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Doulas: Before, During, and After Birth

Written by Jan S. Mallak, Certified Doula   
Monday, 01 September 2008 00:00
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A doula is a woman experienced in childbirth who is specially trained to provide various kinds of support for the mother before, during, and/or after the birth. The term comes from ancient Greece, where a female servant called “the doula” attended the expectant lady of the household.

A movement to bring back this age-old tradition began in 1992 when Doulas of North America was founded. Since then, several other organizations have emerged or expanded to offer doula training and certification: International Childbirth Education Association (ICEA), Childbirth and Postpartum Professional Association (CAPPA), and Association of Labor Assistants and Childbirth educators (ALACE). All can be found on the internet and offer a wealth of information regarding what a doula is, how to locate one, what costs are involved, and how to find the right “fit.”

There are three types of doulas: antepartum (before), birth (during) and postpartum (after). The antepartum doula is the newest kind of doula who can assist the high-risk mother while still pregnant, for example. The woman may be restricted to bed rest for medical reasons and therefore unable to care for herself or others. The antepartum doula can provide mother/child care, do light housekeeping, run short errands and prepare nutritious meals. She educates the mother about pregnancy, birth, or postpartum and provides her with local resources and referrals. Doulas often have a list of complimentary care providers for women to consider during pregnancy and beyond such as massage, chiropractic care, yoga, exercise, acupuncture, etc. She can recommend a variety of area childbirth classes including private lessons if a mom is on bed rest. The doula can also lend an ear to help the mother deal with the additional fears associated with a highrisk pregnancy and possible outcomes. And she helps keep the family on track so their lives can flow more smoothly even if mom is “out of commission.”

Sometimes an antepartum doula is called in to help an expectant mother shop or set up for the baby. Maybe the mom simply has no family in the area and needs assistance with some of the basics associated with preparing for a new baby. Having an experienced woman’s guidance and companionship can be very instructive and reassuring for the mother-to-be.

A postpartum doula does much the same as the antepartum doula, but after the baby comes. Her roles are similar but helping the family transition into their new life with the baby is now the focus. Education often takes the form of “on the job training” since the baby has specific, immediate needs that have to be met. Bathing, dressing, changing, swaddling, feeding, burping and entertaining the baby are some of those immediate needs. And, not everyone feels very accomplished in those areas. The doula steps in to educate, guide, and facilitate the family’s comfort and confidence with their new roles.

Breastfeeding is on the rise, so assistance with nursing is another function of the postpartum doula. Many women lack breastfeeding role models or reliable resources; having an experienced and knowledgeable guide is a valuable benefit for them. Helping the baby latch on well from the beginning seems to really contribute towards early breastfeeding confidence and success. Follow-up and suggestions on almost a daily basis from a doula help the mother maintain her self-belief.

Postpartum depression is also on the rise so having someone around who knows how to prevent, recognize, or deal with postpartum mood disorders can literally save lives. Sometimes a woman’s birth experience can influence her mental state. A debriefing afterwards can be very therapeutic. Doulas are trained to be good listeners, assess a woman’s well being and refer if warranted. No medical care, advice, or interpretations is ever provided by any type of doula. Doulas identify red flags and provide expert resources and referrals, which are integral to their duties. Sometimes the father experiences a postpartum depression of sorts due to little sleep, improper nutrition, new roles and responsibilities, worry, etc. The doula is there to help the whole family with all the new adjustments and challenges and can address these issues as well.