asking for normalcy

It doesn't take very long to know that I am pro-breastfeeding. My support of breastfeeding doesn't include shaming those that don't. Just as I believe that women should be supported in their choice to nurse their babies, I believe women should be supported who choose to formula feed. There are many reasons not to breastfeed. This post isn't about that. I know and respect those reasons. This post is about a cultural attitude that I cannot ignore. It is about human rights.

The breastfeeding rates in the US are on the rise, and that is encouraging (according to the CDC the rate of babies breastfeeding at 6 months of age went from 35% in 2000 to 49% in 2010). Even though more women are doing it, there still hasn't been a cultural shift to "normalcy" yet. There is still vehement opposition to breastfeeding, specifically to the act in public. Breastfeeding in public is protected in federal buildings as long as the woman is legally allowed to be there; the law doesn't not differentiate between using a cover or not. According to the National Conference of State Legislatures, "forty-five states, the District of Columbia and the Virgin Islands have laws that specifically allow women to breastfeed in any public or private location" (http://www.ncsl.org/research/health/breastfeeding-state-laws.aspx). Breastfeeding is encouraged by the Centers for Disease Control, World Health Organization, and American Academy of Pediatrics. It is legally protected both at the federal and state level. Yet why are we, as the American people, so offended by it? 


Like I said before, our country's opposition to public breastfeeding is not universal, but a cultural attitude. The front of the passport for Gabon features a woman breastfeeding, the opposite breast exposed. Talk about normalcy for the Gabonese! One American woman took to the internet to vent about being discriminated against for breastfeeding. An Australian woman replied, "I don't understand your country's problem with breastfeeding! Us Aussies do it without anyone bothering us. It's just a part of life." I find it odd that human beings all over the world can go about their business feeding their babies without opposition, that no one bats an eye, yet we can be utterly disgusted and enraged over breastfeeding in the United States. 

Let's just look to social media for a minute. There is a page that I follow on Facebook that is attempting to support all women throughout pregnancy, birth, breastfeeding, and parenting. It repeatedly gets pictures removed of breastfeeding mothers and bans are placed on the page for "violating the user terms." Women who simply post pictures of themselves enjoying a nursing/snuggle session with their little one often get the same results. The images are removed. Yet, soft porn images are not removed. Women giving life is not allowed, but women as sex objects are. For me, this is the core of the issue. Our society is okay with the sexualization of the female form, but not the nurturing, life-sustaining one.

 *warning! graphic images!*

Let's just look to social media for a minute. There is a page that I follow on Facebook that is attempting to support all women throughout pregnancy, birth, breastfeeding, and parenting. It repeatedly gets pictures removed of breastfeeding mothers and bans are placed on the page for "violating the user terms." Women who simply post pictures of themselves enjoying a nursing/snuggle session with their little one often get the same results. The images are removed. Yet, soft porn images are not removed. Women giving life is not allowed, but women as sex objects are. For me, this is the core of the issue. Our society is okay with the sexualization of the female form, but not the nurturing, life-sustaining one. 

*warning! graphic images!*


This photograph, and many like it, has been removed from Facebook. 

This photo, and many like it, is allowed to stay on the social media site.

 

Here's the thing:

We do not have a problem with breasts in this country. We love boobs! I mean, who wouldn't? We simply have a problem with breasts being used for anything but sex. We can't possibly understand that something has more than one function. It bothers us to see an innocent baby sucking on something so sexual in nature. And this is where the women's rights issue comes in. A woman's body isn't only for sex. It has other purposes and functions.

My mouth has many functions. It can be used to eat and communicate. It can also be used for sex. We don't have a problem separating the two. When the mouth is used for sexual purposes it is expected to be done in private. However, I don't have to keep my mouth hidden when I'm using it for nonsexual purposes, such as eating. I am not denying that breasts aren't sexual because they are. I'm just denying the looney idea that our minds can't possibly separate the two acts- sex and breastfeeding. What you do with the body part, whether it's your mouth or hand or breast, defines its function. 

(I understand that someone will try to use my analogy to say, "Then if I'm not using my penis for sex, I should be able to whip it out anywhere." I understand that the example isn't flawless. I'm just asking you to think differently for a minute. I'm attempting to challenge your perspective.) 

I've heard several arguments. I've heard "I don't have a problem if you breastfeed, I just don't want to see it." or "I do not want to walk into a restaurant and watch someone do that while I'm trying to eat. It's disgusting." or "I don't want my son to see that." I get it. I'm not trying to disrespect anyone's feelings. What I AM trying to do is to challenge you to forget that mindset for just a second. What if your son grew up seeing women breastfeed? What if his first experiences with breasts were that of nurturing? What if he saw a woman's body doing extraordinary things like make milk and sustain a life solely with her own body? What if he grew up learning that breasts are more than sex objects? What if from the beginning of his life he saw the act as an innocent way to feed a baby and not something sexual and perverse? What if YOU grew up that way? Imagine yourself for a moment being from another culture. Imagine that you saw your mom, your neighbor, your sister, your friend all breastfeed. Imagine that it was a normal part of life and no one had anything to say about it. Imagine no one ever asked a woman to cover up, sit in a dirty bathroom, or hide out in a sweltering hot car to feed her baby. It wouldn't be so bad would it? If you grew up seeing it, everyone around you did it, and no one had any objections to it... you probably wouldn't think it was gross/odd/perverse, right? 

Or just imagine you and your child enjoying this Mister Rogers' Neighborhood episode from the 60's. Or this Sesame Street episode from 1977. Our country hasn't always been so against breastfeeding, which gives me hope that us Americans can once again begin to see it as normal. We won't ever get past the sexualization of breastfeeding unless we take down these cultural attitudes that limit breasts to sex. And women will never be free unless they are supported to do what their bodies are meant for. Let's stop the shaming. Let's stop the ugly stares. Let's stop the banning of these images from our society. Let's stop the discrimination. Breastfeeding may be legally protected and encouraged by reputable health organizations, but cultural norms are always more powerful than laws and expert advocacy. 

And please, women, it starts with us. If women won't support other women, who will? 

they call me sissy

"So where did 'Sissy' come from?"

It's a legitimate question. A Canadian midwife in Haiti wants to know why a grown woman is telling other adults, "My name is Carsen, but you can call me Sissy."

It started out the usual way: my siblings- and there are many of them- started calling me Sissy when I was very young. Then my parents did foster care and over the course of four years, 28 different children were in our home and I was Sissy to them too. When my parents decided to expand our family more by doing an overseas adoption, the name spread to Haiti.

My junior year of high school, I flew to Haiti for the first time to meet my siblings. My mom introduced me to them and the nannies overheard and thought "Sissy" was my given name. I tried to correct them once, but soon found out that "Carsen" doesn't sound quite right in Haitian Creole, so "Sissy" stuck.

I like to joke that my parents "take in strays." People that are lonely or in need of a family unit always have seemed to find their way into my parents' home. It doesn't take long for the nickname to become a part of the vocabulary of those who become family along the way.

That little orphanage where I met my brothers and sister became a home for me at the age of 19. I was already known there as Sissy and so it became the name that I went by for the 8 months that I lived there. When I return to Haiti with other organizations, I always introduce myself as Carsen. However, it still seems to be a name that is difficult to remember or say to Haitians, so I generally offer "Sissy" as an alternative. Somehow, the name has sticking power.

For me, however, it is an identity. For some sweet ones "Sissy" isn't enough and it becomes "My Sissy". I am a sister to many. I'm a shoulder to cry on, a hand to blow noses with, a back to climb on, legs to run with. Someone once said, "I like Sissy because she can make her face look like a monkey." I guess I'm good for that, too. I might come with a lecture or two- or maybe I'll just be there to listen about how unreasonable the adults are being. My heart has been broken into a million pieces as the phases of life require changes that little ones don't understand- like why I don't live with them anymore. "I want my Sissy!"- and my heart breaks with each tear as he tries to figure out why Sissy has to leave all the time. I reminisce about the days when my makeup-wearing sister was small enough to bathe in the sink. I miss when my 6 foot tall, nearly 200 lb brother was small enough for me to carry around in a backpack. As they each grow to tower over me, the relationship changes. These large, hairy, hormonal beings no longer want me to read them bedtime stories. However, I may be good at changing my voice to act out each character's part, but I'm also good at talking about periods and dating and sex.

With the name comes a badge of honor. It is a privilege to be Sissy to each one of them, even if only for a short time. I'm blessed to have these sweet souls in my life. Even more, I'm blessed that they call me Sissy.

keep on

ZIIIIIIIIPPP ZZZZOOOOOOM *phew* Life is moving fast and I barely have time to process it.

In seven short longest-of-my-life months, I will graduate nursing school and will hopefully be an RN shortly thereafter. That statement alone makes my eyes spin a little. It's hard to write a blog when your eyes are spinning, which may explain my absence. 

Life is a little bit CrAzY right now. While I'm busy memorizing things like electrolyte levels, John has been busy with work. With an impending promotion and the increased responsibilities of that, as well as an intense training schedule, John's eyes are spinning too. You should see us. We look like cartoons. 

We are at this awkward place in our life. Half of our friends are having babies and the other half are single and partying it up. We are somewhere in between. Some of our friends are young professionals and making good money with few obligations. We are close enough to that reality to dream about extra money someday soon, but we're still eating ramen noodles every now and then. You can't beat 25 cents worth of sodium and cardboard. We also have been married long enough that the delirium of honeymoon bliss is wearing off. I am happy to report that we still love each other, and most days we even like each other. It's just that this is the longest time we've spent in the same country and that comes with some new challenges. Once again, we are in an awkward place: the elated daze of the first few months of marriage is gone, yet we haven't quite found that secure niche that comes with several years of a solid marriage. The ever-changing dynamics of our relationship coupled with perpetual exhaustion leaves us wanting to go out dancing with our fun, single counterparts, but usually ends with us watching TV until our brains ooze out of our ears and we go to bed at 9 pm. I'm sorry I'm not sorry. 

It's a lot of work. All of it. Nursing school, Army life, marriage, finding laughter and spark in the mundane parts of life - it takes work. I wish I had some words of wisdom to offer, but I'm kind of up to my spinning eyeballs in the muck of it all. However, I've heard from those who've been-there-done-that that it's all worth it in the end. So I'll hang my hat on that and keep on keepin' on.

choose life

This week is National Suicide Prevention Week. I've always thought that suicide is the most selfish thing someone could do. I've always thought it was an easy way out that only made the person committing suicide feel better but left everyone behind hurting. I've always thought that it was a detestable thing to do. I've always believed suicide was pain that just created more pain. And then there I was in the midst of more despair than my soul cares to share, staring at a ceiling fan wondering if it could hold my weight.

I began to wonder if we had any rope. I thought about how painful it might be if the fan base couldn't hold my weight and I ended up just crashing to the ground. I wondered if I would feel my neck snap. The thoughts were ever so brief, and they left as quickly as they came, but the fact that they even entered my mind scared me. However, even though it was tempting to fantasize about ending my pain by ending my life, I knew that I would never do it.

I knew that I would never commit suicide because I know how deeply I am loved. Even though there was so much hurt, I knew there was that much more love. I knew that if I were to act in my darkest moment, that it would only give birth to more darkness. I knew that I would be causing pain to the people that I care about, and I decided I never wanted anyone that I love to feel this visceral, unbearable pain I was feeling. So I chose life. And I know that there are people that are very glad I made that choice, even if they never knew those thoughts had crossed my mind.

This experience made me think about the people that don't know that they are loved in that way, the people that have doubts about if anyone would miss them. I thought about those who didn't choose life because they didn't know how dearly loved they were. To those of you who don't have that tangible love to lean on, to those of you in your darkest moments, to those of you with the rope already around your neck, listen to me: I love you. You. are. loved. Do you hear that? Someone, somewhere loves you. Even if it's a girl miles away who never met you... you are loved by someone. It will break someone's heart to lose you. You are valuable. You have a purpose. It will get better. The fog will lift and there will be light again. The sunrise is coming... you know what they say, it's always darkest before dawn. So, please, dear loved one, take the rope off from around your neck, put the cap back on the bottle, get rid of whatever nasty thing you want to use to bring more darkness to the world. Take a big deep breath and feel my love for you. Now get up and go choose life.

The Road Home

I decided to go for a walk this morning. The fresh air and morning sun could do me some good. I left early to avoid the scorching Texas heat. By 8:30, I had completed the route I had set out to take. Enjoying the exercise, I decided to continue on. Though it was heating up considerably and I was sweating more than expected, I was in deep conversation with God and lost in my thoughts. I then realized that I was in a neighborhood I did not recognize. I was lost. Should I go back the way I came from and retrace my steps? The problem was that I wasn't even sure how I got there. The street names didn't look familiar. I stopped in the street and looked at the sun. I wasn't sure exactly where I was, but I had an idea of the direction of my home. Should I cut through all these residential streets and move in the direction of where I want to go? I wasn't sure if those streets went all the way through or if they were a clear shot home.

I decided to continue on the route that I was on. I thought that maybe I would discover something along the way. I decided to make it an adventure instead of anxiety-producing. I don't move that fast, so I knew I couldn't be far. And I still had confidence that I knew the direction of my home and an inkling that this street I was on would lead me to one that would take me straight there. After a couple of twists and turn, my surroundings started to become familiar again. I wasn't lost at all; I knew exactly where I was! And my intuition was right, this street lead me to the one I was looking for, the one that would take me home.

Isn't life like that sometimes? You wake up and look around and have no idea how you got to where you are. Your current situations are confusing and full of uncertainty. You aren't sure what path to take. Do you go back? Do you keep going? Do you take another route entirely? Your surroundings are unfamiliar and there may be some uncomfortable twists and turns. Do you choose anxiety or adventure? Perhaps looking up at the Son will remind you of where your home is. Though it may feel like it, you aren't lost at all. The road home is just around the corner.

I need a doctor

It was a month before my 16th birthday. My mom was taking me to Haiti to meet my siblings who were currently living in a Haitian orphanage. I wasn't a stranger to poverty. I grew up serving meals at the local homeless shelter. My parents had taken in foster children in the middle of the night who were malnourished and scared and ate the warm food past the pain of their rotting teeth. I had gone to Costa Rica. There I saw regions of people displaced from other countries trying to make by in small huts and tents. I wasn't a completely naive, young American girl.

However, I had never seen anything like Haiti and I wasn't yet desensitized to the shocking reality of poverty. The local homeless mission is vastly different from the poorest country in the Western Hemisphere. As I gazed out of the back of a truck, wide-eyed and nervous, down my first bumpy Haitian road, I had no idea how this little country would impact me. I had no idea that it would be here that I would hold a little one as AIDS took his life. I had no idea that I would learn enough of the language to argue with nurses and advocate for babies in Haitian hospitals. I had no idea that it would be this place that helped to decide on a career in nursing. At just 15 years old, I had no idea that I would wrap a stillborn baby up in a blanket and hand it to a man with a wheelbarrow to take for disposal. As I road in that truck, with the smog in the air sticking to my pale but freckled face, I had no idea that someday I would live in this country.

In fact, it wouldn't take long before I decided that I really wanted to go home. My mom stayed with me the first week of my trip. I stayed behind another three weeks to help around the orphanage and learn a thing or two about humility. In the process, I contracted a parasitic infection and lost 11 pounds in the month that I stayed there. By the end of the month, I was exhausted, ill, and homesick. I couldn't wait to get as far away from Haiti as possible and into a warm American shower. I happily packed my bags and was dropped off at the airport in Port au Prince. I had never been so excited at the thought of getting on a plane.

When I arrived at the airport, I had to first make a stop at the bathroom, a frequent necessity when harboring a parasite. As soon as I exited the restroom, I noticed it looked a lot busier than I expected. I got in line and began to wait. The line wasn't moving, but it was growing and growing until there was no more room in the small Caribbean airport. I began to grow incredibly anxious. I had arrived at the airport two hours before my flight, yet I wasn't even checked in yet. As I began to realize that I wasn't going to make my flight as I had been waiting in line for two hours, the crowd began to rumble. Angry protests, pushing, and yelling began. Any sense of personal space I once had was completely gone. An American man told me that the power had gone out in the airport and all of the computers and other equipment was down, and the backup generator was apparently not working.

The airport staff eventually set up tables to manually check each bag since they had no x-ray machine. Other staff members were trying to handwrite boarding passes and communicate without telephones or overhead speakers. It was the most chaotic thing I have ever experienced. My bag was in front of me. The shoving began to get so intense that I flipped right over my bag onto the floor. That's when I decided I had had enough and could no longer just stand in line while other people shoved me. I observed the baggage checking process. When the staff members were done combing through everyone's bags, they put a sticker on the bag to signify it was clear. A lover of rules and order, I have no idea what overcame me, but I have a feeling it had something to do with holding in diarrhea for the last three hours while getting shoved to the floor. I crawled on the ground in the middle of the Port au Prince airport and found a sticker. I put that sticker on my bag and went to the people guarding the ticket counter. They asked if my bags had been checked. I pointed to my "tactically-acquired" red sticker on my bag. They let me through.

The agent at the counter informed me that my plane had left an hour ago. I forcefully said that I didn't care where they sent me, JUST GET ME TO AMERICA. She told me all flights were booked. I gave her a death stare. She wrote out a standby ticket for a flight to Fort Lauderdale and checked my bag. She told me to go to the gate and find the person working there and tell them I am on standby. I did just that. The woman told me to just stand here and wait for her. I didn't. I followed that woman everywhere she went, even to the bathroom. I told her that I will get on a flight. I stared her down as she began the boarding process for the flight I was on standby for. After everyone was boarded, she turned to me and said, "There's a seat available. Go." "Which one?" I asked. There were no jetways. There were several planes on the tarmac with passengers boarding via large ladders. She pointed to one and told me to hurry. I ran and waved and screamed at the people getting ready to close up the plane and remove the ladder. They waited for me.

The flight attendant was completely confused at my handwritten ticket that simply said "standby" and my name. She found me the last seat on the plane. I sat down and cried. A young Haitian boy was sitting next to me eating crackers and offered me one. I smiled, ate a cracker, and collapsed into a deep sleep. I woke up as the attendants were preparing for final decent. "American Airlines welcomes you to Miami." Miami?! I was supposed to be on a plane to Fort Lauderdale! I checked my bags to Fort Lauderdale! I got off the plane, and through customs, and finally called my mom. In a weary voice, I tried to explain all that had just happened. I had no connecting flight, since my original one was long gone, and the only thing the Port au Prince agent booked me for was a flight to Fort Lauderdale, but I ended up in Miami. While my mom was trying to figure out getting me a ticket home from her end, I went to the American Airlines desk. I explained everything to the agent. She was my angel and found me a flight to Dallas with a connecting flight to Sacramento. But she looked at me and said, "They already started boarding. Can you run?"

And run I did. I called my mom out of breath to tell her I was getting on a flight and that I would be home soon. As I came down the escalator of the Sacramento airport, I saw my family at the bottom. My lip began to quiver. I walked straight into my dad's chest and began to sob. My dad took my backpack off of me as I just stood there. My mom kissed me. I looked at both of them, wiping away my cleansing tears, and said, "Hi. I need a doctor. And a bathroom."

OB, Midwife, Doula... what's the difference?

Well, hello there! I'm back into full swing of nursing school- the final 10 months! I'm taking a break from studying about mental illness to talk about something I really love- women's health. (I just don't have any interesting "love" or "camo" topics so I'll bore you with the "other stuff.") I get asked these questions a lot- "What's the difference between an OB and a midwife?" and "What's the difference between a midwife and a doula?" It can be really confusing at first, so I'm gonna break it down for you.

Obstetrician
An obstetrician (OB) is a physician who is inherently a trained pathologist and surgeon. This means OBs are specialists in pregnancy-related diseases, complications, and surgery. An OB first earns a four year degree, then goes to four years of medical school. After those eight years of college, the now MD goes on to more speciality training in his/her field- obstetrics- usually for another four years. (That's a total of 12 years.) They do learn about low-risk, "normal," vaginal birth, but what they are really good at is the high-risk, complicated pregnancies that often necessitate interventions such as medication and surgery. Because OBs have been trained to treat diseases (and fear litigation if they don't act soon enough), care with an OB tends to be very medicalized and full of routine interventions (medications/actions that are done to every woman, whether she needs it or not). Most women in the US see obstetricians for their care even if they are not high-risk. This system is unlike most other countries in the world. Most other industrialized nations have a system in which everyone sees a midwife first, and if her pregnancy is high-risk or complications arise, she is referred to an OB. We have this system for every speciality except obstetrics. For instance, if you have high blood pressure and a heart murmur, your general physician can prescribe medication and monitor your murmur. That may be all the care you need and GPs are generally very good at what they do, even though they are not "specialists" in cardiology.  However, if your GP feels that your heart condition is beyond her scope, she will refer you to a cardiologist. Obstetricians see patients for their prenatal and postpartum care usually in an office, and attend births in a hospital.

Midwife
In the US, there are two different kinds of midwives- direct-entry midwives (Certified Professional Midwife) or midwives that were nurses first (Certified Nurse Midwife). Both are master level degrees, however some states do not allow CPMs to practice midwifery. I will be mainly speaking about Nurse Midwives, however midwives who were not nurses first have just as much merit and worth as CNMs.
CNMs first complete approximately two years of college courses to qualify them to enroll into a nursing program where they become Registered Nurses. After completing a bachelor's degree in nursing, an RN then goes on to becoming an advanced practice nurse with a focus in midwifery. This master's degree gives the RN a new title- Certified Nurse Midwife. The scope of practice for CNMs vary throughout each state, but are generally the same. CNMs have the same level of degree as Nurse Practitioners, but have specialized in the care of pregnant women. Midwifery tends to be more hands-off than obstetrics- waiting until there is an actual problem to act and tailoring care to each individual need instead of routines for all women. Appointments with midwives tend to be a bit longer and have a more holistic focus. This means that midwives put an emphasis on nutrition, exercise, emotions, and thoughts, as well as the basic assessments such as blood pressure, weight, uterine growth. Midwifery tends to be more low-tech, relying more on skills than technology. For example, using a measuring tape and feeling the uterus to estimate fetal size rather than using an ultrasound machine. Midwives tend to be more trained in "normal variations" of vaginal birth. For instance, midwives tend get more training in vaginal breech birth (buttocks or feet first instead of head first), whereas an OBs "go to" for breech birth is cesarean section. (I have a friend in medical school. He told me that his training for breech birth was watching a 20 minute video in class. After the video, the instructor said, "Well, you don't really need to know this anyway because you'll just section.") Midwives appreciate the mind-body connection and understand that things like fear and anxiety can stall labor. Midwives also tend to try least invasive alternatives first, such as upright pushing to use gravity, instead of an episiotomy (an incision to the vagina/perineum). CNMs work in hospitals, birth centers, and attend home births. CPMs attend births in out-of-hospital settings, such as birth centers and at home. Ideally, midwives work closely with OBs in the event that transfer of care is necessary. Midwives are trained how to deal with complications that may arise such as neonatal CPR, administration of emergency medication, how to control a hemorrhage, and suturing tears.

*Disclaimer: These are broad generalizations. Every practitioner is different. There are many OBs who are hesitant about routine interventions and do more individualized care. There are many OBs who strongly support natural childbirth, avoiding surgery if possible, and advocate for a woman's right to make her own decisions about birth. You will also find CNMs who are highly medicalized, do not respect autonomy, and perform many routine interventions. It is always important to interview multiple providers to find one who is a good fit for you.

Doula 
A doula is a non medical person whose sole purpose is to comfort and support a laboring woman. A doula does not do internal exams, check blood pressure, run tests, clamp the cord, etc. There are lay doulas (one without a certification) and certified doulas. There are various certifying bodies, but the training is about the same. One must read a handful of books about birth and breastfeeding, write a paper about the books, attend a certain number of births with a certified doula, attend a childbirth education class for pregnant women and their partners (such as Lamaze or Bradley), take a test, and pay a fee. Those that are not certified have typically done many of these things as well. A doula does not replace family members/loved ones, but is a birth professional who supports, encourages, and comforts before, during, and after labor. Most hospitals do not include a doula in their "count" of people allowed in the room (if hospital policy states only two people can be in the room, it usually means two family members plus a doula.) Most doulas understand the importance of loved ones being involved in the birth and will encourage them to stay engaged and focused on the laboring mother. Generally, a pregnant woman and her partner will meet with a doula 1-2 times before the birth. These meetings including becoming comfortable with one another, sharing information about possible interventions so a woman can make informed decisions, and making a birth plan- talking about the goals and desires for birth and ways to achieve those goals. For instance, if avoiding pain medication is really important to the woman, she and the doula will talk about other pain management options and establish a code word to use if the mother changes her mind during labor. The doula's goal is to help the woman have the birth she desires, no matter what that looks like for each individual client. Doulas are a source of information and bring to the birth a calmness, assuredness, and peace. Doulas tend to manipulate the environment to make it conducive for a happy, relaxed, and healthy birth. She may do this by dimming the lights, playing soft music, or using aromatherapy. Doulas help manage discomfort by giving massages, suggesting position changes, using therapeutic movement, encouraging hydrotherapy (warm bath or shower), and offering food and drink. Doulas also recognize the mind-body connection and help women to discuss their worries and fears and use supportive, encouraging words. A doula's job is to trust a woman's innate ability to birth her baby and helps a woman to have the same confidence in herself. A doula stays with a mother through early labor, active labor, pushing, birth, and initiation of breastfeeding (she will stay to support a woman usually up to two hours after the birth.) Doulas go wherever their clients labor and deliver. Studies have shown that this continuous support leads to fewer complications and interventions, higher breastfeeding success, and a more satisfying experience. Some hospitals are noticing this effect and are starting to implement their own doula programs. The rates for doulas vary widely depending on the area and actual doula; the range can be between $400-$1,500.