The ways in which society views and manages childbirth have evolved over time. Decades ago, women were not able to actively be a part of the labor and childbirth experience. Routine procedures involving chloroform, forceps, and solitude during labor and birth left women feeling “dehumanized” and alone. Many of these women knew of no other way to birth and had very little say in what happened in the delivery room (Harper). Today, however, we have come to understand that birth is a natural, physiological process. Having a supportive birth team and the freedom to express birth preferences can result in a more satisfying and empowering experience for the laboring mother. For women looking to make the most out of their birthing experience, a doula makes the difference. The ancient Greek word “doula” historically meant “woman who serves.” Currently, the term “doula” refers to a trained labor support professional that assists women and their partners before, during, and immediately after childbirth by providing educational, emotional, and physical support. Doulas act as an important aspect of birthing culture because they have the ability to positively alter the ways that individuals perceive and experience childbirth (Simkin, Way).
A doula’s key role is to provide continuous emotional, informational, and physical support to laboring women. She provides physical, hands-on comfort and emotional reassurance by using a variety of techniques, whether it is during prenatal and postpartum visits or during labor and birth. Doulas do not only support laboring women, but also support their partners as well. During pregnancy, the doula will help an expectant couple to map out their birth preferences; during labor, she assists the couple in carrying out these wishes. Rather than speaking for her clients, a doula will facilitate communication between the clinical care provider, the mother, and the partner. The doula does not take the partner’s place. Instead, she provides guidance by modeling numerous techniques the partner can use during labor and birth to bring the mother relief and encouragement. The doula may use relaxation techniques to help the laboring woman, such as visualization, mental imagery, and breathing exercises. She helps women find comfortable laboring positions, such as hands and knees, side-lying, kneeling, and semi-sitting. The doula finds ways to help the woman feel most comforted by using tools like hot and cold packs, a birth ball, hydrotherapy, body movement, verbal reassurance, massage, counter pressure, and aromatherapy. She can also assist in constructing a relaxing atmosphere for the laboring mother and her partner-- a special, intimate space where positive memories are created (M. Klaus, J. Kennell, P. Klaus).
The benefits of labor support to the mother and her family are extensive and extraordinary. Recent studies show that a doula’s continuous support reflects an array of short term, physical benefits and long term, emotional benefits. Women supported by birth doulas tend to give birth with less medical interventions, including the use of Pitocin, forceps, vacuum extraction, and Cesarean sections. They also experience less need for pain medication and tend to labor for a shorter period of time. Women who are supported continuously throughout labor and birth tend to have a higher sense of satisfaction with their birth experience as well as higher self-esteem. A doula preserves a mother’s memories of this life-changing event and helps her advocate for herself, leaving the mother feeling empowered and fulfilled. A doula’s assistance often leads to improved maternal-infant interactions and breastfeeding outcomes. Doulas encourage skin-to-skin contact, and when mother and baby are instantly united after birth by simple, intimate contact, the relationship is nurtured to the fullest extent (Simkin, Way).
Various scientific studies have been conducted since the 1970s, the first developed by Dr. John Kennell and Dr. Marshall Claus. These studies have discovered that, compared to women who received “usual” care during labor and birth, women who labored with continuous support were 26% less likely to have Cesarean sections and 41% less likely to experience vacuum extraction or birth with forceps. These women were also 28% less likely to use any analgesia or anesthesia and 33% less likely to feel discontented with their birth experience. Because of the doula’s presence and continuous labor support, the emotional, physical, and mental aspects of birth for the mother are improved (Simkin, Way).
According to DONA’s Standards of Practice, the doula’s main goal is to help mothers achieve safe and satisfying births. This will be different for each laboring woman because there is no universal. Doulas advocate for the mother and her partner by providing information regarding the risks and benefits of certain procedures and then allowing the mother and her partner to make the decision that works best for them. Doulas do not perform clinical or medical tasks. This includes taking blood pressure or temperature, checking fetal heart tones, performing vaginal examinations, and/or providing postpartum clinical care. Rather than prescribing treatments and diagnosing health concerns, doulas advise clients to speak with their care providers if they have specific questions regarding clinical care.
According to DONA’s Code of Ethics, every woman who desires to have a doula should be able to have one. Doulas should set reasonable fees when working with clients. If a doula is not available for a mother who requests labor assistance, it is that doula’s responsibility to refer the mother to other doulas who are available. When a doula decides to work with a client, she must demonstrate dependability. This involves creating and sharing a contract that discusses services provided, back-up support, refunds, fees, etc. Doulas should always maintain confidentiality when working with their clients. This simple action illustrates respect of privacy and will allow a mother to feel more secure in the care of her doula.
Providing labor support enhances a woman’s birth experience, in both physical and psychosocial perspectives. Labor support facilitates interaction and nurtures the relationship between parents and infants. How a mother is treated during labor and childbirth influences the memories of her birth as well as the relationship she shares with her child and partner. The continuous support that a doula provides tends to create more positive obstetric outcomes for women and their babies. Women who are adequately supported in labor tend to experience less obstetric interventions during labor and delivery. Every woman is unique, and different women have different needs and wants. Nurses and care providers have many patients and very little time to provide one-on-one care. A doula, however, can offer individualized care, which places mom at the center of this novel and miraculous experience.
*All content written and compiled by Lindsey Rupp. Please contact me before using anything found here.*
"DONA International – Code of Ethics for Birth Doulas." DONA International. 2005. Web. 5 Jan. 2011 <http://www.dona.org/aboutus/code_of_ethics_birth.php>.
"DONA International – Standards of Practice for Birth Doulas." DONA International. 2005. Web. 5 Jan. 2011. <http://www.dona.org/aboutus/standards_birth.php>.
Harper, Barbara. Gentle Birth Choices. Rochester, VT: Healing Arts, 2005. Print.
Klaus, Marshall H., John H. Kennell, and Phyllis H. Klaus. The Doula Book: How a Trained Labor Companion Can Help You
Have a Shorter, Easier, and Healthier Birth. Cambridge, MA:Perseus Pub., 2002. Print.
Simkin, Penny, and Kelly Way. The Birth Doula’s Contribution to Modern Maternity Care: A DONA International Position Paper. 1998. A publication on the value of birth doula support.