Check out Kristen Oganowski's VBAC, hypnobirthing, hospital water birth story. Hers was the first water birth at Crouse Hospital in Syracuse, New York. Her birth from the perspective of her doula, Chris Goldman follows Kristen's account. This is a wonderful, inspirational birth story, but even more encouraging are the comments following both articles that indicate hospital waterbirth is on the rise in Central New York.
One of my favorite parts of the article follows. KUDOS to Dr. N, a shining example of what OB's can and should be to birthing women today:
"And then he [Dr. N, Kristen's OB] turned to my nurse and said, "Well, it looks like you aren't getting her out of the tub!" But then he took the time to tell her the following: "Look at how beautifully she's doing. Look at how natural and normal this is. She's pushing on her own, and no one is yelling 'PUSH' in her face; no one is counting for her." And you know what? My nurse started to get really excited about this birth."
Showing posts with label Doulas. Show all posts
Showing posts with label Doulas. Show all posts
4.03.2008
April is Cesarean Awareness month!
Promote Cesarean Awareness and tell a birthing family you love about ICAN and check out their fancy new website!
A friend of mine just had a baby, and the Cesarean rate of the women in her childbirth class was 57%. These were all first time moms who now have the choice between an elective Cesarean and all its attendant risks with their next births, or a VBAC which is increasingly becoming less of an option with many mainstream care providers. Mothers attempting a VBAC face the physical barriers and restrictions in place at many hospitals, as well as the emotional hurdles that come with attempting something widely regarded as "more dangerous" by the medical community and society at large. (for more information on the REAL risk comparison of VBAC vs. repeat Cesarean look here)
This problem is epidemic and it affects us all, whether we are birthing women or not. 57% of women in this class were told they couldn't birth their babies. This is startling, and wrong. It will not stop until we do something to stop it. ACOG is telling us the rising Cesarean rate is due to more overweight and older women getting pregnant and ignoring the other major issues like their own fear of litigation. It's up to us. We cannot know the possible effects that a large Cesarean rate could have on humanity at large. What we do know is that it has the potential to obliterate the confidence and feminine wisdom of an entire generation of women. Women deserve the opportunity to give birth vaginally without fear!
Pregnant women, what can you do to help reduce your risks of Cesarean? This is a short, quick and dirty list. I'll be posting more Cesarean prevention tips throughout April.
A friend of mine just had a baby, and the Cesarean rate of the women in her childbirth class was 57%. These were all first time moms who now have the choice between an elective Cesarean and all its attendant risks with their next births, or a VBAC which is increasingly becoming less of an option with many mainstream care providers. Mothers attempting a VBAC face the physical barriers and restrictions in place at many hospitals, as well as the emotional hurdles that come with attempting something widely regarded as "more dangerous" by the medical community and society at large. (for more information on the REAL risk comparison of VBAC vs. repeat Cesarean look here)
This problem is epidemic and it affects us all, whether we are birthing women or not. 57% of women in this class were told they couldn't birth their babies. This is startling, and wrong. It will not stop until we do something to stop it. ACOG is telling us the rising Cesarean rate is due to more overweight and older women getting pregnant and ignoring the other major issues like their own fear of litigation. It's up to us. We cannot know the possible effects that a large Cesarean rate could have on humanity at large. What we do know is that it has the potential to obliterate the confidence and feminine wisdom of an entire generation of women. Women deserve the opportunity to give birth vaginally without fear!
Pregnant women, what can you do to help reduce your risks of Cesarean? This is a short, quick and dirty list. I'll be posting more Cesarean prevention tips throughout April.
- Consider an out of hospital birth if you are healthy and low-risk. Both birth center and homebirth midwives have dramatically lower Cesarean rates than their hospital counterparts.
- Hire a doula. A doula can help you navigate the childbirth system and teach you how to ask the right questions to decide whether intervention is appropriate or not.
- Read EMPOWERING birth stories. Don't watch "A Baby Story" or shows that focus on "baby emergencies". Try both of Ina May Gaskin's books for a start. Focus on what your body is capable of instead of what can go wrong.
- Take a GOOD childbirth class. Consider an independent instructor. These classes often cost more but they are worth it because you're not going to be fed only what the hospital wants you to know. ALACE and Birthing From Within are organizations to consider.
- Turn that breech and try to prevent the odds of back labor with a well-positioned baby. This offers no guarantees against back labor, babies move throughout labor, but it's healthy to try! Do yoga, and check out Spinning Babies for more tricks and techniques for turning both breeches and posterior babies.
- Stay home until you are in ACTIVE LABOR! Simply getting to the hospital too soon skyrockets your chances of Cesarean. More on how to know "it's time" later...
- Choose your care giver wisely. Ask good questions, and expect them to give you open, honest answers. If you feel like they are being evasive, press harder. Don't put your care giver on a pedestal: you are the ULTIMATE expert on your pregnancy and baby, and they work for you. Don't be afraid to look elsewhere for answers or second opinions. TRUST is essential for a good relationship with your care provider. Another note on care providers: if your OB is known as "THE best C-section doc in town"...there is probably a reason for that. And it is more than likely because s/he performs a lot of them. Find out why.
3.01.2008
The NYT on Doulas
The Fasion & Style section(?!) of the New York Times has a piece on doulas this weekend. If you like headaches, check it out. Tempting as it is to deliver a point-by-point response to the article, I'm going to limit myself to a salient few (below), and instead focus my energies on the very valid question of what, exactly, a doula's scope might be, and offer a few thoughts on why doulas are at the receiving end of so much hostility.
Scope of practice: What the heck is a doula?
A doula provides emotional and physical support for a mother before, during, and after she gives birth. She provides knowledge, resources, comfort measures, advocacy, and suggestions to both the mother and her partner. She doesn't provide any clinical tasks or assessments, make decisions for the mother, speak for the mother, or control the outcome of the labor.
One of the biggest problems in defining the role of a doula is understanding what advocacy means in this role. I think it's vitally important that doulas discuss this with their clients well before the birth to ensure that everyone is on the same page about her role. My personal definition is that I don't speak for the mom, but I will make sure her voice is heard. No one can labor for the mom -- she has to do it herself. Likewise, I believe no one can empower the mother -- she already possesses the power to birth within herself, and all we can do is encourage her, boost her confidence, and do our best to help her feel comfortable (both physically and emotionally). One of my biggest beefs with both doulas and their clients is the very false expectation that a doula can somehow save a woman from her labor or her care provider. (And doulas, just like birth plans, are no substitute for communication with your care provider.)
An independent doula works for the laboring couple, specifically the mother, and no one else. A doula in a hospital-based program works for the hospital, meaning that she may be limited in what she can do or say in ways that an independent doula is not. For example, a hospital-based doula might be obligated by her contract to "report" a woman who eats during labor, while an independent doula would not. Ideally, I firmly believe that the doula should be a bridge between the hospital and the laboring mother, not a wall. However, if I were faced with a hostile nurse (and I never have been, seeing as how I'm awfully charming), I will always come down on the side of supporting the mother's wishes. I am most interested in the parents' satisfaction, though it's nice when everyone's happy! (So are all the other doulas whose thoughts I know on the subject.) And if a case were to arise where the parents' wishes conflicted with each other (say, the dad wants her to be on the fetal monitors continuously, but the mom wants to walk and try new positions), I will support the mother.
So, who determines the role of a doula? As the Times already pointed out, anyone can call herself a doula. ALACE, DONA, and CAPPA are three of the biggest certifying organizations, and they all pretty much define the doula's role in the same way. The differences in the organizations would take its own post to explore, but I'd say overall ALACE is the least discouraging of its doulas taking on additional roles, such as becoming a monitrice and checking dilation and fetal heart tones , as long as they understand that they need training beyond the scope of a 3-day doula workshop to do so.
Being a doula isn't rocket science, but I think that training and certifying with the above, or any other fine doula organization, is a good thing. For one thing, saying, "I'm a DONA doula," or "I'm an ALACE doula," means something. A potential client can learn what that organization stands for and make some assumptions from there. I also think that it lends credence to a doula's role as a professional to have some sort of formal training. Finally, I think clients deserve to have recourse if their doula is unsatisfactory, especially if she attempts to perform way beyond the normal boundaries of her role.
Shorter labors, fewer interventions (including cesarean), increased satisfaction... What's not to love?
Often, the doula is the scapegoat for anyone who was dissatisfied with the way a birth played out, whether it's a nurse who had to accommodate intermittent monitoring, or a mother whose birth didn't go as she had planned. Remember, having a doula doesn't guarantee a certain type of birth; also, just because a laboring mom who has a doula is declining cervical checks, that doesn't mean it's the doula's doing!
I'd be remiss in my bloggy duty if I didn't also address the fact that many doulas do step far from the cozy confines of their scope of practice. I have read things on message boards (told by the doulas themselves) that make me extremely nervous for their clients and for the fate of doulas overall. I can easily understand why an OB would feel angry towards a doula who, for example, is dosing the patient with herbs during labor or attempting to cut off conversation about options for managing a complication.
But for the most part, I think the hostility towards doulas stems from the fact that they tend to make things a little harder for doctors and nurses. Supporting women's choices, even when it goes against the standard protocol, is one of the most valuable things doulas do. So if a doula's presence gives a laboring mom the extra support to resist Pitocin, to spend time off the monitors, or the idea to try pushing upright, the good that does the mother is beyond measure. However, the hassle for other care providers may be quite quantifiable: extra hours, extra paperwork, extra explaining to higher-ups of why this labor was handled the way it was. I'd love to hear from some actual hospital L&D folks on this, though. Anyone?
---
And now, a few responses to the article. First of all, I commend the Times for pointing out that not everyone who bills themselves as a lactation consultant is an International Board Certified Lactation Consultant (IBCLC), which is a highly-trained, experienced medical professional. Folks, you don't have to have any letters after your name to give good breastfeeding advice, but if a new mother is having serious trouble, she needs to be aware that the "lactation specialist" nurse who comes to see her in the postpartum recovery room might not actually know that much about breastfeeding. Hospitals (and all care providers) must start being more transparent about their breastfeeding support.
That said...
Scope of practice: What the heck is a doula?
A doula provides emotional and physical support for a mother before, during, and after she gives birth. She provides knowledge, resources, comfort measures, advocacy, and suggestions to both the mother and her partner. She doesn't provide any clinical tasks or assessments, make decisions for the mother, speak for the mother, or control the outcome of the labor.
One of the biggest problems in defining the role of a doula is understanding what advocacy means in this role. I think it's vitally important that doulas discuss this with their clients well before the birth to ensure that everyone is on the same page about her role. My personal definition is that I don't speak for the mom, but I will make sure her voice is heard. No one can labor for the mom -- she has to do it herself. Likewise, I believe no one can empower the mother -- she already possesses the power to birth within herself, and all we can do is encourage her, boost her confidence, and do our best to help her feel comfortable (both physically and emotionally). One of my biggest beefs with both doulas and their clients is the very false expectation that a doula can somehow save a woman from her labor or her care provider. (And doulas, just like birth plans, are no substitute for communication with your care provider.)
An independent doula works for the laboring couple, specifically the mother, and no one else. A doula in a hospital-based program works for the hospital, meaning that she may be limited in what she can do or say in ways that an independent doula is not. For example, a hospital-based doula might be obligated by her contract to "report" a woman who eats during labor, while an independent doula would not. Ideally, I firmly believe that the doula should be a bridge between the hospital and the laboring mother, not a wall. However, if I were faced with a hostile nurse (and I never have been, seeing as how I'm awfully charming), I will always come down on the side of supporting the mother's wishes. I am most interested in the parents' satisfaction, though it's nice when everyone's happy! (So are all the other doulas whose thoughts I know on the subject.) And if a case were to arise where the parents' wishes conflicted with each other (say, the dad wants her to be on the fetal monitors continuously, but the mom wants to walk and try new positions), I will support the mother.
So, who determines the role of a doula? As the Times already pointed out, anyone can call herself a doula. ALACE, DONA, and CAPPA are three of the biggest certifying organizations, and they all pretty much define the doula's role in the same way. The differences in the organizations would take its own post to explore, but I'd say overall ALACE is the least discouraging of its doulas taking on additional roles, such as becoming a monitrice and checking dilation and fetal heart tones , as long as they understand that they need training beyond the scope of a 3-day doula workshop to do so.
Being a doula isn't rocket science, but I think that training and certifying with the above, or any other fine doula organization, is a good thing. For one thing, saying, "I'm a DONA doula," or "I'm an ALACE doula," means something. A potential client can learn what that organization stands for and make some assumptions from there. I also think that it lends credence to a doula's role as a professional to have some sort of formal training. Finally, I think clients deserve to have recourse if their doula is unsatisfactory, especially if she attempts to perform way beyond the normal boundaries of her role.
Shorter labors, fewer interventions (including cesarean), increased satisfaction... What's not to love?
Often, the doula is the scapegoat for anyone who was dissatisfied with the way a birth played out, whether it's a nurse who had to accommodate intermittent monitoring, or a mother whose birth didn't go as she had planned. Remember, having a doula doesn't guarantee a certain type of birth; also, just because a laboring mom who has a doula is declining cervical checks, that doesn't mean it's the doula's doing!
I'd be remiss in my bloggy duty if I didn't also address the fact that many doulas do step far from the cozy confines of their scope of practice. I have read things on message boards (told by the doulas themselves) that make me extremely nervous for their clients and for the fate of doulas overall. I can easily understand why an OB would feel angry towards a doula who, for example, is dosing the patient with herbs during labor or attempting to cut off conversation about options for managing a complication.
But for the most part, I think the hostility towards doulas stems from the fact that they tend to make things a little harder for doctors and nurses. Supporting women's choices, even when it goes against the standard protocol, is one of the most valuable things doulas do. So if a doula's presence gives a laboring mom the extra support to resist Pitocin, to spend time off the monitors, or the idea to try pushing upright, the good that does the mother is beyond measure. However, the hassle for other care providers may be quite quantifiable: extra hours, extra paperwork, extra explaining to higher-ups of why this labor was handled the way it was. I'd love to hear from some actual hospital L&D folks on this, though. Anyone?
---
And now, a few responses to the article. First of all, I commend the Times for pointing out that not everyone who bills themselves as a lactation consultant is an International Board Certified Lactation Consultant (IBCLC), which is a highly-trained, experienced medical professional. Folks, you don't have to have any letters after your name to give good breastfeeding advice, but if a new mother is having serious trouble, she needs to be aware that the "lactation specialist" nurse who comes to see her in the postpartum recovery room might not actually know that much about breastfeeding. Hospitals (and all care providers) must start being more transparent about their breastfeeding support.
That said...
- Using a photo of a doula seemingly palpating a pregnant client's belly for the accompanying image... Why? Not that that is terrible or outside the scope of what is appropriate for a doula to do, but it almost seems like the editors are saying, "Look, here's a doula who thinks she's a midwife or something!"
- Why throw in lactation consultants along with doulas? The fields are related, but their roles are very different. The article seems to have an agenda of "exposing" the bad behavior/advice of a small percentage of these practitioners. Which leads me to my final gripe:
- I think, ultimately, few hospital-based birth professionals (and certainly not the author of this piece) understand the role of a doula. They may see the doula talking a woman out of an epidural and perceive that the doula is bullying her client. But often, she is simply fulfilling the role she was hired to perform. The doula Pamela Myers hired was perfectly within her scope to recommend avoiding IV fluids (as long as the mother hydrated in another way like, say, drinking water!), and firmly recommending a shower or bath is a time-tested method of pain relief.
Walking out on a client who accepts an epidural is, obviously, very poor form. However, the article admits, "In an era of nurse shortages and high Caesarean rates, doulas and lactation consultants can be godsends for many women. Indeed, multiple studies show that a doula’s presence during childbirth leads to shorter labor, less medical intervention and a happier experience." And then adds, "[F]ew women readily admit to doula discord." What, then, is the point of this article?
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