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Training, Education and Services
March 2007 - Vol 2, Issue 3
The Positive Effects of Drugs
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Hello friends,
chana luba

Hope you are all having a great winter! This newsletter is a bit late and a bit long...I hope you enjoy it
I belive that every woman has the innate wisdom and power to birth babies naturally with out pain medication but there are cases when help from strong drugs is beneficial or even necessary to birthing women. I like to think of all things as tools rather than interventions. It is true that sometimes birth is taken away from women, put into the hands of a controlling care provider and interventions are used to manage her labor. Although, through my experiences I have seen that sometimes if chosen in a conscious way by the birthing mother there are times when pain or relaxation tools can be beneficial. As doulas and educators I think it is important to have a holistic view of the birthing process and all it's options. There are many factors these days that influence a woman's ability to tap into her innate wisdom and power. Sometimes a birthing women is not able to reach her source of inner strength and intuition, does this mean she doesn't deserve to have a positive birth experience? Does this mean she doesn't deserve the support of a doula? Does this mean she has failed? Does this mean she is weak? As complex as the birth process is sometimes so are the reason for the choices surrounding its paths are.

The Positive Effect of Drugs...
in tub w IV
What is the objective when serving a woman in labor? Is it that she have a natural birth, a safe birth and empowering birth, a healthy baby? For many women and for many doulas many of these desired outcomes overlap, but as a professional doula one must remember some of the Golden Rules of Labor Support:





  • It's not your birth
  • Never give medical advice
  • You don't know everything
  • How will the woman remember this
  • Be an Advocate rather than be an Adversary
  • Never be disrespectful of medical professionals
  • Your on the caregivers turf

In keeping the above points in mind it is also helpful to think of medications as tools. Using a certain drug at some point in labor can still afford the woman to have a positive drug free birth, an empowered experience and a good birth memory. The last thing women in labor need is to be judged by the person that they have chosen to support them. It is indeed a fine line but one that must be walked with compassion and and trust. Specific situations in which drugs can be helpful in facilitating a good birth are when:

  • a woman has had a prolonged prodromal labor with no rest, sometimes a sleeping aid early in labor can give her the rest she needs to wake up refreshed and ready to labor naturally
  • When a women is a survivor a sexual abuse and has a hard time letting go of and excepting the sensations of pressure in her vaginal and perinial area. Sometimes an epidural can enable such a women to relax and let her body do what it needs to in order to have a positive birth and avoid a cesarean section.
  • When a women has been in active labor for a long time and needs a break, sometimes a stint of Nubian can give her the rest she needs to deliver naturally with out an epidural
  • Although IV fluids are not a drug, many consider it a negative intervention. I have seen that for the woman who is vomiting a lot, a bit of IV fluids can help stop the vomiting and dehydration and really perk her up.
  • When a baby is posterior or in a difficult presentation sometimes labor can be prolonged and the 2nd stage difficult. In such a case if all other tricks have been used and the mother is becoming exhausted a light epidural might relax her body enough so the baby can turn and she can avoid a cesarean section.
Cultivating Tools...
materanl kiss in hospital
It is also important to keep in mind that women who choose to give birth in a Hospital are doing so for a reason! Although they might be committed to natural birth in the back of their minds they probably feel comforted by the fact that medical tools are available should they need them.
Some women want a good birth experience, choose midwives and hire a doula, but are honest with themselves about the what they think their choices will be. It is important that a woman be well informed about the pros and cons of any medical tool and it is also important that through prenatal work her fears are confronted and healed as much as possible. If after these aspects have been addressed she still makes a conscious decision to use medical tools her choice should be respected and not shunned.

I have been surprised to learn that some doulas will not take on clients who are open to medical tools... While it is true that a doulas strength lies in supporting a women while she is in the throws of natural birth, there are other aspects of being a birth facilitator and guide that can exist if the labor and birth is altered with medical tools. Can you think of any ways.....
Learning Tools...
birth partner book
Penny Simkin has written two good books which clearly illustrate medical tools and their pros and cons. They are The Birth Partner and Pregnancy, Childbirth and the Newborn. These are good resource books and are a valuable resource for an informed doula. They can both be purchased through the Maternal Wisdom affiliate store.

If you have a client that is 'on the fence' about medical pain management, one suggestion is to create a 'code word'. Many times a women in labor will say things like 'help me, I can't do this anymore', etc. As a doula it could be confusing as to what her real desires are. Does she just need to be coaching, encouraged and supported through a difficult phase or does she really want a medical tool, such a pain medication? If you create a 'code word' prenatally than when she 'says the word' you know she is serious about her choice. The word can be anything, 'hot mamma', 'rescue me', 'soda pop', etc....
teaching D&E
The Winter Training was great! A small intimate group of 8 women joined me as we explored birth, learned skill and techniques, learned what is involved in doula work and practice birth scenarios.
Big screen projection of charts and birth videos have been very cool and I have added to by birth video collection and was psyched to share them. My work at Franklin Medical Center has also allowed me access to medical equipment to use in demonstrations bringing the seriousness of medical birth home... (ever held an internal electric fetal monitor probe? AHHH)
My fall and winter training dates are set and will be up on my site soon. Keep a look out for early bird registration and work trade positions. Some great web site developments are in the works, I will keep you posted on the progress of it.
The Winter 2007 Group!
group picture winter 2007
"This has been one of the most valuable experiences in my life so far. I feel like I have learned an extraordinary amount about birth, and it has completely revolutionized my views/opinions. It diffused all of my fears and stereotypes about birth, so that I now feel confident in both ability and other women’s ability to give birth. This was an incredibly enriching experience." Natalie K. Northampton, MA

"The training really inspired me and challenged me to look at doula work in a new way. Chana Luba was a wonderful innovative teacher. I left every class thinking/talking/dreaming about birth. I am so excited to begin my journey as a doula and I am grateful that Chana Luba was my introduction this journey." Amelia A. Amherst, MA

Thanks for taking the time to read this and feel free to forward it...


Chana Luba Ertel, CD (DONA), CLD, CCCE, CAPPA Labor Doula Trainer of MA

Maternal Wisdom

413-253-9618