What is a doula? A doula is not, as my brother thought, a part of the female anatomy. She is a birth companion, someone who has a deep understanding of the birth process. She knows the stages of labor, what helps to keep things moving and when is a good time for the mother to take a break and conserve her energy. A doula is there to make sure the partner feels needed and useful, to remind the couple to eat and drink, and to help couples remember their labor desires in the face of pressure from the medical team. A doula does not have her own agenda; she is there to help the couple have whatever kind of birth they desire and she knows the risks and benefits of various procedures. (Also to note: a doula can be a man, but as they’ve traditionally been women, I will continue to use the feminine pronoun.)

Until somewhat recently, I wasn’t very familiar with the doula concept. I thought she was someone you hired if you were without a partner. But after I had Menininho, I wished I’d had a 2nd person with us, someone to stay with me so Mark could go with our baby to ensure our wishes were carried out.

As I became more active on Twitter, I met several doulas: Kayce, Gina, Cassie, Desiree, and others. They gave me a much more accurate picture of the doula’s role and I realized that if I got pregnant again I would want one. Having another family member or friend to help would be ok, but a doula brings a level of expertise that I knew I’d want to help me be successful with my goal of a VBAC.

There is data to show that doulas are effective:
Women cared for during labor by a birth doula, compared to those receiving usual care were
26% less likely to give birth by cesarean section
41% less likely to give birth with a vacuum extractor or forceps
28% less likely to use any analgesia or anesthesia
33% less likely to be dissatisfied or negatively rate their birth experience
(Hodnett E, Gates S, Hofmeyr G, Sakala C. Continuous support for women during childbirth. The Cochrane Database of Systematic Reviews 2003. Issue 3, via DONA, taken from Birth Faith)

I was lucky that Mark was on board with this desire. After I became pregnant with Smudge, I started my doula research in earnest. I wanted someone who was comfortable with the idea of a high-intervention VBAC, since I knew I’d need an epidural and frequent monitoring, and who would be ok with being a support through a c-section should things end up that. I also wanted someone who had some experience with VBACs and wouldn’t just give up on me as being someone who would end up getting cut again.

The first time I spoke with P., I knew she was the woman I wanted as my doula. I told her a bit about my situation and she immediately had several ideas for keeping labor moving even while being confined to a bed with an epidural. She also counseled me to plan out what an idea c-section might look like for me, because otherwise I might allow the result of c-section equal failure, and that should not be the case. I came home and told Mark that we were set. I did attend a local meet-the-doula night later that week to be sure, liked almost everyone I spoke with (one doula immediately began to question the research about Marfan patients using epidurals and insisted I didn’t need one, so that was the end of that interview), but kept coming back to P., who was also there.

Long story short, she contacted me shortly thereafter about setting up a formal interview with Mark present. That was a great opportunity for him to learn more about how the doula aids the husband during labor. We signed the contract later that evening.

I feel like a huge weight has been lifted from my shoulders! Although I’m very excited to have Smudge, I’ve also been really apprehensive about the labor given my previous experience and knowing at least some of my team would prefer me to have a c-section. (For example, while the anesthesiologist promised I’ll be allowed to go till 5 cm before I get the epidural, I lost track of how many times she talked about “the c-section” and how I am at “high risk” for a c-section and all the different reasons I might need a c-section…not because of having Marfan, but just because I’m doing a VBAC, and research doesn’t support her assertions.) I’m much more at ease now knowing I have someone on our team who is rooting for me to be successful in what I believe is best for me and my baby.

Have you had a doula before? What was the experience like?

Last Tuesday evening I took a big step in preparing for Smudge’s birth by attending my first ICAN meeting. The International Cesarean Awareness Network, or ICAN, is a non-profit devoted to improving maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC). You can find out more about them here.

ICAN offers support groups for women who have had difficult c-sections in the past. My friend Emily runs one where she lives and recommended that I go check out a meeting close to me. I was really hesitant for a while…I didn’t want to walk into a situation where 1) all the other women hated all doctors/hospitals or 2) I’d be given a hard time for not planning a drug-free VBAC.

I tried to tell myself for a long time that my c-section was necessary. It’s not true. The medical record actually marks it as elective. My orthopedist here casually mentioned the epidural isn’t even really near the dura sac, unless the doctor putting it in really messes it up, and that a caudal is an option that eliminates that concern. I feel as though the anesthesiology team simply didn’t want to assume any liability for having a high risk patient (they were scared of my dural ectasia) and in covering themselves put me in the position of having a surgery not recommended for women with my aortic size, which led to complications. I think that that alone I could move on from, but they kept me away from my baby for no reason. They refused to perform tests necessary for my health and refused to give me information about what was wrong with me. They mocked me.

I still have bad dreams, over 18 months later, about my time in the hospital with Menininho. As I’ve prepared for Smudge’s birth I realized that I am so stressed and frightened over a repeat of what happened before that I can’t fully embrace my preparation. I need to be able to let it go.

So, I very nervously attended my first ICAN meeting. It wasn’t at all what I had expected or feared! The women there each briefly introduced themselves and why they were coming, but there were no drawn out stories. This month’s speaker was a therapist who specializes in birth issues. A lot of the background info on therapy that she gave I already knew from my BA in psych, but some of what she said really resonated with me. She talked about how fear of having the baby taken away can delay labor, and how stress in general slows down the beginning and progression of labor. Like cats, who hide to birth, our bodies are designed to birth when we are most comfortable. I think what I am most afraid of is being separated from Smudge like I was for Menininho, and not knowing what is happening to him or having any control over it.

I’m really glad that I went to the meeting and I’d encourage any other women who have issues with their c-sections to check out one as well. I’m already looking forward to next month’s!

Happy Friday! This week I’ve got two birth themed posts.

Kayce is a doula and aspiring midwife who just found out she’s pregnant with her 2nd child. I really enjoyed her post Cesareans Don’t Just Scar Your Skin. I think the grief that can accompany a c-section isn’t something that is talked about…like as long as the baby is ok, that should be all that matters. Kayce describes the reasons a woman may be upset and the healing process that can be needed. As someone who still has frustrations with what happened after her c-section, I appreciated the post.

Cassie is also a doula, also pregnant (#3). She is preparing for a natural birth and wrote her post Why I Take Medication, but Deny Interventions, to explain that. She’s someone who is quick to take medication for headaches and the like, but since childbirth is not an illness, doesn’t need it for that kind of pain. While obviously natural childbirth isn’t for everyone, I really agree with her argument.