Archive | June 2016

Common concerns about hiring a doula.

You have a lot to think about while you are pregnant. I mean A LOT! You’re going through a lot of changes and if this is your first baby then it’s all new, scary and exciting at the same time. Someone mentions hiring a doula for your birth. You may have a few questions or concerns pop into your head. With the first being ‘what’s a doula?’.

The same explanation is given all the time. Continuous, unbiased, physical, emotional and educational support before during and after birth. The teller then can go into great length and detail about what they do and how awesome it is until they turn blue in the face. I know I’ve done it before. Here is the bottom line.

We are on Team You!

You want a waterbirth? No drugs? Some drugs? All the drugs? A scheduled cesarean? An induction? Waiting for labor to start even if that takes a few more weeks?

We support that. We support you! No judgment, ever.

I asked around to see what some common concerns were that women and their families might have when it comes to hiring a doula to support them.

First on the list: Cost. Yes, seeing that number can catch you off guard. But it’s the same as if you were shopping for any other big item you wanted. Did you know Trinity Doula Services works with you on payment plans so that you can have the support you desire fitted into your budget? Don’t be afraid to reach out and talk to us about it. There are also a lot of ways to pay for your doula. Ask friends o family to help pitch in, have a yard sale where all proceeds go towards a doula fund, put it on your baby shower list, give up that trip to Starbuck’s twice a week (don’t hit me!) and save that money you would’ve spent to go towards the doula’s fee. Be creative, it’s always doable!

Second on the list: making the husband/partner/other friends and family feel replaced or left out. This is really common when the role of a doula is not understood. We don’t come in and push people out of the way, I promise. We work to support the family. For everyone be comfortable and happy. But our clients do come first, if they ask that we do more or less, then that is what we do. It’s great to work with friends and family, sometimes they have questions about what is happening and we can be a source of information for them too. Help calm any fears that the mother-in-law may have. The most important thing is that mom and baby are loved and supported and being well taken care of and sometimes that may look like only having one or two people present during labor and birth or having a room full. But this is the parent’s choice to make. It can be hard if you want to be present and mom or dad may not be comfortable with that, it can even make you feel offended if the couple goes on to hire a doula. Doulas are professional birth support. It is nothing personal. It is always them doing what they feel is best for them and their birth. You are still wanted and still very loved.

Third on the list: doulas only support ‘all natural’ births. How can I put this simply? NO. We support ALL BIRTHS. All forms of birth are just that: BIRTH. Are there doulas out there who only want to attend unmedicated births or home births? Sure there are. But I am not one of them. Every pregnancy, labor, mother and baby are different and have different and wants. Trinity Doula Services will never tell you that you are ‘doing it wrong’ or that you made a ‘wrong choice’. That’s not unbiased and nonjudgmental support.

Fourth on the list: not knowing what a doula was. This is hard because you don’t know what you don’t know. Usually you learn something new by reading about it or hearing someone else talk about it. But once you start researching, you’re likely to find all sorts of things and knowledge is power!

Fifth on the list: I only want my husband there, I don’t want a stranger there. Truth time! Unless you are planning a homebirth with a very specific birth team (midwives and her assistants) chances are you are going to meet LOTS of new people when you are in labor. Sure you know your doctor/midwife(or maybe not if the one on call is someone you’ve never seen before) and maybe know one of the nurses. But doctors and nurses change shifts and go home. You could be in labor long enough to go through several shift changes. Your doula doesn’t do that. We don’t go home after X amount of hours. We are there continuously. You may be surprised at exactly how many new faces you will see. Dietary will usually come by 3x a day with some drinks or little things for you, it’s always a different person. You will see at least 2 nurses when you are being admitted, there will be at least 1 or 2 nurses who come at time of delivery that are there for baby. If you receive a epidural then you will meet another doctor and possibly a second one for that too. If you need a cesarean birth then you will meet even MORE nurses and doctors. But you know who you can always turn to and see their calming face? Your doula. Even if just want your doula to support you during labor and then step out for pushing, that’s ok. You just want prenatal support and birth preparation and her not be present during labor ? That’s ok too! Because as long as you are happy and supported that is what we care about.

Trinity Doula Services hopes that this helped to answer some of the questions or concerns you may have in regards to hiring a doula. TDS strives to provide above and beyond support to the families of Southern Illinois.

Have other questions or concerns? Don’t hesitate to contact us!

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Reasons for a C-section, and what you can do about them.

Lots of women go into the hospital to have their baby without thinking that they will end up needing a cesarean section to birth their baby. In America, this happen a whopping 1/3 of the time.  The World Health Organization (WHO) recommends a 10-15% rate for c-sections. So why is the USA doing more than double that at 33%? There are all sorts of things that can lead to a c-section. Some of it out of anyone’s control and some times we do things without knowing it can increase our risk for a surgical birth. Sadly, sometimes things are done to women by their care providers that puts them on the fast track to the OR. Just for the convenience of the care provider. But I’m not going to talk about that part today.

Let’s talk about things that would indicate a need for a c-section.

Placenta Previa: This is where the placenta is covering the cervix, either partially or completely. Often times it is noticed around 20 weeks when most women have their anatomy scan. If it is only partially covering the cervix there is a good chance that as the uterus grows the placenta will move away from the cervix, making it possible to have a vaginal birth. Usually by 36 weeks the care providers check the placement of the placenta again before recommending a scheduled cesarean birth. The risk of placenta previa is that as labor progresses and the cervix dilates it is pulling away from the placenta and reduces blood flow and oxygen to baby, putting baby in distress and putting mom at risk for excess bleeding. A c-section is the much safer option for mom and baby in this case. There is nothing you can do about placenta previa, it just happens.

Fetal Distress: This can mean lots of things, baby is compressing it’s own cord during contractions which is causing the slow of blood and oxygen, there could be a knot in the cord that is causing the distress, baby may just not be tolerating labor. Often times changing mom’s position can be what is needed to shift things so baby gets the blood and oxygen needs. Sometimes the nurse will give mom an oxygen mask and instruct her to take deep breaths while they watch the fetal heart rate on the monitor. Depending on your care provider and how far along you are in labor will be factors on whether or not you need to deliver baby via c-section. If you’re pushing already, your care provider may suggest assisting with vacuum or forceps to help get baby out while encouraging you to push with all your strength. If you’re still in the early stages of labor and baby seems to be in distress ask your nurse or care provider to please explain what they are seeing on the monitor and what they would like to be seeing instead and how you can help it. If baby’s heart rate drops too much for too long they will likely suggest a c-section for the safety of your baby. There is some controversy over the fetal monitoring though. Some say this is why our cesarean rate is so high, that not all babies are actually in distress- that the machine is not working properly or not picking up the heart rate well. In most hospitals you can request intermittent monitoring so you can be free from the machine and walk and move freely while they put you on it for so many minutes every so often or they will check on baby with a hand held doppler. But in the event of an induction or augmentation of labor with pitocin, or after you’ve received pain medication or an epidural you will be required to have continuous fetal monitoring to make sure baby is ok with these interventions.

Cephalopelvic Disproportion or CPD: This is when the baby’s head or body is too large to fit through mom’s pelvis. It can be hard to determine if it is a true case of CPD because often times when a woman is labeled ‘failure to progress’ they say it is CPD. When an accurate diagnoses of CPD has been made, then a cesarean delivery is safest. But according to the American College of Nurse Midwives, CPD occurs 1 in 250 pregnancies. According to a study published by the American Journal of Public Health more than 65% of women that were diagnosed with CPD went on to deliver subsequent babies vaginally. If you truly have a small or misshapen pelvis there is nothing you can do about that but to try positions in labor to help open the pelvis, like being in a squatting position on a ball or using a squat bar to push. But if you are able to do these things and baby does fit, then it wasn’t a true case of CPD. There is no way to tell by x-ray or ultrasound how much your pelvis will or wont open up during labor, you just have to wait and see what happens when the time comes.

Transverse or Breech presentation: This is when baby is not in the head down position when labor starts. Only about 4% of babies are in the breech position at time of birth. Babies being in the transverse (laying sideways in utero) only occurs about 1 in 2,500 births. Breech babies can be born vaginally, you need to have a care provider who is skilled in breech vaginal births and be comfortable with this. Back in 2001 a study determined that a c-section was the safer mode of delivery for breech babies. So they stopped training new OBs how to do breech vaginal births. Since then more studies have come out showing that a breech vaginal delivery is a safe and reasonable option for most women. If you would like to have a breech vaginal delivery you may need to switch providers to find one who is skilled in that. Transverse babies cannot come down the birth canal without flipping to a breech or head down position first. Some doctors will suggest trying to manually move baby, usually done in the hospital with monitoring to watch for distress and with ultrasound right there to confirm success. You can do things yourself to try to encourage baby, http://www.spinningbabies.com is a great place to start for suggestions. Sometimes the force of contractions can move a baby from the transverse position making a vaginal birth possible. But if baby refuses to budge, then a c-section is the best and really only option.

Placental Abruption: This is when the placenta starts to pull away from the uterine wall before baby has been born. Sometimes it happens before labor has even begun. Other times it occurs during labor. When the placenta starts to pull away from the uterus the blood flow is compromised and deprives baby of oxygen and nutrients. Some women feel pain from it while others do not. Usually it is accompanied with excessive vaginal bleeding and fetal distress. It is considered to be rare, happening in less than 200,000 pregnancies in the US per year. Depending on the severity of the abruption and the gestation of the pregnancy will decide the course of action. Sometimes it’s just bed rest and other times it is an emergency cesarean section. Women that are more than 40 years old or have high blood pressure are at an increased risk of placental abruption. This is one those things that you cannot prevent.

Cord Prolapse: This happens when the umbilical cord passes through the cervix before the baby does. This can make it easy for the baby’s head to trap the cord and compress it resulting in fetal distress. When this happens it is a quick run to the OR while usually there is someone(a nurse or dr.) with their hand in the woman’s vagina holding the baby’s head off of the cord to reduce the compression and keeping oxygen flowing to baby until they can get baby out safely via c-section. The most common cause of cord prolapse is the rupturing of membranes prematurely, before baby has gotten nice and engaged into the pelvis. Other risk factors include premature delivery of baby, multiples pregnancy (twins, triplets), excessive amniotic fluid, breech delivery, and a longer than usual cord. A good way to reduce your risk of cord prolapse is to wait for your amniotic sac to rupture on it’s own.

Failed Induction/Failure to progress: This is when your cervix does not dilate and bring baby down to be born vaginally. Sometimes this happens because baby is malpositioned, sometimes it is because your baby and body were not ready for labor. Different doctors and hospitals will all have varying determining factors for what they consider to be a failed induction/FTP before decided that a c-section is needed. Labor is not an exact science and you cannot assume that because someone else (your mom,aunt, cousin,friend, neighbor, lady behind you in the grocery store check out lane) had a failed induction(s) that you will too. There is also no way to tell before hand how quickly or slowly your labor will progress. Some women take 3 days of labor to get to 10cm while others take 3 hours. There is no magic one size fits all. The best way to avoid a failed induction is to not be induced. If you do decide to be induced or have a medical need for an induction discuss with your Dr. all the options you have and ask about your Bishop score.  If you are in labor (induced or not) and you start to stall(cervix stays the same for several hours) and there is talk of being failure to progress change what you are doing,if you are sitting on a ball get up and go walk instead, if you are walking, try taking a slight break and resting and gathering energy. Talk to your nurse and Dr about what you can try to help make progress, there are always alternatives to try. If you have a doula, she will usually have a whole list of things to do and try to help encourage labor to move along.  The majority of the time, the only thing the mother and cervix needs is time. Your cervix doesn’t care about the clock and as long as mom and baby are healthy and safe during the labor you shouldn’t care about the clock either.

Preeclampsia: This is when the mother’s blood pressure is high and usually have high levels of protein in their urine along with quite a bit of swelling in their hands/legs/feet. Pre-e can range from mild to severe. You could have several signs of pre-e(including blurred vision, quick onset of swelling and weight gain, headaches, etc) or have none. The exact cause of pre-e is unknown but we do know that it has to do with the placenta not functioning correctly.

 While it is defined as occurring in women have never had high blood pressure before, other risk factors include:

  • A history of high blood pressure prior to pregnancy
  • A history of preeclampsia
  • Having a mother or sister who had preeclampsia
  • A history of obesity
  • Carrying more than one baby
  • History of diabetes, kidney disease, lupus, or rheumatoid arthritis

Often times it is when the mom’s blood pressure starts to get too high it becomes dangerous to remain pregnant and an induction or cesarean is planned. Usually an induction is what is scheduled where mom and baby are monitored closely. If baby does not tolerate the induction a cesarean is needed to ensure everyone’s safety. If mom’s blood pressure becomes dangerous or she starts to experience seizures then an emergency cesarean is needed. Since the exact cause of pre-e is unknown at this time it is really hard to say what may or may not help keep it away. There are lots of theories out there of special diets and tips and tricks to help, so it may be worth it for you to look into some of those suggestions. Depending on the severity of your preeclampsia and the gestation of your pregnancy you may need to be on medication to help keep your blood pressure under control until you reach a point where it is safe for baby to be born.

Planned Cesarean: Sometimes a mom decides she would just prefer a c-section to birth her baby. Your Dr may ask for your reasoning for coming to that decision but your doula never will.

Of course there are all sorts of circumstances that can require a cesarean birth for your baby and there is no way to know what those would be ahead of time. Every mom should do her best to be prepared for the birth of her baby  and be supported every step of the way. Trinity Doula Services is committed to making sure our clients get all the information they need and are supported 100% in their choices.

 

Q&A with Doula Sarah

I asked in some local mom groups for some questions they had regarding all things pregnancy/birth/baby/doula related. Here’s the questions I got asked, and the answers to them.

Let me start off with the preface that doulas are not midwives. We are not medical professionals. We do not take your blood pressure, check your cervix or catch your baby. I’ve often heard it explained as the midwives are down there and the doulas are up here *pointing to the head*.We are trained birth professionals, as support people. We will support our clients no matter what their birth choices are. At home with a midwife, in a hospital with an OB, all natural, with an epidural, unplanned and planned cesareans. We work very well with the nurses, midwives and OBs. It’s a big awesome team put together just for you. We ‘mother the mother’. We support the whole family, husbands and kids too. We provide continuous support throughout your labor physically and emotionally. We help educate you about your options and give you the information you need to be confident in your decisions. We help facilitate communication between our clients and the medical staff, but we never speak for you.  The most important thing a mother needs during labor is continuous support. Your nurses will change every 12 hours, your Dr may even go off call while you are laboring. Your doula is with you the whole time. Sometimes that is three hours, sometimes that is three days. Only about 3% of women use doulas, but we are starting to see a rise in that so I think a new study about that is due.

While we cannot guarantee any birth outcome(because if we could, we would be way more popular) but studies have shown that overall, women who receive continuous support were more likely to have vaginal births, less pain medication and be more satisfied with their birth experience. To me that last one is HUGE because the birth of your baby is something you never ever forget and will likely talk about several times in your life.

Ok, on to the Questions!

Q: What is the average cost of placenta encapsulation?

A: I charge $275, but if you are a birth client it’s only $225 to add to your package.

Q: Can I encapsulate my placenta myself?

A: Of course you can, but the equipment can get quite pricey and you don’t know exactly how much of the supplies you will or won’t need until you do it. Also, while you think you may have the energy to stand in your kitchen and do the whole process yourself that may change dramatically after baby actually comes. I can usually get your placenta encapsulated and have everything completed before you are even released from the hospital and meet you at home with the finished capsules ready for consumption.

Q: My family thinks placenta encapsulation is weird, how can I educate them on the benefits?

A: The few scientific studies conducted on placental encapsulation have not conclusively supported the effects of this practice, nor have they completely dispelled the possibility of benefits from ingesting the placenta. However, it should be noted by expectant mothers that the majority of the information we have regarding placental encapsulation comes almost entirely from anecdotes of women who have tried it. There is a bigger study currently being held and as soon as it is released I will share it.

Some of the possible(I say possible because not everyone has the same outcome) benefits of PE are

  • Increased release of the hormone oxytocin, which helps the uterus return to normal size and encourages bonding with the infant
  • Increase in CRH, a stress-reducing hormone
  • Decrease in post-partum depression levels
  • Restoration of iron levels in the blood
  • Increase in milk production
  • Increase in energy levels

As far as convincing your friends and family to get on board with it really depends on them. Sometimes no matter what you do, you can’t change a person’s way of thinking. But it’s your body and your placenta, no one is making them eat it so they shouldn’t be too concerned about it.

Q: What are some good foods for increasing my milk supply, any tips in general for that?

A: The best thing for your milk supply is demand, demand, demand. Whether it is nursing baby all the time or pumping often. The more you take, the more you make.

There are some foods that can help increase you supply for a quick boost, but overall having a well balanced diet and staying hydrated is key. Some of the foods are steel cut oats, quinoa, gatorade, flaxseed, brewer’s yeast (to take in tablet form or put in cookies!), salmon, spinach, and my favorite – almonds. There’s a lot more out there that can be contributed to boosting your milk supply but we could be here all day. Again, you may have to try several things because what works for one mom might not work for you.

Q: What about when I’m ready to wean my baby?

A: Given enough time, most babies(or well toddlers) will eventually wean themselves from the breast. But sometimes that isn’t always doable for mom. The easiest way to wean and dry up your milk supply is gradually. If you do it cold turkey you will become engorged and put yourself at an increased risk of clogged ducts and mastitis(an infection in the breast).

Start by removing one nursing/pumping session during the day for about 3-5 days. Then remove another session for the same amount of time. Keep going at that rate and your supply will adjust and slow down in a gradual pattern and will be more comfortable for you and easier for babe to handle rather than just not being allowed to breastfeed all of a sudden. There are some things you can do to help quicken the drying up process, peppermint oil, cabbage leaves in the bra(helps with any pain too), even benadryl or sudafed(but be sure to discuss this with your Dr first).

Q: What is the average cost of a doula?

A: That really varies and is dependent on your area. All of my fees and services are listed on my Services Available page. I know most doulas are more than happy to do payment plans if your budget is a little tight, we get it.

Q: How close should my doula be to me?

A: Ideally you want someone who can make it to you (whether at home or hospital) in 1-2 hours. Anything more than that and you really could risk them not making it in time and baby beating them! In my contract I give myself a 2 hour window to get to  you from the time you call and request my presence, it’s never taken me that long to get to a client. Average is about one hour for me, but this is because we keep in contact when labor is starting and I get childcare and etc taken care of right away so when you say ‘come now’ that’s exactly what I do.

Q: How do doulas help prevent Postpartum Depression?

A: It’s all about support. Emotional support is SO important during pregnancy, childbirth and immediately postpartum. The hormone drop is a big factor and PPD doesn’t discriminate and sometimes no matter what it rears its ugly head. Physical support is SO important after baby is born too. Adjusting to life with a newborn who sleeps in small spurts and eats all the time on top of normal day to day life can quickly become overwhelming. A birth doula helps preemptively with that ‘women being more satisfied with their birth experience’. A postpartum doula does the defensive and helps mom at home, emotionally and physically. Having someone who can help you in every aspect that you need it, knowing exactly what you need is a big factor. When you are supported, its less likely that you will feel overwhelmed and depressed. If you do show signs of PPD, your doula can help get you references and point in the right direction for help.

What questions do you have? Let me know!

Home with baby, now what?

You walk into the hospital with a big belly and after some time out comes the most beautiful little thing covered in vernix and some other sticky things. While you are at the hospital you have help that can come to you with the push of a button. Is baby’s poop supposed to look this that? Are my breasts supposed to feel like this? How much is baby actually supposed to eat at 1 day old? All of these and any other questions you have can be answered by a skilled and experience nurse night or day while you are in the postpartum wing.

But what about when you leave? Who are you going to ask these types of questions to? How are you going to know if that face baby is making is just gas or if something is wrong?

Most new moms have lots of friends and family near by that will come and check on them and hope to get some baby cuddles when they come over. Some moms are living hundreds and thousands of miles away from friends and family and may not have the support so close to them.

One thing that nearly all moms have is Facebook. It can be a vital tool in connecting new moms(and anyone really!) together. There are always new groups popping up for due date months, or pregnant in your local area.

When you get home and all settled in with your new love, it doesn’t take long before people want to start coming by to meet baby. Depending on how you feel will determine the flow of visitors coming and going.

Do not be afraid to ask for them to bring food. You’ve just had a baby, the last thing you want to do is stand at the stove and cook when you could be relaxing with your new baby.

Ask your visitors to ‘work’ for baby cuddles. “Would you care to load the dishwasher for me before you sit and cuddle baby? I sure would appreciate it!”

You can even type up a little list of things you would like help with around the house and tape it to your front door and ask if they read the note. If not, they can go back and check it out. Having it this way can help you avoid needing to repeat it every time someone comes by.

Do NOT feel obligated to have people over if you do not want them to visit yet. Everyone gets anxious and wants to meet baby but sometimes you’re not ready for it. That is ok! You can make a post on facebook, group text, another note on the door. “We know you can’t wait to meet our new addition, but right now Mom and baby are recovering and needing some quiet and rest. We will let you know right away when we are ready for visitors! Thank you!”

Maybe you need all the help you can get. The more the merrier in that case. If you’ve got enough help, have someone do the dishes while another snuggles baby and you take as long of a shower as you want! Have someone take out the trash, feed the pets and stock the changing table for you.

If you don’t have the village of friends and family near you but you need someone to come regularly and take care of things you have some options, a postpartum doula, a baby nurse, a nanny or maybe just a housekeeper to come in once or twice a week.

So I want some hired help, but don’t know where to look. Ask your nurses before you leave the hospital, they may have some names and numbers to pass along. Talk to your neighbors to see who they recommend. Check out those local mom groups on facebook and ask around. I’m sure  you will find just what you are looking for!

Adjusting to a new family member can be overwhelming and exhausting. But don’t forget to take care of yourself too. New moms need cared for just as much as newborn babies do. Have a snack station set up next to your favorite sitting spot. Bottled water, fruits, granola bars, maybe some of your favorite candies too. Everyone says sleep when the baby sleeps. Sounds great in theory, but if you have older children this may not be possible to do. Take it one day at a time. Depending on your older children’s age you may be able to have community nap time once a day. Maybe they’re old enough they can be trusted to entertain themselves with a movie, coloring books, favorite toys for an hour so you can close your eyes with baby in the afternoon.

Nutrition first, sleep second.

If you are breastfeeding and hit some bumps in the road don’t hesitate to get help. Call the hospital you gave birth at and ask to speak to the Lactation Consultant. If you have a local health department with a WIC program they usually have breastfeeding peer counselors or LCs to assist you. A lot of doulas also offer breastfeeding support as well. Some areas have independent LCs who can come to your home and help you. This is another time when you could get on those local mom facebook groups and ask around, see what is available to you in your area.

Let’s not forget about the emotional well being of new moms too. Giving birth is tough, and sometimes things trail off from the birth plan a little or a whole lot. Reach out and talk to someone if you need to. Friends, family, your doula, your doctor or midwife, a neighbor, anyone you need to. A healthy baby is not the only thing that matters, a healthy mom is just as important. Let’s not forget that.

If you’re local to Southern Illinois come join our pregnancy group. http://www.facebook.com/groups/pregnantinsouthernillinois

When should I get a doula?

Q: When is the BEST time during pregnancy to find the doula that is right for you and hire her?

A: Yesterday.

Let me explain a little. There is no specified time frame that it is appropriate to hire a doula. Some women hire a doula before they are even pregnant! (yes, you can do that) You can start looking for a doula the moment that stick shows a + sign! You can wait until the last minute when you are in labor even! (although that can make it a little difficult, it IS doable)

Pretty much at any point that you’ve decided you want the support of a professional doula is the right time.

With that said, usually the earlier the better though. Doulas only take a certain amount of clients due in the same month. So if you wait until last minute, the doula of your choice may be booked up. Also, if you need to pay your doula through a payment plan then having more time to do so will be beneficial for you.

Q: What if baby is already here?!

A: Then you need a postpartum doula!

A postpartum doula will come and take care of you and help you take care of baby.

Do dishes, stock a basket next to your favorite spot to sit with baby full of diapers,wipes, snacks and drinks, prepare meals for you, do some laundry, care for baby so you can shower or nap,run errands for you and be there to answer any questions you have about your newborn or postpartum period. Doulas do all that and more!

When did you hire a doula?