There are many reasons to avoid vaginal exams during labor, or at least keep them to a minimum: discomfort and the risk of infection, since anything that goes in is pushing germs up into your body, especially dangerous after the bag of waters breaks. I am re-posting tips from a doula in Israel:

Happily, there are a number of external cues that can help you and birth partners get clued in to how much labor is advancing. Some are more subtle than others, but if you are ignoring the clock and keeping focused on staying in tune with your body, you will see them. Listen, embrace, wait.  Enjoy the way it responds! It is amazing what it can do, this body that God gave you.

1. Sound. The way you talk changes from stage to stage in labor. With the first contractions, you can speak during them if you try, or if something surprises you, or if someone says something you strongly disagree with. You may be getting into breathing and moving and ignoring people – but if you really want to you can raise your head and speak in a normal voice. When the contraction disappears you can chat and laugh at people’s jokes and move about getting preparations done. During established labor, There is very little you can do to speak during a contraction. You feel like resting in between, you are not bothered what people are doing around you. As you near transition and birth, you seem to go to ‘another’ level of awareness – it’s almost like a spiritual hideaway. You may share this with someone else, staring into their eyes with each surge, or you may close them and go into yourself. In between surges you stay in this place. It is imperative for birth assistants and partners to stay quiet and support the sanctity of this space: there are no more jokes, and should be as little small talk as possible. Suddenly, the sounds start to change involuntarily: you may have been vocalizing before (moaning, talking and expressing your discomfort, singing, etc) or you may have been silent. Listen – there are deep gutteral sounds along with everything you have heard before, just slipping in there. You are about to start pushing.

2. Smell. There is a smell to birth, that hits towards the end of dilation, during intense labor, just before birth. It is a cross between mown hay and semen and dampness. It has a fresh, yet enclosed quality, and is pervasive. The Navelgazing Midwife has also observed this scent and writes about it here.

3. Irrationality. I love this clue – it often is a sign of transition. It always makes me smile, and I always warn women about this phenomenon so that when we hit it during labor I can remind them that what they’ve just said is irrational, and that I told her this would happen, and here it is! Relax, it means we’re nearing the end. Sometimes a mother will say she wants to go home, she is done now she’ll come back and do this later, she wants to put on her trousers and coat and go out the door. A mother who wants a natural birth and has been coping brilliantly will suddenly say she was crazy and needs pain killers right now, or that she didn’t want another baby anyways, who said they wanted a baby? Some will just curl up and say they’re going to sleep now. If she does this, that’s okay. The contractions may die down, get farther apart, and maybe she (and the baby) will get a few minutes of sleep. This slowed down transition sometimes freaks out doctors or hospital midwives and pitocin is offered – try to see if you can put them off for half an hour. Send every one out, lie on your left side propped up by pillows and have a little nap before pushing; it is such a wonderful gift.

4. Feel. Here come some of the more fun tools that you might not have heard of before! Think about the shape of the uterus. Before labor, the muscle of the uterus is thick evenly around all sides, above, below, behind. As the cervix starts thinning and dilating, all that muscle has to go somewhere – it bunches up at that top. The top of the uterus thickens dramatically the more the cervix opens. During a contraction, at the beginning of labor, check how many fingers you can fit between the fundus (top of your bump) and the bra line – you will be able to fit 5 fingers. As the top of the fundus rises higher during labor, you will fit fewer and fewer fingers. When you can fit 3 fingers, I usually tell mothers they can think about going into hospital as they will find they are around 5cm dilated. At 1 finger, you are fully dilated. (Awesome, huh!)

5. Look. There is something called the ‘bottom line’, which is shadow that extends from the anus up towards the back along the crease of the buttocks. It begins as 1cm and lengthens to 10cm, and it’s length correlates with cervical dilation. Why not look down there before inviting a stranger to put their fingers up inside you? It makes sense to me.

6. Gooey Stuff. Also known as bloody show; there is usually one at around 2-3 cm dilation, and it can happen during the beginning of labor or a few days before hand. Sometimes it’s hard to know what is or isn’t a show, since during the days before labor the amount of vaginal mucus increases in preparation and this can be confusing. A show is up to a couple of tablespoons in quantity, so quite a lot. It can be clear, but is usually streaked with pink, brown, or bright blood. If there is more than a couple of tablespoons of blood then you do need to go straight into hospital to make sure the placenta is not detaching, but if there is just a bit and then it stops, then it is just show. There is a SECOND show at around 8cm dilation. This second show means that birth is near.

7. Opening of the Back. This is just at the spot where your birth partner has been doing lower back massage, at the area above the tailbone. It is a little smaller than palm sized, rather triangular-shaped area that bulges out during pushing. At this point you’ve waited too long to go into hospital, and you need to refer to my last post, 4 rules of what to do when delivering a baby!

8. Check yourself. Okay, so technically this one is an internal check, but it done by YOU. You don’t have to announce the results or write them down: it is not an exam. To me it’s obvious that as the owner of your body, you have more of a right than anyone else to feel comfortable with it and understand how it works. It is best to get to know what your own cervix feels like from early on in your pregnancy, if not before, and then to keep a regular check on what feels normal. If you do this through out your pregnancy you will keep your flexibility into the 9th month. This is also an excellent time to remind you to not neglect perineal massage since you’re already down there! Check out the website My Beautiful Cervix to see photos and descriptions of what a cervix should feel like. At 1 cm you can fit the tip of one finger inside. Use a ruler to practice discerning how many centimeters dilation feels like, measuring with your pointer and middle finger. NOTE: Always, always, always wash your hands thoroughly beforehand, up to the elbows, for 4 minutes at least. Do not assess your own dilation after your waters have gone.

For more labor tips and information about external assessment of dilation, I recommend finding a copy of Anada Lowe’s book, The Doula Guide to Birth, Secrets Every Pregnant Woman Should Know.  This is one book packed with practical and useful information!

A great short film by Birth Matters Virginia about why women choose to hire doulas.

From Cate’s birth story:

I certainly wouldn’t have wanted to do this without my husband and baby’s father present, but I needed a woman as my birth partner. I know I am lucky to have a wonderful relationship with my sister, who is certainly cut out for this role, but I would recommend to all women that they think about having a female birth partner.

Your husband or partner is going through his own rite of passage, becoming a father. The whole thing is so enormous for him, he is not necessarily the best person to support the labouring woman. Perhaps, even, he needs someone supporting him. Plus, most men just don’t empathise with a woman like a fellow woman does. I imagine a woman who has given birth herself would make the ideal birth partner, but even one who hasn’t can be an amazing support. She might not understand what you are going through, but she will likely come to an easier understanding of how you feel than a man will.

I know lots of couples don’t want anyone else present at their baby’s birth. However, the right woman will take nothing from the experience you share with the baby’s father, and be there to support you both. Men have only been present at births for a very short time, and I think it’s a wonderful thing that they are, but also that there’s something sad about the loss of the shared women’s experience.

Cate didn’t have a doula, she had her sister as her birth partner, but I think her statements apply equally to a doula! In fact, I’ve heard many people describe the relationship they build with their doula like a sisterhood.

Today I finally had the opportunity to see the movie Babies in the theater. I am on call, so I had my phone on vibrate in my pocket, and when it rang (it was my own mom!), I was convinced it would be one of my pregnant mamas needing me! Wouldn’t that be a funny coincidence?

I really enjoyed the film, which simply shows the lives of four babies in four different parts of the world, with no narration, no translation, so commentary. It was beautiful to see how other people rear their children and it was also a treat to spend an hour and nineteen minutes just staring at adorable babies!

There was even an adorable child with his mom in the row in front of us. The official website has a great interview with all of the babies’ parents too. I definitely recommend the movie if you’re interested in ethnography or just like babies!

I saw this on Bloody Show. It is such a great video of a midwife. I love the first image of the woman breathing too fast and bouncing too fast on the birth ball, and the midwife comes and calms her. That’s what doulas do, too.

Great video on couples who choose to hire a midwife, debunking common myths about hiring a midwife being more dangerous than an OB.

At a blog I read a lot, That Wife, the author, Jenna, just gave birth to her first child, a beautiful son. Jenna had a homebirth and she did so well. She has been posting the birth story and recently answered frequently asked questions about the birth, including sharing this incredible video of the sounds she made during labor. She does a great job keeping her tons low which help open up the cervix and keep the pressure and sound focused low, on opening up and getting the baby out. High-pitched sounds, with the tension up high, in your head, are counter-productive. Near the end of the video, we see Jenna during the “ring of fire” moment of crowning and she expresses that it hurts. This might seem scary if you’re unfamiliar with natural childbirth, but sometimes just being able to express how she’s feeling–this hurts like heck!–is what a mom needs. Her midwife Sarah responds appropriately, honoring Jenna’s feelings, but encouraging her to keep going. Jenna trusts her body to know when to push and when to relax and moments later she birthed a healthy boy in the water with her husband’s support. This is one of my favorite videos (taken by Kelli Nicole, I believe) of a woman in labor:

Sounds of Labor from Jenna on Vimeo.

I just read an article about how Utah is one of the states with the lowest cesarean rate in the US! C-sections make up less than 25% of births. This is great news for a doula like me who longs to support women in natural childbirth and avoid unnecessary interventions. 25% is still higher than the World Health Organization suggests, though. They state that anything highet than 15% indicates more than necessary.

I am so glad that cesareans are available for women who need them. I wouldn’t be here without it, nor would my brother, and I am in total support of whatever intervention is needed to keep mom and baby safe, but I do think there are small, simple changes we can make to help avoid unnecessary surgery. I’m glad I live and practice in a state that agrees!

Reading this article on how to save money on a doula was a refreshing reminder of just how important it is to prioritize your birth! As a student doula, I am very well trained, but very low-cost as I work on gaining experience. I am happy to barter for services, work out a payment plan and I would be happy to talk about possible discounts. Every woman deserves to have a doula with her at birth, so I am eager to work something out with you so you can benefit from a doula yourself!

The economy is suffering and people are trying to cut back any way they can. This can sometimes mean that there are not enough funds for things that you may find important, like doula care for your birth. Since a doula can help reduce the risks of many complications and potentially help lower your overall hospital or labor and delivery bill, it can be a great investment. Here are some ways that you can use a doula, lower some potential risks and potentially save some money.

1. Barter.
If you or your partner has a talent, ask the doula you have chosen if she can barter that talent. This is often a win-win situation. I’ve bartered for new front steps, a new logo design, baby sitting, drapes and many more things. Sometimes I’ve done a full barter, where 100% of my fee is paid in trade. Other times I’ve done a half barter where a portion of my fee is money and the other portion is goods or services. It never hurts to ask!

2. Payment plans.
While a payment plan may not save you money all together it can spread out your payment plans, making it easier on you to afford a doula. How long of a payment plan is between you and the doula.

3. Discounts.
Some doulas offer discounts for various reasons. Common reasons might be if you have taken a certain childbirth class or work with a certain practitioner. Other discounts might be that you are a military family. Ask the doulas in your area what discounts they may provide.

4. Student doulas.
A student doula is someone who has gone through the doula training but may not have many births under her belt. Because she is trying to get experience, perhaps for certification, she may have a reduced fee.

Brilliant Vancouver-based doula Amber Morrisey put together this great slide show to explain the many benefits of placental encapsulation and the process of encapsulation:

In the Salt Lake City area, Kathy Reid offers this service!