Making Informed Choices

       As a labor doula, also known as a birth doula, I support women in their pregnany, birth, and immediate postpartum with physical, emotional, and informational support. Although I am not a medical professional who can oversee your entire pregnancy and birth, I do work alongside your care team to suggest physical therapies, positions, and exercises to alleviate discomfort and support labor goals. I am hired directly by the mom and/or birth family so I have no competing allegiances to providers or birth settings. I also serve as a validating and steadfast presence continuously in labor. I am on-call through the last month of pregnancy so that I am able to quickly join mom when she goes into labor and stay through the duration of her birth. A key aspect of the assistance I provide is the informational support. I am available to help my clients discover what their options are during these seasons as well as the risks and benefits associated with those options. 
       In order to form a solid foundation of knowledge on these topics from which to explore related options, some women opt to take childbirth education classes with me during their pregnancy. I have a 16 hour class series that covers everything from the beginning of pregnancy to the basics of newborn care, as well as studying birth options and learning how to share and advocate for birth preferences. If women choose not to take the full course with me, I still meet with them a few times before birth to answer any questions, help them to develop birth preferences, and discover how best to share them, such as through a birth plan.
       ‘Birth plans’ have been birthed from necessity. Unfortunately, much of modern maternity care in the US is riddled with policies and procedures that are, at best, unnecessary, and at worst, actually harmful to mom or baby. A birth plan is the result of a family researching their options, making choices based on evidence and personal preference, and sharing those with their birth team. They come in many formats, but I typically recommend keeping them to one page, attaching the mom and partner’s names and a picture (since nurses often have many patients and may be keeping track of multiple birth plans), and utilizing visual cues to make it easy for their providers to reference. I actually offer birth plan building as an individual service for clients who want help researching their options but don’t want full doula support or childbirth education. A birth plan can be used with or without additional birth support (like a doula), but whoever is on your birth team (partner and/or provider) should be familiar with your choices before birth and be willing to advocate for them during labor and delivery.
       Many women default to doing what their friends or family chose during these seasons, but it’s important that they know what other options are available to them, even if they don’t choose them. One of the first options a woman has when she discovers she’s pregnant is the type of provider she’d like to see for her perinatal care and what type of birth setting she prefers. There are two options for care providers, a midwife or an obstetrician (OB or OBGYN). A midwife is a licensed medical professional who is trained only is overseeing low-risk women during pregnancy, birth, and postpartum. They typically have a more holistic view and try to minimize interventions (like unnecessary testing during pregnancy or interventions during birth). They may offer care and deliver in your home, at a birth center, or in a hospital setting. An obstetrician is the OBGYN you are probably most familiar with. They are a licensed medical professional capable of performing surgery and specializing in overseeing and treating ‘high-risk’ pregnancy, birth, and postpartum periods. They are the most common type of provider in the US and almost always deliver in a hospital. These professionals are typically more likely to encourage and utilize interventions.
       As a woman is selecting her provider, there are some questions she should ask herself to evaluate if the provider is the right fit for her. The most important thing a woman should ask herself is, “Do I trust this provider?”
Some other questions that may be helpful to ask are:
- “Does their demeanor and level of care make me feel safe?
- Do I agree with their view of pregnancy and childbirth?
- Do I feel this provider really listens to my wants and needs?
- Has this provider ever laughed at or otherwise belittled my questions, wants, or needs?
- Do I feel rushed or flustered at appointments?
- Does this provider take time to educate me about my choices?
- Does this provider value consent?
- Do they ask for my permission before touching me or performing a procedure on my body?”
       Women should ask themselves these questions after each appointment! If they ever feel unsafe or if they ever loose their trust in their provider, they should find a new one! It is NEVER too late to switch providers. Even during delivery, you can ask for a new nurse OR doctor OR midwife if they performed an intervention against your will or otherwise made you feel unsafe.
       Once she has selected her provider, she should begin exploring other topics that will be important during pregnancy, birth, and beyond. A great way to start the exploring her options is to take a childbirth class, particularly one offered by an independent provider because they will be able to offer information on the variety of ideologies and tools available. From there, she can begin researching and developing options for interventions in birth, as well as nutrition requirements through these seasons, exercise options before and after birth, alternative therapies like chiropractic and acupuncture to help with common pregnancy ailments, postpartum care and support plans, coping strategies for labor and intervention choices during the birth, types of pushing strategies, parenting and infant care options, car seat safety information, just to name a few.
       As she is exploring birth options specifically, it’s important that she familiarize herself with the name and evidence behind common hospital procedures during birth, often called ‘interventions’. Interventions are any measure, tool, or procedure during birth that exists outside of what is considered ‘unhindered’ and ‘unmedicated’ physiologic birth. Most of the time, a woman’s body is capable of birthing her baby on it’s own with little, if any, intervention. Her body can cause it’s own contractions, offer it’s own pain relief, and  instinctively move and position itself to optimize this process. Interventions should ALWAYS be optional. Just because it is “standard of care” in your hospital, does not mean you are REQUIRED to accept it. It is your body, your baby, and your care. Optional interventions include an utilizing an IV for hydration (as opposed to hydrating normally), utilizing pitocin (as opposed to progressing biologically or utilizing other tools), utilizing continuous fetal monitoring (as opposed to intermittent or handheld fetal monitoring), performing artificial rupture of membranes (your provider breaking your water), performing cervical checks (unnecessary, not evidence-based, and may increase risk of infection), delivering by vacuum or forceps (position changes or tug-of-war may be used instead).
       An intervention may become necessary when a woman requests it for her care or there is medical indication that she has agreed deems it necessary. One way she can evaluate if an intervention is necessary is to utilize the BRAIN tool, which is a mnemonic device that helps you remember some key questions you can ask when an intervention is suggested:
B - What are the benefits of this intervention?
R - What are the risks?
A - What are the alternatives?
I - What does my intuition/gut feeling say?
N - What happens if we do nothing?/How long do I have to make a decision?
Some times when an intervention may be medically indicated:
- if a woman’s baby is breech and her preferred provider is not experienced or comfortable delivering a breech vaginal birth, a cesarean birth may become necessary. 
- if a woman planned for an unmedicated birth but changes her mind during labor and requests pharmaceutical pain relief, an epidural may become necessary.
       Believe it or not, there are even more options available to a mom in her postpartum season, most of these related to continued care for her and baby. Once baby is born, if I am acting as a doula, I stay for an hour or two to help get the new family situated and support mom as she attempts her first feed (whether she’s choosing to breastfeed or bottlefeed). After that point, I leave and plan to reunite with the family once or twice through the first few weeks to answer any questions, help them discuss and process the birth experience, and sometimes gift a photo book of the big day. If the family is struggling in any way, I have an extensive resource list that I offer and a group of wonderful professionals I may refer out to. These include a postpartum app to coordinate family and friends’ emotional and practical support (called Mothership Rising), a postpartum doula (who can help parents settle in to their new life and create routines), a pelvic physical therapist (if there are any lingering pain or incontinence issues after 3 months), a newborn and family photographer (to capture those first few precious days), and others. Many of these professionals are available to meet at an annual event I coordinate called the “Bellflower Birth Boutique”, born from my passion for families to have all the specialized support they need during pregnancy, birth, and postpartum.

       If you have any other questions on any of these topics, please reach out to me. You can select ‘contact’ from the menu at the top of the page to schedule a complimentary meeting with me to explore mine and other services available to you in our community. You can also find me on business Instagram and FB page @gracepeacebirth. You can also email me at [email protected]. If you are local to Bellflower, I host a “Meet the Doula” night on the first Tuesday of every month at SteelCraft on Bellflower Blvd form 6-7pm. You are welcome to come ask questions and grab something to eat, there are a ton of great vendors to purchase from but I also bring cookies to share. Lastly, if you are interested in taking my childbirth education series, I am offering it for free at Bethany Baptist Church in Bellflower starting January 31, 2022 for 8 weeks. you can find out more about any of these events and register for that class on my ‘events’ page (in the menu above). You’ll also have the option to add their email to receive updates about services and upcoming events to your inbox.

Sending all the beautiful birth-y blessings your way,
Autumn Baker