What is a Doula?
- Recognizes birth as a key life experience that the mother will remember all her life.
- Understands the physiology of birth and the emotional needs of a woman in labor.
- Assists the woman and her partner in preparing for and carrying out their desires for the birth.
- Stays by the side of the laboring woman throughout her entire labor.
- Provides emotional support, physical comfort and an objective viewpoint.
- Provides assistance to the woman in getting the information she needs to make good decisions.
- Facilitates communication between the laboring woman, her partner and her careprovider(s).
- Perceives her role as one who nurtures and protects the woman's memory of her birth experience.
- Practices confidentiality.
Doula, from the Greek word meaning slave, is a woman experienced in childbirth who provides continuous physical, emotional, and informational support to the mother before, during, and just after childbirth. Dana Raphael, in the book, The Tender Gift described Doula as a "title for those individuals who surround, interact with and aid the mother at any time within the perinatal period." And it was from that book that the word came to be used in the context in which we are using it today.
It is now widely recognized that having a female labor support doula assisting the birthing woman or couple can decrease the length of labor, decrease the severity of perceived pain, decrease the need for anesthesia or analgesia, and can help prevent a cesarean section. A good birth experience will enhance the postpartum period by speeding recovery, easing breastfeeding and securing the satisfaction of the mother and father with each other and themselves.
RESEARCH
In Mothering the Mother Marshall Klaus, John Kennell, and Phyllis Klaus; the wonderful group of doctors that made the concept of 'bonding' a household term, (Addison Wesley Publishing Company, 1993 Pages 33-51) describe the crucial evidence that supports the use of doulas.
Their evidence is drawn from six randomized, controlled studies; two in Guatemala, one with 136 women, another with 465 women; a study in Houston Texas with 416 women and one with 192 women in Joahannesburg, South Africa. The fifth and sixth studies were done in Helsinki Finland and in Canada. All participants were primiparas (women giving birth to their first child), they were all healthy and had had uneventful pregnancies. They were invited to participate when they were admitted into the hospital in labor.
The Guatemalan doulas were trained in a 3 week course, but in the South African study the women were untrained lay-women. They were all asked to remain with the laboring women constantly and to use touch and verbal communication focusing on three primary factors: comfort, reassurance and praise. All of the doulas in the study had experienced normal labors and vaginal births.
Doulas used soothing words, touch and encouragement. They explaining procedures and what could be expected to happen next. They also translated medical terms into laymen's terms and did some very minimal charting - such as noting the number of staff contacts that the mother had and any interventions.
The results showed a:
- a decrease in cesarean sections
- a decrease in the length of labor
- a decrease in use of forceps
- a decrease in use of oxytocin
- a decrease in use of epidurals
- a decrease in use of pain medications (narcotics)
- Improved Breastfeeding
- Decreased Postpartum Depression
- Greater Maternal Satisfaction
- Better Mother-Infant Interaction
Not only were these results fairly amazing, but they also reduced costs. Now, to many of us involved in the birth world that is not as significant as the good outcomes. But when the cost of anesthesia, sepsis work-ups on babies resulting from epidural induced fevers, and the cost of cesarean surgery and extra time spent in hospitals is decreased, insurance companies and hospitals sit up and take notice.
Postpartum Doulas
What do postpartum doulas do for the family after the birth?
What a postpartum doula does changes from day to day, as the needs of the family change after the birth. Postpartum doulas do whatever a mother needs to best enjoy, learn and care for her new baby. A large part of the postpartum doulas role is education for the whole family and assisting them in caring for their newborn and breastfeeding support. They share information on newborn care tips with parents. They assist with breastfeeding and infant feeding education, newborn care, such as bathing, dressing, diapering, soothing techniques and umbilical cord care. Postpartum doulas also help around the house, prepare light meals, and will do errands if needed to insure that the new mother rests and feels taken care of.
How long does a postpartum doula spend with a family?
The Postpartum Doulas support can last anywhere from two visits to more than three months. Typically families use the postpartum doula for 2-4 weeks.
What hours can I expect a doula to work with my family?
Doulas usually work part-time, three to five hour shifts during the day. Some doulas work evenings and some can work a longer 10-12 hour overnight shift. Sometimes doulas work every day, sometimes you need them to work a few days a week.
What is the difference between a postpartum doula and a baby nurse?
The role of a postpartum doula is to help a woman through her postpartum period and to nurture the family. Unlike a baby nurse, a doula’s focus is not solely on the baby, but on fostering independence for the entire family, through education, assisting with the baby care, supportive and knowledgeable of breastfeeding. The doula is as available to the partner and older children as to the mother and the baby. Treating the family as a unit that is connected and always changing enables doulas to do their job: nurture the family.
What is a postpartum doula’s goal?
The goal of a doula is to nurture the parents into their new roles. As they experience success and their knowledge and self-confidence grow, their needs for professional support should diminish.
How does a doula nurture the parents into their roles?
Self-confidence has a tremendous impact on a person’s ability to approach any task, and parenting is no different. Postpartum doulas are taught to always consider parents’ feelings and always build confidence whenever possible. Doulas accomplish this through praise, acceptance and a non-judgmental approach. In addition, the doula will teach parents strategies and skills that will improve their ability to bond with their babies. A calm baby who is feeding well, growing well will help parents to feel more confident in their skills.
Do doulas help mothers to deal with postpartum depression?
Unlike therapists or psychiatrists, doulas do not treat postpartum depression. However, they will help by creating a safe place for the mother emotionally. The doula will provide a cushioning effect by accepting the mother within each stage that she passes through. They relieve some of the pressure on the new mother by helping her move into her new responsibilities gradually. By mothering the mother, doulas makes sure that the mother feels nurtured and cared for, as well as making sure she is eating well and getting enough sleep. In addition, certified postpartum doulas are trained to help clients prepare themselves for parenthood, maximizing support and rest. These doulas will help their clients to screen themselves for PPMDs and will make referrals to appropriate clinicians or support groups as needed.
Do doulas teach a particular parenting approach?
No. doulas are educated to support a mothers’ parenting approach. Doulas are good listeners and encourage mothers to develop their own philosophies.
How do postpartum doulas work with a mother’s partner?
A doula respects the partner’s role and input, and teaches concrete skills that will help the partner nurture and care for their baby. The doula will share evidence-based information with the partner that shows how his or her role in the early weeks will have a dramatic positive effect on the family.
