Category Archives: Home Birth

Exploring Your Options Series – Part 5

Deciding on a place of birth is simple for most women. Most women choose to give birth in a hospital. Women generally feel safe in a hospital. Are there any other safe options? Is it safe to give birth out of the hospital? YES! Studies show that out of hospital options, such as a birth center or at home, are safe for low risk women.

I would encourage you to consider and research the different options and their safety before coming to a conclusion about where to have your baby. The location of your birth will determine what other options are available to you. Some links to help with your research Science and Sensibility “Is Home Birth Reasonable Option?”Science and Sensibility “Birth Outcomes by Birth Location”Science and Sensibility “Flaws In Recent Home Birth Research”, Science and Sensibility – “Obstetricians Claim Homebirth is Unsafe…Again. Where’s The Evidence?”

Part of the decision making process should include weighing the pros and cons of each birth place. Previous decisions (ie: deciding on a care provider) will also have an influence on where you give birth. If you want a physician to attend your birth, having a home birth may not be an option. Not many physicians attend home births, but there are some. I am not sure there are any in Utah, though.

Below are some pros and cons I came up with. Because everyone is different and there is no one right answer for anyone, these things may not apply to your situation. Feel free to make your own pros and cons list to figure out what is the best option for you. Where you feel the most comfortable and safest will be the best place for you to give birth.

Most women in this area plan to have a hospital birth and never consider a birth center or home birth. I would encourage you to consider and research the different options and their safety before coming to a conclusion about where to have your baby. The location of your birth will determine what other options are available to you.

  • Hospital
    • Pros –
      • Specialized care for high-risk pregnancies and births.
      • Pain medication readily available
      • A nurse to take care of you and baby, meals brought to you
    • Cons –
      • Birth is seen as a medical crisis.
      • Mother and baby are often separated
      • Difficulties are often resolved with medications and high-tech procedures
      • Standardized care rather than individualized.
      • Often noisy, lack of privacy, strangers (the nurses are likely people you will not have met prior to your birth. Your particular doctor or midwife may not be the one to attend the birth)
      • Institutional feel.
      • Understaffed.
      • Higher risk of infection.
      • Have to pack and travel to birth place
  • Birth Center
    • Pros –
      • Less infection risk than hospital.
      • Midwifery Care Model
      • More home like than hospital
      • Most problems that arise can be dealt with on location.
      • Baby is never separated from the mother
      • Continuous support
    • Cons –
      • Have to pack and travel to birth place
      • Higher transfer rate than home birth.
      • Fewer pain medication options available
  • Home
    • Pros –
      • Your own space/Familiarity
      • Midwifery Care Model
      • Low-risk treatments used to resolve issues that may arise.
      • One-on-one care with your chosen birth attendant (although this isn’t always the case now. There are some homebirth midwives in the area that have a “practice” much like doctors)
      • Individualized care.
      • Continuous support
    • Cons –
      • Arrange for someone to take care of mom’s needs, the home, and other children.
      • No pain medications available
      • May need to transfer if difficulties arise.

Part 1 | Part 2 | Part 3 | Part 4

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Exploring Your Options Series – Part 3

In my last post I talked about choosing a care provider being an important decision in your childbirth experience. In that article I mentioned interviewing several care providers. Today I would like to talk more about interviewing a care provider.care providers

The first step to choosing a care provider is to become clear about what type of birth you want. Think about the experience you want to have. What does the end result look like? How do you want to feel about your experience? Become really clear about what is important to you and your partner as you begin this life changing event. If you decide you want a medicated birth in a hospital, you can eliminate home birth midwives from your list of care providers to interview.

The next step to choosing a care provider is to find some care providers to research and interview. This can be accomplished in several ways; receive recommendations from friends and acquaintances, ask for recommendations on social media, ask your current care provider for referrals and recommendations, you can search the internet. When asking friends and acquaintances for recommendations on a care provider make sure to ask them about their childbirth experience. You will know their care provider would make a good match for you, if their childbirth experience is similar to the one you hope for. If they had a wonderful medicated birth in the hospital and you would like to have an unmedicated birth without medical interventions, their care provider may not be the right one for you. Ask them how their care provider made them feel. I have heard several women talk about their care providers who say they were really nice, but they didn’t feel like their questions were important or the care provider didn’t spend much time with them. These points are important to know when receiving recommendations from friends and acquaintances. Searching online for a care provider can be very helpful. Several sites online have a rating and feedback system. You can read about other’s experiences with a particular care provider and see their overall rating. This can help you narrow down your list of care providers to interview. Keep in mind when hearing or reading feedback about care providers that birth is an emotionally charged event which creates strong feelings (positive and negative) toward those involved. Many times when things do not go how the birthing family had planned the care provider is seen as responsible and the negative emotion is directed solely toward the care provider. It also happens in reverse, when a birthing family has a positive experience, the positive emotion can become directed at the care provider. This is why many women have strong positive emotions toward their care provider and you may hear many say “I LOVE my OB” or “I LOVE my midwife”. Make sure to ask them why! What did they do to earn such a strong emotion?

The next step to choosing a care provider is to compile a list of care providers to interview. After you have become clear on the childbirth experience you want to have and have asked for recommendations, you are ready to compile a list, narrow it down and setup interviews. Take the recommendations you have received and use the information you gathered to determine which care providers can help you accomplish the type of childbirth experience you want to have. Make a list of these care providers. I suggest having at least 3 different care providers (as well as different types) and not more than 5. If a natural birth in a hospital is part of your ideal childbirth experience, I would suggest speaking with at least one licensed home birth midwife. You may find you can have the best of both worlds with a greater chance of having the childbirth experience you want. Make sure to ask questions about the safety of home birth and what she does in the case of certain emergencies (get specific!).

The next step to choosing a care provider is to setup and conduct interviews. Some women wonder why in the world you would interview a care provider. For most it doesn’t make sense, because it is rarely done. We usually just go to whomever is covered by insurance or whoever our mom or best friend go to. However, the care provider that attends your birth is a very important element to the type of experience you will have. If you want to have a natural birth with few medical interventions in a hospital and the OBGYN you choose is not supportive of natural birth your likelihood of having the experience you want is very low. If you want to reduce the risks of having a cesarean section and your OBGYN has a high c-section rate, your risk of cesarean is increased just by the care provider you chose. Choose carefully! Take your time! And if the one you choose isn’t supportive of the experience you want to have, fire them! Go to a new care provider who is supportive. I have known women you have fired their care provider during labor. They work for you!

The final step is to conduct interviews. Call the care provider’s office and setup a “consult” appointment. Tell the receptionist you would like to discuss different birth options with the care provider. This will help them know how much time to give you for the appointment. On my next post I will discuss how to interview a care provider.

Read the previous posts in this series here: PART 1  PART 2

Image courtesy of photostock / FreeDigitalPhotos.net

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Exploring Your Options Series

The focus of my doula business is to help birthing families know what their options are.

For this reason I’ve decided to write a series of posts about how to make informed decisions and what different options there are.

There was a study done in the 60s and 70s to evaluate the factors that influenced a woman’s level of satisfaction in her childbirth experience. In the study, women rated their level of satisfaction, filled out a questionnaire, and related their childbirth experience. Then home water birth, opiefoto.com15 to 20 years later the researchers followed up with these same women. What they found was that women remembered the details of their childbirth experiences very vividly and felt the same emotional intensity several years later. The research showed that the thing that made the difference in the level of satisfaction was whether a woman felt like she had a say in the care she received. Women who had a say in the decision making process reported to have the highest level of satisfaction in her childbirth experience. This is one reason why I believe women need to feel empowered and supported in making informed decisions for their care.

The first thing I would like to talk about is making decisions about your care. This formula is not just for pregnancy and birth. It can be applied to any situation where medical decisions need to be made. Think of the acronym “BRAIN”.

“BRAIN”

  • B – Benefits?
  • R – Risks?
  • A – Alternatives?
  • I – Intuition? (How do I feel about this?) Prayer.
  • N – Not now, but wait?

Take time to discuss. Ask your care provider and/or nurse to give you a moment to discuss your options. Very rarely do decisions need to be made so quickly that you do not have time to ask questions and discuss it privately. In the event of a time sensitive

Midwife - careprovideremergency ask for 1 minute alone to discuss it, if a minute is too long, ask for 30 seconds.  In a situation before the birth, you can get a second opinion. If you aren’t comfortable with what your care provider is telling you, you can change care providers. Don’t be afraid to fire your care provider. They work for you and you can find another one who you are more comfortable with and will honor your wishes. During your birth you can ask for another nurse, if you don’t feel supported by the one assigned to you.

More in depth questions you can ask your care provider:

As you ask questions about your care, you will become a responsible consumer and will gain greater satisfaction in your childbirth experience.

 

When a test is suggested:

  1. Why should I have the test? What problem are we looking for?
  2. What will the test tell us? How accurate are the results?
  3. What are the risks/side-effects of the test?
  4. If the test detects a problem, what will happen next?
  5. What is the cost of the test?

When a treatment or intervention is suggested:

  1. What is the problem? Why is it a problem? How serious is it? How urgent is it that we begin treatment?
  2. Describe the treatment: How is it done? How likely is it to detect or solve the problem?
  3. If it does not succeed, what are the next steps?
  4. What are the risks or side-effects to the treatment?
  5. Are there any alternatives (including waiting or doing nothing?)
  6. Ask questions b,c, and d about any alternatives.
  7. What is the cost?

–adapted by Kristi F. Ridd (originated by Penny Simkin)

Coming up we’ll talk about choosing a care provider, the pros and cons of different care providers, choosing a birth place, and a doula.

Photos take by opiefoto at the birth of my 3rd child.

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Birth Declaration by Babies & Bellies

I thought this declaration was wonderful. It describes much of how I feel about how I feel about birth.  CLICK HERE to read the entire declaration

excerpt from declaration:

“Birth, more than any other experience, has the potential to transform the world. It is time that we support women in experiencing birth as a peaceful, positive, and powerful event.

Birth has the potential to be the most powerful driving force on the planet. The healing of birth will surely change the world.

We must reframe the way we conceptualize birth. We must share this wisdom with the world.

Birth is something to be embraced—not controlled.

Birth is something to be welcomed—not dreaded.

Birth is something to be loved—not feared.”

 

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Dads and Doulas

Dad supporting mom opiefoto.comSometimes I hear about a dad not wanting a doula at the birth because he feels as though the doula would take over his role as the birth partner.  Penny Simkin, an author, physical therapist and childbirth educator since 1968, has written a paper dispelling the myths about dads and doulas. Following is the text of this paper.  I have also included some links about how some dads feel about doulas.

Myths About Dads and Doulas
by Penny Simkin, P.T.

Myth 1 – If a woman has her partner, the doula becomes redundant.

Reality – The doula may be the only person at the labor besides the partner who is there solely for the emotional well-being of the woman. The nurse, the doctor, the midwife have other priorities that compete with the emotional care of the woman: for example, breaks, shift changes, clinical responsibilities, office hours and hospital policies. The doula has few or no other priorities. She stays through shift changes, and until after the baby is born. She is not just another stranger with the couple. She has the woman’s needs as her sole priority. In some cases, the couple will bring several other friends or family members into labor with them. Sometimes these people can be uncertain of how to help which leads to confusion and actually adds to the woman’s stress. The doula can direct and coordinate the efforts of a group of people, giving them all some-thing useful to do, so they work as a team on the woman’s behalf.Dad supporting mom by opiefoto.com

Myth 2 – The doula “takes over”, displacing the partner and interferes with their intimate experience.

Reality – The doula can actually bring the couple closer. By making sure that the partner’s needs are met (food, drink, occasional back rubs, and reassurance), the woman and partner can work more closely together. The doula allows for the partner to participate at his own comfort level. Some partners prefer to be there only to witness the birth of their child and to share this experience with the woman they love. They may not want to play an active role and do not want to be responsible for the woman’s comfort and emotional security. The doula can fill in and allow the partner to participate as he wishes, without leaving the woman’s needs unmet. When the partner chooses to be the major source of emotional support, the doula can supplement his or her efforts by running errands, making suggestions for comfort measures, and offering words of reassurance and comfort. During a long tiring labor, she can give the partner a break for a brief rest or change of scene. While the doula probably knows more than the partner about birth, hospitals, and maternity care, the partner knows more about the woman’s personality, likes and dislikes, and needs. Moreover, he loves the woman more than anyone else there. The combined contributions of partner and doula, along with a competent, considerate and caring staff gives the woman the best chance of an optimal outcome.

Myth 3 – The doula has her own beliefs about how the birth should go, and imposes it on the woman or couple.

Dad holding baby by opiefoto.com

Reality – The doula’s true agenda is to help ensure that the woman’s or couple’s agenda is acknowledged and followed as much as possible. If the doula is thoroughly familiar with the couple’s wishes and their birth plan, she may actually think more about it than the couple, especially when labor is intense and things are happening rapidly. The doula can remind the staff or the couple of some items on the birth plan that are forgotten, but which later might be important. Sometimes if a birth plan is not followed, the couple later look back with regret or disappointment. The doula helps with decision-making by asking questions that will ensure that the right information is given to the woman or couple so that they can make an informed decision. She may also suggest alternatives for the couple to consider. She does not, however, make decisions for the couple.

In summary, the doula helps make the birth experience to be as rewarding and satisfying as possible. As one father said, “I heaved a big sigh of relief when she (the doula) walked in. I hadn’t realized how much pressure I had been feeling. She not only calmed my wife, she calmed me down.”

Penny Simkin, PT, is a physical therapist who has specialized in childbirth education since 1968. Among her books are Pregnancy, Childbirth and the Newborn: The Complete Guide, now in its third edition, The Birth Partner: Everything You Need to Know to Help a Woman Through Childbirth, Episiotomy and the Second Stage of Labor, and most recently,The Labor Progress Handbook: Primary Interventions to Prevent and Treat Dystocia, with Ruth Ancheta. She has written chapters for three major medical textbooks, and a series of materials on pain medications and comfort measures for childbirth has recently been published by Childbirth Graphics.

Currently, Ms. Simkin serves on several boards of consultants and editorial boards, including the journal, Birth: Issues in Perinatal Care; the International Childbirth Education Association; and the Seattle Midwifery School, where she also teaches. She is a founder of the Pacific Association for Labor Support (PALS), Doulas of North America (DONA), and trains doulas and doula trainers. Her practice consists of childbirth education, birth counseling, and labor support, combined with a busy schedule of conferences and workshops.
Copyright 1999 Penny Simkin.

What Some Dads are Saying About Doulas

http://www.bloomspokane.com/2009/07/05/hiring-a-doula-a-husbands-perspective/
http://pregnancy.about.com/od/doula1/a/dads-and-doulas.htm
http://daddyconfidential.com/2012/parenting/i-challenge-you-to-a-doula/
http://www.evolutionofdad.com/a-dads-experience-with-a-doula

Photos

Taken by: opiefoto.com at the home birth of my 3rd child.

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