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What Your Doctor Wants To Tell You About Birth, But Can’t

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Too often, medical doctors are portrayed as the bad guys in the birthing world. In truth, there is a lot we don’t see and which they really can’t talk about. We are excited to share this guest post today from Jessicca Moore, a family nurse practitioner and filmmaker in Petaluma, CA. Jessica is currently raising money to help finish a film all about medical personnel who birth at home. (There are more of them than you would think!) You can read more about her film, “Why Not Home?“, on their website. Her words are wise and incredibly helpful. Happy birthing!

If you’re planning a hospital birth in the US, you’re likely seeing an OB/GYN. Some of you are seeing a family doctor or a certified-nurse-midwife (CNM) who will attend you at the hospital.

Doctors and nurses are trained not to impose their own values and beliefs onto their patients. To the woman who says she doesn’t want to feel any pain during labor and wants an epidural as soon as possible, our training tells us to accept this as her choice and support her in it. To the woman who says she wants an unmedicated natural labor, our training tells us to accept and support this choice as equally valid.

Your provider is supposed to maintain some professional distance and remain unbiased toward her patients. Because of this, she likely won’t tell you about how difficult her recovery from her c-section was and how she couldn’t pick up her toddler for weeks.

She won’t tell you about the intense rush of emotion and joy that came over her when she gave birth to her daughter after a long 30 hour unmedicated vaginal birth. If she did, you might feel like you should do it the way she did, or do it differently, depending on her story.

In your 10-15 minute visits, it can be hard to delve deeply into all the possible risks and benefits of each decision, the research, and your personal values and preferences. Even if you did, the chances that that provider is going to be the one attending your birth are pretty slim.

So much of birth is out of your control. Once you’re in labor, things can go any number of ways.

If you want to have a natural birth, here are some things you can do to stack the deck in your favor.

  • Get prepared. There are lots of great childbirth preparation programs out there. Try a few and see what fits. Knowledge is power when it comes to birth.

  • Read birth stories. Positive ones. Listen to your friends who had great births. Focus on those. Your birth can be great too.

  • Get support. Hire a doula. Don’t think you can afford one? Call and talk to a few. You may be surprised. If you can’t get a doula, ask friend who has experienced birth and knows your plan to be there to support and advocate for you. Your partner will be having their own experience. Don’t rely on them to be everything for you.

  • Get informed. What is your hospital’s c-section rate? Trying for a VBAC? What’s the VBAC success rate at your hospital? Birth by the Numbers has a great site for getting this information. www.birthbythenumbers.org

  • Ask questions. Especially if something doesn’t feel quite right. Is the induction necessary? What if we wait 2 more days? It’s your body and your baby. You’re allowed to ask questions.

  • Take care. Rest. Eat well. Stay active. Try prenatal yoga. You’ll be that much better off entering labor if your body is strong and healthy.

Do all that, and then let go. Birth is big. Birth is beautiful. There’s no one right way to do it.

You are powerful. You are capable. You can do it.

If and when you need help, it will be there for you.

No one can tell you how it will go for you.

You and your baby are starting your journey together. You’ll have your own unique experience.

Your doctor may have seen hundreds or thousands of births, but they’ve never seen yours.

Nurture Nature Photography and Erin Wrightsman -c- 2013 erin@erinwrightsman.com  2013040920130409-RRL_0819 (1)

Jessicca Moore is a family nurse practitioner and filmmaker in Petaluma, CA where she lives with her husband, two children, and two sheep. She is currently in production on her first feature-length documentary, “Why Not Home?” The film follows hospital birth providers who chose to give birth at home. You can watch a trailer and get more information here: www.whynothome.com and support the project on kickstarter at bit.ly/whynothome through October 10th.

Follow the project on twitter and instagram @whynothome and facebook at facebook.com/whynothome

You can find Jessicca on twitter @jessicca_moore

(Photos by Erin Wrightsman, used with permission.)

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Prodromal Labor- What Is It and What Can You Do About It?

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You are 38 weeks pregnant. It is 10pm at night and your labor starts. YAY! Contractions are 7 minutes apart, steady and lasting about 45 seconds. They don’t feel like Braxton-Hicks contractions, so this must be the real thing! Steady, real, feeling like labor.

This goes on until 2am when suddenly, everything stops.

No contractions.

No labor.

The next night the same thing happens. And the next, and the next.

Welcome to prodromal labor.

Though not often talked about and poorly understood, prodromal labor is an important subject. Likely the cause of many early trips to the hospital, emotional and physical exhaustion on the part of the mother, and dashed hopes of natural birth, prodromal labor is something that needs to be talked about more and understood better.

What is prodromal labor?

Prodromal labor is usually defined as a labor that starts and stops, sometimes for days on end. Prodromal labor feels like real labor, it acts like real labor and in many ways it is real labor. Sadly, it eventually stops and doesn’t result in a baby like active labor does.

Andrea, a birth teacher in Granbury, TX described her prodromal labor like this:

“My second pregnancy I had 3 days of prodromal labor. I started having contractions on Sunday. They would last for several hours and would get closer together but never closer than 5 minutes apart. After a few hours they would fizzle out and then a few hours later start back up again.

Other women experience this for weeks. Kristin, a Chiropractor in Burleson, TX described it thus:

“I had 3 weeks of prodromal labor with my third baby with contractions every 15 minutes on the dot. I knew the time by my contractions. Occasionally they would get closer…every 5 min for several hours or every 2 1/2 min for hours in the evenings. It really messed with my emotions.”

Different than Braxton-Hicks (which causes no cervical change and which can feel spotty and is generally painless) prodromal labor contractions feel like regular labor and even an experienced mother may be confused and unsure of what is going on. Cori, a birth teacher in Salinas and Carmel, CA said this about her prodromal labor with her third pregnancy, “I went to the doctor thinking I was in labor one of the nights. I had labored twice before, it felt real.” Her contractions would last for roughly 6 hours, coming every 5-10 minutes.

Prodromal labor is also different than early labor: prodromal labor doesn’t produce a baby in the next 12 or even 24 hours. It starts and seems serious, and then fizzles out, often at around the same time each day.

You can’t talk about prodromal labor without discussing the emotional impact it can have. Hailie an birth instructor in Abilene, TX said that, “I was REALLY tempted to just go to the hospital – I knew they’d give me Pitocin when labor stalled and I’d end up with a baby. It took a lot of energy and willpower to stay at home. It was the most emotionally exhausting thing I’ve ever been through. Prodromal labor almost derailed my attempt at a natural birth.”

What can you do about prodromal labor?

As you have probably guessed, prodromal labor isn’t something that anybody wishes for or really enjoys. Is there anything you can do about it?

Many birth professionals feel that prodromal labor is the result of poor positioning on the part of the baby. Sometimes a baby that is positioned “sunny side-up” or posterior will want to move into a more optimal or anterior position.

To remedy this, labor is triggered and the body, the uterus and the baby try to make that baby turn into an anterior position. But, after a few hours the body will take a break, only to try again a bit later.

If positioning issues are the cause of your prodromal labor, then there are a few things that may help:

Chiropractic- Every Birth Boot Camp 10 week childbirth class will have a focus (class 3) on chiropractic and the huge help it can be in labor. Chiropractic adjustments specifically those done by an ICPA certified chiropractor, can help align the spine and pelvis and allow the baby to move into a more optimal position.

Position changes- Another thing your class will talk a lot about is position changes for the mother. There is actually a LOT you can do to help encourage an anterior fetal position and your birth class will cover this over and over again. From hands and knees position to birth balls to lunges, there are many tools at your disposal. Spinningbabies.com can also be a great resource for this. Your class will guide you AND your partner through specific things that may help.

Fixable or fate?

It is possible that this is just how some women labor, and maybe you are one of these women. While it doesn’t sound fun, it is possible to have a positive and even natural birth experience with prodromal labor. The bad news is that it can be exhausting both physically and emotionally. The good news is that you and your partner will have lots of practice sessions where you can put into use all the relaxation techniques and positions you learned in your birth class. The other good news: often when a woman who has prodromal labor finally goes into the “real thing”- it goes quickly. Your body has been working, warming up, and getting ready for your birth.

Prodromal labor isn’t a sign that you don’t work, but the opposite. Your body is trying to get ready for a great birth! Patience can be hard, especially with the added stress of expectations from yourself and others and the weight and discomfort common at the end of pregnancy. Rest when you can, enlist  outside help in the form of your chiropractor, doula, midwife and partner, and give yourself permission to cry when you need to. You CAN still have an amazing birth.

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From Epidurals To Home Birth- Meet Instructor Hailie in Abilene, TX

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Birth class couples after playing a game to learn how epidurals work in Hailie’s birth class!

We are excited to share with you a series of articles highlighting our diverse group of birth instructors. These are the amazing women who are doing real work trying to make birth better for women and their families all over the world. Today we introduce Hailie Wolfe, a birth teacher in Abilene, TX, mother of five (and kinda famous You-Tuber) who has birthed in so many different ways. In fact, one of her birth videos is featured in our classes! We love Hailie and we are sure you will too. Thanks and enjoy!

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First, could you introduce yourself? Tell us a little bit about your own birth experiences and how they influenced your desire to teach birth classes.

My name is Hailie Wolfe and I own Country Bumpkin Birth Services in Abilene, TX. I have five children – four of them were born in the hospital; three of which were medicated and one was unmedicated.

My medicated births were very standard hospital births. There were several things that I didn’t like about those experiences, but it was years before I realized that how I was made to feel for those births really DID matter. I had some wonderful nurses, but oddly enough, the one I remember most was the one who treated me terribly and that makes me sad. I was given routine episiotomies. I was given the highest pitocin drip on more than one occasion. I thought all of this was “normal”.

When I became pregnant with my 4th child, I decided I wanted to do things differently. At the time, we planned for #4 to be our last baby and I didn’t want to miss out on the opportunity to experience birthing naturally. I came to view it almost as a rite of passage I had missed out on because of my ignorance during my previous pregnancies. When I gave birth naturally, I finally understood WHY it was so important. I had an easy postpartum recovery for the very first time. I was on a birth high for days and felt very empowered.

I enjoyed birth so much that it influenced our decision to add another baby to the family. My fifth child, a surprise breech birth, was born at home in my bath tub. You can watch her birth video here: https://www.youtube.com/watch?v=oFabMR4sg5g

I was able to have a natural birth with self education, but the whole time I was pregnant with my 4th child I wished there was an accessible class where I could get the information in one place. That inspired me to become a Birth Boot Camp instructor. I wanted women in my community to have easy access to this important information. 

What first got you interested in the realm of birth?

Looking back, I always have had an interest in birth itself. I remember as a teenager being really into watching shows about birth on the Discovery Channel and being disappointed when they didn’t actually show the baby come out. When we had to watch The Miracle of Life in high school health class, I was secretly excited to see what it would look like for a baby to come out.

I’d like to say that I was so inspired by birth that I went into the medical field after high school, but that would be a lie. I didn’t want to go to nursing school because I didn’t want to wipe butts or clean up puke – no gross stuff for me. I don’t know why I didn’t realize that was in the job description for motherhood, because I signed up for that without concern! I became an elementary teacher where I wiped noses and pulled teeth. What can I say? I have a mothers’ stomach.

The point that REALLY got me interested in pursuing birth work was when I went through a very painful induction with my third child and had a terrible recovery. When I decided to go natural with my fourth and I had such a wonderful experience – that was when I really discovered my passion sharing birth with others.

What are your particular passions concerning birth?

Over the last few months, I’m becoming increasingly interested in reaching disengaged dads. I hear birth workers constantly blast dads for thinking birth classes, doulas, etc. are a waste of money. It hits home for me because my husband was one of those dads. He pretty much agreed to hire a doula just to make me happy – but then seeing was believing for him. He was amazed at how much better the experience was when we birthed with a doula. I want to figure out how to reach the skeptical dads like my husband, and I want to reach them before their wives are insisting on having a doula because they’ve been through a bad experience. I’m preparing to host a Doula Dad night soon so that my husband can speak to other dads about the benefits of having a doula. I’m hopeful that hearing another dad’s perspective will encourage others to be more open about birth preparation.

There are lots of different birth educator training programs out there. Why did you choose Birth Boot Camp?

I actually have a dear friend, Megan Martin, who teaches classes in Burleson, TX. When I voiced my interest in Birth Boot Camp she really encouraged me to go for it. I didn’t even do very much research on other programs. The organization is very transparent about their beliefs, which perfectly align with my own birth philosophy. It is clear, concise, and complete, and those are attributes that will truly prepare couples for birth. I knew early on that it was the right program for me to teach

Tell us a little about your Birth Boot Camp training experience. Where did you train? What did you like about it?

I attended Birth Boot Camp instructor training in July 2013 in Grapevine, Texas. I really enjoyed getting to meet and gain knowledge from other woman across the country who share the same passion as me. I love my children with my whole heart, but it was refreshing to stimulate my brain for a few days alongside a great group of ladies.

During my hotel stay for the training, I was roomates with Lauren McClain, creator of MyBreechBaby.org. She taught me so much about breech birth during break times and when we’d stay up late chatting. I remember thinking how great it was that I was learning all this new breech information in preparation for teaching other moms. I never would have dreamed that I would personally be putting all that information to use when I delivered my own surprise breechling just three weeks later. I will never forget Lauren.

How is teaching your own classes going for you? What do you enjoy most about it? 

Each series I’ve taught has gone great! The part I enjoy most is getting to connect with couples and share information that I wish I had known earlier in my birthing years. It makes me feel like I am making a difference. It is also incredibly enjoyable to see dads gradually become more and more engaged in birth preparations. Over the 10 weeks it gets very “real” for them. It’s a neat process to watch.

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Hailie with her youngest baby, born at home.

In what ways did the Birth Boot Camp teacher training help prepare you for teaching actual classes?

I was really nervous at instructor training when we had to individually teach a specific topic. It was reminiscent of my elementary teaching days when the principal would come in for observations; judgement from colleagues can be intimidating. BUT, it was completely judgement free with lots of constructive feedback and I even learned new information from some of the other trainees during their presentations.

I also really liked that we practiced relaxation exercises and labor positions in groups. You’d be surprised how difficult it can be to read aloud using a “yoga voice” for the first time ever. It was great practice, though! I was 36 weeks pregnant at the time, so it was super relaxing to be the guinea pig for some of those – I felt like I was getting pampered at the spa!

Tell us a little about your students. How do you believe childbirth education is having a positive impact on them? 

I feel like my students are benefiting so much just from hearing about all the choices they will be making for in preparation for their births. My students almost always leave with a list of questions for their care provider that they would have otherwise never known to ask . I truly feel that it’s also helping the dads be able to connect with the pregnancy on a more meaningful level. As the series progresses, I notice dads becoming more confident in their ability to make joint birth decisions,  and also more confident in their ability to be a good support to their wife on the day of baby’s arrival. Seeing the friendships develop between the couples is great too.

To close, tell us how you see natural childbirth education having a positive impact? Why does this work matter to you?
Specifically in my community, where we have a 37% cesarean rate, I am hopeful that my empowered students will go out into the community and share the impact that education had on their births. I really feel this will lead to more and more couples investing in their births and having more positive experiences. Also, when we as women are educated, we can hold our doctors accountable and at a higher standard. This is the first step in lowering the astronomical cesarean rate in the Big Country.

Where can we find you?
A few different places, actually! Come visit me. I LOVE communicating with moms and dads who are interested in birth!
rockyournaturalbirth

Rock Your Natural Birth…at the Hospital! – Guest Post By Lauren Rauseo

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Today we have a guest post from Lauren Rauseo. A mother of three and author of the recently published book, “Natural Birth for the Mainstream Mama,” we are excited to share her thoughts on some basic things that can help you have an amazing natural birth in a hospital. Her book just happens to mention us as a possible childbirth education option and we couldn’t be more pleased! As you can see, she gives some great advice for getting the birth you want in the hospital, and she manages to do it in a funny, approachable and readable manner. Check out a review of Lauren’s book here and find it on Amazon.

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So you are planning a natural birth. You imagine dimmed lighting and quiet music as you labor, and a peaceful entrance for your baby. The thought of monitors, drugs and a doctor shouting, “Push!” at your va-jay-jay gives you the heebie-jeebies. Maybe you don’t see yourself popping this kid out on your living room sofa, but you long for a more home-like experience.

While the hospital offers comfort that you’re in the right place in the event of an emergency, it also brings a few challenges when preparing for an intervention-free birth. Follow these five tips so that you achieve your goal to go au naturale at the hospital.

1. Choose your hospital and care provider wisely.

This is, hands-down, the most important piece of advice you’ll get. Even if you’ve been with your OB/GYN since you got your first period, you need to interview him like you two just met. What is his C-section rate? What were the reasons for his last 10 surgical births? And since you never know who will be on call on the big day, are the other providers in the practice aligned philosophically? Don’t forget to find out what the hospital policies are as well. How long can your water be broken before the baby needs to be born? Are you allowed freedom of movement during labor? Are different positions encouraged for pushing? What are the monitoring requirements for a low-risk delivery?

Listen to not only what he is saying, but also how he is saying it. If your hunch is that he is not supportive of natural birth, then he probably isn’t. Even if your due date is close, it’s never too late to find a care provider that’s more in line with your birth plan. Consider switching to a midwife. Her expertise lies in trusting a woman’s body to do what it was physiologically designed to do, and not looking for crisis at every turn (but don’t worry; she can recognize warning signs when there is something that requires attention).

If your care provider truly believes in your body’s ability, your natural birth has a much better chance of happening. Your job is to find that care provider.

2. Assemble a supportive team.

Now that you have the right medical crew lined up, you can rest assured that you wont be offered interventions during your birth unless it’s absolutely necessary. (Half the battle has been won already!) But that doesn’t mean you won’t be asking for an epidural yourself when you’ve been in labor for 24 hours and you’re only 4 centimeters dilated.

That’s why you need your birth peeps cheering you on! First, make sure your partner in life is on board with all this natural jazz from the get-go. You both need to see eye-to-eye on your goals, and he’ll need to stand strong as your advocate that day.

But maybe even more important will be your doula, or labor coach. She’s a non-medical birth professional who actually knows what she’s doing and how to be helpful to you in your time of need. She’s seen a lot of these natural births go down, so she’ll know when it’s time to go to the hospital, how much counter pressure to apply to your hips, and why getting on all fours may help baby into a better position.

3. Make a commitment.

Have you ever said you’re going to decide whether you’ll get up early to exercise when your alarm goes off? How often does that strategy work? I’m guessing never. You must commit to your decision and eliminate the option to hit snooze. Likewise, when someone asks you if you’re going to have a natural birth, your answer should be simply, “Yes.” If yours is, “Well, I’m going to see how it goes,” then you have commitment work to do. You need to walk into this adventure with 100 percent confidence that you will do it.

Repeat after me. “My body was made to birth this baby. It will be hard, but I trust this process. I am about to have the best day ever!”

4. Retrain your brain.

Maybe you’re afraid of committing to this because you are terrified of birth! This isn’t surprising. You’ve been trained to be afraid of this event your entire life. How many times have you heard, “Childbirth is awesome! You’re going to love it!”? Zero. Mostly, you’ve been listening to women regale horror stories, and you’ve been watching ridiculous TV that exaggerates the risks and hyperbolizes the pain of childbirth in the name of ratings. You need to stop all that crap. Immediately.

Instead, surround yourself with women who have positive birth stories to share. There are plenty out there! Common themes will include a supportive midwife, an inspirational doula, lots of movement, infrequent (or no) cervical checks, intermittent monitoring, mother-led pushing, immediate skin-to-skin with baby, and overall, an environment where the mother’s voice was heard and respected.

Go places where there are others who are also preparing themselves for an empowering birth. Try a natural-focused childbirth class, and stay away from hospital-based classes, as those will likely center on risks and interventions. Read natural birth blogs and follow them on social media for constant bursts of inspiration. Once you’re in the right frame of mind, it’s easy to commit to your goal. Don’t fear for this birth; get excited for it!

5. Be patient and relax.

Patience begins while you’re still pregnant. Perhaps 41 weeks pregnant. Remember, your baby knows when to be born. Once labor does begin, trust me, you’ll be glad you refined this skill. Your doula will use comfort measures to help you during labor. Maybe she’ll rub your back, let you squeeze her hand, or read birth affirmations aloud. But none of that will help if you’re tense and working against your contractions. In order for your cervix to open, you need to totally let go and release the tension from your body. Think savasana at the end of a yoga class times a hundred; that’s how relaxed you should be. Practice often so that you’ll be able to bring yourself into relaxation more easily on the big day.

Each contraction only lasts one minute or less, even during the hardest part. And I know you can do anything for one minute. Never think about how much longer you have to go. Just breathe into this one contraction you’re having right now.

So there you have it! Are you ready to rock this natural hospital birth? Remember, every moment of this journey is fleeting, and each minute that goes by brings you one step closer to the prize: Your baby. Come on now, you got this.

If you like what you read here, get the whole book, Natural Birth for the Mainstream Mama, in paperback or ebook. http://www.amazon.com/Natural-Birth-Mainstream-Mama-practical-ebook/dp/B00I3448X0


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Lauren Rauseo is a work-from-home mom to Dylan, Liv and Fiona. Her favorite things are going for walks with the kids to collect “treasures” and singing in the car, and she isn’t afraid to admit that Starbucks, manicures, wine and yoga make the list too. Now that she’s done birthing her own brood, she has moved on to sharing her enthusiasm for natural birth with others through her book, “Natural Birth for the Mainstream Mama: A practical guide to achieving a drug-free birth in a hospital setting”, available on Amazon (http://www.amazon.com/Natural-Birth-Mainstream-Mama-practical/dp/1494415321). You can follow Lauren at www.facebook.com/MainstreamMama.

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Doula Myth: I Don’t Need A Doula, My Nurse Will Help Me!

 

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Today we are excited to share a guest post from an incredibly experienced doula and one of the driving forces behind our very own Birth Boot Camp DOULA program, Maria Pokluda. Maria’s words of wisdom on the importance of and difference between both a doula and a labor and delivery nurse are so important.  Enjoy reading, and share with your pregnant friends!

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I attended a birth recently at a local hospital. When we arrived at the hospital the nurse greeted us and did all the right things: she asked for the couple’s birth plan, she told them that everything on their birth plan looked acceptable and she smiled as they talked about their plans. She was a great nurse and this couple (who took a Birth Boot Camp class) did go on to have a pretty amazing natural birth many hours later. As the nurse was leaving at shift change, she mentioned that she was excited to have seen a natural delivery because she had only seen ONE other natural birth in the SIX years she had been working as a labor and delivery nurse. I am still stunned by her comment and I think (and hope) that her experience is not reflective of all nurses who work in labor and delivery rooms. However, the fact is that it is neither a nurse’s primary job nor the focus of her training to help couples have a natural birth.

All couples birthing at a hospital will have a labor nurse, and I frequently get asked why a couple would need a doula since they will have this nurse to help them while they are at the hospital. Labor and Delivery nurses are a wonderful resource, however they have the clinical duties of monitoring baby and mom, the charting that is part of today’s medical care and they also have other patients – how many depends on the time of day and how a particular hospital staffs the floor. All of these other roles can limit the amount of time a nurse has to spend taking care of mom’s physical and emotional needs, but perhaps more importantly, most are simply not trained in helping women who are planning a natural birth and many don’t see natural births all that often.  If one sees medicated births day in and day out, that becomes the norm and a couple planning a natural birth will seem unusual.

In a study examining pregnant women’s expectations, first time mothers anticipated that their nurse would spend 53% of her time offering physical comfort, emotional support, information, and advocacy. However studies have shown that the actual amount of time an obstetrical nurse spends doing these things is closer to 6%*. With hospital interventions at an all-time high, nurses may want to do these things for women, but the reality is that they have to spend a lot of time just managing medical concerns and hospital policies. In fact until a women starts to push, nurses do not usually spend time in the labor room but rather monitor remotely at the nurses’ station. In my own experience as a doula, it is not unusual to attend a whole labor and never see the nurse touch mom in a non-clinical manner. She may move fetal monitors, take a woman’s temperature or feel her cervix by placing her fingers in mom’s vagina but never touch the mom outside of these tasks.

On the other hand, a doula’s primary focus is on the laboring couple. Her continuous care allows for her to respond quickly, make recommendations based on how labor is unfolding and provide immediate emotional and physical support. A doula sees natural birth all the time. She is familiar with the sights and sounds of normal labor and can often anticipate what a woman will want as she labors. She is trained to suggest position changes, relaxation methods and comfort measures. If a couple has taken a great birth preparation class they will have confidence and information, but that does not replace having someone there to answer questions and provide ongoing encouragement. A doula does not have to analyze a fetal heartbeat, administer antibiotics or enforce hospital policies.

The relationship between an expectant couple and their doula is also different than with their nurse whom they generally meet the day of delivery. The doula has likely been working with the couple prenatally and often has been laboring with a couple in their home prior to arriving at the hospital. The doula will know the couple’s desires, their concerns and even the dynamics of the couple’s relationship.  She knows if a relative is someone that should be in the labor room. She knows that mom wants to have the cute nursing bra on for pictures even if she says she doesn’t care at the time. A doula is there through as many shift changes as it takes which offers stability when other faces may be changing and a doula will stay with a laboring woman so her partner can get coffee, check on older children or get some food. In the weeks after the baby is born, the doula is available to talk, to answer questions, and to process concerns.

Despite all the things I just listed that doulas do, a nurse’s role is just as important. The way most hospitals operate means that the labor nurse is the primary liaison between a couple and their care provider. She will be the one calling the OB and passing along the details of the labor, she will be the one that makes ongoing analysis of baby’s wellbeing.  In the rare event that something needs immediate medical attention, it may seem as though the OB is swooping in to save the day…but it will be the nurse that calls the OB to come. Part of a nurse’s training is being a patient advocate. The American Nurses Association includes in its definition of nursing  “advocacy in the care of individuals, families, communities, and populations.” Nurses can advocate for a couple’s expressed treatment preferences which is a very distinct and different role from that of a doula who can help couples express preferences, consider options and facilitate communication, but not actually advocate for a couple or act as a liaison.

I remember working with an excellent nurse at one birth where the care provider and the couple were in disagreement of the use of a routine intervention that was part of hospital policy.  The nurse pulled a chair up to the bed and told the laboring couple exactly what their options were, what could be expected to happen with each choice and how to say no in a manner that would be most respected by the care provider.  She also took it one step further and told the couple that she would speak to the care provider on their behalf and that she could be the one that told the care provider that they had declined. While this may not be a common scenario, a nurse can choose to do this as part of her job; a doula cannot.

The roles of the labor nurse and the doula will overlap in some areas which actually works out well as very few couples will complain about extra support, but they also have marked differences. Ideally the roles should complement each other, which is why laboring couples need both. With a great nurse and a great doula a couple can expect to have an empowering birth.

 

Maria Pokluda has been a doula serving the Dallas/Ft. Worth area since 2004.   She has a Masters in Political Science and while she finds that slightly funny, she feels her degree helps her work with all types of people and she can now appreciate those statistics classes as she reads the research about evidenced practices in maternity care.  In the last 10 years, Maria has attended hundreds of births, helped form Dallas Birth Network and in 2013 and 2014,  she was voted Best Doula by North Texas Child Magazine. (Maria has recently co-written the Birth Boot Camp Doula program and can’t wait to start training Birth Boot Camp Doulas.)   Maria has been married to Brian for 18 years and they have 4 children, each with a very different birth story ranging from one with all the bells and whistles in a hospital to a homebirth.  

* Tumblin A, Simkin P. Pregnant women’s perceptions of their nurse’s role during labor and delivery. Birth. 2001;28(1):52–56. [PubMed]

 

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