Fathers and Partners Help Best as Birth Guardians...

...and/or loving partners, not as coaches; they also need support.

In honour of Father's Day, I decided to write about this Birthing from Within principle.

In our birth culture, we have moved from dads not even being in the room, to an expectation that they are responsible for supporting the mother in every aspect of pregnancy and birth.  This is not fair to either parent.

Birthing from Within Classes and doula support recognizes that fathers are also going through a rite of passage and major life change that is parallel to, and different from, the mother's experience.  Birthing from Within Classes provide a special class for fathers,that address their different needs. Read more about how Birthing from Within helps fathers...

The main role of the father during birth is to simply be present for the mother, to focus all of his attention and love on her.  Many dads learn that their role at the birth is to 'do something', whether that means negotiating with hospital staff, getting ice chips or doing a certain kind of massage for the mom.  While there are times during the birth that specific tasks may be required, the thing that moms remember most is a sense of their partner being present emotionally.  The father's preparation is sometimes about unlearning -- letting go of the instinct to solve a problem or fix something and instead learn to let the mother experience the intensity of labour, simply being there for her and recognizing the birth as the transformative experience it is.

Birthing from Within pain-coping practices (learned in a class) can help the parents stay connected to each other and gives the father something 'useful' to do that maintains and intensifies their emotional connection.

Having a doula or other female support person present is an excellent way to allow the parents to focus inward on the birth, while the doula gets the ice chips!  Doulas can also help direct dad if he is uncertain about what might help the mother and give him a break if he needs to leave for a few minutes to centre himself. Read this article about how doulas help...

Happy Mother's Day

I just wanted to take a minute to wish everyone a Happy Mother's Day.

I am very fortunate to be a mother of a lovely two year old.  

I also am lucky to have a profession as a birth and postpartum doula, where my job is to 'mother the mother'.  Simply put, that means I get to play a role in women becoming mothers by supporting them (and their partners) through the birth experience.  I also get to come to their homes and encourage them as they mother their new children and help their older children adjust to a new baby (or babies) in the household.

Clearly I have the best two jobs in the world.  As a mother and a doula.

I planted part of my garden today as a treat to myself.  I hope all the moms out there treat themselves today.  And a little bit everyday.  If you are pregnant or have a newborn, you can treat yourself by hiring a doula.  If you know a special mother (or mother-to-be) who could use this support, doula services can be given as a gift.

Practices That Promote Safe, Healthy Birth

I recently re-read The Official Lamaze Guide and I was impressed with how much it resonates with me and my own philosophy of birth.  Similarly to Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers, the authors of the Lamaze Guide are able to use a few simple principles to help women move towards the best possible outcomes for themselves and their babies.

They explain that up to 95% of women should have 'no-risk' pregnancies and be able to give birth safely, without the need for interventions.  If this is the case, why are so many women being labelled 'high-risk' and even those who are 'low-risk' ending up with all kinds of unnecessary interventions and births that are not what they had hoped for?  Simply, it is because we (parents, medical practitioners, support people and the general public) need to remember that birth is a natural part of life and that even the most subtle interference can have an a major impact.

The authors cite a lot of research, especially work that can be found on the Cochrane Library database, which proves that many routine interventions do not improve maternal and infant health and in many cases are potentially harmful.  They distill this research in a way that is easy to understand and, more impressively, in a way that supports their common sense birth practices. Most pregnant women will read this book and feel more confident in themselves and their ability to give birth in a safe and healthy way.

SIX PRACTICES THAT PROMOTE SAFE, HEALTHY BIRTH

Let Labour Begin on its Own:
Medically speaking a term baby is between 37-42 weeks gestation.  Many doctors encourage their patients to induce labour between 40-42 weeks or even earlier.  Usually there is no medical indication for this..  Many women at this point are understandably tired of being pregnant and misunderstand their doctor's encouragement as a medical necessity.  If your doctor suggests induction before 42 weeks, ask what the medical indications for induction are.

Sometimes women will be told that there is a risk of their baby being too big (macrosomia). It is important to know that this is not a true medical indication for induction (or for c-section) and that means used for establishing the size of a baby have a margin of error of more than 25% or more.  This means that your supposedly 10 pound baby could end up only being 7.5 pounds.

It is important to know that there are  risks to being induced and it can also negatively affect the birth experience, as most induction methods affect the body's natural ability to cope with pain.

See Lamaze International for more on letting labour begin on its own.

Walk, Move Around and Change Positions Throughout Labour
This one seems kind of obvious, but sometimes labouring women don't want to move.  They either find a position that is comfortable or they are uncomfortable and concerned that changing positions will make it worse.  The authors say the one of the purposes of pain in labour is to encourage us to move, find a new comfortable position and move the baby down.  The best thing to do is trust your body and ask for help from your support people if you want to try something different.

Obviously, the more interventions you have the move difficult movement can be.  In Lethbridge, you generally will not be allowed to move much if you have an epidural, but you should still be able to switch from side to side. If you are induced or labour is augmented with Pitocin, you will be required to wear the monitor most of time.  You can still get creative changing positions in and around the bed.


Bring a Loved One, Friend or Doula for Continuous Support
It is essential that your support people understand and agree with the type of birth experience you want.  Especially if you do not have a doula, the need to be well prepared and ideally have previous experience with birth.  Childbirth education classes can be really helpful and I hope to be offering them starting in the summer or fall of 2011.  Please contact me if you are interested.

You know best who can support you best during your birth.  In the Lethbridge Hospital there is a rule of 2 support people, which means you may have to choose between a family member and a doula.  If you choose a family member or friend along with your partner, try to envision how you would like them to help you during the birth.  Birth is very intimate and emotional and sometimes unresolved issues can come up and negatively affect labour.  Make sure personal issues are resolved before labour begins.


Avoid Interventions that Are Not Medically Necessary
Some interventions (such as IVs, epidurals, breaking your water, continuous monitoring) are done routinely, but have been shown by research to negatively affect labour (by slowing it down, increasing the need for even more interventions, increasing challenges with breastfeeding).  Make that there are good medical reasons for whatever interventions you agree to and try to come up with a compromise that will not affect your birth as much.  For example if you are Group B strep positive and need antibiotics, request a Hep(arin) lock to receive your antibiotics.  This way you can still move around freely without an IV pole and receive medication only when you need it.


Avoid Giving Birth on Your Back and Follow Your Body's Urges to Push
The Lethbridge Hospital has squat bars that attach to the bed and these can be very effective for some people.  You might have an idea for a position to try, don't be afraid to ask, or even move into that position (with help from your support people).

Sometimes women are asked to wait before they start pushing and this is difficult to impossible for most.  In a non-medicated birth the urge to push for most people is overwhelming.  Once you are pushing, medical staff sometimes make suggestions for pushing.  Sometimes they can be very effective, but pushing harder than your body wants to or before you are ready will result in exhaustion.  Some women have a brief rest period after they are fully dilated, before they feel an urge to push.  If you have this break, take advantage of it, it is a gift to help you get ready for pushing.


Keep Mother and Baby Together, it's Best for Mother, Baby and Breastfeeding
Here in the Lethbridge, hospital staff will usually place your baby on your abdomen immediately after birth, if you request this beforehand, if you do not request it, they will usually take the baby away to be weighed, measured and checked.  Weighing and measuring does not need to happen immediately and the baby can usually be checked in your arms.

If the baby is skin to skin in your arms you body will regulate his temperature and he will be more likely to latch on and breastfeed successfully. Babies born without medication have a very awake period immediately after birth and this is the best time to start breastfeeding.  See my post on breastfeeding, for more on this.

If you are pregnant I would recommend signing up for the Lamaze International blog Giving Birth with Confidence.

Mother's Advocate has videos and handouts about the Six Lamaze Healthy Birth Practices.


As always, please feel free to contact me if you have any questions or if you are interested in a doula.

Recommended Reading

Check out (literally!) my list of recommend reads for pregnancy and childbirth.

All these books are available at the Lethbridge Public Library and other libraries in the Chinook Arch System.

Stay tuned for reviews of some of these books in upcoming weeks.

The Role of the Birth Doula - Realities and Misconceptions

I regularly get asked what a doula does and people sometimes mistake me for a midwife.  I have covered the difference in other posts, but basically a midwife is a medical professional who is trained to deliver babies.  As a doula, I work alongside your doctor and nurses to provide emotional support and offer suggestions for comfort measures such as: positions, massage and pressure techniques.

In my last post, I reviewed the book Your Best Birth: Know All Your Options, Discover the Natural Choices, and Take Back the Birth Experience.  The authors of this book are big fans of the doula and there is an entire chapter devoted to how a doula helps.  Because they are such promoters, I am wary of being critical of the contents of this chapters, but I felt like some of their explanations could be clarified.

DOULA vs. CHILDBIRTH EDUCATOR
First, I just wanted to clarify that a doula and a childbirth educator are different things.  Some doulas are trained as childbirth educators, but not all.  Many childbirth educators will teach classes, but will not attend the birth of your baby.  In the book, the distinction is not made clearly.  I am trained as a doula, not as a childbirth educator.  As a doula, I do offer information and resources about birth and I certainly will recommend books and dvds to clients, but I don't offer in depth classes.  There are options in our area for Lamaze and Hypnobirthing classes and I will connect clients to these (and might even attend the classes with them).

I hope to become a childbirth educator for Birthing from Within in the next three years and I am taking the first training in June 2011.  This will enable me to help couples better prepare for their birth and eventually offer classes that compliment my birth doula services.

DOULA TRAINING
In Your Best Birth, Ricki Lake and Abby Epstein say that doulas start by doing a course and then apprentice (attend births) with more experienced doulas before becoming certified.  Maybe this is the case for some doulas in some communities, but in my community the hospital only allows two support people, so it is difficult for more than one doula to attend a birth.  Also, there are very few experienced doulas here who are able to act as mentors.  I think an apprenticeship for new doulas is an ideal scenario, but do not be surprised if your doula has not had the opportunity to work with a more experienced doula.  I am trained through DONA International. For more information about their certification process click here.

DOULAS and DECISION MAKING
Lake and Epstein understand what doulas do, but they don't always explain it well.  The statement: "Doulas can help you make the decisions you're faced with during childbirth" is a good example.  I help couples prepare before the birth and provide them with information that they are interested in, so they can make decisions during labour.  One of the tools I use to do this is the B.R.A.I.N. acronym.  Couples can ask these questions of medical professionals about suggested interventions:

Benefits - what are the benefits of this?
Risks - what are the risks to mother and baby?
Alternatives - is there anything else we could do instead?
Instincts - what do the parents' instincts tell them?
Nothing - what happens if we do nothing?

This allows couples to ask questions and the medical staff to respond directly to them.  As a doula, it is important for me to maintain a good relationship with the caregivers and not be viewed as confrontational.  Also, as I mentioned in my last post, it is important that parents educate themselves and learn to advocate for themselves.

DOULAS HELPING your SUPPORT PEOPLE
This is an area that was covered well in the book.  You are the star of your birth and everyone else is the supporting cast.  As a doula, I want to help the pregnant woman feel confident and powerful and to help her partner (or other support person) do the best job they can to help her.  Often, the most important thing a doula can do for couples is to reassure them they are doing well and that this is what labour looks like. Most people have not seen anyone in labour (TV doesn't count), and don't know what to expect.  If they are fearful or in a really medicalized environment, anything that happens can be seen as potentially dangerous.  Labour is very intense and sometimes the role of the doula is to remind the support people (and the mother) that birth is not an illness and what is happening is normal.

I hope this post helped clarify some of the more complex questions of what a birth doula can help you with.  Please feel free to contact me for more information or an initial interview.

New Year - New Endeavours

Over the past weekend, I put together a small website at www.elliedoula.com.  It is a start.  I want to keep posting new information to my blog, hopefully more often this year, but a recent promotions workshop I attended said that it is essential to have a website, so there you are.

I am also doing a presentation on Friday, January 28th at the Family Centre here in Lethbridge, as part of their 'Parent Talk' program.  The purpose of this presentation is to let more people know about birth and postpartum doulas and that we are available here in Lethbridge.  

'Doula' is still not a word that most people know, at least in this part of the world. I want people to understand that a good doula will be interested in supporting you to have the birth that you want. What we do see, both anecdotally and through research, is that mothers who had a doula present at their birth consistently report a more positive birth experience and have a better self-image (DONA Position Paper: The Doula’s Contribution to Modern Maternity Care).  

As doulas, our role is to ensure mothers feel they had the birth they wanted and that they felt confident and empowered during the birth.  Doulas should not be promising women: “If you hire me, you will not need a c-section, epidural, etc.”  We should be doing what we can to ensure women feel positive about their birth experiences regardless of the outcome. The doula provides clients with information and helps them advocate for themselves, she must not make judgement calls about what kind of interventions a client might need.

DONA Standards of Practice are very clear: DONA International Standards and Certification apply to emotional and physical support only. The DONA International certified doula does not perform clinical or medical tasks such as taking blood pressure or temperature, fetal heart tone checks, vaginal examinations, or postpartum clinical care.  I love this work because it is not medical.  I believe that birth is 90% emotional and psychological and maybe 10% medical.  

There is a huge need for emotional support in women giving birth, which is not being met in hospital settings in my community.  This is not the fault of nurses and doctors, their role is different and broader than a doula’s, and it is not realistic to expect them to provide continuous support the way that a doula can. Professional doulas who understand the scope of their practice are able to meet this need, in a way that is complimentary to the role of medical care providers.

I look forward to the future, when women in my community have the option of a safe home birth with a licensed midwife, and I know doulas will be just as valuable in this situation as in the hospital. In the meantime, I am happy to help clients give birth in a hospital setting, maintaining good relationships with hospital staff, the majority of whom greatly appreciate my role as doula.

The Essential Ingredient: Doula

DONA International has put together a new video on birth and postpartum doulas.  It addresses a lot of what I have been writing about here.  I would recommend watching it if you are interested in hiring a doula.


The Essential Ingredient: Doula from DONA International on Vimeo.


I am a DONA trained birth and postpartum doula, currently working on certification.