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.

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