As a doula, I look forward to a long career serving expectant families. With each birth, I gain valuable experience which helps me guide the next family I serve. As I've written on my website, my goal is to increase the positive experiences of women and their partners in pregnancy and childbirth, in a way that aligns with their goals and values. This includes hours of physically demanding work, an unpredictable schedule, having to leave my own family for hours or days, and emotional skills like holding space without judgment, and putting my clients' needs before my own. Often it can take days to recover from a birth. And you know what? I love it.
But I know that my enthusiasm and expertise in supporting a client is not all it takes to maximize the chances of a positive birth experience. The client plays the biggest role. Obviously, the birthing person is working the hardest, growing a baby then meeting the demands of labor. But it's the choices my clients make, often before they even think about hiring a doula, that have a great influence on what they will experience on the day they meet their baby.
Recently I shared an article on the Elevated Birth Facebook page from ICAN (International Cesarean Awareness Network), listing the Top 11 Ways to Decrease Your Risk for a Cesarean. While some expectant couples opt for Cesareans, most desire to give birth vaginally, resorting to surgical birth when medically necessary for the health of the baby or mother. As the rate of Cesarean birth is on the rise, accounting for roughly 1/3 of all births in the United States, questions have arisen about the numbers and reasons for unnecessary, or preventable Cesareans. Individual physicians serving the same population, in the same hospitals, can have drastically different Cesarean rates, indicating that the attending physician is a key factor in whether a mother ends up with a Cesarean. Choice of provider (doctor or midwife) is the number one factor on ICAN's list.
If reduced risk for a Cesarean is a woman's goal, then choosing her care provider carefully is key. But looking at the bigger picture, if a positive birth experience is the goal, then choosing the right care provider is essential. A woman can end up with a Cesarean and feel happy about the outcome, and she can also give birth vaginally with no complications and feel traumatized. And vice versa.
There are three reasons for the disparity in outcomes. First of all, the care provider (or team of providers, in some cases), sets the tone for how the relationship will go. This includes whether or not:
Not all care providers will meet a couple's expectations in these areas. Some care providers are well-intentioned but act out of their own biases, or act without obtaining the consent of the patients in their care. (These areas comprise the idea of informed consent: Do I have enough information to make a decision, and do I consent to that action/decision?) And some care providers are just not a good fit, for a variety of reasons.
Second, the choice of care provider dictates where the birth will take place. If an obstetrician is hired, the birth will almost certainly be at a hospital where the OB has privileges. Depending on the midwife, and the laws in that state, the birth may be at home, at a birth center (either freestanding or attached to a hospital), or at a hospital. Each of these locations has its own restrictions, policies, and limitations, which can influence the overall birth experience.
Finally, a client's knowledge about the birthing process, and what to expect from the care providers and the birthplace, will greatly impact the birth experience. Becoming educated on the benefits and risks of medical interventions, the roles and limitation of the staff, and the physiology of birth can impact expectations about birth, or lead to making different choices in labor based on learned information.
Expecting couples can play an active role in the beginning of pregnancy, to maximize the chances for a successful end to it, by choosing a care provider that aligns with their goals and values. Sometimes clients are unsure of what they value; they haven't experienced pregnancy and labor before and so don't know what kind of provider or location they would prefer. Or they already have given birth, but are faced with new circumstances or want to avoid the negative experiences of previous births.
If they are unfamiliar with their options, consulting a doula can be a way to sort through the choices available in their area. Even those who are far along in pregnancy, who have been seeing the same provider throughout, still have options and can change to a provider that meets their needs more closely. Or they can choose to stay with their care provider, but communicate their needs and desires more effectively. There are always options.
For a quick, fun way to jumpstart thoughts on where you might want to give birth based on your personality, take this Birth Quiz from The Birth Hour podcast website. It may make you think more deeply about who you choose as your care provider!
A few years ago my son was attending a birthday party at one of those indoor trampoline places. He asked me to come jump with him, which I gladly did-- for about three seconds. I quickly told him I couldn't jump anymore and excused myself. Many mothers can guess why.
I peed myself a little.
I took one enthusiastic jump, and realized I will likely not jump on a trampoline ever again. The second thought that ran through my mind was, "Chalk up one more way Childbirth messed up my body."
I've given birth to two kids, and during pregnancy and in the postpartum period, I've faced: bleeding gums, worsening eye vision, sciatica, a permanently larger shoe size, backaches, mild carpal tunnel, night sweats, hormonal acne, hemorrhoids, hair loss, melasma . . . Mothers, you know what I'm talking about; the challenges of pregnancy aren't limited to weight gain and labor pain. But since my oldest child is now 10 years old, most of these physical side effects are long gone from my everyday life. By most measures, I have felt like "myself" for several years.
Except the pee. Sometimes it happens when I sneeze or cough when my bladder is full. It's not often enough that it negatively impacts my life-- I don't at all pine to jump on trampolines. And I know that as women age, even if they haven't ever given birth at all, it's common to pee yourself, a little bit, every once in a while. Lisa Rinna does commercials for Depends looking totally fabulous, on this very premise.
It is common. But that doesn't mean it's normal. That's a distinction I'm hearing birth professionals talk about a lot lately. And that's what Chelsea Beyers PT, DPT, OCS, a physical therapist specializing in the pelvic floor muscles discussed during a recent presentation for the Treasure Valley Doulas association. She explained that the pelvic floor muscles, a thin layer of muscles at the base and sides of the interior pelvis, support internal organs such as the bladder, uterus, and bowels. They are vital in regulating the passage of urine and feces, and play a role in healthy sexual function. They provide support for a growing baby in pregnancy. They work with the abdominal and back muscles to stabilize and support the spine. They are really, really, really important.
Weakened pelvic floor muscles can be too relaxed, or too tight. One symptom of a weak pelvic floor is urinary incontinence, and that doesn't mean that you pee your pants all the time like Lisa Rinna's target audience. Just one instance of involuntary urine leakage can signify a weak pelvic floor. Other pelvic floor problems include:
The brain plays a role in these issues, as anxiety over physical pain or discomfort can create a brain/body loop that exacerbates symptoms. Diet, psychology, and past trauma can also play a role in pelvic floor dysfunction.
Women are reminded to "do their Kegels" during pregnancy, to strengthen the mysterious pelvic floor. (Just the mention of Kegels is enough to make a woman secretly squeeze her pelvic floor muscles several times in a row . . . You know you just did some).
But not all women should do Kegel exercises. Those with a tight pelvic floor, such as long distance runners; women with a history of pre-pregnancy constipation, painful intercourse, or tampon usage; and some survivors of trauma, may actually be worsening the condition of their pelvic floor muscles by doing Kegels.
Beyers loves to see pregnant women in her office who visit her before they experience serious symptoms. Many new mothers, overwhelmed with caring for a newborn baby, and trying to heal from their births, delay getting treatment or learn to live with their new "normal." (And contrary to popular belief, women who give birth via Cesarean section are also prone to pelvic floor issues).
When Beyers sees patients prenatally, she can preemptively help them to avoid long term problems. "These are the women who won't have pelvic floor problems in the future," she says.
Then there are patients like me, who maybe didn't know they had a problem, or have been living with pain or embarrassment for years, even decades. Beyers treats women of all ages; she even has patients in their 80's, who may be sedentary but can still benefit from pelvic floor physical therapy. She tailors her treatment to each individual woman's lifestyle and goals. Poor sleep, sexual dysfunction, self-confidence, back pain, incontinence-- just about all women can find relief in these areas with pelvic floor physical therapy.
Mothers can enjoy trampolines. What is normal can and should become what is common.
Update for 2018: Chelsea Beyers, PT DPT OCS now offers mobile pelvic floor therapy! She comes to you with her new company, Treasure Valley Pelvic Health. Get more information at http://www.tvpelvichealth.com
I've worked in the forest, in the lab, and in an office cubicle. My favorite and most passionate work has been alongside clients as they reach inside to find their innermost strength, and give birth to their babies. Each birth is an honor to witness.