Keep Calm and use your BRAIN!

This little acronym - BRAIN - is a powerful tool to increase your chances of getting evidence based care. So here goes - your care provider suggests a procedure, such as a stretch and sweep, or an induction, or even an internal exam at 38 weeks, or an episiotomy, or even a Cesarean birth - what do you do?

Sometimes medical decisions are based on outdated policy, financial or convenience factors rather than on what is best for mom and baby. Many parents are not sure how to question their care providers in a way that opens doors of communication rather than slamming them shut. The BRAIN acronym facilitates discussion in a non-threatening way.

What this really all boils down to is making sure that you are making informed choices and giving informed consent. This is a tricky field legally, and particularly in the area of labour and birth where there is a huge emotional component involved and families feel particularly vulnerable. 

Just remember, no one is allowed to do an internal exam or 'adjust' your cervix without your consent - if your care provider asks to do an internal exam and you give permission, and are informed afterwards that your cervix was manipulated or your membranes stripped - that is not informed consent and that is a violation of your patient autonomy. 

Furthermore, no one can inject you with anything or put anything in your drip, or cut into your flesh at any point without your informed consent - and if someone is busy doing something, an internal exam for example, and you say - STOP - you have withdrawn your consent and that person is required to stop what they are doing and withdraw their hand. 

You may be asked to sign a blanket consent when you are admitted to hospital (if you are birthing in hospital) - please read through it and discuss whatever you are concerned about. Perhaps you could get a copy before the time. It really is worth it! I have heard too many stories of women lying in bed for the duration of their labour because they believed that was just how it's done and didn't know they could request otherwise. Or women coerced into unnecessary inductions because of the doctor's leave schedule. For a first time mom, inducing labour drastically increases chances of having a Cesarean birth. If women truly knew the risks of the procedures they are apparently consenting to I think our phenomenally high Cesarean birth rate in our private hospitals would be a thing of the past.

There is much more I could say about this, but you get the idea. When in doubt, use your BRAIN!

Just so you know, I actually have a website dedicated to helping parents make informed choices along their birthing journey. Click here: http://www.giving-birth-naturally.net

When have you used the BRAIN acronym before? Please tell us!

Alternatively, was there a time you would have used the BRAIN acronym had you known about it? Tell us your story!

Private Birthing Venue!

Give birth in personalized privacy! 

Fully customized birthing suites available!

Entrust your birth experience to our highly skilled, passionate staff who have an excellent record of care. We aim to ensure that mothers and babies get the best birth possible, with no compromise on safety.

You will have a midwife and her assistant devoted to your care for the duration of your labour and birth. All essential equipment is provided. 

Immediate postpartum care and follow-up home visits 

are conducted by these same attendants,

available by phone 24 hours a day. 

Birthing suites come complete with double or queen size beds,

including free accommodation for partners and siblings.

You can even bring your pets!

• No set menus or meal times - you decide when and what you eat.
• You decide who may visit, and when they may visit.
• You will be able to sleep while your baby sleeps. No one will wake you at 5am to check your pulse, and your sleep will not be disturbed by the sounds of babies not your own. 

Get all of this for less than half the cost of a natural birth at a private hospital!

Yes, you guessed it, 

GIVE BIRTH AT HOME!

So yes, while I know that not every can or wants to give birth at home, I just thought it was funny that we pay so much to get a home-like birthing environment.

Belly Cast Tutorial

In it's curing spot, before refining and reinforcing.
Such a beautiful belly!

One of my kind doula moms, Candace, agreed to be my crash test dummy guinea pig in my attempts to make a belly cast. I'm considering the possibility of including belly casting as a service for my doula moms or anyone else who wants one for that matter, so I thought some practice would be a good idea!

I'm not a complete newbie when it comes to the art of working with Plaster of Paris; I majored in sculpture at varsity so PoP did feature at some point! I just don't remember it being quite that messy... I digress.

The basic idea behind belly casting is that you put Plaster of Paris bandages all over mom's belly and whatever else she wants casted  (breasts / thighs etc). Once the plaster sets it pops off and once it has cured you can reinforce, sand and paint it and hang it in your baby's nursery or anywhere you want to show off you beautiful belly! You'll need at least one person other than the mom, but having two people working seemed to work well for us. What we didn't take into account was trying to take pictures with plastery hands, so you'll need another helper if you want pics.

So here is how we did the belly casting:

What you need before you start:

From the left: Plastic wrap / Gloves / Vaseline /
Baby Wipes for mom afterwards /
6 rolls of PoP bandage in 2 widths.

• A belly attached to a willing volunteer
• A drop sheet (we cut up some rubbish bags - it's messier than you think!)
• A chair (we used a sturdy coffee table so mom could lean back on one arm)
• Something to smear on said belly to prevent plaster from sticking and causing unwanted nipple waxing Petroleum Jelly is what we used.
• Plaster of Paris Rolls - We used 10cm wide by 4.6m long. 4-6 rolls should be enough. You can get different widths if you like.
• Plaster of Paris Powder - for smoothing and reinforcing
• Flat container with water - warm water sets quicker, cold water sets slower - we just stuck with room temperature! Warm water not recommended!
• Large sharp scissors - I used kitchen scissors
• Hole Puncher - For punching holes in the cast so you can hang it
• Plastic or Latex Gloves - Check for latex allergies  Non-sterile is fine. You could use those gloves like the ones you get in hair dye kits, but I find them a bit clumsy for fine work.



Mom's Throne =
Sturdy Coffee Table
+ Cushion + Plastic

• Plastic wrap if mom doesn't want her nipples to show or if she wants the cast to go over the pubic area. Alternatively you could get those handy disposable paper undies from the discount chemist.
• A bottle of red wine and some jazz on the go - And perhaps some smelly candles depending on the time of day.

Try to make sure you really have everything ready before you start! Otherwise you will end up with white hand prints all over your kitchen. True story...

Before you start: Some considerations

• Decide how big / extensive you want the cast to be. Just belly? Belly and boobs? Belly, boobs and thighs? One shoulder? One or two or no hands on the belly? Just remember that you can't take the cast too far around the body - you want to be able to get out once it's set!
• Pick a position. Most of the time women choose sitting positions - if mom is at all prone to feeling faint or dizzy then standing is not recommended! Changing positions while casting is also not recommended. Make sure her spot is comfortable!
• Cut the rolls of plaster into 30cm lengths, with a couple of shorter ones for more detailed areas - especially if you are including a hand. Square pieces are great for nipples and belly buttons.
• Have a shallow bowl of water ready. Tap water should be fine. Cold water will cause the plaster to set slower, while warm water will speed setting.
• Lay your drop sheets down - and make sure there is space for your water tray quite close to the mom.



A spot for the cast to cure once you're done.
What? It looks like you just rolled up some
newspaper and piled it up on a  chair cushion!
Um, er, yeah, that's exactly what I did.

• Prepare a spot to put the cast to cure once you're done. We used a chair cushion with a stack of bunched newspaper to help maintain the shape while it cured. 

Ready to start?

Double Triple check that mama has had a pee in the last two minutes. You'll need her to sit still for a good half hour so make sure she's been fed and watered too.

My volunteers were Candace and her partner, Mat. I was going to be their doula at their upcoming birth so doing the belly cast was quite a good icebreaker in terms of being in each other's space.

About to pop... Candace and the Cast!

Ok, so once you're ready to start it's time for mom to get undressed. Make sure the room is warm enough / cool enough and that she doesn't feel too exposed. If you're doing a belly cast at a baby shower, just make sure there isn't a chance of Great Uncle Ned walking in on the process.

First you need a lubricant of some kind so that the plaster doesn't stick to the skin and give an unwanted nipple wax. If you're using latex gloves, don't put them on yet! The Vaseline will eat them up. I think you need something pretty sticky i.e. not olive oil. You are not trying to rub it into the skin, but make sure it forms a layer on the skin - like those chaps who do ice water swimming covered in a layer of Vaseline. I'd really like to find a natural alternative to petroleum jelly though, I just didn't have a chance this time. You could also wrap mom in some cling wrap, although you do lose detail that way.

Once the smearing is done the smearer can make sure his/her hands are wiped clean of the lubricant and put gloves on. I guess gloves are not absolutely necessary if you don't want to use them - the plaster will eventually come off your hands. But that's entirely up to you.

So being the good doula, I got Mat to smear the Vaseline all over the casting area and once Candace was sufficiently greased, we took one last sip of red wine and got working. You'll need to work quite quickly from here! 


 Take your strips of plaster bandage one by one, zip them through the water (i.e. don't soak them) and lay them down on mom's belly.

• As you lay the strips and smooth them you will see how the plaster fills in the gaps in the bandage.
• Use the square pieces for the nipples and belly button so you can get reasonably good detail. Again, Mat was happy to oblige. Try not to put too many layers over these areas to keep as much detail as possible.
• Lay the strips in different directions for greatest strength. and ensure everything is covered in at least two layers. 
• Keep going until everything is well covered. Make sure to reinforce the edges and corners and try to make the edges even, but it's not a train smash if they aren't - you can sort that out later.



From the other side

• At the end we smoothed the whole cast over with some plaster paste made with 2 parts PoP powder to 1 part water.

• Mom will feel the cast get warm - Don't Panic! That is what the plaster does as it sets... She will start to feel it popping off as it hardens anyway so it should come off pretty easily after about 20-30 minutes after you lay the first strip. 

Put the cast down in its curing spot and give mom some wipes to take care of the worst of the vaseline, then help her get to a bath or shower to clean the rest off. She may need a loo break. 

Then you clean up...

24-48 hours later

The cast needs 24-48 hours to cure completely so make sure it is well supported. Now you can smooth some of those edges and do some finishing off. 

With this cast I trimmed any rough edges with kitchen scissors and took strips of plaster and reinforced all the edges i.e. laying the strip along the edge and folding it over. I also reinforced the internal points of weakness - the crease under the bust and the space between the breasts. 

Top of the cast with rough edges

Trimmed with kitchen scissors and reinforced with plaster strips.

If you hold the cast up the the light you will see if there are any weak spots. You can also fill in with a little bit of plaster paste where necessary. 

Hopefully you can see the reinforcing here! This is looking from the inside.
 It is reinforced all along the edge,  in the crease of the bust and in the space between the breasts. 

I then used a hole punch to make holes to hang the cast - once I had reinforced the spots where the holes would be. 

Hole punch...

You can sand the cast quite smooth if you like.

Once it is as you want it you can seal it with something called gesso; you can get it at most art shops. You can also paint it with acrylic paints, or write on it with permanent marker - it really is up to you!

I'll add a pic of Candace and her belly cast when they are reunited...

So tell us, what would you do with your belly cast?

Debra's Testimonial

This was my first experience of a private hospital as a doula. I met Debra only a few weeks before the birth on the recommendation of a mutual friend, but we connected straight away!

Debra had an unplanned Caesarean birth after attempted induction. I'll be writing my story about this soon, but here is her story:

Not sure if you can see it here,
but mom is on the ball!

From the time we conceived, my husband and I read books, watched DVDs and sought advice from close friends and family. However, since none of our family were able to make the delivery or help us adjust to life after the birth, we still felt particularly nervous about whether we were always making the best choices for our family. 

This is where the famous Leigh joined our family of 3! I had never heard of a ‘doula’ or birthing ‘servant’ but from the day I met Leigh, she played an invaluable double role as both a passionate baby specialist and devoted friend. 

Leigh spent hours with us, answering our many questions regarding different natural birth pain relief options, emergency hospital procedures, breast verse bottle feeding… All our concerns were addressed. This made us feel confident and completely supported, knowing we could make well informed decisions concerning the safety and care of our baby Mpilo.

On the 6th of September Mpilo was due to be induced. Just in case he decided to arrive early, Leigh made sure we knew where she was at all times. Even if my contractions happen to start at 2am, she guaranteed to be there for us. What commitment! 

Armed with games, snacks, massage oils, stories and a medicine ball, Leigh was ready for anything that might occur on our special day. After 6 hours of trying to prepare for a natural birth, the doctor decided to conduct a C-section birth, due to my increasing BP and the circumference of Mpilo’s head. I would have panicked if Leigh was not there to speak with the medical team, offer us sensible advice and show compassion. 

During the C-section, Leigh talked me through the effects of the epidural, what the doctors were doing, how to recover from the procedure and took photographs, all while holding my hand. While I was in recovery, Leigh had already updated my husband on the success of the surgery, checked Mpilo was okay and organised for him to be exclusively breast feed.

The next day, Leigh was back to check on my recovery, to patiently answer more of my questions and help me effortlessly connect with Mpilo. Since then, Leigh continues to keep in regular contact with us. What a beautiful woman! What an amazing experience! 

Mpilo Samuel Nala, the name of our handsome baby boy, means ‘God’s desire is to give us abundant life’ (1 John 14). This is our testimony of His endless goodness to us. After sharing our baby journey with Leigh, our very own special doula, I would sincerely encourage every expecting mother to do as we did.

Did you have a doula for a caesarean birth? Would you recommend it?

For Love or Money?

Is this doula worth the moola?

Find it here.

So as I'm nearing the end of this doula course I'm contemplating the possibility that I get to earn money doing what I love. That is a very privileged place to be!

High School teaching, ballet teaching, lecturing Art History at three different institutions, importing amber teething necklaces and hazel necklaces - I enjoy all of these things. But, with ballet teaching for instance, I never started my own studio because something in me just knew that as much as I love dancing and teaching, it's not what really gets me up in the morning. If I did force it just because it was what I'd always done, I think it would have eaten me alive.

Working with bellies, birth and babies on the other hand... Now this stuff keeps me up at night! I will sit and read journal articles on the benefits of one birth position over another for hours, or sit with a mom while she labours for as long as it takes and feel more alive at the end of it than I did at the start.

But I read someone the other day writing about how she found a doula who 'isn't in it for the money, but does it from her heart' and while I understand her point, I get a bit frustrated that it's seen perceived as an either/or situation - you do it for the money OR out of your heart...

I'd love to be be able to offer my doula services for free, all day and every day. 

I'd love to be be able to offer my doula services for free, all day and every day. But when I am helping a mom in labour, I need someone to help look after my girls, and that sometimes costs money (or bribes). I want to do extra courses in hypnobirthing and aromatherapy and massage and breastfeeding (and and and) to be able to help my moms even more - but they all cost money and take time.

Furthermore, being a doula can be really inconvenient! For instance, I have a glass of wine with dinner sometimes, but when I'm expecting a mom to go into labour I won't drink at all, because I am quite sensitive to alcohol and I don't want my driving to be compromised and I think it's disrespectful to pitch up smelling like you've been drinking.

I can't organise holidays or travel too far away when I'm expecting a birth soon - or vice versa, I can't take clients due two weeks on either side of a holiday. If you think it's tough not knowing when you're going into labour, I have the buildup every time I have a birth! Don't get me wrong, I'm not complaining, I just think people need to know.

So I am in the situation where I will need to charge precisely because I love what I do. And you know what, I think that my time and skills, and my heart, are worth it.

Get the T-shirt here.

The stats back me up and the moms that I've already helped would agree, continuous care in labour makes a big difference! But, on the other hand, I do believe that every woman deserves a doula and I'm not saying that I won't ever take clients who can't pay, and I most certainly will do volunteer work as well, but in order to have the space and the finance to do that, I need to charge those who can pay for the service.

Perhaps I could offer discounted services for special cases, or barter my services for car repairs, or set aside a small amount per birth to put towards moms who aren't able to pay the full fee; I'm not sure, I'll have to see how it goes!

So what can you do to make doula care more accessible? If your medical aid doesn't already pay towards doulas (Fedhealth and Momentum do, and Discovery should be signing up soon) then write a letter to them saying why they should pay for doulas! If they do, write and thank them and let them know how much you valued your doula! We, the doulas and midwives, don't have as much clout as you do when it comes to getting medical aids to pay up...

If your hospital doesn't allow doulas as an additional birth partner, find one that does and give birth there and write to the original hospital and tell them why you aren't giving birth there. Or have a home birth and have as many doulas as you like...

Hospitals are very precious about their maternity wards as in the bigger cities women have a choice as to which hospital they want to birth at, and maternity wards bring in good money for hospitals, so if they are losing patients because they don't allow doulas, they would love to know about it! If they do allow doulas, write to them and thank them and let them know how much you appreciated your doula!

The same goes for medical aids that won't pay for home births and hospitals that won't allow private midwives. You as the paying client have the power to make a difference in these institutions!

Was your doula worth the moola? Comment and tell us about it!
Have your writtena  letter to your medical aid or your local hospital? Are you going to? Let us know!

Who's your midwife?

So who is your midwife?

Normalizing natural birth...

We seem to have reached a place in obstetric care where interventions, even unnecessary interventions, are so normal that they aren't even noticed. Here in South Africa, most middle to upper-class women automatically hire a gynae (pronounced guy-knee aka OB-GYN) to deliver their babies. For me, that felt like calling a paramedic when I have a cough. 

In private hospitals here, the midwives employed by the hospitals actually get into trouble if they deliver the baby as then the gynae can't collect his full fee, but they also get into trouble if they call the gynae too early, because he (sometimes she) has a busy practice to run. And they need those busy practices because of the incredible insurance they have to pay.

I digress...

Within the last week I attended two screenings of the documentary Freedom for Birth (trailer above) which is about how women's rights are being violated in childbirth  - among a host of other issues related to birth. While I will be addressing this issue again, it really struck me how natural birth needs to be re-normalized.

I am always trying to encourage women to find a caregiver who trusts that a woman's body is designed to give birth, not someone who sees a pregnant women as a emergency waiting to happen. So I chose to have a private midwife in PMB, Arlen Ege, attend the birth of my second daughter at home. When I had my daughter, she was allowed to deliver babies at the local Mediclinic, but has since received notice that this would no longer be allowed. UPDATE: Sr Arlen Ege is once again able to do water births at Mediclinic in Pietermaritzburg as they have installed an outlet pipe for her birth pool! I was able to attend the birth at which this pipe was first used, also the first birth in a while in which a doula was allowed at Mediclinic - It was a beautiful VBAC in December 2013 - Birth Story to follow! 

Why I have to be a midwife...

But, how do we normalize natural birth? How do we help women to see that over 80% of them should be able to give birth naturally, when the current caesarean rate in our private hospitals is over 70%? Because when the number of caesarean births gets too high, they actually start causing more harm than they prevent...

Which brings me to my little revelation... In the city in which I live, Durban, with a population of 3.5 million, there are two practicing private midwives that I know of. If I am mistaken, please correct me, but even if there were 10, or even 50, that would still be too few.

How do we change the tide and restore midwifery care as the norm rather than the exception?

Well, what I've decided to do as my first step, is that whenever I get into a conversation with a pregnant lady, 'Who is your gynae?' will not be one of my opening questions as it usually is among my peers. My first question will be 'Who is your midwife?', and after that perhaps 'Have you found a doula yet?' You get the idea.

Language is such a powerful thing. Doctors use it all the time when they play the big baby card, or the 'but-your-vagina-will-never-be-the-same' card, or the 'If-you-were-my-wife-I'd-recommend-a-caesarean' card. What are you going to do to help normalize natural birth?

Redefining Identity at Age 30...

I thought this was what the early 20s were for...

Confession time: 

I've never seen myself as a particularly caring person. 

Passionate, yes; caring, not really.

Me in one of my Fiercest Mama moments!

I've always admired people who could care for others - especially the frail and infirm of all ages. As a young person I was a little shocked at how indifferent I felt. 

Even when I had my first daughter I wasn't overwhelmed with love as some moms describe - it took a couple of incidents that awakened my inner 'mama bear' for me to see that I loved my daughter with the fiercest love I've ever known. It got much easier with my second...

I am passionate about justice and fairness and sustainability and other such things. For example, I do my utmost to only buy clothes made locally as cheap imported clothing undermines local industries. I can't complain about unemployment and crime if my actions are contributing to the problem. The thing is, this passion arose more out of a sense of justice than out of love.

But, as I start to move into a more directly caring vocation - doula work specifically - and as I try to practise empathy in disciplining my daughters, in a sense as I start to do the work of caring, I find myself becoming a more genuinely caring person. 

I find myself overwhelmed with love and empathy for complete strangers.

I do think it has something to do with the fact that I feel like I'm coming out of a spiritual hibernation. A couple of months ago I had a picture of myself as a 'mama bear' (not that we even have bears here in South Africa!) climbing out of her den (do bears live in dens?) and stretching and blinking in the sunlight. She was on the thin side, and a little weak, but she was enjoying the warmth and the promise of newness and life.

So maybe it has something to do with this spiritual re-awakening - as I lean into this infinite love, strength and wisdom more and more, so I can give love, strength and wisdom into the lives of others. Perhaps I had practiced indifference because I just felt the weight of suffering too keenly. But as I start to understand this Saviour who carried all the suffering that ever was or ever could be, who could empathize to the utmost, so I start to see how I don't have to be paralysed by the suffering of others because he already carried their suffering in himself - and so I can truly be free - free to love with a fierce love, rather than a desperate love.