The Doula and the Breastfeeding Family
By Carol M. Lynch and Patricia B. Holliday
From: NEW BEGINNINGS, Vol. 15 No. 1, January - February 1998, p. 4-7
We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time.
Marianne, who used a doula
during the birth of her son, describes her experience:
When our brand-new baby,
William, was placed on my breast shortly after his birth, it was hard
to believe I really had anything to feed him. He didn't catch on right
away, either. Having our doula there was a wonderful reassurance that
there was nothing strange about us both being unsure how to get started.
She suggested letting my husband hold William for a while and when I
put William back on my breast, he caught right on.
Marianne and Jeff are one
of a growing number of couples who choose to have a doula assist them
during labor and birth. A doula is a woman experienced in birth who
provides emotional, physical, and informational support to the mother
before, during, and just after childbirth. Many couples today hire a
doula to help them have a safer and more satisfying birth experience.
In studying over 150 human
cultures, anthropologists have found that mothers in labor have traditionally
had another woman-usually a friend or family member-present during birth.
As childbirth moved into the hospital during the early part of this
century, mothers became isolated. Hospital routines and concerns about
infection kept family and friends away from mothers and their babies.
As the needs of laboring women have become more widely understood, the
doors to birthing rooms have slowly opened to admit the father, friends,
or other family members, and now, the doula, to help the mother during
her baby's birth.
The Doula's Role
What does a doula do? What
makes her role unique? The doula meets with the birthing couple one
or more times before the birth. She discusses with them their expectations
or ideas of what they want their baby's birth to be like, including
their preferences regarding pain medication and infant feeding. The
doula helps them to achieve their expectations. She also supplements
information learned in prenatal classes and corrects misinformation
gleaned from the personal birth experiences of friends and relatives.
Pat and Mike Drackett were surprised at the comprehensive services their
doula offered, "We were thrilled to have found such a qualified person
available to us as our doula at this important time in our lives. We
didn't expect Kathy to also be an incredible resource of prenatal information
on nutrition and exercise, as well as breastfeeding preparation."
Following the prenatal meetings,
the doula is on 24-hour call - often for two weeks before and after
the due date. During early labor, the doula and mother stay in touch.
When the mother feels the need for additional support, the doula will
come to the mother's home or meet her at the hospital or birthing center.
She will help the mother relax during contractions and suggest ways
to cope. She suggests comfort measures such as hot or cold packs, massage,
pressure, or a bath or shower. She might suggest walking or changes
in position to speed up labor or increase the mother's pain tolerance
during contractions. The doula listens to the mother and responds to
her needs and wants.
Supporting Fathers and Others
The doula is also responsive
to the needs of the father and respects his level of involvement. First-time
fathers are usually inexperienced in understanding and reacting to the
normal behavior of a woman during labor and they appreciate the reassurance
the doula offers. An experienced father may also appreciate a doula.
While he cares for the mother, the doula performs peripheral tasks such
as getting ice, juice, or blankets for the mother. She also fills in
for the father if he needs a break, gives him an occasional back rub,
and supplies supportive information. Since each labor presents its own
unique challenges, even experienced birthing couples benefit from the
services of a doula. A doula may also provide these kinds of support
for others who support a mother in labor, such as friends or other family
members.
The doula's calm presence
and commitment to the mother's well-being helps counteract the effects
of stress hormones (adrenaline and noradrenaline) which are released
when a woman in labor becomes anxious, fearful, or insecure. Elevated
stress hormones cause labor to slow down or stop while heightening the
perception of pain. A trusting, relaxed mother continues to produce
oxytocin (the hormone that causes the uterus to contract). She has more
effective contractions, but with less tension in her body, she feels
less pain. With quiet reassurance, the doula helps the laboring mother
and her partner to draw on their own unique talents and strengths.
Research Shows Benefits
An early study on labor companions
(Haus 1982) demonstrated just how important a doula can be. The authors
investigated the effects of having a supportive companion present during
labor. They wanted to compare two groups of mothers with uncomplicated
births, with 20 mothers in each group. In the group that had a companion
assigned to each mother, they had to follow the labors of 32 mothers
to identify 20 mothers with uncomplicated births for their study group.
To get 20 uncomplicated births in the control group-women without a
labor companion-they had to follow 95 labors! What's more, the labor
companions in this study were untrained and unknown to the mothers to
whom they were assigned, which makes the results even more astounding!
Additional research over the years has confirmed that supportive labor
companions make a difference in the course and outcome of labor. A combined
analysis of research results from six randomly controlled trials showed
that a doula's presence was associated with reductions in cesarean births
(50%), length of labor (25%), epidural use (60%), and pitocin use (40%)
(Klaus, Kennell & Klaus 1993). Research also shows significant long-term
benefits of improved breastfeeding, decreased postpartum depression,
and more positive maternal assessments of baby's personality, competence,
and health.
Having doulas present at
birth enhances mother-infant bonding and breastfeeding, leading to more
positive mother-to-infant interactions and the establishment of an adequate
milk supply during the immediate postpartum period. Doulas appear to
be most effective in the following interactions.
Mutual Interaction
An essential principle of
attachment, or bonding, is that parents must receive some response or
signal (such as body or eye movements) from their infant, to form a
close bond. As stated in THE WOMANLY ART OF BREASTFEEDING, "For a period
during the first hour of life, most newborns are quietly alert and receptive.
A lively and intricate exchange of messages passes between the mother
and the baby who are together at this time." Doulas, as objective observers,
often notice this exchange and can subtly draw attention to specific
behaviors.
Time-Giver
Because a doula provides
continuous support (in contrast to multiple medical caregivers and various
shift changes), she can ensure that the mother and baby have the optimal
amount of time needed to help the baby reestablish the biorhymicity
disrupted by the labor and birth. Biorhymicity refers to the synchronization
of the baby's actions and rhythms to those of the mother. Before birth,
the baby's sleep / wake cycles, day-today activities of the mother,
heartbeat of the mother, and various other rhythms are familiar and
constantly synchronized. Labor and birth disrupt those rhythms. When
the baby is cared for from birth by his mother, these rhythms are more
easily and quickly reestablished. The mother is able to "tune in" to
her baby, letting the natural process occur with as few interruptions
as possible.
Dr. William Sears, in THE
FUSSY BABY, relates the story of baby Michael, who spent his first five
days in the hospital nursery. The first two nights his mother heard
the nurses calling his name continuously. The next two nights were noticeably
quieter. When Michael's mother brought him home, he began crying constantly.
It took his mother eight months of intensive parenting to reestablish
biorhymicity with Michael, which turned him into a relaxed, happy baby.
Dr. Sears feels that Michael was upset by multiple caregivers who imposed
a rigid four-hour schedule upon him while in the hospital nursery.
Heat
The infant's temperature
drops only slightly, if at all, when placed on the mother's chest, wrapped-even
without an additional heat source (Klaus, 1982). The doula can educate
the mother to keep her baby warm on her chest, with blankets covering
both mother and baby. Clinical staff can make well-baby checks of the
baby in the mother's arms, making routine separation unnecessary and
breastfeeding more successful.
Having a doula present when
breastfeeding is initiated can be very helpful. By initiating "on-demand"
breastfeeding at birth and encouraging the mother to continue to nurse
at will, the doula helps breastfeeding to progress with few problems.
In special circumstances, doulas also provide an extra pair of hands
to help support the baby during breastfeeding. Kathy Raskett, a doula
in Gulfport, Mississippi, worked with Vernie, a new mother who related,
"After my baby's cesarean birth, my doula held my baby to my breast
for 45 minutes of nursing. I could not have done it alone."
Most doulas have either breastfed
their own children and/or have had training in facilitating breastfeeding
in the early days. Debbie Young, a doula and mother of five, relates
a story of a new mother whose recovery room nurse kept touching the
baby on the head, stimulating a rooting response in the wrong direction.
This led to a very frustrated mother and a confused, and still hungry,
baby. After the mother had a few minutes alone to comfort her baby,
Debbie asked a few questions (such as what position would be comfortable)
and gave some specific, but simple, verbal information and direction.
The mother then got her baby latched on successfully by herself.
Overcoming Breastfeeding Challenges
When breastfeeding is somewhat
clumsy initially, as it was with Marianne and her son William, the doula
encourages the mother, letting her know that breastfeeding is often
an art learned by both baby and mother. A doula may be a more helpful
source of information about breastfeeding than some physicians or hospital
nurses. In the immediate postpartum period, the doula is in the mother's
home and can monitor the progress of breastfeeding. Since the new mother
established a comfortable relationship with the doula during her pregnancy,
she may also turn to her doula with her breastfeeding questions. The
doula is thus able to refer the mother to support groups, such as LLLI,
or to professional resources as needed or desired.
One couple, Paul and Heather
Dezzutto, parents of Mia Ashlee, summed up their doula experience with
this thought, "For us, a doula is an essential part of a natural childbirth.
She is a competent and knowledgeable caregiver who personifies compassionate
care during the birthing process."
A doula can be a strong link
in the chain of support that new parents need to have a satisfying and
joyous birth experience. Her presence can help ensure that mothers will
be able to be alert during labor and so participate actively during
birth. Her support after birth can give the mother the opportunity to
breastfeed her baby early and often. As LLL's experience shows, these
actions help mothers to have a satisfying and successful breastfeeding
relationship with their babies.
Finding the Right Doula for You
Doulas of North America (DONA)
offers referrals for mothers wishing to use a doula or information on
training and certification programs for anyone interested in becoming
a doula. You can reach DONA by phone at 206-324-5440 or by mail at 1100
23rd Avenue E., Seattle, WA 98112. Or check out their web site at:
http://www.dona.com
If you are unable to locate
a doula in your area, you may wish to ask a friend, relative, or childbirth
educator who supports your birth philosophy to be with you during your
birth. The following books are also helpful:
- The Birth Partner:
Everything You Need to Know to Help a Woman Through Childbirth,
by Penny Simkin
- Mothering the Mother, by Klaus, Kennell and Klaus
- THE WOMANLY ART OF BREASTFEEDING, La Leche League International.
To help you decide if a particular
doula is right for you, use the following list of questions from DONA.
You may ask a few questions over the phone, and then interview one or
two doulas who made you feel comfortable:
- What training have you had?
- What is your philosophy about childbirth and about supporting women and their partners through labor?
- Tell me (us) about your experiences with birth, personally and as a doula.
- May we call you with questions or concerns before and after the birth?
- When do you join me in labor?
- Do you work with one or more backup doulas (for times when you are not available)?
- May we meet them?
- What is your fee?
When you meet the doula (and
it is a good idea for both you and your partner to meet her), pay particular
attention to your personal perceptions of her. Is she kind, warm, and
enthusiastic? Does she communicate well? Is she a good listener? Is
she comfortable with your choices? Do you feel comfortable with her?
References
Sears, William, The Fussy
Baby: How to Bring Out the Best in Your High- Need Child. Schaumburg,
IL: LLLI, 1985.
Klaus, Marshall, H., Kennell,
John H., and Klaus, Phyllis H. Mothering the Mother. Reading,
MA: Addison-Wesley, 1993.
Klaus, Marshall H. Parent-Infant
Bonding, 2nd Edition. St. Louis, MO: Mosby. 1982.
La Leche League International,
THE WOMANLY ART OF BREASTFEEDING. LLLI, Schaumburg, IL: 1997.
Last updated Friday, October 13, 2006 by njb.
Page last edited Sun Oct 14 09:29:58 UTC 2007.
