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.

 

melanie picking up placenta

Sign up for Placenta Encapsulation HERE!

We offer another service that you may find helpful–placenta encapsulation with Melanie Belk. The placenta is perfectly created by your body to nourish your baby during pregnancy. Nearly all mammals consume their placenta after giving birth in order to retain the important nutrients and hormones.  Placenta encapsulation allows you all the benefits of the placenta in a more palatable way.

Consuming the placenta has been known to:

-balance your hormones
-decrease the incidence of postpartum depression
-increase energy and facilitates a faster recovery from birth
-lessen postpartum bleeding
-help your milk production

We offer two different methods of Encapsulation:

placenta-pills-encapsulation

High-potency Encapsulation (Recommended)

The High-Potency Method involves drying the raw placenta at a low temperature, keeping a high level of the hormones and nutrients, and leaving the enzymes intact.  These placenta pills are known to have more of a “kick”– they contain a higher hormone content than the traditional pills.  Mothers often report experiencing a large energy boost when taking them.  These can be taken in a smaller dosage, one in the morning and an optional dose in the afternoon or as needed. This method produces more pills and is taken at a smaller dosage, allowing you to enjoy the benefits over a longer period of time.

TCM Encapsulation

Inspired by Traditional Chinese Medicine (TCM), the TCM Method involves steaming the placenta, dehydrating it at a low temperature for several hours, then grinding it into powder form and putting the powder into capsules. TCM placenta pills offer a steady dose of hormones and nutrients.  It is often taken as a high dose the first week, and then steadily decreased over the next couple weeks as your hormones balance.  While we recommend the high-potency encapsulation, we continue to provide TCM encapsulation to mothers who value the original methodology, though it will produce fewer pills which need to be taken more frequently to achieve the same effect.

Other placenta services offered include:

  • Placenta smoothie–If you’re up for it, a smoothie is a great way to take advantage of the placenta’s benefits at the time of birth.  When I come to pick up your placenta I can cut off a small chunk of the placenta and make a delicious frozen fruit smoothie in your room for you.  You will not taste the placenta in it.
  • Placenta tincture–A tincture is a great way to extend the life of your placenta remedy.  The tincture is a small bottle containing a piece of the placenta in vodka, which is left to ferment for at least six weeks.  After that the mother can take it during times of transition or stress, returning menstrual cycles, and menopause.  The tincture can also be used by the biological mother and daughters of the birthing mother, and by the baby. Specific dosage instructions are included upon delivery.

Melanie has a biology degree and hold both a Bloodborne Pathogen Certification, and a Georgia Food Handler’s Certification. She also has a dedicated lab area for the preparation of your placenta so cross contamination does not occur. At the end of February 2014, she had completed over 300 encapsulations.

melanies_workspace_800x597

Read what others say about using this service.

For more information contact Delandra Vinson at delandra@alaboroflove.org

*these statements have not been evaluated by the FDA and are not meant to diagnose or treat any disorder

Melanie Belk is an independent contractor and Labor of Love does not accept any liability.

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!

Charlotte Scott is a labor doula, childbirth educator licensed massage therapist & body worker, with advanced certifications in prenatal & postnatal massage.

6-Benefits-Of-Prenatal-Massage

Nurturing the mother to be – it’s important to take the time out to nurture your changing body. The increase of blood volume and fluids of pregnancy create stress on your joints and muscles. (She provides this in her office or in your home- which is the preference as she allows you to then tuck into bed relaxed afterwards.)

Prenatal massage benefits:

  • Increases circulation and lymph flow
  • Reduces maternal blood pressure
  • Increases uterine blood supply improving fetal health
  • Reduces stress and anxiety, reduces stress hormones
  • Reduces edema
  • Reduces back pain, joint pain and headaches
  • Reduces prenatal and labor complications
  • Provides specific techniques for labor stimulation when appropriate
  • Improves oxygenation of soft tissue
  • Improves sleep

Nurturing the postnatal body – transitioning back to normal, it takes time to return, to undo what has happened over the past 9 months to your body, it is an intense time of physical and emotional change. Your body is releasing fluids, hormones are changing and breastfeeding demands and sleepless nights have their impact.

Postnatal massage benefits:

  • Cleanses lactic acid and medication residue from tissue
  • Relieves structural tension from new demands on your body
  • Supports physical and emotional changes
  • Reduces stress and assists hormonal balance

Nurturing the infant – a wonderful time to help your baby learn to adapt to a sensory environment. There is proven effects of the value of intentional touch and the development of the human nervous system.

Benefits of infant massage:

  • Improves circulation
  • Assists in digestion
  • Increases alertness / heightened awareness
  • Benefits neurological function
  • Reduces stress hormones
  • Increases nurturing and bonding hormones
  • Improves immune function
  • Creates bonding time with care givers

You can purchase a massage session, or package of sessions here: Prenatal Massage Therapy

Contact Charlotte Scott at  charlotte@alaboroflove.org or 770.688.0519 to schedule your appointment.

As a doula, we hear that comment frequently. “I have a friend who is going to be my doula….” And at first glance it seems like a good thing. but is it?

First let me say, a doula does not need to have been trained or credentialed in any way to call herself a doula. She can say, “I am going to mother the mother, therefore I can call myself a doula.” And this is very true. There is nothing stopping her from doing so. But those of us who have undergone training, read a ton of books, been critiqued and evaluated feel a bit sad when we hear horror stories about the doula who overstepped her bounds at a birth, knowing that with helpful training, she would not have acted or reacted this way. It also makes us sad when someone has a friend who is their doula, without any experience or training and has a false sense of security that they have the support and benefit of a doula. She has not had a doula at all. She had a friend with a huge heart and desire to help her.

If you are going to attend a birth without any training or knowledge of what the trained and certified doulas have as a code of ethics, just call yourself a birth companion. You can still make a huge difference perhaps, but the staff at the hospital will see you as just that, not a professional doula. It helps those of us who feel the need to meet the standards of certification to be seen a bit differently and held to a higher standard. You will not taint our reputations as doulas when you step outside the bounds of a credentialed doula. The truth is a mom supported by a birth companion will be better off than one alone. And I only ask that you make sure those who enter the room know you are there for the mom and do not represent doulas per se or any certifying organization. And the monitrice who is a doula plus offers some additional skills, does not cloudy the water of the doula- call yourself a monitrice when you tell the nurse how far dilated you found her to be when you felt the need to do a vaginal exam. (more…)

A good doula is like a chameleon

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She becomes what the moms needs at the time. Yesterday I attended a tough birth. Not because it was extra long or tedious or even full of interventions- it was a natural birth of average length with a delightful couple. It was difficult because I felt like I could not use any of my doula talents or tools.  I spoke to the midwife, my friend, about it afterwards. She said, “You provided exactly what she needed.” This mom does not want to be touched in labor- that is right- no massage, no counterpressure, no stroking- no touch. And since she is very knowledgeable about the right way to breathe and vocalize, she wanted no guidance in these measures either. So I sat. I quietly supported her husband. I offered a few suggestions for his comfort.I offered words of encouragement along her journey.  I took pictures. I cleaned up the bed when she was out of it. I offered music although in the end she did not like it.  But birth is not about me. It is about her. It is about what she wants. The midwife in mid labor made a suggestion I had just recently made. The mom had declined it. The midwife said, “Sometimes they do not know what will help, what they need. So you just do it.” So we did and the mom took that suggestion for a while. Again later I leaned in and whispered some instructions to her to help her with pushing. I feared she would not like it but she accepted the suggestion and it worked well for her. But I drove home thinking about it- I was exactly what this mom needed. I did not get to play my usual role- but it is what she needed. Before I left she told me how happy she was with my service to her.

As doulas we learn early on the mantra, “It is not my birth.” But it is hard to hold back when you think you know things that may help a mom but she declines the help. But a good doula offers and then honors the mom in her desires. A good doula knows how to be what the mom needs her to be.

 

The term “doula”  is defined as an Ancient Greek word meaning “female slave.” Marshall Klaus and John Kennell, who conducted clinical trials on the medical outcomes of doula-attended births, adopted the term to refer to a person providing labor support. The term is also used for women who come to support the new family just after the birth, mothering the new family.  

Numerous studies have  shown women who had a doula for labor tended to result in shorter labors with fewer complications, a reduction in negative feelings about one’s childbirth experience, a reduction in  the need for Pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans and a reduction in  the mother’s request for pain medication and/or epidurals. Parents were shown to feel more secure and cared for, a re more successful in adapting to new family dynamics, have greater success with breastfeeding, have greater self-confidence, have less postpartum depression and have lower incidence of abuse.

Labor Doulas

We are one of the most experienced doula groups in the state. Our group has supported couples in more than 1000 births! We service the metro Atlanta and Athens areas.

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. We will attend you during the middle part of your labor in your  home, depending on location and distance to the hospital.

During your pregnancy,  labor and postnatally we offer:

  • support and encouragement
  • support for your partner
  • communication of non medical concerns
  • relaxation techniques
  • some reflexology and acupressure
  • massage and touch therapy
  • guided imagery
  • position suggestions
  • pain coping ideas and guidance
  • photography
  • a birth story or timeline
  • continuity of care
  • breastfeeding assistance 
  • follow up communication as needed

We stay an hour or so after the birth to assist with breastfeeding. Most of our doulas have personal experience to share with you in helping you initiate breastfeeding successfully. We offer a postnatal meeting to share your photos and story 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. This is very rare but can happen.

Our labor doula fees range from $525 for less experienced doulas to $1150 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. Teresa offers a reward incentive program for reducing her fee.

Read about what makes us different!

Watch a video on what our clients say about us:

How do you hire a labor doula?

Email Delandra at info@alaboroflove.org or call her 770-241-2078. She will send you an informational packet to review. You can then have a phone interview with any and all of the doulas whose profiles interest you. Their phone numbers are in the packet. You can then set up interviews with the doulas who you feel best meets your needs. At the interview you may choose to hire a doula. Or you may choose to attend a Mingle and Meet to meet us all in person and hear us talk about our full list of services. Many times couples hire a doula at the tea that best meets their needs.

After you have chosen your labor doula and paid the retainer, she will contact you to let you know the agreement has arrived. Communication via phone calls, emails and texts are always a welcome opportunity to get to know you better. Feel free to contact her along the journey. Around 34 weeks you should have your prenatal meeting lined up. This is an opportunity to meet face to face to discuss your birth ideals. At 38 weeks the final payment is due and this puts the doula officially on call. If you have a baby prior to this time, your doula will do her best to meet your needs, and if that is not possible, a back up doula from within Labor of Love will do so.

You can make payments on our website by going to the STORE link and there is a subcategory of payments and registration. Please mark pick up so you are not charged shipping. Or you can mail the payment to the address below

Let me first say, this is what a professional doula does not do. There are folks out there who call themselves doulas who have never had training or have trained but chosen to not certify. That is fine. It is not a requirement to be trained or certified to call yourself a doula. But please act professional. When a doula steps outside of the protocols of a professional doula, she risks the reputation of all doulas. So, this is about what I personally feel a doula should not do.

A certified doula signs a code of ethics and practices within her scope of practice. I have been a certified doula for a long time- with DONA and with CAPPA. I am currently certified with CAPPA.  Here is the scope of practice I follow- CAPPA SCOPE OF PRACTICE.

 

  1. The labor doula assists the woman and her family before, during, and after birth by providing emotional, physical, and informational support. It is not within the labor doula’s scope of practice to offer medical advice or perform any medical or clinical procedure.
  2. During pregnancy, the labor doula’s role is to assist families in preparing a birth plan, to provide information about birth options and resources, and to provide emotional support.
  3. During labor and birth, the labor doula facilitates communication between the family and the caregivers. She supports the mother and her partner with the use of physical, emotional, and informational support.
  4. During the postpartum period, the doula assists the mother in talking through her birth experience, answering questions about newborn care and breastfeeding within our scope of practice, and referring the family to appropriate resources as needed.

So doing vaginal exams is not what a doula does. Have I, yes twice when a mom was birthing at home unexpected and I arrived to find her pushing. I called her midwife both times to let her know that yes the baby’s head was right there! I did check so I could let them mom know my opinion on whether she should get in the car or call 911. Both times the mom asked me to confirm what she was feeling- and it was a small internal finger hitting a head check!  Is that me acting as a doula….NO! It is me acting as a good samaritan person who had the most birth knowledge in the room at the time. Did it feel scary and weird- YES! But did I feel it was needed- YES! Both moms birthed within minutes safely and had a midwife there moments after the birth to provide medical assessment.

So, when a doula says she can offer a vaginal exam – then she is acting like a monitrice- not a doula. She should have learned these skills from a midwife. If she says she does this, you need to ask where she got her experience. And also you need to  think about how important is it to have a vaginal exam performed on you in a normal, non emergent situation. Rarely is a vaginal exam needed in labor at home if you are planning on going to the hospital. Trusting your care provider to send you home if you are not dilated enough, trusting them to not interfere in ways you do not desire, are imperative.

Information gathering is wonderful. Even providing information that is something they did not know is even better. But the role of the doula is not to require a mom to have the birth that the doula wants- but the one that the mom wants. Making sure she has information to make an informed decision is most important. I wear the hat of childbirth and parenting educator- so often I provide a plethora of information. When a mom tells me about the birth ideals she has and I realize the provider or the place she has chosen may not provide what she is looking for, I often tell her about other resources. But whether she chooses those options are up to her. I support what she decides once she has the information.

A doula remains with the mom or couple during the labor. I do not think a professional doula leaves a mom in labor unattended. If the labor is too long, she can certainly call in a back up, but she remains with the mom until her back up arrives. There will be times for bathroom breaks, quick meals and even a nap if the mom is walking the halls with her partner or resting herself. But she does not leave the mom unless the mom dismisses her. If a mom chooses medication, a professional doula does not decide she is no longer needed and leave just because the mom is medicated. I love what Persis Bristol says, “just because the mom’s body is numb does not mean her mind is numb!

Our company provides a postnatal meeting to review the birth and see any pictures that were taken. We love this time. Some moms drop by on the way home from the hospital to get breastfeeding assistance and the postnatal is done then. Others may wait a few weeks, some months and some just ask for me to send the pictures and notes due to hectic schedules and returning to work. But I have to say I miss seeing the new family if this is the case. I have some moms who text, email and call frequently to chat about baby and parenting concerns. We welcome this.

This week four things came up. 1. One was a potential client who asked if we required her to have to be committed to a natural birth. I discussed options, informed decisions and how this was her birth. Sometimes doulas project their own bad birth baggage onto their clients. They also feel the need to “save” their clients. And sometimes they feel compelled to force their birth dreams on others.   2. The other thing that was shared with me was how a doula had some issue with having to pick up her child and left the mom who had gotten an epidural, and then never ever returned to the mom during the labor and birth.   3. I had a strange question asked of me by a nurse.  It made me curious when a nurse asked me if I did vaginal exams on the mom prior to her arrival. I explained that I did not do vaginal exams. Then the attending midwife shared how a doula who says she is a monitrice had a mom arrive and proclaimed her to be in very active labor- 7cm dilated, only to be 2 centimeters. This was making the nurses misunderstand the role of a doula.   4.  I had a mom recently ask if she ended up with good biophysicals from her perinatologist and was like her mom and went to 43 weeks, would I still be her doula since our agreement says 42 weeks. I assured her I was her labor doula until she gave birth!

I think it is important to know all doulas don’t follow the same rules or scope of practice. All doulas don’t provide the same services.You may want to ask a lot of questions. Perhaps you should ask where she received her training. Ask if she is certified and if she is not, ask why. Ask about her scope of practice. Ask about her experience (there are doulas in my area who are just starting out and charge more than very experienced doulas in the same area). Ask away- you may find some of the answers are exactly what you are looking for, or not.

 

Picture this:  A woman in the hospital in labor.  She is lying in the bed, moaning through contractions.  An IV in her arm tethers her to a pole beside the bed.  Her contractions are irregular, often slowing to just four and hour.  She is progressing, but slowly.

If you were to share that image and information with a group of birth professionals, the reaction would be the same from most of them.  Get that woman out of bed.  Get her moving.  Let her eat.  Let her drink.  Get that IV out of her arm!

But let me share the rest of the story.  This woman has been in labor for nearly two days.  She hasn’t slept.  She is exhausted.  She has been drinking water, but has no appetite and is vomiting frequently.  Her exhaustion leads to fear, to doubt.  She doesn’t think she can do this much longer.  Rather than tell her to get up, move, get her contractions going—or worse, administer pitocin– her doula and midwife listen.  Her doula suggests resting in the bed in a position still conducive to labor.  Her midwife suggests that maybe IV fluids would hydrate and revitalize her.

Now she is the picture mentioned above.  And because she listened to her body…. because she had a midwife that knew that the baby would come when ready…because she had a doula that recognized that there is a time for rest as well as activity in labor…. that mom, the one tied to the hospital bed having four contractions an hour, gave birth to a healthy baby boy just 40 minutes later.

– Renee Wymer