Archive for the ‘normal birth’ Category

What is a labor doula? What does she (or he) do?

Sunday, August 9th, 2009

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.

Is pain in childbirth something to fear?

Thursday, August 6th, 2009

The most often fear I hear about is pain in childbirth.  It comes across as if the pain is some external force that is larger and badder than any other entity imaginable. I believe the dramatic cable channel birth shows, network tv shows, a very high epidural rate, and the rampant sharing of scary birth stories has done much to reframe what labor and delivery is today.  Though it started way back in our country about 100 years ago with the writings of Joseph DeLee who believed that women needed to be saved from birth.

Pair those with the idea that we are supposed to always feel perfect, never have an ounce of discomfort or pain in our lives (have you seen the Tylenol advertisement that quips “One more step to a pain free world”?), well it sets up an unreasonable expectation and core understanding that there is no way as a woman “I” can handle it and why should “I”?!

I shake my head that women can think we are SO fragile and cannot tolerate or thrive in such a thing as labor and delivery.  We can be fierce, strong, tender, loving, organizational, multi-tasking, boo-boo fixers, community builders, compassionate, change makers, history makers – let alone having the ability to grow a brand new person (even if in our hearts through adoption or other ways).  WOW we are amazing.

Women are all those things and much more.  Believe in the design, abilities, and intuitive nature.

Back to the pain.  So what if it hurts?  It may. It may not.  Sometimes the work of labor means discomfort or pain though it isn’t normally the sort of pain or discomfort that is alarming.  It is powerful.  It is the woman who is making the hormones required to start labor and keep it progressing.  A woman’s body is designed to offer up endorphins to match the increasing strength of the contractions along with oxytocin.  Her own body medications are powerful and can bring a strong degree of relief though they do not change the incredible power that each woman makes and experiences in labor.

Positioning movement can assist in rotating baby into a more comfortable and optimal position such as, pelvic rocks, lunges, swaying on birth ball, stair walking, curb walking, talking to baby, knee chest, advanced sims,  and a woman listening to her body to find the right movement.

Emotional pain need to be recognized and worked through in whatever way serves the laboring woman best.  Obtaining an epidural will usually not quash emotional pain and may increase it.  If fear creeps in, contractions can become painful.  Addressing the issue at hand, having support around you to, and making the space her own can help.

If at the hospital and there is something happening that is infringing on the mother’s rights or is antagonistic, she may want to consider asking for another nurse or doctor to come in and help the situation and/or seek out the patient advocate.

When it comes to physical pain or discomfort a variety of techniques can be employed. Some of these are – position changes, getting into tub or shower, hot and/or cold compresses, having a doula present, snacking and drinking in labor, refusing routine interventions, massage, visualization, vocalizations, prayer, meditation, relaxation, hypnotherapy, listening to music, soothing smells, visuals, and textures, having supportive people including care provider and using a birth ball.

If another woman shares an incredibly painful birth story, ask questions.  Was she induced? In bed the whole time? Lacking support? Lacking education? Poor baby position?  Augemented labor? Was she scared? Did she feel empowered? In a stressful environment?  Questions that will help understand where the pain came from.

Women can do ANYTHING for a minute at a time culminating in hours after the many months of growing and nourishing a baby on the inside. The work of labor and delivery also can bring a sense of comfidence and ability into mothering her baby on the outside.   Easy it will likely not be, but anything worth something requires effort, steadfastness, and often discomfort.  It is in that place we grow and show what we are made of.

Be confident.  Women are strong!

Molly Ringwald births twins – Congratulations!

Monday, July 13th, 2009

It has been reported that Molly Ringwald naturally birthed her twins (son Roman and daughter Adele) on July 10th, 2009.  Her babies arrived within minutes of each other.  No other details were given.

She had previously spoken publicly in a Fit Pregnancy interview about her desire for a vaginal birth.  Also that she would not schedule a cesarean due to expecting twins alone.  This is no small feat in today’s maternity world.  Women today nearly always deliver twins and other multiples via planned cesarean without labor (unless both babies are head down and the mother agrees to a tethered labor).

Something else stands out to me.  She appears to have bucked the trend of advanced maternal age obstetrics based on this study ama study.  You see Molly Ringwald is a gorgeous, healthy 41 year old!

Though Molly Ringwald is a celebrity, she is like all the rest of us, a  childbearing woman.   If she can do it, so can you!

Congratulations to Molly and her family.

Rise and Shine Birth Thoughts

Sunday, July 12th, 2009

Normal, natural birth is spoken of all the time in the birth world.  It is discussed on many levels from the evidence of being overwhelmingly the safest and healthiest way to birth, to the emotional aspects of privacy, safety and support,  to following the money trail of interventive birth versus natural birth and so much more in between.

I ponder and sometimes struggle with what to share with expecting families and  how to share it.  Why the struggle?  This normal, natural birth viewpoint is counter-cultural.  I, along with many peers believe in the inherent design of women and babies to work as intended.  There is lack of belief in routine intervention, non-evidence based protocols or practice style that is created around pregnancy and birth being a tragedy in waiting.

Even in trepidation, the truths must be shared and not hidden simply because most of what is seen and heard in our culture is the opposite (think as an example of the media and the dramatic voice over person on those birthing shows).  The longer I am in this field and calling of work, I believe that protecting women from the truth for whatever reason is harmful.  I participated in a Henci Goer session several years ago at a conference that set this ideal permanently within me.  She asked many questions for the participants to answer.  One question was regarding telling options to expecting families even if they are not available locally – should you or shouldn’t you?  I stood for quite a time in front of the large paper on the wall while holding the marker in my hand.  There were many NO’s on the paper in front of me and it took some courage for me to write a commanding YES! next to their responses. I had bucked the trend.  Not easy, not a bit. When all the sheets were gathered and Henci peered at them to discuss all of the responses, she overwhelmingly said we have an ethical obligation to tell it all.  Phew I was not wrong in my group of peers, but sadly most of them said no probably out of the same fear as I had in answering the questions.  That moment gave me great strength and clarity not because Henci said so, rather because I stood in my conviction and faced the fear of being apart from others in the truth.

Why is it of the utmost importance to share all?  Because no one else goes home or remains home with that baby.  The care provider, staff, doula, educator….they all go home to their own lives.  Each expecting family must be able to live with the decisions made during pregnancy, labor, and birth.  Natural birth has many benefits but it isn’t consequence or risk free, so that too must be spoken of.  Each woman must decide what she needs and can best live with as a mother, wife, partner, even as a woman in her community who will go out and share her experiences with others.

I will often tell expecting families who contact me about childbirth education classes that they will receive much more than the anatomy, physiology, comfort measures, etc. from my course.  That very likely it will challenge to the core their beliefs and value systems surrounding what they know in their own birth culture of family, friends and personal history.

I love this work.  I hope someday to be replaced by the community based education women ought get back to. If not, I along with many others will be here to keep the conversation and education moving forward.

Push! Bringing Baby Forth During Childbirth.

Tuesday, April 8th, 2008

“Pushing felt good.” “The urge to push was unstoppable.” “I felt like I was going to split apart.” “It hurt so much more than I thought it would.” “I didn’t want to push.” “Why did I have to hold my breath and tuck my chin?” “Why were people yelling at me?” “All I wanted to do was breathe and not push.” “What is the deal? I was told I couldn’t get a baby out on my side, squatting, hand and knees or when I arched my back and threw my head back.” “If I would have pushed in another position would I have torn so much?” “Would I have avoided a cesarean pushing in another position?”

The myths surrounding pushing in our culture are widespread. Over and over women are told unless they push in the “C-position” or reclined position with tucking chin and holding breath “purple pushing” there is no way they can effectively push out a baby. Interestingly, when not coached, most women choose to squat, stand and lean or use a variation on hand and knees to deliver their babies.

So why are we told there is only one way to effectively deliver a baby and expected only to do that?

Here a few reasons I have come up with:

  • 98% of babies in USA are born in the hospital versus at home or birth centers with midwives.
  • Most OB’s are not trained to catch in any other position, are trained to see with their eyes for one orientation, and do not know how to “see” with their hands.
  • In hospitals, nearly ALL women – in some areas close to 100% are medicated with narcotics or more likely with epidural anesthesia.
  • Beds are almost used 100% for hospital deliveries versus a birth chair, birth stool, toileting, squat bar, standing or leaning.

Using alternate positions in pushing (unless you are a small percentage of women who prefer the “C-position”), can reduce trauma to the perineum, shorten pushing time, allow for movement of tailbone thus opening the pelvis more, can lessen stress on the baby, and give mom more sense of control over the birth.

Using alternative breathing techniques other than holding the breath as in directed pushing to a count of ten or more can allow for baby to get more adequate oxygenation and be a more gentle process for both parties. A mom may spontaneously push while breathing non-specifically, she may grunt and growl, she may hold her breath for a moment and then exhale several times during a pushing episode, she may do a slow-exhalation with mouth relaxed and slightly open (open-glottis) while pushing, breath slowly/rhythmically and not push actively allowing for passive dissent of baby through contractions.

Most un-medicated or lightly medicated women will choose a position and breathing style that works for her in the event she is allowed to trust her body, trust the process and feels supported. We don’t really need to do anything.

I urge you to have deeper conversations about pushing and delivery with your care provider BEFORE you go into labor.

  • Find out what positions your provider is comfortable or willing to catch in.
  • Ask about use of compresses and perineal massage
  • Ask about only using coached pushing if really needed
  • Ask about percentage of women under provider care “require” an episiotomy
  • Ask how long pushing will be tolerated
  • Ask your provider what his or her philosophy about pushing and delivery is.
  • Ask for evidence to support practices. Actual studies not just verbal.
  • When you arrive at the hospital, speak to the nurse about what you want to do and the what you and your care provider have agreed upon.

Here’s to pushing with confidence, using your instincts and following your body!

Childbirth in the hospital – Navigational Tips

Thursday, April 3rd, 2008

There are many reasons why a woman chooses to birth in the hospital. Women have the right to choose where and with whom she will birth regardless of what another would choose.

Women need the tools to navigate the hospital setting. She and her baby ARE unique. They are human beings. Laboring women are often placed under one-size-fits-all standing orders and protocols. Because of this, pregnant women need to be very careful regarding the books read, the types of birthing shows viewed, the care provider chosen and the childbirth class taken prior to entering the hospital to birth.

Here are some tips for a truly healthier and safer experience:

  • Take the hospital tour – ask lots of questions – induction rate, induction medications and/or procedures routinely used, average cesarean rate for first time moms, VBAC rate, pitocin use rate, epidural rate, use of non-medical pain relief, natural childbirth rate, IV use versus saline lock, percentage of moms who utilize doulas, is pain management highly suggested to every laboring mom, monitoring norms, availability of tub or shower for labor, standard protocol on eating and drinking in labor, use of non-supine pushing positions, mobility in labor, are the labor and delivery nurses open to anything goes in labor, what is protocol on immediate postpartum baby care, is there a lactation staff available….
  • Read the pre-admit paperwork. If you are not sure what it says, ask a paralegal or lawyer to look at it. Be certain that you agree with what you are signing.
  • Do not sign epidural or cesarean consent form at pre-registration. You want to be fully consented during true decision making time. Be sure though to be familiar with benefits, risks and consequences of everything ahead of time.
  • Take a non-hospital childbirth class or independently run class within the hospital.
  • Only agree to induction for a true medical reason – (suspected big baby, pre-pre-eclampsia, being tired of pregnancy, care provider going on vacation, relative will be in town, being past your “due date”, just because you can – are not medical reasons)
  • When induction is necessary – choose a foley catheter to ripen the cervix over misoprostol (cytotec, miso, or the little pill) and if labor establishes upon cervical ripening – decline pitocin or ask to keep it very low over a longer period of time.
    Keep your “water” (amniotic sac) intact until it breaks on its own. This can keep infection probability much lower, lessen risk of cord prolapse, and lessen the discomfort of contractions among many other things.
  • As long as a mom and baby are low-risk – wait until well into active labor to arrive at the hospital – contractions 3 minutes apart and lasting a minute or more. Shortening the time in the labor and delivery room usually keeps interventions and medications to a minimum.
    Any birth and immediate postpartum preferences need to be discussed PRIOR to labor with your care provider. A concise birth preference plan can be given to the nurse upon arrival.
  • In the event a cesarean is necessary (hopefully not created by interventions and medications in labor), discuss with your care provider prior to labor what you would like to have occur (partner in OR, no separation of baby from mom, pictures taken, etc. – for a complete list, please email me).
  • Make postpartum baby care decisions prior to arriving at the hospital. You do not need to have a pediatrician or family practitioner picked out ahead, as the floor doctor will oversee your baby’s care. If you are unsure of what you want, it is always acceptable to delay any immunization, vitamin K injection, eye ointment, etc. until you have the opportunity to investigate further. As a parent you have the right to say yes or no to anything.

    The key thing to remember is that as a consumer, you are paying your care provider for a service, for the hospital staff to attend you respectfully, and for the use of the room you are renting. You do have rights. Protocols and practices are not laws. You can say yes or no to anything or everything.

    As a woman you are making parenting decisions throughout labor, delivery and early postpartum that should be respected, honored and can have lasting consequences. There is no do-over.

    Remember to be a driver – not a passenger!

    Random Childbirth Thoughts – Do these sound too familiar?

    Thursday, December 6th, 2007

    These are quotes made up by a friend and I to cause a pause and thinking to occur. Sadly, they may sound very familiar to public opinion these days. This is meant to be a spoof, but also is a social commentary on how we as a society are giving up on the precious and magnificent work of normal labor and birth. As women, we are incredibly blessed to be the life growers and to bring life forth from our own bodies under our own power. The work of pregnancy, labor and delivery is just a glimpse into the daily work of being a mother. Motherhood like pregnancy through delivery is not always easy but at the end of the day worth it. I fear we are losing something of vast importance in our society.

    This entry is biting and almost roast-like. Read with caution!

    • “Not my mama’s vagina! Mine is only for sex.”
    • “MY MRSA Antibiotics are so slimming..it was worth the infection I got during my cesarean!”
    • “Ob’s say Vaginas are no longer for non-sexual use due to stressors destroying the capability for penis use”
    • “Men everywhere question the duality of vaginal use. Should they allow women to use their vaginas for birth?”
    • “Women are just saying NO to multi-purpose vaginal use”
    • “My vagina is progressive and evolved – no childbirth for me!”
    • “Kegels, schmegels – just get the cesarean.”
    • “I thought to myself..they can’t really do vaginal tightening..but I can always have another tummy tuck!”
    • “It was GREAT being able to schedule my induction…and the baby being in the NICU for a week meant that I got plenty of rest and was able to shop without interruption!”
    • “I was so ready for motherhood! I had a postpartum doula, a nanny and lots of dr. bronner’s bottles! Oh, and once the baby came, the sleeper, the vibrating chair, the swing…they saved me! I never had to pick the baby up once! Just pacifier and away!”
    • “No vaginal birth for me! I am a modern woman.”
    • “But none of my friends are using their vaginas for birth!”

    Are you thinking yet? Screaming? Yelling at me? And by the way, it is okay to laugh.

    Desirre

    Childbirth Education – Think outside the big box location

    Thursday, November 29th, 2007

    So let’s chat about childbirth education. Of the reported 30% of expecting parents who attend childbirth classes the majority go to the hospital where the birth is planned instead of seeking out independent options. I want to challenge you to think about how strange that is. Does it make sense that the information presented will REALLY be balanced, unbiased and evidence-based? Many protocols and practices used during labor and delivery in the hospital are designed as a one size fits all, no suited to each individual mom and baby. More importantly, they are not designed to suit the usual low-risk mom and baby (the majority of moms and babies are normal and low-risk), but can actually make a mom and baby appear or become high-risk. Some refer to hospital classes as “good patient preparation” classes because of lack of inclusive information. I will admit, that all hospitals do not offer education in this manner, however, in my experience and research many sadly do.

    If a car salesman tried to sell you a car and actually insisted you purchase the specific color, make and model he/she decides for you, would you buy it? You would hopefully say no thank you and leave. How dare some one make such a huge decision for you. How long do you research a piece of electronics or a computer, even a cell phone plane before deciding? Even the pair of shoes you are wearing. Did you have to try on several before finding the right pair?

    So why not think outside the big box, one size fits all class? Every mom, baby and partner deserve to know the wisdom of birth, understand what is normal and how to stay that way, when the abnormal happens what to do and be a skilled consumer.

    There is no re-do here. This time is too important to leave to chance and inadequate education.

    This is at the essence of why I teach my own childbirth classes at a location outside the hospital. I am able to freely give full spectrum information without restriction, bias or without the fear of losing my position.

    Your birth matters to both you and your baby, to your future fertility, to your confidence as a mother

    Below is a list of options available to families all across the US and variations in other countries as well (if if any class types have been overlooked, please let me know and I will add it).

    There are many other great ways to find a class that suits you.

    Here’s to finding the perfect fit and gestating in peace.

    Desirre