 Excellent. Let's go. So there is an event which all of us have been through, but none of us remember. And that event is our birth. For me, as Nina said, the topic of birth is very close to my heart. My background in my education is in the field of psychology. But what I currently do for work is I support families who are expecting a baby or who have just had a baby. So new parents and expecting parents. My profession is called a doula. Who is a doula, you might ask. Let me explain. A doula is a trained professional who knows about the physiology of birth and the psychology of the process as well. The word doula comes from Greek, and it means the one who serves or the one who supports. In this case, during the postpartum period or during birth. Doulas are there to provide continuous emotional support and physical comfort. My main mission when I walk into the room is to give a lot of sense of calm, sense of assurance and make sure that the worries get less and the confidence becomes greater. It's also important to say that as a doula, I'm not a doctor. I always work together with a big wife and a doctor and I do not take medical decisions. I only provide emotional support, informational support and physical support. It may be that you yourself will soon be preparing for birth or maybe supporting your partner or potentially just chatting with friends who may be expecting a baby or thinking about having a baby. I think that if you understand the stages of labor, if you know what the woman might experience during each stage and you learn the tactics to support and cope, then you can help better navigate that experience for your loved ones and maybe even for yourself. So today, I invite you to have an open conversation about birth. Here we are. Please meet Amelia. Amelia is expecting her first son. Meet her son. This is Amelia's baby. He is still inside of her uterus surrounded by the amniotic fluid. And if I say any words that you don't understand, I will definitely explain. The amniotic fluid is a liquid that surrounds the growing baby and it serves as a cushion and makes it cozy and soft and protects the baby as he or she is growing. Here on this diagram, you can also see the placenta. The placenta is a very special organ. It only, we only have it, women have it when they're pregnant. It develops specifically during pregnancy. It's not something that we have all the time. And the placenta has access to the mom's blood supply and it's able to provide oxygen to the growing baby. Connecting the placenta and the baby, we have the umbilical cord. The umbilical cord, you can think of it as a tunnel or as a tool-like structure that takes all those nutrients and all the oxygen and takes it to the baby and delivers it directly. And it can also take any waste products or anything unnecessary and take it back away from the baby and transport it out. You can also see the cervix here. The cervix is a special structure. It's a neck of tissue that connects the uterus and the vagina. What happens when the labor begins is the cervix begins to soften, begins to thin and begins to dilate. Once the cervix begins to stretch a little bit, what happens is there's a signal that is sent to the brain. That signal tells the brain the labor has begun. Once the brain has received that signal, a woman gets cocktail hormones that are flooded into her body. There are quite some hormones that are involved, but for today what we want to focus on is the hormone that's known as oxytocin. That is the most important hormone when it comes to childbirth. Why oxytocin is so special? It is special in such a way that it can actually inform other organs in our body what to do. So once the cervix's beginning started to dilate, a message has been sent to the brain. The brain said, okay, the labor has begun. Oxytocin is being produced and coming into the bloodstream of the mom. And that oxytocin that tells the uterus to start contracting. The uterus will contract greater and greater as we progress into the labor. And if the intensity increases and the amount of those contractions per minute goes up as we go, then we can say that the labor is progressing. What's important to note here is that evolutionary by nature we have developed in such a way that if we feel scared or uncomfortable or threatened during the process of labor, there's another hormone, adrenaline, that will flood into our system. And if the adrenaline comes in, the labor might actually slow down or slow. What that means is through every single stage of labor that I will speak to next, we need to protect that safe and comfortable environment. There are four stages of labor and we will speak to all for today. They're unequal in length with the first stage being the longest, being the cervix dilation, and it takes the longest out of all four stages. The first stage is then further divided into three phases, the latent phase, the active phase, and the transition phase. So remember Amelia, once she has her contractions that are just starting, the cervix is starting to dilate, and those contractions have become regular for her. We can say that she has entered the first latent period of that first stage. Here our contractions are regular, but they're still manageable. So this is the time when Amelia might go ahead and cook some dinner. She can watch the Netflix. She can choose to sleep, to save some energy. She could play board games. She could go for a walk, take a shower. And this is the time when it's quite important to relax and maybe even to distract yourself a little bit during that latent period. The main question is that we're going to ask at each stage is how can you support? What can you do at this point to support the women in labor? What you can do here, you can just keep company. You can cook together. As I said, you can watch a movie and if there are any kind of last minute chores or preparations that need to be done, go ahead and help with those. This latent period is quite lengthy. In the first birth, it takes about 8 to 12 hours. In the succession births, it takes about 3 to 8 hours. So this is when, you know, we're saying we don't necessarily rush to the hospital right away. There are exceptions to it, but usually this latent period takes some time. This could happen overnight. You might even be able to sleep. And this is the time when the cervix dilates from 1 to 4 centimeters. So how do we know that this latent period is over? If it takes 8 hours, how do we know when it's done? The doctors recommend using something that's called a 5-1-1 rule. What it means is that you have contractions that are happening every 5 minutes. Each contraction is lasting 1 minute and it has been going on like that for 1 hour. So once you're able to see that for 1 hour, every 5 minutes you've had a 1 minute long contraction. That means the latent period is coming to an end and we're entering the active period. During the active period, the labor will accelerate. The contractions will become more regular and they will now be closer together. If before Emilia could cook, chat, read a book, call her friends, now she will not be able to distract herself. This is the time when she's really going to tune into those contractions. This could also be the time to start practicing some of that breathing and some of this relaxation techniques that might have learned she has learned before. What's also important to remember, we have the uterus that is contracting and because of quite high pressure on the uterus, the amniotic fluid, this purple liquid that we've seen could actually come out during that time and that is quite fine, that is normal, that is natural. The one thing to note is to make sure that the fluid when it comes out, it's clear in color and it doesn't have any strong smell to it. So how can you support here? Here it's really important to keep this space quiet, warm and calm. We continue to protect that space, to hold that space, to make sure that all the hormonal changes that need to happen do happen, do not slow down and that's the process progresses. You could also give massage to the back for the comfort or for any pain in your leaf and if you're still at home at that time, usually by the middle of this active period will be the time when you're going to the hospital or the birth center if you choose to give the birth there. So you can also go ahead and call your doula, call your midwife, call anybody on your birth team and then prepare for that trip to the hospital. Once the cervix dilates from 5 to 8 centimeters, about 8 centimeters, Amelia will go into this transition phase. The transition phase of the, we're still in stage one and this is the last phase or last period of stage one. This is the time when the cervix will dilate from 8 to 10 centimeters and 10 centimeter dilation is full dilation, meaning that afterward 10 centimeters we're ready to meet the baby. What happens here during transition period, this is the hardest, the most difficult, however also the shortest period in stage one. This period usually takes anywhere from an hour, an hour and a half or so, sometimes even less, but here contractions will come every 2 to 3 minutes and they will last 90 seconds with quite strong sensation. So if you remember when we were at the beginning of stage one in the late period where we're looking at every 5 minutes for 1 minute contraction and you can see how that is different, how much stronger those contractions are and how much more often they come. This is also the time when we hear that woman says, I just cannot do it anymore, that's it, I cannot. And for us this is a really good sign because when we hear something like this, that means the baby is coming very, very soon. What's important to remember here is to rest between those contractions and as a partner or as a supporting figure or a helper, you can breathe with the woman together, you can move together, you can take a wet cloth and put it either on the head or in the back of the neck for some relief, you can massage for pain relief and you can just be that person, the anchor of confidence. So when the woman looks into your eyes, she knows that her and the baby are doing beautifully and most of the time that is enough. So now once we're at full dilation, we're going to switch from stage one to stage two. Stage two is baby's arrival. This is also something that we call pushing phase. So Amelia will be pushing in conjunction with her contractions, helping the baby lower and go through the birth canal. This is what the TV births are all about. This is pretty much the only part of birth that we see on TV and often think that this is what birth is, but now you know it's much greater than that. Also, we might think that once we're at full dilation, the baby will just easily pop out and kind of go out and be born. However, that's not necessarily the case. The baby does need to navigate between the pelvic bones in order to be born. It needs to take a certain path, turn and twist, and only then the little one is born. So here, it's very, very important for the woman to be changing positions. And this is again something that we had in the quiz that Nina has spoken about, is having this right of freedom, of movement during birth is very, very important. By feeling our baby and feeling how we're doing ourselves, we're able to help the baby navigate and thus speed up the process and make sure it's safer and better. This is the time for you as a partner to give hugs, to give kisses, to make sure the oxytocin is still flowing, to give praise, to tell the woman that you're almost, almost there, and once again, just be that person to hold the space and to give that confidence and to give that peace of mind. At the end of the stage two, the baby is here. However, the labor is not over yet. There's a third stage, and this third stage is the birth of the placenta. You might remember this placenta that was in the image in red. That was something that was delivering oxygen to the baby. However, now the baby is here, and he or she can breathe on her own. So there isn't necessarily need for the placenta to be there anymore. So the placenta will be born as well. It will take about 30 minutes or so for the placenta to be born. There's no strong sensation or pain associated with it. There might be some feeling of contractions and a small push that helps the placenta to be born. And this is the time when the baby is on mom's chest or the stomach and they're starting to meet each other that promotes even higher release of oxytocin, allowing for the placenta to be born. So now that the baby is here, the question is what can you do? Seems that everything is over. However, there are times when the mom does require some medical intervention or medical support after the baby has been born. So you could actually be the one to hold the baby and to provide the skin-to-skin contact. You can be the one welcoming the baby with nice words and smiles and warmth. This is also the time to congratulate the birth team, to congratulate the mom, and to congratulate yourself. And your life has born. The last stage, which is also very, very important, is the bonding stage. Once the baby is born, you have a huge oxytocin release. Your birth is the highest oxytocin release that we can have pretty much in our whole lives. There isn't any other vent that produces more oxytocin than birth. Once the baby is on the mom's chest or on the stomach, skin-to-skin, this is also an opportunity for the baby to initiate breastfeeding. This is also an opportunity for the baby to regulate his or her temperature in the best way. And by being exposed to the mom's microbiome, the immune boost is also there for the baby. So what can you do now? How can you support? You can give a warm drink to the mom because she has lost a lot of energy. There's a lot of heat that's been lost in that warm process. You know, for something warm to drink, she might ask for a blanket or something to keep her cozy. This is also a way now you can not hold the space, but give space to the mom and the baby. Or you can ask her if it's comfortable for her and enjoy that time together. This bonding stage is often called the golden hour. However, there isn't any kind of restriction on how long that can take. To summarize, we have four stages of the birth process. First, being in cervix dilation, being the longest process, that's then further divided into latent, active, and transition periods. The second is the baby's arrival. The third is the birth of the placenta. And fourth is the bonding. So I do hope that if in the future you're talking to someone who is expecting the baby, someone who's planning a baby, someone who is your partner, or maybe you're expecting your own baby, that now you know a little bit more than you did 15 minutes ago. And the truth is, no two births are identical. They will vary in length, they will vary in sensation, they will vary in the amount of intervention, in the amount of support needed, in the kind of tactics that will be helpful. But no matter what the experience is, what we usually remember are not those details. What we usually remember is how the people around us made us feel. So I encourage you that once you have an opportunity to support a new family, or to talk to somebody who is expecting, if you could offer support, go ahead, offer it, and potentially you'll be part of a story where new adventures begin. Thank you. Thank you Anna for the talk. Let me quickly share my screen again. Okay, to remind everyone of the questions. So before that, I would love everyone in Zoom to open the videos because now the chatting is going to start and we love to see the people that ask questions and it's also much nicer to compare atmosphere. So if you're with us on Zoom, question yourself, so click on participants and then click on the raise your hand icon and I will call you out and then you can unmute yourself and ask a question or you can just write it into the chat and then I will ask it for you. And everyone who's out there on the streams, please ask the questions on the chat as well and we will have them transformed here. So I saw there was a hand prize already. So Slava, if you want, you can ask it. Yeah, hi everyone. Talk and for sharing this really hidden topic with all of us. I think it's really great to learn all these details of something that you have experienced but have no idea about. So it's really cool. I actually wanted to ask you more about sociological aspect of your profession. So how does it actually work in the families? Who initiates normally this idea to ask for support from the ULA? What is normally the reaction of the partner of the future mother in clinics if the birth takes part there? Let's say I have no idea about the policies. I guess maybe sometimes the partners might not be allowed to be present there. So how is it handled also in the clinics? But as I said, I don't know. But did you also maybe experience in the families any, let's say, conflict situations from the ULA, from you coming to help and let's say taking over the part that maybe is expected from? Thank you. This is an interesting question. So I will start. The first question was how does the idea come? Who initiates and how it was found? It really depends. I think everyone learns about the duals exist. I think that's knowledge is the first place because you can't want something that you don't know that is there or can be of help to you. Usually from my experience, most of the families I've met, one of the partners or both of the partners have chatted with someone who has given birth and who has had support from a doula, either during birth or postpartum and spoke highly of it and that sparked doing more research inside the family. I also know families who had a doula figure with them have had support but never actually thought of it as a doula. That has also happened. So usually mostly just by talking to friends or doing research saying, okay, I'm pregnant, what's next? A Google search, right? Or a partner being, okay, my girlfriend, my wife is pregnant, what's next? How can I help? And doulas generally speak a lot about support and speak a lot about the topic of help in general. So I think by doing research on the topic, or you know, for some people maybe those who like to go the academic route, I also know you can read studies. Let's say latest studies on birth or postpartum or the factors that lead to higher birth satisfaction and then somewhere in those studies you will see a word doula pop up and it will usually be explained. That's on how we are found. And of course as a doula I also really, really try to put myself out there. So I'm being active in that sense as well. The second question was about the hospital, correct? How are we welcomed in the hospital? That differs country to country. There are countries like the Netherlands where every woman who gives birth has a doula. It's not a question. She has a midwife, a doctor and she has a doula. That is covered by insurance. That is just part of your experience because it's important. Just like you have good conditions, you have good care and doula is part of that care. Nowadays most other countries where it's not a given those are welcomed fine with the exception of the time now where when we go into the hospitals or the corona times there's quite big restrictions on who can go. Right now in Germany I believe there's a restriction to one person who can attend and then it's always just the choice usually between a partner and a doula and that's done through conversation and what also we can do is if we know that the partner will be ongoing we meet, definitely we meet a couple of times before the birth and one of those meetings is dedicated to what can a partner do that a doula would be doing there. It sometimes works out, sometimes doesn't because a partner is a person who is very emotionally attached to the situation versus the doula is a little bit more removed but that's one way to go but usually fine but depends country to country and I forgot the third question. So the last question was about how is it handled within the payer whether the doula can evolve or can provoke any conflict situations especially from the side of the partner which is maybe expected from him is taken by the doula and maybe the doula spends let's say more time with the future mother than the partner something like that. If there is I think it's possible in my experience I haven't had that I just in April I was speaking to a family where I first met with the mom and the mom said okay I think we're a match I would like you to meet my husband and the next time we met we met all together and usually there isn't anything that if the doula is there the partner is also very very active and not only the partner is active the partner is also quite feeling a lot of confidence that there's someone else who knows how things should progress and if a partner feels lost and not sure what to do can actually guide him to what kind of support just like we spoke about today but in real life situations so what should I be doing now a lot of that should be done previously kind of pre-birth all of those discussions but however doulas can definitely guide there and the truth is there are births when a doula is there and she's mostly there for the dad a lot of things that she does in terms of special emotional support because for men in general this is a generalization but for any kind of supporting person in birth could be a mom or a sister so if you're not giving birth yourself you may feel like you don't really have much to do or you can't really control and that sign birth is about letting control go okay thank you very much yeah thank you Anna so we have a question on YouTube from Diego Gonzalez and she's referring to the postpartum period that you also mentioned that you're joining and helping them out with actually prepare you need to prepare and if you need to how do you yes I really like this this is something that definitely resonates a lot with my work because I've been doing many many years of postpartum support first and then moved into birth the short answer is yes we need to prepare we need to prepare as much as we prepare for birth the birth is very very important but it's a shorter period of time and the postpartum is a very very long time when it comes to preparing for the postpartum I say that it's important to remember to ask for help and to come prepared which means that while you are still expecting the baby I suggest that you do a visualization exercise so you actually sit down together with your partner or anyone who is there to help you and you write out your date and you say okay this is what I think my day is going to look like we have a certain number of hours which and you'll see that that day with the baby looks very different from the kind of day you have now because especially with the first child no matter how much we prepare there is that moment when one day you wake up and there are three of you or four of you and you've prepared but then now it's happening so definitely do this visualization exercise and look at the list and see what can you delegate who can you delegate it to where will I need help say just like we write in a research paper help to me is such and such what happens during postpartum is we know we'll need help we really need to have very specific kinds of items that we need help on and we also have our friends and our family who want to help us they're excited that we're having our baby they want to come and help they have no idea how to help they think they want to come and hold the baby and spend the time with the baby while you cook or while you're clean necessarily might be the best choice for everybody so if we have an idea of what we need help with and a list of people who are excited to provide us that help to bring us warm food to come and just be a listening ear to us to stay with the older kids then we can match the two and this is really really important because parenthood in general is a transformation and what transformation means is that when you go into something new how you've been doing things before they don't work anymore however the new things are still uncertain and you don't know how they do work that's what transformation is and we are quite alone now in postpartum I know previously I like to say that this is the first time in history when after the baby is born really shortly if we look at the mom's environment she's usually on her own with the baby at home and in order to build that village and to build that care we need to prepare specifically what is our help, who can help us let these people know what we want what we do not want and build that village little by little and that also comes to specialists so have a lactation consultant have a postpartum delivery if you feel like you need to have an osteopath have a gynecologist that you can call so yes prepare think of help think of what help means to you and remember you can always change your mind if you make one decision you can always change your mind what you need to do so how long is the postpartum period so how long do you actually stay with the family okay this is it really depends so when I speak of the postpartum period I speak of the work that involves being there for the mom and for the baby as well but mostly for the mom and making sure the mom and the baby together in fusion are feeling happy therefore as long as they need to be there usually the first month is the time when most of the questions come it also depends on how much we've covered in preparation for the birth so if we've talked about these first two months before the baby was there then it's more kind of check-ins but it really depends I am there for as long as needed I think officially I would say six weeks if we took off, took a look at contracts and things like that they're just not touchable so what then in the end is your difference to admit wife so I think that's much more common term that everyone knows and actually I just heard about doula now what actually makes the difference sure so we'd actually differentiate between three things we differentiate between a doula and midwife and a doctor but the difference between the biggest difference between a doula and a midwife is that doula provides continuous support meaning that's the person when you're a labor it can take 8 hours, 12 hours 20 hours, 30 hours, 35 hours that person is with you unless they need to grab water or run to the bathroom quickly that is continuous support who's always there that's usually the person with whom you interact quite a lot before the birth however midwife is someone who you usually see in the hospital once you're there or in the birth center and someone who comes in to check on you and the doctor is the one to make make big medical decisions if any intervention is needed in Germany the model is a bit different because we do have Hebames here and Hebames in comparison to the rest of the world where we think of a traditional midwife is a little bit more greater continuity of care than the rest of the world that is true but with the doula work there's a big educational piece there's a big educational and big emotional piece also so it's a lot of listening we have one more question from Max yes Anja I have a question do you that is called first emotional help is this a concept that you know first emotional help yeah I asked emotional help yeah E.H. not okay so my question is not valid anymore but I ask you another thing my girlfriend is a midwife and she acts also in the psychology area as you do she doesn't do births anymore but she is working like a doula as asked me whether it's whether you know a model that integrates a Christian aspect since there are here some believers some protestants, some Catholics here in Germany and she's asked for a Christian model and do you think that there is such a model for believers or you know the baby is born and then you go to baptism and so the question of birth and of God comes very early or when how do you say mislabour in English misbirth then the question arises even more and so she also needs a Christian model and so my question is there an author who provides that that is a very intriguing question thank you for that great thank you you've been a great messenger for sure not off top of my head I do not know the specific Christian model that speaks to the birth however when I hear you speak I think especially when it comes to let's say miscarriages or giving birth to a live baby usually when things don't go wrong we talk a lot about trauma and I think this is where psychology comes in and the way that we process trauma is often connected to our religion can be connected to our religion or at least the tools that we use to understand when the things don't go right or don't go right could then be seen through the lens of the religion I will not be able to tell you exactly of an author who speaks of something like that I think in the spiritual journey in general we say we have something interesting that we say that when a woman gives birth there's one belief that you're in between the two worlds between kind of the living world and the world of the dead and in the process of the birth you actually get to see the glimpse of the other side and then you're reborn through that process so we say not only the baby is born, the mom is born as well that is one way to look at it that is one way to talk about it I cannot specifically say when I speak of those words I wouldn't say that they speak necessarily of Christianity to me but it could be something that is then applied to a person to whom their belief of Christianity is important to think of that as well but what you can also do is if you just send me an email or a message or connect with me somewhere and I do cross something I'll be happy to share with you and your wife who is in it you will get my email sure but that's very intriguing that is actually something that I encourage to know as well thank you for that get in touch so I think we will have time for a question which I want to be as someone who might be interested now in supporting families at this stage how do you actually become a doula? okay that's a beautiful question because I've had that question for years before I stayed to do this one first of course there is education and there is a lot of exposure to the content so I think if this is something that someone is interested to do first I will say look at official read about doulas read some blogs, read some stories google the name of Michelle Oden look just read about Michelle Oden look at someone called Lynn Robbins I believe and just get the feeling for what support might look like the non-medical kind of support in birth look at the if you're lucky what you see meet what I did is I scheduled coffees or tea time or juice time with doulas who already work as doulas and I said walk me through just like we're doing any interview right when we want to become any kind of profession we say okay I've read, I've done my homework what is your life really look like what is your day to day I speak now of this support and being present during birth and being present postpartum but there are so many more hours that I spent with the books and doing things behind the scenes and learning myself and sharing knowledge maybe virtually but that's not necessarily when we think of a doula right away we don't think of someone reading a lot of books or someone sitting and doing research everyone has their approach so talk to those who are working as doulas talk to those who maybe have had doua to see what it was like for them because I think it becomes real once you speak to a mom who has said that the experience was such and such and it would have been very different without that kind of care and then look at if you are still in the game and you want to go for it look at certification programs there are about five big ones around the world they differ there are some in Europe there are some in US they differ in the amount of hours they differ in certification and whatnot some are online some are in person some have seminars so look at see what fits for you in terms of the format in terms of the budget in terms of the time frame that you want have an official program have a structured one first this is by personal advice I think once you go abroad having some kind of structure is good and then you build upon that structure but I also had an official program and I also was very lucky to find a mentor so I was following someone whose work really resonated with me and I just reached out kind of I think brave move on my side but this person I didn't know I said ok I really enjoy the work that you are doing would you have the bandwidth to take on a mentee and I was really lucky because she said you know what you are not the first person who is asking I hear some bells I am going to send up a group and for about six months I had I mean I still have of course a mentor but for about six months there was active work in that mentorship group you can think of it as a mastermind you can think of it as an accountability partner but it's the person who has been a doula for ten years across three countries and still loves it and still does it and grows and develops in her profession for me that was important and then after you see that then you find your own thing because every doula has a focus has a niche and it has a sense to her there is a doula for you no matter what kind of woman you are there are clients for us we don't necessarily match to everyone and not necessarily everyone matches to us that is the reality and that is quite fine because the more different we are the more different kind of population we can accommodate okay thank you so much Anna for taking all the questions and let me quickly get some other word out so people if you like what we do then we do have expenses for example right now all the software we need for streaming and right now we are running low of sponsors as pretty much everyone does in this corona times and if you would have just like one euro to spare we would be super lucky to spend it to us on our crowdfunding website and you know we definitely do good with it and I think the link has now been posted to