Doulas

“My labor assistant was my friend, my strength, my shield, my teacher, and most of all, my anchor in a sea of confusion, pain and fatigue. She was to me what a lighthouse was to a ship, a gentle guide showing you your destination and helping you avoid unnecessary hazards.”                                                                                                — a mother

Many people feel that a professional labor assistant can mean the difference between a good birth experience and a disappointing, disastrous or  demeaning birth experience. Research with over five thousand women shows that continuous doula support in labor has astonishing benefits. Cesarean rates are less than half of what they are for unsupported women. Pain medication use is reduced by 35 percent. Drugs used to speed labor are reduced by 71 percent! In addition, labor is generally more than one and one half hours shorter. Particularly if you plan a hospital birth, having a professional labor assistant is a very wise choice to make.

Doula means “to mother the mother”. Most non-industrialized countries offer continuous female support during labor and birth. These women touch, hug, and talk to the laboring mother and as birth draws near often literally hold the mother in their arms. Laboring women also need this intimate, loving support from another woman in addition to having their partners present. Having this help from a woman with training in birth can have immeasurable benefits.

“I was screaming for medication and felt at that point that a cesarean would be the easy way out. Although I begged for an epidural, Janice (labor assistant) and my husband helped me continue. It was just a cry for help. I was really tired. I needed encouragement, not drugs.”

Because the labor assistant has experience with many births, she can help the woman over this hurdle where the father may falter seeing his wife in pain. Most families meet with their doula once or twice before labor. They have discussed their desires for birth and have usually written up a birth plan. It is good to discuss your plan with your care provider and have a copy in your hospital chart. The doula, knowing the woman’s plans, can assist her in achieving this and perhaps fend off the over-zealous people who offer drugs as the only option.

The doula has had training in labor and how it progresses and also has many tools and techniques to facilitate the process. She involves the father in comfort measures and support and relieves him for food and rest breaks.

Some doulas offer labor sypport at home before going to the hospital or birth center. Monitrices have the skills of a doula and can also monitor the baby’s heartrate and do vaginal exams in labor. This can offer, especially for first-time parents, the opportunity to stay in the comfort of their own home until labor is well-established.

Most births in this country are “managed” with an array of medical, technological interventions of questionable necessity. Only ten percent of the 3.5 million women who give birth each year do so without intervention. Staying out of the hospital until active labor–5 centimenters of dilation or more with strong, regular contractions for the first time mother–gives you a better chance of having a spontaneous birth without interference.

“Women who give birth vaginally without anesthesia or drugs have overcome ones of life’s more difficult challenges. Getting through labor is a test of character, determination, strength and will. But it is infinitely easier to do when an experienced woman is leading the way. A woman who has given birth herself, a who trusts in the birth process as the best and right way to bring a child into the world, a woman who knows that birth is a sacred, transcendent experience. This special woman is a professional labor assistant. She can help mothers birth experience that will last them a lifetime. She can make the difference between a joyous time when a new life enters the world, or a frightening, out-of-control experience.”                                                                                                                                                     –Paulina Perez, Special Women

Doulas offer continuity of care. Nurses work in shifts and are notoriously understaffed. Doctors are not usually present until moments before birth and it is not uncommon to have one you never met. The doula is a constant through labor and birth. She knows your desires and her commitment is to you, not the hospital. She knows hospital routines and often the nursing staff and can provide a liaison between you and the hospital. Often doctors and nurses love doula clients because it makes their job easier. Women supported by doulas express greater satisfaction with their births.

Research shows the benefits of doula support extend beyond birth. Mother-infant affectionate interaction scores were significantly higher at two months after birth in women who had doula support. Women reported a reduction in anxiety about parenting and their ability to cope, as well as more positive feelings about their births. Long-term there were increased maternal self-esteem, decreased postpartum depression and increased exclusive breastfeeding. Studies show that if every woman in the US had a doula during her labor and birth, the cost saving would be three billion annually!

Women with special needs can especially benefit from professional labor support. If you are planning a vaginal birth after cesarean, your need for support is increased and there are doulas in some areas that specialize in VBAC moms. Single mothers, teens, high-risk women can all benefit from professional assistance. Some doulas will help with other children while attending the birth or be of assistance where there is language barrier.

Certification for doulas has been offered by several organizations. Training usually requires prior knowledge and experience of birth and consists of a two to three day training seminar. Doulas observe a series of childbirth classes, pass a written exam and are required to have positive evaluations from clients and/or doctors, nurses and midwives.

Some things to consider when choosing a doula are her background and training, level of experience and relationships with the medical community. Does she have a busy practice and backup if she’s at another birth? Fees vary and some insurance will cover them. Most doulas charge a flat rate and may have additional charges for extra services or over a certain number of hours. Usually a postpartum visit is included with breastfeeding support, etc. Clarify your needs and desires prior to labor.

Labor, birth and immediately after are periods of unusual openness and sensitivity for mothers. Care practices during this vulnerable time have significant and far-reaching consequences affecting the mother’s internal beliefs about herself, her body, her mothering abilities and her relationship with her baby. Give yourself the best chance by having a doula, a woman to care just for you during your labor and birth. I guarantee you won’t regret it.

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