Milwaukee Doula Martha at Doula Woman: Why a doula for homebirth?

Birth doulas serve people during pregnancy, labor, birth, and postpartum with physical, emotional, and spiritual support.

When a doula serves at community based birth the  role is somewhat different than with hospital birth.

Since community birth accounts for a tiny percent of births in southeast Wisconsin, the vast majority of the time doulas work at hospital birth.   With hospital birth,  doula support is much more “running interference” in that we must be hyper alert for potentially damaging protocols, emotional abuse, probability of infection, chance of csection and many other  iatrogenic harms (medical acts that negatively effect the patient).  So, while doulas focus deeply on the birthing person in-hospital, there is a split-focus since part of the in-hospital doula role is to clear the path to minimize potential harm while staying in scope of practice.

With community based birth, such as midwife attended home birth, doula support is free from the clutter of split-focused hospital birth and 100% of the doula support is focused on the birthing person.  This is the main difference between hospital and community based doula support.

Since the birthing person is free maximize all the health benefits of physiologic birth,  why have doula support during community based birth?  Here are some reasons:

• Physical support: counter pressure, position change suggestions which even at home are sometimes needed especially with a long labor, hydrotherapy, aromatherapy, specific cues such as hypnobirthing, and more.
• A strong foundation to trust yourself.  This foundation is established during the prenatal meetings
• Reassurance that “yes” this is just as it should be
• Read your cues in the moment and respond accordingly
• Bring food and water
• Provide a break for your partner
• Spiritual support
• Take notes and write a birth story
• Sibling support
• Go with you if you transfer to  hospital
• Open the path for you  to re-ground and focus and breath if things get super intense
• Remind you of your birth preferences
• Postpartum support including feeding YOU and breastfeeding your baby and emotional support
• All of the above can be in addition to your partner’s or other birth support people’s help, as stand-alone doula work, or fluid.

In Milwaukee Choice Matters Midwives offer home birth services.

Sincerely, Martha at Doula Woman 262 902 8714.

 

 

Milwaukee Doula Martha at Doula Woman post on why hire birth a doula?

Doulas serve you with emotional, physical, and spiritual support during pregnancy, labor, birth and postpartum.  Translation of medical talk is my forte. The doula works directly for you.  It is your priorities, values, preferences and lifestyle that determine how the doula supports you.

I, Milwaukee doula Martha, am deep in doula land.  In addition to learning from each client I serve, I daily keep up with area birth trends, learn from fellow birth workers, and take classes. I have attended 101 birth to date:  community based birth, in-hospital free from intervention, in-hospital with planned epidural, planned csection, and unexpected turns.

When we work together prenatally, we carry the specific energy that you need to feel comfortable opening for birth.

What happens at your birth affects you, your baby, and your family forever.  You may choose to keep your voice and your power. This is your birth. When you acknowledge who acts as an authority figure and why, you create a path for positive outcome and owning your birth and your parenthood.

262 902 8714 for a free consult.

 

MILWAUKEE DOULA MARTHA (262 902 8714) AT DOULA WOMAN POST ON INDUCTION MANTRAS

 

WHEN YOU AGREE TO INDUCTION

This is based on my education and what I have learned first hand during birth work and life in general. This is not medical advise or a substitute for medical advise.

You may use all, some, or none of these suggestions. YOU do know from a primal place what is best for your body-baby unit. Look within.

• Create your mantra of self trust. You consented to a labor induction for a reason. Whatever that reason is remind yourself that you consented, so from that place of decision you maintain authority over your body and your baby. For some people an actual mantra such as “I allow these chemicals in my body because they will help myself and my baby” or “This labor is caused by means outside of me, yet my body is responding to this and opening for my baby to come to me” or “This is the right way for this baby to come earthside and I open freely for him/her to move down and out of my capable and strong body. I release all doubt.”

• Open communication with your medical manager(s) about the details of your induction. EXAMPLE 1 Some induction agents such as cytotec cannot be turned off and can cause long-non-stopping contractions which are very dangerous and create a medical emergency. You may choose to discuss alternatives to cytotec such as cervadil or a foley cathater. EXAMPLE 2 AROM carries both potential help and potential harm. You may choose to discuss how AROM will effect the chance of a vaginal birth, specific to your situation (as opposed to general statistics). The above are examples. When your medical manager listens to you, you will be given options in a fair and honest way.

• Skip or minimize cervical exams. The pitocin will be turned up steadily until you show hospital protocol for a labor pattern according to the monitor, about 3 minutes from start to start and lasting about one minute. So how fast you are dilating rarely effects the Pitocin dose anyway. Frequent cervical exams, as with spontaneous labor, are not-predictive of when you will fully dilate. So, to maximize staying primal, to minimize emotional dystocia and to minimize infection you may choose to say “no” to these exams. When you have an epidural, you may choose to say “no” as well and consent to directed pushing (if you do consent) when you can reach into your body and feel your baby’s head. When you are epidural-free you may say “no” entirely and allow your body to take over.(Some providers will want you to have an exam to avoid “premature” pushing. Again, you may choose to say “no” based on if you can’t help it anyway, what is the point?) If you allow cervical exams, you may want to know the timeclock from dilation to birth and you may choose to say “no” based on that time clock. Or, you may be more open to radical position changes to move baby down when you visualize the time clock and may then consent to exams.

• Request alternative options when deadlines presented. EXAMPLE 1 You have consented to cervical exams and your cervix is swollen so you are given 1 hour to fully dilate or go to csection. You could request the Pit be turned down and that you be given help to reduce the swelling and perhaps have the epidural turned off to facilitate spontaneous movement. EXAMPLE 2 Baby has non-reassuring heart tones and you are given one hour to birth vaginally prior to csection. You could request the Pitocin be turned off and your body given a re-set. .EXAMPLE 3 You initially said “yes” to Pitocin and “no” to AROM and now you are told labor not progressing fast enough so you you need a csection. You could then agree to the AROM, knowing that at that point it could help facilitate a vaginal birth. These are examples. When you have open communication with your medical managers, these discussion will flow freely.

• Spontaneous movement. With physiologic labor your body moves spontaneously in the way that is healthiest for your mom-baby unit. When you are induced, you may go in the direction of spontaneous movement. You keep moving and moving. You get out of bed: walk, lean, birth ball, hands-knees. Let your body lead you as baby makes the delicate moves to come down to you! Look within. Talk to your baby. Let your body move and release your baby as you make any sounds or swearing needed and as you release bodily fluids free from apology, then baby comes down to you. When you get an epidural, you may choose to keep this up: frequent position changes including hand-knees will help descent.

• TRUST YOURSELF. LOVE YOURSELF. CELEBRATE THIS BIRTH. THE POWER IS WITHIN YOU, LET IT RELEASE!

Milwaukee birth doula Martha at Doula Woman (262 902 8714) post on pain medicine during labor.

This post is about how pain meds are used in labor and is not medical advise or a medical recommendation.  As a doula, my role is strictly non-medical.

Pain meds differ from epidural anesthesia.  The epidural is the current “go to” during labor and hospital rates of epidural use in southeast Wisconsin during labor range from about 75% to about 99%.  Unlike the epidural, pain medications do not numb your body.

When you choose pain medication here you typically get stadol, nubaine, or fentanyl, all of which are narcotics. Sometimes these meds are put in along with the epidural, and mainly they are used instead of or prior to an epidural.

Following are the main reasons women opt for pain meds during labor:

• Your labor contractions are causing a lot of pain and you are not feeling baby descend yet (especially with an induced labor you miss the hormones that counter the pain, and you often get extremely strong close contractions in early labor, the comparable to which would naturally happen during the transition phase of labor just prior to pushing)
• Contractions are abnormally sharp at peak or very close together (this almost always with an induced labor) and it is increasingly difficult to relax between contractions
• You have back labor and there is no break from labor pains
• You water broke and you suddenly feel a new severity to your labor
• You simply want pain relief but want to feel and experience your labor basically, so you do not want an epidural
• You are completely exhausted
• You want an epidural, but due to a pre-existing condition such as spinal surgery, you are not a candidate for one
• Any other reason.

As with any meds, you may have a contra-indication, allergy, or previously unknown reaction to these meds.

The meds may take the edge off the peak pain of your contraction pain.  Often they do provide a way for you to deeply relax, and perhaps sleep between contractions.  In this way, you get a “break” and the benefit of increased relaxation including the horizontal abdomen muscles.

The meds do cross the placenta and go to your baby.  Sometimes baby may get “sleepy” or have a decrease in heart rate.  Sometimes your labor slows down and the Pitocin is then turned up.

All hospital protocols that I have seen so far, set the time limit for getting these meds such that they are out or nearly out of your system when baby is born  to eliminate or minimize respiratory distress in your newborn.  This means the meds wear off at some point.  Generally, the fist dose works the best and later doses are less effective.

Feel free to discuss pain meds and other ways to minimize pain and stay relaxed during labor.  Thank you

Milwaukee doula Martha at Doula Woman

 

Postpartum doulas by Milwaukee Doula Martha at Doula Woman 262 902 8714

What is a postpartum doula?    This post is about doulas working for you when are home with your newborn baby.

This is an opinion and sharing of information blog.  This is not medical advise or evidence based.

Short definition of postpartum doula: “A postpartum doula provides evidenced based information on things such as infant feeding, emotional and physical recovery from birth, mother–baby bonding, infant soothing, and basic newborn care. A postpartum doula is there to help a new family in those first days and weeks after bringing home a new baby.” by American Pregnancy.

This is a limited definition.  When you are looking to hire a postpartum doula, I suggest choose one with whom you fee comfortable and open. You may need freedom from judgment.  Evidence based support works for some people, not all people. 

When your lifestyle and parenting style differ from “evidenced based” practices you may choose a postpartum doula who supports you, listens to you, and offers fluid support according to your lifestyle. In this way, you are not judged and your confidence builds. For example, until very recently co-sleeping was a “no no” and how to place your baby down to sleep varied from tummy to side-lie to back-lie within about one generation. In each phase the way to place your baby such as “tummy only” or “on his back” was credited as evidence based and pushed on parents with the fear that to do otherwise would increase baby’s risk of SIDS. Breastfeeding, an intimate and timeless bond is also under scrutiny of “evidence based practice.”  On the one hand, moms are pressured to breastfeed constantly if necessary as it is “best for baby” while simultaneously being told to never co-sleep.

A postpartum doula who supports you non-judgmentally will serve you regardless of your feeding, sleeping, eating, and other habits.

What I have done as a postpartum doula:  listening, breastfeeding help, baby calming tips, mom calming tips, referrals to area professionals such as chiropractor, pelvic floor specialist, talk-it-through sessions with partner, hugs, wiped tears, baby-wearing set up, cleaning, meal prep, errands, walks, sibling care, day-care, sounding board for mom to process her birth story, emotional story, or personal challenges, reassurance, and more.

Feel free to contact me.

Sincerely, Milwaukee doula Martha at Doula Woman 262-902-8714

Milwaukee Doula Martha (262-902-8714) at Doula Woman post on labor induction

       This post is to clarify the general nature of labor induction and is not medical advise nor designed to persuade people to allow or not allow a labor induction on their body.

 Spontaneous labor almost always is the safest means to birth.  The likelihood that labor, birth, and  postpartum will be physically, emotionally, and spiritual healthy for the birthing person + baby  greatly increases with spontaneous labor.  Birth with both spontaneous labor and minimal or zero cervical exams very rarely causes fetal distress. Infection, c-sections, breastfeeding challenges, and postpartum depression happen more often with induction than with spontaneous labor.

Labor induction is common in southeast Wisconsin. It  happens about 50 to 70% of the time in first births.  Hospital and doctor protocol determine this percentage, so an individual’s likelihood of being induced is predominantly determined by which hospital they plan to birth in and their medical manager’s protocol.

You can say “no” to induction.

Under Wisconsin law, if you come to a hospital in active labor you must be “treated.” To my knowledge the legal and ethical rules about patient’s rights such as the right to informed consent and the right to be respected still apply when you come to a hospital in active labor.

Doula Woman has about a 32% induction rate. 90% of my clients are offered induction, or have an induction date set.  Of these over half have spontaneous labor prior to the induction date and some of my  clients say “no” to induction, often multiple times.

I wrote up the following summary of induction techniques.

  This is a summary of what I have learned and is  NOT a substitute for medical advise. 

1- AT HOME

NIPPLE STIMULATION:

This  releases hormones, so it somewhat resembles what happens naturally.  Suggest 10 or so minutes on each side for one hour at least.  You can use a pump. If contractions  start and then feel too strong or just wrong, you may want to contact your medical provider.

SEX:   Prostaglandin release can help. So intercourse here.  Also female orgasm.

Raspberry leaf tea:  Some swear by this.

Evening primrose oil:  Some providers will give you a script. I am pretty sure Outpost usually carries this.

Walk-rest combo. So you walk quite a bit and you also treat yourself to an extra good night’s sleep when possible.

Snuggle with your partner and create a spa atmosphere at home!

Acupressure:  Look up and you can do the “bring baby down” points too.  Pinky toe a good one and press hard!

Castor oil or black or blue cobash:  Obgyns say “no”to this.  These are commonly recommended by out-of –hospital or holistic providers and not  by in-hospital providers. FYI castor oil will cause you to poop up a storm.  Castor oil has been used in many cultures historically.

2-IN HOSPITAL

Hospital grade breast pump:  This can cause contractions and sometimes put you into labor.

Foley:  A catheter is inserted vaginally to open and soften your cervix. Usually done at night prior to a morning  Pitocin induction.  This is the most gentle way to soften the cervix.  Sometimes the Foley causes contractions for awhile, then these contractions stop. Rarely, the Foley alone can cause your active labor to begin.

AROM: One of your medical managers breaks your water by inserting a rod into your vagina.  This could kick you into labor, strengthen labor, or do nothing. Baby may have a harder time moving down in your body. You will probably feel contractions get suddenly very harsh.  You may be on shorter time clock than with other induction methods.  Suggest ask provider about potential negative side effects and how much time you have to give birth vaginally should you agree to AROM.   Generally best to do when baby already low in your pelvis.  Especially with a first baby this can lead to csection because baby cannot make the spontaneous moves needed to come down. 

CYTOTEC: 

Cytotec (Misoprostol) is commonly used to induce labor.  It is used to make the cervix “ripe.” It is a synthetic prostaglandin.  The med is off label and it’s intended use is to treat ulcers.  The Cytotec label states that it is NOT to be used by pregnant women.  Cytotec can cause severely abnormal strong-long contractions and hyperstimulate your uterus though  only rarely. Cytotec can cause fetal distress on moniter leading to csection.  Cytotec is strictly prohibited for vbac because it can cause uterine rupture.   It is used to cause planned abortions. Once in your system, cytotec  cannot be “turned off.” Time to work out of your system actually varies among women and the effects can last 6 +hours.  Sometimes cytotec can kick you into natural labor and you may be able to skip pitocin.  Most of the time cytotec  ripens your cervix but does not cause labor to start.  Usually given vaginally-can be given orally.  Cytotec is commonly used in most southeast Wi. hospitals. Suggest ask your medical manager  to go over potential side effects and alternatives.

CERVADIL: Mimics hormone dinoprostone in a hydrogel insert.  Used to ripen the cervix.   You may need to lie still for 12 hours.  May stimulate natural labor OR ripen you for Pit OR do nothing.

PITOCIN:

Artificial oxytocin.   Pit  can be turned down and it can be turned off.  I suggest ask the nurses to tell when they are turning the Pit up or down.   Pit causes your uterus to contract but does not mimic your unique natural labor pattern.   You are on a time clock for cervical dilation.  Medical staff wants contractions every X number of minutes (usually 3 minutes from start to start).

If Pitocin causes your cervix to swell you can ask that it be turned/off down and that something be done to reduce swelling prior to going directly to a c-seciton. 

When you have an epidural and your medical manager gives you x amount of time to push your baby out and if you fail to do so next step is csection, you may ask that the epidural be turned off so you push your baby out in spontaneous positions, thus allowing  for vaginal birth.

Pit contractions are harsher  than spontaneous contractions and you and baby  give up the“love hormone” benefit from spontaneous labor as well as many other mechanisms that help you and baby physiologically.

The vast majority of hospital inductions involve Pitocin.

Hospital inductions include continuous fetal monitoring because these chemicals are dangerous.

 Suggest ask that if induction does start natural labor, could you switch to intermittent monitoring.

Also-if you agree to induction you can ask for your Bishop score….this gives an idea of both how to start the induction and the likelihood of a successful induction.

Oh, and if you agree to a night time arrival, you may look up benefits of a sleeping pill…Inductions can kick in AFTER you have already missed one to three  nights sleep.

Peace

Martha at Doula Woman