Friday, January 30, 2009

The Doula Book - Part III Obstetric & Longer Term Benefits of Doula Support

Posted by Kim:

Covering Chapters 5 & 6 of The Doula Book

Chapter 5 Obstetric Benefits of Doual Support

"Continuous labor support from a doula in the ten studies reduced the odds of receiving analgesia by 31%, decreased the use of oxytocin to stimulate labor by 50%, forceps deliveries by 34%, and cesarean sections by 45%." (page 76)

"If the... continuous emotional and physical support leaves for just five minutes, when she returns, it takes nearly an hour to get the mother back to her earlier calm state." (page 77)

"The length of a first labor is nature's way of gradually, and carefully dilating the birth passage." (page 80)

"When low forceps have been applied by well-trained, experienced obstetricians, there is no harm to the baby." (page 86)

"For several decades in the mind-1900s one measure of a good obstetrical service was that the number of cesarean sections did not exceed 5 percent of the total deliveries." (page 87)

"However, the incidence of cesarean deliveries then skyrocketed to levels of 25 to 35 percent, with a few hospitals well above this. The cesarean delivery rate in the United States was 22 percent in 1999..." (page 87)

"When a mother develops a fever during labor, physicians recognize this as a warning the baby may have a serious and potentially fatal blood-stream infection called septicemia (sepsis). This is an uncommon occurrence, but because the risk of not treating a baby with sepsis is great, and because the diagnosis at the time of birth is difficult and existing antibiotics are effective, babies of mothers with fever are usually considered to have sepsis." (page 89)

"Maternal fever may be the only clue to a life threatening infection." (p 89)

"Mothers who had a fever were significantly more likely to have had epidural analgesia." (p 89)

"When a mother has epidural analgesia during labor, her temperature slowly but steadily rises; if labor is long enough, the temperature will reach the level of a fever." (p 89)

"It is difficult for physicians to be sure whether an individual mother's fever is due to epidural analgesia or to sepsis in the baby.... However, the decreased need for pain relief during labor when a doula provides support would lessen the number of epidurals and therefore the number of women who have fevers and the number of babies who have to be evaluated for illness." (p 90)

"For women whose labors were induced, the overall rate of epidural use was 81 percent." (p 90)

"The total induction group [in a case study] had a cesarean-delivery rate of 43 percent. The group of no-doula couples [in the case study], had had over three times the number of cesarean deliveries." (p 90)

"The more we care for the mother during this sensitive perinatal period [through the long hours of labor], the more sensitively and appropriately she will care for her baby." (p 92)

"Labor that has been progressing normally may slow down or stop when an epidural is started." (p 94)

"An analysis of eleven randomized trials involving 3,159 laboring women recently compared the effects of epidurals nor involving a regional block with no intervention. Epidural analgesia was associated with greater pain relief than nonepidural methods, but also with longer first and second stages of labor. In addition, there was an increased incidence of fetal malposition, increased use of oxytocin, and an increase in instrumental vaginal deliveries." (p 95)

"Medication does get into themother's bloodstream and then into the baby. Babies therefore have mild to moderate changes in their behavior in the first hours and days." (p 95)

"...A number of mothers have told us about their disappointment that they failed to go through labor without medication." (p 96)

*** THAT'S ME*** and it has taken me amny years to process it, but I don't think I will ever get over it! If I only had a doula!

"Mothers who have had epidural anesthesia do not get the same feeling of accoplishment or boost in self-esteem as those who deliver without an epidural." (p 96)

Chapter 6 Long-Term Benefits of Doula Support

"A number of well-designed studies show that humane, sensitive, and individually appropriate caregiving practices ... have produced four important benefits.
  1. Decreasing abandonment in the maternity hospital.
  2. Decreasing rates of infant abuse
  3. Increased success in breast-feeding during the entire first year of life
  4. Increased father involvement in the first three months of the infant's life" (p 102)
"In addition, helping the parents discover the abilities and responses of their newborn and showing them how to carry the infant in a cloth carrier on their chest in the early months of life have
  1. Improved parent-infant interaction at three months, increa
  2. Increased immunization rates at one year
  3. Resulted inan increased incidence of secure attachment at thirteen months" (p 102)
"The one-day postpartum interview results indicated that the doula-group mothers reported less pain during labor and at twenty-four hours after labor." (p 103)

"Fewer doula-supported mothers considered the labor and delivery to have been difficult, fewer thought ti was much worse than they had imagined, and more believed they had coped well during this experience." (p 103)

"The doula-group mothers showed significantly less anxiety, fewer signs of depression and a higher level of self-esteem." (p 106)

"Some aspect of doula support resulted in doula mothers reporting a great increase in satisfaction with their partner since the birth of the baby and a much greater percentage of mothers who reported their relationship was better right after the birth." (p 107)

"Doula-supported mothers reported that their babies were less fussy, compared with reports of mothers who gave birth without a doula." (p 107)

"Doula-supported mothers reported that they were
  1. Pleased to have their babies
  2. Found becoming a mother was easy
  3. Felt that they could look after their babies better than anyone else could.
In contrast, the no-doula group of mothers perceived their adaption to motherhood as more difficult and felt that others could care for their baby as well as they could." (p 107)

"...Powerful effects of early mother-infant contact and interaction during a brief period around the time of birth that we have labeled the 'maternal sensitive period'. In this period - the time in the first minutes, hours, and days after birth - parent-infant contact, as we said earlier, may alter the parents' later behavior with that infant." (p 109)

"The remarkably strong and persistent effects associated with the doula suggests that the sensitive period starts during labor." (p 109)

Thursday, January 29, 2009

The Doula Book - Part II Reducing Discomfort, Pain & Anxiety

As a continuation of my coverage of the The Doula Book by Klaus, Kennell and Klaus here are the excerpts of the book that I highlighted in chapters 3 and 4.

Chapter 3 - Enhancing the Birth Experience

"Knowing the doula will be available anytime during labor lessens the parents' initial anxiety, and the couple can then remain at home longer with more productive labor and less pain." (page 35)

"The doula never interferes with the physician's advice, and the mother will need to follow that advice if there are other concerns." (page 36)

"Most mothers progress more rapidly in familiar surroundings" (page 37)

"During this period (the beginning of labor) mothers have found the following suggestions helpful:
1. Walk as much as possible
2. If the membranes are not ruptured, a warm bath can help you remain more relaxed. However in early labor a warm bath may slow labor; in late labor a bath may increase dilation. If the membranes are ruptured, a shower is preferablebecause of the risk of infection.
3. Change positions at least every half hour
4. Drink plenty of liquids... Urinate frequently" (page 37)

"The doula needs to notice the quality of the environment of the room and the woman's immediate needs or comfort level." (page 37)

"Asking the woman if a suggestion is or isn't working can validate her sense of control and choice as well as help her recognize her own needs and give her permission to voice what is important to her." (page 38)

"A doula will continually be
1. noticing
2. asking the woman
3. doing something to make an appropriate change
4. rechecking to see if the change is helping or not" (page 38)

"Being well hydrated has been shown to help labor." (page 39)

SIDE NOTE - One of my doula clients went to the hospital thinking she was in labor, but when we arrived her contractions completely stopped. After a thorough exam the doctor determined that she had an elevated temperature due to contractions. After receiving liquids via an IV her temperature went down and she was released. I have also read that dehydration can cause contractions and false labor which may have been what happened to my client.

"The doula can reassure the woman that the smells and fluids of birth, like blood, feces and amniotic fluid, are all normal parts of labor and are quickly taken care of by the staff" (page 39)

"The doula can be the one to have the somewhat difficult task to limit the number (of friends and family attending the birth) without offending anyone." (page 39-40)

"When mothers are in the hands-and-knees position infants often rotate in ten to fifteen minutes from a posterior position." (page 41)

"...Squatting during second-stage labor with each contraction. This position increased the area of the bony outlet of the pelvis by 28 percent." (page 41)

"The doula's ability to keep the mother informed is essential." (page 42)

"When a doula continually informs the mother, asks her gently what her thoughts, worries, or concerns are, talks to her confidently with real information, the doula can help the woman shift her fear to more inner security." (page 43)

"It is also important for the woman to feel that she has control not only over her labor but also has choices about what sort of interventions will be used." (page 43)

"...Although the PKU test is very important, it can wait a few days until the mother's milk comes in." (page 43)

"What is important to a laboring woman is sincere talk, not fake or glib reassurance." (page 45)

"The doula stays emotionally connected to the mother and by joining in her reality, may be able to move her to a more comfortable inner place." (page 45)

"Progressing toward full dilation of the cervix and delivery is near, the following signs may be noted:

1. Flushing of the face and body
2. An increase in bloody mucus
3. Longer and stronger contractions
4. Legs often becoming shaky
5. A feeling of nausea
6. feeling of an urge to push" (page 45-46)

"At this point (transition) the doula's support can give the mother the incentive to continue; the doula sometimes holds the woman, she reminds the mother (and the father) over and over again that she can continue and is doing great." (page 46)

"... Everyone attending a woman in labor 'has a responsibility to ensure that [she] genuinely understands the purpose of every medical procedureand the results of every examination' " (page 46)

"Often labor stops when too many people are present." (page 47)

"In reassuring the parents and enhancing their sense of accomplishment, the doula may be modeling the parental role for them - mothering the mother and parenting the parents." (page 49)

*** " The family is born in the delivery room." ***

Chapter 4 - Reducing Discomfort, Pain, and Anxiety in Childbirth

"When a woman comes into labor she brings her past with her." (page 53)

"Pregnant women have varied expectations of pain, based on what they have heard or experienced." (page 53)

"Though a doula cannot solve issues in the mother's past... she can begin her work being fully present with the woman to calm her fears, to validate her strength, to reassure her that she won't be alone, and to work with her on measures to alleviate pain." (page 54)

"Can you remember a time you met a challenge and conquered it?" (page 54)

"If labor is slowing down, a doula might ask 'How are you feeling righ now?' and then when the mother answers, the doula should restate her answer to be sure she understanda the mother's meaning." (page 55)

"By validating themother's fear, instead of dismissing it, the doula can offer new ways to think about the pushing stage." (page 55)

"Relaxin, which causes the tissure to be as stretchy, strong, and supple as soft elastic." (page 55)

"The mother's urge to push and ability to judge how to push in the second stage is reduced [with an epidural]." (page 58)

"If the epidural goes too high, some women feel as though they can't breathe." (page 58)

"Frequently, there is a rise in the woman's body temperature which reaches the level of a fever during an epidural." (page 58)

"During labor, some women copmlain of shivering and itching and experience urine retention requiring a bladder catheter." (page 58)

"The doula can remind the woman to stay relaxed, create positive images with her, help her with breathing and calming techniques, and validate how well she is doing." (page 59)

"The doula has to be sure there is no threat to her breathing." (page 58)

"With cool washcloths to the mother's face, neck, and chest, if all is well, the doula can cool the mother who is overheated or who develops a fever." (page 59)

"Helping women express feelings and utter sounds may relieve tension." (page 67)

"Make sounds along with the woman, encouraging the mother to let tension go with each sound." (page 67)

"Making low sounds or groans deep in the throat through a comtraction has an effect parallel to opening the birth canal." (page 67)

SIDE NOTE - To be honest making noise and validating the need to make noises was a concern of mine when I went to my first birth as a doula. Like a mother going into labor I was concerned that I would sound or feel silly doing this, but after reading this book I realized that no matter how I felt on the inside I had to always project complete confidence and not be concerned about what other people would think about what I was doing or how I was acting. My goal and my only focus was to make my mom focus on herself, relax, and let her let go of any inhabitions she was holding on to. It only took a little time for me to get over any insecurities and I just kept focusing on what my good friend Laurie told me, she said "Trust your instincts, mother your mother and everything else will follow." Now that was amazing advice from an experienced doula!

"When a doula remains accepting, nurturing, competent, and strong, the woman can internalize a model that might help her remain both nurturing and strong with her ownchild during tough moments." (page 68)

"The doula needs the confidence to help the mother express her needs to the caregiver especially before and during intervention." (page 70)

"The doula needs to know her limits, and occasionally when a fetal malposition does not change, ot a woman is not progressing as expected or feels great discomfort, medical help can give her relief. When this is necessary the doula must validate the woman's courage as well as her decision to have such help." (page 70)

Side Note - This is the exact situation I had with my first doula client (as you may have already read) she had been laboring for 5 days prior to the day we decided to go to the hospital. So she had not gotten more than 3 or 4 hours sleep each night for 5 days prior to going to the hospital and had labored at the hospital for 15 hours at the hospital only to discover that in that time she had only progressed 2 cm. Although epidural was not even a consideration for her and her hsuband before the birth, it became apparent that the epidural was something she needed. She was tormented by making the decision and we hugged, cried and proceesed what was going to happen, but I kept reassuring her that no one was judging her and that we would all honor her choices and that getting the epidural did not make her any less of a mom. After receiving the epidural, we hoped she would relax and progress, but it was still another 12 hours before the baby was born. Although she is still working on processing her choice to get the epidural I keep reminding her how hard she had worked and not only for that one day at the hospital, but for the 5 days before as well.

"Reducing th stress response enhances the body's own production of oxytocin, as well as natural opiates called endorphins." (page 70)

"When labor is not impeded by undue stress and fear, the woman's own natural oxytocin is secreted from the posterior pituitary gland intot he bloodstream. At the same time, her brain also secretes oxytocin to other areas within the brain itself. This has four effects:

1. First it markedly increases the pain threshold, so that the mother has reduced sensitivity to pain.
2. Second, it results in drowsiness
3. Third, it results in some relaxation or calming
4. Finally, after the birth it helps the woman feel closer to the baby" (page 71)

"Comfort measures cna be divided into five categories

1. actions and behaviors that give emotional and psychological support
2. mental activites that divert attention from pain or focus attention on thoughts or images that increase mental and physical relaxation
3. physical activities such as relaxed breathing, muscular relaxation exercises, movement, position changes, use of water, heat, cold
4. touch, including massage, acupressure, pressure, and counterpressure
5. rhythmic activities, music, chanting, singing etc." (page 72)

Side Note - Much to my client's pleasure and their ability to relax, there is about a 0% chance that I will ever sing to them to help them relax. However, I could consider my singing a diversion or a relocation of pain (from the abdomen to the ears).

To be continued.....

Wednesday, January 28, 2009

The Doula Book - Part I The Need for Support and the Role of the Doula

Posted by Kim:

The process of becoming a certified DONA Doula has several facets and one part of the certification process is to read 5 books from the required reading list and the DONA International Birth Doula Position Paper.

To see the entire required reading list click here.

One of the first books I decided to read is The Doula Book by Klaus, Kennell and Klaus. Because of the pending births of my doula clients I literally devoured this book and was very impressed by how informative it was and how easy it was to read. In my opinion the authors did a wonderful job intertwining the description of the role of the doula and connecting it with statistically significant studies.

In this blog series I thought I would share with you some of the points I highlighted while reading the book.

Chapter 1
The Need for Support in Labor

"Continuous support from a doula during labor provides physical and emotional benefits for mothers and health bonuses for their babies. With less medical interventions, fewer complications, and shorter hospital stays, there may be financial savings as well." (page 1)

"In studies of over 5000 women... we have seen a major reduction in the length of labor, a greater than 50 percent drop in cesarean sections, a remarkable drop in the mothers' need for pain medication, and several other important and measurable benefits." (page 3-4)

"I want the doula there to assure me that everything is fine and to comfort me. I want my husband there for emotional support." (page 9)

"A recent study found that women giving birth encountered an average of 6.4 unfamiliar professionals during labor." (page 11)

"When... the caregivers goal is to reassure, relax, comfort, and inform the mother rather than to tend only to the needed medical interventions, that person takes the same supportive role as a doula." (page 11)

"With such help, parents can capture the special moments and priceless experience of their own unique childbirth." (page 12)

Chapter 2 The Special Role of the Doula

"A doula learns that she has to be wiling to take anything for an answer... The experienced doula develops enough confidence and self-esteem that she is not offended by the woman's seeming rejection of that action." (page 16)

"The woman can be completely at ease with the doula and unconcerned about having to try to please her or put on a show for her." (page 17)

"The most important assurance that a doula can give in these initial (prenatal) visits is that she will remain with the mother throughout the entire labor and not leave her alone." (page 17)

"By her presence, manner, and comforting touch, the doula creates calmness and the essence of relaxation." (page 19)

"By her words and actions, the doula models behaviors and attitudes that are almost always copied and appreciated by the father. At times a doula needs to be resolutely strong and firm, and at other periods in the labor, tender, soft, and loving." (page 22)

"A woman in labor needs total support - in order to let go completely, to allow her own system to adapt and respond to the power of the birthing process." (page 23)

List of qualities for choosing a doula (page 27)

This book is definitely right on when it comes to the role and the need for a doula. Throughout the labor of my first doula client I kept thinking to myself, man I wish I had had a doula. Why didn't I know about this? I decided to become a doula because after learning more about the role of the doula, hearing stories about Carri's client's births, and attending many birth education conferences for BINSI I was invigorated by how a doula can enhance a woman's birth experience and how dramatically the presence of a doula can effect birth.

The more I learned the more I realized that the role of the doula is not to replace the partner, but rather to be there to support both the partner and the laboring mother so that they can stay emotionally connected. While it is special to me for my moms to tell me that they felt like I was truly there for them, there is a little special extra special when the dads say they couldn't have done it without me. I never want my clients to feel like I was trying to replace them, but rather I want them to feel like I helped them be the best support they could be.

I only wish I had listened to our friend Chuck when he said "Get a doula, it is the best money spent." WHY WHY WHY didn't we listen? Well as with everything in life hindsight is 20/20. So now I have made it my mission to at least educated as many women as I can about the role of the doula and how it can enhance their birth. I still struggle with the decisions I made during my births and will always wonder how different my births would have been if I had had a doula, but truthfully being a doula has helped me heal from some of my birth decisions and has also helped me to process my births. As with everything it is a process, but I hope to use my experiences as a mother and as a doula to help women have the best birth experience. It is my goal, and BINSI's, to Honor Moms!

Monday, January 26, 2009

Partnerships - Operation Special Delivery - CAPPA

Posted by Kim:

Our mission as a company and as mothers is to not only enhance a woman's birth experience by changing what she wears, but also to forge partnerships with other organizations in the birth world so that we can use our business to help benefit women around the world. The first organization we joined forces with was Operation Special Delivery.

Press Release April 15, 2008

Boulder, CO - BINSI, the leading manufacturer of stylish and hospital-friendly labor and birth apparel, has partnered with the Childbirth and Postpartum Professional Association (CAPPA) to support Operation Special Delivery. Operation Special Delivery provides trained volunteer doulas to pregnant women whose husbands or partners are deployed, have been severely injured, or who have lost their lives due to the current war on terror. The CAPPA-certified doulas offer emotional, informational, and physical support to women during childbirth in the absence of their husbands.

BINSI, a female-owned company since its inception in 2005, is committed to supporting women through pregnancy, birth, and beyond. Through this partnership, BINSI is donating 5 percent of their sales to CAPPA for Operation Special Delivery.

"No woman should ever have to give birth without someone there to lovingly support her," says Carri Grimditch, founder and co-owner of BINSI. "Operation Special Delivery offers that support by providing doulas to the women whose husbands or partners are away making an immense sacrifice for our country."

Just as it's important for women to feel comfortable and empowered by the clothing they wear during labor and birth, it's also important for them to have people there to advocate for and encourage them. Research has shown that women who have a doula present during labor are less likely to require emergency C-sections and other invasive medical procedures. "Partnering with Operation Special Delivery seemed like a natural fit for BINSI" Grimditch says.


BINSI's mission is to help women feel supported and empowered throughout their pregnancy, labor, and birth by offering products that make them feel healthy, beautiful and in control of their motherhood journey. BINSI Labor and Birth Apparel is comfortable, modest, and stylish while still being fully compatible with any labor position and medical equipment - a great alternative to unflattering, immodest hospital gowns. All BINSI products are tested and approved by mothers, doulas, midwives, obstetricians, and nurses. For more information about BINSI, visit

Thursday, January 22, 2009

Doula Digest - Bradley Birth Education

Posted by Kim:

As part of my doula training I had to take a childbirth education class (not pregnant). It seems like I am always meeting Bradley birth educators and a lot of people are talking about it so I thought I would check it out, plus I really loved the idea of the Husband Coached Childbirth. It sounded like a method that my husband would have liked and appreciated. If only I was as educated then as I am now. I almost feel like I know so much more now that it is a shame that I am not having another baby. This is not to say that I haven't been lobbying for baby #3 for the last year! Back on track......

For convenience sake and the fact that I already knew her I decided to enroll in Michelle Mueller's Natural Childbirth Education class. There were four pregnant couples in the class and as the weeks passed we became a pretty close group. Unlike the birth education class we took. In our class there were about 50 people in our class and there was absolutely no intimacy or sharing of information between the students. WE simply learned what the teacher wanted us to know. Not that she was a bad teacher, we definitely learned the facts, but we didn't get the different perspectives from the students because no one really felt open to share in front of 50 people! Again I digress, back to Bradley.

Our class met for 11 weeks beginning in September and we covered the following topics:
  • Exercise
  • Nutrition
  • Pregnancy/Gestation
  • Variations and Options
  • Intro to First Stage
  • Intro to Second Stage
  • Birth Plans
  • Coaching
  • Postpartum
  • Advanced First Stage (Labor Rehearsal)
  • Advanced Second Stage
Each class started with Michelle asking each couple how their week went, how their nutrition was for week and if they have any concerns (including concerns about their care provider). In addition Michelle would ask each couple if they had been practicing their Taylor sitting, kegels and relaxation techniques. What struck me the most about this class was how fun it was to see each couple grow and develop during their last trimester. There was definitely quite a difference between the first class and the last, boy could I relate to how they all felt as they grew closer and closer to their due date.

The primary theme throughout the class was nutrition, labor management and the intervention spiral. We discussed the common interventions, why they are done, benefits, risks and alternatives. Some common interventions and their alternatives that we discussed were:
  • Vaginal Exams - request that they do not do the exams unless there is a compelling medical reasons.
  • Non-Stress Test - fetal movement counting
  • Induced Labor - Waiting, nipple stimulation, sex, accupressure, herbs, acupuncture, or Castor oil
  • Membrane Stripping - Nipple stimulation
  • Vaginal exams in labor - Limit exams prior to pushing,
  • Gowning - Wear own clothes
  • Separation of mom from support during admission - Do all admission work ahead of time
  • IV - Stay hydrated
  • Restricting food & drink - eat lightly, drink sips of water, eat ice chips or popsicles. Energy gels or honey.
  • Electronic Fetal Monitoring - Use fetoscope or doppler or intermittent EFM
  • Doptone - Use fetoscope if someone is trained to use it.
  • Restricted movement during labor - walk around, change positions often, take a shower or bath
  • Amniotomy - Use natural ways to speed up labor like walking, suck thumb, nipple stimulation, acupressure or acupuncture
  • Narcotics/Analgesics - Natural methods of pain relief
  • Epidural - Natural pain coping techniques: relazation, changing positions, movement, birth ball, visualization, bath or shower
  • Augmentation - Use natural methods of speeding up labor
  • Episiotomy - Choose a caregiver who does not perform them. Do pre-natal perineal massage. Do not lay on his back to push, practice kegels
  • Forceps or Vacuum Extraction - Prevention: good pushing positions and techniques, avoiding epidural
The Cascade Effect of Interventions:
  1. Break water to advance labor
  2. Gel
  3. Pitocin
  4. Drugs/Epidural
  5. C-Section
Common side effects of the Epidural are:
  1. Drop in mom's blood pressure
  2. They only work 85% of the time
  3. It may only work on one side
  4. Epidural headache 25% of the time
  5. Pain at the injection site
  6. Need for the use of forceps ro vacuum extraction
  7. C-Section
  8. Episiotomy
Overall I really enjoyed this class. I thought Michelle presented a great point of view and each couple could cater the information they learned to their own wants and needs. However, learning about Bradley made me more curious about the other methods of childbirth education. I think I may need to take the other methods so I can learn about them and then be knowledgeable about the different methods my different doula clients may choose to follow. Now I just need to find the time!

To learn more about the Bradley Method of childbirth please visit their website

Monday, January 19, 2009

Facebook etc.

Posted by Kim:

Trying to keep up with the times I have been actively participating on Facebook for personal reason, but now I am trying to bring BINSI into the new age too. Which of course is why I started this blog. My husband has been after me for over a year now to get this blog going. So now that I have caught the social marketing bug, I created a facebook page for BINSI and a Twitter account. We would love for you to become a fan of BINSI by searching for us on facebook and you are welcome to follow me on Twitter, my username is birthinbinsi. Remember that we love pictures. If you have any pictures of you wearing BINSI we would love to see them. You can always email them to me at

Thursday, January 15, 2009

Product Review - Labor Lab

Posted by Kim:

As a new doula I have probably been going overboard trying to devour everything I can find about being a doula, doula techniques, the outcomes of births with vs. without doulas, networking with new doulas, interviewing and seeking out the advice of seasoned doulas (you get the picture here right?). I may be going a little overboard and my new doula bag may be packed (shall we say stuffed) with many I may never use, I have found one amazing item that truly gives me confidence knowing that it is in my bag as a resource: Labor Lab. Because one of my major goals throughout labor is to keep mom active and to help her manage her surges and find positions that help lessen the intensity of each surge, Labor Lab is the perfect resource giving me position suggestions, accupressure points, massage techniques and so many ideas on helping mom manage her labor.

Labor Lab
is an easy, hands-on way to teach pregnant women and their support team, skills to enhance the experience of labor. The lab itself consists of 12, two-sided laminated cards packed with information as well as facilitator's guide with suggestions for use. Each card contains a labor situation practice, a question to discuss and various coping techniques. It is a wealth of information, but the thing I love about it the most is that along with the descriptions there are practical real life pictures so you can actually see the position and why it is used. I often find in a long labor my mind is so driven by adrenaline and I get so pumped up that I can barely think and keeping these cards out as reminders not only gives me position suggestions, but it is helps to me remember to keep mom moving and change positions every 45 minutes or so. If you have the chance check out Laurie's website and I highly recommend purchasing the set.

They are great for childbirth educators too because they can easy be used to assist in creating labor stations when you are having a labor rehearsal and you can even purchase the Parent Booklets as a small, easy item to carry or as reference material in your student folders. The Lab costs only $45 and includes the 12 cards two-sided full color cards, instructor's guide and 1 copy of the Parent Handbook. The handbooks are a screaming deal at only $2.50 and both are available in English and Spanish as well as the fact that they feature moms of different ethnic backgrounds. In my opinion, it is a must have!

The Twelve Labor Lab Cards include:

  • Advantages and disadvantages of
    • Standing
    • Leaning forward
    • Side-lying
    • Squatting
    • Walking
    • Semi-sitting
    • Back-to-back
    • Kneeling/Hands & Knees
  • Coping with Back Pain
  • Rotating a posterior baby
  • Breathing Techniques
  • Tips for riding in the car
  • When to call your doctor
  • What to look for when the water breaks
  • Difference between 'True' and 'Practice' labor
  • When to go to the hospital
  • Using a 'Birth Ball' - positions and safety tips
  • Aromatherapy
  • Massage
    • Hands
    • Feet
    • Jaw
    • Hips
    • Shoulders
  • Ways to progress labor
  • Acupressure points to
    • help nausea,
    • decrease pain, and
    • increase contraction strength
  • Dealing with panic
  • Creating an ideal labor environment
  • Suggestions for encouragement and coaching phrases
  • Ideas for cooling off or warming up during labor
  • Signs and how to help with hyperventilation
  • Ways to help with nausea or vomitting
  • Pictures of
    • single women
    • married couples
    • women with labor companions
    • hospital settings
    • home environments
    • people of different ethnicities
About the Creator

Laurie Boyer is a certified childbirth educator, massage therapist, and labor doula. She has been active in the childbirth field for over 20 years. In an effort to keep her childbirth classes a "hands-on" and exciting learning experience for her students, she incorporated interactive learning stations to her teaching style. With the suggestions and ideas of many educators as well as feedback from class participants, Labor Lab evolved into the product available today. Her hope is to make a distinct and substantial impact on the overall experience of birth by providing Labor Lab to parents, childbirth educators, doulas, doula trainers and hospitals.

Wednesday, January 14, 2009

The Late Preterm Infant & Getting to Know Your Baby

Posted by Kim:

I am the Coordinator of a non-profit group called Exceptional Families and we provide parent to parent support to families who have children with special needs. Part of my responsibility as the Coordinator is to attend the Boulder County Health Department's monthly cross-disciplinary meeting for children birth to 3 years old. This month we had a therapist from the Tiny Tim Center present the following information to us. It is shocking and eye opening considering our current birth environment and the prevalence of preterm induction and cesarean birth.

I am making no judgments here because I am all the things that I would now preach against (unfortunately I have learned more about birth since my children were born). My first son was an induced preterm labor due to fetal distress. While there was nothing I could do about this induction the statistics below are still frightening to me and make me cringe that I never once doubted my doctor or sought a second opinion. This being said, I do believe we did right by Connor inducing his birth and providing him with a better chance of survival outside the womb (I will post Connor's birth story soon). Griffin however is a different story. His induction was the typical convenience birth at 40 weeks. It has taken me several years to process his birth and I will always regret the induction (birth story also to follow).

Please read over the following information and consider it carefully. Share it with friends, family and clients. While it is particularly focused on late preterm births (and sometimes this can not be avoided), I think the "Get To Know Your Baby" section can also be applied to full term children in some situations. Every baby is different, but if you can read their signals you can better respond to their needs.

Children need their 40 weeks!

The late preterm infant is:
  • born 34 - 37 weeks
  • 75% of all preterm births are in this category
  • Many are from induced deliveries or C-sections
  • Studies have shown an increase in morbidity rate, as well as long term outcomes showing developmental delays, special education for pre-k and behavior problems that persisted to 8 years of more.
Brain Development
  • At 34 weeks the brain has fewer sulci
  • During the last 4 weeks of gestation there is an increase in the development of axons, dendrites, synapses etc
  • The is the most active phase of synaptogensis (40,000 new synapses per second)
  • At 34 weeks the brain only weighs 65% of term brain weight
  • Frontal lobes are last to develop
  • Late preterm babies are more vulnerable for bilirubin induced brain injury and neurological injuries
Medical Issues for Late Preterm Infants

Respiratory Control
  • 33-38 weeks there are changes in lung compliance, they are still developing how to
  • breathe, they may have apnea and bradycardia
  • Increase incidences of SIDS
  • Less body weight, decreased ability to regulate body temperature


Motor Challenges
  • Mild hypotonia, decreased stamina & endurance
  • Difficult feedings secondary to tone issues
  • May hear respiratory sounds due to decreased muscle activity in intercostals and upper airway
What we might see

State Organizational Challenges
  • Decreased arousal and alertness (can affect attachment between baby and parents)
  • Sensitivity to environment (light, noise, activity) therefore may have problems getting to deep and active sleep (brain development occurs when in active REM sleep)
Feeding Issues
  • Less effective suck and swallow
  • Breastfeeding may be difficult because they are sleepier, have difficulty stabilizing their temperatures and they are unable to coordinate suck/swallow/breathe
  • Education and support for parents
  • Scheduling babies activities for when they are in arousal states
  • Kangaroo mother care (skin to skin)
  • Infant Massage
  • Knowing awake/sleep states and stressor signs that baby is communicating to you
  • Using environmental modifications keep lights, noise and activity down preserve active REM sleep

Organized Physiological Behaviors
  • Skin is pink and stable throughout
  • Breathing is regular and smooth
  • Gastrointestinal is stable and there are regular elimination patterns
Disorganized Physiological Behaviors
  • Cough, breathing intervals are variable (too fast or too slow)
  • Gasp, Startle, Twitch, Sneeze, Tremor

Organized Motor Behaviors
  • Tone is balanced
  • Posture is flexed and relaxed
  • Movements are smooth and close to the body
Disorganized Motor Behaviors
  • Tone is hypertonic or hypotonic
  • Posture: arms salute, sitting on air, toe or finger splay, fisting, high arm position
  • Movements: squirm, jerky, gape face, tongue extension, arching

Organized State Behaviors
  • Awake States are calm alert, alert and focused, and may be fussy and crying
  • Sleep States are deep sleep, active sleep and drowsy sleep
Disorganized State Behaviors
  • Hypoalert, hyperalert, gaze averting, uncontrollable fussing and crying, upward gaze, staring, grimace

Behaviors that help baby become organized/Helpful self regulation behaviors
  • Hands to mouth/face
  • Hand & Foot clasping
  • Leg/foot bracing
  • Sucking and suck search
  • Tucking
  • Grasping and holding
  • Looking and attending
Ways to promote Baby's Development at Home
  • Light reduction
  • Noise reduction
  • Positioning
  • Comforting
  • Look for signs of stressors indicating need for a rest
To see this complete presentation please visit

Sunday, January 11, 2009

Doula Wisdom Circle - January 13th

I have recently become obsessed with Twitter (my name is birthinbinsi if you would like to follow me) and have met several great new people with interesting ideas, quotes, support, and mini business consulting tips. You should check it out, it is pretty cool. Anyway, one of the Twitter gurus I have been following (and vice versa) is savvydoula. She has offered support as I was going through the births of my last two clients as well as advice on stalled labor and other questions I have had. It is amazing because my new Twitter friends seem to be immediately and almost constantly accessible, it is rather revolutionary I think. Well anyway, savvydoula is hosting a Wisdom Circle tomorrow and I just wanted to tell you about it just in case you would like to join in on the call.

"The Savvy Doula Community Wisdom Circle was created to bring together our community to connect and learn from one another. Held monthly over the phone, doulas are able to seek support, validation and gain new perspectives from the breadth of knowledge and experiences each brings to the call.

Facilitated by Darlene MacAuley, participants will have a safe space in which to share her story and offer and receive feedback from other doulas.

Each month, all participants need to bring to the call is a compassionate heart and an open mind. Participants will have the opportunity to share something that’s been going on with them. In response, those who share will receive acknowledgment and validation from others on the call. Those who share may also be offered new perspectives to the situation or may be asked to come up with their own new perspectives. There is no set agenda, but each participant will leave the call having received support, validation, new knowledge and inspiration."

The Savvy Doula Community Wisdom Circle will be held monthly on the second Tuesday of each month, from noon-1:15 pm Central Standard Time. For more information please check out her website or simply

I am going to check it out and see how it goes. I am definitely in the doula information seeking stage. As my passion for being a doula becomes more and more important in my life, the more knowledge I am trying to absorb. However I am so lucky to have so many wonderful friends you have been doulas for many years and have taken their time to answer my questions and help suport me throughout my client's birth process. Does life get any better than having a beautiful circle of friends?

Saturday, January 10, 2009

Birth Story - Elaine & Greg's Birth

Posted by Kim:

I was lucky enough to be hired as the doula for another wonderful couple and I was honored to be present at the birth of little baby boy Nikolai! It was an amazing experience and has made me even more passionate about being a doula! To be honest it was only the second completely natural birth I have ever seen, the birth of Carri's third son being the first.

It was interesting because Elaine had a few instances of stalled labor as my previous client did. On Monday evening Greg called me to let me know that Elaine had stopped in to see her doctor that afternoon and she was dilated to almost 4 cm and 100% effaced. The doctor said she could check into the hospital then if she wanted to, but they chose to head home and relax to prepare there instead. This was great news seeing as though Elaine mentioned that she had not really had any major contractions, just what felt like some annoying menstrual cramps. Remembering what a marathon Gina's birth was I began to mentally prepare myself for labor and went to bed early anticipating a call from them that night (again, silly new doula). No calls. I ask them to stay in close touch just so I would know how they were feeling. So we talked Tuesday morning and everything was back to normal.

On Tuesday they ended up coming into the hospital again because they were concerned that they really hadn't felt the baby move at all that day. Luckily the nurses monitored the baby and everything was fine. So they went home and Elaine rested, ate and prepared for pending labor.

Around 12:15am on Thursday morning Greg called me again and said that Elaine's contractions were coming on very regular and they were going to head into the hospital and wanted me to meet them there around 1am. So I jumped out of bed, hit the shower (I had some hot water this time) and was in Boulder by 1am. It was a very interesting drive however because the Old Stage fire was raging and literaly lit up the entire sky. I had never been so close to a brush fire like that and actually felt a little guilty that we have had such a dry winter, I guess I better hope for some snow (hard for me to do). In addition to the fire there was also a major accident on the Diagonal Hwy and as I approached I just kept praying that it was not Greg and Elaine, luckily they took 287.

When I reached Elaine's room Greg told me that their contractions were very intense at home, in the car, up the elevator, but as soon as she got into the hospital room they literally ended. Elaine placed the intensity of the contractions at only a 2 on a scale of 10. In addition to the lack kof contractions she also had an elevated temperature so the doctor wanted to monitor Elaine closely and she received an IV of fluids as they were thinking the elevated temperature was possibly due to dehydration. This was hard for Elaine to accept because she felt like she had been drinking tons of water, but as she received the fluid her temperature did go down. Just prior to going into the hospital Elaine had been taking a hot bath so I asked the nurse if that could have effected her body temperature and she said it wouldn't really have effected her overall body temperature, and especially for this length of time. Good to know. So I headed home around 4am and Greg and Elaine were released shortly after. I called Carri later that morning to talk with her about what was going on and her thoughts about the stalled labor again and she said that the contractions Elaine was experiencing could actually have been caused by the dehydration. Again, good to know I will keep that in my knowledge bank.

But the real fun was just about to start because Friday morning around 4:30am Greg called and said that they had been laboring since about 9:00pm Thursday night and they were ready to have me come over. Remembering Gina's labor I didn't freak out, I took a quick shower, gathered my doula bag and personal items and headed out ready for a long day (again, silly new doula). When I arrived at the house Elaine's car was running in the driveway so I figured we would soon be heading to the hospital. Elaine was in her bed and Greg was being an amazing coach. While I could tell the contractions were intense for Elaine she seemed to be handling then amazing. SHe breathed through them as Greg was reminding her to take deep belly breaths and I tried to help her relaxed her hands and face. It was interesting because Greg told me that she was also experiencing significant discomfort in her back but when I tried to apply the same massage and pain relief that I used on Gina this was of no comfort to Elaine. Again, I had to remind myself that this was a completely different person so what works on one may not work on the other. Greg and I began talking about when to go to the hospital and seeing as though she had been laboring for quite a while and the intensity of the contractions were so strong we decided that it was time to go. However, getting Elaine to the car was my biggest fear because she was obviously feeling so much intensity and handling them seemingly so well in the bed that I hated to move her, get her to the hospital and have the contractions slow, but I knew we had to go. So step by step and in between each contraction we headed to the car we eventually reached the Boulder Foothills Hospital around 6:15am.

Greg said that one of his funniest memories of this experience was our trip from the car into the hospital. He had gotten a wheelchair for Elaine and I had made myself in charge of carrying all of our gear. So he said as we were walking down the hall he looked over at me and couldn't help but laugh because all he saw was me carrying 18 bags and a pillow. I told him not to worry that it was my job to take care of the things that he should not occupy his mind with. He should be worrying only about Elaine. So we then named me the Doula Sherpa! : D

When we got to our room Elaine settled in bed and the intensity remained and I think we were all thankful for that. The nurse was wonderful and asked Elaine if she would like to get up and walk, take a bath or try some different positions. She said as soon as she checks her she could do whatever she wanted. Much to all of our surprise, when the nurse checked Elaine she was 10cm dilated and the nurse said she would be able to push whenever soon. The only thing standing in the way of her and the baby was the bulging bag of water. Because Elaine had been experiencing a lot of discomfort in her back I suggested she get on her knees and lean on the birth ball. I told her that this would relieve some of the discomfort and would also be a great position to start pushing once her water broke. It seemed to help for while, but the doctor came in and we all discussed if she should break the bag of water for Elaine or if she should wait for it to happen naturally. It was decided that the doctor would break the water so Elaine could start the pushing phase of labor. By 7:00am her bag of water was broken and the urge to push was rushing over her and by 8:05am little baby Nikolai was born. Elaine was a wonderful pusher and having the nurse use her fingers to help Elaine feel where to push really seemed to help! It was beautiful and amazing, again I felt blessed to be there.

After Nikolai was born the placenta would not expel itself naturally, even after several minutes of nursing (Nikolai was a natural). So they finally decided Elaine needed to receive some pitocin to encourage the placenta to come out. Unfortunately when it did there were pieces of the placenta left behind and the doctor tried a manual extraction to remove the remaining pieces before Elaine bled too much. This however was ineffective and Elaine eventually had to have a spinal epidural and a D & C. Not the ending we anticipated after a healthy pregnancy and beautiful natural childbirth, but medically necessary.

This was another learning experience for me (although I can't think of a birth that won't be a learning experience). I was impressed with the nurses and doctor at Boulder Community Hospital and I was thankful we were there, but I was most impressed and awed by how Elaine breathed through her contractions and how great a coach Greg was. This may sound a little corny, but I could truly see how deep their love is for one another and what an amazing family Nikolai was being born into. It was truly a blessings. Elaine's recover has been more difficult than we would have hoped, but ultimately the most important thing is that there is a very healthy baby and a healthy recovering Mom and ecstatic Dad!

Thursday, January 8, 2009

Birth Story - Kim's First Birth as a Doula!

Posted by Kim:

Well bringing in the new year was VERY exciting this year. I was not with my family when the clock struck twelve, instead I was helping a family be born! Since Friday night I had been in touch with Gina and Steve as their contractions began. The first call from Steve was received on Friday night at 10:30pm just as my husband Paul and I were sitting down to see the new 007 movie! Things were pretty much under control at that time, however I expected to hear from them later that night, but no news (silly new doula). Saturday morning I called at 9am to see how things were going and Gina's contractions had slowed throughout the night, but things kicked in again a little early Saturday morning, but were light. On Sunday morning I heard from Gina and Steve again and contractions started early and they wanted me to come over. I headed over around 9am (after picking up a heating pad) and worked with Gina as her contractions remained 5 minutes apart. Unfortunately they started to fade again so we walked the stairs, I encourage them to be together and kiss, we took a walk together, but nothing seemed to help. So after a while I went home and Gina enjoyed her mother and sister's company for the rest of the day.

On Monday Steve and Gina went to see their doctor and found out that she was 3cm dilated and 80% effaced. Good news that her contractions were actually doing something for her.

On Tuesday morning around 4:15 am Steve called again and asked if I would be willing to come over and help Gina as her contractions were back, but Steve was going to go into work. When I arrived Gina was laboring hard and we worked through the contractions. She sat on the fit ball and once the sun came up we went for a walk. Today however she wasn't able to walk through the contractions as on Sunday. We had to stop, I rubbed her back and she was cool and calm through each one. I was so impressed with how she was able to close her eyes, go into herself as each wave passed through her. Steve returned home from work around 10am, just as Gina's contractions were slowing in time and intensity AGAIN. Poor thing, how many days of labor can one person take? So I suggested she rest as much as possible and call me if she needs me. So once again I headed home expecting to hear from them again soon.

And I did..... It wasn't as soon as I thought, but after a fun evening of taking the boys Dave and Busters, Steve called me around 12:15 am Wednesday morning and said that Gina had been laboring and the intensity of the contractions seems like it had changed. After getting up and getting dressed (couldn't shower because the pilot on the hot water heater was out NICE...) I headed over to their house once again. I arrived around 1am and Steve immediately went to bed to rest. Gina and I spent some time together talked through the waves of contractions and I spent a lot of time rubbing her back, this seemed to be a continuous ache for her. While trying to remain completely confident and in control for Gina, on the inside I was worried that she could be progressing and we were close to birth and I didn't want to catch a baby. Gina kept asking me when we should go to the hospital and I reassured her that we could go any time, and we should especially go when she no longer instinctively felt safe at home. So around 3am and after a call to the hospital confirming that we could come home after being checked if we chose to, we decided to head out.

We arrived at the hospital about 20 minutes later and by 4am they checked Gina and confirmed that she had progressed to 5 cm and was about 100% effaced. This was good news so we decided to stay. Gina continued to labor and we all hoped that the contractions were making her progress, but again by 10am ish her contractions started to slow and become less intense. After talking with the doctor (she wanted to start pitocin right away) Gina and Steve agreed that we would wait until noon and see if she has progressed. At noon they checked her and she was only 6cm. So the doctor broke her water and this definitely brought on active labor. Gina continued to labor and was my hero because she was really handling it well considering the new level of intensity.

Around 6pm Gina decided to have another check and she was only 7cm. This was very discouraging for Gina and frankly after 5 days of labor she was really starting to get exhausted. So she and Steve decided it was time to consider the epidural. We all hoped the epidural would help her relax enough to dilate quicker. Once the epidural was placed there was instant relief and Gina felt much better and could even get a little rest. Unfortunately it did not help her dilate faster however. At 9pm she was 8cm, 11pm 9cm, 1am 9 1/2cm and by 1:40am she was fully dilated and ready to push. This was an exciting moment, but I tried not to get too excited because I knew from experience that there was still a lot of work to be done. I just didn't know how true this was, because it wasn't for 5 more hours before little baby girl Jordyn joined the world at 9 lbs 1 oz and 22 inches. As always it was amazing wonderful and euphoric. Looking at Gina's face it was like the last 28 hours (or 6 days for that matter) hadn't even happened! What a honor to be there. I can't wait for my next birth! I learned so much and it even allowed me to let go of some of the figurative pain I have been going through since Griffin's birth. Its like anything with parenting, you just can't make plans or if you do they have to be written in pencil because they are sure to change!

Wednesday, January 7, 2009

Product Review - Pregnancy Pillow

We just want to congratulate our good friends Anita and Nadia Jamshidi of Utterly Yours ( for having their Pregnancy Pillow featured in Pregnancy Magazine's 120 Best Products for Mom & Baby!

Are you a back sleeper, but you want to do what is recommended for your baby and no matter what you do every night you wake up on your back? Or maybe you just can't get comfortable and your tossing and turning is driving your partner mad! Then the Pregnancy Pillow is the answer for you.

While your body is demanding more sleep, but it is harder than ever to get comfortable, the pregnancy pillow is there for you! Many doctors recommend that pregnant Moms sleep on their left side since it helps to take pressure off the back and keeps the uterus off the large organ, the liver. The Pregnancy Pillow will help you find a comfortable position while supporting the back and belly! High density foam supports the back and keeps you from rolling onto your back while sleeping and memory foam in the front supports your belly.

This product is not only for you, because this product will help you get a better night sleep, your partner will too! The Pregnancy Pillow comes in three different sizes, you can choose from 6 beautiful Amy Butler fabrics and they range in price form $39.95 - $54.95! It is a pregnancy MUST!

Another fabulous Mom Invention! Way to go Anita and Nadia.........

Anita and Nadia are also the inventors of the fabulous Breast Pillow.