Keith Roberts is unfazed by the attention given him as the first man to be certified as a doula by DONA.  He has has spent over 30 years in the field of holistic care, specifically focusing on pregnancy massage therapy and birth support for the last fourteen.  The prenatal massage work he does was a segue to following one mother right into labor where he found expert massage therapy was extremely beneficial to her in labor.  She was the first of fifteen more mothers he supported in labor before he determined to pursue certification as a doula.

Keith is perhaps more determined than female doulas to not replace fathers at birth.  The female support presence is invaluable because she is female and yet that bond is one that many a father may meet with trepidation: a club that he can’t be a member of by virtue of his gender.  Keith recalls an image that influences his genuine welcome of the father, an old cover of International Doula.  The cover’s image showed a mother embraced by her doula and the father is in the background.  Many a father today may not care to be present for labor but just as many men know there was a battle fought by Dr. Robert Bradley and the Hathaways to protect a father’s right to be in the labor and delivery rooms.

Those men who do want to be present for their child’s birth are already engaged in a checklist of all that they are expected to be today: he is to know everything about birth because he will be the mother’s advocate allowing her to focus on her labor; this he must accomplish while also providing physical, mental and emotional comfort.  Then after the baby is born he must strike the perfect balance between staying with mother throughout third stage and going with his baby should there be a medical reason to separate mother and baby.  As many a partner has put it, he/she must be everywhere, have eyes in the back of their heads and know how to play football, delivery room football that is.

Keith’s role is primarily for physical comfort.  It is easy for mom to choose between the two males present for her emotional and mental support….dad is her intimate partner.  “(Partners) are a reflection of mother’s state-of-mind; they tend to follow her lead and birth is just as much of an unknown to them as it is for mom.  They (dads) have as much a desire to meet birth at mother’s level of comfortability and she will want dad in front of her, to see him and be held by him.”  Further, for all of the reasons listed above, men appreciate having another male present in the primarily female energy until and unless a male obstetrician walks in for a few minutes of observation, medical speak and then exits.

When asked how he perceived the choice of a woman to invite doulas, let alone a male doula, to their births over their mothers even Keith’s keen observation of relationships is quick to surface.  In his experience few mothers want their own mothers present because they will feel a need to perform or meet parental expectations whether real or imagined.  Having their own mothers present is often an overwhelming thought no matter how comedic, true or polite the response is expressed!

Keith’s own intimate insight into birth as someone who could not experience birth for themselves but supports laboring women gives invaluable advice to partners.  These are his experienced Natural Birth Critical Factors:

  • Once you are in labor you cannot stop the flow of birth care you signed up for.  Choose wisely.
  • Read. Read. Read.  Take a natural childbirth class and read some more! A natural childbirth experienced and focused birth class leaves mothers and their partners with less “unkowns” and less fear of those unknowns.
  • Learn about fetal positioning.  The more you know about baby presentations and how to encourage optimal ones and work with less than optimal ones the more sense prudent changing of positions in labor makes.
  • Your choice of birth care practitioner directly relates to your odds of having a cesarean!
  • Keep the bag of waters intact!  Artificial rupturing of membranes (AROM) or artificially breaking the bag of waters is trivialized.  EVERY practitioner knows that within a short while of breaking the bag of waters labor intensifies in a ratcheted manner (versus a natural progression) and the majority of women will subsequently ask for an epidural.
  • Hire a doula for the purpose you want be it physiological support, birth knowledge, support for dad.  In all cases the doula can alleviate what stresses you most leaving you better able to meet labor’s demands with all of your own energy.
  • It is very hard to buck the system therefore, go back to Critical item number one.
  • Lastly, but more importantly, he reminds mothers that they have their own voice.  A doula will provide his/her opinion if asked but will never make a mother’s choice for her.  Mom must convey her choice directly to her careprovider and partners must be prepared to be be the first line of support echoing mother’s choice and minimize the number of minutes he/she might otherwise spend playing football by putting all that you’ve learned in a natural childbirth class into action.  Learn more about how your doula can best help you.

Through supporting women in labor hands on, so to speak, Keith has gained a whole new appreciation for the courage of women and for the hospital birth experience.  He concurs with Penny Simkin’s address at the DONA conference in Washington D.C. three years ago where stated the doula backlash is very real.  Keith advises new doulas to be mindful of their standards of practice and ethics.  Unless they have an established relationship with local practitioners then their voice, necessary for the support of laboring women, must be viewed as respectful of the practitioner and facility as well.  Birth is a hands on experience for the obstetricians and nurses themselves.  This is an opportunity for them to observe truly natural childbirth and learn.  If the doula is not respectful and professional in conveying her knowledge and experiences then the entire birth community suffers the backlash.

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The more a midwife speaks to a mother and spends quality time with her, the more likely a mother is to open up and reveal more of her daily routines and habits that can affect her pregnancy and birth.  For example, the midwife will ask a mother the most basic yet critical questions like what is she eating and follow up with nutritional counseling, a topic in which the midwife owns expertise. She’ll ask her what is occurring in her life today, yesterday, expecting for tomorrow. A mother’s every day peace and stress contributes to her body’s sense of well-being and reaching the point where mother and her body believe it is time now to give birth safely and securely.

The psychology of labor is addressed during the med school L&D rotation by incorporating finding other resources for emotional and mental support.  Subsequently we have a number of practitioners in all fields lacking in bedside manner today, but in birth this aspect has an impact intangible to the practitioner but very real to the mother and her family.  The average obstetrical course of education includes fewer than three credit hours in understanding nutrition.  The focus on prenatal nutrition is only a small portion of the syllabus (do your homework choosing a careprovider!).  The home birth midwife also follows the mother into the immediate postpartum and continues home visits to see how mother and baby function as a unit.

It is the midwife who is better versed in delivering babies in various but normal birth situations.  A breech baby can be birthed safer in the hands of a midwife than a hospital attendant.  She has not let her skills fall behind because medico-legal liability has dictated a breech birth to be enough of a risk as to deem a cesarean to be the required course of action; therefore, she continues to hone both her observational and palpating skills.

The American College of Obstetricians and Gynecologists (ACOG), America’s leading organization promoting the benefits of clinical obstetrics in the sterile rooms of trained physicians, has found itself in a dilemma.  The technology and protocols ACOG promotes are the very ones that directly influence our birth statistics negatively.  The birth technology ACOG promotes to prevent or lower risks in birth for both mothers and their babies has not been proven to be beneficial, yet it is used profusely.  Birth in America rarely includes the intimacy of the act that culminated in procreation.  Images of an infant gently caught into its own mother’s arms are so rare that they cause the general public to question the safety of such an event. Debate for and against the licensing of midwifery – and the definition of midwifery itself – is gaining momentum, because statistics for hands off care of normal, natural childbirth are far better than those of managed birth.

In fact, Rebecca Watson of the New Mexico Department of Health has stated, “I sometimes wonder why [we bother compiling statistics on midwives], since their statistics are so much better than everyone else’s.”

While home birth is stereotyped as dangerous because of the lack of medical supervision, it is the lack of that technology and medicine that actually makes birth at home safer than birth in a hospital under today’s protocols.

Studies have shown that once a technology is introduced and mandated, it is difficult to remove it from care practice despite being proven unsafe or unnecessary.  For instance, although the rates involving an episiotomy (cutting the perineum to create a larger opening for the baby to pass through) have dropped drastically since 1980, it is still a common practice.  Ironically, episiotomy rates today are justified as integral to the higher use of vacuum-assisted deliveries or unfounded fears that a baby is stuck because it is a large baby or presenting in a less than optimal position, (posteriors, for example, where a baby faces away from the mother’s back during labor).

America is one of the few nations where birth is managed more with technology than with the hands and eyes of the care provider, but other countries will soon catch up. In a country that boasts technology superior to other developed nations and is not known for undernourishing its citizens, our mothers and babies are faring no better at birth than underdeveloped nations such as Croatia. No improvements have been made in the maternal mortality rate in America since 1982, and  America’s infant mortality rate in the past two decades also has not improved. Our birth technology has increased and the number of routine prenatal screening tests have multiplied since the early 1960s, but our maternal and fetal outcomes have gone progressively backward.

“Despite a significant improvement in the U.S. maternal mortality ratio since the early 1900s, it still represents a substantial and frustrating burden, particularly given the fact that – essentially – no progress has been made in most U.S. states since 1982. Additionally, the U.S. Centers for Disease Control and Prevention has stated that most cases are probably preventable.” states C.T. Lang in a 2008 obstetrics and gynecology report.  Further, the Centers for Disease Control (CDC) reported in 1983 that the maternal mortality rate in the U.S. was 8.0 for every 100,000 live births (Monthly Vital Statistics Report).  In 1993, the rate was 12.0/100,000 live births (CDC).

Among the causal deaths that could be prevented were those that involve both underlying health issues such as poor nutrition and high blood pressure (World Health Organization) as well as those that are physician-caused including infection and hemorrhage.  Bacterium can be introduced first by the mother arriving in an environment where diseases are being treated as well as from infiltrating the natural barriers we have against infection through vaginal exams and, of course, surgical delivery. In addition, there are higher incidences of hemorrhage from forced delivery of the placenta as when a care provider intentionally pulls on an umbilical cord to tear the placenta away from the uterine wall of the mother’s womb. In all instances, normal birth evidence training of the professional birth attendant is critical.

Injuries and deaths related to the physician’s care range from the off-label use of medicine such as Cytotec (also known as Misoprostol) for the inducing of labor as well as the sanctified use of surgical delivery, which gives us embolism, one of the leading causes of maternal mortality and a risk directly associated with cesareans.  Cesarean rates for delivery rose by 46 percent from 1995 to 2006.

Women around the world, the time to look again at the image of women birthing with women versus a medical obstetrical group in normal birth is now. WE can improve global maternal and newborn birth outcomes and experiences. WE know birth. WE know women’s hopes and fears.  A new generation of birth wisdom and experiences is here!

Wishing you a truly happy Mother’s Day secure in the knowledge of your body’s innate wisdom!

Learn more about the wisdom of utilizing your best resource: an Independent Childbirth member led birth education class like Dorene Vaughn’s All Natural Baby!

Visit our comments section (this post) to find some of the most awesome birth wisdom posts our readers have found on the web and to add the ones you’ve found!

Our thanks to Laura Shanley for catching Birth Love re-open on the web!

For many women, both birth advocates and just your every day mothers (not!), Birth Love was the top, up-to-date birth support site.  It has returned and we recommend you visit Birth Love for great info and great birth choices support.   

Since your tea is likely to get a little cool after spending time zoomng around Birth Love, why not warm it up and return to read some Positive Birth Stories next?

“Home Birth Experience 1: Decision and Expectation” is a midwifery clinic teacher’s summary of her interviews with eight women who planned ahome birth in the recent decade.  Author Alison Andrews proposes that the birth experience leaves a very strong imprint on the woman’s mind, while the medicalization of birth has reduced the birth experience to terms relating to a consumer decision, i.e. “satisfaction” or “attitudes on intervention.”  It is the desire to experience birth as an organic experience leaving its memory on the mother’s whole self that is a strong basis for choosing home birth over medicalized birth.

Women will share their birth experience with great detail and acuity in the days immediately following the birth, be it a positive or a negative experience.  The quality of that experience is beginning to be recognized as having a lifetime impact in other areas of the mother’s life, including her marital relationship with whoever was her partner at the birth.  As birth moved into hospitals through historical industrial developments technology served to also separate mothers mentally and emotionally from the xperience, fewer and fewer natural birth experiences existed tobalance the case for home birth as a safe and healthy experience.

Birth “narratives” in fact, are an essential and typical skill for the midwife to have.  The medical profession would relay a birth only in terms of patient notes, regardless of whether the birth was organic birth or some interventions were introduced.  This is a detriment to improving maternal health care because a mother’s birth story is a valuable data source recording live testimony to maternal health care protocols enacted upon them.  Based upon this theorem, Ms. Andrews interviewed eight women from her home region of South Wales with backgrounds ranging from affluent to indigent, from rural to desolate.  Of these women, seven had previously birthed in a hospital and therefore provided that experience in relation to their choice to birth at home.

The results concluded n two themes, each with secondary threads for further discussion.  The two main topics that women related the strongest emotion to was the decision to have a home birth and the expectations they held for their home birth experience.  the reasons behind their decision to birth at home ranged from pragmatic – fewer worries about child care for the siblings of the new baby – to addressing the need for intimacy via familiarity of surroundings.  These mothers also considered the risks of home birth, and in some cases the risk carried less weight in their decision-making process.  One woman sought only to ensure her midwife had basic emergency care items, while another retorted that things go wrong in hospitals too.  All women undertook some form of birth education and preparation but the preparation was more about the physical location itself than about their own body’s preparation for the birth.  This is interesting to note in direct contrast to the often reported indicator for hospital birth being about women desiring to be near pain relief or help if their body cannot manage the labor.  In other words, labor is in the eye of the beholder and that’s another post in itself!  To continue, the women’s expectations themselves were not of as great a note as the importance of recognizing that women held expectations for their births both in terms of the birth itself and the care they would receive.

This last consideration, it was observed, led to both discussion about holding dialogue with their friends and families regarding their decision.  It also led to strife with hospital care providers, who viewed the decision to birth at home as a personal indictment of both their profession and their personal reputation, rather than an honest examination into the quality of care – which is the basis for many of these mothers’ decision to birth at home.  It is this sole perspective from proponents for hospital birth that casts light on the goal of the medical profession: to lobby strongly to keep births in hospitals, although there is little evidence that home birth is not safe for lowl-risk, otherwise healthy women.  If this trend continues, concludes Ms. Andrews,

… childbirth … (will no longer be) part of life in the community for most women and will remain so as long as birth remains centralized in the hospital setting.

She quotes the Welsh Assembly government paper, “Delivering the Future in Wales,”  which concludes the option of a home birth with a skilled midwife must be a protected option.  Further, Britain itself is pleding to strive fora goal of a ten percent (10%) home birth rate based on utilizing home birth as a safe option in maternal health care birth choices.  this humble goal is indicative of the  deft persuasion and patience that will be required to advance the view of home birth is a complementary option to medical obstetrics.

Are you listening ACOG?  Complementary.  Working together.  Is it really your goal to improve mother and infant birth outcomes in the spirit of care and concern for humanity?

For more on the home birth decision making thought processes at large look into the Nursing and Midwifery Council report of May 5, 2005.

Works Cited:  Andrews, Alison, “Home Birth Experience 1: Decision and Expecation”; August 2004, Brtish Journal of Midwifery, Volume 12, No 8

America is pretty unique in the type of childbirth prep our society recognizes.  Did you know in many countries, many cultures our way of birth prep is quite odd: all gather and sit in a hospital provided room or have a workbook and sit in a classroom style?  

Watch our birth link video again.  We are changing birth prep today!  We are centered on YOU.  You are the real woman, real options, real birth link!  Tell us about your birth link and take our survey!

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click here or here!  And go out and rent the Northern Exposure episode of “Shelly’s” birth or there’s “Suki’s” homebirth on Gilmore Girls oh and…..how many have you seen?!