Thursday, February 3, 2011

The doula's first-time mama advice kit

Just about everyone who knows me knows I like to talk. Very quickly they generally find out that I am especially talkative on some of my favorite subjects of birth and breastfeeding. (I am so proud of myself last month that I went to a New Year's Eve party and only ended up talking about breastfeeding once, and very briefly at that!)

So when friends and acquaintances get pregnant, they often come to me for advice. (Sometimes I hear in their voice a kind of loving "OK, know-it-all, NOW you can tell me" tone!)

While I always try to tailor my advice to their specific questions (in part so as not to overwhelm them!) I do find myself answering similar questions and requests more than once. I've been thinking about putting together a set of the links, books, and resources I recommend to the newly pregnant woman (as opposed to the packets of info and resources I put together for my doula clients). That way I won't forget anything and will have it all conveniently in one place, so I can answer specific questions and then say "If you want more information, here's the link".

Here's a preliminary set of the info I'd give to a newly pregnant woman:

Suggested for everyone before they do anything else

The very first thing to do - before ANYTHING else - is read my post on What I Want My Friends to Know.

Next, unless said friend has put up with a lot of my rants or been following my blog for a long time (hi guys! hope you have been!), it's time to start researching options for birth.

So secondly, watch The Business of Being Born (also available on instant view from Netflix). Seriously, this is the first thing I think any pregnant woman and her family can do to help them understand the lay of the land in the U.S. right now, birth-wise.

(Reading "Pushed" by Jennifer Block is also great but not as easy as sitting down to a (very well-made) movie for a couple hours.)

Choosing a care provider and birth setting:

Often the first care provider someone goes to after finding out about the pregnancy (or to confirm pregnancy) is the person's regular GYN provider. That may be a gynecologist, an ob/gyn, a nurse practitioner, a family practice doc, a midwife, etc. If that provider offers obstetric services, the woman may begin her prenatal care with that provider, but wonder if she should investigate other options. If that provider does not offer obstetric care, she'll definitely be looking for a place to get prenatal care and deliver (since the two generally go hand in hand). So people frequently talk to me about how to go about researching and choosing a provider and birth setting.

What I say is that when looking for a care provider and birth setting, it's important that they match YOUR philosophy and what YOU want out of your birth experience... which can be hard to formulate when you're all of 5 weeks pregnant and have never thought about this before! So it's OK to establish care with someone knowing you might switch later.

In the meantime, gather your information and investigate your options carefully.

Why it's important to investigate and choose carefully

The First Birth - No Do-Overs Currently Available - just found this via Birth at Home in Arizona and love it. Make sure to read the comments as well.

You buy the hospital ticket, you go for the hospital ride by Navelgazing Midwife is an honest assessment of why it's so important to look very closely and be realistic about whether a particular birth setting will be right for you.

Information to gather and questions to ask about a care provider/setting

Their state's hospitals' c-section rates if available, from The Unnecesarean.

From Childbirth Connection:
Choosing a caregiver
Questions to ask a health care provider
Choosing a place of birth
Tips and tools for choosing a place of birth

From Birth Sense:
In Search of Dr. Right: 11 Questions to Ask and One More Question to Ask

Considering a home birth? Here are some links for thought specifically to help you interview potential homebirth midwives:

A short discussion and links about the fact that all midwives practice differently, and you will still need to find someone who has the right practice style for you.

From Navelgazing Midwife, advice on interviewing homebirth midwives: Part 1, Part 2, Part 3, Part 4, Part 5, and the finale. A commentary she wrote while posting the series is here. This is another post she wrote about interview questions, critiquing a list of suggested questions. Please read them all if you are planning to interview homebirth midwives!

My biggest piece of advice is to find experienced local doulas and talk to them about your options. They will know not just what local maternity care providers say they will do, but also what they actually do, which can help avoid the problem of the doctor or midwife who seems lovely and then becomes a totally different personality in the delivery room, or claims they practice one way and end up doing something very different. If you aren't ready to commit to hiring a doula or a specific doula, I think most doulas would be open to meeting with you for an hour or two, with the offer of compensation for their time based on the understanding that you may not hire them for the birth. (Doulas understandably feel poorly used when people act like they're going to hire them, spend a long time "interviewing" them while getting lots of advice/information/resources with no compensation, then never call again.)

If I know you personally, I'll usually get on a doula forum or two and ask for local suggestions from the doulas there - so hit me up!

Finally, go into this keeping an open mind. You may think you've found Dr. Right and then when you finish your birthing class at 32 weeks, realize that person is not the right fit for you. That's OK; there is still time to switch. Please don't fall into the trap of thinking that you can't switch after some magic number of weeks! Every doula can tell you the story of the client who switched at [34 weeks, 37 weeks, 41 weeks, in early labor, in active labor, etc.] It's only too late to switch after you've had the baby... and are regretting not switching before.

Here are the instructions for how to switch if you need them.

I'm not done talking about switching care providers, because I can hear people saying "I know I COULD switch, but it just seems too complicated/confusing/difficult/scary... I don't love this person, so I think maybe for my NEXT birth I will choose someone different/a home birth/a new hospital/etc." Do you hear yourself saying that? Stop and go back and read The First Birth - No Do-Overs Currently Available.

Now read the Unnecesarean's post of mothers who did (and didn't) make the switch.

Have you done those two things? Go and do them right now. Okay, REALLY done them now?

Then one more thing to remember: you may never have as many options as you do now - carrying scars, emotional or physical, from your first birth may impact your second in ways you may find hard to think about right now. Do not make excuses for care that does not live up to what you know you want and need! Do not put yourself and your needs off into the future - address them now in whatever ways you deserve.


Along with advice about bras, probably the most frequently asked question - what to read?

Standard warning: NOT "What to Expect When You're Expecting". 'Nuff said.

My favorite suggestion lists for books: What Not to Read, from Bellies and Babies. Along with each book she thinks women should avoid, she has 3 suggestions for better books on that topic.

Childbirth classes

I can't emphasize enough not taking the hospital classes. No matter how great the teacher is or how much freedom she seems to have - she is limited by hospital policy and you cannot be sure exactly what those limitations are.

An independent childbirth class with at least 5-6 sessions is a far better choice. Research a little bit about the philosophy of instructor and the class before signing up - there are many options (e.g. Bradley, Hypnobirthing, Hypnobabies, Lamaze, etc.) This post at Bellies and Babieshas a nice overview of the most common/popular childbirth ed programs.

If you live in an isolated area and can't find local classes, some independent instructors offer DVDs of their classes, and Hypnobabies has a full home study kit.

I have heard several childbirth educators recently saying plaintively that parents are looking for a small number of sessions, or preferring weekend workshops with a lot of information packed into 1-2 long days. I agree with them that it's very challenging to get all the information you need AND (more important) absorb and process it with these kinds of classes. If that's all you can do, go for it - but really try to make the time for something with a slower, calmer pace.

If you have trouble finding affordable birthing classes, ask around for childbirth educators in training, and talk to your local health department and/or community health center - they sometimes offer low-cost options.


By far one of my most frequently asked questions. Fortunately I wrote a series on this!


I recommend, if the mom feels comfortable, going to a couple La Leche League meetings while pregnant. They are a great place to see other women breastfeeding, hearing their questions, and getting advice. And they're free!

You might also think about taking a breastfeeding class. Oftentimes local maternity stores, hospitals, private lactation consultants, etc. will offer them. I currently teach one at a local yoga/wellness studio. No matter who teaches it, you can almost always look forward to practicing latch and position with baby dolls!

Rixa at Stand and Deliver has some excellent suggestions on A Proactive Approach to Breastfeeding.

You'll see a note from me in the comments encouraging confidence. Many of my friends ask me tentatively "How often do women have problems nursing?" or "What percentage of women can't make enough milk?" These are normal concerns coming from a culture where so many women seem to struggle with latch and supply. These are real issues, many stemming from institutional and systemic factors like birthing practices and hospital policies (see more at Rixa's post). But the biggest predictor of breastfeeding success is confidence, and the perseverance to overcome whatever challenges arise.

(And again, if we know each other you know you can call me any time about any breastfeeding question! Seriously. Any time. I have a bizarre sleep schedule anyway.)


Phew! That's all I have for now. Readers, what would you add to this list? What are your first recommendations for a newly pregnant mom?


Sara B said...

thanks! bookmarking this to return to in 3-5 years.

Lacey Jane said...

Just found your blog. We are probably soulmates.

Crystal - Prenatal Coach said...

This is great! Thank you! I'm going to share it with my readers, lots of 1st time moms!

Rebecca said...

@Lacey: I think there are a lot of us out there! I love how blogging has helped connect this network.

@Crystal: Wonderful, thank you!

Rebecca C. said...

what about chiropractic care? some natural birthers seem hot on that, and some don't mention it. I've never been to a chiropractor but I certainly would if it would help with a better birth.