10 Things a Doula Wants You to Know About Birth
I learn something new at every birth. Each birth is different and I doubt I will ever stop learning as a doula, which is one of my favorite parts about what I do! Here are 10 pieces of wisdom that I have collected in my doula life thus far that I want to share with you…
Cervical dilation is just one piece of the puzzle.
Yes, your cervix has to be fully dilated for the baby to pass through, but the baby’s position and station in relation to the pelvis is just as important.
As dilation is happening, the tissue of the uterus is shifting, drawing up from the cervix and building at the fundus (top of the uterus). It is this dynamic process, along with the movements of the birthing person and baby, that brings the baby down and out. If you choose to have cervical exams in labor (and yes, they are optional… see number 7 below), asking for the baby’s station in addition to the dilation can be very helpful in determining what positions to try next to help make space for the baby to descend.
Checking out the awesome resources of Spinning Babies, taking a Spinning Babies parent education class, or hiring a doula can help you to know what positions are helpful at each stage in labor. Check out spinningbabies.com for more info, or reach out to me!
Laboring at home as long as possible sets you up for a better birth experience… (in most cases)
If this is your first time in labor, chances are labor will take awhile (as in many hours or over a day). The longest part of labor is usually early labor, which is when contractions aren’t very strong and don’t last very long. During this stage (and throughout labor), labor will progress best if you are in an environment where you feel comfortable and safe, where you have freedom of movement, and where you are undisturbed. This is also a time when you need to rest, eat, and stay hydrated. For all of these reasons, laboring at home as long as possible is ideal, as long as there are no concerns about your health or the baby’s that may warrant extra monitoring.
How will you know when to go in? For a first birth, you will want to head to your birthing location when you are feeling like you need more support or when your contractions have become 3-4 minutes apart and at least one minute long, for at least an hour. For most people, this timing is about right, but paying attention to the intensity of the contractions, as well as how you are acting between contractions is also a helpful indication of how soon you will be giving birth. Early labor contractions may be painful, but you usually feel fairly normal (and maybe a little tired) in between them. Active labor contractions are very intense and you will start to feel spacey or “out of it” in-between them. Your doula is a great resource for helping you navigate when to leave and many (including me) will support you at your home prior to heading in if you want to stay home as long as possible.
The “best hospital” in your area may not have the best birth culture.
The birth culture of your birth place is one of the most important factors in determining how your birth will go. Some hospitals are very medicalized for birth and interventions are common (and often over-used), whereas some have a culture of being more “hands-off”/low-intervention. Also, some simply have more options for pain relief than others, such as access to a labor/birthing tub or nitrous oxide. The fanciest, most “highly rated” big hospital in your area may be excellent if you are sick and in need of assistance, but could be the wrong place for you to birth if you are seeking a low-key, non-rushed, physiological birth experience.
One way you can start to get a better understanding of your hospital’s culture is by looking at their statistics on things like cesareans. A great resource for this is https://ratings.leapfroggroup.org/ , where you can look up your hospital’s stats. Your OB/midwife should also be able to give you these statistics (and you should definitely ask if you haven’t!).
Another option for getting a sense of which hospital in your area is right for you? You guessed it… Talk to a doula! We have a unique “birds-eye view” of local birth place options, since we attend births at multiple locations. We love to help with the process of finding the right birth location and care provider that fits what you want out of your birth experience!
Many OBs and L&D nurses do not have much experience with physiological birth.
This is somewhat related to number 3 above. If you want an unmedicated, physiological birth and your OB (or even midwife) practices at a hospital that has low rates of unmedicated, low-intervention birth, they may have seen very few of these types of birth and not be very good at supporting them. Asking your doctor/midwife questions like, “Tell me what a typical birth is like for someone who has a similar pregnancy to mine…” or “How do you support patients going for an unmedicated birth?” might help give you a sense of their comfort level. These are open-ended questions so they can’t just say, “Yes, I support whatever type of birth you want.” Don’t be afraid to dig into their answers and trust your gut. Remember, you are paying them! You probably spend a lot of time carefully choosing the restaurants to go to, the type of phone you buy, and anything else you need—treat choosing your doctor the same way.
Coping in labor is both a physical and mental challenge.
When you’re in labor, your mental state is going to have an impact on your physical experience with the contractions. Much the same way that you have to dig into your inner strength and fortitude during a hard workout, you will also need to tap into that power in birth. There are many tools to help you cope: guided meditations, breath work, Hypnobirthing, mindfulness, distraction, words of affirmation, and guidance from your birth support team. Make sure that you surround yourself with people who will help you through this mental challenge and be positive coaches!
Birth happens best when you feel supported and safe.
Our environment has a powerful effect on our labor and birth. When you feel safe, the hormones that your body needs to produce to keep labor moving (primarily oxytocin) will keep flowing. Contractions can’t happen without oxytocin and it is a shy hormone! It responds best to darkness, safety, intimacy, and support. It shies away from bright lights, interruptions, and unsafe/unwelcoming spaces. So how do we encourage oxytocin to flow? We get cozy— whether you’re at home, in a birth center, or even in a hospital. You should be able to labor without all the lights on and you can bring comforting items from home with you. You can also request your care team keep things as calm as possible in the room. And you can hide out in the bathroom (hot water in showers and tubs is a great comfort measure), which feels more intimate, dark, and secluded. Even if you have an epidural, supporting the flow of oxytocin with a dark, calm environment can help you avoid needing any supplemental pitocin (the synthetic form of oxytocin). Planning to birth in an environment where YOU (not your partner or your family or anyone else. With all due respect to them, they aren’t the ones who have to give birth!) feel the most comfortable and safe is ideal, whether it’s the hospital, birth center, or your own home!
You have the right of informed consent and refusal. You can say “no” to anything.
This is a very simple one: Informed consent also means the right to informed refusal. There cannot be true consent without the option of saying “no” without consequence. This applies to all things in your life, not just your birth experience, but becomes critical when you are presented with options in your birth space. A great way to find out if your voice will be respected by your doctor/midwife in the birth space is to practice saying “no” and making your wishes known at your prenatal appointments. Be up front with them about your preferences and the plans for your birth that are most important to you. If you are getting push back at that point, there is a very strong chance that they will not suddenly have a change of heart during the labor process. This may mean it’s time to consider finding a new provider, or preparing for very strong advocacy in your birth.
Sometimes interventions are a good thing, but they are also over-used in many settings.
While birth is an event that may sometimes lead to a need for medical intervention, in the majority of cases, less intervention is the safer, more satisfactory option for birth.
How can you figure out if your chosen place of birth over-uses (abuses) interventions? Ask about their stats! What percentage of their patients get induced? How often is pitocin used to augment labor? Do they always break your water at some point in labor, or do they leave it to break on its own? How often are episiotomies performed and under what circumstances? You may be surprised to learn that the rates of some of these interventions are higher than you would expect. The current rate of induction overall in the US is about 24.5%. The rate of cesarean (the ultimate intervention, that often follows the cascade of other interventions) is 31.9%, which is about three times higher than what the World Health Organization suggests is an acceptable rate (source of statistics: cesareanrates.org). We are over-medicalizing birth often, especially in busy hospitals.
How can you help avoid the overuse of interventions? Ask questions about the medical necessity of suggested procedures and be very skeptical of the answers. Opt for midwifery care when possible. And (you guessed it) hire a doula! A doula has a solid understanding of the times when interventions are necessary and when they are being introduced for convenience or out of a false sense of urgency in an otherwise normally progressing pregnancy and labor. Because of this, doulas have been shown to reduce the rate of cesarean by 39% (source of statistic: Evidence Based Birth).
Movement is key to labor progression.
Labor is a dance between you and your baby. Your body is opening and changing to make space for your baby to come out, while your baby is wiggling and turning to find their way out. The contractions of labor are the main tool that gets this work done, but you can help by moving into different positions throughout the process. Some of these will happen instinctually, as you sway, rock, and stretch in response to what you are feeling. The baby is navigating the hard and soft tissues of your body, so as they turn and move down, your movement helps to make space for them to continue their passage. Whether you are laboring unmedicated or with an epidural, changing positions every 5 contractions (or about every half hour) is a good rule of thumb. This can also help you to avoid getting tired from being in one position for too long. You and your partner can look up different positions ahead of time for ideas, hire a doula to help you work through positions, or listen to your body’s natural tendencies toward certain movements throughout labor. Just keep moving!
There are many pain management options in all settings.
It can seem like you have only two options in the birth world: go completely unmedicated/do everything without pain management or get an epidural. In reality, you have so many more options than just an epidural! Whether you are at home or at the hospital laboring, you can use hot and cold packs (heating pads, ice, hot water bottles, cold wash cloths) for comfort. Massage and counter pressure are also tools that are always at your disposal (but it’s helpful if you learn them ahead of labor). Mindfulness and meditation are great ways to stay focused and calm. Also, changing positions can be a very simple way to find some relief. One of the best pain relief options in any setting is water. Tubs and showers can provide great pain relief at home, in the hospital, or at a birth center, although not all hospitals have tubs in every room.
In the hospital, you have a few more medical pain relief options: IV pain meds, nitrous oxide, and sterile water injections are alternatives to an epidural. If you opt for an epidural, you can also request a “walking epidural,” which is lighter than a traditional epidural, allowing you to have more movement while usually still covering the pain.
