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.

Midwives Make A Difference!

It’s National Midwifery Week this week and the American College of Nurse-Midwives has launched a week long campaign to show how #MidwivesMakeADifference. Doulas and midwives both believe that birth is normal and that women should make informed decisions about their maternity care.

ACNM has this to say about midwifery care: “Even though the general public often associates midwives exclusively with maternity care, many women visit a midwife for a range of services before and after pregnancy. Midwives are critically important in providing care to women from adolescence to beyond menopause, but their expert knowledge of women’s health is often overlooked.”

OMOTFor this year’s National Midwifery Week, ACNM is launching Our Moment of Truth™: A New Understanding of Midwifery Care. With this national campaign, ACNM looks to raise the bar for women’s health and re-introduce midwives and midwifery care as important options that should be the norm for women’s health care services in the United States. The campaign also encourages women to learn about their maternity health care options and become advocates for their own health care. I think we doulas can certainly get behind that!

There are several ways to support or get involved with the campaign including:

  • Share a story
  • Post information about midwives on social media. ACNM has created a handy social media toolkit here.
  • Take the “Your Health Promise” pledge.

The Our Moment of Truth website also has a useful Fact Sheet and a great handout that defines midwives and their role in health care. The “Will my midwife provide pain relief options….” question in the Women’s Health Information handout is certainly one doulas can relate to! You can find these handouts here.

Happy National Midwifery Week!

– Adrianne Gordon, MBA, CD(DONA)

Do Epidurals Reduce the Risk of Postpartum Depression?

The August edition of the journal Anesthesia & Analgesia has an editorial and a research article on a study conducted in China by Dr. Ting Ding and other researchers discussing a possible link between epidurals and lowered risk of postpartum depression. Given the prevalence and impact postpartum depression has on families, any new research offering insight to reduce a mother’s risk of developing this mood disorder is important for doulas to know about. When the media starts reporting on that research, it’s even more critical that we as doulas have an understanding of the evidence including what it does and does not conclude. In our review of these articles, as well as some additional research on the topic, we found some interesting points valuable to doulas and families. You can find links to the full editorial, article and mainstream media references to the study, as well as other resources mentioned here, at the end of this post. We’d love to hear your thoughts on this topic in the comments.

After reviewing the articles and evaluating the research, it seems that the real question may not be do epidurals reduce the risk of postpartum depression, but does pain management by any means – including non-medical comfort measures – lower the likelihood a mother will experience depression during the postpartum period. Below is a summary of the research, additional background on the topic of pain and depression, as well as conclusions to help doulas and the families we serve better understand the implications of this research.

THE RESEARCH
The Chinese study by Ding et. al. described in the Anesthesia & Analgesia article entitled “Epidural Labor Analgesia Is Associated with a Decreased Risk of Postpartum Depression: A Prospective Cohort study” looked at whether women who had an epidural during their labor (107 women in this study) had a higher or lower incidence of postpartum depression as measured three days and six weeks after birth. The study found that the women who had epidurals were less likely to develop postpartum depression. In this study, 34.6% of the mothers who had an unmedicated birth experienced postpartum depression compared to 14% of those who had an epidural. The Edinburgh Postnatal Depression Scale, a widely used ten question self-assessment, was used to assess whether the women participating in the study were experiencing postpartum depression.

There are a few important things to note about this study. First, the sample size is small – only 214 women total. The study does not indicate if the mothers who did not receive an epidural were given any non-medical forms of pain relief or had any time of emotional/social support. The researchers also found that patients in the study who attended childbirth classes had a lower incidence of postpartum depression. Did those childbirth classes include comfort measures the mothers and their support people (if they had any) could employ during their labor? We don’t know from the published information on this study. Dr. Ding and his colleagues also found that women who were breastfeeding at six weeks postpartum were less likely to be assessed as experiencing postpartum depression. Other studies have also validated the link between childbirth classes and breastfeeding in reducing the risk of postpartum depression.

BACKGROUND
As with any research, it is important to look at the context of the study and what other information is known and unknown about the topic or question being explored. In the case of the Chinese study recently published, these elements help frame both the research and the researchers’ conclusions:

1) In 2008, the journal Pain published an article describing a US study of 1,288 women which found that high levels of pain 36 hours after delivery was associated with a 3 fold increase in the likelihood of developing postpartum depression. The type of delivery (vaginal versus cesarean) was not found to be correlated with either pain level or depression postpartum. Other than this study, there has been little research on the role perceived pain during and after birth has on a mother’s risk of postpartum depression. The study by Ding and his colleagues in China sought to explore this question further.

2) Many factors influence an individual woman’s risk for developing postpartum depression. A history of other mood disorders including depression and anxiety at other times in her life, as well as physical or sexual abuse, are strongly correlated to postpartum depression. Other factors that have been identified include experiencing other stressful life events and poor social support.

CONCLUSIONS
The Ding et. al. study published in Anesthesia & Analgesia and the 2008 study in the journal Pain raise a very interesting question about the role of pain during labor on a mother’s risk for experiencing postpartum depression. The article title and the media headlines about this topic seem to jump to a conclusion about epidurals as a tool to reduce the incidence of postpartum depression. Epidurals, both because of how commonly they are used for pain relief during labor and birth and their effectiveness at blocking sensation, are understandably the likely tool discussed in any conversation about pain management. However, as we doulas know, there are other methods that reduce pain during labor and birth. No other form of pain relief – analgesic or otherwise was evaluated in this study. The role of social and emotional support was also not explored. What would this study’s results have looked like if the non-epidural group had a support person with them providing non-medical comfort measures? We know that doula support can reduce the cesarean rate, but can it also reduce the postpartum depression rate? Inquiring doulas want to know!

The researchers themselves recommend that their study be repeated with a larger group of women. Additional research is needed to evaluate the hypothesis that epidurals, specifically, reduce the risk of postpartum depression, and other pain management techniques should be evaluated for their effectiveness in reducing the risk of postpartum depression. Further exploration of the relationship between pain and postpartum depression is also needed to better understand how the two are linked.

Resources:

Study: http://journals.lww.com/anesthesia-analgesia/Fulltext/2014/08000/Epidural_Labor_Analgesia_Is_Associated_with_a.21.aspx

Editorial: http://journals.lww.com/anesthesia-analgesia/Fulltext/2014/08000/Double_Duty___Does_Epidural_Labor_Analgesia_Reduce.1.aspx

2008 study published in Pain: http://www.ncbi.nlm.nih.gov/pubmed/18818022

Media Mentions: Here, here and here.

– Adrianne Gordon, MBA, CD(DONA)

Bloggers unite at DONA/Lamaze Confluence!

Aside

doula blogDay one of the 2014 Lamaze International/DONA International joint conference is in the books!  It’s been a great time for learning and connection with so much more to come. I connected with Lamaze blog community managers Sharon Muza and Cara Terreri for a chat (and of course a quick pic)!  Left to right: Cara, Sharon and me.

Follow along with the confluence via social media. We’re using #lamazedona on both Twitter and Facebook to share what’s happening in Kansas City.

– Adrianne Gordon, MBA, CD(DONA), DONA International Blog Manager

 

Aren’t joining us in Kansas City? You can still earn those contact hours!

While it would be wonderful if every DONA International member could attend the annual conference, given our commitments to clients, families, and budgets, it isn’t possible. But, that doesn’t mean you can’t earn the continuing education contact hours for recertification. You can join the conference right from your own home via the Virtual Conference. Join two, three, five, or eight sessions of the joint Confluence with Lamaze International without leaving home. You can see the package options on the 2014 Joint Confluence Website (link).
Don’t forget about those alternative contact hour options, as well. The DONA Doula Chronicles posted a series this summer on alternative contact hour options for both birth and postpartum doulas. Check out these posts for over a dozen ways to earn contact hours – many of which require very little financial investment:

Ode to Alternative Contact Hours

Teaching & Sharing

Reading, Writing & Research

Audio, Video & Online

 

Paternal Postpartum Depression

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 the condition.

It is estimated that 5-10% of new fathers experience depression within the first year after birth. While it is not as well known as maternal postpartum depression, the effects of depression in new fathers has been well researched and is an important issue for doulas to know about as we evaluate how well the family as a whole is coping following the addition of a new baby.

Paternal postpartum depression has been associated with reduced bonding with the new baby, similar to what is seen in depressed postpartum mothers. Research has also found that paternal postpartum depression is associated with increased spanking by fathers and increased diagnoses of emotional issues, hyperactivity disorders and social problems in the child at age seven years.
The risk of paternal postpartum depression increases when the mother is already experiencing depression. Depression in both parents in the postpartum year is linked to babies who are less likely to be breastfeed and less likely to be put to sleep on their backs. Later vocabulary development in the child has also been associated with dual postpartum depression.

Clearly parental postpartum depression, whether in mothers, fathers or both parents, has strong impacts on the family overall. What can we do as doulas to address this important issue while staying within our scope of practice? Share information with your clients about maternal and paternal postpartum depression including evidence based sources on symptoms and risk factors. Provide families with resources in your community should the need arise or they request it.
If you have any resources to share on paternal postpartum depression, please share them in the comments or with the DONA doula community on our Facebook page: https://www.facebook.com/groups/62550155836/

Sources:
A Longitudinal Study of Paternal Mental Health During Transition to Fatherhood As Young Adults, Pediatrics

Medline Plus: Postpartum Depression

Paternal Postpartum Depression: What Health Care Providers Should Know, Journal of Pediatric Health Care

DONA Postpartum Doulas FAQ

- Adrianne Gordon, CD(DONA), MBA

photo credit: absolut xman via photopin cc

New Member Center from DONA International!

large__8385599034Wondering when your DONA membership renews? When your certification or certification packet expires? Moved or changed your email address? The new DONA International Member Center can help! This new portal allows members to access membership and certification dates and update contact information. Certified doulas can now also a add a photo, bio, and website to their member directory listing. Accessing the DONA Boutique for membership or certification purchases is really easy from the Member Center, as well. It’s also mobile friendly – great for us busy doulas!

If you haven’t receive an email with your log-in information, please reach out to the Home Office at membership@dona.org and provide your full name, city, and state. They will get you set-up and ready to go. Enjoy!

photo credit: Darwin Bell via photopin cc

DONA International Annual Update Now Available

An organization with over 6,000 members in 50 countries always has a lot going on and DONA International is no different. Eighteen months after moving the Home Office to Chicago, DONA International released its first Annual Update to members last month. Much like an annual report, the Annual Update gives an overview of where the organization is and what has been accomplished recently. Here are some highlights:

New mission statement adopted earlier this year:
DONA International’s mission is to promote high quality birth and postpartum support by setting the standard for the doula profession through evidence-based training and certification for doulas of diverse backgrounds.

New strategic goals to guide the organization’s efforts:
1. Remain the premier organization world-wide for evidence-based doula training, certification and continuing education

2. Increase the use of doulas worldwide through the promotion and advancement of the doula profession

3. Build and maintain a sustainable foundation for DONA International members

4. Be a valued source of information on the benefits of doula care

More than 10,000 birth and postpartum doulas have achieved DONA International certification.

Updated brochures and position papers available in the DONA Boutique including “Dads, Partners & Doulas.”

About the new mission statement and the future direction of DONA International, Executive Director Cynthia Keillor said, “We exist to serve our members by providing education, resources, and promotion of the doula profession. We look forward to continuing to evolve and grow in our services to our member birth and postpartum support professionals just as they evolve and grow to support the families they serve.”

The full Annual Update can be found at: http://dona.org/PDF/Annual+Update_2014.pdf

- Adrianne Gordon, CD(DONA), MBA

Making the Right Referral When You Aren’t the Right Doula

You’ve likely had the experience of meeting families during interviews who you can’t optimally serve. When you aren’t the right doula; it’s time to make a great referral to the doula who is a better fit.

Why it’s important to make great referrals.

1. It’s part of our code of ethics. We have an obligation to serve: “The doula should assist each client seeking birth doula support either by providing services or making appropriate referrals.”

2. Making good referrals is key to getting good referrals.

So how do you do it?

First, you have to know your birth doula tipsbirth community. That means showing up to community meetings and gatherings and staying connected, in-person, with the working professionals in your area. Online groups and social media are great augmentations to, but can never replace, face-to-face, in-person gatherings and meetings. Make your local doula community a priority by attending and organizing get-togethers.

Second, find out who in your community serves the populations, personalities and special circumstances that you cannot. It’s as simple as asking other doulas during those gatherings. Find out why the doula enjoys serving that group/place/special circumstance and what she offers. Be curious about your fellow birth professionals, what they do and how they do it. Keep their contact information and availability current in your referral list.

Third, when you make the referral, let both the family and doula know that you are making the referral. The family will appreciate your thoughtfulness and the doula receiving the referral will appreciate the heads-up. Always provide accurate contact information.

Making great referrals feels good. It’s a true reflection of the doula spirit that we all try to live every day and another great way we doula each other.

- Kim James, BDT(DONA), ICCE, LCCE

photo credit: the Italian voice via photopin cc