The Doula Book - Part V The Dublin Experience & Pospartum Care

Posted by Kim:

Covering Chapters 9 and 10 of The Doula Book

The Dublin Experience

"The major emphasis of the obstetricians at the National Maternity Hospital [in Dublin] is on the one-to-one personal attention of the nurse, and we wished to see how similar this was to support by a doula." (p 151)

"The innovators, Drs. Kierin O'Driscoll and Declan Meagher note: 'Mere physical presence is not enough, the nurse must appreciate that her primary duty to the mother is to provide the emotional support so badly needed at this critical time and not simply to record vital signs in a detached clinical manner." (p 151)

"Birth, he [Dr O'Driscoll] pointed out, must preserve a woman's dignity, and must remain a joyous event with a woman feeling in command of herself." (p 152)

"Midwives in Ireland have a different status than do those in the United States. The Irish midwife has a complementary role, now competing with the physicians." (p 153)

"A diagnosis of labor is made if a woman has been having strong and regvlar contractions every eight to ten minutes that last thirty to forty-four seconds each, if her cervix is dilated and thinned out (effaced), and if she has a bloody mucous show." (p 154)

"The nurse-midwife reminds her [laboring mom] to look at the nurse-midwife's face or at something in the hall. Focusing outward is a way for the woman to distance herself from focusing only on the pain." (p 157)

"The effective ingredient in the management of labor in the Dublin program is not rupture of the membranes of large doses of oxytocin, but the presence of a continuously supportive labor companion." (p 164)

Postpartum Care
"Parents' need for support does not, of course, stop at the moment of birth." (p 169)

"Studies have shown that the sooner after delivery mothers start breast-feeding and the more frequently they nurse their babies in the first two weeks, the more abundant their milk supply and the greater the babies' weight gain." (p 171)

"After a mother has a baby, her mind tends to go back to an early time in her life, and many memories come to mind. These memories may evoke in her a special need to be cared for and protected." (p 172)

"As part of this psychological regression a mother needs to feel safe, to be held, and to be cared for." (p 172)

"The doula's presence makes both gather and mother feel safe. The father, too, is relieved of the heavy weight of responsibility that the doula carries." (p 172)

"The more the mother is cared for, the more easily she can manage the baby. The more praise and support she receives, the more love and patience she will have with the infant." (p 172)

"In the hectic atmosphere of the modern hospital, the heightened sensitivity of primary maternal preoccupation is sometimes misinterpreted by physicians and nurses as excessive anxiety." (p 174)

"The 'baby blues,' characterized by a short period of emotional liability, commonly occurring between the second and fifth postpartum day, affect between 80 and 90 percent of new mothers" (p 174)

"The term postpartum depression refers to a group of poorly defined, severe, depressive-type symptoms, which usually begin at four to eight weeks postpartum but, sometimes, later in the first year and which can persist for more than a year." (p 174)

"The incidence ranges from 10 to 16 percent of new mothers." (p 174)

"The symptoms of postpartum depression cover a wide range, including exhaustion, irritability, frequent crying, feelings of helplessness and hopelessness, lack of energy and motivation so that the woman's ability to function is disturbed, lack of interest in sexual intercourse, disturbances of appetite and sleep, and feelings of being unable to cope with the new demands placed on her." (p 174 - 175)

"It is not uncommon for a woman suffering from postpartum depression to have psychosomatic symptoms such as headache, backache, vaginal discharge, and abdominal pain for which no organic cause can be found." (p 175)

"A mild appearance of one or more of these feelings is normal. When they are many and continue over a period of weeks, help is needed." (p 175)

"A person's previous history or a family history of psychiatric problems increases the chances of postpartum depression." (p 175)

"When a mother has had a poor relationship with her own mother or was separated from one or both parents before the age of eleven, she is more likely to be depressed and anxious, according to research." (p 175)

"The mother's inability to confide in her partner or a friend has been noted as a factor in depression." (p 175)

"The father or other helper should have the responsibility for making sure the mother is not overwhelmed with too many visitors or phone calls for too long." (p 176)

"Relaxation exercises continue to be useful in the postpartum period." (p 176)

"The more frequently the mother breast-feeds her baby in the first two or three weeks and, as we said, the more she carries the infant in a Snugli-like carrier on her body, the less the baby will cry." (p 177)

"Studies have also shown that if the response to a baby's cry or fuss occurs within ninety seconds, the baby will quiet rapidly." (p 177)

"After birth the infant's body should be dried thoroughly with three cotton blankets but not the baby's hands, because the amniotic fluid dried on the hands has an enticing smell for newborns and is useful as they find their way on their own to the breast." (p 177)

"To improve the chances of this early suckling the injection of vitamin K and eye ointment should both be delayed one and a half hours while the infant is in the quiet-alert state." (p 177)

"When babies 'latch on,' they open their mouths widely to avoid the tip of the nipple, placing their lips on the areola." (p 177)

"THE FACE OF THE INFANT SHOULD NEVER BE PUSHED INTO THE BREAST." (p 177)

"Sometimes after this is done the infant becomes aversive to the breast. The newborn should always be the one to decide when he or she would like to take a first drink." (p 177)

"The key is to start with a calm and focused infant. Babies have more control over their movements when they are calm." (p 179)

"We start with the baby asleep, or only in very mild hunger, with mother and infant undressed and skin-to-skin, with the infant's chest on her upper chest, usually between her breasts. It's often helpful to hold the baby in a vertical position." (p 179)

"As the baby stirs, his mother can keep him calm by talking to him, getting his attention, even making eye contact if he looks her way. As he gets hungry, he will start twisting his body toward one breast or the other, and may begin bobbing his head up and down, looking for the breast." (p 179)

"As he moves his head toward one breast, his mother may want to help him a little, by moving his rump up toward the other breast, and helping him keep his face in contact with her skin." (p 179)

"At this point, a mother can help by continuing to talk to her infant. Her encouraging voice helps him stay focused and in control. She can also help by assuring that his whole body is against her in such a way that his nose, rather than the mouth, is heading toward the nipple, and by allowing him to keep his face in contact with her skin. The infant knows that breast by feel, not by sight, and knows the nipple by smell, not by sight." (p 179)

"It is helpful for the mother to avoid having a hand on the back of the newborn's head; instead, her hand can support his neck and shoulders. The infant needs neck support but also freedom to move." (p 179)

"A good latch is always comfortable." (p 180)

"The training of a postpartum doula includes CPR, lactation training, common infant health problems, knowledge of what to look for in the mother that may need medical attention, and communication skills often dealing with emotional concerns." (p 180)

"She [postpartum doula] helps organize the household and keeps appropriate emergency and family numbers available for the parents." (p 181)

"An important skill for a postpartum doula is her ability to listen. The mail foal is to be present while the mother is the one talking. By listening to and acknowledging her feelings and memories of the birth and what she is experiencing in the postpartum period, the doula helps the mother process these significant events." (p 181)

"Learning how to become attuned to the infant's signals is a major task for both parents..." (p 181)

"The doula can remind parents that they cannot spoil their infants by picking them up when they cry or by being immediately responsive to their needs." (p 181)

"However, a father has an important role in supporting the mother physically and emotionally in this tender time." (p 181)

"The partner's understanding, support, love and encouragement are especially meaningful at these times. Until feeding becomes established and the mother does not need help, being with the mother during nighttime feedings is unusually supportive to her." (p 182)

"A father needs to have his own time to bond with his baby. He can bathe the baby, change the diapers, dress the baby, nap with the baby on his chest, sing to the baby and rock with the baby." (p 182)

"When the body and mind are calm, healing is enhanced, mental tension is released, and more inner peace and confidence can develop. Relaxation also enhances breast-feeding and milk flow.

"So what you need is one hand on the back of the baby's head, not too high up, right behind the ears, and you need the other hand, the one that's closest to your breast, to support that breast because it's heavy. It could slip out of the baby's mouth. People don't usually think of that." (p 185)

"New parents your new job is going to be sitting there and staring at that baby, feeding the baby, taking care of the baby, but then who takes care of you?" (p 186)

"The first week is really recuperation, getting to know the baby, just taking it easy, and working on the breast-feeding, and working on getting their strength back, and keeping their life calm." (p 188)

"Jaundice is really, really common, especially with breast-feeding. It comes about the second or third day." (p 188)

"We need to make sure that the baby wants to nurse every two to three hours, that they're having real awake time, that they're not lethargic." (p 188)

"...If you pick up a baby within ninety seconds after it starts crying, it will stop." (p 189)

"Babies eventually end up loving the changing table.... They learn pretty quickly after a week or so that on that changing table they are being attended to, being loved, and enjoyed" (p 189)

"Emotional and physical support of new parents that continues after the birth will enhance the well-being of the whole family." (p 190)