MY DREAM TEAM
(For mothers who are thrilled with their birthing experience,
For mothers that are not,
For mothers to be that have no clue what to expect)
This is the story about my pregnancy and natural, vaginal, un-medicated birthing and choosing of the team that helped me accomplish all that.
At the beginning of February 2016th, we found out that I am pregnant. Thrilled with the news, I visited my obstetrician, but my appointment did not go how I expected. I did not feel informed enough about my pregnancy process and different testing that kept being required and never explained; my questions were at times answered in a tone “not a big deal” or “you should know that”; and I was slightly ridiculed when I mentioned that my job (teacher for 2 to 6 year old children) is getting a bit demanding for me in my new condition. It took me few months to admit to myself that I deserve better than that and to start the research for new care-provider, preferably midwife this time. My husband suggested to call each hospital affiliated with midwifes and ask them for their names and phone numbers. First on my list was Hackensack UMC Pascack Valley in Westwood, NJ. They gave me quite a few names so I called each and every one of them. My husband, who was helping with the research, said: “Check this one out, I think you will like her, Donna Tabas.” I did as he said and felt that she is THE ONE! And that is how I started forming my DREAM TEAM.
Now I will tell you more about each and every team member.
First and most important one is MY HUSBAND, of course. The one I took longest time choosing, only little bit over thirty years! And even that was not my choice, I believe, it was God’s preordained plan for us and I am so thankful for him in my life – the most loving, caring, kind, and gentle person that I know of. And he only confirmed all that through my pregnancy and birthing journey. He was by my side when I was doing the pregnancy test – we cheered in amazement together to my pregnancy and our parenthood that was starting; he was researching and letting me know each week what is happening with our baby and what parts of its body is developing at the moment; he supported me when I needed to stop working unexpectedly at three months of my pregnancy due to challenging requirements of my teaching job; he was by my side when I was changing from obstetrician to midwife and did research with me and helped me find the right person for us; he read the books that were teaching him how to help me during the pregnancy and birthing, he coped as a champ to my occasional emotional outbursts of tears and such; he loved me through each and every pregnancy or just womanly tantrum; he was there to not let me give into my sugar cravings at times; he was by my side at the ultrasound exams watching in wonder with me our son growing in my belly; he supported me when choosing the doula; he worked hard after work on our baby’s room fixing the walls with contractor, painting, putting the trim; he was kissing our son each and every morning and night for both of us with such joy and gentleness. He is the love of my life, my rock and my stronghold. I hope that most of the ladies reading this have such support, and that the men will be inspired to be such a support.
The most important medical support that thought me so much about everything that I ever needed to know about my pregnancy and birthing was DONNA TABAS, CNM. I still remember our first meeting and her gentle and calm, yet strong and confident demeanor that won my adoration. Even before we decided to work with her, my husband and I learned so much from her. “SHE IS THE ONE!” we agreed and our real pregnancy journey began. First thing that Donna did was give me the booklet of about two hundred pages that she created that covers all possible questions that a pregnant woman will ever think of asking: from dietary requirements and how much weight I should gain to all the changes my body and mind can possibly experience during this process, and more. She also explained to us what is the difference between medicated and unmedicated birthing and why the first one ends up with C-section in 40% of the cases when the real emergencies are actually only 10%. As I mentioned before, Donna is very gentle but very open and persistent as well - she will do everything in her power to help you birth in the most natural way without distressing you or the baby and only in the real emergencies go for other alternatives. In order to do so, her goal is to keep mother as healthy as possible. In my case that meant – stay away from sweets and watch your weight because it was high to begin with. When Donna faced me with that in her direct but kind way, I was a bit hurt deep down inside. “Well, I was not that much overweight anyways! I am doing my best. I am not even eating the whole chocolate bar a day!” deceiving justifications went on and on in my mind until all of a sudden I realized: “Donna is not my enemy nor will she gain one ounce of anything if I do listen to her or not. The only advantage from her advices will come to me and my child. So, what am I fussing about?!?! Donna is trying to help me and it is up to me if I am going to listen to her and now help myself! And I AM!” So, I took all the paperwork about food that Donna gave me and worked diligently on following the food chart and food intake that was suggested. Whenever I had sugar craving I followed Donna’s advice and took some protein (nuts, egg, piece of whole-wheat something) instead. Little by little my sugar-cravings eased of. Thanks to Donna I concord the reality and the myth of my cravings.
Donna also kept saying: “If you want to have natural vaginal birth you have to have doula, have to have doula, have to have!” Oh man! Coming from a country where that did not even exist yet and where just few decades ago my grandmothers gave birth wherever they happened to be around the house at the moment due to a lifestyle in the countryside, I thought that Donna is surely overreacting about doula. Nonetheless, I decided to find out for myself what that doula really is. After the research, I concluded: “Doula means having a private masseuse at the birthing, and this strong Serbian girl does not need that for sure!” And if Donna did not gently persist, I would live to learn how wrong I was. To find out more about Donna and her wonderful work, please visit her website www.northjerseymidwiferycare.com.
My husband and I decided to research still more the doulas in our area. Once we gathered all the information needed, I started contacting different doulas and I must say that I came across many nice ones. However, some were not available, some were over our budget, some were having clients at the same time as our due date… I managed to interview few still and things just did not feel right with them, until I met HOLLY GRAFF! She came ready in each and every way – she was present, very sensitive to my nature and needs, surprisingly knowledgeable not only about basics but about all different approaches, techniques, and exercises that I was interested in and she was able to do it with me on the spot. WOW! Thank you, God! I really liked her and felt comfortable having her in our birthing room, so I asked her to come again and meet my husband. She won my husband’s heart in a beat also with easy going conversation, but even more so with gentle instructions about his role before, during, and after the birthing process. It was very important that two of them bonded and had good communication, because they would work as a team in helping me go through my highs and lows at birthing. As a person of excellence, which Holly Graff certainly is, she came again to visit us and teach us how to properly do certain exercises that our midwife asked us to do during the last weeks of my pregnancy. Thank you, Holly! If interested in contacting Holly, please send email to email@example.com.
RACHEL CONNOLLY KWOCK is professional doula and photographer. She came unexpectedly into our lives, again through our midwife, Donna Tabas, and at the last minute almost, but we are so grateful that she did! I fell in love with her writing while browsing her adorable website http://www.speakingofbirth.com/ She shared her deepest self in many of the stories which I consider very brave and admired her before we even met. When we did meet, her calm and southing demeanor, none intrusive but gliding curiosity, and gentleness in manner won both me and my husband and we agreed to have her on board of what is to become my dream team. During my birthing, I was ever grateful for that decision, because she was not only completely invisible and quite so I did not even notice that she was photographing me, but she was also invaluable part of the team contributing with the ideas for new positions during my waves, reminding the team that they need to eat to keep the strength, and keeping positive vibe. Thank you, Rachel! If you want to see more of her mastery, please visit her website and enjoy yourself!
And now allow me to share my birthing experience with you:
It was Monday night. We went to bed, but for whatever reason I kept getting these waves that would pull me out of my sleep each time I almost drifted into the dream land. I coped with it for some time, then texted Donna, my midwife. She suggested to take a bath, which would ease off waves and give me some time to rest. I jumped in the tub and took a shower. I have not realized at all at the time that bath and shower are not the same not only linguistically but medically as well for a birthing woman especially: bath is slowing the birthing process while shower is intensifying it. So, that is what I have got – intensified birthing waves (known as contractions in medical vocabulary). Around 1.30am I woke up my husband and told him that I think I am having pressure waves and they are kind of strong. He got ready and we worked together as a team and did all that we learned from Donna and Holly. Around 3am we called Holly to join us. She came ready, as always. Using her rebozo (special scarf, very sturdy and long), Holly guided me through different positions during my waves while she and my husband were either massaging me, or squeezing my hips, or holding me one way or the other. She also brought oil lamp with soothing oils, warm and cold packs to release the tension in my back, and different essential oils for the massage. As I said, Holly is a person of excellence who is always a mile ahead. ☺
Around 10am I was on the phone with Donna during one of the pressure waves and she determined that it is time for her to join us. She came to our home and examined me. “Six centimeters! Great! I am heading to the hospital to prepare everything. You get ready and we’ll meet there.” Donna said and stormed through the door. We got ready and followed her.
We arrived to the hospital around 11am where Rachel, our photographer, joined us. Journey to the hospital and the hospital procedure took some time, which disturbed my flow with the waves. But once it was over, we were able to concentrate on my birthing journey. Donna was directing us all what kind of position I should do next. Alex and Holly were helping me do all of them tirelessly, silently, without any flinch, while Rachel, invisibly for me, documented all that with her magic camera eye. Not to mention that all of them coped with my loud and constant prayers to God, singing, and my outbursts of demands and requests in occasionally unkind way. None of them ever answered back, they just did the best they could to accommodate each and every need that I had. That was tremendously important to me since it gave me all the space to concentrate on gliding through my waves that were slowly but surely intensifying and coming closer. There was a big clock in the birthing room, but God helped me not to focus on it, but rather stay in the moment and let go, let God, and go through waves with Him and my DREAM TEAM. I noticed the time was passing and it seemed rather long, but I did not care. I had one goal and one goal only – to birth our son safely, gently, naturally, vaginally, unmedicated.
Donna later explained to me and my husband what I was going through in order to accomplish that. Our son was positioned head down and started descending. He was on the right-hand side of my belly, which took him the longest way to come to the right position – down my belly button (baby moves clock-wise during birthing, another lesson from Donna ☺ ). This took about five-six hours to happened and for me to open from six to eight centimeters. My DREAM TEAM, led by Donna, had all the time and patience in the world for me and our son, because my goal was their goal too – natural, vaginal, unmedicated birth as long as possible! Once we accomplished the voyage, Donna realized that our son’s head is tilted in such a way that he is hitting one of my pelvis’ bones. He would not be able to come out by himself in such a position, so that would probably ended up being a c-section for me, shouldn’t I have my DREAM TEAM by my side. All their amazing knowledge helped me go into different positions during birth waves so that our son can come out of my pelvis just enough to change the head position and then slide back in. This took some time again and we were bound to infuse some oxytocin here and there to keep things going smoothly (should you ever meet Donna or Holly, they will tell you what that means ☺).
Around 9pm Donna finally said: “You got it, dear! Time to push! Would you like us to direct you or to push at your pace?” I was so focused on going through waves that I did not know how to switch now and I needed direction. So, Donna asked me to lie on the bed while she positioned herself at the bottom of it where my son was about to arrive. She positioned my husband to hold my right leg and Holly to hold my left leg. She directed me how to position my body, follow urges to push and just do it at my timing. This lasted for about an hour, and it took about five-six pushes according to Donna. In the midst of it, Donna asked me to touch my son’s head that was crowning. At first touch I just felt something soft and hairy. Second time when I touched I felt most of his head coming and I screamed the scream of COMPLETE JOY – MY SON IS HERE!!!!!!!!!!
It was 10.06pm on October 4th, 2016th, only about twenty-four hours after it all started. And folks just so you know, I WOULD NEVER MAKE IT WITHOUT MY DREAM TEAM!!!!!!!!!!!!!!!
T H A N K YOU, MY LOVE!!!!!!!!!!
T H A N K Y O U, D O NN A!!!!!!!!!
T H A N K Y O U, H O LL Y!!!!!!
T H A N K Y O U, R A C H E L!!!!!!!!!!
GOD BLESS YOU AND REWORD YOU FOR YOUR AMAZING WORK, DEDICATION, ALL YOUR LOVE AND CARE THAT YOU GAVE ME!!!!!!!!!!!!
A NEW FIVE POINT MODEL OF MIDWIFERY CARE ENABLES FASTER AND SAFER BIRTHS, LOW
CESAREAN SECTION RATES, AND WONDERFUL BIRTH EXPERIENCES.
Donna Tabas, CNM, M.S.
North Jersey Midwifery Care, L.L.C.
Donna Tabas, CNM, M.S., a Columbia University trained Certified Nurse Midwife and the Owner and Founder of North Jersey Midwifery Care, L. L.C. that serves the women of Bergen and Hudson Counties in New Jersey and Rockland County and New York City in New York has developed a new five point model of midwifery care for low risk women that has resulted in faster natural labors in both first time and repeat birthing mothers, low Cesarean section rates, wonderful birth experiences and excellent outcomes. Although many midwifery practices offer some components of her care model, Donna, with 32 years of experience working with birthing families, and a solo, “dedicated” midwife, has discovered that simultaneously combining all five components of this unique care model enables, in the safety of the hospital setting, the excellent, safe, fast, and empowering birthing outcomes that the women under her care experience, with an extremely low Caesarean Section Rate. Using this model eliminates the “Necessary Unnecessary Caesarean Sections.”
“This 5 point model of care is informed by her number one priority of a birth culminating in a healthy baby and a healthy mother, which she believes is facilitated by the motto, “Natural facilitates safety, but safety alwaystrumps natural.”
These five points of care for low risk women combines:
1) Extraordinarily personalized, unrushed home prenatal care. Although Donna does have an office in Union City, NJ, she offers (and prefers) to come to the woman’s own home (in her “Pregnancy Mobile”) for each unrushed, extended time prenatal visit with no time limits, which can be as short or long as the woman desires. As an up-to-date clinician she provides state of the art, evidenced-based standards of maternity care (which she refers to as “dipstick and measure” care). However, Donna Tabas, CNM, understands that pregnant women “are not just uteri walking around with legs,” and that birthing is “5% plumbing and 95% head and heart.” Her holistic model of care allows for all issues and questions to be explored in a sensitive, delicate, and spontaneous manner in ways that are just not possible in the more typical 15 minute prenatal appointments. Working on these revealed issues often impact ways that will facilitate a more normal birth. In addition, this unrushed, home-based atmosphere allows for the kind of trusting relationship to develop that is so crucial to a pregnant woman, her midwife, and ultimately her birth process.
2) Exposure to Hypnobirthing and discussions that transform the expectations of normal birth from that of fear, tension and pain, to that of power, relaxation, confidence, and comfort. Donna becomes the protective guardian of the birthing space to allow this transformation to unfold. In our culture, the medicalization of birth has created an expectation that birth will be extraordinarily painful, frightening andintolerable. These expectations can create an experience that will be infused with fear, tension, and pain (FTP). This FTP cycle releases stress hormones which stops the normal flow of oxytocin, the “Love Hormone,” that mediates both lovemaking and labor, and necessitates the need for a pharmacologically augmented labor with Pitocin. Pitocin requires continuous monitoring and is more painful; therefore a birthing woman may very well request/need an epidural which begins a cascade of medical interventions that lead us away from the normal, physiological model of birth (see below), and closer to the associated high rates of Cesarean Sections (30-40%) currently in our country. Actually, normal, undisturbed physiological birth does not need to be scary, fearful, or extraordinarily painful at all! To birth our babies normally, the birth environment should be similar to the same environment in which we need to conceive a baby--feeling safe, unthreatened, trusting, and private. Over the course of the nine months of prenatal care, through the use of Hypnobirthing and other relaxation techniques, Donna Tabas, CNM, slowly helps her women take any negative preconceived notions about childbirth that may be based on negativity and fear, and transforms their expectations of the natural birthing process to one of power, strength, relaxation, and confidence. This technique is what facilitates having the faster labors that the women Donna attends do have. To facilitate that sense of safety, trust, and privacy, Donna guards, maintains, and preserves the woman’s birthing environment to optimize a birthing woman’s state of relaxation and decrease her stress, to enable a birthing woman to have a more natural, physiological birth.
(3) Doula care in labor for all her women. In addition to being attended by a midwife and perhaps the woman’s partner, doula care is a crucial component of this midwifery model. A doula is usually a professionally trained woman who has attended many births and has a whole repertoire of ways to assist birthing women. The doula is there in a supportive role to facilitate comfort, relaxation, coping techniques, position changes, and physically, emotionally, and/or spiritually support the birthing couple. Having a doula will ensure that the laboring woman has the continuous one-on-one support she needs by someone whose only role it is to assist with coping with labor without interruptions. Using a doula has been consistently documented by several good quality research studies to decrease Cesarean section rates, decrease the use of pain medications and epidurals, help the birthing woman to remain relaxed without fear, and help to achieve healthier birth outcomes.
(4) Guiding and maintaining the birth as normal using the natural physiological model of birth, as opposed to the medical model of birth. Midwives say, “If you can’t move the mother, you can’t move the baby!” The physiological model of birth includes complete maternal mobility, having the woman eat and drink lightly during labor, and allows her unmedicated body to naturally assume the positions that will help the baby journey out of the pelvis. She will push her baby out in whatever position feels right for her, which allows for less perineal injury. Putting the baby skin to skin on mom’s abdomen immediately after birth assists the baby’s transition to life outside the womb more gently, allows for perfect temperature control, and enables the baby to acquire the needed microbiomes it needs from its mother. This skin-to-skin contact facilitates the hormones that help the placenta to be born safely, and facilitates bonding and breastfeeding. Using delayed cord clamping allows the baby to get an extra 1/3 of its blood , helps facilitate the baby’s transition to becoming air dependent, reduces neonatal problems, and results in lower rates of anemia at six months of age. Waiting patiently for the placenta to be expelled gently with physiological help from the natural oxytocin that is released during this bonding time while mother and baby are still together reduces the rate of postpartum hemorrhages. Donna is expertly trained as a midwife to keep births more normal or recognize when there are any problems that may require the benefits of modern medical intervention and consultation with an OB/Gyn. But “If it isn’t broken, don’t mess with it!” Birth outcomes are safer and better if birth is left as undisturbed as possible with the appropriate monitoring for safety.
(5) Donna Tabas, CNM, is a solo “dedicated” midwife, meaning that she is the only midwife that her women will have for all their prenatal care, the birth, and postpartum period, barring extraordinary circumstances (death in family, illness, etc.), and will be present throughout the whole labor and birth process. This reassurance of the presence of the midwife the woman has chosen and with whom she has developed this trusting bond is crucial to feeling comfortable and safe, promoting a more physiological birth. Donna’s continuous presence during the active stage of labor allows her to diagnose and correct problems that might develop in birth, such as malpositioned babies, which, if uncorrected, often do not fit through the pelvis in that position and may not be
able to be born vaginally. Uncorrected malpositioned babies (i.e. posteriors) compose a large component of the high Cesarean Section rates now in our country (30-40 %.) By simply being there at the right time and knowing how to rotate the baby into a more favorable position can restore a birth to one of normality, and avoid a Cesarean Section for “failure to progress or descend,” which ends up being the “Necessary Unnecessary Cesareans” that Donna’s Five Point Model of care tries to prevent.
Donna Tabas, CNM, wants each woman, as she approaches her Birthing Day, to feel confident, prepared, relaxed, and ready to fully experience all the sensations of labor without fear, and birth with power, strength and joy.
Can I really transform my birth from one of
Pain to Power,
Fear to Confidence,
Tension to Relaxation,
Doubting my ability to do this naturally
Knowing that I am Stronger than I Think
Braver than I Knew?
YES YOU CAN!
YOUR LABOR ISN’T STRONGER THAN YOU
BECAUSE IT COMES FROM WITHIN YOU!
IT IS THE NEW FOUND SURPRISING
STRENGTH OF HOW POWERFUL
YOU AND YOUR BODY ARE
WHEN THINGS ARE NORMAL AND SAFE!
I BET YOU DIDN’T THINK YOU HAD IT IN YOU;
BUT IT WAS THERE ALL THE WHILE!
How can you do this? First, we need to escort FEAR out of your birthing space. Fear is an appropriate reaction to threat of bodily harm or survival. Birth does not harm your body: it is a normal bodily function. So Fear energy in your birthing space is misplaced, and it could be a big risk factor for you needing to use medical intervention that does come with risks of potential harm.
Birthing normally and naturally is nothing to fear. We need to change our expectation of childbirth from one of intolerability, danger, fear, and reliance on medical technology to one of power, confidence, trust in your body to work normally, and personal strength and joy.
Our experiences often match our expectations We have re-written our birth lexicon so that we may help to transform our expectations of birth from the negative, violent, painful imagery our society has previously used to refer and talk about birth, to an expectation of birth being the more normative, positive, natural, pleasurable, and powerful event that birth really is.
Part of this transformation involves using different language when we talk about birth that depicts a more relaxing, comforting, and normative expectation of our birth experience. So let us change our birth language from that which has saturated our traditional birth culture involving violent imagery, negative connotations, and being a passive participant (like you being a “container” for your baby), to a new language that changes our birth expectations to that of safety, strength, power, confidence, positivity, and you being an active participant who will birth this child yourself.
OLD NEGATIVE LANGUAGE
CONTRACTION The word even sounds painful, like a spasm, but that is not what defines labor: labor is defined by the opening, stretching and softening of the cervix, the doorway to your uterus, so that you can release you baby and bring your baby into your arms!
LABOR: Hard work that hurts
FALSE LABOR: Contractions that don’t mean anything and do not mean you are in labor. Forget them.
RUPTURING THE MEMBRANES; BREAKING THE WATER: Violent and hurtful words are not helpful in facilitating vulnerable birthing women to escort fear from their birthing space.
MUCUS PLUG CAME OUT: Sounds gross, like a snot ball. It taints this normal beautiful bodily function with a nasty, displeasurable imagery.
STRETCHING AND SWEEPING THE MEMBRANES; ROTO-ROUTER: These words sound violent and painful; the roto-router is a reference to plumber’s fiddling with blocked toilets….this does not conjure up relaxing images. This is a procedure that can be done safely at term to help a woman enter her labor.
FAILURE TO PROGRESS (FTP): A medical model terminology implying that the labor has failed, the baby won’t fit out, or “I give up” instead of knowing how to facilitate a baby to find its way through the twists and turns of the pelvis journey out into the world.
DUE DATE: This date is generated by a logarithm based on a woman having a 28 day cycle, and most babies are not born on their due date. First time moms are averaged to go into spontaneous labor –if they weren’t induced prior—at 41 weeks and 3 days.
BABY IS DELIVERED: These words shift the ownership of the accomplishment to the health care provider, implying that the birthing woman was a container that, like UPS, delivered a baby into the world. Any woman who has given birth knows that is a complete misnomer!
NEW POSITIVE LANGUAGE
Waves, Surges, Expansions;These connote gentle rising of strength waves that will come and then will go and recede, all the while expanding and opening for your baby to come out safely.
BIRTHING TIME That’s what we are doing; birthing, and the time is now! And it is big and powerful and beautiful!
PRE-LABOR: Sensations women feel as their body begins the process of birth; there is nothing false about them; the waves the woman feels are doing the work of ripening your cervix, and if they wane, it means that those sensations will not lead to the birth of your baby yet, and you will have a chance to rest. We are grateful our bodies are doing the work of enabling the cervix to be primed for when you enter your active birthing time.
RELEASING THE MEMBRANES OR WATER: The baby has been swimming in a pool of nourishing amniotic fluid. As we birth, there will be a time when the membranes holding this pool release, and that facilitates the baby making the descent down and out.
BABY GEL OR BABY JELLY: In the cervix during pregnancy your body has made a barrier so that unwanted pathogens do not enter the “private” swimming pool of the baby. As birthing time approaches, it is released and comes out, showing yet another sign that your body is doing the right things to get ready for the big day. The baby gel should not sound or be conceived as gross; it’s natural and miraculous.
STIR THE SOUP: This is a gentle maneuver that your midwife can do to help your own body go into your birthing time naturally: It is gently insinuating the midwife’s fingers between the amniotic sac and the wall of the cervix, and circling around the entire 360 to separate the thinnest connection between the cervix and the membranes to help the woman’s own body to release her own prostaglandins to help initiate her active birthing waves. These words sound nutritive, gentle, and honoring of that which is stirred.
FEAR- TENSION-PAIN OR FAILURE TO TURN POSTERIOR
Both of which midwives avoid #1 and know how to fix #2. We prefer FTP to stand for FABULOUS-TRANSFORMATIVE-POWER
GUESS DATE: The initiation of active birthing is an intricate interplay of a myriad of different physiological events occurring and responding between mother and child. The child can be born within a 5 week window and be considered full term (37-42 weeks.)
THE MOTHER GAVE BIRTH! Yes she did (either vaginally or by C/S), on her own steam, her own courage, her own strength that she didn’t know she had it in her, her own concern for keeping her baby as safe as possible, and her first initiation into giving unconditionally to her child, not because he/she earned it, but just because she/he needs it.
The Birth of a Boy
A Pivotal Transformation
Helping Women to Have Safe, Beautiful Births
My Sons “Birthed Me” into the Midwife I Am
I’m All Yours
Comfort is Key
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