Doulas know the importance of oxytocin in labor. Oxytocin is often called the "love hormone" but in labor and during feeding, it is also the "squeeze hormone" helping the uterus to contract in order to change the cervix and birth a baby, and pushes milk to the baby during lactation.
Doulas can do a lot to help create a birth space that encourages the production of the laboring person's oxytocin to promote labor progress. This shareable infographic gives clients an idea of how doulas can help make the oxytocin flow!
Doulas can play gatekeeper, helping the laboring family to invite or recuse family members as the family desires. At the family's request, they can keep friends and family informed about progress and share information at the request of the family. Doulas are great at finding helpful tasks for people to do to support the laboring person. Creating privacy for the person who is giving birth helps increase oxytocin and promote progress.
Oxytocin goes up when a laboring person feels safe and fear (and catecholamines, the fear hormone) is kept at bay. A doula can help the laboring person and their support ask questions and share concerns if they are worried. Having answers can reduce or minimize their fears. Doulas can assure the family that the emotions and sensations they are feeling are a normal part of labor. They provide continuous support so that the laboring person does not need to worry about being alone.
If the laboring person and their partner want to work closely together during the labor and birth, a doula can set up the support person for success. They can remind the partner or support person to eat and take breaks. They can also help the partner to best support the laboring person and the labor by providing tips and techniques that are appropriate for each stage and phase of labor. The partner does not need to worry about recalling the information themselves. The doula also helps to make sure that the partner's voice is heard along with the laboring person's.
A doula can "model good doula behavior" that helps everyone else in the room follow suit. That includes talking with low voices, stopping conversations during contractions, offering food and drink, helping the laboring person to get into comfortable positions, respecting the modesty of the pregnant person, keeping the room quiet, offering soothing music and more. Doulas know just how to utilize the labor bed for best possible labor and pushing positions that make the laboring person comfortable and the labor effective at the same time.
After the baby is born, a doula can help get the baby skin-to-skin with the birthing parent, make them comfortable and assist in latching on the baby for feeding. This skin-to-skin also helps in immediate bonding for the birthing parent and the baby. If for some reason, the birthing parent is not able to receive their baby skin-to-skin, the doula can assist a partner or other support person to stand in and do skin-to-skin with the baby until the birthing person is ready. There are many benefits for a baby to be skin-to-skin with their parent(s).
Events & Announcements
For Guam moms about to give birth and desiring to breastfeed: Check out this wonderful video on Natural Breastfeeding, by renowned author and lactation specialist, Nancy Mohrbacher.
Go to naturalbreastfeeding.com
She challenges some of the poor practices that used to be taught by lactation professionals, and how there is an easier, better way of breastfeeding. It's quite exciting and is proving to be much easier for mom and baby!
Just because we have the technology for intervention, doesn't mean it's safest to use it, when not necessary. Check out the article on the left.
Committee on Obstetric Practice
Committee Opinion (Number 687 • February 2017)
The American College of Nurse–Midwives and the Association of Women’s Health, Obstetric and Neonatal Nurses endorse this document. This Committee Opinion was developed by the American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice, in collaboration with American College of Nurse–Midwives’ liaison member Tekoa L. King, CNM, MPH, and College committee members Kurt R. Wharton, MD, Jeffrey L. Ecker, MD, and Joseph R. Wax, MD.
This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed.
Continuous Support During Labor
Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor. Benefits found in randomized trials include shortened labor, decreased need for analgesia, fewer operative deliveries, and fewer reports of dissatisfaction with the experience of labor (1, 17).
As summarized in a Cochrane evidence review, a woman who received continuous support was less likely to have a cesarean delivery (RR, 0.78; 95% CI, 0.67–0.91) or a newborn with a low 5-minute Apgar score (fixed- effect, RR, 0.69; 95% CI, 0.50–0.95) (1).
Continuous support for a laboring woman that is provided by a non-medical person also has a modest positive effect on shortening the duration of labor (mean difference –0.58 hours; 95% CI, –0.85 to –0.31) and improving the rate of spontaneous vaginal birth (RR, 1.08; 95% CI, 1.04–1.12) (1).
It also may be effective to teach labor-support techniques to a friend or family member. This approach was tested in a randomized trial of 600 nulliparous, low-income, low-risk women, and the treatment resulted in significantly shorter length of labor, greater cervical dilation at the time of epidural anesthesia, and higher Apgar scores at 1 minute and 5 minutes (18).
Continuous labor support also may be cost effective given the associated lower cesarean rate. One analysis suggested that paying for such personnel might result in substantial cost savings annually (19).
Given these benefits and the absence of demonstrable risk, patients, obstetrician–gynecologists and other obstetric care providers, and health care organizations may want to develop programs and policies to integrate trained support personnel into the intrapartum care environment to provide continuous one-to-one emotional support to women undergoing labor.
NOTE: This is an excerpt from an article published in the Committee Opinion, Number 687, February 2017.