Labor support
By Victoria Nestorowicz
“If a doula were a drug, it would be unethical not to use it.” (Dr. John H. Kennell,1998) The job of a Doula is to provide comfort and continuous care to expecting parent(s). The high quality relationship arranged by the doula and parent(s) facilitates a safe, satisfactory and comfortable pregnancy, labor and delivery. Women experience high self-esteem and confidence when satisfied with the outcome of their baby’s birth, an accomplishment that will always be remembered. With a doula present, the pressure on the partner is decreased and he or she can participate at his or her own comfort level’ The partner and Doula work together, complementing each other’s effectiveness in assisting the labouring mother. This permits the partner to enjoy the experience and have proper guidance in comforting the labouring mother. The Doula can offer respite to the partner who may have significant emotional fears or anxiety surrounding the birth, they may want to get refreshments, use the washroom or notify family members. During these instances the woman in labor still receives continuous care with someone whom they have developed trust and respect with. I have also noticed that the birth partner(s) have an incredible amount of awe for the labouring mother, especially when they have a moment to observe the process.
‘The largest systematic review of continuous labor support, published in 2011, reported the combined findings from 21 randomized controlled trials, including over 15,000 women.. Overall, the supported women had better outcomes than the usual care groups, obstetric outcomes were most improved and intervention rates most dramatically lowered by doulas. According to a summary of the findings of this review (15), the doula-supported women were:
• 28% less likely to have a cesarean section
• 31% less likely to use synthetic oxytocin to speed up labor
• 9% less likely to use any pain medication
• 34% less likely to rate their childbirth experience negatively
Obstetric outcomes were most improved and intervention rates most dramatically lowered by doulas in settings where:
• the women were not allowed to have loved ones present
• epidural analgesia was not routine (when compared to settings where epidurals are routine)
• intermittent auscultation (listening to fetal heart rate) or intermittent (versus continuous) electronic fetal monitoring was allowed’
(Penny Simpkins’ Birth Doula Position Paper: The Birth Doula’s Contribution to Modern Maternity Care. Retrieved from Childbirth Connection “Best Evidence: Labor support”, 2011 www.childbirthconnection.org (retrieved 3/17/2012))
Proper labor support advances the effectiveness of contractions which set up for delivery, improving obstetric outcomes. A healthy pregnancy, labor and delivery contribute to the wellbeing of mother and child, enhancing their relationship. If a mother is not well supported she may be startled by labor, her natural hormones and endorphins can be inhibited by adrenaline and various complications may arise that could require medical interventions. Some of these interventions can be useful when necessary but may impede natural progression of labor and cause fetal and/or maternal stress. In most cases a natural and vaginal delivery if possible, is the best option. If for some reason there are complications, a doula will support the mother and partner and advocate their wishes. This provides the mother with control and power over her experience and helps to avoid the most ‘convenient’ choice for the clinical care providers.
The responsibilities of the doula include; continuous presence for emotional support, physical comfort, non-clinical advice and guidance for the partner.
The ethical obligations of a doula include;
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The client as the doula’s primary responsibility
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Fostering maximum self-determination on the part of her client
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Respect the privacy of clients and all information obtained from the service
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Assist and serve each client seeking birth support or making appropriate referrals
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Being reliable to the client without fail for the term of their agreement
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Setting fair fees, clear terms of payment and refund policies.
The Responsibilities to colleagues include;
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Being respectful, fair and courteous
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relating to a colleagues clients with professional consideration
The ethical responsibility to the labor support profession include;
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Maintaining integrity to the profession
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Community service, “A doula for every woman who wants one”. Providing care at low or no cost when possible.
Doulas are responsible to promote maternal and child welfare.
The role of the doula is to provide emotional and physical support to a labouring mother. The doula can suggest and help with comfort measures for the mother and partner. The Doula can provide information for the clients with the advice to check with their primary clinical care giver. A doula can assist with breastfeeding and post-partum emotional support.
The Doula is limited to emotional and physical support only. Under DONA certification doula’s do not provide clinical checks and medical tasks such as taking fetal heart rate, blood pressure and vaginal exams. The doula advocates the client’s wishes expressed prior to labor, this does not include making decisions or speaking for the client. Doula’s provide support, information and mediation or negotiation. Doula’s can also refer a client to appropriate resources when the needs are beyond the scope of the doula’s training.
Doula’s are encouraged to obtain and maintain certification and experience.
Obligations and responsibilities of a Doula from the DONA ‘Code of Ethics’.
Doula’s role found in the DONA ‘Standards of practice.’
moksha mama 