Kristin Revere and Anne Wallen discuss how doulas can impact the birth and postnatal experience. Anne also describes her doula training and education programs at MaternityWise International.
Hello, hello! This is Kristin Revere with Ask the Doulas, and I am so excited to chat with Anne Wallen today. Anne is the director of MaternityWise International, and our conversation today is going to be all about doulas, since she trains so many doulas and also works as a doula herself. Welcome, Anne!
Hi! Thank you so much for having me! I love it that we can talk birth and that I can be on your podcast. What an honor! Thank you so much.
And I am honored to have you on the show! I’d like to get into a bit about your bio. You’re a respected figure in women’s health with over 30 years of experience and a leading voice on global change in maternity care, particularly for those at greatest risk. You’ve continued to educate and empower birth professionals in more than 20 countries, contribute to a variety of curriculums, and shape the future of maternal health through your impactful role as a speaker and mentor.
So, yes, thank you for all of the years! It’s amazing that you’re still working as a doula to really be able to meet the changing needs of doulas that you train.
Yeah, it’s so crazy. Sometimes you get into this work and you realize, oh, I’ve definitely been called into this. It’s what I’m meant to be doing. It’s what I’m supposed to be doing, what I’m here for. And I definitely feel that way. Even though I’ve had a few other jobs along the way, they really even just added to my skill set as a doula and as a teacher. But I feel really passionate about the fact that we, just as women, oftentimes we really crave that community, that support from one another. And especially in American culture, you know, we’re really oftentimes far away from each other. We’re far away from our family. And when I say really far away, I don’t just mean maybe somebody in a different state, but we’re not living in this communal format anymore. We don’t have the village where you can walk to your friend’s house, your mother-in-law’s house, your sister’s house, whatever. Most of the time, we’re pretty far apart. So just supporting one another looks different, and thank goodness for Facetime and phones and texts and everything, but it’s still not quite the same as being there in person and being able to give someone a hug and put your arm around them or cook them a meal or whatever it is that they need in that moment. But supporting families – it’s so multifaceted. It can be so complicated. But it’s also really, really natural. Like, we crave to do it for one another, and we definitely recognize when we’re in a vulnerable position like early motherhood, like pregnancy, and those early parenting days. We definitely feel it. We definitely feel the need for support and for help and all those beautiful things that a doula brings. Not the judgment, not the unsolicited advice, but the actual support and that loving, nurturing – I even like to say we’re modeling. We’re a role model to other family members of how to treat the family that’s growing or the mother or the baby, even. How to interact with them, because we don’t always see healthy examples.
Exactly. We don’t have the emotional ties that a partner or a parent does to our client. We have a professional relationship, and yes, we get to know them and care for them, but we don’t have a vested interest, where I know with my family, they had their own personal experiences with, say, breastfeeding, and I don’t want to say agenda, but just how they felt things should go for me. And when I wanted to make different decisions in parenting or the type of birth that I wanted, it was met with a bit of resistance. Not all doulas are the same, but you mentioned judgment free, so just not going in with an agenda of, oh, my client needs to have an unmedicated birth or needs to do attachment parenting. Whatever it might be; or feeding a particular way.
Yeah, and some of these can end up being such hot topics. And also, science changes, and things that we used to do sometimes are not helpful or even might end up being detrimental now. So even though grannies might have really great intentions, they can still give advice that can be harmful, not knowing that we now know better, so we should do better. You’ll probably hear occasionally someone say, well, I was formula-fed and I turned out okay, or I’m a Cesarean baby, and I turned out okay. And that’s not really helpful. It’s very invalidating when you have a mom who’s wanting to do something different; when they’re wanting to breastfeed or they’re wanting to give birth naturally or even at home. There’s a lot of not just judgment but so many opinions kind of flying around and almost hurt feelings when you don’t choose what they think you should choose. So it can be really tricky to navigate.
Yes, and as you mentioned, things change. With technology and all of the gadgets for feeding and sleep and really keeping up to date on recalls – it’s like a full time job for our postpartum doula team to know the safest options for our clients. So grandparents are often caregivers now because we’re in a childcare crisis, and feeding is so different. Safe sleep and again, products they might have used are not in use anymore. And certainly car seat safety is a whole different thing. I know when my parents had issues with navigating the modern car seats and understanding all of the changes in modern parenting compared to how they parented me.
Right. And speaking of safety, a lot of times, we’re really motivated – our culture is very motivated by fear, and so we have this – just like a high priority on or a high value on safety, so if a person thinks, oh, well, this is the safest option, they’re going to go with that, versus when it comes to birth, there’s a lot of unknown. There’s so much mystery still around it, even though we can kind of physiologically explain what happens, right, but each individual birth goes its own way and the hormone and chemical makeup of a person’s birth experience can be super unique to them. So there’s a lot of unknowns. There’s not a lot of ways to kind of predict or create a safety plan around how birth is going to go. You just have to – I always say it’s 10% plan, 90% crap shoot, right? So you’re just going to have to flow with it and trust that your body knows what it’s doing and trust that your body and your baby can accomplish a safe birth. And a lot of times, fear and that mystery piece kind of get in the way of people being able to – and it might be grandmas; it could be partners; it could be friends, sisters, whoever’s kind of in the ear of the birthing person – installing this or instilling this idea that there’s danger around every corner and you’ve got to be overly conservative about really everything. This is how we’re now in kind of this induction crisis in the United States. We try to – we think, anyway – that managing – they call it active management – that managing the process is the only way to safely navigate the process. Unfortunately, it’s quite the opposite. Managing the process creates an unnatural scenario that ends up requiring more interventions because you’re creating complications that didn’t have to exist and then you’re managing those complications with more interventions, and you get into that snowball, which maybe if you just left it all alone in the beginning and let it happen, you wouldn’t have encountered all of these – I call them detours you have to take. It’s like we know where we’re trying to get to, but sometimes medical intervention turns into a detour where now we’re going to have to deal with this little side road. We’re going to get there eventually, but it might take us longer and it might be a little more of a bumpy ride. And that’s the beauty of having a doula by your side is that if your doula is well trained, she’s going to know how to navigate those detours, and she’s going to know also how to help you avoid them altogether. And that comes with preparation ahead of what I call “the big day,” the day that you’re in labor where it’s going to end with a baby in your arms. We call that the big day, but there might be a lot of starts in the beginning. Little bits of labor here and there before you actually get to the big day, but a doula who can help you prepare, get educated, know your options ahead of time – you’re going to feel less under pressure to make decisions on the big day. You can feel a little bit more confident in your ability, also, when you have more preparation and you understand what’s going to happen to you and you understand what to expect at your chosen birth location. Basically, there’s less surprises, even though birth is full of surprises. There’s just less of them, or there’s a little more predictability to what’s about to happen and you can anticipate how to navigate, how things are changing and developing within the birth process and with less fear. The more you know, the less you have to fear it, and I feel like fear is just such a big motivator to go ahead and do certain things that aren’t necessarily the right timing or even necessary at all. But in our society, anyway, we’re so afraid. We’re just really afraid of our own bodies, and that makes me sad.
And as you mentioned with preparation, a doula can certainly give resources, so evidence-based articles and information, to have conversations with your provider during pregnancy, create some of your preferences together at that prenatal visit, and certainly know options for comprehensive childbirth classes, whether they’re in or outside of the hospital, ranging from HypnoBirthing to Bradley gentle birth and Lamaze. There are so many options to really understand, as you said, your body, what options, which choices you have for pain relief and interventions that may come up so it’s not all unknown the day you go into labor, so you understand different things that, in a nonemergent situation, you’re able to ask for.
Right, and we use the acronym BRAINS. You’ve probably heard of that. B stands for benefits. What benefit does a particular intervention have for me? What risks might be involved? A stands for alternatives. So are there any alternatives? Is there any other way that we can kind of get to where we want to go without having to use that as a different option? I is for intuition. What is your gut telling you? Do you have some red flags? Do you not feel at peace? Because if you don’t feel at peace, don’t go for it. Wait until you’ve got enough information, you’ve got that peace before you go for it. This is given that you would have enough time to make these kind of decisions and have these kinds of discussions. In a situation that’s emergent, obviously, you’re not going to necessarily sift through all of the BRAINS scenario. But then there’s also N. What if you do nothing, or if you say not now? I always tell my clients, don’t create a yes/no, black and white, all or nothing kind of scenario for yourself. Just say not now because maybe in an hour or two, you’re going to change your mind and you’ll want to do this or that. Or maybe in five hours, it’s going to be necessary to do this thing, whatever it is. So just be open to it, and just say “not now.” I’m not feeling like I should do that right now.
And then we always add S to the end, S being, give us some space. Space to think about it; space to talk about it; space and time so that, again, there’s not a decision being made under pressure, right? Because that feels like bullying, and we don’t want – there’s no place in this experience for bullying. There shouldn’t be pressure or anyone feeling like they’re kind of coerced into making a decision. Yeah, if there’s time to have this discussion and there’s not an emergency going on, then yeah, there’s no reason why we can’t have a little space to kind of think through this, in between contractions, because that’s another thing. It’s like, okay, you kind of feel like I’m under the gun because there’s a contraction coming. I’ve got to give a yes or no right now. Well, actually, no, you don’t. You can think it through after this contraction, and maybe after the next five contractions. You can continue this conversation before you make a decision. Asking for space. These are things I teach my client families so that they understand in the moment, they don’t have to feel like – well, for example, if I haven’t prepared my client well enough ahead of time and I haven’t really gone over BRAINS with them for each specific scenario – let’s say it’s breaking their water or whatever. If my client turns to me in labor and says, “What do I do, Anne?” Then I feel like, wow, I did not prepare them enough. Because they shouldn’t have to ask me what to do.
Unless they’re in the thick of it and they can’t recall anything you talked about and it’s all, like, out the window.
Sure, and when that happens, I do just turn it back onto them and say, how do you feel? What do you feel like you need to do right now? And reminding them that the first answer that your mind gives you when you ask yourself a question, that’s your intuition. So if I say to myself, should I break my water right now? I already know the answer before I finish even asking the question. I already know what my mind, my body, my spirit is telling me, yes or no. So giving them also that confidence and just the internal power – because we’ve kind of taken the power away from moms when we started giving birth in hospitals. We kind of created this authority hierarchy, and mom’s at the bottom when she really should be at the top. So just reminding her that this is her body, this is her journey, this is her decision, and giving her back her power to make a choice versus feeling like she’s just at the mercy of whoever’s in the room making these decisions for her, about her. That’s inappropriate, right? And in any other situation, we would never treat someone this way. We wouldn’t walk down the street and say, oh, look, I think you should go into labor today. I’m going to break your water. We couldn’t do that. It would never be appropriate. It would never be appropriate in any other circumstances, so why, walking into a hospital, does it suddenly become appropriate for us to give up all of our rights and not have any say in the game plan? Again, this is where preparation comes in because if you don’t have any kind of preparation, you’re going to feel like I have to lean on the expertise of these people because I don’t know anything. That’s a big piece of it.
And there’s so much evidence that regardless of birth outcomes, having that continuous support from a doula, not only during labor itself, but throughout pregnancy, does increase satisfaction. So as you had mentioned, Anne, it’s feeling like you are making informed decisions every step of the way. Again, unless it’s an emergency, and instead of birth just happening to you and feeling like things are not in your control at all, then there’s a lot of remorse. There can be so many feelings after the birth that are just challenging to navigate.
Well, and the definition of trauma is when something is happening to you and you’re so scared, you’re so terrified, and you feel helpless. You feel out of control, whether it’s of your circumstances, of your own body, how you’re being treated. And you’re put in this position where it’s a moment of almost terror, right? And so we look at a lot of post-pregnancy, postnatal maternal mood disorders, and it’s like, you’ve got anxiety. You’ve got depression. You’ve got OCD. And I can’t help but look at it and say, how much of this is related to how she was treated during birth, right? So it there a sprinkling of PTSD in there that’s kind of root cause of all these other symptoms that we’re seeing? I mean, if I’m anxious or if I’m OCD and I’m trying to control my environment and I’m getting some paranoia mixed in there or overly cautious and overly concerned and overly doing all the things to make sure my baby is safe and that I’m safe – that actually looks like a trauma response because if you’ve been traumatized, what do you do? You try to control your environment. You’re in protection survival mode. And most people do – if you love your baby with all your being, they’re going to be kind of the object of your obsession at that point and protecting them and making sure everything’s okay with them, and you’re going to question every little thing that seems maybe out of the ordinary when it could, under another circumstance, if you haven’t had your confidence taken away from you, you’re going to look at your baby and just say, oh, we’re in the realm of normal, right? But if you’re an anxious mom, you’re going to look at your baby and say, something’s wrong. This might be in the realm of normal, but looks like we’re outside of the realm of normal and not really seeing things for what they are because the anxiety is the lens you’re seeing everything through. And so, again, too, this is another way that doulas can help because processing trauma takes time. It takes interaction.
I spoke at the Congress on Children in San Antonio several years back. I don’t know, seven, eight years back. And my whole project, basically, was about how touch is a solution for trauma. So doing skin to skin with baby, breastfeeding, all these things because when mom has been traumatized, probably baby has also been traumatized to some degree. And so getting them together can make such a huge difference and sends them leaps and bounds forward in their healing process. You’ve probably heard the say, the body keeps the score. There’s a great book by that same name. And treating the body, doing somatic therapies with the mom, and this is, again, outside of – this is advanced training for doulas, but there’s things that we can do as postpartum doulas just to get moms some relief, some healing, kind of connect the loop for her so that she can stop spiraling downward and really utilize her network, her baby, her own self, work through her memories, process out the story. Just by telling the story to her postpartum doula over and over again; it might seem redundant. The doula might – if the doula didn’t have any kind of trauma training, the doula might think, oh, this is not normal. But for someone who’s experienced trauma, telling that story over and over again and having someone listen. I teach my doulas to use the five senses. Listen; ask questions about the five senses. What did you see? What did you hear? How did it feel? Were there funny smells? Did you throw up? What were you drinking? All these things, because the body is where the trauma was felt. It’s where the trauma was processed. And so using the five senses to kind of uncover what happened helps moms to put the pieces together in ways that her conscious mind might not be able to do, but her subconscious can start tapping into that. With the five senses, you’re starting to tap into that subconscious mind. You can start putting the pieces together a little bit better. It feels less confusing. She can continue to repeatedly tell the story, but it becomes a healing activity rather than being on that wheel where you’re spinning and spinning in the trauma.
And again, to have someone with some training to be able to listen with empathy and without judgment. Not having to wait until that follow up postpartum visit to really feel like you’re being heard by a professional. I find that pediatricians can be valuable because those visits are so frequent. Asking questions and processing versus needing to wait for that six-week visit.
Right. And sometimes even when you’re at the six-week visit, you’ve got five or ten minutes with that person. And you don’t always – I mean, I’ve had six kids. I’ve been doing this for 30 years. As a fresh new mom, even with my sixth baby, I still was like, okay, what’s normal again? You can’t really – it’s good to know yourself, but sometimes you can’t really recognize what’s going on without that outside perspective. So somebody who really understands, looking at your behavior, looking at what you say, looking at how did your birth go, looking at how are you sleeping – are you sleeping? Looking at all those pieces and kind of putting them together and saying, this is what I see. Let me help you formulate some questions to ask your doctor. Let me help you formulate a list of symptoms maybe to take to your doctor because otherwise, moms are in a cloud of sleep deprivation, and they’re just there to show up for their appointment. They don’t always know what questions to ask or what things to bring up or what’s important, especially if it’s their first baby. But having a doula to come in the home and get to know your family and really be working with them. Sleep deprivation is a huge one, right, so just that alone can affect the mind and the ability to form sentences, let alone ask intelligent questions at the doctor’s office. I mean, every aspect of pregnancy and early parenting. My oldest is going to turn 31 and my youngest is 8. I have women around me. God bless having loads of women around me because I’m working in the birth world, so I’ve got all these caring, nurturing doula women around me all the time. Without our tribe – gosh, I just don’t know how women do it when they’re all alone.
We need support, absolutely, and so obviously. That’s why you were drawn to this work. We are unfortunately running out of time, but I would love to hear any final tips you have for our listeners, and then of course, please share how they can connect with you.
Sure! So MaternityWise, which is the company that I am the director for – we do maternity education. So we do labor doula, postpartum doula, lactation. We also have a program called EpiDoula, which is all about how to support someone who’s chosen to have an epidural and how to reduce their complications. We also have a childbirth educator program. We have a bunch of other programs. HIPAA certification; we have classes on how to process insurance as doulas, just tons and tons of things. Love it, right? Anything to do with birth. We even have an infant sleep class. So our philosophy is really very much looking at the whole experience, so I love that we were able to kind of go through the whole experience today during this talk because that is so key to know the end from the beginning. Whether you’re doing postpartum, it’s good to have birth education so that you can really understand what mom’s talking about and give her feedback about how her birth went because you will hear the story, right?
Right. Even if you don’t want to be on call as a birth doula, still having the education, as you mentioned, is so important.
100%. It’s just tools in your tool belt, right? And then vice versa: as a labor doula, a lot of times people want to just get trained as a labor doula because they think that’s the most exciting part, but it doesn’t end there, and you will get asked questions postpartum. You will have people trying to get your help with breastfeeding and stuff. And if you’re not trained, if you don’t have that additional information, you could potentially give bad advice and it could be harmful, with completely good intentions, but it could end up sabotaging a mom’s breastfeeding relationship or whatever, right? So having that full scope, the full spectrum of understanding and knowledge around birth and breastfeeding and postpartum – we just feel like that’s how you create better outcomes, bottom line. You can’t take one piece of the pie and just say, this is good enough. You’ve got to look at the entire experience and have knowledge and have wisdom to share throughout the whole experience. So the way to get trained with MaternityWise and get certified – and our programs are approved by any state that has a state registry or a Medicaid program. We are either already approved, or if they’re in process, we’re in process with them to get approved. So we’re across the nation. We’re around the world, too, but probably your listeners are mostly American, right?
Yes. For the most part.
Yeah. So our training, if you want to look more into it, is at MaternityWise. We would love to hear from your audience. But also, you have a book coming out, right? Tell me about that. I want to be able to make sure that we can help promote that, as well.
So it is called Supported: Your Guide to Birth and Baby. It comes out on Mother’s Day, May 12th, so very soon. And it’s basically what I wish I would have had for my own kids, and it’s based on our online Becoming A Mother course. It’s about understanding all of the members of your birth and baby team, what options you have for providers, where to have your baby, and all of the different planning phases, not only prenatally, but putting as much importance in postnatal planning. We get into everything from insurance to how to pay for your doula and baby registries and registering for services in addition to things, and how to communicate your needs with family and friends. We try to cover all of it. We have a chapter on sleep. Alyssa, my co-author, is a sleep consultant. We’re both newborn care specialists and postpartum doulas, and then I’m the birth doula and childbirth educator. So I wrote the first half of the book, and she wrote the postpartum planning and feeding. We have some experts in the book, as well, from a board-certified lactation consultant to a pediatrician to a perinatal mood disorder mental health therapist. Since doulas are not medical, we wanted to bring in some medical experts, as well.
That’s smart. I love that.
Well, thank you so much, Anne! We’ll have to have you back on again! I could talk to you forever. You are such a wealth of information.
It was super fun. I really love that we could do this. I’m so excited about your book because everybody needs to get their hands on that. Any mom that’s expecting, I’m sure, is going to really appreciate that knowledge to have in their own toolkit. It’s awesome.
Exactly. And I feel like my secondary audience for the book is also anyone who works with pregnant individuals and new parents. They would also benefit in understanding all of the options to refer from understanding car seat safety technicians are a thing, to Webster certified chiropractors to pelvic floor physical therapists to, again, the different types of mental health therapists.
Amazing. It really takes a team. A client of mine that I was just speaking to the other day – she was just saying, she didn’t have all these pieces. She’s got a Pilates person, a yoga person, a massage therapist, a chiropractor. She’s got – in addition to her medical team, her OB, and then she’s also got a midwife because she’s delivering at a hospital that has midwives and OBs, so the team she’s with has both. And of course, she’s got a doula, and she’s working on hiring a postpartum doula. It’s so good to be able to see this. And I know this is about accessibility, too. Not everyone can afford to have all these supportive, coach-like people on their journey. But if you can – and thank goodness, sometimes insurance will be covering it. It’s just so important because, again, like we started out saying, families are very separated now, and even friends. We don’t have that instant person, a lot of times, right there able to help us, and it’s good to have resources that we can reach out to whose eyes are looking at our situation with their own specialty in mind. So they might have a different thing to encourage us to look into or research more or go get help with. It’s really important.
Absolutely. Well, thank you, Anne, and I hope to talk to you soon! Take good care.
Yes, thank you! You too!
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