Tag: birth geek

3 Reasons to Hire a Doula

There are a million reasons that people hire a doula, and I’m only listing three here. As I have written before, families deserve support and doulas know a few things that can help you along the way. I love winning over the skeptics. I honestly find that many of the partners who were skeptical in the first place become the doula’s biggest fan when they meet us and see us in action. Birth and postpartum can be challenging; doulas are here to help.

1. Personalized Care

When you hire a doula you are getting a pregnancy, birth, and postpartum BFF who knows all kinds of great information and resources to send you. Doulas get to know you and what you want for your birth and the beginning of your life with a new baby. Sometimes you scour the internet and ask in parent groups online only to find conflicting and confusing advice. A doula can help you sift through that information for what you really need, what is evidence-based, and what will help you toward your own personal goals. We know about about pregnancy, birth, and postpartum.

2. Navigation

Navigating the healthcare system is challenging, and doulas can help with that too. When you hire a doula you get a professional person who knows the trail and can help you navigate the twists and turns. We have worked with many of the local providers in Evansville and Owensboro, and I always joke that we know all the stuff on the secret menu too. What I mean is that knowing the right things to request at the hospital can be extra helpful.

3. Zero Judgement

Hiring a doula means you have a completely non-judgemental person with professional support training and zero personal interest, because that is good and important thing. Doulas are there to serve you without agenda. We know our opinion is irrelevant and we are there to serve the birthing person and their partner. So no matter if you are planning to get an epidural as soon as possible, birthing at home with a midwife, or planning a scheduled cesarean, we can help.

Don’t take my word for it…

“Couples often wonder if they should hire a doula. Maybe your friends had wonderful births and didn’t hire a doula, why should you? All I can say is that doulas are like guides for the trek of labor. They know the landscape, are familiar with the people, sights, and sounds, and know special tricks that just might help you over a peak or through a valley or help facilitate that magical experience that lands firmly in your memory forever. And doulas are there for the whole family. They support partners, too, helping them understand what’s going on, get food, rest, and much needed breaks, and they can also guide partners in better ways to support the laboring parent. You do not have to go it alone. There are others who have trekked before you and know the way. Ask them for help.” (Transformed by Birth by Dr. Britta Bushnell, p136)

The path may be well worn, but sometimes having a doula can make it more enjoyable. Hire a doula to help you move around and suggest position changes. Hire a doula so your partner can go to the bathroom without leaving you alone. Maybe everything medical makes your partner nauseous. If you want someone there to go through it all with you, hire a doula. A doula works for you and nobody else, and that can be invaluable on one of the biggest days of your life.

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!