Closing Remarks for 2011

With the close of this year and a new one on the horizon, I naturally look back and find myself reflecting.  I've decided to share these here.  It may seem a bit scattered and a smattering of thoughts... I'm ok with that.  These are thoughts I've had this past year-- take them or leave them.

As the EDDs of women I'm supporting approach and come and go, I find myself in a similar mindset as a doula to what I felt like waiting for my own labors to begin.  "Should I schedule our car for service tomorrow, plan to go to the zoo as a family, host dinner with friends this weekend or will baby decide that this is the day and I'll be called to a birth?"  It's easy for me to get antsy from time to time and to hear myself say "Well, it all depends on if there's a baby being born or not."  What I'm trying to remember is that like all of life, we make our plans and then adjust accordingly.  I encourage the women I'm working with to go on with life and to enjoy the moments and memories they have before birthing their baby... and I'm telling myself the same thing.  Live today.  Live now.  Live.

I've seen doctors mention possible interventions to their patients (my clients), such as "cutting a small episiotomy because the perineum seemed short" and then changing their minds moments later, resulting in a woman birthing her baby just fine with very little natural tearing.  I keep on hearing that "episiotomies aren't used all the often anymore," and while this may be the case, I can count at least five births where I've heard them be discussed or used in the past year.  My advice here would be to ask your care provider under what circumstances they would suggest this procedure and then make certain that they know that you are wanting to avoid one unless absolutely medically necessary.

I posted this on my Facebook page in November and it's truly at the core of who I am as a doula.  "I'm all for 'healthy mom, healthy baby,' as being of the utmost importance when it comes to birth... BUT I'm for 'HOLISTICALLY healthy mom, healthy baby,' meaning that mom's and baby's emotions and psychological state are of utmost importance too.  Women giving birth deserve to look back on their experience and feel that they were heard, respected, and cared for on all levels and that they were an active participant in making decisions regarding their care."  At the end of the day, whether a birth went along without a hiccup or a birth took unforeseen and surprising twists, my deep desire for the families that I support is that they know without a shadow of a doubt that they made the best decisions for their specific situation.  This looks different for each woman and each situation.  Whether a labor and birth are intervention-free or riddled with necessary interventions, my hope and prayer for the maternal care system is that women and their families have trusting and mutually respectful relationships with their care providers and that they have the information and space to make informed decisions for their individual labor and birth. 

I'm convinced more and more that choosing a care provider is one of the most important decisions a woman will make.  I want to shout from the rooftops that just because you've gone to a specific care provider for your gynecological care DOES NOT mean that they are necessarily the best fit for you when it comes to prenatal care.  You might find that your OB/GYN is too medical for you and you'd fit better with a midwife or an OB/GYN who takes a more "midwife model of care" approach to pregnancy, labor and delivery.  Before conceiving and then in the early prenatal period, it is vital that you think about what approach to birth you are more in line with.  I go into this at length in this post.  It's unlikely that you've been concerned with your OB/GYN's cesarean rate, their birth philosophy, or under which circumstances they'd recommend induction when only seeing them for gynecological care.  However, these are of utmost importance to know and be on the same page with as you're figuring out what your values are for the birth of your baby.

This year I witnessed the following:

• a medically necessary induction that went on and off for three days resulting in an otherwise unmedicated, vaginal birth
• women overcoming deep fears they had about giving birth
• women taking ownership of their care and switching care providers at the end of their pregnancies
• an unmedicated, vaginal birth of twins
• women showing up at the hospital complete and ready to birth their babies
• babies born in their homes
• women who were planning for an unmedicated birth choose an epidural and it being the very best decision they made... helping me shape my opinion that epidurals are not all good or all bad, but that it's key to be wise with when to have it, if you have it
• women having uneventful labors and births and very eventful third stages (postpartum)... showing me again and again that birth is unpredictable
• a baby being born en caul
• women who go to the hospital thinking they are in active labor only to be sent home since they were not dilated 4cm yet, only to head back to the hospital a few hours later in very active labor, almost transition... showing me that letting go is everything
• women laboring very quietly and women laboring very vocally... women birthing very quietly and women birthing very vocally
• husbands and partners being AMAZING supports and anchors to the mothers of their children
• women knowing what they want and what their rights are and in a firm-but-kind-manner, communicating their wishes to hospital staff
• women who have rapid labors and make giving birth look like such a piece of cake (yet I know that it is intense for them, all the same)
• women birthing with their families surrounding them- children, husbands, mothers, sisters, dads, in-laws, friends... all privileged to witness new life entering this world

Thank you to all of the families who invited me into their deeply life-transforming moments as their babies were born.  I am so, so honored and grateful.  Thank you to the OBs and midwives, doulas, L&D nurses, childbirth educators and others in the birth world who encouraged, mentored and taught me something new this year.

Here's to 2012 and all that it brings.  I'm ready for it... eager to learn and grow and be shaped some more.

Birthing in the Hospital... What to Expect

I often support women giving birth in hospitals.  Birthing in the hospital means that there will likely be routine procedures and potential interventions that take place... it comes with the territory.  It's important that women and their partners are familiar with 1) what these procedures and interventions are, 2) why and when they may occur and 3) what the risks and benefits are to each.

To be clear- the point of this post is not to list out the pros and cons, but to instead list the most common routine procedures and interventions so that they are all in one place.  My hope is that clients of mine, fellow doulas, and parents looking for a list like this can use it as a springboard and do their own research.  I want people to KNOW what can be expected when laboring and giving birth in a hospital.  Follow the rabbit trails of links and suggested reading and be very familiar with what these common procedures and interventions are.

So without further adieu, I give you the list.

Amniotomy or Artificial Rupture of Membranes (AROM) aka "Breaking your Water"
This is often suggested as a way to help induce (start) labor OR to augment (speed along) labor.

• Very detailed article on AROM at PregnancyToday

• Information on AROM along with other induction measures at American Pregnancy Association

Routine IV Placement
Upon being admitted, it's routine for either an IV (Intravenous Fluids) to be started or for a saline lock sometimes called a "Hep Lock," a hold-over from when heparin was used, to be placed.  IV fluids are administered to help with hydration.  If an IV is not started, but the saline lock is placed, it's done so medical staff can have quick access to veins should the need arise.  The jury is still out on whether routine IV placement is the best standard of practice among low-risk pregnant women.  What is important for you to know and to discuss with your care provider is what your options are.  Do you absolutely need to have an IV while in labor if you're not planning to receive pain medication and/ or not needing antibiotics because you didn't test positive for GBS?  Do you need to have a saline lock placed at admission or is your care provider comfortable with waiting to have it placed until you need it? Once you know what your care provider and your place of birth require, you can plan accordingly for your labor. 

• Quick rundown on IV's during labor from the blog Suite101

• Lamaze International's stance on IV use during labor

Denying Food and Water During Labor
For many years, it's been common procedure to restrict eating solid foods and drinking liquids during labor.  Spoonfuls of ice chips have been the main "soup du jour" in many hospitals.  This is mainly due to the concern that should a woman undergo general anesthesia for a Cesarean, she could aspirate anything she'd eaten or drunk while in labor, a condition known as Mendelson's Syndrome.  However, in recent years, there's been much debate on the current likelihood of this happening since general anesthesia routines have changed over the years. 

• The Cochrane Library review on restricting oral food and liquid intake during labor.

• ACOG's (American Congress of Obstetricians and Gynecologists) 2009 statement on food and water during labor.

•  Very, VERY informative article on NursingCenter site with LOTS of links to other resources on the subject.

• Article on MedicineNet discussing food and liquid intake during labor.

• Article on PubMed evaluating the debate on eating during labor.

• Sheridan Ripley of the blog Enjoy Birth writes a post on eating and drinking during labor and links to previous posts on the subject as well. 

Electronic Fetal Heart Monitoring (EFM)
Your baby's heart rate is monitored throughout your pregnancy and during labor and delivery.  During pregnancy, this is typically done with either a fetal doppler or in the case of a non-stress test, with an external fetal monitor. During labor, the external fetal monitor is primarily used and in some instances, the internal fetal monitor. 
EFM is heavily relied upon in hospitals.  Most hospitals and care providers require continuous EFM, but a few allow for intermittent EFM.  It's important that you know what is routine where you'll be delivering and to talk with your care provider accordingly.  

• WebMD takes a look at external and internal fetal monitoring.

• Editorial piece in the American Family Physician (AAFP) online journal on why EFM is being used; very informative.

• SUPER detailed article from the American Family Physician journal on the interpretation of EFM.  More info than you'll likely want to know, but very thorough.

• Article from 2011 in the American Journal of Obstetrics & Gynecology on the use of EFM and its relation to neonatal and infant mortality

• Post from The Clinical Advisor on EFM vs. Intermittent Auscultation (IA)

Vaginal Exams, Cervical Checks, Pelvic Exams
It's not uncommon to want to know what your cervix is up to in the last few weeks of pregnancy and during labor.  Many care providers will offer to begin checking at 37 weeks.  It's important to know that it is YOUR choice to have a vaginal exam or not.  This is true both during pregnancy and during labor.  It should be noted that checking your cervix and reporting the findings cannot and will not indicate when labor will begin and/ or how it will progress.  There are a few different things that can be measured during a vaginal exam

• Well-written and thought-provoking post on the ICAN of Western Maryland site: "Routine Vaginal Exams During Labor"

• Another thought-provoking post on Dare to Birth Naturally site: "The Vaginal Exam During Labor: Is It Necessary?"

Hospital Gown
To some, this may seem like a silly thing to list as a routine procedure and to others, this might be really important to consider.  It's common for a woman to be encouraged to change into a hospital gown when she is admitted during labor.  We've all seen them... the lovely open-in-the-back kind.  There is absolutely nothing wrong with using the hospital gown.  At the same time, there is absolutely nothing wrong with requesting to stay in your own clothes.  For some women, the thought of putting on a hospital gown makes them feel like they're a sick patient vs. a healthy woman who's in labor and happens to be birthing in the hospital.  If you want to wear your own clothes, this is something that you'd want to check out with the L&D at your hospital.
Some alternatives to wearing a hospital gown that I've seen are: a sports bra or nursing tank and loose skirt, a short tank-style, loose-fitting night gown, nothing at all, a custom made labor gown (see links below), or a sarong, to name a few.

• Pretty Pushers

• BINSI

• Gownie by Baby Be Mine Maternity

• B.Y.O.G.

I realize there are more procedures and interventions to write about and I plan to do so in future posts.  These include the use of epidurals, Pitocin, Cytotec/ Misoprostol and Cervidil and various newborn procedures such as Vitamin K shot and eye prophylaxis (Erythromycin).  The ones listed above are what I tend to see as the basic standards of care during labor at the hospitals in which I've attended births.

You might be asking, what now?  I suggest asking questions and conversing with your care provider about what you've read.  Take a tour of the hospital you're planning to birth in and ask questions of the tour guide and/ or the head nurse.  The more you know about what it will be like when you are laboring and birthing in the hospital, the more informed you will be.  The more informed you are, the easier it is to be ready for the routine procedures and possible interventions that will be offered.  As mentioned earlier, the main goal is to be aware and have information so you, along with your care provider and birth team, can make the best decision for your labor and birth.  It's important to remember that in choosing to give birth in a hospital, there are rules and procedures that come along with that choice.  Some of those are flexible and others are not.  In talking with your care provider, my biggest suggestion is to do so without an agenda and without an "Us vs. Them" approach.  Instead, do your research and engage in an open discussion.  If you feel you're not getting anywhere or coming up against resistance, remember you are the one who gets to choose who you're entrusting your care to.  If you want to find a new care provider who might be a better fit, you can. 

As you prepare to give birth in the hospital, keep this in mind, with any suggested intervention- use your BRAIN.

Further Online Resources on Routine Procedures and Medical Interventions
Lamaze Healthy Birth Practice #4
Common Medical Birth Interventions You Should Know
Routine Labor Care

Doulas at Home Births

A majority of the women I support are giving birth in the hospital.  I've been asked recently to support a few women who are planning to give birth at home under the care of a Licensed Midwife.  As I've considered what my role might look like in the home setting vs. the hospital setting, I posed the question to a few birth focused communities that I'm a part of on Facebook.  I thoroughly enjoyed reading responses that I received and thought that sharing them here might be beneficial to other women who are considering hiring a doula for their home birth team and/ or other doulas who are asked to provide support at a home birth.  Feel free to comment below with any additional thoughts or experiences.  

Thoughts from women who've birthed at home...

M- I did have a doula, yes. Her role was "whatever needed doing." She offered emotional support to the whole family, helped filling and emptying the pool, helped care for the kids, tidied up about us. I found her really good! I would suggest having a close friendship with your doula though, because women who don't bond well with them don't find them as helpful as I did!

S- Yes. I had my partner, a doula and 2 midwives (they come in pairs for safety reasons). It was extremely helpful especially at end with my long labor and pushing phase. My partner got really exhausted so I leaned on my doula for support. She also helped by taking care of all the little things like water/hydration, birth pool water temp, food, etc., so my partner could attend to me 100%. I would definitely have doula support at my next birth as well! Very helpful! 

Giving the Gift of Food

I firmly believe that one of the kindest things you can do for someone going through a season of life transition is to provide a meal.  Whether it's moving into a new home, walking through illness, grieving the loss of a loved one or welcoming a new baby, nourishing people physically is such a tangible way to say "I'm here, I care, you matter."  I've been on the receiving end and the giving end of providing meals and both ends are equally as wonderful.  After the births of my children, it was such a gift to not have to think about what we were going to have for dinner in those first few weeks adjusting to the new normal of life with a newborn.  On the flip side, it's quite fulfilling to help organize and prepare meals for friends who are in transitional times.


I responded to a post from a friend on Facebook who was asking for ideas of what to make for a family who'd just welcomed a new baby.  I had a lot of fun reading through the responses and decided to do a little poll myself and asked fans on my Doula Jenna Facebook page for their suggestions of favorite meals brought to them or what they like to make for others.  I thought it would be fun to share some of them here... WARNING- if you are hungry right now, do yourself a favor and grab a snack.  This list is bound to make you salivate.

Four Precious Babies, Three Incredible Women, One Unforgettable Week

Never before have I experienced something quite like I experienced this past week... and I have a feeling that it will be a long time before I do again.  Between Tuesday, March 8 and Tuesday, March 15, I had the privilege (and I mean PRIVILEGE) of supporting three beautiful, strong, inspiring women as they labored hard and birthed their babies.  With their permission, I want to share some of their stories and give you a look at what this week was like for me.

Mama Knows Best... Thoughts on Switching Care Providers

This post has been brewing in me for some time now.  Let me start with a disclaimer... as a doula, I have enormous respect for the men and women who are medically trained to provide care for pregnant women and their unborn babies.  I believe that most have the best intentions in mind when it comes to caring for their patients.  I know that they pay one of the highest malpractice premiums out there.  I think that many are doing the very best they can do.

That being said, I've had a number of women in my life, friends and clients alike, who've shared that as they got further along in their pregnancy, they felt uneasy about their relationship with their respective OB.  For some of these women, as they brought up their hopes for labor and birth during a prenatal appointment, they found their OB not all that supportive or willing to really listen.  When asking to discuss their birth preferences plan, their OB snidely responding with "It's the patients who come in with a birth plan who end up with an unplanned c-section."  For others, they felt like their OB had a typical way of going about things (suggesting induction at 39 weeks and/ or urging induction at 40 weeks, performing cervical checks starting at 37 weeks, etc.) and when the patient questioned if this was medically necessary or just routine, the OB growing visibly frustrated and curt with the patient.

These women who've shared with me aren't demanding or inflexible in nature.  They aren't trying to be difficult or suggest that their OBs don't know what they're doing.  They've simply wanted to have a two-way relationship with their doctor- one where they can ask questions and share their wishes for their prenatal care and impending birth, without feeling belittled or like what they've researched is all bunk because they're not the one who went to medical school.  They are hoping that the one they've entrusted with the care of themselves and their unborn baby would be open to conversing and making the best decisions for their care based on their individual situation.  Some of these women have chosen to stick it out and remain with their OB despite not seeing eye to eye and others have chosen to look elsewhere for a care provider who is more in line with what they're looking for.