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Conscious Empowered Birth
book review

The Doula Book: How a Trained Labor Companion Can Help You Have a Shorter, Easier and Healthier Birth
by Marshall A. Klaus, John H. Kennell, & Phyllis H. Klaus
Reviewed by Cristin Tighe

This book highlights the need for a woman to have support in labor, as it has always been through history. A doula can be key, given more medicalized births and the growing role of the partner (typically male) as we shift from birth that used to involve a woman giving birth surrounded by other women. A doula can provide a level of support the partner can not (because he is intimately connected to the laboring woman), and can provide support for him and fill in where medical staff can not always pay attention.

The special role of doula involves providing information and attention from the first meeting (start of third trimester), a few follow up meetings, during birth and after (helping review the birth experience). The most important assurance a doula provide is that she will remain with the mother throughout the entire labor and not leave her alone. Additionally, the mother needs to know she has permission to let go, do whatever she wants and ask for whatever she needs… “mothering the mother” helping her feel confident and accomplished whatever happens. The doula interacts positively with hospital staff, provides information and support to spouse and family, but foremost stands in attention to the woman for all her needs.

The doula can help enhance the birth experience from early labor by preparing the mother for what to expect before, and encouraging her during this time to move, walk, take a bath, change positions, drink and eat. During labor in the birth room, the doula is attentive to the environment (temperature, light, privacy, space to move, drinks), and asking for changes as desired. Talking with the mother, light touch, massage, helping her change position, and supportive words are all used during this time.  Making sure the mother is informed of what is happening, and that her wishes are respected is also part of the doula’s role. The doula can help assure the birth plan is followed as much as possible, that any stressful situation is avoided, and that after the birth, mom gets to be with the baby right away.

There are ways to reduce discomfort, pain and anxiety in childbirth, such as dealing with past expectations and re-framing the experience in a positive light, allowing the mother to express fear and pain, and to use techniques to move through both.  Even with an epidural, a doula can provide assurance, information and physical help. Relaxation techniques, hypnosis, allowing mom to disassociate and express all feelings and sounds are key. Recognizing and working with a woman’s changing needs during labor helps reduce stress and allows time for the process to unfold in a way that she is secure, so it can happen as smoothly as possible.

Obstetric benefits of doula support are varied and significant, and include improved birth outcomes as well as reduced financial burden. Generally (there is much evidence-based data showing) length of labor is shorter ~25%, vaginal delivery is more likely, ~31% less pain medication is needed, forceps are used ~34% less, cesearan sections are ~45% less likely, maternal fever is less likely, and there are ~10-60% less epidurals.

Longer-term benefits of doula support include better bonding of baby and mom during the sensitive period right after birth (typically the first two hours).  Mothers who work with doulas report less pain after first 24 hours and more time with their babies, as well as more positive reports on feeding behavior and infant health at six weeks. Also at six weeks, moms who had a doula are in a better emotional state, have more positive relationship with partners and more positive perceptions of the baby, as well as positive interaction and bonding later.

Birth with a doula can happen in the hospital, home or a birth center. In all cases, a mom needs emotional and physical support, as well as information, constant assurance and someone watching out for her. The doula can help a father in his role also, and usually works well with the father, providing him suggestions on supporting the mom as well. After the birth, postpartum doula care can also be key in the transition from the hospital to home, by reviewing the birth experience, mothering mom, helping at home (regular tasks and creating new routines), learning to breastfeed, dealing with baby blues and more.

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