Pregnant in a Pandemic? Don’t panic, prepare.

It’s World Doula week and worldwide Doulas are being banned from hospital labour and delivery wards. In some places partners are not allowed in either. Covid-19 is ravaging the planet, and babies are coming into this madness whether we like it or not. Prenatal education is designed to prepare people for the unknowns of childbirth and to help alleviate common fears.  In this current situation, our common fear is the unknown of Covid-19.

I’m getting my information about the effects of this virus on pregnancy and newborns from Evidence Based Birth. Rebecca Dekker and her team are posting the latest information about Covid-19 as it arrives, and it is arriving daily.  What we do know is reassuring – Covid-19 has not been found to cross the placenta and it is not present in breast milk or amniotic fluid. It is too soon to tell if Covid-19 causes birth defects or is responsible for miscarriages. The World Health Organization is not recommending routine separation of Covid-19 infected mothers’ and their newborns, as antibodies against Covid-19 are present in breast milk and it is vital that the baby receives them.

Pregnant women do not seem to be at higher risk than others to contract Covid-19 and the recommendations to avoid it are the same – wash your hands and all surfaces that you and others may have frequent contact with (door handles, light switches, stair banisters, door bells) and stay at home as much as possible. Many women are choosing to reach out to midwives and home birth physicians and changing their birth plan so that they can avoid hospitals, and this is a great option for many people. But if you can’t avoid the hospital, how can you prepare for a birth experience unlike any you have previously imagined?

Step 1) Sign up for Zoom or Skype. If you can’t have your birth team physically with you in the hospital, you can at least have them virtually. Make sure your laptop or tablet is ready to go and the charger is in your hospital bag. Zoom lets you have up to 100 people! This is perhaps too many.  You do not have to have your video on, and you can mute them.

Step 2) Prepare the most awesome music play list imaginable. Shakespeare said “if music be the food of love, play on.” Oxytocin is the hormone of love, and it’s also the hormone that drives your labour. Unfortunely it’s inhibited by stress. When labouring people feel unsafe, the wrong hormones are produced and they put the brakes on oxytocin production. Keep that oxytocin flowing by keeping your eyes closed and your tunes playing.

Step 3) Practice daily self hypnosis. Listening to guided relaxations or visualizations can help pregnant people learn how to relax, and once you’ve mastered the art of deep relaxation at home, it can be easier to get into a deep state of relaxation in the hospital. If your birthing suite has a bath tub available, play your relaxation mp3 and relax in the tub at the same time.

Step 4) Pump up your yoga balls.  Many hospitals provide yoga balls for their birthing clients, but maybe you want to bring yours from home. Get a round one for bouncing on and a peanut ball for helping you labour in bed. Make sure you get the right size, you can find some guidance here.  Peanut balls help your baby progress if you are confined to bed and cannot get into productive, upright birthing positions.

Step 5) Befriend and love your nurse. She continues to show up for work in a world gone mad. She is a superhero, and she has your back.  Describe to her what you had hoped for your birth so that you can say goodbye to it and move forward. If you cannot see her face properly through her PPE, imagine that she is your best friend, your mother or your doula.

Step 5) Be unafraid. Generations of women have birthed their babies without their partner present. You can do this. You are a strong, resilient woman. You can walk into the fire alone and come out the Mother of Dragons. Yours will be the birth story told for years to come. You will survive this and grow stronger. You are surrounded by the love and support of all the generations who came before you. Close your eyes and let them guide you through.

 

So, what does a doula do, exactly?

Frequently asked questions, doula edition.
So you’ve heard the reports and seen the stats and you know that having a doula increases birth satisfaction, decreases interventions and is just the most awesome thing ever. But what does a doula do, exactly? Of course every labour is different and every woman has different needs and desires. Your doula will adapt to suit your specific requirements. She will provide emotional and physical support, guidance and unbiased information throughout the pregnancy and labour. She will make suggestions on books you might want to read, products you might find helpful and positions that will ease your pain. She will hold your hand, wipe your sweaty brow and tell you that you are awesome.

But won’t my husband/partner do that?
Maybe. Hopefully. But sometimes your husband/partner will be a bag of nerves. Sometimes they will freak out when you cry out. Sometimes they will shriek “Get the doctor in here now!” three hours too soon. Sometimes they will turn white and pass out. Your doula can reassure your partner that the noises you are making and the pains you are experiencing are normal, healthy and to be expected. She can help your partner get over their anxiety and suggest ways that they can comfort you physically. She can stay with you while your partner gets a snack or makes some phone calls. She can reassure you both that progress is being made and that there is no reason to be afraid. She can gently suggest that maybe sitting down now would be a good idea. She can hold your partner’s hand, wipe their sweaty brow and tell them that you are both awesome.

But what, exactly, does a doula do?
Your doula will arrive at the hospital or birthing place within 90 minutes of your phone call. She will immediately check out the space, draw curtains and close doors. She will make sure you are comfortable and not sitting in a puddle of your own amniotic fluid. She will find where the dry sheets and blankets are and make sure you have what you need. She will ask questions to find out how you are feeling and what has happened in her absence. And she will get you up on your feet and make you move around as much as possible. It’s good practice to shift positions every 30 to 45 minutes and your doula will keep her eye on the clock and make suggestions as to new positions to try. In the early stages of active labour your job is to find your rhythm and get your coping strategies in place, and your doula will help you do this. You may not even notice that’s what is going on, but your doula will notice what you naturally do during each contraction and will help you keep doing what is working for you. And if things start to change, your doula will try to help you get back on track, whether by trying a new position or motion or water therapy or whatever other tools she may have in her bag of tricks.

Bag of tricks? Tell me more about this bag of tricks.
Your doula will bring a bag to the hospital that is a bit different from what you bring. She will probably have a heating pad or magic bag which can be quite soothing – if you like heat on your stomach or back when you suffer from menstrual cramps you might also like it when you are in labour. Ice packs are also an option. Some doulas bring their own birth ball and some hospitals provide them. (Others refuse to allow them. Boo.) Some doulas use TENS machines. All doulas have training in comfort measures that include massage, counter pressure and light touch. Your doula will probably advice you in advance to provide your own music, pillows and light snacks. Think about the food and drinks you like when you are recovering from the flu. Some hospitals still refuse solid food to women in labour but will provide soup and jello and fruit juice. 20150822_171946
What if I just want an epidural, right now?
In your prenatal visits you will have made a birth plan with your doula, and if your birth plan says “I want an epidural, right now” then your doula will support your choice to have that epidural, right now. If your birth plan says “I really don’t want to have an epidural” then your doula will gently remind you of your original plan, suggest a different position or hydro therapy or whatever but if you say “No, I don’t care, I want an epidural right now!” then your doula will support your choice to have that epidural, right now. Your doula is there to support you and your choices.

What happens in the prenatal visits?
You are likely to meet with your doula three times before you give birth. The first time is a free consultation session at which you will get to know her a little bit and decide if she’s the right doula for you. The second session will include birth planning and a little prenatal education. The third will most likely include breast feeding education, baby care and postnatal planning. By the end of these two sessions you should feel more confident and knowledgeable about the physiological process of childbirth and how you want to approach it, and you will have faith that your doula will support you in whatever choices you have to make along the way.

How long will my doula stay with me?
Your doula will stay 90 minutes to 2 hours after you give birth. She will make sure you have something to eat and drink. She can fetch any family members you have waiting down the hall, or shoo them away if you don’t want to see anyone yet. She will wait with you until your baby shows interest in breast feeding and help you get off to a good start. And when you are ready, she will leave and let you get on with the business of bonding with your baby.

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5 steps to an awesome induction.

251814_10151795813205514_1168844160_nI know what you’re thinking: “aren’t inductions always awful?” “Don’t you hire a doula to avoid an induction?” “aren’t doulas all anti-intervention at all costs?” The answers to these questions are no, yes and not at all. Sometimes inductions are necessary. Doulas are not magicians. Interventions have their place. Last month I was privileged to attend the birth of a sweet-faced little girl. Her Mother had developed complications and the decision was made to induce at 38 weeks. Here is what my client taught me about how to have an awesome induction.

Step 1. Keep a positive attitude. So your birth plan was to have a water birth at home with midwives, and you find yourself checking in to the hospital for an early induction. Oh well. It’s still your birth and your baby, let’s make the best of it.

Step 2. Take one step at a time. The OB is most likely to offer you gel, AROM, Pitocin, and an epidural as a welcome package. Try to space out these interventions. See if the gel will work by itself. Try to relax, sleep, and let your cervix do its thing. Put off the next intervention for as long as possible.

Step 3. Walk walk walk. Try and move around as much as possible. The longer you can stay mobile, the better position your baby will slip into for an easier birth. Remember, gravity is your friend. There are many upright positions for labouring even if you want to rest in bed. A portable fetal monitor even allows you to shower or get in the bath. You can still move around with ruptured membranes and a Pitocin drip if you are determined to do so.

Step 4. Don’t be a martyr. You don’t have to suffer. Pitocin induced contractions are much harder and stronger than the natural kind. Very few women can manage them without pain relief. Getting an epidural does not mean you’re a failure, it means you can enjoy some pain-free time to rest up for step 5.

Step 5. Wait till you feel pressure on your rectum and push that baby out like a boss. That’s what the epidural does best – gets you through transition without batting an eyelid. If you stop pressing the top up button when you begin to feel pressure in your bum you should have enough sensation to push effectively when the time comes. Slow steady pushing is the way to go.

That’s it, my 5 steps for an awesome induction. Remember, it’s still your birth and your baby and you are the one in charge.