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The ancient tradition of wise women caring and guiding other
women in the journey through birth is making a comeback. In
an increasingly high-tech environment, birth doulas are gaining
popularity with expectant parents and quickly becoming an
integral part of the maternity healthcare team.
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| Carol
Roberts, a birth doula in Medina, Ohio, makes
the laboring mother comfortable by massaging her
lower back during a contraction. |
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The word "doula" comes from ancient Greek and today
refers to a woman trained and experienced in childbirth who
provides continuous physical, emotional, and informational
support to the mother before, during, and immediately after
childbirth. The terms "birth assistant" or "labor
assistant" are sometimes used as synonyms for "doula"
but usually refer to women who assist midwives and perform
medical tasks such as vaginal exams, monitor fetal heart tones
and provide labor support.
Why a Doula at your birth?
With a doula at her birth, a laboring woman
is never alone. A mother can count on her doula to guide her
and support her in the kind of birth she wants.
Nurses, midwives and physicians are responsible
for the medical care the laboring woman needs and may care
for more than one woman at a time. The doula's only focus
is on the mother's emotional and physical needs.
Medical caregivers and expert organizations
recognize that continuous emotional support and comfort in
labor can help women have shorter, easier labors and reduce
the risks for complications including the need for a cesarean
delivery.
The World Health Organization, the Medical
Leadership Council of Washington, D.C., the non-profit Institute
for Healthcare Improvement in Boston, the Society of Obstetricians
and Gynaecologist of Canada, and the American College of Obstetricians
and Gynecologists are some of the groups who agree that trained
and experienced labor assistants who meet women's emotional
and physical needs in labor can improve maternal and infant
outcomes.
Studies from several countries including
the United States, Sweden, South Africa, Canada, Guatemala
and Mexico show that when doulas attend births, women have
shorter easier labors, request less pain medications including
epidurals, are less likely to require oxytocin to speed up
labor, and the use of forceps or vacuum extractors. Babies
are also healthier and breastfeed more easily. Mothers have
also said they were much more satisfied with their birth experience.
What do doulas do?
In their book, Mothering the Mother;
How a Birth Doula Can Help You Have a Shorter, Easier, and
Healthier Birth, Dr. Marshall H. Klaus and Dr. John Kennell
recognized researchers in maternal-infant attachment, and
Phyllis H. Klaus, M.Ed., CSW, a psychotherapist specializing
in the care of pregnant women and new parents explain that
the doula's role is "designed to provide a nurturing,
helpful, and objective female supporter so that the family
member chosen to be present does not have sole responsibility
for the labor. It is not an attempt to interfere with the
relationship between the woman and her partner or other family
member."
A doula helps the mother prepare for and
carry out her plans for the birth. She can suggest physiological
positions and comfort measures to help labor progress and
reduce the pain of labor. She can also facilitate communication
between the laboring woman, her partner, and her caregivers.
The doula recognizes that childbirth is
a key experience the mother will remember for a lifetime and
helps to make that experience as satisfying and empowering
for the mother as she can.
Although many parents attend childbirth
classes today, they sometimes find it difficult to integrate
what they learned in class with the actual experience of labor.
The journey to birth can be much longer or more difficult
than anticipated.
What about the father's role?
A doula's presence also impacts the father's
participation at birth. Fathers tend to feel less anxious,
take fewer breaks away from the partner, stay closer to her
and comfort her with his touch more often.
Many fathers also feel more relaxed with
the presence of a doula Fathers may be surprised and overwhelmed
by the intensity of the pain their partners' experience.
Complications can occur that may upset the
hopes and expectations that the couple had for their birth.
A trained labor assistant can help the mother feel more in
control and reassure the father that although labor is intense
it is progressing normally.
For more information about "Dads and
Doulas" visit www.dona.org.
How do I find a doula?
Many doulas have their own private or group
practice. Fees for doula services in the United States vary
from $250 to $600. However, some doulas provide free services
to economically disadvantaged mothers while others with clinical
experience may charge as much as $1000 in large metropolitan
areas. Fees usually include two prenatal visits, continuous
support throughout the entire labor, no matter how long it
lasts, and one or two postpartum visits.
Over 100 US hospitals provide doula services
as part of their maternity care package by having doulas on
staff or contracting with a doula service. With a hospital
doula service, parents may or may not have the opportunity
to meet their doulas before labor begins. Doulas assist mothers
at home births as well as in birth centers. Many community
maternity centers also employ doulas for their clients.
How do I pay for a doula's services?
Although the care that doulas provide is
non-medical, it does have medical and financial benefits.
Many hospitals are recognizing that factor and some insurance
companies are beginning to reimburse parents for doula services.
Medicaid funds are sometimes allocated for doula services
by some county agencies and private foundations have also
provided grants to cover the cost of doula care.
Parents in the United States may have a
flex-spending account in which a percentage of their wages
are placed in a pre-tax account that can be used for non-covered
medical expenses. Hospitals and individual physicians who
directly employ doulas may also bill for doula services.
How do I select a qualified doula?
Doulas can receive training and certification
from several local, national, and international organizations.
Training programs usually require prior knowledge of childbirth,
selected reading material, and a two or three day seminar
that includes hands-on practice of skills including relaxation
and breathing techniques, positioning and movements to reduce
pain and enhance the progress of labor, massage and other
comfort measures.
Doulas who are also certified have completed
additional requirements than include attending several births,
evaluations from medical care providers and parents, additional
education, observation of a series of childbirth classes,
and a written exam or an essay that reflects a knowledge of
the fundamental concepts of labor support.
What questions should I ask a prospective doula?
Parents considering a doula at their birth
may want to begin interviewing a few a couple of months before
their baby is due. They may want to have a phone interview
before meeting personally with her. To help parents feel comfortable
with the doula they hire, it is important to ask a few questions:
 What
training have you had?
Tell
me (us) about your experience with birth, personally as
a doula?
What
is your philosophy about childbirth and supporting women
and their partners through labor?
May
we call you with questions or concerns before and after
the birth?
When
do you join women in labor? Do you come to our home or meet
us at the hospital?
Do
you meet with me (us) after the birth to review the labor
and answer questions?
Do
you work with one or more backup doulas when you are not
available? Can we meet them?
What
is your fee? How do you expect payment to be made?
Parents need to feel very comfortable and
reassured with the doula they hire. Several doula training
and certifying organizations require doulas to meet strict
professional and ethical standards.
By taking the time to interview a doula
and find out about her professional training, and the special
services that she can provide parents will be more satisfied
with their birth experience.
References
DONA Position Paper. The Doula's Contribution to Modern
Maternity Care (1998).
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