When you’re expecting a baby, it’s exciting, and maybe a little bit scary, to think about parenting this new human together. What will you name the baby? When will you first take her/him out of the house? Where will s/he go to college….?

But before all of that, starting right now, it’s already time for a team approach.
I know that it’s common for the pregnant individual to take the lead, and often the partner feels the best approach during pregnancy is to step back and just say:

                      “Whatever you want Dear.”

However, there are already many important decisions to make well before your baby’s birthday, during pregnancy, and even during labor. And these decisions can impact all three of you in both the short and long term. What you decide may affect the birth-giver’s and the baby’s physical health, everyone’s emotional/mental health and the health of your relationship with each other and with the baby. How birth happens even impacts sexual health. Furthermore, memories of the birth experience, and how the people supporting you made you feel, last a lifetime (1).

So instead of assuming what you might call “traditional gender roles”, consider working as a collaborative team right from the start!

Why are we saying delivery when we mean birth?

Saying delivery turns our focus to the birth attendant rather than the birth-giver. But it’s the person who gives birth who does the lion’s share of the work; gestation, labor, birth and caring for the baby.

I believe we should recognize the birth-giver’s effort, power, and relationship to the baby by choosing to say BIRTH rather than delivery.

It is common to use the word delivery when talking about birth. We’ve done so for a long time; since Obstetricians were predominantly men, and birth-givers were always categorized as women. I’d like to make the case that this word choice is about the misattribution of power, often rooted in misogyny. Therefore, although I usually use gender-neutral language when talking about birth, in recognition of ALL people who have the capacity for pregnancy, please note my purposeful use of gendered language in this post.

As a doula and childbirth educator, I have found that one of the biggest concerns of birth-givers is perineal tearing.

So, to help you avoid unnecessary perineal trauma, here are some techniques AND the research on their effectiveness.

But first: one of the most important things you can do is choose a medical birth professional who knows how to support your perineum! There is a wide range of expertise, and variety in approach, among medical professionals. So ask the medical members of your birth team about their practices. [For more about choosing the medical professionals for your birth support team, read my blog post: Who's Responsible? (1)]

You might pose questions like:

• What techniques will you use to support my perineum when my baby's head is emerging?
• What is your episiotomy rate for first time birth-givers (or second, or third...)?
• Are you skilled in supporting people giving birth in a variety of pushing positions?
  
  

The answers to these questions will give you some idea of what to expect. Still, YOU are going to have to be prepared to speak up for what you want in the moment. That can be hard to do, because you're likely to be pretty busy pushing. So read on.

[WARNING: There are pictures below of actual perinea, perineal massage and a baby emerging. Stop here if you're not interested.]

If being home alone with a newborn has left you feeling a little overwhelmed, stressed and unsure about what you are doing, you are NOT the only one. There is nothing wrong with you, and you are not failing at parenthood. New parents have rarely ever done this alone before. The problem is the current cultural structure that fails to support new parents in the USA, especially now.

Back in the day, folks grew up in a “village”. As a young child people regularly saw pregnancy, birth and breastfeeding. Their mother may have had children when they were old enough to remember. Seeing pregnant bellies was a normal part of daily life. Labor was a community event for women. Young girls probably participated in keeping birth-givers company early in labor. When older, many probably had the opportunity to stay with a close friend or relative throughout active labor, and maybe even witnessed the birth of a baby.

I’ve always wondered why people feel entitled to touch a person’s belly when it is full of a baby, while it’s culturally taboo to touch it at any other time. -- No one would dream of touching my daughters’ bellies? Why does it seem OK to touch my pregnant belly?

Along the same lines.... Why is it acceptable to put fingers in a vagina of a pregnant person with no more than a “I’m going to check you now” – when in any other situation, you need permission? 

Why do we tolerate cutting the opening to a birthing person’s birth canal without asking for permission first, when no medical professional would ever cut a patient anywhere without a discussion of risks and benefits and obtaining true consent?

How can one sew up an episiotomy or a perineal tear without ensuring that this sensitive tissue is adequately numbed, when no medical professional would ever sew up a cut or tear anywhere on anyone’s body without adequate anesthetic and pain control?

Why when a person’s body is growing a new life inside, does that body suddenly lose its civil rights, its status as a human being?

Are you pregnant? Here’s what I want you to know:

You still own your body. Being pregnant does not change your right to bodily autonomy. (To read about this issue from a legal perspective, read The Nature and Significance of the Right to Bodily Integrity here. Full reference below.)

Nobody, not a doctor, midwife, nurse or friend… NOBODY has the right to touch you ANYWHERE without asking for and receiving your express permission. You have a right to deny anyone permission to touch you, and you have a right to change your mind and withdraw your permission after you have first given it.

With that in mind, I want to describe for you what a vaginal exam should look like, so that you can recognize when your rights are being respected.

So you’re expecting a baby. They’ve given you a due date, sent you for tests, scheduled your prenatals… So many decisions are being made…

Wait…

Who should be deciding about the particulars of your pre-natal care?  Your birth experience? Your post-partum course? Who, ultimately, is in charge of your physical health, mental health, sexual health, and the health of your baby?

…Let’s try that again: REWIND<<<<

So you’re expecting a baby. You’ve determined your due date, chosen what tests to take, scheduled your prenatal visits. There are so many decisions for you to make…

Do you want to be a passenger or the captain? The first mate or the private? Not sure? Consider this:

I had plans for the launch of this blog right about now… but that was before this Covid-19 global pandemic. Still, if there is one universal truth about doulas, it’s that we are used to adapting to the unpredictability of life. Since we never know when our client is going to go into labor - what will be interrupted, what will have to be rescheduled, postponed or canceled - we know how to do unpredictable.

So - Some thoughts about the importance of “visitors” to birth-givers in the hospital setting.

When Covid-19 cases started rising exponentially in the USA in March, hospitals quickly decided to exclude all visitors. This decision was made in the midst of chaos and panic with a laser focus on infection control, because the immediate concern was preventing the spread of the virus in the hospitals, especially among the staff, nurses and doctors who were (and still are) risking their lives daily to save ours. We know that there wasn’t enough personal protective equipment (PPE) stockpiled to prepare for the sudden surge in need. Thus, without adequate PPE, other measures HAD to be taken to ensure our medical professionals could continue to do the work of attending to sick, and highly contagious patients. And when visitors were restricted, infection rates among these professionals immediately declined.

But when visitors were banned, did we throw out the proverbial baby with the bath water?

Health statistics are reported by race throughout our health tracking systems. Everywhere you look, in every measure, you can see that health outcomes for Black people are worse than for White people. Here’s a sample showing the differences, or disparities, in outcomes reported by race in the USA.

My lane is pregnancy, birth and breastfeeding, so I will focus this discussion there.

From life expectancy and diabetes, to infant mortality (death of a child before age one), Black outcomes are worse than White (1).

So is race a risk factor? Does being Black cause you to have poorer health? NO! Racism does that!

Time to take the gloves off.
I’ve been living in Birmingham, Alabama for 20 years now, working in the birth world as a childbirth educator, breastfeeding counselor, birth doula, birth doula trainer, and director of a small non-profit community doula program called BirthWell Partners (www.BirthWellPartners.org). In all of these spaces I have tried to push against some of the gender-role stereotypes of a Southern woman: lead from behind, defer to others, don’t offend, and speak softly. Today, in my 56th year, it’s time I faced the facts, I’m not good at “Southern woman”, I don’t know how to do that!
I’m not bashing that subtle approach by any means. In fact, using that approach is how things get done around here! There are many advocates in the birth field in Alabama who continue to take this approach - and do so expertly. Their efforts over the past 20 years have made a huge difference. They are the trail blazers who smoothed the way for today’s doulas in the birth room. More recently, after ten years of work, they got legislation passed to license Certified Professional Midwives (CPMs) in AL, opening the door for you to have your baby at home with a licensed provider. For years I have aspired to be like these leaders in the birth field (you know who you are)! For a long time, I have fantasized about being able to carry one of y’all along with me and have you whisper the right words in my ear. Maybe I’ve improved, but basically, subtle and southern doesn’t fit me and I'm no good at it!
So, I’ve decided it’s time for me to stop trying to be that woman, and instead to embrace my strengths and style, however unconventional it may be. Because quitting isn’t an option. There is too much to do and too much that needs fixing!