Your Doula Can't Do It For You

One of my favorite things about birth is that every birth is different.  Some are totally awesome and others just suck to get through.  It varies from person to person and from kid to kid.  If you knew exactly how each birth would go, you would just plan for that experience.  That's the thing though -- no one knows how things will go down.  I like to think that it adds to the excitement!

The costs of adding to your family can be significant.  When you are planning an unmedicated birth, making choices that will help you achieve your goals is so important.  A childbirth class and a doula do add to the costs.  Of course, if you spend time with these people, they'll tell you what you really need with a new baby, which will probably save you money in the long run!

I've seen many couples hire a doula and call it good -- thinking the doula will be their childbirth class and advocate for them.  The assumption is that she'll help them every step of the way.  While this is partially true, it puts all the pressure on the doula and none on the parents.

Many doulas give discounts to couples who take a good childbirth class and birth with care providers who are natural birth friendly.  It makes their job not only easier, but more enjoyable.  They see the parents become empowered by making their own choices.  The doula is there for support and encouragement. She provides occasional education or information about something that may have come up in labor.

To not prepare physically, mentally, and emotionally for an unmedicated birth is irresponsible.  Remember my saying - "90% of birth is in your head, 10% is what happens to you."  I really do believe that.  Not just for moms, but for dads.  He needs to have his head in the game, too!

Are you ready for labor?  Do you know your stuff?  Labor is not the time to be learning or figuring things out.  It is often difficult enough when you are completely prepared!

I am obviously a proponent of hiring a doula, no matter where you are giving birth.  It benefits mom and dad.  I never hear people say that they wish they wouldn't have hired a doula, but I certainly have heard couples say they wish they had.

Childbirth education is my passion.  For me, education was the turning point, knowing I could do it, and having the tools to make it happen.  I want to see all couples being educated and then hiring a doula to help them maneuver through labor and their individual situation.

Your labor is your experience.  The doula is there to make you more comfortable, help you meet your goals, and enhance the experience.  She can't get in your head.  She can't take on the contractions for you.  Isn't is wonderful that no one can birth your baby but you?

A corny way to end this post?  Who cares!  People are always asking me about a gift to get their doula.  There are so many choices in beautiful jewelry.  I just found this necklace and loved it.  Your doula will too.

Happy birthing -- yourself -- but with a doula by your side -- and, of course, some good childbirth education behind you!

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The Effects of a Crowded Room

For years I've been talking about emotional relaxation.  Emotional relaxation is how you feel about your laboring environment.  For example:

Are you confident in your care provider?  

Do you feel that your nurse is supportive of natural birth?  

Is the on-call doctor respectful of your birth plan? 

How is the temperature in the room?  

Are people talking during your contractions?  

Do you feel supported not only during contractions, but between them as well?  

Are your needs anticipated by those around you?  

Do the people at your birth really know how to help you?

How is the lighting?

What does the room smell like?

Are you hungry?  Are you encouraged to eat/drink?

The answers to these questions will impact your labor.  Someone posted on my Banned From Baby Showers Facebook page wanting to talk about prodromal labor and someone else about "longer than normal" labors.  When I hear about a woman having a very long labor, there are some things that pop into my mind, the first one being how many people were in the room?  What did she do in early labor?  Did she watch the clock and wait for contractions to get closer?  Or did she announce it on Facebook and deal with phone calls for the next 3 days?  Did she feel like a watched pot?

My two bits of advice for all my couples in early labor are:  1) Depending on the time of day you realize contractions are regular, SLEEP.  2) Depending on the last time you ate, EAT.  Eventually, you may want to do both of these things and will likely not be able to.  

The 4 top things that women worry about for their labor:  

1) The sounds they will make during labor and birth

2) Modesty and being/feeling exposed

3) Fear of tearing

4) Fear of pooping during the pushing phase

Let's look at this list further.  The only one that is actually a physical fear is #3, the fear of tearing.  The other 3 have more to do with how she is perceived by others in the room.  There are few times in a woman's life where she is more vulnerable than when she is in labor.  She may act like a wild animal, making sounds that might be embarrassing otherwise.   Or, her sounds might be low and sexy -- and she may stop when her mother or mother-in-law comes into the labor, even though those sounds were her "rhythm" and helping her through contractions.  

Very carefully consider the people you invite into your birth.  Often, women feel the need to "perform" for their audience.  Maybe it's for your mother or best friend who never had a natural birth and has been very negative about you having a homebirth.  You feel like you have something to prove.  Maybe you have "media" at your birth, a photographer or are recording a video.  The pressure to "perform" can really hurt a labor.  I feel strongly about recording your birth, but not at the cost of not being able to give in to your labor.  It's just another thing to evaluate and be flexible during labor.

As hard as it may be, you may need to banish these people from your labor.  Most women labor best in dark, quiet, undisturbed places.  The more people involved in your labor, the harder these conditions are to achieve.  Mom needs to feel free to move and vocalize.  We have this idea that if we are vocal, we are not doing well.  This simply isn't the case.  In fact, the opposite may be true.

Of course, there may be physical reasons for a long labor, but the people in the room is something that each couple has direct control over.  Even in a hospital birth, if you don't like your nurse, request another one.  Have your doula or midwife do it if you can't.  If they suggest it, acknowledge that they may able to see something you can't see in the throngs of labor.  Many people don't want to believe that having their mom or sister in the room is slowing their labor, but I've seen it many times over the years.  Hindsight is always 20/20 too. Often, women can't see the effects of the "spectators" until after the birth.

If you feel self-conscious about how you will sound, act, or look, you might consider not having anyone not crucial to your birth team at your birth.  Birth is not a spectator sport!

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When to Reign In Your Birth Team

As most of you know, I teach a 10-week course on natural childbirth.  The first night of class, the number one question is, "When do we go to the hospital?"  Line-upon-line here.  We don't hit that until Class 5!

Over the years, I've learned that this question is really asking, "When can the professionals take over?"  It usually is asked by a dad-to-be.  It's interesting to watch these expectant parents learn and grow.  Education and information is unbelievably empowering!  Several years ago, I was teaching "emergency" (ie. unattended) childbirth.  By the time we get to that point, we've spent countless hours together, watched more than a dozen birth videos, and everyone has a very good idea of what normal childbirth involves and what to do -- or not do!  I asked this particular father-to-be how he felt about the possibility of this happening.  I should preface his answer with the fact that he didn't speak to me until Class 5 and was totally depending on his mother-in-law to help his wife at the birth.  He despised that he was forced into attending this class.  So, when asked this question, I was amazed at his cool reply:  "On the one hand, totally terrified, but on the other -- bring it on!"  I should also mention that the mother-in-law didn't make it to the birth and they were only at the hospital for 22 minutes before the baby was born!

The answer to the question "When do we go to the hospital?" often changes as you get more information.  Let's back up for a minute.  You know how I feel about hiring a doula.  Do it.  Who are the people you are inviting to your birth?  A sister?  Mom?  Mother-in-law?  Other children?  Your best friend?  Do you call them all the minute you have your first "real" contraction?  Of course not.

There is nothing like being pregnant with your first baby.  Not that the other pregnancies and labors aren't exciting, but they are undeniably different.  You've done it before.  You have distractions now that you didn't have the first time around.  Regardless of what baby number this is, enjoy early labor with your spouse.  I love early labor!  Get into a rhythm together.  Figure out what works, what doesn't.  Practice different positions.  Nap.  Eat.  See a movie.  Enjoy this time together.

Everyone's labor is different.  You may have several hours of early labor -- this week I had a mom that did this for several days! -- or it may not exist at all.  You may jump right into active labor and need your doula right away.  There is no way to know beforehand. 

But let's assume that you do have early labor -- you are contracting regularly but are able to talk, walk, or sleep during and/or between contractions.  If your husband is sleeping, and it's 2:00 a.m., let him keep sleeping.  A lot of moms don't like it when I say that.  Here's the thing -- yes, labor is exhausting, but it's also exhausting for your birth team.  This often doesn't get a lot of sympathy from moms, but if your labor is on the longer side, you are going to need your birth team to be able to step it up, and they may not be able to if they are utterly exhausted.  If you don't need his help, let him keep sleeping.  You'll both be glad later.  You may find yourself enjoying those early contractions, just you and the baby.

As things progressively get harder -- and you feel like you need some extra help -- think about who you want to reign in.  Maybe it's your sister or mom or maybe it is your doula.  Whoever it is, be sure that you are ready for the help.  And perhaps even more importantly, be sure they will be a positive influence on your labor.  For example, the mom who is freaking out that you didn't go to the hospital with the first contraction or the minute your water broke may not be the best person to be with you and your husband.  She may not be someone you want at your birth at all!  In the end, if you don't need help yet, you may feel like a watched pot, which won't be good for your labor.

There's not a set time that is right for all couples.  I hate it when couples are told to head to the hospital when contractions are 5 minutes apart lasting 60 seconds.  You could do that for hours!  It's really hard to explain, but there will come a time in your labor that you will know who you need.  With my 2nd baby, I had no early labor and wanted my friend there immediately.  It was a very fast labor.  But with my 3rd and 4th babies, no one was there until about an hour before the birth, including our midwives.  But I knew when I needed them.

Again, it's hard to explain, but there will be an urgency felt to be with your birth team as labor progresses, whether you are in the hospital or at home.  This will be different for each woman.  Some women feel this urgency earlier than others.  This is their emotional relaxation -- how they feel about where they are giving birth, who is there, are their wishes being honored?  I remember with my first homebirth -- 3rd baby -- the minute the midwife walked through the door, I felt like crying.  I felt such a release.  She wasn't there more than an hour and my baby was born.  My body held back until my birth team was in place.

I often think of it as involving people according to their skill set:  my mom was needed because I needed help with the other kids (1st called).  She cleaned up, made food, changed sheets -- a good one to have around!  Anyone else helping out with the kids was next.  They'd usually help my mom too.  One of these people was usually on video duty.   As labor progressed, if I had a doula or doula-friend, they'd be called in to help me and David.  Your chiropractor is also a great person to call in for a period of time.  Eventually, you'll want someone to catch the baby, so either calling your midwife or heading to the hospital will be necessary!  You'll know when this time is.  You'll be very serious, eyes closed, not talking or smiling.  Some women will be sounding out contractions and others won't make a peep.  Either is fine.  One is not better than the other.

My ultimate answer to the question "When do we go to the hospital?"  Alright, here it is.  There will come a point when she (talking to dad because mom won't remember this or be thinking logically) will not want to walk anymore.  She will still get up and go to the bathroom when you encourage it, but she doesn't want to.  She has to wait till the end of a contraction to get up and she will move quickly so she doesn't get caught standing up during a contraction.  Contractions are stronger and longer when she stands up.  Still willing to move, but not wanting to.  This is usually a good time to mosey on down to your birth place or call in your midwife.  Labor is very well established at this point.

Most of all, enjoy your labor.  Choose your birth team carefully and reign them in as you need them.  So many women wish for a fast labor, not understanding how hard a fast labor is -- just to get it over with.  A longer labor is not a bad thing.  Like I always say, labor and birth serve as a bridge between pregnancy and becoming this baby's mother and father.  Enjoy it.  These hours are unlike any in your whole life.

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The Doula -- or "Dude-la" -- Post

Some of you might remember reading about one of my couples that accidentally gave birth at home last year.    The plan was to have their doula - who was at the birth - have a doula-in-training shadow her at this upcoming hospital birth.  Frank, the father-to-be, referred to the student doula as "the dude-la" -- she was to be his doula!  His "dude-la" was actually at another birth when Nancy gave birth at home, much to Frank's dismay.  I wish I could take credit for coining this term, but I have to give credit where credit is due.  It makes me laugh every time I think of it.

I always have a couple of doulas that I refer my students to, usually for a bargain price, as my students are usually very prepared for labor and birth.  A bit less work for her -- certainly less educating on her part.  I am very picky about who those doulas are.  Like lactation consultants, doulas are not all created equal.  I knew of a doula in Albuquerque that had a 90% epidural rate! Certainly not the doula I wanted for my students!

The first question I always ask is why she wants to be or why she became a doula.  I am amazed at how many women become doulas because of a personal traumatic birth experience.  They want to help other women not go through what they went through.  That is totally respectable, but not necessarily who I want at my couple's births.  She will often be defensive and looking for things to go wrong.  Her "bad" birth experience led her down this road and she is, in my opinion, trying to right a wrong.

I have been writing about the birth team a lot lately -- doulas, midwives, and OBs.  I've decided that it is 50% of the "requirement" to having a happy birth experience.  Education is great, an absolute must, but if you are surrounded by people who do not believe in your ability to birth your baby without medication or intervention, you likely will not be doing so, no matter how prepared you and your partner are.

If I were looking for a doula, these are things I would want to know:


Has your doula given birth?  (It is hard for someone who has not gone through labor and birth to understand the thoughts that go through a woman's head during labor.)


Where did she give birth and why did she choose that location? (If you are planning a homebirth and you are hiring a doula who has only given birth in a hospital, you might ask her why she chose to not birth at home.  She may, deep down, be fearful of birth.  Or maybe it was an issue with insurance.  Or maybe her husband was too fearful.  Find out why she birthed where she did.)

Did she have medication or intervention?  (When the going got tough, how did she handle contractions?  What seems to be her general attitude about medications and interventions in labor?  Does she really believe that these things are usually not needed?  On the flip side, is she willing to use intervention if required?  Does she recognize that sometimes a woman may need intervention or medication?)


Has she ever been "overdue" and how did she deal with that?  (A woman will naturally doubt her body's ability to start labor on its own towards the end of pregnancy.  Having an encouraging doula by her side, reminding her that her baby and body knows just when the time is right, is crucial.  The "overdue" woman is bombarded with questions of when she is going to finally induce, and her doula will be her rock in refusing induction.)


How long were her labors?  (There is an emotional tug-of-war here.  Most women hope for a short labor, but that is often much harder, physically, than a longer one.  A long labor is not only physically challenging, but very mentally difficult.  It's just interesting to hear her perspective on length of labor.)

What is her c-section rate?  Epidural rate?  (Some things are obviously out of her control, but if her rates are higher than you think they should be, she may not know how to really help a laboring woman - which may be a physical or mental issue.  If she doesn't know her rate, ask her to figure it out.  You'll be doing her a favor, trust me.  She should know this information if she's never figured it out.  If her rates are high, she can evaluate what she can/should do differently, and if they are low, it will help her in talking to potential clients.)


Where is her favorite place to doula?  Hospital, home, or birth center? (Listen to her answer on this one.  This tells you who is the most supportive of doulas at a birth.  It's usually the places where she feels like she has the freedom to work with a couple and her opinions and experience is valued.  These are usually good places to birth.  If a doctor or hospital is not at the top of her list, it's usually because they have policies and procedures in place that make it hard for her to really help you. They are usually resentful of her presence and feel that she is interfering with their work.)


Does she have backup with similar rates and philosophies?  (I don't want certain doulas at my student's births, so I want my doulas-of-choice to have doulas backing them up with similar styles and philosophies.  Things come up in life, and your doula could have the flu the day you start labor.  Ask about her backups.  You will all be more comfortable if you know these things in advance.)
  

Does she have "time limits" of being away from home (nursing baby, child care, husband's job, etc.)?  This is one reason I don't doula.  I have lots of kids, all attending different schools.  I don't let them ride the bus, so I spend half my day in the car.  I don't live near family to depend on either.   Oh yeah, and I have a husband with a demanding job.  Lastly, I don't have the patience necessary to be good doula!  If she does have "time limits" she may be very distracted.  Know what the issues are and how she deals with them.  For example, she may need to pump breastmilk every 4 hours during your labor.  If you are fine with that, great.  If that will drive you crazy, she's not the doula for you.)

Lastly, ask her what she literally brings to a birth? (One of "my" doulas is a massage therapist so she doesn't bring a lot of physical items to a birth.  She brings her hands, ready to work.  She knows acupressure points that stimulate labor and actively uses them throughout labor.  Other doulas have a bag that they bring, full of "birth toys" to help throughout labor.) 

It's nice to know what your doula brings to a birth, both literally and figuratively.

I hope this list helps you in your search for a doula.  They are such an important part of the birth team.  I see more epidurals and c-sections at births without a doula than those than have a doula.  And if your husband is resistant and wants the job all to himself, start calling the doula a "dude-la" and remind him that she is there as much for him as she is for you!

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Want an Unmedicated Birth -- Or Even Just a Vaginal Birth? Hire a Midwife and a Doula

I have recently had a bad run -- lots of cesareans and epidural births.  I've thought about them a lot over the last several days and weeks, and there are some significant numbers that I want to share.

Up to now, my stats have been about 79% of people that take my class give birth without medication.  14% have a cesarean, and about 7% have an epidural, the majority of the time to avoid a c-section.

These last few months have been the worst statistics I've had in over seven years of teaching.  It's hard for me to put this out there, but I've gone back about 4 months to include a couple of classes and several DVD couples.  There are some interesting things to note, and I hope this improves future outcomes.

In the last 4 months, I've had 23 couples give birth.
10 had unmedicated vaginal births.
5 had epidurals (but still had a vaginal birth).
8 had c-sections. 

Let's break this down, starting with the 10 unmedicated vaginal births.  (This is what everyone was shooting for.)
6 hired midwives (mix of CNMs and CPMs).
4 hired an OB.
6 hired a doula.

Of the 5 epidural births:
3 had a midwife.
2 had an OB.    
Only one of these women hired a doula.  
It should be noted that a few of these women started with OBs and switched to midwives.   Length of labor and/or pushing would have certainly resulted in c-sections had they stayed with their original OBs and hospitals.
 

Of the 8 c-sections:
2 had a midwife.
6 had an OB.
Only 2 of these women hired a doula, and only one had her doula present.
Obviously, these c-sections happened for a variety of reasons, some valid, some not-so-much.  Can't ignore that 80% were with OBs.  Honestly question if they would have happened with a midwife.

Summary:  If you want an unmedicated birth, your birth team is crucial.  All the education in the world won't matter if you have a doctor who is determined that you or your baby "need" a c-section.  As for a doula, the statistics speak for themselves.  A woman who has the support of another woman in labor will almost always have a better outcome, or at least feel better about doing all that she could do to prevent having an epidural or a c-section. 

If you are birthing in a hospital, you need to hire a midwife instead of an OB and you need a doula by your side.  End of story.

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Why I Recommend the UNT Midwives

I am doing something quite different for this post. Instead of picking a topic, I've chosen a group of local midwives to write about. I am continuously sending natural birthing couples their way and I decided to make a post out of it. If you do not live in the Ft. Worth area, I suggest you use this standard in finding a similar type group in your area. I have nothing to gain by promoting this group, by the way. Simply giving information on a group of midwives who are working hard to provide Mother-Friendly care.

If you read my blog regularly, you know how I feel about homebirth. About 25% of the couples that take my class do give birth outside of the hospital. But that leaves 75% in the hospital. That is alright. I understand, having had 2 hospital births before my two homebirths, why couples want to birth in the hospital. The hospitals, however, are not all created equal.

Let me tell you, in a nutshell, why I am singling the UNT Midwives out for this post. They are all CNMs, or Certified Nurse Midwives, and there are five in the group. To be perfectly honest, some are more medically minded than others, as in any group.

There are three reasons I choose this group over the other CNM groups in the area:

1) They are doing water birth at the hospital. Even if you do not think that you want to have a water birth, the fact that you have this option is huge. It's all about options, really. They are not telling you, like the majority of the other hospitals, that they want you chained to a monitor in the bed. Water birth, or at least laboring in water (often called "a midwife's epidural") is a lovely option for moms and babies, and it's wonderful that it has become an option in a hospital setting.

2) They give you the full 14 days "over" your "due date" before they start talking induction. I have decided in my seven years of teaching that the majority of women truly believe that this won't happen to them. "Going 'overdue' and long labors are things that happen to other women, not to me." OK, it's not said outloud or sometimes even consciously, but it's real. So many women are not prepared for this possibility at the end of pregnancy. So much can happen in those extra days that the UNT midwives are willing to give you. A lot of other groups and/or hospitals have a 7-10 day rule. Me no likey.

3) They are VBAC friendly and so is the doctor that backs them. Again, huge. Even if you have never had a c-section and are not having a VBAC, this philosophy, mindset, and belief is important to all pregnant women. No one wants to have a doctor who has a no-VBAC policy. He or she is preoccupied with legal issues and does not believe in the inherent safety of birth. They have a what-if mindset. A woman with a doctor like that will have a c-section. Also, their back-up doctors believe in their midwives. There are other local CNMs that are not "allowed" by their back-up doctors to do VBACs. Huge. This might seem like a big who-cares, but it's not. It speaks volumes about what is going on in their hospitals.

Ultimately, you do not have to fight to have a natural birth. As long as you do not have drugs, you will have intermittent monitoring, allowing you the freedom to walk or be in the water. You will be encouraged to eat and drink. You will have very limited vaginal exams. Other hospitals require an IV, continuous fetal monitoring, no walking if your water has broken, and vaginal exams every two hours. These "policies" contribute to the high c-section rates.

I should mention that not every experience at Harris has been great. I have had a handful of couples birth there where I was disappointed in how things were handled. Overall, however, these instances have been few and far between. I also believe that they are working extra hard to lower their rates of intervention, including c-sections. Bottom line: if you are birthing in a hospital in the Ft. Worth area, I am most comfortable with how the UNT Midwives do things.

I had a couple give birth with the UNT midwives this past weekend and I would just briefly like to share why they did not have a c-section. I believe that just about any other hospital in the area, she'd be recovering from surgery this week.

This mom had been having some strong contractions about 7-8 minutes apart for about 4 days. She had had a difficult time sleeping and was exhausted by the time she showed up at the hospital Saturday morning. She had some Demerol to help her sleep and by late afternoon without a whole lot of dilation, she had an epidural. Eventually, she had pitocin to pick things up, but the baby didn't like that so much. Instead of doing a c-section -- as just about any care provider around would have done, calling it fetal distress and fearing a lawsuit -- the midwife turned off the pitocin and told this mom to go back to sleep. They'd try again later.

Eventually, the epidural wore off, after the mom had gotten in some good sleep, and she was able to squat her baby out! Her midwife believed in her ability to do have a vaginal birth. Except for exhaustion, mom was fine and baby was fine. She recognized what was working for them and what wasn't.

I also must add, when her doula showed up at the hospital, all the lights were on, monitors beeping loudly, and family all standing around watching this laboring woman. Her wise doula created an atmosphere of quietness, dim lighting, head massage, snuggle time with the hubby, and things moved along quickly afterwards. She probably should have been there sooner!

"I like my doctor" is not a reason to stay at your hospital. He or she will very likely not be at your birth. The nurses run the show at the hospital. You want nurses who are used to working with midwives and have a respect and belief in the natural process of birth. If all they ever see is inductions, epidurals, and c-sections, this is what they are comfortable with. Get the heck out of Dodge and run over to the UNT Midwives.

Now, if you decide to birth outside of the hospital, you have lots more options available to you. That's another story for another day!

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"Standing Outside the Fire"

So, I'm cutting onions and jalapenos this morning. No one is home. I have a Garth Brooks box set playing (sorry Tim!) with videos, concert clips, and interviews. I've had it for years but never watched it until this morning. It made the time go so much faster.

They showed the video for "Standing Outside the Fire". I love the song, but had never seen the video. I am such a sucker for sap! I want you to watch the video and then come back to me... (Yes, I have put videos on the blog before, but I can't remember how to do it, but if you click on the song, it'll take you right to the video.)

OK, did you love it? Are you bawling your eyes out? I was really a mess with all the onions!

Everything in my life relates back to birth. But before I went there, I couldn't help but be in awe of this mother's support for her child. The love was so evident and he had so much confidence because of her love and support. It made me think of my own children -- do I support them in their talents and ambitions? Some yes, some, not-so-much. It was a good moment for me as a mom.

Next, I couldn't stop thinking of a woman who plans and prepares for an unmedicated birth. She doesn't want to take the "easy" way out. Nearly all women will "stumble" in labor -- even if it's not obvious, maybe it's thoughts in her own head. What happens from there depends so much on her support team. Do they run to her? Do they cheer her on? Do they tell her, "Get up! You can do it!" Do they tell the doctors to "back off! Let her finish the race!"

What if this young man's parents had just sat in the stand? What would that boy have done? Do you think he would have finished the race? I do not believe he would have. It was his dad's encouragement -- the one who thought he would fail or get hurt -- who was at his side telling him he could do it! The look in the boys eyes -- my dad believes in me! -- was priceless.

And then to finish the race, running into his mother's arms, so proud. The prize at the end of labor, to hold your baby, knowing you did it!

Moms and Dads, it is not just about what mom is able to do. It is so much about her support team (doulas, nurses, midwives, doctors, mothers, mother-in-laws, sisters), cheering her to the finish line. Who would have thought that a Garth Brooks song would lead to such as inspirational birth song and post this morning! Sorry for all the crying. I hope you'll ponder this video and it's meaning in so many areas of our lives. Gotta love Garth! Now get on with your day.

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MY List of Things You Can Do to Avoid a C-Section

I've seen a couple of lists lately about the top 5 things a woman can do to avoid a c-section. While I think these lists are good, they differ from my personal list. I thought I'd take the time to write out my list. I guess I'll keep it to a top 5 as well, so as to not overwhelm anyone.

Education for both husband and wife: Some women are able to advocate for themselves in labor, but most are not. Preparation on the front-end is huge. Dad needs to know what is going on and how he can help. He needs to know what's normal and what's not. He needs to know the questions to ask. Having a doula will help with a lot of this. The doula cannot speak for mom, but dad can. I love The Bradley Method for this reason. Both individuals take responsibility for their role in the birth.

Careful Choosing of a Care Provider: Also huge. All the education and preparation in the world won't matter a bit if you have chosen a care provider and/or hospital who is determined that you need to be rescued from your pregnancy, labor and/or birth. This is the step where, if you ignore the red flags popping up during the education/preparation phase, it will bite you in the end. If you are getting information and statistics about your doctor or hospital that make you second-guess their philosophies, don't ignore them. It's never too late to switch care providers. I've had people change in the middle of labor! Typically, care providers like to see you for the last month of your pregnancy. I changed care providers at 33 weeks with my third pregnancy. A bit nerve-racking, but worth it for a great outcome. You will only give birth to this baby one time. Don't take on the "maybe for the next baby" attitude. Do it this time! Do it for this baby! If you don't know where to start, ask your out-of-hospital educator or doula for referrals.

Keep Moving - Don't Lay Down and Take It: Remaining in a hospital bed is one of the worst things you can do. They can/will strap a monitor on you and "watch" you from the nurses station. Health care at its finest! Laying around for your labor leaves it all up to your baby to make its way out. Baby needs movement. He is moving around, changing position, trying to find the easiest, most comfortable way out. If mom is moving -- walking, sitting on birth ball, pelvic rocking, rotating hips, even standing -- she's using gravity and movement of the pelvis to help her baby descend and get into a good position. Mom will have less vaginal exams (which often lead to Failure to Progress diagnosis), less time on a monitor (which often leads to a false-positive signaling fetal distress), and usually a more comfortable and faster labor. What's good for mom is usually what's best for baby.

Drug-Free Birth: I'm not just talking epidurals here. I'm talking inductions as well. Pitocin is a drug. Prostaglandins (cervical ripeners) are drugs. Baby may react "fine" to induction drugs, and he may not. There's no way to know how your baby will react. So trust in your body to start labor on its own. Don't be induced. Stadol, Nubain, Demerol -- they are all drugs that go to the baby. There will be physical results to the baby when they are born if they received these drugs -- more sleepiness, "laziness" at the breast, depressed breathing. If mom had educated and prepared herself during the pregnancy, she probably skipped this step. It's a tough thing to hear a mom's birth story and realize that her c-section was a direct result of her own actions -- induction, pain-relieving drugs, trusting her doctor, and not educating themselves on the normal process and what to do and what not to do. A woman is 50% more likely to have a c-section if she is induced, and four times as likely to have a c-section if she has an epidural. These are numbers that we simply cannot ignore.

Remain Low-Risk: If you do not take care of yourself and become high-risk, you give up a lot of power. You need to physically prepare your body to give birth by regularly doing pregnancy exercises. You need to eat the required nutrition to grow a healthy baby. A well-balanced diet with plenty of protein will benefit both mom and baby. The old saying "eating for two" does not mean eating for two adults! Be wise and mindful in your life choices. Practice relaxation every day. This will help with all aspects of your life, even after the baby comes. Keep stress out of your life as much as possible. Choose pre-natal tests wisely. There are so many that are done these days. Find out why it's being done and what they expect to do with the results. You can opt NOT to do them. Some may unnecessarily put you in the high-risk category if you test positive.

Of course, I must mention that every now and then I do have couples that do everything right and still have a c-section. I recently had one of these and it broke my heart. This mom worked so hard. I truly do not know what she could have done differently. You can't feel bad about a c-section that comes out of a situation like that. I feel sad for her. She really wanted a natural, unmedicated birth, and was so prepared. ICAN will be an important part of her healing.

My c-section rate of people who take my class is 14%. Some of those were necessary and some were not. Most that were not necessary can be traced back to one of these steps. One other way that can often help prevent a c-section is not rushing off to the hospital the minute your water breaks or you realize you are in labor. The longer you are there, the more excited everyone is to intervene.

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OBs Ban Doulas, Birth Plans, and The Bradley Method

In case you have a hard time reading it, it says: "Because the Physicians at Aspen's Women's Center care about the quality of their patients deliveries and are very concerned about the welfare and health of your unborn child, we will not participate in: a "Birth Contract", a Doulah Assisted, or Bradley Method delivery. For those patients who are interested in such methods, please notify the nurse so we may arrange transfer of your care."

You may have had the privilege of seeing this sign before now. I just saw it yesterday for the first time. Ironically, these OBs, Dr. Judd and Dr. Gordon, had both been recommended to me when I was pregnant with our first baby in Provo. The doctor I had, Dr. Brian Wolsey, I am certain, held the same opinion as these two doctors. In fact, when David saw the sign he even asked if that was hanging in Dr. Wolsey's office!

Well, as crazy as it seems, at least they are honest about the clients they want walking through their door. So often, I see doctors who feel this way, but are NOT honest. They tell women that, yes, they will do whatever they want, but have no intention of doing so.

Remember, birth is safe. These doctors are determined to save their clients, or "patients", from the "dangers" of a birth contract (plan), doula (they even spelled it wrong!), or the crazy Bradley teachers like myself!

If you have a doctor who ignores the evidence and/or your wishes, he is looking out for himself, not for you or your baby, despite making comments like this. This sign makes the reader feel as if these 3 things are unsafe and they are only looking out for your baby. Just the opposite! He or she wants to run the show. Waiting for your baby and body on your schedule is an inconvenience. They want you to have an epidural.

So, consumer beware. If you suspect, or know, that you have a doctor that holds these views, it's never too late to switch. You will only give birth to this baby one time. There are no second chances. Take control of your birth! Do not relinquish it to an ego-maniac doctor that tells you that you can't educate yourself, have a female companion to help you through labor, or have specific desires for this special day.

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Benefits & Stimulants of Oxytocin

This month I had the opportunity to attend the International Childbirth Educators Association (ICEA) Conference in Oklahoma City. I actually had to take a test for another certification (I passed!). The conference ran for three days and there are lots of things I'd like to share with you here.

In honor of all the women that I have due right now and in the next few weeks, I decided the first thing I wanted to write about is oxytocin - its benefits and how to make it flow!

Let's review for a moment: We hear so much about pitocin, but rarely oxytocin. Pitocin is the synthetic form of oxytocin. Oxytocin is what causes the uterus to contract. Released are also endorphins that help mom to cope -- even feel good. In other words, when oxytocin is released naturally, it crosses a blood-brain barrier to release those endorphins. When labor is started artificially with pitocin, or "pit", the uterus contracts without all these extra benefits I'm about to share.

Benefits of Oxytocin that you may not be aware of:
Mom experiences lower blood pressure and fewer stress hormones.
Her pain threshold increases.
Her sleepiness, even laziness, increases, causing relaxation.
Her muscle tension will decrease.
She will feel more calm and even more curious.
She will become more trusting and possible more daring.
She is more open to touch and be touched.
Oxytocin facilitates learning.

Wow! Who knew! Oxytocin levels are at their highest in a woman right after she gives birth. If you have given birth without medication, think back to how you felt right afterwards.

And did you know that women being together will also produce high levels of oxytocin. In comes the doula. Why is it that women are more able to relax and have fewer interventions and medications with another woman by her side in labor? We often assume that it is because she is more sympathetic or has been through this experience before. While these are often true, it's more than that. Think of when you have a girls night out. Oxytocin is flowing! Men will often report that their wives are in the mood for sex they come home from a girls night out. Oxytocin is often called "the love hormone" and makes us feel good!

So how do we get it flowing? There are many different ways. I always talk about nipple stimulation and sex as the number one way. This weekend, another educator reported that some serious kissing can often get oxytocin flowing more than nipple stimulation. If you have read anything by Ina Mae Gaskin, she'll probably say the same thing. Following is a list of several contributing factors to the natural production of oxytocin:

Ways to get oxytocin stimulated:
Warmth
Sex
Stroking
Descent of the fetus
Good food
Doulas/Companions
Low light
Mediation
Visualization
Positive thought
Movement
Suckling
Pleasant smells

Adrenalin is the opposite of oxytocin. If a woman in labor, or one who is trying to start labor, is under too much stress (ie. the threat of induction!), the production of oxytocin is squelched. Too much stress can actually stop labor. We've heard of the "fight or flight" response. It applies to labor as well. You can sometimes tell if a woman is under too much stress by looking at her eyes. Her pupils will likely be dilated instead of her cervix. Her digestion will slow, while her heart rate and blood pressure will increase. When this occurs, not enough blood will get to her vital organs and muscles, including the uterus.

The mind is a powerful, powerful thing. I was talking with one of my moms-to-be this week who was due about a week-and-a-half ago. I found out she was still working because she feels great. Better than sitting around waiting for baby to get here, right?! Wrong! I told her, no matter how the baby comes out, she will be a mother by the weekend. Her brain knows, when she's still working, that she has someplace to be tomorrow. Her focus needs to be on getting oxytocin to flow.

Relax. Take some time for you. Gather your girlfriends for some plain ol' fun. Go see a movie. Take a warm bath. Close your eyes. Take some good deep breaths. Enjoy the end of your pregnancy. Burn a favorite candle. Get a pedicure or foot massage. Wrap yourself in a warm blanket and read a book. Nap. Make out with your hubby and have some great candlelit sex. Let the oxytocin flow. Don't fight it. I feel good just writing all this!

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Can Your Husband Be Your Doula?

It seems like a very long time ago that I posed this question! In fact, I think it was two weeks ago. I bet y'all had about given up on me to ever write the post. You would not believe how much I have gotten done around my house over the last two weeks, in preparation for summer vacation. So, while those things have gotten done, the blog has suffered. I apologize.

I also knew that I have so much information on this topic, so much to say, that I was probably a bit overwhelmed to sit down at the computer to write it. I'd like to post some of the email from a former student/Bradley-teacher-in-the-making that started it all:

"There are a few things I think Bradley has a little off, and I think the whole idea of the husband being "the" labor help person is one of them. It probably sounds preposterous, especially since I am looking into becoming a Bradley instructor. But I agree with Martha Sears in The Birth Book where she says that it is better for the husband to be freed up to be "just" a husband to his laboring wife by a doula being there to help. I think you may agree with me slightly, since I remember you encouraging our classes to hire doulas if we could (and at the time thinking, "Why would we hire a doula? We're taking this class. This--husband--is my doula.").

Now, I am not saying that Bradley should not teach about husbands' involvement. I think it is one of the biggest reasons Bradley is one of the best preparations for natural birth. However, I believe that one of its greatest strengths (educating the husband about the physiological components, benefits and risks of different choices, as well as ways he can be a help in labor) is also a great weakness (raising the woman's expectations that he will be all these things she's been taught in class, even if that person doesn't remotely resemble who he has been throughout the pregnancy). In my experience, it did not happen that way, and I felt let down by my husband that he wasn't there for me the way that I needed him in Ruby's labor. I don't think I would have felt as let down if my expectations not been raised with the Bradley books and classes. What I eventually came to grips with is that I just can't have those kinds of expectations for my hubby (suggesting things, being observant, thinking of things on his own--like food, drinks, frequent bathroom breaks, how to make me more comfortable, verbal encouragement, the works!) and it does not say that he is a terrible husband because he didn't remember to do those things. When it comes to things like this, he is happy to do them, he just DOESN'T think of them himself. Especially on birth day. He needs coaching, and I am not the kind of person to do that while in labor. I just want him to KNOW."


Our results from the poll a couple of weeks ago were:

Can Your Husband Serve as Your Doula?

Even better! 30%

Are you kidding? 13%

He did alright. 56%

Hurray for the dads that did "even better" than a doula could have! I was surprised that the "Are you kidding?" category had so few votes! The majority, as I expected, fell into the "He did alright" category. This is where I would place my husband.

Thank you, also to those who contributed their experiences with their husbands and/or doulas. Some great comments. There was no right or wrong answer, obviously.

Quick history of "doulas" in America: Before birth moved into the hospital, approximately 100 years ago, men were not a part of birth. Birthing women had their mothers, sisters, aunts, best friends, and midwives attend their births. When birth no longer took place on their own turf, they could not take all these women with them. They were alone. Male doctors administered drugs that wiped women out entirely. The nurses, having several women to tend to, were all the female companionship a woman would have as she gave birth. Needless to say, her needs, emotionally and physically, were not met.

In the 1960s and early 1970s, the doctors and hospitals began to be pressured to allow husbands in the delivery room. Dr. Robert Bradley, with the publication of his book, "Husband-Coached Childbirth" advocated for women to birth without intervention or medication with their husbands "coaching" them through the experience. This was an exciting time for women and their husbands. A funny side-note to this time period: They wanted to give the husbands something to do, so the job of cutting the umbilical cord became his. They figured that he couldn't mess this up and he would feel like he had done something significant. It's really rather demeaning to think this is all the husband can do when it comes to birth.

In the 1990s, we started hearing the word "doula" or labor assistant. My first baby was born in 1996. My sister-in-law, who happened to be a doula, was present at our birth, and without her, I am certain that I would have had a C-section. And while I never paid an actual doula money to attend my subsequent births, I was always surrounded by my friends and family. And, of course, I had my Bradley-trained husband! (He was fantastic on the 4th birth!)

Many of the women who commented on their experiences, said that their husbands were a better doula with later births. There are many things that play into this: First of all, he has been through it before! But perhaps even more importantly, he has listened to his wife talk about what she likes and doesn't like in labor, probably many times over the years! He has attended other births and that gave him knowledge and experience. He knew what to expect. Imagine hiring someone who has attended dozens or hundreds of births -- the experience she brings is beyond helpful -- not just for the laboring mother but for the father-to-be.

There is a page in the Bradley workbook that is titled "Whose Job Is It?" Fortunately it appears in Class 11 instead of Class 1 because if I was a husband, looking at this list, I'd have to insist that she have an epidural because I didn't sign up for this! It is a list of 50 things that Dad should be doing. So if the mom has a C-section or an epidural, does that mean Dad failed at his list? He didn't do his job? It's just too much to put on a new dad.

With that being said, I do feel like my Bradley class prepares Dads extremely well for labor and birth. He comes away with good general knowledge of pregnancy, labor, how to help his wife in labor and birth, interventions, avoiding a C-section, consumerism, questions to ask, adjusting to life with a new baby, and breastfeeding. But the fact remains, when his wife is dilated to a nine, but the cervix has a lip, will he remember what positions are good to help with that? Maybe, maybe not. But a doula, who sees this very often, will know how to help. It's like the comment in the beginning: a lot of husbands want to help, but often need to be told how to help. Even with 12 weeks of class, a lot of husbands will not think of helpful laboring positions depending on what "symptom" mom is having. The more one reads about and attends births, the more experience and expertise they will have. In my expereince as a Childbirth Educator, the dads are not the ones reading about birth!

Dads must be advocates for their wives. It is important, even crucial, that he understand the birthing process, and that they do everything they can, as a couple, to prepare for this life-changing day. Doulas cannot speak for their clients, but husbands can speak for their wives in the delivery room. She will not be able to be her own advocate when she is in labor. A doula is familiar with the birth setting and terms, equipment used, etc., and it is easy for many dads to be overwhelmed by it all, especially the first time through. A doula, as Hannah said, is not so emotionally involved and can often help navigate the way through to a great birth.

Here are the simple facts:

Women have better obstetrical outcomes when they are accompanied throughout labor by a doula. She will provide emotional, physical, and informational support to a couple in labor. The presence of a doula reduces the C-section rate by 50% (!), the length of labor by 25%, the use of pitocin by 40%, the need for forceps by 40%, the request for pain medication by 30%, and the use of epidural anesthesia by 60%. If you are planning a VBAC (Vaginal Birth After Cesarean), statistically you are more likely to achieve a VBAC with a doula by your side.

Women who have a doula are more likely to report feelings of having coped well with labor and a greater satisfaction with their birth. They report having less anxiety after the birth and even an improved relationship with their partners after the birth. (Perhaps, in part, because the pressure was off of dad and he could lovingly support his wife without the "coach" role.) In addition, women who have a doula report higher self-esteem and lower postpartum depression and anxiety 6 weeks after the birth.

Babies also benefit from a doula being present for their labor and birth. They have fewer neonatal complications, fewer workups for sepsis, and fewer health problems at 6 weeks of age.

If you decide to have a labor assistant at your birth, ask around. Interview. Some cities have "Doula Teas" where you can go and meet lots of doulas and find one you like. Find out their personal statistics. I once heard of a doula that had a 90% epidural rate! That tells you that she isn't sure how to help you! You also might consider having a friend or two with you. Be sure they are supportive of natural birth and/or have given birth naturally.

Congratulations for making it to the end of this insanely long post. I hope you can appreciate why it took me so long to sit down and type it out.

I want to leave you with a single thought: Many times over the years, I have heard couples say how glad they are they hired a doula, but I have never heard anyone say, "That was the biggest waste of money."

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Can A Husband Be a Doula?

I throw out this question because I want your opinions and experiences before I continue from here. I had a former-student-turning-Bradley-Instructor pose this question to me a few weeks ago, and I've been thinking about it ever since. Remember, the Bradley Method of Natural Childbirth is based on the book by Dr. Robert Bradley, "Husband-Coached Childbirth."

Let's hear what you have to say before I throw out statistical data, etc. Looking forward to hearing from you.

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