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.

Your Best Birth

I have recently finished the book Your Best Birth: Know All Your Options, Discover the Natural Choices, and Take Back the Birth Experience by Ricki Lake and Abby Epstein, who made the filmThe Business of Being Born, which is a documentary about birth in America.  I watched the film more than two years ago when I was pregnant and I really enjoyed it.

Overall, I enjoyed the book too, although it was not as clear and well written as some other books that provide an overview of birth options, such as Ina May's Guide to Childbirth.


TAKING BACK THE BIRTH EXPERIENCE
"This book will serve as a reminder that giving birth is something that women instinctually know how to do, and that you can tap into your own innate sense of power to take back the birth experience."

This idea of taking back the birth experience is central to this book and central to what I try to do as a doula.  Instead of being passive consumers, pregnant women and couples are actively preparing for birth, researching options, educating themselves about childbirth and preparing emotionally as well as physically for the experience of giving birth. A doula can help you with this, but ultimately the responsibility for preparing is that of the pregnant woman.

FEAR AND STRESS DURING LABOUR
In Your Best Birth they talk about the role the fear plays in undermining labour.  Mammals will stop labouring if they feel threatened and this is also true of humans.  In a hospital setting, with bright lights, medical procedures and interruptions, some women will find their labour slowing down or even stopping completely.  They experience a spike in catocholamines (such as adrenaline and cortisol) and this inhibits their ability to produce their own oxytocin (which creates strong contractions).  So artificial oxytocin (pitocin) can be used, which results in extremely intense, sometimes painful contractions that can cause fetal distress.

Another way that fear can affect labour is if there are unresolved issues or concerns the mother feels going into the labour.  Some questions they suggest asking include:

• What was your initial response when you realized you were pregnant?  Have their been any changes in your attitude or feeling since then?
• How has this pregnancy affected your relationship with your partner and other family members?
• If you have given birth previously, what was it like for you? Is there anything you would change if you could? Is there anything you do similarly the next time you give birth?
• How do you envision the birth of this baby? What is important to you? Who will be present at the birth?

While this book does a good job of addressing potential fears that could affect labour, I think they could be more careful with the writing as sometimes their comments could increase potential fears.  For example they mention choosing between an episiotomy and a tear, without talking about ways to avoid tearing for another 100 pages.

CHOOSING YOUR 'TEAM'
Lake and Epstein comment that women are people pleasers by nature, and this sometimes means that we will worry about how everyone else feels before meeting our own needs.  In birth, we must put ourselves first in order to make sure the birth is what we want.

This is key when choosing our support people.  The authors suggest having people at the birth who you trust completely, who approve of your birth plan and who you won't be self-conscious being naked around.

At the Lethbridge Hospital, woman are usually allowed only two support people, including their partner/husband.  What that means is that pregnant women need to choose between having their mother or a doula.  This can be a difficult choice, as a doula has all kinds of tools that a family member might not have.  Then again, a mother might know her daughter really well, or maybe her sister had a great birth and could be extremely helpful.  I think this something where a pregnant women should trust her instincts.  As long as the person they choose will be able to really support them, that is what matters the most.

What about partners or husbands who are afraid for their spouse or not supportive of her choices?  It is so important that the role of researching and preparing for the birth is a joint role.  Also, a doula can really help the father, both in preparation and during the birth experience.  As a doula, I hope the partner will be the primary support person, with me providing suggestions, reassurance and comfort techniques that he can use.

Your Best Birth cautions that we have realistic expectations of our support people (whether a partner, family member or doula). Although we can expect them to share our preferences with health professionals during labour, we can't expect them to argue against necessary medical procedures or body block the anesthesiologist.  I am preparing another post to further address the role of the doula as it laid out in this book.

LOCATION OPTIONS
This book is a strongly slanted towards natural birth and especially home birth with a midwife.  It can be frustrating to Lethbridge mothers, as this is not currently an option in our community.  The are no licensed midwives based here and the midwives working in Calgary have waiting lists for Calgary clients and are not usually willing to take clients from Lethbridge.  Hopefully that will change in the near future.

The most important thing to remember is preparation.  Knowing what you want your birth to be like and having a team (possibly including your partner, family members and/or doula) who are on the same page with you.  It can be important to have a doctor that you trust, but it is also important to remember that your doctor will likely be present only at the very end of your birth and many doctors (both family doctors and obstetricians) take turns being on-call, so your own doctor might not be at your birth.  You need to ask your doctor about this, if it is important to you.

From the last paragraph of Your Best Birth:
"...when women feel safe and empowered around their own births, they are able to bond with their babies and enter motherhood from a place of strength and security.  We have a long way to go toward making this a reality for every expectant mother, but through sharing information that will support woman through this journey, we are moving closer.  Our babies will thank us."




Overall, an inspiring book and well worth the read.  I also recommend the film, especially for couples to watch together.

Healthy Pregnancy, Healthy Baby(ies)

I just finished reading Having Twins And More: A Parent's Guide to Multiple Pregnancy, Birth, and Early Childhood by Elizabeth Noble.  It is part of my required reading for my DONA Postpartum Doula Certification (which I will have all the requirements completed for in the next couple of weeks).  I loved this book, and much of the information it provides is useful for  parents of 'singletons' (as they are called in the book), as well as parents of multiples.

My only complaint about this book is that it was published in 2003 and I hope that a new edition will be published soon.  It is very much based in research and I am certain that even more research has been done in the  past eight years to support some of her points of view.

The book is extensive and covers everything from health in pregnancy to bonding with your babies to coping with infants with disabilities and even the death of a baby (which is more common in multiple pregnancies).

For the purposes of this post, I will pull out just a few of the ideas that struck me as interesting and that are useful to me as a doula, supporting pregnant women and families with new babies.

Pregnancy
Noble shows that the single most important factor that results in a positive outcome for twins (and more) is the health of the mother.  Good nutrition, hydration and moderate exercise are the most important things pregnant women can do to ensure the delivery of full term, healthy babies.  Certainly, this is also true for single babies.  This is great news, because it is something that pregnant women have control over. We can decide to eat well, drink lots of water and go for a walk around the block once a day.

I have recently started taking yoga again, which I previously did when I was pregnant, and I am amazed at the effect it has on me physically and emotionally.  I would highly recommend prenatal yoga classes for all pregnant women.  If you can't afford classes or they are not available in your area, check the online Prenatal Yoga Centre for free videos on yoga to do during pregnancy.

Birth
One of the reasons that taking care of yourself during pregnancy is important is to avoid preterm birth, meaning birth of your baby(ies) before 36 weeks gestation.  According to Having Twins And More preterm birth is by far the major cause of complications and infant deaths.  In fact, 75% of all infant deaths in the U.S. are babies born before 36 weeks.  Some babies are born premature regardless, but good health and nutrition does reduce the chances of preterm birth and therefore can improve outcomes for babies.

Another thing that was interesting to learn from this book, is that prolonged bed rest during pregnancy, does not reduce the chances of premature birth and it greatly increases the potential for health issues in the mother. A NASA study shows that one week of bed rest results in the equivalent of one year's worth of ageing on the skeleton!

Often with twin or higher multiple pregnancies, doctors will recommend elective cesarean section.  Mothers agree to this because they believe it will result in better outcomes for their babies.  But the research shows that multiples (and singletons) delivered vaginally have lower mortality and morbidity overall, as do their mothers.  There are certain situations where a c-section is necessary, but most pregnant women (regardless of how many babies they are carrying) should be able to deliver vaginally.  Also, taking care of newborn babies is much more difficult when recovering from major abdominal surgery.

Parenting Multiples
Having Twins And More has great information about bonding with twins, their relationships with each other and with their parents and other siblings.  One interesting thing that Noble points out is that with more than one new baby the number of new relationships within the family increases. She provides suggestions on how the parents can help foster those relationships.  There is a lot of focus on the importance of recognizing the twins as separate individuals, rather than as a unit.

Overall, I would highly recommend this book for anyone expecting multiples or anyone who works with multiples and their families.

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.

Healthy Pregnancy (and Baby) Tips

from http://www.ewg.org/Health-Tips/10HealthyPregnancyTips
(I have added my comments/suggestions in italics to the original article - EC)

Pregnancy is a critical time. A mother’s chemical exposures can adversely affect her baby in many ways. Here are  some simple but important steps you can take to reduce the risks during pregnancy - and beyond.

EC - It is important to do the best you can.  Sometimes we get so obsessed with following 'rules' put out in baby books, by our doctors, families or in articles like this, that it ends up increasing our stress.  There is a lot to be said for trusting our common sense and taking what works for us and  leaving the rest.  Many of these tips apply not only to pregnancy, but can be adopted every day.

1. Go organic and eat fresh foods
   Use EWG's Shoppers Guide to Pesticides to determine which fruits and veggies you should always buy organic and those with the least pesticide residue that are ok to buy conventionally grown. Choose milk and meat produced without added growth hormones. Limit canned food, since can linings usually contain the synthetic estrogen called bisphenol A (BPA).
   EC - Many farms in Southern Alberta sell pesticide free produce and hormone free, free range meat, that is not certified organic, but still a healthy, sustainable choice.  Check out Broxburn Vegetables and Harris Farms for two great options.
2. Drink safer water
   It's important for pregnant women to drink plenty of water. Use a reverse osmosis system or carbon filter pitcher to reduce your exposure to impurities such as chlorine, perchlorate and lead. Don't drink bottled water, which costs more and isn't necessarily better. If you're out and about, use a stainless steel, glass or BPA-free plastic reusable container. Mix infant formula with fluoride-free water. Get EWG's Safe Drinking Water Guide.
   EC - Exclusive breastfeeding for the first six months is the healthiest choice for babies.  There have been some studies that show toxins appearing in breast milk, but they are at far lower amounts than toxins present in formula.  Following some of these tips, can also decrease the level of toxins in your breastmilk
3. Eat low-mercury seafood
   Choose low-mercury fish such as salmon, tilapia and pollock, rather than high-mercury tuna and swordfish.
4. Get your iodine
   Use iodized salt, especially while pregnant and nursing, and take iodine-containing vitamins. Iodine buffers against chemicals such as perchlorate that can disrupt your thyroid system and affect your baby’s brain development during pregnancy and infancy.
5. Choose better body care products
   Just because the label says "gentle" or "natural" doesn't mean a product is safe for pregnancy. Look your products up on EWG's CosmeticsDatabase.com. Read the ingredients and avoid triclosan, fragrance and oxybenzone. Read EWG's Healthy Home Tips for more tips.
   EC - Also watch out for parabens, sodium laurel/laureth sulfate and parfum (another word for fragrance).  Shop at stores that are consciously selling healthy products for you and your children.  In Lethbridge, check out Naturistas (424 7th Street South) and Ecobaby Canada.
   
   
   
   
6. Wash maternity clothes before wearing
   Clothing is often coated with chemical treatments in the factory.
   EC - Many baby clothes (especially sleepers) are treated with flame retardants.  Choosing 100% cotton (especially organic cotton) clothes that fit well is a good choice.  Always wash all baby clothes, car seat covers, blankets, baby carriers, etc. Before using them.  Use a mild, fragrance-free deter
7. Identify lead sources and avoid them
   Test your tap water for lead and avoid any home remodeling if your house was built before 1978, when lead house paint was banned. Dust from sanding old paint is a common source of lead exposure.
8. Avoid painting.
   When getting your nursery ready, avoid painting and other chemical-intensive jobs.
   EC - If you must paint or remodel while pregnant, get someone else to do the work and try and stay somewhere else to avoid chemical exposure.  Use VOC free paint, which you can buy at most paint stores.
9. Clean greener
   Household cleaners, bug killers, pet treatments and air fresheners can irritate kids’ and babies’ lungs – especially if they have asthma. Check out less toxic alternatives. Some ideas: vinegar in place of bleach, baking soda to scrub your tiles, hydrogen peroxide to remove stains. Use a wet mop/rag and a HEPA-filter vacuum to get rid of dust – which can contain contaminants. Leave shoes – and the pollutants they track inside -- at the door.  Get EWG’s Tips for Greener Home Cleaning.
10. Avoid gasoline fumes
    Ask for your partner's help to fill the gas tank, or use full service..
11. Pick plastics carefully
    Some plastics contain toxic chemicals, including BPA and phthalates. Don't reuse single-use containers or microwave food in plastic containers. Avoid PVC by hanging a natural-fabric shower curtain. When remodeling, go with PVC-free flooring and pipes. Learn more about choosing safer plastics.
    EC - even though some plastics are recyclable, they often end up in the landfill.  Even the for the supposedly non-toxic plastics, we don't really know, because chemicals need to be proven unsafe to be taken off the market, so instead of plastics, think about using alternatives, like glass and stainless steel.
    
    
    
    
    
    
    
    
    This book expands on the points covered in this article and includes information on being green with your new baby too.
    
    
    
    
    
    
    
    
    
    
    A great guide that includes pregnancy, babyhood and beyond.