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4 Reasons a Surrogate Needs a Birth Doula

Surrogacy is a beautiful gift to families that have struggled to have a child. There are so many aspects about surrogacy that are planned and thought out from the beginning. One of them can and should be is if the surrogate should have a doula for the birth. As a doula myself, I see the benefits and importance of having a doula. With surrogacy, there are even more benefits, because of how unique the situation is. Here are four reasons why a surrogate should still have a birth doula:

Photo credit: Andy Richter

1. A doula supports both the surrogate AND the intended parent(s)

Birth doulas are hired by and work for their client, the birthing mother. In surrogacy, the birthing woman is the surrogate. Their job as a doula is to support the birthing woman in pregnancy, during birth, and postpartum. However, surrogacy is a little different. You have the woman who is delivering the baby, but you also have the parent(s) who are welcoming their child as well. Doulas can help support the intended parents (IPs) as well, by being a great resource. As a doula we help educate on what is happening during labor, helping answer questions during the process. As well as what happens postpartum. Often, this is the first time seeing a birth, and having a newborn for the IPs.

2. A doula still helps the surrogate prepare for labor and delivery

While the IPs will have wants and wishes for the baby’s care after birth, the surrogate will also have preferences for how the birth goes, as it is her body. A doula plans prenatal sessions with her to help educate and inform her about choices in birth, and to help her plan out her preferences. With surrogacy things can come up like who does skin-to-skin, and will she want the IPs in the laboring room the entire time, or just when she starts pushing. A doula can help navigate all these options before the birth. Your doula can also help both the surrogate and IPs plan the baby’s care, like tests and feeding, if that is something the IPs are wanting.

3. A doula focuses on the surrogate, while everyone else is focused on baby and the intended parents

In the birthing space, the provider is focused on the baby and surrogate’s health and well-being, first and foremost. The IPs, while they can be supportive of the surrogate, will most likely be focused on the baby, especially after delivery as they become new parents. Having a doula for the surrogate, helps her have that needed physical and emotional support doing birth, but also after delivery when she’ll need it most. Surrogacy is an unusual emotional and physical process, because you are delivering a baby, but essentially you will not bond with baby the same way (which helps with oxytocin after) and most likely will not nurse baby (which helps with contracting the uterine back down to size), and you go home without a baby to take care of.

4. A surrogate still needs postpartum support

Just because the surrogate does not return home with a baby, does not mean she does not need postpartum support. Her body just worked incredibly hard to deliver the baby, whether that is vaginally or by cesarean. Often, because there is no baby to take care of, she may try and get back to “normal” too quickly. Her body still needs time to heal, as does her body emotionally. Having a doula means having that postpartum support as well. Doulas typically do 1-2 postpartum sessions after birth. To make sure she is doing well both physically and emotionally. It’s a good idea to be able to talk with someone who was there, about what you went through and how you are feeling overall.

Photo credit: Andy Richter

Are you a surrogate interested in having a doula on your birth team? If you’re local to Utah, find a UDA doula member or search Doula Match for someone local to you.

 

Hanan Webster, wife and mother of four, is a Birth Boot Camp certified birth doula and DONA trained postpartum doula at Treasured Birth Services. She is passionate about serving families, and when not indulged in her birth work, helps lead her local Mothers of Preschoolers (MOPS) group. You can connect with her on Facebook and Instagram.

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Honoring the Postpartum Period After Loss

By: Raquel Alfaro

For any family, the postpartum period is a time of adjustment and change.  Sleepless nights and demanding days.  It is no less so for you parents experiencing the loss of a pregnancy, the loss of your baby.  It is compounded by not only dealing with the changes of the postpartum period, but also the whirlwind of grief, shock, and dismay while still being required to make important choices, give explanations, or plan events such as a funeral or ceremony for friends and family.

Your mind may be pulled a thousand different directions, your feet may no longer feel like they touch the earth. Your heart, your hopes, and dreams may feel pulled right out of your chest.  I see you.  I honor you.  I honor this journey of pain and longing.  Of hopelessness, powerlessness, and regret.  I see you.  I honor you.  And because I know how simple day-to-day choices, like what to eat for breakfast or how to get dressed are suddenly overwhelming, I’ve made a day-by-day guide for you to begin honoring yourself, your partner, your baby, your emotions, your process, and your body through the first 30 days of your lifelong journey.

Take one day, one hour, one minute at a time.  Follow this in order, or skip around.  It is your journey.  It is your baby.  I see you.  I honor you.  I walk with you, one day at a time:

Day One: I Love You

No matter the amount of time you get to spend with your little one, from minutes to hours, this is your time to meet and say first, “I love you,” before you say, “Goodbye.”  If you are able to hold your baby for a while (no matter how little baby is), send a family member or friend to get two stuffed animals, one large and one small.  The small one will stay with the baby and hold your love inside.  The large one will stay with you in your arms as a tie to each of you and a witness of your love. (Tip: This is the day to consider what may be done with your placenta.  For more ideas, see Day Seven).

 

Day Two:  I love you.  I miss you.

My arms miss holding you.  My lips miss all the kisses I have stored up for you.  My womb is heavy and still.  Hug your partner.  Cry together.  Share, and then, listen.

Day Three: Nourishment.

Allow yourself to be nourished.  Accept meals from friends and family, or order in.  Even if you don’t feel like eating, taste everything that is brought or offered to you.

“Even in my darkest hour, I can nurture myself.”

Day Four: Honor your body.  

Your body carried your baby for weeks or many months.  They were connected within your womb.  You have experienced changes in your body to open and accommodate this beautiful child.  Your body has given strength, nourishment, space, and vitality.  In honor of this gift, schedule (or have a friend schedule) a belly binding session to help tie up the loose ends and bring you into your space.  

“Honor the body.  Honor the womb.  Honor the journey.”

(Tip: Look for an SBD or another bereavement doula who also does belly binding to teach you or a partner or friend to do the binding so you can continue binding for a full 40 days, or however long you choose).

Day Five: Facing the Milk

In the wake of your loss, it can feel cruel to see your body making milk (if you carried beyond 21 weeks this is likely).  How can it not know your baby is gone?  How does it not feel the heaviness and emptiness in your breast?  You can decide to dry up your milk while acknowledging the tears you both cry, some clear, some white.  You can decide to pump and donate it to another baby in need.  If you decide to donate it, add a special touch like your baby’s initials or name on every bag.  “From my baby to yours.”

Day Six: Connection.

Connect to your partner.  Share a couple ways you thought they would make parenting fun and special for this baby.  Hold hands while you share and look each other in the eye.  Let the intimacy of connection guide you.

Day Seven: Token of Love.

Look into (or ask a friend to look into) making or having memory beads made from your dehydrated placenta, some of your baby’s ashes, or your pumped milk.  You can wear this in jewelry or can place simple ashes inside your stuffed animal in a special container as a continued and personal connection.

Photo from: https://www.milkandhoneykeepsakes.com/

Day Eight: Walk Together.

Take a walk outside.  Go as far as you feel comfortable going.  Imagine what it would be like to take your baby on this walk with you.  Think what you might show them, the colors they would see, the way they might feel the sun or the wind across their skin.  In quiet moments, like this, you can hold your dear baby close inside your heart.

Day Nine: Ceremony

If you held a funeral for your baby, you will likely have had the ceremony before now.  If you are not planning a funeral, consider creating a ceremony for yourself, or you and partner, or even include close friends and family.  It can be anything that is meaningful to you, from burying the placenta while music plays in the background, to planting a tree, to holding a salt bowl ceremony, to creating an altar of love at home or in the mountains.

For more ideas visit: https://stillbirthday.com/farewell-celebrations/

Day Ten: Silent Truth.

Though you are far from me, you will be with me forever.  

Day Eleven:  Bath

Take time today to take a steaming hot bath.  Add epsom salt, a favorite essential oil, and some flower petals if you have any handy.  Light some candles and turn off the lights.  If you still have some lochia or postpartum bleeding, just allow yourself to be okay with sharing space with this powerful connection to your body, baby, and journey.

 “I release into the water any thoughts of blame towards myself or others.  I am enough.  You are enough.  We work together to create kindness and compassion.”

Day Twelve:  Puzzled

Get your hands on a 1000 piece puzzle.  When you are ready, begin to set it out in a place where it can stay and be worked on over time.  This is a reminder to be gentle with yourself during your journey.  When you dump out 1000 tiny pieces onto the table, you do not expect it to gather itself up immediately and be whole.  It is a broken metaphor for your journey.  Even if you unite one piece of the whole each day, you will begin to see that over time you make progress.  Your journey is no different.  Only one thing a day to walk towards healing and finding meaning and someday you will begin to feel progress as the pieces come together to guide you.  “I am gentle and kind with myself on my journey.”

Day Thirteen:  Gratitude

Get a piece of paper and write down something you are grateful for about your partner, and put it somewhere they will find it during the day.  “You are a part of me.  We may walk different roads, but we are on the same journey.”

Day Fourteen: Breath and Release

Take some time alone today.  Put on some quiet, relaxing music, and sit or lay down in a comfortable supported position.  Place one hand over your heart and the other over your uterus. Focus on your breath lifting and moving both of your hands.  Allow your body to release any tight thoughts or emotions that come forth and focus back in on the breath.  “With each breath, I release and feel calmer and more at peace.”

Day Fifteen:  Earth and Sky

Go outside and lay down on the earth.  Bundle up if it is cold.  Lay down and watch the sky.  See if you can feel the space where the sky and earth meet.  Breath into this space as you imagine you might be able to either sink into the earth or float up into the sky.  Take at least 20 deep breaths before you begin to sit up slowly.  “I breath the breath of healing up from the earth and down from the sky.”

Day Sixteen: Poetry

Write or read a poem that speaks to you.  Here is one by Rabbi Nina Beth Cardin from her book, “Tears of Sorrow, Seeds of Hope: A Jewish Spiritual Companion for Infertility and Pregnancy Loss

Be gracious to me, O God,

For I am sorely wounded.

My eyes, my soul, my womb

Are consumed with grief.

I am like a broken vessel.

Day Seventeen: Kindness

Look for one small way you can share or give a kind act for another person close to you or even a stranger.  You never know the battles other people are also facing.  

Day Eighteen: Date

Plan or ask your partner to plan a simple date night to share.  Go out if you are up for it, or make popcorn and watch a funny movie together.  Take time to simply connect and share some designated “we” time together.

Day Nineteen: Reach out

Find a connection with someone else who has experienced loss.  Read a story, find a group on social media, or open up to a friend who has walked this road.  

Day Twenty: 20 Second Hug

Hugging for 20 seconds releases oxytocin into the body, which can help reduce anxiety and boost feelings of calm and happiness.  Throughout the day connect with your partner as often as possible in a prolonged embrace: at least 20 seconds.  It may feel unnaturally long at first but allow your bodies to melt towards each other in kindness and compassion.

Day Twenty-One:  Flowers

Take some time to find flowers, either on a walk or at the store. Absorb yourself in the small details of these delicate and lovely plants.  Look so deeply into the color that you can see the elements of the petals.  Inhale the scent slowly while you close your eyes and try to remember the last time you had this scent in your nose.  If you feel inclined, take some home to keep on the table and reconnect with these flowers several times.  “I allow my senses to take in the beauty around me.”

Day Twenty-Two: Gather Rocks and Materials

Go to a stream or other natural area and collect medium-small, flat rocks to be painted. Consider taking a friend with you.  Take time to breathe the air of the plants around you.  Take time with each stone to feel the weight of it in your hand.  Put it in your plans to pick up some paints (or ask a friend or family member to get some) for painting the rocks.  You’ll need permanent paints and very small brushes.  Some rounded sticks, like the flat end of some toothpicks, work well too. Modge Podge works well as a sealant.

Day Twenty-Three: Painting and Hiding

Consider inviting a friend to join you in painting the rocks you gathered.  Choose any colors, design, or layout you wish.  It is more about the process than the final picture.  On the backside of each rock, paint your baby’s name or initials and birthday.  When they are finished go out into some favorite spots the city and “hide” the rocks for other people to find.

Day Twenty-Four: Warming Foods

Incorporate warming, healing food into each of your meals.  Ginger, cayenne, garlic are great additives. Also, hot soups and teas are great for warming.  Miso soup is warm, comforting, and nutritious.  

Day Twenty-Five: Walk Lightly

Today is a reminder to take thing slowly and deliberately, no matter what you do or with whom you engage.  Walk Lightly through your day.  Walk Lightly with your partner. Soft words and actions.  Walk Lightly with yourself.  Loosen your expectations of yourself and allow softness to seep into you like a gentle wind.  “I allow tightness to melt into softness.  Tight words, tight thoughts, tight expectations for myself and others soften and melt away.”

Day Twenty-Six: Sun Therapy

If it is warm enough outside take time laying out in the sun in a swimsuit or as bare as possible. Let the warmth of the sun soak into your skin and revitalize your systems with its touch.  Be aware of time, so you don’t burn your skin.  Setting a timer works well, and rotating if the skin begins to feel uncomfortably hot.  If it is not quite warm enough to be outside, do some indoor sun soaking using the sun coming in from a large window.  Add a space heater to keep you extra warm and simply feel the sun touching your skin as much as possible.  “Even though my world has been spun upside down, the loving presence of the sun reminds me I am loved, I am supported, I am cared for.”

Day Twenty-Seven: Honor the Birth Order

Whether you include your loss when people ask how many kids you have, or whether you count it to yourself, I encourage you to find some way to honor the birth order and hold space for the importance of this baby in your heart.  It could be something simple and unspoken such as a wall hanging with leaves for each of your children, including this and any other losses.  It could be finding a way to remember this in an annual way, through a donation of time or money to a cause that drives you or helps you or your family remember and honor the loss of this special family member.  It can be as quiet and private as you would like, or as open and inclusive as feels comfortable.  “I hold space for you in my heart.  You are with me forever more.”

Day Twenty-Eight: Curl up with a Book

There are many fantastic books written by other parents who have experienced loss.  Sometimes seeing and connecting to what others have gone through, that also mirror our experience, is very comforting.  It helps to know that you are experiencing a normal reaction to a difficult experience.  Here are a couple recommended by other parents:

Empty Cradle, Broken Heart, by Deborah L. Davis

Healing After Loss, by Martha Hickman

When There are No Words, Charlie Walton

The Shack, by William Young

Day Twenty-Nine: Honor each other

Find a way that you and your partner can honor each other.  You can request what you would like, and your partner can request what they would like.  Be open to whatever your partner may request.  Things to consider: a foot rub, a love note, a walk in the mountains together, an hour of cuddling in the nude, a night out.  “As you honor each other, you allow the stress of your loss to fall away as you absorb the gift you bring to share.”

Day Thirty:  I Light a Candle for You

Get a glass candle and decorate the outside in a way that is meaningful to you.  Tie ribbons around it, paint it or draw on it, but make it something that connects you in thought to your little baby.  Each time you find yourself in a dark space of sadness, or heaviness, intense longing, blame or wanting to connect, light your candle.  Acknowledge the light and allow this small flame to open your heart and warm and comfort you.  There may be dark days and dark moments yet to come but know you are not alone on this journey.  I bless you to be gentle with yourself, with your partner, and with your process.  May you find peace as you search for meaning and connection.

“I walk forward with gentleness and kindness to myself and others.  I allow myself to be in the process of healing, of discovering strength, of grieving, of walking forward deliberately and lovingly.”

Everyone handles loss in their own unique way.  It is a process that takes time.  It takes kindness and gentleness for yourself and others around you.  Now that you are through the first thirty days, continue the softness and gentleness you have practiced.  Go back through the list if you find it helpful, as many times as you need to, or whenever you need a little extra guidance along the way.  If you are here looking for ways to support a loved one experiencing loss, I hope you have found some simple and gentle ways to let them know you love and honor them and their journey.  

Raquel Alfaro is a certified bereavement doula (SBD) through StillBirthday and a Certified Advanced Doula (CAD) through the Midwives College of Utah.  You can follow her on Instagram as: @starlightdoula or on Facebook at Starlight Doula Services.

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Diversity Uncategorized

Challenges in Childbirth: What You Need to Know About Trauma and Military Veterans

 

Guest post by UDA Vice-President Rachel Winsley

 

Most people in our community know that I am a combat veteran, and have worked to support women in childbirth, breastfeeding, and peaceful parenting for many years.  What you may not know is that I am also someone diagnosed with Post Traumatic Stress Disorder (PTSD) and Military Sexual Trauma (MST).  My experiences have enabled me to truly empathize with the unique set of challenges many women face throughout their childbearing and breastfeeding years.

What is Military Sexual Trauma?

Military sexual trauma results from an unwelcome sexual advance on the military person without implied consent while on active duty.  You may not know, but sexual assault is underreported in the U.S. military, and more than half of the victims are men.  In an interview with NPR, Eve Davison, a clinical psychologist at the VA hospital in Boston said, “It’s not uncommon for patients with PostTraumatic Stress Disorder (PTSD) to screen positive for something called MST… More than 48,000 veterans screened positive for Military Sexual Trauma (MST) just in 2008.”  Military service men and women pride themselves on being leaders and warriors; self sufficient, strong, and ready to fly, fight, and win.  With that mindset, it is very difficult to be vulnerable or ask for help.  A recent documentary, The Invisible War, depicts the experience of several servicemen and women under the looming shadow of MST in haunting detail.

Military Training on Sexual Assault:  The Bystander Effect

The Sexual Assault Prevention and Response (SAPR) Program is responsible for oversight of the Department of Defense’s sexual assault policy. Sexual Assault Prevention and Response Office (SAPRO) works hand-in-hand with the Armed Services to educate, prevent, and protect service people from sexual harassment and assault.  This program is driven by annual e-trainings on a concept called “the bystander effect”, advocacy roles assigned as an additional duty to service people within each squadron, and operation of the reporting process when MST occurs.  The program is not standardized across the entire military, and resources are governed and limited by officers in charge.  Jackson Katz is just one of the individuals who works within the SAPRO.  In some areas of the Armed Forces, the program is very well developed and supported, but there is a lot of room for improvement.  This matters!  Your client shouldn’t be expected to have the same experience as another military person.  There is a great amount of variability when it comes to training, support, resources, and even the involvement within the chain of command.  Don’t assume anything about what your client may or may not have been through as a patriot and service member.  Jackson Katz is a great boon to the success of the program, but he is only one person in a large patriotic machine with many moving parts.  He recently spoke at a TED conference on the subject.

What does this mean for you and your client?

Abuse issues are sometimes triggered unexpectedly during pregnancy, labor, and birth. Intrusive thoughts or flashbacks to the abuse and unconscious body memories (i.e. tension, anger, sick feelings, or physical manifestations) arise when someone is triggered.  There are several potentially triggering experiences that may arise during the birth process.  As a doula, you can help to alleviate and navigate through these instances if you are prepared and knowledgable about PTSD and MST.  There are tools to understanding and empathizing with the anxious mind.

It is not necessary to be told about abuse or trauma in order to provide sensitive and effective care. While being able to discuss personal history openly is helpful, your client may not be at a point in her healing process where this is possible or constructive.  Your client hired you, because she trusts and values your skillset, and the way she feels around you.

Your words matter.  The language our society uses to refer to people shapes its treatment and beliefs about them. Words are powerful!  Antiquated, inaccurate, and inattentive descriptors create barriers to quality care. When we describe people by their labels of medical or psychological diagnoses, we devalue them as individuals. In contrast, using thoughtful terminology builds trust.  Read more about how to use person first language, here.

Examples:

  • Diagnosis First:  “My MST client is strong and capable.  She has everything she needs within her.”
  • Person First:  “Rachel copes well with Military Sexual Trauma, and she is a strong capable woman.  She has everything she needs within her.”
  • Diagnosis First:  “Your ‘tubie’ is a cute little cuddler and a fighter.  You’ll be out of the NICU soon.”
  • Person First:  “Baby Alice is tube feeding great!  What a fighter.  You’ll be out of the NICU soon.”

Fostering Resilience in Childbirth and Beyond

Many doulas find that connection is the antidote to anxiety and a disordered labor pattern.  Finding connection and vulnerability looks different for each person, but here are some tried and true suggestions for fostering resilience in the birth space.

Bonding with Baby

When your client, diagnosed with PTSD or MST, connects with her baby, she is doing two very important things.  She is developing a sense of awareness within her body and creating space for positive feelings surrounding her child.  This is a powerful coping tool, and it also mitigates her increased risk for postpartum depression.  When I was pregnant, my favorite way to connect with my own baby was to sing, read, or write letters to my baby.  I set time apart everyday to do this, and even now when my child is upset we sit down to connect in the same way.  Listen to Penny Simkin, a world renowned doula, and her thoughts on this very practice.

Mindfulness & Affirmation

If birth could feel like a violation, how can the birthing person feel in their body that this is different — that there is a purpose?  You can work to pinpoint with your client the root of the violation.  At that point, designing affirmations and mindfulness practice around those discoveries can be a powerful tool. There are several Mindfulness-Based Stress Reduction (MBSR) workbooks that you might find to be a helpful tool.  My favorite are “A Mindfulness-Based Stress Reduction Workbook for Anxiety” and “Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy“.  These are a good preparation for childbirth and processing trauma during the postpartum period.

Here are some examples of affirmation.:

  • Consent: “I will be choosing to work with my baby as we spread my pelvic bones wide for his/her descent.”
  • Motive/Intention: “This baby was created from an act of love, as is giving birth.”
  • Safety: “My people are there to protect and support me.  ______ stands watch at the door to guard me and my baby.”
  • Power: “I will give birth. I am in control, and my provider hears me.”

Creating a plan around the fear

Many people who struggle with PTSD and MST will experience a seemingly insurmountable wall of anxiety when they are triggered.  Consider changing your focus from management of pain to management of anxiety.  Most childbirth preparation classes teach techniques to manage pain through mindfulness, breath, hypnosis, etc. Your client can use the same and similar techniques to practice coping with anxiety. This technique and mindset works like a muscle. Your client will respond best to the technique she is most comfortable practicing. There is no wrong way to mentally, physically, emotionally, and psychologically prepare for the intensity of labor.

At a certain point, usually in transition, the intensity of labor can become a distraction from managing anxiety, and therefore presence of mind.  Create a plan around your client’s fears, and design a birth environment where losing control and being fearful will be accepted without judgement. Anyone in the birth space should be able to ‘be with’ fear.  Encourage your client to talk to the baby through fearful moments.  This takes us back to connection, back to the present, and back to the goal.

Communication

It may be helpful to ask your client, “How do you usually cope when you are stressed out?” This question can reveal if it is important that she stay in the present or dissociate in order to cope.  Depending on the answer, you might explore ways you can support her in staying present or help her to turn inward and cope from within.  In my own personal doula practice, eye contact, firm pressure on her shoulders, squeezing her hand, etc., are all ways I have found to bring the birthing person back if she has “checked out,” or is dissociated and not communicating.  Having this conversation ahead of time can prepare you to effectively and empathetically meet your client’s needs in the birth space.

If your client wants to use medication as a tool, encourage the family to research what that might be like.  I have a Google Drive folder dedicated to activities, graphic organizers, and conversation starters to aid my clients in decision making and communication.  Thinking through potential decisions and their implications can help us cope with the risks and benefits of any choice we may make in the birth space.

The postpartum visit

Every doula has a different philosophy around birth and the postpartum period, and this philosophy shapes the way the client processes a birth and bonding experience. Thoughtfully explore which tools are most relevant in the postpartum visit. You might think about doing a fear release, listening to the birth story, preparing a meal, etc. This visit is a good time to ground your client in connection, honor the journey you’ve embarked on together, and watch for warning signs of struggles ahead. If your client seems to be anxious, make sure basic needs are met first.

Local resources for your client

  • Veterans of Foreign Wars – This is a social club and support group for combat veterans.
  • American Legion – This is a social club for all military people who have served during a time of war.
  • The Vet Center – This is a resource for combat veterans seeking treatment for trauma and PTSD.
  • Veterans Administration in Salt Lake City – The VA in Salt Lake City has a women’s only clinic and recreation therapy options.  They provide access to retreats, a sweat lodge, yoga, mindfulness and coping classes, etc.

Read More:

 

Rachel Winsley is a combat veteran, DONA trained doula, childbirth educator (ICEA), La Leche League leader, and birth story author. She is also the current vice-president of the Utah Doula Association. Rachel has extensive experience empowering laboring women to make their own choices and decisions throughout the labor process. Learn more about Rachel on her website.

 

 

Editor’s note: Rachel is a strong proponent of music therapy as a therapeutic modality. It is an important coping tool for her and others with PTSD and MST. Music therapists work with clients to help them manage a wide range of emotional, social, and physical difficulties, using music as the tool for change. To learn more about music therapy with military populations, click here . Locally there are several music therapists, who can be found on the Utah Association of Music Therapy website. Rachel recommends Harmony Music Therapy and Heart Tones Music Therapy & Birth Services.