So, maybe you are new to this doula thing or all of your friends have gotten one for their labors and swear they couldn't have done it without the help of a doula. Now you're wondering if you should get one too. I mean, all the cool kids are doing it, right?

Even though I'd love your business, I'm not going to lie to you. Doulas aren't the only ones who can improve your birth experience. I say it all the time, surround yourself with the RIGHT people! Studies have shown that having doula support during pregnancy and labor can decrease your chances of a C-section, need for pain medication, and assisted delivery. We can also increase your overall satisfaction with your birth experience and improve breastfeeding and bonding outcomes. But how does a doula have that effect and can anyone else give you those amazing outcomes?

Let's talk perineal prep and care! Many women wonder if they will tear during a vaginal birth and if they can do anything to prevent it. 

WHY DO TEARS HAPPEN?
Contrary to popular belief, a baby with a larger head isn't always the cause of tears. They typically happen when the perineum doesn't have enough time to gradually stretch due to a baby who's emerging very quickly or if the skin doesn't easily stretch even with a slowly emerging head. During the pushing stage, you might have a provider tell you to slow down your urge to push if they believe the skin hasn't fully stretched. This is easier said than done, but some controlled breathing, small grunts, or laying on your side can help slow down the process.

Tears may also occur if baby is malpositioned. Getting in certain positions can encourage baby to turn into an ideal position to prevent a tear. Laboring upright for too long can also apply too much pressure on your perineum. I suggest you switch positions every 30 minutes. Pushing with an Epidural means you may end up with directed pushing, where the nurse tells you when and how long to push. Directed pushing could sometimes be ineffective and exhausting because you can't properly feel the urge to push or recognize the muscles required to push. I recommend you turn down/off the Epidural at 8-9 cm. so that you can feel your pushing urges and listen to your body. It'll know how and when to push.
Lastly, you're more likely to tear for your first vaginal delivery than subsequent ones.

CAN TEARS BE PREVENTED?
While no one can predict if you'll tear, you can definitely help yourself during labor by forgoing numbing meds such as an epidural or getting a low dose of them. If you are unable to feel your urge to push, the staff will likely direct you to push before your body is ready, before your perineum is ready. This unnecessary pressure against your perineum can increase your chances of tearing.

During labor, a warm compress to the area can help relax the muscles, provide counterpressure, and help you focus on where your pushing muscles are.

Studies have also shown that laboring with a midwife or at a birth center/home setting reduces your chances of tearing. Midwives are known to do fewer interventions, which can lead to tearing. Laboring in a comfortable environment such as your home leads to better outcomes due to your relaxed nature.

When choosing a provider, remember that YOU are the customer and you have choices. If you're not vibing with your provider, move on and find someone who will support you.

Be honest with your doctor and tell them there are a few important questions you'd like to ask. If they don't even take the time to hear you out then that's your sign to find someone else. It's best to know early on if they're a good match for your labor experience. Keep in mind that there is no labor police and you have total autonomy over your body and baby's. Provider preference/recommendation is not law and you have the right to choose what feels right to you, even if it's outside of the norm.

If you truly have no say about which provider you get and you're not quite comfortable with them, consider switching to a midwife, a home birth, laboring as long as possible at home, or having a rockstar support partner with you at the hospital.

QUESTIONS TO CONSIDER WHEN CHOOSING A PROVIDER:

-Do you support unmedicated births and what are your views on them?
-How do you support medicated births and what are your views on them?
-Do you support breech births, how?
-Who are your backups and will I meet them?
-How do you feel about doulas?
-How do you feel about birth plans?
-What are your induction and C-section rates?
-Do you support a VBAC and how do you ensure it'll be as successful as possible?
-How do you view pain during labor?
-What is your plan if I go past my due date?
-How many hours will you allow me to labor after my water breaks?
-How long will you allow the umbilical cord to remain attached?
-Will you administer Pitocin to deliver the placenta?

Remember that if you choose an OB you will likely only labor with them for a short while, as they tend to cover multiple births at a time. Still, knowing ahead of time how they can support you during the expected and unexpected can help you decide who better aligns with your wishes. 
For an even better experience, choose your hospital wisely and get support from a doula, or make sure you and your birth partner are well-educated and able to make decisions during complex situations.

Not one book could ever truly prepare me for breastfeeding. Yes, I had understood the physiology behind it and knew of the benefits, but the actual feeling and experience could never be accurately described in the books. And it wasn't just the feel of a small mouth on my nipple that was never explained, it was the emotional toll it would take.

Thirteen years ago, I was the first in my family to breastfeed, so I wasn't able to get any insight and words of wisdom from my sisters or mother. It was somehow easier for me to envision being a first-time mom than it was to have a baby latched at my breast. That first feeding in the hospital was so awkward. How could something so natural feel so unnatural? I thought that first latch would be the end of the uncomfortableness of nursing, but so many more challenges faced me.

You're almost there, but don't quit just yet! You did great on that birth plan but have you planned for the "after" time? Also known as the fourth trimester, the twelve weeks after baby's birth is a period of growth, change, and adjustment for parents and baby. It's no secret babies require lots of time and attention from both parents while they're running on little sleep. This can make some new parents pretty overwhelmed and make it harder to make decisions, find time for themselves, or feel like they're nailing it.

To prevent feeling underprepared, many experts recommend crafting a postpartum plan that can help you transition into parenthood and identify helpful resources before you need them. You don't need to literally write one up, but you should discuss important questions with your partner, such as household responsibilities, newborn care, intimacy, and visitor policy.

Just as with a birth plan, your postpartum period may not go according to plan, but it will help you feel prepared to make decisions and make clear how you envision the first few months after giving birth.

Click here for a printable postpartum worksheet and scroll down.

Almost fourteen years ago, my husband and I carefully crafted the birth plan for our first child. We attended the 12-week Bradley Method course, read What to Expect When You're Expecting, and Ina May Gaskin's Guide to Childbirth. In my last trimester, I began attending La Leche League meetings and my baby's nursery was stocked and ready for her. On paper, we were prepared, informed, and diligent. We deserved a good birth experience. We were sorely mistaken and looking back at the plan I had saved on my Google Drive only reminds me of how poorly prepared we were. Sure, my plan detailed what I wanted to avoid, how I would labor, and the newborn procedures we preferred. It all checked out...it was easy to read and even buttered up the hospital staff. The goal: healthy mom and baby. Who doesn't want that?
Me. I wanted more.

If I could redo my births, I'd do them at home! But alas, I was young and uninformed. It goes like this: You're pregnant, you see an OB, and you deliver at a hospital, right? Well, I sure wish someone had told me I was an excellent candidate for home birth and that I didn't need to be a hippie to give it a try. In fact, home births and the use of midwives are on the rise but only 1% of births are at home.
The benefits of home birth appeal to many first-time and repeat moms, including those seeking to avoid a repeat C-section. But a home birth is not for everyone and it requires more preparation and responsibility from the parents.

No nurse interrupting your laser focus with her monitoring and cervical exams?
No time restraints or restrictions on movement or nourishment?
No nurse waking you every few hours after you've had baby? Trust me, sleep is hella precious after birth!
Less risk of infection and use of forceps and C-section?
SIGN ME UP, LIKE YESTERDAY!

Still unsure? Read on to calm those doubts.

I'll admit it, there's something about being in a hospital or doctor's office that just makes you want to say "yes" to everything and question your God-given intuition. But you CAN speak up, ask questions, get second opinions, ask for more time, or just say "NO!"

Having a doula who can educate you on the possible procedures and interventions is a great way of using knowledge to your advantage. She can let you know if you can opt out of something that doesn't sit right with you, help you start a conversation with your provider, give you unbiased info on the topic, and provide you with alternatives so that you can choose what's best. 

Not many women know they can refuse cervical checks, routine IV fluids, membrane sweep, breaking your water, some monitoring, induction if mom and baby are healthy, unnecessary C-sections, and ultrasounds for non-medical reasons. That's why having a doula can be so valuable. She can clearly see through scare tactics and practices that aren't suited for you. 

TIPS FOR SUCCESS
•Create a birth plan and have a conversation with your provider regarding your wishes and how they can support it
•Understand possible procedures/interventions and identify the ones you're not ok with (unless necessary) ahead of time
•Providers are legally required to tell you the possible benefits and risks of any procedure, so ask before agreeing to anything
•You have the right to decline any intervention or medication that you don't agree with, although it's best to consider the benefits and risks 
•Your autonomy needs to be respected and you have the right to informed refusal...but the doctor also has the right to disagree to provide care you may request

Click here to learn more about informed consent.

Fourteen years ago, I was in my second trimester with my first child. I had the usual mix of excitement and worry that most new moms felt, but I decided to silence those fears by educating myself...and I wasn't going to do it alone. With my husband by my side, we decided to take a Bradley Method of Childbirth course which consisted of weekly 3-hour classes with other pregnant couples. What unexpectedly happened was that I developed a fascination for childbirth. Labor was not what I expected. My birth plan was just silly wishing and I was left feeling a bit regretful about how things played out. But in the newness of being a mom and having a perfectly healthy baby girl, I had no time to dwell or revel in what had happened. My sister had made the five-hour drive to be at the hospital with us. She brought peace and love with her and I vividly remember her picking up my hair as if she could read my mind.

One year later, I was living with that same sister and her husband who were expecting their first child. They had also taken the Bradley Method and understood the importance of having support. I was happy to fill that role. She began to labor late in the evening and, after packing last-minute items into the hospital bag, we transitioned to the hospital. I was in disbelief that I was about to witness a child be born. I did what I could to keep her comfortable. I had no training and no experience, but I loved her so much and knew that love would show. During the hours I was there, I felt no hunger, thirst, or exhaustion. I stayed the whole night. I came home the following morning after the birth, in somewhat of a shock, and went back to being the mom of a toddler. I looked at my sweet girl's face and realized that I had also gone through such a life-changing experience. I remembered that I had once roared with power like my sister.