Wednesday, 22 May 2013

What is a Doula?

What Is A Doula?

More recently, it refers to someone who offers emotional and physical support to a woman and her partner before, during and after childbirth. A doula (also known as a birth attendant) believes in ‘mothering the mother’, enabling a woman to have the most satisfying experience that she can, from pregnancy and into motherhood. This type of support allows the whole family to relax and enjoy the experience too.

Women have complex needs during childbirth. In addition to the safety of modern obstetrical care, and the love and companionship provided by their partners, women need consistent, continuous reassurance, comfort, encouragement and respect. They need individualized care based on their circumstances and preferences. The role of the birth doula encompasses the non-clinical aspects of care during childbirth.”

Despite doulas being fairly unheard of in Australia, they have been actively supporting women for a very long time and are fast growing in popularity, as a result of positive word of mouth and the need for increased support.

Doulas are trained and experienced in childbirth and are usually mothers themselves. They have a good knowledge and awareness of female physiology, but a doula does not support the mother in a medical role – that is the job of the midwife or doctor. She works on keeping birth normal and empowering, and should the birth become complicated and require medical assistance, a doula will still remain by your side and help in any way she can. She will not make the decisions for those she supports, but she assists them through the decision making process and provides balanced information so the couple can make their own choices. 

Given the long term emotional and physical effects this can have on the mother, her partner and baby, a doula to me is like an ‘insurance policy’ – which can help protect you from a disempowering, disappointing experience or unnecessary procedures and intervention. With a doula, you know that someone is always on YOUR team, holding the space for you and your family. She works for you and has your best interests at heart, unlike hospital staff who have to abide by policies, which are not always best for a birthing woman, but best to avoid legal issues and to keep things running as a business.

Many women consider doulas to be a must for those giving birth in a hospital, due to the over-medicalisation of birth – unnecessary inductions have skyrocketed and are partly to blame for the 1 in 3 Australian babies now born by caesarean section. In Australia, some hospitals have caesarean section rates as high as 50% and higher. This is a terribly high statistic, well above World Health Organisation recommendations, which makes us amongst the highest in the world. A doula works in birth centres, private and public hospitals and at homebirths in conjunction with midwives – but never as the sole carer at birth. Birthing without a midwife or doctor present is known as free-birthing however its highly recommended at birth with at least a qualified midwife or doctor.

What Do Doulas Do?
A doula may provide some or all of the following, dependent on her training and skills (she may be more than just a doula – some doulas are also qualified in other therapies):

    Birth education and preparation
    Birth planning (including creating a written birth plan/birth preferences document)
    De-briefing previous births
    Massage and other comfort measures
    Optimal fetal positioning
    Suggest positions and changes to help ease pain and facilitate a smoother, more effective labour
    Provide reassurance and encouragement
    Talking through emotional blockages which may come up in labour
    Keep your ‘environment’ going – aromatherapy, music, candles etc
    Assisting you with negotiation of your preferences for birth if what you want and the hospital wants differs
    Photography and/or video if you wish to have momentos of your partner supporting you, the birth itself and those precious first moments as a family, together
    So much more

But I believe the biggest bonus of a doula is that fact that she is a professional birth support person – she has been trained in the art of birth support and has a keen eye and intuition on what a labouring mother needs. Things which a hospital midwife unfortunately does not have time for, and things which partner may not pick up on (or situations he may not know how to deal with). She has a mind that is caring and nurturing, yet able to remain calm and focused even if things go off the rails. Family and friends tend to have an emotional connection that can mean in the event of a problem or at the peak intensity moments, they can buckle not knowing what to do, say or think. A doula can think clearly, see pros and cons of any situation and relay them to the couple to make their own decision. When we’re stressed, we don’t make the best decisions, and in hospital, that may make your partner/mother etc. completely agreeable to what’s being put on the table, because they are uncertain or scared. A doula can help explain what’s happening with compassion and without judgment or medical jargon, so its easier for you to understand.

There are two types of doulas, birth doulas and post-natal doulas, with many doulas performing both roles. The difference is that the role of the post-natal doula is to nurture the mother at home after childbirth. This may include further breastfeeding support, light home duties, massage, emotional and physical support for the mother and so on. Post-natal doulas are particularly in demand as support for new mothers has reduced in modern society. Needless to say, studies show that post-natal doulas make a huge impact on the well-being of mother.

What Are The Proven Benefits Of A Doula?
A recent review of many studies from around the world have concluded that a doula’s support is more effective than hospital staff, friends or family. You can read the review here.
Studies (and reviews of the studies) consistently demonstrate very impressive benefits for the mother, father and baby, including:
    50% fewer caesarean sections
    Reduction in the use of forceps vacuum by 40%
    60% fewer requests for epidurals
    40% reduction in the use of synthetic oxytocin for inductions or augmentations
    30% reduction in use of pain medication
    25% reduction in labour length
    Increased rates of breastfeeding at 6 weeks post-partum (51% vs 29%)
    Higher self-esteem (74% vs 59%), less anxiety (28% vs 40%) and less depression (10% vs 23%)    


   These are not misprints! The benefits are significant. Most of the women in the studies were  accompanied by male partners, however study results show that women who had the support of a male partner and a doula fared best, for example, the caesarean rate of women supported by both a male partner and a doula was significantly lower (15.4%) than the caesarean rate for women supported only by their partners (24.4%). The studies also clearly show the positive benefits of doula support occur regardless of a woman’s economic status or whether or not they were privately insured. Its simply about having the right support with you at birth.


Doulas in action - Check this video out!

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