Do You Doula?

I read an article yesterday talking about why some women don't hire a doula. I decided personally to address the concerns in the article from the point of view of my personal practice. Now being a doula I am obviously pro-doula but I do think finding the right doula for you is just as important as having one in general. I recognize that not all women are going to want me at their birth. So without further ado here is some insight into me as a person, my birth philosophies and what to expect when you hire me!

What does a doula do?
-Quite simply I support you and your choices! I answer questions, I provide resources such as my birth library for you to use if you want. I talk to you about your previous births and meet with you after your birth to let you process it. I help your partner support you and most importantly I stand up for you when you want me to and I make sure you have time to make decisions. I attend difficult appointments with you. I celebrate with you on the good days of pregnancy and labor and on the bad days I cry with you and hold your hand. I will help you achieve your breastfeeding goals and if you change your mind 3000 times about getting an epidural that's ok I will stay right in step with you the whole way!

Do you replace my husband? Can he even be in the room with me if you are there?
-No No No! I do NOT replace your husband or significant other! And most hospitals will allow both me and your significant other in the room with you. If you aren't sure you can ask me or your doctor about the protocols at your specific hospital or birth center. I cannot possibly replace the love and comfort your significant other brings to the table any more than a cheerleader can replace a loving parent at a basketball game. We do separate jobs but help facilitate one another. I know the lingo of birth. I know birth protocols. I know how to help you bring your baby into the world. Your loved ones know you. They love you. They care more about you than anyone in  the world. They will support you in ways I never could. But they don't usually know birth as well as I do just like I don't know you as well as they do. Between us being a team we will give you the best labor and birth possible!

What if my doctor says they don't recommend doulas?
-Most doctors love doulas so you should ask them why they don't like them. They may not understand what a doula is or maybe they had a bad experience with one...but let me clear the air on something- it doesn't matter what they think for several reasons: 1) They most likely will not be at the delivery of your baby because the chance of them being on call when you go into labor is unlikely. 2) They deal with several births a day so you are literally one of thousands. However I only deal with one birth at a time (you will probably be my only birth that week) and each is as unique as the mothers involved. And most importantly you have to live with your labor- birth is transformative for better or worse. Do what is best for you, not your doctor. 3) They haven't met me yet. I will attend an appointment with you (if you want) so I can meet your care provider. And I am pretty good at winning people over to the idea of me being your doula. :)

What if I am using a midwife instead?
-Yay! I love working with midwives! I actually know several of them in the area (2 of them actually were at my baby's birth!) A midwife is great! But they are not doulas. They are there for your healthcare needs and your baby's needs. I am their for your emotional needs! If you need a back rub and for the baby's heart tones monitored you can bet the midwife will ditch your back rub to check on the baby (as they should!) but why have that when I can give you a back rub while they check fetal tones and your hubby tells you how amazing you are and rubs your feet?! :) See life is better with everyone working together!

What if I want to give birth in a hospital instead of at home?
-So far (besides my own labor) I have only been a doula for hospital births! I would love to attend a home birth but if you choose to give birth in a hospital I am just as much there for you as anyone! In fact in a lot of ways that is more the environment I have been trained to work in!

What if I already KNOW I am getting an epidural? This natural stuff isn't for me so why would I need you?
-Don't like pain? Me neither! Did you know that they did a study and having a doula present reduces labor time, reduces chance of an emergency c-section, reduces chance of needing instruments to deliver the baby (can you say ow!) and overall increase mother satisfaction of her birth. It also reduces the number of women who ask for an epidural- now that could be for several reasons but some (like me) think it is because we help to reduce the pain as well. Since it can take anesthesiologists a while to get there with the epidural that is probably a good thing!

What if I don't like hippies or granola ladies? Are you going to make me worship Buddha while I labor?
-Umm NO. I don't worship Buddha so I'm certainly not going to make you do it. I may be a little naturally minded -as in I think women are strong and can birth babies however they feel like- (natural, epidural, c-section, at home or in a hospital) but that means ALL women who take the path to motherhood are strong no matter how you get there! (can I get an amen?) I also wear cowboy boots and ride a horse and am a Texan through and through. I love hippies (my husband is one...gotta love Oregonians) but I am country. I support your right to birth the country way or the hippie way or anyway you feel is best for you. No braids or beads required. (But I will braid your hair if you ask me too)

What about the price?
Well as of right now my services are free but I do ask for a $25 traveling fee because gas has gotten SO expensive! However, I will waive that fee for lots of reasons some of the most popular reasons being:

• Women in a crisis pregnancy
• Women giving their baby up for adoption
• Women on Medicare/caid, SNAPs, TANF, or WIC
• School Teachers (my husband's one so I send a lot of love to you ladies)
• Peace Corp
• Women who's significant other is away for any reason- the most popular being because he is deployed
• If you are a foster parent

*if your specific situation is not listed above but you cannot afford the $25 please let me know and I am sure we can arrange something. :) Every woman should be able to have a doula! -I am also willing to barter if thats best for you and your family- seriously.

Now that you know a little about me, please let me know about you! What your goals are for your labor and delivery? How can I help you achieve them?

I work in the Lubbock, Midland, Odessa, and Amarillo area (basically any place within 2 hours of Lubbock). Feel free to call me at 432.638.6877 or email at sarahjohnsondoula@gmail.com
And please find me on facebook!

-Sarah Johnson
The Cowgirl Doula

The Nuchal Cord Scare

When you start talking about birth a lot of people bring up emergencies and fears. Some of these are legitimate concerns, others are perceived concerns (meaning they aren't actually an issue) and some are a mixture of both.

The issue I want to talk about today is a nuchal cord. Better known as the cord around the neck. This is one of those situation where sometimes it can be a problem but most of the time is just a perceived problem.

When it comes to a nuchal cord there are somethings we need to consider:
1) While the baby is in the uterus the only way it receives nutrition and oxygen (air) is through the umbilical cord. While for some of you this may seem like a given it is important to remember this when it comes to birth too.
2) As long as the umbilical cord has blood flow the baby is receiving all the oxygen they need for "breathing".
3) A cord can become compressed to the point that blood flow is restricted regardless of where the cord is or what is is wrapped around. When this happens the baby losses its continual oxygen flow and is in danger of suffocating.
4)Until the placenta has detached from the wall of the uterus there is blood flow to the baby. In normal births this doesn't happen until after the baby has been born.

Now keeping all this in mind when a baby is born and has a nuchal cord it is not immediately concerning because there is STILL blood flow to the baby- as long as there is blood flow there is limited risk of suffocation. This is an extremely important thing to remember because if your baby has a nuchal cord and they don't unwrap it before cutting the cord the baby may not be able to breathe because the cord then has no blood flow (ie no oxygen) and is wrapped around the neck.

While it may seem lifesaving to cut the cord and immediately unwrap it so "lifesaving procedures can begin" that is actually one of the most dangerous thing you can do. It is much better to unwrap the cord slowly and without pulling on it and then after it stops pulsing cut the cord as oppose to cutting it and then unwrapping it.

In most situations the cord around the neck is not dangerous and is actually safer because it is less likely to become compressed if it is around the neck.

While it is always good to ask your care provider if you have a question or concern also remember to do your own research and discover what are true risks and what are merely perceived risks. Also talk to your doctor/midwife about what they would do in a situation like this. If their answers do not match up with evidence based medicine never be afraid to transfer care or ask to have them do it the way you have researched.

This article has some cool pictures of nuchal cords.

GBS What is it? Why does it happen? Can it be prevented or cured? If you have it once will you have it again?

GBS stands for Group B Strep which is one of many types of bacteria that lives in the vaginal system of any healthy adult woman. In small amounts this bacteria is helpful, however if it starts to colonize in large numbers it can be dangerous if the baby passes through the birth canal at that point or if your water has been broken for quite a while.

Just like other infections, it can resolve itself on its own. However, if you test positive most doctors are going to want to give you antibiotics during your labor to "keep the baby from getting GBS". Antibiotics has been shown to reduce the risk of the baby contracting GBS from 1 in 200 (without antibiotics) to 1 in 4000 (with antibiotics). However, antibiotics have downsides as well. And there are more natural ways to deal with it. This website has lots of good information.

Here are some thoughts though for deciding what to do if you have already been diagnosed with GBS:

• Most women are tested at between 35-37 weeks of pregnancy to determine if there is a risk of a baby becoming infected with GBS. Just like every test during pregnancy you can choose to not be tested for it. If you are not going to do antibiotics (regardless of the results of the test) then it would probably be best to just refuse the test altogether along with the antibiotics for your baby and yourself at the hospital. 
• If you have been tested and found to be GBS positive demand to be retested every week until you have your baby since many GBS infections resolve themselves and most doctors will NOT offer to retest you.
• Just because you had GBS before does NOT mean you will have it again and just because you were negative last time does NOT mean you will be negative this time.
• Just because you have a GBS infection does not mean your baby will contract the disease or have any problems. (The stats on that are listed above) However, for some that will be a risk they are willing to take and for others it will not, but either way know what you desire in the area and have it written in your birth plan and stick to your instincts!

Here is another blog about keeping yourself healthy, she gives some ideas that will also help with GBS. I don't necessarily agree with a couple of the things she recommends such as using silver to prevent disease. But if you are looking for some options for preventing and treating GBS naturally then that website will definitely be of help. 

Antibiotics aren't the end of the world, but they do cause some problems, such as thrush, antibiotic resistance in children, stays in the NICU and inability to "room in" in certain hospitals and all that can lead to issues breastfeeding. But your choices must be right for you and your family.

-Always consult a trusted medical professional about your medical decisions and do your own research!-

The Cowgirl Doula 

Services of a Doula

These services will not be the same for every doula, but these are the services I offer:

Prenatal:

• 3 visits over coffee or at your house to get to know one another, for me to learn about your previous birth experiences, what you desire from this birth, what support you would like from me, and medical updates (such as the baby is breech, scheduling a c-section or induction, or just changes to your birth plan in general)
• A prenatal library of books about birth, breastfeeding, labor, babies, nutrition, etc. These are free for any of my clients to use
• On call 24/7 for questions and advice as well as emergencies
• If you are worried about hearing bad news at an appointment and have no one else to go with you I will attend 2 appointments with you (possibly more depending on the situation)
• Help with writing a birth plan, information on parenting and childbirth, and addressing any labor questions you have.
• Information on evidence based medical practices when requested
• Information of risks and benefits of procedures during pregnancy and labor
• Unwavering support during pregnancy for decisions you and your family make

Labor:

• Providing certain labor aids (birth/yoga ball, music, candles, heat packs, oils and massage help, counter pressure items, a snack pack for other labor support person(s), toys/entertainment for other children, help cleaning or preparing for baby, etc. (many of these items will be discussed at the prenatal meetings)
• 24/7 on call 
• Will attend you while at home in active labor, at the hospital, or birth center
• Offer emotional, physical and continuous support throughout labor for both you, your labor support person(s) and your healthcare provider(s)

Postpartum

• 3 postpartum visits
• Breastfeeding support
• Postpartum library on parenting advice
• Help processing birth/birth story
• Check on bonding and answer any questions
• On call 24/7 for advice or questions for 2 weeks following birth (could be longer depending on certain situations)

Pregnancy Loss

• On call 24/7 for questions, emergencies and procedures
• Support during loss and time after loss (these will be case by case on duration and length of time meeting)
• Help in processing your loss
• Support for labor in loss situations 
• Library support books on recovering and mourning loss
• Support for choices during loss and after loss

If you have questions please feel free to call and ask (or email!) and I am willing under certain circumstances to provide other help on a case by case basis. I would like to remind everyone that these services are provided to anyone within 2 hours of Lubbock, TX and that all services are free for now because I am still in the training phase. I am also willing to work with other doulas, so if you wish to use a doula with the hospital of your choice as well as me that is wonderful! I am also willing to work with another doula that you hire (such as for homebirths or hospitals that don't have doulas included). I would love to serve you and your family during such an intimate time.

-Sarah
The Cowgirl Doula

Breastfeeding and Nursing in Public

These cards from Best for Babes are to give to encourage women who are breastfeeding and help them in case they have issues with harassment while nursing in public can be found here: 

The NIP (nursing in public) harassment line was created to learn about ways people harass nursing women, get accurate statistics, counsel women who are harassed and encourage them to seek the help of local legal personnel (such as police in states that protect breastfeeding women and their babies rights). Most people, regardless of whether they breastfed their babies or not recognize the effort that goes into breastfeeding a child and the accomplishment that it is to be able to breastfeed a child (especially in public). 

Support these women and the NIP harassment line by buying these card for $3 (you get 10) and free shipping. Please also call the NIP harassment line if you ever face problems while breastfeeding (especially in public). 

Praise For a Georgia Doctor and Breastfeeding Tips

At this page you will find the wonderful video I have included below:



This video shows a brilliant doctor in Georgia who is helping women breastfeed. Now it may come to a shock to you, but most doctors are not given much training or info. on breastfeeding and many have no experience with it (now of course this will vary by geographical location and the importance each individual puts on breastfeeding). And from breastfeeding my child, I understand that knowing textbook answers is not the same as practice. I knew all the "correct" ways to breastfeed but almost ended up with my daughter in the hospital because she was not actually getting much milk since her latch was wrong (we met with a great lactation consultant and my daughter is exclusively breastfed at 5 months old and are going strong with no intention to stop anytime soon and now I have a lot more of applicable knowledge not just "book knowledge").

I do like how in the news article that the doctor lists the 3 most common questions/concerns during breastfeeding. Hopefully that will help women who feel alone in their breastfeeding struggles know that many other women have gone through the same things! I also hope it encourages breastfeeding moms to seek out help when they are have trouble. I do wish though that they had also shared some common solutions to these 3 problems. But since they didn't I decided it would be a good idea to answer them.

1) A jaundiced baby- This can come from several things. The first is that the yellow tint that indicates jaundice comes from bilirubin, which is basically broken down red blood cells (yes I know that is the super simplified version but really what causes biliruben in this case is not as important and being able to get rid of it). Bilirubin is iliminated through the poo and therefore it is very important for your baby to get breastmilk because it has a natural laxitive effect. If your breastfeeding is going well but your baby still is showing signs of jaundice consider allowing them to get a little more sunlight or use a light table that your doctor can get you (I prefer natural sunlight). If your baby is not seeming to get better, jaundice can be a serious condition so get them looked at sooner over later.

2) Sore Breasts- I did not deal with this even when I had troubles with the latch, so I do not have as much experience (and fixing a latch is better done in person) but I will tell you that there are a couple times your breasts may be sore and it will be normal and then signs that it is not "normal soreness". When you are engorged, you may feel that your breast are sore (or in my case feel like they are going to bust!) I never found a solution to this, but I promise it does go away. Try to breastfeed often and do not despair  Just take the Tylenol  I tried to be the martyr and not do it and it really just lead to more breastfeeding problems. Another time your breast may feel sore is if you have a blocked duct. These are painful in the breast (not the nipple usually) and the best thing to do is to massage the sore area (I know, not super comfortable) and let your baby nurse on that side a little bit extra. (You can also take vitamin C if you have a plugged duct. I actually take it rather regularly because I am very pron to plugged ducts so if I ever think I feel one coming on I take an little bit to help ward it off). If your nipples are sore you need to look into poor latch (call either your doula, lactation consultant or if you are in west Texas let me know and I will come over for free), yeast infection, etc. I found coconut oil cleared up my yeast infection in a matter of hours and P. never caught it in her mouth!

3) Poor Supply! The dreaded poor supply. First off I will tell you this is more of a myth then fact. Yes some women do deal with supply issues but usually that is from poor breastfeeding habits or lack of nutrient intake, not from actual supply issues. If you are having supply issues we need to look at the cause:

• Are you pumping?
•  If yes- are you pumping with a efficient pump that empties your breasts and are you pumping every 2-4 hours? If not then find a better pump and increase your amount of times pumping especially at night! If you are pumping every 2-4 hours with a quality pump and your supply is still diminishing then try pumping every 1-2 hours if possible. 
• If that does not work skip to supplements
• Are you breastfeeding exclusively? 
• If no: You really need to try to breastfeed exclusively...your supply will diminish if the demand is not high enough from your baby. You might skip down to supplements though if increasing breastfeeding is not an option.
• If yes: Try to spend as much time allowing your baby to breastfeed. One day my child was not feeling well (I only have her so I could do this without needing a babysitter, but it might be worth paying for a all day babysitter one day for the benefits I'm going to tell you about) so she wanted to nurse all day! Literally I think I got up from the couch where I nurse her 4 times all day. The rest of the time she nursed. For the next 2 weeks I have LOTS of extra supply! I was pumping all the time (because she doesn't normally nurse that much and I needed to get rid of some of it) but for someone dealing with supply issues this could really help (especially if you don't encourage it to go away like I did.
• Also try doing what my husband nicknamed "the dessert booby". Basically you feed the baby on side A until the baby stops nursing (like I mean falls off the nipple stops eating, don't remove the baby from you nipple though and don't take the baby away just because they unlatch only once they refuse to take it again should you switch sides) then switch baby to side B and offer that side to him/her. If she takes it allow her to keep nursing until also done on that side. Next time baby is ready to nurse allow her to take side B first and then offer "the dessert booby" which this time will be side A. And so on and so forth. If baby does not want side the "dessert booby" side that is ok too. Don't force it. If you baby is full they are not going to want to keep eating. If they are not full then they will take the other side.
• Are you taking supplements? 
• Prenatals or Breastfeeding vitamins? If no I recommend one. I take one that I get from Sprouts and it is amazing! Its called "Baby and Me" and I love them.
• Alfalfa? Let me tell you if I want my supply to increase I just have to take 3 of these little pills and I'm gushing! And the recommended dose is 9 a day! I can't imagine what would happen if I did that! (I take them for the vitamin K benefits- we chose not to do the shot) 
• Fenugreek? I have never tried it but I know a lot of women swear by it. So you might give it a try too.
• Are you eating enough?
• It takes a lot of calories to create breast milk. Once you get back to your ideal weight you should make sure you are consuming extra nutrients. If you do not you will begin to have supply issues (also try to stay away from junk food or so called "empty calories" healthy food (fresh fruits and vegetables, whole wheat, fiber, protein(!), and healthy fats). 
• Are you drinking enough? 
• Breast milk is a liquid and it takes lots of water to create it! Make sure you are drinking extra water so both you and your baby stay hydrated. 

I hope this helps you in your quest to meet your breastfeeding goals! If you have any questions or would like further help feel free to contact me (through comments or email or by phone)! I believe breastfeeding is the best start you can give your child and I would love to help you do that in any way I can!

-The Cowgirl Doual

What is a Doula

© Jakubjoachim|Stock Free Images

So it has occurred to me that some may not know what a doula is, or what they do. According to Websters Dictionary a doula is "a woman experienced in childbirth who provides advice, information, emotional support, and physical comfort to a mother before, during, and just after childbirth"

That is actually a very good definition. Doulas become experienced in childbirth in a number of different ways. In my case I have actually had a child so that helps. I also read birth stories as well as watch birth videos. That is not all though. I also read books and articles on childbirth, evidence based care and standard medical practices. I also of course attend births and act as a labor support person. 

Because of my knowledge I can also provide advice, information and suggestions (however, these are just that-suggestions. They are not medical advice nor should they take the place of medical advice or personal research). The emotional support is given regardless of choices a client makes. I am not the one that has to live with the births that I attend therefore I defer all decisions to the woman and her labor companion(s). Now, that does not mean I will sit idly by and allow birth trauma or abuse happen, it also does not mean that I will not fight for your choices. It simply means that even if you choose something I would not, I will support you no matter what. 

The physical comfort is something we discuss beforehand, at one of our prenatal meetings. If you have had a child before I will ask you what you liked during labor comfort wise and what you wish you had more of. If you have not had a child before then I will discuss what you like while you are sick, what you think you will like and ways I can help you discover things you will like during labor. There are several types of things I will bring with me to your labor (depending on what you request and where you are giving birth). For example candles (for non-hospital births), a birth/yoga ball, heat packs, washcloths, counter pressure balls and scarfs, pillows, aromatherapy oils and massaging oils, cd player, music, books, etc. 

During our prenatal appointments we will also get to know one another and discuss your birthing preferences and wishes (such as interventions desired or specifically wanting to avoid, breastfeeding goals, location of birth, information on your healthcare professionals, and labor companions, etc.). If you choose to hire me you will also gain access to my birthing library which contains books on childbirth, parenting, pain management strategies, leaflets on different evidence based procedure, videos, etc.  

A doula does not just support you though, they also help your significant other and other labor companions support you as well. They help to take some of the pressure off of your labor companions and help them out if they are feeling fatigued or are not sure what support to offer you. 

Some doulas offer postpartum care as well while others do not. I do offer it, I will check in with you several times after your birth to help you achieve your breastfeeding goals, make the transition to a new person in the family easier and help you process your labor and birth experience.

While where you birth does matter, WHO is at your birth is even more important. A doula is someone who will support you no matter what. Interviewing lots of doulas is always a good idea and then find the one that fits your price and philosophy/style the best. 

-The Cowgirl Doula