Chapter 59.Birth Partners Chapter Contents.Section 59.1-Labor Tips for Fathers and Birth Partners ...... 480 Section 59.2-Having a Doula: Is It Right for You? ................. 482 479.

Pregnancy and Birth Sourcebook, Third Edition Section 59.1 Labor Tips for Fathers and Birth Partners "A Birth Partner Cheat Sheet,"

2009 Lamaze International. All Rights Reserved.

Reprinted with permission.

Uncertain about your role as a birth partner? Follow these nine easy guidelines.

Support is a key element to a woman having a positive birth and postpartum experience. As a birth partner, identify the resources you have for informational, emotional, and physical backup early on.

As you learn more about the process of birth, you will discover your strengths in offering support, and you can decide how you want to contribute to the birth of this child. Will you be the primary support, work more with the other team members, or be by the mother's side with your full love and support while others do the hands-on work? A birth partner can serve in any manner that helps the laboring woman, so be comfortable, even joyful, in whatever role you both agree upon.

Whether you decide to actively work with the mother or just shower her with love, simply being present makes a difference.

The birth partner is usually the one member of the team who best knows her desires and can interpret her cues and express her wishes to others. Your personal history with the laboring woman is something the rest of the team doesn't have.

In order to care for a mother in labor, you must also care for yourself. Eating and drinking during labor will give you the energy you need. Wear comfortable clothes and let the doula or nurse care for your partner while you take an occasional break.

Ask questions. Unless you are birthing at home, you are in an unfamiliar setting surrounded by unfamiliar people. A doula can 480 Birth Partners help you get the attention of the health-care provider so that you are heard.

Be prepared to experience some strong emotions. Often, a birth partner is so absorbed in supporting the mother and remaining strong that he or she is surprised by the powerful feelings of love and awe that accompany seeing this incredible woman go through birth.

You and the mother may have the most familiar voices to the infant. When you talk to the baby, he experiences a feeling of calmness that has a positive effect on his transition to the outside world. Stroking him will also reduce stress hormones and improve his breathing and temperature regulation.

The postpartum period is a mix of joyous and difficult mo- ments. The unpredictability of each day and getting to know your baby can sometimes make for a challenging situation.

After the excitement of birth dies down a bit, enjoy quiet time with the mother and baby, and delight in the miracle of birth and the part you played.

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Pregnancy and Birth Sourcebook, Third Edition Section 59.2 Having a Doula: Is It Right for You?

"Frequently Asked Questions About Birth Doulas,"

2005 DONA International (www.dona.org).

Reprinted with permission.

What is a birth doula?

A birth doula is a person trained and experienced in childbirth who provides continuous physical, emotional, and informational support to the mother before, during, and just after childbirth.

Where does the word "doula" come from?

The word "doula" comes from ancient Greek, meaning "Woman's servant." Throughout history and in much of the world today, a cadre of women support a woman through labor and birth, giving back rubs and providing continuous emotional support. Like their historical counterparts, DONA International birth doulas know how to help a woman in labor feel better. However, today's doulas are much more diverse than their predecessors. DONA International membership includes men and women from a wide range of ages and cultural backgrounds.

What effects does the presence of a doula have on birth outcomes?

Numerous clinical studies have found that a doula's presence at birth: * tends to result in shorter labors with fewer complications; * reduces negative feelings about one's childbirth experience; * reduces the need for Pitocin (a labor-inducing drug), forceps, or vacuum extraction; 482.

Birth Partners * reduces the requests for pain medication and epidurals, as well as the incidence of cesareans.

What effects does the presence of a doula have on the mother?

When a doula is present during and after childbirth, women report greater satisfaction with their birth experience, make more positive a.s.sessments of their babies, have fewer cesareans and requests for medical intervention, and less postpartum depression.

What effects do the presence of doulas have on babies?

Studies have shown that babies born with doulas present tend to have shorter hospital stays with fewer admissions to special care nurseries, breastfeed more easily, and have more affectionate mothers in the postpartum period.

How can I find a doula in my area?

Use DONA International's online doula locator [http://www.dona .org/mothers/find_a_doula.php].

How do doulas practice?

Doulas practice in three ways: privately hired directly by clients, as hospital employees, and as volunteers in community or hospital programs.

Does a doula replace nursing staff?

No. Doulas do not replace nurses or other medical staff. Doulas do not perform clinical or medical tasks such as taking blood pressure or temperature, monitoring fetal heart rate, doing v.a.g.i.n.al examinations, or providing postpartum clinical care. They are there to comfort and support the mother and to enhance communication between the mother and medical professionals.

Does a doula make decisions on my behalf?

A doula does not make decisions for clients or intervene in their clinical care. She provides informational and emotional support, while respecting a woman's decisions.

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Pregnancy and Birth Sourcebook, Third Edition Will a doula make my partner feel unnecessary?

No, a doula is supportive to both the mother and her partner, and plays a crucial role in helping a partner become involved in the birth to the extent he/she feels comfortable.

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Chapter 60.Birth Plans In the happy haze of early pregnancy, you're probably already thinking of baby names and planning to shop for baby clothes. The reality of labor and birth may seem extremely far off-which makes this the perfect time to start planning for the arrival of your baby by creating a birth plan that details your wishes.

What's a Birth Plan?

The term birth plan can actually be misleading-it's less an exact plan than a list of preferences. In fact, the goal of a birth plan isn't for you and your partner to determine exactly how the birth of your child will occur-because labor involves so many variables, you can't predict exactly what will happen. A birth plan does, however, help you to realize what's most important to you in the birth of your baby.

While completing a birth plan, you'll be learning about, exploring, and understanding your labor and birthing options well before the birth of your child. Not only will this improve your communication with the people who'll be helping during your delivery, it also means you won't have to explain your preferences right at the moment when you're least in the mood for conversation-during labor itself.

"Birth Plans," February 2008, reprinted with permission from www.kidshealth .org. Copyright 2008 The Nemours Foundation. This information was provided by KidsHealth, one of the largest resources online for medically reviewed health information written for parents, kids, and teens. For more articles like this one, visit www.KidsHealth.org, or www.TeensHealth.org.

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Pregnancy and Birth Sourcebook, Third Edition A birth plan isn't a binding agreement-it's just a guideline. Your doctor or health care provider may know, from having seen you throughout the pregnancy, what you do and don't want. Also, if you go into labor when there's an on-call doctor who you don't know well, a well thought-out birth plan can help you communicate your goals and wishes to the people helping you with the labor and delivery.

What Questions Does a Birth Plan Answer?

A birth plan typically covers three major areas: 1. What are your wishes during a normal labor and delivery?

These range from how you want to handle pain relief to enemas and fetal monitoring. Think about the environment in which you want to have your baby, who you want to have there, and what birthing positions you plan to use.

2. How are you hoping for your baby to be treated immedi- ately after and for the first few days after birth?

Do you want the baby's cord to be cut by your partner? If possible, do you want your baby placed on your stomach immediately after birth? Do you want to feed the baby immediately? Will you breastfeed or bottle-feed? Where will the baby sleep-next to you or in the nursery? Hospitals have widely varying policies for the care of newborns- if you choose to have your baby in a hospital, you'll want to know what these are and how they match what you're looking for.

3. What do you want to happen in the case of unexpected events?

No one wants to think about something going wrong, but if it does, it's better to have thought about your options in advance. Since some women need cesarean sections (C-sections), your birth plan should probably cover your wishes in the event that your labor takes an unexpected turn. You might also want to think about other possible complications, such as premature birth.

Factors to Consider Before you make decisions about each of your birthing options, you'll want to talk with your health care provider and tour the hospital or birthing center where you plan to have your baby.

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Birth Plans You may find that your obstetrician, nurse-midwife, or the facility where they admit patients already has birth-plan forms that you can fill out. If this is the case, you can use the form as a guideline for asking questions about how women in their care are routinely treated.

If their responses are not what you're hoping for, you might want to look for a health provider or facility that better matches your goals.

And it's important to be flexible-if you know one aspect of your birthing plan won't be met, be sure to weigh that aspect against your other wishes. If your options are limited because of insurance, cost, or geography, focus on one or two areas that are really important to you. In the areas where your thinking doesn't agree with that of your doctor or nurse-midwife, ask why he or she usually does things a certain way and listen to the answers before you make up your mind.

There may be important reasons why a doctor believes some birth options are better than others.

Finally, you should find out if there are things about your pregnancy that might prevent certain choices. For example, if your pregnancy is considered high risk because of your age, health, or problems during previous pregnancies, your health care provider may advise against some of your birthing wishes. You'll want to discuss, and consider, this information when thinking about your options.

What Are Your Birthing Options?

In creating your plan, you're likely to have choices in the following areas: Where to have the baby: Most women still give birth in the hospital. However, most are no longer confined to a cold, sterile maternity ward. Find out if your hospital practices family-centered care. Most women still give birth in the hospital. However, most are no longer confined to a cold, sterile maternity ward. Find out if your hospital practices family-centered care.

This usually means the patient rooms will have a door, furnishings, a private bathroom, and enough s.p.a.ce to accommodate a family, including the baby's crib and supplies.

Additionally, many hospitals now offer birthing rooms that allow a woman to stay in the same bed for labor, delivery, and sometimes, postpartum care (care after the birth). These rooms are fully equipped for uncomplicated deliveries. They're often attractive and have gentle lighting.

But some women believe that the most comfortable environment is their own home. Advocates of home birth believe that labor and delivery can and should occur at home, but they also stress that a certified nurse-midwife or doctor should attend the birth. An important 487 Pregnancy and Birth Sourcebook, Third Edition thing to remember about home birth is that if something goes wrong, you don't have the amenities and technology of a hospital. It can take a while to get to the hospital, and during a complicated birth those minutes can be invaluable.

For women with low-risk pregnancies who want something in between the hospital and home, birthing centers are a good option. These provide a more homey, relaxed environment with some of the medical amenities of a hospital. Some birthing centers are a.s.sociated with hospitals and can transfer patients if necessary.

Who will a.s.sist at the birth: Most women choose an obstetrician (OB/GYN), a specialist who's trained to handle pregnancies (including those with complications), labor, and delivery. If your pregnancy is considered high risk, you may be referred to an obstetrician who subspecializes in maternal-fetal medicine. These doctors have specialized training to care for pregnant women with medical conditions or complications, as well as their fetuses. Most women choose an obstetrician (OB/GYN), a specialist who's trained to handle pregnancies (including those with complications), labor, and delivery. If your pregnancy is considered high risk, you may be referred to an obstetrician who subspecializes in maternal-fetal medicine. These doctors have specialized training to care for pregnant women with medical conditions or complications, as well as their fetuses.

Another medical choice is a family pract.i.tioner who has had training and has maintained expertise in managing non-high-risk pregnancies and deliveries. In some areas of the United States, especially rural areas where obstetricians are less available, family pract.i.tioners handle most of the deliveries. As your family doctor, a family pract.i.tioner can continue to treat both you and your baby after birth.

And doctors aren't the only health care providers a pregnant woman can choose to deliver her baby. You might decide that you want your delivery to be performed by a certified nurse-midwife, a health professional who's medically trained and licensed to handle low-risk births and whose philosophy emphasizes educating expectant parents about the natural aspects of childbirth.

Increasing numbers of women are choosing to have a doula, or birth a.s.sistant, present in addition to the medical personnel. This is someone who's trained in childbirth and is there to provide support to the mother.

The doula can meet with the mother before the birth and can help communicate her wishes to the medical staff, should it be necessary.

Your birth plan can also indicate who else you'd like to have with you before, during, and immediately after the birth. In a routine birth, this may be your partner, your other children, a friend, or other family member. You can also make it clear at what points you want no one to be there but your partner.

Atmosphere during labor and delivery: Many hospitals and birthing centers now allow women to make some choices about the 488 Many hospitals and birthing centers now allow women to make some choices about the 488 Birth Plans atmosphere in which they give birth. Do you want music and low lighting? How about the freedom to walk around during labor? Is a hot tub something you'd like access to? If possible, would you like to eat or drink during labor? You might be able to request things that may make you the most comfortable-from what clothes you'll wear to whether you'll have a VCR or DVD player in your room.

Procedures during labor: Hospitals used to perform the same procedures on all women in labor, but many now show increased flexibility in how they handle their patients. Some examples include: Hospitals used to perform the same procedures on all women in labor, but many now show increased flexibility in how they handle their patients. Some examples include: * Enemas: Enemas: Used to clean out the bowels, enemas used to be routinely administered when women were admitted. Now, you may choose to give yourself an enema or to skip it entirely. Used to clean out the bowels, enemas used to be routinely administered when women were admitted. Now, you may choose to give yourself an enema or to skip it entirely.

* Induction of labor: Induction of labor: At times, labor may need to be induced or sped up for medical reasons. But sometimes, pract.i.tioners will give women the option of getting some help to move things along, or giving labor a little more time to progress on its own. At times, labor may need to be induced or sped up for medical reasons. But sometimes, pract.i.tioners will give women the option of getting some help to move things along, or giving labor a little more time to progress on its own.

* Shaving the pubic area: Shaving the pubic area: Once routine, shaving is no longer done unless a woman requests it. Once routine, shaving is no longer done unless a woman requests it.

Other procedures that you can include in your birth plan are requests about fetal monitoring, extra birthing equipment you'd like in the room, and how often you have internal exams during labor.

Pain management: This is important for most women and is certainly something you have a lot of control over. It's also something you'll want to discuss carefully with your health care provider. Some women change their minds about pain relief during labor only to discover that they're too far along in their labor to use certain methods, such as an epidural. You'll also want to be aware of the alternative forms of pain relief, including ma.s.sage, relaxation, breathing, and hot tubs. Know your options and make your wishes known to your health provider. This is important for most women and is certainly something you have a lot of control over. It's also something you'll want to discuss carefully with your health care provider. Some women change their minds about pain relief during labor only to discover that they're too far along in their labor to use certain methods, such as an epidural. You'll also want to be aware of the alternative forms of pain relief, including ma.s.sage, relaxation, breathing, and hot tubs. Know your options and make your wishes known to your health provider.

Position during delivery: You can try a variety of positions during labor, including the cla.s.sic semi-recline with the feet in stirrups that you've seen in the movies. Other choices include lying on your side, squatting, standing, or simply using whatever stance feels right at the time. You can try a variety of positions during labor, including the cla.s.sic semi-recline with the feet in stirrups that you've seen in the movies. Other choices include lying on your side, squatting, standing, or simply using whatever stance feels right at the time.

Episiotomies: When necessary, doctors perform episiotomies (when the perineum-the area of skin between the v.a.g.i.n.a and the 489 When necessary, doctors perform episiotomies (when the perineum-the area of skin between the v.a.g.i.n.a and the 489 Pregnancy and Birth Sourcebook, Third Edition a.n.u.s-is partially cut to ease the delivery). You may have one if you risk tearing or in the case of a medical emergency, but if there is an option, you can discuss your preference with your provider.

a.s.sisted birth: If the baby becomes stuck in the birth ca.n.a.l, an a.s.sisted birth (i.e., using forceps or vacuum extraction) may be necessary. If the baby becomes stuck in the birth ca.n.a.l, an a.s.sisted birth (i.e., using forceps or vacuum extraction) may be necessary.

Cesarean section (C-section): You might not want to think about this, but if you have to have a cesarean, you'll need to consider a few things. Do you want your partner to be present, if possible? If you have a choice, would you like to be conscious or unconscious? What about viewing the birth-do you want to see the baby coming out? You might not want to think about this, but if you have to have a cesarean, you'll need to consider a few things. Do you want your partner to be present, if possible? If you have a choice, would you like to be conscious or unconscious? What about viewing the birth-do you want to see the baby coming out?

Post-birth: Decisions to be made about the time immediately after birth include: Decisions to be made about the time immediately after birth include: * Would your partner like to cut the umbilical cord?

* Does your partner want to hold the baby when the baby emerges?

* Do you want immediate contact with the baby, or would you like the baby to be cleaned off first?

* How would you like to handle the delivery of the placenta?

Would you like to keep the placenta?

* Do you want to feed the baby right away?

Communicating Your Wishes Birth plans are relatively new inventions, and your doctor or nurse-midwife may not be completely comfortable with them. For this reason, make sure you communicate clearly that you intend to create a birth plan.

Give your health care provider your reasons for doing so-not because you don't trust him or her, but to help ensure cooperation and to cover the possibilities if something should go wrong. If your caregiver seems offended or is resistant to the idea of a birth plan, you might want to reconsider whether this is the right caregiver for you.

Also, think about the language of your plan. You can use many online resources to create one or you can make one yourself. Here are some tips: 490.

Birth Plans * Make your birth plan read like a list of requests or best-case scenarios, not like a set of demands. Phrases such as "I would prefer" and "if medically necessary" will help your health care provider and caregivers know that you understand that they might have to alter the plan.

* Think about the other personnel who'll be using it-hospital staffers might feel more comfortable if you call it your "birth preferences" rather than your "birth plan," which could seem as though you're trying to tell them how to do their jobs.

* Try to be positive ("we hope to") as opposed to negative ("under no circ.u.mstances").

Once you've made your birth plan, schedule a time to go over it with your doctor or nurse-midwife. Find out and discuss where you agree or disagree. During your pregnancy, review the birth plan with your partner periodically to make sure that it's still in line with both of your wishes.

Strive to keep the plan as simple as possible-preferably less than two pages-and list them in order of importance. Focusing on your priorities will help ensure that the most important of your wishes are met.