Positive Birth News

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A Positive Caesarean Birth

If you wish to emerge from your baby’s caesarean birth feeling positive then it is wise to take ownership over your baby’s birth. This means speaking up for what you want and do not want and placing yourself in the hands of people you trust and feel safe with.

Consider what your wishes would be for a caesarean birth when you are doing your birth preparation and planning. Then you will have the opportunity to communicate your most important desires for a caesarean birth with your place of birth and carers ahead of time. This doesn’t mean dwelling on the possibility of a caesarean, it just means considering and documenting what would make this type of birth as positive as possible for you, your partner and your baby.

Most of us like to avoid conflict. We are used to being told what we should or shouldn’t do by health professionals and we are in the habit of giving over our power and ownership to others in medical situations. Although it may be very challenging for you (it is for me!), your baby’s birth is an opportunity to begin advocating for yourself and for your unborn child. Through your experience of birth you can set the scene for future interactions with doctors, dentists, health nurses and teachers where you are a strong advocate and an expert in your needs and the needs of your children.

There are options for a caesarean birth that may not be offered to you as they are not standard care in most hospitals. Although a caesarean is surgery, it is also the birth of a baby, a mother and a father. Even in an emergency, this surgery can be performed with gentle and respectful intentions, with consciousness that this is a birth and it is a special day.

Based on many women’s stories and the work of retired US obstetrician, Robert Oliver, MD, board of directors of APPPAH, the Association for Pre and Perinatal Psychology and Health, these are my suggestions for turning a necessary caesarean into a positive and beautiful birth.

Not all of these are going to be possible for a mid-labour emergency caesarean or in every individual situation, but they are possible and achievable. Reading positive caesarean stories and asking questions of other women will help you to discover that the smallest things can make all the difference to your baby’s birth.

Robert Oliver MD writes about his experience with positive caesarean births: “It is our intention to maintain the mother’s control of the events. She must at all times feel she is important to and guiding the birthing, regardless of the emergency and the operative procedure.This also goes for the baby in a spiritual and metaphysical sense. Ideally the obstetrician and labor room personnel will honor these two people most strongly.”

Preparing for Caesarean Birth
It is OK to feel disappointed, sad, or angry before and after your baby’s birth. Seek an empathetic listener (eg, your doula or midwife) who will not dismiss your feelings, ‘jolly’ you along, or diagnose you with depression before you even have time to grieve the birth and meeting with your baby that you had hoped to experience.

If you feel ready and you have time to prepare for your caesarean birth, read positive caesarean birth stories so that you are familiar with what will happen and what the birth may feel like. These stories will also give you confidence to ask for what you want. Talking to other women will also help you to find out what products there are that may make your recovery easier. (There are three positive caesarean stories in the Birth Journeys book.)

Meet the surgeon and anaesthetist beforehand with your midwife and/or doula to discuss your birth plans and hopes.

Ask that your baby be placed on your chest before weighing, cleaning and paediatric assessment, unless absolutely necessary. Weighing and cleaning are not emergency procedures that have to happen the moment your baby is born – they can wait – but we tend to accept that they take place immediately after birth. There are many possibilities like this that are not widely discussed or offered.

Ask for delayed cord clamping so that your baby receives all the cord blood and oxygen from the placenta while they adapt to life outside the womb. A recent review of studies showed that delayed cord clamping provides longer term health benefits for your baby as well as supporting them as they begin to breathe. A lotus birth is possible with a caesarean birth and it ensures that your baby is not taken away (although baby may be held rather than placed on your chest) before the placenta is birthed.

Ask for the lights to be dimmed and the surgery to be a little warmer than usual for your baby’s birth. This is achievable and it will make your baby’s first moments in the world easier and the birth environment more pleasant for you too.

Ask for talking to be quiet and gentle with attention focused on you, your baby, your partner and this birth. One common complaint couples have after experiencing a caesarean birth is that medical staff carried on with their own conversations ignoring the presence and the feelings of the key people in this important event. Perhaps some surgeons and theatre staff have this habit because other ‘patients’ would not be listening in and they may not be aware of how it makes many couples feel.

Discuss your intentions for breastfeeding and how you will be supported after the caesarean birth. Identify how will you be helped to breastfeed, especially if there is a reason why you are unable to breastfeed your baby for the first few hours. Remember that skin to skin contact and allowing your baby to explore and find your nipple by themselves is a wonderful way to initiate breastfeeding and reconnect with your baby after a separation.

Caesarean births are sometimes linked to difficulties in establishing breastfeeding so consider finding the supportive friends and professionals now before your baby is born. It is easier to reach for support if you have already made contact before the birth.

You may wish to discover your baby’s sex for yourselves. You may like the doctors to welcome your baby by name. Ensure you make your wishes clear so that this special moment meets your wishes.

Use honey not vinegar to get what you want. If you are worried about dealing with potential conflict, try words like these: “It is important to us that… How can we work together to…” Eg, if you are concerned about your baby being taken away immediately after birth you could try words similar to “It is important to us that our baby is not separated from us. How can we do things so we have our baby in our arms straight after the birth?”

This may seem to be giving the power to find a solution to the doctors, but you are actually telling them what your concern is and what outcome you want. I’ve not had to use this method in maternity care, but I have used it in the operating theatre and recovery ward with my children to get what I knew they needed and it really works! Honest and respectful communication with the right person goes a long way.

On The Day
Have your partner place their hands on your belly or speak to your baby in the time before the caesarean birth begins. Your baby knows their daddy’s voice and this can help your partner to feel involved and connected with your baby and the birth.

Before the birth begins, ask to take a moment to welcome your baby and give thanks for their life and the wonderful care and the gentle hands of everyone in the room that will receive your baby into the world. If you would normally pray or say a few words before something momentous takes place then surely the caesarean birth of a baby fits this category. I believe your wish will be respected if you frame it as a need to give thanks, say a prayer or a blessing before your baby’s birth.

If saying something aloud is all too much, then ask for a everyone to share a moment’s silence to give thanks. Taking this small but very personal action will send a very clear message about the way you want this birth to be – respectful, gentle and calm. I have not read of this in any birth stories so you may be pioneers if you try this – be sure to let me know what happens!

Focus on your baby and visualise sending them reassurance and love. Let your baby know that it is safe for them to be born this way and that you are in control of what is happening. Talk or sing to your baby in your head or quietly – keep focused on them and their wellbeing and imagine them coming out into the light and the air. This will help you to feel involved and in control of the birth of your baby. By keeping calm, you support the wellbeing of both yourself and your baby. If this is not for you, use other methods such as counting backwards to help you keep calm.

Have a doula or familiar midwife in the theatre focused on your care and wellbeing. You’ll benefit from having someone there for you and your partner.

If you prepared for birth with hypnosis or meditation methods you may find these are still very useful during the birth. If you have prepared using breathing techniques or counting methods these amy also be helpful for you. (See the links below for hypnobirthing specifically for caesarean birth.)

If you are unable to hold your baby post-birth, your partner can hold your baby against his bare chest with a blanket over them both, or even inside his shirt. Your baby will be kept warm and will love this close contact with daddy.

Remember it is your birth and your baby’s birth not just an operation. Every aspect of this birth may be performed with an intention to help, to care and to show respect for you, your baby and your partner. You deserve this.

Some links you may find helpful before and after a caesarean birth:
Caesarean birth plan: http://www.birthtalk.org/PlanaPosCS.hhtml
Hypnobirthing for caesarean birth: http://www.hypnobirthingaustralia.com.au/preparation-for-caesarean-birth-cesarean-c-section/
What a caesarean is like: http://www.birthingfromwithin.com/cesarean
Birth Rites on positive caesareans: http://www.birthrites.org/caesarean.html
Love letter to mothers who have birthed by caesarean: http://thestir.cafemom.com/baby/131563/a_love_letter_to_csection
Words that heal – why language matters: http://www.huffingtonpost.com/brandy-ferner/words-that-heal-cesarean-birth_b_3722185.html

20130826-213350.jpg No matter how you birth or how your baby needs to be born, you deserve this treatment.

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Positive Birth Story: Choosing Support

Renae’s story illustrates the power of allowing ourselves to be supported during pregnancy and labour. Renae shares her journey from a difficult first birth to a beautiful, powerful second birth. Renae had wanted and prepared for a natural first birth. She had a positive outlook, she had done the birth preparation and she was realistic, but not frightened. However her plans and expectations evaporated as she was overwhelmed by the pain of an intense induced labour. Renae opted for an epidural and experienced a damaging forceps delivery, under the threat of a caesarean.

Before she even became pregnant with her second daughter, Renae decided that she needed and wanted more support next time. She decided that a doula would meet her needs. Renae’s doula was a source of supportive friendship, informative discussion and beautiful encouragement during Renae’s pregnancy. Renae’s second birth was empowering and drug-free with a natural third stage and ‘delayed’ cord clamping. It was everything Renae had hoped for.

My First Birth
I went into my first birth with positive expectations. My sister-in-law had two natural and positive births so she was a great influence on me! My husband and I did a Calmbirth course which I loved (but he thought was a waste of time). I did a heap of magazine reading and read a few books. So I wasn’t scared, but realistic. I thought labour would be natural and instinctive.

I was five days overdue and my doctor was concerned with my blood pressure. I went in for my 41 week appointment and was sent straight to the hospital from there. It caught me off guard! At about 7pm the next night my doctor put in the gel and the machine picked up that I was having ‘tightenings’ but they weren’t considered contractions. They weren’t too painful and I was able to sleep that night. The gel was repeated the next morning but it still wasn’t bringing on labour so I had my waters broken at about 1pm. When that didn’t start labour I went on the syntocinon drip at about 2.30pm.

It took about an hour and then the ‘real’ contractions started. I breathed through them and by 6pm I was at 4cm. I was doing OK but would have done better if I could have moved off the bed, had a shower, or walked around but I was continually hooked to the bed! Then all of a sudden I had this huge long contraction that just didn’t stop! Oh my, it was so painful! I lost my focus. I had the gas and I’m not sure if it helped or hindered the situation. The drip had caused the long contraction so they turned it off to give me a little break. My doctor came back and checked me. I was 7cm (9pm). I was over the pain so I chose to have an epidural. The next two hours were pain free and I progressed to 10cm by 11pm.

I pushed for about an hour and frankly gave up. I just wasn’t getting anywhere and I was exhausted. So my doctor called another doctor who did forceps deliveries and I got a huge top up of epidural. The new doctor said “If this doesn’t work you’ll have to get a c-section!” so I pushed as hard and long as possible (with him pulling!) and with that my baby Eloise was born.

I had an episiotomy, and her head tore me down the middle, to the side, and her hand got me inside too. Thank goodness for epidurals! They put my baby on my chest and it took so long to stitch me up, she was pretty much screaming the whole time. I was shivering and not well at all. I didn’t feel the instant relief or a flood of love. I was so overwhelmed by what had happened.

Soon after my first birth I felt positive. I believed that everything had happened how it had to happen and I was OK with that…for a while. But then I got talking, thinking and did more reading. Now I realised I wasn’t really happy with how things went at all.

I didn’t feel I was strong enough to speak up or question the midwives or my doctor. I went along with what they said even if I was uncomfortable with it. The pain seemed to overtake my will to labour my way. At one stage, when they were putting the drip in my arm, I asked if I had to be hooked up to the drip the whole time. The midwife had said “Maybe, we will have to see how it goes.” Now I know that once you’re hooked up, it stays that way!

Choosing a Doula
Before my next birth, I decided to hire a doula. The idea mainly came from reading the Birth Journeys book. Hardly anyone around my area had even heard of one and I had to do a lot of explaining to my friends!

I felt I needed someone with me who knew what I wanted and would speak up for me. My husband was there for me but he is not the type to question a professional. He was very supportive of my decision to have a doula. He felt that his job would be a lot easier on the day too. I think any pressure or worries he felt from our first birth were relieved knowing we would have a doula there.

Sophie was a student doula and I knew her through a friend. We were pregnant at the same time (but only saw each other once during this time) so we had the basis of a friendship already. Then we bonded over our mutual feelings towards birth activism on Facebook and got talking about our births. Her birth was awesome and empowering. Mine was not! We had our first doula meeting at a play café with our daughters and we found we had an easy friendship. Sophie is so different to me in her parenting style but we agreed on some fundamental points and that got us talking.

For a while I considered going in for a planned C-section. I thought it would be easier and at least I would get the baby with no damage to that ‘sensitive’ area that was so hurt last time. However talking to people and reading Birth Journeys (again!) helped me to want a positive natural birth. My mum is a very positive person and said from her experience (6 births) the first one is always the hardest! She helped a lot. I also had a miscarriage between Eloise and Charlotte and that seemed to change my perspective.

Sophie was always only a conversation away with positive words and support. At one stage the baby was posterior and I was so worried about birthing a posterior baby as I had heard so many bad stories. Sophie sent me links to read to help baby get in a better position and every time we talked she would remind me to do the exercises – I was lazy at doing them!

Sophie helped me to feel excited about birth. Just knowing that she would be there with me made me look forward to it! She gave me two books to read (one by Ina May Gaskin) and they were both a bit out of my comfort zone as Sophie is a lot more of an ‘earth mother’ than me! But I loved Juju Sundin’s Birth Skills. I read it when I was 36-38 weeks while on holiday and it got me in the mood to have a baby! I had lots of conversations about induced labours compared to natural labours. I also talked about being in control and having delayed cord clamping, a natural third stage and allowing my waters to break naturally. My friends couldn’t understand why I would want any of these or that they had that choice.

I also talked to my doctor about my thoughts and my fears and she was wonderfully supportive. The midwives however, had never had a doula, rarely did delayed cord clamping and never did a natural third stage! I was told that delayed cord clamping is dangerous, a natural third stage can cause a haemorrhage and that my doctor wouldn’t do it! It shows they were misinformed! I just said “OK” and went ahead and wrote my birth plan with my doctor’s support. My doctor understood that I was well read and wanted the things I wanted for a reason! I never knew which midwife I would get so there was no point in challenging them.

My Second Birth

I was sure Charlotte would be late like her sister and I was determined not to be induced this time. I decided I was willing to go two weeks over. I decided to go to one last movie in Adelaide (100km from home!). I decided not to waste my time at home and go and enjoy myself. Whilst at the movie (10.30am, Life of Pi) I had a few niggles but wrote them off as braxton hicks – I was in denial from that first pain!

I had lunch with a friend after the movie at 1pm and kept getting slight pains. At one time I had to sit down instead of going to get a drink as I couldn’t walk! But once again, I decided it was nothing. After lunch and a walk around the mall, I went to Bunnings to buy a hose (It was suddenly very important to buy a hose!!) but I left empty-handed as the pains were getting stronger and more frequent. I also had a headache so I bought some water and panadol and decided to drive the hour long trip home.

On the way home, I called my husband and told him that I thought I might be in labour, but probably not, as it felt too easy. I called my doula Sophie and explained what was happening. She confirmed that it sounded like early labour and suggested I have a rest once I got home. During the drive the pains were bearable, coming every 15 minutes or so.

When I got home, there was a lovely surprise from my husband (Matthew) – a beautiful clean house. He must have had the nesting urge instead of me! Instead of relaxing, I ran around the house packing my maternity bag. I was still in denial. With each contraction I would think ‘Yep, this is definitely real’ then when it was over I would think ‘Nah, it didn’t hurt much, so it must be braxton hicks’. I thought I should time them properly using an app on my phone and it turned out the contractions were 10 minutes apart and lasting about 40 seconds but they were still completely manageable.

I decided to listen to Sophie’s advice and I went to bed. It was the best decision because I fell asleep in between the pains and I’m sure they slowed right down. I felt very refreshed after my sleep. The next few hours were spent having a nice long shower, texting Sophie (we were both very excited!) and watching TV. I held a heat pack to my lower bump and paced the kitchen during contractions. I focused on not clenching or holding on during contractions but letting go and relaxing. In between I rested on the fit ball with my eyes closed. It was quite enjoyable!

At 8pm Sophie arrived. She was a lovely, calming presence (like I have often read about doulas) and she helped me to accept that this really was happening and I would meet my little girl soon! By this stage contractions were five minutes apart, still around 40 seconds long and not that painful. I continued to pace and added in counting my steps. I handled the pain quite well this way. Sophie had brought with her the best contraption, a stretchy belt to hold a heated wheat bag in place on my tummy and one on my back. It was a wonderful addition!

Packed to the Rafters was on, and as it is my favourite show, I watched it in between the contractions with both Matt and Sophie sitting on the couch. It was a very calm and enjoyable time. During the ads we talked about our children, about Sophie’s labour, my previous labour and worked on convincing Matt that this was the real thing.

I called the hospital at 8.30pm and told them what was happening. I told them I wanted to stay at home as long as possible and they were happy with that as their midwife started work at 11pm. I also called the on-call midwife who delivered my first daughter and she reminded me that the second stage with her was quite fast, which I didn’t know. I also had to factor in the 30 minute very bumpy drive to the hospital.

By 11pm the contractions were closer and stronger, so I decided to leave for the hospital. I had so many contractions in the car and I dealt with the pain using strategies from Birth Skills by Juju Sundin. I pulled myself up on the roof handle, tapped my foot and counted the taps to distract myself from the pain – it worked so well.

We arrived at the hospital at 11.30pm and I said to Matt that our daughter would be born the next day. I thought we still had hours to go. It still wasn’t as painful as I thought it was going to be. I was contracting frequently but they were short and once again pacing, breathing and counting helped.

My midwife Marlene wanted to check the baby’s heartbeat but only managed two short readings as I needed to move around to manage the contractions. Marlene then checked my dilation, (which was horrible as I was lying down). She knew I didn’t want my waters to be broken so she just did a quick check and found that I was 8cms but my baby’s head was still high. As she removed her hand, something made me gag and I started to vomit. This somehow triggered my waters to break! Stuff was gushing out both ends, and my poor doula had to hold a bag for me to vomit. She was amazing and cleaned me up a bit before helping me to the shower. My husband had gone to get my birth plan and decided to also bring our bags in (as it was going to be ages until the birth) so he missed all the messy stuff!

Once in the shower I felt overwhelming pain and I squatted and held onto the rail. It was a completely instinctive movement. I let out a loud moan. I had been quite silent until now. Matt later told me it sounded very animalistic. I experienced immense pressure through the constant contractions. I didn’t quite ‘get’ what was going on and I put my hand down and right on my baby’s head. I yelled ‘I can feel the head!’ Sophie was behind me the whole time holding the water on my back and telling me how well I was doing and that this was all natural.

Marlene instructed someone to call the doctor and asked me if I could get onto the bed. I said ‘NO!!’ and got on to all fours. Marlene somehow got in behind me (a very small space!) and did her thing as I did mine with a lot of noise. I hardly remember pushing but instead seemed to ‘moan’ my baby out.

It was incredibly intense and then BAM! There was my little girl! I was in shock and just stayed there for a minute, speechless! As I wanted to delay the cord cutting, Marlene had to follow behind me holding Charlotte, while we went to the bed and waited. When the cord stopped pulsating Matt didn’t want to cut the cord and neither did I, so Sophie did the honours.

Charlotte was handed to a stunned Matt as I wanted to deliver the placenta naturally. It happened quite quickly and easily. I only had a slight tear which didn’t need to be stitched. From the waters breaking to Charlotte’s arrival it was only about seven minutes! We had only just made it to hospital in time. We don’t even know the exact arrival time as it happened so fast and everyone forgot to look at the clock!

My second birth still makes me feel great! From moments after the birth I couldn’t stop smiling! I was in shock that it was so good. I feel like I’m amazing for doing it exactly how I wanted it – and it makes me feel proud. I feel that birth is so instinctive if you just let it be! As I’ve read – birth is not a medical problem – it’s a natural part of life.

I bonded with Charlotte so much quicker and she is an easier and more settled baby than Eloise. I actually thought I hated the baby stage, but turns out I don’t!

I had a positive birth experience because I believed I could have one. I was in control and made the necessary changes that I needed to make to make it happen. I looked at birth as something natural not medical and I did the reading to back it all up.


What do you want other women to know about birth?
That knowledge is power and if you don’t get the answer you want from your doctor or midwife – go to another one until you find one that supports you! To be strong – it’s your body, your choice!!

What do you think your journey from your first birth to second birth shows or offers to teach other women?
One bad birth doesn’t mean they will all be the same. You can make small changes to help you be in control and get that positive feeling. Talk to women and read about positive birth experiences because how you feel about birth starts in your head!


Renae is 29 and she lives on a sheep and cropping farm in the near the Clare Valley in South Australia with her husband Matthew and daughters Eloise (2) and Charlotte (5months). Renae is a kindy teacher but she is focusing on being a stay-at-home mum until her kids are all at school. Renae loves to read and still gets to do a lot of it as her girls have been wonderful sleepers!

Sophie is a doula who has studied with the Australian Doula College.


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Ten Great Reasons to Choose a Doula

  1. A doula can help you have a better experience of your baby’s birth. A 2012 review of studies showed that women with continuous non-medical support throughout labour have better birth outcomes in every way.

    “Bottom line: Continuous support in labour increased the chance of a spontaneous vaginal birth, reduced intrapartum analgesia, caused no known harm, and women were more satisfied. In addition, labours were shorter, and women were less likely to have a caesarean section or instrumental vaginal birth, regional analgesia, or a baby with a low 5-minute Apgar score. There was no apparent impact on other intrapartum interventions, maternal or neonatal complications, or on breastfeeding… continuous support was most effective when provided by a woman who was neither part of the hospital staff nor the woman’s social network, and in settings in which epidural analgesia was not routinely available.From Continuous support for women during childbirth, Hodnett ED, Gates S, Hofmeyr GJ, Sakala C, October 17, 2012 http://summaries.cochrane.org/CD003766/continuous-support-for-women-during-childbirth#sthash.VsvNUnvh.dpuf

     

  2. A doula is an independent, educated professional who will give plenty of time to hearing you, sharing information and helping you to identify what you need and want for your journey into parenthood. A doula has usually studied pregnancy, birth, labour, how to support couples and how to be at births. An experienced doula will have knowledge and intuition.
  3. A doula can help you and your partner to understand and communicate with health professionals. A doula can offer you suggestions for how to bring up issues or ask questions. She can support and assist you and your partner to explain what you need, want and are concerned about.This is particularly helpful if you are seeking non-standard care (eg for a VBAC) or you are planning and preparing for a natural and unhindered birth. Some might even say if you are seeking a natural birth then you are automatically seeking “non-standard” care in many hospitals in Australia and the US! If the policies and practices of your place of birth are not aligned with your birth wishes then a doula will be a very good ally.
  4. A doula can give your partner a break, work with your partner as a team, or support your partner in a practical role. A doula won’t take away from your partner’s role, nor destroy the intimacy of experiencing this rite of passage as a couple. However a doula can support and reassure your partner so he (or she) can support you throughout the birth.
  5. A doula is someone to ask you questions and help you reflect on your pregnancy, birth and motherhood. She may ask questions you wouldn’t think to ask or may avoid asking yourself. This process helps you to know yourself better and helps her to support you.
  6. A doula knows how to be around women in labour, to set the tone and protect the birth space you want. A doula is trained and practised in being with birthing couples without allowing her personal circumstances, history or other factors to affect her or you. A friend or relative may not be able to give unconditionally like this especially if they have not experienced positive births before or are bringing their own fears or negative experiences into the room.
  7. A doula is someone who knows your needs, wishes and your history in a personal and emotional way – as long as you let her in and trust her. Your partner also needs to be comfortable with her and trust her. Someone who knows you well is better able to read your needs and support you than a midwife who has only just met you and you are one of several women in her care at that time. A doula who you feel comfortable with will help you to labour well because her presence makes you feel safer, unobserved and more relaxed. This supports the hormonal processes that drive labour.
  8. A doula is someone to stay with you if your partner needs to go with your baby to the nursery, or you need some medical attention post-birth. This is not a scenario you would wish to focus on, but it is reassuring to know that in this situation you would have support.
  9. A doula is someone to visit you in the post birth days to help with breastfeeding, mothering, and your wellbeing. This may be as simple as making you a cuppa, bringing you one-handed healthy food, or holding your baby while you shower. These things are really helpful post birth especially if you do not have other people who will be there for you in this gentle, reassuring and ‘no strings attached’ way.
  10. A doula becomes someone special who has witnessed your baby’s birth in a non-medical, personal way. She will be able to share in your story, hear and understand your feelings, and affirm your memories of what happened. She will hold a special place in your heart and your family.
    Not convinced? Are there blocks to you considering a doula for birth support? Making Good Decisions for a Positive Birth examines some of the common reasons shared with me for not choosing or not needing a doula and asks you to dig deeper and examine what is behind the reasoning. Only you can know whether your reasons are based on evidence, a deep consideration of your needs and an understanding of your fears.


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Making Good Decisions for a Positive Birth – looking at reasons for not having a doula

During my first pregnancy I remember thinking: “A water birth!? What if the baby drowns?” “A doula!? I don’t want a stranger watching me in labour!” “Hypnobirthing – that sounds scary and just plain weird. I don’t think imagining I’m on a tropical island is going to help when I’m in LABOUR!”

Each of these emotional reactions prevented me from learning how these options could have helped me to have the natural birth I wanted. My decisions came from misinformation (don’t always trust what you read in magazines!) and a deep fear of surrendering to labour, letting people in and being vulnerable and exposed. (for my second birth I went on to have a doula, a water birth and listened to hypnobirthing CDs!)
Make Good Choices

The best decisions are based on a consideration of evidence and an honest and deep reflection on our feelings, fears and needs. When discussing doulas and many other choices in birth, I hear a lot of reasons why couples will NOT have a doula or choose birth preparation or labour options that could be positive and helpful like hypnosis, meditation or water birth. Just like my reasoning above, often these decisions are not based on research or a true consideration of the couple’s feelings, fears and needs. Perhaps they are based on misconceptions or fears like mine were.

When we dig deeper and look beneath the surface level reasons we have the opportunity to learn a whole lot more about what we are really frightened of, worried about, and any unspoken needs or expectations we may have. Then we are in the position to make really good decisions.

Here are four common reasons people give for deciding to not have a doula. You may find this a useful discussion if you and your partner are considering having a doula and some of these concerns have come up.

1. A doula is too expensive
Find out about student doulas who may work for free or a minimal cost because they wish to gain experience yet may be very well suited to supporting you. While they may not have as much experience, you will benefit from their passion, commitment and up to date knowledge and they will often have an experienced doula as a mentor. Find out about doulas who offer flexible payments or low fees for low-income families. Many doulas will accept payments throughout your pregnancy and post birth. So, if you have not asked several local doulas what they charge and what are their options for payment, then you can’t honestly say “it’s too expensive”. You don’t know until you ask!

If this reason is a block for you,  ask yourself:

How much is birth support during this important transition worth?

What is the value of a relaxed, safe, positive beginning for you and your baby? Or the value of feeling well supported throughout pregnancy and birth?

And a confronting question: how will you feel if a shattering, traumatic birth could have been avoided if you had a doula by your side?

2. We don’t want a stranger there
If you are birthing in a hospital maternity ward, then most of the people you come into contact with will be strangers. If you have a private obstetrician, the midwives will probably be unfamiliar and your obstetrician often won’t be there until the last few minutes of your baby’s birth. If you had a team of midwives for antenatal care, you may not get a midwife you are familiar and comfortable with during labour. You may have several midwives as their shifts change during your labour. If a paediatrician, anaesthetist or registrar is needed, they will usually be a stranger too.

You will come across a lot of strangers during your labour and the days afterwards in the maternity ward. If you don’t want strangers at your birth then think seriously about where you are giving birth and who you are allowing into your birth space. Consider adding someone familiar to your birth team who will protect you from the impact of these strangers.

A doula is someone you choose to get to know, become comfortable with, and have with you during labour and after birth. You will meet your doula many times before birth to get to know each other and feel comfortable. If you choose the right doula for you then she will not feel like a stranger. Through all the shift changes and different people you may meet, she will be a familiar and friendly support person coming along with you. Everyone else might be strangers but a doula will be one person you do know apart from your partner.

If this is a block for you, ask:

Is thinking of a doula as a “stranger” really valid? 

Am I (or is my partner) afraid of having a doula there?

What is it that makes us uncomfortable about this idea?

And what does this teach us about our needs for birth?

Are we meeting these needs in our other birth plans?

3. We don’t need support 
You deserve the best support around! The more supported, safe and comfortable you feel, the easier it will be to birth your baby. Why not have as much support and help from respectful, educated, professional, experienced people as you can get?

Even couples who have prepared as well as they could for labour can end up feeling lost, alone and overwhelmed. Chrissy Grainger (Birth Journeys contributor and doula) explains that she became a doula because “I previously coordinated a support group for pregnancy and birth and was seeing so, so many women have all the information and support during pregnancy, [only] for the birth to go pear shaped.” Continuous support during birth was what was missing for many of these women.

Unless you have continuity of care with one midwife, and you are her only birthing mother at the time, your midwife will not be there with you all the time. If you have continuous monitoring or a IV drip set up then there will be people checking up on you often – but they may be focused on measurements and machines rather than supporting you. Hours of labouring can become stressful for even the most prepared couples when you are uncertain how things are going, what is normal, what is going to happen next and how much longer it will be before your baby is here.

Also ask:
Why don’t we need support?

Are we expecting support from other people (eg, a relative, friend, midwife, doctor) and will they be able to meet our expectations?

Or, why don’t we want support and what does this teach us about what we are wanting from this birth?

Are we trying to prove we can do it by ourselves, and if so, why?

Are we are seeking an intimate, personal experience of birth, and if so could a doula help to preserve and protect this?

4. I don’t want to be told what to do or be mothered
There are many different doulas and they each have a different personality, a different age and stage in life, a different relationship to offer you. It seems very unlikely that any doula would tell you what to do, make you feel like a child, or take ownership out of your hands, especially if you tell her that you do not want to feel like that. Doulas want to support women to take ownership of their own births. It is more likely that if you choose the right doula for you, she will protect and preserve your birth space, your rights and your needs. A doula knows that birth is not about her – it is about you, your partner and your baby.

On the other hand, there may be other health professionals in a hospital, birth centre, or child health clinic who may “mother” you and make you feel as though you have been placed in the role of a child. There may be others who will tell you what to do without honouring your ownership of this birth, or your motherhood of your child. A doula can help to protect and cushion you from the impact of these interactions and reaffirm that you, your baby and your partner are at the centre of this birth.

Also ask:

What would an ideal birth support person be like for me?

Would it be beneficial to have my kind of support?

And if you want to dig deeper still, you may wish to consider:

Am I worried that letting someone in to support me will take away my power?