My first birth almost three and a half years ago was an unmedicated vaginal birth in a hospital. We had a doula and everything went well. He was born just under 12 hours from my first contraction which got steadily faster and stronger until he was born.
I'll post more about the process of deciding on a homebirth another time, but this baby was born in our bedroom. I loved birthing at home. I'm also glad I hired Ariel Dolfo Photography to capture our birth since it went by so fast I barely remember it!
My first son was born at 40 weeks and 6 days, so I wasn't in a rush. I didn't feel "ready" yet when my due date rolled around.
Sunday I was 40+4, and the first time I felt like the baby was coming very soon was at 4am when I woke up to a few mild contractions. I didn't bother waking my husband up as they subsided and I went back to sleep.
We got up fairly early and I let him know that I thought "today is the day." (more…)
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.
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.
“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!)
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.)
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
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
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.
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
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
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).
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
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!