I can talk. Boy, I can talk! I can talk about babies and superheroes, science fiction, politics, dogs and cats, even the kitchen sink, and I’ve hit on all these topics and more during a birth, but there are also times when I know when to be quiet. You see, a mother doesn’t birth rationally. She doesn’t birth with the frontal lobe, the area of the brain that is in charge of logic and speech. In fact, trying to stay in that conscious area of the brain can keep a mom from progressing in labor
One common misconception we often face is that doulas want or don’t want something specific for you. “Doulas don’t want you to have pain medicine” or “I don’t want a doula to talk me out of….” So what do doulas want for your birth? The answer is easy – what you want! A doula’s number 1 priority is the health and safety of the mom and baby. After that, what we want is for you to get the best possible birth for you, however you define that. Here’s a few things we’ve heard and our answers:
You don’t want me to have any pain medication. We had one client who asked “What if I want all the meds?” One of our doulas answered, “Then my job is to get you all the meds!” We want you to have the birth that’s right for you. While you might surprise yourself and never even ask for pain medication, if you feel that you need it, we want you to know your options (did you know that epidurals aren’t the only choice?) and to get the right medication for you at the right time in your labor. An epidural sometimes is the very best thing for you, and we love to support you during that! There is plenty for a doula to do when you are laboring on an epidural, and if you want it, we are there for you. We’ve even suggested epidurals in some situations!
Labor isn’t a fashion show, that’s for sure! What you wear can have an effect, though, on your mood, comfort, and experience. Some people have unpleasant associations with hospital gowns, or think that wearing one might make them feel more like a patient and less in control. Some might want to wear a certain color that is meaningful to them. There’s more to what you’re wearing than just the gown though, so here are a few thoughts about what to wear when you’re in labor (for this post, we’re going to assume that you’re birthing at a hospital or birth center. At home, of course, it’s always up to you!)
10. Nothing tight. You might think that goes without saying, but you’d be surprised. Even socks or bras that are a little snug will be extremely uncomfortable during labor.
9. Little or no jewelry. Many hospitals have a no jewelry policy, but won’t enforce it until things get dicey. If you’re going to the hospital, you might want to leave your valuables at home. You’ll feel better knowing that they are safe and won’t get misplaced. You’d be surprised at the things that may suddenly start to bother you in labor, and jewelry also can get caught in things like sheets and hair, yanking on you uncomfortably (especially piercings!) If you feel like there is something you can’t live without for a few days, go ahead and wear it, but bring a safe place to store it and have your birth partner put it there as soon as you take it off!
“You’re a doula? What's that? Like a midwife?” It’s a pretty common response when we talk to people about our work. The growing familiarity with midwife care is great for birth, and we hope that awareness of doulas will increase as well!
How is a doula different from a midwife? The biggest distinction is that a midwife is responsible for the physical wellbeing of the mother and baby, and a doula doesn’t do anything medical. A doula won’t take your pulse, blood pressure or temperature or check your cervix. A doula will stay with you continuously from the time you need her until after your baby is born. Heart to Heart doulas don’t change shift or go off duty. A homebirth midwife will often stay with you as well, but may need to take some time to sleep. A doula can do a great job even half-asleep, but your midwife needs to be alert when the baby’s coming out!
“I just didn’t get it.” One of our clients after giving birth to her first told her doula, “I didn’t get why people were concerned about monitoring.” For a first time pregnant mom reading message boards, books, blogs and more, it may seem like the least of things to worry about. It’s external, it isn’t painful, it’s not risky or scary-sounding. So why do we give it a second thought? Put a monitor on, forget it about it, get on with labor, right? “But now I get it, it just messes with everything you do.”
First, let’s be clear. We are absolutely not anti-monitoring. Every responsible labor attendant should monitor the baby’s heart rate, but that doesn’t have to mean constant, electronic monitoring. In this post, we briefly touched on types of monitoring available. So if we agree that monitoring is a necessity, why is it a concern?
Being on a monitor may increase your chance of more interventions, such as forceps or vacuum delivery and cesarean section, while not decreasing positive outcomes. This article from Evidence Based Birth lists several studies showing that while laboring women wearing the external fetal monitors had higher rates of these interventions, they didn’t have significantly lower rates of health problems with their babies. Mothers on continuous monitoring request more pain medication. Even ACOG recognizes that other options for monitoring are appropriate and safe.
We know that words are powerful! During birth, we are careful about words that we use, but we can’t always change the choice of word others use – and that can even start during the pregnancy.
One example is “active labor”. What is active labor? Well, there doesn’t seem to be one accepted definition and that can cause confusion. A quick Google search told me that “Active Labor” is when you are at 4cm or more – or when your contractions are “more coordinated” – or when you can no longer walk and talk during labor – or when your contractions average about 60 seconds long. So what if you are dilated to 5cm but not having regular contractions? One doctor tells clients that active labor isn’t until 6cm, and then on the hospital tour, when the guide said that if you aren’t in active labor you won’t be admitted, the mother-to-be who heard this became worried! A mother who has had regular, strong contractions and gets to the hospital to be told she has progressed to 3cm may be very frightened or discouraged that she is already having intense contractions and isn’t even in “active” labor. Conversely, a mother might be better off not admitted to the hospital if her contractions are faint and irregular, even at 4 or 5cm!
The words “still” and “only” can be devastating to laboring women. When a cervical check includes these words, progress that has been made is ignored and a tired, frustrated mom believes her contractions have been in vain. So, while a healthcare professional might say, “You’re still at 4cm”, what may be missed is progress in effacement, station, or position of the baby. Even if the HCP follows up with that, leading with the “bad news” often means that is what gets the focus.
Some women have unpleasant associations with words or phrases. It’s not uncommon for a HCP to tell a laboring woman “Good girl!” or to tell women that they have to push like they are pooping the biggest poop of their lives. Neither of these is inherently bad, but some moms dislike being called “girl” or find that phrase condescending, even if not meant that way. Clients have asked us to remind people not to talk about poop when they are laboring, because even though it is the same muscles, and yes, feels very much like a large bowel movement, they don’t want to feel like their baby is being compared to poop.
Paying attention to what we say and asking for clarification when needed helps cut back on some of the stresses of ambiguous or discouraging conversations. Remember that even doctors have different definitions of some terms. Words are powerful and during labor, we should use them with great care.
Did you every notice how much birth reflects our lives? There might be more in common than you think:
-Both have a beginning and an end and we rarely know exactly when either of those will be. We have very little control over when and how they will start and end.
-Birth, like life, is much better if you are surrounded by people you love, who love you, and support you and your choices.
-We might have a plan for our lives and our births, but no matter how hard we try and how detailed our plan, things don’t always go according to plan! Adaptability and flexibility are key for both.
-Hopefully you will laugh more than cry, and you’ll appreciate the journey. (Don’t think it’s possible to laugh during birth? We’ve all been to some births that are filled with laughter!) Whether giving birth or living your life, at the end, you want to look back and be proud of your choices and accomplishments.
-Each one is unique and special. No two lives and no two births are ever exactly the same.
-The more you know, the better decisions you can make.
-Things will get messy.
-Both are better when you can eat, drink, and move around when you want to.
-Surprises will happen.
Doulas take our life lessons to births and apply what we learn at births to our lives. Life and birth are too important to treat lightly and just hope things go well. Having a doula can help you get your best birth – which could just change your life!
Around the time I was training to be a doula, one mom told me a story of giving birth in a hospital and questioning the need for Pitocin. She had been young and honestly didn’t even know what the doctor was talking about when he said that he’d like to start her on Pitocin. When she sincerely asked what it was and why they wanted to give it to her, the doctor asked her in what I’m sure he thought was a jovial way, “Hey, who’s in charge here? We know what we’re doing – we do this every day.” She’d been too surprised at the response to ask any more, so she just accepted the Pitocin and went on with her birth. She never forgot that moment.
So – who is in charge here? Well, I can tell you for sure, it’s not the doula! We might say to some extent, it’s the baby! We don’t know what exactly causes labor to begin, but it often depends on the baby’s health and readiness. The mom, definitely, should be in charge of her body, and decisions made about it. In emergency situations, doctors often have to make split second life-saving decisions, though in birth, this is rare.
The idea of a “Birth Plan” can be a hot button topic. We like to use birth “visions” instead of “plans” because one thing that’s certain is that you can’t plan a birth! A birth vision is a tool you, your partner, doula, healthcare provider (HCP) and nurses can all use to help you achieve your best birth by your standards.
If you’re old enough you might remember the old GI Joe cartoon that had the line at the end of each episode “Now I know and knowing is half the battle!” Doulas can attest to the truth of that statement at many births. Too many times, when discussing a past birth with a friend, family member or new client, we hear “I didn’t know that was an option!”, “I didn’t know I could ask for that!” or “No one told me that was allowed.” Doulas are there to inform you of your options as well as help you implement the ones you decide are right for you.
So what are we talking about? Monitoring is a good example:
Our doulas share their thoughts, tips and more with you.