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Frequently Asked Questions |
What is a Doula?
(from the DONA Website) The word, "doula," comes from the Greek word for the most important female slave or servant in an ancient Greek household, the woman who probably helped the lady of the house through her childbearing. The word has come to refer to "a woman experienced in childbirth who provides continuous physical, emotional, and informational support to the mother before, during and just after childbirth." (Klaus, Kennell and Klaus, Mothering the Mother) A doula... Recognizes birth as a key life experience that the mother will remember all her life... Understands the physiology of birth and the emotional needs of a woman in labor... Assists the woman and her partner in preparing for and carrying out their plans for the birth... Stays by the side of the laboring woman throughout the entire labor... Provides emotional support, physical comfort measures, an objective viewpoint and assistance to the woman in getting the information she needs to make good decisions... Facilitates communication between the laboring woman, her partner and clinical careproviders... Perceives her role as one who nutures and protects the woman's memory of her birth experience. The acceptance of doulas in maternity care is growing rapidly with the recognition of their important contribution to the improved physical outcomes and emotional well-being of mothers and infants.
Why a birth doula?
©DONA 2002 Permission granted to freely reproduce in whole or in part with complete attribution. BIRTH DOULAS MAKE A DIFFERENCE The value of providing laboring women with continuous emotional support, physical comfort, and encouragement has been recognized worldwide. Given the clear benefits and no known risks associated with intrapartum support, every effort should be made to ensure all labouring women receive support, not only from those close to them but also from specially trained caregivers. This support should include continuous presence, the provision of hands-on comfort, and encouragement. Hodnett, E.D. “Support from caregivers during childbirth” (Cochrane Review) in Cochrane Library, Issue 2. Oxford Update Software, 1998. Updated Quarterly. A doula provides support consisting of praise, reassurance, measures to improve the comfort of the mother, physical contact such as rubbing the mother’s back and holding her hands, explanation of what is going on during labour and delivery and a constant friendly presence. Such tasks can also be fulfilled by a nurse or midwife, but they often need to perform technical/medical procedures that can distract their attention from the mother. Care in Normal Birth: a Practical Guide. Report of a Technical Working Group. World Health Organization, 1996. Facing unprecedented pressures to reduce expenses, many hospitals are targeting the largest single budget item—labor costs… (An) unintended consequence of nursing cutbacks may be an increased cesarean rate; the inability of pared down nursing staff to provide continuous coverage to laboring mothers (has been) shown to increase the chance of a cesarean…Doulas clearly improve clinical and service quality; they provide an absolutely safe way to reduce cesareans and other invasive birthing interventions. Coming to Term: Innovations in Safely Reducing Cesarean Rates. Medical Leadership Council, Washington D.C. 1996 Professionals have paid much attention to innovative technology and the many new options for monitoring and managing labor. While the technology is important, it can become so prominent that clinicians ignore both the natural aspects of labor and the non-technical needs of women in labor… Changes that support the patient in labor and reinforce the natural, physiologic process…. Includes providing one-to-one psychological support for patients using nursing staff or doulas. Reducing the Cesarean Section Rates while Maintaining Maternal and Infant Outcomes. Bruce L. Flamm et al. Institute for Healthcare Improvement, Boston, 1997 The continuous availability of a caregiver to provide psychological support and comfort should be a key component of all intrapartum care programs, which should be designed for the effective prevention, and treatment of dystocia (non-progressive labor). Guidelines on Dystocia. Society of Obstetricians and Gynaecologists of Canada, 1995. ©DONA 2002 Permission granted to freely reproduce in whole or in part with complete attribution.
Questions to Ask a Prospective Birth Doula
The following questions will help you decide if a particular doula is right for you. You may consider asking these questions on the phone, before having an in-person interview.
1.• What training have you had? (If a doula is certified you may consider checking with the certifying organization.)
2.• What is your philosophy about childbirth and supporting women and their partners through labor?
3.• When do you try to join women in labor? Do you come to our home or do you meet us at the place of birth?
4.• May we meet with you to discuss our birth plans and the role you will play in supporting me (us) through childbirth?
5.• May we call you with questions or concerns before or after the birth?
6.• Do you meet with me (us) after the birth to review the labor and answer questions?
7.• Do you work with one or more backup doulas for times when you are not available? May we meet her/them?
8.• What is your fee, what does it include, and what are your refund policies?
9.• Can you provide references? (Be sure to check the references.)
When you meet the doula (and it is a good idea for both of you and your partner to meet her), pay particular attention to your personal perceptions of the doula. Is she kind, warm, enthusiastic? Is she knowledgeable? Does she communicate well? Is she a good listener? Is she comfortable with your choices or does she seem to have her own agenda? Do you feel comfortable with her? The way you feel with her may be more important than the number of births she has attended. You may want to interview more than one doula and make a comparison to help you find the doula who is right for you. (from the DONA Website)
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Home birth vs Hospital vs Birth Center |
Comparing Home Birth to Hospital and Birth Center Birth
From BirthMattersMidwifery.com Compiled by Beth Overton. Used by permission.
The act of having a baby is a moment of great strength & passion. Where and how you choose to give birth can either enhance
the life experience or diminish it. Please take advantage of this overview of the differences between home birth and hospital
birth. While you read, remember that our so-called modern method of “legs-in-the-stirrups-up-on-a-table” birth in hospitals
comes from a point in history when Louis XIV commanded that a “viewing table” be constructed so he could better see the
birth of one of his mistress’ children. Of course since he was the king, it became the “au courant” thing to do among the elite
and eventually made its way into the accepted norm.
Advantages of Home Birth:
• Statistics show that home birth is as safe or safer than hospital birth for low-risk women with adequate prenatal care and a qualified attendant.
• At home, a woman can labor and birth in privacy and comfort of the familiar surroundings of her own home, surrounded by loved ones, in whatever positions and
attire she finds most comfortable. • The laboring woman maintains control over everything impacting her labor and birth. Meeting her needs is the
only focus of all those present. Nothing is done without consent.
• Labor is allowed to progress normally, without interference and unnecessary interventions. Studies show that the risk of infection is reduced for both
the mother and baby.
• During labor the woman is encouraged to eat, drink, walk, change position, make noise, shower, bathe, etc.• Caregivers are invited guests in the birthing woman’s
home. She can have anyone she desires present: family, friends, children, etc. Her care providers (midwife and birth assistant) do not go home because their shifts have
ended. They also don’t take the day off because they planned something else or because it is a holiday. • The birthing mother doesn’t have to worry about when to go to the hospital since her care providers come to her.
• Continuous one-on-one care is given by the midwife, providing ongoing assessment of the baby’s and mother’s condition throughout the birth process and postpartum
period. Her care provider knows her well and she knows her care provider. They have established a trust relationship.
• Women are supported throughout the hard work of labor, and empowered to realize their magnificent potential from such a powerful life-changing event.
• Bonding is enhanced and includes everyone who has contact with the baby, including relatives and neighbors. Breast-feeding is facilitated by the baby remaining with
the mother.
Disadvantages of Home Birth:
• Clients must assume a greater responsibility for their own health: physical, mental, and spiritual. This requires active ongoing participation in
decision- making in all aspects of their care, and a willingness to accept the consequences of those choices and decisions.
• Since the hospital is currently the socially accepted location of birth, choosing otherwise may result in negative judgments and lack of support.
• Cesarean section, forceps deliveries and a neonatologist are not available at home. Transport to the hospital is necessary for these and other
medical interventions.
• Personal arrangements must be made for postpartum care, such as meals, housekeeping, child care, etc.
• The cost of home birth may not be covered by the client’s insurance.
Advantages of a Hospital Birth:
• Many mothers feel safest laboring at a hospital. • It is the safest environment for the mother at risk of medical complications during labor.
• It is the only option available should a cesarean be necessary.
• Immediate pediatric attention is available should the newborn need immediate medical care. It has round-the-clock help for the mother and baby.
Disadvantages of a Hospital Birth:
• The parents are not on “home ground” and do not have the same control. • Hospitals can seem impersonal and intimidating.
• The father is less likely to be actively involved in a hospital setting, and may feel like an “outsider.” • Some routine separation of the mother and baby is
almost unavoidable.
• The birth is usually managed by experts trained in pathology, not normal births.
• The mother is at a significantly higher risk of having an unnecessary cesarean section.
• The risk of complications or infections caused by medical interference to the mother and baby is
greater among mothers who deliver in hospitals rather than with the help of a qualified midwife in their own home.
• Less privacy is available. • Most hospitals do not allow the mother much rest.
Advantages of a Birth Center Birth:
• The facility is usually only provided for pregnancy and birth events.
• In a birth center, pregnancy is considered a natural and healthy process.
• During pregnancy and birth women are encouraged to show responsibility for their own health care.
• It provides an alternative to parents not comfortable with home birth, yet who are not wanting to give birth in a
hospital.
• It has many of the same advantages as home birth, such as greater parental control, non-interventive obstetrical
care, freedom to eat and move during labor, and to give birth in any position, and to have family and friends
attend the birth.
• It offers personalized care at a much lower cost than traditional hospitals.
• In most centers, parents can meet the entire staff prior to the birth.
• The rate of cesarean and forceps deliveries is less than hospitals.
• The discharge time after birth is normally measured in hours not days.
Disadvantages of a Birth Center Birth:
• Rigid screening criteria often eliminate healthy mothers (i.e., VBAC [Vaginal Birth After Cesarean], mothers over 35).
• The mother is still moved to the birth center during labor, and still labors away from the home
environment.
• Many have rigid rules concerning transporting of the mother to the hospital (i.e., prolonged labor,
ruptured membranes).
• There are usually no pediatricians on staff if the baby has special needs.
• The mother cannot remain at the birth center for a two or three day rest; discharge is usually within 4 to 24 hours after birth. |
Islamic Questions |
Islamic information: What is the ruling regarding a man assisting a woman whilst she is giving birth?
Response: In principle, it is not permissible to say the admitting of a woman to hospital to give birth is outright permissible, rather it is imperative to define the constraints (within which it is permissible). So if the female doctor is of the opinion, based upon her knowledge, that this pregnant woman will not be having a natural birth, and she could quite possibly require a caesarean, then in this case she is to be transferred to the hospital. As for a natural birth, then it is not permissible for her to leave her home and be admitted to the hospital simply to have a natural birth. If the woman is in (genuine) need of being admitted to the hospital, then it is obligatory that a male doctor is not appointed to assist her in the birth process. However, if one (female doctor) is not present, then there is no harm, or rather, if she is in a dangerous state and a female doctor is not present, then it is obligatory that a male doctor assist her (during the birth process). And this response is derived from two principles from the principles of usool al-fiqh and they are: 1) Necessities permit the forbidden. 2) A necessity is assessed in accordance to its extent. So if the woman is able to give birth in her home, then it is not permissible for her to go to the hospital; (and) if she is in need - such as there being no-one to assist her in the birth process - then a female doctor can be appointed, and if there is none present, then a male doctor can be appointed (in her place). So in principle, it is not permissible for a woman to leave her home except where necessary, as is mentioned in Saheeh al-Bukhaaree when the (following) statement of Allaah was revealed: {And stay in your houses, and do not display yourselves like that of the times of ignorance}, al-Ahzaab, 33] And he (sal-Allaahu `alayhe wa sallam said: ((And Allaah has permitted you to go out for your needs/necessities)), [Saheeh al-Bukhaaree Volume 1, > Reference 40; Saheeh Muslim - Volume 4, Reference 1709]
Shaykh al_Albaanee Fataawa Muhimmah li-Nisaa. al-Ummah-Page 240
www.fatwa-online.com
Islamic information: Knowing what is in the womb?
Question: In the December 1975 edition of "al-'Arabee" number 205, page 15, it is alleged under the question and answer column that it is man who decides the gender of the fetus. Is there anyone other than Allaah who knows the unseen? What is the Islaamic ruling on this issue?
Response: First of all, it is Allaah alone Who fashions the fetus in the womb the way He wishes. He either makes it female or male, perfect or deformed, and so on. No one else other than Allaah can do that. He says: {It is He Who fashions you in the wombs as He wills. There is no true God except He, the Almighty, the All-Wise}, [Soorah Aal-'Imraan, Aayah 6] And He says: {To Allaah belongs dominion of the heavens and the earth. He creates what He wills. He gives females to whoever He wills and males to whoever He wills. Or He gives them twins of males and females, and makes whoever He wills barren. He is the All-Knower, All-Powerful}, [Soorah ash-Shooraa, 49-50} Allaah the Exalted, is the only Proprietor of the heaven and the earth. It is up to Him to create whatever He wills, and fashions the fetus in the womb as he likes, be it male or female, perfect or deformed, beautiful or ugly, or any other fetal conditions. He is alone, not a partner nor anyone else, Who does so. A claim that a husband, a doctor, or a philosopher can decide the sex of the fetus is groundless. All the husband can do is to wait for his wife's fertility period to have intercourse with her, for the hope of pregnancy. He may have what he wants fulfilled by the Decree of Allaah. Pregnancy may not take place for one reason or another, or due to a blockage in the fallopian tubes or inferility. Or it may be that Allaah wants to test the endurance of his servants. This means that material means themselves have no effect on the case; rather, they work by the Will of Allaah. Fertilisation is a thing belonging to the universal Will of Allaah, and the human can only do the action with the Will of Allaah. As for the disposal of the affairs, the formation, and the arranging of the causes, all are restricted to Allaah alone. He who contemplates the conditions of people, their claims and lies out of ignorance and excessive estimation of modern sciences, surely exceeds the limits of trusting the material means. He who evaluates the matters properly will be able to distinguish between what is restricted to Allaah alone, and those which Allaah allowed the servant to do through His Decree. And with Allaah lies all success and may Allaah send prayers and salutations upon our Prophet (sal-Allaahu `alayhe wa sallam ) and his family and his companions.
The Permanent Committee for Islaamic Research and Fataawa Fataawa Islaamiyyah -Volume 1 Page 40
www.fatwa-online.com
Islamic Information: Bleeding before birth:
Question: A woman had bleeding during pregnancy, five days before giving birth, during the month of Ramadhaan. Should that blood be considered menstruation or istihaadha and what are the obligations upon her?
Response: If the matter is as mentioned, with her seeing blood five days before giving birth, and she did not have any signs that labor would be soon, such as contractions, in that case, the blood is neither menstruation nor post-partum bleeding. It is simply irregular blood. Therefore, she should not abandon the acts of worship but she must fast and pray. If along with the blood she has signs that her labor is near, such as contractions, then it is considered post-partum bleeding and she abandons, due to it, praying and fasting. Then if she becomes pure after giving birth, she must make up the days of fasting but not the prayers. And with Allaah lies all success and may Allaah send prayers and salutations upon our Prophet (sal-Allaahu `alayhe wa sallam ) and his family and his companions
The Permanent Committee for Research and Fataawa Fataawa al-Mar.ah
www.fatwa-online.com
Islamic Information: Breastfeeding after Menopause
Question: What is the ruling concerning a woman who has reached the age of menopause and she breast feeds a child five sucklings or more during the first two years of that child's life. Does this breast feeding make them illegal for each other [and all the other ramifications], giving him a foster father even though the breast feeding woman may be without a husband.
Response: Breast feeding makes forbidden what blood relations make forbidden. Therefore, the breast feeding mentioned in the question, five sucklings in the first two years, makes the woman a [breast feeding] mother to that child due to that breast feeding. This is based on the generality of the Qur.aanic verse, {[Forbidden to you for marriage are] your foster mother who gave you suck}, [Soorah an-Nisaa., Aayah 23]. Even if the milk was produced after she reached the age of menopause, the ruling is the same. If that woman was married, the child would be her [foster] child and the son of the one whom the milk is ascribed to. If she was not married, perhaps she was not married and produced milk, then she is the [foster] mother of that child and he has no foster father. Do not consider it strange that one may have a milking mother and not a foster father. Also, do not consider it strange that one may have a foster father but no foster mother. An example of the first case is where a woman gave two sucklings to a child, the milk that was the result of her first husband. Then she separated from that husband and married another after her waiting period expired. She becomes pregnant and has a child from the second husband. She then suckles her foster child again for the remainder of the suckling amount [with the milk that is the result of a child with the second husband]. She now has become that child's foster mother due to the five sucklings but he has no foster father because he did not suckle at least five sucklings that were the result of one man with the woman. As for the second case, this is where the child has a foster father but no foster mother . An example is where a man has two wives. One of them suckles the child twice and the other suckles the child three times. In that case, he will be a foster child of the husband since he was breast fed over five times from milk that was the result of intercourse with him. But he will not have a foster mother because neither the first nor the second woman suckled him the minimum amount of times required.
Shaykh Ibn "Uthaymeen Fataawa al-Mar.ah
www.Fatwa-online.com
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