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Friday, October 25, 2013

Why I Used a Doula

If you've never heard the word "doula" before, you're not alone. I hadn't heard of it until a friend of mine used one several years ago. The organization for doulas, DONA International, defines a doula as a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period. The use of a doula seems to be mostly kept to what I like to call crunchy/granola types,which I sometimes identify with.

Services for using a doula can be prohibitively expensive, though. The doula that I used for the birth of my baby was $900. Not cheap. Would I use her again, though? Absofrickinlutely.

I had never seen myself as a person who would use a doula or a birth coach until my father was terminally ill in the hospital in mid-2012. He was in the ICU, and our situation was complicated due to the fact that my dad had remarried and had become close with his wife's children, but his own children had not shared that closeness. In fact, during July 2012, the two families spent more time together than ever before in the 18 years that my dad and his wife had been married. I hadn't even seen some of his children in about 15 years. So, the two families had differing opinions about the approach we should be taking for my father's care. Since he hadn't created a living will or advance directive or anything, we were kind of all shooting in the dark.

To make matters worse, the ICU doctors were rotating, and in the 3 weeks that dad was in the hospital, I never spoke to the same doctor twice. They probably felt the same about us - we were all in and out at various times due to work schedules and they never spoke to any of us twice, either. Each of us was getting different information from different doctors, and each doctor was practicing a different specialty. Most of them seemed to think that he was beyond hope and was going to die. They did their best to guide us, but we were in uncharted territory and didn't have enough of an understanding of the situation and of medicine to make an informed decision. I can't say with any certainty that we made the right decisions about his care, and it will linger with all of us forever about what might have been different if other choices had been made.

What we really needed, I decided, was someone who did have an understanding of end of life care and who was familiar with the doctors, the hospital and the ICU. When a doctor asked us a question and wanted us to do something, we needed someone there to explain to us what the risks of each of the options were, and why we may or may not want to choose each option. That person wouldn't be there to convince us to make one decision or another, they just needed to inform us about what the decision meant. That person should also be with us through the entire thing - from the moment my dad entered the hospital until his body was released - so that they had a full picture of the entire situation. The doctors never had a full picture, they just glanced over his chart, talked to us, maybe ordered a test or something, and moved on to the next patient.

This, what I just explained, is what a doula does for you when you are in labor. She (I am using she  because most doulas are women) meets with you before your birth and discusses your birth preferences. I didn't feel like I had any particular birth preferences early in my pregnancy, except that I didn't want a C-Section, but as time went on and I learned more about birth, I learned that I had very specific birth preferences. The thing is, that you don't know that you have a birth preference until you understand birth. Just like with my dad, when we didn't know the right answer for him because we didn't understand the question.

So, there's a second part to this also - the best birth patients are those who are informed about the birth process. It always floors me when I hear women saying they're just going to "wing it" and go to the hospital without taking any classes. The argument is that women have been giving birth since the beginning of time, so it will come naturally. That works, except that for a very long time, women have had help while giving birth, in the form of midwives or doulas, and birth these days tends to be less on the natural side of things - a hospital isn't particularly "natural." What happens when the doctor comes in and says you're not progressing fast enough and something needs to be done? What often happens is that doctors tell you what they are going to do, when they are really ok with you saying no. So, if they say that they want to give you pitocin, you can actually say "can we try this other thing instead and see if it works to speed things along?" Quite often, doctors will say sure.

Doulas can help with such issues. They can help you make the choices that you need to make in order to have a safe and healthy birth. Safe and healthy are the most important words here - not drug-free. I was willing to try a drug-free birth, and through my childbirth classes, I learned coping methods to try and get through birth without an epidural. In the end, I chose to have one. My doula, contrary to what you might think, was completely supportive in my desire to get an epidural and walked me through it. My informed childbirth class was invaluable in helping me to know what to expect when it was time for the drugs.

At a minimum, if you choose not to have a doula or birth coach, do go to an informed childbirth class. I recommend going to one that is not taught at a hospital. I attended classes with Emily Pelton of Baltimore Family Beginnings and was awesome. While a hospital class will focus on the medical interventions and give more of a doctor-centered instruction on birth, classes like Emily's will focus on understanding the natural process of birth and the medical interventions. Emily considered epidurals and other medical interventions (even c-section) to be tools that are necessary and useful at times. For example, epidurals, when used well into labor, can help mom to relax so that she can dilate more easily. That is exactly what happened when I had my epidural - after 8 or 9 hours of labor, I had only dilated to 6 centimeters, but after the epidural, I was at 10 centimeters in under an hour.

During the labor, Bobbie (my doula), helped me so very much. She allowed Todd to have a break during labor, and certainly made him more comfortable. I knew she was there to help me make decisions and help me through things. Most of all, she was there with me at my house at 6am, working on turning the baby so that he was facing the correct way, and helping me deal with the pain. She followed us to the hospital, and she stayed by my side to help me change while I was having crushing contractions. She was there to help talk me through the epidural, and was by my side while I was resting after I go the epidural. During the pushing phase, she held my leg (Todd had the other) and gave me the pep talk that I needed to get the job done right at the end. I cannot express how much she helped me. Money well spent.

Of course, the hospital where I gave birth was important also. I gave birth at Sinai Hospital in Baltimore, which was very open to working with patients that had doulas and birth plans. This is VERY important - the hospital matters. In Baltimore, GBMC is known as a hospital that does not tolerate patient requests during birth and is very doctor-centric. Not surprisingly, it also has a very high c-section rate. It's a very nice hospital, but I would never give birth there.

So, if you are pregnant, do educate yourself on informed childbirth. Do consider getting a doula. Consider the hospital that you choose and the doctor or midwife that you choose to make sure that they will work with you on what is best for you during your birth. Most of all, enjoy this time :)

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1 comment:

lindsay said...

My sister used a doula as well. From her experience, I learned a lot (and still just a portion) about the birth experience! There are so many 'options' you have that most women do not know about and instead just go with the doctor's first suggestion. I'm glad you had a positive experience with yours and I can only imagine how helpful (and stress-relieving) having a doula there would help the mom! Oh, and definitely on the hospital part - my sister had to go to one ~30 mins away in order to have her doula come vs the one 10 mins away did not allow them.

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