In order to determine whether or not you need a doula, you must first understand what a doula is. The Greek for doula means "servant woman, slave" but in our vernacular is a woman who assists another woman in labor. She is not the same as a midwife- who is the prenatal caregiver, baby catcher, and postpartum caregiver to a pregnant woman. A midwife's role is similar to the care given by an obstetrician, but she is an expert in normal, low-risk pregnancy and birth and encourages normal, low-risk birth experiences either at home, in a birthing center, or in a hospital.
To figure out your need for a doula, there are some things you should discuss with your spouse or partner. First, are you trying to achieve specific goals in your childbirth experience? For example, trying to avoid induction, trying to have a natural childbirth, trying to avoid c-section or epidural. Or are you planning on going in to the hospital and doing what you are told? If you are planning on doing something other than what 95% of other women do, which is follow hospital/doctor protocol, then you may benefit from having a doula- preferably one who has worked with your particular doctor or hospital before.
Second, are you and your husband prepared for childbirth? Taking a comprehensive childbirth education class, like The Bradley Method, completely prepares the husband/partner to act as a coach during pregnancy and labor. If you, as a couple, are choosing to give birth at a birth center or in your home, you will have less of a need for a doula than if you are giving birth in a hospital setting. A doula may be beneficial as an assistant coach in the hospital and can advocate for the laboring couple, answer questions, and assist the husband/partner (taking over if he needs to rest, go to the restroom, grab a bite to eat.)
If your husband/partner is not willing to be an active participant in the labor process, then is it essential that you hire a doula to help you. The Hawthorne Effect was discovered in industrial engineering and showed the when people are watched while doing a job, they do their job much more efficiently and with higher quality. The laboring woman, assisted by either coach or doula, will progress better and labor more efficiently than a woman left to labor alone.
When choosing a doula, you should find a personality that fits yours. Do you need someone to take control? Do you need a gentle supporter and cheerleader? Do you need someone who gives great massages? Do you need an advocate? Interviewing doulas is important, and you want to develop a good rapport with the woman you choose. Some people prefer to have a woman who is certified through an accredited agency, like DONA, and some people just want a woman who has lots of experience, whether certified or not. Just like an other profession, there are many doulas out there and you should be able to find one who fits your needs.
Prices for doulas range just like any other profession. You may be able to find a woman who is trying to get her certification who will be your doula at no charge. And then you may find a doula whose services are upwards of $500-$1000. You must remember that these services are rendered regardless of the time spent in labor. If you have a quick birth, you may have paid $100 per hour. But if you labor is average (15-17 hours), you have a very effective means of help that is essentially very affordable. Given the amount of work that your doula will do and the amount of time she will spend with you, I would definitely recommend interviewing and hiring one, especially if you are having your baby in a hospital. Just like a childbirth education class, it doesn't matter how much you have to spend if you get the birth experience that you want and avoid unwanted or unnecessary interventions or procedures. Those interventions and procedures will cost you in the long run.
Monday, April 13, 2009
Choosing Natural Childbirth
During our first pregnancy, my husband and I chose to go against common and had a natural childbirth experience. I have to say that I have never gotten quite so much flack about a decision ever before in my life. Friends and acquaintances said things like, "Good luck- you just wait until that first contraction hits you." or "You will be begging for your epidural before too long." or "Why don't you just have a c-section?" I didn't want an epidural, nor did I want a c-section. I felt like my body had been created do have this baby and just to prove everyone wrong, I was determined to have a natural birth.
A few things I found out along the way:
First- some people call a vaginal birth a natural birth. I agree that this is the way that nature intended for the baby to come out, but I am not in agreement that this is natural birth, unless the following can be claimed:
1. No drugs given to induce labor (pitocin or cytotec)
2. No drugs given to augment labor (pitocin or cytotec)
3. No drugs given to dull the discomfort of labor (including epidurals and stadol)
I would agree that a natural birth had been experienced even if labor had to be induced or augmented, but was done so with a non-chemical method. There are lots of them out there that aren't widely used. Several methods for natural induction include, but are not limited to: walking, nipple stimulation, sexual intercourse, stripping membranes, castor oil, various herbal treatments, and acupressure. Methods for labor augmentation that don't require drugs but have been found relatively effective are: changing positions during labor, walking, nipple stimulation, sex, and the Foley bulb (a manual cervical dilation device).
Second- childbirth education classes are worth the cost. There are lots out there to choose from. Lamaze, Hypnobirthing, and The Bradley Method are just a few that are readily available in our area. Some cost money. Others don't. The local hospitals offer courses and you can find some held at birthing centers. Your primary goal is to find a class that coincides with your goals. I'm a personal fan of Bradley- I took it during my first pregnancy and have taught it for the past year. I like the common sense approach to childbirth and the fact that there is nothing in the curriculum that is earth-shattering. My students learn a lot, and I've been fortunate to have a 95% un-medicated vaginal birth rate.
Third- a natural childbirth can drastically reduce your hospital bills. There are some insurance companies out there that are happy to pay 100% of the cost of your birth regardless of what is billed, but those are few and far between and are generally offered by large corporations. For the rest of us, individual, small group, or other insurance is what we have to work with. Most of those plans offer maternity coverage at 80-90%, and you have to cover the remainder, probably up to some sort of deductible or maximum out-of-pocket expense. When I put a down payment for my intended hospital birth, I received an invoice for the anticipated total expense for the birth and stay. It was nearly $12,000 and didn't include all the newborn procedures. We all know that a Tylenol in the hospital can be billed at a ridiculous premium (I heard somewhere it could be $4- $7 for each tablet!) so can you imagine how much an IV, pitocin, Stadol, epidurals (plus the cost of the anesthesiologist), etc could be? I don't know exactly, but would imagine that $20,000 would not be out of the question. And all this is on top of the prenatal OB costs. If you are responsible for 10%, that would be $2,000 out-of-pocket vs. $1,200, and at 20% you are looking at $4,000 vs. $2,400. I don't know about you, but I can find something better to do with $800 or $2,400 than shove it in my back.
Fourth- everyone assumes that the worst is going to happen. While I completely understand that our healthcare professionals see the absolute worst case scenario on a regular basis, I also know that staying healthy and low-risk during pregnancy drastically reduces those instances. I must assume that I will have a textbook birth experience until otherwise advised. Because I didn't want my care based on all the things that could possibly go wrong, I eventually switched to the care of a midwifery practice, where normal is assumed unless otherwise assessed.
And finally- determination and staying low-risk mean everything. If you are determined to have a natural childbirth experience, you cannot listen to the naysayers. Surround yourself with people who support your decision and then stick to it. It's safer for you and your baby. It's less expensive. It's empowering. But you have to stay low-risk by having a healthy diet and a proper pregnancy exercise plan. Educate yourself and your spouse so you know what to expect during labor. And talk to other women who have done it. As Dr. Marsden Wagner said (and it is a loose interpretation of his quote)- How can a woman be expected to survive the challenge of motherhood if she is constantly being told that she is incapable of handling the challenge of labor?
A few things I found out along the way:
First- some people call a vaginal birth a natural birth. I agree that this is the way that nature intended for the baby to come out, but I am not in agreement that this is natural birth, unless the following can be claimed:
1. No drugs given to induce labor (pitocin or cytotec)
2. No drugs given to augment labor (pitocin or cytotec)
3. No drugs given to dull the discomfort of labor (including epidurals and stadol)
I would agree that a natural birth had been experienced even if labor had to be induced or augmented, but was done so with a non-chemical method. There are lots of them out there that aren't widely used. Several methods for natural induction include, but are not limited to: walking, nipple stimulation, sexual intercourse, stripping membranes, castor oil, various herbal treatments, and acupressure. Methods for labor augmentation that don't require drugs but have been found relatively effective are: changing positions during labor, walking, nipple stimulation, sex, and the Foley bulb (a manual cervical dilation device).
Second- childbirth education classes are worth the cost. There are lots out there to choose from. Lamaze, Hypnobirthing, and The Bradley Method are just a few that are readily available in our area. Some cost money. Others don't. The local hospitals offer courses and you can find some held at birthing centers. Your primary goal is to find a class that coincides with your goals. I'm a personal fan of Bradley- I took it during my first pregnancy and have taught it for the past year. I like the common sense approach to childbirth and the fact that there is nothing in the curriculum that is earth-shattering. My students learn a lot, and I've been fortunate to have a 95% un-medicated vaginal birth rate.
Third- a natural childbirth can drastically reduce your hospital bills. There are some insurance companies out there that are happy to pay 100% of the cost of your birth regardless of what is billed, but those are few and far between and are generally offered by large corporations. For the rest of us, individual, small group, or other insurance is what we have to work with. Most of those plans offer maternity coverage at 80-90%, and you have to cover the remainder, probably up to some sort of deductible or maximum out-of-pocket expense. When I put a down payment for my intended hospital birth, I received an invoice for the anticipated total expense for the birth and stay. It was nearly $12,000 and didn't include all the newborn procedures. We all know that a Tylenol in the hospital can be billed at a ridiculous premium (I heard somewhere it could be $4- $7 for each tablet!) so can you imagine how much an IV, pitocin, Stadol, epidurals (plus the cost of the anesthesiologist), etc could be? I don't know exactly, but would imagine that $20,000 would not be out of the question. And all this is on top of the prenatal OB costs. If you are responsible for 10%, that would be $2,000 out-of-pocket vs. $1,200, and at 20% you are looking at $4,000 vs. $2,400. I don't know about you, but I can find something better to do with $800 or $2,400 than shove it in my back.
Fourth- everyone assumes that the worst is going to happen. While I completely understand that our healthcare professionals see the absolute worst case scenario on a regular basis, I also know that staying healthy and low-risk during pregnancy drastically reduces those instances. I must assume that I will have a textbook birth experience until otherwise advised. Because I didn't want my care based on all the things that could possibly go wrong, I eventually switched to the care of a midwifery practice, where normal is assumed unless otherwise assessed.
And finally- determination and staying low-risk mean everything. If you are determined to have a natural childbirth experience, you cannot listen to the naysayers. Surround yourself with people who support your decision and then stick to it. It's safer for you and your baby. It's less expensive. It's empowering. But you have to stay low-risk by having a healthy diet and a proper pregnancy exercise plan. Educate yourself and your spouse so you know what to expect during labor. And talk to other women who have done it. As Dr. Marsden Wagner said (and it is a loose interpretation of his quote)- How can a woman be expected to survive the challenge of motherhood if she is constantly being told that she is incapable of handling the challenge of labor?
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