October 21, 2011

Find Your Advocate

There is a reason for the old saying, “It takes a village!” And in the days of my grandmother and mother, there was actually a village present to help with child rearing and birth. In the case of my mother, it wasn’t the “old country” my grandmother came from, but the yentas of Brighton Beach, still very much a village in itself.

Nowadays, with families spread out and births happening in a more medicalized environment, the village one builds may look a little different, but this “village” or community is still vital in helping to provide support for the new mother during this transition.

Deer Caught in Headlights
The other day in class, one of my second time mothers was talking about her first labor. She was explaining, prior to her first birth, that she put a lot of thought and effort into establishing her “labor tools” (the coping mechanisms she would use). However, when she was actually in labor, she drew a complete blank and panicked. I asked her if she shared these ideas with her partner. She explained that she talked it over a bit, but didn’t go to into depth about how she may need help. She knew this time around she would approach things differently.

As a doula, one of the things my clients and I talk about are the different pain management techniques they may like to use. We may use every single one discussed during her labor, or none at all, depending on how they work for the mother. I also suggest that my clients and students, especially those that are not hiring a doula, do a little “test run” of using these tools ahead of time to acquaint their support person with the different options. In prenatal yoga class we practice something called the mock contraction. This is a 60 second wall squat that is rather intense on the quadriceps and takes both mental and physical stamina. The idea is for the woman to take the pain management tools out of the theoretical state and put them to practical use.

At home the pregnant mom can either do the mock contraction or the Lamaze One Minute Ice Cube Test. This is when the mother submerges her hands in bowl of ice cubes or ice water for 1 minute and the partner uses some of the relaxation techniques previously discussed to help the mother through that 1 minute period. This gives the couple a chance to hash out what was helpful and what was not.

During labor, the mother is definitely the one calling the shots as to what works and what doesn’t, but she may need some help in identifying and remembering what those specific pain management techniques are. The laboring woman has enough going on and should not be responsible for coming up with her “tool kit”, which is why it is so important to begin building a “village” early. (See How to Recruit and Prepare Labor Support!)

Fighting the Bully
I was meeting with a group of new moms the other day. And as new moms do, we started talking about our birth experiences. One of the mothers asked me about my birth. She knew that it was a lengthy process and that the second stage (the pushing stage) was a 5 hour marathon. She curiously asked about the different positions I tried. “What position didn’t I try!” I replied. After discussing with her my myriad of pushing positions, she explained that she wanted to try alternate positions other than the traditional supine position, but was bullied into staying flat on her back by the nurse who was attending her birth.

The mother was talking me through her birth story, and was still trying to resolve what happened at the pushing stage. She was unmedicated and was under the impression that she would have the freedom to choose what position was most beneficial and comfortable to push in. She asked the nurse several times if she could get off the bed and try pushing while stand up. The nurse was far from supportive and gave her a snarky answer saying, “If gravity helped with pushing, women would just stand up and the baby would just fall out.” So one would conclude from an answer like that, that the mother remained in the bed unable to have her desires fulfilled.

In a situation like this, the mother may not have the strength to advocate for herself and needs to have the support from her birth partner, care provider or doula. Birth preferences should be discussed ahead of time and if a mother finds herself in a position that is not right for her, she needs to look for her “village of supporters” for help. Also keep in mind, if one member of your birth team is not working for you, you can ask them to leave. In reference to this story, should the mother find herself in a similar situation again, she can have one of her birth partners ask for a replacement of the nurse.

Fighting the System

This advocacy story is a personal one, it is mine. My story is not one about labor or even the postpartum experience. But about getting the support I needed to PAY for the birth I had. My husband and I chose to have a homebirth. When we signed on with our midwife, Stacey, we knew she was out-of network. I had to get permission from my insurance company to cover her services. Luckily, I received a letter stating that my midwife would receive in-network level of benefits. I was greatly relieved and continued to receive excellent care from our midwife.

After the birth, I was informed that the insurance company was only willing to pay a fraction of the cost of the birth and all the prenatal and postnatal visits. This seemed ridiculous to me, especially considering how inexpensive a homebirth is in comparison to a hospital birth. All this started to unravel about 3 weeks after the birth of my son.

Not only was I exhausted and trying to figure out how to sleep, breastfeed and be a mother, I now had to deal with the insurance company! Fortunately, the NYC midwives work with an woman, Haya Brant, who knows how to handle tricky insurance situations. She informed me that New York State laws require insurance companies to cover home birth. She was going to bat for me with the insurance company and also helped me get in touch with the Attorney General to file a complaint. Haya became my advocate for me and my midwife at a time I just could not speak up and fight for myself.

My story ends with Haya passing along the joyful message, she was able to talk to someone at the insurance company, and repeal the claim and finally get the midwife the money she deserves.

Pregnancy, labor and delivery and motherhood can transform a woman. This new woman is strong, supple, fragile and fierce all at the same time. While she is passing through this life changing transformation, she may need some help along the way. Sometimes she can ask for it right out, other times, she may need her “village of supporters” to clear the way for her.

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