Promoting better birth through research and policy change: a doula for every mother

Editor’s note: We are excited to welcome guest blogger, Dr. Katy Kozhimannil! Dr. Kozhimannil has recently brought national attention to the importance of the doula role for positive birth outcomes, especially in under-served populations. We’re grateful to her for sharing a little about her experience and her research here on the blog. 

by Katy B. Kozhimannil, PhD MPA

A doula supports a laboring woman.

A doula supports a laboring woman.

It makes sense to me that pregnant women with personal, emotional, and physical support during labor and delivery have better birth experiences. I did not have a doula when my son Paul was born in 2008.  I could not afford one at that time.  However, I had taken a newborn care class, and the instructor for that course (Teresa) was training for her certification in childbirth education and needed to observe births for her training. Teresa offered to support me during labor for free, so that she could observe my son’s birth and fulfill her training requirements.

My labor experience was best characterized by the phrase “cascade of interventions.” I was overwhelmed and frightened, but there was one moment that stopped the feeling of inertia that seemed to hover around me: when Teresa stood next to me, held my hand, and told me that I could ask whether I had time to rest before making a decision.  The medical team, standing next to me in scrubs waiting to take me to the operating room for a cesarean, confirmed that the situation was not urgent and agreed to wait an hour and reassess. The tide turned in my direction.  I felt a renewed sense of ownership and agency in the birth process.

When I felt the urge to push, I was so grateful for the chance to do something and to feel like I could participate in the birth process. I had a vaginal delivery, and – with Teresa’s help – I regained control of the decision-making during my son’s birth.  Incidentally, I also think Teresa saved my health insurance company a lot of money – approximately $4000 by my calculations (the difference between the costs of a cesarean vs. vaginal delivery).  But she never even got a thank you note.

Unfortunately, many women can’t afford to pay out-of-pocket for doula care, and most health insurance companies don’t pay for doulas.  But labor support is incredibly important.  There is good empirical evidence for this. A 2012 Cochrane review conclusively finds that continuous labor support is associated with many positive outcomes for moms and babies (more spontaneous vaginal births, fewer epidurals, shorter labors, higher infant Apgar scores, and greater satisfaction) and no known negative impacts. These effects are most consistent when labor support is provided someone who is not a friend or family member and not a member of the hospital staff – someone like a doula.

For a year and a half, I have had the pleasure of collaborating with Everyday Miracles, a Minnesota-based non-profit organization that aims to reduce health disparities by providing perinatal education and doula services to low-income women. Everyday Miracles employs a diverse group of doulas (including Somali, Latina, Hmong and African-American doulas) and attempts to match doulas to clients based on language and race/ethnicity.

Given the strong evidence base for the health benefits of doula care, we gathered and analyzed data to look at both the health and cost impacts of doula care among low-income women. In a paper published this spring in the American Journal of Public Health, we reported that cesarean rates were about 40% lower for doula-supported births, compared with similar women nationally. We also estimated potential financial impacts to states Medicaid programs associated with cesarean rate reductions of this magnitude and suggested that states investigate whether reimbursing birth doulas may result in improved birth outcomes and potentially even generate cost savings within their Medicaid programs.

Minnesota took up this challenge, and our state legislature has decided that doula care is a service worth providing to Minnesota’s mothers.  On May 23, 2013, Governor Dayton signed “the doula bill” (SF 699, HF 768) into law as part of the Omnibus health bill (SF 1644, HF1233).  Starting in July, 2014, Minnesota Statues Chapter 108, Sec. 11 will allow Medicaid payment for services from a certified doula for pregnant women in our state.  The passage of this legislation resulted from more than a decade of work by doulas, mothers, community members and led by the Minnesota Better Birth coalition.

The “doula bill” was a great policy victory for mothers, families, and doulas in our state, and as implementation unfolds, I hope that it will lay the foundation for improving birth for moms in Minnesota and beyond.  While the potential “cost savings” of offering health insurance reimbursement to birth doulas is a compelling rationale in a policy context, I think that the fundamental goodness and power of a positive birth experience and the ability of doulas to facilitate such an experience far outshine any benefits that could be measured in dollars and cents.

Dr. Kozhimannil is an assistant professor at the University of Minnesota’s School of Public Health where  she conducts research to inform the development, implementation, and evaluation of health policy that impacts reproductive-age women and their families. She is the mother of two sweet little ones. 


Gail Tully: The Birth of an Idea

by Gail Tully

Twenty years ago an idea was spoken and The Childbirth Collective was formed. Twenty years ago, our dynamic efforts were much the same as today. Beginning with mothers who attended other mother’s births, we invited in a variety of professionals who worked with pregnant and birthing women. Reflecting this inclusion, we chose the egalitarian identity as a collective.

Then The Childbirth Assistants Collective, now The Childbirth Collective, ever upheld the same, current goal of social support, information and continuous care during, and around, the time of childbirth. We also gathered for our own needs for confidential support and professional growth. Members asked for time to process births confidentially and to plan how to promote the role of continuous support from birthing women to nurses and doctors in the hospital. I remember the courage of the two women to first approach the physicians of St. Mary’s Hospital (Now Fairview University Medical Center).  At the same time, the spontaneous metamorphic emergence of the doula role spontaneously arose in Seattle and New Jersey with groups of women including birth leaders, Penny Simkin and Deborah Pascali-Bonaro. The need for peer support gave birth to the movement.

One evening, two nurse-midwives from Regions attended our meeting in the basement of Hamlin Midtown Library on Minnehaha Avenue in St. Paul, Minnesota.  They brought a copy of The Doula Book by Marshall and Phyllis Klaus and John Kennell. Our doula revolution was about to occur. In 1995, The Star and Tribune ran a huge spread on doula care, listing my phone number. One of the 200 phone calls was by Marla Lukes, a mother of six who came on the board and together we moved my monthly parent meeting to weekly Parent Topics. She welcomed every doula with the expectation they’d join and offer their talents. We began to grow.

By 1996, The Collective was invited to provide doula care and supervision for a small pilot project run by Dorothy Walden Woodworth, RNC, to reduce the cesarean rate. Our first meeting was held around my picnic table in the long grass. Many of the doulas that participated are still active birth workers today. The next year, we were approached for a solution for HCMC doula services after the lone doula serving that hospital retired. While I may have initially supervised these doula efforts, the body of Collective doulas gave the ideas and passion to bring about the 3.94% cesarean rate for Allina’s pilot project and supported HCMC lowering their already low rate. As The Collective grew, more and more exemplar women joined.

We attended one another’s births, miscarriages and midnight birth crises. We ate, laughed and cried together. We picnicked, partied, and hot tubbed together.  Through it all we held the hope of supportive, peer-based care for every pregnant woman who wanted it. After 2000, growth became exponential, including Emme Corbeil, Susan Lane, Marion Sealey-Kreisman and more. Its an honor to be recognized as a founder, the original visionary of the Childbirth Collective, yet, all the growth to third party reimbursement, pregnant women’s right to a doula, expanded parent topic nights, a documentary film, an internet social media website, and the list goes on, comes from the women of The Collective. So uniquely, Childbirth Collective members support one another without competition to best take the message forward.

The current Childbirth Collective maintains much the same goals, developing leadership skills among the doulas and carrying our message and our mentorship to expand doula services. One-on-one and as a group force, The Childbirth Collective is one of the most effective doula groups in the world.

Gail Tully is an internationally-known midwife and expert on optimal fetal positioning. Some of you may know her as “The Spinning Babies Lady”. Read more on Gail’s work here

Editorial Response to Minnesota C-Section Rate Article

The following editorial, written by Childbirth Collective president Judith Nylander, was written in response to this article that appeared in the Minneapolis Star Tribune in February 2013. We encourage you to read the article first and then read Judith’s thoughtful response. 

A recent article about the C-section rates for Minnesota clinics surely raises questions, but comes as no surprise to most folks working in the birth world.  And while these statistics do not appear to be “solely driven by medical necessity” they are, perhaps, driven by the medical model of childbirth widely practiced in nearly every hospital in Minnesota.  The medical/obstetrical model of birth includes a number of factors that would be worth questioning as we ponder the reason for the high number of first-time mothers who leave the hospital after major abdominal surgery, and with a newborn in their arms.

The cost alone is reason to question these high numbers. But as a birth doula, I think of the early days of a mama’s life, as she does the stressful, remarkable and unforgettable work of caring for a newborn who needs and deserves our complete attention while simultaneously recovering from major abdominal surgery.    Would asking some questions about the model of care really make a difference?

What would some these questions be?  If I was a first-time mother looking for prenatal care for my pregnancy I would ask: What is your rate of induction for first-time mothers? How you deal with mothers who might need 42 full weeks or more before their babies are ready to be born?   How do you understand informed consent and informed refusal?  How do you deal with a mother who wants, or needs, to give birth in a non-traditional position, say on hands & knees?  I would ask questions like this of an obstetrician, a family practice doctor, a certified nurse midwife and a homebirth midwife.  I think the answers would lead you to the care that is appropriate for you and that model of care is likely to be the midwifery model – as long as you are a healthy woman having a healthy pregnancy.

These are the questions that could impact the statistics in the article.  The World Health Organization  states that a C-section rate over 15% is unacceptable.  Let’s ask some questions.

Judith Nylander, CD(DONA)

President, Childbirth Collective


Postpartum Doula Care: What to Expect

by Kathryn Orr, CD(DONA), LCCE

Are you wondering if you need postpartum doula support? Or if you should gift it to your sister, daughter, friend? Or maybe, what the heck is a postpartum doula? People often aren’t sure where the lines are drawn between birth doula care and postpartum doula care. So here I’ll outline four overarching ways that postpartum doulas care for families during the postpartum time (right after birth until about 3 months postpartum).

Mama Care
A postpartum doula is trained to care for mamas during the postpartum time, physically and emotionally.

Those of us who are also birth doulas have detailed knowledge of the physical healing process that takes place after birth, whether vaginal or cesarean. We can answer questions, recommend natural ways to enhance healing, and provide resources. Our training also includes breastfeeding support, so we can address common concerns about breast and nipple care. We’ll also assist with making sure you have access to nutritious food, whether that means answering questions, providing recipes, grocery shopping, or preparing meals.

A postpartum doula will also care for her client emotionally. We are trained in signs and symptoms of postpartum mood and anxiety disorders, and we work hard to make sure our clients are aware of them as well. We’re always there to provide a listening ear for whatever is on your mind. Postpartum can be an intense time, and a friendly listener never hurts.

Baby Care
Postpartum doulas love babies; it’s our job, and for many of us, it’s our passion as well. We are delighted to hold your baby so you can shower, sleep, or take a walk in peace.

We can also answer questions about the maze of baby options: Which baby carrier should I choose? How does this Moby wrap work? How do I give my tiny baby a bath? How do I file her nails? Is my mother in law right when she says I’m nursing my baby too much? Etc.! Your doula should be able to present you with the whole spectrum of options so you can choose what’s right for your family.

We’re also a resource for feeding support. We can address common breastfeeding concerns, and formula feeding concerns. We’ll provide referrals to specialists if needed – we have a network of wonderful birth professionals in our community so we know who will take good care of you!

Household Management
Your postpartum doula can handle the household tasks that you would normally handle. But when you have a new baby, that’s your full-time job. It’s amazing how one tiny baby (let alone two babies!) can take up 24 hours a day with her constant needs. Your doula will help you with: meal preparation, laundry, light tidying and organizing, emptying the dishwasher, running errands, and more. That way you can rest and snuggle your baby.

Non-Judgmental Support
I think this is the most unique aspect of the postpartum doula’s role. No one else in your postpartum life supports you in this way. Your doula has a deep knowledge base about all things postpartum, but she’s not emotionally involved in your life. She won’t give you her opinions or judge the choices you make. She’ll listen to you as much as you need, and share options and resources when appropriate. For many new parents, this is a huge relief! Especially if it’s your first time, it helps so much to hear, “You’re doing just fine.”

 

Kathryn Orr is a birth and postpartum doula and a Lamaze-Certified Childbirth Educator. She is expecting her first little one this summer. Read more about Kathryn at MotherBaby Doula Services


The Doula As Witness

A baby's first breath

A baby’s first breath

by Jess Helle-Morrissey, MA, MSW, LGSW, LCCE, CLEC

Doulas serve a multi-faceted role in a birthing family’s life: supporter, encourager, normalizer, educator, guide. We rub backs, we squeeze hands, we stroke hair, we breathe, we hold space.  We press cool cloths to a birthing woman’s head as she brings her baby (or babies) forth from the warm, wet womb to the bright spinning world.

One role that is often overlooked, but is perhaps most sacred to my own doula heart, is that of witness. As doulas, we witness over and over again that unique and unparalleled moment in a woman’s life when she becomes a mother. Whether it’s a first birth, or a seventh, a mother is born each time she births a baby.

When a woman has a transformative birth experience (and really, what birth isn’t transformative?), she deserves to be fully seen. And that role is often uniquely the doula’s. Partners are witnessing, but they are most often deservedly caught up in their own personal experience of the moment. Midwives, doctors, and nurses are present, but they have medical tasks to attend to. Doulas are able to attend wholeheartedly to that moment.

We witness the joy of birth. We witness mamas finding their true selves for the first time in their lives as they birth their babies. We see the look on a mama’s face when her baby is five minutes old as she tells us, “Everyone said I couldn’t do it, but I knew I could.” We witness the hilarity of birth – I’ll never forget one mama who turned to me after birthing her twins and exclaimed, “That was f*cking AWESOME!” We get to see the way a partner looks at the birthing woman in complete awe as she makes her way through contraction after contraction. We get to see him or her wipe a tear away as this new little person makes that first yawling cry.

We witness the disappointments, too. And when things don’t go as planned, we can remind her that she is strong because we have seen it with our own two eyes, and we have felt it in our own doula souls. And we remember in a way that she might not.

So as witnesses to those moments, we begin to help her reframe:  Last summer, one of my doula mamas had a surgical birth after a long and difficult labor. In a case like this, it is easy to go to a place of dwelling in what went wrong. I go to my postpartum visit. We talk about all that happened, and I validate the disappointment. I sit with the pain.  But I also tell her, because I need her to hear, “I have never seen anyone work so hard for so long. I have never seen anyone fight so hard for what she wanted. You. Are. Amazing.” And she begins to feel it is true because I have seen it and I know it to be true. She knows I was there. She knows I saw her fully. And as I write this, I remember her fierce birthing spirit as if her baby was born yesterday, and I feel the hair on the back of my neck stand up a bit. Because I will never forget her strength, and the gift she gave me by allowing me in.

Above all, it is that sheer strength of birthing women – no matter how they give birth – that we doulas are witness to. The strength to carry on when it feels like all the reserves have been depleted. The strength to make a choice to go a different direction than we’d dreamed. The strength to joyfully claim a place in the history and lineage of birthing women.

And the repercussions of that witnessing can last a lifetime. I spent a good part of my own life feeling like I was not a very strong person. When I gave birth to my twin boys, I found strength I never even dared to imagine I had in me. Today, more than two years later, each time I see one of my two wonderful doulas, I still stand a little taller and feel that swell in my heart – “SHE has seen my strength! She knows the amazing things I am capable of!” A bit dramatic? Perhaps. But life-changingly, soul-stirringly profound for this mama? Most definitely.

So when you invite a doula into your life for some portion of the nine months of your pregnancy (and a couple months after), know that the benefits don’t end there. We not only witness, but we also remember. I tell my mamas, “If you ever need to be reminded of how incredible you are, call me and I will tell you as many times as you need to hear it to believe it.” So on behalf of all doulas,  thank you to birthing families everywhere who invite us to witness your incredible journey. Thank you for giving us the best job in the world.

Jess Helle-Morrissey is a birth and postpartum doula, a Lamaze-Certified Childbirth Educator, a Lactation Educator Counselor, and a clinical social worker in private psychotherapy practice. She teaches classes for families planning VBAC and for families expecting twins and more at Blooma, and lives in St. Paul, MN with her husband and her identical twin boys, born in January 2011. 


The Childbirth Collective by the Numbers

by Liz Hochman, CD(DONA), LCCE

The Childbirth Collective doulas attended over 700 births in the Twin Cities in 2012.  We took some time to compile some year-end stats, and came up with what we think are very interesting numbers that offer a snapshot into the Twin Cities birth community.  These statistics show the varied settings, providers, types of families, and types of births attended by Childbirth Collective doulas.

Two-thirds of the births Collective doulas attended were for first-time families and over 200 births were for mamas expecting their 2nd, 3rd, 4th, or even 5th baby!  We believe there is a special role for everyone in the birth space as we don’t just support the mother but also the family as a whole. Nearly all (97%) of the births we attended last year included a partner in attendance and almost 20% included another family member as well.

Hospital births made up the majority of our births last year, with 90% taking place at Twin Cities hospitals.  We feel strongly that mamas need doulas in home birth (7%) and Out-Of-Hospital Birth Center (3%) settings as well.  Although we’ve had one of our doulas at every single hospital in the area for at least a handful of births, we spend the majority of our time at Abbott, St. Joe’s, Methodist, HCMC, Fairview Riverside, and Woodwinds (15%, 14%, 12%, 8%, 8%, 9%).

No matter what type of provider you are birthing with, chances are we’ve been there!  While 50% of our births took place with a Certified Nurse Midwife (CNM) in attendance, we attended births with OBs (37%), Certified Professional Midwives (CPM) (9%), and Family Practices Doctors (5%).

Whether you are seeking a natural birth or a birth with pharmacological pain management, a doula is valuable and can support you in ways that are unique to your needs.  Collective doulas report that 55% of their clients used no pain medication, 31% used an epidural for pain management, and 14% used other pharmacological methods.

Even if you are planning a cesarean or NOT planning one, but end up having an unexpected surgical birth – we are trained to change our support and comfort skills as your birth unfolds. Last year, families using a Collective doula had a 12% unplanned cesarean rate. Collective doulas also attended a handful of planned cesareans. When an unplanned cesarean birth was the ultimate outcome, our doulas were allowed into the operating room to perform continuous support for those families 67% of the time.

Liz Hochman is a birth doula and Lamaze-Certified Childbirth Educator who teaches at Blooma in Minneapolis, MN. She is the mother of two adorable girls. Read more about Liz at minneapolisdoula.com


Intuitive Birthing: A Doula’s Role

by Julie Colby, LAC, BD

As a birth doula, mother of three, and a feminist, I view birth as a journey of self-discovery.  The birth journey is an opportunity to travel deeper into one’s being and explore all aspects of it.  Ask any woman who has birthed and she will confirm that the birth journey compels her to fully embrace every aspect of her being. Having witnessed multiple births, ranging from unmedicated home births to surgical hospital births, I have deep reverence for how birthing mothers hold their own space during this journey.

The role of the doula is to serve birthing mothers and their partners physically and emotionally during birth as well as being a resource and supportive influence in the prenatal and postpartum phase.  One advantage of having a doula present, of the numerous reasons, is that doulas are there only to serve, which allows partners or other family members to actively engage in their respective role of partner, sister, mother, friend, and so on.  With each birthing experience that we, as doulas, get to witness, we fine-tune our own awareness more and more precisely.

I have come to know that women honor their strength and challenges in birth and labor differently.  Some women want their partners to be actively involved while others prefer less physical involvement from their partners and lean more heavily on the doula to support them.  Some women like massage, touch, verbal affirmations, while others yearn for no physical touch, stillness, and absolute quiet.  All of these preferences all completely valid and normal, and as doulas, we will protect a birthing mother’s wishes with every thread of truth in our being.

To support families as a doula means that we allow them to birth intuitively.  We acknowledge their own wisdom and power while offering continual support during their birth journey.  While we do not influence their decisions, we sense when they are struggling or need more information about their birth.  We truly act as a birth team to form a solid and trusting relationship prenatally.   If and when questions or concerns arise, families know we are offering wisdom based upon their birth plan and of the multiple meetings that have transpired prior to birth.

Another important attribute of the doula’s role is to honor a birthing mother’s wishes regarding her body, her pregnancy, her birth, and her amazing newborn.  Our intention is to promote awareness of the choices that are available along the journey from a nonjudgmental perspective.  Just as we believe there are no two births or pregnancies exactly the same, no two women are the same and we all have our own unique opinions.  It is impossible for any woman to know how she will feel during her birth journey, what noises will please or disturb her, what aromas will appeal to her, or what comfort measures will feel just right until that moment arises.

That is why, doulas have grown to become observant, aware, and mindful of the present moment when serving families.  It is because we have deep reverence for the transient nature of the emotional, physical, and spiritual aspects of birth and we trust that women know their bodies better than anyone else.  The role of the doula, in the words of a very wise midwife, is of the utmost importance to all birthing families!

Julie is a birth and postpartum doula, a Licensed Acupuncturist, and teaches Sacred Pregnancy. She is mother to three incredible boys and she loves her Circle of Women.  Find out more about Julie at ladysslipperwellness.com

 


Your Doula: Personalized Comfort for your Birthing Time

by Hope Lien, CD(DONA), PD

You’ve practiced the hip squeeze and your breathing techniques in your childbirth education classes. You’ve even been to the Comfort Measures parent topic session. You (and your labor support) feel ready for your birthing time. And, you really should be proud of yourselves for preparing so well. But journeying through the birth process is a big deal, and there are lots of emotions going on. It can be a lot of pressure (especially on a partner) to have to recall which comfort technique is going to help at the right time, and if that is going to help move things along in your labor. What if the birthing mom doesn’t really like the way that the partner massages her or presses on her back? Then what?

If you have hired a doula, you have covered your bases. Your doula knows the various comfort measures backwards and forwards. She is, for the most part, freed up emotionally to just be there without having to go through the process of becoming a mother or a father. She is like a chameleon, quietly changing into the type of support person you need her to be when you need it. Perhaps things are going smoothly– your doula can be available to get you or your partner food, or just step in if your partner needs a nap. She can offer gentle reminders in early labor which comfort techniques you might enjoy, and suggest alternative options in active labor. She can be as much or as little as you need her to be.

She can subtly help your partner get the feel of things so that he or she can support you just right way, and the only thing you remember afterwards is that your partner was “just the best“ at supporting you in your labor. She can help your partner stay hands on, or not, if he or she prefers. Doulas are wonderful at filling in the gaps so that you get what you need, while allowing the partner to participate to their comfort–in a very loving and supportive way.

Your doula may also have specialized training in hypnosis techniques, acupressure, healing touch or spinning babies techniques. This is a great question to ask when you are interviewing doulas, as many doulas have done specialized training in other areas.

The doula can support you in your labor differently than anyone else on your team, because you have met with her before the birth. You know her, and she knows you. When your birthing time comes, she already knows the types of touch you like or don’t like. She knows your greatest fears, your strengths and your weaknesses. She uses that kind of relationship to be a very unique support person for you and your partner.

She knows the kind of environment you would like in your birthing space, and will create that for you seamlessly, so you can have peace of mind knowing things are like you want them to be, without having to say anything. She knows the hospital room well, and has never ending ideas to try to keep things moving along. She even knows creative ways to put that bed sheet to work! She can magically make the birthing ball, warm or cold compresses and warm blankets appear without having a big discussion about it.

Your doula is an abounding resource of different things to try– who wouldn’t like that kind of additional support for their birth? She will work with you and your partner until you find that technique that is just right for you. She will be there with you through the toughest moments you come up against, until you are over that hurdle. And she will be there waiting, cheering you on, as you (and your partner) cross that finish line.

Hope Lien has been working as a DONA-certified birth doula for 3 years,
and also serves families as a postpartum doula. She is passionate about helping each family find their unique path to parenthood. You can learn more about her by checking out hopethedoula.com

Doulas Make a Difference: Meghan and Julie

by Meghan R.

From the beginning of our pregnancy, I knew I wanted a doula to
support our birth. So, the decision was not “if” we were going to have
a doula, but “who.” Through my yoga community I was recommended
several doula names. Also, I heard about the Childbirth Collective
parent topic sessions through Blooma and had been encouraged to check
out the All About Doulas night. My husband was on board with hiring
a doula but didn’t really understand what a doula would provide so
we decided to attend the Childbirth Collective night to gain a better
understanding (besides hearing it from me). My husband was sold. We
hired a doula team and felt instantly connected and supported.

The doulas we selected offered prenatal home visits to discuss our
pregnancy and birth preferences. The home visits were a nice time to
casually get to know each other and build rapport. Our doulas educated
us on choices that may be presented in the hospital (pain management)
and shared resources to support our pregnancy and journey to
parenthood.

Our doula (Julie Colby) was available as soon as our journey began
and attended our (very long) birth. During this time, she provided
great support for my husband and myself. Because my labor was not
progressing, she helped educate us about our decisions along the way
and feel trusting in the process. This was huge for me. Many things
came into our birth experience that we were not anticipating and
our doula helped us to be OK with our choices and trust the hospital
staff. This positively influenced my labor and delivery because I could
surrender to the process, trust, continue to breathe, and remain calm.
Julie helped remove the fear, doubt, and unknown as it bubbled up
throughout our birth. She always used positive and encouraging words.
She honored the mantras, images, and sounds I chose for our birth.
There was absolutely no judgment and she was instrumental to our
successful vaginal delivery and arrival of our precious son, Nolan.


Writing Your Birth Plan

by Karen Bruce, AAHCC, CD(DONA)

A birth plan, or care preferences document, is a statement of your preferences for your birth and it demonstrates to your birth team that you intend to take an active role in the decision-making process of your labor and birth.  Your doula can help you prepare this document, and you should share it with every member of your team in advance in order to address any questions or concerns in advance of your birth or to catch any preferences which cannot be accommodated at your birth place or in your particular medical situation.

Keep in mind that your audience is your care team (OB or midwife, nurses and other medical staff, and your labor support people), and be specific to your birth place — it shows you did your research when you are familiar with specific hospital or birth center protocols.  If you are planning a homebirth, you might have a plan for home with a back-up birth plan in case of hospital transfer.  These two documents should look radically different because of audience and options available in each setting.

Consider the specific options available to you in your birth place and do your research as to the risks and benefits of each option.  What does your intuition tell you is right for your family?

Once you have explored your options, you have an opportunity to communicate your hopes and dreams for the labor, birth, and immediate postpartum period.  What should you include in your birth plan and how should you organize your thoughts?  I recommend you find a few sample birth plans to get you started — ask your doula or childbirth educator for an example or two, or find some online, keeping in mind that online birth plans may not reflect the practices in your birth place, and should be edited carefully.

Here are some basic guidelines for preparing your birth preferences document:

  • Make it personal — use your own voice and language whenever possible, and include information or photos that reveal something of your family’s personality.
  • Keep it to one page.  If you really can’t keep it to one page print it back to back.
  • It’s OK to plagiarise.  If you find a well-put statement on a sample birth plan and like how something is stated, don’t reinvent the wheel.
  • Be succinct.
  • Say it clearly and get specific — don’t be vague.
  • Bullet, bold and highlight your priorities.  It should be obvious what is most important to you.

Whenever possible, make positive statements of what you do want to happen rather than gathering of list of “don’ts”.  Birth plans that demonstrate a cooperative attitude and flexibility will be well-received by your birth team and show your willingness to work together.  Your birth plan does not replace your conversations for informed consent/informed refusal, but can remind you and your partner of your preferences when decisions must be made.  If the circumstances of your birth take you down an unexpected path, writing a birth preferences document will have been a valuable exercise in educating yourself as to the risks and benefits of various birth options, even if you change your mind along the way.


Current Doula Status of Twin Cities Hospitals during Covid-19