Friday, November 30, 2012

Confessions of a doula who....

...doesn't like Call the Midwife. I tried everybody.  I tried really hard. But there are so very few "period" dramas I like. That era, the language. None of it speaks to me or moves me. I just don't get into it. I feel like I betrayed my sisters. :-(

Tell me I'm not alone in my guilt. Although I suspect there are very, very few who can. It's a great hit. I'm happy that it is too. Very happy to see anything midwifery related be portrayed in a positive and realistic manner. Now if we can only get one done set in this century. That would be great!

Monday, November 26, 2012

If I'm getting an epidural why would I need a childbirth class?

How many of us doulas, midwives, and educators have heard this question asked. Sometimes it's not just asked, it's a statement: I'm getting an epidural, I don't need a childbirth class.  Either way, it's not entirely true is it?  Allow me to outline some points that may shed light on the subject:

1. You may not get an epidural:  Now before you get riled up thinking I'm trying to talk you out of it that's not what I mean. What I mean is that labor can be very unpredictable. You may have a fast labor or what we sometimes call a precipitous labor, in which there is actually no time to get the epidural placed before the baby is born. Another scenario is that you may be surprised by how manageable your labor is, opting to labor at home until the you feel the need to go to the hospital. And then your labor may pick up quickly, leaving you no time to get your epidural placed.  In both instances, having knowledge of what's going on, how to deal with it, and tools to manage your stages of labor can be taught in a good, independent childbirth class.

2. The anesthesiologist may be unavailable:  Many women request an epidural early in their labor and others wait until they feel they are in active labor or when the pain of labor becomes unmanageable. In any scenario, the anesthesiologist on-call may have other patients he or she is tending. The Doctor may even be out of the hospital altogether (depending on where you birth), and you may need to wait a length of time before you can be seen. This can be especially troubling to women who do not have other pain management tools to fall back on. Or women who didn't realize waiting was something that could happen. Again you can be taught valuable information about labor coping techniques in a quality class.

3. Your hospital may require you to be in active labor before being admitted:  There are variations of labor in which you feel strong contractions long before active labor. They may not last long, but they vary in pain and manageability. Often this is when a woman has a baby in a malposition, or feels back labor. In this instance, you may not be admitted early in labor, but rather when your labor reaches a more predictable pattern or when you reach a certain dilation. You can be checked for dilation and sent home to manage your labor for a few hours. In this case a childbirth class (and truth be told a doula or very knowledgeable support person) comes in great service. First, you learn that this is a labor variation in the range of normal for birth and second you can learn exercises and position changes to help turn your baby into a better position, relieve pain and pressure and make your labor more efficient.

4. You may want to wait until active labor before going to the hospital:  I've had many clients tell me they were either on the fence about getting the epidural or they knew they wanted one, but they were absolutely adamant about declining many other interventions and strongly desired a vaginal birth. In those cases, taking classes (or having a doula) is very valuable. You may be feeling some strong contractions and sensations long before you decide to make the trip to the hospital and in that case you will need the labor coping techniques and a good understanding of the variations of normal as in labor.

5. Childbirth classes help you learn options, give you an understanding of the process, eliminate fear, and educate you so you can make an informed decision:  Labor isn't just about coping or not. Pain meds or not. There is a lot in this day and age that goes on in the labor and birth room, and a lot has been lost over the years in terms of allowing a woman to birth intuitively. In a good childbirth class preparation series, you can learn about the birthing process from an emotional standpoint, physiological standpoint and a procedural standpoint. You can learn to weigh your options, get a better understanding of the risks and benefits of different interventions and evidence-based practices, and make better informed decisions. This includes not only the decision on whether or not to use an epidural, but when to use one if you decide you want one.  Lastly, a childbirth class can help you ask and answer questions within yourself. It's not enough to make a decision based on fear. Fear of pain, fear of hospitals, fear of bad outcomes. You can explore within yourself why you have chosen an epidural and make sure that you've eliminated fear as a motivator (if it was one) and made a better informed decision for you and your baby. Whatever that may be.

Wednesday, November 7, 2012

How do we obtain choices in childbirth?

I've talked a lot about choices in childbirth in this blog. I've encourage women to choose paths for themselves and own those choices.  Right now though,  I want to talk about how we exercise our rights and give voice to our choices. More than that, how we keep choice from being just a buzz word and a mere illusion that is really system of control to placate us.  

Now the childbirth educator in me says that the key is education. Get as much evidence-based information as you can. Really educate yourself on pregnancy, labor, and birth. Educate yourself on hospital procedures. Educate yourself on postpartum topics like baby care, breastfeeding, and vaccination. However, the warrior in me knows it's not that simple.  Yes, knowing your options is by far the best way to be able to know what choices you want to make and how to make them, but it does very little in preparing you for intricate system that seeks to narrow your choices by simply removing them. So what if you learned there is a such thing as hotdogs and decide you definitely want hotdogs if the chef has completely taken them off the menu. In that scenario lets just say hotdogs are VBACS (vaginal birth after cesareans) and the chef would be insurance companies, hospital policies, your doctor, etc. Are you getting my point?

So what does the warrior in me say? Fight. Advocate. Talk. TAKE ACTION. (Sorry, I really didn't mean to shout. That was the warrior in me) How do we take action? You may ask? Well voting comes to mind, but really that's another blog post. For now lets stick with consumer advocacy.  Many years ago there was shift in what birth looked like in hospitals. Women and families rebelled against protocals such as twilight sleep, separation of family members from the birthing room (in particular husbands), routine drugs and pain medication, and more. We can affect change again by demanding it. Demanding that the standard of care practiced by the people we hire, our doctors, midwives, and their staff,  is evidence-based medicine. Demanding transparency in maternity care data reporting. Demanding an overhaul of the insurance system. We can affect change in policy and procedures by putting our money, time, and efforts where our mouths are. Writing our congress person. Joining grassroots efforts. By signing petitions and organizing and/or participating in demonstrations. Sharing our stories and donating money to efforts that support our causes. The list goes on and on.

I really hope this post didn't come off as preachy. It's just that I've had this idea rattling off in my head for a while and our recent elections have really awaken something within me. There is a huge difference between knowing your rights and exercising them. In the same vein, knowing your options and keeping them on the table are two different things as well. Although many women equip themselves to fight for their choices in birth while in labor, I'm thinking that if we fight collectively for them now we could spend that energy in labor concentrating on something really radical: Birthing our babies. Our way.

1. 'Definition of Twilight Sleep". 7, 2012)