Bold Doula encounters many
myths connected to pregnancy and birth. One constant myth: a birth doula is not
needed for an epidural, cesarean section or induction; a doula is only for
natural, home births. This myth is completely false. Many believe an epidural is not part of a natural birth; many doulas will not support a birth
using an epidural. Bold Doula supports epidurals as well as inductions and
cesarean sections (C-sections) with no judgment.

Epidurals

An epidural is a form of pain
relief accompanied by relaxation that is an intervention used during labor.
Epidurals are controversial, resulting in many researches conducted and
professional papers written on the intervention; how epidurals impact birth and
the fetus/newborn.

With an epidural, a small
catheter is inserted into the epidural space of the spinal canal; a pain relief
drug is administered. The woman in labor is now anesthetized from the chest
down, she confined to the hospital bed because the decrease of sensation results
in being a high risk for falls. Also, she is given a urinary catheter to remove
urine from the bladder keeping the bladder from obstructing the birth canal. It
is important to remember; an epidural
does not take away all pain of labor. A woman in labor using an epidural will
still feel some pain of labor.

An epidural also acts to
relax muscles allowing the progression of labor, cervical dilation and
descending of the baby in the birth canal. Bold Doula works with the woman with
the epidural in the hospital bed using positions & props in conjunction
with support for rest and relaxation techniques.  What
works well with epidurals and newborns: a woman with a epidural dilates to
10cm, is ready to push, requesting the anesthesiologist to decrease the pain
medication going into her spine will allow her to feel the urge to push, she
will feel some pain. The benefit here is the epidural has allowed the woman
to relax and rest as she dilates to 10cm – now she is ready to work with
pushing and having her baby crown.  It is
noticed that women who requested to have the pain medication decreased once she
is fully dilated and ready to push; her baby can be born alert and
breastfeeding is transitioned with greater success than the woman who keeps the
pain medication at a high level in her epidural while she is trying to push;
she has very little sensation to do so because of the high amount of pain
mediation in the epidural.

Several hours after birth, the
epidural catheter is removed, the new mother is still confined to the hospital
bed until she regains high function and sensation to walk and urinate. Bold Doula is present to support the new
mother with the Golden Hour of breastfeeding and skin to skin bonding.
There is no judgment with an epidural for a Bold Doula client; the goal of a
vaginal birth is fully supported.

Inductions

Bold Doula supports
inductions; scheduled or unscheduled using Cytotec, Cervidil and/or Pitocin.
This is a high clinical intervention. Bold Doula works with the woman in her
induction; she is often confined to the bed. Out of the bed, Bold Doula
continues to utilize comfort techniques with relaxation techniques to promote
labor. Having Bold Doula support your induction promotes support, relaxation
and advocacy towards the birth you and your partner are working towards. Having
Bold Doula support your induction can help decrease anxiety, promoting calm
empowerment.

Bold Doula also works with
induction client in preparation of having an induction starting at home before
going to the hospital. There is peace of mind knowing scenarios have been
discussed and the ‘team approach’ is strongly embraced; the woman is in a safe
environment promoting her labor to progress.

Cesarean Section

Commonly believe to be derived from the surgical birth of Julius
Caesar, however this seems unlikely. At that time the procedure was performed
only when the mother was dead or dying, as an attempt to save the child for a
state wishing to increase its population. Roman law under Caesar decreed that
all women who were so fated by childbirth must be cut open; hence, cesarean.

Today it is still a complete
abdominal surgery that done in a sterile environment (operating room) in the
hospital. Considered the birth method of last resort, although many hospitals
have very high rates of preforming C-sections. 
Bold Doula supports C-sections. There’s constant rhetoric C-section
women face when they retain a doula: “Why do you have a doula? You are having a
C-section?”

Here’s the real deal: When a
woman goes in for a C-section there is a team of medical professionals waiting
for her in the operating room.  After the
surgery is complete and the baby is born, the team goes away. The new mother is
now recovering from anesthesia while trying to breastfeed and maintain skin to
skin with her newborn.  She may be
experiencing aftereffects of anesthesia: nausea, vomiting, headache, dry mouth,
feeling woozy and more.

Bold Doula supports C-section
births: being present in the operating room if the partner is not present or
uncomfortable being in the OR, supporting breastfeeding in recovery as well as
skin to skin. Nurses provide excellent care; however they have more than one
patient to care for. Bold Doula provides
one-on-one support.

Labor, birth and post partum,
Bold Doula supports epidurals, inductions and C-sections. The mother’s anxiety
is reduced as Bold Doula works with her and her partner in preparation of an
epidural, induction or C-section. During the event, Bold Doula supports the
woman in labor or surgery. Post partum, Bold Doula continues support with
breastfeeding, comfort techniques and skin to skin as well as supporting the
partner.  All Bold Doula clients receive
free birth photography. Bold Doula provides music and aroma therapy at the
discretion of the client for free.

Bold Doula is here for you,
your pregnancy and birth. You deserve Bold Doula. www.BoldDoula.com Please
research the C-section rate of the hospital you will be giving birth in. On Bold
Doula’s web page you will see the link to C-section rates of hospitals in your
area.

The Plus Size Birth

By Denise Bolds MSW, CD(DONA) February 15, 2016

Curvy, thick, stacked, built, fluffy, fat, plump, big-boned,
hefty, obese, chunky; there’s a ton (pun intended) of monikers for plus size women. I support
many women as a birth doula; quite a few are plus size women who are
pregnant and seeking doula support. It is time to welcome plus size pregnant
women to the table of maternal health. 
Many plus size women are healthy and in healthy relationships; they have
healthy pregnancies and births. They are involved in passionate, loving
relationships regardless of what is portrayed in movies and the media.  Not all plus size pregnancies are high risk. There’s
one client in particular that stands out in a situation that occurs in many
plus size births in many institutions.

Carrie is a vibrant, full figured goddess who is happily
married to Carl; they have two adorable daughters with the third on the way.
Carrie works full time and attends the local college along with being a wife
and mother, Carl also works full time and helps with his daughters while Carrie
is in class. She hired me to support her through her second VBAC.  Carrie’s
already full figure became more voluptuous as she carried her pregnancy to
term.

I was happy to learn from Carrie that she would be giving
birth at one of my favorite hospitals. This hospital is known for their
friendly and supportive environment. I’ve had nothing but wonderful birth
experiences there. Carrie went into labor; as VBAC protocol, we went to the
hospital as instructed. During fetal monitoring the midwife came and introduced
herself from four feet away from the bed as she asked Carrie questions about
her weight. The nurse returned and asked Carrie about her weight and if she was
legally married to Carl.  I witnessed
Carrie shut down; she was not going to give birth with this midwife or this
nurse. Carrie’s labor subsided as I predicted, and we were sent home.  What I witnessed during this triage was the
tip of the iceberg.

We returned the next morning and Carrie was triaged again;
this time the nursing staff had changed; the nurse triaging Carrie asked the
same devaluing questions: “Are you currently being treated for hypertension or
gestational diabetes? Are all of your children from the same father? What is
your weight?”  Carrie answered all the
questions confidently and was adamant that she maintained a healthy diagnosis
free pregnancy verified by her prenatal provider. The nurse asked another
question: “Are you sure you were here for a VBAC and not a cesarean?” The nurse
went to get a larger blood pressure cuff; taking Carrie’s blood pressure five times; each time Carrie’s pressure
reading remained normal. She was then placed on fetal monitoring and after
evaluating the baby, Carrie insisted on getting up and walking to help her
contractions progress.

We all walked in the hallway together: Carl would stop with
Carrie and support her through her contraction; every time we stopped a comment came from the nursing staff about Carrie walking ‘at her size.’ As we
walked, the comments continued: the nurses may have thought they were caring and
encouraging Carrie; in fact their comments devalued her as they focused on her
size: “Look at you doing all that walking! I’m surprised you can do that
much!”….  Carrie would also squat during
her contractions; all with comments from the nursing staff as she did so. 

Carrie went into transition, dilated fully; soon it was time
to push.  She was once again asked about
gestational diabetes and hypertension in her pregnancy.  The comments about her size also continued.
Carrie got into position to push: grabbing the back of her knees as instructed:
one of the nurses remarked: “You are very limber for your size, you can pull
your knees back!”  Carrie and Carl did
awesome job; their baby girl Willow was born beautifully.

Willow weighed just over 8 pounds. The nurses wanted to test
Willow and her blood sugar.  Carrie became
upset and explained again that she was not a gestational diabetic in her
pregnancy and her baby is fine. I supported the new family making sure they
were stable and had their Golden Hour; then I went home. I didn’t know how to
process what I witnessed from the L&D staff for over 10 hours: it was evident Carrie was labeled because of her size. She had a normal, healthy pregnancy; as a plus size woman, the
clinical staff repeatedly attempted to label her high risk simply by visual
assessment. I spent a while thinking how to address this obvious stigmatizing
that was a constant presence in Carrie and Carl’s birth.

I returned to the hospital the next day to check on the new
parents. Carrie had done beautifully with her second successful VBAC. She was breastfeeding as well.  I offered the couple an apology
for what happened during the labor and birth. Both Carrie and Carl went on to say;
they discussed through the night every single comment the clinical staff made
about Carrie’s weight; they believed she was stereotyped because of her size.

I was devastated. It was my hope that Carrie would not have
recalled all that was expressed by the clinical staff during her labor. Carrie
had received glowing recommendations about this hospital from both her prenatal
provider and myself.  How many other plus
size pregnant women experience what Carrie went through while in labor? I am
sure there are many. This is not about me; it’s about the mother facing this type of behavior that simply doesnt have to happen.

I am a proud doula and member of Plus Size
Birth, founded by Jen McLellan. There is an understanding of risks associated
with obesity and pregnancy. There are also very healthy plus sized women who
have awesome pregnancies, births and are lovingly supported by their partners. For
my plus size clients I provide respect as well as a can-do attitude to support
labor and birth. Every one of my plus size client’s work in a team
attitude with L&D staff to have a healthy pregnancy and birth.  The stigmatizing and stereotyping of plus
size births has to end if the goal of best birth outcomes is to occur. Having
compatible equipment that accommodates plus size women with sensitivity
training for clinical L&D staff are paramount.  The link to Plus Size Birth is: http://plussizebirth.com when planning
workshops, conferences and in-services, this topic is an excellent choice in facilitating
training to clinical staff. 

The Black Hole

The Golden Hour & The Black Hole of Birth.
Denise Bolds, MSW CD(DONA)
January 29, 2016

As a woman who has given
birth and a birth doula business owner, I am aware of a common paradigm when it
comes to supporting women in childbirth. It is called the black hole.

What is the black hole?
Scientific explanation is available; theoretically it’s a void of nothing;
where things get sucked into it, never to return out of it. The Black Hole
Theory applies in The United States maternal health care model.

The current prenatal care
model in the United States decrees a pregnant woman is to have prenatal care
from conception until birth. This paradigm is the mantra of motherhood:
complete with evidence base and public service announcements. Prenatal care is
monthly until the third trimester, where it becomes weekly or more frequently if
the pregnancy is high risk.

The pregnant woman receives a
wave of treatment and intervention during the labor and birth. After birth, the
mother and newborn are rewarded with the Golden Hour: skin-to-skin and bonding
in a cocoon of support. Mother and baby are discharged to home, where baby
begins pediatric care, the new mommy is left on her own with an order to follow
up with her medical provider in six-weeks, the same amount of time
for most maternity leave employer benefit.

New mother quickly spirals
into the black hole: The baby shower is over; she is sequestered from medical
care she received for over nine months. The new mother is adjusts to her body
giving birth in a myriad of transitions and questions. She is in the most vulnerable
aspect of her life; her maternal care provider doesn’t want to see her unless
there is bleeding, shortness or breath or fever.

It is inherently assumed
women know how to give birth and be a mother simply because they possess a
uterus. What is commonly ignored is the bridge of trust that must be built in
order for women to cross into motherhood successfully.

The black hole grows with
missed sleep, adjusting hormones, the pulsing of post birth tear sutures,
engorged breasts, sitz baths, demanding families and the stigma of societal
expectation of motherhood.

The new mother is encompassed
in the black hole; she’s not expected to see a medical professional until six
weeks after she has experienced one of the most profound life changing events
she will ever face, birth. All of the above brews into a void of uncertainty
the new mother slips into.  She is
expected to avoid it and to navigate through it without support. Is this the
rite of passage into motherhood or medical neglect?

Twenty-five years ago after
the birth of my son if I could return all the cute little outfits my son was
gifted with in exchange for a post-partum doula, I would have.  New mothers need support that contributes to
the bridge of motherhood; empowerment and validation is key. They require sleep
and a sense of security within a hurricane of uncertainty.  The Black Hole is a rite of passage many
American mother’s face, which does not occur in other countries or cultures.

It is time to restructure the
American prenatal care model. It is vital for families to invest in maternal
support that goes beyond materialism. This support lasts longer than the cute
outfits that the newborn outgrows or the deluxe stroller.  With the high incidences of post-partum
trauma, relapse and depression; it is paramount for the American College of
Obstetrics and Gynecology (ACOG) to rebuild the prenatal care model in American
obstetrics.  The result will impact
generations.