Doula for a Medically-Required Induction?
March 16, 2016 1:45 PM Subscribe
Should my husband and I get a doula to assist at my labor, which will be a medically-required induction at 39 weeks?
Due to a genetic blood-clotting disorder that I have, I'll need to have an induced labor at 39 weeks. My husband and I are now grappling with whether we want to hire a doula to assist us (we're both newbs at this!), since many of the helpful pluses of having a doula (help with thinking through a birth plan, help with early labor at home, help in keeping the labor completely natural) seem to have gone out the window with the highly-medicalized planned induction.
The induction will be pretty set in stone, since my medical team doesn't want to take any chances with clots (I'm, like, a super-clotter of epic proportions, according to my hematologist). The induction will include:
- being hooked up to a continuous IV drip from the moment I check in to the hospital (so that I can get a particular clotting medication)
- some combination of cervical softener and pitocin drip, depending on how labor is progressing. Medical team is willing to take it slow - about half of inductions last longer than 24 hours at this hospital.
- eating is fine during early labor, "clear liquids" allowed (including applesauce, jello, energy drinks, if desired) during active labor
- intermittent fetal monitoring if things are going well, so I'll be able to move around and get into a shower and the labor room tub, should I so desire. I'll have to have continuous fetal monitoring and stay in bed if things aren't going so well or if I want any pain relievers
- pain relief options: nitrious oxide and the typical opiates (Demerol/Fentanyl) in early labor, nitrous oxide and Remifentanil (very short half-life opiate) available in active labor through the pushing stage
- NO OPTION OF EPIDURAL (blood clotting medication means no big needles near my spine)
- general anesthesia will be required if I end up with a c-section (again, no big needles near my spine)
This will be taking place at UCSF which is a VERY women and baby-friendly hospital here in crunchy San Francisco. They're also up-to-date on all of the latest medical research, and have a brand-new women & children's facility where I will be giving birth (this is why I can get nitrious oxide & remifentanil during labor, both of which are relatively uncommon in the States). I'm super-confident in my medical team overall (high-risk maternal-fetal specialists, hematologists, anesthesiologists), although I don't know who will be on-call when I'm laboring.
So, given that set-up, to doula or not to doula?
Pros: give my husband breaks if labor is long (likely), suggest different positions or adjustments for help with the pain (especially since I don't have the option of an epidural!) and to move the labor along, giving massage as desired, helping to keep me focused/calm if I use opiates and get disoriented, and someone to stay by my side during recovery if I need to have a c-section & general, so my husband can be with the baby.
Cons: my birth plan is pretty much "whatever the doctors say is medically indicated" so I don't need a doula to help me think through my options now or during labor, my labor will be highly medicalized/not natural no matter what, I feel pretty happy with my hospital medical team (although maybe I'll get a bad nurse?), I could end up confined to a bed/having pain relief, so maybe a doula won't be that helpful anyway?
I've read through previous Asks on doulas, but if you've used one, what were the big benefits they provided? Do you think those benefits would be helpful given my particular situation?
Due to a genetic blood-clotting disorder that I have, I'll need to have an induced labor at 39 weeks. My husband and I are now grappling with whether we want to hire a doula to assist us (we're both newbs at this!), since many of the helpful pluses of having a doula (help with thinking through a birth plan, help with early labor at home, help in keeping the labor completely natural) seem to have gone out the window with the highly-medicalized planned induction.
The induction will be pretty set in stone, since my medical team doesn't want to take any chances with clots (I'm, like, a super-clotter of epic proportions, according to my hematologist). The induction will include:
- being hooked up to a continuous IV drip from the moment I check in to the hospital (so that I can get a particular clotting medication)
- some combination of cervical softener and pitocin drip, depending on how labor is progressing. Medical team is willing to take it slow - about half of inductions last longer than 24 hours at this hospital.
- eating is fine during early labor, "clear liquids" allowed (including applesauce, jello, energy drinks, if desired) during active labor
- intermittent fetal monitoring if things are going well, so I'll be able to move around and get into a shower and the labor room tub, should I so desire. I'll have to have continuous fetal monitoring and stay in bed if things aren't going so well or if I want any pain relievers
- pain relief options: nitrious oxide and the typical opiates (Demerol/Fentanyl) in early labor, nitrous oxide and Remifentanil (very short half-life opiate) available in active labor through the pushing stage
- NO OPTION OF EPIDURAL (blood clotting medication means no big needles near my spine)
- general anesthesia will be required if I end up with a c-section (again, no big needles near my spine)
This will be taking place at UCSF which is a VERY women and baby-friendly hospital here in crunchy San Francisco. They're also up-to-date on all of the latest medical research, and have a brand-new women & children's facility where I will be giving birth (this is why I can get nitrious oxide & remifentanil during labor, both of which are relatively uncommon in the States). I'm super-confident in my medical team overall (high-risk maternal-fetal specialists, hematologists, anesthesiologists), although I don't know who will be on-call when I'm laboring.
So, given that set-up, to doula or not to doula?
Pros: give my husband breaks if labor is long (likely), suggest different positions or adjustments for help with the pain (especially since I don't have the option of an epidural!) and to move the labor along, giving massage as desired, helping to keep me focused/calm if I use opiates and get disoriented, and someone to stay by my side during recovery if I need to have a c-section & general, so my husband can be with the baby.
Cons: my birth plan is pretty much "whatever the doctors say is medically indicated" so I don't need a doula to help me think through my options now or during labor, my labor will be highly medicalized/not natural no matter what, I feel pretty happy with my hospital medical team (although maybe I'll get a bad nurse?), I could end up confined to a bed/having pain relief, so maybe a doula won't be that helpful anyway?
I've read through previous Asks on doulas, but if you've used one, what were the big benefits they provided? Do you think those benefits would be helpful given my particular situation?
I found pitocin incredibly painful, and epidural was my saving grace. Without an epidural you may want a doula for help with pain management. That alone could be worth it.
posted by St. Peepsburg at 1:54 PM on March 16, 2016 [1 favorite]
posted by St. Peepsburg at 1:54 PM on March 16, 2016 [1 favorite]
Best answer: A lot of the best benefits for me, with a fairly easy delivery, were help afterward... Help with what to tell friends about how to help, help to get what I wanted or needed, helping me find resources that I hadn't expected to need (like meditation tapes when I was anxious and couldn't sleep... She went and got those for me), making sure my house was clean and dinner was waiting when we arrived home...
During labpur some of the benefits included being able to allow mr. chapps to just have his experience alongside me at the delivery,
The deciding factor for me was research that the presence of a doula reduced stress during delivery for mom-to-be, which was true for me, because it meant a constant presence while medical staff came in and out.
Important to me was that my doctor knew and liked my doula, and that she was well liked and appreciated by nursing staff, so I encourage you to ask for references from the doctor/midwife and hospital.
In short, I never regretted having her, and the help provided shifted to meet my needs, I say go for it.
posted by chapps at 1:57 PM on March 16, 2016 [1 favorite]
During labpur some of the benefits included being able to allow mr. chapps to just have his experience alongside me at the delivery,
The deciding factor for me was research that the presence of a doula reduced stress during delivery for mom-to-be, which was true for me, because it meant a constant presence while medical staff came in and out.
Important to me was that my doctor knew and liked my doula, and that she was well liked and appreciated by nursing staff, so I encourage you to ask for references from the doctor/midwife and hospital.
In short, I never regretted having her, and the help provided shifted to meet my needs, I say go for it.
posted by chapps at 1:57 PM on March 16, 2016 [1 favorite]
Best answer: I had a doula when my son was born, and I was *just* telling my fiance (yes, kind of out of the blue) that I would absolutely want to have one again and that it was the best decision I have ever made about medical care. (Despite that it felt financially reckless at the time to spend $300 on a student doula.)
The benefit for me was much less about "someone to guide me through the medical options" and more about "someone who is very comfortable with this whole process and will be there the whole time." Even a super-awesome medical team generally won't have someone actually with you the whole time, just checking on you periodically.
posted by cogitron at 1:59 PM on March 16, 2016 [2 favorites]
The benefit for me was much less about "someone to guide me through the medical options" and more about "someone who is very comfortable with this whole process and will be there the whole time." Even a super-awesome medical team generally won't have someone actually with you the whole time, just checking on you periodically.
posted by cogitron at 1:59 PM on March 16, 2016 [2 favorites]
yes. I was induced with my first and had a midwife with me, but she didn't have medical authority due to the induction, so was performing the job of a doula. it was invaluable. hospital staff can be...brusque? efficient? and she was there to translate jargon for me and remind them that I was a person, not a, like, car engine they were working on. she also guided my husband when he looked like he was getting wobbly. absolutely invaluable.
posted by lizifer at 2:03 PM on March 16, 2016 [1 favorite]
posted by lizifer at 2:03 PM on March 16, 2016 [1 favorite]
I went from zero to c-section in record time and I'm still very glad we had a doula (it was probably her shortest out-call ever!). I vote definitely yes, most especially for a birth that is medically complicated and without the option of epidural.
posted by soren_lorensen at 2:04 PM on March 16, 2016 [2 favorites]
posted by soren_lorensen at 2:04 PM on March 16, 2016 [2 favorites]
Best answer: I'm an L&D nurse and I am very pro-doula in general, but I'm especially so in situations like yours when your assigned RN is going to be very busy managing your medical care/IV drips/etc. and might not have a lot of time to do the back-rubbing-and-counterpressure-and-cool-cloth-applying labor support that is (or at least, should be!) part of our role during uncomplicated labor. A doula can do all of those things, and help your husband best help you.
I absolutely think you should have a doula. I have personally worked with and can recommend Desiree Tamsky and Alexis Cohen, both of whom will be very familiar to and respected by the providers and nurses at UCSF.
posted by jesourie at 2:06 PM on March 16, 2016 [16 favorites]
I absolutely think you should have a doula. I have personally worked with and can recommend Desiree Tamsky and Alexis Cohen, both of whom will be very familiar to and respected by the providers and nurses at UCSF.
posted by jesourie at 2:06 PM on March 16, 2016 [16 favorites]
Best answer: No epidural? Absolutely get a doula, in my opinion. The massage and pain management assistance could be huge. I don't know what other pain management preparation you've done, but my doula meant the difference between "utter agony" and "tolerable, empowering experience." She also provided critical communication assistance when an emergency arose; the medical personnel's jargon was alarming us, but once we understood their meaning, it wasn't bad. If you need a Bay Area recommendation, I have one.
posted by slidell at 2:20 PM on March 16, 2016 [2 favorites]
posted by slidell at 2:20 PM on March 16, 2016 [2 favorites]
Best answer: I would not want a doula. When I'm in pain, I just want to check out unless you're going to give me meds or some other medically necessary thing. If you are like this, a doula may not be all that helpful. You know what you want when you feel your worst (cheerleader vs. Checking out).
That being said, a doula can also help with things like nursing after the birth. My baby was a nursing champ but I understand that difficulty with nursing is one of the worst things so struggle with ever.
posted by Kalmya at 2:34 PM on March 16, 2016 [1 favorite]
That being said, a doula can also help with things like nursing after the birth. My baby was a nursing champ but I understand that difficulty with nursing is one of the worst things so struggle with ever.
posted by Kalmya at 2:34 PM on March 16, 2016 [1 favorite]
I had a medically induced birth due to high risk complications, and I firmly believe that without the doula I would've ended up with a c-section. She was really a life saver for us.
I don't have time to fully respond now, but will definitely come back later this evening to add more.
posted by pallas14 at 2:36 PM on March 16, 2016
I don't have time to fully respond now, but will definitely come back later this evening to add more.
posted by pallas14 at 2:36 PM on March 16, 2016
I vote yes for a doula! I found my doula to be even more helpful after the birth: assisting with breastfeeding, answering endless "is this normal?" questions and holding my baby so I could get some rest. I would highly recommend (if you are able) finding someone who is not only a labour/birth doula but also a postpartum doula.
posted by rozee at 2:41 PM on March 16, 2016 [3 favorites]
posted by rozee at 2:41 PM on March 16, 2016 [3 favorites]
Best answer: Given all that, I'd say yes to doula. Having gone through one spontaneous birth and one induction, the induction was way more painful and unpleasant, and not having the option for an epidural means that even with some pain relief options, I think you will find that having someone who is a "pro" at labor pain management and who is exclusively concerned with your physical and emotional comfort (i.e., does not have to take care of 2 other women or concern herself with your blood pressure and making sure your IV drip is running correctly) will be a big plus. At UCSF you should not have any issues with the doula being unwelcome or unfamiliar to the medical team.
posted by The Elusive Architeuthis at 3:06 PM on March 16, 2016 [1 favorite]
posted by The Elusive Architeuthis at 3:06 PM on March 16, 2016 [1 favorite]
(I would try to make sure you interview carefully to get a doula who is comfortable assisting at a birth that you already know is high risk and will have a lot of monitoring and interventions. Someone with a nursing background is probably the optimal candidate.)
posted by The Elusive Architeuthis at 3:12 PM on March 16, 2016 [4 favorites]
posted by The Elusive Architeuthis at 3:12 PM on March 16, 2016 [4 favorites]
I would absolutely choose to get a doula again and I was induced. I was also in a very doula-friendly, mom-and-baby-friendly hospital, and yes yes yes I would have the doula again. A+++++.
I didn't think of my doula as a cheerleader, but rather someone to talk to who had seen all of this stuff before. Her sole focus was on me and the baby, while the doctors and nurses were obviously busy with other things/patients. I did specifically tell her that I'm not a touchy-feely person, and what I did and didn't want out of the doula experience.
I think that, even though you feel like there's no need for a birth plan, there may, for example come a point where they say "well, we could do the c-section right now, or we could wait and try a bit longer", and it will be nice to have someone to talk to about it, in my opinion.
Also! My doula took fantastic pictures of the c-section that my husband could not have taken.
posted by freezer cake at 3:12 PM on March 16, 2016
I didn't think of my doula as a cheerleader, but rather someone to talk to who had seen all of this stuff before. Her sole focus was on me and the baby, while the doctors and nurses were obviously busy with other things/patients. I did specifically tell her that I'm not a touchy-feely person, and what I did and didn't want out of the doula experience.
I think that, even though you feel like there's no need for a birth plan, there may, for example come a point where they say "well, we could do the c-section right now, or we could wait and try a bit longer", and it will be nice to have someone to talk to about it, in my opinion.
Also! My doula took fantastic pictures of the c-section that my husband could not have taken.
posted by freezer cake at 3:12 PM on March 16, 2016
Best answer: I had a doula. If you do not have any other support (no friends or other family who can trade off with your husband), and if you can afford it easily, then yes. But only if you interview around and find one who clicks with both of you, who supports your particular situation, and who provides the doula support that you need. (For instance -at least in my area- there are labor doulas and postpartum doulas. Those are two separate services. Just be sure you know what you're getting.)
I am glad we had the doula, but I would not hire one again. We paid $800 for labor doula services only. I felt we needed an advocate and that's why we hired her; I was sure the hospital nurses and doctors would be adversaries in my quest for a natural birth, which of course I'd have a natural birth. Nope! Baby was huge and super late, had to be served an eviction notice by induction. After many hours of unmedicated labor, I had an epidural, then pitocin, then c-section. At each step, the dreaded "slippery slope of hospital interventions," I felt judged by the disappointed doula. I had tremendous guilt over betraying my natural birth plans. It sucked. (And later conversations revealed, yes, she was disappointed and I was not just projecting during the throes of labor.)
Meanwhile, the hospital nurses and doctors could not have been nicer or more supportive. I left the hospital a) alive and uninjured (my c-section was easy recovery) b) with a healthy living uninjured newborn, c) with a tremendous amount of relief and wonder at the miracle of modern medicine, and d) with complete frustration at the natural birth community which doesn't consider my experience to be "the right way to birth."
On the pro-doula side of things, my husband was out of his depth at the hospital and even passed out at the sight of the epidural needle. The doula was good support for him, especially in the OR when I was having the c-section. But I'm pretty sure we could have found a friend/family member to be there instead. And that's what I'd do if we ever do it again.
I have a hard time uncoupling the doula support from the natural birth rabbithole, and I am sure there are doulas who don't come with the natural birth baggage, especially in San Francisco. But, again, interview around and find somebody who clicks with you and supports your situation. Make double extra sure that you are all above-board with your expectations.
posted by aabbbiee at 3:22 PM on March 16, 2016 [2 favorites]
I am glad we had the doula, but I would not hire one again. We paid $800 for labor doula services only. I felt we needed an advocate and that's why we hired her; I was sure the hospital nurses and doctors would be adversaries in my quest for a natural birth, which of course I'd have a natural birth. Nope! Baby was huge and super late, had to be served an eviction notice by induction. After many hours of unmedicated labor, I had an epidural, then pitocin, then c-section. At each step, the dreaded "slippery slope of hospital interventions," I felt judged by the disappointed doula. I had tremendous guilt over betraying my natural birth plans. It sucked. (And later conversations revealed, yes, she was disappointed and I was not just projecting during the throes of labor.)
Meanwhile, the hospital nurses and doctors could not have been nicer or more supportive. I left the hospital a) alive and uninjured (my c-section was easy recovery) b) with a healthy living uninjured newborn, c) with a tremendous amount of relief and wonder at the miracle of modern medicine, and d) with complete frustration at the natural birth community which doesn't consider my experience to be "the right way to birth."
On the pro-doula side of things, my husband was out of his depth at the hospital and even passed out at the sight of the epidural needle. The doula was good support for him, especially in the OR when I was having the c-section. But I'm pretty sure we could have found a friend/family member to be there instead. And that's what I'd do if we ever do it again.
I have a hard time uncoupling the doula support from the natural birth rabbithole, and I am sure there are doulas who don't come with the natural birth baggage, especially in San Francisco. But, again, interview around and find somebody who clicks with you and supports your situation. Make double extra sure that you are all above-board with your expectations.
posted by aabbbiee at 3:22 PM on March 16, 2016 [2 favorites]
I work at a crunchy teaching hospital that has doulas on-call for any patient that wants them, at no charge. Does UCSF have a similar offering? Then you could decide on the spot if you want.
posted by Maarika at 3:28 PM on March 16, 2016
posted by Maarika at 3:28 PM on March 16, 2016
Best answer: So I was induced at 38.5 weeks due to some medical complications, and very much had the classic intervention cascade except I did manage to escape without a c-section.
My doula was very very helpful to me. Yes, she was able to give my husband some relief, but she was also very helpful in talking through what was happening medically. I was very well prepared so I pretty much understood all the jargon, and there wasn't much choice in what would happen, but I did have some control over WHEN it would happen, and she helped talk me through it and decide without being at all judgemental.
My daughter was also in a strange position and wasn't dropping and I couldn't get up and move due to some other complications. She was able to (very carefully!) re-adjust and re-position me and used massage to help move the baby down. I had one nurse who was assigned just to me, but even so, she was busy doing other parts of my care and so did not assist with this. There were even things that my (very capable and excellent!) nurse forgot to do until my doula gently reminded her.
I asked my doctor for recommendations on doulas - I wanted someone that I knew would work in a heavily medical setting, particularly since I knew I might end up with an epidural. I would echo the comments above to choose your doula carefully, one close friend had an experience similar to aabbbiee where after she got an epidural, the doula was disappointed and really didn't have much to help with. (I know an epidural isn't an option for you, but here I'm using as part of the whole medical birth that some of the super granola crunchy folks might not be great with.)
Also, I know it's different for everyone, but for me, it was very helpful to hear about other people's birth experiences. If you'd like to hear more about mine, including my advice for people looking at medical inductions with some higher risk things going on, me mail me.
posted by pallas14 at 4:24 PM on March 16, 2016 [2 favorites]
My doula was very very helpful to me. Yes, she was able to give my husband some relief, but she was also very helpful in talking through what was happening medically. I was very well prepared so I pretty much understood all the jargon, and there wasn't much choice in what would happen, but I did have some control over WHEN it would happen, and she helped talk me through it and decide without being at all judgemental.
My daughter was also in a strange position and wasn't dropping and I couldn't get up and move due to some other complications. She was able to (very carefully!) re-adjust and re-position me and used massage to help move the baby down. I had one nurse who was assigned just to me, but even so, she was busy doing other parts of my care and so did not assist with this. There were even things that my (very capable and excellent!) nurse forgot to do until my doula gently reminded her.
I asked my doctor for recommendations on doulas - I wanted someone that I knew would work in a heavily medical setting, particularly since I knew I might end up with an epidural. I would echo the comments above to choose your doula carefully, one close friend had an experience similar to aabbbiee where after she got an epidural, the doula was disappointed and really didn't have much to help with. (I know an epidural isn't an option for you, but here I'm using as part of the whole medical birth that some of the super granola crunchy folks might not be great with.)
Also, I know it's different for everyone, but for me, it was very helpful to hear about other people's birth experiences. If you'd like to hear more about mine, including my advice for people looking at medical inductions with some higher risk things going on, me mail me.
posted by pallas14 at 4:24 PM on March 16, 2016 [2 favorites]
I would not want a doula. When I'm in pain, I just want to check out unless you're going to give me meds or some other medically necessary thing
I thought this is how I would be, but it turned out to be far worse to be alone in my head with the pain and fear. The doula was really good at reaching me through the pain and also at physically helping to relieve it.
posted by slidell at 4:48 PM on March 16, 2016 [2 favorites]
I thought this is how I would be, but it turned out to be far worse to be alone in my head with the pain and fear. The doula was really good at reaching me through the pain and also at physically helping to relieve it.
posted by slidell at 4:48 PM on March 16, 2016 [2 favorites]
Best answer: I feel that a doula would be very helpful in your situation.
Laboring under pitocin can be intensely challenging, and in a labor/birth which you already know is going to be medicalized, I think having someone going to bat for you on making sure everything else runs well is really going to be of benefit. Labor and birth are mediated by the same set of hormones as having sex, and it's really hard for sex to go smoothly with bright lights, busy hospital staff coming in and out of your room, and tubes/monitors everywhere. A doula can help manage your environment for/with you in ways that are unobstrusive but with the goal of the best, gentlest, and most satisfying birth experience for you & your family.
Choosing the right doula is very important, and I'd suggest seeking one out who
1) you feel a good connection with and would trust to respect your birth plan and boundaries (this goes for selecting any birth professional).
-and-
2) has additional training in manual therapy for pain management since you will not have an epidural available to you.
posted by sutureselves at 6:47 PM on March 16, 2016
Laboring under pitocin can be intensely challenging, and in a labor/birth which you already know is going to be medicalized, I think having someone going to bat for you on making sure everything else runs well is really going to be of benefit. Labor and birth are mediated by the same set of hormones as having sex, and it's really hard for sex to go smoothly with bright lights, busy hospital staff coming in and out of your room, and tubes/monitors everywhere. A doula can help manage your environment for/with you in ways that are unobstrusive but with the goal of the best, gentlest, and most satisfying birth experience for you & your family.
Choosing the right doula is very important, and I'd suggest seeking one out who
1) you feel a good connection with and would trust to respect your birth plan and boundaries (this goes for selecting any birth professional).
-and-
2) has additional training in manual therapy for pain management since you will not have an epidural available to you.
posted by sutureselves at 6:47 PM on March 16, 2016
Best answer: I highly recommend a doula for your situation. Caveat: I am a doula, and I feel like I'm doing my best when I can help someone navigate a medical birth smoothly and with humanity.
You're going to want to look for a doula with hospital experience - if they flinch when you describe your plan, they're not right for you. You do not want a student, even though they'll be less expensive.
posted by linettasky at 7:22 PM on March 16, 2016 [3 favorites]
You're going to want to look for a doula with hospital experience - if they flinch when you describe your plan, they're not right for you. You do not want a student, even though they'll be less expensive.
posted by linettasky at 7:22 PM on March 16, 2016 [3 favorites]
Best answer: Because I'm not a doctor or a doula, just someone who had pitocin after I sorta broke water and was considered high risk so induction was the doctor's choice... I wanted to see how this thread progressed before chiming back in... Fuuuuuck pitocin. My lay person direct experience and afterwards understanding is that it was excutiatingly painful (I have a high tolerance for pain) and it doesn't help unless you are already dialated. I was not dialated (see: 24 hours of labor, then c-section)
I'm ELATED to see someone's doula made the difference for them between a c-section or natural birth. You should get an awesome doula. I'm not wanting at all to scare you, I want you to do better than I did it. Without a doula, had I known about the pro's and con's of pitocin, I would have just had the c-section. Maybe. I hardly remember the pain on any real level, just bummed to find out afterwards it usually doesn't work unless you are ready, anyway. I'm going to tell you a sadness I have not shared before because it will help you and it was probably a big betrayal you won't have to deal with, but just in case.... My doctor wanted to induce me but I knew I wasn't ready. I'm pretty sure she loosened my mucus plug even though we discussed it and I said not to - I saw on the sheet after my last exam. That night I started leaking amniotic fluid, went to the hospital, que the pitocin.
It's your body. If you are ready at 39 weeks and if you have considerable extenuating circumstances - go for it. Especially if your cervix is softening and you are showing signs of dialating - ASK ABOUT THIS. If you're no where near going into labor, and it is medically preferable that you give birth under highly controlled circumstances, talk to your doctor about just getting a c-section. I was at the best hospital on the west coast, and no drug administered made what was not ready to happen, happen. YMMV. Talk to your doctor. Please don't freak out! My son is about to turn 5 years old and totally healthy and wonderful, your child will be same! But skip the drama if possible. If your body isn't there yet but that's the date your doctors want, you have decisions to make. It's nice they want to try to give you a chance at natural child birth, not so much if that's not really in the cards but you are being giving a slim chance at the possibility out of respect.
There are a lot of exercises and positions that might have helped labor I could not try because I was also hooked up to IV's and such. If these positions and movements are the difference between labor or c-section, and you can't use them, you need to know this now.
Still get the doula :)) It will be awesome either way!
I wish you the very best experience. I don't regret anything, just telling you the difference between what I knew before, and what I know now. It sounds like you are in better hands than I was, I did not even know to consider a doula way back then. You'll be aces! No worries.
posted by jbenben at 2:26 AM on March 17, 2016 [2 favorites]
I'm ELATED to see someone's doula made the difference for them between a c-section or natural birth. You should get an awesome doula. I'm not wanting at all to scare you, I want you to do better than I did it. Without a doula, had I known about the pro's and con's of pitocin, I would have just had the c-section. Maybe. I hardly remember the pain on any real level, just bummed to find out afterwards it usually doesn't work unless you are ready, anyway. I'm going to tell you a sadness I have not shared before because it will help you and it was probably a big betrayal you won't have to deal with, but just in case.... My doctor wanted to induce me but I knew I wasn't ready. I'm pretty sure she loosened my mucus plug even though we discussed it and I said not to - I saw on the sheet after my last exam. That night I started leaking amniotic fluid, went to the hospital, que the pitocin.
It's your body. If you are ready at 39 weeks and if you have considerable extenuating circumstances - go for it. Especially if your cervix is softening and you are showing signs of dialating - ASK ABOUT THIS. If you're no where near going into labor, and it is medically preferable that you give birth under highly controlled circumstances, talk to your doctor about just getting a c-section. I was at the best hospital on the west coast, and no drug administered made what was not ready to happen, happen. YMMV. Talk to your doctor. Please don't freak out! My son is about to turn 5 years old and totally healthy and wonderful, your child will be same! But skip the drama if possible. If your body isn't there yet but that's the date your doctors want, you have decisions to make. It's nice they want to try to give you a chance at natural child birth, not so much if that's not really in the cards but you are being giving a slim chance at the possibility out of respect.
There are a lot of exercises and positions that might have helped labor I could not try because I was also hooked up to IV's and such. If these positions and movements are the difference between labor or c-section, and you can't use them, you need to know this now.
Still get the doula :)) It will be awesome either way!
I wish you the very best experience. I don't regret anything, just telling you the difference between what I knew before, and what I know now. It sounds like you are in better hands than I was, I did not even know to consider a doula way back then. You'll be aces! No worries.
posted by jbenben at 2:26 AM on March 17, 2016 [2 favorites]
I also found my doula to be very helpful for talking through my pre-birth anxieties. I think that in the Bay Area you should be able to easily find a doula that does not shame you for your non-natural birth plan. I do think you want an experienced doula, probably not a student.
posted by nowmorethannever at 8:52 AM on March 17, 2016
posted by nowmorethannever at 8:52 AM on March 17, 2016
Best answer: I think that in the Bay Area you should be able to easily find a doula that does not shame you for your non-natural birth plan
I really wish this were truer than it is, but unfortunately the cult of natural birth is wide-reaching here. Many, many doulas in the Bay Area have a pretty militant agenda that sometimes includes giving very unsafe and incorrect medical advice to patients. I've had doulas go so far as to slam the room door in my face when I arrive with medically-necessary things like insulin, saying, "This isn't a good time for us." I've had one purposefully tell a trusting first-time mom not to call us when she thought the baby was coming, so no one actually trained and credentialed to deliver babies could be there to catch the baby and the doula herself did it instead. I've seen a very bad outcome when a woman's water broke at 34 weeks and she called her doula for advice, and the doula told her it was fine and she should stay home until she was in labor. It was not fine.
Those are obviously outliers, but I've frequently seen experiences like aabbbie's during which the doula's birth plan was her priority, and her disappointment was loud and clear when the laboring woman made a different choice.
I don't want to name names here in a public forum, but in addition to my recommendations above, I have a few names to avoid. OP or anyone else, please feel free to MeMail me.
posted by jesourie at 11:33 AM on March 17, 2016 [2 favorites]
I really wish this were truer than it is, but unfortunately the cult of natural birth is wide-reaching here. Many, many doulas in the Bay Area have a pretty militant agenda that sometimes includes giving very unsafe and incorrect medical advice to patients. I've had doulas go so far as to slam the room door in my face when I arrive with medically-necessary things like insulin, saying, "This isn't a good time for us." I've had one purposefully tell a trusting first-time mom not to call us when she thought the baby was coming, so no one actually trained and credentialed to deliver babies could be there to catch the baby and the doula herself did it instead. I've seen a very bad outcome when a woman's water broke at 34 weeks and she called her doula for advice, and the doula told her it was fine and she should stay home until she was in labor. It was not fine.
Those are obviously outliers, but I've frequently seen experiences like aabbbie's during which the doula's birth plan was her priority, and her disappointment was loud and clear when the laboring woman made a different choice.
I don't want to name names here in a public forum, but in addition to my recommendations above, I have a few names to avoid. OP or anyone else, please feel free to MeMail me.
posted by jesourie at 11:33 AM on March 17, 2016 [2 favorites]
Best answer: I think obviously you're going to get a lot of different responses, as with any questions and preferences around birth. I liked my doula, but it wasn't a deal breaker in my birthing experience at all. It was nice to have an extra set of hands though. My doula I think helped my husband through the experience more than she helped me, overall! Which was great for him, and sort of, meh, for me :)
I had a medically necessary induction, at 39 weeks also, and though it was nice to have a doula, the very skilled, experienced nurses were really the women/people that assisted me with my birth, advocated for me, and ensured that I actually was able to deliver vaginally. They were friggin' AWESOME!! I have not thought much about my doula since I had my baby last June, but think about those L&D nurses all the time. Is there a midwife on staff at the hospital/team where you are delivering? There probably is. If so, she may be able to assist you while you are in labor (she doesn't have to be YOUR midwife, but a nurse- midwife actually help deliver me last minute because she was around...and she KNEW what she doing.)
It sounds like that might be the case where you are giving birth, too? In that case, I think a doula is very optional.
I don't want to freak you out, but without an epidural, I probably would have had a C-section. It was just so long and so painful. I also had the pitocin, endless monitoring, etc- it really was SO ANNOYING and stressful- but, again, I had an amazing team overall, and boy, if I had not had them, it would have been really different. Of course, it would not have been the end of the world if this had happened, but whatever you can do to manage the pain use it. If that includes the best friggin' doula you can find, I would go for it.
Feel free to write me if you need more information on the induction process. I had no idea, really, until it was happening, so I would have loved more people to talk to!
Good luck!! Keep us posted.
posted by Rocket26 at 4:21 PM on March 17, 2016
I had a medically necessary induction, at 39 weeks also, and though it was nice to have a doula, the very skilled, experienced nurses were really the women/people that assisted me with my birth, advocated for me, and ensured that I actually was able to deliver vaginally. They were friggin' AWESOME!! I have not thought much about my doula since I had my baby last June, but think about those L&D nurses all the time. Is there a midwife on staff at the hospital/team where you are delivering? There probably is. If so, she may be able to assist you while you are in labor (she doesn't have to be YOUR midwife, but a nurse- midwife actually help deliver me last minute because she was around...and she KNEW what she doing.)
It sounds like that might be the case where you are giving birth, too? In that case, I think a doula is very optional.
I don't want to freak you out, but without an epidural, I probably would have had a C-section. It was just so long and so painful. I also had the pitocin, endless monitoring, etc- it really was SO ANNOYING and stressful- but, again, I had an amazing team overall, and boy, if I had not had them, it would have been really different. Of course, it would not have been the end of the world if this had happened, but whatever you can do to manage the pain use it. If that includes the best friggin' doula you can find, I would go for it.
Feel free to write me if you need more information on the induction process. I had no idea, really, until it was happening, so I would have loved more people to talk to!
Good luck!! Keep us posted.
posted by Rocket26 at 4:21 PM on March 17, 2016
Best answer: [I know this is a little off the subject of the question, so if it seems like a derail to the mods, I will understand the deletion.]
Regarding pitocin, so much depends on whether or not it's being used safely and responsibly.
I think a lot of the bad experiences people have with it (and I don't want to appear dismissive, I know those experiences are much too common, I hear and believe women when they talk about their births!) occur because the rate of the drip is being increased too frequently or by too large an increment, causing contractions that are too close together or that last too long. Non-evidence-based pitocin augmentation is basically a matter of cranking it up until the baby doesn't tolerate it and needs a c-section, or until rapid vaginal delivery, whichever comes first. Mimicking the experience of spontaneous labor is not a consideration, and how the laboring woman herself is tolerating the process is basically ignored. Unfortunately, there are still lots of hospitals out there that are operating under this model, and it harms women immensely.
Thankfully, Pitocin's use in evidence-based teaching hospitals has changed a lot. The emphasis is now on a less-is-more strategy, and there are very strict protocols in place for how often the rate can be increased and by how much. A slow ramp-up to active labor is the goal, and causing too many contractions too close together is considered hugely problematic and is avoided. Nurses follow a very complicated algorithm to assess the fetal heart rate and contraction pattern in order to titrate the dose appropriately. And when it doesn't seem to be working, it's turned off, some time passes, and then it's started over again at the lowest dose.
When used correctly, Pitocin augmentation shouldn't be any more difficult than spontaneous labor, keeping in mind that in most women, active labor is characterized by strong contractions that come regularly somewhere between every 2-5 minutes and that last for 60-90 seconds each time. I totally understand the idea that spontaneous active labor would be somehow less intense, but (again, when the Pitocin is being used correctly and only when it's being used correctly) it's usually not.
posted by jesourie at 6:07 PM on March 17, 2016 [4 favorites]
Regarding pitocin, so much depends on whether or not it's being used safely and responsibly.
I think a lot of the bad experiences people have with it (and I don't want to appear dismissive, I know those experiences are much too common, I hear and believe women when they talk about their births!) occur because the rate of the drip is being increased too frequently or by too large an increment, causing contractions that are too close together or that last too long. Non-evidence-based pitocin augmentation is basically a matter of cranking it up until the baby doesn't tolerate it and needs a c-section, or until rapid vaginal delivery, whichever comes first. Mimicking the experience of spontaneous labor is not a consideration, and how the laboring woman herself is tolerating the process is basically ignored. Unfortunately, there are still lots of hospitals out there that are operating under this model, and it harms women immensely.
Thankfully, Pitocin's use in evidence-based teaching hospitals has changed a lot. The emphasis is now on a less-is-more strategy, and there are very strict protocols in place for how often the rate can be increased and by how much. A slow ramp-up to active labor is the goal, and causing too many contractions too close together is considered hugely problematic and is avoided. Nurses follow a very complicated algorithm to assess the fetal heart rate and contraction pattern in order to titrate the dose appropriately. And when it doesn't seem to be working, it's turned off, some time passes, and then it's started over again at the lowest dose.
When used correctly, Pitocin augmentation shouldn't be any more difficult than spontaneous labor, keeping in mind that in most women, active labor is characterized by strong contractions that come regularly somewhere between every 2-5 minutes and that last for 60-90 seconds each time. I totally understand the idea that spontaneous active labor would be somehow less intense, but (again, when the Pitocin is being used correctly and only when it's being used correctly) it's usually not.
posted by jesourie at 6:07 PM on March 17, 2016 [4 favorites]
Response by poster: Thanks to everyone for your advice and recommendations! I've marked a few best answers for the ones that really made me think, but appreciate who weighed in.
One thing I didn't mention (since I thought it muddied the waters) is that we actually already had a doula lined up, but ended up having to fire her when it became clear that she was not comfortable attending an induction, and that, basically, she was shaming us for needing an induction and not having a completely natural childbirth. (Yeah... Let's just say that it sucks to be fed horror stories about inductions-gone-wrong with mom & kid dying when it's very clear that I must get one due to the clotting disorder.)
Anyway, your stories convinced me that our initial get-a-doula instincts were right, despite the first doula not working out. We've since hired someone who knows exactly what the situation will be like, is fine supporting us in any way she can given our labor scenario, and is a super calming and centering presence. Again, I really appreciate everyone weighing in with their stories and advice!
posted by Jaclyn at 6:55 PM on April 6, 2016 [1 favorite]
One thing I didn't mention (since I thought it muddied the waters) is that we actually already had a doula lined up, but ended up having to fire her when it became clear that she was not comfortable attending an induction, and that, basically, she was shaming us for needing an induction and not having a completely natural childbirth. (Yeah... Let's just say that it sucks to be fed horror stories about inductions-gone-wrong with mom & kid dying when it's very clear that I must get one due to the clotting disorder.)
Anyway, your stories convinced me that our initial get-a-doula instincts were right, despite the first doula not working out. We've since hired someone who knows exactly what the situation will be like, is fine supporting us in any way she can given our labor scenario, and is a super calming and centering presence. Again, I really appreciate everyone weighing in with their stories and advice!
posted by Jaclyn at 6:55 PM on April 6, 2016 [1 favorite]
This thread is closed to new comments.
Yes. If just to hold your hand and say with confidence everything is OK (my husband could not do that, obvs) YES, get the doula. For both you and your husband.
posted by jbenben at 1:52 PM on March 16, 2016 [5 favorites]