Birth Doulas

Objectives
 At the completion of this unit the learner will be able to: Understand the background and purpose of a doula Describe positive labor outcomes associated with having a doula Access resources to find "the right doula for you"

What is a Doula?

The word "doula" stems from Greek origin and translates roughly as a "woman caregiver." In more contemporary terms, a doula can be likened to a birth attendant or a birth coach. She offers continuous, uninterrupted emotional and physical support during and just after childbirth. She can also act as an advocate in a complex hospital environment, bringing comfort and familiarity to your birth experience. A doula is not a trained clinician nor does she provide medical intervention. However, there are many certification programs that provide doula training and many options exist to find a professional doula.  Research suggests that the importance of including a doula or female companion in the birth process should be encouraged as part of pre-natal education and has proven beneficial for both mother and baby in the birth process. (Campbell, et. al)

The inclusion of a doula as part of the birth team gained popularity in the 1980's as a response to the increasing rates of cesarean section births. As a means of exerting greater control over the birth experience, women began inviting a friend, labor instructor etc. to help advocate for them during labor and to avoid procedures that would lead to cesarean section. Today, a doula can be helpful to women who want to be supported through a birth without pain medication. Others choose a doula to act as a liaison between themselves and the hospital staff. Some women choose to have a doula because they do not have adequate family support or want to alleviate pressure from their partner. (Papagni, K., Buckner, E.)

How Can a Doula Affect my Birth Experience?

The presence of a Doula during labor has been studied extensively in formal research, and the outcomes have proven overwhelmingly positive in the following areas:

• Decreased need for pain medication
• Reduction in number of cesarean deliveries
• Higher level of satisfaction with the childbirth experience
• Improved infant response immediately after birth
• Increased rates of breastfeeding
• Decreased postpartum depression

(Mottle-Santiago, et. al)

What Does a Doula Do?

What a doula does for you will most likely be determined by your needs and desires and by the process of your labor. Typically, you will meet with your doula to determine a birth plan prior to entering the hospital. Because a natural childbirth can follow an unpredictable course, your doula will provide a 'tailored approach' focusing on how to best provide you support. (Koumouitzes-Douvia, J., Carr, C.A.)

Typically, during labor a doula will:

• Use relaxation techniques such as massage, breathing and visualization
• Assist in helpful positions and comfort measures
• Encourage fluids and nutrition during early part of labor
• Advocate for laboring mother and help her access the information she needs to make informed decisions
• Facilitate communication between the laboring woman, her partner and the rest of the healthcare team
• Provide support to the woman's partner
• Help woman and her partner understand complications should they arise
• Assist with initial breastfeeding

(www.dona.org, www.cappa.net)

What is the Science Behind the Doula?

A survey of research reveals that the presence of a doula during labor reduces the level of stress hormones produced in the mother's body in response to pain, anxiety and fear. This soothing presence and continued reassurance promotes both a physiological and psychological response in the mother. The decrease in the production of the hormone epinephrine which is part of the sympathetic "fight or flight response" results in increased uterine contraction, cervical dilation and swifter labor.

In addition to the decrease in epinephrine, presence of a supportive doula also increases the release of the hormone oxytocin, which further encourages uterine contraction and promotes labor. (Campbell, et. al)

What Kind of Training Does a Doula Receive?

Today, there are numerous certification programs that train professional doulas. While the requirements vary, training usually involves a combination of theoretical study, written work and labor attendance culminating in certification. Medical training is not a part of doula certification.

Birth Doula Videos

The following videos represent testimonials about the benefits of including a Doula in your birth plan.

Where Can I Find More Resources and Information?

The following links are helpful resources for persons interested in further research on doulas. Included is information about where and how to find the "right doula for you".

   * http://www.dona.org
* http://www.childbirthconnection.org
* http://www.midwiferytoday.org
* http://www.icea.org
* http://www.naturalresources-sf.com/resources.html#birthdoulas;
* http://www.doula.com
* http://www.alldoulas.com


Reminder

You should discuss your desire to incorporate a doula into your Birth Plan with your Primary Care Provider, Certified Nurse Midwife or OB/GYN. In addition to medical advice, they may have information regarding hospital-specific policies, local doula references or insights to share.

Sources

1. Campbell, D.A., Lake, Marian F., Falk, M., Jeffrey, R.A. (2006). Randomized Control Trial of Continuous Support in Labor by a Lay Doula. JOGNN, 35, 456-464; 2006. DOI: 10.1111/J.1552-6909.2006.00067.x.

2. Koumouitzes-Douvia, J.,Carr, C.A., Women's Perceptions of Their Doula Support (2006). Journal of Perinatal Education, 15(4), 34-40, doi: 10.1624/105812406X1.

3. Mottl-Santiago, J., Walker, C., Ewan, J., Vragovic, O., Winder, S., Stubblefield, P. (2007). A Hospital-Based Doula Program and Childbirth Outcomes in an Urban, Multicultural Setting. Maternal Child Health. 12:372–377.

4. Papagni, K., Buckner,E. (2006). Doula Support and Attitudes of Intrapartum Nurses: A Qualitative Study from the Patient's Perspective. Journal of Perinatal Education 006 Winter; 15(1): 11–18. doi: 10.1624/105812406X92949.

5. www.dona.org

6. www.cappa.net