A doula (doo-la) nurtures the social experience of childbirth, and by doing this, improves physical and psychological outcomes.
Doula is a Greek word now used to mean a person who gives emotional support, comforting techniques, information and advocacy during the time surrounding childbirth. A doula supports the mother, and her partner, before, during and after childbirth.
Many doulas have a unique interest in fetal positioning. Supporting natural birth in the hospital setting is easier when the baby is well positioned.
Photo by Kim Garrett, © Maternity House Publishing, Inc.
"Continuous support from a doula during labor provides physical and emotional benefits for mothers and health bonuses for their babies. With less medical interventions, fewer complications, and shorter hospital stays, there may be financial savings as well."
-- Harvard Health Letter quoted in The Doula Book; How a Trained Labor Companion Can Help You Have a Shorter, Easier, and Healthier Birth, Second Edition, Klaus, Kennell and Klaus
Is a doula qualified to help with fetal malposition?
The doula is qualified to give, or find, the information for parents to have informed consent and options in pregnancy and birth, including the area of fetal positioning.
There are several fine doula organizations, and DONA International, the premier doula organization, offers both a Scope of Practice (allowable actions) and a method to evaluate whether a doula’s advice or action is within her Scope of Practice. Spinning Babies has used these seven questions designed by Penny Simkin to give the doula plenty of options to help with fetal positioning and stay within her role as a doula. This guideline includes how a doula would approach the patient/doctor relationship with her suggestions for maternal positioning for the goal of labor progress or fetal rotation. Doulas and other interested persons can read an article on Spinning Babies and the Doula Scope of Practice.
How can a doula help with fetal positioning?
The doula is a resource for parents. The doula can refer the parents to books, videos, websites and professionals who can give help and advice. The doula can also share what other women have done to help their babies get in a good birthing position. Story telling is a way of sharing the how-tos without giving medical advice.
A doula may be able to show parents how the Spinning Babies techniques can be done together. The doula often knows how to implement techniques, and improvise techniques, even at the hospital. Local doula groups may have informational evenings where maternal positioning for comfort and labor progress are shown and tried out.
Because the doula listens carefully to the mother and follows the mother's needs and desires, she doesn’t tell the mother what she must do. Different mothers may have different desires and different coping styles when they hear that their baby may not be in an ideal position for birth. The doula may want the mother to do certain exercises, such as the inversion, but the mother may not want to. The doula must be flexible and yielding then so the mother feels heard and empowered in the doula/mother relationship.
A doula can give emotional support during a breech version
In late pregnancy with a breech baby, the doula can be helpful by going with the mother and her partner to the hospital if the doctor attempts a manual version. This is a procedure in which the doctor pushes through the mother’s skin to try to move the baby into a head down position. Read about manual version in the About Breech article under Baby Positions. Penny Simkin offers information for doulas attending a breech version at her website, www.PennySimkin.com
General information about the doula role at childbirth
"The presence of a Doula is a major advantage for physicians, the women and their families. They provide a level of support that is often very difficult to achieve in a busy maternity care service. We see increased satisfaction with the birth experience, lower intervention rates and excellent infant outcomes."
Emeritus Professor of Family Practice and Pediatrics
University of British Columbia
Senior Scientist Emeritus
More from Dr. Klein http://www.scienceandsensibility.org/?author=93
“Now, what did my childbirth teacher say about this?”
Having a doula is somewhat like having a childbirth educator at your birth. She offers individualized and appropriate information and the choices a woman may have within the community and the birth setting she has chosen. She may know doctors and midwives who help with breech vaginal birth, for instance. Or, she may know which hospitals in the area encourage mothers to be up and walking in labor, eating and going through labor naturally, if the woman desires, and which hospitals have staff that want their mothers in bed on IV fluids unable to use the many standing maternal positions.
The doula role is to open communication within the birth team
The doula may help the mother prepare for a conversation with her midwife or doctor. This is helpful because the doula may know from experience of a variety of options that the parents may not know to ask about. If the mother is somewhat intimidated about speaking to who she may see as an authority figure, the doula can help her make a list and feel supported in voicing her concerns. Many doulas take the time to attend a prenatal visit with the mother to meet her care providers and let them meet her.
While encouraging parents in their decision making, the doula does not make decisions for parents. She may make suggestions, but not in a way that shames or blames or bullies anyone. By keeping her own preferences subdued, the doula celebrates the mother's unique, and very personal, experience.
When birth plans go out the window; the doula helps with unexpected events
If the unexpected comes up, the doula helps the parents adjust to these changes while preserving a spirit of hope and kindness. She helps the parents understand the medical terms and helps the doctors understand the mother's emotional needs. Promoting pleasant communication is another way that the doula protects the mother's memory of her birth.
With fetal positions such as posterior or asynclitism, it is not unusual for labor to continue a lot longer than parents expected. Pain in unexpected places, such as a hip or in the back, can surprise women and make it hard to get back to their labor rhythm. Labor patterns that don’t match the description charted at the childbirth education class or pain that exceeds expectations can leave parents feeling bewildered and betrayed. Remember, it is about 15-30% of posterior labors that need extra help. Many posterior babies rotate and come out without significant drama, but for the smaller minority, the labor can be a real challenge.
A mature doula keeps her perspective and calm to reassure them that there are useful techniques and that, in the vast majority of cases, the baby can and will be born. Emotional support for such labors requires creativity and foresight. She must not promise that the baby will be born by midnight, or that the next labor will be easy, rather, she helps the mother stay present in the moment and not anticipating or fearing what is to come.
Doulas and the mother’s partner
Partners find doula care very reassuring and useful. When the partner takes an active role in supporting the birthing woman, the doula steps back being quietly available for reassurance and to keep the room calm and the water glass full. When contractions grow in challenge, the doula is right there to assist the partner in tips and techniques for calming and comforting. This becomes especially valuable in advanced labor, as you can imagine.
Fewer cesarean surgeries happen to mothers who are supported by doulas
When labor progress is slow, the doula often has tricks up her sleeve that can help avoid a cesarean. Not every doula supported birth avoids a cesarean. Not all women wanting natural birth have the kind of labor or support they need to finish the birth naturally. But having a doula increases the chances of a natural or at least a vaginal birth dramatically.
A wonderful side effect of this continuous emotional support is the commonly found reduction in complications and their resulting interventions for both mother and child--during and after childbirth! This is true even with a posterior or asynclitic baby. With fetal position challenges (malposition), interventions can be tools to help labor progress, especially if the woman gets more than tired.
Why have a doula if the birthing woman already has a supportive husband and family?
Mainly because he and they are having their baby, too. Once most partners and family members are at the birth the emotion of their child or relatives birth is so moving that they cannot take care of the constant little details that help a birthing mother to cope and feel strong. One mother didn't have a doula for her first birth and later became a doula herself. Read her story at the BirthYouWant.com website.
My midwife says I don't need a doula when I have midwifery care, what's your opinion?
A midwife is not a doula. She may think she gives the same care as a doula, but as a midwife and doula myself, I can assure you she cannot. She can be loving and kind, she can stay with you, but she can not be a peer. As a midwife and a doula trainer myself, the difference is clear.
The midwife is the person you choose to guide you safely through the passage of Birth.
These are two different roles with different goals. The doula goal should be your emotional experience of birth and comfort measures to help you achieve your goals. Because a goal of a natural birth is important to many mothers and babies, doulas often have some skill in how to use maternal positions and activities for labor progress. But the doula doesn't assess you or your baby's health or your labor. She isn't following your care in the way your midwife or doctor does.
The midwife has responsibilities to see that equipment is set up for the birth right about the time the mother is in transition and needs a woman's reassurance. The midwife is checking the mother and baby's vital signs, charting and sometimes asking the mother to accept things she doesn't want, a position for progress that is not comfortable, a position to help her monitor the baby, perhaps even an intervention, etc.The doulas only responsibility should be to the mother.
See more information about doulas at http://www.dona.org/publications/position_paper_birth.php
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