by Michelle Schnaars
For the CAPPA Quarterly
http://www.cappa.net/quarterly2008-conference.pdf
WHAT IS A REBOZO?
The Rebozo is a traditional Mexican shawl that
is long enough to wrap around a woman's body,
with about an extra 4-5 feet of fabric.
The Rebozo is a multifunctional
tool. During pregnancy
it is used to counteract back
pain, during labor to help the
mother into various positions
and for relaxation. It can also
be worn as a shawl in cold
weather. The Rebozo is also
used as a carrier for a newborn
and up to toddler age.
WHAT DOES A REBOZO DO?
When used by a doula, the
Rebozo can be like an extension
of your arms. It allows
you to help support the laboring mom’s weight.
It can also help to ensure the mother is in the
right position.
The Rebozo can be used to help with changing a
posterior positioned baby or even a breech baby;
and it is commonly used in the second phase of
labor, like a tug-of-war, to help mom focus her
pushing and widen the pelvic outlet.
HOW TO USE A REBOZO?
A Rebozo is versatile, the following are some
basic uses:
Have mom sit upright, position the Rebozo under
her arms and over her chest. Then stand behind
her holding the ends of the Rebozo so you
are supporting mom's weight. You can gently
sway the mom from this position.
Have the mom get in a hands and
knees position. Wrap the Rebozo
under her belly and around her
thighs so that you can hold the ends
above her. Then gently sway the Rebozo
side to side.
Quoting from Spinningbabies.com.“One of the uses of the Rebozo
(woven scarf) in pregnancy is the
Manteado, or “sifting.”
Sifting is a gentle but rapid jiggling
that relaxes the mother’s involuntary
muscles in her abdominal area.
Sifting with the Rebozo is one way
to apply the 1st Principle of Spinning
Babies –relaxing the soft tissues of the abdomen.
Manteado works effectively on the broad
uterine ligament.
Sifting can be the first activity used anytime relaxation
is desired. Sift regularly through pregnancy
to help baby into a good starting position
for birth.”
Resources:
www.cuttingedgepress.net
www.birthwithsol.com
www.cappa.net
www.spinningbabies.com
Wednesday, April 30, 2008
Monday, April 28, 2008
Operation Special Delivery: In need of volunteer labor doulas
OSD is in desperate need of volunteer doulas in the Charleston area of South Carolina. If you or anyone you know could help, please visit www.operationspecialdelivery.com for details on how to volunteer.
A doula in any state can volunteer her services through OSD by applying online at the above link. This service is for military families.
A doula in any state can volunteer her services through OSD by applying online at the above link. This service is for military families.
Friday, April 25, 2008
A Day's Work:
The following article can be found online at http://findarticles.com/p/articles/mi_q4200/is_/ai_n24313159
I am particulary proud of Heidi Rau and Heidi Gonzales because I know them. They are wonderful people and doulas!
Michelle-
Heidi Gonzales and Heidi Rau are doulas in New Orleans
New Orleans CityBusiness, Feb 15, 2008 by Emilie Bahr
Heidi Gonzales and Heidi Rau share a name and a passion for the birthing process; they are doulas -- professionals who assist women before, during and after labor but do not deliver the baby.
If you've never heard of a doula you're probably not alone. Although women have been assisting in births for as long as women have been having babies, the idea of hiring a professional is creeping into vogue, at least in the New Orleans area, Gonzales and Rau said.
A doula is not the same thing as a midwife, who often is certified to deliver babies and, in the case of some certified nurse midwives, can even prescribe medicine. Gonzales is in her second year of training to become a midwife, a process she expects to take five years.
Doulas offer emotional support and advice and calm the patients during labor. They instruct in techniques some believe can shorten labor and lessen pain.
The women also help soon-to-be mothers craft a birthing plan -- a guide kept in their medical file that includes what type of laboring methods they prefer and what drugs, if any, they want to rely on, when they want to begin breastfeeding -- and help ensure their wishes are honored.
"We're there really as educators and supporters," Rau said.
Many of Rau and Gonzales' clients are first-time mothers confronted with what can be a confusing and intimidating process. Others have used a doula for a previous pregnancy and can't imagine labor without one, the women said.
I am particulary proud of Heidi Rau and Heidi Gonzales because I know them. They are wonderful people and doulas!
Michelle-
Heidi Gonzales and Heidi Rau are doulas in New Orleans
New Orleans CityBusiness, Feb 15, 2008 by Emilie Bahr
Heidi Gonzales and Heidi Rau share a name and a passion for the birthing process; they are doulas -- professionals who assist women before, during and after labor but do not deliver the baby.
If you've never heard of a doula you're probably not alone. Although women have been assisting in births for as long as women have been having babies, the idea of hiring a professional is creeping into vogue, at least in the New Orleans area, Gonzales and Rau said.
A doula is not the same thing as a midwife, who often is certified to deliver babies and, in the case of some certified nurse midwives, can even prescribe medicine. Gonzales is in her second year of training to become a midwife, a process she expects to take five years.
Doulas offer emotional support and advice and calm the patients during labor. They instruct in techniques some believe can shorten labor and lessen pain.
The women also help soon-to-be mothers craft a birthing plan -- a guide kept in their medical file that includes what type of laboring methods they prefer and what drugs, if any, they want to rely on, when they want to begin breastfeeding -- and help ensure their wishes are honored.
"We're there really as educators and supporters," Rau said.
Many of Rau and Gonzales' clients are first-time mothers confronted with what can be a confusing and intimidating process. Others have used a doula for a previous pregnancy and can't imagine labor without one, the women said.
Sad, Self-Abosorbed Shoppers Spend More Money
If you're sad and shopping, watch your wallet: A new study shows people's spending judgment goes out the window when they're down, especially if they're a bit self-absorbed.
http://www.msnbc.msn.com/id/23057223/from/ET/
http://www.msnbc.msn.com/id/23057223/from/ET/
How Jim Carrey and Jenny McCarthy's Son Recovered From Autism
This an article published on www.mercola.com
In this CNN op-ed piece, actors Jim Carrey and Jenny McCarthy reflect on their son’s recovery from autism in light of the recent federal court decision which conceded that vaccines could have contributed to another child’s autistic condition.
Carrey and McCarthy’s son, Evan, has been healed thanks to breakthroughs that may not be scientifically proven, but have definitely helped, such as a gluten-free, casein-free diet, vitamin supplementation, detox of metals, and anti-fungals for the yeast overgrowths that plagued his intestines. Once his neurological function was recovered through these medical treatments, speech therapy and applied behavior analysis helped him learn the skills he could not learn while he was frozen in autism.
When Evan was re-evaluated after these treatments, state workers were amazed by his improvement. But although Evan is now 5, not a single member of the CDC, the American Academy of Pediatrics, or any other health authority has asked to evaluate and understand how Evan recovered from autism. Instead, they simply posit that he was misdiagnosed and never had autism to begin with.
Carrey and McCarthy believe that autism is an environmental illness, and that while vaccines are not the only environmental trigger, they do play a major role. Even if the CDC is not convinced of a link between vaccines and autism, changing the vaccine schedule should be seriously considered as a precautionary measure.
Sources:
CNN April 3, 2008
In this CNN op-ed piece, actors Jim Carrey and Jenny McCarthy reflect on their son’s recovery from autism in light of the recent federal court decision which conceded that vaccines could have contributed to another child’s autistic condition.
Carrey and McCarthy’s son, Evan, has been healed thanks to breakthroughs that may not be scientifically proven, but have definitely helped, such as a gluten-free, casein-free diet, vitamin supplementation, detox of metals, and anti-fungals for the yeast overgrowths that plagued his intestines. Once his neurological function was recovered through these medical treatments, speech therapy and applied behavior analysis helped him learn the skills he could not learn while he was frozen in autism.
When Evan was re-evaluated after these treatments, state workers were amazed by his improvement. But although Evan is now 5, not a single member of the CDC, the American Academy of Pediatrics, or any other health authority has asked to evaluate and understand how Evan recovered from autism. Instead, they simply posit that he was misdiagnosed and never had autism to begin with.
Carrey and McCarthy believe that autism is an environmental illness, and that while vaccines are not the only environmental trigger, they do play a major role. Even if the CDC is not convinced of a link between vaccines and autism, changing the vaccine schedule should be seriously considered as a precautionary measure.
Sources:
CNN April 3, 2008
Monday, April 21, 2008
Seams Sew Neat Creations
Seams Sew Neat Creations
Roseburg, OR, United States
We are Shae and Beth: SAHM's who love to make life easier and healthier for you and your troops! We specialize in all sorts of hand sewn products like Diaper bags, Baby Slings, Baby Blankets, Nursing Blankets, Cloth Diapering Products, All Natural Home Products (soaps, detergant, dryer sheets, etc.), and we are glad to hear NEW IDEAS!!! We love custom orders, and we accept out of state orders, so spread the word! Between the two of us, if you can describe it, we can probably fix you up! So shoot us a line, tell us about your needs, and send us your friends! For all of you Roseburg area locals, we have a Flea Market Storefront in KID MART on Diamond Lake blvd, come see us!
Visit them online: http://www.seamssewneat.blogspot.com/
Roseburg, OR, United States
We are Shae and Beth: SAHM's who love to make life easier and healthier for you and your troops! We specialize in all sorts of hand sewn products like Diaper bags, Baby Slings, Baby Blankets, Nursing Blankets, Cloth Diapering Products, All Natural Home Products (soaps, detergant, dryer sheets, etc.), and we are glad to hear NEW IDEAS!!! We love custom orders, and we accept out of state orders, so spread the word! Between the two of us, if you can describe it, we can probably fix you up! So shoot us a line, tell us about your needs, and send us your friends! For all of you Roseburg area locals, we have a Flea Market Storefront in KID MART on Diamond Lake blvd, come see us!
Visit them online: http://www.seamssewneat.blogspot.com/
Friday, April 11, 2008
Operation Special Delivery, Delivers Volunteer Labor Doulas to Expectant Military Wives
Friday, April 11, 2008
For Childbirth and all that Entails…
http://childbirthand.blogspot.com/
by Michelle Schnaars
Due to the war against terror many spouses of servicemen are birthing without their husbands; and often without family or friends. The OSD motto is "A Hand to Hold ‘til They all Come Home". The volunteer Labor Doulas of OSD stand by their word...and the wives of military servicemen, giving piece of mind to both husbands and wives.
I recently had the pleasure of conducting an email interview with MaryBeth Nance who is the Director of Operation Special Delivery. MaryBeth provides answers about the program and insight into what makes this unique program special for military families.
Schnaars: When and why was OSD formed?
Nance: Operation Special Delivery began with the vision of Patricia Newton, a doula in southern New Jersey. Like many people, Patricia felt the need to personally respond to the tragedies of September 11, 2001 and she immediately saw the U.S. military and their families as indirect victims of the attacks. Because she was geographically located between Washington, D.C. and New York, she asked nearby doulas via the internet if they would be willing to donate their services to any pregnant woman who either lost her partner on 9-11, or would be giving birth without the presence of her partner due to military deployments. The response was overwhelming. Not only did doulas on the East Coast enthusiastically respond, but within one week, doulas from twenty states wanted to jump on the bandwagon. After growing too large for one person to maintain, Patricia offered the Operation Special Delivery program to CAPPA, the Childbirth and Postpartum Professional Association. CAPPA began running OSD on January 1, 2005. Patricia knew that CAPPA would take good care of the OSD program, due to our professionalism, care, excellent leadership team, and premier evidence-based doula, childbirth, lactation, and postpartum training and certification programs.
Schnaars: What is your web address?
Nance: www.operationspecialdelivery.com
Schnaars: How can someone apply for a labor doula?
Nance: Anyone who is interested in applying for services from Operation Special Delivery may visit our website at www.operationspecialdelivery.com for additional information.
Schnaars: How many doulas volunteer with the program?
Nance: We currently have 600 volunteer doulas in the Operation Special Delivery program.
Schnaars: How many families have been paired with a doula?
Nance: Since March of 2005, Operation Special Delivery has served 609 families. The number of lives that we touch grows on a daily basis.
Schnaars: Does OSD offer other types of support?
Nance: Currently, OSD offers only volunteer labor doulas but we are hoping to expand in the near future to include childbirth educators, lactation consultants and postpartum doulas.
Schnaars: How many states is OSD in?
Nance: We are present in nearly every state and several locations internationally.
Schnaars: What makes this type of support necessary?
Nance: The women who apply for volunteer doulas from our program have husbands or partners who are deployed and they have no friends or family nearby, or those support people are tasked with caring for older children while the woman is in labor. No woman should have to give birth alone and especially not the women from the families who are giving so much to protect and defend our freedoms.
Schnaars: How do you find doulas who will volunteer their time?
Nance: We promote through websites, including CAPPA’s and our own, promotional brochures and posters. Many doula trainers offer our information in their trainings and a lot of new volunteers find out about our program from other doulas.
Schnaars: Are the doulas trained or certified?
Nance: OSD requires all volunteer doulas to be professionally trained. Many are also certified, however that is not a requirement to volunteer.
Schnaars: What do families say about the support they have received? What is the feed-back?
Nance: Sometimes we hear back from the families who have utilized our services and each time it is with praise and thanks for helping them make their birth experience wonderful even though they were in less than ideal circumstances.
Resources:
If you would like to apply for an OSD volunteer labor doula please visit the OSD website at the address listed below.
For Childbirth and all that Entails…
http://childbirthand.blogspot.com/
by Michelle Schnaars
Due to the war against terror many spouses of servicemen are birthing without their husbands; and often without family or friends. The OSD motto is "A Hand to Hold ‘til They all Come Home". The volunteer Labor Doulas of OSD stand by their word...and the wives of military servicemen, giving piece of mind to both husbands and wives.
I recently had the pleasure of conducting an email interview with MaryBeth Nance who is the Director of Operation Special Delivery. MaryBeth provides answers about the program and insight into what makes this unique program special for military families.
Schnaars: When and why was OSD formed?
Nance: Operation Special Delivery began with the vision of Patricia Newton, a doula in southern New Jersey. Like many people, Patricia felt the need to personally respond to the tragedies of September 11, 2001 and she immediately saw the U.S. military and their families as indirect victims of the attacks. Because she was geographically located between Washington, D.C. and New York, she asked nearby doulas via the internet if they would be willing to donate their services to any pregnant woman who either lost her partner on 9-11, or would be giving birth without the presence of her partner due to military deployments. The response was overwhelming. Not only did doulas on the East Coast enthusiastically respond, but within one week, doulas from twenty states wanted to jump on the bandwagon. After growing too large for one person to maintain, Patricia offered the Operation Special Delivery program to CAPPA, the Childbirth and Postpartum Professional Association. CAPPA began running OSD on January 1, 2005. Patricia knew that CAPPA would take good care of the OSD program, due to our professionalism, care, excellent leadership team, and premier evidence-based doula, childbirth, lactation, and postpartum training and certification programs.
Schnaars: What is your web address?
Nance: www.operationspecialdelivery.com
Schnaars: How can someone apply for a labor doula?
Nance: Anyone who is interested in applying for services from Operation Special Delivery may visit our website at www.operationspecialdelivery.com for additional information.
Schnaars: How many doulas volunteer with the program?
Nance: We currently have 600 volunteer doulas in the Operation Special Delivery program.
Schnaars: How many families have been paired with a doula?
Nance: Since March of 2005, Operation Special Delivery has served 609 families. The number of lives that we touch grows on a daily basis.
Schnaars: Does OSD offer other types of support?
Nance: Currently, OSD offers only volunteer labor doulas but we are hoping to expand in the near future to include childbirth educators, lactation consultants and postpartum doulas.
Schnaars: How many states is OSD in?
Nance: We are present in nearly every state and several locations internationally.
Schnaars: What makes this type of support necessary?
Nance: The women who apply for volunteer doulas from our program have husbands or partners who are deployed and they have no friends or family nearby, or those support people are tasked with caring for older children while the woman is in labor. No woman should have to give birth alone and especially not the women from the families who are giving so much to protect and defend our freedoms.
Schnaars: How do you find doulas who will volunteer their time?
Nance: We promote through websites, including CAPPA’s and our own, promotional brochures and posters. Many doula trainers offer our information in their trainings and a lot of new volunteers find out about our program from other doulas.
Schnaars: Are the doulas trained or certified?
Nance: OSD requires all volunteer doulas to be professionally trained. Many are also certified, however that is not a requirement to volunteer.
Schnaars: What do families say about the support they have received? What is the feed-back?
Nance: Sometimes we hear back from the families who have utilized our services and each time it is with praise and thanks for helping them make their birth experience wonderful even though they were in less than ideal circumstances.
Resources:
If you would like to apply for an OSD volunteer labor doula please visit the OSD website at the address listed below.
If you area a doula and would like to volunteer your services please visit the OSD website and fill out an application.
April is Cesaean Awareness Month!
03 April, 2008
from: http://saffrondoula-coloradosprings.blogspot.com/
April is Cesarean Awareness Month!
31.1% of American babies are born by cesarean section, major abdominal surgery. The World Health Organization has been saying for years that rates above 10-15% for ANY nation are high enough that the risks of the surgery outweight any possible benefits. This means that as much as 20% of new mothers and babies are being put at unnecessary risk.
April has been designated as Cesarean Awareness Month. Take the time this month to learn more about the cesarean rates in the United States, in your state, and in your local area. Visit the International Cesarean Awareness Network's web site and get involved.http://www.msplinks.com/MDFodHRwOi8vd3d3LmljYW4tb25saW5lLm9yZw==.
Consider too, getting involved in fighting for VBAC (Vaginal Birth After Cesarean) by writing to your senators and hospitals that do not "allow" VBAC. In Colorado, the majority of Western Slope hospitals now have VBAC "bans" in place, directly interfering with the human rights of women to birth their babies as nature intended, physiologically. Research has proven time and again that VBAC is safer than an automatic repeat cesarean for the vast majority of women. Medical law makes such bans illegal because they remove a woman's right to choose what will be done to her body. It is a fight worth fighting. Again, the ICAN web site is one to visit to read about this issue.
Get involved. Make change. The health of women and babies depend on it.
from: http://saffrondoula-coloradosprings.blogspot.com/
April is Cesarean Awareness Month!
31.1% of American babies are born by cesarean section, major abdominal surgery. The World Health Organization has been saying for years that rates above 10-15% for ANY nation are high enough that the risks of the surgery outweight any possible benefits. This means that as much as 20% of new mothers and babies are being put at unnecessary risk.
April has been designated as Cesarean Awareness Month. Take the time this month to learn more about the cesarean rates in the United States, in your state, and in your local area. Visit the International Cesarean Awareness Network's web site and get involved.http://www.msplinks.com/MDFodHRwOi8vd3d3LmljYW4tb25saW5lLm9yZw==.
Consider too, getting involved in fighting for VBAC (Vaginal Birth After Cesarean) by writing to your senators and hospitals that do not "allow" VBAC. In Colorado, the majority of Western Slope hospitals now have VBAC "bans" in place, directly interfering with the human rights of women to birth their babies as nature intended, physiologically. Research has proven time and again that VBAC is safer than an automatic repeat cesarean for the vast majority of women. Medical law makes such bans illegal because they remove a woman's right to choose what will be done to her body. It is a fight worth fighting. Again, the ICAN web site is one to visit to read about this issue.
Get involved. Make change. The health of women and babies depend on it.
A Risky Rise in C-Section
http://health.usnews.com/articles/health/sexual-reproductive/2008/03/28a-risky-rise-in-c-sections.html?PageNr=1
(to view this article with working links please click the link above)
Experts worry that the trend is bad for mom and baby
By Deborah Kotz
Posted March 28, 2008
Once the delivery option of last resort, cesarean sections are now all the rage: Nearly 1 in 3 pregnant women had a C-section in 2006, compared with about 1 in 5 a decade earlier. "It's not unthinkable that in our lifetime, the majority of pregnant women will be having C-sections," says Bruce Flamm, an obstetrician-gynecologist at Kaiser Permanente Medical Center in Riverside, Calif., and spokesperson for the American College of Obstetricians and Gynecologists. "Is that a good thing or a bad thing? I think you get strong arguments on either side." Supporters believe that surgery eliminates the rare but terrifying complications of vaginal delivery that result in birth injuries or even a baby's death. Those who favor cutting back on cutting decry the lengthy recuperation and the increased risks during subsequent pregnancies of uterine rupture and other problems.
One driving force behind the surge in surgeries has been the sharp reversal in the trend toward "vaginal births after cesareans" after a handful of studies found a VBAC raises the risk of uterine rupture. Yet now doctors may have gone too far in limiting the practice, says Gene Declercq, a professor of maternal and child health at the Boston University School of Public Health who has researched the use of C-sections. More recent research contradicts the worrisome VBAC findings; a study published in the February issue of the journal Obstetrics & Gynecology found that of more than 13,000 women who attempted a VBAC, nearly three quarters were able to avoid another C-section, and the risk of uterine rupture was less than 1 percent.
Obstetricians' rising malpractice insurance premiums may play a role, too. Individual doctors in many states now pay upwards of $100,000 a year for coverage, a figure that can spike if they're sued for something that goes wrong during labor, regardless of the legal outcome. "If there's no labor, there can be no lawsuit related to labor," says Flamm, who points out wryly that parents rarely sue over unnecessary C-sections. Breech babies are now nearly always delivered via C-section, and the surgery has become routine for twins and large babies. "What would have been a forceps delivery 20 years ago would now be a C-section," says Flamm.
Efficiency factor. And the trend toward favoring surgery could be feeding on itself. "Obstetricians aren't as good at managing vaginal births as they used to be," says Declercq. It's a lot easier for them to, say, take an 8-pound baby out through an incision than maneuver him or her through the pelvic opening. What's more, the efficiency factor is enticing. "It organizes their day infinitely better to do scheduled C-sections," Declercq says.
A growing number of women, too, prefer planned surgical deliveries. Fewer mothers-to-be have the time or willingness to attend natural-childbirth classes, and some request a C-section even without a medical reason; those women now account for an estimated 3 percent of births in the country. Certain celebrities have even reportedly scheduled cesareans three or four weeks before their due date, to minimize stretch marks and saggy loose skin. Flamm says he has done several C-sections without any medical indications, usually for patients afraid of the pain of labor. "One woman told me she witnessed her sister's 'nightmare' birth," he recalls, "and didn't want to go through that herself."
So what's the harm? For one thing, experts say, C-sections mean a longer hospital stay and weeks of recuperation. In a survey of nearly 1,600 new mothers, Declercq and his colleagues found that more than three quarters of the ones who had had C-sections felt abdominal pain over the next two months and about 1 in 5 was having discomfort after six months. More worrisome is the higher likelihood during future pregnancies of having placenta previa, in which the placenta blocks the cervix and detaches during labor (potentially cutting off the baby's oxygen supply), or a ruptured uterus, increasing the possibility of hyserectomy and fetal death in utero. The surgery also carries a slightly elevated risk of death for the mother because of complications from anesthesia, infections, and blood clots. And scar tissue that forms at the incision site can lead to bowel obstruction years or decades later.
Lung risks. Having a planned C-section two or three weeks before the due date is particularly risky, even though babies born at that point are considered to be full term. In December, researchers reported in the British Medical Journal that babies delivered by elective C-section three weeks before the due date, compared with same-age babies delivered vaginally or by emergency C-section, had four times the risk of breathing complications and five times the risk of serious lung problems because of immature lung development. The risks were lower but still elevated among those born two weeks early. Although doctors are supposed to wait until 39 weeks—a week before the due date—to perform a planned C-section, all too frequently they do the surgery earlier for convenience or because of an incorrect estimation of the due date.
Going through the process of labor, regardless of how a baby is delivered, may confer benefits as well, says study leader Anne Kirkeby Hansen, a research fellow at Aarhus University Hospital in Denmark. "Certain stress hormones are released right before and during labor that are very important for lung maturity."
There's no question that some women need C-sections, such as those with placenta previa. But the World Health Organization recommends a cap of 15 percent of deliveries—the U.S. rate in 1978—based on evidence showing that higher levels don't benefit either mother or baby. Though the drama-free planned C-section certainly has its appeal, Declercq stresses that women and doctors need to "stop seeing it as just another surgery."
(to view this article with working links please click the link above)
Experts worry that the trend is bad for mom and baby
By Deborah Kotz
Posted March 28, 2008
Once the delivery option of last resort, cesarean sections are now all the rage: Nearly 1 in 3 pregnant women had a C-section in 2006, compared with about 1 in 5 a decade earlier. "It's not unthinkable that in our lifetime, the majority of pregnant women will be having C-sections," says Bruce Flamm, an obstetrician-gynecologist at Kaiser Permanente Medical Center in Riverside, Calif., and spokesperson for the American College of Obstetricians and Gynecologists. "Is that a good thing or a bad thing? I think you get strong arguments on either side." Supporters believe that surgery eliminates the rare but terrifying complications of vaginal delivery that result in birth injuries or even a baby's death. Those who favor cutting back on cutting decry the lengthy recuperation and the increased risks during subsequent pregnancies of uterine rupture and other problems.
One driving force behind the surge in surgeries has been the sharp reversal in the trend toward "vaginal births after cesareans" after a handful of studies found a VBAC raises the risk of uterine rupture. Yet now doctors may have gone too far in limiting the practice, says Gene Declercq, a professor of maternal and child health at the Boston University School of Public Health who has researched the use of C-sections. More recent research contradicts the worrisome VBAC findings; a study published in the February issue of the journal Obstetrics & Gynecology found that of more than 13,000 women who attempted a VBAC, nearly three quarters were able to avoid another C-section, and the risk of uterine rupture was less than 1 percent.
Obstetricians' rising malpractice insurance premiums may play a role, too. Individual doctors in many states now pay upwards of $100,000 a year for coverage, a figure that can spike if they're sued for something that goes wrong during labor, regardless of the legal outcome. "If there's no labor, there can be no lawsuit related to labor," says Flamm, who points out wryly that parents rarely sue over unnecessary C-sections. Breech babies are now nearly always delivered via C-section, and the surgery has become routine for twins and large babies. "What would have been a forceps delivery 20 years ago would now be a C-section," says Flamm.
Efficiency factor. And the trend toward favoring surgery could be feeding on itself. "Obstetricians aren't as good at managing vaginal births as they used to be," says Declercq. It's a lot easier for them to, say, take an 8-pound baby out through an incision than maneuver him or her through the pelvic opening. What's more, the efficiency factor is enticing. "It organizes their day infinitely better to do scheduled C-sections," Declercq says.
A growing number of women, too, prefer planned surgical deliveries. Fewer mothers-to-be have the time or willingness to attend natural-childbirth classes, and some request a C-section even without a medical reason; those women now account for an estimated 3 percent of births in the country. Certain celebrities have even reportedly scheduled cesareans three or four weeks before their due date, to minimize stretch marks and saggy loose skin. Flamm says he has done several C-sections without any medical indications, usually for patients afraid of the pain of labor. "One woman told me she witnessed her sister's 'nightmare' birth," he recalls, "and didn't want to go through that herself."
So what's the harm? For one thing, experts say, C-sections mean a longer hospital stay and weeks of recuperation. In a survey of nearly 1,600 new mothers, Declercq and his colleagues found that more than three quarters of the ones who had had C-sections felt abdominal pain over the next two months and about 1 in 5 was having discomfort after six months. More worrisome is the higher likelihood during future pregnancies of having placenta previa, in which the placenta blocks the cervix and detaches during labor (potentially cutting off the baby's oxygen supply), or a ruptured uterus, increasing the possibility of hyserectomy and fetal death in utero. The surgery also carries a slightly elevated risk of death for the mother because of complications from anesthesia, infections, and blood clots. And scar tissue that forms at the incision site can lead to bowel obstruction years or decades later.
Lung risks. Having a planned C-section two or three weeks before the due date is particularly risky, even though babies born at that point are considered to be full term. In December, researchers reported in the British Medical Journal that babies delivered by elective C-section three weeks before the due date, compared with same-age babies delivered vaginally or by emergency C-section, had four times the risk of breathing complications and five times the risk of serious lung problems because of immature lung development. The risks were lower but still elevated among those born two weeks early. Although doctors are supposed to wait until 39 weeks—a week before the due date—to perform a planned C-section, all too frequently they do the surgery earlier for convenience or because of an incorrect estimation of the due date.
Going through the process of labor, regardless of how a baby is delivered, may confer benefits as well, says study leader Anne Kirkeby Hansen, a research fellow at Aarhus University Hospital in Denmark. "Certain stress hormones are released right before and during labor that are very important for lung maturity."
There's no question that some women need C-sections, such as those with placenta previa. But the World Health Organization recommends a cap of 15 percent of deliveries—the U.S. rate in 1978—based on evidence showing that higher levels don't benefit either mother or baby. Though the drama-free planned C-section certainly has its appeal, Declercq stresses that women and doctors need to "stop seeing it as just another surgery."
The Tatia Oden French Memorial Foundation
Mission: The Tatia Oden French Memorial Foundation is dedicated to empowering women, specifically in the area of childbirth and pregnancy.
We are dedicated to saving the lives of those giving life to others.The Tatia Oden French Memorial Foundation is presently focusing on the issues of informed consent, the off-label use of drugs, and maternal mortality.
For more information visit www.tatia.org
We are dedicated to saving the lives of those giving life to others.The Tatia Oden French Memorial Foundation is presently focusing on the issues of informed consent, the off-label use of drugs, and maternal mortality.
For more information visit www.tatia.org
Wednesday, April 09, 2008
Benefits of Childbirth Education
By Michelle Schnaars
June 13, 2007
Previously printed in the CAPPA Quarterly
Expectant parents usually have a lot of questions about the process of labor and childbirth. One of the best ways to prepare for the birth of your baby is to enroll in a childbirth preparation class.
Childbirth Education Classes teach relaxation techniques, labor positions, and various coping methods that help make the event as positive as possible. The classes will also give you an overview of the physical and emotional aspects of each stage of labor and birth, the various kinds of pain relief most commonly used, and possible complications.
Most instructors encourage the use of a labor support person, which can be the father of the baby, but can be a relative, friend or a professional known as a labor doula. Among the media used in class are videos of childbirth which depict hospital birth, cesarean birth and un-medicated birth. Often instructors have an extensive library available for class participants to borrow including books and videos.
Childbirth education enhances a woman’s confidence in her innate ability to give birth. It fosters a positive feeling toward the birth and her baby. Understanding the process of childbirth and the sensations and emotional changes that occur can help to decrease the need for drugs such as epidural, and reduce the need for a cesarean section, and reduce anxieties. Childbirth education also facilitates positive birth outcomes and sets the stage for the successful initiation of breastfeeding and adjustment to new parenthood.
During the series parents have the opportunity to practice a variety of birth tools including birth balls and massage tools. Parents also learn about the benefits of different labor and birth positions that will bring about comfort and help facilitate the baby’s birth.
Childbirth education classes are designed to provide information and tools for expectant mothers and their partners so they can strive for as normal a labor and birth as possible. Moms learn ways to remain healthy and low risk throughout pregnancy by exercising and eating healthy foods. Parents are encouraged to ask questions and become a part of the decision making process.
Childbirth education classes help to relieve some of the fears and anxieties that expectant parents may have. You can discuss your fears about labor and birth with the instructor and other couples with the same concerns. Your partner will learn how to support you during labor. Many couples find that attending childbirth classes together helps create a special bond. Expectant parents also gain a support group through childbirth education classes. Often couples form lasting friendships.
Childbirth education classes provide an opportunity to become familiar with community resources including local breastfeeding educators and counselors, postpartum doulas, and baby nurses. Parents have the benefit of learning breastfeeding positions, and newborn care such as bathing, diapering and alternative feeding methods. Often classes include a ‘meet the expert night’ and you can hear from and meet lactation educators, baby wearing instructors, diapering experts, and doulas.
Studies show a women’s confidence in her ability to birth positively is increased when she has attended a childbirth education class.
Resources:
www.cappa.net
www.opertaionspecialdelivery.com
www.welcomebaby.com
www.waterbirth.org
www.risingmoonmidwifery.com
June 13, 2007
Previously printed in the CAPPA Quarterly
Expectant parents usually have a lot of questions about the process of labor and childbirth. One of the best ways to prepare for the birth of your baby is to enroll in a childbirth preparation class.
Childbirth Education Classes teach relaxation techniques, labor positions, and various coping methods that help make the event as positive as possible. The classes will also give you an overview of the physical and emotional aspects of each stage of labor and birth, the various kinds of pain relief most commonly used, and possible complications.
Most instructors encourage the use of a labor support person, which can be the father of the baby, but can be a relative, friend or a professional known as a labor doula. Among the media used in class are videos of childbirth which depict hospital birth, cesarean birth and un-medicated birth. Often instructors have an extensive library available for class participants to borrow including books and videos.
Childbirth education enhances a woman’s confidence in her innate ability to give birth. It fosters a positive feeling toward the birth and her baby. Understanding the process of childbirth and the sensations and emotional changes that occur can help to decrease the need for drugs such as epidural, and reduce the need for a cesarean section, and reduce anxieties. Childbirth education also facilitates positive birth outcomes and sets the stage for the successful initiation of breastfeeding and adjustment to new parenthood.
During the series parents have the opportunity to practice a variety of birth tools including birth balls and massage tools. Parents also learn about the benefits of different labor and birth positions that will bring about comfort and help facilitate the baby’s birth.
Childbirth education classes are designed to provide information and tools for expectant mothers and their partners so they can strive for as normal a labor and birth as possible. Moms learn ways to remain healthy and low risk throughout pregnancy by exercising and eating healthy foods. Parents are encouraged to ask questions and become a part of the decision making process.
Childbirth education classes help to relieve some of the fears and anxieties that expectant parents may have. You can discuss your fears about labor and birth with the instructor and other couples with the same concerns. Your partner will learn how to support you during labor. Many couples find that attending childbirth classes together helps create a special bond. Expectant parents also gain a support group through childbirth education classes. Often couples form lasting friendships.
Childbirth education classes provide an opportunity to become familiar with community resources including local breastfeeding educators and counselors, postpartum doulas, and baby nurses. Parents have the benefit of learning breastfeeding positions, and newborn care such as bathing, diapering and alternative feeding methods. Often classes include a ‘meet the expert night’ and you can hear from and meet lactation educators, baby wearing instructors, diapering experts, and doulas.
Studies show a women’s confidence in her ability to birth positively is increased when she has attended a childbirth education class.
Resources:
www.cappa.net
www.opertaionspecialdelivery.com
www.welcomebaby.com
www.waterbirth.org
www.risingmoonmidwifery.com
Tuesday, April 08, 2008
Looking to Nature, Doula Penny Simkin Practices the Art of Delivery
Monday, March 24, 2008 - Page updated at 01:26 PM
Cover Story
Looking to nature, doula Penny Simkin practices the art of delivery
By Paula Bock
Penny Simkin's cheerfully cluttered basement office looks nothing like a sterile hospital.
It's graced by maternity tchotchkes collected from around the world, piled with books and scientific journal articles about birth (many penned by her), thumbtacked with whimsical reunion snapshots of babies leaning precariously against each other on the couch.
Simkin's pug, Hugo, wheezes while Simkin putters, wadding a doll baby and crimson "placenta" pillow into a hand-knit argyle "uterus" sack. She cinches a rubberband around the opening. There. That's the "cervix" — ready to dilate. Class starts in half an hour.
Nearly 70 years old, Simkin is an internationally revered childbirth educator who, with nurse co-authors Janet Whalley and Ann Keppler, literally wrote the book on giving birth: "Pregnancy, Childbirth and the Newborn." It's been translated into Russian and Italian, among other languages; more than a million copies sold.
Known as the mother of the doula movement, Simkin has trained thousands of these caregivers to provide physical and emotional support for women during birth — the only intervention scientifically shown to decrease time in labor (by 25 percent) as well as to reduce Cesarean-section rates by a third.
"Birth never changes," Simkin says. "But the way we manage it and the way we think of it has. Right now, we're in a culture of fear around birth." Pain, medical mishaps, lawsuits.
"In our fear that we might have a bad outcome, we decide Cesarean is the answer for everything, and so we're losing the skill and art" of delivering babies, Simkin says. "For six years, nobody's done a breech birth. Some don't even know how to turn a baby who's posterior!"
Cesarean rates have climbed to 32 percent in Seattle, an all-time high on par with the rest of the nation, and an increase of more than 50 percent in a decade. While a direct link has not been proven, infant and maternal deaths are rising, too.
"Things are not so marvelous in birth these days," says Dr. Michael Klein, who studies worldwide Cesarean trends as an emeritus professor of family practice and pediatrics at the University of British Columbia. "To say it's medicalized is an understatement. It's industrialized. Somehow, Penny remains optimistic."
With earthy humor and a steadfast belief in evidence-based medicine rooted in scientific study (rather than hospital fashion), Simkin preaches a radical notion: Birth is normal. Birth is natural. Women deserve the support they need to have the kind of birth they want.
Birth is also political — mired in insurance regulation, hospital protocols, legal anxiety and hectic lives. Insurance doesn't reimburse as much for midwives as for doctors; learning how to give birth takes time; Cesarean births are convenient for schedules; high-tech births fuel a big business in drugs and medical equipment.
Experts may differ on whether to offer massage or drugs during hard labor, but they all acknowledge Simkin as a "living treasure" for her knowledge about birth, compassion for women, and ability to teach skills developed during 40 years in the field.
"How Will She Remember It?" Simkin's mantra. She's printed the phrase on doula T-shirts to remind hospital staff to be sensitive to laboring moms. "When you start focusing on a woman's experience of birth and not just the issue of natural childbirth," Simkin says, "it opens up a whole new world."
Simkin is not a die-hard natural-birth proponent, but she does wonder why women have become so timid about birth when they're so powerful in other aspects of life.
"I'm so sad that women think birth is impossible," Simkin says. "They're also very busy and don't have time for classes. There are very few sources where they can get confidence in themselves . . . Women are so fit and athletic and run marathons, and yet think they can't do birth.
"I want people to appreciate how well their bodies are designed to give birth. Every cell in your body knows how."
PENELOPE PAYSON was born in 1938 in Maine, the third of six children. Her father owned a hardware store and served on the school board and water commission. Her stay-at-home mom led a Girl Scout troop and victory projects for the war. They expected their children to do chores and community service and to stay out of trouble.
In a small town where many youngsters drank and a third of the girls got pregnant before graduation, Penny was different, a swimming champion good enough to try out for the Olympics. "She was feisty," recalls sister Helen Seager. "She could do things girls weren't expected to do. . . . Even though I was the older one, she was my idol." Penny, herself, recalls being so sensitive that when punished for misbehaving at 9, she vowed to never forget what it was to be a kid. That vow, Simkin says, has helped her be aware of other people's feelings ever since. Growing up, Penny knew nothing about birth. Her mother, like many American women at that time, had been drugged during births and couldn't remember.
Penny chose Swarthmore College for its undefeated swim team; she graduated as swim captain with a degree in English literature. During her junior year, she married Peter Simkin, a medical student, and after graduation studied physical therapy at the University of Pennsylvania.
At 23, they moved to North Carolina and she became pregnant with their first child. It was 1961, the start of a movement toward natural childbirth, and her doctor told her she'd be an excellent candidate. But her son was 22 days post due-date, 10 pounds 4 ounces, and facing the wrong way. She ended up being induced, laboring unsuccessfully, then having general anesthesia and a forceps delivery.
"I felt awful because the doctor told me I would have a natural birth, and I wanted to please the doctor," Simkin says. "Then he grabbed my ankle, looked in my eyes and said: 'What a trouper.' He made me feel I didn't have to be ashamed." For Penny, the doctor's compassionate treatment was pivotal; it became the philosophical seed of her life's work.
Within five years, she had three more children (two natural births, one with epidural anesthesia to block the pain), and after most of the kids were in school, she started teaching childbirth classes, figuring it would be a good use of physical-therapy skills.
She was a born teacher, delved into research, spoke at conferences, and attended many students' births as a doula before the role had that name. She invented a "birth bar" and birth sling to help women squat and lean during labor; codified birth plans to give women more control over the process; co-authored several books; edited a journal of current scientific literature about birth; pioneered pregnancy-care techniques and counseling for survivors of sexual abuse.
After 20 years, career crisis. Cesarean rates were climbing in the late-'80s, and the trend was to focus on parenting rather than on birth. After all, birth was only one day.
Does childbirth really matter? Simkin wondered.
Over the years, she'd had students write their birth stories and fill out questionnaires, and she'd saved them all. She tracked down 24 students from her first classes, and asked them to recall their birth experiences — 20 years later. Simkin compared original versions with new.
"It was uncanny how clear their memories were and how powerful," Simkin says. She interviewed 20 women in person. Nine wept as they talked, some out of joy and pride, others from anger and remorse. The women who were satisfied with their births didn't necessarily have an easy time or a natural birth, Simkin says. What mattered was how they were cared for by medical staff.
"We can't control labor, whether it's hard; that's a leap of faith," Simkin says. "But we can always control how we care for her." Even though it's only one day, women are more vulnerable, Simkin says. There's pain, exposure, dependence on others, possibility of physical harm, authority figures who may, or may not, be sensitive. One in four women today describes birth as having been traumatic. What women really need, she decided, was an experienced, caring advocate who would not only coach them through the physical part of labor but also tend to their emotional needs. So Simkin helped start regional and international doula associations, PALS and DONA, and trained doulas at a rapid pace. She taught the senior doulas to train new doulas for ripple effect. Within a few years, there were thousands of doulas, and the concept was on the map.
"If a woman is empowered by birth, she thinks: 'If I can do that, I can do anything' — for the rest of her life," Simkin says. "If she was humiliated or shamed, what she learns is: 'I'm a wimp. I can't handle pain.' How does that affect how she deals with other things?"
WOMEN, OF course, have been giving birth since the start of humanity. Yet until fairly recently, birth was likely the most dangerous event of their lives.
A century ago, one in 100 women died during childbirth. In the United States, that number is now one in 4,800. (In sub-Saharan Africa, the current risk of maternal death is one in 22; in Afghanistan, one in eight — a reflection of malnutrition, disease, poor health care.)
In the U.S. through the 1800s, most women gave birth at home, assisted by midwives, relatives, their husbands. Hospital births began in the 1900s, mostly in cities. Doctors began using anesthetics ether and chloroform; narcotics such as Demerol; "forgetting drugs."
Simkin calls the ether-soaked 1940s and '50s the dark age of obstetrics. She roots around filing cabinets in her basement and pulls out a startling investigative series, "Cruelty in Maternity Wards," by the Ladies Home Journal.
The exposé started in 1957 with publication of an anonymous letter from a Chicago nurse asking the magazine to investigate "tortures" in delivery rooms. The nurse described mothers "strapped down with cuffs around her arms and legs and steel clamps over her shoulders and chest" for more than eight hours; doctors suturing without anesthetic; an obstetrician who ordered nurses to "slow things up" by tying a laboring woman's legs together while he went to dinner.
The nurse's letter triggered hundreds more from readers who described other horrors, including children who'd suffered brain damage from lack of oxygen because delivery had been forcibly delayed.
The series helped spark a countermovement toward natural childbirth. Husbands demanded to stay with their wives during labor; expecting parents Clifford and Audrey Stone in Seattle sued to do so in 1958. The judge ruled against them, saying he had no authority to regulate obstetrical practice. Simkin recalls another Seattle father who handcuffed himself to his wife during the labor.
Enter Grantly Dick-Read, a British physician who taught relaxation and controlled breathing to reduce fear and pain. In the late '50s, his worldwide teaching tour touched down in four North American cities, including Seattle, leaving pockets of natural-childbirth advocates. Among them was family doctor Virginia Larson, founder of the Seattle Association of Childbirth Education. She became Simkin's mentor.
Simkin's career grew with the natural-childbirth movement in the 1960s and '70s. Urban middle-class moms were clamoring for midwives so much that some midwives left Appalachia and the migrant communities they'd originally trained to serve.
By the 1980s, hospitals tried to lure back middle-class moms — and their health insurance — by building comfy home-like birthing suites. Advertisements touted flowered curtains, straw hats decorating the doors and epidurals.
Home-birth midwifery dwindled in other parts of the country, but it's still thriving here, fueled by the Seattle Midwifery School. Simkin calls Seattle the best place in the country to have a baby because of the many options: midwives, home births, birthing centers, high-tech hospitals.
The problem with hospitals, she says, is that when it comes to birth, they often don't practice evidence-based medicine. They induce labor unnecessarily, she says, and that feeds C-sections. They use continuous electronic fetal monitoring that has not been found to improve outcomes. "Yet it's a big industry and nurses are terrified if the monitor isn't on," Simkin says. Even worse, slight blips in the baby's heart rate often make docs scurry to do a C-section. "If doctors would just listen to their own literature!"
In 2003, the American College of Obstetricians and Gynecologists gave a nod to elective C-sections requested by healthy moms who want only one or two children. Aghast, other birth professionals cite studies about C-section's hazards, including greater risk of infection, blood clots, death; surgical injuries; increased infertility and a chance the next baby's placenta could get stuck to the old scar and hemorrhage.
Much of the rise in C-section rates is patient-driven, says Dr. Nancy O'Neil, a respected Seattle obstetrician/gynecologist. "The U.S. is such a trendy country. . . In the late '70s, early '80s, people would do anything to have a vaginal birth. Seattle was natural . . . Now, the city has become more of a city. Educated older patients are used to having a lot more control over their lives, and the idea of scheduling something and having it be controlled is very appealing. That's why it's really important to have people like Penny who say, 'Stop! Look at the advantages of vaginal birth.' . . . Some people feel vaginal birth will become archaic."
O'Neil calls Simkin a bridge. "Her book on childbirth is the bible we all use . . . She also helps patients realize, yeah, natural childbirth is great but y'know what? There's a lot that's great about medicine, too."
Simkin, who's attended more than 750 births as a doula and still takes cases, says she's not done. Her goal is to leave vast knowledge about supporting women in natural childbirth "so when we finally hit 50 percent C-sections or 80 percent and people say we have to find a better way, it's time to swing back with the pendulum, (we won't) have to reinvent the wheel."
TEACHING IS what Simkin loves best. With a calm voice, plump lap and Mr. Rogers-like gentleness, Simkin combines common sense with facts-you-can-use science.
Eat almonds, leafy greens and dark chocolate in the last few weeks of pregnancy to stave off anemia as the baby drains mom's iron; touch your tongue to the roof or your mouth so you won't hyperventilate during heavy contractions.
She teaches birth partners how to squeeze a laboring woman's hips to take the edge off back ache; how to rock through contractions in a slow dance; how to manage pain through rhythm, relaxation and ritual.
Simkin's childbirth classes are so popular that Scott and Debbie Fynn stayed up until 2 a.m. while vacationing in Tokyo last fall just to call her office at 9 a.m., Seattle time, on the first day of registration for the three-month class.
"She's so enthusiastic and easy to listen to," Debbie says, "even though you'd think when you're huge and waddling, you wouldn't want to sit in a chair for two hours."
On Monday night, a wiggly class of small children surrounds Simkin; she's preparing them for the births of siblings — "your babies. Can we all say umbilical cord? Um-bil-i-cal! I love that word!"
The Wednesday-night class, the series' last, , has a certain urgency. The couples practice double hip squeezes, slow dancing, then Simkin falls to her knees in hard labor. OOOhh, she moans, face contorted. She shakes, writhes, hyperventilates.
"OK," says Russell Grandinetti, a 36-year-old father-to-be who volunteers to play the role of birth partner. "I know. It's coming."
"HELP me!" Simkin yells. Get your head down close, she stage whispers. Grandinetti kneels, nose to nose with Simkin.
"You're doing great. Look at me, Penny." He breathes loud, rhythmically, flaps his hand, like a conductor. She moans in sync.
"I HATE THIS!"
"You're making good progress. Doing great!"
Gasp! Gasp!! "I'm going to vomit!"
"OK. That's good! Don't worry about it, we got the doula helping!"
Everyone laughs. Simkin commends Grandinetti for helping her cope and keep a rhythm. "He didn't have panic on his face. That's important. You have to look like you have confidence in the woman."
There's a pause as couples realize labor will soon be for real.
"When you get to complete dilation," after the hardest contractions but before spontaneous pushing, Simkin tells them, "your spirits will rise. I love that rise. "
Then it's over. Three months. Videos, role-plays, hundreds of tips. Simkin sips some water, unplugs the projector.
Grandinetti's wife, Hanouf, wanders over to thank Simkin. Hanouf says her blind optimism turned into true confidence as she learned about birth and how to cope with pain. "I'm so excited," she says. "I can't wait!"
Paula Bock is a Pacific Northwest magazine staff writer. E-mail:bpock@seattletimes.com. Benjamin Benschneider is a Pacific Northwest magazine staff photographer.
Copyright © 2008 The Seattle Times Company
Cover Story
Looking to nature, doula Penny Simkin practices the art of delivery
By Paula Bock
Penny Simkin's cheerfully cluttered basement office looks nothing like a sterile hospital.
It's graced by maternity tchotchkes collected from around the world, piled with books and scientific journal articles about birth (many penned by her), thumbtacked with whimsical reunion snapshots of babies leaning precariously against each other on the couch.
Simkin's pug, Hugo, wheezes while Simkin putters, wadding a doll baby and crimson "placenta" pillow into a hand-knit argyle "uterus" sack. She cinches a rubberband around the opening. There. That's the "cervix" — ready to dilate. Class starts in half an hour.
Nearly 70 years old, Simkin is an internationally revered childbirth educator who, with nurse co-authors Janet Whalley and Ann Keppler, literally wrote the book on giving birth: "Pregnancy, Childbirth and the Newborn." It's been translated into Russian and Italian, among other languages; more than a million copies sold.
Known as the mother of the doula movement, Simkin has trained thousands of these caregivers to provide physical and emotional support for women during birth — the only intervention scientifically shown to decrease time in labor (by 25 percent) as well as to reduce Cesarean-section rates by a third.
"Birth never changes," Simkin says. "But the way we manage it and the way we think of it has. Right now, we're in a culture of fear around birth." Pain, medical mishaps, lawsuits.
"In our fear that we might have a bad outcome, we decide Cesarean is the answer for everything, and so we're losing the skill and art" of delivering babies, Simkin says. "For six years, nobody's done a breech birth. Some don't even know how to turn a baby who's posterior!"
Cesarean rates have climbed to 32 percent in Seattle, an all-time high on par with the rest of the nation, and an increase of more than 50 percent in a decade. While a direct link has not been proven, infant and maternal deaths are rising, too.
"Things are not so marvelous in birth these days," says Dr. Michael Klein, who studies worldwide Cesarean trends as an emeritus professor of family practice and pediatrics at the University of British Columbia. "To say it's medicalized is an understatement. It's industrialized. Somehow, Penny remains optimistic."
With earthy humor and a steadfast belief in evidence-based medicine rooted in scientific study (rather than hospital fashion), Simkin preaches a radical notion: Birth is normal. Birth is natural. Women deserve the support they need to have the kind of birth they want.
Birth is also political — mired in insurance regulation, hospital protocols, legal anxiety and hectic lives. Insurance doesn't reimburse as much for midwives as for doctors; learning how to give birth takes time; Cesarean births are convenient for schedules; high-tech births fuel a big business in drugs and medical equipment.
Experts may differ on whether to offer massage or drugs during hard labor, but they all acknowledge Simkin as a "living treasure" for her knowledge about birth, compassion for women, and ability to teach skills developed during 40 years in the field.
"How Will She Remember It?" Simkin's mantra. She's printed the phrase on doula T-shirts to remind hospital staff to be sensitive to laboring moms. "When you start focusing on a woman's experience of birth and not just the issue of natural childbirth," Simkin says, "it opens up a whole new world."
Simkin is not a die-hard natural-birth proponent, but she does wonder why women have become so timid about birth when they're so powerful in other aspects of life.
"I'm so sad that women think birth is impossible," Simkin says. "They're also very busy and don't have time for classes. There are very few sources where they can get confidence in themselves . . . Women are so fit and athletic and run marathons, and yet think they can't do birth.
"I want people to appreciate how well their bodies are designed to give birth. Every cell in your body knows how."
PENELOPE PAYSON was born in 1938 in Maine, the third of six children. Her father owned a hardware store and served on the school board and water commission. Her stay-at-home mom led a Girl Scout troop and victory projects for the war. They expected their children to do chores and community service and to stay out of trouble.
In a small town where many youngsters drank and a third of the girls got pregnant before graduation, Penny was different, a swimming champion good enough to try out for the Olympics. "She was feisty," recalls sister Helen Seager. "She could do things girls weren't expected to do. . . . Even though I was the older one, she was my idol." Penny, herself, recalls being so sensitive that when punished for misbehaving at 9, she vowed to never forget what it was to be a kid. That vow, Simkin says, has helped her be aware of other people's feelings ever since. Growing up, Penny knew nothing about birth. Her mother, like many American women at that time, had been drugged during births and couldn't remember.
Penny chose Swarthmore College for its undefeated swim team; she graduated as swim captain with a degree in English literature. During her junior year, she married Peter Simkin, a medical student, and after graduation studied physical therapy at the University of Pennsylvania.
At 23, they moved to North Carolina and she became pregnant with their first child. It was 1961, the start of a movement toward natural childbirth, and her doctor told her she'd be an excellent candidate. But her son was 22 days post due-date, 10 pounds 4 ounces, and facing the wrong way. She ended up being induced, laboring unsuccessfully, then having general anesthesia and a forceps delivery.
"I felt awful because the doctor told me I would have a natural birth, and I wanted to please the doctor," Simkin says. "Then he grabbed my ankle, looked in my eyes and said: 'What a trouper.' He made me feel I didn't have to be ashamed." For Penny, the doctor's compassionate treatment was pivotal; it became the philosophical seed of her life's work.
Within five years, she had three more children (two natural births, one with epidural anesthesia to block the pain), and after most of the kids were in school, she started teaching childbirth classes, figuring it would be a good use of physical-therapy skills.
She was a born teacher, delved into research, spoke at conferences, and attended many students' births as a doula before the role had that name. She invented a "birth bar" and birth sling to help women squat and lean during labor; codified birth plans to give women more control over the process; co-authored several books; edited a journal of current scientific literature about birth; pioneered pregnancy-care techniques and counseling for survivors of sexual abuse.
After 20 years, career crisis. Cesarean rates were climbing in the late-'80s, and the trend was to focus on parenting rather than on birth. After all, birth was only one day.
Does childbirth really matter? Simkin wondered.
Over the years, she'd had students write their birth stories and fill out questionnaires, and she'd saved them all. She tracked down 24 students from her first classes, and asked them to recall their birth experiences — 20 years later. Simkin compared original versions with new.
"It was uncanny how clear their memories were and how powerful," Simkin says. She interviewed 20 women in person. Nine wept as they talked, some out of joy and pride, others from anger and remorse. The women who were satisfied with their births didn't necessarily have an easy time or a natural birth, Simkin says. What mattered was how they were cared for by medical staff.
"We can't control labor, whether it's hard; that's a leap of faith," Simkin says. "But we can always control how we care for her." Even though it's only one day, women are more vulnerable, Simkin says. There's pain, exposure, dependence on others, possibility of physical harm, authority figures who may, or may not, be sensitive. One in four women today describes birth as having been traumatic. What women really need, she decided, was an experienced, caring advocate who would not only coach them through the physical part of labor but also tend to their emotional needs. So Simkin helped start regional and international doula associations, PALS and DONA, and trained doulas at a rapid pace. She taught the senior doulas to train new doulas for ripple effect. Within a few years, there were thousands of doulas, and the concept was on the map.
"If a woman is empowered by birth, she thinks: 'If I can do that, I can do anything' — for the rest of her life," Simkin says. "If she was humiliated or shamed, what she learns is: 'I'm a wimp. I can't handle pain.' How does that affect how she deals with other things?"
WOMEN, OF course, have been giving birth since the start of humanity. Yet until fairly recently, birth was likely the most dangerous event of their lives.
A century ago, one in 100 women died during childbirth. In the United States, that number is now one in 4,800. (In sub-Saharan Africa, the current risk of maternal death is one in 22; in Afghanistan, one in eight — a reflection of malnutrition, disease, poor health care.)
In the U.S. through the 1800s, most women gave birth at home, assisted by midwives, relatives, their husbands. Hospital births began in the 1900s, mostly in cities. Doctors began using anesthetics ether and chloroform; narcotics such as Demerol; "forgetting drugs."
Simkin calls the ether-soaked 1940s and '50s the dark age of obstetrics. She roots around filing cabinets in her basement and pulls out a startling investigative series, "Cruelty in Maternity Wards," by the Ladies Home Journal.
The exposé started in 1957 with publication of an anonymous letter from a Chicago nurse asking the magazine to investigate "tortures" in delivery rooms. The nurse described mothers "strapped down with cuffs around her arms and legs and steel clamps over her shoulders and chest" for more than eight hours; doctors suturing without anesthetic; an obstetrician who ordered nurses to "slow things up" by tying a laboring woman's legs together while he went to dinner.
The nurse's letter triggered hundreds more from readers who described other horrors, including children who'd suffered brain damage from lack of oxygen because delivery had been forcibly delayed.
The series helped spark a countermovement toward natural childbirth. Husbands demanded to stay with their wives during labor; expecting parents Clifford and Audrey Stone in Seattle sued to do so in 1958. The judge ruled against them, saying he had no authority to regulate obstetrical practice. Simkin recalls another Seattle father who handcuffed himself to his wife during the labor.
Enter Grantly Dick-Read, a British physician who taught relaxation and controlled breathing to reduce fear and pain. In the late '50s, his worldwide teaching tour touched down in four North American cities, including Seattle, leaving pockets of natural-childbirth advocates. Among them was family doctor Virginia Larson, founder of the Seattle Association of Childbirth Education. She became Simkin's mentor.
Simkin's career grew with the natural-childbirth movement in the 1960s and '70s. Urban middle-class moms were clamoring for midwives so much that some midwives left Appalachia and the migrant communities they'd originally trained to serve.
By the 1980s, hospitals tried to lure back middle-class moms — and their health insurance — by building comfy home-like birthing suites. Advertisements touted flowered curtains, straw hats decorating the doors and epidurals.
Home-birth midwifery dwindled in other parts of the country, but it's still thriving here, fueled by the Seattle Midwifery School. Simkin calls Seattle the best place in the country to have a baby because of the many options: midwives, home births, birthing centers, high-tech hospitals.
The problem with hospitals, she says, is that when it comes to birth, they often don't practice evidence-based medicine. They induce labor unnecessarily, she says, and that feeds C-sections. They use continuous electronic fetal monitoring that has not been found to improve outcomes. "Yet it's a big industry and nurses are terrified if the monitor isn't on," Simkin says. Even worse, slight blips in the baby's heart rate often make docs scurry to do a C-section. "If doctors would just listen to their own literature!"
In 2003, the American College of Obstetricians and Gynecologists gave a nod to elective C-sections requested by healthy moms who want only one or two children. Aghast, other birth professionals cite studies about C-section's hazards, including greater risk of infection, blood clots, death; surgical injuries; increased infertility and a chance the next baby's placenta could get stuck to the old scar and hemorrhage.
Much of the rise in C-section rates is patient-driven, says Dr. Nancy O'Neil, a respected Seattle obstetrician/gynecologist. "The U.S. is such a trendy country. . . In the late '70s, early '80s, people would do anything to have a vaginal birth. Seattle was natural . . . Now, the city has become more of a city. Educated older patients are used to having a lot more control over their lives, and the idea of scheduling something and having it be controlled is very appealing. That's why it's really important to have people like Penny who say, 'Stop! Look at the advantages of vaginal birth.' . . . Some people feel vaginal birth will become archaic."
O'Neil calls Simkin a bridge. "Her book on childbirth is the bible we all use . . . She also helps patients realize, yeah, natural childbirth is great but y'know what? There's a lot that's great about medicine, too."
Simkin, who's attended more than 750 births as a doula and still takes cases, says she's not done. Her goal is to leave vast knowledge about supporting women in natural childbirth "so when we finally hit 50 percent C-sections or 80 percent and people say we have to find a better way, it's time to swing back with the pendulum, (we won't) have to reinvent the wheel."
TEACHING IS what Simkin loves best. With a calm voice, plump lap and Mr. Rogers-like gentleness, Simkin combines common sense with facts-you-can-use science.
Eat almonds, leafy greens and dark chocolate in the last few weeks of pregnancy to stave off anemia as the baby drains mom's iron; touch your tongue to the roof or your mouth so you won't hyperventilate during heavy contractions.
She teaches birth partners how to squeeze a laboring woman's hips to take the edge off back ache; how to rock through contractions in a slow dance; how to manage pain through rhythm, relaxation and ritual.
Simkin's childbirth classes are so popular that Scott and Debbie Fynn stayed up until 2 a.m. while vacationing in Tokyo last fall just to call her office at 9 a.m., Seattle time, on the first day of registration for the three-month class.
"She's so enthusiastic and easy to listen to," Debbie says, "even though you'd think when you're huge and waddling, you wouldn't want to sit in a chair for two hours."
On Monday night, a wiggly class of small children surrounds Simkin; she's preparing them for the births of siblings — "your babies. Can we all say umbilical cord? Um-bil-i-cal! I love that word!"
The Wednesday-night class, the series' last, , has a certain urgency. The couples practice double hip squeezes, slow dancing, then Simkin falls to her knees in hard labor. OOOhh, she moans, face contorted. She shakes, writhes, hyperventilates.
"OK," says Russell Grandinetti, a 36-year-old father-to-be who volunteers to play the role of birth partner. "I know. It's coming."
"HELP me!" Simkin yells. Get your head down close, she stage whispers. Grandinetti kneels, nose to nose with Simkin.
"You're doing great. Look at me, Penny." He breathes loud, rhythmically, flaps his hand, like a conductor. She moans in sync.
"I HATE THIS!"
"You're making good progress. Doing great!"
Gasp! Gasp!! "I'm going to vomit!"
"OK. That's good! Don't worry about it, we got the doula helping!"
Everyone laughs. Simkin commends Grandinetti for helping her cope and keep a rhythm. "He didn't have panic on his face. That's important. You have to look like you have confidence in the woman."
There's a pause as couples realize labor will soon be for real.
"When you get to complete dilation," after the hardest contractions but before spontaneous pushing, Simkin tells them, "your spirits will rise. I love that rise. "
Then it's over. Three months. Videos, role-plays, hundreds of tips. Simkin sips some water, unplugs the projector.
Grandinetti's wife, Hanouf, wanders over to thank Simkin. Hanouf says her blind optimism turned into true confidence as she learned about birth and how to cope with pain. "I'm so excited," she says. "I can't wait!"
Paula Bock is a Pacific Northwest magazine staff writer. E-mail:bpock@seattletimes.com. Benjamin Benschneider is a Pacific Northwest magazine staff photographer.
Copyright © 2008 The Seattle Times Company
Monday, April 07, 2008
See fetal development from week one to week fourteen.
http://www.pregnancy.org/pregnancy/fetaldevelopment1.php
http://www.pregnancy.org/pregnancy/fetaldevelopment1.php
Thursday, April 03, 2008
Another Site Worth Visitng
Symptoms of Pregnancy.org is a comprehensive guide to understanding your pregnancy symptoms. The first part of this index page presents articles that provide an overview of the signs of pregnancy from different perspectives. You will even find an article that examines alternative reasons for the symptoms you might be experiencing.
There is a Links page filled with articles about many different subjects, including adoption, prematurity, baby gear, baby items, birth, birth defects, magazines, and much more.
http://symptomsonline.org/symptoms-of-pregnancy/
There is a Links page filled with articles about many different subjects, including adoption, prematurity, baby gear, baby items, birth, birth defects, magazines, and much more.
http://symptomsonline.org/symptoms-of-pregnancy/
A Couple Web Sites That I Like
About BellaOnline.com
BellaOnline's Mission Statement reads:
BellaOnline provides an encouraging, supportive publishing community for women. We provide free training, support and promotion so writers may reach their personal and business goals. Overall, BellaOnline aims to provide high-quality, helpful, trustworthy content, at no cost, in a low advertisement environment for our millions of visitors.
http://www.bellaonline.com/misc/about.asp
About Pink online magazine
PINK exists to promote this new generation of women who are making a significant impact on the world through their work and their lives-while being true to themselves.
PINK shares stories of remarkable individuals along with expert advice and cutting edge data and emerging trends to help readers gain more financial independence, and more equity and opportunity in the workplace.
http://www.pinkmagazine.com/about/index.html
BellaOnline's Mission Statement reads:
BellaOnline provides an encouraging, supportive publishing community for women. We provide free training, support and promotion so writers may reach their personal and business goals. Overall, BellaOnline aims to provide high-quality, helpful, trustworthy content, at no cost, in a low advertisement environment for our millions of visitors.
http://www.bellaonline.com/misc/about.asp
About Pink online magazine
PINK exists to promote this new generation of women who are making a significant impact on the world through their work and their lives-while being true to themselves.
PINK shares stories of remarkable individuals along with expert advice and cutting edge data and emerging trends to help readers gain more financial independence, and more equity and opportunity in the workplace.
http://www.pinkmagazine.com/about/index.html
Wednesday, April 02, 2008
Choosing a Doula: Answers to Your Most-Asked Questions by Henci Goer
Maybe one of your friends or relatives told you how great it was to have a doula during her labor. Maybe you read something about doulas online or in a magazine, book or newspaper. Now you are wondering whether having a doula would be a good thing for you, but you need more information. You have come to the right place. Find out what a doula is, as well as the benefits of doula care and then get answers to some of your most-asked questions about hiring a labor doula for your birth.1. Why isn't a nurse or midwife all that you need for labor support?While there may be exceptions, the demands of modern-day care in hospitals and cuts in staffing keep nurses from giving much in the way of supportive care. In fact, studies show that typical labor-and-delivery nurses spend only 10 percent of their time engaged in labor support activities, and half of that time is spent giving instructions or advice, as opposed to comfort measures or encouragement (1,4). Also, the nurse has probably never met you before. She doesn't know your individual desires or issues, and, unless you are fortunate enough to have your labor fit into one shift, you will have more than one nurse. By contrast, doulas stay with you throughout.Midwives are more likely to provide supportive care, especially those attending home or birth-center births, but they, too, may have other responsibilities that prevent them from staying with you continuously. And like nurses, they may work shifts.2. Why isn't your partner or other family members or friends enough?However important the father's role during labor, studies have not shown fathers to have the same beneficial effects as a woman labor companion (3). Female friends or relations could take on the doula role, as they have in the past and still do in traditional cultures. Nonetheless, few women in our culture today have the requisite knowledge, skills and familiarity with birth.3. Does having a doula detract from the father's role?Working as a team, the doula enhances and complements the father's care while relieving him of the perhaps unrealistic expectation that he know all and be all to you in labor (2). Fathers in one doula study liked having a doula and none felt displaced. They reported that not only did doulas help them help the moms, some of the doulas took care of them too (2).4. Will having a doula sacrifice privacy?Intruding on privacy may be a possibility at home births, but even in that setting, you will probably find an extra pair of hands belonging to someone known to you a welcome addition. In the busy, institutional environment of the hospital, a doula can help preserve privacy and create an intimate atmosphere. Depending on your doctor or midwife's on-call practices, she may even be the only person caring for you who is familiar.5. Should you have a doula even if you plan to have an epidural or narcotic?It is best not to preplan to use pain-relief medications, because they can have adverse effects on you, your baby and the labor. Through the use of comfort measures and her encouragement, a doula can help you avoid pain medication. For example, she can help you find effective positions in which to labor or push despite having an epidural. In addition, narcotics do not completely relieve pain, and if you opt for an epidural, you will still need information and emotional support.Page Two: Find out what to look for when hiring a doulaPage Three: Learn how to find a doula in your area and how to interview candidatesPage Four: ReferencesWhat should you look for when hiring a doula?Is she certified? Certification by a national organization doesn't guarantee excellence, but it does validate that the doula has met some set of standards. On the other hand, lack of certification does not mean the doula is unqualified. For one thing, nationally based doula training programs have only existed for about a decade, and many doulas antedate their introduction. In any case, while certification serves as a useful benchmark, you will still wish to inquire about the doula's experience and background relevant to labor support.What does she charge, and what is in her service package? Most doulas make one or more prenatal visits and one or more visits after the birth in addition to the time spent with you in labor. Most are also available over the phone for information, nonmedical advice or to act as a sounding board. Some doulas come to you whenever you mutually decide; others hold off until active labor. Some labor doulas provide in-home help after the birth as well. (There are also postpartum doulas who do nothing but help after the birth with light housekeeping, meals, baby care, breastfeeding assistance and so forth.)How many clients does she take per month? If she takes more than a few clients per month, she may not be available when you go into labor, or she may arrive at your labor already drained and exhausted from another birth.What are her backup arrangements? Every doula should have backup, because there is always the possibility she may have another obligation or be ill at the time you go into labor. You may wish to speak with or meet with her backup.Does she have any limitations on where she will go or which doctors and midwives she works with? She may have geographic limitations. Some doulas also choose not to attend births in certain hospitals or work with certain care providers either because the approach to labor and birth runs so contrary to her own or the staff or care provider opposes using doulas.Will she provide references? She should provide references at your request.Page Three: Learn how to find a doula in your area and how to interview candidatesPage Four: ReferencesHow do you find a doula?Take a look at the referral areas at these sites:
Doulas: A Risk-Free Option for Pain Relief During Childbirth
Doula is a Greek word that originally meant a servant for a woman who had given birth. Today the term “birth doula” refers to a caring woman who provides continuous physical, emotional, and informational support to a mother during labor and delivery. A postpartum doula is a caring woman who provides care for a new family.
Depending on whether they are a birth or a postpartum doula, their period of involvement may change, but one thing remains the same: Doulas are there to support the mother continuously through labor until birth. After the baby is born, the postpartum doula assists the new family in their home for several hours each day or every other day for a week or more during the adjustment period.
A doula is not meant to replace the partner or a loved one, but to support the laboring woman, include and help the partner or loved one, and answer their questions. She increases their understanding of events as they occur and anticipates what lies ahead. By working collaboratively with the family, the doula can support decisions made by the expectant parents when appropriate. Partners feel they are able to participate more effectively in the birth with a doula present because the doula provides suggestions and support which allows them to take part on the comfort level of their choosing.
Benefits of the Doula
Studies examining doula programs have produced several important findings about how babies and mothers fare after birth. The support of a doula can help to reduce:
Duration of labor
Likelihood of complications
Need for epidurals or epidural pain medication
The support of the doula often also reduces the normal physical and physiologic stress a child experiences during birth. This benefit to the baby may occur as a result of the doula's care, reducing the anxiety of the mother and her partner throughout labor and delivery. In fact, the newborn is often more attentive and ready to begin the bonding interactions with the mother.
Studies About Doulas
Numerous medical centers have conducted studies to examine the effects of enlisting a doula to stay continuously with a pregnant woman through labor and delivery. In 2003 the prestigious international Cochrane Collaboration review of 15 randomized studies that met their research criteria stated: “Given the clear benefits and no known risks associated with support, every effort should be made to ensure that all laboring women receive continuous support. This support should include continuous presence, the provision of hands on comfort and encouragement.”
They found:
Cesarian Section - 26% less likely
Forceps or Vacuum - 41% less likely
Analgesia or Anesthesia - 28% less likely
Dissatisfaction or negative rating of birth experience - 30% less likely
As an added benefit, those with doula support often report:
Higher self-esteem
Less depression and anxiety
Breastfeed more successfully
More confidence about caring for the baby
Lower tendency to develop fever
Types of Doulas
Birth Doula
A birth doula assists the woman before, during and often after the delivery. Birth doulas are trained in childbirth, and most have given birth themselves. The main goal of a birth doula is to help the woman have a safe and satisfying childbirth as the woman defines it.
The birth doula has three main responsibilities:
Emotional Support - The doula provides emotional support through her constant presence throughout labor and delivery. Once labor begins, the doula remains by the side of the mother-to-be until the birth is completed and frequently for the first one or two hours afterwards.
The doula provides emotional support in an active way. She adjusts her style to fit each patient and responds as the patient’s needs change during the labor. She understands and accepts the woman’s pain and fear and serves as a source of support, helping the woman remain confident and in control. The doula also supports the father and any family members who may be present.
Education - The doula educates and informs the mother about obstetric routines and procedures and thus keeps the mother advised about her progress during birth. The doula encourages the mother to manage the situation by listening to the messages the body sends during birth, changing her position, adjusting breathing, and using other stress and pain reducing techniques.
Especially now with the discovery of the importance of skin-to-skin or kangaroo care immediately after childbirth the doula can act as an emotional and informational resource for the mother. The doula can explain what will happen immediately after childbirth and the woman can prepare to have the baby on her chest, skin to skin.
Liaison - The doula functions as a liaison between the patient and the medical staff. She does not give medical advice or perform any medical duties, but she’s on hand to support the mother if she has questions for the medical staff. Most medical staff appreciate the extra attention and support the doula gives their patient.
Postpartum Doula
A Postpartum doula works in the fourth trimester, just after pregnancy. The role of the postpartum doula is to provide support, advice, and assistance in the weeks and months following birth. In the past, the family of a new baby could rely on their family members or friends to assist them. After giving birth women are often surrounded by caring family members who have a great deal of experience and wisdom to offer. While these resources are available today, they may not always be provided due to increasing distances between family members and their loved ones.
The postpartum doula provides:
Education
Non-judgmental support
Companionship
Assistance with newborn care and family adjustment
Assistance with meal preparation
Assistance with light household tasks
Postpartum doulas offer evidence-based information on:
Infant feeding
Emotional and physical recovery from birth
Infant soothing
Coping skills for new parents
Safe infant sleeping
Referrals for more education on these topics when necessary
The doula may also be a buffer to parents who may have received outdated advice. The doula can help friends and family to foster and support the parenting decisions of the new parents. By modeling a deep respect for the wisdom and decision making abilities of the new parents, she makes clear that supporting them in their own choices will have the best results.
John H. Kennell, MDProfessor of PediatricsSchool of Medicine Case Western Reserve University
Depending on whether they are a birth or a postpartum doula, their period of involvement may change, but one thing remains the same: Doulas are there to support the mother continuously through labor until birth. After the baby is born, the postpartum doula assists the new family in their home for several hours each day or every other day for a week or more during the adjustment period.
A doula is not meant to replace the partner or a loved one, but to support the laboring woman, include and help the partner or loved one, and answer their questions. She increases their understanding of events as they occur and anticipates what lies ahead. By working collaboratively with the family, the doula can support decisions made by the expectant parents when appropriate. Partners feel they are able to participate more effectively in the birth with a doula present because the doula provides suggestions and support which allows them to take part on the comfort level of their choosing.
Benefits of the Doula
Studies examining doula programs have produced several important findings about how babies and mothers fare after birth. The support of a doula can help to reduce:
Duration of labor
Likelihood of complications
Need for epidurals or epidural pain medication
The support of the doula often also reduces the normal physical and physiologic stress a child experiences during birth. This benefit to the baby may occur as a result of the doula's care, reducing the anxiety of the mother and her partner throughout labor and delivery. In fact, the newborn is often more attentive and ready to begin the bonding interactions with the mother.
Studies About Doulas
Numerous medical centers have conducted studies to examine the effects of enlisting a doula to stay continuously with a pregnant woman through labor and delivery. In 2003 the prestigious international Cochrane Collaboration review of 15 randomized studies that met their research criteria stated: “Given the clear benefits and no known risks associated with support, every effort should be made to ensure that all laboring women receive continuous support. This support should include continuous presence, the provision of hands on comfort and encouragement.”
They found:
Cesarian Section - 26% less likely
Forceps or Vacuum - 41% less likely
Analgesia or Anesthesia - 28% less likely
Dissatisfaction or negative rating of birth experience - 30% less likely
As an added benefit, those with doula support often report:
Higher self-esteem
Less depression and anxiety
Breastfeed more successfully
More confidence about caring for the baby
Lower tendency to develop fever
Types of Doulas
Birth Doula
A birth doula assists the woman before, during and often after the delivery. Birth doulas are trained in childbirth, and most have given birth themselves. The main goal of a birth doula is to help the woman have a safe and satisfying childbirth as the woman defines it.
The birth doula has three main responsibilities:
Emotional Support - The doula provides emotional support through her constant presence throughout labor and delivery. Once labor begins, the doula remains by the side of the mother-to-be until the birth is completed and frequently for the first one or two hours afterwards.
The doula provides emotional support in an active way. She adjusts her style to fit each patient and responds as the patient’s needs change during the labor. She understands and accepts the woman’s pain and fear and serves as a source of support, helping the woman remain confident and in control. The doula also supports the father and any family members who may be present.
Education - The doula educates and informs the mother about obstetric routines and procedures and thus keeps the mother advised about her progress during birth. The doula encourages the mother to manage the situation by listening to the messages the body sends during birth, changing her position, adjusting breathing, and using other stress and pain reducing techniques.
Especially now with the discovery of the importance of skin-to-skin or kangaroo care immediately after childbirth the doula can act as an emotional and informational resource for the mother. The doula can explain what will happen immediately after childbirth and the woman can prepare to have the baby on her chest, skin to skin.
Liaison - The doula functions as a liaison between the patient and the medical staff. She does not give medical advice or perform any medical duties, but she’s on hand to support the mother if she has questions for the medical staff. Most medical staff appreciate the extra attention and support the doula gives their patient.
Postpartum Doula
A Postpartum doula works in the fourth trimester, just after pregnancy. The role of the postpartum doula is to provide support, advice, and assistance in the weeks and months following birth. In the past, the family of a new baby could rely on their family members or friends to assist them. After giving birth women are often surrounded by caring family members who have a great deal of experience and wisdom to offer. While these resources are available today, they may not always be provided due to increasing distances between family members and their loved ones.
The postpartum doula provides:
Education
Non-judgmental support
Companionship
Assistance with newborn care and family adjustment
Assistance with meal preparation
Assistance with light household tasks
Postpartum doulas offer evidence-based information on:
Infant feeding
Emotional and physical recovery from birth
Infant soothing
Coping skills for new parents
Safe infant sleeping
Referrals for more education on these topics when necessary
The doula may also be a buffer to parents who may have received outdated advice. The doula can help friends and family to foster and support the parenting decisions of the new parents. By modeling a deep respect for the wisdom and decision making abilities of the new parents, she makes clear that supporting them in their own choices will have the best results.
John H. Kennell, MDProfessor of PediatricsSchool of Medicine Case Western Reserve University
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