Doula's: They're bloody awesome!

In honour of all of the doulas - we’d like to wish you a wonderful

International Doula Week 22nd - 27th March 2023.

We celebrate you, the monumental effort to hold space for women and their families, the belief you have in women’s ability to birth their babies, even in the incredibly challenging hospital settings that often overshadow the natural birth process.

The hands you hold, the hearts you protect, the traumatic events that you witness, process and work through, for all of the joy that you are privileged to bear witness to

- Today (and all week) we Celebrate You -

@laceybarrattphotography All hands on supporting this powerhouse of a birthing woman to birth her baby surrounded by love and belief in her ability to trust the process of birth, work with her body and her baby.

So What is a Doula?:

Doulas are passionate about the birth experience and respect this rite of passage. They understand in the process of physiological birth and the benefits for both mother and baby. They are trained to honour the heart, mind and body connection taking place during pregnancy, birth and the transition to motherhood.

Doulas support women at home or in hospital. They support physiological birth, medicalised birth without judgement - they simply follow the labour with you. one contraction at a time.

Doulas respect the layers in a woman’s belief system, culture, chosen birth environment and the many complexities that are unique to every individual and how these stories can influence her birth experience.

Doulas support a woman and her birthing partner to make informed decisions without bias or judgement.  They can however fill the gap with  missing information  and provide a framework for questions and advocacy.  Doulas are reminded constantly that the woman they are supporting has the freedom to walk her own path in meeting her baby whatever these choices may be - so choosing the doula that aligns with your preferences is vital in your connection. 

Doulas believe that women are strong and capable of meeting the challenges required of them to birth their babies. That birth is a natural normal life event that may sometimes require medical intervention. She understands the cascade of medical interventions and works with the birthing woman to prepare and cope with the unpredictability of labour and birth. 

Doulas understand the cascade of medical intervention. They know how to minimise the impact of this railroading your birth, while also supporting you through this complicated birth challenges if this is where your birth takes you.

The medical approach to birth within hospitals can conflict with the desire  for a natural birth and the challenge to avoid the medical interventions routinely offered.  A Doula helps you to navigate these decisions and to assist in good conversations with your medical health team.  A Doula trusts the woman to make the best decisions that feel right for her and her baby, and some women who choose to birth within the hospital system are OK with  utilising everything the hospital has on offer,  Including epidurals and or inductions and maternally requested cesarean surgery, - your doula is well prepared to support your choices.  

Your doula doesn’t lead you down a specific path, she supports your informed decisions, as your unique birth story begins to unfold and helps with endless options for comfort and coping techniques. Whilst also providing an extra pair of hands to your loved one through support and advocacy. They witness birth unfolding at home and in hospital so have a great appreciation for the challenges that women face in both settings. 

A doula offers you continuity of care - research highlights the benefit of continuity of care from a known birth professional - we’ve pulled  the most poignant points forward in the benefits of hiring a Doula; collectively they conclude: 

• More spontaneous vaginal births

• Shorter duration of labour

• decreased use of oxytocin augmentation (induction) 

• Fewer cesarean surgeries

• Fewer instrumental vaginal births

• Decreased use of epidurals and other pain medications

• Higher rates of initiation of breastfeeding 

• Greater satisfaction with their overall birth experiences

Concluding the best results occurred when a women received continuous labour support from a doula– someone who was NOT a staff member at the hospital and who was NOT part of her social network 

In addition, the evidence suggests the emotional, physical, and informational support doulas give to women during the birthing process accounts for the reduced need for clinical procedures during labour and birth, fewer birth complications, and more satisfying experiences during labour, birth, and postpartum. 

Women need to meet their babies emotionally well and physically safe

That's Not consent; This is Consent! The problem with obtaining your consent in the heat of the moment...and what respectful maternity care should look like....

“I’m just going to pop a little clip on baby’s head” “Um, OK” you reply

“I’m just going to give you that injection now” “Um, OK” you reply

I’m just going to leave my fingers in a little longer through this contraction is that OK…. “Um OK you reply”…

As doulas we witness Maternal Health Providers (MHP) using this language all too often at births. It’s not OK!

This is not an example of you making an informed decision, nor does it demonstrate you providing consent for a procedure, assessment or intervention. #ENOUGH

Imagine yourself in labour, you’re in the peak of your effort, you’re being challenged by your contractions, you’re doing everything you can to focus. Your Maternal Health Provider (MHP) needs to have a conversation with you. Most often they will wait until the intensity of your contraction has reduced and begin talking to you during the rest and recovery space. This interruption has implications too, as this is the time that you will need to free your body of tension, let your body go soft and floppy, zone out, close your eyes and regroup ready for the next wave of activity and effort. If you are distracted during the rest and recover stage you have a high probability of building tension and taking this you into the next contraction making that contraction more difficult to manage. So, it really is difficult for MHP’s to have conversations with you during labour, however, they often need to and often do - so prepare yourself for frequent disruptions whilst in labour at hospital

So here you are a conversation needs to be had, there’s a short window in which to have this conversation so your MHP cuts some corners to quickly relay a message for a procedure they they deem necessary, or they routinely do, or they assume you’ll consent to anyway, so they scurry through the process of gaining your consent. It’s a scenario we see, and we hear all too often.

So how can you protect yourself from having things done to you while you are in labour that you would not typically consent to? How can you protect yourself from receiving interventions that lead to the cascade of interventions? How can you advocate for yourself while in a position of vulnerability? How can you say no to things when you are in a blissed out Oxycontin high where it is know that women are more compliant? How can your partner or Birth support team advocate for you during labour, without causing conflict, tension and further disruption?

Our top 4 tips to avoid saying yes to a procedure without adequate prior information.

1) Choose a continuity of care model within your chosen hospital.

2) If a continuity of care model is not available hire a Doula or an Independent Midwife

3) Invest the time into creating a Solid Birth Plan. A Birth Plan that you fully understand, that you deeply connect with. A Birth Plan that is thorough, one that includes your Birth Vision and plenty of space for your pre planned thoughts surrounding interventions, birth challenges and contingency plans. Your Birth Plan needs to be a collaboration with your Maternal Health Provider (MHP). You must feel respected and heard when discussing your birth plan with your MHP. Ask yourself how do you feel when discussing your birth plan with your MHP? If you feel intimidated, silly, unimportant or rushed during an antenatal appointment this is a red flag. We’d recommend either a change care providers, the confidence to speak up and communicate how you are feeling with your MHP or bringing in additional external support for each antenatal visit and building a well prepared birth team to support you through your labour and birth.

4) Use the BRAINS acronym to support your ability to ask good questions

The BRAINS acronym stands for.: BENEFITS,   RISKS,  ALTERNATIVES,  INTUITION,   NO/NOT YET, and SPACE

Here’s how it works : You’d ask: What are the BENEFITS of this intervention, assessment or procedure. Then you’d ask What are the BENEFITS of NOT having that intervention, assessment or procedure?

What are the The RISKS of having this intervention, assessment or procedure? What are the RISKS of not having this intervention assessment or procedure?

What are the ALTERNATIVES to this intervention, assessment or procedure?

The you ask yourself what is Your INTUITION telling you?  

At any point you can say NO thank you or NOT NOW/ NOT YET

At anytime you can ask for SPACE, space, time and privacy away from your MHP ( you can ask them to leave the room for a moment or two to make your decision, to discuss things in private with your partner and support team and to ask more questions when you are ready.

It’s really tricky to do all of this in labour under pressure or during times of stress. It’s almost impossible to learn about the intricacies of interventions in labour. The opportunity to learn is now. As early on in your pregnancy as you possibly can.

So what does asking for your consent look like and more importantly how does this FEEL for you when you do not know your Maternal Health Provider?

You should feel that any decision is yours to make, that you felt respected, validated and have had time to ask good questions should you want to. You should feel that the decision you make are in your best interest and the best interest of your baby.

The information should be communicated without coercion, bias and without judgement. You should not feel that you need to people please, that you can’t say no or feel any pressure to consent or be a ‘good girl’. You can decline any procedure at anytime regardless of the outcome. You can also request procedures, assessments and interventions.

Your MHP should explain a procedure in detail especially if it is invasive, or has any known side effects, risks or likelihood of causing a cascade of intervention.

One example of a cascade of medical interventions, whereby a decision can step you towards other more complicated interventions

For example: An internal Vaginal Examination: Ideally your MHP is in a position of equal eye height if possible to ensure that they are not physically creating a feeling power over you, they should speak clearly and slowly, pausing if your contraction begins to build.

• “I’d like to perform an internal examination of your cervix because X….

• This procedure will involve X…. (require me to touch your vulva and enter your vagina with ,my fingers to feel your cervix)

• This procedure will take X amount of time

• If at any point you wish me to stop I will remove my hands immediately.

• This is a once off procedure.

• The risks of me doing this procedure are X

• The risks of me NOT doing this procedure are X

• The benefits to you and your baby in having this procedure are X

• The benefits to you and your baby in declining this procedure are X

• If I feel a second internal assessment is required I will fully explain the procedure again, why it may be necessary to repeat and ensure that you feel that you can offer your consent or refusal.

• Do you have any immediate questions?

• If you choose to go ahead with this procedure, I will have some information about your cervix, and possibly about your baby’s position in that moment. Would you like to receive any information after the assessment about what I feel or notice, Would you prefer that I discuss these findings with your partner or would you prefer that I note my findings without further interruption?

• Your MHP should then offer you the following: SPACE “I can just pop out of the room for a moment so you and your partner can have a discussion about what you would like to do from here. Feel free to have your partner pop their head out of the room to call me back in when you are ready”.

• Please let me know if you would like to proceed or decline this procedure,.

This is long and yes it takes time, but this is a fair example of respectful maternity care, and one example of how you might consent or decline to a procedure, intervention or assessment.

It's not the Plan that's important - it's the planning. Are you well prepared to avoid the cascade of medical interventions in your chosen place of birth?

Many women have on their birth plans a ‘preference’ to avoid an episiotomy. We bet you agree, Who would want an intentional incision to their perineum if that could be avoided? Not many is our guess. However, how many women writing down a preference to avoid an episiotomy truly understand what it takes to reduce the likelihood of requiring one?

Birth Plans: A conversation you want to have with a Maternal Health Provider that you have not previously met when you are busy focusing on your labour and do not want to be interrupted. What do you want your Maternal Health Provider to know about you and the birth you are working towards?

Are you pregnant and writing your birth plan? Do you have a clear idea of how to avoid unnecessary medical interventions including an Episiotomy?

In 2020 79% of women used analgesia (so opted for medical pain relief) during their labours, 40% of these women chose an epidural. First time mums choosing an epidural 26% required an instrumental delivery (ventouse or forceps) and 82% of these women required an Episiotomy - that’s 4 out of 5 1st time women requiring an episiotmoy.

We need to remember that not only is an episiotmoy a significant trauma to the perineum, vaginal, perineal and or anal trauma requires suturing/stitches post birth. This procedure is typically performed in the birth suite within the first hour post birth, disturbing, interfering and overshadowing the most significant time for a new mother and baby, The Golden Hour.

Interruptions during the Golden Hour can result in difficulties in birthing your placenta and increased challenges for breastfeeding, bonding and attachment.

These alarming statistics highlight how the cascade of interventions can and do unravel. One decision can step you towards a very high possibility of requiring further often more challenging interventions for you and your baby. This is one example of the cascade of interventions; epidural - instrumental delivery - episiotomy. There are many other variables that can cascade from an epidural. Including but not limited to a straight forward vaginal delivery without further incident to fetal distress requiring emergency caesarean

@childbirth_education_australia resources

If you are Birthing in a Hospital and your Birth Vision is to avoid using an epidural, ask yourself the following:

1. Are you birthing within a continuity of care model?

2. Have you hired an Independent Midwife or Doula?

3. Is your Birth Partner well informed, well prepared and emotionally capable of supporting you through the challenges of labour?

4. Have you discussed your Birth Vision and Birth Plan with your Maternal Health Providers and received adequate time to discuss each and every aspect of your birth preparation?

5. Do you feel that your Maternal Health Provider has engaged with you in a respectful collaborative manner when you discussed your Birth plan? Or did you feel rushed, dismissed or not important?

6. Do you have the self confidence and trusted support to let labour begin on its own?

7. Do you know what to expect upon arrival at hospital?

8. Does your place of birth provide access to water immersion/ birth pool?

9. Do you have strategies for coping with labour including techniques you have practised and that your partner is aware of and know’s how to maximise their benefit to you?

10. Do you know the episiotomy rates of your chosen Maternal Health Provider or place of Birth?

Red Flags:

1. Know the episiotomy rates of your Maternal Health Provider or place of birth - if they don’t have them or won’t provide them to you this is a red flag. ( The WHO recommends an episiotomy rate or 10% for all normal deliveries)

2. If your Maternal Heath Provider is asking for your prior consent to perform an episiotomy during an antenatal appointment - this is a red flag

3. Does your birth environment enable you to birth in privacy, with a feeling of safety whilst being unobserved? - if not this is a red flag

Giving Birth is a transformational time, a rite of passage for you and your baby. Giving birth in our busy medicalised hospital systems is challenging if you are trying to avoid unnecessary medical interventions, especially if you don’t truly understand your birth plan and the cascade of medical interventions relating to the early decisions you make for you and your baby.

You and your baby deserve to birth physically well and emotionally safe xo