Women in Health: Meet Krystina Friedlander - you don't need to be pregnant to benefit from this awesome doula's wisdom


I am so delighted to introduce my friend, Krystina Friedlander, who has very kindly agreed to be interviewed for Nourished Living's Women in Health interview series. Krystina is a doula, childbirth education instructor and herbalist (check her out at Baraka Birth). We met a few years ago in Cambridge, MA where she is currently residing, and I have missed her dearly ever since we moved away. Krystina is  one of the most passionate advocates for women's health I have ever met - I have had the privilege of taking one of her classes, and I can honestly say it was life-changing!

Krystina is not only brilliant (truly, she is one smart cookie), but she also never hesitates to generously share her knowledge and passion with others, whether in the classroom, over a casual brunch, or, of course, in this interview. I am sure you will enjoy reading her thoughts below, and, if you are itching for more, you'll find all sorts of fascinating insights on her blog.  

Let's begin with a question about you. How did you come to pursue this [awesome] line of work? 

As a sophomore at Tulane I took a fascinating course on the Anthropology of Sex and Reproduction, and we read a study on doulas at a hospital in Mexico. The results clearly showed that women benefited from having a trained assistant available to them, and it sort of blew my mind; why wouldn't every country do this? I didn't realize that doulas existed outside of Mexico. Years later living in Doha, Qatar, I met an American Muslim woman working as a doula there and it reawakened my interest. I planned to train with her, but got married and moved back to the United States before that could happen. My husband strongly encouraged me to pursue it here in Boston and I discovered a thriving childbirth community.

What type of support does a doula offer?  Why do you think it is important for a doula to be a part of a mom-to-be's birthing team? 

What I’m available to offer is support in the weeks leading up to the birth, not just to get to know mom and her partner but also because some women and couples have questions and concerns about the birth process in the hospital, qualms about procedures, and want more information and to have someone outside of the hospital to serve as a sounding board for them. Once active labor starts I’m either with her laboring at home for as long as she wants, or in the hospital, providing massage, words of comfort, grounding her in the normalcy of the experience. I stay with her through the birth and until breastfeeding is established, so about two hours afterwards. We then meet once or twice after she’s back home to talk about the experience, see how she’s doing with the postpartum, and to share resources. I'm available by phone and email during pregnancy and whenever she has questions in the months or years ahead.

I think doulas are very important, especially in hospital settings. It’s useful in a homebirth for the added physical support, but homebirth moms tend to be very well educated about the birth process and need less information, plus they’re receiving continuous care from their midwife or midwives who may also provide more of that physical support. In hospitals, a woman often sees various care providers leading up to and even during the birth. There’s not that continuity of care, there can be lots of unfamiliar faces, including students coming in and out of the room. And a big misconception about hospital birth is that the nurses, midwives, and doctors are there to comfort you. It’s great if the team you get is supportive and friendly, but they have a busy schedule and it’s not their role to provide the comfort measures that doulas do.

Massage, position change suggestions, hydrotherapy and other tools, plus the emotional encouragement and support in such a vulnerable moment is at the root of why moms with doulas are less likely to request pain medication. Doulas also help mom or parents advocate; there are plenty of procedures and processes going on in American hospitals that are not evidence based and parents are increasingly aware of that--it takes a long time for things to change in American healthcare--but in the moment it can be a challenge to ensure that their birth preferences are honored. So, something like delayed cord clamping, a doula can remind the staff that parents want and expect that. Doulas can also create the space for conversation and negotiation when the staff wants something that parents are unsure about. So as a result, people who hire doulas have a significantly lower rate of cesarean section and other interventions.

As a doula, you get to witness some of  the most precious (and intense) moments of a family's life. What do these experiences teach you?

Incredible patience, for one thing. Contrary to what people assume from watching American media, birth is (mostly) boring. It’s about waiting for a process to unfold and supporting a woman in that process every step of the way. It’s long nights awake stroking a woman’s back, trading off naps with her partner. I’ve also learned that no two births are alike, everyone brings their own physical and psychoemotional dynamics into childbirth. I’ve seen that fear makes birth much harder, and that’s tough because we spend our whole lives stewing in a culture of intense, intense fear around childbirth and it takes a lot of work on mom’s (and partner’s) part to release that. I’ve learned that I’m not in control nor am I responsible for a woman’s experience of her birth; I do my best to support her regardless of the situation as it unfolds, I don’t tell her what to do (nor is that my job), I’m there to listen and hold space.

Working with other women in a variety of settings has also helped me to think about my upcoming first birth later this summer, which we’re planning at home. I’ve learned that women need to feel safe in childbirth, and for some people that will be in the hospital with all the staff and technology, and for others, including myself, it’s the safety of a skilled and experienced practitioner in the comfort of familiar surroundings.

I know that you are also an expert in herbalism and fertility. Could you offer some advice to readers who are thinking of starting a family on how to best prepare the body for a healthy pregnancy?  

I wouldn’t say that I’m an expert, but it’s something that I’ve learned a fair amount about. We have so many health issues as a society, so a preconception routine is going to look a lot like any other healthy routine, with some added points. Hormonal contraception can do a number on our bodies, and perhaps not in the ways we’d expect. It depletes the body of folate, which is critical for healthy fetal development, so I recommend a year to recalibrate the body (and at least three months if that’s not feasible) and rebuild folate stores using dietary means. It also includes working on improving our bacterial flora, which hormonal contraception alters. Eating healthy, whole foods, avoiding processed flour and sugar, incorporating plenty of healthy fats into the diet (reproductive hormones are fat soluble). A midwife friend swears by adding cod liver oil, which is rich in Vitamins A and D.

If you had the power to make everyone adopt 3 healthy daily routines, what would they be? 

Joyful movement, of any kind. Nourishing food that we take time to be thankful for. Displays of affection, whether a phone call or a really good, deep hug.

Finally, I can't let you go without asking you about the elusive quest for work-life balance. As a woman who I know always has a lot going on, could you share with us your philosophy on this, and also some ways you find balance despite your hectic schedule?

I waited tables for a long time while living in New Orleans, and we used to get slammed during Mardi Gras. At first it was totally overwhelming, everybody asking for everything at the same time, having to meet a million demands. Then I figured out that you can only do one thing at a time. Seriously, I carry this with me wherever I go. The challenge is to do that one thing mindfully and well, without my brain already latching on to the next thing on the list. I’m certain that having a baby will make this even more of a challenge, but all I can do is that one thing at a time.


Krystina Friedlander is a childbirth doula, childbirth education instructor, and herbalist in Cambridge, MA. She holds an MA in Cultural Anthropology from Tulane University and is interested in diverse childbirth practices across the globe. She writes about her experiences at www.barakabirth.com/blog.