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Cascade of interventions

The Cascade of Interventions

Doula shoot-157

The Cascade of Interventions

If you are taking a childbirth class, you will inevitably hear the term, “cascade of interventions.” No, we aren’t talking about a waterfall or dishwasher soap that leaves your glasses sparkling. When it comes to childbirth, the cascade of interventions is a term used to describe how one intervention in birth can lead to another, and another, and another until the whole process seems to spin out of control.

Lets walk through what is considered a typical “cascade of interventions” in birth.

Our birthing mom goes into labor. She is excited! The day to meet her baby has finally come! Thrilled at the prospect of having a baby, she and her partner quickly pack their bags and head to their birthing place.

When she arrives at her hospital she goes through admissions, fills out paperwork, has some standard tests done, and receives a vaginal exam. She is found to be three centimeters dilated and her contractions have slowed a little. They are now five to seven minutes apart.

Because this birthing woman is five days past her due date, she is admitted. Protocols at her hospital demand she receive a mandatory IV. A needle with a bag of saline is hooked up to her and she is given fluids and her vein is kept open, just in case more fluids are needed later.

The birthing mother is attached to two straps, one to measure the fetal heart rate, and one to measure her contractions. This is known as continuous fetal monitoring and it often requires that the birthing woman not leave the bed because these monitors are easily disturbed or inadvertently moved.

The mother is now confined to the bed because of her monitors and her IV. In her recumbent position, she finds that the excitement for labor has dissipated and her pain level has increased. Her partner is feeling somewhat helpless as he sits to the side of her bed, blocked by the rails and his lack of knowledge.

The birthing woman is having vaginal exams every hour or two, and while her contractions are becoming more painful, her body seems to be making little or no progress. She measures just four centimeters dilated. Hospital staff has broken her water in an effort to help speed labor. Many believe that breaking water can encourage dilation and help the head drop and allow more pressure on the cervix.

After three hours of struggling in the bed, mom opts for an epidural to help her pain and allow her to rest. The epidural is not a stand-alone product. Along with her epidural comes a bladder catheter, continuous monitoring, more IV fluids and a possible intrauterine pressure catheter. The epidural gives her respite but slows the contractions. She is given Pitocin in her IV. Pitocin is known to help strengthen and speed contractions. The Pitocin seems to work well and her contractions speed and her cervix cooperates. After several more hours she is found to be 8 centimeters dilated.

Our birthing mother has now been in labor for many hours and her water has been broken for some time. The birthing woman begins to develop a low grade fever. It is hard to know what caused this- is it a side effect of some of the interventions so far, or is mom developing an infection? Mom is given two more hours to labor.

The baby and mother however, seem to have had enough. Her cervix seems stuck at 8 centimeters and the baby is not handling contractions well as time goes on.

Mom is prepped for a cesarean section. Her baby is taken via c-section, and a healthy 7 pounds 6 ounce baby enters the world. He has a little trouble breathing in the beginning and there is concern about mom’s fever that developed in labor. The baby is taken to the nursery to be observed for a few hours and is then brought to mom in a recovery room. Both mom and baby are healthy and recover in a normal period of time.

The above is one version of the “cascade of interventions.”

There are a few things to know about the above illustration:

First, this story, while contrived, is not totally fictional. Similar scenarios play out daily in hospitals around the country and world. While the specifics may vary, the general theme is repeated often. Maybe an induction was the first intervention, maybe the epidural, or maybe breaking water. However it happens, this “cascade of interventions” is a very real thing in childbirth today. For an uninformed couple, it can seriously derail their planned birth.

Laurie, a childbirth educator and doula in Calgary, Alberta, Canada, tells her story. "When we arrived at the hospital in labour, we were told that if I wanted an epidural I had to receive it right away as the anesthesiologist was going home for the night and would not be available. I said yes and was shocked by everything that came along with it. I had no idea about the swelling from the fluids, how awkward it was to feel pressure and to look to a monitor to tell me when to push. I knew the next birth had to be different so I educated myself a lot more as to how a woman's body works during normal labour and birth. My second birth was unmedicated and so much more freeing as I moved as I needed and voiced my intentions." Laurie's story shows that the consequences of even common interventions are often unknown to the birthing woman and her partner.

Second, interventions exist for a reason. All of them are necessary and sometimes lifesaving in appropriate situations. Because something is an intervention in the natural process of birth, that doesn’t mean it is wrong all of the time.

In fact, sometimes that first IV can be helpful and save a mother from a cesarean section- especially if the IV helped prevent other interventions that could not have been prevented otherwise. Sometimes an epidural for pain relief can also help prevent a cesarean section. And sometimes, a cesarean is needed to preserve life or health of the mother and/or baby. And sometimes, though we prefer not to think of it, women will prepare and do everything “right” and this cascade still happens, possibly out of necessity.

Thirdly, while “the cascade of interventions” is often thought of as a linear chart where one thing inevitably leads to another and it all ends with a c-section, this is not always the case. While this does happen, birth is far too fluid and unpredictable to script down to one clear page with an obvious ending.

It is also important to realize that the policies and procedures of your birth place can play a powerful role in what interventions will be required during your birth. As Hailie, a childbirth educator and doula in Abilene, TX says, "You have to understand that when you go into the hospital, there is usually a set protocol for their model of care. Your birth is not the time or the place to buck the system - it will not go well. If some of these protocols are not negotiable for you, it is truly imperative that you start researching other options for your birth location. You may want to look at a different hospital or a location completely separate from the hospital like a birth center or your own home." Your birth teacher and doula can be invaluable resources helping you navigate the birth options in your area.

Some have said that in birth the first intervention is walking out your front door. While that view may be somewhat extreme, the thought is one that is worth pursuing. We have become very accepting of the interventions of birth. In fact, some of them are so commonplace and “standard” that we no longer think of them as interventions any more. For most birthing women it doesn’t even occur to them to ask for intermittent monitoring in labor or to skip the IV or the epidural. Women are often surprised to find that they don’t need to have their water broken in order to have a baby successfully. The vaginal exam has become so entrenched in our model of care that women wonder how they will know to push without this external measurement.

Truly, the interventions possible in our labor and birth are many. While they are not always as predictable as is taught, it is well worth the effort and time to re-examine them for necessity.

As you go forward in your preparation for your own birth, take the time to learn about what the standard of care is in your place of birth. Talk to your childbirth educator and your doula about care providers in your area that adhere to the mother-friendly childbirth initiative. Learn in your birth class about each of these interventions so that when you experience your own birth, you understand what is happening to and within you.

Sometimes interventions are necessary, and they don’t always cascade, but you deserve to be a knowledgeable, confident, decision maker in this process and not a helpless victim.

 

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5 Ways Any Woman Can Feel More Like Royalty When She Gives Birth

5 Ways Any Woman Can Feel More Like Royalty When She Gives Birth

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It's royal baby time again and the world is buzzing with the news of baby princess Charlotte born to the Duke and Duchess of Cambridge. With the drama and pageantry of royalty, Kate emerged from the hospital just hours after giving birth in a springy gown, windswept curls and beautiful bundle in her arms. Some reports even claim that the Duchess delivered all natural and skipped the epidural. Who would have thought that something as everyday as giving birth could light the world on fire, not just because the baby is of royal blood, but because mom looked so great after giving birth.

And not everyone was happy! No, wherever there is birth there seems to be drama, hurt feelings, and accusations. While most of us don’t have our personal hairdresser show up before we leave the hospital, nor do many step out in three inch heels and flawless curls, more women CAN birth like the princess. In fact, more women DESERVE to birth like the Duchess Kate.

Without further ado, here are 5 ways any woman can feel more like royalty when she gives birth.

  1. Use midwives! - Word on the street (from the very reputable royal tabloids) is that princess Kate didn’t deliver the royal baby into the hands of a waiting surgeon- oh no. Instead Kate was accompanied by two faithful midwives as she birthed her first daughter. Tabloids reported that she “bonded” with said women and used them at the birth of her first child too. While we may not all get the royal treatment in a designated hospital wing for our birth, more women can (and should) choose midwifery care. In the US most women birth with OBs rather than trained specialists in natural births like midwives.
  2. Keep the OB, but just for emergencies. - The tabloids (and Wikipedia) also report that while Kate had her midwives there with her, she did have trained obstetricians near- but only in case of emergency. Most women in the US take an opposite approach and birth with trained surgeons and skip midwifery care altogether. In fact, OBs are a great resource for high risk women or for births that become high risk, but not every woman needs them. Many midwives consult with an OB in case a problem arises and refer out if needed.
  3. Feel beautiful- We have all seen the pictures of Kate, just hours after giving birth, radiant on the steps of the hospital. While heels and a new dress aren’t required, every birthing woman SHOULD feel beautiful when she is giving birth. She should be surrounded by support, love, and cheerleaders for this event. Why? Because a birthing woman IS beautiful. Each and every one of them. There is beauty in the raw power of birth and we shouldn't be surprised or angered by it.
  4. Be pampered- We all know that those luscious curls didn’t curl themselves. Kate has “staff”. And while you may not be a duchess of anything, you deserve to be pampered during and after your birth. Every woman, no matter her situation financial or otherwise, could use some help around the house, cooking meals, cleaning up, and giving her a chance to bathe and practice self care. Yes, even you. It might be someone in your family, your partner, or even a postpartum doula.
  5. Supportive partner- Who doesn't love those pics of the Duke himself holding their older child or looking on with awe? Every woman should have a partner who loves her, supports her, and is an active and integral part of her pregnancy, labor, and postpartum. Partners matter and they don’t have to be a duke to be awesome and prepared.

Anytime a celebrity has a baby the world pays attention. It is a beautiful thing that we still get excited about something as commonplace as birth. And while royal births aren’t realistic for most of us (and who would want to have a photo shoot in heels just after giving birth or the pressure surrounding that?!) we can remember that birth and the women who do it deserve to be honored, respected, and cared for during this time. As Ina May says, ”If a woman doesn’t look like a goddess during labor, then someone isn’t treating her right.”

Maybe we need to treat birthing women a little better.

What Makes Birth Boot Camp DOULA training different?

What Makes Birth Boot Camp DOULA Different?

What Makes Birth Boot Camp DOULA training different?

What Makes Birth Boot Camp DOULA Different?

We know that the prospective doula has many certifying organizations to choose from. When choosing to certify as a doula, you should look carefully at each organization and choose one that has traits that will serve you best as you embark on an incredible and fulfilling doula career.

What makes Birth Boot Camp DOULA different from other doula certifying organizations?

-Birth Boot Camp DOULA requires extensive pre-certification reading-

Our doulas read many books and are expected to also own and be familiar with several more for use in their doula practice. Not only are you expected to read these books, we want your feedback. What did you learn from them? What did you love? How will these books further help you as a practicing doula? Our doulas are accountable to us, to their clients, and to themselves.

-Study guide submitted BEFORE training-

In addition to your reading, there is a comprehensive list of questions that you will receive once you have applied to become a Birth Boot Camp DOULA. As you read your books and study, you will fill this out. Two weeks prior to your training, you will submit your study guide (including reading material reviews) to our Birth Boot Camp DOULA certification coordinator, Nancy Rebarchik. Yes- two weeks BEFORE training!

We value this work being done before we meet together for our incredible training experience because it carries many advantages. All our training doulas are on the same page, with the same basis of knowledge. While some may be training as doulas after working for years as L&D nurses, and some may be attending training just after finishing high school and before giving birth themselves, all will have the same basic knowledge necessary to help them be the best doula possible for their clients. Our doula training is not your chance to learn what birth is about- you have already done that!

-All inclusive!-

Maybe you have noticed that many doula trainings expect you do other learning before training also. Often this additional training involves breastfeeding education or childbirth education or both. One thing that is different with Birth Boot Camp DOULA is that we include almost all of this childbirth education and lactation training WITH the single cost of your training. The only exception to this is our requirement for a blood borne pathogens exam which can be completed for a nominal fee through a few respected organizations.

When you register as a doula trainee with Birth Boot Camp DOULA, you will receive access to our 10 week childbirth education online classes. This is INCLUDED in your cost of training. No searching your area for a birth teacher and hoping she will let you watch her teach. No coming a day early for training and paying extra to take a crash course in childbirth with your doula trainer. You get the same intensive, quality, childbirth class that is taught by Birth Boot Camp instructors as part of your training.

-Breastfeeding education and advanced lactation training-

We mentioned that your training price is all-inclusive, right? This includes two things. First, each trainee watches three hours of video, Breastfeeding: the Ultimate MRE. This video taught by an IBCLC, is a fabulous piece of breastfeeding education. Then, at training, each doula trainee has in-person advanced lactation training from Mellanie Shepphard, IBCLC which focuses on the special role of the doula in the early days of breastfeeding. There is no need for you to scramble to find a breastfeeding class in your area and “hope” that it will prepare you for the incredibly important task of assisting a new mom with her first days of breastfeeding. We provide this for all our trainees at no additional cost AND on a consistent, quality basis. This benefits both you and all your future clients. We want our doulas to be confident and capable of providing excellent breastfeeding support for their future families.

-Community and camaraderie among our instructors and doulas-

Many doulas feel so alone when they first start. They are trained up and eager to serve birthing women, but they feel lost and they themselves have no community or support. The work of a doula is both sacred and emotionally taxing. You will need community and support just as much as the women you serve. Birth Boot Camp DOULA provides this. As a company we adore our instructors and doulas and recognize that without them, we are nothing. With constant online support from your peers and trainers (see below) you will never be alone. You will always have a supportive and strong community to build you up no matter the circumstance. Whether you have attended a birth that was difficult for you, or if you just need tips on marketing and community work, we are here for you, every step of the way.

Birth Boot Camp DOULAS support each other.
The relationships built at Birth Boot Camp DOULA training last a lifetime!

-High quality materials-

One thing that has always been important to us as a company is high quality materials for our instructors and our doulas. We want you to be proud of what you are doing and be able to easily share it with those you come in contact with. We want to make it easy for you to reach out to women and care providers in your area with professional, beautiful materials tailored for your market. Not only will you have access to marketing materials, we provide all our doulas with stock photography that they can use in their own personalized business promotional materials for print and online.

But wait- there’s more! Birth Boot Camp DOULAS have access to the Supporting Arms booklet for their clients which helps organize your pregnancy and postpartum visits and helps with what education is needed with your clients. You will love this book, and so will they. It was designed by doulas for doulas.

Birth Boot Camp DOULA materials are beautiful!
Birth Boot Camp DOULA strives to provide the highest quality materials to our doulas so that they always make a great first impression.

-No certification births-

Our doulas are not required to attend certification births before they are officially trained. We respect you, your time, your value, and your in depth training too much to require such antiquated, doula de-valuing practices. Read more about that here.

-You come to us!-

Yes, we realize that not all doulas live in Dallas/Fort Worth and we realize that many other doula trainings will virtually appear in your backyard for certification. We don’t do this. There are many reasons to travel for doula training. Because our training is so comprehensive and awesome, we have a big team that we bring to the table. They are too expensive to cart all over the country, so you come to us. Not only does this keep the cost of our doula training down, but it helps encourage the community and closeness of our doulas that we feel is so important to doula career sustainability.

-Sustainability-

What does sustainability have to do with doula work? A lot. There are many people who train and try out doula work but only practice for a few short and struggling months or years. We train doulas for the long haul.  We want your doula practice to be sustainable for you, your family and your community. This means you don’t help a few women at a reduced price before you burn out and can’t take it any longer. You build a career that supports you and the women in your community. Doula work for the long haul is something we feel strongly about and which we support you in. We can’t express how important this is.

-Business training-

This plays into sustainability because no matter how perfected your double hip squeeze, if nobody hires you, you can’t use it. There are other doula programs just starting to provide business training for doulas separate from their regular training. Again, we include it along with everything else. Business training isn’t an add-on that you pay for when you have enough money- it is an integral part of your training.

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Your doula trainers, Amanda Devereux and Maria Pokluda are two incredibly successful and professional doulas in their own right. They were chosen by Donna Ryan to lead this program because not only are they good at what they do, they are respected in their community and have built careers out of doula work. They didn’t take a training to become a trainer. They were hand-picked because of their unique skill set. You will learn so much from them at training (and after) that you will treasure as you build your own business. Not only that, they treasure you. They are there for you, to answer your questions, provide support, and even be a shoulder to cry on, if that is what you need. You won’t realize how much this matters until you need it.

-Relational support-

You have probably never heard of the term “relational support” and you wouldn’t be alone. This is something sadly unique to Birth Boot Camp DOULA but one of the most important parts of our training. In fact, this will help you in your doula business more than learning tricks or jam packing your doula bag with fancy comfort do-dads.

You are a passenger on the journey of pregnancy, labor, and birth with a woman and her family. Knowing how to support them on an emotional level is a gift you give to them, their birth, and yourself.

Birth Boot Camp DOULA is a new program right now, but it is not a recycled version of all the other existing doula programs out there. You would be surprised how many current  and already certified doulas come train with us for this reason (and those listed above.) We provide something unique that you will get at no other training. You get it for one price, in one place, with a quickly growing group of amazing women who will mentor, support, and lift you up in the years ahead as you practice as a fabulous doula. Join us. You won’t regret it.

 

What is it like when my water breaks?

What Is It Like When My Water Breaks?

What is it like when my water breaks?

What is it like when my water breaks?

If you are pregnant, you have probably started to wonder what it is like when your water breaks. And if you have ever watched television or movie depictions of birth, you may have some very firm ideas about what happens when your water breaks. Maybe it looks something like this:

Your water breaks suddenly and powerfully! Oh no! Just as you enter the freezer aisle at your local Piggly Wiggly, you are startled by a loud “Pop!” and suddenly your cart is slipping quickly past the frozen fish fillets. Yikes! Clean up on aisle three! Immediately after this explosion of amniotic fluid, labor starts with a vengeance and you can barely make it to the car before a newborn the size of a four month old comes sliding out of your nether regions. Whoa! Labor is scary and FAST!

Well, well, well…

The way water breaking is usually portrayed in the media is actually not how it happens for most women in a real life birth. The bag of water that protects your baby as it lives inside you is an incredible thing. It provides cushioning, prevents bacteria from getting to the baby, aids in lung development and it even keeps baby at a constant and comfortable temperature. While we think of the breaking of water as a minor emergency, it is actually a very normal part of labor that has many variations. Now let’s talk a little bit about how things (usually) go when the amazing amniotic sac breaks.

My water will break EVERYWHERE!

We tend think of water breaking with a bang. Suddenly dad is soaked or mom is standing in a telltale puddle. Sometimes the bag DOES burst all over the place with great drama and power. Birth Boot Camp instructor Emily in Minot, North Dakota, said that, “ I was kinda pushing and yelled, "The baby's head!!!" and my midwife came running back into the room. Then, POP! Water explosion. It hit the wall!”

For Jill, a birth teacher in Fargo, North Dakota, people could hear her water break in another room! “I was sitting on the toilet when my water broke. I announced to my birth team in the other room that "My water broke!” to which they replied, "Yeah, we heard!"”

A startling gush of fluid is not, however, the only way your water can break. Caryn, one of our instructors in the Dallas/Fort Worth area describes how the experience was different with each of her VBAC (vaginal birth after cesarean) birth experiences. “With my first VBA3C, water really did break in early labor and I had the baby within four hours. With my second VBA3C, I thought water broke but when I got to the hospital, it tested negative (I think it was a high leak) and I was sent home. I had the baby 24 hrs later and water really broke in transition.”

Some women, like Caryn, feel a gush of water but then test negative for amniotic fluid. (If you believe your water has broken, your care provider will often test to see if the fluid is urine or amniotic fluid.) Some will experience a “slow leak” of amniotic fluid. Rather than a burst, the fluid will trickle intermittently, possibly only when you have contractions. While this can necessitate the need for maxi pads to catch the fluid, the situation isn’t impossible. In fact, some believe that the bag of water can re-seal, just like what seems to have happened with Caryn.

What do you do if your bag of water leaks?

Make sure you know what your care provider recommends in this situation. Some may recommend you come in for a check, and others may just want to be kept in the loop and are happy to have you labor at home for a while. Some may want you to periodically check your temperature. They will often ask you to notice the color of the water. Amniotic fluid should be clear and odorless. They may have you empty your bladder to make sure you aren’t leaking urine rather than fluid. If your water has broken, there may be extra concern if you have tested positive for Group B strep. Your provider’s main concern when water breaks and labor doesn’t start is the risk for infection. so ask them what they recommend. They will discourage you from putting anything in your vagina and may use vaginal exams with caution so to prevent the introduction of bacteria.

 When your water breaks and labor doesn’t start, this is called premature rupture of membranes (PROM) and can be a cause of concern. This is particularly concerning for some providers if you are before 37 weeks in your pregnancy. However, labor almost always starts on its own within about 24 hours. And while we think of the amniotic fluid as a one-shot deal, it actually replaces itself constantly so there is no such thing as a “dry birth.”

Breaking water starts labor, right?

While we think that water breaks and then labor starts, this is another misunderstanding perpetuated by media representations of birth. In truth, often the early part of labor is “invisible” and involves the cervix dilating and other things happening that go on inside the birthing woman’s body. While this is beautiful and natural, it doesn’t make for very good television, so the media fast forwards to copious amounts of amniotic fluid spillage and screaming women in wheelchairs.

In reality, water can break at any time during labor. In fact, often water breaking is one of the last things that happens. Your water can break during pushing, and sometimes doesn’t break at all! For Julia, a birth teacher in Grapevine, TX, that is how it worked for her. “With my first birth, water broke in the birth pool, but at top. A bulging bag of water came out ahead on baby's head, intact, filled with water.”

This phenomenon called “being born in the caul” is fairly rare, but does occur and makes for some incredible pictures. Being born “in the caul” is considered by many to be good luck!

What if my water never breaks!?

This is a sincere concern for women. But, as mentioned above, breaking water doesn’t actually have to happen in order for the birth to take place. Artificial rupture of membranes (AROM), is however a commonly done procedure in the induction process. When women are induced to start labor, the bag of water is often broken with an amniohook at around four centimeters dilation. You may want to ask your care provider what their policy is when it comes to breaking water to encourage or speed labor. This matters to you because women are often on a time clock once water has broken and are expected to birth within about 24 hours.

What is it like when water breaks?

So, what IS it like when water breaks? The answer to that question really varies from one woman to the next. Some (but not most) will begin labor with the stereotypical “burst” in the grocery store. Others may notice an intermittent trickle or leak of their bag of water. Some women will complete most of their labor before water breaks during transition or pushing. Melissa, a Birth Boot Camp instructor in St. Cloud, Minnesota said that, “With my unmedicated birth, I distinctly remember having a contraction and feeling like something was in my way. I gave a little push at the peak of it, and broke my water myself. I wasn't numb, so I literally could feel my bag of waters getting in baby's way!” A rare few may even deliver their baby “in the caul”. Whatever happens to you, it is probably normal to some degree. After all, there are many variations in the timetable of labor and birth and each woman experiences them a little differently. Your birth class will prepare you for whatever happens.

Check out our founder, Donna Ryan, talking about what it is like when your water breaks.

 

cesarean rates lowered with childbirth education

Childbirth Education Helps Lower Cesarean Section Rates

cesarean rates lowered with childbirth education

Childbirth Education Helps Lower Cesarean Section Rates

At Birth Boot Camp we love being a part your life as you prepare to welcome a new baby into the world. There are many things we strive to teach in our comprehensive childbirth education classes. From nutrition and exercise for mom, to common tests and procedures, to learning to relax as a couple, we teach a truly comprehensive childbirth class.

One of the results of this all encompassing childbirth class is that our students have a lower cesarean section rate than the national average. And we feel that when they do need medication or surgery to assist in the healthiest birth possible for them, they are better prepared for this situation and hopefully more at peace with their birth, no matter how it goes.

We are proud to present the statistics for our students (both online and live classes) for 2014.

What do students get from their Birth Boot Camp childbirth class that helps make it so effective?

- 10 weeks of instruction-

Each series is 10 classes. Yes, we know that you can take a shorter birth class, but we don't feel they are nearly as effective. There is so much to learn about when it comes to birth, and we want our students to be prepared for all of it. This reduces fear and raises awareness. It also gives couples time to get to know each other and communicate together and with their birth team.

Here we talk about all the incredible topics covered in this 10 week class- for both our live classes and the online version.

- Field Manual-

Yes, not only do our students show up for 10 weeks, but they do their homework! This is part of the reason why the class is so effective. We truly believe that education can help you have an amazing birth. And the homework is worth it!

Check out the beautiful Field Manual that every student receives.

-Breastfeeding-

We realize that no matter how the birth goes, having a baby is about so much more than just the birth. Breastfeeding preparation is a huge part of what we do. Every student receives a breastfeeding download, "Breastfeeding: The Ultimate MRE" as part of their series. This is theirs to keep forever and is so helpful in achieving a successful breastfeeding relationship.

Join a class near your or take our online class to maximize your chances of an amazing birth!

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