Tuesday, May 03, 2011

What Doulas Do

By Katie Henderson © 2011        
Read more from at SAHM I Am



Right after, "What is a doula?" the question I am next asked most often is, "What does a doula do?"

In larger cities doulas are much more common and in-demand. But living in a small town and trying to develop a practice has presented unique challenges. Too few people have actually ever heard the word doula so it's difficult to convince people that they really need something they've never heard of and know nothing about.

A doula's role is unique to each mother she works for, as each mother has different needs for each pregnancy.

Much of a doula's job is to offer education and guidance. Pregnancy and labor often present a mother with many different decisions. Making a decision with the confidence that it's right for you and your baby can be difficult if you don't understand all the nuances of each option. A doula is well educated and can explain every option and help a mother make the decision that falls best in line with the mother's own birth plan.

Most often, doulas are called on to act as comforters. Doulas are trained in many different methods of drug-free pain management. You may be surprised to know how small things, like patterned breathing and guided visualization, can help manage pain. But so much of the comfort a doula offers is emotional. Birth is such a personal and transcendent experience for a woman. It can take her through the complete range of human emotions in a very short amount of time. Having continual support from an experienced woman is priceless! It offers the freedom to scream if you need to scream, laugh if you need to laugh, or cry if you need to cry. A doula is not there to hamper your emotions. She is there to allow you to experience them fully with love and understanding.

In many ways a doula is your cheerleader. Often, she will gently remind you that your body is made to birth your baby. That you can give birth. And to celebrate with you as you get through each contraction. Unlike a doctor or nurse, your doula is with you 100% of the time (except for brief bathroom breaks). She may suggest different positions or actions to help you get through when labor becomes particularly difficult. Unlike a doctor or nurse who may not support your wishes or respect your birth plan, a doula is always on your side!

Your doula will also help you to get off on the best possible start with breastfeeding your baby. Doulas are trained in breastfeeding support and can offer valuable advice and insight. Unfortunately, much of the art of breastfeeding has been lost from everyday North American society. And the medical model of childbirth doesn't usually provide adequate information or support.

Doulas are constantly seeking to expand on their practices and a lot of doulas will offer a bevy of other services outside of those previously mentioned. Miscellaneous services a doula may offer include (but are not limited to):

Placenta Encapsulation - If you so choose, your placenta can be saved. A professional trained in placenta encapsulation will dry your placenta and grind it up, add herbs, and put it into pill form for mom to take. Placentophagy (the consumption of the placenta) has scores of benefits for new mothers.

Acupressure/Massage - Activating certain pressure points has shown to be effective in relieving many difficulties during pregnancy. And we all know that massage can be very healing and relaxing.

Babywearing - Your doula might have received special training in babywearing education. Babywearing is as old as humanity and an extremely beneficial practice that cultivates healthy bonding between parent and baby.

TENS Machine - Transcutaneous Electrical Nerve Stimulation unit is a machine that has electrical diodes that are applied to areas where mom is experiencing discomfort, and blocks those pain signals. Specialized training is required to use this device.

Blessingway Ceremony - A blessingway is a mother-centered birth celebration. Typically a Blessingway is very spiritual and is tailored to the mother's individual spiritual beliefs. Doulas who perform Blessingways will guide a mother's guests through ceremonies meant to bless the woman on her way to becoming a mother by honoring her strength, adorning her body (i.e brushing her hair, decorating her belly, washing her feet etc.) and offering small gifts, prayers and positive thoughts.

Aromatherapy - The use of essential oils in different fragrances to relax the mother and ease discomfort.

These are just a few examples of the many services a doula may offer. When interviewing a potential doula be sure to ask what extra services she offers, and select a doula who fits well with your needs and wishes. Extra services may cost more, but are well worth it.

Even if your doula doesn't offer any services outside of the standard model of practice, there are many benefits to having a doula present for your birth.

Studies show that labor with a doula is actually shorter than labor without (a whopping 90 minutes shorter on average!!) Typically when I ask a potential client what her ideal birth would be, one of the most common words used is "short." A shorter labor is ideal for many reasons and labor that is an entire hour and a half shorter than average could mean the difference between a drug free labor and using chemical pain management that can cascade into many different medical interventions most women wish to avoid.

Laboring with a doula often leads to less labor augmentation measures such as pitocin. Pitocin is synthetic oxytocin (the "love hormone" that starts labor). It's often administered to speed labor along. Unfortunately an artificial labor of pitocin is much more difficult and painful than a physiological labor with natural labor hormones, and this augmentation can cause your baby to go into distress.

Having a doula present for your labor can also drastically reduce the odds that you will require the aid of forceps or vaccuum extraction. These methods of removal are undesireable as they can potentially cause lasting injuries to your baby. Even if administered safely, they can lead to a baby born with an intense migraine. This will often inhibit a baby's desire to initiate breastfeeding, and create bruises and sore spots on baby's tender little head.

Overall, having a doula present for your labor simply makes the experience better. The way you remember an experience as life changing as birth, is just as important as the experience itself. For a client to look back on her labor with fondness and satisfaction is a doulas goal. A mother can go against every aspect of her birth plan - but as long as she can look back and be happy with what she's accomplished, a doula has done her job correctly.

What a doula doesn't do...

There are so many things a doula contributes to childbirth, but there are also clear cut things a doula does not do.

A doula does not replace a spouse or partner in labor. It's true that a woman whose spouse or partner is no longer present in her life, or cannot be in attendance for the birth, can greatly benefit from the presence of a doula. However, a doula is not there to get in between the mother and her partner. In fact, a doula encourages the partner to be an active participant in the birth. For this reason a doula is not only greatly appreciated by the mother, but also by her partner.

A doula is not a medical professional. A doula cannot prescribe or administer any medications or perform any medical procedures. She may recommend home remedies for common problems, but it's merely on an advisory basis. She offers non-medical support only.

A doula does not make decisions for a mother, nor does she offer or deny consent for any procedures on the mother's behalf. For example, if your doctor offers an epidural, even if that is against a mother's birth plan, a doula only reminds the mother that it runs counter to her desired birth plan. She does not give the doctor a "yes" or "no" response. Sometimes it can be difficult to stand up to a doctor and refuse consent for a procedure that you don't want when everyone around you is pressuring you to "just do it," but a doula only support your decision, and your wishes in the midst of it all. She is your advocate, and may call for a "time out" so that you have time to think without others pressuring you and be able to make up your own mind in solitude.

There are so many nuances of a doula's role in childbirth - to address them all would fill entire volumes! It is my hope that you come away from this article with a solid place to start in your understanding of what a doula contributes to labor and birth.

~~~~

Katherine Henderson is a wife, and mother to one, in Ardmore, OK. She is currently working toward her Birth Doula Certification through DONA International. Read more from Henderson at SAHM I Am.

8 comments:

  1. Great and informative post! I must agree every woman deserves a doula. My question to all pregnant women is always... Whoz your Doula?

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  2. I have a question for you, Dr. Momma. I'm expecting my seventh baby, and he will be coming via c-section. I've never had one before and it's most definitely medically necessary due to a neural tube defect. He'll be having brain surgery about 24 hours after birth, so it's important that his head not be compressed through the birth canal.

    I love the many things Doulas can do for moms. I'm already an experienced breastfeeder, babywearer, and my friends are even having a Blessingway for me. I'm very blessed, which is good since I'm scared to death.

    But is there anything a Doula could do to help me prepare for a c-section? Is there anything I can do to prepare myself ahead of time for such a very different birth experience? I want to find what ever ways possible to connect to his birth as much as I can without the joy of being able to push him into the world myself.

    If you have any advice, or information, I'd love to hear it! Peace and thank you as always for your blog.

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  3. Muse Mama,

    A doula can help prepare you for what exactly will happen during your c-section, help with relaxation techniques to calm your nerves, and can stay with you afterwards while the dad goes with the baby. This post was written for doulas, but can give you a better idea of how a doula can help: http://navelgazingmidwife.squarespace.com/navelgazing-midwife-blog/2011/3/8/guest-post-doula-ing-for-cesareans.html

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  4. Dear Muse Mama,

    I've attended several amazingly beautiful and humane cesarean births as recently as yesterday! :)One of the best things a doula can do is to meet with you and your partner 1-2 times before your scheduled birth to help you write a birth plan that details out what you would like for a gentle and humane surgical birth. Here are the things I suggest you advocate for in your birth plan and some ways a doula can help facilitate a gentle surgical birth for this baby.

    -Ask for the curtain to be lowered at the moment of birth so you can see your baby be born.

    -Ask the OB to tell you right before they are about to deliver your baby so that you can 'push' and thus 'birth' your baby and be an active participant in your baby's birth.

    -State that, barring any extenuating circumstances, you would like skin to skin contact with your baby. so that means if baby is vigorous and crying, good apgars, etc that baby come straight from the warmer to you.

    -Have the anesthesiologist place the EKG leads on your shoulders to that they won't interfere with your baby's access to your chest.(At yesterday's birth the anesthesiologist just cut mom's gown down the middle for her so the baby could come right to her chest).

    *Have all of these things on your birth plan and bring it to your care provider before your birth and discuss them. All of these things ARE possible and with good apgars there is NO need for a separation of mom and baby with a surgical birth. Mom is the BEST person to observe her baby! :)

    I've been to two cesareans now where these things were possible and where baby was even nursing while mom was getting stitched up!!!

    I recommend advocating and stating in your birth plan that you would like your doula present in the OR for your baby's birth to help you achieve the above goals. If your care provider pushes back and says, Only 1 support person is allowed in the OR, the truth is there IS NO WRITTEN POLICY on the amount of support people. It is fully and completely up to the anesthesiologist, s/he RUNS the room. The doctor has no bearing on that decision at all. So I would do some research into who the anesthesiologist practice is that will be attending your birth since it will be scheduled. See if you can talk to them and find one who has perhaps attended a birth like this before, someone compassionate and respectful to the process of birth. If you're doula is still not able to be in the OR with you she can still be waiting in the post partum room for you getting it ready etc.

    (cont. in next comment)

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  5. How does a doula help during c/s birth?

    A doula can be with you when you get to the hospital and offer support during check in and surgery prep.

    She can offer massage, aromatherapy, listen to any fears you may have help you to advocate any last minute wishes with the staff before going into surgery.

    Once in surgery she will be there to advocate your wishes and remind your husband etc about lowering the curtain and allowing you to 'push'.

    Once baby is out it allows dad to go right to baby and you will not be left alone. The doula can prepare you to receive baby on your chest by cutting your gown or pulling it down. Once baby is on your chest you may feel very shaky etc from the major surgery happening on the other side, understandable, so the doula can keep a steady hand on baby to make sure baby is safe.

    I've even (with mom's permission of course)taken mom's breast and tickled baby's mouth and had baby latched and nursing WHILE mom was getting repaired. Amazing. They usually allow baby to stay with you until right before they close you up and then dad and baby go wait for you in recovery. At this time while baby and dad are gone your doula will stay with you throughout the rest of your procedure so that again you will not have to be left alone.

    She can help you deal with any nausea or shaking via pressure points etc and just be a friendly, loving touch in a sterile environment reminding you of how amazing you and your baby are!!

    If you would like any assistance writing a birth plan like this please PM me at jen.naturalblessings@gmail.com I would love to help or chat further with you about your rights and options. Blessings!!

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  6. @JenQ: This is great! I copied/pasted this, and emailed it to my sister. She had a c-section with her first baby, and isn't sure if she will try for a vbac or not next time. So just in case she doesn't, those are some great tips for making a c-section less of a "procedure", and more of a birth. :) I also am going to dig up some resources about vbac's for her though.

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  7. "A doula does not make decisions for a mother, nor does she offer or deny consent for any procedures on the mother's behalf." ...."She does not give the doctor a "yes" or "no" response..." ... "She is your advocate,"

    These phrases are contradictory. If a doula is not authorized to express what a mother wants or defend the mother's wishes vis-à-vis medical personnel, then she is *not* an advocate. She is merely a coach to the mother. The two are not the same. An advocate, by definition, can act as an agent of person the advocate is defending. Otherwise, no "advocating" can be done, just coaching.

    It would be good to get some clarification on this. Is the doula an advocate for the mother, or is she just a coach to the mother?

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  8. Just wonder what advice you have for what doulas do for high risk ob moms or moms of preemies?

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