A doula is a person who provides labor support. Traditionally, women had female birthing attendants from their communities to assist with comfort and knowledge during a support.
However, in today’s modern society more and more women have families that live far away. Many women work jobs outside the home with increased demands on family life. So, support has dramatically lowered during birth and postpartum. Women nowadays labor mostly in unfamiliar environments of hospitals, with unfamiliar medical team with the support of a husband or partner who may have no prior experience with childbirth. So professional doulas have been up and coming to assist with this gap in care in modern times or in more developed countries. In developing countries, the traditional communal support is more present still to today.
A doulas role is to provide non-medical support to assist a laboring person emotionally, physically, with information, advocacy and involving the partner. This may look like massage, getting water or juice, wiping a brow, counter pressure to hips, post on changes, affirmations, breathing techniques. A doula can help the partner be involved and know how to support the mom during labor. A doula also assists by presenting information (or transferring knowledge), facts, pros and cons about birth, interventions to help the birthing mom make the best decision for herself so she is informed.
During labor and prenatally as well, a doula can help facilitate communication with physicians and midwives and nurses, and she can remind the mother of her birth plan. This is advocacy and it does not mean speaking for the client, or to making decisions for her. Being pregnant and going through labor is a lot of work. And sometimes moms just need reminders or help figuring things out. Advocacy is supporting the birthing person in their right to make decision over their care.
In the Cochrane review in 2017 bohen et al, they state that doulas are essential is supporting moms in labor. The study included 26 trials for over 15000 women with half in high income and half in middle income with none in low income in over 17 countries. It was hard to find an all-inclusive study that included low income families or countries.
The study compared support from hospital staff only, family, no support or doulas. 15 of the studies no husband was allowed in the room. The researchers concluded that people who have continuous support during labor like a doula results in a:
25% decrease in the risk of Cesarean; 39% with specifically a doula
*8% increase in a spontaneous vaginal birth;
*10% decrease in the use of any medications for pain relief; the type of person providing continuous support did not make a difference
Shorter labors by 41 minutes on average;
38% decrease in the baby’s risk of a low five minute Apgar score;
31% decrease in the risk of being dissatisfied with the birth experience; mothers’ risk of being dissatisfied with the birth experience was reduced with continuous support provided by a doula or someone in their social network (family or friend), but not hospital staff
Pitocin was used less with a doula vs continuous staff
I like how this article broke it down by doula vs hospital staff vs family/friends. That’s very specific and helpful to show the difference. Yes continuous support is key but sometimes women prefer family only. And this does show the difference a skilled doula can make.overall a doula improved outcomes for families all around!
Cesarean sections have risks for mothers including infections, hemorrhage, transfusion, injury to other organs, anesthesia complications, psychological complications, and a maternal mortality up to four times greater than that for a vaginal birth. and risks for babies, including “increasing the risk to the infant of premature birth and respiratory distress syndrome, both of which are associated w
multiple complications, intensive care and burdensome financial costs. Even for mature babies, the absence of labor increases the risk of breathing problems and other complications.” The decrease in cesarean birth for women accompanied by a doula decreases the risks of these negative outcomes, and so therefore doula care has a positive effect on the health and wellbeing of laboring women and their newborns. http://www.childbirth.org/section/CSFact.html
Another important topic is the mother’s satisfaction with her birth experience. Mothers who have a doula are less likely to remember their birth as a negative and, they may be less likely to have postpartum depression and anxiety.
There are also better outcomes for having a doula plus the father vs just having the father or partner present. In the McGrath 2008 article, they explain how fathers felt more involved with the birth because things were explained to them. A doula doesnt take the role of the partner but helps involve them and shows them how to help their wife labor. Satisfaction from the mom and partner increased when a doula was present. This shows how doulas and partners can work together. Also two is better than one! One person can take a break while the mom is never left alone!
Spport is also great for women of color! Women of color are 3-4x more likely to die from pregnancy related issues than any other population including other minorities. That’s astounding in today’s modern medicine. The main issue is racism and neglect of listening to black women’s concerns. This doesn’t just happen for low income black women. But also those in high income populations such as celebrities. Some examples are Serena Williams and Beyonce! Their birth stories come with sad and tired experiences from their medical team. They could have been another statistic but lived to bring awareness to this not talked about issue in the birthing world. Thomas 2017 explained how black women experience higher rates of c sections, low birth weight, increased use of pain medicine despite accounting for health, finances and economic factors, education, and marital status. Stress does have an influence on birth and racism and other life factors build on each other. A doula for these women helps them feel safe, especially if the doula is of similar background and culture to understand where they are coming from. Feeling safe in birth is key for easing labor and reducing stress.
To attempt to fill the need for doulas for black women, many non -profits have been started to make sure access to affordable or free doulas is available. In San Diego where I serve, “For the village” is one organization helping provide free volunteer doulas for women of color!
In conclusion, doulas are essential in labor support. The evidence is there. There are no negatives! If you want an optimal birth experience you will need a doula by your side.
References:
Bohren, M.A., Hofmeyr, G., Sakala, C., et al. (2017). “Continuous support for women during childbirth.” Cochrane Database of Systematic Reviews
McGrath, S. K. and Kennell, J. H. (2008). A randomized controlled trial of continuous labor support for middle-class couples: effect on Cesarean delivery rates. Birth 2008; 25:3.
Thomas, M. P., Ammann, G., Brazier, E., et al. (2017). Doula Services Within a Healthy Start Program: Increasing Access for an Underserved Population. Maternal and child health journal, 21(Suppl 1), 59–64.
www.Forthevillage.org