Let’s Talk About It: Doulas!
By: Dr. Brynn Lay
We’re starting off Dr. Brynn’s “let’s talk about it” series with Doulas!
Have you heard of a Doula? Weird word. Awesome profession.
Doulas help with pregnancy throughout every stage, but especially during labor and delivery. They have certifications and specific training so they are very qualified to have in your birth room as supportive beings. They provide continuous one-on-one care that isn’t just physical support, it’s emotional support as well (Morton, Stone, Romano).
The amazing part about Doulas is that they help YOU with whatever YOUR birth plan is, which is a huge deal and oftentimes overlooked by health care providers for various reasons. Planning the pregnancy of your dreams is exactly what we do in this office as well. We can work on a birth plan when you come in (and a couple back ups just in case) and make it so it is exactly what you want it to be. No judgement ever, empowerment only! Birth should be a joyous time and have good memories attached to it (Morton, Stone, Romano).
Vocabulary time! Labor Support: a therapeutic presence of another person that leads to caring behaviors because of that supported human-to-human interaction. Labor Support based around four pillars: physical support, emotional support, informational support, and advocacy (1,2,3,4).
- Physical Support: they physically help momma to be empowered, confident, and have control. They are there to provide a comfortable environment and to aid in any way that’s not Obsentrics, so getting water, ice packs, food, walking, etc.
- Emotional Support: they are there to make you feel reassured, praised, confident, and advocated for. Think of them as a human diary. You can tell everything to them and they are there to support you in whatever way necessary.
- Informational Support: they help with guiding them through labor. As in what to expect and what the options are along the way as birth progresses. They offer up breathing techniques and can even work along with your spouse/partner to understand how you might be feeling.
- Advocacy: they will always ask you what you want and empower you to find your voice. They are there to make sure you are heard every step of the way. They create a space that is open, evidenced-informed, and honest.
Switching gears now, let’s talk about evidence. In a Cochrane Review that delved into the effects of continuous support during childbirth, they studied 15,000 people between the 26 studies. Something to note is that this review is under the category of “low” quality of evidence. There are 3 categories: high, low, and very low. Low is right in the middle meaning it isn’t amazing research, but you do not need to throw it away either. It is hard to blind the moms in labor to their doulas, that would defeat the purpose of a doula wouldn’t it?
Anyway, births with doulas present tended to have more vaginal births and less likely to have epidurals, emergency interventions, or pain medications. Labor times were reduced by 40 minutes and were shown to be less likely to have low APGAR scores. There was lesser evidence that having a doula present would help keep postpartum depression away. There was also no evidence to say that having a doula present was negatively impactful (8).
I imagine that your next question is, why are doulas so awesome and effective? First of all, you know them, you chose them to help you during this laborious time in your life so when you walk into that steril hospital you have someone to bring you comfort and to exude confidence for you. No one wants to be around someone that isn’t confident when they are going through something traumatic (3). Doulas can actually be a pain reliever too. Having them there has shown that less epidurals are used. People were more empowered and motivated to have an unmediated birth. A lot of times this happiness and connectedness leads to a release of oxytocin and decreased stress hormones which stimulates uterine contractions and less anxiety (2,3,4,6).
Doulas can have a positive impact on the birthing process for BIPOC. Read that again. Black women have higher rates of poor birth outcomes, which include cesareans, pre-term babies, low birth weights, and infant death (5). These disparities survive past even socioeconomic backgrounds like household income, education, drug usage, marital status, and insurance coverage. This is not okay. So where is this inequality coming from? Research has shown that BIPOC go through many different inherent forms of racism throughout their lives (systemic racism) which can lead to more anxiety and stress and eventually more stress when pregnancy is added into the mix (5).
How can doulas help with this? They help with agency. This creates a space for momma-to-be to feel empowered to voice her wants and needs. They also might feel more comfortable with their doula, so having them in the room will automatically bring ease to labor. Because doulas usually know their patients personally, they can translate what the OB is saying or doing and really provide connected emotional care to comfort during labor (2,3,4)
So can Doulas do what my OB/GYN does? Nope, they are purely a support team that are defined by those four pillars we just talked about above! They cannot perform any medical procedures. Boom. A straight to the point answer (2,3,4).
How does a chiropractor work into pregnancy? I’m so glad you asked!! We can help with all of those pillars as well if you would want that in your birth plan. Mostly though we can help with keeping your joints movin’ and groovin’ as the body goes through all of the pregnancy changes and hormones. Keeping joints moving properly can help with baby comfort as well. Think about it: you’re moving with ease and properly, so the baby will be able to as well while in the womb. Not having the stress of pain either can be beneficial mentally and in-turn positively affect the baby’s wellness, too. We can also help with giving some strengthening and cardio exercises to help condition for birth. You will become an athlete during labor so we will plan for as such! We will also work with your Doula and your whole birth team for that matter, no problem!
Want to know more about Doulas, Chiropractic, or anything else (health related- please)? Give us a call at 720-484-5677 or email [email protected]. You can also schedule an appointment with me by calling our office or going to wurthchiropractic.janeapp.com !
Before you leave, we are offering free consults right now, so, if you want to dip your toe in and just chat, we can absolutely do that!
References to check out:
Birth Ambassadors by Dr. Christine
MortonBest Practices of Midwifery by Susan
StoneOptimal Care in Childbirth by Amy Romano
1.DONA International. (2015). Code of Ethics: Birth Doula. Published at https://www.dona.org/wp-content/uploads/2016/09/COE-SOP-Birth.pdf. Accessed on July 24, 2017.
2. Gilliland, A. L. (2010a). “ A grounded theory study of effective labor support by birth doulas. In Human Development and Family Studies, Vol. Doctorate University of Wisconsin, Madison, Wisconsin, pp. 452. Available at the bottom of this page.
3. Gilliland, A. L. (2010b). “After praise and encouragement: Emotional support strategies used by birth doulas in the USA and Canada.” Midwifery, 27(4): 525-31.
4. Gilliland, A.L. (2016) “What motivates people to attend birth doula trainings?” J Perinatal Educ, 25(3), 174-183.
5.Giscombé, C. L. and Lobel, M. (2005). Explaining Disproportionately High Rates of Adverse Birth Outcomes Among African Americans: The Impact of Stress, Racism, and Related Factors in Pregnancy. Psychological Bulletin, 131(5), 662-683.
6. Hofmeyr, G. J., Nikodem, V. C., Wolman, W. L., et al. (1991). “Companionship to modify the clinical birth environment: effects on progress and perceptions of labour, and breastfeeding.” BJOG 98(8): 756-764.
7.Thomas, M. P., Ammann, G., Brazier, E., et al. (2017). Doula Services Within a Healthy Start Program: Increasing Access for an Underserved Population. Maternal and child health journal, 21(Suppl 1), 59–64.