Doulas: Exploring A Tradition Of Support

by Coburn Dukehart

Baby Project mom Lucy Peck was initially going to use a doula for her birth, but has since decided to have her sister act as a birth companion. Regardless, we decided to explore the topic more to find out exactly, "What is a doula?"

To read the rest of this post click here.

Capturing the Doula Spirit Photo Contest

A Contest in Celebration of International Doula Month, May 2011
A picture is worth a thousand words, or so it is said. What can a photo say about the work of a doula?
In celebration of International Doula Month, DONA International will honor its members, their doula spirit and the contribution they provide to maternity care by accepting photo action shots that tell their story as a birth or postpartum doula. Photos must be submitted during the month of May, which is International Doula Month. The winners will be announced in the June eDoula.

First Prize:
The winning photo will be featured in the December issue of the International Doula and on the DONA International web site and the doula contestant will be awarded a free one year membership.

Second Prize:
The second place photo will be featured on the DONA International web site and the doula contestant will be awarded a $25 gift certificate for the DONA Boutique.

Third Prize:
The third place photo will be featured on the DONA International web site and the doula contestant will be awarded a $15 gift certificate for the DONA Boutique.

Submission requirements:

Photo (see photo specifications below)

Doula’s name and credentials

Doula’s address

Doula’s day phone number

Doula’s e-mail address

Name(s) of each person photographed, listed from left to right

When and where the picture was taken and why you think it reflects the doula spirit

A signed DONA International Photo Release form for each person photographed, available on the web site at http://www.dona.org/publications/id.php.

Photo specifications:
All photographs will be accepted for consideration. However, the best quality photos for print publication are 300 dpi TIFF files or high resolution compressed JPEG files with good contrast of light and dark. Images intended for cover use must be at least 8˝x10˝ (original size, not enlarged) at 300 dpi and should be sent in their original, untouched/unaltered format. Color photographs must be in RGB color format, but they may be converted to black and white.
All submissions should be sent to Doula@DONA.org, with “Doula Spirit Photo Contest” in the subject line, by May 31, 2011.

The Essential Ingredient - a Doula!

Both Kim and I are certified Doulas with DONA and are very proud of it! You deserve the best care and support during your labor and birth. Make sure you look into a doula - you deserve one.

Doulas can make a world of difference

As written for the Royal Gazette by Fiona Dill

"I can't believe I did it!", were the first words exclaimed by the mother who had just birthed her baby vaginally having had a C-section two years earlier.

I was privileged to be present at that birth, as a doula. The concept of having an experienced woman at the side of another woman in labour is as old as childbirth itself and spans many cultures. But it is the unfamiliar name (doula) and the emergence of the trained, paid doula that is relatively new, particularly here in Bermuda.

In November 2008, Bermuda had its first Doula Training event, hosted by Sophia Cannonier (herself an experienced doula) who was instrumental in bringing down a DONA (Doulas of North America) trainer for a weekend course. Fifteen women attended the course and as a result, we are privileged to have many new doulas on the island.

Doulas are trained to provide a pregnant woman and her partner with continuous one-to-one support during childbirth. Their remit is non-medical, physical and emotional care that complements the clinical services provided by the hospital staff and obstetrician and the intimate, but usually inexperienced, care offered by the partner. The doula does not displace the partner but supports him also and often relieves much of his own anxiety.

"There was also a far greater level of peace throughout because my husband had the support and advice he needed at a time that can often leave men or birth partners feeling quite helpless. We cannot say enough about the level of support that we received before, during and after the birth of our daughter."

The advantage of the doula's position is that because she has no medical or decision-making responsibility, has no other patients, and does not work on a shift, she can devote herself fully to the needs of the couple. Usually she will have met with the couple a few times before the birth so she has had the opportunity to ask about fears and individual preferences. Thus she is able to focus on the emotional needs of the woman, not medical issues and is able to remain calm and objective. Generally, the doula stays continuously with the woman until her baby is born, regardless of how long that may take.

"Having someone knowledgeable and gentle to support us. It helped me stay calm and focused, as I knew that I could depend on you throughout the labour."

It is often assumed that it is only couples that are planning to have a natural childbirth who can benefit from hiring a doula, but this is not the case.

As doulas, we are there to assist our clients to have the best possible birth experience, as they define it. We are there to help the couple identify their options by encouraging communication with their caregivers, not to tell them which options to choose. And then ultimately to give our unconditional support no matter how the birth progresses.

"Having a doula gave us the encouragement we needed to birth as naturally as we could, and helped support us through the most important day of our lives so far! We couldn't have done it without her! Everything she did was designed for us!

She helped us try different things during labour to try to progress things and to help alleviate the pain (or at least the focus on the pain) of the contractions. She made us feel comfortable about the process in the hospital and it reassured us!"

Increasingly, couples are aware of the improved clinical outcomes for both mother and baby associated with doula care during pregnancy, labour and birth.

Physical

■ Fewer requests for epidurals and narcotic pain relievers

■ Reduced use of pitocin

■ Reduced duration of labor

■ Fewer forceps deliveries and vacuum extractions

■ Reduced cesarean section rates

■ Neonate hospitalisation and rate of complications reduced

■ Reduced chances of maternal fever and infection

■ Reduced maternal bleeding following birth

■ Increased chance of spontaneous vaginal birth

Psychological

■ Mothers report more positive reviews of their birth experience

■ Reduced levels of anxiety

■ Mothers have higher regard and increased sensitivity towards babies

■ Mothers feel more secure and have more confidence

■ Reduced incidence of post-partum depression

There is no doubt that as doulas we do make a difference. The statistics and the testimonials above speak for themselves. If you are interested in knowing more about having a doula at your birth, please visit www.healthcoop.bm or www.greatbeginnings.bm or www.bermudadoula.com for more information and contact details.

Capturing the Doula Spirit - Photo Contest

Written by Yana Katzap-Nackman CD (DONA), PCD (DONA), DONA Director of Membership Support

A Contest in Celebration of International Doula Month

May 2009

Have you ever heard the phrase, "every picture tells a story" or the phrase, "a picture is worth a thousand words?" In celebration of International Doula Month, DONA International will honor its members, their doula spirit and the contribution they provide to maternity care by accepting photo action shots that tell your story as a birth or postpartum doula. Photos must be submitted during the month of May, which is International Doula Month. The winners will be announced in the June eDoula.

First Prize:
The winning photo will be featured in the December issue of the International Doula and on the DONA International web site and the doula contestant will be awarded a free one year membership.

Second Prize:
The second place photo will be featured on the DONA International web site and the doula contestant will be awarded a $25 gift certificate for the DONA Boutique.

Third Prize:
The third place photo will be featured on the DONA International web site and the doula contestant will be awarded a $10 gift certificate for the DONA Boutique.

Submission requirements:
• Photo (see photo specifications below)
• Doula's name and credentials
• Doula's address
• Doula's day phone number
• Doula's e-mail address
• Name(s) of each person photographed, listed from left to right
• When and where was the picture taken and why you think it reflects the doula spirit
• A signed DONA International Photo Release form for each person photographed, available on the web site at http://www.dona.org/publications/id.php.

Photo specifications:
All photographs will be accepted for consideration. However, the best quality photos for print publication are 300 dpi TIFF files or high resolution compressed JPEG files with good contrast of light and dark. Images intended for cover use must be at least 8˝x10˝ (original size, not enlarged) at 300 dpi and should be sent in their original, untouched/unaltered format. Color photographs must be in RGB color format, but they may be converted to black and white.

All submissions should be sent to PublicRelatons@DONA.org by May 31, 2009.

May is International Doula Month

Posted by Kim:

Did you know that May is not only Skin Cancer Awareness month but it is also International Doula month? WOW! May is a busy month!!! Carri and I both honor doulas and respect their role during a woman's birth experience. After all it was Carri's role as a doula that helped her create and design the BINSI birth skirt and through my passion for BINSI I have been impassioned to become a doula myself.

What is a doula?

According to the DONA (Doulas of North America):

The word "doula" comes from the ancient Greek meaning "a woman who serves" and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.

What are the benefits of having a doula at your birth?

Studies have shown that when doulas attend birth, labors are shorter with fewer complications, babies are healthier and they breastfeed more easily.

A Birth Doula

* Recognizes birth as a key experience the mother will remember all her life
* Understands the physiology of birth and the emotional needs of a woman in labor
* Assists the woman in preparing for and carrying out her plans for birth
* Stays with the woman throughout the labor
* Provides emotional support, physical comfort measures and an objective viewpoint, as well as
helping the woman get the information she needs to make informed decision
* Facilitates communication between the laboring woman, her partner and her clinical care
providers
* Perceives her role as nurturing and protecting the woman's memory of the birth experience
* Allows the woman's partner to participate at his/her comfort level

How can we celebrate doulas?

Some suggestions DONA has are:

* Write an article for a local publication or send a press release to your local media.
*Host a free doula info night at a library or community center to let parents know about your
services, which might also be a great reason for your local press to do a story on doulas.
*Have a movie night for parents and/or doulas. Show the latest movies such as "Orgasmic
Birth", "The Business of Being Born" or "Pregnant in America", or revisit some of the classics.
*Create a birthing circle where women can share their birth stories to support each other and/or
heal from their birth trauma
*Organize a networking day for local doulas to meet, network and support each other with new
ideas and co-opetition.
*Host an at-home spa party for local doulas.
*Put together info packages that hospitals and birth centers can hand out to expectant parents
and/or laboring mothers with suggestions for position changes and comfort measures.
*Create a goal sheet of what you'd like to accomplish between now and International Doula
Month next year.
*Give yourself a big pat on the back for working tirelessly to help women enter parenthood in a
positive way!

Partnership - Birth Source

Posted by Kim:

Tracey and I met at the DONA conference in 2006 and were immediately drawn to each other. Tracey was excited about our skirts and tops and how something as simple as a skirt can completely transform a woman's birth experience and I was excited about Tracey's experience and passion for birth! It seemed like the perfect fit. So after a few discussions and a lot excitement we finalized an agreement that made Tracey BINSI's first international distributor. BINSI went global (well sort of)!

Tracey bases her work out of her boutique, Birth Source, in Alberta, Canada and has been a very special support and partnership for BINSI. Both Carri and I have appreciated having her as a part of the BINSI extended family and are comfortable knowing that she is helping our Canadian customers receive our products in a timely and cost effective way.

In addition, our partnership with Tracey and Birth Source is simply another validation of our products. One of the greatest compliments for us throughout our company history is how well we have been received by the birth community. Many birth educators and birth professionals support and promote BINSI products because they completely understand and concur with our company mission to help women feel healthy, comfortable, confident, and in control as they enter their amazing journey into motherhood. Carri and I both are honored by this support and find it another validation for all of our hard work. The thought the our products are having a direct impact on the outcome of a woman's birth experience is the ultimate reward for us. So we have been honored and excited to be partnered with fantastic companies, like Birth Source!

A little about Tracey:

She is married and has four of her own children. She is also a busy doula and childbirth educator located in Edmonton, Alberta, Canada. Her Birth Source website began with her own desire for high quality, beautiful and practical supplies and products for both her family and her business.

Almost all of the items she sells on The website has been used by her own family or many of her clients as well. These items are chosen carefully for their quality, practicality and ability to enhance the lives of families and professionals.

BirthSource.ca is dedicated to the best customer service possible and will strive to make your shopping experience the most positive it can be.

The Doula Book - Part II Reducing Discomfort, Pain & Anxiety

As a continuation of my coverage of the The Doula Book by Klaus, Kennell and Klaus here are the excerpts of the book that I highlighted in chapters 3 and 4.

Chapter 3 - Enhancing the Birth Experience

"Knowing the doula will be available anytime during labor lessens the parents' initial anxiety, and the couple can then remain at home longer with more productive labor and less pain." (page 35)

"The doula never interferes with the physician's advice, and the mother will need to follow that advice if there are other concerns." (page 36)

"Most mothers progress more rapidly in familiar surroundings" (page 37)

"During this period (the beginning of labor) mothers have found the following suggestions helpful:
1. Walk as much as possible
2. If the membranes are not ruptured, a warm bath can help you remain more relaxed. However in early labor a warm bath may slow labor; in late labor a bath may increase dilation. If the membranes are ruptured, a shower is preferablebecause of the risk of infection.
3. Change positions at least every half hour
4. Drink plenty of liquids... Urinate frequently" (page 37)

"The doula needs to notice the quality of the environment of the room and the woman's immediate needs or comfort level." (page 37)

"Asking the woman if a suggestion is or isn't working can validate her sense of control and choice as well as help her recognize her own needs and give her permission to voice what is important to her." (page 38)

"A doula will continually be
1. noticing
2. asking the woman
3. doing something to make an appropriate change
4. rechecking to see if the change is helping or not" (page 38)

"Being well hydrated has been shown to help labor." (page 39)

SIDE NOTE - One of my doula clients went to the hospital thinking she was in labor, but when we arrived her contractions completely stopped. After a thorough exam the doctor determined that she had an elevated temperature due to contractions. After receiving liquids via an IV her temperature went down and she was released. I have also read that dehydration can cause contractions and false labor which may have been what happened to my client.

"The doula can reassure the woman that the smells and fluids of birth, like blood, feces and amniotic fluid, are all normal parts of labor and are quickly taken care of by the staff" (page 39)

"The doula can be the one to have the somewhat difficult task to limit the number (of friends and family attending the birth) without offending anyone." (page 39-40)

"When mothers are in the hands-and-knees position infants often rotate in ten to fifteen minutes from a posterior position." (page 41)

"...Squatting during second-stage labor with each contraction. This position increased the area of the bony outlet of the pelvis by 28 percent." (page 41)

"The doula's ability to keep the mother informed is essential." (page 42)

"When a doula continually informs the mother, asks her gently what her thoughts, worries, or concerns are, talks to her confidently with real information, the doula can help the woman shift her fear to more inner security." (page 43)

"It is also important for the woman to feel that she has control not only over her labor but also has choices about what sort of interventions will be used." (page 43)

"...Although the PKU test is very important, it can wait a few days until the mother's milk comes in." (page 43)

"What is important to a laboring woman is sincere talk, not fake or glib reassurance." (page 45)

"The doula stays emotionally connected to the mother and by joining in her reality, may be able to move her to a more comfortable inner place." (page 45)

"Progressing toward full dilation of the cervix and delivery is near, the following signs may be noted:

1. Flushing of the face and body
2. An increase in bloody mucus
3. Longer and stronger contractions
4. Legs often becoming shaky
5. A feeling of nausea
6. feeling of an urge to push" (page 45-46)

"At this point (transition) the doula's support can give the mother the incentive to continue; the doula sometimes holds the woman, she reminds the mother (and the father) over and over again that she can continue and is doing great." (page 46)

"... Everyone attending a woman in labor 'has a responsibility to ensure that [she] genuinely understands the purpose of every medical procedureand the results of every examination' " (page 46)

"Often labor stops when too many people are present." (page 47)

"In reassuring the parents and enhancing their sense of accomplishment, the doula may be modeling the parental role for them - mothering the mother and parenting the parents." (page 49)

*** " The family is born in the delivery room." ***

Chapter 4 - Reducing Discomfort, Pain, and Anxiety in Childbirth

"When a woman comes into labor she brings her past with her." (page 53)

"Pregnant women have varied expectations of pain, based on what they have heard or experienced." (page 53)

"Though a doula cannot solve issues in the mother's past... she can begin her work being fully present with the woman to calm her fears, to validate her strength, to reassure her that she won't be alone, and to work with her on measures to alleviate pain." (page 54)

"Can you remember a time you met a challenge and conquered it?" (page 54)

"If labor is slowing down, a doula might ask 'How are you feeling righ now?' and then when the mother answers, the doula should restate her answer to be sure she understanda the mother's meaning." (page 55)

"By validating themother's fear, instead of dismissing it, the doula can offer new ways to think about the pushing stage." (page 55)

"Relaxin, which causes the tissure to be as stretchy, strong, and supple as soft elastic." (page 55)

"The mother's urge to push and ability to judge how to push in the second stage is reduced [with an epidural]." (page 58)

"If the epidural goes too high, some women feel as though they can't breathe." (page 58)

"Frequently, there is a rise in the woman's body temperature which reaches the level of a fever during an epidural." (page 58)

"During labor, some women copmlain of shivering and itching and experience urine retention requiring a bladder catheter." (page 58)

"The doula can remind the woman to stay relaxed, create positive images with her, help her with breathing and calming techniques, and validate how well she is doing." (page 59)

"The doula has to be sure there is no threat to her breathing." (page 58)

"With cool washcloths to the mother's face, neck, and chest, if all is well, the doula can cool the mother who is overheated or who develops a fever." (page 59)

"Helping women express feelings and utter sounds may relieve tension." (page 67)

"Make sounds along with the woman, encouraging the mother to let tension go with each sound." (page 67)

"Making low sounds or groans deep in the throat through a comtraction has an effect parallel to opening the birth canal." (page 67)

SIDE NOTE - To be honest making noise and validating the need to make noises was a concern of mine when I went to my first birth as a doula. Like a mother going into labor I was concerned that I would sound or feel silly doing this, but after reading this book I realized that no matter how I felt on the inside I had to always project complete confidence and not be concerned about what other people would think about what I was doing or how I was acting. My goal and my only focus was to make my mom focus on herself, relax, and let her let go of any inhabitions she was holding on to. It only took a little time for me to get over any insecurities and I just kept focusing on what my good friend Laurie told me, she said "Trust your instincts, mother your mother and everything else will follow." Now that was amazing advice from an experienced doula!

"When a doula remains accepting, nurturing, competent, and strong, the woman can internalize a model that might help her remain both nurturing and strong with her ownchild during tough moments." (page 68)

"The doula needs the confidence to help the mother express her needs to the caregiver especially before and during intervention." (page 70)

"The doula needs to know her limits, and occasionally when a fetal malposition does not change, ot a woman is not progressing as expected or feels great discomfort, medical help can give her relief. When this is necessary the doula must validate the woman's courage as well as her decision to have such help." (page 70)

Side Note - This is the exact situation I had with my first doula client (as you may have already read) she had been laboring for 5 days prior to the day we decided to go to the hospital. So she had not gotten more than 3 or 4 hours sleep each night for 5 days prior to going to the hospital and had labored at the hospital for 15 hours at the hospital only to discover that in that time she had only progressed 2 cm. Although epidural was not even a consideration for her and her hsuband before the birth, it became apparent that the epidural was something she needed. She was tormented by making the decision and we hugged, cried and proceesed what was going to happen, but I kept reassuring her that no one was judging her and that we would all honor her choices and that getting the epidural did not make her any less of a mom. After receiving the epidural, we hoped she would relax and progress, but it was still another 12 hours before the baby was born. Although she is still working on processing her choice to get the epidural I keep reminding her how hard she had worked and not only for that one day at the hospital, but for the 5 days before as well.

"Reducing th stress response enhances the body's own production of oxytocin, as well as natural opiates called endorphins." (page 70)

"When labor is not impeded by undue stress and fear, the woman's own natural oxytocin is secreted from the posterior pituitary gland intot he bloodstream. At the same time, her brain also secretes oxytocin to other areas within the brain itself. This has four effects:

1. First it markedly increases the pain threshold, so that the mother has reduced sensitivity to pain.
2. Second, it results in drowsiness
3. Third, it results in some relaxation or calming
4. Finally, after the birth it helps the woman feel closer to the baby" (page 71)

"Comfort measures cna be divided into five categories

1. actions and behaviors that give emotional and psychological support
2. mental activites that divert attention from pain or focus attention on thoughts or images that increase mental and physical relaxation
3. physical activities such as relaxed breathing, muscular relaxation exercises, movement, position changes, use of water, heat, cold
4. touch, including massage, acupressure, pressure, and counterpressure
5. rhythmic activities, music, chanting, singing etc." (page 72)

Side Note - Much to my client's pleasure and their ability to relax, there is about a 0% chance that I will ever sing to them to help them relax. However, I could consider my singing a diversion or a relocation of pain (from the abdomen to the ears).

To be continued.....

The Doula Book - Part I The Need for Support and the Role of the Doula

Posted by Kim:

The process of becoming a certified DONA Doula has several facets and one part of the certification process is to read 5 books from the required reading list and the DONA International Birth Doula Position Paper.

To see the entire required reading list click here.

One of the first books I decided to read is The Doula Book by Klaus, Kennell and Klaus. Because of the pending births of my doula clients I literally devoured this book and was very impressed by how informative it was and how easy it was to read. In my opinion the authors did a wonderful job intertwining the description of the role of the doula and connecting it with statistically significant studies.

In this blog series I thought I would share with you some of the points I highlighted while reading the book.



Chapter 1 The Need for Support in Labor

"Continuous support from a doula during labor provides physical and emotional benefits for mothers and health bonuses for their babies. With less medical interventions, fewer complications, and shorter hospital stays, there may be financial savings as well." (page 1)

"In studies of over 5000 women... we have seen a major reduction in the length of labor, a greater than 50 percent drop in cesarean sections, a remarkable drop in the mothers' need for pain medication, and several other important and measurable benefits." (page 3-4)

"I want the doula there to assure me that everything is fine and to comfort me. I want my husband there for emotional support." (page 9)

"A recent study found that women giving birth encountered an average of 6.4 unfamiliar professionals during labor." (page 11)

"When... the caregivers goal is to reassure, relax, comfort, and inform the mother rather than to tend only to the needed medical interventions, that person takes the same supportive role as a doula." (page 11)

"With such help, parents can capture the special moments and priceless experience of their own unique childbirth." (page 12)

Chapter 2 The Special Role of the Doula

"A doula learns that she has to be wiling to take anything for an answer... The experienced doula develops enough confidence and self-esteem that she is not offended by the woman's seeming rejection of that action." (page 16)

"The woman can be completely at ease with the doula and unconcerned about having to try to please her or put on a show for her." (page 17)

"The most important assurance that a doula can give in these initial (prenatal) visits is that she will remain with the mother throughout the entire labor and not leave her alone." (page 17)

"By her presence, manner, and comforting touch, the doula creates calmness and the essence of relaxation." (page 19)

"By her words and actions, the doula models behaviors and attitudes that are almost always copied and appreciated by the father. At times a doula needs to be resolutely strong and firm, and at other periods in the labor, tender, soft, and loving." (page 22)

"A woman in labor needs total support - in order to let go completely, to allow her own system to adapt and respond to the power of the birthing process." (page 23)

List of qualities for choosing a doula (page 27)

This book is definitely right on when it comes to the role and the need for a doula. Throughout the labor of my first doula client I kept thinking to myself, man I wish I had had a doula. Why didn't I know about this? I decided to become a doula because after learning more about the role of the doula, hearing stories about Carri's client's births, and attending many birth education conferences for BINSI I was invigorated by how a doula can enhance a woman's birth experience and how dramatically the presence of a doula can effect birth.

The more I learned the more I realized that the role of the doula is not to replace the partner, but rather to be there to support both the partner and the laboring mother so that they can stay emotionally connected. While it is special to me for my moms to tell me that they felt like I was truly there for them, there is a little special extra special when the dads say they couldn't have done it without me. I never want my clients to feel like I was trying to replace them, but rather I want them to feel like I helped them be the best support they could be.

I only wish I had listened to our friend Chuck when he said "Get a doula, it is the best money spent." WHY WHY WHY didn't we listen? Well as with everything in life hindsight is 20/20. So now I have made it my mission to at least educated as many women as I can about the role of the doula and how it can enhance their birth. I still struggle with the decisions I made during my births and will always wonder how different my births would have been if I had had a doula, but truthfully being a doula has helped me heal from some of my birth decisions and has also helped me to process my births. As with everything it is a process, but I hope to use my experiences as a mother and as a doula to help women have the best birth experience. It is my goal, and BINSI's, to Honor Moms!