Can the Postpartum Doula Care Model Improve a Mother’s Psychosocial Wellbeing, and Responsiveness in Low and Middle Income Countries (LMICs)?

Sustainable feminist futures begin with a healthy birth, an empowered woman and an informed society.  Birth is a feminist issue and a Doula’s core practice is enshrined in the feminist framework that ensures women have the right and control over where, when, and how to give birth. We can’t begin to speak of, or envision a just future of equality, rights and justice for women and families without confronting and dismantling economic and political structures that nurture disparities and inequalities in maternal and child health outcomes in communities of color around the world, especially in Africa and Diaspora communities-Deborah Dauda.

The post below also appears on WorldPulse.Com

Childbirth is a bittersweet experience for many mothers. It can bring joy, happiness and satisfaction to the home. It can also be challenging, overwhelming and stressful, especially in the context of poor social and physical support networks.  The sound of a baby crying can cause significant stress for a mother ill-equipped to soothe her child. By extension, the type of response the crying child receives from the mother (i.e. holding to feed vs. letting baby “cry it out”) can influence a child’s sense of trust or mistrust. Maternal sensitivity (also known as maternal responsiveness[1]) is the ability of a mother to respond in a timely and appropriate manner to the cue of her child. It is a critical component of the maternal caregiving system[2] and has also been positively associated with mother-infant interaction, attachment and children’s cognitive development[3]’[4].

Historically, through different cultural practices and rituals, pregnant women received free physical and social support during and after childbirth from a community of women, and their families through a process called social birth7. Research by Stern & Kruckman (1983), suggests that postpartum rituals and psychosocial support available to women in non-western settings, for example, among the Ibibio (Nigeria), Punjabi (India), and Mayan (Yucatan) women, contributes to the lower incidence of postpartum mood disorders[5].

Today, in the U.S., the Doula embodies this role as someone who is experienced and professionally trained to provide non-clinical support to the birthing mother, and family, according to their respective needs and wishes[6]. Doulas who help during childbirth are called birth doulas and those who facilitate the transition into parenthood are called postpartum doulas.  Investigations by Eschel et al., (2006), Zeanah, Stafford, & Zeanah, (2005), and Cooper et al., (2002) show that professionals and trained lay-person (s) can facilitate maternal responsiveness. These studies and others have yet to explore the postpartum Doula care model as an integrated framework that could work in tandem with a mother’s clinical team to mitigate psychosocial stressors associated with the postpartum period. Preliminary studies have shown promising outcomes on maternal-child relationship in western societies utilizing a doula care model in childbirth but not in their non-western counterpart, perhaps due to the lack of empirical data, or poor institutional support for this type of practice. For example, review of twelve randomized clinical trials by Scott K., Klaus P., & Klaus M., (1999) substantiates evidence that the benefits of a Doula supported childbirth extends into the postpartum period, through increased rates and duration of breastfeeding, improved self-esteem, decreased symptoms of depression[7], and increased maternal sensitivity.  In addition, an observational study conducted by McComish & Visger’s (2009) reflect the benefits of the postpartum care model in facilitating maternal capacity and responsiveness in the areas of feeding, attachment and integrating the child into the family.

Since studies amongst impoverished communities in industrialized countries already demonstrate that Doulas help improve birth and psychosocial outcomes[8], contextualizing, and operationalizing this model to fit into an ecological framework for Low and Middle Income Countries (LMICs), especially in Africa can prove useful in achieveing dignity in maternity and motherhood, while increasing the possibilities of achieving promises of the post-2015 development agenda.

Sources:

[1] McComish J., & Visger J., (2009). Domains of Postpartum Doula Care and Maternal Responsiveness and Competence. JOGNN 38(2).

[2] Pechtel, P., et al., (2013). Reactivity Regulation, and Reward Responses to Infant Cues Among Mothers With or Without Psychopathology: An fMRI Review. Translational Developmental Psychiatry (1).

[3] Eshel N., et al., (2006). Responsive Parenting: Intervention and Outcomes. World Health Organization.

[4] Farsi M., & McCarroll E., (2010). Crying Babies: Answering the Call of Infant Cries.

[5] Stern G., & Kruckman L., (1983). Multidisciplinary Perspectives on Postpartum Depression: An Anthropological Critique. Social Science and Medicine 17(15).

[6] Placksin S. (2000). Mothering The New Mother: Women’s Feeling and Needs After Childbirth. Newmarket Press.

[7] Scott K., Klaus P., & Klaus M., (1999). The Obstetrical and Postpartum Benefits of Continuous Support During Childbirth. Journal of Women’s Health & Gender-Based Medicine 8(10).

[8] Gruber K., Cupito S., & Dobson C., (2013). Impact of Doulas on Healthy Birth Outcomes. Journal of Perinatal Education 22(1).

 

One thought on “Can the Postpartum Doula Care Model Improve a Mother’s Psychosocial Wellbeing, and Responsiveness in Low and Middle Income Countries (LMICs)?

  1. Pingback: Can the Postpartum Doula Care Model Improve a Mother’s Psychosocial Wellbeing, and Responsiveness in Low and Middle Income Countries (LMICs)? | LEPA Initiative

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