Meeting the Doulas

We have been advising women to strongly consider having a doula or birth coach present at their childbirth and to look for help for a postpartum doula when baby comes and more help is needed. Doulas provide personal and customized help to couples and support to attain their birth plans and beyond. My own experience of having a doula with me during childbirth (twice) was so important in getting the experiences that my husband and I wanted with the best possible healthy outcomes. We provide guidance to women in how to choose a doula.

I had the pleasure of talking with doulas who are members of the Central Texas Doula Association on December 3, 2013 in Austin. Each of the doulas has helped women who are age 35 or better in their work and were interested in the focus of our nonprofit.

Central Texas Doula AssociationNotes from the meeting are shared below, which show the understanding and support that doulas have for women and their partners during this important time in their lives.

“Founder Sharon Munroe of the Advanced Maternal Age project shared with us today. She became a mom for the first time at age 40, then fostered to adopt at age 42, then had second baby at age 44; she has experienced first hand the deleterious effects of modern medical care on the psyche of the advanced maternal age (AMA) mom. She is a market researcher by training.

The words commonly used to describe an AMA mom can be depressing. “Elderly primigravida”, you could be referred to the new specialty of “geriatric obstetrics”. In her experience, the OB automatically assumes the AMA is a high risk patient, when sometimes there are NO risks at all, mom may even be in great shape. Many moms come away feeling more distressed and scared due to more tests, that “warnings” may be standing orders, but it may be the norm for that particular practice, they just don’t know any better.

She wants everyone to know YOU CAN HAVE A HEALTHY BABY AT AGE 35 OR OLDER, and believes that the more women who defy the odds and tell their stories the better.

Her website includes info on how to choose: a doula, midwife, OB and is intended to be reassuring, reinforcing that women have multiple choices/multiple paths in prenatal and birthing care. She feels she is seeing a trend to using midwives, more about getting what they want in birth and to be treated as a woman, not just a patient. She also acknowledged that if fertility was an issue, those women tend to lean more to hospital/obstetric care and often have a significant amount of fear and sometimes loss issues.

Her desire is that we channel our AMA moms to the website and then after the birth (sometimes years later) have them tell their story.”

 

Doulas in the Hospital

We have begun a new column where our readers can write in with their questions. We’ll field the questions to one or more experts in the subject and post the responses typically within 2 weeks. Write Us with Your Question!

Shelley Scotka

Shelley Scotka, Birth Doula and Childbirth Educator


Our expert for this question below is Shelley Scotka, an experienced doula and childbirth instructor in Austin, Texas.  Shelley is a mom of two and has been helping women and their partners since 1995. Read more about Shelley here.

Q: How does a doula work with my physician and the nurses in the hospital where I am delivering?

A:  A birth doula works alongside medical care providers but does not provide medical care. Instead, a doula provides emotional, physical and informational support for the laboring woman and her partner. Medical care providers, including your doctor and labor nurses, are really “lifeguards” who oversee the safety of the mother and baby. A doula is there to offer continuous support, to make sure the woman feels cared for, safe and respected. A doula listens and reassures, offers suggestions for positioning and comfort, uses touch and massage, and encourages communication between a woman and her medical care providers. After the baby is born, a doula stays in touch with the family and offers additional support with breastfeeding, newborn care, and making sure the family transitions well during postpartum.

 

We’d love to see your question. Write Us!

Surround Yourself with Support – Ideas from Editor, Sharon

After getting the Advanced Maternal Age stamp on my medical chart with my first son at age 39 and waiting over three years for another viable pregnancy, I made up my mind to do things differently and even more deliberately with Shannon, my second son. Now at age 43, my life was drastically different. My husband and I were raising a 3-year-old biological son and a 6-month old foster daughter, who had been our home since she was 5 days old. I became a business owner the year prior, starting Little Green Beans. I was older, but at the same time, wiser. Most importantly, I considered my choices again.

I share these choices and suggestions with first-time moms of age 35 or better not to say that my/our way is best, but to open your eyes to the possibilities and to get the birth you want, if at all possible for you and your baby.

 

Choose your practitioners with care.

In every part of the U.S., there are skilled practitioners, including obstetricians, perinatologists, midwives, and nurses. There are many schools of thought. Research your options, interview the people who you will be working with for the next 8 or so months, ask them about pregnancy outcomes (e.g., such as c-section rates).

  • Does their practice, style, experience, and philosophy match yours? If yes, move forward. If not, do more research to find a match.

Where do your prefered practitioners deliver babies? Hospitals with certain restrictive policies or ones with more flexible practices based on mothers’ choices, birthing centers, or at-home deliveries are some of the options available. Why do the practitioners deliver where they do? Again, seek a match with the birthing location and your own choices, health and needs in mind. This is another considered decision. Read my earlier story for more info.

Prepare by writing a birth plan.

This is a plan, not a mandate, for what an ideal childbirth is like for you and your partner. What are your preferences regarding medications, walking and monitoring during labor, and showering (yes, you have that option in many cases)? Do you prefer low lighting and soft music during contractions, prior to the bright lights required for delivery? Do you wish to wear your own pajamas until the big “push” when your baby is delivered? Who holds the baby and when? When do you want to try nursing and have the basic newborn care done?

  • Preparing a birth plan of preferences and are very important to most moms of age 35 or better. Otherwise, assumptions and stereotypes could creep in.

Hire a doula.

Unless your mother or sister is someone that provides you with unconditional support and uniquely understands you, childbirth, and all of the challenges, I strongly recommend hiring a doula. A doula is your support person, who helps you and your partner understand the specifics of this unique pregnancy, labor, delivery and even postpartum. She works for you and agrees to respect your wishes and choices. She is literally someone to lean on during labor. Most doulas have assisted with many births and worked in a variety of settings. She can visit you after birth and support you as you transition to life at home. My doula Shelley Scotka, saw my strong back aches after birth and sent over a wonderful friend Sally Leissner, a fellow doula, who is also a massage therapist to my home. Find someone who is a true match for you, your partner, your practitioner and your childbirth facility.

  • With the advanced maternal age label on your chart, an unknowing doctor (not yours but their colleague) or nurses (and you will see many during the numerous hospital shifts for the labor and delivery ward) may make assumptions.

You want your labor and delivery preferences and choices known. Your doula is your voice, communicating your wishes and supporting you and your partner on this special day.

Supplement medical care with mama care.

In addition to the basics of seeing your practitioner for scheduled visits, plus any additional visits due to issues that arise, consider holistic options as needed.

I suffer from indoor and outdoor allergies regularly and this pregnancy was no exception. During my second trimester with Shannon, I had allergy-induced headaches that were painful. Mindful that I could take Tylenol (only), I went to Cindy Freeman, trained in acupuncture and oriental medicine, and received treatments of 30 minutes twice per month. When early in my third trimester, pubic synthesis pain hit me hard and fortunately was relieved through some additional fine needles.

Chiropractic care and adjustments can bring relief for certain types of pain. When my pregnancy headaches appeared, I had a 30-minute consultation with an experienced chiropractor to see if the pain would subside. It didn’t in my case, and acupuncture did fortunately. After birth, I sought out a chiropractor to relieve the back pain that the 8 hours of back-labor with Shannon. I had a couple weeks of pain, that fortunately went away.

Eat well, exercise in moderation and take your vitamins.

Hopefully, if you are trying to get pregnant you are already taking prenatal vitamins. If not, there are many choices, including some affordable ones from the natural food stores. With my first pregnancy, I was convinced that I needed to take the prescription vitamins that I had sampled at my OB’s office. With my second pregancy, I learned that the price of those same vitamins would cost me $3/per pill, based on a different insurance policy. (I did the math and multiplied by 270+ days and beyond when you elect to breastfeed and that adds up) You have choices in vitamins. Just make certain that you are getting the recommended 800 mcu of Folic Acid or supplement with another pill.

If you are physically fit, by all means continue to do what’s working as recommended by your practitioner. Weightlifting is typically off limits for most pregnant mamas.

  • If you haven’t been on an exercise routine, walking and swimming can be ideal.
  • I spent most of last summer (months 7 to 9), which were some of the hottest on record here in Austin in the pool. Swimming relieved my back strain, kept me cool, and gave me an easier way to play with my kids.

On eating, we are all tempted to eat more and richer foods while pregnant. I had different cravings with both of my boys. It was important to watch it though as we gain about a pound each week in the second and third trimesters of pregnancy.

  • Eating healthy with protein, vegetables, fruits, and whole grains versus a complete meal of ice cream, while tempting, is always advisable.
  • Eating smaller meals and more frequently is ideal for many women who have cravings and/or nausea.

Prenatal yoga helps women of all ages and, importantly, does a few things like nothing else we can do to prepare for pregnancy and childbirth.

Prenatal yoga for yourself and together with your partner.

I am a big proponent of prenatal yoga and my recent conversation with my longtime friend and instructor Sarah Evans reminded me why. Prenatal yoga helps women of all ages and, importantly, does a few things like nothing else we can do to prepare for pregnancy and childbirth.

  • It helps us form or strengthen a mind-body connection. During childbirth, especially an unmedicated birth, we must prepare our minds to talk with and not fight our bodies. Pain in childbirth is real (for me it was intense due to back labor due to the positioning of both of my boys).
  • Mindful, deep breathing, poses for relaxation during and between contractions, and practice mini-sessions of pain endurance are some of the tools in the prenatal yoga toolkit.

Prenatal yoga provides community for expectant moms. It is a place to talk about our physical health and concerns. It’s a place to get answers, not medical advice, from experienced moms and your instructor, typically a mom herself. When we share in that setting, we give and get a lot. (Two of my good friends were met in class and we shared for weeks. My friend Alicia (from my 2007 birth) and I have stayed in touch with her older son being a month older than my Patrick. It is her OB practice that I chose for Shannon’s birth after hearing her experiences. Preetha’s son and my Shannon share the same birth date (they were born just one hour apart in the same hospital). ) These are unique connections. Read more about prenatal yoga in Sarah Evan’s Guest Blog.

“Practicing yoga with one’s birth partner in a class or private session helps to connect with one another and consider what birth might feel like in a highly supportive setting.”

  • What can your partner do to support and not hinder your childbirth? Can they help relieve stress through massage or calming words? All of this can be part of what you practice together.
  • Seamus and I took the Prenatal Yoga for Partners course offered by Sarah’s studio, Yoga Yoga, both in 2007 and 2011, with the goal of being on the same page for our sons’ births.

What has supported you in your pregnancy and childbirth in an advanced maternal age? What other choices are there for mothers to consider?

 

Images courtesy of: http://www.freedigitalphotos.net/

Sharon’s Story: Part 2

Text Book Pregnancy – an Earlier Chapter

After a hard loss of a first pregnancy, I was thrilled to find myself pregnant just four months later. Still early in my marriage at age 39, I was optimistic (always one to look at the glass half full). Advanced Maternal Age was stamped on my chart at my traditional OB’s office. Dr. B. knew my name, having been my gynecologist for over 10 years, but it was an otherwise impersonal greeting for my very positive pregnancy test that was administered on that warm April day.

Early tests were good, a heartbeat on an ultrasound, no feelings of discomfort or bleeding. Then the reminder of the dreaded CVS test at 12 weeks, the one that had vanished my dream of my first pregnancy and loss the year prior. Into the perinatologist’s office I went with my husband clutching my hand tight. “This time will be better,” he assured me. I held my breath while the long needle gathered fetal cells, ones that could be normal. I kept faith during the long weeks of waiting. I checked in with the genetic counselor I knew well. “Should be next week,” K assured me. “Let’s not worry.” Our next conversation was one week to the day of that initial call and yes, it was good news, “a healthy baby boy was coming in December.”

I felt healthy with limited morning sickness and other symptoms, and was again optimistic. I worked, enjoyed free time with my husband and friends without too much concern. Despite this, Dr. B. was full of warnings each month during my routine visits. There were no emergency calls or extra visits to cause alarm

She likely felt she was helping me by reminding me about upcoming tests. Every time my blood pressure was taken, the new nurse seemed surprised that it was low and healthy. (No one cared to notice that during the prior 10 years of routine care at that office that I never had elevated blood pressure.) After the first trimester, it seemed that Dr. B.’s commentary about risk factors became longer and more frequent. I had no symptoms of a troubled pregnancy so why was I being warned about gestational diabetes, hypertension, and the high probability of c-section?

The chapters and complete books I had read about high-risk pregnancy contained similar warmings and the associated doom and gloom. Why was my doctor worrying me? Was there something else looming? I didn’t understand it. I considered (and still consider) myself young and healthy.

After the standard 20 week anatomical ultrasound, we were thrilled to see all 10 fingers and 10 toes, healthy organs and that our baby boy was growing at a normal rate. I continued to feel good and started to make plans for childbirth. Lots to research and think about I thought.

I enrolled in prenatal yoga class at the well-known Yoga Yoga in Austin. With some 5 prenatal classes per week, I could fit one or two into my busy work and travel schedule. I exercised, learned yogic breathing, and more importantly made connections with my instructors (all wonderful, caring mamas), and new friends. We were in a club of soon-to-be mamas who met weekly to share ideas, and we were going to have babies, many within the same month.

Two of my yoga instructors, including Sarah Evans, my now long-time friend, talked a great deal about the use of yoga in labor and delivery. I was a good student of all of the yoga postures designed to release and relieve pain, and get comfort. I learned to breathe deeply and consciously for the first time in an early evening class. My husband and I attended the studio’s yoga for partners session that focused exclusively on working through childbirth together. I felt empowered and supported in this new chapter in my life.

One of the yoga instructors, Dawn pointed us to certain books that would complement our yoga practice and support us in childbirth. My sense was that this were not the typical books I had found, which were filled with warnings about high risk pregnancy. I read Ina May Gaskin’s Guide to Childbirth cover to cover one evening. It changed everything for me. No, I was not going to her famed “Farm” in Tennessee but my new, aspirational goal was to have natural childbirth, no planned c-section or medications unless absolutely medically necessary. Imagine the surprise on Dr. B’s face when she heard that out of the mouth of her 39-year-old patient?

Next I asked my yoga instructors about doulas. They had mentioned that doulas provide couples with outstanding support in birth and beyond. I wanted a strong, experienced doula on my side if the going got tough. I couldn’t have found a better support person than Dawn Martin, one of Austin’s most experienced doulas and mamas. Dawn had taught Birthing from Within classes, and now is one of the most sought after lactation consultants in our city. We discussed what an ideal childbirth looked like for us and began writing a birth plan to serve as a written document of our childbirth wishes.

In the 25th week, Dr. B. looked at my birth plan with surprise and a bit of shock. “Do not offer me medicines for pain. Do not limit my movement with a fetal monitor UNLESS ABSOLUTELY MEDICALLY NECESSARY for my and my child’s health.” I forced her to sign it and she shrugged her shoulders and scribbled a doctor’s scrawl on my persuasive, marketing-like document.

Dr. B. didn’t deliver my son. She’s since retired from delivering babies. Her partner and a nurse delivered my healthy boy with my husband and Dawn by my side on a warm December morning. Despite 28 hours of back labor and a lot of associated pain, there were no complications and no high-risk delivery in my Advanced Maternal Age of 40 and 2 months. This experience was powerful. This age is about blowing past the stereotypes and working hard to fulfill one’s goals as many of us have done in every other aspect of our adult lives.

Read Part 1 of Sharon’s Story!

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