Doulas and Homebirth: Knights in Shining Armor

“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?

Why I didn't hire a doula for my homebirth

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

Cooperative Childbirth Education: Class Descriptions

Cooperative Childbirth Education classes in Muskegon

Birth Quest’s fall 2017 and winter 2018 childbirth education classes can be taken a la carte.

Interested in attending childbirth education classes, but don’t have the time to research your options, travel outside of Muskegon or attend a full series?

Busy families like yours want to be able to make the best use of their valuable time when expecting a new addition. That’s why Birth Quest offers a la cart classes so that you can seek out knowledge according to your unique interests and circumstances. I have taught a wide variety of classes privately, in group settings, for non-profit organizations, and as a guest presenter in classrooms. Since 2014, I have taught classes in the following settings (places in italics were as a volunteer):

Please contact me if you would like to host a class!

Are you having trouble deciding which classes to attend? Check out the class descriptions below:

  • Choices in Childbirth: Providers and Settings — Did you know that the choice of where and with whom to give birth best predictor how it will turn out? The purpose of this class is to educate you about all of your choices are so that you can give birth where you feel safest and the most supported.
  • Self-Care for Your Changing Body — This class is for those who are motivated to optimize their health during pregnancy through diet, movement and tending to their emotional needs. Strategies for alleviating common pregnancy discomforts will also be shared.
  • Holistic Pregnancy Care Options — Many families are turning to less invasive and more natural solutions during pregnancy and birth. This class will look at several different complementary and alternative medicine options, along with where to find practitioners in the Muskegon area.
  • Birth Plans: What Parents Need to Know — There sure are a lot of choices to be made when having a baby! You will leave this class confident, knowing what the available research says about birth plans, staff responses and birth outcomes. Parents will be provided with multiple templates for creating a birth plan, as well as advice for forgoing a birth plan altogether. Whatever families decide, they will learn all the key decision-making points from early labor to common newborn procedures and everything in between.
  • Labor & Delivery: Prepared & Informed — Birth is unpredictable, full of unexpected twists and turns, making it something families anticipate with both excitement and apprehension. Highlights of this class include indications for, risks and benefits of and how to prevent common interventions, such as inductions, episiotomy and cesarean. Childbirth education does not guarantee an outcome, but it can lead to empowerment: knowledge is power!
  • Essentials of Labor Support: What Birthing People Need — This class is for the birthing person and whoever they choose to support them during labor and delivery, including spouses, partners, friends and family members. Topics include communication skills, practicing massage comfort techniques and so much more!
  • Pain-Coping Strategies: A Smorgasbord of Options — Pain relief during labor is a primary concern for many pregnant people. Some believe that they must choose between no pain relief or an epidural. Fortunately, we’ve come a long way since the days of a one-size-fits-all approach. We will explore a full spectrum of both pharmaceutical and natural ways to lessen and cope with the pain of childbirth.
  • Postpartum Wellness: The Fourth Trimester — This class is focused on the physical and emotional health of parents after a birth. We will cover recovery from a vaginal or a cesarean birth, movement, nutrition and mental health with lots of resources for further exploration. This class is appropriate for any expectant or new parent.
  • Newborn Care — Babies aren’t born with an instruction manual, but the good news is that you are the expert on caring for your baby! We will cover what to expect from newborns in terms of appearance and behavior, as well as bonding, development, diapering, bathing, safe sleep and more!
  • Breastfeed Successfully with Knowledge & Support — This class is for anyone interested in learning more about the benefits of breastfeeding how it works, and how to avoid common pitfalls, as well as community resources to support breastfeeding families.
  • Childbirth After Cesarean: Making Informed Decisions — With about 1/3 of West Michigan moms delivering their babies via cesarean, many are faced with limited future childbearing options. This class seeks to inform and empower families before and during pregnancy to make the best decisions for themselves and their families.
  • Introduction to Birth Work: Doulas & Childbirth Educators — This class explains possible career paths for doulas and childbirth educators, what they do and how they positively impact birth outcomes. The presentation concludes with a sample childbirth education class.

You can find out about upcoming classes on my calendar or under “events” on Birth Quest’s Facebook page.

Classes can be tailored to suit the needs of any setting or population, like youth, maternal and infant health professionals, homeless shelters, or places of worship. Presentations can also be developed to cover other specific topics, like pregnancy complications, anger management during pregnancy, substance abuse prevention or parenting. What topics would you like to see Birth Quest offer?

VBAC Bans Limit Options for Muskegon Women

VBAC Bans Limit Options for Muskegon Women

Healthy People 2020 (HP2020) is a national initiative through the Centers for Disease Control (CDC) to improve the health of all Americans by creating targets for improving leading health indicators in a specified time frame. Increasing vaginal births after cesarean (VBAC) for low-risk women is one of those indicators.

There is no way to measure progress on these outcomes without data. Data is essential to any process to improve health. If we don’t know where we’re starting, we have no idea if our interventions are having the intended impact. For this reason, the Michigan Department of Health and Human Services (MDHHS) started collecting and sharing information by county on the percentage of women with a prior cesarean who have a repeat cesarean (to calculate the opposite, or percentage of women with a prior cesarean who did not have a repeat cesarean, subtract the percentage given from 100).

Not surprisingly, when compared to surrounding counties, Muskegon ranks last. In fact, in 2014, the most recent year for which data is available, only 16 women in Muskegon had a VBAC! This was not always the case. When women were encouraged to plan VBACs and deliver at local hospitals in 1999, this number was 83! VBAC bans make a difference.

Kent County leads West Michigan in the percentage of women having VBACS. When it comes to options, Kent County women can choose from three hospitals, Metro, Spectrum Health Butterworth and Mercy Health St. Mary’s. All of these hospitals allow VBACs.

Why does this matter? Why should women be concerned about their access to options for giving birth after a cesarean? The truth is that laboring and attempting a VBAC is less risky for most women than having major surgery. Family size also matters. The risks decrease with each successful VBAC and increase with each subsequent cesarean.

While many providers inform women of the risk of uterine rupture when attempting a VBAC, women are almost never informed of the risks of repeated cesarean surgeries. Every year in the month of October, the International Cesarean Awareness Network (ICAN) works to educate women about one of those risks: accreta. Accreta is a condition in which the placenta attaches too deeply into the uterine wall. According to their website, in the presence of placenta previa, the risk of accreta is 3% with the first repeat cesarean and increases to 67% for fifth or higher. Seven percent of women with placenta accreta will die from excess blood loss. Many women are encouraged to have a repeat cesarean without ever being informed of the risk of accreta. In fact, many women first learn about what accreta is when they are diagnosed with it!

When I speak with women in Muskegon about what influences their decision on how to birth after a cesarean, most tell me that the distance to travel to a hospital without a VBAC ban is just too far. They don’t want to travel for care or risk having a baby in their car. Some don’t have reliable transportation or gas money to make it to a hospital that allows VBAC. Most women want to give birth in their own community with the providers they know and trust. This is where their support system is and they don’t want to accept additional challenges by having a baby far from home.

One of the roles of doulas is educating the public on their options. If you are pregnant or planning a pregnancy after a prior cesarean, hiring a doula may be a first step in learning about your available options.

At Birth Quest, we’d like to hear from you! Are you a Muskegon woman who planned a VBAC? If you chose a repeat cesarean, what were the factors that influenced your decision? Your experiences may help another woman in a similar situation. Thanks for sharing!

Hospital Midwives on the Lakeshore – Remaining Options

Having a midwife attend your labor and birth increases the chance of having your baby naturally and without drugs!

Having a midwife attend your labor and birth increases the chance of having your baby naturally and without drugs!

In a prior blog, I wrote about how North Ottawa Community Hospital (NOCH) closed their midwifery practice in 2014. At that time, I contacted both federally qualified health centers (FQHCs) in Muskegon to ask them if they would be willing to have me interview them to help spread the word to expectant women in the area about their remaining options. Hackley Community Care (HCC) got back with me and we were able to videotape an interview with their collaborating physician, Dr. Danielle Koestner.

I have been at several births with the HCC midwives and have always been impressed by the way they respected and supported the wishes of my clients. The good relationship we had benefited our mutual clients because we were able to communicate concerns to better coordinate care.

When I learned that the HCC midwives were going to stop catching babies, my initial response was, “Not again!” Like others, I am still upset about losing the option of midwife-attended deliveries at NOCH. Still, I wanted to wait and find out more information. Earlier this week, I received the official letter from HCC, stating that the midwives were going to continue to provide pre- and post-natal care and that they were officially certified as a Centering Pregnancy site. Now, however, the obstetric laborist and residents at Mercy Health Hackley would be in charge of their pregnant patients’ labor and deliveries.

The laborist comes with a wealth of knowledge and experience. While many women include avoiding residents in their birth plans, I have found them to be on top of the latest research, open to patient preferences and supportive of evidence-based care. For some women, this will be an acceptable option. During their prenatal care, they will benefit from an evidence-based group prenatal care model, the individualized care characteristic of midwives and access to a host of other services offered on-site.  However, for women specifically looking to benefit from the better outcomes research shows continuous care from a midwife during labor and delivery offers, this change will be unacceptable. The research shows that interventions are lower and outcomes improve when midwives provide care throughout the pregnancy, labor and delivery.

For women who seek a midwife to provide their prenatal care and attend their birth, Muskegon Family Care (MFC), Muskegon’s other FQHC with a midwifery program, recently hired new midwives and are now fully staffed. In July, I had the pleasure of meeting with one of them, Katie Van Heck, CNM, to discuss how to improve their services by increasing their patients’ access to doulas. I now have a couple of clients who are seeing the midwives there for care and I am excited to work more with this practice in the future!

If you live along the West Michigan lakeshore and you wish to deliver in a hospital, with a Certified Nurse Midwife (CNM), the only midwives who can practice in Michigan hospitals at this time, these are some of your remaining options:

  • Muskegon Family Care – With three midwives on staff, this practice is located in a federally qualified health center in Muskegon Heights. This means they primarily serve low-income people, but they can serve anyone.
  • Midwifery Services at Advanced Women’s Ob/Gyn – If Muskegon-area women are willing to travel to Spectrum Health Butterworth in Grand Rapids to deliver, this private midwifery practice has an 6% c-section rate, which speaks for itself.

What will be the next news for midwifery options along the lakeshore? Hopefully, something positive, like a new private practice or free-standing birth center opening up!

Did you have your baby with a midwife in a hospital? Please share your experiences in the comments!

Reference:

Sandall, Jane, et al. “Midwife‐led continuity models versus other models of care for childbearing women.” The Cochrane Library (2016).