Abby Block, CD(DONA), CBC

Doula & Breastfeeding Support ~ Serving Brooklyn & NYC

natural birth

Evidence On Doulas

Abby BlockComment
DoulaHeader1.png

The following text and photo is excerpted from "Evidence on: Doulas" a recent article August 14, 2017 by Rebecca Dekker, on her incredibly informative website, Evidence Based Birth. You can read the full text of her article here: https://evidencebasedbirth.com/the-evidence-for-doulas/


Why are doulas so effective? 

There are several reasons why we think doulas are so effective. The first reason is the “harsh environment” theory. In most developed countries, ever since birth moved out of the home and into the hospital, laboring people are frequently submitted to institutional routines, high intervention rates, staff who are strangers, lack of privacy, bright lighting, and needles.

Most of us would have a hard time dealing with these conditions when we’re feeling our best. But people in labor have to deal with these harsh conditions when they are in a very vulnerable state. These harsh conditions may slow down a person’s labor and their self-confidence. It is thought that a doula “buffers” this harsh environment by providing continuous support and companionship which promotes the mother’s self-esteem (Hofmeyr, Nikodem et al. 1991).

A second reason that doulas are effective is because doulas are a form of pain relief in themselves (Hofmeyr, 1991). With continuous support, laboring people are less likely to request epidurals or pain medication. It is thought that there is fewer use of medications because birthing people feel less pain when a doula is present. An additional benefit to the avoidance of epidural anesthesia is that women may avoid many medical interventions that often go along with an epidural, including Pitocin augmentation and continuous electronic fetal monitoring (Caton, Corry et al. 2002).

This finding—that people with doulas are less likely to have an epidural—is not due to the fact that clients with doulas in these studies were more likely to want these things up front and were more motivated to achieve them. In fact, randomized trials account for these differences—this is why they are called randomized, controlled trials. The people assigned to have a doula, and those assigned to not have a doula, are randomly assigned, meaning that the same percentage in each group would have a desire for an unmedicated birth.

A third reason why doulas are effective has to do with the attachment between the birthing person and doula which can lead to an increase in oxytocin, the hormone that promotes labor contractions. This theory was proposed by Dr. Amy Gilliland in her 2010a study about effective labor support. In personal correspondence with Dr. Gilliland, she wrote, “I believe the Doula Effect is related to attachment. When the mother feels vulnerable in labor, she directs attachment behaviors to suitable figures around her, who may or may not be her attachment figures (parent, mate). When the mother directs attachment seeking behaviors to the doula, the experienced doula (25 births or more) responds in a unique manner. She is able to respond as a secure base, thereby soothing the mother’s attachment system. The accompanying diminishment in stress hormones allows for a surge in oxytocin in both the mother and the doula… theoretically, oxytocin is the hormone of attachment, and it is released during soothing touch and extended eye contact, which are habitual behaviors of birth doulas.” (Personal communication, Dr. Amy Gilliland, July 2015).

Swedish oxytocin researcher Kristin Uvnas Moberg writes that the doula enhances oxytocin release which decreases stress reactions, fear, and anxiety, and increases contraction strength and effectiveness. In addition, the calming effect of the doula’s presence increases the mother’s own natural pain coping hormones (beta-endorphins), making labor feel less painful (Uvnas Moberg, 2014).

Based on the evidence, I have come up with a conceptual model of how doula support influences outcomes.

A conceptual model  is what researchers use to try and understand how a phenomenon works. Here is my conceptual model on the phenomenon of doula support.

 

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What A Doula Does

Abby BlockComment

I adore this blog post written by my dear doula colleague, Yiska Obadia. You can read an excerpt below, and the full article here.

"Doulas are there to serve their clients. You want to birth naturally? I will support you. You want an epidural? I will support you. You want an epidural and to avoid a c-section? I will do my best to help you achieve that. Doulas serve our clients in helping them to achieve the birth THEY want as well as supporting them wholeheartedly with the birth they get."

From Spinning Babies... The Sacrotuberous Ligament: Key to Unlocking a Long Labor

Abby BlockComment

This article is definitely worth a read if you are pregnant and preparing for labor. And especially if you are interested in anatomy! According to the article, it may be particularly applicable if any of the following are present:

  • A long and difficult labor in which normal remedies (Rebozo Sifting, Position Changes, Spinning Babies Maneuvers) are not fully effective

  • Persistently malpositioned baby

  • Highly athletic mother (especially those who are highly athletic into their pregnancy)

  • History of any trauma in which the ligaments of the pelvis could have been affected (accidents, falls, etc.)

  • A visible Pelvic Upslip: One (usually left) iliac crest superior to the other, one leg (usually left) functionally shorter than the other.

 

http://spinningbabies.blogspot.com/2016/04/the-sacrotuberous-ligament-key-to.html?m=1

Tongue Tie and the Newborn Baby

Abby BlockComment

Since I have been training to become a Certified Breastfeeding Counselor, I've been thinking about and learning a great deal about breastfeeding - more than I had ever imagined. Something that comes up quire frequently with many new mothers is the challenge of breastfeeding. At a certain point, once you begin to hear of so many stories of difficulty breastfeeding, and depending on how much detail you hear in these stories - you may start to hear of tongue ties, lip ties, and the procedures done in attempt to remedy these situations. Why, if breastfeeding is supposed to be so natural and necessary for the survival of our species, are so many humans struggling with it? There are MANU reasons. One of the many possible reasons might be folic acid vs. folate. Read on in this article to learn more...

Tongue Tie and Breastfeeding, By Dr. Wilson

Natural Hospital Birth

Abby BlockComment

As a birth doula serving clients who live primarily in Brooklyn and Manhattan, I work with many women who see both OBs (often low intervention practices) and midwives in the hospital setting. However, many of my clients are looking for a holistic birth experience, or a natural birth experience, within a setting that typically is not set up to accommodate un-medicated births. The odds are generally stacked against women hoping to have intervention-free births in a hospital. BUT, as a doula, I have witnessed many women successfully do this! Here are a few resources on how to work towards, or achieve some version of, a natural hospital birth:

Video

Book

 

Flipping A Breech Baby

Abby BlockComment

It happens! Babies are breeched and babies flip to the head down position. Occasionally they stay in the breech position. Ideally, baby flips! If your baby is in the breech position and you need to get them to flip, these are my recommended resources:

Spinning Babies: Breech Babies - very informational and detailed - recommend reading it all the way through

Prenatal Chiropractic Visits - ask me for a recommendation, based on where you are

Acupuncture - ask me for a recommendation, based on where you are

Good luck!!
 

Ina May Gaskin Documentary

Abby BlockComment

Looking for a birth-related movie to watch? Here's one: a documentary on the famous Ina May Gaskin, author of Ina May's Guide to Childbirth.

Birth Story Ina May Gaskin and The Farm Midwives ( 2013 )

"Ina May Gaskin and The Farm Midwives captures a spirited group of women who taught themselves how to deliver babies on a 1970s hippie commune. Today as nearly one third of all US babies are born via C-section, they fight to protect their knowledge and to promote respectful, safe maternity practices all over the globe. From the backs of their technicolor school buses, these pioneers rescued American midwifery from extinction, changed the way a generation approached pregnancy, and filmed nearly everything they did. With unprecedented access to the midwives' archival video collection, as well as modern day footage of life at the alternative intentional community where they live, this documentary shows childbirth the way most people have never seen it--unadorned, unabashed, and awe-inspiring."

New Birth Plan Template

Abby BlockComment

Many of my birth doula clients - whether they are planning a natural birth in a hospital or birthing center, or birth with medication, or a home birth - want to create a birth plan. One hospital in NYC (NYU) provides a fairly succinct birth plan template, which is great, however I don't know many other hospitals that do provide a template. You can find some templates online, some simple and some that are pages and pages long (which I don't recommend). The image above is of a new one that I came across and thought I'd share - link below. Enjoy!

https://thebestseasonofmylife.wordpress.com/2015/08/20/a-downloadable-visual-birth-plan/

 

Breastfeeding: Do Older Babies Need Night Feeding?

Abby BlockComment

I have the honor of witnessing my clients give birth as they become mothers in an instant, and then visiting them several days after their baby is born. I love being able to answer newborn questions, to process their birth with them, and to answer newborn care and breastfeeding questions. Many of my clients prefer to go as holistic or natural as possible with caring for their baby in the early days, and even beyond. By the time my clients have "older" babies, I'm long gone! I thought this article would be a great help for parents who are attempting to breastfeed in the most "natural" way possible. This article is by Nancy Mohrbacher, breastfeeding expert.

"Has somebody told you that your baby doesn’t need to breastfeed at night past a certain age?  This age often varies by advisor. However, science tells us that in many cases, this simply isn’t true.

Why? Babies and mothers are different and these differences affect baby’s need for night feedings. Some babies really do need to breastfeed at night, at six months, eight months, and beyond.  This is in part because if their mother has a small “breast storage capacity” and tries to sleep train her baby, her milk production will slow, along with her baby’s growth. To find out what this means and if this applies to you, you need to know the basics of how milk production works."

Read the rest of the article here.

The Forgotten Art of Untucking The Tail

Abby BlockComment

Very interesting as it relates to birthing a human...

“Modern birthing science has placed a large burden on secreted hormones (like relaxin) to prepare the body for needed mobility.” Katy Bowman says. Yes, hormonal relaxin is useful in letting the body open up for the birth, but it’s not enough, unless we have strong muscles that can fully contract, but also fully release. But then, strong isolated muscles are not enough either. In order to have smooth births we need to have a whole-body endurance. A great way to develop endurance is to walk as much as you can. “The woman who wants to go about a birthing process naturally can follow the lead other “natural” processes women have been doing for millennia — walking 5–6 total miles per day, and squatting to bathroom multiple times daily” — she adds.

Read the full article here.

 

Eating during labor? YES, it's very important!!

Abby BlockComment

Newsflash, everyone: Eating during labor is safe, and might even be beneficial! (Insert some sarcasm and eye rolling.) Can you imagine running a marathon and not being able to have anything except water and ice chips? For women in labor, who are embarking on one of the most physically (and emotionally) intense experiences, eating and drinking to hunger and thirst is essential. Read more here.

The Rise of the Birth Center

Abby BlockComment

Unfortunately in the NYC/Brooklyn area, birthing center options are very limited. Hopefully, as the demand continues to increase, we will see more birthing center options for women. An excerpt is below from a recent article by CNN on the rise of birthing centers.

"There are nearly 4 million births a year in the United States and 98% still arrive in hospitals, but the increase in birth centers run by midwives has obstetricians, health insurers and hospitals taking notice. The number of babies born annually in birth centers has jumped 56% since 2007 to about 16,000, while total U.S. births have dropped nearly 10% in the same time, according to federal data."

Read the full article here: Not a Hospital, Not a Home Birth: The Rise of the Birth Center.