Wednesday, April 02, 2008

Doulas: A Risk-Free Option for Pain Relief During Childbirth

Doula is a Greek word that originally meant a servant for a woman who had given birth. Today the term “birth doula” refers to a caring woman who provides continuous physical, emotional, and informational support to a mother during labor and delivery. A postpartum doula is a caring woman who provides care for a new family.
Depending on whether they are a birth or a postpartum doula, their period of involvement may change, but one thing remains the same: Doulas are there to support the mother continuously through labor until birth. After the baby is born, the postpartum doula assists the new family in their home for several hours each day or every other day for a week or more during the adjustment period.

A doula is not meant to replace the partner or a loved one, but to support the laboring woman, include and help the partner or loved one, and answer their questions. She increases their understanding of events as they occur and anticipates what lies ahead. By working collaboratively with the family, the doula can support decisions made by the expectant parents when appropriate. Partners feel they are able to participate more effectively in the birth with a doula present because the doula provides suggestions and support which allows them to take part on the comfort level of their choosing.

Benefits of the Doula
Studies examining doula programs have produced several important findings about how babies and mothers fare after birth. The support of a doula can help to reduce:

Duration of labor
Likelihood of complications
Need for epidurals or epidural pain medication
The support of the doula often also reduces the normal physical and physiologic stress a child experiences during birth. This benefit to the baby may occur as a result of the doula's care, reducing the anxiety of the mother and her partner throughout labor and delivery. In fact, the newborn is often more attentive and ready to begin the bonding interactions with the mother.

Studies About Doulas
Numerous medical centers have conducted studies to examine the effects of enlisting a doula to stay continuously with a pregnant woman through labor and delivery. In 2003 the prestigious international Cochrane Collaboration review of 15 randomized studies that met their research criteria stated: “Given the clear benefits and no known risks associated with support, every effort should be made to ensure that all laboring women receive continuous support. This support should include continuous presence, the provision of hands on comfort and encouragement.”

They found:
Cesarian Section - 26% less likely
Forceps or Vacuum - 41% less likely
Analgesia or Anesthesia - 28% less likely
Dissatisfaction or negative rating of birth experience - 30% less likely
As an added benefit, those with doula support often report:
Higher self-esteem
Less depression and anxiety
Breastfeed more successfully
More confidence about caring for the baby
Lower tendency to develop fever

Types of Doulas

Birth Doula
A birth doula assists the woman before, during and often after the delivery. Birth doulas are trained in childbirth, and most have given birth themselves. The main goal of a birth doula is to help the woman have a safe and satisfying childbirth as the woman defines it.

The birth doula has three main responsibilities:
Emotional Support - The doula provides emotional support through her constant presence throughout labor and delivery. Once labor begins, the doula remains by the side of the mother-to-be until the birth is completed and frequently for the first one or two hours afterwards.

The doula provides emotional support in an active way. She adjusts her style to fit each patient and responds as the patient’s needs change during the labor. She understands and accepts the woman’s pain and fear and serves as a source of support, helping the woman remain confident and in control. The doula also supports the father and any family members who may be present.

Education - The doula educates and informs the mother about obstetric routines and procedures and thus keeps the mother advised about her progress during birth. The doula encourages the mother to manage the situation by listening to the messages the body sends during birth, changing her position, adjusting breathing, and using other stress and pain reducing techniques.

Especially now with the discovery of the importance of skin-to-skin or kangaroo care immediately after childbirth the doula can act as an emotional and informational resource for the mother. The doula can explain what will happen immediately after childbirth and the woman can prepare to have the baby on her chest, skin to skin.
Liaison - The doula functions as a liaison between the patient and the medical staff. She does not give medical advice or perform any medical duties, but she’s on hand to support the mother if she has questions for the medical staff. Most medical staff appreciate the extra attention and support the doula gives their patient.

Postpartum Doula
A Postpartum doula works in the fourth trimester, just after pregnancy. The role of the postpartum doula is to provide support, advice, and assistance in the weeks and months following birth. In the past, the family of a new baby could rely on their family members or friends to assist them. After giving birth women are often surrounded by caring family members who have a great deal of experience and wisdom to offer. While these resources are available today, they may not always be provided due to increasing distances between family members and their loved ones.

The postpartum doula provides:
Non-judgmental support
Assistance with newborn care and family adjustment
Assistance with meal preparation
Assistance with light household tasks
Postpartum doulas offer evidence-based information on:
Infant feeding
Emotional and physical recovery from birth
Infant soothing
Coping skills for new parents
Safe infant sleeping
Referrals for more education on these topics when necessary

The doula may also be a buffer to parents who may have received outdated advice. The doula can help friends and family to foster and support the parenting decisions of the new parents. By modeling a deep respect for the wisdom and decision making abilities of the new parents, she makes clear that supporting them in their own choices will have the best results.

John H. Kennell, MDProfessor of PediatricsSchool of Medicine Case Western Reserve University

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