Friday, May 24, 2013

What are the Benefits of Having a Doula

"If a doula were a drug, it would be unethical not to use it.". 
                                 ~John H. Kennell, MD

In my last post I explained a bit of what a doula does, for this post I wanted to show some benefits in having a doula at your birth; whether you birth in a hospital, in a birthing center, or at home. Mothers giving birth vaginally as well as via c-section both benefit from having a doula at their birth. 

Let's get right to the statistics:

Doulas reduce the labor time, reduce the need for medication, and reduce the need for cesarean. Plus, there is the added bonus of a women there to support you.
Studies have also shown:
  • 50% reduction in cesarean birth
  • 30% reduction in requests for pain medication
  • 60% fewer requests for epidural anesthesia
  • 25% decrease in the length of labor
  • 30% decrease in use of Pitocin
  • Reduction of medical cost
  • Increased breastfeeding success
  • Greater overall satisfaction
Source: Klaus, Kennell, and Klaus, Mothering the Mother, New York, Addison-Wesley, 1993.

Numerous clinical studies have found that a doula’s presence at birth
  • tends to result in shorter labors with fewer complications
  • reduces negative feelings about one’s childbirth experience
  • reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans
  • reduces the mother’s request for pain medication and/or epidurals
Research shows parents who receive support can:

  • Feel more secure and cared for
  • Are more successful in adapting to new family dynamics
  • Have greater success with breastfeeding
  • Have greater self-confidence
  • Have less postpartum depression
  • Partner's have more confidence in their ability to assist in the birth.
Suggested Reading: The Doula Book Klaus, Kennell and Klause

If you are pregnant I would be honored to speak with you further on the benefits of having a doula at your birth.

Thursday, May 23, 2013

What Does a Doula Do?

The majority of my friends are excited that I'm in the process of becoming a doula, but the majority of them have no idea what a doula is or what it is that I'll be doing as a doula.

One friend wants me to be her doula to "deliver her baby"
Doulas don't do that.

Another said she'd like me there to help her talk to the doctors.
Doulas don't do that either.

And yet another wants me there to help her figure out what to do.
Doulas don't really do that either.

So what, exactly, does a doula do?

A doula is a non-medical support person for the laboring woman and her partner. Because a doula is a "non medical" she cannot prescribe or recommend medications or interventions. She also cannot help in any aspect of the birth (delivering the baby, handing surgical tools to the OB). She's there solely as a support to the mother and her partner.

A doula is professional trained in childbirth and provides emotional, physical and informational support to the mother who is expecting, is experiencing labor, or has recently given birth. The doula’s purpose is to help women have a safe, memorable and empowering birthing experience.

A doula recognizes birth as a key experience the mother will remember all her life. She facilitates communication between the laboring woman, her partner and her clinical care providers

A doula will show support by looking into a woman's eyes while she's having contractions, matching her breathing to the mothers'. A doula will offer massage, aromatherapy, essential oil therapy, or simply hold and stroke the hand of the mother.

A doula will work with the couple or mother during prenatal appointments to help craft a Birth Vision (Birth Plan)

A doula encourages and supports the partner, allowing them to break for naps and stays with the mother during those times.

A doula helps the couple understand various comfort measures and teaches the partner how to do them with the laboring woman.

A doula is encouraging and comforting.

A doula informs the expecting parents on all aspects of birth, labor and encourages the couple to learn about medical interventions and assess which interventions the couple is comfortable with.

A doula is patient, sincere, kind and compassionate.

When labor can last anywhere from 12-48 hours (and sometimes longer!) A doula provides constant and uninterrupted support if only through tender touch.

Tuesday, May 14, 2013

Study Finds Adverse Effects of Pitocin in New Borns

Cross-posted from The American College of Obstetrics and Gynecology

New Orleans, LA -- Induction and augmentation of labor with the hormone oxytocin may not be as safe for full-term newborns as previously believed, according to research presented today at the Annual Clinical Meeting of The American College of Obstetricians and Gynecologists. Researchers say this is the first study of its kind to present data on the adverse effects of Pitocin use on newborns.
Given intravenously, Pitocin (a brand of oxytocin), is often used to start labor when a pregnant woman is overdue. It is also used to keep a lagging labor going by increasing the frequency, duration, and intensity of uterine contractions.
Primary Investigator Michael S. Tsimis, MD, and fellow researchers at Beth Israel Medical Center in New York City, conducted a retrospective analysis of deliveries that were induced or augmented with oxytocin. The study included more than 3,000 women delivering full-term infants from 2009 to 2011. The researchers used the Adverse Outcome Index, one of several tools used to measure unexpected outcomes in the perinatal setting and to track obstetric illness and death rates.
Keep Reading

I believe that every mother's birthing choices, whether she delivers vaginally via c-section, in a hospital, at home or a birthing center should have her choices validated. I also think it's vitally important to learn about the risks and benefits of any intervention.

Monday, May 13, 2013

Vaginal Birth and Preemies

Pregnant woman holds her stomach
Pregnant woman holds her stomach ( Ian Waldie, Getty Images / February 11, 2013)
From the Chicago Tribune

by Genevra Pittman

NEW YORK (Reuters Health) - Very premature babies have fewer breathing problems when they're born through vaginal delivery compared to cesarean section, a new study of more than 20,000 newborns suggests.

Based on those cases, researchers found that regardless of why a C-section was performed - whether because of pregnancy-related complications or the mother's medical problems, for example - vaginal delivery tended to be safer.

"My suspicion is that the labor process, the contractions, that natural squeezing probably does something to clear out the lungs so that when babies are born they have a better breathing status," said Dr. Erika Werner, who led the new study at Johns Hopkins School of Medicine in Baltimore.

"If a vaginal delivery is safe, it's something that should be attempted," she said.

Keep Reading

It is interesting to note that some children born by c-section also have problems breathing when they are born or when they get older. The beauty of labor is that every stage has a function. When the baby moved from the uterus through the cervix and into the birth canal its body is squeezed, helping the delicate longs extract the amniotic fluid and prepare for breathing oxygen through the air.

Friday, May 10, 2013

Are you on Facebook?

I am! Please be sure to go to my page and share your birth stories, tips and pictures. Be sure to share my page with your friends as well.

Shabbat Shalom and blessings for a wonderful weekend.

Thursday, May 9, 2013

Essential Oils for Pregnancy and Birth

Last night I several doulas, massage therapists, midwives, nurses and birthing and lactation consultants at a wonderful event in Manhattan on essential oils. I've got to say, I never gave much thought to ways in which scents, aromatherapy could help a pregnant and laboring woman other than to lift her spirits  to relax her, to calm her. Learning about the healing properties of essential oils was really wonderful and informative. I cant' wait to learn more and incorporate them into my practice.
Be sure to read this article from Doula Training International, Essential Oils 101 for Doulas and Mothers

Wednesday, May 8, 2013

Is a Doula Right for You?

The word doula is a Greek word meaning women’s servant.Women have been serving other women in childbirth for many centuries and have proven that support from another woman has a positive impact on the labor process.
My husband, wife, partner is my left hand and my doula is my right.- adapted from Doulas Making a Difference
A doula is a professional trained in childbirth who provides emotional,physical and informational support to the mother who is expecting, is experiencing labor, or has recently given birth. The doula’s purpose is to help women have a safe, memorable and empowering birthing experience.

Most often the term doula refers to the birth doula, or labor support companion. However, there are also antepartum doulas and postpartum doulas. Most of the following information relates to the labor doula. Doulas can also be referred to as labor companions, labor support specialists,labor support professionals, birth assistants or labor assistants.

Most doula-client relationships begin a few months before the baby is due.During this period, they develop a relationship where the mother feels freeto ask questions, express her fears and concerns, and takes an active role in creating a birth plan, or birth intention. Most doulas make themselves available to the mother by phone in order to respond to her questions or explain any developments that might arise during the course of the pregnancy. Doulas do not provide any type of medical care. However, they are knowledgeable in many medical aspects of labor and delivery. Many doulas are trained in massage, as herbalist, acupressure  and yoga-all of which can be helpful to a mother. Consequently, they can help their clients gain a better understanding of the procedures and possible complications of late pregnancy or delivery.

During delivery, doulas are in constant and close proximity to the mother.They have the ability to provide comfort with pain relief techniques that include breathing techniques, relaxation techniques, massage, and laboring positions. Doulas also encourage participation from the partner and offer reassurance. A doula acts as an advocate for the mother, encouraging and helping her fulfill specific desires that she might have for her birth.The goal of a doula is to help the mother experience a positive and safe birth, whether an un-medicated birth or cesarean.

After the birth, many labor doulas will spend some time helping mothers begin the breastfeeding process and encouraging bonding between the new baby and other family members.
Numerous studies have documented the benefits of having a doula present during labor. A recent Cochrane Review, Continuous Support for Women During Childbirth, showed a very high number of positive birth outcomes when a doula was present. With the support of a doula, women were less likely to have pain relief medications administered, less likely to have a cesarean birth, and reported having a more positive childbirth experience.

Other studies have shown that having a doula as a member of the birth team decreases the overall cesarean rate by 50%, the length of labor by 25%,the use of oxytocin by 40% and requests for an epidural by 60%.
Doulas often use the power of touch and massage to reduce stress and anxiety during labor. According to physicians Marshal Klaus and John Kennell, massage helps stimulate the production of natural oxytocin. The pituitary gland secretes natural oxytocin to the bloodstream, causing uterine contractions,and to the brain, resulting in a feelings of well being, drowsiness and higher pain threshold. By contrast, because synthetic IV oxytocin cannot cross into both the blood stream and the brain, it increases contractions without the positive psychological benefits of natural oxytocin.

The role of the doula is never to take the place of wives, husbands, partners, or selected support people in labor, but to compliment and enhance their experience. Today, more wives, husbands and partners are an active role in the birth process. However, some partners prefer to enjoy the delivery without having to stand in as the labor coach. By having a doula as a part of the birth team, a father, wife or partner is free to do whatever they choose. Doulas can encourage the father, wife or partner to use comfort measures and can step in if they want a break. Having a doula allows the father, wife or partner to support their partner emotionally during labor and birth and to also enjoy the experience without the added pressure of trying to remember everything learned in childbirth class!

The presence of a doula can be beneficial no matter what type of birth you are planning. Many women report needing fewer interventions when they have a doula. But be aware that the primary role of the doula is to help mothers have a safe and pleasant birth–not to help them choose the type of birth. For women who have decided to have a medicated birth, the doula will provide emotional support, informational support and comfort measures through labor and the administration of medications. Doulas work alongside medicated mothers to help them deal with possible side effects and other needs where medication might be inadquate, because even with medication,there is likely to be some degree of discomfort.

For a mother facing a cesarean, a doula can be helpful by providing constant support and encouragement. Often a cesarean results from an unexpected situation leaving mothers feeling unprepared, disappointed and lonely. A doula can be attentive to mothers at all times throughout the cesarean, letting them know what is going on throughout the procedure. This can free the partner to attend to the baby and accompany the newborn to the nursery if there are complications.

There are three types of doulas: the Antepartum Doula, the Labor Doula and the Postpartum Doula:
Antepartum Doulas provide help and support to a mother who has been put on bed rest or is experiencing a high risk-pregnancy. They provide informational, emotional, physical and practical support in circumstances that are often stressful, confusing and emotionally draining.

Postpartum Doulas provide help and support in the first weeks after becoming a mother. They provide informational support about feeding and caring for the baby. They provide physical support by cleaning,cooking meals and filling in when a new mother needs a break. They provide emotional support by encouraging a mother during those times when she might be feeling overwhelmed.
Some doulas have training in more than one area and are able to serve as more than one type of doula.
The most important thing in choosing a doula is to find a person with whom you feel comfortable and who gives you confidence. Most doulas do not charge for an initial consultation and interview, so take the time to interview as many as necessary until you one that meets your needs. 

Questions to Ask a Potential Doula:
  • What training have you had?
  • What services do you provide?
  • What are your fees?
  • Are you available for my due date?
  • What made you become a doula?
  • What is your philosophy regarding childbirth?
  • Would you be available to meet with me beforethe birth to discuss my birth plan?
  • What happens if for some reason you are not available at the time of my birth?
Adapted from The American Pregnancy Association to be more inclusive to LGBTQ families and single mothers.

Monday, May 6, 2013


Hello and welcome to Kavanah Doula-Birthing with Intention. My name is Erika and you can find out a bit about who I am in the "About" section. I wanted to take this space to explain how and why I decided to become a doula. Of course, it all started with the movie The Business of Being Born.

Like many women who grew up in the 90s I watched television shows like A Baby Story on TLC. I watched in awe, shock and sometimes horror as women were often wheeled into ORs screaming, tied down to stretchers and hooked up to IVs and breathing machines.

I was confident that when I gave birth, I would schedule the day and time walk in looking amazing and walk out looking amazing- albeit a little sore, with a perfectly round-headed child and a large scar. That was, until I actually saw a cesarean section in high school.

My cousin is an anesthesiologist and I shadowed her for a week as part of my senior project. I spent a day with her colleagues in labor and delivery where I didn't see any vaginal births, but one c-section. The patient was an black, French-speaking woman probably in her 20s. She spoke little English and the doctors and nurses spoke little French. She didn't have family or support with her and I held her hand as she got her epidural (not administered by my cousin).

I watched as the doctor clamped her skin. I heard her scream in pain-the epidural didn't work. I held her hand again as she got another epidural and I watched as the doctor cut open her mid-section and drew out her child. When the baby was born I went over to where the nurses were cleaning her and cooed at her little new born face.

Fast forward about fifteen years and my views on childbirth have drastically changed. My partner and I are currently TTC and we'd like a home birth. Through movies like The Business of Being Born and reading everything by Ina May Gaskin I've learned that birth and the birthing process need not be frightening, scary or medical. That birth can be a beautiful, spiritual and rewarding time. That birth, in the hands of capable midwives and doulas, is the way that birth has always been in our country up until about 30 years ago.

I also realize that sometimes doctors are necessary and that women can and should chose to have any type of birth they want.

I'm in the process of completing my doula training. Once complete I will be a birth doula as well as a postpartum doula with infant CPR certification and lactation experience.

If you or someone you know is expecting, first-b'sha'ah tovah! Second, I would love to be your doula.

Many blessings,