Archive for the ‘All Things Doula’ Category

What You Need to Know About Birth Plans

Friday, September 27th, 2013

As a doula, I require all of my clients to put together a birth plan, discuss it with their care provider, and to provide me a hard copy. I make very few exceptions to this requirement. I believe firmly that a birth plan is a critical piece of the puzzle in good perinatal care.

As much as we want to believe that our prenatal care is individualized, it often is not. Even home birth midwives can get into a “this is how I always do it” habit, though that is far less likely. Still – I have learned to never take anything for granted when it comes to care providers.

I spend a good amount of time with each client in helping them form their own unique birth plan, and provide them with role-playing opportunities that teach them how to have open, honest, and clinical discussions with their provider about their individual needs. If I am hired late into the third trimester, that is almost all I end up doing prenatally – birth plan work.

It’s that important.

That said, I don’t particularly care for the term “Birth Plan,” and I use it only because that’s the common vernacular. I think the word “Plan” conjures up images of precise blueprints and/or legally binding documents. A birth plan is neither of those things, and the sooner we understand that, the better.

Instead, I believe that birth plans are tools designed to help you, your care provider, and any staff you encounter to communicate effectively about your individual needs and expectations regarding your care.

It provides a basic framework that helps your care provider and staff to better care for you, but it does not legally bind them to your every whim and wish.

Instead, a birth plan gives you and your care provider an opportunity to pursue individualized care together, and to be on the same page before you go into labor. It has the potential to build rapport, trust, and respect between you and your provider–a critical factor in enjoying a positive, healthy birth experience, no matter what the circumstances end up being.

For this reason, I really prefer the term “Birth Preferences,” “Birth Goals,” or even “Birth Desires.” Those make a lot more sense to me. When a birth plan is viewed this way, it is often much easier to mentally and emotionally process anything that derails those plans.

Birth is still unpredictable, and there are no guarantees, no matter how safe we have made it. The reality is that birth is like any major event we plan: There will always be at least one thing that does not go the way we expect it to, for good or ill.

Mommas get sick. Babies get sick. Babies get into funky positions. Mommas get exhausted. Heart rates get wonky. Side effects of drugs happen. Things stretch on longer than we thought, or go far faster than we anticipated.

Stuff happens.

Overall, birth is a safe and healthy process, but it has a lot of variables within a very wide range of Normal. Accepting that fact, and writing a birth plan with flexibility in mind is key to processing those funky things that happen during our births.

I find that the most flexibly written birth plans get the most respect from staff. They see clearly that my client has done her research, and has realistic expectations. Frankly, I find that my clients are more likely to get exactly what they want when their language is open and flexible.

I also find that when things get weird in a birth, staff and providers tend to bend over backwards to keep the spirit of the plan intact. They seem to view themselves as being on my client’s side, and try very hard to make it work within the parameters this particular labor has laid out for them.

My clients come out of these births processing all of it in a very healthy way. They understand that they don’t have to like what happened, but if they felt respected, understood, and as though their choices mattered, they are often okay in the long run. They understand that it’s okay not to be okay for awhile. They grieve the stuff they didn’t like, but are grateful for the support and good care they received within the circumstances their birth chose for them.

Care they might not have received had they not communicated clearly what they hoped for, ahead of time, via their birth plan.

So, when writing your birth plan, be careful about the language you use. Really examine how it comes across, and how you view your relationship with your care provider. Some basic tips:

  • Open with a sentence like: “We understand that circumstances may arise that preclude the following desires, but we expect to be fully informed before consenting to any procedure that may be proposed, and we appreciate your help in achieving a healthy and pleasant birth.” This lets them know you understand that birth has a lot of variables, and that you are willing to work with the staff.
  • Have a short introductory sentence or two explaining your overall desires. (Natural birth? Well-timed epidural?) The staff will automatically know what requests will go along with that, and you can eliminate a lot of specifics. For example: If you know you want an unmedicated birth, and state that fact right away, you won’t have to tell them you’ll want to move around, have dim lighting, etc…
  • Keep it simple. It shouldn’t be more than one page long.
  • Use bullet points and clinical language.
  • Tailor it to your provider’s practices, as well as the protocols at your place of birth. If you know they do rooming-in, you don’t need to request it.
  • Do your research. Take an independent childbirth class. Hire a doula.
  • Take your first draft to your provider and ask specific questions. “Under what circumstances might you do an episiotomy?” This helps you know if something needs to be added or taken off the plan.
  • Have a cesarean plan. Look up “Family-Centered Cesarean,” and choose your top 3-5 items you think might be important, and add those.

Be decisive and clear in your desires, but remember to stay open as well. Choose carefully your hills to die on, and let everything else go if it becomes necessary. Ask questions. Even if all you can think is to keep asking “Why?” That one word can gain you a lot more information when a decision becomes critical. Open your eyes, and walk forward confident in your desires, your ability to birth, and your ability to make good decisions for you and your baby.

You are already a good mother. Go for it.

I could write mountains of information on this subject, but this post would get too long. Did you write a birth plan? Why or why not? Do you feel your desires were respected? Do you feel it created a sense of cooperation with the staff who cared for you? Why or why not?

Grace & Peace,
Tiffany

Birthy Weekend Links

Saturday, September 7th, 2013

This weekend is coming up fast! What plans do you have? I have family coming in for a five-day visit, I’m on call for a midwife, and I’m trying to put together some bouquets for my sister’s upcoming wedding. In the meantime, here are a few things worth reading this weekend.

Interested in reading more? “Like” my Facebook page, since I tend to share a lot more of these on my Facebook page, almost daily!

Happy weekending to you!

Grace & Peace,
Tiffany

This Is Hard.

Friday, May 31st, 2013

I can no longer describe myself as a stay-at-home-mom. Of course, I am still home the majority of the time, but I am definitely working more now.

Slowly, my business is building and increasing. I have at least one client a month through July, and a few births a month with Desirre as her assistant. Also, I am still teaching as the only educator at Preparing for Birth. That work will have some relief soon, as one of our other doulas is pursuing her childbirth education certification too. She’s student teaching under me right now.

Needless to say, I’m officially a Really Busy Mom. Adding work hours has been tough. Tougher than we thought it would be as a family, but we’re working out the logistics pretty well. I am so grateful that my husband is not just grudgingly supportive, but encouragingly so. He has really stepped up to help on the days I have to go in to work, or get called to a birth.

In addition, with my mom living here for now, we have had some welcome relief. She cannot help but pitch in and do things that need doing around here. She is a beautiful gift. She would make a great postpartum doula.

I know that I am called to this work. When doubts creep in, someone always comes along to remind me of the truth of my calling in birth work. They usually don’t know that’s what they’re doing, but it is.

God is faithful, and is holding me up in this journey.

This is hard, but I am glad I am here.

What has been worth it in your life, in spite of difficulty? Why?

Grace & Peace,
Tiffany

Essential Oils in Pregnancy, Labor, & Birth: Part I ~ Safety Guidelines.

Thursday, November 8th, 2012

Welcome to Birth In Joy, and a new, short series on essential oils you can use in pregnancy, labor, and birth by my dear friend and colleague, Kim Prather.

Kim Prather is a wife to Ryan and mom of 5, learning how to use therapeutic grade essential oils to live a healthier life! Join her, as she learns more about the wonders of God’s creation and how to use essential oils in everyday life, and special situations! She is learning and sharing about Young Living Therapeutic Grade Essential Oils, and loves to help those who are interested in learning more themselves. You can contact her at Front Range Scentsabilities by clicking HERE.

Disclaimer: The essential oils described in this post refer only to therapeutic grade essential oils. I only recommend Young Living essential oils, as I am certain of their high quality. This is for informational purposes only. Different people will respond differently to the use of essential oils.

Essential Oils in Pregnancy, Labor, and Birth: Part I ~ Safety Guidelines for Essential Oils

I created this information sheet for a class that I taught recently to birth professionals. A few of the warnings at the beginning I included as I wasn’t allowed to ONLY promote Young Living, so I wanted to be sure to have my bases covered in case they tried inferior oils. I’ve added a few personal notes in here too! Please comment with questions and your stories!

Important Essential Oil Safety Rule:

Always have carrier oil or pure vegetable oil close by to wipe off essential oils if needed. Apply the pure vegetable or carrier oil to a cotton ball, tissue or handkerchief to dilute and remove the oil. Keep essential oils away from the eyes and the eye area. DO NOT rub your eyes or handle contact lenses with essential oils on your fingers.

The most common Essential Oil Safety Mistake:

If you get oil in your eye, immediately remove the oil by gently dabbing your eye with a cotton ball or tissue that has vegetable or carrier oil on it. This will help dilute the oil. Do not flush the eyes with water! Water spreads the oil and could make it worse. Oils are not water soluble.

One of the most important rules for essential oil safety is to always test an essential oil on the skin before use. Each person has their own unique body chemistry and just as foods affect people differently, so do oils. Testing the oil on the soles of the feet is the safest place. Always test here for babies and children and for those with allergies. Another location is on the inside of the arm just above the elbow. 10-15 minutes is usually sufficient. If the person you are testing is prone to allergies, or unusually sensitive, allow for 30 minutes. Testing allows you to see how their body will respond. Always ask about allergies.

The following are essential oil safety guidelines that are important for you to know:

1. Always have vegetable oil or carrier oil close by when applying essential oils. This is to dilute and remove the oil if necessary. Do not try and dilute the essential oils with water, it will spread the oil and could make it worse.

2. Certain oils should always be diluted. They can burn and injure the skin. Oils high in phenols, citrals and cinnamic aldehyde, such as Thyme, Oregano, Clove and Savory (phenols), Lemongrass (citrols), Cinnamon Bark (cinnamic aldehyde).

3. Always use a dispersing agent, such as bath gel base, when adding essential oils to bath water. Never add undiluted essential oils to bath water as they can injure or burn the skin.

4. Do not apply undiluted or neat essential oils to parts of the body that are hot, dry, or tender. Instead, use a compress that has been soaked in cold water filled with dispersed essential oils.

5. Use only therapeutic grade essential oils and oil blends. This is extremely important regarding essential oil safety. Before ingesting essential oil, or applying it to your skin, know and trust your source. Most oils contain chemicals that may be dangerous and toxic. I only recommend Young Living Essential Oils because of their purity and quality.

Sources:

CAPPA Conference 2012, Day 1: My Take on Things

Friday, July 20th, 2012

I’m beginning to wish that I had brought my camera after all. I decided to leave it home so that my husband could take pics of all the fun things he planned to do with the kids while I was gone. Turns out we have a sick kiddo, so that fun is not necessarily going to happen.

After five great, brain-busting, heart-tugging sessions, my mind is full. The theme this year is building bridges, and all the sessions so far have really given me some practical tools and advice on how to make productive, positive changes to the way I approach my clients and students.

I thought that tonight, I’d just share a few quotes that I really liked from the various sessions today, as well as a few things I learned.

1) Bridging the Nutrition Gap (Laurel Wilson IBCLC, CLE, CLD, CCCE):
The nutrition moms are able to get lay the foundation for her unborn baby for the rest of their life. Sure, we can make changes as needed as adults, but it’s far easier to make healthier choices if the foundation is already laid. Nutrition affects our epi-genome. (Google epigenetics – it’s fascinating stuff. Not going into it here, but man alive…)

2) The Accidental Parent (Tracy Wilson Peters CLD, CLE, CCCE):
I learned the H.A.L.T. principle. Never make important decisions or have important discussions with your spouse when you are Hungry, Angry, Lonely, or Tired. Makes sense!

3) Birth & Postpartum Rituals Around the World (Darla Burns CPD, CLE, CCCE):
We need to learn to value the trichotomy of father/mother/baby, not just the dichotomy of mother and baby. We all know fathers are important, but we do tend to sort of leave dads out a little in childbirth education.

4) Building Birth Bridges (Janice Banther CCCE, CLD, CD):
I learned here how to get things done, reach my goals, and fulfill the dreams I have in birth work by building communication bridges based on the interests and needs of others before myself. Super-inspiring lecture!

5) The eBirth Professional – Best Practices in Technology Use (Desirre Andrews, CLD, CLE, CCCE, Intern Midwife, Advocate):
Oh, MAN – all the stuff I learned in this session! The balance of being real, but professional. Human and accessible, but appropriately private. Developing and establishing my online presence, and finding my own voice.

Looking forward to tomorrow, so much. I can’t wait to really process all this and put it into practice!

Grace & Peace,
Tiffany

Announcing Something Cool

Tuesday, July 17th, 2012

Just a moment ago, I signed a doula contract with Preparing For Birth. Though I will be retaining my business name as a doula (Birth In Joy), I will be working exclusively with Preparing For Birth.

As a result, my fee structure will be changing.

Watch for the upcoming changes on my website, and hop over to Preparing for Birth to take a look at all we offer as a group.

Being part of a growing organization like PFB this past year has been exciting and filled with opportunity to learn, and I am so ready to change and grow and learn even more!

Grace & Peace,
Tiffany

Really?! Fear Slows Down Labor?!

Tuesday, July 10th, 2012

It’s been awhile, birthy world! Thank you for your patience. I’ve had quite the interesting summer so far, how about you? Anyway. Today’s post.

Go ahead and go read this short article before you proceed here: Fear Makes Labor Longer, Study Finds.

Image found at seamlessbrand.blogspot.com

So, they’ve “discovered” that fear slows down labor. Really?

This is something women have known innately for thousands of years, and something that natural birth professionals have been preaching for decades.

We cannot make labor happen faster than it should. However, there are things we can do to slow it down – and harboring fear is one huge one. It’s called the Fear-Tension-Pain cycle. A phrase coined by Dr. Grantly Dick-Read, a pioneer in natural childbirth.

Essentially, it works like this: Mom feels the pains of her first contractions, and fear creeps in that she will not be able to cope when it gets harder. This raises her stress hormones, which ready her for flight, and she tenses up. At the peak of her contraction, her carried tension leads to a greater sensation of pain, and she again begins to fear what comes next. She fears she will not be able to cope, and the cycle begins all over again. Not much fun, I’m afraid.

How do we break that cycle?

1) Hire a doula.
I address a mother’s fears by listening to her, and helping her work through them verbally ahead of time if at all possible. This can even be done in labor. Even small fears have the potential to become big ones in the right environment, so never dismiss any fears you have as “silly.” Address it, work through it, and let it go as best you can.

2) Take an evidence-based childbirth class.
In class is where you can find all kinds of practical tips, tools, and techniques (hooray for alliteration!), for coping with any kind of pain or discomfort you may have during labor. It’s a chance for your support person to learn how to best help you, and you can prioritize ahead of time what techniques you would like to try first.

Also, the more you know about the basic anatomy and physiology of normal birth, the less likely you are to fear it. It kind of takes away all the mystery, and sheds light on an aspect of your womanhood you may never have really understood before. I know that very understanding was a huge help to me as I labored with each of my children.

3) Consider home birth.
No, really. Do it. Look into it. Especially if you have a strong aversion to hospitals and doctors normally. What better way to minimize fear than by being in your own space? Where everyone caters to your needs in labor. Where no one crosses personal boundaries “for your own/baby’s good.” Where you have the most control over the environment. Midwives almost always offer a free consultation, and it never hurts to ask questions! (Visit my home birth & midwifery link at the top of the page if you have more questions.)

4) Learn effective stress management techniques.
These don’t just work for labor – they work for life. They are practical things you can even teach your young children to do when they are feeling stressed. We all know that stress can make us sick, so learning to do this is paramount to all of us in the crazy-fast-paced world. Incidentally – many of the basic relaxation techniques taught in childbirth classes are great stress management tools!

Among many other tools, you can use prayer, physical relaxation techniques, massage, warm compresses, breathing, essential oils, and herbs.

Once the cycle is broken, and you are relaxed, your labor will progress much more quickly and bearably. You may even enjoy many parts of it! It’s not as overwhelming when you know that it is all perfectly orchestrated to bring your baby earthside as safely and effectively as possible. Eliminating fear from the equation allows a better cycle to work: Rhythm, Relaxation, & Ritual cycle (Penny Simkin).

Well, it’s not so much a cycle as it is a principle at work.When you are able to get into a groove of some kind, to find your rhythm, you are able to relax more effectively. You will create little rituals that mark time and space for you in a place where time and space mean almost nothing. It sends you to your primitive brain (a.k.a. “Labor Planet”), and helps you handle your labor as you were intended to handle it: one contraction, one rest period at a time.

When you are relaxed well, you are able to handle everything your labor brings forward. You can crest your contractions like waves, accepting them and holding realistic expectations of your own ability to continue working as long as you need to.

A woman relaxed in childbirth is a woman of power, strength, and faith.

A woman relaxed in childbirth allows her labor to work as quickly and efficiently as it was designed to. There is nothing to slow it down when fear is out of the way.

The beauty of it is that it also has a physiologic effect on your labor! Women, relaxed and uninhibited, will MOVE in labor. They will move a lot. And every movement of mother encourages the baby to move, which in turn encourages the cervix to move, which encourages mom to move, and on we go. The beautiful cycle of relaxation and courage!

Embrace it by educating yourself and taking nothing for granted.

If you have had children before, what was the one thing that helped you cope with each contraction the most? What led you to try that? What fears, if any, did you confront in your childbearing year?

Grace & Peace,
Tiffany Miller, CLD, CCCE

New Happenings!

Tuesday, June 12th, 2012

Image from: homeandgardenideas.com

My business is beginning to thrust up little green shoots of growth, and I am deliciously excited with the doors that are opening for me in this privileged line of work! My responsibilities in my work grow, and I find myself considering each and every commitment in my life, my list of priorities, and my dreams as a birth professional in a new light as I experience growth and learning through change.

It seems to be a bit of a bumpy ride, but like birth, it will all be worth it in the end! The hard work, prayer, and rearranging I am committed to in order to keep growing is a lot to digest, and is a little bittersweet. It means that my life will not be the same. That’s great though – it was time for a change!

This summer will be a time of transition for me, as I begin to phase out a lot of personal outside commitments, and focus on more family and birth work commitments. By the fall, there will be a lot more birth work, if all things go as planned, and I am working hard to make small, daily changes to give my work a greater chance to thrive.

I cannot do otherwise. Every time I turn around, I’m receiving “random” confirmation from the God I serve that “this is the way, walk in it.” It’s exciting and scary and new and so very, very right.

One of the changes I am implementing is committing to real-live, genuine office hours as a part of Preparing For Birth! They are short, but they will be expanded come fall. These hours will allow me to keep my word to a few friends who need me over the summer, but still initiate the growth in birth work that is on the horizon.

I will be in the office from 1:00pm to 5:00pm every single Tuesday. I will reserve the mornings for home visits and postpartum work, while the afternoons will be open to interviews and prenatal office visits. It’s also a time that anyone who would like to can stop by, borrow a book, ask a question, pick up supplies, register for classes, etc… Preparing for Birth is growing, and I get to be in on it!

Another change is that, in addition to being a private practice doula, and a contracted educator, I will also be offering my doula services under contract with Preparing for Birth. There will be benefits to my clients whether I am hired under the Birth In Joy name or the Preparing for Birth name – I feel strongly that this will be the best way for me to give greater access to my services to a wider range of women and their families.

Also, I will become the official “librarian” for Preparing for Birth. Over the next few weeks, I will be collecting and cataloging all the books we have at our disposal, and implementing an easy system for our clients and students to check out books and videos. To be honest, this sounds fun to me. My natural bookworm tendencies has me excited about this!

As I sit in the office, typing this post, I smile. I know that there are challenges coming up, and there will be some inner conflict as I work to change some deeply ingrained habits, but I know that I am strong to meet them, by the grace of God. I’m sure that there will be a few stumbles as I unlearn a lot of things, and open my heart and mind up to learning new things, but I am also sure that I am not alone. I have an incredible community of support, and I am truly as excited and happy as I am nervous about it all.

I cannot wait to see those small green shoots grow into lovely shade trees – perhaps kind of willowy – stable and richly green in season. I am willing to work and wait, water and weed, protect and persevere to see it all come to fruition. To rely on the grace and wisdom of Jesus as I walk.

I can do this.

I was made for it.

Grace & Peace,
Doula Tiff

Intangible Reasons

Tuesday, May 29th, 2012

Image from imdb.com

My husband and I watched “Away We Go” last night. It’s a movie about a pregnant couple’s quest to find the place where they want to give birth and raise their baby. Along the way, they meet up with a lot of old connections to try and get a feel for where they belong. During the obligatory “hippie-tandem-nursing-birkenstock-wearing-freaks” scene, one line really stood out to me, and bothered me.

As filled as the scene was with exaggerated stereotypes, it wasn’t those that bothered me, because all of the families in the movie were portrayed in a way that was a bit over the top. (Except the infertile couple – THAT was one of the best movie scenes I have ever witnessed. Ever.)

John Krasinki’s character explains why he and his girlfriend don’t need a doula. He says something along the lines of “Doulas are for women who are clueless, or have a partner who doesn’t want to be involved, and since I am involved and educated, we don’t need one.”

While he is right in the fact that a doula can be a great asset to a couple who are “clueless,” the quote illustrates the common misconception that doulas replace fathers in the birth room. That if the father is involved and supportive, a doula is just an extra. It’s simply not so.

For one thing, “clueless” clients have more potential to drive a doula crazy! We try to teach our clients to take responsibility for their own births, and encourage them to educate themselves as much as possible about everything relevant to their situation. Some do, and some don’t. The hardest births to be on as a doula are ones in which a mother has not educated herself much at all, and has unrealistic expectations of both birth and her doula. That is a problem that is usually easily remedied. However, not really the point of this post.

Moving on. Sorry to slow you down.

The truth is that men in the labor room is a recent phenomenon. For eons, it’s been women’s work. Birth is what women do. And we do it well. We did not “need” our men in the birthing room – we could handle it pretty well, thankyouverymuch.

However, we began to want our men in the birth room, and welcomed them. Super-cool! We felt it only made sense for the one who helped create this child, be there to help bring him into the world. And we were right. Men should have the chance to see the women in their lives be so strong.

We then threw the baby out with the bathwater, and banished everyone else in favor of the men in our lives.

No one – and I mean no one – can replace the father, husband, lover in the labor room. However, neither can the father bring the shared connection all women have. They can’t bring the “girl power” women thrive on when they are laboring.

Birthing women need both.

For example, I had both my husband and my mother at all of my births (this was before I’d ever heard the word “doula” – my mom essentially filled that role). I could not have done what I did with either of them missing. It is hard to explain tangibly the reasons that this is so.

When I tried to explain it to my husband, I told him that when Mom said I could do it, she was the one I believed.

It’s not that I didn’t believe anyone else, it’s just that it was her energy, faith, and connection to me that helped me put feet to my own belief in my ability to birth. I believed my husband when he said he believed in me, and I appreciated his confidence, but when my mom looked me in the eye and said “You can do this,” something inside me responded, and I could not doubt that she was right.

That is why even the most educated, proactive, emotionally-healthy, bonded couple can benefit from having a doula – and I would even venture to say, needs a doula.

I hear it all the time from my clients: that they just believe me when I tell them they can carry on. They tell me that they love and appreciate the safety and security of their partner’s presence; the love that radiates from his eyes when he holds her hand or brings her water gives her a comfort that cannot be matched. She blossoms under such romance (which is exactly what it is).

But when the doula speaks, moms listen, and their faith in their own ability to birth is given wings.

The truth is this: She cannot do as well as she wants to do without either.

Nearly every client tells me, “I couldn’t have done it without you!” then immediately turns to her partner, “But I couldn’t have done it without you either!” Both statements are as true as true can be. I feel the same way about my mom and my husband.

Of course, there will be exceptions to this, and only you can decide if you are one of them. There are also many situations in which a mother doesn’t have a partner at all, or her situation varies from the norm in some other way. Her need for a doula who will walk alongside her, hold her hand, and support her unconditionally is even greater! I have supported several such women, and stepping into what is essentially a dual role is tough. I could never do that for all births!

My point is that just because factors, A, B, and C all line up for you does not mean that you don’t “need” a doula. Sometimes, it’s the most educated clients that need me the most when push comes to shove. (No pun intended.)

Never say never. Talk to doulas in your area, gauge your needs well, and make the right decision for you and your family. Don’t let anyone – especially a care provider or Hollywood – tell you that you don’t “need” anything when it comes to your birth. Only you can decide that. And take what the media says with an extra-large grain of salt.

Grace & Peace,
Tiffany

Do Moms Planning an Epidural Need a Doula?

Friday, May 25th, 2012

This question was posed on her facebook wall by my mentor, Desirre Andrews. I appreciate the thought that her questions provoke, and the way she challenges me to dig a little deeper and search out what my answer would be to this question.

I think, overall, there is an assumption in our country that an epidural is a panacea. The concept of labor with an epidural on board is one of passivity and a desire for separation from the experience because of fears about the process of labor. Whether those fears are well-founded or not really does depend on the individual, and is not the subject of this post. I would very much like to see a more realistic, knowledgeable view of epidurals begin to take prevalence in my community, and the world at large.

As a doula, I know that I can bring my community closer to that vision, one mother at a time. So, here is my answer to the question posed in the title of this post:

I usually tell someone that they don’t “need” a doula (if they want to get all technical), in that they can definitely have their baby without one. Yet, I would never say that a doula is a luxury, either. There is too much benefit to the presence of a doula, supported by scientific evidence, to label them luxuries. Not to mention the fact that women, for all of our world’s history, have always supported women during birth. Women need women who believe in them at their births. Period. Again – a subject for another lengthy post.

Moving on.

In the specific case of a mom planning an epidural, a doula can really help to optimize the use of this particular tool — maximizing its benefits, and minimizing the risks associated with it — if that’s what she wants.

A doula can help a mother stay calm through the procedure, and prepare her ahead of time to have realistic expectations of what epidurals do and do not do. Contrary to popular belief, epidurals are not a panacea. They vary in effectiveness for many women, and come with some side effects that are common enough that every woman who wants one should know about them.

A woman with a doula who has educated her ahead of time who experiences, for example, the drastic drop in blood pressure that can go along with an epidural, will know that the nurse will come in, place her on her side, put an oxygen mask on her face, and give her medication to raise her blood pressure immediately. The nurse will act, she will not ask. This prepared woman will be less susceptible to fear as the nurse takes quick action. The unprepared woman may end up scared out of her wits, and experience fear for her baby because of this process, if she did not know ahead of time that it could happen. A doula can prevent the latter circumstance. Doulas can help take fear out of the equation for women.

Along the same lines, a doula can assuage the fears of a woman’s partner, and reassure him/her that what’s going on is common, normal, and that mom and baby are likely to be okay. Partners who love these women so much often forget all they learned, as their gut takes over, and having a doula there for reassurance can really bring a sense of peace to the partners, freeing them to be fully present in their relationship to the laboring mother.

Doulas can also give women tools to cope with labor up until the time the epidural is placed. Mom is having a natural birth up to the point the epidural is in place, after all! A woman and partner equipped with basic labor coping skills and techniques will be able to handle whatever their labor throws at them up to the point the epidural can be placed.

Many moms, without the presence and preparation of a doula, may not know that the timing of an epidural is critical in avoiding some of the risks (both for herself and her baby), and maximizing its benefits. For one thing, an epidural placed too early can cause labor to slow down enough that Pitocin will be needed, beginning the lovely “Cascade of Interventions” all of us in the birth community are familiar with.

Without a doula, a mom may not have the confidence to believe she can handle labor beautifully until the time comes that an epidural would be more to her and her baby’s benefit than a risk. A doula can bring a strong sense of “I can do it” to the labor room, and help a mother to gauge when the time is right for her epidural.

Once the epidural is in, a doula will help a mother assume multiple positions that can keep it working well, keep her pelvis moving, and encourage progress. Progress in labor is directly linked to the amount of movement mom is able to do, and a doula knows this. She can help a mother and her partner work to keep an active role in her labor by maneuvering mom into alternating positions. Since epidurals are gravity-based, this also helps keep the pain relief on a more even keel, and minimizes uneven sensation.

A doula can also walk moms through what pushing with an epidural might be like, and teach them about different options for that stage. She is equipped to help them advocate for the option to “labor down” (a technique that can help preserve mom’s energy for more active pushing when baby is much further into the pelvis/birth canal), instead of beginning active, hard pushing as soon as she reaches full dilation. She can help mom assume different positions every few contractions, to maximize baby’s ability to descend and rotate well. This can also minimize the risk for forceps or vacuum extraction being needed.

After the birth, during the postpartum visits, a doula can help walk moms through any after effects she may be experiencing. She will have prepared the mother to recognize signs of a spinal headache (one possible side effect that is fairly common, but not overly so), and to get help quickly for it. She can help moms understand the back pain that may come along with it; the longer recovery time often associated with it; and – if it was on board for more than four hours – the side effects that her baby may experience. Usually, a baby might be sleepy, and have trouble latching on for the first time.

Once a mom is fully equipped with all the information about an epidural, she is equipped to take any side effects in stride, without fear. She knows that they may happen, and she accepts and owns her decision. She can come out on the other end still satisfied with her experience, even if she has experienced some negative side effects, when she is fully informed and fully supported in the way that only a doula can really do.

So, do moms planning an epidural need a doula?

You tell me.

This is just the tip of the iceberg regarding the knowledge a doula can bring to an epidural birth. If you are a birth professional, what would you add to this? If you are a mother who chose an epidural: Did you have a doula? If so, how did she help you? If not, would you want a doula the next time? What was your experience – doula or no doula?

This is a safe place for you to share – so, please do!

Grace & Peace,
Tiffany