Author Topic: To doula or not to doula?  (Read 10530 times)

naners

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To doula or not to doula?
« on: March 17, 2016, 09:26:23 AM »
Hello Mustachian parents, does anyone have thoughts about hiring a doula (or not hiring a doula) for childbirth? Here in NYC my sense is that they are very expensive ($2000+). I'm planning to be delivered by my OB in a hospital, have an epidural, feel generally very comfortable with the medical system and don't have strong opinions about how I want the birth to go (beyond ending with a healthy baby in our arms, fingers crossed). DH is good under pressure. It doesn't seem necessary in our case but I can see the pros: having someone there the whole time who knows exactly what is going on, can give DH a break etc. Your thoughts are much appreciated!


little_brown_dog

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Re: To doula or not to doula?
« Reply #1 on: March 17, 2016, 10:16:12 AM »
I did not use a doula, and I think everything went exactly as it needed to without one. I had a natural, completely unmedicated labor until baby got stuck during pushing and I required an emergency epidural to rest before resuming. Many would say that my baby's birth is the reason for doulas (unmedicated with complications requiring a change in plans; needing to weigh the costs of the epidural vs c section when neither was my original plan), but I was in control and felt fully supported by my husband and care team. I don't think having a doula there would have done anything. The change in plans helped me deliver my baby safely and I was 100% on board.
To me, doulas are great if you feel like you need extra support/struggle to advocate for yourself, have had a bad birth experience in the past, or are nervous/afraid of labor and birth and could use some extra tlc. If you have a regular pregnancy and feel confident that you and your partner can advocate for your wishes during birth, I think a doula is probably an unnecessary extra. I actually have never heard of someone having a doula with a planned epidural...most people seem to go for one because they want extra help in managing pain or making decisions when they are exhausted.

Edit: Now that I'm thinking about it, doulas seem to be just a modern day replacement for experienced women family members and friends who would often be present at a birth. If you have a mother friend like your mom, a sister, or close friend who you trust, you could probably enlist them to be present if you want someone to just be there to get your husband snacks, offer encouragement, etc. Obviously this only works if you really feel comfortable having the person there. I just had my husband and that was perfect for me.
« Last Edit: March 17, 2016, 10:35:22 AM by little_brown_dog »

alwayslearning

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Re: To doula or not to doula?
« Reply #2 on: March 17, 2016, 10:24:52 AM »
In my birthing center group, many of the other moms are considering a doula. They feel this person will be able to move them into positions that their husbands may not know about or may have forgotten about in the mix of labor.

Personally, I opted out of having a doula for a few reasons:

1. I'm a pretty private person and feel much more comfortable with having my husband be my coach. My husband is very supportive, doesn't get squeamish around medical situations and is very calm during emergencies. Had my husband been nervous or uninterested in helping out, I'd totally understand needing a doula.

2. I want my husband to feel as much apart of the birth as possible and I think having a doula would almost replace his role.

3. They are pretty pricey and our birthing center offers a lot of the services they offer (breast feeding assistance, following your birth plan, assisting in transfers if you need to go to the hospital) for free.

sjc0816

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Re: To doula or not to doula?
« Reply #3 on: March 17, 2016, 10:46:14 AM »
Maybe I was lucky for my two births, but my labor and delivery nurses were STELLAR.  My husband wasn't much of a "coach"...and I had two fairly difficult births (posterior positioning and heart decelerations both times)....and the nurses got me through seamlessly. I can't imagine a doula being necessary?

My cousin had a twin home-birth and had to fly a doula in from Brazil (no doula would do a twin home-birth in the US for an older mom). The doula apparently was fantastic but I thought my cousin was nuts.  All went great, though.

jeninco

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Re: To doula or not to doula?
« Reply #4 on: March 17, 2016, 11:31:11 AM »
We loved our doula, both times. I had back labor with both kids, and the doula and my husband alternated counter pressure on my back which helped enormously. Both were planned home births (*): with the first we went to the hospital after being in transition for a few hours (because my husband was getting nervous, not because anything was going wrong: about 1 mile away). The doula knew a bunch of the L&D nurses, snagged the one who would be the best fit with our group, set up the squat bar on the bed and everything went on as planned. With the second, again, the doula's massage therapy background was super-helpful (although everything was faster that time).

Congrats, and good luck!

*I had interviewed every obstetrics practice in a 20-mile radius of my house, and wasn't getting satisfactory answers to "so, why is your C-section rate approaching 30%, and when would you decide to do a C-section", so with no pre-existing conditions and the best data available in 2001 (which suggested that it doesn't matter where you have the baby with a low risk pregnancy), went with planned home births. Having the doula was super-helpful both at home and when we moved.

Gin1984

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Re: To doula or not to doula?
« Reply #5 on: March 17, 2016, 11:54:06 AM »
As long as you are comfortable with the medical field, standing up for what you want, communicating that and your husband is able to advocate for you, I don't think you need one. 

MrsDinero

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Re: To doula or not to doula?
« Reply #6 on: March 17, 2016, 12:28:58 PM »
I was induced and had an epidural with my first and it was an awful experience and I ended up needing a lot of stitches.  One of the reasons I hated it, is because once you have an epidural you are pretty much trapped in the hospital bed until you give birth, however long it takes. 

My second we hired a doula and went with a "make the decisions as they come" plan and it went amazingly well.  I ended up being induced again, but did not use pain meds of any kind. 

The reason I really wanted a doula was because I had a lot of anxiety from the first birth and knew I needed help with my second (mentally). 

What I got from the doula was a person I could talk to during the last 4-6 weeks of pregnancy about anything.  We were concerned about the baby being breech, so she not only gave us exercises but was also very calming.

One of the big thing was that I wanted to be as informed as possible about everything that was going on in the delivery room.   Basically acting like a liaison.  I also did not want a c-section and stats have shown that having a doula assisting reduces the chances of having a c-section.

She encouraged me to try different positions until I found a couple that really worked for me.  I walked a TON, sat on the ball, and tried the warm water tub (this really got things moving along).  I basically got through the entire labor, except for the last 30 minutes or so.   I ended up having natural labor, but honestly it wasn't something I actively wanted.  I didn't have any tearing and literally walked out of the delivery room after 2 hours of skin to skin contact with my newborn. 

I'm now pregnant with my third child and we plan on using the same doula.  I haven't decided if I'm doing natural labor or not, I'll make that decision when I'm in labor and need to make it.  Every birth is different. 

Knowing the labor and delivery staff like we do now, we could probably do without a doula, because they are all of the same philosophy of "let the body does what it needs to do".

 For me I wanted to be in control of my body and what was happening as much as possible.  I have a friend, on the other hand, who doesn't want to even have a drop of sweat roll down her head during birth, so she always went with an epidural as early as possible (around 5 cm dilated). 

When it comes to birth, it comes down to what you want most.


Edit:  There are some people who think only having natural labor is the mark of a "real" woman.  I call BS on that.  I went with natural because everything was going so very well during labor that it felt "right" for me at that time.  I was able to breathe through and manage all the contraction pain, but I am not against having an epidural.  So do what you feel is best for you. 
« Last Edit: March 17, 2016, 12:42:08 PM by MrsDinero »

Revelry

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Re: To doula or not to doula?
« Reply #7 on: March 17, 2016, 12:33:48 PM »
OP, sounds like you'll be fine without a doula.  I can see the value in them but they still seem a little, hmm, indulgent?  Like paying for a massage.  I'm kind of an a** though.

DW gave birth to our first in the hospital w/o a doula and it was fine.  She had an epidural and a 12-stitch episiotomy so it took a couple weeks to really get back on her feet.  Our second is now six weeks old and was born at home with two midwives attending.  We hired a student doula but DW wasn't quite far enough in her pregnancy for the doula to be on call, and since second children come out quicker she ended up missing the birth.  Her fee was only $300 and I don't regret it, but with the midwives (they were excellent!!) and how quick it went I'm not sure how much assistance the doula would have provided.
YMMV.

I will caution you that however calm your DH is under pressure and comfortable with medical situations you are, there is a definite power imbalance when dealing with doctors.  Hospitals are not designed with your comfort and ease of labor in mind.  Epidurals slow down contractions, so the doctor will advise you to start Pitocin.  Pitocin causes longer and more intense contractions than your body naturally makes, which places stress on the baby.  The fetal heart monitor shows the baby is distressed and the doctor recommends doing a C-section (and he/she can make it home in time for dinner).  Maybe you're okay with that.

The midwives were awesome.

jezebel

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Re: To doula or not to doula?
« Reply #8 on: March 17, 2016, 12:53:38 PM »
I had two great birthing experiences at a hospital without a doula - first one with an epidural and second one without any pain meds.  My delivery nurses were great and my husband is very calm in a "crisis."  It easy for everyone to report their experiences, but it's hard to guess what you will need. 

I will caution you that however calm your DH is under pressure and comfortable with medical situations you are, there is a definite power imbalance when dealing with doctors.  Hospitals are not designed with your comfort and ease of labor in mind.  Epidurals slow down contractions, so the doctor will advise you to start Pitocin.  Pitocin causes longer and more intense contractions than your body naturally makes, which places stress on the baby.  The fetal heart monitor shows the baby is distressed and the doctor recommends doing a C-section (and he/she can make it home in time for dinner).  Maybe you're okay with that.

I believe there are studies that have disproven that epidurals slow down contractions/labor, and no one recommended pitocin when I had an epidural.

okits

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MrsDinero

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Re: To doula or not to doula?
« Reply #10 on: March 17, 2016, 01:10:18 PM »
Did you catch this thread from the fall?

http://forum.mrmoneymustache.com/antimustachian-wall-of-shame-and-comedy/so-you-are-hiring-a-butler-for-a-day/

There have been a couple of threads on doulas.  I personally would not consider my doula a butler, but absolutely a coach and then some.  It is obvious some people feel they are worth it and some feel they are a waste of money. 

My SO originally thought it was a waste of money,but went along with it because I was the pregnant one.  In the end he loved having her there.  He was a first time dad and she not only encouraged him to get involved (his eyes were as big as saucers), but showed him what to do and helped him relax too. 

hunniebun

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Re: To doula or not to doula?
« Reply #11 on: March 17, 2016, 01:14:24 PM »
I had a doula both times (because I was very nervous and wanted the extra support). The first time around it was great to have the extra set of hands and reassurance. The 2nd time around it was so fast, it really wasn't necessary at all.  Having said that, it was 500$ the first time and only 300 (she was a midwife in training) the second time.  In both cases, I  do not think it would be worth 2K.  Really you need to assess how you are feeling about everything. If you are feeling confident, ready for all the different things that can come up (such as it being too late for an epidural!), then I think you would be safe to go without!  Good luck with everything!!

okits

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Re: To doula or not to doula?
« Reply #12 on: March 17, 2016, 01:27:05 PM »
Did you catch this thread from the fall?

http://forum.mrmoneymustache.com/antimustachian-wall-of-shame-and-comedy/so-you-are-hiring-a-butler-for-a-day/

There have been a couple of threads on doulas.  I personally would not consider my doula a butler, but absolutely a coach and then some.  It is obvious some people feel they are worth it and some feel they are a waste of money. 

My SO originally thought it was a waste of money,but went along with it because I was the pregnant one.  In the end he loved having her there.  He was a first time dad and she not only encouraged him to get involved (his eyes were as big as saucers), but showed him what to do and helped him relax too.

The first response in that thread is from me, explaining that a doula is not a butler.  It runs for about two pages, with comments including personal birth stories (with or without doula involvement), discussion on benefit (reduced interventions) vs. cost, why a need for this paid role may exist in the first place, and arguments why a doula is or isn't worth having.  Naners, if you're interested in other people's thoughts on the subject it's worth a read.

little_brown_dog

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Re: To doula or not to doula?
« Reply #13 on: March 17, 2016, 01:39:56 PM »

 Hospitals are not designed with your comfort and ease of labor in mind.  Epidurals slow down contractions, so the doctor will advise you to start Pitocin.  Pitocin causes longer and more intense contractions than your body naturally makes, which places stress on the baby.  The fetal heart monitor shows the baby is distressed and the doctor recommends doing a C-section (and he/she can make it home in time for dinner).  Maybe you're okay with that.

The midwives were awesome.

This is not accurate in many circumstances.

Many maternity wards are definitely designed for ease of labor and patient centered care nowadays. In my unit, women were wandering around, bouncing on balls, lazing in gigantic jacuzzi tubs with fake candlelight and relaxation music...the works. No, it was not a house with couches and fluffy beds, but it was really freakin nice. And a crapload safer than homebirth- thankfully, because my perfect labor went wrong when the baby got stuck while pushing. The certified nurse midwives and OBs were extremely respectful of natural birth. So respectful in fact, they allowed me to push unmedicated for 3 hours, and then offered me an emergency epidural so I could continue to try to birth vaginally instead of rushing me in for a c section (I was so worn out I needed to rest, there was no way I could have completed the delivery without rest or surgery at that point). At 3 hours, it would have been reasonable to go the c section route, but they didn't. The fetal monitoring was amazing - not terrible - that's how they knew my baby was fine and that I could keep trying to give birth vaginally. Without it, they wouldn't have known what condition she was in or that it was okay to continue without surgery. Please don't act like epidurals are awful and selfish and bad for mom and baby - my baby was delivered safely and without surgery because of an epidural. They aren't just about avoiding pain or making life easy for the staff...they have a legitimate medical purpose.
I'm pretty damn strong...try pushing every minute with all your might for 3 hours nonstop with a baby stuck halfway through your hips and then tell me about how terrible epidurals are.
« Last Edit: March 17, 2016, 01:53:57 PM by little_brown_dog »

La Bibliotecaria Feroz

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Re: To doula or not to doula?
« Reply #14 on: March 17, 2016, 02:32:07 PM »
It might be worth looking into trainees, or you might even have a knowledgeable friend. I don't think I would have shelled out $2K, but I had my mom present in that role and it was great. Some advantages that are not immediately obvious:

1. I went into serious labor at 11 pm--so no sleep that night--and did not deliver until 9 pm the next day. My husband and mother were basically awake for 40 hours straight--except for the breaks they gave each other. It was nice that they could go nap, get lunch, etc. without my being left along.
2. Both my kids were c-sections. First time, they sent baby to the nursery with Mr. FP. My mom was waiting for me in recovery, so I wasn't alone there. (The second time, they had changed their procedures, and Mr. FP and baby were waiting for me in recovery.)

My mother was also helpful in kind of telling me what to do. I wanted to go to the hospital too soon, for instance, and I'm not sure I would have let my husband talk me out of it.

A lot depends on your personality. YMMV.

Tawcan

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Re: To doula or not to doula?
« Reply #15 on: March 17, 2016, 03:19:49 PM »
We had a home birth for our 1st one and plan to do another home birth for our 2nd. No doula for either one but had/have a friend helping out. Doula can be a great helping hand and great mental support. It's quite a bit of money. If you can find a willing friend that has some birthing experience that might be a better route to go.

smella

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Re: To doula or not to doula?
« Reply #16 on: March 17, 2016, 06:00:19 PM »
I gathered info on a bunch, and you definitely don't have to pay $2k in our city.   Yes, that's what the experienced ones charge, but since you're having a hospital birth and planning epidural, hiring a lower-cost doula to do advocacy, massage, etc, could be a good middle option.  (Many of the very experiences ones charge under $2k as well - I actually interviewed a doula who has attended >90 births and she was charging $1,200.  I did like her, if you want her name- just ended up choosing someone who also had some additional skills I needed.)

We budgeted a lot for our doula- $1,800*- because I am really, really hoping to go unmedicated.  I'm also birthing in a hospital over a birthing center for geography's sake even though if I had more confidence I would do a homebirth.   After reading and listening to hundreds of birth stores (I recommend the podcast The Birth Hour) and hearing time and time again how interventions pile up during hospital births (of course! they're hospitals, its what they're for!), I really want someone who can be a strong advocate when my wife's rational thinking may be compromised by emotion.    Since I am also planning on breastfeeding with some pre-existing concerns, and my wife is also planning on breastfeeding as a non-gestational parent, we chose a doula who is also a certified lactation consultant.  She also does the placenta encapsulation, and since I want to do that it's great to have the same person.   Another huge one for me is wanting to labor at home for as long as possible to avoid additional interventions/misdiagnosis of "failure to progress."  Since this is my first birth, having a skilled professional at home with us during early labor is going to be a godsend (doula comes over whenever I want her to).  She then accompanies us to the hospital and stays for the entirety of labor and delivery, until 6 hours post birth.  Two pre-natal home visits and two post-natal home visits.    Going through all that, $1,800 actually feels like a bargain :).


*I'm using the money we had set aside for sperm banks+conception procedures since I got pregnant unexpectedly fast
« Last Edit: March 17, 2016, 06:02:19 PM by smella »

La Bibliotecaria Feroz

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Re: To doula or not to doula?
« Reply #17 on: March 17, 2016, 08:52:26 PM »
I had two great birthing experiences at a hospital without a doula - first one with an epidural and second one without any pain meds.  My delivery nurses were great and my husband is very calm in a "crisis."  It easy for everyone to report their experiences, but it's hard to guess what you will need. 

I will caution you that however calm your DH is under pressure and comfortable with medical situations you are, there is a definite power imbalance when dealing with doctors.  Hospitals are not designed with your comfort and ease of labor in mind.  Epidurals slow down contractions, so the doctor will advise you to start Pitocin.  Pitocin causes longer and more intense contractions than your body naturally makes, which places stress on the baby.  The fetal heart monitor shows the baby is distressed and the doctor recommends doing a C-section (and he/she can make it home in time for dinner).  Maybe you're okay with that.

I believe there are studies that have disproven that epidurals slow down contractions/labor, and no one recommended pitocin when I had an epidural.

The problem with medical evidence on epidurals is that you can't do double blind studies! And you can't randomly assign half the moms to an "epidural" group and half to a "non-epidural" group. So maybe epidurals are associated with C-sections. I had both epidurals and c-sections because I had giant-headed babies that were wedged in crooked--epidural for the hellish back labor, then c-section because they were stuck. I had two interventions trying to solve the same problem, not one intervention causing the other.

I also FWIW had excellent hospital birth experiences, even the second time when I was a TOLAC patient and my regular doc was not available.

bonjourliz

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Re: To doula or not to doula?
« Reply #18 on: March 17, 2016, 09:22:57 PM »
I considered a doula for my first and decided against it, mainly for privacy and financial concerns.  Plus I loved my Midwife (hospital birth) and had heard great things about the hospital.  Well.... It all went to hell.  My nurse and I did not get along, and the OB ended up being the one who started me pushing. She was awful in so many different ways. And there was no privacy; the room was full of strangers, none of whom were successful at establishing any kind of connection with me.  Eventually I had a C/s and the whole experience left me emotionally wrecked and totally vulnerable.  I experienced some pretty severe PPD and it took me a long while to come to peace with the way things went down. Understand, both baby and I were "healthy." Except I wasn't.

For my second, I had a doula. Actually two -- one experienced (and paid) and one in training (and unpaid). The difference was night and day.  Because I knew my doula would be with me, I was able to push aside my fear that I would end up as "alone" as I was in my first birth. That was huge, and allowed me to get my head on right going into the birth.  The birth itself, the doula had great tips on keeping me calm and progressing.  Things I'd heard before but couldn't recall in the moment.  I walked away from that birth feeling like I could conquer anything.  And really, that is how a new mom should feel. We need that boost if confidence before we head home with a newborn in tow!

I am not a wallflower and I have unfortunately had quite a bit of experience advocating for myself and my husband in medical situations. (Prior to either of my births.) But birth was different.  I was vulnerable in a way I never have been before.  It's hard to explain and I realize I probably sound very hippie dippie, but I'm not. It's just that I've seen women come away from birth totally crushed and defeated, and other women -- who prepared in exactly the same way -- walk away perfectly content. No explanation for why some women end up on one side vs the other. And I myself have been on both sides of that coin.

I recommend a doula to everyone. My husband does, too. And he was a total non-believer until after our second birth, and he saw the complete difference. Now he is like, you're pregnant? Congrats! Have you hired your doula yet?

To save cash, consider a doula who is still certifying. She will have completed training and observing some births, but hasn't secured her certification yet. DONA should have a list on their website. You can also look for local birth oriented FB groups, and ask for leads on new/certifying doulas.

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goatmom

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Re: To doula or not to doula?
« Reply #19 on: March 18, 2016, 05:53:03 AM »
I did not use a doula.  I don't think I would have like one.  I kind of zone out during labor and enter my own world.  I don't even really want dh talking to me or touching me.  I want quiet and dark.  I think an outside person would have bothered me.  I know most nurses did.  But as soon as baby is born I return to my usual friendly self. Had unmedicated births.  One c/s that was an emergency and I wasn't in labor yet so that doesn't really count for this discussion.  But a doula really would have been a waste since from the time I walked into the hospital to delivery was about 30 minutes.  I like my dh there just so later I have someone who shared the experience with me so we can remember it together.  $2000 seems very pricey.   

little_brown_dog

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Re: To doula or not to doula?
« Reply #20 on: March 18, 2016, 07:51:22 AM »
I gathered info on a bunch, and you definitely don't have to pay $2k in our city.   Yes, that's what the experienced ones charge, but since you're having a hospital birth and planning epidural, hiring a lower-cost doula to do advocacy, massage, etc, could be a good middle option.  (Many of the very experiences ones charge under $2k as well - I actually interviewed a doula who has attended >90 births and she was charging $1,200.  I did like her, if you want her name- just ended up choosing someone who also had some additional skills I needed.)

We budgeted a lot for our doula- $1,800*- because I am really, really hoping to go unmedicated.  I'm also birthing in a hospital over a birthing center for geography's sake even though if I had more confidence I would do a homebirth.   After reading and listening to hundreds of birth stores (I recommend the podcast The Birth Hour) and hearing time and time again how interventions pile up during hospital births (of course! they're hospitals, its what they're for!), I really want someone who can be a strong advocate when my wife's rational thinking may be compromised by emotion.    Since I am also planning on breastfeeding with some pre-existing concerns, and my wife is also planning on breastfeeding as a non-gestational parent, we chose a doula who is also a certified lactation consultant.  She also does the placenta encapsulation, and since I want to do that it's great to have the same person.   Another huge one for me is wanting to labor at home for as long as possible to avoid additional interventions/misdiagnosis of "failure to progress."  Since this is my first birth, having a skilled professional at home with us during early labor is going to be a godsend (doula comes over whenever I want her to).  She then accompanies us to the hospital and stays for the entirety of labor and delivery, until 6 hours post birth.  Two pre-natal home visits and two post-natal home visits.    Going through all that, $1,800 actually feels like a bargain :).


*I'm using the money we had set aside for sperm banks+conception procedures since I got pregnant unexpectedly fast

Smella - I commend you on choosing a hospital instead of homebirth. You say you have read alot of birth stories, but it sounds like you are very "green" and "natural" oriented. Be aware that many of these natural birth stories are very romanticized and that alot of these natural childbirth sites avoid describing the happy stories about emergency c sections, epidurals (like mine!), and situations that show medical intervention was the best and happiest course of action for everyone. It is critical to read these stories too, that way if you need assistance, you can know that what you chose was just as good, just as right, as your original plan. I would also recommend visiting a homebirth trauma and loss support page, to reinforce why you have made a good choice about giving birth in a hospital. No one in the green community EVER talks about these groups and these moms, but there are sadly far too many out there.

Please be gentle with yourself as you go into the birth experience. As someone who has never given birth before, you have yet to experience what it is like to go through unmedicated labor. If you end up with complications, or protracted labor, etc you may NOT want a bunch of people reminding you (the person who is actually giving birth) that unmedicated is best, and why don't you keep trying, etc etc. Before you are in the throws of labor, it is easy to think that having people push back on your requests for help (aka: being a "strong advocate" for your original plan - you know, the one you made before you were in the situation) might get you the birth you want. But in reality, when you are in that much pain, there is a good chance anyone arguing against your requests will just upset youk, and worse, make you feel out of control. Feeling confident and in control is a huge part of making it through the psychological gauntlet that is childbirth. Remember, pushing an idea of what a birthing woman "should" do is not just the realm of bossy OBs - partners, parents, and other support people can also pressure a woman because of what her original plan was, or because they personally don't agree with what she is asking for.

The message for every woman who is attempting unmedicated labor to her support team should be: "I really want to attempt unmedicated labor and delivery. I want to try X, Y, and Z to get through it. But if things change, I may need to change my mind too, please help me do that if that is what I think I need at the time." Avoid anything that makes it seem like you want people to question your decision-making when you are in labor. That's a recipe for disaster.

I say this only because  as someone who is very into the green community, I have seen alot of "recommendations" where advocates of no/low intervention birth push women to tell their support partners to fight against anything but the unmedicated plan, even if the woman herself is making the request. They view this as a way of fighting interventionist strategies, but all it does is actually drown out the woman's voice and desires when she actually is in the situation. It can add anxiety and confusion to an already chaotic day, and at its worst, it can delay the provision of immediate medical care that is necessary for safety of mom and baby. A truly empowered woman is one who knows she can change her mind because it is right for her, and that her request will be respected the first time it is made.
« Last Edit: March 18, 2016, 08:18:32 AM by little_brown_dog »

SomedayStache

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Re: To doula or not to doula?
« Reply #21 on: March 18, 2016, 11:06:35 AM »
The message for every woman who is attempting unmedicated labor to her support team should be: "I really want to attempt unmedicated labor and delivery. I want to try X, Y, and Z to get through it. But if things change, I may need to change my mind too, please help me do that if that is what I think I need at the time." Avoid anything that makes it seem like you want people to question your decision-making when you are in labor. That's a recipe for disaster.
Exactly!  Yes.

I say this only because  as someone who is very into the green community, I have seen alot of "recommendations" where advocates of no/low intervention birth push women to tell their support partners to fight against anything but the unmedicated plan, even if the woman herself is making the request. They view this as a way of fighting interventionist strategies, but all it does is actually drown out the woman's voice and desires when she actually is in the situation. It can add anxiety and confusion to an already chaotic day, and at its worst, it can delay the provision of immediate medical care that is necessary for safety of mom and baby. A truly empowered woman is one who knows she can change her mind because it is right for her, and that her request will be respected the first time it is made.
I will provide an alternate POV.  While laboring in the hospital with my first child I reached a point where I wanted to just give up.  I looked over at my husband and told him that "I think I need some pain medication".  His response was a simple shake of the head and a gentle "No".

I know, I know.  With these bare details he sounds like a horrid, uncaring, MAN.  But this was what we had discussed numerous times.  That was what my pre-labor self had told him to say and it was exactly what I needed.  I made it through with the birth that I wanted.  If I had asked a second time for pain medication, his answer would probably have been different.  He wasn't in charge, and he was never going to stop me from doing anything - his saying no was, indeed, exactly the support that I needed at that time.

So that first birth went fine.  We didn't have a doula because I had my husband.  It was rough on him because he'd put in a 12-hour shift at his restaurant the day that my labor started (right at bed-time of course!).   So he was awake for about 35 hours straight before baby was born and on his feet for a large part of the time.  He was nodding off during portions of the labor which left me feeling very abandoned (the nurses were not in the room very much and provided me no support). 

After the baby was born was the worst and this was when I was kicking myself so hard for not hiring a doula.  I had a ton of stitches and was told not to get out of the bed without assistance.  Then all the staff disappeared.  For hours.  I was left in a blood soaked bed that the foot was still lowered down for birth.  I was holding a newborn baby for the first time in my life and had no idea what to do with him.  My husband fell asleep on the couch. And I couldn't move.   I kept waiting for someone to come and help me.  No one did.  I couldn't even reach the call button.

After 30 minutes or an hour I got my husband to wake up and call a nurse.  Someone did come help me use the bathroom and settle into an uncomfortable chair - but still nobody fixed or cleaned up the dang bed.  I've had two more births and attended a friend's hospital birth and this is not a normal situation.  Maybe there was an extreme emergency occurring in another room that required all hands on deck.  I will never know, but I wasn't moved into a recovery room where I could rest in a clean bed until 6 hours after my baby was born.  If there had been a doula there she would never have let that happen. 

I was calling doulas as soon as a I got a positive pregnancy test with my second child.  (But doula's are in the $500 range in my area....).  My doula was awesome at the hospital.  She coordinated with the nursing team so well that after the birth one of the nurses actually thanked the doula and expressed great delight in working with her. 

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Re: To doula or not to doula?
« Reply #22 on: March 18, 2016, 11:10:14 AM »
Thanks for sharing everyone! Lots to think about here (and hopefully we can steer clear of too heated a discussion of medicated vs. unmedicated, minimal interventions vs. standard care). It sounds like since I'm planning on an epidural it's not quite such a clear benefit as for an unmedicated delivery. In fact from other things that I've read it seems like some (many?) women are able to nap a bit with an epidural so with luck that should cut down on the exhaustion factor. Will probably stick with the original plan not to have a doula, although I'm liking the possibility of a postpartum doula and will look into that.

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Re: To doula or not to doula?
« Reply #23 on: March 18, 2016, 11:29:52 AM »
In your situation, and with those dollar numbers you quoted (!) I agree that a doula is probably overkill. 

Your birth wishes and the hospital's modus operandi are probably pretty well aligned which will smooth your path.  It still might behoove you to consider if there is a friend or close family member that could be on call to back up your husband or provide him relief (picking up forgotten items from home, bringing in food, giving him a chance to step out, etc.)

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Re: To doula or not to doula?
« Reply #24 on: March 18, 2016, 11:56:39 AM »
Thanks for sharing everyone! Lots to think about here (and hopefully we can steer clear of too heated a discussion of medicated vs. unmedicated, minimal interventions vs. standard care). It sounds like since I'm planning on an epidural it's not quite such a clear benefit as for an unmedicated delivery. In fact from other things that I've read it seems like some (many?) women are able to nap a bit with an epidural so with luck that should cut down on the exhaustion factor. Will probably stick with the original plan not to have a doula, although I'm liking the possibility of a postpartum doula and will look into that.

Just an anecdote.  I had an epidural with my first, which was amazing.  Though I asked for an epidural with my second, it all went to fast for one to be placed.  Between my bouts of cussing, I remember a doc telling me that my recovery would be easier without an epidural.  Well, I must have had a great anesthesiologist, because the recovery was the same.  I was up and walking immediately after both births.

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Re: To doula or not to doula?
« Reply #25 on: March 18, 2016, 12:59:55 PM »
Thanks for sharing everyone! Lots to think about here (and hopefully we can steer clear of too heated a discussion of medicated vs. unmedicated, minimal interventions vs. standard care). It sounds like since I'm planning on an epidural it's not quite such a clear benefit as for an unmedicated delivery. In fact from other things that I've read it seems like some (many?) women are able to nap a bit with an epidural so with luck that should cut down on the exhaustion factor. Will probably stick with the original plan not to have a doula, although I'm liking the possibility of a postpartum doula and will look into that.

Just an anecdote.  I had an epidural with my first, which was amazing.  Though I asked for an epidural with my second, it all went to fast for one to be placed.  Between my bouts of cussing, I remember a doc telling me that my recovery would be easier without an epidural.  Well, I must have had a great anesthesiologist, because the recovery was the same.  I was up and walking immediately after both births.

HAHA So true!  On my last birth when things got REALLY intense, I was yelling for anything.  In my case everyone pretty much lied to me (my version of events) by telling me that they will check with the doctor, even though they all knew it was too late.  Less than 10 minutes later I had a baby in my arms.

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Re: To doula or not to doula?
« Reply #26 on: March 18, 2016, 01:31:56 PM »
Thanks for sharing everyone! Lots to think about here (and hopefully we can steer clear of too heated a discussion of medicated vs. unmedicated, minimal interventions vs. standard care). It sounds like since I'm planning on an epidural it's not quite such a clear benefit as for an unmedicated delivery. In fact from other things that I've read it seems like some (many?) women are able to nap a bit with an epidural so with luck that should cut down on the exhaustion factor. Will probably stick with the original plan not to have a doula, although I'm liking the possibility of a postpartum doula and will look into that.

Just an anecdote.  I had an epidural with my first, which was amazing.  Though I asked for an epidural with my second, it all went to fast for one to be placed.  Between my bouts of cussing, I remember a doc telling me that my recovery would be easier without an epidural.  Well, I must have had a great anesthesiologist, because the recovery was the same.  I was up and walking immediately after both births.

HAHA So true!  On my last birth when things got REALLY intense, I was yelling for anything.  In my case everyone pretty much lied to me (my version of events) by telling me that they will check with the doctor, even though they all knew it was too late.  Less than 10 minutes later I had a baby in my arms.


During one delivery, I was sure I wanted something.  They sent someone who was supposed to be the anesthesia guy.  He never came back.  Then they told me I was too far along.  I am convinced to this day that they just sent the janitor in to humor me.  Then the next time I was convinced I wanted an epidural, only to be told my platelet count was too low.  Oh well, once the baby is my arms I forget and can laugh about it.  Best of luck!

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Re: To doula or not to doula?
« Reply #27 on: March 18, 2016, 01:40:12 PM »
Thanks for sharing everyone! Lots to think about here (and hopefully we can steer clear of too heated a discussion of medicated vs. unmedicated, minimal interventions vs. standard care). It sounds like since I'm planning on an epidural it's not quite such a clear benefit as for an unmedicated delivery. In fact from other things that I've read it seems like some (many?) women are able to nap a bit with an epidural so with luck that should cut down on the exhaustion factor. Will probably stick with the original plan not to have a doula, although I'm liking the possibility of a postpartum doula and will look into that.

Just an anecdote.  I had an epidural with my first, which was amazing.  Though I asked for an epidural with my second, it all went to fast for one to be placed.  Between my bouts of cussing, I remember a doc telling me that my recovery would be easier without an epidural.  Well, I must have had a great anesthesiologist, because the recovery was the same.  I was up and walking immediately after both births.

HAHA So true!  On my last birth when things got REALLY intense, I was yelling for anything.  In my case everyone pretty much lied to me (my version of events) by telling me that they will check with the doctor, even though they all knew it was too late.  Less than 10 minutes later I had a baby in my arms.


During one delivery, I was sure I wanted something.  They sent someone who was supposed to be the anesthesia guy.  He never came back.  Then they told me I was too far along.  I am convinced to this day that they just sent the janitor in to humor me.  Then the next time I was convinced I wanted an epidural, only to be told my platelet count was too low.  Oh well, once the baby is my arms I forget and can laugh about it.  Best of luck!

Ha!  I told me husband that the hospital staff was conspiring against my desire to have a medicated childbirth :)  Of course all is forgiven and forgotten when you get to hold that healthy baby.

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Re: To doula or not to doula?
« Reply #28 on: March 18, 2016, 04:20:48 PM »
We did not - I wanted the smallest number of people in the room and was happy with that. If you're considering birth photography though, I have some friends who just asked the doula to snap a few pictures when she felt like it and wasn't busy - they were happy with their pics and saved $2k on photography. I am a very private person but I do wish I had some pictures.

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Re: To doula or not to doula?
« Reply #29 on: March 18, 2016, 04:30:43 PM »
I had a doula with my first.  She split her fee - I think it was $500 base and $350 for the delivery.  Since my son was complete breech and we had to schedule a C-section, she did not attend the birth and did not ask for the second fee.  My husband was a little peeved that we still had to pay $500, but I think it was worth it.  She had assisted at 500+ births and had two C-sections herself at the very hospital I delivered at.  She gave me big discounts on prenatal massage to help relieve the pain from my son's awkward position.  She came to our home and talked with us about how to set things up to make caring for a baby easier after a C-section.  She helped me with a very detailed and specific birth plan for the C-section, once I knew I was having it.  She helped me out with exercises to try to turn my baby.  She helped me decide whether or not to have an External Cephalic Version at 37 weeks (I did; it failed) and whether to try the Version again under anesthesia when I checked in at 39 weeks for the C-section (I didn't).    She even made a home visit after my son was born to check on us.  She checked my Diastisis Recti and recommended a home exercise regime to repair it.  In short, she was awesome.

I'm pregnant again now and just put "Call Regina" on my to-do list!  I want to go for a VBAC this time and since there is a 1% risk of exploding uterus (I know there is a medical term for this but it is not coming to mind at this time), I think her guidance will be invaluable.  Plus my husband doesn't deal well with intense medical situations, and if my labor is long he will probably want to run home to do bedtime with our toddler or something...

wordnerd

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Re: To doula or not to doula?
« Reply #30 on: March 18, 2016, 05:26:16 PM »
I strongly considered one because I wanted to have an unmedicated birth, and everyone swore by them. But when I'd specifically ask what they doula did, it seemed to be small-ish things (two that come to mind are wheeling the IV bag around on a walk and getting the hospital bags from the car). i wasn't worried about needing one to advocate for me because I was delivering with a midwife practice, with which my views closely aligned.

In the end, I didn't get one, had an awesome unmedicated birth, and was very happy with the decision. I think if you don't think you need an advocate (i.e., your views align with your practice's), you probably don't need one. YMMV.

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Re: To doula or not to doula?
« Reply #31 on: March 18, 2016, 08:40:33 PM »
If you're not planning an unmediated birth and don't foresee that you need any advocating (outside of yourself and your husband), you likely don't need one. I had one for both of my (unmedicated) births and found her very helpful, as she knew positions for me to try and how to apply pressure to relieve contractions that my husband would not have known, but if I had an epidural I don't think I would have needed that. As another poster mentioned, you can consider a student doula. Mine was a student for my first birth, and so there was no charge for her services.

TabbyCat

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Re: To doula or not to doula?
« Reply #32 on: March 20, 2016, 06:29:23 PM »
I had an unmedicated birth and am still very happy with the decision to not have a doula. The midwives did a little bit of suggesting different positions, but were mostly quiet and let me labor on my own with my husband. Minimal intervention, minimal talking, and absolutely no "you can do it" was what worked for me. You can kind of picture what may work for you by thinking of how you normally react to pain. I like to be left alone to process it, and my labor was an extreme version of that. But you also won't know until you are there. It's really unlike anything else in life (that I've experienced so far). If you think you may want one, it will be worth it to meet with one and see how comfortable you are with them, and maybe even worth it to hire one even if you end up sending them away day-of.
« Last Edit: March 20, 2016, 06:32:14 PM by TabbyCat »

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Re: To doula or not to doula?
« Reply #33 on: March 21, 2016, 11:50:05 AM »
Birth doula here (disclaimer - I may be a tad biased) & new mum here.

If your plan is to head to the hospital ASAP in early labour, get a narcotic until you're far enough along to get an epidural, and then sleep until it's time to push - do you need a doula? Then I'd say likely not, assuming everything goes according to "plan". You may be better off spending that $$$ on something else (like maybe a postpartum doula, or cleaning services, or food delivery, etc).

However if your plan is un-medicated (or even mostly un-medicated) then a birth doula can be very helpful, possibly even necessary for you to achieve your goal. There are labouring women who just lock themselves in the bathroom & labour on the toilet until it's time to push, but many many women require more support than that. Oftentimes a labouring mum needs someone @ her head, helping her focus on breathing, whispering encouragement, offering water/food AND someone else massaging her back/thighs/feet, doing more of the physical support of labour. And this may well go on for hours. The L&D nurses are looking after several women @ once, and unfortunately can't stay with one woman thru her entire labour if she only has one support person.

If you have a partner & family members/friends who are willing to support you throughout your entire labour & birth - that's wonderful. But some women don't have partners, or friends who are willing, or family members would add stress instead of support.

PS: I had a completely med-free birth in January 2016, with midwives @ a freestanding birth centre. My husband was present, as well as a friend who was also an experienced doula. I definitely needed both of them supporting me. And my husband was extremely thankful that there was someone to spell him off from the extra-hard back rubs I required pretty much my whole labour!

jezebel

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Re: To doula or not to doula?
« Reply #34 on: March 21, 2016, 12:09:55 PM »
If your plan is to head to the hospital ASAP in early labour, get a narcotic until you're far enough along to get an epidural, and then sleep until it's time to push - do you need a doula? Then I'd say likely not, assuming everything goes according to "plan". You may be better off spending that $$$ on something else (like maybe a postpartum doula, or cleaning services, or food delivery, etc).

This is a tad dramatic - there are several posters on this thread that had unmedicated deliveries without doulas.  I arrived at the the hospital in both advanced labor and very early labor (that one was unmedicated) and there was no discussion of narcotics. 

Meowmalade

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Re: To doula or not to doula?
« Reply #35 on: March 21, 2016, 01:36:03 PM »
To save cash, consider a doula who is still certifying. She will have completed training and observing some births, but hasn't secured her certification yet. DONA should have a list on their website. You can also look for local birth oriented FB groups, and ask for leads on new/certifying doulas.

Thank you for this, my sister loves the doula that they're getting prenatal counseling from but she charges $2k for the birth (SF Bay Area).  I decided to look for a doula-in-training for my sister as a gift and got an immediate response from e-mailing DONA!  One of the doulas who got back to me has already certified and would charge $1k including a local discount since they live in the same town, but she offered me a referral to a doula who finished her training but needs more birth experience.  She has done one birth so far and is only asking $150 because she is less experienced!  My sister said she'd be happy to talk to her, so maybe it will work out.  Still waiting to hear from some others, but hopefully she loves this very inexpensive one  :)

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Re: To doula or not to doula?
« Reply #36 on: March 21, 2016, 04:52:04 PM »
I don't understood people who think that medicated birth must be super-simple. It's not necessarily so! Sure, I could get a nap after my epidural, but it's not like I was done making decisions. For instance, I wanted to try getting up on hands and knees and doc wanted to do internal monitoring. Then, of course, there was the question of when to call it and head for the OR.

Also, my first epidural didn't take. Lying on my back with that Pitocin drip going, feeling no relief... if there's ever a time in my adult life when I needed my mommy, that was it!

Ellabean

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Re: To doula or not to doula?
« Reply #37 on: March 23, 2016, 08:47:51 AM »

Doulas are amazing! REsearch shows that women with doulas are more likely to birth vaginally, birth with fewer interventions, and birth more quickly.

I had a doula with each birth. Both times, the doula made key contributions that helped me have the vaginal, unmedicated birth that I wanted.

I highly recommend a doula. They are there to support you and your partner through the entire process. I'm happy to share more if you are interested!

jezebel

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Re: To doula or not to doula?
« Reply #38 on: March 23, 2016, 08:59:47 AM »
Doulas are amazing! REsearch shows that women with doulas are more likely to birth vaginally, birth with fewer interventions, and birth more quickly.

Ok, but obviously woman who hire doulas are more likely to have vaginal births and fewer interventions - women aren't typically hiring doulas for their scheduled c-sections and high-risk, medicalized pregnancies.  And women who have quick births are clearly going to have fewer interventions.  I would challenge those studies a bit more.

Ellabean

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Re: To doula or not to doula?
« Reply #39 on: March 23, 2016, 11:35:04 AM »
That makes sense on the surface, but it's not that simple. Even randomized trials show that having a doula or a "lay doula" will improve outcomes for mothers and babies.

Having continuous support leads to a better birth experience, and there's plenty of evidence to back up that assertion. See below.

Here's a randomized control trial:
http://onlinelibrary.wiley.com/doi/10.1111/j.1552-6909.2006.00067.x/abstract?userIsAuthenticated=false&deniedAccessCustomisedMessage=

Objective:  To compare labor outcomes in women accompanied by an additional support person (doula group) with outcomes in women who did not have this additional support person (control group).

Design:  Randomized controlled trial.

Setting:  A women's ambulatory care center at a tertiary perinatal care hospital in New Jersey.

Patients/participants:  Six hundred nulliparous women carrying a singleton pregnancy who had a low-risk pregnancy at the time of enrollment and were able to identify a female friend or family member willing to act as their lay doula.

Interventions:  The doula group was taught traditional doula supportive techniques in two 2-hour sessions.

Main Outcome Measures:  Length of labor, type of delivery, type and timing of analgesia/anesthesia, and Apgar scores.

Results:  Significantly shorter length of labor in the doula group, greater cervical dilation at the time of epidural anesthesia, and higher Apgar scores at both 1 and 5 minutes. Differences did not reach statistical significance in type of analgesia/anesthesia or cesarean delivery despite a trend toward lower cesarean delivery rates in the doula group.

Conclusion:  Providing low-income pregnant women with the option to choose a female friend who has received lay doula training and will act as doula during labor, along with other family members, shortens the labor process. JOGNN, 35, 456–464; 2006. DOI: 10.1111/J.1552-6909.2006.00067.x

See these articles:

http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.301201
Objectives. We compared childbirth-related outcomes for Medicaid recipients who received prenatal education and childbirth support from trained doulas with outcomes from a national sample of similar women and estimated potential cost savings.

Methods. We calculated descriptive statistics for Medicaid-funded births nationally (from the 2009 Nationwide Inpatient Sample; n = 279 008) and births supported by doula care (n = 1079) in Minneapolis, Minnesota, in 2010 to 2012; used multivariate regression to estimate impacts of doula care; and modeled potential cost savings associated with reductions in cesarean delivery for doula-supported births.

Results. The cesarean rate was 22.3% among doula-supported births and 31.5% among Medicaid beneficiaries nationally. The corresponding preterm birth rates were 6.1% and 7.3%, respectively. After control for clinical and sociodemographic factors, odds of cesarean delivery were 40.9% lower for doula-supported births (adjusted odds ratio = 0.59; P < .001). Potential cost savings to Medicaid programs associated with such cesarean rate reductions are substantial but depend on states’ reimbursement rates, birth volume, and current cesarean rates.

Conclusions. State Medicaid programs should consider offering coverage for birth doulas to realize potential cost savings associated with reduced cesarean rates.




Read More: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.301201



http://onlinelibrary.wiley.com/doi/10.1177/0884217502239209
Birth outcomes;Infant outcomes;Labor support;Maternal outcomes
Supportive care and childbirth have been connected for all of recorded history. The impact of supportive care on health outcomes, however, has only been investigated over the last few decades. Research provides powerful evidence of improved outcomes for mothers and babies when mothers are supported in labor. These outcomes include, but are not limited to, lower rates of analgesia and anesthesia use, lower operative birth rates, shorter labors, fewer newborns with 5-minute Apgar scores less than 7, increased maternal satisfaction with the birthing process, and much more. Intrapartum nurses must be knowledgeable of the research that is directly related to critical aspects of their care, such as labor support. This article provides an overview of the quantitative research related to the effect of labor support on birth and maternal and fetal outcomes during childbirth. By understanding and applying this research in clinical practice, bedside nurses may improve outcomes and transform intrapartum care.



jezebel

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Re: To doula or not to doula?
« Reply #40 on: March 23, 2016, 11:58:55 AM »
It makes sense that outcomes are improved with support during birth.  I'd be interested in a study that controls for education and income.

Gin1984

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Re: To doula or not to doula?
« Reply #41 on: March 23, 2016, 12:14:36 PM »
It makes sense that outcomes are improved with support during birth.  I'd be interested in a study that controls for education and income.
There are a ton of them from back in the 70s/80s ish (basically when they started letting the husband in during birth).  Those studies are why hospitals started allowing it.  I truly dislike that something done for a medical benefit has turned into a clusterfuck for many laboring women, but was is, is.  Often you will find Medicaid patients used in studies like this because of access.  However, both groups are Medicaid patients so income is controlled in that way.  Education, not as much except for the correlation between low income and low education.

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Re: To doula or not to doula?
« Reply #42 on: March 23, 2016, 12:15:49 PM »
I'm really interested to know what the "lay doula" techniques were.  I tried a journal search at work, and that isn't one I can access, so I can't read the full text.

Is it any different than the support techniques partners are taught in standard birth classes?  (Not even talking about intensive classes like Bradley or Hypnobabies... just the 2-4 hour classes that most hospitals offer to help you know what to expect. Where they teach the Mom how to breathe and the partner how to rub he back, or to help her move positions.)

I'm also interested in the study showed any benefit of a professional doula vs the lay doula with 4 hours of training...

I wouldn't want to go at childbirth alone in any case, but I'm not sold on needing anyone more than my husband based on the information provided in those studies.  They actually seem to be anti-doula, if we think that 4 hours of lay doula training is sufficient.

(Note- I actually had planned on using a doula for an unmedicated birth, because I cannot get an epidural, and I had been told they are great for that situation.  But I ended up not birthing a live baby, so I had narcotics as pain medicine, since there was no concern of transferring to the baby; since the baby had passed away at 7 months, I delivered before I was able to meet with the doula, so didn't use one. My husband did fine helping me through labor, and moving me through various positions. Without either of us having any training at all, so we hadn't done classes yet. The body knows what it wants in labor.  I'm now torn on using a doula if I get pregnant again- my husband was good support, but I also think giving birth again is going to be traumatic due to the first one.)
« Last Edit: March 23, 2016, 12:42:23 PM by iowajes »

jezebel

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Re: To doula or not to doula?
« Reply #43 on: March 23, 2016, 12:32:47 PM »
I don't find at all that helpful, with respect to determining whether to hire a doula, to know that otherwise unsupported, low-income, and possibly under educated patients have a better outcome with a support person during delivery.  I think it's pretty undisputed that hiring a doula, depending on cost, etc, is preferable to laboring alone.

La Bibliotecaria Feroz

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Re: To doula or not to doula?
« Reply #44 on: March 23, 2016, 02:40:42 PM »
I don't find at all that helpful, with respect to determining whether to hire a doula, to know that otherwise unsupported, low-income, and possibly under educated patients have a better outcome with a support person during delivery.  I think it's pretty undisputed that hiring a doula, depending on cost, etc, is preferable to laboring alone.

It doesn't say that they were other unsupported. It said they had a female friend or relative willing to act in this role--NOT that, for instance, the baby's father was not present. My brother's girlfriend at the time was a Medicaid patient when she delivered their daughter, but he was present. My mother was something of a lay doula for them--she spent a lot of time with them at the hospital, although she was not present at the actual birth (it was a c-section--dunno if she would have been there for vaginal).

I agree that middle-class women may have different results.

seattlecyclone

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Re: To doula or not to doula?
« Reply #45 on: March 23, 2016, 03:12:27 PM »
My wife recently gave birth to our first child. We did not hire a doula. The birth ended up happening vaginally with no pain medication. That's the way we wanted it, but we weren't strongly opposed to pain medication or whatever else if the situation warranted it.

I don't doubt that hiring a doula to help out would increase the odds of things going according to plan, but I will strongly dispute that someone who wants to deliver without medication needs to hire a doula.

I guess it comes down to how important this is to you. Doula or no, you'll have a baby at the end of the day. You will be spending most of your energy caring for that baby, not looking back at whether the delivery day was everything you hoped it would be. Spend the money if you really feel strongly enough about being "natural" that increasing your odds of success is worth a few hundred bucks to you. If not, don't.

Cranky

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Re: To doula or not to doula?
« Reply #46 on: March 23, 2016, 03:55:28 PM »
I think much depends on how much other support you have, and possibly how nervous you are about the whole thing.

My oldest dd had her first baby a few weeks ago, and *we* paid for her to have a doula (it's $1000 in her area.) She lives out of state, and hasn't been there long enough to have close mom friends. I knew that I wouldn't be able to be there until after the baby was born. I knew that she was anxious. I knew that her dh was a great guy, and he was going to be a great dad, and I also knew that he'd never had a baby, either.

And until you've had a baby, you just don't know what to expect. I know that I wished, in retrospect, that I'd had someone with me who wasn't emotionally involved in that process.

My dd had a long, slow labor. There were 40 hours between when her water broke and when the baby was born. She had pitocin and an epidural and forceps and suction and an episiotomy - none of which were in her birth plan. The doula stayed with them the ENTIRE time. Dd said she was fabulous. She was supportive, but not bossy. She had lots of tricks, because she'd been there for hundreds of births. She took pictures after the baby was born. She was a certified lactation consultant.

I'm so, so glad that we were able to make that happen for them. (And it's a darned cute baby!)

jezebel

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Re: To doula or not to doula?
« Reply #47 on: March 23, 2016, 08:00:18 PM »
I don't find at all that helpful, with respect to determining whether to hire a doula, to know that otherwise unsupported, low-income, and possibly under educated patients have a better outcome with a support person during delivery.  I think it's pretty undisputed that hiring a doula, depending on cost, etc, is preferable to laboring alone.

It doesn't say that they were other unsupported. It said they had a female friend or relative willing to act in this role--NOT that, for instance, the baby's father was not present. My brother's girlfriend at the time was a Medicaid patient when she delivered their daughter, but he was present. My mother was something of a lay doula for them--she spent a lot of time with them at the hospital, although she was not present at the actual birth (it was a c-section--dunno if she would have been there for vaginal).

I agree that middle-class women may have different results.
It was an option. Would it be more likely or less likely that someone would elect the option of having a female family member be elected as a support person under these circumstances (training in doula techniques) if they had a support person in place?  I'm contesting that a doula is preferable based on studies reflecting a better outcome, not that women don't need support. 

There is an obvious difference between having one or more trusted family members present, for some time, during labor and/or delivery and paying hundreds to thousands for a professional doula.
« Last Edit: March 23, 2016, 08:14:12 PM by jezebel »

TabbyCat

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Re: To doula or not to doula?
« Reply #48 on: March 24, 2016, 07:46:34 PM »
Hiring a doula will help you achieve a vaginal pain-med-free birth (if you want that) only if having a doula there sounds like something you could be happy with and comfortable with. For many women, doulas are wonderful, but not for everyone. It was actually really important to me to not have a lot of verbal support, counter pressure, or movement suggestions. In labor it's hard to talk much, but I remember the majority of what I said was "shhhhhh" to offers of "you can do it" and "no touch" to attempts to position or counter pressure. I thought I might feel that way, and I was not wrong, but it will be different for all and that's ok. It does not discount doulas or what they do, but if it doesn't sound nice to you to have someone else there, you will still do fine without one.

wordnerd

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Re: To doula or not to doula?
« Reply #49 on: March 28, 2016, 12:05:45 PM »
Hiring a doula will help you achieve a vaginal pain-med-free birth (if you want that) only if having a doula there sounds like something you could be happy with and comfortable with. For many women, doulas are wonderful, but not for everyone. It was actually really important to me to not have a lot of verbal support, counter pressure, or movement suggestions. In labor it's hard to talk much, but I remember the majority of what I said was "shhhhhh" to offers of "you can do it" and "no touch" to attempts to position or counter pressure. I thought I might feel that way, and I was not wrong, but it will be different for all and that's ok. It does not discount doulas or what they do, but if it doesn't sound nice to you to have someone else there, you will still do fine without one.

I felt that way too. I know myself well enough to know that I hate being encouraged or managed in a hard situation. I even dislike people cheering for me when I'm running a race. (I know I'm weird.) In any case, I was glad it was just my husband, the midwife, and an L&D nurse. Anything more would've been overkill for me personally.