Oh the decisions!

Some of you hear me talk about our birth plans pretty often, while others of you have no idea what we hope for other than we do indeed plan to have this baby come out of me! Even if you know some of our hopes, they may not make a lot of sense. I throw around words like “midwife,” “doula,” interventions and speak of private childbirth education classes, but what do those things mean and why did we choose them?

I had the opportunity to explain some of this to my brother recently and decided I would do the same for my adoring readers, i.e. the handful of you that are really just waiting for pics of the baby or for Andrew and I to throw in the towel on our never-ending renovation.

To begin, two definitions that will become important if you choose to read further:

midwife: it means “with woman.” There are different designations depending on education and licensing, but I see a group of certified nurse midwives, meaning each has “graduated from one of the advanced education programs accredited by the American College of Nurse Midwifery (ACNM).  In addition, nurse midwives must pass a rigorous national certification exam and meet the strict requirements of the state health agencies (from my care provider’s website).”

So yes, they know what they’re doing, which is  a question I get a lot. There are midwives that work with OB/GYNs in offices and hospitals, those who work in birthing centers and some who attend home births. In Mass, the latter are not under consistent regulation, but hopefully will be in the near future. In Alabama, it’s actually illegal to be a home birth midwife, so many do it under the radar.

I could say more, but in any case, I see CNMs who are very skilled in “catching babies,” and they also perform routine gynecological care.

doula: (from dona.org) “The word "doula" comes from the ancient Greek meaning "a woman who serves" and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.

Studies have shown that when doulas attend birth, labors are shorter with fewer complications, babies are healthier and they breastfeed more easily.”

Another way to think of a doula is a labor support coach. And they don’t catch babies.

So why did I choose a midwife? Mainly because I could. There are several options in my area for having a midwife so I wanted to give it a shot. Also, the nurse who confirmed my pregnancy asked, “What kind of birth do you want?” I said, “natural.” She recommended I definitely choose the midwives in the office, so I did.

The big difference I find in seeing a midwife versus an OB/GYN is that midwives don’t do surgery. OBs are trained surgeons. Many women who are looking to deliver with less medical interventions (these include but are not limited to episiotomy, epidurals/other anesthesia, continuous electronic fetal monitoring, induction) feel they have a better shot of achieving that with a midwife. That’s not saying midwives don’t use interventions—they do. (If a woman wants an epidural, she can certainly still deliver with a midwife.) It’s just that many midwives seem to be more patient and allow a woman’s body to do what it was created to do. The majority will give more time and try more alternative techniques. Some deliveries still end in C-sections. Some don’t. If a woman wants natural childbirth, with a midwife she may be allowed to labor for many, many hours before any interventions are suggested.

I’ve also just done a lot of research on labor and delivery in the last year or more and midwifery is the common practice in not only underdeveloped nations but in developed nations outside of the U.S. In many developed countries, women only deliver with OBs when there is an emergency.

And not to completely open a can of worms here, but through that research I really began to realize I wanted to deliver with the least medical interventions possible. I’ve always wanted natural childbirth, too. In the U.S. the national C-section rate is about 32-33%. The World Health Organization recommends it should be 15% or lower. Through my research (and even looking at birth statistics for various offices/hospitals in my area) I found that cesarean rates are lower with midwives. It all goes back to allowing a woman’s body to take the time it needs to deliver rather than trying to speed things up. Once one intervention is used, a lot of times things spiral from there and more follow. There are appropriate uses of all of the interventions—research just shows that many are used inappropriately in our country. (As my friends here know, I could probably talk about this for hours, so I’ll stop now. I can definitely recommend books and other resources to back all this up, though.)

So why did I choose a doula? To help me work toward having the labor and delivery I desire. A friend of mine in Alabama used one a couple of years ago and found it really helpful when approaching natural childbirth. I know very well that something could wrong with my delivery and it could end in the use of medication or even a cesarean. However, I’m preparing to do it differently. We hired an awesome doula named Lisa Beauchemin who also happens to be a childbirth educator, so she really knows her stuff.

Through our childbirth ed classes and prenatal doula appointments, Andrew and I really feel prepared for what will hopefully be a natural delivery. We’ve not only learned techniques to deal with pain and such, but doulas also help you advocate for yourself once in the hospital. In the heat of the moment, so to speak, you can’t be expected to remember everything, so a doula can remind you of questions to ask your practitioner and things like that. They also attend lots of births so they recognize when certain things may be happening that parents don’t because they aren’t in delivery rooms multiple times a year.

We actually have co-doulas due to some possible scheduling conflicts, but if everything goes well, we’ll have two doulas with us for the birth. Soon I’ll post more about things we’ve learned from our doulas in relation to helping get our baby in the right position for labor…stubborn Baby Floyd needed some help. More on that later.

One other thing we’ve found to be not necessarily essential to working towards our ideal labor and delivery but super helpful is taking our childbirth education classes privately, in our own home. I mentioned that Lisa is also a childbirth educator—she teaches at a local hospital, but she also does private classes. We have loved this option.

I originally looked for it because my Alabama friend who used a doula recommended I take classes outside the hospital since I wanted a natural delivery. I feel like I know so much more from having done private classes. We spend more time on the things Andrew and I need and want to know about while still covering all of the material related to birth. We don’t have to wait while others have their questions answered, and if something doesn’t make sense or we want to know more, it’s just us so there’s plenty of time.

The added bonus: it didn’t cost us anymore to take classes privately than it would have to take them through the hospitals in our area. I would highly recommend it to anyone, regardless of the kind of labor you want.

Before I close out this enormous post, I will say that just because I want a natural birth with zero interventions doesn’t mean I think it’s the right way to go for everyone. I do think it’s important to educate yourself on these things regardless of what you want—you wouldn’t buy a house without an inspection or send your child to a new school district without checking it out, why deliver a baby without knowing all the possible things that could happen?

I do think our country has gone down the wrong road in several ways regarding childbirth, but I also know there are appropriate and needed uses for all of the things I don’t want in my delivery. In addition to mentally preparing for the birth I want, I’m mentally preparing for that to go wrong because no one can predict what will happen once labor starts. I don’t want anyone to break my water, but if all other options have been exhausted and it has to happen, it has to happen. The same for other interventions.

As Andrew continually reminds me: the goal is for mom and baby to come home. Period.