The Doula and the Breastfeeding Family
By Carol M. Lynch and Patricia B. Holliday
From: NEW BEGINNINGS, Vol. 15 No. 1, January - February 1998, p. 4-7
We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time.
Marianne, who used a doula during the birth of her son, describes her experience:
When our brand-new baby, William, was placed on my breast shortly after his birth, it was hard to believe I really had anything to feed him. He didn't catch on right away, either. Having our doula there was a wonderful reassurance that there was nothing strange about us both being unsure how to get started. She suggested letting my husband hold William for a while and when I put William back on my breast, he caught right on.
Marianne and Jeff are one of a growing number of couples who choose to have a doula assist them during labor and birth. A doula is a woman experienced in birth who provides emotional, physical, and informational support to the mother before, during, and just after childbirth. Many couples today hire a doula to help them have a safer and more satisfying birth experience.
In studying over 150 human cultures, anthropologists have found that mothers in labor have traditionally had another woman-usually a friend or family member-present during birth. As childbirth moved into the hospital during the early part of this century, mothers became isolated. Hospital routines and concerns about infection kept family and friends away from mothers and their babies. As the needs of laboring women have become more widely understood, the doors to birthing rooms have slowly opened to admit the father, friends, or other family members, and now, the doula, to help the mother during her baby's birth.
The Doula's Role
What does a doula do? What makes her role unique? The doula meets with the birthing couple one or more times before the birth. She discusses with them their expectations or ideas of what they want their baby's birth to be like, including their preferences regarding pain medication and infant feeding. The doula helps them to achieve their expectations. She also supplements information learned in prenatal classes and corrects misinformation gleaned from the personal birth experiences of friends and relatives. Pat and Mike Drackett were surprised at the comprehensive services their doula offered, "We were thrilled to have found such a qualified person available to us as our doula at this important time in our lives. We didn't expect Kathy to also be an incredible resource of prenatal information on nutrition and exercise, as well as breastfeeding preparation."
Following the prenatal meetings, the doula is on 24-hour call - often for two weeks before and after the due date. During early labor, the doula and mother stay in touch. When the mother feels the need for additional support, the doula will come to the mother's home or meet her at the hospital or birthing center. She will help the mother relax during contractions and suggest ways to cope. She suggests comfort measures such as hot or cold packs, massage, pressure, or a bath or shower. She might suggest walking or changes in position to speed up labor or increase the mother's pain tolerance during contractions. The doula listens to the mother and responds to her needs and wants.
Supporting Fathers and Others
The doula is also responsive to the needs of the father and respects his level of involvement. First-time fathers are usually inexperienced in understanding and reacting to the normal behavior of a woman during labor and they appreciate the reassurance the doula offers. An experienced father may also appreciate a doula. While he cares for the mother, the doula performs peripheral tasks such as getting ice, juice, or blankets for the mother. She also fills in for the father if he needs a break, gives him an occasional back rub, and supplies supportive information. Since each labor presents its own unique challenges, even experienced birthing couples benefit from the services of a doula. A doula may also provide these kinds of support for others who support a mother in labor, such as friends or other family members.
The doula's calm presence and commitment to the mother's well-being helps counteract the effects of stress hormones (adrenaline and noradrenaline) which are released when a woman in labor becomes anxious, fearful, or insecure. Elevated stress hormones cause labor to slow down or stop while heightening the perception of pain. A trusting, relaxed mother continues to produce oxytocin (the hormone that causes the uterus to contract). She has more effective contractions, but with less tension in her body, she feels less pain. With quiet reassurance, the doula helps the laboring mother and her partner to draw on their own unique talents and strengths.
Research Shows Benefits
An early study on labor companions (Haus 1982) demonstrated just how important a doula can be. The authors investigated the effects of having a supportive companion present during labor. They wanted to compare two groups of mothers with uncomplicated births, with 20 mothers in each group. In the group that had a companion assigned to each mother, they had to follow the labors of 32 mothers to identify 20 mothers with uncomplicated births for their study group. To get 20 uncomplicated births in the control group-women without a labor companion-they had to follow 95 labors! What's more, the labor companions in this study were untrained and unknown to the mothers to whom they were assigned, which makes the results even more astounding! Additional research over the years has confirmed that supportive labor companions make a difference in the course and outcome of labor. A combined analysis of research results from six randomly controlled trials showed that a doula's presence was associated with reductions in cesarean births (50%), length of labor (25%), epidural use (60%), and pitocin use (40%) (Klaus, Kennell & Klaus 1993). Research also shows significant long-term benefits of improved breastfeeding, decreased postpartum depression, and more positive maternal assessments of baby's personality, competence, and health.
Having doulas present at birth enhances mother-infant bonding and breastfeeding, leading to more positive mother-to-infant interactions and the establishment of an adequate milk supply during the immediate postpartum period. Doulas appear to be most effective in the following interactions.
An essential principle of attachment, or bonding, is that parents must receive some response or signal (such as body or eye movements) from their infant, to form a close bond. As stated in THE WOMANLY ART OF BREASTFEEDING, "For a period during the first hour of life, most newborns are quietly alert and receptive. A lively and intricate exchange of messages passes between the mother and the baby who are together at this time." Doulas, as objective observers, often notice this exchange and can subtly draw attention to specific behaviors.
Because a doula provides continuous support (in contrast to multiple medical caregivers and various shift changes), she can ensure that the mother and baby have the optimal amount of time needed to help the baby reestablish the biorhymicity disrupted by the labor and birth. Biorhymicity refers to the synchronization of the baby's actions and rhythms to those of the mother. Before birth, the baby's sleep / wake cycles, day-today activities of the mother, heartbeat of the mother, and various other rhythms are familiar and constantly synchronized. Labor and birth disrupt those rhythms. When the baby is cared for from birth by his mother, these rhythms are more easily and quickly reestablished. The mother is able to "tune in" to her baby, letting the natural process occur with as few interruptions as possible.
Dr. William Sears, in THE FUSSY BABY, relates the story of baby Michael, who spent his first five days in the hospital nursery. The first two nights his mother heard the nurses calling his name continuously. The next two nights were noticeably quieter. When Michael's mother brought him home, he began crying constantly. It took his mother eight months of intensive parenting to reestablish biorhymicity with Michael, which turned him into a relaxed, happy baby. Dr. Sears feels that Michael was upset by multiple caregivers who imposed a rigid four-hour schedule upon him while in the hospital nursery.
The infant's temperature drops only slightly, if at all, when placed on the mother's chest, wrapped-even without an additional heat source (Klaus, 1982). The doula can educate the mother to keep her baby warm on her chest, with blankets covering both mother and baby. Clinical staff can make well-baby checks of the baby in the mother's arms, making routine separation unnecessary and breastfeeding more successful.
Having a doula present when breastfeeding is initiated can be very helpful. By initiating "on-demand" breastfeeding at birth and encouraging the mother to continue to nurse at will, the doula helps breastfeeding to progress with few problems. In special circumstances, doulas also provide an extra pair of hands to help support the baby during breastfeeding. Kathy Raskett, a doula in Gulfport, Mississippi, worked with Vernie, a new mother who related, "After my baby's cesarean birth, my doula held my baby to my breast for 45 minutes of nursing. I could not have done it alone."
Most doulas have either breastfed their own children and/or have had training in facilitating breastfeeding in the early days. Debbie Young, a doula and mother of five, relates a story of a new mother whose recovery room nurse kept touching the baby on the head, stimulating a rooting response in the wrong direction. This led to a very frustrated mother and a confused, and still hungry, baby. After the mother had a few minutes alone to comfort her baby, Debbie asked a few questions (such as what position would be comfortable) and gave some specific, but simple, verbal information and direction. The mother then got her baby latched on successfully by herself.
Overcoming Breastfeeding Challenges
When breastfeeding is somewhat clumsy initially, as it was with Marianne and her son William, the doula encourages the mother, letting her know that breastfeeding is often an art learned by both baby and mother. A doula may be a more helpful source of information about breastfeeding than some physicians or hospital nurses. In the immediate postpartum period, the doula is in the mother's home and can monitor the progress of breastfeeding. Since the new mother established a comfortable relationship with the doula during her pregnancy, she may also turn to her doula with her breastfeeding questions. The doula is thus able to refer the mother to support groups, such as LLLI, or to professional resources as needed or desired.
One couple, Paul and Heather Dezzutto, parents of Mia Ashlee, summed up their doula experience with this thought, "For us, a doula is an essential part of a natural childbirth. She is a competent and knowledgeable caregiver who personifies compassionate care during the birthing process."
A doula can be a strong link in the chain of support that new parents need to have a satisfying and joyous birth experience. Her presence can help ensure that mothers will be able to be alert during labor and so participate actively during birth. Her support after birth can give the mother the opportunity to breastfeed her baby early and often. As LLL's experience shows, these actions help mothers to have a satisfying and successful breastfeeding relationship with their babies.
Finding the Right Doula for You
Doulas of North America (DONA) offers referrals for mothers wishing to use a doula or information on training and certification programs for anyone interested in becoming a doula. You can reach DONA by phone at 206-324-5440 or by mail at 1100 23rd Avenue E., Seattle, WA 98112. Or check out their web site at: http://www.dona.com
If you are unable to locate a doula in your area, you may wish to ask a friend, relative, or childbirth educator who supports your birth philosophy to be with you during your birth. The following books are also helpful:
- The Birth Partner: Everything You Need to Know to Help a Woman Through Childbirth, by Penny Simkin
- Mothering the Mother, by Klaus, Kennell and Klaus
- THE WOMANLY ART OF BREASTFEEDING, La Leche League International.
To help you decide if a particular doula is right for you, use the following list of questions from DONA. You may ask a few questions over the phone, and then interview one or two doulas who made you feel comfortable:
- What training have you had?
- What is your philosophy about childbirth and about supporting women and their partners through labor?
- Tell me (us) about your experiences with birth, personally and as a doula.
- May we call you with questions or concerns before and after the birth?
- When do you join me in labor?
- Do you work with one or more backup doulas (for times when you are not available)?
- May we meet them?
- What is your fee?
When you meet the doula (and it is a good idea for both you and your partner to meet her), pay particular attention to your personal perceptions of her. Is she kind, warm, and enthusiastic? Does she communicate well? Is she a good listener? Is she comfortable with your choices? Do you feel comfortable with her?
Sears, William, The Fussy Baby: How to Bring Out the Best in Your High- Need Child. Schaumburg, IL: LLLI, 1985.
Klaus, Marshall, H., Kennell, John H., and Klaus, Phyllis H. Mothering the Mother. Reading, MA: Addison-Wesley, 1993.
Klaus, Marshall H. Parent-Infant Bonding, 2nd Edition. St. Louis, MO: Mosby. 1982.
La Leche League International, THE WOMANLY ART OF BREASTFEEDING. LLLI, Schaumburg, IL: 1997.