Ok, as some of you may or may not know, I am in Nurse Practitioner school and have been consumed by my doula research project this semester. I am almost in the final stages of getting this paper ready for journal submission.

Here is a line I have in the intro of my paper:

Many women feel that birth is a natural process that a woman's body was designed to do and that the current medical system has made birth too medicalized. Some women have turned to doulas in an effort to achieve a more natural birth experience.

This is the deal here...I wrote that as an opinion statement in my original draft last semester.
I believe it to be true....duh...isn't that why we are all here?!?
My problem now is that to include it in this type of research paper in a professional journal it has to be referenced. You would think that it would be easy, but not so much. And it has to be from something reputable from this stand point...in other words, it can't come off a blog on Kellymom or something like that.
Any ideas??? Any help would be appreciated.

Next thing....

Here is a line in paper:

The review of the literature on the subject has led to several questions. If the use of a doula is so beneficial, then why is doula use not encountered more often in south Louisiana? The question then becomes, do women in south Louisiana know about doulas, the services that they provide, and the benefits of using these services?

Does anyone know any official/ or referenced stats on doula usage in Louisiana, south La...could be B.R., N.O. or all of state. What about stats in rest of U.S.? Could be state by state, or general geographical regions...east coast, west coast, midwest....

Any help would be appreciated!!!!
Thanks a bunch!!!

I don't know if this will help, but here's a passage from Pushed: The Painful Truth about Childbirth and Modern Maternity Care by Jennifer Block, Cambridge, MA: Da Capo Press, 2007.

"Her [the doula's] increasing prevalence in hospital delivery rooms suggests that women may be striving for something more. In 2005, doulas attended between 120,000 and 200,000 births, and demand for doula training has grown each year for the past decade. Doulas are currently the most highly rated form of labor support in the hospital setting, above doctors, nurses, partners, and even nurse-midwives." (page 154).

The footnote for the statistics points to Listening to Mothers II, the survey published by Childbirth Connection (I think you can download the summary of the report from their website). Also, DONA has a chart of the number of members for the past 15 years, which certainly suggests an increase in demand for doulas. I have a PDF of the full report, so if you need it, let me know (though it might be too big to email, I don't know).

As far as doula usage for specific areas, my understanding is that no one is officially keeping up with that (because hospital records don't reflect whether a woman had labor support or not). Maybe you could ask the doulas in town to estimate how many clients they've had in the last 5 or 10 years? I think that's where the between 120,000 and 200,000 estimate came from --- by asking doulas to report how many women they'd served in a given year. But I don't know of any official record-keeping on how many births doulas are attending in specific locations. Does anyone else?

I'd love to read your research when you finish!

YES!!!! HUGE HELP! And I have read Pushed....why didn't I think of this???? (b/c my brain is so fried I could poke my eyes out w/ a stick!) This is just the stuff I was looking for and a huge help!!!! Thank you so much!!!

I do plan on sharing my info here when done. I would also love to list all the research I used to get to my own research project in a reference type setting when I am done....great stuff...just gotta get the time to get it to Amy.

If you don't mind try to e-mail me that pdf....if can't no biggie...this should get me most of what my prof. wants.

I will pm address to you, b/c my comp. just gave me big red warning not to put in here....never saw that before...

I really appreciate your help!!!!!

So glad you got the help you needed! It always helps to have a fresh pair of eyes....I am the same way. Something will be right in front of me and I just need someone else to point it out!!!

Me too --- there's only so much information your brain can hold at once, right?

At this point, I'm so happy for all the reading I've been doing to be helpful to someone, rather than just sitting in my head or on my computer screen (which is what it feels like most days!)

Good luck finishing your project, Rebecca!

If the use of a doula is so beneficial, then why is doula use not encountered more often in south Louisiana? The question then becomes, do women in south Louisiana know about doulas, the services that they provide, and the benefits of using these services?
Thanks a bunch!!!

Hey Rebecca--glad to see some much needed research being done! I don't think you have to look farther than the desk behind you to find most of the answers to your questions though. You work at a hospital, you work with nurses, doctors, CNMs, other personnel. These ppl, are the general publics first line of defense, so to speak, for obstetrical info and awareness. Have you or anyone else at the PP desk mentioned to a mother/father/family the benefit of a postpartum doula? Do you know any L&D nurses who have said 'ya know you might benefit from having a doula if you want a supportive person to attend your birth and be with you the entire time.'

YOU all know WE are out there. Why doesnt the hospital/doctor staff mention doulas to mamas? Is it out of your scope of practice or licensure to encourage moms to look into support personnel?

I think the term doula gets lost also---many mamas bring doulas to their births, they just arent called doulas. They are the REAL doulas--those friends, family members, spouses, who care so much about respecting, creating, honoring that mothers experience that they will sacrifice their time, energy, and knowledge.

I think many birth books either gloss over the doula section or make a doula seem so out-there, that no one here in BR would ever be so 'hippie' to hire one of those ppl.

I dont know what the average level of education is of most Louisianas, but i would be willing to bet the smarter ones use doulas more often (no data)--could it be that LA is last in education, that doula isnt very popular term--maybe if it was of french origin, it would be more popular? LOL

Have you experienced birth at Touro in NOLA? I bet you would get a different feeling for birth down in that part of south louisiana. In NOLA, the Doulas form a cooperative. They have a yahoo group and usually get together annually for a potluck dinner. I have seen their table, equipped with several doulas, at at least one baby fair, where they hand out flyers with ALL doulas in the area's names, certifications if applicable, and what that doulas speciality is. There are about 20 doulas in NOLA right now and many more apprentices coming behind those certified ones. NOLA is not short of Doulas, but that is because they work together in every sense of the word doula--there is not just one doula, there is a doula for every woman. Most of the doulas down there encourage moms to interview other doulas, they back each other up, so moms dont get left alone, and they embrace supporting women together, collectively, as it should be.

Touro hospital hands out flyers promoting Crys Aprill, a local childbirth educator's class info. She conducts her classes in the hospital. She is a Doula. She rents birth tubs.

In the spirit of the NOLA doula group, we tried desperately to begin our own Baton Rouge Doula group, AKA the Louisiana Childbirth Collective. This was about 3 years ago, after taking the doula-training course Birthhelp offered. With my fellow new doulas, I invited all doulas, childbirth educators, and lactation consultants, birth ppl in town to collaborate in creating a local birthing network. All local BR doulas joined the collective and even Andrea, who was new in town then, encouraged our group--the only local group not willing to join our cooperative was birthhelp. I am not bashing, bad mouthing, or otherwise slandering birthhelp, just stating facts ppl.

Birth is political here. At a babyfair in ToysRUs one year, I, okay so maybe it was Tera ;) but one of us told a mama that Woman's hospital was not very conducive to 'natural' type birthing. We werent trying to scare her, again, just stating our opinions---well, as it turns out Womans is a HUGE sponsor or BabysRUS, so guess who was 'asked' not to speak 'badly' about Womans? HMMMMMMMMMM.

This happened to me the other day---I met a wonderful mother-to-be, had a casual conversation about doulas and it sounded like she was very interested in having me attend her birth. So I REFER her to the CNMs at Ochsner---Bethanie, Kathy, Colleen, and Jennifer. The mama loves them. Things are great! What is not so great is that these CNMs are telling her and mothers like her (she isnt the first I have heard this from) that I do not cooperate with them and I cause conflict in the birthing room. When questioned why or what do they mean---no one answers or the answer is a vague--that I am this toxic, controlling nazi-birther. OK, so those were not words from the CNMs mouths, but basically that is what I hear. May I mention I have never even attended a birth with Jennifer--seen her a few times--and have never met Colleen. So how do these women know me so well to know I shouldnt attend births? So, these CNMs, and it is probably the doctors too, are telling moms not to have me attend their births. And you ask why dont more moms use doulas???? I am not the best doula by any means, in fact I dont even like attending births in hospitals since I usually have to see so many unnecessary procedures take place. But for the love of God, how can it be professional or ethical to tell mothers who they can or cannot have in the room for fear it might make the healthcare provider uncomforatble? WTH? Umm, where is the mom in this picture? WHat about her feelings? So, they feel entitled to tell moms what is best for them? How is that for personalized, midwifery model of care?

My question to all these mama is dont you wonder why your CNM doesnt like me? Is it because I advocate for you? Is it because I dont work for the hospital or have a vested interest in any birthing machine in town? I work for the moms, plain and simple. I am not an enabler of this system. I dont think moms need hospitals, hospitals need moms. Moms are healthy until proven otherwise. We should be referring healthy moms out of hospitals--

This scenario has been playing out for months. I meet someone who wants a Doula and she mentions it to Ochsner doctors/CNMs and I get the call that goes something like 'well, I dont think I will need anyone (you) besides my husband and my midwife, ' which iplies, to me, that the CNM will be with the mother the whole time, when most of us know that the CNM will not be with the mother the whole time and dad, well, he might appreciate having an experienced, support person there as well, but I digress. The mama only wants a tub from me and wants a good deal on it---I cant blame her. I rent them for cheap. really cheap. I usually give discounts for students, nurses, doctors, almost anyone who asks. And then if you dont get a discount you still get to rent the tub for half of what birthhelp offers it for and I refund money if you dont use it.

So, not only do I get 'badmouthed' from the Ochsner group, but I get used for my cheap tubs also. How pathetic.

So, unless I play the political birth game in BR and become part of the system, which will continue enabling this false belief that pregnancy is a sickness and needs to be fixed BS, I wont be the preferred Doula for most. Well, it saddens me deeply to have to choose between the mothers who could have used a tub to have a better birth and my own self-worth.

to finish the long rant, I will no longer be offering tubs to Ochsner mamas. Those who I already have contracts with, I will honor those and fulfill your rental agreement, but I cannot with a good conscience continue to talk to moms who I know are being told lies about me but only want to rent my tubs. I dont believe in THAT model of midwifery care nor can I endorse it.

It is a cruel world, but I have better things to use my energy, passion, and money towards. I still can be hired as a doula. I am willing to work with Ochsner or any doctors, midwives. Of course, you can still borrow a tub from me, if you twist my arm ;), seek breastfeeding support, and if you are lucky enough you might see me at your homebirth :)

Now i am going to get my big girl panties on and quote my imaginary husband ' Get the Hell out of the hospital.' Gotta love Marsden Wagner!

Jackie, I LOVE you. Someone's gotta stick up for the mommas 100%. You are way "braver" than I am. Spoken like a true midwife, btw :)

Which is one reason I second guess me even wanting to be a doula. Am I STRONG enough to help a momma stand up to the hospital staff? I have always been such a diplomatic person that I am having a hard time deciding. My husband and I FINALLY have the money to do it. I tried to sign up the other day and my check card got denied twice on the CBI site. Was it a sign? I took a break to figure it out. Maybe if it goes through the third time....I've been too chicken to try :(

Anyway, I hope I can get the cohones to do this....Even though I am not in BR I would love to join a group with you for "support"!!!!

Jenny

OH - I don't think doulas are encountered so much b/c I just don't think the climate, or culture of women is that of natural birth. Almost all of my friends are mainstream and are completely and totally into medicalized birth. They don't even think twice about epidurals, episiotomies, c-sections. Most of them do know the risks and just choose to ignore it. They are educated women and just don't have the time or the energy to invest in a natural birth, especially since it goes against the grain of the medical establishment.

For now, I am just glad that Lafayette is a little more natural birth friendly than BR or NO. At least we got that going for us. Some may disagree with me, but when you know someone who just had a vaginal twin birth at WOMEN'S hospital in lafayette, it gives you some hope!

Jenny

When I read your question, Rebecca, about why are doulas not as common in south La my thoughts went to the issue that Jackie brings up. I know this type thing goes on but not from any personal account so I didn't post about it. I have tried a couple times to drag it out in other post from those that would know, not because I want to creat some drama but because I want to see a resolve to a big problem. I believe you have to hash things out sometimes to get to that resolve. There is no room in this system for backstabbing, bickering, and slander amoungst the birth professionals. The goal is to give woman good care and support, that can only be accomplished by working together and by giving woman a choice, educating her about ALL her options. There is badmouthing going on all over the place, there is not one group/person responsible. It needs to come to a stop, people need to get over themselves and think about the mother. I don't blame Jackie for wanting to throw in the towel but i hate to see that happen. I know Jackie, she attended my birth, she has become a good friend, and I have shared many conversations with her about birth. Her heart is in the right place, her only ulterior motive is to see women have the best birth possible. I think the same can be said for the CNM's, the nurses, Birthhelp, and anyone else giving their time to helping woman in the birth process. I think everyone has a different prepective and approach, maybe even a different goal. We don't all need to think alike but we do need to be honest and respect others perspective.

I personally don't think a HCP should tell a client who they should bring to thier birth, that is not their business. It is not about the HCP and thier relationship to the doula...it's about the relationship between the HCP and client, the Doula and client. If you wonder why there is not more people aware of doulas in our area, Jackie hit it on the nose, the people at the forefront are not advocationg for them....in fact they are discouraging them. Birthhelp is a wonderful group that does offer woman information and resources, the doulas are "accepted" by the hospitals and maybe even refered to by HCPs but they come with a hefty price and not all woman feel they are getting what they need from the doulas there. That is not a stab, certain personalities mesh and some don't. That is why a network of doulas is so important, just as with a HCP a woman should be able to shop around and find a doula that is a good fit for her and her needs. cost should not be a factor. If the HCPs are deciding what doulas are good and which ones are bad then the woman is taken out of the scenerio. Women are being told they have the choice between no one or a $600 doula that may or may not fit them, most chose noone. I personally did not chose a doula with my hospital birth because the only resource, at the time, that I knew of was birthhelp and I simply could not afford that (we were paying out of pocket for our entire birth). I also was told by my doctor that I did noit need a doula, the staff at woman's was wonderful and an extra person was just not neccessary. My doctor fully intended on my throwing in the towel with this whole "natural birrth" thing the second contractions hit.

As for the tubs, I am unnerved at the way Jackie has been taken advantage of with the tub rentals. She does not care about making money off her tubs, she has them available so that any woman can have access to a tub during labor. It is discouraging to give your time and effort to make sure woman have this option and then to recievce no payoff whatsoever. To have people making you out to be some radical doula who comes in the hospital guns a blazing shouting orders to the staff and taking over the birth.....I just can't imagine Jackie fulfilling that role. I do understand where conflict can arise. It can be difficult to hide your face when something is happening that you don't think it right. I personally do not attend births for this reason, I couldn't stand there holding a moms hand and keep a look off my face while she is told complete BS about some unneccessary intervention. I just know better now, and I wouldn't be able to put that out of my head and smile and tell the mom how wonderful she is doing, and how great her care is. I don't think that HCP's or nuses are doing anything deliberately to harm mothers, I believe they are doing what they think is neccessary. I am not saying that I am more knowledgable about birth than an HCP, I am just coming from a different place. Having been around woman who have experienced birth in it's most natural, most normal state, and having experienced this myself, it is hard for me to see things from the prespective of someone who has only seen birth in a hospital. This doesn't mean I cannot meet in the middle with someone who is of a more medical perspecive, but I don't like being brushed off as some ignorant homebirther who was just lucky to have had a healthy baby and can't know anything about the birth process without having a degree. Just as it's unfair for me to judge a CNM for being too medical, I don't want to be judged as being radical.....we are just on different sides of a triangle, at a certain point we do come together and want the same thing.