Doulas Lower C-Section Rates? You Bet We Do!

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Another study regarding doulas and their relationship to mothers avoiding medically unnecessary C-Sections was recently published. The study compared mothers who hired doulas with mothers who either wanted doulas and were unable to hire one, mothers who were not familiar with doula work (and therefore did not know they could hire one), and mothers who did not wish to hire a doula as part of their birth team. The study looked at their birth outcomes and overwhelmingly concluded that, statistically, women who knew what doulas were and were able to hire one greatly reduced their C-Section rate.

Here’s the article:

http://www.huffingtonpost.com/2014/08/29/doula-benefits_n_5730720.html

“The presence of a doula at birth was linked to an almost 60 percent reduction in women’s odds of having a C-section, and 80 percent lower odds of having a nonmedically indicated C-section compared with women who had no doula. (Overall, 10 percent of the women in the survey said they had no clear medical need for a cesarean delivery, yet delivered via C-section anyway.)”

Wonderful news for most of us! My heart is breaking for the 27% of women who wanted a doula, but were unable to hire one. Most were low-income families who did not have the resources to pay for a doula’s services.  This article suggests something that most of us have been shouting from the rooftops for years, WHY AREN’T INSURANCE COMPANIES COVERING DOULA SERVICES!?

Some do. Some cover up to 70% of a doula’s fee. Some HSA accounts will let you use your funds for doula services. Why not ALL? Why not Medicaid? If there was a $1000.00 (average doula rate in the U.S.) pill that decreased a woman’s odds of having a C-Section by 60% with no negative side effects and decades of studies behind it, I would consider it criminal not to administer that medication. You decrease what insurance companies pay on average for a birth by $9000.00 if doulas were covered by insurance companies. Nine THOUSAND dollars, per cesarean birth.

One of the reasons why it has not been DEMANDED that women have access to quality doula services can be found in the comments section of the article.

Robert Jackson, a Physician from Houston, Texas states
“… saying sweet things and rubbing someones back isn’t going to change c section rates. That is, unless the patient has chosen an obstetrician who is willing to do a c-section for the indication that labor hurts. Bring on the doulas but please don’t try to tell patients that this will change the anatomy or physiology of the pregnancy….”

If all a doula did was whisper sweet nothings in their client’s ear and give her a little back rub, then, by all means, this gentleman would be correct. We are skilled members of the birth team. We educate our clients, we motivate our clients, we physically move our clients. We know, operate in, and promote normal birth. We can read our clients, and help them to break through their walls, because we walk the path of labor WITH them.

No one is questioning that most of the medical staff want the best for moms and babies, but we, as doulas want the best for THIS mom and THIS baby, and we are going to work our tails off to make sure that they get their best outcome. My hope is that insurance companies will see the financial benefits, promptly, so that any woman who desires has access to doula services.

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Ask A Doula: Why Would I Hire A ‘Stranger’ To Be With Me In the Delivery Room?

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“I just don’t think I would want a stranger in the room with me while I’m in labor.”

I have heard this, or similar sentiments expressed on a number of occasions after sharing with someone that I am a Labor Doula.  Let me tell you something:  I could not agree with you more!

Labor is the most thrilling, joyous, terrifying, intimate, amazing, exhausting and life-altering experience that many of us have ever, or will ever experience.  It is a time when a woman needs to feel safe, secure, cared for, and empowered.  She and her child are on a journey that they alone are experiencing firsthand.  No one else has experienced her contractions, her determination or her love for that child.

So, let’s think about who is present in a normal vaginal hospital delivery (According to the latest CDC study only 1% of American women deliver at home, so this will represent most women).  You have a large team involved in the safe labor and delivery of your little bub.  Some that you will have had the opportunity to meet ahead of time, and some that are your brand new BFFs.  Let’s take a look at all the different people who will see you naked… I mean, be a part of your birth team!

Your Obstetrician or Midwife. If you go to every Prenatal exam (which you definitely need to do) starting at 9 weeks (usually the earliest they will see you) up to 40 weeks, that gives you between 12 and 14 office visits before your big day.  You will probably split those visits up between your Doctor/ Midwife and the Nurse Practitioner/ Physician’s Assistant.  So, that is about 7 visits with your chosen Care Provider (less if they are part of a large Provider Group that shares patients).  Even though you may spend an hour at the Doctor’s office, we all know that you are actually getting about 10 minutes of face time with your Provider.  So, with that in mind we are looking at about 70 minutes with your Doc pre-delivery.

The caveat to this, is that sometimes the Dr. you chose is not even on-call when you go into labor.  In that case, you may end up with someone you’ve never even met being the Provider who delivers your sweet babe.  You should discuss with your Provider ahead of time who goes on-call for them when they are unavailable, and if you will be able to meet the other Provider(s).  Also, check if your Doc has any vacations scheduled around your due date.  Don’t let a strange Doc in the room be a surprise!

When you go to your hospital or birth center in labor, you will probably start out in Triage.  This is usually a large room with several gurneys (movable beds) partitioned by curtains.  They will hook you up to two monitors.  One lets them see if, and how frequently you are contracting.  The other lets them keep an eye on baby’s heartbeat.  They will also do an internal exam to see how far dilated you are.  If you are, indeed in labor, and they have a room available, you will be moved to a private labor room.  Here you will meet your wonderful partner in crime:

Your Labor Nurse.  This is your primary care giver throughout labor and most of your pushing.  (S)he is the one who will be in charge of your well-being.  (S)he will start your I.V., be your medication provider, ask you all of those probing questions, and be your advocate with your Doctor.  There are just a few things you may not be prepared for.  First, you are not her only patient.  She probably has one more laboring mama she’s caring for, and if she is covering for another RN (while they quickly eat and potty), she may be keeping an eye on one or two more.  Second, these angels work 12 hour shifts which means they are running around for half a day making sure you and baby are safe.  At the end of those twelve hours you are given to a new Nurse who will have you for the next 12 hour shift.  If you have a longer labor, you may have 3 or 4 different Nurses providing your care.  Third,with all of the work they are required to do, most studies put them actually in the room with you for only about 25-30% of your labor.  That is a significant amount of time you are laboring with only the support team (your partner, friend, mother, etc.) you brought with you.

Let’s take a look at your support team. This is usually made up of your partner, your immediate family, and/or your closest friends.  In many cases, you are only allowed three other people in your labor room.  Mainly because the Nurses and Doctors need to be able to get to you quickly and easily if there are any issues that come up with you or the baby.  So, we are going to assume a few things.  First, that your partner has been with you at your 6 to 12 week-long childbirth class.  They have learned all of the ways to best support and comfort you during labor.  They anticipate and meet your needs.  They are understanding of all the ways you are communicating with them (usually it is breathing, body language, and primal vocalizations, NOT words).  They also understand all of the things that are happening around you.  They know what all the machines do, and why they are beeping.  They know when to get the Nurse involved, and when to dig in and support you through sensations that you have never experienced before.  They keep a cool head and help you to remember that the pain does not control you, even when it feels like it is all consuming.  The problem is, you’ve never had this experience before.  Even if you’ve delivered 10 babies, you’ve never delivered this baby with your current body before.  This can mean that your partner/ mother/ friend who loves you and your child is confronted with an unknown factor… what you need in this pain.  This can throw even the most involved and level-headed partner into a major stress they have never experienced before.  They want to help.  They want both of their loves (you and that baby) to be safe, happy, and comfortable. They just get a bit overwhelmed and may not be able to focus fully on you because they are managing their own stress.  Bless ’em!

Sometimes you get something that looks like the following:

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Who is helping them cope with their stress appropriately?  Who is reminding them that they know you and your needs better than anyone else?  Who is empowering them to be the best birth partner they can be?  Oh, that’s something Doulas do!

So, let’s talk about how well clients get to know their Doula before the big day.  I usually like to have at least 3 meetings with my clients before they reach 38 weeks.  If they contact me earlier in their pregnancy, that can increase as needed.  Our meetings last a minimum of an hour, but depending on what questions and concerns my client has, they have been known to last up to three hours.  If you want me to attend childbirth classes with you, we’ll obviously get more time together.  During our meetings, not only are we preparing for the birth you want, but we are getting to know each other, as well.  I help my clients walk through what they want in their pregnancy, labor, delivery, and their first hours, days, and weeks as a family.  This is a very intimate time, so we tend to get to know each other pretty well, pretty quickly! That means that you will probably spend at least 3 hours with your Doula.  That is twice the amount of time that you get with your Doctor, or you may end up with a Doctor you have never met before.  You’ve likely never met your Labor Nurse before that day.  While you known your partner ahead of time, knowing how they will react in this situation can be difficult to predict.

So, why a Doula?

According to a 2012 Cochrane Study titled “Continuous Support For Women During Childbirth*”, having continuity of physical, emotional, and educational support provided by a non-medical support person throughout your labor and delivery leads to a lot of wonderful outcomes!  Including:

– A 34% increase in the satisfaction with her birth experience

– A 31% decrease in the use of Pitocin

-A 28% decrease in the chance of a C-Section

-A 14% decrease in your newborn being admitted to the Special Care Nursery

-A 12% increase in the chance of a spontaneous vaginal birth

-A 9% decrease in the use of any medications for pain relief

We, as Doulas, are here to be a part of your birth team.  We are trained to emotionally, physically, and educationally support the mother during labor, delivery, and immediately after the birth.  We do not take the place of your partner.  We empower them to meet your needs (and we also know what those machines are, and why they won’t stop beeping).  We cannot provide your medical care, but strive to help you have the knowledge and support that you need to make informed decisions, during a stressful and exciting time.

Love Thy Labor,

Meghann

 

 

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If you feel like a Doula may be right for you, you can search for local Doulas at http://www.doulamatch.net

You can visit my Facebook page for more articles and information at www.facebook.com/allaboutmomdoula

You can visit my blog at http://www.allaboutmomdoula.com

 

*http://www.ncbi.nlm.nih.gov/pubmed/21328263