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Wednesday, 23 July 2014 16:57

Code Word

During transition in my last labor, I remember being on my hands and knees on the floor of the hospital and moaning, “I can’t do this...I need an epidural...I want an epidural.”

But I wasn’t serious, and even in those moments of intense discomfort I knew I wasn’t serious. I didn’t really want medicine.

 

Fortunately, my husband and nurse were completely on board with my all-natural birth preferences and didn’t rush to get me drugs when they heard me asking. However, after reflecting on that birth and looking ahead to my next one, I think there’s a lesson to be learned.

 

I need to be able to complain. I want my pain and strength to be validated when I am in labor. I realize now that when I asked for an epidural, I was really asking for my pain to be validated and for more support through the process of labor. It was a cry for both praise and help, not for pharmacological pain relief.

 

So this time, going forward, I’ve decided to designate a “code word” to be used if I need pharmacological pain relief. This will enable me to whine and complain, to ask for drugs or an epidural all I want, but without tempting my husband to call for them. Instead, I will use the “code word” if I begin to suffer and an epidural becomes necessary. Something like “code red!” or “bananas!” so that my labor team will know when I’m not kidding around anymore.

 

If my labor team hadn’t patiently urged me to keep going without drugs, I may well have ended up with an epidural when I asked for one. I don’t want to risk that again. I want easy access if I need medicinal pain relief, but I don’t want to get it unless I really need it. I think a code word will enable me to do just that.

 

Did you use a code word for your labor? Would you consider doing so? Share your thoughts with me!

Published in Labour
Monday, 10 March 2014 03:00

How to: Contact a Doula

Once you've found a doula whose availability, area, and available information looks like it might fit, Your next step is making contact. What follows are some rough guidelines for how to do that in a way that will help you gauge early on if you’re a good fit for one another.

Most of the time, your initial contact with a doula will be through a contact form, by e-mail or phone. In either case, you want to cover your basics—usually focusing on availability and setting up a consultation. Your first contact isn’t about whether or not you want to hire them. It’s about whether you want to set up an interview to get to know each other further.

E-mail gives you a little bit more room to explain what you’re looking for than a contact form, but your first e-mail should usually still be fairly concise. I personally find it difficult to have in-depth conversations by phone in a world where mobile reception on both ends is often a very real barrier to communication, so I often ask that people who’ve contacted me by phone first follow up with me by e-mail.

Things to Include in Your First Contact by Phone, Contact Form, or E-Mail:

  • Your estimated due date. Even if you’re choosing not to consider a due date very firmly, which can be wise, we need some idea of when you’ll need us so we know whether or not we have other clients expecting around the same time.
  • Your home location—be specific. Whether or not you’re planning to birth at home, most doulas will meet you there for early labour. You probably don’t need to give your exact address, but I usually ask for post codes or neighbourhoods to make sure I can get to you.
  • Your planned birth location, and if you’re planning a home birth, the hospital where your midwives have admitting privileges for you in case you require a transfer. We need to make sure your birth location is also accessible to us, as well as confirming that there are no restrictions or special requirements for doulas supporting clients in that location.
  • What kind of medical support do you plan to have? Most doulas support births attended by either midwives or doctors. Some will support otherwise unassisted home births, but if that’s your plan, you’ll want to be up-front about it to avoid surprises later on.
  • Do you have any special concerns? Things like multiples, VBAC/HBAC, or other particular needs are worth mentioning right away. Some doulas may refer you to someone with more experience with certain kinds of births.
  • Any particular birthing method you plan to use, if you’re hoping the doula will be able to help you with it. For example, if you’re using hypnobirthing, you want a doula who is, at minimum, familiar with the basic concepts of that plan.
  • Questions about fees, if this is unavailable on the doula’s website. If you see fees listed, assume those are her starting point, and if you don’t know if you can afford them…
  • Any concerns about your ability to pay her fees as listed. Just asking about fees will usually only get you the same summary she gives anyone and has listed online. If you’re concerned you can’t afford her, say so. Ask if alternative payment schedules are available, or if she accepts alternative forms of compensation. See this post for more on affording a doula on a tight budget.
  • Ask what the decision time will be following your consultation, especially if you plan on interviewing more than one doula; you'll want to know what your time frame is for getting all your options before you have to decide.


Leave These Topics for Your Consultation

Although most doulas will happily answer the following questions, they’re usually best left for a time when you have an opportunity to discuss them at length, with time for follow-up questions as they arise naturally. They’re important questions you’ll probably want answered before you hire her, but they’re not usually the best for your very first inquiry. You'll also be better able to evaluate what the answers mean to you after you've spent some time together.

  • What is your philosophy?
  • What is your experience?
  • How many clients do you take at once?
  • Do you arrange back-up?
  • Can you give a basic outline of what your packages look like in terms of services?

 

Published in Birthing Assistance
Monday, 24 February 2014 09:31

Birth Partner No-No's

As a doula, I have had the privilege of witnessing so many beautiful moments during labor. From loving embraces to funny (but appropriate) jokes to lighten the mood, a woman’s birth partner can most certainly be her rock during labor. But I have also observed those moments where someone says the wrong thing or eats the wrong food that people in the Twitterverse like to call #epicfails.

It really doesn’t take much to anger or upset a laboring mama, so here are some tips to help you stay on her good side:

  1. This first one is a biggie, but it can be a tough one to master, especially for all you men out there (sorry, but it’s true). Try not to say anything stupid. In case you don’t know what would constitute a stupid thing to say, here are some examples: “does it hurt?”, “are you okay?”, “how long is this going to take?” or “I can’t believe I am missing the big game”. Do not say any of these things. And keep in mind that these examples are far from extensive, so think before you speak.
  2. General complaining is also a BIG faux pas. I do understand that it has been a long night/day/days. You have every right to be tired, hungry, sore and anxious. But for the love of bananas, act like you are perfectly fine! Your partner doesn’t need to hear you whine. Nothing you are experiencing is as uncomfortable as what the laboring mom is going through, so suck it up, buttercup.
  3. A laboring woman (or women in general, really) can quickly tune into how others are feeling and acting, so if you think you aren’t coping well don’t let her see it. If you can, leave the room until you feel more composed.
  4. If you are having a hospital birth it may be hard to turn away from the super cool mountain drawing machine (AKA contraction monitor). Those things are borderline hypnotic, but ignore that pesky monitor! All of those beeps and buzzes mean nothing of consequence and distract you from mom. In fact, I feel like they give partners a false sense of understanding what the laboring woman is going through. Avoid comparing the monitor to her pain level, and steer clear of phrases such as “these contractions aren’t nearly as big as they were two hours ago” or “here comes a contraction”. Trust me, mama knows what’s going on with her body way better than the machine attached to her does.
  5. Don’t interrupt a woman who is coping well with a technique or idea. Encourage what is working for her instead of trying to introduce new ideas or tips.
  6. Sense of smell is heightened during labor and many women become nauseated. Avoid eating in front of her (unless she is okay with it) as the smell of food might be a big turn off. And you never know what smell mama may find offensive…during the birth of my first son I became very agitated when the smell of cucumber wafted in my direction. If you do step out for a bite to eat then brush your teeth before you return. And most importantly, if mom has medical circumstances that do not allow her to eat food, then eating in front of her would constitute cruel and unusual punishment.
  7. Try not to be preoccupied with other thoughts such as getting the car seat installed, getting to the coffee shop before it closes or calling your mom. Your partner is your main focus, and being overly concerned with anything else will earn you some evil stares.
  8. As labor progresses, mom will likely want the chatter toned down a bit. Follow her lead. Be silent if she is being silent. Bring a book to read in the corner or nap if you can. Don’t ask open ended questions, especially late in labor. Stick to ‘yes’ or ‘no’ questions. And most certainly do not ask any questions during a contraction. I’ve witnessed this occurrence on several occasions and it is never pretty.
  9. Do not encourage mom to do things that do not fit into her birth plan. For example, if mom desires to avoid pain medication do not suggest it because it is hard to see her in pain.
  10. Don’t ask her what you can do to help. She is likely too exhausted to come up with an answer, or she simply just doesn’t know. Instead, just try things that you think might help. She’ll let you know if she doesn’t like it and if she does let you know, don’t take it personally.

Above all, women in labor need love and support. When all is said and done, even if you make one thousand “mistakes,” she will remember that you supported her, and that is all that matters.

Pregnant women: print this out and hand it right to your partner, you will thank me later.

By now you’ve already gone through the excitement of a positive pregnancy test, received the hugs and high fives from friends and family, and made the decision whether to find out if you’re expecting a he or a she. Now, though, it’s starting to sink in: you have to have this baby! This cheat sheet is by no means everything that your partner will need to know on the big day, rather it is something to fall back on if it’s go time and all the information from childbirth classes fly out the window.  

By now you’ve learned more about the uterus and cervix than you ever thought you would; even heard about something called a mucus plug. Now it’s time to connect the dots, to understand just what’s going on down there, in there, and out here. The uterus and cervix, believe it or not, are actually one in the same. The cervix is the gateway to the uterus, which contains your baby, the placenta, amniotic sac and nearly a gallon of fluid!

Early Labor: How to Know & What to Do!

When the early stage of labor begins, the cervix begins to thin out and become softer, allowing it open easily.  She may feel what is described as a shooting or pricking sensation along with mild cramping, similar to PMS cramps for some. She will probably be able to maintain a nice conversation with small pauses while going about her business. The best thing to do is to go about what you had planned and focus on your last few hours or days as just a couple (or more!) It’s also important to note here that if she has had a cervix check done at the midwife or doctor’s office, it may not mean much. Some women are 4 centimeters for weeks before going into labor. My mother went from 0 centimeters to nearly having me in the hospital parking lot!!

Active Labor: What now!?

The next stage is active labor, this is when the cervix begins to open at a more rapid pace and your baby begins to make the journey into the pelvis. This is strong, amazing work, and she should be treated as it is by everyone in the room. Contractions become stronger, longer, and take on a regular pattern, happening every few minutes.

This is the time to encourage and support every single minute. Suggest that she relax her mouth and muscles while contracting, letting out deep sounds from her belly along with deep breaths to give oxygen to your baby (fun fact: the mouth, anus and vaginal muscles are all related! Relaxing and opening them helps labor progress effectively.

Physical support is critical during this time frame. You don’t have to be a licensed massage therapist to give her fantastic pain relief, just rub wherever you see her tensing up, especially the shoulder area. Alternate hot and cold cloths on her face and the back of her neck, this will help with her constant temperature changes.

Encourage changes in position, being on all fours, sitting and bouncing on a Pilates ball, and side lying on the bed are all great choices.  Avoid laying on the back as much as possible, contrary to popular belief, this can actually close the pelvis and make baby journey uphill.  Make sure you always have a water bottle handy, offering it to her constantly, even putting the straw right in her mouth. Snacks on hand will keep her energy up, but remember too that labor can be a time for puking. So choose foods that are high in protein, healthy fats and natural sugar while keeping in mind that it needs to be able to come back up as easy as it goes down.

When to make the call

By now, you may be wondering if it’s time to head into the hospital or call the midwife (for home birthing families.) While there is no right or wrong answer, short of actually seeing the baby coming out (CALL 911!) it’s a personal decision.

The general rule is 4-1-1: contractions that are 4 minute apart, lasting at least 1 minute, for 1 hour, but we all know that not everyone plays by those rules, babies included.  Some better signs to look for are emotional markers.  She may begin to enter a phase of self-doubt, you may hear the tell tale “I can’t do this!” mantra.  It’s common shortly before the quickest and most intense part of labor, transition; by the way, the appropriate response to this is always “You are doing it!”

She may be short on conversation and might be short with you, period. Don’t take this personally, it means that she is in the labor zone and conserving energy whenever she can. Physically, you may notice that she is starting to get closer to the ground and, sorry to say, but she may start farting. A lot. Your partner may also poop a bit. If you need to take a moment to giggle, let it all out now; we can almost guarantee that she is self-conscious about this. If she does do either, put down the air freshener. Most birthing women will poop on the table.  Pretend it didn’t happen, instead tell her how she’s getting so close to having her baby! She will thank you later. Isn’t it funny that in labor, rudeness and flatulence are encouraged? These are all great signs that point towards going in.

You will need to speak to you practitioner about the procedure for calling and arriving at labor and delivery before hand.

At the Hospital!

Once at the hospital, your support is a top priority! Quite a few first timers believe that their doctor, midwife or labor nurse will be there 24/7, but this is rarely the case. Nurses are the unsung heroes of the maternity ward (bring them cookies, seriously) and often take on a huge patient load to help many mamas birth. Your care provider usually comes in to “catch” your baby and maybe to discuss options with you once in awhile. There are exceptions, of course, but this is why it pays to be prepared (and hire a doula their expertise will help greatly…just saying!)

As she enters the transition phase, contractions will come very close together and she may look like she is in a totally different place. She may not be able to respond, so consider suggesting position changes, keep giving her water and food (depending on hospital policy) and through each contraction, remind her of how close she is. This is the most common time to ask for pain relief, usually while she is in the middle of a walloping contraction. Remind her that she is going to be holding her baby very, very soon and maybe suggest: “Let’s talk about an epidural in three more contractions,” so she can make a real, informed choice at a better time. Generally though, transition only lasts thirty minutes to an hour before pushing begins, it is both the hardest work and the most relieving as it means you are almost there!

All About Pushing

First timers always ask, “when will I know to push,” trust me you will know. She may start feeling as though she needs to use the toilet really badly. She may start making grunting or growling noises. If you haven’t already, this is the time to hit the “call nurse” button.

While each practice or hospital may have different policies on pushing, evidence shows that any position other than the back is best to let gravity do the work.  Yes, babies do come out! The pushing you see on TV, with the people shouting “ONE! TWO! THREE!” are only usually used in labors where mama has had a strong epidural and is no longer able to feel the need to push.  When she knows she has to, she rarely needs someone else to guide her.  The best encouragement is to remind her to follow her body, to push when it feels best for her.  

It’s Baby Time!

When your baby is crowning, you could ask for a mirror to hand to her if she’d like to see the action or encourage her to reach down and touch her baby. This may be too much for her, so say something like “wow, he/she has a lot of beautiful hair!” this will remind her of her ultimate payoff. Then, it’s baby time! Out comes a new, amazing little creature, covered in waxy vernix; encourage having the baby placed skin to skin on your partner’s chest. Now would be a great time to remind your care provider if your partner would like to keep the cord pumping precious blood to your baby while still attached and uncut, as well as a reminder if she has chosen not to receive Pitocin to deliver the placenta unless medically necessary. The placenta, thankfully, does not have bones and usually detaches and comes out by itself within a few minutes to half an hour, usually with just one push.

After this there’s not much else to say. Bask in your love for your partner as well as your new daughter or son. Go ahead and enjoy that oxytocin high; both of you have earned it. You only get one birth experience for each child, why not do everything you can and hire the best fitting doctor/midwife and doula support for your family? Do your research, find your voice and give your partner your all, for your baby—for your whole family.

Published in Birthing Assistance
Thursday, 06 February 2014 22:04

With Woman

It has not been long that I've been a doula. My training is nearing completion with a few more births to be evaluated. I take great pride in my training efforts; read far more than required, watch every film and documentary, listen earnestly to other birth workers and other mothers like myself who have experienced a birth trauma, only to redeem their experience with a subsequent birth. I think I can confidently say "I know the basics" just as confidently as I can say "there is so much to be learned". 

As a training doula, I often focus my learning on techniques to be used: massage, Rebozo, essential oils, memorizing positions and their uses. Important stuff, as in most descriptions of a doula these are the highlights of our work. We know how to help you cope, physically. We know the process, and believe in the process, of natural childbirth. We also know about the interventions and how to work with them so they don't fall into the "cascade" we birth workers fear will take away from the childbirth experience. Ask any lay person what a doula does, and if they know anything about us at all, they will know that we can help you deal with the pain of labor. 

But despite all the wonderful uses and intentions of those techniques, I fear I have left out focus of a key factor of my work. As a doula can tell you, the most beneficial part of having a doula at your birth is the CONSTANT SUPPORT. I knew this. I believed this true. And yet I still didn't understand the extreme impact that statement has. 

WITH WOMAN. 

Not "doing it with woman", not even "helping a girl out". WITH. With? Such a simple implication of a word. Defined easily, categorized simply.

Not until the last birth I attended did I truly understand the full weight of importance of "with" in my role as labor support.

Although, I should have as I experienced it in my own birth of my second child. In my personal experience of a rather quick labor/birth (6 hrs total), I did not want coping techniques to be used on me. I was fighting off the panic of how quickly my birth approached. I holed myself up in the smallest room of my house and made a small nesting area reminiscent of the way the dogs my family bred in my childhood did. I was offered a simple, and known to be quite effective, hot water bottle; but the presences of the gentle, loving, midwife's apprentice and the trying of that physical ease made me loose focus. I did not like either, and so I stayed alone in my safe place listening to the conversations of my husband and midwife, my mother crushing ice for me in the kitchen, my father retreating to another area of the house so not to disturb the process; alone and content working internally to handle my labor. 

And then, eventually, I came out of my nest because I honestly felt a little out of the loop. I wanted to be near the people. I entered the hardest of my labor there, with them. I needed them there. I did not need them to assist my labor and frankly they couldn't have anyway. No, I just needed them. After a unfavorable positional change I remember grabbing my midwife's knee suddenly as a heavy contraction hit before I was ready. Her face was shocked by my sudden grasp as I up until this point had labored within myself, not reaching out for help. And then her eyes told me what I needed to know:

"I know it's hard. I know you're working harder than you ever have. I know." 

After that moment I felt a new level of trust. Not because she helped ease my pain or even because she said some scholarly fact about transition being the hardest but shortest part, but because she empathized and validated my experience..... all in a look. 

WITH WOMAN.

Yes, a doula can offer you many helpful things to deal with your labor but not all who labor want a massage or a positional suggestion. Some just need you to be WITH them. To hear them when they cry out that they don't want to do this or that they don't think it can be done. To know they are suffering. To somehow with your presence tell them you understand. Perhaps a word of "but you are doing this" or "your work is paying off" or even "you are further than you realize and doing more wonderfully than you think" but mostly just WITH. 

The last birth I attended was a mother's 3rd and first attempt at a totally natural and un-augmented childbirth. Much like my own, quickly moving. She fought her labor until she couldn't fight anymore. She voiced her retreat of intent for this birth so I could hear it, not because she really meant she wanted to give up but because someone had to know how difficult it was. And I did. I knew. It was hard and it was fast and it wasn't exactly how she pictured herself laboring. Once she had told me and I agreed that it was hard, she stopped fighting it. She danced beautifully the dance of a laboring woman, drawing her baby further through the pelvis. And when her dance was sufficient she found herself a bed to rest in. And when her rest was sufficient, she pushed the baby out in 2 waves without voicing to anyone that it was happening (in fact, in that dark hospital room, we nearly missed that the baby was being born, let alone a doctor to be present for its entirety!). Her birth was beautiful and it was hers. She was strong, even when she tried to say she wasn't. I did not help her with counter pressure or positions as I so often do. No, instead I was simply "with". 

With woman.

To sum up the whole, the best part, the most important part, is that I, and all the striving birth workers in our present, past and future, are WITH you, woman. Every mother that has ever been is WITH you, birthing goddess. And if you need to be validated while you work to bring your baby earth-side, just look to the woman at your birth-she is WITH you in this momentous right of passage and that, I hope, will sooth your soul. 

Published in Birthing Assistance

Women go through labor in a similar manner to the way they live, and because childbirth can be a hyped-up and emotional time behaviors are often magnified. Coping skills are vital to have during this process, as certain personality characteristics are potential risk factors for a high or low risk birth. Inner conflicts and anxieties that are not dealt with before labor can make a woman feel out of control, victimized, and in crisis. Northrup described some of these issues as physical abuse, sexual abuse, self-image issues, dependence, passivity, resistance to change, and lack of support (473). What is necessary is that women become aware of their weaknesses and strengths so that they are capable of physically and psychologically enduring the labor process and becoming a mother. 

Fear of Pain

When the average woman enters the delivery room they have no idea of the extent of pain or discomfort they will feel. Pain is a strange experience and perceptions vary. Their reactions to the pain also vary and are often influenced by the way they deal with stress or fear.  First time moms often feel that the experience will never end. Some women enter the labor and delivery room and the first words they express is, “I don’t want to feel a thing.”  These women convince themselves that they are not capable of giving birth naturally. Some are scared, many feel unprepared, and others believe that labor is a complete inconvenience.  Other women react to labor pain as if they are being wounded or physically hurt - instead of relaxing into the contractions they resist. 

 Surrender or Resistance

It is common for some mothers to come into the hospital with a list of items that they refuse during pregnancy- no IV, no monitors, no students, particular room requests, and no interventions. I want every mother to feel safe and in control.  I agree with most of these requests under the right circumstances, trust me! Sadly control is often a survival mechanism and an attempt to remain safe when scared. The longer list of items a woman attempts to control the higher tendency there is for intervention.  

If you desire to - write a birth plan - be prepared and know your options. Also know that you are entering a hospital – many of these facilities are focused on business and protocol. If you feel that the medical team is moving too fast ask them to slow down and explain what is going on and offer options. 

Know Yourself

Events do not always go as planned and it is necessary to have adequate coping skills.  A woman should know herself. Her attitude towards life and the way she deals with problems will come up during labor.  Northrup described potential risk factors in childbirth (473).  Here are some questions based off this research that all women should ask themselves as they prepare for labor and delivery.  If you answer yes to most of these questions statistically you have a better chance at a low-risk childbirth. If you have issues in these areas, start to address them so you will be prepared during birth and into motherhood.

Do you consider yourself an active and independent woman? 

Are you able to take support from others? 

Are you able to deal with changes in an appropriate manner or do you tend to resist?

Are you honest in your communication?

Do your spiritual beliefs match your birth plan?

Have you been abused or sexually abused? If so have you dealt with these issues? (women who have experienced sexual abuse are more likely to have dysfunctional or high risk labors)

Do you ever consider yourself powerless?  If so what types of situations does this happen in, and how do you deal?

Do you and your partner have a loving relationship? Do you trust one another?

Do you have an internal control of your life rather than a supposed external control?

Is there anything you are scared of, if so are these fears being worked through?

 

For more information on this topic, pregnancy, or to read birth stories visit: http://birthwithbalance.com

 

Northrup, Christiane. Women’s Bodies, Women’s Wisdom Creating Physical and Emotional Health and Healing. New York City. Batman Books. 2010. Print.

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