Friday, July 15, 2011


Dear Birth Peeps,
One of the ways each of us can change birth in our culture is to listen deeply to birth stories, to understand and embrace the postpartum journey through a mother's story. Let's continue.

Within the day or two of giving birth, most mothers are chatting circles-around,or gushing through, their second birth story Gate, the GATE OF RELIEF AND GRATITUDE. This is usually a short, repeating, litany of praise for anyone and everyone who helped in anyway; it is probably fueled by endorphins and adrenalin, as well as genuine and overwhelming relief and joy. In addition, in the early weeks of postpartum, a new mother is falling in love with her baby; her
attention is naturally directed toward learning to care for her baby, getting enough sleep, and hosting a flurry of visitors. There isn’t time for reflection, yet.

For many years I used to be confused when a woman—who had just endured a terrible labor ordeal, often with excessive interventions —would be gushing gratitude and giving fruit baskets. Did I miss something? Why isn’t she traumatized, asking questions, blaming or more upset?!

Unfortunately, hospitals collect patient evaluation surveys from parents while they are still in this Gate of Relief and Gratitude! So administrators pat themselves on a job well done, verified by “patient satisfaction.” I wonder if the survey were given (or given again) three to six months later, if the satisfaction ratings would be the same. I think this timing on the part of administration is probably a combination of not being aware of how the evaluations (i.e., birth story) might/would change over time and convenience: get the paperwork done quickly.

But then weeks, months, or years later, when this mother had time to reflect on what she lived through, she would begin to put the fragmented pieces together, learn more about birth, and question what happened. It was then that her story would spontaneously change, at a time she had the time or emotional reserves to sort it out.

Any Second Gate stories to share? If you were to draw your second birth story Gate, what would it look like?



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  3. I can remember writing a letter to my midwife after my cesarean birth telling her how glad I was that I had switched to her as a care provider, because with her as my birth attendant I "knew that the cesarean truly was necessary." At the time she said she hoped I would come back to them for my next baby and I couldn't understand why it would even be a question. By the time I was pregnant with my next child and choosing a care provider I understood completely.

  4. This is the question that comes up for me: Is it a good idea for doulas to accept tips or allow parents to decide what to pay in the first few days after birth?

    I had such intense gratitude for my doula who went above and beyond postpartum. I couldn’t believe it when she offered to work an overnight with me, helping me tube feed with a nipple shield so my husband could sleep. She was there is so many ways that first week, and I couldn’t thank her enough for it. I borrowed money I didn’t have to give her a couple hundred extra dollars. Did she deserve it? YES. Do I regret it? NO, but as I got further from the moment, I did realize that what I had paid her to begin with was enough. I had given birth in less than three hours in the middle of the day. She was there for about an hour and a half. Then, my difficult postpartum began, and while she was under no obligation to, she put the time and effort she was prepared to put in at birth into postpartum instead. I am glad I found a way to give her a little extra as a thanks, but I can see where my gratitude was clouded a bit by the second birth story gate. After the next birth I attended as a doula, the couple gave me an extra $200 two days after the birth. Just weeks before they were not able to pay my full fee and then were suddenly glowing with gratitude, and offering me a tip. They had a three day long labor, that ended in a successful home birth, followed by a hospital transfer for postpartum hemorrhage. I can’t help but wonder, should I have accepted? Wouldn’t it be rude not to? How would you respond if you don’t think its right? I know their financial troubles will probably get harder postpartum, at least for awhile. Is it morally repugnant to accept money from someone who is in that state of intense (and perhaps a bit irrational) gratitude and thankfulness? I did accept the tip, with the rationalization that I had spend a ton of gas money going back and forth during the long labor and the tip brought their payment up to the bottom of my sliding scale. But, after my experience I didn’t really feel comfortable accepting.

    I have heard of doulas letting parents decide what to pay at the postpartum visit. It will probably turn out well for the doula, but is that an ok thing to be doing? Asking someone to make a decision about money (something that should be rationally thought through) when they are in a place where it is really hard (or even impossible) to think rationally?

    Since, I am not personally comfortable with it, I need to come up with a way to respond that is both respectful and authentic. Thoughts?