Doula
Encyclopedia
A Doula is someone who provides non-medical support to women and their families during labour and childbirth
, and also the postpartum period. The term can also be used to describe other supportive roles for other life events such as abortion
, death
and more.
Dana Raphael used the term for experienced mothers assisting new mothers in breastfeeding
and newborn care in Tender Gift: Breastfeeding (1973). Marshall Klaus and John Kennell, who conducted clinical trials on the medical outcomes of doula-attended births, adopted the term to refer to labor support.
A doula helps fill this gap by providing support to the woman and her partner or support system throughout the childbearing year. A doula does not replace the support system; instead, they help support them so that they can focus on loving and encouraging the laboring woman.
Doulas can serve as a source of information during pregnancy, labor and birth. A doula assists families in gathering information about their pregnancy, labor and the options available for delivery.
Doulas can be trained and experienced in childbirth, however, in most countries there is no government regulation of their training (see below). Their goal is to provide continuous physical, emotional, and informational support before and during labour, birth, and the immediate postpartum period. The intent of a doula is to help the woman have a safe and satisfying experience, as the woman defines it.
However, some medical institutions have banned doula participation citing that doulas can "cross the line" during delivery, endangering mother and child. Some doula clients have also found their doulas carried personal agendas into the birthing room that were contrary to their wishes and a risk to their health. A well trained doula understands and works within the doula's scope of practice and should not interfere with any medical aspect of labor and birth.
support (physical and emotional) to a woman leading up to and during her labor and delivery, an aspect of care that was traditionally practiced in midwifery. A labor doula may attend a woman having a home birth or a woman laboring at home before transporting to a hospital or a birth center, where she will continue support. Doulas do not perform clinical duties such as heart rate checks or vaginal exams, or give medical advice. Labor doulas rely on techniques like massage, aromatherapy, visualization, positive positioning, emotional support, encouragement, and nurturing to help women through labor. Many offer phone and email support as well as prenatal and postpartum visits to ensure the mother is informed and supported. The terms of a labor/birth doula's responsibilities are decided between the doula and the family. The doula is also an ally for the father or partner, who may have little experience with the labor process and may also find the process anxiety provoking. Often the doula will help the partner find ways to support the laboring woman. Studies have shown that childbirth education can help reduce paternal anxiety and one of the doula's roles is to educate. A responsible doula supports, encourages, and educates the father or partner in his or her support style rather than replacing them.
Dr. John Kennell, who has studied the impact doulas have on mothers, babies, and childbirth, says, “If a Doula were a drug, it would be malpractice not to use it”. Studies have shown that these same results may be achieved through the inclusion of a close friend or relative with minimal or even no formal training in the birthing process.
Volunteers play an important role for women who cannot afford to hire a private doula and they can encourage mother-based birth advocacy and may help a woman to feel more empowered during her labor and birth. .
A postpartum doula a.k.a. postnatal doula provides support to the mother and family following the birth and immediate postpartum period. This can be for a few days or up to and beyond six weeks, depending on need. This may include breastfeeding support, newborn care assistance, cooking, light housekeeping and errands. She offers education, companionship and nonjudgmental support during for the few weeks following the birth, as well as evidence-based information on infant feeding, emotional and physical recovery from birth, infant soothing and coping skills for new parents and makes appropriate referrals when necessary.
Steps are being made in the UK to integrate doulas into more mainstream maternity services. UK doulas believe that much of the 'doula effect' is due to the doula's independence from Health Services and parents choosing their own doula.
The Swiss Association of Doulas (called 'Doula CH', www.doula.ch) was founded in 2006. In 2011, approx. 90 members of 'Doula CH' offer their services as birth doulas and postpartum doulas. In most Swiss hospitals, doulas are welcome. Training for German-speaking Swiss doulas is currently offered for 16 students per year. There is also a course offered to French-speaking doulas. Women who want to take part in the training offered by Doula CH have to have given birth themselves.
Doulas who have certificates of other organizations (like Birth Arts Int.) can become member of Doula CH on request.
and Canada
, labor/birth doulas are not regulated although training and optional certification is available. Some of the better-known training/certifying organizations are:
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...
, and also the postpartum period. The term can also be used to describe other supportive roles for other life events such as abortion
Abortion
Abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced...
, death
Death
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....
and more.
Etymology and history of usage
Doula comes from Ancient Greek (doulē) meaning "female slave." Because of the negative connotations, Greek labor supporters as well as various other global doulas instead call themselves labor companions or birthworkers. AnthropologistAnthropology
Anthropology is the study of humanity. It has origins in the humanities, the natural sciences, and the social sciences. The term "anthropology" is from the Greek anthrōpos , "man", understood to mean mankind or humanity, and -logia , "discourse" or "study", and was first used in 1501 by German...
Dana Raphael used the term for experienced mothers assisting new mothers in breastfeeding
Breastfeeding
Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or...
and newborn care in Tender Gift: Breastfeeding (1973). Marshall Klaus and John Kennell, who conducted clinical trials on the medical outcomes of doula-attended births, adopted the term to refer to labor support.
History
The concept of a doula is not new. Personal support by a close friend or relative through labor is a tradition that goes back many years in all cultures. Some women do not live in close-knit communities where their sisters, mothers, aunts, and friends are there to support them through pregnancy, childbirth and motherhood; these events can be scary and can make a woman feel lost if she has to experience them alone.A doula helps fill this gap by providing support to the woman and her partner or support system throughout the childbearing year. A doula does not replace the support system; instead, they help support them so that they can focus on loving and encouraging the laboring woman.
Doulas can serve as a source of information during pregnancy, labor and birth. A doula assists families in gathering information about their pregnancy, labor and the options available for delivery.
Doulas can be trained and experienced in childbirth, however, in most countries there is no government regulation of their training (see below). Their goal is to provide continuous physical, emotional, and informational support before and during labour, birth, and the immediate postpartum period. The intent of a doula is to help the woman have a safe and satisfying experience, as the woman defines it.
However, some medical institutions have banned doula participation citing that doulas can "cross the line" during delivery, endangering mother and child. Some doula clients have also found their doulas carried personal agendas into the birthing room that were contrary to their wishes and a risk to their health. A well trained doula understands and works within the doula's scope of practice and should not interfere with any medical aspect of labor and birth.
Types
A labor doula or birth doula is someone (often trained, though this is not required) who provides non-medicalObstetrics
Obstetrics is the medical specialty dealing with the care of all women's reproductive tracts and their children during pregnancy , childbirth and the postnatal period...
support (physical and emotional) to a woman leading up to and during her labor and delivery, an aspect of care that was traditionally practiced in midwifery. A labor doula may attend a woman having a home birth or a woman laboring at home before transporting to a hospital or a birth center, where she will continue support. Doulas do not perform clinical duties such as heart rate checks or vaginal exams, or give medical advice. Labor doulas rely on techniques like massage, aromatherapy, visualization, positive positioning, emotional support, encouragement, and nurturing to help women through labor. Many offer phone and email support as well as prenatal and postpartum visits to ensure the mother is informed and supported. The terms of a labor/birth doula's responsibilities are decided between the doula and the family. The doula is also an ally for the father or partner, who may have little experience with the labor process and may also find the process anxiety provoking. Often the doula will help the partner find ways to support the laboring woman. Studies have shown that childbirth education can help reduce paternal anxiety and one of the doula's roles is to educate. A responsible doula supports, encourages, and educates the father or partner in his or her support style rather than replacing them.
Dr. John Kennell, who has studied the impact doulas have on mothers, babies, and childbirth, says, “If a Doula were a drug, it would be malpractice not to use it”. Studies have shown that these same results may be achieved through the inclusion of a close friend or relative with minimal or even no formal training in the birthing process.
Volunteers play an important role for women who cannot afford to hire a private doula and they can encourage mother-based birth advocacy and may help a woman to feel more empowered during her labor and birth. .
A postpartum doula a.k.a. postnatal doula provides support to the mother and family following the birth and immediate postpartum period. This can be for a few days or up to and beyond six weeks, depending on need. This may include breastfeeding support, newborn care assistance, cooking, light housekeeping and errands. She offers education, companionship and nonjudgmental support during for the few weeks following the birth, as well as evidence-based information on infant feeding, emotional and physical recovery from birth, infant soothing and coping skills for new parents and makes appropriate referrals when necessary.
UK and Switzerland
The main doula organisation in the UK is Doula UK. Founded in February 2001, Doula UK is the first and currently only non-profit association of doulas in the UK.Steps are being made in the UK to integrate doulas into more mainstream maternity services. UK doulas believe that much of the 'doula effect' is due to the doula's independence from Health Services and parents choosing their own doula.
The Swiss Association of Doulas (called 'Doula CH', www.doula.ch) was founded in 2006. In 2011, approx. 90 members of 'Doula CH' offer their services as birth doulas and postpartum doulas. In most Swiss hospitals, doulas are welcome. Training for German-speaking Swiss doulas is currently offered for 16 students per year. There is also a course offered to French-speaking doulas. Women who want to take part in the training offered by Doula CH have to have given birth themselves.
Doulas who have certificates of other organizations (like Birth Arts Int.) can become member of Doula CH on request.
US and Canada
In the United StatesUnited States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
and Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
, labor/birth doulas are not regulated although training and optional certification is available. Some of the better-known training/certifying organizations are:
- Birth Arts International
- CAPPA (the Childbirth and Postpartum Professional Association)
- CBI (Childbirth International)
- DONA (Doulas of North America)
- ICEA (the International Childbirth Education Association).
Australia
In Australia, the doula industry is not regulated and certification is not compulsory, thus, anyone can be a doula. Course requirements are not regulated; courses range from weekend, online courses to year-long courses. Registration is not available. It is illegal for doulas to practise midwifery as this is considered practising midwifery without a licence. Doulas may not provide clinical care such as listening to the baby's heart rate or checking the blood pressure. They may not give clinical advice nor provide opinion on the advice of professional care providers.External links
- VIDEO - Doulas 101 from the University of Wisconsin-Madison School of Medicine and Public Health, 2011.