WHAT IS A DOULA?

Doula is a Greek word for servant. The definition has been adapted to mean a woman serving a woman in childbirth.

Doulas are trained to provide continuous physical, emotional, and informational support to you and your partner before, during and after childbirth. They assist you during labor with relaxation, breathing, message, verbal encouragement and other comfort measures. They also work with your partner, encouraging his involvement and creating an atmosphere of teamwork and trust.

A doula does not offer medical assessments, advice or treatment. They provide continuous personal support for you and your partner during your birth experience.

I want you to have the best birth experience possible, that's why being a doula is my passion...

Inductions

If a woman is trying to avoid an epidural and allows herself to be induced when there is no pending emergency she will find it nearly impossible. The way doctors induce is aggressive, it is so common to use the epidural with inductions that they don't take any thought for trying to keep the induction as close to a natural simulation as possible. I have known midwives to use pitocin this way with success at giving women a pretty natural experience without drugs, but women should not count on the prudent use of the drug. The standard induction makes the contractions harder and faster than a natural labor progression would be.

An induction stacks the deck against natural birth and one medical intervention inevitable leads to another and another. The induction makes the continuous EFM a necessity to safeguard the baby, which causes unmanageable pain and stress for the mother. The EFM is very physically uncomfortable because of the placement of the EFM around the abdomen a very sensitive area during labor, but it is even more upsetting to the labor process because it limits the mother's mobility so much so that the mother has no physical pain relief at her disposal. She can't really move very easily and usually ends up in bed on her back so the nurses can adjust the straps just right to get a good reading on the EFM, in order to prevent fetal distress. The constant interruptions to adjust the EFM straps disrupt the woman’s concentration and relaxation which is essential to the progress of natural birth.

Women who are induced are also seldom allowed to use the shower or birthing tub to get relief from the pain (except with some midwifes who provide continuous labor support and supervision). It is my opinion that if you are induced you will not likely be able to cope with labor naturally and will just feel like you failed in the end. What you need to know is that failure in natural birth is most often related to medical intervention and not the mother's ability. A women's best chance at having a natural drug free birth is for a women to go into labor naturally, be free from as many medical tools and interventions as absolutely possible, and have natural birth support from a wise woman who knows natural birth well, like a doula or midwife.

My Thoughts on Why Women Fail

Why do so many American women who "try" for a natural birth fail...only to be convinced that for them it is impossible? In my experience as a doula, women put far too little thought into it at the start...that there isn't enough "try" in their tepid desire. Though most women I come across seem interested in the subject of natural birth and even express a desire to have a natural childbirth, they don’t really want to bother reading a natural birth book or seek the right labor support. Usually they just go far enough to say, “I think I’ll try to go natural.” not realizing that it takes a full commitment and fervent desire to have a good natural birth.

This laissez faire approach to natural birth preparation might have worked long ago when it was a foregone conclusion that babies come into the world in only one way; when women were surrounded by women with extensive knowledge of natural birth capable of aiding them in the process, but today when almost everything women face in the hospital environment hinders the progression of natural birth, it is naive to think that they will be successful without a fervent commitment to natural birth.

Besides the lazy faire attitude of many women toward natural birth, women today face a challenge to their success that women in the past did not. The soft living of our modern age has become a pitfall that often leaves us unprepared to face the "labor" of birth because of the extraordinary exertions it requires. We have become too conditioned by the easy life, constantly having our basic needs meet with little effort.

Convenience and ease is standard in our world of prepared foods and eating out, high-tech appliances, and instant gratification. We have an easy pain free life and so naturally we expect and want a pain free labor (a paradox in itself, perhaps labor should get a new name). To me it is sad that we’ve been taken in by the pursuit of the easy way and the soft life, since “the most worthwhile things aren’t easy”. We are missing out on some of the most worthwhile experience in life when we avoid the difficult pursuits. This is definitely true with child birth.

Women who go into labor with a casual commitment to a natural childbirth rarely make it past six centimeters dilation before they decide they can’t do it. Most women I talk to these days simply tell me they tried and it was too hard. They've come to believe that women who are able to labor naturally simply must have better genetics and easier labors. They draw no connections between methods they used and the types of labor interventions they allowed and the fact that most natural birth mothers fervently reject such interventions as the only way to achieve their goal of "natural birth".

I do not want to marginalize legitimate birth complications which are real challenges for some women, but the statistics clearly show that these complications happen very rarely when labor is left alone and medical interventions are not used. Only 5% of normal healthy women who are supported by doulas or midwives and reject common medical interventions end up with cesarean births, startling when compared to the average rate of 30%.

The sad part about these common experiences is that most of them are avoidable with some preparation and good labor support. Women who think they are unable to have a successful natural childbirth would be wise to take an independent look at their labors and ask themselves what medical interventions were used prior to the problem that arose, and could the problem be caused by those unnecessary medical procedures. It is my experience that very often the emergency measure is needed because of the unnecessary medical procedure that preceded it.

A midwife (who provides continuous labor support) or a doula can do a lot to help a woman who has a history of large babies, lots of back labor, or long and difficult labors. Baby size is one of the most common "medical reasons" for routine inductions which are most often the cause of medically induced emergencies during labor and birth. As a doula I have seen women push for hours only to deliver a 6 pound baby, and another will push twice and a nearly 10 pound baby charges onto the scene. I have watched this phenomenon many times and it is my opinion that the traction that large babies have in the birth canal aids them in the birthing process as long as their mothers are using movement and gravity to help them along. Still baby size is one of the most common "medical reasons" for routine inductions which are most often the cause of medically induced emergencies during labor and birth.

The thing that most often contributes to long and difficult labors is the improper presentation of the infant, an obstacle often overcome by simple positions changes and movement during labor. Medical interventions become the common obstacles to the correction of the baby’s placement because they cause a woman to be held captive to her hospital bed stealing her mobility and therefore snatching from her the most effective means of bringing her baby into the world by the power of her own body.

Women who labor lying down and immobile are not only going to experience more pain, they will have longer labors and more difficulties at the pushing stage. This alone is the most common reason women fail in their pursuit of a natural birth, and one that is easily overcome by the presence of constant capable labor support.

Whatever the reason for the failure the tragedy is that many of these mothers who walked into the hospital hoping for a natural birth walk out disappointed in themselves, or worse, horrified that they ended up on the c-section table. It has been my experience that the vast majority of women are able to labor naturally and bring their babies into the world by their own power so long as they lean upon the support of women who have confidence in and knowledge of natural birth.

Natural Birth Ingredients

In order to have good natural birth experience there are many factors that must come together in harmony to make it possible in today's hospital environment. The best place to start is by educating yourself, most women today know very little about the differences between a truly natural labor and birth, and the standard medical labor that doctors often portray as natural. Having your baby your way is mainly a matter of putting together the right ingredients and trusting the recipe to turn out as it should, 95% of the time it will.

Below are the ingredients you will need to make a good natural childbirth, collecting these ingredients and putting them into practice is the best way to get the birth of your choice. Once you have put these ingredients together just sit back and relax, there is no use worrying about things that are out of your control.

Ingredient 1: Belief and Confidence:

Belief... in your ability to give birth to your baby in your own unique way, trusting in your body's ability to give birth, tuned in to your intuitive sense, an inner wisdom that guides you.

“Many women’s early conditioning makes them believe they are unable to give birth normally, when women realize that their bodies know how to give birth and that their babies know how to be born, they gain confidence. Only then is gentle birth a possibility” Gentle Birth Choices, by Barbara Harper.

Confidence... that birth is a normal and natural process and that your body was designed to safely deliver your baby into your waiting arms. Confidence that birth is not inherently dangerous, anymore than being pregnant, sleeping, or eating is.

“Women’s bodies have a near-perfect knowledge of childbirth; it is when their brains get involved that things can go wrong. Women must have confidence in the intrinsic intelligence of their own body in order to find their own unique ways of dealing with labor.” Gentle Birth Choices, by Barbara Harper.

Ingredient 2: Labor Support

Besides your own belief and confidence in your self you need only a guide, a calm and experienced woman, who can help the struggling you “along the rocky paths of Laborland.” Your labor support must be calm, reassuring and most of all you need to be surrounded by people who trust in your ability to give birth. When you are surrounded by confident and calm labor support you will be able to trust yourself, your body, your partner, your baby, and this process of giving birth.

Ingredient 3: No Time Constraints

“A gentle birth is not rushed. The baby emerges at its own pace and in its own time, received into the hands of those who love and recognize it for the divine gift that it is. A gentle birth respects the mother’s pivotal role, acknowledging that she knows how to birth her child in her own time and in her own way, trusting her instincts and intuition. In the words of one such mother, “I instinctively trusted my body and its ability to birth my baby. I just knew I could do it. I felt the energy of the birth moving through me, and I just let it happen. I was so incredible.” Gentle Birth Choices, by Barbara Harper

Ingredient 4: Reassuring Environment

Most of the circumstances of a natural labor and birth are up to fate. Creating the right birth environment is up to you. Give birth surrounded by peace of mind and comfort. Here are a few ways to create a peaceful and reassuring birth environment–

Quiet…in a quiet distraction-free environment a woman is able to stay centered within herself, and more likely to shift into a more instinctive level of concentration or consciousness that will enable her to labor spontaneously. Ideally a baby is best welcomed into a quiet place, a safe place, an environment free from bright lights and jarring loud noises.

Freedom to Move…the worst possible position for laboring and giving birth is the lying-down position. Dr. Roberto Caldeyro-Barcia, has stated: “Except for being hanged by the feet, the suspine position is the worst conceivable position for labor and delivery.” Movement during labor gives a woman control of her body, and removes her from being a patient upon whom birth is performed and empowers her to become a women giving birth. 

Relaxation...A women’s ability to remain relaxed and maintain her sense of humor is the best predictor of a positive birth experience, even if there are difficulties. It’s important to keep an open mind as to how the birth will actually proceed. Flexibility is essential, because in some cases medical intervention may be necessary.

Concentration...A women in labor shifts into a deeper level of concentration; she removes herself from concepts of time. In the words of one such mother...

“During each contraction I concentrated on relaxing every mussel in my body, I breathed deeply. I went deep down and listened to my body, I did whatever felt comfortable. I labored for many more hours than my memory can account for. I was in such a deep concentration most of the time that I wasn’t aware of what was going on around me. I can’t remember much about what was going on around me during those times of concentration, but I know that the room was dark and quiet, and very peaceful. I felt the comforting presence of my husband and mother. I was lost in the magic of birth. I didn’t fight the contractions instead I welcome them as the source and power that would bring my baby into my waiting arms.” ~ Natural Birth Mom

Gentle Babies

How Gentle Birth’s make “Gentle Babies” 

Dr. John Grover commented, “I noticed immediately that babies born in this peaceful, twilight atmosphere seemed calmer and more alert than those I had delivered in the past. After awhile the nursery nurses began to comment, ‘Ah, you’ve brought us another gentle birth baby!’ Without having to point out the fact. When I asked them how they could tell, the reply was ‘Oh, most babies are either asleep or crying most of the time; yours look about more, they seem to follow us with their eyes.’”

· The First Breath…The first breath can be gradual or abruptly painful, depending on when the umbilical cord is cut. By keeping the newborn attached to the umbilical cord while it is still pulsating, the transition to breathing with the lungs is gradual and gentle. The baby moves from being breathed for to breathing alone.

· Bonding…The newly emerged baby is immediately placed on the mother’s waiting arms, receiving immediate skin-to-skin contact with mom. Newborns of non-medicated, awake mothers are significantly more responsive at delivery. If free from medication the newborn’s first response after birth is to move into a quiet but alert state of consciousness.

· Breastfeeding…Breastfeeding contributes to a baby’s emotional life as well as its health and well being, but it can also increase the mother’s sense of well-being and give her an immediate sense of her ability to mother. Skin-to-skin contact and breastfeeding for at least the first hour after birth has many benefits including increased milk supply, helping to stop bleeding, and most importantly welcomes the newborn child into a peaceful and loving environment, and lays the groundwork for becoming a deeply bonded family.

Labor Support

The Doula’s Labor Role

“It is an age-old scenario, women helping women give birth. It was intended that way, every woman should have another woman at her side helping her, loving her, and supporting her through labor.” (Mothering the Mother) Doulas are trained to provide continuous physical, emotional, and informational support to you and your partner before, during and after childbirth.

The Feminine Connection during Labor

The doula also offers the "female" connection, a same-sex empathy much like the identification men have with other men in a time of crisis - like soldiers on a battlefield. They assist you during labor with relaxation, breathing, message, verbal encouragement and other comfort measures. They also work with your partner, encouraging his involvement and creating an atmosphere of teamwork and trust.

The feminine connection during labor is powerful, in the words of a natural birth mom, “My husband’s presence was very important to me, but mostly I wanted the women. I was standing at my bedside surrounded by my sister, my aunt, my mom, and my midwife. I snatched brief glimpses of the knowledgeable loving women I had come to love and trust. Mom rubbed my calves. Stephanie stood at my side, and with each contraction I pushed my face against her cheek and rubbed, rubbed, rubbed. Tammy rested her hands on my shoulders, whispering words of encouragement. I pushed standing at the bedside, leaning into the wall of women, sure wherever I flung myself, they would support me.”

This connection between women during labor can leave a husband feeling left out, after all birth is women’s work, and there are times that he feels useless. If he understands that this female connection feeds his wife’s strength to bring their child into the world, he can comfortably watch the incredible intuition of women working together to accomplish a miracle.

Father’s

The Father’s Labor Support Role

The doula does not and can not replace the father in his essential role in the labor and birth of his baby, and the comfort and welfare of his wife. This is most evident in the adverse effects women who labor without the support and loving commitment of the father experience. They are more often inhibited by worries and self-doubt, distraught over being alone, and suffering from a desperation that comes naturally to any woman who faces alone the enormity single parenthood.

The most important thing a father does for the mother is what he does long before she is in labor and long after the work of labor is done. A women who is in a loving committed relationship, who knows that she isn’t going into motherhood alone has nothing holding her back, and is less inhibited and has less fear about becoming a mother. She will feel empowered to reach deep inside herself and open up to release her baby into a secure world.

The father's presence during the labor is also very important. Women are often unable to engage the labor and work through it when they are separated from their husbands. As a married couple, mother and father need to be close during the labor and birth of their child. Labor and birth is unlike any earthly experience that a couple will share, it strengthens the marital bonds in a magical and unique way, and it forges a lasting tie that will aid parents in the nurturing and rearing of their children.

Father's need not feel replaced by a doula or midwife, there just is no possible way a doula can give to the mother the assurance that the father gives his wife year after year as they love, support, and parent together. Father’s just need to understand simply that their wife is in need of many different types of support in labor, and the more loving and experienced support she has the easier her labor and birth will be for both her and the baby; what father does not want that? Instead of turning to drugs for that extra help, your wife may find more wisdom and fulfillment in turning to experienced and reassuring women to help guide her through labor. This is not a sign of weakness; it is a sign of wisdom.

Husband Coached Childbirth

The husband coached childbirth movement was a revolution in a time when few fathers where even present for the births of their babies. Dr. Bradley developed his method when at the completion of a birth the mother through her arms around his neck and said, “thank you, thank you, I love you!” He was disturbed by this and realized it would be better for a women to throw her arms around her husband instead of her doctor. He developed a birth education course designed to teach fathers to be “all the labor support their wife would need.”

Though a well meaning idea, and though no education is wasted, we may have done fathers a disservice by convincing them that they could be everything their wives would need to cope with the demands of labor. Many fathers have since described there disappointment and feelings of failure, when their training didn’t pay off, or their natural childbirth goals were thwarted.

The natural role of father, which is primarily a role of provider and protector to his wife, can be the very reason he experiences feelings of failure when the entire labor support role rests on his shoulders. It is not easy for the father to watch his wife in pain as she labors and births their baby. It is his natural instinct and a expression of his deep love and concern to want to end her pain in some way, and often the more he tries to help her the more discouraged he becomes because it seems that his efforts do little to change the fact that she suffers still. To complicate matters husbands instinctively desire to fix what is wrong, to move any obstacles out of the path of his wife that she may comfortable pass by. This protector instinct is at odds with natural birth because no matter how fervent a desire he has to remove her from pain and danger it cannot be done.

What father’s really need to know is that they have already done so much for their wife by committing to her, loving her, supporting her, and trusting her ability to birth their baby. He needs only to stay near her, love her, and trust her. Women in labor have an intense need to feel the presence of the father near them, knowing that he is there is comforting and puts them at peace. If a father understands that what his wife needs most is mothering from a wise and experienced woman, he can comfortably watch the incredible intuition of women working together to accomplish a miracle.

Midwife

The Midwife’s Labor Role

Midwifery is not a new trend in childbirth, long ago in a land far, far away, natural childbirth wasn’t so foreign a concept as it has become, and women wouldn’t have dreamed of being able to have a baby any other way than the one God created. The midwife’s view of birth reflects the natural history of human birth in this world. Midwifery respects birth as a natural process, and midwives are very careful not to intervene with a process that works perfectly 95% of the time.

The Caregiver you choose is very important because that person’s biases, beliefs, habits, attitudes, and training will affect which route your childbirth experience takes. A nurse-midwife if often the perfect choice for a woman who perceives pregnancy as a natural event rather than an illness, and who seek a birth that is allowed to proceed without undo medical intervention.

Midwifery Model for Maternity Care

CNM’s are registered nurses who have experience in labor and delivery as a R.N., and then go on to receive a two-year degree in Nurse Midwifery. In general Nurse Midwife’s have a particular view of Pregnancy and labor that is very different than most doctors. The Midwifery model of maternity care includes ideas such as–

• Women are able to give birth safely in a supportive atmosphere of mutual respect.
• Pregnancy and birth are not generally a serious medical condition but rather a normal and beautiful process,
• Mothers work in a spirit of cooperation with their midwife to accomplish their goals.
• Nurse Midwife’s emphasize preparedness for their patients – through nutrition, exercise, and childbirth education.
• Midwives take more time to listen to a mother’s concerns in prenatal visits, so that women don’t feel they’ve been rushed in and out to accommodate a fifteen-minute time slot.
• Midwives tend to provide more constant labor support compared to doctors who only attend the delivery of the infant.

Home Birth

Home birth is controversial mainly because of ingrained cultural norms that leave women asking, "If home birth is safe, why do we have hospital birth?" The answer is not an easy one, when I asked myself this question it led me to a very thick book in the reference section of my local library and before I knew it I was browsing through a thousand pages of history on the obstetrics profession, from dark ages to modern ages. Needless to say the Obstetrics community in America has grown up under unique circumstances into what we know today, and we are one of the only industrialized nations in the world with nearly every mother giving birth in the hospital. In many European countries 20-40% of women still give birth at home.

Our American medicalized childbirth has not served the natural birth mom well and more and more women have left the hospital in search of the comfort and autonomy of home. Recently I read an articled title, "Home birth: The wave of the future". I chuckled as I thought that home birth is more a relic of the past, but I certainly hope that home birth which was once the only choice will in the future be a routinely accepted birth option.

It is my belief that home birth is a safe birth option if a women in good health is cared for by well trained midwives throughout their pregnancies and throughout labor and birth. As a doula I am struggle to do my job in our current medical system, almost every hospital regulation hinders the natural birth process and the system regularly fails women who desire a natural birth. I work hard to prepare women for births that in our medical system are realistically not possible. Many natural birth advocates like myself find that home birth is the only truly natural birth option.

All too often in America pregnant women are viewed as being in need of serious medical attention throughout pregnancy, labor, and birth; they are not viewed as experiencing a relatively common, normal, and natural life experience. This philosophy flies in the face of reason and human history; women have bodies made for this work. The statistics of home birth bear this out. Less than 5% of home birth mothers aided in labor by a midwife end up with a C-section, while the national average for cesarean sections in nearly 30%. Though some of this discrepancy can be explained by the fact that midwives do not often oversee the care of high-risk patients it does not account for the total discrepancy. Three in ten American women end up delivering by cesearean section, while only one in ten are due to known complications prior to birth, such as premature labor or Preeclampsia.

Midwives are generally the care giver at home births, and they generally practice a very different type of maternity care than Obstetricians do. This is due in part to their unique training in the natural processes of birth left to proceed naturally without so many external interruptions, but it is also a philosophical difference in the way they view birth from the get go. In Peggy Vincent's book, Baby Catcher, Chronicles of a Modern Midwife, she illustrates this difference by relating a conversation she had with a doctor in which he stated that "normal birth is a retrospective diagnosis, no birth is normal until after the fact. All births are complicated until proven otherwise" a medical philosophy that treats every birth as a medical event in need of medical treatment. Though the attitudes toward natural birth among many doctors today are changing, the standard operating procedure in hospitals today still make it very difficult for women who want to have a perfectly natural uninhibited birth to reach that goal.

This is why many women have chosen to stay home and have their babies in their own environment and in their own way, aided by the support and wisdom of midwives. At home they are not thwarted in their desires by the constant fetal monitoring by machines, instead they have the loving hands of a midwife ever present, who can closely monitor the labor and the infant while creating a gentle and reassuring environment that helps the mother to labor undisturbed by hospital intrusions. At home a women is not impeded in here labor progress by hunger as she may be in the hospital when she is told half way through a long and difficult labor that she cannot eat, a practice that is wholly foolish, as the denial of food can lead to greater fatigue and put in motion events that may cause the infant to be taken by cesarean. At home a woman is free to move, dance, moan, yell, and do whatever feels natural and helpful to her as she works through her own power to labor her child into the world.

When weighing your options for a natural birth, it would be worthwhile to explore the home birth options in your state and community. Home birth options vary widely by state and community. There are many places though who have an active home birth community of experienced midwives and doulas who can aid you in your birth. It is a peaceful and rewarding experience worth having if you are able to put it together. Below are some considerations to help you in determining whether home birth is for you. Home Birth Pro’s and Con’s There are many advantages to doing things the old-fashioned way. Having your baby born in the comfort and privacy of your own home can be warm and wonderful. There are also some risks and disadvantages that should be considered carefully before you make a decision.

Advantages Of A Home Birth
If a woman is healthy she is considered to be “low-risk”, meaning there is no reason to assume that the birth will be anything but normal, she is a good candidate for a home birth. Women considering a home birth should be carefully screened to determine the safety of such a birth. Planned home births are safe; some people think they may even be safer than the hospital. In the Netherlands, where about 40% of the babies are born at home, the rate of prenatal mortality is one of the lowest in the world.

• For some women there own turf is the most comfortable place to deliver.
• The whole family is near. This is a comfortable setting for siblings to be a part of the birth in a non-threatening way.
• The home is quiet, comfortable, and familiar; powerful in helping a laboring woman to relax.
  A home birth allows the most individuality and flexibility.
• At home, you can avoid the often-routine interventions practiced in most hospitals that often impede the natural progression of labor.
• The cost of home birth is less.
• There are no admission policies.
• You feel free to move around, eat, and drink if you please.
• There are no uninvited doctors or nurses, your privacy and the privacy of your family is never disrespected.
• Drugs are not used.
• Your labor is more likely to progress naturally without interference.
• The baby won’t be taken away from you after birth; and the first moments of your baby’s life are not stolen by the loud clamoring ciaos of the deliver room.
  

Disadvantages of a Home
Birth Women choosing a home birth should have no heart disease or diabetes and no family history of genetic disorders. Multiple births, breech births, and premature births can be attended by some very serious life threatening complications, because of this a mother should carefully considered the risk in these situations. Even if a woman meets all the medical criteria for a home birth, there is always the chance that a problem will arise that cannot be dealt with at home; she may have to be moved to the hospital in the event of an unforeseen complication. For this reason a women should live a reasonable distance from the hospital.

• You may not want to be moved to the hospital during labor if there are warning signs of maternal or fetal distress.
• Emergencies are more stressful in the home birth setting.
• The move to a hospital can be upsetting to parents both because it signals problems and because plans for a special and personal birth are now so radically altered.
• You may feel nervous waiting for your caregiver to arrive and prefer to have the responsibility of getting yourself to the caregiver on time.
• You may feel uncomfortable about having your other children around or nervous that they will hear you shout or scream, even if they are kept out of the mother’s room.
• Even though home birth sounds good, you may feel it’s too unconventional or that it seems somehow unsafe to deliver at home. This uneasiness may slow down your labor.
• At home you won’t have the 24-hour hospital care at your beck and call. You might find this especially helpful after the baby is born.

The advantages and disadvantages of home birth differ from woman to woman, and from family to family, but for those families seeking the most natural and gentle of births for there family, home birth is a safe option that should be considered.