Breastfeeding Resources for Doulas

common_questions_webAs National Breastfeeding Awareness Month wraps up with Black Breastfeeding Week, we wanted to share some Internet-based resources on breastfeeding for doulas and the families we serve. We know that breastfeeding provides important bonding for mother and baby, key nutritional needs for baby and provides health benefits to nursing mothers. While not all of our clients choose to breastfeed and some who wish to may find they cannot, doulas often provide information and support to mothers on breastfeeding. We hope you find these resources helpful as you provide informational, emotional and physical support to your client families. As always, it is important to remain within your scope of practice as a doula allowing families to make their own informed decisions and refer to lactation consultants or care providers when appropriate.

Resources to Share with Families:
Breastfeeding USA – With a stated mission “to provide evidence-based breastfeeding information and support, and to promote breastfeeding as the biological and cultural norm,” Breastfeeding USA’s website offers an extensive selection of articles, each with detailed references. Topics include breastfeeding aids such as “Nipple Shields: Friend or Foe?”; special circumstances like cleft palate and nursing with a cold or the flu; and support resources such as breastfeeding in public and gaining support from partners. The articles are written for families, which make them a good resource for doulas to share evidence-based information with our clients.

Giving Birth With Confidence is a blog and resource center for new and expectant parents from Lamaze International. Like DONA International, Lamaze is committed to evidence based information and practices for the childbearing year. In honor of Breastfeeding Awareness Month, a new series of articles on preparing for breastfeeding before birth, common challenges and resources have been added.

International Breastfeeding Center – The website for this Toronto based educational resource and clinic (formerly known as The Newman Breastfeeding Clinic & Institute) offers evidence-based information sheets and video clips in over a dozen languages.

Office on Women’s Health, U.S. Department of Health and Human Services includes breastfeeding in its A -Z Health Topics section. Families can find information on the importance of breastfeeding and information on pumping. The national breastfeeding helpline is available to nursing mothers, their family members, support people (including doulas!) and health care providers to answer questions and provide support on breastfeeding from latching to storing pumped milk. The helpline is staffed by peer to peer counselors trained by La Leche League International.

The OWH also dedicated a section of their website with resources to African-American mothers. It’s Only Natural provides articles on getting support, breastfeeding myths and common challenges.

Your doula resource list is also an invaluable source of local resources including classes, support groups and lactation consultants for your clients. Be sure to keep it updated to provide the most recent and relevant information for the families you support.

Additional Education for Doulas:
Healthy Children’s Center for Breastfeeding is the largest provider of continuing education on lactation for health care providers. For doulas interested in deepening their knowledge of breastfeeding, their in-person, Learn at Home and DVD education programs are a great option. Continuing education credits for nurses and lactation consultants are available, which means these trainings also count toward DONA International recertification contact hours. The Healthy Children’s bookstore includes both books and DVDs for your library (and with a write-up, they too count toward your DONA International continuing education requirement).

— Adrianne Gordon, CD(DONA), MBA, Blog Editor, DONA International

Best of International Doula: A doula acts as an important conduit – An interview with Sherry Payne

Note: This article is the first in a new series here at The DONA Doula Chronicles to feature some of the wonderful content in DONA International’s quarterly magazine, International Doula. “A doula acts as an important conduit: An interview with Sherry Payne, RN, MSN, CD(DONA), IBCLC” by Carrie Murphy, CD(DONA) appeared in the June 2015 edition of International Doula. The magazine focuses on information, resources, interviews and insights specifically for doulas. It is available free to DONA International members. — AG

A doula acts as an important conduit
An interview with Sherry Payne, RN, MSN, CD(DONA), IBCLC
by Carrie Murphy, CD(DONA)

We all have our birth worker heroes. From the inimitable Penny Simkin to the legendary Ina May Gaskin, there are generations of women (and men) who spurred this work, forging the path for a more supportive, family-centered birth culture. rsz_sherry_payneMy own birth hero is Sherry Payne, a registered nurse with a master’s degree, DONA certified birth doula, lactation consultant and soon-to-be certified nurse midwife, who is revolutionizing birth for her community of African-American women in Kansas City, Missouri. Sherry’s amazing work is a source of inspiration and motivation for my own doula practice, as well as my outlook on what it truly means to make birth better.

I was lucky enough to talk to Sherry about her own journey to birth work, her incredible commitment to changing the face of perinatal inequalities and why it’s important for all doulas to understand the myriad racial disparities that affect pregnant people and their babies.

You are a nurse and lactation consultant, in addition to being a doula and studying to become a midwife. Can you tell me a little about what led you to birth work and specifically, what inspired you to become a doula?

I was inspired to become a doula because of my first homebirth experience. I had my first homebirth with my fourth baby in 1989. It was such a remarkable experience that I went on to have five other homebirths. I was so amazed to learn what my body could do on its own. I had three hospital deliveries that just could not compare to my homebirths. I immediately wanted to get into birth work.

I became a doula and started attending other people’s births, especially homebirths. I started nursing school, became a labor and delivery nurse and am now working toward becoming a midwife. I really appreciate my doula roots and call upon that experience now as a doula trainer. I wrote and teach my own birth and postpartum doula courses and am currently submitting them for approval by DONA International.

Tell me about your nonprofit organization, Uzazi Village. What caused you to start it, how is it working now and where do you see it going?

Uzazi Village was founded in 2012 by me and a small group of women committed to improving birth outcomes in the urban core. I am the Executive Director of Uzazi Village and oversee its direction and vision. We have a three-pronged approach to decreasing health disparities in communities of color: culturally congruent community-based education and services to pregnant women in the community, anti-racism training and cultural respect training for clinicians and service providers, and support, guidance and nurturance for candidates of color entering the perinatal fields.

Our Sister Doula Program training at Uzazi Village is specific to our community. The doula candidates come from our community and serve our community — that is our model. That way, the care and advocacy they receive is culturally appropriate. This is a critical, but often missing, component of healthcare. Our mothers are often deemed unknowledgeable and can be taken advantage of and are often manipulated. Just having a doula in the room who looks like the mother, but also knows the system, really changes outcomes. We contract with local insurance agencies and Medicaid Managed Care Organizations (MCOs) to provide doulas to low-income mothers. Our community has never had the benefits that doula utilization has been shown to produce, because they were inaccessible.

I don’t believe uncompensated doulas are the answer because those programs are not sustainable. I believe strongly that doulas should be compensated for their valuable work. Using a model of third-party payer reimbursement makes doulas accessible to populations they never have been accessible to before. We want to see doula reimbursement become universal. We collect data so that we can demonstrate the value that our Sister Doulas add to our more socially and medically at-risk clients.

What are some of the barriers that aspiring doulas of color experience? How about practicing doulas of color?

Barriers for doulas of color might include cost of training (our doulas have the option of working off their training with us, so that cost is not a hindrance to those who want to do this work), accessibility of training (which often does not occur in the urban core, where we are located), training that does not include a culturally congruent component (ours is culturally specific and addresses health disparities) and a client base that is unknowledgeable about what a doula is, because there has not been previous access or exposure. Practicing doulas may also encounter social tensions in being hired by dominant culture clients.

Why is it important that women of color have access to doulas of color? I frequently hear doulas say that they will support any woman, regardless of race or cultural background, but that attitude seems to be missing the point.

That attitude is missing the point. 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.

Statistics are clear that women of color, specifically African American women, have significantly worse outcomes during the perinatal period, including a higher likelihood of cesarean1 and a higher infant mortality rate for black newborns2. What role do you see doulas playing in helping to address some of the racial disparities in the perinatal period?

Our Sister Doulas have so much impact, just being in the room. Our doula clients are educated throughout their pregnancies about their birth options and their birth care. They understand what a full-term pregnancy is, why they should question inductions and why they should breastfeed their babies long term.

For our clients, the doula acts as an important conduit to breach gaps in knowledge, but also as a navigator to the health care system itself, which can seem overwhelming to individuals who are already marginalized and disempowered. Our Sister Doulas stand in that gap, advocating, educating, informing, assisting, comforting, strengthening and bringing their human presence to bear. That changes what happens in the birth room for the better.

Tell me about your Black Infant Mortality Awareness Walk. Do you plan to continue to raise awareness for this particular issue, and if so, how?

This past September, I set out to walk across my state and stop in towns and universities along the way to talk about black infant mortality. I set aside the first two weeks of September to walk about 175 miles across a midsection of Missouri along the Katy Trail, a hiking and biking trail. I made it 61 miles, about midway across the state, and had to stop walking after our support vehicle (a rented RV) was involved in a hit and run. No one was hurt, but the vehicle was totaled. However, I count it as a great success.

Uzazi Village raised several thousand dollars from supporters, I spoke in several venues around the state (even after the accident, I stopped walking, but kept all my speaking engagements), got countless radio interviews and newspaper articles, met some wonderful folks around my state who care deeply about this issue, met and spoke with legislators in my state capital and proposed to do it again next year. Folks were shocked to discover that black infant death rates in their local county might be two, three, even four times the national average for white infants. This issue is very near and dear to my heart because the rates of loss are much higher in my community.

I find that providers are often not aware of the disparities, nor are the communities that are impacted by them. I speak to mothers and fathers who have experienced infant loss who see their situation as isolated events, when it is actually a part of a national trend.
In 2015 the Black Infant Mortality Awareness Walk will go national. We have joined forces with the National Perinatal Taskforce to increase awareness and have local mini-walks, where funds are raised for local communities and draw attention to what I call a silent epidemic.

What advice would you give to others who are interested in increasing access to doula services for women of color? How about to those who are interested in racial justice and equity in the birth community?

All doulas should educate themselves on issues impacting communities of color. Doulas certainly can be a part of the solution to perinatal health inequities, but it does not occur automatically. Doulas need more education on what disparities are, how they are created and what it takes to dismantle them. Racial injustice and inequity will not fix themselves. It is tied to a deep sickness in our society that permeates the very fabric of our social structure. Doulas and doula work are not immune.

It would benefit the doula world to see anti-racism training embraced by our authoritative bodies, creating and leading structural change first from within. The birth community has no immunity to the systemic racism that impacts us all. Consider this: The women who would derive the most benefit from the services of a doula are still the least likely to access one. Until we work together to change that dynamic, we still have a long way to go to achieving health equity in communities of color. This is everyone’s problem, because as Martin Luther King Jr. so eloquently put it, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” This is certainly the case when that injustice threatens infant survival.

About the Author:
Carrie Murphy, CD(DONA) is a doula, poet, freelance writer and birth activist living and working in Albuquerque, New Mexico. She also works as the Baby-Friendly Event Coordinator for the New Mexico Breastfeeding Task Force. Originally from Baltimore, Maryland, she earned her in creative writing masters in fine arts in creative writing from New Mexico State University in 2011.

1Getahun, Strickland, Lawrence, Fassett, Koebnick, Jacobsen, 2009

2CDC, 2014

The Annual Conference Continues!

Think you missed out on the 2015 DONA International Annual Conference? Think again! This year’s virtual conference is available to you from the comfort of your own living room until November 7th. You can register and watch any or all of the conference sessions between now and then. The sessions this year are in keeping with the Annual Conference’s strong 20 year history and span a wide range of topics to help new and experienced doulas stay current, expand your practice and be inspired. Here’s a sneak peek from some of the sessions:

Understanding A Woman’s Choice To Use Hypnosis For Childbirth, Amy Neuhedal, CD(DONA), dip.HB, M. Ed.

Hypnosis_Neuhedel_screenshot2Hypnosis_Neuhedel_screenshotThe 10 Things You Need to Know About VBAC, Jen Kamel

101 Things_VBAC_Kamel_screenshot101 Things_VBAC_Kamel_screenshot2 Code Red: Perinatal Anxiety Disorder and Doula Interventions, Walker Karraa, Ph.D.

Code Red_Karraa_screenshot       Code Red_Karraa_screenshot2Woman-Centered or Baby-Centered: The Truth of Being a Doula, Kerry Francis, MA, CD(DONA)

Francis_Woman_Baby Centered_screenshotFrancis_Woman_Baby Centered_screenshot2Additional session topics include breastfeeding, hospital doula programs, language sensitivity, how social trends influence birth, doula support during loss and pelvic positioning. Those who have already attended the conference have raved about the inspiration they received from The Source of Energy Within Ourselves with Naoli Vinaver. Penny Simkin closed the conference with Epigentics and the Microbiome: The Latest Buzzwords in Maternity Care which generated interesting conversation on DONA International’s social media.

The 2015 DONA International Virtual Conference: Building on Tradition, Embracing the Future will be available for on-demand viewing until November 7th.

Important conference links:
Speaker bios
Session descriptions
(DONA International members, don’t forget to get your VIP code – check your email!)

— Adrianne Gordon, CD(DONA), MBA


DONA International Announces New Advanced Doula Designation

During the 2015 Annual Conference, a new credential was unveiled for veteran doulas working to advance the maternal-child field. Beginning this fall, we will see doulas using the AdvCD(DONA) and/or AdvPCD(DONA) designation after their names. These credentials indicate a doula is an Advanced Certified Doula with DONA International. DONA International Board of Directors President, Sunday Tortelli explains:

“Doulas who have invested time, energy and effort to maintain their certification, promote the doula profession, further the maternal-child field, pursue additional training or licensure and publish on topics for or related to doula work are making important contributions to the advancement of our field. These doulas deserve special recognition and to be easily identified as the doula leaders they are within the birth community. We hope this new designation will encourage doulas to continue to learn, grow and share with others.” – Sunday Tortelli, President, DONA International Board of Directors

To be eligible for the Advanced Doula designation, doulas must meet all of the following criteria:

1) Certification: Achieved and maintained certification in good standing with DONA International for at least two consecutive certification periods (6 years)

While a DONA certified doula in good standing, applicants will have also:

2) Pursued additional training, certification and/or licensure in a related field.

3) Published a book, magazine article or professional blog post (other than on their own personal or business blog) on a topic related to doulas, birth, breastfeeding, parenting or the postpartum period.

4) Made a major contribution to advance the mission and purpose of DONA International, the recognition of doulas and/or the maternal-child field locally, regionally and/or internationally beyond that which supports their own personal or business endeavors.

Please note that criteria 2, 3 and 4 must have taken place while certified by DONA International.

Applications will be accepted through September 15, 2015. Selected doulas will be notified by October 30, 2015. Doulas receiving the Advanced Doula designation in 2015 will be honored on the DONA International website, publications, social media and with a video to be published on YouTube.

Beginning next year, applications will only be accepted during International Doula Month (May) each year and honored at the annual conference in addition to recognition via DONA International publications and media.

For additional information, view the Eligibility and Application Procedure document and the Application.

This designation is an important recognition for doulas who are leading the advancement of our field and will demonstrate their additional expertise and commitment to their communities and the wider birth community. Good luck to all those who apply! We will feature the selected doulas here on The DONA Doula Chronicles this fall.

Doula Support for Early Breastfeeding

Happy Breastfeeding Awareness Month! This month, The DONA Doula Chronicles will provide doulas with a series of articles dedicated to breastfeeding so that we can better inform and support nursing mothers. Look for online resources for doulas and much more in the coming weeks. Today we share information on risk factors to successful breastfeeding and suggestions on how doulas can support nursing in those critical early hours and days from researcher, author and speaker, Barbara Wilson-Clay.

About the Author: Barbara Wilson Clay plain backgrdBarbara Wilson-Clay has been a lactation consultant in private practice in Austin, Texas since 1987 specializing in difficult breastfeeding cases. Barbara helped found the Texas Chapter of Healthy Mothers/Healthy Babies, the Texas Breastfeeding Coalition and the non-profit Mothers Milk Bank at Austin.She has been a La Leche League Leader since 1981.Barbara’s research and com mentaries have appeared in The Journal of Human Lactation, Current Issues in Clinical Lactation, Birth Issues, Breastfeeding Abstracts, The International Breastfeeding Journal, the ICEA Journal, and Archives of Disease in Childhood. She participates on the editorial review boards of several professional journals. She has served as the ICLA representative to the International Board of Lactation Consultant Examiners(IBLCE) where she sat on the Ethics and the Exam committees. A clinical photographer as well as an LC and lecturer, Barbara is (with Kay Hoover) the author of the internationally acclaimed text book, The Breastfeeding Atlas, now in its 5th edition.

Doula Support for Early Breastfeeding

Doula care is one of the most impactful ways that birth outcomes can be improved. The role of the doula in early breastfeeding support can also help women reach their goals of a satisfying and successful transition to motherhood. And yet, many doulas may not be aware of new and important research into risk assessment for mothers and babies for whom early breastfeeding does not go smoothly.
In the past two decades, research has identified a number of maternal and infant factors that may contribute to delays in breastfeeding being well-established. These include for mothers: long, difficult labor, instrument assisted delivery, cesarean section, postpartum hypertension (swelling of limbs), thyroid disorders, diabetes or insulin resistance, obesity, excessive blood loss/anemia, infection, retained placental fragments, previous breast surgery or unusual breast development, and challenging nipple configurations (flat, inverted, large, long).

For the infant the clearly identified risk factors are: premature (including late preterm) birth, small for gestational age infant, birth injury, congenital deformity, tongue-tie, conditions that impact muscle tone, syndromic conditions (Down’s, etc.), receding chin, illness, compromised respiratory function, multiple births, and early separation from the mother.
How can the doula assist when these risk factors are present? First, reassure families that there is no “sell by” date on breastfeeding. Many babies take a while to breastfeed well and will go on to enjoy months and years of normal breastfeeding. But to protect that option, there are three important rules to follow:

Feed the Baby: A weak or starving baby cannot effectively remove milk from the breast. If milk is not removed, supply will quickly down-regulate. Many early problems are simply outgrown, so ensuring calories to the baby is critical. The safest milk is mother’s own, so it may be necessary to express milk to feed to the baby until things stabilize. Colostrum can be easily spoon fed to newborns to help maintain blood sugar levels and to help the baby begin to pass meconium and avoid jaundice.

Protect the Milk Supply: Calibration of a full milk supply is time sensitive. If a mother waits two to three weeks to begin expressing, she may never regain a full supply. In the presence of known risk factors, the most current research indicates it is best to begin hand-expressing colostrum within the first hour. If colostrum remains in the breast longer than three hours, it signals the brain to reduce production. It is especially critical to ensure that the breast is well emptied during engorgement. A combination of eight pumping and hand expressions within each 24 hour period gives the best milk volumes and provides an insurance policy that the mother will have a good supply when the baby is being transitioned back to at breast feedings.

Protect Breast Focus: Skin-to-skin holding (kangaroo care) lowers infant and maternal stress hormones, protects infant body temperature, and increases beneficial milk producing and releasing hormones, and ensures that the infant has time to practice at the breast. These practice sessions may be very brief if the infant is very small or weak, but the eventual transition to full breastfeeding is made easier if the infant maintains this proximity to the breast. Encourage the mother to be patient and to have reasonable expectations as the risk factors are systematically managed and things stabilize.

Evidence Based Resources on Breastfeeding for Doulas:
Academy of Breastfeeding Medicine (ABM). ABM Protocol Committee. ABM Clinical Protocol #22: Guidelines for management of jaundice in the breastfeeding infant equal to or greater than 35 weeks’ gestation. Breastfeeding Medicine 2010; 5(2):87-93.Agnostoni C. Small-for-gestational-age infants need dietary quality more than quantity for their development: The role of human milk. Acta Paediatrica 2005; 94(7):827-829.

Bonuck K, Stuebe A, Barnett J, et al. Effect of primary care intervention on breastfeeding duration and intensity. Am J Pub Health, Dec. 19, 2013.

Brownell E, Howard CR, Lawrence RA, et al. Delayed onset lactogenesis II predicts the cessation of any or exclusive breastfeeding. J Pediatrics 2012; 161(4):608-614.

Buckley KM, Charles GE. Benefits and challenges of transitioning preterm infants to at-breast feedings. International Breastfeeding Journal 2006; 1:13. Online.Caughey A, Sandberg P, Zlatnik M, et al. Forceps compared with vacuum: rates of neonatal and maternal morbidity. Obstetrics & Gynecology 2005; 106(5 Pt 1):908-912.

Chapman D, Perez-Escamilla: Identification of risk factors for delayed onset of lactation, Journal of the American Dietetic Association 1999, 99(4):450-54.

Chen D, Nommsen-Rivers L, Dewey K. Stress during labor and delivery and early lactation performance. American Journal of Clinical Nutrition 1998; 68(2):335-344.

Dewey K, Nommson-Rivers L, Heinig M, et al. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics 2003; 112(3):607-619.

Evans KC, Evans RG, Royal R, et al. Effect of caesarean section on breast milk transfer to the normal term newborn over the first week of life. Arch Dis Child Fetal Neonatal Ed 2003; 88(5):F380-382.

Hall R, Mercer A, Teasley S, et al: A breast-feeding assessment score to evaluate the risk for cessation of breast-feeding by 7 to 10 days of age, Journal of Pediatrics 2002; 141:659-64.

Hilson J, Rasmussen K, Kjolhede,C: High Prepregnant Body Mass Index is Associated with Poor Lactation Outcomes Among White, Rural Women Independent of Psychosocial and Demographic Correlates, Journal of Human Lactation 2004; 20(1):18-29.

Huggins, K, Petok,E, and Mireles,O: Markers of Lactation Insufficiency, in Current Issues in Clinical Lactation 2000, ed. K. Auerbach, Pg 25-35.

Humenick S and Hill P: Breast engorgement: patterns and selected outcomes, Journal of Human Lactation 1994, 10(2):79-86.

Hummel P, Fortado D. Impacting infant head shapes. Advances in Neonatal Care 2005; 5(6):329-340.

Hurst N: Lactation After Augmentation Mammoplasty, Obstetrics & Gynecology 1996, 87(1):30-34.

Issler R, Wilson-Clay B. Slow weight gain and failure to thrive. in Core Curriculum for Lactation Consultants, ed. R. Mannel, P Martins, M Walker. Burlington, MA: Jones and Bartlett Learning. 2013. pg. 849-865.

Kramer M, Demissie K, Yang H, , et al: The Contribution of Mild and Moderate Preterm Birth to Infant Mortality, Journal of the American Medical Association 2000, 284:843-849.

Lawrence RA, Lawrence RM. Breastfeeding: a guide for the medical profession (7th ed). Philadelphia, PAL Elsevier Mosby, 2011. pp. 343, 346-347, 492, 542-543.

Mannel R. Defining lactation acuity to improve patient safety and outcomes. Journal of Human Lactation 2011; 27(2):163-170.

Mejiri A, Dorval VG, Nuyt AM, et al. Hypoglycemia in term newborns with a birth weight below the 10th percentile. Paediatr Child Health 2010; 15(5):271-275.

Morton J, Hall J, Wong RJ, et al. Combining hand techniques electric pumping increases milk production in mothers of preterm infants. Journal of Perinatology 2009; 87(11):757-764.

Morton J, Hall J, Wong RJ, et al. Combining hand techniques with electric pumping increases the caloric content of milk in mothers of preterm infants. Journal of Perinatology 2012; 32(10):791-796.

Parker L, Sullivan S, Krueger C, et al. Effect of early breast milk expression on milk volume and timing of lactogenesis stage II among mothers of very low birth weight infants: a pilot study. Journal of Perinatology 2012; 32(3):205-209.

Peitsch W, Keefer C, La Brie R, et al: Incidence of Cranial Asymmetry in Healthy Newborns, Pediatrics 2002, 110(6):e72.

Pressler JL, LaMontagne LL, Hepworth JT, et al: Behaviors of macrosomic newborns compared to nonmacrosomic newborns: effect of delivery by cesarean section. Journal of Neonatal Nursing. 2001;7:106-164.

Walls V, Glass R: Mandibular Asymmetry and Breastfeeding Problems: Experience from 11 cases, Journal of Human Lactation 2006; 22(3):328-334.

Wilson-Clay B, Hoover K. The Breastfeeding Atlas (5th ed). Manchaca, Tx: Lactnews Press. 2013.

Wilson-Clay B, Maloney B: A Reporting Tool to Facilitate Community-Based Follow-up for At-risk Breastfeeding Dyads at Hospital Discharge, in Current Issues in Clin Lact 2002, ed.K. Auerbach, Jones and Bartlett, Boston. Pg.59-66.

World Breastfeeding Week 2015: Breastfeeding & Work

Happy World Breastfeeding Week! August 1- 7 is dedicated to promoting international breastfeeding. Organized by the World Alliance for Breastfeeding Action (WABA), World Breastfeeding Week began in 1991 as “one unique unifying social mobilisation event that can build solidarity and action” according to the event’s original website. The theme this year is Breastfeeding and Work: Let’s Make It Work.

The stated objectives of World Breastfeeding Week 2015 are:

Galvanise multi-dimensional support from all sectors to enable women everywhere to work and breastfeed.
Promote actions by employers to become Family/Parent/Baby and Mother-Friendly, and to actively facilitate and support employed women to continue breastfeeding.
Inform people about the latest in global Maternity Protection entitlements, and raise awareness of the need to strengthen related national legislation and implementation.
Strengthen, facilitate and showcase supportive practices that enable women working in the information section to breastfeed.
Engage with target groups e.g. Trade Unions, Workers Rights Organisations, Women’s groups and Youth groups, to protect the breastfeeding rights of women in the workplace.

WABA states there are three key elements that determine success for women who work and breastfeed: time, space/proximity and support.

world breastfeeding week logoTime refers to adequate paid maternity leave to establish and support breastfeeding, paid breaks or reduction of work hours for breastfeeding and flexible hours to allow for more time with their babies or to pump.

Space/proximity addresses keeping mothers and babies physically close to one another to facilitate adequate nursing, a safe location for breastfeeding or pumping and a work environment that is clean and without harmful chemicals.

Support includes information about laws and benefits related to pregnancy and breastfeeding, positive attitudes by employers and co-workers regarding not only breastfeeding, but pregnancy and motherhood as well and elimination of employment discrimination around maternity and breastfeeding.

For US based doulas, below are some resources related to the laws that affect employed nursing mothers:

The US Department of Labor published a blog in 2013 in honor of National Breastfeeding Month called, “Know Your Rights: Breastfeeding in the Workplace” that states that the “Fair Labor Standards Act requires breaks for mothers to express breast milk during the workday” for up to a year after birth and specifies the requirements for the space. There is an entire section of the Department of Labor’s website dedicated to nursing mothers:

To find laws by state that affect pregnant and nursing women, consult this handy and searchable map.

How you can get involved in World Breastfeeding Week:

Social media is a powerful communication tool and there are several ways to use social media to support the goals of World Breastfeeding Week:

• Change your profile picture or simply share the World Breastfeeding Week Logo (available in the Action Folder in in various size, colors and languages).
• Use these hashtags (individually or in combination): #WBW2015 #breastfeeding #MaternityProtection #WomenandWork in your posts about breastfeeding.
• Share the World Health Organization’s Infographic about their 2025 breastfeeding goal.
• Share information on breastfeeding laws and rights in your country and state/province via social media. Use the #KnowYourRights and #breastfeeding hashtags.
• Follow WABA on Twitter and/or Facebook to be part of the conversation and get great content to share.

Beyond social media, you can:
• Write a post about breastfeeding and work for your own blog. You can use the resources and images suggested above for social media or tell your own story.
• Write a Letter to the Editor of your local newspaper about breastfeeding and work.

After World Breastfeeding Week:
• Continue the conversation about the importance of time, space/proximity and support to successful breastfeeding while working. This can be person-to-person in your community, in your prenatal meetings with clients or via social media.
• Educate clients on their rights and the laws that affect them as related to breastfeeding and work.

We’d love to hear how you are participating in World Breastfeeding Week!

— Adrianne Gordon, CD(DONA), MBA

Top 10 Reasons to Attend the Virtual Conference

Recently, The DONA Doula Chronicles shared some ways to stay up-to-date on research and information for doulas. One of the absolute best ways to get the latest information in pregnancy, birth, breastfeeding and the postpartum period is DONA International’s Annual Conference. This year it will be a virtual event with sessions available beginning August 7th. It’s not too late to register! Not sure if you should attend? We bring you:

The Top Ten Reasons to Attend the 2015 Virtual Conference

1) You can attend in your pajamas. The Virtual Conference is the ultimate come as you are experience!

2) Get doula focused education from leading researchers and practitioners in the birth community. DONA International conferences are created specifically to support the unique role that doulas play in the birth and postpartum experience. Topics and speakers are selected that provide valuable information and resources for labor support and postpartum support professionals.

3) This is a great introduction to online training for those who are new to this learning format. The conference website is easy to use and there is no software to download.

4) No worrying about missing a birth to attend a training with this online conference. The sessions will be waiting for you on the conference website when you return from supporting that new family.

5) Rewatch sessions again and again for three months. Because all of the conference sessions are recorded, the ideas and insights can be paused while you take notes or reviewed to make sure you don’t miss a thing.

6) You can say Penny Simkin, Walker Kaarra, Amy Gilliland and other birth experts were in your living room (no cleaning required).

7) Attend all of the sessions and you’ll have more than the required continuing education contact hours for recertification.

8) The Virtual Conference is the most cost effective way to access this level of training. No travel or hotel expenses, but the same evidence based information you’ve come to expect from DONA International.

9) If you miss this one, you’ll have to wait a whole year for the next DONA International conference!

10) No choosing between sessions offered at the same time. The most difficult part of attending an in-person DONA International conference is deciding which concurrent sessions to attend! With the virtual conference you can attend all the sessions you are interested in, on your own time and at your own pace.

We received great feedback from the 2013 virtual conference and are excited to offer this experience again this year. As always, DONA International members receive a discounted registration for the Annual Conference. Registration will remain open until November 7th but there’s no time like the present for expanding your knowledge and skills!

Delayed Cord Clamping – Evidence & Resources for Doulas

The clamping and cutting of the cord is “one of the oldest interventions in the birth process” according to the American College of Nurse-Midwives Position Statement on Delayed Umbilical Cord Clamping. Early cord clamping was thought to prevent maternal postpartum hemorrhage and it was this idea that helped the practice gain acceptance as a standard of care in the 1960s. While research has since shown that early cord clamping does not reduce postpartum hemorrhage, there is still debate within the maternity care community about the optimal time to clamp the umbilical cord. While delayed cord clamping is discussed in most childbirth classes and often appears on the birth plans of families interested in a low intervention birth, it may be that families, doulas and care providers are not using the term to mean the same thing or all have the same understanding of what the evidence does and does not say about the practice.

First, let’s define “delayed cord clamping.” Just as we found with postpartum depression, this is a phrase that is commonly used in the maternity community but is not as clearly defined as one might think. The World Health Organization (WHO) considers cord clamping to be delayed when the cord is clamped “more than one minute after birth or when cord pulsation has ceased.” The American College of Obstetricians and Gynecologists (ACOG) has not issued a specific definition of delayed cord clamping. Their most recent document on the subject, an Opinion from the Committee on Obstetric Practice issued in December 2012 references 30 – 60 seconds after birth. The American College of Nurse-Midwives (ACNM) recommends delaying cord clamping for two to five minutes after birth depending on certain circumstances in their May 2014 Position Statement. If you are confused at this point, you are not alone. This lack of consistency across maternity care organizations about how to define delayed cord clamping is likely part of why there is still little consistency in how this practice is carried out despite growing evidence that waiting to clamp the cord has benefits for babies that last for months or even years.

Benefits of Delayed Cord Clamping
We know that the umbilical cord is a baby’s lifeline before birth. Once the baby takes her or his first breath does the umbilical cord still have a function? The short answer is yes, but only for a brief period of time. The cord, as we know, connects baby to placenta. The baby’s blood circulates through its body and through the umbilical cord to the placenta and back again receiving oxygen and nutrients from the mother. A full term baby may have as much as one third of its blood in the placenta when labor begins. During labor and birth, the placenta transfuses most of the blood back to the baby, but not all. The cord continues to pulse after birth to continue this process and, if left undisturbed, can transfuse enough blood to supply the baby with iron for around three months. A 2013 Cochrane Database Review of research on delayed cord clamping found that infants whose cords were clamped one minute or later after birth had higher iron levels when measured at two to six months of age. ACOG’s Committee Opinion on the subject states that the extra iron received after birth from the placenta “may help prevent iron deficiency during the first year of life.” Iron is very important for normal cognitive and social development in infants and deficiencies can lead to long-term consequences.

There are particular benefits of delayed cord clamping for preterm babies. ACOG recommends waiting 30 – 60 seconds after birth in these cases due to a nearly 50% reduction in the incidence of intraventricular hemorrhage or bleeding within the brain, a life threatening condition. Preterm infants also benefit from reduced need for blood transfusions and improved circulation when cord clamping is delayed by at least 30 seconds.

In a study published earlier this year in JAMA Pediatrics, researchers found that benefits to delayed cord clamping extend into early childhood. A Swedish study found that four-year-olds whose cords were clamped three minutes after birth had higher fine motor and social skills than those whose cords were clamped less than 10 seconds after birth. This is one of the few studies of full-term infants on the impacts of delayed cord clamping.

Risks to Delayed Cord Clamping
Research indicates no difference in immediate birth outcomes between babies whose cords are clamped early versus delayed including APGAR scores and respiratory distress. In their 2012 Committee Opinion (i.e. prior to the 2013 Cochrane Review), ACOG mentions several concerns (their term) regarding the universal adoption of delayed cord clamping including: risk of polycythemia in the baby, or too many red blood cells, particularly when other risk factors for the condition such as maternal diabetes, severe intrauterine growth restriction and high altitude are also present, the impact on timely resuscitation efforts for infants in respiratory distress, and that the practice may be technically difficult. ACOG notes that maternal hemorrhage due to delayed cord clamping remains a “theoretical concern” because of the volume of blood that continues to flow through the uterus at birth.

Recommendations for Delayed Cord Clamping
WHO (2014) – Not earlier than one minute after birth.
ACOG (2012) – No recommendation. Evidence supports waiting 30 – 60 seconds in preterm infants. Evidence is insufficient to support delayed cord clamping in term infants.
ACNM (2014) – Delayed cord clamping as the standard of care for term and preterm infants in all birth settings. Their Position Statement specifies time length in certain circumstances:
• Five minutes for term infants placed skin-to-skin
• Two minutes for term infants placed at or below the birth canal
• 30 – 60 seconds in preterm newborns

With a range between 30 seconds and five minutes it’s easy to see how there can be confusion about what is meant by “delayed” clamping of the cord. As doulas, our role is to share information with our clients and encourage them to discuss issues that matter to them with their care providers. Sharing up-to-date evidence on the risks and benefits of a care practice so that families can make informed decisions is an essential role of doulas.

ACNM Position Statement: Delayed Umbilical Cord Clamping

World Health Organization, “Optimal timing of cord clamping for the prevention of iron deficiency anaemia in infants”

ACOG Committee Opinion, “Timing of Umbilical Cord Clamping After Birth”:

Cochrane Database Review: “Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes”

Science & Sensibility post on the 2013 Cochrane Review:

JAMA Pediatrics, “Effect of Delayed Cord Clamping on Neurodevelopment at 4 Year of Age”:

Certification Matters: CDs and PCDs Get Higher Fees & More Clients


Kim JamesAbout the Author: Kim James has run a successful birth doula business for 15 years in Seattle, Washington. Kim’s roles in the birth community include: DONA-approved birth doula trainer at the Simkin Center for Allied Birth Vocations, childbirth and parent educator at Parent Trust for Washington Children, DONA International Washington SPAR (State Representative) and Lamaze International membership committee member. Kim is also the owner and operator of

From the doula availability database,, we have solid evidence that DONA International certified doulas consistently earn a higher fee and receive more referrals than non-certified doulas and doulas certified through other organizations.

From January 1 through May 31, 2015, 2,627 active doulas in the database received at least two or more referrals.

Doula_Match_#1DONA International certified doulas commanded a 25% higher fee than non-certified doulas and a 7% higher fee than doulas certified through other organizations. DONA International certified doulas also received twice as many monthly referrals.

What’s more interesting is to look at how DONA International certified doulas compare to other doulas with the same amount of experience.


At all levels of experience, certified doulas, and DONA International certified doulas in particular, earn higher fees and attract more clients.
For new doulas, achieving a meaningful certification means you are more attractive to potential clients. When you don’t have a lot of clients under your belt, having a recognized certification demonstrates to potential clients that you have the skills necessary to be an effective doula. With certification, doulas achieve a major professional milestone that provides an edge over doulas with the same amount of experience who are not certified or are certified through lesser-known organizations.

For established doulas, experience is the great equalizer and decreases the fee and referral gaps. However, achieving and maintaining certification demonstrates your professional commitment and validates your higher fee, even when your practice is established and thriving.

Families who use a database to reach out to doulas are probably looking for mid-priced doulas with moderate experience. When faced with a lot of choices, whether or not a doula is certified seems to matter. For doulas with moderate experience of two to seven years, 59% of all referrals went to certified doulas. Of those certified doulas, 56% were certified by DONA International.

Whether you’re just starting out or firmly established, achieving and maintaining certification is a solid business decision that benefits not just families and our profession, but you as a doula business owner.

Keeping Up With News, Research & Trends in Birth and Postpartum

There seems to be more information every day, but we certainly don’t seem to have more time to take it all in! Here are a few tips on how to stay up-to-date on information and articles related to birth and the postpartum period.

Google Alerts

Google_alert_exampleYou don’t have to search the web daily to find the latest research or news articles. Search engine giant Google offers a free service that sends an email when new information on a particular topic appears on the Internet. This can be a great way to keep up with news or information in your local area or follow a subject you are very passionate about such as VBACs, pregnancy nutrition, etc. Go to and type in the topic you want to receive updates on. You can choose to receive alerts on everything from the web or only news or blogs. Google also lets you set how often you want to receive emails. It’s possible to edit an alert once you’ve set it in case you aren’t getting the kind of information you want or feel you are getting too many messages. Target your alerts using quotes such as “postpartum doula” to be notified only of items that use that phrase exactly. A minus sign in an alert such as “research birth –control” can help filter out certain sub-topics that you don’t need. You can learn more about Google Alerts on their help page.

The DONA Doula Chronicles

TDDC_in_your_inboxWe try to do a good bit of the legwork for you by offering summaries of reports and protocol changes soon after they happen. We also collate several pieces of research or a collection of resources on a specific topic such as Cesarean Resources for Doulas and New Research on Premature Birth.

Tip: You don’t have to remember to check back here to get the latest posts; you can sign-up to receive posts via email to get research and resources right in your inbox.

International Doula

This quarterly print publication from DONA International covers topics in more depth than a blog or news article. Every issue includes media reviews and information specifically for doulas and the unique role we have in providing support during the childbearing year. Editions are printed in March, June, September, and December. DONA members can access back issues of the ID via the online Member Center. This is a great reference library! Issues are available back to 2011 in the Member Center.


Not currently a DONA International member? Here’s a free back issue of the International Doula to see the type and range of content included.

Trusted Resources

Part of our scope of practice as doulas is informational support. Birth doulas provide clients with “assistance in acquiring the knowledge necessary to make informed decisions about [their] care” according to the DONA International Scope of Practice.  For postpartum doulas, the Scope of Practice says, “the doula offers evidence-based information.” Clearly, our role is to serve as a conduit for families to reputable information so that they can make informed decisions for their family. Determining what information is reputable, or even evidence based, can be a real challenge. To help, we’ve compiled a short list of websites that are well known in the birth community to provide evidence based information both for doulas and for the families we serve.

Childbirth Connection is a nearly 100 year old organization that recently joined forces with the National Partnership for Women & Families. Their website offers evidence-based information for families in clear, approachable language covering topics such as choosing a care provider, induction and cesareans. Pregnancy resource recommendations and information on labor support are also available. Childbirth Connection is likely a name familiar to many doulas from the Listening to Mothers surveys and the Hormonal Physiology of Childbirth report.

Lamaze’s Science & Sensibility blog provides in-depth coverage on research related to pregnancy, birth, and the postpartum period for childbirth educators, doulas and care providers. Giving Birth With Confidence,another Lamaze offering geared toward families, can be a good source of evidence-based information to share with clients. Their “Your Pregnancy Week by Week” emails are informative yet positive, which can go far to help reduce fear or anxiety in expectant moms.

The stated mission of International Cesarean Awareness Network (ICAN)  is “to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC).” Their website offers supportive and evidence based information for pregnant and parenting families through articles and blog posts. ICAN chapters can be an excellent source of support for families and an important resource for doulas.

Rebecca Dekker’s Evidence Based Birth is exactly as the name suggests – articles on birth related topics that are rooted in research. While the material here is steeped in studies and scholarly articles, the information is presented in a very approachable way. Handouts, newsletters, and even classes are also available from Evidence Based Birth that are appropriate for both doulas and families.

How else do you stay up to date? Do you have favorite resources we missed? We’d love to hear from you!

— Adrianne Gordon, CD(DONA), MBA