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) reflects 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 achieving 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).

 

#MenstrualNarratives: The Story of Neelam (38yo, Los Angeles (USA) ): “She told me that the first three days I was considered impure and couldn’t go to the temple or touch the altar in our home. This information didn’t really jive with my new found superpowers, but I didn’t say anything.”

My mom is an obgyn so I grew up with her magazines laying about and her speaking to patients over dinner about vaginal discharge. Still, I felt unprepared. She told me what was coming but it seemed unreal, especially the bleeding part. I remember by breasts forming, the acne, and my labia growing. At the time, I thought my enlarged labia meant I had super powers! I never told anyone but I held on to the belief… And who knows, I was probably right!

The day my period came I was home with my dad. Mom was working and so I had to tell him. He became flustered and immediately called my mom to come home. I had flashbacks to the incredibly outdated video we watched in school about tying napkins to menstrual belts. Why were we watching a video about menstrual belts?? I guess being informed and feeling prepared wasn’t the goal of that particular educational movie.

My mom came home twenty minutes later. I waited for her in the bathroom. She seemed excited as she helped me put on my first pad (a very large monstrosity). Then her face turned grave and she said I could get pregnant now. I’m not sure I fully understood but I nodded. Then she told me that the first three days I was considered impure and couldn’t go to the temple or touch the altar in our home. This information didn’t really jive with my new found superpowers, but I didn’t say anything. Getting to stay home from trips to the temple seemed like a good thing at the time. More time to attend to the very serious business of recording my own MTV show and practicing to be Janet Jackson’s back up dancer.
We left the bathroom and the day proceeded at usual. But it wasn’t just any other day. The world had changed for me and I couldn’t wait to tell my friends!

The Story of Blessing (22yo, Los Angeles (USA)): “I am grateful for the resources I have… I have relatives in Nigeria whom are less fortunate”

About a month after my 14th birthday, I was at home practicing one of my dance routines from school. I began feeling a slight aching in my stomach. I went to the restroom. As soon as I pulled down my panties, I saw red dots of liquid drop down from my body and stain the cloth. I immediately believed I was going to die. I reached for tissue paper and vigorously wiped my self over and over in the hopes of stopping the bleeding. After a few moments, I wondered if this is the “period” that my friends talked about in school. I did not expect the experience to happen so suddenly and painfully. I called out to my mother who was down the hall. She saw my condition and smiled, telling me it was ok and normal. Then, she handed me a couple of pads and told me to be downstairs in 5 minutes for dinner.

Since I got my period much later than girls around me, my menstruation was expected yet the experience was surprising. The thought that I will now bleed from my bottom area once a month for a great portion of my life seemed like one of the worst punishments that could be handed to me. Most months I experience cramping, vomiting, and fatigue. However, I am grateful for or the resources i have to make my periods more comfortable for me. I have relatives in Nigeria whom are less fortunate. Feeling awful about menstruating effects how I view womanhood and my role within it. I learned to deal with my menstrual episodes the best I can.

The Story of Ms Achivo (26yo, Atlanta, USA): “I noticed some spotting in my under garment”

I had injured myself badly when I broke a glass cup while washing dishes. My mother (who was a nurse) was not home so my father did his best to patch up the injury. Unfortunately the cotton balls became entangled in the wound and when I later removed the dressing at school the next day, it started bleeding again. My Dad came to pick me up to go home to get the wound looked at. That evening I noticed some spotting in my under garment. As the third bleeding occurrence in under 24 hours, I truly freaked out. Thank God for my dear mother who helped to pacify me reminding me that they two occurrences, the injury and my first menses were unrelated and that everything would be ok.

The Story of Teresa. H ( 27yo, Glendale (California)): “My dad asked me what it was, and I said that I think I started having my period today”

I went to a Catholic private school. They started what was supposed to be sex-ed in the 4th grade. We were given workbooks – “Family Life” was what they were called – which had chapters covering anatomy, sex, marriage, etc., and after each chapter was covered in school, we had to take home the workbook, read through the chapter with our parents, and have them sign a page saying we went over the content together. Usually my parents just turned to the last page of the chapter and signed it. In any case, it was around this time, the 4th grade, that I learned about menstruation.

I was a competitive gymnast until I was 14 years old. On June 1, 1998 I was at one of my practices, and went to the bathroom to pee. When I took off my leotard (ya, I was rocking my FAVORITE leotard – a plushy, teal, tie-dye work of beauty that actually accommodated my growing breasts), I noticed a red spot in the crotch area. I remember just ignoring it because I felt that something like menstruation couldn’t possibly happen to me. Puberty was for “older people,” and I never considered myself to be older (I know, that’s not how it works.). I think I tried to reason my way out of it – maybe I cut or scratched myself sometime in practice – did I straddle the beam at some point? I finished practice and went home, and when I changed to go take a shower. I put the leotard in the laundry hamper, just as I always did. After showering, I just thought that I would ask my mom about it, since it did seem a little out of the ordinary. She was a nurse, so I trusted her. I showed her the red spot that had grown a little bit over the course of the evening. I don’t remember exactly how she reacted, but it was something to the extent of her telling me that it means that I started my period. I remember her being very calm, but I know she probably wanted to cry – she always got emotional when we exhibited any sign of “growing up.” The WORST part, get this, was that she MADE ME TELL MY DAD immediately. He was in the home office, at the computer. My mom said, “Teresa needs to tell you something,” and stood in the doorway. My dad asked me what it was, and I said that I think I started having my period today. I don’t remember everything that he said after that, but he eventually said, “Well, it’s June 1st. That’s easy to remember.” And I guess he was right, I never forgot the date of my first period.