What is a Doula?
Many definitions have been assigned to the word doula. Birth coach, labor assistant, childbirth companion and labor supporter to name a few. In Greek the word doula means woman caregiver. Today’s doulas are a combination of all these different definitions, in some ways the actions of these women are the definitions and they change with every birth. Labor and giving birth is a very individual process, there are as many different labors as there are women, therefore a doula brings something different to every woman’s birthing experience depending on the wants and needs of the mother and her partner.
A doula is a non-medical assistant, she does not perform any procedures, medical checks, or make any diagnosis or decisions. Instead she dedicates herself entirely to emotionally and physically supporting the mother, her partner and any other friend or family members present at the birth. A doulas role in a mother’s life usually begins several months prior to the birth of the child. It is during this time that the doula becomes acquainted with the mother and her partner and learns their wants and needs for labor. Furthermore, she becomes familiar with the mothers emotions, preferences and desires. During labor, the doula will assist the mother through every contraction using breathing exercises, different body positions, visualizations, verbal encouragement or simply through her presence. Consistent aspects of a doula’s role include: “Providing specific labor support skills, techniques, and strategies. Offering guidance and encouragement to laboring mothers and their families. Building a team relationship with nursing staff. Encouraging communication between patient and medical caregivers. Assisting mothers to cover gaps in their care” (Gilliland p.2). According to The Doula Book, by Klaus et al., the most important thing that a doula can do for a mother is reassure her that she will be with her the whole time.
In recent years research has started to show that the presence of a doula decreases the need for pharmaceuticals, assisted deliveries and Cesarean sections. A recent couples study done in Clevland with 555 couples showed that the couples supported by a doula showed a statistically significant decrease in Cesarean section and mothers choosing an epidural. With no doula’s the percent of C-sections was 22.5 and 76.8% rate of epidurals. Couples that did have the continuous support of a doula had C-section rate of 14.2% and an epidural rate of 67.6% (Klaus et al. p. 79). Another more extensive study done in Houston Texas showed that the presence of a doula decreased length of labor, use of oxytocin, maternal fever and Cesarean deliveries while increasing the amount of natural vaginal births. Length of labor for women with a doula decreased from 9.4 hours to 7.4 hours, use of oxytocin decreased form 44% to 17% and forceps deliveries decreased from 26% to 8%. Furthermore rate of cesarean decreased from 18% to 8% and maternal fever decreased from 10% to 1%. The number of mothers that had natural vaginal births was 116 out of 212 for women with a doula and 23 out of 204 for women without a doula (Klaus et al. p.83-89).
Other studies have also been done to look at the effects of a doula on the mothers and infants well being postpartum. A study done in Jahonnesburg showed that six weeks after delivery women who had a doula were more likely to be breast-feeding exclusively, demand feeding and experiencing few feeding problems. Furthermore mothers reported fewer health problems with the baby compared to mothers who did not have the support of a doula (Klaus et al. p.104-105).
In addition a doula often serves to bridge the gap that often exists between the mother and the medical staff. Sometimes the mother is restricted in her choices for a medical professional whether by insurance or medical issues and a doula helps to provide familiarity and support as well as a link between the professional and non-professional world (Gilliland p.1). A doula can form an amazing team with the obstetric nurses, who often have the desire but not the time to dedicate their full attention to the mother, each bring a very unique skill set to the birth and help make sure that the mother is never alone, scared or unattended to. A doula will encourage the mother to communicate with her care providers and talk to her about the type of questions to ask and how to best make her desires heard and understood by medial professionals without causing conflict. Working on a birth plan can be a big part of this process, helping the parents verbalize there wishes in a respectful and concise manner can greatly ease communication between parents and staff members ( Gilliland p.4-6). During a birth that requires intervention, such as a C-section, the doula, if she is allowed in the operating room, can help the mother understand what is going on during the procedure and reassure her afterword if the baby has to be taken to the nursery. She can stay with the mother while the partner goes with the baby and serve as a messenger between the two places, providing information, pictures and encouragement.
Furthermore, after the birth the doula can facilitate the mothers first moments with the baby whether it is breast-feeding or simply skin-to-skin contact. The doula can help parents write down their birth story and fill in any gaps they may have during that time period or any misconceptions or guilt they may feel. A doula can often reassure the parents about the experience help them understand anything unusual that happened which may have scared the parents or made them feel guilty or discouraged (Gilliland p. 7).
A doula should always maintain a level of professionalism and be able to clearly understand the boundaries of her scope in practice. A Professional Doula should meet certain expectations without overstepping boundaries or pushing her own beliefs. Having this kind of assistance can be a great resource and support system for the parents and, with good communication, a positive asset to hospital staff.