DOULAS. THE
HOTTEST BIRTH COMMODITY!
Compiled and Written by
Mélissa Cowl, CD/DT (DONA)
With help from the files of
Doulas of North America
The birth of
each baby has a long lasting impact on the physical and mental
health of mother, baby and family. In the twentieth century, we
have witnessed vast improvements in the safety of childbirth,
and now efforts to improve psychosocial outcomes are receiving
greater attention.
The importance
of fostering relationships between parents and infants cannot be
overemphasized, since these early relationships largely
determine the future of each family, and also of society as a
whole. The quality of emotional care received by the mother
during labour, birth, and immediately afterwards is one vital
factor that can strengthen or weaken the emotional ties between
mother and child. Furthermore, when women receive continuous
emotional support and physical comfort throughout childbirth,
their obstetric outcomes may improve.
Women have
complex needs during childbirth. In addition to the safety of
modem obstetrical care, and the love and companionship provided
by their partners, women need consistent, continuous
reassurance, comfort, encouragement and respect. They need
individualized care based on their circumstances and
preferences. The role of the Doula encompasses the non-clinical
aspects of care during childbirth.
In nearly every
culture throughout history, women have been surrounded and
cared for by other women during childbirth. Artistic
representations of birth throughout the world usually include at
least two other women, surrounding and supporting the birthing
woman. One of these women is the midwife, who is responsible for
the safe passage of the mother and baby; the other woman or
women are behind or beside the mother, holding and comforting
her. The modern Doula is a manifestation of the woman beside the
mother.
Doulas are
trained and experienced in childbirth, although they may or may
not have given birth themselves. The Doula's role is to provide
physical, emotional, and informational support to women and
their partners during labour and birth. The Doula offers help
and advice on comfort measures such as breathing, relaxation,
movement and positioning. She also assists families to gather
information about the course of their labour and their options.
Perhaps the most crucial role of the Doula is providing
continuous emotional reassurance and comfort.
Doulas
specialize in non-medical skills and do not perform clinical
tasks, such as vaginal exams or fetal heart rate monitoring.
Doulas do not diagnose medical conditions, offer second
opinions, or give medical advice. Most importantly, Doulas do
not make decisions for their clients; they do not project their
own values and goals onto the labouring woman.
The Doula's goal
is to help the woman have a safe and satisfying childbirth as
the woman defines it. When a Doula is present, some women feel
less need for pain medications, or may postpone them until later
in labour; however, many women choose or need pharmacological
pain relief. It is not the role of the Doula to discourage the
mother from her choices. The Doula helps her become informed
about various options, including the risks, benefits and
accompanying precautions or interventions for safety. Doulas can
help maximize the benefits of pain medications while minimizing
their undesirable side effects. The comfort and reassurance
offered by the Doula are beneficial regardless of the use of
pain medications.
"Doula"
also refers to lay women who are trained or experienced in
providing postpartum care (mother and newborn care,
breastfeeding support and advice, cooking, child care, errands,
and light cleaning) for the new family. To distinguish between
the two types of Doulas, one may refer to "birth
Doulas"and "postpartum Doulas."
The Doula and
the Partner Work Together:
The woman's
partner (the baby's father or another loved one) plays an
essential role in providing support for the woman. A Doula
cannot make some of the unique contributions that the partner
makes, such as intimate knowledge of the woman and love for her
and her child. The Doula is there in addition to, not instead
of, the partner. Ideally, the Doula and the partner make the
perfect support team for the woman, complementing each other's
strengths.
In the 1960's,
the earliest days of fathers' involvement in childbirth, the
expectation was that they would be intimately involved as
advisors, coaches and decision- makers for the woman. This
turned out to be an unrealistic expectation for most men because
they had little prior knowledge of birth or medical procedures
and little confidence or desire to ask questions of medical
staff. In addition, some men felt helpless and distressed over
the women's pain and were not able to provide the constant
reassurance and nurturing that women need. With a Doula present,
the pressure on the father is decreased and he can participate
at his own comfort level. Fathers often feel relieved when they
can rely on a Doula for help; they enjoy the experience more.
For those fathers who want to play an active support role, the
Doula assists and guides them in effective ways to help their
loved ones in labour. Partners other than fathers (lovers,
friends, family members) also appreciate the Doula's support,
reassurance and assistance.
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