A Day in the Life of a Doula

Some days as doulas are totally normal… Other days we are hyper vigilant because a client could go into labor at anytime. Or maybe you weren’t expecting a client to go into labor and you have to quickly figure out and change the days plans to accommodate your client’s needs.We aren’t ever far from our phones and the phrase “I’d love to come, as long as I am not at a birth!” comes out of our mouths often. This is from a day last year when I had plans but knew a client was in the early stages of labor.

My morning started by gathering all of our booth supplies. Gentle Transitions was a vendor at our local Cloth Diaper Expo. My daughter loves to come with me and help set up and meet people, so we ran through Starbucks and went to set up for our show. Thankfully I have wonderful team members and I was able to leave early for a family event while they finished the expo.

A client had texted me the night before that she was having some contractions so I wasn’t surprised to hear from her at my cousin’s bridal shower that day. We talked through what she was feeling and some other positions to try and get relief/comfort.

I checked in with her once I got home- she was still doing good at home! But she could tell things were progressing and getting harder to handle.

We had dinner and my husband prepared to go out for a night with friends. He had planned to carpool with someone but had to let them know they might have to come back early if I had to leave.

He left and called me about 2 hours afterwards from a number I didn’t recognize. He was worried wondering if I had tried to call. His phone didn’t have good service where he was and he was concerned that I called or would need to and he wouldn’t get it. So he called me from a friends phone so I had an alternative number. You never know when you will need to go- these babies run the show! 😉 I am also thankful for a husband who cares about my job and all the little things that go along with it.

Around 2am my client decided to head to the hospital and continued to check in with me throughout the night… Until about 4am when they decided they were ready for me to come. I gathered my things and left for the hospital. When I got there she was on her hands and knees over the bed. She let me know most of her pain was in her back and she wanted to rest but the back pain became much worse while laying down. We worked on a few other positions that were restful but more upright. She continued laboring while her husband and I took turns applying pressure or massaging her lower back and fanning her while changing out cool washcloths for her neck and forehead. She was doing great and the hospital staff was so helpful. Not long afterwards she felt the urge to push slightly with her contractions. We followed her lead as she pushed and breathed as her body led her through each contraction. Soon, we could see much more of the baby’s head and before we knew it our nurse was making phone calls and asking to get the delivery set up finished quickly. Just minutes passed until that sweet girl was born. The new parents were so thrilled!

We got mom and baby skin to skin and baby started nursing pretty easily with just a few tips.

I got home in time for lunch and to hang out with some friends before heading off to meet another couple for our prenatal meeting. It was a great weekend full of babies, clients, friends and family! And I slept really well that night!

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Pit: Labor and Postpartum

This is the 4th and final blog post on our series about pitocin. Check out our introductory post about pitocin here, our post about the differences between pitocin and oxytocin here, and pitocin in inductions here

We’ve talked about the role of pitocin during inductions, how pitocin differs from oxytocin, and how pitocin works in the body  biologically. Pitocin is not only used during inductons, but also to augment, or speed up, the labor process.

The most common use for pitocin during labor is what many providers deem “failure to progress.” What FTP means depends on the care provider. Often times providers base labor progress on something called the Friedman’s Curve. The Friedman’s curve was created in 1955 (over 60 years ago!!) that plotted the average woman’s dilation time, which came out to approximately 1cm dilation per hour of labor. For a GREAT detailed evaluation about the Friedman’s curve, please check out this post over at Evidence Based Birth. The most important thing to realize about the Friedman’s curve is that it cannot apply to every woman (that’s the nature of a bell curve!), and that so much has changed in the labor and delivery process since it was created so long ago. Thankfully, here in Champaign-Urbana, there are very few, if any, providers who still expect all of their patients to progress at the rate of the Friedman’s Curve. However, that does not mean that FTP no longer exists. It is still often diagnosed when mom is not dilating as quickly as their care provider would like (for a myriad of reasons).

No two labors are the same, and labor can speed up or slow down based on so many factors. Some of these include:

  • Malposition of baby
  • Epidural use
  • Mom feeling stressed/scared/anxious about her labor/location/people around her

There are obviously many factors at play, but in my personal doula experience, these are the most common reasons that labor seems to slow down, or “fail to progress.”

Labor slowing down, or stalling, does NOT mean that a mom needs pitocin to help it progress. Let’s look at some ideas that mom can try in order to get things moving again.

Malposition of Baby

If baby is positioned “perfectly” in the pelvis, and mom’s pelvis is properly aligned, generally labor and delivery will go very quickly. If the baby’s head is not aligned in the pelvis properly, her head will not be engaged properly on the cervix to increase dilation. Then, if mom does get to 10 cm, the baby can get lodged into the birth canal at a less-than-ideal angle, causing problems during pushing and delivery. So what can we do to help make sure baby is aligned properly? The biggest one that we doulas recommend is chiropractic care during pregnancy, and even labor. Seeing a Webster-Certified chiropractor during pregnancy can help keep everything aligned (and also relieve a lot of typical pregnancy discomforts!). Even in labor, a chiropractor can gently manipulate the pelvis to help create the right space for baby’s head to be engaged in the pelvis. (Check out our Community Partners page for some great chiropractors in C-U).

Additionally, we also recommend all of our clients check out Spinning Babies. Spinning babies is a series of exercises and body positioning to help encourage the baby to be in the best position for labor and delivery. If a mom is in labor and her care provider or doula thinks the baby is not in a great position, there are different positions that a mom can try to encourage the baby to turn even in labor. Check out the spinning babies “In Labor” page for more details on those!

If a baby truly is malpositioned in the pelvis, pitocin is only going to make things worse by intensifying contractions on the baby and for the mom, and potentially wedging baby into the pelvis even more tightly, rather than letting labor slow down to give the baby an opportunity to turn and get into a better position for birth.

Epidural Use

Epidural use in labor can also slow down labor, because the laboring woman is confined to the bed and not up and moving. Think about gravity–if a mom is up and moving, gravity is going to help the baby engage the cervix and move down. The opposite is also true–laying in bed, not upright, does not work with gravity, and can make the labor longer and slower. Additionally, mom’s reduced movement doesn’t allow ample opportunity for the baby to turn into the best position for birth. If a mom does choose to have an epidural during labor, it does not mean that she is doomed to have pitocin, too! In fact, one of the more recent labor tools that we have been using has been shown to drastically help reduce the length of labor and the risk of c-section: a peanut ball! Peanut balls come in different sizes to fit different women, and are used especially if the mom has an epidural. The peanut ball allows care providers and doulas to help get mom into different positions that will open her hips and pelvis, and allow more room for baby to move through the pelvis and into the birth canal in a good position. I remember after one particularly challenging labor, we tried using the peanut ball as a last ditch attempt to get mom to rest and open her hips. Less than an hour later she pushed out her baby, and the nurse exclaimed to me (in the hallway), “the peanut ball saved that birth!!” She was shocked and surprised, and to be honest, so was I! We couldn’t believe how quickly things started moving after 30 minutes of hip opening positions while mom was resting with the epidural in place. If your hospital doesn’t have peanut balls, consider getting one to bring with you in labor–you won’t regret it!

 

Emotional Blocks

Emotional blocks in labor are one of the more difficult things to discuss, purely because we can’t know exactly how a mom is thinking and feeling. Only SHE can know that! She may try to explain it to us, but when a woman is in the throes of labor, explaining how she feels emotionally in a given moment is difficult, to say the least! However, as doulas, we can help watch and observe our clients, and if we notice that mom is starting to appear nervous, or suddenly stressed, or uncharacteristically anxious, we can broach the subject and try to help. Sometimes it can be because mom had to move from a location where she felt comfortable to a less comfortable place (like moving from home to the hospital). This can disrupt the labor flow, and make the mom feel unsafe. When a woman feels unsafe, and her cortisol (stress hormone) levels rise unrelated to labor, her labor will slow or stall–it’s biology’s way of trying to give us the greatest odds for our baby’s survival. Talking through (ahead of time) what it will be like to get out of the house, into the car, and into the hospital can help alleviate some of those concerns ahead of time. In the moment, it’s important to do sort of a reality check. Am I really unsafe? What is scaring me? What can make me feel safer right now? These are all questions to ask yourself (if you can), or that a doula will ask you to help facilitate a smooth emotional transfer, and get labor back up and running again.

I heard someplace, sometime (super specific, I know) that for every additional person in the labor room, the length of labor increases by an hour. I have no idea if this is statistically true, but on paper it makes sense! If a woman is being watched during one of the most vulnerable experiences in her life, she’s bound to feel a little bit uncomfortable, or even unsafe depending on who the person is. It is ALWAYS okay to ask people to leave your labor space, be it at home or the hospital. If you don’t feel comfortable with that, your doula can help you get people out! Decide ahead of time who you’d be most comfortable with in labor, and either stick to your guns or remove people from that list! Once you start to feel safe and less “watched,” chances are good that your contractions will kick back in and start making progress.

If labor is slowing or stalling, running through these three categories can absolutely help get things moving again. There are lots of things to try before pitocin becomes the only option.

 

Postpartum

Immediately after birth, it is very common and sometimes protocol for women to have an injection of pitocin. It’s given so that it can help the (presumably tired) uterus to start clamping back down and healing the wound that is in there from the placenta, which slows blood flow and helps to prevent hemorrhage. Many women are less opposed to pitocin postpartum because it is not going to affect their labor or delivery (and is safe for nursing). Speaking of nursing, that’s the best way that you can prevent needing pitocin postpartum. When a mom nurses, the bond she is creating is created because of the release of oxytocin. That oxytocin helps the uterus contract, to encourage it to heal it’s own wound. Yet another reason to start breastfeeding right away after birth!

 

Conclusion

While I hope that you have learned a little bit (a lot!) about pitocin through this series, I hope that you take away the most important message, which is to be educated and not be afraid to talk with your own doula and care provider about your feelings on pitocin.  If interventions/options exist  for labor, delivery, and postpatum, but are not discussed ahead of time, very people know they are options and can be implemented. Make sure to keep the lines of communication with your care provider open, and discuss your wishes for labor and delivery at one of  your prenatals. Don’t be afraid to speak up if pitocin is being offered to you and you don’t understand why. Most importantly, feel empowered to enjoy your birth!