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 Ukhengching (21yo, Chittagong, Bangladesh) “we could not think to share this thing with our male teachers. In My Family I am so lucky that this thing is not stigmatized “

My first menstrual cycle experience was not bad as i was taught by my mother and she is nurse. She first taught me when i was in class 6 about this fact which every girl has to experience. That day i was in school and i was in class 7,i felt something wet in my underwear and i rushed into bathroom. Then i saw that ! But i was not freaked out and i went to my female teacher to take permission. During that time we could not think to share this thing with our male teachers. In my family i am so lucky that this thing is not stigmatized. I have seen my aunties who are not allowed to cook and touch any food during this time because they think they become impure this time. I think this condition about being impure or stigma about mensuration should be changed.

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 Rubo (22yo, Gaborone (Bostwana)): “she saw it, called me and had me go to the office where I put on some pads and rinsed off my dress. I am forever grateful to her for saving me from the embarrassment”

It’s funny because even though I knew of periods and that women menstruate at some point in our early adolescence, I didn’t know what it was when I first had it. The first day, I saw a drop of a reddish thing on my underwear, I thought it was just some liquid from my vagina and ignored it. The second day, there were two drops, so I showed my mum. She told me “You need to go buy ‘those things'” that women use at that time of the month” I can’t remember what I felt like; maybe relieved because I thought it had been something worse or awed that I had finally started my period. So I bought some pads and used them for two days. On the morning of the 3rd day, I woke up and there was no flow (I’ve come to learn that sometimes the monthly period won’t flow early in the morning but starts some time after you are awake). So I went to school thinking that I was done with my period. By “break time/recess”, I knew something was wrong because I felt really wet. We had just finished out English lesson and the teacher was female, thank God!! I let everyone go out of the class before I stood to leave; she saw it, called me and had me go to the office where I put on some pads and rinsed off my dress. I am forever grateful to her for saving me from the embarrassment. That was my first menstrual experience.

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.

Menstrual Narratives: The Story of MaDube (40yo, Harare): “I tore the centre page of my exercise book and crushed it and used it to absorb blood”

I was in primary school in grade 7. I did not tell anyone. I had been told that people who have blood coming from underneath there have been naughty with boys. I was scared. I was not prepared for it. I was afraid boys would laugh at me as was the case with others who had had their menses at school. I tore the centre page of my exercise book and crushed it and used it to absorb blood. I remember how i smelled during that time. I stayed away from everyone. I did not play sport. I faked illness the next few days to skip school. The trick worked the first month, in subsequent months mother forced me to go to school thinking i just didnt want to go to school. She didnt know what i was going through, she was a busy woman, widow, left home very early and came back home after dark as she worked as a house help. I had abdominal and back pain. I was afraid of telling anyone because it was associated with sleeping around, children were not supposed to have backache. I used crushed newspaper till the following year when i went to boarding school and could afford to buy myself cotton wool using my pocket money. This meant that I could not buy myself biscuits and sweets like other children as I had to save money for cotton wool. I did not tell anyone I was menstruating for two years. My mother discovered that I was menstruating when she found a soiled pantie I had hidden under the bed one time and I was beaten for that. I could not tell my siblings why I was beaten because I was afraid they would find out I am menstruating and think I have been sleeping around. I did not know what menstruation meant as I had not been told about it. I leant about it at school in biology lessons.

Menstrual Narratives: The Story of Louisa O. Eikhomun (40yo, Nigeria): “I had by bath and washed very well thinking the flow will stop and went to school”

I woke up from sleep one morning and saw blood stains on me and on my sleeping mat. I did not know what it was as I have not been told about monthly period, not at home nor in school.
I dashed to the bathroom and quicly had my bath trying to see if I had a wound or something.I did not see a scratch on my thighs. I squatted to look into my vagina but could not see exactly where the blood was flowing from. I washed and washed to stop the flow. I had by bath and washed very well thinking the flow will stop and went to school. I was wet with blood before closing. I wrapped my cadigan around my waist as I hurried on the the long treck home to wash again. I was too embarrased to share this experience with anybody. Not even with my mother or elder sisters. I just could not breath a word of it to any one. I suffered for many months in pain, torment and shame hiding it from everyone until one night I was wet all over with blood and and my mother finally noticed and sent for sanitary pads for me.
That was where it all ended. It was not discussed and neither was I asked how I was feeling. Till date I find menstrrual discussion embarrassing.
I have only been able to share this experience with my teen daughters, telling them to confide in me always.

Menstrual Narratives: The Story of Blackbeauty (28yo, Accra): My mum was so happy… She offered [me] a boiled egg

I remember being a little anxious because most of my friends had started menstruating and I hadn’t. It was a bit of a taboo subject in my family, we never really talked about it. One day in middle school I went to the bathroom and discovered blood in my panties. I didn’t know what to do, so I stuffed a lot of toilet paper in my pants. I walked out of the cubicle, terrified that all the bloodied tissue will fall out for everybody to see. I was relieved when the day was over and I went home. My mum was so happy when I told her. She offered my a boiled egg, I wasn’t sure what the significance was, but I said “no, thank you” politely.