This guest post was written by Austyn Smith.
Remember sex ed? All the funny phrases and shocking details that made you and all your 5th grade friends giggle nonstop at recess for the next month?! Good stuff. Important stuff. But I feel like women need ONE more sex ed class maybe around the end of high school or start of college. All about how a woman’s cycle REALLY works. What’s REALLY going on every month in terms of fertility.
When I had a hard time getting pregnant with my first baby, I came across a life-changing book, “Taking Charge of Your Fertility,” by Toni Weschelr. Having taken many science/anatomy/physiology classes in college I felt like I had a pretty good handle on how things worked, but after reading this book I realized how little we are really taught about the amazing work of art that is a woman’s body.
Weschler’s aim is to help women understand their fertility physiology for two purposes:
- To achieve pregnancy
- To practice natural birth control
Using the Fertility Awareness Method for pregnancy achievement.
Many women mistakenly believe they are infertile, when they’ve tried to conceive for 1 year without success. This can be exacerbated by irregular cycles, using the calendar to guestimate ovulation and periods, doctors prescribing clomid prematurely, doctors testing levels at the wrong time, etc. Many times infertility is not an issue, but more knowledge is needed both for patient and doctor.
Let’s start out by mapping out all the hormonal changes that happen during a normal menstrual cycle.
All of these different lines represent different hormones. I once showed this to my husband at a well-timed moment of emotion. It really helped me drive home my point that it’s just hard sometimes!
These powerful hormones are hard at work all doing different things during your cycle, preparing your body for peak fertility. The 3 fertility signs we’ll focus on here are:
- Waking Temperature
- Cervial Fluid
- Cervical Position
- Ovulation Test Strips (This one isn’t really part of the FAM but it’s a great way to back-up your results while you’re getting used to using FAM).
Tool #1—Waking Temperature
A normal pre-ovulatory temperature is 97.0-97.5 degrees. What’s cool is that after the egg has been released during ovulation, there is a big temperature surge, almost by 1 whole degree, (97.6-98.6 degrees) and it will remain high until the period comes…or pregnancy. One tricky thing about basal body temperature charts is that women can mistakenly wait until their temperature has spiked and then think, “Oh, perfect! I am about to ovulate. Time to have sex.” When in reality, the egg has already been released, and optimal conception time was a day or two earlier.
In terms of fertility tools, charting basal body temperature (BBT) can help a woman know IF she has ovulated, and WHEN she has ovulated. This can be a really helpful diagnostic tool if a woman is unsuccessful in getting pregnant. Ovulation can be delayed for many reasons—sickness, travel, stress, excessive exercise, diet changes. If you stop “trying” after the typical 14 day estimate (half of a 28 day cycle), you could miss ovulation entirely if that egg is not released for another 5 days. I once had a 54 day cycle when I was actively trying to get pregnant. Had I not been charting my temp I might have been frustrated at the slew of negative pregnancy tests, but I knew I hadn’t ovulated yet.
Another cool thing about knowing your temps is that after ovulation, the days until your period (the luteal phase) are ALWAYS the same. So once you chart a month or two and can tell your ovulation days, you know you’ll have your period in x number of days (usually 12-16). Helpful right?! This can also be a diagnostic tool, because if a luteal phase is less than 12 days after ovulation, pregnancy cannot occur. A doctor will know the exact treatment for this without you ever having to go through invasive tests.
Directions for taking waking temperature
- Take temperature first thing without even getting out of bed. Try not to move much, except to grab the thermometer.
- Take temperature orally
- Take at the same time every day, within one hour
- Make sure you’ve had three hours of consecutive sleep beforehand, or don’t count that day.
Here’s an example of a typical temperature chart.
Look at whole broad pattern, as temps will vary day to day. When there is a steady surge of temperatures .5 degrees higher than normal, you can know you’ve ovulated.
Tool #2—Cervical Fluid
The environment in a uterus is constantly changing throughout a month, while it is preparing for a potential pregnancy. Different hormone surges affect cervical mucus at various times during the cycle. A typical cycle usually follows this pattern: menstruation, nothing/dry, sticky, creamy, egg white, nothing/dry, menstruation. The most fertile type of mucus is egg white. The book has amazing pictures of different types of mucus to help familiarize yourself with all the types. If you are paying attention, you will start noticing wetness a few days before ovulation, usually on your underwear, and mucus will change. I feel naive to say that I had no idea this was normal! I thought something weird or gross was going on with me and that it didn’t happen to other women. Really it is just a signal to get moving with baby-making! This mucus is an ideal environment for sperm to thrive and move. And while we’re talking about it, most lubricant is toxic to sperm. Your best bet is to use your own fluid but if you need lubricant, use this one that is specifically meant for conception.
Directions for checking cervical mucus
- Start noticing mucus on the first day after menstruation ends. Focus on vaginal sensations throughout day.
- Check before you use bathroom (kegals before helps), about 3 times a day. Notice if it’s on your underwear throughout day. You can look on your toilet paper, on your underwear, or even check internally.
- Learn difference between semen and cervical mucus- what each type looks, feels, and stretches like. Eggwhite mucus is very stretchy, sometimes up to 8 or 9 inches!
- During the most fertile time, things should be wet often down there. Look in the toilet water during fertile time, especially after bowel movement. There will occasionally be some gooey globs of cervical mucus down in the bowl.
It might make you squeamish at first, but I have found this completely fascinating, and it has led to easier conception as a result!
Tool # 3—Cervical Position (optional)
Cervical position is also constantly changing during a menstrual cycle. At the beginning of a cycle, it starts out firm and low, then becomes closed and dry. During the fertile time, it is soft, high, open and wet. Then it returns to firm, low, closed and dry, and then finally, menstruation.
Directions for checking cervical position
Check once a day starting the day after menstruation. Wash hands with soap, and check at a consistent time every day. The most effective position for checking is squatting, but sitting on a toilet is also fine. Just be consistent.
A few other secondary fertile signs include: midcycle spotting, pain in ovaries, abdominal bloating, water retention, and breast tenderness.
Using the Fertility Awareness Method to track these 3 tools all together will give you a broad overall picture of where you stand as far as fertility is concerned. It will help you know when you are nearing your most fertile time (not always accurate by calendar!), and whether or not your body IS i fact getting fertile. You might find that your temp is changing, so you know for sure you are ovulating, but maybe you never have any egg white mucus. That can point you to the possibility that your uterine environment is hostile toward sperm. There are countless clues available from charting these variables every month. It can even help you know if you are achieving pregnancy regularly, but then miscarrying early. Knowledge is power, and the more info you can bring to your doctor the better.
FAM can be a very helpful tool in achieving pregnancy or diagnosing specifics with infertility. I’ve used it for many many years and have loved it. It’s brought me my babies, but equally important has helped me to better understand what’s happening with my body every month, physically and emotionally. And let’s just say- that’s a benefit for the entire family!
This post is sponsored by Theralogix, makers of of the TheraNatal line of nutritional supplements. TheraNatal preconception vitamins contain all the nutrients you need to prepare your body for pregnancy, including folate and vitamin D. For women 35 and over, TheraNatal OvaVite also contains CoQ10. Use this link to get a discount of approximately 15% off your purchase and be sure to listen to my chat with Theralogix at the end of this episode about how their products support women with infertility issues.
Bringing Awareness to Infertility
Infertility affects 1 in 8 couples or 15% of of couples in America according to the CDC. National Infertility Awareness Week strives to bring more attention to the struggle of infertility. At The Birth Hour we feature all types of pregnancy and birth stories and wanted to highlight some of our infertility stories this week.
1. Infertility Journey, Pregnancy and Birth Story
Camille knew going into her marriage that her PCOS had caused infertility issues and she and her husband had a long road ahead. After years of trying, she finally got that positive pregnancy test.
2. Surrogate & IVF Pregnancy & Birth Stories
Nancy and her husband went through cycle after cycle of IVF and eventually decided to use a surrogate to carry their first pregnancy. As fate would have it, Nancy became pregnant the same month that her surrogate got a positive pregnancy test. They welcomed two daughters within weeks of one another!
3. Infertility, Placental Abruption Cesarean, and VBAC Birth Stories
Alexandra Barretta is from Queens, NY. After struggling with infertility, she was able to get pregnant after several IUI’s and 2 IVF’s. Her son was born 6 weeks early due to a placental abruption via c-section.
4. Surprise Pregnancy at 33 Weeks Birth Story
Phuoa and her husband had been trying to conceive for 5 years and she had put getting pregnant towards the back of her mind. She actually didn’t realize she was pregnant until she took a test after noticing a linea negra and by the time she went in to get her ultrasound found out she was 33 weeks along and her baby was born premature the very next week!
5. Pregnancy and Birth with Type 1 Diabetes
Kate is a 35 year old Type 1 Diabetic, diagnosed at the age of 25. She’s insulin dependent, and uses a medtronic insulin pump and glucose sensor to manage her blood glucose. She was categorized with unexplained infertility and after 5 years of trying, conceived a baby through IVF. She was only able to transfer one embryo at a time to prevent the risk of carrying more than one baby as a Type 1 Diabetic. Their third (and last) embryo took, and she now has a beautiful baby boy!
6. Surrogacy: Carrying My Brother’s Babies
When Tiffany’s sister-in-law had to have a hysterectomy after a postpartum hemorrhage with her first birth, Tiffany almost immediately offered to be their surrogate for a future child. After some time passed and lots of planning and discussion, they decided to go down the path of surrogacy with Tiffany carrying her brother and sister-in-laws next child. It turned out to be two babies instead of one and soon Tiffany was pregnant with their twin boys!
7. Gestational Carrier Birth Story
After multiple methods and attempts at getting pregnant the best diagnosis doctors could give Sarah was “unexplained infertility.” While her infertility journey has been incredibly frustrating, especially being unexplained, Sarah never gave up her dream of becoming a mom. And after almost 9 years of infertility, a miracle happened; her and her husband were blessed with two beautiful twin baby girls through the amazing gift of a gestational carrier.
8. Pregnancy & Childbirth after PCOS
Marissa Lawton discusses getting pregnant with PCOS (polycystic ovarian syndrome) and dealing with fertility treatments and the anxiety she dealt with about infertility, about whether a fertilized egg would be viable, how many babies she would carry and whether her baby would be healthy throughout her pregnancy.
Travel Tips for Breastfeeding Moms Traveling without Baby
I absolutely love that the look of motherhood today is so varied and quite the mosaic. Women today have decided that they not only want a family but they also want a career, a higher level degree, time away with friends, their own business, solo trips abroad, and so much more. And I say, “Right on!”
One of the most exhilarating yet also daunting things for a new mama to do is travel without her baby while trying to also maintain a healthy milk supply. For many of us traveling for work is the first time we must leave our little one for an extended period of time. Whether you’ll be traveling abroad for work or to the next town over for a weekend getaway with girlfriends, there are a few things that you can do to prepare for your trip and feel confident to stick to your breastfeeding goals.
Before you leave
#1 Leave feeding schedule for your partner or caregiver
Detail even the tiniest of concerns you may have, as well as tips and tricks to help them sooth your baby. If you know that your little one needs to be propped up for 30 minutes after feeding, then let them know. If you want your baby to be fed in 2 oz. increments to avoid any waste of your precious milk, write it down. Be clear about your expectations so that you don’t feel a constant sense of angst while away.
Providing these details will allow you to enjoy your time away more and give you a sense of ease with the fact that the necessities have been covered. You’ve also allowed yourself time to review and think over the things you’d like done in your absence.
#2 Begin to document your baby’s normal feeding schedule
Write down the times they normally feed, whether or not they feed on one or both breasts, and if they are currently taking a bottle, how much they’re drinking at each feeding. Your baby’s caregiver can then use this as a guide for when to feed your little one and you can use it as an outline for yourself as to when to pump while away.
#3 If you’re traveling out of the country, bring a plug adaptor
These can easily be purchased online. It’s also a great idea to have a few batteries packed with you as well. This will allow you to pump in the airport during a layover if the voltage is different than back home and not the one you’ll need for the country you’ll be visiting. It’s also a great backup in case you’re in a location with unpredictable electricity. Bringing along a car adaptor for your breastpump is a great idea as well!
# 4 Record a video of your baby nursing & bring a piece of your baby’s clothing
You can play the video during your pumping sessions and smell your baby’s clothing while trying to get your milk to let-down. These physical mementos can really spark an emotional and physiological response that may help you when trying to relax and “perform” without your baby being present.
During Your Trip
photo via @thehappypumper
#5 Stay hydrated
As you probably already know, flying can really dry you out. Carrying a foldable water bottle or grabbing a cup of water at the airport coffee shop once you’re through security is a great way to remind yourself to stay hydrated. Also, once you’re on location and having a good time, a simple rule you can follow is for every glass of wine or alcohol you drink, you have a glass of water to go with it. Remember it’s best to wait between 1-2 hours per drink before pumping breastmilk for your baby.
READ MORE ABOUT KEEPING UP MILK SUPPLY HERE
#6 Shipping Milk Home
For moms traveling across the U.S. If you’re trying to figure out how to bring your milk back home, there’s this amazing company that will allow you to simply pack and ship home up to 72oz. per box of your milk straight to your front door! Awesome right?! This is also a great option for a mama who’s going on a last minute trip and hasn’t had a chance to store up enough milk for the time she’ll be away. Simply pump, pack it up, and send it home to your babe! Be sure to check out the CDC’s guidelines for proper storage and handling of breast milk.
#7 Stick to baby’s feeding schedule
Follow your previously created feeding log to determine how often you should pump. Even if your baby only fed on one side during your feedings at home, it can be very helpful to your milk supply to pump on both sides while away. Be sure to use a double electric or hospital grade pump, which provides the proper suction strength and stimulation needed for milk expression while not also feeding at the breast.
GET A FREE BREASTPUMP THROUGH YOUR HEALTH INSURANCE
#8 Try and plan for moments of calm and still in your day
This may not be possible for all of your feedings, but allowing yourself to take time and just relax or meditate can help you mentally and physically while away from your baby. Many mamas have difficulty letting down and filling bottles when in the midst of stress and work. A way to combat this is by meditating or doing simple relaxation exercises that help you reconnect and feel grounded while away.
When you are back home
#9 Take a nursing vacation
Try and plan for a day or two of home time with your baby after your trip away. Use this as a nursing vacation where you do unlimited skin-to-skin and feeding on demand. Take long herb baths with your baby resting on you and carry your baby in a carrier, so that your hands can still be free. This will help to give your milk supply a little boost in case you’ve noticed a dip while away.
#10 Let go and practice self care
Fully embrace the time you spent away and carry no guilt for the choice you made. It’s not selfish to invest in yourself, your business, and your friendships. Every mother deserves time away and support to mother in her own unique way.
The tips I shared here are from lessons I learned personally while traveling away from my own little one while maintaining my breastfeeding goals, as well as my role as a Lactation Educator Counselor supporting other mamas who live global boundless lives. I hope they support you in your breastfeeding journey and encourage you to mother in the way that’s most natural to you.
This guest post was written by Anjelica Malone. Angelica is a Lactation Educator Counselor and Breastfeeding Coach. She’s passionate about helping women incorporate breastfeeding into their lives, instead of allowing it to take over their lives. Anjelica is the mother of two little island-born girls and now resides in Seattle, Washington. Anjelica grew up traveling the world with her family and now loves sharing the experience of travel with her husband and kiddos. You can follow her adventures via the hashtag #AGlobalTribeOfWomen and learn about how to live a more conscious and globally-minded life at AnjelicaMalone.com.
What is a Babymoon and Should I Take One?
Pregnancy is a super sweet time of excitement and happiness but can also start to feel a little hectic now and then. Doesn’t it feel like there are so many to-dos and checklists? In between doctor/midwife appointments, baby showers, nursery painting, maternity photos and classes you’re also supposed to relax and take good care of yourself. It’s all a little overwhelming!
What is a Babymoon?
For all you expecting mamas, it may come as no surprise then that babymoons have become so popular in recent years.Though the term ‘babymoon’ used to mean the days immediately after birth when a couple took time to rest, bond and generally bask in the glow of their new baby, it’s now applied to a couple taking a big (or not so big) trip away together before the birth of their baby. Consider it a last hurrah before life changes in a major way.
Celebrities have made these getaways all the more mainstream and can be a great source for inspiration on locations to check out. A consistently popular destination is Mexico (famous babymooners include Kate Hudson, Kourtney Kardashian and Kristin Cavallari) and the Caribbean (Uma Thurman) but with Zika Virus other spots like Hawaii (Hilary Duff, Marissa Miller), Italy (Camila McConaughey, Sienna Miller and Hayden Panettiere) and California (Natalie Portman, Mariah Carey) are getting more love from couples wanting a beautiful babymoon without the worry.
Why Take a Babymoon?
Babymoons aren’t just for the rich and famous—the reasons why a babymoon is beneficial for all couples are simple but so important: Whether this is your first baby or your fifth, your free time is about to get cut down. Way down. A babymoon is a great opportunity to slow down, reconnect and make new memories as a couple. Use your babymoon to sleep in, relax and indulge in self-care before your focus shifts to midnight feedings and diaper changes. After all, happy, loving parents often make for a more relaxed baby so think of your babymoon as a gift for your baby as well—once your little one is on the scene you’ll be glad you invested in your relationship as a couple.
Babymoon Options for Expecting Couples
And lest you think a babymoon has to be expensive and exotic (although who doesn’t love a good tropical beach?!) think again: consider a ‘staycation’ style babymoon by spending the night in a nice hotel near you or a long weekend away to someplace within driving distance.
It’s now even possible to knock out two birds with one stone: as babymoons have become more popular—and expecting parents busier than ever—you can find beautiful weekend getaways that include all of your classes to prepare for childbirth and beyond. Here are a few of our favorites:
Set in the rolling hills of Fredericksburg, Texas just 80 miles west of funky Austin, The Babymoon Retreat offers a 4-night stay for couples in a boutique bed and breakfast. Led by doulas, childbirth educators and lactation counselors couples get daily classes in birth, breastfeeding and baby care so they don’t need to take a single class at home. Activities include complimentary massage therapy, daily yoga, Ask the Doula Session and more.
When: Late March and Mid October
Cost: $2,495 – $3,000 per couple depending on early bird sign-up
If you’re looking for an east coast getaway, this one’s for you! Hidden away in beautiful Maine, this 3-day weekend at a luxury resort includes private daily childbirth preparation and coaching with Laura Thompson Brady, founder of The Nourished Home. Activities include massage therapy, yoga, hiking and more.
When: Dates are customized to you! Laura takes only one couple at a time and offers this Babymoon to only a handful of couples each year
Cost: Also customized based on your needs
Regardless of where you end up, you won’t regret this little pitstop for two before reaching your final destination of parenthood!
This guest post was written by Phyllis Braesnell.
As a childbirth educator, there are a couple of topics that fill me with dread when addressing a group of soon-to-be parents, and one of them is circumcision.
If you’ve spent any time at all on the internet as it relates to parenting, you may have noticed that this topic can spark some very heated discussion, so much so that it can be hard to wade through the rhetoric to find solid information. Folks hold some strong opinions on this topic—and for good reason! The decision whether to circumcise or not will carry into every day of a boy’s life. So, how to give accurate information that will help parents decide? Here’s how I do it:
There are basically 3 things for parents to consider in deciding whether or not to circumcise their baby boy:
Religious or cultural reasons
On this point, I don’t figure I have too much to contribute as a childbirth educator, though occasionally I have helped Jewish clients who did not want to circumcise to explore the idea of holding an alternate ceremony (known as a brit shalom).
These usually fall under the headings of: “wanting him to look like Daddy” or “wanting him not to be bullied in the locker room.” Again, I don’t feel that I can speak to one person’s sense of what looks right or wrong, and I particularly don’t need to know which of the fathers in my class were circumcised or not. But I can note that since the rate of infant circumcisions performed nationwide in the US is around 55%, there is a high probability that there will be another boy in the locker room whose penis looks like your kid’s, whichever route they choose to take.
Health benefits and risks
Since I work very hard to research and present information based on current research evidence in my classes, this final category is the one to which I can really speak. And it can be surprisingly hard to sift through the claims that are out there about risk and benefit!
The American Academy of Pediatrics has been equivocal, to be sure. Their current statement on the one hand seems to endorse the practice, and on the other hand it doesn’t. This statement can be found on their website for parents:
“The American Academy of Pediatrics believes that circumcision has potential medical benefits and advantages, as well as risks. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it, however, existing scientific evidence is not sufficient to recommend routine circumcision.
Therefore, because the procedure is not essential to a child’s current well-being, we recommend that the decision to circumcise is one best made by parents in consultation with their pediatrician, taking into account what is in the best interests of the child, including medical, religious, cultural, and ethnic traditions.”
Their longer policy statement can be found here and the very detailed and long article from the task force behind the policy statement is here.
So, according to the AAP, the benefits outweigh the risks, but not so much as to become “essential to a child’s current well-being.” Which leaves us where, exactly?
I did my best to dig for solid numbers, and came up with this handy chart to compare benefits and risks. Let’s work our way down the list together, shall we?
Yes, Circumcision is painful
First off, circumcision is painful, and medical professionals recommend adequate pain relief both during the procedure and during the healing process (which takes about a week). The choice to circumcise your baby means he will feel pain, and there is always a small risk that he will have an adverse reaction to the pain medication.
Complications can occur
Further, the choice to circumcise means incurring the risk that there will be complications to the procedure. It is basically impossible to get hard numbers on this, since there is no universal reporting standard on complications. The numbers in my chart are a good guess. Mild to moderate surgical complications include: irritation of the glans, infection, excessive bleeding, painful urination, or scarring of the urinary outlet. The much more rare severe surgical complications include: hemorrhage or having too much skin removed. Some babies will need to have the procedure redone, either because the first attempt was inadequate, or because the skin re-adhered while healing.
For a small number of babies whose parents chose to leave them intact, they will develop a medical reason (often phimosis) that will require circumcision in adolescence or as an adult.
Perceived benefits of circumcision
Now we get to one of the benefits of infant circumcision: the reduction in risk of UTI. It is important to note that most UTIs in males occur in the first year of life, but overall incidence is still low at 1%. Baby boys who are circumcised do have a three to ten-fold reduction in risk of contracting a UTI in the 1st year of life.
Sometimes a reduction in the risk of penile cancer is mentioned as a benefit of circumcision, but the overall incidence of this type of cancer is so low, that the slight reduction in risk for circumcised men is barely statistically significant.
Finally, the other major purported benefit of circumcision is the reduction in the risk of contracting HIV and some other STIs. There have been several high quality studies done in Africa that show significant reduction of these risks. Whether their findings can be generalized to the population of American men is debatable.
It is important to note that rates of contracting sexually transmitted infections are affected to a high degree by socio-cultural influences. For example, the rates of circumcision in Northern Europe are much lower than the United States, but their STI rates are much lower as well. Regardless, the reduction in risk for circumcised men would not be completely protective. In other words, parents would need to teach their sons to wear condoms.
And on the somewhat uncomfortable topic of considering one’s baby boy’s future sex life, it is debatable whether adult men who have been circumcised experience diminished sexual satisfaction and function. I’m not sure whether this could ever be definitively proven, but there are certainly plenty of people who like to argue this point.
And that’s it. The risk/benefit ratio for circumcision as it regards to health concerns. You can see why the AAP has had a hard time making a definitive recommendation in favor of circumcision. It is, as they wisely put it, a decision that parents must weigh for their own sons. If you want to read more science-based conclusions, check out The Informed Parent: A Science-Based Resource for Your Child’s First Four Years.
This guest post was written by Stephanie Spitzer-Hanks. Stephanie gave birth to her first child in the Netherlands, where the nurturing and encouragement she received from so many women there inspired her to become a doula. Now she strives to give unconditional support and evidence-based education to families so that they can be confident in making the choices that are right for them. She is an ICEA certified childbirth educator, an Evidence Based Birth® Instructor, a DONA certified birth and postpartum doula, a StillBirthday certified bereavement doula, and a certified lactation counselor through Healthy Children’s Center for Breastfeeding. On the side of all of that, Stephanie is an ordained minister in the United Church of Christ, and she serves as a chaplain at a hospital and writes and speaks about birtheology when she gets the chance. You can find out what she is up to at www.revdoula.com.
Advancements in technology, industry, and business have brought about many changes within the last century. Society has likewise evolved both for better or for worse. Among these evolutions has been a big shift in the standard process of childbirth. Back in the day it was fairly normal to live near extended family and close friends, so it was very natural to have many of them support a woman during labor and delivery. As we have changed over time, it is now more common to live far away from family and delivering in the hospital has become the norm. A side effect from these changes is that mothers have lost the standard support team of women around them while they labor. A possible replacement for this lack of support is to hire a doula. Despite the myriad of positive benefits of a professional doula, only a small percentage of women utilize them. Many newly pregnant women often wonder if a doula is a worthy investment.
Benefits of having a doula
Many studies have been conducted that show the positive effects of doula support, although currently only about 6% of women use one. These benefits include, but are not limited to: decreased labor time; and a lower rate of epidurals, c-sections, pitocin administration, and instrumental assistance during delivery. A Mother who hires a doula also tends to have a much more positive view of her experience. When she feels safe and protected, she lets go of fear (which interferes with progression). Stress levels decrease, and natural oxytocin levels rise, thus encouraging labor advancement. After babies are born, they are more likely to have higher apgar scores (Hodnett, Gates, Hofmeyr, Sakala, & Weston, 2013), and there is an earlier initiation of breastfeeding as well.
Do I need a doula?
There are many known benefits of doula support during labor, but do you really need one?
The large majority of women deliver babies in a hospital and are left to the care and attention of a medical team. A staff may be concerned and aware of a mother’s physical and emotional needs, but they are often distracted by their duties as part of hospital procedure and policy. A nurse, midwife, and doctor all have their own specific tasks to complete—monitoring the baby’s vitals, reading charts and logs, making sure mom is hydrated, and has good stats, etc. They are preoccupied with the safety of mother and baby and are also overseeing a large number of other laboring women at the same time. They will be in and out of the room constantly, and even monitoring moms from machines in the hall. Think of all that is going through the minds of these healthcare workers during delivery.
Making sure baby’s position is optimal, providing perineal support, trying to prevent tearing, coaching mom how to push, monitoring baby and mother’s vitals, assisting the baby when it emerges, making sure the baby is breathing, checking apgar scores, cleaning things up, performing sutures, baby care, delivering the placenta, avoiding hemorrhaging, and keeping things sterile. They have so much going on mentally and physically that although they may be sympathetic to the mother’s needs, they cannot be too preoccupied with them. Plus they have other patients simultaneously.
A Doula’s Purpose
Conversely a doula’s primary purpose is to provide emotional, physical, and informational support for the mother for the entire duration of labor, and afterward. She will be solely focused on you and at your side continually. But what if you have a partner, sister, mother or friend with you? It is highly recommended to have support from people you love and trust. Yet keep in mind that your support group is not always specifically trained in how to care for a laboring woman, no matter how much they love you, whereas a doula is. In order to become a certified doula, a candidate must meet many qualifications. DONA International, “the international leader in evidence-based doula training, certification, and continuing education,” requires that a doula meet the following criteria:
- have a minimum of 28 hours of labor support time logged
- read several required textbooks on labor and birth
- attend at least 3 births and be evaluated by a doctor, nurse or midwife, and the mother.
This knowledge and skill set put into practice is truly invaluable in knowing intuitively how to support a laboring mother.
Doula Services Prior to Delivery
A doula will usually meet with a client about two times prior before the mother goes into labor. During these meetings, she will get to know you a bit, get a feel for what your birth vision and preferences are, and help with a birth plan. She can address any concerns and fears you have about birth, and offer educational materials to review. She can learn about your personality and what calms you, as well as what gives you a boost when you are tired, and how you best anticipate needing support.
A good doula will also be well connected to the birth community for additional support and education. This can be a great resource for women wanting to gain more childbirth education and to get involved with other moms and resources in the area.
Doulas Stay With You the Whole Time
The best thing about doulas is that they are usually available as early as you’d like them in the process, even from the first few contractions. They can come to your home and be with you while you labor there, then transfer with you to the hospital. One of the main advantages to hiring a doula is that you meet her and know her before you go into labor, whereas your nurse and perhaps the doctor on call at a hospital can be complete strangers. Having your doula with you can help you feel more at ease when you arrive. Another advantage is she will stay right with you whereas doctors and nurses, and sometimes even partners will be in and out throughout the process.
Doulas Support Your Partner Too
Doulas are also valuable resources for birth partners. A doula does not replace a partner’s support; rather she assists both parties. She can allow the partner the main role of offering words of encouragement and emotional support while she provides some physical support, and vice versa. She can offer suggestions of what a partner can do to help mom. She can also support the partner should he start to feel anxious or overtired. In one recent study, it was recorded that on average, doulas touched the laboring mother 95 percent of the time, as compared with less than 20 percent by male partners. This in no way discredits the helpfulness of a partner, but rather sheds light on the fact that a doula and a partner have different primary roles. In the end she will be able to read signals from mom and partner of what their needs are in the moment.
A doula’s job is to be there for the mom and to encourage a safe and satisfying birth experience. She provides three kinds of support—informational, physical, and emotional.
Physical Support from a Doula
A doula draws upon her knowledge of many different labor positions and offers suggestions to the laboring mother to help ease discomfort and keep labor progressing. She can offer massage or counter pressure, adjust mother’s temperature with blankets or cool washcloths and fans. She can help to implement breathing and relaxation techniques, and will offer verbal reassurances. She can offer ice chips, drinks, and food if the hospital allows it. She remembers things mom might not think of like to use the bathroom frequently. She knows mom’s preferences and will guard the atmosphere so it remains as calm and peaceful as possible. This is invaluable, especially when the mother is focused and does not want to be bothered with details.
Doulas Offer Informational Support
A well-trained doula will be aware of the hospital policies where the mother is delivering, and will know what kinds of things are allowed and/or prohibited. She can offer advice and information if the mother has concerns or questions. A doula can be a liaison between the staff’s medical jargon and the procedures that are happening. Should unexpected complications arise, a doula can offer extra information, advice and encouragement for big decisions.
Emotional Support from Your Doula
Should some unexpected things arise during the course of the labor, a doula can offer emotional support and encouragement, especially if a c-section or epidural is ordered. She can help to ease fears and guilt and allow a mother to process her potential anxiety or confusion.
Keep in mind that a doula is not only valuable for mothers planning a natural birth, but for all kinds of deliveries. Birth can be an unpredictable event. Even if you plan on getting an epidural or having a planned c-section, a doula can offer tremendous emotional guidance during the process. She can help to aid in your comfort level both physically and mentally. She can be aware of the details that are happening while you are “in the zone.” If a lot of information is being thrown at a mother all at once, and she is already overwhelmed, it can be hard to process and remember what is being said. A doula can be a valuable second set of eyes and ears to absorb information and help answer your questions.
Postpartum Doula Services
Many doulas will offer care for postpartum mothers and charge an hourly rate. Their tasks can range anywhere from breastfeeding support, emotional support, physical care and healing of mother, to cleaning, cooking meals, or taking care of the baby so mother can rest. They will usually offer services up to a certain amount of time (like 4 hours), and some will even offer to sleep over and help with night feedings for an extra fee. The postpartum period can be a difficult time, especially for brand new moms, and the aid of a doula can be very valuable, so it’s something to consider. Even knowing the option is available can put one’s mind at ease.
An Example of a Positive Doula Experience
Elaine Stillerman of Massage Today tells of her positive experience with a doula.
“I called Ilana when I became pregnant. She came to my home to interview me and my husband about our hopes for the big day. Ilana took copious notes in the attempt to get to learn my likes, dislikes and what would be most helpful during labor. She gave us a realistic list of items I would need to make my labor more comfortable. Since then, I have provided my clients with that invaluable list and offer it in my textbook.
When the day came, Ilana had just returned from another birth she had stayed at for 13 hours. She had been home for two hours when I called. “Don’t worry,” she said, “I’m on mommy time.” My water broke and I went into active labor within minutes. The contractions were coming one after the other. She asked to hear a contraction. Did this mean put the phone on my abdomen? Or did she want to hear the sounds I was making? By this time, all rational thought was out the window. “What?” I asked. “Let me hear a contraction,” she repeated. Mine were silent. “I’ll meet you at the hospital.”
Once there, she directed my husband to get a different nurse and a private room for me. She disappeared for a few minutes and came back with a pile of waterproof pads and clean gowns. She opened her bag of goodies and asked if I was hungry or thirsty. And she held me. She massaged me. She danced with me. When the pains got intense, she took my face in her hands and said, “Give me the pain. Give it to me.” And the pains lessened.
When I felt I was losing strength, she told me to relax my feet and let Mother Earth’s power help me. She stayed by my side for 19 hours, encouraging me, honoring my efforts and nurturing me. And when my son was born, she told me how magnificent I had been. A week later, Ilana came to my home for a visit, bringing lunch, gifts, pictures and my birth story. We shared a life-affirming experience and I wasn’t going to let her out of my life since she had been such an important part of it.”
If this sounds like an experience you’d like to have, it is worth looking into hiring a doula.
How to find a doula
There are a few resources to help with finding the right doula for your specific needs. You’ll want to read reviews, choose several options, and then interview them to get a feel for the right fit for your personality. Here are some places to look.
- Dona.org – Doulas of North America
- Cappa.net– Childbirth and Postpartum Professional Association
- Alace.org– Association of Labor Assistants and Childbirth Educators
- Birthcenters.org– National Association of Childbearing Centers
- Doulamatch.com– online database of certified doulas, where you can search by state, years of experience, and price.
Doctor or Midwife Office- many offices have a list of doulas in the area or that they have personally worked with before. This is a great sign that the office is mother-centered and practices evidence based birth!
Hospital—Similarly, some hospitals have doulas on staff full time that they offer to laboring mothers.
What does a doula cost?
A doula’s services can range anywhere from about $300-$1800. They will usually charge a down payment upfront and then collect the rest after delivery. Many doulas are willing to work with you on price if you are not able to afford their fee. Some believe that every woman has a right to have the support they need. Don’t rule someone out just because their fee is high. Check with them first and see if it is flexible, or if they would accept a payment plan. Many insurance companies are now helping to cover the cost of doulas as well, so check there to see if you qualify.
Having a baby is in itself a monumental accomplishment. A doula can provide the additional physical, emotional, and informational support a mother needs to navigate labor and delivery more easily. A mother’s birth experiences are some of the most significant she will have in life. Consider enlisting the aid of a doula to make it the most positive experience you can.
- Bolbol-Haghighi N, Masoumi S, Kazemi, F. “Effect of Continued Support of Midwifery Students in Labour on the Childbirth and Labour Consequences: A Randomized Controlled Clinical Trial.” Journal of Clinical and Diagnostic Research. 10. 9 (2016):QC14-QC17. Effect of Continued Support of Midwifery Students in Labour on the Childbirth and Labour Consequences: A Randomized Controlled Clinical Trial-PubMed-NCBI. Feb. 2017. https://www.ncbi.nlm.nih.gov/pubmed/27790526
- Stillerman, Elaine. “In Honor of a Doula.” Massage Today. Dec. 2008. Massage Today Digital Issue. Web. Feb. 2017. http://www.massagetoday.com/mpacms/mt/article.php?t=38&id=13902
This guest post was written by Austyn Smith.