Getting out of the bathtub at Spectrum Health Butterworth, after laboring under the light of LED flameless candles.
— By Beth Singleton, Birth Quest birth doula and photographer
I still remember my last labor like it was yesterday. Waking in the wee hours to discover I was in labor, only to have it stall during the daylight hours and then ramp back up after the sun set. When pushing, the room was dimly lit and to make things even darker, I had my face buried into the couch.
What is it about darkness that seems to ease and promote the progress of labor? A very common desire among laboring women, I thought it’d be a great idea to look into this.
The need for darkness is observed in nature.
If you’ve ever had the experience of witnessing a cat during labor, you probably noticed her need for a safe, dark place. When my cat had her kittens a few years back, that’s exactly what she did. In a box under my bed, our proud momma cat gave birth to her babies. This need stems from the mammalian brain, a commonality that affects cats, dogs, mice…and humans! I mean, we’re mammals, too, so regardless of the countless ways in which we’re nothing like our pets, the biological event of birth reaches deep to reveal that our needs are ultimately very similar.
Bright lights can make a laboring woman feel exposed.
Birth is a very private event for a woman. During such an intimate moment in her life, bright lights shining down can cause her to feel like she’s being observed or like she has no privacy. In nature, laboring animal mother’s will stop mid-labor if they think they are being watched in order to find safety. In a hospital setting, though, a woman can’t follow in the footsteps of her fellow mammal mothers and relocate if she feels like she isn’t safe.
This increases brain activity during a time when labor progress relies on a woman’s primitive brain instincts. This stimulation can interfere with a woman’s ability to produce the hormones necessary for labor to progress and to help with pain. Some sources of bright light include:
• overhead lighting
• cell phones
In particular, electronic devices affect the body’s ability to rest. Blue light, the light produced from items like cell phones and tablets, interferes with the production of sleep-promoting hormones. So even in a room where the lights are off, it’s important to consider the effect of having the television on or staring at a phone if relaxation is the goal.
How does darkness aid in relaxation?
When the lights go down and the room darkens, this signals to the brain that it’s time for rest. One of the hormones produced is melatonin. Also known as the “hormone of darkness”, melatonin promotes relaxation and sleep. When a laboring woman is better able to relax, she will probably rest better and more deeply between contractions. Her contractions might also be less painful if she isn’t holding so much tension in her body.
There are numerous ways to labor with the lights down low.
Whether laboring at home or in a hospital, there are several ways to create a dimly lit setting.
For a home birth, consider some of these ideas:
• night lights
• LED candles
• string lights
• votive and/or pillar candles
• dimmable lamp
• blackout curtains
• indoor light projector
For a hospital birth, most of the above options aren’t as feasible. For example, a hospital probably isn’t going to permit burning candles; they will, however, allow LED candles. And items like string lights or lamps are bulky and may not be allowed, either. Night lights and indoor light projectors, on the other hand, are small and the room will likely have at least one outlet you can use to plug them in.
Sometimes, though, darkness isn’t the best option.
While it makes sense that many women desire to labor in darkness or a space that is dimly lit, there are
circumstances when the issue shouldn’t be pressed. Examples include:
• women who are afraid of the dark
• women who might become anxious if they feel the darkness would interfere with their care
• women with a history of trauma who feel safer with the lights on
• women who simply object to having the lights off
In the end, it all comes down to a woman’s preference.
Whether she chooses to labor with the lights on or off, the point is that she gets what helps her the
most. Ultimately, it’s the support she receives from those around her that will have the biggest impact
on her birth experience.
If you’ve already given birth, did you dim the lights? Why or why not?
We’d love to hear your feedback on this!
“Although this moment is bittersweet, it’s one of my favorite photos and I’m glad it was captured. Just before I was taken into surgery, after 24 hours of hard labor at home. My #doula, Faith, never left my side.”
— Ottawa County client, after a homebirth transfer to hospital
“[Faith] provided me with many resources, and I also really appreciated the teas she made me. Her evidence based approach was very unbiased and nonjudgmental. I felt like I could be honest about my needs with her… She really proved herself when the birthday came. She was my knight in shining armor! She made me feel so confident and comforted through my labor. Her knowledge of a birthing woman’s body and need for support was obvious. I credit my smooth labor and delivery to her…”
— Norton Shores mom, of her homebirth with Birth Quest
When I tell people that I’m a birth doula, the most common response I get is, “Oh, so you help women having their babies at home?”. To which I reply, “Yes, doulas support women at homebirths, but all of the women I’ve supported have given birth in hospitals”.
Because the word doula is not a part of everyday vocabulary for most people, I think many confuse a doula with a midwife. This is usually the second thing I have to explain to people about my job. I don’t catch the babies; I hold space for mom and support her through the process.
The next question usually revolves around why doulas attend more hospital births than homebirths. Several factors impact a woman’s decision on whether or not to hire a doula. For the woman choosing to give birth at home, the biggest factor is likely financial. Homebirths are generally paid for out-of-pocket, as are doulas. Since doulas don’t provide the clinical support a pregnant woman needs and they don’t catch babies, women who desire a homebirth are often faced with the decision to choose between hiring a midwife or a doula. In this scenario, the midwife is usually chosen because of the necessity of her services.
But what if having a doula AND a midwife were an option?
It’s true that your midwife will spend more time with you while you labor and provide a different model of care during pregnancy and delivery. It’s also true that she will likely have assistants who can attend to some of your needs. However, with their focus primarily on the clinical aspects of care, there are other elements left unaccounted for.
Generally, a doula will meet with you in your home at least a couple of times before you have your baby. She’ll be familiar with you and your surroundings. It’s during these meetings that doula and mom become acquainted and comfortable with one another. If there are pets, the doula will get to know them. If there are other children or family members, the doula will get to know them, too. This process is vital in developing a safe relationship as the mother will depend on the doula to cover the non-clinical elements that are a part of the birth process. It’s during these visits that mom can share her hopes and her fears. While she’s probably also done this with her midwife, the doula provides more time for mom to process and plan. The more informational and emotional support a woman receives during her pregnancy, the better.
And in the event of a hospital transfer?
Your doula will be with you. Your midwife probably will be, too, but if your doula is the one you’ve been leaning on emotionally during your pregnancy and labor, her presence is vital. Odds are, she was with you earlier in your labor than your midwife was, as well. That’s the beauty of a doula: no shift changes and present with you from the beginning to the end. Another benefit is that a doula is likely to be very familiar with the hospital environment and maybe even some of the staff, so she can help to explain what is going on and bridge the gaps between a homebirth and a hospital birth.
Regardless of the outcome, whether you had your baby at home or had to transfer to the hospital, your doula will be there postpartum for you to process the experience. Your midwife will, too, but depending on how the birth went compared to how you had envisioned it, your doula provides added space and opportunity to share things that you might not wish to share with your midwife. I know for me, I’m no good at confrontation and had I been upset with my midwife or disappointed, there’s no way I could have told her that (fortunately, that wasn’t the case for me!). A doula is trained to listen to your grievances and your joys. Validating your feelings and helping you to pick through the pieces and put them together, a doula can offer perspective, encouragement, and reassurance.
Birth is one of the most unpredictable events in nature. No matter how much you know about it, curveballs often appear in the form of all the little things that surface in the midst of the limbo of labor that no one had planned on.
I think back to my last pregnancy, when I had finally planned the homebirth I’d always wanted. It honestly was an amazing experience to labor at home and push my baby out the way I wanted with a supportive group of women (midwives, assistants, my mom and mother-in-law) and my husband. All of it was golden. I was even doing “doula talk” in my head, like focusing on the words soft and open. You see, I’d had my birth doula training through DONA only a few short months before the birth. So at the very least, I was able to focus and feel pretty in control during the more intense moments of labor. Super proud of myself for that!
However, the entire day leading up to my precious little one’s arrival, my anxiety and the negative self-talk going on in my head was relentless. Fourth baby, longest labor. Why? Was I not moving around enough? How long was it going to take? Why were the contractions that woke me in the wee hours of the morning that were 4 minutes apart and very uncomfortable spacing out to 15 minutes and not as painful? And there went my thoughts for the better part of an entire day. It’s the one part of my labor I look back on and wish I’d had a better attitude about. As helpful and supportive as my husband was physically for me that last time around (so grateful for the counter pressure and back rubs!), I needed someone to help ease my mind. I needed someone to remind me that every labor is different and that what I was experiencing was normal. I’d fed my fear of waking in labor and things moving quickly, as they had in the past (with my third baby, I went from 5cm to holding my baby in under a couple of hours after painfully relentless contractions). Instead, I spent the better part of the 24 hours that I was in labor anxious, discouraged, and feeling guilty for having sent my kids away first thing in the morning because I was sure “this is it!”. I wasn’t mentally prepared for a long labor. I’d never had one.
Don’t get me wrong; my birth team was incredible! I’d depend on them again in a heartbeat for their care and support during pregnancy and birth. Looking back, though, I know I needed more in those long hours before my little guy finally made his arrival.
Doulas meet so many needs that are maybe overlooked or not considered.
I know when my son was born, my house was a mess. Pretty sure there were dishes and laundry that needed to be done. I didn’t feel like cooking and no one brought food while I was in labor. It was a long, lonely day. I struggled to find distractions. There were so many things during that entire day of early labor that a doula could have helped me and my husband with. We were both so tired.
When I was in active labor and pushing, I soaked up every encouraging word and touch my birth team provided me. They were tender, attentive, and confident. In hindsight, I realize I had needed that all day to better cope with my apprehension about the imminent arrival of my baby. I needed someone to hold that space for me and remind me that everything would be okay. I needed someone to tend to the things my husband and I couldn’t get to while I tried to rest.
My other children were born in the hospital, where food and laundry weren’t an issue. While the hospital environment is not my personal favorite for giving birth, those two things ended up being huge oversights for me with my homebirth. I don’t have sisters or super close girlfriends that I would have felt comfortable having with me while I labored; and I wanted my mom and mother-in-law present for the birth, not running around my house cleaning and cooking. While having my son at home was truly a dream, waking up the next day to the reality of…well, real life, wasn’t. Looking back, I hadn’t planned for how to handle those seemingly tiny details. Who knew that while I did the hard work of bringing life into the world that my house wouldn’t clean itself or cook a meal for me! Or take care of my other children when they returned home the very next day (totally needed a postpartum doula, too).
My business partner and Birth Quest founder, Faith, also had her last baby at home. Her labor, which was the complete opposite of mine, was quick and intense. Despite her doula training, she found herself in need of one and speaking the words women the world over often say when it’s become too much…“I can’t do this! Make it stop!”
I needed a doula; but even if I’d wanted one, I couldn’t have afforded one anyway.
At least, that’s what I thought. I know better now. I could have asked family to help with the expense or sought a doula out that would take my finances into consideration and work with me to make it affordable. Our vision is to increase access to doulas for every person who wants one, so please contact us if you have a financial hardship, especially if that is due to the unreimbursed expense of an out-of-hospital birth. Everyone deserves a doula!
As one Birth Quest client of her having a doula for her homebirth said, “My parents paid for my doula as a gift for our Homebirth. If they hadn’t, cost might had been an issue but I definitely would choose to hire a doula again. Their knowledge and support are so priceless if you can find one you love!”
My story and Faith’s are just two of many stories. Doulas do so many things. If any one part of your labor and birth could be considered customizable, it’s who you choose as your doula. With you from the moment you feel like you need her, she’s the one you’ll have expressed your desires to about labor and birth. Whether you need someone behind the scenes – doing your dishes, folding laundry, or getting a meal ready – or someone to be a part of the action – holding your hand, taking pictures, or showing your partner where to apply counterpressure – your doula is the one person attuned to your wants and needs. And if at any time you want what your doulas doing to change, just say the words…that’s what she’s there for.
What does a doula do at a homebirth anyway?
At a homebirth, a doula is going to do everything she’d do for you in a hospital, except that she is in your space where there are more personal elements that might need tending to. Because the list could go on and on, here are a few examples:
- Ideally, she arrives earlier in your labor to provide support (informational, emotional, physical, etc.)
- Support for your partner (in the form of breaks, encouragement, direction on how to apply pain management techniques, etc.)
- Support for others present during your labor and birth (friends, relatives, children, etc.)
- Light household chores (dishes, laundry, etc.)
- Meal preparation
- Tending to the needs of pets
- Taking pictures
- Crowd control (making sure mom has the space and privacy she desires)
- Immediate postpartum support
- Assistance with breastfeeding
- Preparing a place to rest postpartum
- Meeting needs specific to the individual
- Hold space for the woman in labor
- Create/maintain a peaceful and calm environment
Who could use a doula at a homebirth?
There’s no denying that as a doula, I feel the benefits are universal and for all women. With that being said, specific reasons a doula is perfect for a homebirth include:
- Women whose family/friends are not near enough to provide support
- Women without a partner or whose partner might not be available for support
- Women with anxiety or other health issues that might impact their confidence in their ability to give birth
- Women who want to be prepared in the event of a hospital transfer
- Women who know they need a lot of support
- Women who don’t want to worry about meals or cleaning during labor and after birth
- Women who know their partners will need additional support
- Women who want support but aren’t comfortable with family/friends present
- Women who have specific wants and needs
- Women who have other children that will be present that need support
- Women who want someone to promote and maintain a calm, peaceful environment
- Women who want a safe person to hold space for them
Since doulas aren’t as commonly present at homebirths as they are for hospital births, we did a little investigating into why.
Thanks to the women who took part in our Facebook poll (@birthquestservices) to find out why they, women who’d had homebirths, didn’t have a doula. Not surprisingly, the leading reason was cost. A close second were women who felt they already had enough support while the third reason was a desire for privacy.
However, because women were allowed to choose more than one option, some chose both cost and sufficient support as their primary reasons for not hiring a doula. This leaves us to wonder…which was the biggest factor?
Answers to a 2017 Muskegon-area Facebook post asking, “If you had a homebirth and didn’t hire a doula, why not?”
— Blog written by Beth Singleton, DONA-trained Birth Quest birth doula and photographer,
who had her fourth child at home in Muskegon
From module 12 of the VBAC Education Project (VEP).
Women in Muskegon and elsewhere along the West Michigan lakeshore have several options for childbirth after cesarean. What are some of these options?
The majority of women in Muskegon County who have a prior cesarean have a repeat cesarean section (RCS). This may be because they decide this is the safest option for them based on their medical history, while others prefer the certainty and convenience of scheduling their birth. Other times, women don’t realize that they have other options or don’t have the support to access them.
Vaginal Birth After Cesarean (VBAC)
I’ve heard Muskegon birthing people being prepped for surgery be told that they can deliver vaginally in the future, but that they would have to go to a Grand Rapids hospital. That’s only part of the story. While currently, all three of the hospitals in Grand Rapids, Spectrum Health Butterworth, Metro and Mercy Health St. Mary’s, offer VBAC, distance makes this option a challenge for many people. Holland Hospital also offers VBAC as an option. Others are intimidated by the prospect of receiving prenatal care and delivering with a large practice and facility, which feels impersonal compared to the care they are accustomed to in their community. Despite the challenges, some Muskegon people will travel out-of-county for their VBAC.
Another option that appeals to some families is to deliver in a community hospital that has a VBAC ban, or policies that discourage VBAC, but is known to have supportive providers. Dr. Michele and her colleagues at Spectrum Health Gerber Memorial have an excellent reputation for supporting those who choose to have a VBAC. Others receive their prenatal care locally, put off scheduling a RCS or do not show to appointments, with the plan to show up in labor at their local hospital. Local community hospitals include Mercy Health Hackley in Muskegon and North Ottawa Community Hospital (NOCH) in Grand Haven. I have heard of people having VBACs at Hackley, despite the ban, but not at NOCH.
Free-standing birth centers are an option for women who want to deliver with a midwife in a home-like atmosphere outside of, but close to, a hospital. There is some evidence that choosing midwifery care through a free-standing birth center increases VBAC success rates. Simply Born Birth House is the only free-standing birth center in West Michigan. Sara Badger, a Certified Professional Midwife (CPM) is the provider there. Birth centers have criteria they use to screen women to see if they are good candidates for this type of care. If this is something you are considering, I recommend scheduling a consultation before pregnancy to learn more.
The final option is to plan a home birth after cesarean, or HBAC. In the event of a rare complication, like a uterine rupture, this may not be the safest option, but some people are willing to take the risk to birth on their terms, in the privacy of their own home, with a provider who believes in their body’s ability to birth. As with birth centers, home birth midwives have criteria for screening clients who are candidates for HBAC. You may have to interview several in order to find the right one for you.
As with any birth, there are many decisions to be made. Since providers vary a great deal in their support of VBAC, it isn’t a bad idea to do some research prior to your next pregnancy. A provider may also have good advice to increase your chance of having a successful VBAC, like the amount of time to wait between pregnancies and how to optimize your health.
While those in Muskegon and along the lakeshore may not have all of the options available to birthing people in large, metropolitan areas, they do have possibilities. Knowing what those are is the first step to choosing the course of care best for you and your family.
These are my predictions for childbirth in 2016. What do you think? Please include your thoughts and your own predictions in the comments!
5.) WHO changes their position on episiotomies
“Perhaps it is time to move beyond the question ‘What are the appropriate indications for episiotomy?’ to the more fundamental question ‘Is there an appropriate indication for episiotomy?’
— From D. Lyon, Global Library of Women’s Medicine
In 1996, the World Health Organization published “Care in Normal Birth: A Practical Guide,” recommending an episiotomy rate of 10%. Since that time, episiotomy rates in most countries have declined. The practice of selective episiotomies has continued despite the fact that there has never been a randomized controlled trial showing that they have any benefit whatsoever.
This has become a point of contention between some birthing women and their providers. In fact, in 2015, an obstetrician in the United States surrendered his license after being caught on video performing a forced episiotomy on a patient.
In 2014, a study was undertaken in Brazil called, Comparison of Never Performing an Episiotomy to Performing it in a Selective Manner, or EPISIO. Although the study is complete, the results are not yet published. The researchers collected data on newborn, as well as maternal outcomes. If this research shows that, even in cases of macrosomia and fetal distress, episiotomy holds no benefit, the World Health Organization may take a stand that even 10% is too high, with global implications.
4.) ARRIVE study results increase elective inductions
In June of 2015, the Over the Moon Doula Group in Grand Rapids, Michigan, hosted Rebecca Dekker of Evidence Based Birth as a part of their Seminar Series. The topic was due dates.
Dekker’s lecture introduced me to the A Randomized Trial of Induction Versus Expectant Management (ARRIVE) study, in which women would be randomly assigned to either induction at 39 weeks or expectant management. Although some of the sites are still recruiting subjects, the data should be in by the summer of 2016 and results may become public by the year’s end.
Other than furthering the schism between the medical and natural childbirth camps, news that elective induction at 39 weeks prevents adverse outcomes could place a strain on hospitals. As Dekker pointed out, if hospital maternity wards are full with women being induced, will there be enough room left for women who arrive already in labor?
3.) US cesarean rates continue to decline
The cesarean rate for birth in the United States hit an all-time high in 2009, but has declined for most racial and ethnic groups since. This has not been an accident, but due to a concerted effort by consumers, researchers, hospitals and providers.
For example in 2014, the American Congress of Obstetricians and Gynecologists (ACOG) changed the definition of active labor from 4 to 6 cm, cause more women who present in early, or latent labor, to be sent home.
The coming year may also see changes in hospital policies on Vaginal Birth After Cesarean (VBAC), which holds the potential to further decrease the cesarean rate. Many women choose to have their VBAC at home, not because that is their first choice, but because no other options are available. A study published in the Dec. 2015 issue of Birth showed that, although Home Births After Cesarean (HBAC) have high success rates, when a uterine rupture does occur, perinatal death is more likely. As local work on perinatal regionalization, a system of designating where infants are born or are transferred based on the amount of care that they need at birth, continues, more community hospitals may reverse their VBAC bans. This will make VBACs more accessible and safer for women who prefer a hospital birth closer to home.
2.) Out-of-hospital birth rates continue to rise
While out-of-hospital births represent a small percentage of all birth in the United States, they have been on the rise since 2004. When it comes to home births in one West Michigan county, Kent, home births have increased 116% in the last 8 years!
According to the American Association of Birth Centers, the number of freestanding birth centers in the United States also continues to rise, from 170 in 2004 to 248 in 2013. There are currently two freestanding birth centers in West Michigan, Cedar Tree Birthing Suite in Grand Rapids and Midwifery Matters in Greenville. As more birth centers continue to open, the number of women choosing this option will also grow.
1.) More states will pass laws providing insurance reimbursement for doulas
All the research points to the potential healthcare savings if doulas become more widely available, due to the lower rates of cesareans, pitocin induction, medical pain relief and more. At the present, only two states, Minnesota and Oregon, require Medicaid to cover the cost of a birth doula.
All that could change now if three national organizations, Choices in Childbirth, the National Partnership for Women and Families and Childbirth Connection, have anything to do with it! Key Recommendation in an executive summary released in early 2016, include having congress mandate Medicaid coverage for doulas and state legislatures mandating private insurance coverage for doulas. If policy makers take their advice, 2016 may turn out to be “The Year of the Doula”!