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Tuesday, 14 January 2014 17:06

Doulas: Who Are They?

To tell you the truth when I first heard the word "doula" I could only think about homebirth and mothers who totally reject anything which is in connection with hospitals. Then the more I learned from them, the more I started to believe that every woman really needs a doula before, during, and after birth. During this journey I got a lot of help from Anikó Földi; a doula who helped me create this writing with a great interview.

Note: I live in Hungary (Central Europe) where things are pretty different from the USA. A lot of women there don’t even know that doulas exist.

-- How can ’being a doula’ be defined briefly?

-- A doula is a woman who has personal birthing experience;[1] a supporter who helps the pregnant woman when and in what way she needs the most. But she doesn’t decide anything for the mother.[2]

-- What kind of tasks does the doula have during pregnancy, birth, and postpartum?

It depends on what the pregnant woman wants. The doula can help make head or tail of the big amount of information; help the mother make decisions based on authentic information; and help prepare her for the birth. If it is needed she is there during the labor either via phone or personally. These are all individual decisions. It can also depend on the doula to what extent she can assume helping beside her own family.

-- In case of a c-section, how can a doula help the mother? Can she enter the operating room?

Unfortunately in Hungary doulas are “persona non grata” in the hospitals, not to mention the operating rooms. Fortunately there are exceptions, for example where there is an opportunity for the father’s presence in the operating room, then a doula may also enter.

A doula can be a big help in case of a c-section, in caring for the baby, effectuating skin contact, supporting the mother physically, helping the mother spiritually and mentally, and of course every other way that the family needs.

-- In case of homebirth what is the doula’s scope? Does she have any responsibilities?

Doulas are "laymen.” During a homebirth a doula cannot take the competencies of the midwife; it is not her task or responsibility to follow the medical / physical condition of the mother and the process of labor professionally.[3]

In Hungary during a homebirth two skilled midwives have to be present, it is regulation. The professional responsibility is theirs. The task of the doula is the same everywhere; they support the mother in what she needs: compress, massage, physical support, etc.

-- What kind of legal background do doulas have?

As the doula is a supportive person, she doesn’t have any legal or medical responsibility. Unfortunately being a doula in Hungary is not an official profession. (Although her presence should be allowed in hospitals as it is stated in the medical law of 1998 that "Every woman has the right for the presence of a major person chosen by her, during the whole birth process”)[4]

-- Is there official doula training? How can someone learn to be a doula?

There are many schools in Hungary (MoDulE Doula Training, Dona Doula Training, Békés (Peaceful) Doula Circle). In every school training is a bit different, but it usually lasts for some days to learn about being a doula, about the birth itself and the postpartum period. You can learn from authentic lecturers and therapists. As for Anikó, this beautiful world – motherhood, childbirth, being born - opened for her after the birth of her first child. It called her with such power, and more and more information got into her way that she realized she was sitting on a MoDulE training.

-- Can a doula work as it is her main job? What kind of "salary” does a doula get?

As it is not an officially registered job in Hungary, you cannot do it as your main job. The other reason for it is the responsibility towards your own family. Beside a family a doula cannot assume more than 1-2 births in a month.

As for the compensation, every doula works with different rewards. Some are volunteer, some work for a one-time salary, and some are paid after every meeting. Anikó works for about 140 US dollars during the whole pregnancy, birth and postpartum period.

-- For whom is it recommended to hire a doula?

Mostly in those cases when the mother feels that she is looking for the best way for her; she needs authentic information and wants to make head or tail of birth. For mothers who want to be in labor and give birth in the presence of a supportive person. Anikó believes that it is the biggest wonder of a women’s life when she gives birth. Women have this special power, which cannot resemble anything in the world. It’s a special joy if it can happen in an unmedicated (untroubled) way. So Anikó can recommend a helping doula to any woman who has the desire for any of the above mentioned things.

Resources:

[1] MODULE egyesület http://www.module.hu/index.php?option=com_content&view=article&id=111&Itemid=76

[2] Kovács Katalin: A dúlaságról http://www.katadula.hu/a_dulasagrol.html

[3] Békés dúlakör Működési szabályzata

[4] MODULE egyesület http://www.module.hu/index.php?option=com_content&view=article&id=111&Itemid=76

Published in Birthing Assistance
Wednesday, 09 October 2013 15:58

What Doulas Do

The word doula comes from an ancient Greek word that literally translates “woman’s servant.” That is great for an anthropologist, but it doesn’t really explain much about the modern women who attend birth. Some people confuse the services of a doula with the services of a midwife, yet some doulas are also midwives. Each doula brings a unique set of skills and attitudes to her clients, but all labor doulas support laboring women and their partners during birth.

Doulas are often (though not always) specially trained and certified by organizations. Doulas of North America (DONA), Childbirth and Postpartum Professional Association (CAPPA), and Childbirth International are three of the largest certifying groups in the US. To become certified, a doula must educate herself through research and required reading, attend a training workshop, and submit positive evaluations of her performance during 2-3 births. Some doulas have chosen not to become certified, but may have completed any or all of these steps and possibly more.

Doulas are not medically trained, however, some doulas may wear more than one hat. Some are also registered nurses, massage therapists, or midwives. The role of a doula doesn’t require any of that. Doulas can provide information, suggestions, and support, but not diagnosis or treatment. They place an emphasis on service and caring for parents both physically and mentally.  Doulas are appropriate in any birth setting, but are especially effective in hospital births.

Early research about supporting women during birth found that simply having a more experienced woman in the room with a laboring mother reduced her anxiety and pain. Doulas start there and expand, often meeting women prenatally to address concerns and provide education. During labor, in addition to being a comforting background presence, doulas provide suggestions and support on a wide array of topics.

A doula can recommend positions to help speed up a slow labour. She can apply techniques for reducing pain and positioning baby. For example, if a baby is sunny side up (posterior), a doula will encourage a mother to be on her hands and knees so that the baby is more likely to spin around to a better position. If a mother is experiencing a lot of back pain, doulas can massage and use counter pressure to help her deal with labor.

Doulas support birth partners as well. They can prepare Dad ahead of time with what to expect and provide suggestions during labor about how he can best help the mother. Possibly her most important role is someone who brings water and snacks to tired parents while frequently reassuring them that they are doing well. Especially for parents who are new to birth, just being reminded that everything they are experiencing is normal comforts and reassures them enough to walk the twisting road of labor with confidence. Women who are undergoing a cesarean can also benefit from the knowledge and experience of a doula.

Occasionally, doulas are called upon to act as mediators between hospital staff and clients. Though doulas don’t speak for parents, they often help them to understand procedures and suggestions as well as act as ambassadors between clients and care providers.

Most doulas remain present with the new family after the birth to make sure that their needs are met and that breastfeeding gets off to a good start. Many doulas follow up with clients in the early days of postpartum recovery to provide advice about breastfeeding and baby care. Studies suggest that women who receive this kind of early support have more successful breastfeeding relationships and lower rates of postpartum depression.

If you think a doula is a good idea for your birth, meet one and learn more.

Published in Birthing Assistance
Monday, 30 September 2013 23:34

The Secret to CALM & CONFIDENCE in Childbirth



  

The Secret to 
CALM & CONFIDENCE  in Childbirth
 
 
With Excerpts from New Mother
 
Throughout my thirties I watched not one or two, but almost all my friends enthusiastically enter the hospital in labor, having claimed for nine months that they would have a natural birth. Yet they came out two (or ten) days later having been induced, forced to labor on their back, drugged, cut, and observed by countless strangers. Their babies had been taken from them immediately after birth and they were having problems nursing.
I wondered what had gone on behind the doors of the L&D that all of them were checking out with dramatically altered birth stories.
In my third trimester I attended an all-day birthing class at a store for new moms and babies. The women in attendance were from around the world, highly educated in their fields of work, and well to do with all conveniences of life available to them.
And yet... here are some things I heard during class:
• “I’ve heard that babies nurse every two hours when they are born, but I sleep about nine or so hours per night. What will happen to my breast milk during the nine hours that I’m sleeping?” (after telling the class that her father was an OB-GYN).
• “I’ve never heard of a birth without an epidural... I didn’t know it was possible.”
• “What is the areola?” asked on learning how to help the baby latch.
   Not one had considered a homebirth.
   Not one had considered a natural birth.
• “How much is it going to hurt?” and “How can I avoid the pain?” were the primary concerns of almost all in attendance.
Although I had already studied so much, explored, and found quality help, I attended the class to learn more about childbirth and postpartum care of baby and mom. But these women were only now seeking education and help.
What they received, though, was a lecture about towing the industry line:
• You will have an epidural and likely other drugs.
• There’s a high chance that you’ll have a C-sectionand the instructor showed a video so we "could know what it looks like and be prepared." (I left the room.)
• Postpartum instruction: if you are going to drink wine, pump first—if you breastfeed—or “pump and dump” after you drink.

How could women feel calm and confident about labor with that lack of knowledge and the guidance offered in such a class?
Women were being trained to think of childbirth and postpartum as a “procedure”—to be endured and gotten through as quickly and painlessly as possible—and to rely entirely on a system that was treating them as a “workforce” and “profit center” rather than a family being gifted with another spirit in their lives.
There was no focus on natural childbirth. No mention of home birth. No discussion of postpartum as a healing, bonding, growing, significant, and once-in-a-lifetime experience for mother, father, and baby.
A treasure lost for those parents and babies. Precious, fleeting time and experiences that will never come again!
I had a different vision for my childbirth and postpartum experience, and I believe if those women in class, and thousands—if not millions—of other expecting moms knew of other options, if they knew they could get natural, loving, nurturing help, they would create a different vision for their own childbirth and postpartum time.
A great percentage of women in the U.S. spend two to four years after high school in education and preparation for the workplace. We are even willing to take out enormous loans for the cause.
Then when it comes to motherhood, we throw ourselves into the most important role of our lives with little study and no training— subject to tremendous influence from the medical industry, Hollywood, and other commercial enterprises—reliant on professionals to do it for us, whether “it” is conceiving, birthing, or raising children.
Doesn’t our role as mother and homemaker deserve commitment, study, and investment as we give to any job in the workplace?
If you’re like I was—with your intuition hinting that something better than the norm is possible—but without knowing what a doula really does, not knowing what really qualifies a midwife, and certainly not knowing what kind of help you’ll need postpartum (but hopefully knowing you will need some), I’ve got a suggestion for you: 
We’ve been encouraged to concede our knowledge and experience of childbirth to the medical industry—but that’s exactly why so many women are fearful and end up with altered birth stories.

As with preparation for any task we want to do well—be it a test, a job interview, creating art, etc.—we must study, research, practice, watch DVDs, talk to friends who chose a similar path, look for teachers and help with congruent practices and beliefs.  
  
Let's take back and own our childbirth experience: study; find help and support congruent with our desires; do our best; then forget the rest.
That’s the secret! Knowing we've done our best we can release our fear and concern about the outcome, and move forward with calm and confidence.
If we really prepare ourselves with knowledge and support, we can go into any task—even childbirth—with confidence and calm. 
After we’ve prepared to our best ability and found that place of calm confidence, we can respond to and handle whatever develops in the process, and live happily with the outcome—even if it isn’t exactly as we planned.

For those interested in learning more about natural childbirth, here are some recommended titles to get you started:

 

Ina May's Guide to Childbirth, by Ina May Gaskin

Doulas by Midwifery Today

and my book, New Mother

 
 
Wishing you joy on your sacred journey of motherhood!
 

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