Doulas: Another Birth Attendant Option

What is it?
The term doula refers to a supportive companion, other than a friend or loved one, who is professionally trained to provide support during labor and childbirth. There are also post-partum doulas who are experienced in providing care for the family after childbirth. Such care may include mother and newborn care, breastfeeding support and advice, cooking, errands, and light cleaning. They can do overnights in those first days and weeks and let mom get some sleep. This is where they help the most. Even if you don't think you need support during birth, to have them afterwards is worth. But, keep in mind that moms' view of douling in the exact opposite of theirs. Doulas want to be at the birth and consider the post-partum domestic help less desirable. As a result, it is almost impossible to find a post-partum doula only. And some will promise a lot of post-partum help, but not follow through once the birth is over. It is wise to make sure your contract pays as much toward the end as possible to discourage abandoning you for another birth, or just her own kids and responsibilities.

The Role of a Doula
Doulas provide physical and informational support to women and their partners during labor and birth. Such support includes help and advice on breathing, relaxation, massage, and positioning. Doulas also give assistance to families in finding information about labor options. Perhaps most importantly, a doula is there to give continuous emotional reassurance and comfort. In short, a doula provides any sort of help that a woman and her partner may need so that the woman has a safe and satisfying childbirth. However, a doula is not trained in any medical skills and thus does not perform any clinical tasks. Consequently, a doula is an addition to an obstetrician, not a substitution. Since she is not licensed, she has no automatic requirement to keep whatever she learns about your medical history secret. Make sure your contract (and always get a written contract) has a confidentiality clause.

A doula does not take the place of the partner. She is there in addition to the partner and, ideally, she and the partner provide a support team for the woman. For those partners who feel uncomfortable giving help, they can rely on the doula. A doula can also assist a father who wants to play an active support role and guide him in ways to help his loved one during labor. Partners other than fathers (lovers, friends or family members) also are helped by the doula.

Finding a Doula
Finding the right doula to assist you during labor should be a careful process. Some helpful information to find out about potential doulas is what kind of training they have had, what their experiences with childbirth are, and at what point in labor they join the women. You should also find out about their philosophy. Many doulas are training to be lay midwives. They may have a hidden agenda about how your birth should be. They end up nagging you to go without safeguards and pain releif. You should find out their fees and ask them to provide references. Find references from women who share your preferences. It is also a good idea for both you and your partner to meet the doula before deciding on her. The most important thing is that you feel comfortable with her, since she will be helping you through one of the most difficult and exciting times in your life.

To find a doula you can contact Doulas of North America, any organizations dealing with childbirth, your hospital or birth center, your childbirth educator, or your doctor or midwife.

Advantages of a Doula
There has been a lot of research on the impact that having a doula has on a woman. Findings suggest that introducing a doula during labor may improve the bond between the mother and infant through her post-partum help and the workload she takes off the mom, especially moms with older kids under foot. They are associated with decreases the incidence of complications, but that is simply a function of the fact doulas are asked to leave when complications develop and high-risk women tend not to have them in the first place. There are reports that breastfeeding is also enhanced. Women who have a doula express greater satisfaction with their birth experiences and even experience improvement in their self-esteem. Again, this seems to be more a function of the fact that less complicated births are the ones that tend to have doulas, and the lack of sleep deprivation and stress with post-partum doulas rather than anything the doulas do during birth.

Services and Payments
There are two types of doula services: independent doula practices and hospital or agency doula programs. Independent doulas are employed directly by the parents. They usually maintain telephone contact leading up to the birth and have at least one prenatal meeting with the parents to establish a relationship. The doula arrives when labor begins and stays with the woman until after the birth. An independent doulas service usually includes a postpartum meeting to discuss the birth. Most charge a flat fee for their services, but some base their fees on a sliding scale. A good estimate of the cost of a doulas services is around $350 and continuing up from there. This would include two prenatal visits, labor support, and a postpartum visit.

Some doulas are associated with a hospital or community service agency. In some situations, the hospital or agency contracts with an independent community-based doula group to provide women with doulas. Other hospitals or agencies train and employ their own doulas. A rotating call schedule ensures that one or more doulas will be available at all times. One potential downside is that doulas provided through hospitals and agencies meet the woman for the first time and establish their relationship during labor. Some hospitals or agencies even provide backup doulas. Most doulas provided by hospitals and agencies are paid for directly by the clients.

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