When people hear the term doula they either have no idea what it means or this word conjures up stereotypes. Some people think all doulas are against pain medications, doctors, hospitals, and vaccines. But most of us are just women who feel passionate about helping woman and their partners’ unforgettable journey into parenthood.
So, what is a doula anyway, why do you care and why would you want one? Do they actually make women have faster labors, fewer medical interventions and increase breastfeeding rates? Yes!
DOULAS ROLE
*Education: Prenatal meetings – talk about your birth preferences, teach you labor coping techniques, what to expect in labor, birth, pain management options, common labor interventions, postpartum, breastfeeding (Simkin, 2008) (Kennell 2002).
*Non-medical: not a doctor or a nurse, do no do cervical checks or interpret fetal heart monitors, we give no medical advice.
*Protector of the laboring space: We recognize birth as an experience that you will remember the rest of your life, a defining moment; and as such seek to provide you with as much comfort as possible. Low lights, soft voices, just right temperature, encouragement, and guidance. We do all this by remaining calm so you don’t have to. By doing this the doula helps keep mamas’ natural pain relieving hormone high. Endorphins are released throughout labor and get higher as labor discomfort increases (Anonymous C, 2015).
*Advocacy: Our job is to ensure you have a voice. We facilitate this by encouraging you to ask questions so you can make an informed choice about you and your baby’s care. We do not directly interfere with medical staff on your behalf. Most importantly, we support your choices. We are however well versed in the typical medical interventions and can explain them to the parents (Kennel, 2002).
* Takes fear out of the birth room by reminding mom and partner that throwing up, shaking, hot/cold, and all that intense pressure is normal. Penny Simkin compares the hundreds of births she has witnessed and notices that three characteristics are all commonly shared by the mom who copes well; relaxation, rhythm, and ritual (Simkin, 2008). Adrenaline plays a huge part in labor. This flight or fight hormone can inhibit a mom in labor if she is scared or frightened by slowing down her contractions, make it feel more painful and can stop it completely (Anonymous D, Unknown).
*Enhances role of partner: Dad and doula work together to help mom labor. Dad’s can be fearful of having to know everything and with a doula present dad is more relaxed and emotionally available for mom (Klaus, 2002). We of course take care of dad too by giving them breaks, taking over when they are tired and being there emotionally for them.
*Keeps labor progressing: keep mom focused and working with her contractions not against them. Reminds her to void, drink, listen to her body, do what feels good and change positions. Movement in labor is very important to keep labor progressing like swaying, walking, lunging, squatting, and hand and knees (Kennell, 2002). When a women is in upright positions it encourages the release of more oxytocin as the baby’s head puts pressure against the cervix releasing more oxytocin which stimulates longer, stronger, closer together contractions (Anonymous C, 2011).
*Remains after the birth: Usually we stay one to two hours to give continued emotional support especially if separated from baby. Help with breastfeeding latch on. Take picture or video if desired.
THE EVIDENCE FOR DOULAS
- One study in 2013 found that mamas had expected the nurse to spend 53% of their time with them, when in actuality the time spent actually engaging during labor was only 6-8% (Cupito, 2013).
- In DONA’s position paper (Doulas of North America), they reference a study done in the late 1970’s by Drs. Kennell and Klaus whereby it was discovered that when a mother in labor had a doula there was a decrease in complications and the average labor in first time mothers was only 9 hours. Their research also found that in those mothers who had no doula and no family support, interventions rose and the average labor for a first time mother was 19 hours (Kennell, 2002).
- A randomized control study done in Houston by McGrath, Kennell, and Suresh between 1984-1987, compared the effects of managing labor pain either by using narcotics, an epidural, or a doula. The laboring mom was randomly given either a narcotic, a doula or an epidural for pain (Kennell, 2002).
Doula group results
Fewer vacuum/forceps deliveries
Less augmentations
Shorter labors – 7.8hrs
Fewer C-sections 3.2% (4 of 126 moms)
Epidural group results
Ave labor 9.9 hrs.
C-section rate 16.8%
Narcotics group results
Ave labor 9.5 hrs.
C-section rate 11.6%
- The long term effects of doula care can be seen in a Johannesburg study. The psychological effects of women after labor show that women with a doula reported less anxiety, less depression, and higher self-esteem (Kennell, 2002). Feeding behavior at six weeks was also assessed and it was found that the women who had a doula were breastfeeding at a rate of 51% compared to non-doula women which was only 29%. Infant feeding problems were also down at only 16% compared to 63%. And, 81% of doula mothers were feeding their babies on demand.
Written by Abbie Alvey
*no part of this may be copied and distributed without permission from the author.