An Epidural is NOT a doula
“I’m planning to get an epidural so I don’t need a doula.”
This is unfortunately the primary thought among birthing women today, particularly those who plan to choose medication for their births. Obviously, doulas have historically done a very poor job of educating the public about the role of a professional doula. To further muddy the waters, many “doulas” that have made poor impressions on society at large about doula support. They have cheapened the meaning of the words “I’ll support you” by following it with the word “if.”
I’ll support you IF you choose not to circumcise.
I’ll support you IF you want (my definition of) a natural birth.
I’ll support you IF you labor at home as long as possible.
I’ll support you IF you decide to have a home birth.
I’ll support you IF you don’t get induced.
I’ll support you IF you don’t get an epidural.
I’ll support you IF…. You do things my way.
And most of the time, these “doulas” want to see only one kind of birth: an unmedicated one. They leave once their client asks for an epidural. Beware these “doulas.” That is not a doula.
That is a birth activist posing as a doula to use a woman’s birth for her own agenda. It’s no surprise that women choosing to have medication feel like they don’t need a doula. It’s as if to say that an epidural can replace everything that a doula does. But friends, an epidural is no substitute for a professional doula.
An epidural cannot meet with you during your pregnancy, spend personal time listening to your thoughts, fears, expectations, and apprehensions about your upcoming birth.
An epidural does not personally know the care providers in your area. Therefore, it cannot get to know your personal situation and make appropriate recommendations for who may be a good match for you.
An epidural cannot help you process and discuss your previous births as you prepare for another one.
An epidural is not connected with a network of birth related support professionals to provide you with extra support prenatally and postpartum.
An epidural does not have lending libraries of priceless information for you to look through as you prepare for labor, birth, and life with a new baby; it cannot know your personal situation or preferences and make recommendations accordingly.
An epidural cannot talk you through all of your birth and baby care options, help you from your birth plan, or answer questions as you put it all together.
An epidural cannot provide reassurance that your experiences and emotions in pregnancy and are normal and it cannot sympathetically encourage you to hang in there as you wait during the last few weeks.
An epidural does not go on call for you 24/7 in the last weeks of your pregnancy to answer questions, offer physical or emotional support, or help you understand what may be a confusing and inconsistent early labor phase.
An epidural can not support your labor at home before you get to the hospital, and it cannot help you decide when is a good time to go.
An epidural cannot watch you as you labor to help you understand what stage of labor you may be in, which is sometimes a general guide for when to leave for the hospital.
An epidural cannot support you as you labor until the pain medication takes effect.
An epidural can provide you with one option for effective pain control.
An epidural is not an expert in positioning during labor in such a way that the baby has the best chance of moving through the pelvis.
An epidural cannot support your partner.
An epidural cannot communicate about your labor to other family members.
An epidural cannot help you understand the medical language that may be used around you and about you as you labor.
An epidural cannot reassure you that any medication side effects you may be experiencing are completely normal. It cannot offer you options for managing those either.
An epidural cannot massage your feet, brush your hair, or gets something to drink for you and your partner.
An epidural cannot help coach you through the pushing phase.
An epidural cannot take pictures of you, your new baby, and your partner during or after the birth.
An epidural cannot help you get into a comfortable position after the birth.
An epidural cannot help your baby achieve their first latch.
An epidural cannot follow up with you days or weeks after the birth to see how you and baby are doing.
An epidural cannot provide you with ongoing postpartum support or resources.
A doula can.
A professional birth doula will support you regardless of your birthing decisions – even an epidural.
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Use your BRAIN(ED): Navigating Choices in Childbirth using THIS easy to remember Acronym
In childbirth today, women have more choices than ever in history. There are high tech options, surgical interventions, low tech management options, pharmacological interventions, pain medications, augmentation capabilities, natural remedies, and other paths that can be used to help manage complexities of labor.
With all the options, good childbirth education is key to understanding the options available to you. Still, even with a solid foundation of knowledge, every family is going to have their own path to walk as they bring their baby into the world. How a family prioritizes their options are going to be unique to them.
When navigating labor, a mother will make many choices. Having a simple but efficient way to weigh risks and benefits as you navigate labor is of tremendous benefit. So, just remember, when you are faced with a decision in labor, use your B.R.A.I.N.(E.D.)
How does this look in the application? Say you are in labor and your provider suggests augmentation with Pitocin. Go through this list so you can be fully educated and comfortable with your decision.
Benefits – What are the benefits of this particular intervention at this time? How will it change my provider’s approach to my care? What outcome are we hoping to achieve with beginning Pitocin? What will we have as a result of this intervention that we currently are not experiencing?
Risks – What are the risks associated with this option? Explain the risks that Pitocin carries and their effects on both mom and baby.
Alternatives – What can we do instead of Pitocin? Are there natural remedies we can try? What about nipple stimulation? Can mom walk around on the labor and delivery floor a while?
Intuition & Indication – Mom, what does your intuition tell you about this course of action? Never ever underestimate your gut feeling. Your intuition is strong and wise and it’s prudent to heed its warnings and follow its peace, especially in labor. Also ask and consider, what is the indication motivating the provider's recommendation?
Nothing – What happens if we do nothing? If I choose not to go forward with augmentation with Pitocin, what is going to happen? As long as mom and baby are doing fine, sometimes doing nothing is the safest option. This requires patience, but it’s many times worth it.
Evidence – What does the evidence say about this option? For instance, pharmacological augmentation with Pitocin is supported by evidence after a woman’s water has been broken for 18 hours. It is not supported for a woman who is not progressing at the same rate as the Friedman’s curve. What reason is your provider giving for wanting to go down this particular path?
Decision – What is your decision? Own it. The consequences of this decision lie with you and you alone. If you choose to have Pitocin and it leads down a common path of causing further intervention and complication, ultimately you are the one that is going to be living with that decision. Your provider is not, your doula is not, your partner sometimes is not. Responsibility for the decision you make needs to be yours alone and you can move forward with it confidently after weighing all the factors at hand.
Using this acronym is something your birth doula can help you with at each step of the way as you labor. It can be applied to each decision in your pregnancy, labor, birth and postpartum time. For instance, you can use it to decide if you want to move forward with artificial rupture of the membranes (AROM), induction, cesarean, or even epidural anesthesia.
Labor is never “textbook.” It is a very individual experience for each family. Every situation is different the way labor progresses, the priorities that a family places on certain values and the way those two things come together as a baby is being born. There are no wrong choices in birth – just make sure your choices are fully informed ones.
A birth doula can help you formulate questions and think outside the medical box for options.
Doulas Benefit Providers TOO!
By now, many people know and understand the way birth doulas support mothers in labor and how this support creates healthier births. While the research backs it up, it’s kind of just plain old common sense. Women need support on the biggest day of their life, performing the greatest physical and emotional feat they will ever accomplish – of course!
But what about doctors and midwives? For their patients that employ the service of birth doulas, what benefit is a doula to the care provider? It’s a sad reality that many people – physicians included – think of doulas and care providers as being opposing forces, always trying to “win” on the side of what they feel is best for the patient/client. A professional birth doula will do no such thing.
In fact, a well trained, professional, career doula will make every effort to be of service and support to the client while being a valuable member of the birth team. Professional doulas recognize and respect that they are working within a limited, yet extremely valuable scope of practice. Fully embracing that role, they can be of benefit to care providers in many ways.
A primary priority for birth doulas is making sure that their clients have all the information to make a fully informed decision. The care provider can rest assured that their patient is discussing at length the risks, benefits, and alternatives to their options. Patients are not alone in their rooms consorting with Google, but with someone who is knowledgeable. Furthermore, the birth doula is not emotionally or financially attached to the birth so the information they give is unbiased toward any particular path. Providers are busy in hospitals caring for several patients at a time and they don’t always have the time to have great, lengthy discussions with their patients. A doula’s job is to stay with the client through the whole birth. She is committed to being there anyway and she can take all the time needed for an informed decision to be made that satisfies the family.
Once a birth doula has spent time discussing options, she can help facilitate open communication between the provider and the laboring mother. Since she has a client relationship with the mother, the doula can make sure that the mother is fully understanding what the doctor is saying. Doulas do not speak on behalf of their clients. Rather, the doula’s priority is to facilitate an open conversation where fully informed consent can be made and this limits a provider’s liability if complications arise.
Research shows that women who hire birth doulas are much more likely to rate their birth with a high level of satisfaction, regardless of how the birth played out (http://evidencebasedbirth.com/the-evidence-for-doulas/). Patients are more satisfied with their natural birth, their induction, and their cesarean. Satisfaction with the overall birth experience naturally translates into higher satisfaction with the provider. This increases the likelihood that this patient will return to this provider and that they will recommend them to others.
Doctors and midwives can also rest assured that the patient is being monitored with trained eyes. For instance, if a woman spontaneously begins pushing, a doula can recognize that and notify the staff. A professional doula knows that her scope of practice does not include any clinical skills, including catching the baby. She can sometimes be the first line of defense in ensuring that everything happens as it should ensure a healthy birth.
Evidence also shows that births with doulas have lower intervention rates. This benefits the physician because it means lower complications associated with interventions. Patient satisfaction further increases and makes the birth with a doula more likely (but of course not guaranteed) to be straightforward and uncomplicated. These tend to be simpler births for physicians.
Doulas work primarily for women in labor. However, their unique expertise in the labor room is beneficial to all of the birth team, including the primary care provider. A doula is an advocate, a source of information, and a benefit to all involved in the birth.
A “textbook” labor is said to look something like this – depending on the “book”.
From start to finish, the “average” birth is said to be around 12 hours.
*cue giggles from the birth professionals*
Ladies, throw out the book. Your bodies and your babies have not read the book, and even if they had, they are going to do their own thing anyway. We all want to know how long we are going to be in labor. If we were blessed enough to have a crystal ball that would answer such questions, we would gladly inform you! How many more contractions? How many more hours? Do I have time for my mom to arrive? Should I go to the hospital now or wait a while?
What it comes down to is: is my labor normal?
Here’s a bit of wisdom from us birth doulas: a body of experienced women that has been supporting birthing women for many years: the range of “normal” in birth is vast.
It’s normal to be in labor for 26 hours. Or more! That’s ok. In fact, longer labors tend to be easier for some women. The body gets slowly warmed up to its own rhythm while giving the mother’s own opiate-like hormones a chance to keep up with the changes happening in labor. Mom is able to stay in a very relaxed state the whole time. Furthermore, these opiate hormones tend to alter a woman’s sense of time. Hours and hours can pass and the birthing mother will have no idea how long she has been working on this labor.
Long labors are normal – and they aren’t automatically intimidating as they may sound.
It’s normal to be in labor for only 45 minutes until birth. Now, some people think that this is a great deal for the mom – only 45 minutes of labor! “Lucky you” they all declare! Except for one thing. Moms that have really fast labors still get an “8-hour labor” packed into that 45 minutes. Moms that have faster labors tend to feel like they were simply along for the ride that whole time. Her hormones are always trying to play catch up, and they don’t always reach their peak in such a short time. On the other hand, the birth went fast, then it’s over!
Short labors are normal – and they aren’t necessarily pure bliss because they are short!
All things related to birth vary in the spectrum of normal. It’s normal to be at 4 cm for several weeks. In fact, some have been known to be at 6 cm for a couple weeks while they were not having any contractions! It’s normal to have a cervix that is high, closed and firm at 40 weeks. It’s normal to be in active labor and still have contractions 5-7 minutes apart. It’s normal to be in early labor and have contractions 3 minutes apart. It’s normal to push a baby out in two pushes, as normal as taking several hours.
It’s normal for you and your baby. And that is good enough.
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Have you heard mothers compare contractions to really intense period cramps? That’s not altogether inaccurate! Many times in early labor, mothers will describe what they are feeling as “just crampy” type sensations in the lower belly. Those cramps just get stronger – it’s as simple as that.
Surely labor can’t be compared with cramps! Actually, it can! While working with my clients, I realized simplicity to help partners remember valuable techniques can be very helpful. Conveniently, I found the Acronym “CRAMPS” works well to describe ways to deal with contractions.
Counter pressure may help relieve lower back pain and pressure by opening the pelvis into a more accommodating position for the baby’s passage through the pelvis. There are two types of counter pressure: hip squeeze and sacral pressure. Both of them aim to lift the mother’s sacrum bones off of where the baby’s head is. This provides a laboring woman with tremendous relief during contractions.
DEMO: hip squeeze by hand & with Rebozo
Relaxation (guided). Guided relaxation techniques include visualization and breathing exercises. During labor and birth, these can be extremely helpful for 2 reasons. First, our muscles need oxygen to function properly. The uterus is comprised of 3 muscle sets which contract during labor. Deep breathing allows the muscles to receive a good supply of oxygen, which makes the contraction feel more like radiating waves. This keeps contractions from feeling overwhelming, and women feel that they can stay on top of them.
Second, the mental-emotional state of the woman is more stable when she is deeply relaxed and focused, and this allows her to labor more peacefully.
There are 2 techniques: Most common deep slow abdominal breathing and short and fast breathing similar to painting which is a distraction method and can be helpful during last stages of labor, though in early and active labor it increases adrenaline and fights with oxytocin.
Acupressure and Aromatherapy are very helpful tools in labor. While most doulas are not certified in acupressure or aromatherapy, parents who wish to use these techniques are encouraged to research them so they have them handy in labor.
Example: P-6 inner gate nausea
Movement allows you to play a more active part of labor. A moving mom is a moving baby. The “labor dance” uses gravity to increase the effectiveness of contractions and move your baby more deeply into your pelvis. Many women feel tremendous relief in labor simply by being able to move.
DEMO: “junior high” labor dance
Positions are crucial in labor! There are many positions to labor and birth in. Trust your body to tell you what feels right. Many women enjoy laboring on their hands and knees, standing, lunging, sitting on a birth ball, and squatting, just to name a few. Position changes are important because they help encourage the baby to move through the pelvis.
DEMO: hands & knees with birth ball
Sensation There are many types of labor support that fall into this category! Hydrotherapy (laboring in a tub or shower), tens unit, hot/cold therapy, touch/massage are just a few. Some women like to be touched in labor and others don’t. Some women enjoy it for a while then suddenly can’t stand to be touched. All of this is completely normal.
DEMO: Rebozo “Shrug Hug” – Grounds the woman and keeps her eye to eye in close proximity with her partner helping release that Love Hormone Oxytocin to help labor progress more quickly.
So, to summarize:
C- Counter pressure
R – Relaxation
A – Aromatherapy or Acupressure
M – Movement
P – Positions
S – Sensations
I hope this easy to remember acronym helps you achieve more satisfying birth experiences.
I’d love to hear what you think in our comments section down below. Is this an “Aha!” moment?
Which comfort measure do you look forward to trying?