71. How Doula Support Helps You Feel Empowered and in Control of Your Birth

In this episode, we chat with Karissa, a dedicated doula and birth educator, who provides a wealth of knowledge on navigating medical interventions in pregnancy and birth. 

We talk about:

• Typical experiences with interventions suggested by providers, from pregnancy through active labor…
• Discussions around common interventions like cervical exams, Pitocin, AROM, and epidurals…
• Client-provider interactions and strategies to ensure families feel involved in decision-making…
• How doulas can establish a supportive role with the medical team while advocating for clients’ birth preferences…
• Tips for birth planning, preparing for unexpected interventions, and advocating for birth rights…
• … and an inspiring story where Karissa supported a client through a medically complex birth due to preeclampsia, helping them feel informed and in control.

Join us as we uncover practical strategies for creating a birth experience that’s informed, supportive, and empowering. Whether you're expecting or supporting someone who is, this episode offers valuable insights for every birth journey!

✨ Connect With Karissa

Podcast - The Birth Tide Podcast
Website - www.thebirthtide.com
Instagram - @thebirthtide

🌸 Connect with Beth

Website - www.familyfocusedmidwifery.com
Instagram - @family.focused.midwifery
Pinterest - bethconnors_cnm
Etsy Shop - Your Birth Bestie

👋 WHO AM I?

Welcome, friends! I am Beth, a certified nurse midwife, doula, and childbirth educator. My philosophy is rooted in autonomy, informed decision making, and positive mindset to help expecting parents plan for a beautiful, stress-free birth. I am here to provide value to YOU through tips and practical advice, either to guide you through pregnancy or to help you prepare for childbirth, postpartum and beyond. There’s no fluff here - only info that adds to your positive experience and saves you stress and uncertainty.

Transcript

 Hello, everyone, and welcome back to Episode 71 of Your Birth Bestie Podcast. Thank you so much for being here as I am catching up on past guests that I've interviewed and have a lot of amazing episodes to share in the next few weeks. Harper is already three and a half months old, so we are in the thick of the four month sleep regression, and we're going And my work time is a little bit unpredictable, so I'm working through all of that, but I'm so glad that you are back here with me, and I look forward to getting back to these weekly episodes.

And today, I am thrilled to welcome Carissa, an experienced birth doula and birth educator who shares her insights on navigating medical interventions, advocating for clients preferences, and empowering families to stay informed and involved throughout their entire experience. This is really the foundation of a positive birth experience and is something that we definitely could have talked about for hours, and it's really my why to why I'm working in this field.

In the birth space. So I love talking to Carissa about her experiences and together we will dive into real scenarios that many expecting families face from early interventions to last minute changes in their birth plans. And I hope this episode helps you feel better prepared to advocate for your own birth experience and make empowered choices because you absolutely deserve a beautiful autonomous birth experience where you call all the shots and you are completely in control. 

Hey there, I'm Beth Connors, a midwife and mom of two, but also your birth bestie. In this podcast, we'll dive deep into everything you need to feel confident, prepared, and in control, from baby bump to delivery room, from practical tips to personal stories. We'll cover it all so you know exactly what to expect every step of the way.

Let's get into it.  I'm Carissa. I am a birth doula and childbirth educator in southeastern PA. If you're familiar with the area, I'm like halfway in between Philly and Harrisburg. So right now in Reading, I'm moving to Lebanon soon though. Um, so as a doula, my goal is to help both the moms in labor and then also their support team to feel comfortable and to feel safe, taken care of,  and to understand what's happening.

So I don't have a lot of medical training. I'm not a nurse. I don't do. Cervical checks, blood pressure, that kind of thing. Uh, but I do love learning. I love research. Uh, so I spend a lot of time just researching, listening to lots of podcasts, uh, observing and learning so that my clients can know what is happening.

Um, and so I can, you know, explain things to them. And so I'm familiar with the medical system, uh, so that hopefully they can feel more safe and relaxed. So yeah, I love birth. I've been doing this for now a little over a year and hopefully I will keep doing it for many more years to come.  Yes, I love that.

I think you have so much experience to just, I'm surprised it's only been a year, honestly, with how busy you've been, um, and all that you've done and learned and all the things. So, um, yeah, today I really want to talk about, you know, a doula's role with medical intervention, how we kind of help navigate those situations.

So, if you could tell us a little bit about your experience with With, you know, medical intervention being recommended in the hospital, and if that's something that you kind of come across often, or maybe not so much, because your clients are more prepared. I'm just kind of curious to hear your experience about that. 

Yeah, so it kind of depends on what we, I guess, would call an intervention, because sometimes they're negative, sometimes they're positive. I think as birth workers, we typically would, um, like, agree that interventions are something that intervene with the natural birth process, whether that's Uh positive or like medically necessary or sometimes unnecessary a lot of times my clients in particular are like hoping for Um a lower intervention birth because we can see statistically that those typically have better birth outcomes And so sometimes they're trying people are trying to avoid these interventions, so These interventions are often suggested um A little bit more, maybe often in hospitals than maybe out of hospital births, and it also really depends on which hospital.

So in my area, I never really counted actually how many different hospitals are in my area. I've probably been to about 10 different hospitals within an hour radius from me. So while one hospital is like used to supporting c section of vaginal birth after two c sections and might have a 24 7 breach of vaginal delivery team on standby, then the next hospital might have You know, none of that available.

They might not really do feedbacks that much. And they might, you know, moms might have to fight to even like not have IV fluids during their labor. So every hospital will be very different. Um, some common interventions though, I would see in pretty much every hospital I've worked in, um, is electrical.

fetal monitoring and that's where there's the continuous monitors to monitor the baby's heart rate. Inductions to get labor started. Sometimes orally or vaginally medications are given to help ripen the cervix. Pitocin  medication that helps the contractions speed up, get stronger, closer together.

Cervical exams can also be an intervention. Artificial rupture of membranes where the provider ruptures the membranes rather than them break on their own. Membrane sweep. Um, and then the lesser ones, but also. Things that can happen, episiotomy, vacuum, forcep. So I would say all these things I see in hospitals.

Uh, but then it just depends on which hospital, uh, how often maybe they come up, or how heavily they are pushed. In a hospital where they are very familiar with physiological birth, and the nurses are trained in spinning babies, they might, you know, be a little bit more welcoming to like, Oh, yeah, you can define that.

No worries. Whereas in another hospital, they might be, uh, suggested, um, a lot more. I also attend a quite a few home births. Um, these things don't come up, uh, quite as often. Um, and then, um, Home birth clients typically are a little bit more, um, maybe  familiar or like know what they want as far as some interventions if they would transfer.

Also midwives often transfer with their clients to help like advocate, um, for them too. But sometimes out of hospital births, um, interventions that I can happen to are things that help stimulate the contraction. So herbs, nipple stimulation, membrane sweep also. Sometimes, um, the waters, um, bags are broken, cervical checks, all those things are pretty common interventions that can happen.

Do you feel like in your experience that's something that clients will struggle with, with, you know, informed consent piece and not knowing how to advocate for themselves, or how do you feel like I guess the system, specifically in the hospital, helps inform patients. So I guess it, again, kind of depends on which hospital is, but generally what I see is the nurses are the ones that are really good at informing the clients.

Now sometimes there are nurse midwives in the hospitals and sometimes like OBs, like I had one time at an OB that he just like sat down on the chair in the corner, crossed his leg, and is like, Tell me about what you're hoping for. And I was like, wow, you don't see that much from  an OB. Um, so generally it's more the nurses that Are like advocating for um, and informing the clients my clients their patients of what's happening.

Um, so Sometimes like a nurse might or a midwife might be talking with the nurse like hey Like I think we should go start toson And so that's why we hear from the nurse more that the nurse might come in Hey, your midwife like would like me to start pitocin. Um, sometimes the nurses are really great and they might be like Hey, we're seeing this and you've not progressed Uh in the last like couple of hours we typically like you to see for See you progressing like this.

Here's kind of like what the midwife is thinking. What do you think? Um, I would say more often though. It's kind of approached as like here's what's happening So now we would like to take this next step So sometimes like they there is room for clients to decline it But it might not be You know placed into their hands as like a yes or no decision.

It's more like Hey, this is like what we would like to do next. Um, and they could decline it if they would want so I don't unfortunately, I don't really see Um a lot of informed consent. Um, like I was like saying so Yeah, I think it's a lot of that like matter of fact Kind of this is the plan. This is what we're going to do.

This is what we would like to do. And, and there's other ways too, that it can be helpful for patients to have that invitation to make a decision, like asking, what do you think about this? Or is it okay if we like that just simple asking of a question, I think is. Yeah. Yeah. Yeah, for sure. Because like some women won't feel as confident to like, you know, Be like, wait, hold up, I'm not really sure if I want that.

And to like, say no, whereas if it's put into their hands of like, Do you want this? Yes or no, then they can kind of weigh their options even like as someone like myself who is um more confident driven kind of um against the grain kind of person even it's hard for me sometimes to like stand up to providers and be like Oh, we actually don't don't really want that uh, because you know, they do have more training they have um a lot of experience they've seen a lot of births and we are taught we're raised, you know that they are You Um, like an authority figure and birth is just a little bit different in the fact that we can have autonomy, we should have like a say in what happens in our birth.

And I think it's really important for moms to have, be part of that decision making pro process. And we can see too that moms are less likely to have a traumatic birth experience when they had a voice and when they were a part of the decision making process, rather than things just happening to them or being told, Hey, we're gonna check your cervix now because.

In a sense that is  Um, they are being informed, like, hey, we're doing this, so they understand what's happening, but it might not be as much consent, like, are you okay with this happening? Right. And it's really hard to speak up. I feel like as a patient, even myself, when I was a patient with my first two kids, I didn't want to go against the grain.

I didn't want to be that difficult, you know, quote unquote, difficult patient. Um, I was afraid that they would maybe treat me differently or, you know, think less of me and, you know, things like that. So. Yeah. Now being on the other side of it, I think it's easier to advocate for somebody else, honestly, but also giving that invitation from a provider or a nurse, I think is something that I wish there was more of just to create the space for conversation that is definitely needed.

Um,  In terms of when you are kind of communicating, you kind of mentioned that sometimes it can be difficult, you know, to speak up, is there a certain way that you,  you know, involve the patient or how do you normally go against, I guess, a recommendation or ask for more time or things like that with the medical team?

In a respectful way, I guess.  Yeah, yeah, so this is something that has actually been way more of a challenge for me than I thought it would be because I am typically like outspoken, opinionated, um, but it's sometimes challenging because  they are the authority and, oh, I don't really want them to have like a bad taste of doulas or I don't want them to like, You know, ban me from coming to that hospital, but it's something that I really try to I'm like trying to learn to, uh, navigate.

So, uh, so for instance, like one way is that sometimes I just, you know, let the nurse or the provider know like, Hey, this is what, um, remind we're just reminding them of like, Oh, this is what they wanted. Um, but especially. Navigating that with the nurse and like going over the birth plan with the nurse in the hospitals.

The nurses are the people who are going to really make sure the birth plan happens at a C section. Once I had a mom that really wanted skin to skin right away and her nurse made sure she got that skin to skin. There was another nurse in the OR that's like, Hey, let's just like quick way the baby first.

And the nurse was like, Oh no, she just wants skin to skin right away. And another nurse was like, let's just quicken it. Diaper though. And the baby and the nurse was like, no, she actually just wants skin to skin. And so I was like, go her, like, um, having that nurse there that knew her birth plan. So I always try to make sure the nurse knows the birth plan.

Like, as soon as we, um, get to the hospital, it's a little easier to advocate and stand up for my clients when things are slower. And maybe we like first get there to the hospital. Um, but if I know that there's something that mom is going to have to sign an AMA for. Uh, such as like maybe she doesn't want postpartum pitocin or if she doesn't want erythmicine, like the eye ointment or vitamin K afterwards.

Like if I know that she's going to have to sign something for it, I don't really want her to have to do that when she's pushing or like in transition. So I really try to make sure the provider, the nurse knows about that, um, ahead of time. Um,  sometimes things come up like when pushing, for instance, today I was at a birth and the mom The provider really wanted the mom to be pushing on her back.

And so then I like offer solutions when the provider is like, okay, let's get her into the lithotomy position. Uh, that's the laying on the back position. I was like, Oh, she actually didn't want to be on her back. And that didn't work. Cause like literally the next contraction, the provider's like, Why don't you just get in your back?

It'll be easier for you. And I was like, Hey, could we just do side instead? And so offering a solution then helped in a couple of contractions later, the provider kind of understood that she really didn't want to be on her back. So I found like offering a solution, um, instead can be really helpful. Uh, because sometimes I get that point, mom isn't really able to, uh, speak up or, um, Yeah, speak up maybe as much for herself.

Um, sometimes if things are, like, offered or be or, like, happening in the room, uh, that I know that mom would want to know about or maybe they're going to administer medication without really informing her and getting her consent, then I'll get, like, really close to the mom and, like, Quietly just like talk with her.

Um, sometimes like I've seen like a mom get sick in labor and they were, they started throwing up during pushing and the provider is like, Oh, give her Zofran. And like, they're just like going to go and put Zofran right into her IV and I knew like this mom really didn't want a lot of medications. And so, you know, there's a lot of people talking in the room.

I assume that she probably didn't really hear what was happening. And so I would just get close to her face and say, Hey, like they saw you're sick. The Zofran can help you not be nauseous. They were going to put that in your IV. Are you okay with that? And then, you know, there's been times when she's like, Oh no.

And then the privater is like, Oh no, she actually doesn't want it. Um, but that was one way that like, I could like advocate for her to just say, um, let her know kind of what's happening, especially when there can be kind of like commotion in the room. So just kind of, uh, offering solutions, offering alternatives.

Being observant of what's happening and like explaining things to her, uh, and then also just staying in good communication, uh, with a nurse. Generally, I've seen it's better to just over explain things than under explain things. Moms would typically prefer to know what's happening and like why this is being suggested rather than just like, Let's give you a friend.

Let's get you onto your back kind of thing. Yeah. Telling patients what's happening in the room and just kind of explaining it in lay terms is the most beneficial thing to honestly, because  yeah, a lot of times things just happen and yeah, there's not a third party, like a doula there or somebody that kind of what the next steps are.

You can kind of be like, Oh, this is, you know, I heard this. You're, you're kind of also just like listening and it's like, well, I heard this. I'm talking about this over there. Just so you know that they're thinking about this, you know, if that comes to be, what is your thoughts about it? I think is just the best way to involve them because that's really the most important part.

Um, which I guess kind of leads to my, you know, my next question about feeling in control of their birth. And maybe if an unexpected intervention Is necessary and they are agreeable to it. Do you normally like prepare clients for this in pregnancy or is that something that you feel like you have time to do in the moment or how do you navigate that? 

Yeah. So I encourage all of my clients to take a birth class, either my own birth class, or I have a couple online I recommend. Uh, and sometimes I see like birth classes do like skip over these like emergencies or things that like, Can come up or whatever. And so it's something that I discussed in my birth class.

And if they don't take my birth class, then I discussed that too. Um, so we make a birth plan in our prenatal visits. I meet with them twice. We make a birth plan and we go over all the things. So in the case of like. baby's heart rate declining, like it is possible that like your provider might mention like a pseudotomy.

This is why this is like statistics. This is why they might recommend vacuum. Here's the cases where they might like use that. And we just like talk about all of these things ahead of time. I really try to get to know their birth philosophy and how they feel about the medical field as well. So if I know my clients, um, will be very anxious and medical setting, then I make sure to  Turn off the lights, close the door.

Cause sometimes a lot of times actually providers will just like leave the door open and like, you hear all the hospital noises and, um, or if I like hear beeping, I just immediately, you know, tell them, Oh, here's what's beeping. That's why the nurse will like get it kind of thing. But I try to like, get to know how are they going to be feeling in the medical system, if they're going to be anxious, then I know I might like be explaining things even more to them.

Uh, I also try to prep the partner ahead of time too. So like. Explaining to him like ways that like he can advocate because, uh, providers are more likely to listen to the partner than to the doula because, uh, yeah, you know them better. And so sometimes, you know, I explain ahead of time, you know, will you want me to be the person who like stands up or, um, speaks directly to the provider?

Or do you want me just kind of like. nudging you or like kind of giving you like a look and being like, Hey, you can say something to the provider. Most times the husband are like, Yeah, no problem. I have no problem saying like, no, or whatever to the provider.  And so sometimes they just need a little like extra encouragement to be like, Oh, yeah, like now's the time that you can be like, No, she actually doesn't want this.

So I usually try to Yeah, prep the husband to like know how to Um, advocate, but I try to like, get to know their birth plan. And, and then also like, I tried to understand too, how strongly they feel about, um,  specific like things, like, are they very, very strong on not wanting that, but Daryl, or are they kind of like, they want unmedicated, but they like are open to it if their provider like brings it up kind of thing.

So it's really about, I think like really just getting to know the clients ahead of time. Yeah. That's my, probably my favorite thing about being a doula is like that one on one connection, being able to know exactly what they want and advocating for them, because that's the part I missed being in healthcare as a nurse was you just met them, you know, maybe a few hours ago and yeah, you don't know what they want.

They have a plan, potentially some people brought in birth plans, but not to the level of like the doula or the partner. And then also having that. Connection as the doula with the families is you're able to like, open their mind to all these possibilities of the options that they have and the birthrights that they actually are able to advocate for themselves and make decisions and be involved.

And that sometimes is like really mind blowing for people. Um, and I love, I love that part of it. Cause it's like, no, you don't have to do that if you don't want, and they're like, really, wait, seriously? And I'm like, yeah, I know. It's like the best part of, I feel like the job is just telling people that they have the autonomy and.

Yeah. Helping them like achieve that because that's so empowering and just like makes the experience so individualized. Yeah.  Yeah. Exciting for them.  And showing them again, that like they can trust in their body and listen to their intuition because the medical system really approaches birth as like, it's a medical event.

It's potentially a medical like emergency C section is always on the table until your babies are in your hands, um, kind of thing. And so, yeah, it's really cool to be a doula and just, you know, help them trust in their intuition more and listen to that voice and get to know like, Oh, do I want this? I think that's really cool. 

Yeah. Do you have like a favorite story or example about how you cared for? A mom as a doula and like helped her whether it was a medically complicated birth or maybe something that like far deviated from the birth plan and how your support really helped them get through that.  It was hard to come up with like a favorite story just because I feel like most births that are in the hospital end up needing some kind of, I mean, any birth needs advocating and oftentimes like.

Things like end up coming up, but, um, I guess one that stands out though, is, um, a mom that I supported her, her water broke at 34  weeks. So she was preterm. Um, and that day that it happened, I met them at the hospital. Um, so then I was there with them when MFM,  maternal fetal medicine came in to talk with them.

And then also the nicotine comes in to talk with them, to talk about like the steroid shot, to help get the lungs more developed for the baby when they're born to go to breathe better. Um, and then also like the OB and the nurses came in and they actually had a lot of conflicting ideas. And so like after they left for like an hour, we just like sat there and talked about and wait.

Was that MFM saying we should like induce or is that NICU and what was that then that was saying we should like wait or, you know, just like helping them like navigate and sift through like they just got like a fire hydrant of information and now they need to make these decisions. Um, so I was able to help them navigate through that.

Um, a couple of days later, they did decide to go through with induction. So, uh, they started the cytotech, uh, that there, this one, like evening, it was actually the night before Christmas Eve.  Um, and so I was figuring, okay, his baby's probably going to be born sometime on Christmas Eve, or maybe even Christmas day, cause inductions often take long.

Uh, but I reminded her that, you know, sometimes cytotech, even though it's meant to solve in your cervix, it can like make you actually go into labor. Um, So most the night she was feeling really crampy. She actually didn't get hardly any sleep at all. And in the morning, like we were texting and she's like, she's going to jump in the shower.

This is really uncomfortable. And I was like, Oh, that's interesting. Kind of sounds like maybe she's having contractions, but the provider and the nurses, they were just like, no, this is only cramping. You shouldn't be having like contractions yet. Kind of thing. Around 9 AM, her husband texts me and she's like, She's having really strong cramping every two minutes.

And I was like, okay, I'm headed there  anyways. And he was like, and they want to start Pitocin now. And I was like, well, how's she doing? And he's like, well, she's really breathing through them. And I was like, well, you know, it sounds like she pursues she's progressing really nicely. It might feel really like intense to get Pitocin now.

So like, if you want, you can just say, Hey, can we hold off on the Pitocin, uh, the provider. So it was one of the hospitals that is more, um, medically.  maybe intervenes a little bit more often, um, more medically. And so they were a little hesitant to be like, uh, we don't really want to hold off in the Pitocin.

You are doing this induction, but they were willing to wait an hour. So in that hour, I was able to get there and I could see she is really in labor. So that hour mark, they came in and they're like, Hey, we're going to start your Pitocin. And she was like, I feel so much pressure. And so they checked her.

She was Oh my God, one contraction.  And later she started bearing down and she was nine centimeters and the next contraction she also  started bearing down again. So they checked her again. And she was 10 centimeters. So then she started pushing and I think one or two contractions later, like we could see the baby's head.

And honestly, the only reason why the OB got in the room fast enough, cause I like looked at the nurse. I'm like, this baby's coming. I think that you should call them. She told me later, she had never seen, um, a birth like happened so fast, but, um, I also knew that my client was going to be very calm and labor.

I knew how much mental prep she had been doing. Um, and so I knew that she would, you Be handling the contractions probably very, very well because I knew that she just had a lot of peace. Um, afterwards, like she told me, she was like, she was so glad that I was like, you can just say no to the Pitocin because her goal was having this unmedicated birth.

And she just was so, so happy with her birth outcome. She had an unmedicated birth. It was a fairly like quick, like induction. She also had, um, an hour of skin to skin. The baby was just a little over four pounds, but she was able to breastfeed before the baby had to go to the NICU since she was not able to keep her body temp up.

And so I think like, if I wouldn't have been there, they probably would have started the Pitocin baby might've been taken away right away. And so she was really, really grateful that I was like, Hey, just, you can hold off on the Pitocin. Um,  So that was, yeah, that was really cool to be able to see that even a preterm, yeah, birth like that, uh, didn't have to be maybe as medically involved as they were, uh, maybe recommending. 

Yeah. That's such a good example too, of just knowing your client like individually and all that work that you do prenatally, how important that is. And then actually giving them the tools to advocate for themselves and, you know, helping them prepare, having them feel confident that, you know, you know, what you're talking about and you're able to also offer support and guidance through these situations that are  very difficult, because it's so hard when, you know, you're.

Two different providers or even just specialties, like you said, are saying different things and they're like, well, then you can decide. And it's like, well, I want some guidance otherwise. So  being able to kind of pull from each of them and have them, you know, understand more about it and give them more time, I think helps with that initial part of that story.

And then also at the end with,  um, yeah, like actually letting them. Have this, that skin to skin time. I recently had a delivery just the same where it was a preterm delivery. And I think they probably would have taken baby right to the NICU to assess them and get all the, you know, things checked off the list.

If mom wasn't very adamant about keeping the baby, as long as the baby was okay with her for as long as possible. And then they actually never ended up having to take baby to the NICU and babies are 35 weeks. So, which was just such a cool thing that. That potentially could have also made the difference of that, you know, skin to skin, baby perked up right away, had a really good first breastfeed.

So, um, yeah, just, yeah, the power of being able to advocate for yourself and,  you know, as long as things are medically stable and everything's okay, knowing that you have those options, I think it's so, so beneficial for, for dual support as well.  Um, so as far as for people to connect with you, I know you have an online birth course and some other things that you are offering.

So if you want to just kind of share where people can find you, connect with you and what you've been up to. Yeah. So my business is called The Birth Tide. I have a podcast and Instagram, both of them are called The Birth Tide. On Instagram and on any podcast platform. And so basically my biggest thing is I just really tried to give information to moms to help them feel more at peace and more confident going into the birth journey, and I think that that comes with just being more informed and having these like practical, simple tips rather than, um, having a lot of things in like big medical terms.

We don't really understand. And then also, um, things that aren't really tangible. I think it's. Uh, better for moms. If they have something tangible, they can like hold on to or see or be able to do. Uh, so I'm pretty active on my Instagram. You could go follow me there at the birth tide. Um, I have, I'm going to be launching my online birth Academy soon as well.

So if you just follow me on there, you'll see all the updates for that.  Thank you so much for joining us in this episode today. I hope our conversation has given you some valuable insight into navigating birth interventions. And feeling empowered in your birth journey. Always remember that with the right support and preparation, you can make choices that are true to your needs and preferences. 

If you enjoyed this episode, please don't forget to subscribe and share it with a friend and make sure to tune in next week for another episode, giving you even more tools to feel confident and supported throughout pregnancy and childbirth. I will see you next time. Bye everyone.