Wednesday, June 17, 2009

The Daddy-Doula Dynamic

A commenter left the following comment on a birth story a week or two ago, and it was such a great question (and one that I've wanted to address for some time) that I wanted to devote a blog entry to it. Thank you, Michelle! I'm sorry this has taken so long! Let me know if you read this so I won't feel so guilty for procrastinating!

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"I was just wondering....what is the relationship dynamic in the room if there is a partner present? The entire time I was reading this, I was wondering about either the father of the baby, or J's partner. Is there none? And how does that change the doula dynamic? My husband would be with me when I delivered, so what roles can he play that the doula played here, etc. "

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I'm going to insert a quick note here, in case anyone does not know what a birth doula is. A birth doula, according to DONA (Doula of North America), is "a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth." A doula is almost always a woman (I've never heard of a male doula).

Here are the functions of a doula, according to DONA:

"A Birth Doula:

- Recognizes birth as a key experience the mother will remember all her life

- Understands the physiology of birth and the emotional needs of a woman in labor

- Assists the woman in preparing for and carrying out her plans for birth

- Stays with the woman throughout the labor

- Provides emotional support, physical comfort measures and an objective viewpoint, as well as helping the woman get the information she needs to make informed decision

- Facilitates communication between the laboring woman, her partner and her clinical care providers

- Perceives her role as nurturing and protecting the woman's memory of the birth experience

- Allows the woman's partner to participate at his/her comfort level"

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Honestly, one reason I've waited so long to answer this question is simply that there is so much to say on this subject that I don't know where to start. (Anyone who has input, please chime in.)

The question, restated: Yes, doulas are wonderful for single women, but why have a doula if a woman's husband is going to be with her?

It's a question that needs to be addressed, because oftentimes a husband is the objecting party to having a doula. I participate in a monthly birth circle meeting, and time after time I have heard the following: "I really want to hire a doula, but my husband doesn't want one."

Why would a husband not want a doula? Well, the reason is quite obvious when we consider it. What is the function of a good husband? He protects his wife; he provides for his wife; he meets his wife's needs; he supports his wife. When a wife says, "I want a doula," it can often feel, to a man, like a threat to his masculinity and a statement of his insufficiency. "I'm not good enough for her; she thinks I can't meet her needs." Many husbands quite understandably react negatively to the unspoken (and unintended) message.

And after all, why would a couple need a doula? If a couple has taken decent childbirth classes, the husband knows enough to support his wife during childbirth, right?

While doing my best to conceal my maniacal giggling over that question, let me just say the following: Unless a couple is very unusual, neither husband nor wife has been present at a birth. They may have watched birth videos, but being present for a labor and/or experiencing labor (as the mother or the father) is a COMPLETELY different story. Labor, especially first-time labor, can be very frightening for the mother, because she is unfamiliar with what her body is doing and doesn't know what's going to happen next, and to the father because he is seeing his wife in pain. (And thinking that one is prepared for real-life contractions because one has practiced in childbirth ed classes.... is like thinking that because one has seen a breeze, one is prepared for a hurricane. Don't kid yourself.) To top that off, neither is experienced with the hospital system and able to deal with it efficiently while in active labor.

So why have a doula when one has an attending husband? Here are the reasons, listed in no particular order:

(1) A doula can reassure a husband about the normalcy of labor and birth.

Husbands tend to freak out when they see their wives in pain. In fact, they are often the motivating factor in urging their wives to accept pain medication, which may be counterproductive for a woman who wants a natural birth. Doulas have "been there, done that" with birth, often many times, and their calm acceptance of the birth process can help husbands to calm down and focus on support rather than "rescue."

(2) Doulas help the husband to support the mother.

Oftentimes a husband will want to support his wife but will not know which comfort measure would be most effective. A doula knows many, many comfort measures (counterpressure, movement, posture changes, heat/cold, massage, etc.), and can say, "Maybe she'd like it if you did this."

(3) Doulas can give husbands a break during labor.

Even the most devoted husband needs to use the bathroom, make an occasional phone call, eat a snack, take a quick walk, or even grab some sleep during a long labor. Doulas make that possible, rather than having a husband sacrifice real needs to stay with his wife or leave her stranded while he takes care of them.

(4) Doulas can protect the couple's privacy by dealing with hospital staff for them.

When interactions with hospital staff are necessary, a doula can answer questions, give directions, and watch out for the mother's welfare, allowing the husband to give undivided attention to his wife (rather than having him distracted between the two).

(5) Doulas make sure the mother's wishes are honored.

In the current system, it is often a fight to make sure a mother's wishes and/or birth plan are honored. That is not a fight that a husband or wife should have to fight in the middle of labor. Doulas can (hopefully peacefully) bring caregivers' attention to a mother's wishes and make sure that they are honored.

(6) Doulas provide trained "labor sitting."

Traditionally, a doctor or midwife would stay with a mother during her entire labor and provide trained information to the laboring mother. That is extremely rare today. And unless your husband has a hobby of studying midwifery and/or obstetrical textbooks in his spare time, he won't be able to do that either. A doula can (within limits) give the mother information and support from a knowledgable background, which can be reassuring to the couple.

(7) Doulas have a wide variety of comfort measures to suggest

No matter how hard your hubbie studies, he will not know all the comfort measures out there. A doula will have a vastly wider knowledge-base and will be able to offer a greater variety of comfort measures and see what is working for the mother.

(8) Doulas have an amazing track record for providing better birth experiences and fewer harmful interventions for mother and baby.

Just look at the following:

The presence of a doula at birth results in:

• Reduced cesarean birth rates by 50%
• Reduced length of labor by 25%
• Reduced use of Oxytocin by 40%
• Reduced requests for pain medication by 30%
• Reduced the rate of Epidural usage by 60%
• Babies had fewer health problems at six weeks than the infants of women who had not had a doula present during labor.
• Babies had fewer neonatal complications
• Babies had fewer workups for sepsis

The data speaks for itself.

(9) A doula allows the husband to be involved at his own personal comfort level.

Some husbands (like mine) are the super-involved kind who want to be there every moment, catch the baby, and cut the cord. Some husbands feel more reluctant to be that deeply involved. A doula can show the super-involved-type husband how to be involved, so that he doesn't feel left out, and can also pick up the slack for a husband who doesn't feel overly comfortable being deeply involved. That way a husband doesn't have to be more or less involved than he would like, and the wife is still completely supported throughout labor either way.


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To add what DONA has to say on the subject, here is DONA's "Daddies and Doulas" sheet (emphasis mine), which you can view online here:

Dads and Doulas: Key Players on Mother's Labor Support Team

"There was a time when expectant fathers were portrayed as anxious, floor-pacing, cigarsmoking men who were tolerated in hospital corridors until the long-awaited moment when a nurse or doctor would announce they were the proud father of a daughter or a son. Today's expectant fathers are different.

"When it comes to pregnancy, birth, and parenting, today's father may want to share everything with his partner. He may want to be actively involved; ease his partner’s labor pain, welcome his baby at the moment of birth and help care for his newborn at home. A birth doula can help a father experience this special time with confidence.

"Studies show that when doulas are present at birth, women have shorter labors, fewer medical interventions, fewer cesareans and healthier babies. Recent evidence also suggests that when a doula provides labor support, women are more satisfied with their experience and the mother-infant interaction is enhanced as long as two months after the birth. With doula support, fathers tend to stay more involved with their partner rather than pull away in times of stress.

"Today, a father's participation in birth preparation classes or his presence at prenatal visits and in the birth suite is a familiar occurrence. Yet, we sometimes forget that the expectations of his role as a labor coach may be difficult to fulfill. Sometimes it is also culturally inappropriate for an expectant father to be so intimately involved in the process of labor and birth.

"The father-to-be is expected, among other things, to become familiar with the process and language of birth, to understand medical procedures and hospital protocols and to advocate for his partner in an environment and culture he may be unfamiliar with. A doula can provide the information to help parents make appropriate decisions and facilitate communication between the birthing woman, her partner and medical care providers.

"At times a father may not understand a woman’s instinctive behavior during birth and may react anxiously to what a doula knows to be the normal process of birth. He may witness his partner in pain and understandably become distressed. The doula can be reassuring and skillfully help the mother to cope with labor pain in her unique way. The father-to-be may be asked to accompany his partner during surgery should a cesarean become necessary. Not all fathers can realistically be expected to coach at this intense level.

"Many fathers are eager to be involved during labor and birth. Others, no less loving or committed to their partners' well being, find it difficult to navigate in uncharted waters. With a doula, a father can share in the birth at level at which he feels most comfortable. The doula’s skills and knowledge can help him to feel more relaxed. If the father wants to provide physical comfort, such as back massage and change of positions, and help his partner to stay focused during contractions, the doula can provide that guidance and make suggestions for what may work best.

"Physicians, midwives and nurses are responsible for monitoring labor, assessing the medical condition of the mother and baby and treating complications when they arise; but birth is also an emotional and spiritual experience with long-term impact on a woman's personal well being. A doula is constantly aware that the mother and her partner will remember this experience throughout their lives. By mothering the mother during birth, the doula supports the parents in having a positive and memorable birth experience.

"The benefits of doula care have been recognized worldwide. The Medical Leadership Council of Washington, D.C, the Society of Obstetricians and Gynaecologists of Canada and the World Health Organization are among the many healthcare organizations that value the benefits that doulas provide to women in labor.

"The father's presence and loving support in birth is comforting and reassuring. The love he shares with the mother and his child and his need to nurture and protect his family are priceless gifts that only he can provide. With her partner and a doula at birth, a mother can have the best of both worlds - her partner’s loving care and attention and the doula's expertise and guidance in birth."

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Here is my own story:

My hubbie and I signed up for Hypnobirthing classes, and I was a complete flop in them. I couldn't successfully complete the simplest exercise. (DH, on the other hand, was wildly successful - but that wasn't much help to me!). While bewailing these circumstances to our long-suffering midwife, she said, "Why don't you try a doula?" And so we were off!

(Some may wonder why homebirthers would need doulas... The answer is that most homebirth midwives don't stay for the entire labor. Our own midwife was there for the last five or six hours of our labor - plus two hours postpartum - but not for the whole thing. For labor-sitting, homebirthers still need a doula.)

In retrospect, we should have done things differently. We went with the first doula she suggested, rather than "shopping around," and we only met her one brief time the Saturday before our birth (yes, we put things off till the last minute). But other than those snafus, having a doula was wonderful. She calmed down DH when he was getting scared at seeing me in pain (and vocalizing loudly about it!), she stayed with me while he ran out to get food, she made suggestions, and provided calm support the entire time. We wouldn't have a birth without one.

For our upcoming birth, we have engaged two doulas who I know from our local birth circle, and I cannot wait to have their help!

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Doulas can range from the super-experienced and thus rather-expensive (though if you're having a hospital birth, they're worth it!) to the student-doula who is usually free. There is a doula out there for everyone!

If anyone has any more questions about doulas, or about how daddies and doulas can work together, please let me know!

The summary: Doulas ROCK! Don't be without one!

5 comments:

  1. I was going to write on this next week, but your post is TONS better than any I'd write, so I'm just gonna link here!

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  2. Great post, Diana! I'm going to share it on my Birth Faith facebook page. :-)

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  3. "While doing my best to conceal my maniacal giggling over that question, let me just say the following: Unless a couple is very unusual, neither husband nor wife has been present at a birth. They may have watched birth videos, but being present for a labor and/or experiencing labor (as the mother or the father) is a COMPLETELY different story. Labor, especially first-time labor, can be very frightening for the mother, because she is unfamiliar with what her body is doing and doesn't know what's going to happen next, and to the father because he is seeing his wife in pain. (And thinking that one is prepared for real-life contractions because one has practiced in childbirth ed classes.... is like thinking that because one has seen a breeze, one is prepared for a hurricane. Don't kid yourself.) To top that off, neither is experienced with the hospital system and able to deal with it efficiently while in active labor."

    Well said. I think you make the point nicely. Folks have no clue what is really going to happen and it is good to have a tourguide when you are in unchartered waters.

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  4. I recently came accross your blog and have been reading along. I thought I would leave my first comment. I dont know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.

    Lucy

    http://maternitymotherhood.net

    ReplyDelete
  5. Thanks, Mabel! Glad to have you here! I don't get to write nearly as often as I would like, but I very much enjoy homebirth blogging. I'll look forward to hearing your comments!

    ReplyDelete

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