Nannies and Baby Nurses and Postpartum Doulas, Oh My!

So many families these days are realizing that when a new baby comes along an extra set of hands may become necessary.  And many women now a days do not have immediate family members close by or even in the same country to help out when baby arrives.  So these smart families are turning to outside help.  

The options available to new families is vast.  From Nannies, to Baby Nurses, to Postpartum Doulas and more.  But what is the right choice for you? 

First you have to decide what it is you are looking for? Do you want someone to look after your baby for you?  Do you need someone to look after an older sibling while you look after baby and recover?  Do you need someone to help with baby and you and assist with breastfeeding? Are you worried about postpartum mood disorders? Do you need something completely different? 

Let's look at a few of your options?

Nannies are generally used to look after older babies and children and follow the instructions given by the parent. They often live in with the family and don't usually assist with housework or laundry or caring for the postpartum mum.  They are not trained in breastfeeding support or in recognizing postpartum mood disorders.  They often work with families for many years. 

Baby Nurses are usually hired to care solely for the baby.  They too are not hired to assist mum with her postpartum recovery, take on housework or do laundry.  As with Nannies, Baby Nurses are not trained to assist with breastfeeding, though if they have had babies of their own, they may have a basic knowledge.  And as their primary function is to care for baby, they are also not trained to recognize postpartum mood disorders or look after older children.  Baby Nurses also must be trained nurses if they are using that title.  

Postpartum Doulas are trained to work with families in the first few days, first few weeks, first few months after baby comes home.  They are hired to support a new mum and her family while she recovers from her birth.  Their main priority is the mum.  Helping her with breastfeeding support, making sure she is eating, letting her rest while the doula watches the baby, listening to her process her birth experience and recognizing if mum is experiencing any postpartum mood disorder symptoms.

Postpartum Doulas will also help with educating the new family on all things infant.  How to bath and diaper a baby, tips for helping to soothe a crying baby, baby wearing, showing families real life hacks on how to cope with a new baby in the house.  Postpartum Doulas educate and support with the latest, up to date, evidenced based information and not just anecdotal suggestions.  

Postpartum Doulas will help with light duties around the house including mum and baby's laundry, cleaning the kitchen, preparing meals and anything else that might alleviate any stress from mum so she can concentrate on her recovery.  They can also help when there are older children in the house, keeping them entertained and happy to ease the pressure off of mum or watching baby while toddler has some mummy time, so they don't feel left out.  

Postpartum Doulas are also trained in supporting a family that may have been blessed with more than one precious bundle.  When babies come in multiples doulas can be that extra set of hands either during the day or over night when having more than one newborn can be overwhelming.  

Postpartum Doulas also support the rest of the family, including partner and grandparents, by modeling helpful support of the new mum and baby, answering questions, offering resources and educating everyone to help bridge the gap between old traditions and modern practices.  

We as a society were never designed to raise our offspring alone.  Like our ancestors so many generations ago, we are supposed to have our babies and raise them in a community, surrounded by our women, our mothers, sisters, aunties and grandmothers.  Being supported while we recover and learning from these experienced women on how to care for our babies.  Today, however, we are disconnected from our families either by distance or fractured family dynamics.  Yet we still need the support to make mums recovery quick and easy and to learn the many things associated with having a baby.  Mum still needs to have the tools to feel confident in her role as mother and nurturer and she can't get that from a book or the internet.  New mothers need mothering.  Postpartum Doulas are a great option for women and families that want more from their postpartum experience.  

So if you are having a baby, think about what you need, what you want. And consider hiring a doula for you and your newly expanding family. 

I Want To Become A Doula!

When I gave birth to my third child almost 10 years ago I did so with only the support of my partner. We didn't think we needed anyone else with us.  We'd done this before.  Twice.  My partner was great, but the birth was a bit of a farce.  I was induced in the morning and by the afternoon things were progressing quickly.  I did not have an epidural as I had the first two times and my partner needed to stay with me the whole time.  He could not leave my side.  I needed him.  But as a result he was not able to eat, drink, or go to the bathroom.  When it came time to push the deprivation he had endured for eight hours took its toll and he fainted.  The staff were more concerned about him than me and my perfect birth was out the window.  After the birth I experienced lots of Breastfeeding issues that ended with my daughter back in the hospital.  I later suffered from postpartum depression that ultimately took over my life.  If we had support during the birth or the postpartum period I do believe things could have ended differently.

I became intrigued with the aspect of support during birth and the postpartum period and did some research.  By fluke I came across the profession of "Doula".  But how did one become a doula? How did you make this a profession?  I'm often asked this now as a doula trainer so I thought it would be a good idea to lay it out here for everyone to see the steps involved.  

When I first began my research there were really only two organizations that were available to choose from, especially for a Canadian.  I looked at both and sought some advice of other doulas I had met on line in doula chat rooms, remember this was before FaceBook.  One doula in particular suggested I look at each organization's Vision Statement, Position Paper and their Approach to Birth. When I did I found I was drawn to the Vision that CAPPA had toward birth and their doulas. So now I had a path. 

I started with the labour doula workshop.  It was two days and explored a doulas scope of practice, the stages and phases of birth, comfort measures, how to support women and their partners during labour, how to handle unexpected outcomes, how to support a cesarean section or a VBAC, pain medications and the doulas role, supporting Breastfeeding and offering resources to pregnant women and new mums, the business side of your job and finding clients and oh so much more.  It was amazing! 

I walked out of that workshop as a doula in training.  I could now work with women and support them in their births.  During the early years of my doula life I continued to run my Home Daycare.  The families I served were very forgiving if I needed to have my husband watch the kids or my Mum or had to call in sick one day every now and then.  I also spent a number of years working at Shopper's Drug Mart and had a younger teenage cashier agree to take a shift on a moments notice if I had to go to a birth.  I also found like minded doulas who I got along really well with and we worked as back ups for each other.  I was nervous giving up guaranteed income for the risk of being self employed, so in the beginning I took just one a month, and worked slowly to gain experience and immerse myself in the birthing community.  One day I realized I was becoming popular, in demand and I had to make a decision to either do this "doula thing" or quit.  By that time I was also a Childbirth Educator and Postpartum Doula.  So while my income was not Millionaire worthy it was comfortable enough to take away my safety net.  And I'm so glad I did.

During those early years I was also working on the steps to become certified.  Being certified was important to me because I believe if you are going to do anything, you do it right and you do it fully. These days being certified is becoming more important as our profession becomes more popular and clients are now requesting certification.  And, as we creep ever more closely toward regulation, certification will definitely become a requirement.  

The steps to labour doula certification are many but not difficult.  And CAPPA allows 2 years for you to work on these steps.  I also used an extension which was easily granted as CAPPA understands that life happens and family comes first.  

Steps to Certification- Your Road Map To Becoming Certified:

(For the sake of this piece I will discuss the current steps to certification as things have changed slightly in recent years. You should always check the CAPPA website for the most up-to-date list of steps)

The order in which you do these steps is not important except for signing up for CAPPA Academy.  CAPPA is unique in that it has an online certification process.  All your documents, forms, exam and steps are found in CAPPA Academy.  

Once you have signed up then you would be free to tackle the steps as you see fit.  Those steps include: 

- Become a member of CAPPA.  As a member and a trained doula you will appear in CAPPA's referral section so expectant and new parents can find you.  You do not have to be certified before you appear on the website. 

- Complete the preworkshop study that you would get when you register for a workshop.

- Read the manual that you will get and go over extensively in the workshop.

- Read 5 books from the reading list.  You'll probably read more than that as you find books that peak your interest and expand your knowledge. 

- Complete part one of the HUG Your Baby Training program.  This program gives professionals strategies and tools to help prevent or solve problems around newborn sleep, eating, playing and attachment.  Professionals will be able to boost parent confidence, enhance Breastfeeding and promote bonding. 

- Create a resource list that you can use to make referrals to new mums and expectant parents.  That list would include lactation consultants, support groups, midwives and more. 

- Attend a Childbirth Education Class.  

- Attend a Breastfeeding Class

- Pass the multiple choice and essay exam found on CAPPA Academy.  This is an open book exam so no need to worry. 

- Attend three births and have them evaluated by the labouring mum, her primary care provider (Doctor or Midwife) and her secondary care provider (nurse or secondary midwife) for a total of nine evaluations. 

- Sign and agree to CAPPA's Code of Conduct and Social Media Policy, Grievance Policy, Missions Statement, CAPPA Approach / Philosophy Statement, Vision Statement and Scope of Practice. 

And that's it! Once you have completed these steps you gather everything together that needs to be sent in to the office, make copies and send those copies in.  Give the amazing office staff 6 weeks to mark your package and if all is in order you will receive your certification and be able to use the letters CLD next you your name. 

When I received my certification from CAPPA it was one of the proudest moments of my life.  I am so thrilled to be a member of and trainer for CAPPA.  This organization is a true sisterhood of support.  Their motto is "Love Wins!" And they truly mean that! 

So if being a doula is something you have thought of, or you have more questions about how to become a doula you can check out CAPPA's website at www.cappa.net or find workshops on my website at www.torontodoulagroup.com/becomeadoula.htm or you can email me at kim@torontodoulagroup.com. 

Being a doula and childbirth educator is the most rewarding job I've ever had and I can't thank CAPPA enough for being such an amazing, supportive and forward thinking organization.  

The Real Doulas of Toronto!!!

As a doula I've spent almost 10yrs meeting and working with amazing women in the birthing industry.  No two of us are alike, except perhaps for our passion for supporting mothers, babies and their families.  So I thought wouldn't it be great to highlight for the people of the Greater Toronto Area and beyond some of the utterly fabulous women I work with on a regular basis.

I've set it up like an interview with their responses below.  The first doula I'd like you to meet is Carrie Barr.  Not only is she an amazing mom but an incredible birth and postpartum doula.  She would definitely be on my team should I ever become pregnant again....which I'm totally not....ever....and I mean ever....Carrie is one of our Durham Doulas.  So if you are pregnant or a new mum in the Durham Region, you need look no further than Carrie!

So without further delay, here is Carrie Barr!!!

1.  What brought you to become a doula?

I was fascinated by people's birth stories and horrified at the number of people coming home thinking they had an "emergency" section for blah, blah, blah reasons and would never have a baby normally.

2.  How do you think postpartum and birth doulas benefit parents?
Birth doulas help empower a couple for the birth experience they want, doulas reduce interventions and increase chances of successful breastfeeding.

Postpartum doulas help integrate the new family member into the house, provide breastfeeding support, create a longer breastfeeding relationship, provide sleep support and help design a postpartum plan for the family.

3.  Besides Birth support, what other related services are you passionate about?

Placenta encapsulation, waterbirth and every woman having access to support.
4.  Would say it is still important to have a doula with Midwifery care?
Absolutely, while midwives are amazing support they do not have training in comfort measures like doulas do and they have tons of charting to do which occupies their time.  Doulas and midwives make an amazing birth team.
5.  If you attend births in hospitals which is your favourite and why?

My favourite is Port Perry because it's small, quiet, and the staff have time to be attentive, they LOVE having doulas, the birthing suites are on the main floor with it's own entrance and the rooms overlook a private garden so women have a beautiful private view while labouring.  And they can walk in the garden!! No need for the blinds to be closed and the sunshine shut out!

6.  One of the biggest concerns is that doulas will replace the partner, how do you ensure that this is not the case?

I always tell clients that I am there to support both of them and that I always offer to show the partner what the client needs so that he/she has the opportunity to be involved on whatever level they are comfortable with.

7.  What questions do you feel are important to ask a birth and or a postpartum doula?
Experience, references, bias's, back up

8.  If you could put together the perfect support service package what would you choose?
All my services! A tub rental for a homebirth in which I was the birth doula, who then encapsulated her placenta and do 6 weeks 5 nights a week of pp support

9.  How do you juggle family and doula work?
I try to focus on services that allow me to be at home like tub rentals and encapsulation, I do pp nights so I am here when my family is awake, limit births to 2 a month and try not to take any when I have pp booked.
10.  How do you answer the question "You're a Do-What?"I provide professional support to pregnant and labouring women and sleep and breastfeeding support to families at home after the baby has been born!

10 Reasons Not To Not Hire A Doula

I read a blog entry recently about doulas called “10 Reasons to not hire a doula”.  It was, according to the author, meant to be a parody.  As a doula I found none of it funny.  And actually was annoyed by its perpetuation of the doula stereotype.  So I decided to write a rebuttal.  I’ll try for humour as best I can and I hope to not anger anyone in the process of examining the “10 Reasons not to not hire a doula”.

Point one, Expense.  Yes Doulas are an out of pocket expense for most people.  And as the writer of the blog was American who probably has to pay medical expenses to have a baby I can see where this would be an issue.  In Canada we spend our money on the acres and acres of crap you don’t need when you have a baby.  Thousands of dollars in nursery furniture and décor in a room your child won’t even use for the first 6 months of their life, clothes from Old Navy and Baby Gap that your infant will enjoy spitting up on and pooping in.  Have you experienced the explosive poop? You better hope it isn’t in the $40 Gap onsie, cause no amount of Oxyclean will get that stain out.  And what about the $50 Nike baby running shoes? You squeeze them onto your baby’s potato shaped feet and if you’re lucky you won’t lose one in the mall, never to be seen again. 

Perhaps saving some of that money to spend on the day of your birth might be money better spent.  When you are 90 years old and you can’t remember what you had for breakfast that day, you will be able to recall your birth.  You probably won’t be giving birth 20 times like Michelle Duggar so why not make the experience as calm and stress free as possible.  Having a doula helps you be involved in the birth, have your questions answered and makes you feel a part of the birth and not that the birth just happened to you.  Also for the dads, we make you guys look like rock stars.  We show you how to help and let you be as involved as you want to be, at your own comfort level. 

And if the expense is still too much for you, many doulas work on a sliding scale or you could get a doula-in-training who may work for expenses or free. 

Point two, apparently all women just want to get the baby out as fast as possible. Funny, this is the precise reason to hire a doula.  Studies have shown that having a doula has been instrumental in shortening the length of labour and decreasing the severity of the discomfort felt.  I really don’t think I need to say more on this one. 

Point three, “A doula may try to talk you out of having drugs.” That is crazy.  I’ve had two epidurals and they are wonderful things.  I’ve also done it without drugs.  I would never talk a momma out of having an epidural unless her baby was sitting on her perineum.  This is not the doula’s birth.  Its the momma’s birth and if she wants drugs, no problem.  Hook her up.  If she doesn’t, I can get her to the end.  If she wants to try to go as long as possible without, I’m there.  Whatever momma wants, momma gets.

Point four, if the doula becomes a peppy cheerleader, the author will punch her.  Well so would I.  You hire a doula that fits with our personality.  If you are dragging and the end is overwhelming you we can be peppy if that’s your style, we can be strong and tough, we can be the shoulder to cry on, we can give you hints and tips to get you over that hump.  So I encourage you to interview several doulas to make sure you find the right doula for you, one that fits with your personality.

Point five, Doulas do not offer the doctor help.  We are not medical.  We assist in comfort measure suggestions, tidying the room, helping mum shift position, getting cold cloths and ice chips, supporting mum’s leg during pushing, watching dad so he doesn’t faint, but never suggestions on momma’s medical care.  That’s just crazy.  Doulas help parents make decisions by ensuring they have all the information and in order to do that we read lots of studies, on the internet.  But we help parents navigate the crap that can be found on the internet so what they know is evidence based and up-to-date.  Though I’ll admit, there is the odd doctor I’d love to see have a head explosion, that is out of my scope of practice.   And I’ll address the “hippie” comment in point nine.

Point six, I agree you shouldn’t have dozens of people in the labour room.  But the people you have shouldn’t be spectators either.  The people you invite to your birth should be helpful and encouraging and supportive of your choices.  That may not be your mother-in-law or you teenage sister.  Birth is not a spectators sport.  It’s an intimate experience that you will remember for the rest of your life.  So choose wisely.  And as for the oblivion mommas used to experience and get their babies three days later?  Well in my opinion, that’s what’s wrong with the world today.  We are a messed up society because we messed up birth for so many generations.  I’ll jump off my soap box here as I could go on a tangent.

Point seven, Breastfeeding. Yes we help with breastfeeding.  If you don’t want to breastfeed that’s your choice.  Doulas support choice.  Many mommas though want to breastfeed and it isn’t easy.  The most successful breastfeeding mommas are those that have support at home and can have their questions answered and latches checked.  But if you don’t want to breastfeed, doulas can help in giving advice on safe formula feeding. 

Point eight, lady bits? Really? I can’t even come up with a decent response to that one. 

Point nine, Crunchy granola hippie doulas.  Let’s see, I shave my legs and arm pits, wear make-up, dye my hair and get my nails done every two weeks.  I recycle and compost because my city requires me to, not because I want to and my car is far from eco-friendly.  As doulas go, I’m lumpy oatmeal at best.  I don’t say Yoni. I say Vagina, because that’s what it is.  I don’t chant or wear flowy skirts and beads.  I wear high heeled shoes not Birkenstocks.  I have never been a hippie and would never be accused of being one.  This point is the one that irritated me the most.  I don’t have a problem with my doula sisters who are crunchy, they are beautiful women.  But that’s not who I am. 

Point ten, the best point. Postpartum Doulas are awesome and very helpful in assisting new moms in the early days and weeks of motherhood.  They help with breastfeeding, making sure mom is getting rest, getting good food, having her house tidied and her questions answered, all without judgment of her choices.

Look, having a doula isn’t for everyone.  But having a stereotyped opinion of a doula and knocking them without really knowing who we are or what we do is just bad form.  So the next time you’re pregnant or the first time, look at what you want for your birth and the experience you will hold for a life time and consider the benefits of hiring a doula to ensure you get the birth you want, whatever it happens to look like. 

Partners.....

What is the role of the partner in the birthing room? For so many generations partners either didn't want to be in the birth room or were barred from being there.  Women were surrounded by their female family members and women in their community.  They were supported with love and compassion and the skill of women who had birth before them.

These days the skill comes from doctors and nurses and midwives.  And the love and compassion comes from their partners.  This can put many partners in an awkward position.  To see the woman you love, in perceived pain, and unable to sympathize or make it go away.  Desperately trying to remember what was said in the prenatal classes, kicking yourself for not reading those pages she had flagged for you and scrambling to find the birth plan she printed off to bring to the hospital.  What is a partner to do when suddenly faced with labour day and being overwhelmed and under prepared?

Step One:  Remain Calm
Even if you are freaking out on the inside, stay strong and in control on the outside.  All that comedic drama we see birthing mothers and their partners pull in the movies is FICTION! She needs your strength even when you aren't feeling it yourself.

Step Two:  Be There
That may seem obvious but I don't mean just physically.  You must be there mentally as well.  So that means no iphone, no blackberry.  Watch her, not the monitors.  Hold her hand, rub her back, listen to her wants and needs and respond to them.  Don't be distracted by the buzzing of your phone with texts and calls from anxious family members.  They can wait.  She needs you now.

Step Three: You are Papa Bear
You are there to protect your family and make sure they are safe.  How do you do that? Ask lots of questions, follow your gut and don't assume every suggestion is right for your family.  Most protocols are based on averages.  And your woman is not average.  She is an individual and her birth is as unique as she is.  She should be treated as such.  Protect her and her space so she can feel safe enough to let go and work at her labour.

Step Four: Plan Ahead
You can't show up for the birth and expect awesome.  No one wakes up one day and decides to run a marathon and win. You have to train or your twitter feed from the finish line will end with #fail.  Listen in prenatal class and practice the comfort measures you are taught.  Most importantly create the birth plan together.  This way you will know what she wants and why and how important each item is to her.  Know what you are fighting for when you are Papa Bear. 

Step Five: Know Your Limitations
Know what you are capable of.  What are your strengths and weaknesses? If you cannot do steps one to four with 100% of your abilities, get help.  Preferably a Doula who will assist you in all your steps and do it so you end up looking like a rock star.  Take all the credit, she won't mind.  Being honest about your ability to assist momma and asking for help is what she needs.  Being macho is not a welcome trait in the labour room, but honesty is.

Answer these questions: Can you be all she needs? Can you handle everything you may face? Do you have the stamina to run this marathon with her? If a voice in your head said no at any point, ask for help.  She'll love you for it in the end. 

Pleasant Hospital Experience

It has been just over a year since SunnyBrook opened their doors to their new Women and Babies unit. I had not had the opportunity to attend a birth there until this past weekend. As it was, it was not my client but I was called in to back up my partner. I was extremely impressed.

The facilities were beautiful. Of course it still had that shinny new feeling to it and the paint was probably still wet but it was nice none-the-less. The room had a fabulous deep tub and the room was large and spacious. And to my delight there was a private mini fridge for mum and partner to bring nutritious snacks and drinks, or a small bottle of champagne. And best of all you don't have to keep food in a communal fridge to be stolen by others.

But beyond the cosmetics and bells and whistles of the hospital, one of the best things about this hospital is the staff. The first nurse I met was Aggie. I had met her when this program was done through Women's College and she is still a fabulous, friendly and caring care provider. Then we met Karoline and she was equally wonderful and caring. The doctor who came on shift while I was there, Dr. Nevo and the resident Stephen (I didn't catch his last name), they were both very patient and spoke calmly and slowly about what their recommendations were and what the procedures would entail. This goes along way to making a potentially stressful situation easier for mum and partner.

Unfortunately for our client the end result was a cesarean section but for the comfort and support of both mum and partner, the doula, me, was allowed to attend the section as well. I was very happy for that, as the situation did require more then one set of hands to keep mum calm and comfortable for the hour it took to complete the procedure.

Overall, the entire experience was more then I could have hoped for, for any couple having a baby. The respect for birth and women and their ability to give birth is a rare gem in our world today. While the bells and whistles are great, women have been giving birth without them since the beginning of time, but what they have always needed to give birth is kindness, caring, support and above all respect. And SunnyBrook Health Sciences Women and Babies Program has that in spades.

Can't wait for my next birth there.

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.

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

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.

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!

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.

Labour and Delivery: The Movie

Don't get excited. There isn't a new movie coming out about childbirth. I just thought it would be nice to compare movie birth to real life birth.

The Hollywood Version
Scene One:
Woman enters the hospital in a wheelchair, clutching her abdomen, screaming in pain. The husband is frantic, sweating and pale. The nurse rushes to them and leads them to a hospital room right away.

Flash to a new scene; the woman is in bed, strapped to monitors and intravenous tubing, screaming obsceneties at her husband. The doctor is looking at the chart, while the nurse reads the monitor. All the while the woman is freaking out on her poor husband, blaming him for putting her in this situation and vowing never to have another child.

Next scene, the woman is sitting forward, knees up with a sheet drapped over them. The doctor is shouting to push. The woman is sweating, teeth clenched, moaning, grunting, screaming while she pushes. Then suddenly the baby is placed on the mother's hospital gown covered chest, looking like a three month old, covered in cheese curd.

The Reality Verson:
Scene One: The mother, her husband and their doula walk into the hospital triage. They are slow because the mother has to stop every now and then to breathe through a contraction. Once the contraction ends, she begins walking again, supported by her partner. He is attentive and they appear to communicate without needing to talk.

The woman is assessed after waiting for a while in triage and then they are moved to a fairly nice room and encouraged to walk. The woman and her support team spend several hours walking, sitting on the birth ball, using the tub or shower and utilizing focused breathing.

The atmosphere is calm and controlled. The mother is listening to her body and her support people are following her lead. Every now and then a nurse appears and checks that all is well and then disappears again.

Eventually it is time to push the baby out. The mother chooses several different positions to push from and follows her instincts and eventually the baby emerges and is placed goopy and bloody on the mother's bare chest and with smiles and tears the woman kisses her newborn baby's head, while her partner kisses her head and tells her how proud he is of her.

*******************************

Okay so some of what I put in the reality version was a bit optimistic. Generally women don't get to choose their own positions but occassionally they do and of course there is usually a whole lot of time missing there but overall the moral of all this is the same; reality is much better then fiction.

So stop watching "A Baby's Story" and any other hollywood version of birth, because it is fiction. A story made up and sensationalized for entertainment purposes. Real, non-high risk birth simply isn't scary and horrible enough for Hollywood to film. Sadly though, we as women grow up with these images and horror stories from our sisters and friends and we enter labour and delivery with an expectation of how it is going to go and we end up with a self-fullfilling prophesy and get that horrible birth we were expecting. We aren't taught that birth is normal and safe and beautiful. We can birth with calmness and beauty, but we have to believe it first. So tell your friends, your sisters and your daughters beautiful stories of birth and save your horror stories for Hollywood, and may one day Hollywood will follow suit.

Breech Babies

The last two clients I've had ended up in Cesearean Sections because the baby was breech. We attempted several different methods to get the babies to turn but to no avail.
My clients went to Spinningbabies.com. One had an EVC or External Cephalic Version, where by the doctor attempted to turn the baby manually from the outside. One tried Chiropractics which had the best potential for success, except the baby was stuck on the cord and couldn't move, even if he wanted to.

Which lead me to wonder, how can this be prevented. Well, after a lot of thought and after listening to a wonderful Doctor at a conference recently I am more convinced then ever that Chiropractics can work. But I'll add that you have to be seeing a Chiropractor for several months before your due date.

During pregnancy, chiropractics:
* Allows your nervous sytem to be free of any interference and therefore function better.
* Reduces stress and tension (physically and emotionally)
* Optimizes your body's adaptation to the changes of pregnancy (resulting in less aches and pains, 'sciatica,' pubic symphysis pain, headaches, shortness of breath, swelling and more.)
* Improves digestion (including morning sickness, heartburn and constipation)
* Helps reduce labour time, labour pain, and the need for interventions and c-sections.

A Chiropractor can perform what is called The Webster In-utero Constraint Technique. This non-invasive, gentle proceedure works on the pressure points on the round ligaments that attach to the uterus.

If your baby is breech, studies have shown this technique to be up to 97% effective in allowing a breech baby to turn on his or her own accord.

So if you want to learn more about this technique visit www.icpa4kids.com
(**information taken from CAPPA Canada conference lecture given by Dr. Amy Robinson of Vibrant Life Chiropractic in Woodbridge.)

The Business of Being Born

The Business of Being Born.
I recently purchased and viewed Ricki Lake's documentary called the Business of Being Born. I was thrilled. It was such an amazing look at what birth could and should be. It showed that birth isn't like what you see on television. Women aren't hanging from the ceiling, screaming their heads off.

The DVD shows women who are calm and relaxed and listening to their body and following their instincts. They are at home and comfortable. I'm not saying that all women should birth at home but it gives you a perspective about what birth could be like. Stay home as long as possible and keep that momentum when you do get to the hospital. It's hard to do but it is essential to keep things calm and stress-free. It will go a long way to ensure you experience little to know interventions. Also having a doula will do that for you. (There's my doula plug)

I encourage everyone who is pregnant or thinking of becoming pregnant or who has even already given birth, to watch this movie and think about what stories we share with our friends and daughters. All women should believe that birth is beautiful and rewarding. Not scary or horrifying, like what we see in the movies or on television.

Also once you've watched it, feel free to come back and tell me what you think about it, good, bad or thought provoking.
The Business of Being Born Website