Ask Rachelle, the childbirth expert

Vol XX: Is a doula really necessary or does the midwife who is with me at the hospital give me the same support?

By
December 27, 2006 13:20
Ask Rachelle, the childbirth expert

rachelle lamaze 298.88. (photo credit: )

Rachelle Oseran is a Lamaze Certified Childbirth Educator with 23 years of experience working with pregnant and postpartum women. She is also a fitness professional certified by ACE (The American Council on Exercise) and a certified prenatal and postnatal exercise instructor. She co-directs Great Shape Exercise Studio at the Jerusalem YMCA. Rachelle also teaches Lamaze childbirth preparation classes and can be reached at www.childbirtheducation.co.il * * * Volumes I - IX Volumes X - XV * * * Vol XX Q: Several of my friends have used a doula for their hospital births and they had good experiences. Is this really necessary or does the midwife who is with me at the hospital give me the same support? My husband wants to be at the birth and I'm concerned that he will be pushed aside if I hire a doula. I live in Jerusalem. A: According to "The Doula Book" by Klaus, Kennell and Klaus, a doula is "an experienced labor companion who provides the woman and her husband or partner both emotional and physical support throughout the entire labor and delivery, and to some extent, afterward." In many cultures, women are supported during birth by other women who are experienced in childbirth. However, in our society with its focus on medicalized birth, this has become the exception rather than the norm. A research review published by the Cochrane Database that studied the labor experiences of almost 13,000 women found that women who have continuous support during labor were 26% less likely to give birth by cesarean section, 41% less likely to give birth with vacuum extraction or forceps, 28% less likely to use any analgesia or anesthesia and 33% less likely to be dissatisfied with or negatively rate their birth experience. This review also found that continuous labor support was associated with greater benefits when the support person was not a member of the hospital staff and when it began early in labor. Their conclusion was that "All women should have support throughout labor and birth." As this review indicates, the labor support person should not be a member of the hospital staff. Additional disadvantages of relying on the attending midwife for labor support are that she works in shifts so she is unable to provide continuous support and she is usually shared by a few women in labor. Some hospitals in the Tel Aviv area do not allow doulas at all, and some only allow women to hire the doulas who are employed by the hospital. Jerusalem hospitals are much more open to doulas. Most husbands want to participate in the birth of their children and wish to provide support to their wives. Labor can surprise both the woman and her partner by its power and it may be difficult for the husband to see his wife in pain. An experienced doula can reassure both of them that labor is progressing normally. She will take her cues from the labor partner, without interfering in the intimate relationship between them. She will provide additional support and her presence will also allow the husband to take a bathroom or a meal break. A doula provides uninterrupted support during labor and birth. She recognizes that birth is a key life experience and the memory of that birth will stay with the woman all her life. Her job is to protect the woman's memory of her birth. She recognizes the effect of emotions on the physiology of labor. She provides comfort techniques and encourages positions that facilitate the progress of labor. A woman's satisfaction about her birth experience does not so much depend on whether or not she used medication, how long the labor was or how much pain she experienced. It depends more on her feeling that she was being listened to and that her choices were respected. An experienced doula will empower each woman to make her own choices by helping her sort through her options and help her achieve the type of birth she wants. Your childbirth educator can provide you with a list of doulas. These can be anything from volunteer doulas (doula-trainees who need to be with several women in labor before they can become certified) to experienced, professional doulas. You should also interview a few doulas until you feel comfortable with the woman with whom you will share one of the greatest experiences of your life. * * * Vol XIX Q: Dear Rachelle, I am trying to find a midwife in Beersheba or close by. Do you have any phone numbers or email addresses so I could contact them? A: Thanks for contacting me. The only homebirth midwife in Beersheba is Shayne Bergner. She is very qualified, experienced, warm and caring. You can reach her at [email protected] or on 052-3627000. * * * Vol XVIII Q: Hi Rachelle, I am a new immigrant to Israel and in my seventh month of pregnancy. I am looking for a childbirth class in English in the Tel Aviv area. Unfortunately, all of the classes offered through the hospitals that I have contacted are in Hebrew, and there are no Lamaze instructors listed for Tel Aviv. Is there a class or an instructor that you could recommend to me? It would help a lot. Regards, Beth A: Hi Beth, Welcome to Israel. There are no Lamaze Certified Childbirth Educators in the Tel Aviv area. If you are interested in a Lamaze childbirth preparation class, contact me directly at [email protected] I checked with the Israel Childbirth Education Center, and the only English language childbirth class in the Tel Aviv area is given by Debby Englard, though she is in Bnei Brak. You can reach her at 054-5553354 or 03-6187875. Good luck, Rachelle. * * * Vol XVII Q: I am making aliya and read about the negative birth experience of the woman who thought she was in a natural childbirth-friendly hospital. Please tell me, are there any lists- English or Hebrew- where I can get information on various hospitals from actual people's experiences- and not the hospital's advertisements? A: Sara, your question is uppermost on the minds of most pregnant women. Unfortunately, there are no such lists AS YET. However, I am part of a task force under the auspices of CIMS, the Coalition for Improving Maternity Services (www.motherfriendly.org) that is putting together an internet questionnaire that will promote what we call "transparency in maternity care" in our effort to promote mother/baby friendly childbirth. In other words, every woman, in every community, will have the opportunity to answer this basic questionnaire with objective questions regarding her medical care during childbirth and during the early postpartum period. This will give women like you the opportunity to read about the factual reality of delivering in a particular hospital, without the subjectivity of individual opinions. This questionnaire should be ready in a few months. In the meantime, I encourage you to look back to Vol. 1 of this column, in which I wrote a list of questions to ask the hospital. I recommend this list because what is important to one woman may not be important to another and each woman has her "red lines" over which she will not compromise. I don't know which birth this is for you but you might still want to take a childbirth preparation class to help you deal with the reality of delivering in a hospital in Israel. At such classes you should learn how to have the birth you want. You should also know that, if you are interested in natural childbirth in a hospital, several hospitals have opened birthing centers attached to the regular labor and delivery unit. While the disadvantage is that you will have to pay for this option, the advantage is that you are much more likely to have medical personnel who will respect your wishes for natural childbirth. You will find, however, that even in the regular labor and delivery wards in the hospitals, some of the midwives and the doctors do not believe in routine medical interventions and encourage mothers to have unlimited access to their babies after birth. However, if you have hospital staff who do routine interventions in a normal labor and separate the mother from her baby (when the baby is perfectly healthy), you will need to use the assertive skills taught in a childbirth preparation class in order to have the birth of your choice. Good luck with your aliya plans. * * * Vol XVI Q: Hi Rachelle, I'm an olah chadasha in the 5th month of my pregnancy. I'm interested in prenatal classes in Tel Aviv, but it's been hard to know where/how to look. Do you know of any places I can call? A: I commend you for wanting to get in shape during your current pregnancy. While you might find several prenatal yoga workouts or prenatal stretch and tone workouts, there are very few places in Israel that offer an all-round workout that includes all the components necessary for prenatal fitness, i.e. cardiovascular training (e.g. low-impact aerobics), muscle toning and flexibility. The closest thing to Tel Aviv that I could find is a studio run by Irit Golovner, a prenatal exercise specialist who teaches prenatal exercise classes in the Bnei Brak area. You can reach her at 050-5358908. Of course, we at Great Shape/YMCA in Jerusalem have ongoing prenatal exercise classes (02) 625-8436. While that's not in your area, you may want to come to one class to see the type of exercises we do. We run national and international teacher training programs in prenatal and postnatal exercise. Be aware of the positions of certain exercises. After the 16th week of pregnancy, no exercise should be done in the supine position (lying on the back). This is one of the current guidelines of the American College of Obstetricians and Gynecologists. Some exercise teachers believe that if the pregnant woman doesn't feel any of the signs of supine hypotension (lowering of blood pressure as a result of lying on the back), then there is no problem. However, researchers who have studied this position with ultrasound equipment have found that, even though the mother may feel ok, there may be some changes in the blood flow to the uterus and in the fetal heart rate as a result of this position. Until the guidelines are changed, it's important that the exercise instructor does not have any pregnant woman lie on her back after the 16th week of pregnancy. For more information on what to look for in an exercise class, you can look at an article I wrote on http://www.greatshape.co.il/fit to deliver.doc Good luck, Rachelle. * * * Cafe Oleh experts have been chosen for their knowledge and reputation. Cafe Oleh does not take responsibility for any advice they offer. Send your questions for Rachelle


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