A few weeks ago I was getting my hair done at a new hairdresser. She asked what I do for work and I said I was a birth doula. After I said this, I expected the question that is usually asked next. "Whats that?" Instead, I was pleasantly surprised when she said "Oh I know what that is!"
However as we continued talking I realized she was mistaking a doula for a midwife. This is a very common misunderstanding. Doulas and midwives have vastly different roles, but because most women use an OB for medical care, these roles can sometimes become confusing.
“It's time for a vaginal check.”
“I would like to break your water”
“Let's schedule your induction.”
What do these three phrases have in common? These are all things you might hear from the medical staff during your pregnancy or birth, but all three are missing something of critical importance. CONSENT! These three phrases are worded in such a way that consent is not asked for at all, in fact all three imply that consent has already been given. I've unfortunately been the victim of, and witnessed medical staff talk to women in a way that implies that consent has already been given, when proper informed consent was never actually given at all. What is most shocking to me is how often women undergo treatment, unaware that their fundamental right to informed consent has been violated.
So what is informed consent?
Informed consent is not an abstract idea but it is a legal precedent that has been clearly defined. By law, “A care provider must not provide health care without an adult's consent”. Informed consent practices require your health practitioner to provide the following:
Now lets take a second look at the three phrases that I started this post with. When these statements are made to a woman, it gives her the impression that there is no option, no permission to say no. I've noticed that medical staff choose these words very intentionally, and carefully in order to maintain cooperation within their patients. It's important for birthing women to be aware of this and watch out for it.
Why is informed consent important?
First and foremost, the idea of informed consent is rooted in the dignity and respect of the patient. Informed consent recognizes the basic human right to have autonomy over your own body, as well as parental rights to the healthcare of your children. Birth is an occasion you will remember for the rest of your life, and each pregnancy only has one opportunity to make this memory a good or a bad one. The decisions made during birth will have a lasting effect, not only on the mothers memories but also on the life and well being of herself, her baby, and her entire family.
With the Women's March taking place just a few days ago, and the #metoo movement still trending on social media, sexual abuse is being talked about much more frequently than ever before. One out of every six women is a victim of sexual abuse, and this abuse has lasting effects. For these women, feeling out of control or unable to say no can be a huge trigger. Yet, many do not understand how this can carry over into the birthing space. Lets think about this.. You have a woman, often being cared for by nurses and doctors they have just met, and those medical professionals are not freely giving them the option to say no. Sometimes this happens even when the interventions proposed are involving the most intimate areas of women's bodies, such as vaginal exams. When you think it through, it is easy to imagine how horrific this could make an abuse survivor feel.
I don't believe doctors or nurses do this on purpose. I'm sure things like cervical checks just become routine, and they are unaware of how their actions can make victims feel. However, we need to consider how our words (intentional or not) could affect women, especially victims, during childbearing and birth. Our words matter. Consent matters.
How do I acquire informed consent?
The first step for acquiring informed consent during birth starts when choosing a medical provider and a birthing location. Make sure your birth team knows how important it is to you to play a leading role in your healthcare decisions. Understanding informed consent gives you a leg up in receiving the care and birth you want. Make it a priority to choose a health practitioner who also values your role in making decisions. Secondly, taking a birth class may help you to better prepare for the procedures and interventions that may be proposed during birth. Most birth classes will cover the basic benefits, risks, and alternatives for commonly suggested interventions. Thirdly, it is important that you are ready to ask the right questions when an intervention is proposed. Remember the acronym BRAIN
B- Benefits- What are the benefits to this procedure?
R- Risks- What are the risks to this procedure?
A- Alternatives- What are the alternatives to this procedure?
I- Instinct – What is my instincts telling me?
N- Nothing- What would happen if I do nothing or revisit this procedure at a later time?
By taking a minute to ask the nurse or doctor these questions you are taking the ability to gain informed consent back into your own hands. Another tip I always suggest to parents is to ask for a moment to discuss the procedure in private after they have asked the necessary questions.
For those parents hiring a doula, you should be aware that a doula should never speak on your behalf. However, they can help you to obtain informed consent by reminding you to use the BRAIN acronym, informing you of risks, benefits, and alternatives, and empowering you to speak up about your thoughts and feelings on procedures being proposed. Doula's are a great way to ensure you receive proper informed consent about your birthing choices.
Informed consent is a cornerstone of good medical care. It builds trust between patients and physicians, it empowers parents, and it is a legal right to all. However, oftentimes it's importance is ignored. It's time for mothers and parents everywhere to share their experiences (good and bad), and to take informed consent into their own hands. As consumers, we can influence the degree of consent by the questions we ask, the research we do, and by the voices we have. Hiring your medical staff wisely, educating yourself, asking the right questions, and surrounding yourself with support will help to ensure you are given proper informed consent during pregnancy, birth, and parenting.
It is a common misconception that doulas only work with parents planning an unmedicated birth. This could not be farther from the truth! For parents planning on using an epidural, a doula can still support the family is a number of ways...
In honor of the first day of world doula week, here is a small sampling of some of the families I am honored to have supported! Each family imparts something special and teaches me something new. I'm continually amazed at how unique each birth is. I love what I do.
Happy world doula week! Please leave me a comment telling me how your doula was a benefit to your family. I cant wait to hear!
There really is no right or wrong when it comes to your labor playlist. Listen to whatever makes you happy! Most moms seem to perfer a slower soundtrack during active labor, but in early labor many moms like to get up and dance. Music apps like Spotify and Pandora have even released birthing playlists that feature curated music for laboring moms. If you perfer to make your own soundtrack, here are a few song suggestions to get you started.
Birth affirmations are a powerful tool used during labor. Positive words can help you maintain mindfulness during your pregnancy and seeing those affirmations during labor help to ground you and keep you in control. If you are interested in using birth affirmations during your birth, check out these birth affirmations from around the web. Some contain scriptures, some are geared for natural birth, some are geared for everyday life. Whatever kind of affirmations you are looking for, these should satisfy your need!
Printable Scripture Cards
Tricking the Mind: 20 Printable Mantras to Get Through a Natural, Unmedicated Childbirth
8 Free Printable Birth Affirmations
Affirmations and Becoming Your Own Cheerleader
Free Printable Credit Card Size Positive Affirmations
Inspirational Printable Quotes
Brave Quote Printable
40 Birth Affirmations Cards
11 Printable Birth Affirmations
Pretty Printable Birth Affirmations
Neutral Birth Affirmations
A whopping 80%-90% of women experience some degree of morning sickness. I experienced it with both my children. With one of my pregnancies I suffered through Hyperemesis Gravidarum, AKA the nausea from hell. If you are like the majority of women who are experiencing morning sickness, here are a few survival tips.
As a doula, I attend all types of births. Hospital births, home births, birth center births, inductions, surgical births, births on water, births on land, epidural births, and pain medication free births. I believe that you can have a spectacular birth in any of the above ways. However, if you are wanting a natural birth, here are some tips to help you get there!
1. Get prenatal education
Having some type of prenatal education is SO important! There are tons of different natural childbirth class options. Some favorites are Bradley, Lamaze, Hypnobabies, and Birth Boot Camp. I am trained in the Bradley method and find that its common sense approach to childbirth works beautifully for most of my clients. Not being in the correct mindset and not knowing what to do are the two biggest road blocks when trying to achieve a natural childbirth, and good prenatal education addresses them both. If you are interested in natural childbirth classes, check out my classes page for upcoming dates.
2. Hire a doula
I'm not just saying it because I am a doula, I promise. Science actually backs up the fact that the presence of a doula increases a womans chances of having a spontaneous vaginal birth and decreases her chances of using pain medications. How does a doula do all of that? Well since she is a trained childbirth expert, she takes the weight of birth from you and your partners shoulders. You can rest assured that your doula is going to take care of all the little details and help keep you informed about all of your options. She can translate the medical jargon your doctor may use into words that you and your partner can actually understand. Your doula knows millions of tips and tricks for optimal positioning, speeding labor, and keeping you comfortable. Her presence increases your self esteem, and decreases anxiety, which makes for shorter, easier labors, that are more likely to be free of interventions and pain medications.
3. Hire a good care provider, and pick a good birthing location
Your birth team can make or break your birth experience, and I dont just mean your personal support. Your medical team makes a huge difference as well. Some hospitals have ammenities that significantly help with pain management, such as tubs or showers for hydrotherapy. Some routine procedures can make a huge difference as well. Consider heart rate monitoring, does your hospital require constant, or intermittent monitoring? Do they have wireless monitor options? The most common heart rate monitors used are made of 2 large belts that go across your belly. Not exactly the most comfortable during contractions (I bet a man invented them...). If your hospital prefers constant monitoring, this can severeley limit the postions you can labor in, because in some positions its hard to hear the baby. Another common rule that can really help or hinder natural birth, is eating during labor. Without a little bit of nutrients, moms can run out of energy during a long labor. Some providers and nurses are also more "natural friendly" than others. Do some research and ask your friends and doula for their experiences and reccomendations. Remember that its never too late to switch providers. If your provider doesnt see eye to eye with you during pregnancy, you shouldn't expect for that to change during birth.
4. Aim for low interventions
Some interventions are medically needed and unavoidable, but the majority of interventions are done for mother or provider comfort. Many interventions can unknowingly add to the pain level of labor. For instance, artifical rupture of membranes (letting the doctor break your water rather than it breaking on its own) can cause a lot of extra pain during labor, but this is rarely mentioned! Think about it, your baby is surrounded by a cushion of boyant water that is pressing on your cervix evenly during contractions. Take that away and instead your babies head is pressing on your cervix. This can also cause the baby to get stuck in a bad position, because they dont have the bag of water surrounding them allowing them to easily change positions. A non optimal position can cause extra pain and back labor. This can also cause your cervix to dialate unevenly, because the babies head is not placing pressure evenly on your cervix.
5. Spend early labor at home
Early labor can sometimes be a long, long process. Most moms are most comfortable spending it at home. At home, you can lounge in your favorite clothes, you can eat and drink whatever and whenever you want, you can take a bath or a shower, or even an uninterupped nap. You can watch your favorite movie or blast your music up loud if you want. At the hospital you are generally hooked up to some monitors, a nurse is checking on you regularly, and they just dont have all of the comforts of home. Early labor can seem so much longer when you are not in your own comfortable space. This can lead to more stress, more pain, and more suggestions for interventions (most commonly to speed things along). Especially for first time moms, there is usually plenty of time to get to a hospital, and your doula can help you decide when it's really time to go.
6. Take it one contraction at a time
Instead of thinking of labor as this long marathon event, just focus on what you can do to get through this one single contraction. We dont know how long labor will take, so dont waste your energy fretting over it. Just accept that it is a process and that your body knows exactly what it is supposed to be doing. If you focus on labor one bite size piece at a time, it's a lot easier to manage than thinking about all the hours you may or may not have left to go. Contractions during active labor are generally 60-90 seconds long. Think about what you can do to get through the next 60 seconds and do that. You can do anything for 60 seconds. :)
I've joined The Coop! The Coop is a co-working space for women right in the heart of downtown Norman. I am so excited about this new venture and you should be too!
What this means for my clients:
Sooner State Doula
317 E. Main Street
Norman OK 73069
A day with a newborn doesn't have to be hectic and tiring, as it is often depicted. New moms can be confident, efficient, and prepared, if they have the right help! That's where a postpartum doula comes in. But what does a postpartum doula really do? Well, lets take a look at an average day.
8:00 AM: My husband wakes me up as he leaves for work. Geez I'm tired.. The baby was up probably a million times last night. It seems like no matter what he is just not content. I remember that the doula is coming by at 9 and feel much better. I guess I should take advantage of the sleep while I can!
9:00 AM I wake up to a soft knock on the door. Yay! The doula is here! I roll out of bed and answer the door in my PJ's. My doula wont judge me, and I know that. I tell her about our broken sleep last night and she lets me know the baby is going through a growth spurt. Oh duh! that's why he's eating 24/7. I feel so much better now that my doula has assured me my baby is acting normally and it will soon go away. The doula says I should go take a shower and she will take care of the baby.
10:00 AM I take a hot, long, relaxing shower. I even take time to shave my legs, which hasn't happened since probably the second trimester. My belly was so big I couldn't reach! I go into the kitchen and am greeted by the smell of bacon. Now this is how I want to start everyday! On the table, there is a plate of scrambled eggs and bacon waiting for me. The doula has the baby in the sling and he is happy and content. The dishwasher is unloaded and I hear the laundry going. How does she do it?
10:15 AM I gobble up my breakfast while the doula sets me up a nursing area. She grabbed some water, a snack, the TV remote, phone charger, and the book I'm reading. I get settled on the couch and she hands me the baby who is starting to get hungry. We talk about my plans and goals for the day. She explains that her goal is to work herself out of a job. She is going to lay the foundation and equip us to be the best parents we can. We set a goal of one chore per day, to keep me feeling accomplished and productive, and one outing a week, to keep me sane. She notices that I hold a lot of tension in my shoulders while I'm nursing and helps to correct my position. Wow! That's much more comfortable!
10:45 AM We talk a little bit about my labor and delivery and my postpartum doula listens as I admit I really wasn't all that happy with the birth. She doesn't tell me "well you have a healthy baby!" Or "You should have done this or that." She just listens and holds space for me to work through my feelings. As the baby finishes up, we hear a large PBBBBBHHHTTTT. Oh great.. another poopy diaper. My doula offers to change the diaper which I happily accept. I changed 4 poopy diapers yesterday and am glad for a break.
11:00 AM The doula returns with my baby, he is in a new outfit. She explains that he got some poop on his clothes and the changing table, but how in the world did she change him without any screaming?? And why isn't she covered in poop? I always manage to get it all over myself. She sets up a blanket for tummy time and shows me how to get on the ground and talk to him, so he likes it more. While I admire my happy, clean, and cute baby, she throws the poopy stuff in the washer.
11:30 AM Time for a little nap. The doula shows me a trick for swaddling the baby and settles us into bed as she goes to make us some lunch.
12:30 PM My husband arrives home for lunch just as we are getting up. We sit down to eat as the doula takes the baby so I can enjoy a hot meal with two hands for once. This is so nice, I never want her to leave! When we finish, the baby starts to get hungry. My husband really wants to give him a bottle of pumped milk. I'm a little nervous about nipple confusion and bottle preference, but the doula let's me know she will teach us the proper way to bottle feed, so that our breastfeeding relationship isn't compromised. I relax as she instructs my husband on how to pace bottle feed and the baby happily drinks his bottle. My husband kisses me goodbye and is back to work.
1:00 PM The doulas shift is coming to a close but I'm feeling confident and relaxed. She reminds me of my chore goal for today and I'm able to get it done quickly and easily as the baby naps in the swing. This parenting thing is easy! Why was I so nervous? My doula lets me know she does overnight care as well, which could really help during the growth spurt. She says she will bring the baby to me when he is hungry, then when he is done nursing she will take him back to the nursery to change his diaper and get him back to sleep. I never even have to leave my bed! I schedule her to come over tomorrow night. Sounds like just what I need! As the doula leaves I realize that I feel renewed, and energized. I'm ready to tackle the rest of the day.
To schedule a shift with a postpartum doula, contact Miranda at firstname.lastname@example.org
Miranda is a birth and postpartum doula serving the central Oklahoma area.