Suze Orman: A doula is a "NEED, not a want!"

Suze Orman's recently said on her show segment "Can I Afford It?" that a doula is a NEED, not just a want!

So, yes, you can afford a doula!

Watch the clip here: http://video.cnbc.com/gallery/?video=3000162344

Optimal Fetal Positioning

In the past year, I've had some clients whose babies were malpositioned, either during pregnancy or (suprise!) during labor.

A baby who isn't positioned exactly right can make labor difficult. Ideally, a baby will be head down, occiput anterior (OA, facing mother's backside), and not get stuck in a left or right position. Not so ideally, a baby could be breech transverse (head up or laying sideways), occiput posterior (OP or 'sunny side up'), left occiput anterior/posterior, right occiput posterior/anterior. Babies can also present face-first or with their hands beside their faces!

Some postulate that our sedentary lifestyles may contribute to a baby becoming malpositioned during pregnancy - we do a lot of reclining! - and suggest trying to avoid this during late pregnancy, if possible. In a Bradley course I once heard some "tricks" to try to get or keep baby head-down: playing music down low so the baby turns toward it, same thing with heat packs, handstands in the pool, and so on.

A baby can turn in pregnancy and labor right up until the last second, especially if you employ some techniques to help the baby along. External version or Webster's Technique are two ways that professionals might try to help a breech baby turn.

Chiropractic care can open up tight abdominal ligaments, which aid in a baby's positioning through your pelvis. Spinningbabies.com is a great resource for moms who are worried about the position of their baby. As long as you don't have blood pressure issues, one can practice the Inversion daily. Prenatal yoga is also a great way to stretch everything out and get stronger at positions that will help you in labor (not to mention help you learn to breathe well for labor!)

Since the goal is often to avoid a Cesarean section or a long, painful labor, many mothers are looking for ways to promote optimal fetal positioning. 

Doulas have a lot of tricks up their sleeves for helping reposition babies who may not be in the most ideal position for birth. Signs during labor that the baby might be mis-aligned include a prolonged active labor (first stage), back labor, or a prolonged pushing stage. Use of a rebozo, the Captain Morgan stance with a lunge, open knee chest position, and the breech tilt are some that I know for repositioning babies during labor.

captain morgan pose

open knee chest

breech tilt

rebozo sifting

Many of these positions work by opening up the pelvis, lifting the baby out of a position he/she might be stuck in so that they are loose and able to move, and allowing for rotation.

Recently, someone suggested that I look into using the Miles Circuit with my doula clients.

It takes 90 minutes to complete and, like many of these techniques, are somewhat difficult and require preparation. It consists of:
1. Knee chest for 30 minutes
2. Exaggerated SIMS (side lying or semi prone with top leg bent at right angle) for 30 minutes
3. Upright movements - can be lunging, movement on a birth ball, climb stairs, for 30 minutes

It seems like this could really work! It already incorporates things that doulas already do - get mom moving, side lying for when she needs rest, and the classic open knee chest to first lift baby out of the pelvis.

Have you ever heard of this?   Used it yourself?


One question that often comes up is whether these things can put the baby in a worse position. Probably not, but just in case, I couldn't actively do something like the Miles Circuit during pregnancy or labor if the baby was already in an optimal position!

Are Doulas a Form of Complementary and Alternative Medicine?

Last week we discussed medical pluralism and complementary and alternative medicine (CAM) in an anthropology course. CAM is hard to define, but basically brings to mind chiropractors, acupuncture, massage therapy, homepathy, Reiki, dietary supplements, yoga, meditation, traditional chinese medicine, etc. The 2007 National Health Interview survey found that approximately 38% of adults use CAM. Alternative medicine is used instead of conventional medicine, while Complementary medicine (or therapies, treatments, etc) are used in conjunction with conventional (bio) medicine.

Kaptchuck (2001) writes “any therapy deemed unacceptable by the mainstream can find a receptive home in CAM,” all that is required is that they can be described as alternative (202).  Harvey (2011) builds on this point, also emphasizing that “it gathers or is granted meaning from what it is not (Western) as if having no meaning-making, capabilities or significance of its own” (48).

As we were discussing CAM, one of my classmates asked me to talk about being a doula. When asked, I was a little bit thrown off. Is a doula really a CAM practitioner? Doulas are non-medical. I don't consider myself "medical" but could certainly fit into a form of "therapy," as I provide psychosocial support. After all, is yoga and massage medical? They're definitely therapeutic. And am I "alternative" or am I "complementary"? Well, no one really uses a doula INSTEAD of biomedicine, generally in addition to it, so perhaps doulas are complementary.

So, I agreed to speak about these thoughts I was having about being a doula and perhaps being complementary medicine. It's true that many people who hire doulas do so because they feel they haven't received appropriate care from biomedicine/conventional medicine. Often, CAM is sought because biomedicine is not meeting some health need. Alternative therapies attempt to “address what orthodox biomedicine seems both unable and unwilling to address” (Nairandas 2011:69). Also true is the fact that people who hire doulas also tend to be into massage, yoga, acupuncture, chiropracty, and other forms of CAM.

I struggled with this topic, though, because I had never considered myself a CAM practitioner before. This was what my professor found the most interesting. Perhaps I hadn't thought of myself that way because I do get hired mainly by people who, even if they desire a natural birth, are still birthing in the hospital and are not the hippie crunchy granola new age people one associates with users of CAM.

I think after considering this for a while I have come to the conclusion that yes, a doula is a form of complementary medicine. It is a form of mind-body therapy. Like acupuncture, for example, it doulas are seeking legitimacy by proving their worth and efficacy through randomized control trials. Further, doulas can on occasion be paid by health insurance, also a fight that CAM undergoes.

The only place I could find a clue about doulas as CAM was at this Integrative Medicine blog where the blogger mentions doulas and health insurance.

To many, it might seem obvious that doulas are CAM, especially if they've never heard of them. But to me, because I work in biomedical settings, it seems hard to separate what I do from conventional medicine. Perhaps a midwife and/or doula at a home birth seems more alternative.


What do you think? Is a doula a complementary and alternative health practitioner?



Our CAM and medical pluralism readings:

Baer, H. A., C. Beale, R. Canaway, and G. Connolly 2012 A Dialogue between Naturopathy and Critical Medical Anthropology: What Constitutes Holistic Health? Medical Anthropology Quarterly 26(2): 241–256.
Baer, H. A. 2002 The Growing Interest of Biomedicine in Complementary and Alternative Medicine: A Critical Perspective. Medical Anthropology Quarterly 16(4): 403-405.
Harvey, T. S. 2011 Maya Mobile Medicine in Guatemala: The “Other” Public Health. Medical Anthropology Quarterly, 25: 47– 69.
Kaptchuk, T. J. and D. M. Eisenberg 2001a Varieties of Healing. 1: Medical Pluralism in the United States. Ann Intern Med 135(3): 189-195.
Kaptchuk, T. J. and D. M. Eisenberg 2001b Varieties of Healing. 2: A Taxonomy of Unconventional Healing Practices. Annals Of Internal Medicine 135(3): 196-204
Micozzi, M. S. 2002 Culture, Anthropology, and the Return of "Complementary Medicine". Medical Anthropology Quarterly 16(4): 398-403.
Thompson, J. J. and M. Nichter 2012 Complementary & Alternative Medicine in the US Health Insurance Reform Debate: An Anthropological Assessment is Warranted. Topic paper prepared for the SMA 'Take A Stand' Initiative on Health Insurance Reform.
Barnes, L. L. 2005 American Acupuncture and Efficacy: Meanings and Their Points of Insertion. Medical Anthropology Quarterly, 19: 239–266.
Green, G., H. Bradby, A. Chan, M. Lee 2006 “We are Not Completely Westernised”: Dual Medical Systems and Pathways to Health Care among Chinese Migrant Women in England. Social Science & Medicine 62(6): 1498-1509.
Kaptchuk, T. J. 2011 Placebo Studies and Ritual Theory: A Comparative Analysis of Navajo, Acupuncture and Biomedical Healing." Philosophical Transactions of the Royal Society B: Biological Sciences 366(1572): 1849-1858.
Langwick, S. 2010 From Non-Aligned Medicines to Market-Based Herbals: China's Relationship to the Shifting Politics of
Traditional Medicine in Tanzania. Medical Anthropology 29(1): 15-43.
Naraindas, H. 2011 Of Relics, Body Parts and Laser Beams: The German Heilpraktiker and his Ayurvedic Spa. Anthropology & Medicine 18(1):67-86.
Thompson, JJ, and M Nichter 2007 The Compliance Paradox: What We Need to Know About "Real World" Dietary Supplement Use in the United States. Alt Ther Health Med 13(2):48-55.
Yuehong Zhang, E. 2007 Switching between Traditional Chinese Medicine and Viagra: Cosmopolitanism and Medical Pluralism Today. Medical Anthropology 26(1):53-96.

Postpartum Reading

I've decided that once I have time in my life to read things unrelated to grad school, I want to enhance my postpartum knowledge. I don't want to pay for a postpartum doula training, because I don't think I need to add that certification, but I will read the books!

Here is the list that DONA International suggests:

Section One: Becoming a Mother (choose one) 
The New Mother: Eagan, Mothering the New Mother: Placksin, Misconceptions: Wolf, The Year After Childbirth: Kitzinger, Ourselves as Mothers: Kitzinger

Section Two: The Newborn (choose one)
Your Amazing Newborn: Klaus and Klaus, Touchpoints: Brazelton, The Mind of Your Newborn Baby: Chamberlain, The Vital Touch: Heller, Infancy: Field The Baby Book: Sears, The Year After Childbirth: Kitzinger
 
 Section Three: Breastfeeding (choose one)
The Ultimate Breastfeeding Book of Answers: Newman, The Breastfeeding Answer Book: La Leche League, Dr. Jack Newman’s Guide to Breastfeeding (Canada), Breastfeeding Made Simple: Morbacher and Kendall-Tackett
 
Section Four: Family Building, Touch and Attachment (choose one)
Bonding: Kennell and Klaus, Becoming a Father: Sears, The Vital Touch: Heller, The Baby Book: Sears, The Family Bed: Thevin, Fathering Right From the Start: Heinowitz
 
Section Five: Infant Care (choose one)
The Baby Book: Sears, Pregnancy, Childbirth, and the Newborn: Simkin, The Mother of All Baby Books: Douglas
 
Section Six: Postpartum Mood Disorders (choose one)
Overcoming Postpartum Depression and Anxiety: Sebastian, The Postpartum Husband: Kleiman, This Isn’t What I Expected: Kleiman, I’m Listening: Honikman, Depression in New Mothers: Kendall-Tackett
 
Section Seven: Birth (choose one)
The Complete Book of Pregnancy and Childbirth: Kitzinger, The Birth Book: Sears, The Birth Partner: Simkin, Pregnancy, Childbirth, and the Newborn: Simkin

Section Seven: Birth (choose one)
The Complete Book of Pregnancy and Childbirth: Kitzinger, The Birth Book: Sears, The Birth Partner: Simkin, Pregnancy, Childbirth, and the Newborn: Simkin

Section Eight: Multiples (choose one)
Having Twins and More: Noble, The Art of Parenting Twins: Malstrom, Multiple Blessings: Rothbart, Mothering Multiples: Kerkhoff Gromada

Section Nine: The Mother’s Changing Body (choose one)
Essential Exercises for the Childbearing Year: Noble, The Year After Childbirth: Kitzinger, Pregnancy, Childbirth and the Newborn: Simkin

Section Ten: The Work of the Postpartum Doula (choose one)
Nurturing The Family:The Guide For Postpartum Doulas: Kelleher, Nurturing Beginnings: Pascali-Bonaro


Seems like a lot! Doesn't it? Whew. That's 10 books, minus the categories from which I've actually already read (i.e. breastfeeding, birth).

Any mothers, postpartum doulas, doulas, childbirth educators, etc have any suggestions on which books I should choose to read? Or not read? Let me know! 

I appreciate the help, and I'm sure other mothers and birth professionals do as well.

Re-Blog: I Don't Think You Should

What a Doula is all about!
I'm re-blogging this because it is just that good.
Enjoy!

I Don't Think You Should
by Kristen at Birthing Beautiful Ideas

I’ve talked a lot about my individual pregnancy and birth experiences on this blog.

I’ve had a cesarean section.  I’ve planned two VBACs.  I’ve birthed two babies in the hospital, and one at home.  I’ve chosen to give birth twice with an obstetrician/gynecologist, and once with Certified Professional Midwives (CPMs).  I’ve breastfed all three of my babies.  Heck, I’ve even encapsulated my placenta.

With all of this sharing of my personal experiences, some people might worry that I am advocating for everyone else to make the same decisions that I have.  Perhaps, one might wonder, my goal is to create an army of HBAC-ing cyborgs whose babies will take over labor and delivery units with a vengeance.  [Sadly, I could not find a graphic to depict this bizarre yet intriguing image.]

But really, this couldn’t be further from the truth.  In fact, I don’t think you should make any of the same exact decisions that I’ve made.

Truly.

If anything, what I think you should do is far different from doing exactly what I’ve done.

For I don’t think you should have a home birth.

I think you should give birth in a setting where you feel respected by your care providers.

I don’t think you should have a hospital birth.

I think you should give birth where your birth site and your care providers make you feel safe.

I don’t think you should birth with an OB/GYN, a midwife, or unassisted.

I think you should birth with a care provider who is well-trained to serve your particular prenatal, birth, and postpartum needs and wishes.

I don’t think you should have a vaginal birth.

I think you should be given every chance to have the safest, healthiest mode of birth for you and your baby.

I don’t think you should have a cesarean section.

I think you should have access to discretionary and judicious use of medical technology if and when you and your baby need it.

I don’t think you should have an epidural.

I think you should be viewed as an autonomous woman who can make her own decisions regarding pain relief and comfort measures during labor.

I don’t think you should have an unmedicated birth.

I think everyone around you should reinforce just how powerful and amazing you are for bringing a baby into the world, no matter how you do it.

I don’t think you should have a VBAC.

I think you should have access to accurate and transparent information about your birth options, and that no one should use scare tactics to dissuade you from your choices.

I don’t think you should have a repeat cesarean.

I think you should make birth decisions that are right for you and your family–not anyone else.

I don’t think you should breastfeed.

I think you should have access to accurate and transparent information about baby-feeding options well before your baby is born, and that you should encounterall of the support you need to pursue your baby-feeding goals.

This is what my blog is about, what my advocacy is about, and what my doula work is about: I think you should do what is right for you.  Not anyone else but you.

Happy Birthday, Doula Baby

Today is the 1 year birthday of one of my doula client's birthdays. This is clearly not my first doula baby birthday, but today I was feeling really happy about seeing pictures of a 1-year-old who has gotten so big that I saw born one year ago today!

I like e-mailing or calling my clients on their first birthdays. Not all of my clients have kept in touch, and I don't always hear back from them all, but I like to reach out. I put the date of their birth in my calendar and have it repeat one year later to remind me. And it makes me think about how time passes, how children grow so fast, and where I was exactly one year ago. It's also a reminder of the part I played in the lives of others, and how they have touched and shaped mine.

So, I am just taking this post to reflect on all of these things, and to say Happy Birthday to all my doula babies out there in the world!


Do you say happy birthday to your doula clients and their babies? How do you keep in touch?

The Baby-Friendly Rap

A Tale of Two Births: The Baby-Friendly Rap

See birth at a Baby-Friendly Hospital versus a Typical Hospital. 
Cosponsored by the Breastfeeding Coalition of Oregon and the Massachusetts Breastfeeding Coalition.

Um, I definitely love that the breastfeeding success all depends on the presence of the Super Doula!

Want to know more about what this "Baby Friendly" hospital means? Here's more info on the Baby Friendly Hospital Initiative

"Sometimes we just like to let our clients BE"

A snippet of a blog post from MotherWit Doula called "Where the Magic of Doula Care Lies" in which she explains why "the magic of doula care lies in the relationship between the doula and her clients."

In my years working as a doula, I've come to understand that sometimes it can look to an unsuspecting nurse or doctor that we don't know our doula skills because we're not doing the general things they've learned about to support their patient. For example, sometimes, even though moms "should" be upright a lot through labour and "should" use the bath or shower in active labour to relax and reduce pain, it's important for caregivers not to assume we're ignorant of the application of these comfort measures simply because we're not suggesting them. My way of being a doula is to NOT be over-solicitous, meaning I don't with every contraction ask Mom to get up, change positions, haul out a ball or massage oil, or suggest things. Why? Because after a while it becomes a pain to hear the mosquito buzz of questions in your ear in labour. Sometimes we like to just let our clients BE. It's also important for caregivers to realize that our client has already probably pretty strongly let us know what she needs. Perhaps she's lying on her side because this is her "happy place" and is indeed progressing just great as she is. We can be trusted to ensure she's getting up to pee once in a while and in the process shaking her pelvis around a little. Unless a mom is clearly trying to avoid the hard work of active labour and needs a little energy reversal to shake things up, leaving her to it is often a wise choice.

I've heard doulas have encounters with nurses who thought the doula was acting very strangely, even ignorantly, by fully supporting the mother's insistence upon a seemingly early epidural, and were chided by the nurse who wanted to give them a crash course in comfort techniques. When (with the clients' knowledge and permission of course) the doula took the nurse outside the room and explained the mother was a survivor of sexual abuse and that they had in advance of the labour come up with a plan to demand an epidural when the pain started triggering feelings of emotional instability, the nurses immediately did what was asked, recognizing the value of the doula/client relationship. I remember walking the hall of a hospital and the mom stopped for a contraction, leaned over, and I rubbed her back in the way we had discussed, due to an issue with her sacrum. A nursing student ran up, and said, "Let me," and proudly "showed" me how to do a sacral press because I guess she had learned it was better, even though it was wildly inappropriate for this particular mom. I've had a couple of students chewed out by hospital staff for looking like they weren't doing anything for a mom who had just clearly told them she wanted to rest quietly for a while.

Doulas craft their relationships with their clients painstakingly and lovingly. We find out what coping skills they have to weather the sensations of labour, find out whether or not they prefer fancier breathing techniques, what kind of essential oils they like, and what scares them.

I particularly like this excerpt because I have had been in similar situations, where the hospital personnel seemed to imply that I wasn't doing enough. The reason for this is exactly as explained here above. 

Doulas, have you ever had this experience?  

"It may surprise some to know that our magic may run just a little deeper than double hip squeezes and lavender spritz."

Doula for a Home Birth

I think its interesting that most people I encounter who know little to nothing about doulas right away tend to assume that I attend only home births. They'll ask something about if I do mostly home births or if I'll do hospital births, too, or if I only do births in water, or even if I catch babies. "Doula," if its even known, is assumed to be a "hippy" or "alternative" choice, associated with birthing at home. In reality, if I only attended home births, I might not have very many to attend! 99% of women in the U.S. deliver in the hospital. If I want to have any doula clients, in the hospital I must be! And, indeed, the reason many women hire a doula is precisely because they are giving birth in a hospital.

I also think its interesting, then, that many people who do think about planning a home birth do not think that a doula is even necessary at a home birth at all. Many say that they have a midwife, what do they need a doula for? Won't the midwife do everything that a doula does? In reality, this varies. Some midwives may not show up early in labor, and may wait until the time seems close to attend the birth. Or, if they have other clients whose births are imminent, they may have to leave to attend them. Furthermore, if a midwife attends a birth without an assistant, then she isn't likely to be able to check blood pressure, take notes, set up birth equipment, etc AND provide the physical and informational support that a doula provides.

Photo Credit

There are some midwives who work in pairs, where one can take care of the medical side of things and the other can provide doula support. And there are many midwives who want to be there in a doula capacity for a long labor! But this is not true 100% of the time, and many women and partners feel they greatly benefit from having a doula at their home birth.

To read more about perspectives on doulas at home births, check out this post from Citizens for Midwifery: Doulas and Homebirth

What do you think about Doulas at Home Births?



  

Reimbursement for Doula Services

I recently attended webinar on how a doula can set things up so that her clients can submit a request to their insurance company to be reimbursed for doula services!

If you are a member of DONA you can download their Third Party Reimbursement packet for more information. I really enjoyed the webinar, though, because it explained to me face-to-face how to go about something like this. It made it seem a lot less daunting!

First, a doula needs to obtain an NPI at https://nppes.cms.hhs.gov. The taxonomy code actually falls under Nursing Service Related Providers type 374J00000X. NPI is only referring to doula work. The doula must also have a Tax ID#, or use their SSN.

The doula can help a client fill out a form with their health insurance company. If the insurance co does not have a form, a universal 1500 form can be used. The code for birth doulas is CPT 59400. A diagnosis code is required - V22.2 Intrauterine Pregnancy

When submitting it is also beneficial to include:  A letter from the client, a description of a doula, the DONA International position paper, Standard of Practice, and Code of Ethics. Additionally, details such as the number of client meetings, number of hours in labor, and exact services provided should be included along with your certification credentials, if any.  A letter from a provider about the benefits of a doula is a plus; more likely to be reimbursed if you can show that your services helped lower costs for the insurance company! For instance, helping a mom to not require an epidural or end up with a cesarean section is a big money saver! 

At the moment, no company is paying consistently, and none have been covered by Medicaid. Some states do have grant money for doula coverage, so look for those!

Remember: the doula does not submit the forms, the clients do. Clients pay the doula in full and then submit request to the insurance company to be reimbursed. Claim submissions can be submitted multiple times up to 12 months after the birth. 

Has anyone successfully been reimbursed for doula services? Share your story!

In the DONA packet on Third Party Reimbursement they include an interesting section that I am going to include here as food for thought:

Concerns about third party reimbursement The Third Party Reimbursement Committee will continue to gather information about the potential consequences and challenges to third party reimbursement. At first glance, it may seem to have no drawbacks. However, realistic assessments reveal that third party reimbursement may have costs that are not immediately apparent. The following concerns have been raised.  

1. Will the reimbursement for doula services paid by third party payers be too low? Will it force doulas to reduce the fees they normally charge for private, self-paying clients? While doulas would not necessarily be required to accept low reimbursements or require clients to make up the difference between reimbursement and the actual fee, it is possible that financial pressure would cause doulas to consider lowering their fees.
2. What restrictions or responsibilities might be added to the doula’s role by third party payers (e.g., licensing by the state, longer training, proficiency exams, different certification requirements or additional health care training or licensing)? Would doulas be required to carry malpractice insurance and would that make them more likely subjects of lawsuits?
3. What conditions or requirements might be placed on the consumer in order that her doula’s services will be reimbursed? At least one third party payer has already limited the consumer’s options by covering the cost of birth doula services only if the woman agrees to not request an epidural. Birth doulas cannot be put into a position of preventing women from having an epidural or of supporting only particular choices.  

It is possible that, if reimbursement were available only for doulas with state licenses, doulas could choose not to seek reimbursement and could remain unlicensed. It is also a remote possibility that it might become illegal for unlicensed doulas to practice in some states. Some hospitals might require certification to support women in their facilities. The benefits of regulation must be balanced against the loss of freedom it entails. 

If you are looking for liability insurance - CMF Group has the cheapest (called "postpartum" services)

Writing Client Birth Stories

A former client in the state I moved from a year ago, and one of my first doula moms, said: "I have been thinking of you because I know like 6 preggo people! I'd be giving you lots of business if you were here!" Awww :)

She also said that she showed some people the birth story that I wrote for her, and it made them want to hire me just from that! This is interesting, because I wrote birth stories for all my first clients, and since moving have stopped doing so. You can actually read a couple of the ones I wrote, with names removed, here: Doula Double Header Part 1 and Doula Double Header Part 2. There are many ways to write one - to the parents, to the mom, to the baby. You can say "you" or "I" or "mom."

There are differing opinions on the alldoulas.com forum about whether or not writing a birth story for your client is a good idea. Many doulas do it, but others don't think its a good idea.

The reasoning is that writing a birth story may alter the mom's perception of the birth, while it is not the doula's story to write. Many doulas say that writing it down from our perspective tells our story, not the mom's, and that's not the point.

The doula may write that the mom was powerful, or the caretakers were kind, and the mother may see it entirely differently.  And what to do if it was an incredibly difficult labor and delivery? Can you write the story in a positive light, if the mother doesn't see it that way at all? Or what if you felt it was difficult, but the mother thinks everything went well? It would be terrible if we negated a mother's experience of joy or trauma based on our own perspective of it.

Many get around this by writing only simple timelines of the things that happened - when contractions began, when the doula was called, when they left for the hospital, when vaginal checks occurred, when the baby was born, etc. This removes all emotion and makes it not technically a story at all.

Since doing my certification births I have stopped writing birth stories for my client. One reason was because I read the forums and was confused about how I felt about it all. Another reason was because I liked writing the stories for my blog, but then realized that I shouldn't be posting another person's birth story with my opinions on my blog, in case the mother found it. A third reason was because I had my first birth where I felt a little bit like a failure in some aspects of my doula work - it was so different from previous births - so how should I write it down for the mom? So I just didn't. And I didn't want to write birth stories only for the births I thought were perfect, because that didn't seem fair. So now I don't write any at all.

I still talk about the births with my moms afterward, at the postpartum visit. I ask them how they felt about it, what they remember, tell them funny things people said, or what time things occurred. I tell my opinions if asked, which is hard to do sometimes. And I've learned a lot! Things that I'd feel terrible about they didn't think was a big deal, and things I thought were good choices they felt really upset about.

It's hard to not want to write birth stories for the parents, sometimes, though. Especially when my former client tells me that her husband loves reading the story I wrote for them because it makes him cry, or she shares it with all her pregnant friends. I love to be able to continue to make a happy difference in people's lives for years to come through the story, but I'm still not sure the benefits outweigh the possible risks in other situations.


Do you write birth stories for your clients? What are your thoughts on all this? Please share!

The Childless Doula

...is still worth hiring.


After all, women hire male obstetricians every day!  And I've definitely heard of childless midwives.

A doula who has never given birth herself, such as myself, may still be a great support person. The truth is, even if I had given birth, my birth experience is going to be nothing like your birth experience. A woman with a traumatic birth, or a cesarean birth, has her experience, thoughts and worries that she is bringing, but it may be a far cry from their doula client's birth experience. Precisely because I have never experienced a birth of my own I have no baggage to leave behind. This way, I go in with an open mind.

Another bonus to hiring a doula who doesn't have kids is that her schedule is more flexible; there is no need to find childcare at the last second!

It's also important to note that a doula without children may not be that way by choice. In her post, What Not To Ask Your Doula, Yoruba Doula notes:

A childless doula may not have children because she simply doesn’t want any. The doula you’re interviewing may not be able to conceive. The lovely woman sitting across from you at the coffee house as you feel out her qualifications may be overcoming the heartache of a miscarriage. She may be a single woman who wants children, but can’t afford artificial insemination or IVF. The woman who scores high in every area on your checklist except for whether or not she has children may have given birth to a baby that didn’t survive. 

As my DONA trainer put it, "have you ever known someone who couldn't have children who would have made a great mother?"

You don't have to have been a mom to be a motherly supportive presence during birth. And you don't have to have given birth to know what a normal birth looks like, what the usual processes with a birth are, what positions would help you find comfort or change the baby's position, and so on. Many childless midwives and doulas still have a passion for birth and babies, a natural empathy, and a great pool of knowledge to draw from!

Photo from an article on Young Doulas

However, if it is personally important to you that your doula have experienced childbirth, breastfeeding and motherhood herself, then that is your priority. Yoruba Doula writes:

Does this mean you should stop caring about whether or not your doula has children? Absolutely not! Your desires are yours, and you deserve to have your needs met by all means. Do continue to ask ask, “Do you have children?,” as you interview. Please do not ask, “So, why don’t you have kids?” It may seem like a harmless question, but it’s one that could have devastating effects on a doula who planned to have a lovely afternoon chatting with you.

Opinions vary on whether or not to hire a doula who has never given birth, but it is a personal decision to make for every pregnant woman.

For many doulas, it is not an issue to be asked. I am not always asked, but I have been. I simply say I am waiting for the right time in my life to have kids. My training, testimonials, knowledge and experience speak for themselves (obviously I've been hired before despite my childlessness), and if the couple are comfortable with me, they hire me.

The most important thing is that you click well with your doula!

Links - World Breastfeeding Week style

In case you didn't hear the great news, The U.S. Department of Health and Human Services adopted the recent recommendation of the Institute of Medicine, to require insurers to provide breastfeeding support  and pump rentals, free of co-pays and other cost-sharing!
For information about the newly adopted Guidelines for Women’s Preventive Services, click over to read more at Birthing Beautiful Ideas.




The CDC recently released the 2011 Breastfeeding Report Card. Reuters reports:

Less than 4 percent of the country's hospitals fully support breastfeeding, said a report issued by the Centers for Disease Control and Prevention.

In nearly 80 percent of hospitals, healthy babies who are being breastfed are given formula even when there is no medical need for it, making it more difficult to continue breastfeeding at home, the report says.

Only a third of hospitals have "rooming in" policies that allow babies to stay in the hospital room with their mothers 24 hours a day, which can increase breastfeeding opportunities.

Nearly 75 percent of hospitals do not provide adequate support for mothers once they leave, including follow-up visits and phone calls, the report said.

What every doula should know about breastfeeding: Tip #2: When to refer, how to refer 

and

What every doula should know about breastfeeding: Tip #3: A few must-knows for pumping

via Public Health Doula

Great tips for doulas from a doula/IBCLC!

On Saturday, August 6 at 10:30 am local time, for one minute, women nation wide will be breastfeeding! Find a local BIG LATCH ON event near you! 

The World Alliance for Breastfeeding Action is has created a video to show you how have a Breastfeeding-themed flash mob using the song they developed for this year's World Breastfeeding Week:

Books: The Doula Advantage

The Doula Advantage: Your Complete Guide to Having an Empowered and Positive Birth with the Help of a Professional Childbirth Assistant
by Rachel Gurevich

I just finished reading The Doula Advantage and have found it a great overview of the doula profession.

Rachel Gurevich covers why doulas are needed in our modern society, a great overview of the research on labor doulas, such as on the positive birth experience, the reduced need for pain medication, breastfeeding and bonding, and medical interventions overall. She then describes in detail each role the labor doula plays: Informational, Emotional, Physical, and more.

There is a chapter devoted especially to Dads and Doulas and commonly asked questions, especially by those who are unsure about the interplay between dads and doulas. This chapter even includes the opinions by dads who have hired doulas themselves.

There is also a chapter explaining the facts surround many myths about doulas and epidurals, for example: "Doulas are only interested in supporting women who plan on giving birth without medication," "Doulas push their opinions and philosophies onto their clients," "A doula will make me feel guilty if I 'chicken out' and choose to use medication," and "Women who use medication during childbirth do not need the services of a professional labor support person. There will be nothing for the doula to do." If you are interested in the truth behind these myths, I encourage you to pick up this book!

The book explains the different roles of the doula vs the labor nurse, the doctor, the midwife, as well as birth locations. It also explains the difference between a postpartum doula and a maid, baby nurse, lactation counselor.

Most importantly, the book is a fantastic resource for how to find a doula, how to decide what kind of doula is the right one for you, how to interview a doula, and how to hire one.

The Doula Advantage is full of quotes, testimonials, opinions, and unique experiences of women who have used a Labor Doula, Postpartum Doula, or Antepartum Doula which are extremely helpful for anyone interested in finding a doula.

The most interesting aspects of the book for me, as a labor doula, was the detailed explanation of what exactly a Postpartum doula does and doesn't do, and the information on Antepartum doulas (which are the least known type of doula). I also enjoyed the part on Becoming a Doula, which is full of great information for anyone to know to help understand what goes into training, business, and lifestyle of a doula. Most importantly, Gurevich outlines the Six Traits that all Great Doulas Must Have:
1. Self-motivation
2. A desire for lifelong learning
3. Perceptiveness
4. Passion
5. Flexibility
6. Professionalism

Even if you are a friend of a doula or a doula yourself there is something to learn from this great book!

I would recommend The Doula Advantage book to women, men, mothers, fathers, doctors, midwives, nurses, family members, etc who are:
- New to the concept of a doula,
- Unsure exactly about the role of a doula, postpartum doula or antepartum doula and the benefits the doula provides,
- Looking to hire a doula and get a better idea of how to go about doing so,
- Interested in becoming a doula themselves!

Maternal Wisdom: A doula birth story

In response to my call for birth stories featuring doulas, Avital of Mamafesto shared this beautiful story about her birth and her wonderful doula, Chana Luba. Enjoy!

If you have a doula birth story that you'd love to share, either about how indispensable your doula was or a doula birth from your own perspective, please feel free to send it my way - I would love to feature it! 

Avital, a couple days postpartum, with Chana Luba

I was five months pregnant when we moved. We knew in our hearts that we had moved for all the right reasons, but it still felt so terrifying. We were moving further away from our family and friends, and knew less than a handful of people in our new town. My husband's work had him away for long days and sometimes nights, and while I wasn't working, I was finishing up my thesis project for my master's degree. I spent most of my days working diligently on my thesis while taking occasional walks into town as my belly expanded. I visited coffee shops and art galleries, book stores and boutiques, but still felt a lack of community.

Having already sadly shelved the notion of a home birth for a variety of reasons, I did my best to immerse myself in the various programs the local hospital offered pregnant mothers. Around my seventh month of pregnancy I started taking a prenatal yoga class, held in the community room of the hospital. It was there that I met my soon-to-be best friend. She was pregnant as well, only a couple of months ahead of me. She had lived in the area for a while, and as we got to know each other, my desire for community started being fulfilled. It was through her that I learned about the work of doulas. She was actually a doula in training at Maternal Wisdom and suggested I call the woman she studied with. 

I took the information home with me and let the idea percolate in my brain for a bit. A person that would help me throughout my labor and birth? Wasn't that what my husband was for? The more I thought about it, the more unsure I was. The concept sounded interesting, but wouldn't the cost be prohibitive? I wanted to talk to my new friend about the idea of a doula more, but she ended up going into labor and was occupied with her newborn daughter. 

In the end, I called up Chana Luba Ertel, the doula behind Maternal Wisdom and it was there that my community continued to solidify. The first time we met, all of my hesitations and concerns seemed to melt away. It was as if Chana Luba could sense what we needed and worked to give us that. After we had made the decision to have her attend our birth, everything seemed to be that much easier. We met frequently and she gave us a few exercises to practice while we were apart. She answered all of my phone calls and emails (some made in non-rational pregnancy induced panic) with grace, humor and kindness. Toward the end of my pregnancy, when I was having prodromal labor for what felt like a week, she helped by visiting me at home, providing me with not only alternative treatments to urge along the pregnancy, but reassurance and strength as well.

The night I went into actual full on labor, I finally relented and called Chana Luba around two in the morning, feeling bad for waking her. She of course only had words of encouragement and reminded me to hydrate, eat a little if I could, and relax. She arrived a few hours later as things began to pick up. From then on, she was the guide to our ship, allowing me to labor as I had hoped for, while allowing my husband his own space as well. When my contractions began getting more painful, she drew me a bath, and then, when my water broke in the bath and the pressure and urge to bear down became too strong, she hustled us along to the hospital.

I was able to stay at home as long as I did because she was there. Despite birthing in a hospital setting, I wanted to labor at home as long as possible and got my wish. Her support continued as we made the short, five minute trip to the hospital. I arrived between shifts and a midwife from my practice didn't see me for another twenty minutes. A nurse began taking vitals and became concerned when she noticed the baby's heart rate had decelerated. At that point, had Chana Luba not been with us, I have no idea what could have happened next. I was mid contraction and not fully present and my husband was concerned for both me and the baby. Chana Luba suggested I change positions, and that immediately helped the baby's heart rate go back up to normal. A little while later she went off to get me some juice and a banana on the sly to help keep my energy levels up. Only a couple of hours later my son was born, and some of those first few pictures we have of him include Chana Luba.

I wouldn't have wanted it any other way. 

She ensured that we stuck as closely to our birth plan as possible and helped us to navigate the unfamiliar. She stepped in and helped us out when we needed it, allowing us to stay the course we were on instead of heading down the slippery slope of intervention, which was my biggest fear with a hospital birth. She already had a relationship with this particular hospital, which made many things easier for us, including allowing me to leave only a few hours later. Her help didn't stop there, however. In the days that followed, she remained in touch, checking up on me and making sure our nursing relationship was going well. She provided me with homeopathic treatments and herbs for a range of things from post-partum hormones to nursing woes. She was also there for me like nobody else eight days post birth when I needed her the most. She truly embodies the name behind her business, Maternal Wisdom.

A former teacher and lifetime learner, Avital Norman Nathman is a play-at-home mama, freelance writer, wife and feminist (and not necessarily in that order). When not gardening, cooking or dancing around the house, you can catch her musing about motherhood and feminism at The Mamafesto.

Thank you, Avital!

(Was your doula worth every penny? Share your story! anthrodoula at gmail dot com)

A Doula's Birth Story

A fellow doula, Nicole, aka Sweet Song Doula, has graciously shared a wonderful story that tells not only the story of her own birth, but also the reason she became a doula.

(If you have a doula birth story that you'd love to share, either about how indispensable your doula was or a doula birth from your own perspective, please feel free to send it my way - I would love to feature it!)

Enjoy!

A Doula's Birth Story

The one question I get asked in all of my interviews is “Why did you become a doula?” 

The answer to that question lies in the journey I took to and through my own birth experience, and the incredible support I received from my doula and wonderful husband.

When I became pregnant, I did what most women in the United States do. I made an appointment with an OB/GYN (who was recommended to me by the primary care doc I’ve been seeing since college). I went to my prenatal visits, the longest of which was my intake appointment. I did the early prenatal screening tests. And when the pregnancy finally started to “feel real,” I started to think about a birth experience.

At the time, I didn’t exactly know what sort of birth experience I wanted to have. I knew I wasn’t afraid of birth, and that I was definitely interested in an unmedicated and intervention-free birth. I asked around to see if anyone I knew had birthed without either of those things, and not many had. “Don’t be a martyr,” they said. “Just get the epidural,” I was told. “What’s wrong with a little pain relief?” I was asked. The only people I knew who hadn’t had epidurals and such were women in my mom’s generation. My mom herself, in fact. She’d had her babies (me in 1978 and my sister in 1981) with a forward-thinking female OB who saw no need for mamas and babies to do anything but work together during labor and birth.

This got me thinking. So, being me, I got to reading. I picked up Henci Goer’s The Thinking Woman’s Guide to a Better Birth. I devoured Ina May Gaskin’s Guide to Childbirth (just to name a select few). I read little snippets of information in magazines like FitPregnancy. And it was there, in the pages of a glossy, fairly fluffy periodical, that I first encountered the statistics about how doulas help to reduce the rate of epidurals, c-sections, and a number of other interventions in birth, simply by the virtue of their presence.

That information stopped me in my tracks. I had done enough reading to know that I didn’t want a surgical birth and a medicalized birth didn’t feel like the right choice for me, either. I wanted my baby to be born gently, sweetly, and surrounded by loving supporters who were committed to a mama having an old-school birth (with credit to Toni Negy).

We obviously needed to hire a doula.

Research, research, research. Troll the Mothering.com forums, ask around for recommendations (no one I spoke to had hired a doula, and most had no idea what one was). Fast forward to June. I was five months pregnant and interviewing doulas. We chose three out of a larger list I had compiled and met our first candidate on a dreary early summer evening. Erin welcomed us into her space and I immediately liked her. It was an instant connection. The interview was wonderful. My husband asked as we got in to the car to go home: “Do we really have to bother with interviewing anyone else? I loved her, and I could tell that you did, too.” He was right, but I felt obligated to do our due diligence. We completed our interviews with the other doulas and then called Erin to ask her to be our doula. She said yes!

Prior to meeting Erin, I had realized that the OB/GYN I was seeing for prenatal care wasn’t the right fit for me, so halfway through my pregnancy I switched to a midwifery practice affiliated with a community-based hospital. I was happy with the practice, and felt very positive that I would be well-supported there. But as my pregnancy progressed, I became more and more interested in having a homebirth. The more I learned about birth, the more excited I got about it, and homebirth seemed the way to go.

Then I had my 30-week ultrasound to check on my low-lying placenta, and I learned that my baby was breech.

“Don’t worry!” said the radiologist. “Your baby still has lots of time to turn, and most of them do.” But I was worried, so I went home and I researched some more. To make a long story short, I spent hours trying to encourage my baby to turn. Anything you’ve heard about doing to try to turn breech babies, trust me, I’ve done it: lying on an ironing board, flash light in my crotch, music in my crotch, talking to my baby, listening to hypnosis scripts, moxabustion, accupunture, accupressure, shiatsu, walking, somersaults in a pool, homeopathic remedies, external cephalic version. The list goes on.

Despite my efforts, my baby stayed right were he was, content to have his head nestled up under my heart, all the better to hear it beat.

We continued interviewing homebirth midwives, with the idea that based on the information we learned about the safety of vaginal breech births with an experienced attendant,  we’d still pursue a homebirth if we could find the right fit. But the midwives who were available for our due date and simultaneously a good personality fit, were not comfortable with a breech birth with a first time mom.
We were unable to find any information on doctors in our area who would remotely consider supporting a vaginal breech birth.

I began to realize that I was most likely facing the very birth I had most wanted to avoid: a cesarean. My baby would born out of an incision made through my skin, abdominal muscles, and uterus. I would be an inactive, immobile, and frightened participant. I began to feel sad, overwhelmed, and, quite frankly, cheated out an experience I very much wanted to have: labor and a vaginal birth.

Throughout all of this, my husband and doula remained hopeful that my baby would turn. They encouraged me to continue trying things that might get him to turn, so long as those things felt worth my time and energy. They asked me to talk with them about how I was feeling. Never once did either of them say, “The only thing that matters is a healthy mom and a healthy baby.”

In our second and final prenatal visit, Erin gently said to me that it seemed to her as though we had come to the decision to have our baby in the hospital, and in doing so, that we could be consenting to a cesarean birth. I remember tearing up. I remember feeling angry. I remember my husband rubbing my back, and holding my hand.

I remember Erin saying, “Nicole, I know this is the not the birth you wanted for your baby. It’s not the birth I wanted for you. I know you wanted him to enter the world vaginally. Though a cesarean is not the birth you envisioned, it may be the birth you will experience. And remember, it is still your birth. I am here for you. Zac is here for you. Babies are wise, and perhaps there is a reason yours is so happy head’s up. I encourage you to honor your baby’s wisdom, and to work on making peace with the birth you will experience.”

Erin suggested that we spend some time reading about cesarean births. She told us it would be a good idea to ask lots of questions (if we wanted to do so) at our upcoming prenatal appointment with the midwives. She reminded us that there were still things we could do to personalize our cesarean birth. Did we want to request music in the OR, ask for silence during the procedure, ask that the doctor’s not announce the sex of the baby (even though we already knew it), find out whether or not it would be possible to initiate breastfeeding during the repair, or at least have as much skin to skin contact as possible.

She was right. Zac and I knew that and so I began making preparations for the birth I didn’t want. I told my midwives that I would not be scheduling a date for my son’s birth. It felt cosmically wrong to pick his birthday. One midwife in the practice actually had to present our request for a “trial of labor before cesarean” during a staff meeting to get “approval” from the backing OB/GYN. Ours was not a common request. We were informed of the very short list of “risks” of not scheduling our cesarean: 1. Not knowing the doctor on call (which didn’t matter anyway, because I’d only met the OB/GYN in the practice once and had no real relationship with her). 2. Having to experience a significant amount of labor if labor and delivery was particularly busy that way and couldn’t get us in to the OR in a timely manner. 3. The possibility of a cord prolapse should my waters release in labor.

We reviewed the risks, did not find any that were reason enough to schedule our son’s birth. I spent the final weeks of my pregnancy settling in to the apartment we had recently moved to. I worked full time up until the night my waters broke at 1:00 in the morning on October 16, my son’s official due date.

After my waters broke, I called to Erin to see what she thought we should do, and after speaking with her my husband and I decided to go back to bed and that we would meet Erin at the hospital at 9 a.m. Erin met us at check-in, and rubbed my back while we answered all the questions we’d already answered in our pre-admission forms. She massaged my hands and feet in the ante-natal room, while I was hooked up to the monitor and leaking amniotic fluid into the chux pads beneath me. We joked, told stories and laughed together while we awaited a visit from the OB. Erin reminded us to ask questions that had come up in conversations at our prenatals about pain medication options. She took photos of me and my husband’s last moments as a family of two.

When the time came for me to enter the operating room, I was walked down the hall by one of the surgical nurses. I remember feeling scared, anxious, and ready to see my husband’s and Erin’s faces again as soon as I could. I remember really not wanting to lay on the operating table. I remember feeling very alone.

The prick of the needle in my back was startling, and the numbness that followed was anything but a relief. I hated the sensation of feeling nothing. I lay on my back, staring at the ceiling, listening to unfamiliar sounds: machines, voices, the clinking of surgical instruments.

“We’re going to begin now,” the doctor said.

“No!” I exclaimed. “You can’t! Where is my husband? Where is my doula? I’m all alone in here!” I started to cry. Someone hustled out the doors to usher in my husband and Erin. It still amazes me that no one noticed that I was a woman about to have her baby, and that I was alone. It hadn’t occurred to anyone in the room to bring them in.

Though I’m sure it was only a matter of moments before Zac and Erin were in the room after my saying something about their absence, it felt like a lifetime and I was quite upset when they got there. Erin immediately showed Zac where he could sit so that he could get in very close to comfort me.
To be honest, I don’t remember much that happened between the time they entered the room until the time I was recovery. During the procedure I went inside myself and focused on the feeling of my husband’s hand on my cheek, the sound of Erin’s breath. The warmth of my tears. I mostly kept my eyes closed. I remember my son crying when he was born. I remember Zac going to be with him. I remember Erin by my side, telling me, softly, in my ear, what she could see of my baby. When I expressed upset at the noises I was hearing during my repair, she asked me what was bothering me, sounds, smells, or sensations. I told her the sounds, so she spoke to me, telling me how wonderful things were going, how beautiful my baby looked. How close I was to having him all to myself.

Erin stayed with us for about an hour in post-operative recovery. She helped us with breastfeeding. She did all the things a doula is “supposed” to do. But what I will be forever grateful for is the human connection she forged with me and my husband in a maternity health care model that has all but done away with compassionate one-on-one care and support.

Erin encouraged us to follow our instincts, to trust ourselves, to trust our baby, and to educate ourselves on our options. She told us to ask questions, get answers, seek advice. She fostered communication between me and my husband, and shared with us an enthusiasm and appreciation for family, pregnancy, and the transformative power of labor and birth that is often forgotten in our “What’s on your baby registry?”-focused culture.

And I loved all of that so much, that I wanted to pay forward that same care and support to other mamas, babies, and families. That is why I am a doula.

Thank you for your beautiful story, Nicole!

Informed Choice and the BRAIN Acronym

I vary my prenatal visit topics depending on my client's experience and knowledge, but one of the things I talk about with every doula client is Informed Choice and Informed Consent. Specifically, we discuss what it will be like to exercise their right to informed choice during the sometimes highly emotional experience of pregnancy and childbirth in a medicalized setting where informed consent is not always practiced (sad, but true).  An excellent tool to use to talk about this topic and help clients see what this looks like, especially during labor, is the BRAIN acronym. 

Use Your BRAIN! 

In most instances, there is time to discuss every treatment or procedure with the care provider. This includes the nurses, too, not just the doctor or midwife. The reason this is a great tool is because everything that happens to a patient should include an informed choice, which includes both the option of informed consent and informed refusal. Yes, the doctor has been to medical school, but that doesn't mean that everything she says or proscribes is based on scientific evidence, or that it is your only option.

Benefits - What are the benefits of this procedure? How will this help me/my baby/my labor?

Risks - What are the risks of this procedure? How might this negatively affect me/baby/labor?

Alternatives - Are there alternatives to this procedure? Are there other options?

Intuition - What is my gut feeling about this?

Need Time, or Nothing - Can I delay this procedure and take some time to think about it/Discuss it with my partner? What will happen if I choose to do nothing for now?

The BRAIN acronym and Informed Consent exercise may seem obvious, but for many people, especially pregnant and laboring women, it doesn't always occur. Many people don't realize that they have the right to ask these questions or even to refuse certain procedures when they are being told they "have" to by a physician with authoritative knowledge. There is a social power play going on, and it is going on while a woman is nervous for her and her baby's health.

I recently had a client use the BRAIN acronym for informed consent/refusal that I had taught her and her partner! Her doctor started talking about induction at her 40 week prenatal visit, and then scheduled some dates for her at the hospital, even though he told her at 2 check-ups that she and baby were doing well. She felt very nervous about it, but also nervous because of the way the doctor talked about "what could happen" to the baby. So she went home and talked to her partner about the Benefits, Risks, Alternatives, Intuition, and Need Time aspects of the decision to induce. Then she called me and told me that the only benefit they could think of was seeing the baby sooner! Which wasn't enough to make them feel comfortable with inducing, so they decided to tell the doctor they'd like to wait until 42 weeks. So awesome!

• No person should give you a pelvic exam or manipulate your cervix without your prior consent.
• No person should pressure you into attempting induction unless it is medically necessary.
• No person should pressure you to dilate faster for his or her own convenience.
• No person should break your water or cut your perineum without consulting with you first and gaining your permission.
• You have the right to refuse a course of treatment that you feel is not in your or your baby’s best interest.
• No person should rush you to make a decision.

These things are true, and childbirth educators and doulas say these sort of things all the time, but they still happen. I see them happen. So it is an important thing to pass on to our clients -  YOU HAVE A RIGHT TO CONSENT TO AND REFUSE ANYTHING THAT INTERFERES WITH YOUR BODY OR THE BODY OF YOUR CHILD.

There are some great informed consent role plays out there, where mom and partner can practice asserting their rights. I really like these (via Prep for Birth), because these are very difficult situations that almost every woman birthing in a hospital will find herself in:

You are laboring along slow but sure. Early labor is taking awhile. Your contractions change and seem stronger. You go to the hospital and are 5 centimeters. Baby looks good on the monitoring in triage, so you are assigned a room. The labor and delivery nurse would like you to stay in bed and not move around or get into the shower/tub. That is ALL you want to do.

What would you do?

 Hopefully, you would use your BRAIN! Let's practice:

B: What are the Benefits of staying in the bed? Well, your labor has been normal and the baby looked healthy on the monitor. Your body is telling you that you would be more comfortable moving around. So why would the nurse ask that of you? There are benefits for the nurse - he/she can keep you securely hooked up to the electronic fetal monitor, the blood pressure cuff, possibly an IV, and all the other gadgets being used to record your vitals. That way she can leave the room to do other things but you are still being "monitored" by the equipment. The nurse has also been told in training that birth must occur in the bed and that the monitor is the best and only way to detect fetal stress, which in her experience happens all the time.

R: What are the Risks associated with staying in bed? Well, you would be extremely uncomfortable the whole time, especially if getting out is all you want to do. Another risk is that staying in bed may make your labor more painful and possibly slower. Moving in response to labor contractions and change of positions makes use of gravity and changes the shape of your pelvis, helping baby make his/her way down. The freedom to move and to use pain coping techniques like the shower gives you an increased sense of control and lessens your anxiety. (For more about the proven benefits of movement during labor, click here).

A: Are there alternatives to this procedure? Can we get more information about why the nurse wants you to stay in bed? If its to keep the baby on the monitor, you can request intermittent monitoring (every 45 minutes or so)? Or maybe something that is portable, like a fetoscope or a telemetry unit, and that way you can even get into the shower. If you have done your research, or if the nurse/doctor does theirs, you will know that routine continuous EFM provides no benefit for babies and increases the risk of cesarean for mothers.

I: What is my Intuition telling me? Well, that's easy - its I WANT TO MOVE! 

N: Its ok to Need some time to think about it. You might choose to stay on the monitor for a bit and see if you can get comfortable with that. Or, after you gathered all the information you can from your nurse and or doctor on the benefits, risks, and possible alternatives, you just want a few minutes to talk to your partner and your doula about what you're thinking and feeling. There is no rush to decide.

Here's another scenario:

You have been assured that after your push out your baby, he will be placed right on your belly or chest for assessments even if he needs oxygen without separating you two. After you birth your baby, he is making good effort to breathe, is vocalizing, and his color is just right. The baby nurse wants to take him right away. You ask her to do all his assessments on you and she says no and without your consent takes him off to the warmer.

What would you do?

(Some may recognize this in a different form - BRAND. I like BRAIN better because it includes Intuition, and also because the "Nothing" and the "Delay" of BRAND seem too similar to me, and are encompassed well under "Need time.)