A Recent Email

I recently received an email with these questions and comments- and thought it would make a great blog article!

Hi there: I’m just at the beginning stages of considering a doula. I’m giving birth in a local hospital with a doctor . I have a couple of concerns and I was wondering if you could give me your opinion.  I’m thinking about hiring a doula because my mother and sisters don’t live in the United States.

 

We doula mostly in hospitals, although we love supporting women at home births as well. And often folks have family that either does not live close or they do not plan to include for a number of different reasons. Having a doula provides one more set of hands to support and certainly can act as a bit of information guidance along the way. Even with a sister or mother along for support, often women find a doula a wonderful addition to the labor support team.

 

I told my doctor I’d like to try to give birth without an epidural and she asked me if I would also have a root canal without anesthetic- which I wouldn’t. She also said since this is my first baby, it’s more likely to be long and difficult. So now my husband thinks I should have an epidural too. But I don’t want to give birth laying on my back etc. 

 

I do think when a physician makes comments like this, it is important to understand they do not support natural birth. They do not believe in it. And guess what- most endodontists won’t give you anesthesia for a root canal if you are pregnant- the risks are too great. My first labor was my easiest and fastest. A labor does not have to be difficult or long. And if you have the option of an epidural and are making an informed decision, you can choose one if you need one or desire one later. It is fine for your doctor and husband to think you need an epidural- but why don’t you wait till you are in labor to make that decision? It is your birth. Prepare yourself in a way that you have the most options and then decide once you are in labor. I would recommend that your husband attend classes with you so you both are part of that informed decision. And I hope you understand your doctor is not a natural birth supportive physician when they make comments like this. You shared what you wanted and were immediately dismissed for making a foolish decision rather than being supported and then guided to help you succeed in your goal.

 

And if you get an epidural, with the lower half of your body numb, you will more than likely give birth on your back, be told when to push and how, have a catheter to empty your bladder and have a higher chance of an episiotomy or tear and the use of a vacuum to assist in the birth.  There will also be a higher incidence of the use of Pitocin and the risk of a surgical birth being needed. This particular hospital has more than a 1 in 3 chance of a cesarean already.

 

The thing is that I also don’t want a crowded room with a dozen people trying to talk to me and ask me questions. I told my husband that if I could do what I want, I would go in a field with just him and give birth myself. Does the doula have to be in the room all the time and will my husband get pushed out of the way because he’s nervous and he doesn’t know what to do?. And I wonder if it’s weird to have somebody you don’t know very well in the room during a time like that.  

 

You should communicate with your support folks long before labor begins- thus the need to ask a lot of questions should not be happening in active labor. And if you choose to have it quiet and not have conversations, which should be honored. But since you have not been in labor before, leave this option as one you could choose- others may like conversing in labor. But dozens of people would be too many for most women. In a hospital birth there are usually only a few during the actual labor- the nurse visits, your partner is there- with the option of breaks, the doula is there with you with bathroom breaks and occasional meal breaks and the midwife or doctor visit as well. When birth is more imminent the nurse will be staying and a second nurse often joins who is responsible for the newborn.  At any time during your labor you can ask for more privacy and have anyone who you have invited to support you leave and give you that privacy if you so choose.

 

The doula never takes over for the dad if he wants an active role in labor. She is a support person for the couple. We offer lots of contact along the journey of pregnancy to begin a relationship with you in emails, phone calls and your prenatals. But ironically we all have backed up another doula due to an emergency and the couples find an immediate bond with their doulas most of the time.  We are birth professionals and know how to create an environment that is conducive to you being safe in sharing vulnerability.

 

Do you know anything about the nurses in this local hospital? Are they supportive enough that I won’t need a doula? Does the doctor absolutely have to come in if nothing is wrong? I feel like I’m going in to have a heart lung transplant. Where I’m from everyone just has midwives and nurses there for the birth and the doctor comes if there’s a problem. I’ve already been told that that’s not an option  but it would be nice if I didn’t need one. I especially don’t want a male doctor and my OB is part of a group. At the same time, I’m scared to not have a doctor because of the really high rate of problems in the United States.

 

The particular hospital this mom has chosen has the highest cesarean rate in the whole metro area. So it is hard to tell her she will have anything like the birth she desires here especially if she does not have a doula. But nurses are different all the time. Some are supportive of natural birth and others have no experience with supporting a natural birth and do not feel comfortable in being with a mom who is not choosing an epidural. Sometimes it is the luck of the draw. But no hospital has one on one nursing for a laboring mom. Occasionally when they can a VBAC mom may have one nurse assigned to her, but that nurse does not stay in the room supporting her like a doula does. They will not be bringing tools for natural birth- lotion and the use of her hands for massage, massage tools, gentle guided imagery or even facilitate the kind of continuous one on one support a doula does.

 

The nations around the world who have better outcomes than the US include nations whose primary care of a woman in labor is a midwife. If you are looking for a safe, non interventive birth with the best outcomes, you should consider a midwife. They will not be with you continuously either since they may have other moms in labor, but their support is very different from most physicians. In fact often the interventions that are offered in a medicalized births create the outcomes of needing more epidurals and more cesareans. We have some wonderful hospital midwives in the metro area who have wonderfully supportive physician back ups as well. If an emergency was to arise, the physician has already been alerted and is ready to step in- albeit that does not happen often as it is usually not needed.

 

Nurses know how to catch a baby, but if they are not a nurse midwife, it is not considered optional and if the physician is available- or any physician for that matter, it is frowned upon for them to do so. And when you choose a group of physicians for your care, again it is the luck of the draw as to who is on call when you go into labor. The desire to have a particular physician over another is one of the things that lead to so many inductions. But if the induction takes longer than anticipated, you may end up with a different physician anyway. And inductions do lead to many more interventions.

 

I am acting as a doula in the next few months to a woman who wanted a doula the first time. She asked her provider about the use of one. She was told by her care provider that she would not need one. She still considered it but thought it may create animosity if she chose to hire one. She had a cesarean birth after a long unsupportive labor. She chose to change care providers and hire a doula this time in hopes for a better outcome.  If your care provider- midwife or physician feels threatened by having a doula present, you may want to ask yourself whose birth is this anyway? It should be up to the labor woman who she needs and desires to support her in her labor and birth. Choosing a doula with a scope of practice and training is important to helping that doula act in a professional way and not antagonize the care provider.  But your doctor or midwife should not impede your decision to have extra support in your birth.