As a part of my course, my students are asked to find resources in their area that is related to alternative health care. I thought a list of just basic resources would also be useful, so here’s my list for my state: Arizona. (more…)
This is an interesting video that discusses the importance of providing holistic care for women during childbirth. I often describe the role of a doula by first describing Maslow’s hierarchy of needs. This is a concept that is taught in my course. It can be depicted like a pyramid with phsiologic needs and safety at the bottom of that pyramid, but three other layers on top. These include love/belonging, esteem, and self actualization. All of these needs are considered to be important to our happiness in life.
In our current system, we have done a good job at paying attention to the physiologic and safety needs, but we have forgotten the whole rest of the pyramid that ultimately is necessary for complete health. That bottom part of the pyramid can also take up all the time and effort of a health care provider, depending on the situation. Because of this, doulas form an important part of the health care team as they work to provide the care at the top of the pyramid which then provides complete comprehensive care.
Here’s a video that discusses the importance to paying attention to our clients social/physiological health during birth.
Depression During Pregnancy and Beyond
Depression is one of those areas that we need to pay more attention to. In pregnancy it has been associated with poor weight gain, pre-eclampsia and premature labor. Thus is it is important that we look for it and learn how to treat it.
Because doulas work so closely with their clients it is often the case that they can pick up on signs of depression before others might. While we don’t diagnose the disease, we defineatly have some tools up our belt to help decrease it’s severity and hopefully increase the possibilities of a better outcome at birth.
Just recently a new report came out discussing the benefits for pregnant women to utilize something called mindfulness yoga, which combines yoga with a technique called mindfullness that helps to decrease anxiety and depression. Again, this is something that is taught fully in my course, but I thought I’d give you a preview.
There are two reasons that I think this technique may be importnat.
1) More research is showing health concerns with the use of antidepressants during pregnancy,
2) Mindfullness yoga provides a good way to help the mother prepare for birth by helping her to develop an effective relaxation technique.
I am putting together a series of videos on yoga positioning and exercises, so stay tuned.
Simpson KL, Weaver, KJ, de Villers-Sidani E, et al. Perinatal antidepressant exposure alters cortical network function in rodents. Proc Natl Acad Sci USA 2011;108(45):18465-70.
Muzik M, Hamilton SE, Rosenblum KS, et al. Mindfulness yoga during pregnancy for psychiatrically at-risk women: preliminary results from a pilot feasibility study. Complement Ther Clin Practice. 2012;18:In press.
I thought I’d give you guys another free preview of part of my online doula course. Remember, you can get the whole first unit free. This content comes from my unit on pain during labor and birth. It has a small assignment at the end. If you want, write me a response below, I’d love to see what people come up with.
Typically pain tells us that something is wrong in the body, but many theorists feel like labor pain is different. Some propose the idea that labor pain does not signify a disorder, but is a natural part of physiologic labor. Others feel like different pains during labor may signify the need to change positions or slow down.
Many different theories have also been presented for the cause of labor pain. Hypnobirthing sees it more as cultural construct that is related to fear and anxiety. Others have theorized that it is due to hypoxia and pressure on the structures within the pelvis.
In this course we will be teaching you that pain has physical, emotional and cognitive causes, and that it is unique to each and every person. The way women deal with it is also unique. As a doula, it will be your job to address all of these aspects in your care as well as respect the fact that women themselves are the ones that should describe their experience of pain, not the doula or the other care providers. The causes and theories of pain will be presented, while the actions a doula should take will be discussed later on in the course.
Causes of Pain
There are numerous theories related to how our physiology causes pain during contractions. One has to do with how our cells react to a depletion in oxygen. When the uterus contracts, it may constrict the blood supply and cause a decrease in oxygen. This in turn causes the release of prostaglandins, substance P, and lactic acid. All these are involved in our pain response.
The pressure and stretching of the cervix and perineum may also be described as painful. This pain is also sometimes felt in the rectum or lower back.
During the second stage of labor, pain is caused by pressure on the other organs surrounding the uterus, as well as the stretching of tissues in the vaginal wall and perineum.
Pain can also be caused by how your uterus is tilted. This causes a greater amount of pain during contractions and also decreases the blood supply which then lead to a pain response. How the uterus is tilted and what internal organs may be pushed on during labor may be affected by the position a woman is, so this may play a role in how much pain women feel.
Fatigue can also play a role in how much pain a woman feels. When a person is exhaustd, their ability to cope with pain decreases.
Genetics may also play a role in how we feel pain.
Past emotional experiences also make a difference in how women percieve pain. Situations that tend to increase feelings of pain include: a previous traumatic birth, previous sexual abuse, or any other perinatal or birth losses previously experienced.
Fear also tends to increase feelings of pain, which in turn increases feelings of fear and anxiety. This is believed to happen because the area of the brain that regulates emotional reactions is also stimulated when pain is felt. It also affects our hormones, that then tighten the uterine muscles. Fear is created in many ways during childbirth. Things like hospital routines, unfamiliar environments, strange people around you, and being confined can all lead to feelings of fear or that something is wrong.
Dr. Grantly Dick-Read also theorized that pain during labor is caused by fear. He felt like fear caused the sympathetic nervous system to be stimulated. This in turn causes the circular muscles of the uterus to contract, which opposes the normal action of the uterus and results in oxygen deprivation and more pain. This theory has come to be known as the fear-tension-pain theory.
People view pain and their ability to cope with it in different ways. Some woman may see themselves as being able to cope with pain and feel like they are capable and responsible for controlling it themselves. Others are more dependent on others for help in coping with pain. This may include medication, but it also may just be more hands on care by the doula. It is important to understand what coping style a women uses to best meet her needs.
Culture plays a big role in how women respond to pain also. Culture, very often, determines what is acceptable and unacceptable ways of dealing with pain. Some cultures view labor and birth as unacceptable painful, while others view it as normal and okay. Some may see it as a test of faith, a challenge to overcome, or a punishment. It helps to understand how your client views pain in order to help her work through her labor.
Physiology of Pain
There are three processes involved when pain is transmitted to the brain. The first begins at the point of injury and includes how the pain impluse is transmitted. The second is how our brain interprets it, and the third is how the brain responds to the information given.
When an injury first happens, A-delta fibers transmit sharp and localized sensations that are also very fast. A-beta fibers transmit sensations from the skin, ans A-alpha fibers transmit sensations from the muscles. A C-fibers, on the other hand, are slow, dull, aching feelings.
These impulses are transmitted from the area of injury to the spinal column and then to then brain where the impulse is interpreted. This is not a simple process and involves previous experiences, cultural influences and our own feelings about pain.
Once a stimulus is interpreted as being painful, the body releases chemicals like endorphins, serotonin, and norepinephrine that help produce a pain-relieving effect.
Most theorists use the gate control theory of pain to describe how we feel and process pain. This theory proposes that pain can be stopped at three seperate points: 1)at the ends of the nerves, 2) Where the nerves first connect at the spinal column, 3) and where pain is interpreted in the brain.
Pain at the ends of the nerves can be reduced by increasing the amount of natural endorphins produced, which provide a pain relieving effect at the end of the nerves. Once the pain impulse reaches the spinal cord, it is transmitted to the brain, but the a gating mechanism blocks the transmission of other impulses. Thus, triggering the faster A-delta fibers before the C-delta fibers, helps to block some of the impulses that may be received. This may also explain how techniques such as imagery or or distraction help to relieve pain. It also helps explain why touch may help.
Find a birth story online, then tell what may cause pain in that situation and why(remember that pain is caused by physical/social/and cognitive processes).
Read about epidural/endorphin relationship. Read about assessment of research. Assess this article, discuss how this might impact your work as a doula and what information you can provide to your clients when they are making decisions.
You can find these articles under current students unit 4 required reading.
I want to pose a question for my student doula’s out there. There has been some research that has suggested that women with gestational diabetes have decreased contractility during labor. So their uterus does not contract as efficiently, with or without pitocin. How can you as a trained doula, help provide labor support before and during labor for a woman with this condition? If you’ve been through my course, use the process discussed to come up with this clients needs and specific actions you would take.
I’m making up a case study on this as we speak:)
In one post I did, I mentioned the importance of validation during labor and birth. I then asked that you think about ways that you can validate women during labor. As I thought about this, my train of thought turned to how my husband helped to validate my ability to birth during my last labor.
I was very tired and kept telling him how I didn’t think I could do this any more(sound familiar?). He just looked at me, and then said, “Rachel, you’ve done this before and you can do it”. That changed my whole thought process. When you find a woman faltering or feeling inadequate sometimes all they need is a little validation from a spouse, a friend or family, or doula.
In Maslow’s Heirarchy of needs, self-esteem is one of the needs he mentions. You can see this manifested in the birthing room in various forms, but one of the most important, is a validation for the woman as a person capable of making her own decisions. To help illustrate this point, I’ve added this video. After viewing, try and think of ways you can help validate women during labor and birth as a doula.