Posts Tagged ‘homebirth’

Childbirth Education Myths 1

Monday, January 27th, 2014

Over the next several weeks, Team Preparing for Birth will be debunking some common myths surrounding childbirth education classes. Check back every Monday to see the newest post.

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MYTH #1: “I’m having a homebirth, and my midwife will do all my education.”

Home birth families often see childbirth classes as an extra, rather than a valuable and necessary tool to help them have the birth they are hoping for. The most common objection they have is that they will be able to get all the education they need from their midwife. While midwives do educate their clients to some extent, this perception that they can (or should) cover everything is a myth, for several reasons.

1) Education is not a midwife’s job.

Just as obstetricians are not childbirth educators, neither are midwives. Just because midwives are more likely to do more education than an obstetrician, does not mean they give comprehensive education, and they should not be expected to. That is not their job.

Rather, a midwife’s primary job is to maintain the clinical safety and health of the mother-baby dyad. This will involve some education, yes, but only as a by-product of good midwifery care.

A good midwife will encourage her clients to be active participants in their care by reading, taking classes, and educating themselves proactively, instead of passively relying on the lack of intervention common to home birth. Midwives want clients who are thinking women, who take responsibility for their own care, and who can integrate what they learn in practical ways.

 

2) The reality of transport.

Another downside to relying solely on your midwife for childbirth education is the preparation for hospital transport. Realistically, around 10% of women and babies need something that cannot be offered at a homebirth, for whatever reason. It is not a midwife’s job to prepare you for the hospital.  Her job is to prepare you for birthing safely at home. Therefore, an expert on the hospital system is needed to prepare a birthing woman, in case of a transport. Most midwives spend very little time in the hospital, due to the low transport rate, so their expertise on local practices may be limited.

On the other hand, childbirth educators work very hard to stay up-to-date on all policy changes, protocols, and the general attitude of the staff in local hospitals. They often work (or have worked) as doulas, and have regular opportunities to interact with staff in the local hospitals that midwives simply don’t have. (This is not a criticism, merely a reality.)

While a midwife can go over what a typical transport looks like in her practice, a good childbirth education class will be able to prepare the client for what a hospital birth will look like. She can help the client to understand how to navigate the environment, and teach her how to communicate with the staff effectively.

 

3) The birth tool belt.

Midwives know that most women need a wide array of pain management techniques available to them, since an epidural is not an option at home. While a midwife will teach her clients the importance of stress management, emotional health, and relaxation, there is no substitute for a good independent childbirth course where you can actually practice tried and true techniques from all kinds of sources. This creates a solid foundation of knowledge, provides varying perspectives, and allows the birthing pair time and space to learn or review valuable tools for labor.

 

4) Prenatal appointments can only cover so much.

Even though midwifery appointments are much longer than typical obstetric appointments, it is still a very limited amount of time for a woman to learn all she needs to know about birth. Not to mention the birth partner, who may not be able to attend very many of the appointments. Childbirth education can fill in the gaps, empower a birthing pair, and provide opportunity to practice valid techniques in a real-world environment.

It is never wise to assume that your care provider will simply take care of everything, no matter who they are. Leaving the decision-making and responsibility solely in your midwife’s hands is not fair to her, to you, or to your baby. You owe it to yourself to take a proactive approach to childbirth education.

 

EMAB and Doulaparty Team Up

Friday, June 22nd, 2012

 

 

Join the #doulaparty on Twitter or follow along at DesirreAndrews.com, June 22nd 6pm PT/9pm ET to kick off summer birth work with something extra special!

 

I am very excited that Earth Mama Angel Baby is sponsoring this weeks live chat. EMAB has amazing products for all types of birth professionals and families.

 

A note from the EMAB Team:

 

Are you a midwife, doula, nurse or obstetrician looking for pure, safe products to comfort postpartum mamas and brand new babies? You’ve come to the right place! Earth Mama Angel Baby offers safe alternatives for your clients who are concerned with detergents, parabens, 1,4-Dioxane, artificial fragrance, dyes, preservatives, emulsifiers and other toxins. Earth Mama products are used in hospitals, even on the most fragile NICU babies, and they all rate a zero on the Skin Deep toxin database, the best rating a product can receive. Earth Mama only uses the highest-quality, certified-organic or organically grown herbs and oils for our teas, bath herbs, gentle handmade soaps, salves, lotions and massage oils.

Earth Mama now offers a Birth Pro Cart for wholesale pricing available for birth support professionals! Join Earth Mama Angel Baby on the #doulaparty chat Friday June 22 to talk about their new shopping cart plus answer any questions you may have. Earth Mama will be giving away Postpartum Bath Herbs and Monthly Comfort Tea, Mama Bottom Balm, Mama Bottom Spray, and a grand prize of their new Travel Birth & Baby Kit!

Doulas and Home Birth

Tuesday, May 29th, 2012

Is there benefit to hiring a doula for a home birth? I say YES absolutely.

As a seasoned doula who has attended home births as labor support and now an  intern midwife who clinically supports the mother, I believe that many women can keenly benefit from a doula when having a home birth.

The most simple reasoning is that the doula is there physically, emotionally and educationally specifically for the mother and family just like at the hospital or a birth center. She (he) is an integral part of the birth team.

  • The doula will likely be laboring with the mother first, providing a continuous care support framework for when the midwifery team arrives.
  • As the midwifery team sets up and prepares the space clinically, the doula is right there maintaining the comfort, peace and encouragement of the mother. Often lessening any disruption that new people in the environment can cause.
  • The doula is there SOLELY for the mother and husband (partner), step by step, eye to eye while the midwifery team is there to first and primarily clinically assess, maintain safety and be unobtrusive as possible.
  • The doula offers guidance and suggestions for position changes, physical/emotional comforts and helping to ensure the mother eats, drinks, voids and rests.
  • The doula gives the husband (partner) the opportunity to rest, have less stress, do the very best he/she can do along with enjoying the process more.
  • A doula can be present specifically to help with the other children.
  • A doula’s presence offers reduction in any interventions and cesarean.
  • A doula’s presence offers increased satisfaction with birth, bonding and breastfeeding……….

Simply put. A doula being present at a home birth is effectively the same as at a hospital or birth center, with the general exceptions that she would have to help a mother and family self advocate or navigate  institutional policies,  protocols and staff.

I again say YES to doulas at home births.

 

 

Interviewing Your Home Birth Midwife

Thursday, September 22nd, 2011

Interview Questions

  •  Why are you a midwife?
  •  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?
  •  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 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 does your cord clamping protocol look like?
  •  What do you do in the event a complication arises during labor or birth?
  • When would you transfer a patient?
  • What percentage of your patients do you transfer to the hospital? Cesarean rate?
  •  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.
  • What does postpartum care look like for me and my baby?
  • Do you have a midwifery student or an assistant that attends births with you? If so, what is her role?
  •  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 home birth?
  • Do you have a back-up physician?
  • What do your fees cover?
  • Do you take any insurances?
  • Should I take childbirth education classes? Do you recommend any? What do you cover?

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 Preparing For Birth 2011

A Guide to Finding Your Doula

Tuesday, August 2nd, 2011

Building a labor support team is part of conscious preparation during pregnancy for your labor,  birth and life with the very newborn. Hiring a labor doula continues to gain in popularity for the expecting family. Your doula comes alongside you in pregnancy through labor and delivery with some additional early postpartum follow-up.  For additional after birth support, a postpartum doula is a great addition.

Step 1: Finding a Doula

  • Inquire with friends, family, local support/informational groups (for example – ICAN, LLLI, Birth Network, Birth Circle, Cloth Diaper store), 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 ToLabor , Birth Works and Birth Arts International
  • Search general doula sites such as All Doulas, Doulas.com, About.com, Doula Match or Doula.com

Step 2: First Contact

Once you have located local area doulas, the next step is  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 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 initial 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 after the phone or email contact and response, set-up in-person interviews with the doulas you found most compatible with you.

  • Unless the doula you are meeting has her own office, interviews are usually held 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 never expected.
  • Your partner, husband or other support who will be attending the birth needs to be at in-person interview if at all possible.
  • 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  about yourself and what you want.  It is customary for the doula to either email ahead of time her client packet or bring it with her to the interview. It may include her professional profile, client agreement, services, and support details, as well as, additional 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 accept barter?
  • 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 and process after each interview. If a doula is pressuring you to hire on the spot because she fills so quickly, that could be a red flag and cause for you to take a pause.

Step 5: Hiring the Doula

Within 1-2 weeks,  contact the doula you would like to hire and proceed and those you did not choose 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).
  • Return any intake paperwork by mail or email.
  • 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.
  • Get clarity on what routine contact she would like from you (updates after care provider appointments, etc.)

Happy doula-ing!

Picking Your Care Provider – Interview Questions

Thursday, July 28th, 2011

Being an active participant in your pregnancy and birth journey begins with choosing your provider. You can begin the search for the right provider fit prior to becoming pregnant, in early pregnancy or anytime before your baby is born. So much of how your pregnancy and birth unfold are directly related to your care provider so this is really a key element. Every provider is not the right fit for every mother and vice verse. If you already have an established provider relationship, these questions can be used as a re-interview tool.

When asking these questions, take care to really listen to the answers. If a provider will not meet with you prior to you becoming a patient, that can be a red flag.

______________________________________________________________________

Begin by expressing your overall idea of what your best pregnancy, labor and birth looks like to provider.

  • What are your core beliefs, training, experience surrounding pregnancy and birth?
  • Why did you choose this line of work?
  • What sets you apart from other maternity providers?
  • How can you help me attain my vision for pregnancy, labor and birth?
  • If I have a question, will you answer over the phone, by email or other avenue outside of prenatal appointments?
  • How much time will you spend with me during each appointment?
  • What routine tests are utilized during pregnancy? What if I decline these tests?
  • What is the average birth experience of first time mothers in your practice?
  • How do you approach the due date? What do you consider full term and when would I be considered overdue?
  • What are your patient intervention rates? (IV, AROM, continuous monitoring, episiotomy, etc.) Cesarean rate? VBAC rate? Induction rate? What induction methods are used? When are forceps/vacuum used? These numbers are tracked.
  • What positions are you comfortable catching in? Birth stool? Hand/Knees? Squatting? Standing? Water? How often do patients deliver in positions other than reclined or McRoberts positions?
  • How do you feel about me having a birth plan?
  • What if I hire a doula? Do you have an interest in who I work with or restrictions? If yes, why?
  • Do you have an opinion on the type of childbirth or breastfeeding class I take? If so, what and why?
  • Are you part of on call rotation or do you attend your own  overall? Will the back-up or on-call CP honor the requests we have agreed on?
  • Are there any protocols that are non-negotiable? If you cannot refuse – you are not consenting.
  • What if I choose to decline a recommended procedure or intervention in labor or post birth, how will that be viewed?
  • When will I see you during labor?
  • What postpartum care or support do you offer?
  • Will I be able to get questions answered or be seen before the 6 week postpartum visit?

Points to ponder afterward:

  • Did you feel immediately comfortable and respected at the interview? If already with a CP, do you feel comfortable, respected and heard at each appointment?
  • Were there red flags or white flags?
  • Was or is care provider willing to answer questions in detail without being annoyed?
  • Is choosing your care provider based on your insurance or lack of insurance?
  • What are you willing to do in order to have the birth you really desire? Birth location?
  • How much responsibility are you willing to take for the health care decisions for you and your baby?

Wish List In 2011

Sunday, January 2nd, 2011

A clean slate. A fresh start. Hope and dreams reactivated. Passions toward change are stirred. All of this by the calendar rolling over from one year to the next. It is not just  anew year though, it is a new DECADE to set precedent in. To make a mark. Oh the possibilities and opportunities that are ours to reach for and accomplish.

In the spirit of all of this, I decided to make an #in2011 wish list on New Year’s Eve 2010 and with some help from a few friends here is what flowed out.

#in2011 breasts will be viewed as nurturing, comforting, and beautiful.

#in2011 the majority of women will be served under the midwife model of care for the majority are low-risk and will remain so.

#in2011 Childbearing women will be greeted with open arms by providers with their questions, needs and knowledge.

#in2011 pioneering social media women will gain even more ground in their work liberating childbearing women.

#in2011 delayed cord clamping and physiologic third stage will become the norm.

#in2011 doulas will be respected as educated, knowledgeable birth professionals by staff and care providers.

#in2011 childbearing women will be given opportunity not limited

#in2011 Those striving to improve the maternity system at the ground floor as educators will be mutually respectful and supportive.

#in2011 Doulas from all backgrounds and organizational affiliation will be open to one another, supportive, sharing.

#in2011 a woman with needs and opinions with not be marked for a cesarean because of it.

#in2011 Homebirth transports will be treated with dignity and respect.

#in2011 Stigma of mental illness and motherhood will be adsressed by every childbirth care provider. RT @WalkerKarra

#in2011 Childbearing women will not have to live in fear of their providers.

#in2011 We CAN change the world together for childbearing women. Put your words intro action.

#in2011 More birthing women will have low-intervention births that lead to healthier outcomes.

#in2011 Childbearing women will be seen, heard, respected and offered a variety of care options.

#in2011 there will be less imbalance of power between maternity patient and provider.

#in2011 childbearing women will rightfully claim their health records as their own -RT @midwifeamy

#in2011 we will wake up to and address the shameful disparities in access to and outcomes of maternity care RT @midwifeamy

#in2011 Less pointing fingers among insurance companies, providers & orgs that continues to feed this ever medicalized maternity system.

#in2011 I would like to see an equal playing field with accessibility to all to maternity research, guidelines, statistics…

#in2011 I would like see accountability for providers and institutions in their maternity care practices.

#in2011 I would like to see hospitals treat only the patients they serve the very best – high-risk or in-need mothers and babies.

#in2011 I would hope more women stop blindly trusting and do their own research for pregnancy, birth and postpartum.

#in2011 I would like to see arrogance leave the treatment room. It is not a personal affront for a patient to have an opinion and needs.

#in2011 I hope women are treated as holistic beings especially in pregnancy.

#in2011 I hope for care providers to be transformed into partners with their patients instead of authorities.

#in2011, I want to see care providers and family members taking postpartum mood disorders seriously. RT@smola04

#in2011 I hope women stop being treated with hostility and looked down upon for wanting something more in pregnancy, birth and postpartum.

#in2011 I would like to see more women receiving comprehensive postpartum care from their OBs and hospital based midwives.

#in2011 I hope that women will openly mentor those coming up after them to better understanding and expectations in birth.

#in2011 I hope social media efforts have even more impact on unveiling the hidden and progressing healthy birth practices.

#in2011 I hope less mamas are unnecessarily cut open in pursuit of delivering a baby.

#in2011 I hope to see midwives working together no matter the track they came up on. Being respectful and open.

#in2011 I hope to see women who have experienced amazing births be loud and proud sharing the good news without fear.

#in2011 I hope that midwives of all types will be fearless in their pursuit of their model of care for women.

#in2011I hope that hospitals and providers realize they need to offer individualized care to women and babies for the health of it.

#in2011 I would like to see women openly breastfeeding their children without shame or discrimination.

#in2011 A drop in the cesarean rate would be progress toward healthier practices.

#in2011 I want to see women in droves having their eyes opened and being fierce about the care they receive. About their maternity options.

#in2011 I would like to see less care providers offering up defensive and fear based medicine to their maternity patients.

#in2011 I hope for more accessibility to home and birth center births for women and babies.

#in2011 I would like care providers to view women as a sum of all parts, not a uterus growing a baby more valuable than she is.

#in2011 I would like to see more women taking charge of their care, taking personal responsibility and being powerful pregnant women.

#in2011 I desire more respect and autonomy for maternity patients.

#in2011 For women who want a VBAC to easily find an accommodating provider.

Is all this attainable in one year? Perhaps not, but pushing toward the positive and never taking the eye of the reason for all of this, the childbearing women and families, I do believe we can change the world and make the maternity care system as a whole a safer, healthier  and more respectful place.

What is on your 2011 wish list? If you would like to have it added here, leave a comment.

Reader Additions:

Kay Miller:

I hope that we (doulas/educators) can stop alienating the providers, instead partnering with them to provide the best care possible for the mamas and babies that we work with.
I hope that doulas/educators and providers can have mutual respect for one another, and realize the value of the care and support that each provides.
I hope that while we work to change the negatives of health care for pregnancy, birth, and postpartum, that we can remember to openly recognize and affirm the positives.
I hope that families will make decisions based on education and research, not on fear.
I hope that both “sides” stop using fear tactics to persuade families to make certain choices. A decision to home birth due to fear of hospital birth is still a decision based on fear.

Grateful For My Birth(s) Carnival

Wednesday, November 24th, 2010

I am so thankful to all of the submissions I received for this Why I am Grateful for my Birth(s) blog carnival. I have found no matter what a woman can learn something and be grateful for something in every birth experience no matter how difficult or wonderful. Enjoy these quips and please go to their blogs to read in completeness.

Tiffany Miller of Birth In Joy says in an excerpt from her post The Most Important Piece, “I am thankful that Mom believed in my ability to breastfeed my new baby, even though it hurt at first. She never told me that I had so severely damaged her nipples, as she tried to learn with no support whatsoever during my own newborn days. Nary an ounce of bitterness did she carry from that time. She knew and accepted that my path was my own, and supported me completely.” She goes on to further outline how the mentoring and support of her mother paved her way.

How grateful she is for all four natural births and her mother’s unwavering assistance. Assistance and presence she could never imagine doing without.  Just beautiful and shows how important in our lives are the ones who came before.

Kristen Oganowski of Birthing Beautiful Ideas in her post Your Births Brought Me Here writes this gorgeous, tear inspiring letter to her two children about what amazing changes they spurned in her own life, in the very life that they would come to know. Without one birth, would the other have come along the way it did?

Here is an excerpt: “When you both were born, I called myself: Graduate student (unhappily).  Teacher (happily).  Feminist (always).  Mother (timidly). Today I call myself: Doula (happily).  Birth and breastfeeding advocate (unflinchingly).  Blogger (smirkingly).  Writer (finally).  Feminist (permanently).  Mother (confidently).  Graduate student (temporarily). Your births brought me here, to this place where I am (finally) content and impassioned. All wrapped up  with a Love, Mom.

Our next post is by Sheridan Ripley of Enjoy Birth. She writes very plainly about how grateful she is for varied experiences that give her insight to what other women experience and that she is better able to support them.

Here is a peek.

  • If I had only amazing natural birth experiences would I have judged those moms who choose epidurals?
  • If I had only vaginal births would I have understood and fought so hard for VBAC moms?
  • If I only had easy times creating that nursing relationship with my boys, would I have been as supportive of my moms struggling with nursing?

Very poignant and open…..

We come to Bess Bedell of MommasMakeMilk.Com came to a place of self-awareness, peace and a fierceness to help others in her experiences. Like others her heart grew and expanded with her own knowledge and walk. A strength and confidence awoke in her to the benefit of so many coming after.

My two births birthed a new women. A mature women who has opinions, knowledge, experience and a passion in life. If I had not had my c-section I may never had given VBAC a second though. The lack of VBAC support and availability would probably never have entered my radar. My second birth showed me that success and perfection are not the same but both are wonderful and I can be happy for and embrace a mother and her experience even if it wasn’t a completely natural, completely med-free birth. Both of my experience have prepared me for the future. My future of birthing, and next time I plan on birthing at home, and my future of educating and supporting pregnant and birthing mothers.

And lastly my own blog post entry. I know I rarely speak of my own births in any detail unless it is one on one. As a community member, advocate, doula, educator, I strive NEVER to be an intervention on a woman. Today I decided to give a small window into my own experiences and why I am grateful. Please read and comment freely – Grateful For My Births.

Thank you so much to those who submitted posts. The openness of other women allow all of us to learn, grow and share as we are meant to within a healthy society. We are not there yet, but I have a hope that through this sort of connection, we are healing some brokenness.

In reading all these posts, not one is the same, not in tone or style, but every woman was changed positively in the end.

Why Childbirth Education?

Monday, November 22nd, 2010

I sit here and ponder Why childbirth education is important?. I am an educator because I think it can be a vital piece to the preparation puzzle prior to welcoming a baby.  I use the word “can” versus “is” due to the fact that all educational offerings are not created equally.

It is known that only a percentage of expecting mothers attend a childbirth class series. Perhaps they believe the staff will explain everything when they get to the hospital, they really have a deep trust in the process and are reading up on everything, or since they are having a home birth that additional education is unneeded. Whatever the reason, women are not getting the foundational information that can be incredibly helpful toward confidence, ability, decision making and mothering far beyond the birth itself.

A good childbirth class series (or rather perinatal class) is well worth the monetary and time investment for most first time mothers and can benefit those who have already birthed.  My post on choosing a childbirth class is a good jumping off point to figuring out what type of course suits the individual expecting mother (her partner or labor support).

A class series worth the time and effort will be comprehensive in nature, not just covering labor and birth. What does that look like? A class that covers midway third trimester pregnancy through 4-8 weeks postpartum. It is content that is deep and is applicable to real life.

A sample of course content:

  • Pregnancy Basics
  • Common Terminology
  • Normal Physiologic Changes and “helps”
  • Exercise
  • Nutrition
  • Prenatal Testing
  • Birth Plans
  • Informed Consent
  • Communication and Self-Advocacy Skill Building
  • Overview of spontaneous Labor and Birth
  • Labor milestones with Comfort and Positioning Strategies
  • Overview of all Options in Labor, Birth and Postpartum
  • Labor Partner Role
  • Immediate Postpartum
  • Navigating first weeks Postpartum
  • Overview of Infant Feeding and Norms
  • Bonding
  • Medications and Interventions
  • Cesarean and VBAC
  • Unexpected Events
  • Role-playing Scenarios
  • Relaxation and Visualization Practice
  • Local/Online Resources

How the educator reaches her class is fundamental to the learning process and take away of participants.  I encourage women to interview the potential educator. Finding the right fit in a class is no different that in provider, doula or birth location.

Even if a woman knows she wants an epidural, TAKING A GOOD CLASS is vital because she will be having a natural birth the epidural is on board and her Plan B could very well be a natural birth. Being prepared will only serve her well in the fluid process known as labor and delivery.

Gaining knowledge that will help a woman to partner with her provider, address her own needs fully and help her to define her own birth philosophy gives her a leg up on being responsible and in charge in her own health care and even outcomes.

The vast scope of what a solid class series can offer an expecting mother (her partner or support person) is incredibly valuable and can not be understated. A class that provides for encouragement, comfort, safety, respect, connection, structure, evidence-based information and real life application can plant seeds and prosper skills that will carry a woman well into her mothering years. These skills are for life, not just for labor and birth. I am stunned often by how birthing knowledge carries me in daily ability with my own family.

Here’s to happy and deep learning!

Blog Carnival – Grateful for Birth Experiences Due 11/23

Tuesday, November 9th, 2010

I invite you to participate in Preparing For Birth’s upcoming Blog Carnival set to appear on Thanksgiving morning.

Topic: “Why I am grateful for my birth experiences.” This is your point of view. I encourage you to be open about expectations, what it was really like and how it impacted you as a woman, mother, etc.

When Due: Entries need to be received by November 23, 2010 to email desirre@prepforbirth.com

What to include: Blog copy and link to your blog along with name, website, and contact information for attribution.

I look forward to hearing from many of you.

What’s a doula to do?

Sunday, October 10th, 2010

There is such a deep chasm and fracture within the doula community regarding in-hospital and out-of-hospital birth. On the one hand there are those who say anything goes in supporting women and their choices. On the other, there are those who say no doula should support a woman in the hospital environment because it is a “bad and dangerous” place to birth,  or at the very least should get kicked out if she is doing her job “right”.

Who is right? This is where it gets tricky to be sure.

With upwards of 98% of the birthing women going to the hospital in the United States, are WE really within the general doula scope of practice by taking such a hard stance of ignoring those women in need? Who is benefiting here? It is well known, that I am all for a doula deciding her practice style, what scenarios she is best suited to support within, and knowing who she is best able to support.  But to abjectly say, no doula should ever support a woman in a hospital birth, is to me akin to very interventive practitioners who believe that birth is inherently dangerous and a trauma waiting to happen. Thus, viewing every women and baby through high-risk lenses and subjecting them to high-risk protocols where there is no medical need encourages more intervention and higher-risk scenarios to actually occur.

Who does this serve taking such a hard line? Perhaps those speaking it, thinking they are pressing for the greater good. Definitely not the mothers who need the support and assistance navigating a sometimes difficult and stressful system. The mothers and babies are caught then between a rock and a hard place. Then they are effectively forced to go without support and help. The truth is women having hospital births NEED DOULA SUPPORT MORE than women choosing an out-of-hospital option.

Bottom line: I make no claim that it is an easy task to doula within the hospital environment. It is not. It can be brutal. Imagine for a moment, really, close your eyes and think of what happens, what you witness as a doula when you are there — then think of all the women who have no doula present — what happens to them? What do those women experience? What do those babies experience? Now, open your eyes and breathe for a moment. It is not pretty is it?

Right there is what keeps me taking hospital birthing clients. It requires very open communication and immense work prior to labor during prenatals running through scenarios, detailing needs and desires, making certain informed consent and refusal is understood for a variety of procedures, medications, and cesarean. A mother needs to be well-versed in how to use her self-advocacy voice as does her husband, partner or other main support person.

Looking at the flip-side now.

So the other ideal, er rather idea, is that a doula should support anyone and anything because she is a doula poses other issues in my mind.  I do not see anywhere in the job description that this is what a doula ought do.  Any one doula cannot be the right doula for every mother or scenario. This way of thinking can fall into  a cookie-cutter way of practicing, thinking one can be all to everyone. Doulas are people too. Each has individual abilities, biases that need to be addressed, history and points of view.

I think it has been mistaken that a good doula is one that has no say in how she practices or who she is best to serve.  I believe there is a doula for every type of scenario and mother. It is a very individual pursuit and fit.

I know some amazing niche doulas out there who support only high-risk mothers, multiples, same-sex couples, in-hospital birthers, planned cesareans….. The list could go on.

Honestly, I will say there are some amazing doulas who can work under this very open practice style effortlessly and with excellence.  I applaud those doulas, though I think that is the minority and most are not able to keep it up without finding a comfort zone long haul.

Childbirth is such a deeply intimate and intense process with so many variables, being the right fit all the way around is necessary in my humble opinion.  I have seen doulas deeply wounded and traumatized by what happens in the birth room. Sometimes that is unavoidable, but through years of interaction with many doulas, the running thread is that the doula had misgivings even during the interview that this was probably not a good fit but chose not to refer the mother out to someone she knew was better suited for whatever the reason.

Are women and babies really being served best under this model of practice? This is for you to go ahead and answer for yourself.

Bottom Line: Women and babies need individual care whether from a doula, nurse, or care provider. Can a doula be all things to all mothers? Some, I am sure. Overall I believe not. For the health of a doula and the health of her ability to practice and support well, finding the “comfort zone” can make the difference for the mother, baby and doula. Why? Because doula work is such an intense giving of oneself (emotionally, physically, even spiritually). A continual self-assessment needs to be done just where her true and honest “comfort zone” is. By doing this, a doula is caring not only for herself by avoiding burnout, but also for her future clients and her ability to care for others with excellence and utmost professionalism.

Looking for video clips or pictures of labor support

Sunday, April 25th, 2010

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

What Does Pushing Feel Like? Many perspectives.

Wednesday, April 7th, 2010

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.

Technology and the Prenatal “Diet”

Wednesday, February 17th, 2010

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.

Affording the Birth You Want

Monday, February 1st, 2010

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.

Some thoughts on birth and being a consumer.

Sunday, January 3rd, 2010

While “teaching” childbirth class the topic of being a consumer is addressed often in a variety of ways.  I have a firm belief that a woman has the ability to understand, be well educated, and make her own decisions. It is in no way in my job description to tell someone else how she must birth or how to do it in the right way.  She is the one who needs to take the information, explore it and apply it to her self and situation.  Being a consumer in her childbearing year is a key component.

I have a great and deep sense of obligation to give truthful, helpful, real life applicable information to the families I am blessed to work with.  Because of this my mantra is,  “You go home or stay home with your baby and are the one who must live with the decisions and outcomes from them. Not the doctor, midwife, nurse, doula, educator – no one else.  We all go home to our own lives. So if you have to live with all that happens then do your best to choose wisely to what you can live with.”  No mother escapes the outcomes and the legacy it leaves behind forever no matter who makes the decisions for her. Even if it seems easier at the time to allow others to call the shots, I can hope the epiphany of this will help the pregnant woman to push for what she really needs and wants instead of being a passenger in her own process.

Birth options are integrated into prenatals and/or class structure as we discuss birth philosophy, birth planning, re-interviewing care provider, realistic expectations for chosen birth location, and interventions and medications.  Most often I find that women have no idea that there are so many options available for the asking or available in a reasonably close proximity to our local area.  This tells me that care providers expect the burden of knowing the options is to be on the pregnant woman to find out about, explore, and ask for.  She may find that in this process she and her care provider/birth location are either well on or not on the same page with her needs and desires.  This is where she can decide if needed to seek another provider and/or birth location.  There almost always is a way, it may mean more work, effort, and at times out of pocket expense. Some women choose to relocate, ask for help with out of pocket expenses in lieu of baby shower gift, petition insurance to cover the “right” provider…

Really as a consumer the burden is on her to find the right fit and go for it.  It is not for her to fit into whatever is the local expectation for her as a birthing woman.  This comes down to something akin to buying a car because the dealer tells you this is the car you must buy because everyone else has bought it and even though it clearly does not suit your needs, you still buy it.  I have never heard of that happening, yet I hear of women day in and day out having this sort of exchange from prenatal care through the birthing day with their care provider and/or birth location staff.

When it comes down to it, I really want women to have what is individually needed and desired. Who is paying the bills? Who is keeping the hospitals, birth centers, ob/gyns and homebirth midwives in business? Those caring for birthing women ought sit up and take notice. You all wouldn’t exist without birthing women paying for your services.

Every provider or birth location has a practice style, protocol base,  etc.  So why not honestly explain expectations, protocols, practice style in detail at the first visit or during the tour so the mother who is hiring you or birthing at your location can decide whether or not right off the bat if this is a solid fit? No one provider or location is going to fit with every mother nor is every mother going to fit with every provider or location.  Whatever a provider or birth location is good at, expects,  and is striving to be, put it out there so the mother coming in knows what she is buying in to.

My dream is that every birthing woman will know all the options and subsequently exercise her want to the care she desires even if it means walking with her cash or insurance card, since ultimately she lives with all that transpires positive, negative, or in between.

Building Your Birth Support Team

Monday, November 23rd, 2009

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?

“I didn’t realize that I didn’t have the right kind of birth support until it was too late. This in no way is meant to say that my practitioner, or the staff, or my husband were not supportive . . . they were, but I didn’t have anyone on hand to advocate for my needs. Even though I prepared extensively for a natural birth and hired a CNM, I ended up having a cesarean. I firmly believe that the most important member of your hospital birth team is your doula.” Kimberly J.

“…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.

“Because it means the difference between a baby and mom being healthy vs. the million of things that can go wrong if a mom is stressed, confronted, or generally ignored.  Support during birth, whatever that means for the mom, is more important in my hunble opinion than support during pregnancy. Giving birth in a hostile or unfriendly environment is dangerous.” Rachel A.

“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.

Increasing your opportunity for a vaginal birth in a cesarean stricken culture.

Tuesday, August 4th, 2009

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.

Cesarean vs. VBAC: A dramatic Difference

Wednesday, July 22nd, 2009

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.



Thank you Alex for allowing me to share your story!  Many blessings to you and yours.

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



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