Doulas Jason England Ashley Strayer Laura Wetherington Ellisa

Doulas Jason England Ashley Strayer Laura Wetherington Ellisa Watson Merril Tydings Kaileen Morgan

Why are doulas important?

n n The word "doula" comes from the ancient Greek meaning "a woman who serves" It is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.

n Numerous clinical studies have found that a doula’s presence at birth: n n tends to result in shorter labors with fewer complications reduces negative feelings about one’s childbirth experience reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans reduces the mother’s request for pain medication and/or epidurals

n n Other studies have shown that having a doula as part of the birth team decreases the overall cesarean rate by 50%, the length of labor by 25%, the use of oxytocin by 40% and the request for an epidural by 60%. Doulas often use the power of touch and massage to reduce stress and anxiety during labor.

Why not use father? n n n The role of the doula is never to take the place of the husband or partner in labor, but to compliment and enhance their experience. Today, many husbands are taking a more active role in the birth process, but some partners feel that this is a huge expectation and would rather be able to enjoy the delivery without having to stand in as labor coach. With a doula as a part of the birth team, a father can do whatever he feels comfortable with at each moment.

Incorporating Cultural Practices • Incorporating cultural practices in the birthing experience is important for most women and families. • Labor support that understands these practices and supports them is important. • Doulas receive training in cultural competence, communication and advocacy.

Incorporating Cultural practices n n Jewish Culture: Women may not be able to give birth on the Sabbath as well as ring call bell or raising bed. Latin American Culture: Midwifery and doulas are considered very positive. Some also believe that colostrum is not good for baby. Asian Cultures: Surgery is viewed as a violation. Eastern Indian Culture: Women fast during pregnancy. Breastfeeding begins on 5 th day and honey is the most common first food.

Incorporating Cultural Practices n n Latino Community Outreach: Doulas care recruit and train a small group of bicultural and bi-lingual volunteer doulas who provide Latina women with free doula services. In 2008, the program served approximately 200 families.

Support Measures Provided During Labor

Participants Advice for Doulas and Nurses Working Together n n n “Nurses should be positive and encouraging. ” “Medical personnel shouldn't feel threatened or displaced just because a doula is present. ” “Take mothers' wishes into consideration before acting. ” “The choice to give birth without medication should be supported. ” “Recognize that doulas are not there to take over your job but just to provide comfort and support for the mom. ”

TRAINING n n n FOCUSES ON THE EMOTIONAL NEEDS OF WOMEN IN LABOR AND NON-MEDICAL PHYSICAL AND EMOTIONAL COMFORT MEASURES. PRIOR KNOWLEDGE OF THE CHILDBIRTH PROCESS AND TRAINING/EXPERIENCE RELATING TO CHILDBIRTH EXTENSIVE 2 -3 DAY COURSE: HANDS ON PRACTICE OF RELAXATION, BREATHING, POSITIONING AND MOVEMENTS TO REDUCE PAIN AND ENHANCE LABOR, AND OTHER COMFORT MEASURES.

CERTIFICATION n n n n WORK OR EDUCATION BACKGROUND IN A MATERNAL FIELD OBSERVE A SERIES OF CHILDBIRTH CLASSES ATTEND DOULA WORKSHOP COURSE BREAST-FEEDING TRAINING COURSE WORK (READING, ESSAY, RESOURCE LIST) POSITIVE EVALUATIONS (CLIENTS, DOCTORS, MIDWIVES, NURSES) DETAILED OBSERVATIONS FROM A MINIMUM NUMBER OF BIRTHS

COST n n COST VARIES MOST OFTEN PRIVATE PAY--SET RATE OVER 25 INSURANCE COMPANIES PROVIDE SOME THIRD PARTY REIMBURSEMENT FOR LABOR SUPPORT. GRANT FUNDING/MEDICAID FUNDED AGENCIES HAVE CONTRACTS WITH DOULA ORGANIZATIONS TO SUPPORT WOMEN IN POVERTY AND WOMEN WITH SPECIAL NEEDS.

QUESTIONS FOR SELECTING A DOULA. . . n n n n n WHAT TRAINING HAVE YOU HAD? TELL ME ABOUT YOUR EXPERIENCE WITH BIRTH, PERSONALLY AND AS A DOULA. WHAT IS YOUR PHILOSOPHY ABOUT BIRTH AND SUPPORTING WOMEN AND THEIR PARTNERS THROUGH LABOR? MAY WE MEET TO DISCUSS OUR BIRTHS PLANS AND THE ROLE YOU WILL PLAY IN SUPPORTING ME THROUGH BIRTH? MAY WE CALL WITH QUESTIONS OR CONCERNS BEFORE AND AFTER BIRTH? WHEN DO YOU JOIN WOMEN IN LABOR? COME TO OUR HOME OR MEET AT HOSPITAL? DO YOU MEET WITH US AFTER THE BIRTH TO REVIEW THE LABOR AND ANSWER QUESTIONS? DO YOU HAVE BACK UP DOULAS FOR TIMES YOU ARE NOT AVAILABLE? MAY WE MEET? WHAT ARE YOUR FEES AND YOUR REFUND POLICIES?

TYPES OF DOULAS n n BIRTH DOULA POST-PARTUM DOULA

WHAT IS A BIRTH DOULA? n n n A PERSON TRAINED AND EXPERIENCED IN CHILDBIRTH. PROVIDE CONTINUOUS PHYSICAL, EMOTIONAL AND INFORMATIONAL SUPPORT TO MOTHER BEFORE, DURING AND JUST AFTER CHILDBIRTH. SPECIALIZE IN NON-MEDICAL SKILLS. DO NOT PERFORM CLINICAL TASKS, SUCH AS, VAGINAL EXAMS OR FETAL HEART MONITORING. DO NOT DIAGNOSIS, OFFER SECOND OPINIONS OR GIVE MEDICAL ADVICE. DO NOT MAKE DECISIONS FOR CLIENTS. NOT THEIR ROLE TO DISCOURAGE USE OF PHARMACOLOGIC PAIN MANAGEMENT. THEY DO INFORM CLIENT ABOUT VARIOUS OPTIONS, INCLUDING RISKS/BENEFITS. THEY HELP MAXIMIZE THE BENEFITS OF PAIN MEDICATIONS WHILE MINIMIZING UNDESIRABLE SIDE EFFECTS.

HOW THEY PRACTICE. . . n PRIVATELY HIRED- EMPLOYED BY EXPECTANT PARENTS, TELEPHONE CONTACT AND PRENATAL MEETINGS BEFORE BIRTH TO BUILD RELATIONSHIP. ONCE LABOR BEGINS, STAYS WITH MOTHER UNTIL THE END. POSTPARTUM MEETING USUALLY INCLUDED. n HOSPITAL EMPLOYEES OR VOLUNTEERS IN COMMUNITY/HOSPITAL PROGRAMS- MEET CLIENT FOR FIRST TIME AND ESTABLISH RELATIONSHIP DURING LABOR.

EFFECTS ON BIRTH. . . n n n SHORTER LABORS WITH FEWER COMPLICATIONS REDUCES NEGATIVE FEELINGS ABOUT CHILDBIRTH EXPERIENCE REDUCE NEED FOR PITOCIN, FORCEPS OR VACUUM EXTRACTION REDUCES REQUEST FOR PAIN MEDICATION AND EPIDURALS REDUCES INCIDENCES OF CESAREANS

POSTPARTUM DOULA WHAT DO THEY DO? n n n n Education Sharing of information Sibling involvement Partner role “Mothering the Mother” Breastfeeding Keeps mom healthy

HOW LONG DOES A POSTPARDUM DOULA SPEND WITH THE FAMILY? n n n Decision made by the family and the doula Focus on mom’s comfortability One week to several months Length of visit depends on need Minimum two hours up to 24 hours

THE GOAL OF THE POSTPARTUM DOULA n n “Nurture the family. ” Comfortability in new parent roles Self confidence Knowledge growth

POSTPARTUM DEPRESSION n n Doulas do not treat Focus on prevention Maximize rest and relaxation Support through phases of depression

Conflicts arise when… • • Doulas and nurses have had previous negative working experiences. Doulas carry their own birth experiences with them into the clients birth. Nurses are frustrated or uncomfortable with the presence of the Doulas are new and overly eager. Doulas do not adjust their plan when problems arise. Nurses do not understand the role of the Doulas are blamed for their clients behaviors and actions. During nursing shift changes.

• • Ways to resolve nurse/doula conflicts. Nursing benefits of having a Doula at the bedside.