Preparing For Birth

With the majority of women heading to the hospital to birth their babies, planning for the impending birth has become an important aspect of preparation in the United States (though the percentage of out of hospital births is rising).  Standardized, highly medicalized, non-individualized perinatal and postpartum care has really led the way to this being a need. Sadly for most women, attaining evidence-based and individualized patient care going into the hospital environment is not often simple or accessible even with a well thought out, communicated, and researched plan.

In light of the care women are likely to come across for themselves and their babies, below is a list of the common information that needs to be addressed during pregnancy for labor and birth  (for a comprehensive pdf, please email me at desirre@prepforbirth.com):

• What level of care is needed – low-risk (the most common) or high risk
• Eating and Drinking Orally
• Saline-Lock, running IV or Neither
• Fetal Monitoring – continuous or intermittent
• Pain Management Options
• In the event of Labor Induction
• In the event of Labor Augmentation
• Pushing and Delivery Options
• Cord Clamping Options
• Immediate Postpartum Baby Care, Assessments, Interventions & Treatments
• Immediate Postpartum Mother Care, Assessments, Interventions & Treatments
• In the event of a Cesarean
• Infant Feeding Options
• In the event of Mother/Baby Separation or NICU Stay

Once the information is gathered women are often urged to write it all down in document format.  The most recognizable term is Birth Plan. The very word plan though can be a stumbling block for both mothers and staffers alike.  It can come across hard line and lacking flexibility. Unfortunately, this can be construed by a staffer or care provider that a woman is telling them how to do their jobs or that she has very set even unrealistic expectations. Don’t kill the messenger here, that is really how it can be looked at and thought of by the medical professionals receiving it. I am not saying it is the “right” thinking.

The idea that the term “Birth Plan” may very well be outdated is intriguing to me.  Upon research, I have indeed found so many other ways to name this document.  I highly encourage a pregnant woman to try many different titles on for size to see what best suits her communication style and personality.

A birth plan by any other name list (please send me any other titles to add that are missing):

• Birth Preferences
• Birth Map
• Birth Dreams
• Birth Vision
• Birth Wishes
• Birth Needs
• Birth Desires
• Birth Wants

Be aware that whatever the document is called, it should be no more than a single page that speaks to the current practice culture in any given area. For example, if Cytotec (misoprostol) is never used for ripening, then saying it isn’t to be used is moot and can negate the other portions of the document to the reader because the reader may think the writer is out of touch with what goes on. Do the research on the birth location practices and protocols along with the care providers standing orders so the details are up-to-date.

By no means though should cookie-cutter care be what defines a woman’s options, desires or needs for her written “Birth Plan”.  Always discuss with care provider ahead of time. If a provider uses responses like, “You can try that but…”, “Just get the epidural because….”, “Why would you want to do that?”, “Having a natural birth doesn’t make you a hero.”, or anything similar, these are giant red flags. This could be the first insight that a woman and her provider do not share the same philosophy or idea of expected care. Red flag responses may very well be leading to a serious compromise to the provider’s desires no matter what is agreed to. Well crafted and designed lip service is how I see it. Please listen intently to the answers to questions.

Writing a “Birth Plan” is a valuable and pretty necessary undertaking when birthing in the hospital in my opinion and experience.

As a last thought, a “Birth Plan” document is not legal, but rather a communication tool and values clarification vehicle for a woman, her provider and the staff she will come in contact with.

I am looking for some short video clips or pictures of pairs (couples or labor support pairing) to use in my in progress on-line childbirth class series.

General, activities or positions needed:

• Birth ball use
• Knee-chest
• Squatting
• Hands and knees (modified and traditional)
• Belly lift
• Rebozo use
• Slow dancing
• Labor walking
• Swaying
• Leaning
• Birth stool
• Side-lying
• Advanced sims
• Hip squeeze
• Sacral pressure
• Knee press
• Tailor sitting
• Pressure massage
• The dangle
• Laboring outside
• Laboring in tub, shower or birthing pool
• Variety of pushing positions
• Crowning or birth
• Delayed cord clamping
• Cutting the cord
• Assessments on mom
• With IV
• Being monitored either electronically, handheld doppler or fetascope

Please email to desirre@prepforbirth.com by April 30th for a release form and item(s) to submit including name, date of labor and birth and any other pertinent information.

Thank you so much for participating,

Desirre Andrews

Women often ask me what does pushing feel like. As an educator and doula it is probably one of the more challenging concepts to address.

Some of the imagery can be quite vulgar.  “Push like you are pooping.” Do women REALLY want the image of pooping out their babies?! Or the imagery puts pushing in a neat box. “The urge will overwhelm you and you cannot help it.” “You will just know.” Those do not adequately speak to what can occur. Some women get no urge to bear down until the baby is very low and engages the nerves. Others will have the urge when baby is high and dilation isn’t complete. Still other women do not get an intense urge at all regardless of pain management or natural birth.

For that matter, great rectal pressure may be felt, intensely abdominal use, incredible pelvic pressure may be experienced,  or frankly not much at all can be felt.

I believe whatever a woman’s body does is right for her birth and her baby.

Below are many quotes that others openly offered to help women everywhere have a deeper understanding of what pushing is like.

Quotes from real women

“My babies #1-4 practically fell out. #5 I was in what looked like early labor for 4 days. Midwife assistant came over, checked me, I was at 7 cm but ‘not in active labor’. I got into it quickly! Long story short I pushed, painfully, for 3.5 hours, baby had 11″ cord with a true knot. She needed to be pinked up but is almost 3 and is doing well.”

“When I was coached to push (w/ no 3..first natural birth) I was in agony. When I was left alone and did not push (w/ no 4), life was good.”

“I feel like if I can just get to the pushing phase, it will be a breeze from there.” (and it was. The whole “surrender/dilate” phase is much more challenging to me than the whole “take control/pushing” phase.)”

“Pushing was fantastic with my 2nd baby and awful with my 3rd! It was really surprising because after my 2nd birth I thought “Okay so pushing is the really fun and satisfying part! That’s when it gets EASY.” Then my third birth totally shocked me. Pushing was the most painful and difficult part of the birth. I had stayed so calm and collected… until then. Every pregnancy and birth is so different!”

“I love the way it feels to have a baby move through me and into my waiting hands.”

“The mirror really gave me focus and helped me push very effectively when I inspired by seeing a peek of baby head.”

“I *loved* pushing. I didn’t do it for very long (two contractions), but it was so great to finally get there. I was told to purple push (not in those terms – the nurse told me to hold my breath), and intellectually I knew I shouldn’t, but I tried it and it really did feel like I was more productive that way. I felt like a warrior. It was awesome.”

“Before anyone hates me for only pushing through two contractions, you should know that I’d been in labor for three days – so it all comes out in the wash ”

“Pushing with my 2nd was horrible. 3+ hours of the worst pain I had experienced at that point in my life. Turns out her little fist was up by her cheek (um ouch) and her head did not mold much. My 3rd I did not push because she was precipitous and we were trying to get to the hospital. I felt like all the energy in the world was gathering and swirling at my fundus and then suddenly flowed through me carrying her with it. It was the best physical experience of my life.”

“I have heard some say that pushing feels good.. um, I personally have not experienced that and I have had clients remark the same … :p”

“Hmm…Definitely the best part of labor and delivery. For me though – never had any “urge” to push but still had baby out in 20 mins…I think I was feeling determined being a VBAC mom…still, would have been easier if I felt the need to and not just contractions. “

“Heard lots of clients say it feels good after hours of labor”

“Difficult. I had an urge to push “early” every time. Once I got to the “ring of fire” it was awesome though.  I knew I almost was there.”

“Ahhh, I’m not so fond of the pushing. Did it for 2 1/2 hours with my daughter (LOA) and though it was only about 20 minutes with my boys, they were both OP. That was, shall we say, unpleasant. I cannot relate to those who’ve told me it was such a relief!”

“My labor was surprisingly short, only 6 hours and she’s my first baby so far. I woke up in active labor and at 4 cm and I wanted to push THE WHOLE TIME! It was horrible having the nurse say I couldn’t push yet when I wanted to so badly, but once I did get to push, oh my goodness, it felt incredible. So much control and power, it felt so good to finally work to end. 3 big pushes and there she was. ”

“Sheer, immeasurable power. Unbelievable!”

“Babies actually come out of your butt. Don’t let anyone tell you otherwise.” One of my clients recently said that. ”

“Birth is shockingly rectal” – Gretchen Humphries. She was totally right.”

“Pushing with my first felt like I was satisfying an urge, an uncontrollable urge. It felt almost desperate I couldn’t stop it. (kinda like having that rectal urge when you REALLY have to poop). Pushing with my second was no big deal, I followed my urges again and pushed 3x and out she came in her 10# glory. It was extremely satisfying and powerful I felt like I had just finished exercising. Amazing!”

“The ring of fire OH MY it is indeed! Though as soon as the burn started the whole are went numb almost like too hot or too cold numb and the power of the urge to push my son out was almost beyond description.  Pushing was never easy for me as I have an unusual pelvic shape.  But my last son WOW no molding and quite a large head to birth him was incredible really.  No tearing, just some abrasion.  Recovery was a snap.”

“I had at the point of delivery what was the best orgasm of my life!”

“Pushing was totally primal.  I had an incredible urge and it took over.”

“The pressure of the baby entering deep into my pelvis and vagina was wild and almost overwhelming.”

“Feeling my baby when he was partially inside and partially outside of my body was a euphoric and surreal moment. The hour of pushing was well worth it.”

Bottom line – you and your baby are unique. You work together during all parts of labor including pushing through to delivery. Be confident. Use your intuition. Follow what your body desires to do.

Questions and Answers

1. I have had a previous episiotomy, do I need another one automatically? No you don’t.  Depending on how your scar has set and the position you push in the scar can re-open or it adhesions in the scar will need to be broken up.  I would suggest perineal massage prenatally if there are any adhesions to break them up and soften the area prior and to choose a pushing position that doesn’t put all the tension on that exact area.
2. Is is wrong to push when I am not fully dilated? Not necessarily.  Now I think grunty smaller pushes with those contractions can be effective to complete dilation if you are in transition.  Prior to that change the position you are laboring in to change where baby is placing pressure.  Knee chest can be very effective to abate very early pushing desire.
3. What if I poop during pushing? Some women will pass some stool and some won’t.  An open bottom is vital to pushing, so it is a normal but not always occurence.  A fantastic nurse, MW or doc will not actually wipe it away but simply cover as to not cause constriction of the sphincter muscles which can disturb the pushing progress. If it is possible to discard the stool without disrupting you, it will be done very quietly, quickly and discreetly.
4. I am very modest, do I have to have all my “glory” showing? Absolutely not.  You can maintain good modesty all the way up to delivery.  Even then you do not need to be fully exposed.  Truthfully a home birth or birth center birth with a midwife if likely going to help you have your modesty concerns respected and honored. Really no one needs to put hands in you during pushing, needs to stretch anything, or needs to see everything either.  A midwife is trained to see by taking a quick peek or simply to know when she needs to have hands ready to receive baby and to offer external positive pressure if mom wants.
5. Is there a “right” position to push in? There IS a right position for you, your baby and your pelvis. The only way to know is to try a variety of positions, pushing spontaneously and listening to your body.  Generally the lithotomy or semi-reclined position disallows the tail bone to move up and out to create more space. Side-lying, squatting, leaning in a mild squat, hands and knees, hands and knees with a lunge, and even McRoberts can be excellent to open a pelvis to a large degree. Pay attention and go for what feels right.

This is a personal post written 10 years to the day of my third son being born. I was also birthed that day into my fullness of voice as a woman and as a full throated advocate for mothers and babies.  You see my son was a CBAC (cesarean birth after cesarean) after a failed natural VBAC (vaginal birth after cesarean).

I had a VBAC with my second son, though by other peoples standards might not be said to be wonderful because at the very end of a totally natural, spontaneous labor after arriving at the hospital at 9cm’s with waters having broken on the way in the car,  forceps were used by an impatient on call doc after merely an hour of pushing. I was thrilled though it was ultimately less than ideal with a baby overnight in the NICU. I was not broken. An impatient doc who gave me an awful episiotomy could not take it away from me. But I digress. We can talk heinous episiotomy at another time.

Of course when I became pregnant with my third some 14 months later I assumed of course I would have another VBAC this time with no forceps. Of course I didn’t have to think about another cesarean I already disproved the need. There is a piece  of information that I was missing though………

My pregnancy goes well. I am terrifically healthy though more fluffy than I should have been. You see  my dear husband was laid off during pregnancy and well, I clearly didn’t exercise and eat properly the second half of the pregnancy.  A very dear friend and her children were flying in from out of state near my due date.  She arrived and I was contracting already. I must have been waiting for her to arrive to round out the support team.  She has clinical skills so I ask her to check me and allow her to sweep my membranes (okay stop groaning at me I was already in the beginnings of early labor). I was a few centimeters dilated and well effaced. She wasn’t sure of baby position though.

The membrane sweeping helped move labor along. I was 5 centimeters before very much time once contractions became nicely regular. My husband had gotten a job two weeks prior and was scheduled for work so off he went though I knew I would be calling him before too long. Sure enough contractions picked up very nicely and I could no longer tend to any of the children.  I decided to call my husband home.

Around this time I was about 6 cm’s dilated… good news right? WRONG! I also began having severe back labor. I had this with my first and he had an acynclitic head ending in cesarean after 4 hours of pushing. After my husband got home it was so much worse. You see I am a natural birther but this caused a panic stricken heart. I really freaked out. Not from the pain, but thinking OH no not another cesarean. How could this be happening? I was screaming inside my head. Sheer terror actually. I had not prepared at all for a malpositioned baby – I mean I had gotten him to turn vertex at 37 weeks from frank breech on my own. OP how could this be? In my panic I insisted that we go to the hospital though my dear friend and husband thought we should stay home longer. I was about 7 cm’s at this time. My friend now suspected an OP baby but didn’t tell me. Why did they not insist we stay home? I mean I was in no condition to drive myself the 15 minutes to the hospital. I don’t know.

We arrive at the hospital, I am indeed about 7 cm’s and yes baby is OP. No one worries though that I am a VBAC again. Basic monitoring, no saline lock, all is well in l&d land (so it would seem). In my head I am still in sheer terror though from the outside apparently it was not visible. That is still tough for me to comprehend. I was screaming through my eyeballs but I made no noise at all from what I am told.

I tried many positions to get him to turn, and probably would have but……..

At some point during a vaginal exam, my water was broken without my consent. This my dear readers is what caused the downhill slide to a repeat unexpected cesarean. I have since learned I have an android pelvis and without intact waters rotating a poorly positioned baby is near impossible if possible at all.  Back to the story.

I cannot say how much time went on for sure, a couple of hours I believe. Somehow in this room filled with two nurses, my dear friend and husband, a complete breakdown of emotional care took place. I felt totally and utterly unsafe, scared, terrified, and without hope. My husband too was overwhelmed and felt displaced in the situation though he admits he allowed it to occur. I did blame him and to some degree my dear friend in the beginning, but I do not now. I didn’t prepare well. I assumed. I didn’t define the roles of support between my husband and dear friend. I was a Pollyanna.

I was now complete and still trying everything possible to get baby to rotate. Nothing worked. I was desperate. By the way, I was unmedicated and only on intermittent monitoring for most of the time. So cannot blame the epidural or being strapped down.

I pushed for over three and a half hours in varying positions. During pushing (I am pretty sure of timing) an internal monitor was put on my son and a scalp sample was taken to check his stress level. Oh, the SAME on call doc that was impatient and used forceps on me during the last birth was my attending. That very much did not make for a safer, happier birth space.  At the end of the hours of pushing, she again pulled out forceps to see if she could rotate him or help me deliver him, but my dear friend discouraged it highly since he was still higher up (forgive me the station escapes me without my records in front of me).   I was then told the scalp sample came back showing my baby was becoming acidodic, which means he was getting very stressed. His FHT’s were fluctuating quite a bit as well.

At this point I could hardly keep my eyes open. I was in despair, heart broken, and becoming very angry. The doctor presented me with a cesarean consent form. I refused to sign it. I said I wouldn’t sign it but my husband had a power of attorney. I made him do it. I could not do it. I could not agree to another cesarean. Somehow having my husband sign it helped me face it better. Perhaps because then it was out of my control.

So another cesarean for a “stuck” and this time fetal distressed baby. So I was told. I was taken to the OR where the anesthesiologist would eventually place the epidural. I begged and begged and begged for a dose of terbutalin to slow the contractions as I still had the uncontrollable urge to push.  He essentially told me I was being a baby. To man up. He would get my epidural in soon enough. He was mean. He was verbally hostile. In between intense contractions, I actually thought over and over as I sat on the metal table with feet dangling of how I could take a swing at him without falling and hurting my son. I wanted to make this anesthesiologist feel pain. Punching him in his condescending, smug face would have been extraordinarily satisfying. I was so angry at how I was being treated. I will never know if he was punishing me for being a natural birther or a failed VBAC mother.  Maybe both.  He still is in practice and no I cannot be in the room if a client of mine gets an epidural with him as the anesthesiologist. My response is still visceral to his mere presence.

It seemed like a very long interval of time before the I.V was put in, the epidural was placed, the OR team was fully assembled and my husband was at my side. After reading my records it was a long interval. My husband signed the consent form and my son was not surgically born until more than 45 minutes later. Was he REALLY fetal distressed with that long of a wait in between? 45 minutes when the OR was open and available? I was IN there with the anesthesiologist the whole time. That is not an emergency or even emergent. Plainly he wasn’t coming. Yes he was OP.

I was laying on the table, armed strapped down, husband standing next to me watching the cesarean take place. I have no memory of what the epidural felt like. My eyes were closed out of exhaustion, grief and anger. My son was delivered at 535am.  His APGAR’s were decent not that of a highly distressed baby. I wonder if during the long wait and the rest period, he normalized. I may have been crying but not for the good reasons. My son was waved by my face. I do not remember seeing him. My husband was heading to the nursery with him. I screamed after him at the nurse, “If you give my baby formula, I will sue you.” It seems the woman who wouldn’t send back a wrong order at a restaurant was forever changed. Like a light switch my voice was established.

While I was being repaired. I decide to talk to the doctor (at this point I had no idea she broke my water without consent and had falsified my medical records in a few areas), so I tell her I want another baby. I then asked her if my uterus was good for another VBAC. She said sure you can have another VBAC if you want. No problem. My uterus looked beautiful. Wow, I should have felt wonderful that I am such an amazing healer from previous surgery.  I didn’t. Sigh. I wanted to die except my baby would want to nurse. Oh yes, my baby J.

Once out of recovery and into my room my husband came and gave me report on J. He was being observed, seemed very well. No they didn’t feed him anything. M had to go home and check on our other children who were just 4 and 23 months.  He swapped off with my dear friend who had gone to check on her children. I still hadn’t held my baby. I had no idea what he looked like. I was distraught but no one knew it. I would make a heckuva poker player I think.

Five hours post op and I want my baby. I want him NOW. He must be hungry. He must be wondering where I was.  The thoughts ran through my head. I called my nurse and asked her to bring me my son or take me to the nursery to feed him. She said no to both requests stating various reasons. This did not suit the new me at all. I asked her again. She again said no.  This did go on for a few minutes where we were actually raising our voices back and forth. Finally I noticed the wheel chair by the door, I looked the nurse in the eye (who by the way was no more than 6 inches from my face), and I said “Fine you want me to get up and walk across the room to the wheel chair then you will take me?” She said, “Yes” in a non-believing tone. HM she didn’t know me at all. THAT my dear readers was a dare in her voice. I called her bluff. I took a deep breath, held my belly, stood up and walked right over to the wheel chair on my own.  Needless to say she took me to the nursery to see my son.

My voice was completely in full bloom. Never to go back.

As she wheeled me around my son’s bassinet I grabbed his chart much to everyone’s dismay and horror. Why were they worried, well they had performed several tests, admitted him to the nursery for a minimum of 24 hours, started I.V. antibiotics and put in a central line ALL without consent. All done under implied consent which does not exist once the cord is severed and baby is his own patient. I thoroughly read his chart (no reasons given for the battery of tests), made certain they hadn’t him or given him I.V. fluids to curb his hunger, then I held my precious, sad little boy. Almost 8 pounds. Gorgeous. Very hungry. He nursed beautifully. I was elated and even more stricken. I stayed with him until he fell asleep then instructed them to call me at ANY sign of hunger.

I went back to my room and within another hour I was walking myself back and forth alone to the nursery. They had to ask me to come back for vitals to be taken and implored me to rest. He was MY baby not theirs. Mine to care for, nurse, be with….. Sigh.

When evening rounds took place the I asked the pediatrician to come to my room so we could discuss getting my son out of the nursery and into my room. He went through his whole chart with me and told me exactly what needed to happen for him to be released at 7 a.m.  Yes I noted it all.  He wrote it in the chart everything he told me.

During one of my evening trips to the nursery, the truly decent and kind night nurse informed me that my son never needed to be admitted to the nursery and she was better equipped to take care of in need babies. My son was fine. She said sure he needed to be observed for an hour or two but never should the tests been done or a central line placed for that matter. She encouraged me to stay as long as I wanted but it was good for me to go and sleep to heal best too.

In the morning I was there before the floor pediatrician was doing rounds. You probably guessed it, my son was in my room by 8 a.m. I can be very persuasive. The funny part about the scenario was that immediately when the doctor walked away the nurse implored me to help her get all the leads off and my son unhooked from everything quickly. Why? Because she had never seen a doctor release a baby like that and feared the doc would change her mind.

I finally had my son with me. Finally. I was hurting physically. I didn’t rest enough. I was his mother after all, that is what we do. Had I not done exactly what I had he would have still been in the nursery and breastfeeding could have been a disaster. More ibuprofen please. I do not even remember my husband bringing the other boys to the hospital. I do not remember anything but advocating for me and my son.

By 48 hours post cesarean I was desperate to go home. As I put it not so delicately to the doctor who didn’t want to release me so early after surgery, “I can sit on my own damn couch and I have better cable than you do here.” Seriously the full throated voice was speaking. Yes, she released me though against medical advice. I assured her I knew what infection looked like and I would be back if I needed to be.

My husband was there shortly thereafter with car seat and our other sons in tow. I was traumatized and shell shocked BUT I had well spoken up for the two of us when all was said and done.

Just like the Grinch who’s heart grew in size, I powerfully came into my own as a woman, as a mother and as an advocate.  For this and this alone I am tearfully grateful for my CBAC and though much was lost so very much more was gained.

I am very excited to announce the addition of  Lori Welch, BS, CCCE to the Preparing For Birth teaching team. She is a CAPPA Certified Childbirth Educator and also Lamaze trained. She has experienced both hospital and home births herself.  She has a deep calling for assisting others in their pregnancy, birth and early parenting journeys.

Beginning in May 2010, she will begin teaching and overseeing the bulk of  PFB group classes.

Class registration will remain the same. Her contact information will be lori@prepforbirth.com.

I look forward to working alongside her and expanding the available offerings for birthing families.

Building a labor support team is a vital piece of conscious preparation during pregnancy in preparation for birth and life with the very newborn. Today as part of that support team many women are opting to hire a labor doula to come alongside them at the end of pregnancy through labor and delivery with some additional early postpartum follow-up.  For additional after birth support, a postpartum doula can be hired.

Step 1: Finding a Doula

• Inquire with friends, family, local support/informational groups (for example – ICAN, LLLI, Birth Network, Birth Circle), childbirth educators, care providers, prenatal massage therapists, prenatal exercise instructors, lactation experts and chiropractors for referrals.
• Use your favorite search engine and type in your city or area name with the keyword doula
• Search training and certifying organizations such as CAPPA, DONA, ICEA,  ALACE and CBI
• Search general doula sites such as All Doulas, Doulas.com, About.com or Doula.com

Step 2: First Contact

Once you have located local area doulas, the next step is a visit to make contact. You will likely find that most doulas are women though occasionally you will find a male doula in your area.  After visiting any applicable websites, phone or email only the doulas that most interest you and fit your particular needs.  Generally there is not much need to contact more than three perspective doulas.

During your phone conversation or in your email be sure to include:

• Full name
• Contact information
• Estimated Due Date
• General location where you live
• Care Provider
• Birth Location
• Top needs and desires for birth
• If referred, by whom
• Any financial considerations

Step 3:  Setting up the Interview

I encourage an initial interview via phone prior to meeting in person to get more of an idea for compatibility that email alone cannot offer.

• Unless the doula has an office, interviews are done in a public place such as a coffee house, restaurant, library, park, or shopping center. If you meet at a place where beverages or food will be ordered you can offer to pick up the tab for everyone if you desire, but it is not expected.
• Your partner, husband or other support who will be attending the birth needs to be at in-person interview.
• Expect the interview to be approximately an hour and to be free of charge.

Step 4: The Interview

The interview is to gain more detailed information from the doula, as well as, share more detailed information about yourself and what you want.  It is customary for the doula to bring a client packet with her that may include her professional background, client agreement, services, and support details and offerings.

Suggested Interview Questions:

• Why are you a doula?
• What is your philosophy of childbirth?
• Where did you get your training?
• Are you certified? Why or why not?
• How long have you been a doula?
• What is your scope of practice?
• What types of births have you participated in?
• What types of birth locations have you been to?
• How many births per month on average do you attend?
• How many clients would max you out in a month?
• Have you ever missed a birth? Please explain why.
• Do you specialize in working with a specific type of clientele or birth plan?
• What has been the most challenging birth you have attended? Why?
• How do you work with my husband/partner/other support?
• Have you worked with my provider before? If yes, please describe the experience.
• How many prenatal visits would there be?
• In general, what is covered in the prenatal visits?
• Will you help me make a birth plan?
• Please explain how your fee is structured.
• Do you have a back-up and do I meet her ahead of time?
• When do you go on-call?
• Do you labor at home with me?
• What do you do if I am induced or need to schedule a cesarean?
• When will you see me postpartum and what does it include?
• What are your expectations of me as a client?
• How long do I have to decide before you would contract with someone else around my EDD?

Of course that is a fairly long list of overview questions. Brainstorm some of your own. The interview is not meant to be a free prenatal visit, it is simply to find out if you and the doula are a fit personality wise and in how she practices.  Most doulas do not expect to be hired on the spot. You  need time to think over all the interviews before making a decision. If a doula is pressuring you to hire on the spot, that could be a red flag.

Step 5: Hiring the Doula

When you make your decision, please also contact those you are not choosing as well to let them know you have hired someone else so they will not be holding your EDD space open any longer.

Details to be clear about when initially hiring your doula:

• Sign and return the agreement/contract she gave you at the interview (if applicable).
• Payment  – First portion of fee is usually paid upon hiring a doula.
• Ask her usual business hours and contact preference for non-emergencies or labor related needs.
• Let her know your contact preferences and all phone numbers to reach you and your spouse/partner or other support.
• Set the date and time for the first prenatal appointment. Give her directions if your home is not easy to find.

Congratulations!

In westernized countries, television and the internet have almost completely replaced the generational teaching and learning found in the “circles” of the past. Women would gather over sewing, quilting, canning, and life events including pregnancy and childbirth. They offered support, told their stories, spoke of family life, shared their everyday knowledge, wisdom and expertise while the children played at their feet.

At first glance it seems that through these technologies women are able to gain vast amounts of incredible knowledge regarding childbirth.  There are very popular websites, message boards and forums to meet and greet other women who are expecting the very same month.  Any topic is available to explore. Excellent places for a sense of community and belonging. The information is so prevalent that some women even eschew childbirth classes because they feel well enough prepared from all the exposure. Fantastic to be sure, at first glance.

Upon a deeper look  with a critical eye at the most popular shows and on-line communities, it becomes pretty obvious that overwhelmingly the messages and scenes actually have little to do with real encouragement and instilling confidence in a woman’s design and inherent ability to birth.

Let’s start with the satellite/cable television shows on the learning and health channels. Stop for a moment and think of what occurred during the last episode you viewed.  Did you see a spontaneous labor from entry to hospital to birth without augmentation, epidural, or any other intervention except for intermittent monitoring and perhaps a saline lock (IV port) placed? Was it an induction with an epidural? Was it a cesarean or a vaginal delivery? Did she have adequate support? Was her background given in any detail? Who made the decisions? What about informed consent? Was the laboring woman paid attention too or were the machines heeded more? What sort of comfort measures did she employ? Was she ever out of bed? Who delivered the baby?  What response to her baby did the mother have? Who saw her baby first? With that clear memory in mind, how did you feel after viewing it? What thoughts came to your mind? Now consider that essentially all of the births shown take place in a hospital. In fact any birth that does not, is often touted as extreme or some other like descriptive.

Let’s move on for a moment.

Now let’s take a look at the most popular pregnancy websites, message boards and forums where women connect with one another.  The “conversations” and threads are filled with all things related to the impending birth. Chatter about baby showers, maternity leave, body changes, vaccinations, previous experiences, breastfeeding, nursery preparations and so much more. Really anything under the prenatal sun. Inspecting further though, there seems to be an inordinate amount of discussion regarding the need for scheduled inductions and cesareans and very little conversation or even support for natural or spontaneous labor and birth.

With intervention appearing to be the ruling majority within the technological communities and filling the television, how is a pregnant woman feeding her eyes, heart, and mind on this type of diet supposed to feel confident, uplifted and excited about her upcoming birth? I am uncertain that she can with the seeds of inadequacy, fear, brokenness, helplessness, and lack of options being sewn into her being at such an alarming ratio.  Sometimes yes interventions are needed, however, in practice it isn’t a need for many women and babies.

These shows and internet locales are like junk food. Like all junk food they are not to be an integral part of a healthy prenatal “diet” that will be encouraging, expand useful knowledge, grow confidence, spark self-advocacy, promote self-awareness, ignite excitement, and offer joy to the expecting mother.

How can an expecting mother improve her “diet” regardless of the type of birth she is planning? What are the better places to “shop”?

• Turning off the TV
• Check out and attend local groups and support meetings. Educational sessions and workshops are often free of charge. For example: Doula Groups, ICAN, Midwifery Groups, Birth Network, Birth Circles, and similar.
• Try some different message boards, forums and sites. See Blog Roll and Resources listed on this site.
• Seek out positive free videos to watch on You Tube.  http://prepforbirth.com/2009/07/30/birth-videos/
• Talk to women who have birthed in the hospital, birth center and at home. Get a variety of positive stories.
• Try some different reading on for size. http://prepforbirth.com/books-videos-and-more/
• Rent or borrow movies from Netflix, a doula or childbirth educator, such as, Business of Being Born, Pregnant in America, or Orgasmic Birth to name a few.
• Take the challenge to learn about and be open to the variety of birthing techniques, locations, options and provider types that women are utilizing.

Bottom line, the most prevalent “food group” in a diet is going to positively or negatively affect the parts and the whole of the journey to having a babe in arms.  No matter what the mother and baby live with the outcomes from the birth. Enriching the prenatal “diet” is not a guarantee of outcome or path to the birth. It does however give much more possibility and opportunity for both mother and baby to have a better birth and start together.

This is my Valentine to you all my “sisters”.  We are in this together, weaving the past, present, and future through who we are and what we do.  I ache for us women to encircle each other, grow each other and be real with each other.  Be blessed.

Sister never be satisfied with just living. Hiding. Being less. In the shadows.

Find your “it” and fly sister. Don’t fear being who you are intended to be. Shake off the layers others have put upon you. Peel off the veneer you have placed upon yourself. Soar Sister

You are a jewel worth polishing. Brilliant. Perfect. In the light.

Be you and fly sister. Adventurous and alive. Alive down into your soul. There is a splendor and beauty begging to be set free. To be seen. Soar Sister.

by Desirre Andrews

http://blog.ican-online.org/2010/02/07/mother-sized-activism-nbc/

The International Cesarean Awareness Network wants you to get involved and speak your mind about what you think of the NBC “Live in the OR” piece from last week. Here is the link to ICAN’s official response.

The only way that mass media will be responsible for what they put on the airwaves is for real people, the  consumers to speak their minds.  Please click on the above think and go for it. Be heard. It does make a difference.

There is much in the news and in community talk how women are signing up for cesareans electively. I am very intrigued by this assumption and believe there is much misinformation regarding the topic out in the public for consumption. I am seeking to shed some more light on this topic.

Though this is not a scientific survey, I believe your experiences can help others in understanding why women are making this choice, as well as, potentially aiding other women in informed decision making.

If you have had or are planning an “elective” cesarean, I appreciate you answering this informal survey.  Answers can be submitted via confidential email to desirre@prepforbirth.com. By responding you are agreeing to allow me to use the information anonymously in a future blog, writing or other educational medium.

1. Was your “elective cesarean for a medical reason?  If so, what?
2. Was your “elective” cesarean for a non-medical reason?  If so, what?
3. How were you given informed consent?
4. What information were you given in the cesarean consent for benefits, risks, consequences, and alternative for you and your baby?
5. Were any words such as: Easier, safer, painless, no big deal, not risky, saves vagina or less pain used to describe potential experience?
6. Were you told your cesarean was necessary and found out later it was coded as elective?
7. Did you ever feel pressured or led by care provider to choose cesarean?
8. After your cesarean, did you feel you were consented fully enough prior to the surgery?
9. Did the cesarean “do” or live up to what you were told for you and your baby?  How so?  How not?
10. Would you make the same choice again or would you “go for” a VBAC?
11. What country do you reside?

Thank you very much for answering these questions. I am so grateful for input on this subject.

If you would like any information shared and attributed to you as a quote,  please indicate in your email to me.  As stated above, otherwise your identity will be kept completely anonymous and confidential.