The Purpose and Value of Doula Support


I am often asked what a doula does and how she can help a mom through her labour. I am going to cheat here a bit and post a short essay that I wrote a long while ago for the certification process. There are not a ton of details but you get a better sense of the general idea. The role a a doula is always dependent on the needs of a labouring mother, and as such, changes not only with every client but also through each labour. We are great adapters and fill the role/s that are needed when they are needed and do our very best to help the mother and her partner have positive, empowered birth experience. My apologizes for the lameness of the essay.     

The Purpose and Value of Labour Support
Women have been caring for each other through labour and birth since the beginning of our existence, and childbearing and childrearing was once a community effort. Families were large and tightly knit. When a daughter became pregnant, her mother, and possibly grandmother, all of her sisters and aunts would be by her side throughout her pregnancy, labour, birth and motherhood. She was never alone in this journey and could rely on the wisdom of her elders and the support of her female community for advice, emotional care and physical encouragement. Somewhere along the way our society has lost these values, and pregnancy, birth and childrearing have become isolated and unsupported. Birth is no longer an event for the entire family or female community and all responsibilities of birth and labour have fallen to the mother and her partner. Mainstream media has turned birth into something unnatural and frightening, instead of the empowering, fulfilling, natural triumph it is. Western society, and the medical community in particular, continually perpetuate messages of fear and doubt, leading the majority of women to believe that they are unable to birth their babies naturally. This has had grave implications on our communities and for the mothers of this world, driving childbirth even further from a place of joy and love in the process.
The Doula, meaning “woman caregiver,” works to bring birth back to where it belongs: in the hands of an informed laboring woman. A doula is the support system for a woman and her family through pregnancy, childbirth and the early postpartum period. She helps to empower the childbearing woman by providing her with information and support in the form of continuous emotional care and physical comfort techniques. A doula is not part of the medical staff and, therefore, uses only non-medical methods to comfort and care for her client, such as breathing techniques, massage, physical support and reassuring touch and encouragement (1).  With her knowledge, training and skills in the birthing process, a doula can help a mother birth more comfortably and quickly by suggesting position changes that allows her body to create more room for baby to find their way Earth-side. Positioning and other techniques learned by doulas may also be used to move a mal positioned baby allowing the birthing process to continue more rapidly with less discomfort for the mother.    
The doula not only cares directly for her client but also does so indirectly by supporting her partner though the birthing process. She helps the partner enjoy their experience by allowing them to take on whatever role they feel most comfortable in. For example, when the doula plays a more physically active role in supporting the mother, her partner is able to provide the loving encouragement and emotional support essential to the birthing process, or vice-versa. A doula is able to make suggestions for ways the partner can effectively support their loved one when they are unsure of how to help (1). The doula also ensures the partner is rested and has time to eat and care for their own needs so they are better able to care for mom and baby once born.
The doula’s calming reassurance allows both parents to understand that what happens during labour and birth is normal and natural, which helps to maintain a relaxing, positive birthing environment. A doula also advocates for her clients wishes by encouraging and enhancing communication between the family and birthing staff, but she does this without speaking on behalf of or making decisions for the laboring mother and without projecting her own values and desires (1,2). A doula helps the mother and her partner make informed decisions for herself and her new baby by providing information about their options and associated benefits and risks or by suggesting questions to ask their care provider (2). Through all of these means, the doula assists the mother in having a safe, empowering and fulfilling birth experience.
The benefits of a doula’s continuous labour support have been well established. In the most recent 2011 review of labour support studies, Hodnett et al concluded that women with continuous, one-on-one support were more likely to birth vaginally with fewer complications and medical interventions such as cesarean sections and the use of forceps, vacuum extraction, and synthetic oxytocin (3). Doula supported labours also tended to be shorter in length and the mother’s request for pain medication and/or epidurals were significantly decreased. Negative feelings about one’s birthing experience were also reduced with the presence of a doula. The babies born to women with supported births also tended to have better five-minute Apgar scores and increased success with breastfeeding (3). Spouses also feel more supported by a doula and in turn provide more support to their labouring partner (3). Although continuous support in general improves a mother’s birth experience, the 2011 review found that doula-supported labours had the greatest results and most impact for a mother, partner and baby when compared to labours that were supported by friends, family or hospital staff (3).    
The role and benefits of a doula extend far beyond those of the labouring mother. Doulas carry the potential to positively influence society as a whole. The care doulas provide to women during pregnancy, labour, birth and early postpartum is paramount to strengthening the early emotional relationship between mother and baby, which in turn will prove to be positive for the future of the family, and on a large scale, society in general. These mothers gain greater confidence and self-esteem, which helps them to adapt to their new family life and decreases the likelihood of developing postpartum depression (1). Research has also shown that women who have doula-supported labours have an increased sense of satisfaction with their partner and display greater affection and bonding with their baby, all of which are likely to enhance the long-term family bond (5). The decrease in medical intervention during labour and birth, often attributed to the presence of a doula, allows for a decrease in medical expenditure, allowing medical finances to be allocated more efficiently (5).  
Because the role of a doula has such vast impact, her responsibilities are extremely important. A doula carries great ethical responsibilities to her clients, colleagues, society, and to the doula profession itself (4). She continually strives to improve her knowledge of the birthing world, uphold the values and mission of the profession and promote maternal and child welfare.

References
1.     The DONA International Position Paper
2.     DONA International Birth Doula Standards of Practice
3.     Hodnett ED, Gates S, Hofmeyr GJ, Sakala C, Weston J. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub3.
4.     DONA International Birth Doula Code of Ethics
5.     Klause MH, Kennell JH, Klaus PH. The Doula Book. Second Ed, Da Capr Press, 2002.

We Really Don't Know the Effects Of Labour Interventions

 "Inducing labour may contribute to autism

Why babies were being induced in the first place still needs to be considered

Posted: Aug 13, 2013 12:01 PM ET

Last Updated: Aug 13, 2013 12:00 PM ET



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The biggest study of its kind suggests autism might be linked with inducing and speeding up labour, preliminary findings that need investigating since labour is induced in increasing numbers of U.S. women, the authors and other autism experts say.
It's possible that labour-inducing drugs might increase the risk — or that the problems that lead doctors to start labour explain the results. These include mothers' diabetes and fetal complications, which have previously been linked with autism.
There is a growing consensus that risks for autism occur before birth or soon after.There is a growing consensus that risks for autism occur before birth or soon after. (Veejay Villafranca/Getty )Like most research into autism causes, the study doesn't provide conclusive answers, and the authors say the results shouldn't lead doctors to avoid inducing labour or speeding it up since it can be life-saving for mothers and babies.
Simon Gregory, lead author and an associate professor of medicine and medical genetics at Duke University, emphasized, "We haven't found a connection for cause and effect. One of the things we need to look at is why they were being induced in the first place."
Government data suggest 1 in 5 U.S. women have labour induced — twice as many as in 1990.
Smaller studies suggested a possible tie between induced labour and autism, but the new research is the largest to date, involving more than 600,000 births. The government-funded study was published online Monday in JAMA Pediatrics.
The researchers examined eight years of North Carolina birth records, and matched 625,042 births with public school data from the late 1990s through 2008. Information on autism diagnoses didn't specify whether cases were mild or severe. Labour was induced or hastened in more than 170,000 births.
Overall, 5,648 children developed autism — three times as many boys as girls. Among autistic boys, almost one-third of the mothers had labour started or hastened, versus almost 29 per cent of the boys without autism. The differences were less pronounced among girls.
Oxytocin and prostaglandins are used to start or speed up labour but the study doesn't identify specific medications.
The strongest risks were in boys whose mothers had labour started and hastened. They were 35 per cent more likely to have autism.
Among girls, autism was not tied to induced labour; it was only more common in those born after labour was accelerated; they were 18 per cent more likely to have the developmental disorder than girls whose mothers had neither treatment.
Autism affects about 1 in 88 U.S. children. Symptoms may involve communication problems including avoiding eye contact and unusual repetitive behaviour including arm-flapping. Causes are uncertain but experts believe it probably results from a combination of genetics and other factors. These may include mothers' illnesses and medication use while pregnant, fathers' age at conception, and problems affecting the fetus during childbirth — all suggested but not proven in previous research.
The study's biggest strength is bolstering the growing consensus that risks for autism occur before birth or soon after, said Dr. Byron King, director of Seattle Children's Hospital's autism centre. He was not involved in the study."

The above is an article from cbc online and can be found here.

I am aware that nothing in this study is conclusive but it really makes you think about our lack of knowledge when it comes to the effects of any labour augmentation or assistance. There has simply not been enough research done or time elapsed to really see the full effect of the medical system's actions in pregnancy, labour and birth. It is terrifying to think about but the fact of the matter is we just don't know. I am NOT suggesting that there is no place for medical intervention when it comes to labour and birth because there most certainly is. In my short time as a doula I have witnessed labours that indeed would have ended in tragedy had medical advances not been available. Conversely, I have also attended births where medical interventions used were seemingly unnecessary and in some cases even harmful. I do believe there is a place in labour and birth for modern medicine but I know it is grossly overused in our society. Because long-term effects of these medical interventions are unknown I think we should not be so nonchalant with there uses and greater care and consideration should be used by those caring for women in labour.       

Ina May Gaskin and Reducing Fear of Birth

Ina May Gaskin, MA, CPM, PhD (Hon) is legendary in the world of Midwifery. She is founder and director of the 41 year old Farm Midwifery Center in Tennessee. 
Ina May Gaskin, photo credit: http://www.tumblr.com/tagged/birth%20story

You can read a Bio of the lovely Ina May on her web site here.

One of my favorite 'birth prep' books is Ina May's Guide to Childbirth. It was the only book I found useful while awaiting my own birth journey and I have since lent it to many friends and family. Instead of filling your head with all the things that could possibly go wrong during labour, Ina May provides a much needed dose of positive birth stories and confidence boosting facts about the natural ability of a woman's body to birth a baby. She has an amazing ability to bring a pregnant woman and her obsessing thoughts back to the reality of the entirely natural process. Ina May focuses on reducing fear in labour and birth and talks much about the fear-pain response of a labouring woman. Much of the work a doula does before and during birth is to reduce that woman's fears and therefore the pain she experiences. I entered my labour with 100 percent confidence in myself and my body's ability to birth and believe Ina May's words have much to do with that.

 
Very Recently a movie was made called Birth Story: Ina May Gaskin and the Farm midwives which look amazing. The trailer alone is beautiful.

Thank you Ina May for all that you do to empower women and families and allow people to view birth the way it should be - "unadorned, unabashed, and awe-inspiring"  


Aida is TWO!!

Nope, I still cannot believe that I am the mother of a two-year old. Just like every other parent out there, I'm continually amazed at how fast these babies grow and change into little people with very distinct and sometimes very large personalities. Every second of everyday they are growing!

Every month for the last 2 years my husband and I have been recording our little lady's growth alongside Alfie (a childhood toy of Curran's). I thought it was pretty interesting so I decided to share it with you all. 










We had a very nice birthday day with Aida. The hubby took the day off and we spent it with our lady.






 Thank you for being such an awesome person Aida. We love you more than anything else! We are so lucky to call you ours. Happy Birthday my little lady!

PS: Happy Summer!!! And in case you were wondering, my 30 day yoga challenge went swimmingly. I accomplished 34 yoga classes in 30 days! I feel great and most definitely rejuvenated. It was a great experience but I am ready to slow it down a bit. The hardest part of this challenge was feeling like I was constantly rushing off and missing out on lots of family time. I have taken a week off of yoga since the end of the challenge which has allowed me to spend some much-needed time with my favorite people but has not been the best for my body. I love yoga and I am going to continue practicing 3-4 times a week, which I hope will bring the right balance into my life. Thanks again to my family for being so patient during the last month and encouraging me to take care of myself. Love love love! 



Detoxifying My Mind and Body into Spring

Like most everyone else right now I am feeling pretty done with this winter. I keep hoping for spring to show it's messy, wet, mucky self but it seems to be rather shy this year. Try as I might, I cannot coax it from winter's grasp. I begin to feel this way every year, but lately my desire for warmer weather seems particularly huge. This winter has been a tough one by bringing a never ending onslaught of frustration for us. Seemingly non-stop colds and flus piled on top of a teething, non-sleeping toddler mixed in with breaking appliances, cars, roofs, ceilings, phones, and wallets all rolled into a cluster cuss of bad luck. I was also handed my first ever traffic ticket, which I will say on record was complete BS and I did not actually violate any road rules. Non-the-less I still got the ticket. Having a toddler that needs to run and play outside and who easily becomes stir crazy doesn't help much either. We just want to be able to go outside without the mitts, the jacket, the tuque, the boots, the icy sidewalks and piles of snow that have taken up all the space everywhere. Its time for grass and sun and picnics and parks and evening drinks outside with friends and family.

The snow is making us all crazy!

But we are doing our best to make the most of it!

The past months have been weighing heavily on both my mind and body. I have fallen into the terrible circular habits of poor eating and little exercise that cause me to feel sluggish and put my mind into an unhealthy state. I decided that I needed a change. I needed to jump-start my body and my spirit out of this slump and ready myself for the spring. I need to un-fog my mind and re-discover the beauty in the calm, the simplicity, the humor, the frustrations, the happiness, the crazy that is everyday life.

One week ago today I challenged myself to do a minimum of 30 yoga classes in 30 days. I have practiced yoga on and off for about 8 years and through that time I have found that my yoga passion lies in Moksha. For those who don't know, Moksha yoga is practiced in a room kept at about 40 degrees Celsius and fairly high humidity. It is definitely not everyone's cup of tea but I love it. I love the heat and I love the sweat! When I leave each class I can literally wring the sweat from my clothes, and as grossed out as you probably are right now, it makes me smile every time. Sweating allows your body to rid itself of toxins that build up and are stored in your tissues. When I am sweating to the point of a steady stream flowing off the end of my nose I can't help but think of all the nasty stuff leaving my body and it makes me feel great. I find the heat makes the practice much more challenging and because of this my mind has no option but to focus on the task at hand. For the hour or hour and a half of each practice my mind is shut off from the outside world. I don't think about my day or what I am going to make for dinner or when I am going to have time to finish this project or that, or anything else. I just am. I am able to be solely in the moment and this is so rejuvenating. All my thoughts melt away and the constant background chatter of my mind dissolves into nothing.


Aida's version of Downward Facing Dog


Yoga feeds both my mind and body. By allowing my thoughts to turn inward and focus only on my breath and the postures, I come away feeling rested, calm and in good spirits. The physical aspects of  yoga stretch and strengthen my muscles while detoxifying my body. Since having Aida I have discovered muscles I didn't know I had and discomforts I had never experienced before. The physical toll your body can take simply from nursing a child really blows my mind. I have neck and back issues I have never had to deal with before. And try as I might to carry my daughter evenly with my left and right side I still become unaligned and muscles on one side become tighter than the other. Yoga has REALLY helped me begin to correct these problems and I feel better and better with each class.

Also, for all those mamas-to-be out there, Yoga is a fantastic way to stay comfortable and healthy throughout your pregnancy. Many women begin to experience discomfort and pain at some point in their pregnancy. Often, this discomfort is caused by the much needed hormone called Relaxin that begins to course through your body almost immediately following conception. This hormone functions to soften the joints that will need to stretch and alter for delivery. Unfortunately, Relaxin doesn't specifically target the pelvic area and many women experience lose joints all over their body which, as you can imagine, can become quite uncomfortable and even painful. I personally began to feel the effects of this hormone almost immediately. My hips and pubic bone got more and more painful throughout each day. I started taking prenatal yoga when I was just 8 weeks pregnant and continued until just days before Aida was born. I also regularly visited a chiropractor who specialized in pregnancy. The combination of these two things kept me extremely comfortable and pain-free through my entire pregnancy. As soon as I began yoga and chiropractic care, I felt completely normal. No pain, no achy joints, no stiffness, nothing. I had the best pregnancy one could ask for and I attribute much of that to the yoga that kept me strong to balance my lose joints and opened my pelvis with ease and control.

So, the challenge. I will do my absolute best to attend at least 30 yoga classes in 30 days. It has been exactly one week that I began my challenge and so far (by the end of today) I will have done 10 classes in 7 days! Big thanks to my hubby for encouraging me to do this and taking on more so I can take this time to care for myself!   

I will let you know how things are going as I progress through this month. Wish me luck!



    



   

Interview

I was recently interviewed about being a doula by Jennifer for her blog, Regular Everyday People. Her blog is one of inspiration. The entire concept of her blog is captured perfectly in her tag line "Finding magic in ordinary life, because that's where it is." You should take a bit of time, grab yourself a cup of coffee and dig in to the richness of the everyday people she interviews. It's worth it, I promise. At least read my interview:) Enjoy!

Who Doesn't Love Fresh Juice?

My daughter and I are both fighting colds at the moment so it has been juice mania around here. Juicing is a great way to pack your body full of the vitamins and nutrients it needs, especially when trying to overcome illness. Juicing separates the juice from the fiber of the fruits and veggies which allows your body to easily absorb their nutrients. Releasing the vitamin filled liquid from the fiber before ingesting it means that your body doesn't have to work as hard to digest it, allowing that energy be used for other things like fighting off colds.


Juicing has saved my sanity lately as my daughter has decided to go on a vegetable strike. I have been amazed at the lengths she will go to avoid consuming the vegetables I put in her food. She has mastered the art of separating the foods in her mouth and spitting the vegetables back onto her plate. She has not always been this way and I know it is just a stage, but it makes me feel better knowing she is getting most of the benefits of fresh fruits and vegetables through their tasty juices. Making juice has become a daily event that my daughter gets excited about. She pulls a chair up to the counter and clambers up to help as soon as I mention juice time. She loves to help in the kitchen so once I get everything prepped I let her put it all into the feed tube of the juicer. We have definitely had some spills to clean up but letting her be a part of her own healthy food preparation is worth all the beet juice pooling on the counter top and running down our white cabinets.

I wish I had hopped on the juice train much earlier, especially when I was pregnant. One of the hardest things I encountered through my pregnancy was my inability to eat lots of fresh veggies. Just like most pregnant women, I experienced the most painful bloating and gas whenever I would eat uncooked vegetables. It was awful! I hear this complaint a lot from my clients too. Pregnancy can be such a catch-22; the very foods that contain so many vital nutrients for growing a baby can be so unforgiving to your digestive system while trying to do just that. Pregnancy changes everything in your body including hormones and the way your major systems function. One of these major changes is the speed at which your digestive system moves. Since your body is trying to capture every morsel of nutrient for that growing baby, your digestive system slows to a near halt. This is why so many pregnant women complain of bloating, gas and for some, the feeling of constantly being full. Although fiber in your diet is essential to avoiding constipation, a consumption of too much fiber can contribute to even slower digestion causing more gas and discomfort. So, the question is, if we are supposed to eat so many of these fresh fruits and vegetables to maintain a health pregnancy, but these foods put us in a state of constant discomfort, what is there to do? One solution would be to JUICE! Juicing would cut down on your intake of fiber without cutting out all those important nutrients that both you and your wee baby need. Remember though, fiber IS important to proper digestive functions so DON'T cut it out completely.

Have a happy healthy day!