The Mindful Doula: Supporting Mamas One Breath at a Time

As a doula I always understood the mind-body connection during birth, and how the breath supports and helps a woman’s body with the contractions and the downward movement of the baby.

As I started to explore mindfulness and it’s use in birth I noticed that this idea is not one that is well understood by many mamas-to-be, partners, or even doulas. I was surprised to hear that some doulas never talked about how the breath impacts the birth process and how the nervous system reacts to stressful situations.

There’s nothing complicated about this practice and there’s nothing weird about it either. Often times mamas and doulas become frustrated with where to start with mindfulness because it seems like a foreign  or trendy concept. The truth is that the only place to look is in your own body. We all have the natural ability to use mindfulness because we can breathe and we can pay attention to our breathing.

First off, just pay close attention to your breathing right now. Does it make a sound, is it shallow or deep, where does your breathing originate and can you follow its trajectory? Are you a chest breather or a belly breather?

Second, focus your attention to your breath and begin breathing in more deeply and notice how with every breath you become more and more relaxed. Now where is your breathing located? Most likely your breathing in coming from your belly. If it is, good job! Belly breathing is the best way to access your vagus nerve which is connected to your brain stem down to your abdomen We can soothe our vagus nerve by breathing deeply and relaxing. When we breathe and we relax we also activate our parasympathetic nervous system.

The VEGAS what?!

Vagus: Pronouced “vay-gus”

For those of you who are more scientifically minded here is a quick and dirty breakdown of how our breathing impacts the bodies nervous system and how it directly impacts a pregnant woman’s experience during childbirth.

The vagus nerve helps to regulate the heart beat, control muscle movement, keep a person breathing, and to transmit a variety of chemicals through the body. It is also responsible for keeping the digestive tract in working order, contracting the muscles of the stomach and intestines to help process food, and sending back information about what is being digested and what the body is getting out of it. When the vagus nerve is stimulated, the response is often a reduction in heart-rate or breathing.

Your breathing pattern is directly connected to your autonomic nervous system. The autonomic nervous system is broken down in to two separate systems, the parasympathetic and sympathetic nervous systems.

The parasympathetic nervous system is responsible for responsible for stimulation of “rest-and-digest” or “feed and breed” activities that occur when the body is at rest, especially after eating, including arousal, salivation, tears, urination, and digestion. This is your chill-out mode. This is where we should all strive to be.

The sympathetic nervous system is responsible for stimulating activities associated with the fight or flight response. It dilates pupils, increases heart rate, pumps more blood into your heart, circulates adrenaline, activates sweat glands, and slows down your need to urinate and your digestion. Basically this is stress out- freak out mode. Sadly, most people live here permanently which significantly impacts overall health (but that topic is for another day).

Now, let’s imagine that you are in the hospital with the woman who is about to give birth. She is dripping in sweat, screaming in pain, she is yelling at her partner and the nurse just came in to tell her that they can’t give her an epidural yet because it’s too early or if she’s birthing at home, imagine the midwife just called and said she was stuck in traffic. What is her nervous system doing?  Not to mention what is happening to her body is directly impacting her babies reaction. Mama freaks out, baby freaks out.

Answer: She is on Sympathetic over-drive. Her breathing is shallow, her pupils are dilated because the baby is coming and she is in pain. Mama is in fight or flight mode.

How do you as the doula get her to activate her parasympathetic nervous system? How do you get her to come down from her fight or flight mode? How do you use her breathing to get her to calm down? How do you as a doula get her to be in the present moment, while calmly acknowledging and accepting her feelings, thoughts, and bodily sensations?

Things you can do to support her:

1. Ask her to look at you and match her breathing with yours (slow, steady breathing).

2. Help her find a word(s) that helps her and have her focus on that word during each contraction (I am strong, I can do this….).

3. Remind her that after this one contraction she gets a break. Don’t let her use up her break with a freak out. Instead help her realize that after the contraction comes a moment of peace and stillness.

4. Remind her that each contraction means she is closer to meeting her beloved baby.

5. Use walking, pacing of the room can help her see her experience from a different perspective. Open a window, or open the shades, change the lighting in the space or light some candles.

6. Her senses are extremely heightened. Bring in her favorite flowers, a plush pair of slippers or some essential oils and give her a light hand or foot massage or draw a bath for her.

7. One of the most important things you can do is to remind her that she will be okay, remind her how well she is doing. Praise her for her ability endure and remind her that her body is strong and knows exactly what it needs to do.

8. Sometimes as doulas we can come across mama’s who place judgment on themselves for choosing a hospital birth, home birth, midwife, epidural, c-section, whatever the case you job is to help her re-focus that attention back to her experience because it is unique and special. Remind her that her experience is her own and bring it back to her breathing.

As doulas our job is to help women feel comforted and supported. Using the breath mindfully we can help enhance a mothers experience by changing her perspective on pain.  This is not to say that the “pain” of childbirth will disappear, but instead staying in panic mode the goal is to have her notice that for every moment of pain there is a moment of peace. And each contraction gets her one step closer to meeting her beautiful baby.

Yoga Pants Confessions

I walk into class with my water bottle in hand and my target brand yoga mat. It’s the one I’ve had since 2006 and despite it being old I can’t get rid of it.  I am wearing my tight black yoga pants, the faded ones that make my ass look bigger than it is and the ones that hide my tummy the best. As I find a spot on the floor I walk past the pretty blondes and the men with their chiseled chins, their Lululemon outfits and high end $130.00 yoga mats. I make eye contact with the only other woman of color in the room and produce an internal sigh of relief because I am not alone. Through out the class we smile when we both can’t do the same pose and feel a sense of connection in knowing that there is another person sharing this feeling of slight embarrassment.

I started practicing yoga in 2006 in the quiet of my college apartment while my roommates were in class. I bought three yoga dvd’s that started with the basics of breathing and some yoga poses. I could not muster the courage to actually go to a class so instead I did it at home while everyone was away. I hid my yoga practice from the world because I was ashamed of my body. I hid because it was easier and safer to practice by myself than to be in a room full of strangers who were strong, thin and beautiful. The fact that I wasn’t emotionally ready to practice in front of people didn’t stop me and I  practiced diligently 3-4 times per week by myself. I began going for walks and the occasional jog. I felt myself becoming braver and more confident in my own skin.

It’s been about 9 years or so since I first stepped on to a yoga mat. Last year I decided that it was time to get serious and commit to doing a yoga teacher training. In about two months I will have completed my 200 RYT training and the question of whether I want to teach or not has come up several times. At first, I thought that this training was just for me and get me out of my yoga comfort zone. But the more I think about my journey with yoga the more I am convinced that this training is not about me. This training is about the women who are hiding their practice because they can’t imagine walking into a room full of “perfect” looking people without feeling self conscious about their weight or their inability to do certain poses. My hope is that this practice becomes a way to help women discover their bodies and not see themselves as separate from those sitting in class with them. My hope is that I can create a safe space for women to come and practice in their no-label yoga pants and their target brand mats because it’s not about the label or how pretty the studio is; this is about women connecting with other women. This is about supporting one another through movement and what yoga is truly about- connecting the mind, body and spirit.

Connecting the “Impossible”

The word “depression” was never spoken in my family. Actually, depression was just another word for “lazy.”
That being said, at the young age of twelve and around the same time I began menstruating I experienced my first symptoms of depression. My doctor told me it was because my hormones were trying to “regulate themselves” and that I once my periods became regular I would have no problem.
Fast forward to high school, my periods never became “regular.” At this point my irritability and moodiness were attributed to me being a teenager. After going for a routine doctor’s visit it was recommended that I be put on birth control to fix my period issues. I happily obliged and began taking birth control. Needless to say that this magic little pill did the trick! I lost weight,I had regular periods, my cramping went away and I did not have to use the super tampons every single day! Additionally, my mood was better and the symptoms of depression I had experienced in the past were gone. At this point I was in college and living on my own, things were great.
Fast forward to age 25. At this point I have been on birth control for 8 years. I was in grad school and met my future husband. Once married I decided I wanted to get off of birth control. Not because I wanted to get pregnant, but because I wanted to learn my body’s unique rhythm.
After 6 months of no periods I began to worry. One year went by and still no period. I was in grad school and working full time so I attributed my lack of period to stress.
I thought, “If I quit my job everything will go back to normal.”
Around this same time I began having constant urinary tract infections that would be resolved after taxing rounds of antibiotics. I would find relief only to have another infection the next month. I started seeing an acupuncturist and a Chinese herbalist and that seemed to help a bit with the stress, the periods and the infections, but I was not cured. The stress of possibly having another UTI was becoming a daily stressor for myself and my husband. I saw specialists all over the greater Boston area. I paid thousands of dollars in appointments, medication and over the counter treatments. I read everything I could on how to treat UTI’s and how to eat for a healthy period. After all of that research I think I could write a book on the topic!
So, how do the UTI’s and lack of periods tie in with depression?
After seeing a Naturopath and a Women’s health specialist/Endocrinologist I was diagnosed with Hypothyroidism. I had been dealing with symptoms of depression, my hair was falling out, my skin was dry, my moods were erratic, my hormones were abnormal and I still had no period. For the first time in my years of seeing specialists someone acknowledged how the health stress I was dealing with everyday was affecting my symptoms and at times making them worse. I was told that it was possible that my long time struggle with my periods and hormones could have been managed by the birth control pill I had been on.
This theory seemed very plausible given that my symptoms only worsened after stopping birth control. After having doctors tell me that it was “not possible” for everything to be connected because the urinary system, nervous system and reproductive system were not the same, I finally felt like I was not crazy for thinking that somehow the stress I was putting on my body was impacting my overall health.
I am not saying that reducing stress is the cure all for depression, hypothyroidism and UTI’s, what I am saying is that for me, reducing my stress levels helped me manage some of the symptoms I was dealing with.
My recovering has not been easy and not without its compromises. Daily I think about my diet, have routine blood work, take vitamins and take medication to help manage my symptoms.  The struggle is never over, and I still fear another UTI or that one day I will have a difficult time having children because of my hypothyroid diagnosis.
What I have learned from the journey is that I have the power to make a difference every single day. I am strong, and believe that I was given a body that has the power to heal itself. My choices in food, my choice to stay in bed longer or go to a yoga or cycle class, and even my choice to take long, deep meaningful breaths impact how the rest of my day goes. My choices impact my health, it just took me longer, and thousands of dollars in medical bills to figure that out.
Sometimes we have to realize that our bodies need a little boost and medicine can provide that, but also being aware that our whole bodies need love is important. Acknowledging that our symptoms affect our whole beings is part of the self- care process. Whether it’s in the form of meditation, prayer, deep belly breathing, yoga, knitting, running or qi gong, finding a self-care practice that works for you is important. It is okay to take your medication and also do your daily self-care practice. Finding your body’s self -care rhythm, working with the tools you have at your disposal, asking questions and keeping a health journal can significantly help you work through your diagnosis and help you find some relief.