Friday, July 31, 2009

Doulas: Before, During and After Birth

by Jan Mallak, 2LAS, ICCE-CD, CD-PCD(DONA), CPD

A doula is a woman experienced in childbirth who is specially trained to provide various kinds of support for the mother before, during and/or after the birth. The term comes from the ancient Greek who called a female servant chosen to attend the expectant lady of the household the doula.

A movement to bring back this age old tradition began in 1992 when Doulas of North America was founded. Since then several other organizations have emerged or expanded to offer doula training and certification ICEA (International Childbirth Education Association), CAPPA (Childbirth and Postpartum Professional Association), ALACE (Association of Labor Assistants and Childbirth educators). All can be found on the internet and are a wealth of information regarding what a doula is, how to locate one, what costs are involved and how to find the right “fit” for you.

There are three types of doulas: antepartum (before birth), birth (during) and postpartum (after). The antepartum doula is the newest kind of doula who assists the high risk mother while still pregnant. The woman may be restricted to bed for medical reasons and therefore unable to care for herself or others. The antepartum doula can provide mother/child care, do light housekeeping, run short errands and prepare nutritious meals. She educates the mother about pregnancy, birth or postpartum and provides her with local resources/referrals. She can also lend an ear to help the mother deal with the additional fears associated with a high risk pregnancy and possible outcomes. And, most importantly, she helps keep the family on schedule so their lives can flow more smoothly even if “mom is down.”

A postpartum doula does much the same as the antepartum doula, but after the baby comes. Her roles are similar but helping the family transition into their new life with the baby is now the focus. Education often takes the form of “on the job training” since the baby has specific needs that have to be met RIGHT NOW! Bathing, dressing, changing, swaddling, feeding, burping and entertaining the baby are some of those immediate needs. And, not everyone feels very accomplished in those areas. So, the doula steps in to educate, guide and facilitate the family’s comfort and confidence with their new roles.

Breastfeeding is on the rise, so assistance with nursing is another function of the postpartum doula. Many women lack breastfeeding role models or reliable resources. So, having an experienced and knowledgeable guide is a valuable benefit for them. Postpartum depression is also on the rise so having someone around who knows how to prevent, recognize or deal with postpartum mood disorders can literally save lives. Sometimes a woman’s birth experience can influence her mental state so debriefing afterwards can be very therapeutic. Doulas are trained to be good listeners, assess a woman’s well being and refer if warranted. No medical care, advice or interpretations are ever provided by any type of doula. But, identifying red flags and providing expert resources and referrals is integral to a doula’s duties.

A birth doula is quite different from the other two types of doulas. She specifically helps a woman prepare for the birth, deal with it and recover from it. She provides 5 types of support: physical (like being a personal handmaiden), emotional (like being a trusted friend), informational (like being a walking textbook), mediatorial (like being a nurturing protector) and spiritual (like having a special woman to woman connection).

Every woman’s response to labor is different so the doula must be able to meet her client’s particular needs. Meeting before the birth, working on a birth vision together (like a birth plan), going to an appointment, attending the birth and visiting afterwards creates a trust relationship that develops over time. This results in comfort with the doula and confidence in the process so the mother tends to have a safe, satisfying and successful birth.

Research since 1980 shows that there are many benefits to having doulas - shorter labors, less interventions used, fewer cesarean deliveries done, more successful breastfeeding and decreased postpartum depression to name a few. Even though a doula can dramatically reduce the cost associated with births, insurance companies do not routinely cover their fee. Some couples participate in a tax-free employee benefit plan which reimburses for medical expenses not usually covered by traditional health insurance. Doula fees are sometimes paid in that case. It’s always worth a call/letter to your insurance company or employer to investigate this possibility.

Since giving birth is a rite of passage for a woman, pregnancy, delivery and postpartum should be a special time for the mother. By hiring a doula/doulas to assist during this unique phase in a woman’s life, she can truly feel well educated, supported and assisted. After all, generations of women have been helping other women to prepare for and to deal with being a new mother. Why not consider taking advantage of a system that has worked for hundreds of thousands of years?
Editorial provided by Jan S. Mallak, 2LAS, ICCE-CD, CD-PCD(DONA), CPD. Jan has over 25 years in the baby business. She is the founder/coordinator of “Heart & Hands” Doula Service which is the largest, oldest and only doula group in the Pittsburgh area to offer all 3 kinds of doulas. Jan is also an educator, doula trainer, speaker, author and birth consultant.

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