1. The Role of the Doula in the Labor and Delivery Room Presented byNew Beginnings Doula Training Rachel Leavitt RN, BSN, CD For more information on doula certification visit www.trainingdoulas.com

2. What is a doula?

This is difficult to define, but my favorite definition comes from Mark Sloane, MD.,author of Birth Day

3. What is a doula cont.

• • • A doula

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 4. What is a doula cont

Some things that people often mention:

Nurture

5. Guide 6. Assist 7. Support 8. Encouragement 9. Continuous support(this is something that nurses alone may or may not be able to provide) 10. What is a doula cont.

Something that makes a doula unique from other healthcare workers:

11. She stays with the mom from the time labor starts(or starts and stops and starts:)) to a few hours after birth. 12. She usually meets with the mom before and after birth. 13. What does a medical professional do?

Performs clinical and medical tasks

14. This may include taking the blood pressure, checking the cervix, giving medication 15. Diagnosis medical conditions 16. Pre-eclampsia, dystocia, failure to progress etc. 17. Determines the best medical decisions to make along with the client 18. Case Study

To illustrate the differences between the two professions check out this case study

19. obgynmorningrounds.com/blog/morning-rounds/3-101-chorioamnionitis/ 20. Case studyWhat a doula does

I wanted to explore this from a doula's perspective, and what care a doula gives.

21. Life Process-as experienced by the mom-Hunger

Offer easily digestible foods.In this scenario, this woman wanted pizza.

22. 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. 23. If food is not allowed, clear liquids like jello, broth or popsicles may be offered. 24. Process-Fatigue

Assess:

how long she has been laboring

25. what time she started 26. how much sleep she's had in the past 24 hours and the quality 27. does she look tired or exhausted 28. does she say she is sleepy or fatigued. 29. Fatigue cont.

Find positions that may be comfortable for her to sleep in.

30. A foam pad may help the beds feel more comfortable for sleeping. 31. Help work with contraction pain to facilitate rest

positioning, hot pads or water.

32. May want/need medication or epidural 33. Process- Thirst

If allowed, give her water or juices

34. ice chips or small sips of liquids, may help if you she has an iv bag or can't have fluids. 35. Process-Pain

For abdominal pain caused by infection:

hot pads or ice packs may help where it hurts the most.

36. Different positioning like side-lying or reclining in a chair. 37. rocking or walking may help, but don't push it. 38. Pain cont.

For generalized pain

Massage

39. lavender, rose, or jasmine essential oils. 40. Feeling warm(fever)

Discuss with mom and doctor whether tylenol is an option

41. Wet washcloths to cool 42. Peppermint oi 43. Ice packs 44. Fans 45. Pain with cervical exams

Discuss with care provider how many are needed

46. Start some deep breathing exercises and visualizations before, during, and immediately after the exam. 47. Have her ball up her fists and place them behind her hips during the exam.This helps tilt the cervix closer. 48. IV pain

Warm cloth wrapped around the hand or arm prior to the procedure to help bring up the blood vessels.

49. Again, deep breathing can help before, during and after the procedure. 50. Afterward a warm or cold compress may be useful to decrease the pain. 51. Process-Anxiety

Foot massage

52. Lavender oil 53. Deep breathing 54. Music therapy 55. Process-Fear

Make sure that she has all the information she needs to understand what is going on.

56. Assess her spiritual resources

Things like prayer, meditation or other spiritual practices can help when she is feeling fearful.

Focus on the things she does have control over. 57. Process-Social Network

Discuss with the woman who she really feels comfortable having at this birth.

58. Also discuss whether or not she wants outside distractions like the phone or computer network. 59. Help the spouse or significant other to feeling included in the birth process. 60. Process-Feelings of being cared for

Encourage her to express her needs or desires, even if they don't seem significant.

61. Process-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

62. Before any procedure is done(ie vaginal exam, iv, medication), make sure she gives at least her verbal consent. 63. Continuous support for women during childbirth(Cochrone Review)

Historically continuous labor support has been the norm for women in labor.

64. In current history, this is no longer true and is more the exception rather than the rule. 65. This particular review was done to look at the effects of continuous support versus the usual care. 66. They also wanted to look at what effects certain variables may have on continous support. 67. Benefits of labor support

More likely to have a spontaneous vaginal birth

68. Less likely to have intrapartum analgesia 69. Less likely to report dissatisfaction 70. Labors were shorter 71. Less likely to have c-sections 72. Less likely to have instrumental deliveries 73. Less likely to have regional analgesia 74. Less likely to have a baby with low apgars. 75. When is it most effective?

When the labor support was not a part of the hospital staff

76. When the labor support was not a part of the woman's social circle 77. In settings where epidural analgesia was not readily available. 78. 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.

79. Support from a chosen family member or friend appears to increase woman's satisfaction with their childbearing experience. 80. How does labor support help? Theorectical foundations

Certain environmental influences may effect the progress of labor and feelings of competence in the new mother

81. These factors include:

Institutional routines

82. High rates of intervention 83. Unfamiliar personel 84. Lack of privacy Continuous labor support provides a buffer for these situations. 85. Theoretical Foundations cont.

Having continuous labor support helps the fetus move through the pelvis and soft tissues

86. This may happen due to:

Encouraging mobility

87. Helping to effectively use gravity 88. Supporting women in whatever position they choose 89. Recommending specific positions for specific situations 90. Theoretical Foundations cont.

Anxiety and fear during labor may lead to complications for both mother and baby

91. Continuous labor support helps to decrease anxiety and fear by:

Offering emotional support

92. Information and advice 93. Comfort measures 94. advocacy 95. 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.