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Saturday, January 10, 2009

Are Doulas Necessary at Unassisted Births?

Question from Tophat:

I bought your book last month and in it you really promote the use of a doula and said something on the lines where you think everyone should have a doula.

I (Unassisted Childbirth) UCed last March. I did end up calling a friend for emotional support once the labor hit somewhere around 30 hours and it was wearing on me, but had I had a labor shorter than 30 hours, I wouldn't have called her.

Because of that, I'm inclined to not get a doula in the future. If a woman is UCing, what would the advantages of a doula be? I'm interested in your thoughts.

I love your book, though. :)

On a side note: the labor ended up being 44 hours, wonderful healthy pink little girl.


Thank you for noticing my emphasis on the benefit of having a birth doula. I know you really read carefully and with interest. This is a great question.

Yep, I pretty much think all birthing woman should have an experienced doula. I am so tired of women being in denial about the amount of effort and focus it takes to get through labor and birth. I am so tired of hearing labors gone badly and observing the emotional scars and separation. Tired of hearing women aren't researching birth. Tired of women thinking that the first birth was easy and the second (or third, etc...) will come easy, too (you never know). Tired of hearing women emphasize unimportant details like nursery themes and token ultrasounds. Tired of hearing the same women complain they can't afford a doula (but they could afford the nursery and ultrasound). Women need to be prepared and arm themselves with all the support possible in this horrendous birth climate we have. I must recognize the value of an experienced doula. I also recognize the value of a student doula or any loving, caring women who serves in this role (which is what you had).

While writing the book, I anticipated getting asked your question by an "UCer." I admit my main concern or intended audience for my statement was the uninformed mother making no decisions for herself. I want to wake that woman up.

OK- So what do I think about unassisted birth (UC) and doulas? First of all, I commend anyone who researches birth like you do, prepares themselves for complications and emergencies and how to handle them independently, and doesn't give in to hostile and anti-intuitive birth practices and wants privacy. If one has done all that research and trusts that they can have a hands-off birth, and has meticulous nutrition, I fully support them. The woman who has done all this preparation may be the exception to my "everyone should have a doula" rule.

Most women haven't done this research and most women don't know their bodies. Just look at our full maternity wards.

BUT, the fact is, you never know how your labor will be and how you will emotional respond to it. Nor do you know how helpful your partner will be if you haven't birthed together before. You did the right thing. You DID prepare and have a "doula" available to you and you called her when you needed her.

If my labor was short and easy the first time, I would not have had a doula the 2nd time. I suppose I could also say if my labor was real quick the second time, my doula may not have made it. Perhaps, I could say the same for my 3rd birth. I am certain my 2nd and 3rd labors stayed focused with the doula support I planned for. Wouldn't it be great if we could all have short, easily managed labors?

It makes me wonder, if perhaps you called your friend/doula sooner for the physical support and emotional and spiritual reassurance could it have helped your wear. That's just a rhetorical thought and it may help give another woman perspective and something to consider. I am not really directing it at you. Chances are really great your next labor won't be 2 days.

Personally, as part of the "back-up" plan for UC, it's a great idea to have a support person on-call and call if your intuition tells you too. Discuss ahead of time under what circumstances you will be calling. Discuss if you do call them, do you want physical (touch, massage) support or perhaps just verbal support, or perhaps just to pass cool rags and drinks only. Having a doula supported birth doesn't mean you failed at "medically unassisted childbirth." Having someone available in the doula role can keep your birth clinically hands-off if your labor becomes more difficult than you thought. You can even discuss ahead of time, if they should leave the room after a bit or leave the house if you regain your focus.

I would like to point out that the term "Unassisted Childbirth" is used very lightly and to mean a lot of different things. When I think of unassisted birth, I think of someone who has read, researched, found like-minded support during pregnancy, had no midwifery/obstetrical care during pregnancy and intended to have a totally hands off delivery. No pregnancy ultrasound. Knows their plan to handle (or ignore) GBS, meconium, bleeding, lacerations, etc… Relying on their partner for support.

Is that what others think UC birth means?

I have heard it used in so many other contexts:

  • Precipitous delivery before getting to the hospital (and possibly transferring to hospital)
  • Precipitous delivery before midwife arriving
  • prenatal care and staying home without ever intending to call the provider
  • midwife arriving just after the birth
  • medically unassisted, but with an active involved birth doula
  • medically unassisted, but with or without the partner

One recent woman in my practice planned an unassisted birth, but with "prenatal" visits to me. I've included two women in the book who had unassisted birth. One was a quick labor, unplanned(page 35). The other had left several OB groups who wouldn't agree to VBAC(page 79). By including these women it was one way to give balance to my statement "everyone needs a doula." Obviously I accepted and learned from both births (and encouraged it!). The first example actually had hired a doula, which arrived after the baby delivered. The latter tried to hire a doula. I don't know the details of how it fell through. I also helped support a unassisted home birth after cesarean, that ended up transporting and being a repeat C. Having a doula isn't a guarantee of anything. But this transfer occured on her own terms.

Since the book, I have several readers who have birthed unassisted. I am especially interested in comments and feedback on this topic.


womantowomancbe said...

I think doulas should be necessary at just about every birth -- as "birth support", whether or not an official, trained, paid doula. Using the term loosely, I'd say that your commenter did have a doula -- the friend that she called. It's usually better to have someone experienced, of course, but the emotional support is what is important.

I had an unplanned unassisted birth (wide-spaced contractions that left me in doubt as to whether I was in labor, despite the pain and emotions, so I didn't call my midwife until my water broke just before my son was born), and really regret not having a doula or midwife there for me during labor. My labor was also 24 hours long, compared to my 9-hour-long first labor; I think a lack of support had something to do with it.


Rixa said...

Speaking as a doula, midwife's apprentice, and UCer, I have some hesitations about the necessity of doulas for every woman. I do agree, though, that women planning an unassisted birth should have someone they can call on for support if needed; that might be a doula or a close friend or relative.

I think whether or not a woman would benefit from a doula depends a lot on her personality and on the way she labors and births (in addition to unexpectedly challenging situations, of course). Adding yet another person to my birthing space would be incredibly disruptive to me, unless there were a very specific, very compelling reason to have someone else there. But that's because I labor best in total privacy. I don't want or need support, encouragement, massage, etc that I have given as a doula. I just want to be left alone, to have no one touching me or watching me or talking to me. I am still debating whether or not to call the midwife when I go into labor for this reason. I decided to see a midwife this time around to have access to certain services, but I also find myself feeling quite conflicted about how I will be able to labor with someone else (two someone elses, actually, since she brings an assistant as well) in my birth space. I still haven't solved that yet and am trying to keep an open mind to what my needs are as the pregnancy continues and as labor progresses.

I think you'd enjoy reading my dissertation, which is about unassisted birth in North America. I'll send a PDF of it your way!

Permission to Mother said...

Rixa, Thank you for sending your thesis. I am really enjoying it!
It is worthy of publication and wide distribution.

TopHat said...

Thanks for posting this. Actually, my friend has said that she's afraid that she prolonged my labor. When I called her, I was calling in desperation and when she got here, I threw up all the food she brought- lots of transition signs, but then the labor stalled for another 14 hours and I never actually had a transition later. Of course, we can't go back and see what might have happened otherwise. She was very helpful to my husband as he was doing the work of many people- giving me support and keeping the tub warm with boiling water. And it was nice to talk to another woman. Although my DH is kind and understanding, having spent a day and a half with only him, I needed to talk to someone else. :)

And our UC was just as you described UCs- it was planned and I did do a lot of research and chose to do my own prenatal care, etc.

anastasiadenton said...

I'm a UC supporter but it was not to be for my 3rd child. I still got prenantal care (in fact high risk care) but unfortunately my hubby is not so great in the delivery room. Also no labor support in a busy maternity ward. A doula would have been better for BOTH of us! The midwifery student assigned to interpret did her best (Baby #3 was born in europe, WOW culture clash, ob/gyn style) but ultimately couldn't be THERE & after 2 days of induction (slow but still false contractions) I finally get a epidural. At that point my hubby left the hospital, it was too much! THAT ACT got me what I TRUELY needed, someone by my side who knew what they were doing and WANTED a natural birth just as much as I did! I got some rest & the epidural wore off & Was NOT refilled for the rest of the labor. In the end my daughter was born as natural as possible for someone with hellp. With the doc standing in the doorway watching unlike a previous ob who just shouted at me "You have an epidural, shut up already, you can't feel anything" Uh someone didn't tell him they don't always work or in my case only 1 out of 3 would have been good enough for surgery, lol! But better support in the beginning would have been better as well as an advocate for MY wishes (If I've had more babies then you why don't you listen to me tell you about MY body instead of proceeding to tell me what the book says?) And a doula does NOT have to be rebriefed every 6 hours during shift change! A doula is NOT a medical person but a voice of experience & reason. And free cooking! IF I am ever blessed to have another, I'll sign one one, regardless of where I give birth, because alone, REALLY alone, well......sucked. not to mention tore me in places I didn't know a woman could tear, ouch, LISTEN to the screaming woman NOT the textbook!

AWESOME blog, I've just found it wish I had sooner!

Jenne said...

I have to say that I disagree with your definition of an unassisted childbirth, because you have lumped UP (unassisted pregnancy) in. For my unassisted birth, I believed that I was making a responsible choice in finding a midwife who would be back-up and in an advisory role if I chose to seek out her knowledge. In order for her to be comfortable with me, I visited her a few times throughout the pregnancy (I think less than 7) which is half the normal number in the United States. Those visits were more for the sake of establishing a relationship than "prenatal care."

I could have chosen also to have an unassisted pregnancy but felt that I was "covering my bases" by having a wise woman to consult with if necessary, who if in labor I needed support, I could call and who could transfer with me in case of that eventuality.

But on your point about doulas that not all UC'ers will find it helpful to have a doula, I agree. With my second birth (a UC) did not at any point feel the need for a doula, but if I had, I would have had women to call who could fulfill that role.

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