Help Your Doula Help You

Written by Dale Bernucca, Childbirth Educator and Doula, with input from other childbirth educators at www.independentchildbirth.com.Childbirth Educators and Doulas have permission to share this article with their students/clients, as long as the author and website are cited.

Support: sup·port (s -pôrt , -p rt )

tr.v. sup·port·ed, sup·port·ing, sup·ports

To bear the weight of, especially from below; To hold in position so as to keep from falling, sinking, or slipping; To be capable of bearing; withstand; To keep from weakening or failing; strengthen; To provide for or maintain, by supplying with money or necessities; To furnish corroborating evidence for; To aid the cause, policy, or interests of, To argue in favor of; advocate; To endure; tolerate; To act in a secondary or subordinate role to (a leading performer). source: The Free Dictionary

Synonyms: uphold, back1, advocate, champion

uphold: maintain or affirm in the face of a challenge or strong opposition; back: material or moral support intended to contribute to or assure success; advocate: verbal support often in the form of pleading or arguing; champion: fight for one that is under attack or is unable to act in their own defense source: The Free Dictionary

It is natural to want to consider having a woman experienced in labor and birth with you when you are in labor. Women have birthed with women for centuries (midwife) and in many parts of the world including the USA women still bring a female relative or friend with them along with their partner when they go to their birth place or make a  conscientious choice to birth at home specifically because they desire the female presence to be primary.

As we have moved further and further away from birth as a normal, organic process women find themselves intuitively feeling a sense of an incomplete birth setting as they near their due date. Some women are unable to define what is missing because they’ve never witnessed a natural birth taking place where it began, in the home. Today the majority of births in America take place in hospitals and hospitals at one time denied women any family support in labor and birth. We are making progress as today many fathers want to be at their children’s births and most hospitals are beginning to outright protect a pregnant woman’s patient rights.1

Still, women find themselves desiring ‘more’. As birth educators, women who have experienced joyful births and as women who have been with women at birth can attest ‘I need something more’ is an oft repeated thought in the laboring woman’s mind. The ‘more’ that the laboring mother cannot define is the intangible that a clinical staff can rarely provide thoroughly if at all: physical, mental and emotional support. This lack can be attributed to many causes ranging from the clinical need to distance oneself emotionally in order to best assess and manage the medical case to never having  witnessed or experienced a spontaneous, unmedicated birth over an intact perineum.

After viewing, sharing and learning about natural childbirth without interventions you may find yourself realizing that you need something ‘more’ at your birth. Hopefully the ‘more’ will be a bit easier for you to define now that you know what your body is capable of doing and you’ve explored where you are on your mental and emotional journey to your baby’s birth day.

Take a look at the definition of ‘support’ above. Right now you are your own best resource for planning your birth. You know yourself better than anyone else you’ve met or will meet as you near the start of your labor. If there is something that you identify as needing bolstering in your labor now is the time to give serious consideration to mending it. For most women who understand the physical process of labor the ‘more’ that is needed is recognized immediately and it is easy for them to choose from the above list why they desire an extra female presence at their birth. If you don’t understand the process of birth then you are probably finding it more difficult to pinpoint exactly why you want a doula and that’s okay IF you let your doula know that. This will help her be at ease in opening herself up to you and exploring all avenues of support she is experienced in giving.

Your doula helps you best when you are proactive in learning about natural birth and all of your birth options. Many books, articles even doula certifying organizations themselves can put out messages about doula definitions. Some say that doulas provide only comfort measures. Some say that doulas are advocates. Some say that doulas cannot make decisions for you. Some say that doulas provide information. The truth is that doulas can be one or all of these things but what they are is dependent on the individual mother they are supporting at that one birth. A doula can play different roles for the same woman for different births. The greater the mutual exchange of insight ~ including setting  boundaries for your doula ~ the more positive your birth experience will be especially if you find yourself presented with a cesarean for true medical indications.

If you are hearing your intuitive voice say that you need something ‘more’ start thinking about what you know about natural birth, all birth options in your area from homebirth to hospital birth, what you know about yourself and what you know about who you currently have in mind to be at your birth.

If you are early in your pregnancy start with a comprehensive natural childbirth class. You will need time to:

Learn about keeping yourself low-risk and healthy so you can keep all of your options open

Learn about your local birth care options

How labor begins

Variations of normal first stage labor

Variations of normal second stage labor

Variations of normal third stage labor

Recognizing the true medical situation requiring medical intervention

How your baby’s health is affected by how you labor including,

Breastfeeding and how you and your baby’s breastfeeding relationship is affected by how you labor

Understand how your local birth care community affects your birth (you may decide it’s your careprovider that’s leaving you feeling less than fulfilled!)

Learn about your resources should you experience a traumatic

Process the information and make some informed decisions and birth planning including changing from your original careprovider and birth location if necessary

This is the knowledge foundation you need before interviewing doulas. You will be prepared to know exactly what you need. Using the same process you applied to identify the careprovider right for you, you’ll be able to recognize the right doula for you. To be clear, your doula will never make decisions for you but she can be pivotal to your decision-making process as at this point you will know what real birth is and you’ll be prepared with real options. Options that she can remind you or your partner about rather than try to educate you when you’re in no mental or emotional condition to think them through with the time and effort you and your baby deserve. She can provide the physical comfort you’ve read about AND she can give you the mental and emotional support that comes from sharing her own birth experiences as well as those of women whom she has witnessed labor and birth. She can share the insight of births with unexpected outcomes, what may have contributed to them and put your decision in a educated perspective rather than being motivated by irrelevant external influences. These priceless experiences shared intuitively let your birth unfold as YOUR birth. The moment you’ve waited a lifetime for.

1 Patient Rights Program http://www.patient-rights.org/about/about.html, Health Law Department of the Boston University School of Public Health

Permission to reprint is hereby granted without further authorization as long as the text remains unedited and the author and source, Dale Bernucca for Enjoy Birth are properly cited and credited. Copyright 2007

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The problem with "great ideas"

        They are not used wisely.   I thought of this when at the last birth I attended as a doula, the OB says, “You have fallen off the ‘curve’ of typical labor progression. ”  Referring to the bell curve of the length of typical stages of birth, developed by Emanual Friedman.  He is horrified on how that information is used today.  “We found an average.  People think the average is what women should fall upon.  That is clearly not true but rather a broad range of normality beyond which a potential abnormality may or may not exist.  These abnormalities are not in themselves justification for forceps or cesarean…  It doesn’t’ mean she’s doing so badly that you have to do something terrible to her. That is being abused.”  (From the book Birth by Tina Cassidy, as seen in my review below)

              Now in this particular case the mom was exhausted and really wanted a cesarean.  The OB said, “Baby is fine and you are fine, so we can wait, but there is no guarantee you will continue to progress, or you will have the energy to push the baby out”   Mom chose cesarean and as she was SO tired, I don’t think she could have pushed the baby out if she was at 10cm at that moment, she feels good with her choice.  BUT, misuse of a “great idea”. 

              Another “great idea” was Electronic Fetal Monitoring, which was supposed to help during birth, to monitor the baby and determine if their was problems.  This was in replacement of the care provider or nurse listening to the baby’s heartbeat on their own.  Today nurses don’t even have to be in the room with a birthing mother, instead they are at a desk outside their room, watching monitors of many women.  This has only made women feel more isolated and alone during their births.   The machine is the center of attention instead of the moms or even the babies (though it is monitoring the baby, the machine is where the focus is)  

           Today intermittent fetal monitoring is standard in hospitals, where they monitor the baby for 15 minutes out of the hour.  This has been shown to be as effective as continuous monitoring in predicting problems.  Sadly because of litigation many hospitals now require continuous fetal monitoring.  So begins the cascade of interventions, where mom is strapped to a machine and unable to move. 

         How does one of the creators of Electronic Fetal Monitors feel about this great idea?   Well, it is another misused “tool” of the obstetrics world, leading to the increase in cesareans with no improvement of baby outcome.  Read an article about him in the Wall Street Journal here

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Birth by Tina Cassidy

Birth by Tina Cassidy

Who is the intended audience of this book?  Care providers of pregnant women… if they actually take time to read it, the may learn something.  Women of childbearing age or younger or anyone in their families…. DO NOT read this book

It is scary to read and starting with the first chapter, that alone will make you question mankind’s ability to still exist because of all the horrible things that can go wrong during birth.  Most of these stories are from women who lived long ago and had Rickets, which caused bone softening and pelvic deformation.  Luckily if you are reading this you most likely live in a society where Rickets no longer exists.  But the fear and scariness doesn’t stop there.

As a Childbirth Educator and doula, I found it an interesting though disturbing read.  It was one of those books where you are yelling at it at times.  Partly because of the stupidity of what has gone on throughout the history of birth.  But also party because I felt like it was SO negative.  I just would NEVER let a pregnant women read it, she might go sign up for an Elective Cesarean, because the overall tone of the book is birth is scary… complete with horrific stories (mostly due to Rickets which no longer exists in America) to demonstrate it. 

I did enjoy the section on the Dawn of Doctors, where I learned more about some inspired care providers and their journeys.  Grantly Dick-Read who wrote Childbirth Without Fear and Fernand Lamaze were of extra interest to me as a Hypnobabies Instructor, because I learned that their teachings included a lot of mind over body thinking, as well as the importance of hospital staff supporting and believing in the moms ability to have a comfortable birth.  Having been a mom using hypnosis during my 2nd birth, totally comfortable and the nurses telling me at least 3 times, as soon as your water breaks it is going to hurt… not surprisingly when my water broke it did start to hurt.  When I had my 3rd baby, I used Hypnobabies and had a Bubble of Peace to protect me from the negativity of those around me, including the hospital staff. 

I learned about Emanuel Friedman who watched birthing women and came up with the bell curve of the length of typical stages of birth.  He is horrified on how that information is used today.  “We found an average.  People think the average is what women should fall upon.  That is clearly not true but rather a broad range of normality beyond which a potential abnormality may or may not exist.  These abnormalities are not in themselves justification for forceps or cesarean…  It doesn’t’ mean she’s doing so badly that you have to do something terrible to her. That is being abused.” 

So this one chapter I found to be very informative and enjoyable to read. 

The tools and fads chapter was an interesting look at the different ways people dealt with and currently deal with Childbirth.  It was disappointing to me how in a chapter that could have had positive parts to it… ie waterbirth, hypnosis etc, there was still an over all fear feeling to it.  In the waterbirth section the main focus seemed to be on why it is fought against by many care providers, with of course stories of babies dying included.

Please if you are pregnant or ever will be do NOT read this book, it is too negative, with the exception of the Dawn of Doctors chapter, there was nothing positive I will take from this book. 

I especially disliked the last 2 pages.  The author looks back even after all she has learned she wouldn’t change anything about her birth… sort of defeatist attitude.  (She had a very medically managed birth ending up in a cesarean,) but does concede maybe she should have chosen a midwife and had a doula. 

“Women will forever give birth in many different ways – either by design or through forces out of our control.  As for the latter, we can only hope to be pleasantly surprised.” 

Really, I guess one might believe this after reading the book.  But knowing what I know as a childbirth educator and VBAC mom, the choices we make starting with our care provider down to positions we choose during birth can make a HUGE impact on our birth. 

If you want to be empowered by books about birth, I suggest reading the following instead of this one.

The Thinking Women’s Guide to a Better Birth by Henci Goer

Ina May’s Guide to Childbirth by Ina May Gaskin

If you want a history about childbirth in the USA but would like to feel empowered by the knowledge rather than defeated try,

Born in the USA by Mardsen Wagner

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New Hypnobabies Class starting in Lake Forest, California

Classes start Monday November 19th 6:30-9:30.

Visit http://www.enjoybirth.com for more details on what the classes cover and to contact me for more information.

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Business of Being Born Movie Review

I was so excited to go to Belly Sprout, in Fullerton to see the Business of Being Born.  I had heard good reviews of it and I love birth, so it seemed obvious I would love this film.  Belly Sprout is a great little space, with natural items for babies and moms, with room in the back for classes or film screenings.  It was fun meeting new people as we waited for the film to start.   

    The film overall was enjoyable.  The intention of the film seems to be showing how homebirth can be safer and better than hospital births.  There were interesting interviews and quotes throughout the movie.  Some wonderful home births were shown.  They were empowering to me as a natural childbirth enthusiast.  These same births could be seen as scary by moms who are afraid of the pain of birth.  As a Hypnobabies instructor, I know birth can actually be comfortable and enjoyable if you have the right hypnosis tools, so I wish a Hypnobabies birth had been included.  I worry that some moms might see the births in this film and say that is why I am going straight for the epidural.   

     They did discuss some of the different problems that come up with hospital births.  Including the cascade of interventions, though I wish they had been a little more explicit in that, because while as a childbirth educator I am well aware of what that entails, many women are not.  It was fascinating to see OBs interviewed and when asked the question, “How often do you see a natural birth?”  They were sitting there dumbfounded.  The answer was basically never.  My friend’s husband is doing his residency in Obstetrics and he agrees with this statement, they never see a normal, natural birth.  They are taught not to be lifeguards, jumping in if something goes wrong, rather they are taught only how to actively manage birth, which leads to problems of their own.  So how are they going to learn to support moms who want this?   

     The ending of the film ruined the whole film for me.  I think it was important to show that at times it is medically better to have a hospital birth (in this case the baby was preterm and breech).  This birth would have been better towards the front of the film, I am thinking after the OB says “95% of my job is boring, but then 5% is exciting/scary”  Ok, show the scary birth at that point of the film, then spend the rest of the film showing the wonderful 95% that are safe at home.   I think they were trying to have this moms story be one that wound its way throughout the film, but I really think its position in the movie undermines the whole purpose of the film.     

     Since this mom did end up with a cesarean, PLEASE use this as a chance to talk about VBAC (vaginal birth after cesarean) and how next time this mom can have a vaginal birth and it would be ok.  Tell the world about ICAN and how it is a wonderful organization to help moms avoid cesareans or recover from them if they have one.  Let this film really educated and help the world in more ways than just homebirth.  It would add maybe 1 minute to the film, but would have the potential of helping thousands of women.   

     Overall I guess I would give the film 3 out of 5 stars.  If they could edit it and change where the cesarean birth is in the film I would make it 4 out of 5.  I would not recommend my Hypnobabies Moms watch it while pregnant, as I want only positive images in their mind as they prepare for their births.  But I do think it would be a great film to show in a college class to help women think about births before they are in that stage of life.  If we educate women earlier about their choices in birth and their power as women and mothers, we can change the world! 

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Great article to read

about What Women Aren’t Told About Childbirth.

It is talking about all the information they gathered from the Listening to Mother’s Survey. 

http://www.alternet.org/healthwellness/65608?page=1   Enjoy!

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I LOVE being a doula.

It is such an honor to be invited by a family to support them during the birth of their child.  I was lucky enough to attend 2 births this past week.  While they were both long, I was energized throughout because I was at such a momentous wonderful occasion!

How can a doula benefit you?

       Up until the late 1800’s women were attended to, by other women during their births.  They may have been midwives or just a caring neighbor or family member.   A basic belief was shared that a woman was able to give birth  The same woman would stay with the mom throughout her birthing time, giving her physical and emotional support, continuing for a time afterward to make sure that the mom and baby were doing well.  This continuity helped the mothers feel safe and supported in this transition from pregnancy to motherhood. 

       The thing that is missing from many births today is that continuity of a caring woman.  It is expected that the dad can be the “coach”, but the dads often do not know what to expect any more than the moms do.  They aren’t usually educated in what the typical interventions are in a hospital birth and the pros and cons of them.   It is hard for them to see their partner uncomfortable and stay calm and confident.  Dads often just don’t have the same kind of touch a woman would have. 

       Typically parents are going into an unfamiliar environment (a hospital) to have a baby, where the birth is sadly treated like a medical event instead of a life changing spiritual event.  Mom is treated like a patient and is frequently forced into the hospitals and care providers routines, procedures and timelines.   It is often an unknown of who will even be there when the baby is born… which Dr. will be on call, etc.   The moms hope for a nice nurse (knowing the OB will just be there to “catch” the baby) to guide them, but even if they get a great nurse whom they develop a great rapport with, she has other responsibilities and patients to care for and she might have to leave because her shift is over, regardless of if her shift ends right at a crucial part of the birth. 

       A doula fulfills this role of being a consistent, caring, supportive person during a family’s transition from pregnancy to parenthood.  She can help translate medical talk, reminding the parents of the pros and cons and natural alternatives of suggested interventions, reminding them of what they desired in their birth plan.  Then the doula steps back and lets them decide what is best for them, continuing to support them with whatever they choose.  A doula stays with the mom throughout the birth suggesting positional changes, giving massages, making sure she stays hydrated, empties her bladder frequently and offering emotional and other physical support.  The doula continues to stay for about 1-2 hours after the baby is born to help in whatever way she can; offering breastfeeding support, getting nourishment for the mom and dad, taking pictures.  If the baby needs to go to the NICU, the dad is able to go with the baby and the mom is able to have a caring supportive person with her during this difficult separation.     

       The main purpose of a doula is to support the mom and dad in whatever way they need during and immediately after the birth, while remaining a calm and positive presence.  Depending on the couple or the situation, the doula may take more of a guiding position, where she helps the dad help the mom; if he is unsure in a situation she can offer him encouragement and give him ideas of what to do.  The dad and doula make a great team, working together in supporting the mom.  I was in a situation where the dad was sick with a bad cold during the birth and I took much more of an active roll, while he sat in a chair watching and offering verbal support.  It was nice for him to know she was taken care of, with me giving her massages, helping her get to the bathroom, getting them both drinks and snacks (I felt like I was HIS doula too).   This helped make the birth better for both of them.   

My experiences have shown and studies confirm that everyone benefits when a doula attends a birth.   The dad feels a weight lifted from his shoulders, he feels supported in his role and can relax and enjoy the birth more.  The mothers benefit physically by having a decrease in cesarean births, decrease in some interventions such as pitocin augmentations and the length of their labors are shorter.  The mothers also benefit emotionally.  Studies show that mothers with doulas are more satisfied with their births than mothers without doulas.  The babies benefit as studies have shown that mothers that have doulas are more likely to still be breastfeeding at 6 weeks and these mothers bond more quickly with their babies. 

       I think that when every birthing mother who wants a doula, has one at her birth, the childbirth climate in the USA will change for the better.    Mothers will be empowered to make their own choices regarding their birth.  Dads will better know how to support their partner as they make this special journey together of the birth of their baby.  Birth will become a more positive experience that women look forward to with anticipation and joy. 

 

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Enjoy Birth

Is that really possible?  Isn’t birth scary, hard, painful, horrible? 

No, it doesn’t have to be.  Birth can be beautiful, wonderful, enjoyable. 

How?  Educate yourself, empower yourself and choose wisely who, where and when you have your baby.

Check out www.enjoybirth.com  for Hypnobabies and Hypno-doula Information and  www.independentchildbirth.com  for other independent childbirth class options and www.dona.org for birth doula information

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