Cesarean Awareness Month: Evidence-based, Practical Cesarean Resources

April is Cesarean Awareness Month. While it can be a life-saving procedure for mom and baby, a cesarean is often prescribed when vaginal birth is a safe and sound option. Be aware that you have options, that you have a right to ask questions, and a right to know your risks. Educating yourself about birth is your best and first defense against an unnecessary cesarean. 

Throughout the month, Giving Birth with Confidence will be posting cesarean resources for moms. We encourage you to comment with your experience as well as any questions. For more information be sure to check out the International Cesarean Awareness Network Blog.

Knowing what happens before, during, and after a cesarean birth is helpful for moms who are scheduled to have a cesarean, but also for any mom approaching birth. It’s common not to want to learn about something you so desperately want to avoid, but educating yourself about a cesarean — even just a little — will help prepare you for all possibilities in birth, which could help ease your fears about the process should you need one.

There are several resources on cesarean around the web. About.com/pregnancy, however, seems to have the most complete, succinct, and practical resources. The author of About.com’s pregnancy resources is Robin Weiss, a Lamaze Certified Childbirth Educator, a doula and doula trainer (DONA), a childbirth educator trainer, author of several maternal/child care books, and mom to eight children.

Moms who plan to have a vaginal birth, but want to know more about a cesarean, may want to read:

 

Moms who have a scheduled cesarean may want to read:

 

All expectant moms can benefit from reading the following:

Cesarean Awareness Month: Avoiding a First-Time Cesarean

April is Cesarean Awareness Month. While it can be a life-saving procedure for mom and baby, a cesarean is often prescribed when vaginal birth is a safe and sound option. Be aware that you have options, that you have a right to ask questions, and a right to know your risks. Educating yourself about birth is your best and first defense against an unnecessary cesarean. 

Throughout the month, Giving Birth with Confidence will be posting cesarean resources for moms. We encourage you to comment with your experience as well as any questions. For more information be sure to check out the International Cesarean Awareness Network Blog.

10 Tips for Avoiding a First-Time Cesarean

By Jessica English, CD(DONA), LCCE

More and more women in the United States (and around the world) are having cesarean births. A recent study from the Yale University of Medicine showed two main reasons for the rise: more c-sections in first-time moms and lower rates of VBAC (vaginal birth after cesarean).

For your first baby, what can you do to reduce your chances of an unnecessary cesarean birth? We’ve identified 10 areas where you can be proactive and stack the deck in your favor.

1) Hire your provider wisely. This point is number one for a reason – it’s critical. In most practices, you could have any one of several doctors or midwives. You get whoever is on call when you go into labor. It’s helpful to know your practice’s cesarean rates. The labels “obstetrician,” “family doctor” and “midwife” don’t necessarily tell you what you need to know about your provider’s philosophy. Some doctors practice more like midwives, and some midwives practice more like a stereotypical doctor. Will they have a toolbox of natural techniques or only medical tool to help you if your labor is complex? If you’re not sure which doctor or midwife to choose, ask a doula. Doulas see all kinds of births with many different practices, and they will be happy to make a recommendation of a provider with a low cesarean rate and good bedside manner.  If you find out that your provider is not supportive, it is never too late to switch, even if you are just a few weeks or even days before your due date.

2) Hire a doula. Simply put, doulas make birth better, and there’s research to prove it. A meta-analysis of studies shows that women who use a doula are 26 percent less likely to have a cesarean birth, among other dramatic benefits. Having continuous support from a friend of family member can be helpful too, but the best results come when women hire an outside doula, according to a recent Cochrane Review. What exactly is the doula magic? The research hasn’t pinpointed the magic, but I think the unique combination of physical, emotional and informational support, plus gentle advocacy makes a huge difference. Doulas help women feel safe and comfortable so the hormones of labor can work at optimal levels, positioning ideas and tricks can help babies work their way out, and evidence-based information and help communicating with the medical staff can help women have their best chance inside a system that doesn’t really promote natural birth.

3) Take an independent natural childbirth class. It’s not so much that you need to know a lot about giving birth, but many women (and men) need to undo what society has taught us about birth. Independent classes are usually longer and more in-depth, with more interaction and less lecture. A good instructor can help increase your confidence in your body and help you trust in the normal birth process. An independent Lamaze-certified instructor will base her class on the six Lamaze Healthy Birth Practices, a wonderful resource that lays the groundwork for the best possible birth. Another benefit of an independent class is that your teacher works for you. She can teach you how to advocate for yourself within the system, without having to worry about what doctors, administrators or anyone else might think.

4) Avoid induction unless there’s a serious medical problem. As a first-time mom, some studies show that simply walking in the door for an induction of labor doubles your risk of a cesarean. Doubles it. That’s huge! Avoiding induction is never more important than with a first baby. But if you must be induced for a medical reason, call on your natural childbirth instructor and your doula (remember them?) to help you with tips to keep it as normal and natural an experience as possible, even with the unexpected circumstances. If mom and baby are not in immediate danger, low-and-slow inductions can result in a better chance of a vaginal birth, but you’ll need great support on the journey.

5) If having your baby in the hospital, stay home at least until strong, active labor. Your independent childbirth instructor will teach you how to recognize active labor. If you follow the common hospital recommendation to “come in when contractions are five minutes apart, at least a minute long, for at least an hour,” most women having their first baby will be very early in labor. The intensity of contractions is a much better guide than the timing. The more hours you are at the hospital before your baby is born, the higher your risk of intervention (including a cesarean). In her book “Pushed: The Painful Truth About Childbirth and Modern Maternity Care,” Jennifer Block tells the story of a hospital in Florida that lost power after a major hurricane. A generator kept the essentials running, but there was not enough power for air conditioning. They wanted to save resources and keep laboring women cool, so for a full week they turned away any woman who was not in full-blown, active labor. Their emergency cesarean rates during that week dropped dramatically.

6) Avoid an epidural, at least in early labor. Research is a bit mixed, and not all studies have been high quality. But still, the best evidence available does seem to show that epidurals, especially when women get them early in labor, do increase the cesarean rate in first-time mothers. Childbirth Connection is a great resource for information on the benefits and risks of epidurals. There are rare times, of course, when getting an epidural can actually help a woman have a vaginal birth, if she simply doesn’t have the strength to go on. Every labor is different. But an epidural also makes it harder for a baby in a bad position to move into a better one, it limits your ability to move, and it requires a lot of other interventions (IV, continuous monitoring, bladder catheter, etc.). Your doula and your independent childbirth class may give you enough natural tools so that you won’t even need the drugs. Most women don’t.

7) Read only the best childbirth books. Get these books, and read them cover-to-cover. Seriously, throw away “What to Expect When You’re Expecting,” and dive into these wonderful books instead.

And while you’re at it, buy the DVDs “The Business of Being Born” and “Orgasmic Birth” – they’re even on Netflix. That’s right, I’m recommending “Orgasmic Birth.” Stretch yourself a little!

8) Get your partner on board. It’s hard to do this alone, you need support! Even with the best doula, your partner is still an integral part of your birth journey. Penny Simkin’s book “The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas and All Other Labor Companions” is a great place to start. Be sure your partner attends that independent childbirth class with you – sometimes partners benefit even more than moms from that information and support.

9) Consider an out-of-hospital birth. It’s possible, with the right support, to have a great first birth in the hospital – even a vaginal birth without pain medication. As a doula I see them fairly often, and you should definitely choose the hospital if that’s where you feel safest and most comfortable. But the best research is pretty clear that your odds of a vaginal birth are better outside of the hospital: at home or in a birth center. In 2005 the British Medical Journal published a large study that looked at home births in the United States attended by Certified Professional Midwives. The women who gave birth at home had similar outcomes to low-risk women who had hospital births in terms of safety for moms and babies. But just 3.7 percent of the women who had their babies at home transferred to the hospital for a cesarean, while 19 percent of the low-risk women who had their babies in the hospital ended up with c-sections. The current cesarean rate in the United States is 32.9 percent, according to the Centers for Disease Control. Many studies have shown similar results, which makes out-of-hospital birth at least worth considering.

10) Believe in your body! The cesarean rate for women who birth at The Farm in Tennessee is less than 2 percent. Many industrialized countries around the world have cesarean rates of 15 percent or less. Women have been doing this for millions of years! Your body works. Birth works, in all its complex and wonderful variations. Surround yourself with knowledgeable support, of course, in case you encounter any rare and unexpected complications. But truly… trust your body. Trust birth.

 

Jessica English, CD(DONA), LCCE, is the owner of Birth Kalamazoo, which offers birth and postpartum doula services, natural childbirth and breastfeeding classes, and in-home lactation consults. A DONA-certified birth doula and Lamaze-certified childbirth educator, she teaches an 8-week series of classes called “The Best of Natural Birth.” She is the editor of DONA International’s eDoula newsletter. A longtime writer and business woman, she also works as a consultant for organizations and birth professionals.

New Resource: What Every Pregnant Woman Needs to Know About Cesarean Section

Childbirth Connection has published a new mother and family-friendly resource that speaks in detail about cesarean section. The free resource guide talks about the current statistics, the possible benefits and harms, how to make informed decisions, how to help prevent a cesarean, and provides realistic information on what it’s like to have a c-section, including the particulars during birth and postpartum recovery.

If you are pregnant, I encourage you to read through this informative, easy-to-read, and helpful guide. Many pregnant women do not want to think about the possibility of having a c-section, but it’s important for everyone to know about and understand the procedure.

 

Cesarean Awareness Month: Postpartum Recovery Tips for Cesarean Birth

April is Cesarean Awareness Month. What should you be aware of? Be aware that a cesarean, while it can be a life-saving procedure for mom and baby, is often prescribed when vaginal birth is a safe and sound option. Be aware that you have options, that you have a right to ask questions, and a right to know your risks. Educating yourself about birth is your best and first defense against an unnecessary cesarean. 

Throughout the month, Giving Birth with Confidence will be posting cesarean resources for moms. We encourage you to add comments with your experience as well as any questions — we will tag cesarean questions and answer them in a subsequent post. For more information and stories this month, check out the International Cesarean Awareness Network Blog.


Postpartum Recovery Tips for Cesarean Birth

By Sharon Muza, CD(DONA), BDT(DONA), LCCE, FACCE

 

Giving birth, whether vaginally or by cesarean, is a major physical event. A mother’s body goes through immense physical changes in the minutes, hours and first days after birth.  Recovering from major abdominal surgery while making the transition to not being pregnant and caring for a newborn can be extra challenging.  Here are some tips for the very first days after you have had a cesarean, and some of this information is just good info for the first days after birth, no matter how your baby arrived.

1. Discuss with the anesthesiologist about the possibility of having them administer Duramorph for immediate post-op pain.  This medication is placed through the spinal needle or epidural catheter during the surgery, and usually provides effective regional pain relief for 18-24 hours.  After that, you can switch over to oral medications as prescribed by your doctor or midwife.

2. Stay on top of your oral pain medication.  This is not the time to be a hero!  Make sure you are taking the right dosage of meds at the right time, even if the pain has not returned fully yet.  It is really hard to play “catch-up,” so taking your medication in a timely manner allows you to feel your best, be more open to moving and functioning, and gently participating in baby care. You may even want to set your smart phone to “alarm” a few minutes before each dose is due, to help you track and remember what is needed and when. Give yourself some time before you try and reduce the amount of oral pain meds you need. The more you move and do some gentle, easy walking, the faster your recovery may be. Adequate pain medication will help in this process.

3. Think about your recovery set up at home?  Where is your bedroom?  Is your bed very low to the ground?  Where are your baby changing stations?  If you have a lot of stairs, consider relocating your sleeping area to one that is more accessible, close to a bathroom and the kitchen/place to eat.  It will only be a temporary move, but may make things easier for taking naps and resting.  If your bed is very low, consider placing it temporarily on cement or wooden blocks to make it higher.  It will be easier on your abdominal muscles to get up and down from a higher bed.  You can set up a portable changing area for the baby close by or in the same room as where you will be spending most of your time.

4. Use a pillow to “brace” your abdomen when getting up from a chair, couch or bed.  Sometimes, when you are laughing, sneezing or coughing, that can be helpful too.  If your couch or favorite chair is too low, think about adding some extra pillows for the additional height that you need in the early days.

5. Consider using a TENS (Transcutaneous Electrical Nerve Stimulation) unit to help with post-surgery discomfort.  Several studies show that women who used a TENS unit around the incision area needed less narcotic pain medication during their cesarean  recovery. (TENS units can be purchased online or may be acquired from your care provider.)

6. You may want to consider using a gentle belly binder or even a rebozo to “hold things together” for the first days or even weeks post cesarean.  Some women find that the gentle support offered by these products helps them to feel less sore and more supported.  Just be sure that whatever you use does not irritate the incision. (Some care providers offer belly binders automatically during your hospital stay. If not, you can ask for one.)

7. Work at becoming an expert in the side-lying breastfeeding position, which I consider the hardest to master for the mother-baby dyad, but the most useful once you do.  This way, you can rest as much as possible, and even doze for a few minutes during those extended feedings.  The key to doing this successfully is lots and lots of pillows!  A couple for your head, one between your legs, one behind your back at a minimum.  In general, your milk may come in a little slower after surgery than after a vaginal birth, so frequent nursing sessions, and lots of skin-to-skin time with your baby will help this to happen sooner.

8. Be sure to use stool softeners, stay very hydrated and eat food with lots of fiber. Oatmeal is a galactogogue (food that helps increase milk production) and is high in fiber at the same time.  Narcotic pain medication can cause constipation, and post surgery, the thought of having to strain to have a bowel movement can be emotionally challenging.  Most women find the fear is worse then the reality, but it is good to do what you can to keep things “moving,” so to speak.  Also, your bladder and urethra may be a bit irritated from the foley catheter that was placed to drain urine during surgery and the first hours of recovery. You may want to take cranberry pills or drink cranberry juice to help with bladder health and prevent a urinary tract infection.  Also, you will have received IV antibiotics before or during the surgery to prevent infection, and some women are more prone to getting yeast infections after receiving antibiotics.  A  yeast infection on your nipples (Thrush) is no fun either, and can be shared between you and the baby. You may want to use some probiotics (found over the counter in a pharmacy) or eat yogurt with live cultures, to help restore the balance of good bacteria normally found in your digestive tract.

9. Create a “nursing bag” full of all the things you need during a nursing session.  Cell phone, snacks, filled water bottle you can operate with one hand, something to read, burp cloth, breast care products, etc. can all be put in a bag or basket, and moved around with you, so that you have everything you need when you sit down to nurse.

10. Ask your friends and family to do some of the more physical household tasks and contribute meals during your recovery.  Use a website like Takethemameal.com or Care.com for scheduling assistance and for letting people know how and when they can help.

11. Recognize that you will have lifting restrictions that limit the weight you can carry to just the baby for at least a couple of weeks or even more!  It is recommended that you not lift the carseat with the baby in it until you have done some healing.  You also may not be driving for several weeks, (and certainly not while on narcotic pain meds) and your partner may have returned to work already, leaving you feeling a bit isolated.  It would be nice to have someone stop be every day to help, visit, or take you out for a short trip if you are up for it.  You may want a baby carrier (sling, Moby Wrap etc.) to help you hold/carry your newborn while your physical recovery moves forward and your mobility returns.

12. Working with a massage therapist who specializes in postpartum recovery can also help with postpartum pain and minimize the development of internal adhesions and promote healing.  Get a recommendation for someone skilled in this type of scar work and see if they make house calls!  Some massage therapists will come to the house in the first days of your postpartum period.

13. Connect with your local International Cesarean Awareness Network chapter, (www.ican-online.org to find one near you) and consider joining their online group or attending a meeting when you are ready.  This peer-to-peer support is invaluable as you process your birth and recover from a cesarean.

 

Go easy on yourself after you have had a cesarean birth.  It is hard to recover from surgery and ease into parenting a newborn at the same time.  Ask for help, make little changes around the house to support your recovery, and take it easy to give your body a chance to heal.  Laying low and resting will give you plenty of time to connect and snuggle with your new little one while you get your strength back.

 

Sharon Muza, CD(DONA), BDT(DONA), LCCE, FACCE, is a birth doula, doula trainer and Lamaze Certified Childbirth Educator in Seattle, WA.  Sharon is also the co-leader of the Seattle chapter of the International Cesarean Awareness Network, (ICAN.)  Sharon can be reached through her website, www.newmoonbirth.com, if you would like more information. 

Cesarean Awareness Month: Making Your Cesarean Mother-Baby Friendly

April is Cesarean Awareness Month. What should you be aware of? Be aware that a cesarean, while it can be a life-saving procedure for mom and baby, is often prescribed when vaginal birth is a safe and sound option. Be aware that you have options, that you have a right to ask questions, and a right to know your risks. Educating yourself about birth is your best and first defense against an unnecessary cesarean. 

Throughout the month, Giving Birth with Confidence will be posting cesarean resources for moms. We encourage you to add comments with your experience as well as any questions — we will tag cesarean questions and answer them in a subsequent post. For more information and stories this month, check out the International Cesarean Awareness Network Blog.

Making Your Cesarean Mother-Baby Friendly

By Sharon Muza, CD(DONA), BDT(DONA), LCCE, FACCE

You may find yourself headed for a cesarean birth, even when that was not what you planned.  A cesarean might have been in the cards all along for a variety of reasons, or  this change in plans might occur before labor begins, or during labor, when you, your partner and health care providers feel that a cesarean is now the best option.

As a long time birth doula and Lamaze certified CBE, I always encourage my clients and students to plan for a potential cesarean, even though many mothers feel like that outcome is unlikely.  Current cesarean rates in theUnited States tell us that more than 1 in 3 women will give birth by cesarean this year.  Having a simple plan with some wishes that continue to honor the birth of your baby, can go a long way toward making the experience a positive one.

Here are my top tips to make your cesarean birth as mother-baby friendly as possible. Discuss these items in advance with your health care provider to see what is possible in your situation and in your place of birth.

1. If you know you are going to have a cesarean, without an opportunity to labor, discuss with your provider if there is any risk in letting the baby pick his/her birth date and you heading to the hospital when your water breaks or gentle contractions start.  There are many benefits to your body, your baby and future labors if you allow your baby to initiate labor.  There are certain situations that may preclude this from being an option available to you, like placenta previa, where the placenta covers the cervical opening.

2. When the decision is made to have a cesarean, and if time allows, take a moment to talk to your baby.  Let him or her know what will be happening, that you have confidence in your team and your baby and that you will soon be holding him or her in your arms.

3. Walk into the operating room if possible.  It is very empowering to move to the OR under your own steam, if you and the baby are stable.  If you have been laboring without an epidural or the cesarean is planned, anesthesia is usually done in the OR, so you should be able to walk there on your own.

4. Ask for two support people in the operating room with you.  Your partner can be one, of course, and then your doula, family or friend may also be included.  Having two people in the OR means that your partner can go over to greet your baby at the warmer, and you can still have support with you right by your head. If your baby needs immediate transfer to a special care nursery, your partner can go with the baby, without worrying about leaving you alone.

5. Bring in music of your choice that can be played during the birth.  A CD or even an mp3 or smartphone placed on the pillow near your head playing softly can help you remain relaxed and positive.

6. Ask that everyone in the room take a moment to introduce themselves before the surgery begins.  There are several more people than you might expect in the OR during a cesarean birth, and everyone may look the same, all gowned and masked.  It can feel a little more personal to hear the staff introduce themselves and state their job…”I am Mary and I am the baby nurse…” can help you to feel like it is not such an impersonal procedure.

7. If you were waiting to discover the sex of the baby at birth, you can still do that.  The staff and surgeons do not need to announce “boy or girl” but leave that to be discovered by you and your partner.

8. Ask if it is possible to delay cord clamping for even a very short amount of time, if baby is stable.  Even 30 seconds of continued pulsing can provide benefit to your baby.

9. Sometimes, women may feel a bit nauseous during the surgery.  It may be a result of the procedure, or nerves, or unfamiliar sights, sounds and smells.  Consider bringing a little cotton ball or gauze pad with some peppermint oil dabbed on it, in a Ziploc bag.  Peppermint oil can reduced the nauseous feeling and help you to not vomit.  There is medication that can be given to you during the operation, but it may also make you sleepy, so if you can avoid it, that is great.

10. Talk to your baby after s/he has been born.  Ask your partner to tell you what is going on, and what your baby looks like; “Oh, honey, he has the same long fingers as you do…” Talk or sing to your baby, so that your little one can hear your voice as it makes the transition to the outside world.  When your baby is brought over to you, you and your partner can sing happy birthday or a special song that you may have been singing to your baby during pregnancy.

11. Ask that all possible newborn procedures be delayed until after you have returned to your room with your baby and had a chance to breastfeed.  Unless it is critical to have the weight of the baby immediately, this measurement and other procedures, (Vitamin K, eye antibiotic medication, dressing, etc.) may be able to wait until you and your baby have had a good snuggle and a breastfeeding session back in your room.

12. Ask if it is possible to get skin to skin with your baby in the OR, while your incision is being closed.  Prepare for this in advance by having removed or unsnapped your gown, and having just a warm blanket on top of you, ready for the baby.  While the baby may not be able to breastfeed in the OR, while you are on the table, you can certainly have the closeness and skin-to-skin snuggles.  You will always need some support during this time, so make sure that partner knows to keep their hands on the baby for safety.  If you are unable or prefer not to have skin-to-skin in the OR, consider letting your partner have some skin-to-skin time with the baby while sitting next to you.  Wearing a shirt that opens in the front, or even a t-shirt that has been cut a little down the neck will make it easier to slip your naked little one inside their OR gown or scrubs.

13. Ask that your uterus not be exteriorized during the procedure.  Exteriorizing your uterus is when the surgeon moves the uterus out of your body and onto the sterile field for examination and repair.  Studies show that postpartum pain after the surgery is greater when this has occurred and offers no benefits over doing the repair “in situ” (in position).

14. Ask that your uterus be double-layer sutured.  While current research is not clear that this provides any advantage over single-layer suturing, should you wish to attempt a vaginal birth after a cesarean with a subsequent pregnancy, some physicians are more comfortable and supportive of this VBAC attempt if there has been double layer suturing during the repair.

15. When you return to your room and get a chance to spend those first minutes really holding your baby and initiating breastfeeding, try and keep visitors and guests away for just a little bit, so you and your baby can get a chance to get acquainted on the outside.  This time is precious and the fewer distractions the better, to help you and your baby connect and bond.

A cesarean birth, whether expected or unplanned, offers unique challenges and circumstances for you and your baby.  It is helpful to recognize that a cesarean birth is still a birth, and you can prepare in advance by including plans for a birth on your terms, even when it occurs in the operating room.

 

Sharon Muza, CD(DONA), BDT(DONA), LCCE, FACCE is a birth doula, doula trainer and Lamaze certified childbirth educator in Seattle, WA.  Sharon is also the co-leader of the Seattle chapter of the International Cesarean Awareness Network, (ICAN.)  Sharon can be reached through her website, www.newmoonbirth.com, if you would like more information or need some support in planning your birth.

Cesarean Awareness Month: “Big Babies” and Cesarean

April is Cesarean Awareness Month. What should you be aware of? Be aware that a cesarean, while it can be a life-saving procedure for mom and baby, is often prescribed when vaginal birth is a safe and sound option. Be aware that you have options, that you have a right to ask questions, and a right to know your risks. Educating yourself about birth is your best and first defense against an unnecessary cesarean. 

Throughout the month, Giving Birth with Confidence will be posting cesarean resources for moms. We encourage you to add comments with your experience as well as any questions — we will tag cesarean questions and answer them in a subsequent post. For more information and stories this month, check out theInternational Cesarean Awareness Network Blog.

The following is a previously posted blog from obstetrical expert Henci Goer in which she answers one mom’s question about “big babies.” For more answers from Henci, visit her forum on the Lamaze website

Q

More and more we hear about “big baby” as a justification for induction or c-section. I was one of those mothers myself before becoming more educated in my options. However, my second baby was 11lbs. at birth. What do you feel are the things to consider when you may be genetically prone to growing a “big baby”? Do you feel the position of the baby is more important than the baby’s size when it comes to birthing a “big baby”?

A

Unfavorable position is clearly the bigger problem because it affects babies of all sizes, but while, logically, size has to be an issue as well, there are no neat cut-off points. Here is what the research tells us about big babies that can inform strategies for maximizing safe, healthy birth:

  • High BMI women tend to have bigger babies. Take home message: losing weight sensibly before pregnancy might be beneficial.
  • Eating a healthy diet and exercising regularly optimizes sugar metabolism. Take home message: this, too, could optimize fetal weight.
  • When obstetricians wrongly believe (based on sonographic weight estimates) that the baby will be big, women are much more likely to have a cesarean than when the baby actually is big, but the doctor didn’t suspect it and vice versa. Take home message: I’m not sure that refusing a weight estimate will help because, as this makes clear, it is a matter of what the obstetrician believes. I think it would be more useful for women to explore early on how her care provider feels about women’s ability to birth bigger babies and how he or she handles that situation. Specifically . . .
  • Inducing labor for “suspected macrosomia (baby predicted to weigh 8 lb 13 oz or more)” increases cesarean surgery rates without reducing incidence of shoulder dystocia (the head is born but the shoulders hang up behind the pubic bone) or delivery injury rates. Take home message: await spontaneous labor onset.
  • Planning cesarean surgery exposes women to the serious potential harms of major surgery. The best way of determining whether the baby is too big to come out is to go through labor and see. Take home message: don’t plan surgery.
  • Labor with a big baby is likely to take longer, at least partly because the cervix may have to open further to pass a bigger head. (The “10 cm diameter” definition of full dilation is actually not really 10 cm. For the last few cm of dilation, clinicians measure, not the diameter, but how much rim is left. This means that the true diameter might be a cm or two bigger.) Take home message: find a care provider willing to be patient with a longer labor and who has no preset time limits for making progress.
  • Epidurals, confining women to bed, pushing while reclining or semi-reclining can all impede progress. Take home message: choose a place of birth that allows freedom of movement and plan alternative means of coping with labor pain so as to bypass or delay an epidural. Also, hire a doula. Doulas can help with strategies to promote good progress and increase comfort as well as with emotional support should labor progress slowly.
  • The best “first response” to shoulder dystocia is assuming a hands-and-knees position: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9610468. Take home message: either plan to give birth in this position or have a plan with the care provider to turn to this position should the shoulders hang up. (With today’s modern “light” epidurals, it should be possible to turn to all fours with assistance even with an epidural in place.)

10 Tips for Avoiding a First-Time Cesarean

By Jessica English, CD(DONA), LCCE

More and more women in the United States (and around the world) are having cesarean births. A recent study from the Yale University of Medicine showed two main reasons for the rise: more c-sections in first-time moms and lower rates of VBAC (vaginal birth after cesarean).

For your first baby, what can you do to reduce your chances of an unnecessary cesarean birth? We’ve identified 10 areas where you can be proactive and stack the deck in your favor.

1) Hire your provider wisely. This point is number one for a reason – it’s critical. In most practices, you could have any one of several doctors or midwives. You get whoever is on call when you go into labor. It’s helpful to know your practice’s cesarean rates. The labels “obstetrician,” “family doctor” and “midwife” don’t necessarily tell you what you need to know about your provider’s philosophy. Some doctors practice more like midwives, and some midwives practice more like a stereotypical doctor. Will they have a toolbox of natural techniques or only medical tool to help you if your labor is complex? If you’re not sure which doctor or midwife to choose, ask a doula. Doulas see all kinds of births with many different practices, and they will be happy to make a recommendation of a provider with a low cesarean rate and good bedside manner.  If you find out that your provider is not supportive, it is never too late to switch, even if you are just a few weeks or even days before your due date.

2) Hire a doula. Simply put, doulas make birth better, and there’s research to prove it. A meta-analysis of studies shows that women who use a doula are 26 percent less likely to have a cesarean birth, among other dramatic benefits. Having continuous support from a friend of family member can be helpful too, but the best results come when women hire an outside doula, according to a recent Cochrane Review. What exactly is the doula magic? The research hasn’t pinpointed the magic, but I think the unique combination of physical, emotional and informational support, plus gentle advocacy makes a huge difference. Doulas help women feel safe and comfortable so the hormones of labor can work at optimal levels, positioning ideas and tricks can help babies work their way out, and evidence-based information and help communicating with the medical staff can help women have their best chance inside a system that doesn’t really promote natural birth.

3) Take an independent natural childbirth class. It’s not so much that you need to know a lot about giving birth, but many women (and men) need to undo what society has taught us about birth. Independent classes are usually longer and more in-depth, with more interaction and less lecture. A good instructor can help increase your confidence in your body and help you trust in the normal birth process. An independent Lamaze-certified instructor will base her class on the six Lamaze Healthy Birth Practices, a wonderful resource that lays the groundwork for the best possible birth. Another benefit of an independent class is that your teacher works for you. She can teach you how to advocate for yourself within the system, without having to worry about what doctors, administrators or anyone else might think.

4) Avoid induction unless there’s a serious medical problem. As a first-time mom, some studies show that simply walking in the door for an induction of labor doubles your risk of a cesarean. Doubles it. That’s huge! Avoiding induction is never more important than with a first baby. But if you must be induced for a medical reason, call on your natural childbirth instructor and your doula (remember them?) to help you with tips to keep it as normal and natural an experience as possible, even with the unexpected circumstances. If mom and baby are not in immediate danger, low-and-slow inductions can result in a better chance of a vaginal birth, but you’ll need great support on the journey.

5) If having your baby in the hospital, stay home at least until strong, active labor. Your independent childbirth instructor will teach you how to recognize active labor. If you follow the common hospital recommendation to “come in when contractions are five minutes apart, at least a minute long, for at least an hour,” most women having their first baby will be very early in labor. The intensity of contractions is a much better guide than the timing. The more hours you are at the hospital before your baby is born, the higher your risk of intervention (including a cesarean). In her book “Pushed: The Painful Truth About Childbirth and Modern Maternity Care,” Jennifer Block tells the story of a hospital in Florida that lost power after a major hurricane. A generator kept the essentials running, but there was not enough power for air conditioning. They wanted to save resources and keep laboring women cool, so for a full week they turned away any woman who was not in full-blown, active labor. Their emergency cesarean rates during that week dropped dramatically.

6) Avoid an epidural, at least in early labor. Research is a bit mixed, and not all studies have been high quality. But still, the best evidence available does seem to show that epidurals, especially when women get them early in labor, do increase the cesarean rate in first-time mothers. Childbirth Connection is a great resource for information on the benefits and risks of epidurals. There are rare times, of course, when getting an epidural can actually help a woman have a vaginal birth, if she simply doesn’t have the strength to go on. Every labor is different. But an epidural also makes it harder for a baby in a bad position to move into a better one, it limits your ability to move, and it requires a lot of other interventions (IV, continuous monitoring, bladder catheter, etc.). Your doula and your independent childbirth class may give you enough natural tools so that you won’t even need the drugs. Most women don’t.

7) Read only the best childbirth books. Get these books, and read them cover-to-cover. Seriously, throw away “What to Expect When You’re Expecting,” and dive into these wonderful books instead.

• “The Official Lamaze Guide: Giving Birth with Confidence,” by Judith Lothian and Charlotte Devries (the book that inspired this blog!)

• “Ina May’s Guide to Childbirth,” by Ina May Gaskin

• “The Thinking Woman’s Guide to a Better Birth,” by Henci Goer (Written in 1999, this book is due for a revision, but it’s still excellent information and routine procedures and hospital technology have not changed much since that time. Henci also runs a helpful Q&A forum on the Lamaze International web site, so you can ask the expert yourself.)

• “Your Best Birth: Know All Your Options, Discover the Natural Choices, and Take Back the Birth Experience,” by Ricki Lake and Abby Epstein (they also offer a great web site and community)

And while you’re at it, buy the DVDs “The Business of Being Born” and “Orgasmic Birth” – they’re even on Netflix. That’s right, I’m recommending “Orgasmic Birth.” Stretch yourself a little!

8) Get your partner on board. It’s hard to do this alone, you need support! Even with the best doula, your partner is still an integral part of your birth journey. Penny Simkin’s book “The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas and All Other Labor Companions” is a great place to start. Be sure your partner attends that independent childbirth class with you – sometimes partners benefit even more than moms from that information and support.

9) Consider an out-of-hospital birth. It’s possible, with the right support, to have a great first birth in the hospital – even a vaginal birth without pain medication. As a doula I see them fairly often, and you should definitely choose the hospital if that’s where you feel safest and most comfortable. But the best research is pretty clear that your odds of a vaginal birth are better outside of the hospital: at home or in a birth center. In 2005 the British Medical Journal published a large study that looked at home births in the United States attended by Certified Professional Midwives. The women who gave birth at home had similar outcomes to low-risk women who had hospital births in terms of safety for moms and babies. But just 3.7 percent of the women who had their babies at home transferred to the hospital for a cesarean, while 19 percent of the low-risk women who had their babies in the hospital ended up with c-sections. The current cesarean rate in the United States is 32.9 percent, according to the Centers for Disease Control. Many studies have shown similar results, which makes out-of-hospital birth at least worth considering.

10) Believe in your body! The cesarean rate for women who birth at The Farm in Tennessee is less than 2 percent. Many industrialized countries around the world have cesarean rates of 15 percent or less. Women have been doing this for millions of years! Your body works. Birth works, in all its complex and wonderful variations. Surround yourself with knowledgeable support, of course, in case you encounter any rare and unexpected complications. But truly… trust your body. Trust birth.

 

Jessica English, CD(DONA), LCCE, is the owner of Birth Kalamazoo, which offers birth and postpartum doula services, natural childbirth and breastfeeding classes, and in-home lactation consults. A DONA-certified birth doula and Lamaze-certified childbirth educator, she teaches an 8-week series of classes called “The Best of Natural Birth.” She is the editor of DONA International’s eDoula newsletter. A longtime writer and business woman, she also works as a consultant for organizations and birth professionals.

 

To VBAC or Not… Deciding My Birth Route

Since I haven’t been around much on Giving Birth with Confidence in the last couple weeks, I feel like I should take a couple moments to explain and share some news. We learned about a month ago that we are expecting our third child. This was a very big shock for our family, but apparently it is the curse of the Lamaze Passion for Birth workshops. Teri Shilling shared with our class, at least one of us would get pregnant in the next calendar year, despite plans not to.

Well I guess I was the lucky one because I am the first one to announce a pregnancy from our class (unless any others are hiding)! Almost instantly after learning the news, the constant exhaustion and then the morning sickness, which is really all day sickness, set in, making me prisoner to my to-do-list and my couch my best friend. I am 9 weeks along now, and started to slightly feel better while trying to tackle everything on my list of important things to get done. At the top of which was a post for this lovely blog!

The dilemma we are facing now is the decision of care, and our essential plan for the birth of our third child. At first I was set on trying for a second VBAC attempt, after having two previous cesarean surgeries. If you don’t already know, you can read about the births of my boys and my work in the cesarean recovery field. After learning more about adhesions, damage that was found during my second cesarean delivery, and speculation about my pelvis, I started to lean toward the option of having a family centered cesarean.

The problem is, we do not have a crystal ball. Depending on who you ask or what study you read, either having a VBA2C or repeat cesarean could be viewed as the safest option for not only my health and well being, but the safety and well being of our child. This fact is making this one of the toughest decisions I have ever had to make. Thankfully, I have months before I need to ultimately come to a final choice on what is best for us.

I am looking forward to sharing my journey with all of the readers here, as well as sharing my research, studies, and other information I come across when looking into the safest of birthing a child after two prior cesarean sections.

Healthy Birth Blog Carnival #6: MotherBaby Edition

We’ve hosted Blog Carnivals for each of the Lamaze Healthy Birth Practices at our sister blog, Science & Sensibility.

This time, we’re bringing our 6th Blog Carnival to Giving Birth with Confidence.  As usual, the bloggers offered up such insightful, thoughtful contributions and I believe yet again that we have one of the best collections on the topic out there on the internet!

Why does keeping moms and babies together after birth matter? Because separating moms and babies is harmful.

Kimmelin Hull at Writing My Way Through Motherhood and Beyond writes:

The research on this issue is crystal clear: babies do better in the first minutes, hours and days, the more time they spend in skin-to-skin contact with their mothers. Their breathing and heart rates remain more stable. Their body temperatures fluctuate less. Ditto for their blood sugar levels. They cry less and they nurse and sleep better, too.”

Danielle at Momotics also reviews the harms of mother-infant separation and suggests that her baby’s 30 hour stay in the NICU for management of blood sugar instability may have been preventable if the hospital had allowed for skin-to-skin contact instead of routine separation. She also points out that skin-to-skin contact exposes newborns to normal bacteria on the mother, which can protect them from getting sick from hospital-acquired bacteria.

All of this just from putting our newborn’s baby against our own? Kristen at Birthing Beautiful Ideas says it simply (and beautifully): Women have superpowers!

Perhaps babies have superpowers, too. The power, that is, to protect their mothers from postpartum depression. Lauren at My Postpartum Voice discusses the amazing health benefits for preterm or low birthweight newborns who experience “Kangaroo Care” — skin-to-skin contact with their mothers in the neonatal intensive care unit. Research also suggests that Kangaroo Care offers protection or relief from postpartum depression. Lauren reports on a study in which no mother developed depression during their Kangaroo Care stay.

Research aside, what about common sense? From the baby’s perspective, the “maternal environment” represents a familiar landscape in which to feel safe and avoid distress (which has well-documented physiological effects.)

Danielle at Informed Parenting describes the moments after birth from the perspective of the baby held skin-to-skin:

Then suddenly he is enveloped in warmth, laying wet and slippery on his mothers chest. He hears it- the beating of his mothers heart. He hears her voice, so clearly for the first time. He knows what he needs and he seeks out that attachment, the physical bond to tie them back together. Little toes flex and dig into his mother soft belly as he wiggles and squirms forward, his little mouth open and questing. The sound of her voice draws him forward. Her arms support him in his journey. In a feat of strength and coordination that is truly amazing he reaches his goal and re-establishes their physical bond. As he suckles her nipple, drops of liquid gold land on his tongue.

Mamapoekie at Authentic Parenting describes a similar scenario, and then contrasts it with the far more common scenario:

You are being pulled away from the one smell and feel you knew to again another entirely different setting. They prick you and it hurts and they rub you down and put stuff in your eyes, it stings even more than the light! You are starting to feel very desperate, very helpless.

From the mother’s perspective, we yearn for closeness with our babies, to take in every detail of their newborn bodies. After all, we’ve worked so hard to grow and give birth to them.

Molly at first the egg writes that while the yearning instinct is deeply primal, yearning is not part of birth when mother and baby are kept together. With gorgeous pictures from her own birth in 1981 and her son’s birth in 2006, Molly shares,

My mother had to yearn for closeness while she fell in love with me. I am so grateful that, twenty-five years later, my newborn and I got to have it.

Kori at Babble.com’s Band On the Diaper Run, who as one-half of the band Mates of State, just hit the road for their summer tour with kids in tow. She shares a powerful testament to the importance of a strong support network to keep her working family together. Her story begins with her yearning for closeness just after her first daughter’s birth:

I shouted across the room, with a strong, primal urge, “Give her to me..I want to hold her..I need to feed her!” Until finally, she was in my arms. I didn’t even recognize my own voice, the words just came out. I needed to have her with me. They really couldn’t ignore me.

And from the family’s perspective, keeping mother and baby together in the hours and days after birth helps them develop a rhythm together and begin to bond and grow as a family. Lauren at Hobo Mama wrote:

Sam, Mikko, and I stayed together from the time we entered our room, three hours prior to the birth, until we all exited as a new family two days later, and it was absolutely the best way I can think of handling it.

boheime at Living Peacefully with Children believes that both birth and bonding are easiest when the mother feels well cared for, and can simply be with her baby to find the right rhythm. She relies on her very willing husband as her primary support for both.

With the birth of each child, he has taken off 2-3 weeks from work in order to cook, clean, and help out however I need him. It’s because of his support that I have been able to focus on getting to know each of our children, establish breastfeeding with them, and not feel as though the entire house has fallen apart.

With so many documented harms from mother-infant separation, not to mention the primal urge for mothers to hold their babies, routine separation of mothers and babies is a mainstay of modern obstetrics, and may give rise to the epidemic of breastfeeding problems.

Sheridan at the Enjoy Birth Blog remarked that her students who have given birth before are among the most surprised that mothers are “allowed” to have their babies with them right after birth. She writes:

It is shocking to me how many moms who are taking my Hypnobabies class for the 3rd or 4th baby and they are amazed that they have the option of keeping the baby on them for an hour or two.

After participating in many hospital births, Carol van der Woude at Aliisa’s Letter also had an awakening about how unnecessary hospital routine are. She describes the first time she saw a home birth:

My wonder at the miracle of birth was renewed. I watched as the baby emerged and the umbilical cord was left intact. The pulsating cord delivered oxygen to the baby as he made the transition to life outside the womb. The baby was placed on the mother’s chest, skin to skin, for warmth. The infant was comforted and stimulated in his mother’s arms.

Lamaze educator Nicole VanWoudenberg who blogs at A Little Bit of This and a Little Bit of That was in fact one of those women who didn’t know about the importance of immediate and close contact after birth until after she had had several babies. She describes her first and last births. After her first birth:

They cleaned her up, weighed and measured her, gave her the vitamin K shot, the eye ointment and whatever else, I was stitched up and approximately 45 minutes later, I got my burrito-baby. Seriously, she was diapered and all wrapped up in towels!! I did not know better, and left her like that while “bonding” with her. Did I have breastfeeding issues? Absolutely. Are the two connected? Absolutely.

For her fourth baby, born at home, she recalls:

I didn’t wait 45 minutes to receive my son. I birthed him and brought him up to my chest, for skin to skin snuggling myself. And there he stayed while we marveled at the wonder of birth, and his appearance! I only let him go while I got out of the pool to birth my placenta. As soon as I was settled on the couch, he was back in my arms, skin to skin – starting to nurse. He breastfed the best, and the longest of all four of my children. Are these two things connected? Absolutely.

Molly at Talk Birth discusses the Birth-Breastfeeding Continuum in her post. She writes:

New mothers, and those who help them, are often left wondering, “Where did breastfeeding go wrong?” All too often the answer is, “during labor and birth.” Interventions during the birthing process are an often overlooked answer to the mystery of how breastfeeding becomes derailed.

Kmom at The Well Rounded Mama reviewed the research surrounding “Baby-Friendly” practices, points to a study that reported only 8% of babies actually experience the six Baby-Friendly practices, and then examines breastfeeding issues in women of size. She writes:

The role of aggressive birth interventions in the lower rate of breastfeeding among obese women typically goes conveniently unexamined in the research. Breastfeeding failure is blamed solely on fatness, when in fact, the high level of interventions in obese pregnancies and births may also play a significant role.

Laura Keegan, author of Breastfeeding with Comfort and Joy writes about the birth stories of women she works with in her practice. “A common theme in all of these stories has been the shock from the denial of contact with their babies or the importance of having that yearned-for close contact at birth,” and asks, “How many breastfeeding problems could be prevented if we facilitated this close contact at birth?”

 

Hobo Mama and her babe.

 

So, why are women and babies separated? Usually for routine care. But it doesn’t have to be that way.

Sheridan at the Enjoy Birth Blog is one of several bloggers who remind us that nurses can do everything they need to do for a healthy baby with the baby in the mother’s arms. She writes, “I understand that nurses have jobs they need to get done, checklists to mark off, but this time is so precious and these routines can wait!”

Fortunately, a new video has just become available to train hospital staff to incorporate skin-to-skin contact after both vaginal and cesarean births. Jeannette Crenshaw reviewed it on Science & Sensibility.

Both sections begin with health professionals teaching pregnant women about immediate skin to skin care prenatally, and on admission to the hospital—which “sets the stage” for immediate skin to skin contact as a normal part of the birth process. After the vaginal birth, the clinician immediately places the baby on mom’s abdomen. After the cesarean birth, the nurse immediately places the baby on mom’s chest, above the sterile field and drapes, as the doctor continues the surgery and the anesthesiologist monitors the mother. The baby’s father is at mom’s side in both segments…Both sections show competent nurses assessing the newborn, providing care, and supporting the mother and baby as the baby moves through the 9 stages of skin to skin.

Also on Science & Sensibility, I discuss a new vital sign for nurses to document after birth, the duration of skin-to-skin contact. I argue that this data may help hospitals comply with new Joint Commission perinatal quality standards.

If hospitals are serious about improving their exclusive breastfeeding rates, they should get serious about measuring the duration of skin-to-skin care. A new study in the Journal of Human Lactation demonstrates a strong dose-response relationship between skin-to-skin care and exclusive breastfeeding at hospital discharge.

The Nurse Blogger at At Your Cervix looks at how weighing babies can be done more humanely, when the time comes (after skin-to-skin contact and breastfeeding). She vows to start weighing newborns in the prone position on soft layers of blankets and states the expected outcome of her new approach:

newborns in the prone position while being weighed, lying on soft blankets, will be more content, with decreased startle reflex, as evidenced by reduced or absent crying.

Let us know how it goes, At Your Cervix!  Or better yet, publish your results!

Dionna at Code Name Mama points out that circumcision is another common reason mother and babies can be separated, and is not medically necessary.

The reason that American medical associations (and the vast majority of medical associations worldwide) do not recommend routine infant circumcision is because it is not medically necessary. And as the Lamaze Healthy Birth Practice Paper #6 details, “experts agree that unless a medical reason exists, healthy mothers and babies shouldn’t be separated after birth or during the early days following birth.” Consequently, unless there is a medical reason to circumcise your newborn son, it is inadvisable to agree to this unnecessary medical procedure.

Cesarean surgery is another major contributor to mother-infant separation after birth. But if this Blog Carnival has achieved anything, it has been to get the blogosphere talking about the fact that skin-to-skin contact is possible immediately after cesarean surgery. A powerful video emerged and was passed around in several of the bloggers’ contributions and on Facebook and Twitter:

Kathy at Woman to Woman Childbirth Education asks, “If you had a C-section, were you able to have your baby put skin-to-skin in the operating room? Did you even know that was a possibility?”

CPN at Cesarean Parent’s Blog got skin-to-skin contact with her baby after her cesarean without even asking for it, and didn’t know what a gift it was until after learning that this is not standard practice. She compares her experience to the typical experience in “reality” TV shows about birth, noting that OR staff do not just separate babies from their mothers for assessments, but for “silly things…, such as having foot prints taken, diapering, and tight swaddling, all before baby gets to meet their mom.”

Birthing Goddess also wrote about the care of mothers and babies after cesarean birth, including the importance of a “Baby Moon” and plenty of support during the longer recovery.

As much as I wish every woman to experience a truly undisturbed and gentle birth, I also know that as of today, close to one out of three women in North America gives birth in the OR. It is up to us to demand things to change for the sake of our children, up to us to bring back a more humane and healthy perspective on birth. Hospital policies can be changed, but the consequences of risky practices for our children can’t. As a community, we can also support our fellow moms who have gone through a difficult birth, help them adjust to motherhood and their new babies, without judging, with compassion and care.

All of these bloggers agreed that, until our system changes, women who want skin-to-skin contact with their babies after cesarean birth need to speak up and ask for it. At Stork Stories…Birth & Breastfeeding, the OB nurse/change agent author writes about how she made immediate skin-to-skin contact happen in the operating room after a mother gave birth by cesarean:

“Give him to me, give him to me! He has to be ON me! You just took him OUT of me, now he HAS TO BE ON ME!” She was literally trying to sit up. Anesthesia was drawing up meds for her (that was his answer). I said “OK here he comes!” So I didn’t ask anyone’s permission this time….. just held that naked baby in one hand, snapped open her gown with the other and helped him move in. I asked for a warm blanket and looked up to see the other nurse and doctor staring at me. I said “Seriously… she’s exactly right, he does belong ON her!”

A system that pits babies’ needs against those of mothers give poor care to both.

Molly at the Citizens for Midwifery Blog muses about the phrase Maternal-Fetal Conflict and discusses the need for terminology that accepts mothers and babies as interdependent:

I think it is fitting to remember that mother and baby dyads are NOT independent of each other. I have written before about the concept of mamatoto–or, motherbaby–the idea that mother and baby are a single psychobiological organism whose needs are in harmony (what’s good for one is good for the other).

The blogger at Thoughtful Birth discusses bonding as an act that involves both the primitive brain and the rational brain, and happens easiest when the birth and postpartum settings facilitate the woman’s integration of the two.

Certainly the ability to override the physical is an amazing skill that allows a woman to overcome a traumatic birth to bond with her baby, or even to bond with an adopted baby. But when we take it for granted that a mother will use her powers of reason to bond with her baby no matter how much we abuse their relationship, we ignore the way the emotional, physical, and spiritual sides of ourselves participate in the birth and bonding process. Pregnancy and labor involve neurochemical and physical changes that make it easier for us to be mothers, and that emotional and hormonal dance does not end with labor.

Michelle at The Parenting Vortex suggests that what happens in the moments right after birth remains a mystery to many pregnant women, but these moments represent a major life transformation for both the woman and the baby, who now become separate but interdependent beings. She writes:

Reforming birth practices in countries where birth has become a highly medicalized event means recognizing birth as a multi-dimensional, life changing event for all members of the family. When birth is recognized and honoured as an emotional, spiritual, transformational AND biological process, then the importance of keeping a new baby and mother together will become more apparent.

Your Questions Answered: What Is a Doula?

Q

I’ve heard a lot about doulas, but I don’t really know what they do and how they can help me during birth — can you provide more information?

A

A doula is a care provider who understands and trusts the normal process of birth. She provides care from the prenatal period through to postpartum. She provides emotional support, such as encouragement, reassurance, and continuous presence for a mom and her partner. She also offers physical support during labor and birth, such as comfort and relaxation measures, and suggesting different positions to facilitate labor. A doula is also a great resource for helping mom and her partner to understand medical tasks, so mom and her partner can make informed decisions.

A doula can be very helpful for you and your partner during your birth experience. The power of labor may surprise you and your partner, so it is helpful to have a knowledgeable person like a doula to reassure you that what is happening is normal. A doula’s presence can relieve anxiety for you and your partner so you can stay home longer and transition easier to your birth place. A doula also can sense when a laboring you need to change positions or when you need a comforting touch. She may also sense when it is beneficial for you to take a walk or a relaxing shower. When you are comfortable and feels well supported by your birth team, your labor may progress more quickly and feel easier.

Doulas stay with you through the whole process of labor and birth and through early postpartum. She also helps guide you through your first breastfeeding. Doulas do not perform any medical tasks, but she will help you understand and be able to explain any medical interventions that may arise. Doulas are there for your continuous emotional and physical support.

Studies have found that with continuous support, like that offered by a doula, laboring women are less likely to have:

  • Cesarean surgery
  • Assisted delivery with vacuum or forceps
  • Epidural or need for other pain medication
  • Dissatisfaction or negative feelings about their childbirth experience

For more information or how to find a Doula for your birth, visit www.dona.org or www.childbirth.org.