What doulas do and don't do: Birth-support workers make experience more positive
The Kingston Whig-Standard
Tue 06 Apr 2004
Page: 21
Section: Health
Byline: Karen Gram
Source: CanWest News Service
VANCOUVER - Judith Law holds her baby girl Acacia away from her body so they can look into each other's eyes while Law coos at her.
"Hello little worm," she says, using the nickname her seven-week-old daughter earned for all her wiggling in the womb. "Is it time to eat?"
She sits on the couch and Acacia easily latches on to her breast. Law continues to coo encouragingly.
This quiet domesticity is a far cry from the in-control businesswoman Law was not that long ago, travelling the globe, eating in restaurants and playing squash. Law continues to be amazed at her own ability to switch gears and spend all day with a baby.
"I thought I would throw myself off the balcony after three weeks," she says with a laugh, pointing to the ground-floor patio outside. "But now I have separation anxiety."
It's thanks in part to her doula, or birth-support worker, that Law feels so confident now. As a first-time mother, Law and her husband, Neil Philcox, wanted a friendly, experienced face at their labour.
"I had the overwhelming sense of not knowing how to prepare for labour or breastfeeding," says Law, recalling that the labour was long and very painful and the doula knew what to do to make her as comfortable as possible.
"Spouses need coaching too," she says. "Especially for emotional support and how to physically support me."
In an effort to make the birth experience more positive and less medical, western medicine has moved to allow husbands - then husbands and other family, then anyone the mother wants - into the delivery room.
Midwives have become standard and delivery rooms have become almost extinct. Now we have birthing rooms painted pink or yellow. There is art on the walls, dimmer switches and birthing chairs and balls rather than just a bed.
But doulas are the latest big trend in childbirth. Unlike midwives, doulas do not deliver babies. In fact, they don't do anything clinical. They don't read the fetal heart monitor, or recommend medical therapies, or take blood pressure. Nor do they challenge the medical staff on treatments. All of this makes them much more welcome by doctors at a birth than midwives were when they first came on the scene.
Doulas make eye contact, protect dignity, relieve anxiety and relieve pain using non-interventionist techniques. They stay with the client continuously, sometimes acting as an intermediary between the medical staff and the client.
They make sure medical staff read the client's birth plan and do their best to help the client adhere to it, appreciating that you can't always control the birth experience. They often provide translation services for women who don't understand medicalese.
The service costs $300 to $1,000 for the entire birth experience depending on how much pre- and post-natal care is included.
According to a number of studies, the introduction of doula services during birth is what has really made the difference in terms of reduced medical interventions and positive memories.
In one study conducted in a hospital setting, Dr. John Kennell, professor of pediatrics at Case Western Reserve Medical School in Cleveland, Ohio, and a pioneer in the field of perinatal health care, found that doula care reduced the need for a caesarean section by 50 per cent.
He and his colleagues also found doula care shortened labour by 25 per cent and reduced requests for epidurals by 60 per cent. It also increased the incidence of breastfeeding and the satisfaction of mothers and their partners at six weeks post partum. Other studies have corroborated the results, though not always with the same percentages.
But isn't the father supposed to be the coach, encouraging proper breathing techniques and helping the labouring woman to focus? Isn't he supposed to talk to the doctors and nurses and relay to them the needs of the mother?
The father plays an important role in the birth, says Jalana Grant, a doula for 21 years. Doulas are not there to replace them. "But it is not fair to ask a man to coach a sport he has never played and probably never even seen before. Having husbands in the room did not change outcomes at all."
Indeed, she says, women often love their partners more when they have had a doula. It takes the pressure off, she figures.
Law's doula couldn't prevent the emergency caesarean section she needed to give birth to Acacia, but she made the difference during 20 hours of pain up to that point. Law suffered constant excruciating sciatic nerve pain down one leg, plus terrible pain around her coccyx, all of which was topped off with labour contractions.
The doula, Jan Nusche, took care of the sciatic pain and contractions and assigned Law's husband to the coccyx. She massaged for hours, recommended changes in Law's position and got her into a bath with a ball so she could get some water pressure on her back.
She knew what she was doing, says Law. "My doula had done over 100 births and she was able to say at the 20th hour, 'you are exhausted, these are your options.' "
At that point, Law opted for the epidural, which relieved her pain but resulted in a sudden drop in the baby's heart rate. Law was rushed into surgery and Acacia was born by C-section. Still, Law was glad for her doula's support. When she came out of surgery, Nusche was still there, wanting to make sure Law didn't have problems helping her baby start breastfeeding.
Doulas - at least those certified by Doulas of North America, the continent's largest doula organization - have strict standards of practice and a code of ethics which limits their role to non-clinical emotional and physical support. The standards stipulate that doulas must not speak for the client, but just help them to speak for themselves by providing the information they need.
It's a service that the medical establishment is starting to notice. Obstetricians and GPs now welcome doulas into hospital birthing rooms. Across North America, health authorities have established doula programs to meet the needs of particular population targets.
In Chicago, a program trained teen mothers to become doulas for other pregnant teens. Operation Special Delivery provides free doula services to U.S. women preparing for birth while their partners are deployed overseas and the Pacific Association for Labor Support offers doula support to incarcerated women who would otherwise give birth in the company of prison medical staff and a prison guard.
In South Vancouver, a doula program is getting under way to meet the needs of the many immigrant women in that area. With a $300,000 budget over three years funded by the Vancouver Coastal Health Authority, the program has trained 18 women who speak multiple languages in the intricacies of doula services. They plan to provide a free doula at 350 births each year, about a quarter of the births in that area.
"We wanted to figure out how to do things differently," says Dr. Sue Harris, who founded the program with midwife Lee Saxell. Harris said South East Vancouver is bereft of caregivers for prenatal care and childbirth.
"We couldn't actually find any family physicians, no midwives and no obstetricians either. We felt this was an issue in an area with a high immigrant population. They had needs that weren't being met."
In focus groups, they learned that women in that area did not feel they got enough time with their physicians, were not getting their questions answered and felt disrespected.
Harris says she is confident that having a doula will go a long way toward improving their birth experiences. As an attending physician, Harris has experienced firsthand the benefits of doula services many times.
But recently, she attended a birth in which both the labouring mother and her spouse were extremely anxious. The doula was so effective that the woman gave birth without using any pain medication except gas.
"I have seen positive doula support before, but it was even more important to this woman. I am more sold than ever."
It was pretty important to Law as well. She says she entered into the labour with the confidence of a well-prepared businesswoman, expecting things to go her way. "But at the end of the day, everything I did not want or expect to happen happened."
That is where the doula came in. She was able to help Law get her head around it all.
"I feel like I have made a friend."
DOULAS IN KINGSTON
Childbirth Kingston keeps a doula registry. To find a doula in this area, call 384-7774.
Online: www.childbirthkingston.com
E-mail: info@childbirthkingston.com
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