- Women's Health
Ante natal sessions with your doula...how knowledge and preparation help during labour
What difference will preparation make?
The importance of good antenatal preparation for the mother can not be overstated. This will be done in depth by the independent midwife, and by a good birth doula. Depending on how things stand in your area, hospital-employed midwives may offer varying degrees of preparation.
I have known a couple of women who chose to have no antenatal preparation for the very specific reason that neither wanted their minds to be influenced by any negative, worrying or undermining information that they might be given. In the event, both women had great inner faith in the workings of their bodies, and all turned out well for both of them. I have seen women (not under my care as a doula) in hospital who were overcome by panic and the feeling that they didn’t know what was happening to them, or what was supposed to be happening, and what to expect. It is not easy to predict how a woman will react in labour, so as in so many things, knowledge is power, and preparation is key.
It is very difficult to explain what’s happening to the mum whilst she is in the heat of labour. It is also detrimental to the labour to stimulate the woman’s neocortex with intellectual information at a time when she needs to be in what doulas and some midwives call ’labour-land’
Mindset, outlook and attitude
The balance of hormones that govern labour and birth is very powerful, but also very delicate. In other words, it is easily upset, and the fundamental way it is upset, is if the mother is frightened. Fear causes the secretion of adrenaline which blocks the output of oxytocin and the endorphins that ensure that the mother can cope with the intense sensations of labour. If all this remains undisturbed and is allowed to progress then the chances are that all will be well. The mother’s mindset, outlook and attitude is the most vital component of labour, and is one of the determining factors in whether she achieves the kind of birth she desires.
Once labour begins, it is in many cases too late to start addressing the mindset of the mum.
Mum’s attitude to, and expectations of the impending labour is shaped by many different factors. A big part of antenatal preparation is concerned with winkling out these fears one by one, and exploring them. If you can stop running, turn round and face a fear then it may remain, but it will be changed, diminished, and will no longer have such a firm grip. Some women experience huge relief at being able to explore experiences they have stored away and not talked about to anyone.
This book is a real eye-opener to anyone who thinks that birth has to be an unpleasant, painful experience which has to happen in a very medical environment. The authors are knowledgeable women with a passion for bringing positive labur and birth experiences to women and their families.
Janet Balaskas has had many years of experience of preparing women for an active birth. She began changing the way that people thought about labour and birth back in the 1970s, when women's choices and what was best for a safe normal birth were not considered. Being active during labour makes a very big difference to the mother's experience.
In our modern nuclear families, actual real live birth is a mysterious and private event. Years ago, birth happened frequently, and at home. It was part of the life of the community, and supported by midwives, mothers, grandmothers, sisters, or knowledgeable local females. Now it is an event that takes place behind hospital doors, attended by masked, gowned figures, in a sterile, rather than homely environment. Most of us don’t come into contact with this event unless we are professionally involved, or actually going through it.
Popular culture, television and film is one of the main ways the lay person forms an impression of the reality of labour and birth. The event is usually portrayed in a overly dramatic, frightening way, and out of context. Friends and relatives may regale the pregnant woman with birth stories, which can perpetuate negative impressions unless they are balanced by positive stories. Even documentary type programmes can portray incorrect practice, out of date protocols, and a birthing woman who appears to be in distress, but is actually just busily and noisily birthing. Women can make some strange, animal type noises when birthing that do not necessarily mean that they’re in pain, and unless this is explained, an uninformed observer might assume the worst.
Get into a positive mindset by watching some empowering and amazing birth stories like these!
The film that was made by film maker Abby Epstein at the behest of talk-show host Rikki Lake after she had a disappointing birth experience with her first baby. It is an indepth look at the state of modern maternity care as a business. It looks at several real-life couples who are going through birth in their own ways, rather than following the accepted normal hospital-lead route. The film-maker herself becomes pregnant, so the film has a very personal feel
This wonderful film shows how doulas work both during labour and birth and postnatally. These are positive birth stories, both at home and in hospital, where the mother has chosen to have the support of a doula for herself and her partner during labour. Very valuable in helping if you are wondering about hiring a doula, or even if you have decided not to, this is a great film to watch if you want to see what a positive experience a gentle home waterbirths can be. Also shows the benefits of good ante natal preparation.
Doulas support mums and partners
Doula-preparation differs from the preparation offered by the hospital in a number of ways. A doula is chosen by the mum, as her own personal support, and is available to answer questions by email or to talk to on the phone at any time during the ante natal period. Depending on the mother’s need, the doula may arrange two or even three, sessions lasting typically a couple of hours. Hopefully mum’s husband or partner will be there too, or whoever else is going to be supporting her, for at least one of the sessions. This gives everyone a chance to get to know each other, and assimilate what may be very new information.
A great deal of antenatal preparation by the doula is spent listening! One mouth, two ears! How has the pregnancy been so far, what does mum feel about the oncoming labour and birth? How has this been influenced by her previous births? What are her expectations? When these areas have been explored, it is important to remember that her partner may have his own doubts and questions, and in some cases, experiences of birth from a previous marriage, which may never have been addressed or worked through. These questions are just prompts for mum to talk through everything she’s been thinking and wondering, and this easily forms the first part of antenatal preparation with the doula.
How did/will you prepare for labour?
Leading on from this, and depending upon their most pressing questions, the doula will probably find herself discussing different aspects of labour. Perhaps she will be imparting coping skills such as positions to adopt during labour, or information about the advantages of using water as pain relief. If a homebirth is planned, with an independent midwife, the midwife will have discussed the best time to call her, but if they are travelling to hospital, they may want to discuss how to know when to go in. Information about the stages of labour is useful, because mums can understand what is happening physically, and therefore what is the best way not to hinder the work of the womb in each of the phases.
Doulas and midwives
Useful things to consider
The doula can discuss, if asked, the methods of pharmacological pain relief used at home, and in hospital, and the pros, cons, and unwanted side-effects for mother as well as baby. What does mum want from the actual birth? Does she want the baby to be born into her hands, does she understand the importance of skin-to-skin contact for newborns? Does she want a physiological third-stage of labour (third stage of labour is the birth of the placenta) or is she happy to go along with the usual protocol of a syntocinon injection. Does she want baby to have the Vitamin K injection?
Information about breast and bottle feeding is useful, as well as what to expect from baby during the first few days. Some couples are familiar with a lot of this information, and may need the focus to be on one particular area of the experience. Others may be in completely uncharted territory, and will be really happy to know that the doula is someone who is there at any time to answer questions at all, however trivial they appear, and whenever, (within reasonable waking hours, unless of course it is urgent) they crop up.
So the antenatal preparation offered by a doula really is tailored to the needs of the mother and her partner, and is, essentially, lead by them. There is on piece of information vital to the understanding of the needs of the labouring woman, which is not widely known, or usually discussed by midwives or doctors. This is a description and explanation of the physiology of birth, I have it on a printout to give to couples so they can read and assimilate it at their leisure.
Here it is, just scroll down until you find the article on the physiology of birth by Michel Odent. If you know nothing else when going into labour, its all you, and your birth companion, need to know.