The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS,
a homebirth midwife in Mountain View, CA
The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS,
a homebirth midwife in Mountain View, CA
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Orgasmic Birth -- the documentary! ABC's 20/20 will be airing a segment about Orgasmic Birth on May
16th for their special Mother's Day show.
Interviews with Christiane Northrup, MD, Ina May Gaskin, MA, CPM, Sarah J Buckley, MD, Marsden Wagner, MD Joyous, sensuous and revolutionary, this pioneering film will compel many to reexamine their perceptions about childbirth. Viewers will understand how the use of normal, undisturbed birthing methods can aid the health and well-being of future generations. |
Many lay people are confused about the difference between a doula and a midwife, and they may sometimes expect their doula to make specific clinical recommendations regarding prenatal herbs, position for breeches, Group B Strep, and a variety of other complicated topics. They simply don't understand the difference between a three-year midwifery program that prepares a midwife to handle life-and-death emergencies and a weekend doula program that prepares a doula to comfort and reassure laboring women about normal labor.
I guess it's a good thing that lay people understand that both midwives and doulas contribute to a better birth experience, lower rates of interventions, and successful breastfeeding and mothering, but a doula can feel very conflicted when she's asked a clinical question.
Naturally, a doula wants to help and support her clients, and she has also naturally learned quite a lot about the clinical aspects of maternity care. She may have doula friends who have also studied herbalism or homeopathy, and they may share some information with her, and she may feel that she knows the answers to some important questions.
But there is much more to making clinical recommendations than knowing SOME answers to important questions. Here a midwife responded to a doula's question about recommending Evening Primrose Oil (EPO) to her client. This is a great summary of the thought process that needs to be taking place in the mind of someone making clinical recommendations. If you find that your thought process is simpler, such as, "Well, I've heard that EPO softens the cervix", then you're doing your client a dis-service to pass this along and leave her thinking that she has received a sound clinical recommendation from someone who knows her medical history and understands the subtle nuances of how this might affect her individually.
I don't know if you are a certified Doula and if you are what scope of practice your certifying group has but with what training, experience or education are you recommending EPO? I know how easy it is to read in a book or on the internet how great such and such is but I wonder how profound your understanding of EPO is.What are your reasons for thinking this supplement is needed or necessary? What are your expectations?
Additionally, what are your recommendations for usage? Oral vs vaginal? Dosage?
What responsibility are you willing to accept for this suggestion?
I am not throwing stones either. I have made my way to midwifery via the childbirth educator and Doula route too.
Midwifery training tends to focus on facilitating a normal birth, correcting minor problems before they become major. Midwives are obligated to recommend a transfer of care for cases that deviate from normal to the extent that they require a physician's care. And, of course, midwifery training includes a heavy emphasis on handling unpredictable mergencies, such as shoulder dystocia, postpartum hemorrhage, and neonatal resuscitation.
A doula's training may be no more than a weekend workshop, and they don't provide any clinical care; their focus is on comfort measures. It's actually problematic that some doulas give the impression that they're qualified and licensed to advise women on clinical choices, which they're not. They can give information about what is currently known generally, but they cannot make a specific clinical diagnosis or recommendation.
The similarities are that they are usually women, and they are a key part of an optimal birth experience.
This paper from DONA gives a good description of what a doula does. And here's a good description from the UK about midwives.
Some women hire midwives as "doulas" because they want clinical midwifery care while laboring at home, and they want a birth advocate who is qualified to make clinical recommendations.
Some midwives are trained as both and practice as both, although DONA asks them not to call themselves doulas if they are providing clinical care. So you may see the word "monitrice" used to describe someone providing clinical midwifery care during labor, with a transfer of care to another provider as the birth attendant.
Midwifery care does NOT include doula training, and many midwives are
actually lousy doulas.
http:
Looking
to nature, doula Penny Simkin practices the art of delivery - beautiful
article about her work.
Doula
Support and Attitudes of Intrapartum Nurses: A Qualitative Study from the
Patient's Perspective [Full
text]
BirthSource.com has a fabulous
collection of doula supplies (plus a great selection of childbirth education
materials). They have one of the best dilation
charts I've seen; they really show the changes in effacement along
with dilation, for a first baby.
Labor Support
Initiative from the Maternity Center Association
The Doula School will come
to your area. 510-728-8513
Advanced Online Doula
Training, free when you join BirthLove,
which is well worth the modest subscription fee.
Operation Doula Care
has been formed in response to the events of September 11th, 2001. Doulas
all over the United States have come together to form America's first ever
"Doula Reserve". Our mission is to provide, FREE of charge, birth doula
support to the pregnant wives of U.S. Military men (Active Duty, Reservists,
National Guard, Coast Guard) that have been called up, deployed, injured
or have become deceased as a direct result of any military actions relating
to the war against terrorism.
Certified
Perinatal Support Specialist (CPSS) - an apparent invention of Birth
Wisdom, expanding the role of the doula.
Labor
Support Initiative - a detailed online guide to help pregnant women
understand the benefits or labor support, options for labor support, and
how to make arrangements for such support from maternitywise.org. Continuous
Support for Women During Childbirth, a new Cochrane Review, presents
the benefits of continuous labor support based on the experiences of nearly
13,000 women who participated in 15 randomized controlled trials.
Birth Empowerment Support Team
(B*E*S*T) Doula Service is a group of qualified birth and postpartum
doulas serving childbearing families throughout the greater Los Angeles
area. Their web pages offer comprehensive information for and about
doulas, including a great set of handouts.
A Child is Born offers
a variety of workshops
in the US and Mexico: Doula Certification Workshop, Advanced Doula Certification
Workshop, Childbirth Educator Training, Childbirth Educator Apprenticeship
Polly Perez' Cutting Edge
Press - lots of doula resources!
Frequently Asked
Questions About Doulas/Childbirth Assistants
Mother-Friendly
Nurse Recognition - from www.anacs.org
- A certificate to print out to recognize L&D nurses for a job well
done . . . to acknowledge a nurse for going the extra mile to help a woman
have a good birth, that is part of a movement to recognize that the nurse's
attitude really impacts birth outcomes.
DONA - Doulas of North America
ALACE - The Association of Labor Assistants
and Childbirth Educators
Space will be extremely limited in the birth experience program.
If you are interested, it is highly suggested that you call now and reserve
a space to ensure that you will be able to get in.
Cochrane
Review on effects of "Continuous Support for Women During Childbirth"
(click for PDF file).
If I told you today about a new medication that would reduce fetal asphyxia
by 2/3, cut labor length by 1/2 and enhance mother-infant interaction after
delivery, I expect there would be a stampede to obtain this medication,
no matter what the cost. Just because the supportive companion (Doula)
makes common sense does not decrease its importance.
-- John Kennel, author of Birth, Interaction and Attachment
"If a doula were a drug, it would be unethical not to use it" attributed
to John Kennell and/or Marshall Klaus.
Nervous
dads-to-be worsen cesarean pain
"As birthing partners can improve the experience of women giving birth,
Dr Keogh suggested: "Rather than removing them from the operating theatre
altogether, it would be better to target the emotional well-being of the
birth partner to help reduce the anxiety and fear experienced by the mother."
This study is about cesareans, but most people would agree that it applies
to all births. Doulas sometimes help moms by helping the dads.
Doulas Can Improve
the Health of Both Mother and Newborn - This is a great summary of
doula benefits!
Fathers
'a pain' during childbirth [1/25/06]
Many pregnant women will tell you their partners can be a pain during
childbirth, but scientists have now discovered they're right. Anxious men
pass on their fears to mothers giving birth by Caesarean, researchers from
the University of Bath and Imperial College London found. [Ed. Here's
a case where a doula's calming the dad helps the mom. And many birth
attendants would bet that this effect carries over into all of labor and
birth.]
The
obstetrical and postpartum benefits of continuous support during childbirth.
"The results of these 12 trials strongly suggest that doula support
is an essential component of childbirth. A thorough reorganization of current
birth practices is in order to ensure that every woman has access to continuous
emotional and physical support during labor."
Continuous
emotional support during labor in a US hospital. A randomized controlled
trial.
50% reduction in the cesarean rate
Female
Comforter During Labor Benefits Both Mother and Infant [Medscape registration
is free] [Obsolete link - please
e-mail me if you find this article anywhere online. Thanks.]
A
comparison of intermittent and continuous support during labor: A meta-analysis.
A recent study contrasted the influence of intermittent and continuous
support provided by doulas during labor and delivery on five childbirth
outcomes. Data were aggregated across 11 clinical trials by means of meta-analytic
techniques. Continuous support, when compared with no doula support, was
significantly associated with shorter labors (weighted mean difference
-1.64 hours, 95% confidence interval -2.3 to -.96) and decreased need for
the use of any analgesia (odds ratio .64, 95% confidence interval .49 to
.85), forceps (odds ratio .43, 95% confidence interval .28 to .65), and
cesarean sections (odds ratio .49, 95% confidence interval .37 to .65).
Intermittent support was not significantly associated with any of the outcomes.
Odds ratios differed between the two groups of studies for each outcome.
Continuous support appears to have a greater beneficial impact on the five
outcomes than intermittent support. Future clinical trials, however, will
need to control for possible confounding influences. Implications for labor
management are discussed.
Doula: A woman trained and experienced in childbirth who provides
continuous physical, emotional, and informational support to a woman during
labor, birth and the immediate postpartum period. Postpartum doulas care
for new families in the first weeks after birth providing household help,
advice with newborn care and feeding, and emotional support.
Effects on birth outcomes: Eleven studies showed the following
effects of doula support: shorter labors, fewer complications, reduced
cesarean rates, less need for oxytocin to speed up labor, reduced use of
forceps, fewer requests for pain medication and epidurals.
Effects on the mother: greater satisfaction with childbirth,
more positive assessments of their babies, less postpartum depression
Effects on the baby: shorter hospital stays and fewer admissions
to special care nurseries, babies breastfeed more easily, mothers are more
affectionate with their babies postpartum
Effects on the healthcare system: dramatically reduced cost of
obstetrical care, women are pleased with the personalized care doulas offer
Given the clear benefits and no known risks associated with intrapartum
support, every effort should be made to ensure that all labouring women
receive support, not only from those close to them but also from specially
trained caregivers. This support should include continuous presence, the
provision of hands-on comfort, and encouragement. -Hodnett, E. D. "Support
from caregivers during childbirth." (Cochrane Review) in Cochrane Library,
Issue 2. Oxford Update Software, 1998. Updated quarterly.
Facing unprecedented pressures to reduce expenses, many hospitals are
targeting the largest single budget item--labor costs . . . . [An] unintended
consequence of nursing cutbacks may be an increased cesarean rate; the
inability of pared down nursing staff to provide continuous coverage to
laboring mothers [has been] shown to increase the chance of cesarean .
. . . Doulas clearly improve clinical and service quality; they provide
an absolutely safe way to reduce cesareans and other invasive birthing
interventions. -[Coming to Term: Innovations in Safely Reducing Cesarean
Rates. Medical Leadership Council, Washington DC. 1996. ]
The continuous availability of a caregiver to provide psychological
support and comfort should be a key component of all intrapartum care programs
which should be designed for the effective prevention and treatment of
dystocia (non-progressive labor). [Guidelines on Dystocia. Society
of Obstetricians and Gynaecologists of Canada, 1995.]
Dr. Nancy P. Gordon and others at Kaiser Permanente in Oakland, California,
examined the effects of providing hospital-based doulas to pregnant women
in labor in a randomized study. They used medical records and an interview
conducted 4 to 6 weeks after delivery to compare epidural use and perceptions
of the labor experience in 149 women who had doulas during labor and 165
who received usual care.
Women who had doulas were significantly less likely than others to have
epidural anesthesia during labor, according to a report in the March issue
of Obstetrics and Gynecology. Rates of other medical nterventions, on the
other hand, were similar in the two groups.
Doulas also appeared to improve women's perceptions of the birthing
process, Dr. Gordon and colleagues say. The birth experience was rated
as good by 82.5% of women with doulas and 67.4% of those without doulas
during labor. Women who used doulas were also significantly more likely
than others "...to feel they coped very well with labor...and to feel that
labor had a verypositive effect on their feelings as women...and perception
of their bodies' strength and performance."
"What didn't show up was an effect on self-esteem or depression," co-author
Eileen McAdam told Reuters Health. She explained that prior studies had
indicated that doulas would have positive effects on both of these outcomes.
Most "...women who had doulas were very enthusiastic about them," the
investigators report, "...and even women who did not have doulas thought
they would like to have one if they had another baby." The findings support
further examination of the use of doulas in the delivery room, Dr. Gordon
and her team conclude.
McAdam said in an interview that physicians and others interested in
more information on doulas should consult the meta-analyses, cited in the
report and published in 1996 in Obstetrics and Gynecology, volume 88, pages
739-744.
Obstet Gynecol 1999;93:422-426
Doulas of North America
Position Paper: The Doula's Contribution to Modern Maternity Care from
the DONA Web pages. This article
has a lot of good statistics at the end.
Benefits of
Assistant for Childbirth Go Far Beyond the Birthing Room By SUSAN GILBERT
Assistance of a
`Doula' May Reduce Childbirth Complications
Someone recently mentioned that there was a study done that showed that
even with one on one nurses to moms they only spent 6 % of their time with
the moms.
From Vol. 3No.3 (Sept/Oct 1995) of The International Doula.
McNiven, P.; Hodnett, E.; O'Brien-Pallas, L.L. "Supporting women in
labor: a work sampling study of the activities of labor and delivery nurses."
BIRTH (1992 Mar)19(1):3-8; discussion 8-9
....This study piloted a work sampling method that was adapted to determine
the proportion of time the average intrapartum nurse at a Toronto teaching
hospital spends in supportive care activities. Supportive care was operationally
defined within four categories of activities: emotional support, physical
comfort measures, instruction/information, and advocacy. Work sampling
was an effective method of measuring support as a specific aspect of direct
ntrapartum care. The proportion of time that nurses spent in supportive
versus all other activities was 9.9% percent (95% confidence interval 7.5%
and 12%), based on a sample of 616 random observations of 18 nurses. ...
About Labor & Delivery Nurses Not Providing Labor Support
Why aren't they paid to labor support? I see them sitting at the desk,
true that isn't true in all places but here sometimes there is only 1 or
a couple in labor, they get no more time, yet I see them sitting , smoking
and drinking coffee at the nurses stations and many times there are several
there. I don't think that more labor nurses want to get personal, I work
with a CNM who said that when she was a labor nurse they discouraged it.
I have to respond to this, although I have been content to sit on the
sidelines for this discussion. I have now been drawn into it from the above
message. I have worked as a labor and delivery nurse in one of the hospitals
in Great Falls, and I do not believe I ever said that the nurses were discouraged
from providing labor support. Rather, we were often assigned a patient
load that made it difficult to be one-to-one with the laboring woman. I
must strongly object to the assertion that labor and delivery nurses do
not want to get personal with their clients. Let's be careful to comment
only on what we know for a fact, not speculation, rumor or misinterpretation
of someone else's comments.
Doula Participating in Study at Kaiser
How Dads and Doulas
Work Together - A Help for Fathers During the Labor and Birth of Their
Child
Female
Comforter During Labor Benefits Both Mother and Infant [Medscape registration
is free]
Moreover, doula-supported mothers bond more quickly to their new baby
— 2.9 days versus 9.8 days for non-doula mothers — and spend less time
away from them. They are also more likely to rate their baby as better
than the average baby, Dr. Kennell said.
Exactly why doulas are helpful is unknown, but touch may play a role.
While support from the father-to-be is rated highly by new mothers, systematic
observations show that fathers tend to touch their partners less during
late labor compared with a doula, Dr. Kennell said. Fathers also routinely
leave their place at their laboring partner's side when hospital personnel
enter the room for any reason. Brochure - Nurses, Midwives, Dads and Doulas
My husband read "The Birth Partner" and talked to a man whose wife had
a natural birth . He came home and told me HE wanted a doula.
He did not want to be responsible for remembering everything, knowing what
positions were helpful when, etc. etc. He wanted to be my husband
and the daddy. I frequently tell dads that their job is to love the
mom and baby, my job is to think. I always get the husband as involved
as possible. For example, suggesting a position change, then letting him
do the massage etc. I also manage the details--run for drinks and
snacks, adjust the lights, get wet rags all that stuff. Dads like
to be able to go for a walk and pee during labor. Doulas let them
do that without leaving the mom.
A good doula makes the dad look like a hero.
As a doula, part of the work that I do is fostering the relationship
that the couple has. Part of the beauty of this work is that we can
really help the dads to have a better birth experience too and also give
them the opportunity to support his partner is his own way, whether that
be right in there in the thick of it all, or in a more back of the scenes
way. The moms don't have to get mad at their partners when he just
doesn't seem to know what to do because we are there guiding him while
we serve both of them. I don't think the dads are giving over their
role at all. I do find, however, that at some point during labor
even the most actively supportive dads step back just a bit into a more
protective role and allow the "women's work of birth" to take over.
Most of the time when this happens it is as labor becomes very active,
just before full dilation when it can get very intense. They always come
right back to it when she is pushing. There was some study done,
maybe by Klaus and Kennell showing that moms who have doulas and their
spouses with them feel closer to their spouses after the birth than those
who don't have doulas.
This is how I share information with dads/partners and other family
birth supporters - I have a sheet of paper which is mostly blank, except,
along the left hand side I have:
Dad, Mom, Doula, Other, each as its own section with lots of blank space.
I give a copy to each person and ask them to fill out on their own what
they feel each person's role is. We then get together and discuss this
and work towards each of us being in sync with each other's wishes.
Economics of A Doula's Fees - How are
fees set?
In my quest as a Doula and a business professional I have been guilty
of charging less for my time. We all know the importance of the work
we do... treating it as such sometimes means applying a material
value that translates to others as "an important" service.
In today's society our exchange of energy with others takes the form
of money. By understanding that the energy we give as Doulas
is equal/worth a valuable exchange might help others to know its
value.
You can find my
contract on my WWW site.
This address will take you directly to my contract. I made up my contract
from 2 examples given in Cheri Grant's "Labor Support Forms: A Guide to
Doula Charting." I do not consider it copyrighted, since I combined and
changed what she had presented. Actually, that's what I've done with most
of the forms in that book, but they sure were a great place to start!
Doulas of East Central Indiana - Contract/Letter
of Agreement and Description of Doula Services
ICAN offers
liability insurance for doulas and CBEs
I am covered for postpartum work; I am not sure if they cover
birth doulas but I would be surprised if they did not.
CM&F Group, Inc.
[Feb, 2000] We have a market for doulas who are dually licensed (e.g.
also as RN, massage therapist, accupunturist, etc.). We have also received
approval to insure doulas/CBE's/Lamaze/Monitrice for policy limits
of $1,000,000 each claim/$3,000,000 annual aggregate for annual premium
of $236.93, regardless of number of hours worked (full or part time). Program
details will be finalized within thirty days. Thanks! Ann Geisler/Dean
Insurance 800/721-3326 ageisler@deania.com
I carry Postpartum Care Provider Professional Liability Insurance from
National Union Fire Insurance Company of Pittsburgh, PA an authorized Representative
of Cotterell, Mitchell & Fifer, Inc. out of New York # (800) 221-4904.
This does cover all you Doula Services birth and pp. It's about $ 50. a
year. I haven' t checked out any other options so I would welcome any feed
back. Another Doula out of New Orleans gave me the # a couple of years
ago.
I recently followed-up on a post that gave the name and number of an
insurance company which offers liability insurance to doulas.
My finding is: National Union Fire Insurance Co. offers doula services
coverage -- for birth and post partum work -- for an annual fee of $47.00
for $1 million of coverage and $79.00 for $3 million dollars of coverage.
The insurance co.'s number is 800-221-4904.
National Union Fire Insurance Company offers liability insurance for
BIRTH doulas. $1M is $47/yr. $3M - $79/yr. 1-800-221-4904
I contacted the National Union people a few months ago when I returned
home from my doula training workshop. Liability is a big issue around here
(the Philadelphia suburbs). The people that I reached were in Louisiana,
had no idea what a doula was, and said they couldn't cover me anyway because
I was in Pennsylvania - I don't know if it was that I was out of state,
or the particular state I am in that made the difference.
At any rate, I was under the impression that the coverage was for PP
doulas only anyway?
Most doulas are trained to assist at hospital births and have most (or
all?) of their training there. Something that is very different at
homebirths is the timing and the pacing. Many homebirth midwives
don't rush things along the way they do in hospitals. It is
important for doulas to understand and respect that this is what the mother
has chosen.
As a doula, I've felt pushed away from homebirth midwives as well...which
is a shame, because if anything I feel inspired by them and would love
to learn from them.
If you view attending homebirths as a learning opportunity that you're
especially eager for, you could make your services more attractive to homebirth
clients by offering those clients a discount.
I wonder if you aren't expecting much more from a homebirth midwife
than you expect from hospital birth attendants? Are you expecting
her also to be a midwife to your hopes and dreams? Are you expecting her
to teach you and nurture you in ways that you wouldn't expect in a hospital?
I don't know, but I keep hearing these very personal responses to what
is essentially an impersonal, role-based relationship between a birthing
woman's midwife and her doula. Sometimes I wonder if doulas are expecting
the midwife to protect and nurture them and their experience at the birth
in the same way they protect and nurture the birthing woman?
The bottom line is that if your doula services improve things for a
birthing woman (and subsequently her midwife), then the midwife is going
to want you there, if she has any sense. I don't discount the possibility
that there are irrational or neurotic midwives, just as irrational and
neurotic people can be found among the ranks of doulas, hospital midwives
and OBs. But most midwives are quite happy to have their lives made
easier and their outcomes improved.
So, to doulas in general, if you haven't had an opportunity to "prove
your worth" to your local homebirth midwives, make them an offer they can't
refuse. Every midwife at one time or another has a client who will
obviously benefit from professional labor support. If you're especially
looking for opportunities to attend homebirths, offer your favorite midwife
a special deal for her clients, or for the first client you help or whatever.
Then, if you do a terrific job, she'll obviously be recommending you to
her other clients as well if they ask.
It may be that there are some midwives that you get along with better
than others; it seems sensible to work harder to build a relationship with
the midwives you like. If it turns out that you don't like any of
the midwives or don't get along with any of them, well, maybe your community
is in desperate need of midwives and you might want to consider becoming
one yourself. Then you can treat doulas the way you wish you were
treated. (This isn't exactly how I became a midwife, but I was a
doula first.)
I LOVE the idea of doulas and labor support.... I'll take any extra
help mom can get. And I love it when clients ask questions and want to
discuss things. I even like it when the doula wants to discuss things.....
but a doula who contradicts and challenges the midwife is a different situation.
If as a midwife, I think it best for mom to go to sleep in early labor,
but her doula decides mom should walk to stimulate labor --- then what
happens? Some doulas are so used to managing labors in hospital (where
they often ARE the only one present iwth the laboring mom) that they forget
there is midwife/client relationship which might be damaged when
they suggest something contrary to the midwife's advice.
I would love to have doulas available who are supportive of -- and trained
in -- midwifery style homebirth, but it's out of my hands. Parents hire
someone from the phone book to doula at their births and the expectations
at home are very different from the expectations at hospital.
At a hospital, I imagine folks would be shocked if the doula cleaned
the room and helped change the bed and mopped the floor. At home -- this
is simply part of labor support (or should be). A doula used to hospital
wouldn't expect to spend the next four to six hours after birth to help
the mom --- the mom doesn't need it. There is a whole staff of folks doing
the things mom needs. But not at home.
So when a family pays as much as $500 for a doula to come to a home
birth, there are conflicting expectations. If all mom is getting is labor
support and no home care or postpartum help, then it's a lot of money to
pay -- especialy considering most moms are getting labor support from thier
husbands, freinds, family or the midwive's themselves.
On the other hand --- a doula in hospital can save a mom a world of
interventions -- she is greatly needed and is a wise investment.
If expectations are clear from the outset, then that;'s fine.
Homebirth is just a different scene from hospital birth, that's all.
I think -- in a perfect world -- the doula role should be different too.
But people should know what is expected --- I rememer one doula looking
at me like I was nuts when I asked if she would take the birthbed sheets
to the laundry room!
So I think it is partly my own expectations which are to blame. I have
a hard time thinking of my role at a homebirth as being just the woman
who catches the baby -- and by default -- does all the cleanup afterwards
-- while a doula does the labor sitting, labor support, and "labor
management". Conversely, it's probably frustrating for a doula who attends
a homebirth and finds the midwife doing the things the doula is trained
to do -- and then being asked to do maid's work after the birth!
It's worth taking time to discuss these roles all before labor
begins. My mistake was that I have seldom met a doula before mom goes into
labor. should insist on it so we can talk and get to know each other
first.
As for homebirth doulas, I welcome them in my practice. Our geographical
area is tight so I know most of the birth attendants here. If a client
expresses a desire to have a doula, I don't try to talk them out of it.
I will recommend a few names if they so desire. More times than not
they will opt for labor support from my assistants. But if they are
married to the idea of a professional doula, I say go for it. I
always meet with the doula during a prenatal so that we have a clear understanding
of responsibilities. I know where they're coming from and vice versa.
All of my assistants/apprentices are required to be doulas and learn the
very patient art of labor sitting...not to mention clean up, cooking, babysitting,
etc. Everything is a learning experience. I have had only one occasion
in which I had a difference of opinion with a doula...and as luck would
have it, so did my client! So the doula didn't make it to the birth.
She was a rather pushy newbie-doula with a trunkful of oils, candles, toys,
etc. that literally intimidated my client to distraction. I believe
the heart of the problem may be that a paid doula (and not ALL of them
by any means!) feel the need to earn their $$$ by performing and intervening.
I agree, most hospital based doulas do not know how to doula at home.
More often than not, the support is redundant for homebirth clients. I
am a doula and a midwifery student, and I LOVE to attend homebirths. I
don't feel out of place, but I have had 5 homebirths of my own and feel
comfortable in that setting; it takes more for me to be comfortable in
the hospital! Unfortunately, doulas are a product of their
environment as we all are. If they have only seen hospital birth and the
complications that ensue from intervention, they may not feel safe with
homebirth. They may think it sounds groovy, but deep down (or even on the
surface) they don't trust the process and they are afraid. Birth is so
much more an intimate sexual act at home, it can be tricky, as you all
know, to blend. Personally, I would not choose a doula for a homebirth
whose knowledge base was obtained predominately from hospital births. Now,
if I knew I was going to have a hospital birth, I would want those skills
and someone who was familiar with the turf and sights and staff.
I did have a doula for my first (home) birth, 17 years ago. She was
called a "labor sitter" back then, the term "doula" hadn't been coined.
She was my angel! She became my mentor for motherhood, she was like a knowledgeable
big sister, and during my labor, she wiped by brow, emptied my barf bucket,
reminded my mother and young husband that this was birth looked like, that
I was doing it perfectly. All this before I had reached 3 cms - (smile)
It is a completely different role at a homebirth. If someone is going
in with only the tools they have for hospital birth, they are going to
be lost. Most homebirth clients don't need a written birth plan to avoid
interventions, or have worries about being able to wear their own clothes
or not having a hep lock, they don't need someone going to bat for them,
or body guarding for them, or holding space for them.
I have been privileged to work with doulas for years, both in hospital
and home birth settings, and overall, my impression has been positive.
Many of my home birth assistants (I am in solo practice) are doulas, and
their devotion to the normalcy of birth and these families is exceptional.
Never have I seen a doula fail to respond to any request for assistance
or support from either the family or me. Some of these doulas are
midwife wannabes who just cannot take the time/energy/money to pursue education
at this time, and some of them are perfectly content to be a support person
for either home or hospital births. But I have never been disappointed
with their skills (they have taught me tricks too!!), and their devotion
is impressive. I have done what I could to further their education,
and accepted their assistance gratefully.
In the local hospital, they have taken their faith in the normalcy of
birth into the labor room, and in their calm and peaceful support of women,
enabled the hospital staff to once again revere birth for the intimate
experience that it is. Although personally, as doulas, they sometimes
would much rather be at a home birth than the hospital one, their skills
are much more necessary in that interventionist environment and the clients
need their assistance!!!
I have the utmost respect for these ladies and their calling.
Doulas need to be aware that the midwife isn't midwifing to support
the doula in her role or her personal path. I am in agreement with
the laboring couple to have at their birth anyone they choose. That
labor support will stand or fall on their own. I have a job to do
and I do it and am mindless of anyone other than the couple and that babe.
It saddens me that this type of talk that feels like "there is no place
for doula's" is happening. Isn't that what so many midwives have
to contend with???!!! Yes, Some doulas in a home setting would feel
and maybe act like a fish out of water. Guide them, teach them, assuming
of course they are willing and so are you. But please, don't place
the burden of bad experiences on the backs of all of us. We have
worked as hard as you to learn and to define our place within birth.
Yes, maybe some fall short, but don't characterize all on limited experience.
As midwives, it burns you to be characterized on the basis of hospital
stats, or someone's bad outcome, or just because you are trained unconventionally.
This is the same type of talk/attitude that can and does pull the birthing
community apart. It really is not constructive, but destructive.
It is not supportive of your doula sisters. Midwives ask for support,
deserve support, as a choice for America's birthing women. Doulas
deserve no less.
Doulas are supposed to be the labor support that you spoke of - intelligent,
caring, compassionate, giving NO MEDICAL ADVICE OR INTERPRETATION, but
supporting the couple and their choices. Unfortunately, I've worked
with some who had their own agendas. They seemed to figure that if
being a midwife was just waiting for the process to unfold, well there
couldn't be much to it. One doula decided that an hour of serious
pushing was a clear indication for a cesarean. We transported for
other reasons. I was driving my own car, with all my equipment in
case we had a birth en route. During the ride, the doula convinced
the mom that she needed an immediate cesarean, and then the doula did everything
she could upon arrival at the hospital to make sure that a cesarean happened
ASAP. It made no sense to me until I got the big picture; immediately
after the mom was wheeled into the surgery suite, the doula took off to
catch a flight to a family reunion. What treachery!
OK, that's a pretty extreme example. I would think any doula would
be embarrassed to show her face at a birth after that. But that doesn't
mean all doulas are like that!
We try and stress to the moms who have doulas or family members acting
as doulas that they need to stay with them beyond the time we do (which
averages 2 hours postpartum). It's really frustrating to find that
the doula has left before we have.
I don't know if I agree with this; it implies that the doula is working
for the midwife, rather than for the client family. I treat client-hired
doulas as one of their family/friend circle, and who am I to say when they
should arrive or leave? (And, still, I must admit, it wouldn't earn
that doula any extra brownie points in my book!)
i work as a doula in the homebirth setting quite often. it has
worked quite well, as i am just another part of the team but someone who
is not focused on any of the medical aspects of it. sometimes i am
the gofer and will be the person to make smoothies for the mom, get the
shower ready, tub, etc. but usually it is just like in the hospital that
i am with the mom continually. i usually come before the midwife,
but not always. i still work for the birthing couple so when there
is a problem (ie 'overdue') and maybe the midwife wants the mom to do something
and the mom isn't sure, i will still help her make an educated decision.
also, when there is a transfer, that can be where you are really needed
to help the mom stay connected to her baby and make the transition from
home to hospital go as smoothly as possible, as that can be a very difficult
time for most people.
A few weeks ago, I requested feedback about communicating with doulas
at a homebirth about possible transport situations.
Thank you all so much for contributing your thoughts on this issue.
It has all helped me to realize that most doulas have a somewhat hazy idea
of the politics involved in homebirth transports.
I'm sure you've all seen situations where the nature of communication
with hospital staff has affected the type of care provided to the mother
and her baby. If you don't understand the issues involved in homebirth
transport, then you can't know how to modulate your communications with
hospital staff for the benefit of the mother and baby.
Christina said many helpful things about the delicate nature of homebirth
transports, especially with regard to the midwife's exposure to arrest,
investigation and possible loss of license. In our area, this applies
to all midwives attending homebirth, regardless of type of midwife license.
However, my concerns were more about protecting the mother and baby from
punitive actions in response to prejudice against homebirth.
I'll admit I was fairly baffled by some of the responses. Anybody
who hears the phrases "homebirth transport" and "delicate situation" together
and thinks I'm talking about a conflict between the midwife and doula doesn't
understand the politics of homebirth transports, at least in this area.
I find myself both laughing and crying at the interpretation of my concerns
as a power play. Quite frankly, if I transported a mom in and she
was being well cared for, and she turned to me and said, "Ronnie, you've
been up with me for 48 hours straight now - why don't you go home and get
some sleep; my doula will make sure my comfort needs are met.", I would
not be worrying that the doula would somehow be alienating the affections
of my client. Birthing women need all the support they can get, and
good support from a doula lessens the demands on the midwife.
It saddens me to hear of situations where doulas find themselves at
odds with midwives, which was implied in many of the responses. Is
this because you believe that the midwife isn't acting in the best interests
of the mother and the baby?
It has been especially helpful to be reminded that a professional doula
will not be discussing clinical issues with hospital staff, which is what
I was concerned about. (In my work as a doula, I routinely perform
clinical monitoring at home, including vaginal exams, and I do report this
information to the hospital staff when we phone in or arrive at the hospital.
It makes sense that non-clinical doulas wouldn't be discussing clinical
issues.)
Given what I've seen of the responses here, I don't think I can take
for granted that a doula would necessarily understand the politics of a
homebirth transport. It probably makes most sense for me to require
that the doula come to a prenatal meeting with the clients so we can all
discuss what needs to happen in the event of a transport to get the best
possible care.
Or . . . I've put together a brief handout - does this seem to hit the
highlights? I've written this for family members as well, since I
do recognize that the woman's doula has the same "standing" as any of her
own family members she has chosen to attend her labor and birth.
****************************************
Dear Homebirth Support People:
In the event that it becomes necessary to transport into the hospital
for medical care, there are a few things to keep in mind:
Please do not try to communicate the clinical situation to hospital
staff. If they ask you any questions about this, please refer them
to me so I can get accurate information from the charts. This can
be vitally important in getting the best possible care for the mother and
baby.
Unless the mother requests otherwise, please leave the advocacy role
to me. Even though my legal responsibility for care is greatly reduced
once we transport into the hospital, I still have some very strong ethical
responsibilities regarding the outcome. Obviously, I would be happy
if you reminded me about the details of the birth plan if there is any
confusion about this, but the situation may not always allow me to explain
my recommendations in the moment.
Many hospitals limit the number of support people who are allowed into
the birth room; our party is likely to exceed that limit. Hospital
staff are more likely to be OK with that if we keep a lower profile.
Wall Street Journal Article - Doula Controversy
- As 'Doulas' Enter Delivery Rooms, Conflicts Arise Hired to Help in Childbirth,
They Sometimes Clash With Doctors and Nurses [January 19, 2004]
CIMS
responds to Wall Street Journal article on Birth Doulas [main
page for CIMS Coalition for Improving Maternity Services (CIMS)]
This article brings up some good points that deserve some good discussion.
-Doula's are not medically trained.
-The Doula's role is to support the choices of the birthing woman.
Included in this could be to provide pros and cons of the suggested medical
procedure to help her make her choices, but should always default to what
feels right to the birthing woman. However, I must say that when I first
started my journey as a Doula, I don't know that I would feel comfortable
enough with my knowledge base or experience to adequately comment in the
best interest of the woman and her baby.
-Doula's are to have no personal agenda as should anyone else.
We are hypocrites if we expect the Doctors, Nurses and hospitals to abstain
from personal agenda if we do not do the same.
-Sometimes medical intervention is what is best.
Additionally however, there are a multitude of holes in this story.
-A Doulas role is not adequately described
The real issue that stands out to me is - Why was the Doctor/patient
relationship such that the woman did not trust her recommendations?
This is an issue that deserves more consideration from the medical community
as well as the media.
Now, I read the article from the paper about doulas, and want to address
a point or two.
I think that the article was, in general, biased as all get out.
It included the usual scare stories and misconceptions about doulas.
I also imagine that all of the stories included components that we were
not privy to in the interest of editing.
However, I think that we as a community have got to admit that we do
have some members whose dogmatic views on birth tend to get in the way
of their ability to support women in the most effective way possible.
I am sure that there have been doulas who plowed over women's wishes and
caregivers' medical advice in favor of their own agenda. I also do
not doubt that there have been doulas who gave rather dubious birthing
and nursing advice that was barely disguised medical advice.
In the rush to condemn an article as totally unfair, we must admit to
the shortcomings of some of our colleagues, and work to help all doulas
achieve balance in this area. Can we let ourselves be walked over
and not acknowledged in the birth room? Absolutely not! The
fact that some of the powers-that-be are getting so mightily pissed off
means that we are a growing force in the birth world, and are providing
a necessary link to the birthing woman. I really do take it as a
good sign most of the time.
But some of the doulas in this world are taking big time issues into
the birth room with them, either as the result of reading, personal experience
as a doula or their own past birth experiences. (I think this would
make for an interesting topic at the DONA conference.) I know I have
to let go of my preconceived notions about childbirth every time I step
into a birth room. I'm there for HER, not for me or my own birth
high.
Now (and it's a big now), I will also add that the doula community is
hardly alone in the birth world as dispensing bits of rather icky advice
at times. OB's, family practice docs, midwives/medwives, lay midwives,
lactation consultants, League leaders et al. have all been known to have
some really bad days. Using the experiences of a few people to color
the entire profession is wholly unfair. But let's be fair to ourselves
and remember to address our issues. It will be a most beneficial
step toward advancing ourselves as a professional cause and organized movement.
No need for the suit here. I agree with you. But the two
things about the article that bothered me so much were:
1) I saw nothing that showed that the doula was even the problem.
It may have been her and it may not. I've had times where I wanted
to scream, "I hope you don't think I put her up to this cause I didn't
even know she felt this way".
2) That they were all kicked out instead of this one doula being dealt
with.
Can you imagine if a doctor or nurse was a big problem at a hospital
(and it happens all the time) and because of it *all* doctors or nurses
were kicked out? Not gonna happen! It's hard to get a bad doctor
or nurse dealt with never mind that one kicked out!!!
The things I like are: (and are the things that I include in a labor
support kit in my catalog)
Birth ball; Heat pack ( not a sock. It has a removable washable flannel
cover and covers a larger area) Lavender scented massage oil, Anti-nausea
wrist bands (for those women who get so nauseated that they cannot drink
enough fluids to ward off an I.V. {if that's their goal} ) Relaxation music
(Transitions(tm) cassette with womb sounds and soft meditative harmonies)
I would like to include a carrier/bag for the birth ball with my kit,
(because I'm tired of lugging it or kicking it through hospitals!) but
haven't found one reasonable enough to include) Feel free to e-mail me
if you have a suggestion.
I don't carry those "universal ice packs" because they are expensive
and the hospital can provide a baggie of ice (I don't think I'd want ice
anywhere else but right at "that spot" in my back, so the large size of
the pack doesn't impress me)
I've recently learned about magnets that help alleviate pain safely
(kind of like a tens unit would) but they are expensive.
Also, there is a "childbirth kit" with cards of different pictures to
focus on depending on the stage of labor. I personally passed on carrying
these because I am a Bradley teacher and teach to focus inward for the
most part. It might be fine for some parts of labor, but I feel only as
an alternative when other things aren't working (totally my humble opinion.
. . I mention it because it's a great product for those who work with distraction
methods. Very interesting pictures! Perhaps just the right thing for some
transitions)
I typically carry the following:
I've found a backpack to be an effective birth bag, that way I can easily
carry the birth ball too. I have yet to find the perfect bag though--a
backpack can be hard to find things in.
1) What is in your doula bag?
big hand mirror (for Mom to see baby emerging)
> 2) What items do you find absolutely necessary?
....honestly? None of it usually! I so rarely get out most
of these things.
I know you will hear this again..but my hands, brain and heart are my
best and most useful tools.
Generally what will come out is the food and often some massage oil.....if
things go long the personal toiletries can give me a whole new outlook
on life!
I bring almost all you have listed but I also include my camera (no
music they bring that) also Tylenol I wish I could down size but
I don't know how plus like I said I use it all especially the food, my
favorite is miso soup in packages from trader Joe's it is the best!!!!
altoids are a must
They are men's tube socks that you fill with rice and lavender(that
is a relaxing scent). I get white and dye them pink or blue, then fill
them and sew the top. You heat them in the microwave for 3 min then it
lasts for 15-20 minutes. It feels great, the heat is almost a moist heat....the
sock lets it fit under the belly or folded in 1/2 for the back. I use mine
for my neck....and cramps when I wasn't preggers. I give them to my moms
when we do our prenatal appt(for labor support). We went to our local saving
whse and bought 12pr socks and 25lb of rice (not expensive). I have also
used baby diapers that I put together and made a pillow of sorts. Haven't
used that style in labor yet.
About the rice packs, I don't use socks for three reasons, 1) the sock
shape, especially if overfilled, is too hard and firm for a mom to lean
against or to form to the mom's body, 2) the sock packs are not washable,
therefore should be replaced for each new client, and 3) The cheap, affordable
socks are usually acrylic, and I cannot imagine anything yuckier than hot
acrylic on my skin. IMO, YMMV.
Sooooo, what do I do? I make a three chambered (lengthwise) muslin sack,
about 8 inches by 20 inches, fill it up about half way, and fold it down
from the top and sew it closed. This makes a nice, flat shape, and the
channels keep the rice evenly distributed. Then I make covers, like little
pillowcases, for them out of cotton velvet and cotton flannel. The covers
are washed after each client in HOT water. Sometimes I give them as gifts.
These are so easy to make. BTW, I use the short grain white (sticky) rice
because of it's smooth oval shape, but any grain would probably work. I
like the weight of rice.
Can someone tell me why the dry rice, when heated, feels like moist
heat? I'm stumped. BTW, I use rice packs on my belly for cramps, and on
my neck, shoulders, and low back for aches and muscle pains. Everyone in
my family got one for Christmas.
I read the package of one of the tube socks and guess what an
ingredient is on some socks??? Latex!! I never would have guessed.
So, needless to say I will be very careful from now on with so many people
having latex allergies. Buyer beware!!
Good Point. I always just make rice packs out of cute flannel that I
find on the dollar per yard table in Walmart. I give them as gifts to my
clients. The flannel works great. Just cut out two 10 x 5 inch rectangles
with pinking shears, sew around three edges, fill with rice and whip-stitch
closed. So easy and greatly appreciated by clients. If your client has
a favorite scent, you can stir some essential oils in the rice to customize.
My faves for labor are lavender & nutmeg combo.
Another easy way to avoid latex is to get cotton stockinette material
from any medical supplies place - 3" or 4" makes a nice tube. You
can leave really long tails on it so you can wrap it around the mom's belly
and tie it in back. If you do it just right, the knots will put pressure
on the sacral area, which can feel really good.
I have never tried making them with barley, but I have made them with
oatmeal. When you fill the sock with oatmeal it is much lighter and some
people prefer the smell to the rice. The rice smells a little "pasty" when
it is heated. Both can be heated over and over again provided you don't
get them wet (they get moist when you heat them anyway.) I make mine sooo
inexpensively. I buy tube socks in bulk at Kmart or Walmart or wherever.
I get the long, over the knee kind and I fill them and tie a knot in the
end.
It's so simple I never mess with the sewing machine (I hate to sew).
I add a few drops of lavender essence or dried lavender either works well.
I just do it till it smells good to me, but keep in mind that laboring
Mom's senses are heightened. I carry a scented and unscented one with me
as some Mom's I've worked with actually didn't like the lavender scent.
I put it in a plastic bag when I heat it up...especially if I am using
the hospital's microwave...that keeps the sock from picking up odors in
the microwave and keeps your microwave from smelling like lavender. You
could fill any kind of sock or pocket with rice or oatmeal to make any
size warm compresses you want. I think this is one of the most important
items in my birth bag. My rice socks cost me about $1.50 each so I just
let Moms keep them after the birth and they really appreciate it.
How to Respond to Bad Hospital Treatment
I was intrigued by the mention of walking a labyrinth during labor as
a birth ritual. This was mentioned in the "International Doula",
Spring 2001 issue, on p. 22 in the "Birth Rituals" article. Where
can I find such a thing?
The following are online resources for full-size labyrinths.
There is a company here in Baltimore that makes portable labyrinths:
http:
They are gorgeous, but very expensive - $700 and up depending on
size and whether they are sketched or painted). [They offer a Personal
Sacred Space six-foot square canvas for only $199!]
This site has an online
"labyrinth locator": - You might be able to find a stationary
public labyrinth close enough to take a mom there to walk.
Garden labyrinths are amazingly peaceful places, even when many other people
are there walking with you.
This site has an instruction booklet for sale ($10.00) on how to draw
your own labyrinth: http:
Another portable labyrinth maker: http:
Again, very expensive to purchase ($1800 + shipping).
More portable labyrinths for sale: http:
Astronomically expensive (several thousand $).
I haven't found any portable labyrinths that are not severely cost prohibitive,
except for the "doormats" you mentioned, which are very pretty and
decorative, but not terribly practical for walking, particularly for someone
who can't see her own feet. :-)
http:
More
links to labyrinth resources (where to find them, how they are used, etc.)
This web page is primarily about birth doulas, because I have only worked
as a birth doula. But here is some information that focuses on postpartum
doula work. Please do look through the other parts of this web page,
though, for other relevant information.
Postpartum AyurDoula
Care - lots of helpful information about postpartum rejuvenation
Papagni, Karla; Buckner, Ellen
Journal of Perinatal Education, Volume 15, Number 1, Winter 2006,
pp. 11-18(8)
Doula Organizations
Doulas Make A Difference! ®
A Student Doula Birth Experience Program is under construction through
Doulas Make A Difference! ®. In the near future, you may be able
to come to Southern Oregon and stay for 2-3 weeks and receive birth experience
at the local hospital. For more information call (541) 732-0548
Benefits of Doula Care/Good Labor Support
from the Journal Psychosomatic
Medicine
Scott KD, Klaus PH, Klaus MH.
J Womens Health Gend Based Med 1999 Dec;8(10):1257-64
Kennell J, Klaus M, McGrath S, Robertson S, Hinkley C.
JAMA 1991 May 1;265(17):2197-201
25% shorter labor
60% reduction in epidural requests
40% reduction in oxytocin use
30% reduction in analgesia use
40% reduction in forceps delivery
Scott KD, Berkowitz G, Klaus M
Am J Obstet Gynecol 1999 May;180(5):1054-1059
Doulas improve perceptions of labor, reduce epidural use
WESTPORT, Mar 02 (Reuters Health) - Doulas, women who provide praise, reassurance
and coaching to pregnant women during labor, can reduce the use of epidural
anesthesia and improve postpartum perceptions about the birth process.
New York Times - May 19, 1998
Doulas and Dads/Partners
Studies show that the father-to-be provides support to 80%
of laboring women in the United States. To study whether the father eliminates
the benefits of a doula, 555 healthy women were randomly assigned to be
attended by the baby's father and a doula or only by the father. Among
women assisted only by a male partner, 22.5% required cesarean delivery,
Dr. Kennell said, compared with only 14.2% of those assisted by the father
and the doula.
Doula Business and Fees
Doula Contract
Doula Liability Insurance
151 William Street
New York, NY 10038
1-800-221-4904.
info@cmfgroup.com
Doulas at Homebirth
So her example was set for me, and later, when she was a MW herself,
she helped me have my next baby. That set me on my way.
Doula at a Homebirth Transport
Doula Controversies
-Doula's should not be giving medical advice or assessing the well
being of the mother or baby, even if they have a medical background.
This is not the role of a Doula.
-The Doctor does not state that she witnessed the Doula advising the
woman to decline Pitocin.
-It is not revealed if there was evidence that the baby was in jeopardy,
such as, maternal fever, GBS, or accelerated HR.
-If the Doctor felt so strongly about the baby's well being why did
she not employ the help of the Doula, with her powerful influence on the
mother, to recognize the baby's well being was evidence based.
-If there was no Doula in attendance and the same scenario presented,
would the Doctor state that the woman was to blame and ban pregnant women
from her practice?
-If the woman never questioned or denied the recommendation and the
baby's outcome were the same would she ban herself from treating other
pregnant women?
First, let me don my asbestos suit, as I know I'm going to catch hell
on this one. :) Also, let me assure everyone that my
comments below in no way negate the fact that I am a huge natural childbirth
advocate and doula advocate/proponent.
What Doulas Carry in Their Bags
food for me
some food to share
money for more food ;)
mints and gum
pads and tampons (always start it if I'm anywhere near it!)
toothpaste, toothbrush, hairbrush, lipstick, deoderant,
2 clean washcloths
hair ties (several)
bottle of hand sanitizer
lip balm for me and a new one for Mom
at least one complete change of clothes
2 books:
Optimal Foetal Postitioning and
Labor Progress Handbook
clipboard/pen/paper
client folder
massage oil
couple of massage tools
tennis balls
music
essential oils on washclothes in ziploc bags
2 bottles of water for me
2 rice socks
Rice Packs
Oatmeal Sock
Labyrinths
Postpartum Doula Work
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