Natalie Sainsbury
Essay for DONA doula
certification
10/14/12
Purpose and Value of
Labor Support
I have had the opportunity to have four beautiful healthy
children. I did not know about labor
support during those childbearing years.
Unfortunately, if I did, I doubt I would have understood the purpose and
value labor support offers. I was able
to give birth unmedicated with my second child.
It was a great experience. I
lucked out getting an older nurse who had full confidence in me and my interest
to deliver without medication. Things
went quickly, although more painful than I would have imagined, and postpartum
was bliss (unlike my first child.) I
went forward into my third and fourth birth experiences culturally educated having
given birth twice and being a bit older.
However, I truly remained uneducated about my options and naïve to the
idea that just because I'd given birth naturally before, I would be able to do
it again. I had a nurse, upon my asking
her what she thought about the benefits of waiting for an epidural, she said
she felt you may as well get your money's worth and get it early. That sounded logical and enticing to me in my
vulnerable state. I ended out with one
positive epidural birth and one overmedicated, emotionally void, epidural
birth. The second of which left me
longing for the rich and edifying experience of birth and postpartum which I
had with baby #2.
Women have always wanted and needed support during
childbirth. It is not a time where
women, particularly in our culture, want to be left alone. Women have always wanted and needed support
during childbirth. It is not a time
where women, particularly in our culture, want to be left alone.
Childbirth used to be a women-helping-women event. Then, in
the 50's, doctors were knocking women out and they came to with no memory of
the birth. Recently, in the 70's, came an era of husbands in the birth room,
women having more choices for medication, less sterilization (no shaving down
below, etc.) Men were somewhat thrown
into a sort of rite of passage experience to go to the hospital with their wife
and be the support person. I used to be
naïve as to the pressure that men experienced and really chalked it up to,
"oh well, it's a growing experience and they have to step up to the
opportunity." I read an article by
a renowned French obstetrician, Michael Odent, who wrote on men in the birth
room. In it, he stated how men are not
naturally made up of the nurturing, caring support women need in
childbirth. They are more comfortable as
providers and protectors. It is
difficult to keep their adrenaline from getting in the way. Many men feel much
comfort and assurance in a predicted (medical managed) experience along with a
pain-free epidural experience for their loved one. There is a reason they are not the ones
giving birth, they can barely handle watching the experience (sorry guys, it
just takes a different set of hormones.)
Sometimes women assume doctors will be there to assist them through
labor, however anyone that has at least one child knows that doctors come at
the end to catch (deliver) the baby and do any stitching necessary
afterwards. Next logic would lean
towards the nurses providing adequate support.
While nurses are absolutely vital and completely irreplaceable, they
have a primary responsibility as to you and your baby's physical wellbeing (ie:
blood pressure, fetal monitors, chart notes, etc.) Additionally, they typically have multiple
patients to care for and unfortunately you can't interview and hire them ahead
of time, as to match your personality and preferences.
I knew immediately that a doula did not take away from a
husband's experience, but I had no idea how a doula's presence literally did
the opposite. I have seen husband's be
more calm, supported, and encouraged.
They feel more confident, capable, and participate more. They are less insecure, vulnerable, and
helpless. Husband's seem to stand tall,
engaged, and have a more positive birth experience themselves. They love having a partner on their team when
it comes to helping them provide all the comfort and support their wife
needs. They often have humbling
experiences, oftentimes an overwhelming amount.
I have heard this leads to more help and participation postpartum and a
better father-child bond. A doula has
the ability to bring couples closer together by being a personal guide and
empowering them to use their front-seat ticket of choices and opportunities
through the memorable experience of childbirth.
What a doula does is offer physical, emotional, and
educational support that starts when hired (usually 3rd trimester or
earlier) by way of 1-2 prenatal visits to find out what the couple's wants and
wishes are and how the couple sees a doula being most effective for them. For me, one or both of these prenatal visits
are accompanied by a foot soak, massage and mini pedicure. The support continues with the doula being
on-call generally starting 2 weeks before the due date until the baby is born
(which can be considered normal 2 weeks past the estimated due date.) The client is offered unlimited phone
communication and often access to educating books, DVD's, etc. Once labor begins, the doula is notified and
is on stand-by. She arrives to assist
the couple when they are "ready" for her help (usually at the onset
of active labor.) She then offers her
uninterrupted physical presence through birth and 1-2 hours postpartum.
Prenatally, the doula can offer support by listening to
concerns, opinions, personal stories, and fears. She can offer education via her experience,
education, and understanding. She can
also recommend where or how to get information or support (books, classes,
websites.) Her experience and ability to
understand the natural physiologic process of birth gives a special comfort and
reassurance to husbands and wives individually and collectively.
During childbirth, a doula can provide comfort in many
ways. First is by using physical
modalities that alleviate pain (counter pressure on mom's back, massage, heat,
cold, breathing techniques) and emotional reassurance and mental coping
techniques that create relaxation for the mother (a state conducive to the
hormone, oxytocin, that provides the vehicle that moves labor along.) Those techniques may include guided imagery
and relaxation, music, education, affirmations.
Additionally, ensuring privacy and a birth/mother-centered environment,
nurturing/assisting the father offer physical and emotional support to his wife
(at the participation level he is comfortable with.) A doula
can remind a laboring woman/couples of their options. Those options may include different positions
to labor in (side-lying, birth ball, standing, walking, using the
bathtub). She may remind the couple to
get all the information necessary to make an informed decision (ask for
pros/cons to any recommended intervention like breaking your water, using
pitocin, etc.) A doula will not make
choices for the couple, but will empower the couple to make their own informed
choices. She may also be helpful in suggesting
the right question to ask in order to get the information necessary to make the
best choice for them. The emotional
support doulas provide help women have confidence and trust in their bodies and
in their choices during childbirth.
Postpartum, a doula helps ensure skin-to-skin contact and
nurtures the couple in what is known as the "golden hour." This is where the baby and mother are at
heightened levels of the hormone oxytocin releasing wherein feelings of love,
trust and bonding occur. A doula can
also assist the mother with initiating breastfeeding and providing support or
information postpartum.
An important part of a doulas job is the postpartum
visit. It is where the doula visits the
new mother and baby to check in on them and review the birth experience. Positive memories are emphasized. Things that would be done differently are
discussed and processed. More emotional
reassurance, support and praise are given.
Connections to resources for information and support are given as
well.
Research has shown women with doulas have less requests for
pain medicine (60% fewer epidural requests, 30% fewer analgesia use,) fewer
interventions, better luck breastfeeding, 50% fewer C-sections, 40% less need
for pitocin, and 25% shorter labors. Women
remember their childbirth experiences however good or bad. The love and support they receive, along with
the choices and education they have, help contribute to positive memories.
