The Purpose and Value of Labor Support (My essay for certification as a DONA Birth Doula)

I have been a Nurse for 25 years. My only area of specialty has been Neonatal ICU/Nursery Nursing. The best estimate is that I have been present at the births of more than 1,500 babies. I am pretty comfortable in the delivery room. Then, about 2 years ago, I was present at a birth attended by a doula. I was intrigued, I wanted to learn more about the role of a doula and a new passion was born (pardon the pun). I realized I wanted to broaden my knowledge base and get out of my comfort zone. As a nursery nurse you are only present at very end of the first stage of labor through the fourth stage of labor. Even being present for that short of a period of time, I was able to observe the difference with an un-medicated birth. The mothers appeared more joyous and blissful. They appeared to be able to bond, care for and breastfeed their babies with a greater ease. Now, having gone through training and being a doula at many births I can’t help but think how wonderful it is to be a part of something so important!
As I set forth on this new adventure I had a lot to learn. First, what is a doula? Doula is Greek for woman who serves. A doula provides emotional, physical and educational support. Doulas began to increase in popularity in the 1980’s primarily in response to the dramatically rising C-section rates. Women like Ina May Gaskin and Penny Simkin and Dr. Klaus and Dr. Kennel revolutionized the role of the Doula. Drs. Marshall Klaus and John Kennell, Phyllis Klaus C.S.W., M.F.C.C., Penny Simkin, PT, and Annie Kennedy, MA, all renowned experts in childbirth and newborns, founded DONA in 1992. It has become very important to me to define and communicate the role of a doula. Doulas do not perform medical exams or interventions. A DONA doula must adhere to the code of ethics outlined in the DONA International Code of Ethics for Birth Doulas. The DONA position paper “The birth doula’s contribution to modern maternity care” discussed the role of a doula as an advocate, without giving medical advice or making medical decisions, to ensure a safe and satisfying birth experience. The paper also discusses the importance of not projecting their own “values and goals onto the laboring woman”.
By far the most important role of a doula is to provide physical and emotional support throughout the pregnancy, during labor and after birth. Doulas use techniques such as imagery, massage, acupressure, hot/cold therapy and patterned breathing to help reduce a woman’s pain during labor. The Doula is not there to replace the father/family or the healthcare team; she is there to enhance them. Women who feel cared for are less likely to cross over from pain to suffering (one of the many things I learned from Penny Simkin).
When I tell people I am a doula, sometimes I get a response like “that’s great, you must enjoy it so much” . However, the more likely response is a blank stare and the question “what’s that?”. Next they usually say “oh, like a Midwife?” I actually like when someone asks me that. It is such an opportunity to educate people about the wonderful aspects of being a doula. The primary purpose of a Midwife or other healthcare provider is to attend to the medical needs of the mother to ensure the health of the mother and the safe delivery of the baby. The purpose of a doula is to provide the mother with physical, emotional and educational support. A mother or significant other at one point usually asks another important question “If I have a midwife and family present, why do I need a doula and won’t my labor nurse in the hospital help me?” A labor doula is trained for labor and birth to provide continuous support to the mother in a one-to-one setting. Unlike a Midwife or a Labor Nurse, the doula stays with the mother and works as a team with the family to attend to the mother’s emotional and physical needs. I often tell people, isn’t that a wonderful idea? The thought that there was one person with the mother that has no agenda other than to ensure the mother is cared for and that her wishes are respected. The Hodnett, et al. study that is referenced in a DONA position paper states that “the supported women had better outcomes” and that “obstetric outcomes were most improved and intervention rates most dramatically lowered”.
The World Health Organization has acknowledged that there are benefits to continuous labor support. Studies have shown the MULTIPLE benefits of having a Doula. The birth doula position paper from DONA cites that women who have a trained birth doula present are 28% less likely to have a cesarean section. They also cite that these same women are 31% less likely to have their labor augmented by the use of synthetic Oxytocin and 9% less likely to use any pain medication. These statistics prove that the presence of a trained birth doula decreases the ‘cascade of interventions’. Avoiding these interventions logically will improve obstetric outcomes and more significantly improving maternal and fetal mortality rates. The DONA position papers also cite that the mothers are 34% less likely to rate their childbirth experience negatively.
The birth of a child can be the most significant experience in a woman’s life. A doula, functioning within the scope of practice, can significantly improve a mother’s experience and improve maternal and fetal outcomes. In the end, I don’t think that there is there anything more important than improving society by improving birth even if it’s one birth at a time.

Quite the day for celebrating

Welcome to IDoula4U’s latest baby!!! Such a sweet story!!!!

Tales of a Mom

Yesterday was quite eventful. My premie cousin got to finally bust out of the NICU and go home. A niece celebrated her first birthday. It was the feast day of St. Augustine (thanks Meg!), the troublesome son turned saint of the saint I chose at confirmation, St. Monica. Aaaand…our dear daughter was born.

At 4am I woke up with period like cramping. I took it as more Prodromal. I tried to get back to sleep, it was hopeless. When GamerDad woke up for PT, I let him know what was going on and that it was probably nothing again. When he got back I was still crampy and had zero appetite. That gave me a small glimmer of hope that it was the real deal. By 6:45 or so, I had breakfast ready and forced food down my throat just in case.

The boys and I did our daily routine…

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Operation Special Delivery

I am a Doula for an organization called Operation Special Delivery (OSD). If you are a trained Doula, and you want some way to thank those who serve this country, I can think of no better way to use your unique skills to give back. If you are the significant other of a person that serves this country and will not be able to attend your delivery or who was killed in action or was injured and could use some support with your delivery, you can find a volunteer Doula to help you free of charge. The best way to find a OSD Doula is to visit http://www.doulas.com/

You can also look for the symbol below  on a Doulas website or Facebook page.

 

Here is information taken directly from the Operation Special Delivery Website:

 

Operation Special Delivery (or OSD), provides trained volunteer doulas for pregnant women whose husbands or partners have been severely injured or who have lost their lives due to the current war on terror, or who will be deployed , or unable to attend the birth due to military reasons. The doulas that are volunteering are doing so at a pro bono (free) rate, and are doing so by their own discretion

Why military moms? OSD believes that no one should go through childbirth without support, especially the women who are giving birth while their husbands or partners are making such a great sacrifice for our country and our freedom.

Many people ask, “How did Operation Special Delivery get started?”

There’s no short answer to that question, so here’s the low-down.

Like many people, Patricia Newton, a doula in southern New Jersey, felt the need to personally respond to the tragedies of September 11, 2001. Being a childbirth professional, she immediately saw the U.S. military and their families as indirect victims of the attacks. Because she was geographically located between Washington, D.C. and New York, she asked nearby doulas via the internet if they would be willing to donate their services to any pregnant woman who either lost her partner on 9-11, or would be giving birth without the presence of her partner due to future deployments.

The response was overwhelming. Not only did doulas on the East Coast enthusiastically respond, but within one week, doulas from twenty states wanted to jump on the bandwagon.

You can learn more about this organization by visiting their website http://www.operationspecialdelivery.com/index.htm

http://www.operationspecialdelivery.com/

The Evolution of the Modern-Day Doula

The practice of women helping women give birth is by no means a new idea.  Before the evolution of the medical profession and hospitals, it was the norm for relatives, neighbors, friends and traditional midwives assist a woman to give birth in the home. Their role was to strengthen and encourage the birthing mother. They gave emotional and physical support to sustain the mother to bring a new life into the world.   This was the norm for the 19^th and early part of 20^th centuries.  In the early 1900’s, as the social classes was at a greater distance, there was a change in the way women gave birth. As doctors became more and more respected, the model of childbirth changed from that of a home based event to that of an illness based hospital event. The female support unit was taken away, fathers were kept in waiting rooms and birth changed to an illness based model. The practice of midwifery all but disappeared. Women (especially in the upper classes) began to give birth in a hospital with the aid of primarily male, physicians. These changes hugely benefitted women who were considered to have a “high risk” pregnancy. On the other hand it began to subject “low risk” pregnancies to a cascade of interventions that could result into (what would have been a routine home delivery) into a complicated labor and delivery. In the 1920’s the “routine” use of forceps was actually promoted for a births, especially first time mothers. By 1940, anesthesia was commonly used and by 1950 it was commonplace for a woman to be anesthetized to the point of unconsciousness (has anybody watched the BBC show “Call the midwife”?).  Nitrous Oxide (laughing gas) was given to put the mom in an un-alert state. Later in the 1950’s continuous caudal anesthesia (a localized anesthesia……a regional block, saddle block…etc) was being developed and used.  In the 1960’s continuous lumbar anesthesia was introduced. By 1970 continuous lumbar epidural anesthesia and continuous fetal monitoring was common.  With continuous epidurals, the evolution of labor became a bed-ridden event. Walking during labor was a thing of the past.  As hospital births increased the Cesarean Section (C-Section) rate, in the United States, has steadily risen. We are now at an all time high of 33% in 2011. Here are the current C-Section rates for some other countries:  Italy 40%, China around 50% and Brazil has a rate around 85% and in some private facilities the rate in Brazil it is approaching 99%…..Check it out, it’s easy to find the statistics on the World Health Organization (WHO) and other websites.  The WHO states that there is no reason for a countries’ C-Section rate to exceed 15%. As C-Section rates rise you can alos see the mortality rates rise. It’s not all bad….worldwide I mean…..some Nordic countries have a C-Section rates around 14%. So, it can be done!!!!

The modern-day Doula (Greek for “woman who serves”) started to reappear in the 1970’s. Marshall Klaus and John Kennell began to study the effects of a woman being supported during labor. In 1971, Ina May Gaskin founded “The Farm Midwifery Center” in Summertown TN.  The Farm was one of the first out-of-hospital birth centers founded in the United States. Ina May and the farm Midwives returned to the family centered home based birth model (Ina May has recently released a documentary based on her experience on the farm…..a DVD I highly recommend you watch).

 Doulas began to increase in popularity in the 1980’s in response to the dramatically rising C-Section rates. Women like Ina May Gaskin and Penny Simkin and Dr. Klaus and Dr. Kennel revolutionized the role of the Doula.  Drs. Marshall Klaus and John Kennell, Phyllis Klaus C.S.W., M.F.C.C., Penny Simkin, PT, and Annie Kennedy, all renowned experts in childbirth and newborns, founded DONA International (formerly known as Doulas of North America) in 1992. Their goal was to promote doula care: continuous emotional and physical support for women during labor and early postpartum. DONA registered 750 certified doulas in 1994 (their first Doula was certified in 1994), increasing to 2,000 in 2002. Between 1994 and 2004, DONA has provided training to approximately 25,000 people and as of 2012 has 8,500 certified Doulas in 50 countries.  Doulas use techniques such as imagry, massage, acupressure and patterned breathing to help reduce a woman’s pain during labor. The Doula is not there to replace the healthcare team; she is there to enhance it. Studies have shown the MULTIPLE benefits of having a Doula (refer to my earlier entries about the benefits of hiring a Doula). Now fast forward to 2012 the University of Minnesota published a study in the American Journal of Public Health about Doula support during labor. The study showed that women who were supported by a trained Doula were 40% less likely to have a C-Section. That bears repeating……40% LESS likely to have a C-Section!!!!! The study was conducted among pregnant women with Medicaid. Check it out, it is pretty interesting!!! http://www.minnpost.com/second-opinion/2013/02/doula-support-linked-lower-c-section-rate-among-medicaid-moms-u-study-finds The study shows that in the hospitals involved the study, the average cost of a vaginal delivery was around $9000.00 and the cost of a C-Section was around $13,000.00. Hopefully more and more hospitals will start to recognize the benefits of a Doula or at least do the math!!  Other studies have shown the patient satisfaction surveys are improved by the presence of a Doula. Hospital based Doula programs are on the rise.

 When all is said and done, the modern-day Doula is here to stay!!!

http://watch.birthstorymovie.com/

Would you hire a childless Doula?

Would you hire a Doula that is childless?  Does the fact she has never been through a pregnancy and labor make a difference?  Let me ask you a few questions…..Would you have a problem with a hospice nurse taking care of someone you love? After all they have never experienced death. Would you see a male Obstetrician? They have no personal experience with any part of being a woman.  Can you learn from a history teacher? They did not experience the history they teach (for the most part).  Would you love a song written by a songwriter that cannot sing? I could go on but, I think you see where I am going.

I openly admit to potential clients that I have never been pregnant and at my age, will never be pregnant.  In my experience and after reading numerous posts asking if you would hire a childless Doula, the answer is…….Yes, most women would hire a childless Doula. I think, for the most part, the decision to hire a particular Doula is based on how well the client and Doula “click”. If you can form a bond, the fact your doula has never given birth shouldn’t matter.

In my opinion, there are a few benefits to hiring a childless Doula.  If you think about it….a childless Doula doesn’t bring any personal issues related to her own experience to your delivery. She doesn’t have any “birth baggage” that could possibly influence her thoughts and emotions.  Another “perk” is that a childless Doula can be more available….they don’t have to arrange for childcare (well, in my case, I would have to arrange for puppy care….I just got a puppy and she has severe separation anxiety. But, I think that is a whole other blog).

When consulting with a potential Doula it is important that you feel a bond with her.  Your Doula is going to be your advocate, teacher, coach, and cheerleader. She is your source of empathy, caring and support.  She is the source of information and support for your partner/family. Your Doula should have an open mind. In my opinion her only goals/priorities should be to help you have the best birth experience you can have and to help ensure your baby is born healthy. If you feel your Doula is capable helping you, then childless or not….she’s the Doula for you!!!!

Happy Mother’s Day 2013

Image

First Mother’s Day

New Mom.

New fun.

So blessed.

This one.

Long nights.

Short days.

Go back?

NO WAY!

-Author Unknown

Happy Mother’s Day 2013

 

 

 

How to hire a Birth Doula

I have discussed why you should hire a Birth Doula, now let’s discuss HOW to find a Doula.  Let me start by giving some background about Doulas.  Doula is Greek and means “Woman who serves”.  There are two most common types of Doulas: Birth Doula and Post Partum Doula. Sometimes women are both types. I will focus on Birth Doulas in this post (I guess that is because that is what I am).  Anyone can call themselves a Doula. When you are doing your research about hiring a Doula, I advise you to look for a trained/certified Doula. The two organizations (in the US) that certify doulas are DONA International (formerly known as Doulas Of North America) and CAPPA (Childbirth And Postpartum Professional Association). These are both international, non-profit organizations that help to ensure that there is consistent and evidence based training for Doulas.  When you hire a certified Doula you are hiring someone who has been through organized/evidence based training and the doula adheres to a set of standards set up by that organization.  The doula has gone through a rigorous certification process. This is a quote from the DONA.org website “ A Doula’s education, training, experience and credentials are important. When Doulas have DONA International certification, you know that they have had the best education and training available. You can also be assured that they have a strong sense of professionalism and integrity.”

There are many websites that help you find a doula (for example Doulas.com). If you want a certified doula, look for the title designations CD(DONA) or CLD after their name. You can also go right to the certifying organization’s website and use their search engine (go to DONA.org or CAPPA.net) to find a certified Doula.  You may consider hiring a birth doula that has yet to be certified but has undergone that organizations training and is now completing the deliveries needed for certification.  I am currently a DONA trained Birth Doula and I need one more delivery to qualify and I will be sending in all of my paperwork for certification. Some apprenticing Doulas provide their services for free or (depending on experience) they may charge a reduced rate or their full fee. There is no set fee structure for Doulas in the United States (but I will address that at another time). You will have to consult with Doulas in your area about their fees.

The decision to have a Birth Doula present at your delivery is something that must be right for you. I think all women and their partners/family can benefit from having a Doula whether it is your first or fifth delivery.  You can also benefit no matter what type of delivery you are having…..un-medicated birth plan through a planned C-Section.  I close with a quote from the CAPPA.net website “CAPPA certified professionals aim to facilitate empowerment, connection, and self-advocacy in families from pre-conception through early parenthood. CAPPA works to foster and encourage culturally relevant education, support, and training in countries around the world.”  That sounds pretty good….doesn’t it!!!

 KEEP CALM AND HIRE A DOULA!!!

Visit http://www.DONA.org or http://www.CAPPA.net to find a Certified Birth Doula near you.

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The Benefits of having a doula for your birth

Now that we have talked about “Why” to hire a Birth Doula, I want to talk about the benefits you may receive from your Doula.  If you visit the DONA website and click on “Why use a Doula”, you will see a list of the benefits. This list is “Evidence Based” which means these benefits are based on theoretical studies, qualitative studies and/or  quantitative studies. On the website you can even click on links to read the research it is based on. http://www.dona.org/mothers/why_use_a_doula.php  Numerous clinical studies have found that having a doula present at your delivery:

•  Tends to result in shorter labor
•  Fewer complications
•  Reduces the need for Pitocin (a drug that induces labor)  Reduces medical interventions (use of forceps, vacuum    extraction & C-Section).
•   Reduces the mother’s request for pain medication and/or epidural  Mothers have less negative feelings about their childbirth experience

Research also shows that parents have found that having a doula present can:

•  Help them feel cared for and more secure
•  Have improved success with breastfeeding
•  Help them feel more confident
•  Help them feel more successful at adapting to their new family
•  Result in less postpartum depression

Now, if that’s not enough to sway you in the direction of having a doula help you…….here is my opinion!  Based on what my clients have reported, they were glad I was there because a good doula can:

•  Think of pain management techniques you may never think of
•  Help prepare you and educate you before, during and after birth
•   Be there to help you advocate for your birth plan
•   Help you adjust/adapt when your birth plan may change

Remember…..a good doula has no agenda (as I say…….I have no horse in the race) when it comes to your birth plan. DONA or CAPPA (those are the 2 best known agencies that certify doulas) does not give us brownie points if you have an un-medicated birth, nor do they take points away if you have an epidural (there are no point, no rewards, no incentives for a specific style of birth). My only stake in your birth is an emotional one. I want my clients/families to be happy. That is my driving force.  In my opinion….a good doula is there with 2 goals in mind:

1. Help make sure you have the best birth experience possible
2. Help to ensure your baby is born safely

That’s it!!!!!! I think any mom would agree that sounds like a great idea. So, do your own research and decide for yourself.  Doulas make a difference!

To find a doula near you try DONA.org, doulas.com, cappa.net

Why Hire a Doula? Part 6: “I can’t afford a Doula.”

Just recently Suze Orman (during a segment on her show called “Can I afford it?”) said to a caller that the expense of a doula was a “NEED NOT JUST A WANT”  (Hear for yourself, go to http://video.cnbc.com/gallery/?video=3000162344) .  In my opinion a doula is worth every penny and then some!!! Most doulas usually charge between $300.00 and $800.00 (some are higher) depending on the area you live in.  Some (very few) insurance companies will reimburse for doula services. Unlike insurance companies, it is customary to pay your doula and you submit paperwork to your insurance company for reimbursement.  Since sometimes partners need a little more convincing to spend the money for a doula, here is some information for them……In a 2012 study by the University of Minnesota they provided every Medicaid patient with a doula. The University covered paying for the doula. The study concluded that a woman who was supported by a doula was 40% less likely to have a C-Section.  Here are some numbers for you: the study estimated the cost of a vaginal delivery to be about $9,000 and the cost of a C-Section was around $13,000. Read the study for yourself…..go to http://www.minnpost.com/second-opinion/2013/02/doula-support-linked-lower-c-section-rate-among-medicaid-moms-u-study-finds.  I once saw a button that said…..MY DOULA WAS WORTH THE MOOLA. I can tell you of most of the doulas that I know, none of them are in it for the $$$$. They are doing it because they love what they are doing. Becoming a doula has been one of the most emotionally rewarding things I have done. Please keep in mind that a doula does needs to cover the expenses involved in caring for you (childcare of their own children while they are with you, mileage, educational materials, the cost of certification, supplies and their time). Think about all the things you spend money on when preparing for your precious baby. I think the cost of a doula is worth it to improve the chances that you will have the birth experience you want.  Recommend that you ask someone who had a birth doula for their delivery.  They will tell you if it was worth it!!!

A Doula is a NEED not a WANT

Why hire a Doula? Part 5: “I don’t need a stranger to help me.”

I can pretty much guarantee that by the time you are ready to deliver, your doula will no longer be a “stranger” to you. Although I haven’t been a doula very long, I can tell you that I have already established some kind of a bond/friendship with every one of my clients.  I have attended quite a few baby showers and am sure I will keep in touch with most of them. For most women, (for a hospital birth) the L&D team will be new to you. Wouldn’t t be nice to have a doula that you are familar with be there to support you and your partner?  A bit of advice here…..trust your instincts when interviewing potential doulas. Most doulas offer free/no obligation consultations (you can meet on neutral ground….like for coffee if you don’t want someone new coming into your home). Take advantage of that time to get to know her. Most women have those mommy instincts about new people. You will usually be able to tell if it is going to be a good fit. Remember, you will be spending some of your most personal/intimate times with your doula. Make sure she is right for you. Most doulas offer, in addition to the initial consultation, several prenatal meetings with you to discuss your birth plan, comfort measures and any other needs you may have. Most offer unlimited email and phone contact. I will even go with you to a prenatal appointment with your healthcare provider to discuss your birth plan. If any questions come up during your pregnancy, your doula can be an excellent resource. I even have a lending library of books, CDs and DVDs that I make available to all my clients. So, between visits, phone conversations, emails, calls and texts, my clients get to know me (and vice versa) very well by the time they’re ready to deliver. I think it is nice to have one more person in the delivery that is just there to take care of you and your baby.

What a doula looks like!