From the moment a woman in the United States gets that life-changing reading on a little plastic stick, discovering she is pregnant, there are decisions big and small to be made. Such as, how she will exit the bathroom? Will she be jumping up and down, calmly beaming her pregnant radiance, or clammy with a dazed look in her eye? Who will she tell first – her partner, her parents or everyone in one grand status update?
Invariably one of the first people contacted is her obstetrician and in many cases, at that first appointment the mother hands over all the decision making to the medical profession. She is told by her doctors what tests are required, how her birth will go and, very often, when exactly it will happen. Women in the United States are stripped of their right to be in control of one of the most, if not the absolute most, important thing they will do in their lives: bring a child into this world.
It is a message our culture is saturated with by the media and the recent generations before us. Having a baby is a medical procedure, like an appendectomy. It requires women to be strapped to a table, hooked up to wires, with any number of medications and interventions to move the process along. According to a report by the Center for Disease Control the national cesarean rate for births in 2010 was 32.9percent, the highest in the industrialized world. The United States ranks 41st out of 193 countries in infant mortality rates, a sad placing for the most powerful country in the world.
But a movement has begun. It has no leader. It is not comprised of any one race, religion, political or sexual orientation. It is fueled by education, information, and the need of women in this country to take back the reins, trust their bodies, and give birth on their own terms.
Angela Garvin of Birth Louisville teaches a birthing class called Empowered Birth and instilling women with the knowledge that they have options and what those options are is her main objective.
“Everybody deserves and needs childbirth education,” Garvin said. “It is the beginning of parenting.”
Her Lamaze-based class does not focus on outcomes, so, for example, people who come in wanting an un-medicated birth are equipped with the information they need to accomplish that, but are also prepared to make the decision to have an epidural should the birth turn in an unexpected direction.
“I tell them to just surrender to the fact that there are things you can’t control,” said Garvin. She provides them with evidence-based information, without inserting her own opinions or personal experiences, regarding their pregnancy, labor, giving birth, and post-natal care for mom and baby.
“I remind parents that they deserve and have the right to ask questions,” said Garvin. “You do not have to have a parent/child relationship with your care provider.”
Garvin, who is also a Doulas of North America (DONA) certified doula, has been teaching her birthing class for six years. It has morphed from focusing on teaching couples how to achieve a completely natural, un-medicated birth, to arming them with knowledge so they can make the best decisions in the heat of the moment.
“The more births I attended the more I realized natural birth is great, but it isn’t for everyone,” she said.
The woman who comes to Garvin’s class dead set on pain medication during labor learns all of the risk factors and implications that are commonly dismissed in a typical OB’s office. Such as, the common practice of inducing labor more than doubles a woman’s chance of having a C-section. Once the mother has this information she can then re-evaluate her plan and move forward or change her path, depending on her personal preference. She and her partner are in control.
“There’s nothing wrong with an epidural,” said Garvin, “I would tell the mother – don’t get induced, don’t go to the hospital too early and get a doula.”
A birth doula like Susan Linville, DONA, of Fearless Birth Doula Services. Her code of ethics is very similar to Garvin’s. She aims to “empower women with options and choices and allow them to make well informed decisions.” While Garvin prepares couples for birth with her classes, Linville supports them during labor and birth. She helps the couple formulate a plan for their ideal birth and supports them through labor, assisting them in achieving that plan and providing them with time to discuss how to proceed should things go in another direction.
“Many clients want me to normalize the situation for their partner,” Linville said. “I help their husband, help them [mother and father], and I also help the husband not freak out.”
Many of Linville’s clients come to her after being disappointed in the outcome of a previous birth. Some have had non-emergency cesareans that may have been avoidable under different circumstances and they want to have their next baby vaginally. VBAC (vaginal birth after cesarean) clients are one of Linville’s specialties.
“It’s really great to see the triumph of a VBAC if the first C-section was unnecessary,” said Linville. “Their confidence has been undermined and it’s so empowering when their body works.”
When the hypotheticals from Garvin’s birthing class become realities in the chaos of birth, Linville is there to keep everyone grounded.
“I help them focus on the path that is laid for them, instead of the one they planned,” she said.
Linville works as an advocate for her client, but she is not there to argue with the doctors. If the doctor suggests an intervention, such as induction, epidural or even a more serious option, like a C-section, she takes a diplomatic route.
“I lay it all out there and remind them of their choices,” said Linville. “But I never want to get in the way of what the doctor says.” And she admits that while she respects her client’s choices, “it can be disappointing, when you see mothers miss out on some very important experiences.”
Doula services and support continue even after the little bundle has been delivered safely. The new parents might be happy with their birth, and feel they have been well supported by their doula and the birthing classes over the last nine months, but they aren’t left to fend for themselves in experiencing life with a new baby.
Amy Farnsley is a postpartum doula and lactation counselor who takes over where the birth doula leaves off. When the new family arrives home, she is there to lend a hand where needed – light housework, making meals, or taking the baby for a while so the new mother can get some rest.
“It is unbelievable,” said Farnsley, “how many women feel alone and don’t talk about it.”
She keeps an eye out for signs of postpartum depression and helps the partner get in the groove of having a new little person around the house. Farnsley is there for the baby too. She assists in breastfeeding, can do weight checks and, with a high tech scale, can even answer every breastfeeding mother’s number one question – how much is the baby eating?
Farnsley’s services are often utilized by couples who don’t have close family living near them or by families who are having a second or third child.
“I help moms learn to prioritize,” she said. “When you’re adding a third child, something’s got to give.”
She says her main goal is to make sure moms are taken care of.
“I love it when I can walk in and I can say to a mom – feed the baby and take a nap,” said Farnsley. “And when she wakes up the house is clean and there are snacks in the refrigerator. There’s always such relief on their face.”
While it’s a case by case basis, Farnsley likes to work her way out of a house sometime before the baby is twelve weeks old, which is most likely disappointing to many moms who probably want to keep her around for much longer than that.
When searching for the best birth team, in whatever combination of birthing classes, birth or postpartum doulas, midwives or OBs is right for the individual, one key thing is important to remember – personalities must jive. These are very intimate situations and the mom and her partner should feel 100 percent comfortable with the people they choose. Do some research on birthing classes and interview several doulas, midwives and even OBs to make sure they are a perfect fit. In making the decision to have an informed and supported birth, the decisions that follow will be that much easier.
–By Sara Jones Rust
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