Doulas, ACOG Has A ‘Fourth Trimester’ Postpartum Toolkit – What You Need To Know About It

Are you a birth doula wondering how to best support your clients after birth?

Are you a postpartum doula looking for evidence-based information to share about your work?

While most doulas are aware of the importance of the postpartum period, the general public, potential clients and even some healthcare providers aren’t always aware of the importance of the ‘fourth trimester’.

Many expectant parents prepare for birth, register for the latest baby gear and design a gorgeous nursery without ever being aware of how important it is to have postpartum care and support.

Why? As a culture, we fail to recognize this important time for a mother and her baby.

ACOG’s Postpartum Toolkit

Fortunately, ACOG President, Haywood L. Brown, MD, worked with colleagues to create the ACOG Postpartum Toolkit to help providers better support their new mothers.

In the toolkit’s introduction, Brown wrote, “The weeks after birth are a critical period for a woman and her infant, setting the stage for long-term health and well-being. There is a need to educate health care providers and patients on the importance of attending postpartum visits and leveraging postpartum care as a doorway to future health. During my presidential term, I convened a task force with the goal of redefining the concept of the postpartum visit by reevaluating the timing and content of postpartum care.”

As a doula, you’re not responsible for the clinical aspects related to postpartum recovery or their postpartum follow-up visit. However, you can play a vital role in helping prepare parents for the reality of the postpartum period and encourage them to attend all follow-up visits.

Shockingly, upwards of 40% of women don’t attend their postpartum visit. Yet nearly 70% of women report at least one physical problem in the 12 months following birth. This doesn’t even account for around 16% of women who are diagnosed with postpartum depression (PPD).

What does this mean for doulas? Your support and education can be vital for women during the ‘fourth trimester’. Helping women understand the importance of follow up visits with their midwife or doctor can help them address any physical complications as soon as possible.

There’s also a lot to be said for a new mother realizing she isn’t alone in her recovery. It’s normal to need weeks or even months to physically recover from pregnancy and birth. Reminding a mother that her postpartum recovery is recognized by ACOG can reassure her that her healing is important.

What Do Doulas Need To Know About The Postpartum Period?

Whether you’re a birth doula or a postpartum doula, understanding the months immediately following birth is vital to helping your clients adjust to life after baby.

ACOG’s toolkit covers several topics, including these which are important for doulas to know:

• Postpartum Complications
• Reproductive Life Planning, Contraception, and Sexual Health
• Support Team for New Mothers
• Newborn Care
• Breastfeeding
• Postpartum Depression
• Intimate Partner Violence
• Long-Term Follow-up from Pregnancy Complications

As a birth doula, the topics above can be used during prenatal education and postpartum support. While doulas aren’t clinical providers, we can help point clients to evidenced-based information and help them be aware of topics to discuss with their midwife or doctor.

Being aware of postpartum complications can help doulas educate their clients about typical healing. When a new mother is aware of what is typical as well as what might be concerning, she might be able to reach out to her provider as soon as she sees red flags, rather than waiting until something becomes extremely concerning.

As a postpartum doula, it’s helpful to be aware of evidenced-based newborn care, breastfeeding, perinatal mood disorders and more. Before services start, you can help parents understand what to expect during the postpartum period and help support them.

If more families are aware of the potential physical complications in the postpartum period and the risk of PPD, they may be more likely to have a postpartum plan in place, including hiring a professional postpartum doula for support.

By having a postpartum plan in place, new families can get more adequate rest and time to heal. Should complications arise, they already have support in place to work through the challenges.

What Does ACOG Say About Breastfeeding And Newborn Care?

As doulas, preparing and supporting parents for breastfeeding and newborn care is an important part of our career. While ACOG presents a lot of evidenced-based information regarding these topics, this toolkit provides more information about each of these topics in easy to understand printouts.

While these are geared towards OB/GYN providers, the information can be helpful as a doula.

Their breastfeeding printout says:

• “Mounting evidence supports the substantial benefits of breastfeeding for women and their infants. Breastfeeding rates in the United States continue to increase as 81% of infants born after 2013 started to breastfeed and more than one half were breastfed at 6 months.”
• “Adequate evidence indicates that interventions to support breastfeeding increase the duration and rates of breastfeeding, including exclusive breastfeeding.” – doulas can provide breastfeeding support, our role is important!
• “…women should be provided with contact information for community-based lactation support for follow-up and telephone support information, if available.” – doulas should be able to provide community-based support and maintain a resource list for their clients

You can read the printout in its entirety by clicking here.

Their Newborn Care printout can be accessed by clicking here and provides a number of resources geared towards parents.

Why Is The ACOG Postpartum Toolkit Important?

Recognizing the importance of the postpartum period is vital in reducing postpartum complications, perinatal mood disorders and helping parents adjust to life with a new addition.

The US has some of the least postpartum support resources and professional follow up among developed countries. Our women return to work sooner after a period of less support, and it’s no wonder so many women are struggling.

This toolkit is designed to help ob/gyn providers better educate and support their patients. It also serves as a reminder to new mothers that their recovery and health matters.

As doulas, this information can help you educate and support your clients. It also serves as evidence of the importance of doula care in supporting new families.

How Can I Learn More About Supporting My Clients?

Are you looking to learn more about supporting your clients?

Be sure to check out the doula and breastfeeding counselor courses available through the International Doula Institute.

Should I Hire A Birth Doula? Evidence, ACOG, And Celebrities Say, ‘Yes!’

Are you an expectant parent wondering if you should hire a doula?

While few details of Duchess Meghan’s pregnancy and birth plans have been confirmed, recent reports say she’s working with a doula.

When word broke that she may use a doula for the upcoming royal birth, many began to wonder what a doula is and if they should use one too.

Aliza Bancoff, founder and director of the International Doula Institute, says a doula is a, “professional support person trained in the needs of the family during pregnancy and childbirth.

“The doula offers non-judgmental support, guidance, evidence-based education and practical hands-on support during childbirth including comfort measures. Doula originates from the Greek word meaning woman servant.”

Why Would The Royal Family Use A Doula?

While hiring a professional doula may be a newer concept, the use of continuous labor support isn’t new. In past generations, many gave birth surrounded by women with the knowledge and skills to support them through birth.

When birth took place in villages, in the home and surrounded by grandparents, aunts, etc., many possessed the skills to provide continuous, caring support to laboring women.

Today, many of us have little to no experience with birth before going into labor for the first time. Some couples may have a few hours of childbirth preparation classes, but not truly understand how to best cope and make decisions during labor.

Our midwives, doctors and nurses provide excellent medical support. Our partners know us well and play a major role in our support. However, a doula can provide professional, continuous labor support to both the person in labor and their partner.

While Duchess Meghan hasn’t said why she may use a doula, we can assume she is looking for continuous labor support that evidence shows:

• Reduces the likelihood of medical intervention
• Lowers the risk of c-section birth
• Increases the likelihood of a reported positive birth experience (how a person feels about the birth experience, not based on specific birth outcome)
• Supports breastfeeding initiation.

By working with a doula, Duchess Meghan can rest assured she has someone present with the sole purpose of providing her with ongoing emotional, physical and practical support. Midwives, doctors and nurses provide exceptional support, but their primary role is to ensure a medically safe birth for both mother and baby. This leaves less time for continuous support as they manage their clinical role.

Is Continuous Labor Support Evidenced Based?

It’s very possible for a woman to have a wonderfully positive birth without a doula. A woman can also have a challenging birth with a doula. While birth is a natural, physiological process that often unfolds well, it is unpredictable, especially in an era with vast medical interventions available.

While a doula can never guarantee outcomes, evidence shows many benefits to continuous labor support.

The World Health Organization (WHO) recognizes the importance of maternal child research and recently shared about a Cochrane Review comprised of 26 randomized controls including more than 15,800 women.

The WHO reported, “The authors found that women who received continuous labour support were more likely to give birth vaginally, and had fewer caesarean, forceps or assisted vacuum births. In addition, women were less likely to use pain medications, were more likely to be satisfied with their birth experience and had shorter labours. It was also found that newborn babies were less likely to have low ‘Apgar’ scores – a test for the vital signs of health and well-being in infants. No harms of continuous support were identified.”

While more research is needed, given the lack of risk associated with continuous support, and the many potential benefits, it makes complete sense Duchess Meghan would consider using a birth doula.

What Does The American College of Obstetricians and Gynecologists (ACOG) Say About Doulas?

ACOG compiles research, looks at the evidence and makes recommendations for the OB/GYN providers in the US. These recommendations are meant to reduce adverse birth outcomes for mothers and babies and increase positive long-term health outcomes.

Reducing unnecessary medical interventions (not to be confused with medically necessary interventions) which improves outcomes is an important topic for ACOG.

ACOG released Approaches to Limit Intervention During Labor and Birth, a committee opinion. They wrote, “Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor.”

With high c-section rates, reducing the primary c-section rate is a public health concern. While c-sections are medically indicated at times, our current c-section rate in the US is nearly 50% higher than the WHO recommends.

For this reason, new research and official recommendations are released to help reduce c-sections. While there are several guidelines and evidence, ACOG included continuous labor support as one method to reducing c-sections.

ACOG’s Safe Prevention of the Primary Cesarean Delivery says, “Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula. A Cochrane meta-analysis of 12 trials and more than 15,000 women demonstrated that the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery. Given that there are no associated measurable harms, this resource is probably underutilized.”

Both the WHO and ACOG recognize that continuous labor support, like that of a professional doula, is an evidenced based method for reducing the likelihood of birth interventions and increasing the likelihood of positive outcomes.

Celebrities And Birth Doulas – Do Celebrities Use Doulas?

Want to give birth like the Royal family? Choosing a midwifery attended birth and perhaps a birth doula is one way to birth like a member of the Royal family.

While living like a Royal or a celebrity is appealing to some, for many there’s no appeal to emulate a celebrity life.

However, what’s interesting about celebrities using doulas is they have access to top services and yet one service many choose is available to everyone. With all the resources at their fingertips, they choose to use a birth doula, and you can too.

They have the time, money and resources to choose anything for their births and many choose to utilize professional labor support to improve their birth experience and health outcomes.

Some celebrities who have used birth doulas include:

• Kelly Ripa
• Mayim Bialik
• Erykah Badu
• Kristen Bell
• Jessa Duggar
• Nicole Kidman
• Tamera Mowry-Housely
• Alyson Hannigan

As you can see, this celebrity list is quite diverse. They’re all famous for different reasons and are known for different lifestyles. A birth doula isn’t for one type of person, or even one type of birth. These celebrities could have made any birth preparation and still chose to include a birth doula.

Every person, pregnancy and birth are unique. While one can’t say you must have a doula, evidence, major health organizations, a duchess and many celebrities say using a birth doula makes a lot of sense.

Why Hospitals Need Breastfeeding Counselors – ACOG Breastfeeding Guidelines

Wondering how you can help your patients with breastfeeding?

Are you looking for professional training to support your new mothers?

Many new mothers hope to breastfeed their babies. In the US, over 80% of mothers initiate breastfeeding at birth. By 3 months, just under half of babies are exclusively breastfeeding.

While most mothers begin breastfeeding, a good portion struggle to meet the recommendation of exclusive breastfeeding for 6 months.

While breastfeeding is a personal journey for each mother-baby pair, overall breastfeeding rates are a public health priority.

On a population level, breastfeeding is associated with a reduced risk of postpartum hemorrhage, female cancers, diabetes and more. For infants, breastfeeding reduces the risk of illness, sudden infant death syndrome, asthma and more.

A mother-baby pair’s ability to meet breastfeeding goals is strongly tied to breastfeeding management in the early days and weeks.  For healthcare professionals, evidenced-based breastfeeding education is vital.

What Is A Breastfeeding Counselor?

If you’re a maternity or pediatric healthcare provider, chances are you’re familiar with International Board Certified (IBCLC) lactation consultants. These professionals have extensive academic breastfeeding education and clinical experience.

An IBCLC lactation consultant plays a vital role in supporting mother-baby pairs facing challenges like tongue ties, difficulty transferring milk, slow gaining, flat nipples, and more. They play a vital role in helping establish breastfeeding and aid in mothers meeting breastfeeding goals.

However, another important professional in lactation support is a Breastfeeding Counselor. Breastfeeding Counselors are individuals educated in normal breastfeeding support. They provide education and support to new mothers, helping them to reach their breastfeeding goals.

For maternity nurses, OB/GYNs, midwives, NICU nurses, and pediatricians, becoming a Certified Breastfeeding Counselor (CBC) is one way to help your patients reach their breastfeeding goals. By helping your patients, you’re also aiding in improving breastfeeding rates in your community and your hospital.

The American College of Obstetricians and Gynecologists’ (ACOG) current recommendations support additional breastfeeding training for OB/GYN professionals.

What Are ACOG’s Current Breastfeeding Guidelines?

ACOG recognizes that a woman’s maternity care provider has a unique opportunity to influence her prenatal breastfeeding views and early breastfeeding initiation. They also understand the impact breastfeeding has on reproductive health, including its ability to reduce female cancers.

Their recent recommendations include providing education, support and policy changes which support breastfeeding.

Education guidelines include:

• Recognizing that clinical lactation management is a core piece in reproductive health care.
• “Because lactation is an integral part of reproductive physiology, all obstetrician-gynecologists and other obstetric care providers should develop and maintain skills in anticipatory guidance, support for normal breastfeeding physiology, and management of common complications of lactation,” written in the ACOG committee report.

Recommended support for breastfeeding women:

• Providing and encouraging women to breastfed and recognizing each woman’s right to do so.
• Supporting and encouraging women in breastfeeding in accordance with current recommendations to exclusively breastfed for 6 months, then alongside solids for a minimum of one year, then as long after as mutually desired by mother and baby.
• Advice and encouragement from OB/GYN professionals should support informed infant feeding decision making free of coercion or pressure.
• OB/GYN professionals should support each woman’s informed infant feeding decisions.
• Be aware that women facing breastfeeding challenges are at an increased risk of postpartum mood disorders, proper awareness and screening is important.
• Healthcare professionals should support mothers of preterm or otherwise medically fragile infants to establish a full milk supply through proper guidance, milk expression within 1 hour of birth when possible and frequently thereafter.

Policies also have a big role in breastfeeding outcomes:

• The World Health Organization’s “Ten Steps to Successful Breastfeeding” should be integrated into maternity care.  This can increase the likelihood of women initiating and sustaining breastfeeding, as well as achieving personal breastfeeding goals.
• OB/GYNs should support policies in their practices, hospitals, and communities which support women in initiating and sustaining breastfeeding.

How can maternity professionals implement the above breastfeeding support recommendations? One way is to become a Certified Breastfeeding Counselor.

Why Do Hospitals Need Breastfeeding Counselors?

As mentioned above, many maternity and pediatric healthcare providers are familiar with IBCLC lactation consultants. Many hospitals have seen their breastfeeding rates improve since having staff IBCLCs has become the norm.

While breastfeeding rates have increased, we can still improve our rates, especially breastfeeding duration.

What if a new mother was given a bit of evidence-based breastfeeding information at each prenatal appointment via her OB/GYN’s nurse who is also a CBC? What if a new mother’s midwife had additional lactation skills to help prepare for breastfeeding initiation?

What might breastfeeding rates look like if several L&D nurses were trained in up-to-date, evidenced-based breastfeeding initiation recommendations? Beyond suggesting breastfeeding within the first hour, additional education can help nurses keep an eye for an appropriate latch, support through edema impacting latch, help reassure moms about normal initial breastfeeding challenges and more.

Most hospitals can’t have an IBCLC in each delivery room. However, having a nurse who is also a CBC available in the immediate postnatal period could be a reachable goal for many hospitals.

Having a NICU nurse familiar with lactation can be a vital part of supporting the most vulnerable mother-baby pairs. Combining the knowledge of premature infants with lactation education offers a unique advantage in planning care both in the short term and well after discharge.

An OB/GYN with breastfeeding education has the ability to make decisions and support women just before and after birth with the knowledge of how each choice can impact breastfeeding. In the postpartum period, they’re able to provide continued support and education at follow up visits.

How Does Becoming A Certified Breastfeeding Counselor Support My Career?

As a healthcare professional, continuing education is an important part of your career. With breastfeeding rates, baby-friendly hospital initiatives, and overall support for birthing women being current priorities, a certification which supports those can be an excellent career move.

Some healthcare employers also increase pay with relevant certifications added to your career education. Any additional skills you possess increases your marketability as a valued employee.

The IDI program is designed as a stand-alone credential, or to meet the requirement for the IBCLC Lactation Specific Training. Whether you’re looking to advance your education for your current position or considering a career move, this program is a great first step.

The CBC program meets the requirements for the first 40 hours and the other 50 hours are offered in our CBC Advanced Programs.

Career benefits aside, becoming a CBC equips you to support your new mothers and babies in a way that can positively impact them for years to come.

Be a part of the change focused on increasing breastfeeding rates to best support mothers and babies. You can begin your journey today by clicking here.

Photo Credit: Wikipedia

As Meghan Markle, the Duchess of Sussex, prepares to welcome her new baby with Prince Harry this spring, she is sure to be busy making lots of decisions on nursery colors, pram options and adorable new outfits for the impending royal. One decision British papers are reporting she made is to hire a doula, which is a departure from tradition for the Royal Family.

A doula is different from a midwife or doctor in that doulas are not medical professionals. Rather, a doula offers continuous, non-judgmental support and comfort measures before, during and after birth to the parent(s). The support a doula offers can be emotional, physical and/or educational in nature. Some of the comfort measures a doula can offer includes touch techniques, breathing techniques and comfort positions to help ease the pain of labor. Doulas are there to assist the mom in labor, however, they by no means take the place of the other parent. The doula can help the partner offer the best support possible and they can also take turns offering support so no one gets too tired during the process.

Numerous studies, such as the Cochrane Review, have supported the use of a doula during childbirth to help the mother have a more positive experience during childbirth. Studies have shown that the use of a doula can decrease the use of Pitocin, the incidence of Cesarean Section and increase in the incidence of the birthing mother feeling like she had a more positive overall birth experience. 

There is no word yet on whether the Duchess of Sussex will acquire a postpartum doula, which could offer educational support about breastfeeding and caring for the baby. They can also offer physical support in the form of cooking meals, cleaning and/or taking care of older siblings while the new parents bond with the baby. They also offer much needed emotional support as the mom settles into a new routine.

Whichever choices Meghan Markle makes in her journey to motherhood, we will have to wait patiently to find out. Meghan is due in April.