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.       

Pelvic Floor Muscles - A topic for EVERYONE!

As a doula I like to attend as many secessions and classes possible so I have the most up-to-date information for my clients. A while ago the Women's Health Clinic (WHC), which operates out of Winnipeg's new birthing centre, offered a class on pelvic floor muscle (PFM) health. PMF is a huge topic in the birthing world so I was most definitely there. A large part of the class was a refresher for me but there were also many new things I learnt. Most moms and moms-to-be have lots of questions on this topic so I thought I would share some information with those who care to learn.  Although, as it turns out, it is not only mams and preggos that should be learning about PMF, this is a topic that affects EVERYONE. Yes, that means you too gentlemen.

All the information that follows comes from my doula training and the information presented at the PFM health class provided by the Women's Health Clinic (WHC) and their informational brochures and handouts. Much of this information can be found on their site www.womenshealthclinic.org. More great information can also be found here www.pelvichealthsolutions.ca 
This information should not be used to replace a visit with your health care provider.

What are the PFM? The PFM are muscles that originate from the tailbone and insert onto the pubic bone forming a sling that fills the bowl of the pelvis. These muscles not only create a muscular hammock but they also form an intricate network that weaves around and throughout the pelvic organs. The PFM serve five major functions which include supporting the pelvic organs (bladder, uterus, vagina, rectum), they also act as the sphincters to control the passage of urine, stool and gas. The PFM assists in respiration through interactions with the diaphragm while also working with the abdominal and core muscles to help stabilize the trunk and spine to improve posture. As if that wasn't enough, the PFM play a significant roll in sexual function and enhanced pleasure. How does that grab ya?!


There are two types of PFM dysfunction: Hypotonicity (Weak pelvic floor muscles) which can contribute to stress incontinence (aka: peeing yourself when you cough, sneeze, run or jump ect.), urge incontinence (feeling like you need to go all the time) both of which are NOT a normal part of aging, pelvic organ prolapse (yes, this can happen), uncontrollable passing of gas or stool (you know who you are), and a feeling of pelvis/sacroiliac instability. Conversely, Hypertonicity (Tight pelvic floor muscles) contributes to urinary and fecal urgency, urge Incontinence, chronic pelvic pain, constipation, dyspareunia, vaginismus, vulvodynia, pudendal neuralgia, interstitial cystitis and chronic prostatits. Both weak or overly tight PF muscles can also cause hip, pelvic or low back pain and stiffness or fatigue. 

One of the most shocking things I learnt in this class was the population percentage of those with some form of PFM dysfunction. 96% of the population is affected by at least one aspect of PFM dysfunction and 87% show 2 or more symptoms! That is nearly every one! 

Causes of unhealthy PF muscles are plenty. Many things can lead to either weak or tight PF muscles like pregnancy and childbirth, hormonal changes (as in menopause), chronic constipation and straining, chronic coughing (like smokers cough), surgery, recurring UTIs, poor posture, excess weight and lack of exercise are but a few. Some PFM dysfunction symptoms like urge incontinence are made worse by consuming food/drinks that cause irritation to the bladder. For example, the following list worsen symptoms in most people: Coffee, caffeinated tea and sodas (some medications also contain caffeine), alcohol, chocolate and smoking. Some people's symptoms also worsen with the consumption of the following: acidic foods (including tomato and tomato products), citrus fruits and juices, artificial sweeteners, spicy foods, milk and milk products, sugar and honey for some, corn syrup and cranberry juice. I know this last one seems weird considering that cranberry is used to cleanse the kidneys and is good for bladder infections, but it is best to consume cranberry extract. Also, concentrated urine (which happens when we don't drink enough fluids - which most people don't) can irritate the bladder and result in greater symptoms of urgency and frequency. Further, I personally know many of you out there who refuse to use the bathroom anywhere but in the comfort of your own home or, when forced to use a public washroom, hover over the toilet seat in order to avoid any contact with said toilet. Both of these actions (or lack of action I should say) can also wreak havoc on those oh so important PF muscles. Holding in your pee or bowel movement regularly can cause PFM issues while hovering counteracts what you are trying to do by tightening everything up instead of releasing. Also, terrifyingly, propylene glycol and other chemicals found in many soaps, shampoos, perfumes ect, can weaken the muscles which absorb these chemical through your skin. Gross!!     

Fortunately, most PFM disorders can be corrected although it may take time and work. Whenever the topic of PFM comes out the first thought is usually 'kegels' or PF exercises (I'll let you look up how to do kegels). Although these are extremely important and crucial in strengthening PF muscles they may not be the answer to all forms of PFM dysfunctions or symptoms. For those with symptoms caused by tight PFM, Kegels would be the last thing you would want to do. It is important to maintain a balance of taught and firm pelvic floor muscles without being overly tight or too weak. Thankfully there is PF physiotherapy available for those who need it. The Incontinence & Pelvic Pain Clinic (IPPC), a division of the Nova Physiotherapy & Sports Fitness Clinic, is run out of the medical arts building and specializes in PFM therapy. Another local physiotherapist that specializes in PFM is Donna Sarna. Also, the WHC has a pelvic pain nurse, Lynn Crocker-Loat who helps women with pelvic issues.

So please be kind to these muscles that serve so many purposes. Keep healthy, drink lots of water, eat well, exercise, do go to the bathroom once when you feel the need and don't hold it forever. Just sit on that dang toilet seat (you can clean it first if you so desire) instead of hovering and try not to strain so much. Do exercise your PFM if they are not overly tight and do see a physiotherapist if you are experiencing unwanted symptoms (you don't have to live with them!). 

Thank you for visiting and taking the time to read! Please leave comments and tips for other readers if you so feel the urge.   

Happy Summer Guys!!