Category: Evidence

Families Deserve Support

The continuous support of a doula is supported by science!

The continuous support of a doula is an evidence-based approach to improve outcomes, decrease intervention, & increase satisfaction. Multiple scientific studies and committee opinions have concluded that doulas make a difference! This is an easy to read summary of the evidence if reading academic text isn’t your thing. As a birth doula, I believe that all birthing families deserve support, and not just on the big day.

These are the kinds of support that I have been able to provide for my clients in the past:

Prenatal

Knowing what all the local options are for prenatal care and planning for birth. Calming fears is another thing I do to support my clients in the prenatal period, and this comes in many forms, but most often through education. I also find myself supporting clients prenatally by connecting them with trusted professionals. This can be for all kinds of things including prenatal massage, chiropractic, and more. I also am happy to share my shopping tips when clients are looking for specific things!

Birth

As a doula, during birth I am giving physical support by helping my clients move around. I give hand massages and help keep their gown closed as we walk the halls. I also like to say that I help clients ask more questions about their care. This is part of helping them know what all their options are as well. I like to say that sometimes I help them order off the secret menu of options that aren’t necessarily the norm, but are perfectly fine to request.

One area that I wish I could support birthing families better here is during cesarean surgeries. All families deserve support, and it can be so hard for families when their plans go sideways. In many other places in the United States, they allow doulas in the operating room as a second support person. Doulas are even trained in how to behave inside an operating room, and how to support clients having a cesarean. Doulas are not currently allowed in operating room of all our local hospitals, but maybe we can change that in the future.

Postpartum: direction to proper resources & support!!

The most important thing that I can do for birth doula clients is to direct them to the people who are actual experts in the things that they are dealing with in the moment. If they have questions about breastfeeding, I make sure I send them to an International Board Certified Lactation Consultant. That is just one example, but knowing WHO to ask questions is really important. Breastfeeding is a great example because so many people don’t really understand how little training most physicians have in breastfeeding science, and they end up getting non-evidence-based advice despite best intentions by everyone involved. Part of my job as a doula is helping clients connect to the right people for whatever questions they might have. I don’t always have the answers, but I do make it my business to know who to send you to.

I have not had the capacity to serve postpartum clients this year, but VERY soon, I am going to have an announcement coming, so be on the lookout for that in early 2020!

All families deserve the support of a doula. Part of my job is helping insure you get the right support at the right time from the right people. I’m constantly learning, so I can continue to know the best local and online resources for my clients.

What was the most helpful resource you found to help you after you brought your new baby home?

Midwives in Southwest Indiana?

Evansville needs midwives to support healthy birthing families!

Southwest Indiana needs midwives, and the lack of them here is surprising. It is frustrating for me as a doula for several reasons. Our area deserves to have midwifery options, especially as midwifery care has proven benefits for patient satisfaction, cost, and birth outcomes.

What does the landscape look like for people searching for midwifery care here? We currently have two Certified Professional Midwives that travel here for home births, one from Bedford and the other from Bloomington. However, home birth is not an option for everyone. In 2019, we only have one Certified Nurse Midwife catching babies at one Evansville area hospital.

So what is the big deal? Midwives are experts in normal pregnancy and birth. According to the Midwives Alliance of North America “all midwives are trained to provide comprehensive prenatal care and education, guide labor and birth, address complications, and care for newborns.” Midwives are not surgeons, and all obstetricians are, which fundamentally changes the way that they approach your care. The Midwifery Model of Care “whether practiced in clinics, private homes, hospitals or birth centers, has at its core the characteristics of being with women, listening to women, and sharing knowledge and decision-making with women” (MANA). Midwives expect pregnancy and birth to be normal and watch out for signs that pregnancy, labor, and delivery might need intervention. That is not the same approach as an Obstetrician, and if you want to read more about the comparison or some social science research about this I highly recommend this book and especially this article and this one too from Robbie Davis-Floyd. She is the most renowned anthropological expert when it comes to this stuff!

Midwives have also been proven time and time again to be linked to better outcomes for their patients. People who use midwives for their care are THREE TIMES more likely to be satisfied with their care when compared with obstetrician-led care. Midwifery care has also been shown to be the most cost effective care in the hospital setting.

Who cares? Well, I do, and I’m not alone. I chose midwifery care for myself when I delivered my babies in Cleveland. As a doula, I regularly get asked for recommendations about providers, and I can’t even count the number of disappointed people I have talked to when I tell them that there is only one midwife here in town available to catch babies in one hospital. There are plenty of factors that go into choosing a provider, including insurance, location, practice style, personality, and so much more. While one midwife is certainly better than none, people choosing to birth here surely deserve more options. We need more midwives in Southwest Indiana.

For a little comparison, just down the road in Owensboro, KY there are 4 Certified Nurse Midwives catching babies at the hospital. Owensboro has a population of around 60,000. Evansville has a population of >115,000! If we include the populations of the surrounding 5 counties (Gibson, Posey, Spencer, Vanderburgh, & Warrick) We have a local population of over 320,000 people, and we know that there are people traveling here from Northern Kentucky, Eastern Illinois, and even further counties in Indiana to give birth, and they aren’t even included in that population count! Not every pregnancy and birth here needs to be attended by a surgeon. Yes, family practice physicians are also an excellent option, and there are some great ones here, but midwifery care is more specialized and has a different approach than the medical model of birth.

Southwest Indiana needs midwives, and we have some currently working to complete their training. As I sit writing this I know three midwives who are currently in school and planning to practice here when they graduate. Two will be Certified Nurse Midwives who catch babies in the hospital and one will be a Certified Professional Midwife who attends home births. Growing families deserve options for their care, and these midwives will be an amazing addition to our community when they are finished with their training. I can’t wait for the day when birthing families in Southwest Indiana have more midwives to support them as they grow.

Have you ever considered hiring a midwife instead of a physician for your pregnancy, birth, and postpartum care?

4cms is NOT Active Labor

Active labor starts at 6 centimeters

Many moons ago, we thought that once you reached 4cms, you were in “active labor” and the pace of your labor should start to pick up and keep going no matter what. In 2010 Zhang and colleagues published a groundbreaking research study that re-examined labor patterns and redefined the beginning of active labor as starting at 6 centimeters! This was a HUGE academic smack-down of the 50+ year standard of Friedman’s curve that defined active labor as starting at 4cms.

Why does it matter? The BIGGEST reason physicians were recommending cesarean section in 2011 was “arrest of labor” or “failure to progress” and apparently they were making the call far too early! You can read more about that whole thing here. After this study was published, the American College of Obstetrics and Gynecology (ACOG) came out with this position paper saying, whoa, let’s slow down this trend in the rise of cesarean births, and even outlined why and how. That position has since be reaffirmed multiple times by ACOG, BUT, I am still not seeing all local providers using this evidence in their practice and I still hear some providers and staff telling people that they are in active labor when they are 4cms. Look, your Aunt Becky might not know the evidence, but you surely hope the people taking care of you are up to date on best practices from 5+ years ago right?

The evidence is clear: If you are 4cms dilated, you are NOT in fact, in active labor. Your labor still has a chance to stall out or even stop. While that is frustrating news if you are in that position, it is also good information to have in case someone might suggest that something is wrong because labor stalls and that you need to DO something about it. Labor takes time and patience. If you are not in active labor yet, leaving is actually an option. (And no, your insurance will not refuse to pay, that is a myth that has been debunked many times over including here.) As long as everyone is safe and healthy, asking for more time to allow your labor to progress without unnecessarily intervening with medicine you might not need is NOT an unreasonable request. Remember to use your B.R.A.I.N (Benefits, Risks, Alternatives, Intuition, & Nothing or Not Now), sometimes that N of NOTHING is important to remember to request!

As your doula, it is my job to know that 6 centimeters is when active labor begins and to help you remember to ask great questions about your care! Getting to 6 cms is typically what takes the longest time, and I help people cope with getting there physically too. I promise I do try not to geek out too much while hanging with clients in labor, but it does happen.

So remember 6 centimeters is when active labor begins!