ADVANCE FOR NURSES ARTICLE
Publication: ADVANCE for Nurses Online Issue Date: 4/1/2002 Vol. 2 Issue 7 Page 14
Lean on ME
A new partnership supports mothers, families and babies through the journey of birth
By Pamela Tarapchak
Pat Lindsey-Salvo, MA, RN, LCCE, IBCLC, remembers the birth of her child, as most mothers do. However, her memories are not necessarily fond ones. As a young, expectant mother, she faced the prospect of birth alone -- no support system, no encouraging words from family, no familiar faces to share in her pain and anxiety. She experienced her labor and delivery only with fear.
Today, Lindsey-Salvo makes caring for new mothers her mission. As coordinator of parent/family education at Beth Israel Medical Center in New York City, she strives to provide families with a birth experience far removed from her own; one where the mother feels confident, happy and, most importantly, supported. With the new creation of a collaboration fostered by Lindsey-Salvo between Beth Israel and BirthFocus, a doula mentoring and referral company, parents and families are being offered more opportunities to experience a joyful birth.
AN IDEA EVOLVES
Soothing words and a comforting touch provide mothers in labor with reassurance. With the help of labor support doulas, more women are feeling these comforts as they embark on the journey of birth. Doula, from the Greek meaning servant, is a woman experienced in childbirth who provides continuous physical, emotional and informational support to the mother before, during and just after childbirth.
A doula's role is one of listener, massage therapist, coach and advocate. She does not perform clinical tasks/assessments or diagnose medical conditions, but rather creates a soothing environment for parents and their new baby.
It was the scent of lavender oil that drew Lindsey-Salvo to the idea of having doulas available for patients at Beth Israel.
"One day, I'm walking down the hall in labor and delivery and I smell this nice lavender scent coming from a room," Lindsey-Salvo recounts. "I look in and there's this mother postpartum with her legs up, and a woman is massaging her feet and legs with lavender oil. She was smiling and it turned out the woman with her was a doula. She was one of the happiest patients I'd ever had. She was so good with the baby; it was such a different experience from my own."
It was this encounter, along with Lindsey-Salvo's own birth experience, that molded her mission to do everything possible to support women through all phases of the labor process.
ADVANTAGES OF LABOR SUPPORT
Beginning in April 2001, Beth Israel and BirthFocus began working as a team to bring quality doula services to women giving birth at the hospital. In this new program, a new mother is introduced to the role of the doula well before her baby's birth. The hospital holds a monthly open house for parents and families where they can meet the doulas and see what the program is all about.
"It's here where mothers can see if they connect with someone and find just the right person," says Elizabeth Ponte, MA, RN, director of patient care services at Beth Israel.
It's this connection that can make a true doula-mother relationship beneficial for all involved in the birth process.
Ilana Stein, CD, director of BirthFocus and mentor of the doulas, believes that mothers benefit most from just having a doula listen to them.
"It's beneficial to have someone see what you're going through without commenting or judging your experience," she says. "Quite often a first-time mother is confused; a listening doula will give her the space and time to explore where she is within the birth process."
During pregnancy, doulas learn the wants and needs of the mother, staying in contact with the mother until the time of birth. During labor and delivery, the doula provides continuous care through comforting touch and massage, effective labor positions, and emotional support and reassurance. This can mean helping the mother get comfortable if she's restricted by monitors, guiding a father who may be tentative about his role in the birth, playing music to comfort the mother, or simply telling her she's doing a great job.
Immediately after the birth, the doula will offer breastfeeding assistance, help the family with immediate needs and get the mother settled in her postpartum room. A short time after the mother and baby have been released from the hospital, the doula will visit them at home to review the experience with the family, answer any questions and offer information on postpartum services as needed.
Along with the advantages of both physical and emotional support, a doula's services may also provide better outcomes in the actual birth, as well as the health of the mother and child postpartum. Researchers have recognized that having a doula assisting a birthing mother or couple results in: 50 percent decrease in cesarean sections; 25 percent decrease in the length of labor; 30 percent decrease in the use of forceps; 40 percent decrease in the use of oxytocin; 60 percent decrease in the use of epidurals; and 30 percent decrease in use of pain medications.1
In addition, some long-term benefits of labor support include improved breastfeeding, decreased postpartum depression, greater maternal satisfaction, better mother-infant interaction and secure, well-bonded children.1
In addition to offering doula services throughout the birth process, Beth Israel has also worked to include postpartum and bereavement doulas, providing additional support to their patients. Postpartum doulas help women make the transition to motherhood.
"They are there if you need somebody to take care of you and the baby," Lindsey-Salvo states. "They'll come to your house, rally around you and listen to what you need. They'll even do laundry and cook for you, allowing the new mom to be able to take care of her baby."
For women who must endure a delivery that ends without a live birth, Beth Israel also offers bereavement doulas free of charge to all patients. They offer comfort and allow the patient to grieve during this difficult period.
With so many services being offered at the hospital, orientation and training of the doulas within Beth Israel has become an essential element of the successful program.
WORKING TOGETHER
To ensure that all services reflect the ideals of both the hospital and BirthFocus, the Beth Israel Parent/Family Education Department educates the doulas on the policies and procedures of the facility including training on hospital birth, breastfeeding, the immediate postpartum period and bereavement. Most doulas also have been, or are in the process of being, certified by Doulas of North America, the Association of Labor Assistants and Childbirth Educators and other nationally recognized certifying organizations.
"What was important for us was that the doulas understand the philosophy and approach to family-centered care that we have here at the hospital," Ponte says. "That would include collaboration with physicians and nursing staff. It was important that we all came from the same philosophical position on patient care."
Lindsey-Salvo notes that the labor and delivery nurses at the hospital have been very receptive to the idea of doulas working with the patients, making it a true collaborative effort in the care of mothers giving birth.
"Nurses do a great job with supporting women in labor, but they have a different role," she stresses. "The doula is there as a constant companion to make patients feel safe; mothers know this person is there for them. Sometimes a nurse can have 2 patients at one time, and along with supporting the mother, her work has a clinical and technical component."
Stein also states that doulas may often help the nurses perform their duties with the mother more efficiently. For instance, if a patient has a problem with needles, a doula can provide comforting words and guide them through a certain procedure, allowing the nurse to complete her job more easily and effectively.
"Some of the nurses are very happy to have us," Stein says. "They really see us as their allies and we work together as a team."
Lindsey-Salvo notes that a few of the nurses have been so impressed by the newly created program that they have applied to become doulas themselves.
"People see this as such wonderful work; it's starting out small, but exploding and going in many directions," she adds.
CONCLUSION
For now, mothers interested in having a doula must pay for the service. Through the collaboration of Beth Israel and Birth Focus, fees vary according to the experience of the doulas and are very affordable.
Lindsey-Salvo says the facility hopes to find funding in the future for patients who can't afford the service. Quite often, these individuals are the ones who don't have support systems during the birth process and may need the program the most. Because of this work, Lindsey-Salvo's mission of providing support to all women giving birth continues.
Through the combined efforts of doulas and nurses, expectant mothers and families at Beth Israel are finding the experience of birth to be a more positive life-altering event, making the next step of life's journey a happier and healthier one to take.
Resource
Klaus, M.H., Kennell, J.H., & Klause, P.H. (1993). Mothering the mother: How a doula can help you have a shorter, easier and healthier birth. Reading, MA: Addison-Wesley Publishing Co.
Pamela Tarapchak is senior associate editor at ADVANCE.
Providing Strength
Birth is most often synonymous with joy, exuberance and miracles. But for many women, a miscarriage or stillbirth overshadows a birth experience and what once was cause for celebration has become tainted by grief.
At Beth Israel Medical Center, New York City, a new program has been created to help women through this period of loss. All patients and their families who experience the loss of a baby in the hospital are provided with a special labor support person, also known as a bereavement doula, free of charge. Trained in the grieving process, the doula remains with the patient during the delivery of her lost baby, offering comfort and reassurance through an almost unbearable time. She also provides a constant presence for the mother that other health care professionals may not be able to maintain due to other responsibilities within the hospital.
"Sometimes it takes a very long time to deliver these babies," says Pat Lindsey-Salvo, MA, RN, LCCE, IBCLC, coordinator of parent/family education at Beth Israel. "And for nurses, it may be hard to be with the mother when they have other duties, especially when the mother can't deliver for hours."
The doula maintains a strong support base for family members as well, often encouraging them to express their loss and guiding them to other available resources in the community that can help them cope with their grief.
For Beth Israel, helping mothers through this terrifying experience is necessary to ensuring a healthy patient in the future.
"We recognize the enormity of the stress related to a fetal demise," says Elizabeth Ponte, MA, RN, director of patient care services at Beth Israel. "While we do have a very strong, active Perinatal Bereavement Committee, we want to provide these patients with extra support at this stage of the grieving process."
Pamela Tarapchak
