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Preparing for Childbirth Series (Part 1 : Doulas)

September 18, 2010

Holding Maxwell for his first breath

 

I think it’s important to be sensitive to where a woman is in her life. Every woman deserves the respect of feeling  ownership and closure about her birth experience, be it unmedicated or medicated, hospital or homebirth, vaginal or surgical. In the end we are ALL mothers!  With this said, in this series I will share with you the steps my husband and I took to prepare for an unmedicated natural childbirth*. I believe women have  much greater capability and strength than they often believe (and are told) they do. The season of childbearing is a wonderful and fertile time to help women realize this potential.  

Welcome to my series, Preparing for Natural Childbirth – 10 Steps. During this series we will explore and discuss 10 ways to prepare your mind, body, and partner for natural childbirth. There are many ways to prepare for this journey and this series is in no way all inclusive. Even if you are not planning for an unmedicated birth you may still find many parts of this series helpful and informative.   

 Please feel free to share, (in the comments so we all may learn from your mama wisdom): anything I missed, what worked for you and your family, your birth experience,  or if you like please email me any questions you may have.  

 Finally, I am NOT a childbirth expert or a medical doctor/ midwife. Use this advice at your own risk, use common sense. (bla bla bla… lawyers…)  

Part 1: Hire a Doula

What is a doula? Doulas are trained birth professionals with experience and instinctual knowledge to offer. Simply put, a doula provides continuous emotional, physical, and informational support before, during, and after birth, for the birthing mother and her family. She does not normally do any kind of medical assessments or advising, but educates a family on choices. My husband and I like to think of a doula as a personal tour guide. You’re planning a trip and your tour guide can help you decide on the things you definitely want to avoid and the things you want to include. A doula is NOT  there to replace your partner but to help them perform and support the laboring woman. The doula’s goal is to help the woman have a safe and satisfying childbirth as the woman defines it.  

What effects does the presence of a doula have on birth outcomes?
 In their book, Mothering The Mother: How a Doula Can Help You Have a Shorter, Easier, and Healthier Birth, Marshall Klaus, John Kennell and Phyllis Klaus summarize studies which have been carried out on the advantages of doula-assisted births.  

The results of the studies were as follows:  

  • Reduced the overall cesarean rate by 50%
  • Reduced the length of labor by 25%
  • Reduced oxytocin use by 40%
  • Reduced the use of pain medication by 30%
  • Reduced forceps deliveries by 40%
  • Reduced requests for epidural pain medication by 60%
  • Reduced incidences of maternal fever
  • Reduced the number of days newborns spent in NICU (neo-natal infant care unit)
  • Reduced the amount of septic workups performed on newborns
  • Resulted in higher rates of breastfeeding
  • Resulted in more positive maternal assessments of maternal confidence
  • Resulted in more positive maternal assessments of maternal and newborn health
  • Resulted in decreased rates of postpartum depression

Are doulas expensive?  

 Nope! In most cases you can hire an apprentice doula for free or minimal payment.  The more experienced doulas in your area may range from $600 – $800. Take into consideration the increased birth outcomes (see above) and (depending on your doula) this fee includes 1-2 prenatal visits, laboring with you until baby is born and breastfeeding is established, 1-2 post-natal meetings to make sure you are healing properly and breast-feeding is going well. This in our opinion was money well spent and even money saved in the long run.Insurance companies are taking note of the proven benefits of doula-assisted births. As a result, some providers have started to reimburse for doula care. If your company health care plan covers in-home care, nursing care, lactation consulting, or similar fields, doula care is most likely covered as well. It never hurts to try and submit the bill to your insurance company. In addition, many doulas may even provide you with a birthball, heating pad, sitz bath as a gift to you; be sure to ask when interviewing. Start interviewing doulas by your 4th month to ensure you have the time to find the best fit for your family.  It’s never too late to hire a doula, but your seletion may be limited. Please interview prospective doulas in person since you want be sure you and your partner are comfortable with them and your personalities jive.  

Questions to Ask a Birth Doula (taken from www.dona.org)  

  • What training have you had? (If a doula is certified, you might consider checking with the organization)
  • Tell me about your experience with birth, personally and as a doula.
  • What is your philosophy about birth and supporting women and their partners through labor?
  • May we meet to discuss our birth plans and the role you will play in supporting me through birth?
  • May we call you with questions or concerns before and after the birth?
  • When do you try to join women in labor? Do you come to our home or meet us at the hospital?
  • Do you meet with us after the birth to review the labor and answer questions?
  • Do you work with one or more back up doulas for times when you are not available?
  • May we meet them?
  • What are your fees and your refund policies?

How do I find a doula?  

In the Twin Cities area we are blessed with the Childbirth Collective . This is a wonderful place to start your journey. They hold weekly parent topic nights on various subjects including doulas. If your husband or partner is wary on the idea of a doula, this meeting may change his/her mind. It opened my husband’s mind to the idea. Guy advocates for the use of doulas to many of his friends who are having children,”They definitely help!”  

Outside of MN,  D.O.N.A. (Doulas of North America) is a comprehensive place to begin your search for a doula in your area.  

Ask your midwife or OB about doula referrals. This may also help you decide if this care provider is a good fit. If they are turned off by the idea of a doula you may want to reconsider your provider choice. The midwife practice I go to is VERY open to doulas, one of the midwives is even a member of the Childbirth Collective, always a good sign! Another great place to ask is your childbirth educator, many are very plugged into the childbirth community. If all else fails search online for doulas in your area.  

A little about our personal experience:  

I loved having a doula! My husband, Guy was a completely awesome birth coach, and I could NOT have done it without him, nor would I have wanted to. Our doula, Karen (for both of our births), came to our home while I  labored, supported Guy, and helped Guy help me. Which meant for us someone to fill in for Guy while he showered, went to the bathroom, ate, took a nap. She assisted Guy in massaging me during contractions. Especially when I needed to stare him down look at him through a contraction and at the same time needed him to apply pressure to my hips/back.   She also helped us determine when to leave home for the hospital based on the timing of our contractions and emotional signposts of labor avoiding the all to frequent “false alarm”.  

 She was a reassuring voice for Guy reminding him he was doing a great job ( since I really wasn’t in a state to be quite as encouraging).She was a wonderful resource, for Guy when nothing he did seemed to be helping, suggesting new positions, massage techniques, or sometimes even just giving him a much deserved break.  Karen brought the little things to the hospital we didn’t such as: LED tea light candles for the bathroom, a tub pillow, massage balls, hot packs, soothing music, essential and massage oils, and probably many other items I was completely unaware of in my laboring state of mind. During our second birth Karen reassured Guy and I when my water broke early. She came to the hospital for my “mini-induction” and helped (along with Guy of course!) me achieve the water birth I desired.  

 Upcoming parts of this series:  

2. Choosing a natural child birth method/ class  

3. Choosing  a supportive healthcare provider  

4.Hospital choice, etc..  

5. Diet and nutrition  

6. Stretch and excercise  

7. Breastfeeding  

8.Mental visualization/relaxation  

9. Writing your birthplan  

10. Supportive partner/spouse  

* I have not had a completely unmedicated childbirth (yet!). My first birth I had a dose of nubain while pushing and my second my water broke a week early, after 48 + hrs. of attempting to augment labor naturally at home, I needed a little pitocin to get into active labor. During my second birth I did not require analgesia.

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