My Essay written for doula certification

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 3^rd 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.