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 Irene (58yo, Durban, South Africa) “My mother however was not as open as my Dad and she did have certain prejudices towards menstruation that it was something to be borne and endured and it was a hassle”

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I remember having a very serious talk with my dad about the special gift that ladies had to give to a man and that was one’s virginity. I remember then getting into discussion about sex and pregnancy and babies and marriage, but I was not yet menstruating. However I did have an older sister with whom I shared a bedroom so I had first hand experience of her first menstrual period.

So when it came to mine although it was a shock and I felt afraid of what was happening to my body I had a sister, mother and father with whom I could talk. My mother however was not as open as my Dad and she did have certain prejudices towards menstruation – that it was something to be borne and endured and it was a hassle and men were more fortunate that women etc.

It was a scarey experience but I was able to get support and assistance both at home and at school so the adjustment was quick and easy.

However, much later on in life I came across a book that suggested a totally different perspective on the menstrual cycle in that one should celebrate one’s fertility and it had a prayer that one could say in thanksgiving for the privilege of being able to be fertile. If I can find it I will share it on this site.

The Story of Sharon (19yo Nairobi; Kiambu) ” I was dying…well…I thought I was. I was so embarrassed but didn’t understand why”

‘Well…here I am in the bathroom. A tear in my right eye. It must have been that puddle of water I stepped in outside the house. I could have sworn it had a tadpole. I am going to die…I should tell mum…I will probably bleed out by the time I get to her room. Why me? My science teacher never told us bilharzia spreads this quickly. How can such a small animal carry such a deadly disease? He never mentioned there would be so much blood. It’s time to tell mum.’
My first time was too scary for a girl that was just about to turn thirteen in two days. One could say it was a gift from Mother Nature but for this little miss…it was a nightmare! It was a sunny Sunday. The clock had just stroke eight and I was stuck in the washroom. I was dying…well…I thought I was. I was so embarrassed but didn’t understand why. We had just had a class on water-borne diseases the previous Friday thus my conclusion for the blood would have been accurate. The teacher said victims would bleed out and eventually die. I got on my knees, said my duly prayers and called out for my mother. My tone must have petrified her as she rushed into the room in a jiffy. I could not believe it when she laughed and gave me a hug. I had just handed her a blood-stained pair of knickers…I was dying! What was more astonishing was that she left me to bring back a piece of padding. It was unbelievable. Any minute I would drop down and never wake up again and here she was looking amused.
“Sweetheart…don’t be frightened…you’ve just gotten your first period. You’re a woman now!”
Oh well, figures why I’m still alive and writing this huh.

The Story of JerseyNai Chic (24yo, Nairobi): “I decided to do my research.. and learn about this mysterious womanly function”

It had finally come. I was in the eighth grade, stick thin, flat ass, a member of the Itty Bitty Titty Committee (IBTC), with badly permed hair that sat atop of an almond shaped face framed with crooked glasses. Needless to say, I had not had my transition from ugly duckling to beautiful swan. And yet, it seemed all the other girls in my class had. Many had already began their journey into womanhood, curves starting to show, boobs starting to sprout, boys starting to take interest. I was keen to unlock the secret to their womanhood. I was determined to learn why I was behind and they were ahead.

And soon I had figured out what it was they had that I didn’t. They had started their period! The menses, the monthly flow, the big red dot. By thirteen, most of the girls in my class had gotten their period, and like all other child developmental milestones, I was last in line.

But once I figured out the key to my eighth grade “Fly Girl” success, I decided to do my research, and learn about this mysterious womanly function that seemed to be the answer to all my awkward teenage angst. For months, I had been scouring books on puberty– mostly procured from the pre-teen section at my nearby public library–that graphically illustrated the functions of my female anatomy, both inside and out. All those icky things that made me cringe but also intrigued me at the same time. I read magazines, watched movies, and kept by my side at all times the bible for prepubescent girls at the time “The Care and Keeping of You” by American Girl.

So by the time mine decided to come, I was fully prepared. With all the knowledge I had digested, I began to create this grand image of the day I finally would get my period. Trumpets would blow, confetti bursting from thin air, my mother would cry tears of joy–finally her baby girl is a woman. I would be taken out for a special “Just Got My Period” dinner at my favorite restaurant, “Fun Buffet”, on Danforth Avenue, where you can get all you can eat lobster legs for $10. It would be the best day of my life.

But sadly, it did not turn out that way. When D-Day (or should I say P-Day) finally came, it was the most underwhelming event. I was sitting in front of the television, watching my favorite show “As Told By Ginger”, when I felt a peculiar wetness in my nether-regions. I shot up from the couch like a canon, and ran to the bathroom with haste, as if I had just found hidden treasure, and had to run to a secret spot to open it. When I got into the bathroom, I pull down my pants, and low and behold, a brownish, crimson dot sat boldly on my K-mart, fruit of the loom panties. I was ecstatic, and began to think of the grand reaction my mother would have. “Fun Buffet here I come!” I thought as I walked boldly to the living room, panties in hand, and turned to my mother and said “Mommy, I think I just got my period. Silence. She then stood up, grabbed the stained panties from my hand, took a keen look, and with the uninterested flare of a chemistry teacher said plainly, “yes, that is your period.” She then handed me back my panties, and nonchalantly walked down the corridor, back to the kitchen, where she was preparing our meal for the evening: ugali, with cabbage and stewed chicken. No congratulations, no grandiose pouring of affection, no instructions. Just a simple confirmation, “yes, that is your period.” I guess being the daughter of a single African mother, whose main concern was the constant collection of A’s on my report card, did not lend itself to open discussion or celebration of a basic, expected biological turning point as my period. So, dejected by the celebration that never was, I unceremoniously took my stained undies, threw them in the garbage, grabbed a fresh pair, got the “Always Teen” pad I had been given by my school nurse at our last sex-ed class, put it on, and went back to the couch to finish my “As Told by Ginger” episode. As the show’s theme song played at the closing credits—Someone once told me the grass was much greener, on the other side—I sat thinking to myself, the grass is just the same. Fun Buffet another day.

Menstrual Narratives: The Story of Sophie (38 yo, Nairobi): “I ‘knew’ that ‘bad girls’ got their periods early so I was happy I was not among the bad girls “

I knew it would come but somehow it found me unprepared. I had been told by my teacher to expect it, I had been told that once it comes it would mean I can get pregnant! Mind you it had not even crossed my mind to engage in sex yet that was a real fear. I still recall that day which was a public holiday in Kenya, possibly October 20th so I was at home. I went to the toilet and felt ‘funny’. Checking I realized my panties had blood. I felt sad, and the thought that went to my mind is “I can get pregnant”. The fear of pregnancy was more than anything else. I didn’t know who to tell, I did not think I was meant to tell anyone! Somehow I was among the last girls who got their first periods but I ‘knew’ that ‘bad girls’ got their periods early so I was happy I was not among the bad girls. Still there were some girls who had not got their periods, so I didn’t feel that much achieved. I needed to have it remain a secret! It did remain a secret. I was in primary school and since there is no pocket money for primary school students I looked for tissue then later cotton wool that was cheap. It took going to secondary school to have ‘shopping list’ where sanitary pads featured. I have never ever spoken about this, let alone write! Yes I wish I knew that this was the time to celebrate womanhood.

The Story of Phillomen N. (31yo, Uganda): My Sister Called and asked if I was Raped, I was so Embarrassed.

I applaud the 28th May initiative and ask God to permanently break the silence. 
My 1st menstrual experience was a horrible one. I was living with my sister and when I realized something that seemed abnormal then; blood on my under wear I was so scared! I could not tell her because I felt so ashamed. I got some old clothes padded myself but this caused more embarrassment because I think I used such a big clothe that I could hardly walk. My sister called me and asked if I was raped I was so embarrassed. I did not know what to tell her. Then I thought that may be it is to. I thought everybody is going to laugh at me just as it happened to girls at school then I would not go back to school again. My sister showed me what I should do but that made me feel more embarrassed. We need to break the silence.

The Story of Morenike Badmus (32yo: Lagos): I Thought I was Going to Grow to be a Boy…my Menses Were Such a Disappointment.

 

How do people do that? All I can remember is that I was terrified and disappointed. My mother sent my brother to buy pads and he played with them as if they were a soccer ball..oh my, I didn’t know how to use them so I removed everything and was left with cotton….and of course blood was everywhere. I thought i was going to grow to be a boy later…so, my menses were such a disappointment and I saw it as a complete disaster, future plans ruined. I wouldn’t miss it anyway…too much stress

The Story of Victoria Fadipe-Kpekpe: I was Told I Would Get a Hysterectomy.. When I did get my Period, I had to get Shots or use Really Powerful Pain Meds.

I really didn’t have a menstrual cycle. I would get my period maybe three to four times a year. I was told I would get a hysterectomy because when I did get my period, I had to get shots or use really powerful pain meds. Needless to say, I didn’t believe the report of man and sought God and eight blessing (children) later, I give God all the praise. I also want to mention that while in college, I had the opportunity to have an Asian doctor who treated me with a Medication called Prover, which regulates the cycle. I never got the correct effect of that medication as my cycle is still irregular, but I did have relief with the pain. His side joke was ” the side effect is pregnancy”. I was only treated for the medication for one week but with prayers and belief, I rejected what was spoken to me about dealing with my menstrual pain.

The Story of Kemi (28yo San Francisco): 
I Thought my Liver had Busted- I kept Seeing Black Spots and not Red Spots on my Panties.

It was definitely a moment of confusion for me. 
I thought my liver had busted because I kept seeing black spots and not red spots on my panties at the age of 10 or 11. 
I saw the spots for like 3 days and was scared to tell anyone. I started thinking maybe I had a disease. 
I was in a boarding school and
I knew when people had their period it was red, 
but I was seeing brownish stuff
and was terrified. I used tissue through out that month. 
The following month, 
I saw red instead of the brownish stuff and I was more comfortable telling my friends and my family. I decided to send a letter home to my mom through my guardian counselor at my boarding school
to inform her about my period. 
She came to school a few days later with my older aunt and they asked me if I was sure. 
I said yes, they asked if anyone touched me, 
I said no. 
I was very small with
no breast, 
So they were shocked that I started my period early…. yeah
damn! 
I had to manage my pad, and had no chance to shower often because I was a Junior in boarding school. The Seniors could take showers twice or thrice a day when they were on their periods because they got Juniors to fetch water for them for free. I had to wear one pad for a long time-
I don’t remember taking showers except in the morning. I also never knew when my next period was coming, 
nobody taught me
so I went through that whole getting stained experience. 
 I had my sweater in my locker
Just in case it happens- that saved many of us 
LOL. It was very disturbing at first but I got used to it after months. 
It is crazy, 
I know students who couldn’t afford pads. 
They brought pieces of Ankara (rags) to school..
and washed it. The advise I received about menstruation was just don’t let any boy touch you. 
I thought I was pregnant
when I saw the blood the first time. 
All kinds of thoughts
I don’t even know
But I got used to it…

Let’s Start The Conversation About Menstruation-May 28 is Menstrual Hygiene Day

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Why a ‘Menstrual Hygiene Day’?

Menstrual Hygiene Day was created to publicly recognize the right of women to hygienically manage their menstruation wherever they are. By acknowledging that menstruation is a normal human process and a sign of good health, Menstrual Hygiene Day confronts the stigmas attached to menstruation with collective advocacy, education and action.

What does ‘Menstrual Hygiene Day’ want to achieve?

Menstrual Hygiene Day aims to help break the silence and raise awareness about the importance of menstrual hygiene management. The long-term goal is to have Menstrual Hygiene Day become an official UN Day by year 2020.

Who supports ‘Menstrual Hygiene Day’?

MH Day has brought together over 80 partners from social businesses, NGOs, advocates, academia and other influential sectors.

When is ‘Menstrual Hygiene Day’?

Menstrual Hygiene Day is on May 28th and will be celebrated in 2014 for the first time. The number 28 refers to the average days of the menstrual cycle, and 5 refers to the average amount of days a woman or girl experiences menstruation in a month.

What will happen on ‘Menstrual Hygiene Day’?

From small villages to big cities, Menstrual Hygiene Day will be celebrated in places such as Berlin, Delhi, Kathmandu, Nairobi and more, with exhibitions, meetings and trainings.

Want to know more?

Visit http://www.menstrualhygieneday.org