Folic vs Folate Acid - What's In Your Prenatal Vitamins?

One of the most crucial ingredients to be found in your prenatal vitamin is folate acid, widely known and distributed in its synthetic form as folic acid.  Why is folate acid is so important and is there any real difference between folate and folic acid?  The answers to these questions may surprise you.   

What is folate acid?

Folate acid is a B-vitamin (B9) that can be found naturally in many food sources.  Folate acid is readily converted into it's activated form, L-methylfolate or methyltetrahydrofolate (MTHF), in the digestive system prior to entering your bloodstream.  L-methylfolate is required to make DNA and other genetic material. It also plays a role in creating red blood cells, building your immune system and maintaining good mental health.  

What is folic acid?

Folic acid is the synthetic version of folate acid.  It is almost identical molecularly to folate acid and was once believed to be metabolized more efficiently in our bodies than it's naturally occurring counterpart.  However we now know that unlike folate acid which easily converts into L-methyfolate, folic acid is metabolized by the liver and goes through a lengthy process to complete its full conversion.  This biological process is inefficient and has been linked to certain health issues.  

What role does folate acid play in fetal development?

Folate acid is vital in the development of your baby's nervous system, especially during the formation of the neural tube.  This tube is the building block for your baby's spinal cord and brain.  Folate acid is so important for fetal development that women who are planning on or actively trying to become pregnant should also be taking a folate supplement.  This is critical because neural tube defects occur between the third and fourth week of pregnancy which is well before most women even know they are pregnant*. Taking the minimum of between 400 and 800 micrograms (mcg) of folate acid daily prior to conception helps eliminate the risk for neural tube defects.

In 1996 the United States passed a law mandating that certain grain and cereal products (like bread) be fortified with folic acid.  This was to ensure that women of childbearing age where meeting minimum daily requirements of folate and reduce the instances of neural tube defects as many women are unaware of the importance of taking folate acid prior to conception.  Even with these fortified foods, women routinely do not get the amount of folate needed to prevent neural tube defects without taking some form of folate acid supplement, either as a part of a prenatal vitamin or as a single supplement.  

So if both folate and folic acid provide the necessary conversion to L-methylfolate, why does it matter which one to take during pregnancy?

Many physicians firmly believe there is no significant difference between using a folate acid supplement vs a folic acid.  In fact, since there is such a minute difference between the two many people use the terms "folic" and "folate" interchangeably, which can lead to a lot of confusion.  While it is true that folic acid ultimately converts into the active form of L-methyfolate, the process it must go through is lengthy and rather inefficient.  Studies have shown that even with this process there is still a detectable amount of un-metabolized folic acid left in the bloodstream, even after fasting.  High levels of un-metabolized folic acid has been linked to several health concerns, including increasing your risk for cancer**.  

As many as 40% of the population may also suffer from what is known as the MTHFR mutation.  This mutation can halt the body's natural ability to convert folic acid into L-methylfolate.  Essentially, because your body cannot convert the folic acid into its activated state it is not able to metabolize it, which can lead to deficiencies and serious health issues.  

While not everyone who has the MTFHR mutation suffer from its possible health issues, some health practitioners recommend genetic testing for this mutation if you have suffered multiple miscarriages as this gene mutation and the subsequent vitamin deficiency may be the root cause.  

It is important to remember that if you are not metabolizing all of the folic acid you are taking, whether due to its inefficient metabolic processing or a genetic mutation, your developing baby is not benefiting from it either.   

How do I ensure that I am taking a more readily usable form of folate?

Besides eating foods high in folate like spinach, avocados, asparagus and broccoli, you want to find a prenatal vitamin or a folate acid supplement that has an activated form listed as an active ingredient.  The following are a few of the activated forms of folate/folic acid that do not need to go through any conversion process in the body***:  

• L forms
• 6(s) forms
• Quatrefolic
• L-methylfolate Calcium

How do I find a good prenatal vitamin with folate acid vs folic acid?

There are many good prenatal vitamins available on the market today.  Frustratingly, the majority of them use folic acid rather than a form of activated folate acid.  Fortunately there are a few brands that use the activated form, and more and more are becoming available as people become aware of the difference between the two.  A quick search online can  provide you with a variety of options that suit your individual preferences and nutritional needs.  You can also take a stand-alone folate acid supplement along with a prenatal that does not have folic or folate acid as an active ingredient.  

Whatever method you ultimately decide on, DO NOT wait until you are pregnant to start a good prenatal vitamin with folate/folic acid of some form.  If you are trying to conceive, or think you may already be pregnant, now is the time to start taking care of your body and your health in order to give your baby the best prenatal nutrition.  

*Neural Tube Defects: MedlinePlus (US National Library of Medicine) 

**Cancer incidence and mortality after treatment with folic acid and vitamin B12; Ebbing M, Bønaa KH, Nygård O, Arnesen E, Ueland PM, Nordrehaug JE, Rasmussen K, Njølstad I, Refsum H, Nilsen DW, Tverdal A, Meyer K, Vollset SE.

***For a more complete list, information and comprehensive video explaining the different types of folate and folic acid, please check out this article written by Dr. Ben Lynch,  mthfr.net/l-methylfolate-methylfolate-5-mthf/2012/04/05/.  Dr. Lynch's site also provides in depth information regarding the MTHFR mutation as well as information pertaining to folic acid and pregnancy. 

Suggested Supplements:

Here are a few of the prenatal vitamins I have found that have the activated type of folate/folic acid and also adequate amounts of the other vitamins and minerals recommended for pregnancy.  Always talk to your care provider about questions regarding your unique needs and requirements before starting a new supplement if you are currently pregnant or have health concerns.  

• Isotonix Prenatal Activated Multivitamin - I personally have used and recommend this prenatal.  It comes in a powdered form that is added to water.  This helps the formula reach the same pH as your body's fluids.  I especially like that it is in liquid form when you ingest it vs a big pill, which eliminates the need for binders and fillers.  This also ensures optimal absorption of the ingredients so I feel you are getting a bigger bang for your buck (why pay for nutrition you aren't actually absorbing?).  You can connect with Julia, who is a distributer, for more information regarding this product here.
• Seeking Health Optimal Prenatal - This pill does not have any iron added to it and so may be gentler on the gut for those who are sensitive to it.  However, iron is very important to create the extra red blood cells you need to support your baby and the placenta as well as help limit postpartum bleeding.  Talk to your doctor about how much iron you need in your diet and whether or not you need to supplement with an additional iron tablet to maintain a healthy pregnancy.
• Smartypants Prenatal Complete - This gummy contains Omega-3 fatty acid, DHA, and EPA sourced from small fish (indicating fish types that may be lower in heavy metals) and does not contain any iron (which may be gentler for those who are sensitive to it).  Please talk to your doctor about how much iron you need in your diet to maintain a healthy pregnancy and whether or not you need to supplement with an additional iron tablet.  

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Why Choose A Doula?

Living in a time where everyone has to jump on the latest pregnancy or baby trend can be difficult. 

I understand because I have been there.  It is challenging to sift through the overwhelming amount of information regarding health during pregnancy and delivery, sorting trends and fads aside from important information and fact.  If you haven't heard of a doula before, the topic might be easily seen as belonging in the "trends and fads" pile.  Again, I have been there.  The term 'doula' certainly never came up in conversation in the circles I was a part of, either as a young woman learning about reproductive health in school nor when I was an adult discussing pregnancy and childbirth with friends.  However if you have dismissed the idea of hiring a doula out of hand because of stereotypes or preconceived notions about who they are and what they do,  you may want to take a moment to learn about some of the proven benefits of having the support of a doula during your pregnancy, labor and delivery. 

The fact is, birth culture in the United States doesn't really foster the idea of hiring someone to attend your birth for emotional support.  We have been brought up believing that birth is risky and laboring women are best left in the hands of highly trained physicians and nurses.  Hiring a doula, in most people's limited knowledge of the word, might require you to have a full-on-all-natural labor and forgo that epidural you have been considering.  Some of you may even think hiring a doula means you have to commit to a home birth.  These ideas couldn't be farther from the truth. 

A birth doula's sole job is to support the expecting mother emotionally and physically throughout her labor and delivery process in all of her choices.  All of them.  Doulas do not put their personal feelings or preferences regarding the method of labor or delivery in the mix when supporting their clients.  Doulas have the specialized training and skills to help a mother achieve a completely natural birth at home or to support a mother who has a planned cesarean section scheduled for her baby's birthday, and everything in between.  A doula differs from a doctor, midwife or nurse because she is completely devoted and focused on one mother, one baby, one family, one labor.  She is not there for medical support or care; she is there to help the mother achieve a satisfying birth experience by honoring her choices and providing the physical support, resources and emotional support to achieve them. 

Perhaps you are struggling to sift through the myriad of information and options for care during your pregnancy and your delivery.  Doulas can be very helpful in narrowing down what it most important to you and your individual needs and wishes in regards to care.  During their time spent with you before your labor, your doula will discuss all of your options and help answer any questions you have about common procedures and interventions that might be offered or necessary during labor.  Or perhaps the hospital or practice you are delivering with have certain interventions that they use routinely and you want to become more informed about them.  Doulas provide a completely nonjudgmental space for you to ask questions and discuss concerns, something you may not be comfortable doing with your physician.  Let me be clear though, a doula should never offer medical advice or suggest you forgo the advice of a care provider.  Her role is to provide information and resources that go over the pros and the cons of each choice you get to make for your care, not to steer you one way or the other.

Multiple studies have shown that having a doula attend your birth not only allows mothers to have a more satisfying birth experience overall, regardless of their method of delivery, but also improves the health outcomes of your baby.  Babies born to mothers who hire doulas typically have higher APGAR scores and are more likely to succeed in breastfeeding*.  Not only that, mothers who hire doulas are statistically less likely to have a cesarean section**.

What about your spouse or your partner?  How can a doula help emotionally support a laboring mother without pushing their most important emotional bond to the side?  It's simple, really.  A doula is not there to replace anyone or to take over your labor.  She is there to reassure you and your partner that everything is fine - that everything you are experiencing and feeling are normal.  She may help your partner support you by guiding their hands to your hips to do compressions or showing them how to 'talk' you through a contraction.  Her presence allows your partner to focus on you while she gets you water or a cool cloth for your forehead or any number of other, minor things that would otherwise draw them away from your side.  She gives your partner the opportunity to take quick breaks for food or to sneak off to the restroom without the fear or guilt of leaving you alone.  She can also relieve a lot of your partner's anxieties about how and what they are supposed to do when you are in labor - knowing that someone is there to help can be just as big of a relief for them as it is beneficial to you.

Many women and their partners struggle to justify the added expense of a doula during their labor.  While some FlexSpending accounts allow you to use them for doula services, as of now no health insurances cover the cost of hiring a doula.   For families that have little or no exposure to doulas or the benefits of having one attend your birth, this alone can be reason not to pursue the matter.  You are not splurging on a luxury when you are hiring a doula, you are paying for a trained professional to assist you with one of the most important events in your life.  If you have looked into hiring a doula and it is truly something outside of your family's means, it never hurts to contact a few doulas in your area and see if they are willing to work out a payment plan or if they offer a sliding scale where they charge families what they can afford.  Some metro areas also have community doula programs, like Urban Baby Beginnings based out of Richmond, VA,  for at-risk or economically vulnerable families. 

Lastly, having a doula present at your birth can empower you to advocate for yourself while in labor.  During the end stages of labor a mother is 100% focused on one thing: her body.  The late stages of labor require an intense amount of concentration and focus, and most women are simply unaware of their surroundings once they reach this point.  Having a doula present can help ensure there is someone there able to see and asses what is happening in the delivery room.  Perhaps it is important to you that you be able to labor in the position of your choice.  The staff at the hospital may not be aware of this and could try and encourage you to lie on your back in the bed.  While your doula cannot intervene with any medical staff she can gently remind you or your partner that you did not want to labor that way, and ask if you are alright with being moved.  This allows you to make the choice; lie down or let the staff know you prefer to labor as you are.  Keep in mind, birth does not have to be something that happens to you.  Birth can be an incredibly empowering and spiritual event that you are an active and joyful participant of, and a doula can help you achieve that! 

So while you are sifting through your options for labor, keep an open mind about hiring a doula.  Ask friends and family if they have had a doula attend one of their births or if they know anyone who has.  Reach out to local mom groups and talk to other mothers like you who may have used a doula and see if hiring one is right for you.  You won't regret it. 



If you have questions or would like to share your birth experience with a doula please do so in the comments below!

* Impact of Doulas On Healthy Birth Outcomes; Kenneth J. Gruber, PhD, Susan H. Cupito, MA, and Christina F. Dobson, MEd and Doula Care, Early Breastfeeding Outcomes and Breastfeeding Status at 6 Weeks Among Low Income Primiparae: Laurie A. Nommsen-Rivers, Ann M. Mastergeorge, Robin L. Hansen, Arlene S. Cullum, Kathryn G. Dewey

** Doula Care, Birth Outcomes, and Costs Among Medicaid Beneficiaries; Katy Backes Kozhimannil PhD, MPA, Rachel R. Hardeman MPH, Laura B. Attanasio BA, Cori Blauer-Peterson MPH, and Michelle O’Brien MD, MPH

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Interested in hiring a doula?

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RESOURCES:

Interested in meeting with a doula in your area?  Doulamatch.net is a searchable database for birth and postpartum doulas using your city and state or your zipcode.

DONA.org also provides a nationwide searchable database for doulas that have been certified through their organization.

Estimated "Guess" Dates

If you are like most women, your due date is probably something that you will want to know as quickly as possible - maybe even before your home pregnancy test has a chance to dry!  However it is important, especially for first time and healthy mothers, to view your estimated due date as just that - an estimated date.  In this post I will explore how your due date is calculated and how likely your baby will be born on that specific day.  

Why are estimated due dates so important?

Besides giving the mother and family a time frame to expect their new addition, estimated due dates allow your care provider to determine your baby's gestational age.  Since there are certain developmental milestones and approximate sizes reached each week and month of gestational age, care providers use this dating method to ensure that the baby is getting adequate nutrition and blood-flow from the placenta.

Estimated due dates are also crucial in determining when it is safe to allow a mother's labor process to continue on through delivery.  Labors that start before 37 weeks gestation are considered pre term and may pose great health risks or even death to the baby if the labor cannot be stopped.  The closer you are to 37 weeks, which is known as early term, the lower these risks become. 

Gestational age is also important if the mother or baby develop health issues, like gestational diabetes or intrauterine growth restriction, and an induction or cesarean section before the baby reaches full term becomes a necessity. 

Even with normal, healthy pregnancies it is important to know when your baby is due.  Many care providers are very comfortable routinely offering inductions at 39 weeks when the baby is considered to be full term, some even insist upon them.  The issue then falls on whether or not the baby is in fact truly 39 weeks gestational age when the induction is performed, as the last few weeks in pregnancy are crucial in the baby's lung, digestive tract, and body fat development.  
  

Where can you find out your estimated due date and how are they calculated? 

There are hundreds of websites and apps available that offer to help calculate your due date.  Some are very simple and show your Estimated Due Date (EDD) calculated by the first day of your last menstrual period (LMP).  More complex apps base your EDD off of ovulation date or the date of conception. Some pregnancy calculators may even give you a day-by-day count down to your EDD, including when each trimester starts, and when you can have certain ultrasounds or prenatal testing done.

Your care provider will also calculate your EDD based off these methods, with LMP calculations being the gold standard.  Later your EDD can be confirmed when you are between 10 and 14 weeks along by an elective dating ultrasound. During this ultrasound they will measure your baby's crown-rump length (CRL) to determine their gestational age.  Since most fetuses grow and develop at a similar rate until the 14th week this measurement is considered to be fairly accurate, and your EDD may change based off the results.

How accurate are these calculations and measurements?

Well, quite a few factors come to play when determining the accuracy of an EDD.  The first being whether or not you have a "textbook" 28 day cycle.  Most online pregnancy calculators, apps and your care provider use a specific calculation that assumes you have regular cycles 28 days apart.  This calculation gives you an EDD that is exactly 40 weeks after your LMP date.

Here is why this may be inaccurate if you have irregular cycles: it takes an average of 14 days after ovulation for an egg to be fertilized, travel through the fallopian tube, turn into a blastocyst (fancy word for a fertilized egg that has yet to become an embryo) and embed into the uterine lining in a process called implantation.  Once implanted your body starts producing the hormones necessary to maintain the pregnancy.  Based on the 28 day model, this would mean that you would have  to ovulate the 14th day of your cycle.

For women who have cycles that are longer or shorter than 28 days this is problematic.  For example, if you consistently have a 35 day cycle you likely ovulate closer to the 21st day of your cycle, meaning your EDD would be close to a week off.  While that may seem like a small margin of error, that one week could make a big difference for your baby's development, especially if an elective induction or planned cesarean section are a possibility. 

Other issues in determining an accurate EDD based off and LMP date involve women who may have fertility or other health issues, such as polycystic ovary syndrome or diabetes. These issues may cause them to have several months in between cycles.  It is possible that these women may be several weeks to a few months into their pregnancies before suspecting anything, or they may only be in the very early stages of pregnancy but their last cycle started many months prior.  

For women with irregular cycles, using your ovulation date may be a more accurate method to determine your EDD.

While using your ovulation date is generally more accurate than using the your LMP to calculate an EDD, unless you have been religiously tracking your fertility it may be tricky to determine precisely when ovulation occurred during the cycle you concieved. Some women have signals that indicate ovulation has occurred, such as tender breasts or spotting, however these signs usually occur 24 hours or more after ovulation. Other women may experience mittelschmerz (a German word meaning "middle pain"), which is mild to moderate cramping associated with ovulation.  This type of cramp usually is a sharp, acute pain that tends to focus on the right or left side and usually differs from menstrual cramping.
  
It should also be noted that many women do not experience any ovulation symptoms,  or are not attuned to them so they are dismissed or ignored. Tracking your fertility signs like your basal body temperature, cervical position, and cervical mucous consistently over two to three months can help pinpoint your ovulation day.  Keep in mind many care providers doubt the accuracy or ability of most women to be able to determine what day they ovulated, so typically prefer to base calculations off of LMPs or crown-rump-length measurements.

Another way of calculating your EDD is pinpointing the exact date of conception.  

Though this may be tricky or impossible unless you have been scrupulously keeping track of your fertility signs and/or only had intercourse once or twice during your fertile window.  You may also know your conception date if you have undergone fertility treatments like IUI or IVF.  

The final factor that determines the accuracy of your EDD is your baby.  

Spontaneous labor, meaning a labor that has not been induced by any type of intervention, occurs when a number of cues from your baby signal your cervix to start its process of dilation and effacement (thinning).  While we have yet to discover what ultimately causes spontaneous labor to start, it is theorized that your baby may produce a hormone that stimulates labor when their lungs are fully mature.  Other women go into preterm labor either for undetermined causes or related to health issues with the mother or the baby.  Still more women, albeit a smaller percentage, go two weeks or longer past their EDDs without any signs of their body intending to go into labor and have to be induced.  

So exactly how likely is it that you will go into labor on your estimated due date?

Only 4% of babies are born on their actual estimated due date.  

90% of babies are born within the two weeks prior and the two weeks following their EDD.  Studies have shown that most women actually go into labor closer to 41 weeks gestation versus the traditional 40 week model.  Because of this, I encourage expecting mothers to try and not to get hung up on a specific date; instead mark off the two weeks before and after your EDD as your "Birth Month" vs a single day circled on your calendar.  

Why is this important to keep in mind?  

It is normal for a mother to feel emotionally and physically exhausted by the time she reaches her final weeks of pregnancy.  Most mothers are extremely uncomfortable and are anxious for labor to start.  Many care providers routinely start checking for dilation and effacement at the 37 week prenatal appointment.  Mothers, especially first time ones, may feel a deep sense of disappointment or defeated when they are told they are not "making any progress".  In situations like these it is important to remember to trust in your baby and your body; your labor will start when your baby is ready to be born.  It is worth the wait!   


I would love to see expecting mothers post their Birth Months and new mothers willing to share their EDDs along with their little one's actual birthday in the comments below!  

Also, check out Evidence Based Birth's article about inductions to start labor in women who have gone past their due dates.  It goes into great detail about how EDDs are calculated, their accuracy and provides links to several studies supporting this information.  

Interested in hiring a doula?

Questions about pregnancy, birth or postpartum life?

Please feel free to contact me

meagan@beltanebirthservices.com

or check out my website!

Beltane Birth Services

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My Journey On Becoming a Doula: Part 1

Birth wasn't something that I was really exposed to growing up.  Almost every birth story I had heard was unpleasant, starting with the story of my own birth.  My mother labored with me in a hospital in South America where she was not only manually dilated by the nurse but was also given an episiotomy that cut deep into the muscles and tissues of her thigh.  When I was a few days shy of turning four and living in the United States, my mother delivered my sister.  I have no memories of the birth, most likely because my mother had an elective induction so she did not labor at home at all.  What I remember vividly is that she had to be rushed back to the hospital shortly after returning home due to postpartum hemorrhaging.  From my perspective as a child, birth was scary and life-threatening.    

I didn't have any more experience with birth or babies until High School, where I had a friend who became pregnant.  I remember her telling a group of us what a miserable experience her delivery was and how the doctor had to suck her baby out with a vacuum.  At the time, I had no idea what that meant and envisioned a suctioning device that tore the baby out of her.  That mental image stuck with me.  I began to think that babies were simply not meant to fit through a woman's pelvis. 

As an adult, I began making friends with women who had already started their families. Not one of those mothers had a positive birth experience.  I listened to stories filled with pain and emergencies; and they horrified me.  I wondered why people even bothered having more than one child after all of these terrible births.  

When I was pregnant with my first child I did what most first-time expecting mothers do and began reading everything I could get my hands on about what was happening inside my body.  The excitement I felt as I read about all the stages that little speck of life-dust burrowing into my uterine wall would go through was indescribable.  Armed with my trusty copy of What To Expect When You're Expecting, I fancied myself an expert on all things baby and pregnancy related.  Each month brought a new chapter to read, new developmental milestones reached, and new fruit to compare my baby's size to!  

The farther along I got in my pregnancy, the more felt I needed to become more familiar with the  delivery process so that I could start to have a more positive mindset about it.  I started watching, and became addicted, to the TLC show "A Baby Story".  Here were women with (mostly) positive and normal birth experiences.  Women like me.  I began to see and learn about things I didn't even knew happened during labor, which was a complete shock to me because I figured there couldn't be much more to it than what they taught you in Health Class.  

The more episodes I watched, the more strange new thoughts and ideas started entering my mind.  Maybe birth was not a traumatic thing that we women must accept and endure as something necessary to have a family.  Maybe birth could be a positive, empowering experience instead.  One episode even featured a mother who wanted to decline an epidural.  Now this was truly something new for me - here was a woman who was willing to embrace the well-documented pain of labor.  In fact, she was excited about and devoted to having an unmedicated labor and delivery.   To help her achieve this, she had hired a doula to attend her birth.  

Doula.  Now that really was a strange and new word for me, as I think it is for most people who have not had a great deal of exposure to birth.  As I watched the episode, I tried to puzzle out what exactly this doula was.  

She offered support, encouragement and love to the mother as her labor progressed from manageable, to a struggle, to what appeared to be unbearable.  She suggested the mom try different positions during contractions, encouraged her to walk around when things where getting started, and gently reminded her that she wanted to avoid the epidural when her resolve began to break.  Ultimately, the mother on this episode did get the epidural (and the relief on her face further cemented my own feelings about getting my own as soon as possible during labor) but the doula was not disappointed or discouraging of this.  She told the mother how well she had done and how well she was still doing and I thought, "Wow.  That's amazing."

I watched many, many more episodes of "A Baby Story" and noticed that the majority of women on the show who hired doulas were also having home births.  The women with these births seemed more comfortable and better able to manage their labors without drugs or complications than the women who were delivering in the hospitals, so I began researching natural birth.  I ditched What To Expect and picked up Ina May's Guide To Childbirth.  I learned about midwives and home birth and informed consent.  I kept seeing the word "doula" flash up here and there.  I did a Google search and ended up at the DONA International website:

Doula

a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible.

I was still shaky on what exactly a doula did during childbirth, though.   Isn't your partner there for your emotional and physical support?  Does a doula take over their role?  Do they speak on your behalf to the doctor if you're in a hospital setting?  Are they like apprentice midwives?

As I neared the final weeks of pregnancy, I started feeling very uneasy about my planned hospital birth.  I had moved on from Ina May and spent hours pouring over research articles and studies online about cesarean section rates, routine interventions, and the dreaded "cascade of interventions".  I no longer wanted the epidural that I had fantasied about, I did not want an induction or a c-section.  I had watched the documentary "The Business of Being Born" and I was no longer scared of the pain of delivery; I was scared of my consent being violated in the delivery room.  I thought back on all of the horror stories and found that the common theme WAS NOT that delivery was a miserable experience, but that women routinely have things done to them that they did not want or did not think they could refuse.

That wasn't going to happen to me.  I knew what I wanted and what I didn't.  I did my research - I was going to be able to make informed decisions about my care and my labor.  I would be in charge.  I knew my wishes would be respected because I had a good midwife and she was receptive to everything I talked about.  I was ready to have a baby. 

At my 37 week appointment, my blood pressure was slightly elevated.  This was not a big surprise to me as I was diagnosed with hypertension several years before getting pregnant.  I was very overweight and in poor health at the time of this diagnosis.  Immediately prior to getting pregnant, I changed my eating habits, quit smoking and started exercising.  I dropped almost 100lbs and, surprise, my hypertension went away.  During my pregnancy I had gained almost 70lbs back so I had been expecting a return of the hypertension.  The midwife, however, did not like that explanation.  I was sent to Labor and Delivery to have labs drawn to make sure I did not have pre-eclampsia.  When the labs came back all clear, including a 24 hour urine catch, the midwife was still uneasy.  She stated firmly that she would not allow the pregnancy to progress beyond 39 weeks.  We scheduled an induction.

In the delivery room, my world spun out of control.  All of my plans went out the window.  Intervention after intervention was done.  My husband, who was extremely supportive of my wish to have as natural a birth as possible, firmly (albeit gently) told me that I had to let all of my angst about that go - as well as let go of my intuition - and put our trust in the medical staff.  The ones with the degrees. 

I found myself agreeing to things softly as I inwardly cringed.  I felt like I couldn't decline things.  There were things that felt so wrong, that I did not want (or did want) to do but all of my concerns and wishes were overridden by protocol.  I felt defeated.  The pain after they broke my water was worse than I imagined and I held on as long as I could but ended up begging for an epidural. 

About 11 hours after the induction was started with Pitocin, my daughter's head delivered but the rest of her did not follow with the next push.  Her shoulders had firmly wedged against my pubic bone. 

Sixteen months later, I was still having flashbacks to when her head was out but the rest was not.  I would hold my daughter close and breathe in her scent while we read a book or played and I'd be thinking how everyone panicked at that moment.  I had anxiety attacks.  Nightmares.  After the rest of her finally delivered, she had to be rushed to the nursery and then was transferred to another hospital.  One with a NICU.  She was three weeks old before I was allowed to hold her.  Everything I had read about, everything I had feared had come to life.  It was like some awful, dark comedic parody of how my labor should have gone.  None of my wishes had been honored. 

I found I was pregnant again shortly after my daughter turned seventeen months old.  I was thrilled.  I was petrified.  After discussing all of my concerns with a close friend who had recently had a successful VBAC delivery at home she recommended I contact her doula. 

There was that word again.  "Doula". 

My husband was firmly opposed to the idea but saw how hard I was struggling emotionally with the thought of laboring again so consented, grudgingly, to interviewing her.  We met.  She was a quiet, calm soul who listened as I dumped a year and a half worth of pent up, unresolved fear and anger and hurt on her lap.  She accepted and validated my concerns and the guilt that I carried over for not speaking up for myself, as well as the anxiety I had to face it all over again.  I finally began to feel better about delivering a second time. 

I started reaching out to my doula when I was having anxiety attacks.  At first, I was hesitant to do so.  I was still very unclear about her role in my pregnancy.  Was she there to advise me?  Was I bothering her?  What were her expectations of me in the delivery room?  I agonized over these questions every time I reached out to her.  She was always reassuring, always asked me what I wanted and how she could best support that, always supported me and my choices even when I wasn't confident about them.  Fear and doubt still crept into my heart a lot. 

I was diagnosed with gestational diabetes and told that, even though they were fully aware of my anxieties related to another induction and my continued adamance against consenting to a cesarean section, I would need to agree to an induction no later than 39 weeks. 

My doula told me to listed to my gut.  And I did.  As much as I feared a repeat of my first labor, I knew I couldn't take the risk of losing my baby due to complications from my diagnosis.  So I signed on for another induction. 

Because I was so anxious about the induction process, my doula showed up at the hospital well before active labor had started.  The three of us, myself, my husband and my doula, all chatted and shared stories and life experiences with one another while my body started responding to the Pitocin drip.  Every time doubt crept in to my mind, I remembered that my doula was there supporting me and that she trusted me to make the right decisions for myself.  This was different than the support I was getting from my husband; while he supported and loved me unconditionally throughout my labor, I knew he was also acutely aware of how close he came to losing both me and our daughter during my last labor and, in my mind, that meant if it came between my choice or a doctor's recommendation he would probably (though not maliciously or wrongly) err on the side of caution and push for whatever the doctor wanted.  

I labored for several hours while she gently suggested positions to try to ease the intensity of the contractions and to help move the baby down.  I could hear her murmuring to my husband to touch me or press on my hips or snuggle in next to me, her offering to get my ice chips or a cool washcloth for my forehead.  Her presence was soothing and reassuring. 

When transition hit I lost my footing, lost control of my reserve and was unable to get back to a place where I could manage the pain.  My fear and anxiety crept in again and I broke and begged for the epidural. 

After it was placed I felt ashamed, like I had let my doula down.  Here she had worked so hard with me so I could have a baby without drugs and I caved!  I started apologizing to her and she was shocked.  Why would I apologize?  She was there to support me no matter what I needed or wanted. 

She told me how well I had done, how well I was still doing. 

My doula, Leslie Cuffee*, and me after
delivering my second daughter.

Three hours later, I was holding my daughter.  I had delivered her on my side after laboring on all fours - something I had been told during my first labor impossible with an epidural.  My doula calmly told me that of course I could get on all fours if I wanted and that if I could not hold myself up then she and my husband would support me.  Just knowing that I could made me able to do it. 

I had never held a brand new baby before even though this was my second child!  I didn't know how to initiate breastfeeding or how to hold her.  My doula stayed while we settled.  She took joy in sharing all of those new experiences with us and helped me figure it all out without being intrusive. 

Once she insured we were all happy and ready to begin bonding alone as a family, she quietly packed up and left.  As I nursed my new baby, I thought about how amazing my experience had been delivering her; how healing, and empowering.  How incredibly special.  And how having a doula present changed my experience so much.  

Over the first few weeks postpartum I noticed an incredible thing had happened; all of my anxiety attacks, flash backs and nightmares I had been experiencing for the past two years since my first delivery had vanished.  During the countless hours spent nursing and caring for the new baby, I found myself reflecting upon my two very different birth experiences.  I began to have this drive - this need - to help other women in the profound way that Leslie, my doula, had helped me.  And so the seed was planted in my mind to become a part of the birth community.  

*image used with permission
Leslie Cuffee - Professional Birth Doula Services

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