Stages of Labor

Pregnancy A-Z Series

Teaching the Stages of Labor is one of my favorite things to do in my Comfort Measures for Childbirth Class. Read on to learn about the 3 Stages!

First Stage: This begins with the onset of contractions and ends with the cervix being fully dilated (open) and effaced (thinned out). Within this stage, however, there are also three phases. The early phase, the active phase, and transition or transformation. A lot happens during the first stage! Many of the comfort measures, pain relief techniques, breathing exercises that we think of for coping with labor are used during this stage and of course many people choose to get an epidural.

Also in this stage you will learn about the Station of the baby’s head. What is the Station? An indication of how far the presenting part of the baby (usually the head) has progressed through the pelvis. A baby who has just begun to descend may be at -4 or -5 station. A fully engaged baby (one whose head has reached the bony landmarks of the pelvis) is said to be at “zero station”. As the head continues to descend through the pelvis, it is considered +1 or +2 station until it crowns at the vaginal opening at +5 station. When I work with birth doula clients I want to know where the station of the baby is so we can use positions to help encourage baby to descend through the pelvis.

Stage Two is pushing and when the baby is born! First, however there will some amount of pushing – maybe a little, maybe a lot. And this is where the station of the baby also comes in. Where was baby when pushing began? What pushing positions can help baby be born?

Stage Three is the delivery of the placenta. Once baby is here you may not notice that your uterus is continuing to contract to expel the placenta but it is! Usually the placenta comes fairly quickly -15 to 30 min, sometimes even sooner. If the placenta does not seem to be detaching on its own your provider may give you some medication such as pitocin to encourage the placenta to come out.

Taking a childbirth class can help you better understand the different stages and phases as well as different coping methods, effective pushing techniques (even with an epidural!), different options available to you — and you know I am going to highlight the advantages of having a birth guide, a doula, with you to navigate labor and birth. Sending warm wishes for your labor!

<a href="http://<a href="https://www.freepik.com/vectors/pregnant-mother">Pregnant mother vector created by freepik – http://www.freepik.comhttp://<a href=”https://www.freepik.com/vectors/pregnant-mother”>Pregnant mother vector created by freepik – http://www.freepik.com</a&gt;

Kimberly Sebeck, CLD, CCCE, HCHD, Knoxville Doula, All Rights Reserved 2022

Expectations – A-Z Series

Expectations — we have many months to build up in our heads the “perfect” birth scenario, the “perfect” baby, the “perfect” postpartum experience. Some of us try to conceive for some time, too, and imagine/long for a “perfect” pregnancy as well. And really there is a benefit to visualizing things going in a positive way. Imagining worst case scenarios isn’t the best way to spend our time or energy while growing our babies and preparing to add to our family.

So how do we balance optimistic expectations with reality?

• Education — whether that be by experience, classes, reading books or online material, etc. Seek reputable sources.
• Set yourself up for success for your desires — if you are wanting a natural unmedicated birth, for instance, seek out a provider and birthing facility in line with that goal. Consider hiring a doula. Take a natural childbirth class. Practice any techniques you learn and are taught.
• Realize that pregnancy, birth, and postpartum are times of great changes and can be unpredictable. Some flexibility may be required. A change in your plans does not equate to failure. Take the time to acknowledge there may be some disappointment at the change without attaching judgment. *
• All babies are good babies. Some are low key and some are more needing of attention. Some come out with perfect scores and take to feeding immediately and others have multiple doctor visits and require more of a learning curve in their transition to the outside world. All of this falls into a spectrum and you will get the swing of things very soon!
• Having a new baby, juggling your own healing, lack of sleep, hormonal changes, a different body, can all make us feel like a different person.  This is ok! This is a period of adjustment. Perhaps you aren’t feeling the rush of love for This is othe baby you thought you were or you are just really tired. Again, all of this is new to your new family and give yourself some time and grace.
• Having flexibility, a plan for some help after baby comes, giving yourself grace/being non judgmental, and injecting some humor when possible are all ways to balance those first few weeks. You’re a new parent! That’s amazing! You’re doing hard work– pat yourself on the back, give yourself some time — oh and take a nap if you can.

 

*If you find yourself traumatized by an experience, please reach out to someone to talk to, such as an experienced counselor or physician, or even a friend if you are unable to speak to a professional in a timely manner.

 

Kimberly Sebeck, Knoxville Doula 2020
All Rights Reserved

 

 

 

Due “Date” A-Z Series

Continuing in the A-Z Pregnancy Blog Series we come to the letter D. I bet you thought I was going to write about doulas, didn’t you? Well, I have written previously quite a lot about doulas. Here a few links if you want to read about:

https://knoxvilledoula.wordpress.com/2015/06/12/reasons-to-hire-a-doula-for-cesarean-birth/  Reasons to hire a doula for a Cesarean Birth

https://knoxvilledoula.wordpress.com/2012/01/17/doula-musings-today/ What I can and cannot do as a doula

https://knoxvilledoula.wordpress.com/2010/02/09/hiring-a-postpartum-doula/  Hiring a postpartum doula

So for D I thought I would write about the “due date” or EDD, estimated due date. It is an estimate and some feel it should be more of an estimated due month rather than a date. After you see how it is calculated perhaps you will also feel the same.

In order to calculate your due date, add 7 days to the date of your last period and then add nine months, with the assumption of a 28 day cycle.  But remember that babies don’t know anything about this estimated calendar date and a full term pregnancy is considered anywhere from 37 to 42 weeks.

Due dates are usually calculated on your last period instead of the date of conception because of a number of reasons.

• Although the average woman ovulates (releases an egg) approximately 2 weeks after her period, the exact time is not always known.
• Once an egg has been released, it can remain fertile for up to 24 hours.
• Sperm can last for up to 7 days after intercourse to fertilise an egg.

Nowadays an ultrasound is frequently used for dating but the date can be off by a week or more. Depending on which study/evidence is cited, approximately only 5% of women give birth on their estimated due date. But it’s fun when it happens! Only 35% of women go into labor the week of their EDD.

Keep your due date in mind, absolutely, but don’t panic if baby ends up surprising you. Parenthood is all about surprises! You will soon be holding your baby in your arms.

All Rights Reserved, 2019
Kimberly Sebeck, CLD, CCCE, HCHD
Knoxville Doula

Advocacy and Doulas

 

Advocate is a big buzz word in the birth world. There is no wonder there is some confusion when it comes to the role a doula has concerning advocacy regarding clients and at a birth.

The definition of advocacy as a noun is “someone who publicly supports or recommends a particular cause or policy”. Merriam Webster defines it further as someone who “pleads the cause of another”, often specifically before a tribunal or judicial court.

A court case isn’t something we would expect or hope a doula would need to be involved in at all. In fact, doulas do not speak for a client because doulas do not have a legal right to make medical decisions for clients. So what do most people mean when they use the word advocate when speaking about the role of a doula?

Most of the time when a client is interested in having a doula present they are interested in having their voice and preferences be heard. This is why hiring a doula well before birth and working with one prenatally is so important. Professional doulas who stay within their scope of practice are well versed and trained in helping their clients learn how to advocate for themselves! Prenatal meetings to go over different options, childbirth preparation, birth option plans, ways to discuss important topics with providers, and navigate twists and turns as they come up during pregnancy is vital to empowering pregnant people to speak up and be heard. Preparing your partner to answer questions and ask for time to make informed decisions is part of the process as well. As a doula I am not going to make a decision concerning the welfare of your baby and yourself. I will give you unbiased information and remind you to ask informed consent questions, just like we have practiced in prenatal sessions. I can reference your written birth plan as well. Most of this work is done prior to labor so it is familiar and second nature.

Doulas are often advocates for evidenced based birth practices as a whole, in society. We form support groups and are members of national organizations. But if it seems like you are gearing up for a fight for evidence based birth practices with your birth provider, we would encourage you to look up ACOG’s recommendations and see if those recommendations are being followed. Honest communication between yourself and your provider is extremely important — expecting anyone — a doula, your partner, a sister to “protect” you from your provider may signal that this is not a good working relationship with this particular provider or perhaps there needs to be an open communication about the disagreement in care and expectation.

So while it can be a little confusing to answer outright if a doula is an “advocate” (in some ways we are and in some ways we are not), the main answer is we teach our clients to advocate for themselves and we are there to remind them how if necessary.

All Rights Reserved, 2019
Kimberly Sebeck, Knoxville Doula

Repeat Clients — Or Not?

Oh, doulas love repeat clients! There is just something so rewarding about working with a family for a second or third time — or even more! Often a doula is the first one to know that another pregnancy has happened. We get a text with a positive pregnancy test photo attached or a question of, “Hey are you available for a (fill in the blank) due date?”.

But sometimes, especially with flourishing social media, we find out a family hasn’t rehired us. It has absolutely happened to me. And I am writing this not only for people interested in doulas/have used doulas but also newer doulas. What is the etiquette regarding this?

First, I’d like to acknowledge there are very real reasons to not be rehired! Just off the top of my head:

• Funds may be an issue, especially as a family grows
• Perhaps the client went natural last time and is choosing not to this time and feels a doula isn’t necessary
• Maybe they learned so many techniques in their other birth(s) they feel they can handle this on their own (I believe in them!)
• Maybe they have become close to another doula and want to try her out (yes, I 100% support that!)
• Possibly they had a traumatic birth experience and having the same birth professionals feels like a trigger (yes, a traumatic birth can happen even with a doula present)
• It could be they hired a midwifery team that provides extra support like birth assistants or even doulas
• A new medical condition has changed their perspective of birth (same for pregnancy loss(es)
• They may be trying a different type of pain management like hypnobirthing or hypnobabies and planning to use medical grade hypnosis
• Another local doula has skills they feel more drawn to or simply feels more connected to them
• Or… It is none of your business

Yes, I have had some of those scenarios play out for not getting rehired and I am here to say it is totally fine! It doesn’t hurt my feelings one bit. While I hope if it’s over funds that I could connect them with a lower fee or sliding scale doula, I also understand a budget is sometimes set in stone and cannot be stretched. Additionally it can be awkward for some people to say they are low on funds for something. It can be awkward if you run into your doula and feel you have to explain why you aren’t/can’t/don’t want to rehire her.

Please let me reassure you that there is no reason to feel awkward. While I would love to support your family again I also trust you know what you need. I still want to hear how your pregnancy is going. I still want to hear how your birth went, watch your birth video or see your photos. I still want to be your friend on social media if that is your comfort level. Any good doula will feel this way. It’s not about us, it’s about you. If you feel like sharing the reason, feel free, and if not, that’s ok, too.  Doulas empower women and families. You do you and we will cheer you on.

All Rights Reserved, 2018
Kimberly Sebeck, Knoxville Doula

 

 

Where Did Your Doula Train?

Today I read on www.doulamatch.net that there are 67 different doula organizations listed on their site. Wow. While there has been an increase in recent years of different certifying paths I had no idea there were that many.

As with just about everything in life and business there are pros and cons to this explosion of new ways to train doulas. Respectfully I submit a few of my thoughts on this matter:

Pros:

• More professionals and parents are seeing and reaping the benefits of doulas
• Easier access to training, along with likely various payment methods
• Doula has become a household name
• Being a doula does not have to be synonymous with charity work; more doulas are rightfully charging a living wage, which in turn allows for more pro bono or volunteer work when their own financial needs are met
• Teams of doulas can partner up or create agencies which can lessen the hard work of being on call
• Fresh organizations can bring fresh ideas and instill new energy
• More families are being served

Cons:

• The trusted and well known organizations who have been around for years have a well crafted method of making sure they are creating professional doulas, do the newer organizations also have the same ethic or are they jumping on an opportunity to sell an online program to as many people as possible?
• Clients and professionals may find that there is no standard of ethics, codes, or grievance policy — essentially there is no national standard for doulas.
• A person seeking to become a doula may not be able to tell the difference and spend their educational budget on a program that is not suited to them or does not equip them to be a doula. They may choose one solely based on ease of training, location, or budget price.
• Doulas who are fresh out of training, in my opinion, require mentoring from their organization as well as continuing education and hands on experience. Will they receive this from a course that only includes a booklet of skills they check off and submit?
• The doula profession has a high burnout and turnover rate. The initial interview process and reference check can save an applicant much time and money — sometimes being a doula isn’t a good fit for everyone or it isn’t a good fit for a particular time in someone’s life. If it isn’t a good time or fit for the doula it is not going to be a good fit for their clients or the professionals they are in contact with.

I mentor newer doulas in our area who reach out to me and go through an application process and are a good fit. My view is the world needs more doulas. Experienced doulas should be available to help the newer ones where possible but one of my requirements is for my mentees to have completed a training through an approved certifying organization and either to have been certified or actively working towards that certification. Certification is for everyone’s benefit. It demonstrates the doula understands and is committed to a scope of practice and follows it. It gives any families and medical personnel a place to file a grievance should that ever be necessary. It gives the doula ongoing support through the certifying organization and continuing education. I myself trained and certified through CAPPA (Childbirth and Postpartum Professional Association) and kept my certification active for many years. Eventually I moved my certification over to Hypnobabies once I became a Hypno-Doula but I still attend CAPPA conferences when I can and I was an ICAN (International Cesarean Awareness Network) leader for 7 years and received extensive training, support, and continuing education through that organization as well.

So if you are considering becoming a doula, carefully consider who to train through. How long has the organization been around? What do they offer in the way of not only training and certification but also in ongoing support and continuing education? Their low training fee may not be a bargain if their philosophy does not mesh with yours or if you are getting an incomplete education. My advice is to always try to round out any training with local volunteer opportunities such as a Birth Network or La Leche League, etc, in your area.

If you are considering hiring a doula, how can you know if they have had a good training? Ask who they trained (and hopefully certified or are working on certification) through. Google the organization and see if there is a public scope of practice listed, if there is a grievance policy, if the organization has been around for some time. There could be a new organization that is wonderful and has just begun so also listen to your instinct! Was there any in person or hands on training or was it completely on line? Do they connect their trainees with any mentors? Do their trainees attend yearly conferences or continued educational opportunities? Are there clearly defined guidelines of how to achieve training goals (ex: a set amount of births in a set time frame with satisfied clients as well as satisfied medical personnel giving reviews). Do they do background checks or at minimum, call references? (you probably wouldn’t want a doula with an arrest record, for example).

Growth is good and at times it can be messy. For the first half of my career I usually had to explain what a doula was. Rarely do I have to do that now and I love that! Few people are going to go into birth work unless they have a desire to help families. I feel most of the newer organizations are trying to make it easier to have training easily accessible and are trying to bring in fresh ideas to improve on trusted outlines.  We just have to make sure there are some professional standards and that everyone is getting the training and the trained doula they expect and deserve. Happy doula-ing and birthing!

 

All Rights Reserved, 2017, Kimberly Sebeck, Knoxville Doula.

 

Doula Cost & Payment Questions

Many more families are using doulas because they hear how valuable they are. The use of doulas are not relegated to “crunchy” or “natural” clients any more. However, if you’re new to the world of doulas, you may have some questions about the fee and payments. Rather than wonder about it — let’s talk frankly about it.

While I can’t speak for all doulas, I can tell you how my pricing and payment is set up.

• A complimentary, no obligation consultation is available for anyone curious about hiring me as their doula.
• A $200.00 non refundable deposit holds your spot. Why is it non refundable? Because I may refer out/turn away other clients near your estimated due date to ensure I do not have too many clients. It also helps me schedule any mentees or backups, prepare my birth bag, and helps you to have less than a full balance to pay in the coming months.
• The remainder of the package you purchased is due by 37 weeks. Why is it due before the birth? Because, simply put, I don’t want to ask you for a check on the way to the hospital or bring that energy transfer (money) into the birth. By 37 weeks our money transactions should not even enter into our energy exchanges, appointments, and interactions. We will have already had our prenatal appointments, classes, and gotten to know one another. My life will revolve fully on being on call for you at that point.
• Pay how you need up until the deadline of 37 weeks. It doesn’t matter to me if you pay something each month, the full fee at the beginning or the end, etc. What types of payments do I take? Cash, check, credit cards, and PayPal.
• Discounts are available for postpartum care if you have hired me as your birth doula or if you have purchased in advance a certain amount of hours. Why is this? Again, it helps me with planning and I can focus much more time on your family based on a suggested schedule.
• Postpartum services in smaller amounts or randomly are available but not at the discount. I usually ask for a weekly check for postpartum services rendered without a contract.
• Insurance is not yet happily reimbursing for doula clients. Can you file to your insurance and see? YES. I encourage it. I do have a NPI (national provider identification number) and can create an invoice for you to submit after the birth of your baby. Medical Savings Accounts are the easiest way to receive reimbursement, however, your insurance may attribute the charges to your deductible or out of pocket and submitting a form is worth your time.
• This is my career as a birth professional, not a hobby. My overhead includes rent for an office, class materials, doula materials- many of which are replaced at every birth, continuing education, a life on call not knowing when I could be supporting a client for days at a time, payment processing fees, lending library, self employment taxes, professional organization fees, and a cap on how many clients I can take per month.

I hope this answers some of your questions and if you have specific questions about package pricing, please contact me at kimberly.sebeck@gmail.com

Kimberly Sebeck, CLD, CCCE, HCHD “Knoxville Doula” 2016

 

Friends & Family At Births

This post might not be popular with some people, especially if you are a family member or friend who finds they resemble some of these descriptions. However, I work for my doula clients to make sure their birth experience is one they can cherish and this needs to be said:

If your pregnant daughter, friend, niece, granddaughter, cousin (or any imaginable relationship) requests that you not come to the place of birth while she is in labor — respect her wishes.

I can hear the excuses now. But we want to be there. But we want to see baby be born. But we want to be the first in the family to hold the baby. But she is my (insert relation). But the partner is (insert relation). But, but, but.

She said she didn’t want you there. Actually, she probably didn’t say I don’t want you to be there. She probably said something polite and nice like, please respect our privacy. I will be working hard to bring a child into the world. We would like our privacy. We will call you once we want you to come or once baby has arrived. It may take a long time and we don’t want you hovering. Please respect our privacy.

Please listen and respect her wishes. Please know this is an important day and if she has made any attempt to ask you to not intrude on her privacy and concentration, she has thought long and hard about how to convey this to you without hurting your feelings.

Let me tell you what happens in some scenarios when people don’t listen to and respect a laboring woman’s wishes. At worst, you can cause her labor to stall or completely stop or contribute to a dysfunctional labor that can put her at risk for interventions she has been wanting to avoid. This is especially true when a woman is attempting a natural birth, but it can happen even with an epidural for pain relief. On a less serious level you are disrupting her concentration and possibly creating a memory she would rather not have attached to the day her baby and your (insert relation) is born.

Why do I sound so harsh about this? Because after 16 years of being a doula I can tell you I have seen some family members behave in peculiar ways. Yes, I understand you are coming from a place of love and concern but it boils down to people making choices to disrespect what a laboring woman has requested. Here are some scenarios I have witnessed:

• A laboring woman tells her family she is going to the hospital to be checked out and she will give them an update. Upon her arrival, she finds there is a room full of family eagerly asking private details she may not want to share and interfering with the staff assessments. Her labor stalls or stops and she is sent home, only to return a few hours later and this time to keep it to herself.
• Despite clear instructions and a sign on the door that the laboring woman does not want visitors, family members continue to come in because they “just have to know what is going on.”
• Family members falling down and wailing on the hospital floor when they hear a woman requires a cesarean for safety, disrupting the precise and necessary care from the medical providers.
• Family members physically grabbing me and shaking me for updates.
• A laboring woman finally getting a break from her labor either via a natural spacing in her contractions or some medicinal pain relief and taking a well deserved and needed nap only to have family members barge in wanting updates even though they had been told she is napping.
• Family members bringing cheeseburgers and fries into the room of a laboring woman who hasn’t eaten in 12 hours.
• Family members threatening to sue the staff if the baby isn’t here soon.
• Family members accosting all staff, doulas, partners, and even the woman if any of them come out of the room and going so far as to be standing in the hallways eavesdropping with their ear against the door.
• Family members making comments that they have never seen such a large belly, telling her to get an episiotomy, random myths and outdated advice, asking her why she is trying to go natural, telling their own birth horror stories, or one of the worst, saying I just don’t know what I would do if you or the baby died.

Are you thinking this is fabricated? It isn’t. This actually goes beyond a case of bad manners. These sorts of behaviors can be dangerous, especially if there is a medical situation going on. When an emergency cesarean is needed, staff needs to move fast. As a doula, I move out of the way and let them do their job when something becomes medical. Family members falling down in the hallway is hindering the staff and the well-being of mother and child, and possibly even other mothers and children. People expressing their love and projecting their fear by voicing that the process is taking too long or they are bored or that something negative will happen to the mother and baby is not only not helpful, it is harming the process and the persons you profess to love. Showing up at a hospital when you have been asked to wait for instructions is crossing a boundary of respect and can make a woman feel like she needs to hurry up. Speaking of, many family members actually say, can you hurry up and have this baby? I have had women hiding in their bedroom or hospital room and sometimes locking themselves in a bathroom simply to find the privacy she desperately requires.

Each woman is different on how she views the need for privacy during labor. In the early stages of labor, a room full of chatter and excitement may be helpful for some and unhelpful for others. As active labor begins, most women prefer a quiet and private environment. There are times I will step out and allow partners to work privately during labor. There is a reason nurses, midwives, and doctors do not sit and stare at their patients. We know that disruptions are disrupting, it is as simple as that. Childbirth is not glamorous and is usually messy. We have not arrived at a point in our society where it is acceptable or comfortable for women to ooze bodily fluids in front of others. Would you want someone to watch you moving your bowels? No, you would probably try to wait until you had a private moment and birth is much the same. Women need to feel supported and one way to support them is by listening to their wishes. If you have been asked to respect their privacy, please listen.

As the mother of an adult daughter, I have often wondered how difficult it would be for me to know she is in labor and to have been asked to not participate in or view my grandchild being born. I understand it must be hard. I understand that our society has created much fear about birth. I understand that Hollywood makes it seem that a woman’s water releases/breaks and we have a baby born at the hospital mere minutes after a screeching ambulance races her there.

That’s not how it works. That’s especially not how it works for first time moms. Average labor time is approximately 15 hours. Average pushing time is 2 hours for first time moms.The placenta may take several minutes or longer to be birthed after the baby.  Unless you live many hours away, there will be time for you to arrive. After a baby is born we want mom, partner, and baby to have a minimum of one hour for bonding and breastfeeding and that is after the clean up, physical assessment of baby and mother, and any repairs. Your loved one just birthed a baby into the world and needs that time to de-escalate and bond with and nurse her baby. You could be notified the moment the baby is born and if you live locally would still have time to be waiting to see the baby.

The baby will not grow 2 heads or horns or grow up and go to college before you get there. I promise. And you might be able to bring that new mama a wonderful favorite meal on your way to visit (don’t forget daddy or partner!).

If you are anxious, excited, nervous, antsy (and who wouldn’t be) I have a list of suggestions for you.

• If you are crafty, work on creating something for baby
• Go grocery shopping or cook freezer meals for the new family
• Clean their home (with permission of course)
• Walk their dogs, do any errands they may need
• Write a letter to your loved one(s) and the new baby arriving
• Go shopping for last minute essentials or just for fun
• Assemble any baby items that need assembling (swings, bouncers)
• Make every attempt to send peaceful and positive thoughts, prayers, and vibes
• Trust that her request for privacy is in her best interests and what she needs

If you simply must be at the place of birth, find the waiting area and occupy yourself with something and wait for more information. Family members can be a wonderful source of encouragement. I am in no way advocating that family and friends be kept out of the loop or prohibited from being at the birth if the mother wants their support and company. I have seen mothers, sisters, cousins, best friends, brothers, fathers, mother in laws, etc., be a positive and useful source of support and encouragement– but please be invited.

Kimberly Sebeck, AKA Knoxville Doula, 2016

Knoxville Doula Is Growing

Knoxville Doula is growing! I will be joining a fantastic massage therapist and a fertility and pregnancy acupuncturist at our beautiful office in West Knoxville. I will still be at my current location through the end of this month. We look forward to serving the community as a whole for your fertility, pregnancy, birth, and postpartum needs! You can check out their info atTransformations Massage and Wellness Center and Tennessee Center for Reproductive Acupuncture. ‪#‎knoxvilledoula‬ ‪#‎doula‬ ‪#‎knoxvilletn‬‪#‎professionalsworkingtogetherforyou‬ ‪#‎fertility‬ ‪#‎pregnancy‬ ‪#‎reproductive‬‪#‎massage‬ ‪#‎acupuncture‬ ‪#‎childbirthclasses‬

Statement

Knoxville Doula does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, size, or military status.  I am comfortable meeting the needs of most pregnant people.