Doula

A doula is an experienced, non-medical assistant who provides physical, emotional and informed choice support in prenatal care, during childbirth and during the postpartum period. A birth doula is a continuous care provider for labor in many settings, also assisting the parturient woman during transport from home to hospital or birth center. A postpartum doula may begin care in the home (nutritious cooking for the mother, breastfeeding support, newborn care assistance, maternal-child bonding support, errands, light housekeeping) the next day after the birth, providing services through the first six weeks postpartum.

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Etymology and history of usage

The word doula comes from Greek, and refers to a woman who personally serves as slave to another man or woman. In Greece, the word has negative connotations, denoting "slave", as some doulas have inadvertently discovered through their international social networks. For this reason, some women performing professional labor support choose to call themselves labor companions or birthworkers. Anthropologist Dana Raphael first used the term doula to refer to experienced mothers who assisted new mothers in breastfeeding and newborn care in the Philippines^{[citation needed]}. Thus the term arose initially with reference to the postpartum context, and is still used in that domain. Medical researchers Marshall Klaus and John Kennell, who conducted the first of several randomized clinical trials on the medical outcomes of doula attended births, adopted the term to refer to labor support as well as prenatal and postpartum support.^[1]

Types of doulas

Labor/birth support doulas are trained and experienced labor support persons who attend to the emotional and physical comfort needs of laboring women to smooth the labor process. They do not perform clinical tasks such as heart rate checks, or vaginal exams but rather use massage, aromatherapy, reflexology, positioning suggestions, etc., to help labor progress as well as possible. A labor/birth support doula joins a laboring woman either at her home or in hospital or birth center and remains with her until a few hours after the birth. Some doulas also offer several prenatal visits, phone support, and one postpartum meeting to ensure the mother is well informed and supported. The terms of a labor/birth doula's responsibilities are decided between the doula and the family. In addition to emotional, physical and informational support, doulas work as advocates of their client’s wishes and may assist in communicating with medical staff to obtain information for the client to make informed decisions regarding medical procedures.

Postpartum doulas are hired to support the woman after birth, usually in the family's home. They are skilled in offering families evidence-based information and support on breastfeeding, emotional and physical recovery from childbirth, infant soothing, mother-baby bonding, and coping skills for new parents. They may also help with light housework, coordinate freshly made nutritious meals for the mother, and help incorporate older children. The terms of a postpartum doula's responsibilities are decided between the doula and the family.

Some hospitals and foundations offer program for volunteer community doulas [5]. Volunteer doulas play an important role for women at risk for complications, and those facing financial barriers to additional labor support. These doulas will offer continuous encouragement and reassurance to laboring women. In this way, volunteer doulas can encourage mother based birth advocacy, and motivate a woman to feel in control of her pregnancy.

The doula is an ally and occasional mentor for the father/significant other. Their respective roles are similar, but the differences are crucial. The father or partner typically has little actual experience in dealing with the often-subtle forces of the labor process, and may receive enormous benefit from the birth-familiar presence of a doula in the vicinity. Even more important, many fathers experience the birth as an emotional journey of their own and find it hard to be objective in such a situation, and a doula facilitates the family process. Studies have shown that fathers usually participate more actively during labor with the presence of a doula than without one.^{[citation needed]} A responsible doula supports and encourages the father in his support style rather than replaces him.

Labor/Births Doulas in the U.S. and Canada

In the United States and Canada, labor/birth doulas are not required to be certified, however certification is available [6] through several different organizations [7]. A labor doula provides:

• Continuous physical, emotional, and informational support during labor and childbirth.
• Support from a professional care provider who understands, and trusts the process of birth, and who helps facilitate the birth experience for the parents, baby, and primary care providers.
• Explanations of medical procedures and interventions;
• Emotional support;
• Advice during pregnancy;
• Exercise and physical suggestions to make pregnancy and childbirth more comfortable;
• Help with preparation of a birth plan;
• Facilitation of communication between members of laboring woman's birth team;
• Massage and other non-pharmacological pain relief measures, aromatherapy, any other non-medical comfort techniques she may be trained in;
• Positioning suggestions during labor and birth;
• Support the partner so that s/he can provide support and encouragement to the laboring woman;
• Help to avoid unnecessary interventions;
• Help with breastfeeding preparation and beginning;
• Some doulas offer a written record of the birth (birth story);
• Is present during entire labor and afterwards as long as is needed by parent(s).

Postpartum Doulas in the U.S. and Canada

In the United States and Canada, postpartum birth doulas are not required to be certified, however certification is available through several different organizations. A postpartum doula provides:

• Assistance with breastfeeding education and offers tips and informational support
• In home support for the mother, baby and family, any where from a couple days postpartum to several months.
• Informed and helpful newborn care help and assistance.
• Support for the partner so that s/he can support and nurture the mother, and the newborn baby.
• 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.
• May also offer help in the following areas: household care, help with childcare/sibling care, meal preparation, errand running, and other tasks that may be requested.

Benefits

Studies have found that doulas offer numerous benefits both to the mother and child. Women supported by a doula have a reduction in the duration of labor, less use of pain relief medications, lower rates of operative vaginal delivery, and in many studies a reduction in caesarian deliveries. Newborns in births supported by doulas have lower rates of fetal distress and fewer are admitted to neonatal intensive care units. In addition, one study found that 6 weeks after delivery, a greater proportion of doula-supported women, compared to a control group, were breastfeeding, and these women reported greater self-esteem, less depression, and a higher regard for their babies and their ability to care for them.^[2][3] These results are similar to findings that support from a female relative during childbirth has similar effects.^[4]

One study found doula support (without Lamaze classes) to be more helpful than Lamaze classes alone, as measured by levels of emotional distress and self-esteem evaluated at an interview 4 months after birth. In particular, it was noted that women in the doula-supported group reported their infants as less fussy than the Lamaze group.^[5]

References

1. ^ Stamatis, George. (2005). “John Kennell, M.D., and colleagues to receive award in Germany - for fostering early parent-infant bonding.” Case Western Reserve University News Center.
2. ^ [1] M.H. Klaus, J.H. Kennell, "The doula: an essential ingredient of childbirth rediscovered." Acta Paediatr. 1997 Oct;86(10):1034-6.
3. ^ [2] P. Keenan, "Benefits of massage therapy and use of a doula during labor and childbirth." Altern Ther Health Med. 2000 Jan;6(1):66-74.
4. ^ [3] Madi, Banyana Cecilia; Sandall, Jane; Bennett, Ruth; MacLeod, Christina, "Effects of Female Relative Support in Labor: A Randomized Controlled Trial." Obstetrical & Gynecological Survey. 54(10):627-628, October 1999.
5. ^ [4] Manning-Orenstein, Grace, "A birth intervention: the thereapeutic effects of doula support versus Lamaze preparation on first-time mothers' working models of caregiving." Alternative Therapies, July 1998, Vol. 4, No. 4, pp. 73-81.