What is a Doula?

A doula is your advocate to achieve a positive birth experience.  She is a companion that provides emotional, physical, and informational support during pregnancy and throughout your labor.  Doulas are present to comfort and support the mother and coach.  She should not function as a go-between for the laboring couple and the health care provider.  She does not replace the partner/spouse; rather her goal is to enhance the confidence of the primary support person by offering practical advice and experience.

What services do Doulas provide?

While each doula will offer her own package of services, you can anticipate something similar to the following:

• 1 to 2 prenatal visits
• Phone and email support during pregnancy and then 24 hours a day beginning just prior to your due date and for a period of time after the birth
• On-call status
• Continuous labor support
• Immediate postpartum support, up to maybe 2 hours after the birth
• Candid pictures of the birth, if  requested

How do I choose a Doula?  

Choosing a doula is a very personal decision and it is certain that not just anyone is a good fit. Those who surround you as you labor and birth your baby must be people with whom you feel comfortable and connected.  Most doulas offer no-cost interviews to provide prospective clients with the opportunity to ask questions and learn more about their services.  Interview many doulas and be open as you share your vision for your birth experience.  Be patient as you look for that “right match.”

What will my OB think if I hire a Doula?  Why the stigma about Doulas?

Your health care provider wants you to have the best birth experience possible.  If you feel that a doula will help you to feel more confident and prepared during labor, then chances are your provider will welcome the presence of your doula.  However, it’s best to discuss your plan to hire a doula with your OB or midwife beforehand so that everyone can be on board with your birth plan.  While most doulas stay within the scope of their practice, unfortunately some few have sought to advocate for the laboring couple by acting as a go-between between the couple and the healthcare staff, over-stepping the partner’s role and sometimes creating a negative stigma for doulas in general.  Be open with your provider and your doula about your expectations, and you’ll set yourself up for success!

Do you have to have a doula if you’re trying for a natural, unmedicated birth?

Your doula is a paid support person who is experienced in helping moms cope with labor.  If you feel like you have a good support team for your labor in place (husband, mom, friends, etc), and also if your partner feels comfortable with the support team and his/her role, then you could move forward confidently without a doula.  If this isn’t the case, hiring a doula might be a good option to help increase the support system you have during labor.

How much does a Doula cost?

Doulas charge a wide range of fees, depending on their certification and experience.  Some doulas-in-training will offer their services for free, however anticipate spending at least $600 for a doula in the Charlotte, NC area.  When you think of the expense of a doula, consider that you’re paying not only for the prenantal, postnatal, and labor visit (which can last for many hours), but you’re also paying for your doula to be on-call and ready to drop everything when you go into labor.  Most doulas require a retainer fee of $200-300 prior to the birth with the balance to be paid a few weeks before the expected due date.

Does Confident Childbirth Method^SM of Charlotte provide Doulas support?

The Confident Childbirth Method^SM is focused exclusively on childbirth education and offering classes to prepare couples for natural birth.  You can contact your CCMethod instructor directly to see if she offers doula services in addition to her role as an educator, or if she can offer you names of local doulas to contact.

• The Birth Process
• Deep Relaxation (similar to a Hypno-style course)
• How to Use Guided Imagery to Prepare for Labor and During Labor
• The Stages and Phase of Labor
• Patterned Breathing Techniques (similar to Lamaze)
• The Pros and Cons of Routine Medical Interventions
• Medical Indications for Inductions and Cesarean Birth
• Positions of Comfort for Labor
• Positions for Pushing
• Preparation for Partners
• Mock Labor Night….and much more!

Come join us at The Milky Way @ 1419 East Blvd Charlotte, NC 28203 for our 4-Week Birth Prep Course and at the CPCC Overcash Building @ 1206 Elizabeth Ave., Charlotte, NC, 28204 for the Saturday Intensive Class.  Private Childbirth Classes are also available.  View our Charlotte-area class registration page for class schedules, fees, and other details.

But first, let’s establish something….and this might sound crazy coming from a group that supports natural birth, but here’s the reality:  Cesareans aren’t all bad.  The truth is, cesareans can sometimes be the best option to promote the health and safety of mom and baby.  There are scenarios when a cesarean section is medically indicated, such as complete placenta previa, cephalic pelvic disproportion, or placental abruption.  (You’ll learn all about the true medical indications for cesarean birth in your Confident Childbirth Method class.)  When interventions promote “healthy baby/ healthy mom,” we should consider our options and weigh the pros and cons very carefully.

With that said, the c-section rate in the USA is shockingly high.  According to the CDC, the cesarean rate rose by 53% from 1996 to 2007, reaching 32%.  Wow.  That assumes that 1 in 3 American women require surgery to give birth.  North Carolina can’t boast much better at 31%, and Mecklenburg County comes in at 32.5%.

Let’s break up those percentages by looking at the cesarean birth rates at specific Charlotte-area hospitals in 2008.

FYI, when wading through all of this information, it’s important to note the “Primary C/S Rate” if you’re a first-time mom and the “Repeat C/S Rate” if you’re trying for a VBAC.  The “Total C/S Rate” can be misleading for both groups if viewed independently.  If I am preparing for a natural, vaginal birth with my first child, I’d keep a close eye on the primary C/S rates for my hospital of choice.

If I learned anything from my stats classes in college, it’s that you need to view all statistics with a critical lens and remember that “correlation doesn’t equal causation.”  Let’s brainstorm about WHY these statistics might be what they are:

Presbyterian Main hospital has the highest c-section rate in the Charlotte area (as of 2008), coming in at 37.2%.  Does this mean that every laboring woman who walks in the door has greater than 1 in 3 chance of a c-section if they deliver there?  Maybe, maybe not.  Note the high acuity of the NICU.  Is it possible that a large percentage of women with high-risk births choose to deliver at this hospital because they are comforted by the quality of the NICU, and that those high-risk pregnancies are more likely to result in a cesarean delivery?  And yet, CMC Main, which actually saw more births than Presbyterian, also has a level IV NICU and only a 29.8% c-section rate.

Is the explanation in the chosen provider, the nursing staff at the hospital during labor, the pro-natural-birth amenities that the hospital may offer (water birth, tubs, birth balls, squat bars)?

You might also consider the type of providers that operate out of the hospitals.  Some hospitals may staff a higher-than-average percentage of midwives.  As you probably know, midwives can not perform c-sections.  With this in mind, high-risk pregnancies might be directed to an obstetrician or those clients might choose an obstetrician right off the bat.

I have worked with many couples over the years who experience fabulous natural births at hospitals that many would consider unfavorable to natural birth.  I have worked with moms who have c-sections under the care of the most natural-birth friendly midwives at low-intervention hospitals.  If  you want to avoid an unnecessary c-section (we can’t do much to control the truly necessary c-sections), it’s important that you do your homework and critically examine your chosen place of birth.  It’s also important that you choose a health care provider that is less likely to perform a c-section.  View our blog post on How to Choose a Pro-Natural-Birth Provider.  Last but definitely not least, don’t underestimate the importance of your own preparation.  Confident Childbirth Method of Charlotte classes will prepare you with tools to promote a successful natural birth, as well as the information you need to make wise choices about the interventions that are offered to you.

(Thanks to the North Carolina Department of Health and Human Services and Angela Hathaway for providing the C-Section at Charlotte-Area Hospitals statistics)

Charlotte Age of Mother and Birth Weight

Charlotte Number of Births Categorized by Age of Mother and Birth Order

Charlotte Number of Prenatal Visits and Birth Weight

Total NC Births:  122,302

Largest Live Birth:  14 lbs 3 oz   (Can we just say, YOWZERS :0)

Oldest Mother:  53

Oldest Father:  71

Sets of Twins:  2,095

Sets of Triplets:  51

Sets of Quadruplets:  2

Sets of Quintuplets:  0

Most Births Occurred on:  December 30  –  443 births

Fewest Births Occurred on:  December 25  –  197 births

Day of the Week Most Births Occurred:  Thursday  –  19,966 births

Info retrieved from:  http://www.schs.state.nc.us/SCHS/vitalstats/2010/births.html

Births by Cesarean in all of North Carolina: 31.2%

Births by Cesarean in Mecklenburg County: 32.5%
Cabarrus County: 33%
Rowan County: 29.7%
Union County: 30.4%
Gaston County: 30.7%
Lincoln County: 38.2%
Catawaba County: 27.7%
Iredell County: 33.5%

If you’re interested in learning more about the c-section rates in other counties, you can read the report yourself at http://www.schs.state.nc.us/SCHS/data/databook/CD8A%20Csection%20births.html.