period of almost 12 hours. I wrestled with mother in laws negative experiences and fears and watched her transform her birthing beliefs by watching how calm and graceful her daughter in law was during her whole labor. I then had to tame the energy in the room while comments of a prejudice P.A. insisted in telling us how well women of color delivery babies because “Our bodies were meant to reproduce.” I, as a Doula have been honored to be asked to create a sacred space for this family to welcome their baby girl no matter what was happening around them.
After two hours and smiling faces and a now topless Father Charlie, I knew my job that morning was done. After a twelve hour shift I was ready to go home, rest, and regroup. Baby was beautiful and healthy and grandma was overjoyed and impressed beyond belief of how well her daughter in law and son went through the journey of childbirth.
A week later I visited Arlene, Charlie, and Baby girl Charlie at home. Mother in law had gone back home to puerto rico and the home smelled like love and new born baby. The couple remembered everything except some of the funnier moments I would have to keep out of this story because I can easily make this into a novel. We shared pictures and drooled over how adorable baby Charley was. After making sure the couple was in high spirits and in love I was overjoyed especially when they confirmed their gratitude for my Doula services. To make a long story short, we are good friends now and I can’t wait to see Baby Charley the warrior princess grow into a Queen like her mum one day.
Yasmintheresa was a wonderful doula to me and my family. During what is a really intimate time and life changing event you need someone in your corner who understands the transition into motherhood as well as the hospital procedures that you may or may not be aware of and Yasmintheresa was on point in this regard. Her warmth and energy is what made me choose her from the others that I interviewed and she instantly had a good rapor with my family during our first meeting.
I initially decided on going with a doula due to being unfamiliar with the American health care system, having moved here from abroad. She was able to give me sound advice about the best ways to advocate for the type of birth suited to our needs and was then also on hand to facilitate our requests during labour when my focus was obviously elsewhere. This is no way interfered with my partner’s role allowing him to be as involved as he wanted whilst alleviating some of the anxiety that comes with bringing a new being into this world.
I can honestly say it felt like she was a member of the family or that best friend who holds your hand in times of need. She even showed up to the hospital with healthy snacks and drinks and just surprised us with her generosity and kindness. She also captured our moments on camera for us which ca easily be forgotten in those minutes after giving birth.
When finding a doula you want a person who you feel comfortable with in your space from the get go and Yasmintheresa was that person. In her post natal visit to check up on us her concern for not only our newborns well being but also mine was heart warming beacuse most visitors naturally are so excited to meet the newborn they forget about the new mother and how she might be coping. All was well but it was nice to be reminded that you did a good job. Looking back we are so grateful to have had her as part of this life changing experience. Good luck ladies! ~Dami Akinnusi
Many women including myself have swayed through life not understanding why we suffer from health disparities. We often face issues like PCOS: Polycystic Ovarian Syndrome, PMS, Fibroids, experience miscarriages, and infertility for years without understanding why and usually are told to treat the pain and discomfort with drugs rather than being educated about the cause of the syndrome and encouraged to create a lifestyle suited for our personal predispositions.
An exam may be necessary
I was once lucky enough to have visited the most prestigious Emergency room I have ever been to. While living in Thomasville, NC when I started feeling lower abdominal pain in fear of it being cyst like I’ve had before, I was referred to an OB-GYN that was adequately trained. This OB was doing my follow up and wanted to thoroughly exam my pelvis to understand why I was having pain near my ovaries. After I mentioned having once suffered a horrific burst of an ovarian cyst that left me on bed rest for almost a month; She wanted to rule out all worst case scenarios. This doctor felt a sonogram was not sufficient therefore she went on to perform a vaginal sonogram on me. It was a bit nerve wrecking for me because I was not sexually active at the time but the information she provided me with during this exam made the whole examination worth it. My boyfriend at the time held my hand through the exam and made the experience less dreadful. This doctor proceeded to educate me about my uterus being retroverted.
A retroverted uterus (tilted uterus, tipped uterus) is auterus that is tilted posteriorly. This is in contrast to the slightly “anteverted” uterus that most women have, which is tipped forward toward the bladder, with the anterior end slightly concave.
Since learning about being with a retroverted uterus I realized how my physiology differed from other women. 1 in 6 women are born with a retroverted uterus. Some may live their wholes lives not knowing unless they inquire to find out or they experience some of the disparities I was dealt. Some of the causes are, painful sex, yeast infections due to high levels of acid in your ph., and painful periods. Some women learn about having this, way into their pregnancy and if their lucky enough they will have a Doula, who will instruct them on how to minimize the nausea episodes and perhaps provide some insight on why it is detrimental to eat the right foods for a more comfortable and easy going pregnancy.
It is very important to understand that our body parts are not separated. We often lose sight of the truth being that everything is connected and in tuned especially when we are not in tuned with our own bodies. We often pop a pill an ignore aches and pains when it can very well be our body telling us to pay attention BEFORE something goes wrong. I was grateful to have learned about my beautifully unique uterus because I was able to change my diet and life style in order to prevent things like fibroids, endometriosis, PMS and more. I learned early that my diet effects my PH-balance and if my PH (hormones) are off then my body becomes a home for disease and ailments especially when I am already sensitive because of the way I was created.
Before we continue our lives not knowing how magical and intricate our bodies are I hope we can all become a bit more curious about our Uterus’ and how different they can all be. Perhaps now we can tend to our personal needs as women and not be shocked when sudden issues begin to effect our health during our child bearing years.
The good news is that in most cases it is possible to have a baby if you have one of these uterine abnormalities:
This is an uncommon abnormality where the uterus has two inner cavities. Each cavity may lead to its own cervix and vagina. This means there are two cervixes and two vaginas. It affects about one in 350 women.
A unicornuate uterus is half the size of a normal uterus and there is only one fallopian tube. Because of its shape, it is described as a uterus with one horn. It is a rare abnormality, affecting about one in 1,000 women. It develops in the earliest stages of life, when the tissue that forms the uterus does not grow properly. If you have a unicornuate uterus, you probably have two ovaries but only one will be connected to your uterus.
Instead of being pear-shaped, this type of uterus looks more like a heart, with a deep indentation at the top. It is called a uterus with two horns, because of its shape. It’s thought that fewer than one woman in 200 women has a bicornuate uterus.
This is where the inside of the uterus is divided by a muscular or fibrous wall, called the septum. About one woman in 45 women is affected. The septum may extend only part way into the uterus (partial septate uterus) or it may reach as far as the cervix (complete septate uterus). Partial or subseptates are more common than complete septates. A septate uterus may make it more difficult for you to conceive.
This looks more like a normal uterus, except it has a dip, or slight indentation at the top. It is a common abnormality, affecting about a quarter of women.
About one in six women have a uterus that tilts backwards toward the spine (retroverted uterus). This is not an abnormality. It won’t affect how your baby grows, although it may mean your bump starts to show later than for other women.