How did you react to and what were your feelings, words or thoughts after your baby was born (within the first one or two hours)?

Women have supported women throughout the ages.  In our very busy and ever transient culture, the woman to woman education and support of yesteryear is sorely lacking.  It is very common for an expecting woman not have family nearby or to have support women who know the ways of natural, normal pregnancy, labor, delivery and immediate postpartum. The labor doula was born out of this need.  Essentially this is a woman of knowledge and skill in pregnancy, birth, and immediate postpartum (yes there are a few men in who are labor doulas as well) who comes alongside a pregnant woman (family) offering education, physical support and emotional support to both the mother and partner/husband/other support.

Below is a detailed description of what a doula is and does according to CAPPA a wonderful organization that trains a variety of doulas and other birth professionals.

What is a Labor Doula?

A doula is a person who attends the birthing family before, during, and just after the birth of the baby. The certified doula is trained to deliver emotional support from home to hospital, ease the transition into the hospital environment, and be there through changing hospital shifts and alternating provider schedules. The doula serves as an advocate, labor coach, and information source to give the mother and her partner the added comfort of additional support throughout the entire labor. There are a variety of titles used by women offering these kinds of services such as “birth assistant,” “labor support specialist” and “doula”.

What Does a Doula Do?

The following is a general description of what you might expect from a CAPPA certified labor doula. Typically, doulas meet with the parents in the second or third trimester of the pregnancy to get acquainted and to learn about prior birth experiences and the history of this pregnancy. She may help you develop a birth plan, teach relaxation, visualization, and breathing skills useful for labor. Most importantly, the doula will provide comfort, support, and information about birth options.

A doula can help the woman to determine prelabor from true labor and early labor from active labor. At a point determined by the woman in labor, the doula will come to her and assist her by:

• Helping her to rest and relax
• Providing support for the woman’s partner
• Encouraging nutrition and fluids in early labor
• Assisting her in using a variety of helpful positions and comfort measures
• Constantly focus on the comfort of both the woman and her partner
• Helping the environment to be one in which the woman feels secure and confident
• Providing her with information on birth options

A doula works cooperatively with the health care team. In the event of a complication, a doula can be a great help in understanding what is happening and what options the family may have. The doula may also help with the initial breastfeeding and in preserving the privacy of the new family during the first hour after birth.

What does a doula cost? This can be a huge spectrum and is defined by where you live.  A labor doula may volunteer, work for barter, or basics like gas reimbursement, childcare coverage, snacks, etc.  I have heard of fees from $100 to $1800 (mind you this is in NYC).  On average I would say a labor doula costs $250-$600 in many areas.   Call around or visit websites in your area to get a firm idea.

What about insurance? Private doulas usually do not bill insurance though many will give a super bill to be submitted for reimbursement by insurance.  many insurance companies after some effort will pay a portion of the fee as an out of network provider.

Will a doula provide my complete childbirth education? Sometimes.  Often not.  Some doulas are educators. I provide classes separately from doula services. The labor doula will often fill in the blanks and personalize the education the client already has.  Many doulas have lending libraries or recommended reading and watching lists.

If I am going to a birth center or having a homebirth will a doula still benefit me? Yes in both cases.  When going to a birth center a doula would labor at home then arrive at the birth center at the same time as the laboring mother just as with a hospital birth.  In a homebirth scenario the doula who is not a midwife and does no medical tasks is often a welcome extra set of hands and does the same emotional and physical support as she would do in any other location.

Does evidence support that having a doula in attendance has benefits? YES. Here are some of the benefits. Lowered epidural, narcotic, induction, cesarean, and instrumental delivery rates. Increased satisfaction, breastfeeding, and bonding.  Also shorter labors!

For more information, email me at desirre@prepforbirth.com.

I have been invited to share with you an intimate and challenging (and graphic) journey of a mother from an unexpected primary cesarean, physician decided repeat cesarean and a home water birth after those two cesareans.

Before you watch it, take a deep breath and have an open mind. A box of tissues may be in order as well.

Cesarean vs. VBAC: A Dramatic Difference from Alexandra Orchard on Vimeo.

Watch how a baby is delivered in a cesarean birth and see the dramatic difference of what both the mother and baby experience in a home water birth after cesarean.

For more information on cesarean recovery, support, prevention and VBAC information go to www.ican-online.org.

Visit http://www.birthingtouch.com/ for upcoming childbirth classes serving the Colorado Springs area and for CAPPA childbirth educator trainings in Colorado, Missouri, and Utah.

• Proper support is important for childbirth – builds confidence in mom, builds safety in mom, lowers complications, interventions, medications and cesareans.
• Induction is only for medical reasons – big baby, past “due date”, tired of being pregnant, care provider preference, upcoming holidays… all put mom and baby at risk for complications, interventions and cesarean.
• Cesarean only for medical reasons – cord prolapse, placenta previa, pre-eclampsia or HELLP syndrome where induction fails, true fetal distress, some breech positions, placental abruption, uterine rupture (there are other less common reasons as well – notice previous cesarean, non-medical reason, large baby, gestational diabetes, obesity, convenience are not on the list)
• Unrestricted movement in labor –
• Pushing in gravity prone positions – only use reclined or lithotomy of mom desires it.
• No separation of mom and baby unless there is a complication.
• Drinking and eating in labor – the uterus is a muscle it needs to be watered and fed.
• Intermittent monitoring of mom and baby – only high risk moms and babies need continuous monitoring.
• No routine medications or interventions – pain management should not be pushed on a mother, episiotomies should not be routine, augmentation of labor should only be done AFTER non-medical methods are tried and patience is used, naturally occurring rupture of membranes, etc.
• Unrestricted breastfeeding access.
• Informed consent and refusal need to be utilized.

Check out http://www.cappa.net/, http://www.independentchildbirth.com/, http://www.lamaze.org/ for resources outside of Colorado Springs, CO (classes, doulas, other related professionals).

CHOOSING YOUR MIDWIFE: INTERVIEW QUESTIONS

· What is your birth philosophy?
· What is your training? Are you certified? If yes, with whom and why? If no, why not?
· Are you licensed in the state of _____?
· What is your scope of practice?
· When would you find it necessary to go outside your scope of practice?
· Are there any circumstances (physical, emotional, and/or spiritual) would you not take a woman as a patient?
· When would you risk out a patient?
· What is your style of practice (laid back, hands on, managing)?
· How much time will be spent with me during each appointment? Do you come to my home or do I come to your office?
· At what intervals will you see me during pregnancy?
· What can I expect at a prenatal visit?
· What routine tests are utilized during pregnancy? What if I decline these tests?
· What routine herbs or supplements do you like your patients taking during pregnancy?
· At what point in labor do you normally arrive?
· What positions are you comfortable catching in? Birth stool? Hand/Knees? Squatting? Standing? Water?
· What do you do in the event a complication arises during labor or birth? When would you transfer a patient?
· Do you ever do episiotomies? If yes, when, why and how often?
· How are post-dates (post-42 weeks) handled in your practice?
· Do you ever encourage induction by pharmaceutical, herbal, AROM or other natural means? If yes, please describe.
· Do you have a partner or an assistant?
· Who would attend me if you are ill, had an emergency or are at another birth?
· Briefly please describe the types of births you are most and least experienced with.
· What if I hire a doula? Are there restrictions on the doula I may hire? If yes, why? What is your perception of the role of a doula at a homebirth?

Points to ponder afterward:

· Did you feel immediately comfortable and heard at the interview?
· Was MW willing to answer questions in detail without being annoyed?
· Are you comfortable with her scope of practice?
· Are her expectations of you reasonable?
· Are your expectations of her reasonable?
· Are you able to take full responsibility for your decisions with this midwife?

All Rights Reserved Desirre Andrews Birthing Touch 2008