When Evidence Based Means Squat

Sometimes an evidence based choice is not the best choice.
Sometimes an evidence based choice is not the best choice.

Recently we had been having some troubles with my youngest son having emotional outbursts. We finally went to the doctor and his diagnosis (from seeing us for all of five minutes, after sitting in his boring office waiting room for over an hour right after school with no chance to grab snacks) was a lack of consistent parenting. Thanks. That made me feel awesome. He “prescribed” an over the phone one on one parenting course.

A few months later we finally made it in the next round and started this program focused on positive parenting, with lots of charts and rewards systems for encouraging good behaviour. We had difficulties using many of the tools offered and when that was expressed to our coach, I was repeatedly told “This program is evidence based.”

When the program ended and our little guy kept having these outbursts (though a lot less frequently and less severe), I decided to try another plan of action and took him to a free drop in counselling program I had heard about. After a more thorough discussion with me, the counsellor and my son, it was suggested he had a learning disability. But not your typical reading or math type. He was having troubles learning how to manage disappointments, frustrations and changes in routine. The more I learned, the more I felt it described him to a “T”.

It was frustrating to learn that we had spent that much time and effort (15 weeks!!) in a program that didn’t really address the problem, but as I learned more about his needs, it was clear that that type of parenting program could have the opposite effect. A child with this type of disability can become so focused on the outcome that they ignore the method to get there (behaving appropriately). By setting up charts and rewards systems for good behaviour, you can actually trigger an explosive response when the child doesn’t get the reward at the end.

What this has taught me about evidence based care is that it doesn’t mean shit if it doesn’t apply to your situation. This evidence based program was not designed for us in our circumstances. And so, it was useless (for us). Having someone repeatedly tell me that it would work if I just did it right was degrading, frustrating and made me feel like a bad parent, when I was doing nothing wrong.

Evidence is a collection of information that we look at as a whole. If a treatment works for 80% of people when used correctly, guess what? It doesn’t work for the other 20%. That is a big deal if you are one of the individuals that are the 20%.

Doulas like to tout “evidence based” this and that. I have been guilty of this myself, and may still do it now and again to be honest. Old habits and all that, and I apologize. We do this as if somehow, knowing the evidence is going to change the actual situation. Knowing the evidence that vaginal breech birth is as safe as cesarean delivery for the baby and safer for the mom, does not change the fact that for many women, they do not have access to a provider that will support that. Evidence will not change the mind of a woman who was sexually assaulted and does not want to have a vaginal birth, or breastfeed. And many times, the reasons why are none of our business. Evidence also cannot change a deeply ingrained culture around birth overnight.

Evidence based care is still needed. Having care providers basing recommendations on what is proven to be true is definitely preferable to the alternative. But, it is also important to remember the individual and their situation. And to respect when and if a client is requesting information, or would prefer to not know.

I am committed to learning and offering only evidence based information, but I am working to do so only when requested, and I even better understand now when my clients may choose not to follow it. You know what will and will not work for you better than I do and I fully respect and support your choices.

If you are looking for unbiased and non-judgmental support during your pregnancy and birth, contact The Birth Nerd Kelowna today.

To The Client Who Quit

I saw it in your eyes long before. The fight was gone. Almost every single one of your hopes for your birth had gone exactly the opposite of your wishes. And still you soldiered on, hope lighting the fire of your determination to keep trying.

Then suddenly the fire in your eyes just died. That was it, you were done. And we tried to encourage it to catch again, but it was no use.

It struck me suddenly as I listened to everyone in the room tell you how well you were doing and to just keep on keeping on. What are we doing? I looked at your face and realized that continuing to encourage you to keep trying at this point could be traumatizing. We were just trying to help.

And then quietly, you surrendered “I can’t. I just can’t do this anymore.”

At that moment, I couldn’t have been more relieved and more proud.

What I want you to know is that sometimes a quiet surrender is more courageous than a loud roar of power. Knowing where your limits are and having the courage to say it to a room full of people telling you otherwise will serve you well on your journey as a parent. For there will be many times that others will tell you what you should do and making a decision from within is probably the most valuable parenting skill there is.

Not to mention, having the courage to speak it to people who are trying to change your mind, especially to those you respect, love and care for.

So, to my client who quit; you got this. Trust yourself. I believe in you.

 

Your Doula,  Amanda

A Doula for Camping?

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This summer my family went on a trip to Alberta to visit friends and family and to see some sights (you can’t have a six year old who is obsessed with dinosaurs and not visit the Royal Tyrell Dinosaur Museum!). Originally, we had planned on going with my sister and brother in law and camping our way around. It seems almost sacrilegious to admit, living in BC; that we don’t go camping. We have such beautiful mountains and valleys and places to go that it seems a shame we never camp outdoors. So, when we couldn’t arrange all of our work schedules to coincide, my husband and I decided to just book a hotel because we have only a very basic idea of how to camp, so really we have no idea what we’re doing.

Besides knowing that we would need a tent, some sleeping bags, some hot dogs and s’mores, we really have no clue about the real things we need to have and know in order to go camping. I’m pretty sure you need to book space to camp in, that you can’t just show up in the woods and camp, or that there are places that aren’t good to camp in. And what do you do if it rains? See, I have no idea. At least we know enough to know we don’t know. Y’know?

So anyway, the plan was to all go together and my sister and her family could teach us what to do and show us the ropes. They were going to be our camping doulas.

Now, I’m sure we could have just googled what we needed to know, bought some stuff, booked a place, shown up and figured it out and had a good time. But, we decided not to chance it so if they couldn’t come with us, we weren’t going either.

Camping for the first time is a lot like having a baby. You kinda know you need some clothes, diapers and they don’t sleep through the night, but you don’t really know what it’s like to have a baby until they’re there. Especially in our society that frowns on sharing birth stories. You’re taught that there’s some screaming, some swearing, some asking for pain medication and then poof there’s a baby.

But, what about all the other stuff? Wouldn’t it be nice to have that person that can hold your hand and walk you through it? Can tell you the ins and outs, that one person you can go to who has helped others through this before? Well, you can!

As a birth doula, I am experienced in helping families understand the process of birth and prepare as much as possible. I can help them understand their preferences, prepare for the unexpected and am an unwavering support of their choices. I understand the unique benefits of different types of care providers, places of birth, pain management options, community resources and more. Having supported many clients through each of these, I have firsthand knowledge of how birth “works”.

For postpartum support, it is about having someone to tell you, unequivocally, that you are doing alright. And I know, because I’ve supported others through this time as well. I can help families through the first diaper changes, learning how to dress and swaddle baby, bathe baby and tips to help with feeding. How to clean bottles, as well as offering tips and tricks on caring for yourselves.

It’s hard to know what you don’t know until you’ve been there. If you feel like you have a million questions or blank areas of knowledge, it can be good to know that you can ask your doula because they have supported someone else through it. And if they don’t have the answer, they definitely know where to find it.

One day we will go camping with my sister and brother in law and have them teach us what we don’t know. But in the meantime, we’ll stick to hotels and restaurants for our trips. However, having a baby is one trip you can’t cancel. Consider hiring a doula for support.

 

Thanks to the Birthful Podcast #37: Birth Prep Essentials for the inspiration for today’s blog post!

 

Is Doula Support For Me? Birth Edition

How can a doula help me_

Pregnancy brings many questions, and one is a particularly common concern; what kind of support do doulas provide?  Here I will break down different kinds of support I give all types of clients.

If you want information: If you are looking for reliable information on different topics related to pregnancy, birth, and baby; I can provide suggestions on books, reliable websites, and local resources such as classes and support groups.

If you want no information:  If you are simply seeking support for your choice to rely solely on your care provider for the information you need to make decisions about your care.  You have chosen your care provider carefully and trust their suggestions completely.  I will be a listening ear and unwavering support of your choices.

If you want no interventions: You are seeking support to help have an intervention-free birth and are wanting support and care for your choice.  Someone who will listen to your concerns and help you understand your options.  I can provide experienced support, I know what to expect and can provide suggestions for discussion with your care provider to help you stick to your birth plan.

If you want support for wanted/needed interventions (including planned cesarean): You are looking for someone to listen and understand your choice to seek out/ accept interventions that will help keep you and your baby healthy.  I will not convince you it is right or wrong, but will provide evidence based information as is appropriate and non-judgmental support.

If you want no medical pain relief:  You are wanting to experience birth with no pain relief and understand that doula support can help you reach those goals.  As a trained and experienced doula, I can provide suggestions for “natural” pain relief options that you and your partner can try.  We will practice a few at home during your prenatal appointments that will work well for early labour.  I will also provide in person support for these techniques during active labour, whether at home or your chosen place of birth.

If you want all the pain relief:  Experiencing the full range of childbirth sensations is not on your to-do list.  Your expectation is to accept pain relief as soon as possible and be able to relax and enjoy the birth of your baby.  I will provide non-judgmental (there’s that word again!) support, as well as help make your pain relief choices work optimally through suggestions of questions to ask your care providers, position changes and more.

If you are planning on your partner being your main support:  You (or your partner) are planning on them being right in there doing as much as possible to support you.  I will coach your partner with ideas of things to try to provide the best support, and fade in to the background when you have found a rhythm that works for you.  Then I will best assist by making sure you have everything you need when you need it, and allowing your partner to take breaks as necessary so that they are rested and at their best to be able to better support you.

If you are planning on little to no additional support:  You are wanting someone to provide that primary support.  As an experienced doula, I have supported families in this role before.

The list goes on and on.  As you can see, doula support is for every kind of pregnancy and birth experience.  If you feel your situation is unique and are looking for information on how I can best support you, please feel free to contact me.

The “You’ll just know” Debate

Disclaimer: do not take any information here as medical advice, always check with your care provider (Dr, midwife, OB) before trying anything and definitely check in with them or visit your L&D department if you have a feeling something is wrong.

woman labour

Can we talk labour for a minute?

One common question that expecting women and their support people have is: “How will I know I’m in labour?”.  And, honestly, this is one tough question to answer.  Many people will say that “You’ll just know.”  “When it’s time, you know.”.  We are trained from media (TV, movies, etc) to expect a big gush when our water breaks, then hard and fast contractions, rushing to the hospital, being wheeled down the hall in a wheelchair and then furiously pushing for a few minutes before baby comes.  These are some of the very obvious signs of labour.  The truth is that labour signs can build up over days or weeks and once things get rolling, you may not recognize the signs until you are well into the active phase of labour.

But this can be a good thing!  Evidence tells us over and over that the healthiest births are the ones that are least tampered with, and a slow, steady (and sometimes sneaky) start to labour can help prevent us and our care providers from jumping in too early with unnecessary interventions.  Having a slow start to labour can help mom and baby adjust to the rhythm and flow before things get intense.

Some early signs (days and weeks before baby is born) that your body is preparing for labour include:

– Baby “dropping” or engaging.

– Losing your mucus plug.

– Nesting.

– Braxton hicks practice contractions.

– Frequent and/or watery bowel movements.

Early labour is characterized by regular contractions that get progressively closer together and stronger.  The trick with these is that they may feel like cramping or just an annoying back pain for some women and they may not recognize them as labour (I was one of those!).  If you are feeling like you may be in early labour try laying down, having a relaxing bath or shower and drinking some water (see Disclaimer above).  If you are dehydrated, it can increase the level of oxytocin in your system, causing irritable but not labour contractions.  If the cramping does not subside once you have had a drink of water and relaxed, you may be in early labour.  Do not be surprised if this early labour comes and goes, or persists for days; it can be absolutely frustrating, but completely normal for some women.

Now, back to the original question: “How do I know it is labour?”.  Labour signs are sneaky and don’t always start the same way for every woman.  For one woman, labour signs may start with Nesting, progress to back pain and then jump right into full on labour.  For others, they may just wake up one day in full blown labour without any other signs, and others still will trickle along, having lost their mucus plug weeks before labour starts, or even having any other signs.

As a doula, I can give you information to help you assess the signs, we will discuss how you are feeling and whether it is appropriate at this time to assume labour has started (it is always best to discuss with your care provider what signs they are looking for and when they want to be called), and support your choice for the next steps (wait some more, give some coping suggestions over the phone, have me come over and see how you are managing in person, meet you at your planned place of birth, etc).

The truth is, it is sometimes not until labour is over that you can look back and go “Oh, so those middle of the night cramps that were waking me up every 30 minutes was the real start of my labour”.  When deciphering labour signs, hindsight is 20/20 after all, even for us doulas.

But, my clients will always be able to call me to listen, help them understand and support them when (and if!) these early signs start to appear.

Why “The Birth Nerd”?

I have been working as a doula for almost five years now.  In that time, I have searched my soul for my “thing”, the one thing that makes me and my doula services unique.  It has taken a lot of hard work, soul searching and frankly, trying to force myself to work with clients that I just don’t mesh with because I felt I was supposed to doula a certain way.

So over the last few weeks, I really asked myself a lot of difficult questions, searching for an answer.

And suddenly, it struck me. I am an avid inhaler of information.

When I was pregnant, I was the one reading birth stories, borrowing stacks of books from the library, and buying any books that I wanted to read over and over.  I had a small library worth by the time our first was born.  I could not (and still cannot!) stop myself from learning more and more.  Anytime I come across a new word I don’t know that might be about birth work, I google it for a quick definition.  Then I look it up in my books and I learn everything I can.  In our prenatal class, I was the one in the back of the class rolling her eyes and going “How can you not know this!?” at the eight month pregnant woman who didn’t know what a placenta was.  (Disclaimer:  As a doula, I absolutely understand that everyone chooses to approach their birth differently; as someone who deals with things by learning as much as I can however, I could not understand how you could not know this stuff!)  In doula training, it was the same for the doulas-to-be who regularly stopped the class to have certain words or concepts – that were in the required reading- explained to them.  What happened to, you know, actually reading the books (there were several, by the way) that were on the required reading list!?

My strength lies in information and non judgmental support.  While I have my opinions on how I do things with my children, and I will share if you ask (because who doesn’t love talking about their kids?), I am not here to judge, make you see my side, or do things my way.  The only perfect way for you to give birth is your way.  I will give you information to find your way and then stay by your side on your journey. Think of me as your travel guide for birth.

So, on my journey to find out what kind of doula I am, I discovered that I am a bit of a nerd.  I geek out learning about this amazing process and how to support women and their families through it.  I am sure I have frightened a few potential clients away after getting too excited and sharing a little bit of TMI about birth at an interview.  So, let’s get this out of the way now: I love birth.  It is amazing, it is powerful and wonderful and miraculous.  It is also a minefield of choices, options, opinions and misinformation.   Wading through all the information is very difficult to do alone.  If you are looking for support, are up to learning about it, what your options are and discovering what your preferences are, give me a call, and we can talk birth!