The Purpose and Value of Labor Support

May 23, 2009 at 2:46 pm (Comfort Measures, Doula, Informed Consent) (, , , , , )

Labor support is not a new concept.  Traditionally, a birthing mother’s female relatives and friends would gather to assist her through labor, birth and the postpartum, with or without the added assistance of a trained birth attendant.  Now, with an increasing number of extended families living great distances from one another, and with the demands and pressures of modern life and careers, that traditional support has been interrupted.  Women labor in the unfamiliar environment of hospitals, alone or with the support of a husband or partner who may have no prior experience with childbirth.  The creation of the professional doula’s role serves to address that lack of experienced, usually female, support that women used to provide for one another.

The birth doula’s role is to provide nonmedical support to mothers, families, and/or their friends throughout labor, birth, and the immediate postpartum. This support may take the form of physical comfort measures such as gentle massage, hand holding, positional support and recommendations, as well as many other techniques gleaned from modern and traditional sources.  Doulas also nurture their clients emotionally, providing encouragement and acceptance throughout the intense experience of labor.   Another part of the doula’s role is her advocacy for her clients.  Doulas meet with their clients prenatally and listen to their needs, values, and plans for their birth.  They assist their clients in gathering information about aspects of labor and birth that are important or of concern to the client.  During labor, a doula can help to facilitate communication with medical caregivers, and she can remind the mother of aspects of her birth plan or prenatal conversations.  This advocacy does not extend to speaking for the client, or to making decisions for her.  Doulas must be careful to shed all of their own values and standards of what constitutes a good birth, choosing instead to serve as a recorder and reminder of the mother’s decisions and needs.

The birth doula has responsibilities to the women and families she works with, her colleagues, the labor support profession and society in general.  “The doula’s primary responsibility is to her clients.” (DONA Code of Ethics)  She allows and encourages her clients to make their own decisions regarding their care.  She maintains their privacy and confidentiality, and does not spread information she has heard in client meetings to anyone else.  The doula strives to assist each mother who is seeking labor support in finding a doula.  She makes sure she is available to provide the care she has agreed to provide, and if she is unavailable, she makes sure to have a backup doula who can serve the client in her place.  She maintains reasonable fees which she clearly communicates to her clients, as well as the services provided for those fees.  With respect to her colleagues, the doula maintains a fair, reasonable, respectful relationship with them, and treats their clients with courtesy.  Doulas support their profession by maintaining its “values, ethics, knowledge and mission.” (ibid.)  When possible, she provides some clients with free or reduced cost services, to continue the “vision of ‘A Doula For Every Woman Who Wants One’” (ibid).  Finally, a doula commits to advocating for the health of women and children across society.

When birth doulas act according to their roles and responsibilities, the rewards to mothers and children are obvious and encouraging.  According to the findings of Hodnett’s et al meta analysis of 15 trials from North America, Europe and Africa, “Women cared for during labor by a birth doula, compared to those receiving usual care were

Cesarean sections have documented risks for mothers “including infections, hemorrhage, transfusion, injury to other organs, anesthesia complications, psychological complications, and a maternal mortality two to four times greater than that for a vaginal birth,” (http://www.childbirth.org/section/CSFact.html), and risks for babies, including “increas(ing) the risk to the infant of premature birth and respiratory distress syndrome, both of which are associated with multiple complications, intensive care and burdensome financial costs. Even for mature babies, the absence of labor increases the risk of breathing problems and other complications.” (ibid)  The decrease in cesarean birth for women accompanied by a doula in turn decreases the risks of these negative outcomes, and so therefore doula care has a positive effect on the health and wellbeing of laboring women and their newborns.

 An equally important consideration is the mother’s satisfaction with her birth experience.  Since mothers who have the help of a doula are less likely to remember their birth as a negative or traumatic event, they may be less likely to succumb to certain postpartum mood disorders, such as postpartum depression and post-traumatic stress disorder. 

These scientifically verified outcomes of labor assisted by a doula are encouraging in a country whose maternal and neonatal mortality rates rank among the worst in the developed world. “American babies are three times more likely to die in their first month as children born in Japan, and newborn mortality is 2.5 times higher in the United States than in Finland, Iceland or Norway, Save the Children researchers found.”  (http://www.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/)  Doulas, with their information gathering and nurturing support, are well-placed to assist families in achieving a healthy, positive, and powerful birth, and therefore the best possible start for their life together as a family.

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Do You Doula?

May 16, 2009 at 2:49 pm (Uncategorized)

Just watched a sweet little film called Do You Doula?

It was a great overview of doula care.  It interviewed moms, dads, doulas, and medical professionals and asked them what kind of care doulas provide, how mothers can benefit from that care, and how doula care differs from and meshes with medical care.  At the end were some lovely statistics about the effects of doula care-  similar facts about doula care can be found in Klaus’  The Doula Book.  My favorites were that doulas reduce the need for epidurals by 60%, and the occurrence of Cesareans by 50%. 

I liked the mom and dad who both said that they primarily hired a doula for the dad- so he wouldn’t worry about his wife and would have someone to ask about what was normal while she was coping with labor.

I do wish that the film hadn’t started with a doula who was crying about how her birth had been stolen from her.  I don’t want my clients to have the idea that without me, they would be disempowered in their birth- I believe that however they choose to birth is right for them.  But that same doula said later that a very important factor in a mother’s satisfaction with her birth is her perception of her own power, so her message overall was a positive one for birthing mamas.

Thanks for this informative film!

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What’s in Your Doula Bag?

May 14, 2009 at 5:40 pm (Uncategorized)

doula bag 004My clients are always interested in what I’m going to bring to their birth.  I thought I’d do a little inventory of what’s in my bag right now, what still needs to go in there, and what my favorite things are to use at births.  And if any other doulas or midwives are reading this- let me know what’s in your bag, too!  What’s the one thing you wouldn’t want to be without?  What’s the most helpful at your births? I hope to expand my bag just as I expand my knowledge- by sharing with other birth professionals so we can all serve women better. 

Mamas, too- let me know what helped you the most at your births.  What would you have wished your doula had that she didn’t?

Here’s what I carry:

For mama-

  • Organic sports drink- usually lemon flavored so as not to interfere with homeopathic remedies.
  • Some hard candies for energy and to sweeten mama’s mouth if she throws up.  Lately I’ve been using pomegranate candies, and everyone loves them.
  • A few granola bars.
  • Flower remedies: at present, I have Bach’s Rescue Remedy, Aspen (for unnamed fears), Impatiens (for impatience), Chicory (for letting go) and Perelandra’s ETS plus (another rescue remedy-like solution)
  • My 30c homeopathy kit and a few 200c remedies.

    doula bag 002

    homeopathy kit

  • Massage oil
  • Arnica oil
  • St John’s wort oil
  • Lavender and peppermint essential oils (careful to keep them separate from the homeopathy)
  • An unopened chapstick, unscented.
  • Hairbands
  • 2 large wooden combs (for gripping during contractions)
  • A wooden toy (see picture) that’s soothing to play with.
  • Playing cards.
  • Lansinoh.

    labor toy

    labor toy

  • Organic alcohol wipes.
  • Hot/Cold pack and cover
  • Books: The Thinking Woman’s Guide to a Better Birth (better at resolving disputes with caregivers than talking from the doula) by Henci Goer, Homeopathic Medicines for Pregnancy and Childbirth by Richard Moskowitz, and the Labor Progress Handbook by Penny Simkin and Ruth Ancheta.

For me:

  • A few sandwiches
  • Water bottle
  • A clean shirt
  • A watch
  • Pen and notebook
  • A knitting project, just in case
  • Some cash
  • Cell phone and charger

If I had to choose one thing I couldn’t be without, it would be the massage oil.  After that, I would choose my homeopathy kit (if mama likes homeopathy- some clients don’t), and the wooden toy.  I used the toy at my last birth, and the mom just twirled it and twirled it through contractions.  It was very calming for her. I still want a nice rebozo and a TENS unit.

Even though I carry a lot with me, and sometimes use a lot of what I bring at births, I still feel that my hands and to a lesser extent my voice are the only things I really need.  With those, I can massage, do reiki, calm a mama and hold her up, and the rest of it is mama finding her own way as I watch her in wonder.

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My Doula Herb Garden

May 5, 2009 at 4:54 pm (Doula, Herbs) (, , )

St John's Wort

St John's Wort

This weekend I went to the Asheville Herb Festival with my daughter and our 9-year-old friend.  We spent  a happy hour wandering, looking at all sorts of green growing things, and talking about plant medicine.  I intended to pick up some staples for my garden, but I got drawn into the medicinal herb area.  As I spoke with the girls about how each herb can help women and mamas, I decided it was time to start my own doula herb garden.  Here’s what I chose:

Motherwort:  A pretty little plant with pink flowers, it promotes relaxation and helps to de-jangle mama nerves.  I used it after Stella was born, when caring for two rowdy boys and a brand-new baby girl pushed me right up to the edges of my coping abilities. 

Chamomile:  An all-around good herb to have in a garden.  Its flowers make a lovely and calming tea.  I mix it with red raspberry, alfalfa, and nettle to make a nurturing and nutritional brew for the mamas I know.  Chamomile tea is also great for a nursing mama (and as it goes through the milk, it helps to calm the babe), and it’s wonderful for young kids as well.  My boys love to drink it, and it tones down my eldest son’s energy when he’s wound up too tight.

Lavender:  Another calmative with a great scent.  Combined with other herbs, it makes a great sitz bath. I love lavender tea, and the dried flowers can fill a small stuffed animal or pillow for a new baby gift.  Lavender essential oil is also a great addition to a massage oil, for mamas or babies.

Comfrey:  A skin and tissue healer.  Comfrey is another good addition to a postpartum sitz bath, especially if mama has torn or had an episiotony.  Comfrey poultices or comfrey salves are great on scrapes, cuts, and sprains. And the fuzzy leaves are fun to rub:)

Blue Cohosh:  This one isn’t going in my doula bag, as its effects are stronger and need to be monitored by a midwife or doctor.  But I planted it anyway, in anticipation of the midwifery training I plan to embark on in a few years.  Blue Cohosh is a labor enhancer, and can sometimes be used to induce labor as well. 

I plan to include many more herbs as the summer goes on- I’ll let you know as I plant more gentle and helpful herbs!

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