World Doula Week 2018

Happy World Doula Week to all the doulas out there!

5 Simple Ways to Encourage a Healthy, Satisfying Pregnancy and Birth

Ina May Gaskin, by Timeline

This past fall I had the incredible opportunity to study at The Farm, the community where Ina May Gaskin and the Farm Midwives made their home, birthed they children, and their names as pioneers in the modern day American natural birth movement, delivering thousands of babies. All around the world, for centuries, women had been giving birth at home and naturally. By the time many of these midwives had come to have children, the maternal care system had become overly medicalized and severely limiting women's choices. Ina May Gaskin and the Farm Midwives gave women another safe option, and I am so grateful for their bravery, courage, and hard work in paving the way for women to have options in childbirth today. Check out the video below to learn more.

https://www.youtube.com/watch?v=y_qqxilWcb0

Birth Stories of All Kinds

For some birth stories, check out these websites below. They feature all kind of birth - at home, in the hospital, in a birthing center, with midwives and doctors, as well as natural births, births with pain medication, birth with interventions, and Cesarean births. Enjoy the beautiful variety!

Birth Becomes Her

The Birth Hour

Birth Without Fear

Tell Me a Good Birth Story

Evidence On Doulas

The following text and photo is excerpted from "Evidence on: Doulas" a recent article August 14, 2017 by Rebecca Dekker, on her incredibly informative website, Evidence Based Birth. You can read the full text of her article here: https://evidencebasedbirth.com/the-evidence-for-doulas/

Why are doulas so effective? 

There are several reasons why we think doulas are so effective. The first reason is the “harsh environment” theory. In most developed countries, ever since birth moved out of the home and into the hospital, laboring people are frequently submitted to institutional routines, high intervention rates, staff who are strangers, lack of privacy, bright lighting, and needles.

Most of us would have a hard time dealing with these conditions when we’re feeling our best. But people in labor have to deal with these harsh conditions when they are in a very vulnerable state. These harsh conditions may slow down a person’s labor and their self-confidence. It is thought that a doula “buffers” this harsh environment by providing continuous support and companionship which promotes the mother’s self-esteem (Hofmeyr, Nikodem et al. 1991).

A second reason that doulas are effective is because doulas are a form of pain relief in themselves (Hofmeyr, 1991). With continuous support, laboring people are less likely to request epidurals or pain medication. It is thought that there is fewer use of medications because birthing people feel less pain when a doula is present. An additional benefit to the avoidance of epidural anesthesia is that women may avoid many medical interventions that often go along with an epidural, including Pitocin augmentation and continuous electronic fetal monitoring (Caton, Corry et al. 2002).

This finding—that people with doulas are less likely to have an epidural—is not due to the fact that clients with doulas in these studies were more likely to want these things up front and were more motivated to achieve them. In fact, randomized trials account for these differences—this is why they are called randomized, controlled trials. The people assigned to have a doula, and those assigned to not have a doula, are randomly assigned, meaning that the same percentage in each group would have a desire for an unmedicated birth.

A third reason why doulas are effective has to do with the attachment between the birthing person and doula which can lead to an increase in oxytocin, the hormone that promotes labor contractions. This theory was proposed by Dr. Amy Gilliland in her 2010a study about effective labor support. In personal correspondence with Dr. Gilliland, she wrote, “I believe the Doula Effect is related to attachment. When the mother feels vulnerable in labor, she directs attachment behaviors to suitable figures around her, who may or may not be her attachment figures (parent, mate). When the mother directs attachment seeking behaviors to the doula, the experienced doula (25 births or more) responds in a unique manner. She is able to respond as a secure base, thereby soothing the mother’s attachment system. The accompanying diminishment in stress hormones allows for a surge in oxytocin in both the mother and the doula… theoretically, oxytocin is the hormone of attachment, and it is released during soothing touch and extended eye contact, which are habitual behaviors of birth doulas.” (Personal communication, Dr. Amy Gilliland, July 2015).

Swedish oxytocin researcher Kristin Uvnas Moberg writes that the doula enhances oxytocin release which decreases stress reactions, fear, and anxiety, and increases contraction strength and effectiveness. In addition, the calming effect of the doula’s presence increases the mother’s own natural pain coping hormones (beta-endorphins), making labor feel less painful (Uvnas Moberg, 2014).

Based on the evidence, I have come up with a conceptual model of how doula support influences outcomes.

A conceptual model  is what researchers use to try and understand how a phenomenon works. Here is my conceptual model on the phenomenon of doula support.

What to expect with your baby's weight after birth

This is an excellent article, with very wise advice on baby's weight loss within a the first couple of weeks of life. If you have concerns or questions about your newborn's weight loss and milk intake, you are of course advised to seek support from a Lactation Consultant (IBCLC), a Certified Breastfeeding Counselor (CBC), or a Certified Lactation Counselor (CLC). Any of these lactation professionals should be able to support you or point you in the right direction.

An excerpt is below and the full article can be read here.

"This weight loss has nothing whatsoever to do with breastfeeding and milk intake.  In fact, the authors suggest that if clinicians want to use weight loss as a gauge of milk intake, they calculate baby’s weight loss not from birth weight, but from their weight at 24 hours.  According to their findings, this could neutralize the effect of the mother’s IV fluids on newborn weight loss.

This is one more reason weight loss alone should not be used to determine when newborns need formula supplements.   The Academy of Breastfeeding Medicine put this well in one of its protocols: “Weight loss in the range of 8-10% may be within normal limits….If all else is going well and the physical exam is normal, it is an indication for careful assessment and possible breastfeeding assistance.”

What A Doula Does

I adore this blog post written by my dear doula colleague, Yiska Obadia. You can read an excerpt below, and the full article here.

"Doulas are there to serve their clients. You want to birth naturally? I will support you. You want an epidural? I will support you. You want an epidural and to avoid a c-section? I will do my best to help you achieve that. Doulas serve our clients in helping them to achieve the birth THEY want as well as supporting them wholeheartedly with the birth they get."

From Spinning Babies... The Sacrotuberous Ligament: Key to Unlocking a Long Labor

This article is definitely worth a read if you are pregnant and preparing for labor. And especially if you are interested in anatomy! According to the article, it may be particularly applicable if any of the following are present:

• A long and difficult labor in which normal remedies (Rebozo Sifting, Position Changes, Spinning Babies Maneuvers) are not fully effective

• Persistently malpositioned baby

• Highly athletic mother (especially those who are highly athletic into their pregnancy)

• History of any trauma in which the ligaments of the pelvis could have been affected (accidents, falls, etc.)

• A visible Pelvic Upslip: One (usually left) iliac crest superior to the other, one leg (usually left) functionally shorter than the other.

Can a midwife administer pain medication?

For a hospital birth, whether or not a midwife can administer pain medication depends on what kind of pain medication we're talking about. For a home birth, it depends on the midwife. Read the article from Choices in Childbirth to get more information:

Can A Midwife Administer Pain Medication? By Barbara Sellers, CNM

Natural Hospital Birth

As a birth doula serving clients who live primarily in Brooklyn and Manhattan, I work with many women who see both OBs (often low intervention practices) and midwives in the hospital setting. However, many of my clients are looking for a holistic birth experience, or a natural birth experience, within a setting that typically is not set up to accommodate un-medicated births. The odds are generally stacked against women hoping to have intervention-free births in a hospital. BUT, as a doula, I have witnessed many women successfully do this! Here are a few resources on how to work towards, or achieve some version of, a natural hospital birth:

Video

Book