And how does a doula advocate for you?
When you choose to give birth within the system (through a public or private hospital or one of the homebirth programs), you must be aware that Obstetricians and Midwives will treat you according to the policies of their hospital and state. In South Australia, these are the Perinatal Practice Guidelines, and you can find a link to them at the end of this blog.
The government website states that "The statewide guidelines do not address all the elements of clinical practice and assume that clinicians are responsible for discussing care with consumers in an environment that is culturally appropriate to ensure informed decision-making and individualised care for pregnant women, mothers and their babies.
The emphasis on specific terms is mine. Because although the health departments mention this in their documents, women rarely receive wholly culturally appropriate, individualised care with a real opportunity for informed decision-making.
Let me share some examples.
Is it culturally appropriate care to tell a woman she can not have her placenta straight away for burial because part of a policy says that the hospital must stick it in a fridge for seven days, along with every other placenta born there that week? No.
Is it individualised care for a midwife to tell a woman that the last person she saw with higher blood pressure was induced straight away, so that is what she will need to do also? No.
Has the opportunity for informed decision making been given when a midwife performs a stretch and sweep while doing a cervical exam without asking the woman first? Just because the midwife wanted to "razz things up a bit" No.
Is a decision free from coercion when the unit manager storms into a woman's birth space without introduction, demanding to know why the labouring woman isn't consenting to a suggested course of action? No.
Is it individualised care for a midwife to tell a woman that she will not attend her birth if she doesn't consent to cervical checks, despite knowing the woman has a history of sexual abuse? No.
Has a woman given legally valid consent to have continuous monitoring if the OB only tells her that if she refuses, her baby could suffocate and they won't know about it until it is too late? No.
These aren't made-up scenarios.
My clients have disappointingly experienced them all and I have witnessed the majority of them.
So as your doula, what do I do in these types of situations? How do I advocate for you? It's a question I often get asked.
I know that these are all stressful situations which can interrupt the labour process, so my first action is to remind my client that she isn't alone in this - reassuring her with a touch, eye contact or even a smile to help her settle her nervous system as much as possible.
Depending on the situation and timing of the event, I might also do any of the following:
If you would like to learn more about what informed consent and refusal looks like, you can download the free handout below. Click on the picture to get your pdf and print it out. Hey, you could even take it with you to your appointments if your health professional needs a little reminder =)
Why knowing how you want to feel during childbirth is more important than what type of birth you want.
Vanessa and her family hired me to support them for the birth of their second baby with a planned VBAC (vaginal birth after caesarean).
As part of my prenatal visits with clients, I talk a lot about birth preferences. Birth preferences include what I call "checkbox items". You know, like the boxes you might tick on a form or birth plan template:
However, the birth preferences I want my clients to really focus and work on are how they want to feel during labour and birth and how they want to be treated. Feelings that are important to my clients often include phrases such as calm, respected, not pressured, informed etc.
We can't control (but can influence) how our bodies and our babies work during childbirth but we do have control over our actions and role. We can think about how we want the maternity provider we have chosen to treat us. We can determine the level of responsibility we are ready to claim in decision making and the actions we are willing to take to achieve these goals.
Because when the unpredictability of birth kicks in and clients have to adjust their checkbox items, we can still focus on these feelings and their values.
How can I change my checkbox items from a VBAC to a repeat caesarean while still feeling informed of what is happening to me and my baby, while still feeling respected, while keeping the environment calm and not rushed?
That’s where the magic lays in a positive birth.
"HOW the birth is conducted might be just as important as WHAT you do.... Positive communication and interactions throughout the birthing process significantly affect the woman’s experience, which in turn can affect both her mental and physical health, as well as her relationship with her baby postnatally."
Click here to read the whole article related to the above quote about the
importance of the language used by care providers in birth.
In Vanessa's own words
"I was worried (in fact, super scared) that I would have another birth where I walked away feeling like I didn’t have a very nice birthing experience. Hiring Kelly meant that I could work through many scenarios and know that I could put my mental health first and have others ‘checking in’ on my mental health. So as the birth didn’t end up being as I had planned, I came away from the birth this time in love with my new little human.
The most helpful thing was having someone who knows the system on my side. It was like having a very strong emotional pole to hold onto and to feel grounded the whole time. This was important for me as it meant I could be confident in my choices throughout the process. She was a sounding board throughout the birth.
I found the hospital system and birthing classes just gave a general overview of the birthing process but nothing was customised to me and my birthing situation (what happened the first time). This time around, with Kelly’s help, I felt like I had more knowledge so was able to ask deeper questions and research more to ensure I was happy with what was going on around me.
She was a great support for my partner who felt he had a better understanding of my situation too with both my physical and emotional needs. It’s great to have a professional person to looking out for me mentally and emotionally.
Although my birth didn’t go quite as planned (I was hoping for a VBAC but ended up with a RCS) I came away from the birth in my baby love bubble, something I didn’t experience first time round.
Because of this, Kelly is worth her weight in gold."
Vanessa & Baby Jett - Happy Valley
I have a bunch of books in my office that clients are welcome to borrow. Please let me know if you are interested in reading any of them. I do ask for a $20 fully refundable deposit for any item I lend out just in case they don't come back and I need to replace them =)
Click on the thumbnail to see the full cover and scroll through the other books
Elemental Beginnings - Adelaide Doula Services
Name: Kelly Harper
Services: Birth Planning & Coaching, Private Childbirth Education Classes, Birth Doula
Location: All Adelaide metro & hills locations, Mt Barker, Gawler, Flinders Medical Centre, Women's & Children's Hospital, Lyell McEwin Hospital, Ashford, Burnside, Calvary, North Eastern.
Enlightened Birth and Beyond
Name: Edriana King
Services: The Hypnobirthing Australia Positive Birth Program provides expecting mothers and their birth partners with knowledge, tools, techniques, support and preparation for a more positive birth experience.
Location: Para Hills West
Do Dads Dig Doulas?
During pregnancy and birth, one of the biggest decisions you will need to make is who you are going to have supporting you and present in your birth space. That decision includes the possibility of hiring a doula to provide information, resources, physical comfort and emotional well-being.
Often it is the mums-to-be from around Adelaide who will contact me first. We'll have a bit of a chat and then they'll take some time to discuss it with their partner. Sometimes I'll have a chat with the other parent at the same time and often their questions or concerns centre around what role a doula will play. Will I take over their role? Why do they need a doula if they have a midwife or obstetrician taking care of them? Why should we invest in a doula when I can support my wife myself?
To help answer these great questions, I thought it might be best to hear from those I have worked with so you can get first-hand information. I sent out some interview type questions for Dads to answer to hopefully make things easy for them.
Thanks to Simon for being the first Dad to share his thoughts on hiring Elemental Beginnings as their doula.
1. What were your honest thoughts when Kate first mentioned hiring a doula?
My first thoughts were very positive. I knew a bit about Doulas before we looked further into it.
I knew that Doulas are quite simply an added set of safe hands who have a lot of experience and knowledge with birth, labouring and after birth care. I knew that having a Doula present before/during and after the birth of our son was always going to be valuable source for us.
2. If you had any initial questions or concerns about working with a doula, what were they?
I had no concerns at all. We had an instant connection with Kelly so I (we) knew it was the right thing to do.
3. Could you talk a little about our work together, both during the birth and before and after, from a partner's perspective?
Reassurance was the key. This was the first time I was involved in the birth of a child. I was nervous but with all our preparation I was fairly confident. I was nervous that I was going to do or say the wrong thing, especially in labour. Kelly was gentle, and her presence was always felt. She knew when to be involved and when to step back. Her subtle guidance just reassured me that I too was doing a good job.
4. If your birth didn't quite go to plan, how did having me there or our prenatal sessions make a difference for you?
Our plan/preference was to have a home birth, surrounded by love and support instead of machines, bright lights and interference. The labour was very long (24 hours) and our son was a little stuck by the end of it. My wife’s heart rate was getting higher and higher so the midwives called an ambulance. We always knew that our ‘plan’ might not go perfectly so we were prepared for the hospital.
Having Kelly there, especially after the call was made to go to hospital, made me feel comfortable knowing that this is something that can happen and that everything was going to be ok. She reassured me that this was normal procedure and our midwives had my wife and son's health as their top priority - something that can be forgotten about in the heat of the moment.
5. How would you explain a doula to your best mate?
A Doula is someone who has a lot of experience in childbirth, someone who offers knowledge, comfort and ongoing support with child birth and after care.
6. What is your advice to other dads and partners who may be considering hiring me, now that you've experienced birth with a doula?
My advice is do it. It is a guarantee that someone will be working with you. Someone who has experience, a safe set of hands, and someone who will help you have a memorable and empowering birthing experience.
If you would like to talk to Simon further about his child's birth, he has kindly offered for me to pass on his email address. Just get in contact with me and I can forward you his details. Just click the button below and pop in your details.
Prepare for an easier fourth trimester with these 25 Secrets From A Postnatal Doula!
Kelly Harper is the owner of Elemental Beginnings Doula & Placenta Services in Adelaide. She provides placenta encapsulation and doula services to families during pregnancy, birth and in their fourth trimester.