Worried About a Big Baby?

Like many women, I've watched my share of pregnancy/birth shows (like A Baby Story), and recently I've noticed that many of the moms are told at some point towards the end of their pregnancy that they could possibly have a "big" baby and should consider induction. Having a larger than normal baby can be some women's biggest fears when it comes to childbirth.

The difficulty lies in the idea that there is no way of truly knowing how big a baby will be at birth. Fundal height measurements are affected by amniotic fluid levels, baby's position and mother's body. Ultrasounds have not proven completely accurate in measuring how big a baby actually is. Even a skilled practitioner cannot be totally sure of a baby's size by palpitation (although some really like to try and guess).

I think the key to a healthy and happy birth is truly accepting the idea that women's bodies are designed to give birth. We will grow a baby that is the perfect size for us. The greatest majority of the time, all will be well with our labor and delivery if we trust our bodies to do what they are made to do without interference.

If you would like to do further reading on the subject, check out this wonderful article by a very experienced birth doula.

Wondering Whether to Hire a Doula?

If finances has been a concern in whether or not to hire a doula for your upcoming birth, I wanted to put it out there that I will be offering my services at a HUGE discount while I am working towards DONA certification. Please contact me if you would like more specific information.

What About Dad?

Many fathers may wonder how having a doula present at birth will affect their role in their child's birth. I think it's natural to feel nervous about the prospect of bringing another person into the birthing space. Penny Simkin, P.T., a world-renowned doula and birth educator wrote the following, which will hopefully put dad's mind at ease.

Myth 1 - If a woman has her partner, the doula becomes redundant.

Reality - The doula may be the only person at the labor besides the partner who is there solely for the emotional well-being of the woman. The nurse, the doctor, the midwife have other priorities that compete with the emotional care of the woman: for example, breaks, shift changes, clinical responsibilities, office hours and hospital policies. The doula has few or no other priorities. She stays through shift changes, and until after the baby is born She is not just another stranger with the couple; she has the woman's needs as her sole priority. In some cases, the couple will bring several other friends or family members into labor with them. Sometimes these people can be uncertain of how to help which leads to confusion and actually adds to the woman's stress. The doula can direct and coordinate the efforts of a group of people, giving them all something useful to do, so they work as a team on the woman's behalf.

Myth 2 - The doula "takes over", displacing the partner and interferes with their intimate experience.

Reality - The doula can actually bring the couple closer. By making sure that the partner's needs are met (food, drink, occasional back rubs, and reassurance), the woman and partner can work more closely together. The doula allows for the partner to participate at his own comfort level. Some partners prefer to be there only to witness the birth of their child and to share this experience with the woman they love. They may not want to play an active role and do not want to be responsible for the woman's comfort and emotional security. The doula can fill in and allow the partner to participate as he wishes, without leaving the woman's needs unmet. When the partner chooses to be the major source of emotional support, the doula can supplement his or her efforts by running errands, making suggestions for comfort measures, and offering words of reassurance and comfort. During a long tiring labor, she can give the partner a break for a brief rest or change of scene. While the doula probably knows more than the partner about birth, hospitals, and maternity care, the partner knows more about the woman's personality, likes and dislikes, and needs. Moreover, he loves the woman more than anyone else there. The combined contributions of partner and doula, along with a competent, considerate and caring staff gives the woman the best chance of an optimal outcome.

Myth 3 - The doula has her own beliefs about how the birth should go, and imposes it on the woman or couple.

Reality - The doula's true agenda is to help ensure that the woman's or couple's agenda is acknowledged and followed as much as possible. If the doula is thoroughly familiar with the couple's wishes and their birth plan, she may actually think more about it than the couple, especially when labor is intense and things are happening rapidly. The doula can remind the staff or the couple of some items on the birth plan that are forgotten, but which later might be important. Sometimes if a birth plan is not followed, the couple later look back with regret or disappointment. The doula helps with decision-making by asking questions that will ensure that the right information is given to the woman or couple so that they can make an informed decision. She may also suggest alternatives for the couple to consider. She does not, however, make decisions for the couple. In summary, the doula helps make the birth experience to be as rewarding and satisfying as possible.

As one father said, "I heaved a big sigh of relief when she (the doula) walked in. I hadn't realized how much pressure I had been feeling. She not only calmed my wife, she calmed me down."

I know my own husband was so happy with our doula's services that he wished we could have paid her twice her fee, because her presence made him feel so much more relaxed and able to focus on the birth, rather than worrying about me.

What Is a Doula?

The word doula is derived from Greek and meant a servant (a woman) who attended to other women. The meaning has changed slightly to now mean a woman who assists another woman and her family achieve the type of birth that they desire. Usually a doula meets with the pregnant woman two or three times before the birth so that they can establish a relationship and so that the doula can learn what the woman's desires and wishes are for her birth -- like laboring at home, no interventions, changing positions during labor, massage, holding baby and nursing before baby is taken, etc. Every woman is different in their desires and vision of their birth, and, of course, things can happen that are unexpected, so it is important to play out all scenarios. The main "work" that a doula does comes when the woman goes into labor. The doulas job is to totally support the laboring woman, providing comfort measures, and also to support the mother's partner in fulfilling his role as a support person, as much as he feels comfortable. A doula is knowledgeable of different laboring positions, relaxation techniques, and the general physiology of birth, so that the mother's experience during labor will be improved and she will usually have a shorter labor and pushing stage. Usually a doula will stay with the family for one or two hours after the birth, to make sure everyone is settled and that breastfeeding has been established. Two post-partum visits in the home are arranged in order to check in on mom, to see how she is adjusting, and to also debrief the birth with her.

Doulas are not medical personnel. I am not trained to deliver a baby or do vaginal exams. My job is to work with the medical team (nurses, doctors, midwives) to help the mother achieve the birth she desires. I am also not there to replace the mother's partner. I know some women who have spouses that really want to be intimately involved in all aspects of the labor and delivery, desiring to be the mother's primary labor coach. That's great. The doula would then be there in a secondary capacity, maybe providing suggestions for laboring positions, providing refreshment, helping to keep mother comfortable, and allowing the partner to take breaks as needed. Some men feel very overwhelmed by the whole experience, and wouldn't even know where to start. Seeing their spouse in pain can be very stressful for some men, and the doula is there to assume a primary role, including the partner to the degree that he desires to be. All of these things would be discussed ahead of time.

Doulas are not just for women who desire an unmedicated birth. Some women may go into a birth knowing they want an epidural, others may not be sure. Just because a mother receives an epidural, doesn't mean that she doesn't need encouragement and support. She may still need an advocate or her spouse may need his own support. A lot of first-time moms aren't sure what to expect, so it is nice to have someone there to support in every type of scenario. Some women even hire doulas when they have a planned cesarean, simply because there is a lot going on at the birth, and usually mother and baby are separated for a short while, causing the partner some conflict about who to stay with. Doulas can be there to continue their support of the mother, when the father goes with the baby, and assist in breastfeeding, immediately after mother and baby are reunited.

The cost of a doula varies by where you live and is usually based on cost of living. When I initially looked at hiring my own doula, I didn't think that there was any way that we could afford it, but we went ahead and did just because I had been feeling so much anxiety. Afterwards, my husband said that he would gladly have paid double the price, just because of how wonderful our doula was and how instrumental she was in helping both of us through the process. Please read Charlie's Birth Story if you would like to learn more about how my doula assisted me during my labor and delivery.

Statistically, doulas are proven to reduce cesarean rates by 50%, epidurals by 60%, the use of Pitocin by 40%, the need for a forceps or suction delivery by 30%, and women who use a doula have been shown to have a labor that is 25% shorter than women who don't (this was taken from the book Mothering the Mother). Those are pretty good statistics. If you are interested in finding a doula in your area, check out DONA's (Doulas of North America) website. They have a listing of all certified doulas by state and then city.