Post-term or post-date pregnancy is one that exceeds 40-42 weeks gestation, depending where you live. If a woman is healthy and well nourished then her placenta is likely to thrive and nourish the baby at any gestation. If there are signs that mother or baby will be healthier with baby Earth-side, then induction is warranted; otherwise it’s a much overused intervention that leads to a Cascade of Intervention.
What’s a doula?
A doula is a woman experienced in childbirth who provides continuous physical, emotional and informational support to the mother and partner during pregnancy, birth & early postpartum. In much of the world today and throughout history, women support women through labour & birth.
What’s the difference between a midwife and a doula?
Doulas work as part of a team with doctors or midwives, but not instead of. They provide non-medical support and comfort measures (e.g. encouragement, massage, positioning suggestions). They do not perform clinical tasks such as heart rate, blood pressure, or internal exams.
Midwives are highly trained in the medical aspects of birth. The carry oxygen, medicines, resuscitation equipment and other gear, and are known as primary care-givers during birth. In North America primary/medical birth care is offered by either a midwife or a physician.
Why choose a doula over simply using a friend or family member as support?
Doulas are trained and experienced in childbirth support. They know the sounds and behaviors of laboring women, and what that may indicate about progress. Doulas are trained in pain-reducing comfort measures, natural methods to keep labor progressing, and to support both the laboring woman and her partner. Doulas are familiar with local hospital policies & practices and have often built a rapport with the doctors, nurses and midwives. See http://evidencebasedbirth.com/2012/06/26/why-wouldnt-you-hire-a-doula/
In most Canadian hospitals, women are allowed 2 support persons – usually that’s her partner and a support person. Some hospitals accommodate a 3rd support person. Homebirths and birth centers encourage women to have all the support they wish.
How does the doula fit in with nursing staff?
Doulas do not replace nurses or other medical staff, but rather work as part of the team. They are there to comfort and support the mother & her partner. Nurses change shifts; doulas stay.
How does a doula assist with communication in hospitals during labor & birth?
During prenatal meetings doulas learn what’s important to a couple and discuss how to make informed decisions. A doula may remind or encourage a client to ask the questions necessary to understand a procedure and make informed decisions. Doulas do not speak on a client’s behalf nor intervene in their clinical care. They do not make decisions for clients, nor judge the decisions clients’ make, but are there to support those decisions.
What difference does the presence of a trained doula have on birth outcomes?
The presence of a doula tends to result in shorter labours with fewer complications and less interventions. When a doula is present during and after childbirth, women report greater satisfaction with their birth experience, make more positive assessments of their babies, have fewer caesareans and requests for medical intervention, and less postpartum depression. In case of unplanned circumstances, doula support helps reduce negative feelings about one’s childbirth experience. Studies ,,, have shown that babies born with doulas present tend to have shorter hospital stays with fewer admissions to special care nurseries, breastfeed more easily and have more affectionate mothers in the postpartum period.
Analysis of six randomized trials1 demonstrates that lack of doula presence correlates with:
- Double the overall caesarean rate
- 33% increase in length of labour
- 67% increase in oxytocin use
- 2 ½ times more requests for epidurals
Will a doula make my partner feel unnecessary?
A responsible doula compliments and enhances the father/partner in their supportive role rather than acting as a replacement. (While I respect people’s individual circumstances, I will use “father” words for most of this paragraph.) The presence of a doula allows the father to support his partner emotionally during labor & birth without the pressure to remember everything he learned in childbirth class! The father typically has little-to-no actual experience with the birth process, yet is expected to act as a coach. Some partners feel (accurately) that this is a huge expectation. Many fathers experience the birth as an emotional journey of their own and find it hard to be objective. A doula is supportive to both the mother and her partner, and plays a crucial role in helping a partner become involved in the birth to the extent he/she feels comfortable. Studies have shown that fathers usually participate more actively during labor with the presence of a doula than without one.
When a couple works well together during the birth process they’re better able to handle the challenges of early parenthood. An incredible bond forms or is made stronger.
How often and when do we meet?
We’ll meet 2-3 times before the birth. The introductory meeting is any-time – it’s never too early. The prenatal meetings are best done between 24-36 weeks. After your baby is born there will be a minimum of one postpartum visit, more if needed or desired.
Are doulas only useful if planning an un-medicated birth?
The role of the doula is to help attain a safe and pleasant birth, not to choose the type of birth. The presence of a doula is beneficial no matter what type of birth you are planning. In fact, women who choose a medicated birth need as much support as those who choose a natural birth, but a different kind of support. For women who know they want a medicated birth, the doula still provides emotional support, informational support and comfort measures to help the women through labor and the administration of medications. Doulas can help a mom deal with possible side affects and by filling in the gap that medication may not cover; rarely does medication take all discomfort away.
For a mother who faces a cesarean, a doula provides comfort, support and encouragement. Often a cesarean is an unexpected situation and moms are left feeling unprepared, disappointed and lonely. In this case doula support is especially helpful during the early postpartum period.
What if I planned a drug-free birth then change my mind during labour?
Doulas don’t make decisions for clients or intervene in clinical care, nor do they judge women’s choices. They provide informational & emotional support while respecting a woman’s decisions.
What kind of comfort measures do you use during the labour & birth process?
While there are common comfort measures taught in doula training courses, each doula also brings her own tools and methods. Ours include the following:
- Positioning suggestions
- Massage & various touch methods
- Homeopathy & Bach Flowers (optional; no extra charge)
- Encouragement & reassurance
- Heat or cold as desired
- Hydrotherapy (water for comfort in labour, and/or water-birth)
- Create space for partner, and recommendations to help partner to offer support
- A calm, reassuring presence who trusts the birth process
When do we call you in labour?
Please call at the first signs of suspected labour. We’ll discuss what those are. From then on you’ll keep us posted on your progress and what’s happening.
When and where do you join us in labour?
When depends on the woman, her partner, and the labour. Early support often takes the form of checking in by phone and/or dropping by your place. Your doula joins you either at your home or in hospital or birth center and remains with you until 1-2 hours after the birth.
How does shared-care work?
Doulas team up to provide enhanced service. Clients benefit from combined experience, education, and availability. Since doulas are on call for up to a month for each client, shared care allows them time for important life events and days off without having to turn clients away or rely on unfamiliar back-up. Clients meet both doulas prenatally so they’re familiar with whichever one attends birth.
What if you can’t be at the birth?
In the rare circumstance that one of your doulas can’t be there, you will be well supported. We work with reliable back-ups who offer excellent care. Fees remain the same. If the back-up is likely to be part of care, some clients wish to meet her prenatally, which can be arranged.
Do we pay more to work with 2 doulas?
No. Fees are outlined in the contract. The cost of working with both doulas is the same as hiring one of them individually.
What kind of postpartum support do you offer?
Your birth doula usually stays for 1-2 hours after the birth, until you’re ready to be on your own with your baby. We also visit in the first day or two postpartum, offering basic breastfeeding support, answering questions, and going over your birth. We are available for questions and can offer resources (educational and community). A second postpartum visit is offered.
What if I need extra help with breastfeeding or baby-care?
The information above describes our work as birth-doulas. Another kind of doula, a “postpartum doula”, specializes in extended care and breastfeeding support. There are also breastfeeding counselors and lactation consultants that can be arranged through public health or hired privately. We can provide resources and contact info. If you’re on the Mother-Baby Unit the nurses or unit Lactation Consultants can provide support.
Where’s that name from?
In ancient Greece “doula” meant the highest female servant who helped the lady of the house through child-bearing. Medical researchers Marshall Klaus and John Kennell, who conducted several randomized clinical trials on the medical outcomes of doula attended births, adopted the term to refer to labour support as well as prenatal and postpartum support.
 Klaus, M.H.; Kennel, J.H.; Berkowitz, G.; Klaus, P. “Maternal Assistance and Support in Labor: Father, Nurse, Midwife or Doula?” Clinical Consultations in Obstetrics and Gynecology 4 (December 1992).
 Sauls, DJ. Effects of labor support on mothers, babies, and birth outcomes. J Obstet Gynecol Neonatal Nurs. 2002 Nov-Dec; 31(6):733-41.
 O’Driscoll, K. and Meagher, D. Active Management of Labor. 2d ed. London: Bailliere Tindall, 1986.
 Klaus, M.H. and Kennel, J.H. Parent-Infant Bonding. St. Louis: C.V. Mosby, 1982.
Prepare Your Home Before 37 weeks:
- Midwife & doula contact info entered into cell-phones.
- A contact page on your fridge or pinned to a wall, easy to find, in case we have to call for fast help. (Trust me – brain-freeze is a thing!) Please print, fill out and post this Homebirth Contact Form, or add the extra info to the page your midwives provide and ask you to post.
- Other “Important Phone Numbers” list on your fridge.
- Some cleared surfaces for equipment set-up.
- Plan for birth-attendant parking.
- Outside lights working, house # visible at night (may require a temporary # to be put up).
- Clear a path to door and through halls in case we have to quickly run in equipment for set up or quickly depart.
- Child-care plan (unless they’re attending birth; MW & doulas can offer tips).
- Pet-care plan – pets with teeth / claws absolutely need to be locked up or sent elsewhere as even the most gentle animal can become over-protective and stressed while mama’s in labour.
- If you’d like candles then please use only beeswax or battery-candles. The rest are toxic and can give your support people headaches.
- Get your bed “birth-ready” – make bed in this order (from bare mattress): extra mattress pad, sheets for after the birth, then a plastic liner/sheet or water-proof mattress pad, a regular mattress pad if you’re using a plastic sheet (optional but nice, because plastic gets hot and sticky; an extra flannel sheet works too), “birth” sheets, blankets & pillow cases that can be used for birth. Have pillow cases and blankets for after the birth nearby. Note: if you don’t wish to sleep with plastic in the days/weeks before birth, please have all this ready near bed so someone can quickly make the bed during labour.
Note: Waterproof plastic liner/sheets can be a clear shower curtain liner or plastic drop-sheet (like a thin tarp). Mattress stores sell nice waterproof mattress pads that feel like normal bedding.
- If you’re planning a water birth then ensure hot water temperature is turned up
- Birth-Kit from MW (if she provides this; otherwise purchase and assemble yourself):
– Package of 10 or more large absorbent under-pads / “blue pads”
– Peri-bottle for postpartum perineal care (one per washroom)
– 4 -6 pair disposable mesh underwear
- If you have a guest-room, it’s nice to have it ready for birth-attendants, just in case.
- Extra bits if you’re planning a water birth:
Note: I am a water birth expert and can offer all kinds of guidance if there are issues with any of this, but we need to know ahead of time!
– Purchase / rent birth pool (unless your bath-tub is appropriate) and all related supplies.
– Determine where and when to set up the pool.
– Tarp to protect the floor. Padding under the tarp is nice.
– Hot water temperature is turned up.
– Ensure the hose for filling the birth pool fits one of your taps and reaches your pool. Seriously, you can not imagine how often this isn’t done and foils waterbirth plans! Do not just assume it all fits. If the hose won’t connect then you’ll need an adapter or extra pump; ask me.
Please prepare in plastic tubs or reserved laundry baskets; boxes work in a pinch.
1) Dryer Items
These items will be warmed in the dryer prior to birth. Place in a separate bag or container, stored near dryer or with Birth Container). Washed and ready for use; will get soiled or stained so consider Thrift Store purchases.
- 6 towels (make it 8-10 for waterbirth!)
- 6 receiving blankets
- 2 hats for baby
- 3 flannel sheets/blankets for mother (4 for for waterbirth)
2) Other Linen
This is in addition to the Dryer Items above. This linen is kept in a separate container please, near birth-spacee e.g. in bedroom, by birth-pool. Washed and ready for use; will get soiled or stained so consider Thrift Store purchases.
- Newborn outfit incl. diaper, undershirt, sleeper, socks, hat and blankets
- Nighty / PJs for mother
- Set of sheets to fit bed
- 1-2 flannel sheets/light blankets for waterbirth
- 6 old washcloths, old diapers, etc. for hot compresses
- 10 washcloths for mother comfort
- 6 towels; make it 12 minimum for waterbirth!
- 10 cloths/rags for clean-up after
3) Other Items
Keep this in a container close to or in birth-space.
Note: There may be some repeats from the Birth Bag Suggestions list, which you’re encouraged to check out for some great ideas of things you can use at home, hospital or birth centre.
- Large plastic sheet to protect bedding – e.g. drop sheet or plastic shower curtain liner (see above for how to prepare your bed for birth)
- 4 large, strong garbage bags (2 for garbage, plus replacements)
- Large laundry bin or an additional large strong garbage bag to collect soiled linens
- 1 large roll paper towel (please – no matter how much you love Mother Earth
- Plastic ice cream pail or other suitable container with lid for placenta
- Flashlight with new batteries
- Large pkg. maxi pads, extra long (the bigger, thicker the pad the better). Avoid pads with a “dry-weave” topping as they can be irritating to your perineum
- Small bottle of peroxide – best thing ever to clean blood from surfaces and fabrics
- Flexible straws
- Cookie sheet or other large firm portable surface
- Bottle of hydrogen peroxide (cleans blood stains)
- Digital thermometer
- Q-tips, in case of care of umbilical cord
- (optional) Small unopened bottle of food-grade oil e.g. coconut for crowning
- (optional) Large saucepan or Crockpot for heating compresses and oils
Your pool should have come with a supply list. Please ask if you need more info. If you’re lucky enough to have a big comfy built-in tub, the only extra thing you’ll need is a floating thermometer and a small fish-net or sieve.
Think about lots of healthy foods and drinks (Labour-Drinks) you and your family might enjoy during and after labour and birth, and stock up. HINT– birth attendants LOVE tea and snacks too! 😉
Make a few trays of ice-cubes (can keep cubes in a zip-lock).
(There is a connection – stay with me here!)
Cytotec (misoprostol) is a drug for stomach ulcers. However, it is used “off-label” in the USA, (and has recently been approved in Canada too) to induce labour, per obstetrical guidelines. It’s not approved by the FDA for such use. In fact the manufacturer issued a written warning against use of Cytotec for labour induction as it can cause hyper-contraction of the uterus, which can lead to uterine rupture, which can obviously lead to death.
So, when Cytotec is used as directed by the ACOG (American Congress of Obstetricians and Gynecologists), a well documented, possible side effect is uterine rupture.
Ina May Gaskin started a quilt project in which each square represents a woman who died in childbirth. Many of these squares are dedicated to women who received Cytotec induction.
This issue was raised by some classmates today. Many good points were made; the most obvious being, why are Cytotec inductions allowed, despite ample evidence to show it’s a dangerous practice. It was suggested that this demonstrates the extent of disregard for women and their bodies. My friend and classmate, Kelly Graham, a passionate advocate for women’s health, speculated, “I wonder how many (of these same) doctors would prescribe Viagra if a side effect was penis explosion.” Or – another analogy – would we use a drug to help asthma if a possible side effect was ruptured lungs?
Want to explore further?
- Ina May Safe Motherhood Quilt Project:
- Ina May Gaskin article, Induced and Seduced: The Dangers of Cytotec
- ACOG Induction Guideline
- A comparison of the American and UK guidelines for induction
- RCOG Induction Guidelines (UK), which recommend: “Misoprostol should only be offered as a method of induction of labour to women who have intrauterine fetal death or in the context of a clinical trial.”
- Canadian Induction Guidelines (discussion of Misoprostol starts at the bottom of p4)
- Cytotec Pharmaceutical Insert, which begins with an all-caps warning enclosed in a text-box: “CYTOTEC (MISOPROSTOL) ADMINISTRATION TO WOMEN WHO ARE PREGNANT CAN CAUSE ABORTION, PREMATURE BIRTH, OR BIRTH DEFECTS. UTERINE RUPTURE HAS BEEN REPORTED WHEN CYTOTEC WAS ADMINISTERED IN PREGNANT WOMEN TO INDUCE LABOR OR TO INDUCE ABORTION BEYOND THE EIGHTH WEEK OF PREGNANCY.”
- Warning sent to physicians from Searle, the Cytotec manufacturer
- Henci Goer’s blog, ACOG’s 2009 Induction Guidelines: Spin Doctoring Misoprostol (Cytotec)