- Associated Press - Saturday, November 26, 2016

EVANSVILLE, Ind. (AP) - Hillary Melchiors has never seen a birth that didn’t move her in some special way.

She’s attended 57 births. She’s been up two days straight with laboring moms. She’s gotten “the call” at all hours of the day. She’s an advocate for her clients helping them make medical decisions. And she has done it all with a passion and conviction ensuring those new mothers have the best birth experience she can possibly provide.

That’s the life of a doula.

“People think a doula is only for natural or home births,” Melchiors said. “I don’t care what kind of birth you want. There are ways that I can help and support you no matter the kind of birth you are having - planned C-section, epidural, natural, home birth - a doula can help.”

A birth doula gives informational, emotional and physical support during labor and delivery. There are also postpartum doulas who come to your home after birth doing things such as holding the baby while the mom showers or doing housework.

Melchiors has a PhD in medical anthropology and has taught at the University of Southern Indiana in addition to owning The Doula Group of Evansville, although this is her last semester of teaching so she can focus fulltime on her work as a doula. She is DONA International certified, one of the larger Doula training agencies.

“I think one of the benefits I bring to the table as doula and a medical anthropologist is I have much different insight and a broader view of birth,” Melchiors said.

She’s trained to analyze academic research but is also able to see the practical implications of that research putting it all into perspective for each birth.

When Michelle Elbert found out she was pregnant, she went into research mode. Pretty quickly she realized she wanted a doula and discovered Melchiors.

“She answered every question I had,” Elbert said of Melchiors. “I felt confident going in but having her support, experience and evidence-based research helped me make my decisions all the way.”

Much of Elbert’s focus throughout her pregnancy was on doing things as naturally and intervention-free as possible. Her goal was to give birth without pain medication, and she knew having a doula as both an advocate in the delivery room and an aid through that arduous process would be a necessity.

Elbert went into labor on Aug. 21. She and husband Jamen Elbert called Melchiors after her water broke. They all headed to The Women’s Hospital for more than 26 hours of labor.

“I needed validation that I was making the right decision,” Elbert said. “After 26 hours of labor and no real progression, we both knew this was right, but it helped to have Hillary and all her experience and research confirm that for me. She helped me realize it was the right decision.”

Although Melchiors and Elbert had only met a few months before, in those 26 hours it was if they were the best of friends. Communication came easy; at times Melchiors was able to meet a need only via eye contact. For most of those 20-plus hours in that labor and delivery room it was only Elbert, her husband, Melchiors and the photographer. A nurse came in on occasion to check on things.

In the first 10 hours, things were pretty upbeat. There was laughter, the lights a little brighter, the music a little more upbeat. But as labor intensified, the relaxation music and the lights lowered. Melchiors directed Elbert into several different positions to help comfort her through her contractions. The movement was constant. Laying on her side on a birthing ball. A special ball between her legs. Laying in the tub. Walking the halls. Kneeling.

Melchiors was able to help direct Jamen Elbert, who said he felt helpless through much of the labor, to doing something that was productive and provided relief and comfort for his wife.

“He was upset that he couldn’t fix it,” Elbert said. “I was in so much pain. It helped him getting direction from Hillary about what to do.”

When the doctor walked into the room, Elbert looked to Melchiors for guidance, her trust and confidence in the doula clearly evident.

“It is all about informed consent,” Melchiors said. “I want to make sure they are being presented with all of their options.”

For example, if the doctor suggests starting Pitocin to strengthen labor contractions, Melchiors may look to the mom and inform her that a natural way to produce oxytocin is by using a breast pump and she may want to try that.

“The doctor may not think to present that option to her because they are typically in the medical mindset,” Melchiors said. “But my goal is to help present the options, benefits, risks and alternatives. And in some situations, the option is nothing, and we talk about what would happen if we do nothing.”

Elbert’s strength through an extraordinarily trying labor was unwavering. And although she was committed to her desired nonmedicated, natural childbirth, things don’t always go as planned.

“Knowing that I had a doula provided a calm and confidence,” Elbert said. “I knew I had Jamen and Hillary as my support and that I could do this.”

When Elbert was being wheeled away from her caesarean section Melchiors was right there the entire time, gripping her hand, answering questions. In those last moments the two shared an emotional moment with her. The two had been through a lot in the last 24 hours. They’d not slept. And Elbert was moments away from bringing another life into the world.

And then, when the squeaky hospital bed was out of sight and Melchiors was left back in the hospital room, there was a moment of respite, but just a moment. Elbert’s mom was there. She sat with her explaining what had happened during the first 26 hours of labor and what was to come. Not too long after, Jamen Elbert came back with word that Elbert had made it through the surgery great, and they’d had a girl - Claire Edith, 6 pounds, 10 ounces and 20 ½ inches long. She was born at 4:21 a.m.

Melchiors hugged him and said, “OK, I gotta go,” as her backup doula had arrived. She had to go home and get ready to go teach her USI class.

That’s the life of the doula though, Melchiors said. Each birth, she says, has been “special, amazing” and made an “giant impression” on Melchiors. There are weeks where she’s up 36 hours straight and weeks where she doesn’t handle any birth-related calls. In addition to her load of clients, Melchiors teaches Lamaze Childbirth Education classes. Some of her students are clients but many are not.

Melchiors goes when she is called by the laboring mom. For some it is in the very early stages and for others it has been when they are in the “ready to push” stage. Her longest labor has been 39 hours and shortest doula call 2 1/2, but she missed that birth as the couple gave birth before even getting into a labor and delivery room at the hospital. Her typical delivery falls in between the two.

“I’m invested in the process, I’m invested in my clients and their outcomes,” Melchiors said.

Often doulas and midwives are seen as interchangeable. The two are very different. Midwives are medical professionals who can provide the same services as an obstetrician whereas a doula provides no medical services or advice. A doula is an advocate, resource and supporter.

A doula can provide help with birth planning only, as well, she said. The doula, Melchiors stressed, is just one member of the birth team. Her role in a labor and delivery is to support and advocate for the laboring woman, but she does that by working together as a part of that birth team, not in an adversarial way.

“So often people say, ‘I don’t need someone there, I’ll have my husband or my mom.’ Or they say, I’ve done this before.’

For Melchiors’ clients, they receive two prenatal visits and one postpartum visit in addition to the birth. In the first prenatal visit they sit down talk about birth preferences. In the second, they do a “run through” or labor practicing differing labor comfort measures so the mom can develop a physiological memory of some of the positions that help alleviate pain during labor.

She also gives them a tour of her doula bag so they can see all the “tools” she brings with her to the deliveries.

“My two biggest tools though are my brain and my hands,” she said. “Half the time I don’t even get anything out of the bag. I do a lot of hip squeezes and counter pressure to work on the position of the head and pelvis.”

Research shows that outcomes with a doula are better than those without. According to the Cochrane review, when there’s continuous labor support provided by a doula, women experienced a: 31 percent decrease in the use of Pitocin, 28 percent decrease in the risk of C-section, 12 percent increase in the likelihood of a spontaneous vaginal birth, 9 percent decrease in the use of any medications for pain relief, 14 percent decrease in the risk of newborns being admitted to a special care nursery and 34 percent decrease in being dissatisfied with the birth experience.

“It is one of the biggest life experiences you will ever have,” she said. “A doula is passionate about making sure people have a good experience. I’m passionate about helping families have a positive birth experience.”


Source: Evansville Courier and Press, https://bit.ly/2fLqtkj


Information from: Evansville Courier & Press, https://www.courierpress.com

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