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Doula
Jul 22, 2009 14:01:26 GMT -5
Post by medic09 on Jul 22, 2009 14:01:26 GMT -5
Any of you doing L & D? How important do you think is the role of a doula?
A colleague was asked about this concerning the doula meeting the patient on Shabbat, etc. I found it an interesting question. I don't do L & D (except emergencies or precipitous deliveries!), so I don't know how important or substantial a doula's presence might be. Interesting question.
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Doula
Jul 23, 2009 0:29:53 GMT -5
Post by Rivka P on Jul 23, 2009 0:29:53 GMT -5
I am not in L&D but I did deliver a baby with the assistance of a (frum) doula and our plan was that if I went into labor on shabbos, she would ride in our car with us to the hospital. Her assistance was definitely necessary in my case. She made the pain bearable and a lot less apparent. She helped me stay quite calm with multiple interventions and encouragement. I also felt that it was important to my husband that the doula be there. As it was, he was very nervous and stressed out, so it was good for him to know that I had another support person there. Everyone asks their own shaila, obviously, but as I outlined above, I do think that the doula's assistance warrants her coming along with the patient on shabbos. I have a friend who has met her client at the hospital (driven her own car.) I don't know if my doula would have been comfortable doing so.
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Doula
Jul 23, 2009 12:15:40 GMT -5
Post by medic09 on Jul 23, 2009 12:15:40 GMT -5
I should clarify: the person with whom I've been discussing this is the rav of a kehilla. He was approached by a new doula who asked him what is possible, appropriate, permissable. He asked for my input since I actively work as an RN, in addition to my other involvements.
So, the question revolves around how necessary for the welfare and safety of the mother or baby is the doula. Do they fill a role that isn't or couldn't be done by a husband, nurse, etc.? Are mother or baby outcomes better with a doula? (I need to do a lit search on that one.)
You all get the idea. I'm very interested in hearing your thoughts.
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Doula
Jul 23, 2009 22:04:04 GMT -5
Post by psyched on Jul 23, 2009 22:04:04 GMT -5
I am actually looking into becoming a doula. You can pass on to the rav the following: It has been proven via study that a doulas presence can reduce risk of c-section and other interventions significantly. Women who use doulas are less likely to get epidurals (which can oftentimes cause complications) and, on a whole, have shorter, more productive labors. (Partly, perhaps, BECAUSE they don't take epidurals which can lengthen labor time.) A woman in labor is a cholah sh'yesh lah sakana and I would think that in that status, anything that can help her would be allowed. I was told by my doula that she was allowed to be driven to the hospital on shabbos for a patient so long as the patient would TRY to do the labor without epidural- making her role helping the yoledet give birth easily - without the aid of epidural. If in the end, the woman needed it, fine. but l'chatcheela she was only able to go if the woman would try to not have one.
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Doula
Jul 23, 2009 22:09:29 GMT -5
Post by psyched on Jul 23, 2009 22:09:29 GMT -5
I couldn't resist- this is something I'm very passionate about. From americanpregnancy.org:
What are the benefits of having a doula? Numerous studies have revealed the benefits of having a doula present during labor. A recent Cochrane Review, Continuous Support for Women During Childbirth, revealed a very high number of positive birth outcomes when a doula was present. When a doula was present, women were less likely to have pain relief medications administered, less likely to have a cesarean birth, and reported having a more positive childbirth experience1. Find a Doula Now.
Other studies have shown that having a doula as part of the birth team decreases the overall cesarean rate by 50%, the length of labor by 25%, the use of oxytocin by 40% and the request for an epidural by 60%2.
Doulas often use the power of touch and massage to reduce stress and anxiety during labor. According to physicians Marshal Klaus and John Kennell, massage helps stimulate the production of natural oxytocin. The pituitary gland secretes natural oxytocin to the bloodstream which causes uterine contractions and also secretes it to the brain, which results in a feeling of well being, drowsiness and a raised pain threshold. Synthetic IV oxytocin cannot cross into the blood stream and brain, so it increases contractions without the positive psychological effects of natural oxytocin.
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Doula
Jul 24, 2009 0:43:49 GMT -5
Post by achot on Jul 24, 2009 0:43:49 GMT -5
I agree with psyched, in my day we didn't have doula's we were thrilled that our husbands can be in the room at all - not like my grandmothers day... However our husbands have a really limited role and can't really help, in fact often are a hindrance. I have noticed here in Israel many girls bring their mothers into the L &D room and leave their husbands in the waiting room with their fathers. If I can't be there I would feel better having a Doula there, she is much more than moral support.
I had to grin and bear the pain, as I refused to have an epidural and didn't want my husband to see how much I was suffering- to this day he thinks it was a walk in the park...
Perhaps someone should do a study on the outcomes of births for Jewish religious women- using a doula and not...or perhaps it was already done among the other studies. In any event, the Rav should ask the Doula what she does professionally for the patient that the patient will not be getting from the medical staff from the hospital and decide if the situation warrants her breaking Shabbat to ride on the ambulance. Personally (and I'm no expert in this situation) I think she does a great deal and could save a life just by being there with the Yoledet. SHe can identify or prevent problems the staff cant.
I understand that Rav Shlomo Zalman Auerbach gave an answer that if a Jewish soldier is brought to the ER on Shabbat, the Shabbat may be broken in order to bring a family member to be with him as it is Sakanat Nafashot to be alone in a hospital these days with the shortage of staff...an accompanying person can alert staff to problems and can help the patient when the staff is too busy to even come answer the call bell (assuming the patient CAN reach the call bell)
In the zechus of saving a life by breaking one SHabbat may we be zocheh to fulfilling MANY Shabbatot!!(Ramban) Shabbat Shalom!
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Doula
Jul 24, 2009 1:25:48 GMT -5
Post by Rivka P on Jul 24, 2009 1:25:48 GMT -5
Because we are talking about the risks of epidurals, I wanted to add that one of my patients the past two nights is a mom that went into cardiac arrest during childbirth after administration of a third epidural. She suffered an anoxic brain injury and now is flaccid with a trach, feeding tube, foley etc. It's so sad! and to think that it was from an epidural. Makes me never want to get one ever again. (not that I wanted one the first time, but I needed it. long story.)
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Doula
Jul 25, 2009 13:25:57 GMT -5
Post by achot on Jul 25, 2009 13:25:57 GMT -5
Yes we have had pts like you described, young mothers whose life was stolen from them and spend the rest of their "lives" unresponsive, quadriplegic, tube fed etc. Complications of an epidural. So Sad!!!
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Doula
Jul 26, 2009 18:29:11 GMT -5
Post by psyched on Jul 26, 2009 18:29:11 GMT -5
WOW. Seriously? I thought mistakes that that are one in a million. That strengthens my no epidural stance!
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Doula
Jul 27, 2009 7:23:00 GMT -5
Post by achot on Jul 27, 2009 7:23:00 GMT -5
WOW. Seriously? I thought mistakes that that are one in a million. That strengthens my no epidural stance! even one in a million is too much for me !
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Doula
Aug 2, 2009 0:21:32 GMT -5
Post by achot on Aug 2, 2009 0:21:32 GMT -5
My brother tells me that Rav Gans from Mattersdorf ( a well known and respected Rav who deals with these kinds of shailas) gives a heter to a doula to travel to the hospital for a Yoledes. (Traveling home...we dont know)
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Doula
Aug 8, 2009 22:06:54 GMT -5
Post by chavamom on Aug 8, 2009 22:06:54 GMT -5
I'm an L&D RN and was a doula previously. I was told I could travel to the hospital on shabbos with a yoledes AND that I could come home. I also think the role of a doula is really important for many women - even if they plan on getting an epidural.
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Doula
Aug 8, 2009 23:48:20 GMT -5
Post by achot on Aug 8, 2009 23:48:20 GMT -5
I'm an L&D RN and was a doula previously. I was told I could travel to the hospital on shabbos with a yoledes AND that I could come home. I also think the role of a doula is really important for many women - even if they plan on getting an epidural. I agree with the need for a doula even if an epidural is planned, who told you about the traveling on Shabbat? I am asking for a doula here in my neighborhood.
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Doula
Aug 16, 2009 2:04:22 GMT -5
Post by chavamom on Aug 16, 2009 2:04:22 GMT -5
I honestly don't remember who told me about traveling on shabbos - I believe it was Rav Leff, though it might have been R. Yitzchak Berkowitz. I was living in Israel when I was a doula. That I could come home, that was a chidush to me and that was told to me about our local rav (no longer live in Israel).
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Doula
Aug 16, 2009 12:47:01 GMT -5
Post by medic09 on Aug 16, 2009 12:47:01 GMT -5
If any of your could remember and specify WHO gave WHAT instructions, and under WHAT CIRCUMSTANCES; that would be very useful. I could then follow up with that rav to ask what his rationale was, etc. You may email me off-forum if you prefer.
Although general comments such as, "I was told..." and "I heard from my SIL..." are informative, they have no halachic value since the specifics cannot be reviewed. Halachah is a bit like peer reviewed research; there has to be an ability to question the source and the his rationale.
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