"Cynthya was our doula for the birth of our third child in April 2016. As this was my third birth, and I had been attended to by a doula at the first two, I knew that finding the right doula was crucial to a successful and satisfying birth." - Winter Wheeler-Young
Epidural, Please!
I've had several women tell me, “Oh, I don't need a doula. I'm planning to get an epidural.”
An epidural can be an amazing thing! There's a reason why 60% of women who give birth in the U.S. choose to get one during labor. Many women feel like their birth experience is more positive after receiving an epidural, and I have seen laboring women that I'm working with become so much more relaxed, focused, and finally able to catch their breath and rest after opting for one. For many women, just knowing that an epidural is part of the plan, when labor becomes too painful and intense, relieves some of the anxiety associated with the unknowns of being in labor and having a baby.
I've had several women tell me, “Oh, I don't need a doula. I'm planning to get an epidural.” Or they think that a doula will only support women who want a natural birth. Before I became a doula and when I first started my training, I thought the same thing! I now know that having a doula is a great resource, no matter what kind of birth you are planning to have.
Your doula sees the bigger picture, and is there for you and your partner before, during, and after labor. As a continuous and trusted presence, your doula is there to help you understand the labor process, what your labor will look like and how it will change when you get an epidural. Your doula wants you to be informed and in control of your birth and can provide information and suggest questions you can ask your health care provider.
“Having a doula is a great resource, no matter what kind of birth you are planning to have.”
Even if you are planning to get an epidural, a doula can support you while you labor at home and when you first arrive to the hospital. The transition from laboring at home to getting set up in the hospital and receiving an epidural will take some time. Knowing different methods to cope with the labor pain and any anxiety you feel will help make the transition easier. An epidural is just one form of pain management. A doula will help with other relaxation techniques before you get the epidural and can show you epidural friendly positions as you labor. You won't be able to move around as freely, but you can still change positions while in the bed, which will help you as you labor.
Your doula has a peanut ball and knows how to use it!
The peanut ball is most commonly used when a laboring mother needs to stay in bed. Studies show that epidurals lengthen the amount of time women spend in labor. Lengthy labors and ineffective pushing increase your chances of needing a c-section. Your doula will help you use a peanut ball to promote dilation and descent, change positions while you're in bed, and stay relaxed, which can help shorten your labor and make it less likely that you will need a c-section! Getting an epidural won't necessarily take away your anxiety about giving birth. Having someone with you, however, who is familiar with the labor process and can be reassuring and help you feel more confident and relaxed.
Your doula will also be a great resource to your birth partner! Sometimes our birth partners are so focused on their loved one, they forget to take care of themselves! A doula is there to provide an extra pair of hands and remind both of you to rest and stay nourished. As Cynthya describes in one of her posts about the role of a doula,
"A doula can preserve the intimacy of the birthing room and be a consistent care provider for you and your partner. Doulas maintain the ambiance of a labor room, keep good energy flowing, and help limit distractions, which allows the couple to relax and know they are cared for. Your doula wants to make sure that you both enjoy the birth of your child and has only your interest in mind. After all, birth is her passion and you've hired her for this special event - use her to your full advantage."
Your doula is on your team and trusts that you are a strong and capable woman who can listen to your body and decide what kind of birth you want to have and wants to help you embrace whatever forms of pain management you decide to use. She will be there supporting you along the way.
Review your options for building your support team by reading the profiles of our team.
How Taking a Childbirth Class May Help Prevent Birth Trauma
You go to one baby shower and inevitably, you start to hear the worst of the worst birth stories. “Did you hear about Kim’s birth? She pushed for FOUR hours and the baby was 11 pounds. Imagine. that. tear.” Everyone squirms.
by Megan Ciampa, Birth Boot Camp Childbirth Instructor
You go to one baby shower and inevitably, you start to hear the worst of the worst birth stories. “Did you hear about Kim’s birth? She pushed for FOUR hours and the baby was 11 pounds. Imagine. that. tear.” Everyone squirms.
“Andrea had to have an emergency c-section. She was induced and the baby’s heartbeat decelerated and they needed to deliver the baby immediately. Andrea’s blood pressure dropped and it was really scary. They said she almost died.”
Or, still, even worse:
“She asked for no episiotomy but the doctor insisted and cut her right before the baby was born. She had a 4th degree tear. Healing from that was the worst. She’s afraid to have another.”
While some of these stories may sound like just another unfortunate birth story, some of them are legitimate birth trauma. There is a term, called “obstetric violence,” that, on its surface, seems implausible. Obstetricians are all about bringing new life into this world; how could one be violent?
But when abuses bring with them “loss of autonomy and the ability to decide freely about their bodies and sexuality,” there is a price women pay at the hands of their care providers [Law on the Right of Women to a Life Free of Violence, supra note 13, art. 15(13)].
We know this does not characterize all or most OBs. But in the United States, in 2018, there are still too many women who experience birth trauma and feel more like a vessel of a person delivering a baby, and not like a human themselves.
“When you do not expect to have a problem with birth and then it happens, there can be long lasting psychological scars.”
Experiences such as these can have unfortunate consequences. Of course there’s the physical pain and recovery one must heal from. There’s also psychological and emotional recovery one hopes to experience as well.
In an article for The Atlantic, Ilana Strauss recounted stories of women who experienced post-traumatic stress disorder (PTSD) after giving birth. Not to be confused with postpartum depression, postpartum PTSD can be characterized by “hyper-vigilance, intrusive memories, flashbacks, severe emotional distress, irritability, trouble sleeping, and nightmares,” as is explained by Anastasia Pollock, a therapist who specializes in treating trauma.
Strauss also explained that the theory behind women who develop postpartum PTSD is complicated, but it often has to do with expectations. When you do not expect to have a problem with birth and then it happens, there can be long lasting psychological scars.
So… what does one do? How do you appropriately create your expectations?
Aside from talking to a wide range of women who have given birth before you and hearing their experiences, another very practical thing you can do is actually quite simple: take a childbirth class!
Not all childbirth classes are created equally, so do your research on with whom you study. What all is covered? Policies and procedures of the hospital? What meds you’ll be given? It’s important to discuss who your care provider is, and what his/her track record is for vaginal vs. cesarean deliveries. It’s also important to know your hospital or birth center’s policies and statistics. Even Consumer Reports is reporting on this. Read CR's article here.
To see Florida's c-section rates from 2016 and 2015, take a look at this spreadsheet from Florida Health Finder (source linked below). Check your state’s c-section rate here.
What else would you cover in a childbirth class?
In our Birth Boot Camp series, Training for an Amazing Hospital Birth, we discuss EFM or electronic fetal monitoring, the use of IVs, frequent vaginal exams and your care provider and/or hospital’s VBAC (vaginal birth after caesarean) policies.
We look back on the history of birth in this country and how it continues to impact the birth experience today. We discuss the physical and emotional happenings of labor and arm both mom and her partner to navigate it successfully. We share the stages of labor, including pushing and what positions are helpful and how the birth partner can help.
We educate on ways to avoid a cesarean, and how to feel at peace with one if needed. And perhaps most importantly, we arm you with the tools and knowledge you need to ask informed questions as you plan your birth and postpartum.
Taking a birth class does more than just show you how a baby is born. It shows you how amazing your body is, and how it’s your body, and how you can have a say over what happens to it. It encourages you to find and work with care providers who honor you and that process and respect your baby and you.
Sources:
https://scholarship.law.duke.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=3924&context=dlj
http://www.floridahealthfinder.gov/researchers/QuickStat/cesarean-buffer.aspx
Related articles:
Positivity, Positions and Personal Support
5 Labor Tools for Partners
Postpartum Expectations and Must-have Items
2 More Reasons You Don’t Need an Induction
No two pregnancies are the same (even within the same body), no two labors are the same; there are so many factors that play into a pregnancy and her subsequent labor and birth.
by Lauren King, Registered Nurse, Certified Lamaze Educator, and DONA Labor Doula
What is the average size of a baby born in America? Would you guess 7 pounds? Maybe 7 and a half? Eight pounds. Eight pounds is the average size of babies born in America. That means some (lots!) of babies are bigger than that – and many babies are smaller than that. Genetics and mom’s lifestyle, among other things, play a huge role in how big you grow your babies. I’ve seen babies born vaginally that weighed over 10 pounds! I’ve heard stories of babies just as large born vaginally with no pain medication! It’s certainly not impossible. (Maybe not necessarily the most pleasant thought… but not impossible!) Do you know how much amniotic fluid is adding to your weight? Well, not much honestly, but if you’re around 34 weeks, you have now reached the peak amount of amniotic fluid at about 800 mL. From 34 weeks on, amniotic fluid levels will gradually decline. Read on to learn why this matters.
Some doctors suggest an induction for “big baby” because they believe it decreases the chance of a shoulder dystocia (difficulty delivering the shoulders) or the need for a cesarean due to the baby being too large to fit through the pelvis. However, research shows this is simply not true. The risk of shoulder dystocia is relatively small – and it’s impossible to predict who will have a shoulder dystocia. Furthermore, for a doctor to suggest a woman to induce for this reason, the doctor must assume the ultrasound is accurately assessing the size of the baby. Next time a late-pregnancy ultrasound is recommended to you to assess fetal size during your pregnancy, ask your doctor or the sonographer how accurate it is. If they tell you the baby “might” weigh about 8 pounds, please know they can be off by as much as 2 pounds either direction. There is a HUGE difference between a 6 pound baby, an 8 pound baby, and a 10 pound baby. I have seen elective c-sections performed on first-time mothers due to “possible macrosomia” (big baby), only to discover the baby weighed LESS than 8 pounds.
I often tell people that things in labor and delivery can be very dynamic. The more I think about it, the more I realize how true that statement is in so many ways. No two pregnancies are the same (even within the same body), no two labors are the same; there are so many factors that play into a pregnancy and her subsequent labor and birth. Another dynamic aspect of pregnancy? Amniotic fluid. As I mentioned above, the amount of amniotic fluid peaks at about 34 weeks, reaching around 800 mL, and gradually declines to around 600 mL by 40 weeks. However, there are many factors that can play into these numbers. The baby, the mother, and the sonographer measuring the amniotic fluid can all affect the actual or perceived level of fluid.
The baby constantly circulates the fluid by inhaling it, swallowing it, and then releasing it through the urinary tract. Near term, the baby swallows more and urinates less often, thereby holding more fluid at any given time. Other baby-driven factors include: post-term (past 42-weeks), birth defect, or problems with the kidneys or urinary tract.
If you are dehydrated, such as in the coming summer months especially, if your water is broken, or if the placenta is no longer functioning properly, you may be diagnosed with low amniotic fluid. Some things you may try to increase amniotic fluid levels include drinking more water (at least 2-3 liters a day) and laying on your left side during an ultrasound when measuring fluid levels. Other factors that can play into an inaccurate reading include too much pressure on the ultrasound transducer, floating particles in the fluid, and an obese mother. Yes, “low amniotic fluid” could be a sign of a health issue and can be a medical reason for induction, but ask your doctor what their specific concern is before agreeing to induction simply for “low amniotic fluid.” Furthermore, you may wish to have a reevaluation in a couple days. Drink lots and lots of water, and when you return for another ultrasound (hopefully by the same sonographer!), if the fluid level is still low, or has decreased further, then you may wish to discuss the next step with your provider. If it has increased, then you might have saved yourself from an unnecessary induction! For a brand new diagnosis of “low fluid” without any other known cause, you may be better off to wait.
"What I have heard, and what I suspect it ultimately boils down to, is for one thing, doctors are human." - tweet this!
So, knowing all of this, why do doctors recommend things that are not backed by research or ACOG? My honest answer is: I don’t know. What I have heard, and what I suspect it ultimately boils down to, is that for one thing, doctors are human. Meaning: doctors want convenience and easy and predictable and good ratings. What? Good ratings? Exactly. Doctors and hospitals have a business to run. They have to keep their patients happy to keep them coming back for subsequent care! And businesses are consumer-driven. How many times have you heard that you can’t treat a viral infection with antibiotics? And yet, when a patient goes into a doctor’s office, demanding something to be done about their illness, they just might walk out with an antibiotic prescription in hand. Same thing with inductions. When a patient begs, pleads, whines, and complains about all the aches and pains, and difficulties of pregnancy, their doctor wants to appease them. No, not all doctors act this way, but the ones that do are the ones contributing to the problem and making it “okay” for other doctors to do the same. Although, I have to say – it’s not ALL the doctors’ faults. We, as women, as mothers, as consumers are just as much to blame. If I walk into my doctor’s office, demanding an induction – all the while, knowing all the risks of doing such – my doctor doesn’t want to lose me as a customer, so he agrees.
You Have More Power Than You Know
On the flip side, if more women – more consumers – are asking their doctors to allow their bodies to go into labor naturally, they will stop suggesting and allowing for non-medical inductions. If more women are getting educated on their options and on the pros and cons of such procedures, and refusing inductions for the sake of convenience, doctors will follow suit. Ultimately, they want to make their customers happy.
For more information on inductions, please visit MedLine Plus, American Pregnancy Association, and the Adventures of a Labor Nurse.
"Amniotic fluid peaks at 34 weeks, reaching around 800 mL, and gradually declines to around 600 mL by 40 weeks." - tweet this!
Related articles:
Knowing Your Options Is Vital To Your Labor And Birth
How To Avoid a C-section Without Changing Hospitals
6 Comfort Tips For NOT Breastfeeding
So You Need An Induction, Eh?
So You Need An Induction, eh?
I believe women (actually any person) should be able to whole-heartedly trust their doctors. We want to believe our doctor is doing what is in our best interest – and they should be.
by Lauren King, Registered Nurse, Certified Lamaze Educator, and DONA Labor Doula
Photo By BirthYearBook
I feel the need to provide a disclaimer before I delve into this topic. I am not saying all doctors, midwives, or other medical staff are bad. There are definitely a lot of really great medical personnel out there. But just like anything in life, there are always a few bad apples.
I believe everyone should be able to whole-heartedly trust their doctors. We want to believe our doctor is doing what is in our best interest – and they should be. But I don’t think it’s a secret that there are doctors that sometimes do things in their own best interest. The question is: how do you know? As a non-medical person, how does one know their doctor is top-notch, and not suggesting every intervention, hoping for another nickel in their pocket, or hoping to be out on the golf course in an hour?
Of course, the obvious response here is: talk about your options with your doula from The Happiest Doulas, and we will do everything we can to help you achieve the beautiful birth you want and deserve. But equally as important is to be educated. You don’t need a nursing degree or a medical license to make important medical decisions, but you do need at least a pretty basic understanding of some of the top decision areas. And for everything else, ask lots of questions. Specifically, discuss the B-A-R with your provider: benefits, alternatives, and risks. When discussing pros and cons about procedures (especially induction) a great question for your provider is, “What research do you have about that topic?” or, “Where can we get more research-based information about that to help us make a decision?”
I’ve written before about inductions, but this is a topic that comes up a LOT in my classes. Plus, it’s the topic that really gets me started, gets me up on my high horse, my soap box… and it is hhhaarrrddd for me to get off it! “My doctor wants me to have another ultrasound next week because the baby is measuring big,” – and as a bonus to that one, “And if I don’t deliver by my due date, the doctor wants to induce me.” “My doctor said my amniotic fluid level is low.” “My doctor told me I need an induction because I conceived through IVF.” Ok, well, I don’t actually know what the literature says specifically about IVF, but just in my personal OPINION, it doesn’t make sense to me.
"I whole-heartedly believe in inductions for medical reasons for mom or baby’s health." - tweet this!
Let’s talk about the reasons for induction, though. There are actual medical reasons for induction, and I whole-heartedly believe in inductions for medical reasons for mom or baby’s health. What I don’t believe in is disguising a convenient induction in medical terminology. Here are some medical reasons for induction, according to ACOG: pregnancy that continues 1-2 weeks past the estimated due date, high blood pressure, uncontrolled gestational diabetes, an infection in the uterus, or a baby who is not growing properly (IUGR). This list is not completely exhaustive, but “big baby” and even “low amniotic fluid” (by itself) are not included in the list of medical reasons for induction.
I’ll discuss those two things in a later post, but for now, let’s discuss induction for postdates (going past your due date). Do you know what “EDC” or “EDD” stands for? Both start with E for estimated. (EDC stands for “estimated date of confinement”, in case you didn’t know.) A point I made in one of my classes recently was this: do you always have a 28-day cycle? Do you know, for a fact, that you ovulated on day 14 when you got pregnant? Do you know, for a fact, the exact date you conceived? (Ok, so some can truthfully say ‘yes’ here.) So, I went on to say: Did you all walk at 12 months? Did you all crawl at 7 months? Did you all roll over at 3 months? My point is that just as we all grow and develop at different rates Earth-side, so too do our babies grow and develop at different rates in the womb.
Due dates are calculated based on an archaic formula, called Naegele’s Rule, which assumes every woman has a 28-day cycle. Even then, the man behind Naegele’s Rule, Frederich Naegele, was not the original “inventor” of “how to estimate the length of human gestation.” It was an 18th-century professor of botany and medicine, Hermann Boerhaave, who developed the formula. Am I the only person who thinks this whole business of calculating a due date deserves a little more visitation by the research and medical community?!
Many Are Mislabeled as "Post-Term"
I do a lot of reading to keep up with the newest information. One of my favorite places to get information is from Evidence Based Birth. Rebecca Dekker, the author, just published a very extensive article on the evidence for inducing for going past your due date. She touches on Naegele’s Rule as well, but one thing she wrote really struck me. She wrote, “using the LMP [last menstrual period] to estimate your due date makes it more likely that you will be mislabeled as “post-term” and experience an unnecessary induction.” The reason for this is just as I stated above: not everyone’s cycles are cookie-cutter perfect! Even if a woman does ovulate on day 14, if she conceives that month, the embryo may not implant for several days! I was so thrilled for this article to come out, I wish everyone could take the time to read it word-for-word; however, I realize it is lengthy. I encourage you to skim it, and if nothing else, read the section “What’s the bottom line?” found at the end of the article.
"If a woman ovulates on day 14, and conceives that month, the embryo may not implant for several days." - tweet this!
So that you have more time to read that very important article, I’ll go ahead and end now. I hope this has given you some valuable information and resources. Next up, I’ll discuss why doctors induce for “big baby” and low amniotic fluid, so come back soon!
