Abby Block, CD(DONA), CBC

Doula & Breastfeeding Support ~ Serving Brooklyn & NYC

natural birth brooklyn

ProPublica: A Larger Role for Midwives

Abby BlockComment

So happy to see this study and the article!!! It's long overdue. Read on below for an excerpt, and click on the link to read the full text, explaining the benefits of a midwife, the research, and the politics.

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A Larger Role for Midwives Could Improve Deficient U.S. Care for Mothers and Babies

by Nina Martin, Feb. 22, 2018

According to a new study, states that give midwives a greater role in patient care achieve better results on key measures of maternal and neonatal health.

Now a groundbreaking study, the first systematic look at what midwives can and can’t do in the states where they practice, offers new evidence that empowering them could significantly boost maternal and infant health. The five-year effort by researchers in Canada and the U.S., published Wednesday, found that states that have done the most to integrate midwives into their health care systems, including Washington, New Mexico and Oregon, have some of the best outcomes for mothers and babies. Conversely, states with some of the most restrictive midwife laws and practices — including Alabama, Ohio and Mississippi — tend to do significantly worse on key indicators of maternal and neonatal well-being.

“We have been able to establish that midwifery care is strongly associated with lower interventions, cost-effectiveness and improved outcomes,” said lead researcher Saraswathi Vedam, an associate professor of midwifery who heads the Birth Place Lab at the University of British Columbia.

Read the full article here: https://www.propublica.org/article/midwives-study-maternal-neonatal-care

Vaginal Exams: Pregnancy & Labor

Abby BlockComment

Are vaginal exams (also called pelvic exams, or cervical checks) necessary during pregnancy and labor? They can certainly be helpful at specific times, such as for being admitted to the hospital or birthing center when you're in labor, if you've gone past your due date, if an induction is needed, if there is a concern about labor progress, or perhaps a question of the baby's position during labor. What about checks during pregnancy, or during labor - when everything seems to be progressing normally, and the mother is fine and the baby is fine? This is your choice to make, based on the pros and cons, your care provider's recommendation, and your feelings, opinions, and intuition. More information on vaginal exams is below, from a few different sources. Read, be informed, and decide for yourself - based on you, not anyone else.

Evidence on Cervical Checks at the End of Pregnancy

Pelvic Exams Near Term: Benefit or Risk?

Vaginal Examinations: A Symptom of a Cervical-centric Birth Culture

Ina May Gaskin, by Timeline

Abby BlockComment
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This past fall I had the incredible opportunity to study at The Farm, the community where Ina May Gaskin and the Farm Midwives made their home, birthed they children, and their names as pioneers in the modern day American natural birth movement, delivering thousands of babies. All around the world, for centuries, women had been giving birth at home and naturally. By the time many of these midwives had come to have children, the maternal care system had become overly medicalized and severely limiting women's choices. Ina May Gaskin and the Farm Midwives gave women another safe option, and I am so grateful for their bravery, courage, and hard work in paving the way for women to have options in childbirth today. Check out the video below to learn more.

https://www.youtube.com/watch?v=y_qqxilWcb0

Evidence On Doulas

Abby BlockComment
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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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Beautiful Birth Photos

Abby BlockComment

These photos are beautiful! Whether it's a home birth, hospital birth, natural birth, cesarean birth, midwife birth, water birth, OB birth, breastfeeding or formula feeding, or it's a first or second or third child... there's no one right way to do it. Take a look here.