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Is Doula Care For You?

Maurenne Griese, RNC, BSN


....A Doula "is a woman experienced in childbirth who provides continuous physical, emotional and informational support to the mother before, during and just after birth." (Klaus, Kennell & Klaus, "Mothering the Mother.")

As the benefits of continuous physical and emotional support in labor become more apparent, many expectant parents are seeking out the services of doulas, or trained birth assistants. What exactly is a doula? What training and qualifications does the doula undergo to become certified? What attributes should the parents interviewing a doula look for? And most importantly, what are the benefits of continuous labor support? The focus of this article will be on the birth doula, even though postpartum care doulas are also becoming increasingly popular with many new mothers. The term doula is from ancient Greece and loosely translates as 'slave' or 'servant' (to give service). Doulas provide informational, emotional and physical support (service) throughout their relationship with the mother. Physical comfort measures used during labor can include massage, counter-pressure, gentle touch, and literally supporting the laboring woman's body weight during a strong contraction. Positioning and frequent position changes are proving to be helpful in labor progress; doulas often help mothers in a squat or other positions that require strong support. Emotional comfort is essential if the mother is to feel safe and secure in the birthing environment, which is highly important according to Michel Odent, French Obstetrician and longtime pioneer in the area of improving birth practices and techniques in the 20th century. Informational support helps remind and inform the birthing couple when labor doesn't progress as expected; in these instances, strange people with strange machines and equipment offer technological assistance that is somewhat confusing and frightening to the mother-to-be and her partner. A doula, with her knowledge of the natural physiology of labor and delivery can explain suggested medical procedures and interventions and help provide the clarity expectant parents need when faced with difficult decisions. A doula does not, however, function in any medical capacity and does not ordinarily use any clinical skills. Labor assistants with clinical skills such as those used by nurses (fetal heart tones, blood pressure checks and vaginal exams) are called monitrices, and are usually professionally trained as nurses or midwifes.

In order to become a doula, academic study combined with practical experience is required. Prospective doulas study the anatomy and physiology of pregnancy from conception to birth, and are required to attend childbirth preparation classes such as Bradley or Lamaze. Attendance and participation at many different types of births is mandatory, usually accompanied by a trained doula, midwife or labor and delivery nurse. Birth evaluations on each birth observed are prepared by the student doula and often discussed with her mentor, or a senior doula. Reading assignments and book reports are also required. There are local and regional trainers that offer courses of various lengths and duration, and national organizations offering certification such as DONA (Doulas of North America) and ALACE (Association of Labor Assistants and Childbirth Educators.)

In interviewing a doula, parents should consider their anticipated needs and desires with regards to their birth plan and consider the following: What training and experience does the doula have and what is her certification status? How many births of different types has she attended? Has she worked with your care provider and at your place of birth? How does she see her role during early labor, and later at your birth? What is her fee, and does that include prenatal and postpartum visits? Does she have back-up arrangements? Doulas can be found through the various organizations that offer childbirth preparation classes, your care provider, your anticipated place of birth, lactation consultants, and quite often through baby specialty stores. Ask the doula for references and meet with her personally after an initial phone conversation. Look for clues that will tell you about her personality and attitudes to ascertain if your beliefs are compatible. Look for signs of a warm heart and strong, sure and capable hands. Most doulas have them!

When considering the presence of a doula at your birth, keep in mind the documented benefits a birth doula can offer. (Klaus, Kennell & Klaus.)

50% reduction in cesarean rates 25% shorter labor 60% reduction in epidural requests 40% reduction in oxytocin (pitocin) use 30% reduction in analgesia use 40% reduction in forceps delivery

The birth of your baby is a momentous occasion and many couples are concerned that the doula somehow infringes on the father or partner's role as labor coach. This is a sad misperception. Doulas are usually very respectful of the intimate bond between mother and her partner and other family members, and will often work in the background to encourage participation and develop confidence in the support team members. By demonstrating her training and skills in a quiet and calm manner, the doula models ways of being helpful to the mother in a positive way, allowing others the opportunity to be of assistance as well.

My name is Maurenne Griese, RNC, BSN . I am a certified childbirth and breastfeeding educator and have a bachelor of science degree in Nursing. I am also a Registered Nurse and am board certified in Inpatient Obstetrical Nursing. I have been a writer for as long as I have been able to write! From essays in grade school to articles in professional journals and parenting magazines, writing has been a passion of mine for most of my life. Of course, I like to write about what I am passionate about, that being pregnancy, childbirth and breastfeeding. I have my own website for my home-based company, Birth and Breastfeeding Resources, at I sell baby slings and breastpumps from this site.

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