We are honored to have Ana Paula Markel, ICCE, CD (DONA) on our site to answer any birth related questions this week. Ana Paula Markel is a mother of 4, birth doula, birth doula trainer and childbirth educator. Ana has supported hundreds of families to transition into parenthood. In Ana's view there is no right or wrong way to give birth or parent but there is informed decision and conscious and awareness in choice. Women deserve support and to be heard in their life changing transition into motherhood.
Feel free to ask Ana anything about taking birth education classes, a doula's role during labor and delivery, home birth, hospital birth and anything else related to having the birth experience you desire and she will reply here throughout the week.

Tags: birth, doula, education

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I have a question. I've decided to give birth at a hospital, considering my insurance and financial limitations. I have found an OB, whom I have heard great things of, and who I really feel comfortable with. I am considering a doula because I'd like to labor at home as much as possible. What I want to know is what does this usually mean? Who makes the call as to when mom should go to the hospital? Is this something I have to negotiate with my OB beforehand (like water breaks and no contractions, should I go in?)? Also, I have questions about the role of the doula during labor. My whole concern is around not being informed and wanting to get info as things are suggested/ or about to be done to me by hospital staff. How can a doula help here? I've heard that doulas shouldn't advocate for you but help you have better communication with your provider, but I would like a doula who will step in and give me information, is this beyond the scope of their work or is it dependent on each doula?
Hello,

I have decided to deliver my baby at a Birthing Center and I am currently trying to decide on a birthing class. Initially I planned to sign up for a 12 week Bradley Method Class...is this the best class or would you recommend something else?

Thanks
Hello! I am a mother of two beautiful children both born via c-section. After 20 hours of 'labor' induced by the hospital and no sleep or food, they allowed me to push for what they say was about 2 hours, I feel it was closer to the 30 mins. Regardless, I ended up w/ a CS due to my daughter being 'stuck'. I remember seeing her head, and her hair, but they forced me in my drug induced state to have a C. With my 2nd child I just did what the doctors said and scheduled my second C-Section. The day of, I went into labor naturally, but they insisted that I have the C section. After attending my friends home water birth, and reading and attending conferences, I feel that had I had the knowledge and support I do now, that I could have sucessfully vaginally birthed both my children. So we are hoping to get pregnant with #3 this summer, and I would love to have a vaginal birth. I have had issues with breastfeeding (to the loss of why to many lactation specialists) and I feel that I can do this. With having 2 prior C-Sections, do you feel it's safe enough (in a hospital setting) to attempt a vaginal birth? My children were 8lbs 1oz and 9lbs 4oz. Thank you! !

Michelle,
Sacramento, CA
after two c sections a vback is entirely contraindicated. vag birth after one c section still carries risk, but is reasonable in a hospital setting with 24 hr anesthesia coverage and doctors readily available. risk of uterine rupture increases exponentially after two c sections, and i doubt you will find any obstetrician who will participate in a trial of labor after 2 or more c sections. hope that helps.
amanda RN L& D
Doulas come at a premium here in Los Angeles (some cost as much as the OBGYN), and according to my insurance company (Blue Cross PPO) they are not covered. Can you tell me ways to help my husband take on this role during our hospital birth? Are there networks of Doulas in training that I may find?
'I am considering a doula because I'd like to labor at home as much as possible. What I want to know is what does this usually mean?'
A: I myself considered a doula but decided to take it on with my husband. We took a hypnobirthing course and we decided to go to the hospital when i felt ready. I was in labor for four hours before I got to the hospital.

Who makes the call as to when mom should go to the hospital?
A: I would discuss this with your Dr. My Drs. advice was to go to the hospital if my water broke or if my contractions were 4mins apart for an hour. After getting to the hospital if I was less than 4cm then I could go home (I was 5cm when they checked me at the hospital). You can also ask to be checked at the Drs. office instead of going to the hospital (during office hours). With the hospitals in my area there's a 24hour time clock from the time a woman's water breaks to the time a woman needs to have the baby delivered. - Something to consider if your in the hospital and they want to break your water (the baby looses cushioning and cause stress on the baby).

Also, I have questions about the role of the doula during labor. My whole concern is around not being informed and wanting to get info as things are suggested/ or about to be done to me by hospital staff. How can a doula help here?
A: I would have a great birth plan and discuss it with your Dr. and make sure your husband and doula are all on the same page. If your in a stage of labor where you can't 'talk' then you'll need your husband or doula for support in communicating.


I've heard that doulas shouldn't advocate for you but help you have better communication with your provider, but I would like a doula who will step in and give me information, is this beyond the scope of their work or is it dependent on each doula? A: I can't comment on having a doula but i can comment on having a rock solid birth plan and hashing out all the scenarios ahead of time with the Dr. My husband and I did that politely of course with our Dr. In our experiences there are several protocols on the nurse level, hospital level, insurance level and Dr. level - and they all compete with one another.

Most importantly keep a positive mind set and "don't take on others experiences as your own"

Have a Happy Birth!

PS - i'm a mom of two - one was induced and one was completely natural and the natural childbirth experience for me was awesome!
I am currently pregnant with my first baby and my husband and I are planning a home birth. In addition to my midwife and doula is it helpful to have anyone else there to assist? Or are those two attendants and a birth partner typically sufficient to help everyone feel cared for and comfortable? Thank you, Sara
HI Sara! My husband and i had our daughter one year ago at home and we had 2 midwives. My husband was an amazing birth partner and our midwives were attentive without being overbearing, which was exactly what i wanted. One of the reasons we chose a homebirth was so that i could labor comfortably at home and not have nurses and doctors telling me what i should be doing. My midwives honored my requests and i had a lovely (and fast!) birth. Both he and I felt completely cared for. Have as many people as you and your husband will feel comfortable with in your home and if you choose to have more than your midwife and doula make sure to explain your wishes. Birth is a VERY intimate experience and you only want to be surrounded by positive and supportive people. Follow your gut!
Good Luck! Hope this was helpful!
kate

I hope this was helpful!

Good Luck!
I attended home births for 4 years. Your doula and midwife will support you and provide your care. It is helpful to have a family member present that can assist with food and drinks for your team. Other background tasks might be the knowledge of your kitchen and laundry--helping with clean linens, finding something that you discover you need. Your husband is going to want to be involved in supporting you--help with household things is good. It just needs to be a person that understands the role and that you are comfortable with. Labor for a first baby can be 12 to 18 hours or more.

Sara Intonato said:
I am currently pregnant with my first baby and my husband and I are planning a home birth. In addition to my midwife and doula is it helpful to have anyone else there to assist? Or are those two attendants and a birth partner typically sufficient to help everyone feel cared for and comfortable? Thank you, Sara
Hi, I am hoping for a VBAC with my 2nd child. My son was born via C-section b/c I developed a fibroid (12-13 cm in diameter) low on my uterus. My previous ob said that b/c my son couldn't drop due to the location of the fibroid, I had to have a C. My new ob says that b/c the fibroid is a bit smaller (9cm) that I might be able to try for a VBAC. She says that as long as the baby can get her head around the fibroid, there shouldn't be a problem.

Do you have any experience with VBACs and fibroids? Are there any resources you can recommend? We plan on having a doula and delivering all natural (although my ob is strongly advising me to keep an open-mind as far as pain control considering my situation) but will have to deliver in a hospital. Luckily, my ob is very supportive and fully intends to deliver me via VBAC. Thanks!!!
Hello BK Mom, Congratulations on the upcoming birth y=of yoru baby and also for finding a supportive team to be with you during that time, including your OB and doula.

The first thing to do is write a Birth Wish List, Birth Intention List , what we called Birth Plan. The biggest benefit of that would be to discuss such details with your OB before the birth. Which would give you a very clear and detailed idea of where he stands in some of the issues you brought up, like water breaking without contraction, etc... It is also a great time to dialogue with him so he can know about your dreams and ideas for the birth. A lot of the time you can find a happy medium.
Now, when it comes to the birth with the doula. The doulas are not suppose to make decisions for you but that does not mean she won't assist you in making your decisions. You can either ask for privacy to discuss options, or I personally like to that with the careprovider and staff. Just by encouraging them to ask questions.
A lot of times all a doula need to say is: " Hold on everyone, let me check with my clients if they have questions about this"... That opens the dialogue, with staff and careprovider, I like to be part of that as most of the time that are alternatives and it can be done in a very open and flexible conversation.

I hope this helps, if not feel free to write me again.
Hugs,
AP Markel
BK Mom-2-b said:
I have a question. I've decided to give birth at a hospital, considering my insurance and financial limitations. I have found an OB, whom I have heard great things of, and who I really feel comfortable with. I am considering a doula because I'd like to labor at home as much as possible. What I want to know is what does this usually mean? Who makes the call as to when mom should go to the hospital? Is this something I have to negotiate with my OB beforehand (like water breaks and no contractions, should I go in?)? Also, I have questions about the role of the doula during labor. My whole concern is around not being informed and wanting to get info as things are suggested/ or about to be done to me by hospital staff. How can a doula help here? I've heard that doulas shouldn't advocate for you but help you have better communication with your provider, but I would like a doula who will step in and give me information, is this beyond the scope of their work or is it dependent on each doula?
Hello April, how wonderful that you found a Birthing Center for your birth. Have you discussed with the midwives of the center which classes they recommend? I personally find the Bradley Method to be very complete and detailed and if that is what you are looking for, it is the best class for you, it is also very natural birth oriented. Bradley classes run for 12 weeks so make sure if that is your goal to sign up fast. I would rather the partner to be called something different than "coach" but that is my own little thing... I think if that would be a coach in the birth, it should be the mother, she is the one that needs to be telling everyone what she wants and not wants and also, what is working or not for her. I favor the power to be with the mom and to come from her.. but that can be also adapted to Bradley. Most Bradley instructors are ver commited and loving.
Did that answer you?

Hugs,
AP Markel

April Nicole Young said:
Hello,

I have decided to deliver my baby at a Birthing Center and I am currently trying to decide on a birthing class. Initially I planned to sign up for a 12 week Bradley Method Class...is this the best class or would you recommend something else?

Thanks

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