Fantastic Birth in Bangalore!

I want to share a little about a birth I attended a week ago. I'd been traveling up north and returned to have a prenatal visit with my clients . My client, who I will refer to as C, looked beautiful, felt good and was excited about the upcoming birth. As her due date was only three days away, she and her doctor had discussed her doc's induction protocol, which was that she would need to go in for induction six days after her due date. C had a feeling her baby would come late, as both she and her brother had been more than a week late. (The American College of Obstetricians and Gynecologists has a guideline of 42 weeks, or two weeks after the estimated due date; given that due dates are often so uncertain and most first-time babies come late, allowing only six days before inducing isn't giving the baby much of a chance!) She very much wanted to avoid being induced, so during our prenatal visit we talked about natural induction methods: sexual intercourse (prostaglandins in semen help ripen the cervix), nipple stimulation, acupressure and herbs.

Her husband, D, called me at 12:30 that night and said she was having contractions that were four minutes apart! I said I'd meet them at the hospital, got dressed and was on my way. Luckily, we arrived at the same time, and by the intensity and frequency of C's contractions, I could tell that she was in transition. We went straight to the delivery room, where we met the on-call doctor and a few nurses. The doctor checked C: fully dilated and ready to push! Of course there was no time for pain medication, and my clients had come prepared with a birth plan, which stated clearly that the doctor and medical staff should avoid common and often unnecessary interventions such as shaving, enema, IV, episiotomy, oxytocin, immediate cord clamping, separation of mother and baby, etc. C was amazing, listening to her body and following its natural urges to push, while D supported her in the most gentle and loving way until their baby boy was born at 2:19 am. He was placed on C's chest immediately and kept there, skin to skin, for 40 minutes. (It's extremely unusual for doctors/hospitals to allow this much time to pass before they take the baby away, but as long as a newborn is pink and breathing, all newborn procedures can and should be delayed for at least an hour so that mom and baby can be skin to skin and establish breastfeeding.)

Unlike in most hospital birth settings I've been a part of in Bangalore, the doctors and medical staff were kind, quiet (for the most part), calm, and respectful of C's wishes as stated in her birth plan. (That said, it was a very short labor, so it's impossible to know how much pressure for interventions there would have been if labor had slowed or did not progress as quickly.) She was not given an IV (just a hep lock) nor did the doctor cut an episiotomy. She tore naturally, and was extremely pleased to have a natural tear instead of an episiotomy. Both parents are very satisfied with the whole experience, and I'm so honored to have been a part of it!

Readers Respond to New York Times Article About Doulas

A couple of weeks ago, the New York Times ran this pretty negative article about doulas and lactation consultants. I wanted to post the letters to the editor that were published a week later.

New York Times
March 9, 2008
Letters in Defense of Doulas

To the Editor:

Re "And the Doula Makes Four," by Pamela Paul (Sunday Styles, March 2): I recently gave birth to my son with the assistance of an experienced doula, without an epidural and other interventions that I had hoped to avoid. Your article, in emphasizing negative experiences with doulas who seem to be acting inappropriately and outside their scope, does a disservice to parents. Medical literature has demonstrated that with a qualified doula, a mother is likely to have a shorter labor with fewer complications, including a lower chance of Caesarean section.
Diana Graham, M.D.Raleigh, N.C.

***

To the Editor:

Your article reported that "44 percent of women described the relationship between their hospital nurses and doulas as hostile, resentful and confrontational." In fact, this study - which surveyed a total of nine women from a single hospital in north-central Alabama - found that four women described their nurses as behaving that way. The doulas, on the other hand, were described as "calm," "respectful" and "the best investment I have ever made in my life." In my experience as a doula, the vast majority of nurses welcome doulas' respectful support and nonmedical role. I can only hope doulas will become more widely available so every woman who wants one can have this kind of support during childbirth.
Dorian Solot
Albany
The writer is a birth doula certified by DONA International, a
professional organization that provides training and certification as
well as information for prospective clients.

***

To the Editor:

It seems Americans do more research on car purchases than on medical providers and hospitals. I did my research and had an amazing doula for the birth of my first child. When my second son was born, we had trouble with breast-feeding. A certified lactation consultant saved our breast-feeding relationship. While I am sure there are bad doulas and lactation consultants, I believe the majority are excellent and much needed in our over-medicalized birth environment and pro-formula society.
Corinne Griswold
North Granby, Conn.

More evidence that women shouldn't be made to labor alone

Many, many women in India, especially poor women, go through labor alone. Government and even private hospitals do not allow anyone to accompany the laboring woman. This practice is not only ludicrous and inhumane, it makes no sense given what we know about how women who are supported in labor have better health outcomes, as do their babies. I think this should be one of the first issues to be tackled by our newly forming Bangalore Birth Network (BBN)!

Women happier with childbirth when accompanied

NEW YORK (Reuters Health) - Women who go through labor and childbirth with a companion of their choice are more satisfied with the experience, and the care they receive, than women who deliver alone, Brazilian researchers report.

Furthermore, the presence of a companion did not create any safety issues, In fact, women with a companion on hand were about half as likely as unaccompanied women to have amniotic fluid stained with fetal stool -- meconium -- which can be dangerous to infants if it is inhaled.

While having a companion to provide support during labor and delivery is accepted practice in much of the world, many health facilities do not allow companions or discourage their presence, Dr. Odalea M. Bruggemann of the Federal University of Santa Catarina in Florianopolis and her colleagues note. This is especially common in the developing world, they add.

Bruggemann and her team randomly assigned 212 women to solo labor or labor with a companion of their choice, to compare childbirth experiences.

About half of the accompanied woman (47 percent) chose their partner or the child's father, while 30 percent chose their mother and 23 percent chose another female relative or a friend.

The women who received support from a companion were significantly more satisfied with labor and delivery than those who went through childbirth alone. They were eight times more likely to be satisfied with their labor experience and nearly six times as likely to be satisfied with delivery.

The accompanied women were also more satisfied with their medical care and medical guidance during labor and delivery. "Perhaps because there was someone else in the room, medical staff were more forthcoming and user-friendly than when no support person was present," the researchers note in their report in the online journal Reproductive Health.

Women with companions were 49 percent less likely to have amniotic fluid stained with meconium than women who delivered on their own. This may have been because they were less anxious and fearful, Bruggemann and her team suggest.

"If on one hand there is a general belief that a labor companion has always positive effects, there are, on the other hand, still a lot of health facilities where companions are not allowed, especially in developing settings," the researchers write. "It is expected that the results of this study could help providers to acknowledge and respect women's rights during birth."

SOURCE: Reproductive Health, July 6, 2007.

Copyright 2007 Reuters News Service. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Copyright © 2007 ABC News Internet Ventures

Article about doulas on CNN.com

Doulas Deliver Help for Laboring Moms
By Judy Fortin

ROSWELL, Georgia (CNN) -- The lights were dimmed, soft music was playing and a scented candle burned on the counter. In the center of it all was Julie Trotter -- moaning through hard labor contractions.

Doula Kai Martin Short works to ease Julie Trotter's pain during labor.

For more than six hours, Trotter, a 23-year-old from Duluth, Georgia, tried different techniques to ease the pain of natural childbirth. Not only was her husband offering encouragement, but so was her doula, Kai Martin Short.

"She definitely was a lifesaver for sure," Trotter says. "She used a lot of counter-pressure through each contraction, and that helped so much."

Doula is a Greek word meaning "woman's servant." Part birthing coach, part mother's assistant, doulas are showing up in more delivery rooms than ever before.

Short, from Atlanta, Georgia, is among 2,500 certified doulas in the United States.

"Doulas trust birth and are not afraid of it even when the mom and dad get afraid," Short said. "We're there to just say things are fine; you're doing great; this is all normal."Video Health Minute: Watch how a doula helps a woman through labor »

Short offers more than comforting words. For a flat fee of $700 per client, she meets with the parents before the baby's due date to talk about their expectations and to share techniques to be used during labor. She is by the mother's side in the delivery room and visits the parents at home after the baby is born to offer advice on such topics as breastfeeding.

In her three years as a doula, Short has attended more than 30 births. Her training with a group called DONA International involved 26 hours of instruction on pregnancy, childbirth and comfort measures. "Whatever [mothers] need, whether it be changing positions, encouragement, massage or saying comforting words, there are so many things we do to help with the process," Short said.

Short tries to create a calm atmosphere in the delivery room with music and candles. Throughout the labor, she massages the birthing mother's back and rubs her head. Another one of her tricks to relieve pain involves having the woman sit on a big rubber exercise ball during contractions.

She encourages the father or other family members to get involved in the process and shows them how to help the mother breathe through contractions.

"I think it's really hard for a loved one to see their loved one in pain," Short said. "They don't really know how to help them."

While Short has plenty of advice for parents, she has no medical training and is not supposed to offer a medical opinion. She does not take the place of a doctor, midwife or nurse. Her role is to strictly work with the family and motivate the mother during labor and delivery.

But Dr. Sean Lambert, an OB/GYN who delivered Trotter's baby at North Fulton Hospital in Alpharetta, Georgia, says that sometimes, doulas can cross the line.

"It's almost as if some women and some couples have turned to them for too much advice and guidance," he said. "Occasionally, it will cut across what we recommend on a medical basis."

Short says she's never had any clashes with medical professionals. "Really, it's separate roles," she said. But she can understand how the relationship can get tricky. "It can be territorial sometimes if the doula is a little bit more strong-minded or opinionated."

Short encourages her clients to ask questions, and she's careful in her approach to the answers she gives.

Ten days after the birth of her son, Braydon, Trotter reflected on the experience. "It was a perfect one in my eyes," she said. "I think having a doula definitely would be helpful for anybody, and I wouldn't change anything about the birth."

Short enjoys seeing new families come to life and concludes, "The best part for me is helping women realize what their bodies can do. Just having that support can make all the difference."

Judy Fortin is a correspondent with CNN Medical News. Producer Leslie Wade contributed to this report.

Active management of long labors

The other day I had the privilege of attending a Metropolitan Doula Group (MDG) meeting at which midwife Cara Muhlhahan spoke about managing long labors. [I'm in New York for 2 weeks, heading to Texas for some family time, and then back to Bangalore at the end of July.]

Cara emphasized the importance of not pathologizing long labors. When the baby is in the occiput posterior (OP) position (back of the baby's head is facing the back of the mother, accounting for about 15-30% of labors), latent labor can last three to four days while the baby's head molds to fit into the mother's pelvic opening. Long labors are not harmful to mothers or babies, rather, they are physiologically normal. The head must mold before the cervix can open, and it's best to simply wait it out without wearing the mother down or suggesting that the she is at fault.

Cara pointed out that women are looking for any excuse to believe they are inadequate. It's no wonder sometimes, when you look at hospital practices, in the case of long labors, for example. Most doctors would never let a woman labor for three days. She would be called in to the hospital, given Pitocin to augment the labor, and the cascade of interventions would begin, potentially leading to a cesarean birth.

We know this happens often in many hospitals, including those in Bangalore, where cesarean rates tend to reach 70%. (The world health organization (WHO) recommends a safe target rate of 10-15%.)

It was pretty amazing to be back at an MDG meeting; more than twenty doulas attended, including a few from the Brooklyn group I'd been hosting at my apartment in New York last year. I miss going to regular meetings and consistently having opportunities to share information and get support and inspiration from like-minded colleagues in the birthing field. I hope this blog serves to connect people interested in normal birth, both new and expectant mothers as well as childbirth professionals.