Doula Class 1

• Class 1 presents: history of childbirth and midwifery, the role of the doula, course expectations, introductions, individual and group goals.
• The course takes place every Tuesday and Thursday, 6:00 PM to 8:00 PM via Zoom.
• To qualify for graduation, attendance and active participation in all classes is required.
• For security reasons, the classroom will be locked 15 minutes after the start of class, so arrive on time for each class.
• Notify in advance if unable to attend a class to be granted permission to watch a recording to make up for the missed session.
• Only two absences are allowed per participant.
• Cameras need to be turned on for at least 50% of each class to be counted as present, and microphones should be muted unless instructed to unmute in order reduce feedback.
• Personal materials required include: laptop/computer, digital or physical notebook, writing utensils, and recommended readings.
• Course materials include: welcome email, required readings (PDFs), and access to the Course Portal.
• The content in this training may trigger certain experiences, emotions or even fears.
• It is encouraged to be kind and supportive of others, and taking a moment if triggered by any of the content reviewed.

Doula Program Overview

• Week 1 contains history and background, and introductions.
• Week 2 focuses on childbirth education.
• Week 3 addresses clinical considerations.
• Week 4 discusses labor dynamics.
• Week 5 covers doula business operations.
• Week 6 entails professional development and graduation

Midwifery

• Midwifery is one of the oldest professions.
• Midwives are experts in vaginal birth and reproductive health.
• The main clinical provider in midwifery is women-centered childbirth.
• Apprentice models were followed.
• Enslaved Black Women served as midwives in the South.

Obstetrics and Gynecology

• Obstetricians are trained surgeons.
• This field grew over the course of the 1800s.
• Dominated by white male physicians.
• J. Marion Sims, "Father of Gynecology" experimented on slaves.
• Midwifery practice was taunted and ridiculed.
• Dr. Joseph DeLee introduced Twilight Sleep in 1914.

Midwifery vs. Obstetrics

• Midwifery focuses on: Shared decision-making/patient-centered care, childbirth as a naturally occurring physiological process, avoiding unneeded interventions, birthing person determines pushing position, and "the baby will come when it's ready"
• Obstetrics involves: Clinical procedure, provider knows best, encouraging interventions to make patients easier to labor and manage, most birthing people need assistance to start or progress, and supine pushing position for easier access of baby and visibility of vagina.

Present Day Midwives

• CNMs: RNs with 2 years of nursing school, MSN with midwifery concentration, typically work in clinical settings or hospitals.
• CNMs can bill insurance, but not at the same rate as MDs, and can write prescriptions for certain medications.
• CPMs/DEMs: Trained directly through a credentialed midwifery program, following the traditional apprentice model, and attend home/birth center births.
• CPMs/DEMs cannot bill insurance and cannot write prescriptions.

The Role Of The Doula

• Doulas has existed for as long as midwives.
• Doulas provide emotional, physical, educational, and social non-clinical care
• Doula work has increased in popularity in recent years due to social media.

Kinds of Doulas

• Prenatal: pregnancy, labor, and breastfeeding education, patient navigation, birth preferences, referrals/recommendations, emotional support, companionship, the family's dynamics.
• Labor/Birth: nonclinical interventions, physical comfort measures, emotional support, immediate postpartum, care team liaison, early breastfeeding and bonding encouragement.
• Postpartum: longer term breastfeeding support, newborn care and education, home visits through 6 weeks postpartum, processing birth and postpartum, the family and care team liaison, long term home visiting program referrals, and PMAD screening.

Doula Requirements

• Anyone can be a doula.
• Some argue it is a spiritual calling.
• There is no exam for a doula, or national certifying agency.
• You technically practice with no formal training.
• Some insurance companies work with specific doula training companies.
• The BIPOC doula community is opting to be trained by BIPOC doula trainers.
• Medicaid covers doula care in select states, including Massachusetts.

Childbirth Outcomes

• Outcomes are inequitable in the United States for Black people compared to White birthing people.
• There exist 3 times the higher risk of mortality.
• The risk of severe maternal morbidity is times 1.2 times higher.
• It is 1.3 times less likely to breastfeed.
• It is 1.4 times more likely to have early postpartum depression.
• Discrimination in maternity care due to race, culture, or language occurs 2.4 times more.

The Doula Difference

• Doulas have leads to increased sense of self-worth following childbirth, fewer low-Apgar scores, and fewer cesarean and operative vaginal births.
• With doulas, you can see more trust/social connectedness and valuing of cultural congruence and strategies in doula-specific communication.
• Doulas help provide more breastfeeding exclusivity and initiation, and more delayed introduction of solid food.

Next Steps

• Consider what kind of doula you see yourself as, and what specialties you have that can be utilized in doula care.
• Create an account on the Course Portal and read the three required articles.