Paternal Postpartum Depression

donainternational:

As we think about dads this month, in particular how we as doulas can support fathers during the childbearing year, we wanted to re-share important information about paternal postpartum depression. If you have any additional articles or resources on this topics, please share in the comments.

Originally posted on The DONA Doula Chronicles:

paternal postpartum depressionDid you catch the first word in the title? Yes, that’s paternal, as in dads. We don’t often see the words paternal and postpartum together, and you may not have heard the term “paternal postpartum depression” before at all. Postpartum depression is a topic that we associate with new mothers. In fact, the very definition is depression in a woman after she has given birth. But what about new fathers? Feelings of irritability, guilt, anxiety, isolation and sadness, loss of energy or changes in appetite are not yet as widely recognized as cause for concern in a man after the addition of a baby to the family as they are for the new mother. Yet paternal postpartum depression is a very real issue and “is currently underscreened, underdiagnosed, and undertreated” according to a 2012 article in the Journal of PediatricHealth Care aimed at helping care providers recognize and treat…

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Early birds get Annual Conference discounts!

DONA International’s 21st Annual Conference will take place August 7 and 8 from the comfort and convenience of your very own home. As a virtual conference on-demand viewing of conference sessions will be available until November 7, 2015. With less time away from busy doula practices and our families and without the financial investment of travel, a virtual conference is a great way to gain world-class training to expand knowledge and sharpen skills. Early bird registration rates end June 30th so don’t delay! This year’s conference has an incredible speaker line-up including:

speaker_captureFifteen sessions are available for DONA International contact hours for recertification. Session topics include: ways to attract clients, the pelvis and birth positions, hospital based doula programs, supporting women who choose hypnosis for childbirth, language sensitivity, vaginal birth after cesarean, and woman-centered or baby-centered doula support.

For the full list of sessions and speakers, visit the virtual conference site.

Register now to take advantage of early bird pricing!

Happy learning!

— Adrianne Gordon, CD(DONA), MBA

Dads & Doulas: Myths & Resources

dad hands

Happy Father’s Day! In the United States, we celebrate dads this Sunday and so it seems like a great time to discuss how doulas support fathers before, during, and after the birth of a baby and share resources for new and expectant fathers.

There was a time when expectant fathers were portrayed as anxious, floor-pacing, cigar-smoking men who were tolerated in hospital corridors until the long-awaited moment when a nurse or doctor would announce they were the proud father of a daughter or a son. Today’s expectant fathers, loved ones and families are different.

This is the opening text to the DONA International topic sheet, “Dads, Partners and Doulas: Key Players on Mother’s Labor Support Team” and illustrates how much things have changed about the role of fathers in childbirth. Today’s dads are (thankfully!) active participants in pregnancy, childbirth and parenting. Doulas sometimes encounter questions or even resistance because the dad-to-be, or even the mom-to-be, are concerned that a doula will somehow replace or diminish the father’s role in labor and the postpartum period.

Penny Simkin, one of DONA International’s founders, shares three myths about doulas and partners in a widely circulated article addressing concerns about the doula/partner relationship. Her full article can be found here: http://health.ucsd.edu/specialties/obgyn/maternity/facilities/doula/Documents/simkin.pdf

# 1 – Role redundancy. There may be concerns that the roles of the doula and partner are so similar that only one is needed. The doula’s role is unique because she is not going through a personal transition like the father is; she is there simply to provide support to the mother AND father. The doula’s training and experience allows her to bring a wider perspective to the birth or postpartum period, tips and tools for coping with labor, recovery, newborn needs and breastfeeding in addition to information to help the couple make decisions. A doula cannot provide the same level of emotional support and connection a partner can, just as the partner cannot bring the same objectivity a doula can, including partners with extensive training and experience in birth or breastfeeding. Fathers are sometimes the ones initiating the conversation about hiring a doula! Doulas may find that some fathers, while they want very much to be involved and supportive of their partner during birth and the postpartum period, feel a great deal of pressure to remember everything from childbirth or breastfeeding class. Doulas bring a fountain of knowledge with them to the birth and postpartum period and this knowledge is available to both parents.

#2 – Doulas displace partners. Having a third person involved may raise concerns that doulas will come between the parents. Doulas are, in reality, a support person for fathers as well, ensuring that the partner’s physical and emotional needs are also met. Just as doulas see to the comfort, hydration, nutrition, and calm of laboring and new mothers, they also see to these needs for fathers. When doulas and partners work together, they are a very powerful support system combining knowledge of birth, labor, breastfeeding and newborns, with intimate understanding of this particular mother and her needs, desires, communication styles, and emotional responses. The doula’s training and knowledge are available to fathers and are shared via suggestions, examples, or referrals allowing the partner to be a greater participant in providing support and decision making.

#3 – Doulas bring agendas. This is a typical concern of families who are planning for the birth of their baby. Parents, understandably, want to craft their own plan for their labor, birth, and early parenting. Education on the role of the doula, to provide objective support for the couple’s wishes, can go a long way to dispelling this myth. A father may be concerned that he will have to be in the role of peacekeeper between his partner and the doula to ensure that what the couple wants remains paramount. For fathers who are already feeling anxious about being able to meet their partner’s needs, this concern may be exacerbated. Doulas can help dads feel more confident in supporting their partner since the doula is likely to be more familiar with the medical system and the process and typical behaviors expected during labor and postpartum by mothers and babies alike.

While a doula’s primary focus is the mother, supporting and partnering with fathers is key to serving the entire family’s needs. Understanding his needs and perspective allows the doula to expand her skills and impact on her clients. Below are a few resources that may be helpful to doulas supporting expectant and new fathers. These resources may also be useful to share with dads you are supporting as well. Please note that inclusion here does not suggest an endorsement or relationship with DONA International. Consider doing additional research to identify resources in your local community, books, videos or classes.

Resources:

Fathers To Be International

University of Michigan Health System – Fathering Resources

Fathers’ Forum

National Fatherhood Initiative 

— Adrianne Gordon, CD(DONA), MBA

Watch your mailbox for the June 2015 Issue of International Doula

Editor’s Note: Susan Troy, Editor of International Doula, DONA International’s beautiful, informative and inspirational quarterly magazine for doulas, shares this preview of the upcoming edition. — AG

We’re excited to feature Sherry Payne of Uzazi Village on the cover of our next issue of the International Doula. Her presentation at the 2014 Annual Conference in Kansas City was so well received that we wanted to make sure all of our members had the opportunity to learn more about her work. Here’s a small snippet:

“Though the willingness may be there, the opportunity to support women of color is often deficient. The training to support them in a culturally congruent manner is nearly always deficient, if not completely absent. It is important to understand a client’s cultural context when providing such personal care. Without that knowledge the care is inconsistent and incomplete and may even be detrimental.”

 In addition to the insight and inspiration of Sherry’s work, you’ll also find articles about closing the sale, the recent study by Sarah Buckley and a more in depth introduction to our Advisory Council. The Spring 2015 issue also includes book reviews, Ask Penny and essays from our members. We hope you find information and inspiration for your practice.

Keep an eye out for the Spring issue of DONA International’s magazine in your mailboxes in the coming weeks! Remember, you can always check your membership status and update your mailing address via the online Member Center. If you need help logging in, instructions are available here.

The International Doula is just one of the many benefits of joining DONA International. We welcome doulas, childbirth educators, maternity care providers and anyone supporting the role of doulas in birth and the postpartum period to become a member.

ICAN features postpartum doula support after cesarean

While we doulas know that every woman and every birth is unique, a cesarean birth can create special support needs for families, particularly in the postpartum period.
Debbie Young, CD(DONA), PCD(DONA) Past President of DONA International shares some of the ways a postpartum doula supports families who have given birth via cesarean in a new post “Postpartum Doulas: support after cesarean” on the International Cesarean Awareness Network (ICAN)’s blog. From her article:

“When a mother and baby come home after a cesarean birth there are a few extra things to think about, that road includes a few twists of its own. A postpartum doula can be very helpful in smoothing out this joyful, stressful, exciting, tiring and healing time for the new family.”

As one example, Debbie shares:

“Some mothers (and family) need help processing the birth, especially if it didn’t turn out as they expected. The doula has a great listening ear and if things are escalating beyond normal processing, the doula can refer the mother to the appropriate specialist to continue to deal with the events of the birth. And at the same time, the doula is a stable presence in the home to help the mother know she is not alone.”

Our thanks to ICAN for sharing the ways in which postpartum doulas provide support after a cesarean with their members and readers.

— Adrianne Gordon, CD(DONA), MBA

Collaboration: Doula Practice Models in Action

Editor’s Note: Melissa Hartley, CD(DONA), BDT(DONA), LCCE is a certified birth doula, birth doula trainer and childbirth educator. She also serves as the Southeastern US Regional Director for DONA International. In her doula and childbirth education practice and her role on the DONA International Board of Directors she is always considering how best to collaborate with colleagues and the wider birth community. — AG

doula collaborationWhat kind of doula practice should I have? Is my current arrangement serving me and my clients best? New doulas and veterans alike often consider models for their practice and some doulas try several throughout their careers. A significant piece of the equation is how each model – solo with back-up, co-op or agency – collaborates with other doulas. As doula work evolves, so too does the way in which we work with our fellow professionals. Just as different doulas are the right “fit” for different families, no practice model is one-size-fits-all. Let’s look at some of the benefits and trade-offs of a few of the options for developing your practice and collaborating with doula colleagues.

Solo practice with back-up arrangements: Many doulas choose to serve clients in a solo practice. This does not mean that the doula operates as an island without the support and collaboration of her colleagues. Even for a doula who plans to only take one client at a time, back-up arrangements should be made in case of urgency/emergency in which the doula can’t be with her client when she is needed. The DONA International Standards of Practice for Birth Doulas discusses the need for a doula to collaborate with a back-up by stating:

II. Continuity of Care A) The doula should make back-up arrangements with another doula to ensure services to the client if the doula is unable to attend the birth.

Another benefit to the collaboration of a solo-practice doula with a back-up is that the doula has sole decision making abilities and control over her/his business. Back-up doulas are typically paid by the original doula and a great collaborative effort makes the client experience seamless should the back-up be needed.

Doula Co-Op: In a co-op each person participates in the group and each participant profits from the efforts. A doula co-op is a great option for doulas that want to work with other doulas but maintain their own business/practice. In a co-op, doulas collaborate with marketing, back-up, continuing education and more; however, each doula runs her/his own business and makes all business decisions. Co-ops often charge a small membership fee that pays for the administrative costs (website, advertising, gatherings, etc.); however, funds exchanged between doula/client do not go through the co-op. The doula is still responsible for all aspects of her/his business.
Co-ops often breed a sense of community that many doulas find to be effective as they have others to bounce ideas off of and share efforts to build the doula community and their own businesses.

Agency: In the agency model, doulas collaborate as business partners or employees. The biggest difference between agencies and other collaborative efforts is that with agencies, funds are shared within the group. Doulas come together as business partners or as owner/employee and all contract fees are paid to the agency before paychecks are written to the doula for her work. The agency keeps a portion of the fees as agreed with business partners/owners. With an agency model, the individual doula is not working under her/his own business but rather a shared business or as an employee of the agency.
Agencies can be a great option for doulas who wish to employ other doulas, or doulas who prefer not to own their own businesses and work underneath a doula business owner. Agencies are also a great way to collaborate for those who want to be in partnership with other doulas and share business responsibilities, expenses and profits.

Practice models are just one of the ways that doulas collaborate together to serve clients and their community. DONA International will continue to explore the many ways our doulas collaborate. Look for articles and information here at The DONA Doula Chronicles, our social media accounts, the eDoula enewsletters, and the International Doula magazine. We can’t wait to explore this topic together and invite you to contribute articles and ideas too. How do you collaborate and what does doula collaboration look like in your community? You can reach us on Facebook or via email at blog@dona.org.

— Melissa Harley, CD(DONA), Southeastern US Regional Director, DONA International

Doula Support for Cesareans: ICAN President Guest Post

Editor’s Note: In honor of International Doula Month, International Cesarean Awareness Network (ICAN) President LaQuitha Glass shares her thoughts on doulas and cesareans as she reflects on her own birth experiences. ICAN is one of many resources The DONA Doula Chronicles has highlighted for doulas supporting families during and after cesarean births (“Cesarean Resources for Doulas”). — AG

When I gave birth to my first child by scheduled cesarean due to breech presentation, I had no clue about the concept of doulas and had never even heard mention of one. As a first time mother, I had taken great care to attend all of my prenatal appointments and the birth education workshop hosted by my hospital, all in preparation for the birth of my baby.

After an ultrasound for suspected intrauterine growth restriction, it turned out that the baby was not too small but actually in a breech presentation that caused me to measure smaller than what would have been expected. Although I was not planning to have an intervention-free unmedicated labor and birth, I was caught off-guard when, after being in breech presentation for eight weeks, I was scheduled to come in for a cesarean at 39 weeks.

Although the cesarean experience itself went as smoothly as could be expected, after having two more children by unmedicated hospital VBACs with the assistance of doulas, I sometimes can’t resist the urge to compare the difference in the experiences. The one thing that I am fully certain of is that the presence of a doula during my cesarean would definitely have made a beautiful time for my family even more enjoyable. The knowledge and emotional support provided by an empathetic doula before, during and after birth can significantly enhance the experience for mothers having a cesarean.

Here are my personal reflections on situations during my own cesarean when a doula’s assistance would have been invaluable:

1. While waiting my turn: Prior to my scheduled cesarean, the operating room was running behind. A doula’s presence to distract me and help to keep me focused while I waited the additional hour to be wheeled back would definitely have helped to alleviate any pre-surgical anxiety.

2. During the cesarean: I do believe that having a doula present when I got a case of uncontrolled shaking due to the medication would have been valuable. Having someone with me after my spouse and baby were taken to the nursery would have enhanced the experience as well. A doula present during the immediate recovery period when I was alone would have made the room seem a little smaller.

3. In the postpartum period: Hands down, the most difficult part of my cesarean for me was the period when I got back home. Knowing what I know now, the services of a postpartum doula would have dramatically enhanced the overall experience, making a special time for my family even more special.

If you feel that the main demographic for doulas is mothers seeking natural, unmedicated vaginal births, know that cesarean moms benefit greatly from the support of doulas too! Sometimes, the doula is the only factor keeping a mother and her perception of her experience from getting lost in the shuffle of standard hospital routines and policies. It is generally accepted that a doula’s presence can help to reduce the chance of cesarean, but doulas can also greatly increase the chance of a satisfying birth experience in the event of a cesarean.

— LaQuitha Glass, President, International Cesarean Awareness Network

New Research: Premature Birth – Causes & Factors Influencing Outcomes

baby-256857_640Premature birth, when a baby arrives before 37 weeks gestation, occurs in 11% of all births in the United States, and 15 million babies are born preterm worldwide. Prematurity is associated with significant and sometimes long term complications for these babies including health problems, developmental delays, learning disorders and even autism. Three new research studies offer new perspectives on the causes of premature birth and impacts of premature birth on the overall health outcomes for babies born before 37 weeks.

Role of Vitamin A in Outcomes for Babies

Researchers looking to evaluate whether the use of Vitamin A had a significant impact on the overall health of premature babies made a surprise discovery about another factor which can significantly impact the rates of lung disease and death in very low birth weight babies. Vitamin A was a common supplement for premature infants for nearly a decade until a shortage in 2010 reduced its availability. Data from 6,200 premature infants was evaluated and showed that use of Vitamin A did not reduce rates of lung disease or death in very low birth weight babies. This research likely means that although the Vitamin A shortage has ended, its use won’t likely increase dramatically saving premature infants the 12 injection series required for one Vitamin A dose.

While evaluating the data further, the study found that the location of birth had a direct link to overall outcomes. Lead researcher Veeral Tolia, MD said, “If you’re a premature baby, who your doctors are is probably more important than what medications they have available to treat you.” Dr. Toilia went on to say, “Independent of these drugs, I think we’re getting better at caring for these infants in a non-pharmacologic way.”
Sources: http://www.irvingweekly.com/s/1894/Baylor-Research-Findings-Could-Eliminate-Need-for-12-Injections-in-Preemies.php and http://www.ncbi.nlm.nih.gov/pubmed/25222512

Role of Genetics in Preterm Labor

In evaluating cause of preterm labor, new research has found that the baby’s genes, not the mother’s, may be behind some preterm births. While we know that some maternal conditions, such as high blood pressure, substance abuse and infection, can contribute to preterm birth, award-winning research from the University of Alabama-Birmingham indicates that the infant’s genetics may also be a factor, at least in some cases. For this study, researchers obtained blood and saliva samples from hundreds of mother-baby pairs to evaluate certain segments of their DNA. The study found that in babies who had duplicates of any four genes or if any seven genes were deleted, the likelihood of preterm birth was significantly higher. Researchers noted that it isn’t clear exactly what about these genetic elements is triggering early birth. It could be that these genes make a baby more sensitive to environmental factors or infection which then causes preterm labor, for example. This groundbreaking research does help explain why current maternal treatments for preterm birth, such as progesterone, may not be effective in all cases. Learn more at: http://www.uab.edu/news/innovation/item/5697-new-research-finds-baby-s-genes-not-mom-s-may-trigger-some-preterm-births

Protection from Infection-Induced Preterm Birth

While a number of factors can influence preterm birth, maternal infection is the leading known cause of prematurity. A study published in December in the Journal of Clinical Investigation, found that hyaluronan, a naturally occurring substance in the cervix and other tissues, may help protect against premature birth caused by infection. Since infection causes 25 – 40% of preterm births, information on factors which offer protective benefits could be very important in reducing the number of premature infants. Hyaluronan has long been thought to have a role in the ripening of the cervix in anticipation of labor and birth. In a study of mice, researchers found that depleted levels of hyaluronan increased susceptibility to infection-induced preterm birth. Read the full study at: http://www.jci.org/articles/view/78765

Sources:
Statistics on premature birth and the associated risk factors:
http://www.marchofdimes.org/mission/prematurity-campaign.aspx
http://www.marchofdimes.org/mission/the-global-problem-of-premature-birth.aspx
http://www.marchofdimes.org/baby/premature-babies.aspx
http://www.marchofdimes.org/baby/long-term-health-effects-of-premature-birth.aspx

Maternal causes of preterm birth:
http://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm

11,000 Doulas Certified & Counting!

On this 11th day of International Doula Month, we thought it would be fitting to highlight an incredible milestone for doulas: DONA International has certified its 11,000th doula!

11000Congratulations to Stacey Lassnig of Morden, Mannitoba, Canada newly minted certified birth doula! In a truly international connection, Stacey’s certification materials were reviewed by Elena Carillo Flores of Mexico. We asked each doula a few questions to learn more about them as we celebrate the growth and reach of the DONA International community.

Name: Stacey Lassnig, CD(DONA)
Trained by Jenn Fontaine and Tami Tozeland in Winnipeg, Manitoba September 2014
Number of births attended to date: 10
Why she became a doula: “I became a doula because I wanted every mother to have a birth that was as beautiful to them as mine was to me. My doula was a warm, strong, beautiful, caring, intelligent woman that helped me feel safe and sure during my births. I wanted to give this sense of strength and peace to as many women as I could.”
Plans for the future: “In the future I would consider becoming a trainer, but as of this point my hands are full with two young children and two businesses of my own. I love being a doula and I hope that I will continue to feel this way about my work.”

Every application for certification (often referred to as a certification packet within the DONA International community), is reviewed by another doula to ensure the packet is complete and that all requirements have been met. Certification packet reviewers are volunteers who give of their time to help support a professional standard for doulas. They first spend 2 -3 hours reviewing the documents provided by the certification candidate. Then the reviewer contacts all of the candidate’s references. Additional time is needed to communicate with the certification candidate if there are questions or if additional information is needed.  Stacey’s packet reviewer, Elena, tells us a little about herself and why she volunteers as a reviewer:

Name: Elena Carillo Flores
Hometown: Mexico City, Mexico
Certified doula since: 2004
Certification packet reviewer since: 2006
Estimated number of packets reviewed: Around 500!
Why she volunteers as a reviewer: “I volunteer as a reviewer because I love working with new doulas and helping them through their certification process. I admire their passion and commitment. It is fascinating to witness how proud they become when they are finally able to use the CD(DONA) credential after their name. Most of all, I enjoy the opportunity to be able to get in touch with fellow doulas from around the world.”

Certification with DONA International
Certification demonstrates a standard of training and experience that promotes the role of doulas to families and the medical community as professional support providers. And, like any doula with CD(DONA) or PCD(DONA) after their name will tell you, it takes time and dedication to achieve and maintain this level of professional credentials. You can find out more about the requirements for certification for birth doulas and postpartum doulas on the DONA International website.

Note: If you’re sharing this post via social media, don’t forget to use the hashtags #IDM15 and #DONAIntl. Happy International Doula Month!

Doulas on TV: Frasier to Bones and Beyond

donainternational:

In honor of the repeat of Bones that aired last night:

Originally posted on The DONA Doula Chronicles:

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…

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