I frequently get emails from women asking questions about pregnancy, birth, breastfeeding, circumcision and all things in between. I get phone calls from random strangers or from friends of friends. I get approached by both women I know and do not know that know I am a doula. I always have an open ear and I always try to the best of my ability to point these women to the direction of the best information to answer their questions.
I am both a DONA trained birth doula (CD DONA) and have trained as a Lamaze Certified Childbirth Educator (LCCE). There is extensive training and worked involved in both of these designations, but especially in the LCCE. I take my exam in April and I will tell you I am preparing for it harder than I ever worked on any high school or college exam and I have an accounting degree if that gives you any indication of the amount of work I am putting into this. While it is true that I am not medically trained I am trained and have been exposed to a variety of topics pertaining to women’s and infant’s health, birth, pregnancy and breastfeeding. I do not give medical advice. When I am asked a medical question, I may give my opinion based on what I know but it is always preceded with ‘ask your doctor.’ What I do is give information, facts, data, research results and how to find this information and decipher it.
I also have spent and do spend a good bit of time talking to both OBs, general practitioners and RNs including labor and delivery nurses. When I attend a birth I ask a lot of questions about the clinical procedures carried out during the birth even it is something as simple as a charting requirement. Of course that all depends on how friendly the staff is and how open they are to sharing information but most are. They see that I am there with the sole purpose of supporting my client and that I am in no way trying to interfere with the clinical needs of her birth and they respect that and are typically happy to answer my questions. They usually realize that I have a genuine interest in both my client and all aspects of her birth and it makes for a much better experience overall for everyone. It also helps to plant good seeds of thought on doulas for wary staff who have not been exposed to them before me or who may have had bad experiences with a doula in the past.
My point to all of this is that between the work I have put in to have both the CD (DONA) and LCCE designations by my name plus the practical experience of attending births and exposure to hospital staff and systems I do have a lot to offer a woman who may have questions about her pregnancy or birth or newborn. Part of my training has included the tools and resources to provide evidence based information to women both in a class room setting and informally by email or what not. All of the information that I give women is fact based and generally given with references and resources so that they can research the information for themselves. I don’t want people to just take my word or believe what I am telling them just because I said it. I want to see people take responsibility for their bodies, births and babies and learn some things in the process.
I am a support person. I am a sharer of information. I strive to do the very best that I can to give good information and resources. It’s up to the individual to do the rest of the work. My hope is that after I have answered a question or sent and email that the asker will go forward and look into what I have told her. I know it doesn’t always happen and because I am human it frustrates me a little. I don’t want to see someone not heed my advice and have a bad experience but I am not also not on a mission to save any one either. It’s at that point I take a step back and not interfere with what a woman chooses.
Please keep the questions coming. I am always happy to help in any way I can. Please continue to give me your feedback. It is motivating not only to me but to other women who read these blog posts or hear about your positive experience. And thank you for sharing with me, I am always honored to be a part of any birth whether directly or indirectly.Read Full Post | Make a Comment ( 1 so far )
As I said in Part One of this article, there are six care practices that support normal birth. Lamaze International says “The six care practices below are supported by research studies that examine the benefits and risks of maternity care practices. Therefore, they represent “evidence-based care,” which is the gold standard for maternity care worldwide. Evidence-based care means “using the best research about the effects of specific procedures, drugs, tests, and treatments, to help guide decision-making.”
Unfortunately, in the U.S., the trend is not towards normal birth and adhering to the six care practices that support normal birth. Maternity care in the U.S. has a “prominent position, large expenditures and troubling performance” according to the Milbank report Evidence-Based Maternity Care: What It Is and What It Can Achieve released in October of 2008. This report discusses the issues with the U.S. maternity systems, the overuse of routine interventions and the harm they cause and closing the gap between them and the normal birth practices for healthier moms and babies. I will talk about this report in depth in another post as it has some great information that every pregnant woman should know.
This seems so obvious but women are being induced more and more and for more and more reasons that really are not means for induction. In my Truth About Pitocin post, I discussed the difference between medical inductions and elective inductions. The medical reasons for induction are:
* your water has broken and labor has not begun.
* your pregnancy is postterm (more than 42 weeks).
* you have high blood pressure caused by your pregnancy.
* you have health problems such as diabetes that could affect your baby.
* you have an infection in the uterus.
* your baby is growing too slowly.
Suspected big baby is not reason for induction and ACOG doesn’t recommend it either but it is commonly a reason for induction. Also common to that is the birth of an 8lb baby after the induction failed and a cesarean had to be performed when if given time, the mother would have spontaneously began labor on her own when both she and the baby were ready.
Also important to note is that a pregnancy is not considered post term until AFTER 42 weeks. Only after 42 weeks should the pregnancy be induced if all else is normal.
Labor induction is not without risk. Research has shown there is a significant increase in
* vacuum or forceps-assisted vaginal birth;
* vacuum or forceps-assisted vaginal birth;
* cesarean surgery;
* problems during labor such as fever, fetal heart rate changes, and shoulder dystocia
* babies born with low birth weight;
* admission to the NICU;
* jaundice (yellow skin caused by the breaking down of red blood cells) that required treatment; and
* increased length of hospital stay.
In addition, the chance of cesarean is nearly doubled when induced and there is a higher risk of prematurity as due dates are only estimates. There are also psychological effects as it makes us think that there is something wrong with us for not going into labor on our on. I have had clients ask me if I thought a friend was capable of going into labor or if someones water can break on it’s on. These are pretty valid questions, especially for a first time mom who has seen most of her friends get induced for one reason or another and every one of them had artificial rupture of membranes (water broken for them). The thing is, our bodies will not stay pregnant forever. We are meant to birth the babies that we grow. We are just forgetting that in this day in age where most women are given pitocin and think that they just HAD to have it or they couldn’t have birthed their baby. It’s really sad that we have come to this. We do not HAVE to have pitocin to give birth.
This one is pretty simple but too often women are told to get in the bed and stay there. Usually this happens because they are on some medication (pitocin, cytotec, anesthesia) that requires continual fetal monitoring and IV lines. All of this is counterproductive to what the body and the baby are trying to do. The uterus works better when a woman moves around. It’s a muscle and movement increases circulation. The pelvis not stationary. It moves and flexes and bends and as it does the baby is able to moved and wiggle down into it with the help of gravity. Being on the back in bed prohibits this movement and closes the pelvis up making a smaller exit for the baby to move in to.
The research has shown that movement causes:
more efficient contractions
less need for pain medicine in labor
Even if there is a medical reason to have continual electronic fetal monitoring, there is enough slack in the line to get out of bed and sit in a chair or a birth ball or to sway with your partner.
I am a doula, I think every woman should have a doula. It’s not because I am trying to justify the profession or the cost or to promote myself, but I really believe that no woman should have to birth without someone who is trained to support a laboring woman. There is a big difference between a doula and a loving partner, a doula and a best friend who has had five kids and a doula and the grandma. While a doula does form a relationship with her clients, she doesn’t have that intimate relationship these other people do and can help the laboring woman without the emotions that are often involved with these family members. Doulas are also trained professionals who study birth and labor and ways to make labor easier and more comfortable with different positions and massage and other techniques that even someone who has had a few kids of their own may not know. Doctors, midwives and nurses often times have several patients at once and cannot stay with the laboring woman.
The research has shown that the presence of one-on-one support such as that of a doula a less likely to have:
have a cesarean section;
give birth with vacuum or forceps;
have regional analgesia (e.g., an epidural)
have any analgesia (pain medication)
report negative feelings about their childbirth experience
Doulas can also help incorporate the partner into the labor experience. Often times partners are very inexperienced in childbirth and they are nervous and worried and are scared of labor pains. They are often scared and unsure of how to help their partner even though they very much want to. I have found that they are relieved to have the help of a doula, especially once labor kicks in to high gear and they do feel more of a part of the labor process when they are shown ways to help the mother. It gives them a greater sense of importance and usefulness that they very much appreciate. I love working with the partners as much as the moms because they are so willing and grateful by the end. Even the strongest, most loving and supportive dads benefit from having a doula around.
There are three more care practices supporting normal birth. I will discuss them in Part Three.Read Full Post | Make a Comment ( 5 so far )