Back in March the American Journal of Obstetrics and Gynecology released q study that confirmed what a lot of midwives and doulas (and yes many OBGYNs) have been saying for a while. Pregnant people need more time to push. In fact, the study proved that if women and pregnant people were given as little as one extra hour to push their rates of unplanned C-Section went down by roughly half. HALF!
According to the Huffington Post article about the study, while this information has he potential to radically change how people give birth in the U.S, it may not actually amount to concrete change. Author Catherine Pearson writes, while the study is small, it's "unlikely to fundamentally change medical norms any time soon, researchers say it offers a much-needed critique of potentially outdated standards."
Just how outdated are the standards you may ask, well the allotted time a woman is "allowed" to push was adopted in the late 1800s. “[The time recommendation] came from expert opinion from the 1800s,” said Dr. Alexis Gimovsky, a fellow in maternal fetal medicine at Thomas Jefferson University in Pennsylvania, and an author on the study. “Since then, there’s really only been retrospective data used to validate that guideline.” In the 1950s, researchers looked over earlier data and found that women who delivered their babies within two hours had lower rates of infection and serious postpartum bleeding, for example. In 1955, another team concluded that most women without anesthesia give birth within two hours."
So what does this all mean? In my opinion it goes back to the idea of B.R.A.I.N, being armed with knowledge, and being confident that your body knows how to give birth.
As a review B.R.A.I.N is an acronym I suggest pregnant folks and couples start to using during prenatal appointments with your caregiver.Using it early on in pregnancy and frequently helps you get accustomed to the process of coming to your care provider with questions and being ready with responses that are best for you and your baby. Frequently using B.R.A.I.N also is great so that when something is suggested during labor, you're ready to ask:
B: Benefits - What are the benefits of doing this?
R: Risk -What are the risks of doing this?
A: Alternatives -What alternatives do we have?
I: Intuition/Instinct - What's your gut say?
N: Nothing - What happens if we do nothing?
I will close by saying that there are many reasons that birth visions fall off track and interventions and potential c-sections are how some babies are born. I like to say that there is no "right" or "wrong" way to give birth. And this evidence-based information about not rushing into pushing and giving you, the person giving birth, time to ease into pushing and to let pushing happen can result in the birth you vision.
One of my favorite births was a dear friend of mine. She had a hard labor that totally veered off of our Birth Vision. Low fluids followed by an induction and a strong reaction to Cervidil followed by epidural and Pitocin and a lovely, healthy baby boy. Through the hard times and the bliss that an epidural can sometimes bring, I felt like I was a witness to the birth, rather than a participant. Which sounds strange as a doula.
What I mean is that this mother and her husband were so connected, so in sync, so in their own world that much of my role was to support them.
A doula doesn't replace the role of husband or partner or birth partner, our role is to enhance and support. And yes, sometimes to stand watch while the partner takes a nap.
What About The Father’s Role When Using A Doula?
The role of the doula is never to take the place of husbands or partnersin labor, but to compliment and enhance their experience. Today, more husbandsare an active role in the birth process. However, some partners prefer toenjoy the delivery without having to stand in as the labor coach. By havinga doula as a part of the birth team, a father is free to do whatever hechooses. Doulas can encourage the father to use comfort measures and canstep in if he wants a break. Having a doula allows the father to support his partner emotionally during labor and birth and to also enjoy the experience without the added pressure of trying to remember everything he learned in child birth class!
Read the rest of this article outlining the benefits of having a doula.
So what is the evidence for doulas?
In 2012, Hodnett et al. published an updated Cochrane review on the use of continuous support for women during childbirth. They pooled the results of 22 trials that included more than 15,000 women. These women were randomized to either receive continuous, one-on-one support during labor or “usual care.” The quality of the studies was good.Continuous support was provided either by a member of the hospital staff, such as a midwife or nurse (9 studies), women who were not part of the woman’s social network and not part of hospital staff (doula 5 studies; childbirth educators 1 study, retired nurses 1 study), or a companion of the woman’s social network such as a female relative or the woman’s partner (6 studies). In 11 studies, the husband/partner was not allowed to be present at birth, and so continuous support was compared to no support at all. In all the other studies, the husband or partner was allowed to be present in addition to the person providing continuous labor support.
Overall, women who received continuous support were more likely to have spontaneous vaginal births and less likely to have any pain medication, epidurals, negative feelings about childbirth, vacuum or forceps-assisted births, and C-sections. In addition, their labors were shorter by about 40 minutes and their babies were less likely to have low Apgar scores at birth.
What does this mean?
It means that if you have continuous labor support (that is, someone who never leaves your side), you are statistically more likely to have better outcomes and your baby is more likely to have better outcomes! How did doulas compare to the other types of continuous support?
The researchers also looked to see if the type of support made a difference. They wanted to know—does it matter who you choose for your continuous support? Does it matter if you choose a midwife, doula, or partner for your continuous support? They were able to look at this question for 6 outcomes: use of any pain medication, use of Pitocin during labor, spontaneous vaginal birth, C-section, admission to special care nursery after birth, and negative ratings of birth experience.
For most of these outcomes,* the best results occurred when woman had continuous labor support from a doula– someone who was NOT a staff member at the hospital and who was NOT part of the woman’s social network. When continuous labor support was provided by a doula, women experienced a:
Why are doulas so effective?
A doula can act as a buffer in a harsh environment.
There are 3 main reasons why we think doulas are so effective. The first reason is the “harsh environment” theory. In most developed countries, ever since birth moved out of the home and into the hospital, women have been giving birth in conditions that can often be described as harsh. In the hospital, laboring women are frequently submitted to institutional routines, high intervention rates, personnel who are strangers, lack of privacy, bright lighting, and needles. Most of us would have a hard time dealing with these conditions when we’re feeling our best. But women in labor to deal with these harsh conditions when they are in their most vulnerable state. These harsh conditions may slow down a woman’s labor and decrease the woman’s self-confidence. It is thought that a doula “buffers” this harsh environment by providing continuous support and companionship which promotes the mother’s self-esteem (Hofmeyr, Nikodem et al. 1991).
A dad says: “My experience has shown me that, whether you’re giving birth in the hospital, birth center, or at home, your impact and ability to connect and support your wife during the birth process is both supported and maximized by having a doula there on your team.” Credit: www.yourbirthjourney.net and Seattle Birth Photography
The third reason that doulas are effective is becausedoulas are a form of pain relief (Hofmeyr, 1991). With continuous support, women are less likely to request epidurals or pain medication (Hodnett, 2011). Why are women with doulas less likely to request pain medications? Well, women are less likely to request pain medications when they have a doula because they just don’t need an epidural as much! Women who have a doula are statistically more likely to feel less pain when a doula is present.Furthermore, by avoiding epidural anesthesia, women may avoid many medical interventions that often go along with an epidural, including Pitocin augmentation and continuous electronic fetal monitoring (Caton, Corry et al. 2002).
Read the entire article here.
Hi there! I'm Erika Davis and I'm a doula working in the Seattle and South Puget Sound area.