Doula

I worry sometimes that because I myself have not experienced pregnancy that I might ignore the “obstetrics” portion of this blog. I hope that is not the case because many young women are dealing with pregnancy (before, during, and after). So, to try to balance this blog I am going to write about a very important topic to childbirth–doulas.  (And I dedicate this article to all my friends who have given their time to serve women as doulas.  We all thank you.)

A doula is person, most often a woman, who provides support to a woman during pregnancy, during delivery, and/or after birth.  A doula does not act in a medical capacity in supporting the mother.  Rather, it can be said that a doula’s main role is to provide informational, physical, and emotional support.  A doula is usually a person trained to be knowledgeable about the entire process of birth. The history of the word “doula” is interesting and points to its current meaning and usage.  It is an ancient Greek word that means “woman of service,” but in its historical context connoted “slave-woman.”  (For this reason, some modern-day doulas prefer to use terms such as birth companion to avoid this negative connotation.)  So, essentially, a doula is there to help the mother in any capacity but is not there to make decisions for her.

Studies show that doulas play a very positive role during delivery and in postpartum circumstances.  Births in which a doula is attendant are shorter than those births unattended by a doula and are also less-likely to use or need pain medications such as epidurals.  Babies born to mothers assisted by doulas are more likely to be born healthy, without complications, and are more likely to successfully breastfeed.  In most countries, there are no formal or legal certifications required of doulas, though most doulas do go through training and are aligned with a doula registry.  In the United States the most prominent doula registry is DONA International (Doula of North America).  From their website, you can read much more about doulas and their services and look up doulas in your area.  If you are looking for a doula, I also recommend searching the web with your town’s name and “doula” in the search phrase as many doulas have formed smaller, local organizations.

If you are more interested in seeing a doula in action both during  birth and postpartum, I recommend watching two television shows on TLC.  The first is A Baby Story.  Many of the women delivering babies in this series employ a birth doula.  The second show is Bringing Home Baby, which documents new parents bringing home their babies many of whom employ a postpartum doula who assists the mother in adjusting to motherhood often including lactation and breastfeeding advice.  Doulas are useful for all mothers, not just first time mothers.  Think about the assistance needed by a mother of more than one child when delivering a baby and bringing it home from the hospital.  In all, I think doulas are a integral tool to birth, providing valuable information often neglected by doctors and other medical staff.  They are immensely helpful after birth in helping the mother adjust to life with a new child.  If you are expecting, at least look into the idea!  Have questions, comments, or otherwise?  Please don’t be shy.

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Vaginismus

My apologies for an absence! There were finals, work, a brief foray at an ivy league university, and two family emergencies–and my birthday was a week ago. Time marches on. Now I am back to talk about a subject I know quite a bit about–vaginismus.

Vaginismus is a disorder of the muscles in the vagina, specifically of the pubococcygeus muscle or PC muscle. The PC muscle controls urine flow in both women and men and is the muscle targeted by the popular Kegel exercise. The PC muscle is also very important to childbirth.  With vaginismus, the PC muscle reacts to stimulus by becoming spastic and wildly contracting, which the woman cannot control.  Stimulus that causes this reaction can include any sort of vaginal penetration from sexual contact to the insertion of a tampon to a gynecological exam.  These spasms are completely involuntary and are said to be like an eye blinking when an object comes too near it.

Vaginismus is most usually caused by trauma to the vagina or psychological trauma connected to the vagina.  For instance, an invasive and painful surgical procedure or childbirth could cause vaginismus.  Rape very often causes vaginismus because of the combined physical and psychological trauma.  Other, less personal forms of psychological trauma could cause vaginismus such as hearing that initial sexual activity is painful and therefore forming a fear (whether realized or not) of penetration.  Sometimes, vaginismus is a result of generalized trauma or stress that is unrelated to the vagina or sex.

The PC muscle reacts to this physical-psychological impetus by forming an automatic response to all contact.  This reaction makes sexual activity for a woman painful and oftentimes impossible.  Estimates of how many women suffer from vaginismus vary widely because so many women who have it are unaware of it what it is.  In any event, vaginismus is more common that most realize probably affecting 5% or more of the female population.

Treatment for vaginismus is most effective when it takes into account both psychological and physical factors.  In this treatment, the woman consults a therapist to work through feelings towards sexuality and vaginal penetration to remove the negative associations attached to them.  Additionally, the woman physically conditions her PC muscle to be less spastic.  These methods vary, though the most common is probably dilation therapy.  With dilation therapy, the vagina is slowly desensitized to penetration by inserting dilators that increase in size.  Dilators do not harm sexual sensitivity, but rather allow the PC muscle to build up a stimulus memory in which it does not spasm.  A relatively recent treatment for vaginismus is the use of Botox injections to relax the PC muscle to prevent spasms.  Studies have shown that it is highly effective against vaginismus but dilation therapy combined with psychological therapy is still the standard for most sufferers.

So, whether you have heard of vaginismus before or not, it is an important and under-discussed gynecological subject.  Please take the time to talk to your girlfriends and family members about what you have learned about vaginismus.  By spreading the word, more women will feel more confident about seeking treatment for this disorder that, if treated, is highly combatable.  Have any questions or something to add?  I’d love to hear from you!