A Gentle Birth Pie

I wrote this initially in 2013 but feel it needs to be back at the top of our blog. So often folks come to our Mingles to meet us and say that they want to avoid a cesarean. Yet they are choosing a hospital where the cesarean rate is over 40%. They do not plan to take classes or they plan for a hospital based class or a one day abbreviated one. Please realize that today with the high levels of intervention, you have to do a lot of things to avoid the interventions that lead you to the OR. There are lots of ingredients that go into making a gentle birth pie:

Provider
1. Your gynecologist may not be the best one for your pregnancy care- well woman care vs pregnancy and birth care
2. Communication goes both ways- can you discuss things and be heard and feel listened to now?
3. Back up is important- who covers what- do they share call- will you get to meet them beforehand?
4. Midwifery model vs the medical model of care=What do most women choose? Obstetricians are by far the most common choice in the United States, although certified nurse-midwives are becoming more popular: In 2006, CNMs attended almost 8 percent of deliveries in the United States and over 11 percent of vaginal births. provide handout
5. CIMS questions to ask
6. Marriage – then date- can lead to divorce- when is it too late? Don’t stay where the rules of the games are different than the game you want to play.

“Midwives see birth as a miracle and only mess with it if there’s a problem; doctors see birth as a problem and if they don’t mess with it, it’s a miracle!” Barbara Harper in Gentle Birth Choices

“Unfortunately, the role of obstetrics has never been to help women give birth. There is a big difference between the medical discipline we call “obstetrics’ and something completely different, the art of midwifery. If we want to find safe alternatives to obstetrics, we must rediscover midwifery. To rediscover midwifery is the same as giving back childbirth to women. And imagine the future if surgical teams were at the service of the midwives and the women instead of controlling them.” Michel Odent, MD

“When meeting with my OB, I described—in a light way—the feeling I had about the baby telling me he was coming out vaginally. Unfortunately, this kind of thing does not provide confidence to everyone in the medical community! And much to my dismay, they wanted to schedule me for a C-Section, just like that. Thankfully, at least one very important local midwife did believe me and believe in me (and my baby). She encouraged me to do what I needed and go where I needed to get my try at a VBAC. “– Jenna’s story

“Switching practices mid-pregnancy was perhaps the best decision we have made. Last week I was so fed up with being pregnant that I just about begged her to induce me. Had I stayed with my old practice, they would have scheduled a date right then. But not Janet. She just calmly reminded me that no one stays pregnant forever and that my baby would come when she was ready. She talked through natural things we could do to help get labor started and walked us through what would happen if she doesn’t come by 41 weeks.

As we left her office I turned to D and said, “We picked her for a reason. I don’t really want to be induced. But I was desperate. And instead of letting me cave to my uncomfortableness, she talked me out of it. Gently. I’m thankful for that.” She has been a rock for me during the last half of my pregnancy. I’d recommend her to anyone. {This is Janet Fedullo with Alpharetta Women’s Specialists}”- Chrystal Rowe from the blog (more…)

How to Choose a Doula

doula bierman

You know your girlfriend may have loved a particular doulas, but that does not mean she is perfect for you.

You know your midwife or doctor may suggest a particular doula, but that does not mean she is the right choice for you.

You will know who is the best doula for you if you do a few things:

Read their bios on the website
Give the doulas you are drawn to a call and chat a bit
Come to the Mingle to meet them all in person
Or set up an interview if you did not make the mingle with the ones you feel may be a good fit
Sit and be mindful of which doula you are most drawn to- and hire her!

So many times a woman will tell me about herself and ask me to tell her who would be the best fit.

I do not presume to know who is the best doula for you. I believe you will be able to figure that out for yourself.

I think you will not go wrong with any of our doulas. We are all very different in personality and experience. But we are all the same in regards to our hearts for birth and families. We all offer the same services as doulas.

So trust your instincts and heart when choosing a doula who is the best fit for you!

What Makes Us Different?

When Labor of Love Doula and Childbirth Services began as a group almost two decades ago, we were the ONLY group in town. Now there are several groups.

But how are we different in terms of our group in the area of labor doulas?

1. We are a true mentoring- apprenticing group of doulas who work together as a sisterhood of support and back up. We are not working for other groups at the same time or on our own, nor are we a referral only group. We meet together to share new ideas and concepts we have learned. We come together for our Meet and Mingle once a month to offer you a time to meet us all and select a doula who is the right fit for you. We are not competitive with each other. We truly feel that you should select the doula who is right for you. We are all very similar and yet all very different in personalities although our approach remains the same. We provide a real sense of community and shared spirit.

2. We provide back up if and rarely as it is needed within our group of doulas only. We allow you to let it be known who your preference is for that backup if the need arises, and try our best to meet that desire. You will never be without a doula. And we find more than 93% of the time it will be the doula you hire. You are able to meet the potential backups by attending our monthly tea.

3. We have over 1000 births as a group of doulas. There are several labor doulas who are actively taking births every month! We have one doula in our group who has been doing this for over twenty years, Teresa. She has over 660 births of experience. She eagerly shares her wisdom from that experience with all of the other doulas in the group. In fact, she is the go to call if something arises in your labor and you are with a different doula. No matter the time of day, she is there to offer any input she feels may help in your situation. We have four doulas in our group, Teresa, Delandra, Charlotte and Renee, who have over 100+ births of experience each. Experience is one of those things that can not be manufactured. It is what causes your doula to be able to quickly assess needs that she may be able to help you within labor. We often have newer doulas, who have been mentoring with our group for several months who offer a lesser fee that is more in line with limited budgets. But when you hire one of them, you get this experience full available to them if it is needed. And we usually have an apprentice doula, who is able to offer a second pair of hands for those who are willing to allow her to apprentice their births with a mentoring doula. This is how we take the training from their initial certifying organization to a different level. Each of our doulas has apprenticed with a mentoring doula at some time in their training. Learning by doing is a great way especially if there is an experienced guide showing the way.

4. Our fee is all inclusive. We are fully available to you for phone calls, emails or texts if you have hired us. We love to hear how things are going and offer guidance when it is desired. We provide one or two prenatals depending on your specific desires. We do not charge extra if your birth is long. We may offer to bring in an apprentice or experienced doula if the primary doula needs some extra hands for a long birth, but that is up to you. We offer continuity of care. And we love to meet with you after the birth to share the photos we may have taken the notes from your birth to help you with bridging your memory with some events you may have forgotten.

5. Our fees reflect experience levels. They are reflective of experience in our group. Some doulas in the metro area charge what the market will bear regardless of their experience. We do not. Perhaps they bring other skills to the table that cause them to have a higher fee. But it is important to know that fees are not reflective of experience overall in this town. So, if the experience is important to you, ask the woman you are interviewing how many births she has actually attended to ascertain her level of experience.

6. All of our labor doulas are trained by a national or international doula certification group. Most of our doulas have completed their certification. But our training and education do not stop there. We encourage our doulas to continue to read new books on birth, attend workshops and conferences and seek another level to their certifications and training. Many of our doulas wear other hats as well. We have childbirth and parenting educators, a massage therapist, child safety experts and lactation specialists who are labor doulas.

So, although the model of being a group of doulas (and educators and other birth professionals) has sprung up around town, note that we are not all modeled the same. You can make the right choice for you as to what model works best for you and your family. There are some wonderful doulas in this town outside of our group. And although over the years some of our labor doulas have moved on – changing careers, shifting dimensions of being a birth professional or moved elsewhere, we will continue the model of care that we have had going forward into our second decade.

We have more than just labor doulas – we have postpartum doulas, childbirth and parenting educators, bodywork therapists and a placenta encapsulator within our group. Our group is currently made up of six labor doulas, one apprentice labor doula, three postpartum doulas and a placenta encapsulator. Many of us teach the multiple classes we also offer.

What’s In the Doula’s Bag?

I bring a rolling small suitcase to a birth. I met a doula on the way out from a birth who only had a bag on her shoulder. I thought it was quite odd that she carried so little to a birth. She told me she tells the couple to bring all of the stuff she may use in labor. I bring quite a few things. I have a small bag inside my suitcase that is must pull out for birth bags- and usually it is brought out. It has little twinkle lights. These create a nice ambiance to any room. And if the mom is in the bathroom instead of having the overhead lights- I bring them in and bundle them up for a nice glow. This bag has a few lotions- clary sage and peppermint-lavender blended. I bring some peppermint oil for nausea- sprinkle a bit on a tissue to help keep it away. It is also a great way to help a mom empty her bladder postnatally with a few drops in the toilet water. I carry a hand mirror so the mom can see if she desires during pushing. I carry a wireless speaker and my tablet for music and note taking. It is also the place for my rebozo to stay. My clients sometimes call it my Mary Poppins bag!

My bag also houses some sterile gloves and a umbilical cord clamp for those emergent births- I have only had to use these once in 20+ years! I carry some sarongs that a mom may use when getting out of the tub for a while- to help her cover a bit. I bring a hip scarf with jangles for the moms who may choose to dance during their labors. There is a compartment that houses some breastfeeding reminder cards and a latch assist if the mom needs it. I carry some tub plugs for those hospitals who discourage the use of the tub so much that the stopper is missing! There is a small bag with toiletries for the long labors where tooth brushes and such are very needed. There are a few odds and ends- some massage tools for dads who prefer to use those instead of hands- but they rarely come out of the bag. I have a few packets of honey to ward off fatigue when the mom needs a sugar boost quickly. And I carry a small bag with snacks for me and a microbial kneel pad. And if the mom has not brought her birth ball- which I prefer since it is the right size for her and one she is familiar with, I bring my birth ball. And I bring a camera for picture taking.

The last few births I realized I took out very little….my rebozo, my camera, my tablet for music. I like having the other things just in case. I do not rely on the parents to bring these things- because they already have to pack for their births needs personally and for postpartum. I also do not want to be without these things if they would be helpful.

But there are two things every good doula brings to her births besides her birth wisdom; her hearts and her hands. There are many times that those are the only things needed. Whispers of encouragement,a touch of love to the couple and patience and trust in birth.

Timeline for Working with a Doula

Often folks ask us about how working with a labor doula works. I thought I would share a timeline with you as to how it works with us.

Consider having a doula… review the website bios and give Teresa a call. Teresa tells you based on your due date and location for your birth who is available and sends you our information packet.
Receive the information packet and decide to attend one of the monthly Meet and Mingles to meet all of the doulas or contact the doulas who seem to “speak” to you.
Interview the doulas you are interested in and hire them or hire them at the Meet and Mingle.
Once the retainer and agreement has been received in our office- you are added to the doula’s calendar who has been hired. Within 24 hours she contacts you to let you know how excited she is to be your doula!
You can then email, text or call your doula to let her know how you are doing along the journey- she likes to hear how your appointments with your care provider, what you are learning in your childbirth classes and any other things you want to share with her. The more sharing, the more she gets to know you and your dreams for your birth. (We would encourage you to read the blog and consider some of our classes.)
At 34 weeks or soon after, you will get a prenatal form in an email. She wants you to give some thought to the questions and send it back via email filled in prior to your prenatal. Teresa has a private class space where she offers many teaching tools to help solidify things you may have learned in your classes. It is a plus having a dedicated teaching space, it is a great place to learn some new things if you did not learn them in the class you took. The place for your prenatal should be private it possible. Although you may think a coffee shop is a great place to meet, it may be fine for an interview, but your prenatal may need to be much more private. It is best to not do this in your home as the normal day to day distractions of pets, interruptions by your children or just day to day distractions are not present. So try to pick a time that you have several hours- at least two and maybe even more like three hours to be able to open up and get into some great discussions that will help you work wonderfully with your doula. This can be just you and your doula but ideally we would love to have your partner there for at least part of that meeting.
As you begin to believe you are in labor, your doula would love to hear from you along the way. She may have some tips and ideas to help you in early labor. She is available to meet you at your home if you desire or to meet you when you are on your way to your birth location. That is up to you and how your labor is unfolding.
She will meet you and stay with you for the duration of your labor. Being present and focused on your needs. She will stay with you usually until you are ready to move to your postpartum room or around two hours unless there are extenuating circumstances that require her to stay longer.
Your doula will text you usually the next day to see how things are going. Because you could be finally dozing off, she will leave the phone calls up to you- she wants to make sure nursing is going well and you do not have any questions or concerns. Feel free to contact her for additional help she can either provide or suggest other to help with- we have postpartum massage, lactation educators, postpartum doulas and more. But often your needs can be met by your doula and she wants to help.
We offer a postnatal time to share pictures from the birth and a birth timeline. Since we are active doulas and many of us are also educators, we want to do this in a timely way that also meets your needs and works around our busy schedules at the same time. We want to see you and your baby. This is special time for us to share with you. Based on where you live and where your doula lives, you need to keep in mind she may be on call for other moms and need to work around being close to home to head out to her next birth. Teresa loves to offer a special time with her moms in her class space. She can offer a book or handout that may be helpful during this time, breastfeeding tools that she has in her space or other tools that you may find helpful. But we all can come to your home if that is what is desired and needed. Getting out the first time seems so overwhelming, especially for first time moms, but you may find that a short drive out to a different location is exactly what is needed. Often the time you desire to set up this prenatal is delayed by having family in town. We leave the timing up to you. Contact us when you are ready. If there is some delay in us being able to meet, we can send your pictures and timeline to you prior to getting together.

This is just an idea of what is normally done. We believe in flexibility and are more than willing to do what you need. Let us know how we can assist you. Thanks!

Making a Partner Feel Inadequate?

I had a dad attend the Meet the Doula Tea last week. He had interviewed one doula already and had come to meet the doulas in our group. He said he was on the fence on using a doula. He said that he understood we talked about teaming up with the partner but he felt it was a subtle way of saying that partners were inadequate. It made my heart sink. Oh my, why does this dad feel like having a doula would mean he was in adequate?

It made me quite sad that he felt that having an experienced guide with him meant that he was incapable of being a great support to his wife. I wondered if he felt that way in other areas of his life. If you had a mentor at work who was to teach you how to do something at work, does that mean you are inadequate? When he had professors or teachers sharing information with him, did he feel inadequate? When his neighbor who was a plumber offered to come over and help show him how to fix a pipe and use his tools, did he feel inadequate?

If this is a place you have never been- or even been involved with but understand having an extra hand and heart to support, how does that make you less of a partner? How do we expect those who are so personally involved to not allow their emotions to overcome them? Why do we expect someone to sit in a class series and come out an expert to the information received? We don’t do that in any other way or situation.

I love supporting families- not just the mom in labor- but her family- her partner- her mother- her father- her sisters… I love being there to help all of them. I love seeing them step up into a role they may have been afraid to do but with a little guidance feel much more capable. I love taking pictures of partner’s supporting their lover. Rarely are there pictures of me- since I am the one taking the photos. Instead the memories will be filled with her power and their support.

I hope this dad reconsiders the added support of a doula for him and his wife. I hope their birth goes gently and he will feel more than adequate and fully supported.

Roles of Care Providers During Labor and Birth

Someone recently asked me if using a doula was really needed if you had a midwife. How about if you plan to have a home birth? I thought I would share roles as determined by some internet sites (the title is a hyperlink to go to the site) for each type of job that the labor support folks offer. In our area it is not unusual for a midwife to have multiple women in labor. She can not be everywhere at the same time. It is not unusual for her to be on for 24 hours straight- so she may be eating and sleeping some of that time as well. In our area most nurses are assigned to two patients at the same time. Her role limits her contact with the mom during a lot of her labor. As far as home birth midwives, some come once labor is well established and others may send their apprentice initially to assess how you are doing if she has another mom in labor. Some will have a back up midwife in case more than one mom is in labor. A home birth apprentice at a birth acts more like the nurse in a hospital birth- assisting the midwife. She may have been a doula before, but her primary role is to learn the art of midwifery by assisting the midwife- not being the primary support to the mom. The doula has one role- to be there for the mom or couple. Her role is to be fully attentive to the emotional and physical needs of the mom. So look over the roles- they may differ within your practice, and determine who you want to have with you in labor. think about your needs and I am sure you will make the right choice for you.

Role of a Midwife during Labor and at a Home Birth:

“If you choose home birth for delivery, your midwife’s role will begin long before your due date. A midwife will provide regular checkups and refer you to a doctor for prenatal exams, such as ultrasounds. Your midwife will see you throughout your pregnancy, tracking your baby’s growth and checking you for any possible complications. Because prenatal visits with a midwife are longer and more relaxed than in a traditional medical setting, you and your midwife will develop a much more personal relationship than is typical with a doctor.

When it’s time for your baby’s birth, your midwife will come to your home with any equipment that may be necessary during the birth. She will monitor you throughout childbirth, typically checking the baby’s heart rate with a hand-held Doppler, as well as monitoring the baby’s position and the progress of your labor. She will stay with you throughout your entire labor, helping to keep you comfortable and making sure your labor is progressing as it should. After your baby is born, your midwife will clean up any mess, examine you and your baby and help you to try to start nursing. She will stay for a little while to make sure you and your baby are happy and healthy. She will visit you a day or two after your birth for a postnatal checkup, as well.” (more…)

Our Labor Doula Services

We are the most experienced doula group in the state. Our group (the doulas currently working with our company) has supported couples more than 1200 births!

We are available for unlimited telephone and email support throughout pregnancy. We offer prenatal meetings- one minimum, sometimes two to discuss your birth ideals and to get to know each other more. We provide unlimited labor support- one fee no matter how long your labor may be. Usually, we will attend you during early labor in your home, depending on location and distance to the hospital. We offer massage, guided imagery, some reflexology, position suggestions, and guidance during labor. If possible, we take photographs and write a birth story or timeline for your review after the birth. We stay an hour or so after the birth to assist with breastfeeding. Most of our doulas have personal breastfeeding experience to share with you in helping you initiate breastfeed successfully. We offer a postnatal meeting to help you with any problems and for the doula to see “her baby,” once you are ready to get out and about.

We back each other up in case of an emergency that does not allow us to attend your birth, but you choose your primary doula.

Our labor doula fees range from $475 for less experienced doulas to $800 for the most experienced doulas in our group. We all include all of the services above. A fee is paid by an initial retainer of $250 and the balance being due two weeks before your due date. We also offer payment plans and never want our fee to discourage your use of one of our doulas. Contact TDelandra for an agreement to be sent to you via email.

See what our clients and students share about what we were to them: Students and Clients Share {youtube}xmiuIC8gHxE{/youtube}

Are Doulas Anti-Epidural?

NO! We support women in the choices they make. But… we do hope women are making informed decisions. This week one of my doulas had a mom with a long induction and the mom received an epidural after many long hours of labor. The midwife told her when the baby was born that she was pleased that the doula had stayed for the birth. The doula was shocked by the comment and inquired as to why that was shocking. She then went on to say that most often doulas did not stay once the mom received her epidural. We stay with the mom throughout her labor and birth irregardless if she chooses to be medicated.

We had a mom recently told that she was pre-pre-eclamptic- meaning that he felt she was going to end up with an induction due to her having one symptom of possibly having a future of pre-eclampsia. It is difficult to have moms have a care provider who seems to diagnose this six weeks before she is due and with only one symptom. But she was considering not having a doula since she felt an induction would mean she would need to have an epidural. This is not always true- in fact we have several moms who are induced every year and are still able to have an epidural free birth.

But speaking of informed decisions- Leigh William just sent me a document that is worth reposting so you can make sure you understand the risks of an epidural. There is a time and a place for epidurals. You may have your reasons for getting one that we do not understand or know- that is okay- it is your choice. But don’t make it uninformed or due to your friends or family telling you to get it- or feeling you will need it before you go into labor- give yourself an opportunity to labor before you make that decision.

Common Side Effects of Epidurals: Minimizing the Risks

Side Effect / Who affected	Incidence: What percentage of moms or babies experience this	What medical staff does to prevent this.	What you can do which may help prevent this.	What other interventions this side effect could lead to.
Limited Mobility / Mom	100% Some studies indicate that women may have more muscle mobility than they realize, but required monitoring equipment tends to make movement difficult.	Can’t prevent it once you have an epidural. Can give a lower dose of medicine to minimize.	You may choose to delay epidural so you can move around a lot in early labor to help prevent problems due to immobility	Could lead to a posterior baby or other malpositioning, or could lead to failure to progress at any stage in labor, which may lead to cesarean.
Low Blood Pressure / Mom	0 – 50% † Relative risk (RR) 74.2 *	Give extra IV fluids before epidural is given.	Rather than lying flat on your back, prop one hip up on a pillow.	More fluids, oxygen, or medication. If mom’s BP drops too much, baby’s heart rate can decrease, oxygen supply to baby can decrease.
Fever / Mom	4 – 24% ** RR 5.6 * The longer mom has epidural in place, the higher the fever risk.	Monitor mom’s temp.	Keep cool: eat ice chips, use cool cloths under arms or between legs, on forehead and back of neck. Fan.	May lead to elevated heart rate for baby, which may indicate fetal distress, which may lead to c-section. Mom may be given antibiotics for possible infection.
Urinary retention in labor / Mom	0 – 68% †	Bladder catheter	Wait as long as possible for epidural. Urinate (pee) just before getting epidural. Try using a bed pan if you can…	A full bladder can prevent cervical dilation and fetal descent. Increased risk of infection, postpartum urinary problems.
Postpartum urinary incontinence / Mom	Immediate postpartum: 27% with epidural, 13% without	Keeping bladder drained during labor.	See above. Kegel exercises before & after labor. Biofeedback can be used to treat.	May last for weeks. (At 3 months, was 16% for women who had used epidural, 4% for those who had not.)
Shivering / Nausea / Vomiting / Itching	Shivering 33% (Thorp) Nausea 0 – 30% † Vomiting 0 – 13% † Itching 8 – 100% †	“Harmless”. No need to prevent.	Blankets, massage for shivering. Support.	Can give medication for nausea and itching. May make mom very sleepy.
Backache after birth / mom	Immediately after birth: 53% with epidural, 43% without	Proper placement of catheter.	Try to avoid awkward positions and muscular strain during labor	Postpartum pain medications.
Incomplete Pain Relief / Mom	5 – 10%	Proper placement of catheter. Adequate levels of pain meds.	Tell caregivers if relief is incomplete, or if you have painful spots. Change positions.	May be more stressful than no pain relief at all. Epidural can be re-positioned; medication can be increased.
Slower first stage / labor	Most studies show this effect. -.4 – 4.8 hours longer. ** Average is 26 minutes longer.*	Pitocin (artificial oxytocin through IV). 3 times more common with epidural	Wait as long as possible to have epidural	If first stage stalls, you may require a c-section for failure to progress. Also, Pitocin can cause longer, stronger contractions. May lead to fetal distress, which may lead to c-section.
Longer second stage (pushing) / Labor	All studies show this effect. 0 to 55 minutes longer.** Average is 15 minutes longer.*	Pitocin and/or Second stage interventions	Ask for a “light-weight” epidural, so you still have some mobility. Change positions. Turn down epidural for 2nd stage. Delay pushing till baby’s head crowns.	22 out of 24 studies indicate a higher risk of instrumental delivery (forceps, vacuum) With IV narcotic pain medication, chance was 3-7%. With epidural, chance was 15-53%.
Fever / Baby	30%	Monitor mom’s temp.	Try to keep mom’s temperature down.	May cause elevated heart rate. If baby has fever, may be assumed to have an infection: can lead to observation or isolation, blood tests, antibiotics.
Fetal distress due to Pitocin, mom’s low BP, maternal fever, or other causes/ baby	10 – 15% of babies	Monitor baby, attempt to avoid maternal conditions which may lead to fetal distress.	Stay off your back, change positions frequently. Breathe.	Oxygen for mom. Treat maternal conditions. Decrease pitocin, which may lead to failure to progress. May lead to cesarean section.
Baby in posterior position, other malpresentation / Baby	One study showed 20 – 26%. Another showed that all but 4% of babies rotate without epidural. With epi. 19% will stay posterior.		Change positions frequently in early labor, especially using positions that bring weight of baby forward. Wait until baby is engaged in pelvis (0 station or +1) before getting epidural.	Greater chance of c-section or instrumental delivery.
Cesarean Birth / Effects mom and Baby	Studies consistently show that c-section is 2-3 times more likely with epidural. One study showed that risk was 26% if epidural at 4 cm, 33% at 3 cm, 50% if epidural given at 2 cm dilation.	Pitocin to aid dilation. Forceps or vacuum extractor to aid delivery.	Delay the epidural as long as possible in labor. Follow all other recommendations given above.	Risks of c-section for mom include: risks of infection, increased bleeding, longer postpartum stay, possible anesthesia effects, more postoperative pain, and possible impact on future pregnancies. Effects on baby may include respiratory distress syndrome and other impacts of surgical birth.

By Janelle Durham, 2004.

* Leighton, B.L., and S.H. Halpern. 2002. The effects of epidural anesthesia on labor, maternal, and neonatal outcomes: A systematic review. American Journal of Obstetrics and Gynecology 186: S69-77.

** Lieberman, E., and C. O’Donoghue. 2002. Unintended effects of epidural anesthesia during labor: A systematic review. American Journal of Obstetrics and Gynecology 186: S31-68.

† Mayberry, L.J., D. Clemmens, and A De. 2002. Epidural analgesia side effects, co-interventions, and care of women during childbirth: A systematic review. American Journal of Obstetrics and Gynecology 186: S81-93.

Additional Sources: “Epidural Anesthesia in Labor: An Evaluation of the Risks and Benefits” by Thorp and Breedlove, Birth, June 1996. This was a literature review article, which summarized the results of numerous studies involving thousands of births. Other information from: Pregnancy, Childbirth, and the Newborn by Simkin, Whalley, and Keppler (2001 edition). Maternity & Women’s Health Care by Lowdermilk, Perry, and Bobak (6th Edition, 1997). Family-Centered Maternity and Newborn Care by Celeste R. Phillips (Fourth edition, 1996). “Epidural Epidemic” by Dozer and Baruth, Mothering, July-August 1999. “What no one tells you about Epidurals” by Penny Simkin; “The Cascade of Interventions” by Pam England; and Epidural’s Effects on Babies” by Beverley Lawrence Beech, in Mothering, March-April 2000. “Epidural Express” by Nancy Griffin, Mothering, Spring 1997; “So you Want an Epidural” website by Kim James.

Additional data from the most recent studies can be found on the childbirth educator resources page.

What Doulas DO NOT DO

You need not be certified to be a doula. But if you are certified, then the organization has what is called the “Scope of Practice.” Here is what DONA considers the scope of practice:

A. Services Rendered
The doula accompanies the woman in labor, provides emotional and physical support, suggests comfort measures, and provides support and suggestions for the partner. Whenever possible, the doula provides pre- and post-partum emotional support, including explanation and discussion of practices and procedures, and assistance in acquiring the knowledge necessary to make informed decisions about her care. Additionally, as doulas do not “prescribe” treatment, any suggestions or information provided within the role of the doula must be done with the proviso that the doula advise her client to check with her primary care provider before using any application.

B. Limits to Practice

DONA International Standards and Certification apply to emotional and physical support only. The DONA International certified doula does not perform clinical or medical tasks such as taking blood pressure or temperature, fetal heart tone checks, vaginal examinations, or postpartum clinical care. If doulas who are also health care professionals choose to provide services for a client that are outside the doula’s scope of practice, they should not describe themselves as doulas to their client or to others. In such cases they should describe themselves by a name other than “doula” and provide services according to the scopes of practice and the standards of their health care profession. On the other hand, if a health care professional chooses to limit her services to those provided by doulas, it is acceptable according to DONA International’s standards for her to describe herself as a doula.

CAPPA’s scope of practice is very similar.

Doulas are sometimes confused with folks who act as doulas but are not acting like doulas should… so I wanted to clarify. A few months ago I entered a hospital with a client and the nurse asked me how far dilated she was. I told her based on how she was acting I would guess 6 to 7 cm. She asked me didn’t I check my clients. I told her of course not I was a doula, not a monitrice. Seems a doula recently who was acting as a monitrice had recently attended a birth there and had been checking the mom at home. I clarified that we did not do that.

This past week I received a call from a mom who was 38 weeks pregnant. She asked if I was available to be her doula. When I asked where she was birthing, she told me at home. I said great, who is your midwife. She told me she only had a clinical midwife who would not be attending her birth. I explained that we do not attend births without a care provider present. I believe women should be able to choose to birth anywhere and any how they choose, but the doulas in my group do not attend a planned unassisted birth. We are not trained to do so nor do we have the necessary equipment to do so.

Doulas do not suggest a mom stays home when she is ready to go to the hospital. It is up to the parents to decide when to leave to go to the hospital. The doula should not be encouraging the couple to not go- nor should she be demanding that they go- it is their responsibility to make that decision.

Doulas do not encourage a mom to stay home when she is obviously in active labor if she plans a hospital birth. As a doula we can suggest that labor is progressing and let the client know that they may want to consider moving to their birth location.

Doulas do not diminish the importance of having a midwife or doctor present at a birth. Sometimes having great confidence in the doula makes clients feel she is more than capable of catching their baby. It is not her role to do so, she has not been trained as a doula to do so.

Doulas do not bring a doppler to a birth- she is not trained as a doula to use this piece of equipment. Sometimes having tools that are used by medical providers makes folks think that the doula has medical skills. It is best to leave medical equipment to medical personnel.

Doulas do not take your blood pressure. See the previous statement.

Doulas do not take your temperature. If your water has been broken for a while or you show signs of a fever, she may suggest you take your own temperature.

Doulas do not do vaginal exams. This is way outside of our scope of practice. If you are a doula and doing this I hope you are calling yourself a monitrice instead.

Doulas do not catch babies intentionally. If no one else is around, and the labor moves quickly, we may assist the partner in doing so or even catch the baby ourselves. But we are adopting a policy that all labors that are precipitous in the future will also have a call to 911 in case it is needed.

I have personally caught two babies at home in precipitous births- where the mom was pushing when I arrived. I offered to help them possibly make it to a hospital. I called their midwives to alert them. I got a midwife to come but they arrived only after the birth. I suggested calling 911 both times but it was declined. In the future I will make that call and they can then decline going with the emergency folks if they choose to do so.

As per our agreeement:

” Doulas DO NOT: perform tasks such as blood pressure, fetal heart checks, or vaginal exams. Our role is one of nonintervention and is non-medical. We are there to provide physical comfort, emotional support, and advocacy. Doulas do not make decisions for you. We will help you get the information necessary to make an informed decision. We will also remind you if there is a change in your birth ideals that you have shared with us. We will discuss your concerns with you and suggest options, but you and your partner will speak on your behalf to the clinical staff. We will only act as a liaison between you and the staff if you ask us to do so and when it is appropriate.”

Labor of Love doulas do not attend planned “unassisted births.” There needs to be midwifery care for us to attend a home birth. We understand that sometimes births happen quickly, but the plan always needs to be one in which a midwife plans to be in attendance for us to be in attendance.

If you have any questions about our services, please contact us at info@alaboroflove.org. Thanks!