Monday, August 30, 2010

What the heck is a doula?

I have heard a lot of confusion before about this term and what the role of a true doula is. I have heard people think a doula is the same as a midwife (no), that doulas assist with deliveries (sort of but not in the way you think), that you don't need one if you have a husband/partner there to help (but what if your partner needs one?) and that you can only have an unmedicated natural childbirth with a doula.
Well, let me address some of these questions. A doula is a trained support person (usually a woman) that is there during labor and delivery to support both the mother AND her partner. Doulas are trained in assisting with non-medical comfort measures, psychological and emotional calming and support for the parents, and to act as an advocate for the mom and partner if the need should arise. Research shows that women who have doulas present during labor and delivery have less need for medications, less dystocia, and fewer c-sections (from Hospitals are beginning to realize that doulas address a crucial part of the laboring mother-her emotional and psychological comfort-that hospital personnel aren't always set up or able to provide care for.
Doulas don't take the place of a husband or partner but rather help him provide the most effective support for the mother and spell him when he needs a break. Doulas don't force moms into making choices about epidurals or interventions, but help a mother educate herself on these interventions and support her choices whenever possible.
For more info on doulas go to:
or read:

Emotional reasoning and should statements

Two more cognitive distortions are emotional reasoning and should statements. Here are some examples:
“I feel so guilty about being sick, I must deserve being ill.”
In emotional reasoning we take our feelings as facts. In the example above the person feels guilty so she rationalizes that she must deserve being sick. Often our feelings are intense, uncomfortable, and pervasive but feelings are not always facts. A more rational example might be:
“I feel so guilty about being sick but I know that I am doing the best that I can.”
An example of a should statement is:
“I should be able to keep up with other people my age in going to both school and work. “ In this situation the person is irrationally blaming herself for having limits due to a very real illness. A more rational statement would be:
“I will do the best I can and fit my lifestyle around what is realistic and healthy for my limits.”
I know so many of these seem like basic ways to tweak your thoughts but it’s amazing how these negative thoughts can pile up and affect our mood and health. I hope you’re following along, picking out your statements and finding ways you can be healthier and more realistic with yourself!
‘Til next time!

Thursday, August 19, 2010

Healing Mommies

Healing Mommies is a subset of my practice dedicated to helping women with the unique issues that pregnancy and motherhood can bring up. Pregnancy and motherhood is supposed to be a joyous time but for some women it brings up feelings of fear, loss, anxiety, and doubt. For example:
• If your mom was absent physically or emotionally as you were growing up due to mental illness, jail, alcohol or drug abuse.
• A mother that was abusive or was unable to protect you from abuse.
• Sexual abuse survivors often feel out of control or anxious during pregnancy and lactation due to their changing body and the potential of medical intrusion.
• Women who have lost their moms at a young age.
In these situations and similar situations women feel anxious about their ability to mother, memories of abuse can re-surface, or the grief of losing your mom can come back once you begin to mother. These feelings are normal and with proper help most women can get relief. Addressing these feelings can allow you to better bond with your baby or child, feel more comfortable during pregnancy and labor, and reduce chances of postpartum depression or trauma. It’s my belief that happier moms = happier babies = happier families = happier communities. So taking care of yourself is really a very self-less thing to do! I offer a $10 new family discount for pregnant moms and families with children under the age of two. Please watch my website and blog for more updates.

Thursday, August 12, 2010

"She said what?"

“She said yes…now what?”

I want to thank Jackie Belau aka the Maternity Maven for a fantastic networking event where I finally got to meet some awesome care providers and businesses that cater to women, pregnant moms, little kids, and families in the Sacramento/Placer county area. Many of these care providers are midwives and doulas who routinely ask their clients about a history of trauma whether it be childhood abuse or adult abuse. 99.99% of the time I hear that the midwives, doulas, and OBs do a good job at following up when a history of trauma is indicated by a woman in their practice, but I wanted to write this as some reassurance and suggestions and reminders about how to proceed.
First of all asking and truly listening to the response can be a very healing moment for somebody that has been through abuse. By not treating that moment as another box to check off and really actively listening you are providing unconditional positive regard and support. That can be healing in and of itself. But beyond that what are some specific things that caregivers can provide?
Ask the woman where she is in her healing process. Note that I didn’t call her a victim or ask if she had been in therapy. Not all women feel like victims or even need therapy. Some women are in denial about the effect that the abuse has had on them and starting off by using words like victim or automatically referring to therapy can push her further down the path of denial or traumatize her. Moving through abuse is truly a healing process that can take on many facets and it is important to acknowledge that there are a wide range of responses to being abused.
If a woman is struggling help her identify resources in her life. These resources could range from family and friends, a spouse or partner, a counselor, a spiritual advisor, even pets and coping skills such as journaling.
Know as a provider that it is not unusual for feelings that were thought to be resolved to re-emerge as any survivor goes through developmental milestones. Milestones such as pregnancy and children are no different. This doesn’t mean that a client is “back at square one” or there is something wrong with them. In my experience as a person evolves her understanding of significant life events also has to evolve. If those life events are very difficult ones she may need a bit of additional work or support but because she has “been there, done that” with her abuse history she will already have coping tools she can use.
Ask your client if any counseling that she had in the past was helpful or not. It isn’t always helpful. Sometimes the fit between counselor/client isn’t right or the timing is off for a woman to fully process her issues. Ask her what was helpful and what was not helpful and take the time to truly listen, as this answer will give you vital information about what the woman needs right now and how you can help her get there. Have referrals available if your client chooses counseling. Make sure the referrals are trustworthy and have some ideas about a variety of sliding fee clinics if necessary. Feel free to contact me for specific suggestions on this.
Remind her that the healthier she is the better start she can give her babies, her children, her partnership, her marriage, everything. Many women feel they are too busy to re-visit these issues and that they are selfish for “indulging” in the time and money it takes to fully process a history that has come and gone. A happier mom means a happier baby, a healthier attachment for mom and baby, a healthier attachment between father and baby, a healthier family unit and I dare say that that lays the foundation for a healthier community and world. I can’t think of a better investment of time or money. Pregnancy is a time that I refer to as “emotionally porous.” So while we absolutely work with our clients to “do no harm” and provide a safe space for them to create a new life remember that we can also plant seeds of well-being and healing that can take root and blossom.

Feelings...nothing more than feelings...

The next two cognitive distortions I would like to look at are “Jumping to conclusions” and “Magnification/Minimization.” Each of these distortions has subtypes. “Jumping to conclusions” has the subtypes of mind reading and fortune telling. “Magnification/Minimization” has the subtype of catastrophizing.
An example of jumping to conclusions and mind reading would be:
“I called in sick to work twice this week because of my pain. My co-workers must think I’m lazy and hate me for having to pick up the slack.”
A thought that might be more rational and healthier would be, “I will let my boss know the chronic nature of my illness and find out what I can do so I can do my share. I will also check in with my co-workers to ensure that I can cover what I missed.”
For fortune telling the thought might go along the lines of:
“I will lose my job for sure if I keep calling in sick!” Think about the feelings this thought would bring up. Anger at your body, fear of the future and for your income, helplessness over the situation.
A healthier thought would look like, “I will communicate with my boss to see what I can do to preserve my job, including getting a doctor’s note for accommodations if need be.” A thought like this is just as rational and real as the last thought, but gives the individual power and hope.
Magnification looks like this:
“This is the worst pain ever. Everyone else is out living their lives and being healthy and I am stuck at home and in pain.”
Well….actually there are lots of people out there with varying degrees of difficulty, pain and strife that they are dealing with. A thought like this can make a person feel physically worse and helpless. A healthier thought might be:
“This is difficult but I know I’m not the only human being who deals with adversity. I will also focus on positive things going on in my life right now such as….”
Many of these distortions are so automatic we don’t even challenge them as the truth when in fact they are not completely true. When we look at these distortions in a more balanced life we free ourselves from a self-imposed set of limitations and allow for more hope, health, and healing in our bodies and lives.
Here is a wonderful book from one of the founding fathers of cognitive behavioral therapy:

Monday, August 2, 2010

Disqualifying the positive and knowing when to get professional help

The next cognitive distortion I would like to examine is "disqualifying the positive." This one is an easy trap to fall into. For example, if you had 10 tasks to do in a day and did 8 of them perfectly and 2 you had a tough time with you don't go home and think about the 8 ones you accomplished with ease, you obsess on the 2 that were difficult. An example of disqualifying the positive when it comes to coping with chronic pain would be:

"I have felt awful for the past week. It is awful living with fibromyalgia!"

Well, yes, living with fibromyalgia is really unfun at times. But a statement that would be just as accurate and more helpful to your ability to cope would be:

"I have felt awful for the past week but thankfully for four weeks prior to that I felt fantastic and it feels as if I am coming out of this flare-up. All of my flare-ups have passed at some point and this one will too."

See the difference? By looking at the big picture you give equal weight to all facts-including the fact that the days where you feel good are just as valid as the days you don't. This isn't being pollyanna-ish it is being rational. Through this rationality we can improve our ability to cope with pain and not allow it to rule our lives.

So...obviously this blog is not a substitute for professional, individualized mental health help. How do you know it's time to seek help? If you are suicidal immediately get help via an emergency room or doctor's visit. That aside, if your significant life activities are hampered by your mood it is time to get help. If it is tough to get out of bed, go to work, enjoy your relationships and hobbies due to your mood it's time to invest in yourself.

A good self-help book for depression: