Penny Simkin: Using Doulas for Birth Care - Midwifery Today Birth Essent...

All my training materials came from this wonderful woman. Love her.

photos photos photos

One thing that every couple I have doula-ed for has requested is: pictures.  Everybody wants pictures of that life-changing day.  Who wouldn't?

But I do find significant variety in what people want photographed.  Some just want pictures after everyone is decent, coherent, and rested.  Others want pictures of that moment when they first meet each other face-to-face.  Still others want detailed photographs of the entire process.

Whatever you'd like, be sure you assign someone to be on picture-duty before everything happens.  Usually the hubby is not the best choice ... believe it or not, he's going to be quite distracted.  Moms can get distracted too.  Nurses are generally going to be quite busy with you and typically 2-3 other patients and won't have the time. 

Doulas can be extremely useful when it comes to picture-taking.  Some even have a little experience with photography.  I recently purchased this little beauty:

And I am excited to put it to work!

If you haven't been able to find a doula, then get a friend ... someone you trust, but not someone who will be too worried about you to keep at their task.  I found a blog of a gal who photographed her friend's birth, and the results are about the most adorable thing ever: http://www.amelialyon.net/personal/introducing-sweet-lola-dee.html

Once you've got your photographer figured out, you then need to decide what you want pictures of.  Here's some food for thought:

• How do you want to remember this experience?  Would you rather re-live every incredible moment, or focus on the happy ending?
• Do you want pictures of you and your significant other working together to bring your child into the world?
• How do you feel about blood?
• Would you be distracted from the intense work of labor if there was a flash or clicking going on every few minutes?  Could the camera be kept quiet and still do its job?
• Will you be embarrassed later by how some of the photos turn out?
• Would you like to have pictures of everyone there?
• Will the hospital allow pictures of the actual birth?  Most do not.  They don't want clients to have documentation against them should something go wrong.
• Would a simple point-and-shoot camera work?  Or will you need to seek out something more substantial?

Birth is an incredible, life-changing moment that you will never forget.  Photos are the best way to highlight your favorite parts, and beautify the less-than-favorite.  Be sure to work some kind of photography into your birth plan.

after having a little experience under my belt ...

I have now attended five births; three of which I served as the actual paid doula.

I absolutely love this.

It is such an honor to be asked to participate in such a moving, life-changing moment in a young family's life; and to be trusted that you will bring something positive and vital to the experience.  I am in awe of the strength and will of the mothers as they work with their bodies to bring these little ones into their open arms.  I adore the doting fathers; all of those I worked with were excited, nervous, and itching to find a way to work with his wife and lighten her load.  I remember one man after his wife decided to get an epidural.  She went straight to sleep, and he stood next to her, watching her breath.  Finally, after a few minutes, he turned to me and said, "Is there anything you would suggest I could do for her right now?"

The love and the raw emotion that surrounds this event are positively gripping; I won't lie, I shed a slight tear or two at every single birth.  It has been amazing to me how focused and consumed the parents will be with the hard work of labor; the atmosphere is generally quiet, inward, and intense.  But then, when that little one finally comes out, all intensity vanishes.  Laughter, tears, and gasps are all that remain.

Is there anything more holy than watching that little threesome gaze into each others' eyes, marveling in every little bit of each person?  I surely can't think of much.

I am so incredibly grateful to have this experience, to know that I have done some good in the world, and have gained so much more in return.

I pray that I will continue to have these opportunities to serve.

my current resume

Allison Gunn                                         Resume

Trained doula                                                                                             435 512 4861

            The family unit is the fundamental unit of human society.  I am a firm

            believer that if things are well in the home, it trickles out to create a

            world-wide effect of peace.  There are many elements to creating that

            loving home, but I have decided to aide in the beginning of that family.

            Through emotional support, physical comfort measures, and non-biased

            information,  I believe I can help couples achieve a positive experience

            in the birth of their little one, and therefore feel more empowered

            and confident in their own abilities to raise and love that child to the

            best of their abilities.

Completed Doula Training Oct. 3 2010 Trainer: Ellie Shea RN, CD, HBE, BSN (310) 326-2764 

A s   y o u r   d o u l a,   I   c a n   p r o v i d e :

Basic Massage                                             Infant Wrapping

Information                                                    Help with Hypnobirthing

Training for your partner                             Breathing Techniques

Birthing Ball                                                  Breastfeeding Tips

Photos                                                           One on One Meetings

Your child’s Birth Story                               Resources you might find helpful

B  a  c  k  g  r  o  u  n  d :

MOTHER OF ONE – To MacAlister Gunn, born September 13, 2009

CHIROPRACTIC  ASSISTANT – Holland Chiropractic

Dr. John Holland                   

562 694 8347                         

How does this apply to my doula work?

This job enabled me to do more hands-on work with the patient’s body than I had previously been able to.  I also thoroughly enjoyed the “natural” atmosphere and learned much about the body’s ability to heal itself.

DIRECT CARE SUPERVISOR – Avalon Hills

Doriann Pye-Petersen            

 435 753 3686                        

How does this apply to my doula work?

Here I learned much about the complexity of the female mind, and the power therein.  I watched these girls overcome incredible things, and was amazed by the abilities we posses when we are determined, informed, and loved.

PHYSICAL THERAPY AIDE – Mt. West Physical Therapy

Brad Thomas PT                    

435 755 0781                         

How does this apply to my doula work?

This job was my intro the workings of the human body.  I witnessed people come back from some incredibly difficult circumstances, and learned that a little movement can go a long way in helping the body perform the functions needed.

aromatherapy

Aromatherapy is a great resource for labor!  Most doulas will have massage oils with essential oils in them, but you might want to look into what scents you prefer and what feels most relaxing to you.

A great basic recipe for massage oil during labor:

Ten drops of clary sage, five drops of rose, five drops of ylang-ylang mixed in 2 fl oz (10 tsp) of sweet almond oil.

Look a little more into aromatherapy here:
http://www.birthsource.com/scripts/article.asp?articleid=45

it is easier to love when you are loved

In "The Doula Book" and in "Birthing Within", a study was cited that took place in Johannesburg, South Africa.  They took 189 women having their first babies, and assigned doulas to half of them.  These doulas were to "remain with the laboring women constantly and use touch and verbal communication to focus on comfort, reassurance, and praise." The purpose was to study the long-term effects a doula has on the first several weeks after the birth of a baby.  Their findings were amazing.

To quote from "The Doula Book":

"Fewer doula-supported mothers considered the labor and delivery to have been difficult, fewer thought it was much worse than they imagined, and more believed they had coped well during this experience.  When the mothers were asked about their experiences with their babies, the doula-group mothers spent less time away from their infants.  These results suggest that doula support during labor has effects similar to those of mother-infant contact directly after delivery; both appear to increase the mother's interest in her baby and her interaction with the newborn."

Here is a graph I pieced together from numbers found in "The Doula Book":

Johannesburg Study
	CONTROL GROUP	WITH DOULA SUPPORT
Feeding Behavior at Six Weeks
Breast-feeding only	29%	51%
Demand feeding	47%	81%
Feeding food other than milk	53 %	18%
Feeding problem	63%	16%
Average number of days breast-feeding only	24 days	32 days
Infant Health Problems at Six Weeks
Vomiting	28%	4%
Cold or runny nose	69%	39%
Cough	64%	39%
Poor appetite	25%	0%
Diarrhea	33%	19%
Maternal Outcome at Six Weeks
Mother brought baby to postnatal visit	47%	64%
Mother always picks up baby when crying	40%	80%
Hours away from baby/week	6.6	1.7
Emotional State of Mothers at Six Weeks
Reported anxiety	40%	28%
Reported high self-esteem	59%	74%
Reported depression	23%	10%
Satisfaction with Partner
Before pregnancy	63%	65%
During pregnancy	48%	49%
Since the baby was born	49%	85%
Reported their relationship being better right after the birth	30%	71%
Maternal Perceptions at Six Weeks
Perception of baby
Cries less than others	17%	55%
Special	71%	91%
Easy to manage	27%	65%
Clever	47%	78%
Beautiful	67%	89%
Regards baby as a separate, sociable person by 6 weeks	80%	100%
Perception of self
Feels close to baby	80%	97%
Pleased to have baby	65%	97%
Managing well	65%	91%
Communicates well	68%	91%
Becoming a mother was easy	11%	45%
Can look after the baby better than anyone else	31%	72%

The differences here really are amazing.  If you are able to find a doula that you connect with, please use their trained services. 

But most importantly, make sure you surround yourself with people at your birth who will be supportive, loving, positive, and completely on your side.  Find a doctor you agree with.  Ask if you can trade nurses if the ones assigned to you aren't fitting.  Talk with your husband about the hopes the two of you have for this experience.  And find an experienced mother or doula to help the two of you bring about those hopes. 

Our thoughts and emotions are tied to our health just as much as the food we put inside our bodies.

doula defined

This is an excerpt from my DONA Birth Doula Workshop manual.  I think it is the best, most simple definition I've found:

"The Greek word 'doula' means 'woman caregiver'.  We now use the word to describe a trained and experienced labor companion who provides the woman and her husband or partner continuous emotional support, physical comfort and assistance in obtaining information before, during and just after childbirth.

A postpartum doula provides care to a family with a newborn baby. 

A birth doula:

• Recognizes birth as a key life experience that the mother will remember all her life.
• Understands the phusiology of birth and the emotional needs of a woman in labor
• Assists the woan and her partner in preparing for and carrying out the plans for the birth.
• Stays by the side of the laboring woman throughout the entire labor.
• Provides emotional support, physical comfort measures, an objective viewpoint, and assistance to the woman in getting the information she needs to make good decisions.
• Facilitates communication between the laboring woman, her partner, and clinical care providers.
• Perceives her role as one who nurtures and protects the woman's memory of her birth experience.

The acceptance of doulas in maternity care is growing rapidly with the recognition of their important contribution to the improved physical outcomes and emotional well being of mothers and infants."

doula research

DONA (Doulas of North America), an international organization, has a fantastic in-depth description of what doulas are.  Read it here.

This is an excerpt describing the research behind doula care.

"In the late 1970s, when Drs. John Kennell and Marshall Klaus investigated ways to enhance maternal-infant bonding they found, almost accidentally, that introducing a doula into the labor room not only improved the bond between mother and infant, but also seemed to decrease the incidence of complications.(6,7) Since their original studies, published in 1980 and 1986, numerous scientific trials have been conducted in many countries comparing usual care with usual care plus a doula.

Table 1 summarizes the findings of North American trials and a meta-analysis of all trials of continuous labor support.(12) Obstetric outcomes were most improved and intervention rates most dramatically lowered by doulas in settings where the women had no loved ones present, the intervention rates were routinely high (as indicated by the data for the control groups) and the doulas were not health care professionals.


Results of 7 North American Trials of Labor Support including 2259 women
(comparing continuous labor support by doulas with usual care)

Author Year (# subjects)	Cesarean Rate	Oxytocin Use	Epidural Rate	Narcotics Use	Instrumental Delivery	Maternal Emotional Distress	5 min. Apgar <7 NICU
Cogan (13) 1988 (25)	N.A.	No diff	N.A.	decrease	N.A.	N.A.	decrease
Hodnett (14) 1989 (103)	No diff	increase	N.A.	decrease	No diff	N.A.	N.A.
Kennell (7) 1991(616)	decrease	decrease	decrease	No diff	decrease	N.A.	decrease
Kennell (8) 1993 (570)	decrease	N.A.	No diff	N.A.	N.A.	N.A.	N.A.
Gordon (15) 1999 (314)	No diff	No diff	decrease	No diff	No diff	decrease	N.A.
McGrath (9) 1999 (531)	decrease	decrease	decrease	decrease	No diff	N.A.	N.A.
Trueba (16) 2000 (100)	decrease	decrease	decrease	N.A.	N.A.	N.A.	N.A.

KEY: No diff- no statistically significant difference between groups;N.A. – not assessed; increase – statistically significant increase in the supported group; decrease – statistically significant decrease in the supported group.

The results of 3 North American Trials 3, 17, 18 including 8052 women (comparing continuous labor support by NURSES – not doulas – with usual care) showed no differences in any outcomes listed in Table 1.
Findings of Hodnett’s et al meta-analysis of 15 trials from N. America, Europe, and Africa(10)

Women cared for during labor by a birth doula, compared to those receiving usual care were

• 26% less likely to give birth by cesarean section
• 41% less likely to give birth with a vacuum extractor or forceps
• 28% less likely to use any analgesia or anesthesia
• 33% less likely to be dissatisfied or negatively rate their birth experience"