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Therapies

doula

What Is It?
How Does It Work?
What You Can Expect
Health Benefits
How To Choose a Practitioner
Cautions
References
Evidence Based Rating Scale
 

 

What Is It?

 

Doula is a greek word for “woman’s servant.” A doula is a traditional, professionally trained attendant for mothers during the birthing process or during the postpartum period. A doula (in most cases) is hired by the family to provide continuous physical, emotional, and informational support to the mother before, during and just after childbirth.

Doulas do not replace nurses or other medical staff. Doulas do not perform clinical or medical tasks such as taking blood pressure or temperature, monitoring fetal heart rate, doing vaginal examinations or providing postpartum clinical care. Doula’s can help a woman communicate more effectively with the attendant medical staff, but will not make medical decisions on your behalf. A doula’s main objective is to make you as comfortable as possible with the birthing process and with the birth itself. After all, this will be one of the most important events in your life you should be free to concentrate on what really matters, welcoming your new baby into the secure and loving environment of your new family.

How Does It Work?

The doula’s main goal before and after the birthing process is to make you feel as comfortable and supported as possible. She will typically coach you through the final stages of your pregnancy, and through labor and delivery. She may instruct you on birthing positions, and offer massage or other pain relieving techniques. She can act as a conduit of information between you and your partner and you and the other medical staff. Doula’s do not make medical decisions for you or provide direct clinical care. These services are more traditionally offered by mid-wives. Doulas are not meant to be mid-wives they are ultimately a birth advocate who’s purpose it is to make your pregnancy, labor and delivery as comfortable and stress free as possible for you and consequently for your new baby.

What You Can Expect

Doulas can be hired to attend to you during the childbirth period or during the postpartum period. There is no prescribed set of instructions that outline what a doula will or will not due for her charge. Generally she will provide emotional support to the mother, partner, and family. She can also act as a valuable informational resource.

Doulas will typically provide one or two prenatal meetings with you and your partner. These meetings will be to discuss your plans for the birth of your child, any health concerns you have regarding the birth, and will typically provide educational resources and emotional support for not only yourself but your partner. The doula will attend the birth and then if under contact will provide postpartum support such as breastfeeding tips, baby care information and provide sources where the mother can locate any additional information she would like to have on infant or child care.

Most doulas charge a flat fee which is largely dependent upon their length of training, any additional certifications they hold, and what the market rate is for doulas in your area. You will typically enter into a contract agreement that spells out the fees and services.

Health Benefits

The health benefits for having a doula attend your birthing are multifold. Apart from the emotional benefits of having someone attend to your needs during this busy and tense time. Research has just been initiated on the benefits of this ancient practice. Preliminary results demonstrate promise. Specifically doulas can help to:

  • Reduce your dependence on epidurals during labor.  A study conducted by Johns Hopkins nurses from 1999 – 2002 showed that 89 women who were attended by a doula during used reduced amounts of lower epidural during the birthing process (1,2). Epidurals are not unsafe per se. They do tend to lengthen the labor process by an average of 25 minutes. So for a quick and less painful delivery it helps to hire a birth doula.
  • Boost satisfaction with the birthing experience. Not every woman is lucky enough to have a smooth and stress free birthing process. Some babies come early, some babies decide to show up late, and sometimes unexpected events happen that surprise even the most organized and prepared parents. However, research has shown that with a doula’s care fewer women had unsatisfactory birthing experiences (3). This satisfaction is important – because the less pain and inconvenience you experience during labor and delivery will allow you to spend extra energy and attention at the spectacular task at hand.
  • Reduce the need for medical intervention during delivery. Doctors don’t know why women who employ doulas during the birthing process have reduced rates cesarean delivery, analgesic and anesthetic use, and fewer incidents of vacuum extraction, and forceps use (4,5). These beneficial results have been replicated in stressed and non-stressed births across socio-economic and cultural groups. It seems the benefits of having a doula are universal.
  • Reduce psychological and adjustment difficulties in the postpartum period. A study in the Journal of Women’s Health and Gender Based Medicine found that having a doula present during the birthing period decreased symptoms of depression, improved self-esteem, encouraged earlier breastfeeding, and increased sensitivity of the mother to her child's needs (6).
  • Improve the outcomes for your child. Certainly having a doula present does not guarantee you will have a 100% problem free birth. However, a smaller percentage of newborns whose mothers’ employed doulas experienced fetal distress and/or were admitted to neonatal intensive care units (7,8).

How To Choose a Practitioner

The most important aspect to consider when hiring a doula is confidence in her knowledge of the birthing process and an established comfort level between her, the mom- to- be and the family. Your doula should understand your hopes and expectations for the birthing experience as well as, in regards to parenthood in general. Doula’s can be excellence resources in this very busy and confusing time. However, it is important to select a doula that will meet your new family’s needs. Some questions you should ask perspective doulas include:

  • What training and or certifications do you hold?
  • How long have you been a practicing doula?
  • What is your personal philosophy on the support needed by women and their partners and families during childbirth?
  • Do you usually join the birthing party at their home or at the place of birth?
  • Do you work with back-up doulas in case you are unavailable? May we meet anyone with whom you have a back-up agreement?
  • How much do you charge and what does this fee include? Do you offer refunds?
  • Can any prospective doula provide references? May we contact them?   

If the prospective doula satisfactorily answers all of your concerns, the next step is to call and verify their references. You can also go online and research any organizations to which they belong. Some professional doula organizations even offer a doula locator or reference verification service. Do your homework. Giving birth is bound to be one of the most important events in your life, ensure that your attendant demonstrates all the necessary and desired skills to share in your experience.

If the perspective doula passes this next round of checks it is important to schedule an in-person interview. Since this person will be an intimate member of the birthing process and your personal birthing advocate, it is essential that you be very comfortable with them on a personal level. They will be interacting with you, your partner, and your family, not to mention your new baby. Personal chemistry and fit can only be assessed in person.

The four main professional certifying organizations of doulas in North America are Doulas of North America (DONA, http://www.dona.org), the International Childbirth Education Association (ICEA, http://www.icea.org), the Association of Labor Assistants and Childbirth Educators, ( ALACE, http://www.alcace.org) and Childbirth and Postpartum Professional Association (CAPPA, http://www.cappa.net). These organizations maintain online directories of certified doulas by geographic area. When trying to find a doula these organizations can provide useful tools to help narrow your search.

Cautions

  • Check perspective applicants’ references. This person will be a front row partner for one of the most awe inspiring and tense times in your life. You must be comfortable with the person and her coping and assistance style. You have enough to worry about with the birth of your child, your choice of birth assistants shouldn’t be one of them.
  • Know the difference between a midwife and a doula. Doulas act more as a birth coach and personal assistant but do not replace the care provided by your obstetrician. Read any contracts for services carefully. Again you will be very busy the closer you get to your due date, and the more you manage your expectations at the outset the more attention you will have to devote to other things.

References

  1. Van Zandt SE, Edwards L, Jordan ET. Lower epidural anesthesia use associated with labor support by student nurse doulas: implications for intrapartal nursing practice. Complement Ther Clin Pract. 2005 Aug;11(3):153-60.
  2. Scott KD, Berkowitz G, Klaus M. A comparison of intermittent and continuous support during labor: a meta-analysis. Am J Obstet Gynecol. 1999 May;180(5):1054-9.
  3. Leeman L, Fontaine P, King V, Klein MC, Ratcliffe S. The nature and management of labor pain: Part I. Nonpharmacologic pain relief. Am Fam Physician 2003;68:1109-12.
  4. Pascali-Bonaro D, Kroeger M. Continuous female companionship during childbirth: a crucial resource in times of stress or calm. J Midwifery Womens Health. 2004 Jul-Aug;49(4 Suppl 1):19-27.
  5. Thomassen P, Lundwall M, Wiger E, Wollin L, Uvnas-Moberg K. Doula--a new concept in obstetrics. Lakartidningen. 2003 Dec 18;100(51-52):4268-71.
  6. Scott KD, Klaus PH, Klaus MH. The obstetrical and postpartum benefits of continuous support during childbirth. J Womens Health Gend Based Med. 1999 Dec;8(10):1257-64.
  7. Keenan P. Benefits of massage therapy and use of a doula during labor and childbirth. Altern Ther Health Med. 2000 Jan;6(1):66-74.
  8. Klaus MH, Kennell JH. The doula: an essential ingredient of childbirth rediscovered. Acta Paediatr. 1997 Oct;86(10):1034-6.

Evidence Based Rating Scale 

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies with what our clinical advisors have found to be efficacious in their personal practice. This tool is meant to simplify which supplements and therapies demonstrate promise in the treatment of certain conditions. This scale does not take into account any possible interactions with any medication/ condition/ or therapy which you may be currently undertaking. It is therefore advisable to ask your doctor before starting any new treatment regimen.

Condition

Rating

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Childbirth

 

 

 

 

 

 


Date Published: 01/10/2006

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