Archive | March, 2016

What Is a Doula? (Happy #WorldDoulaWeek!)

26 Mar
Happy #WorldDoulaWeek! Wait, what? What in the world is a “doula,” you might wonder? I’m glad you asked! A doula is a powerful tool toward a better birth. If you are an expectant parent looking for ways to have one of those, read on…

What the heck is a DOULA & why do I need one? Sounds awfully hippy-crunchy-granola.

A birth doula (which originates from a Greek word meaning “a woman who serves”) is a non-clinical professional who supports expectant parents in the following ways:
  • Prenatally — Most doulas provide 1-2 prenatal visits to get to know each other and strategize for labor day as well as ongoing support to answer questions or provide resources as needed. She will be on call 24/7 for you from 37 weeks until you give birth.
  • Continuous support through labor to help ensure a safe and satisfying birth experience and into a few hours after birth to provide breastfeeding support, if desired. She joins the laboring parent/couple at whatever point they decide they’d like her to come to them, whether that is at home, birthing center, or hospital. 
  • Postpartum — usually there is one optional postpartum visit, which can be used for breastfeeding or other newborn care skills support, processing the birth together, etc.
  • Some doulas have special skills that can be add-ons or part of their package price, such as photography or massage (the latter wouldn’t be an optional add-on so much as a specialty that you might pay a bit more to have in a doula), so you can consider whether one of these things might be appealing to you to seek out. Quite a few doulas also provide services such as placenta encapsulation or birth pool rental (for home births).
  • In my work as a DONA-certified birth doula, I routinely type up my notes about the labor/birth and provide those for my client. I aim to not editorialize, but just to state facts as much as possible. Not all doulas do this, but you can ask as you interview candidates if this is something you’d like. Sometimes it helps to have another person to fill in gaps the parent(s) might have in their memory as they seek to remember and perhaps journal this big day in their family’s life.

A doula draws on her professional training, knowledge and experience to provide emotional and informational support, physical comfort and, as needed, communication with medical staff to make sure that you have the information you need to make informed decisions as they arise in labor. She can provide reassurance and perspective to you and your partner, helps to normalize an otherwise potentially unnerving process — particularly for first-time parents — and therefore help alleviate anxiety, strategize and make suggestions toward labor progress, and help with relaxation, massage, positioning and other techniques for comfort. In this way, a doula effectively supports laboring at home as long as possible, which is a great way to avoid unnecessary intervention (more on this topic in a future post).

“Not quite convinced,” you say? No problem, here’s more:

Statistical evidence shows that a doula’s presence during labor and delivery produces better birth outcomes:
  • Tends to result in shorter labors with fewer complications
  • Reduces negative feelings about one’s birth experience
  • Reduces requests for pain medication
  • Reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction & cesareans 
Research shows parents who receive doula support: 
  • Feel more secure and cared for
  • Feel more respected and heard — a top contributing factor to satisfaction in birth
  • Are more successful in adapting to new family dynamics
  • Have greater success in breastfeeding
  • Display increased parenting confidence
  • Experience lower levels of anxiety / depression (in pregnancy as well as postpartum)

Sources: DONA InternationalKlaus and Kennell study, 2002, Listening to Mothers III Survey.

It’s worth mentioning that doulas aren’t only worthwhile for those aiming for a natural, unmedicated birth. There’s immense value in doula support if a person is planning to use the epidural/pain meds, or even if she is having surgical birth. Seek out a doula who is supportive of your specific birth preferences or scenario.
Keep in mind that your care provider and nurse are not present most of the time, and are not there to provide hands-on, physical support for pain management (aside from offering pharmacological pain relief). Nurses are there to monitor the baby’s and laboring parent’s vitals. OBs/midwives come in only every 2-4 hours to do a vaginal exam and then continuously from just before the baby is crowning through an hour or two after birth.
If you are a single parent, you definitely will need someone to support you. If you have a partner, it’s an awful lot to expect said partner to be everything to and for you both on a support and logistical level in this marathon of labor. Securing a doula’s help is an investment not only for the laboring parent, but also for partner. There are times in labor when she so desperately needs intensive support (and quite likely all hands on deck) that she will not want anyone to leave her side. With a doula on hand, there’s at least the possibility of trading off when one support partner needs to step away momentarily — whether it’s for a nap, food, or bathroom break — without the laboring parent being in distress.

What do doulas NOT do?

  • Doulas do not catch the baby. It’s a common point of confusion, but doula does not equal midwife. Catching baby — and protecting the physical health of mom and baby — is the definitive role of your clinical care provider (OB or midwife).
  • A doula does not replace an involved and supportive labor support partner — she counsels with not just the pregnant parent but labor support partner(s) as well to learn how to best serve the family unit.
  • Most of the time, doulas should not speak directly to hospital staff to express a client’s wishes — or at least should be very slow to do so and only do so if necessary. Most hospital staff prefer, and often must legally have, the laboring parent or her partner be the one to communicate preferences. It’s usually better for a doula to confer with the laboring parent/couple to help them make decisions throughout their labor, and then they can communicate their decision to their care provider. 

What to look for in a doula

  • It’s important to interview more than one doula to find the right “fit” for you. Ask yourself, “Will I feel comfortable being in my most vulnerable moments with this person?”
  • Ask questions of the doula. Here’s a good interview resource from Childbirth Connection.
  • The “right” doula for you will bring a sense of calm into the room for you and any applicable partner just by her presence.
  • A doula should have a thick skin. I promise my clients that they can’t hurt my feelings in labor. This is important so that the laboring parent can labor unhindered, unconcerned with manners, allowing herself to go to the primitive state often required to allow labor to progress in a healthy way.
  • You want a doula who is a straight shooter — who will always tell you the truth and not sugarcoat things.
  • Look for a doula who doesn’t seem to still be heavily processing her own birth experience(s). This will obviously be YOUR birth, not hers, and she needs to be able to put her issues aside. Otherwise, it can sometimes hinder her ability to provide effective, non-judgmental, compassionate support that engenders a congenial atmosphere with hospital staff.

I do recommend that you ask your care provider (OB/midwife) what they think about doulas before seeking out one — after all, you want to work toward a collaborative, positive atmosphere and birth team, and avoid inviting tension. If your care provider doesn’t seem keen on doulas, I’d consider looking for another care provider or definitely want to gain a deeper understanding of why they feel this way.

Most birth doulas work on a flat-rate cost basis, whereas postpartum doulas more often work on an hourly basis, often with a front-end minimum. In NYC, newly trained doulas might work on a volunteer basis up to around $300-750 at first, with the cost heading toward $800-1,000 after around 10 births, and rising to around $4,000 as experience is gained. When you consider the many hours that a doula must be on call and the “marathon of indeterminate length” that is labor, the price begins to make a lot of sense and not seem quite so steep. I’ve never met a couple who didn’t swear by this investment as the BEST one they made toward a happier, more fulfilling, positive birth experience. I’ve heard more than one new parent say they seriously considered naming their baby after their doula because the support was so invaluable! 
Whatever your birth scenario, you deserve to feel and be treated like a queen through your labor, and a doula can help you have that experience. Hire a doula. Find the right support professional for you, and I am convinced you’ll thank me when all is said and done.

To find a doula anywhere:

Doulas of North America (DONA) International
Doula Match (U.S. & Canada)

Snuggle with Your Baby: Benefits of Skin-to-Skin

21 Mar

In the birth world we talk a lot with expectant and new parents about the benefits of holding babies skin-to-skin. When I was pregnant I didn’t fully grasp, for whatever reason, that it didn’t just mean holding your baby lots, but actually meant what it says – rip off that clothing that stands in between you and your baby and go literally skin-to-skin!

Here are a few of the benefits of skin-to-skin contact:

  • Calms your baby – lowers her blood pressure and reduces crying
  • Great for baby’s microbiotic health and immune system as baby is populated/seeded with parent’s microflora
  • Stabilizes baby’s blood sugar
  • Facilitates bonding
  • Helps get breastfeeding off to a good start; ideally in the 1st hour or two after birth
  • A breastfeeding mother’s chest is baby’s perfect “warmer” as it heats up warmer than the rest of mom’s body
  • Baby adopts parent’s healthy respiratory patterns, contributing to safer sleep and optimal development

A few weeks ago, I had the rare opportunity through NYU Langone Medical Center’s Perinatal Outreach Program to take an all-day class with Dr. Nils Bergman, who is a pioneer in the birth world – specifically on the topic of kangaroo mother care/skin-to-skin benefits. It was fascinating to go deeper into the science behind the importance of skin-to-skin contact.

Dr. Nils Bergman and a bunch of my CEA/MNY childbirth educator colleagues who also attended the all-day conference.
I’m in the blue shirt and glasses in front of Dr. Bergman.
I initially wrote a blog post (and compiled my colleagues’ contributions, as well) for educator colleagues, which I will post once it has gone live, but for now I will post a few thoughts that are tailored a bit more for expectant parents.

Here are selected favorite takeaways from the day on the topic:
  • Two critical sensory/brain needs of a newborn are smell & contact
  • 1st1,000 days critical for neurodevelopment/brain wiring (this includes the gestational time, so equals the first 2 years of life).
  • Maternal absence doubles cortisol (“toxic stress”) levels of the infant
  • Baby ideally stays skin-to-skin with breastfeeding mom for the first 1,000 minutes (almost 17 hours); Dr. Bergman writes“Hospitals that are up to date with best practice and evidence-based medicine will strive to keep mother and baby together for the first hour. The new knowledge from NINO is that the first hour is only the first hour: the first 1,000 minutes is the important time to keep uninterrupted skin-to-skin contact and togetherness. 1,000 minutes is over 16 hours, practically speaking the first day and night. “Zero separation” time can be achieved with the help of father or any other family member, but mainly to support the mother to be able to spend as much time as possible with baby. In this way they can synchronise their wake-sleep time, they can learn each other’s body language. The newly fired pathways in both their brains become stronger and coordinated: this is what bonding is actually about.”
Keep in mind that babies are more resilient than we often give them credit for and can bounce back from separation if and when it is necessary. I always want to be careful to stay balanced in these things, as unnecessary guilt is not fruitful for parents or families. Any degree of skin-to-skin snuggling from anyparent or loved one is always going to be beneficial. This Dr. Bergman video points to this.

The standard in many hospitals today is for baby to go straight to mom’s chest in an uncomplicated, vaginal birth. However, I recommend asking your care provider and advocating for this to be the case, if necessary, along with delaying as many newborn protocols for at least the first hour, so you can maximize the time just after birth – the “golden hour” – with lots of skin-to-skin contact.

FURTHER READING / RESEARCH:

“Nothing an infant can or can not do makes sense, except in light of mother’s body.” – Dr. Nils Bergman

Can you catch your baby? Yes you can! (My 2nd birth story, told before the 1st)

14 Mar
Yesterday, our daughter celebrated her 8thbirthday, so I thought it would be a good time to get back to blogging and share her birth story. (Spoiler alert: This is a POSITIVE birth story.)
Important note: This is the tale of a second labor, not a first. My first was 20+ hours, as compared to a significantly shorter one the second time around (under 5 hours), which is the general trend for many women.
Also, please keep in mind that this was written before I started professional birth work/studies, so some things I might say herein won’t seem entirely expert.
I hope to share my first birth story before long; perhaps around our son’s 11th birthday in May. I hope for this to be the beginning of sharing a number of birth stories from clients and friends who grant permission, as well as other topics of interest. Enjoy!

Thursday, March 13, 2008

The story of BABY GIRL TAYLOR’s (unintentionally) UNASSISTED (intentionally) HOME BIRTH
I stayed up late Wed. night preparing a powerpoint presentation for my boss for a board meeting.  Good I did, too, since I went into labor overnight and never made it for my last day of work!  Bryan got home from work and we went to bed together.  As we kissed goodnight, I remember saying, “You ready?”  Weird, since I didn’t know I was about to go into labor!  He said, “Not really.  Not sure we can ever be ready for something so big.  But I’m thrilled to be having another baby with you.”  Such an amazing husband.
As we went to sleep—around 1:20—I had what was the first true labor contraction.  I wasn’t positive, but I thought so.  However, I figured I should go to sleep if I could and save up energy.  Had no problem going to sleep.  Woke at 3am to go to the bathroom, but didn’t have any contractions.  Woke again at 5:50am and from that point on couldn’t sleep as the contractions started coming regularly.  Didn’t want to wake Bryan that early, especially because you never know how long labor might be, and he had just been pretty sick a couple days earlier, so I wanted to make sure he got enough sleep.  My contractions were really unevenly spaced, which was confusing—made me think perhaps either it was really early on, or perhaps we had another posteriorlabor.  I finally woke Bryan up at 8:30—I told him I thought we were in labor, and he said, very calmly, “Okay.”  I love his calming, peaceful presence.
Before I forget, wanted to mention something I found a little odd—I felt during contractions like I almost always had to stay completely upright—would normally think bending over, or on all fours (I hear of quite a few women spending much of their labor in this position) might help relieve some of the pain, as it did last time…but not this time at all!
We decided to call Cara, our midwife, at that point.  Talked with Cara from about 8:30 until 8:56.  She was at another birth (at a pediatrician’s office with the new parents and their new baby) on the Lower West Side of Manhattan.  Since my contractions were erratically spaced and I wasn’t yet vocalizing through contractions (she listened to a couple), she said to give it an hour and check back in at that point.
A bit from my husband (Bryan) here: Since our son (we’ll call him “Buddy”, 2 years + 9 months old) wasn’t awake but would be soon, I called friends to see if they were able to come over and help.  I got the husband (working) who said wife and kids were occupied in a class.  I told him I’d try to get our doula and call them back later if we needed help.  We went downstairs here to see if Lisa could be distracted from contractions by some food and activity.  She had some cereal, reclined on the couch and watched a few minutes of Gilmore Girls on DVD.  This didn’t last long, though, because the contractions started coming more frequently and she couldn’t concentrate on the show.  I was trying to time the contractions and get organized for the birth, and the contractions were coming so quickly that I couldn’t figure out how to use the irritating digital stopwatch we had on hand, so we were estimating intervals and duration (made more complicated because the clocks in the living room and kitchen weren’t exactly in sync, and of course I don’t use a watch, because how useful are those, really?  I called Doula Ellen’s cellphone but couldn’t get through, so called her home and got her daughter, who said she would try to reach Ellen.  Once Buddy woke up, things were moving really quickly, and the contractions were getting very strong.  Lisa decided to go upstairs so she could lie down, and I got Buddy from his room, took him downstairs, and started filling up the AquaDoula (labor tub).  Ellen called, and I told her we were in labor.  She asked me about the timing of the contractions, and said she wished we had called her earlier (we later explained the reason we didn’t call earlier was because the erratic contractions were so similar to the long back labor Lisa had with little Buddy), but that she’d come over as soon as she could.  The AquaDoula wasn’t filling very fast, because the connection to our little 1st floor bathroom wasn’t great, but I didn’t have much time to mess with it anyway, as Lisa was making dramatic sounds upstairs.  Buddy and I went up to check on her, and…
Back to Lisa’s POV: By 9:56, when Cara called us back, I was beginning to have the urge to push.  After hearing one contraction, she said, “Lie down on the bed,” (I already was, in an attempt to get the contractions to slow down), “I’m on my way…try not to have the baby before I get there!”
Bryan and Buddy ran downstairs to check on the Aquadoula, but they quickly abandoned the idea once Bryan realized I needed his help more than the tub needed to be filled.  They returned back up to me.  Buddy previously had been laughing and saying, “That’s silly!” whenever I’d groan through contractions, but then once they became the strongest (transition contractions), I began yelling through a contraction just as soon as little Buddy came up to me to talk to me—I felt so bad, because it really scared him, and he ran away crying.  After the contraction was over, I called him back over to me to explain that I wasn’t yelling at him, and he didn’t need to be scared, but that mommy was having some pain trying to get his sister out and it was just part of her being born.  We prayed aloud that Cara would make it to the house quickly, and that Baby Girl would wait for her to get there.  Soon thereafter, another strong contraction came on, so I quickly asked Bryan to get Buddy farther away from me, but it couldn’t happen fast enough so I scared him again.  Almost immediately after that, I began getting the uncontrollable urge to push and realized that Baby Girl wasn’t going to wait for Cara to arrive, and told Bryan that she was coming.  Remembering a birth story from The Compleat Mother that Ellen loaned me, in which a woman had a very fast labor and had planned to have a water birth but ended up squatting on her bathroom’s white tile floor, I told him I had to get to the bathroom.  Bryan, poor thing, was trying to figure out a way to help stall the labor (such as considering suggesting the knee-chest position, which I absolutely hate, especially when having the urge to push!  He—after the fact—told me he decided he’d better refrain from suggesting that out of fear of getting swift kick to the groin!  I said, “no not a kick, but probably a defiant yell!”)…So, I headed to the bathroom.
More from Bryan: Once we got in the bathroom, I got out my phone to call Ellen–thinking at least we could have someone talk us through this on the phone–but realized she had called me from some number I didn’t recognize (not her cell or home), so I figured I wouldn’t reach her.  Lisa, on the commode, said she felt the head(!), and, not sure whether she’s freaking out or just rolling with the pain, I ask Lisa to look at me and tell her “You can do this.  You can do this.”  She gives me a look which could mean, “Thanks, hon, you’re right, I needed that.”  Or it could mean, “You’re so sweet and that was so unnecessary.”  I call Cara’s pager.  We pray out loud that everything will turn out okay.  Not knowing when Cara would be able to call back, I call Ed and Marilyn, two doors down.  I half-ask/half-explain to Lisa why I’m calling them (Marilyn’s a retired nurse).  Marilyn answers, and I say, “Hi, Marilyn.  We’re having a baby, here at our house, right now, and we could use another set of hands.  Might you be able to come over and help us?”  Lisa’s phone rings in the bedroom (it was Cara calling back) and I almost ask Buddy to go get the phone, but I don’t know where he is (I figure he’s hiding out in a bedroom).  Lisa says, “My water broke.”  Marilyn didn’t ask if an ambulance was on the way (to my surprise), but did ask if someone was on the way, and I said our Doula and our Midwife were headed to the house but hadn’t made it yet.  She said she’d be over soon.  After the next contraction, Lisa said she felt the head (she’d realized that she had been feeling the bag of waters earlier).
Another contraction, the head appears, Lisa puts her hand on it, I put mine underneath, and Lisa says, “What do I do?”  I say, “Can you stand up?”  At some point I’m aware that little Buddy is standing near the door, watching.  Lisa stands up, and in one more push the baby slides right out, wet and purple and immediately crying.  We ease her onto my lap, and then lift her up to Lisa’s chest.  Buddy has this look on his face like he’s really not sure what he’s seeing.  We tell him, “It’s our baby!  It’s Baby Sister!”  And a big smile spreads across his face.  Lisa checks the umbilical cord and we stand there for a moment looking at each other.  The doorbell rings, and, thinking it’s Marilyn, I ask Lisa if she doesn’t think she should sit down(!), but she says, “I’m fine, honey.”  I ask again, and she says she’ll get into the bathtub.  I run downstairs and open the door, and there’s Cara.  I say, “We have a baby!”  She steps in and I point her upstairs.  Later, calculating by the times of the phone calls I made and the phone call Cara made to L’s phone, we determine that Baby Girl Taylor was born at 10:34AM.
Just a minute or so after Cara arrived, our neighbor Marilyn arrived as well.  Marilyn came upstairs, saw the baby, said hello and congrats, asked if we were okay, and once we told her we were and introduced her to our midwife, she left.


Back to Lisa: Bryan got on the phone soon thereafter and started calling people to let them know about the birth.  I sat in the bathtub with Baby Girl on my chest for a good long time (in retrospect, I felt bad, because we should have at least grabbed a towel so she wasn’t cold as well as to shield her from the light because the bathroom was really, really bright)—probably a total of around an hour and twenty minutes or so.  She nursed quite soon and for about a good long hour—encouraging.  Bryan came and cut the cord once it had stopped pulsating—I think that was before the placenta was pushed out, but I’m not sure; can’t remember the order very well.
Cara encouraged me (once she checked and had me check for myself to make sure it had stopped pulsating) to go ahead and push a couple times, and it came out pretty easily. She looked at the amount of blood in the tub, and said that I hardly lost any blood—a well below average amount.  If I recall correctly, at this point, Bryan had returned downstairs to make some breakfast.
While I was upstairs nursing Baby Girl, Cara did some cleanup. After she had a chance to warm some towels in the oven, she brought one up for baby.  I think one of them brought up some eggs and perhaps toast for me to eat while we were still in the bathtub.  Cara put any linens and clothes that had blood on them into a bowl with hydrogen peroxide (apparently amazing for blood removal), and then did laundry to clean everything up.  I’m not really sure of the order of anything, but I think Cara weighed and measured baby while I was upstairs eating some breakfast, too.
Then at some point Cara came up to help me get cleaned up, dressed, and come downstairs for her to examine me to see if I needed stitches. She was great and never rushed me at all.  It was really, really hard to get up after sitting on the hard bathtub all that long time on my tailbone, and of course I was quite sore. She helped me up, and then I took a shower to rinse off all the blood — some of which had dried because I sat there for so long. She tried to find clothes for me, but it was difficult to instruct her on where to find anything — particularly with regard to pants, since I hadn’t prepared anything and didn’t know what would fit. She helped me get dressed, and then we went very slowly downstairs.
She put a chux pad on the couch underneath my bum and examined me.  I only had a tiny tear, she said, and she said it was so small that it could probably heal on its own if I was really careful for the next couple of days and didn’t do the stairs except when absolutely necessary.  She said she could do stitches if I wanted it, and I think she said she actually wishes she had gotten stitches after she had her son, yet it seemed like she was saying I didn’t really need them…it felt like a bit of a mixed message, but I appreciated that she wanted us to have the facts and make our own decision.
Cara didn’t have any of our paperwork (such as birth certificate form, etc.) with her because she had to come so fast to us, directly from another birth instead of from her house, so said she would bring it at the 3-day visit.
Before she left, Cara took a family pic of us (see below), in which Buddy looked very unhappy…because he didn’t want Cara to leave! (She is not only great with her mamas but amazing with kids, too.) Instead it of course looks like he’s unhappy that his sister was born.  Got lots of comments on that one!

Our dear pastor’s wife came over in the afternoon around 3:30 or so and cooked a meal for us in our kitchen while I lay on the couch (Cara’s orders!) and made calls to all my Texas girlfriends, family, etc. to share the good news and exciting story.

In closing, I would like to clarify that it was not the fault of my midwife or my doula that they couldn’t make it in time. Our little girl is a sassy one and there was no keeping her in; we think she wanted it to be a family-only affair! But seriously, Cara and Ellen are birth pros with total integrity and this was a very rare occurrence. I wanted to be sure, therefore, to mention that they both are wonderful and I would highly recommend either of them (in fact, Ellen was our doula through our first labor and we couldn’t have done it without her!).
So there you have it, folks. We will always describe our daughter’s birth as follows: “We had the simultaneously exhilarating and terrifying honor of catching our baby girl.” My beloved boss gave us a pink catcher’s mitt as a baby gift with the phrase, “Safe at home!” written on it along with her birth stats – totally fitting.

Have you considered the possibility of catching (or helping catch) your own baby? If it’s something that appeals to you, discuss it with your care provider. Many care providers are open to mom, dad, or partner participating in this way. Never hurts to ask!
HAPPY BIRTHDAY to our darling,
sassy baby (not so baby anymore) girl!
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