The researchers found that overall, people who have continuous support during childbirth experience a:. The rate of special care nursery admissions was no different between people who received continuous support and those who received usual care. The rate of Pitocin was also no different but there was a trend towards more Pitocin with continuous support from hospital staff and less Pitocin with continuous support from a doula. Relative risk is the risk of something happening to you in comparison to someone else.
Absolute risk is the actual, or true risk of something happening to you. There are several reasons why we think doulas are so effective. In most developed countries, ever since birth moved out of the home and into the hospital, laboring people are frequently submitted to institutional routines, high intervention rates, staff who are strangers, lack of privacy, bright lighting, and needles.
But people in labor have to deal with these harsh conditions when they are in a very vulnerable state. A second reason that doulas are effective is because doulas are a form of pain relief in themselves Hofmeyr, With continuous support, laboring people are less likely to request epidurals or pain medication. It is thought that there is fewer use of medications because birthing people feel less pain when a doula is present. An additional benefit to the avoidance of epidural anesthesia is that women may avoid many medical interventions that often go along with an epidural, including Pitocin augmentation and continuous electronic fetal monitoring Caton, Corry et al.
This finding—that people with doulas are less likely to have an epidural—is not due to the fact that clients with doulas in these studies were more likely to want these things up front and were more motivated to achieve them. In fact, randomized trials account for these differences—this is why they are called randomized, controlled trials. The people assigned to have a doula, and those assigned to not have a doula, are randomly assigned, meaning that the same percentage in each group would have a desire for an unmedicated birth.
A third reason why doulas are effective has to do with the attachment between the birthing person and doula which can lead to an increase in oxytocin, the hormone that promotes labor contractions.
This theory was proposed by Dr. Amy Gilliland in her a study about effective labor support. In personal correspondence with Dr. When the mother feels vulnerable in labor, she directs attachment behaviors to suitable figures around her, who may or may not be her attachment figures parent, mate.
When the mother directs attachment seeking behaviors to the doula, the experienced doula 25 births or more responds in a unique manner. The accompanying diminishment in stress hormones allows for a surge in oxytocin in both the mother and the doula… theoretically, oxytocin is the hormone of attachment, and it is released during soothing touch and extended eye contact, which are habitual behaviors of birth doulas.
Amy Gilliland, July Swedish oxytocin researcher Kristin Uvnas Moberg writes that the doula enhances oxytocin release which decreases stress reactions, fear, and anxiety, and increases contraction strength and effectiveness.
They randomly assigned first-time mothers to doula support or no doula support and used standard questionnaires to measure anxiety and pain levels. They found that on average, the mothers who received doula support had less anxiety and lower average pain scores during labor. They recommend that all hospitals and maternity care centers in Iran provide access to doulas since having a safe and calm delivery is considered a human right.
Based on the evidence, I have come up with a conceptual model of how doula support influences outcomes. A c onceptual model is what researchers use to try and understand how a phenomenon works. Here is my conceptual model on the phenomenon of doula support. In one research study that took place in the U.
More experienced nurses were more likely to spend time providing emotional support Barnett et al. Nurses may also touch the birthing person in a variety of ways, some of which may be unpleasant, like having an IV put in or a cervical check done.
Although all of these procedures are optional, they may not be presented as such. When and how a doula touches is up to the person giving birth, so the laboring brain probably anticipates and responds to the doula more positively over time Personal communication, A.
Gilliland, Nurses may also go off shift, at which point their support ends. Most doulas, on the other hand, remain with the birthing person through birth. Also, nurses are employed by the hospital and while they see themselves as patient advocates, they also have an interest in satisfying their employer, while an the primary responsibility of an independent doula one not employed by the hospital is to their client—the person giving birth.
Some people think that they do not need a doula because their partner will be with them continuously throughout labor. It is true that the birth partner is an essential support person for a birthing person to have by their side. However, the birth partner will need to eat and use the bathroom at times, and they are having their own emotional journey that requires support.
Also, many partners have limited knowledge about birth, medical procedures, or what goes on in a hospital, while doulas have knowledge and experience about all of these things that they can use to inform and support both the partner and birthing person.
Ideally, doulas and partners can work together to make up a labor support team. In , McGrath and Kennell randomly assigned first-time mothers to have routine care including a supportive partner or care that also included a professional doula whom they met for the first time during labor. All of the women in the study were classified as having middle- to upper-class financial income levels, having supportive partners, and in the care of obstetricians.
During labor, doulas provided continuous support, including encouragement, reassurance, and physical support. The results showed a substantial improvement in outcomes for women who had both a birth partner and a doula, compared to having a birth partner alone. The women who had their labor medically induced experienced an even more striking decrease in the Cesarean rate with a doula—the Cesarean rate with labor inductions was Also, fewer women in the doula group required an epidural Research has shown that the most positive birth experiences for fathers were ones where they had continuous support by a doula or a midwife.
In other studies, fathers have said that when they had labor support from a midwife or doula, things were explained to them, their questions were answered, their labor support efforts were guided and effective, and they could take breaks from the emotional intensity of the labor without abandoning their laboring partner Johansson, Access to continuous labor support from a doula is especially vital for birthing people of color. Black women experience higher rates of poor birth outcomes, including higher rates of Cesarean, preterm birth, low birth weight, and infant death Thomas et al.
Then what does explain the health inequity? In public health, racism influences social determinants of health , which include housing, education, and employment. Doula care offers many benefits including better birth outcomes, but people of color often face barriers in accessing doula support.
To address this critical need, we need more programs like the By My Side program through Healthy Start Brooklyn in New York that offers free doula services to low-income people in Black and Latino neighborhoods Thomas et al.
The idea for the By My Side program came about when Gabriela Ammann, a local doula and Lamaze instructor, noticed that many of the women attending her free childbirth-education series did not have reliable support for their labor and birth. To address this need, she matched birthing people with volunteer doula care. In , the process of pairing these women with free doula support was formalized when Healthy Start Brooklyn hired certified doulas to provide support during pregnancy, childbirth, and the postpartum period.
A birth doula assists during pregnancy, labor and childbirth. A postpartum doula, as the name implies, helps the family during the postpartum period, the first few weeks after the baby is born. The good news is many doulas offer both services, so if that's something you're interested in, you may be able to stick with one doula throughout the whole process.
A doula may also act as a mediator and an advocate who's there to run interference with hospital personnel, as well as translate medical terms and explain procedures. A doula can offer a treasure trove of non-medical pain-management techniques including massage, reflexology, aromatherapy, music and mantras.
She'll try different combinations to find the right one for you. One thing a doula doesn't do is relegate your partner or coach to third-wheel status. A good doula will never push a co-parent or other coach aside but instead enhance that support — and even help him or her relax, which in turn will help you relax. Some people think a doula and a midwife are the same thing, but their educational backgrounds and duties differ.
CNMs are medical professionals like registered nurses who have completed graduate-level programs in midwifery and are licensed and certified by the American College of Nurse-Midwives to practice throughout the U. CMs are licensed to practice in certain states. Both certified nurse-midwives and certified midwives are trained to care for low-risk pregnancies including ordering tests, prescribing medications and providing routine gynecological care such as physical exams and to handle deliveries without complications.
Doulas, on the other hand, don't need a graduate-level education. DONA-approved workshops provide a minimum of 16 hours of instruction time, with an emphasis on practical, hands-on techniques, the history of birth, the benefits of hiring a doula, and the significance of doula support for families. Doctors or midwives may change shifts, and some may only be present during the final stages of birth.
Doulas, however, typically meet with you before the birth, will stay with you during the entire labor and delivery process, and will often make one or two post-labor follow-up visits to check on your breastfeeding progress and make sure baby is latching on correctly. Their assistance has even been shown to improve the odds of breastfeeding success, since many doulas are also lactation consultants.
A doula may be especially helpful for a mom-to-be who's on her own, either by choice or because her partner can't be or isn't present for reasons including military deployment. Doulas usually meet you around your seventh month of pregnancy to discuss a birth plan — including whether you want a drug-free birth or one with an epidural or other pain management medication, and what labor techniques would work best for you.
If you're planning to hire a doula, you should start looking around month four or five so you have enough time to interview candidates and make sure your choice is available around your estimated due date.
During labor and delivery, a doula will be there to help you manage pain, ease stress and reassure you when you need it most. Make sure you and your doctor or midwife are on the same page in terms of support for you and your baby. If you think you might want or need additional support and coaching in the delivery room, a doula could be a good choice for you. And if you have your heart set on a specific birth plan , a doula can be a good option because she'll be your advocate if you're having a hard time fighting for yourself.
Doulas are usually trained to support all kinds of births. Some doulas offer even more than the traditional services for further mother support. You will often find helpful, value-added services such as:. Create your own thriving doula practice in just 4 weeks with our guide that provides everything you need to know. Thank you for signing up, an email will arrive shortly with your guide to finding your very own doula mentor! Newsletter Blog About Privacy and Terms. What is a Doula? Types of Doulas What does a Doula do?
Doula Training State Regulations. Start Your Practice Today. Types of Doulas There are many types of doulas including the labor doula, postpartum doula, antepartum doula all with unique skills and services. Postpartum Doula After Birth Doula The postpartum doula supports and encourages the family in bonding between mother, father and child. Antepartum Doula High Risk Pregnancy Doula Antepartum doulas take care of the mother and family during time that she is still pregnant.
Your caregiving skills are most valuable no matter what type of doula you become Other Types of Doulas There are a couple of extras roles that doulas can take on: Abortion doula - specializes in helping during the tumultuous process of abortion.
Sensitivity and open-mindedness are very important in the practice of an abortion doula.
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