VBAC

Preparing for birth-some excellent resources!
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Preparing for birth-some excellent resources!

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I love collecting birth resources-be it books, DVD’s, magazines, articles-you name it! The only problem is, with the limited amount of “extra” time I have (or don’t have!), I don’t always get a chance to preview and read the resources I collect right away. And I find myself hesitant to pass along information to clients and friends that I haven’t read or previewed myself.

    This winter I’ve found myself in the remote hills of Arkansas, with more time on my hands than usual, as my husband is teaching at a small winter Bible School for young people. Keeping the children occupied is my main job here, but with the absence of our usual activities and schedule AND having all our meals provided, I’ve enjoyed the chance to finally dig into some of the resources that have been sitting on my shelves at home waiting for me to get to them.
    So, with that introduction, I want to mention a few EXCELLENT resources that would be worth any of you expectant moms, or anyone wanting to learn more about birth, to take time to watch or read. I can’t believe I’ve had these around this long and didn’t realize what treasures they were!
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The first one I’ll mention is the Parent Class DVD by Spinning Babies teacher Gail Tulley. I’ll confess that this one I have recommended to clients as I’ve taken one of her classes in person myself, and know she has alot to offer. But I didn’t realize how many jewels were in this educational presentation! It was a great refresher to me as a midwife, as Gail does and excellent job of teaching you how to help “make room” for your baby in your pelvis, and help your entire body to function more efficiently with less discomfort. The only drawback with this DVD is that, while she is teaching this class to a participating group of expectant couples, she does get fairly technical with some of her explanations. But in the long run it is helpful, as I think it helps you to get a better idea of WHY some of her positional suggestions and exercises help to eliminate certain issues. Using a great variety of teaching aides, examples, charts and object lessons, Gail shows you how exactly the uterus, baby, brain and body all work together, and how you can help. This would be great DVD for an expectant couple to watch together, or for any midwife or doula to watch in order to give you some great ideas of how to help your clients through specific issues and achieve better positioning for babies. It is well worth the $ you would need to invest, in my opinion! You can find out more about Gail, and purchase this DVD here.
    Next in my pile of resources was a book by Ina May Gaskin. If you’ve been in the childbirth realm long, you’ll recognize this name as one of the most famous midwives in the USA. Ina May has been practicing since the 1970’s, and is probably most well known for her involvement with births on “The Farm” in rural TN. People have come from all over the world to have their babies in this community that has come to be known for it’s amazing work with natural childbirth. I’ll admit that while I’ve appreciated many of the things I’ve read or heard taught by Ina May, I was still a bit skeptical of her book “Guide to Childbirth”. I think I was expecting it to have a real “back to earth” or “hippie” type flare, which I know can turn off families who are looking for evidence-based and scientific information on preparing for birth. I was in for a big surprise! Ina May’s Guide to Childbirth has been amazing. Written in an easy-to-read manner, it is full of so much helpful information. Starting with birth stories to help women realize that birth is both natural and do-able, it then proceeds to teaching you about the things you really need to know about how your body works, how to care for yourself during pregnancy, how to understand tests and the “whys” behind them, helpful suggestions for choosing both caregivers and birth locations, ways to prepare for labor, and the list goes on. I love her honest, down-to-earth style of writing, yet all of her information is based on evidence, research, and studies, and she includes citations and information for further study. If you are wanting just one book to help you understand pregnancy and prepare for birth, this one is it. And it’s not just for moms planning to birth at home-there is information in this book that would help anyone to be better prepared and ready for the amazing experience of labor and delivery.
    The last resource I’ll mention here is a DVD that was given to me by one of my clients. She had purchased it during her last pregnancy, and wanted to pass it on to other moms when she was done with it. “Practicing for an Active Birth”  is basically a childbirth class presented by Instructor Neri Choma by Birth Coach Method. While Neri could probably be a bit more dynamic in her teaching style (I’d suggest watching 30 min. at a time-the DVD is about 2 hrs. and 15 min. long), she does a very good job of helping  you to understand the process of labor and the terms used to talk about each stage, and gives couples LOTS of great position and relaxation techniques. Using charts and models, she helps you to learn how to visualize what is happening during each stage of labor, and how you might be able to help facilitate comfort and relaxation during each stage, working together as couples. While I think that it is best for couples to take a live childbirth class whenever possible, this would be an excellent option for those who might not have that opportunity in their area.
    I personally feel like much of preparing for a great labor and birth involves understanding how your body works so you are not tensed with fear of the unknown. If you KNOW what is happening, understand WHY you are experiencing certain sensations, and have IDEAS for what to do and when, you and your partner will be able to relax and work together much better. Moms (and dads!) that are prepared tend to do much better emotionally and physically through the marathon of labor. I would strongly recommend you look into any or all of these resources as ways to prepare for a wonderful experience of bringing your baby into the world.
    I’d love to hear about what worked for you. Do you have any favorite resources you would care to share with others? Tell us about it in the comments! And consider sharing  this post with your pregnant friends to help them hear about ways they can prepare for labor and birth from the comfort of their own home.
Do I Need a Doula if I’m Planning a Homebirth?
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Do I Need a Doula if I’m Planning a Homebirth?

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So you’ve heard of the advantages of having a doula with you if you’re planning a hospital birth. The positive aspects include such things as: continuous support that doesn’t change shift, possibility of laboring in the comfort of home knowing someone will help you decide when it’s time to go in, someone who can help you and your spouse keep perspective and act as a liaison with the medical staff, a friendly person to call directly with questions during those last days before labor, and the list goes on. All of these things sound good, but if you’re planning a home birth, then you don’t need all this, right?!? You already know who your caregiver will be, you’re staying in your comfy home, your midwife will provide support and perspective, and you can call your midwife directly…which means that a doula is totally unnecessary, correct?!? Well, that’s a question I hear often, and I wanted to take some time to explore how a doula can actually be a great benefit at a homebirth, as well. If you’re trying to decide whether or not you want to add a doula to your birth team, hopefully this post will give you some help, and maybe even answer some of the questions you have.

To get some input on this subject, I contacted several different groups of midwives, doulas and birthworkers, and asked them to tell me from their experience how homebirths could benefit from doula support. Their responses were very helpful, and provided the bases of what I am going to share below.

When it comes down to it, a midwife and doula offer to distinctly different services. While both are attempting to provide women with personalized, professional care, they are coming at it from two different angles. A midwife’s job is to help ensure that mom and baby both maintain the low-risk status. She is concerned with providing a safe, professional and knowledgeable environment to women seeking out-of-hospital births. This means that she must put mom and baby’s safety first-which sometimes means that she will have to stop providing labor support in order to monitor heart tones, for instance.  There are also those times when the midwife will need to conserve energy in order to maintain the needed mental and physical alertness needed for the actual delivery, which may mean not being able to constantly apply back pressure for hours on end! For some mamas, especially those who appreciate privacy, a midwife and her assistant may be all that she needs in order to feel supported and cared for, but there are others where this may not feel like enough. As a midwife myself, I seek to provide labor support whenever I can, but I am also always acutely aware of what is going on medically. The role of a doula is that of providing consistent emotional support and physical support. Because she does not have to be responsible for the medical aspects of birth, she is free to focus on helping the couple work together, and helps mom to achieve the space and birth atmosphere that she desires, without distraction.

At a homebirth, a doula can:

  • Give valuable input and educational support during the prenatal period.
  • Provide early labor support, and help the couple decide when it’s time to call the midwife to come.
  • Free dad up to focus on mom by paying attention to other details (like keeping the tub water warm, setting up the bed, changing linens as needed, keeping birth atmosphere tidy, etc.).
  • Keep mom and dad fed and hydrated.
  • Help the birth team to remember mom’s preferences-whether it’s the desire for quiet and privacy, or a certain music playing at a certain time, she keeps everyone aware of what mom wants.
  • Help with comfort measures such as massage, positioning techniques, etc.
  • Provide positive encouragement about progress and what is happening.
  • Give mom support during pushing, especially for those families where daddy wants to catch, and mom still needs support by her head that is focused on HER.
  • Assist with childcare as needed, especially if children are present for the birth.
  • Help the mom to feel an extra measure of help and support, through extended availability before and after, and checking on mom’s emotional well-being during the initial postpartum period.
  • Protect and nourish the new family’s space as nursing and bonding are taking place.

A doula is especially beneficial when:

  • A mom is expecting her first baby or is planning a VBAC. The potential for prodromal labor and/or need for extra physical and emotional support make a doula an especially good choice for these moms! For the same reasons, moms who have a history of long labors may also find a doula an excellent addition to their birth team.
  • Mom is lacking other support systems. For single moms, or those who have no family or close friends nearby, a doula can be a tremendous asset in providing a consistent, dependable support person during the pregnancy, labor, delivery and postpartum periods.
  • When using a very busy midwife, or if your midwife has travel plans over the time you are due. If you know there is a good possibility that you may be using your midwife’s backup, then having a doula whom you have already connected with can help make that a smooth transition, as you won’t have to totally “start over” with your birth team.
  • If your chosen midwife usually practices solo (without an assistant). In these cases, it may be hard for her to provide consistent labor support, as she will have many responsibilities to stay on top of.
  • When mom knows that she needs extra hands and extra support. Some moms prefer quiet, privacy and extreme “hands-off” during labor, while other moms know that they would relax better when surrounded by encouragement, positive input, touch, massage, etc.
  • If you’re planning to have your children present at the birth, and don’t have a specific care-giver for them. This can allow dad to spend time with mom or with the other children, and know that no one is being neglected!

So, to tie all of these comments up, you can see that a doula can be a lovely complement to a planned home birth. The moms who have experienced doula care at a homebirth made comments such as “I wouldn’t do it any other way”, “it was the ultimate support group”, “I gained a trusted friend”, “My doula could be someone my midwives could never be (though my midwives were awesome and perfect for me)…All her energy and focus went to me, she had no other obligations”, “she provided a different perspective”, “the little things made a big difference…her doing things that allowed my partner to stay with me was key”. The midwives who have had doulas present at births say, “Doulas are worth their weight in gold, literally!”, “The women who have both feel SO supported”, “Having a doula…helps to share the load, and each individual has something different to bring to each unique situation”, “Doulas provide a different type of connection”,  “I think there are some births where there is plenty of work for many hands…and some where there isn’t”.

All that said, I do want to underline the fact that each mother and each birth is unique. While having a doula can make your birth experience even more special, I totally understand that it is not the choice for everyone. For some mamas a more private, intimate and quiet birth environment with as few people as possible is better.  And this is totally okay. It’s one of the beautiful things I appreciate about the option of birthing at home…the birth team can be personalized to suit the preferences of the individual mom. Each mom/couple has to figure out what is right for them, as this is what will enable them to relax and give birth in the best way. The goal of this article is not to make you feel like you HAVE to hire a doula! But for those who have wondered if a doula could be beneficial, my hope is that you now have a better picture of how a doula can fit in to your homebirth plans, and how this option can make a mama feel even more supported.

Did you use a doula for your homebirth? Or have you been a doula at a homebirth? I’d love to hear about it! And if you’re looking for a doula, be sure to check out www.doulamatch.net in order to find out about doulas offering services near you! For those living in central PA, I’d be glad to refer you to some excellent doulas who serve the surrounding areas.

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Frequently Asked Questions
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Frequently Asked Questions

If you are considering a home birth, perhaps the following are questions you have wondered about. Don’t hesitate to contact me with any specific questions…I’d love to help you in any way I can! Please note, these questions and answers pertain specifically to my practice here at Gentle Delivery Childbirth Services, and may not apply to other midwives and practices.

Q. At what point in my pregnancy should I contact you?
A. You are welcome to contact me at any time-with preconception questions or as soon as you find out your pregnant. A free no-obligation consultation where you can ask questions and see my office can occur at any point, but I typically schedule your first actual appointment once you are between 10-12 weeks along, as that allows the baby to be mature enough to hear the heartbeat. The earlier you are in touch, the greater chance I will have an opening over the time you are due, though it’s never too late to talk with me about your options, either…we can begin care late in the pregnancy when necessary, too!

Q. What does a normal prenatal look like, and where does it take place?
A. Prenatal appointments normally take place in my home office, usually on Tuesday and Thursday afternoons, although other times are possible. I generally expect to take anywhere from 30 min. to an hour, with the goal being able to spend enough time to answer any questions or concerns a couple might have, as well as including education regarding exercise, nutrition, positioning, childbirth, etc. At each visit a urine sample is checked, weight is recorded, BP is taken, and baby is listened to, measured, and palpated to see his or her position. Other testing and/or procedures will be performed as needed. The normal schedule for visits is every month until 28 weeks, followed by bi-weekly appointments until 36 weeks, and weekly visits thereafter. A home visit is performed at 36 weeks, in order to give myself and any other birth attendants a chance to see your location in normal daylight hours! 

Q. Do I need to see a doctor besides seeing you for prenatal care?
A. That honestly depends upon your personal preferences. The prenatal care I give would be similar to what you would receive from a doctor, including labs and referrals for things like sonograms. Most of my clients do not see a doctor while receiving care from me, as it keeps costs down and keeps them from multiple prenatal care visits. If your OB office is open to co-care, it can provide you with a seamless transition in case of transport, especially if it is covered by your insurance provider. If care with an OB is covered in full by your insurance provider, you may benefit from continuing care with them in order to have the costs for your labwork and other testing covered completely.

Q. Will my insurance cover your services, or how can I afford it?
A. Sadly, many insurance companies do not cover home midwifery care, though it is always worth checking into thoroughly. I would be happy to provide you with some information on how to best discuss this with your insurance company, and I am also willing to give you a written statement complete with insurance codes to submit to your insurance company. In order to keep my own costs down, I do not file insurance, but I do try to make care accessible to all families by charging a sliding scale fee based upon your family’s income. Keep in mind, too, that when using insurance, you will have a co-pay, and for some people the cost of my services are either similar or lower than the co-pay amount you would be paying with a hospital delivery.

Q. I notice you have a student working with you. How does that influence my care?
A. When a student is interning for midwifery training, their level of involvement varies according to where they are at in their studies. A student midwife begins by observing all aspects of midwifery care, and applying the academic knowledge she has already received to practical, hands-on situations. As her experience expands, so do her opportunities-she assumes more responsibility depending upon her level of experience and skill. Students are always grateful for any opportunity afforded them to learn, and would love to be as involved with your care as you feel comfortable with. I always strive to make sure the client feels completely comfortable with any care provided by a student, whether that is allowing the student to feel for baby’s position and fundal measurement, or whether it is as extensive as allowing the student to participate in a high level of care during delivery. Whether you prefer lots of involvement or minimal involvement, a student generally acts as my birth assistant during the actual labor and delivery, helping to provide labor support, take notes, and in general act as my second set of hands. 

Q. Who will attend my birth? Is is okay to invite others to be present in addition to the birth team?
A. Normally I attend births with one or two qualified assistants. These ladies are usually either skilled students or birth attendants, and enable me to know you are getting the best care possible, allowing both baby and mom to be cared for in case of emergency. Besides this, whomever else you choose to have present at your birth is up to you. I’ve been at births where it was the bare minimum of people, and I’ve been to births where there was a crowd! The main issue is that you feel totally and completely at ease and comfortable with whomever is present, as that can majorly impact your experience.

Q. Are children welcome to attend the birth?
A. It’s your birth, so you get to decide if you want your children present or not! If you are planning on having your children attending, I strongly recommend you having an extra person handy whose sole responsibility is caring for your child(ren) so that you can focus on the delivery.

Q. Do you do waterbirths?
A. Yes! Laboring and delivering in the water are both options. For many people, their home tub is comfortable enough, but if you’re wanting to use an actual “birth pool”, I can put you in touch with rental possibilities.

Q. I had a cesarean with my previous delivery, does that rule out a home birth?
A. I am happy to help women VBAC whenever possible. For most women, a VBAC at home is statistically safer than a repeat c-section. Make sure you get a copy of your previous medical records, and we can discuss your particular situation in person in more detail.

Q. What birth positions are options at home?
A. There are about as many options as there are women!  One benefit to delivering at home is the flexibility to figure out what works the best for you…whether that is squatting, laying in bed, standing in the shower, or wherever you are the most comfortable. I have a traditional “birth stool” that I bring along to births which gives you the option of a low squat, but most women instinctively find a position that works the best for them.

Q. Are you prepared for possible emergencies?
A. Yes. I maintain current certification in both neonatal resuscitation and CPR, bringing along emergency equipment in case of a baby with breathing difficulties. I also carry equipment to assist with stabilizing a mom in the rare case of hemorrhage. It’s my goal to make your home birth experience as safe as possible, which includes careful monitoring of both baby and mom during and after labor, so as to catch any concern that is out of the scope of “normal”. Consistent prenatal care combined with healthy, low risk moms lowers the chance of emergency procedures drastically, but your birth team stays alert for any signs of possible surprises. We can discuss this question in more detail during your consultation if you wish.

Q. So, laboring at home sounds nice, but what about the mess that comes along with birth?
A. Most people are surprised at how little mess is involved. I have families purchase disposable underpads (available at most drugstores) and a cheap shower curtain, which we use to protect surfaces such as the bed and carpet for the actual birth. These things get thrown away afterwards, and myself or my assistant will start laundry before we leave your home. We also make sure to tidy things up so that you aren’t left with clean up!

Q. How do I go about getting documentation for my child?
A. I will file all needed paperwork with the state, which includes the official birth certificate and request for a social security number. I also perform the newborn screening test on your baby during the home visit which occurs 24-48 hours after birth.

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Sweet baby feet as baby is being weighed during the newborn exam!