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emotional support, physical comfort, and assistance in obtaining information before, during and just after childbirth. A "Postpartum Doula" provides care to a family with a newborn baby. A "Birth Doula" recognizes birth as a key life experience that the mother will remember all of her life. The doula understands the physiology of birth, the emotional needs of a woman in labor. She assists the woman and her partner in preparing for and carrying out their plans for the birth. She stays by the side of the laboring woman throughout the entire labor. She provides emotional support, physical comfort measures, an objective viewpoint, and assistance to the woman in getting the information she needs to make good decisions. She facilitates communication between the laboring woman, her partner, and clinical care providers. She perceives her role as one who nurtures and protects the woman's memory of her birth experience. Doulas do not normally do any kind of medical assessments or advising, but she is able to educate the family by explaining the various choices they will face during the birthing process. A doula advocates for the mother and her family by providing childbirth education and discussion, before and during the birth. In this way a doula helps a mother find her own voice without speaking for her. Up until relatively recent, women all over the world have given birth with the help of other experienced women present. Even with the increased safety of hospital birth, and homebirth with trained midwives, we must not disregard the important ingredient of a doula. We can have both. A doula will come to you in your home, and meet with you several times during the prenatal period. You will spend some time getting to know each other during that time. She will listen to your needs, wants, fears and birth goals. She will make sure you understand the labor and birth process. She will teach you pain relief measures that are natural and drug-free. She will go over relaxation skills, and exercises you can practice to allow you to have the best fetal positioning at birth. She will discuss breastfeeding issues if need be. When your labor starts, she will join you in your location of preference, either at home, or at the hospital, and stay with you throughout your entire labor and delivery, and even for a short while postpartum. Doulas don't have shift changes, as nurses do, and doesn't need to follow hospital protocol and leave to update records, or attend to another patient. She will be your familiar voice during labor, encouraging, suggesting, and reminding of labor positions and comfort measures. She works as a member of your health care team. Following your birth, your doula will stay with you until both you and baby are all settled in. And will meet with you once or twice postpartum to go over your birth experience, and talk about any concerns you might have. If you have hired her to stay postpartum, she will attend to your every need, and do her best to help you adjust to your new role as parent, or as parent again! Experience has shown that doulas do not "take over" the job of the partner, but enhance their participation by modeling behavior, drawing them closer, and assuring them that the process of birth is normal and desirable. Our society has gone quickly from barring partners from birth rooms, to relying on them to participate at their comfort level in birthings. Fathers and partners usually end up being our best advertising! Studies on doulas have shown improved outcomes in many areas, from reduction in cesarean birth and other surgical procedures, shorter labors, less use of medication, to improved satisfaction with your baby and an improved relationship to your partner, and your medical caregivers. Every birth is unique, and individualized. Doulas strive to help each mother and her family to have the experience that they feel is perfect. We are there to witness and acknowledge, encourage and support. We are there to let you know that you CAN do birth the way you want to. We can't guarantee a short labor, or an absolutely perfect outcome. But a doula's job is to care for you before, during and after your birth, and to help each family have a "Treasured Birth". |
website for more information on finding a Doula in your area: www.childbirthcollective.org.; or call me at: (952) 212-8634. |
For more information on Doulas, please see DONA's website at: Doula's of North America: www.dona.org. |
Marshall H. Klaus, M.D.; John Kennell, M.D.; and Phyllis H. Klaus, C.S.W., M.F. |
THE BENEFITS OF HAVING A DOULA: Researchers Kennell and Klaus et. al. found among six studies: - Cesareans down 50%; - Length of Labor down 25%; - Pitocin down 40%; - Forceps down 40%; - Requests for Epidurals down 60%. THE IMPACT OF A DOULA ON LABOR AND EARLY PARENTING: (Adapted by Penny Simkin from a handout used by Sandy Arpen in 1992). - Increases positive feelings about
- Decreases interventions; - Decreases cesareans; - Decreases anxiety; - Decreases tension; - Shortens labor. SUPPORT IN LABOR FROM A DOULA: - Increases acceptance of the baby; - Enhancement of maternal/infant bonding; - Decreases neonatal problems; - Increases self-esteem; - Increases feelings of control; - Increases mother's cooperation and participation; - Decreases postpartum depression.
needs are met, clinical outcomes are improved for mother and baby. In addition, the long-term impact may be enhanced self-confidence and self- esteem in the mother. (See References Below for Sources.) |
1. Hodnett, Ellen D., and Richard W. Osborne. "A Randomized Trial of the Effects of Monitrice Support during labor: Mothers' Views of Two to Four Weeks Postpartum". Birth. 16:4, December 1989. 2. Hofmyer, G. J. et al. "Companionship to Modify the Clinical Birth Environment: Effects on Progress and Perceptions of Labor and Breastfeeding". British Journal of Obstetrics and Gyn. 98: 756-764, 1991. 3. Kennell, J. Klaus, M., et al. "Continuous Emotional Support During Labor in a US Hospital". Journal of the American Medical Association. 265: 2197-2201, May 1, 1990. 4. Simkin, P. "Just Another Day in a Woman's Life? Women's Long-Term Perceptions of Their First Birth Experience, Part 1." 5. Birth 18:4, December 1991 and "Part 2", Birth, 19:2, June 1992. 6. Sosa, Klaus, Kennell, et al. "The Effects of a Supportive Companion on Perinatal Problems, Length of Labor and Mother-Infant Interaction". New England Journal of Medicine 303: 597-600, 1980. 7. Wolman, Wendy-Lynne, et al. "Postpartum Depression and Companionship in the Clinical Birth Environment: A Randomized Controlled Study". Am. Journal of Obstetrics and Gynecology, May 1993. |
QUESTIONS TO ASK A DOULA When you are looking to ask someone to attend your birth, there are several questions that you should ask
the way a doula approaches a birth. This is your birth and you are looking for a woman who will serve you in accordance with your specific needs. Doulas want to be hired by someone who is confident in our abilities and experience. Because each doula brings into birth their own experiences and philosophies, we are usually asked to serve the women we are most compatible with. And many times become long-time friends with these women. A good match is almost always mutual! Question 1: What is the doula's philosophy of birth? Will she support your goals and beliefs about birth? My philosophy of birth is that birth is a natural process. That interfering with that process through un- necessary interventions, augmentation can be detrimental to both the mother and the baby; both physically and psychologically. I support natural unmedicated birth. However, I have attended many births, and I also support each mother's right to experience birth the way she is comfortable. If pain medication, an epidural, or other methods of pain relief are part of a woman's birth plan, I am there to support, and advocate for her choices. Question 2: What is her scope of practice? What are the limits to her practice? What will she do, and not do to assist you? This is what the DONA (Doulas of North America), through which I am trained and certified, says a doula's "Scope of Practice" is. As a DONA Certified Doula, I must adhere to this Scope. - Services Rendered: The doula accompanies the woman in labor, provides emotional and physical support, suggests comfort measures, and provides support and suggestions for the partner. Whenever possible, the doula provides pre- and post-partum emotional support, including explanation and dis- cussion of practices and procedures, and assistance in acquiring the knowledge necessary to make informed decisions about her care. Additionally, as doulas do not "prescribe" treatment, any suggestions or information provided within the role of doula must be done with the proviso that the doula advise her client to check with her primary care provider before using any application. - Limits of Practice: DONA standards and Certification apply to emotional and physical support only. The DONA Certified Doula does not perform clinical or medical tasks such as taking blood pressure, or temperature, fetal heart tone checks, vaginal examinations, or postpartum clinical care. - Advocacy: The doula advocates for the client's wishes as expressed in her birth plan, in prenatal conversations, and intrapartum discussion, by encouraging her client to ask questions of her caregiver and to express her preferences and concerns. The doula helps the mother incorporate changes in plans if and when the need arises, and enhances the communication between client and caregiver. Clients and doulas must recognize that the advocacy role does not include the doula speaking, instead of the client, or making decisions for the client. The advocacy role is best described as support, information, and medication or negotiation. - Referrals: For client needs beyond the scope of the doula's training, referrals are made to appropriate resources. Question 4: What is the doula's experience? How long has she been a doula? I have been a birth doula for ten years and as such, I have been primary doula for many couples, and single women, some of which were teen moms. I have supported birthing parent's from many different cultures and backgrounds. I have done both home births and hospital births. Question 5: Can the doula provide you with references? I do have several references from happy new parents that have used my doula services recently. They are available for you to contact upon your request. Question 6: What are the doula's fees? I charge $625.00 a birth. With every 20 births I attend my fee will increase as my experience and expertise increases. Question 7: Does your doula work with a partner or student? Can you request or reject that she work with another doula? I am happy to work with a mother and her partner to hire two doula's, however, I will still charge my full fee. I always welcome another experienced doula's help because it is always a positive experience to work with other doula's. Question 8: What is your doula's availability? For how long before and after your due date will she I will inform you of my availabilty for your due date when I receive first contact with you. If I commit to attend your birth I will be available to you 24 hours a day, 7 days a week. I will not leave town when it is close to your due date. You can reach me preferably at home, and if not at home, on my cell phone, which I will be happy to provide you with telephone numbers for. I usually allow two weeks between client's due dates. I have never had an issue with overlapping births, however, I will do my best to find a "back-up" certified doula from a group of doulas who are connected to me, for your due date. If for some unforeseen reason I cannot attend your birth (that has NEVER happened before), I would provide you with a back-up doula. At that time my fee would be paid to me, and I would be responsible for paying the back-up doula. Question 9: How many prenatal visits does she provide? How many postnatal visits? I usually try to provide two to three prenatal visits to allow us time to get to know each other better. During those visits I will listen to your expectations for your birth, and discuss your birth plans. I am able to provide you with prenatal education through the Bradley Method of Natural Childbirth series if desired. Please reference that information page for more details. I will also visit you one or two times postnatally. Usually the day after the birth in the hospital, and once in your home to talk about the events of the birth. Question 10: What is the doula's role during early labor? Will she come to your home? When? The doula's role in early labor is emotional support. Unless a mom requests that I attend that phase of her labor, I usually require telephone contact, until your labor is well established. When you can no longer speak through your contractions, that is when I prefer to come and assist you. I will come to your home when this time arrives. My goal in aiding laboring moms is to keep mom at home for as long as it is safe for both mom and baby. The longer you can stay at home, the healthier it is for both you and baby. Staying home will help to discourage interventions and augmentations at the hospital for as long as possible, or even allow you to accomplish a natural birth. It is necessary for you to be in contact with your care provider during this time. For most normal labors, it is safe to stay home for a great deal of time. It is beneficial to mom to labor in a familiar and comfortable environment for as long as it is possible. Question 11: How will the doula work with your partner in birth? It is extremely important for a partner to be incorporated actively in the labor and delivery process. I encourage partners to be hands-on, and I will give suggestions throughout labor to them in how to help. There are some dad's who don't want to be hands-on, and I respect that also. Labor and birth for each person, brings with it previous life experience, and how you participate in your birth will be greatly influenced by those experiences. I am not there to take the place of a partner during labor and birth. I am there to enhance the experience in any way that is comfortable to both of you. Question 12: How will the doula work with your primary care provider and with the nurses and other hospital staff? Hospitals have "protocols" that they need to follow, and I respect those protocols. Your care provider provides you with medical support, which I do not provide. It is important for you to follow your care provider's advice. I am there to compliment your birth experience, and work with any professionals involved in your care. It is your responsibility to advocate for the desires in your birth plan. I can educate, and inform you of choices, and empower you with information thereby giving you the tools you need to make decisions. However, I can not make medical decisions or speak for you. As a doula I am there to support you emotionally, physically, and to help with natural methods of pain relief. I will do my best to help you have the birth experience that you would like to have. I will help you find your voice, and help you advocate for yourself, and help you stay as close to your birth plan as is possible. Question 13: Will your doula attend a prenatal appointment with you to meet your caregiver? I would enjoy accompanying you to one of your prenatal appointments to meet a caregiver. However, please keep in mind that most medical providers work in groups. The chances of having one particular caregiver on the day of your birth is very rare, unless you are having a midwife and a home birth experience. Consistency of care is always the goal, and having a doula attend your birth will help you maintain that consistency. During nursing staff changes, doctor/midwife changes, etc. I will strive to be one of the consistent care giver throughout your labor and birth. Question 14: Please tell your doula any special concerns you have regarding your birth. I am happy to discuss any other information, or details that would be relevant to your birth. Physical concerns, psychological concerns, past birth issues. All of these will be discussed during the prenatal visits. It helps to write down your questions as they come up, and present them to me either through email, or a telephone call. I am happy to speak with you any time prior, or after your birth! |
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