Tuesday, July 19, 2011

All Eventualities

So, I think I've mentioned a couple of times that I'm working through the required reading part of my doula training over the summer, right? And that in the fall I'm going to attend my various classes/workshops, and then right afterwards I have my first birth lined up? (!!) I'm very excited for the workshop part. VERY. I would have done it a lot sooner but it's a pretty intensive three day process, and you aren't allowed to bring babies older than six months to the sessions. AAAAAND even if I were allowed, I sure as heck WOULDN'T be bringing my wriggling, squirming, teething, not exactly crawling but sure not staying in one place, either, almost ten month old into a classroom of any sort. So, I'll be going in November, when Jameson will (oh pleaseohpleaseohpleaseohplease) be sleeping through the night, and probably only nursing in the morning and evening; i.e., missing me less AND on a schedule that won't require me to be running back to my room to pump every few hours.

Anyhoo. Long winded introduction to the thing rattling around my brain when I woke up this morning, which was what exactly my goals as a doula are. One of the books I've been reading lately (not actually required but I'm reading anything I can get my hands on right now, basically) is called The Doula Advantage, and something it talks a lot about is finding the right doula for you. Some doulas have a certain agenda, albeit unspoken and probably even unacknowledged in their own minds, of getting all of "their" moms through labor medication and intervention free. That is, it is a failure on the DOULA'S part if the mom ends up needing or wanting either of those things, so she has motivation that goes beyond simply trying to support the laboring mother's wishes.

This, obviously, is a problem, or at least is a problem if the laboring mother's wishes happen to differ from the doula's. It is especially a problem if the laboring mother's needs change during labor but the doula is not sensitive or respectful to that due to some prior dedication to an ideal of "natural" childbirth. Most doula clients, probably, go into childbirth hoping to avoid medication, but in some cases even the most passionate normal/natural labor advocates will admit an epidural (or a sedative or a shot of Stadol or whatever) can be the difference between a vaginal birth and a c section simply for lack of progress brought on by exhaustion. A dedication to drug-free labor at all costs is an unhealthy and unprofessional mindset for a doula. One of the things The Doula Advantage really stresses is that the job of the doula is to support, empower, reassure and inform the mother, but not to impose the doula's own opinions or preferences on her at any point.

It also talks about how a doula's presence at an epidural or c-section birth can actually be just as important as at a vaginal, drug free delivery, if not more so! Since most doula clients aren't planning for either of those things, they might be upset, feel stressed or confused, and, at a vaginal delivery, need a lot more coaching during the pushing stage if they are still numb enough not to feel the natural urge to push. A c section, especially first time and unplanned, can be very alarming to both parents, but a doula who has experienced this before (or at least studied it extensively) can be a very calming presence for both mom and dad.

This was something I hadn't really considered before, that a doula can be just as useful at a birth with interventions as during a completely drug free labor. This makes me really happy, because the birth I'm scheduled to attend is for a mom in her thirties, who hasn't given birth in almost fourteen years and who I know experienced a long labor the first time around and was quite happy with her epidural decision. Her doctor has told her that since it's been so long in between births, and since she's at an advanced maternal age (worst term ever!), her body may very well handle this baby just like a first baby and that labor may be long/difficult. (I have my own thoughts about practically setting someone up to dread their labor with all this negative talk, but whatevs.) The point is, I think she may be planning on an epidural at this point, and it's nice to know that whatever she decides, I can still offer support and information.

Having had a doula myself, twice, I certainly know what was helpful for me during unmedicated labors and births. When thinking back on the boys' births, these are the things I feel our doula did for me: helped me go over, out loud and on paper, any specific wishes we had re: hospital policy; encouraged me to visualize and discuss ways in which I hoped to cope with labor pain and how I hoped to be supported by Jim and Stacy; during the birth, with massage, counter pressure, company during a long, restless night when I wanted the rest of my "team" to be resting up to help me later (!), aromatherapy when I felt nauseous, reminders to eat, drink, and rest, music (she brought her ipod and speakers,) discussion about pros/cons when we were deciding when and if to have my water broke, position suggestions as we tried to rotate a sideways baby, and then a lot of verbal reassurance during a fairly rapid transition/descent stage, and gentle reminders about staying loose and opening my pelvis during pushing. This was really helpful since pushing is generally the roughest part for me, mentally, and I always go through this little stage of physically resisting it and trying to fight it back.

So now I at least have my own experiences to go on in terms of what was helpful for me, what I might have liked even more of, in retrospect, and also what was helpful/what wasn't so helpful at other births I've witnessed. What I'm hoping you all can tell me is what YOU would have found helpful if you had had a doula present with you for labor (including how you think a doula might have helped other people there supporting you.) Or, of course, what you DID like/didn't like if you did in fact have a doula. I'm especially interested in how your doula supported and helped you if you chose drugs/interventions right from the start, or how she helped you if you hadn't wanted those things but ended up choosing or needing them.


Tracy said...

I loved that book. Honestly, loved it. It's hard to find a doula around here who isn't very pro-natural childbirth. I mean, you probably aren't going to training to be a doula unless you have *some* interest in intervention free births. HOwever, I tend to lean towards letting the mom be the guide. I had 3 epidurals myself, a c/s and 2 vbacs. I know, personally, the emotions that come with a lot of different situations. Long labors are hard on a mom, and sometimes epidurals are what makes the birth more pleasent- during the birth and the memory after. Anyway, I'm rambling. lol. It's a good book. ;)

Nik-Nak said...

I think a Doula could be very helpful in ANY situation. For example: My husband, mom, and sister were present for my daughter's birth. Now my husband did the best he could but he isn't a very emotional person by nature and most of the birth was spent with him looking wide eyed in the direction of the midwife waiting for someone to tell him something to do. My sister was filming and my mom was alternating between putting cold rags on my head and being overcomed with joy at the experience. So as you can imagine, I dind't have much encouragement. Not to say that I had a bad experience, I have an epi, everything went well and I was pleased. BUT did I miss having someone there to say Hey, you're doing a great job, keep it up, breathe like this? Yes, I did. I think had I had a Doula there, even if she was simply my own personal cheerleader, would have been awesome. So I think there are all kinds of situations where that could come in handy.

Swistle said...

Oh, what an interesting thing to think about!

Over the years, Paul and I have considered whether we might like to do some traveling someday. And I gradually realized that the ONLY way I want to START is by going with one of those tour groups some travelers consider cheesy and inauthentic---because when I'm doing something new to me, what I want is a guide. I want someone who speaks the language and can translate for me if necessary; I want someone who is knowledgeable about the area and can say "This is what most people like to do; this is what some people like to do; this is what you could do if you liked x or y or z," etc.

So that is what I would have wanted from a doula. I had one labor followed by a c-section; then three scheduled c-sections. By the third scheduled c-section I felt totally comfortable: I knew everything to expect, I knew how long I'd end up waiting for this or that, I knew what order things would go in, I knew when they'd take the catheter out, I knew when I could expect to stand up, I knew when I could expect to shower, I knew how to order food, etc. But before that, I would have LOVED to have someone with me who could have said, "Okay! Here's the order things will go in! It's normal to wait about ___ minutes past the time you expect! Now you'll probably feel ____! What the nurse means by that is _____. Now we're just waiting for the pediatrician's nurse. Now you'll be in recovery for about ____ minutes, or until they've established that you're this, that, and this."

ETC. I spent so much time during my labor and scheduled c-sections thinking, "Is this normal? Am I supposed to be _____? She just said to ____, but could I do ____ instead if I just asked? Am I allowed to open that cabinet? Can I just start the tub, or do I have to ask? What is that beeping sound? Is this when I'm supposed to be doing the hee-hee breathing, or is it too early for that? She said I should lie on my side, but I thought I was supposed to be walking around---is this one of those ADVOCATE YOUR BIRTH!! moments, or is it that I had pitocin and so now they need to monitor me? What does that word mean? Who are all these people in the operating room?"

I mean, sure, I could/should have asked nurses, and I often DID, but nurses are often in a hurry, and also sometimes I had questions that would SOUND confrontational (because of being normally asked in a confrontational way) but I didn't mean them confrontationally and didn't know how to communicate that, and sometimes I didn't even realize there was an option (like that there was a birthing ball in a cabinet, or that I was allowed to leave my room). And sometimes I just needed someone to say, "They say the anesthesiologist will be here 'in a minute,' but it's typically an hour or more."

I would want someone who was familiar with hospital protocol, both the kind that's spelled out ("We don't give pacifiers in the nursery unless requested by the parent") and the kind that's not (They don't give pacifiers unless you ask, because they've gotten so much flak for it). I would also want someone who knew things like when is it appropriate to use the nurse-call button, and when should you just go out to the desk in person. I would also want someone to hold my hand, put a hand on my shoulder, etc.: there was a medical student who did that before/during my last c-section, and I could not BELIEVE how much it improved things---even though I am not a touch-oriented person and would have THOUGHT I wouldn't be helped by it.

Nowheymama said...

SO many thoughts, but off the top of my head: My sister was present at all four of my births, and it was so wonderful to have her there, even though she is 10 years younger than me and hasn't given birth. (YET.) She was such a great support to Scott and me.

It was especially helpful and calming to have her with us during my unplanned c-section. I REALLY hated not being able to hold the baby right away, and I wanted ONE of his parents to hold him, but of course Scott wanted to help me. With my sister there, she was able to hold my hand/arm and talk me down during the stitching up, etc, while Scott held the baby where I could see him. If it had been just Scott trying to comfort me *and* hold the baby like I wanted, it would have been very rough. I can see where a doula could provide the same support/help/calming influence.

Scottish Twins said...

I personally wouldn't have found a doula helpful during my medicated birth. To me, it would have been a waste of money, but maybe that's because I had enough support there. I could see a mother without support wanting another woman there to help her through everything. I also had a midwife who was there through most of it, so maybe a woman with an OB who just rushes in for the final pushes might be comforted having a doula there.

I do think, however, that if I would have had a doula there for birth #1, I wouldn't have ended up with the epidural. But that's a different story.

We've talked ad nauseum about doula expieriences before, so you know what I would say about my birth with the doula present.

I agree with everything you wrote about empowering women to have the birth of their choice. I get really upset when women who are very pro-birth try to talk down to women who chose interventions. I've had three very different births and I am happy that I have those choices. I guess instead of being pro-natural birth I should calssify myself as pro-choice (probably the only time I will ever say that ;) I want to be able to have my baby at home without anyone standing in my way, just as another women should have the right to have her elective induction/c-section without anyone standing in her way.

You just reminded me that I have a stack of documentaries to give you.

d e v a n said...

My husband was actually pretty good, but my 3rd labor, and part of my 4th, where I had another support person (Tracy) it was helpful for a couple of reasons.
She reminded me how to breathe, especially during my drug free birth. She kept me company. My husband is NOT a conversationalist, by any means. She took pictures - something my husband does NOT DO EVER.
I guess it was just nice having another person there, asking if I was OK and willing to do something about it without me having to think of asking.

CAQuincy said...

I wish I had had a doula for my first birth because I was scared and confused towards the end, and really, my husband wasn't much help. The poor guy was just as confused and scared as I was and couldn't understand my frantic sign language (as I was in too much pain to talk). And my doctor! No help AT ALL! We had no idea what was going on.

It would have been nice to have someone there to coach me through my breathing techniques (um, who KNEW what techniques were needed when), and someone to actually explain to me WHY the room swarmed full of people out of the blue after they broke my water at 8cm. And maybe tell me WHY the doctor had a panicked look on her face. I am thinking that possibly an episiotomy could have been avoided if I understood a little better what was going on.

My next two births were so "easy" (partly because I knew what to expect) that I wouldn't have needed a doula.

Parkingathome said...

I never even considered a doula, because they have always seemed like they didn't give two shits about anythong but their own agenda. It always seemed that if I wanted an epidural or god forbid need a c-section, theyd laugh and call me weak. What I needed wad someone saying, "lets chrck that blood pressure again in a few minutes before ordering an ultrasound, shes very angry that she had to wait two hours to be seen for her scheduled appointment." And then, "you can only see low fluid in one of four quadrents? Thats no reason for induction when the baby is in distress." And then, "its been two days, give her the damn c-section BEFORE she starts vomiting stomach acid." Or even just someone kind who would explain things further, ask questions for me, and tell me that I could get out of bed. I asked hubs to advocate for me, make sure everyone had seen my birth plan, etc. and he did the best he could, but he knew less than me, and I was so alone. I wish I had known that there was such a thing as a true mother advocate instead of a scary bitch telling me I sucked because I couldnt talk my cervix into dialating beyond a 5 after 40 hours. Its a shame so many first births are so bad and scary and confusing all because a few women made doula a bad and scary and confusing word.

Parkingathome said...

Omg sorry so many errors...new phone. That would also be "the baby ISN'T in distress" eesh