Doula

What can help reduce the cesarean rate by 50%, length of labor by 25%, epidural requests by 60%, oxytocin use by 40%, forceps delivery by 40% and analgesia use by 30%?

A doula is a birth coach who can be there to teach you exercises to reduce pain, back strain before labor and help you get through labor with another hand to hold, another coach to cheer you on and help you have strength, courage and decreased fear. She can make you feel special during a time when you deserve it most! The word, "doula" comes from ancient Greek meaning "a woman who serves." Today we refer to the professionally trained, experienced helper who participates in the birth process at the invitation of the mother.

Your spouse or partner might be all you need, but most of us would welcome another friend, especially when he is feeling unprepared or helpless. A doula has the experience and empathy that is "just what the doctor [or patient] ordered". She has skills in communication, labor, breastfeeding, and resources for childbirth classes. She uses a variety of comfort measures to help you, including massage, relaxation, breathing techniques, music, imagery, etc.

For more information, call the Utah Doula Association at 1-888-838-1456. Fees vary, but are often negotiable to ensure every woman the support she needs. At this time, no insurance benefits apply, however.

Back Up Plan

An epidural is an elective procedure

You don't have to have one, and there is no guarantee you will get one. I always recommend that expectant moms take a natural childbirth class, even if they want an epidural the minute they are in labor.

This is not just because there are advantages to natural childbirth. But, realistically, you may not get an epidural or if you do it may not work for various, often completely unknown reasons. Your birth plan may not go exactly the way you hoped and there are lots of factors that come into play. You know what they say about the best laid plans... Flexibility is essential. If someone is promising you a "pain free birth" they are not being honest.

A few possible scenarios:

• You come in to the hospital in full-blown labor, almost completely dilated and there is no time for an epidural (this might be a very GOOD thing if it’s not TOO fast).

• The L & D unit is completely crazy with high-risk moms needing emergency c-section, hemorrhaging, blood pressure is out of control or other problems and all available anesthesiologists are occupied with higher-needs cases.When you’re laboring, wanting an epidural, this is not what you want to hear (that you are not # 1) but, the staff must triage according to seriousness and the “normal” laboring mom may have to go it alone for a while.You’ll be very glad you learned some natural childbirth techniques such as breathing exercises, visualization and self-hypnosis which not only help with the discomfort but give you a sense of control in the situation.(One clue that your hospital may be having one of “those days” is if you have to call back several times to get in for an elective induction – electives are low on the totem pole and get in on a space-available basis.)

• You may deliver in a place that does not have a qualified practitioner to place and monitor an epidural or the equipment required such as oxygen, IVs emergency resuscitation medications, airways, a qualified provider who can manage emergencies if they should occur since regional anesthesia is not without risk.Location problems could even be due to emergencies, natural disasters, inability to make it to a facility that can accommodate this, or just due to limitations in small, rural community health centers.In a pandemic outbreak, mothers should not deliver in hospitals where there is massive infection such as influenza going on.In such circumstances (or in hurricane-torn areas, etc.) laboring women could be shuffled to midrange care facilities for their own safety but they may not have all the conveniences they would desire.Remember, ultimately it’s a safe delivery that is most important; not the epidural itself.

• Your body does not respond to the epidural. I experienced this first-hand with my last child. One half of my body was numb; the other half felt every contraction. Being only half in pain does not mean “half the pain” - this was not an improvement over the natural deliveries I had previously experienced. A non-working epidural also occurred with two of my daughters so this is not just a rare event (maybe hereditary?). You’ll probably hear friends’ stories about such experiences too. I suspect veteran moms sometimes like to frighten first-timers:)

• You could have a condition for which epidural anesthesia is contraindicated.A back or spinal cord injury could prevent this choice, depending on the severity of the injury.Active maternal hemorrhage, very low blood pressure, septicemia, infection near the placement area of the catheter, or a clotting condition (possibly even use of anticoagulation therapy for blood clots).

So, what about the back up plan?

There are several alternatives and methods for prepared childbirth such as Lamaze, Bradley, Hypnobirthing, etc. Your hospital prenatal class schedule probably includes some training in unmedicated childbirth preparation, but if you really want to master it and would like a more natural birth, I would advise you to take a class that has several sessions and focuses on the specific technique you desire. There are many similarities in methods but you may like the features of Bradley or Lamaze (or something else). This class may also be offered by your hospital so that's a good place to begin. If they don't offer it, they may have lists of practitioners who teach classes. Otherwise, you can google "childbirth educators," "natural childbirth" or "lamaze" along with the state and find a listing.

About.com's Robin Elyse Weiss, LCCE says:

"Studies have shown that taking childbirth classes can reduce the amount of stress in labor, which is the goal of all childbirth classes and the use of medication. By using other techniques to help you through labor you can have a more relaxing experience until the point at which you decide medication is the right option for you. Or you can simply choose to not use medications, as some women find labor to be much easier than they had anticipated.

.... In choosing a childbirth class, find one that really teaches viable alternatives to the epidural, not one that merely gives lip service to relaxation. Ensure that the instructor covers medications in labor, there are also other choices besides the epidural. Talk to the instructor and ask her about the outcomes in her classes, ideally you'll find a good mix of unmedicated and medicated births. If her outcomes go drastically in one way or the other, it might indicate she doesn't offer as much of one in the class. If you're concerned ask her. Tell her what you're looking for. You can even ask to speak to other people who've had her class. Check her affiliations. Is she a member of an organization that promotes freedom of choice in birth practices? Basically do your homework and make sure she is not affiliated with anyone who would influence her instruction. (This can include some hospital classes.)"

Hip Chic Pregnancy also has a listing of natural childbirth books. You can read about various methods and see what sounds right for you.

For a graphic video of an epidural placement, go here. Baby Center has other interesting childbirth videos, including natural birth on this site as well.

Liquids in Labor?

An ACOG (American College of Obstetrics and Gynecology) press release says:

Washington, DC -- Women in labor may be allowed to quench their thirst with more than just the standard allowance of ice chips, according to a new Committee Opinion released today from The American College of Obstetricians and Gynecologists (ACOG) and published in the September issue of Obstetrics & Gynecology. Although the guidelines on prohibiting solid food while in labor or before scheduled cesarean surgery remain the same, ACOG says that women with uncomplicated labor, as well as uncomplicated patients undergoing a planned cesarean, may drink modest amounts of clear liquids during labor if they wish. (Read the rest of the story here).

It's about time. We have known for years that clear liquids while laboring is not a problem and is only restricted based on the slight possibility that a general anesthesia might become necessary if an epidural didn't work for an emergency c-section. However, even that has been questioned since a small amount of clear liquid moves quickly through the stomach and doesn't remain as solid food does, presenting the small risk of aspiration.

What does it mean to "strip the membranes"?

You may have heard someone say their health care provider "stripped their membranes." The purpose of this procedure is to attempt to hasten the onset of labor, especially once you have passed your estimated due date. It sometimes results in contractions beginning and it is believed it may slightly reduce the number of full-blown inductions.

In this procedure the midwife or doctor places a finger inside the opening of the cervix and separates the amniotic sac from the uterus, but not with the intent to rupture the membranes. It was believed to be risky for infection but recent studies have indicated no increased risk when done by your provider using good technique. Some women find it a bit painful and there can be some leaking or spotting afterward.

It is hard to say if this actually makes much difference since it is only done at the end of pregnancy, usually with a routine vaginal exam in the final week. If a woman labors within two days following the procedure, she may have regardless of this. It is thought to release prostiglandins in the cervix, encouraging contractions.

Every woman gets anxious toward the end of pregnancy but it is important that the baby comes at the right time, which can be up to two weeks on either side of the estimated due date.