A Doula's Tips from 100+ Births!

By Erin Stertz-Follett

Since 2012, I have been honored to attend more than 100 births throughout the Twin Cities. First-timers, repeat parents, vaginal and cesarean births, VBACs, and the births of multiples! In some ways, I have "seen it all." Over this time and through bearing witness to the most tender and powerful moments, I have learned a few valuable lessons. I hope that sharing these will help expectant parents and birth professionals alike as they voyage through the process of birth. These are pieces of wisdom that are hard to gain just by reading a book or attending a workshop or birth class - They have been learned through watching many clients labor and birth their babies.

Preparation matters.
Birth, just like parenting, is a little bit planning and a little bit on-the-job experience. In our society, "going with the flow" is often championed as the best way to move through life. This is most certainly true in many ways. However, in birth, with all of the options there are, messages we receive, feelings we have (personally and as a culture) around birth, and energy that is necessary, "going with the flow" without a firm foundation can have undesired consequences (in our humble experience). First you need to learn what this whole birth "flow" is all about!

I like to encourage parents to take *some* kind of childbirth education to learn not only what the process of birth looks like, but also how to mentally and physically navigate the process. Of course, I am a bit biased towards out-of-hospital classes like these, because they teach you how to be good parents/birthers vs. just being a good patient. They cover how to make informed choices, and be your own best advocate, which makes you feel powerful. Whatever you do, prepare in some way and encourage others to do the same! Trust me, you will feel ready for whatever turn your birthing may take. And you will be able to take full ownership over your own birth.

Provider choice is so important. Trust your gut.
A common adage we "birth nerds" use is this: Don't go to a Chinese restaurant and expect to eat the best Italian food of your life. In other words, don't choose a provider (OB, midwife, family practice doc) that is clearly not in alignment with what you want, while simultaneously expecting to have the birth you want. Instead, choose a provider who truly, sincerely embraces your birth preferences. How will you know it's the right fit? Ask them questions - How do they feel about common labor interventions and how often they use them, how often do they support parents who want your type of birth, what is their cesarean rate, etc? The answers of your doctor or midwife should affirm that they routinely practice in a way that is compatible with your birth preferences. If their answers don't meet your criteria, look elsewhere. It is never too late to make a change.

The same can be said for birth location - If you want a no- or low-intervention birth, don't select a hospital with a higher cesarean rate, or whose "birth of the day" is a high-intervention one. Birth is a time in which women are very powerful, but also very vulnerable to the input they are receiving from their surroundings. Medical providers wield power and expertise, and birth is the very last place you want to be in "fight-or-flight" mode or feel intimidated. You need endorphins and oxytocin being released (happy hormones!), not adrenaline/catecholamine ("Help, I need to escape!" hormones). Remember that doulas/support professionals/partners cannot "save you" if you wind up in a situation during your birth that puts you on the defense. Plan ahead, interview providers, ask your support team for their opinions, and shop around *ahead of time* so you can feel calm and confident going into your birth! Check out this previous blog post for more tips on finding a supportive provider!

Water is everything.
Water is the source of all life, this we know! Doulas also know that it is an essential source of energy (and of course, hydration) throughout labor and birth. It provides a balance in your body's fluids, boosts circulation (including circulating oxygenated blood to your uterus), helps to maintain your body temperature (laboring women get warm!), reduces swelling, and distributes nutrients.

One easy way to get enough water intake is to take a sip after *every* contraction/surge, especially as labor moves along into the more active phase. Of course, snacking as much as you can/feel comfortable doing is also important in keeping you energized throughout labor! But, if you don't feel hungry, be sure you are continually drinking - Smart Water is a great alternative to plain tap water, as it contains energy-boosting electrolytes! While you're at it, be sure to also use the bathroom about once every hour, even as labor advances and it feels like the last thing on your mind. This allows baby an easier journey down (no full bladder to wrestle with!) and helps you see if your fluid intake is where it should be. In cases where mom hasn't been taking in enough fluids, we see longer labors with moms tiring-out much sooner. So, drink up!

No two births are exactly the same. Never predict how things might go.
"My last baby came in just five hours, so this one should fly right out!" -- "My first labor was 64 hours, so I bet I am in for the long haul this time too." -- "My mom had a cesarean, so I think I will need one as well." -- "My friend had an epidural, and she and I have the same personality, so I bet I will want one, too."

These are all just examples of things I have heard from birthing parents in my time. The problem? None of these are inherently true. Sometimes baby #1 (or #2) is fast, while the subsequent little one takes their sweet time. And sometimes the opposite is true! There is nothing to support the idea that the type of birth your mother had is a prescription for what your birth will look like. Your birth will most certainly look different than your friend's... or your neighbor's... or the woman down the hall in the labor and delivery unit. My point? Go in with as few expectations as possible when it comes to exactly what your birth will look like. Focus on positive messages, yes, but do not make any finite assumptions! If we knew exactly what each birth would look like, doula and educators would soon be out of jobs as you wouldn't need our guidance anymore (and that would make us so, so sad).

"Slow" labor doesn't mean something is wrong, and patience is important.
One of the first skills we doulas learn is how to "help a labor progress." This may mean changing positions, movement, certain types of gentle bodywork, 'Spinning Babies' fetal positioning techniques, etc. However, let it be known that sometimes, there is really nothing "wrong" and nothing that needs doing. This can be hard when we feel/assume that all women want a "fast" birth and there is something in the way if it doesn't happen speedily. Or when we as doulas assume that our job is to constantly be "doing" something. Sometimes, we just need to wait for baby to find his/her way and for mom's body and baby to continue to work together at their own pace during the dance of birth. We just need to hold the space and bear witness. Turn down the lights, turn up the soothing music, and allow the process to unfold unless there is a real reason to try to move things along.

Cervical exams mean very little.
"The cervix is not a crystal ball." It cannot tell us exactly when labor will start, how long it will last, or when baby will be born. In both pregnancy and labor itself, cervical exams are best kept to a minimum and used judiciously - When you have a good reason to be going on a search for answers, AND when you know what you will do with that information. If they are being done out of sheer curiosity on your provider's part, or because you are on a "time clock" with your labor, then they are not being used wisely. Think to yourself, before accepting a check, "What will we do with the information found? Will it change our decision-making before or during labor? What if I am not as far along as I think I am - Will that be deflating?" After all, curiosity killed the cat.

Where the mind goes, the body tends to follow.
Ever hear of the Law of Psycho-Physical Association (aka the Mind-Body Connection)? Yeah, this is huge in birth. Whether we know it or not, for every thought or feeling we have, there is a physical or chemical reaction in our bodies. Fear = jumpiness, shaking, heart racing. Nervousness = red face, or pale face, shaking, sweating. Stress = sore muscles, tight jaw, fatigue, etc. Sexual arousal = lubrication, hormonal shifts, and yes, baby-making. It is so important that those around a birthing person help to keep them calm and in full-on endorphin-release mode. We want them laughing, crying happy/healing tears, reciting positive affirmations, and working through each little transition in labor without thinking or feeling in ways that cause negative reactions within the body. This allows for a smoother, easier birth experience for mom and for baby!
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Sometimes things don't go as planned.
"Even the best-laid plans..." Birth is magical, mysterious, and unpredictable. There are no guaranteed outcomes. Sometimes babies tell us that they need to be born in a different way or on a different timeframe than what we had assumed. Sometimes there are answers, and sometimes they are slow to come. Sometimes they never do. In those moments, I have found it paramount that birthing families are surrounded by understanding medical providers and support people who will explain the options, sit with them in the quiet time and process, remind them how powerful they are, and be there afterwards in case they need extra guidance and healing. If anyone, any place, or any program promises specific birth outcomes, that should be a red flag. Be prepared, educated, and supported. But also be flexible.

Happy Birthing, and if I can do anything to make your experience a better one, please let me know!

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About the Authors

Erin Stertz-Follett and Brittany Kubricky work in partnership to bring doula services, empowering childbirth education, and early parenting support to Twin Cities families. Flutterby is located in Minneapolis, Minnesota!