How a Doula can Benefit You (yes, YOU)

This is a post I started a while ago and left it unfinished. When I found out about the Support Doulas Giveaway at Birth a Miracle Services, I decided to take the opportunity to finish it so I could enter. Today is the last day to enter the giveaway, so check it out if you are interested in winning some homemade natural hand cream!

What are the benefits of having a doula?
I am becoming a doula because I want more women to have all the benefits of doula support. Scientific studies have found clear benefits to having a professionally trained doula with you during childbirth. These include:

* 26% reduction in cesarean sections,
* 41% reduction in use of vacuum extraction or forceps,
* 28% reduction in need for pain medications, and
* 33% reduction in dissatisfaction with the birth experience
(Hodnett and colleagues 2004).

What benefits does having a doula offer over just having my husband as my birth support person?
It is wonderful that the "father pacing in the waiting room" has become a thing of the past, and fathers are now able to participate in the births of their children, to whatever degree they are willing and comfortable. The support that a loving, in-tune partner can provide a woman is of great value. However, it's important to recognize that the birth of your child is a highly significant experience in the life of your partner as well. Expecting the father, for whom the experience is extremely emotional, to meet all the emotional and physical needs of the laboring woman is a lot to ask. He may be worried about you and the baby and may find it difficult to watch you struggling with the obstacle of labor. He may not know or remember what he needs to do to help you. Doulas can be great for reminding or teaching the partner ways to better support the birthing mother. Having a doula also may allow the partner to take breaks if labor is long, without you having to be left without emotional and physical support.

How is a having doula different from having a female friend or family member at my birth?
Having an extra support person can be beneficial, and I recommend this if having a doula is not an option for you. A professional doula does offer unique benefits. She has more knowledge about the birth process, the medical procedures that may be offered, and pain reduction or coping techniques. She may be better equipped to support your plans than a friend or family member may not understand the choices you make. A friend or family member may also find it scary to watch you go through labor, while a doula is more objective and more familiar with labor and what is normal and not normal for women.

What is the benefit of having a doula in addition to the medical staff who will be there?
Most doctors are only able to be with their patients at the very end of labor to catch the baby. A midwife will typically spend more time with you, though in some situations, she will have to care for more than one laboring woman at once. In a hospital, you will have never met the nurses and they may also not be able to stay with you continuously. Some nurses are much better than others at support techniques, and you may not know in advance how good yours will be, though sometimes your choice of hospital plays a role. A doula is a person you choose, who you can get to know in advance, and who will be with you constantly during your labor and birth. Also, the primary responsibility of your medical care providers is to be concerned with the safety of you and your baby. A doula is primarily responsible for your emotional and comfort needs. The medical staff also has to worry about regulation by the hospital and their malpractice insurers. A doula works for you, not your doctor or hospital, and can often offer a more balanced perspective on your options.

Doulas sound great for women who are planning unmedicated birth, but I'm planning on having pain medication. Do I still need a doula?
Many women do choose to hire a doula to support them in their choice for an unmedicated birth, as such support can be difficult to find. However, having a doula can benefit all women, regardless of what kind of births they have. Most women will have to cope with some labor before they receive pain medication, and a doula's support can be beneficial to help the woman get through while she waits for it to be administered. Also, pain medication does not take away a woman's needs for emotional support and unbiased information. Even if a woman needs to have a cesarean, a doula can help keep her calm before and during the procedure and stay with her while the partner stays with the baby. A good doula will support the woman completely in whatever she chooses.

A woman's birth experience matters!
Research conducted by doula, childbirth educator, and author Penny Simkin indicates that women remember accurate details about their births 20 years later. Simkin's research also found that the most significant factor in the satisfaction rating a woman gave for her birth experience 15-20 years down the road was not the length of labor, whether there were complications, or whether or not she had pain medication, but how she was treated by those who cared for her. All women deserve the loving, continuous emotional and physical support of a knowledgeable professional while giving birth. (from Simkin, The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions, Third Edition, pg xi-xii)

Maslow's Hierarchy of (Birth) Needs

At a church meeting I attended recently, a speaker brought up psychologist Abraham Maslow's Hierarchy of Needs to make a point about serving others. It had been years since I thought about Maslow's Heirarchy, but I was familiar with it from the AP Psychology class I took in high school and I think it was also covered in the Child Development course I took as a requirement for my Bachelor degree in Early Childhood Education. This course was actually where, as a college freshman, I first learned that placentas come out. I don't know what I thought happened to it before--guess I figured it was just a permanent part of the mother's anatomy or something. Perhaps public high school curricula are a little lacking on the subject of childbirth?

In my high school psychology class, we discussed the different theories of psychology--Freud's psychoanalytic theory, behaviorism, etc. We divided into groups, each representing a theory. I chose to join the Humanist group. Basically, the theory of Humanism is that people are like seeds with the potential to grow into something great if all of their needs are met. For plants, the needs are soil, water, sunlight, etc. Maslow attempted to explain what human beings need with his Hierarchy of Needs, usually depicted as a pyramid like this:

www.abraham-maslow.com

Maslow arranged the needs this way because he believed that certain types of needs must be met before other needs manifest. In other words, if more pressing needs like needs for food, sleep, and safety are unmet, then the person can't be very concerned with higher needs, like belonging and confidence.

Here is an explanation of each level of needs, quoted from this site.

Physiological Needs

These are biological needs. They consist of needs for oxygen, food, water, and a relatively constant body temperature. They are the strongest needs because if a person were deprived of all needs, the physiological ones would come first in the person's search for satisfaction.

Safety Needs

When all physiological needs are satisfied and are no longer controlling thoughts and behaviors, the needs for security can become active. Adults have little awareness of their security needs except in times of emergency or periods of disorganization in the social structure (such as widespread rioting). Children often display the signs of insecurity and the need to be safe.

Needs of Love, Affection and Belongingness

When the needs for safety and for physiological well-being are satisfied, the next class of needs for love, affection and belongingness can emerge. Maslow states that people seek to overcome feelings of loneliness and alienation. This involves both giving and receiving love, affection and the sense of belonging.

Needs for Esteem

When the first three classes of needs are satisfied, the needs for esteem can become dominant. These involve needs for both self-esteem and for the esteem a person gets from others. Humans have a need for a stable, firmly based, high level of self-respect, and respect from others. When these needs are satisfied, the person feels self-confident and valuable as a person in the world. When these needs are frustrated, the person feels inferior, weak, helpless and worthless.

Needs for Self-Actualization

When all of the foregoing needs are satisfied, then and only then are the needs for self-actualization activated. Maslow describes self-actualization as a person's need to be and do that which the person was "born to do." "A musician must make music, an artist must paint, and a poet must write." These needs make themselves felt in signs of restlessness. The person feels on edge, tense, lacking something, in short, restless. If a person is hungry, unsafe, not loved or accepted, or lacking self-esteem, it is very easy to know what the person is restless about. It is not always clear what a person wants when there is a need for self-actualization.

Now, I've heard that birth is psychological. There are many examples of birth stories in Ina May's Guide to Childbirth where the woman couldn't give birth until she solved some issue with her partner or voiced a fear or something like that. I also have read a lot about the mind-body connection and how a woman feels during birthing can affect the physical process of birth (a explanation of this is in Better Birth: The Ultimate Guide to Childbirth from Home Birth to Hospitals by Denise Spatafora). I've also heard explanations from an evolutionary standpoint, that humans, like animals, have to feel comfortable in our surroundings to give birth.

However, I've never heard the psychology of birth explained in terms of unmet needs before. If we assume that meeting the needs on Maslow's Hierarchy is essential to a woman's emotional well-being, and hence, important for both the physical progress and the woman's experience of birth, then it's easy to see why some births go smoother and are better experiences than others. A lot of what is common in birth in America actually denies women of their needs.

In the average hospital birth, women are usually denied food and sometimes denied drink (physiological needs) and given an intravenous drip and ice chips instead. Women can't feel safe (safety needs) in the hospital if they fear strangers, unfamiliar places, needles, or bodily injury from episiotomy or cesarean. Traumatic birth stories sometimes mention the woman feeling alone, deserted, or unloved (social needs) when she was taken away from loved ones to be preped for surgery or left to be "watched" by a fetal monitor. Sometimes women are disrespected (esteem needs) by being ordered around, spoken to demeaningly (you can find a lot of examples of these two at www.myobsaidwhat.com), or not being free to move. With so much frustration of women's needs, no wonder there are so many unsatisfying birth experiences.

If you were to look at my birth plan from my son's birth (unmedicated hospital birth), you would find evidence of my needs to be able to drink, to feel safe, and to be respected. Perhaps social needs explain the results the various doula studies. Wanting a birth environment that allows these needs to be met certainly explains why some women choose out-of-hospital births.

Emjaybee, in a post at the Unnecessarean, recently asked so what does "good" look like? I think that the ideal birth environment would be one that supports the fulfillment of women's needs. This means one with unrestricted access to food and drink, one that is non-threatening in both appearance and practice, where women who want continuous emotional support can have it and there is no restriction on the presence of family members, and where caregivers are religiously respectful of the woman's autonomy, decisions, space, and person--where thy ask permission instead of stating their intentions and they avoid any unnecessary disruptions or interventions.

For women who are able to have all their needs met at birth, it can be a highly satisfying event, maybe even, I suggest, a self-actualizing experience.