Thinking about a birth doula for the big day?

Many families ask me the following questions about choosing a birth doula: Do we need one? How do we pick one? And who do you recommend?  I suppose as we are a postpartum doula group that doesn’t offer labor support, we are in the category of being fans without being biased towards our own offerings.

Here are some of my guidelines for answering the birth doula questions:

Do we need one?

The biggest question here is what you really want from your birth. Are you birthing at home, in a birth center, or in a hospital?

Homebirth and birth center midwives often have assistants or apprentices that can sometimes act as your doula and many of them do births in teams, so a labor doula isn’t always needed. However, some of them welcome doulas at the birth and appreciate the emotional support that doulas can provide as they care for more of the physical/clinical concerns around the birth.
If you birth in the hospital, even though you often have one nurse assigned to one patient during labor, the role of a nurse and a doula are very different. Nurses used to provide many aspects of doula care, but now their time is buried between charting, running all the equipment used in a hospital birth, and carrying out the orders from the doctors or midwives. Certainly nurses can be a huge source of emotional support, but their work also runs in 12 hour shifts, and you are likely to get a few different nurses during your labor process—this usually is not a good continuum of care for the laboring mother.

Do you have women in your family that have experienced birth who can be present with you to meet your needs during labor? Sometimes mothers, sisters, and other female relatives or friends can be great doulas, trained or not. It is important that they know your desires for your birth and are operating on your agenda, not their past experiences or biases.

The main reason I see a lot of women hiring birth doulas is to avoid some of the interventions that make birth more difficult and often surgical. Yes, the Cesarean rate is still way too high by anthropological standards (over 30% in some hospitals in PDX) and having a doula at your birth reduces the chance of a cesarean by 50%. It also reduces many other often unnecessary interventions. Unless you have the doula role covered by other professionals (not your doctor or midwife, they rarely will sit with you throughout labor) or other family members/friends who you confidently feel can meet your needs in a calm way, I would recommend you look into getting a birth doula. I have had one birth with a doula, and one birth without a doula, and I will tell you it does make a big difference!

How do I pick one?

Here again, the question to you is: what do you want from your birth? Are you looking for a medication/intervention free birth? Do you have a Cesarean planned where your partner might be torn in different directions as you and the baby could be separated after surgery? Are you looking to delay an epidural for as long as possible? Are there concerns about your family members wanting to help but your gut tells you that they might not be the best person for the job?

All of these are great reasons to have a birth doula, but I would recommend different people based on the circumstances!

The beauty of the doula is that she should be there for you. Your needs/desires should be at the top of her list. If your doula has an agenda about “saving birth” or “changing the system,” you also need to feel strongly about this before going into labor as you don’t want to be caught in the middle of a conflict between your healthcare team and your doula.
The best recommendation I have for choosing a doula is to talk to several on the phone, get a feel for their care, and then interview at least 3. You should follow your instincts when making decisions about who to have at your birth. You will likely be naked with this person, and make funny sounds and have this strange primal behavior—you need to feel VERY comfortable with whomever you chose. If you have a twinge of hesitation, move on. There are hundreds of birth doulas just in the Portland, Ore. area, and you are bound to find one that meets your needs perfectly.

Do you want a student doula (one with less experience but also charges little to nothing) or an experienced doula (where the fees can range from $300 to $800, depending on the package that your doula has to offer)?

Is this your first birth? I would probably recommend an experienced doula that can reassure you when you have questions (as there are MANY the first time around). If this is a subsequent birth, then it depends on your first experience and what you are looking for this time. The studies on doulas report that having a woman quietly staying with you throughout labor can reduce interventions and empower you in many ways, even when she doesn’t have a bag full of tricks that help you cope with labor and work together with your partner. I have met many women who want to be “good patients” who prefer to follow what the doctor decides about their birth. These women would benefit from a quiet doula that can help fill in the gaps of knowledge when the primary caregiver is busy doing other things.

Families who are looking for more of an advocate to their care will want a doula with a lot of experience, a strong knowledge base, and a good ability to read you in stressful situations.

And finally, whom do I recommend?

Yes, I do have a favorites list, but even within that list, there are variations based on the client’s needs. And there are so many wonderful doulas that aren’t listed as well. I would probably recommend looking at http://bsnnorthwest.org/ first for their list of caring doulas. There are many doulas listed there who have received rave reviews for the past several years and some new doulas who are getting involved with the community of birth supporters and can offer services for low or no cost.

You can also contact http://www.birthingway.edu and look for their list of trained and/or certified birth doulas, as they are a local midwifery college and have a long list of women looking to do births at low cost for experience. Many women check out http://www.dona.org, http://www.cappa.net, or http://www.icea.org to find their list of certified or trained doulas. This does insure that your doula has gone through the initial training requirements, but these are often overwhelming lists to work from with the numerous options.

Most women tell me that their birth doula was invaluable during their birth. I have heard a few stories reporting otherwise though, and I would want to caution you against compromising your goals.  Also make sure to budget for help after the baby arrives. Many women tell me that the help of a lactation consultant, postpartum doula, home-chef or a postpartum massage was as helpful, or even more helpful, as the services a birth doula provides.

I hope this has helped you figure out what would be best for you as you plan for your birth. As I am certainly a fan of birth doulas, I hope you find someone who is a perfect fit for you and that you have a great birth! Birth and early postpartum is a time that women remember for the rest of their lives, so it pays to have really wonderful people surrounding you to help you make the best memories!

Swaddling seems not to be mentioned, although we know as long as the blanket isn't loose it is usually recommended.

The updated guidelines from the AAP have just been released on safe sleep for babies. Some important changes are:

• Breastfeeding is recommended and is associated with a reduced risk of SIDS.
• Infants should be immunized. Evidence suggests that immunization reduces the risk of SIDS by 50 percent.
• Bumper pads should not be used in cribs. There is no evidence that bumper pads prevent injuries, and there is a potential risk of suffocation, strangulation or entrapment.

Here are the other recommendations:

• Always place your baby on his or her back for every sleep time.
• Always use a firm sleep surface. Car seats and other sitting devices are not recommended for routine sleep.
• The baby should sleep in the same room as the parents, but not in the same bed (room-sharing without bed-sharing).
• Keep soft objects or loose bedding out of the crib. This includes pillows, blankets, and bumper pads.
• Wedges and positioners should not be used.
• Pregnant woman should receive regular prenatal care.
• Don’t smoke during pregnancy or after birth.
• Breastfeeding is recommended.
• Offer a pacifier at nap time and bedtime.
• Avoid covering the infant’s head or overheating.
• Do not use home monitors or commercial devices marketed to reduce the risk of SIDS.
• Infants should receive all recommended vaccinations.
• Supervised, awake tummy time is recommended daily to facilitate development and minimize the occurrence of positional plagiocephaly (flat heads).

Source: http://www.healthychildren.org/English/News/pages/AAP-Expands-Guidelines-for-Infant-Sleep-Safety-and-SIDS-Risk-Reduction.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token

• Feed, burp, and allow your baby to have a change before trying them on their tummy.
• If you baby has reflux, keep them upright 20 min before giving it a try.
• Try taking off the baby’s pants and diaper, laying them on a clean diaper or towel. They WILL PEE. Trust me. (This is the best trick I have seen yet. Not sure why nudity helps, but it really does!)
• Use a bolster (like the one shown) to keep their bodies more lifted. It will help keep their face off the floor and allow them more mobility and view.
• Try an unbreakable mirror under their line of sight so they can see their curious little face.
• Place art cards or black and white images near them to focus on.
• Get down on the floor and put your face close to theirs, encouraging them.

Ok, now off you go to try this! Better naps await!

For some mamas this is a luxury that they never get to enjoy...a simple daytime nap to grab a bit more rest in that exhausting newborn period.

I laid awake a lot last night. It was the night before my lactation exam–that I have been preparing for now some 7 years–and I was pretty anxious. Normally I have the luxury of having my head hit the pillow and sleep just comes. Sometimes within seconds. But last night, hour after hour, I sat there and stared at the ceiling fan.

I am sure I did sleep a little, as I somehow got through the test and didn’t fall asleep on my answer sheet, but I think I watched each hour go by. This is so new to me, but what a compassion builder. It made me realize how many mamas are dealing with this night after night. Lying there when baby has finally gone to sleep, and yet…sleep doesn’t come (or comes at a struggle).

Did you know that anxiety is a major cause of insomnia in the postpartum mother? That many moms find it challenging to go back to sleep, even with the baby is finally ready for some slumber?

We work with many moms who find it hard to nap as well. Even when their doula is magically keeping baby happy while doing dishes, laundry or meal prep, mamas tell us they just can’t seem to let go and actually drift off to sleep.

While this isn’t always anxiety, and certainly not necessarily postpartum anxiety that would need some kind of treatment, it is still a hurdle that mamas have to tackle. We do know that mamas who take more than 25 min to fall back to sleep are more likley to have some kind of postpartum mood disorder (and I tell you this to help you assess yourself…not to make you feel guilty or make yourself more anxious!).

 Here are some signs that our bodies might be experiencing some postpartum anxiety (from www.postpartum.net):

Constant worry
Feeling that something bad is going to happen
Racing thoughts
Disturbances of sleep and appetite
Inability to sit still
Physical symptoms like dizziness, hot flashes, and nausea

Just thought it was worth sharing how sleep neglected we can get, and how much a body can take…for awhile. Eventually our body starts to show signs of not getting enough sleep. These show up in a myriad of ways, but none of them very pretty (or easy on our relationships).

So if you are one of the many mamas who do your share of staring at the ceiling fan…think about assessing yourself. Do you feel like your old self (except now with a baby)? Do you feel like you can never let down and relax? Think you might be experiencing more than just the new mama exhaustion?

Just some food for thought. Now I am going to bed (test is over and the anxiety left with it!).

A 30 week preemie enjoys some skin to skin time with his mama in the Second Skin Sling.

I am attending the CAPPA 2011 conference this weekend in Valencia, CA and we learned so much today about the science of attachment from Robin Grille and Laurel Wilson. (I am actually so thankful my family got to join me on this trip as I need to snuggle them every few hours after talking about bonding all day long!)
I had to share this photo today because it symbolizes so much how much a mother can give. A demonstration of my new favorite sling (now called the “Second Skin Sling” www.secondskinsling.com) with a 4 lb preemie doing skin to skin care with his mama. I love the look of bliss on his face, and the obvious joy and pride the mama is illustrating as well.
This work we do as childbirth and postnatal educators, doulas and other birth support workers is so precious. Investing in families when they are just beginning (or just growing!) is such a privilege. I am so grateful for the opportunity.
Conference time celebrates our work in such a fun and supportive way, but tonight I am feeling very grateful for the chance to do this work. Thanks to all of you who allow me into your lives for a season. Can one do a higher work than facilitating bonding?
What a joy for me to see this example of a Mother’s love on a day when we heard about the value of their attachment.

If you are jealous of babies being carried so close, try being cradled in a sling chair.

Over the years as I have snuggled so many of my clients babies in slings, pouches and wraps, I sometimes wondered if there was adult equivalent. I think I have finally found it! Last year at Costco I came across a magical chair the kids now call the swing chair, but I think of it as the sling chair.
Green Mountain Hammocks makes this amazing product they call a string chair and after installing one on our deck, we had to have 2. I had to have one for me, and the kids needed one of their own. (And of course when I am not there, they each need one or the fighting is not much fun…)
Even though I happen to have a sweet baby in this photo, make no mistake: although the chair is nice to hold babies in, this is much more for the adults who want a womb like experience themselves. This feels to me like being carried in a sling, supported effortlessly with just the subtle shifting of the wind or body movements keeping you moving. It even wraps around you (although not in a claustrophobic way) and supports your body out to your feet for relaxing those hardworking parenting legs after hours of walking your baby.
When was a nursing mama, we had an air chair that was wonderful for coming home after work and snuggling my nursling (and admittedly I spent many early evenings catching a power nap in mine!). Green Mountain makes one of those too, as do many others online. But I haven’t seen another string chair quite like this one, hence the above link for this great company. (Costco sells them for less of course, but finding them might be challenging.)
So if you as a grown up have ever wanted to crawl into a sling and make the world go away, I recommend checking these out.

For all the coming spring and summer babies (or the tiny ones already here!), I have a new product that is worth a look. One of my favorite companies Precious Image Creations has just released a new product that I LOVE. It is called the Double Sling Wrap, and it is the easiest product to use I have ever seen for holding babies skin to skin.

Yes, you can! There are few safe ways to wear a 5 point harness and still keep your baby swaddled for a happy transit from point to point. As much I hate the current car seat safety equipment (when will they invent a womb like bubble to keep the baby moving and cushioned from every angle at every possible moment???) I do like this adaptation of the ever popular swaddle for newborns.

Setting up the "bat wings" blanket wrap inside the straps before the baby is put in is key.

 If you can set up ahead of time it is the easiest. Take a thin cotton blanket–it can be stretchy or just thin flannel, but the key is to use something not bulky. (If you use the ‘bat wings’ swaddle or ‘diaper swaddle’ that we teach in our baby care classes and moms groups, this is just another way to use this approach.)

Lay the blanket on the bias (usually in a triangle) and then fold up the bottom tip so it doesn’t interfere with the buckle. Then tuck each ‘wing’ under the straps and put the baby in. Once baby is properly fastened in (no pinch on the belting or you need to tighten more) then you can wrap the blanket around the arms.

As with swaddling, do each arm separately and adjust the position for the maturity of the baby (i.e. preemies get bent arms, very new babies get their hands up so we can see feeding cues, ‘Houdini’ older babies get arms straighter down). The finished product might look something like this:

Happy baby wrapped in car seat swaddle and ready to go! (Just needs some socks...)

There should not be a lot of thickness of material between the baby and the car seat itself. This could cause problems in an accident, so it is important to dress baby modestly and layer over the straps and swaddle for temp control.

Moms have reported at moms group that this technique is a lifesaver for being in traffic and not being able to attend to their babies. Until they invent a new system, it seems worth a try for babies who don’t magically go to sleep as soon as they are in the car and moving.
I hope this is a handy hint to send to your friends who have unhappy car travelers. I had one too, and I sure wish I would have figured this out a few years ago so we could have tried it with her!

Yep, I said it again. Placenta. I am getting more used to using that word all the time. And this week I learned something I didn’t know (but should have).
In my quest to help mothers meet their breastfeeding goals, I am asked weekly if not daily how to make more milk. I also recently trained a new bunch of doulas and had 2 women present who were encapsulation specialists. That means they dehydrate placenta, pulverize it, and put the powder into capsules for women to ingest over the first several weeks after they deliver.