{new post} Why Hire a Birth #Doula

Guest Post: Tara Owens-Shuler

At my 10th year high school reunion in 1998, I received an award for having the most unique career as a Doula!  When I told my classmates that I was a birth doula, many of them asked, “You are a what?”  Doulas, a Greek word meaning “with woman”, are now more familiar in the birth community and being hired more often by women and their partners. So, what is a birth doula?

Doulas are like community health workers or patient navigators for expectant women.  We provide continuous physical, emotional, and informational support to laboring women and their partners. We do this three ways:

• provide informal education and social support; 
• help women connect to community and hospital services or resources;
• assist women in evaluating and preparing for safe and healthy birth practices during labor. 

In the current hospital settings, neither the nurse nor the doctor will remain by the bedside continuously. Doulas, on the other hand, are continuously by the bedside and provide constant support to women and their partners. Doulas do not replace the husband, partner, or other family member, we assist them with skills to better support their loved one.  Doulas help families advocate for themselves by helping them ask the right questions to get the necessary information to make informed decisions.  

A review of several research studies summarized that women who are supported by a doula during birth are:

• less likely to have a cesarean; 
• less likely to use any pain medication in labor; 
• and more likely to report greater satisfaction with their birth experience. (DONA International Position Paper).   

So, even with the credible research that strongly supports the impact that professionally trained birth doulas have on birth outcomes and satisfaction, I am often still asked, “why hire a birth doula?”.

Women hire birth doulas for all of the labor support and evidence-based reasons above and more. Expecting women who want to become more informed consumers of healthcare hire birth doulas because they offer informed, evidence-based education. Women who want to feel empowered and confident going into the childbirth experience are also ones who hire a birth doula. And women who want to feel a part of the decision-making throughout their labor are more likely to hire a birth birth doula and afterwards report feelings of satisfaction with their birth experience.

The comments below, from some of my former clients, illustrate just how much women do value the labor support services:  

“…cannot express how much you helped this be the ideal birthing experience.”

“You made the whole experience much easier and to some extent enjoyable.”

“Knowing we had your support gave us such confidence.”

“It was invaluable to have you on our ‘team’!”

One of my favorite quotes, “If a doula were a drug, it would be unethical not to use it (Dr. John Kennell)”,  speaks to why I advocate for women to hire a doula for their birth!  We are an important member of your birth team and provide immeasurable support.  

If you are interested in finding a doula for your birth, a great place to start is the DONA International website.  You can search by State and City to find doulas nearest to you.  You can also ask friends, co-workers, or family members, who have used birth doula services.  

About Tara:

Tara Owens Shuler, M.Ed., LCCE, FACCE, CD(DONA) is a Lamaze Certified Childbirth Educator (LCCE) and a certified DONA birth doula.  She is currently the Past-President of Lamaze International, having served on the Lamaze International Board of Directors for the past 5 years.  She’s a leader and advocate for women being informed and educated on evidence based birth practices.

In her spare time, Tara teaches Lamaze childbirth education classes at Rex Hospital in Raleigh, NC and independently in Durham, NC through The Birth Library.  She provides doula services to women across the Triangle area. 

Note from Elizabeth: This piece from HuffPo that came out late last week underscores Tara's mention about how doulas lower c-section rates. It's absolutely worth a read.

{new post} #bookreview : The #Doula Book

I am coming to The Doula Book recently via my When Survivors Give Birth Educator training. When I was pregnant, I was very sure that I wanted a birth doula, especially later on so it didn’t occur to me to seek out a book to help me make this decision. But after reading it, I’m so glad that I did find it because it is just a terrific resource for a first time pregnant woman and her partner as they navigate the journey of education and decisions toward their childbirth experience. The Doula Book examines all facets of what it is like to have a trained labor companion, or birth doula, accompany a woman and her family during childbirth as well as the why’s and how’s about  this decision. 

The authors of The Doula Book, two medical doctors and a family therapist, look at the issue of a doula from all possible angles including medical and emotional reasons why a pregnant woman might look to support from a doula. I think this is one of the strongest aspects of the book. It feels like there are a lot of books that look at what is happening with the woman, physically, over the course of her pregnancy but not as many that focus on the whole person, as this book does.

As an example, the book talks about doula “basics” that one might expect (a doula might suggest different positions for the laboring woman, experienced doulas are respected by medical personnel, etc.) but beyond the practicality, there is as strong an emphasis on the emotional support that the doula provides.  And this piece is especially important for women who are survivors to be aware of.

All women are wary of labor and many do fear it but survivors have an entirely different set of challenges when it comes to childbirth. The Doula Book does an excellent job of talking about, in a more generalized way without mentioning survivors, how triggers (“excretions, sounds, sights, smells, cries or screams may trigger old memories of hospitalization or elicit other unexpected reactions.” 47) can come up in childbirth and why a doula is such an important person to have on hand to be there for the laboring woman. Later on in the chapter called “Reducing Discomfort, Pain and Anxiety”, the authors talk about reducing stress in labor and the flight / fight response. The connection is made back to the doula whose purpose is to create that cocoon of support and care that laboring women need in order to feel protected and informed enough to birth their baby. By telling us “Letting the woman say what she wants is the cornerstone of doula care. ” (69), the reader can see why this is so important in labor, especially for the survivor.

The Doula Book is a rich resource for the evidence behind using a doula in childbirth. For those science-y, non believers, there is plenty of research in the book that talks about the relationship between satisfaction with the childbirth experience; the numbers in studies that looked at the relationship between having a birth doula and the prevalence of sections and much more. But for the pregnant woman who might need to hear more about why the emotional support that a doula is so crucial, The Doula Book will become her go-to guide.

And if you are local pregnant woman looking for more emotional support, remember my support group: 2nd Thursday of each month (this Thursday!) from 6:30-8:30 pm at Outside The Mom Box offices, 1200 Broad Street Suite 104 in Durham.

Knowing instead of assuming

Genevieve Paiemont-Jacobson's recent piece in Salon trashing both her birth and post-partum doula has gotten a lot of attention.  Most of the comments following the article seem to blame Paiemont-Jacobson for the negative experience she had.  I agree in part but I think the bigger issue are the assumptions she had about her doulas-

First, most birth and post-partum doulas (because there are two kinds) are independent contractors.  They work for themselves which means that they do all their own marketing, vet their own clients, are themselves on hand for the job that they were hired for.  Except, of course, when they're not.  Like other professionals, doulas have clients other than us.  And while I do think that many birth doulas tend to overbook themselves, it's important to remember that there is still a customer and a provider here.  If Paiemont-Jacobson wasn't comfortable with the possibility that her birth doula may be at another birth when you go into labor, she shouldn't have booked that doula.

Secondly, birth doulas aren't angels who, if on hand at your birth, ensure "smooth sailing and rainbows and unicorns".  They are real people without magical powers. Yes, having a birth doula can reduce your chance of a C-section.  But it's no guarantee against unexpected complications, such as the ones that arose at Paiemont-Jacobson's birth.  Same for post-partum doulas.  At our intake conversation, my post-partum doula clients are provided with a clear list of what they can expect of me during my time with them and what is not included.  Missing that, I can see why Paiemont-Jacobson feels she was "ripped off" but, to be fair, some of the blame does rest with her for not getting the information she needed by asking the right questions. 

Pro tip: Both kinds of doulas are providers, like any other. Interview carefully in advance to make sure you are hearing what you need to.

Thirdly, it sounds as if Paiemont-Jacobson assumed her birth doula was also a childbirth education expert. Whether she was misled by the birth doula or if she just connected these disparate dots doesn't matter.  What's disturbing is that Paiemont-Jacobson still remains misinformed about the role of a birth doula in childbirth.  My own birth doula recommended a wonderful CD to help with relaxation and visualization but my husband and I took childbirth classes with-you guessed it!- someone trained as a childbirth educator. Birth doulas are real people.  

Pro tip: If a resource is recommended to you by your birth doula, or anyone else, check it out. But taking any recommendation as insurance isn't smart.

Rachel Gurevich over at Womb Warrior made a good point in our Twitter exchange about this article: "more time to process would have helped,".  A natural place for processing your birth experience is with your post-partum doula.  I spend a great deal of time, really as much as they need, with new moms on processing their birth experience because it is so important. But Paiemont-Jacobson's experience with hers was so completely lacking that I imagine the processing piece was absent too. Which is a shame.  It is essential for women to process their birth experience (I wish I'd done this!) no matter what kind of birth they have.  And often that's difficult to do, whether it is because of preconceived ideas about childbirth or because we lack someone with whom to speak frankly and emotionally about our birth experience.  This is one of the reasons that I offer a service called NewMamaLuve with this idea in mind.

A lessons learned piece from Genevieve Piedmont-Jacobson would have not only served other pregnant women and informed the general public but gained her more sympathy for her experience and perhaps even greater respect for her writing.  Her anger isn't the problem; her assumptions are.