7 Reasons You Should Have a Doula

dou·la
/ˈdo͞olə/

noun: doula, plural noun: doulas

1. a woman who is trained to assist another woman during childbirth and who may provide support to the family after the baby is born

I've only had 3 major fights with my husband in over a decade spent together. One was about artichokes. Another was about fabric scissors. The third was an actual shouting match - 5 years before I was even pregnant - while walking down the street in downtown Minneapolis about doulas.

"I don't like doulas," my husband sniffed.
"What? Why? What do you even know about doulas?"
"What do they even DO? I think they're annoying. Why would you need one? Isn't that what the doctor is for?"
"YOU HAVE NO IDEA WHAT YOU'RE TALKING ABOUT."

Fast forward to 2013.

"Honey," my husband chirped, "my co-worker's wife is pregnant! I asked if they had interviewed doulas yet. He had never even heard of them, so I told him they have to have one."

Doula literally comes from the Greek term for "woman servant," and a doula serves as support for you (AND your partner) during pregnancy, labor, and the postpartum period.

Why would you want a doula?

The presence of a doula has been shown to reduce labor times and improve birth outcomes for both mother and baby. My favorite statistic is that even a doula simply sitting in a chair in the room without actively doing anything else has improved outcomes! Amazing.

The real question is why wouldn't you have one?

A big factor for us was that we didn't know which midwife or OB would be at our son's birth. Knowing my personality and my desire for an unmedicated birth, I knew that having someone I trusted and felt comfortable with would be key for me to relax. We had also never experienced birth before and wanted someone on our team, not the hospital's, to help guide us through it.

7 Reasons You DO Want a Doula

What does a doula do (and not do)?

A doula does NOT advocate or speak for you. She is there to support you. Some doulas are massage therapists and may offer bodywork, give counterpressure during contractions, offer aromatherapy options and other comfort measures. Our doula was instrumental in guiding us through early labor and helping us decide when to leave for the hospital. What was most valuable for us as first time parents was her experience of witnessing birth to let us know what was normal.

I still say she was 80% for my husband and 20% for me.

A doula does not speak on your behalf. She may say something like, "You said you didn't want an epidural. The nurse is offering one. Do you want to try to get through a few more contractions before you decide?" Or she may say, "You said you didn't want an epidural, but it's been a long time and you seem really tired. Do you want to discuss your options?"

Where do you find a doula?

A trusted friend or family member can be a doula, but it should be someone you're comfortable with since they'll be present when you're in a vulnerable state during labor.

DONA is the group that certifies trained doulas, and you can search for a local match who is available around your due date at DoulaMatch.net. It doesn't make them a better choice necessarily, it just verifies that they have training and some experience.

How do you pick?

We found a list of local doulas, visited their websites, contacted several to make sure they were available, and interviewed 3 doulas. We really liked them all, but we chose the one who provided what we felt was the personality we needed in the delivery room. I'm very organized and responsible, so I wanted someone with a softer presence.

Many cities have doula meet-and-greet events so you can mix and mingle with a group of doulas and decide who you might want to interview. Then of course their schedule and pricing needs to be a good fit.

People are sometimes surprised at the cost of doula support, but they can only take so many clients due to the unpredictability of birth. Most also offer prenatal and postpartum support, may have additional lactation training, and probably need childcare for their own kids for the potentially long-haul of your labor.

Some may work on a sliding scale, offer payment plans or trades, or there may be student doulas in your area with less experience and a lower cost. Several we met offer discounts for homebirths since they're not always covered by insurance. The earlier you make a decision, the earlier you can budget for it.

When my husband and I started talking about trying for another baby, one of his first questions was, "Do we just have the same doula again? Is that a thing?"

But do I NEED a doula?

Of course not. And some women prefer their mother, sister, or friend to act in a similar capacity.

But if you have the option, I can't think of a reason NOT to have that additional help.

Did you have a doula at your birth?

Want to stay in the loop?

Let's be honest - you'll forget to check back. Because mom brain is real.

Where Should I Give Birth?

“Oh, you had your baby at home? Yeah, we were gonna do that, but we wanted our baby to live.”
- Jim Gaffigan, Mr. Universe

How are you feeling, Mama?

Let's be honest: first trimester kinda sucks.

Hormones flood your system. Your digestive system is on strike with each part protesting something different. You're exhausted, possibly bloated and nauseous, and may not want to explain why to your employer or friends yet.

I once described the first trimester of pregnancy as similar to having mono, but without the sore throat. The kissing disease, indeed. And just like in college, you have plenty of studying to do.

Because in addition to choosing your future child's favorite sports team and college major, you also have to decide the location in which your baby will exit the cozy mobile home that is your uterus. (Don't worry about the decor, newborns can only see about 8-12 inches away at birth!)

Hospital

Almost 99% of U.S. births take place in hospital labor and delivery units, and physicians attend 86% of them. This is based on cultural norms, and probably on your health insurance coverage.

(Note: This would be a great time to review your maternity coverage to avoid dropping your newborn in shock and horror when you get your hospital bill. We were asked "cash or credit?" about 2 hours after I squeezed our son out of my body.)

Beautiful happy hospital birthing mama

Photo credit: Ariel Dolfo

Why most expecting mothers choose a hospital:

  • It's expected, so women may not know there are other options
  • Insurance coverage may not cover anything else, at least not obviously
  • High-risk pregnancies, which make up about 15% of hospital births, are generally not eligible for alternative locations
  • Concern that something will go wrong and wanting to be at a hospital just in case
  • Medically necessary induction or Cesarean birth

Some hospital birth statistics(*):

  • The Cesarean rate is around 33% for low-risk women (health organizations look for 10% as an acceptable level)
  • 87% of laboring mothers receive continuous fetal monitoring and 76% are restricted to bed
  • 80% receive IV fluids
  • 43% have labor induced, and 47% have their labor accelerated with medication
  • 92% give birth lying on their backs

Birth Center

According to the American Association of Birth Centers, a birth center is "a home-like setting where care providers, usually midwives, provide family-centered care to healthy pregnant women." Though much less common than a hospital setting, they can be a great midpoint between a medical hospital environment and a home birth.

Relaxing in the birth tub at the birth center

Photo credit: Vuefinder Photography, San Diego Birth Photographer

Some reasons women choose a birth center:

  • Low-risk pregnancy with little need for medical care
  • Preference for a "wellness" model of prenatal care
  • Desire to avoid artificially induced labor or other interventions
  • Traumatic associations with a previous hospital birth

Some birth center statistics(*):

  • 84% of women who planned to were able to give birth at the birth center
  • Even with women who transferred to the hospital, the overall Cesarean rate was only 6%
  • Less than 1% of women had to transfer to the hospital during labor, and over half were still able to have a vaginal birth
  • The average birth center birth costs roughly half that of an uncomplicated vaginal birth in the hospital

Home Birth

Fewer than 1% of American women choose to give birth at home (compared with around 2.5% in the UK and around 20% in the Netherlands). Statistics can be hard to come by since they are less common, and there is a difference between a planned home birth and an unplanned one (baby arrives quickly, for example).

Happy homebirthing family

Photo credit: Ariel Dolfo

Some reasons women choose home birth:

  • Control (fear of medical interventions at the hospital)
  • Comfort - no travel required, able to stay in familiar surroundings
  • Cost - home birth can be less expensive than a hospital birth
  • No need for childcare if not a first birth

Some home birth statistics(* and *):

  • Between 2004 and 2010, the number of home births in the United States rose by 41% (from ~.5% to ~.7% of total births), and only 22% were first births
  • Of planned home births studied from 2004-2009, over 89% were able to give birth at home
  • Cesarean rates were 5.2%
  • Postpartum transfer rates were 1.5% for mothers and 0.9% for infants

Well that's a lot of math, isn't it?

How is a hormonal, exhausted, overwhelmed mama to choose? Especially when they like to throw around statistics involving death.

  • Take your risk factors into account and you may find the hospital is the best place for your birth.
  • Talk to your partner. My husband's only request was that I give birth in the hospital, though he was eventually willing to consider a birth center. (We are planning a home birth for our next child.)
  • Think about how far you (or your caregivers) are from that location.
  • Know your budget and the costs of what is and isn't covered by your insurance - it may surprise you.

Whatever you decide, know this:

You can absolutely have a beautiful, peaceful natural childbirth experience at a hospital, or birth center, or at home. You can absolutely have a beautiful, peaceful childbirth with an epidural. You can even have a beautiful, peaceful Cesarean birth.

If you feel drawn toward a birth center or home birth but are nervous, tour/interview the facility/midwives. You can always opt for the hospital anyway.

More about birth plans next time. Happy gestating!

The Sh*tty Side of Pregnancy (Literally)

On the other end...

My last post covers what you may be putting into your body, but there's also the topic of what comes out. Or doesn't.

Yep, I mean constipation, one of the most annoying side effects of pregnancy that hits you like a brick. A brick that won't move. Right in your colon.

Hit back with a full frontal (middle?) assault of tons of water and fiber. If you're having trouble drinking enough water, try adding fruit (citrus slices, strawberries), cucumber slices, or mint for a hint of flavor. Your goal should be around half your body weight in ounces of water per day (if you weigh 130 pounds, aim for 65 ounces of water and see how you feel).

Drinking a large glass of water first thing in the morning can help ward off nausea and headaches, and it help get things moving in your GI tract as well. If you're up to it, physical activity also stimulates digestion, so a walk or other exercise is not only good for you, but good for your gut.

green smoothie ingredients

"Fiber" doesn't sound sexy, so think in terms of:

  • eating whole grains instead of refined ones
  • incorporating nuts and seeds
  • snacking on fresh and dried fruit
  • and adding dark leafy greens to your diet (try a smoothie, or sauteed with eggs)

It's not as hard as it sounds. Try brown rice or whole wheat pasta instead of white. Eat some trail mix. Have fruit available at all time. Opt for a side salad instead of fries when you eat out.

Have you ever eaten too many blueberries or prunes in one sitting? No such thing when you're baking a baby. And those micronutrients in leafy greens include the folate you need to help in the earliest days of your pregnancy.

What about supplements?

Normally I'm a whole food, plant-based kind of girl, but sometimes you need a little oomph. I pretty much ate cereal and yogurt my first trimester. Nothing with flavor sounded good and I was too tired to cook.

Some groups suggest eating tons of organ meats and a zillion fermented things. No thanks, guys. I barely have an appetite anyway, and my own organ meats are having a hard time. But if you need a little energy boost and are worried, these can help.

(This is not medical advice and should not be construed as such. This is what I have personally taken, however, and have recommended them to clients and friends. Amazon links are affiliate links, so if you purchase the items I suggested I get a few cents from it.)

Some supplements I actually do recommend

  • Floradix. This liquid iron supplement is non-constipating. It tastes like juice stirred with a rusty nail, but I felt less fatigued after only 2-3 days of taking it.
  • Your prenatals. A vitamin supplement doesn't cancel out a bad diet, but it can help smooth over rough patches. Also, your body is drawing on your nutrient stores to build your placenta and baby, so you need to replenish them for yourself!
  • Magnesium. There is a range of opinion on rates of magnesium deficiency, but taking a little too much isn't dangerous, it just can give you diarrhea. If that happens, back off! Magnesium is the active ingredient in milk of magnesia, a laxative. As a side bonus, magnesium can help those restless legs and cramps at night, too. Several friends swear by this calcium-magnesium combo (just don't take it with your iron supplement since calcium can inhibit absorption).
  • Vitamin D3. 95% of American adults are deficient in vitamin D. Most of us aren't out in the sun long enough with enough skin exposed to get enough naturally, and while foods are fortified with it, we're still not getting enough. Vitamin D helps with the absorption of other nutrients as well as sleep. (It's also important when you're breastfeeding.) I recommend at least 5000iu. You'd have to take about 40 bottles at once to overdose, and it doesn't store in your system, so you can't take too much without trying.

Is it nap time yet? I thought so.

Happy pooping!

Can I Eat That If I’m Pregnant?

Ok, let's talk happy hour.

By now the newness of pregnancy may be wearing off.

How much reading have you done so far? The self-declared "bible" is What to Expect When You're Expecting. The subtitle should be "Horror Stories to Keep You Up at Night Between Bathroom Trips for the Next Nine Months."

Instead they just call it "America's #1 pregnancy book." Weird choice, but whatever!

I dutifully checked a copy out from the library and started reading, but I didn't even make it through the first trimester. This from someone who sat through the entirety of Battlefield: Earth in the theater.

The conflicting information out there about what you can and can't eat during pregnancy is enough to drive someone to drink - except that's off limits, too!

...Isn't it?

DISCLAIMER! I'm not a medical professional and I'm not saying you SHOULD do anything I say, I'm just telling you what *I* did. Please do what feels comfortable for you based on your research and professional advice, and don't sue me. I'm going to have to feed a teenage boy in a decade or so and need to invest that ish. Thanks!

The most common questions I hear are about alcohol, sushi, and soft cheese.

BOOZE, yay or nay?

blanc de blanc at gloria ferrer
Women in Europe are advised to have only a few drinks a week. Our litigious society in the Land of Malpractice isn't willing to say you can drink, but there's a difference between having a glass of wine and tossing back a 40 of Mickey's in the parking lot.

My husband likes to point out that if drinking any alcohol during pregnancy was harmful, we wouldn't have the French, Italians, Irish, Austrians, Germans, Russians... You get the idea. He also took his duty of "drinking for two" very seriously during my pregnancy.

That said, alcohol smelled and tasted awful to me for most of my gestational tenure. While I wasn't opposed to drinking in principle, it didn't appeal to me in practice anyway. I'm not saying you should take it up, either, but a glass of wine your third trimester can actually help you relax according to some midwives I know.

SAY CHEESE!

boucherondin cheese
Back away from the cheese plate of CERTAIN DEATH. Right?

Listeria bacteria are actually quite common, but pregnancy's immune suppressing qualities make moms-to-be 20 times more susceptible than average to falling ill from exposure. The concern is unpasteurized varieties of cheese, usually soft and blue ones. The irony is that the U.S. outlawed most unpasteurized cheeses that aren't aged for 60 days (figuring that soaking in salt for 2 months will kill off the bacteria) in 1949.

Heat kills the bacteria which is why cold cuts are also at risk, as are coleslaw, hot dogs, and chicken. Cold cuts aren't really doing you any nutritional favors, and listeria would just be the disgusting icing on the salty meat cake. Ewww.

The cheese probably won't hurt you, but there are a lot of alternatives since most cheese isn't a risk.

SUSHI

my favorite homemade sushi roll
Mmm, sushi. First off, "sushi" actually means "vinegar rice," so there are plenty of fish-free options no matter what you decide. The recommendation to avoid uncooked fish apparently stems from concern for a particular parasite found in fish. Specifically found in freshwater fish which aren't used for sushi. This parasite is killed by flash freezing, which is required for all fish (including sushi-grade) that's served in the U.S.

So don't eat sketchy back alley sushi, whether you're pregnant or not. My bigger concern would be avoiding fish with high mercury levels like tuna.

If you're afraid of food poisoning, it's anecdotal, but I know more people who have gotten food poisoning from fast food than from sushi, and no one is saying all pregnant women should avoid Wendy's. Well, that's not true, because I am. Consider yourself warned!

CLICK HERE for my favorite resource of "Things Pregnant Women Supposedly Shouldn't Do" over at Pregnant Chicken.

Wow, that was long.

You should go take a nap.

Congratulations, you’re growing a baby!

Isn't that crazy? And exhausting!

When you first get pregnant, your body kicks into baby-building mode by flooding your system with HCG. I like to think of it as a reverse hormone hangover (the higher your blood alcohol, the bigger the headache; the bigger the spike in hormones - twins, for example - the stronger symptoms you may have).

Did you know less than half of pregnant women experience morning sickness? If you were surprised that you weren't terribly sick, you're not alone. If you WERE terribly sick, you're a special snowflake and it sucks to be you. Sorry!

First up: growing a placenta.

Growing is HARD WORK you guys, that's why kids take naps. And so should you. Resistance is futile, so just cave in now -- you'll feel better, I promise. I was just lucky I work at home because I took 2 naps a day. I even turned down a job offer because it would interfere with my nap schedule. #naps4eva

So! There's a 50/50 chance you're nauseous, you're so tired you can barely sit upright, and now you have to feed yourself?

Well, crap.

A few thoughts on eating during early pregnancy

  1. A puppy dies every time someone says, "You're eating for two!" You are eating for 1, plus a clump of cells the size of a pea which requires no extra calories.
  2. Lightning should strike people who say, "The baby takes what it needs." The baby can't take what's not there, so if you are low on folic acid, so is the baby.
  3. There is no such thing as too much fiber during pregnancy. The same goes for water. True story: I once ate half a watermelon by myself one day when I was pregnant with no deleterious side effects. (Yes, then I took a nap.)

Do I really need to take prenatal vitamins?
As a health coach, I work with clients to get nutrients through whole foods. However, pregnancy is tough and exhaustion can take a toll on your desire and ability to cook. Taking vitamins isn't going to hurt you or the baby, and will probably help. Missing a dose will not cause your child to have webbed toes or something.

My first trimester diet staples were Greek yogurt and cereal because that's all I could tolerate or prepare. Taking a prenatal vitamin reduced my stress about trying to cook. There was also a major heat wave when I was pregnant and Ryan Gosling coming over for a home-cooked meal would not have enticed me to turn on any appliance.

Other ideas for easy, nutrient-rich foods:

  • Fresh fruit has fiber and water - double win! Dried fruit can be high in sugar, but is a great snack combined with nuts for slow-digesting fat and protein.
  • Green juice and green smoothies flood your system with nutrients but don't take much work. Especially if you just grab one at the juice bar. Make sure it's not too fruit-heavy.
  • If you normally cook a lot from scratch, don't feel guilty getting pre-cut fruit and veggies, or getting take out more often. Focus on getting enough protein and iron, then just try to eat as much fiber as possible.
  • Protein can help reduce nausea and fatigue, plus it keeps you full longer. I ate a lot of eggs. If you can only tolerate carbs, at least make them whole grain to prevent spiking your blood sugar.

Many pregnancy books suggest meal plans that are more food than many women want to eat. Your blood volume increases by 50% or more, and dehydration can masquerade as hunger. Drink a metric crap-ton of water (start with half your weight in ounces - so 140 pound woman should drink 70 ounces of water) every day, take your vitamins, and do your best.

Next time: What NOT to eat. ...Or can you?

Now go take a nap. You've earned it.