Month: November 2018

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What A Doula Wishes You Knew About Inductions

There is quite a bit of information on labor inductions out there. With many people opting for elective inductions or medically indicated inductions, I think this is a great time to talk about what I have seen as a doula at labor inductions and what I wish everyone knew going into one to help have the most successful outcomes.

 

NOTE: This is not a post about shaming anyone for choosing an elective induction or for being induced AT ALL! As a birthing person, you are preparing yourself by making the best decisions possible for you, your baby, and your family.

 

To give an overview, here are some quick statistics on inductions:

 

  • As of 2014, around 30% of labors in the United States are medically induced, which is close to 1 in 3 labors that are medically induced.

 

  • According to ACOG in 2005, 23.4% of medically indicated inductions and 23.8% of elective inductions end in cesarean sections for First-Time Birthing People.

 

  • For a reference point, the cesarean section rate in the U.S. is close to 32% which is also 1 in 3 labors that result in a belly birth.

 

 

 

Around 75% of my clients will tell me that one of their birth goals is to avoid a C-Section. To work through that goal, we discuss the process of a cesarean, how they can take steps to preventing an unnecessary one, and create a portion of their birth plan that touches on wishes they might have in the event of a cesarean.

 

Very few of my clients tell me that a birth goal of theirs is to avoid a medical induction of labor unless absolutely necessary. But when I read statistics like the one above and accompany my clients to their induced labors, I wonder why that isn’t a topic of discussion. Based on the above information, it is about as common as a cesarean birth, yet there isn’t much knowledge about the process of inducing or augmenting labor. So when my clients are assessing their options and speaking with their providers about an induction of labor, they can be somewhat caught unawares of their options.

 

One of my jobs as a birth doula is to facilitate communication between medical providers and my clients. Another job is to provide evidence-based information to my clients to help them make the most informed decisions.

 

Here is my best NON-MEDICAL advice on labor inductions:

 

 

You may have time!

The average first-time birther goes into spontaneous labor around 41 weeks and couple days gestation. Your Estimated Due Date is just that: an estimate. So if you are beginning to feel pressured (by yourself, your family/friends, random strangers, and provider) and anxious about moving beyond that 40-week mark just remember: You most like have time!

 

There is no one-size-fits-all.

 

Medically induced labor is different for everyone, including the methods and medications that are used to augment your labor. Because of this, it is extremely important that you speak to your provider about their preferred method of induction and come up with a game plan TOGETHER that will best suit your needs and safety during your birth.

 

Inductions are not always fast.

A large misconception of induced labor is that it will be a similar length to spontaneous labor. The average length of labor for a first-time birthing person is 12-24 hours. Inductions can take around 24-48 hours. THIS IS NOT ALWAYS A NEGATIVE THING. Your body is not ready to have a baby when you are being induced, so it takes time to safely move through the stages of labor without exhausting your body and your baby. Don’t get me wrong, I have definitely had a few clients with inductions whose babies were born within a couple hours (especially with subsequent births), but more often than not, inductions take some time. Yes, your baby’s birthday may be earlier, but it is not always faster.

 

A shower can do wonders.

 

Many inductions begin with an overnight hospital stay of cervical ripeners to prepare your cervix for the day ahead. If you are someone who is not comfortable sleeping in a hospital, it is important to make your space as comfortable and comparable to home as possible. You may be anxious for the day ahead and sleep is not coming easily. I always suggest following your normal bedtime routine when you arrive. That way you are moving with your schedule and keeping things as normal as possible. In the morning, take a shower and eat something or even take a walk outside (if you can) before your next steps. This will reset your brain and help you start the day anew so it doesn’t feel like you have been in a hospital all night and are about to labor in one all day.

 

Your birth plan is NOT ‘out the window’ or obsolete!

 

It always breaks my heart when I hear my clients say that they want to chuck their birth wishes now that they are in the hospital to be induced. Depending on your hospital many of your birth wishes are still very possible to achieve! Saline Lock? Mobility? Wireless Monitors? These are all possibilities that can be discussed with your providers before and when you have arrived at the hospital on your induction date. This is still your birth. YOU ALWAYS HAVE OPTIONS.

 

Treat yourself before you arrive.

 

I love this one. This definitely relates back to the length of your hospital stay. Take the time before your birthing date to enjoy this little bit of pregnancy joy with your baby and partner. Go for a walk outdoors, have a nice filling dinner, maybe throw in a little sex if that’s an appealing option. Do all of the things a couple without babies does because soon your only responsibility will be to healing and caring for that little love. As someone once told me during pregnancy, “They (your baby) are the most portable now than they will ever be”.

 

Know your Bishop Score!

 

A Bishop Score is a great tool for assessing the success of a vaginal delivery with labor augmentation. It takes into consideration your cervical position, effacement (how flat), dilation (how open), Consistency (how soft) fetal station (how low the baby is in your pelvis). The results give you a good understanding of the vaginal birth success rates of inductions with your current cervical state. This is especially helpful for those wishing to do an elective induction but also for those with inductions that are medically indicated. It gives you an idea of the possible timeline of your labor to discuss with your provider.

 

Mind Over Matter.

 

Finally, with inductions more so than any other type of labor I have supported, it is all about mind over matter. Yes, it may take a long time. Yes, you can feel overwhelmed about being in the hospital and any changes of plans or medical interventions. But REMEMBER: YOU are still in charge. YOU are still in control of what happens to your body and your baby. Birth, no matter how it begins, always brings the unexpected. How you move with those changes drastically impacts your emotional and physical outcomes.

 

 

 

DISCLAIMER: I am not a medical professional. This information comes from personal experience, the experiences of my clients, evidence-based research, and anecdotal evidence. If, at any point during your pregnancy or postpartum period you have a question or concern, please contact your care provider for medical support.

 

Resources

 

Bishop Scores

Induction and Labor – NHS

Parents.com – Inducing Labor 101

National Partnership – Facts About Labor Induction

Consumer Health Pregnancy Information

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First Trimester Talk: Partner Support and Communication

The first trimester of pregnancy is TOUGH. Those able to carry a baby might be experiencing any number of the following:

 

  • Morning (AKA ALL DAY) Sickness

  • Appetite Changes

  • Sluggishness

  • Emotional and Hormonal Fluctuations

  • Fear of Miscarriage

  • Fear of the Future

Not everyone feels an immediate connection to the baby they are carrying. I equate it to the feeling of being ‘pregnant’ and not quite yet ‘with child’. This is a totally normal feeling and one that most pregnant people go through during this first trimester.

If you are a partner of an expectant person, you might be feeling a little helpless in terms of supporting them. You might also be feeling disconnected to this pregnancy. As time goes on and your baby grows, this will definitely begin to shift and change. Until then, here are four steps you can practice that will help you to connect and communicate with your pregnant partner and your pregnancy journey:

 

1: Listen

 

Ask a pregnant person and a majority of the time you might hear them say that all they want their partner to do when they share their pregnancy concerns is to LISTEN. As a partner who wants to show their loved one that they care, you might want to jump in and still their fears by telling them that the number of concerns that they have ‘will not happen’, ‘everything has a purpose’, or one of the many responses that intend to inspire confidence and quell anxiety. But don’t be surprised if it may not. Sometimes the best thing you can do is just focus in and listen with your ears and your heart instead of your mouth.

 

Example:

 

Pregnant Person: “I’m really nervous about having this baby? I don’t want to, but what if it’s breech and I have to have a C-Section”?

DON’T:

Cut them off in the middle of the sentence. Share your personal opinions of your partner’s feelings. Do some other activity while they are sharing.

DO:

Tune in, make eye contact, connect heart-to-heart and hear your partner.

 

2: Acknowledge

 

This is a very simple next step if you did well during #1. What did you hear from your partner when they shared their feelings? Acknowledging has to do with honestly repeating back what you heard to your partner and asking for confirmation. This provides space for healthy and unbiased conversation. More importantly, it tells your partner that they were being heard and they have a chance to hear what they said for themselves. The bonus is if you misheard something or if your partner said something that they didn’t quite mean, they have a chance to reword their statement with more clarity.

Example:

DON’T:

Partner: “Don’t worry about that. That’s a long ways away to be stressing you out now. Besides, what will be will be.”

DO:

Partner: “I’m HEARing that you’re nervous about having this baby. You’re nervous about the baby being breech and having a C-Section and you don’t want a C-Section. Is that correct”?

If your partner needs to reword their statement of concern then repeat steps #1 and #2 again until they feel confident about what they mean.

 

3: Respond From Your Heart

 

Use this mindful opportunity to take a listen into your heart and think about how you might feel about their statement. Maybe you might also be concerned about birthing outcomes or maybe you are completely confident that everything will go to plan. Either way, you are entitled to your feelings and it’s important to know where you stand and that your partner hears you, too. Responding from your heart allows your partner to know what you feel about their worries and how you feel about your partner. It also allows your partner to see and feel that you are a team.

Example:

DON’T:

Tell your partner how they are feeling (You can only know your heart and acknowledge their words).

DO:

Partner: “In my HEART, I’m FEELing very confident that every part of the birth will go to plan. I love you and I want to support you in this.”

 

4: Do Your Research

 

One of the best things you can do after discussing your feelings about an unresolved situation is to Do Your Research. Your partner is worried about a breech baby or a C-Section? Maybe work together to look up statistics on breech babies, literature on vaginal breech deliveries, finding out what your provider’s stance is on breech births, or ask your DOULA about info on the subject. This can really put your thoughts and concerns into perspective and help you to feel in can help you to feel prepared and in control of your thoughts.

Example:

DON’T:

Put off to tomorrow what you could do today.

DO:

Partner: “How about we talk to our provider at the next visit and I can text our doula for more information today?”

 

 

Practicing at least one meaningful and present conversation a day can be so beneficial to your relationship development with your partner as you grow on the journey of parenthood. By showing your partner that you want to listen, support, and share you are showing them that you are invested in this pregnancy and birth. The bonus is that you will then have a strong foundation for healthy communication for years to come.

 

DISCLAIMER: I am not a medical professional. This information comes from personal experience, the experiences of my clients, evidence-based research, and anecdotal evidence. If, at any point during your pregnancy or postpartum period you have a question or concern, please contact your care provider for medical support.

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Why I Offer FREE Consultations

 

 

‘If a doula is meant to provide you with information, why offer a FREE consultation?’

I believe a doula is so much more than a walking, talking, Google. They are your support, your best friend during pregnancy, the glue that holds your birth team together and keeps your head in the game.

But not every doula is right for every person. As your potential doula, I already want you to get the support you and your partner need for your birth experience. We have to VIBE.

 

That is why I offer initial consultations for FREE.

 

What do these consultations look like?

 

Usually we will meet at a public location (for both of our safety) – a coffee shop, park, library, etc. I like to get an understanding of your birth wishes and what you might be expecting from doula support. I answer any questions you might have about doula support and about me. Some common ones include:

  • Are you trained? What did that entail?

  • Are you certified?

  • How many births have you attended?

  • Are you experienced in High Risk Birth, Multiples, Cesareans, Home Birth, Hospital Birth, etc

  • What if I go into labor in the middle of the night, can I still call you?

  • How will you help support my partner? They want to be involved and don’t want you to replace them.

  • How do you work alongside Nurses and Providers?

  • What is your fee?

  • Do you have back-ups?

Then I will have some questions for you:

  • How has this pregnancy been?

  • What are your hopes and concerns for this birth?

  • What role does your partner want to play in your birth?

  • How do you see me supporting you?

We talk about next steps, exchange contact information, and I give you a folder with more information and contracts should you choose to peruse and sign.

NO HASSLE, NO FUSS, and you get to decide if I am the right doula for your birth team without any pressure.

So let’s schedule a consultation today!

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A Day In The Life: How A Doula Supports You During Labor

At least once a day new friends and strangers ask me,

 

“So what does a doula do anyway?”

 

I do my best to answer with the most concise elevator speech I can manage.

 

“A doula provides continuous physical and emotional support to a laboring person and their partner. They facilitate communication between the care provider and client, promote evidence-based resources and choices, and create a safe and loving pregnancy and birth environment for their clients. I like to think of it as your best friend who also happens to know a whole lot about childbirth and will always respect and support your choices.”

 

While the above statement is completely true, I think of my work as so much more than that. Sometimes when I give my elevator speech to people I actually want to shout,

 

“BUT IT’S SO MUCH MORE THAN THAT!!!!”

 

This is also a big reason why I offer free consultations. Everyone is different and a doula molds and shifts to your needs and wishes to help you have the most positive birth outcome. I am here to help you figure out what that might mean for you and your partner.

 

I thought that a great way to describe what a doula does is to go through a typical ‘Labor Day’ as a doula. This, of course, is a fictional description of someone’s labor day. It is comprised of my extensive birth support experience of what is common of a typical full-term, unmedicated, vaginal delivery at a hospital. This is not the support case for everyone and definitely not how every birth I attend goes but it is a great insight into what doula support might look like in this case.

 

Doula Diaries: Nadia and Jim

 

So we will call this Birthing Person Nadia and her Partner’s name is Jim. They have expressed wishes for an unmedicated vaginal birth in the hospital. This is their second baby. Their first was born vaginally 3 years ago and is named Poppy. During our prenatal appointments we have discussed their birth wishes and preferences, practiced comfort measures, and done evidence based research to support choices or answer any questions they might have as pregnancy goes on.

 

EARLY LABOR

2:00PM

Nadia has reached her 41st week and is beginning to feel some contractions every 15 minutes or so. She calls me and tells me of the sensation. I talk to her on the phone and listen through a contraction, using guided imagery to slow her breath and help her to relax. I encourage her to go about her day-to-day activities as much as she can. She loves walking around the mall with her mom so she makes that a plan and promises to keep me updated, drink water, and eat fulfilling meals. I begin to prepare my doula bag, eat something healthy, and update my childcare and back-up doulas so that they are prepared for the upcoming birth.

 

 

5:00PM

Nadia calls me with an update that her contractions are getting closer together – every 7-8 minutes – and they are feeling more intense but definitely manageable and that she does not need me there yet. Labor feels REAL. Now that Jim is home, I encourage him to work on the comfort measures we talked about. I remind them both that this is a great time to bond with one another, to be intimate (in whatever form that takes) and foster that love connection while it is just the two of them. Nadia’s mother takes Poppy to her house for a play date so that Nadia and Jim can be alone.

 

7:00PM

Jim calls and says that Nadia’s contractions are 5-6 minutes apart and she is starting to work hard through each of them. Nadia and Jim are ready for me to come over. I encourage Nadia to try to go potty while Jim refills her water and then get into the bathtub and get comfortable while I head over.

 

ACTIVE LABOR

7:30PM

Once I arrive, I find Nadia in the tub relaxing in the warmth. I find her playlist she created on Spotify and turn it on so she can relax to the music. I set up some LED Candles and turn off the lights. I put a big towel over her exposed skin and begin pouring water over her to keep her warm and relaxed. I know that she wants Poppy to come see her during labor so I suggest to Jim that he call the Midwife to update her on the contraction patterns while I call Nadia’s mom to ask them if they can come over now that she relaxed into labor. Nadia’s Midwife suggests, since they are close to the hospital, that she labor until 2-3 minutes apart before heading in. After every contraction I offer her some water.

 

8:30PM

Contractions are now 3-4 minutes apart and I have been squeezing Nadia’s hips in the tub while Jim strokes her hair and repeats the words of encouragement they have written together. Nadia is focused and calm through each contraction. Poppy has come in to give her kisses and has left to go get ready for bed with Nadia’s mom. I encourage her to relax her jaw and make whatever sounds are comfortable for her, I even chime in to help her feel more comfortable. I gently help her to sway her hips to the music from her playlist. She expresses that she is ready to go to the hospital and I help her to get out of the tub and change into her laboring nightgown, slippers and a sweater while Jim gets the car ready to go. Nadia’s mom comes to kiss her and says she will come to the hospital as soon as she can with Poppy. On the way to the hospital, I call ahead to labor and delivery and inform them that we are on our way in active labor and to alert Nadia’s midwife. They know to expect us and have a room ready so that Nadia can skip over being stuck in triage for another hour without a room.

 

9:00PM

While Nadia is answering questions in Labor and Delivery, I am putting away her things, spraying her room with a Lavender Spray she likes, covering the clocks, putting the LED Candles up, dimming the lights and screens, turning down the monitor volume, upping her music, giving the nurse her birth plan and introducing myself, and getting her water and comfy pillows close to her. Her contractions during this time are met with hip squeezes from me and loving caresses from Jim. Her Midwife arrives and she gets a cervical check – 7cm, 0 station.

 

9:30PM

During the excitement of the hospital trip, Nadia’s contractions have spaced out to 5 minutes apart and is having a hard time getting back into the labor zone. I suggest moving to the shower, but she does not want to move because she is in pain (her words). We get her onto her birthing ball so she can be upright and I wrap a Rebozo around her head, covering her eyes and ears. Jim places his hands on her hips and assists her in rocking side to side. I guide her through imagery of facing the ocean with the waves rushing over her feet and rocking her side to side. We stay like this through a couple of contractions. Everything gets very quiet in the room.

 

10:00PM

Nadia begins grunting and quietly says, “I have to poop. The baby is coming.” I call the nurse and let her know that she is feeling the urge to push. The nurse comes in and we both get Nadia up so that she can do a cervical exam. Nadia is fully dilated and ready to push the baby out. I remind the nurse that Nadia’s preference is to push unassisted in a quiet space so that we can all be respectful of that. The nurse is excited for Nadia and goes to get the Midwife and delivery team ready for the birth.

 

BIRTH

10:15PM

There is excitement all around as the L&D Team fills the room. Lights come on, there is a lot of movement, and the energy has shifted away from the peaceful anticipation. My focus is on Nadia and I help her get into her most comfortable position for pushing. I cannot control the room, but I can be there for her. I remind Jim to focus on her and be her support, and I lean in to Nadia and whisper in her ear, “Just stay focused on your baby and Jim’s voice. Nothing else here matters. You are incredible, let’s breathe slowly together.” We start breathing through the pushes all together. Within a few minutes, the baby is born and is immediately placed on Nadia’s chest.

 

POSTPARTUM

10:30PM

As per my client’s request, I take as many photos on my phone as I can to capture the moment. I also ask Jim and Nadia if Delayed Cord Clamping was something that they still wanted to do and, if so, to remind their midwife. I congratulate my client and help to facilitate their post-birth wishes.

 

11:00PM

Once everything has calmed down in the room, I dim the lights again and make sure they are comfortable. I encourage them to rest and bond in this first hour. I plan to leave for a bit to give them space and ask if there is anything they would like to eat. I take their food orders and begin moving all of their things to their new postpartum room, setting it up so it is ready for them when they transfer. I pick up food and upon my arrival back in the room, I help Nadia to facilitate a good breastfeeding latch.

 

12:00AM

Once everyone is comfortable and in their new postpartum room, I congratulate my clients, pack my bag, and thank the nurses on my way out. We will have a phone call in the next day, a gift drop off of herbal baths and lactation cookies when they arrive home, and a postnatal visit to walk through their birth and provide any resources they might need.

 

But it never has to end there. My clients and I usually remain friends. We connect through social media and text with check-ins and questions. I stay a support for this postpartum period, making sure they don’t feel that they are alone.

 

IT IS SO MUCH MORE.