Unmedicated Birth

Is it possible in this day and age to have an unmedicated birth? With all the media attention on planned c-sections and the world of famous people spouting the necessity of pain medication and planned inductions for timing when your baby comes. (Don't get me started on that one)

I think it is possible, if you truly want an unmedicated birth. There are just a few things you need to do in order to increase your odds.

First off, have a midwife, family doctor or an OB who is laid back and supportive of natural birth. Find a health care practioner who believes in what women's bodies can do. You aren't looking for a surgeon. You are looking for someone to assist you in birthing your baby.

Secondly, work with a doula to help guide you and support you and be you and your partners advocate in achieving a natural, unmedicated birth.

Thirdly, choose your childbirth classes wisely. Choose non-hospital based childbirth classes, where you can discuss options for pain such as birth balls, tubs, showers, massage and more.

Fourthly, choose a hospital that has such things as tubs, showers and supports natural, unmedicated birth. Yes they exist.

Fifthly, let go. You cannot control your labour. Your body knows what to do, you have to have faith that it will do it. You need to let your body go, get into the contractions and let them do their job. You have to surrender to them and let them work at bringing your baby down dilating your cervix.

The value of a supportive word...

This was not the topic I was intending to write about but sometimes situations arise and you can't help but voice your outrage and concern.

A friend recently came home from a VBAC birth and told me how the doctor basically told her client to stop wasting her time, it was just going to be a ceserean any way, he refused to take responsibility for her and that walking around was a complete waste of time. The client did everything she could and my friend had her doing things we never knew a labouring woman could accomplish while in active labour.

Unfortunately after more then 24 hrs it did end up in a ceserean section.

But why would a doctor come into a hopeful and happy situation and burst every balloon in the room with his words. When a woman is in labour she is so open to the connotations of words. A woman who feels supported and loved and safe will do amazing things during her labour. Her discomfort will be diminished, her labour will go faster, she will not fear the process and listen to her body, and she will preceive the birth in a much better light regardless of the outcome when her basic human needs are met.

Now I'm not saying that in the case of my friend her client would have had a vaginal birth if her doctor hadn't been such a mean guy, but perhaps she would have had a better outcome, a more pleasant experience, a shorter experience, who knows.

Kindness costs nothing, it doesn't infringe on our health care costs but the benefits are huge and it would go a long way if doctors and nurses and friends and family would remember that when talking to a pregnant or labouring woman.

That's my soap box for today, perhaps I'll get to write the next post I was planning on and chat about why you aren't too fat, short or old to have a baby.

How to Hire a Doula?

The last few weeks I've been hearing a lot of people ask questions about hiring a doula and what to look for. In fact just yesterday I recieved a call from a woman who had been 'chatting' with a woman who claimed to be a doula and it all sounded very suspect. In fact she had originally spelt the word doula wrong. My advice in that case...run away!

So I thought I'd put a few things down that will help the novice pregnant family look for, interview and hire a doula.

First!
Why are you hiring a doula? Do you even know what one is?
"A doula is a professional who provides emotional, physical, informational and practical support for the expectant, laboring or postpartum mother. She does not perform any medical tasks but actually compliments the medical birth team."1

Consider what you kind of support you are looking for. How do you envision your birth or postpartum period going? Do you need support during your pregnancy and labour? Then you are looking for a labour doula. Are you looking for support after you come home with the baby? Breastfeeding support or help with twins? Then you are looking for a postpartum doula.

Many doulas are both labour and postpartum doulas so if you need or want both then you need to ask the doulas you speak to what their services include.

Second!
Where do you find a doula?
Ask your friends and coworkers if they had a doula or if they know someone who did. Word of mouth goes a long way in hiring a doula. If that search leaves you empty handed turn to the internet.
You can start by a google search. "Doula Toronto" and see what you get?
Or you can search the many different doula referal sites such as:
http://www.torontodoulagroup.com/
http://www.doulacare.ca/
http://www.babyontheway.ca/

Third!
Once you've found and called several doulas (you can email as well but I suggest calling) get a feel by the ones you speak to who ou might like to meet in person. Each doula should offer a 'no obligation, no cost' interview to chat and answer questions with both you and your partner. If they don't, then they are not the doula for you.

I suggest interviewing 3 or 4. If you only have one or two that's okay too, but make sure that the doula you hire is the one for you. If it doesn't feel right or you just don't connect with the doula then they aren't the doula for you. Keep in mind too that the doula has to get a feel for you too. If she does not feel the connection then she may decline being hired. Don't take it personally, if she's not feeling it then she won't be at her best for you when you really need her.

But what do I ask?
You want to know where they trained? When they trained and if they are certified. Being certified is not the be all and end all but it is an extra step in training that I feel shows dedication to their field and respect for their training and continuing education. Now you may find that a doula you really connect with is in the process of getting their certification or has done a hundred births but is not certified. Don't worry.

As long as they are trained by a reputable training organization and is a member in good standing then you are good to go. As I said, being certified is not the be all and end all so don't get hung up on it if the doula you like isn't certified.

Fourth!
Check their creditentials. Go to the websites of the organizations they trained with or call them and see if they are a member in good standing. Are they a member of any other organization, call them and see if they are a member in good standing. If they aren't, you won't be able to find out why but that is a red flag! run away.

Fifth!
Ask questions. Labour Doula
What made them decide to become a doula?
How long have they been a doula?
How many births have they done?
How many births do they do in a year?
What do their services include?
Do they work with a back up Doula?
What are the terms of their contract?
What additional services to they offer?
What is their childbirth philosophy?
What is their opinion on pain medication?
When during the labour do you call the doula?
Do they have references?
Where and with whom did they train?
Cost?

Postpartum Doula
What kind of training and experience do they have?
How do they see the role of the doula?
What kind of services do they offer?
Are there different packages available?
Ask for references?
Why did they decide to become a doula?
What do they find is the most challenging aspect of their work?
How will they help the partner/family/older children?
Do they have back up?
What can you expect from a typical day?
Do they help with breastfeeding?
Are they opposed to bottle feeding?

Finally, I've alluded to training organizations. The two main ones are CAPPA, and DONA.
Have a look at their websites, you'll be able to find doulas on their sites too.

http://www.cappacanada.ca/
http://www.dona.org/

And trust your instincts! Hiring a doula is 50% experience and 50% personality. There is a doula for every woman and a woman for every doula. You'll find the right one, she's out there waiting for you.

1. The Doula Advantage by Rachel Gurevich - available a most Chapter and Indigo stores.

Hypno...what?

"You should read, Hypnobirthing by Marie Mongan." I say in all seriousness. Instantly a look comes across their faces and you can almost read their thoughts. 'We can't hire her, she is way too crunchy granola for us...' or 'Hypnobirthing...what kind of crazy mumbo jumbo hippie crap is she talking about.'

The funny thing is, I'm not crunchy granola, more like lumpy oatmeal and hypnobirthing, despite the name is not mumbo jumbo.

Contrary to popular belief Hypnobirthing will not allow your partner or me to make you bark like dog or act like a chicken during labour. It will however allow you t become completely relaxed and free of tension. When you are in this state, you are better able to listen to your body and follow your instincts.

You will still be completely conscious but during your contractions or surges as they are called, you will be able to go into a deep relaxation with the help of breathing and imagery.

Some of the best birth's I've been to have been Hypnobirths and my clients have been able to go unmedicated, and have been relaxed and stressfree.

So whether you take the classes or just read the book, I suggest that this state relaxation is something you should strive for in your labour. And it isn't surprizing for me to say that having a doula will aid in that goal

Well at least I'm not the only one saying it!

Medical interventions in childbirth adding undue risk

UPDATED: 2009-01-28 12:14:10 MST

By THE CANADIAN PRESS

TORONTO - The group representing Canadian obstetricians and gynecologists says there should be fewer medical interventions used in low-risk pregnancies.

The Society of Obstetricians and Gynaecologists of Canada says doctors should be promoting “normal childbirth” to women who seem unlikely to undergo difficulties during delivery.

A new policy statement from the group says the number of medical interventions used in healthy pregnancies is on the rise and could be subjecting mothers and babies to risks they don’t need to take.

It says health professionals are turning too quickly to interventions such as caesarean sections, induction of labour prior to 41 weeks of pregnancy, and the use of forceps or vacuum assistance during delivery.

The statement says doctors should only resort to these types of interventions when there is a valid reason, and should not use them when labour and birth are progressing normally. (But then I ask, what is normal for one my not be normal for another)

Supporters of the statement include the Association of Women’s Health, Obstetric and Neonatal Nurses of Canada, the Canadian Association of Midwives, the College of Family Physicians of Canada and the Society of Rural Physicians of Canada.

“We are seeing a significant increase of medical intervention during childbirth, but there is a real concern that unnecessary interventions introduce risks for mother and baby that could be prevented,” says Gisela Becker, president of the Canadian Association of Midwives.

“We want to be sure that women who are at low risk for complications receive adequate information and support to have a normal birth.”

So then we need to remember or rather have faith that women's bodies were designed to do this particular job. Without assistance from drugs, contraptions, monitors and what not. Women who have a team to support her, to help her feel loved, safe and supported will labour at her own pace follow her bodies own natural tendencies and birth her baby safely and easily.

Why must we send women into hospitals only to be hooked up, told they aren't labouring effectively, tell them their contractions are ineffective, basically saying you can't do it and then pump her full of drugs to force her baby into being born when perhaps they weren't ready.

My favourite saying from a renowned doctor I met was..."Nature doesn't screw up that badly. Human's screw up, but not nature." So why must we constantly believe that nature doesn't know what it's doing?

Pleasantly surprized!

I spent Valentines at the birth of a wonderful couple in Women's College Hospital. The birth was wonderful, everything went very well. So why was I pleasantly surprised? My only experiences with this hospital was one birth with midwives and several women telling me that their doctor was insisting they not have a doula.

One woman, a single mother with only her elderly mother for support asked her doctor about getting a doula and he told her it wasn't necessary, that he would be there and doulas were not worth it and would ruin their birth. She was a candidate for a volunteer doula and was the one person who really did need a doula. Thankfully she didn't listen to her doctor and had a doula and that took a lot of pressure off her and her mother to be there all on their own. Their doctor was not there for her, he wasn't even there for the birth.

My client this weekend told her doctor that that she was having a doula. He told her that their doula "had better watch her place. I'm not talking to her about you." I was worried that this doctor would ban me from the birth. He had some chip on his shoulder that a doula would encourage a client to go against their doctor. That a doula would give medical advice. That simply isn't the case. Doulas are not medical. Our role is to comfort, physically and emotionally. Our job is to educate and make sure that when a client has a big decision to make they are doing it with all the information.

So when I entered the hospital I was concerned that I would not be able to support my clients to my fullest abilities. Turns out the only problem I had was the incredibly small room. The nurses were awesome and respected my role on the team. The anesthesiologist was fabulous and let me stay for the epidural despite the size of the room. Her doctor went off shift and the new doctor was great and very pleasant.

I was very pleased with how everything went and stayed longer then I usually do. I'm actually looking forward to my next birth there.

2009 is the year of optimism

So I'm feeling particularly optimistic these days about what 2009 has to offer. Let consider 2008 as the year of trial and error. I had some awesome births, I had some that were horrible and one that was completely devestating to me and made me question my strength to continue on in the birth world. I took courses, I learned lots, not only about birth and breastfeeding but about myself. I became a stronger person. I became a better mother, a better wife, a better daughter and a better doula.

2009 will see the birth of many babies and also the birth of a new chapter in my doula life. This chapter includes new training, a new partnership and the birth of a new organization. The Toronto Doula Group will be emerging and taking on the doula world by storm.

I'm so excited about this and I know that there is only good things ahead of me in this brand new year. So watch out, I'm here and I'm not leaving.

Inductions suck! (A Very Tired Rant)

Let me start by saying that for some, inductions are necessary. Those women with high blood pressure or PIH, those with gestational diabetes and those who suffer from other illnesses that may threaten their or their baby's life. For them inductions have saved lives.

Having said that, for women who are "past date" or their water has broken or their doctor is impatient inductions SUCK!

The main reason being that they are designed to fail. Lets consider how it goes:
The pregnant mother comes into the hospital with the belief that her baby is 'overdue', 'very large', 'her water has broken 24 hrs ago', or they had thought they were in labor and the hospital was not busy and even though they were only 1 cms dilated they were kept and given a room. (Hint, go home!!!!)

She is told, for whatever reason, that she will need to be induced. The reasons given sound grave and usually the mother is so sick of being pregnant it is a straw she can't help but grab.

And thus it begins.
She is sent to a room. Forced into a hideous blue gown with her butt exposed. Propped up all comfortable in bed, (The first of the problems). Attached to fetal monitors (The second of the problems) and either her water is broken or she has an iv started and is pumped up with pitocin. (The third of the problems).

If the induction begins with breaking her water, there is usually a shred of hope in that she is able to walk around at least after a little bit of monitoring. This is good and necessary because women need to move in labour.

If she has pitocin then she is doomed. Women in labour can't remain in bed, unless their body is telling them too. Being on pitocin she must stay monitored and thus stuck in bed. Thus begins the interventions.

An epidural follows because the contractions she is getting from the pitocin are unnatural and very painful and being stuck in bed she can't move around to find a comfortable position. You can try sitting in a chair or standing or even on the birth ball, but heaven's forbid she should move because then the monitor won't pick up the baby and the nurse has to reposition it until the baby can be 'found' again and that usually involves the mother being uncomfortable and begging for pain medication.

Thus the epidural now has slowed the labour and mom isn't labouring at the rate she should. According "the text book" you should dilate at a cm per hour once you hit 4cms. Now because of this delay the pitocin is continuing to be increased. After a while the baby may not tolerate the pitocin contractions and the heart rate will dip repeatedly and the pit is stopped but the contractions do too and then the cycle starts. After a while, usually just enough hours to really drain on the mother and her partner the doctor mentions the dreaded "C" word. At this point, the dips on the monitor have scared the parents, they are exhausted and just want to see their baby and be done with it all.

Thus the end of the induction is a c-section. Failure!

So then what are you to do? First off get as much information as possible before you are induced. Ask the following questions:
"Am I or my baby in danger?" If the answer is yes then you have no choice and the induction is necessary.
"What happens if we wait a little longer?" Most of the time it will buy you some time and if the answers you get are satisfying to you then, wait!
"What happens if we do nothing?" Again, more time is bought and you get more information to make a sound decision about the care you are going to be receiving.

Don't blindly jump into an induction without all the facts.

Second, there are lots of great ways to get your body ready for labour:
Massage, accupuncture, chiropractics, sex, and more.

Try everything else first.

Well that is my rant for the day. In case it wasn't obvious I had a failed induction on the weekend and while mom and baby are doing great I'm saddend by the fact that she missed out on the birth she was hoping for.

Therefore: Inductions Suck!

Skeptic Nurses and doctors.

Why is it that whenever a woman dilates quickly, that nurses are so apt to disregard their pleas that they need to push or they need to be checked.

I've had two, no four incidences where the hospital staff thought my client was either lying or simply over reacting.

One occurred back in 2007 and I had a volunteer client. When we get to the hospital my client is doing really well and then around 2:30pm is checked and is found to be 5cms. A few minutes later the doctor comes in and they want to put a scalp monitor on her because they are having a hard time getting the baby's heartbeat. While the doctor is fiddling around with the package I sense my client pushing and ask her if she is and she says she can't help it. The doctor is still fiddling and I say that she is pushing and the nurse is convinced she is pushing on a full cervix. I try to tell her to breath through the contractions but she keeps insisting the baby is there and then that the baby is out. The doctor and nurse are completely ignoring her and then when the doctor lifts the sheet to insert the scalp monitor, there is the baby! Head out, ready to have the shoulders birthed. That was at 2:50pm. It was crazy but shows that women know their bodies and the medical community don't trust what the woman says about her experiences.

I bring this up because it happened again last night. My client whom I had just met as I was called in for back up was assessed in triage and found to be 1-2cms. They came to the hospital early but given that their drive was over an hour, mom felt like she needed to be there. I always say, if you feel like you need to be there, then you need to be there. They called and told me it was early but I felt like I should go, (I was already half way there) to meet them and get to know them a little. I met them in the hall, they were sent for a walk and had basically had taken 20minutes to walk up the hall and were on their way back down. Her contractions were intense and over a minute long. They were coming every two minutes. Her skin was goose pimpled with each contraction, that's how intense they were. She said she felt like she needed to push and I don't take that lightly anymore. Her husband and I got her back to the room they were using to store their stuff and I suggested going to the bathroom to see if perhaps it was a full bladder she was feeling. Trying to urinate was just far too intense and she said again she felt like pushing. I confirmed with her that she was feeling pressure in her bottom and she was clearly loosing her control. I told the dad to go out and get the nurse and tell them she is feeling pressure and needs to push. "That outta get a reaction out of them" I said. The nurse came in and tried to calm her through the contractions and the look on her face clearly said "I don't believe you, suck it up." My client was begging for pain medication and the nurse finally decided to check her and in the 40minutes since they had been checked she went from 1-2cms to 7-8cms and then 20minutes later was fully dilated and pushing her baby out. She pushed for about 20 minutes and her beautiful daughter was born.

These labours are called Precipitous Labors or Precipitous deliveries. They are births where the labour lasts less then 3hrs. Some information I've read says they occur between 2 and 5% of labours and are less likely to happen in first time labours. These labours are so rapid and it is so hard to manage the pain. The mothers are literally overcome by the contractions. Epidurals are useless in this case as even if one is able to be given in time the medication will not be able to cover the intensity and or catch up with her pain. One key thing will be to remain as calm as possible and not be over come by fear and tension. I know, easy to say, harder to do. But it is critical that you let your body do what it has to do and not stand in its way.

So as a doula it is my job to listen to the woman and trust in her body and trust in her own reading of her body. She knows better then anyone what is going on and if given the ability to labour in safety and a stress free environment her instincts will rarely be wrong.

Toronto East General Hospital

Wow, is all I can say for this hospital. It was amazing. The birth itself was great. Unmedicated, my client was in complete control and she was a rock star. I'm so proud of her. And to top it all off the hospital was amazing. Great jacuzzi tub that the nurse suggested to use. (Normally I get a weird look if we ask to use the tub.) One nurse brought out the birthing bar for my client to squat if she wanted to. (Normally they pretend like they can't find it.) The room was beautiful and very quiet. The doctors were all so nice and amazing. One actually complimented me as opposed to treating me like wallpaper, and they seemed pleased that my clients had a doula. I would give my eye teeth to do another birth there. Oh wait I am. I'm jazzed to have been hired by another client who is birthing there. Yeah me. Yeah them!

All I can say is Kudos to Toronto East General Hospital, to Dr. Maya Ganz and all the nurses there as well. And finally Kudos to my client and her strength and her control.