Theresa’s Insights after Course Completion

January 7th, 2013 | Posted by Rachel in Student Responses - (0 Comments)

Theresa recently completed the New Beginnings Doula Training course. She shared her experience going through the certification process with a potential student.  I’ve reprinted her response here for others to read.  Thanks again, Theresa!

I LOVED the training with NB. I chose to train with them because I could not
find what I was really looking for in the other Doula certification
organizations, and NB seemed to fit most with my own beliefs. I was not
disappointed in my choice at all. The content is VERY thorough, and
encouraged me to seek information from all aspects. This is why I feel so
rounded in my ability to help my clients.

I also just LOVE Rachel. She is a wealth of information, and so very quick
to get back to me with any information I seek. Even though I’m certified and
now out of the class, I can still ask her anything and she will do what she
can to help me.

Because of what I’ve learned with Rachel and New Beginnings, I am now a
doula with a wonderful doula organization in my area, and have attended 4
births (2 more coming in the next month!). I am so happy to be affiliated
with both Rachel and New Beginnings.

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Touch in Labor and Birth

January 6th, 2013 | Posted by Rachel in Doula Action - (0 Comments)

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.

One of my favorite comforting memories of my mother is when she would trace my face. I would lay down to sleep and she would sit by my side and with her finger trace around my lips, nose and eyes. There was just something about that soft touch that gave me peace. I find myself doing this with my own children and they’ll trace my face back.Touch can certainly be a comforting action. Of course in labor there are times when being touched is definitely not wanted:) But I remember one time when I was close to the pushing stage, the nurse that was with me at the time just held my hand. That simple gesture of touch meant a lot to me. It didn’t lesson my pain or make me more comfortable, but it let me know she cared and wanted to help. I suppose that was what my mother’s face tracing meant to me also. There is peace in a touch that means that someone loves us.

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Psoas and How They Effect Pregnancy, Labor, and Birth

January 5th, 2013 | Posted by Rachel in Exercises - (0 Comments)

If you are like me, the first time I heard this word, I had no idea what it was and what, if anything, it had to do with birth. I had high hopes of drawing my own pictures and presenting you with my own videos, but those fell flat quickly :) . (I may someday add these to the course). So, I’m going to provide some links for the pics and then provide you with some ideas as to why you, as a doula, should care about your client’s psoas.

For some major anatomical discussion on what the psoas is and what it is used for, check out this link. Essentially, the psoas is a muscle that attaches at your thoracic (mid back) bones and your femur (upper thigh bone). A few important points to note:

1) The psoas act like a shelf for the internal organs. Because of this, a tight psoas can affect the space within the abdomen.

2) A tight psoas can limit the range of motion in the spine, pelvis and legs. This can then limit the ability to assume positions in birth that may be beneficial.

3) Tight psoas also decrease circulation and innervation to the uterus and other organs which may cause more problems with pain and function during labor.

What can we do about it

There are some stretches that everyone should be doing, but pregnant women should be doing them with the idea that it will help create an easier birth for the reasons listed above. The first thing that needs to be done is a psoas release. Basically, it is just allowing your muscles to relax. Doing this stretch and this one will also help release the psoas.

These should be added to our daily exercise routine.

A note on fear and pain and the psoas

Pain which leads to fear, can lead to the tightening of the psoas, which then has the consequences listed above. Learning to relax the psoas as well as the rest of the body is important, not just for controlling pain, but for helping our body to function optimally. This is important for a mom who is working on a natural birth, as well as a mom who has an epidural. Being free from pain does not equal being free from fear and anxiety. Thus, learning techniques such as progressive relaxation, deep breathing, mindfullness training, along with therapies such as aromatherapy, reflexology and hydrotherapy(the use of hot water to control pain) is a big part of helping a woman in labor no matter their choices(all of these are taught in the certification course).

 

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What Is the Difference between a Doula and an Experienced Mother for Labor Support?

January 4th, 2013 | Posted by Rachel in Doula - (0 Comments)

In order to answer this, let’s first look at what the research says about the different forms of labor support and how they compare.

One of the major research groups that analyses current research has found that women who receive continuous labor support (which means it is uninterrupted by other patients or tasks) were less likely to be dissatisfied, had shorter labors, and were less likely to have a c-section or instrumental birth (using forceps or a vacuum).  It also showed that this was most effective when given by someone not employed by the hospital or already a part of the mother’s social network, and has been trained in labor support.  Support from the spouse, family, or friend does increase satisfaction, but you do not see the other benefits.

According to a survey of mothers (links listed below), doulas also had the highest percentage of excellent support given followed by family member or friend, spouse, doctor, midwife, and then nursing staff.

Second, let’s look at the different types of support a woman can receive during labor and what roles they all play.

1) Doctor or midwife.  Both of these will provide you with the medical care you need.  They will monitor both you and your baby to make sure you are as safe as we can make it.  They will do things such as perform tests, evaluate vital signs, monitor the baby, and prescribe medication if needed.  Depending on the training, desire, and model of care they follow, they may also provide some labor support.  This may be difficult to do even if they want to, though, if medical emergencies arise and safety must be attended to first.

2) Your nurse has similar responsibilities as your doctor or midwife, with the drawback that you can’t really choose your nurse.  Some nurses are very good at labor support and others aren’t.  Most nurses are not trained in natural ways to support labor other than a brief run down (and that’s not guaranteed).  They also may have other patients and charting to care for.

3)Spouse or father of the baby.  The connection you have with your baby’s father makes it very important to have them there at the birth.  They also provide emotional support in a way that no one else can.  Their exposure to birth may be limited, though, and they may need support themselves to work through the work of labor.

4) Mother or other experienced woman.  These women may be helpful depending on many different factors.  Having someone who has been through birth can be helpful emotionally and they can at least provide you with acceptance and love.  Their exposure to birth may be limited to their own experiences, though, so that may affect what they view as normal.

5) Doula.  This is a trained labor assistant.  If they are certified, you know they have had some training that has provided them with different ways of supporting women.  In my course they are taught ways to communicate with the medical staff and they learn how to work with different care providers.  They also learn how to assess what is normal in a laboring woman and how to help them cope with anxiety, fear, and pain.  They are exposed to numerous different ways that women give birth and have many ways of addressing the needs of laboring women.

Skills Check Off is a link to the skills list that my students have to pass off.  If you can find an experienced mother that has learned these same skills plus works well with different care providers and has a basic knowledge of birth and labor, then you will probably get the same support as a certified doula.

 

Links to references:

Continuous Support Cochrane Review

Listening to Mothers

7-Week Exercise Guide to a Better Birth

January 3rd, 2013 | Posted by Rachel in Whole Body Health - (0 Comments)

In my doula course, I teach specific exercises to help prepare for an easier birth.  These exercises are designed to increase the strength and function of the muscles utilized in birth and to optimize the birthing space.  To help with our New Year’s goals for a healthier pregnancy and an easier birth, I am including an 7-week exercise guide which incorporates these exercises.

What exercises are included and why?

Walking is one of the best exercises that anyone can do including pregnant women.  It is cheap, requires no extra equipment, and helps strengthen and stretch the muscles needed to provide your baby with the space he/she needs to get into the best position before and during labor.  It also provides your body with the movements it needs to keep all systems healthy and strong as your baby is growing.

Hamstring stretches help stretch the muscles needed to open up the birthing space.  While this may seem strange, our muscles are all connected in a way that requires us to keep these muscles supple and strong to fully support a pregnancy.

Prepping for squats and other alternative birthing positions not only increases your stamina during labor, but it also helps those pelvic floor muscles open up your birthing space and bring in oxygenation and nutrients to the muscles that will be working the hardest.

7-Week Exercise Guide to a Better Birth (see below for pictures on how to do the stretches)

Week 1

Walking frequency: 10-15m/day

Stretching: 10m hamstring stretch

Lifestyle Changes: Drink 8 glasses of water/day

Week 2

Walking frequency: 10-15m/day

Stretching: 10m hamstring stretch; 5m hands and knees

Lifestyle Changes: Drink 8 glasses of water/day;

Week 3

Walking frequency: 20-30m/day

Stretching: 5m hamstring stretch: 10m hands and knees

Lifestyle Changes: Drink 8 glasses of water/day;

Week 4

Walking frequency: 20-30m/day

Stretching: 5m hamstring stretch: 5m hands and knees; 5m squat with a towel between your knees

Lifestyle Changes: Drink 8 glasses of water/day;

Week 5

Walking frequency: 30-45m/day

Stretching: 5m hands and knees; 10m squat with a towel between your knees

Lifestyle Changes: Drink 8 glasses of water/day; stretch your hamstrings throughout the day as you are doing your daily routine

Week 6

Walking frequency: 30-45m/day

Stretching: 10m squat with a towel between your knees; 5m squat with the towel under your heels

Lifestyle Changes: Drink 8 glasses of water/day; stretch your hamstrings throughout the day as you are doing your daily routine

Week 7

Walking frequency: 40-60m/day

Lifestyle Changes: Drink 8 glasses of water/day; stretch your hamstrings throughout the day as you are doing your daily routine; squat instead of sitting throughout the day

Description of Stretches

Squat with towel between legs. Make sure feet are straight forward(I slipped in this picture, so don’t follow my example:)). Make sure your back is straight. If you can’t keep it straight, then go back to the hands and knees stretch for a while.

Squat with towel under heels. You can give up the towel once you can keep your balance in the right position.

Make sure your back is straight and your shins are shoulder width apart. Lean back into the stretch.

Hamstring stretch. Keep legs shoulder width apart and back as straight as possible.

New Course: “Just the Basics” Doula Skills

December 3rd, 2012 | Posted by Rachel in Course Suppliment - (0 Comments)

Note: After an executive council between the husband and wife team here at New Beginnings, we have decide to postpone the launch of the Basic Doula Skills course. This is in an effort to give more attention to the main course for the present time.

I am now offering a new course for those who are just interested in learning the basic skills associated with doula work.  To help you make the decision on what is best for you, here is a list of what each path of education will give you.

Full Doula Training Certification:

  • Learn assessment skills to help you understand when and how to help women before and during labor.
  • Learn the different needs of women in labor and how to identify them.
  • Small amount of training in research and how to use it to communicate with the birth team and help your client.
  • Childbirth courses that teach a new paradigm on normal labor versus the old stages theory.
  • Training in natural movement as a way to prepare for an easier birth.
  • A new way of teaching breastfeeding that more closely follows women’s and infants’ instinct.
  • Training in medical terms and ideas that most women will be exposed to that will allow you to communicate more effectively with care providers and your client.
  • Experience interacting with the care providers of your clients.
  • In depth look at the skills you will use as a doula and why they work.
  • Full on-line support or scheduled conference calls, as needed.

Basic Doula Skills Course:

  • Designed for those who just want to jump in and get their feet wet.
  • Training provided on just the basic, hands-on doula skills.
  • No assignments due except a skills pass off sheet that must be signed by others present when you did the skills(these don’t necessarily need to be women in labor).
  • No specified number of births
  • Paid course support is available for an additional $10.

To request the “Just the Basics” Doula Skills course, visit my contact page and let me know that you’d like to take the course.

Webinar Offer: On Spontaneous Labor

November 21st, 2012 | Posted by Rachel in Course Suppliment - (0 Comments)

Limited Time Offer: Expires December 19, 2012

I am offering an AWHONN webinar on the importance of spontaneous labor.  (AWHONN is the largest organization in the United States focused on women and children’s health for nurses.) This webinar will give you updated research and information to give to your clients and their care providers on the benefits of waiting for labor to start.  You can find more information at:
http://www.awhonn.org/awhonn/content.do?name=04_ConsultingTraining/4F_19WebinarSeries_SmartBrief.htm

I am offering the course for $20 (a $40 value).  For those who are taking my course, I am offering the webinar for free,  if they are up-to-date on their payments and finish one assignment this month (November 2012) . To register for the course, contact me.

What Labor Support Means to Me: Kelly’s Response

November 21st, 2012 | Posted by Rachel in Student Responses - (0 Comments)

Here’s another student response to the question: What does labor support mean to you?

I have been passionate and interested about pregnancy, labor and delivery for many years now.  Often women have so many fears, anxieties and unknowns going into labor, as their doula I would like to inform them of everything I know and have studied over the years.  A woman who is entering into labor (especially for the first baby) sometimes has no idea what to expect or what exactly is going to happen to her body.  I want to be their labor support in order to help calm their fears, keep them well-informed through-out the labor, give dad a break from emotional stress of labor, be constantly there to help with whatever the mother needs.  Sometimes it will be just to be reassured that everything is ok and progressing exactly as it should, or to rub the lower back during contractions and applying counter pressure, watch and time her contractions to see how close until baby will arrive etc.  Often in hospitals nurses and doctors have so many babies being born in the same day that they cannot pay as much attention as they would like to their moms in labor, that is why having your own doula is helpful to be at your side for whatever you need.

Course Supplement: Care of the Woman with Low Amniotic Fluid (Oligohydramnios)

November 17th, 2012 | Posted by Rachel in Course Suppliment | Doula Handouts | Medical diagnosis - (0 Comments)

A recent discussion with a family member has led me to look into more research concerning the use of the AFI(Amniotic Fluid Index). The AFI is used to determine whether an overdue mother should be induced. Coincidentally, the bloggers at www.scienceandsensibility.org recently came out with a blog post on the same topic. Thus, I thought it would be timely to discuss the doula’s role when a medical provider decides that an induction is needed due to low amniotic fluids when pregnancy is at term (39+ weeks).

First off, a few points from the research discussed at scienceandsensibility.org.

  • The Ultrasound measurement is a poor predictor of actual amniotic fluid volume.
  • Another method, called the single deepest pocket method of measurement, actually has fewer risks and is a better predictor of amniotic fluid volume.
  • Poor outcomes seen with low amniotic fluid are usually due to underlying complications such as pre-eclampsia, birth defects, or fetal growth restriction.
  • The main risk of low amniotic fluid at term in a healthy pregnancy is induction (and Cesarean delivery as a result of the induction) and potentially the risk of lower birth weight.
  • Current evidence does not support induction for isolated oligohydramnios at term.

With the science on the table, many doctors still will determine that a women needs to be induced if her AFI comes back low, particularly if she is overdue. As a doula, it is not your job to be the decision maker in this type of scenario. Rather, you need to attend to the woman’s needs at the time the decision is being made between her and her caregiver.

Here is what I would write as a birth plan. (For those who are taking my course, you’ll recognize the format. For those who haven’t, I teach a specific format based off of theories in nursing and psychology to help organize the plan).

Birth Plan for Oligiohydraminos (Low Amniotic Fluid)

From previous interviews and discussions, you know that your client wants a natural birth and does not want to be induced. She wants to be able to move around, eat and drink, and use the birthing ball. This is her first pregnancy and is not quite sure how she will react or what to expect, but she is very worried about being pressured into an induction or c-section. She is going to a midwife, but she is residing in an area that has a high induction and epidural rate. She is currently 40 weeks and 4 days. She just had her amniotic fluids levels checked to make sure that her baby is still doing okay. Her fluids are low, and she was told that if she was not induced at this point, her baby may have serious complications. After her appointment, you sit down with her to discuss her new plan and figure out how she wants to deal with the information given her.

Client’s three main goals:

  1. I want to make sure both me and my baby have minimal medical complications.
  2. I want to avoid induction.
  3. I want to have a natural birth.

Problem identification:

Physiological Needs

Mom is healthy overall, but needs more sleep. Her anxiety related to this event has interfered with her ability to sleep well at night. She is eating well and gaining appropriate weight.

Safety Needs

Fear and anxiety is the major concern at this point. She is worried about her baby’s health, but she also feels like the midwife is not listening to her concerns. She is worried that she may need an induction and what the consequences of that may be. She feels pressured to just go along, but is not sure that it is the safest choice. She is unsure that she has the ability to make the right choice and that she may jeopardize the health of her baby.

Social Needs

She feels like she would like to discuss her options with her friends and family. Other than that, her social needs are the same.

Esteem Needs

She does not feel capable of making these decisions.

The very first thing I would do  is see if she would like to take a little time to sleep. When she feels more rested, she will be able to think more clearly.

One of her biggest problems was her disbelief in her ability to make decisions, so giving her information will be a top priority. (Remember the scienceandsensibility.org blog post  has a lot of good information that you can share with clients that are in the same situation.) She may also need to discuss and confer with family or friends that she feels will help her. As the doula, you can help facilitate this by helping her find a time where people can meet.

Fear and anxiety will also be high on the list of concerns. Giving her information will help her with this, but she may also need some physical exercises to help her calm down. There are numerous ways to do this. I just list a few here: music, massage, reflexology, positive affirmations, hot water, aromatherapy and deep breathing.

A doula can help her to relax and come to a place where she feels she is able to make decision that she feels comfortable with. If a woman is not wanting to make decisions, or feels she is unable to, the comfort measures for fear and anxiety will at least help her to feel she is safe and supported.

The birth plan could then go on to mention some of the most important things you have talked about surrounding her other goals.

(Pam England, a midwife and birth advocate, also has discussed the need to face our fears. I am including one of her handouts that she uses to help work through some of the fears your client may have.)

Discussion with Care Provider

Ideally, the care provider is included in this discussion. Yet often, they are not and it is never addressed until the moment of decision is at hand. When a decision needs to be made, the care provider may not be there and wait for the woman to make a decision on her own.  Some may even put pressure on the woman to make the decision right then. In either case, a brief example follows of what the woman needs to discuss with her care provider.

I feel safer waiting to be induced for these reasons, even with low amniotic fluids because (the woman should explain her reasons for wanting to wait which will be unique to every woman).

Other questions that may be asked:

  • What are the risks associated with induction?
  • What are my risks associated with waiting?

Here is one example of what the woman might discuss with her care provider (ideally, before the moment of decision is at hand):

I understand that my fluids may be low and would like to get my fluids rechecked after I have had more to drink. I would also like to request that the single deepest pocket method is used. I would like my baby to continue to be monitored for any other signs of problems. If it is determined that I do need to be induced, I would like to try natural methods first. If that is not working, I would like to not use cytotc, and I would like my pitocin to be at the lowest level needed.

My hope would be that this discussion will help illustrate how a doula may help in this situation, as well as promote communication between all parties involved.

Handouts:

Research on amniotic fluid index

Facing your fears

An Outsider’s Perspective

November 16th, 2012 | Posted by Rachel in Introductory information | Misconceptions - (0 Comments)

Greetings Ladies,

My name is Brent. I’m married to the wonderful woman that has spearheaded this online doula training course. In fact, I set her up on this “blog” about 10 months ago, kind of on a whim. (It took me all of an hour or two to do so.)  Almost a year later, she’s managed to create a service that has proven to generate substantial interest for prospective doulas.  I’ve  begun to take it more seriously.

By way of updates, we’re making significant improvements to the course materials and resources available to our paying students. While the rest of the site may appear a bit more dormant, we’re doing a lot of unseen work on the back end. We expect that with improved course materials, that the price of the course will also increase. (Rachel won’t let me push it too high however, as she’s very committed to training as many women as possible at the lowest possible price. ) Immediate improvements are being made in the course manuals, and will be implemented as they become available. Some of our long term plans are even more exciting, but we have to work in “baby” steps until we can take this on as a full time gig.

One of the most frequent concerns that we have received from students involved in the course is that it appears to be too medically oriented. I thought I’d take a moment and address that concern here. My perspective is that of being married to a medical professional, while not having any desire to be medically minded myself. (I’ve had to explain to my wife that certain conversations at the dinner table cause me to get queasy.)

In discussing the above mentioned concern with my wife, I asked her a simple question: what percentage of births happen outside of the hospital? Her quick response was one percent(1%).  If this is in fact the reality of the world in which we live, then it would appear that without exception that every woman that trains to become a doula should be versed and experienced in working within the medical model of childbirth.

I can feel the tension and anxiety that such a statement may be creating within you.  Perhaps your idea of birth is one without doctors and hospitals. Arguably, that’s acceptable.  But statistically, you may be limiting yourself to just one percent of expectant mothers, and completely avoiding those who might benefit most from your service as a doula.

Taking a step back, as I discuss with Rachel the purpose of the New Beginnings Doula Training course, she has concluded that it is ultimately to provide the complete support and care that a doula provides to as many women as possible. Notice the difference. She’s not wanting to training as many doulas as possible; she’s wanting to train doulas to serve as many expectant mothers as possible.  Given that mission and focus, it is inevitable that a doula would need to be versed and trained on how to function within a medical environment.

Fortunately, the work of a doula begins long before the hospital and ends well after it. The work of a doula is to prepare a woman to descend into the valley that is childbirth, both internally and externally.  The hospital stay, and anything that may be experienced as a part of it, is a reality for most birthing women. Doulas do well to be versed and experienced in the medical world to help their clients traverse this challenging experience.

That the New Beginnings Doula Training course may appear a little heavy handed on the medical terminology may be something of a setback for some aspiring students. Admittedly, as I’ve read through the course materials, there is terminology used throughout the course that is not familiar to me –  maybe because I’m a man, but mostly because I reside outside the medical world, as do most of us. I’m working with my wife to smooth out this transition for students.

What this isn’t is a medical oriented doula training program, as opposed to a natural or home birth oriented program.  This course offers a holistic approach to care. Holistic (which was a foreign term to me) means “complete” or “the whole picture”.  While there is great deal of medical information presented in this course, there is abundant and increasing information being prepared and presented about natural treatments, such as working with essential oils (natural herbal extracts), acupressure, and reflexology. Such procedures and processes have helped in relieving pain and anxiety but have not be extensively clinically tested as have have more traditional medical remedies.  New Beginnings Doula Training looks at both models of care (medical and natural) and takes the best in both approaches and presents that as a comprehensive treatment and training.

Given that approach, and the passion that so many women bring to the table with this line of work, it is both an honor and privilege for me to work with you and my wife to make this the best doula training program available online.

Warmly,

Brent Leavitt

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