The birth center at Ashland Community Hospital called at 10:45 today with a VBAC patient dilated at 2 or 3 cm, whose water had just broken. They said she had requested a doula, and asked me to come right in.  Five years ago, Julia had labored with her first baby to 8cm, then the doctor realized the baby was breech and did a ceasarean section.

       When I arrived at 11:45, Julia was in the bathroom with her husband. She was pretty uncomfortable, and wanted to get in the shower. They stayed in there together for about half and hour, until things had obviously intensified, and she just wanted to go lie down.  We wrapped her in a warm blanket and helped her back to the room.  She was starting to panic, to say she didn't think she could do this.  She was afraid, and unsure if she could go on, if things would be okay, if she could deliver this baby vaginally.  We helped her focus on her breath, its rhythm, and assured her that things were intensifying because everything was going the way it should.  Her body was making space for baby to pass through.  The nurse checked her again and she was now at 5 or 6 cm. 

       In the bed we tried a few different positions, but she just couldn’t get comfortable, and was having a hard time staying on top of her breath. Her father, husband and I coached her with every breath to find her rhythm, to stay with it, to reassure her that things were going just as they should. I found a place to press on her lower back, which felt good when she laid on her side.  She seemed to stay with her breath as long as she had consistant support, but she was having a hard time handling her dicomfort.  I thought she could be in transition, and although, as a VBAC patient, they would not let her give birth in the tub, I thought it could help her to get in a relax for a little while.  She agreed and I went to turn on the water.

     By the time I got down the hall to the tub room and turned it on, the nurse signaled to me that her cervix was dilated and she was complete.    Very soon, Julia was having a hard time not pushing. Her doctor was on the way, and the nurses were getting ready.  She pushed her baby out in about half an hour with incredible strength and even moments of humor.  I held her leg, and took pictures as her little one was crowning and emerging into the world.  It was 1:50 pm, so I was there for only about three hours before the birth. Julia had been in labor since 5:30 am.

     This was my first successful VBAC experience.  I felt a layer of doubt and fear, as though she had some expectation, formed through her experience, that her baby could not come out of her vagina.   She had the support she needed, though, and her body and baby worked their magic! The baby was at least 9 lbs. and gorgeous!

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      At the Ashland Community Hospital's Birth Center, doula care is provided for any laboring woman who requests support, and the service is at no extra cost.  A doula is a woman, experienced with birth, who provides constant physical and emotional support for a laboring woman.   She can be there as a main support person, if the woman has no family or partner with her, or she can be there to assist the husband or mother.   She will make suggestions about position changes, offer massage, and share her knowledge of the birthing process. She is there as a guide, and her main purpose is to help the woman feel safe and relaxed, so that her body can drop into a rhythm and give birth.   The nurses at the Ashland Hospital provide excellent labor support, but are also responsible for taking blood pressure, checking cervical dilation, keeping records, and caring for other patients.   Since they  cannot always provide constant support,  they have  hired a team of skilled and compassionate women to stay present with their patients.  It is an incredible gift to women, and unique for a hospital to provide this service.

     This Oregon hospital's progressive program began in 1995, as a way to support Spanish speaking women.  Originally, the doulas were fluent Spanish speakers and were there to translate, in addition to offering labor support.  A couple of years ago, the program expanded to include support for all women, and now there are doulas on call 24 hours a day, seven days a week.   Many of the current doulas speak Spanish, but not all are fluent. 

      Having a doula present greatly reduces the need for medical interventions and greatly increases the chances of a woman remembering her birth as a life transforming accomplishment.   You can see photos and read a little about the doulas, including myself,  on the Ashland Community Hospital website: http://www.ashlandhospital.org/Page.asp?NavID=175    

     

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       Women need the constant support of experienced women when they give birth.   Studies have shown that simply having a calm, present woman sitting in the room while labor is happening will reduce the need for  interventions and unplanned medical procedures.  A doula can be that calm, present woman, and she is trained to provide emotional support for a women experiencing fear, discouragement, and fatigue.  Doulas also provide physical support, in the forms of massage, breathing practices, suggestions for change of position, and many other helpful techniques to help mamas relax and release to the flow of birth energy.

      Many couples have experienced discomfort at having a doula present, as she may not be a close friend.  There is a sense that perhaps the nurses will provide the needed female support.  Nurses are indeed wonderful and helpful, but unfortunately, they  have many people to care for at once, are in charge of taking diligent notes and may have little experience with natural birth.  Some nurses feel more comfortable administering drugs than foot massage.  Your doctor will most likely communicate with the hospital staff by telephone until the birth is imminent, unless there is some complication. 

      A doula will meet with you ahead of time to get to know who you are and what you are comfortable with.  She will discuss your fears and plans with you, and she will come to your home when labor begins to help you decide when to go to the hospital.  She will remain by your side, offering words of encouragement, suggestions for your partner, loving touch, and whatever you might need.

   Some hospitals, like The Ashland Community Hospital in Ashland, OR, provide doulas for their patients upon request, free of charge.  Even though she may not be a familiar face when she arrives, the hospital doula provides excellent support and is your friend, advocate and wonderful, calm presence.

These are some statistics for birth with a doula present:

• 50% reduction in the cesarean rate
• 25% shorter labor
• 60% reduction in epidural requests
• 40% reduction in oxytocin use
• 30% reduction in analgesia use
• 40% reduction in forceps delivery

Information was obtained from Mothering the Mother: How a Doula Can HelpYou Have a Shorter Easier and Healthier Birth, Klaus, Kennell, and Klaus (1993).

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This evening, I returned from a fourteen hour day at the hospital newly inspired by the dear friend of the woman I was there to help.  "A"  had been in labor all night, after being induced by cytotec at 42 and a half weeks pregnant.  Her dear friend "S," who happens to be a yoga student of mine was with her all night, and in the morning, when things were getting tough, they requested a doula, and hoped that I would be available.  It worked out well for us all that I was on call today, and picked up the phone right away.

"S" remained by her friend's side all night and all day, whispering words of encouragement, demanding her focus when she lost hope, soothing her, holding her, and simply being there with her for the entire experience of labor and birth.  I was able to support them both in many ways, but in the truest sense of the word "doula,"  "S" was there for her friend, and I was inspired and touched to experience this woman's devotion.  At a particularly difficult moment, she got on the bed right in "A's" face and told her, "I have a plan for us now.  You close your eyes and rest, and I'll sit right here the whole time.  If things get hard, open your eyes and look right here at me, and we'll breathe together, one breath at a time.  We'll get through this together."

Every woman deserves a doula who can breath with her and help to carry her through this most difficult trial of her life.

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