Flu & Pregnancy – New Research Published

flu in pregnancyTwo studies published this fall provide important information on the flu in pregnancy. First, reviews of Centers for Disease Control data from recent flu outbreaks show that pregnant women who contract the flu are at higher risk for complications and overall have worse outcomes. Their babies can also suffer complications, including preterm birth and low birth weight. The flu is a serious illness for pregnant women but little has been known on exactly why. Theories have included a) that pregnant women have a weakened immune response to illness in general which may help prevent the rejection of the fetus and b) that changes in the body due to pregnancy exacerbate flu symptoms. New research from Stanford University, however, has uncovered new and surprising information about how a pregnant woman’s body responds to the flu.

The Stanford researchers found that pregnant women actually have an unusually strong immune response to the flu virus. Senior author of the study Catherine Blish MD, PhD said, “We now understand that severe influenza in pregnancy is a hyperinflammatory disease rather than a state of immunodeficiency. This means that treatment of flu in pregnancy might have more to do with modulating the immune response than worrying about viral replication.”

This could have important effects on how the flu is treated in pregnant women. The current course of treatment is medication to slow the replication of the virus. This, however, does not address the newly discovered hyperinflammatory response of a pregnant woman’s immune system. This is particularly important in maintaining adequate lung function in pregnant women suffering from the flu where inflammation – even when caused by too many immune cells – is of particular concern.

The physician authors of both studies recommend pregnant women receive a flu shot to reduce their risk of contracting influenza. We recognize there is a strong debate about vaccinations and encourage doulas to share evidenced based information with clients so that they can make informed decisions. Our friends over at Lamaze International’s Science & Sensibility blog have a great post from 2011 about the flu vaccination in pregnancy with a number of resource links.

- Adrianne Gordon, MBA, CD(DONA)

CDC Flu Data Review
Study Summary
Interview with CDC Study Author

Stanford Study on Immune Response
Press Release from Stanford Medicine
Study Abstract

Positions Available With DONA International!

DONA International is currently accepting applications for two publications committee contract positions, Blog Manager and eDoula Newsletter Editor. These positions are open to experienced and qualified DONA International members, preferably those currently certified. The application deadline is December 23rd, so don’t delay if you are interested!

The eDoula Newsletter Editor oversees and coordinates publication of our quarterly regional e-mail newsletters, working closely with our director of publications and regional directors to deliver newsletters that keep our members informed and connected. A generous stipend is offered for this one-year appointment, with the option to renew.

The Blog Manager oversees and coordinates publication of this DONA Doula Chronicles blog by authoring or commissioning content that will build and sustain awareness of birth and postpartum issues relevant to our members and the general public. A generous stipend is offered for this one-year appointment, with the option to renew.

We are looking for creative, energetic and enthusiastic professionals with related experience to engage and support our membership! Perhaps you have the necessary qualifications and are the perfect person for one of these positions? Email Publications@DONA.org for the job descriptions and application details.

Winter Weather Tips for Doulas

Originally posted on The DONA Doula Chronicles:

This winter has packed a powerful punch with snow, ice, and frigid temperatures for parts of the U.S. and Canada that hardly ever see this type of weather.  What’s a doula to do? Support and availability to clients during the winter months can present unique challenges. Whether you are a veteran doula used to snow storms or a novice doula from the balmy South, here are some tips to help you stay safe, comfortable, and better able to serve your clients during the winter months:

1. Keep your gas tank full.  This doesn’t mean you need top-off your tank daily, but keeping your car with a good amount of gas is a good first step in staying safe and warm. There’s nothing fun about having to stop for gas on your way to a birth on a freezing winter night.  In the event you get stuck, you’ll have fuel…

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Doulas on TV: Frasier to Bones and Beyond

screen-92134_640The birth community has been abuzz about the latest portrayal of doulas on a primetime television show. Yes, the doula in Bones was outside of our scope of practice and, in general, did not provide the appropriate emotional, informational and physical support she was hired to provide (which is why she was fired). Many blogs and social media accounts related to birth have decried this portrayal of doulas to the millions who watched Bones that week.

Wait…..over five MILLION people saw the episode of Bones that included a doula? And since then there have been dozens if not a hundred conversations in on-line birth communities about what doulas do and don’t do? Is that necessarily a bad thing? Would there have been so many conversations if the show portrayed a doula practicing within her scope and providing excellent support to the mother? Probably not. No one is talking about the OB-GYN in the episode, now are they?

While it is hard to watch (personally, I have been known to yell at the television during birth scenes but I digress), the inclusion of doulas on mainstream television shows is a testament to how far we have come. The episode didn’t include people mispronouncing “doula” or questioning the mother for hiring one, for example. It was assumed that the viewers knew what a doula was and that hiring one was a completely appropriate choice!

This isn’t the first or last time doulas will be mentioned or shown in a sitcom or drama. Doulas were portrayed for the first time on primetime American television in 2004 when the then number one comedy show Frasier introduced millions of people to doulas through a character named “Harvest.” Doulas and the birth community were abuzz then as well. Then DONA International President Ann Grauer said at the annual conference that year, “Thanks GOODNESS there was a doula on Frasier! It’s the number 1 comedy in America and we just made prime time history! Yes, she was far from reality, but so are wine enthusiasts, radio talk show hosts, and psychiatrists as portrayed on Frasier. To be parodied in a mainstream television program means we have arrived and we need to celebrate it and have a sense of humor about it.”

Her wise words apply to Bones and the various appearances of doulas or the concept of a doula on TV in the last 10 years. Since Frasier, doulas have been shown on Mad About You , A Baby Story, Tia & Tamara, The Rachel Zoe Project (featuring DONA International Board Member Ana Paula Markel) and Mulaney among others. And just like the lawyers, accountants, police officers, bartenders, and contractors shown in television shows, these portrayals are dramatizations or caricatures. Even so called “reality shows” use plot lines and editing to create drama and humor to keep audiences interested. And remember, not every mention or portrayal of doulas is negative. Suze Orman’s show Can I Afford It? addressed the value of doulas with this great quote from the financial advisor “You cannot afford to not get a doula. It’s a need, not a want.”

Our job as doulas and doula advocates is to use TV portrayals of the profession to start conversations about what doulas do, what we don’t, and the value we bring to birth and the postpartum period. And yes, to have a sense of humor about it. After all, not every workplace is The Office, either.

- Adrianne Gordon, MBA, CD(DONA

Tis the Season – Tips for Doulas During the Holidays

candle-432813_1280While marketing began weeks ago, the holidays are closing in (really). It is a special time of year, yet one that can bring a good bit of stress, too. Here are a few things to keep in mind as you support clients between now and New Year’s:

This time of year includes extra events, activities and demands on your time and energy. Pause before saying yes to commitments and evaluate your overall schedule and obligations. Be realistic about what you can do. Not overcommitting will help reduce stress and mean less to juggle.

Create back-up plans for events and responsibilities. Having more on your plate means needing a wider safety net than usual, whether that’s extra child care support, backup doula arrangements or even a plan B for getting those cupcakes to your child’s school event. Ask for help where you need it. Everyone needs a hand now and then, and doulas are no exception!

Increase your communication with doula partners or back-up. This can be incredibly helpful in alleviating stress and providing support to one another. Coordinate client check-ins or follow-ups and adjust on-call schedules, if needed.

Make time for self-care. Give yourself what you need to manage your own stress and wellbeing, whether its downtime, connection with others, exercise or quiet. Support your own health and remember that this is the beginning of cold and flu season. Eat well, sleep, stay hydrated and be mindful of sugar and alcohol consumption.

This is a busier and more demanding time of year for our clients, as well. They may be pushing themselves too hard or may be too distracted with activities, shopping, cooking, visitors and travel to pay attention to how they are feeling. Self care declines for clients also during November and December. Be sure to check in and encourage rest, hydration and healthy eating.

Be compassionate with yourself and others. We’re all busier and more distracted this time of year. This is a season of giving and gratitude, so don’t forget to extend that to yourself! We’d love to hear your tips for supporting clients during the busy holiday season. Share in the comments. Enjoy the season!

– Adrianne Gordon, MBA, CD(DONA)

In Case You Missed It: Online Continuing Education for Doulas

Staying up to date on evidence-based information, best care practices and how to continuously improve a doula practice is no easy task. These days many educational options are available on-line for degrees and certifications. While doula support is a very hands-on and personal service, staying up to date via the web can be a great way to stay informed and keep your doula practice inspired and growing around your busy schedule. To support the continuing education of busy doulas and build on our 2013 virtual conference, DONA International has launched Every Doula Everywhere & Anytime Webinars.

These webinars are available via on-demand viewing, so they are available 24/7 and have already been evaluated by DONA International to ensure they are relevant, current, evidence-based and within the organization’s scope of practice for doulas. Most are around an hour in length, and all provide DONA International contact hours (1 hour for 60 minutes of webinar) for recertification. If you are a member of DONA International, you get one FREE webinar per calendar year. Watch your email for your code for your free session. Otherwise, webinars are $20 each with the proceeds going to DONA International to support, train and grow doulas.

There are four webinars available now with two more offerings being added every month. Currently available are: Master the Doula’s Advocacy Role (Kim James), Successful Ways to Manage Your Doula Business (Stefanie Antunes), Decision Fatigue (Penny Simkin) and Cracking the Code of Social Media (McCulloch/Boucher). December will bring Safely Wearing a Newborn (Serena Weingrod) and Beyond Competition: Birthing Your Doula Business (Sarah Juilusson).

Keep up with what’s being offered here at The DONA Doula Chronicles, via DONA International’s Facebook group or right on the virtual training site: https://www.vconferenceonline.com/dona/.

Listening to Mothers – Postpartum & Breastfeeding

New Mothers Speak OutLast week we shared some highlights from the information-packed Listening to Mothers survey on the pregnancy and birth experiences of 2,400 women who gave birth between July 1, 2011 and June 20, 2012. You can find that post (with more on the Listening to Mothers intiative) here. This week, we’ve outlined survey results related to the postpartum period including breastfeeding from Listening to Mothers III and the follow-up New Mothers Speak Out survey. You can find both reports on the Childbirth Connection website.

Breastfeeding and Postpartum (Listening to Mothers III)
While most mothers (66%) felt the hospital staff encouraged breastfeeding, those who planned to exclusively breastfeed reported being offered formula or given samples (49%) and their babies were given pacifiers (37%) or formula or water supplementation (29%) while in the hospital. A birth plan that includes breastfeeding support requests can go a long way to reduce these experiences for our nursing clients.

Less than 10% of survey participants said they were “usually” or “always” treated poorly in the hospital because of their race, insurance coverage or because they had a difference of opinion with their care provider. Doulas must be sensitive to the reasons clients may not receive positive, supportive or compassionate treatment by hospital staff and serve as a sounding board, resource and support for self-advocacy in these situations.

Postpartum pain that interfered with routine activities was reported more often by women who had a cesarean birth (26%) than by those who had a vaginal birth (9%). For those who gave birth more than six months before completing the survey, 16% reported on-going pain from a cesarean. For those who birthed vaginally, 11% still had urinary issues and 7% continuing perineal pain. While we can’t know from this data why these mothers experienced postpartum pain and complications for this duration, educating clients on what to expect in terms of their recovery and providing resources (i.e. acupuncture, pelvic floor specialists, etc.) may help our clients know when to seek help and where. Encouraging clients to give themselves time to recover from their births so that their bodies can heal and rejuvenate may also help lessen postpartum pain or other lingering conditions.

Twenty-two percent indicated they had discussed concerns regarding their emotional or mental well-being with a professional (health care of mental health) since having their baby. We know that postpartum depression is a significant issue for new mothers with serious impacts on them and their families. While awareness is increasing, doulas must continue to educate clients and their families regarding what is normal in the postpartum period and what is not, as well as provide resources for help when it is needed.

Postpartum (New Mothers Speak Out)
Sleep loss (58%), stress (54%), exhaustion (51%), sore nipples/breast tenderness (48%) , backache (46%), weight control (45%) and lack of sexual desire (43%) were reported as at least a minor problem for mothers in the first two months after birth. Knowing the most commonly cited problems for new mothers is valuable information for doulas so we can be prepared to provide support, information and resources to help our clients cope with the challenges they are most likely to face.

For those who birthed six months before or more, 34% said they were still feeling stressed, 30% still had issues with sleep and 29% reported challenges with weight control. Helping clients know what to expect in the months ahead, as well as support for stress management (which can contribute to both sleep and weight issues) may help clients care for themselves as they care for their newly expanded family.

Thirty-seven percent said that their own physical health interfered with their ability to care for their child at least “some” during their first eight weeks postpartum and 29% said their emotional health interfered at least “some” during that time period. This data underscores the importance of postpartum support for families. Relieving mothers of newborns of some of their household duties, encouraging rest, setting appropriate expectations for recovery and providing support during this important time of transition and healing go far to encourage mother-baby bonding, breastfeeding and getting a newly expanded family off to the best start possible.

Mothers who intended to breastfeed but were not one week after birth reported a range of reasons including that the baby had a hard time nursing (31%), breastfeeding was too difficult to get established (23%), convenience of formula (23%) and lack of support (17%). While breastfeeding rates have risen in recent years, mothers still face many barriers to successfully establishing breastfeeding. Early postpartum support by doulas can help new mothers overcome those barriers through education, encouragement and resource referrals.

The Listening to Mothers initiative is a powerful repository of information on the expectations and experiences of pregnancy, birth and the postpartum period by American mothers. Learn more about it here.

Listening to Mothers – Pregnancy & Birth

Listening to MothersHave you heard of the Listening to Mothers Initiative? It is an incredible resource for doulas, childbirth educators and other maternity and postpartum care professionals (including medical providers)! This online survey of 2,400 women who gave birth in American hospitals between July 1, 2011 and June 30, 2012 is chock full of very valuable information on everything from women’s expectations to their actual experience of pregnancy, birth and the postpartum period. The data collected even sheds light on where expectant women search for and obtain information on care providers and professional support services.

The full 94 page report (Listening to Mothers III Pregnancy and Birth Survey and Report) is available from Childbirth Connection as is a follow-up survey report called New Mothers Speak Out which is focused on the postpartum period.

With so much data, we’ll cover the highlights in two posts here at The DONA Doula Chronicles with the first outlining survey information on pregnancy and birth relevant to doulas. Check back next week for the second part on the postpartum period.

Pregnancy and Birth (Listening to Mothers III)
Most survey participants rated maternity care providers as “very valuable” sources of information (82% of experienced mothers and 76% of first time mothers). This suggests that most of our clients place a high level of trust in the information they receive from their care provider. It is important that as doulas we provide evidence-based information without challenging care providers or undermining our clients’ relationship with their medical team.

More than half (53%) attended a childbirth education class. Yet, many indicated they were “not sure” when asked about specific risks related to labor induction and cesarean sections, such as future placenta problems, breathing problems in baby, inducing because of anticipated baby size and the affect of induction on the likelihood of delivery via cesarean. Doulas play a valuable role in supplementing childbirth education classes, particularly on the risks associated with interventions.

The most commonly cited reasons for not asking questions of medical providers were: 30% because the provider seemed rushed, 23% were concerned that their provider might think they were being difficult and 22% because the woman felt that what she wanted for her care was different from what her provider wanted. These answers underscore the important role doulas play in supporting clients to advocate for their desires and feel confident enough to ask questions about their care.

Nearly all mothers who completed the survey said they had supportive care during labor. A partner or husband filled this role for 77% of women, nurses for 46%, another family member or a friend for 37% and a doctor for 31%. Just 6% received the support of a doula, but 75% of those who did not have a doula had heard about doula support. Of those, 27% said they would like to have had the support of a doula. While we can’t know why so many women birth without the support of a doula, these numbers are very encouraging in terms of awareness of the role of a doula and recognition of the value of our support.

43% of respondents indicated they walked around after being admitted to the hospital while experiencing regular contractions. Doulas know the value of movement in labor!

Of those who birthed via cesarean delivery, less than 2% said they made the decision for this birth method before labor began and without a medical reason for this choice. For first time mothers birthing via cesarean section, 63% reported that their doctor was the decision maker in choosing their type of delivery. The myth of maternal choice for cesarean delivery continues to be debunked by research.

Mothers who had an induction or cesarean birth reported pressure to have those interventions more often (25%) than those who did not (8%). Can increased education on induction and c-sections help mothers feel less pressure? Could support in advocating for themselves and asking questions of their care team so they better understand and participate in the decision-making process help?

Of women whose most recent birth was a repeat cesarean, 60% reported that they had a discussion with their care provider about why they should have a vaginal birth after cesarean while 97% reported discussing why they should have a repeat cesarean. Doulas can start the conversation with families after a primary c-section during postpartum visits to help lay the foundation for planning for the next birth.

We’ll have more from the Listening to Mothers survey next week, don’t miss it!

Look for the October eDoula in your inbox!

Each quarter, DONA International members receive a regional e-newsletter, highlighting initiatives, education opportunities and other resources in their area. The latest eDoula went out on October 15th. In addition to regional information, this issue also had important updates and announcements from the joint confluence with Lamaze International, third party reimbursement for doula services and a new on-line continuing education program for doulas.

If for some reason you didn’t get the eDoula, please log-in to the DONA International Member Center to confirm the information we have for you on file. Even if your information hasn’t changed, sometimes databases have glitches and having each member verify their information goes far to ensure accurate records. Log-in information for the Member Center was emailed in August. If you didn’t receive it or need your information again, please contact the Home Office at membership@dona.org. Please include your full name and mailing address in your email. This helps the Home Office search the member database to find your record.

For those DONA Doula Chronicles readers who aren’t currently DONA International members – you’re missing out! The quarterly eDoulas are just one of the many ways doulas are supported, connected and informed through their membership in DONA International.

Happy fall!

- Adrianne Gordon, CD(DONA), MBA

Community Based Doulas

What is a community based doula? A community based doula works with clients who are typically young in age, of low income and have little to no support. Community based doulas meet with their clients several months before birth, attend the birth and meet in the weeks to months following the birth. They develop a strong relationship with the client due to the fact that the doula is typically their only support. During their visits, these doulas discuss topics ranging from birth and breastfeeding to bonding with the baby, something that many of us take for granted. They also tend to collaborate with other community programs to provide greater support and aid for their clients.

A pilot program offering community based doulas in Indiana found that these support professionals “improve access to early and regular care, improve continuity of care, increase breastfeeding, improve mother-infant bonding, reduce medical interventions, and detect and reduce post-partum depression.” They also had very impressive statistics stating that “93% of clients did not use tobacco during their pregnancy, 91% of clients had a full-term pregnancy, 76% of clients gave birth vaginally and 28% without an epidural, 91% of babies were born at a normal birth weight, and 85% of clients initiated breastfeeding.” Learn more about the pilot and its results here.

Providing support to these women during such a special, and often stressful, time is important. Many women who choose to become community based doulas have either been through a similar situation or have a heart for women in crisis. The work community doulas do is so important and this form of support for birthing families can be valuable in any community.

This article was originally published in the July 2014 DONA International eDoula. Our thanks to Brandy Earls, CD(DONA) for the contribution.