Thursday, March 19, 2009

The Doula Difference

I wrote this post last month for my personal/family blog, but I wanted to re-post it here for those of you who haven't seen it. :-)

I think every laboring women needs a doula. And here's why...

1) Doulas are nothing new.
A lot of people, when they first hear about doulas, think... oh, that's new. But it's not at all. For thousands and thousands of years women have been supported by other women during childbirth. We watched an awesome film at our training called "The Timeless Way" which showed the history of childbirth starting with ancient artifacts and moving to more modern depictions. I was struck how the very same image was represented through sculpture, wall carvings, pottery, and art over and over and over again. It is the "classic birth triad"--an upright laboring woman supported from behind by another woman, with a midwife in front ready to catch the baby. It has only been in the last century that this "classic birth triad" has all but disappeared. Doulas are not new. Modern obstetric practice is what has strayed (very far, I might add) from the time-tested norm.

2) Women need a "buffer" (i.e. Hospitals and drugs mess with birth).
Don't get me wrong. I am so grateful we have hospitals and drugs to handle birth complications (which do happen!). But, really, when used excessively (as they are) they mess with birth big time. The hospital with its policies (no food or drink, IVs, restriction to bed, bright artificial lighting, time constraints, flat on back or semi-recumbent positions for pushing, etc.) is really the least ideal place to facilitate the birth process. And pretty much any and all of the drugs hospitals introduce into the process screw up birth's carefully orchestrated hormonal responses, often leading to the need for further interventions to counter-act the drugs' side effects. So... here's my point... because 99% of American women give birth in hospitals (80-90% of those with drugs), there is a dire need for a buffer of sorts--something or someone to help women and babies come out of the modern birth machine as unscathed as possible. Doulas can be (and are being) just that buffer. And, I should add, sometimes epidurals just don't work (or only work on one half of a woman's body). Plus you still have to get through early labor (0-4 cm) before most doctors/hospitals will allow you to get an epidural. For some women, even early labor is killer. So it's a good idea to have someone present who is trained to help you cope with labor pain (even if you plan to get an epidural)!

3) Birth is women's work.
We put a lot of pressure on dads (particularly first-time dads) to be the sole support for their wives in labor. The fact of the matter is that it's overwhelming to many of them. They are often at a loss when faced with their own difficulty in seeing their wife's pain while simultaneously trying to help support her through that pain. A study comparing first-time fathers' and experienced doulas' participation in birth showed that males touched their laboring partner only 20% of the time while doulas touched them 95% of the time. They also spent less time with the women and were close to them less than the doulas (Bertsch et al. 1990). I absolutely believe that a husbands' presence can be vital. I would never want to give birth without Ax by my side. But I also believe that the assistance of wise, experienced women is also vital for laboring women. As much as a husband's support is wanted and needed, he is a man and can't ever understand what his wife is experiencing. Experienced women offer a different and much-needed emotional support. Doulas are also trained to assist fathers, giving them suggestions for ways to help their wives when they are unsure how (or are reluctant) to step in and help. My first "doula" did this beautifully.

4) Doulas are proven to improve outcomes for mothers and babies.
Study after study has shown that doulas have a profoundly positive impact on birth outcomes. Check out these numbers (from one of my doula training handouts):
When all the studies are calculated together, the presence of a doula reduces:

* Cesarean sections by 50% (!)
* Length of labor by 25%
* Oxytocin [Pitocin] use by 40%
* Pain medication [opiates] use by 30%
* Forceps deliveries by 40%
* Requests for epidurals by 60%

Other findings:

* Decreased maternal fever
* Decreased newborn admissions to NICU
* Decreased sepsis workups on newborns
* Decreased infant health problems

Long term benefits:

* Increased mother/infant bonding
* Decreased postpartum depression
* Increased success in breastfeeding
Who wouldn't welcome those amazing benefits?! As my doula trainer so aptly pointed out, if a doula were a machine, every hospital would have three of them.

I'm not telling you all this to drum-up business for myself. Even if I was looking for clients, I wouldn't be charging anyone. I'm telling you this because I am (excessively) passionate about helping women have wonderful, satisfying birth experiences. Doulas can work wonders, but I don't think most women are aware of just how much difference a skilled doula can make. I just had to spread the word!

As for me... I've got two fabulous births under my belt, and I'm a trained doula myself, but I am still going to have TWO doulas (and two midwives) at my next birth. I am thrilled that we will be surrounded by supportive, experienced women as we bring our first son into this world. I feel confident that their loving presence will make this our best birth yet.

P.S. If you'd like to hire a doula but can't afford one, have no fear! There are always doulas willing to volunteer their services. It's a generally universal doula belief that all women should have access to doulas regardless of ability to pay.


Sarah H said...

I love your blog! I haven't been blogging in a bit so I need to catch up.
I love this explanation of doulas. I love the idea that every woman who wants one deserves a doula, regardless of ability to pay. My doula trainer advised us to do a free birth for every paid birth we do.
Right now I'm trying to get certified and it's stressful because I'm SPENDING money to become a doula, which we don't have in abudance, and I've offered to be a doula for two of my friends for FREE and they didn't take the offer. So I'm feeling a bit down about that but reading this entry made me excited that I'm pursuing being a doula. It really is important in today's birthing climate.

HollySteffen said...

i agree 100% and i'm sure my husband would agree more than i do. =]

emily said...

another great post--especially the part about doulas being "new."

Linda said...

There have been several times that I have left big long comments on your blog, but they didn't work because I was doing it from my phone. I just found a moment to log onto your blog on the computer, so I'm going to try to remember a few of my old comments.

1) You posted someone's success story about having a baby without medication and she said it was great to feel her baby being born. That planted in me a little desire to actually be able to feel my next baby being born. It is a little sad that I didn't get to feel Ethan being born. Then again, I'm not sure that I want to go through a lot of pain when I don't have to. :) Mike is a big fan of epidurals because he really struggles to watch me in pain.

2) You talked about how you got the hospital to just put an IV start in your hand when you were in labor (heplock or something). I HATED being all tethered up. I expressed my concern about this many times and even started crying when they put the IV in because I had that on one hand and the heart monitor on the other, and just felt so tied down. They tried to be nice about it, but the best thing they offered was to put the heart monitor on my toe and allow me to walk around with my IV (without the thing on my toe of course). Next time I am doing it the way you did!

3) A friend of mine just had a baby a few weeks ago and posted her story yesterday.
It made me think of you because her story made me so mad at the hospital staff. :) When she felt that her contractions were getting really bad she asked for an epidural and they said she couldn't have one because she wasn't really in labor. Eventually she convinced them she was ready for the epidural and the nurse offered to check her. She was fully dilated and the baby was right there. They told her not to push while they tried to find someone to deliver the baby. She said not pushing was the hardest part of the whole labor. By the time they got someone in there (not her doctor) she pushed once and the baby was born! She had second degree tears because the baby came so quickly! She said next time she'll just push when her body tells her to and someone will catch the baby. :)

4) I had another friend just give birth. She told me before hand that she wanted to go without medication. I asked her if she had a doula, and she said she did not because hers was about to have a baby. I wanted to ask you where she could find another one because to me it doesn't seem like a good idea to go without medication without some knowledgeable help, but she had the baby early, so I didn't get to ask you about it. For the future, how should women go about finding doulas?

Ok, I think those are most of my stored up comments. :)

Buscando la Luz said...

Oooh! Thanks, Linda! I love those comments. I think I might do an "Ask Busca" post with some of your questions. :-)