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Labor Attendents

November 2, 2009
Times Observer
BY HEATHER M. NUGENT, HOMESCHOOLING MOTHER, WRITER, REGISTERED NURSE, DUNKIRK, NY

If you are expecting the pitter-patter of little feet in the near future, you are undoubtedly faced with many exciting decisions regarding your labor and delivery. Today’s expectant couples have access to seemingly unlimited information and advice in the form of books, television shows and the world-wide-web. This information makes it possible for mothers-to-be to have an informed voice when it comes to healthcare decisions during labor and delivery. Still, a mother-to-be may feel that even with access to all the information, she would like to have someone to whom she can turn for advice and support as she journeys toward childbirth. The women of my generation are most likely the daughters of women who were given very little information or choices in childbirth. They were escorted through a medical system that thought it was best for women to be passive in labor and birth, often receiving consciousness-altering drugs that left them barely able to witness their own children being born, much less actively participating.

For this reason, our mothers are not always able to offer the wisdom that daughters of generations past relied upon as they prepared for birth. Increasing numbers of expectant couples are turning to professional labor attendants for advice and assistance during their labor and delivery. By now, most of us are familiar with the word “doula”, which means woman-servant. A doula is a specially trained, non-medical caregiver who acts as a constant source of support and encouragement to laboring women. Doulas do not perform any medical assessments or offer medical advice. Rather, they learn what kind of birth experience the expectant mother wishes to have and offer her support in achieving her goals.

A monitrice is a professional labor attendant with a medical background. Unlike a doula, a monitrice is qualified to perform assessments of fetal heart tones, maternal blood pressure and cervical changes during labor. This information can provide the security a laboring mother may need to feel comfortable laboring at home as long as possible. The benefits of laboring at home are numerous! They range from increased comfort and shorter labors to fewer complications and decreased incidence of cesarean section for "failure to progress". Women labor best when they are comfortable and feel safe. For many women, this means laboring on their "home turf" even if they are not comfortable with the idea of birthing at home. A monitrice works with the expectant family in the months before labor begins. She assists them in visualizing and verbalizing what kind of birth they wish to have and what steps can be taken to make that possible. She is a consumer advocate who not only educates expectant mothers, but also can assist the expectant mother in communicating her desires with her physician or midwife. Once at the hospital for the impending birth, a monitrice acts as a support person and an advocate for the expectant family. Families can also work with their doula in the weeks prior to their birth. If the attendant and expectant family are able to develop a relationship before the woman goes into labor, the expectant family will have one more person present at the birth who understands their needs, situation and desires. The prenatal period also offers the doula or monitrice time to make sure the expectant family is educated about normal labor and to answer any questions they may have about the birth process. So often women feel a sense of a loss of control when they enter the hospital to deliver their babies. Many women feel they have not had enough time at visits with their obstetrician to develop a relationship and learn about what to expect when the baby is ready to be born. A professional labor attendant can bridge the gap, offering experience and wisdom, helping families to choose a childbirth education program and suggesting other resources for self-education. During labor, a professional labor attendant can offer assistance with pain management, help a mother to stay active and facilitate communication between busy staff and expectant family. Because they work for the parents-to-be, the role of the doula or monitrice is flexible. Their role depends on the type of birth the mother-to-be wants to have. An attendant’s job is not to make choices for the expectant parents, but to facilitate their education and support their decisions. Doulas and monitrices do not make medical decisions for the expectant family, nor do they communicate with medical staff in place of the expectant mother. They take on a supportive role, facilitating the mother and father’s ability to be active participants in their plan of care. Most importantly, a professional labor attendant provides care and support to the expectant mom. Women who labor with a doula or monitrice are less likely to need epidural anesthesia and less likely to have cesarean births. While these caregivers can not guarantee the outcome of your birth, they can ensure that you will be empowered by education, that your voice will be heard and that you will have a strong hand to hold as you journey toward meeting your new addition. Your childbirth educator is often a good referral source for a birth attendant. DONA provides national certification for doulas and can act as a referral source, but not all professional labor attendants choose to be certified through this organization. If you are interested in finding out if a doula or monitrice is right for you, word of mouth referrals from those who know you may be the best route to take. Most labor attendants will meet with you in person before you officially agree to hire them and any reputable attendant will be eager to offer a referral if either of you feel you are not a good match. A professional labor attendant's number-one commitment is to helping you to have your best birth, whatever that may mean to you.

Heather Nugent is a homeschooling mom of two who lives in Dunkirk. She works outside the home as a labor and delivery nurse in Buffalo. Heather also works as a midwife's assistant, labor doula and massage therapist.

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