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WHAT IS A DOULA?
The term doula is from ancient Greece and loosely translates as 'slave' or 'servant' (to give service).
A Doula is a woman trained, knowledgeable about the natural physiology of labor and delivery, and experienced in labor support and childbirth who provides continuous physical, emotional and informational support to the mother before, during and just after birth. She is a labor companion to the mother and her partner. A doula is not meant to replace the birthing woman's partner or coach, or nor is she a midwife or a midwife's assistant. A doula should be considered an addition to the mother's care and is there specifically to help the mother with her labor.
A doula offers advice on physical comfort measures such as breathing, relaxation, massage, counter-pressure, gentle touch, and literally supporting the laboring woman's body weight during a strong contraction. Positioning and frequent position changes are helpful in labor progression. Doulas can help mother's to squat or other positioning that requires strong support. Emotional support is essential if the mother is to feel safe and secure in her birthing environment of choice. As with any birthing animal, this is very important for positive labor and birth experiences, favorable outcomes, and fewer complications. Informational support helps remind and inform the birthing mother and her partner when labor does not progress as expected. In a clinical setting, this may include strange people with various strange machines and equipment offering technical assistance that may prove to be confusing and frightening to the laboring mother and her partner. A doula will be able to explain the suggested medical procedures and interventions and help provide the clarity expectant parents may need when confronted with difficult decisions. Postpartum doulas are also becoming more popular with many new parents.
As the benefits of continuous physical and emotional support in labor become more apparent, many expectant parents are seeking out the services of doulas, or trained birth assistants. A doula is especially helpful in a hospital or birthing center birth as they provide the continuous support that is often lacking in these situations. In a homebirth setting, a doula may or may not be as much of an asset since the midwife (and any of her assistants) are already there providing the continuous care that the mother needs. In a homebirth setting, it is wise for the mother and her partner discuss the use of a doula with the midwife prior to the labor and birth.
A doula does not, however, function in any medical capacity and does not ordinarily use any clinical skills such as checking fetal heart tones, blood pressure checks, and vaginal exams. Midwives and her labor assistants will do the clinical skills required for properly monitoring the labor and birth. Doulas do not diagnose medical conditions, offer second opinions, or give medical advice.
In order to become a doula, academic study combined with practical experience is required. Prospective doulas study the anatomy and physiology of pregnancy from conception to birth, and are required to attend childbirth preparation classes such as Bradley or Lamaze. Attendance and participation at many different types of births is mandatory, usually accompanied by a trained doula, midwife or labor and delivery nurse. Birth evaluations on each birth observed are prepared by the student doula and often discussed with her mentor, or a senior doula. Reading assignments and book reports are also required. There are local and regional trainers that offer courses of various lengths and duration, and national organizations offering certification such as DONA (Doulas of North America) and ALACE (Association of Labor Assistants and Childbirth Educators).
In interviewing a doula, parents should consider their anticipated needs and desires with regards to their birth plan and consider:
- The training and experience the doula has had.
- The doula's certification status (if certified or not).
- The number and types of births she has attended.
- If she has previously worked with your midwife or health care provider.
- If she has attended births in the same environment as your planned birth.
- How she sees her role during the various stages of labor and during the birth.
- What is her fee, and does that include prenatal and postpartum visits?
- Does she have back-up arrangements if she is not available?
Doulas can be located through the various organizations and birthing directories that offer childbirth preparation classes, your midwife or health care provider, your anticipated place of birth if you are not planning a homebirth, lactation consultants, and quite often through baby specialty stores. You can ask the doula for references, if desired, and meet with her personally after an initial phone conversation. You should look for clues that will tell you about her personality and attitudes to ascertain if your beliefs are compatible. Look for signs of a warm heart and strong, sure and capable hands.
Doulas are usually very respectful of the intimate bond between mother and her partner, other family members, and members of the birthing team (midwife and her assistants) and will often work in the background to encourage participation and develop confidence in the support team members. By demonstrating her training and skills in a quiet and calm manner, the doula models ways of being helpful to the mother in a positive way, allowing others the opportunity to be of assistance as well. Make sure your doula, if she hasn't worked with your midwife previously, meets with her to make sure they will be compatible working together during the labor and birth (this is VERY important for the birth to go smoothly!). Also, if a doula has not previously attended homebirths, you will need to find out if she will feel comfortable with the relaxed, informal birth setting in your home as compared to the hectic, structured setting found in most hospitals and in some birthing centers.
When considering the presence of a doula at your birth, keep in mind the documented benefits a birth doula can offer.
- Cesarean birth reduction by 50 percent.
- Length of labor reduction by 25 percent.
- Fewer epidural requests by 60 percent.
- A reduction in oxytocin (pitocin) use by 40 percent.
- A reduction in analgesia (narcotic) use by 30 percent.
- A reduction in forceps or vacuum extraction delivery by 30 percent.
WHAT IS A BIRTH DOULA?
A Birth Doula recognizes birth as a life transitioning experience that the mother will remember all her life.
A Birth Doula understands the physiology of birth and the emotional needs of a woman in labor.
A Birth Doula assists the laboring mother and her partner in preparing for and carrying out their plans for their birth.
A Birth Doula provides emotional support, physical comfort measures, an objective viewpoint, and assistance to the birthing mother when getting information from her midwife or health care provider she may need to make good decisions.
A Birth Doula stays by the laboring mother's side throughout the entire labor.
A Birth Doula facilitates communication between the laboring woman, her partner, and her midwife and/or health care providers.
A Birth Doula sees herself as a nurturer and protector of the birthing woman's memory of her birth experience.
WHAT IS SUPPORT?
Support is unconditional.
Support is listening.
support is not judging, not telling your own story.
Support is not offering advice.
Support is offering a handkerchief, a gentle touch, a hug, and caring.
Support is helping women discover what they are feeling.
Support is not to make the feelings go away.
Support is here to discuss steps with a woman, not to take the steps for her.
Support is here to help a woman discover her own strength.
Support is not to rescue her and leave her still vulnerable. It is helping her to discover she can help herself.
Support is not to take responsibility for her. But the help a woman learn to choose.
Support is not to make it necessary for her to make difficult choices.
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