Who am I?

It’s Our Milky Way game time! Who am I?

  • When in my presence, laboring mothers undergo fewer cesarean sections, vacuum extraction and forceps deliveries.
  • When in my presence, laboring mothers experience shorter labors.
  • When in my presence, laboring mothers have less need for analgesia and oxytocin augmentation.
  • I increase breastfeeding initiation and duration rates.
  • I decrease the likelihood of postpartum depression.
  • My support results in a significantly more positive level of interaction between mother and infant two months after delivery.
  • Many consider my support an essential component of childbirth. [Clues retrieved from: http://www.nature.com/pr/journal/v43/n4s/full/pr1998210a.html and http://online.liebertpub.com/doi/abs/10.1089/jwh.1.1999.8.1257]

Ding, ding, ding! I am a doula.

In Doula Support and Attitudes of Intrapartum Nurses: A Qualitative Study from the Patient’s Perspective, authors Karla Papagni, BS and Ellen Buckner, DSN, RN summarize a doula’s role in seven objectives:

  1. To recognize birth as a key life experience that the mother will remember all of her life;

  2. To understand the physiology of birth and the emotional needs of a woman in labor;

  3. To assist the woman and her partner in preparing for and carrying out their plan for the birth;

  4. To stay by the side of the laboring woman throughout the entire labor;

  5. To provide emotional support, physical comfort measures, an objective viewpoint, and assistance to the woman in getting the information she needs to make good decisions;

  6. To facilitate communication between the laboring woman, her partner, and clinical care providers; and

  7. To perceive the doula’s role as one who nurtures and protects the woman’s memory of her birth experience.

Isn’t it fascinating that an ancient model of women helping women birth, also referred to as the social childbirth philosophy, has such positive, profound effects on mother and baby?

Tragically, in the early twentieth century in the U.S., “childbirth became a means of demonstrating new advances in technology and medicine” and the traditional birthing model was “practically abolished.” [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595283/]

Today, the United State’s childbirth intervention rates and maternal mortality rates are shameful.

Our current health care system also presents flaws in its continuity of care, or lack thereof. Because birth experience strongly influences breastfeeding outcomes, interruptions in maternal infant health care can be everlasting.

2010-11 075Co-author of The Doula Guide to Birth: Secrets Every Pregnant Woman Should Know and doula Ananda Lowe, CLC explains a doula’s influence on continuity of care like this:

As a doula, I am likely to be the only person in a mother’s life who witnesses her birth as well as her early days at home learning to breastfeed.  She knows and trusts me, and we have already established our ability to communicate well with each other.  I can respond to her breastfeeding issues without delay in the postpartum period.  I am aware that there is a debate about the effect of birth interventions on breastfeeding, and my lactation colleagues as well as my medical colleagues offer conflicting evidence on this topic.  Aside from the issue of birth interventions, I feel that the lack of continuity of care is problematic for the majority of mothers; with the exception of those who have doulas, women don’t have a plan for who they will turn to with lactation questions in their first days home alone, and this is when floundering and cessation of breastfeeding often occurs.

(Visit http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812877/ to learn about the risks of not breastfeeding.)

As a certified lactation counselor (CLC), Lowe offers her clients an even higher standard of  care.

In a recent The Doula Guide blog post, Lowe cites using skin to skin as one of her favorite pieces of advice for families.

“Specifically regarding skin-to-skin, I encourage mothers to utilize it at every feeding for at least the first 48 hours of life, not just in the hour after birth, because babies need the sensory input that skin to skin provides to help them finesse their latching abilities,” she tells me.

Lowe is also excited about the advice she learned in her CLC training: follow the angle of the dangle.

“That is, different breasts and nipples point in different directions – straight ahead, upward, downward, or slightly to the sides,” she explains.  “There is no one breastfeeding position that can work for all mothers and babies, because everyone’s anatomy is slightly different.  A mother needs to hold her baby in alignment with her specific anatomy, which may be different than the way another woman would hold a baby.”

Lowe says that she learned this on a personal level when she initially had a difficult time nursing her daughter using the football hold.

“Mothers should be encouraged to listen closely to their instincts as they learn to position their babies, not to only rely on (even a well-meaning) nurse or lactation specialist who is positioning the baby for them,” she says.

While we know the support of a doula is beneficial to mom, baby and family, the doula profession can often be difficult within a landscape that does not adequately support normal birth.

“ It can…be stressful to do work that promotes change and best practices, when you may be surrounded by protocols and cultural views that undermine normal birth and breastfeeding,” as Lowe puts it.

She suggests that there needs to be a revolution in support for parents and doulas alike. Organizations have been formed in numerous states with the name “[State] Friends of Midwives,” but nothing similar exists for friends of doulas, Lowe explains.

“I believe we need to shift the paradigm of the doula working in solo practice and attempting to provide superhuman support to families by herself,” she says.  “The doula movement evolved around that model, we are attached to it and even afraid to change it, but it is not sustainable.  In some areas, such as the San Francisco Bay area, it is becoming more common for doulas to work in pairs.  We have a high level of burnout as a profession, but this one change would make a big difference.”

In What I Learned from 17 Years as a Freelance Doula, Lowe also reflects on doulas’ struggles including “society’s devaluing of women’s work, and our own shaky professional self-esteem”.

She offers a comprehensive list of advice for the “freelance soul.”

Occasionally warding off burnout, Lowe tells me she finds inspiration from Gretchen Rubin, author of The Happiness Project.

“In the book, she describes how she gave herself the assignment to “be Gretchen” (or to be herself) as much as she possibly could, in order to find happiness and best contribute to society,” Lowe explains. “I now frequently remind myself to ‘be Ananda’ when I need to make decisions about my Maternal Child Health career or other aspects of my life, and I really do feel that it helps lead me in more satisfying and appropriate directions!”

Despite the pressures Lowe and other doulas often assume, Lowe says she is optimistic about future breastfeeding outcomes in our nation. She cites our changing national healthcare reform and The Joint Commission perinatal policies as positive forces.

“It is a long, complicated process to change attitudes and protocols, and some mothers and babies lose out along the way which is very unfortunate,” she says.  “But more resources are available every day to protect, promote and support successful lactation outcomes.”

Lowe doesn’t express the same kind of optimism about our nation’s birth outcomes.

“My feeling is that clinicians themselves, OBs, nurses, even some of our midwives, have a deeper investment in all their years of training to perform their jobs in a certain way, as well as being saddled with heavy malpractice fears,” she says. “Mothers are becoming more outspoken and they are the roots of change, but they have a lot to fight against.”

Challenges aside, Lowe acknowledges the movement to change birth outcomes as crucial.

“Doulas are a key element of this, and I am proud to have helped create the doula movement over the last 18 years.”

Are you optimistic about birth and breastfeeding outcomes in our nation? Share your thoughts in the comment thread below.

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