Monday, October 25, 2010

Doula. Do Whaaa...???

So here's the thing about babies.  You can buy all kinds of cute little clothes and shoes.  You can scour the interwebs for bargains on adorable furniture and accessories.  You can try to limit the amount of hideous plastic toys that end up invading your home.  You can plan to breast feed or bottle feed, co-sleep or crib sleep, stay at home or go back to work.

But no matter what you do, you've eventually got to get that baby out of your belly.

In a world where one in three (yes, one in THREE) first-time moms has a c-section, you basically have two options:  push it out of your yoo-hoo or cut it out of your guts.

Before I go on, I should say that I have hesitated to publish this post because a popped-out belly seems to be a beacon for unsolicited advice (or ass-vice, as others call it).  While I have welcomed some of it (mostly the sort that says I should nap whenever I feel like it), I also know that a lot of it needs to be tuned out.

Still, I am amazed at people who feel no need to research best practices, but just take what is "typical" as the best thing for them and their baby.  I know many people who seem to think that their particular experience is somehow a universal truth, or those who are willing to wipe away documented, statistical evidence with a wave of their hand: "Oh, it wasn't like that for me" or "Well, look at all the babies who turn out just fine."  Then there are those who seem to think that I shouldn't make any plans at all because you never know what might happen (trust me, I've pretty much imagined every possible situation and I'm choosing to plan for the best case scenario).

So I hesitate not because I think someone could make me doubt my decisions (I research and I analyze, it's what I do, and no anecdote is going to change my mind--also I'm stubborn once I've made up my mind about something), but because I don't want to come off as someone who's got it all figured out or to seem as though I'm criticizing people who have made a different choice or who have been forced to take a different path due to various medical issues.  We all have our reasons for doing what we do, and we're all trying to do the best we can.

Oh--and the thing about labor and delivery is that a lot of times you don't get to decide!  I've had people tell me that I shouldn't go into labor with lots of expectations because I will be disappointed if things don't turn out right. But I disagree.  Things do not always go as planned!  I get it!  But that doesn't mean that I'm not going to research and make plans so that I personally can make every effort toward having the kind of birth that I want.  If it doesn't work out, it doesn't work out.  But it won't be for lack of knowledge or effort on my part.

And the more I've read, the more I've come to the realization that I want to have this baby without unnecessary medical interventions.  This means that I want to avoid having a c-section, but it also means I want to avoid having an epidural.

Yup.  You got that right.  No epidural.

Let me state right away that (1) I know that labor hurts and (2) I am not the sort of person who would say she has a high pain tolerance.

I, however, am the sort of person who has a real phobia of needles.  (Please see this post for evidence of said phobia).  When I think about labor right now, the thing that makes me the most nervous is not the pain or the worry about pooping while pushing (although both are valid concerns that make at least the top ten list).  The thing that makes me nervous is the thought of having an IV in my arm.  I'm so horrified by the idea of a needle and a tube in my veins, that I can't even start to think about the rest of it. 

It's totally mental, yeah.  But that's why it's called a phobia.

At the same time, whether I'm abstaining from my most favorite summertime sport of drinking white wine out of doors (it's the out of doors part that makes it sporty) or choking down an enormous prenatal vitamin (I find that if I take them with grapefruit juice, they don't make me gag), I'm already in the mode of trying to do what I feel is absolutely the best thing for me and for Baby Duck.

Epidurals are relatively safe, yes.  But there are also some risks involved with any kind of drug intervention.  The most common risk (although I will acknowledge that this gets disputed) is that an epidural is likely to slow down labor, which then causes a need for pitocin (a drug to cause contractions) and these interventions can sometimes cause problems for the baby (too forceful or too frequent contractions can cut off oxygen to the baby) which can then result in the need for more drugs to slow down contractions, and all of these interventions can sometimes lead to an unplanned c-section.

I'm not trying to be a martyr when I say that I'm willing to endure natural childbirth--for me, personally, based on my research and my needle issues, I simply think the pain of natural contractions is a preferable alternative to the unknown and slightly riskier experience of having a huge-ass needle stuck in my back.  Other people (including many of the ladies in my prenatal yoga class) think that's crazy, and I don't want to try and change their minds.  It's just that the more I think about my best case scenario for labor and delivery, the less it involves needles and drugs.

At the same time, I have to be realistic about this.  I've never had a baby before.  I can't quite imagine what it will be like.  I also realize that going in with good intentions is not enough--the medical culture is set up to offer me an epidural, to monitor me continually, to give me drugs to cause contractions that I can't feel, and to tell me when to push.  If I'm going to resist that scenario, I have to be fully informed, but I also have to be fully supported by my doctor, my husband, and... my doula.

A few months ago, I'd never even heard of a doula.  It's a Greek word that means a labor attendant.  A doula stays with you throughout your labor and helps to coach you through labor and delivery.  A doula is not a midwife--she doesn't do exams, she doesn't have a medical license (although most--including mine--are certified through doula programs).  She does offer an experienced, objective point of view, alternative methods of pain management (including relaxation exercises and massage) and she offers lots of positive reinforcement.  As Science Daily reported in May, 2008, "During labor, the continued presence of a doula – an experienced non-medical female companion who provides continuous labor support – has significant beneficial effects for middle- and upper-class women in childbirth, even when they have their male partner or other family member with them, according to a new study in the journal Birth."  Doulas reduce the rate of epidurals and c-sections and can reduce the time a women is in labor by a significant amount.  In a recent study, women who had an epidural and women who had a doula but no epidural rated their pain level in labor exactly the same

Still, when David and I first considered having a doula, we were both pretty skeptical.  We decided that in the effort to have non-intervention birth that we'd take Bradley Method classes.  The Bradley Method advertises that over 80% of couples who take their classes experience spontaneous, non-medicated births and for a while we thought that the two of us would take these classes and have this baby and be totally fine.  We weren't sure we wanted to hire some stranger to be in the room with us and all up in my business, especially when there would be plenty of hospital staff there and up in my business.

But then I did a little more research and we thought about things a little bit more.  About how we deal with stressful situations, for example.  Having a baby is not exactly like traveling in a foreign country, but some aspects of it seem strikingly similar.  For example, in both cases, you're excited and happy to be there, but you're also probably a little anxious about all of the things that seem totally unfamiliar.  Maybe you don't speak the language well.  Maybe you don't know all the rules or customs.  I know from experience that if David doesn't feel totally comfortable, he's not likely to be very assertive.  And I know that if I am tired, hungry, and stressed out, I want him to be more assertive and to help me figure things out.  And then I get frustrated with him pretty easily.

So we talked about our experiences vacationing in other countries and we both agreed that on an initial visit, we really enjoy having a tour guide.  Someone who gives us plenty of opportunities to experience things on our own, but who is also available to answer questions, make recommendations for lunch, and help us navigate unfamiliar territory.  This was true when we signed up for tour groups to see certain sites in London and Paris, it was true when we had a guide assigned to our group in Italy, and it was true when my brother showed us around Seoul.  Some people are free spirits who would prefer to have their own adventures and see the world by trial and error.  My brother might be the kind of person who can just wander around Indonesia and have the biker guy with the ricksaw take him to whatever hotel is close and convenient.  David and I are the kind of people who like planned itineraries, hotel rooms booked in advance, and restaurant recommendations.

We both realize that the best-laid plans can't account for how labor will actually go, but in keeping with this insight about our personalities and the likelihood of encountering the unexpected, we decided that it might be a good idea to have a tour guide for this upcoming experience. We're still taking the Bradley classes, but with a doula, we will also have someone who stays with us for the duration of my labor, who will help David support me, and who will help me advocate for what I want (and don't want) at the hospital.

After we made that decision, it was easy.  We looked up a certified doula website, found a listing of doulas in our area, and compared bios, experience, and prices for doula services.  We interviewed a doula whose full time job is a chiropractor, and we liked her.  David liked her enough to overlook the fact that she's--gasp!--a Cubs fan.

But he did make her promise not to wear Cubs blue to the delivery.

So now we have a doula.  Basically, this means that as soon as I start having contractions, I can give her a call.  Before I would call my doctor, before the contractions are regular, I already have someone who has attended lots and lots of births and who has had one c-section and two unmedicated births of her own, who is on-call to answer my questions and help reassure me that things are going well.  (Of course, she can also recognize quickly if something isn't going well, and recommend that we head right for the hospital.)

She will come over to our house once or twice before we have the baby to get to know us a little bit and to help us work out a birth plan of what we want and don't want (examples:  I don't want an episiotomy, I want to try and nurse immediately, I want to donate cord blood, and I obviously don't want an epidural).

Once I go into labor, I'll give her a call and she will come over whenever we want her to.  She recommends laboring at home for as long as we feel comfortable doing so, or until the contractions get pretty regular and close together.  I think that having her here will help us feel more confident about staying home for a while, where I can eat, walk around, shower, and maybe even sleep, within the privacy and comfort of my own home.

When things really start moving, she'll recommend heading to the hospital (we've selected a hospital in our area known for being doula-friendly and respectful of birth plans) and will follow us there in her car.  She'll stay with us for the duration of labor at the hospital as well.  She will help remind David of massage techniques and changes of position for pain management and will also be another set of hands.  She will make sure that I am made aware of my options and she will help me communicate my choices to the hospital staff.

She will stay with us until the baby is born, and for a couple of hours after the birth.  She will assist with breastfeeding if necessary and will basically stick around until we feel comfortable and are settled in recovery.

A week or so after we're home, she'll come over for a final home visit, we'll talk about the baby's birth and how everything went.  If I need a lactation consultant in the days or weeks after the baby is born, she will be able to make recommendations and put me in touch with someone.

The service isn't cheap, but for what we're getting, I think it's actually reasonably priced and worth the money.  I feel more comfortable with the uncertainty of everything because we have a great resource right there with us.  As much as I love my doctor (and I love that my doula has worked with him before), I know that he won't be there until the very end.  He catches the baby, but he doesn't coach me during the hours of labor ahead of time.  If I am going to do this thing without medication, I am going to need a lot of positive reinforcement and someone to reassure me that I can handle it.  As much as I will rely on David for that stuff, I think having a more objective opinion in the room will be incredibly useful.  David also thinks it might keep me on good behavior...

I also think that if things don't go as planned--if I end up needing to be induced or needing to have a c-section, it will help me to be able to talk things over with a doula who can take the time to reassure me that we're doing what it takes to get a healthy baby and even if it's not the way I imagined things working out, they're working out for the best.

Although you can never be sure how labor and delivery will go, I am confident that this decision puts both Baby Duck and me in the best position for having a healthy, non-medicated birth.

So, yeah.  We're going to do the doula thing.

1 comment:

  1. OMG-- if you think the assvice is bad now, JUST WAIT UNTIL THERE IS AN ACTUAL BABY that people can pass judgment on you for taking care of. OMG. The things people think they can say to mothers. OMG. Especially about infant feeding.

    I have had two vaginal births, one with an epi and one drug-free. I hope to have another drug-free birth if and when I have another baby. For me, it was a much better experience even though it hurt like freaking hell.

    Like you, I had researched every possible angle, and I have to tell you, I am very jealous of people who don't question intervention-- I wish I could unlearn some of what I discovered in my research.