doula

How To Hire A Doula

Posted on January 5, 2010. Filed under: doula, How to Hire a Doula | Tags: , , |

*If you have previously hired a doula, please be sure to share how you did it in the comments section!

When you are bringing in another person to your birth and you are paying them to attend it, you need to make sure that it’s the right person. You should interview a doula just like you would interview someone to babysit your child, build your house, deliver your baby (YES, you should interview your OB or MW!). I think before you ever interview a doula, you need to interview yourself a little though.

Before meeting with a doula you should sit down and answer the following questions…

  • What kind of birth experience am I looking for?
  • Why do I want a doula?
  • Why do I need a doula?
  • What do I expect from a doula?
  • Do I want a doula to advocate for me to the staff?
  • Do I want a doula to help me stick to my birthplan?
  • Do I want a doula to help my partner be more involved in the birth?
  • Do I want a doula to be the main support person during my labor or in the background?
  • What do I need from my doula before the labor begins?
  • Do I need a postpartum doula or postpartum help?

The answers to these questions are the base for what your philosophy of birth is. Do you feel as if birth is a means for getting a baby out and it doesn’t matter how that happens? Do you feel like birth is something that should be experienced and you want to experience it in full? Are you attempting a VBAC and feel as if you need extra support to ensure success? Do you want a natural birth or a medicated birth? Do you want an intervention free birth? Doulas can be valuable in all of these situations but in finding the right doula for your job, you should have an idea of where you stand on these things. Knowing your own philosophy of birth will help you find a doula who has a similar philosophy.

Once you actually meet a doula, here are a few questions to get you started:

  • How do you feel about natural birth?
  • How do you feel about medicated birth?
  • How do you envision your role in my birth?
  • Would you be willing to be in the background letting my partner be my main support person?
  • Will you be my main support person if my partner gets nervous about everything?
  • Can you help my partner better support my by showing him/her ways to help me?
  • What are some of the comfort measure techniques that you use (i.e. massage, guided imagery, hypnosis, breathing, Rebozo, etc)?
  • What kind of training have you had?
  • How many births have you attended?
  • Do you have a back up doula and may I meet her?
  • Why did you become a doula?

If you are a second (third, fourth, etc) time mom, you may have very specific questions based on how your last birth experiences went. Some may include…

  • What is your comfort level with VBAC and how many have you attended?
  • I prefer a very low intervention birth and require advocacy to the staff, can you do that?
  • I prefer to labor at home as long as possible before going to the hospital, can you help me do this?
  • I prefer my labor room to be as peaceful and quiet as possible with no unnecessary staff interruptions, can you help me achieve this?
  • My first labor was ___________ and I know that in my next labor I will need ______________, will you help me do this?       (for me i would say, my first labor was very long and I know that I will need a lot of encouragement if this one is very long also. I will need someone to stay strong and positive and upbeat and to encourage me to change positions frequently and remind me to eat and drink. I will also need for someone to be on the look out for signs of fetal malpositioning and to help me find ways to correct it).

The main thing to remember when selecting a doula is that you want to hire someone who will support whatever it is you want at all times rather than someone who has their own idea of how (your) birth should go. You want someone strong that can help you stay with your birth plan and communicate to the staff but that can also step back at the right time too. Hire someone that can help create a peaceful labor environment and provide the right words and comfort measures as needed. I always say trust your instinct. If in doubt don’t but at the same time if you find the ‘perfect’ person, go for it!

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Where My Advice Comes From

Posted on December 17, 2009. Filed under: doula | Tags: , , , |

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.

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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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OP (Sunny Side Up), Cervical Swelling and Slow Dilation

Posted on November 14, 2009. Filed under: AROM, doula, Epidural, occiput posterior, Premature urge to push, Swollen Cervix, Vaginal Tear | Tags: , , , , , |

OP (Sunny Side Up), Cervical Swelling and Slow Dilation…These are a few of the issues my last client had. With her permission, I want to talk about her birth. It’s actually a pretty amazing story. In addition to what I mentioned, she also had a 9lb baby with a very large head and managed to get out with only a 2nd degree tear.

So this client had been complaining of back pain for a couple of weeks. She works at a desk so I was worried that her posturing may have aided in her baby positioning himself OP (occiput posterior) or what some people call sunny side up or face up. When a baby is OP, the back of the head, which is the largest and hardest part of the head, digs into the moms back in utero. This sometimes causes chronic back pain. Some moms never feel any back pain at all when their baby is OP. I had talked with her about this and suggested that she do pelvic rocks daily and spend as much time as possible in the open knee chest position. Open knee chest is when mom puts her head and breasts on the floor and sticks her butt up in the air with her knees about hip width apart. Sounds easy but when you are very pregnant it is quite difficult.  I also suggested that she sit on a birth ball that was inflated enough so that her thighs where parallel to the floor in the hopes of relaxing her pelvic floor and encouraging baby to turn. She is quite tall and I don’t think she found the ball very comfortable. I also told her no reclining on the couch.  I feel as if I should have done more to encourage her to encourage the baby to turn but her back pain came and went and she didn’t feel fluttering indicating hands in the pelvic area and I couldn’t see her tummy (She was two hours away from me) to see if she had the dip in the stomach that OP babies often make.  I guess I didn’t want to freak her out with all the optimal fetal positioning techniques when in reality babies that are OP before labor almost always turn before labor or in labor.

This is a baby that is occiput anterior, the optimal fetal position for easier birth…

190px-Smellie_XIV

This is a picture of  an occiput posterior baby. Notice how the back of the head is in the mother’s back…

10929W

This woman, who we will call Alyssa,  began her labor at 4am the morning that she was 41 weeks and 3 days pregnant. At around 5am or so she began to have leaking that she believed was her water.  I joined her at 9:30am. The time line for her birth m my arrival goes as follows…

9:30am: I arrive
Contractions about five minutes apart, less than one minute long
You were breathing through them very well
10:00-10:30am: We walked, contractions started getting longer and more intense
10:30-11:30am: Complaining of back pain, we do pelvic tilts and open knee chest, I worry baby is OP
Breathing well through contractions but growing more intense with each one
You rest in bed for a few contractions
11:30am: Contractions are very intense. Still around 4-5 minutes apart, a minute long.
You are ready to go to the hospital
12:00pm: We arrive at hospital. Staff is busy. We walk for half an hour and take it one contraction at a time. Back pain is  intensifying and you are feeling a lot of pelvic pressure
1:00pm: You are admitted. You are 4cm and 100 effaced and your water is leaking. Baby is at a +1 station. You are monitored for half an hour and the baby looks great. You continue working through each contraction one at a time.
1:45pm: You are taken off the monitor and get into your labor room. Labor is very intense and you labor standing while leaning on the bed for an hour.
3:00pm: Labor is so intense and contractions are coming every three minutes for about a minute and a half. You have a lot of  pelvic and rectal pressure. You are a bit shaky and very hot. We put ice cold towels on you.
Because labor is so intense, the nurse figures you must be very progressed and asks if you want to be checked.
You are 8cm dilated. You are having urges to push.
4:30pm: Contractions continue at 3 minutes apart and about 2 minutes long. Your back pain is much worse as is the rectal  pressure. We try many positions to help complete your cervix. A check shows that you are stlil 8cm. Midwife breaks  your water and your cervix closes to a 5 or 6 and the baby retreats back to a zero station. We talk about the baby possibly being OP but she cannot confirm with exam. We spend the next hour trying to get the baby to turn.
5:30pm: The nurse checks and says you are 9cm with a lip. We spend half an hour getting you in positions to aid dilation.
6:00pm: Labor has become unbearable and you are having urges to push, your back pain is very intense. Midwife checks you and you are 6cm and your cervix is swollen. She again is almost certain the baby is OP. She offers and epidural and you accept. You also have a shot of Nubain to  hold you over until the epidural is placed.
7:00pm: Epidural is in place. You feel pain on one side for an hour or so.
8:30ishpm: You are 10cm
9:30ishpm: You begin pushing. The baby is at a +2/3 station when you being. After an hour is becomes clear that the baby is OP. It is also clear that he has a very large head. You push for another hour holding the squat bar and/or sheet tied to it  while his head molds.
11:30pm: Baby is coming down but getting hung up on the pelvic bone. You push flat on your back with your knees pulled far  back and   apart. He is able to descend past the pubic bone and begins to crown. The doctor uses baby shampoo as  lube and supports your perineum as you push the final few pushes before he is born.
just before
12:00am. Baby is born!!!! He comes out crying and looking around and after being checked out for a
few minutes is brought to you for skin to skin contact. You try to nurse immediately but he was interested just yet.
12:20am: Less than half an hour after being born, your baby is successfully nursing!!!
12:30am: The doctor is finished tending to you and leaves. You and dad bond with your baby.
1:30am: I leave

So the time line is a synopsis and not the birth story with all the details. What I’d like to include in that is that as her back pain intensified and the midwife agreed with me that the baby was probably OP, we began to get Alyssa into every position we could to get the baby to turn. The bed was broken down with the squat bar attached because when she was 8cm we tried to get her to sit on the bed with her legs on the lower portion with her upper body on the bar in a semi squat position in order to put pressure on the cervix to complete it. She didn’t like it because she had so much rectal pressure, so we took the bar off but left the bed broken down. Once the OP presentation because very obvious, we had her lower body on the bottom part of the bed with her upper body on the middle so that she was basically on her hands and knees.  We tried to apply counter pressure but Alyssa didn’t like it. She had not wanted very much massage or touch so we didn’t not try to relieve her back pain that way. She mostly responded to cold on her lower back.

Another point I’d like to talk about is that she was at 8cm for more than two hours before the midwife broke her water.  She had been in active labor for about 13 hours at that point and was ready for things to move along. By this point her labor had become all but unbearable.  I believe that the baby’s OP presentation was making labor much much more painful. She was already beginning to lose control during and even between contractions and I think that even though AROM (artificial rupture of membranes)  was not part of her birth plan, it really did sound like the best idea at the time.  Of course, once it was done and the midwife  felt her cervix close and the baby retract, she had this “OH SH!T” look on her face. And also of course, once it was done the contractions became even more intense.

I am not sure if the midwife breaking the water at 8cm is what caused the  chain of events that followed. If it would have broken on it’s own, the same thing could have happen. I had it happen with another OP baby client. Her bag ruptured spontaneously at 8cm and her cervix went back down to 7cm and the baby retracted from +1 to -1/0 station. I also think that after having been at 8cm for two hours with transition strength contractions after having labored all day, that Alyssa was running out of both steam and motivation, understandably.

The former OP client I mentioned who went from 8cm to 7cm took SIX FULL HOURS to get from 8cm to complete.  She had no option for an epidural as she was in a Korean hospital that did not offer them outside of business hours. The doctor was also performing c section so she didn’t have anyone offering to end the labor for her and her cervix wasn’t swelling either.  She managed and made it through it but it was incredibly difficult. I have no doubt that in that scenario that Alyssa could have continued her labor without an epidural.

What made Alyssa’s labor even more difficult was to spend two hours at 8cm with pushing urges, eventually get told she was 9cm and still have pushing urges and then learn that she was 6cm with a swollen cervix. I think that hearing this was incredibly difficult for her.  Maybe there were too many vaginal exams, maybe she didn’t have to know all of that was going on with her cervix but the fact is, she was pushing involuntarily even at only 6cm.

I have read that premature pushing does not always make a cervix swell and that her swelling was probably more the result of fetal positioning. It could also be a combination of the two, it’s hard to say. At any rate, with the intensity of pain she was feeling the midwife thought it best that Alyssa get an epidural to relax enough to be able to dilate. I was incredibly worried about this because it would be hard to get the baby to rotate with the epidural but I really do believe that at this point it was necessary. Her cervix wasn’t going to get a break and she was in too much pain to be able to invert her with open knee chest to pack the baby out of the pelvis some.

The midwife was right, the epidural helped and she dilated quickly. As the time line mentions, she pushed for nearly two and a half hours. The head was large and had a lot of molding at birth. He did get hung up under the pubic bone but the McRoberts maneuver, flat on back, knees far apart and up as possible dislodged him and within a few pushes he was out.

The most amazing part of this birth is that mom had only a second degree tear. OP babies are often associated with a higher incident of third and forth degree perineal tears and considering the size of this baby as well, I think this mom was incredibly lucky. I think that the fact that Alyssa had a successful vaginal delivery is a little bit of a miracle. We had THE BEST nurse on staff that day who helped me encourage Alyssa to move through her labor before she got the epidural. We had her doing a lot of things she didn’t want to do but she trusted us and we helped her and she did it.  All of these things helped, I really believe this. They helped her baby move down so that when she did get the epidural, labor continued to progress.  The support continued after the epidural in that we continued to help her move to help the baby move down.   The woman used a squat bar to push with an epidural, THAT is a feat in and of itself.  It took three of us (nurse, dad, me) to support her through it but she totally did it.

Here are some facts that I found regarding OP babies…

  • The incidence of persistent occiput posterior babies at delivery is about 5.5% overall

  • With a persistent posterior, both first and second stages are prolonged (Ponkey et al). However, longer second stages do not in themselves cause worse maternal or neonatal outcomes; in one study, as long as the fetus was stable, the second stage could continue without harm to mother or baby (Kuo et al).
  • The likelihood of cesarean section or instrumental delivery (forceps or vacuum extractor) is greater when there is a persistent posterior position; in fact, the 5.5% of persistent posteriors account for 12% of all cesarean deliveries performed for dystocia (Fitzpatrick et al).
  • Persistent posterior positions are associated with an increased incidence of premature rupture of the membranes, oxytocin induction and augmentation, epidural analgesia, chorioamnionitis, , episiotomies, severe perineal lacerations, vaginal lacerations, excessive blood loss, and postpartum infection (Pearl et al, Ponkey et al).
  • Worse, there is a sevenfold increase in the incidence of anal sphincter injury, that is, third- or fourth-degree perineal lacerations (Fitzpatrick et al). Babies delivered from the posterior position were more likely to have Erb’s Palsy and facial nerve palsy than those delivered from the anterior position (Pearl et al)
  • Occiput posterior babies often times cause a premature urge to push (pushing before 10 cm dilated)
  • Occiput posterior babies can cause cervical swelling due to the hardest part of the head bearing down unevenly on the cervix. Cervical swelling can cause a stall in dilation or not allow the baby to descend enough to be pushed out despite the mother’s best efforts.

This study also explains the implications of epidurals with OP babies…

Epidural Analgesia Linked to Increased Risk of Occiput- Posterior Babies
Lieberman, E., Davidson, K., Lee-Parritz, A., & Shearer, E. (2005). Changes in fetal position during labor and their association with epidural analgesia. Obstetrics & Gynecology, 105 (5, Part 1), 974-982. [Abstract]
Summary: This prospective cohort study used periodic ultrasound examinations during labor to evaluate changes in fetal position and their relationship with epidural analgesia. The researchers sought to determine whether epidural analgesia is responsible for higher rates of fetal malposition (occiput-posterior (OP) or occiput transverse (OT)) or whether women experiencing labor with a malpositioned baby have more painful labors and are therefore more likely to request epidural pain relief. A total of 1562 nulliparous, low-risk pregnant women were enrolled in the study.The researchers found that the position of the baby (occiput anterior (OA), OP or OT) at the time of enrollment (in the early part of active labor) predicted position at birth poorly. For instance, of the women with an OP baby at birth, only 31% had a baby in the OP position at the initial ultrasound scan. Similarly, sonograms done later in labor were also poor predictors of position at birth. The data demonstrated that changes in fetal position were common during labor, with 36% of participants having an OP baby at the time of at least one scan. More than one-half of the women who gave birth to a baby in the OP position never had an OP baby at any ultrasound assessment in labor. Overall, 79.8% of babies were born in the OA position, 8.1% were OT, and 12.2% were OP at birth.

Epidural analgesia was strongly associated with delivery from the OP position: 12.9% of women with epidurals gave birth to babies in the OP position versus 3.3% of women without epidurals (relative risk 4.0, 95% CI 1.5-10.5). Transverse position was not related to epidural use. In a statistical model that controlled for various medical and obstetric factors that could affect outcomes, epidural use was still associated with a 4-fold increase in the risk of OP birth.

The data suggest that the association between epidurals and OP babies is not because women in labor with an OP baby are more likely to request an epidural. Women who received epidurals were no more likely to have OP babies at prior to or at the time that the epidural was administered. Furthermore, women with OP babies in labor or at birth reported the same degree of pain as those with OA or OT babies and were no more likely to report “back labor,” which is commonly thought to be related to the OP position. Finally, women with OP or OT babies at birth were much more likely that those with babies in the OA position to give birth by cesarean section, with 6.3% of OA babies born by c-section versus 64.7% of OP and 73.8% of OT babies (p<.001).
Significance for Normal Birth: Epidural use increases the risk of instrumental (forceps or vacuum) delivery in first-time mothers. Experts have proposed various reasons for this association, including diminished urge to push and changes in the tone of the pelvic floor muscles that inhibit proper rotation of the fetal head. Letting the epidural “wear off” has been thought to increase the likelihood of unassisted vaginal birth, however, this systematic review calls into question that common practice.
In normal birth, there are complex hormonal shifts that help labor progress and facilitate delivery. The laboring woman produces natural endorphins that help her manage the pain of labor. Her ability to move freely and assume a variety of positions while pushing work in concert with these hormonal changes. Epidural analgesia numbs the sensations of birth, and the production of natural endorphins ceases as a result of the disruption of the hormonal feedback system. When the epidural is discontinued, the woman’s pain returns but her natural endorphins may remain diminished and therefore her pain may be greater than if the epidural had not been given in the first place. Furthermore, when an epidural is administered, the woman is usually confined to bed and attached to fetal monitors and an intravenous line. The woman and provider may become accustomed to laboring in the bed attached to machines. When the epidural is discontinued the restrictions! on her movement may persist. Under these conditions, it is likely that the impact of an epidural on normal birth may outlast the epidural itself.

Ann Tumblin also sent me this regarding OP (face up) babies. It was done by Penny Simkin who is basically the mother of all doulas. It is very informative so if you have ever had an OP baby and are nervous about it a second time, I highly recommend you taking a look at it.

I believe that Alyssa’s birth outcome was the combination of her determination and trust that we were supporting her in every way we could and we were. I was sore the next morning which isn’t saying much compared to how she felt but more of a testament to the work I was doing. We were incredibly lucky to have the staff that we had and  I also believe that if any piece of the puzzle had of been missing that her birth story would be very different. I think the point that I want to make about her birth is that if a mother is supported completely and if epidurals are not done too early that even very difficult births can have a great outcome. Mom is satisfied with her experience which is, other than healthy baby and mom, the best thing.

If you had an OP baby, please share your experience with us.

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Every Mama Needs A Doula!

Posted on July 1, 2009. Filed under: Birth, Breastfeeding, Cesarean, doula, Pregnancy, vbac | Tags: , , , , , , , |

I just realized that I am a doula and I write a blog about birth and I have never done a post on doulas!

A doula (doo-la) is a Greek word that means ‘woman who serves.’ A doula is a professionally trained woman who provides information, physical and emotional support before, during and immediately following birth. Women have attended birthing women for centuries in all cultures. Ancient hieroglyphics show women birthing with other women supporting them. It is only in modern times that we have begun to stray from this support with the medicalization of birth. The need for one on one support in labor is so crucial to the birthing woman’s perception of the birth experience and ability cope with birth. Women supported by a doula frequently report a significant decrease in the length of labor, the perception of pain and the need for anesthesia or analgesia as well as fewer cesarean sections.

I said this about doulas in a previous post

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

With a doula you can have up to*

• 50% reduction in the cesarean rate
• 25% shorter labor
• 60% reduction in epidural requests
• 40% reduction in oxytocin use
• 30% reduction in analgesia use
• 40% reduction in forceps delivery

*Information was obtained from Mothering the Mother: How a Doula Can Help You Have a Shorter Easier and Healthier Birth, Klaus, Kennell, and Klaus (1993).nc

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.

With every birth I attend, I believe more and more that no woman should birth without a doula and that every woman has the ability and probably should birth without drugs. I have not had a client get an epidural yet but I would completely support a woman if she chose to.

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