Doula Life: Grief and Loss, Episiotomies and self-care, oh my!

I am in the home stretch of the communication skills module for doula training. “Grief & Loss” is the heading. Topics include “Theories of grief,” “Stillbirth and neonatal death,” “Men and grief,” and – perhaps a most important reminder – “Caring for yourself following grief.” It’s the dark and silent side of being a childbirth professional. Babies and mamas die: in this country far more often than we should accept. Birth is not all cooing and home to a new glorious chapter of life. It’s a topic we have to address, but no one wants to talk about. It’s a topic I will surely write about much more. 

Yesterday, I finished up the section on informed consent and choice with discussion of how to divide medical research with clients who don’t have a science background. The example article was from the British Medical Journal, “Midline Episiotomy and Anal Incontinence: Retrospective Cohort Study.” The study examined the results, after three and six months, of 900 women who had experienced surgical episiotomies versus natural tearing and how their bodies had healed. 

An episiotomy, for those who haven’t been around birth, is a word that makes a woman’s beautiful vagina crawl into her gut. It is a word I couldn’t actually say until I was eight months pregnant and my midwife coached me through the sound. An episiotomy is an incision made at the base of a birthing woman’s vagina, toward the anus.  It’s very often unnecessary and can potentially cause lifelong complications, but other times it is necessary and usually goes perfectly smooth, heals flawlessly, and helps mama avoid a c-section. The other option is to allow natural progress and a tear may happen where the body needs to give. Regardless if a woman’s body naturally tears (and many  women do not tear at all during birth) or a surgical cut is made, imagaine getting cut anywhere else on your body, all of our skin heals the same way.  

These are the conversations that are now my daily life. A major part of my work is in helping mamas, and their partners, understand options and clearly review what their choices are in birth. Thus, when it is time to labor and mama’s body is ready to release the baby, everyone is empowered, can be present, and the birth can be more relaxed and healthy for all involved parties. 
But today, I learn about communication skills around grief and loss. And I am writing this post because the topic of grief and loss is more uncomfortable than an episiotomy. I have a history of running from grief. I wasn’t taught how to sit with it. In my family, grief wasn’t honored. No one demonstrated or shared that to heal you have to let go in your own way and at your own pace. “We are still here and have to just keep going,” is how my mother handled the emotional side of my father’s death. I was eight and I kept going, not knowing why the world couldn’t stop, yet nothing seemed to move. 

At almost 43, I’ve learned to address grief, to meet it and work through it. I still loathe it though and know my healthy relationship with grief is young. I hope my blessings are great and I do not have to meet grief too many more times in this life, but I intend to live long so I know grief will be a companion once more. I turn to this work, this vocation, and I hope / pray / manifest for healthy mamas and babies and births that are never short of magical, pure joy.  

But, realistically, I know that day may come where no medical intervention can keep a baby’s body goin or a mother will have a heart attack or a staph infection may sneak it’s way into a mama’s exhausted body. All these things could happen and it scares the living shit out of me. I know with life and birth we also sit at the edge of death. To be in this profession, I have to live with both sides. And we all must cope with grief at some point. We all must face the darkness and choose to move back into the light, or never experience the joy. 

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