DOULAS IN DAKAR

“My sista, where are you from?”, Yaye asked me with her beautiful toothy grin as I perused fabric at her market shop. As a Black woman whenever I travel, especially to Africa, this tends to be a complicated question to answer. “I’m from America, and my family, we’re from Ayiti”, I say in broken English, French/Kreyol, and Wolof. “Oh Ayiti!”, she exclaims proudly, “Pale Francais?”. I giggle nervously and shake my head. See, I was able to get by in Senegal with 3 broken languages, rizz (charisma as the Gen Z-ers say it), a wish, and a prayer. I felt so affirmed in my interactions with the town locals, a voice whispering in my ear, “You are meant to be here” on loop. What I came away with was more grounding than I could have imagined, more questions than answers, but something to guide me into this new year.

Hey Fam,

Thanks for sticking with me through the hiatus of this newsletter. It’s taken me some time to put into words what I experienced and learned during my time in Senegal. As some of you have been following my journey on social media, I recently returned from my much anticipated Wombs of Wata (WoW) birthkeeper workshop in Senegal. An opportunity that so many of you gifted, donated, and contributed to. I am forever grateful.

HOW IT ALL STARTED

With the assistance of local community members and birth keepers, the Wombs of Wata workshop was developed and facilitated by head birthkeeper. Joyell Arvella. Let me explain my understanding of what a birthkeeper is. Birthkeepers choose a life where they support people during the full lifespan of the uterus. From prepubescence, menstruation, fertility, pregnancy, menopause, and through various uterine related illnesses. Pretty dope huh? This has also made me rethink how I define the work that I do, and what kind of work I could be expanding to. We also participated in some amazing introspective sessions facilitated by thee Shaconna Haley, MA, CHD. An integral part of being a birthkeeper is to know yourself. What moves you, what triggers you, stalls your movements, who are you?

MAMI WATA

To start, we stayed in the charming coastal town of Somone, in a beautiful pink villa, a 5 minute walk to the beach. Yall know that I was on that beach EVERYDAY. One way or another, I found myself at the water. We started each morning with a moving meditation, setting intentions for the day. On our first full day, we had a sacred water blessing ceremony at the ocean. Asking permission to be there, calling on Mami Wata to help us release things from our current lives and things that we might unintentionally be holding onto from generations past. Afterwards, we all gathered to discuss our birth stories and how that connected to the insights that were revealed to us at the water ceremony. An interesting point about sharing our birth stories is the realization that so many birthkeepers seem to have complex mother/daughter wounds. Hello therapy! Amiright?


BIRTHING PRACTICES IN SENEGAL

For our first workshop, we met with 7 month old Ndebele, her mother Awa, Ndebele’s maternal aunt and paternal aunt (badjenu). As the father’s sister, the Badjenu is almost like her brother’s representative/replacement in child care for the first few months of life. Because dad’s primary role is to financially support the family. But really the Badjenu plays this important role in their niblings’ lives for the rest of their lives. She is the second mother, confidant, mediator, etc. She also assists in any marital tension/issues that arises between her brother and sister in law. On this day, our Badjenu demonstrated a typical infant massage, which Ndebele delighted in. It consisted of movements that helped to strengthen the spine, enhance flexibility, tone muscles, and shape the body (hips, breasts, buttocks). We all had an interesting conversation about the need for breastfeeding support specialists in the US. The family was genuinely baffled that breastfeeding specialists are even a need in the United States. We tried our best to explain the factors that impact breastfeeding like time, access to resources, societal pressure, public judgement, work schedules, etc. But it was definitely an interesting cultural perspective that I didn’t think about until then.

Next we met with Fanm Saj (traditional midwife) Baty. She traveled 11 hours to be with us that day! Before she even proceeded with her presentation though, she made time to shower, change her clothes, offered her salat (prayers), and eat. In such a seemingly small way, this pause to handle her needs before presenting to us taught us the importance of taking care of ourselves even in the midst of servicing others. She taught us about the important herbs that are needed for postpartum healing and brought shea butter and massage oil to demonstrate postpartum massage. She used banana leaves soaked in a hot water tincture to begin her demonstration. A funny, and incredibly magical moment happened. Confused about having to demonstrate this massage on a large water bottle, she asked for a volunteer. One of our amazing participants agreed to be her subject. Little did we know that the volunteer would have to strip down completely naked, in front of a room full of 15 strangers. Charnise took it in stride and did what needed to be done. She laid on the table, awaiting instruction, and in the blink of an eye Baty jumped up on the table, straddled Charnise, and commenced to vigorously massaging her. It was almost like an instinctive dance between the two of them.

THE GODMOTHER OF BIRTH

We then met with Marie who has been supporting families for 40 years. She is called a Badjenu Gox. Remember that Badjenu is auntie. And Gox means neighborhood. So she’s known as the neighborhood auntie or godmother, so to speak. Her role expands way past birth and postpartum. She’s also responsible for mediating issues among members of her community, arranging visits to the hospital, and negotiating payment for medical services. Fees for services are a huge barrier to receiving perinatal care, contraceptive care, and routine medical care. She is the fixer, the handler, the Olivia Pope of her town.

The Badjenu Gox are chosen by the people in her neighborhood and supported by government funding. It is an honor and a privilege to serve as one. What was also interesting was learning about the ways that the Badjenu Gox and the Traditional Midwives do and don’t work together, and how colonization and subsequent policies have significantly impacted that. Check this article out for some interesting facts about the 2010 origin of the Badjenu Gox in Senegal. If you really wanna nerd out on health/birth stats in Senegal, check this one out. This experience with Badjenu Marie was of course an exchange of resources and information, and so we had the opportunity to share with her what we do as birthworkers in the US. She said several times throughout her few hours with us, how proud she was of us. It was so affirming to hear, and incredibly humbling how generous she was with sharing her knowledge.

CAKE FOR BREAKFAST?

In the midst of this absolutely transformative experience, I celebrated my birthday! I actually had the pleasure of sharing birthday festivities with three other women in my cohort who had birthdays the same week. There was a local patisserie that sold the most delicious croissants, baguettes, and sugary confections. So a lil birthday cake for breakfast was only fitting. At the encouragement of one of my cohort buddies, we treated ourselves to a photoshoot with Mamy Photography and a spa day by the ocean. Best decision ever.

MARKETPLACE MEAL PREP

Towards the end of our time together, learning, reflecting, shedding ego and expectations, we engaged in a really fun activity. The plan was to explore the produce market in Somone, practice our language skills at the market by purchasing ingredients from the vendors, and develop a collective postpartum meal based on what was in season. With the help of our market Yaye (term of endearment and respect for an older woman) and Joyell, we decided to make couscous, stewed veggies, fried plantain, garden salad with homemade honey mustard dressing, and a tropical fruit salad featuring one of my favorite postpartum fruits, the Papaya. Just know that this meal was absolutely scrumptious!

DOULAS IN DAKAR

On our second to last day, we traveled to Dakar for the day, spent some time on Goree Island, and visited a few other sites in Dakar. What I learned and felt on Goree island was both heavy and empowering. I’m still processing what we learned about the brutal history of the slave trade, seeing and feeling things when entering the slave dungeons, juxtaposed to the stunning coastal view of the ocean. The same ocean where old, weak, and rebellious enslaved people were carelessly tossed to die because they were deemed useless. We also had the opportunity to visit the local clinic on the island. We took a tour of the midwife’s office and the birthing room next door. Because of funding resources there were some deficits in the resources and equipment available to birthing people. So they refer many people, especially complex cases to birth at the hospital in Dakar, which is a 30 minute ferry ride away.

 

MOVING FORWARD

What I learned during Wombs of Wata has shaped me not only professionally but also personally. I learned the importance of introspection, deep diving into my sense of purpose, and engaging in routine self evaluation. I learned to surrender, listen to receive and not to react, and to call in patience. My journey to and time in Senegal reminded me of how unfair this world can be to the underprivileged, but also how much beauty, grace, and love exists to combat the dark. I’m always in awe of Black women/femmes and how brilliant and resourceful we are. I am reminded of how our softness is our strength. I am so honored to continue to do this work and to inspire and teach newer birthworkers. Thank you for taking the time to read my reflections. Feel free to reach out if you have questions/comments.

With much Love & Gratitude,

Doula Jo

Special recognition and thanks to the following:

Joyell Arvella

Shaconna Haley

Our incredible Wombs of Wata Cohort 2023

Interpreter: Kanur Raïssa Minkilane

Photographer and videographer: Mamy Hawa

Awa and baby Ndebele

Traditional Midwife: Baty Gueye

Badjenu Gox: Marie Thiane

101 Homebirths

Hey fam!

I wanted to write this month’s newsletter for those of you who are considering a homebirth, on the fence about a homebirth, or absolutely terrified at the thought of considering a homebirth. Sometimes when we lift the veil and we demystify something, it becomes more accessible, relatable, and less anxiety provoking. So, below are a few questions that you sent in that are some common questions folks have about homebirths. There were so many similar ones, so I consolidated them. If any of these questions spark some additional questions, feel free to book a consultation with me to discuss your options and seek guidance with your homebirth journey.

Where do I start?

It’s important to note that while I absolutely LOVE homebirths, I recognize that homebirths are not suitable for everyone. Hospital births were really made for high risk labors that require more monitoring and possible surgical intervention. However for those pregnancies that are healthy and low risk, you may very well be eligible for a homebirth. Most people start out seeing an OBGYN for their routine prenatal care. Fun fact, a midwife can also see you for routine gynecological care. If your plan is to inquire about a homebirth, the best place to start is to find a licensed midwife and eventually switch your prenatal care over to them. Your midwife can guide you with information about homebirth laws and regulations in your local jurisdiction. Homebirths are not only for people who rent or own a home. Folks can choose to birth in apartments, shared rooms, vacation rentals, or hotel rooms. I’ve seen it all. You want to choose a location where you know you’ll be comfortable, with minimal interruptions.

How do I find a midwife?

I highly recommend interviewing ALL of your medical providers, including your potential midwife. You want to make sure that your provider aligns with your values, is ready to support your goals, and is open and honest with you when they need to share difficult information. Finding a midwife is as easy as starting with a quick Google search of local homebirth midwives. I would say that you could ask your doc for recommendations but in my experience, they don’t always seem ready to refer their patients to homebirth midwives. No shade docs. It is what it is ::shrugs::

If you’re a member of some birth-related online groups and forums, you can ask for recommendations there. Also, if there are birth centers in your area, that is another great place to find local midwives. I posted on my blog a list of interview questions that you could ask your potential midwife. It is a pretty long list so I advise folks to pick and choose which few questions are vital to you in the 30-60 minute initial consultation and then you can save the other questions for your subsequent visits. Midwives work in community with other midwives and birth assistants, so you’ll want to know what package deal you’re getting when you book.

How much does a homebirth cost?

According to a 2021 NIH study, “On the basis of a nationwide study, we estimate that the average cost of a home birth in the United States is USD 4650, which is significantly below existing cost estimates for an uncomplicated birth center or hospital birth.” With homebirths, there are a couple of things to consider in addition to the main midwifery fee. There are many midwives who require a birth assistant (BA) to work with them. You may want to ask if the BA fee is included or if that’s a separate cost. Usually the doula is also a separate cost. Lastly, you will want to budget for purchasing all the homebirth materials that you don’t already have in the home; birth pool rental and water hose (optional), extra towels, extra linens, waterproof bed sheets, postpartum pads and briefs, etc. Typically the family also provides a community meal for the family and birth team, which comes in handy during the long overnight hours of labor.

What happens if there’s an emergency?

This depends on what kind of emergency. Firstly, there is a lot of pre planning before the actual homebirth so that you and your birth team have a detailed strategy for any emergencies that may arise prenatally or during the immediate postpartum. Whereas with hospital births, baby’s vitals are typically monitored continuously, during homebirths, there are intervals for monitoring. This allows the parent to have free range in the home and not be so focused on the numbers and stats but rather what is happening in their body. Again, for low risk births, intermittent monitoring is absolutely safe.

So if any kind of emergency arises during labor, it’s usually caught during monitoring, proceeded by a swift response from the midwife and their team. Homebirth midwives roll deep with their equipment and medications. They have tanks of oxygen, suctions, medications to navigate pain management (not to the level of an epidural though yall) but just enough to take the edge off during early labor, and basically everything they need to monitor your and baby’s vitals, provide IV and suturing if needed, and all the components for the newborn exam.

If something happens that requires a hospital transfer, the midwife and your birth team would have already mapped out the nearest hospital to go to and the mode of transfer. For non emergency transfers, usually a member of the family/birth team would transport the birthing parent to the hospital. For emergencies that require a higher level of care, an ambulance transport would be called in. This is very rare in low risk and healthy full term births. The factor that I appreciate most about the homebirth midwives that I’ve worked with is that they are incredibly skilled at identifying a risky situation during a homebirth BEFORE it becomes a serious issue. That way, everyone is involved in a discussion, making a decision, and executing the plan.

Who all gon be there?

This is absolutely up to you. I usually advise folks to be very discerning about who you invite to be in your space during labor and birth. Their presence, energy, and input can impact labor progression. You are not obligated to invite folks just because of blood relation or longstanding relationships. Protect your peace. Regarding the hired birth team, you typically have the midwife, birth assistant, and doula there. Invite a support person who is committed to be by your side throughout the whole process, it could be the co-parent or could be a dear friend/family member who is aligned with your goals. You may also invite someone who can manage other children or pets in the home, and someone to coordinate food and light cleaning of high traffic areas. I like to call them the birth elves. Children are fed and occupied, pets are walked and fed, food magically appears, trash gets thrown out, and the kitchen, bathroom, & living room look immaculate.

What happens after baby is born?

Magic happens! First your midwife and medical team will assure that baby is showing signs of alertness and responsiveness (crying, good muscle tension, good blood flow). Typically delayed cord clamping is a standard practice in homebirths. Baby stays on the chest receiving skin to skin while parent and baby’s vitals are taken. Midwife is focused on the birth of the placenta, and so once that happens, routine vitals continue to be taken. Routine fundal massages (argh) are done as well, to help manage bleeding and expel clots. If there was any perineal tearing, the midwife will focus on suturing that repair and managing bleeding.

Then there’s the much anticipated “golden hour” where the birth team allow the parent(s)/family to be together as a family, encourage bonding and rest, try breastfeeding, and the birthing parent usually gets their first postpartum meal during this time. Vitals are taken intermittently but typically no other medical assessment/intervention is done during this rest/bonding time.

Once that time passes, then the midwife does a full newborn exam. I love this part so much because they use this as a teaching moment for the family members present. Midwives take the time to walk the family through each of the newborn assessments and encourage them to ask questions. They also walk parent(s) and families through the placenta exam and educate them on what a healthy placenta should look like. It’s these teaching moments that make such an impact for parents as they start their postpartum journey.

The birth team encourages parents to choose a pediatrician before birth, so that once baby is born, the midwife can update your baby’s doc, and you can follow up with a Peds visit within 48 hours of birth. Now, regarding homebirth postpartum care, it differs from midwife to midwife. Typically though, they visit the home and follow up on healing, recovery, and chestfeeding support within 24 hours of birth, week 1, week 2, week 4, week 6, and a few extra visits beyond that. Isn’t that amazing! 

I can’t wait to hear your feedback and follow-up questions. Yall know I’m a birth nerd and welcome all questions. Mostly though I want to debunk many common misconceptions about homebirth, and help folks make an informed decision about their method of birthing. Let me know if you want a Part 2!

Tata(s) for now,

Doula Jo

Choosing a Midwife for your Prenatal Care

Hey fam!

For folks who are in the process of choosing a midwife for their prenatal care, I’ve compiled a list of questions to consider during your interview. These questions were inspired by a list created by doula and birth photographer Paulina Splechta  I edited and organized them based on my years of professional experience in this field. I hope you find this as helpful as my families have over the years.

Prenatal/Postpartum Care:

  1. *What is the cost of care and what is included? How does it work with my insurance covering your midwifery services and how often are clients reimbursed the full fee by their insurance? Do you offer payment plans or discounts for early payment in full? What “extra” or surprise costs might we encounter while in your care? What is your refund policy if we decide to switch care providers?
  2. What is your preferred method of communication (phone, email, text)?
  3. *What are your prenatal visits like? How long are they? Where do they take place? How often are they scheduled?
  4. Do you offer or suggest taking childbirth preparation (CBE) courses?
  5. My partner has concerns about home birth. How have you dealt with this in the past?
  6. *When do you consider yourself “on-call” for me? When can I expect you to join me in labor? What do you do if two families are in labor at the same time? Will you ever leave a labor?
  7. *How do you proceed in the event of pre-term labor or a medically necessary induction?
  8. *What are your policies or recommendations regarding urine dips, basic blood tests and labs, genetic testing, routine ultrasounds and growth scans, gestational diabetes testing, group beta strep (GBS) testing, iron levels testing? Are there any you don’t recommend declining? Can you draw blood or will we need to use an outside lab?
  9. *Do you continue to see clients with Gestational Diabetes, or do you refer them to an obstetrics practice?
  10. *What is your philosophy on weight gain, nutrition, prenatal supplements, and exercise? We will receive counseling or education on those topics?
  11. Do you facilitate water birth? Does a tub rental come as part of my package? Do you have a recommendation for where to rent or buy your favorite pool? Are you comfortable delivering in my bathtub?
  12. *How long will you and/or your support team stay with couple and baby after the birth? What kind of postpartum care do you offer? Do you work with postpartum doulas? How many postpartum visits are offered under your care and on what days do these visits occur? What changes if I transfer and deliver in a hospital? Does your visit include care for the baby? Will you be available for well-woman visits?
  13. *What are the pros and cons of vitamin K shot and eye ointment for the baby? Can you administer Vitamin K and Erythromycin if we want? Can you administer the PKU test or will we need to see our pediatrician? Will you administer Rhogam if needed? Can you provide us with a hearing screening, and if not, where do you recommend clients go?
  14. Is breastfeeding support offered? Do you have local IBCLCs that you recommend?

Birth Experience:

  1. *How long have you been practicing midwifery? How many births have you attended? Why did you become a midwife? What is your training/education/certification?
  2. *Do you have experience working with clients like me?
  3. Do you have references that would be willing to discuss their experiences with your work and care?
  4. *Are there any induction methods that you are comfortable using (stretch and sweep, foley bulb, castor oil, black and blue cohosh, breaking waters) and when might you suggest them?
  5. What is your experience with herbs, homeopathy, and alternative medicine as pregnancy and labor support?
  6. *Can you resuscitate an infant?  Are you NRP certified? 
  7. *Which hospital(s) are you approved for working in case of an emergency?
  8. *Do you have experience with postpartum hemorrhage, shoulder dystocia, breech baby or cord prolapse?
  9. *Do you deliver breech? Do you deliver all kinds of breech? Do you have training and experience in this kind of delivery? If not, do you have a midwife you would refer me to if the baby had not turned?  Do you have experience with turning babies?
  10. *What do you do in the case of a nuchal cord? Or if the baby changes into a breech position during labor and it is too late to be transferred to the hospital?

Birth Team:

  1. *Who comes with you to the birth?  If that person is another midwife, how does their experience compare to yours?  If that person is NOT another midwife, what qualifies them as a birth attendant?
  2. When can I meet your back up midwife and back up OBGYN? 
  3. *Are you and your team neonatal resuscitation (NRP) certified? Have you ever had to resuscitate a baby? Are you and your team CPR certified? Have you ever had to resuscitate a birthing person? How recently have you recertified?

Birth Procedures:

  1. How many vaginal checks do you do, during pregnancy, during labor; should I get them, how necessary are they, what are the benefits/downsides and when do I need to have them done? 
  2. *What equipment do you bring with you to a birth? What kinds of medications (Pitocin Cytotec, Methergine) or tools (birth stool, Rebozo) do you have access to in case of an emergency? Are you legally allowed to carry Pitocin (for rare post-birth hemorrhaging)? Do you?
  3. What methods of pain management do you recommend?
  4. *At what point during my labor will you come to my home? When should I call you?
  5. *How does it work if I am GBS positive – how often do you administer antibiotics during labor and do you do specific procedures with the baby after birth?
  6. Under what circumstances, if any, do you perform episiotomies?
  7. How long do you usually leave the cord intact? How long are you comfortable waiting for a placenta?

Hospital Transfers:

  1. What kind of medical situations during pregnancy would require me to be transferred into the care of an OBGYN?
  2. To what gestation are you comfortable waiting? What is your standard protocol for clients going over 40 weeks before you transfer my care to an OBGYN? How many minimum weeks pregnant must I be to be able to have a home birth (36 weeks? 37 weeks? 38 weeks?)
  3. If my water breaks before labor (contractions) even begins, how long can I labor at home for before you are required to transfer me to the hospital?
  4. What is your protocol for non-emergency transfers to the hospital? For emergency transfers? (Once this is answered, look to the following questions for things that were not covered in the Midwife’s answer that you may want clarification)
  5. Under what circumstances would you transfer to the hospital? In the event of a transfer, (whether or not you have any privileges at the medical facility or know the doctor who I was transferred to) will you stay with me and support me through my entire birth and for the first couple of hours once the baby is born?
  6. What constitutes a non-emergent transfer vs. emergent transfer? Where do I go in the event of a non-emergent transfer vs. emergent transfer?
  7. What things would make me “high risk” and necessitate transfer of care either during pregnancy or labor?
  8. What is your hospital transfer rate?
  9. If I change my mind about home birth during labor and ASK to be taken to the hospital, how will you respond? 
  10. How bad would a perineum tear need to be for you to feel it required a hospital transfer? 
  11. What would it look like to transfer a baby to the hospital if needed after birth? What would it look like to transfer a birthing person to the hospital after birth?

Self Reflection:

  1. How did you feel as the midwife spoke?
  2. How did the things they said make you feel? 
  3. Did they let you feel heard and not rushed?
  4. Did their personality help you to feel connected and instantly safe and supported?
  5. Take note of what feelings may rise from your instincts.

What we should know about Endometriosis

Hey fam!

March is Endometriosis Awareness Month. Endo is a condition that, in the United States, affects 11% of people born with a uterus. That’s 6.5 million people nationwide! According to the World Health Organization, the stats are comparable globally, affecting about 10% of people born with a uterus.

First let’s start with, what the heck is endometriosis? The uterus is lined with something called endometrial tissue.  Each menstrual period, this tissue swells with blood and it eventually sheds. The body grows a new lining of endometrium with each menstrual cycle. Endometriosis is a disease where endometrial tissue grows outside of the uterus and on other areas of the body where it doesn’t belong. Endometriosis growths may swell and bleed in the same way the lining of the uterus does every month — during one’s menstrual period. Ouch! This can cause inflammation and incredible pain because the overgrown tissue actually swells and bleeds in an area of the body where there’s little to no room for it to grow and where the blood cannot shed out of the body. Imagine a swollen bloody growth on your stomach, liver, intestines, or ligaments.

In addition to debilitating pain and bleeding during and in between menstrual cycles, endometriosis can also cause pain during intercourse, GI issues, and most commonly infertility. How? Well, patches of endometriosis block off or actually change the shape of the pelvis and reproductive organs. This can make it harder for the sperm to find the egg. Endo also impacts the body’s immune response. Once fertilization occurs, the immune system, which normally helps defend the body against disease, may attack the embryo as a foreign entity.

Because Endo causes vague symptoms that present as other conditions, endometriosis is often misdiagnosed for YEARS. According to the organization Endo Black, “on average, it may take 6 to 10 years to be diagnosed. As for African American women and women of color, it may take 11 to 15 years for a diagnosis.”  It occurs in folks ages 15-40, whose menstrual cycle lasts longer than 7 days, and there is evidence that there is a genetic component. There are some non-surgical forms of treatment for Endometriosis like hormone based therapies, as well as surgical treatments such as laparoscopic excisions (removal) and ablations (heat blasted destruction, pyew pyew!).

Why is it important for you to know all of this? If you know and love someone who presents with some of these symptoms and/or whom has a family history of Endo, share this information with them. A confirmed diagnosis could be the key to resolving years/decades of life altering symptoms. I also want to call in more empathy for menstruating folks who have such painful and long lasting cycles, that their life literally stops for weeks at a time. 

This month we bring awareness to this debilitating disease, affecting millions of people worldwide, in the hopes that with more research we can find a definitive cause and cure for Endometriosis.  

 

In Gratitude and Solidarity,

Doula Jo

For more information visit the following sites for more education on Endometriosis.

Supporting Children When a Loved One Dies

Hey fam,

Give yourself some kudos for delving into this difficult conversation about end of life (EOL). I first would like to start with a reflection**. Think of a time in your youth when someone you knew and loved died. Ask yourself the following questions:

  • How did you find out? How did adults communicate with you about their death?
  • If it was a death from illness/injury, were you prepared ahead of time?
  • How were you included in the events and rituals around the death?

I invite you to come back to these questions if ever in doubt about how to approach this. The death of a loved one is hard enough, but considering how to navigate that with a child may seem daunting and insurmountable. Adults concerned about having end of life (EOL) conversations with children argue that it may traumatize the child or affect their ability to cope. On the contrary, open, consistent communication and planning around a loved one’s death helps to promote meaningful engagement, strengthen relationships, establish a sense of safety, build trust, and equip children with the emotional regulation tools that they need to cope with life’s challenges. This conversation calls for us to be brave and reckon with our own coping around death.

The Talk

So, where do you even begin? It’s important to tap into how you’re feeling. Center yourself with some deep breaths, debrief with a trusted support person, and get all the accurate information that is available to you in order to have this conversation. Create the conditions for a safe and supportive conversation. Choose a place that is familiar, comfortable, and private. It’s okay to have 1-2 other trusted adults there, especially if they are in a caregiving role to the child(ren). If there are multiple children, it’s a good idea to share the news with them all together, especially if they are close enough in age/developmental level. If there is a vast difference in age (toddler/teen), then it would be okay to separate the children by developmental stages so that you can break down the information in developmentally appropriate language. I’ll give some examples in a bit.

Our role as adults is to model behavior for the children in our lives. So it is absolutely okay to be sad, openly cry, and take breaks during this talk.

  • You can start the conversation by letting your child know that you have something sad and difficult to share.
  • Reassure them that they are not in trouble, that they are safe, and that the adult(s) in the room will be available to care for them and comfort them through this process.
  • Start with what they may already know about the illness or circumstances of injury/death. Children know a lot more than adults give them credit for.
  • As you explain further, it’s important to be clear and direct.
    • With young children especially, avoid coded language and euphemisms. Use the words “died” and “dying” as opposed to some popular phrases like “we lost Grandpa”, “they’re in a better place”, “Aunt Sheila left us”. Young children are quite literal in their comprehension of language. So imagine if they hear these coded phrases and think, “Well if Grandpa is lost, let’s go find him.”, “What’s a better place for mommy than being here with our family?”, or “What did we do to make Aunt Sheila leave?”.
    • Be direct in stating the actual illness, e.g. “She has cancer”, “His brain was hurt in a car accident” instead of just “They were sick and died”. Young children don’t do well with vague and metaphoric language.
    • Young children may need you to define in simple terms what it means to die. For example:
      • “When someone dies, their body stops working. The person no longer talks, walks, breathes, or eats. After someone dies, we don’t get to see them face to face anymore. We can still look at pictures of them, talk about them, and always remember them in our hearts.”
      • Cultural and religious explanations may add an extra layer of comfort to this conversation.
  • Emphasize ways that they can foster continued bonds with the loved one, during the dying process and after their death.
    • Some ways that they can engage meaningfully with their loved one and make memories; Record the love one’s voice, take videos of the child and loved one together, handprint/fingerprint crafts, letters, and a memory box
  • Leave time and room for emotions, questions, and reassurances
    • Children may not emote right away and need time to process the info. You may witness a wide range of emotions. They may seem unfazed, numb, fearful of another loved one dying, distracted, distraught, etc. Just continue to validate and normalize their emotions.
    • Children have this remarkable ability to pick up their grief, and then put it right back down until they’re ready to face it again. Their grieving process is not as continuous as it is for adults. Also, people often underestimate the grieving process of children who are on the spectrum, neurodivergent, or have cognitive delays. They absolutely grieve in their own way and I’ve included some resources on how to support them.
    • Encourage an open-door policy where they can come back to you to revisit the conversation and ask questions as you all move forward.

Choices

Consider giving the child a choice in HOW they want to engage after they’ve been informed about a loved one’s end of life. Some children may want to visit with the loved one as they are dying, some children may not. Some children may want to attend the funeral service and burial, others may not. Helping children to make informed choices during this time can help to bolster their sense of autonomy at a time when so many things are beyond their control. Also, children may be less likely to experience regrets and resentment when they are invited to make choices about their own participation in a loved one’s end of life, as opposed to when adults have made decisions for them without seeking their input. Giving the child a choice will impact how they reflect on their relationship with grief for years to come.

Community

It’ll be helpful to discuss with the child any potential changes in their daily routine, how the family will navigate around the dying process, and what to expect after the death. Help them identify support people within their community (school staff, spiritual leaders, coaches, neighbors). Speak to their school’s counselor about providing extra support in school. Seek the support of a professional experienced with end of life.

Part of my role as an end of life doula/consultant is to help families facilitate these difficult conversations, prepare for the death of a loved one, help them with planning and making funeral arrangements, linking families to community resources that can help with reduced funeral costs, and educate folks on how to financially and legally protect their families after their death. I’m especially passionate about helping families who have the unfortunate circumstance of navigating the death of a child. Please feel free to schedule a consultation if you’d like to learn more, or if you’d like to refer me to someone who is in need of these services.

Check out the links below for some additional book and video resources to help support children through grief. Should I do a Part 2 about how to help children cope after the death of a loved one? As always, I love hearing from you and am looking forward to the conversations that this will inspire.

 

Warmly,

Doula Jo

Resources:

Sesame Street Grief Videos

Children with Special Needs Grieve

Book: The Invisible String

Book: When Dinosaurs Die

Teen Grief Toolkit

Children’s Grief Support

**Information adapted from a presentation I co-created with Certified Child Life Specialist Polly Hurlburt, M.Ed, CCLS

Kicking Off the New Year in Hibernation

Happy New Year Fam!

Wow, we made it! I hope your year is off to restful and healthy start. I’ve been gravitating towards books, lectures, and videos that emphasize the importance of allowing ourselves to heal and giving ourselves grace. I stopped doing New Year’s resolutions many years ago; instead opting for a broad layout of the direction I wanted my life to go in the new year. Soooo, basically a rebranding of New Year’s Resolutions ™ lol. (Hello vision board parties.) I recently came across a short video and then later a poignant quote about reframing the way we look at the “new year, new me” mindset.

So for this month’s newsletter, I wanted to share this message in hopes that it resonates with whomever needs it, and inspires you to extend grace to yourselves and others. There’s absolutely nothing wrong with being proactive about establishing goals during a time of collective transition, but for those of us who may not have been ready by the New Year, or still don’t quite know what direction they’d like to take this year, I offer you this.

Courtney Yellow Wolf Wilson-Graham of the Choctaw Nation writes:

“A gentle reminder that we are in Winter. If you don’t feel ready, prepared, or amped up for this new year right now, know that this is not the cycle of Nature. It is the cycle of capitalism. You don’t have to have it all together. You don’t’ have to have vision boards, resolutions, prayer circles, plans laid out on how to improve. Existing is enough.”

If you’ve heard other versions of this very idea, wonderful! I’m glad to add to the voices reinforcing this mantra and shift in cultural perspective. The New Year comes at such an interesting time for most of us in North America. Winter is a time of hibernation, marinating, pause, repose, and (if you think of deciduous trees) a regenerative death. So it makes sense that when the new year comes around, we would take this opportunity to continue our time of introspection, dormant dopeness, and just plain existing. It also makes sense that when Spring comes around, our motivation, inspiration, and goals begin to bloom and re-emerge like we see in Nature. My wish for you (and myself) in the first few months of this new year is rest, reset, and to just be.

I’m excited to be bringing some cool, interesting content to you this year, covering birth, postpartum, family planning, death, grief, mental health, and beautifully random things like this that I learn along the way. Next month, I’ll be talking about ways to cope with sudden, unexpected loss. Thanks for rocking with me yall!

With love,
Doula Jo

*January’s Book Rec: Tricia Hersey’s Rest is Resistance: A Manifesto aka the Nap Ministry

Thank you! Luna Doula’s Year in Review

Hey Fam,

Today is my BIRTHDAAAY!! I thought what better way than to start off my day celebrating with you all. My amazing community! So please accept this month’s newsletter as a love letter of gratitude to all of you for your support, trust, and encouragement. I wanted to share how you all have impacted the work that I have done with Luna Doula this year, and some lessons learned that I will be taking with me into the new year.

This year, I was able to support 25 families, spanning birth, postpartum, end of life/grief support, and abortion support. Many of my families came by word of mouth from current Luna Doula families, friends, and colleagues, but some found me through internet searches for Black Doulas in the DMV area. How amazing! Through some generous donations over the last two years, I established the Mbusa Fund which enables me to provide discounted and pro bono support to families in need that cannot financially meet my sliding scale prices. Although I raised my prices this last quarter, I’ve worked hard to maintain accessibility with my sliding scale pricing. This year with the help of the Mbusa Fund, I provided two weeks of discounted overnight postpartum care for a family, pro bono abortion support for two families, and pro bono end-of-life consulting for another grieving family. We faced the overturn of Roe v. Wade which significantly impacted abortion support in addition to the quality of care during pregnancy loss and life-threatening situations for pregnant folks. With the help of thousands of educators, activists, and policymakers, I found myself engaging in resource coordination and educating folks on ways to navigate the changing laws and how to find the life saving support despite restrictive policies. Let’s keep our foot on their necks to ensure equal and just reproductive rights for all.

This year, I ventured into some fun and exciting projects, attended trainings to enhance my work, and was featured on some pretty dope media outlets. I was cast and performed in two plays this year. Both plays, Fences and King Hedley II, were written by acclaimed Black playwright the late August Wilson. What a fun and empowering experience. Thank you to my Doula families, friends, and family who came to see me perform and support the local community theatres in Bowie, MD and Alexandria, VA.

I expanded my birthing knowledge and attended the Spinning Babies training with my doula sistahs Brittany Martin and Leah Hairston. I also attended a two day grief symposium and learned more about how to offer grief support in creative, culturally affirming, and expansive ways. I also learned more about Haitian Postpartum traditions and care from midwife Barbara Verneus, which I was able to put to use with one of my postpartum families who requested a traditional Haitian Bain (postpartum herbal bath). As some of you know, I launched this Newsletter series in March, with the help of my Virtual Assistant Lisa Trinidad. This has been one of the most challenging yet rewarding ventures for me. Each and every one of you who have emailed, texted, and commented to share stories and continue conversations started in my newsletters, have been the fuel to keep me going. I hope you know how impactful you have been.

I had the distinct honor of being interviewed and featured in the Black Doula Project’s documentary about the importance of Black Doulas and how families have benefitted from the work of Black doulas. My work was also discussed in the Angry African Podcast featuring guest doula Leah Hairston. This episode also mentioned some dope local doulas Vanessa Hanible and Zaynab Aden, so I was in really great company.

The major lesson I learned this year is how to actually incorporate the rest that is so needed for this work to be sustainable and consistent. I took an intentional break from births these last three months, and focused on rest, postpartum support, and planning for next year. I’ve learned my limits and I’m enjoying establishing healthy boundaries to maintain them! For me, rest looked like more quality time with my parents, my siblings, and my niece. I’ve been able to make plans with friends, hike more, attend Black ass events, sleep, graduate to a new level of psychotherapy, learn some cool things about myself, incorporate more moving meditation into my weekly routine, and sleep. Did I mention sleep? Haha. Next year I am booked until May for births, with some flexibility to take on an extra birth each month. I am hoping to acquire some more educational materials for my prenatal education work, like Black and Brown infant dolls and a flexible life-sized pelvis with accompanying reproductive organs and surrounding organs/muscles. I’m also hoping to expand the reach of my End-of-Life consulting and grief support.

Mostly though I’m looking forward to keeping in touch with my Luna Doula families, helping new families, continued growth, and community partnerships. I learn so much from all of you. I thank you for your trust in my work, your sweet family updates, grateful for sharing in your joys and challenges, and bearing witness to the love you have ever so present in your lives. Wishing you all a lovely Holiday season, and a gentle, restful, and joyous New Year!

With love and gratitude,

Doula Jo

Postpartum Prep

Hey Fam!

How are yall doing in this new season? I know a few families have been hit with the tridemic of RSV, Flu, and Covid and I hope that you are all recovering quickly and gently. Thank you for the grace that you extended as I took a much needed hiatus from our newsletter in October. Ya girl was TIYAD! I hosted my family for my dad’s 82nd birthday, I was in Tati mode with my niece staying with me for a few weeks, my godchildren staying for a few days, I had intense rehearsals and was in a play for three weeks, and in the midst of all of this, I was still working

my full time hospice job in addition to my doula duties. All of these events and activities really invigorate me, but I have to do better at managing the timing of it all, within my control anyways. But now I’m back and ready to share some helpful tips on ways to prepare for postpartum, with a little twist.

Now remember what I always say, postpartum is forever. So when I say prepare for postpartum, I not only mean the typical one year after birth, I mean to include ways that help you prepare for the long-term effects of childbirth as well as logistics for a growing family. Let’s start with preparing physically. If it is within your means and insurance coverage, I recommend having a chiropractor and pelvic floor physical therapist on deck for your postpartum recovery. The birthing body changes as it helps to grow a baby, weight is distributed differently, bones and supporting muscles are stressed in different ways, and the function and use of the pelvic floor changes. Having chiropractic and pelvic floor PT care can help with urinary retention and incontinence, breathing, digestion, mobility, sleeping comfort, sexual comfort and pleasure, and much more. It doesn’t hurt to tap into these services during pregnancy as well.

Regarding vulva and perineal care postpartum, there are so many options out there. Discuss with your provider and/or doula, herbalist, natural healer if you have one. Some people prepare ahead of time a supply of “padsicles”, frozen witch hazel pads that provide soothing, cool relief. Others use a mixture of herbs for a sitz bath, full bath, or peri bottle wash to help promote healing and blood flow after a vaginal birth. Whether it’s a planned or unplanned cesearean birth, it’s always helpful to discuss c-section recovery support while you’re creating your birth plan. If you have stairs in your home, who will help you get the food and supplies that you need on other levels of the home? Who will help you bathe? Will you curb visitors for the first few weeks, or would you like to have company as soon as possible? Consider who you would like to have around as you recover, and who you trust to provide care, resources, physical/emotional support.

When it comes to establishing your support network, communication and flexibility are key. Identify one or two main people, have one or two back ups, and then have a conversation with them to make sure that everyone is on the same page regarding expectations and limitations. If you are partnered and/or have older children in the home, make sure to have open and direct conversations about the division of labor in the home as you and baby recover. If you have the means to, hire a postpartum doula, a nanny, house cleaning service. Lean on your community to help with food/grocery delivery, meal planning, and foods that promote healing, lactation, and energy. A pitfall that can often happen is that people assume folks will step up and step in, and when that doesn’t happen, resentment and tensions build. During pregnancy is also a great time to help prepare any older children for postpartum changes in routine, changes in your availability, and to identify a trusted support person to help with school pick ups or weekend activities. This all requires you to be intentional about building that “village”. Take a look back at my September Newsletter: How We Show Up, for suggestions on how to start that conversation.

For folks who work and have to navigate parental leave, you also have to consider how it impacts your finances. Some employers offer paid leave, while others do not. You’ll have to balance and negotiate your savings with how much time you are able to take off. Some parents are able to stagger parental leave for at least the first 6 months. Some have family members come for extended stays so that one of the parents can save their parental leave for a few weeks/months down the line. There’s FMLA, short term disability, saving up on vacation and sick leave; ask your colleagues how they planned theirs out, meet with a trusted HR rep to strategize. If you work for yourself, you might want to do this well in advance so that you have time to come up with other contingencies in case a part of the plan doesn’t work out. With the limitations of legislation and systemic allowances, we gotta get creative with how we plan for infant care and postpartum recovery support.

Mental health is a component of postpartum recovery that can be overlooked but is so important to consider and assess, for both the birthing parent and non-gestational parent. If you’ve had difficulty with coping or mental health concerns in the past, it might be helpful to speak with your provider about ways to prepare support in the event that Baby Blues (which typically lasts about 2 weeks) turn into something prolonged and debilitating. There are assessments that your provider can guide you through to determine the scope of your coping challenges, and they may even be able to help you identify mental health providers and therapists that specialize in postpartum mood issues. In addition to postpartum depression, we’re learning a lot more about postpartum anxiety, rage, and psychosis. Important to note that non-gestational parents can also experience postpartum mental health challenges, due to a significant life change, lack of sleep, changes in relationship/parenting dynamics, etc.

Lastly, my work as an end-of-life social worker allows me the skills and perspective to discuss emergency planning with my families. Because historically marginalized communities have not had access to certain wealth building and financial security resources, many of us in these communities are not privy to the ways that we can protect our families in the event of an emergency. In the event that one or both parents become incapacitated or dies, here are some things to consider. Designate guardians for your children. Be explicit, intentional, and communicative about this decision. You want to make sure that all parties are informed and on board, and you want to revisit this decision every few years. If you have life insurance, find out about setting up a life insurance trust so that your child(ren) may have access once they become adults. The rules differ state to state. If you can, work with an Estate Planning Attorney to develop a Will, a trust, and durable power of attorney. These documents are also things that you want to revisit every few years and change accordingly. If you live in MD, there is a free online resource where you can establish a health care decision maker and detail your health care decisions. All you need are two witnesses and a notary and it is an officially recognized legal document. While these are very difficult conversations to have, contemplating our own death, completing these documents can help to establish a comfortable future for your family in the unfortunate circumstance that you are no longer here.

Postpartum is forever. When you work with me, you’ll have access to an emergency plan template and an array of community resources. If you didn’t have a chance to do all this planning during your pregnancy or even for the first few months of your postpartum journey, that’s ok. As the years go by and your family grows, there is always opportunity to:

Establish a support network and secondary guardians for your children,
Plan for extended work leave and manage finances to accommodate time off
Work with a Doula
Seek mental health support
Create a will & Advanced Directive
Apply for life insurance
Set up appointments with the various healing professionals.

What’s most important is that you recognize there is a life long need for postpartum support. We learn to care for ourselves by allowing others to care for us. Are there any other ways that you’ve prepared for your postpartum journey? I’d love to hear more!

With gratitude,

Doula Jo

How We Show Up

Hey Fam!

How do we build that village and foster relationships that carry us through the hills and valleys of life? Our concept of community and showing up for each other has shifted in recent decades. We’re either too overwhelmed with our own lives, uncomfortable with other people’s discomfort, lack adequate boundaries, or just unaware of social norms that prevent us from genuinely being there. I’ve seen the ways that individuals and families are left feeling isolated and even abandoned by the people they thought would be their biggest support. A part of that though, is knowing how to ask for what we need. That takes vulnerability and courage. So, let’s get into it, shall we?

Best place to start is to ask. If you don’t know *how* to be there for someone, just ask. That opens the door for the person in need, to really think about what would work for them. “How can I best support you in this moment?” or “What would be the most helpful way to support you?”. I know, I know, it sounds a bit corny. But hey, if you can’t be a lil corny and cheesy (mmm corn and cheese!) with those you care about, then what’s the point? Sometimes the person in need doesn’t know what would be helpful. So be ready to make a suggestion or two, careful not to overwhelm them with options. “I’m making some goat and roti for dinner, can I bring you a plate?”, “I’m heading to the grocery store, can I pick anything up for you?”. If after offering, they decline your help, then let them know that you are ready and willing, free of judgement when they are ready to reach out. If they cross your mind randomly, reach out and let them know. Let a few weeks pass and then check in again about ways that you can support. Ultimately people want to know that they haven’t been forgotten after a life changing event has passed. They want to know that someone is keeping them in mind, and that they have at least one or a few people who they can call on when their head is above water and they have a clearer idea of what kind of support they need. But of course, if they’ve asked for some time to themselves, give em time. That, too, is a gift.

Now, as a recovering people pleaser (anxious attachments unite!), I cannot stress how important it is to establish healthy boundaries as the giver AND receiver. “No” or “not right now” is a complete answer. If someone is overstepping your boundaries and smothering you with offers to help, it may take a bit more energy to let them know your limits, but it is okay to ask for some space before they reach out again. I like the good ol’ compliment sandwich approach. “You have been so gracious in your offer to help. I am feeling overwhelmed at this time. I hold you in my heart and look forward to reaching out to you in a few weeks.” If you absolutely do not have the capacity to be the support that someone needs, you can express your love for them, regret that you cannot show up in the way that they need, but that you can offer whatever is within your capacity. It really is all about communication and having some initially uncomfortable conversations, but ultimately honest and heartfelt conversations.

Let’s get into some specific examples from my line of work. We do not handle death well as a society. It’s uncomfortable, it’s scary, and it brings up some hard emotions. When someone you know is grieving (whether that’s the loss of an elder or the loss of a baby), what’s most important to keep in mind is that eventually the calls stop, the sympathy cards peter out, the casseroles stop coming. One of the most compassionate things you can do, is check in a few weeks/months after the death. If this person is really close to you, take note of the death anniversary and try to reach out, take on an errand, or do something nice for them around that time. Say the deceased loved one’s name, and share a fond memory you have of them or a way that they may have impacted your own life. Find out if there are any cultural grief practices that would be meaningful to them (repast, sitting Shiva, military commemoration, etc). Also significant to note that someone can be grieving a loss other than a death (divorce, unemployment, friendship, physical ability).

As someone prepares to give birth, they may want some help getting the home set up and ready for baby. You can offer to wash baby’s clothes, fold, and organize them. You can offer to wash and sanitize baby bottles/pump parts. Perhaps, with their input, you can help to start a meal train for them so that they have prepared meals for the week leading up to the birth, and for the few weeks postpartum. Could they use a light housecleaning or a deep clean? You can offer it yourself or offer to pay for a service. Gift them a birth/postpartum doula (wink wink)! During postpartum, you can offer to do all of these things as well; the laundry, dishes, meals, cleaning, etc. Don’t just come over and fawn over baby. Ask and genuinely listen to how the birthing person and their partner are doing and coping. If there are other children in the home, can you babysit or take them for a day or more to help lighten the parenting load. Parents with a newborn need adult time too, so feel free to talk about things other than the children.

In general for anyone going through a life transition or celebrating something, a greeting card, a gift card, a meal, and offering your time and skills in any capacity, go a long way. Establish and maintain those boundaries so that you can show up as your full, best selves. And if folks haven’t stepped up in the way that you expected, ask if they have the capacity to help and then, if so, ask for what you need. Looking forward to hearing your feedback, as always. This is such a dope community!

Peace,


Doula Jo

This Newsletter was inspired by a book I read last year, of the same title,

“How We Show Up” by Mia Birdsong. Brilliant read!

Black Maternal Health Week

Hey Fam!

This week is Black Maternal Health Week (April 11th-17th). This is a time to call attention to the devastating maternal health gap in the U.S., and to advocate for policy solutions to the systemic inequities that lead to adverse health outcomes for Black birthing people. I think it’s important to highlight those who are often left out of this conversation. The Black birthing folks who are most often marginalized when it comes to health care, reproductive care, and most in need of reproductive health care justice; immigrant and incarcerated Black women, Black queer femmes, Black trans folks, visibly disabled Black birthing people, and Black nonbinary birthing individuals. It’s time that we are inclusive of all Black birthing bodies when we discuss the disparity in birth and postpartum outcomes for Black folks in our health system.

While the presence of, advocacy, and education from doulas can help improve birth and postpartum outcomes for Black Birthing Individuals, we must also look at how the system fails to make way for these vital systems of support. We’re seeing more legislation working to sponsor doulas and doula trainings but it is important to delve into the details. Most of these proposed bills support agencies and certifying bodies that do not and have not worked within and towards the equitable treatment of Black communities and communities of color. Ahem…DONA.. ahem (and some others). The monetary compensation offered by some major insurance companies is not equitable and does not provide a livable wage, often only covering half of what doulas typically charge on average. We still have a long way to go, and for some folks, this is the first time they are learning about this. I encourage you to donate to the Black Doula Project and look into the work being done by the National Black Doula Association and Black Mamas Matter. And as always, support your local Black Doula, *raises hand*. If you know a family who could benefit from in-person or virtual birth/postpartum support, head to my website to book a consultation. I’d love to help develop a customized support plan!

With Gratitude, 

Luna Doula Jo 

Click these links for more information on Black Maternal Health Week, and Health DisparitiesDoula LegislationDoula Insurance Coverage, and orgs you can support, Black Doula Project and National Black Doulas Association