Woman of Valor Birth Services

Megan Othling - Albuquerque Doula

Responding to Labor Pain: What Are Your Options, Part III

This is the third part to my series about responding to pain in labor. This time I will be focusing on what you can do if you are for some reason confined to the bed, but still desire to have an unmedicated labor and birth. I will also include a couple of options I left out in Part II of the series. 

In some cases, for one reason or another, you might not be able to utilize comfort measures such as movement or hydrotherapy. If, for example you have been induced due to high blood pressure, your care provider will likely want you to have continuous fetal monitoring. You may also be given magnesium sulfate, which can cause dizziness and muscle weakness, which would make it unsafe for you to be up and around. 

So, if this is the case for you and you would still like to avoid pharmaceutical options, what can you do? Many of the non-pharmaceutical options I wrote about in Part II can still be used. Relaxation techniques such as meditation and prayer, visualization, self-hypnosis, and patterned breathing can be done in the bed. Some rebozo techniques for relaxation can also be used. Vocalization, massage, and some counter-pressure can also be used. 

Movement can be a little bit more tricky. You obviously cannot walk around or dance if you are confined to the bed. You can, however, switch which side you are lying on. You can use an inflatable peanut-shaped ball between your legs to help open your hips. You may be able to be on your hands and knees or even squat on the bed, depending on hospital policy and depending on the reason you are having to stay in the bed. There are also certain rebozo techniques that your partner and doula or nurse or other support person can do while you are in the bed that move you. One of these is called the Manteada, which is a rocking or sifting motion. A rebozo can be placed under your bottom and two people stand on either side of the bed, holding on to the ends of the rebozo and shifting your hips back and forth. This can provide relief and relaxation and the benefits of movement. 

Another comfort measure that can be used it acupressure. Acupressure is applying pressure to certain points on the body to relieve tension or pain. This can be used whether you are able to leave the bed or not. It works in much the same way as acupuncture, but uses fingers instead of needles. Speaking of acupuncture, depending on hospital policy and your local resources, acupuncture could also be an option for relieving pain.

If hospital policy allows, and you have access to a chiropractor who will come to your place of birth, chiropractic adjustment during labor can be helpful for dealing with pain and also for helping baby get into an optimal position for labor to progress well. 

Application of hot or cold packs can also help alleviate pain whether or not you are able to move around. Heat of cold on the lower back during a contraction can bring comfort to some mothers. 

Another option that may be available in some hospitals is sterile water injections. This method is most effective for the relief of the pain associated with back labor. Sterile water can be injected under the skin into four places on the woman’s sacrum. The injection causes an intense burning sensation, lasting 30-90 seconds. This intense pain causes a confusion in the pain centers in the brain, and after the burning sensation wears off, women often feel a complete relief of back labor pain for about 3 hours. The procedure can then be repeated. Again, this method can be used whether or not you need to stay in the bed. 

I hope that this series has been a helpful discussion of the different options you may have for responding to the pain of labor and birth, regardless of your birth plans or circumstances. 

 

 

 

Responding to Labor Pain: What Are Your Options? Part II

In the last blog post, we discussed the different pharmaceutical pain relief options you might have available to you in labor. This time we will focus on options that do not involve medications. Most likely, you will labor for some amount of time before having access to pharmaceutical options so it is a good idea to think about implementing some of these responses to labor pain, even if you are planning to choose to use medication later in your labor.  You may also find that some methods will be helpful during one point in your labor, and will no longer work as effectively at a different time, or you might want to combine two or more of them at the same time. So you may benefit from looking into a variety of these options so you can switch around and find what works for you in the moment. 

I won't go into specific risks with each option this time because the major disadvantage of non-pharmaceutical options is that none of them will completely take away the pain. But many of them might help you cope with it without any of the risks associated with the medications. So here we go.

  • Relaxation: Tension and fear accentuate the perception of pain. So if you are able to relax your mind and body into the work you are doing instead of fighting against it, you will perceive the pain less. Relaxation encourages effective breathing. This, of course, increases the amount of oxygen in your body and helps the the contractions of the uterus to be more efficient. It can also increase the level of endorphins in your body, thereby lessening your perception of pain.

There are several types of relaxation including visualization techniques, meditation or prayer, self-hypnosis, focusing on breathing patterns, and focusing on your baby.

Visualization can be anything that helps you to let go and think positively about the work your body is doing. Some people like to envision a flower, slowly blooming and opening with each contraction. Some prefer to visualize their cervix opening and the baby moving down through the pelvis as they breathe through contractions. Think of things that you can visualize that help you relax now and how you might be able to adapt them to labor. Meditation can mean having your partner or doula talk you through a guided meditation or repeating a mantra that is helpful to you. You could pray throughout contractions or between them or have your partner pray aloud for you. There are a couple of hypnosis based programs that have been helpful for many women. These include Hypnobirthing, Hypnobabies, and Blissborn. Focusing on your breath can be a helpful relaxation technique, and can also be used in conjunction with any other response to pain. Deep breathing, patterned breathing, and focusing on your out breath are some basic breathing techniques. 

  • Vocalization: Vocalization is exactly what it sounds like -- using sound to diminish tension. This can include things like yelling, groaning, singing, moaning, humming, chanting or even cursing. Think about what you automatically do when you stub your toe or bump your head. You vocalize! There's a reason this is an instinct we have when we are in pain. Vocalizing encourages effective breathing. It can also actually help you dilate more effectively because opening and relaxing the jaw and throat can also help open the cervix. You can choose to make noise in a positive way, saying, "I can" or "yes" instead of "I can't" or "no." What you say and think about what your body can do can actually change what your body is capable of. On the other hand, simply repeating a curse word might end up relieving more tension than a positive mantra. Know yourself and allow yourself to feel free to do whatever you need to do during your labor.
  • Movement: Sometimes movement and staying in upright positions during labor is referred to as "active birth." This simply means being free to move around as your body dictates and using different postures and gravity to help the baby get into a good position and move down through the pelvis. It is based on the idea that if you are able to listen to your body and get into a position in which you feel more comfortable, you will be more relaxed, perceive less pain, and birth more smoothly. This method can allow you to feel some sense of control over your labor. Gravity helps the baby descend and can sometimes shorten labor. Moving around can help with back labor and can help baby move into a more optimal position. Staying off your back can also increase oxygen flow to the baby, decreasing the risk of fetal distress. Movement can include many things, such as swaying, walking, dancing, or even bouncing on a birth ball. Upright positions can include sitting on a birth ball, squatting, hanging on your partner's neck, being on hands and knees, etc. 
  • Massage: Some women find massage helpful during different points in their labor. Having your partner or doula rub your back, shoulders, face, hands, belly, legs or feet can help you to relax and focus on the positive physical sensations rather than just the pain. Massage reduces tension and increases endorphin levels, especially if the person massaging you is your partner -- someone with whom you have a relationship and history. 
  • Hydrotherapy: Hydrotherapy just means using water to relieve pain during labor. Depending on where you give birth, and what their policies are, you can soak in the tub or sit or stand in the shower. If the tub is large enough you can use upright positions such as hands and knees or squatting as long as you are well supported. In the shower, you might want your partner to get in with you, or make sure you have something to sit on or hold on to. Some hospitals or birth centers have regulations against giving birth in the tub, while others do not. Water helps in relaxation and can alleviate some of the pressure you might feel during contractions, as the baby descends, and during pushing. Hydrotherapy might lower your blood pressure if it is too high, and can reduce stress levels. For some women the relaxation that they are able to find in the water lets the cervix dilate more quickly, therefore shortening the first stage of labor. On the other hand, during some labors the water can relax a woman so much that her labor slows down. It is always important to listen to your body and see how it is responding to what you are doing.
  • Rebozo Techniques: Using a rebozo in labor can help in many ways. A rebozo is a long, woven traditional Mexican scarf. It has a rich history, and has been used by midwives in Mexico for centuries. There are many rebozo techniques that can help you relax, connect with your partner, relieve pressure on your back, and help give you leverage while laboring in upright positions. If you have a rebozo certified doula or childbirth educator she can share with you some techniques to practice during pregnancy that could become your go-to methods during labor.
  • Oxytocin: So this isn't really a pain-relief method, but it is one of your best friends throughout labor and birth. Oxytocin is also known as the "love hormone." It is the hormone released by our bodies during orgasm, is the main hormone responsible for labor contractions, and is released during breastfeeding. It aides in bonding in our human relationships. Any time you are able to feel safe, relaxed, and connected to the people you love, oxytocin will flow more freely. Natural oxytocin (as opposed to pitocin, which is synthetic oxytocin and does not work in exactly the same way) increases endorphin levels, thereby reducing pain perception. There are a few simple ways to make oxytocin feel more welcome in your body and your birth. Dimming the lights increases melatonin levels, and melatonin can increase and work with oxytocin. Surrounding yourself with people who make you feel safe and comfortable and being in an environment in which you feel safe can allow oxytocin to flow more freely. Adrenaline blocks oxytocin, so anything that increases stress or creates a "flight or fight" response will decrease oxytocin. Unfortunately, some of these things are not always under our control. The best way to increase oxytocin is to connect with someone you love or feel safe with. For women who have partners, being near them, cuddling, feeling their touch, hearing their voice, looking into their eyes, even kissing during labor, can all help create a feeling of safety and bonding and increase oxytocin! 

There are many things to be said about the purpose of labor pain and how it is different from other kinds of pain, and about the important role that hormones play in labor. But those are for other posts. I hope this has been a helpful discussion of some of your different options for responding to pain during labor. 

Responding to Labor Pain: What Are Your Options? Part I

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Probably the biggest thing looming in the minds of most pregnant women when they think about their upcoming labor is pain. This can be a touchy subject. Some people feel very strongly that using pharmaceutical pain relief in labor and birth is unnecessary and unwise. Others liken the refusal of medication to insisting on getting a root canal without pain relief -- i.e. why torture yourself? This is NOT going to be a discussion of which view is "right" or "wrong." Every woman and every birth is different, and there are many factors that go into the decision about whether or not to use pharmaceutical pain relief. What I want to do here is outline the different options you may have for responding to the sensations of labor and birth, and provide information about the risks and benefits of each option. This is such a big topic, so I'm going to break it up into two blog posts.

The first, sometimes only, thing that comes to mind for most people when it comes to pain relief in labor is the epidural. It seems that many think their choice is either to get an epidural or to do nothing and just "tough it out." In fact, there are several options for responding to the pain of labor. All of these options may not be available at your place of birth, but I will highlight some common ones. Please note that I am not intending to give medical advice or to sway readers in one direction or another. I just want to provide a detailed list of the risks and benefits of each option.

Pain relief options fall into two major categories: pharmaceutical and non-pharmaceutical. In this post we will talk about the pharmaceutical options.

  • Epidurals: The most famous of all labor pain relief options, an epidural is a local anesthetic (meaning it only affects part of the body, not the entire body). It is inserted into the epidural space near the spine, and it works by blocking the the transmission of nerve impulses. The injection is usually made up of local anesthetics such as bupivacaine, chloroprocaine, or marcaine. These drugs may be combined with narcotics like fentanyl or sufentanil so that the anesthesiologist can reduce the amount of local anesthetic being used so that the side effects of the epidural will be lessened. Sometimes the local anesthetics are combined with morphine, epinephrine, or clonidine to allow the epidural to last for longer or to stabilize your blood pressure.

Benefits: The epidural often gives complete relief of pain, although sometimes it will only numb one side of the body, meaning you could have areas where you feel the full effect of contractions. If you have high blood pressure, an epidural could be helpful because one of the side effects is that is lowers blood pressure. If you are having a hard time relaxing or are feeling very tense, an epidural might give you the relief you need to relax enough for your cervix to begin to dilate. If you are exhausted from a long labor, getting an epidural might allow you to sleep for a little while so that you have enough energy to face the rest of your labor. If you are giving birth via a cesarean, having an epidural is safer than going under general anesthesia (being unconscious), and it allows you to hold your baby immediately after birth in most cases. 

Risks: There are several common, short-term risks and some risks that are more rare associated with epidurals. We'll start with the more common risks. Epidurals often lower the blood pressure. They can cause a fever, nausea, vomiting, and/or uncontrollable shivering. Having an epidural can cause your labor to last longer. Epidurals can cause generalized skin itching, and sometimes cause a ringing in the ears. Some mothers report feelings of emotional detachment, and sometimes they just don't work all the way or at all. There are some more severe risks, which are far more rare. These include respiratory difficulties, convulsions, toxic drug reactions, slight to severe headache, septic meningitis, allergic shock, and cardiac arrest. There are also a few risks to the baby including sleepiness at birth, which can make the baby less eager to breastfeed. If you get a fever after getting the epidural, there is no way of knowing for sure if the fever was from the medication or the result of an infection. Because of this, your baby may be given antibiotics and be subjected to testing to make sure he or she does not also have an infection. The medication in the epidural can cause poor muscle tone in the baby in the first few hours, and difficulty with breastfeeding because of poor sucking reflex. It can also increase the chances of jaundice in the baby. An epidural also increases the possibility of an assisted delivery using forceps or a vacuum because it reduces the tone of the pelvic floor muscles.

  • Spinal and Caudal Blocks: Spinal and caudal blocks are very similar to epidurals. The main difference between spinal and caudal blocks and epidurals is the area of the spinal column that the needle is inserted into. A spinal block is placed into the subarachnoid space, beneath the epidural space. A caudal block is injected into the caudal canal at the base of the spine, close to the sacrum. The risks and benefits are similar to those of an epidural.
  • Narcotics: Narcotics commonly used for labor include stadol or demerol, diamorphine, nubain, and meptid. All of these work similarly to morphine. They are given through an IV or as an intramuscular injection and they block opioid receptors in the body, preventing the transmission of pain messages to the brain. They affect the entire body.

Benefits: The use of narcotics can give you a chance to rest if your labor has been exceptionally long, and you are exhausted. If you're having a hard time letting go of tension, this could relax you and allow labor to speed up later. 

Risks: Narcotics cause your stomach to empty more slowly. This may increase the risk of aspiration of the contents of the stomach if you go on to go under general anesthesia. It might make you feel nauseated, out of control, and unable to communicate. For some mothers, the medication does not actually relieve the pain, or it causes them to sleep for the first part of a contraction, and then woken up aware of the pain at the peak of each contraction. It could slow your breathing, resulting in less oxygen in your blood. Also, if you decide you don't like the way the drugs make you feel, the effects cannot be turned off; you just have to wait until it wears off. Your baby could be sleepy after birth and have a hard time breastfeeding and/or be especially fussy in the first few days. Narcotics cross the placenta and take awhile for the baby to metabolize. The can cause the baby to be born with breathing troubles. There is an antidote called Narcan that can be given to the baby to help with respiratory problems, but this does not stay in the baby's system as long as the narcotic does, so when it wears off, the baby may start having trouble breathing again. There is also a higher risk of jaundice in babies whose mothers have had narcotics in labor.

  • Pudendal Block: A pudendal block is a local anesthetic that is injected into the pudendal nerve, which is in the vagina. It numbs the vagina and perineum, but does not affect the pain of contractions. They are most often administered right before the pushing stage. There are no significant risks or benefits.
  • Entonox: Entonox is a combination of nitrous oxide and oxygen. You can administer it yourself by breathing in through a facemask or small plastic tube. It begins working right away and gives a feeling of separation from the pain. This effect wears off a few seconds after you stop inhaling the medication. It does cross the placenta, but it metabolizes very quickly, and there are no known risks to the baby. 

Benefits: You, the mother, can be in complete control of when and how often you inhale the medication. It can lessen the intensity of the pain, but not leave you with a feeling of being out of control. 

Risks: Some women experience nausea and vomiting as a result of entonox.

Whew! I know that was a lot of information, but I hope that at least some of it will be helpful as you make decisions regarding how you will respond to be sensations of labor and birth. Next, we will take a detailed look at non-pharmaceutical methods of pain management. 

Why You Might Want to Consider Creating a Postpartum Plan

Most pregnant women know the term “birth plan.” Many women and their partners research and consult with their friends, families and care providers for months, honing the details of what they will write in their birth plan -- what their ideal birth experience will look like. The birth of a child is a life-changing experience, and the way a woman is treated while giving birth can affect her physically, emotionally, and spiritually for the rest of her life. So knowing our preferences before giving birth (as a birth doula I hesitate to use the word “plan” because you cannot plan birth, though you can prepare for it) is very important. It is good for parents to know what coping mechanisms, interventions, medications, etc. they are and are not comfortable with before labor begins, so that when it comes time to make a decision, they are informed and prepared. But something that I believe is equally important, and often neglected, is thinking about what life will be like after the baby arrives. What happens when you come home from the hospital or birth center, or when the midwives pack up and leave and you’re left to begin navigating life with this new little creature?

Our culture is so wrapped up in the idea of “bouncing back” that many mothers don’t give themselves time or permission to truly recover from the amazing and beautiful, but really hard work of giving birth. We want to be seen as strong and selfless, so we get out of bed and greet visitors, and try to keep up with dishes. We start exercising right at six weeks because that’s the arbitrary time-frame we’re given to be “ready,” and we’ve got to fit back in those pre-pregnancy jeans. The internet is full of articles praising the newest celebrity to give birth and get right back on the runway or behind the camera looking as glamorous as ever. I believe we are not made to bounce, especially after bringing new life into the world. We are made to sit or lie down and feed our babies and smell their heads and sleep and be fed. In other cultures, the idea of caring for a new mom and allowing her the time and space to truly recover and bond with her new baby is something that is built in.

Unfortunately, we are not always surrounded by family who are able and willing to help, or we have no choice but to return to work very soon after giving birth. Self-care as a mother is not going to just happen, so it helps to make a plan. Most of us no longer live in that “village” that would come together to care for each other. So we have to build our own.

So what might be part of your postpartum plan? The guiding principle, I believe, should be gentleness. Be gentle with yourself as you imagine how soon you will be able to receive visitors. Be gentle with yourself as you imagine how long it will really take you to get back to housework or exercise. And most of all be gentle with yourself if it turns out you’re not able to do what you thought you would be able to. Practically, here are some steps for creating a postpartum plan:

  • Sit down before your baby arrives and talk with your partner, or whoever you might have around for support, about what kinds of household duties he or she will be responsible for and what they expect you to be able to do. If their expectations don’t line up with what you think is realistic, talk about that.
  • Don’t be afraid to say “no” to people. If people want to visit and you don’t feel up for it, be honest. If you feel your baby is being passed around from grandparent to aunt to grandparent to cousin too much, feel free to remind them that this could be overstimulating for the baby or simply that you are ready to have the baby back in your own arms. Most people will not be offended.

  • Consider setting up a meal service where friends and family can sign up to provide meals for your family for a few weeks after the baby is born. If you truly don’t have friends and family nearby, consider stocking your freezer with pre-prepared meals or setting aside room in the budget for ordering takeout once or twice a week.

  • If you have a partner who will not be able to take time off work, think about what kind of support you could have in place during those first weeks. Or if your partner will have to return to work after a couple weeks, who can you have to help you when that happens? If you have the resources, a postpartum doula can be a great help. If not, consider asking a friend or family member to pop in every couple days and tidy up or do the dishes or clean the bathroom or make a meal. People want to help; they often just don’t know how or don’t want to intrude.

  • Think about what kinds of things you need each day in order to “feel like a person.” Do you need to have a cup of tea or coffee? Do you need time to shower? Time set aside for prayer or meditation? Think about the things that you need now in order to not feel “on edge.” Talk to your partner or support person about how to make sure you are able to get those things after the baby is born. Sometimes this can be just a matter of a mother feeling that she has permission (from herself and her supporters) to ask for that time.

  • If you have to return to work right away, is there some way that you can schedule more rest into your time while at home? Again, try forgetting about housework and cooking, realizing that this is just a season and that your most important work is caring for your and your baby’s immediate physical and emotional needs.

  • Don’t forget about your partner! Your partner did not go through the physical process of giving birth, but he or she did undergo a transformation. Partner also lose sleep and have emotional changes to process. Make sure you are both listening to each other so that you can both get what you need to feel human and to be able to parent well. Both of you might not get everything you want or need every day, but if you are practicing listening to each other, you will probably both feel more refreshed and strengthened.

  • And again, remember gentleness -- gentleness with yourself, gentleness with your baby (he or she has gone through a lot and also has a lot of learning to do in these first months and years), and gentleness with your partner. Be sure that you have permission from yourself and those around you to say how you’re feeling and what you need, even if those needs are different from what you expected or are different from what they were yesterday.

Remember that the postpartum period is not over after six weeks. You might not even feel ready to get back to “normal” life after the end of the fourth trimester (the first three months of your baby’s life). So don’t be afraid to get the rest and help you need for as long as you need it. I hope these have been helpful thoughts as you consider how to care for yourself and baby.

 

Why Choose Independent Childbirth Preparation Classes?

When you are pregnant you are faced with so many choices. What care provider will you see? Where will you choose to give birth? What will you name the baby? What kind of stroller should you get? The questions go on and on. It can be pretty overwhelming. So if you choose to take childbirth preparation classes, it can be tempting to just choose whatever is offered by your hospital or care provider. After all, that's one less decision you have to make. But I'd like to offer a few reasons you might like to consider taking a class taught by an independent childbirth educator -- one who is not employed or sponsored by a hospital.

  1. An independent educator does not have to conform to hospital policies. Since we are not associated with a specific hospital, we can teach you in an unbiased way. Independent childbirth preparation classes are focused on preparing parents to navigate pregnancy, labor, and birth in the way that is best for them, not in the way that is most convenient for the hospital staff. The goal is to inform parents, not to protect the hospital or to tell you what the hospital policies will "allow" you to do.  In these classes you will not just be taught how to be a "good patient," but rather given tools to take ownership of your birth and remember that your care providers are employed by you.
  2. You will learn about more options. My goal as a doula and childbirth educator in Albuquerque, New Mexico is to give evidence based information about all of the options in childbirth. For example, if we are talking about comfort measures, parents will be presented with methods including pharmaceutical and non-pharmaceutical. We will talk about what to do at home before it is time to go to the hospital or birth center (or before your midwife arrives at your home). What kinds of things can your partner do to help you relax? What are the risks and benefits of all of the methods of pain relief? And what is the purpose of pain in labor in the first place?
  3. An independent class can provide more a more personal touch. Pregnancy and birth are normal, but they are certainly not the same for everyone. Your experience will be as unique as you are. With small class sizes, an independent educator is able to teach to your individual needs, and may be more available for questions and discussion outside of class. 
  4. The focus is not just on having a healthy mom and baby at the end. As a childbirth educator, I realize that while everyone wants a healthy outcome for mother and baby, that is not all that pregnancy and birth is about. There is value in the entire process, and there is great value in knowing that you as mother and partner have been truly seen and cared for through every step of the process. Health matters, but so does respect. Health matters, but so does taking ownership of your choices. And birth is not just about bringing a baby into the world. It is about the creation of a family, whether that family is a single mother, or a mother and her partner. So my classes don't focus just on mother and baby, but on preparing and listening to the partner as well. The focus is holistic, not merely clinical. 
  5. An independent class can give you the tools to craft your individual birth preferences. In my classes you will not be given a pre-typed template for you to fill out to express your birth preferences. Instead, you will be given information on as many options as possible so that you can decide what you want, remembering that you can prepare for birth, but you can't predict it. You will be shown your options so that you can decide what is most important to you or you and your partner. 
  6. Childbirth educators are obsessed with birth. We really are. And we are obsessed with giving women and their partners the best information. 

Now, of course, this is not meant to badmouth childbirth education sponsored by hospitals. They will offer a lot of information, and it might be the right fit for you. These are just things to consider when making this decision. And there are many independent classes to choose from. Some focus on unmedicated birth, some offer education on hypnobirthing, some are partner focused and others are not. There are early pregnancy classes and classes focused strictly on birth. Do your research and choose what is best for you!

What is a Doula, and Do You Need One?

As soon as you announce that you are pregnant, people will start giving you advice. Some of this is welcome and helpful, and some is neither. One piece of advice you might get is, "You have to hire a doula!" If you're just entering the world of pregnancy and birth, you might have only a vague idea of what a doula is. So before you decide whether or not to heed this advice, let's talk about what a doula is.

Many people think the word "doula" is interchangeable with the word "midwife." These two professions actually provide distinctly different services. A midwife is a person trained to care for women throughout their pregnancies, and to attend women during their labors and catch their babies. Midwives monitor the mother and baby's physical health -- checking blood pressure, checking the baby's heart rate, measuring the mother's belly, etc. During labor the midwife might check the dilation of the mother's cervix (if the mother wants her to), and will most likely be the one to catch the baby when it is delivered. She will cut the baby's cord after a few minutes, assist in the delivery of the placenta, and make sure the mother and baby are still in good health after the delivery. A doula will do none of those things. 

A doula does not do anything that is considered medical or clinical. She (usually, doulas are women, but not always) does not offer medical advice to her clients. Instead, she offers informational, emotional, and physical support to the pregnant woman and her partner, if she has a partner. 

So that's the short answer to the question, "What is a doula." But why, as your friend might say, do you have to have a doula at your birth? This answer might surprise you coming from me, a doula in Albuquerque New Mexico, but I don't believe that you need a doula. I believe that you are completely capable of birthing your baby on your own. You are strong and you have intuition. I believe that if you have a partner, there is no better person to support you during this transition into parenthood. No one can bring you more comfort than the person with whom you have chosen to share your life. But there are some things that a doula does that can be very valuable.

As a doula, I have had education and experience in pregnancy, labor, and birth. I can provide you with evidence based research so that you can make your own informed decisions. And I can remind you that everything actually is your decision. During our prenatal appointments I can show you and your partner techniques to help with relaxation during labor and birth. I can help you think about your preferences for your birth, and remind you of those choices during labor. I will never speak for you, but I will do my best to remind you of your strong voice when it comes to your prenatal care and birth preferences. And I can walk with you as you navigate the things that might be causing fear or tension regarding your birth. 

During your labor, I can remind you and your partner of the comfort measures we have practiced. I can help with the transition from home to hospital or birth center (if you choose to birth in one of those places; I also attend home births). I can help with counter pressure or massage, especially if your partner needs a break. I can get you or your partner water or food. I am there to think about all of these practical needs so you can focus on bringing your baby into the world. I will be there to listen to you if there are things you need to process. And I can be a consistent, safe presence for both parents during a time when things might be unpredictable. 

Immediately after birth I can help provide boundaries for friends and family if you want to be alone with your new baby for a little while before welcoming visitors. I can provide assistance with breastfeeding, if you choose to nurse your baby. And I will be there a few days after the birth to check in and make sure you, your partner, and your baby are adjusting well to your new rhythm of life. 

Perhaps the most valuable thing I offer as a doula is that I support your choices without judgment and without my own agenda. I am there to make sure that you and your partner are respected, listened to, and supported no matter your choices, and no matter the outcome of your birth. The only goals I have for your birth are your own goals. 

Now that you know what a doula is, the question isn't do you need a doula, but do you want a doula? Does this sound like a valuable addition to your birth team?