Demaris Rae Bruce is state certified as a Massage Therapist and as a Doula by DouLA Birth Partners of Los Angeles, DONA certification pending. She provides prenatal and postpartum massage (with the use of the Prego Pillow™) and labor support throughout the Los Angeles,Ventura, and Santa Barbara counties. Her business, A Mother’s Touch, offers full postpartum care in the home to new mothers and families in the immediate postpartum period.
…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 form 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 squat or other positions that require strong physical 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 midwives. 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 often are required to attend childbirth 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. Evaluations on each birth observed are prepared by the student doula and discussed with her mentor, or 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 two national organizations offering certification: DONA (Doulas of North America) and NACA (National Association of Childbirth Assistants).
When interviewing a doula, parents should consider their anticipated needs and desires with regard to their birth plan and should 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 birth? How does she see her role during early labor, and later at your birth? What is her fee, and does it 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, in the Wet Set Gazette classifieds, 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 capable hands. Most doulas have them!
When considering the presence of a doula at your birth, keep in mind the documented benefits, according to Klaus, Kennell & Klaus, a birth doula can offfer: 50% reduction on cesarean rates, 25% shorter labor, 60% reduction in epidural requests, 40% reduction in oxytocin (pitocin) use, 30% reduction in analgesia use, and 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 misconception. 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, she models ways of being helpful to the mother in a positive way, allowing others the opportunity to be of assistance as well.