Monday, June 16, 2008

Doula as "Obstetric Technique"

Check out the MedWire News synopsis of a new study that was recently published in the journal Birth (2008: 35: 92-7)

Doula support reduces cesarean and epidural rates
by Lucy Piper 03 June 2008
Examining the perinatal effects of doula support for nulliparous middle-income women accompanied by a male partner during labor and delivery.

MedWire News: The continued presence of a doula during labor significantly reduces cesarean delivery rates and the need for epidural analgesia in middle- and upper-class U.S. women accompanied by their male partner or another family member, researchers report.

They suggest that maybe fathers should not be expected to fulfill the role of primary labor companion.

Susan McGrath and John Kennell from Case Western Reserve University, Cleveland, Ohio, USA, investigated the potential benefit during labor of an experienced doula to provide both emotional and instrumental support. A total of 420 women were randomly assigned to either have a doula present throughout labor in addition to their male partner or no such additional support.

Women who had the support of a doula had a significantly lower cesarean delivery rate than the control group, at 13.4 percent versus 25.0 percent. They were also less likely to need epidural analgesia, at 64.7 percent versus 76.0 percent, respectively.

Among women with induced labor, just 12.5 percent of women with a doula had a cesarean delivery, compared with 58.8 percent of those without a doula.

All women and their male partners who received the support of a doula rated their experience as positive.

"Continuous labor support by a doula is a risk-free obstetric technique that could benefit all laboring women and should be made available in all maternity units," the researchers conclude.

Fabulous study (Under "Do your Homework" in the sidebar, click on Birth: Issues in Perinatal Care or read the entire study via Recent Notable Journal Articles.) Who knew that continuous support by a doula would ever be called a "risk-free obstetric technique?" Only in the U.S., eh? The guys at Monty Python could have really used that in their birth scene in "The Meaning of Life"..."Oh, and we're forgetting the doula, that new risk-free obstetric technique! Put her next to the machine that goes "Ping!""

But, don't let that one phrase muddy the results of the study...they're great!
- Jacquie Munro, Vancouver Doula

Sunday, June 15, 2008

Ten Questions

I think there’s a purpose behind the nine long months of pregnancy. This time is vital for introspection, reflection, setting boundaries, and discovery. As I’ve said so many times before, birth is not a “body”’s an act of the soul and the mind and the will.

Yes, I have a checklist of the things that I need to discuss with clients...and worksheets for them to fill out if they’re “paper people”. But, in order to serve my clients well, I need to go further, deeper. So, over the months, we talk on the phone discussing everything from diapers to spirituality. I often ask couples some unusual questions to help them uncover how their life experiences may affect them during the birth and postpartum. Usually, the deeper we go, the greater the understanding, resulting in a much more positive emotional experience for everyone.

If we skim the surface in our phone calls or visits...or if clients don’t share honestly with me...or give me only SOME of the pieces to the puzzle...then the house of cards may fall down, and a challenging birth and postpartum period may result. I can only work with the information that is given to me.

So, thank you to all my clients who take the time to build a bridge of earned trust. Thank you to those who hear me, to those who share openly and honestly with me, their partners, their families, and friends. Those who share without masks or guilt or shame should find that the process of pregnancy and birth will take them to a whole new level of living.

So, here are just 10 of the questions that I may ask over those nine months...some might appear unusual...but there’s a method to the madness...
  1. What kind of an suitcase packer are you? Do you have games to see who can take the least amount of stuff in your MEC duffle? Or do you always end up paying for overweight luggage? (This question is not just about what you pack!)
  2. How long does it take for you to make decisions - on your own, and as a couple? Did you take 10 years to decide to get married? Or do you often kick yourself for being too impulsive (like Dharma and Greg on TV)?
  3. How much guilt do you take on in life? Do you think you’ll be able to be pragmatic and avoid “mother guilt”? (We have enough guilt in the world...)
  4. Would you ever consider going on standby? Would you be okay with the wait? If three flights were cancelled, would you just “roll with it” or feel like you were being tortured by the wait? (One dad described waiting for labour as “Sitting at the gate, waiting for a standby flight to Auckland. You know New Zealand is beautiful, and you’ll love the trip, but you have a love/hate relationship with the flight - you might even get to the point where you want to jump out of the plane - but it’s all worth it!”)
  5. As a couple, how do you think you would you do on “The Amazing Race”? Would you be the “bickering couple” or the “couple who accepts any challenge happily”? Would you spur each other on to better things, or do you think you’d give up? (One couple described themselves as the “bickering couple” who you know love each other incredibly - and win!)
  6. When you’re on a big ride, or hike, or in competition, how to you respond before the endorphins kick in? What strategies have you come up with to cope with your known response? (I whine initially, but my husband encourages me, lets me go slow, then cheers when my endorphins kick in - the best supporter!)
  7. What kind of family boundaries do you have? What family issues are swirling around you as a couple? Would you be able to say “We’re on a baby honeymoon...and we’ll see you in two weeks”? Or would your families’ actions become the talk of your small town? (One couple went “underground” for a week at week 2 postpartum, because they had been bombarded by family visits, and the new mother/baby connection had suffered as a result. Going “underground” helped them to claim their autonomy as a new family.)
  8. What was your role in your family of origin? What was your partner’s role? How do you plan to reconcile the differences as you become parents yourselves? (One client realized that her actions as a first-born, and her husband’s actions as the “baby of the family” required discussion prior to the birth of their first baby...and looooong walks on the beach.)
  9. What has been your greatest emotional challenge in life? How did you cope? How has it changed you? (One client said being thrown into the shark-infested waters of the Indian Ocean made her face her fears. Another said writing her bar exam taught her to take life “lightly”. Another said her battle with cancer at age 19 had changed her “from a lamb into a warrior”.)
  10. What have I missed? Is there an elephant in the room? (Though I’m not the family physician or midwife, I do need to know, in advance of labour, if a client has a clinically diagnosed fear of giving birth. That happened in 1990...and it’s a long story... )
- Jacquie Munro, Vancouver Doula