2017 International Doula Month Member Spotlight:

Robin Douthit, CD(DONA), CLC, MA, LCCE

Where do you live?

New York City, New York, USA

How long have you been in the childbirth field?

11 years

Why did you become a doula and childbirth educator?

I became a birth doula because I wanted to support women while they were doing the challenging work of giving birth. Sadly, I saw many were coming into their birthing experiences terrified of what lay ahead, and that broke my heart. I wanted to reach women earlier and I knew that becoming a childbirth educator would give me the opportunity to demystify labor and that would, in return, remove a great deal of anxiety and fear women have about the labor experience. I believe women should be given the opportunity to be excited about and to look forward to their birthing day instead of being fearful and dreading it. Every woman deserves that and educating women gives each a better chance of having a satisfying birthing experience. That is why I teach.

What's your favorite moment from your career so far?

I love it when I see the lightbulb turn on in my students' minds while I'm teaching about normal physiological birth and the role of hormones in labor. I see them begin to relax in their seats and even smile a little when I share how their bodies not only know what to do but also allow for a pleasurable experience with the release of oxytocin (the love hormone) and endorphins! I love those moments!

NY Times Article: Why Delayed Cord Clamping is Best

Study Finds Benefits in Delaying Severing of Umbilical Cord

Newborns with later clamping had higher hemoglobin levels 24 to 48 hours postpartum and were less likely to be iron-deficient three to six months after birth, the study determined.

In most hospital delivery rooms, doctors routinely clamp and sever the umbilical cord less than a minute after an infant’s birth, a practice thought to reduce the risk of maternal hemorrhaging.

But a new analysis has found that delaying clamping for at least a minute after birth, which allows more time for blood to move from the placenta, significantly improves iron stores and hemoglobin levels in newborns and does not increase the risks to mothers.

Doctors usually clamp the umbilical cord in two locations, near the infant’s navel and then farther along the cord, then cut it between the clamps. The timing of the procedure has been controversial for years, and the new analysis adds to a substantial body of evidence suggesting that clamping often occurs too quickly after delivery.

The new paper, published on Wednesday in The Cochrane Database of Systematic Reviews, may change minds, though perhaps not immediately. “I suspect we’ll have more and more delayed cord clamping,” said Dr. Jeffrey Ecker, the chair of committee on obstetrics practice for the American College of Obstetricians and Gynecologists.

Newborns with later clamping had higher hemoglobin levels 24 to 48 hours postpartum and were less likely to be iron-deficient three to six months after birth, compared with term babies who had early cord clamping, the analysis found. Birth weight also was significantly higher on average in the late clamping group, in part because babies received more blood from their mothers.

Delayed clamping did not increase the risk of severe postpartum hemorrhage, blood loss or reduced hemoglobin levels in mothers, the analysis found.

“It’s a persuasive finding,” said Dr. Ecker. “It’s tough not to think that delayed cord clamping, including better iron stores and more hemoglobin, is a good thing.”

The World Health Organization recommends clamping of the cord after one to three minutes because it “improves the iron status of the infant.” Occasionally delayed clamping can lead to jaundice in infants, caused by liver trouble or an excessive loss of red blood cells, and so the W.H.O. advises that access to therapy for jaundice be taken into consideration.

By contrast, in December a committee opinion by the American College of Obstetricians and Gynecologists reviewed much of the same evidence as the new analysis but found it “insufficient to confirm or refute the potential for benefits from delayed umbilical cord clamping in term infants, especially in settings with rich resources.”

The committee cited the risks of jaundice and the relative infrequency of iron deficiency in the United States as reasons for not changing longstanding practice.

But Dr. Tonse Raju, a neonatologist and an author of the guidelines, said he personally favored delayed cord clamping, even more so after this “very strong paper.”

The new report assessed data from 15 randomized trials involving 3,911 women and infant pairs. Eileen Hutton, a midwife who teaches obstetrics at McMaster University in Ontario and published a systematic review on cord clamping, called the report “comprehensive and well done” but said she felt the conclusion was “weakly worded,” considering the sum of evidence on the benefits of delayed cord clamping for neonates.

“The implications are huge,” Dr. Hutton said. “We are talking about depriving babies of 30 to 40 percent of their blood at birth — and just because we’ve learned a practice that’s bad.”

Said Dr. Raju, a medical officer at the National Institute of Child Health and Human Development: “It’s a good chunk of blood the baby is going to get, if you wait a minute and a half or two minutes. They need that extra amount of blood to fill the lungs.” Healthy babies manage to compensate if they do not get the blood from the cord, he said, but researchers do not know how.

American doctors hesitate to recommend delaying cord clamping universally, Dr. Raju said, because there can be situations in which early clamping is required — if an infant requires resuscitation, for example, or aspirates meconium, or infant stool.

The new analysis also found a 2 percent increase in jaundice among babies who got delayed cord clamping, compared with those who did not. Dr. Raju noted that the risk, although slight, increases the need for follow-up testing three to five days postpartum.

Susan McDonald, the lead author of the Cochrane review and a professor of midwifery at La Trobe University in Melbourne, Australia, said, “In terms of a healthy start for a baby, one thing we can do by delaying cord clamping is boost their iron stores for a little bit longer.”

The new analysis did not include many women who had Caesarean sections, some experts noted.

“We don’t have enough information on the effects of delayed cord clamping for someone undergoing a Caesarean delivery in terms of postpartum hemorrhage,” said Dr. Cynthia Gyamfi-Bannerman, medical director of the perinatal clinic at Columbia University. “Waiting 30 or 60 seconds in a vaginal delivery in a low-risk patient is probably something we could do and wouldn’t have maternal consequences, but in a caesarean delivery, you’re cutting into a pregnant uterus that has a huge amount of blood.” In some scenarios, “there’s an increased risk of postpartum hemorrhage.”

Dr. McDonald acknowledged that the review did not include data on the long-term neurological outcomes for babies.

“What will sway A.C.O.G. are a couple of studies in progress showing a potential long-term neurological benefit,” Dr. Raju said. Improved iron stores in theory could help reduce the risk of learning deficiencies and cognitive delay in children, which have been linked to iron-deficiency anemia in school-age children.

Its World Doula Week!

World Doula Week – All About Doulas

In celebration of World Doula WeekGiving Birth with Confidence would like to share some of the basics about doulas (compiled from previous posts on our blog). If you’ve never heard of a doula or aren’t quite sure what they do, listen up! A doula can be an incredible asset to your birth. 

What Is a Doula?

The definition of a doula is: a woman experienced in childbirth who provides advice, information, emotional support, and physical comfort to a mother before, during, and just after childbirth. (Merriam-Webster) A doula provides care from the prenatal period through to postpartum. She provides emotional support, such as encouragement and reassurance, and physical support during labor and birth, like comfort and relaxation measures, and suggesting different positions to facilitate labor. A doula is also a great informational resource on pregnancy, labor, and birth for moms and partners.

Doulas stay with you through the whole process of labor and birth and through early postpartum. She also helps guide you through your first breastfeeding. Doulas do not perform any medical tasks, but she will help you understand and be able to explain medical interventions that may arise. Doulas are there for your continuous emotional and physical support.

Why Hire a Doula?

The power of labor may surprise you and your partner. A doula can help relieve anxiety by reassuring you that what is happening is normal. Support from a doula can enable you to labor in the comfort of your home for longer before transitioning to your place of birth.  A doula is also trained to sense when a you may need to change positions or when you need a comforting touch. Additionally, research has shown that women with continuous support during labor and childbirth are more likely to have a spontaneous vaginal birth (give birth without a vacuum, forceps or cesarean surgery), have a slightly shorter labor and be happier with their childbirth experience.

Alisa Harrison, who blogs at The Juggling Matriarch, hired a doula for her first birth, but not her second — and she wishes she would have. In reflecting on her second birth, which ended in cesarean surgery, she says: “I could have really used someone who was there only for me—not for my baby, just for me.  Who had nothing more invested in the scenario than to support and help me.  Who wasn’t watching monitors or checking dilation or recommending any procedures, but who would have been watching my face and hearing my voice, doing laps around the hospital with me and my husband, or maybe urging me to stop doing laps, stop trying so hard to make things happen and instead just look me in the eye and help me experience each moment for the moment it was.  Who knows what a doula might have been able to help me do?”

In addition to a good childbirth class, doulas can provide solid, evidence-based information to help women in their decision-making process. Karen Mabe says, “My doula, Tequita Williamson, helped guide me through the slew of decisions leading up to my birth by answering my million-and-a-half questions and providing resources to help me achieve the unmedicated birth I wanted.”

How to Find the Right Doula for You

How do you find someone who is a good fit to be part of your labor support team? Here are some tips:

  1. If you have a friend who has used a doula, ask her to share her story and have her introduce you to her doula. Keep in mind that each woman and her birth are unique. While this doula may have been perfect for your friend, you must decide if this doula is a good match for you.
  2. Ask your midwife or doctor for recommendations. Some hospitals and birth centers provide doula services or referrals. Some providers regularly work with doulas. But remember that a doula works for you, not for your doctor or midwife. If you don’t click with the person your provider recommends, keep searching.
  3. Ask your childbirth educator for a referral. They have heard many birth stories and may know the local doulas who have helped other women, or may work as a doula too. By spending time together in your classes, you’ll get to know each other before your birth.
  4. Contact your local Birth Network if available, or attend a La Leche League meeting or a local moms group. You’ll meet women who have used doulas at their births and may meet doulas there, too.
  5. Check the Web sites of the organizations that certify and train doulas, such as DONA International. Most of these sites will let you search by location for a doula near you.
  6. Interview several doulas if possible before choosing one. When getting ready for your interview, think about what you want your doula to do for you. How will she fit in with the rest of your labor support team? Think about the ways you deal with challenges and how you like to be treated when you need support. What helps you to relax? Do you like lots of massage or do you prefer the distraction of a conversation? How does your partner want to support you? Does he or she want to participate in the physical support or just to be there emotionally for you? Ask the doula how she sees her role at your birth.
  7. If your insurance doesn’t cover doulas and you can’t afford the doula’s fees, look for a doula-in-training. She may not have as much experience with birth as someone who is certified, but she may attend your birth for little or no fee in order to earn her certification. Some communities have volunteer doula services for women in need. Some doulas will write a contract for women to pay over time or even barter for another service that you can offer.

About Cara Terreri

Cara began working with Lamaze two years before becoming a mother. Three kids later, she's a full-fledged healthy birth advocate and the Site Administrator for Giving Birth with Confidence. She is enamored with the awesome power and beauty in pregnancy and birth, and enjoys helping women to discover their own power and ability through the journey to motherhood.

Fenugreek for Increased Milk Production

Is Fenugreek Safe? What Breastfeeding Moms Need to Know

Is your breast milk supply low? Find out if fenugreek can help increase your breast milk production

What is fenugreek?
Fenugreek is an herb that's been used medicinally for millennia, though more commonly in the U.S., the seeds from this plant are taken in capsule form or as a tea to increase milk production in nursing women.

Is fenugreek safe?
"Mothers around the world have always used herbs and foods to enhance milk production, but for the most part they haven't been evaluated in any scientific way," says Allison Walsh, a lactation consultant and childbirth educator in New York City and the past president of Lamaze International. The U.S. Food and Drug Administration (FDA) does not regulate fenugreek, but it does appear on this group's "Generally Recognized As Safe" list, as it can be used as an ingredient in food (it's sometimes found in curry powder).

What's the appropriate fenugreek dosage?
Since fenugreek isn't standardized by the FDA (this is the case with most herbal preparations), doses for it can vary widely from one pill or tea to the next. "Generally, healthcare providers who recommend fenugreek tell new moms to take one to four capsules three or four times a day," says Walsh. It can also be administered as a tea: steep ¼ teaspoon of fenugreek seeds in 8 ounces of water for 10 minutes. Some mothers see an increase in their milk after 24 to 72 hours on the regimen.

Fenugreek and breastfeeding: What do I need to know?
While fenugreek seems to anecdotally benefit nursing moms, it's not a substitute for proper breastfeeding technique. Working with a lactation consultant early in the learning stages of breastfeeding can help yield a solid latch-on and better comfort for both mom and baby. Low milk supply may result if a mother isn't nursing or pumpingfrequently; getting enough rest and drinking plenty of fluids can also help with milk flow.

Are there side effects to fenugreek?
As with any medication, check with you doctor or lactation consultant before takingfenugreek. Potential side effects can include gas, bloating, diarrhea and worsening of asthma symptoms. Some women report a maple syrup scent in their babies and their perspiration.

Is fenugreek dangerous?
When taken in large quantities, fenugreek may prevent the blood from clotting. It should also be avoided during pregnancy, as it can stimulate uterine contractions.

Inductions and Choosing Wisely

“Choosing Wisely” in maternity care: ACOG and AAFP urge women to question elective deliveries.

February 21st, 2013 by Amy Romano

http://flic.kr/p/4v3Zeh

Last April, the ABIM Foundation, with Consumer Reports and other partners, drew national attention to overuse of ineffective and harmful practices across the health care system with their Choosing Wisely campaign. As part of the campaign, professional medical societies identified practices within their own specialties that patients should avoid or question carefully. Today, the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Family Physicians (AAFP) have joined the campaigndrawing national attention to the overuse and misuse of induction of labor. ACOG and AAFP are telling women and their maternity care providers:

• Don’t schedule elective, non-medically indicated inductions of labor or cesarean deliveries before 39 weeks 0 days gestational age.

• Don’t schedule elective, non-medically indicated inductions of labor between 39 weeks 0 days and 41 weeks 0 days unless the cervix is deemed favorable. 

(“Favorable” means the cervix is already thinned out and beginning to dilate, and the baby is settling into the pelvis. Another word for this is “ripe,” and doctors and midwives use a tool called the Bishop Score to give an objective measurement of ripeness. Although ACOG and AAFP do not define “favorable,” studies show cesarean risk is elevated with a Bishop Score of 8 or lower in a woman having her first birth and 6 or lower in women who have already given birth vaginally.)  

Much work has already been done to spread the first message. Although ACOG has long advised against early elective deliveries, a confluence of quality improvement programs and public awareness campaigns have made it increasingly difficult for providers to perform non-medically indicated inductions or c-sections before 39 weeks.

But as the public and the health care community have accepted the “39 weeks” directive, concern about unintended consequences has grown. Christine Morton, a researcher at the California Maternal Quality Care Collaborative and regular contributor to Science & Sensibilitysums up concerns shared by many, including Childbirth Connection:

It is possible that this measure may sensitize stakeholders to the wrong issue: timing of birth rather than the fact that it is generally best when labor begins on its own.  Additionally, is it possible that 39 weeks could become the new “ideal” gestational age, because it will be assumed that 39 completed weeks is the best time to be born?

The second Choosing Wisely statement aims to mitigate these unintended consequences. Inducing with an unripe cervix significantly increases the chance of a c-section and its many associated harms. Women considering induction for a non-medical reason deserve to know about these excess risks, and should question whether it is worth any non-medical benefits of elective delivery they perceive or expect. Lamaze Internationalhas spoken to the importance of letting labor begin on its own, as it is the first topic in the Six Healthy Birth Practices.

But will the new message lead women and care providers to think that delivery is indicated once a woman’s cervix is ripe? Through the Choosing Wisely campaign ACOG and AAFP have made powerful statements acknowledging that scheduled delivery is unwise if the baby or the woman might not be ready for birth. Although gestational age and the Bishop score are tools to estimate readiness for birth, the best indicator of readiness is still the spontaneous onset of labor at term, the culmination of an intricate interplay of hormonal signals between the fetus and the woman. Anytime we intervene with the timing of birth we have to weigh the potential benefits and harms of overriding that process in the context of the fully informed preferences and values of women.

This summer, our collaboration with the Informed Medical Decisions Foundation will culminate in the release of our first three Smart Decision Guides. These evidence-based, interactive decision support tools will help women learn the possible benefits and harms of scheduled delivery versus waiting for labor to start on its own and to weigh these based on what is most important to them. These tools help women choose wisely – to identify when an option is not appropriate or safe for them, and to thoughtfully weigh options when there are both pros and cons to consider.

Interested in learning more about shared decision making in maternity care? Sign up for a free webinar on March 13 sponsored by the Informed Medical Decisions Foundation to hear more about what clinicians, consumers, employers, and others thinking about the importance of maternity care shared decision making.

Midwives Make a Difference

Healthier Births and Babies—With Midwives

Modern American obstetrics is great at reacting to catastrophe, but less skilled at preventing it

Something has gone wrong with the way that we handle birth in this county. After nearly a century of progress, deliveries are now getting more dangerous rather than less so. The number of women who go into shock during childbirth has more than doubled in the past decade, and those who suffer kidney failure rose 97%. Globally, we are tied with Belarus in maternal mortality.

After a century of progress, deliveries are getting more dangerous rather than less so.

As we look for solutions, we'd be well served to examine a remarkable 1920s success story that has almost been forgotten. The key was taking a more personal approach, with a focus on prenatal care, in the style of British midwives. While Americans treated birth as a medical event performed on the mother, British midwives learned that birth was a physical event, performed by the mother.

In 1923, Mary Breckinridge started the Frontier Nursing Service in rural Appalachia. At that time, nine women died for every 1,000 births in the U.S.—a rate 100 times higher than we see today. And in these deep hollows, where people were cut off from medical care, the risk for pregnant women was even greater. Breckinridge changed all that when her horseback midwives began riding out into mountain snowstorms to deliver babies by candlelight.

Vote

Within a decade, the astonishing impact of that care was apparent. (Breckinridge recruited Louis Dublin, vice president and statistician at the Metropolitan Life Insurance MET -0.05% Company, to do the numbers; the results were published in 1932.) The women the Frontier Nursing Service cared for, who were desperately poor and usually gave birth at home, were 10 times less likely to die in childbirth than the average American at the time. The nation as a whole wouldn't catch up until the 1950s, after the widespread acceptance of antiseptic and the discovery of antibiotics.

There was nothing mystical about this improvement. The midwives simply understood that, instead of focusing narrowly on the birth, they needed healthy families to produce healthy babies. They treated snakebites, fevers and men shot in feuds. They made frequent house calls—18 prenatal visits and 12 postpartum checkups were standard for an uncomplicated pregnancy.

Today, there are a few modern Breckinridges. Among low-income minority women in Washington, D.C., 15% give birth before term, and 14.5% of their babies are dangerously small. But when those women work with the midwives at the Family Health and Birth Center, the preterm birthrate is just 5%, and the rate of low-weight babies is 3%.

The standard response to health problems in the U.S. is more: more hospitals, more highly skilled surgeons, more access to the top technology. But we know for sure that at least some of the increasing danger of birth has been driven by the medicalization of the process. For example, a rare but often deadly condition where the placenta grows into a scar left by an earlier C-section has increased fivefold since the 1980s.

Of course, the idea that increased medical care is causing harm is controversial. Many argue that the benefits of C-sections outweigh these complications and that the real reasons that birth has gotten riskier have to do with a changing population; women are giving birth later in life, they are more likely to be obese, more likely to have heart disease. All of this is true. The profile of the American mother has changed, and she's much more likely to have a C-section. We should be trying to solve all these problems, and midwives are uniquely equipped to address them.

The great strength of American-style obstetrics is in reacting to catastrophe. But we're terrible at preventing catastrophes before they happen. While our traditional obstetric mode is reactive, the style of midwifery demonstrated by the Frontier Nursing Service is proactive. A low-tech, high-touch approach has been shown to effectively lower rates of C-sections and early births in several modern cases. Moreover, this personal, coaching approach is the most effective way to address chronic problems like obesity and diabetes.

Facing these chronic problems head on would have profound effects, lasting long beyond delivery. Birth is one of those inflection points where it is possible for people to change their lives, and midwives can assist in that process. Thundering in on horseback, as in Breckinridge's day, is optional.

—Mr. Johnson is the author of "All Natural: A Skeptic's Quest to Discover If the Natural Approach to Diet, Childbirth, Healing, and the Environment Really Keeps Us Healthier and Happier," to be published this month by Rodale Books.

A version of this article appeared January 19, 2013, on page C2 in the U.S. edition of The Wall Street Journal, with the headline: Healthier Births and Babies—With Midwives.

Common Birth Interventions

What You Should Know About Common Birth Interventions

By Teri Shilling, MS, CD(DONA), IBCLC, LCCE, FACCE

You may be planning a natural birth, but there are times when your health-care provider must intervene for health and safety reasons. Or you may find that standard hospital practices often include medical interventions. In either situation, it’s important that you be involved in the decisions related to your care. You can do that by asking questions and openly communicating your desires to everyone in attendance. When a medical intervention is suggested or presented as routine procedure, ask about the benefits, risks, alternatives and whether you can do the procedure later – or not at all. Most important, trust your intuition. Everyone, including you, should stop and think before an intervention is suggested. Research shows that many times interventions are done more for convenience sake than for medical reasons. Being well-informed about the common interventions that might arise will enhance your ability to make crucial decisions. Educate yourself, communicate your preferences well in advance and stay involved in all decisions related to labor and birth. Your choices will be critical to the health and safety of you and your baby.

Read more about medical interventions:

Why have a Birth Plan?

The article below was written by Cara Terreri for Giving Birth With Confidence.  It details nicely why it is very important to create a written birth plan before labor begins.

Don’t Just Hope for the Best — Plan for it: How to Write a Good Birth Plan

If writing a birth plan seems like a frivolous step to birthing your baby, you may want to reconsider. It is true that your baby will come whether or not you “plan” (or write a plan) for his entrance, but the act of writing about your upcoming birth can help you learn more about the care you’ll receive and the needs you may have during labor and birth. Writing a simple, informed and succinct birth plan helps you: consider and research the many choices available surrounding labor and birth; open a discussion with your care provider that can sometimes reveal surprising differences in your “vision” for birth; and provides useful information to your birth team.

While there’s no right or wrong in creating a birth plan, there are some things to consider to help you get the most out of the process and make it more likely that your care providers will read your plan.

A Birth Plan is Not a Script — or a “Plan”

You can plan your wedding day, you can plan a vacation, you can even make plans to build a house. The idea that you can “plan” a physiological event like birth is a bit of a misnomer. You can’t plan — or predict — exactly how labor and birth will unfold, but you can request preferences for you and your baby’s care during birth. With that in mind, it’s important to understand as you create your birth plan that birth is unpredictable and flexiblity is key. While certain birth plan requests, like allowing the baby’s cord to stop pulsing before being cut or delaying (or refusing) the Heb B newborn vaccine, should be observed regardless of the birth situation, other preferences may have to be amended depending on the health of both mom and baby.

Rixa Freeze, MA, PhD, a well-known birth advocacy blogger at Stand and Deliver who has written at length about birth plans, has this to say:

“…planning for birth is like preparing proactively for breastfeeding. There are the individual choices you make and have control over during pregnancy, such as provider or place of birth. There are the institutional protocols and provider preferences that will influence what happens to you during labor and birth. And then there are the unpredictable, uncontrollable events that may throw you a curveball during labor. Birth plans are primarily for the second category of events–navigating institutional routines and employee protocols that may or may not be what you want, and may or not be beneficial for you or your baby.

Involve Your Partner and Your Provider

Writing your birth plan is not a one-woman-show, but rather a group effort. Talk to you care provider about your birth plan preferences — are they in line with your care provider’s philosophy or what she will even allow? Are they in line with typical hospital protocols? If your birth plan is chock full of requests that go against standard hospital protocols or ask for tools (bath tub, wireless fetal monitoring, birth stool, nitrous oxide) that aren’t available, you might be disappointed on the big day. Involving your providers in your birth planning process will help you understand alternative options to achieve the care you desire or perhaps, seek a different care provider or place of birth.

Write an Outline, Not an Essay

Remember the “succinct” part I mentioned above? There’s good reason to keep birth plans short and sweet. For one, your care providers and birth team have will have limited time, especially on the day of your birth. If they are presented with a two and-a-half page, text-heavy document to read, it will most likely not happen. Create a birth plan that is easy-to-read and short (one side of a one 8.5 x 11 page is great!), with bulleted text and only the necessary details. For example, I didn’t include on my birth plan that I wanted to eat and drink as necessary — I just did it.

The Specifics

To help you get started, use the following questions as a prompt for writing your birth plan.

What message would you like for your care providers to read first? Here’s a sample of an opening message:

Thank you for taking the time in advance to read our birth preferences. We realize that unexpected circumstances do arise and do not intend this as a “script” for our birth. We hope you will be able to keep us informed and aware of our options. Thank you!

What would you like for pain relief during labor (narcotic or non-narcotic)?

What routine interventions do you want to avoid (IV, continuous fetal monitoring, etc.)

How would you like to be able to push? As you feel the urge? In a position that feels most comfortable to you?

Who would you like to announce baby’s gender (if you don’t already know)?

Would you like baby’s cord to stop pulsing before being cut? Who would you like to cut the cord?

Unless there is an emergency situation, would you like immediate, uninterrupted skin-to-skin contact with your baby?

Would you like the staff to delay routine newborn procedures (weighing, washing) until after your baby has breastfed?

What routine newborn procedures would you like to avoid or include (eye ointment, Hep B vaccine, vitamin K shot, baby bath)?

How will you feed your baby? Do you wish to avoid bottles or pacifiers?

Even if you don’t “plan” on a cesarean, it’s important to include cesarean preferences, just in case. The following are examples of those preferences:

  • Please allow partner/dad to be present at all times.
  • Please allow doula to be present. (This is sometimes against hospital policy, but it doesn’t hurt to ask.)
  • Please allow dad to announce baby’s gender.
  • Please allow baby’s cord to stop pulsing before cutting. Dad would like to cut cord.
  • Please allow mom to have skin-to-skin contact with the baby in the OR. (Skin-to-skin in the operating room after a cesarean surgery is not standard, though it is starting to happen in a few locations across the United States. When mom is not under general anesthesia for a cesarean, this should be a reasonable request and will help with the initial mother-baby bonding that might have otherwise been missed.)

a fall into spring....

Years ago, when I had the idea to develop and grow my doula practice I knew I wanted 2 things.... a website and this lovely and talented lady's music floating somewhere in and around and through my web pages.

Being the forever-careful-to-cover-all-of-one's-bases kind of a gal, I contacted her by email and asked if I may feature a tune or two of hers on my website and she said yes.  Well, not only did she say yes, but she said she had a soft spot for doulas and that bit of information, my friends, made me adore her all the more.

Children everywhere jump and hop and twirl to her lovely melodies (OK, I admit I do too, even though I no longer have little ones).  I highly recommend her music for little ones already here, and those who are on their way!

Everyone, may I present to you, Frances England.