In my course, I teach a different way of making birth plans. These birth plans allow for planning as well as flexibility. It is also not just a list of things the mom wants, but a plan for both the doula and the mom to follow as they work together. The plan includes assessing your clients needs, figuring out the goals, making a plan, deciding what needs to happen and then continuing to evaluate and change the plan as needed. (more…)
I am going to state upfront, that I do not like electivel inductions be it natural or not. We do not fully understand how and why labor starts and I don’t like to mess with that system:) So there’s my bias upfront, but I still feel like it’s important to present all information, so these posts are my attempt to do so.
In my doula certification course, methods of induction are presented so that the doula can help provide information to the birthing mother. The doula must be careful, though, not to advocate for a particular method. She must also make sure that her information is as accurate as possible. When it comes to non-medical methods of induction, there has not been a lot of research done to support or refute them. This should be conveyed to the mother if she is going to be able to assess her choices accurately.
Primrose Oil for Induction of Labor
What it is:
Evening primrose is a plant that was used by the Native Americans for various ailments, but it is also used by many midwives today to prepare the body for labor. It has chemicals that are part of the production of prostiglandins which are hormones that help soften the cervix. Some believe that taking primrose oil helps to release these prostiglandins, thus providing a way to soften the cervix earlier.
What the research says:
There is not a whole lot of research on evening primrose oil, and the research that I’ve seen shows no effect on the length of labor or starting labor. One small study also showed an increase in the bag of waters breaking when women took evening primrose oil.
There is no standard dosage, but 500-2000mg daily after 38 weeks has been suggested. The capsules can be taken orally or vaginally.
The benefit appears to be in it’s ability to soften the cervix, thus preparing the body for labor. The idea is that it may keep the woman from going overdue, or help shorten the labor.
May cause an upset stomach or nausea and vomiting. There is possibility of premature rupture of membranes (based off of one small study).
What the Doula can do when her client is using primrose oil
-Provide your client with as accurate information as possible
-Help the your client work through the pros and cons of this method
-Encourage your client to also take care of herself, as this helps the body work better regardless of what else the mom is doing
-Provide some ways to help decrease stress and anxiety as this inhibits labor and is often a part of women’s lives when they are feeling pressured(from themselves or a care provider) to have their baby soon
-Continue to remind them of the different ways their body is preparing to have this baby. So often we focus on dilation, but that is really one of the last ways your body prepares and it’s overused as a method of judging when the baby is going to be born. Focus instead on the baby moving down, the cevix softening, any increases in contractions (even braxton hicks).
Dove D, Johnson P.Oral evening primrose oil: its effect on length of pregnancy and selected intrapartum outcomes in low-risk nulliparous women. J Nurse Midwifery. 1999 May-Jun;44(3):320-4.
Disclaimer: I am not a doctor and recommend that anything you should choose to do should be discussed with your care provider first.
I’m kind of cheating today because today is Sun:) I’m stealing something I wrote years ago:) But I liked the thought in it, so I hope you enjoy.
This is an interesting video that discusses the importance of providing holistic care for women during childbirth. I often describe the role of a doula by first describing Maslow’s hierarchy of needs. This is a concept that is taught in my course. It can be depicted like a pyramid with phsiologic needs and safety at the bottom of that pyramid, but three other layers on top. These include love/belonging, esteem, and self actualization. All of these needs are considered to be important to our happiness in life.
In our current system, we have done a good job at paying attention to the physiologic and safety needs, but we have forgotten the whole rest of the pyramid that ultimately is necessary for complete health. That bottom part of the pyramid can also take up all the time and effort of a health care provider, depending on the situation. Because of this, doulas form an important part of the health care team as they work to provide the care at the top of the pyramid which then provides complete comprehensive care.
Here’s a video that discusses the importance to paying attention to our clients social/physiological health during birth.
Depression During Pregnancy and Beyond
Depression is one of those areas that we need to pay more attention to. In pregnancy it has been associated with poor weight gain, pre-eclampsia and premature labor. Thus is it is important that we look for it and learn how to treat it.
Because doulas work so closely with their clients it is often the case that they can pick up on signs of depression before others might. While we don’t diagnose the disease, we defineatly have some tools up our belt to help decrease it’s severity and hopefully increase the possibilities of a better outcome at birth.
Just recently a new report came out discussing the benefits for pregnant women to utilize something called mindfulness yoga, which combines yoga with a technique called mindfullness that helps to decrease anxiety and depression. Again, this is something that is taught fully in my course, but I thought I’d give you a preview.
There are two reasons that I think this technique may be importnat.
1) More research is showing health concerns with the use of antidepressants during pregnancy,
2) Mindfullness yoga provides a good way to help the mother prepare for birth by helping her to develop an effective relaxation technique.
I am putting together a series of videos on yoga positioning and exercises, so stay tuned.
Simpson KL, Weaver, KJ, de Villers-Sidani E, et al. Perinatal antidepressant exposure alters cortical network function in rodents. Proc Natl Acad Sci USA 2011;108(45):18465-70.
Muzik M, Hamilton SE, Rosenblum KS, et al. Mindfulness yoga during pregnancy for psychiatrically at-risk women: preliminary results from a pilot feasibility study. Complement Ther Clin Practice. 2012;18:In press.
As the doula, it is your job to make sure that a laboring woman is adapting well to the stressors that are placed on her during labor. Anxiety and stress can be beneficial, as noted above. It moves the woman to action when needed, it produces endorphins to help her cope, it can give her strength and determination when she is tired or fatigued. Anxiety becomes maladaptive when it interferes with the birthing process. This can happen when it causes muscle tension that slows down labor, uses up the woman’s energy stores, or interferes with the transfer of oxygen to the baby. Thus, it is the signs of maladaption that you need to focus on rather than whether or not she is actually experiencing stress or anxiety.
Physical signs of maladaption include a high heart rate or blood pressure that may become harmful, the babies heart rate begins to decrease during or after contractions, a slowing down of labor when it has been progressing steadily, and fatigue that makes it difficult for the woman to cope with labor.
If a woman has been determined not to use pain medication, the desire for pain medication may also be a sign that anxiety is no longer working with the woman’s body, but against it. In this case, it may be necessary to try both medical and non medical means to help her adapt successfully to labor and birth.
It is important to assess what their fears and anxieties are and how they usually deal with them before labor even starts. This will give you an idea of what works best for that particular woman.
In general, anxiety should not be viewed as a good or bad thing, but as a normal human response that can sometimes hurt and sometimes help a laboring woman. As doula’s, we should make sure that we are looking for specific signs of maladaptive to help guide us in how we help our clients.
This is a post mainly for those who are wanting to help me do a little bit of “research” on how to help lower back pain and sciatic nerve pain. For others who are interested, though, you are welcome to read on.
I put research in parenthesis because it is not the rigorous research you will find in journals. Right now, I just don’t have the time or money to do that, but I am interested in finding out what I can do to better help my clients. So, I am performing a small experiment just to get an idea of what might be helpful.
At this time, I am looking at the effect that alignment and exercises geared to help keep our bodies aligned has on lower back pain and sciatic nerve pain. For those who have signed up, here’s what I need you to do(if you are interested in doing this, just drop me a note and I’ll keep your records also).
First off, to give you a little bit of background on alignment and why it may help during pregnancy here are a few links.
While these articles discuss alignment and exercise in terms of preparing for a natural birth, rest assured that these exercises will benefit you way before you start labor. They are also helpful even if an epidural or c-section is in the final plan.
If you are planning on being a part of my research, download the instructions and enjoy.
Did you know there really is something you can do about the aches and pains of pregnancy? Not only that, but you can also help open up and widen your birthing area. Below is a link to some really simply exercises that will help to get rid of those sciatic and lower back pains as well as help you prepare for an easier birth. These are great exercises to share with your clients as they gear up for birth and beyond.
I want to pose a question for my student doula’s out there. There has been some research that has suggested that women with gestational diabetes have decreased contractility during labor. So their uterus does not contract as efficiently, with or without pitocin. How can you as a trained doula, help provide labor support before and during labor for a woman with this condition? If you’ve been through my course, use the process discussed to come up with this clients needs and specific actions you would take.
I’m making up a case study on this as we speak:)
In one post I did, I mentioned the importance of validation during labor and birth. I then asked that you think about ways that you can validate women during labor. As I thought about this, my train of thought turned to how my husband helped to validate my ability to birth during my last labor.
I was very tired and kept telling him how I didn’t think I could do this any more(sound familiar?). He just looked at me, and then said, “Rachel, you’ve done this before and you can do it”. That changed my whole thought process. When you find a woman faltering or feeling inadequate sometimes all they need is a little validation from a spouse, a friend or family, or doula.