Newsletter for doula's or just for those interested

If you haven't noticed, I've got a new newsletter button on the side.  I decided I want to work on a doula manual, but needed some way to get down my ideas and thoughts.  Thus, I thought I'd offer it to those who want it via newsletter here.  I hope to focus on actual processes that doula's go through rather than just on helping women sift through there choices.  I also hope to provide easy to understand information that you can provide for women.  So, if your interested, click on the subscribe button.  I'm planning on making it a weekly thing....hopefully:)

What does a Doula do?

I just wanted to repost this.  I don't even remember where I found it ,but  I really liked it a lot. Speech by Patrick M. Houser

DOULAS: Serving Humanity

In 1952 British author, anthropologist and humanitarian Ashley Montague wrote:
“Women are the mothers of humanity; do not let us ever forget that or underemphasize its importance.
What mothers are to their children, and to others, so will men be to men.
Women must assume the full birthright of motherhood.”

We are here today to honour women, women who serve humanity. A 1995 film called First Knight characterizes the Arthurian legend of Camelot and the Knights of the Round Table. In this version the fabled, circular table has an inscription carved into it. It reads, “In serving each other we become free”. So, as I see it, we are here to celebrate freedom; freedom to support and to be supported when the very foundations of the family are being laid. The primary role of a doula is to be of service to parents, and by proxy babies, during the most impactful period in the individuals’ and the family’s life.

Personally, my passion for birth was ignited by the births of my own children. The first was a significant challenge and awakened my need to know more. I received my second son from his mother underwater, in 1980. This was the first waterbirth in the US. I have supported numerous births since. I have listened and learned from birth and birthing mothers. I listened to mother’s timing and I learned not to try and fix what does not need fixing. All fathers need to learn these lessons, and more. They also need to be supported to feel safe with birth and doulas play a valuable role in this. Professionally, I gratefully work to support parents and professionals toward a more satisfying experience of the birthing time.

The family has just come through the most transformative era in history. In 1975 fathers spent an average of 15 minutes a day with their children. By 1995 it was 2 hours. That is an increase of 800%. During this same time frame fathers’ attendance at the birth of their children rose from small numbers to nearly 90%. These renovations in the family have occurred almost entirely without societal support. There have been virtually no gender specific dad’s classes on offer to assist men in their understanding of, or integration into, the birthing process. In addition, birth professionals and educators have not been provided with a class during their training called, “Fathers-To-Be 101…what to do with the bloke in the room”.

In 2006 Elmer Postle and I conceived Fathers-To-Be to help remedy this situation. We choose the primal time as the focus for our initiative. At that time, I knew I needed to do some research in order to feel the cultural pulse of fatherhood and fathers’ role. I fired up my trusty PC and invoked the greatest Oracle of our time, Google. I typed into the search field our reference for expectant dads, “fathers to be”.

The ‘Wizard of the Web’ responded with a most shocking, albeit excruciatingly truthful reply. “Do you mean mothers to be?” Google knew I was seeking information about expectant parents but had no reference what so ever for the male of the species. It was like I had misspelled my query…or worse… that no such person existed. The truth however is that society was not embracing expectant fathers.

As I explored this phenomenon further I discovered that virtually all websites, as well as printed literature, regarding birthing culture such as; pregnancy, birth, midwifery, childbirth education, government policies, hospitals and conferences were all the same. The one thing they all had in common, almost without exception, was that they neglected to use the word father.

Some of these important information sources, for parents and professionals, alluded to fathers by using euphemisms such as “the rest of the family”, “other family members” and ”birth partners”(who could be of course be various people). They were neglecting half of the birthing family and as such denying the experience fathers were having, by not naming him.

Research shows that unless the word father or dad is used a man will tend to not include himself. How can a man find himself in this incredibly female world unless he feels welcome? I have written an article called, “Go Ahead…Use the F Word…FFFF Father”. It is available on our website FathersToBe.org. A brief 3 years on and Google has upgraded its feedback. Check it out for yourself. Some progress has been made, much more is needed. I encourage everyone to scrutinize your websites and literature to see if you think fathers will feel welcome and included when looking for information to support their new family.

The result of this state of affairs is that our families, and ultimately society, are operating under a handicap. I see doulas as a possible bridge for the family. A viaduct between the highly challenging and medicalised environment mothers and fathers find themselves in, and the love parents are aiming to give and receive as their child is being born. Parents are doing it together. In addition, for the majority of mothers, a significant key for her successful pregnancy, birth and breastfeeding is the care provided by the father.

Doulas, in essence, have always been part of birthing culture; they used to be called mothers, grandmothers, sisters and best friends. However, trained, professional birth attendants are relatively new. Perhaps there is potential inherit in this detail. As doulas influence the environment of birth new policies and practices will be introduced. I think an element of this could incorporate support for fathers, the missing link in the family system. In addition, all midwifery, childbirth educator and doula training courses, and continuing education programmes, could incorporate significant elements of fathers’ awareness into their curriculum. Fathers-To-Be provides these consulting and training services.

A father’s participation during birth can be highly advantageous for the labouring mother. When a couple’s relationship is loving and its sanctity preserved and supported, they are a virtual oxytocin generator. However, fathers can also be a significant impediment if they are ill-prepared, do not understand and embrace their role, or are afraid. Gender specific educational programmes for expectant dads, father to father, are a crucial and necessary element for insuring strong and lasting foundations for our families’ structure and legacy.

Doulas typically practise whole family support. They give loving attention during the birthing time when and where it is needed and I salute them.

And so we are here today to recognise the Doula UK, Doula of the Year. By acknowledging one person in a particular occupation we celebrate everyone in that profession. So let’s celebrate all doulas and childbirth professionals today. Let’s recognise ever increasing numbers of those who know the value and importance of bringing our children into a world filled with love, gentleness and support; a sense of sacredness and freedom.

I spoke Ashley Montague just last night and he gave me permission to adapt his resounding words from 1952, for this special occasion.

“Doulas are serving humanity. Let us ever remember that and celebrate its importance.
What doulas are to mothers and fathers, so will parents be to their children…and their children.
We must all assume our full birthright of serving our children, and the future of humanity, in love.”

In serving each other we become free. Thank you!
© 2009 Patrick M. Houser

Patrick M. Houser is the author of the Fathers-To-Be Handbook, freelance writer, keynote speaker
and parent and childbirth professional educator on fatherhood and the family. www.FathersToBe.org

cultural sensitivity in birth

"Cultural Sensitivity

The third piece of the puzzle is cultural sensitivity, which:
• is an affective construct that relates to values, beliefs, and attitudes.
• implies that an individual has an open attitude in relationship to themselves and others, allowing them to explore their own beliefs and values as well as being receptive to the beliefs and values of others.
• emphasizes approaching others with humility while taking the role of learner rather than assuming one has sufficient knowledge."


I had to explore this idea after reading it in my cultural competency course.  This idea made me step back and think about how I help people learn.  Do I really do this, with this kind of attitude in mind?...and if I don't I really should.


As a doula, I come in contact with all sorts of viewpoints regarding birth.  Some are super natural and others prefer any and all intervention.  Most are somewhere in between.  Then, there is me.  I come to them with my own set of assumptions and world view regarding birth.  The key is learning how to teach, while also figuring out what it is that I need to learn about the person  I am teaching.


Most of the time, as care providers, we need to do a lot more listening than talking.  I like the idea in this quote of allowing others to explore their own beliefs.  We do this by presenting information, then listening to what the other person has to say about that information.  I know that this is something that I need to work on.  

Doula discussions-reflexology

Here's the link to the article I've been looking at:

http://journals.tums.ac.ir/full_text.aspx?org_id=59&culture_var=en&journal_id=10&issue_id=1886&manuscript_id=15957&segment=fa

It's written in Persian, so you need to translate it online. It also makes it a little funny to read, but I thought it was worth it:) This trial was only 60 women, so it is small. More research(like always) should be done.

Here's a brief description of what was done during labor. Again, it's translated from the computer, so the English is a little different.


"Where the reflex points to reduce pain and stress of uterine contractions in sunken area between the inner ankle and heel, so the group area for 10 minutes per leg in active phase (the first stage of labor) at the time was between uterine massage. A total of 20 minutes for each person was doing reflexology. After 20 minutes the second time within uterine Ashpylbrgr questionnaires completed and pulse and blood pressure were measured again and the people in these groups were also similarly, with the difference that another point them in the right leg was massaged. Count uterine massage reflex points (2 or 3 times) the number of individual contractions during the 20 minutes because it depended on the distance between reflexology contractions start and stop the contractions were starting."

Scenario:

Samanatha began labor at home. She wanted to have as little interruptions as possible ,so she waited to call her doula until she was sure she was in active labor and she had to focus more on working through her contractions. When the doula got there, she was breathing deeply through her contractions while on her hands and knees. She also was holding onto her husband during contractions.

The doula would apply counter pressure to Samantha's lower back. This helped but Samantha was beginning to get tired ,so she laid down on her side for a little bit. This helped her rest, but she wasn't able to do the counter pressure as well. She then tried relaxing in the bathtub. She found this was helpful also.

Soon she began to feel the contractions coming on more intensely and decided it was time to go to the hospital. The checking in routine made it hard for her to concentrate and because they were wanting to monitor the heart rate for 20m before they took her off, her movement was restricted.

Once the monitor's came off she began pushing. During the pushing she became very tired after the first hour and started to worry that she wouldn't be able to push her baby out. Eventually she was able to and her baby was born 1.5 hours after she started pushing.

Questions:

1. At what points in the scenario would reflexology be useful?

2. At what points would it not be useful?

3. What other situations could reflexology be useful other than the scenario described above?


For those who are living in the Utah area, MCU is offering courses for students and the public. One of those courses includes one on maternal reflexology. I think I'm going to see if I can go to this one.

http://www.midwifery.edu/

Doula discussions

I've started some doula discussions on facebook. If anyone is interested here is what we'll be discussing. If you want to join in go to my facebook page at http://www.facebook.com/pages/The-Beginning-of-Motherhood/175908596269

It should be under the discussion tab.

For these discussions I'll give a research article and some scenarios...then present some discussion questions. I'll usually give a scenario that is based solely off of comfort and another scenario that is more clinical. I would love to hear all your experiences in relation to the research and what you have or have not encountered.

Here's a link to the research article that I'll be discussing....

http://www.ncbi.nlm.nih.gov/pubmed/9892892

For those who want the whole article you can buy it for a price.

From the article's introduction is this quote..."Patterned breathing is a major element of childbirth education. It is applied widely and is considered an effective way of managing pain and stress during labor. Nurses midwives physicians and doulas enourage this breathing to distract the laboring woman from her pain and also to involve the partner in her care....Used correctly patterned breathing is purported to maintain oxygenation of mother and baby...increase relaxation...decrease pain and anxiety...and provide a means of focusing attention...No research studies were found that documented the effectiveness of these techniques but they are part of accepted practices in labor and delivery education...In anecdotal reports many nurses have questioned if patterned breathing techniques tire women when they are begun too early in labor".

"The findings suggest ways to use patterned breathing in managing the first stage of labor. During the latent phase of labor the raw fatigue scores increased as the complexity of the type of breathing pattern increased(Table 1). For the latent phase the differences in scores were statistically significant suggesting that the most appropriate management of women in the first stage of labor is to postpone the patterned breathing until the active phase. The paced type of patterned breathing related to the highest fatigue scores which were found in women in latent labor. This suggested that women should not be encouraged to begin using paced breathing during the latent phase and that traditional breathing should be approached cautioulsy if at all.

During the active phase differences among breathing types were less pronounced and were not statistically significant. Hence it may be appropriate for nurses midwives physicians and doulas to recommend traditional and paced patterned breathing when women shift into active labor".

In this research patterned breathing was both slow breathing and paced(a quicker pace of breathing). For more info on different types of breathing go to this link: http://www.babies.sutterhealth.org/laboranddelivery/labor/ld_breathe.html

1st scenario:

Melissa is a first time mom that started labor at 7pm on a Mon. night. Her contractions started out at a half hour apart and so she paced her house to try and get them closer together. At this point her contractions were mild cramps and very manageable. By 11pm they were 5m apart and stronger. When she went to the hospital however she was only 2cm dilated. At this point her contractions felt like strong menstrual cramps. They were ones that she would call painful but do-able. She had wanted to try a natural labor though and felt ok about going back home for awhile.

Melissa had taken a short childbirth class and she started doing slow deep breathing through her contractions while continuing her pacing. Her contractions remained about 5-7 m apart. The breathing helped her focus on something else for a while but by 2am she was very tired. She decided to take a bath and try and get some sleep. While in the bathtub she noticed that her contractions slowed down to about 10-12 min apart. This made her a little anxious that she wasn't progressing enough but she was so tired that she layed down afterwards anyways. She had a restless night of sleep as she would wake up every so often with a contraction.

At 5am she got up to eat breakfast and noticed her contractions pick up to about 5m appart again. At this point she was using slow breathing and focusing inward to work through contractions. They were getting hard to work through and she was very tired. She remembered that her classes talked about a different kind of breathing that was faster paced. She switched over to that one to see if it would help more.

She found that these helped to distract her more but took more energy out of her. She decided to go to the hospital again at this point. While at the hospital she was 3cm dilated with contractions3-5m apart. She was using the paced breathing as these still seemed to help distract her. While there they had her walk around for an extra hour because she a changed a little bit but was also spotting a little. Two hours after getting to the hospital she was 4cm dilated.

Melissa felt like the contractions were getting very difficult and she could feel her exhaustion pulling her down. After another hour in the hospital and doing the paced breathing she felt like it might be best to get an epidural to help her rest a little bit more. Her baby was born at 12 noon.

Questions:

1. Was the use of patterned breathing here appropriate or inappropriate?(Keeping in mind the research article and also your own experiences)

2. What else might have helped Melissa to cope with this labor?

3. What could have been done to help with her fatigue?

4. How might patterned breathing been used differently?

2nd Scenario:

Sandy was having her second baby and had been admitted to the hospital at 5cm dilated at 3pm. She had brought a doula with her to help her with this labor as she was not wanting to use any medications. While at the hospital she had been using the tub and a birth ball to cope with the contractions.

After an hour in the hospital she wanted to know how far dilated she was. When she got out of the water though she could feel the contractions getting harder to cope with. Her doula could sense the change and started reminding her to try taking some deep abdominal breathes during her contractions. These helped Sandy refocus and continue with her labor even while the nurse was checking her.

She was 7cm after that check and Sandy could feel the contractions getting stronger. She started to panic at one point but then found that it was helpful to do more of a patterned breathing as she had been taught in her childbirth class. The rhythm of the breathing helped her to cope better. At 4:30 Sandy felt the urge to push and a little boy was born a half hour later.

Questions:

5. As labor support how can we help a woman find her own pattern of breathing that helps her cope?

6. Is it appropriate to make them breath with you when you feel they are not coping?

7. If this woman had not previously taken any childbirth classes and did not know about patterned breathing how would you help teach her this while in labor?

For these next two scenarios I wanted to add a little bit more information that will help with decision making...

When a practitioner is watching the babies heart rate they will be looking for signs that the baby is coping well. One trend that they will look for is if the heart rate is having late decelerations. This is where the heart rate is having dips after a contraction. This is indicative that the baby is not being well oxygenated during the contractions. If you would like to see a more detailed description of this you can go to by blog at this site: http://thebeginningofmotherhood.blogspot.com/search/label/fhr.

If you are only acting as labor support it is not your job to treat this but there are some things you can do to help if you notice this happening.

Deep Breathing

“Some benefits of abdominal breathing include

1.Increased oxygen supply to the brain and musculature.

2.Stimulation of the parasympathetic nervous system. This branch of your autonomic nervous system promotes a state of calmness and quiescence. It works in a fashion exactly opposit to the sympathetic branch of your nervous system which stimulates a state of emotional arousal and the very physiological reactions underlying a panic attack.

3.Greater feelings of connectedness between mind and body. Anxiety and worry tend to keep you “up in your head”. A few minutes of deep abdominal breathing will help bring you down into your whole body.

4.More efficient excretion of bodily toxins. Many toxic substances in the body are excreted thorugh the lungs.

5.Improved concentration. If your mind is racing it's difficult to focus your attention. Abdominal breathing will help to quiet your mind.

6.Abdominal breathing by itself can trigger a relaxation response.

Bourne Edmund J. The Anxiety and Phobia Workbook Fourth Edition

Abdominal Breathing Exercise

Slow inhale...Pause...Slow exhale (“Ten”)...allow body to relax

Slow inhale...Pause...Slow exhale (“Nine”)...allow body to relax

See also...http://thebeginningofmotherhood.blogspot.com/2010/01/effects-of-stress.html

Also from The Anxiety and Phoebe Workbook

"Studies have found differences in the breathing patterns of anxious and shy people as opposed to those who are more relaxed and outgoing. People who are fearful and shy tend to breathe in a shallow fashion from their chest while those who are extroverted and relaxed breathe more slowly..deeply and from their abdomens....

If you breathe from your chest you may overbreathe...exhaling carbon dioxide in relation to the amount of oxygen in your bloodstream. You may also tend to breathe through your mouth. The result is a cluster of symptoms..including rapid heartbeat...dizziness...and tingly sensations that are so similar to the symptoms of panic that they can be indistinguishable. Some of the physiologic changes brought on by hyperventilation include:

Increased alkalinity of nerve cells...which causes them to be more excitable. The result is that you feel nervous and jittery.

Decreased carbon dioxide in the blood..which can cause your heart to pump harder and faster as well as making lights seem brighter and sounds louder.

Increased constriction of blood vessels in your brain...which can cause feelings of dizziness...disorientation and even a sense of unreality or separateness from your body".

3rd Scenario: Dawn had been in labor for about 4 hours and she knew she was know in transition. She was using visualization and paced breathing to help her cope. Both of these were working well for her at this point.

Soon though a nurse came rushing into the room and told her her baby was having a more difficult time with her contractions and that the heart rate was having late decelerations. Dawn became a little more frightened at this point and was trying to do what the nurse asked while working through her contractions. They were noticeably harder at this point and she was no longer able to keep up with the deep focus and visualizations. Though she did keep up with the pace breathing.

She noticed that she was feeling a little dizzy and the nurse was now getting nervous that her blood pressure was getting a little too high. When Dawn mentioned to the nurse that her fingers where also feeling tingly the nurse wasn't quite sure why. The nurse also asked that she lie down to help decrease her blood pressure. These made the contractions even more uncomfortable and difficult to work through. The babies heart rate was still having late decelerations and Dawn was starting to get a feeling of panic.

Questions:

8. In this situation how would you change the focus of your labor support?

9. Would you still continue to use patterned breathing?

10. How might patterned breathing help or not help in this situation?

11. How do you differentiate between latent and active phase and how would you apply the research article to women in your definitions?( see this web site for other ideas...http://midwifethinking.com/2010/12/22/stages-of-labour-and-collusion/

A doula in provo-another stepping stone

So I've decided to do it...I am wanting to focus more exclusively on just providing labor support. It's been an interesting journey for me...one that I don't think is really over.

When I first went into nursing, I really had no idea that I would love labor and delivery. Even after the birth of my first two children, I had no clue that I would be pulled to do this. And I was pulled...I have felt like this has almost become a calling for me in many ways. And my love for new moms and babies has grown so deeply. When I applied for the labor and delivery job I have now, I knew it was where I was supposed to be. But it's now time to move on.

Now December will be the last month I work for the hospital system I am working with. I am just about finished with my doula certification and I've felt like this is where I need to go now. But I feel like this is just another stepping stone....to something much more.

I have aspirations for becoming a midwife, but these stepping stones are something much more. By serving women, I have learned to love. I have learned to cry. I have learned to be amazed. All these things I have brought with me now...so where will this next stepping stone lead me. Who will I become now? For sure a better mom and woman...hopefully a little bit less selfish and more humble. These are all stepping stones we take, no matter what profession we have or who we are.

I have an image in my head of a wonderful loving woman who looks at me with a heart full of kindness and a desire to see me find joy. This is the woman I hope to be at the end of my life...and these stepping stones are just ways for me to find her. But for now I'll be a doula in Provo. And for anyone who is looking forward to a new little one and is in my area...I would love to be privileged to help you with your stepping stone in your journey to motherhood.

Calm and peace

I just had an interesting comment from a lady tonight. She told me, that even though there were a few people around her telling her how to push and counting and holding her, that it was my calm, quiet voice, that she heard. It made me wonder how and why someone could latch on to something like that in the middle of noise. And how much we really need that.

I know I have never liked the noise of delivery. I had that at only one of my births and I swore I would never do that with a woman in labor. The thing is, when your in labor, you need calm and quiet. You need a peaceful feeling, and quiet reassurances. It's interesting being on the other end of this also. As a caregiver, I find myself connecting much more with a woman in labor when I quietly breathe with her, or focus her attention to my face to work through contractions.

The hard part, sometimes my attention can not be so focused. Sometimes the baby needs attention, sometimes there are medical things I need to focus on. So, I applaud those women who choose to support laboring women..be they doula's, mothers, friends, husbands, or sisters. The work you do is so important and I appreciate the calming influence you have.

And then I remind myself, that this applies to many areas of life. How much more effective are we as mothers when we calmly talk to our children, rather than yell. When we watch for the right moment to speak, rather than interrupt what others are saying. When we focus our attention on what others really need, rather than just being noisy. I know it makes me want to try to much more of a peace maker in my own home.

So what position should I be in anyways?.....

This post comes from a question about positions during the pushing stage of labor. In one of my previous posts http://thebeginningofmotherhood.blogspot.com/2009/02/emergency-pain-control.html, I mentioned how you should not give birth laying on your back. So, if that's the case, what position can you push in? Answer: just about any position but that one:)

Here's the extended answer:)

It has been shown that being in an upright position helps to decrease the amount of pushing time, decrease the amount of tears, and decrease the amount of instrument deliveries. These positions include squatting, sitting, and on your hands and knees. There are good things and bad things about all of these. Obviously squatting would get tiresome, but if you have good help, they can help support you from behind. Hands and knees can also get tiresome, but it is one of the best positions to turning baby into the right position. You can also use a birthing stool to sit on, or if you are at the hospital, get the bed positioned to help support you sitting up. This is one of my favorite positions.

For those who have epidurals, or are just plain exhausted, the side-lying position has been shown to help. Essentially you have one leg raised while you are pushing on your side. With an epidural, you can also have the head of the bed raised to allow you to be more upright. Just make sure you are fully up and not just half way as this will decrease the space in your pelvis.

A good book to look at for positioning is Penny Simkins book, Labor Progress. She does a wonderful job of explaining different positions throughout the labor and why you would use them.

If you feel a need to be in any kind of position, I would stick with that. Many times, a woman's body can tell how they need to be to help move that baby down. Your biggest hindrance will be with medical staff that aren't used to these positions. I would make it clear from the get go that you want to push differently. Talk to your doctor about this also. Some are fine with doing whatever, and others are pretty stuck in the lying on the back mode.

I also had a question about doula's. First off, I'll say that I never had a doula, but probably could have used one. I have a wonderful supportive husband, but I feel like a doula who has been trained and been to many births, has experiences that neither I nor my husband had had at the time. Plus a doula allows the husband to take breaks when needed. A good doula will help the husband in his supportive role. I also think that there is something different about how men and women think, and having a women's support along with your husbands would make a difference.

Studies on doula's have shown that women who use doula's have shorter pushing times, less instrument deliveries, and breastfeed longer(Journal Of Obstetric, Gynecologic, And Neonatal Nursing: JOGNN / NAACOG [J Obstet Gynecol Neonatal Nurs] 2009 Mar-Apr; Vol. 38 (2), pp. 157-73.).

I would interview them first to see if they would fit well with what you want to do and how you feel about things. If you plan on having a hospital birth, I would also try and find a doula that has worked well with the medical staff in the past. If money is an issue, try and request a nurse that has had natural birth experience. Sometimes, you can get a nurse to help with the labor support if needed.

References:

The Journal Of The American Osteopathic Association [J Am Osteopath Assoc] 2006 Apr; Vol. 106 (4), pp. 199-202.

The Journal Of Perinatal Education: An ASPO/Lamaze Publication [J Perinat Educ] 2006 Fall; Vol. 15 (4), pp. 6-9.

Journal Of Obstetric, Gynecologic, And Neonatal Nursing: JOGNN / NAACOG [J Obstet Gynecol Neonatal Nurs] 1997 Nov-Dec; Vol. 26 (6), pp. 727-34.

Begin at the beginning

I love being a mom.

I had never thought about it until I had my own children who are now 7, 5, 3, almost 2, and 7 weeks. What really surprised me, though, was my reaction to labor. It hurt, yes, I expected that. What I didn't expect was how much that experience would mean to me. It has been something that has stuck with me. So much so that I am now working on becoming a doula. Which leads to this blog. I wanted something to organize my thoughts and share what I have learned about being a woman and a mom specifically from my labor.

So here is the beginning of my journey...