The Role of the Birth Doula - Realities and Misconceptions

I regularly get asked what a doula does and people sometimes mistake me for a midwife.  I have covered the difference in other posts, but basically a midwife is a medical professional who is trained to deliver babies.  As a doula, I work alongside your doctor and nurses to provide emotional support and offer suggestions for comfort measures such as: positions, massage and pressure techniques.

In my last post, I reviewed the book Your Best Birth: Know All Your Options, Discover the Natural Choices, and Take Back the Birth Experience.  The authors of this book are big fans of the doula and there is an entire chapter devoted to how a doula helps.  Because they are such promoters, I am wary of being critical of the contents of this chapters, but I felt like some of their explanations could be clarified.

DOULA vs. CHILDBIRTH EDUCATOR
First, I just wanted to clarify that a doula and a childbirth educator are different things.  Some doulas are trained as childbirth educators, but not all.  Many childbirth educators will teach classes, but will not attend the birth of your baby.  In the book, the distinction is not made clearly.  I am trained as a doula, not as a childbirth educator.  As a doula, I do offer information and resources about birth and I certainly will recommend books and dvds to clients, but I don't offer in depth classes.  There are options in our area for Lamaze and Hypnobirthing classes and I will connect clients to these (and might even attend the classes with them).

I hope to become a childbirth educator for Birthing from Within in the next three years and I am taking the first training in June 2011.  This will enable me to help couples better prepare for their birth and eventually offer classes that compliment my birth doula services.

DOULA TRAINING
In Your Best Birth, Ricki Lake and Abby Epstein say that doulas start by doing a course and then apprentice (attend births) with more experienced doulas before becoming certified.  Maybe this is the case for some doulas in some communities, but in my community the hospital only allows two support people, so it is difficult for more than one doula to attend a birth.  Also, there are very few experienced doulas here who are able to act as mentors.  I think an apprenticeship for new doulas is an ideal scenario, but do not be surprised if your doula has not had the opportunity to work with a more experienced doula.  I am trained through DONA International. For more information about their certification process click here.

DOULAS and DECISION MAKING
Lake and Epstein understand what doulas do, but they don't always explain it well.  The statement: "Doulas can help you make the decisions you're faced with during childbirth" is a good example.  I help couples prepare before the birth and provide them with information that they are interested in, so they can make decisions during labour.  One of the tools I use to do this is the B.R.A.I.N. acronym.  Couples can ask these questions of medical professionals about suggested interventions:

Benefits - what are the benefits of this?
Risks - what are the risks to mother and baby?
Alternatives - is there anything else we could do instead?
Instincts - what do the parents' instincts tell them?
Nothing - what happens if we do nothing?

This allows couples to ask questions and the medical staff to respond directly to them.  As a doula, it is important for me to maintain a good relationship with the caregivers and not be viewed as confrontational.  Also, as I mentioned in my last post, it is important that parents educate themselves and learn to advocate for themselves.

DOULAS HELPING your SUPPORT PEOPLE
This is an area that was covered well in the book.  You are the star of your birth and everyone else is the supporting cast.  As a doula, I want to help the pregnant woman feel confident and powerful and to help her partner (or other support person) do the best job they can to help her.  Often, the most important thing a doula can do for couples is to reassure them they are doing well and that this is what labour looks like. Most people have not seen anyone in labour (TV doesn't count), and don't know what to expect.  If they are fearful or in a really medicalized environment, anything that happens can be seen as potentially dangerous.  Labour is very intense and sometimes the role of the doula is to remind the support people (and the mother) that birth is not an illness and what is happening is normal.

I hope this post helped clarify some of the more complex questions of what a birth doula can help you with.  Please feel free to contact me for more information or an initial interview.

Healthy Pregnancy (and Baby) Tips

from http://www.ewg.org/Health-Tips/10HealthyPregnancyTips
(I have added my comments/suggestions in italics to the original article - EC)

Pregnancy is a critical time. A mother’s chemical exposures can adversely affect her baby in many ways. Here are  some simple but important steps you can take to reduce the risks during pregnancy - and beyond.

EC - It is important to do the best you can.  Sometimes we get so obsessed with following 'rules' put out in baby books, by our doctors, families or in articles like this, that it ends up increasing our stress.  There is a lot to be said for trusting our common sense and taking what works for us and  leaving the rest.  Many of these tips apply not only to pregnancy, but can be adopted every day.

1. Go organic and eat fresh foods
   Use EWG's Shoppers Guide to Pesticides to determine which fruits and veggies you should always buy organic and those with the least pesticide residue that are ok to buy conventionally grown. Choose milk and meat produced without added growth hormones. Limit canned food, since can linings usually contain the synthetic estrogen called bisphenol A (BPA).
   EC - Many farms in Southern Alberta sell pesticide free produce and hormone free, free range meat, that is not certified organic, but still a healthy, sustainable choice.  Check out Broxburn Vegetables and Harris Farms for two great options.
2. Drink safer water
   It's important for pregnant women to drink plenty of water. Use a reverse osmosis system or carbon filter pitcher to reduce your exposure to impurities such as chlorine, perchlorate and lead. Don't drink bottled water, which costs more and isn't necessarily better. If you're out and about, use a stainless steel, glass or BPA-free plastic reusable container. Mix infant formula with fluoride-free water. Get EWG's Safe Drinking Water Guide.
   EC - Exclusive breastfeeding for the first six months is the healthiest choice for babies.  There have been some studies that show toxins appearing in breast milk, but they are at far lower amounts than toxins present in formula.  Following some of these tips, can also decrease the level of toxins in your breastmilk
3. Eat low-mercury seafood
   Choose low-mercury fish such as salmon, tilapia and pollock, rather than high-mercury tuna and swordfish.
4. Get your iodine
   Use iodized salt, especially while pregnant and nursing, and take iodine-containing vitamins. Iodine buffers against chemicals such as perchlorate that can disrupt your thyroid system and affect your baby’s brain development during pregnancy and infancy.
5. Choose better body care products
   Just because the label says "gentle" or "natural" doesn't mean a product is safe for pregnancy. Look your products up on EWG's CosmeticsDatabase.com. Read the ingredients and avoid triclosan, fragrance and oxybenzone. Read EWG's Healthy Home Tips for more tips.
   EC - Also watch out for parabens, sodium laurel/laureth sulfate and parfum (another word for fragrance).  Shop at stores that are consciously selling healthy products for you and your children.  In Lethbridge, check out Naturistas (424 7th Street South) and Ecobaby Canada.
   
   
   
   
6. Wash maternity clothes before wearing
   Clothing is often coated with chemical treatments in the factory.
   EC - Many baby clothes (especially sleepers) are treated with flame retardants.  Choosing 100% cotton (especially organic cotton) clothes that fit well is a good choice.  Always wash all baby clothes, car seat covers, blankets, baby carriers, etc. Before using them.  Use a mild, fragrance-free deter
7. Identify lead sources and avoid them
   Test your tap water for lead and avoid any home remodeling if your house was built before 1978, when lead house paint was banned. Dust from sanding old paint is a common source of lead exposure.
8. Avoid painting.
   When getting your nursery ready, avoid painting and other chemical-intensive jobs.
   EC - If you must paint or remodel while pregnant, get someone else to do the work and try and stay somewhere else to avoid chemical exposure.  Use VOC free paint, which you can buy at most paint stores.
9. Clean greener
   Household cleaners, bug killers, pet treatments and air fresheners can irritate kids’ and babies’ lungs – especially if they have asthma. Check out less toxic alternatives. Some ideas: vinegar in place of bleach, baking soda to scrub your tiles, hydrogen peroxide to remove stains. Use a wet mop/rag and a HEPA-filter vacuum to get rid of dust – which can contain contaminants. Leave shoes – and the pollutants they track inside -- at the door.  Get EWG’s Tips for Greener Home Cleaning.
10. Avoid gasoline fumes
    Ask for your partner's help to fill the gas tank, or use full service..
11. Pick plastics carefully
    Some plastics contain toxic chemicals, including BPA and phthalates. Don't reuse single-use containers or microwave food in plastic containers. Avoid PVC by hanging a natural-fabric shower curtain. When remodeling, go with PVC-free flooring and pipes. Learn more about choosing safer plastics.
    EC - even though some plastics are recyclable, they often end up in the landfill.  Even the for the supposedly non-toxic plastics, we don't really know, because chemicals need to be proven unsafe to be taken off the market, so instead of plastics, think about using alternatives, like glass and stainless steel.
    
    
    
    
    
    
    
    
    This book expands on the points covered in this article and includes information on being green with your new baby too.
    
    
    
    
    
    
    
    
    
    
    A great guide that includes pregnancy, babyhood and beyond.