This slideshow provides a comprehensive look at what a doula is and why they are needed. It is the first unit in the certification course from New Beginnings Doula Training.
- 1. Introduction to Labor Support Presented byNew Beginnings
Doula Training Rachel Leavitt RN, BSN, CD For more information on
doula certification visit www.trainingdoulas.com
2. Goals
3. Describe the different roles various professionals play 4.
Become familiar with the Cochrone Library 5. Describe the benefits
of having a doula 6. Introduction into labor support for nurses 7.
Understand the role doula's play in medicated/c-section births 8.
Understand how doula's can become agents of change 9. Explore your
feelings about being a doula 10. Reading Assignments
- The Nurturing Touch at Birth chapters 1 & 2.
11. The Birth Partner chapter 3 12. All included material given
in introductory e-mail 13. What is a doula?
- People have given this various definitions.
- A doula guides and supports women and their partners
continuously through labor and birth...[she] is on call for you,
arrives at your home or the hospital when you need her, and remains
with you continuously, with few or no breaks, until after the baby
is born.The doula is trained and experienced in providing emotional
support, physical comfort, and nonclinical advice-Penny Simpkin,
The Birth Partner
14. What is a doula?
- Doulas...are trained labor assistants who nurture and assist
the laboring and postpartum couple...Without adding her own agenda,
the skilled doula assists parents in making informed
decisions...the provide one-on-one, continuous labor support
(without shift-changes) throughout labor and early postpartum.-Pam
England, Birthing from Within
15. What is a doula?
- doulas are sympathetic and knowledgeable labor companions who
typically provide some form of prenatal preparation and stay at
your side once labor begins until your baby is born.The doula's job
is to make you as comfortable as possible and to reassure your
partner as well-Ina May Gaskin, Ina Mays Guide to Childbirth
16. What is a doula cont.
provides nonmedical physical and emotional support to a woman
during labor and sometimes well beyond.She offers information about
pregnancy, birth and hospital/birthing center routines, provides
continuous support and comfort during labor, and acts as something
of an interpreter between mother and medical staff when needed.Her
job, in sum, is to support a woman's prenatal desires for the birth
of her child while helping her adjust to the realities of the
actual labor-Mark Sloane, Birth Day 17. What is a doula?
- For purposes of this training, these are the tasks I feel are
important to know:
- Non-medical(not pertaining to medicine, medical diagnosis, or
treatments)
18. Holistic care(pertaining to the physical, emotional,
spiritual, and social) 19. Provides information 20. Continuous
labor support 21. Facilitates communication between her clients and
the medical staff 22. What is a doula?
23. A doula provides non-medical, holistic care to the
childbearing family.Prenatally, she provides information to help a
family plan what they would like for their birth.During birth, she
provides continuous labor support and helps the laboring family
work smoothly through the process of labor and birth.She also helps
facilitate communication between the laboring family and the
medical staff. 24. What is a doula cont.
- Something that makes a doula unique from other healthcare
workers:
25. She stays with the mom from the time labor starts(or starts
and stops and starts:)) to a few hours after birth. 26. She usually
meets with the mom before and after the birth. 27. She is trained
specifically in labor support techniques. 28. What does a medical
professional do?
- Performs clinical and medical tasks
29. This may include taking the blood pressure, checking the
cervix, giving medication 30. Diagnosis medical conditions 31.
Pre-eclampsia, dystocia, failure to progress etc. 32. Determines
the best medical decisions to make along with the client 33. Case
Study 1: medical terminology
- G-2, P-1: Gravida(G) refers to the number of times a woman has
been pregnant. Para(P) indicates the number of live births.
34. Pain intensity scale: scale used to quantify pain.0 is no
pain and 10 is the worst pain. 35. BM: bowel movement 36. Rebound
pain: pain felt after the removal of pressure 37. Palpation: using
the hands or fingers to feel to exam a certain body part 38. Case
Study 1: medical terminology
- Cervix: the lower end of the uterus.It is about I inch
thick.
39. Dilation: the opening of the cervix.It is measured as 1-10
cm.Once it is 10 cm, the baby's head is able to come through. 40.
Pyelonephritis: a urinary tract infection that has reached the
kidney. 41. Straight Cath: a tube is inserted into the urethra from
the outside in order to get a sample of urine.It is then removed.
42. Case Study 1: medical terminology
- CBC: complete blood count.A test that exams different parts of
the blood.
43. WBC: white blood count.Done as a part of the cbc.Normal
values are 4500-10000.This can be elevated normally during
pregnancy. 44. Appendicitis: infection of the appendix 45.
Purulant: pus like drainage 46. Chorioamnionitis: inflammationo of
the fetal membranes, usually due to a bacterial infection. 47. Case
Study 1: medical terminology
- Electronic Fetal Monitor: a monitor that is strapped around the
mothers belly.It measures the heart rate of the fetus which allows
the doctors to make clinical judgments about the baby's well
being.
48. Unaysn: an antibiotic used to treat certain infections. 49.
Pitocin: synthetic form of oxytocin(which is a hormone) that will
start labor or increase contractions 50. Case Study 1:
- Melinda Halsey is a 31 year old G-2, P-1 at 35 4/7 weeks
gestation who presented yesterday with abdominal pain. Her pain
started in her right flank and was intense, lasting several
minutes, before easing off. This would occur every 10 minutes. When
she had the pain, it was an intensity of 9/10. The pain shifted to
her central lower abdomen, where it is still cramping in nature.
She took her temperature at home and it was 101.2 by ear
thermometer.
51. Case Study 1
- Shes had no trouble with urination other than her usual urinary
frequency. She had three episodes of loose BMs this morning, but no
BMs since then. She is hungry and would like some Pizza.
52. Her pregnancy has been uneventful and her previous pregnancy
was also uneventful, resulting in a full term delivery. She has no
significant medical or surgical history. 53. Case Study 1
- Her exam is significant for uterine tenderness with mild
rebound. The rest of her abdomen is soft and non-tender unless
palpation impacts the uterus.
54. Her cervix was noted to be dilated 1 cm, and 2 cm thick,
with the presenting fetal head at a -2 station. There was a foul
odor coming from the vagina and there was a purulent drainage
present in the cervix. 55. Case Study 1
- When first evaluating her, the migration of her pain from the
right flank to her lower midline suggested the possibility of renal
stone, or possibly pyelonephritis. For that reason, we ordered a
straight cathed urine specimen, which was reported as normal. This
effectively ruled out both pyelonephritis and renal stone.
56. Case Study 1
- I ordered a CBC, primarily to assess the white blood count,
which in this case was 13,500, a little high for pregnancy.
57. I considered appendicitis to be very unlikely in view of her
enthusiastic hunger. 58. With the foul-smelling purulent cervical
drainage and tender uterus, chorioamnionitis seemed the most likely
diagnosis. 59. Case Study 1
- The fetal monitor tracing was normal, so we have started her on
Unasyn to treat her infection, and pitocin to induce labor. For
pain relief during labor, we have started an epidural anesthetic,
with good results.
60. Case study used with permission from
www.obgynmorningrounds.com 61. Case study 1: what the medical
professionals do
- Checked uterine tenderness
62. Noted symptoms present that might indicate disease Performed
cervical exam 63. Inserted a straight catheter 64. Ordered and
performed labs 65. Monitored fetal heart rate 66. Prescribed
medication 67. Started IV, pitocin and epidural 68. Case study
1-what a doula does
- In this scenario, the doctor diagnoses and treats a
disease
69. This is not something that doula's are trained to do, but
during this course, you will be taught to understand and identify
different needs that a doula may help with. 70. For this scenario,
these are described below. 71. Nurses training in labor support may
use these in conjunction with their training in disease and disease
process. 72. Need Identified-Hunger
- If allowed, offer easily digestible foods.In this scenario,
this woman wanted pizza.Knowing that pizza is a harder food to
digest, I would offer something else and tell her why.If she still
wants the pizza, honor her wishes.Peppermint tea might be a good
thing to offer at this point(sugar or honey can be added).This
relaxes smooth muscles and aids in digestion.Peppermint oil may be
used for a similar purpose.If food is not allowed, clear liquids
like jello, broth or popsicles may be offered.
73. Need Identified-Fatigue
- This scenario didn't specify if this woman had been contracting
through the night or how much sleep she got.This may be something
you may want to assess. Things to ask or assess for: how long she
has been laboring and what time she started, how much sleep she's
had in the past 24 hours and the quality, does she look tired or
exhausted, and does she say she is sleepy or fatigued.
74. Need Identified-Fatigue cont.
- If she is tired, try helping her find positions that may be
comfortable for her to sleep in.I always recommend bringing a pad
of some sort to put on the laboring beds because they are so
uncomfortable.Helping ease her pain may be of importance at this
time as she may have been laboring for a while.This may include non
medical means such as positioning, hot pads or water.But you may
also want to discuss with her the possibility of getting some
medicated help to allow her to sleep if she is needing it.
75. Need Identified- Thirst
- If allowed, give her water or juices.She may have an iv bag
already going.If that's the case she may not need as much liquids,
but might appreciate ice chips or small sips of liquids.
76. Need Identified-Pain
- There are a lot of different kinds of pain that need to be
addressed here.First, she is having abdominal pain that is
different than normal laboring pain as there is an infection
present.For this kind of pain, hot pads or ice packs may help where
it hurts the most.Different positioning may also be useful in
decreasing the amount of pain she is feeling.Try different
positions, like side-lying or reclining in a chair.
77. Need Identified-Pain cont.
- While movement is great for normal labor, this may not be true
in a labor with an infection.It may be useful to see if things like
rocking or walking help, but don't push it.Massage may also be
useful as this helps to release her own endorphins to help her
cope.I would also try lavender, rose, or jasmine essential
oils.
78. Need Identification-Pain cont.
- She may also be feeling uncomfortable from the fever.You may be
able to talk to her care provider to see if she can have a Tylenol
to bring it down.Wet washcloths can also be used.Soaking a
washcloth in a little bit of peppermint oil and water may be useful
as peppermint has a cooling effect.Other things you can use to help
a woman feel cool are ice packs and fans.
79. Need Identification-Pain cont.
- Numerous cervical exams can also be uncomfortable.Discuss with
her and her care providers how many are actually necessary.For
those that are needed, help her start some deep breathing exercises
and visualizations before, during, and immediately after the
exam.It is also helpful to have her ball up her fists and place
them behind her hips during the exam.This helps tilt the cervix
closer.
80. Need identified-Pain cont.
- While this may not be important to some women, many woman find
it distracting if they do not have anything to keep them
covered.This in turn can lead to more focus on the pain of the
procedure.
81. Need Identified-Pain cont.
- The woman also needed to have a catheter placed in her briefly
to get a sample of urine.I would ask whether or not she could have
a clean catch, as this is how I have done it in most places.If not,
much of what you did to help with pelvic exams, will help with this
procedure also.
82. Need identified-Pain cont.
- To obtain a blood culture, an iv or needle must be used.I would
request that a warm cloth be wrapped around the hand or arm prior
to the procedure to help bring up the blood vessels.Again, deep
breathing can help before, during and after the
procedure.Afterwards a warm or cold compress may be useful to
decrease the pain.
83. Need Identified-Anxiety
- Things that work well for this include foot massages, lavender
oil, and deep breathing.Music may also help.
84. Need Identified-Fear
- Knowledge helps to alleviate fear.Make sure that she has all
the information she needs to understand what is going on. Since
this baby is early, she is also going to need information on what
to expect with a baby this early.Assessing her spiritual resources
may also be useful.Encourage her to use whatever she feels
comfortable doing.Things like prayer, meditation or other spiritual
practices can help when she is feeling fearful.Focus on the things
she does have control over.
85. Need Identified-Social Network
- Discuss with the woman who she really feels comfortable having
at this birth. Allow her to make the decisions, but help her to
explore who may or may not be good to have there.Also discuss
whether or not she wants outside distractions like the phone or
computer network.Help the spouse or significant other to feeling
included in the birth process.
86. Need Identified-Feelings of being cared for
- Encourage her to express her needs or desires, even if they
don't seem significant.
87. Need Identified-Decision making
- Encourage her to ask questions and discuss what she would like
to have happen.Make sure that she is OK with any procedure that is
being done.Before any procedure is done(ie vaginal exam, iv,
medication), make sure she gives at least her verbal consent.
88. Case Study 2
- Read pg. 33-40 in Homebirth in the Hospital by Stacey Kerr
- List everything the care providers to that is medical in
nature
89. List what others did that you would consider labor support
90. For extra help in seeing what the difference is,read chapter 3
of The Birth Partner by Penny Simkin 91. The role of the doula and
medical professional
- On the surface, this may seem simple to understand, but
sometimes the roles can be confusing.
92. It is important to keep in mind why your client hired you,
which include some of the reasons listed earlier. 93. A medical
professional is hired to safeguard the safety your client. 94. No
matter what situation, it is always appropriate to ask your client
if they feel they have enough information or have questions. 95.
The role of the doula and the medical professional-example
- A woman who is going natural wants to be in the shower, but it
is time for her to have the baby's heart checked and the nurse
wants her in bed.You offered to hold the heart rate monitor on, but
the nurse feels this is over stepping your bounds because you have
not been trained to do that.
96. One woman wants a warm compress with oils on her perineum
during crowning.Her care provider is used to being in charge during
pushing, and does not want you to help. 97. The role of the doula
and the medical professional-example
- Your client is laying down in bed when the nurse notices that
the babies heart rate is not doing very well.She wants to turn your
client on her side to help, but your client is very uncomfortable
on her side.You ask if she can be on her hands and knees
instead.The nurse gets flustered and feels you are over stepping
your bounds as a doula as this is more of a medical issue.
98. The role of the doula and the medical professional
- We will be discussing situations like this later on in the
course, but keep in mind that you will probably encounter some time
when the roles between providers are blurred.
99. What is the Cochrane Collaboration?
- The Cochrane Collaboration is an international, non-profit,
independent organization, established to ensure that up-to-date,
accurate information about the effects of healthcare interventions
is readily available worldwide.
100. What is the Cochrane Collaboration? cont
- It produces and disseminates systematic reviews of healthcare
interventions, and promotes the search for evidence in the form of
clinical trials and other studies of the effects of
interventions
101. http://www.cochrane.org/about-us/newcomers-guide 102. What
does the Cochrane Collaboration do?
- The Cochrane Collaboration prepares Cochrane Reviews and aims
to update them regularly with the latest scientific evidence.
Members of the organization (mostly volunteers) work together to
provide evidence to help people make decisions about health
care.
103. What are Cochrane Reviews
- Cochrane Reviews are systematic assessments of evidence of the
effects of healthcare interventions, intended to help people to
make informed decisions about health care, their own or someone
else's. Cochrane Reviews are needed to help ensure that healthcare
decisions throughout the world can be informed by high quality,
timely research evidence.
104. The Cochrane Library
- The Cochrane library has the Cochrane reviews as well as other
research.
105. This is something you should become familiar with to help
you look for abstracts on research about birth. 106. This will help
you keep up to date as well as educate our clients. 107.
http://www.thecochranelibrary.com/view/0/index.html 108. Type in
labor support into the search button 109. The Cochrane Library
- If allowed, give her water or juices.She may have an iv bag
already going.If that's the case she may not need as much liquids,
but might appreciate ice chips or small sips of liquids.
110.
- There are a lot of different kinds of pain that need to be
addressed here.First, she is having abdominal pain that is
different than normal laboring pain as there is an infection
present.For this kind of pain hot pads or ice packs may help where
it hurts the most.Different positioning may also be useful in
decreasing the amount of pain she is feeling.Try different
positions, like side-lying or reclining in a chair.
111. Cochrone Review
- Click the first link that is listed under the search results
entitled Continuous support for Women during childbirth
112. This should take you to an abstract of the review I've
given you to read. 113. The abstract is a brief description of the
review and it's conclusions. 114. 115. Assignment-Cochrane
Review
- Think of a topic that you are interested in.
- Do a search for it in the cochrane library.
116. Find one cochrane review.E-mail me the topic, name of the
review and the conclusions that were drawn.[email_address] 117. If
you have any questions let me know. 118. Play around in the
cochrane library for awhile.There is a lot of information to
explore. 119. Continuous support for women during
childbirth(Cochrane Review)
- Historically continuous labor support has been the norm for
women in labor.
120. In current history, this is no longer true and is more the
exception rather than the rule. 121. This particular review was
done to look at the effects of continuous support versus the usual
care. 122. They also wanted to look at what effects certain
variables may have on continuous support. 123. Cochrane
Review-Benefits of labor support
- More likely to have a spontaneous vaginal birth
124. Less likely to have intrapartum analgesia 125. Less likely
to report dissatisfaction 126. Labors were shorter 127. Less likely
to have c-sections 128. Less likely to have instrumental deliveries
129. Less likely to have regional analgesia 130. Less likely to
have a baby with low apgars. 131. Cochrane Review-When is labor
support most effective?
- When the labor support was not a part of the hospital
staff
132. When the labor support was not a part of the woman's social
circle 133. In settings where epidural analgesia was not readily
available. 134. Conclusion from the review
- Continuous labor support has clinically meaningful benefits for
women and infants and no known harm.All women should have support
throughout labor and birth.
135. Cochrane Review-Who should provide support
- Continuous support from a person who is present solely to
provide support, is not a member of the woman's social network, is
experienced in providing labor support, and has at least a modest
amount of training appears to be the most beneficial.
136. Support from a chosen family member or friend appears to
increase woman's satisfaction with their childbearing experience.
137. Cochrane review-How does labor support help? Theorectical
foundations
- Certain environmental influences may effect the progress of
labor and feelings of competence in the new mother
138. These factors include:
139. High rates of intervention 140. Unfamiliar personnel 141.
Lack of privacy Continuous labor support provides a buffer for
these situations. 142. Theoretical Foundations cont.
- Having continuous labor support helps the fetus move through
the pelvis and soft tissues
143. This may happen due to:
144. Helping to effectively use gravity 145. Supporting women in
whatever position they choose 146. Recommending specific positions
for specific situations 147. Theoretical Foundations cont.
- Anxiety and fear during labor may lead to complications for
both mother and baby
148. Continuous labor support helps to decrease anxiety and fear
by:
- Offering emotional support
149. Information and advice 150. Comfort measures 151. advocacy
152. The Benefits of a Professional Doula vs nurses or midwifes
- Nurses and midwifes often have other patients that they are
taking care of
153. They also have to spend a large proportion of their time
managing technology and keeping records 154. They may begin and end
shifts in the middle of the woman's labor. 155. They may lack labor
support skills. 156. Professional Doula vs friends or family
- Friends or family may not as be familiar with birth
157. They themselves may need support when working with the
laboring woman 158. Statistics of satisfaction of support from
Listening to Mothers Survey
- Percentage of women who feltthey had received supportive care
with:
159. A family physician-44% 160. Midwife-66% 161.
Husband/partner-88% 162. Doula-100% Proportion of excellent ratings
given for their supportive care: Doulas-88%, family member or
friend-73%, partner/husband-72%, doctor-71%, midwife-68%, nursing
staff-68% 163. End of Unit Project
- Teach a course in your community about the benefits of using a
doula.
164. You may use any of the slides I have presented, or you may
make your own. 165. Specifics for this project should be sent to
you. 166. There is no deadline for this, but you must finish this
before you move on. 167. If you need help finding a venue e-mail
me, and I will help you look for one. 168. Labor support for
nurses
- While the work environment does not always allow you to just
focus on continuous support, having you there to provide support
when needed is still important.
169. This course will help you to find strategies to help you
provide support when you can, and to advocate forpolicies that help
promote the abilities of the nurse to provide labor support. 170.
AWOHNN position on the need for nurses to provide labor support
- Continuously available labor support from a registered
nurse(RN) is a critical component to achieve improved birth
outcomes.....labor care and labor support are powerful nursing
functions, and it is incumbent on health care facilities to provide
an environment that encourages the uniquepatient-RN relationship
during childbirth -AWHONN position statement
171. Barriers for nurses in providing labor support
- Two High-alert drugs are commonly used in labor and
delivery(oxytocin and magnesium)
- Require intensive administration precautions
172. Continuous monitoring and assessment Competing
priorities
- Higher acuity than in past
173. More inductions and cesareans 174. These demand more
attention to technology and documentation Institutions have not
increased staffing to help 175. Advocate for change
- As we discuss the doula's ability to advocate for change this
also applies to nurses.
176. AWHONN staffing recommendations are a good place to start.
177. Other situations which doula's may help with
178. C-Section 179. Pre-term labor 180. Goals during an
epidural/c-section/pre-term labor
- Minimize emotional and physical distress during the procedure
and afterward
181. Provide the opportunity to discuss with care providers 182.
Minimize pain if still felt before, during and after the procedure
183. Minimize the complications of the side-effects 184. The
specifics of each of these will be taught later in the course. 185.
Assignment
-
- Read Listening to Mothers, particularly the quotes from
mothers.
- 186. Pick one situation that you agree with and how her
situation could have been better with the use of a doula.
187. Pick three situations which contain choices made that you
wouldn't have chosen.Describe how you would have served these women
as a doula. 188. Doula's as change agents
- Part of the revolution involves changing disease care to health
care based on health, healing and empowerment-Paulina Perez
- The focus is on creating health rather than treating
problems.
189. Doula's as change agents
- We must build bridges with others and invite views that are
divergent-Paulina Perez
190. We have the opportunity to work with all birthing
professionals to provide the best care for women and their babies.
191. Doula's as change agents
- We can be prepared to make new paths and be innovative in our
care-Paulina Perez
192. This involves:
- Seeking alternative ways to reach our goals when needed
193. Anticipate crisis and working together to solve them 194.
Educating yourself, so that the paths available to you are more
open 195. Doula's as change agents
- We have the opportunity to find out what families really need
and provide that for them-Paulina Perez
196. How this course will help you to become an effective change
agent
-
- What women experience during labor is not always a disease or
diagnosis, but a life process.
- 197. In this course, you will learn toidentify and focus on the
labor and birth as a life process specific to each individual.
198. In this way, you will be promoting health rather than
treating disease. 199. How this course will help you become an
effective change agent
- Part of my goals for this course is to help you learn to
communicate and work effectively with other care givers.
200. There will be various assignments that will stretch you to
do so.By doing this, you will learn to work with others who may
think differently, but you can also help them to see things
differently. 201. How this course will help you become an effective
change agent
- You will be provided with the education and experience to be
able to adapt to many different situations and people.
202. You also be taught skills to help women in many different
situations, from the very few interventions to numerous
interventions being used, as well as how to help women make the
choices they desire. 203. You will be provided with the information
that will help you form your own opinions on what should be
changed. 204. What does being a doula mean to you?
- Caring that comes from the heart and soul brings back humanity
and kindness to the birth process that has lately been dominated by
machines, tubes, and wires.We often get so caught up in the 'ought
to,' and 'need to' of our jobs that we forget completely the 'want
to' and 'why' of what we're doing in the birth room.-Paulina
Perez
205. Assignment
- As a tool for you to remember why you are doing this, as well
as letting potential clients know what your goals are, prepare a
1-2 paragraph description of why you care about labor support and
what you hope to bring to the woman's birth.
206. Chapter 2 of The Nurturing Touch at Birth has some good
ideas of what some of those reasons may be, but feel free to add
whatever you feel is important.