Wednesday, April 02, 2008

Choosing a Doula: Answers to Your Most-Asked Questions by Henci Goer

Maybe one of your friends or relatives told you how great it was to have a doula during her labor. Maybe you read something about doulas online or in a magazine, book or newspaper. Now you are wondering whether having a doula would be a good thing for you, but you need more information. You have come to the right place. Find out what a doula is, as well as the benefits of doula care and then get answers to some of your most-asked questions about hiring a labor doula for your birth.1. Why isn't a nurse or midwife all that you need for labor support?While there may be exceptions, the demands of modern-day care in hospitals and cuts in staffing keep nurses from giving much in the way of supportive care. In fact, studies show that typical labor-and-delivery nurses spend only 10 percent of their time engaged in labor support activities, and half of that time is spent giving instructions or advice, as opposed to comfort measures or encouragement (1,4). Also, the nurse has probably never met you before. She doesn't know your individual desires or issues, and, unless you are fortunate enough to have your labor fit into one shift, you will have more than one nurse. By contrast, doulas stay with you throughout.Midwives are more likely to provide supportive care, especially those attending home or birth-center births, but they, too, may have other responsibilities that prevent them from staying with you continuously. And like nurses, they may work shifts.2. Why isn't your partner or other family members or friends enough?However important the father's role during labor, studies have not shown fathers to have the same beneficial effects as a woman labor companion (3). Female friends or relations could take on the doula role, as they have in the past and still do in traditional cultures. Nonetheless, few women in our culture today have the requisite knowledge, skills and familiarity with birth.3. Does having a doula detract from the father's role?Working as a team, the doula enhances and complements the father's care while relieving him of the perhaps unrealistic expectation that he know all and be all to you in labor (2). Fathers in one doula study liked having a doula and none felt displaced. They reported that not only did doulas help them help the moms, some of the doulas took care of them too (2).4. Will having a doula sacrifice privacy?Intruding on privacy may be a possibility at home births, but even in that setting, you will probably find an extra pair of hands belonging to someone known to you a welcome addition. In the busy, institutional environment of the hospital, a doula can help preserve privacy and create an intimate atmosphere. Depending on your doctor or midwife's on-call practices, she may even be the only person caring for you who is familiar.5. Should you have a doula even if you plan to have an epidural or narcotic?It is best not to preplan to use pain-relief medications, because they can have adverse effects on you, your baby and the labor. Through the use of comfort measures and her encouragement, a doula can help you avoid pain medication. For example, she can help you find effective positions in which to labor or push despite having an epidural. In addition, narcotics do not completely relieve pain, and if you opt for an epidural, you will still need information and emotional support.Page Two: Find out what to look for when hiring a doulaPage Three: Learn how to find a doula in your area and how to interview candidatesPage Four: ReferencesWhat should you look for when hiring a doula?Is she certified? Certification by a national organization doesn't guarantee excellence, but it does validate that the doula has met some set of standards. On the other hand, lack of certification does not mean the doula is unqualified. For one thing, nationally based doula training programs have only existed for about a decade, and many doulas antedate their introduction. In any case, while certification serves as a useful benchmark, you will still wish to inquire about the doula's experience and background relevant to labor support.What does she charge, and what is in her service package? Most doulas make one or more prenatal visits and one or more visits after the birth in addition to the time spent with you in labor. Most are also available over the phone for information, nonmedical advice or to act as a sounding board. Some doulas come to you whenever you mutually decide; others hold off until active labor. Some labor doulas provide in-home help after the birth as well. (There are also postpartum doulas who do nothing but help after the birth with light housekeeping, meals, baby care, breastfeeding assistance and so forth.)How many clients does she take per month? If she takes more than a few clients per month, she may not be available when you go into labor, or she may arrive at your labor already drained and exhausted from another birth.What are her backup arrangements? Every doula should have backup, because there is always the possibility she may have another obligation or be ill at the time you go into labor. You may wish to speak with or meet with her backup.Does she have any limitations on where she will go or which doctors and midwives she works with? She may have geographic limitations. Some doulas also choose not to attend births in certain hospitals or work with certain care providers either because the approach to labor and birth runs so contrary to her own or the staff or care provider opposes using doulas.Will she provide references? She should provide references at your request.Page Three: Learn how to find a doula in your area and how to interview candidatesPage Four: ReferencesHow do you find a doula?Take a look at the referral areas at these sites:

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