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Doulas and Midwives: Their Roles During Birth

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Many women elect to become a doula because they want to help other women during a vulnerable time in their lives. As part of an online doula training program, doulas in training will learn all about the birthing process, but they will also learn about the role of midwives and how they work together. It is critical for doulas to know and understand the role they play in birth, the role midwives play, and how they can work together to help both mom and baby have a safe experience.

Role of a Doula

Although doulas are trained and certified, it is not the same training and certification as a midwife. Doulas are not required to have a medical background. This is because the primary role of a doula during labor and delivery is to provide the mother with physical and emotional support. Prior to labor, a doula can help a woman develop a birth plan outlining her wishes for the birthing experience.

Throughout the childbirth process, doulas are trained to use techniques and tools to help mothers effectively manage stress and pain. These methods may include massages, deep breathing, and visualization. Doulas also know different birthing positions so they can make suggestions throughout labor to facilitate the birthing process. A doula’s primary concern is to help both the mother and their partner remain calm and feel supported throughout labor.

Role of a Midwife

A midwife is a trained healthcare professional who provides medical care to the mother and baby from preconception through the postpartum phase. Midwives are able to run prenatal tests and perform gynecological exams. They can also prescribe medications and supplements before conception and during pregnancy. Another important part of a midwife’s job is to educate patients by providing advice for staying healthy during pregnancy. They are responsible for monitoring both the mom and the baby throughout labor, along with assisting with the birth.

How They Work Together

The decision to have both a midwife and a doula can help make the birthing process easier for everyone involved. Although each play different roles, they are both incredibly important. Midwives are responsible for monitoring the health and safety of both mom and baby, and a doula is responsible for offering support throughout the process. The two work well together and complement each other.

Examples of how the two can work effectively together include when the midwife cannot provide attention to the emotional or physical comfort needs of the mom. This is generally because her attention is needed to be focused on the mother or baby’s safety. During these times, the doula is able to continue focusing on the emotional and physical comfort needs of the mother. When a woman feels emotionally supported and knows how to deal with the pain, the birthing process goes smoother.

During some stages of labor, such as pushing, mothers can feel out of control. When possible, helping a woman feel relaxed and in control of her pain will result in more effective pushing and faster childbirth. Doulas are able to offer suggestions about different positions that can help facilitate birth, making the process go more smoothly.

When you have a midwife and a doula on your birthing team, the mother will feel safe and supported, making the birthing experience a positive one. International Doula Institute offers an online doula training program that can be completed from anywhere in the world. Start helping other women through their birthing experience by becoming a certified doula.

What You Need to Know About a Water Birth

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Beautiful young woman during labour, having painful cramps, giving birth in water.

Water birth is the practice of spending part of labor and/or delivery in a pool filled with warm water. Many laboring moms enjoy a water birth because the warm water helps their body relax, making it easier to handle contractions. Water birth is a practice widely practiced by midwives and is an important part of the curriculum in any doula course. If you are new to the idea of water birth, you might be wondering what it entails and how safe it is for mom and baby.

What is a Water Birth?

A water birth is when an expectant mother experiences labor in a warm bath of water, ultimately delivering the baby in the water. The tub can be a permanent fixture in a birthing center, or in the event of home birth, even specially erected to fit the mother’s needs. The water will be warm with coarse rock salt added.

Benefits of a Water Birth

There are a few benefits that come along with having a water birth, including the following:

  • Warm water can help ease some of the discomforts of labor and serve as pain management for the mother.
  • Water provides the mother with the ability to experience weightlessness while in the water, allowing her to get into comfortable labor positions.
  • It creates a calm environment for the baby to be born.

Can My Baby Drown During a Water Birth?

A common concern that many expectant mothers have regarding a water birth is whether there is a risk of their new baby dying. When delivered correctly, the baby will go from one fluid environment in-utero to another. When this happens, the baby is still attached to the umbilical cord, which means that they are still receiving oxygen from the mother. Newborns also have something that is known as “dive reflex,” what this means is that any water that the baby encounters will be swallowed and not inhaled. A baby will only take its first breath once it is taken out of the water or is exposed to a temperature change.

How Long Do You Stay in the Water?

Another common question or concern that many expectant mothers have is how long they are going to stay in the water. Many want to know if they can spend the entire duration of their labor in the water, or if they are restricted to a limited time period or stage of labor. For mothers that are experiencing pain, and determine that they need some form of pain management, such as an epidural, can leave the birthing bath. If at any point you feel unhappy or uncomfortable, you can get out of the bath and try to find comfort and happiness in another position. If there are any complications with either the delivery or with the baby, the mother may have to get out of the water.

Can I Have a Water Birth in my Tub at Home?

When considering a water birth at home, there are a few things to consider. A trained medical professional with experience with water birthing should attend. It is important that both the mother and the baby be closely monitored throughout the process. If at any time there are signs of problems or complications, the birth may need to be managed differently. That is why it is important that you have a doula on your birthing team who knows your wishes and will help you advocate for them. Yet, it is equally important to listen to the medical professionals who are advising you on your birthing options, and what is best for both you and your baby.

Many women elect to have a home birth because it is an intimate and personalized experience. When monitored by a midwife and supported by a woman who has completed a certified doula course, mother and baby are in good hands. If you are considering having a water birth for your labor and delivery, talk to your doula about what you need to know to determine if a water birth is right for you.

FDA Approve New PPD Drug – What Doulas And Birth Professionals Need To Know

FDA Approve New PPD Drug – What Doulas And Birth Professionals Need To Know

The first drug designed to treat postpartum depression (PPD) recently received FDA approval.  This debilitating form of depression impacts around 16% of new mothers, making it one of the most common pregnancy complications.

Kellie Wicklund, MA, NCP, LPC, a licensed psychotherapist and clinical director of the Maternal Wellness Center said, “The FDA’s approval of Zulessro (brexanolone), a new drug to treat postpartum depression (PPD) is exciting in that it legitimizes PPD as a disease in the medical model.”

One of the biggest struggles for women and families impacted by PPD is finding adequate treatment in a world that’s just beginning to recognize our mental health crisis.

We’ve made great strides in recent years with PPD screenings, education and awareness. However, the FDA approval of this drug says that we recognize it as a true and legitimate medical condition – an extremely important step in tackling this crisis.

However, will this drug be the solution many women are hoping for?

What Is Zulessro?

While many depression, anxiety, and general mood disorder medications exist, Zulessro is the first drug FDA approved specifically to treat PPD.

PPD is a unique form of depression in that it occurs within a year of giving birth and we aren’t certain why it occurs. We have theories, we know of some risk factors, but we aren’t certain exactly why it happens and the exact best course of treatment.

To date, the only pharmaceutical treatment options are medications approved to treat other forms of depression. While this works for some women, there are women with severe PPD that doesn’t respond to treatment.

Zulresso is an intravenous (IV) administered medication that can only be given in an inpatient setting.

The FDA said, “Zulresso will be available only through a restricted program called the Zulresso REMS Program that requires the drug to be administered by a health care provider in a certified health care facility. The REMS requires that patients be enrolled in the program prior to administration of the drug.”

Women could lose consciousness during administration and experience other side effects. Due to the risks, women must be monitored for their health and while they’re interacting with their child(ren) to ensure the safety of everyone.

8 Things Doulas Need to Know About Postpartum Mood Disorders

Who Is Eligible To Take Zulresso?

While around 16% of new mothers face PPD, severe PPD leading to self-harm or harm of others is rarer. For those with severe PPD resistant to previously available medication, and not fully helped by therapy and lifestyle support, Zulresso may offer much-needed relief.

Tiffany Farchione, M.D., acting director of the Division of Psychiatry Products in the FDA’s Center for Drug Evaluation and Research said, “Postpartum depression is a serious condition that, when severe, can be life-threatening. Women may experience thoughts about harming themselves or harming their child. Postpartum depression can also interfere with the maternal-infant bond. This approval marks the first time a drug has been specifically approved to treat postpartum depression, providing an important new treatment option.”

Wicklund, who regularly provides psychotherapy for women experiencing PPD, said, “It will be used on a very limited basis, and reserved for the most severe cases of PPD that have to that point been resistant to other forms of treatment.  It will save lives, and it is only the beginning of research and new medications that will become available to a broader population of those suffering from postpartum mood and anxiety disorders”.

For new mothers experiencing PPD, it’s likely their healthcare providers will recommend first-line treatments with few risks such as therapy, extra support and possibly lifestyle changes (e.g. finding ways to reduce stress). If they’ve tried those methods or their symptoms are severe, their healthcare provider may recommend previously available medications.

For those with severe symptoms, especially with concerns related to self-harm or harming others, with little to no relief from other medications, it’s possible they’ll be eligible to try Zulresso.

Is Zulresso The PPD Miracle We’ve All Been Waiting For?

If you’ve ever suffered from PPD, or you’re a birth professional supporting families through it, the thought of a 2.5-day treatment sounds miraculous. For those truly suffering from severe and persistent PPD, it very well may be a miracle.

However, overall, this may not be the solution for PPD. While we aren’t certain why we have such high rates of PPD in the US, we do know that rates vary in different countries, demographics, and communities.

We know that some things reduce the risk of developing PPD. We aren’t certain of the exact reasons, but we know women who have more support, more sleep, continuity of care, etc. may be less likely to develop PPD. And if they do have PPD, those things can be an aid in healing.

Many professionals value pharmaceuticals in treating mood disorders but recognize they aren’t fully effective when used alone.

Wicklund said, “While we already have a good arsenal of medications that work well for perinatal mood and anxiety disorders (PMADs), they demonstrate the best results when used in combination with specialized supportive counseling and psychotherapy.  

“The healing power of psychotherapy is in the person to person connection in the moment. We are social beings, and it is in relationships that we heal. When we are witnessed and understood with deep compassion and accurate clinical information, change inevitably begins to happen.

“It is powerful and altering to hear the supportive and informed words of a knowledgeable therapist letting a woman know that they understand what’s happening to her, and how to get her better asap.”

What Do Doulas And Birth Professionals Need To Know About Zulresso?

As a doula, you play a valuable role in supporting women and families during very vulnerable times. While doulas do not give medical advice or perform clinical or diagnostic tasks, knowing available treatment options can help you in supporting your client through decision making.

As a doula, in the prenatal period, you can support families by helping them be aware of risk factors, red flag symptoms, and normalizing seeking help and treatment.

Continuous support throughout labor, adequate support transitioning to life with baby, rest, support reaching personal breastfeeding goals, support when things don’t go as planned, etc., may reduce the risk of a mother developing severe PPD. If she does develop PPD, which can happen regardless of circumstances, those things can be valuable support during healing.

It’s important to be aware of resources in your community as well. Knowing which therapists and doctors treat PPD with evidenced-based and compassionate approaches is an important way to support your clients.

Do Women Using Medications For PPD Still Need Therapy?

Every case of PPD is unique. Every woman and family are unique. We can’t say across the board what is best for all, but we do know that therapy does work for many. Therapy plays a vital role in healing from PPD, with or without pharmaceutical use.

Some women successfully manage and heal from PPD with extra support and therapy. Other women find medication, in addition to her therapy, important. For women using Zulresso, their PPD is likely severe making the support of therapy important in overcoming the entire experience.

Wicklund said, “Therapy works because it validates and normalizes an experience that many women believe they should feel ashamed of. Therapy corrects the distorted thoughts and beliefs, it offers practical solutions, it holds sacred space for difficult feelings, and most importantly, it offers HOPE to a woman who is suffering – that she will indeed feel better again!

“Lastly, a good therapist will also acknowledge the broader context of modern mothering as well; that we do not have adequate policies or social supports in place to support women and families during their transition to parenthood, and we see very high rates of PMADs because of this gap in resources. We can do better than this for more moms and families, and policy-level change is sorely needed.”

While doulas can’t treat PPD, we can be a part of solving the gap in support and resources.

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

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.

 

Things Every First-Time Mom Needs to Know: Part 2

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Congratulations! You are going to be a mom for the first time and we bet you are beyond excited and maybe also a tad nervous. Don’t worry, your birth doula learned all about helping women make the transition to motherhood when they were becoming a doula. Here are a few more things that first-time moms need to know when they welcome their new bundle of joy into their family.

Don’t Stop Doing the Things You Love

Just because you have a new baby, doesn’t mean that you have to completely give up everything that you did before you had your baby. Although it might be a little more challenging to find the time or the money to pursue your passions, it is still possible. Remember you are more than a mother, you are still a person with needs. Continuing to do your favorite things allows you to take care of yourself and be a better mom for your new child.

Sleep Deprivation is Rough

Chances are the last time you pulled an all-nighter was either in college. With a newborn baby at home, be prepared to pull a few all-nighters. Sleep deprivation is real. Also, as a result of repeated sleepless nights, you may experience an increase in irritation and sadness. If you have a partner to share this responsibility with, determine a sleep schedule. If you’re exclusively breastfeeding, your partner can participate in other ways, like bringing you the baby or changing diapers throughout the night. Also, always follow the rule of thumb: nap when the baby’s napping.

Postpartum Depression Doesn’t Always Feel Like Depression

As a new mom, you will experience a wide range of emotions. It is not uncommon for new moms to feel overwhelmed, sad, angry, or panicked when first left alone with their new baby. Don’t be too hard on yourself when everything isn’t sunshine and butterflies during the first few months. If at any point you feel like your emotions are getting in the way of your daily life, it might be time for you to talk to your doctor or midwife.

Don’t Be Hard on Yourself

As a mom, it is easy to beat yourself up. There’s no manual for bringing a baby home and while you might feel lost at first, you’ll figure it out as you go. Learn to forgive yourself and only fret over the things that matter most. Many first-time moms feel like they are doing everything wrong when they first bring their baby home. If you feel this way, reach out to friends and family members who have been through it before, learn from their experiences. Never forget that you are not alone.

Surround yourself with those who have been through it before and can provide you with valuable advice and support. Although it won’t always be easy, it is totally worth it in the end. Another valuable resource is a postpartum doula, as they are passionate about mothers and babies, and have further developed their passion by becoming a doula. Take a deep breath and remember, you got this.

Things Every First-Time Mom Needs to Know: Part 1

become a doula

As a first-time mom, you are going to have a lot of questions, concerns, and fears. Which is perfectly normal, because you are starting a new adventure. Most moms spend a lot of time doing research, reading articles and books, and talking to other moms to prepare themselves. If a doula is part of your birthing team, you can also rely on the knowledge they’ve gained when training to become a doula to help you prepare for motherhood. Here are a few things that every first-time mom needs to know when preparing to bring their new little one into the world.

Don’t Be Bothered by the Small Things

It is extremely easy to quickly become overwhelmed and stressed out by small things. Additionally, don’t beat yourself up over the small things and it’s okay to make a mistake or two along the way. Your baby isn’t going to remember that you were too tired to go for a walk to the park. In today’s world, we put a lot of pressure on parents, and especially moms. Your baby doesn’t have to listen to Mozart every day to be smart and if you have dirty onesies piling up in the corner it’s not the end of the world. Focus on what’s important, like making sure your baby is fed, safe, and loved.

Hold Your Baby as Much as You Want

Some people will say that if you hold your baby too much it can actually be harmful because they believe it can negatively impact your child’s independence and create attachment issues. But most moms and dads will tell you that you can’t hold your baby enough. When babies are first born, it is crucial that you hold your baby often to develop a bond. This bond will promote a feeling of security in your baby and help with breastfeeding and overall development. Don’t be afraid to hold your baby as often and as long as you like.

Always Trust Your Instincts

You have probably heard countless stories where mothers have felt something was wrong, and they were right. More often than not, your maternal instincts are spot on. Don’t ever hesitate to listen to your instincts and take action when necessary.

Don’t Forget to Take Care of Yourself

You can’t take care of your new baby if you don’t first take care of yourself. It’s okay to take a little time for yourself, for your sanity’s sake. If you need a break, ask a family member or friend to watch your baby for a couple of hours. Treat yourself to a spa day or a little bit of retail therapy to clear your head and focus on yourself. If it is not possible to get a break from your baby, use their nap time to focus on yourself, indulge in a movie or bubble bath. You have a child now, but that doesn’t mean your world has to consistently revolve around them. You still have the same needs you had before they came along. And being your best self will make you a better mom.

Having a baby can be a huge adjustment to your lifestyle, but with a little forethought, you can make the transition as smooth as possible. With the help of a woman who has become a doula with the intention of making your life easier, you are going to be prepared to take on motherhood.