Monday, May 23, 2011

Hospital L&D Tour

Yesterday I went with my doula client on the tour of her hospital's labor and delivery unit. I've wanted to do this in the past, so I was excited to do it, especially at a hospital I hadn't been a doula at yet.

Unfortunately, both my client and I had heard that this particular hospital was not majorly doula-friendly. I had also heard that it was not a natural birth-friendly place, and had a high cesarean section rate. Oy. 

The first thing we did was sit around a table in a classroom while she told the group what procedures they could expect during labor, during and after delivery, and postpartum. The nurse leading the tour spoke in the most patronizing way - like she had a lifetime of experience of talking down to her patients. This wasn't just my opinion - my client agreed that we were being spoken to like we were children! And the voice and mannerism never let up - it was like the nurse talked like this all the time without realizing it. Very odd.

She also spent a lot of time on strange details like how any cameras or laptops that we brought had to be battery-powered because although there were outlets in the room, we can't use them in case they were needed in an emergency. I found that an odd 3 minute rant... She also spent time talking about how if you have a dog at home, you need to take home your baby's first hat (the one covered in vernix) and give the hat to the dog so they can get used to baby's smell. It makes sense, I guess, but relevant to knowing what the labor and delivery experience will be like? Nope.

She did not leave an open atmosphere for questions, or solicit questions.

We visited the labor and delivery floor to see a room, and I noticed the floor was totally empty. Not one room's door was closed. The place was totally empty! The nurse emphasized how "homey" the room felt, with all its wood instead of metal. The L&D room looked just like the room I had seen in one other hospital, which happened to contain the most irritating L&D nurses yet (yelling and "if you're breathing you're not pushing!" kind of thing). I wonder if there is a correlation between the hospital's effort to make the room feel "homey" and worse L&D experiences. 

Then we went up to the nursery on one of the postpartum floors. The nursery only had 2 babies in it! Granted, the hospital practices rooming-in, which is great, but only 2 babies in the nursery and 0 women laboring on the delivery floor made the hospital seem like a ghost town. The postpartum room was small, just like all the postpartum rooms I've been in, with an uncomfortable couch for the partner to sleep on.

Luckily, the hospital seemed very pro-breastfeeding. She repeated several times that they want the baby to be skin-to-skin as soon as possible because it helps with breastfeeding success. Unfortunately, who knows how long the skin-to-skin will last, and how helpful the postpartum nurses and lactation counselors will be. Someone asked about Lactation Consultants and the nurse said you could "request" one. I'm guessing that means its not standard that everyone see one, and that the LC is not there all the time.

At the end of the tour we asked if the newborn procedures (APGAR, heel prick, eye gel, vitamin K, etc) could be done with the baby on the mother's chest. The nurse thought for a really long time and said she really didn't know, no one had ever asked before and she had never seen it done (not good odds that it will occur then). She assured us it all gets done in "a blink of an eye" while mom is going to the bathroom anyway, so we won't even notice. I've never seen it happen in a blink of an eye, I've seen mothers and fathers peering sadly over at the other side of the room wanting to see and hold their newborn that they worked so hard for and who just got whisked away. It usually takes as long as it takes for the doctor to stitch the mom's perineum if she has torn, which is a while. We also asked about rooms with showers and tubs, which the nurse said are only in two of the room, and are reserved for the mother's who want to go natural. This makes me sad.

I was nervous to ask irritating questions about epidural and cesarean section rate, as I was there with my client, and I didn't want to further give doulas a bad name.

What questions should we have asked? Have you been on a hospital tour with your doula clients?

A blogger at Science and Sensibility just posted a blog about taking a hospital tour - If you'd like to check it out, click here.

Wednesday, May 18, 2011

Doula Progress Report

Last week I finally sent in my DONA doula certification paperwork. Hooray! A journey that was begun in November of 2009, interrupted by a big move and starting a graduate program, has finally been completed. I can't wait to announce that I am a Certified Doula - CD(DONA)! They say the review process can take up to 2 months, so I don't know when I will find out. In the meantime, I will be going on-call this coming weekend and I am so excited!

For those of you who are unfamiliar with what a DONA birth doula certification entails, here is what I have done over the past year and a half:
  • Attend a DONA Birth Doula Training Workshop
  • Read 5 books - The Birth Partner, Klaus Kennell and Klaus' Doula Book, a comprehensive pregnancy book, a breastfeeding book, and a book on natural childbirth. 
  • Read the DONA Birth Doula Position Paper, Code of Ethics, and Scope of Practice.
  • Attend a Childbirth Education course
  • Attend a Lactation Education course (can be done online)
  • Write a list of resources for clients in your area - at least 45 from 30 different categories
  • Attend a minimum of 15 hours of labor from 3 different births. Must be the primary doula and be present before the onset of active labor (4-5 cm dilation). Receive positive evaluation forms from the mother PLUS the midwife or an OB/nurse combo. 
  • Fill out labor and delivery progression chart and record forms for each birth, and write an essay on each birth experience including what I learned and how the mother felt. 
  • Write an essay on the Purpose and Value of Labor Support.
  • Provide professional character references, pay fees, and maintain DONA membership.
To date I have attended 7 births:
1 as the secondary doula, 6 on my own, 1 home birth, 1 epidural birth, 6 natural births, 0 cesarean sections, 2 midwife-attended births and 5 OB births, 4 primips and 3 multips, and only 1 where the mother was no longer breastfeeding at the postpartum visit.

Labors that occurred mostly at home were the fastest labors. When the majority of a woman's labor took place in the hospital, these were my longest labors. I don't know if this is a rule/fact or a coincidence...

I've had some really awesomely doula-supportive nurses and doctors, and I've had some apathetic or mildly unfriendly nurses and doctors. None were openly hostile. Everyone signed my evaluation forms without much annoyance. The home birth midwife was the one that got me the most involved - Look at the placenta! Here, hold the baby! Hold this flashlight still while I stitch mom's perineum! The hospital midwife sat down with me and discussed each point on my evaluation with me. One nurse made copies of the form and handed it out to multiple other nurses to fill out (unnecessary, but I didn't tell her that in her excitement - "I'll help you get certified!")

Advice to other doulas:
The process will probably take longer than you think it will. You might put a lot of time and money into your first births and not even have them count for certification. Chase those OB's down ASAP for your evaluation form signatures because they disappear fast. Find and talk to other local doulas - for resources, to vent, to shadow, etc. Do not go head-to-head with a nasty nurse or doctor - this could ruin the birth experience for your client, you won't get your good evaluation, and you will harm the doula profession.

In academic news, this summer I am continuing my public health required core courses, so I haven't yet delved into the interesting maternal and child health part of public health.
Also, I received a first-year evaluation from my anthropology department. My professors said that I am "very good at thinking anthropologically"! It's always nice to be validated in one's chosen field of study.

Tuesday, May 17, 2011

Just Doula!

Fabulous TEDtalks video by a Singaporean doula about her birth experience and about being a doula.

"I wanted someone to believe in me... to tell me, Ginny, you can do this!"

"Empowering mothers, not telling them what to do but believing in them and showing them the way."

"If I see a stranger and I say, 'hey, you are going to have an easy, short, relaxing, comfortable birth' what would be the immediate response? 'you're crazy!' Why? Because we believe that childbirth is painful! But from my experiences as a doula I see women giving birth in such a pleasurable way!"

"All the hormones we use for making love are the exact same hormones we use for giving birth"

She has some great advice on some things that can help a woman have an easy, short, relaxing, comfortable birth:
1. Eliminate Fear - Get all the skeletons out of the closet. Educate yourself about what Childbirth is going to be Like.
2. Find Coping Techniques - Condition relaxation to the point that its of second nature to you, so you don't fight contractions with tension.
3. Prepare a Birth Plan - If things don't go as planned, what is Plan B, C, and D.
4. Get Support - Find a doctor and a hospital that will support you in the birth that you want. Doulas can help you embrace the good birth experience.
The video she mentions at the end of her talk can be found here.

Monday, May 16, 2011

Link Roundup: International Edition

Amnesty International
Science and Sensibility does a focus on some information on maternal mortality from Amnesty International, presenting some truly shocking statistics. Here are a few:
49: The number of countries that have lower maternal mortality ratios than the US.  Women in the US are more likely to die of pregnancy related complications than in 49 other countries, including nearly all European countries, Canada and several countries in Asia and the Middle East.
3 to 4x: African-American women are 3 to 4 times as likely to die from pregnancy-related causes as white women.
2x: Women living in low-income areas across the US were 2 times as likely to suffer a maternal death as women in high income areas
1,000: The number of women around the world who die every day from complications of pregnancy and childbirth. That’s over 350,000 women every year – one woman every 90 seconds.  The vast majority of these deaths are preventable.

Every Mother Counts    
Every Mother Counts is an advocacy and mobilization campaign to increase education and support for maternal and child health. Model Christy Turlington has created a film called No Woman No Cry - powerful stories of at-risk pregnant women in four parts of the world, including a remote Maasai tribe in Tanzania, a slum of Bangladesh, a post-abortion care ward in Guatemala, and a prenatal clinic in the United States.

The organization also takes donations of cell phones to medical clinics in the Democratic Republic of Congo to help save mothers' lives. Donate Your Phones to Hope Phones Today.


Birth Around the World: Midwifery in Tanzania
from Rixa at Stand and Deliver


Postpartum Care Considerations in Muslim Communities: Part II of theInterview with Hajara Kutty 

A two-part series from Science and Sensibility on Childbirth and Postpartum Care among Muslim Women

Throughout Time, Throughout the World: Baby Wearing
Bellies and Babies blog posted a great post full of history and photos of women wearing their babies as they went about their lives in cultures and countries all over the world.
"In 1733, William Kent invented a wheeled baby transportation device. In the 1830's, they were brought to America, but it wasn't until the mid 1800's that 'prams' truly became popular."
"But, it wasn't until 1985, when William and Martha Sears began baby wearing their youngest, that baby wearing began to truly gain recognition in the United States. Coincidentally, the Sears' also coined the term “babywearing”.

Thursday, May 12, 2011

One World Birth

Check out this new and in-progress documentary and movement, One World Birth.

The ongoing documentary will consist of interviews worldwide with proponents of normal birth.  

Check out the trailer:

Thursday, May 5, 2011

Happy International Day of the Midwife!

International Day of the Midwife - 5 May 2011

Over 340,000 women die each year, with millions more suffering infection and disability as a result of preventable maternal causes. The International Confederation of Midwives (ICM), alongside UN agencies, World Health Organization (WHO) and a range of other international partners, is committed to addressing maternal mortality and morbidity through greater access to essential midwifery care worldwide, particularly in developing countries where 90% of maternal deaths occur.
The WHO has recognized that the promotion of midwives as the prototype for the skilled birth attendant is crucial for the attainment of the Millennium Development Goals to reduce maternal and child mortality.

Why Choose a Midwife?
Well, most importantly, there's the midwifery model of care:

This model recognizes that birth is a social event and a life-transforming experience for the woman and her family. Birth is seen as a holistic process: professionals recognize the mind-body connection and treat the woman as a whole. Care is family- and relationship-centered and relationship. Midwives are trained to recognize the normalcy of birth and minimize technological interventions, but also to identify women who may require obstetrical attention. This holistic model recognizes that the woman’s mind and body are connected, as are mother and child. The goal is not simply a physically intact woman and baby, but a mentally healthy woman and baby as well.

This model is woman-centered, unlike the biomedical technocratic model, which is physician-centered. The woman delivers her baby, not the physician. Alternate forms of care are respected and used, such as emotional encouragement, touch, and non-pharmacological interventions. Midwives understand that birth is a respected process that cannot be managed or controlled. Unfortunately, only eight percent of pregnant and birthing women receive care from a midwife (see Declerq et al 2006).

Birth Models that Work, a new book edited by Robbie Davis-Floyd (and others), who studies birth models all over the world, has identified the elements of systems that do not work and those that do.
It is an exploration of anthropological, epidemiological, and medical research on various birth models. In areas with birth systems that do not work, mothers and babies are dying because of a lack of access to life-saving health care, or lives are saved but mothers and babies are physically and/or psychosocially damaged.  

Birth models that work “apply the latest scientific evidence to support and facilitate normal physiological birth, deal appropriately with complications, and generate excellent birth outcomes – including psychological satisfaction for the mother." She and her co-editors have discovered that the ideology that underlies all birth models that work is the midwifery model of care, which exemplifies the humanistic model. 

And if you don't take my word for it, get some further opinions in this video:

What are the Types of Midwives?
Midwives come in all kinds of different settings and certifications. Different states have different names and laws regarding midwifery.

A Certified Nurse Midwife (CNM) generally, though not always, provides care in a hospital or birth center setting.

A Certified Professional Midwife (CPM) and a Direct Entry Midwife (DEM) generally practice in out-of-hospital settings, like home birth.

A Licensed Midwife (LM) means the midwife is licensed in her state.

A "Lay Midwife" means that the midwife is trained but is not licensed, either because the state she lives in has no license procedure or because she has chosen not to.

How Can I find a Midwife?
Check out:
Midwives Alliance of North America
American College of Nurse Midwives
The North American Registry of Midwives

Or find a Birth Center near you:
American Association of Birth Centers

Or find one in your health insurance network

How Can I Celebrate Midwives?
Find out if there is a local rally or event celebrating International Day of the Midwife
Join our local Friends of Midwives group or donate to one
Buy your favorite midwife a special thank you gift!

Monday, May 2, 2011

Happy International Doula Month 2011!

 May is International Doula Month!

 How will you celebrate the doulas in your lives? Here are some ideas:

Call up your doula just to say hello and catch up
Tell as many moms as you can about doulas
Say "thanks" to your doula with a doula t-shirt or piece of jewelry
Search for local events related to birth, like these

Doulas, Celebrate! Here are some ideas:

DONA's Capturing the Doula Spirit: A Contest in Celebration of International Doula Month:
A picture is worth a thousand words, or so it is said. What can a photo say about the work of a doula?
In celebration of International Doula Month, DONA International will honor its members, their doula spirit and the contribution they provide to maternity care by accepting photo action shots that tell their story as a birth or postpartum doula. Photos must be submitted during the month of May, which is International Doula Month.
For more information, click here

Put a display up at the local library
Host a "Doula Informational Evening"
Host a "Belly Casting" or "Henna" Workshop
Offer doula services for half price
Write an article for a local newspaper about doulas

What are some other ways to celebrate doulas this month?
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