Everything Old is New Again: The Benefits of Adding a Birth Doula and Prenatal Yoga to Your Birth Plan

Women helping women survive and thrive through pregnancy and birth is an ancient service well worth reviving in this day and age. Childbirth is a transformative experience, and should be a positive one. But too often today, it is unnecessarily traumatic for both mother and baby. In America, we need to re-think how we help mothers bring children into the world, and how we help these mothers care for themselves and their infants through, during, and after the birth process.

I personally do not believe that America does this right, let me share some sobering statistics that show our nation lagging well behind ‘underdeveloped’ countries when it comes to mortality rates of both mothers and babies. Women need to re-take charge of the birth process, from pregnancy, labor and delivery all the way through to the postpartum period in a more natural, beneficial way.

For these reasons I am devoted to sharing what I have learned as a prenatal yoga instructor and as a doula with my fellow women, because with these wonderful natural tools, in their belt, women can properly prepare themselves for the most gentle birth experience possible.

Yoga is the ancient science of “yoking” the breath with the movement of the body to calm the mind. Prenatal yoga, as taught by a certified prenatal yoga instructor, is one of the best ways to remain strong and flexible when pregnant. It helps a woman learn breathing techniques and the ability to remain focused moment-to-moment. These skills are excellent pain management tools and my prenatal yoga classes are specifically designed to facilitate a gentle birth as well as ease the common aches and pains that come along with pregnancy.

The word doula comes from the ancient Greek and refers to a woman who is devoted to caring for another woman during her entire pregnancy cycle, a relationship as ancient as humankind itself. Nowadays, a doula is a non-medical companion who offers physical and emotional support to the mother-to-be and to her birth partner during the entire birth process. A doula can also remain in this support role for the vital first twelve weeks postpartum (the Baby Moon). Doula service is often referred to as “mothering the mother”.


The combination of these two ancient tools seems a perfect match, as pregnancy-oriented yoga works hand in hand with the skill set of the doula. My recent experience assisting other women leads me to believe that these supportive services are not just a nice alternative, but an absolute necessity for women navigating the murky waters of common American birth practices.

According to WHO (World Health Organization) most pregnancy and childbirth related deaths are preventable if women have access to skilled and appropriate care. You would think this is a slam-dunk in America. But the numbers say otherwise. WHO reports that 28 out of 100,000 US women died in 2013 from maternal causes, this is comparable to the Maternal Morbidity Ratios (MMR) of Iran and Romania -- almost double the percentage found in other developed countries such as France, England and Canada. America is the ONLY industrialized country in the world with a climbing rate of birth-related maternal deaths and this represents an increase of 136% since 1990.

These figures directly correspond to the lack of access to quality health care and insurance in the United States. The Affordable Care Act seeks to get coverage for all pregnant women and mandates that insurance covers 100% of prenatal care, maternity care and contraception, but only if it ever gets fully passed by Congress.

The sad fact is that in America maternal deaths do not just arise from the lack of quality prenatal care as they are also due to health conditions that are either pre-existing or exacerbated by pregnancy (such as diabetes or obesity, conditions of near epidemic proportion today), and complications directly related to medical interventions during labor and delivery.

The frightening reality is that the US ranks 3rd in the world for Cesarean Section operations, where approximately 30% of American women have surgical deliveries. A significant portion of these surgeries were not medically necessary, procedures done by choice rather than as a last resort under a life-threatening situation.

The overuse of medical interventions such as labor induction, epidurals and Cesarean Section may be why the United States is among just eight countries in the world to see increases in maternal mortality rates since 2003.

ACOG (American College of Obstetricians and Gynecologists) recently published new guidelines in an attempt to change expectations about time involved during labor. It now says that women need to be given more time to labor and deliver vaginally instead of doctors moving swiftly to unnecessary interventions and surgery. These guidelines cite “continuous labor and delivery support” as a way to reduce Cesarean Section rates. Stalled or slow labor is often cited as a reason for an “emergency” C-section. The most common cause of slow or stalled labor is the use of artificial augmentation and/or the use of an epidural.

Worse is the story for babies. The United States has the highest first-day infant mortality rate out of all the industrialized countries in the world and we are dropping steadily backwards to a ranking of 30th at this time. America also has one the highest rates for preterm births (1 in 8 babies are born at 22 to 37 weeks). Complications during these births cause deaths in 35% of these infants. More shocking is that American women are seldom encouraged to go full term (40 weeks) and are often encouraged instead toward speeding things up with the use of medical interventions such as pharmaceutically induced labor, and scheduled Cesarean Sections.

How is it possible that a country like America --- with access to wealth, knowledge, food and medicines --- can have such an appalling record? It is a scandal in the words of The World Health Organization and Amnesty International. These pitiful statistics do not even include those American women who successfully give birth but are left with shabby birth experiences, full of unnecessary complications, interventions, and extended hospital stays for themselves and their babies, and perhaps lingering health problems for life.

On first encountering these facts, the US seems a grim and scary place to be a pregnant woman. Women receive better care even in places like Afghanistan. It left me to wonder how I or any pregnant woman make a change in a health care system gone so horribly wrong?

The good news is that at the grassroots level there is plenty one person can do for herself or for her fellow women. What is needed is a call to action by American women to re-take charge of their bodies, their babies and indeed the whole birth process.

First off, accept and own the fact that the birth of a baby is a biological process and NOT a medical procedure performed on women by doctors. Number one thing you can do is educate yourself about the whole birth cycle including pregnancy, labor and delivery, as well as postpartum care. Knowledge equals power.

Women have the legal right to informed consent. That means receiving full and accurate information about all proposed procedures and medications offered by your healthcare provider and actively participating in all decisions made about yourself. You have the legal right to make all medical decisions made about yourself and your baby, this comes with the legal right to refuse treatment. Your decision to make prenatal care and education a priority ensures that you have the ability to make accurate choices and empowers you to make the decisions that are in your best interest and in the best interest of the health of your newborn and that these decisions are not solely based on doctor or hospital convenience.

Hospitals are quick to advise women to pack makeup and hair dryers, but tell them very little about what their bodies are doing or how to help themselves through the actual phases of pregnancy, labor, delivery, and postpartum.

Excellent resources for childbirth education (beyond making yourself look pretty following delivery) do exist. You must do some research, looking for classes that offer practical, up-to-date and knowledgeable alternatives. Childbirth classes are often covered by insurance plans, but it is necessary to ask to be sure.

It is also possible for women to “vote” with their choices. If your doctor, hospital or insurance provider is not supportive of your birth plan, you should switch --- and let them know why the switch was made. The system will eventually follow the money and where you choose to plant your dollars means a great deal in our capitalistic society.

Vote more women into office. We make up 51% of the population but only hold 19% of the seats in Congress and Senate. The United States ranks 96th in the world for women representation in government. Why is that percentage so important? In Finland (currently ranked number one), where women hold about 43% of parliamentary seats, women face a one-in-12,000 chance of death in childbirth. In Rwanda, where women currently hold 58% of parliamentary seats, the maternal morbidity rate has dropped from 34% (1990) to 13.6% (2013).

It bears repeating, America is the ONLY industrialized country in the world with a climbing rate of birth-related maternal deaths. Voting more women into office could easily translate to better health care policies that focus more on women and children, which could mean real change.

But, in the meantime, if you are already pregnant, it is vital that you get the best prenatal health care you can afford and to take care of yourself and your baby with good nutrition, hydration, rest and appropriate physical activity. Many agencies, doctors, hospitals, yoga studios, childbirth educators, etc. will work with you towards a payment plan you can afford. Personally, I am happy to work out an agreeable arrangement with anyone who wishes to contract with me as a doula and/or as a prenatal yoga instructor.

Thirdly, you need a strong, succinct birth plan. Discuss the plan point by point with your medical caregiver to determine if they are a good fit for birth you are envisioning. If they are not, seriously consider changing doctors. Again, this is a way to vote with your wallet. Schedule a visit to the hospital birthing ward. Go with birth plan in hand. You may have to compromise, but advocate for those things that are truly important to you and your birth partner. Work to make allies out of your caregiver and labor delivery nurses—offer them brownies.

Surprisingly enough, the desperately needed support to help mothers care for themselves and their babies, through all the phases of pregnancy, delivery and postpartum, comes through the revival of two ancient practices. Current clinical research shows that the addition of a birth doula and pregnancy oriented yoga into modern American childbirth practices can improve birth outcomes for both mothers and babies.

You don’t have to wait on the government, hospital policy, insurance or your healthcare provider. You can positively change your birth outcome right now for yourself and your baby simply by implementing any of the techniques and tools mentioned in this article.

Benefits of Prenatal Yoga

Certified prenatal yoga instructors, such as myself, help expectant mothers learn the foundations of yoga in a way that is specifically tailored to pregnancy. These classes utilize gentle but powerful movements to build strength and endurance as well as to open and relax the hips and pelvic floor. Your instructor will teach you how to use your breath to release anxiety, ease pain, manage blood pressure, and the ability to focus and stay in the moment.

The Mayo clinic reports that prenatal yoga decreases the risk of preterm labor and supports going full term (40 weeks), which is best for you and your baby’s overall health and development. Prenatal yoga also gives you confidence in your own body and abilities, so critical to the demands of childbirth. Attending these classes also helps you build a network of other pregnant women, as well as establish a vital relationship with your instructor and both are welcome support during this transformative period in your life.

Women should seek designated prenatal yoga classes taught by an experienced, certified (RPYT) teacher throughout pregnancy and attend designated postnatal classes after giving birth. During pregnancy certain poses and practices are unsafe for pregnant women and baby and without proper modifications and awareness, this can be dangerous, so seek the guidance of an experienced prenatal teacher.

It is also unwise to significantly raise the body temperature or practice in a an overheated environment. Avoid hot yoga classes. Even experienced pregnant yogis will benefit from slowing down a little in honor of the changes in their body, so please consider the wisdom of attending designated prenatal yoga classes because of the tailored attention to preparation for labor and childbirth that they provide.

While it is never too early or too late to begin a yoga practice, you do not need any prior yoga experience to attend prenatal yoga classes. However, it is sometimes not recommended to begin practice during the first twelve weeks (first trimester). Many women opt to start prenatal yoga after the first trimester exhaustion and nausea are over. You should learn to listen to your body and honor its needs and limitations.

Whether you start prenatal yoga practice early in your pregnancy or late in the third trimester, know that is safe to begin a responsible practice at anytime during your pregnancy, as long as your healthcare provider has not told you otherwise.

If you are also planning on hiring me as a doula, I can build on the knowledge gained during our interaction in prenatal yoga classes. This deeper relationship allows me as your doula to learn your particular needs, likes and dislikes, and to factor those into a more succinct birth plan.


Benefits of Postnatal Yoga

Specified postnatal yoga classes, as taught by a certified yoga instructor, provide a safe way to recover from delivery, utilizing movements specifically tailored to help the postpartum body heal. These classes will help you learn to breathe fully again after nine months with cramped lungs, diaphragm, and intercostal muscles.

Babies are a welcome participant in these type of classes but be sure to seek out a studio that is a safe, secure space, a space that encourages you and your new amazing new baby to bond. Postnatal yoga classes let you get out of the house, meet and talk to other new moms and build a community of support -- all vital ways to ward off the “baby blues” and the symptoms of postpartum depression.


Benefits of a Birth Doula

A birth doula is a trained labor coach who assists the mother and birth partner during labor and delivery by providing continuous physical, emotional, and informational support before, during, and directly after childbirth. There are varying levels of support a doula can offer, but it is all focused on ensuring that birth is a positive life-affirming experience for all involved, given circumstance.

According to the website Evidence Based Birth, if a woman has continuous labor support, (someone who never leaves her side), both she and her baby are statistically more likely to have better outcomes. With a doula present, pain relief requests are reduced by 30% and epidural requests by 60%; a woman’s labor is at least 25% shorter. A doula guarantees the mother a 50% less chance of needing a Cesarean Section, and a 40% less chance that forceps or a vacuum cup are needed to deliver the baby.

The statistical evidence clearly shows that women who had continuous labor support from a doula (a woman who is not a hospital staff member and not a part of a woman’s social network) have decreased use of pain medication. A doula’s presence shortens labor, which equals less overall pain. Even if a woman has an epidural, a doula can help her encourage her body to do its natural job, pushing, etc., and this can reduce the waterfall of complications commonly associated with epidurals. Epidurals often lead to the need for artificial augmentation such as Pitocin, delivery via instruments and Cesarean Section.

The doula is also great for those who wish to breastfeed, since the doula assists with the initial ‘latch on’ and with continuing support. The doula’s comforting presence makes a new mother less anxious, less depressed and she has better self-esteem. All of that creates a more affectionate responsive bonding between mom and baby.

So what can an expectant mother, like yourself, expect from engaging doula service? The presence of a doula reduces the need for labor drugs such as Pitocin, decreases your risk of having a Cesarean Section, increases your likelihood of having a spontaneous vaginal birth, lessens the risk that your baby will require time in a Special Care unit, you will have a good start at breastfeeding, decrease your risk of being dissatisfied with your overall birth experience and decrease your risk of postpartum depression.

Doctors, midwives, and nurses all play pivotal supporting roles in the birth experience, but they all come and go during the different phases of labor and delivery, often leaving you alone for extended periods of time. While your caregivers are highly trained medical experts, you and your baby are not their sole point of focus, as they often have many other patients to monitor as well.

A doula is neither part of the medical team, nor a replacement for it, but she complements that team by providing continuous one-on-one support directly to you from the beginning of labor, through delivery, and during several hours postpartum.

A doula gives NO medical advice, runs no diagnostic tests, nor does she diagnose medical conditions. A doula is trained to take care of the non-medical aspects of pregnancy and birth, anticipating your needs, and helping carry out your wishes. A doula can also give assistance with creating and maintaining a strong, well thought-out birth plan.

Doulas are an impartial voice of reason; a source of information to help get questions answered. A doula advocates for your wishes, can soothe and guide you through breathing techniques and visualizations, or simply suggest a helpful change of birthing position. A doula shows up no matter what time you go into labor, whether at home, midwife center and/or hospital. She stays after the birth, helping you settle in and begin breastfeeding, she also helps by allowing your birth partner to take much-needed breaks.

In short, the doula represents the best of many worlds: it is like having a birth “maid of honor” a person who is an impartial advocate for your wishes and who offers unconditional, non-judgmental support in helping you facilitate the most gentle birth possible, given circumstance. Hospital stays are shorter with a doula, and breastfeeding is more likely to happen and for a longer period of time. The doula nurtures you as you nurture your baby.


Benefits of a Postpartum Doula

Engaging a doula during the first 12 weeks postpartum is extremely valuable, as a postpartum doula provides support as you settle into your new family by taking care of duties around your home, doing what is needed to allow you to best enjoy and care for your baby each day. A postpartum doula (like myself) will give you the chance to bond with your amazing new baby and the rest of your family, knowing that both you and your baby are clean, hydrated, well-fed, and well-rested.

The presence of a doula takes away some of the stress and worries common to new parents, and when your needs are meet, when you feel supported and understood, then you will naturally be better able to focus on nurturing your new baby.

A postpartum doula is a judgment-free information source so feel free to openly discuss parenting styles or other concerns with her, she can assist you and your partner find answers that ultimately support the growth and development of your new child and the overall health and well being of your family.

A doula is trained to recognize the warning signs of the postpartum baby blues and can advise on what is normal and when to consider seeking help. However, doulas are not therapists or psychiatrists and therefore do not make any sort of diagnosis. A certified postpartum doula can help a client screen themselves for postpartum medical depression and, if the client feels they might need help, can make recommendations for the mother to get the support she feels necessary, such as names of therapists and support groups in the area.


It Is In Your Control To Take Charge Of Your Personal Birth Experience

The first step is realizing that the current medical approach to childbirth in America is statistically poor and very one-sided, geared more to the convenience of the government, insurance companies, doctors and hospitals and not so much to the mother and baby.

Instead of marching to the tune set by “those guys”, and armed with the information presented here, you have the power, through your own grassroots effort, take charge of your own birth experience and make it the wondrous event that nature intended it to be, in the first place.

The birth experience should be awe-inspiring, fulfilling… the starting point of a incredible journey for mother, baby and the rest of the family. I strongly believe that adding prenatal yoga and a doula to any birth plan can ensure positive outcomes for all involved.

Expectant women, their birth partners and their babies DESERVE and have a RIGHT to this type of support, help, and respect, it is a scandal that most American women do not.


Sources & Further Reading: Save The Children State of World Mother’s Report 2014, A 2013 Study done by the Institute for Health Metrics & Evaluation at the University of Washington published in Lancet The World Health Organization WHO Maternal Morbidity Country Profiles U.S. Maternal Rates on the Rise U.S. Slips in World Ranking

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