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oh baby!
Are You Expecting?...
You May Want to Consider a Doula
This month we interviewed Stephanie Donelson, a certified
doula since 1999. Stephanie resides in Wilmore, KY with her
husband and children.
What is a Doula?
A doula is a woman experienced and usually trained in
childbirth who provides continuous physical, emotional and
informational support to a woman during labor, birth and the
immediate postpartum period. Doulas who complete training
usually become certified, but some doulas for various
reasons choose not to become certified -- this does not mean
they are any less capable. The basic training consists of
self-study in the form of reading and researching required
books, attending a 3 day intensive hands-on training,
providing labor support for at least 3 women and obtaining
satisfactory evaluations from the attending doctors, nurses
and from the laboring mother, writing birth essays and self
evaluations. All of the paperwork gets sent into
the certifying organization to be evaluated and a decision
is made to grant certification or not to the individual.
Some newer doulas choose to apprentice with an experienced
doula as part of their learning process until they feel
comfortable supporting a client on their own. A doula
doesn't necessarily have to be formally trained, technically
a doula can be any woman who is experienced with the birth
process who is willing to provide labor support -- for many
women, nurturing a woman in labor comes instinctively. But
most doulas today are trained and most choose to be
certified to give themselves additional credibility with the
public.
How Long Have Doulas
Been Around?
Historically doulas have been around since the time of the
ancient Greeks and Romans, and probably before then. If you look
at historical pictures of women giving birth, there are usually
other women in attendance at the birth assisting the mother. The
word "doula" is Greek and translates to "servant." The role of
doulas reflect a time long gone, when women gave birth at home
assisted by female family, friends and neighbors. Most girls
grew up witnessing birth, something that rarely happens in this
country today. As generations passed, society changed, birth
became medicalized and women lost these skills.
Today, most women give
birth in hospitals - where doctors are usually only in
attendance for the actual delivery and nurses have
paperwork and other patients to care for as well.
More women are seeking alternatives such as birthing
centers or homebirth, midwives and doulas, they are
seeking out the personalized care that usually gets lost
in today's hospital settings. In the US, Doulas of North
America (DONA) has seen its membership grow
significantly -in just the last year membership has
grown from 2800 to 3800. Childbirth and Postpartum
Professionals Association (CAPPA), a newer
organization, has also seen similar growth. Some parts
of the country have a huge demand and supply of doulas,
and in other parts of the country women are just
learning about the option. Locally speaking, doulas are
a newer concept in the Central Kentucky area. Families
are satisfied with the care they receive from doulas, so
the demand is growing. |
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How Does a Doula Help
During the Birthing Process?
A doula is present solely to take care of the laboring woman, to
meet her every need, to "mother" the mother. The most important
things a doula brings to a birth are her undivided & continuous
attention, emotional and informational support, physical comfort
measures and her total belief in the mother's ability to
give birth. Doulas also act as an advocate who can help
facilitate communication between parents and hospital staff,
make sure parents get their questions answered and make sure
that they understand the benefits and risks of any interventions
such as epidurals, inductions and monitoring. Each mom should
make her own truly informed choices and it is a doula's job to
support those choices in whatever capacity she can.
Doulas will come to the woman's home while she is in early labor
and labor with her until she feels she is ready to move onto the
hospital or birthing center if that is where she will be
delivering. Once at the hospital or birth center a doula tries
to protect the mothers space and make her feel safe and
comfortable. For instance one of the first things I do upon
arrival is to dim the lights, start some soft music, maybe spray
some light aromatherapy spray, try to limit the coming and
goings in and out of the room and get that darn TV turned off!
We work with the laboring woman on the birth ball, perform
massage & counter pressure, relaxation techniques, offer
suggestions for beneficial positions to labor in or at different
points in labor, some doulas offer aromatherapy and birth
hypnosis if they are trained in that.
A doula's "birth bag" contains many items which she brings to
each birth such as the birth ball (a large physical therapy ball
that has proven to be extremely useful and comforting for many
women while laboring), massage tools, lotions and essential
oils, CDs, hot and cool packs, hard candy, a battery operated
fan, a mirror, a towel with a knot at each end which is very
useful with women during the pushing phase -- particularly
if an epidural has been used, and other assorted necessities. We
try to have on hand all of the little things that can make a
difference that mom may have forgotten such as hair ties and lip
balm, a disposable camera, extra batteries, etc.
We have many learned "tricks of the trade" but we always provide
comfort measures that fall within the individual guidelines
established for the woman by her medical care providers. After
the birth, in the immediate postpartum phase, a doula assists
mom with any additional comfort measures/support needed while
delivering the placenta or undergoing vaginal repairs due to
tearing or an episiotomy.
Doulas stay with the family for a period of time after the birth
and help the new family unit get settled in, help mom establish
breastfeeding, etc. Additionally, if there are complications or
problems with the mom or baby, a doula can stay and offer
additional support and assistance. A one or two week postpartum
visit is also performed by the doula to check on the mom and
baby to talk about the birth, get feedback and see if there are
any problems or needs. If any additional assistance is needed, a
doula can make referrals to outside agencies.
How does a doula differ from a midwife? Do hospitals recognize
doulas as an integral part of the birthing process?
Unlike midwives, doulas don't deliver babies or provide any type
of medical care or clinical tasks, but they do share
the philosophy that birth is a natural process and not a medical
procedure. Many hospitals do recognize that doulas are an
integral part of the birthing team, they realize that a woman's
emotional support team is just as vital as the medical support
team. Most doulas practice privately and are hired directly by
the clients, however there are hospital based doula
programs throughout the country that have been very
well received. In areas where doulas are not widely utilized, it
takes time for the medical community to come to accept doulas,
medical staff may at first feel threatened by the presence of a
doula until they work with doulas and come to
learn what doulas do and do not do. In these areas there is
usually some misunderstanding surrounding the work of doulas
throughout the general public and within the medical community
in particular. Doulas in these areas work to educate both
of these areas of the community of the many benefits doula care
provides.
If Someone Is Considering a Doula, What Next?
An interview is arranged, the doula usually meets the
mother/couple at a public place, sometimes the couples home. It
is important that a doula and her client "click" if a doula
doesn't feel that she is right for the client for whatever
reason, I feel she is morally and ethically obligated to refer
to her another doula in the community.
Once a pregnant mom feels comfortable with her choice of doula,
a fee is agreed upon & a contract for doula services is signed.
A minimum of two prenatal visits take place. Phone calls &
emails & questions are welcomed by the doula throughout
the pregnancy. Once the mom reaches the 36-38 week in her
pregnancy (it varies by doulas), the doula is on call for the
mom 24 hours a day, 7 days a week until she goes into labor. The
mom is advised to call her doula as soon as she believes that
she is in labor, so the doula can make the needed
arrangements for her own family's needs. The mom typically lets
the doula know when she needs her to come.
Doula stays with mom continuously throughout labor, delivery
and immediate postpartum.
Once mom and baby have settled in back at home, the doula makes
at least one postpartum home visit, although mom is free to call
doula with any questions or concerns she during the postpartum
period.
How Much Are Doula Fees?
Fees vary depending on what part of the country you are in & how
experienced a doula is, the typical range is from $250 -$500.
Most doulas will arrange payment plans and some offer bartering
and sliding scale fees. In the Central KY area fees usually
range from $300 - $400. Some doulas will offer reduced rates
while they are working on their certification.
Is There Anyone
Who Shouldn't Use a Doula?
Any woman who desires having a positive birth experience should
investigate hiring a doula. Eleven different medical studies
have concluded that doulas are beneficial to women during labor
and birth.
A study done by Drs. Kennell and Klaus revealed that women who
utilize the services of a doula have:
25% shorter labors
50% less chance of a cesarean birth
60% less need for epidurals or analgesics (if
desired)
Higher success rate of VBAC (vaginal birth after
cesarean)
40% less need for assisted delivery (forceps, vacuum,
etc.)
Better feelings about the birth experience
More nurturing attitude toward their infant
Also, babies have shorter hospital stays and breastfeed more
easily and the cost of obstetrical care is greatly reduced (less
interventions/ c-sections). Many people mistakenly believe
that a doula is not needed if the father or another primary
support person is involved. This is not true. A doula works to
support and enhance the role of the primary support person.
Fathers can initially be wary about the idea of a doula, they
can be worried that she will replace his role. That's not
the case. A doula works at encouraging the father, taking the
pressure off of him. She brings him into the picture & gets him
involved by explaining how he can best help mom during the
different phases of labor and birth, she does not take his
place. A doula supports the support person by offering help and
advice, or a much needed break. I think for a lot of
fathers/primary support persons, they are not sure exactly what
to do, or with the emotions of the day, they forget what they've
learned. A doula is
instrumental at keeping him involved at whatever his comfort
level may be. More than a few times I've arrived to be greeted
by a very relieved father!
It is also an incorrect assumption that if you are having an
epidural or a c-section, you don't need a doula. In each of
these situations a doula plays a very beneficial role. Epidurals
don't usually take all of the pain away and there can be
different problems and side effects associated with them. Most
wear off at least some by the completion of dilation and rarely
pain relief can be spotty or almost non-existent.
Epidurals can also slow labor. Help is usually needed with
pushing as an epidural interferes with the ability to push as
effectively. Most times, even with an epidural comfort measures
are still needed. Also an epidural does not provide help with
any of the emotional or informational support.
A doula can be beneficial during a cesarean birth in several
ways. Doulas are familiar with cesareans and do not find them
upsetting. The doulas presence can calm & reassure both the
mother and father/primary support person, who are likely to be
frightened and worried. The doula can explain what is happening
during the operation. If desired by mom, the doula can provide
video or photography if permitted by the hospital.
Once the baby is born, the partner usually goes to see the baby
- leaving the mothers side. The doula remains with the mother,
tell her how and what the baby is doing and helps the mother to
feel less alone and unsupported. Anesthesia can produce side
effects in the mother that a doula can help deal with.
While the doctors work to repair the mothers abdomen, it can be
a lonely and time for the mother, having probably only seen her
baby for a few moments, the doula can sit by the mothers head
and provide companionship. The doula also accompanies the mother
into recovery. If the partner has gone to the nursery with the
baby, the mother still has a trusted, comforting support person
with her and be with her to help with post-op pain and
difficulties. If there is a problem with the baby, the doula can
do her best to support the parents emotionally & buffer the
situation as much as possible. Some hospitals still do not
permit doulas in the OR, as the policy is still a one support
person maximum, but many consumers and doulas have worked to
change those policies successfully across the country.
I have discussed with my fellow doulas the question of who
should not hire a doula. The answer that we came up with is any
women who would feel her space was being violated by having a
doula present should not hire a doula. Or a woman who truly felt
that a doula had nothing to offer them, a woman who was
completely sure that her primary support person would be enough
for her.
Additional Information
As an aside there are also certified antepartum doulas (for
assisting mothers who need additional help during pregnancy due to bedrest
or other conditions) and certified postpartum doulas who offer assistance to
families once they are home from the hospital, especially good for nervous
new parents and mother of multiples or premature/impaired or fragile
newborns. The services of a postpartum doula make a great gift from friends
and family, what exhausted new mom couldn't use a little help!
Also, if you need some supplemental reading or more information
about doulas, Stephanie recommends these sites:
www.dona.org,
and
www.birthingfromwithin.com.
We'd like to thank
Stephanie Donelson for her time and contribution for this
article.
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