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Keeping Doulas at Births in Hospitals During Covid-19

Stages of Grief: Our community was thrown off-kilter mid-March 2020 with the official arrival and acknowledgement of COVID-19 as a global threat in the United States. It was upon us and as with any stressful event, many birthworkers, myself included, walked through the stages of grief in regards to the pandemic.

First Stage Denial: Surely this wasn’t really a thing, was it?

Second Stage Anger: I felt anger acutely as a doula. The restrictions on birth support hit me in the gut and I’m not ashamed to admit that initially I took it as a personal attack on doulas. Of course, I have since come to my senses and understand that at the heart of the decision by hospital administration was to keep everyone safe, including doulas, which brings me to the third stage.

Third Stage Bargaining: Birthworkers explored how to continue to offer birth support, even if virtual, and they pivoted to accommodate the needs of their clients through FaceTime, Zoom, text, and phone.

Fourth Stage Depression: Depression was in there too, and lingers today for many of us. As doulas, we yearn to be with our clients, sharing their birth space and offering physical support in their presence. It pains many of us when we are separated from our clients during birth. It’s truly a struggle that hits a doula right in the heart. And finally, we
encountered acceptance.

Fifth Stage Acceptance: COVID-19 will remain in our midst for awhile and have far-reaching implications on how births will look for the foreseeable future. It is our new, indefinite normal, restrictions, masks, hand sanitizer, and all.

Acceptance is unacceptable.

Doulas and birthing families have had six months of processing the restriction of doulas from physically attending births in the hospital setting. It’s time to push more aggressively to reintegrate doulas in-person at birth. If you are a birthing parent, I implore you to advocate for your doula, and for all doulas, to return to the hospital. Doulas should be
permitted to attend in person because it is the right of every laboring woman to have support, but also because the research is extensive proving that the continuous labor support doulas provide improves birth outcomes. Doulas help everyone, including the staff and care providers! In fact, reputable birthing organizations such as The Association of
Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) have made statements early on defending doulas as essential members of the birth team, and encouraging them to be permitted to continue to serve in person DURING the pandemic. (https://awhonn.org/covid-19-archived-updates/)

Advocacy: So what are we to do to affect change in hospital policies? There needs to be a push from the birthing parents to hospital leadership. Contact the manager of the labor and delivery unit, and the administrator of the hospital. Make a phone call. It’s harder to ignore a voice on the line. Follow up your phone call with an email and a letter. Paper trails are also hard to dismiss. If there are other hospitals who have allowed doulas to return, be sure
to mention them as well. In Hampton Roads at the time of this writing the only hospitals permitting doulas to attend births alongside the primary birth partner are: Sentara Leigh, Sentara Obici, and Sentara Williamsburg. And don’t forget to express your wishes with your provider. Not just one, but to each doctor and/or midwife at every appointment.

This needs to come from the birthing families, not the doulas. The amount of research in favor of the presence of a doula is dizzying. And the number of statements by various obstetric, nursing, and birth organizations is compelling. The evidence is there and the need is higher than ever. What’s lacking is the advocacy for the presence of doulas during the pandemic. I have compiled some links in an effort to cut down on your need to research data. You will find them at the end of this post. Feel free to use any or all that you see fit. And write those letters, send those emails, and make those phone calls. The change must begin with the birthing women. Not the doulas. We believe in you and we support you. Be an advocate not just for yourself, but for all birthing families.

Below are some links to incorporate into your letters/emails/calls campaigning for the reintegration of doulas to attend births in-person. They are particularly timely and relevant since the statements were made in March 2020, right as the pandemic was taking hold in the US.

Cochrane Database Evidence that continuous labor support may improve outcomes for mom and baby:  https://www.cochrane.org/CD003766/PREG_continuous-support-women-during-childbirth

AWHONN Position Statement for Continuous Labor Support for Every Woman: https://www.jognn.org/article/S0884-2175(17)30482-3/pdf

ACOG (American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine’s joint document on the Safe Prevention of the Primary Cesarean Delivery: https://www.acog.org/en/Clinical/Clinical%20Guidance/Obstetric%20Care%20Con sensus/Articles/2014/03/Safe%20Prevention%20of%20the%20Primary%20Cesarean%20Delivery

ACOG Approaches to Limit Intervention During Labor and Birth: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/02/approaches-to-limit-intervention-during-labor-and-birth

March of Dimes Position Statement on Doulas and Birth Outcomes, January 30, 2019: https://www.marchofdimes.org/materials/Doulas%20and%20birth%20outcomes%20 position%20statement%20final%20January%2030%20PM.pdf

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The Infant Microbiome: 6 Things Every Parent Should Know

Guest post by Toni Harman

Unleashing the Science: 6 Things Every Parent Should Know About The Infant Microbiome

Filmakers Toni Harman and Alex Wakeford collaborated on MICROBIRTH
Filmakers Toni Harman and Alex Wakeford

For the past five years, I have been fully immersed in bacteria. More specifically, my partner and I have explored the wonders of the human microbiome, the bacterial ecosystem that lays the foundations for lifelong health.

As documentary filmmakers, we’ve been in a privileged position to travel tens of thousands of miles interviewing dozens of world-leading professors.
Continue reading The Infant Microbiome: 6 Things Every Parent Should Know

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We Must Do More to Honor Birth as a Peak Life Experience

by Molly Wales, CCE(BWI)

Excerpts from a talk given on Labor Day Weekend, 2012, at the Unitarian Universalist Fellowship of Athens, Ohio.

Molly with her newborn daughter
 My name is Molly Wales.  I am the director of The Birth Circle (a consumer birth group) in Athens, Ohio, and am a BirthWorks childbirth educator.  I’m here today to talk to you about why I believe that we aren’t doing enough in our country to honor birth as a peak life experience.  Perfect for Labor Day!
A short review of where I stand:  I believe that all people are deserving of equal treatment and opportunity.  I believe that a woman is born with the knowledge of how to give birth, and that if Mom can give birth with people who make her feel safe and secure, she’ll be able to follow her instincts and her body and her baby will know just how to work together.  I believe that a woman should have the right to give birth wherever she pleases, with whomever she pleases.  And I believe that birth is a hugely pivotal moment in life, and that the birth experience has a life-long impact on the mother, the child, and on their relationship.
These views do not represent the norm in our society.  Americans, in general, are taught not to trust birth.  Many, if not most, fear it.  And so we keep developing new ways to manipulate and change what already works. And as we force our control like this, the effects are disastrous.
According to a recent Amnesty International report, “The USA spends more than any other country on health care, and more on maternal health than any other type of hospital care. Despite this, women in the USA have a higher risk of dying of pregnancy-related complications than those in 49 other countries, including Kuwait, Bulgaria, and South Korea.”  What?!  WHAT?!  Why is this happening?  What has gone wrong with maternity care in our country?
Imagine a mom has her first visit with her care provider, be it an OB or midwife.  She’s told, “You are capable of having this baby without drugs.  And if that’s what you choose, we will support you in that.  If you or baby needs medical attention, we’ll be here.  But otherwise our job is to let your body do what it was created to do.”  If that were that norm, we wouldn’t be in such a crisis.  Rates of intervention would drop substantially, and our moms and babies would be healthier.
But that isn’t the kind of support that moms in our country generally receive, unless they choose a home birth assisted by a midwife.  Because OBs and hospital-based midwives work under protocol and deadlines that rush the process and place little to no value on the emotional importance of the experience.  Now I don’t mean to say that the OBs and midwives themselves don’t value the experience, necessarily, but rather that they are put under restraints that severely limit what they can do to honor birth as normal and natural, and to work with a mother on her body’s own timeline.
For example:  One of my students recalled going in for her very first visit with her OB, to talk about her exciting new pregnancy.  The doctor told her, “You’ll go into labor, you’ll come to the hospital, and we’ll get you an epidural.”  Notice the commands.  Notice the lack of choice.  Notice the complete failure to acknowledge this mom’s innate ability to give birth to her baby on her own.  In one short sentence, her power was robbed from her.
Or another student, who, while having a perfectly normal labor at the hospital, noticed that everyone in the room kept their eyes fixed on the monitor, telling her when a contraction was coming, telling her how hard it was…when all she wanted, needed, was some eye contact, someone to acknowledge that SHE was doing the work here, and that she was a healthy human mother, not just another illness hooked up to a machine.
And so most moms, at least in our country, never get that chance to realize their own power, that chance to feel accomplished as a mother, right from the very start, those sensations of labor that combine intense vulnerability with unimaginable atomic power.  When a woman gives birth naturally, she has to open up, physically and emotionally, to greet her baby.  It is an incredible start to the mother-child relationship, one of deep bonding, as mom and baby work together through one of life’s greatest challenges.  If we in the U.S., this world power, honored birth as the baby’s start to life-long mental health, and as the mother’s chance to untap her human potential, just think of how we could empower whole generations of women and children.  I remember saying to my little Lola, six short months ago, as I held her there on my living room floor in the darkness of the morning, “We did it, honey, we did it!”  So she was born into that joy, that total soul bearing, that pride.  What an advantage for us both. And I am no extraordinary woman.  Most healthy women are capable of having their babies without medical intervention.  Now certainly homebirth isn’t the right choice for every woman, but imagine what a difference that would make, in our country and in the overall state of our planet, if the majority of mother-baby pairs were trusted, unrushed, and just given a chance to let their bodies work in their own way.
But they aren’t.  Instead most pregnant women in the U.S. are highly uninformed.  They are treated as if their pregnancies are an illness. In labor, they are offered drugs when they should be offered emotional encouragement.  And yes, of course, a healthy baby and healthy mom are the most important things.  But they aren’t the ONLY important things.  There is a chance there for a peak life experience, for both mom and baby, a chance for that relationship to begin with a surge of strength, hormonally and emotionally, that fortifies them for years to come, if not for their whole lives.
In the end, it’s all about creating a peaceful world, isn’t it?  And where better to start, than our barest beginning.
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Value of a Doula

by Tiffany Hare
When people ask me what I do, I always respond by saying, “I’m a doula and a childbirth educator.” And then I wait. I wait for the look of uncertainty to fill the face of the person who asked me the question, or for them to say, “What’s a doula?” The word is still a very unfamiliar one in some parts of the country, and even though I live in a large suburban area outside of Philadelphia, many of the people I come into contact with outside of the birth-world have never heard of a doula.
 
And that makes me a bit sad.
 
I think back to a time when women were surrounded by other women during their labors and their  births; a time when by the time a woman had reached childbearing age, she would have seen birth happen so many times that she was well-prepared for it herself.
But we don’t live in that time. We live in a time in which birth is unknown and frightening to many women. It is during this time that we need doulas.
We need doulas to help us get the information that we need so that we are empowered to make the right decisions for ourselves and for our babies. Doulas can help us make decisions by providing us with information and guidance. Doulas help us through our labors and our births by offering constant companionship .
 
The value of having a birth doula cannot be underestimated. As anyone who has given birth can tell you, giving birth is one of the most life-alerting events that one can experience. Birth is an intimate event. It is an event that does not come with a do-over button. And while we can never predict an outcome, especially in an event as unpredictable as birth, we can take steps in order to achieve the birth experience that we dream of.  Doulas are one step you can take in order to get the birth that you hope for.
Since the beginning of human history, birth took place in the home, with family present, and with a midwife who was experienced in normal birth. Girls and women witnessed birth and experienced it long before they gave birth to their own children. Today, in a culture in which birth typically takes place outside of the home, most women have no experience with childbirth until they give birth themselves. It is a new and foreign experience for most of us.
On average, the length of time a woman who giving birth for the first time spends in labor is about eighteen hours. During most of that time, she and her partner are left to blaze this unexplored trail on their own. It can sometimes be a scary experience that is full of unknowns.
However, studies have shown that having a doula present at your birth can greatly increase your chance of having a birth outcome that you feel good about. Doulas can help to increase positive birth outcomes and decrease the use of medications such as Pitocin and epidural anesthesia. Doulas can decrease the total length of labor by about 25% and decrease the incidence of cesarean delivery by about 50%. Overall, doulas can help you avoid unnecessary interventions and they can help you get off to a better start with your baby and increase your chances of having a successful breastfeeding relationship.
A doula is present during the entire labor and her knowledge and experience can help the mother find confidence and security throughout her birthing experience. When a woman feels safe, confident and secure, oxytocin (“the love hormone”) flows freely and facilitates the progression of her labor. Feeling safe reduces the presence of adrenaline, the hormone responsible for fight or flight syndrome, which can slow or stall a labor. When a woman is supported by a doula, she feels that she has better control of her birthing experience, can make decisions with confidence, and is free to trust what her body is telling her. 
Birth is an event that is not forgotten. The experience stays with us throughout our lives. In birth, as in life, there are no guarantees, but having a doula present at your birth can help get one step closer to realizing the birth that you hope for. 

 

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Choices In Childbirth

At every turn of life, there is a choice to make. When I was pregnant with my daughter, who was a single footling breech, I had to decide whether to go into labor or opt for a Cesarean two weeks before my due date like the doctors advised. I took the time to think about it and decided that there was a chance she could turn in labor. She didn’t turn but to this day, I am grateful that I felt the contractions of labor. I will never wonder, “If only I had labored, maybe she would have turned.”
I had another choice as to whether or not to go back to work when she was young. I thought about it. I decided that I would never have this opportunity again and wanted to enjoy every minute of it fully, so I stayed home. To this day, I am glad that I did.
Each time I had to make a decision, I took time to think about it. Awareness and expression of thoughts is very important. In BirthWorks classes, birthing parents are given ample opportunity to express their thoughts, fears, and joys. Speaking fears is a way of releasing them. They hear stories from other women who have given birth. They begin to develop a base of current and evidence-based knowledge. This will serve them well when having to make decisions in labor.
In childbirth, women are faced with many decisions such as choosing their birth place, the birth team, positions in labor, and whether or not to accept various medical procedures and/or obstetrical drugs. These decisions will be based on knowledge, love, self-confidence and too often fear.
A fear based thought might sound like, “If the contractions become too painful and I can’t take it, I’ll request an epidural.” A thought based on knowledge and love/self confidence might sound like “If the contractions become too painful, I’ll go into the birthing pool and find positions to work with the contractions, and I’ll make sounds. Thousands of other women have done this and I can do it too!”
I believe that choices women make in childbirth that are based on fear and/or lack of knowledge, are ones they later live to regret. Choices they make that are based on love and self confidence are usually ones they feel good about in the months and years after birth. Regardless of the choices that women make, I believe one thing- that every choice a woman makes is right for her at that point in time because she is her own best friend. If indeed we are doing our very best at any given point in time, what more can we ask of ourselves than that? It is not anyone’s place to judge another person’s choice. As childbirth educators, all we can do is offer information in terms of options, and alternatives to expand the available choices open to birthing parents. And we can do one more thing; we can offer them our love.

This is a letter written by our BirthWorks president Cathy Daub for the Summer 2006 Edition of our newsletter.

Please feel free to use our comment section below to post your thoughts and experiences of choices in your own childbirth.