Do you need a doula?

When most people think of labor support, they conjure up images from movies and sitcoms: the idea of nervous dads and meddling mothers-in-law, in a scenario of total chaos where everyone freaks out so much they pay little attention to the laboring mother. I've talked to a few people who, if they even know what a doula is, think they're a waste of money and would never hire one, because they have their husband, after all. This is really quite unfortunate.

I'm not downplaying or underestimating dad's role as labor coach. Some dads are terrific - rocks of strength and support for their laboring partner. Some are not - quivering, uneasy blobs of jelly who hit the floor the moment the first real contraction hits. And some are on the fence - they want to support their partner in labor, but often fall prey to the hospital staff who sometimes use fear and scare tactics to get mom to comply.

This is where a good doula comes in. Perhaps not just to support mom, but both parents in labor.

A few days ago a most disturbing blog entry was posted on My OB Said What?!?. A mom was going over her birth plan with the OB, and requested no pain medication. The OB responded, "That's okay, we'll just get your husband to sign the release and give you an epidural anyway."

I can't think of anything more repulsive.

I'm not even going to join the "at least they were honest" crowd, because regardless of whether it's a bad joke or not, it's downright despicable. And clearly it's obvious that this doctor willingly uses dad as a pawn to manipulate the mother into things that she doesn't want and might not even need.

Some OB's, in discussing birth plans or other details with the female patient, will completely overlook mom and make eye contact with dad instead. As if he's her overseer; her boss, her daddy, if you will. This is why it's so important for both parents to be on the same page about birth wishes. And if they're not - if dad is on the fence - I strongly recommend a doula, who will help both mom and dad in the process.

This is another reason why it might not be a good idea to have dad, or another family member, as labor coach: they love you, they don't want you to suffer or be in pain. If dad, or mother-in-law, or whoever, is quavering even a little bit, that fear comes out and someone will tap into it: whether it's an overbearing nurse or a doctor who just wants to get it over with and move on to someone else. Having a neutral third party there, if doctors and nurses are unsupportive or blase about mom's birth plans, is essential.

I also recommend hiring a doula if you you have no labor support. Mothers whose partners are deployed, or where family is far away, could greatly benefit from having a doula. Think of all the inductions that take place simply because mom is waiting for parents, grandparents, sisters, etc. to roll into town. Just because of this perceived lack of support, mom now puts herself at greater risk of cesarean section and a whole host of other potential complications, and for what? I often think that if women and their loved ones knew what an induction entails, and the complications that could - and often do - arise from them, they would never want you to go through all that just for their sake.

If you desire a natural, normal birth like the woman mentioned above - with no induction unless absolutely necessary, no Pitocin and no epidural - then hiring a doula is probably the best thing you can do. While there's definitely no shame in asking for drugs if you need them, you should not buy into the illogical farce that you absolutely need drugs to get through labor, because you might not. It's the doula's job to remind you of that, much to the chagrin of the OB. While some hospitals are completely supportive of natural birth, many are not, and those women who truly want that experience might find it hard to combat aggressive nursing staff or the idea that they are stupid, uneducated or ill-informed because they recognize the risks of pain meds and want to forego it if they can.

Mothers who are attempting a VBAC or twin vaginal delivery would likely benefit from having a doula as well, mainly because women in these situations are finding increased pressure to perform a cesarean because the medical establishment sees these scenarios are increasingly seen by the medical establishment as "dangerous" or impossible

Another group of women who could benefit tremendously from a having a doula are teen mothers. There is already so much negativity and bias towards young mothers while they're pregnant that it often makes it very difficult for them to find support while in labor. Their youth, coupled with the possibility of being completely uninformed about the birth process, as well as their rights and choices in childbirth, can make it a disastrous situation that no doubt ends with more primary c-sections. Not to mention it further embeds a very abnormal view of birth in their minds, which is hard to erase or change.

Yesterday I had a wonderful conversation with a friend whom I am going to lobby hard for this year to become a doula. She has been the labor support person at almost all the births of her grandchildren, and attended nearly two dozen births while working as a crisis teen pregnancy counselor. She told me one interesting story of a young mother who was in active labor, and the nurse wanted to give her Pitocin.

ML showed up at the birth and the nurse demanded to know who she was. Nurse Ratched then told her that the patient needed to be put on Pitocin, and ML demanded to know why. "What do you know about Pitocin?" the nurse asked defensively. In other words, How much can I get away with telling you before you'll realize I'm giving you a load of crap?


The nurse explained that they needed to free up more beds on the L&D floor, to which ML replied, "This girl is already in active labor. Go speed up somebody else's contractions."

As far as ML is concerned, I think she'd make a great doula. She is compassionate, caring, and yet outspoken. Even if you don't know the ins and outs of something like a doctor or nurse would, just asking questions - "Why do I need to do this?" - makes a world of difference. And if they can't give you a good answer, chances are you don't need whatever they're selling.

ML affirmed my opinion that teen mothers - who are already in a position of vulnerability - are often the scapegoat of frustrated care providers who are out to "teach them a lesson" because they got pregnant so young. No one needs that care and support more than someone who is not that far out of childhood herself.

Studies have shown that doulas can actually decrease the rate of epidural use and cesareans (although they most certainly can attend you if you do have a cesarean). Although I kept an open mind about pain relief when I had my VBAC, my doula was - literally - a focal point for me while in labor. She talked me through it, was supportive and focused on me, and I focused on her. It was literally like having an extra person there to guide my husband in his support for me, too, so that the care and attention he paid me was more productive and meaningful. (In other words, he didn't look at the monitor and say, "Looks like another contraction is coming!" like he did during my first labor, God bless him.) Following the doula's lead can encourage other family members who might be present not to contribute to the general freak-out factor when they see how things can progress normally, without such a sense of urgency.

Unfortunately, some doctor practices forbid the use of a doula, which in a strange way I find sort of comforting. Not only does it tell you that perhaps your control-freak doctor might not be the right fit for you, but it effectively admits that the doula can be a symbol of peace and calm, yet power all at the same time. Because of her neutral advocacy, she is there to remind you that yes, you can do this! and provide mother-focused care that the OB might not, which means you just might get the birth you want and deserve.

More recommended reading:
Doulas of North America (DONA)
Statistics on doulas and how they can help in labor
He Ain't Creepy: He's My Doula

"He ain't creepy, he's my doula"

I've heard some buzz lately about a new Vince Vaughn movie due (no pun intended) to come out next year called "Male Doula." To some people, this might be the first time they ever hear the word, much less understand what a doula does.

My first exposure to doulas was back when I worked at a newspaper, and the reporter in the cubicle behind me was doing an article on them. I never dreamed I'd ever understand their importance during labor and birth, much less hire one myself one day.

Hot towel, anyone?

Although our conversation about male doulas on my FaceBook page was meant to be somewhat comical, a reader posted a link about real-life male doula Keith Roberts, who has been serving his clients for over a decade. He rides a Harley, brings a crockpot to warm towels, and helps assist a laboring mother just the way any other doula would, with one exception: he's a man.

This article recounts his time as a massage therapist, and how that segued into becoming a doula. He also tells the rather sad tale of being relegated to watch the births of his two children from behind glass because he, like so many other men in that time period, was barred entry to the delivery room.

There is, apparently, some controversy surrounding male doulas. Some - even members of the Canadian Doula Association, who has no male members - wonder if they are "sickos who get off on childbirth," according to the association's president.

Some find them creepy, and on some message boards I've read, women have said they wouldn't want a man filling that role. Some have even asserted that midwives should be female, too, which I find absurd. If they can offer talents and a level of skill that prevents you from unnecessary interventions and cesarean, and they just happen to be male, are you going to turn them down?

I find that so sad. Yes, there probably are some people who have their weird fetishes, but honestly - would they go to the trouble of getting themselves certified? Why is it that we automatically assume, as our predecessors of the 1960s and 70s, that men who want to support a woman in labor either can't possibly know what they're doing, can't be taken seriously because they don't have a vagina, or are a threat - and are therefore useless in the labor room?

Perhaps Mr. Roberts can provide support to the dad as well, who is often a sounding board for ideas and threats against mom's ability to labor. If there is a supportive male presence in the room to help bolster dad, then he can be a better support system for his laboring partner. When a doctor wants mom to give in to a particular intervention and mom isn't agreeing, they often look to dad in order to strong-arm the patient into consenting. If dad caves in, then mom sometimes follows.

One dad, whose wife had a 40-hour labor with the assistance of Mr. Roberts, said he didn't mind his presence and the couple felt they never would have had the natural birth they desired without Roberts' help. Dad also didn't consider it any different than having a male doctor.

And as it was pointed out, Dr. Biter - who has been nicknamed "Dr. Wonderful" - is very patient-supportive and often called a 'male midwife in disguise.' What's the difference? Dr. Biter, and every male OB out there, have never given birth; but it doesn't mean they can't give you quality care. And really, there are lots of female OBs who probably have never given birth either - so does that really have to be a qualification?

As far as care provider gender preferences, some people prefer a female OB because it's perceived that she is more connected to the pregnant patient by virtue of the fact that she's female, or because she has children, so that makes her a "better" caregiver. However, it's been my experience - and probably lots of other people - that that "connection" somehow gives her the authority to coerce or lead you into certain decisions because "I have a uterus, too, so I know what it's like." Um... not quite.

One man mentioned in the article was apparently barred entry into midwifery and prenatal yoga teaching classes because of his gender, which I find perplexing and sexist. Who's to say he doesn't have anything to offer his clients, even though he's male? I find it sad that our society assumes that there is something somehow wrong or sick with a man wanting to fill a role otherwise reserved for the stereotypically nurturing female. It reminds me of the British dad who was confronted by another female parent because he was photographing his children - and no one else's - while out in public, and she suspected he was a pedophile. Why? Just because he's a male? People often want men to be all warm and fuzzy and "get in touch with their female side!," and yet when they do, they're either perceived as "sickos" or homosexuals. Huh? Just because they're not grunting, standing glassy-eyed in front of the TV, beer can and remote in hand?

As for Mr. Roberts, while he was denied the privilege of supporting his wife Jane in the births of their children, he acted as a doula to his daughters during the births of his two grandchildren. Good for him!

Debbie Young, president of DONA International, thinks that "it takes having a warm heart, a passion for helping pregnant and postpartum women and the training [to make] you a good doula," not whether you're a man or woman, or even if you have personal experience giving birth. I agree!

Regardless of whether the doula is male or female, they've been shown to do tremendous good to the laboring mother. Anyone who can help you manage pain, possibly lower your chances of having a cesarean and just provide attention and support in what can be a somewhat chaotic, sterile environment, is worth it to me, regardless of gender. Who wouldn't want that?

More reading on gender bias and obstetric caregivers:
Burn the Male Midwife! - Rixa Freeze at Stand and Deliver

Low Expectations: Labor Pain Management

I often visit a ton of forums that deal with pregnancy and childbirth, and am saddened, shocked and amused at what I read. The perceptions that women have - and pass on to each other - often frustrate the crap out of me, and I wish we could somehow erase all those myths, misperceptions and unfounded fears that often swirl around being pregnant and giving birth. 

Pain management is one of them. One forum that I used to frequent often had first-time soon-to-be-moms asking questions like "How will I know I'm in labor?" or "How badly does childbirth hurt?" All perfectly good questions, that are usually met with total crap answers. Of course, the minute the semi-crunchy granola mom like myself answers those questions you're usually scoffed at or blasted for your opinion that pain is different for each woman. "Trust me, honey," one woman says, "you'll want that epidural!"

Well, not necessarily. I am totally not trying to sound like SuperMom in need of a "vag badge" (good Lord, I hate that expression!), but geez, pain management is different for everyone! I usually tell people, when they ask, that you should take it as it comes - not insist for an epi the minute you step off the elevator - but wait and see what happens. You might get through it and say, "That wasn't too bad," or maybe need something like Nubain instead. There are alternatives to an epi that can bring some relief, or at least relax you so you can focus on the business at hand. 

I had Nubain with my vaginal birth and while it didn't do squat for the pain, it at least made me not care about it. LOL I remember getting half way through my delivery thinking, "Maybe I should get an epidural." Then I thought, "Nope, too late for that." (Maybe it was the Nubain talking? Who knows. LOL) 

With my third child, I essentially went through the entire labor, minus the pushing stage, and didn't have anything. It wasn't anything terribly unmanageable until my water broke, and even then, changing positions totally helped. That's the thing - pain is different for everyone, and can be totally dependent on a number of things: your positioning, the baby's positioning (back labor stinks!), and especially your state of mind. If you go into it with another woman's idea of what pain is, simply because they told you "you'll want that epi!," then you're bound to be scared to death and clenched up tighter than a clamshell about to relinquish its prized pearl. 

Midwife Ina May Gaskin has a terrific analogy for this, which she calls "Sphincter Law," as far as relaxation and dilatation during labor. Picture a man who's been offered a $100 bill, if only he can pee in front of 50 people. There's no way that's happening, right? Just like some people can't go to the bathroom in strange places, giving birth can kind of be the same way for some people. If you're more focused on the pain, or especially the idea that strange people are in the room looking at your female parts, then you cannot relax and neither can you effectively dilate. Some women no doubt become exhausted at this point and stall, causing the cervix to stop opening. 

One thing I did to encourage dilatation was to meditate and picture in my mind the cervix opening up, almost like a flower. I pictured the chart in my doctor's office that shows the different stages of dilatation, and made a circular shape with my hands to further illustrate that point to myself. For my third baby, I actually carried the lid of a coffee can (which is roughly the same size as a fully dilated cervix - can you believe it?)  around in my purse LOL and looked at it whenever I thought about it. (Perhaps it worked a little too well, then, when I showed up at the hospital and my water broke as I was signing myself in!)

Other ways to manage pain in labor can include massage, walking and changing positions. With my second baby, she was nearly posterior, which meant painful back labor. Lying on my left side encouraged her to turn, which made the pain much more manageable. Having a doula present can also help by keeping you focused on something other than the pain, and has been shown to decrease the rate of epidural use. Either way, if you decide to have one, then that's perfectly okay - some women have other issues going on that might necessitate having one, and there's nothing wrong with that. 

Whatever happens, I encourage women to take it on a "let's wait and see" basis, because you just never know how things will turn out. If you go into it having low expectations, then they will almost always be met. But if you think positively and say to yourself, "I think I can do this!," you might be pleasantly surprised. 

Better Late than Never: A VBAC Success Story

Just the other day I got word that an acquaintance had a successful VBAC. The baby was ten days (yes, 10) days overdue and weighed 9 lbs. 6 oz., I believe - the high side of normal and nothing terribly huge. The mom told me that she hired a doula for this labor (yes!) and had a great practice of midwives (even better!) and it sounded to me like a much better experience than before. 

With her first, she labored for about 17 hours and failed to progress. I think she did mention how nurses were very pushy about getting an epi and finally, she caved, which is probably why she never fully dilated. I assured her early on in this pregnancy that a doula would help her to stay more focused, and while she could have the epi this time around, her doula would be a non-partial advocate for her that could take her mind off the pain. 

I didn't want to be too pushy about suggesting a VBAC but was elated when she told me she was going to try for one. I figured I'd offer her advice based on my experience but not get too overbearing. So when she told me she was hiring a doula, I figured she'd done all the right research and would be just fine.

Welcome to the world, little man, and you can thank your mommy later for letting you come in your own sweet time.