Tuesday, November 19, 2013

Birthing options: Doulas


We've come a long way from the 1950s, when my grandma was apparently so heavily sedated that she couldn't remember giving birth. We have so many options compared to generations that came before us. I asked my friend and doula Jenne Erigero-Alderks to give us the scoop on what having a"doula" actually means. You can read more on her blog, Descent Into Motherhood. Feel free to post any questions in the comments-- I am sure she would love to answer them. 

Time and time again, we continue to be amazed by how few people know what a doula is. There seems to be a varying level of misunderstandings as well, regarding what a doula is and what a doula actually does. In this post, we hope to introduce you to a profession and concept that is both ancient and has the potential to dramatically improve the modern birthing experience for every childbearing woman.

"A Doula is a word that has most closely become associated with a woman who provides nonmedical support during labor and birth, and also the postpartum period. The term can also be used to describe other supportive roles for other life events such as abortion, death and more." [1]

Let's start with the basics. Doula is pronounced DOO-luh (noun) and is a woman who assists another woman during labor and provides support to her, the infant, and the family after childbirth. There are two main types of doulas, Birth Doulas and Postpartum Doulas. Doulas are evolving to provide unique skills in other areas of life as well: Antepartum Doulas, Bereavement Doulas, Adoption Doulas, to name a few. I don't know any personally, but I've even heard of Divorce Doulas.

Doulas aren't anything new either. In fact, the word doula dates all the way back to ancient Greece, meaning "female slave." Greek labor supporters began referring to themselves as "labor companions" or "birthworkers" after deciding they didn't want to interpreted or treated as a slave, as the historical definition depicts. Even the word “gossip” derives from the Saxon women who were invited to attend  birth and support the laboring mother. Dana Raphael, an anthropologist, used the term for experienced mothers assisting new mothers in labor, breastfeeding and newborn care in Tender Gift: Breastfeeding (1973) It wasn't until Marshall Klaus and John Kennell, physicians and authors, conducted clinical trials on the medical outcomes of doula-attended births that the word doula was brought back to life to refer to those who provide labor support.

Not too long ago a woman contacted Angie inquiring about her services as a local Seattle
Doula. She said very little over the phone but wanted to schedule a free consultation as soon as  they could. The following day, She met her and her husband at a local coffee shop. Angie writes,

"At first I thought I was approaching the wrong couple because they had such a quizzical expression on their faces. As we began to talk and warm up to one another the husband sat back in his chair, crossed his arms across his chest and said to me "you're normal". Quicker than I had time to process his comment I had answered "Eh, only sometimes". It wasn't until much later that the husband elaborated on this. He said that he expected an older woman with warts and Birkenstocks. I couldn't help but laugh and it was okay because both he and his wife did too.

To this day I can only imagine that the he visualized doulas and midwives to look something similar to what Vincent van Gogh depicted in The Midwife."

On the topic of midwives, Doulas are not only for those that choose to have a midwife provide their maternity care. (Doulas don't provide any kind of medical or clinical care - we're here for emotional and physical support purposes - so if you're looking for someone to assist your midwife you should look for a midwife's assistant or monitrice.) We are not on strict reserve for those choosing homebirth either. For the most part, a doula will provide support to any woman who wants one. Of course individual doulas may have their own preferences limiting them to specific geographical areas while others may prefer not to cross any bridges or attend an unassisted childbirth. Just like deciding on their fees for doula services, it's all up to the individual doula. This is all part of the process of meeting your potential doula and interviewing her thoroughly.

When choosing a doula it is recommended that you consider what qualities you would like to have in a doula. You might find it helpful to make a list of these qualities, much like you would list desired amenities in a home you were looking to buy or rent. Although it isn't customary for a doula to come with a big yard, walk-in closets and eat-in-kitchens, doulas do come with an impressive resume of experiences, trainings and skill-sets. Don't be afraid to ask questions that you think will help you to determine if a doula is right for you. It's important to remember that a doula is there to support you and your family. You are inviting her into a private, sacred space that is only yours and your partner's. You want to be sure you're comfortable with your doula and that there is a connection between you both (or at least the possibility of one).

When it comes time for us (as a mamas) to find a doula to support us through labor and birth, we focus on just a few meaningful qualities: we make sure she's local because we want peace of mind that when we call for her it won't take too long to come to us. We make sure wecan afford her fee (and if we can't, we know we can ask if she has any discounts, a sliding fee scale or if she's willing to make payment arrangements). Lastly, and in my opinion most importantly, we make sure she's huggable. After all, who doesn't love a good hug?!

Our short three-quality-checklist may not work for anyone besides us and that's okay. You may find other qualities more valuable, like whether or not the doula is certified, how many births she has attended, or how many clients she books each month. It might be crucial that she offer other services as well, like placenta encapsulation, belly casting or childbirth education classes.

Lucky for us Seattle Mommas, we have the advantage of living in one of the most doula-rich areas in the U.S. making our search for labor support that much easier. Its a good idea to do a little research on the topic. The Internet (as well as the good ole' fashioned library) is a great resource to find out about Kennel and Klaus' research, specific statistical information on the benefits of having a doula, how having a doula can improve birth and things that you can expect from a doula. To get you started, take a look at this handout from Evidence Based Birth that summarizes The Evidence for Doulas

Written by Angie Valentin and Jenne Alderks, doulas with Doulaville Affordable Birth Services, serving the Greater Puget Sound region from Marysville to Olympia. 

Sources: [1] Wikipedia [2] The Free Dictionary, [3] The Online Etymology Dictionary. See gossip (n.). The Doula Book: How a Trained Labor Companion Can Help You Have a Shorter, Easier and Healthier Birth, Kennel and Klaus







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