Episode 1: Doulas

Episode 1 is all about DOULAS!  What is a doula and who can utilize one? I I talk about the scientific evidence on the benefits of a doula, as well as all the crunchy goodness a doula can provide. Whether or not you've given birth or utilized a doula I hope you learn something new here.

The music you here at the start of this and every episode was created by the "Wonderful" Obediya Jones-Darrell.    You can check out his work here.

Show Notes:

Peggy Simkin- “The Meaning of Labor Pains”

Non-medical Support of Women During Childbirth: The Spiritual Meaning of Birth for Doulas 

Cochrane Review: Continuous Support for Women During Childbirth

World Health Organization: Companion During Labor 

12 Ways to Change Birth in Our Culture, Part 10: know that Birth is a Heroic Journey

Birth Ambassadors 

The music you here at the start of this and every episode was created by the "Wonderful" Obediya Jones-Darrell. You can check out his work here.

Transcript

0:32

I'm your host, Emily gold masters of public health doula, yoga therapist, spirituality, mind, body. Psychology masters. And most importantly, mother of two, I'm gonna work on shortening that intro, I think for the future. I want to start off every episode checking on my own biases, sharing my own experiences. And this one's super easy because this episode is all about doulas and I'm a doula. So I definitely think doulas are awesome, but even as I say that I'm realizing I had a doula, I actually had two doulas at my first birth. And I chose not to have doulas at my second. So I definitely am not a, everyone needs to have a doula all the time. I also was a doula before I was pregnant. So I think I have that perspective. That's maybe a little different than many other doulas. And I actually came to doula work through my public health work in maternal health. I came at that from both a scientific and spiritual interest. I was doing a lot of work with maternal health reproductive health, which I loved and still love. But often felt very dry, often felt like because it is public health. You're looking at a big group of people and often felt like, what was I missing from the other side of this? I think doulas are often depicted very, very crunchy, I know people often have that expectation when they meet me. So I think people are actually missing out on doulas because of that depiction. I really did my best for this episode to check my biases on all fronts and I hope you can do the same as we go to episode one of evidence based crunch. Today. We are talking about birth doulas and a birth doula is in case you don't know. A non-medical birth companion. That's how I always describe them. I actually looked up and bunch of different definitions of doula. The word doula comes from the ancient grease word, meaning woman who serves and the definition that I found that sort of encompassed what I thought the best and easiest explanation. And I apologize for just reading to you, but this came from the book birth ambassadors by Dr. Christine Mor. I will add that reference and all the other references I mentioned to the show notes for this podcast, It's one of the big books that's often used in doula trainings. Doulas are defined as companion who supports a birthing person during labor and birth birth doulas are trained to support continuous one-on-one care, as well as information, physical support and emotional support to birthing persons and their partners. So what does a doula do? A doula can do all different things. A doula can support a person with their breathing, with their different positions. Doulas often provide. Nonmedical pain support. So whether that's using massage, some doulas use essential oils, Doulas provide a whole range of emotional support. I know I've been hired as a doula for clients who. Just wanted to make sure that there was always someone there until they got the epidural that they knew they wanted. I know I was hired by clients. Who've had previous traumatic birth experiences and wanted to be sure that there was someone there that was aware of these experiences. I've been hired by people who have come and done prenatal yoga with me and liked the breathing instructions that I'd provided. So really that's just me. One person doulas provide a whole range of care. doulas can also help you if you have a birth plan or I like to say a birth map can help you work with that. So, you know, if, if a person is pretty sure they don't want an epidural, I know for me, when I work with birth clients, I often suggest having a. Safe word so that when someone offers you an epidural, you can use that word if you really want it versus, you know, you're just screaming for an epidural during a contraction. That's just an example. It, I'm not against epidurals in any way. Doulas can support the partner. I know I've often been. Sent out to get water or some food, and also give a partner a chance to step away. So the, the partner can go get some food, call some grandparents, just go take a breather. Cuz birth can be intense for everyone. Having a second person there means one person can be providing massage while someone else is looking at the birthing person in their eyes, et cetera, et cetera. So these are all the roles of ADU. a doula is not tasked with any sort of medical care. They're not catching babies. They're not providing any sort of medication. A doula is not there to advocate they might remind the birthing partner. This is what you had said you wanted, but they're not going to argue with a nurse or a doctor about what they're proposing as a medical intervention. That work is often expanded to the prenatal and postpartum period. There are full spectrum doulas who support people through pregnancy and birth as well as fertility, treatment, miscarriage and abortion. And there are also death doulas who provide specific end of life. and if you hang out with doulas long enough, you often hear people saying they need a doula for anything. I know I was moving last year. I was seven months pregnant with a four year old. It was hot. There was a pandemic. And I kept saying, I need a moving doula because basically a doula is someone who is there to support you and help you reach your intended goals. In this case, when we talk about birth, So, what we're gonna do today is start by just thinking about some of the beliefs in the culture about doulas. Honestly I think maybe in the future, I'll do another whole episode just looking at doulas and pop culture because whenever there's a doula and a movie or a TV show, I hear about it. It shows up all over, but there's a very common depiction of doulas. They're often seen as super duper crunchy and used specifically for pregnant people and couples who desire a natural birth. One of the first big depictions of doulas in the media was a plot line on Fraser. There's two different plot lines in Gilmore girls. If you like Gilmore girls of doulas both for, again, these very hippy dippy births. They're often seen as very controversial, like fighting against the doctors. And I know another depiction is often like instead of a midwife, someone will have a doula at their birth, but as I've noted, doulas are non-medical support. So those things are really something that I wanna make sure we address that doulas are not fighting against doctors. They're not there to argue with the medical care practitioner and they're also not there to be doing anything medical. So I just wanted to get that out of the way. I chose doulas for this first episode, because this was actually one of the big inspirations for this podcast. I'm very passionate about doula work, even though I'm not currently working as a birth doula because I have two little ones. I've worked as a doula for many, many years. And I think doulas often have a very, a certain rap. I don't wanna say it's a bad rap. But like I noted in the media, but also in real life, I think people often expect you're gonna have a doula. If you wanna give birth in your tub, in your house or in a field, or, you know, if you don't like what your doctor's telling you get a doula and they'll make sure you have the birth that you want. And maybe that is some doulas. I am not against births and tubs. I had two home births, both involved, a tub, and this podcast is all about no judgment. So if any of the things I just mentioned were your ideal birth, I think that's awesome. We're gonna talk all about ideal births. but most people in the global north are giving birth in hospitals. Most of us either hospital home or birth center with a medical care practitioner, whether it's a doctor or a midwife. And I think that this depiction is actually keeping a lot of people from doulas. So I think often when we think of, you know, misinformation in the health and in the pregnancy and birth world in particular, we think about misinformation where people are misunderstanding medical advice. But I think in this case, there's actually something that's seen as more crunchy that the people that are more worried about evidence based care are actually missing out on. I think there is a whole host of negative ideas people have about doulas. I see it just when I tell people that I'm a doula, I definitely see it in some of the media I mentioned. And because I also work in public health and have a science background, I'm maybe particularly attuned to it. But I think one thing people are really worried about is that a doula is going to stand in the way of medical advice that a person would only hire a doula if. They don't trust the medical advice they're getting, or they don't want medical advice or they wanna be quote unquote alternative. And that is certainly not the case, but I think that is a very widespread belief. So I really wanted to open the conversation to talk about the scientific side of doulas and the spiritual side of doulas. So what's really cool. Is there actually is a lot of science about doulas. One of the largest and most cited pieces of research on doulas is the Cochran review. Cochran reviews or systematic reviews of scientific litera. so there are like big meta lyses where they look at a pre-specified eligibility criteria to answer a specific research question. So Cochran reviews will choose a specific topic and curate all the scientific literature of the topic, weigh it through its legitimacy and how relevant it is to the topic. So in 2017 Cochran published a review examining continuous support of women during childbirth. So that just meant what they defined that as was essentially support from someone who wasn't a doctor or a nurse or a midwife. And also wasn't the partner during the entire childbir. So they ended up looking at 26 studies from 17 different countries involving more than 15,000 women. in a wide range of settings and circumstances, and I'm using the term women here because that's the term that the researchers used. So I apologize if that is not the most inclusive term. And I will just note that the review found women who received continuous labor support may be more likely to give birth spontaneously and what they meant by that was give birth vaginally without forceps, vacuum or Cesar. in addition, women may be less likely to use pain medication or to have a cesarean birth and may be more likely to be satisfied with their birth experience and have shorter labors. So essentially all the research on having these birth companions found women who had birth companions were more likely to have vaginal birth without extraction or cesarean. Tended to have shorter births. And the one I find very interesting is that they were more likely to be satisfied with their births. Another finding was that that postpartum depression could be lowered women who were supported in labor, but this finding was a little less clear because the studies were pretty difficult to compare. They were in lots of different settings in different countries, high income countries, low income countries. different kinds of support. So more official doula support as more as well as sort of less on official support, like a sister or mother, and then on the counterside, the researchers did not find any differences in the number of babies admitted to special care. and there was no difference in whether babies were breastfeed eight weeks for those that had continuous support and those who did it, and there was also no adverse effects found to, for continuous support at birth. So whenever we're talking about evidence, one of the first things I always wanna look at. What is being measured because once we take something scientific and start using it to justify or talk about something that is being used to make parenting decisions we just always wanna think about what is being measured. I'm gonna return to this again and again, because you know, a research can quote unquote, prove something, but is it answering the question you are asking as a parent is it proving the advice someone's giving you? So in this case, the reviewers, one of the things they looked at was vaginal birth. And less medication and they subbed that in as successful birth. So they said that women who had continuous support had successful births and they defined successful birth as vaginal birth and less medication. So if that's also your definition of successful birth, that's. That's not necessarily everyone's definition of successful birth. They didn't look at anything about empowerment. They didn't look at anything, a feeling of safety. There was a little mention of, of outcome of baby, but not very much. I think this is you're gonna hear me come back to this again and again, but what's being measured, even if it's using. Objective numbers, objective statistics and science what's actually being measured can be subjective because the researchers decided to measure success in this particular way. So we have to rely on what they used. And so the evidence for doulas have were that they can be a part of a successful birth, as long as we're thinking of success in this particular. So the Cochran review gets used a lot as evidence for doula care. I see it all the time. But I think it is often important to remember that the continuous care can be coming from all sorts of different people. Just not the main health provider or the birth partner, the husband or wife. But it doesn't have to define doula, this often gets cited as great research as evidence for doulas. So this study was expanded by a recommendation by the world health organization and the world's health organization recommended. Having a companion at birth who is, and I quote, trustworthy and supportive. The recommendation also notes that many women are unable to get the support from male partners who may be nervous or not confident. I know that's a reason I've been hired as a doula. So what I really liked about this recommendation was that it specifically notes that doulas are not just a tool for their rich and privileged. So I think this is an important point to raise from both a scientific point of view. And a spiritual point of view is that a doula is something that everyone should have access to, or a birth companion is someone that everyone should have access to. And the review also noted that women who had doulas. May develop closer bonds with their doulas, often meeting with them before birth, to build rapport and understand expectations and for refugees, migrants and foreign born workers and high income settings, community based doulas, specifically doulas from the same ethnic linguistic and our religious background. We're particularly helpful in providing culturally competent care. So I think that's a really important note for some of the less privileged in our society. Having access to some non-biased non-medical birth support can be so important and there's actually lots of evidence towards that. So that's a basic science Roundup of doulas. There's also a lot of crunch or spirituality around doulas. So lots of people do hire doulas because they want less medical birth. They know that doulas are trained in providing non-medical pain support, whether that's different positions, different kinds of touch, as well as other things like using essential oils, using specific breathing techniques, it varies from doula to doula. I came across a really interesting piece of research. It was actually dissertation research by a then PhD student, uh, Patricia Lee, Brent, that was looking at the role of doulas in spirituality. And how she cited. It was that one way to think about doula's spiritual role is to see them preventing actions that would prohibit or mask the spiritual experience of birth. And I think as someone who's been in been to a lot of births as someone who's given birth twice and attended a number of births, I believe that birth always has the possibility of being a spiritual experience. No matter how you give birth at home in a hospital, vaginal birth, C-section birth drugs, no drugs. The actual experience of welcoming a new being into the world is for most people, no matter what you believe, no matter how spiritual you typically are, there's something. Spiritual about the entire experience. And that said there can be things that sort of tone down that spirituality, whether it's a sense of fear, a sense of judgment, a lack of control or a loss of control. And I think what, what this research was really saying is that a duals role is to prevent some of those things from happening to the degree possible. You see a family growing. You get to be one of the first people that meet an entirely new human being you're holding space for someone who's in this truly liminal space, the space of becoming a mother, becoming a parent, rebecoming a parent, welcoming someone new into their family. That to me is very, very spiritual and the doula's role is to hold that space. Be part of that space and make sure to whatever extent is a wanted by the birthing person, the birthing person and their partner, that space can be held to the way that they want it. So whether that means a space free of pain and trauma, or a space with less medication, a space where they feel empowered, it's different for each person, but the doula spiritual role is to help ensure that spiritual experience. So that ties in with the science. So as I noted that women who are again, I'm using the term women, because that's what the study used, but we can say people who utilize doulas are less likely to request pain medication, the nurse and author, Peggy Simkin, who wrote one of my favorite books about birth, the birth partner notes that for some women. Or many women, labor pain is accompanied by feelings of emotional wellbeing, of being in control and being nurtured and respected by their loved ones and caregivers. Their later recall, focuses more on their sense of accomplishment and having dealt with the pain successfully as they define success and de emphasizes the severity of the pain. So, again, this is just for some LA laboring people, not for all, but actually being able to experience that pain is a very empowering experience. A very spiritual experience. Peggy Simkin often talks a lot about birth and trauma. We're gonna have a whole episode about that, but being able to hold that space as a doula can certainly be a very spiritual role. birth can sometimes be viewed through the lens of a hero's journey. We can see it as a transformation of the birthing person to mother or parent. And the doula is acting as the role of a spiritual guide. Often in the way religious or spiritual leader would in any kind of life changing. Providing guidance, providing feedback when needed, providing more quiet support when needed. And for some people, religion is a big part of their birth. The birthing person may call out to their higher power requesting guidance or strength. and a doula with openness and understanding can remind them of this connection throughout the birth, especially at those low points. And like I said, even for people who are not religious, I'm not a particularly religious person. Birth often is defined as a spiritual experience. It's that liminal space that we spend time in. And again, I say that for any kind of. and for many I know for myself as a doula, we can often introduce and make space for more rituals into the birthing process. So sometimes that means dancing sense, prayer singing. So this, again can be part of this spiritual role, but it doesn't have to be anything outside of what the birthing person wants. and I think that's really what it comes down to. And we're thinking of this idea of evidence based crunch. And I know from the doula perspective, a lot of this has to do with the depiction of the doula and the individual doula. So the media. social media has a very specific idea of doulas. And I think doulas, we have a job to really make sure that we're dispelling some of these myths. That's where this podcast is coming in. And if you're someone who's pregnant or thinking about becoming pregnant or trying to become pregnant and thinking about a doula, I think one thing that's really important to think about is where is your. evidence based crunch level. Let's call it for this particular thing. Some doulas are going to say, I only attend home births. And that's really great because that's where they are in their comfort level. Other doulas are going to be in a totally different place. I know someone who. Only attend C-sections or only attends VBAs vaginal births after C-sections. I know for myself as a doula, I really, you won't be surprised if you've made it through this podcast, like to combine the evidence based and the crunchy. So I really like to be able to work with people who. are definitely interested in some level of evidence based care, whether that's with a midwife, with a doctor home birth, hospital birth, but are looking to add a bit of spirituality to their birthing experience because that's where I hold space. So that's basically what this episode is all about. Doulas can do a whole range of things. There's not. One role of the doula, I hope you come away from this episode with a bit of understanding that a good deal of doula work is more evidence based than maybe the media or society has led us to believe. Doula work is also a great way to welcome some spirituality into the birth. No matter what your beliefs about spirituality are, no matter how spiritual a person you consider yourself, it's a safe way to have a birth that falls into what are your own desires, which are different for each person. And still welcome some of that spirituality. I truly think doulas are for everyone. I hope we live in a world one day where everyone can have this kind of unbiased and unconditional support. This, as I said, this was one of the real motivations for this. There's always room for some spirituality in the science and for some science in the spirituality. Thank you so much for listening to this episode of evidence based crunch, please remember to like, and subscribe. I'm so glad to have you on this journey.