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).

 

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.

Menstrual Narratives-The Story of Akyaa N. (29 yo, Accra): I was very sad and devastated by the fact that it had come

It happened at home and my mother had explained to me what is would be like previously so I knew but I was very sad and devastated by the fact that it had come. I thought I was too young. I wasn’t ready to be a woman yet. I told my mother and she assured me that everything would be ok. That was it

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

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 SolaMimo (28yo, Nigeria): My first Experience was so Painful, I Thought I had Eaten Food Poison.

Growing up was fun, but I was afraid because of the stories I have heard concerning the menstrual cycle especially with the pain. I was not too sure of what to believe, Although some people say it is painless, others say menstrual pain is similar to what happens when one goes into labor- these stories escalated my fears. Unfortunately I was not able to get the right information from my peers or Parent but I was courageous to handle the menace, whichever ways it comes. My first experience was so painful, at first I thought I had eaten food poison, because it made my stomachs so uncomfortable, I came to realize that my menstrual stage had begun when I saw blood dripping from my private part, it was not pleasant and I was not prepare for it as at that time, I was also too shy to talk to my parent about but when it became bearable I had to open up for help.

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…

#BRINGBACKOURGIRLS- Chibok is Worth Fighting For

Video

I created this video for the Red Elephant Foundation (REF), a wonderful organization based in India and fighting for the rights of young girls and women around the world. I am inspired by the founder, Kirthi Jayakumar who is also a mentor and sister. Although we are yet to meet in person, I believe we are related from a different planet. It’s a beautiful feeling when women work together, in solidarity to achieve goals-large or small.