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.

#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 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.

Engaging #Men&Boys to #EndVAWG (Violence Against Women and Girls) Tweetathon June 15-16, 2014

Dear Friends,

Join us! On Father’s Day (June 15th) and the Day of the African Child (June 16th) to highlight ways in which men and boys are engaged in and can mobilize to end/prevent Violence Against Women and Girls (VAWG). VAWG is a grave violation of human rights and bodily integrity, that not only affects the well-being of women, but their families, their community and country-causing greater healthcare/legal expenses, losses in productivity and overall development.

This conversation is a follow-up and a response to the following ongoing campaigns: #EndChildMarriageNow (Africa Union 2-yr campaign), #TimetoAct, #MenstruationMatters, #BringBackOurGirls, #JusticeforLiz, #WEA and #TheAfricaWeWant. This is also the first in our series to raise consciousness for gender equality using hashtags #Men&Boys to #EndVAWG.

We want to know how your country is engaging #Men&Boys to #EndVAWG | what the challenges are | why it is important to engage #Men&Boys? | And is violence against women and girls a #Men&Boys issue?

Join in from June 15-16 to engage in dialogue that illustrates the progress, challenges and solutions to #EndVAWG. Please use the hashtags: #Men&Boys and #EndVAWG on Twitter and Facebook. Find our social media toolkit here, and invite your friends on Facebook.

Importantly, to help us stay in touch with you, and improve the sustainability of #EndVAWG via #Men&Boys as allies, take 2 minutes to participate in this survey.

We look forward to engaging with you on Twitter and Facebook.

In Solidarity,

Joanne Oport, MPA | @awuoroport

Deborah Dauda, MA/MPH| LEPA_Initiative@LEPA_Initiative

Kennedy Otina | Men 2 Men Program, @FEMNETProg@jakateng

#EndVAWG #Men&Boys As Allies Flier June 15-16 2014