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As a Doula, Siena Vaccara, Ed.M, M.A, LMHC firmly believes that birth work should be educational. Meaning, all individuals deserve access to information that not only empowers birthing people-but also loved ones, friends, partners, children and peers!

Coping With Pain
By Siena Vaccara, Ed.M, M.A

Coping with pain: Oxytocin, is an integral hormone when it comes to labor progression. Oxytocin communicates with our reproductive system, telling it to contract, to expand, to prepare. The release of oxytocin can be done naturally, through sexuality, sensuality, joy, tenderness and harmonious interactions with what is around you or who you are around. The three R’s are how Doulas can conceptualize this release. 


Rhythm- Is one of the best ways of addressing pain, find your movement, your methods of staying grounded. Whether that be holding the one you love, using tools such as a peanut ball, water or massage. 


Relaxation- Privacy, trust, comfort in knowing you are held and steady. Objects of importance, your favorite song. 


Ritual- Faith in your body’s ability to birth. You are capable. 


These three R’s can be interpreted in many ways. When it comes to pain, fear versus understanding of what is happening with your body can change the trajectory of experience.

(Simkin, 2018).

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Reproductive Identity
By Siena Vaccara, Ed.M, M.A

"Empowerment is about change, it refers to the expansion in people's ability to make strategic life choices, in a context where this ability was previously denied to them." 

-Nalia Kabeer

Reproductive Identity: For many people, the prospect of becoming a parent seems too far to hold. In the doula community, we call this phenomenon or weighing choices, recognizing capabilities and capacity reproductive identity development. 


No matter who you are, and whether or not you wish to start a family, you are entitled to challenge your perspectives, adhere to your self concept and decide a path that enriches your sense of security. For birthing people, the body can serve them, and bring one’s deepest desires to fruition in unexpected ways. For non-birthing people, the choice to refrain from having children is just as empowering.

(Athan, 2020).

Gender Affirming Birth Work
By Siena Vaccara, Ed.M, M.A

Our current healthcare system still exacerbate heterocentrism and cis views of the perinatal period. Doulas are here to counter that and highlight inclusive, affirming care for birthing people. By creating nurturing places for men, women, non-binary, queer families to receive prenatal and labor care without harm.


You should not have to defend who you are. You should be able to walk into your OB or Midwifery clinic without having to correct others. You should be able to have providers who respect and see you.


Gender is spiritual, gender is expressive, gender is innate and discovered but the culture surrounding expectant people is hyper focused on binary boxes, not only surrounding your new baby but you as well. Doulas are working to change this by educating birth workers with more universal language:



Birthing people 

Expectant people 

People experiencing birth 

Chest feeding 

Lactating individuals

Birth partners 

Support People 

(Froom, 2021).

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Natural Induction
By Siena Vaccara, Ed.M, M.A

Natural Induction: Oftentimes, Synthetic Oxytocin is utilized to induce labor medically, which can disrupt the natural hormonal process of birth and in turn, delay dilation and increase pain response. However, there are some steps people can take to induce labor naturally, to protect our built in Oxytocin process.


(Check with your midwife to ensure you are in a state to begin these techniques) 


- Bounce on a yoga ball

- Have sex! 

- Masturbate 

- Eat some spicy food, dates or drink raspberry leaf tea (check with provider prior)

- Stimulate your nipples 


Even if you are past 40 weeks, babies still decide when they come. It is important to facilitate a discussion with your provider about whether waiting will compromise your placenta’s efficacy. If it is not medically necessary (and sometimes it is) to synthetically induce labor, natural induction will reduce your chances of increased pain, slower labor progression and possible cesarean. 

*Reminder (I provide non-medical doula support. Always check with your healthcare provider prior to attempting to induce labor.)

(Evidence Based Birth, 2021)

Hormonal Physiology
By Siena Vaccara, Ed.M, M.A

The Hormonal Physiology of Birth: Our minds have the ability to communicate actions that promote healing and protect us from harm. The following hormones are are influenced by who is around us, what we allow in our bodies, our space, and our dialogues. A healthy neurological process is contingent upon how we experience our surroundings and the external support we receive.


Oxytocin: Love, Relatedness, Assuage

Beta-Endorphins: Stress Reduction

Catecholamines: Alertness, Safety

Prolactin: Nourishment, Milk, Bonding


The science behind hormonal physiology is magnificent, and yet sometimes we can neglect to acknowledge the incremental human forces behind it. A trauma informed caretaker, a partner to encourage, and TIME to be with baby postpartum matter. 

(National Partnership for Women & Families, 2022).

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Decision Making Approaches
By Siena Vaccara, Ed.M, M.A

Decision Making Approaches: The acronym BRAIN is a method of option consideration that Doulas use to help birthing people and their families confront choice, in their way. 


Hospital or home birth, midwifery or obstetrics, epidural or holistic pain management, possible episiotomy or preventative vaginal massage, water birth or dry birth, cesarean or waiting, delayed chord clamping or immediate skin to skin- and so, so much more. When it comes to ensuring that you and your unborn child are cared for, faster decision making during procedure propositions in high stress situations can better ensure that your voice is amplified. 


Benefits- What are the possible good outcomes? 


Risks- What could happen? How frequent do these detrimental outcomes occur? 


Alternatives- What are my other options? 


Intuition- What is my gut feeling? 


Nothing- What would happen if I chose to do nothing? 


As your doula, I will encourage the practice of option consideration and your decision making skills will follow you throughout your birth and in life.

*Reminder, I provide non-medical Doula support. Meaning sometimes in emergency situations, decision making must be contingent upon the risk your healthcare provider determines.

(Pascali-Bonaro, 2022)

Cervical Dilation
By Siena Vaccara, Ed.M, M.A

Cervical Dilation- in the medical community is usually used to incorporate language that tells you how far along you are during labor; and although knowledge of your progress can be very affirming!- for some it can be anxiety provoking during moments of uncertainty. 


With me as your Doula, we will discuss cervical dilation, the stages of birth, and what to expect prior to the time your baby decides to come earth-side. We will also talk about consent surrounding cervical and vaginal examinations, how you are feeling, risks, benefits- what can be necessary, and trauma informed care. 🌸


Cervical dilation stages can also give us insight into what is needed emotionally at each stage. 


- 0-4cm is Early Labor- conserve your energy, stay hydrated, shift the energy in the room, perhaps with humor when you have longer breaks in between contractions. 


- 5cm begins Active Labor. Stimulate feelings of peace- dim lighting, music, calming touch- love- sensuality, everything you need to get oxytocin flowing, and labor progressing.


- 6cm on- respect quiet, privacy, hold space for the intensity. Do not overwhelm with information, speech, distractions. 


- 8-10cm-Transition-the greatest pain but expect power to wash over the space. Reprocess the pain as meeting the maximum, and getting closer to the cries of a child. You are capable. 


*All of these needs depend on the individual as well, and they can shift and change with the environment or safety changes. What is important is that the birthing person is heard, respected, autonomous and held.

(Simkin, 2018).

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The Four Pillars of Reproductive Well-Being

By Siena Vaccara, Ed.M, M.A 

Listed are guidelines that all providers should follow-to guarantee the presence of choice and non-judgmental care in reproductive spaces: 


1. Autonomy = People have decision making power.


2. Control = People have the right to receive all available information. 


3. Respect = People must be seen, heard, and understood. 


4. Systems of Support = Law, healthcare, education etc., must work together to enhance well-being for all people.

If any of these pillars are not respected, you have grounds to stand up for yourself, your health, and your family. 

(RHNTC, 2023).

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Acceptance & Commitment:
      Pain Versus Suffering


Our ability to process and move through distress is largely dependent on fear reduction.


Being in pain and not understanding why can make us feel powerless, hopeless and defeated. Moving through pain with education and knowledge of its temporary nature-can aid us in not only establishing resilience physically but emotionally as well. 


Acceptance & Commitment is a tool used by both Mental Health providers and Doulas to help clients recognize their feelings, without judgment, and to not avoid but navigate difficulties. 


Acceptance & Commitment can look like allowing yourself to cry out in frustration, practicing affirming your capabilities to overcome, and receiving facts about your body so as to not be scared of what you are going through. 


Attempting to avoid pain entirely can decrease our overall capacity to cope. Our brains are always trying to protect us, and through positivity, teachings and belief in our abilities-we can experience pain without suffering.

By Siena Vaccara, Ed.M, M.A
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Holding Space, Being Held

By Siena Vaccara, Ed.M, M.A

How can you be there for someone when you have no way of relating to their experience? By holding space.

The act of Holding or Holding Space is not to offer immediate solutions, advise, or try to make the situation better. Holding is the act of being in the moment with the person you are supporting-being attuned, listening attentively, and acknowledging their emotions to ground them.


Sometimes all we need is someone who is able to provide a stable presence, who lets us feel what we are feeling. 

Doulas and counselors are able to be the person who offers consistency & comfort in the form of holding. Being that person whose job is to have a broad look at the situation, who is not connected to other obligations or expectations, who can look at things objectively-offers immeasurable safety. 

When the people around you are preoccupied with their roles-whether that be of partner, nurse, or healthcare provider, having an extra person in the room who can hold space offers much needed relief in being seen.

Siena's Past Research:

Sexuality, Women & Gender Integrative Project: "LGBTQIA+ Perinatal Experiences, Reproductive Identity & the Future of Affirmative Care" (Vaccara, 2022). Columbia University. 

Perinatal Research: “A Doula’s Role in Promoting Positive Perinatal Mental Health Outcomes” (Vaccara, 2021). Columbia University. 

Reproductive Identity & Psychology Research Citations/Article Resources:

Athan. (2020). Reproductive Identity: An Emerging Concept. The American Psychologist, 75(4), 445–456.

Berkowitz, & Marsiglio, W. (2007). Gay Men: Negotiating Procreative, Father, and Family Identities. Journal of Marriage and Family, 69(2), 366–381.

Besse, Lampe, N. M., & Mann, E. S. (2020). Experiences with Achieving Pregnancy and Giving Birth Among Transgender Men: A Narrative Literature Review. The Yale Journal of Biology & Medicine, 93(4), 517–528.

Bogaert. (2015). Asexuality: What It Is and Why It Matters. The Journal of Sex Research, 52(4), 362–379.

Carroll. (2018). Gay Fathers on the Margins: Race, Class, Marital Status, and Pathway to Parenthood. Family Relations, 67(1), 104–117.

Chabot, & Ames, B. D. (2004). “It wasn’t ‘let’s get pregnant and go do it’:” Decision Making in Lesbian Couples Planning Motherhood via Donor Insemination. Family Relations, 53(4), 348–356.

DONA International (2021), What is a Doula? DONA International.

Darwin, & Greenfield, M. (2019). Mothers and others: The invisibility of LGBTQ people in reproductive and infant psychology. Journal of Reproductive and Infant Psychology, 37(4), 341–343.

Everett, Limburg, A., Charlton, B. M., Downing, J. M., & Matthews, P. A. (2021). Sexual Identity and Birth Outcomes: A Focus on the Moderating Role of Race-ethnicity. Journal of Health and Social Behavior, 62(2), 183–201.

Flanders, Gos, G., Dobinson, C., & Logie, C. H. (2015). Understanding young bisexual women’s sexual, reproductive and mental health through syndemic theory. Canadian Journal of Public Health, 106(8), e533–e538.

Flanders, Gibson, M. F., Goldberg, A. E., & Ross, L. E. (2015). Postpartum depression among visible and invisible sexual minority women: a pilot study. Archives of Women’s Mental Health, 19(2), 299–305.

Froom, Moss [@mossthedoula].(n.d.) Posts. [Instagram Profile]. Retrieved April 18th, 2022.

Goldberg, Allen, K. R., Ellawala, T., & Ross, L. E. (2018). Male-Partnered Bisexual Women’s Perceptions of Disclosing Sexual Orientation to Family Across the Transition to Parenthood: Intensifying Heteronormativity or Queering Family? Journal of Marital and Family Therapy, 44(1), 150–164.

Goldberg, Ross, L. E., Manley, M. H., & Mohr, J. J. (2017). Male-Partnered Sexual Minority Women: Sexual Identity Disclosure to Health Care Providers During the Perinatal Period. Psychology of Sexual Orientation and Gender Diversity, 4(1), 105–114.

Goldberg, Harbin, A., & Campbell, S. (2011). Queering the birthing space: Phenomenological interpretations of the relationships between lesbian couples and perinatal nurses in the context of birthing care. Sexualities, 14(2), 173–192.

Hoffkling, Obedin-Maliver, J., & Sevelius, J. (2017). From erasure to opportunity: a qualitative study of the experiences of transgender men around pregnancy and recommendations for providers. BMC Pregnancy and Childbirth, 17(Suppl 2), 332–332.

International Board of Lactation Consultant Examiners (2022). Vision & Mission.

​​MacTavish. (2011). Supporting LGBTQ families: a brief cultural competency guide for childbirth educators and Doulas. The International Journal of Childbirth Education, 26(3), 7.

MacDonald, Noel-Weiss, J., West, D., Walks, M., Biener, M., Kibbe, A., & Myler, E. (2016). Transmasculine individuals’ experiences with lactation, chestfeeding, and gender identity: a qualitative study. BMC Pregnancy and Childbirth, 16(1), 106–106.

Pascali-Bonaro, D., (2022). Childbirth Doula Training Workshop-Birth Day Presence. 

Pilkington, Milne, L., Cairns, K., & Whelan, T. (2016). Enhancing reciprocal partner support to prevent perinatal depression and anxiety: a Delphi consensus study. BMC Psychiatry, 16(23), 23–23.

Riggs, Pearce, R., Pfeffer, C. A., Hines, S., White, F. R., & Ruspini, E. (2020). Men, trans/masculine, and non-binary people’s experiences of pregnancy loss: an international qualitative study. BMC Pregnancy and Childbirth, 20(1), 482–482.

Rubio, Vecho, O., Gross, M., van Rijn-van Gelderen, L., Bos, H., Ellis-Davies, K., Winstanley, A., Golombok, S., & Lamb, M. E. (2020). Transition to parenthood and quality of parenting among gay, lesbian and heterosexual couples who conceived through assisted reproduction. Journal of Family Studies, 26(3), 422–440.

Sanders, C. , B. Carter and L. Goodacre ( 2008) ‘Parents’ Narratives about their Experiences of Their Child’s Reconstructive Genital Surgeries for Ambiguous Genitalia’ , Journal of Clinical Nursing 17(23): 3187-95.

Sevelius, Chakravarty, D., Dilworth, S. E., Rebchook, G., & Neilands, T. B. (2020). Gender Affirmation through Correct Pronoun Usage: Development and Validation of the Transgender Women’s Importance of Pronouns (TW-IP) Scale. International Journal of Environmental Research and Public Health, 17(24), 9525–.

Simkin, Penny. (2018). The Birth Partner. Harvard Common Press. 

Singer. (2012). Improving prenatal care for pregnant lesbians. The International Journal of Childbirth Education, 27(4), 37–.

Singer, Crane, B., Lemay, J., & Omary, S. (2019). Improving the Knowledge, Attitudes, and Behavioral Intentions of Perinatal Care Providers Toward Childbearing Individuals Identifying as LGBTQ: A Quasi-Experimental Study. The Journal of Continuing Education in Nursing, 50(7), 303–312.

Trettin, Moses-Kolko, E. L., & Wisner, K. L. (2006). Lesbian perinatal depression and the heterosexism that affects knowledge about this minority population. Archives of Women’s Mental Health, 9(2), 67–73.

Kabeer, Nalia (2002), Resources, agency, achievements: Reflections on the measurement of women’s empowerment. International Institute of Social Studies, Dev Change. 1999;30(3):435–64.

Zeiler, & Wickström, A. (2009). Why do “we” perform surgery on newborn intersexed children?: The phenomenology of the parental experience of having a child with intersex anatomies. Feminist Theory, 10(3), 359–377.

Trauma Informed Care
By Siena Vaccara, Ed.M, M.A

Trauma Informed Care. When we are moving through a time period in which we feel a loss of control-whether that be childbirth & experiencing bodily changes or circumstances that warrant the help of other people-past instances of trauma and distress have the opportunity to re-surface. 


This is why consent based care is crucial-for honoring choice and for promoting healing. 


-You do not need to consent to cervical exams. 


-Your provider must tell you what they are doing to you when you do consent to pelvic exams. 


-You have the right to informed conversations surrounding procedure risks.


-You have the right to switch providers.


-You have the right to confidentiality (with a doctor, doula & counselor!)


-You have the right to breastfeed in public spaces. 


-You have the right to question things that have occurred under the care of a provider.

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