The Purpose & Value of Doula Support

The Greek word “doula” translated actually means female servant.  That is what being a doula means, being a servant to someone who is in labor and giving birth.  I believe Ina May Gaskin’s was the one to say, “If a woman doesn’t look like a goddess in labor then someone isn’t treating her right.”  A doula makes her client feel like a goddess. She waits on her hand and foot to make sure every comfort measure is met so the laboring mom is as calm and relaxed as she possibly can be during the most life changing moment in her life!  A doula is there to comfort, encourage, support, guide, educate, empathize, nurture, listen, help create a safe and warm birth environment and most of all, to empower the birthing mom and her partner.  “The doula accompanies the woman in labor, provides emotional and physical support, suggests comfort measures, and provides support and suggestions for the partner. The doula advocates for the client’s wishes as expressed in her birth plan, in prenatal conversations, and in postpartum discussions, by encouraging her client to ask questions to her care providers and to express her preferences and concerns.” This is all taught to the DONA doula in her training through the Standards of Practice.

The birth doula is not a medical provider, they are not there to make medical decisions on behalf of the birthing family.  They are not there to communicate on your behalf with your medical providers or be the bridge between the doctors, midwives and nurses.  Doulas are not there to judge your decisions and instill or project their beliefs on to you.  “The doula should act in accordance with the highest standards of professional integrity.” DONA Code of Ethics

The doula’s primary responsibility is to her client. Doulas are here to serve, educate, support and empower the birthing family.  They are there to help you find your voice so you feel supported and confident in the birth choices you make, based on all the facts and evidence you have been shown.  They are birth mentors,  experienced birth workers guiding you down the best path with choices that fit your specific birthing wishes and needs.  They are your rock to lean on, your supportive face to turn to, and your biggest fan, cheering you on as you cross the finish line in the giant marathon we refer to as childbirth, letting you know that, yes, YOU GOT THIS!

The doula does not replace the birth partner rather, “with a doula present, the pressure on the partner is decreased and he or she can participate at his or her own comfort level. Partners often feel relieved when they can rely on a doula for help; and enjoy the experience more.  For those partners who want to play an active support role, the doula assists and guides them in effective ways to help their loved ones in labor.” Written in the Position Paper: The Birth Doula’s Contribution to Modern Maternity Care from the DONA International Birth Doula Manual, 2017.

Is there evidence about doulas and how their continuous labor and birth support can be beneficial?  Yes! There have been many studies done.  “In fact, the largest systematic review of continuous labor support, published in 2011, reported the combined findings from 21 randomized controlled trials, including 15,000 women. (1)  The trial compared “usual care” in the hospital with various types of providers of continuous labor support: a member of the hospital staff (i.e., a nurse); a family member or friend; and a doula (not a hospital employee, family member or friend) whose sole responsibility was to provide one-to-one supportive care. While overall, the supported women had better outcomes than the usual care groups, obstetrics outcomes were most improved and intervention rates most dramatically lowered by doulas.”  According to a summary of the findings of this review (2), the doula-supported women were:

·       28% less likely to have a cesarean section

·       31% less likely to use synthetic oxytocin to speed up labor

·       9% less likely to use pain medication

·       34% less likely to rate their childbirth experience negatively

These facts were stated in the Position Paper: The Birth Doula’s Contribution to Modern Maternity Care from the DONA International Birth Doula Manual, 2017.

The bottom line according to the Evidence on: Doulas by Rebecca Dekker, PhD, RN, APRN:

“Of all the ways birth outcomes could be improved, continuous labor support seems like one of the most important and basic needs for birthing people. Providing labor support to birthing people is both risk-free and highly effective. Evidence shows that continuous support can decrease the risk of Cesarean, the use of medications for pain relief, and the risk of a low five-minute Apgar score. Labor support also increases satisfaction and the chance of a spontaneous vaginal birth. Continuous support may also shorten labor and decrease the use of Pitocin. Although continuous support can also be offered by birth partners, midwives, nurses, or even some physicians, research has shown that with some outcomes, doulas have a stronger effect than other types of support persons. As such, doulas should be viewed by both parents and providers as a valuable, evidence-based member of the birth care team.”

Need a doula? Check out this list of highly experienced certified doulas who have all gone through the Avalon Birthing Center Workshop Orientation. Click Here to Learn More About The Avalon Approved Doulas!

References:

1.           Hodnett ED, Gates S, Hofmeyr GJ, Sakala C, Western J. “Continuous support for women during childbirth.” Cochrane Database Syst Rev. 2012 Feb 16; (2):CD003766

2.          Childbirth Connections. “Best Evidence: Labor Support: Labor Support.” 2011. Retrieved from http://childbirthconnection.org/article.asp?ck=10174&ClickedLink=257&area=27

3.          Rebecca Dekker, PhD, RN, APRN. “ Evidence on: Doulas.” Evidence Based Birth. Updated on August 16, 2017.  Originally published on March 27, 2013: