Friday, January 30, 2009

The Doula Book - Part III Obstetric & Longer Term Benefits of Doula Support

Posted by Kim:

Covering Chapters 5 & 6 of The Doula Book

Chapter 5 Obstetric Benefits of Doual Support

"Continuous labor support from a doula in the ten studies reduced the odds of receiving analgesia by 31%, decreased the use of oxytocin to stimulate labor by 50%, forceps deliveries by 34%, and cesarean sections by 45%." (page 76)

"If the... continuous emotional and physical support leaves for just five minutes, when she returns, it takes nearly an hour to get the mother back to her earlier calm state." (page 77)

"The length of a first labor is nature's way of gradually, and carefully dilating the birth passage." (page 80)

"When low forceps have been applied by well-trained, experienced obstetricians, there is no harm to the baby." (page 86)

"For several decades in the mind-1900s one measure of a good obstetrical service was that the number of cesarean sections did not exceed 5 percent of the total deliveries." (page 87)

"However, the incidence of cesarean deliveries then skyrocketed to levels of 25 to 35 percent, with a few hospitals well above this. The cesarean delivery rate in the United States was 22 percent in 1999..." (page 87)

"When a mother develops a fever during labor, physicians recognize this as a warning the baby may have a serious and potentially fatal blood-stream infection called septicemia (sepsis). This is an uncommon occurrence, but because the risk of not treating a baby with sepsis is great, and because the diagnosis at the time of birth is difficult and existing antibiotics are effective, babies of mothers with fever are usually considered to have sepsis." (page 89)

"Maternal fever may be the only clue to a life threatening infection." (p 89)

"Mothers who had a fever were significantly more likely to have had epidural analgesia." (p 89)

"When a mother has epidural analgesia during labor, her temperature slowly but steadily rises; if labor is long enough, the temperature will reach the level of a fever." (p 89)

"It is difficult for physicians to be sure whether an individual mother's fever is due to epidural analgesia or to sepsis in the baby.... However, the decreased need for pain relief during labor when a doula provides support would lessen the number of epidurals and therefore the number of women who have fevers and the number of babies who have to be evaluated for illness." (p 90)

"For women whose labors were induced, the overall rate of epidural use was 81 percent." (p 90)

"The total induction group [in a case study] had a cesarean-delivery rate of 43 percent. The group of no-doula couples [in the case study], had had over three times the number of cesarean deliveries." (p 90)

"The more we care for the mother during this sensitive perinatal period [through the long hours of labor], the more sensitively and appropriately she will care for her baby." (p 92)

"Labor that has been progressing normally may slow down or stop when an epidural is started." (p 94)

"An analysis of eleven randomized trials involving 3,159 laboring women recently compared the effects of epidurals nor involving a regional block with no intervention. Epidural analgesia was associated with greater pain relief than nonepidural methods, but also with longer first and second stages of labor. In addition, there was an increased incidence of fetal malposition, increased use of oxytocin, and an increase in instrumental vaginal deliveries." (p 95)

"Medication does get into themother's bloodstream and then into the baby. Babies therefore have mild to moderate changes in their behavior in the first hours and days." (p 95)

"...A number of mothers have told us about their disappointment that they failed to go through labor without medication." (p 96)

*** THAT'S ME*** and it has taken me amny years to process it, but I don't think I will ever get over it! If I only had a doula!

"Mothers who have had epidural anesthesia do not get the same feeling of accoplishment or boost in self-esteem as those who deliver without an epidural." (p 96)

Chapter 6 Long-Term Benefits of Doula Support

"A number of well-designed studies show that humane, sensitive, and individually appropriate caregiving practices ... have produced four important benefits.
  1. Decreasing abandonment in the maternity hospital.
  2. Decreasing rates of infant abuse
  3. Increased success in breast-feeding during the entire first year of life
  4. Increased father involvement in the first three months of the infant's life" (p 102)
"In addition, helping the parents discover the abilities and responses of their newborn and showing them how to carry the infant in a cloth carrier on their chest in the early months of life have
  1. Improved parent-infant interaction at three months, increa
  2. Increased immunization rates at one year
  3. Resulted inan increased incidence of secure attachment at thirteen months" (p 102)
"The one-day postpartum interview results indicated that the doula-group mothers reported less pain during labor and at twenty-four hours after labor." (p 103)

"Fewer doula-supported mothers considered the labor and delivery to have been difficult, fewer thought ti was much worse than they had imagined, and more believed they had coped well during this experience." (p 103)

"The doula-group mothers showed significantly less anxiety, fewer signs of depression and a higher level of self-esteem." (p 106)

"Some aspect of doula support resulted in doula mothers reporting a great increase in satisfaction with their partner since the birth of the baby and a much greater percentage of mothers who reported their relationship was better right after the birth." (p 107)

"Doula-supported mothers reported that their babies were less fussy, compared with reports of mothers who gave birth without a doula." (p 107)

"Doula-supported mothers reported that they were
  1. Pleased to have their babies
  2. Found becoming a mother was easy
  3. Felt that they could look after their babies better than anyone else could.
In contrast, the no-doula group of mothers perceived their adaption to motherhood as more difficult and felt that others could care for their baby as well as they could." (p 107)

"...Powerful effects of early mother-infant contact and interaction during a brief period around the time of birth that we have labeled the 'maternal sensitive period'. In this period - the time in the first minutes, hours, and days after birth - parent-infant contact, as we said earlier, may alter the parents' later behavior with that infant." (p 109)

"The remarkably strong and persistent effects associated with the doula suggests that the sensitive period starts during labor." (p 109)

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