Baby Shower Extravaganza: Meet a Doula

Name: Kayce Pearson

Website: http://kaycesdoulajourney.blogspot.com

Occupation: Doula and Midwifery Assistant

How many births have you attended? I have attended 1 homebirth and 2 hospital births

What made you decide to become a doula/midwife assistant? I had an unnecessary procedure when I was pregnant with my now 2 year old daughter which resulted in an emergency cesarean and a NICU stay for her prematurity. When she was a year, my friend had an emergency cesarean and I realized there is much that needs to change with the hospital system. I was joking with my husband and he said I should become a midwife so he can stay home and write novels all day. After that it just stuck. I decided to become a doula first until I could go to a midwifery college, but now I am just going to go through the midwifery apprenticeship route instead of college.

Is there one birth that stands out in your mind? The one homebirth I have attended. Everything was completely calm, and even though she was so tired and had been in labor for three days, she had such an inner beauty and strength that amazed me. It was the very first birth I had ever been to, and when watching her baby descend and crown brought tears to my eyes. I still cry thinking about it. The room was calm, even when she bled more than she should have after birth, and everyone was able to work together to help her bring her baby into the world. It was just amazing.

How often have you witnessed a home birth candidate requiring to go to the hospital before, during, or after birth? I haven’t, since I have only been to one homebirth. I do talk to the midwife I work with all the time, and her transfer rate is a little under 10% for all her clients. She has never had to drive to the hospital in an absolute emergency, just because she keeps very close eye on them and transfers before things go bad.

Do you know the statistics of home birthers requiring medical attention? It does depend on where you live, but most homebirth midwives have a transfer rate of around 10%. A lot are just for long labors and tired women that require epidurals and pitocin augmentation, rarely is it truly an emergency that has them speeding through traffic.

What happens if your child is home birthed and there is a problem that requires an emergency c-section? Since the midwife is with them most of the labor and monitoring mom and baby every half hour to hour, most problems show themselves before it truly gets to be an emergency. There are the rare few cases, but even in those, the midwife calls the hospital as they are transferring and they are able to go right into surgery. Even in the hospital there is a delay from when the emergency happens and when surgery happens. Depending on if you live in a big city or not can be the time from decision to have surgery to the actual incision. 30 minutes is the average time, but sometimes it is as little as five minutes.

What happens in an unexpected emergency? The midwife does a lot of quick thinking, and decides what the best course of action is. If there truly isn’t time to inform the mother of all that is going on, which is very rare, the midwife decides to transfer and calls her back-up. A lot of the time they are able to get to the hospital and have the necessary back-up there for what is needed. Again, this depends on where you life and how big the hospital near you is.

What happens when the mother has excessive pain? If the mother is in more pain than she can handle, and it goes for a very long time, it is time for pain management. Whether that means IV medication or an epidural is the mother’s choice. In a homebirth, that means a transfer, but if the pain is that severe, it normally means something is not right. In labor, most pain is never more than you can handle, it still hurts, but it shouldn’t overpower you. If it does, and no coping measures or alternative pain management techniques are working, then it is time for pain medication and/or transfer.

What if there is a problem with the baby after he/she is born if you have a homebirth and there is no special equipment readily available? In all homebirths, you keep all your equipment you need at arms reach. You do keep the ambubag or oxygen out of the mother’s sight, just because it is prone to worry them, but you always have them within reach. A lot of midwives also have either an assistant or an apprentice available as a second pair of hands so that they can help you. If it is a problem that homebirths cannot handle, such as a baby that you cannot get to breathe, or bleeding that will not stop, you transfer as soon as possible. The midwife keeps trying on the way to the hospital to fix the problem so it doesn’t get completely out of hand, but the true place is in the hospital. The majority of problems that arise at homebirth can be solved by the midwife there, but as in everything, a higher level of care is sometimes needed. A lot of midwives transfer before it gets out of hand just to be safe.

Is there a certain point they are required to call into an OB/GYN? In the state I live in, no. But, if something is beyond the midwife’s expertise or if she even just has a feeling, the best thing to do is for the patient to go into the OB or for the midwife to consult with them. If the patient ends up developing a high risk problem in pregnancy, her care will be transferred to an OB that can handle it. The midwife might still consult and/or be there for delivery, but the woman is no longer in her care.

Do they provide any pain meds at all or is the experience completely natural? The experience is completely natural. They do have pain coping techniques, such as a TENS unit or a bath, but they do not carry pain meds like the hospital. If pain meds are needed, you do have to transfer.

What are the benefits of home vs. hospital birth? At home, you are in an environment that you are comfortable in. You know where your room is, where your bathroom is, and you are free to eat and drink as you will. You are immune to the germs that are in your house, so it is rare for you to get a post birth infection. Babies are less likely to suffer respiratory distress after birth, are less likely to get sick after birth, have higher breastfeeding rates, they do not lose as much weight after birth, and are less likely to suffer distress in labor. Women are less likely to hemorrhage at home also. You are less likely to end up with a cesarean section if you decide to homebirth, since most homebirth midwives only have a cesarean section rate of around 4%. You are less likely to end up with any augmentation or your labor, like pitocin or having your water artificially broken, since most midwifes will not rupture your water and they do not carry pitocin, except for a shot for after birth if the bleeding cannot be stopped. After birth, you can shower or take a bath as you see fit. You are able to do what you feel like doing during and after your birth. You don’t have to ask permission to do anything. You are fully informed of everything that could happen and what the midwife could do, and you decide on the course of action, unless it is truly an emergency. You are completely in control of your care. You do not have to have an IV, a blood pressure cuff, electronic fetal monitoring. You do not have people coming into your room without knocking and trying to talk to you through your contractions. It is completely and totally your birth.

Do you do VBA2Cs? The midwife I work with does do VBA2Cs. She does all VBACs whether you have a single layer suturing or a doula layer suturing. She does pay extra close attention to women having a VBA2C just because there are a little bit more risks.

How do you handle twin births? Twin births are handled a little different than singleton births. Since two are being born, the uterus sometimes doesn’t realize there is another baby and starts to take the placenta off after the first baby born, which can be harmful to the second baby. Depending on how the twins are positioned in the uterus, the way labor is handled differs. Whether they are both vertex, both breech, or one of each defines the type of care. Breech takes more care than a vertex, especially since you do not touch a breech baby as they will try to breathe when touched, even if they are not born yet. You do have to keep a closer eye on a twin mom, such as good nutrition, and making sure there is enough fluid throughout pregnancy, and you are not allowed to deliver ones at home before 37 weeks, since they are more at risk for being premature. You have to make sure the second baby is doing great when the first is being born and after birth, and make sure the contractions start again to push the second baby out. You have to watch closer for irregularities in the heart rate and the contraction pattern since it could mean a problem. A backup plan is more needed in a twin birth since there are two babies, so there could be double the problems. But, that is no reason to have a cesarean or even to go to the hospital. As long as the midwife is prepared and knows how to deliver twins and knows the things that could happen, you are in very capable hands.

What is the longest time a birth has taken in your experience? The first birth I attended, she was in active labor for three days and pushed for five hours. It was the homebirth, and it was very intense, but it was very beautiful.

Have you met more openness or hesitancy about your position? A lot more hesitancy than openness. People think that working with birth is an occupation only made for OBs and hospitals. Labor support and doulas are something that is seen with hesitancy since they are not “needed”. A lot of people think that they nurses or their OB will be with them through their whole labor and completely support the birth they want. When they get to the birth, they are often left alone with just their spouse and labor has a lot of unexpected places that need to be explained. When I say I am a homebirth midwifery assistant and apprentice, people look at me like I have a third eye. I have heard a lot that “Home deliveries are for pizza.” People are very skeptical and think that homebirth is something that takes place in a barn with the midwife grabbing towels and hot water. When I try to explain, I get a lot of people that say that they wouldn’t have been able to birth without drugs and that homebirth is the first step to child abuse. There are the rare few that think it is great, but the majority find it absolutely crazy and think that it is something only hippies and irresponsible women would do.

How much do you normally charge for services? I charge $20 for my doula services right now. Since I am still certifying, I don’t charge my full fee, and I just love getting new experience from the births. I charge the $20 just so it is a commitment from the couple or woman and it pays for gas money and my babysitting fee.

What services do you include in that charge? I include 3 prenatal appointments, where we go over your birth plan, and I discuss pain relieving measures and how the spouse (if there is one) can help the woman with her labor until I am called or if the labor progresses too fast. I also include 2 prenatal appointments with their caregiver that I attend so I can get to know them and they can get to know me. Also, 2 postpartum appointments for breastfeeding support and to talk over the birth to get unhappy or unresolved feelings into the air if there are any. I come to the birth when the couple or woman decides they need me, and stay until they say I can rest and come back or until 2 hours after birth. I like to stay until the woman and baby have successfully breastfed and everyone is doing okay. I do require that if I am at the birth for 24 hours or more, I get an hour of rest, and then if another 24 hours goes by, I get 2 hours of rest. I am also a postpartum doula, and I can be hired to come to the couple’s house after the baby is born to help the new mother. I help cook, clean, take care of older kids, to talk through the birth, and to help with breastfeeding. New moms need a lot of support, and being in a college town, there are a lot of new moms that don’t have family around. I am a woman they can turn to to help them out in one of the hardest transitions of their life. We decide what days and times I come, and what my duties with them are at the initial interview.

Do you offer additional services? Eventually I will offer belly casts and also placental encapsulation. As of right now, my services are basic, but I will add more with time and more experience.