Dr. Marshall Klaus, MD, co-author of  Mothering the Mother

Get referrals. Ask your childbirth class teacher, friends, and your care provider.

Check online. Well here you are. Check. Visit organization’s websites that train and certify doulas, such as DONA.org.

Interview several doulas before choosing one. Interviews can take place over the phone, but it is wiser to meet the doula in person. Youc an meet at a neutral ground for each of you, such as a local coffee shop or lunch spot, or in either your home or the doula’s. Imagine how this doula will fit in with the rest of your support team. Ask the doulas you interview for references.

If cost is a challenge, look for a doula-in-training, or ask the doulas they interview if they offer their services on a sliding scale. I am happy to provide referrals to other doulas, certified and training doulas.

Trust your intuition. Just as your intuition can guide you through birth and in parenting, it can also serve you well in this decision.

See my article, “Your Doula Interview” for questions to ask during your doula interviews.

This YouTube video by Birth Matters Virginia discusses the roles of doulas during childbirth. Hear from care providers, doulas, and couples who have used doulas.

Watch here:

DoYouDoula?

After 15 months, my journey of seeking doula certification is over! The week before Christmas 2009 I sent my complete doula certification packet into DONA. It was amazing how the time opened up in the normally busy weeks before Christmas for me to be able to complete all my paperwork. Only three weeks later I heard back from my doula reviewer that my paperwork was “fantastic” and congratulations, I am now a certified doula! I am often asked what are the requirements to become certified. There are many components, some small and some large, but all of it requires documentation and a number of forms are submitted to fulfill the certification’s requirements. To review what DONA requires from doulas to certify them, visit here: DONA doula certification requirements.

As stated in DONA’s position paper:

• What training have you had?
• Tell me about your experience with birth, personally and as a doula.
• What is your philosophy about birth and supporting women and their partners through labor?
• May we meet to discuss our birth plans and the role you will play in supporting me through birth?
• May we call you with questions or concerns before and after the birth?
• When do you try to join women in labor? Do you come to our home or meet us in the hospital?
• Do you meet with us after the birth to review the labor and answer quesions?
• Do you work with one or more back up doulas for times when you are not available? May we meet them?
• What are your fees and refund policies?

My Thanksgiving this year was spent at the hospital serving a family in birth. The sweet parents had a long go of it, and it gave me much time for introspection and time to reflect on the first Thanksgiving. The laboring mother was new to American culture, and so I also had the gift of explaining our Thanksgiving tradition to her. I wanted to be sure that I didn’t give any faulty information, so I did a little wikipedia reading during rest periods. I read (and remembered the second grade teacher who had taught me this) that a baby was born on the pilgrims voyage on the Mayflower. The baby was named Oceanus Hopkins. How apropos. I wonder what the birth was like for Elizabeth, Oceanus’ mother. Was it calm and quiet or were the seas uproarious and the birthing room a place of chaos and concern? I was thankful to be present for my clients on Thanksgiving, where, at times we weren’t sure where the journey was headed, but we were together, and they were able to make informed decisions.

The Mayflower birth reminds me of my annual meditation on the physical birth of Jesus Christ. I never wondered much about Mary’s experience until seeing Andrew Peterson’s “Behold, the Lamb of God” Christmas retelling musical (a terrible word for such a beautfiul experience) that includes a song titled “Labor of Love.” Labor of Love is about Mary’s experience and tells that “it was not a silent night… you could hear a woman cry … no mother’s hand to hold.” It conjures up images of what it may have been like for Mary at the first Christmas, and brings an incredible empathy for any woman who may have labored alone or without the love and support of someone who understands birth.

As a doula, my goal is to simply be there for a couple on the precipice of parenthood and to be present as a woman who has experienced birth myself and through other women. Welcome to the world Antonia, sweet girl.

Some suggestions to help you minimize or eliminate the use pain medication:

- gather a supportive birth team, which could include a doula, and practice relaxation and comfort measures with them before labor

- be sure that medical staff knows your wishes.  Ask for their help and ask to not be offered pain medication.  If you need it, you will ask for it and receive it.  They can help you by giving you comfort measures and giving advice about progress

- use labor coping skills; body awareness, passive or active relaxation, massage and touch, baths and showers, heat and cold, movement, the birth ball, fluid intake, and attention focusing

- when your cervix is dilated to 6 or 7 cm, you and your partner can do a coping assessment.  If you are able to relax between contractions, if not during contractions, and are able to use another coping skill during contractions, you are doing great.

- at about 7 or 8 cm, your contractions are as intense as they are going to get, although they may come closer together.  If you made it to 7 cm without pain medication, you most likely will be able to continue with labor and birth without any medication if you desire, and if labor continues to follow a normal course.

- Questions to ask if you begin to get discouraged: How far dilated am I? How is labor progressing? Is it likely to last much longer? Are there other coping or comfort measures that would help? Can I postpone for 3-5 more contractions and then reassess? The answers to these questions will help you determine how to proceed.

In encouraging women who are considering planning a VBAC, I recommend ICAN (Internation Cesarean Awareness Network: http://ican-online.org).  In exploring their pages further I found this fantastic list of the best way to prepare for a VBAC.  I love that they also identify that although you can plan, we can’t predict what will actually happen.  Some mother’s planned VBAC will become a CBAC.  And this ok.  I especially love the parts in the following about following The Brewer Diet, educating yourself through books and a preparation course, using a doula:), and relying on more non-medical methods to aid in labor.  Here’s their list:

Vaginal Birth After Cesarean Checklist

Read good pregnancy and Vaginal Birth After Cesarean books. Two suggestions are: “The VBAC Companion” by Diana Korte and “Open Season” by Nancy Wainer Cohen.

Focus on good nutrition and exercise. Make a daily checklist to ensure you are getting essential nutrients. Engage in daily exercise such as swim, walk, yoga, prenatal fitness class- whatever feels good. For information on diet throughout pregnancy, we recommend reading, “What Every Pregnant Woman Should Know” by Dr. Tom Brewer and Gail Sforza Brewer or The Brewer Diet.

Register for VBAC, refresher or another quality, independent prenatal program. Even though you may have taken classes in a previous pregnancy, an evening out together with your partner will help to prepare you both, promoting discussion, giving you ideas on coping with labor and bringing a focus to this baby and its birth.

Enlist the encouragement of a supportive care provider. Find a caregiver/hospital who ALREADY provide the options you want. Find someone who believes in VBACs, has a VBAC success rate over 75% and a cesarean rate that is lower than the community average. Consider having a midwife as your primary caregiver. Midwives have a very low rate of cesarean birth. If you are unsure about anything, get a second opinion. Trust your inner strength and knowledge.

Hire a doula/labor assistant/support person. It is worth every penny to be reassured during labor by someone who believes birth is a natural function. This person will have supportive non-medical skills to help you through labor for the birth you want. This person will assist you from your first contractions at home right through postpartum. A labor assistant, or doula, takes the pressure off fathers and family members so that the whole family can be supported.

Throughout pregnancy practice relaxation and visualization with exercises, tapes, massage, affirmations and touch. Use affirmations such as “Each contraction strengthens my baby and me.” Or “I will birth my baby vaginally, naturally, and joyfully.”

Write a birth plan. Discuss everything that is important to you with your care provider, putting it all into your birth plan. Make extra copies to be put in your chart. Know your hospital’s VBAC policies and negotiate well before the birth for anything different. Things to consider when writing your birth plan are:

• Establish a safe, supportive birth environment to encourage labor.
• Try a variety of positions. Instead of lying down, try standing or walking. Squatting to push can be most effective. Try the birth ball. Try walking the halls. Try ‘dancing’ with your partner.
• Continue your calorie and fluid intake. Labor is work and takes energy. Far from eliminating the risk of aspiration with general anesthesia, total fasting (NPO) may increase the risk by raising the acidity of the stomach contents.
• Avoid medical intervention whenever possible. Continuous electronic fetal monitoring may restrict your movement. Ask for noninvasive options. Ask what will be done with the results.
• Artificial induction should be avoided, if possible. Medical induction is linked with high rupture rates and many interventions.
• Ask for time to try non-medical methods to stimulate labor if your labor is not progressing. These include change of position, walking, nipple stimulation, aromatherapy, acupressure. Every labor is different. Unless you dilated to five or six centimeters during a previous labor, consider this one your first labor.
• Avoiding an epidural may increase your chance for a vaginal birth. An epidural interferes with the baby being optimally lined up and will reduce your ability to push effectively. Try natural pain relief measures, such as: hot/cold compresses, bath/shower (once labor is established), tenns unit, massage, relaxation, guided imagery, birth ball. If you start to think you really need an epidural, give yourself a few more contractions, or request that you be checked one more time. You may be moving quickly into transition without realizing it.

Having a birth plan cannot guarantee that your wishes will be followed. Working with a careprovider who believes in birth is easier than fighting one who does not. No amount of demanding or asking nicely will get you the birth you want.

Many cesareans are done due to posterior or asynclitic presentation. Avoiding reclining positions prenatally. Read Val el Halta’s “Posterior Presentation – A Pain in the Back” article and “Understanding and Teaching Optimal Fetal Positioning” by Jean Sutton and Pauline Scott.

Believe in yourself and the process of birth. Repeat affirmations to yourself constantly. Encourage yourself to believe that you are capable of delivering your baby vaginally. Get in touch with your inner self; your resources and abilities. Forget about your scar and focus on the positive aspects of your pregnancy.

Work on leftover negative emotions (guilt, disappointment, anger) from previous cesarean birth(s). Two wonderful books for this are Lynn Madsen’s “Rebounding From Childbirth”, and “Ended Beginnings” by Claudia Panuthos.

Learn to trust, cooperate with and listen to your body and baby. Listen to your own unique labor pattern.

Feel good about yourself and your relationship as a couple and keep a positive outlook.

Enlist the support of family and friends. Remember that according to medical studies VBAC is usually safer for both you and your baby than a repeat cesarean. Don’t be afraid to let your family know how much you need their unconditional emotional support.

Attend VBAC support meetings and join national organizations. Through meetings and newsletters, you will hear from others who have been there, sharing their VBAC experiences. Read “The VBAC Experience” by Lynn Baptisti Richards, a collection of VBAC stories.

Having a VBAC is worth it! You can do it. Not everything is within our control — however, it is within all of us to prepare ourselves as best we can to maximize the chance of VBAC.

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© International Cesarean Awareness Network, Inc. All Rights Reserved.

A doula is not only trained or experienced in homebirth or unmedicated births. Doulas are trained to support women and their partners through many different birth experiences and situations. Every woman, even if she is planning a medicated labor and delivery, should learn comfort measures for labor, because you don’t arrive at the hospital and are immediately given an epidural. In fact, many care providers, even with planned epidurals, prefer to wait until a laboring woman has developed a regular labor pattern, which sometimes doesn’t occur until the onset of active labor, which is usually around 5 cm dilation. So what happens before 5 cm dilation? Comfort measures: walking, different positions, swaying, hydrotherapy, breathing, relaxation. All these comfort measures is what a doula is an expert in.

No.  A doula is not a medical professional, although she works in a field that is usually associated with conventional medicine.  A doula is trained to be very knowledgeable about pregnancy, labor, birth and the postnatal period, and can provide an expectant mother with lots of information to help her make informed decisions about her labor and birth.   A doula can also provide emotional and physical comfort measures that standard care givers do not have the capacity to provide.  Conventional medical tasks are out of the doula’s realm, such as taking blood pressure readings or doing vaginal exams.