‘The Birth Partner’ Review

This is my review of the book The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and Other Labor Companions by Penny Simkin. This book was a part of the required reading list for my Madriella birth doula certification.

Penny Simkin’s The Birth Partner is a necessary “baby book” for people who think it’s not important to read baby books. It is packed full of essential information about childbirth in an easy-to-follow format. Even if your partner doesn’t want to read the whole book, there are checklists, charts, position photos, and tons of other helpful resources within these pages that make tracking, following, and participating in labor so much easier. In pregnancy and childbirth, you are empowered by information. During labor, the mother is focused on having the baby; it is the birth partner’s responsibility to focus on all the other details. By reading The Birth Partner during pregnancy, the partner will be better equipped to help the mother create a birth plan, and will be more prepared and flexible when things don’t go according to said birth plan. Many women expect their birth partner to be their “rock” during a challenging labor, and it is much easier for the partner to provide support for the laboring mother when they understand the process of birth.

The book is divided into four parts: Part 1 Before the Birth, Part 2 Labor and Birth, Part 3 The Medical Side of Childbirth, and Part 4 After the Birth. In Part 1, Simkin states that the birth partner’s role is defined before labor actually begins. There is much to be done in preparation for birth, and the birth partner can help the mother in many ways. The birth partner may attend childbirth classes and prenatal appointments, encourage healthy habits, and help plan for the upcoming birth. The partner can help the mother create a birth plan, with backup options in case things don’t go as smoothly as anticipated. This is a good time to decide whether a birth doula would be a good addition to your birth team. (On a personal note, I already know that I will need a doula whenever I have a baby. My fiancé is extremely uncomfortable with all things medical-related, so I will definitely need an extra rock on my birth team.)

Some partners can’t stand the idea of their wife or girlfriend being in pain, and the usual noises and intense energy of labor might scare them into thinking the mother needs an intervention they don’t want or need.

A doula does not replace the partner, but rather works with the partner to provide the best multi-faceted support possible for the mother in labor. Toward the end of pregnancy, the birth partner should help the mother stay hydrated, assist with strengthening exercises, practice labor positions and comfort techniques, talk and sing to the baby, and make preparations for when the baby comes home. In the last few weeks before birth, the birth partner should make themselves readily available to the mother as much as possible, ready to head to the hospital, birth center, or home for a home birth when the mother goes into labor. Part 2 dives into what mothers can expect of a “typical” labor and birth, which is typically not typical at all. Simply put, “The most predictable thing about childbirth is total unpredictability” and “the key is to accept the unpredictability and pace yourselves while the labor process unfolds” (p 59-60). Simkin explains the differences between prelabor (“false labor”), first stage (dilation), second stage (birthing of the baby), and third stage (placenta or afterbirth is delivered), and everything in between. These descriptions can help a birth partner distinguish between when things are progressing normally versus when something isn’t right. Simkin also discusses comfort measures, labor positions, and the Three R’s: Relaxation, Rhythm, and Ritual. All of these things are often rehearsed during pregnancy for use during labor to help the mother cope with labor progression. While the mother and baby’s well-being are the focal point of labor, it is also important for the birth partner to take care of themselves by resting, eating and drinking, wearing comfortable clothing, and asking for help when needed. There is also a chapter on labor complications and how to address them. The information in this chapter can aid in a successful transition from Plan A to Plan B, C, D, etc. In the event of labor complications, the mother will likely be shocked, afraid, unconfident, possibly annoyed, but mostly dependent on her birth partner for reassurance and help coping. Various medical interventions and procedures are discussed in Part 3. It is important to be informed about common medical interventions before the birth because “most interventions carry some risks or disadvantages along with benefits… Except in emergency circumstances, there is usually more than one way to accomplish the intended purpose of any proposed intervention” (p 235). Different medical procedures are described, such as induced or augmented labor, episiotomy, forceps delivery, vacuum extraction, and cesarean delivery. Pain medications and anesthesia options are also reviewed. Common complications like premature labor, high blood pressure, gestational diabetes, arrest of labor, breech positioning, and postpartum hemorrhaging are also explained in detail.

A complicated labor is a scenario you hope you never run into. However, if you do have to face something so difficult, it is better to be prepared ahead of time so you can make informed decisions on the fly when time is sensitive.

Finally, Part 4 is about adjusting to life after the baby is born. The birth is officially over and the birth partner has a whole new set of responsibilities now. This section covers everything from the first hours after birth to the first few days, including newborn assessments, healing pains, bathing, circumcision, pooping (mother and baby), sleep deprivation, breastfeeding, and baby blues/postpartum depression. Mother-baby bonding is particularly important during this time, especially if they are breastfeeding. The partner should do everything in their power to promote that bond, like helping around the house, scheduling appropriate visiting hours, preparing meals (or arranging a meal train with family and friends), hiring help if needed, and making sure the mother’s needs are met.

Penny Simkin’s The Birth Partner was the first birth book I read when I decided I wanted to become a doula. When I finished it, I knew that I had built a solid foundation of knowledge about labor and childbirth, and I was so excited to learn more. I made sticky note flags on almost every page because so much of it felt critical to my learning. The way the book is broken down, it can be used as a full preparation guide for labor and birth or a quick reference during labor. The most important sections even have darkened pages for easy access. Simkin’s knowledge of childbirth is highly respected; she just celebrated her 50th year of teaching childbirth education! Childbirth education classes are a great idea for new parents, but if you can’t fit classes into your schedule, books on birth are extremely valuable. I would highly recommend The Birth Partner to new parents for a comprehensive overview of what to expect during labor and childbirth.

Owning Your Cesarean Birth

April is C-Section Awareness Month.

If you’re here, you’re probably already “aware” that C-section is also known as cesarean section, cesarean birth, or cesarean delivery. This method of delivery is surgical, involving an incision in the mother’s uterus to deliver the baby and placenta. Cesarean births (including elective, unplanned, and emergency) account for approximately one third of all births in the US. What you may not be aware of are your options. Outside of the base knowledge (or Google search) of what a C-section is and what percentage of births are cesarean births, there is a lot more information out there that you might not find out about unless you ask the right questions to the right people, or read a specific section of a specific book. In my training as a doula so far, I have learned some interesting uncommon knowledge about C-sections that I felt compelled to share.

  • You and your baby will benefit from laboring as long as is safely possible before a cesarean birth, due to the beneficial birth hormones that come into play at different points throughout labor. If you wait for labor to begin on its own, that is your body and your baby signaling that baby is ready to be born, and that baby’s lungs are fully matured and ready to breathe outside the womb.
  • Before your surgery, you can request that sterile gauze be placed inside your vagina, which can be used to swab your baby after birth. This is a way for baby to experience the positive effects of the vaginal microbes they would normally encounter by passing through the vaginal canal (please note: this is not safe for women with genital herpes outbreaks and other STIs – check with your healthcare provider if this option is right for you!)
  • When your baby is delivered, they can benefit greatly from delayed cord clamping (waiting at least 1-3 min). Delayed clamping increases the baby’s blood volume, increases iron reserves to help prevent anemia, and reduces the need for blood transfusions. In some emergency cases, delayed cord clamping might not be possible. Let your provider know if you are interested in delayed clamping, as long as it is safely possible per your situation. If delayed cord clamping is not possible, consider asking your provider about cord milking instead, pushing the blood from the placenta toward the baby in the first 20 seconds or so after birth before clamping and cutting the cord.
  • Request a double layer uterine closure for a better chance of a successful future VBAC. Single layer sutures may be easier in the immediate postpartum period, but double layer sutures are more effective in preventing uterine rupture during labor during future vaginal deliveries after your cesarean delivery.
  • Breastfeeding is sometimes more challenging after a cesarean birth. If you are interested in breastfeeding, skin-to-skin contact immediately following delivery has been proven to help establish bonding for breastfeeding. Many newborn tests can be performed while your baby is on your chest, and your bare chest is more effective in warming your baby than a hospital warmer. If you and your baby must be separated for whatever reason and your baby cannot be skin-to-skin with you, encourage your partner to spend time with the baby skin-to-skin instead.
  • Your recovery will be more difficult than recovering from vaginal delivery. Try to enlist the help of friends, family, or a postpartum doula to help you take care of older siblings, pets, cooking, household chores, etc. while you focus on your baby and your healing process.
  • Birth doesn’t always go according to plan. Even if you plan for a non-medicated vaginal delivery with your midwife, the need could arise for an unplanned or emergency C-section. It helps to familiarize yourself with the procedure and medications ahead of time. Consider adding an “In Case of Emergencies” option in your birth plan, and discuss the potential for a C-section with your provider.

If your Plan A doesn’t work out, remember that there are 25 more letters in the alphabet.

When it comes to C-sections and all other medical birth procedures and medications, I encourage every expecting mother to ask your provider questions, read books, and connect with other moms. There is no sense in stressing too much over any potential outcome. The idea is to understand the procedure ahead of time, so that you have time to process beforehand, instead of trying to process everything on the spot in an emergency. Being informed and prepared can help you to feel empowered in what could potentially be a scary situation. Women who take the time to learn about their options feel more satisfied and connected with the outcome, even if things didn’t go according to their original plan. To all expecting mamas, I hope I was able to shed some light on this topic for you and that you feel more knowledgeable about your options when it comes to cesarean birth.

‘Gentle Birth, Gentle Mothering’ Review

This is my review of the book Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices by Sarah J. Buckley, MD. This book was a part of the required reading list for my Madriella birth doula certfication. I’d like to share an overview and my thoughts on the material.gentle-birth-gentle-mothering-cover

This book is a guide to the choices we make in birth and early motherhood, including birth medications, cesarean sections, and breastfeeding. The book also includes autobiographical elements from Dr. Buckley, as she tells the birth stories of her four children, all birthed at home. The theme of this book is in the title, ‘Gentle Birth, Gentle Mothering,’ and is presented in a way that is very informative and encouraging for mothers-to-be. Dr. Buckley discusses the common practices that have lead birth from a natural, instinctive act to a highly medicalized procedure, and the benefits, risks, and alternatives to those practices. Her outlook on birth gave her four healthy and connected pregnancies, births, and postpartum periods with her children. She even had two babies in the occiput posterior position and one breech baby, all birthed at home without any major complications! She believes that all women can have similar outcomes by trusting their babies and their bodies.

The book is divided into Part 1 & Part 2, the first section is related to “Gentle Birth”, and the second is related to “Gentle Mothering.” In each section, Dr. Buckley goes into great depth to explain the ways our society has moved away from trusting our bodies’ natural processes and is now placing our trust in machines, medicines, and formulas when we don’t necessarily understand the effects these things can have on our babies’ health and development, or on ourselves as mothers. In Part 1: Gentle Birth, Dr. Buckley states her belief that birth is a completely natural phenomenon, which women should have the right to experience as they choose, as long as they are informed of their choices. According to Dr. Buckley,

“a woman’s satisfaction with her birth experience is related more to her involvement in decision-making than to the outcome.”

Based on Dr. Buckley’s research, somewhere between 70-80% of healthy women could give birth without drugs or medical intervention, but most births are interfered with by some form of medication or medical action. Why? Most women truly don’t know their options. Many women choose their doctors through their insurance. They show up to their doctor’s appointments and they listen to their doctor, who they believe knows what is best for them and their baby. This is simply not true. We know what is best for us and what is best for our babies. Doctors, like mothers, have their own sets of beliefs, preferences, and standards. Instead of having a doctor tell us what we should be doing, we should do our own research and tell our doctor or midwife how we would like to give birth. We should choose a provider who respects our wishes, who will do their best to honor our birth plans and preferences, within reason and with regards to the safety of mother and baby. Birth should be a natural, instinctive, undisturbed, and even meditative act. Buckley believes that there is a time and a place for medical interventions, but the mother should always try to use the BRAN Model to weigh her decisions carefully before accepting medication or consenting to medical procedures. The BRAN Model encourages families to “consider the Benefits, Risks, and Alternatives and to also consider the effects of doing Nothing in the situation.” The mother should do her own research and create a plan for emergencies, so that she is informed of all the possible ways that birth could require medical attention, and be prepared to consent or refuse when these things come up. Above all, the mother should first trust in the process of birth, and her body’s ability to use the hormones that are already programmed in her brain to allow for an uncomplicated pregnancy, natural birth, and early breastfeeding success. Buckley also strongly believes that the hormonal cocktail for a smooth natural birth works best if the birthing mother is undisturbed during labor. Birth and sex are alike in that they require the basic needs of privacy and a sense of safety to be met. When a mother is made to feel safe and is given privacy except when absolutely necessary during labor, then her birth hormones will have the opportunity to take over and run the show exactly as they are meant to. Any disruptions or stressors could lead to kinks in the hormonal assembly line and could prolong labor. An undisturbed birth also works best when paired with an undisturbed early postpartum period, so that the mother and baby can bond skin-to-skin and establish a strong early connection for breastfeeding. Dr. Buckley also advocates for homebirth, as it is historically and cross-culturally the most natural way to welcome a baby into their new life outside the womb. While homebirth has become an unpopular choice in the last 50 years or so, women who chose homebirth are typically the ones who are most educated and trusting of the natural process of birth. In Part 2: Gentle Mothering, Buckley describes mutual regulation, an almost telepathic bond that is shared between mother and baby as their bodies learn from one another to communicate exactly what the baby needs. A naked baby who is placed on a mother’s bare chest for warmth will become warmer than a baby placed in a crib wrapped in warm clothing. A mother’s breast milk can learn from a baby’s saliva to determine exactly what the baby needs to stay healthy. This relationship also benefits the mother, as the mothering hormones from closeness with her baby will enhance her maternal instincts. Babies who are cared for by baby-wearing, breastfeeding, cosleeping, and establishing healthy attachment will have optimal brain development. No parent is perfect, even the ones who seem to have it all together all the time. Embracing this imperfection is healthy and humbling, and Dr. Buckley highly recommends it.

Overall, I enjoyed this book. It was thoroughly informative and eye-opening. I appreciate how comprehensive Dr. Buckley’s research was in regard to all of the ways that birth has become a medical procedure in today’s society, and how we can empower ourselves with information to prevent a medical birth if that is not what we want. I believe that it is so important for women to take the time to understand the effects that inductions, epidurals, pain medications, synthetic hormones, or elective cesarean surgeries can have on their babies. These medical interventions are disrupting the wonderful birth hormones from doing their job and depriving the baby of the benefits of the natural process of labor. If the mother has carefully considered her options and believes that she is doing what is best for herself and her baby, then the most important thing is that she is informed and feels empowered in her decision. I plan to breastfeed when I have my own children, and I support women who breastfeed, however, I personally do not think I could breastfeed my own children to age three or four as Buckley did. I do not think I would enjoy breastfeeding more than one child at once, and I also do not really see the benefit for the older child. Breast milk is supposed to be specifically formulated for the baby based on mutual regulation, and as the child grows older and starts consuming solid foods, the breast milk is supposed to change in composition to become richer and fattier. I am not sure I fully understand how a mother’s breast milk can be exactly what her new baby needs when another older child is also breastfeeding and their needs are different, but I suppose that is part of the magic and mystery that is a woman’s body. As a doula, it will be my job to support mothers however they choose to give birth. I can provide information during prenatal visits, and highly recommend this book, but ultimately it is not baby, not my birth. I am personally not a mother yet, but I do plan to have children someday relatively soon. I feel like I am better prepared for motherhood and natural birth thanks to Dr. Buckley’s book, and I would encourage all mothers-to-be to take the time to read it. It could help make a lot of the tough decisions about birth just a little bit easier.

Source:
Buckley, Sarah J. Gentle Birth, Gentle Mothering: a Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices. Celestial Arts, 2009.

The Journey Begins

It’s never too late to be what you might have been.
— George Eliot

If I’m being completely honest, I had no idea what a doula was until Liz Sandoz was a contestant on Nick Viall’s season of The Bachelor. Let me explain. When I watch The Bachelor, I always pay attention to each contestant’s job title to get a better idea of who they are as a person. Liz’s title was Doula. As a non-mom, I had no idea what a doula was, so I assumed it was another made-up “job” like Hipster, Free Spirit, or Chicken Enthusiast… yes, those have all been contestant’s job titles in the past! I Googled what a doula was, and learned that it is definitely a real job, and a really incredible one at that! A doula is a non-medical “labor support person who has specific training and experience in providing informational, emotional, and physical support during the childbearing experience, especially during labor and immediately after the birth.” (Source)

I went to school to be a dental assistant, but even during my program, I knew it wouldn’t be my forever job. I worked in the dental field for a while as a chair-side dental assistant and more recently as an orthodontic insurance coordinator (talk about made-up sounding jobs), but ultimately it just wasn’t enriching my soul in the way I knew my true passion would. I have always been a naturally caring, empathetic, and compassionate person, but that wasn’t translating into my life for at least 40 hours every week. It even seemed like my coworkers knew I was meant for something a bit more magical, because I was known around the office as the “Mermaid Unicorn.” While it’s cute to be referred to as a mythical creature while verifying insurance benefits, the lack of opportunity to show the real me at work was frustrating and I knew deep down that I needed to do something more. Week after week, I kept thinking back to Liz the Doula from The Bachelor.

I met my fiancé in 2015, right as I was finishing my dental assisting program and starting my first job in the field. Even then, he knew that I was already on the hunt for what was next. Don’t get me wrong, I loved the people I worked with at the time and I learned so much, I just already knew it wasn’t what I wanted to be doing forever. In the three years that Kennon and I have been together, I have run numerous ideas past him as potential new careers to pursue. Every time I came up with a new job idea, he came up with a very logical reason why that job probably wouldn’t work for me. While discouraging at the time, it made me dig deeper and figure out what I really needed to be doing to make money AND feed my soul. That’s how I knew I needed to become a doula. When I told Kennon I was thinking about this career path, he told me it sounded like it was a perfect fit for me. After I picked my jaw up off the floor, I proceeded to do a ton of research.

I have chosen to certify as a doula with Madriella Doula Network. I feel very aligned with their mission to support women during pregnancy and birth, and to ensure that anyone who wants to become a doula is able to learn the skills needed to do so. I am also starting a program to become a Pre/Post Natal Exercise Specialist through AFPA and plan to obtain additional certifications related to pregnancy, birth, & postpartum in the future. I want to promote mama wellness inside and out. I am so excited to share my journey with all of you as I progress through my training. Let the fun begin!