A doula's support...priceless!

In my previous post, you will have seen the kind of services I offer to women and families during the pregnancy, birth and postpartum period.

There is no 'one size fits all' when it comes to doula care.

Each mother is unique. Each pregnancy is unique. Each situation is unique. Each woman's history is unique. Each woman's choices are unique. I think you get my drift.

You may have noticed that I am a strong believer in natural birth, including homebirth.

But most of all, I am a believer in information and choice. A woman's right to bodily autonomy (in other words, being able to choose what happens to her own body).

Obviously, MY history/views/pregnancies/experiences are different to the womens' that I will be supporting. I have my opinions and wishes, just like every other woman does. But I realise it is not my job to tell a woman what to do, but to provide information and encourage her in making her own decisions with that information. If I were to bully her into a decision, or make her feel as though she was making the wrong decision, I wouldn't really be any better than the 'medwives' and 'knobstetricians' that are accused by many in the natural birth community of doing the exact same thing.

Many of you are probably also aware that I've never had a homebirth myself, so how can I support it so strongly? No, I haven't had a homebirth. Hopefully one day in the future that will change. I have had one pretty standard hospital birth (which was straightforward in hospital terms, but looking back could have been a lot different), and one birth-centre-turned-hospital birth which was certainly not what I imagined and hoped for. It was these less than ideal experiences which led me to thinking 'there's gotta be something better, something more, out there'. So I looked far and wide...and came to the conclusion that if a woman's wish is to have a trulynatural birth, not a 'natural' (aka the baby came out of a vagina but it was far from what would have happened in nature) birth, then the place to have that is at home.

Why? Because EVERY procedure that is carried out as 'routine' in a hospital interferes with the physiological process of birth. EVERY vaginal examination, EVERY medication, EVERY ultrasound/doppler use, EVERY time you are strapped to a CTG monitor, every time you are made to lie flat on your back on the bed. That is NOT NATURAL. And each of these routine interventions can lead to more intervention. Obstetricians, and sadly also many midwives, view birth as being pathological (basically a problem that needs to be controlled/'fixed'/'dealt with') rather than physiological (the body's natural process that does not require outside interference). And this is not to even mention things like forceps deliveries, vacuum extractions and cesarean sections.

I mean, how can you compare these...






This is a cesarean birth, embedding was disabled.

To these...







In the majority of births, but not all, mothers and babies survive. But should it just be about survival? Should a just be a matter of wanting to come out of it alive? And is it only the physical repurcussions that matter? What about the birth trauma the mother experiences, sometimes even feeling like she's been raped? Surely that's not a good start to motherhood. A healthy baby matters. No doubt about it. But would you call some of these babies healthy...?



So yes, I have been shaped by my own two experiences of hospital birth. I've been touched by the stories of homebirth, and the amazing (though absolutely normal) things that can happen when birth is left alone, to happen in it's own way and it's own time.

But that is absolutely not to say I won't support a woman in ANY setting she chooses. From unassisted birth to elective cesarean, I will support a woman in HER choices. I will encourage her to research the benefits and risks of these choices, and the alternatives, but once presented with the information, the choice is hers and hers alone. Because that is what birth, and autonomy, and empowerment is all about. Only when a woman has knowledge and support, and makes her own choices, can she have an truly empowering birth experience - at home or hospital, vaginal or cesarean, and anywhere in between.

And though I believe that homebirth is safe, another woman may not feel the same. And a woman must feel safe to birth, wherever that may be. Homebirth is not for everyone, but it should be an option for everyone. While I don't beieve it takes a certain 'type' of woman to homebirth, I do believe that a woman has to be mentally prepared to give birth at home. To be willing to take responsibility for her choices and the outcomes of these choices instead of surrendering responsibility to care providers. This is where birth is truly empowering. Many women, after a birth where THEY have made the choices, feel a huge sense of accomplishment, empowerment, and faith in their bodies. On the contrary, where control has been handed over to someone else (obstetrician, midwife, doula, anyone other than the woman herself), women can walk away from the experience feeling incredibly disempowered and bitterly disappointed. Either of these scenarios can happen anywhere, in any type of birth. But research suggests, overwhelmingly, that woman who birth at home are more satisfied with their experiences, bond more with their babies, and have decreased incidence of postnatal depression.

"Women who give birth in a hospital are much more likely to experience postpartum depression or even post traumatic stress disorder. British childbirth expert Sheila Kitzinger states that the more interventions a woman experiences, the more likely she is to be depressed, with cesarean sections obviously carrying the greatest risk of depression.

Aidan McFarlane, a British physician, notes that while 68 percent of hospital mothers experience postpartum depression, only 16 percent of homebirth mothers do. On The Farm, a self contained, alternative lifestyle community in Tennessee, the rate of postpartum depression was 0.03 percent. Almost all mothers on The Farm had both a homebirth and a supportive, loving community of women to assist them postpartum. Avoiding depression, in itself, would be a major reason for mothers to consider giving birth in their own homes, if that is where they are most comfortable, especially if they had previously experienced postpartum depression and thus were at high risk for a repeat episode.

Aspects of hospital birth that may strongly contribute to the incidence of postpartum depression in our country are the way the moment of birth is handled and routine separation of baby and mother. In a study published in the New England Journal of Medicine in 1972, Marshall Klaus found that holding the baby close released "dormant intelligences" in the mother and caused "precise shifts of brain functioning and permanent behavior changes." Bonding therefore is not just an emotional thing that only mothers think happens; it is a biochemical process that forever changes the mother so that she knows more instinctively how to relate to her baby. Routine separation of mom and infant makes baby frightened and mom depressed. This may be why postpartum depression and difficult adjustments are so common in the United States and rare elsewhere." -Jennifer L, Griebenow, excerpted from "Home Birth vs. Hospital Birth: How Safe?," Birthing magazine, Summer 1998

This article by SA midwife Lisa Barrett explains much more eloquently what I'm trying to say - have a read.

It is important, when you are considering where to give birth, that you think about what will make you feel safe in each environment. Whether that be the ability to move freely, having familiar support people, a quiet and dark environment, nourishing food and drink, having the SNU/NICU/an obstetrician close at hand, monitoring equipment and other 'technology' nearby? What will make you feel unsafe? Bright lights, strangers, an unfamiliar environment, the very same equipment that to others may be reassuring but to you are dangerous (ie surgical/monitoring equipment), being far from medical help?

It is really only after you have considered what will make YOU feel safe, where YOU will feel comfortable, that you can make a decision on where to give birth. There are benefits and risks no matter what you decide. There will be fears and 'what ifs'. And statistics and evidence can only help so much - ultimately it is the woman who decides where and how to give birth.

Sometimes there are complications that DO require obstetric intervention or close monitoring. Obstetrics DOES have a place. Women who truly need that intervention have just as much right to information and continued support as anyone else, particularly if they had originally wanted an intervention-free birth. It can be incredibly difficult to have that choice taken away.

A doula can provide support, physically and emotionally, to ANY woman in ANY environment.

So, in a very long winded way, while I am a home birth/natural birth supporter, it does not mean I will not support women in alternative choices.