Naturopathic Doula Training Course DR. JESSICA SANGIULIANO-DUPONT, ND © Jessica Sangiuliano HELLO ¡ Doula since 2012; Naturopath since 2013 ¡ Course administrator since 2014 ¡ Practice focus is Women’s Health, Endocrinology, Fertility, Perinatal Care and Birth Services ¡ Attended over 200 births across the Dr. Jessica Dupont, ND & Birth Doula GTA (hospital, homebirth, birth center, midwives, OB/GYNs, water births, cesareans, etc.) ¡ Owner York Region Naturopathic Doulas ¡ www.yorkregiondoulas.com Course Goals You will: ¡ Learn to manage perinatal cases effectively utilizing proper assessment techniques, standard diagnostics, and treatment. ¡ Realize the importance of the spoken word as well as body language in affecting the outcome of a birth ¡ Have a good understanding of proper nutrition and supplementation during the childbearing year and beyond ¡ Learn useful, natural remedies for common perinatal concerns and issues that arise during labour/childbirth ¡ Be able to demonstrate various exercises, maneuvers, massage techniques, and acupressure points used in labour ¡ Be able to support a woman and her partner through pregnancy, a live birth and post-partum. ¡ And so much more… INTRODUCTION MODULE 1: DOULA BASICS MODULE 2: PREGNANCY MODULE 3: LABOUR/BIRTH MODULE 4: POSTPARTUM MODULE 5: BUSINESS & CASES MODULE 1 DOULA BASICS DOULA: DOULA-ing: dou-la \ doo-la “The act of , loving, “…a woman educatng experienced in respecting, listening, embracing, childbirth who advocating for, & assisting provides continuous a woman prenatally, during labour, physical, emotional childbirth & after, so that she may and informational support to the remember this experience in a mother before, positive way for the rest of her life” during and just after childbirth.” Mothering the Mother by Klaus, Kennell & Klaus Benefits of Doula-assisting labours Benefits to Mother Benefits to Baby A more positive Shorter hospital stays experience Fewer admissions to Fewer requests for interventions special care Fewer C-sections Easier breastfeeding Reduced post-partum More affectionate depression mothers post-partum Quicker healing time Fewer interventions Shorter labour with less complications therefore less side effects How is a Naturopathic Doula different? Combine the supportive efforts of a Doula with our ability to properly assess, diagnose, and treat utilizing our Naturopathic modalities. Have the opportunity to see the client before the birth and assist with a healthy pregnancy via proper nutrition, supplementation, and preparation acupuncture. You also have the ability to use your Naturopathic treatments during the labour, as well as treat baby and mom post-partum. At this point, they are not only your Doula Client, but life- long Patients. DONA certified Doulas: require many hours of experience before certification. DONA training alone does not train the attendees to use Naturopathic modalities; in fact, it is illegal for them to use these modalities unless they are also Naturopaths or Acupuncturists or Homeopathic Doctors and able to prescribe remedies within their scope. Choice, choices, choices… OB/GYN - an OB/GYN is a medical doctor with a specialization in Women’s Health. They take over when a birthing situation becomes high risk, and can perform surgical procedures such as Cesarean, Vacuum and Forceps. GENERAL PRACTITIONER – an MD is a medical doctor who also delivers babies. They can deliver babies when the labour is low-risk, but cannot perform high-risk procedures such as vacuum extraction or C-section. MIDWIFE - Registered midwives are health professionals who provide primary care to women and their babies during pregnancy, labour, birth and the postpartum period. As primary care providers, midwives may be the first point of entry to maternity services, and are fully responsible for clinical decisions and the management of care within their scope of practice. Midwives provide the complete course of low-risk prenatal, intrapartum and postnatal care, including physical examinations, screening and diagnostic tests, the assessment of risk and abnormal conditions, and the conduct of normal vaginal deliveries. Midwives can deliver in hospital, home or birth center. Midwife references: http://www.canadianmidwives.org/what-is-a-midwife.html, http://mana.org/ Hospital or Homebirth? Water birth? Positions? 100% Natural? Mostly natural with some interventions? Cesarean? Induction? …. Midwives vs Family Physicians Where do you fit in? Pregnancy – You can prescribe natural remedies for common pregnancy concerns; you can provide emotional support but shouldn’t counsel unless you have additional counsel training; you can do regular checkups and physical examinations (including fundal height and Leopold's Maneuver) but you are never to check cervical dilation or do cervical “stretch-and-sweeps”. Birth – You are NOT the primary healthcare provider; this means that you are NOT to do temperature, heart rate, blood pressure, etc. during the labour at any time. You are also NOT to make any decisions for this client. You are there for physical and emotional support ONLY but you can still use acupuncture, homeopathy and other tools safely at this time as long as it is within your scope. Postpartum – You can treat postpartum ailments with natural remedies within your scope. You can also assist with breastfeeding if you are comfortable. The client is still within the OBs or Midwives care for 6 weeks pp. After this time, they can choose to have you as their infants primary care provider. HOME vs HOSPITAL HOME BIRTH HOSPITAL BIRTH Any position, any room A lot of waiting time Choice of number of supporters Limit of 2 support persons in the Quiet and less interruptions room Midwife Emergency care readily available STATS: moved to hospital for C-section Higher risk of intervention or being 5.2% of the time sent home More likely to breastfeed for longer period of time Midwife/OB/MD Familiar environment STATS: Cesarean sections 8.1% YOUR JOB IS TO: • Encourage your client to interview multiple healthcare providers • Inform them of their options and aid them in making an informed choice • Encourage good communication with their healthcare team and supporters to ensure that everyone is familiar with the Birth Plan. Fearless Birth • There is a direct correlation between a mother’s mindset and how her birth moves forward • Fear and anxieties will increase adrenaline and cortisol, leading to stalled labours (cases of labour stopping, or even reversing) • Tension in any muscles will cause tension in the uterus and cervix, causing more intense contractions and a longer labour due to a tense cervix. Sphincter Law • According to Sphincter Law, labours may not progress or stall because of fear, lack of privacy, humiliation, being self-conscious, emotional upset and stimulation of the wrong part of the brain. The Sphincters will close. • Just as the rectum and bladder need complete relaxation to function properly, as does the cervix and vagina. • They function best in an environment of intimacy and privacy • They do not respond well to demands such as “Push!” “Relax” “Harder” • The relaxation of the mouth and jaw is directly related to the opening of the cervix • Sing “Ooooh and Ahhhhs” Reference: Ina May Gaskin Fear vs. Confidence Fear during childbirth can cause: Confidence during labour brings: Increased need (or give in) for medical Peace of mind interventions Smooth and easy labours Lack of trust in the process Understanding and making the right Indecision choices for you and baby Increased “pain” Less unnecessary interventions Slowed labour Relaxed muscles and therefore less intense contractions and faster Stalled Labour or Reversal “Failure to progression of labour Progress” Builds a strong bond right away Hormones in Labour • Prostaglandins: soften and thin the cervix to prepare it for labour. • Oxytocin: causes uterine contractions; when baby moves through the birth canal a sudden rise in oxytocin stimulates the “falling in love” connect between mom and baby • Adrenaline: does the opposite of oxytocin. Secreted under fear and stress and stalls or slows labour progression. • Endorphins: nature’s opiates; releases when we are warm, feeling loved and supported; block receptors of painà “orgasmic birth” Uterine Physiology During Labour During pregnancy, the cervix is thick and closed. As you approach the time of birth, your contractions draw the cervix up into the body of the uterus, and it becomes thinner (called effacement) and opens (called dilation). When the cervix is fully dilated (10cm), contractions help the baby begin to move from the uterus into the vagina. Myometrium (2 layers) – forms a protective web Inner layer is circular and perpendicular to the long axis, spirals up around uterus (close the outlet) – sympathetic state (“fear”) Outer layer run parallel to the longitudinal axis (expulsive) – parasympathetic state (“relaxation”) Releasing Fear • Understand the natural process of labour: what to expect physically, emotionally and in the labour room • Trust your body • Identify fears and anxiety ahead of time and release • Identify areas of your life that could possibly serve as obstacles • What was your birth like? (ask your mother) • How are other people’s birth stories affecting you? • Previous labour experience? • Support? Relationship? • Experience of abuse? END OF MODULE 1 SUMMARY • A doula is a woman experienced in childbirth who provides continuous physical, emotional and informational support to the mother before, during and