Winter Issue 2020
Birth Work in Kentucky
By Leslie Dobbins
As a 20-year-old who had an otherwise normal and healthy pregnancy, I was coerced into scheduling an induction at 41 weeks. Up to that point, I had hoped and planned to have an unmedicated birth at the local hospital, but upon learning that an induction was unavoidable due to my small stature, and presumed small pelvis, I conceded. After having my water broken, I received my epidural and a dose of Demerol. I immediately became so tired that I could not stay awake. The nurse giggled at me for trying to speak while failing to move my mouth correctly. After dozing off for at least an hour or two, I woke up to back-to-back contractions and an intense urge to push. The nurse demanded I wait a few minutes until the doctor rushed in, and my son was born only a few minutes later. In the hours following the birth, I remember struggling to keep my eyes open to speak with visitors who stopped by. My arms barely had the strength to hold my son, and it was hours until the drugs finally began to wear off.
My family is extremely private. I had no memories of women in my family talking about their own birth experiences, and none of my close friends had ever given birth. I felt I was thrown into a world I didn’t know with no idea how to begin learning about it. Growing up in southern Kentucky, my views about childbirth came almost exclusively from my fundamentalist Christian background. Abortion, birth control, and even childlessness were considered immoral by most. But in the years following my son’s birth, as I gravitated naturally towards mothers, I began to hear other women’s birth stories. Most of them were not particularly romantic. Some of them spoke of enduring 30-hour labors. Some made it a goal to deny narcotics entirely, while others had accidental home births, meaning unattended by a professional, after laboring at home for too long.
Photograph courtesy of Emelia’s partner, Eliott
Perhaps I overly-romanticized these stories, but I still felt as though I had missed out on something powerful in my own birth experience, as if my baby had been removed from me. Taken out of me. As though I had not been trusted to bring him into the world on my own accord. Later, in doula training, I learned that doctors often use scare tactics to convince birthing people to give birth during the physician’s preferred time frame. I became very sad and very angry, and I looked for someone to blame. As I reflected on what I believed about birth prior to my pregnancy, I realized I had never given much thought to the process at all. From a hypothetical standpoint, I wanted to have children eventually, but in my naivete, I never really considered, discussed, or thought about childbirth, which directly affected my birthing experience.
While I had heard the term “doula” before, it wasn’t until after the birth that I started to learn about their areas of expertise. A doula is someone well-educated in the different stages of labor and delivery, who supports and guides the laboring person through the decision-making process of both pregnancy and birth. A person typically selects and hires a doula whose views about birth complement their own. Having a sense of trust, shared culture, and shared values is extremely important. A doula may teach laboring positions, breathing or visualization techniques, and how to minimize pregnancy woes and pains. The doula remains on-call the last few weeks of pregnancy, attends the birth, and supports both the birthing person and their family during the prenatal and postpartum stages. The doula makes sure that the birthing person is treated with integrity and respect throughout the birthing process and considers their needs and desires above all else. However, it took a while to understand why so few birthing people have the support of a doula at their birth.
In contemporary obstetrics, birth is often treated like a pathological process, involving the nature of a physical or mental disease, instead of a natural one. The midwifery model, which was standard until the early 1900s, is much more person-centric, and supports the notion that childbirth is a natural and transformative event in the birthing person’s life. The medical model requires nurses and physicians to attend and intervene, while the birthing parent is treated like a standard patient rather than the facilitator through which this natural phenomenon takes place. Until the twentieth century, those who gave birth were typically surrounded by practitioners who were proficient in the birthing process. This assistance was usually provided for several months following the birth of a newborn.
Photograph courtesy of Emelia's partner, Eliott
But by 1935, midwives attended less than 15% of births in the US, and less than 5% of births occurred outside the hospital. Those giving birth no longer had traditional birthing partners. Instead, many people birthed unconsciously under the influence of drugs that induced a state called “twilight sleep,” after which the laboring parent had no memory of giving birth. Those who were pregnant readily sought after this newly advertised “painless childbirth.” It wasn’t until the 1970s that birthing professionals began to see a shift back to a more holistic approach, largely due to the work of midwives such as Ina May Gaskin and Penny Simkin, among many others.1 Midwives found the hospital model of birth to be insufficient and desired to play a larger role in assisting childbirths. Laboring people needed better options, better outcomes, and better advocates.
Following my own birthing experience, I immediately wanted to help other pregnant people through their birth journeys. Intuitively, I felt I knew what they needed—a strong listener, a mentor, someone to help them better understand how their past may inform their birth choices, and someone to explain their options and the potential consequences. I knew what it was like to be scared, confused, and in desperate need of an advocate, and I felt confident that I could provide quality assistance to other birthing people. As I internalized this knowledge, I knew that one day I would become a doula. It was 7 years before that vision started coming to fruition. When I began taking my own birth clients, the insight I gained from my doula training, combined with my own personal history, informed my view of what birth work could mean for other people. My client intake form asks questions about who their mother was, what stories they heard about birth, and how their environment growing up may have impacted their philosophy about birth. My clients all seem keen to share this information, and it informs how comfortable they are with the entire birthing journey.
Photograph courtesy of Leslie Dobbins
After a year of taking my own birth clients, I decided to talk with other women, not just clients, about their personal stories as well. I spoke with a few people in my community—friends, fellow birth workers, and former clients—and asked them to share their childbirth narratives with me. The following stories are just a few of the conversations I’ve had with various women, all from Kentucky, about the kind of support they received and how their births were impacted by that support.
I met Elyse Castle, from Lexington, Kentucky, on the internet earlier this year. She grew up in Berea, Kentucky and now resides in Lexington with her partner and their two children. We have never met face-to-face, but we connected through a common interest in all things art, plants, birth, and tattoos. One day she responded to a post I shared on Instagram with some details about her own home birth story. I was immediately overwhelmed with gratitude that this woman—whom I’d never met—was so willing to share her story with me and allow me to include it here.
I was always very fascinated with natural birth and breastfeeding after my mother shared her birth story with me at a young age. Her empowered demeanor and expression when describing her unmedicated labor with both my brother and I, stuck with me through all these years. Later in life, around high school, I ran across a copy of Spiritual Midwifery, written by Ina May Gaskin. I was fascinated and quickly learned how miraculous childbirth, especially without unnecessary intervention, can be. When I found myself pregnant almost three years ago, those two experiences are what predominantly guided me on my own journey through pregnancy and into motherhood.
I had a network of women that were very supportive of my choice to give birth naturally and to breastfeed. Most, however, did not fully understand my reasoning for a pregnancy and birth with minimal interventions, and my disposition towards a holistic approach. In turn, that lack of understanding created internal doubt and uncertainty, something I wasn't fully prepared to deal with, especially postpartum. Luckily, a long-time friend, though miles apart, was my biggest support without variation of opinion or judgement. Not only was she supportive with affirmations, advice, and encouraging gifts, she was very open and candid about her own pregnancies. I do believe if it weren't for her, the trajectory of my birth would have been much different otherwise.
In 2019, I met Emelia at a “Meet the Doulas” event in my hometown. She became a fast friend and my very first doula client. I was there to support her and her husband for the birth of their first child, Wrenn. What struck me first about Emelia was the close relationship she had with her mother, who was incredibly supportive of her daughter throughout the entire process and became an irreplaceable presence for us both during that time.
This is Emelia’s story.
I was fortunate to know and speak candidly with many women who felt comfortable enough to share their birth and breastfeeding stories with me. I feel like those conversations made me feel more confident in my own abilities to accomplish what they had as far as giving birth and getting a handle on breastfeeding. My mother speaks about breastfeeding like it is the most amazing thing in the world. I feel like her overly positive portrayal didn't really prepare me for how hard it actually is, but it definitely made me stick it out until baby and I found our groove and for that I am thankful.
Having a doula at our birth was such a blessing, and having Leslie there absolutely took some of the pressure off of [my husband] to be by my side for every second and made my mom feel more comfortable having an educated person in the room to help me through. My daughter got stuck in my birth canal and my midwife said that she was going to give me an episiotomy after my next push to help get her out to which I firmly replied, “NO!” After that push I managed to finally get my daughter out and behind my midwife I heard one of the nurses say, "We should threaten them with episiotomies more often."
I followed up with Emelia several times after the birth of her daughter. While her confidence as a new mother flourished quickly with the support of myself, her husband, and her mother all nearby, she openly discussed her disappointment in the treatment she endured from both the labor and delivery nurses and her Licensed Midwife. Before the birth, Emelia and I planned what needed to happen should her birth plan go off course. One thing Emelia and I had not planned for was arguing with the hospital staff, mid-labor, to have her birth plan followed and respected. We talked through the experience together in her first few months postpartum. We found it to be healing for us both. It was in the months following her birth that she began to think differently about what had transpired. Because Emelia discovered she was pregnant only 5 months into a new relationship, she was thrown into a decision-making process she had not anticipated. Consequently, Emelia believed she had been limited in what she considered as possible for her birth.
Photograph courtesy of Sage's mother, Cassie
My friend, and fellow birth worker, Davida Flowers, from Oakland, Kentucky, shared a bit of her birth story with me as well.
My closest relationship to anyone with a baby when I got pregnant at 22 was my mom. According to her, she was the rebel of her family when it came to birthing vaginally, without medication, and breastfeeding. Out of all her six siblings, she was the only one to choose to do so. Despite my grandmother being from Arkansas, and herself delivered by a midwife, she thought babies were supposed to be born in the hospital and that breastfeeding was improper and generally, something country (read: poor and uneducated) people did. My mother happened to have a good OB who counseled her about breastfeeding and explained to her all the benefits as opposed to formula. By the time I was pregnant she had been pregnant more than seven times, experienced loss, successfully raised two teenagers and an adult, and was the perfect resource to talk to. I was fortunate that she was extremely candid about her journey which bolstered me on mine.
Each of these women carry within them the birth stories of those who came before them. They carry with them the power and the pride, along with the trauma and the fear, felt by their mothers and grandmothers. However, those same women have offered a gift to those who will come after them—their children, their grandchildren, and so on—by sharing their stories with others.
I am grateful to know many women who have shared their stories with me. When I became pregnant, I was scared. I needed someone to help guide me in making decisions for myself and my baby, and to do so with confidence. As a birth worker, people often want to know if I have felt the pain of having an unmedicated birth, or if I have birthed at home with a midwife, so I tell them my story. I tell them about the pain of having no idea what was happening within or around me and the lack of control from beginning to end. That is why I am a doula today. Without that experience, I might have never known what happens to birthing people in Kentucky, every single day, when they go to the hospital to give birth, often completely alone, and are required to make decisions without a trusted advocate. Adequate birth support can mean the difference between an empowering birth story and a traumatic one. It offers a snapshot into the stories the next generations will grow up hearing about how they made their entrance into this world.
Leslie Dobbins was raised and resides in Bowling Green, Kentucky. After becoming a single mother in 2012, she began working at a local coffee shop and attended Western Kentucky University for Diversity & Community Studies and Religious Studies. Her studies furthered her interests concerning the influence of Southern culture and religion on the lives, relationships, and births of women. In 2019 she completed a Doulas of North America International birth doula training in Louisville, Kentucky. In addition to being a birth doula, she also works for a local farm, has continued working for the coffee shop part-time, and homeschools her 8-year-old son.