some doula question(s)

[happynappies]

Hi - I posted here a while back and got some great support and advice about the traumatic time I'd had with my first labour. Am really hoping to ttc soon for my second, but want to get things straight in my head so that hopefully I won't panic/get terrified of labour second time around. One thing that I am quite clear on is that I want to try to find a doula closer to the time. My question is, how do doula's ensure that they are available to birthing mothers, i.e. so that they don't get 'double-booked'? Do they only take on one pregnant woman per month or is it a bit 'hit and miss'? I woudn't want to put my faith/hope etc in someone and then find they couldn't be there at the time to support me, so can someone explain how it works?

If any doulas do pop by, perhaps you'd be able to answer these questions for me too:

1. If you choose to have an epidural, do you have to allow it to 'wear off' before the pushing stage? (I was told I had to last time, and although this time I'd hope to manage the pain better, I'd like to know that if I coudn't and needed an epidural, that I wouldn't have to let it wear off).

2. If you have an episiotomy/tear, do they have to put your legs in stirrups to stitch you up? I had severe SPD which was made worse by being in stirrups for over 2 and a half hours... really want to avoid that next time, but not sure if you can put that in your birth plan.

3. Second time around, is it any easier to discern when you should go into hospital? My contractions were every 5 minutes but (I didn't know it then) not intense enough, so I spent longer in hospital than I needed to. As second labours are often shorter, would it be difficult to work out when you actually need to go to hospital? (I say hospital - I'd love to have a home birth but have been told that because of shoulder distocia and post-partum haemorrhage, I wouldn't be able to, and because of my fears I think I probably would be better in a hospital but with a doula/private midwife to help me with managing pain and keeping me from panicking completely which is what I did last time!!)

Thanks for taking the time to read this - I really would be very interested to hear from anyone who'd like to reply. Thank you.

hello

re availability: either have a back up doula available who you will meet before the due date or book women 4 weeks apart to ensure no crossover ...

1. You don;t have to do anything yu don;t want to.....there are benefits to letting it wear off, and to not having one at all.. being able to feel the pushing sensations is useful, rather than being told when to push. But you can request to have it topped up. I would think that with the support of a doula, you could thikn abotu not having an epidural, or a really low dose mobile one? Ultimately, yoiur decision.

2. Usually yes, pelvicpartnership.org has good info about dealing with SPD and birth. You might not tear, and if you do, might not need stitching. Also, if you do have SPD and have to have stitches, there might well be ways round it. Talk to the MW. And 2.5 hours in stirrups sounds very long ... were you being stitched for the whole time?

3. You can have a homebirth, even with your past history, if that is what you want. www.homebirth.org.uk if not, then once you are having regular ctx, strong, lasting around a minute, needing to close eyes and concentrate, it is usually time to go. depending on how far away the hospital is. A doula will also know the signs for when it is time to thikn about going..

if you go for a private midwife but not a homebirth, she cannot deliver the baby for you , her status will be as a doula/ birth partner with you in hospital, but obviously she can do all your antenatal care for you.

Hi Lulumama,

Thanks for your comprehensive answers to my many questions.

I have thought about my labour over and over, and am reading up on e.g. hypnobirthing, and Juju Sundin's birth skills - anything that might enable me to cope better. I realise on reflection that I was coping well with the pain of contractions early in my first labour, but when put on a syntocin drip the 'cascade of intervention' followed as I couldn't cope at all with the pain, had pethidine, then epidural, then ventouse... I want to have a totally different approach this time - but also want the 'back up' of an epidural being available. I know this might sound defeatist, but it really was so unbearable I don't think I could cope knowing it wasn't available if that makes sense!!

I was in stirrups forty five minutes before my dd was born, then just over an hour and fifteen minutes beingt stitched afterwards, so sorry it wasn't 2.5 hours, I've just checked my notes.

I suppose there are a lot of unknowns for me - I might not get SPD next time, but last time I could barely move before contractions started, so really couldn't get into the best positions for labour, which didn't help.

I suppose because my dd was 9lb 3 oz I fear that I might have a bigger baby, it might get stuck by the shoulders again, or it might be that my pelvis just wasn't the right shape/size (don't know if this is possible - my thoughts just run riot). I was told that my dd's head was 'high' throughout my early examinations... I'd like to believe that I could manage better a second time around, but I found the transfer from mw unit to hospital so traumatic, I think I'd be more comfortable arriving at the hospital when I was coping rather than planning for a homebirth and facing the possibility of a transfer if needed. I realise I must sound so negative - I really am trying to approach 'next time' positively but I think I need reassurances that just can't be given. Even if I were able to speak to e.g. head of midwifery at the hospital - I don't think they could fully explain all the aspects of my previous labour that I don't understand. Thats why I really hope that with a doula I could talk about last time and build up a relationship that might help me next time... Sorry to ramble on!

don't know if I've done this properly, but this was my original post re my labour

Hello happynappies
God you really went through it didn't you?

I am not a doula but I had a doula with my first baby (also 9lb 3oz and also delivered by forceps)

Epidural
i had an epidural and I made damn sure they did let the bloody thing wear off - I actually argued with my MW and won!!! (poor woman!)

Doula
My doula only had one client booked in every 5 weeks so she was guarenteed to be around for 3 weeks before and 2 weeks afer due date.

My doula was brilliant I was scared to death of labour and i knew that neither my husband or i knew enough about labour to fully understand the delivery process when our time came. She knew EXACTLY what I wanted and helped to communicate this successfully to the MW team. It was also lovely to have a friendly face there all the time at shift changes.

Hope this helps a little.

I think by the sounds of it you need extra support this time around becuase of what happened last time - maybe a doula would be a good way for you to go.

xxx

can only echo what lulu says!!! well put!!

Just one point I wanted to make as I saw your post wondering about why you had a shoulder dystocia - was it your pelvis, etc?

Did you know that a ventouse is a major risk factor for a shoulder dystocia? Statistically you're less likely to need an instrumental with a second baby even if you have an epidural again. Obviously though not having an epidural would lower the chance of needing a ventouse even more.

If you do have an epidural again try and give birth lying on your side rather than on your back so that your pelvis can open to the max.

Hopefully if you don't need synto this time then the pain will not be as intense and you may find you don't need the epidural.

BTW - I don't think its fair to let epidurals wear off for the 2nd stage - your body hasn't had a chance to build up endorphins. However it can be difficult if the mw has thought you weren't pushing effectively because of a dense block - I'm sure (hope) she had your best intentions at heart - trying to avoid a ventouse for you?

SKSS I don't know why. I did go to the 'talkback' session to review my notes with a mw, and also had some written feedback from the hospital, but I don't know what caused the shoulder dystocia. I know the mw's were keen to avoid a cs, which is the explanation they gave when I asked why various things had happened the way they had. Thanks for your comments. I'd love to know that I could avoid pethidine, epidural and ventouse, and SD,second time around. There seem to be so many variables involved, and I doubt I will ever find out exactly why my dd's birth turned out the way it did.

1. If you choose to have an epidural, do you have to allow it to 'wear off' before the pushing stage? (I was told I had to last time, and although this time I'd hope to manage the pain better, I'd like to know that if I coudn't and needed an epidural, that I wouldn't have to let it wear off).

The only problem with not allowing the epi to wear off is that it makes pushing more difficult. You would be unable to feel where you need to push and when you need to push. You were therefore be more at risk of an assisted delivery or even a c-birth should the baby go into distress.

2. If you have an episiotomy/tear, do they have to put your legs in stirrups to stitch you up? I had severe SPD which was made worse by being in stirrups for over 2 and a half hours... really want to avoid that next time, but not sure if you can put that in your birth plan.

If you have SPD then that should be written in your notes and capitalised on your birth plan. Whoever goes as your birth companion should have that as their mantra... "She has SPD! She has SPD". I say mantra because mws are people and as busy people tend to be carrying a lot around in their heads so the mantra works because it reminds them. It's not necessary for your legs to go up in stirrups though it makes stitching easier. So you might want to request a registrar do any stitching if necessary.

3. Second time around, is it any easier to discern when you should go into hospital? My contractions were every 5 minutes but (I didn't know it then) not intense enough, so I spent longer in hospital than I needed to. As second labours are often shorter, would it be difficult to work out when you actually need to go to hospital? (I say hospital - I'd love to have a home birth but have been told that because of shoulder distocia and post-partum haemorrhage, I wouldn't be able to, and because of my fears I think I probably would be better in a hospital but with a doula/private midwife to help me with managing pain and keeping me from panicking completely which is what I did last time!!)

I think that having a doula or an IM with you would help. Second time around you tend to be more aware of your body and more likely (note I said more likely not definitely) to trust your body and it's responses. A doula or IM would probably help you there.

I hope that helps angel and that you get the right support for you.

Hi, I read what you said on the other thread, and everyone has given such good responses I can't add anything useful directly, but you mentioned hypnobirthing and I think it'll be fabulous for you.
My hypnobirthing teacher said she'd had ttc couples on the course, so whenever you want to do the course contact someone- have you found a practitioner already?
I had a very easy birth last time compared to you, but I remember the dread and how scared I was of the idea of it, which had started to build this time around before I went on the course (though this time I had specific anxieties rather than just scared of the whole thing) and now I can actually say I'm looking forward to labour and the birth! The birthing affirmations daily and rainbow relaxation actually can make a difference (sorry, I'm talking Mongon method here, but I know there are different courses/CDs out there) and I would recommend going on the course, so your partner and you are both 'on the same page'- it isn't you pushing him to learn it ( after all, all you need to do is relax, he has to do all the work to keep you relaxed!!) and the course turned my husband from 'if you say so, dear'(big sigh) to 'wow- this stuff really works' so he's been advertising it to pg women in his office- he learnt a technique on the course to 'fix' his back pain so we're looking at it as 'skills for life' rather than just an expensive course for labour.
My teacher is karen riley, who's lovely, and if you google her name her website stuff comes up- she's probably not local for you but her accreditation body (no idea what it is but I'm sure its on her website) can probably get someone near to you, if another mumsnetter doesn't give you a personal recommendation!
Oh, and I'm another person with missing notes- my post-natal ones have gone AWOL. I can't decide if thats better or worse than the wrong information being recorded in them, but its meant I've been threatened with consultant referral all through my pregnancy this time as I'm having a home birth. Grrr is the polite term, I think.
I truly hope you can work through all this and have a happy and relaxed pregnancy!

Erm... can I please ask some more questions?

I've read up more on birth skills, and understand why people say the epidural should wear off before pushing. When my epidural wore off I had no pushing urge, so I'm in the dark about this whole are:

1. When in 2nd stage, are the contractions still as painful, or does pushing sort of cancel out the pain of the contractions? (wishful thinking...)

1. I know (as I was told by my particularly unsupportive mw) that my pushing was useless, and have since read about a 'coffee plunger' analogy, using diaphragm to 'breathe' baby down etc, but I still don't get it. I remember pushing until my eyes were popping and my lungs felt bruised last time. Any advice about how to push effectively?

1. I've sent some query emails out to local doulas, and have had some interesting replies. I know lots of people on MN are doulas or training to become doulas. Would you recommend going with a trainee doula? I know the important thing will be how we get on face to face, and whether we 'click' but DH is worried about the fact that one of the doulas who got back to me was a trainee...

Thanks so much to everyone who is helping me through this... I really appreciate anybody taking the time to read my lengthy questions and queries.

i'm officially still a trainee, if that helps, as i have not caught up with my paper work !

re being a trainee : the doula is not there to do anything clinical or to make medical decisions, but to support you and empower you, so it is not just about how many times you have doulaed, but about passion and interest and vocation, IMO

2nd stage : it is a different type of contraction pain than the first stage, it is often when your body takes over, and the urge to push can be overwhelming, it is a more purposeful pain, if you like, and pushing down through the pain can be very satisfying

effective pushing: pushing with your body, not when your MW tells you, nor holding your breath until you go purple!pushing like that makes you tired and is not that effective. pushing down into your bottom is kind of the way to go , but being able to listen to your body's urges is more helpful. also, being upright or in a supported squat can be helpful as gravity plays a part . breathing the baby out is possible, it is more of a hypnobirthing thing i think.

i'm officially still a trainee, if that helps, as i have not caught up with my paper work !

re being a trainee : the doula is not there to do anything clinical or to make medical decisions, but to support you and empower you, so it is not just about how many times you have doulaed, but about passion and interest and vocation, IMO

2nd stage : it is a different type of contraction pain than the first stage, it is often when your body takes over, and the urge to push can be overwhelming, it is a more purposeful pain, if you like, and pushing down through the pain can be very satisfying

effective pushing: pushing with your body, not when your MW tells you, nor holding your breath until you go purple!pushing like that makes you tired and is not that effective. pushing down into your bottom is kind of the way to go , but being able to listen to your body's urges is more helpful. also, being upright or in a supported squat can be helpful as gravity plays a part . breathing the baby out is possible, it is more of a hypnobirthing thing i think.

i'm officially still a trainee, if that helps, as i have not caught up with my paper work !

re being a trainee : the doula is not there to do anything clinical or to make medical decisions, but to support you and empower you, so it is not just about how many times you have doulaed, but about passion and interest and vocation, IMO

2nd stage : it is a different type of contraction pain than the first stage, it is often when your body takes over, and the urge to push can be overwhelming, it is a more purposeful pain, if you like, and pushing down through the pain can be very satisfying

effective pushing: pushing with your body, not when your MW tells you, nor holding your breath until you go purple!pushing like that makes you tired and is not that effective. pushing down into your bottom is kind of the way to go , but being able to listen to your body's urges is more helpful. also, being upright or in a supported squat can be helpful as gravity plays a part . breathing the baby out is possible, it is more of a hypnobirthing thing i think.

oops, not sure what happened ther e!

happy where do you live?