Doulas are for Women Who Have Planned Cesareans

May 24th, 2010

Every now and then I come across something that is so powerful that I have to share it. So it was with this blog post.

“Doulas are for Women Who Have Planned Cesareans is a wonderfully thought out and beautifully written blog post by Kristen Oganowski of Birthing Beautiful Ideas. (www.birthingbeautifulideas.com). Kristen is a mama to two little guys as well as a wife to a pretty cool big guy (her words not mine!) and a future lactation educator who’s working on a PhD in philosophy. She’s also a birth and breastfeeding advocate, a lover of good food and wine, an obsessive fan of various books and television shows. Kristen blogs about childbirth, her work as a doula, breastfeeding, being a mom and how crazy life can be when one has all these elements to juggle.

After I read this post, I immediately contacted Kristen to ask if I may share it with you, the many mamas on bed rest and those who love and support them. Too often high risk pregnant women (aka Mamas on Bedrest) feel powerless and without options. Kristen’s post is yet another reminder that no matter how tough it gets, it’s still your birth, your body and your baby. So Thank you, Kristen, for this fabulous reminder and for hopefully empowering many mamas on bed rest to seek out the births that they want and the support necessary to get them.

The Original Blog Post

It can sometimes be a mental hurdle for people to get past the idea that doulas aren’t only for women who choose a “natural” or drug-free birth.

It can be even more of a mental hurdle for people to get past the idea that doula support is only for women who are planning vaginal births!

But in reality, doula support can be quite valuable for women and families who are planning a cesarean section for the upcoming birth of their child (or children).  Here’s how.

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A doula can help you to create a cesarean birth plan.

Yes, you can create a birth plan or birth preference list for a planned cesarean section!

And a doula can help you to determine what preferences you would like to include on your list.  What’s more, she might even inform you of some options that you didn’t even know that you had!

For instance, would you like to specify that your urinary catheter to be inserted after the spinal epidural is placed?

Would you like someone to explain the surgery to you as it happens?

Would you like to have music playing during the c-section?

If your baby is healthy, would you like to be able to hold him or her while you are being moved to the recovery room (with assistance, if needed)?

Do you have any postpartum preferences, such as those related to breastfeeding or vaccines?

These items and more can all be included in a cesarean section birth plan or preference list.

(If you’d like to read more about cesarean birth plans, Morgan at Adventures in Diapering and Beyond created this example of a C-section Birth Plan for her readers.  She has had four c-sections herself and has some great experiential wisdom to offer here.)

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A doula can take the time to discuss your feelings about the c-section and offer any tips or advice on recovery well before the big day arrives.

Especially if this is your first cesarean section, you might have some fears or concerns about your upcoming surgery.  Well before your baby is born, a doula can help you practice relaxation techniques (such as breathing exercises or visualization) that you can use during the epidural or spinal placement, throughout the surgery, and during your recovery period.

Where appropriate, a doula can even help you to devise ways to alleviate your fears or concerns in your birth preferences list.  For instance, some women who become nauseous at the very thought of surgery might request that no one describe the cesarean section as it happens–or at least that any conversation between the medical staff be as least graphic as possible.

A doula can also help you to plan ahead to ensure that you to have your best recovery possible. Whether it’s demonstrating the breastfeeding positions (such as the football hold) that seem to be most comfortable to women recovering from a c-section, or recommending that you bring a breastfeeding pillow (such as a Boppy or My Brest Friend) to wrap around your abdomen even when you’re not nursing, or suggesting that you ask friends to offer to perform light housekeeping in lieu of bringing baby gifts, a doula might be able to offer you just the sorts of tips and advice that will make your initial recovery from major abdominal surgery as smooth as possible.

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A doula can support your husband, partner, or other support person while you are being prepped for surgery.

In many cases, a dad and/or a doula is not permitted to accompany a woman into the operating room during the initial preparation for surgery (including the spinal or epidural placement).

And in many cases, dads or partners are extremely nervous during this waiting period!

A doula can help a woman’s support person to remain calm while s/he is waiting for the “okay” to enter the operating room.  She can help to describe what will likely occur during the surgery, she can remind him or her of any “responsibilities” that s/he might have (such as taking pictures after the baby is born), or she can even just offer the general emotional support and encouragement that the dad or partner might need at that very moment.

If your anesthesiologist and OB/GYN allow it, your doula can remain by your side during the surgery.

In some cases, care providers will allow a second support person (such as a doula) to accompany a couple during a cesarean section.

This can be particularly helpful after the baby is born.  Oftentimes, the baby must be monitored in an area of the operating room that is relatively far away from the mother.  Sometimes, this monitoring is even performed in a separate nursery.  With a doula by your side, your husband or partner can go to be near the baby without having to worry about leaving you alone.

In addition, it can be particularly helpful for a woman to have a doula by her side while her uterus is being repaired.  To the surprise of many women, this is the longest part of a c-section, ranging anywhere from twenty minutes to a couple of hours, often depending on how many previous cesareans a woman has undergone.  Having continuous emotional support from a doula at this time can be exceedingly important for some women.

If you would like your doula present during your cesarean section, especially if you plan for your husband or partner to accompany you as well, please make sure to discuss this option with your care provider and with the hospital staff.  Often, the policies on this issue vary from doctor to doctor.

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Your doula can offer physical and emotional support in the recovery room.

The  initial recovery period can be quite stressful for a new mom.  Her spinal or epidural is wearing off, she may feel groggy from that or other pain medication she is now receiving, and she has very limited mobility.  And did I mention that she also has a new baby?!

A doula can help both a mom and her partner to have as peaceful a recovery as possible.  She can guide a mom through various physical comfort measures (such as guided breathing or visualization) if the mom is experiencing a lot of pain.  She can help with positioning, both for breastfeeding and for simply holding the baby.  She can take pictures, she can wipe away tears, and she can even set up an appointment to join you at the hospital later that day or the next to help you as you regain your mobility and begin the sometimes arduous task of walking.

And when desired, she can recommend local or national groups (such as ICAN) that can offer you peer-to-peer support in your physical and emotional recovery.

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So while doula support during a planned cesarean might look much different from doula support during a planned vaginal birth, it is still the same in spirit.  In other words, a doula can still offer physical, emotional, and informational support to you before, during, and after your cesarean birth.

And you might even be surprised find how much this support enhances your experience and eases your recovery!

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Emergency Funds for Mamas on Bed Rest

May 18th, 2010

Last week I had the pleasure to work on behalf  of a mama on bed rest who is in need of funds. This single mama works as a fast food restaurant manager to support herself and her 9 year old son. While working, she began experiencing preterm labor and when she was evaluated her cervix had dilated to 4 cm. She was admitted for observation, but whenever she got up, she would experience preterm labor so she was admitted. She has now been in the hospital since April 26th and isn’t due until August 28th. Unfortunately, her employer benefits are going to run out after 12 weeks but they are trying to cut her off June 1st.

First and foremost I am completely ticked that this woman has to be so concerned about providing for herself, her son and her unborn child. She has worked for her employer for 4 years and states that she typically works 50 hours a week. (No wonder she went into preterm labor!). Yet now in her time of need, she stands to lose her livelihood.

This is not a new scenario. Those of us in the maternity field are constantly sounding the alarms that maternity care benefits in the United States, one of the richest industrialized nations in the world, lag far behind most industrialized nations. The Work, Family, and Equity Index, put out by The Institute for Health and Social Policy at McGill University in 2007 is an update of the original 2004 research looking at the impact of social conditions and health on global working families. The reports look to see how the United States measures up against other nations when it comes to compensation and paid time off. You can read the entire report yourself but suffice it to say that the US fared very poorly when it came to maternity/family leave. Out of 168 nations studied, the US ranked in the bottom 4 for (un) paid maternity leave, sharing the dubious distinction with Liberia, Papau New Guinea and Swaziland. As a result, women in the United States are taking shorter and shorter maternity leaves due to the need to help support their families and to avoid being edged out of job promotions and advancements.

So what is a single mother working at a fast food franchise without benefits and other support to do? If she gets out of bed she is likely to lose her baby. As of June 1st, she is going to lose her job and her benefits. Now what? She did have the forethought to apply for Medicaid benefits before this all happened, so she will receive some health care assistance. But that won’t cover rent, food, utilities or care for her son. What is available to her right now?

In all honesty, there are few if any resources readily available for this Mama in need. After making a few calls, I came into contact with the United Way here in Texas. Their representative Christine informed me that there are some limited community resources available, mostly one time resources available through Catholic Charities. She also gave me the number for food stamps and the local Medicare office. Here are some other local (Texas) charities she shared with me. I am sure that there are similar charities in other areas, so I highly recommend checking out your local United Way for assistance.

Local Charities

  • Catholic Charities: The Gabriel Project. This local charity provides diapers, formula, baby clothes and furniture to families in need.
  • The Austin Pregnancy Resource Center. This case management center assists mamas in need to get pregnancy tests, ultrasounds and to start prenatal care. They also assist women if they choose to put their babies up for adoption to get set up with an agency.

National Foundations

  • The Modest Needs Foundation – This foundation provides small grants for one time emergency expenses to anyone in the United States.
  • Better Bed Rest – This non-profit organization provides modest grants to families in need because mama has gone on pregnancy bed rest. In order to be eligible, Mama must be able to show loss of income and be willing to participate in their peer mentoring program.

Prepare for Pregnancy

As I looked at this situation, I wondered if it could have been avoided-at least from the benefit standpoint. It turns out that a bit of advance preparation may have circumvented much of this scrambling. Now I don’t know if my client’s employer offered short term (or any form) of disability to its employees, or if it was offered and my client was unable to afford to participate. But I called AFLAC (You know, “The Duck” insurance) and spoke with a representative who states that they do in fact provide short term disability policies, but they must be administered through employers. The policies must be in place for 10 months prior to a person becoming disabled.

When I visited the AFLAC website, I saw that individual policies do exist for short term disability as well as for hospitalization, intensive care and various illness and injury circumstances. The great thing about AFLAC and insurers like them is that they pay you directly when you are out of work due to illness or injury and you can use the money for whatever you need-not just for hospital bills. You can get these policies in addition to your employer benefits.

Supplemental insurance and short term disability are out of the question for my client. I truly hope that she will be able to get one of the grants that I was able to find for her. Other mamas on bed rest reading this post may be thinking, “Well shoot, this won’t help me now.” But it will. You may struggle through this pregnancy, but once it is done, take a moment amidst the daze and sleep deprivation, to plan for your next pregnancy. You may not end up on bed rest, but even the time you spend in the hospital to have the baby and the time that you take off for maternity leave are covered benefits for which you can be reimbursed.

If you know of funds available on an emergent basis for mamas and families on pregnancy bed rest, please share the information in the comments section so others may benefit.

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Mamas on Bedrest: Survey Says….

May 6th, 2010

At the beginning of April I sent out a survey to see just what do Mamas on bed rest need? I wanted to survey women who are on bed rest as well as “veterans” who have moved past bed rest into motherhood to see if the products and services that Mamas on Bedrest & Beyond are offering are what mamas really wanted.

First and foremost, A huge THANK YOU to everyone who responded to the survey. Your answers are greatly appreciated.  I will use the information make improvements to the website and to seek out services and alliances with other providers and to make sure that when women on bed rest come to my website or seek services, they can get exactly what they need and don’t need to look any further.

The survey consisted of 6 (actually 5 questions. The last question was for their name and e-mail address to follow up) questions ranging from what sort of physical problems women are having to what one thing made being on bed rest better. While many of the responses were expected, there were a few that were a surprise. Below are the questions and the tabulated responses.

1. What has been the hardest part of being on prescribed bed rest?

By far the most difficult thing for mamas on bed rest was not being able to care for their existing children, not being involved in their day to day care and having to surrender that care to someone else. This was followed closely by boredom and a feeling of isolation. Other common worries were:

  • inability to care for themselves, being dependent on others to care for them
  • inability to care for their homes and families
  • not knowing if being on bed rest would help-prolong the pregnancy or keep baby safe/healthy.
  • Loss of muscle tone/body aches/becoming deconditioned

Inability to work or to prepare for being out of work, worrying about what would happen with the pregnancy and anger/frustration at husband who was able to go about freely and work were each felt by one women.

Interestingly, most of the mamas in this survey were strong ladies and were not spending time worrying but just focusing on making it through and having a healthy baby.

2.  What are your biggest physical challenges (body aches, stiffness, weakness,etc…) being on bed rest?

Pain and stiffness in the back, hips/butt and legs was by far the greatest physical challenge reported by two thirds of the respondents. The next most common problems were:

  • Inability to sleep comfortably/insomnia from laying around all day
  • generalized fatigue
  • shortness of breath.

The shortness of breath at first surprised me, but given that women on bed rest more than 2 weeks become quite decondititoned, and when one is on prolonged bed rest, one doesn’t take deep breaths to expand the lungs, I’m not surprised shortness of breath became an issue. Cervical pressure, a rash and chest pain all received one vote.

3. What is your greatest fear about being on bed rest?

The greatest fear of being on bed rest is that in the long run, it wouldn’t help. By nearly 2:1 over the next most common answer, mamas were mostly afraid that even being on bed rest would not be enough to have a healthy, term infant.  The second most common concern, was losing their baby and/or dying themselves! The next most common worries:

  • Being too weak to care for their babies post partum
  • Being too weak to have a normal vaginal birth
  • Excessive weight gain
  • A long post partum recovery

4. What is THE ONE THING that if you had it/knew it beforehand/could do right now would make bed rest infinitely more bearable?

In this age of technology, having cable tv/NetFlix was the number one way women passed the time. This was very closely followed by having a computer or smart phone to surf the web and to watch movies. Other must haves:

  • Housekeeper and support services like a chef/meal planner
  • Exercises/Physical therapy
  • Visits from friends and family

I was happy to see that one participant would have liked to have seen/toured the NICU. This was something that I had wished I could have done given that my daughter ended up there for 10 days. I think this participant is right in that there should be some sort of video available to help prepare parents. Another interesting response was that one respondent felt that being on bed rest at home would have been better than being on bed rest in the hospital. We’ll have to investigate that!

Women also noted that doing projects/crafts, keeping a positive attitude, remembering that bed rest is a finite situation and being comfortable (one woman recommended a bed rest pillow while another recommended getting a recliner) made bed rest bearable.

5. What can Mamas on Bedrest & Beyond do (better) to help?

This had to be the most gratifying section for me. The number one response was having the Mamas on Bedrest & Beyond website!(Honestly, I didn’t pay anyone for their responses!) It beat out all the other answers 5:1!

Interestingly, when I started this business I was sure that women would want support services; massages, laundry, housekeeping services, errands, etc… But that’s not what mamas want. Here’s what I have found in business and now from this survey:

  • They want their existing children well cared for
  • They want activities to pass the time
  • They want support – They want visits from friends and relatives.  They want to interact with other women going through the same process (I highly recommend the KeepEmCookin’ forum for this!). They need reassurance that it’s all going to be okay.
  • They want to learn more about bed rest; indications, how effective it is, what are alternatives and what they can do to be at their best when their bed rest journey is over. They also want to hear from women who have made it through the bed rest journey successfully.

This was HIGHLY informative to me. As the owner and founder on Mamas on Bedrest & Beyond, my mission, my goal and my passion is to serve women on bed rest and to make sure that they have all that they need to get survive bed rest, transition safely and healthily to motherhood and to remain strong-physically and emotionally. In the coming months I’ll be integrating the suggestions from this survey into products, services and resources on the website.

In the meantime, As per request, please share your bed rest testimonials. Women need to hear that you can go on bed rest and have a normal pregnancy and healthy baby. They also need to hear that even if things don’t go as planned, it’s still okay. Please share your bed rest survival stories at info@mamasonbedrest.com.