Thursday, 22 March 2018

What does a birth doula do?

*disclaimer - this is an amalgam of births I have supported, to give the feel of what I do rather than telling the story of one particular birth and to protect client confidentiality.*

There have been texts to and fro for a few days, signalling that changes are happening that might  mean that birth is imminent, so I've made sure I head to bed early and am not surprised when at 2am the phone rings.

"We think that I'm in labour and we'd like you to come over please." As their birth doula, I will support this family from whenever they feel that they would like the one to one support, rather than from a particular point in the labour. There's no need to wait for established or active labour to be in full flow - if the family feel like they would like my presence then I head straight to them, whatever time of day or night.

When I arrive the mother is in the living room, using her birth ball, and I check when she last ate, drank and used the bathroom. I observe her having a contraction, and when it is over ask if there is anything that might make her more comfortable - a warm compress, a lower back massage or some music. Her partner shows me the record they have been making of the contractions and I agree that it seems to point in the direction of increasing intensity and decreasing gaps, which is great. I suggest that her partner has something substantial to eat and ask the mother to be if she fancies some cut up fresh fruit to nibble on, which she does so I prepare a little for her to snack on and refill her water with fresh.

We talk through how the last couple of days and the changes that they've both been noticing. Whilst I've been here I've noticed definite changes in how the mother is managing each contraction - she now has to stop talking and really think and breath through what is happening. Her partner looks a little anxious, but I reassure them that this all looks normal and just shows that things are all heading in the right direction. By now I'm giving a lower back massage through each contraction, which seems to be helping, and her partner is on the other side of her, holding her hands to balance her on the ball. It's fabulous that she is surrounded by love and support.

The family have chosen to birth at the local midwife-led birth centre, and the partner asks me if we should call them and head over. I remind them that it's their decision and that they can always call in to the midwives for a chat to help them make their choice.  Having spoken to a midwife they decide it's the right time to go in, so I travel in the back of the car with the mum as her partner drives (slowly) to the birth centre.

As they get checked in, the midwife asks about when the mother last used the toilet - as she can't remember I remind them that it was half an hour ago, as I've been making sure that I suggest a visit at least every hour. I pop out to let the midwife know that the wee sample is ready for her to test. I also make sure that the special things the mother wanted on display are taken out of the bags and are placed so that she can see them, and connect up her ipod to the room's sound system so that she can listen to her chosen music whilst she labours. The midwife asks the mum if she wants a vaginal (internal) examination, and as she's not sure, I remind her of the pros and cons and what she'd put in her birth plan, then suggest she asks the midwife more about why she's recommending it to help her make the right decision for her.

As the labour progresses I suggest changes of position to help the mother to remain active, which is great for the baby's descent, and use my doula bag of bits and bobs to help her to be comfortable - straws so that she doesn't have to tip her head back to drink, honey sachets when she needs energy but doesn't want to eat, and a cold flannel on her forehead when she's getting too warm in the birth pool. I remind her of the awesome job she is doing, and how well her body is working.

Because contractions have slowed a little, the midwife and I work to support the mother in some 'Spinning Babies' positions. It's great when everyone's on the same page with what might help, and it turns out that the midwife and I were at the same training session last year!

Things are getting more intense, and I'm reminding the mother of the breathing techniques she wanted to use by mirroring them to her, as her partner has taken over massage duties. I reiterate the midwife's suggestions, making sure that the mother has heard and taken them in, and that her partner also understands what is being suggested and why. I also keep smiling at her partner, so that they know all is well and going just as expected - it can be pretty daunting if you've not witnessed a birth before!

As the birth gets closer, the partner and I work together to physically support the mum in the positions she wants to be in and as the baby is born I'm able to take a few photos which was a special request from this family. I then help the mum move her leg back over the cord, so that she can welcome her baby onto her chest as she had planned. I help the midwife to put some fresh pads and bedding underneath the mother so that she is more comfortable, and congratulate the new family. When they are ready, I fetch both parents some tea and toast which they devour with gusto.

After a couple of hours of getting to know their newborn, mum decides that she'd like some help with showering, so we head off to the en suite together with fresh clothes and I help her to get cleaned up. Back with the baby, I point out some of the features that help the parents to see if the baby is latched and positioned well for breastfeeding. The family are staying in the birth centre for a few more hours to get some sleep, and decide that it is time for them to be alone as a new family, so I hug them all and head home to enjoy a sleep too. We'll meet up again in a week or two when they are ready to talk through their birth.

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