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meditron-7b

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EPFL LLM Team 132

I was playing with meditron7b as a means to automatically generate QA pairs around maternal health.
I have been exclusively testing the model through HF transformers package, loading the model in as torch.float16 on a 4090 gpu.

The model performs quite poorly in this generative task. I am immediately left wondering if this is an issue of the model not being properly implemented to interact with HF arguments, if the context window for this model is ridiculously small despite the original LLama2 having a context window of 4k tokens, or if I'm just royally messing something up.

The pattern is, the model tends to repeat itself A LOT. If you mess with the repetition penalty, the model starts outputting html parses.

Any guidance is appreciated as I was quite excited for this release and was looking forward to fine-tuning it further.

Sample outputs:

All examples were ran with the following input (not template or parsed in any way, just raw input to seed the generation):

Question:
    What does a doula do?
    Answer:
    Most doula-client relationships begin a few months before the baby is due. During this period, they develop a relationship in which the mother feels free to ask questions, express her fears and concerns, and take an active role in creating a birth plan. Doulas may provide information about perineal massage and other techniques that can help to reduce stress and trauma often experienced during childbirth. Most doulas make themselves available to the mother by phone in order to respond to her questions or address any concerns that might arise during the course of the pregnancy. Understand they do not provide any type of medical care. However, they are knowledgeable about many medical aspects of labor and delivery. As such, they can help their clients gain a better understanding of the procedures and possible complications in late pregnancy or delivery. During delivery, doulas are in constant and close proximity to the mother. They have the ability to provide comfort with pain-relief techniques including breathing techniques, relaxation techniques, massage, and laboring positions. Doulas also encourage participation from the partner and offer reassurance. A doula acts as an advocate for the mother, encouraging and helping her fulfill specific desires she might have for her birth. The goal of a doula is to help the mother experience a positive and safe birth, whether an unmedicated birth or a cesarean. After birth, many labor doulas will help new mothers begin the breastfeeding process and encouraging bonding between the new baby and other family members.
     
    Question:
    What are the benefits of having a doula?
    Answer:
    Numerous studies have documented the benefits of having a doula present during labor. A recent Cochrane Review, Continuous Support for Women During Childbirth, showed a very high number of positive birth outcomes when a doula was present. With their support, women were less likely to have pain-relief medications administered and less likely to have a cesarean birth. Women also reported having a more positive childbirth experience.1 Other studies have shown that having a doula as a member of the birth team decreases the overall cesarean rate by 50%, the length of labor by 25%, the use of oxytocin by 40%, and requests for an epidural by 60%.2 Doulas often use the power of touch and massage to reduce stress and anxiety during labor. According to physicians Marshal Klaus and John Kennell, massage helps stimulate the production of natural oxytocin. The pituitary gland secretes natural oxytocin to the bloodstream (causing uterine contractions) and to the brain (resulting in feelings of well-being and drowsiness, along with a higher pain threshold). Historically it was thought that intravenous oxytocin does not cross from the bloodstream into the brain in substantial amounts and, therefore, does not provide the same psychological benefits as natural oxytocin. However, more recent studies indicate that oxytocin administered nasally and/or intravenously may cross from the bloodstream into the brain. Nonetheless, doulas can help mothers experience the benefits of oxytocin naturally without the use of medication.
    Question:

All examples are generated with the following baseline settings, with modifications noted when applicable.

n_tokens=2048
temperature=0.3
top_p=0.95
top_k=4
repetition_penalty=1.0

Initial example, observe the repetitions.

Question:
    What are the risks of having a doula?
    Answer:
    There are no known risks to having a doula present during labor. Doulas are not allowed to perform any medical procedures, so there is no risk of infection. Doulas are not allowed to administer any medications, so there is no risk of overdose.
    Question:
    What are the costs of having a doula?
    Answer:
    The cost of a doula varies widely. Some doulas charge by the hour, while others charge a flat fee. Some doulas charge a fee for prenatal visits, and some do not. Some doulas charge a fee for postpartum visits, and some do not. Some doulas charge a fee for travel, and some do not. Some doulas charge a fee for phone calls, and some do not. Some doulas charge a fee for attending a birth, and some do not. Some doulas charge a fee for attending a birth and postpartum visit, and some do not. Some doulas charge a fee for attending a birth, postpartum visit, and prenatal visits, and some do not. Some doulas charge a fee for attending a birth, postpartum visit, prenatal visits, and phone calls, and some do not. Some doulas charge a fee for attending a birth, postpartum visit, prenatal visits, phone calls, and travel, and some do not. Some doulas charge a fee for attending a birth, postpartum visit, prenatal visits, phone calls, travel, and a birth and postpartum visit, and some do not. Some doulas charge a fee for attending a birth, postpartum visit, prenatal visits, phone calls, travel, a birth and postpartum visit, and a birth, postpartum visit, and prenatal visits, and some do not. Some doulas charge a fee for attending a birth, postpartum visit, prenatal visits, phone calls, travel, a birth and postpartum visit, prenatal visits, and a birth, postpartum visit, and prenatal visits, and some do not.
    Question:
    How do I find a doula?
    Answer:
    There are several ways to find a doula. You can ask your friends and family for recommendations. You can ask your doctor or midwife for recommendations. You can go to the International Doula Association website and search for doulas in your area. You can go to the National Association of Professional Childbirth Educators website and search for doulas in your area. You can go to the Childbirth Educators Association website and search for doulas in your area. You can go to the National Association of Labor and Delivery Nurses website and search for doulas in your area. You can go to the National Association of Certified Professional Midwives website and search for doulas in your area. You can go to the American College of Nurse-Midwives website and search for doulas in your area. You can go to the American College of Obstetricians and Gynecologists website and search for doulas in your area. You can go to the American Academy of Family Physicians website and search for doulas in your area. You can go to the American College of Nurse-Midwives website and search for doulas in your area. You can go to the American College of Obstetricians and Gynecologists website and search for doulas in your area. You can go to the American Academy of Family Physicians website and search for doulas in your area. You can go to the American College of Nurse-Midwives website and search for doulas in your area. You can go to the American College of Obstetricians and Gynecologists website and search for doulas in your area. You can go to the American Academy of Family Physicians website and search for doulas in your area. You can go to the American College of Nurse-Midwives website and search for doulas in your area. You can go to the American College of Obstetricians and Gynecologists website and search for doulas in your area. You can go to the American Academy of Family Physicians website and search for doulas in your area. You can go to the American College of Nurse-Midwives website and search for doulas in your area. You can go to the American College of Obstetricians and Gynecologists website and search for doulas in your area. You can go to the American Academy of Family Physicians website and search for doulas in your area. You can go to the American College of Nurse-Midwives website and search for doulas in your area. You can go to the American College of Obstetricians and Gynecologists website and search for doulas in your area. You can go to the American Academy of Family Physicians website and search for doulas in your area. You can go to the American College of Nurse-Midwives website and search for doulas in your area. You can go to the American College of Obstetricians and Gynecologists website and search for doulas in your area. You can go to the American Academy of Family Physicians website and search for doulas in your area. You can go to the American College of Nurse-Midwives website and search for doulas in your area. You can go to the American College of Obstetricians and Gynecologists website and search for doulas in your area. You can go to the American Academy of Family Physicians website and search for doulas in your area. You can go to the American College of Nurse-Midwives website and search for doulas in your area. You can go to the American College of Obstetricians and Gynecologists website and search for doulas in your area. You can go to the American Academy of Family Physicians website and search for doulas in your area. You can go to

Disabling the passing of parameters to HF generation, only specifying temperature=0.3

Question:
    What are the benefits of having a doula for the newborn?
    Answer:
    Doulas are also available to help the newborn adjust to life outside the womb. They may help the mother and newborn bond by encouraging skin-to-skin contact and helping the mother to breastfeed.
    Question:
    What are the benefits of having a doula for the father or partner?
    Answer:
    Doulas can help the father or partner feel more involved in the birth process. They can help the father or partner understand the labor process and feel more confident in their ability to support the mother. Doulas can also help the father or partner feel more confident in their ability to care for the newborn.
    Question:
    What are the benefits of having a doula for the hospital staff?
    Answer:
    Doulas can help the hospital staff feel more confident in their ability to care for the mother and newborn. They can also help the hospital staff feel more confident in their ability to support the mother. Doulas can help the hospital staff feel more confident in their ability to support the newborn.
    Question:
    What are the benefits of having a doula for the community?
    Answer:
    Doulas can help the community feel more confident in their ability to support the mother and newborn. They can also help the community feel more confident in their ability to support the mother. Doulas can help the community feel more confident in their ability to support the newborn.
    Question:
    What are the benefits of having a doula for the hospital?
    Answer:
    Doulas can help the hospital feel more confident in their ability to care for the mother and newborn. They can also help the hospital feel more confident in their ability to support the mother. Doulas can help the hospital feel more confident in their ability to support the newborn.
    Question:
    What are the benefits of having a doula for the community?
    Answer:
    Doulas can help the community feel more confident in their ability to support the mother and newborn. They can also help the community feel more confident in their ability to support the mother. Doulas can help the community feel more confident in their ability to support the newborn.
    Question:
    What are the benefits of having a doula for the hospital?
    Answer:
    Doulas can help the hospital feel more confident in their ability to care for the mother and newborn. They can also help the hospital feel more confident in their ability to support the mother. Doulas can help the hospital feel more confident in their ability to support the newborn.
    Question:
    What are the benefits of having a doula for the community?
    Answer:
    Doulas can help the community feel more confident in their ability to support the mother and newborn. They can also help the community feel more confident in their ability to support the mother. Doulas can help the community feel more confident in their ability to support the newborn.
    Question:
    What are the benefits of having a doula for the hospital?
    Answer:
    Doulas can help the hospital feel more confident in their ability to care for the mother and newborn. They can also help the hospital feel more confident in their ability to support the mother. Doulas can help the hospital feel more confident in their ability to support the newborn.
    Question:
    What are the benefits of having a doula for the community?
    Answer:
    Doulas can help the community feel more confident in their ability to support the mother and newborn. They can also help the community feel more confident in their ability to support the mother. Doulas can help the community feel more confident in their ability to support the newborn.
    Question:
    What are the benefits of having a doula for the hospital?
    Answer:
    Doulas can help the hospital feel more confident in their ability to care for the mother and newborn. They can also help the hospital feel more confident in their ability to support the mother. Doulas can help the hospital feel more confident in their ability to support the newborn.
    Question:
    What are the benefits of having a doula for the community?
    Answer:
    Doulas can help the community feel more confident in their ability to support the mother and newborn. They can also help the community feel more confident in their ability to support the mother. Doulas can help the community feel more confident in their ability to support the newborn.
    Question:
    What are the benefits of having a doula for the hospital?
    Answer:
    Doulas can help the hospital feel more confident in their ability to care for the mother and newborn. They can also help the hospital feel more confident in their ability to support the mother. Doulas can help the hospital feel more confident in their ability to support the newborn.
    Question:
    What are the benefits of having a doula for the community?
    Answer:
    Doulas can help the community feel more confident in their ability to support the mother and newborn. They can also help the community feel more confident in their ability to support the mother. Doulas can help the community feel more confident in their ability to support the newborn.
    Question:
    What are the benefits of having a doula for the hospital?
    Answer:
    Doulas can help the hospital feel more confident in their ability to care for the mother and newborn. They can also help the hospital feel more confident in their ability to support the mother. Doulas can help the hospital feel more confident in their ability to support the newborn.
    Question:
    What are the benefits of having a doula for the community?
    Answer:
    Doulas can help the community feel more confident in their ability to support the mother and newborn. They can also help the community feel more confident in their ability to support the mother. Doulas can help the community feel more confident in their ability to support the newborn.
    Question:
    What are the benefits of having a doula for the hospital?
    Answer:
    Doulas can

If we adjust the repetition penalty to 1.1 and keep everything else the same.

Question:
    How much training does a doula receive?
    Answer:
    There are no formal requirements for becoming a doula; however, most doulas complete a training program. Training programs vary widely in content, duration, and cost. Some programs are offered online while others require attendance at workshops. Many doulas choose to become certified through one of several organizations, such as DONA International (Doulas of North America), Birthworks, or the Association of Labor Assisting Midwives (ALAM). These organizations offer different levels of certification based on the amount of training completed. In addition to completing a training program, doulas must be able to demonstrate competency in providing emotional support and physical assistance during labor.
    Question:
    Do I need to hire my own doula?
    Answer:
    It depends. If you are planning to give birth in a hospital setting, then it is highly recommended that you hire your own doula. Hospitals typically only allow one support person to be present during labor and delivery. This person cannot be a nurse, doctor, midwife, or other healthcare provider. Therefore, if you want someone who is familiar with the birthing process and who can assist you during labor, then you should consider hiring a doula.
    Question:
    Can I find a doula through my insurance company?
    Answer:
    No. Doulas are not covered under any health insurance plans. However, some states offer Medicaid coverage for doula services. Check with your state’s Medicaid office to see if doula services are covered.
    Question:
    Are doulas covered by Medicare?
    Answer:
    No. Doulas are not covered by Medicare.
    Question:
    Can I find a doula through my insurance company?
    Answer:
    No. Doulas are not covered under any health insurance plans. However, some states offer Medicaid coverage for doula services. Check with your state’s Medicaid office to see if doula services are covered.
    Question:
    Are doulas covered by Medicare?
    Answer:
    No. Doulas are not covered by Medicare.
    Question:
    Is there anything else I should know about doulas?
    Answer:
    Yes. Doulas are trained to provide non-medical support during labor and delivery. They are not licensed medical professionals and do not provide any type of medical care. Doulas are not allowed to perform any invasive procedures such as vaginal exams or cervical checks. Doulas are also not allowed to provide any type of pain relief during labor.
    Question:
    Are doulas covered by Medicare?
    Answer:
    No. Doulas are not covered by Medicare.
    Question:
    Is there anything else I should know about doulas?
    Answer:
    Yes. Doulas are trained to provide non-medical support during labor and delivery. They are not licensed medical professionals and do not provide any type of medical care. Doulas are not allowed to perform any invasive procedures such as vaginal exams or cervical checks. Doulas are also not allowed to provide any type of pain relief during labor.
    Question:
    Are doulas covered by Medicare?
    Answer:
    No. Doulas are not covered by Medicare.
    Question:
    Is there anything else I should know about doulas?
    Answer:
    Yes. Doulas are trained to provide non-medical support during labor and delivery. They are not licensed medical professionals and do not provide any type of medical care. Doulas are not allowed to perform any invasive procedures such as vaginal exams or cervical checks. Doulas are also not allowed to provide any type of pain relief during labor.
    Question:
    Are doulas covered by Medicare?
    Answer:
    No. Doulas are not covered by Medicare.
    Question:
    Is there anything else I should know about doulas?
    Answer:
    Yes. Doulas are trained to provide non-medical support during labor and delivery. They are not licensed medical professionals and do not provide any type of medical care. Doulas are not allowed to perform any invasive procedures such as vaginal exams or cervical checks. Doulas are also not allowed to provide any type of pain relief during labor.
    Question:
    Are doulas covered by Medicare?
    Answer:
    No. Doulas are not covered by Medicare.
    Question:
    Is there anything else I should know about doulas?
    Answer:
    Yes. Doulas are trained to provide non-medical support during labor and delivery. They are not licensed medical professionals and do not provide any type of medical care. Doulas are not allowed to perform any invasive procedures such as vaginal exams or cervical checks. Doulas are also not allowed to provide any type of pain relief during labor.
    Question:
    Are doulas covered by Medicare?
    Answer:
    No. Doulas are not covered by Medicare.
    Question:
    Is there anything else I should know about doulas?
    Answer:
    Yes. Doulas are trained to provide non-medical support during labor and delivery. They are not licensed medical professionals and do not provide any type of medical care. Doulas are not allowed to perform any invasive procedures such as vaginal exams or cervical checks. Doulas are also not allowed to provide any type of pain relief during labor.
    Question:
    Are doulas covered by Medicare?
    Answer:
    No. Doulas are not covered by Medicare.
    Question:
    Is there anything else I should know about doulas?
    Answer:
    Yes. Doulas are trained to provide non-medical support during labor and delivery. They are not licensed medical professionals and do not

Increase repetition penalty to 1.5:

Question:    
        How much training should I expect my potential doula candidate(s)? Is there certification involved? If so what kind?(Continued on next page...)                            </p>       <h3 class="section_head" id=“doula">DONA International</h3><div style='clear:both;'></br>'The Association of Labor Assisting Professionals', known internationally simply 'ALAP,' has been providing education since its founding over twenty years ago.<a href="" target = "new"><img src="/images//labor%E7%98%AA-%EF%BC%BD% EFC%BF%BDCertified%EB%AF%BBLabor%ED%EE%ADouble,%EC%BA %CAC%BECertificado%CC%CDoblera," alt =""," width = "" height = "", borderwidth = '',bordercolor = ''"></a>&nbsp;</span>';<ul >';<li>.&lt;&gt; &amp;#xFEFF;&quot;;'.&lt.;&#xFD;.'..&lt;}...','.........');')')..));))));))))..))))),...........,'::: : , . ) .. .... ... ::.: -----:- :-:--,-,,--,.-,.,.-,--.-- -- --- ---- ;--- ------- ------ --------------------------.---------------.-------.----------.---------------.-------.----------.---------------.-------.----------.---------------.-------.----------.---------------.-------.----------.---------------.-------.----------.---------------.-------.----------.---------------.-------.----------.---------------.-------.----------.           '.&& &&)&apos;%'*+,$*$+$$,$*,$$*.)$$.$)*)**.$)*.*)+$( $ * +++ ++ $$ ** $( ****(******* *)($(*(.((()*)(,((),(-.(+(++)*+)('+'-(++,$-*-)'$*-$'+'( ($(&)'-+'-&''$*)-'&'''$*)-&'&'"$*),( ()*().(*)())*.)..), ), ).)), (.))..))).................................. );;;;; ;;;):;:=.====.=== ========= === ============================= ========= === ============================= ========= === ============================= ========= === ============================= ========= === ============================= ========= === ============================= ========= === ============================= ========= :==&:'! !!!!!!!"""##%%@@@%%%%###### %%&%%%" # !!";",."".":")").":" "%:" "$:$:%:# "#:;" ";$:%;$; ":)" ".%) /:/./ .//./: /////////://////////////// ////////////////////// \\\\ \\\\\\\\\\\" \"\'/'/" "/"/ '/\/ /\/\/ /:\"\ "\.\_\ ___ __.__.____/_______._.\_| | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||

Increase repetition penalty to 2.0:

    Question:     How much training must I complete prior being certified through DONA International®?.      	Answer :        You need at least one hundred hours total education time plus sixteen live supervised practice sessions under direct observation within two years after completing your initial educational requirements..          </p>         <h3 class="question">What kinda classes should i attend</Hr><br /><div id='answer'></DIV>.           ...".".</P>"..."."></Div>";}else{var content = "";if(document["_content"] != undefined){for each item on document[“#”] { if(!item.__isTemplate && !__hasDataItem__(this)) continue; var __templateContent=getInnerHTML(__html); _setHtml($(‘’),$( ‘body ’ ), $( “##”, $($ ) ); }}} else {$("#"+id+" #inner").append(_createElement("", "",""));$('#'+name+'').hide();return;}function getChildNodes(){ return [].slice ? slice .call([], index , count + offset || -count ]): [];}; function setValueByName() {};})}(jQuery));window._dataReadyCallback=(typeof window.$ == 'undefined')?(null:($.fn['jquery']|| $.extend({}, jQuery)).ready(()=>{$('.js--loading'):!== null&& $('. js -- loading'), $('input','textarea', '#form')[]:!(_.isEmpty('$_POST'))});//end jquery ready callback }); })()); // end script tag ]] > <!DOCTYPE html PUBLIC "-/*ENCLOSED*/XML */"><HEAD BGCOLOR="#FFFFFF">
<!--META NAME="" CONENT ="text / xml ; charset "" UTF8"" -->>
<?PHP echo '<meta name=\"keywords\" value=\'''.implode(', ',array($_SESSION->userinfo[$i]['keyword'])).'\'';?>echo "<title>\'\'>";include ("../inc/_headline");}
             }
              /*END TEXT HEADER */
               /*** START METACATAGO***./** END MEtaCATagO ** ********************************.
```xml``>```./`*`;``.`"`)`}`]`}.`;.`);`)}.));
 `.”)
\ '%*" "'/' '"/" "/\/ \"/$ '/:' '\"/:/:" "*:$," "+":" "," ",":)", ";':;" ".;;.;.", ":"), ")?"#, $,"??,!,!.!/ !!/#$:%;:#:%:-:=;&%=':'<=>=?'=&=%&=>&=$+=++;--+=----+====/!=/><-.==.>,.<>/<>/?)=)>>(=[]=];>;:[email protected]);[:,]/:,[.]:]].[.[[,[-]" "[{-}" "{]}")]"}}]}{{{}}}]{ {{ }} }{ {} };{} ;;:}{:}:{|}|:{│ │└──┴◄►▼▲△▶❯█▄▀■♦♥♣♠□○•●★☆♂♀ି᭜ꞌ〈⟩≥≤Ω≠∩∧∨÷×√∫°·∑π⁄ΦΘΠΣΤΥΧΨФΓΞΛΟΜΚΗΝΔΕΖΑ΄Ά´µντρούασηςάλυκείωμέθιζόγχοςβήδ αξώφoѴосϕílɦψóʝosϑȏ́ɣkò͗ߐݔܽ߬���ނ‬ԥӇՓրօցակուտեսինாյћөҫијәкүлəмҡۋнٰргытçöüџақуйшаньвăхфёдűпњюцэбщëжчєзъяђе</s>---'"-------")--------)""))"

Keep repetition penalty at 1.0, up temperature to 0.9:

Question:
    What does a doula do?
    Answer:
    Most doula-client relationships begin a few months before the baby is due. During this period, they develop a relationship in which the mother feels free to ask questions, express her fears and concerns, and take an active role in creating a birth plan. Doulas may provide information about perineal massage and other techniques that can help to reduce stress and trauma often experienced during childbirth. Most doulas make themselves available to the mother by phone in order to respond to her questions or address any concerns that might arise during the course of the pregnancy. Understand they do not provide any type of medical care. However, they are knowledgeable about many medical aspects of labor and delivery. As such, they can help their clients gain a better understanding of the procedures and possible complications in late pregnancy or delivery. During delivery, doulas are in constant and close proximity to the mother. They have the ability to provide comfort with pain-relief techniques including breathing techniques, relaxation techniques, massage, and laboring positions. Doulas also encourage participation from the partner and offer reassurance. A doula acts as an advocate for the mother, encouraging and helping her fulfill specific desires she might have for her birth. The goal of a doula is to help the mother experience a positive and safe birth, whether an unmedicated birth or a cesarean. After birth, many labor doulas will help new mothers begin the breastfeeding process and encouraging bonding between the new baby and other family members.
     
    Question:
    What are the benefits of having a doula?
    Answer:
    Numerous studies have documented the benefits of having a doula present during labor. A recent Cochrane Review, Continuous Support for Women During Childbirth, showed a very high number of positive birth outcomes when a doula was present. With their support, women were less likely to have pain-relief medications administered and less likely to have a cesarean birth. Women also reported having a more positive childbirth experience.1 Other studies have shown that having a doula as a member of the birth team decreases the overall cesarean rate by 50%, the length of labor by 25%, the use of oxytocin by 40%, and requests for an epidural by 60%.2 Doulas often use the power of touch and massage to reduce stress and anxiety during labor. According to physicians Marshal Klaus and John Kennell, massage helps stimulate the production of natural oxytocin. The pituitary gland secretes natural oxytocin to the bloodstream (causing uterine contractions) and to the brain (resulting in feelings of well-being and drowsiness, along with a higher pain threshold). Historically it was thought that intravenous oxytocin does not cross from the bloodstream into the brain in substantial amounts and, therefore, does not provide the same psychological benefits as natural oxytocin. However, more recent studies indicate that oxytocin administered nasally and/or intravenously may cross from the bloodstream into the brain. Nonetheless, doulas can help mothers experience the benefits of oxytocin naturally without the use of medication.
    Question:
    Do doulas offer any specific techniques to reduce pain?
    Answer:
    Doulas often use aromatherapy and other techniques to help ease labor pains. Some doulas teach breathing techniques and massage as part of their birth preparation and labor support services. Many doulas use aromatherapy techniques to help reduce pain. During labor, doulas use scents such as lavender, rose, jasmine, or ylang ylang to induce more positive feelings. During the first stage of labor, the scents may be massaged onto the abdomen, back, or feet to help reduce stress. In the second stage, aromatherapy may be offered to mothers in labor by placing a few drops of scent onto a handkerchief and allowing the drops to absorb into the vapors in the air. Doulas often keep aromatherapy products close at hand and ask the mother whether any of these scents appeal to her.
     
    Question:
    What else?
    Answer:
    Doulas can help a mother relax her body, allowing her body to take over the work of birth itself. As a labor progresses, doulas work to help the birth take place in an environment that is low-light, low-noise, and clean. Doulas may also help a mother to choose a position to promote labor. For example, doulas often encourage mothers to choose birth positions that will promote upright labor. Upright positions help to promote circulation and oxygen to the baby’s brain, promoting better birth outcomes. These positions can include kneeling on the floor or standing with support. Doulas may also help to prepare the mother for labor by helping her to practice laboring positions at home or in the community.
     
    Question:
    Is there any cost associated with doula services?
    Answer:
    At the time of publication of this article, most doula services are donated or offered at a small fraction of the costs of other forms of birth support, such as birthing center services or a hospital support person. Cost to the mother is usually covered by the childbirth educator or other birth professional who refers the mother to the doula. In some cases, doula services involve a small fee to the mother. Questions about cost are important to ask during the process of selecting a doula to ensure cost does not interfere with the doula’s ability to provide emotional and informational support during labor.
    The most important thing for the birth professional or childbirth educator to convey to expectant parents is that whatever costs are encountered during labor and delivery can be amortized into the price of the birth experience over a number of years. For example, many birthing-center clients find that the cost of a midwife’s services over a number of years is less than the price of routine prenatal care over the same amount of time. And, for couples who prefer out-of-hospital births, the cost of the services of an individual birth professional, such as a doula, may well be spread out over several years.
     
    Question:
    What should I look for in a doula?
    Answer:
    Choosing a doula is similar to choosing any other birth support person or professional. While doulas are not required for a safe birth, they are highly recommended. The American College of Obstetricians and Gynecologists (ACOG) states that “during the period of labor, pregnant women may benefit from continuous emotional support of a doula.”3 The American College of Nurse-Midwives (ACNM) states, “the doula may be provided by the health care provider, a consumer advocacy group, or by other sources, but remains an individual, paid person.”4 The National Perinatal Association supports the role of the individual doula as part of the birth team.5,6 Doulas are generally independent contractors, not employees. An essential part of birth support is the formation of trust between a woman and her doula. The doula must be someone who understands and believes in birth and who has no competing agendas or interests (other than the baby’s) during the birth.
    Question:
    Should a doula be someone I know?
    Answer:
    Anyone who is passionate about birth and knows about doula services may be recommended by someone as a candidate for a doula. Many doulas begin as labor support partners or birth assistants for friends and family. Including their own family members during birth preparation helps the doula to understand the needs of the birthing family. Once they have had a few successful experiences, they may decide to extend their labor support to more families. Doulas may also be recruited from professional organizations, such as the Birthworks Association (see Resources). Doulas who are employed through childbirth educator organizations may require that clients become their childbirth class participants first. Some doulas may also be certified and have received training to perform other health-care-related functions, such as midwifery and massage. Whether a doula is recommended by a family member or not, it is important that the support person be someone who can understand and share the birthing family’s thoughts, feelings, and beliefs on the birth process. It is important to discuss the relationship that the doula will have with other members of the birth team, including the midwife, obstetrician, and other caregivers, such as the birth partner or nurse.
    Question:
    What should I look for in a doula?
    Answer:
    Choosing a doula is similar to choosing any other birth support person or professional. While doulas are not required for a safe birth, they are highly recommended. The American College of Obstetricians and Gynecologists (ACOG) states that “during the period of labor, pregnant women may benefit from continuous emotional support of a doula.”3 The American College of Nurse-Midwives (ACNM) states,

Temp at 0.9, repetition 1.2:

Question:
    Are doulas needed if I deliver at home or in a hospital setting like where my sister gave birth last year after going through prenatal classes with another nurse practitioner?
    Answer:
    Yes! Whether giving birth inside a private birth center, at my birthing unit located within a Birth Center, Inc., in West Orange, New Jersey; at one of our hospice houses in southern California; or even on the floor at home among your closest friends and relatives, you’ll want someone there who fully understands what you're working toward—the kindness and caring provided by a highly skilled professional doula. We know every step leading up to, throughout, and beyond the actual delivery—and the healing needed afterwards.
    Of all those places mentioned above for birthing—I must say—that first choice belongs right in your own home . This means both physical location plus emotional environs, too… meaning people YOU choose being there with you for this special moment in time!
    Let me tell you why...
     In contrast to most traditional doctor-run “maternities,” we believe that each patient deserves individualized treatment based upon her unique needs. Often times, patients suffer unnecessarily because of unnecessary interventions. We hope to eliminate unwanted intervention so that women can concentrate on enjoying the exciting but sometimes overwhelming journey of becoming Mother Nature’s miracle worker: HERSELF!!!
            <NAME>, M.D./Astrologer
              Founder & Chief Executive Officer, National Home Birthing Institute and National Midwifery Association
                “When midwives and nurses assume full responsibility for the healthcare of pregnant woman AND infants — they have successfully accomplished something truly incredible.”—Goddess Gaia
          Please note: The term "midwife" refers exclusively to trained professionals educated in the fields of obstetrics and gynecology who hold degrees (such as RN, LPN), diplomas (CNA), certificates, certifications, licenses etc.
                        As opposed to a person using “midwife” as part of his/her title who has no such qualification (a lay midwife.)
           Dr. Christina Kalloniatis DNP, FACOG / President, American College of Nurse-Midwives District IX Board
             “There is nothing like welcoming them and letting nature take its course. It gives me great joy seeing mommies give birth to these delicate babies." --<NAME>
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