DoulasDoulasJason EnglandJason EnglandAshley StrayerAshley Strayer

Laura WetheringtonLaura WetheringtonEllisa WatsonEllisa WatsonMerril TydingsMerril Tydings

Kaileen MorganKaileen Morgan

Why are doulas Why are doulas important?important?

The word "doula" comes from the ancient The word "doula" comes from the ancient Greek meaning "a woman who serves" Greek meaning "a woman who serves"

It is now used to refer to a trained and It is now used to refer to a trained and experienced professional who provides experienced professional who provides continuous physical, emotional and continuous physical, emotional and informational support to the mother informational support to the mother before, during and just after birth; or who before, during and just after birth; or who provides emotional and practical support provides emotional and practical support during the postpartum period. during the postpartum period.

Numerous clinical studies have found that Numerous clinical studies have found that a doula’s presence at birth:a doula’s presence at birth: tends to result in shorter labors with fewer tends to result in shorter labors with fewer

complications complications reduces negative feelings about one’s reduces negative feelings about one’s

childbirth experience childbirth experience reduces the need for pitocin (a labor-inducing reduces the need for pitocin (a labor-inducing

drug), forceps or vacuum extraction and drug), forceps or vacuum extraction and cesareans cesareans

reduces the mother’s request for pain reduces the mother’s request for pain medication and/or epidurals medication and/or epidurals

Other studies have shown that having a Other studies have shown that having a doula as part of the birth team decreases doula as part of the birth team decreases the overall cesarean rate by 50%, the the overall cesarean rate by 50%, the length of labor by 25%, the use of oxytocin length of labor by 25%, the use of oxytocin by 40% and the request for an epidural by by 40% and the request for an epidural by 60%. 60%.

Doulas often use the power of touch and Doulas often use the power of touch and massage to reduce stress and anxiety massage to reduce stress and anxiety during labor.during labor.

Why not use father?Why not use father?

The role of the doula is never to take the The role of the doula is never to take the place of the husband or partner in labor, but place of the husband or partner in labor, but to compliment and enhance their experience. to compliment and enhance their experience.

Today, many husbands are taking a more Today, many husbands are taking a more active role in the birth process, but some active role in the birth process, but some partners feel that this is a huge expectation partners feel that this is a huge expectation and would rather be able to enjoy the delivery and would rather be able to enjoy the delivery without having to stand in as labor coach. without having to stand in as labor coach.

With a doula as a part of the birth team, a With a doula as a part of the birth team, a father can do whatever he feels comfortable father can do whatever he feels comfortable with at each moment. with at each moment.

Incorporating Cultural PracticesIncorporating Cultural Practices

•Incorporating cultural practices in the Incorporating cultural practices in the birthing experience is important for birthing experience is important for most women and families.most women and families.

• Labor support that understands these Labor support that understands these practices and supports them is practices and supports them is important.important.

• Doulas receive training in cultural Doulas receive training in cultural competence, communication and competence, communication and advocacy.advocacy.

Incorporating Cultural Incorporating Cultural practicespractices

Jewish Culture: Women may not be able to give Jewish Culture: Women may not be able to give birth on the Sabbath as well as ring call bell or birth on the Sabbath as well as ring call bell or raising bed.raising bed.

Latin American Culture: Midwifery and doulas Latin American Culture: Midwifery and doulas are considered very positive. Some also believe are considered very positive. Some also believe that colostrum is not good for baby. that colostrum is not good for baby.

Asian Cultures: Surgery is viewed as a violation.Asian Cultures: Surgery is viewed as a violation. Eastern Indian Culture: Women fast during Eastern Indian Culture: Women fast during

pregnancy. Breastfeeding begins on 5pregnancy. Breastfeeding begins on 5thth day and day and honey is the most common first food. honey is the most common first food.

Incorporating Cultural Incorporating Cultural PracticesPractices

Latino Community Outreach: Latino Community Outreach: Doulas Doulas care care recruit and train a small group recruit and train a small group of bi-cultural and bi-lingual volunteer of bi-cultural and bi-lingual volunteer doulas who provide Latina women doulas who provide Latina women with free doula services.with free doula services.

In 2008, the program served In 2008, the program served approximately 200 families. approximately 200 families.

Support Measures Provided Support Measures Provided During LaborDuring Labor

Nurse Doula Nurse DoulaHolding legs Massage Verbal encouragement Verbal encouragementVital signs Counter pressure MusicIV insertion Assistance with bath/shower Calm environmentCervical exams Coached breathing Reassurance

Positioning PresenceWalking FocusSwaying LoveHomeopathic remediesIce ChipsBirthing ballWarm Compress

Physical Psychosocial

Participants Advice for Doulas Participants Advice for Doulas and Nurses Working Togetherand Nurses Working Together

““Nurses should be positive and Nurses should be positive and encouraging.” encouraging.”

““Medical personnel shouldn't feel threatened Medical personnel shouldn't feel threatened or displaced just because a doula is present.” or displaced just because a doula is present.”

““Take mothers' wishes into consideration Take mothers' wishes into consideration before acting.” before acting.”

““The choice to give birth without medication The choice to give birth without medication should be supported.” should be supported.”

““Recognize that doulas are not there to take Recognize that doulas are not there to take over your job but just to provide comfort and over your job but just to provide comfort and support for the mom.” support for the mom.”

TRAININGTRAINING

FOCUSES ON THE EMOTIONAL NEEDS OF FOCUSES ON THE EMOTIONAL NEEDS OF WOMEN IN LABOR AND NON-MEDICAL PHYSICAL WOMEN IN LABOR AND NON-MEDICAL PHYSICAL AND EMOTIONAL COMFORT MEASURES.AND EMOTIONAL COMFORT MEASURES.

PRIOR KNOWLEDGE OF THE CHILDBIRTH PRIOR KNOWLEDGE OF THE CHILDBIRTH PROCESS AND TRAINING/EXPERIENCE RELATING PROCESS AND TRAINING/EXPERIENCE RELATING TO CHILDBIRTHTO CHILDBIRTH

EXTENSIVE 2-3 DAY COURSE:HANDS ON EXTENSIVE 2-3 DAY COURSE:HANDS ON PRACTICE OF RELAXATION, BREATHING, PRACTICE OF RELAXATION, BREATHING, POSITIONING AND MOVEMENTS TO REDUCE POSITIONING AND MOVEMENTS TO REDUCE PAIN AND ENHANCE LABOR, AND OTHER PAIN AND ENHANCE LABOR, AND OTHER COMFORT MEASURES.COMFORT MEASURES.

CERTIFICATIONCERTIFICATION

WORK OR EDUCATION BACKGROUND IN A WORK OR EDUCATION BACKGROUND IN A MATERNAL FIELDMATERNAL FIELD

OBSERVE A SERIES OF CHILDBIRTH CLASSESOBSERVE A SERIES OF CHILDBIRTH CLASSES ATTEND DOULA WORKSHOP COURSEATTEND DOULA WORKSHOP COURSE BREAST-FEEDING TRAININGBREAST-FEEDING TRAINING COURSE WORK (READING, ESSAY, RESOURCE LIST)COURSE WORK (READING, ESSAY, RESOURCE LIST) POSITIVE EVALUATIONS (CLIENTS, DOCTORS, POSITIVE EVALUATIONS (CLIENTS, DOCTORS,

MIDWIVES, NURSES)MIDWIVES, NURSES) DETAILED OBSERVATIONS FROM A MINIMUM DETAILED OBSERVATIONS FROM A MINIMUM

NUMBER OF BIRTHSNUMBER OF BIRTHS

COSTCOST

COST VARIESCOST VARIES MOST OFTEN PRIVATE PAY--SET RATEMOST OFTEN PRIVATE PAY--SET RATE OVER 25 INSURANCE COMPANIES PROVIDE OVER 25 INSURANCE COMPANIES PROVIDE

SOME THIRD PARTY REIMBURSEMENT FOR SOME THIRD PARTY REIMBURSEMENT FOR LABOR SUPPORT.LABOR SUPPORT.

GRANT FUNDING/MEDICAID FUNDED GRANT FUNDING/MEDICAID FUNDED AGENCIES HAVE CONTRACTS WITH DOULA AGENCIES HAVE CONTRACTS WITH DOULA ORGANIZATIONS TO SUPPORT WOMEN IN ORGANIZATIONS TO SUPPORT WOMEN IN POVERTY AND WOMEN WITH SPECIAL NEEDS.POVERTY AND WOMEN WITH SPECIAL NEEDS.

QUESTIONS FOR SELECTING A QUESTIONS FOR SELECTING A DOULA...DOULA...

WHAT TRAINING HAVE YOU HAD?WHAT TRAINING HAVE YOU HAD? TELL ME ABOUT YOUR EXPERIENCE WITH BIRTH, PERSONALLY AND AS A TELL ME ABOUT YOUR EXPERIENCE WITH BIRTH, PERSONALLY AND AS A

DOULA.DOULA. WHAT IS YOUR PHILOSOPHY ABOUT BIRTH AND SUPPORTING WOMEN AND WHAT IS YOUR PHILOSOPHY ABOUT BIRTH AND SUPPORTING WOMEN AND

THEIR PARTNERS THROUGH LABOR?THEIR PARTNERS THROUGH LABOR? MAY WE MEET TO DISCUSS OUR BIRTHS PLANS AND THE ROLE YOU WILL MAY WE MEET TO DISCUSS OUR BIRTHS PLANS AND THE ROLE YOU WILL

PLAY IN SUPPORTING ME THROUGH BIRTH?PLAY IN SUPPORTING ME THROUGH BIRTH? MAY WE CALL WITH QUESTIONS OR CONCERNS BEFORE AND AFTER MAY WE CALL WITH QUESTIONS OR CONCERNS BEFORE AND AFTER

BIRTH?BIRTH? WHEN DO YOU JOIN WOMEN IN LABOR? COME TO OUR HOME OR MEET AT WHEN DO YOU JOIN WOMEN IN LABOR? COME TO OUR HOME OR MEET AT

HOSPITAL?HOSPITAL? DO YOU MEET WITH US AFTER THE BIRTH TO REVIEW THE LABOR AND DO YOU MEET WITH US AFTER THE BIRTH TO REVIEW THE LABOR AND

ANSWER QUESTIONS?ANSWER QUESTIONS? DO YOU HAVE BACK UP DOULAS FOR TIMES YOU ARE NOT AVAILABLE?DO YOU HAVE BACK UP DOULAS FOR TIMES YOU ARE NOT AVAILABLE? MAY WE MEET?MAY WE MEET? WHAT ARE YOUR FEES AND YOUR REFUND POLICIES?WHAT ARE YOUR FEES AND YOUR REFUND POLICIES?

TYPES OF DOULASTYPES OF DOULAS

BIRTH DOULABIRTH DOULA POST-PARTUM DOULAPOST-PARTUM DOULA

WHAT IS A BIRTH DOULA?WHAT IS A BIRTH DOULA?

A PERSON TRAINED AND EXPERIENCED IN CHILDBIRTH.A PERSON TRAINED AND EXPERIENCED IN CHILDBIRTH. PROVIDE CONTINUOUS PHYSICAL, EMOTIONAL AND PROVIDE CONTINUOUS PHYSICAL, EMOTIONAL AND

INFORMATIONAL SUPPORT TO MOTHER BEFORE, DURING AND INFORMATIONAL SUPPORT TO MOTHER BEFORE, DURING AND JUST AFTER CHILDBIRTH.JUST AFTER CHILDBIRTH.

SPECIALIZE IN NON-MEDICAL SKILLS. DO NOT PERFORM CLINICAL SPECIALIZE IN NON-MEDICAL SKILLS. DO NOT PERFORM CLINICAL TASKS, SUCH AS, VAGINAL EXAMS OR FETAL HEART MONITORING.TASKS, SUCH AS, VAGINAL EXAMS OR FETAL HEART MONITORING.

DO NOT DIAGNOSIS, OFFER SECOND OPINIONS OR GIVE MEDICAL DO NOT DIAGNOSIS, OFFER SECOND OPINIONS OR GIVE MEDICAL ADVICE.ADVICE.

DO NOT MAKE DECISIONS FOR CLIENTS.DO NOT MAKE DECISIONS FOR CLIENTS. NOT THEIR ROLE TO DISCOURAGE USE OF PHARMACOLOGIC PAIN NOT THEIR ROLE TO DISCOURAGE USE OF PHARMACOLOGIC PAIN

MANAGEMENT. THEY DO INFORM CLIENT ABOUT VARIOUS MANAGEMENT. THEY DO INFORM CLIENT ABOUT VARIOUS OPTIONS, INCLUDING RISKS/BENEFITS. THEY HELP MAXIMIZE THE OPTIONS, INCLUDING RISKS/BENEFITS. THEY HELP MAXIMIZE THE BENEFITS OF PAIN MEDICATIONS WHILE MINIMIZING UNDESIRABLE BENEFITS OF PAIN MEDICATIONS WHILE MINIMIZING UNDESIRABLE SIDE EFFECTS.SIDE EFFECTS.

HOW THEY PRACTICE...HOW THEY PRACTICE...

PRIVATELY HIRED- PRIVATELY HIRED- EMPLOYED BY EXPECTANT EMPLOYED BY EXPECTANT PARENTS, TELEPHONE CONTACT AND PRENATAL MEETINGS PARENTS, TELEPHONE CONTACT AND PRENATAL MEETINGS BEFORE BIRTH TO BUILD RELATIONSHIP. ONCE LABOR BEFORE BIRTH TO BUILD RELATIONSHIP. ONCE LABOR BEGINS, STAYS WITH MOTHER UNTIL THE END. POSTPARTUM BEGINS, STAYS WITH MOTHER UNTIL THE END. POSTPARTUM MEETING USUALLY INCLUDED.MEETING USUALLY INCLUDED.

HOSPITAL EMPLOYEES OR HOSPITAL EMPLOYEES OR VOLUNTEERS IN VOLUNTEERS IN COMMUNITY/HOSPITAL PROGRAMS- COMMUNITY/HOSPITAL PROGRAMS- MEET CLIENT FOR FIRST TIME AND ESTABLISH MEET CLIENT FOR FIRST TIME AND ESTABLISH RELATIONSHIP DURING LABOR.RELATIONSHIP DURING LABOR.

EFFECTS ON BIRTH...EFFECTS ON BIRTH...

SHORTER LABORS WITH FEWER SHORTER LABORS WITH FEWER COMPLICATIONSCOMPLICATIONS

REDUCES NEGATIVE FEELINGS ABOUT REDUCES NEGATIVE FEELINGS ABOUT CHILDBIRTH EXPERIENCECHILDBIRTH EXPERIENCE

REDUCE NEED FOR PITOCIN, FORCEPS OR REDUCE NEED FOR PITOCIN, FORCEPS OR VACUUM EXTRACTIONVACUUM EXTRACTION

REDUCES REQUEST FOR PAIN MEDICATION REDUCES REQUEST FOR PAIN MEDICATION AND EPIDURALSAND EPIDURALS

REDUCES INCIDENCES OF CESAREANSREDUCES INCIDENCES OF CESAREANS

POSTPARTUM DOULAPOSTPARTUM DOULAWHAT DO THEY DO?WHAT DO THEY DO?

EducationEducation Sharing of informationSharing of information Sibling involvementSibling involvement Partner role Partner role ““Mothering the Mother”Mothering the Mother” BreastfeedingBreastfeeding Keeps mom healthyKeeps mom healthy

HOW LONG DOES A POSTPARDUM HOW LONG DOES A POSTPARDUM DOULA SPEND WITH THE FAMILY?DOULA SPEND WITH THE FAMILY?

Decision made by the family and the Decision made by the family and the douladoula

Focus on mom’s comfortabilityFocus on mom’s comfortability One week to several months One week to several months Length of visit depends on needLength of visit depends on need Minimum two hours up to 24 hoursMinimum two hours up to 24 hours

THE GOAL OF THE POSTPARTUM THE GOAL OF THE POSTPARTUM DOULADOULA

““Nurture the family.”Nurture the family.” Comfortability in new parent rolesComfortability in new parent roles Self confidence Self confidence Knowledge growthKnowledge growth

POSTPARTUM DEPRESSIONPOSTPARTUM DEPRESSION

Doulas do not treatDoulas do not treat Focus on prevention Focus on prevention Maximize rest and Maximize rest and

relaxationrelaxation Support through Support through

phases of depressionphases of depression

Conflicts arise when…Conflicts arise when…• Doulas and nurses have had previous negative Doulas and nurses have had previous negative

working experiences.working experiences.• Doulas carry their own birth experiences with them Doulas carry their own birth experiences with them

into the clients birth.into the clients birth.• Nurses are frustrated or uncomfortable with the Nurses are frustrated or uncomfortable with the

presence of the Doula.presence of the Doula.• Doulas are new and overly eager.Doulas are new and overly eager.• Doulas do not adjust their plan when problems arise.Doulas do not adjust their plan when problems arise.• Nurses do not understand the role of the Doula.Nurses do not understand the role of the Doula.• Doulas are blamed for their clients behaviors and Doulas are blamed for their clients behaviors and

actions. actions. • During nursing shift changes.During nursing shift changes.

• Ways to resolve nurse/doula conflicts.Ways to resolve nurse/doula conflicts.• Nursing benefits of having a Doula at the Nursing benefits of having a Doula at the

bedside.bedside.