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 Doula (doo-la) comes from the Greek and now refers to a woman who cares for the needs of another woman before or after birth.
The birth doula is a person who helps parents prepare for and personalize their childbirth experience. The postpartum doula is trained in helping mothers and families during early parenting. Doula care enhances your birth experience and, so, your life. Read Minnesota Public Health Association recommendation for doula care. Click on the Read Doula link below to read more.
The doula role evolves from the historical role of aunts and mothers and elderly neighbors who shared the same experiences and values of the birthing, and new, mother. Women feel differently about birth and early parenting today. What women face in technological childbirth is much more complex than 20 to 40 years ago. Unless she stayed up-to-date in the childbirth scene, the relative of the birthing mother will not be familiar with today's childbirth and parenting practices.
Many scientific and philosophical insights are being made at this time
about the fetus and the newborn baby. These insights are dramatically
changing how many parents care for and attend to their wee ones.
"Evidence-based labor and delivery management"
by V. Berghella, J K Baxter and S P
Chauhan called doula care "one of the most effective interventions" and
concludes that the US Prevention Services Task Force "strongly
recommends that clinicians provide [doula care] to eligible patients. The USPSTF
found good evidence that [doula care] improves important health
outcomes." The article goes on to say " A support person (doula) present during labor is associated
with decreased use of analgesia, decreased incidence of operative birth,
increased incidence of spontaneous vaginal delivery, and increased maternal
satisfaction in 15 trials, including 12,791 women.
The most effective form of support
starts early in labor, is continuous, and is not provided by a member of the
hospital staff. The mother should be encouraged to select her doula during
pregnancy; they establish a relationship (which is likely to involve the woman’s
partner, if any) and discuss the mother’s and partner’s preferences and concerns
before labor. The doula brings her experience and training (often to the level
of certification) to the labor support role during childbirth, and the mother
and doula frequently have telephone and/or face-to-face contact in the early
postpartum period.
Susan Lane of the Minnesota Better Birth Coalition says, "...Strong support of doula care
has been offered in the Cochrane Review for many years. There is no
contrary source of evidence, nor any known side effects of doula care.
Withholding this care, chosen by the client, is unethical and harmful."
Susan reports, "The Minnesota Public Health Association recommends doula care for all women
based on the review of evidence presented to their policy committee.
Finally, the legislature of the State of Minnesota has granted women the
right to doula care by statute in 2003 and 2009 (Sec 144.651 subd 10)."
So does the doula replace the women in the family? No. We need our loved ones to support us as we become mothers and honor our choices.
Does the doula replace the partner? What about the baby's father? Women look to their partners for an intimate acknowledgment of the transformation that takes over them as they advance through pregnancy and go through labor. The partner might stay near and keep alert to what's happening in and around the birth room so the birthing woman doesn't have to.
Links to learn about doulas
DONA International
CAPPA
ICEA
Lamaze - tips for finding a doula
Links to local doulas in Minnesota
Childbirth Collective (Mpls, St. Paul, Fargo, Winona)
Everyday-Miracles (Anoka, Hennepin, Scott, Carver Counties)
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
St. Paul Community Doula Program
University-Fairview Somali Doula Program
Birthing Ways Doula Connection in Duluth
Northland Birth Network in Duluth
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Pipestone, MN/SD Childbirth Doula Collective
More about the doula
The birth doula is a peer who has birth experience and know-how.
She's not medical, but a little like a personal childbirth teacher.
(Women and couples benefit greatly from independent childbirth
education.) But even with know-how, she doesn't tell the mother what to
do. She listens to the mother to hear what is important to her. Then
she shares the options and possibilities available to the mother within
the vision and values that mother describes. She may have experience
with the hospital that the mother will give birth in. When hospital
staff have come to trust the doula many more options seem to be
available to the birthing families. These may be the little details
that matter. Small things accumulate to make a more pleasant and
personal experience.
Not only more pleasant, but healthier. Doula care is associated with
better birth outcomes. There is something about an unrelated female who
stays near, and often touching and/or speaking kindly to the mother.
Labors tend to be a little shorter and mothers find them, overall, less
painful than mothers who did not have doula support reported.
Payment of doulas
Some doulas work on a sliding fee scale, others charge 300, 500 or more dollars. Doulas who are learning their skills, and just gettingtheir certification requirements done may offer care for free. To find all kinds of doulas, look at the resources listed above, and if there is a Collective meeting in your area, please attend one and state your intent to find a doula who fits in your income needs when you introduce yourself, or after the meeting during the time when parents and doulas chat.
Doulas are paid in different ways. Parents may pay their doula directly, out of pocket. They can use their pretax dollars if they have an account through work.
Non-profit organizations that provide doula care, such as Everyday-Miracles, pay their doulas through their fund raising efforts or grants.
Some HMOs and insurance companies will pay the doula. Some don't. Billing can be a chore for parents, but is worth it in the end if some reimbursement comes through.
Hennepin County Medical Center will provide doula care from their pool of staff doulas. Parents need to voice their desire for a doula to get one. Ask the nurse clearly for a doula, once, and maybe twice on a busy night. Its helpful to get a doula to you before active labor gets underway.
I just found out that one of my clients got a full reimbursement from Medica on the 1st try! Go Medica! -MT, local doula
Training and certification of the doula
Since the doula is a peer and not a medical professional, training to be a doula is not through college. Those of us that are doulas have natural tendencies to nurture and anticipate needs. We are those who comfort and sooth. We inform without directing the action taken. These are all life skills that cannot be taught in class, only emphasized.
A person can be a doula, can call herself a doula, without having taken a course or gotten certified. There is no state regulation. Minnesota is the first state to have a doula registry. This is a voluntary registry to begin the steps to legislative protection of parental rights to a doula. But that is another subject for another article. Look for such an article here at MNBirth.com
There are large and small doula certification organizations that train and certify doulas. DONA International is the largest doula organization and there are many other fine ones. DONA (meaning "to give") has an expert board of founders and a curriculum created by Penny Simkin, world-class birth educator and author. CAPPA , Childbirth International, and ICEA are other doula certifying organizations. However, not all doulas will want to work with the largest organizations. With a good web design, a woman at her kitchen table could present a doula certifying "organization" made up of herself and a couple friends that looks just as developed as one of the larger organizations. What benefits would that provide a doula? Would she have the support and ethical guidance that a board of experts could provide?
Its helpful to look into the certification or non certification of the doula you might choose for your birth. See why they chose to be certified or not, and what knowledge they may have through that path. The gift of a training is entering a vibrant community, learning the philosophy and the value of guidelines to doula activity, or Scope of Practice. This is the sort of enhanced awareness to the role of a doula that benefits parents as they interact with medical and community resources. The heart of the doula, and her experience with birth and with navigating emotional and physical challenges, her open communication and reliability are characteristics that don't need certification to benefit parents.
Certification is a sign of commitment along the personal journey of being a doula. There are several fine doula workshops offered in Minnesota each year. Check the web.
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