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Birth Doula, Child birth, Evidence Based Care

What is informed consent, and what does it mean for your pregnancy and birth?

What Informed Consent During Pregnancy and Birth

Informed consent is one of those phrases that is becoming a signature phrase in birth circles. You might have read in a blog or on a Facebook post something like, “We support informed consent,” or “Every woman has the right to informed consent.” But what does that really mean and why is it important to pregnant an birthing women? Informed consent is the concept that a patient has the right to be fully informed of the benefits and risks of any medical procedure or intervention, as well as the alternatives to the procedure prior to agreeing to undergo the procedure.The doctor in charge of the patient’s care would take the time to explain these things to the patient prior to obtaining  her consent. It also means that, if consent is later withdrawn to an agreed upon procedure, the medical staff will cease treatment. Informed consent is the right of every patient being treated medically, including prenatal care and labor and delivery.

That sounds so logical, doesn’t it? You might even be thinking, “Of course, that’s what doctors and nurses do all the time.” Unfortunately, that’s not always the case. Often, what happens is a professional comes into an exam room or the delivery room and says something like, “We’re going to schedule your Group B Strep test for your next visit,” or  “We’re going to do a vaginal exam now to see how far you’ve dilated,”  or “We’re going to get your IV started, okay?” Consent is assumed in all the cases, even the last one. There really isn’t an opening left for questions or alternatives. Have you heard this sort of language during your pregnancy or your birth experiences? I know I did, and I just kind of assumed I had no choices or that there were no other options. I certainly didn’t think to myself, “I can refuse this if I want to.” In fact, it wasn’t until I was pregnant with my third child and was seeing a midwife that I realized I had a choice in a lot of routine medical procedures because we were discussing a routine procedure I was not really sure about and she said, “You know you don’t have to do that, right?” and then proceeded to discuss the risks/benefits and the alternate options I had with me. What an eye-opener! I had assumed that all these routines and procedures were just a given during pregnancy and birth. It was very empowering to realize that I did have options, and beyond that, to feel like a full participant in my medical care. The idea of  informed consent is not about denying all interventions all the time, but rather having access to all the information and making an informed choice either way, using that information to make the right choice for you in your specific situation. It’s about being empowered in your care, an active decision maker, rather than a passive participant. So many women who report dissatisfaction with their birthing experiences list feeling like their autonomy was not respected as one of the main causes. The goal of this article is to help empower women and reduce this occurrence.

Disclaimer 1: I am not at all talking about emergency situations here. I am talking about the right to decline routine procedures such as a cervical check if you wanted to, or to request a hep-lock instead of being tied to an IV pole in the case of a normally progressing labor, for example, or the right to ask questions and know your options in the face of interventions that you  may be facing in a non-emergent situation. In a medical emergency where all the minutes and even seconds count, I absolutely advocate relying on the advice and expertise of the doctors and nurses in charge of your care; they want a healthy outcome for you and baby and are using all their expertise and best judgement to achieve that.

Disclaimer 2: The vast majority of doctors and nurses truly want the best care and outcome for their patients. In cases where informed consent is not pursued, I truly believe that it is not usually because the medical staff is trying to bully or control the mother or is pursuing their own convenience. These things have become routine and fairly expected, so I think it is often assumed the mother is in full consent or that if she is not, she would speak up when consent is assumed.  I realize there are cases when medical professionals were in fact not really pursuing the best care for their patients, but those are for the most part the exception rather than the rule.

So now that we’ve looked at informed consent and why it’s important, how do we make sure that’s what is happening in our own medical care and births? First, take a good childbirth education class and/or do your own research and what procedures are routine with your doctor and your place of birth and what common interventions are. Find out the evidence for these procedures and interventions (Evidence Based Birth is a great place to start). Talk to your doctor or midwife about all of these things. Find out what options and alternatives you may have. Talk to your partner as well. It is so much easier to think clearly and make important decisions prenatally, before the intensity of birth hits. Second, consider hiring a doula to support you. She is there to help you find the information and research you need prenatally and to help you create a birth plan or list of what you do and do not want during your birth. She is also there to help you advocate for yourself during labor. Remember, a doula does not make decisions for you or speak to the medical staff on your behalf; rather, she facilitates communication between you and your birth team and can help you ask questions and get the answers you need. And she’s there to support you if birth leads to necessary interventions that you did not want so that even in that case you feel empowered in making the right choices for your situation. Third, ask for a little time. If you need a minute to consider your options or to discuss a procedure with your partner, it is absolutely okay to ask for a few minutes alone to do so.  Unless it is a truly emergent situation, do not feel pressured to make a snap decision on the spot.

And, finally, ask questions of the medical staff. Good, clear communication between everyone on the birth team is key. Do not assume that because you wrote something in your birth plan, everyone is automatically going to know what you do and do not want in each situation. Again, your doula can help you open this conversation, often by asking you questions such as, “Are you comfortable with this procedure? Did you have any questions about that before it’s done?” I love using the BRAIN acronym because it is short and memorable and helps you make sure you are asking all the right questions to get the information you need.

Benefits:

  • What are the benefits of this procedure or intervention? What is the desired goal to be accomplished by pursing it?

Risks:

  • What are the risks associated with this procedure or intervention? What possible side effects are there for the mother and the baby? What limitations might it impose on mom such as needing to remain in bed, not being able walk, etc.?

Alternatives:

  • What other options for treatment are there? Different medicines, non medical options you could try, etc. such as positioning to help get labor going again rather than immediately starting Pitocin.

Intuition:

  • What does your gut feeling say about this procedure? Mothers are gifted with strong instincts, especially when it comes to their bodies and their babies. Consider your intuition. Also consider your wishes for your birth. How does this align with those?

Nothing:

  • What would happen if you simply did nothing in this instance? What is the evidence for doing and not doing something in this case?

 

Once you have gathered your information, be sure that you are very clear in speaking with the staff that you are or are not consenting. State clearly, “I consent.” “I want to proceed with_______.”  On the other hand, clearly state, “I do not consent to that procedure.” Not, “I don’t really want…” “I’d rather not…” “I don’t like…” Again, good, clear communication is key. Be open and plain about what you do and do not consent to, and be sure your partner and/or doula is ready to help you make your voice heard. You cannot be forced into any procedure or intervention against your wishes, nor bullied into not consenting to a procedure you do wish to consent to. (I have seen that happen in cases such as the mother has changed her mind about not having an epidural and others in the room are trying to persuade her not to do it.)

I believe in you and your ability to birth your baby. I believe in your ability to make solid, informed choices for you and your baby. Remember: It is your body and your birth. It is your right to be fully informed about the benefits and risks of every procedure and to make the choices best for your situation and to be fully supported in doing so.

 

 

Birth Doula

Dads and Doulas: Complementary Partners During Birth

Dads and Doulas_Complementary Partners During Birth

There is a wealth of information out there about why doulas are a great choice for moms and about the many benefits of having a doula at your birth, such as higher satisfaction with the birth experience, lower incidence of c-sections, lower incidence of interventions, and a general feeling of being better informed and capable of making informed birth choices. I agree, all of these are great reasons to hire a doula for your birth! But what about dads? When a mom starts looking into hiring a doula, there is often some fear there that the doula might take over the partner’s role in the birth, or sometimes the feeling is, “I’ve got a terrific partner who wants to be very involved at the birth, so I don’t really need a doula, right?” Take a look at the logo on the website and on this article–doula and dad, surrounding mom and baby with love, care, and support. I believe that this is exactly the way doulas and partners are meant to work together in the birth. We see mom leaning into dad as he surrounds her with love, protection, and support, while the doula is just to the side, supporting not only the mother and baby but also the father, in fact, the entire family unit. So, how does this actually play out? Let;s go down the list.

  1. Partners know Mom, doulas know birth. A doula cannot know and understand a woman the way her partner can. He knows her better than anyone else, knows what makes her feel comforted, and knows what may cause anxiety. He knows her desires, her hopes, and her wishes for both the birth and for the baby. His touch can sooth her like no one else can. A doula could never take that place with the mother and would not want to! But, while the partner knows mom, how much does he know about the physiological process of birth? The possible interventions and their risks/benefits? A doula has undergone extensive training on the physiology of birth and has a deep understanding of how the body works to bring the baby into the world. She is familiar with the terminology the medical staff may use in the delivery room and with common interventions and the risks and benefits of each. A doula also has varied birth experiences on which to draw as she informs and supports the couple during pregnancy and birth.  She will provide reassurance  to both partners.
  2. Doulas support dad by giving suggestions and assistance as he supports mom.    You’ve taken a 12 week childbirth education course and maybe even read a book or two. You’ve done your best to prepare yourselves for labor and delivery. And then, the contractions hit. The intensity of the moment can feel overwhelming. What do you do now? Did you just forget all the comfort measures you two rehearsed in the previous weeks? Are you unsure what to do if mom is having back labor or if baby is in a wonky position? This is where your doula comes in. She is there to remind you of comfort measures you wanted to try and to suggest others. She is there to show your partner how he can support you during back labor or to make position suggestions to help your baby position better. She is there to remind you to breathe, to give a comforting smile, and to provide a calm presence in those intense moments. She is there to bring mom water while dad is supporting or comforting her or to be more hands on with counter pressure while dad holds mom close. She is there to make dad look like the white knight of the delivery room, to help him be his partner’s greatest support.
  3. Doulas provide continuous support and take care of dad, too. It has often been said that birth is not a sprint, but a marathon. It’s true! It’s exhausting and emotionally intense for both the mother and her partner. If mom has been 16 hours in labor, her partner has been right there by her side. A doula allows dad the ability to take care of himself too by providing continuous support to the mother while he runs to the restroom, grabs some food, or catches a quick nap. Your doula will make suggestions for your partner’s well being and care too, remind him to stay hydrated and be there if he needs to step out of the room for a moment so that the mother is never left alone. In the event of a c-section or if the baby needs to go to the nursery for some reason, the doula allows the dad to go and watch over the baby while making sure the mother is not left alone.
  4. Doulas allow the partner to be involved in the birth at his comfort level. Perhaps your partner is uncertain about being your sole labor support; he may struggle seeing you go through the pain and the work of labor. Perhaps he is a bit squeamish. Whatever the case, your doula will help him be involved to the degree he is comfortable. If he prefers to be a little less hands on during your birth, your doula is there to do that for him while he offers comfort and emotional support. During your prenatal visits, your doula will discuss with both of you at length what role you wish him to play and what he is comfortable with, and she will honor and assist that.

Okay, so doulas are actually a great asset to dad as well. But what if your partner is still feeling a little unsure? The best thing is to bring him with you on the initial consultation when you are interviewing doulas. Let him get all his questions answered, and let him be a part of the choosing process. It is so important that both the mother and the partner feel comfortable with everyone who will be in the labor room. Doulas are available to dads during the pregnancy too, so if he has additional questions and concerns he can always text/e-mail/call the doula as well. And don’t worry if at some point during the labor you and your partner want a little privacy–privacy can help labour progress! Let your doula know that you would like some privacy for a bit. A good doula honors your needs and will not feel put out at all. She’ll happily give you that space and rejoin you when you are ready for her to come back.

The bottom line is that doulas are there to support you and your partner as you usher your little one into the world in whatever way works for the two of you. She works hard to promote the special bond between the two of you and to facilitate those special birth moments that you will both look back on over the years.

Birth Doula, Uncategorized

What is a Doula?

What is a Doula?

“Doula” is becoming one of those new buzzwords that you hear everywhere–on blogs, in casual conversation, and all sorts of print media. Maybe you’ve even had a friend say she hired a doula for her birth or had someone suggest, “Have you considered hiring a doula?” But what exactly is a doula, anyway? The Merriam Webster Dictionary defines “doula” as “a woman experienced in childbirth who provides advice, information, emotional support, and physical comfort to a mother before, during, and just after childbirth.” A doula, then, is a specially trained childbirth professional whose job is to provide support for the mother during the entire childbearing year.

A doula IS:

  • Trained in the physiology of pregnancy and birth. Doulas possess a good understanding of what takes place for both the mother and the baby during pregnancy, birth, and the early postpartum period, providing invaluable informational support.
  • A good researcher! Not even doulas know all the answers to every pregnancy or birth question. However, they know where to look for good, evidence based information to provide the mother so she can make informed choices for herself and her baby.
  • An emotional support for the mother throughout the wonderful, sometimes scary, sometimes tough journey of pregnancy and birth. A doula provides a nonjudgemental listening ear for all the mother’s fears and concerns, as well as her feelings surrounding pregnancy and birth. She will help the mother work through these feelings and concerns and help her to feel empowered in her birthing experience. She also helps facilitate communication between the mother and medical professionals.
  • Trained to provide physical support, especially during the birth. She may use techniques for non medical pain relief, touch, massage, positioning, and visualization, among others, to support the mother.
  • Continuous labor support. A doula joins the mother and her partner during labor and will remain with the mother through the entire experience, usually including one to two hours after the birth.
  • A supporter of the mother’s wishes and goals, not her own. A doula supports a mother in whatever choices she makes for her pregnancy and birth, whether that is to have a natural childbirth, an epidural, an induction, a cesarian section, or any other medical interventions or procedures she may decide on. A doula does not impose her own biases and preferences on the mother.

What is a doula NOT?

  • A medical professional. She does not perform any medical tasks. She does not do cervical exams, catch the baby, monitor blood pressure, or anything of a medical nature. She also does not make clinical diagnoses or recommendations.
  • The spokesperson for the mother. A doula does not communicate for the mother with her care providers or medical staff. She instead helps the mother and her partner speak for themselves and endeavors to build a good working relationship among all the members of the birth team.
  • A replacement for dad. A doula does not replace the mother’s partner during labor. She does not seek to take over his vital role of loving support for the mother. She instead supports him as well, helping him to be the mother’s hero and providing suggestions and assistance to him as he supports the mother.

Why do you need a doula?

One goal all mothers have for their birth experience is a safe, healthy baby and mother as a result. One way this goal can be achieved is by decreasing risks of interventions during birth. Studies show that women who have continuous support during labor experience:

 

  • 31% decrease in the use of Pitocin
  • 28% decrease in the risk of Cesarean
  • 12% increase in the likelihood of a spontaneous vaginal birth
  • 9% decrease in the use of any medications for pain relief
  • 14% decrease in the risk of newborns being admitted to a special care nursery
  • 34% decrease in the risk of being dissatisfied with the birth experience

Another goal women have is to feel empowered by their birth experience however it unfolds, not traumatized by it. A doula helps a mother achieve this goal in several ways.

  • She provides informational support during pregnancy to help the mother explore and understand all her options regarding the upcoming labor and delivery and often helps with the writing of a birth plan or birth wishes. She continues to provide this support during labor by facilitating communication between the mother and her care providers so that as much as possible, her wishes are honored and she is able to make any decisions about any recommended or necessary interventions her medical provider may suggest. In this way, birth is not something that happens to her, but rather something she does, whether she delivers vaginally or by cesarian. Her autonomy is respected, and she can feel good about the choices made.
  • She provides emotional support during pregnancy, labor, and the postpartum period by listening to the mother, validating her feelings, hearing and addressing her concerns, and providing empathy and understanding. She becomes the mother’s cheerleader by providing encouragement all throughout the childbearing year and especially during labor when emotions run high and things may be hard.
  • She is with the mother continuously during labor and delivery. This is especially important in hospital deliveries where the mother may never have met the staff caring for her or even the physician delivering her baby if she delivers when her doctor is not on call.
  • A doula is hired by the mother, to support her and to help her achieve her birth goals. She is not hired or employed by the hospital, the doctor’s office, or the midwife. Her sole focus is the support of the mother. She is constantly observing and assessing how she may support the mother both emotionally and physically.
  • A doula is familiar with birth, with various support techniques, and with medical terminology. She provides a calm presence for both the mother and the partner. She can support the partner and also allow him to take a break, get rest if he has been up all night with the mother, allow him to get food, etc. without the mother ever being left alone. She also can remember the couple’s preferences and techniques they may have wanted to try and remind them during the birth when they are tired and emotional and may not remember themselves.