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.
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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.
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 )