The Importance of Labor Support

Posted on December 15, 2009. Filed under: doula, Value and Purpose of Labor Support | Tags: , , , , , , |

I actually had to write an essay about this for my doula certification. I will add it to this post later but for now I wanted to share with everyone what my friend and doula (well, one of them, I am actually having two) Karen had to say about being on my birth team.

Go HERE to read her blog post about it.

Karen is doing such great work to help women have better births. She has not formally trained as a doula but she has as a childbirth educator. She is a wealth of knowledge, especially here in Korea as far as the birth culture is concerned. She spends a good bit of time pointing women in the direction of the information that they need and because of this has helped many women have good birth experiences. I am very proud of her and proud ot have her on my birth team.

I will also have a Korean doula on my team. Her English name is Janice. She is a new doula and also trained as a childbirth educator. She works for a milk bank in Seoul, helping to get donated breast milk to mothers who do not want to use formula but cannot breast feed for some reason. She is also an RN here in Korea but does not work as a nurse any more. Her English is great as she lived in Hawaii for a few years and she is just all around a very nice person. I have referred doula clients to her and she will attend her first birth in January. Karen has also referred a client to her. By the time my birth comes around she will be fairly seasoned and experienced. Her role in my birht is different from the typical doula however, in that the will be in the background. She will be there to help communicate to the Korean hospital staff and admin and through the postpartum time at the hospital.

Because I am using Hynobabies I prefer for my support team to be in the back ground and my husband to be my main support if necessary. Karen and Janice will be there if I need them and that for  me is such a huge confidence booster. I wish every woman could have that kind of support in birth.  My hope is that one day every woman will.

The Value and Purpose of Labor Support

Labor support can be priceless to a mother. As Doulas we often times do put a price tag on our services and time but the benefits received outweigh the cost. Studies have shown that by hiring a Doula a mother can reduce her need for pain medication, increase overall satisfaction with the birth experience, drastically reduce the risk of a cesarean and reduce the risk of assisted delivery by forceps or vacuum extraction. The studies have  also shown a reduction in postpartum depression for mothers who had a Doula or continual labor support by a person trained in birth. I believe that much of this is the result of an increase in confidence levels by both the mother and the father. I have had several second time mothers tell me that their birth with a Doula was so much better than their first birth without one because they knew they had someone there whose sole purpose was to tend to her physical and emotional needs.

Part of labor support is empowering a mother to have confidence in her ability to birth. Having someone available for the entire length of labor provides security and confidence for the mother as practitioners are typically caring for multiple patients at a time or have other responsibilities such as the clinical needs of the mother and the baby. There is also paperwork that must be done and shift changes that bring in new people to the birth environment. Having a constant throughout the entire labor process provides a sense of familiarity and safety for a laboring mother. Doulas also help the mother and father both communicate with the staff which is necessary in a time such as labor when the parents are usually distracted with the labor itself. While it is not the role of a Doula to speak for the parents to the practitioner she should advocate in order to help the mother or partner speak for themselves. Helping the mother and partner ask the questions appropriate to their situation and navigating the terminology used is also often helpful.

Supporting a mother emotionally during labor and birth helps the mother to believe that she can do it. Sometimes being told that she can do it is all that a mother needs to hear to keep going strong during a long labor. Understanding that laboring women are vulnerable and that the birth space should be protected is very important. Laboring women should have peace and quiet and no unnecessary interruption and holding that space for a mother is a priority. When a Doula and a partner help create a peaceful and safe environment for a laboring mother often times practitioners will follow suite and respect that space. It allows a sense of calm for the mother that helps her to maintain stamina through labor. Emotional support doesn’t end at the birth however. Helping a mother to process her birth experience is equally important. In unforeseen complications or unexpected situations or traumas a mother needs the continued emotional support to facilitate healing. Being especially sensitive to these needs helps to reduce postpartum depression and negative feelings towards her birth.

Labor support also includes physical support for the laboring mother. Every woman has a different need in labor whether is continual touch, massage or counter pressure while other women want very little physical touch. Often times women will not know what their need will be until labor has progressed and it is important to be able to understand what the mothers needs are and at what time her needs are the greatest. Incorporating the partner into the physical aspect of labor support is often very affective as they usually already have a certain intimacy between them as a couple.

The needs of a laboring and birthing woman are very complex. Mothers deserve the continual support of a Doula, someone trained in labor support. I believe that if all women had a Doula that most of them would be able to birth without medication and with little medical intervention. The cost of maternity care would lower as a result and there would be higher success rates in breastfeeding. Postpartum depression rates would also lower. I believe that every woman deserves a Doula and that every woman that wants one should have one.

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20 Responses to “The Importance of Labor Support”

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This is definitely something I’m looking into. I know one of the big issues I had the last time around was NO support from the time I was sent home from the hospital (not that I had much support at the hospital or just before I went) to the time I went back. When I went back, it was after being home about 9 hours and I had gone to a TWO. That whole time though I was having to labor alone and had back labor. My husband was sleeping and I had just barely gotten him awake enough to help me out a little bit. Other than that, I was alone and it was that that pushed me to going to the hospital when I did. It didn’t help that both sisters were like, “let us know when you get to the hospital and we’ll come over.” Well, I needed support BEFORE I went to the hospital. Laboring alone was not fun! I was doing the best I could under the circumstances but having been up since 8:30PM the night before and having been having back labor since 2am, I was not doing well on my own. But going to the hospital that soon was the start of many interventions and issues that lead me right to a cesarean. And my husband was pretty much worthless as a support person. He either slept or ate the whole time. My nurse was great but I really needed someone who was there for me and only for me so I know that finding a support person is going to be key with this birth.

Continual labor support by someone trained in birth makes a HUGE difference and yes you need that before you go to the hospital. I will get my essay posted over in the next week, I think it will do a better job of saying everything that I want to say about it since I have already said it there (if that made sense). Do you know if your baby was OP (sunny side up?). I’m sorry if you have already told me this. You are down in Yongin right? There are a couple of doulas in Seoul that could come to you. I really think you should consider talking to them. And of course finding the right place to birth. VBAC is trickier here in Korea but if I can pull it off with my inverted t cut then you most certainly can. Let me know what you need and I’ll be happy to pass on any info.

I’m not sure if she was OP or not, not really even sure they looked at that when they got her out. I’m just past Bundang in the outer parts of Yongin, near Jukjeon Station. To be honest, I’m kind of freaking out about the whole thing because more and more I don’t even want to go into a hospital. I’m having some huge issues right now due to the last birth and due to things that have happened in my history prior to that. Losing control is something I don’t like and I’m terrified I’m going to have a pregnancy of all of these different interventions and then walk in the hospital in labor and completely lose all of my control and I don’t think I can go through that again. I’m already being told that I’m going to have to pick my battles and I don’t have a lot of choices and it’s seriously freaking me out. I’m going to need a TON of emotional support because I do have post traumatic stress disorder and I’m worried that it’s really going to get triggered around the time I’m due because I don’t do all that well around the end of June and between that and the trauma I went through with my daughter’s birth which had a lot to do with not having control over the situation, I’m not doing very well. I seem to do okay and then the next day start to totally freak out again and I’ve spent more of this pregnancy freaking out than being happy about it and that’s not good. I don’t really have much of a support network here so it’s really been difficult. And unfortunately, my husband just doesn’t get it and he’s making things worse looking into possibly moving us to Suwon for a position that doesn’t even provide housing! We would have to provide the key money and then try to get furniture and I am seriously overwhelmed right now and not even sure if I can do this. We were not trying for another baby. My husband didn’t even want anymore children and we ended up with an oops so I was completely and totally unprepared for this and just totally freaking out and to top it off, I am overweight but had no issues with my pregnancy because of it the last time around, just had issues with positioning at the end and there was merconium in the amniotic fluid but no gestational diabetes and no high blood pressure. My daughter was almost 9 and a half pounds but she was only half a pound more than what I weighed when I was born.

I’m just at a loss figuring out what to do and am almost to the point of seeing if someone can take me in for three months and I try to have a homebirth in the US. I don’t know. I just don’t like the idea of getting hit with all kinds of interventions again like I did with my daughter.

You read my VBAC plan. You have my OB as an option. You tell him your history and I guarantee you will birth the way you want. It’s not too far for you to go to birth if you birth in the city. I live at an Army base two hours away from the Army hospital in Seoul and all these women here make it there to birth. You would be fine time wise or you could get a hotel in the city as it got closer. Either way. You can also homebirth. There is a homebirth midwife here that actually works with my OB. He is a homebirth doc as well. I don’t know their feelings on homebirth VBACs but it doesn’t hurt to ask. Or you could hire a traveling midwife that I know. $2000 plus expenses getting here and she stays at your house. She has been to Korea twice and also to Italy among other places to VBAC with women who had limited VBAC resourse. She’s attended almost 900 births and many VBACs.I’d hire her myself if I didn’t have the scar that I had. You have options, you have more options that I have. Lots of options you just need to look at them. You could go back to the States but it doesn’t sound like a good option for you and if you have other potentially better options by staying here maybe you should explore them. There are several doulas here that would go to where you are. There is also a hospital in Bundang that does water births though I do not know if they attend VBACs. Even if you go to the states you are going to have to fight for what you want.VBAC friendly docs, I mean truly VBAC friendly and natural birth friendly docs are harder and harder to come by. At least here you can play the foreigner card and have a good chance.

There is a doula in Seoul teaching Hypnobirthing classes. Even if you aren’t interested in Hypnobirthing the program really does a good job of dealing with fear in birth.

Order a copy of your birth records, positioning should be mentioned. It sounds to me like she was OP. 9.5 lbs is not huge. I was 10 and my husband was 11 both born to healthy non GD moms. My MIL is 5’2″. Some women grow big babies but your body will not grow a baby that you cannot birth unless you have uncontrolled GD or some kind of pelvic deformity from an illness or an injury.

What do you want? Set aside all the fears (and i know that is hard to do, I’ve been there) and write down what you truly want for this birth. Copy the questions I asked my doc (on my VBAC post) and use them if you want. The PTSD will get better with knowledge and preparation. As you find confidence you will relax. I promise. This baby may have been an oops but it happened for a reason. Maybe that reason was to help you heal and do it your way this time.

That’s what I’m hoping, just seems like a lot to still try and figure out, that’s for sure. A few people mentioned Dr. Chung but also said he’s VERY expensive and not covered by the national insurance which is what we likely have (though even that’s iffy since schools are so bad about getting that information to the ESL teachers). I’m definitely torn between a homebirth and a hospital birth. One one hand, I really do not want much invention at all, not even an IV but on the other, I’m a little nervous about trying to handle it all not in the hospital and our apartment is SUPER tiny. Money is a bit of an obstacle as my husband is on his third job here and things haven’t been stable enough to really start setting a lot aside and then things came up while I was in the US that cut into the little we did have. So that’s been kind of the big thing too, all of the details that we have to discuss and figure out and the fact that we’re living on just one income and it’s not very much and that’s IF all goes well, which I have to admit, I worry about too this being my husband’s THIRD job in the year he’s been here and it’s due for renewal the end of February. Just a lot of things up in the air which yeah, probably wouldn’t be much better in the US but (and I hate to say it) there’s at least state assistance that comes in in a pinch. That’s not quite the case here.

Not trying to make excuses, just sort of throwing everything out there because there’s definitely a lot to figure out and unfortunately, I don’t know a lot of people in this area. The last time around, I went with the hospital I had been going to for years, went with the same OB my sisters had had and followed along with everything that was said to do with the exception of the quad screening and vaccinations. I know a lot more now and that’s making it a lot harder.

I know I have a lot of time, I’m just trying to get it all figured out and figure out what I need to do step by step and it’s been kind of overwhelming, especially since I’ve been back here only a week.

I haven’t asked how much Dr. Chung is because my insurance is paying 80%. I guess I should find out what to expect the 20% part I have to pay will be. I do know that as of now his homebirth fee is only 3 million won which is cheap even compared to most US homebirth midwives. He is going up on the fee though. I have an appt with him on the 30th and I will ask what his fees structure is for in hospital and out. I’ll also ask him about the national insurance as well.

I would find out specifically what your insurance covers and where it covers etc.

I don’t think you are making excuses, those are real life issues that you are dealing with it and it all has to be considered.

You know that my doula was unable to make it to my actual birth but the support and help she provided while I was pregnant was priceless. Since my 3 previous births were all “standard” hospital births with epis she treated me as a first time mom and gave me info and advice on how to listen to the cues of my body. That put me in the mindset that I could do this with no meds which put me in control of my labor and birth instead of the hospital staff. Her knowledge and advice also helped my husband be more at ease with the process which was key considering how Ellis made his enrty into the world. My doula offered great labor support even though she wasn’t physcially there, I don’t think that my labor and delivery would have gone as smoothly has it had if I hadn’t hired her.

I was wondering how you felt about everything after the fact. I figured she was probably still an asset to you after all the things you said about her during your pregnancy. I think your situation is a great example of the confidence building that hiring a doula provides.

On another note, how did your daughter react to being there for the birth? I am hoping that it was a really positive and empowering experience for her and that when she is having babies herself it will have an impact on how she births 🙂

she was great and not freaked out at all. she wanted to be there and was bummed when i told he the hospital had new age limits on ages because of h1n1. she and my sister both (and even anthony some) kept telling me I should just have him at home so when that actually happened she was happy she got to be there. she was my little cheerleader telling how overrated drugs were when I was asking for them towards the end. Overall I think when and if she has kids it will be an experience that she will remember and pull from to be more in control. (I hope)

It’s true about the second (and fourth) timers, or at least it was for me. I told you before that if it wasn’t for you and some of the other moms on the WTE site I wouldn’t have thought anything about my birthing experience because I never thought of it as an experience before. I wish I had the info or had given it more thought with my previous pregnancies. At least I ended with a great experience.

And also, I too tend to approach my second time moms (never had a fourth timer 😉 as if she is a first timer. I find that they often know as little about the birthing process as first time moms do even though they have already given birth or had a c section. It really astounds me sometimes but I am very proud of them for learning from their experiences and taking their subsequent births into their own hands.

The last comment has me wondering, when should I look into hiring a doula and what is the average fee for one? I suppose I should get on the ball for that now since I’m due around July 16/17 (I really should look into making a ticker) and there are a number of moms in Korea due in July, I’m seeing. That might be a first good step for me. The holidays are probably going to complicate things though for at least another couple of weeks but hopefully I can get going on that.

Thanks for your patience. This has all been kind of overwhelming and I’m on totally unfamiliar territory trying to do this overseas.

I don’t really know what the average fee is. I tend to charge less than the doulas in Seoul but most of my clientelle is US military and often junior enlisted military. I charge rank based rates and rates prorated to family income. I think for the doulas in Seoul it depends on how in demand she is and how experienced she is. I think you are just going to have to talk to each one. I do think you should probably go ahead and start the process because one of doulas I know is already booked for July, I am out and of course have my doula (who would’t be able to take you most likely) and I just referred another July mom to another doula I know. Here are some doulas that you can contact. If they aren’t available they can refer you to someone else. If you run into trouble there, I can ask my Korean doula friend about the other Korean doulas that she trained with. One of them is bound to speak good ENglish.

Lisa Fincaryck: birthinginkorea@gmail.com (she’s booked but she can refer you)
Annette Boese: annette.boese@gmail.com (I just referred her another mom with your due date but they haven’t talked yet)
Janice: aegean@naver.com (she is Korean and is my doula, she cannot take you but may know an English speaking Korean doula that can at a discounted rate)

Let me know how it goes.

I went to Annette’s the other day and she is taking clients. She has to limit herself because she has a job, but she doesn’t currently have any right now. She is probably the best one to negotiate the fee with because her income comes from her work as a research scientist.

Yeah, I thought Annette would be a good option. Janice is talking to the Korean doulas as well. We need to get her to get the ones that speak English to come to the birth share in January. We need to meet these ladies!

Yikes! I hope we don’t run out of doulas! I didn’t realize that there were so many due-in-July moms.

OH don’t worry about that. There isn’t a huge abundance of doulas in Seoul but there are enough that if you want one you will have one. My Korean doula is going to talk to her group and see who is available and like Karen said, Annette might be a really good option for you as well. Do you want to get together with Karen and me sometime in January? Even though neither of us can be your doula, we can help you hash everything out and start prioritizing. You don’t have to do all of this alone and we can give you suggestions and ideas for your circumstances.

Definitely! I come from a VERY medicine (what’s the word here?) liking family, I guess. My family was very much into following what the doctor said about everything and birth especially. There was quite a bit of hubbub when I had to have the cesarean between my husband and my family and my family never did forgive my husband for that. I do have her birth story on my blog, kind of long but it may give you somewhat of an idea of what all happened. It was written six weeks after she was born:
http://theworldofnatalie.blogspot.com/2006/02/miss-natalie-has-arrived.html#comments

But yeah, most of what I’ve been learning about birth and stuff since then has been from more natural minded people than I grew up with. The friend of my husband who called has been able to help his wife have a VBAC with the seven kids she had following her firstborn who was born by cesarean. Unfortunately, by the time he called, I was out of my mind with fear and everyone else there was freaking out so it just fed into the hysteria I ended up feeling. And of course, I was drugged which definitely didn’t help.

Thanks for sharing. It sounds as if she were OP (Face up) from the sound of your labor and the way it was very slow to start and you were slow to dilate and having back pain. Data has shown that a mandatory IV, continual monitoring, internal monitoring and AROM (breaking the water) can all cause more problems than good. There is a cascade of interventions that often does lead to a c section and your birth story is a classic example of it. I have read this birth story (well, some variation of it) probably a hundred times. You are definitely not alone in your experience. Have you been to http://www.solaceformothers.org ? It is a forum dedicated to birth trauma. It think you should go share your story and read some of the others. Also, read this birth experience of my last client who had an OP baby, some of it may sound familiar to you…

https://doulamomma.wordpress.com/2009/11/14/op-sunny-side-up-cervical-swelling-and-slow-dilation/

All that said, there is nothing in your birth story that would indicate an inability to VBAC or the need for unnecessary interventions. I think if you can go from here and switch from “trauma mode” to “I will birth my way” mode (and I say that sincerely, anyone suffering from a previous trauma has to do that at some point), then you can prepare yourself for a very beautiful birth in July.

The only question I have then is what are the chances of me having another OP baby? That kind of concerns me because the back labor was just awful! And that 65% of OP babies come out via cesarean concerns me too. And a 90kg weight limit on epidurals? Good thing I don’t plan to get one this time! I’m probably about 50 kg above THAT!

I read the story earlier of the OP baby you helped deliver. It gives me some hope but I’m hoping that I won’t have another OP baby because man that was just rough.

I don’t know specific chances on another OP baby. I had one client who had two OP babies but vaginally delivered both. The first was with an epidural and vacuum extraction and episiotomy and the second was nearly intervention free and with only a small skin tear that healed in a week. The second labor was hard but doable and she was well supported and says she wouldn’t get an epidural again.

The reason 65% of OP babes are c sectioned (in my opinion) is because a) the mother is not supported well b) the labor is harder and without proper support the mother gives up C) labor is usually much slower and the provider doesn’t give mom time and d) mom has an epidural and physically cannot push the baby out because she is stuck on her back.

There is a lot you can do to prevent and to turn an OP baby before labor even begins. Be sure to read this post…

https://doulamomma.wordpress.com/2009/06/10/optimal-fetal-positioning-for-a-better-birth/

and also be sure that your doula is familiar with techniques to facilitate turning the baby. One method is the Rebozo. I need to do a post on Rebozo techniques, when I do I’ll call your attention to it.

But mostly heed the advice on the post above, all of those things will help. And you will be more aware this time so you will probably know what the baby’s position is and can work on it daily.

Baby steps Janeen:) You are getting there. Getting all the fears and concerns out now and learning eveyrthing you can along the way will make this much smoother.


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