Who’s in charge here? Why a doula is not going to save your birth.

I’ve received several emails from moms, seen birth stories go awry and known people, who are completely unaware of one simple fact: a doula is not in control of your birth.

 You are.
 
With that said, just as finding the right doctor is important, the right birth place (hospital, birthing center or home) and having the right birth team are all crucial to a great birth: nothing holds the “power” over your birth like you do.
 
Let me explain.
 
Moms are growing more aware that they may meet some resistance with their birth plan/vision therefore they enlist the help of a doula. The intentions are different for everyone, but I have seen many a couple shocked to hear that the doula’s role should NOT include making decisions “on your behalf.” Meaning, you’ve written a birth plan and now it is up to the doula to make sure it happens.
 
1. Mom is the only one that can consent to anything. The opposite is true as well. If you have on your birth plan that you want skin to skin with the baby immediately and any procedures that need to happen can happen while baby is on your chest, and the nurse has the baby and is trying to get all her “stuff” done as quickly as possible, the doula can say, “Can we get baby to mom for skin to skin now?” If the nurse shows any resistance, as a doula I can only repeat my sentence. But if mom, who wants her baby, looks over and says, “I’d like to hold my baby now.” Guess what? They do it. And even if they say, “oh but i was just going to do this one last thing and be done.” If that is not what you want . . . YOU (alone) are the one to say “No thank you. I want to have my baby.”
 
This is true with anything on your birth plan. If you are being asked to do something that you don’t want to do, the doula is not in the place to answer for you. You have to speak up. Because even if your doula does say “she doesn’t want to do that,” everyone else in that room (including the doula) knows that it holds no water if the momma doesn’t say it. You see, you are the patient. Informed consent only applies to you. Not to your husband and not to your doula.
 
What the doula does: the doula can remind the doctor/nurse of your birth plan, and advocate for those items, but they can not “make” anyone do anything. Especially if it means an argument would ensue between her and the staff. That is NOT the role of a doula.
 
2. A doula does not give medical advice. On your last prenatal visit your doctor recommends that you get an induction. You immediately call your doula to ask what she thinks. Instead of opening up a long discussion about how insane your doctor is, your doula should respond in a different way.
 
What the doula does: The doula should help get information to you that would help YOU make a decision. The doula’s role is to help you realize that YOU have what it takes to make the best decision for you and your baby. Not based on what the doctor thinks OR what the doula thinks. **Everyone has an opinion, the doctor as well as the doula, but the ultimate decision is yours and both (doctor and doula) are to support you in whatever you decide.**
 
3. A doula does not guarantee birth plan success. However, it does increase it. Yes, there are studies showing the continuous support of a doula does increase your chance of having the birth you planned for. However, there are times where changes are necessary. Medically necessary.
 
What a doula does: A doula’s role in the face of a change in the birth plan is to buy you time for the opportunity to discuss it with your partner. If the doctor comes in and says that he thinks it’s time to consider pitocin, the doula may say, “Jason and Samantha, would the two of you like some time by yourselves to discuss what you want to do?” The goal there is not to say, “umm, I think ________” because doula’s don’t give medical advice. We can guard your space and allow you the time to make the decision for yourself. **I am aware there are times where time is of urgency, in those times it is different. But in most cases there is time for you to have a discussion to determine if there are other options.**
 
So you may be left asking yourself, “why do I need a doula then?” A doula knows the process of birth, is a huge resource for physical support, suggestions for comfort as well as tips to get labor to progress naturally. A doula helps you from start to finish and never leaves your side. A doula is there to support you and what you decide, and to offer information (covering all sides of a decision) to help you know your options. Just like you don’t want your health care provider making decisions for you, same goes for the doula.
 
It’s best if that part is left up to you.
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Jenna and Chris, 1st baby-Natural birth

Jenna and Chris contacted me while they were still living in Boston. They were planning the move to Birmingham (for Chris’ residency at UAB) and were wanting to go ahead and interview a doula for their upcoming birth. Thankfully, they hired me and the waiting began. Jenna also decided that she wanted to do a Hypnobabies birth. I went to their last class (taught by fellow doula, Kaleigh Naylor) so that I could learn how support them in that effort (since I was new to Hypnobabies). It all seemed pretty interesting and I was excited to see it in action. **There is a lot of “reframing” in Hypnobabies, so in honor of that, I will refer to contractions as pressure waves (pw’s) for this birth story** 😉

On September 14th at 40w2d, Jenna texted me at exactly 4 pm and said she was having a lot of irregular pressure waves, all happening since around 11 a.m.She said she was still doing “normal” stuff (like chatting with friends online) and would let me know of any changes. She said they were lasting about 30 seconds and some for a minute but didn’t give me a time for how far apart.

Two hours later she was still having waves and I asked if she’d be up for an after dinner walk (to see what the pressure waves would do) followed by a resting period (again, to see what the “pw’s” would do). She was up for it and said she would let me know the results. So two hours later she texted me and said she had finished her walk and was lying down. During the walk the pw’s moved to 3-5 minutes apart lasting 30-60 seconds long. And then as she was lying down: they stayed the same. (YAY!)

At 9:30 p.m. they emailed me the pressure wave list from their phone app (very cool). And from that I could tell that they were still sporadic (anywhere from 3-9 min apart, lasting max 45 seconds). So I suggested they follow their normal routine for this time of day (namely, try to go to sleep), and to let me know when the pw’s picked up in duration, i.e., 45-60 seconds. Jenna decided she would listen to one of her hypnobabies cd’s and then lie down.

At 11:30 Chris let me know that the last 4 pw’s were 1 minute long and intense enough to cause shaking.She also had a bit of nausea.I asked if they would like for me to come and they said yes.

I got to their house at about 12:15 a.m. When I came in, Jenna was in her bedroom sitting on her birth ball and looked beautiful. She was so relaxed and was listening to a hypnobabies music track.After getting there I asked if she’d be up for a walk around the house (inside) and she was. The pressure waves were 2-4 minutes apart lasting 45-60 seconds long.She and Chris would do the prom dance whenever a wave came.Then after some more time on the birth ball, I suggested that she try and get some “rest” (code for sleep, in between waves).So at around 1:45 she got in a side lying position on her couch.She also put in another hypnobabies track and got some good rest in between waves, for at least an hour.(I also suggested that Chris go lie down as well as he would need the rest too, and I would wake him up when things changed).

Laboring at home (pictured below). 

So an hour later, Jenna was making beautiful progress.It was obvious that the waves were getting stronger and I asked if she would be up for transitioning to the hospital.She agreed and said she would rather transfer before the waves were more intense.(Again, trying to not to have a momma do transition in the car).

We got to the hospital at 3:00 and she was asked to go to the triage room first.She was found to be 6/50/-2.She got back to her room by 3:45 and the nurse we had (Emily) was amazing.She asked if there was anything we needed and if not, she would just slip out and come check the baby every 30 minutes.AWESOME.Over the next three and a half hours Jenna was amazing.She was able to use all sorts of comfort techniques including: walking, the birth ball, getting in the shower and resting in the bed.She handled transition (transformation) beautifully.At one point, when she was lying in the bed, getting rest in between pressure waves, I texted Chris (yes, we were both in the same room, but you gotta be quiet, you know) that I think it would be helpful for Jenna to stand up for a few pw’s to enable the baby to labor down.She stood up, had two pw’s and then a big gush!! YAY, her water broke.A few pw’s after that, she had the urge to push.

She made her way to the bed, to try out the squat bar. That wasn’t exactly what she wanted, so she moved to standing at the end of the bed and used the bar to support her arms. Then I suggested she sit in the bed, leaning back, and use the towel (around the squat bar) for leverage to pull with. That seems hard to explain, but it worked well. In just a short time, baby was crowing. Jenna also used the mirror, which was allowing her to see her progress and give her a visual as to what “kind” of pushes were more effective.

I should also note here that the doctor and the nurse were both in the room, but they were not saying anything, but smiling and giving occasional words of encouragement.They were allowing me to give suggestions to Jenna and allowing her to push as she felt she needed to.They were totally letting us do “our thing.”After about 45 minutes of pushing, at 7:18 Jenna pushed out her beautiful baby GIRL, little Iyla Rose weighing in at 7 lbs 5 oz.She is so beautiful.

Jenna also had two requests on her birth plan that I was curious how they might be handled at UAB (since this was my first birth at UAB): delayed cord clamping and natural detachment of the placenta. The longest I’ve seen a doctor wait on a cord to stop pulsating is 3-4 minutes, max.Well, Jenna’s cord was, as the doctor described it, “the little cord that could” and it took 28 minutes for it to stop pulsating.Which means that the doctor left it alone for 28 minutes and not only that, she was happy to do so. Okay . . . well surely once it’s clamped they will start applying traction to detach the placenta.  The doctor, however, told me to watch for the “show of blood” and that’s when we would know the placenta was detached (UAB is a teaching hospital, can you tell?). So one hour after Iyla Rose was born, the doctor said that the placenta was fully detached and mom could push it out. Which she did. Not one pull was done before it was completely detached. And I can say that I have NEVER seen that done.

Also, after baby Iyla was born, we had shift change and got another nurse. Her name was Shelia. And she was so cool. She is actually studying to get her masters in midwifery there at UAB and we had so much fun talking all things birth, eh hem, natural birth in a hospital setting. She and the doctor even brought over the delivered placenta to show it to Jenna when she asked a question about how it was attached.

The entire time all this was going on, Jenna had her baby in her arms. Well, she did share Iyla with Chris at one point so that she could go to the bathroom. And when I left (two hours after the baby had been born) the baby had not been weighed yet, nor had she had any other procedure done. She was still with her mommy and daddy. It was just beautiful.

Jenna and Chris did such an amazing job. The Hypnobabies scripts really helped Jenna to focus and UAB was stellar. The nurses and doctors made it awesome. In fact, Jenna texted me the day after and said that when the doctor came by to say hey, he told her it was the best birth he had ever witnessed. And that is a pat on the back to no one and nothing but Jenna and Chris! She is the one that did all the work and she did it very well!

Good job you guys. I am so proud of you. And honored to have been invited to your big day.

Birth Story: Melissa and Bobby, 4th baby- 1st natural.

Melissa called me while in her third trimester. She was referred by her pediatrician (a dear friend of mine) after she told her that she was curious about doing a natural birth. You see, just like me, Melissa had three prior inductions and had never had a spontaneous birth. But she wanted one. So after meeting with Melissa and Bobby, she was sure she could do it and I was thrilled to be part of their process.

Not only did Melissa get the opportunity to trust her body during birth, she also got the opportunity to trust God in His design during pregnancy because her due date came and went and seemed like the spontaneous labor would never happen. At 41w2d (September 9th) she had a doctor appointment. After Melissa’s doctor’s appointment she texted me to say that everything was the same as the last appointment: 4/100/-3. She said that she had her membranes stripped again but didn’t have much faith in it working.

At 1:19 she texted me and said she had been having ctx’s since she left the office and when she timed them they were 7 mins apart lasting 45 – 60 seconds in length. GREAT! She decided to lie down to see what they (ctx’s) would do. They stayed steady and she felt better while lying down.

At 2:30 she let me know they were about 6 mins apart and that she was getting in the tub. I got to her house at about 3:40. When I arrived she was on her knees with her arms draped over a pillow on the couch. Bobby was behind her, rubbing her back. The contractions were coming every 3-4 minutes and she was handling them beautifully. They were about 60 seconds long. She was breathing nicely and was very calm and controlled. She walked some and lay down as well.

(laboring at home)

About an hour later, she was on the birth ball leaning against Bobby with me behind her applying counter-pressure to her lower back. It was in this position that she started to moan for the first time.

She communicated earlier that she wanted to stay at the house and labor there for as long possible. We also had to take into consideration that on a good day (without traffic) they live about 30 minutes away from the hospital. But the baby decided to initiate labor when we would need to transfer in rush hour traffic, at 5 o’clock on highway 280.

Once she started to moan with her contractions I suggested that we head on to the hospital. I was confident that, while she was not in transition, she was very close to it and NO ONE can predict how long or short transition will be. They agreed and we made our way to the hospital at 5:15.

We pulled up to the hospital 6:05. When I got out of my car I saw Bobby making a sprint for the door: without Melissa. I was fully aware that since I don’t ride in the car with the clients, but follow behind them in my own car, I am unaware of what actually happens during that ride to the hospital. But when I saw Bobby run to the door and then answer me with “she can’t walk. She isn’t going to walk.” I was VERY confident that (evidently) she had probably started transition on the way over. Once I walked to up to her at her car, I was SURE she was in transition. I said, “Hey Melissa, what’s going on?”

“I WANT AN EPIDURAL NOW!”

Yep, transition. For those that don’t know: the emotional signpost of transition is “self-doubt.” When you think either, “I don’t want to do this anymore,” or “I can’t do this anymore.” And that just means one thing: you are about to hold your baby. It also means (for the doula) that I better get you to your room pronto so that we can make you more comfortable and help you gain your bearings again. The car ride over (especially if you are in transition) can be one of the most difficult parts of the birth story. It’s hard to get comfortable, on top of the “self-doubt” thoughts you may be having.

So a nurse came out with a wheelchair and we got Melissa to her room. When she got in the room, she stood up beside the bed, leaning on the birth ball. She had two contractions there and then headed to the bathroom to try and give a urine sample (yeah right) and change clothes. When she sat down on the toilet she had a very strong contraction with a lot of pressure and expressed that she did not want to do this anymore (all very normal). At that point I had her look right into my eyes and hear me: You are about to push out your baby. You are no doubt 10 cm’s and you are doing it! Lets get you settled and into a comfortable position okay? Lets do one contraction at a time, okay?

She agreed and then immediately started another contraction and then announced “the head, the head!! IT’S COMING!!” She stood up a little off the toilet and, because I was the right there in front of her, I instinctively reached to make sure I could support the baby’s head. But what I felt was more squishy and felt like a balloon. A balloon full of water. Yup, I was supporting the BOW (bag of waters), intact. AWESOME! I have never seen that before. So I called out to the nurse (who had run out to find a doctor) that it was the BOW and she came back and helped us get Melissa to the bed. She managed to get in the bed and seated upright when the next contractions came and then that bag of water (outside) ruptured.

After a few more contractions Melissa told us that she wanted to get on her hands and knees. At that point she was in the bed on her knees, upright and leaning on Bobby. She was bearing down, but was having trouble staying upright, and Bobby’s arms were taking a beating. So I asked her to get in the same position (since she liked it) but instead to lean over the head of the bed. Magic.

She began to push and in just a few contractions the baby’s head was out. And then at 6:36 her beautiful baby girl was born: Katelyn Grace, 8lbs 4oz and 19 ¾ inches long. Little Katelyn was perfect, with the prettiest pink skin you’ve ever seen.

So just 30 short minutes after getting to the hospital, Melissa pushed out her baby. Wow.

Melissa, I am so thankful. Beyond thankful to watch your process. You did an amazing job. You were in control of EVERY.SINGLE.CONTRACTION. You were so strong and handled that car ride like a rock star. You are a natural pro and I am so proud that you waited patiently for your body to do what it was created to do. And as I said on that day, we are now best friends because your music playlist was a copy of my own. 😉 And Bobby, you were stellar. Strong and confident for Melissa. Being a physician suits you. But being Melissa’s coach, beautiful. You guys are an amazing couple to watch and I am thrilled that you didn’t have to run any red lights, even though you wanted to. You both did amazingly! Congratulations on that beautiful girl.

SHOUTOUT: While I don’t have the permission of the doctor and nurse involved in this birth (to use their names) I want to make it known how amazing both were. I am always amazed at this doctor’s calmness and willingness to let mom do what she wants to do to be comfortable (namely, pushing in whatever position is most comfortable for momma). And I’ve worked with this nurse before and loved her then too! I can’t say enough good things about Brookwood!