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.

Many times over I have heard something similar to “If only my insurance would cover the childbirth class, doula, that provider or birth location. Then I could have the birth I really want for me and my baby.” That statement sadly says to me that women are settling for a provider, birth location, type of birth even that would not otherwise be chosen.  Even so far as having a repeat cesarean because the insurance covered location or provider does not “allow” VBAC.

So practically how is someone going to get the desired provider, location or birth? First think of appealing to the insurance company to add a specific location (even home) or provider (even a  home birth provider) to the plan. This may or may not come to fruition, but unless the process is undertaken it isn’t even a possibility. Second, think outside the insurance box.  Be creative. I am a believer that almost 100% of the time there is a way. It may not be easy, simple, or lack stress but likely possible.

Here are some of my ideas for paying for the birth location, care provider, education, or doula support really desired.

Ask for family, friends, co-workers to donate to fund(s) in lieu of routine shower gifts (you will likely not use most of that “stuff” anyway no matter how much you think you will).

Trimming Down = Money Savings

• Satellite/Cable tv – Lower or cancel service.
• Cell phone – lower minutes, negotiate new fee structure, change plans.
• Household utilities – Lower thermostat, take short showers, heat or cold proof home.
• House phone – Get rid of all extras on phone that you don’t need or go VoIP. Even set-up answering machine.
• Food – Grocery shop sales only (no impulse buying), use coupons, eat at home, brown bag to work, no more fancy coffee drinks.
• Entertainment – Get Netflix instead of going out to the movies, visit with friends or family in their homes or yours.
• Shopping – Cut back on extras you do not need to live.
• Vehicle – Car pool whenever possible, only run multiple errands together, walk if possible, use public transportation is available.
• Housing – Move to a lower rent area or to a smaller home. Even consider moving in with family to maximize savings.

Extra Cashflow

• Sell any unneeded items via yard sale or something akin to Craig’s List. This can apply to second vehicle as well.
• Take on a second job that can be done from home or even with a multi-level company.
• Ask husband or partner to temporarily take on a second job.
• Do you gourmet cook,  write, musically talented, sew, knit, paint or craft? You may be able to sell your creations or services.

Miscellaneous

• Barter
• Ask for payment plan.
• Look for less expensive supplies such as a “fishy pool” versus renting an AquaDoula.
• Choose a birth center or a home birth as the cost is significantly less than even a no-intervention natural hospital birth. Also your prenatal care is included in the fee unlike a planned hospital delivery.
• Hire a training doula. Often a lower fee.
• Start a savings account before you are pregnant.
• Plan ahead and pay down any existing debt prior to getting pregnant or in early pregnancy.

I hope some “light bulb” moments are had and there is encouragement in the ideas. There is almost always a way.

If I have left anything off the lists, please feel free to leave a comment and I will add.

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Thank you!

Desirre

As practice through the ages and evidence shows, support during the birth process can be greatly beneficial to both mothers and babies. It is not about having an experience. It is about healthier emotional and physical outcomes for mothers and subsequently for babies as well.  Putting together a support team is not as simple as inviting a family member or friend along. There are many components to consider as this is the most intimate time to allow others to share in except for the conception of your baby.

Prior to putting together your Labor Support Team (LST):

You and your spouse/partner are generally the only persons who can speak on your and the baby’s behalf unless another individual has a medical power of attorney for the labor and postpartum time period. Learning how to be a self-advocate is an important piece of the support team puzzle.  Answering very specific questions prior to looking at who ultimately will be with you at your birth will be helpful to you in addressing specific needs, goals, philosophy, and expectations.

• What education and self study are you doing during pregnancy?
• Do you feel confident and equipped to birth your baby?
• Are you confident and at ease with your provider?
• Are you comfortable with his or her requirements and practice style?
• Are you comfortable with the policies, requirements, and protocols of your birth location?
• Do you have special circumstances or health concerns?
• When you close your eyes who do you see being the most supportive of you and your choices?
• Are you a single mother or is your spouse/partner deployed?
• What type of help does your spouse/partner or your main support person need?
• How involved does your spouse/partner or main support person need?
• What type of physical support do you need (massage, positioning help, any chronic pain or health issues to contend with?)?
• What type of emotional support do you require (affirmations, encouragement, quiet and positive, no questions asked, reminders…)?
• What type of educational/informational support do you expect to need?
• Are you comfortable discussing needs and desires with provider?
• Do you feel confident in addressing the staff at a hospital or birth center?
• Do you have a birth plan?
• Planning a natural birth?
• Planning an epidural in your birth?
• Traveling a distance to your birth location?
• Are there any specific cultural barriers or needs that ought be addressed?
• What other considerations or needs might you have?

Now that you have answered the questions, it is likely a much more clear picture why being specific about your LST is so important.  This is an opportunity to look at and personalize what is needed in labor.  It is not for anyone else to decide what it will look like, who is going to be there, and who is not going to be there.

Putting together your LST

The birth of a baby is only less intimate than the act of making the baby. Inviting anyone into the area surrounding this event can affect the process positively or negatively. Privacy, comfort, safety, and honoring the birth of a baby are a must so choosing the person(s) to take the journey with you needs to be well thought out. Some candidates for a LST are on the below list.

• Husband
• Partner
• Mother/Father (other family members)
• Friend
• Older Children
• Doula (skilled and trained labor support)
• Care Provider (OB, Midwife or Family Practice Doctor)

Many on the list are pretty obvious choice considerations. The best person(s) to have around you during labor and birth will aim to provide what you need physically, emotionally, and by way of information while supporting your decisions and desires without bringing in negativity, fear, bias against what you want, distrust for the process, anger, a sense of undermining, etc. Your support team can make or break the outcome of your labor and delivery simply by what he or she brings into your birth.  Your birth is not about any one elses satisfaction, background, needs, wants or the like. This is your birth, your baby’s birth.

The one person on the list you may or may not have heard of is the labor doula. 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.  A doula does not take away from a husband or partner during the process.  Doulas are shown to decrease interventions, cesarean, epidural use, narcotics use, need for induction, and increase satisfaction, bonding, breastfeeding success, and more! For more information regarding labor doulas, click here  http://prepforbirth.com/2009/08/09/what-is-a-labor-doula-what-does-she-or-he-do/.

From the Birthing Front

Here is a sampling from women who have birthed, are pregnant or attend women in birth who answered the question “Why is having a supportive birth team important?

“…because a woman in labor is in the most vulnerable state of her life. When I was in labor I needed someone holding my hand telling me I could do it… telling me all those incredibly intense sensations were, indeed, normal. I was vulnerable, and my support team protected me and supported me as I gave birth.  “For me, feeling “safe” didn’t just mean feeling safe physically… it meant feeling emotionally safe to welcome the vulnerability that labor brings and thus to be able to let go” Lily B.

“Birth is one of the biggest events that define a woman’s life. When she is in labor her senses are heightened by the hormones going through her body. Her perception of those around her will make or break her birth experience. A trained experienced birth team knows how to keep the emotions of both professional and non professional people positive and empower the woman to birth not only her baby but a stronger more confident self into being.” Amber-joy T.

“A supportive birth team can mean the difference between a physically healthy birth and a birth that can take months to recover from. Regardless of the actual events at a woman’s birth (vaginal birth, cesarean, medicated, non-medicated, home, hosptial, birth center), a supportive birth team can also mean the difference between having a happy, rewarding, and empowering birth and a birth in which the birth is not owned by the mother emotionally. Mental health can be more important than physical health and more costly to treat down the road. Always take care of yourself emotionally.” Nora M.

“Birth is such a vulnerable and powerful experience. I remember that I had to tap into a side of myself that I had not yet known until birth. Every *vibe* from others around me affected my state of mind during the process. Without the complete support of my birth team, and husband, I would’ve when that point of surrender hit, given into the doubts and crumbled under the pressure; But becauseI did have a supportive team, I was empowered to press forward and experience the most amazing moment of my life uninhibited.” Julie W.

So now take a moment to think about who will offer you what you need and help you attain what you want in labor and delivery.  Having continuous support no matter the type of birth you want is important because you and your baby matter.  Your birth matters.

Joy Szabo has been in the news lately for desiring a second VBAC for her fourth baby (vaginal birth, emergency cesarean, and vaginal birth).  She has been denied locally in her area of Page, AZ to have a vaginal birth. Due to this situation, the International Cesarean Awareness Network has been assisting her in fighting the VBAC ban along with seeking out additional options.

After reading the latest article regarding Ms. Szabo, I am completely dumbfounded by the remarks made by other readers of her story.  I am stunned by how it seems the general populous regards a woman’s autonomy and medical rights.  I am also including positive comments as counterpoint. Where do you fall?  What do you believe? Many of these comments point me in the direction of what is so wrong with the system.  That of physician and hospital trumping patient.

You decide is the comment pro or con?

“…..it seems like many people do not grasp malpractice and insurance companies. This is not about the hospital, but about medical professionals and hospitals not wanting litigation. Can you blame them? After spending tens of thousands of dollars on an education before making a dime, I would do what I needed to to avoid a lawsuit, too! … we go to doctors because they DO know what is best for our health! Like another poster said, in health care, the customer is NOT always right.”

“My son was born by c-section, then my daughter vaginally, with no adverse affects. While I agree it’s the doctor’s decision to take the risk or not, it seems over-the-top conservative. Does the doctor’s insurance premium go up if this procedure is performed? Then charge more and give the patient the option.”

“C-sections are done in the US more routinely than in any other developed country but our infant mortality rate is not lower but higher. Doctors do not want to deliver on weekends, at night, if the mother is one week over her electronically determined due date. Yes complications can happen, more so if you are made to stay in a bed hooked up to monitors, a monitor screwed in to the baby’s head, your water broke prematurely, inducement before the baby or mother are physically ready to give birth. All of this leads to more injuries and deaths than needed. Doctors look upon birth as an illness, not the process that it is – an inexact human birth. I am not suggesting giving birth in a field alone, but a c-section has a greater risk than the V-Bac especially if she has had one already. C-sections for true emergencies yes, otherwise no.”

“Did anyone else notice that when they list the risks of a C-section, they failed to mention that the mother is 4-7 times more likely to DIE than with a vaginal birth.?!?!?! They also fail to mention all the potential complications to her health, the roughly 30% rate of problems following the surgery (some severe enough to require rehospitalization) and the challenges associated with caring for children while recovering from major abdominal surgery.  Good for this mom and I hope more mothers will take courage from her”

“This story is exaggeration. If the woman wants a vbac, she just has to show up at that hospital in labor and refuse a section. They can’t force her to have a c-section no matter what they would prefer she do. You can’t force a woman to have a c-section under any circumstances, so as long as the docs and nurses say she and the baby are tolerating labor, she has no reason to fear being forced into an operation.”

“I worked in the hospital for 5 years and then in a birth center for the last 4 years. I had to get out of the hospital because I started feeling guilty about my complicity in that system in which so much goes on behind closed doors of which the patient is never informed. I’ve had docs tell me in the lunch room that they are doing a c-section because they have an important golf game, fishing trip, or hot date. Then they go into the room, lie to the woman and say, ” oh your baby is too big, your progress is too slow, it’s never going to happen.” the woman believes them and thanks them so much for saving their babies lives. Over and over and over again. In Miami we have over 50% c-section rate, and it’s way more convenient for the docs. If VBACS are not allowed at more and more hospitals, the rest of the country will soon be like it is here…..”

“I find this decision by the hospital(s) to not do a VBAC as a little crazy. My older brother was born (in 1955) by C-section; both me (in 1958) and my younger brother (in 1962) were born vaginally. NO COMPLICATIONS. It could be done 50 years ago, but not now??”

“The risk of MAJOR complication from a second cesarean is TEN TIMES that of the risk of uterine rupture in a VBAC mother. Someone please explain to me how an “elective” repeat cesarean is safer than a VBAC? Especially since more than 75% of uterine ruptures occur PRIOR to the onset of labor. How is a scheduled cesarean at 39 weeks (which is the ACOG recommendation) going to save the mother who ruptures at the dinner table at 34 weeks? Using their logic, we should all go live at the hospital the moment we become pregnant after a previous cesarean, just in case our uterus blows up and we need an OB and an anesthesiologist “immediately available”.”

So what do you think?  It worries me that is seems the mother’s rights do not count for much. That in some of the comments the idea of  forcing a cesarean is no big deal if it makes the doctor’s position safer.

I think that most people are woefully under educated on childbirth and what safety really means.  A conservative physician errs on the side of evidence not defensive practice.  Do your own research. Be your own advocate.

The below writing in my opinion is one of the most eloquent and beautiful takes on labor and birth I have read.   I am using it by permission of the author, Marcie Macari from her book She Births.   I encourage you to go to her site and see her offerings.  Inspiring and fantastic. Thank you Marcie for allowing me to bless others.

I have and will continue to use this piece as a visualization with clients and class participants.  Enjoy!

“The Passage” from She Births by Marcie Macari

The earth shook. The women gathered.

The chanting of The Women Of a Thousand Generations began,  their hands intertwined.

I breathe low, moaning deep through my body to touch the depth of sound they generate.

And for a moment I am with them.

“We’re here-with you, you are one of us-you can do it!”

One of them

I breathe.

The coals glow-mocking my strength

Embers flick their tongues tormenting my courage.

I step onto the coals-

The Women Of a Thousand Generations push closer to the embers- their faces glowing from the coals.

I keep my eyes on them, focusing on THEIR ability to push through the pain, to keep walking in spite of their fear- remembering that they made it to the other side.

I find MY courage and step again.

I feel the embers, and wince.

The Women start beating a drum.

I find their rhythm in my abdomen, and slowly move forward:

One step- look at the face.

Second step- focus on the eyes.

Third step…

I see the African dancers, rehearsing their steps as I walk my last few.

I see the circle being set-the fire at the center,  the food and festivities.

This will be the stage for my welcoming into this elite group- this Women Of a Thousand Generations.

My heart swells.

I am close to the end now, and my body starts to shake-

Spirit stronger than flesh.

I want to give up-to step on the cool grass

And off these coals.

I look for the faces, and my eyes meet theirs.

One of them smiles.

She who is With Woman, reaches out her hand

Her face is the clearest, eyes at my level.

“Listen to your body and do what it tells you” She says-no trace of concern.

The chanting changes: “Listen to your bo-dy”

In rhythm, hands are again joined, like an infinite chain.

I realize just how many have gone this way before me.

The one who smiled places her hand on the shoulder

of the One who is With Woman- with me, and I breathe,

stretching out my hand to grasp the outstretched.

I am about to cross over-

Silence comes over the Universe.

I near the end-

my body aches,

my mind is empty of everything but that last step.

Last step.

Hands grasped.

Cool grass. On my toes, cooling my feet-

my arms reach out to claim my prize-

“Reach down and take your baby.”

I hold him to me tightly, and proudly take my place in the chain.

I am now a Woman Of a Thousand Generations.

The celebration begins.

Excerpt from She Births: A Modern Woman’s Guidebook For an Ancient Rite of Passage, by Marcie Macari.

“There is more to Birth than the physical process of having a baby. Birth is a Spiritual Rite of Passage for women, offering an opportunity for profound transformation. She Births challenges each woman to consider how their Birth Choices profoundly affect not only their lives individually, but the world as a whole.”

Please share with me what encouraged, supported, and enabled you to continue in labor and delivery.  I may use your quote later in a post!!!

Email me at desirre@prepforbirth.com or simply add comment to post.

Below is a compilation of common terms and acronyms that women often will come across during pregnancy, labor, and delivery.  Check back as more will be added from time to time.

• AROM – Artificial Rupture of Membranes – using a finger or tool to open the amniotic sac to to allow the fluid to release.
• PROM – Premature Rupture of Membranes – when the amniotic fluids releases before labor starts.
• SROM – Spontaneous Rupture of Membranes during labor.
• ROM – Rupture of Membranes
• Miso – Misoprostol is the pharmacological name for Cytotec a drug used for cervical ripening and induction though a controversial, off and against label used ulcer Medication
• VBAC – Vaginal Birth After Cesarean
• HBAC – Home Birth After Cesarean
• WBAC – Water Birth After Cesarean
• UBAC – Unattended Birth After Cesarean
• CBAC – Cesarean Birth After Cesarean – This is a repeat cesarean after a woman desires and tries to have a vaginal birth after cesarean.
• ERCS – Elective Repeat Cesarean
• RCS – Repeat Cesarean
• Natural Birth – Labor and vaginal delivery free from intervention except for intermittent fetal monitoring. In the hospital only a saline lock and intermittent monitoring.
• Vaginal Birth – Baby born vaginally with or without medication and intervention.
• First Stage – Early, Active, and Transition. This encompasses the effacement to 100%, dilation to 10 centimeters/complete, position movement of cervix from posterior to forward as contractions begin while staying longer, strong and closer together prior to pushing and delivery.
• Second Stage – Pushing phase after cervix is completely dilated to delivery of baby.
• Third Stage – Delivery of baby to delivery of placenta.
• Fourth Stage – First hours after placenta is delivered.
• Oxytocin – A hormone made in the brain that plays a role in childbirth and lactation by causing muscles to contract in the uterus (womb) and the mammary glands in the breast. It also plays a role in bonding with mate, child, and socially.
• Pitocin (oxytocin injection, USP) is a sterile, clear, colorless aqueous solution of synthetic oxytocin, for intravenous infusion or intramuscular injection.
• Prostaglandin – Any of a group of hormone like fatty acids found throughout the body, esp. in semen, that affect blood pressure, metabolism, body temperature, and other important body processes such as cervical ripening.
• Uterus -The muscular organ in which a fertilized egg implants and matures through pregnancy. During menstruation, the uterus sheds the inner lining.
• Cervix -The lower portion of the uterus that provides an opening between the uterus and the vagina. Also known as the neck of the uterus that softens, effaces, dilates and changes position during labor.
• Vagina – A muscular canal between the uterus and the outside of the body. Also known as the birth canal.
• Perineum – The area between the anus and the vulva (the labial opening to the vagina).
• Pelvis -The basin like cavity formed by the ring of bones of the pelvic girdle in the posterior part of the trunk in many vertebrates: in humans, it is formed by the ilium, ischium, pubis, coccyx, and sacrum, supporting the spinal column and resting upon the legs.
• Pelvic Floor Muscles -The sphincter mechanism of the lower urinary tract, the upper and lower vaginal supports, and the internal and external anal sphincters. It is a network of muscles, ligaments, and other tissues that hold up the pelvic organs.  Includes bladder, rectum, vagina and uterus.
• Fundus -  Top of the uterus. During labor contractions the fundus thickens and gets more firm as the strength of contractions increase and dilation increases.
• Placenta -The organ that develops during pregnancy that transports nutrients to the fetus and waste away from the fetus. The placenta is attached to the uterus and is connected to the fetus by the umbilical cord.
• Umbilical cord – The cord that transports blood, oxygen and nutrients to the baby from the placenta.
• Bloody Show – Mucous and blood mixed together as dilation and effacement occurs.  Starts off as blood tinged mucous and becomes heavier as labor progresses.
• Stripping membranes -  Pressing the amniotic sac away from the inside of the cervix.
• Mucous plug - The mucous that blocks off the non-dilated and non-ripened cervix for protection.
• Lochia – Post birth bleeding that though a wound site from the placenta detaching from the uterine wall, it mimics a heavy and long menstrual period.
• Cesarean – Baby born via a surgical incision made through the abdomen into the uterus.
• Obstetrician – Is the surgical specialty dealing with the care of women and their children during pregnancy, childbirth and the immediate post birth time.
• Midwife – Is a person usually a woman who is trained to assist women during pregnancy,  during childbirth, and postpartum as well as the newborn post birth.  There are many types of midwives – some work in the home, at birth centers or in the hospital.
• Doula – Is an assistant who provides various forms of non-medical and non-midwifery support (physical and emotional) in the childbirth process. Based on a particular doula’s training and background, the doula may offer support during prenatal care, during childbirth and/or during the postpartum period. A birth doula provides support during labor. A labor doula may attend a home birth or might attend the laboring at home and continue while in transport and then complete supporting the birth at a hospital or a birth center. A postpartum doula typically begins providing care in the home after the birth. Such care might include cooking for the mother, breastfeeding support, newborn care assistance, errands, light housekeeping, etc. Such care is provided from the day after the birth, providing services through the first six weeks postpartum. In some cases, doula care can last several months or even to a year postpartum – especially in cases when mothers are suffering from postpartum depression, children with special needs require longer care, or there are multiple infants.
• Birth Center – Free standing location usually run by one or more certified nurse midwife. True birth centers are almost always independently run. They are not overseen by a hospital or in a hospital. May be near a hospital. Often set-up like a home birth space and epidurals or other pain medications are not available.   Hospital “birth centers” are labor and delivery floors not birth centers in the true sense of the term.
• Intervention – Anything that does not exist in a naturally occuring labor and delivery that is done.
• Saline Lock/Buffalo Cap/ Hep Lock – Is the apparatus that the IV line hooks into.  It is silicone tubing that is lightweight with a plastic needle that stays under the skin to allow easy vein access.
• Foley – A foley catheter is used to release the bladder if a woman unable to urinate due to an epidural, post surgery, or with a swollen urethra post birth.  It can also be used for successful cervical ripening in lieu of cytotec.
• Induction – To attempt to artificially start labor usually by pitocin, artificial rupture of membranes with or without cervical ripening (Cytotec or Foley Catheter).
• Epidural - A medical method of giving pain relief during labor. A catheter is inserted through the lower back into a space near the spinal cord. Anesthesia is given through this catheter, and results in decreased sensation from the abdomen to the feet.
• Contraction – Tightening and loosening of your uterus. Productive contractions are often felt at the bottom of the uterus, start out like period cramps and progressively grow stronger, longer in length, and closer together.
• Braxton-Hicks – Practice contractions that do not dilate or efface the cervix often felt at the top of the uterus versus the bottom.
• Episiotomy – A surgical procedure to widen the outlet of the birth canal to facilitate delivery of the baby and avoid a jagged rip of the perineum. (Natural abrading or tearing is preferred and episiotomies are not evidence-based to be used except under specific circumstances).
• Ina May’s Sphincter Law -Tapping into the concept that if one sphincter is open and relaxed, the others will also open, relax and be able to handle, quite adequately, the task at hand. This also includes the aspect of birth requiring privacy, sacredness, and honor as well so a woman feels safe, unwatched and supported.
• Kegel Exercises – Named after Dr. Arnold Kegel, consists of contracting and relaxing the muscles that form part of the pelvic floor (sometimes called the “Kegel muscles”).

Today the cesarean rate is an alarming 31.8% (CDC 2007 preliminary data).  Only a maximum of 15%  of birthing women should be having cesarean deliveries in order to keep mortality (death) and morbidity (poor outcomes) to the healthiest levels according to the World Health Organization. With the staggering discrepancy in what should be and what is, you NEED to care about this topic.  You could have a questionable cesarean like so many others.

It is important that you the childbearing woman understand how to have the healthiest birth for you and your baby which is most often a no-to-low intervention vaginal birth.

When a cesarean occurs for a truly medical and/or life saving reason it is necessary and the benefits far outweigh the consequences for mom and baby.  The cesareans that occur for other than truly medical and/or life saving reasons are often not necessary or became necessary due to external influence that skewed the labor and delivery outcome (routine induction, epidural,  impatience by provider, mal-position of baby, staying in bed during labor, routine continuous monitoring, pushing in one position, lack of food and water during labor, routine augmentation of labor, lack of support, etc.)

Below is a list of ways to promote having a vaginal birth even if you have already had a baby this information needs to be known.

• Take the ICAN webinar on cesarean prevention.
• Interview before choosing your care provider – you are doing the hiring! Know his or her statistics.  If you do not get a clear answer, that is a RED flag.  You need individualized care. ou and your baby deserve no less.
• Interview both midwives and OB’s.
• Research your chosen birth location well.  There are other options outside of the hospital – home and birth center.
• Hire a doula who shares your philosophy and is comfortable with the type of birth you desire. Some searchable places for a doula are: www.cappa.net, www.dona.org, and www.alldoulas.com.
• Without medical reason standing in the way, labor at home into active labor if traveling to a hospital or birth center.  Well established labor upon arrival to the hospital or birth center decreases the opportunity for interventions, medications, and cesareans.
• Get educated! Take a childbirth class that promotes confidence, consumer awareness (knowing rights and responsibilities), and evidence-based practices. A “good patient” class is not what you want to take.  READ books that share positive stories and good information.  A few of the searchable sites are: www.cappa.net, www.independentchildbirth.com, www.lamaze.org, and www.ican-online.org.
• Turn off your TV – stop watching the dramatic birth shows.  They are not real.
• Use mobility in labor.
• Drink and snack in labor.
• Say NO to routine interventions – meaning interventions or medications without a true medical reason. These can include, IV with fluid running, artificial rupture of membranes, continuous monitoring, wearing of hospital gown, and vaginal exams.
• Say no the the epidural completely or at the earliest at 6 cm’s dilated.
• Push and deliver in positions other than the reclined or “C” position unless that feels good and baby is coming well that way.
• Only have those around you who will support what you need and desire in labor and birth. When you close your eyes who is there with you in your labor “cave”? Who doesn’t fit well there?
• Study yourself for what comforts, assures, and adds to your feeling of safety.
• Eat healthy and exercise during pregnancy.
• Read What Every Woman Needs to Know About Cesarean Section – http://www.childbirthconnection.org/article.asp?ck=10164
• For more information on Cesarean recovery and support, VBAC education and support, and Cesarean prevention go to www.ican-online.org.
• Bottom line – take your money and walk if you are not being listened to and treated as a partner in your care.