FAQ

Does a doula replace the nursing staff?
No. Doulas do not replace nurses or other medical staff. Doulas do not perform clinical
or medical tasks such as taking blood pressure or temperature, monitoring fetal heart rate, doing vaginal examinations or providing postpartum clinical care. They are there to comfort and support the mother and to enhance communication between
the mother and medical professionals.

Does a doula make medical decisions for me?
No. A doula does not make decisions for clients or intervene in their clinical care.
She provides informational and emotional support, while respecting a woman’s decisions.

Will a doula make my partner feel unnecessary? 
No, 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, by giving ideas and suggestions
to help the partner support the mother as well. Having a doula and your partner at your birth also means that if your partner or your doula needs to leave to get food or some sleep,
you will not be left alone. We support the partner as well. We call it the home team advantage. Doula Family support comes in many ways for the partner - emotional, physical, but most of all, they know he has someone that he can turn to for support as well.

Water birth is considered by professional providers and mothers alike to be
the most gentle method of natural childbirth. Below are some frequently asked questions about water birth. If you are interested in a water birth please let us know. 

Why water birth?
It is essential that we adjust the way we bring our children into this world. By providing
a safe and comfortable environment with plenty of privacy, and a feeling of love
​and security for the mother, she is better able to release her baby with an experience of joy, - an experience shared by her baby. The use of water for labor and birth is one way
of providing this opportunity for women and their babies.

What is the temperature of the water?
For a waterbirth, the water in the pool is maintained at a temperature which is comfortable for the mother, usually between 95-100 degrees Fahrenheit. The water temperature
should not exceed 101 degrees because it could lead to overheating, which can cause the heart rate to accelerate and it increases the babies oxygenation needs. It is important
that the mother continues to drink plenty of fluids. Cold compresses and a cool facial mist make many hot mamas cooler.

When can I get into the water?
A woman in labor should be encouraged to use the labor pool whenever she wants.
If a mother chooses to get into the water during early labor, before her surges
are strong and close together, the water may relax her enough to slow
or stop the labor altogether. That is why some practitioners limit the use of the pool
until labor patterns are established and the dilation of the cervix is at least 4 centimeters. The first hour of relaxation in the labor pool is usually the best and can often help a woman achieve complete dilation even in short amounts of time.

What prevents a baby from taking a breath under the water?
There are several factors that inhibit the baby from beginning to breathe
during the period when its head emerges into the water and just after the full body
has been born. First of all, the water temperature is basically the same as the amniotic fluid in the womb, so there is no shock of a temperature change. Second, the baby
is receiving oxygen from the umbilical cord just the way it has for the previous nine months. And third, the baby has an autonomic reflex, called the dive reflex, which prevents it from inhaling any substance that is in its throat and causes it instead, to swallow. This reflex
is present for approximately six months after birth and than it disappears. Air breathing begins only after the baby is out of the water and exposed to a change in temperature
and air pressure, and experiences a complex metabolic chain reaction of hormones
and chemicals that cause the process to begin. Know that it is physiologically impossible
for a newborn to breathe until its body is out of the water and in the air.

How long is the baby left in the water?
Here in the U.S., all practitioners bring the baby out of  the water within the first ten seconds following birth. There is no physiological reason to leave the baby under the water
for any length of time. There are several water birth DVDs
that depict leaving the baby under the water, and the babies are just fine.
But physiologically, the placenta is supporting the baby with oxygen during this time
and it can not be predicted when the placenta begins to separate and stops the flow of oxygen to the baby. The umbilical cord pulsating is not a guarantee
that the baby is receiving enough oxygen. The safe approach is to remove the baby,
without hurrying, and gently place him into his mother’s arms.

Is waterbirth safe?
The safety of water birth needs to be judged in looking back at the number of cases
that have been reported world wide, and the number of problems that have occurred
as a result of birth in water. To date, over 100,000 documented cases of water births
gives us a good look at the statistics. The opinion of practitioners is that water birth
poses no threat to mother or baby, if all the normal parameters are met during labor
and birth. If complications arise they are evaluated and sometimes the mother
is asked to leave the water before the birth takes place. Everyone’s goal is to keep
mother and baby safe and to facilitate a satisfying birth experience. The British government stated in a  published health report that any woman who wants a waterbirth,
should be able to have one, and that it is up to the practitioner to become familiar
with the technique if they are not already educated.

How is the baby monitored during a waterbirth?
The manufacturers of monitoring equipment and hand held dopplers
have developed water proof varieties of monitoring equipment. In typical waterbirths
the baby’s heart tones are listened to every 30 minutes during first stage
​and after every pushing contraction during second stage.

What does a Certified Midwife provide? for a home birth or in the hospital birth?

Complete Prenatal Care for both birthing locations.
Midwifery offers individualized and complete prenatal care for home births, 
including water birth. Midwifery care enables women to actively share
in the decision making that occurs during pregnancy, labor and birth
by offering personalized prenatal care and education. 

You receive hands-on assistance during labor, birth, the immediate postpartum
and the newborn exam, with an emphasis
on establishing a good breastfeeding relationship. 

Thinking of having Certified Midwifery Services? you would normally receive the following:

• Free consultation and pregnancy testing
• Midwife on call 24 hours/day throughout pregnancy and 1st month postpartum
• Lab work appropriate for pregnancy, birth and postpartum, including the Expanded AFP Test and the Newborn Screening (labwork not included in midwifery fee)
• Referrals for childbirth education classes
• Attendance at your labor with a midwife and skilled assistant, having a doula present is always recommended 
• Newborn exam
• A mother & baby check-up within 24-48 hours of your baby's birth
• Two subsequent mother & baby check-ups in the 1st two weeks
• A final six week check-up for mother & baby
• Referrals to community resources

You will need a birth kit for a homebirth.
​This contains supplies that are necessary and useful

• That’s the interesting thing about being a doula - each mom is looking for something different. When a mom goes to hire a doula she usually interviews a few before choosing who she feels is the right fit for her family. So there are many different personalities among doulas. I would say one constant among doulas is patience and trust in the ability of women to give birth and the desire to support them during the process.
  
• And what about your schedule?
• Doula work is unpredictable by nature. I’m on-call for each mom two weeks before and after her estimated due date. I have my phone on me and my doula bag in the car packed with clothes and snacks at all times. Along with never knowing when you are going to “get the call,” you also do not know how long each mom will be in labor. Sometimes for a couple of hours, and others for a couple days! A doula has a commitment to stay with the mom as long as she needs, and also should have a back-up doula who can give her breaks or fill-in if she is not available.
• Why do you work with 2 doulas with each client?
• Since, 1980 I have found that when there are 2 doulas during the birthing...
  it sets a standard of insuring focused care and prevention of either dad or the doula is over-stressed or tired. Whether it is a Home birth or hospital births, nursing staff is always appreciative of having a doula on the floor who  is working with one of their patients. They know that that mom is in good hands, So many hospitals are short-staffed, requiring the nurses to do even more. A doula supports the nursing staff, and because of her presence they can focus on moms who don't have the personal doula support.
•  2 doulas working together with the father: their goal is to keep high quality service. If the mom has been laboring for 12 hrs or more, it is reasonable and a benefit for mom, baby and the father to have a team game plan for endurance. The doula(s) and dad each partake in helping the mom during her labor.  When the dad needs to lay down, he can Intermittently rest. It is so important for everyone to stay alert.  At the hospital there are shift changes, but a doula doesn't go off of her shift until at least 3 hours after the baby has been delivered.
• DONA is one organization, fairly new since they were founded 1992. The experience and training of each doula varies. Many are certified through Doulas of North America (DONA). DONA certification involves a 16 hour workshop; 5 books required reading; attendance of a 12 hour childbirth education series; completion of breastfeeding workshop; attendance at three births with good evaluations from a nurse, the midwife or doctor, and the mother; written essays about the births attended, as well as an essay about the benefits of labor support. There are many specifics about each of these requirements. DONA’s website www.dona.org is the best place to see exactly what is involved in the process. Also, it should be noted that not all doulas are certified and this is not a requirement. The benefit of being certified, however, is that clients tend to trust doulas who have taken the time to complete this training. It assures them that their doula abides by specific standards of practice and code of ethics. There are many doulas who are not certified who are excellent doulas. Certification is not a requirement, but focusing on the mother's needs with compassion and experience plus attending a number of births is usually the key.
  

Postpartum Depression and Anxiety
Brooke Laufer, Psy.D.
The postpartum period, or the year following the birth of a child, can be a miraculous and terrifying time for a woman. As many women find,
life with a new baby is a raw and fragile experience. There are many factors that come into play during this period; beginning with the labor and birth of the baby,
women experience dramatic hormone shifts, inevitable adjustments to relationships (husband, parents, friends), new financial stressors, identity issues, and issues of social support. These are experiences typical of a postpartum period. It is not uncommon for other health issues, colic, a traumatic birth, or a loss, to compound stress and emotions
following a birth. Emotionally and psychologically, it is a dynamic time that can surprise a woman with depression and/or anxiety symptoms.

Psychological and psychiatric disorders occur for about 20% of women during their postpartum period. These disorders are on a spectrum
starting from what many know as the "baby blues" -- which lasts only a few weeks and includes feelings of overwhelm, tearfulness, nervousness, and confusion --
to a much more rare and extreme disorder called postpartum psychosis -- experiencing delusions and/or hallucinations. In between lie postpartum adjustment disorders,
postpartum depression, anxiety, and postpartum obsessive compulsive disorder.

Aside from the "baby blues," postpartum depression is perhaps the most commonly identified postpartum condition, and yet anxiety symptoms are also frequently reported. Postpartum depression or anxiety lasts up to 1 year after delivery and includes excessive sensitivity, low self-esteem, apathy, withdrawal, appetite disturbance, lack of pleasure, function impairment and marked distress. Women may feel overwhelming fatigue or insomnia, disconnection, anxiety attacks, suicidal thoughts, and--
in the case of postpartum obsessive compulsive disorder--intrusive thoughts of harm coming to their baby.

A new mom is expected to immediately fall in love with her newborn baby, and to naturally take to motherhood, breastfeeding her baby, and connecting to her baby.
To feel anything but this can feel confusing and shameful. To whom can she admit that she doesn't feel connected to her baby? That she has visions of dropping him down the stairs or that she doesn't want to get out of bed to care for her baby? It becomes the job of those around her--a partner, parents, friends--to connect her to support,
as it is the mother's health that comes first in these moments. Postpartum depression and anxiety are temporary conditions that are treatable. The sooner they are identified
​and a mom finds the right treatment--whether it be therapy, medication, group support--the sooner she can enjoy being a mom.

Resources:
In Illinois: Perinatal Depression 24 hour hotline (NorthShore University HealthSystem) 1-866-364-MOMS
Outside of Illinois: Postpartum Support International 1-800-944-4PPD www.postpartum.net
Local: Adeline's Room Mom Support Group (downtown Evanston) (847) 859-2312

Brooke Laufer, Psy.D.
Clinical Psychologist specializing in postpartum issues
847-440-7361
brooke@drbrookelaufer.com
www.drbrookelaufer.com