The role of the doula in the labor and delivery room

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This slideshow documents the importance of doulas in the labor and delivery room and the benefits of continuous labor support. It was created to specifically address the needs of continuity of care and collaboration between doulas and the medical professionals that care for birthing and laboring women.

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The role of the doula in the labor and delivery room

  1. 1. The Role of the Doula in the Labor and Delivery Room Presented by New Beginnings Doula Training Rachel Leavitt RN, BSN, CD For more information on doula certification visit www.trainingdoulas.com
  2. 2. What is a doula? <ul>This is difficult to define, but my favorite definition comes from Mark Sloane, MD., author of Birth Day </ul>
  3. 3. What is a doula cont. <ul><ul><ul><ul><li>A doula </li></ul></ul></ul><li>“ 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” </li></ul>
  4. 4. What is a doula cont <ul>Some things that people often mention: <li>Nurture
  5. 5. Guide
  6. 6. Assist
  7. 7. Support
  8. 8. Encouragement
  9. 9. Continuous support(this is something that nurses alone may or may not be able to provide) </li></ul>
  10. 10. What is a doula cont. <ul><li>Something that makes a doula unique from other healthcare workers:
  11. 11. She stays with the mom from the time labor starts(or starts and stops and starts:)) to a few hours after birth.
  12. 12. She usually meets with the mom before and after birth. </li></ul>
  13. 13. What does a medical professional do? <ul><li>Performs clinical and medical tasks
  14. 14. This may include taking the blood pressure, checking the cervix, giving medication
  15. 15. Diagnosis medical conditions
  16. 16. Pre-eclampsia, dystocia, failure to progress etc.
  17. 17. Determines the best medical decisions to make along with the client </li></ul>
  18. 18. Case Study <ul><li>To illustrate the differences between the two professions check out this case study
  19. 19. obgynmorningrounds.com/blog/morning-rounds/3-101-chorioamnionitis/ </li></ul>
  20. 20. Case study What a doula does <ul><li>I wanted to explore this from a doula's perspective, and what care a doula gives. </li></ul>
  21. 21. Life Process-as experienced by the mom-Hunger <ul><li>Offer easily digestible foods. In this scenario, this woman wanted pizza.
  22. 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. 23. If food is not allowed, clear liquids like jello, broth or popsicles may be offered. </li></ul>
  24. 24. Process-Fatigue <ul><li>Assess: </li><ul><li>how long she has been laboring
  25. 25. what time she started
  26. 26. how much sleep she's had in the past 24 hours and the quality
  27. 27. does she look tired or exhausted
  28. 28. does she say she is sleepy or fatigued. </li></ul></ul>
  29. 29. Fatigue cont. <ul><li>Find positions that may be comfortable for her to sleep in.
  30. 30. A foam pad may help the beds feel more comfortable for sleeping.
  31. 31. Help work with contraction pain to facilitate rest </li><ul><li>positioning, hot pads or water.
  32. 32. May want/need medication or epidural </li></ul></ul>
  33. 33. Process- Thirst <ul><li>If allowed, give her water or juices
  34. 34. ice chips or small sips of liquids, may help if you she has an iv bag or can't have fluids. </li></ul>
  35. 35. Process-Pain <ul><li>For abdominal pain caused by infection: </li><ul><li>hot pads or ice packs may help where it hurts the most.
  36. 36. Different positioning like side-lying or reclining in a chair.
  37. 37. rocking or walking may help, but don't push it. </li></ul></ul>
  38. 38. Pain cont. <ul><li>For generalized pain </li><ul><li>Massage
  39. 39. lavender, rose, or jasmine essential oils. </li></ul></ul>
  40. 40. Feeling warm(fever) <ul><li>Discuss with mom and doctor whether tylenol is an option
  41. 41. Wet washcloths to cool
  42. 42. Peppermint oi
  43. 43. Ice packs
  44. 44. Fans </li></ul>
  45. 45. Pain with cervical exams <ul><li>Discuss with care provider how many are needed
  46. 46. Start some deep breathing exercises and visualizations before, during, and immediately after the exam.
  47. 47. Have her ball up her fists and place them behind her hips during the exam. This helps tilt the cervix closer. </li></ul>
  48. 48. IV pain <ul><li>Warm cloth wrapped around the hand or arm prior to the procedure to help bring up the blood vessels.
  49. 49. Again, deep breathing can help before, during and after the procedure.
  50. 50. Afterward a warm or cold compress may be useful to decrease the pain. </li></ul>
  51. 51. Process-Anxiety <ul><li>Foot massage
  52. 52. Lavender oil
  53. 53. Deep breathing
  54. 54. Music therapy </li></ul>
  55. 55. Process-Fear <ul><li>Make sure that she has all the information she needs to understand what is going on.
  56. 56. Assess her spiritual resources </li><ul><li>Things like prayer, meditation or other spiritual practices can help when she is feeling fearful. </li></ul><li>Focus on the things she does have control over. </li></ul>
  57. 57. Process-Social Network <ul><li>Discuss with the woman who she really feels comfortable having at this birth.
  58. 58. Also discuss whether or not she wants outside distractions like the phone or computer network.
  59. 59. Help the spouse or significant other to feeling included in the birth process. </li></ul>
  60. 60. Process-Feelings of being cared for <ul><li>Encourage her to express her needs or desires, even if they don't seem significant. </li></ul>
  61. 61. Process-Decision making <ul>Encourage her to ask questions and discuss what she would like to have happen <li>Make sure that she is OK with any procedure that is being done
  62. 62. Before any procedure is done(ie vaginal exam, iv, medication), make sure she gives at least her verbal consent. </li></ul>
  63. 63. Continuous support for women during childbirth(Cochrone Review) <ul><li>Historically continuous labor support has been the norm for women in labor.
  64. 64. In current history, this is no longer true and is more the exception rather than the rule.
  65. 65. This particular review was done to look at the effects of continuous support versus the usual care.
  66. 66. They also wanted to look at what effects certain variables may have on continous support. </li></ul>
  67. 67. Benefits of labor support <ul><li>More likely to have a spontaneous vaginal birth
  68. 68. Less likely to have intrapartum analgesia
  69. 69. Less likely to report dissatisfaction
  70. 70. Labors were shorter
  71. 71. Less likely to have c-sections
  72. 72. Less likely to have instrumental deliveries
  73. 73. Less likely to have regional analgesia
  74. 74. Less likely to have a baby with low apgars. </li></ul>
  75. 75. When is it most effective? <ul><li>When the labor support was not a part of the hospital staff
  76. 76. When the labor support was not a part of the woman's social circle
  77. 77. In settings where epidural analgesia was not readily available. </li></ul>
  78. 78. Who should provide support <ul><li>“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. 79. “Support from a chosen family member or friend appears to increase woman's satisfaction with their childbearing experience.” </li></ul>
  80. 80. How does labor support help? Theorectical foundations <ul><li>Certain environmental influences may effect the progress of labor and feelings of competence in the new mother
  81. 81. These factors include: </li><ul><li>Institutional routines
  82. 82. High rates of intervention
  83. 83. Unfamiliar personel
  84. 84. Lack of privacy </li></ul><li>Continuous labor support provides a buffer for these situations. </li></ul>
  85. 85. Theoretical Foundations cont. <ul><li>Having continuous labor support helps the fetus move through the pelvis and soft tissues
  86. 86. This may happen due to: </li><ul><li>Encouraging mobility
  87. 87. Helping to effectively use gravity
  88. 88. Supporting women in whatever position they choose
  89. 89. Recommending specific positions for specific situations </li></ul></ul>
  90. 90. Theoretical Foundations cont. <ul><li>Anxiety and fear during labor may lead to complications for both mother and baby
  91. 91. Continuous labor support helps to decrease anxiety and fear by: </li><ul><li>Offering emotional support
  92. 92. Information and advice
  93. 93. Comfort measures
  94. 94. advocacy </li></ul></ul>
  95. 95. Conclusion from the review <ul><li>Continuous labor support has clinically meaningful benefits for women and infants and no known harm. All women should have support throughout labor and birth. </li></ul>

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