Wednesday, September 21, 2011

What do you do during labor?

Short Answer: Whatever you need me to do!

Long Answer: You may be wondering, "Is it really worth it? Do I really need a doula? I know what a doula is, but what does a doula do? What do you do? Can you really help me? After all, you're new at this."

Ultimately, only you can answer those questions, and sometimes it isn't until after the fact that you find out whether or not you really need a doula. Hopefully it's a good response of, "Man! I am so glad I had a doula!" And yes, I really can help you- even though I am new. I am learning all the time, and I learn and improve at each and every birth I attend. Yes, experience is very helpful in a doula, but it really is about having a person there with whom you feel a connection. You want your doula to be someone that you feel comfortable sharing this experience with and someone you feel good about. Of course, it never hurts that most newer doulas charge a significantly lower fee than more experienced doulas.

So, back to the question, "What do you do?" Most of our preparation for labor occurs at our prenatal visits. At the second prenatal visit, I show clients everything that I have in my doula bag that we could possibly use during labor. We also practice labor positions, and in the course of our journey together prenatally, I try to get a general sense of the family's ideal birth. One of the homework assignments (yes, I give out homework) I give to Mom is to have her ponder how she would like her birth to go, i.e. what location, what positions, what time of day, who would she like present, what tools would she like to use, etc. Usually when I ask, "How would you like your birth to go?" I get the response, "FAST!" Well, there is more to it than that! Although one of the perks of having a doula present is a shorter labor, I can't guarantee that your labor will go as fast as you would like. Also, just because a labor is FAST doesn't mean it is easier. But that is another story for another day.

I like to have mom get an image in her head. Of course we don't have control over every aspect of how our labors will go, but I still like to have her imagine her dream birth as if she could hand pick the experience. For example, a mom may ideally want to give birth in the ocean at night, but she may have a hospital birth in the middle of the day. However, having that image in her head can give her a scene to focus on while she is in labor. Even though I may not be able to bring the ocean to her, we can make sure that she has access to water. If she really likes the dark, we can make sure to turn the lights out. If she wants a cozy, quiet, intimate environment, we can accommodate her wishes. My goal is to try to help mom get as close to her ideal birth as possible, and we discuss ways we can make it work in the setting in which she wishes to give birth, whether it is home, birth center or hospital.

I tell my moms that, so far, typically, the only tools I have used are my hands, my voice and a cool washcloth. I have many more items in my bag than that, but the births I have attended have gone by so quickly, I never had a chance to use most of my tools.

One mom enjoyed sitting on the birth ball and talking with her family during early labor. At that time, I participated in their light-hearted conversations as much as they seemed to want me to. When labor started to pick up and take her attention, most of the family left the room and/or slept (I don't know how they did) through her contractions. It was just me and mom. We vocalized together, I rubbed her back where she was feeling pain, I held her tightly when she wanted that and when she called out for her family members that were in the room, I woke them up for her.

Another mom had a beautiful home birth and I tried to do all the "little things" that needed to be done so that her husband could be her main source of support like they both wanted. At one point, every time she would begin a contraction, the husband would run off to try to do something. As her contraction would begin I would say, "Here comes another one." After a few contractions, he realized that he needed to stay where he was when I said that. After that, he never left her side and I fetched all the things that he needed to comfort her.

Another mom liked using the rebozo around her belly during contractions while we labored at home. She liked the feeling of having that secure pressure around her belly. After awhile she used the birth ball while I provided counter pressure to her back. At some point she really wanted some mood music. Immediately upon her request, I opened my Pandora app and provided some mood music. Yes, I even have a folder on my iPhone called "Doula Bag" with various apps to help comfort mom. For awhile it was just me and mom as dad bustled around trying to get everything ready for the trip to the hospital. Once we arrived at the hospital, she used the birth tub and I would provide sips of water as needed and vocalize with her. Dad sometimes needed to walk away during the birth, so I was there to provide him relief.

Last example, I had a mom who merely wanted my presence. I provided her with a cool cloth and waved it over her face with some essential oils dabbed on the cloth to provide a little aromatherapy. She was the first mom who wanted me to do that and I was excited to try it. Her birth was a classic example of a doula's presence being a calming influence to the birth environment. Once I arrived, both she and her husband relaxed into the task of giving birth to their baby. It was wonderful.

As you can see, all the moms wanted and needed something a little different to help them throughout their labors. However, each mom had something in common, and that is, they all had me as their doula and I never left them. They were never left alone. Even if I had to step out for a minute, it was only when their husbands, partners or other family members were present. A couple of the moms would have been completely alone for a good portion of their labors had I not been present, and for the others, I helped relieve the dads so they could focus more on their partners. For these moms, they were happy with their decision to have a doula present.

Thursday, September 1, 2011

My first VBAC birth

I've debated whether or not I would share the birth stories of those whose births I attend on this page, but this birth story is so exciting! I was too inspired not to share. I can't wait to hear it from Mom's point of view. Enjoy!

What a beautiful and inspirational birth story I have to share! I met this couple for the first time about two months ago and I have enjoyed getting to know them as they prepared for this birth. Mom had a cesarean with her twins about two years ago, and I just knew that this birth was going to be great! I could tell by her determination and all the research and work that she was doing that this was going to be a wonderful experience for her and for me too. I was honored to be a part of this special day.

Mom called me at 12:06 am to let me know that her membranes ruptured, but she was not yet having contractions. We talked for a minute, and she decided she was going to take her time and try to get some rest. I attempted to do the same. Of course I tried in vain! I went to my baby's room for a little while to snuggle with her and that seemed to help calm me down, but I just could not fall into a deep sleep. I had a feeling that things would be pretty fast once they started going because she had been 4-5 cm dilated for at least the past week, and she also had a feeling things would progress quickly. She was worried that her birth wouldn't count towards my certification because she was already 4 cm dilated before labor even began and I assured her not to worry about that! I told her I am doing this for a living and not just to get a few births for certification and be done with it. I am honored to be there! Little did I know at the time what a truly amazing experience this would be.

She called again at 4:19 am to let me know that they made it to the hospital and that she was ready for me. I quickly brushed my teeth, changed clothes, packed my bags and drove the nearly one hour drive to the hospital. I made it to the hospital, checked in, went through security and made it to her room a little before 5:30 am. The lights were dim and everything was quiet and serene. It was just her and her husband at that time. They quickly showed me what he was doing to help her cope and I helped them out. Dad was able to sit for a few minutes and get a little break. He was doing so great! She was already at 8 cm when I arrived. Wow!

After a little while, Mom asked what we could do to relieve some of the back pain, so we had her move to her side. She was reclining on her back a little. Moving to her side made the contractions quite a bit stronger, but we had better access to apply counter pressure to her back as she needed it. I helped her with her vocalizations and we focused on relaxing a certain body part during each rush. Sometimes it was her shoulders, the next her neck, the next her jaw. Just one part at a time. She did so beautifully. I say I helped with her vocalizations, but she barely made any sounds at all!

Just an aside, I have a hard time filling out my certification paperwork as it is during a birth. I am pretty busy helping mom! This time was pretty liberating not to have to worry about filling out this or that form or worry about getting a doctor I never met to fill out a form when he didn't really see me in action. I could focus completely on mom and dad and the labor.

I finally had a chance to break out my essential oils! I applied cool cloths to her forehead and put a few drops of lavender to help her relax during labor. I would wave the cloth as a cool breeze too, which helped her be able to smell the oils. Dad told me that the doctor was supposed to arrive between 6-7 am. With the way she was progressing, they were a little bit worried. I teased Dad, "Well, YOU'RE here to catch the baby if he decides to come before the doctor!" It was halfway a joke because he really WAS planning to catch the baby.

As promised, the OB arrived about 6:15 am. I was impressed with him for two reasons. First, he arrived when he said he would! Second, he introduced himself to me and was so kind and gracious. I really appreciated that.

It became somewhat a flurry after that. The doctor wanted to have her checked. The nurse was trying to rush her somewhat, but I would whisper to her, "Take your time! Take your time! When you are ready, you can tell them when you are ready for them to check you." She did a great job with commanding respect of her body, and I was so very impressed and proud of her. However, I was also impressed that the staff graciously obeyed her wishes. Once they realized how much she was in control, they really worked with her. I loved that.

The doctor checked her and she was complete. They helped her try to push to see how the baby would handle it. According to the doctor, Baby did not seem to like that push, and he asked that she labor down for a little while. She was really having a hard time NOT pushing as she was feeling the urge. The nurse worked with her more actively to help her not push. Dad and I helped her stay comfortable with a cool cloth, encouragement and counter pressure. I was able to whip out the lemon essential oil to help energize her for pushing. Very cool.

After just a few contractions, the doctor came back and she began pushing. She did great! After 27 minutes of pushing, her sweet baby boy was born at 6:48 am! Daddy caught the baby! It was such a beautiful moment for that sweet family, with tears running down Dad's face and the most elated and joyful expression on Mom's. She did it!

Dad was able to place Baby immediately on mom's chest, with a little guidance from the staff, which was so wonderful! He was in such awe and shock. What a beautiful time for that family and such a pleasure, honor and joy to be able to witness this inspirational birth!

Congratulations to Mom for having a beautiful and successful unmedicated VBAC birth! I am so proud of you!