What is the difference between a Doula and a Birthkeeper?
Really, there should be no difference but it seems society has made it a huge difference. By definition, a Doula is a woman, typically without formal obstetric training, who is employed to provide guidance and support to a pregnant woman during labor. This is also what Birthkeeper is! To be honest, there is no documented definition of a birthkeeper. A Birthkeeper is what she chooses to be.
Why the Separation?
Doulas often come with a scope they must obey. Most Doula certification organizations will limit women in what they can and cannot do, instilling them with false fear that they are looking legal complications in the eye if they ‘disobey’ as well as the stripping of their certification. For example, carrying/suggesting essential oils, homeopathy, offering suggestion on what you would do, or attending birth without medical providers present. Something that limits what they can and cannot do for a woman in her childbearing years. If we are being quite frank, a doula’s provided ‘scope’ is “a means by which contributes to the violations birthing persons experience and validates the very exact system that oppresses the one birthing”. It limits her ability to serve. (Those are wise words from Allison Tate @BacktoBirth)
There are Doulas who see what society/organizations deem a ‘scope of practice’ for their profession, and they smash that scope. They discard its limiting bounds and serve women to the fullest extent of the law- just like a birthkeeper! Doulas are not one size fits all. Many choose to limit themselves, but there are gems out there, claiming the title Doula, serving at her fullest potential. I call them Diamond Doulas! They are my people!
So, What is a Birthkeeper?
A Birthkeeper holds the sacred wisdom surrounding physiological birth and walks with women in their childbearing years. They are the keepers of sacred space. They are able to serve the woman to her desire and fullest extent of the law. Supplying genuine care and concern with no limit. Birth does not have limitations, neither should a support person (outside of refraining from offering medical assistance). A woman being supported by a Birthkeeper would likely be supported to the fullest extent of the law -where as most Doulas aren’t able to or their certification will be stripped.
A Birthkeeper is not limited by a scope. She serves to the fullest extent of the law (varies by state) and bases her service offerings/limitations on her own personal training. Some may carry more knowledge on the physiological birth process, with different supplies in her birth bag than a mainstream Doula might. Some may be comparable to that of a Monitrice. What she will or will not do is up to the Birthkeeper themselves, they are not limited by definition or scope, they set their own boundaries.
Birthkeepers often support (not supply medical care) those who are dropped by birth professionals. The birth professional may be legally unable to show up and support, but a Birthkeeeper is, there is no license to lose when simply supporting a choice. Sometimes, this is better than the mother attending a facility. This choice is and always should be the mothers, herself. The Birthkeeper can bridge the gap of support. But guess what! Doulas can, and some do this, as well!
If you ask me, titles are trash. I do not like titles, any of them. If I had to pick one, Id choose Birth Attendant or Birthkeeper. Why? Because there is no definition, I make my own. Is there a true difference between a Doula and Birthkeeper? It depends on each individual worker!
Regardless of which you choose to hire, make sure she isn’t limited in serving you! Make sure your views align. Know that no two are alike!
What do you feel the difference is between a Doula or Birthkeeper? Is there a difference? Is it all the same?
We asked the HERBAL students! Here are a few of their responses:
“Doulas are a scope. Birthkeepers are free. Doula is a title, Birthkeeper is an honor. Doulas have to follow rules, Birthkeeper only limits themselves to what they are comfortable with. Doulas are working…. Birthkeepers are the sacred keepers of birth and we are answering our calling.” – Veronica Hart
“There is no simple and succinct answer for me to find but I do have some thoughts. I believe that the definition of each “title” is different depending on the belief system of birth held by the person who uses it. This accounts for the huge variation in definitions. I also think that the definition of each title is forever changing and reflects the complex birth culture (socially and medically) we find ourselves in today. The title “Doula” I believe has seen the most change and now finds itself in a place far removed from where it inherently began. It has fallen prey to a new identity that conforms to social expectations of birth and over medicalisation. A drastic shift from lay role to professional role with scope, constraint and narrowly defined parameters. I see “birthkeeper” as a means by which to reclaim the ownership of birth back from the very constraints its sister title “doula” has fallen to. For me “birthkeeper” is an uprising, a statement to remind us who birth truly belongs to and that ownership has landed in the wrong place. It brings with it, the authentic generational power that the title “doula” has always held but unlike the term “doula” the term “birthkeeper” has yet to experience the same fate. For me the significance does not lie in each term, it lies in the belief system that underpins it. We find ourselves today in a place where “Doula” has been shaped to fit social and medical expectations of birth. It has lost its authenticity, wisdom and person centered power. Step fourth “birthkeeper” ready to reclaim the wisdom and hand the power back to those giving birth” – Allison Tate
“A doula supports birthing people within reason. A Birthkeeper supports birthing people. Period.” – Kristyn M Gerchalk
“Doula uses the word scope. But seriously. A birth keeper serves women to the fullest extent of her ability, comfort level and legalities. A doula stops at some invisible line drawn in the sand. I use them interchangeably on public posts because people are more familiar with the word doula, but it does not resonate with me. Obviously a birth keeper won’t risk arrest… and honors her own biases and what she is comfortable with for her own mental health… but that is the ONLY boundaries for a birth keeper.” – Sierra Jean
“I believe this can differ with each person.. Some doulas are absolutely amazing and will go above and beyond for their client.. some use the word “scope” and act as if their job isn’t to protect their client, when in all actuality that is one of the main things a doula is supposed to do (in my opinion). A birthkeeper is the holy grail. They always go above and beyond, they don’t believe in “scopes”. They know their purpose and don’t question it. Some doulas are just like birthkeepers, the only difference is the label.” Char Sondrol
“A birthkeeper sets their own limitations. A doula has them set for them.” – Amanda Jones
“To me I feel that doula is the perfect word to describe someone who provides more full spectrum services including pre conception, pregnancy and postpartum. Birthkeeper is the perfect term for someone attending a birth who intends to keep birth in its most wild and natural state. I think there are doulas our there who have made ‘doula’ a dirty word but I don’t believe they are doulas at all. Real doulas are mother servants and I think the essence of a doula is someone who respects pregnancy, birth and women in the way they are supposed to. I am a doula and I am proud to be one in the most traditional sense of the word. ‘Scope doulas’ are not doulas at all. They don’t embody the true meaning of the word. I am taking it back.” – Casey Hone
“A doula is a profession, a birthkeeper is a calling; the former pursued with a desire to help people, the latter is part of who they are.” – Kristi Whitten
“There isn’t one significant difference. Both serve women to the fullest extent of the law. I think the differences would be social differences. The word “doula” has gained terrible traction lately. It’s been “defined” on the internet as someone who follows scope mainly due to certifying organizations like pro doula and DONA. But just the same, the word “birthkeeper” has also gained terrible traction all the same. It’s been “defined” by the other side of the internet as those who don’t follow the laws of their state at all (not necessarily true at all) and that are argumentative and rude.” – Hope Lauren
“i don’t know that there is a difference basically. i think it all comes back to who is using the words and how they are using them. i use both terms interchangeably, mainly because i feel like doula is a term more widely recognized. but i do think there is a difference in the mainstream doula, and what/who i am.” – Tamara Niedermann
“I don’t see a difference in the two. I feel like they both serve women to their extent and to what they are comfortable with. There are wonderful doulas and there are horrible ones. There are horrible birth keepers and there are horrible ones.” – Cheyenne Richards
“A doula has one single role. A Birthkeeper is like water, taking whatever role is needed.” – Tara Alexandra Ortiz
Birth space is such a sacred area to be in. If someone invites you into this space, you should feel honored. There are a few things to keep in mind when being courteous of this space.
One of the first things to keep in mind is that birth is a physiological event (in the case it is left unhindered). There is no emergency, no need for fear, concern, or anxiety. Birth is a naturally occurring bodily function that more often than not, needs zero help. Women have been doing this for centuries!
Second, the energy you hold in her space. If you start to become
anxious or frightened, it may be best for you to step out and move
away from her. Your energy effects those around you. In the time a
mother is laboring, she is very spiritually/energetically open, and
receptive to the energy you give off. It is key to have positive
energy in the birth space.
Thirdly, time. Just because your birth was 6 hours start to finish does not mean another woman’s will be. Each birth has its own time frame and no two are identical. Do not make her feel rushed or become fearful due to the length of labor. Labor can be only minutes long or it could be days long. Go in with no expectation, and enjoy the unknown journey with her.
Next, is staring. Mind your eyeballs at her labor and birth. Women are not circus acts. A laboring mother is absolutely beautiful and admirable every. single. time. but, staring and watching her will likely only delay things. Women, more often than not, will labor more efficiently not being watched. I personally do not like to stare a laboring mother down. It is not respectful and I know it is not doing her any good. I also believe I will learn much more from her voice/sounds than looking at her face, more often than not. More ears, less eyes.
Lastly, remember that this is HER birth. It doesn’t matter if you
laid on your back to birth your children, if she wants to hang off of
the door frame and birth her baby, she should. She should not be
encouraged to meet someone else’s desires for her birth. The
navigation map of labor and birth is generic, no two identical. Let
her navigate her own way through, know that she does not need your
suggestions. Her body will relay necessary information. Let her make
her own choices in her birth, and respect them, even if you might not
agree. Her autonomy is important and something to respect.
What are a few things you wished others would have minded at your
birth? What advice would you give someone who will be holding sacred
space at a birth?
The partner’s role in labor and childbirth has changed drastically over the course of time. It used to be that men would not be around for labor or birth, they would go off and do their own thing while the woman birthed their child. But now, it has become the norm for the partner to be with the birthing woman. Not only this, but his involvement is proving to be highly valuable.
In fact, it is even suggested that having the partner absent from pregnancy, labor, and birth could lead to adverse health outcomes for both mom and baby. Here is a portion from this study, which briefly discusses the harms of not having the father present. “..fathers who are absent at birth, having already largely withdrawn from the child’s life beforehand, are more likely to have children with health problems at 3 months old.”
This study divulges how the father’s involvement with cord cutting has impact on their bond going forward. Those who did cut their child’s cord showed continuous improvement in emotional involvement with the infant. These partners found empowerment in being able to participate in this life changing event, which encouraged their continuous connection with their child. This connection, love, and affection from the father/partner benefits the child’s emotional development and overall health.
This study reveals that fathers are beneficial in comforting and calming baby in the first 2 hours postpartum from elective cesarean birth. Birth where mom might not have been able to experience skin to skin, so the father filled this role. These babies found comfort and security being skin to skin with their father. As in, they stopped fussing and became calm within 15 minutes of being placed on the father.
This is beneficial to the infant’s crucial emotional development. This experience also leaves the father feeling empowered in his role, and more emotionally connected to the child. This supplies a great start for a lifetime of healthy bonding.
I mean, there are hundreds of studies and articles produced discussing the impact of the father’s participation and attendance of birth. It has a positive impact for everyone! – Mom, Baby, and the Father/Partner themselves.
In the births I attend, I like to encourage partner/paternal involvement as much as possible. I see with my own two eyes how this empowers them. I see how this makes the partner confident in their role. I also see the child who is soothed simply by their fathers voice and touch.
Ways that the father can be incorporated in labor and birth are endless, they will also vary depending on the birthing woman’s desires. A few ways I would suggest a father’s participation and involvement would be:
Being a physical and emotional support for mom during labor. Applying counter pressure, holding her, reminding her how well she is doing; offering her water/snacks, and giving her intimate affection (whatever that means to the individual couple).
Catching baby as they emerge. I personally feel this plays a huge impact on the father’s empowerment. This is such a special moment and it often leaves them feeling overwhelmingly competent in their ability to fill the parental role.
Cord cutting! This is something I also encourage the partner to participate in. The tying of the umbilical tie as well as the severing of the cord itself.
Weighing of baby! Nothing is quite as special as seeing the father read and reveal the stats of their newest little love! They almost always smile, just permeated with pride!
The ways a partner can positively impact a labor, birth, and postpartum experience are endless, as are the benefits. Did your partner play an active role in labor and birth? How did you, as the birthing mother, feel about your partner’s involvement?
I love birth but some aspects of birth are very triggering to me, it literally makes my skin crawl.
I support women’s choice to birth wherever they feel most comfortable. The woods? I’m with that. Your house? Call me, I’ll show up! Birthing center? I support it, but you won’t be hiring me. The hospital? I support that choice too! – but I, physically cannot support you there. I have nothing to offer a woman that chooses a medicalized birth. Be it a birthing center, hospital, or any other assisted setting.
If a woman births in these locations, she is literally signing her birth over to the provider’s power and discretion. If the provider feels mom needs an episiotomy, forceps use, a cesarean, etc., she will endure this and it will be legal, even if she is screaming “NO”. She can sue, but from what I see, she will not win. How can I support a woman with zero rights, who legally, cannot support herself? I’d be happy to explain, feel free to ask.
The trauma that occurs in these facilities is not worth any set dollar amount for me to endure witnessing. I’m not down with the secondary trauma involved in assisted birth. Some women are strong enough to watch this all play out, and sleep at night – I cannot.
Here’s something many people do not know; I have never attended in support at a hospital birth. This does not mean I have not seen hospital birth. Don’t get it twisted, sistah. I am triggered in this setting – it is hard for me to watch all that a hospital birth has to offer, play out. Even in social media shared videos or photos – I won’t look, I do not want to see that. In fact, I will not step foot into a facility unless there is a case of an emergency. In this case, I would be the most fierce guard dog for mom. This has not been necessary thus far. I personally will only attend births where the mother is 100% in control of her birth and choices being made.
When I see assisted birth photos or videos, the items listed below are what make me cringe. I literally want to throw up when I see these things. I wasn’t always this way! Only after learning what birth could be for women, do I cringe at the sight of anything less.
The room itself, the setup, the equipment, the tubes and cords, the bed, the baby table, the hazardous waste bin, and the privacy curtain.
The needle in mom’s arm, taped to her with cords and tubes.
The crowd of people in the room, most being random strangers mom has never met before, and the excessive energy that will impact mom.
The harmful constant fetal monitoring bands on moms’ belly, penetrating baby constantly.
The unnecessary interventions being performed by the medically mined provider.
Mom confined on her back, like a helpless victim.
Mom’s positioning during birth and there immediately after – often, legs spread, up in the air, with a light shining right on the women’s vagina. Very degrading and disempowering.
The provider pulling baby from the vagina or interfering manually in any unnecessary sense.
The Placenta being pulled/tugged only an hour or less after birth as if they cannot wait for the woman’s body to release it.
The bracelets on mom. Plastic rubbing against laboring women’s skin.
The horrid hospital gowns, making one look like an unwell patient of illness.
Gloved hands being the hands welcoming baby earth side.
The immediate wiping off of the baby.
The separation of mom and baby immediately postpartum.
The suctioning of baby’s mouth and unnecessary handling of baby.
The staff uniforms, from the shirt to the shoes.
The gloves and masks worn by people present, as if it is a toxic event.
The rough handling of baby after birth.
The plastic bands placed on the newborn’s arms and legs after arrival.
The ointment in baby’s eyes, interfering with physiological bonding and wiping out all good flora/bacteria.
The band aids on baby’s legs from the injections they snuck in almost immediately postpartum.
The unnecessary and hindering hat placed on the newborn baby.
The hustle and bustle immediately postpartum
The PURE lacking of autonomy and biological normality’s in labor, birth, and postpartum.
I could go on but it is impeding my energy.
Nothing about any of the above or the actions occurring in this setting are physiological. It starts out medicalized from the second mom walks in. Putting plastic bands on her arms, needle in her arm, monitoring bands on her belly, and whatever else they can deem necessary. Almost as if there is some sort of emergency occurring, not a biological function.
I am not comfortable with this, and that’s okay! Many women aren’t comfortable with unassisted birth either, I’m sure. Seeing something I know is often better off untouched, being touched and turned into a medicalized event, brings me so much anxiety. I stay away from settings that can contort my view of birth, give me anxiety, or are likely to leave me with secondary trauma and stress. The medicalized birth setting is not for me, I simply am not best fit to serve in this setting. It literally makes my skin crawl.
*NOTE: This is simply my perspective and feelings surrounding hospital birth. I do not need your agreement or understanding to make them valid. I also know that not all of the list above occurs in all facility birth, no need to point out the obvious.
If you were a fly on the wall on a Labor & Delivery floor, you would see a bag of Pitocin or Synthetic Oxytocin being hooked up to a majority of the IVs on the floor. For some, Pitocin is absolutely necessary to stop a serious hemorrhage, but why is it being used routinely for women that are having perfectly normal postpartum lochia?
Postpartum hemorrhages are responsible for about a quarter of maternal deaths worldwide, so it is absolutely a valid fear for birthing women, babies, and providers. About 1-5% of birthing women have a postpartum hemorrhage.
We also must factor in and unpack the fact that many hemorrhages ARE iatrogenic, aka caused by the providers themselves. Ripping a woman’s placenta out two minutes postpartum is not acceptable unless there is a true emergency. Pitocin, while effective at ceasing a hemorrhage in progress, can also cause a hemorrhage, when used to force uterine contractions over a long period of time, by hyper-stimulating the uterus.
What Causes Postpartum Hemorrhage?
Are there pre-disposing factors to hemorrhaging? Kind of. Black women are more likely to hemorrhage than white women, due to routine poor provider care, and a higher chance of iatrogenic-induced complications. If you have a history of hemorrhage, you are more likely to hemorrhage again. Poor nutrition may also pre-dispose a woman to hemorrhage, depending on the deficiencies.
If we reflect on the above statistic again, that an estimated 1-5% of birthing women hemorrhage, that leaves a fair 95% that DO NOT, so why are we routinely administering Pitocin to prevent hemorrhage, when we can simply treat hemorrhage when and if it occurs?
What are the Risks of Using Pitocin?
The reasons we feel Pitocin should not be used preventatively include mental wellbeing, breastfeeding, and supply/demand purposes.
Pitocin is related to a 36% increase in postpartum mood disorders, including depression and anxiety, and with the prevalence of mood disorders being 1 in 7 REPORTED cases, we seriously feel that providers should be taking this more seriously.
Pitocin can interrupt the flow of natural hormones, after all, it is derived from pig hormones these days. This can also disturb the natural placental delivery, and the breastfeeding relationship by disrupting the physiological process involved in one, the other, or both.
Now, onto the supply and demand reason. When you utilize a valuable resource on someone that does not need it, it is obviously a waste of a resource, making it a waste of time, money, and creating a gap that needs to be filled in the supplies. This leads to lower quality product because hospitals desperately have to keep replenishing, for those that are actually in need, and then continue to use the product on those who DO NOT need it. If you have a person on your left dying of dehydration, and a person on your right that just drank two cups of water, and you only have one cup of water, are you going to give both of them a half cup, or would you rather give the dehydrated individual all of the water, since the other person is fine and well-hydrated already? I think the answer is obvious, myself. I would much rather those that genuinely need Pitocin to receive higher quality Pitocin from a safe source, than for everyone to receive lower-quality Pitocin, preventatively.
For my animal-loving friends, it also must be pretty unimagineable how many pigs must be used and abused to keep the Pitocin manufacturers up to speed on supplying…
Also be mindful that Pitocin administration postpartum does not only occur in hospital settings, there are MANY midwives that routinely administer Pitocin injected intramuscularly, postpartum, so be sure to discuss this with your midwife if you are having a home or birth center birth, as well.
To address the title, we compared Pitocin to episiotomies because for a very long time, episiotomies were seen as absolutely necessary, to PREVENT tears. This is exactly what is happening with Pitocin as well, it is being used to PREVENT something that may never happen. Now, the ACOG organization advocates against the use of episiotomies in any scenario, allowing the body to naturally tear and stitching/repairing as needed. It would be optimal for everyone to use Pitocin the same way.
Should Pitocin be used in an emergency, despite the risks? ABSOLUTELY. It just does not need to be used for every single person that just had a baby.
Recently I have seen a rise in people claiming to be a home-birth midwife that are not trained or equipped to provide the services they offer – all across the US. This has resulted in multiple fetal deaths, maternal deaths/harm, and unnecessary birth trauma. These ‘midwives’ are something to shy away from – here is how you can avoid them for your own birth.
Midwives are not interchangeable; no two are the same. Most serve with a heart of true passion and care; some serve solely with a wallet to fill or ego to boost. Some will walk with women throughout their entire journey, and some will bail on them for various reasons. Some midwives undergo years of training/attending/learning/practicing. Some claim to be a midwife but has nowhere near enough training to do so. It is crucial to interview properly to make sure your midwife is a good fit for you. Don’t hire a woman who will be ‘a deer in the head lights’ when you or your baby needs assistance.
Keep in mind, a licensed midwife does NOT mean a well-trained and educated one. More often than not, it only limits how they can serve you. In my experience, it is the licensed midwives who can be fear ridden, as taught in their medicalized schooling – not all though! Again, none are the same. It should never be a degree or license you are looking for. You want one who is there to serve YOU, not serving the state or medicalized model of birth.
Here are a few questions that would be great to ask a possible Midwife. Be sure she has answers, if you have questions that go unanswered – you should not take this lightly. She should not be hired. Never ‘settle’ on a Midwife.
What training have you had? Schools, degrees, certificates, preceptorships, internships, etc.?
(You can look up their schooling history, degree, and certificates online. Do not take anything for face value. Do your research before signing a contract. Again, some midwives do lie about qualifications. If they attended internships/preceptorships, ask to reach out to their preceptors. Some are fired or let go before completion and choose not to disclose this information. You may want to know why.)
Are you trained/certified in neonatal resuscitation? (You can ask to see their NRP certification card as proof. Yes, many birth workers do lie about their trainings!)
How many times have you had to resuscitate in your career?
How many births have you attended?
Where can I find reviews for your services? (You want to be sure you hire someone who is backed by past clients. If she does not have reviews, this could be a red flag)
How long have you been attending births as a primary midwife? (This asks how long they have been attending on their own, without a preceptor – someone guiding them)
How many births do you attend per month?
Do you have a backup midwife? Will I meet her? (Every midwife should have a backup. You should ask to meet this backup prior to labor if you do not want a stranger possibly walking into your home on birthing day)
Do you have an assistant or will you be attending alone? (Some bring an assistant and some charge more for the assistant)
How many times have you had to transfer during labor? (A midwife’s transfer rate says a great deal about her ability to serve women)
Do you stay with mom once she is transferred? (Many midwives will transfer mom to the hospital then leave once she is admitted. This likely isn’t something you want, be sure it will not occur)
How many times have you had to transfer mom/baby postpartum?
Will you attend twin, breech, and VBAC births? Why or why not?
What complications and emergencies have you seen and how were they handled? (i.e. prematurity, prolonged labor, fetal distress, breech, bleeding, dystocia)
What circumstances/conditions would rule out your attendance? (In many states, especially with licensed midwives, they are required to drop you from their care for many unnecessary reasons. Do not get to 37 weeks and find out she is dropping you because your baby chooses to present breech. If she is not competent, or holds her license above your births wellbeing – she might be a MEDwife and might leave you hanging with no care or reimbursement.)
Can you list each scenario that could possibly risk me out of your care?(Know ahead of time EVERY reason you could be released from her care. Depending on state, the midwife’s knowledge, her licensing, and her competence, there are many reasons they can drop you from care. Things that are not in your control Be aware of EVERY possibility before signing a contract)
What complications/emergencies are you prepared to handle?
Under what circumstances do you transfer to a hospital? (Some midwives are known to transfer women for silly reasons that are not science based. Be sure your midwife will not bail on you when you are vulnerable.)
What percentage/exactly how many clients have had cesareans in your practice?
Will you accompany us through a hospital birth if one was necessary?
Do you offer prenatal care? What is your schedule for visits?
What is included in prenatal care? (i.e. lab work, urine checks, blood pressure, fetal heart tones, fundal measurement, baby’s positioning, & vaginal exams & PAP)
What type of nutrition counseling do you provide?
Do you visit the home at any time before the birth?
Am I required to complete any kind of testing? (Some Midwives require specific testings or they will drop you from care. This is not autonomy and likely not something you want to sign up for. You should have complete control and say over your prenatal care)
Am I required to attend a certain amount of prenatal appointments?
What happens if I refuse appointments, procedures, or suggested medications? (If they have an issue with your having say over your pregnancy and refusing XYZ, run the other way)
When do you like to be called once labor has begun?
When do you come to the home once labor has begun?
What equipment do you bring and what must we provide? (You can tell a great deal about a midwife and the care she supplies by what she carries in her bag. Does she carry herbs and tinctures or does she simply carry Pitocin and oxygen. Know what she will be showing up with! Know what you are comfortable with being used.)
What emergency equipment do you provide?
How do you view the father’s role?
What is your role during labor? birth?
How do you feel about sibling participation in birth?
What non-drug measures do you suggest for pain relief?
How often do you listen to the baby’s heart rate during labor?
How often do you check the mother’s blood pressure?
Do you require vaginal checks at all, ever? (Vaginal checks can be harmful and mean nothing in regards to progression during labor. If she requires vaginal checks, she might not be a good fit. That would be a red flag that she does not support autonomy.)
What is considered fetal distress in your opinion?
What do you consider prolonged labor/birth pushing?
Do you have preferences for labor/ birth positions? (This answer should always be “It’s the mother’s choice”. If she requires you to lay in a certain position, this is a concern.)
How do you feel about water-birth? Have you attended any?
What measures do you take to prevent tearing?
Will you allow partner to “catch the baby” instead of you?
Do you check for tears after delivery?
Do you have local anesthetic & suturing equipment for this repair to be done without going to the hospital? Do you suture all tears or only major?
How do you prevent/treat excessive postpartum bleeding?
How do you handle the baby immediately after birth?
How long do you stay after the birth? What do you check at this time?
What is your schedule for follow-up care?
Do you do the newborn screening tests?
What are your thoughts regarding circumcision?
How is the filing of the birth certificate handled?
Do you routinely give me a copy of all my records after the birth?
How much do you charge for your services?
What services are not included in this fee?
Do insurance plans cover your fee? Do you accept direct payment?
When do you want the full fee paid?
Are there any refunds if I risk out of care? (I see it occur so often that a mom “risks out” of care and mom is left with no midwife and no refund. 7K+ down the drain at no fault of her own, and no home birth to show for it. Know about her refund policy and make sure you agree before signing!)
Determine the midwife’s willingness to be open to communicate, explain things that you don’t understand, and willingness to let you make your own decisions. If she is unable to answer all questions without hesitation, be wary.
Be sure to reach out to your local birth community and ask around. Some providers will present themselves to be something they are not. Their abilities will reflect in their past client’s experiences. Read all reviews, ask questions.
Hiring a midwife is not a simple choice, this plays a HUGE role on birth outcome. Knowing the difference between a CNM, CPM, and traditional midwife is also helpful in making a midwife selection. Again, Midwives are not interchangeable – none are the same. Do not settle, find one that is a perfect fit for you!!
Surrogacy has really taken off recently. In the most popular surrogacy group on Facebook, there are over 13,000 members eagerly asking questions, commenting and either completing or beginning their surrogacy journey as an intended parent or as a surrogate, gestational or traditional. It seems more and more I see my timeline popping up with friends going through surrogacy, that I really never expected to.
I have people reach out to me daily asking about my surrogacy experience and honestly, answering is becoming exhausting, time consuming and draining, so I will put it here for the world to see and it will find the people it’s meant to find and if you’re looking for answers and perspectives, here they are. Please read in full before reaching out to me with questions. It’s long but it’s necessary if you feel you are wanting to make an informed decision on whether surrogacy is right for you. If you are contemplating egg donation, please see our egg donation article for my perspective on that here.
Preparing for Surrogacy
You must know that the process going into surrogacy is a hurry up and wait game. Whether you go through an agency or independent, you can expect to be waiting at minimum 6 months before even starting to get pregnant; some women wait much longer – even years. So do not go into this expecting to get pregnant or get a paycheck quickly, by any means.
Before you even get into the nitty gritty, check if your state even allows surrogacy. The ability to be a surrogate depends on the state YOU live in, not the parents. For example, in New York, surrogacy is not permissible or legal. There are ways to get around it, but it’s a gamble for you and the parents legally. For a state by state guide, learn more here.
Types of Surrogacy
There are different types of surrogacy, so you must decide which route you will take.
Traditional surrogacy involves using your own egg, so you would be biologically related to any baby you carry. This may involve home insemination, in clinic insemination, IUI or the full IVF process, extracting your eggs, creating an embryo or multiple embryos, and transferring the embryo(s) into your uterus.
A gestational carrier is just that – a carrier. You are simply hosting the embryo(s) and they are not directly biologically related to you, though, if you are carrying for a cousin, sister, daughter or any other relative, they will be distantly related to you, of course. This involves the second half of IVF and we will go in depth with that explanation in a bit.
The Legal Side
Once you’ve decided whether you want to be a gestational carrier or a traditional surrogate, you will pursue an agency. Typically agencies do not aide traditional surrogates as they are legally more complex and involved. There are TONS of agencies to choose from; vet them wisely. Ask questions about how they support you through the process, what process steps they handle prior to you getting matched with parents, if they can match you with parents that fit your values and birth plan, how compensation is handled, and if you are 10-99d for the compensation you receive (if so you must save at least 15% of your compensation for the following tax year, or you will be investigated by the IRS).
Some values that are important to consider in surrogacy are:
Compensation: What is the compensation amount to make it worth it for you to dedicate your body for a minimum of 10 months, sometimes over a year if transfers fail, you have to do mock cycles, you have an early loss, etc? What about lost wages if you have to miss work for appointments, or quit your job all together? What will be your transfer fee? What about if you have to have a hysterectomy from birth complications?
Embryo Transfer: This is one that really stirs the surrogacy community up, but let me make it clear that transferring multiple embryos to increase likelihood of pregnancy is no longer evidence based. It sounds like it makes sense at first, but it is not backed by science. It just increases your risk of multiples, and there are some theories that transferring a lower grade embryo with a higher grade embryo makes a pregnancy LESS likely to occur or sustain. Multiples occurred through IVF increase the interventions pushed in pregnancy and birth and enhances your risks for pre-term labor, placental complications, pain, rupture and more. If your Reproductive Endocrinologist recommends transferring two or more, run away. You should always transfer ONE for yours and baby’s safety. Transferring two or more, to “save money”, is NOT worth it.Also, how many separate transfers are you willing to do before you have the option to drop the contract? The standard is three, but it’s absolutely your choice. It can be very taxing on your body and may require out of state travel and lots of time away from your own family.
Termination: Under what circumstances are you willing to terminate? None? Any? Parents choice? Specific birth defects? Multiples? You absolutely must know what your stance is on this and put it in the contract.
Parental Involvement and Contact: How involved do you want the parents to be? Would you like someone local that can attend every appointment? Or do you prefer someone to give you space through the pregnancy and update them via text or call after each appointment? Can you tolerate communicating via translator if your parental match is foreign? Are you comfortable with them being present through the entire birth, or are you more private?
Birth plan: Do you want someone that is okay with a natural birth? Home birth? Birth center? Hospital? Who will your provider be? Are you okay with being induced if requested? Would you agree to a scheduled cesarean? What are your limitations on intervention? At what stage of labor do you plan to go to the hospital? Who will be present in the room if you need a cesarean and only one person can go with you? What happens if the parents don’t make it to the birth? Who will cut the cord? Who do the baby/babies go to immediately? Would you like a doula present? A birth photographer? If so, who covers those costs? Will you share a room after birth? Who gets the placenta(s)?
Providing Breast Milk: Are you willing and able to provide breastmilk?What will be your charge per oz? Will you do it for free? How long are you willing to provide for?
There are certainly other factors to consider as well that your lawyer will discuss with you in building contracts, but those are the main, important factors.
The Evaluation Stage
Now, let’s move on to the evaluation stage! In this stage you will be required to attend several appointments, gas and time coming from your own pocket. This involves a medical evaluation of your reproductive organs and general health at a Reproductive clinic, an approval from your OBGYN for clearance of pregnancy, a psychological evaluation for you and your partner, a background check, and a blood draw to screen for diseases, drugs, hormones and nutrient levels.
You will need to get a hysteroscopy during the medical evaluation, in which they insert a catheter into your uterus and fill a balloon with saline to examine you for cysts, endometrial tissue abnormalities, and uterine shape to check for optimal conception and pregnancy chances. It’s not really painful but definitely feels odd and you may experience period like cramps and bloating after. You will need a recent healthy, normal Pap smear and pelvic examination from your OBGYN for pregnancy clearance. If you are not immune to specific “preventable diseases” some reproductive clinics may require you to be immunized before proceeding. If you have any drugs in your system, you will be denied point blank, for obvious reasons.
During the psychological evaluation you will need to take a test that’s about 300 questions long, it tests for psychotic and sociopathic tendencies and how risky of a person you are. It’s all multiple choice and true or false, and based on your own opinions, so don’t worry, you don’t need to study. Then you will meet with the psychologist where she or he will chat with you about your surrogacy motives, family psychological well-being, how safe your home is, how your birth and previous pregnancy experience was, how you feel about different surrogacy scenarios and what you would do in those situations, and they will gauge your partner’s well-being and how supportive they are of the surrogacy. Your partner must be completely on board. If you don’t have a partner, you must have great support, such as your parents, reliable childcare or someone else that can be there when you call, as needed.
You also must be at least 21 years old, not be on any type of government financial assistance (food stamps, WIC, or any variety of that), have had at least one healthy, complication-free and term pregnancy and be raising said child. People who have had gestational diabetes, pre-eclampsia, antenatal depression, pre-term delivery, hyperemesis gravidarum, placenta accreta, or any other complication may not qualify.
Once you have gotten through all that, now it is time to start contracts. Contracts can take several months for some matches, and as little as a couple weeks for others. Have your lawyer go over EVERY SINGLE DETAIL and ASK QUESTIONS. ADVOCATE for yourself, or you may regret it. Remember all those values we mentioned before and include them ALL. It doesn’t matter if you are “being complicated,” the lawyers are making thousands off this contract and it’s so worth it to protect yourself. Take your time, don’t feel rushed by this part. You will need to have your contract notarized and if you are married, your spouse will need to sign as well, in most states.
Now, we move forward into the process of getting pregnant! Are you exhausted yet?? LOL
You may have a mock cycle to see how your body responds to medications, or may be put on birth control to syncopate your cycle with the Intended Mother’s if doing a fresh transfer. The medication protocol is different per every clinic, and sometimes different per each individual, so it’s truly hard to gauge what your specific cycle will look like. It is EXTREMELY rare that a clinic allows a natural cycle so do not hang on those hopes going into it.
The medications you may be put on include:
Birth Control (this may be the mini pill or something stronger)
Lupron (this is an ovulation suppressor and is self-injected into your abdomen)
Estrogen (this may be oral or self-injected)
Progesterone (there are many forms, PIO, or progesterone in oil is the most common and effective, and is injected into your upper buttocks or your thigh, you may be on this for 2 months or more once transfer occurs. There is also oral progesterone and vaginal suppositories and those may be used in combination with progesterone in oil or solitary.)
PLEASE research the side effects of these medications before proceeding, they can have life long effects and include but are not limited to, dizziness, fainting, vaginal bleeding, painful and sore knots at injection site, allergic reaction, nausea, vomiting, migraines, sore breasts, infertility and cancer of the breasts, cervix and ovaries. Progesterone supplementation can lead to placental complications and those complications are common in the surrogacy world.
I also strongly encourage you to look into birth trauma and primal memories of infants, but that’s a subject for a different day. Surrogacy is not victimless and not solely a positive gift, no matter the relationship between the surrogate and parents. Moving forward…
My Surrogacy Story
This is my personal story and perspective of my surrogacy, after sharing that informational bit. Take it and do with it as you will!
I had always envisioned myself one day carrying a child for someone that couldn’t, I was not actively pursuing, it wasn’t something I was necessarily looking to do right away at the time, but I was open to it and researching it and did talk to a couple women that were connected to me by a friend that had her babies via surrogate. Between these first conversations I realized what was important to me.
I met a woman that was the sweetest soul, her story touched my heart. I spoke with her about my intentions and knowledge for the pregnancy and birth, and she communicated that there was trust and free reign, that she agreed with how I felt about interventions, that it was my body to make informed and safe choices with, that she believed in the natural lifestyle, she was raised naturally and her business seemed to jive with exactly what she was saying. I thought we connected very well, that I had found my soul sister. We talked for months and months, and I even drastically lowered my compensation to almost nothing because I truly thought this was a lifelong bond and connection, as it should be, and as it was portrayed from her that it would be. The monthly compensation wouldn’t even pay my rent by itself, if that gives you any idea of how low it was. But I was okay with it because I felt that she truly respected and appreciated me, and that’s all I wanted, to bless a loving pair of souls with a beautiful little baby, it was never about money for me. I bring up the low compensation because when you’re a surrogate, at least in my experience, apparently it’s justifiable that the parents treat you however they want because they pay you so well. I beg to differ.
I went through every check of the process with flying colors. I responded to the medications with ease, was injecting myself daily but pushing through.
We transferred two embryos and both of them implanted, that evening I felt the actual implantation and remember pointing out the exact spots of the implantation to the mother, it was pretty cool to be so in tune to my body at that time. We got a positive pregnancy test just 3 days later. I flew home the day after.
Then, just 6dpt…
About 5 weeks go by and my pregnancy tests have just been getting darker and darker and my HCG is through the roof. A little nausea and sickness has started to show itself, but I didn’t think much of it. I went to my first ultrasound of the pregnancy and I remember the tech asking me how many embryos I had transferred as she turned the screen to me to show me two distinct sacs with little beans growing in them.
As the days passed after this appointment and my HCG kept spiking, my little bit of nausea turned into violent all day sickness, barely keeping water down, fainting spells, and basically bed ridden. Turns out, the medications used for surrogacy and IVF can stimulate H Pylori overgrowth and cause Hyperemesis Gravidarum.
And then things got worse again… Had my first and only ER trip at 14 weeks because I started to faint again, and felt like I was dying this time. My body was so depleted. My BP was very low and my heart rate was 150 resting, obviously my body was in dehydration survival mode. My husband quickly whisked me to the hospital and they were able to replenish my fluids and check on the babies but they also found placenta previa. Handling my sickness was a challenge between the parents and I because they weren’t comfortable with CBD oil, or prescription meds. I was at a loss.
There were also payment complications with bills. Somehow my moms FSA account got charged from that hospital bill, payment plans in my name were discussed, but in the end it all got paid, after a very stressful few days for everyone. So be aware this can happen! This is why it’s important to have an escrow account.
Finally, around 17 weeks, I came out of the horrible sickness I was experiencing. Around 20 weeks the placenta previa cleared on its own.
At 24 weeks the parents came down again, this time for a little bit longer, and I was forced into a high risk MFM appointment, for absolutely no reason, where they did almost a two hour long ultrasound that was very painful. If anything, those high risk appointments are WHY women lose babies because of how stressful they are. The doctor there put it in the mother’s head that an induction must be done at 38 weeks for twins or else they could die. Couldn’t give any statistical or scientific back up for this, she said it just is what it is. On our two hour car ride trip back to my house, I explained how inaccurate that is and even found studies that negated what the doctor said.
For the remainder of my pregnancy, this would be an issue that continuously came up – the doctors wanting to schedule an induction. At this point, I felt I was the only one truly advocating for the health of the babies, and that no one understood how dangerous this was and started to shut down emotionally. After all, lung development continues well up to 40 weeks and beyond, why would we want to risk them having poor breathing and spending time in the NICU?
For the rest of the pregnancy it was almost nothing but a hassle, and dealing with people watching me in surrogate groups on social media. Anything I would post in private surrogate only groups were immediately sent to the parents, so I didn’t even have a safe place to express my feelings anymore. Things were taken out of context and made the parents feel concerned with my emotional well-being and state of mind. Even someone I thought was a good friend sent screenshots of text messages of me venting, which caused a major wedge in the surrogate-intended parent relationship that never needed to be there.
As “induction day” drew nearer, tensions were high, speaking terms were non-existent, and I was gathering the necessary tools and speaking with legal people in preparation for a court battle, if need be. I cancelled the induction appt.
At the same time, the OBs office was also giving me a hard time, refusing to even see me if I wasn’t going to be induced, which is completely unethical and from what I read up on, actually illegal. I forced my way into the office and demanded an on the spot appointment because I wasn’t about to be accused of breaching contract just because I didn’t have my weekly appointment. I allowed the weekly NST, as usual, and the chart immediately picked up back to back contractions, and a hard time picking up baby A (the boys) heart rate. The OB asked me to just do an hour of monitoring in the hospital to be safe.
Monitoring at the hospital still showed contractions back to back, though I wasn’t feeling a thing so I assumed it was at best early labor, I could see them and they were nice and strong and steady. But I wanted to go home.
About mid point of monitoring, I got up and had to go to the restroom pretty badly. I felt a lot of pressure. My water gushed out with a pop and was a heavy flow, there was no mistaking, but I was still doing great. They came back in to hook me up and I let them know my water had broken and she asked to check me to see where I was at and I agreed to one check, I was 7cm. Well, guess go time is soon then, I thought. The OB came in quickly and announced that I needed an epidural, and with a calm and collected face (still having no contractions), I told her absolutely not and signed a non consent for pain medication form. My beautiful doula friend came to support me at this point. I asked them to call the mother and when she got there, things got really obnoxious with them trying to force the epidural.
Basically telling me I either get it or I’m having a c section right now. I asked the doctor to place it without running it, so if there was an emergency, it was quick easy access. I thought this was a good compromise that I could live with.
While they were preparing the anesthesiologist, I entered transition and was in my zone. On the floor, on all fours, full on growling though contractions in a true animalistic state. It was the most powerful feeling that I will never forget. Toe curling, full body coursing, back to back intense pressure. Like a hug from a large person that’s just way too tight, but is warm and familiar.
Now let me tell you, trying to sit still through transition with nurses holding you down while they place a needle in your spine is outrageous and gross. A needle that I didn’t even want. A needle that served me no purpose. I was at the finish line, let Birth happen for goodness sake.
And, wouldn’t you know it, they ran the damn medication anyways without permission. My body instantly reacted very badly. At first I started to go numb, then I felt my body go weak, tingly, my vision went blurry, now black and in and out of consciousness. I was shaking profusely. All I could think in my head was don’t pass out or they will cut you, don’t die for this, you have your own baby at home. My BP tanked to 70/30.
Tons of nurses rushed in to try to stabilize me. All of this for a medication that I was refusing. I should have kicked them in the face. I should have been stronger. In this test, I surely failed. The strength that I am for other women, I couldn’t even be for myself. I was ashamed.
They pulled the epidural and I regained myself and started to regain feeling and immediately went straight to the best part, when the babies came from womb to earth. I didn’t have all my feeling back for when the boy came, I was still a bit limp in my legs so I gave a little effort of push for him. With the girl I had my body back and FER completely took over when she was ready! She took her sweet time, coming 45 minutes after the baby boy, descending and my body taking a nice little break in between them, but she flew on out when she was ready with minimal efforts on my part!
The parents and I shared a room the first night and the babies were discharged before I was. I was able to make it home just in time for my baby boy’s third birthday party on the 7th! My son’s birthday is July 3rd and the twins is July 5th.
Because of misunderstandings, the parents and I didn’t talk from about 3 weeks postpartum to about 4-5 months postpartum, in which we fought about bills and all the complicated crap that happened in the surrogacy. It all surrounded expectations that weren’t met and hurt feelings.
If you ask me if I would ever do surrogacy again, the answer is no. I wouldn’t even go back and re-do the surrogacy I had. I would have never chosen to pursue it, knowing what I know, now. I think it is one of the least natural and most emotionally complex things you can do. I would only ever do it for my siblings, if needed. It aged me immensely, caused an array of health issues that who knows when I will fully recover from and has a lasting emotional impact. Not because of the bonding with the babies, I didn’t feel sadness when they were given to their parents, but the sadness that the surrogacy was everything I didn’t want. The birth wasn’t even breezy, though short, it too, was stressful. There are some that have beautiful, heart warming stories about their surrogacy and go on to have many journeys, and I wish I did too, but alas, there are two sides to surrogacy, and I’m here to share that it isn’t all rainbows and butterflies.
It has been a year since I had the twins, and my, oh my, how things have changed. I have not spoken to the mother in several months, even prior to my son’s cancer diagnosis in April. Needless to say I am so disappointed that she did not even care enough to reach out when my son was diagnosed, when mine or his birthday came around, or even at all on the twins’ birthday. It is such a shame to give someone so much love and happiness into their world without any gratitude. But I am generally at peace with it, I cannot make other people be good people out of pure desire, they have to choose to do so on their own.
Thanks for reading. Feel free to reach out with anything I did not answer here..
That’s a great choice! There are many great midwives that serve women all across the world. They usually serve in a more natural-minded manner, and know more about physiological birth than their obstetric counterparts.
When you go about hiring a midwife, it is important to be aware that they are not one size fits all. They are each very different, will practice differently, will have different views on what physiological birth is, and not all midwives are ideal for YOU.
When choosing a midwife, be aware that most are limited in how they can serve you, due to state laws. Most licensed midwives will not serve you completely autonomously without risking the loss of their license; which is sad – but important to be aware of, as many women are not. There are also midwives that are not bound by legalities and can serve you completely autonomously. These women are often considered Traditional or ‘underground’ midwives.
I’ve also heard of licensed midwives who are willing to bend rules and fudge numbers to ensure a safe, out of facility delivery – making you the number one priority.
Be sure you know who you have along for your journey before hiring!
Questions for Your Midwife
1. What does a physiological home birth look like to you?
Some may have a more medical version of home birth in mind with monitoring vitals, checking the cervix, and so on. Some will have a more natural flowing version where medical monitoring/assisting only occurs when needed.
2. How often do you need to monitor baby?
In some states, licensed Midwives are required to monitor baby every few minutes. This can be an unnecessary bother during labor. If this is something you’d like to avoid, be sure your midwife is able to support your choice of limited monitoring.
3. Are cervical checks ever required, if so, how many?
Most women do not enjoy cervical checks during labor. They can be hindering during labor and are 100% unnecessary. If your birth plan is to avoid cervical checks, be sure to discuss this, as some may require them.
4. What could cause me to ‘risk-out’ of your care?
Closer to the end of pregnancy, many women are shocked when their provider tells them they’ve “risked out” of care. This means you are no longer a client and they will no longer serve you. Some midwives will risk you out for silly reasons, such as baby being breech, solely to protect their license. Be sure you are aware of every situation that could risk you out of their care before signing a contract.
5. What would necessitate a transfer during labor?
During labor, your midwife can choose to transfer you. Transfer is necessary in some situations! Unfortunately, some will choose to do so for unnecessary reasons and without warning. Of course, you can refuse transfer, but they may be required to call 911 before they leave – this then becomes your issue to deal with while you are vulnerable. Some will transfer for silly reasons such as two slightly elevated blood pressure readings, baby being breech, or “failure to progress”. Be sure you are aware of all scenarios your provider will transfer for, before labor. It is important to also discuss what you will do in the case of a suggested unnecessary transfer. Will you stay home and continue with delivery or will you do as she suggests? This should all be discussed prior to laboring day.
It’s comforting to believe that all home birth midwives have your best interest at heart, but this unfortunately is not always the case. Those are a few questions that might be able to help you decipher if she is more concerned about you or licensure.
A few things you could do to protect yourself if your midwife drops you or suggests unnecessary transfer would be:
Do not pay in full until the deadline of payment.
Be informed on your state’s midwifery laws and the legalities surrounding.
Have a plan of what you will do in the case she drops you out of care.
Discuss each unnecessary transfer scenario and what you and your partner would do if she made the suggestion to transfer.
Discuss with your midwife prior to labor what you will do if she feels she needs to leave your birth to protect her license. Discuss each situation and scenario.
Make sure there is a refund policy in your contract, be sure you agree with it.
Be sure your partner and/or Doula are in the loop with all of the above because they will be the ones you look to for support if your midwife drops you or suggests transfer. Everyone involved should know what would cause you to “risk out” of care, as well as what might necessitate a transfer. No need for surprises on laboring day!
I’ve heard too many stories where a home birth midwife left a woman hanging, mostly for unnecessary reasons. Most times, the woman was unaware that their midwife could abandon them like they did. Most did not get any amount of refund, and many were left with traumatic births. This is what drove me to create this article. Women in their childbearing years need to be aware that this can happen. They need to know what questions to ask and how to decipher if the potential midwife is a good fit, prior to signing a contract and paying in full. She can be a sweetheart and say she supports, you but there is more to it than that.
Again, not all midwives are the same. It’s important to acknowledge that there are a few snakes in the grass. Many midwives will have your best interest at heart, will bend silly rules for you, and put you before themselves – be sure the woman you hire is one! There are amazing midwives out there, you just have to look! Keep in mind, if your midwife is driven by the law, that is exactly what she will deliver.
You know how when you watch movies, doctors will instruct a woman when to push while delivering her baby? Did you know that “pushing” usually isn’t even necessary during natural labor and birth? Instructed pushing can actually be harmful. Mother should be following her instincts, solely, instead of relying on others to tell her when and what to do.
When mother is left to labor undisturbed, it’s possible she may experience what is called the Fetal Ejection Reflex. This is when the body expels the baby with no real effort from the birthing mother. Her body simply does it on its own, naturally. It’s like a sneeze! Once it’s coming on, you can’t stop it! But if you don’t experience it, you can’t force it, as Dr. Michael Odent says.
FER happens in the transition stage. High levels of adrenaline and norepinephrine trigger the Fetal Ejection Reflex (FER). These adrenaline and oxytocin surges create strong, rapid waves, and these powerful waves (otherwise known as contractions) move the baby from the uterus and into the birth canal. The pressure from baby in the vagina triggers the uncontrollable expulsion of the baby. The nerves in the pelvis are stimulated and baby descends through the birth canal. This automatic bodily function sends messages to the brain to release more oxytocin, resulting in two or three strong contractions. The baby is then born quickly and easily without voluntary pushing from the mother.
When a large amount of adrenaline enters the mother’s bloodstream, it gets her out of the exhaustion state she may have been in previously, preparing her for baby’s arrival. This makes her alert and prepared to catch and protect her young.
FER can come on suddenly. Prior to FER kicking in, many will experience sudden thirst, dilated pupils, and a period of panic or fear. This is normal and no reason to be concerned!
What to Expect from FER
The birthing mother may show a sense of fear. She may say she can’t do it, she does not have any control, or may be frightened. This is when she should be assured that what she is experiencing is normal and that she is about to meet her baby! She should NOT be checked for dilation. She should simply follow her body’s lead and allow baby to exit naturally! Her body will begin to “push” on it’s own.
Sometimes the woman may yelp, screech, or scream. It is an overwhelming moment where mom isn’t in control and the sensations themselves are overwhelming in the moment while your body is in overdrive. I know I definitely screeched the last 2 contractions, when I experienced FER! I had no control and the last 4-5 contractions were back to back, with no break. It’s overwhelming, so her noises are rightfully so!
If a provider steps in and checks for dilation or tries to interfere, it can interrupt the FER process. Women that feel delivering in a hospital is the safest place to be should also be aware of the impact their birthing environment has on their desired natural birth experience. FER rarely happens in a hospital with bright lights, intervention and so forth.
FER can happen when:
Mother has a sense of danger in the last stage of labor.
Spontaneously when the birthing mother is undisturbed and at peace in her own space and feels safe and supported, not being interrupted by commotion or bright lights.
It can, but rarely, happen in a hospital setting. This is because women are interrupted quite often with procedures and unnecessary interventions. If the mother is threatened with intervention, this could make her feel a sense of danger. In this scenario, if the woman is in the last stage of labor, the body will eject baby instead of stalling labor.
Labor stalling is what usually happens when a woman is in labor and is uncomfortable, feels threatened, is being bothered, in bright lights, feels anxious or senses danger. Labor stalls to protect baby from the environment mother is currently in. This is where unnecessary interventions come into play and mess up the whole natural birth flow. All because mom was in a place she couldn’t be completely relaxed and get into her birth zone.
That’s a different topic for a different day. Gahhh, I could talk about unnecessary interventions and the importance of birth environments for days! Any who, that’s FER and how it all works!
Allow your baby to arrive earth side naturally. No coached pushing, no intervention, just you and baby working together to bring babe earth side! Get yourself a doula if you would like to increase your chances of a natural birth and experiencing FER. You won’t regret it!
Have you experienced FER? Please share your experience!!