Sunday, May 24, 2009

Can Your Husband Be Your Doula?

It seems like a very long time ago that I posed this question! In fact, I think it was two weeks ago. I bet y'all had about given up on me to ever write the post. You would not believe how much I have gotten done around my house over the last two weeks, in preparation for summer vacation. So, while those things have gotten done, the blog has suffered. I apologize.

I also knew that I have so much information on this topic, so much to say, that I was probably a bit overwhelmed to sit down at the computer to write it. I'd like to post some of the email from a former student/Bradley-teacher-in-the-making that started it all:

"There are a few things I think Bradley has a little off, and I think the whole idea of the husband being "the" labor help person is one of them. It probably sounds preposterous, especially since I am looking into becoming a Bradley instructor. But I agree with Martha Sears in The Birth Book where she says that it is better for the husband to be freed up to be "just" a husband to his laboring wife by a doula being there to help. I think you may agree with me slightly, since I remember you encouraging our classes to hire doulas if we could (and at the time thinking, "Why would we hire a doula? We're taking this class. This--husband--is my doula.").

Now, I am not saying that Bradley should not teach about husbands' involvement. I think it is one of the biggest reasons Bradley is one of the best preparations for natural birth. However, I believe that one of its greatest strengths (educating the husband about the physiological components, benefits and risks of different choices, as well as ways he can be a help in labor) is also a great weakness (raising the woman's expectations that he will be all these things she's been taught in class, even if that person doesn't remotely resemble who he has been throughout the pregnancy). In my experience, it did not happen that way, and I felt let down by my husband that he wasn't there for me the way that I needed him in Ruby's labor. I don't think I would have felt as let down if my expectations not been raised with the Bradley books and classes. What I eventually came to grips with is that I just can't have those kinds of expectations for my hubby (suggesting things, being observant, thinking of things on his own--like food, drinks, frequent bathroom breaks, how to make me more comfortable, verbal encouragement, the works!) and it does not say that he is a terrible husband because he didn't remember to do those things. When it comes to things like this, he is happy to do them, he just DOESN'T think of them himself. Especially on birth day. He needs coaching, and I am not the kind of person to do that while in labor. I just want him to KNOW."

Our results from the poll a couple of weeks ago were:

Can Your Husband Serve as Your Doula?

Even better! 30%

Are you kidding? 13%

He did alright. 56%

Hurray for the dads that did "even better" than a doula could have! I was surprised that the "Are you kidding?" category had so few votes! The majority, as I expected, fell into the "He did alright" category. This is where I would place my husband.

Thank you, also to those who contributed their experiences with their husbands and/or doulas. Some great comments. There was no right or wrong answer, obviously.

Quick history of "doulas" in America: Before birth moved into the hospital, approximately 100 years ago, men were not a part of birth. Birthing women had their mothers, sisters, aunts, best friends, and midwives attend their births. When birth no longer took place on their own turf, they could not take all these women with them. They were alone. Male doctors administered drugs that wiped women out entirely. The nurses, having several women to tend to, were all the female companionship a woman would have as she gave birth. Needless to say, her needs, emotionally and physically, were not met.

In the 1960s and early 1970s, the doctors and hospitals began to be pressured to allow husbands in the delivery room. Dr. Robert Bradley, with the publication of his book, "Husband-Coached Childbirth" advocated for women to birth without intervention or medication with their husbands "coaching" them through the experience. This was an exciting time for women and their husbands. A funny side-note to this time period: They wanted to give the husbands something to do, so the job of cutting the umbilical cord became his. They figured that he couldn't mess this up and he would feel like he had done something significant. It's really rather demeaning to think this is all the husband can do when it comes to birth.

In the 1990s, we started hearing the word "doula" or labor assistant. My first baby was born in 1996. My sister-in-law, who happened to be a doula, was present at our birth, and without her, I am certain that I would have had a C-section. And while I never paid an actual doula money to attend my subsequent births, I was always surrounded by my friends and family. And, of course, I had my Bradley-trained husband! (He was fantastic on the 4th birth!)

Many of the women who commented on their experiences, said that their husbands were a better doula with later births. There are many things that play into this: First of all, he has been through it before! But perhaps even more importantly, he has listened to his wife talk about what she likes and doesn't like in labor, probably many times over the years! He has attended other births and that gave him knowledge and experience. He knew what to expect. Imagine hiring someone who has attended dozens or hundreds of births -- the experience she brings is beyond helpful -- not just for the laboring mother but for the father-to-be.

There is a page in the Bradley workbook that is titled "Whose Job Is It?" Fortunately it appears in Class 11 instead of Class 1 because if I was a husband, looking at this list, I'd have to insist that she have an epidural because I didn't sign up for this! It is a list of 50 things that Dad should be doing. So if the mom has a C-section or an epidural, does that mean Dad failed at his list? He didn't do his job? It's just too much to put on a new dad.

With that being said, I do feel like my Bradley class prepares Dads extremely well for labor and birth. He comes away with good general knowledge of pregnancy, labor, how to help his wife in labor and birth, interventions, avoiding a C-section, consumerism, questions to ask, adjusting to life with a new baby, and breastfeeding. But the fact remains, when his wife is dilated to a nine, but the cervix has a lip, will he remember what positions are good to help with that? Maybe, maybe not. But a doula, who sees this very often, will know how to help. It's like the comment in the beginning: a lot of husbands want to help, but often need to be told how to help. Even with 12 weeks of class, a lot of husbands will not think of helpful laboring positions depending on what "symptom" mom is having. The more one reads about and attends births, the more experience and expertise they will have. In my expereince as a Childbirth Educator, the dads are not the ones reading about birth!

Dads must be advocates for their wives. It is important, even crucial, that he understand the birthing process, and that they do everything they can, as a couple, to prepare for this life-changing day. Doulas cannot speak for their clients, but husbands can speak for their wives in the delivery room. She will not be able to be her own advocate when she is in labor. A doula is familiar with the birth setting and terms, equipment used, etc., and it is easy for many dads to be overwhelmed by it all, especially the first time through. A doula, as Hannah said, is not so emotionally involved and can often help navigate the way through to a great birth.

Here are the simple facts:

Women have better obstetrical outcomes when they are accompanied throughout labor by a doula. She will provide emotional, physical, and informational support to a couple in labor. The presence of a doula reduces the C-section rate by 50% (!), the length of labor by 25%, the use of pitocin by 40%, the need for forceps by 40%, the request for pain medication by 30%, and the use of epidural anesthesia by 60%.
If you are planning a VBAC (Vaginal Birth After Cesarean), statistically you are more likely to achieve a VBAC with a doula by your side.

Women who have a doula are more likely to report feelings of having coped well with labor and a greater satisfaction with their birth. They report having less anxiety after the birth and even an improved relationship with their partners after the birth. (Perhaps, in part, because the pressure was off of dad and he could lovingly support his wife without the "coach" role.) In addition, women who have a doula report higher self-esteem and lower postpartum depression and anxiety 6 weeks after the birth.

Babies also benefit from a doula being present for their labor and birth. They have fewer neonatal complications, fewer workups for sepsis, and fewer health problems at 6 weeks of age.

If you decide to have a labor assistant at your birth, ask around. Interview. Some cities have "Doula Teas" where you can go and meet lots of doulas and find one you like. Find out their personal statistics. I once heard of a doula that had a 90% epidural rate! That tells you that she isn't sure how to help you! You also might consider having a friend or two with you. Be sure they are supportive of natural birth and/or have given birth naturally.

Congratulations for making it to the end of this insanely long post. I hope you can appreciate why it took me so long to sit down and type it out.

I want to leave you with a single thought: Many times over the years, I have heard couples say how glad they are they hired a doula, but I have never heard anyone say, "That was the biggest waste of money."

Friday, May 8, 2009

Can A Husband Be a Doula?

I throw out this question because I want your opinions and experiences before I continue from here. I had a former-student-turning-Bradley-Instructor pose this question to me a few weeks ago, and I've been thinking about it ever since. Remember, the Bradley Method of Natural Childbirth is based on the book by Dr. Robert Bradley, "Husband-Coached Childbirth."

Let's hear what you have to say before I throw out statistical data, etc. Looking forward to hearing from you.

Sunday, May 3, 2009

"Orgasmic Birth" Needs Your Help by June 1st

Debra Pascali-Bonaro, Director of Orgasmic Birth, along with Elizabeth Davis, CPM, are putting a book together and they need our help. Here's your chance to be famous! These are Debra's words from Facebook:

"Elizabeth Davis, CPM and I are writing Orgasmic Birth: Your Guide to a Safe, Satisfying and Pleasurable Birth Experience to be published by Rodale in spring 2010. If you have any great comments about sex during pregnancy please share and encourage other too and/or pleasurable, ecstatic and orgasmic birth stories. Thanks!

We appreciate all stories and comments to us by June 1. The sooner the better, especially any comments about how women felt about sex during pregnancy. Thanks so much for your help. I really appreciate it! Please ask people to submit to us on our web site"

Don't be shy. Rethink your births and submit them. What an exciting subject to be famous for! Good luck!