This is an essay I wrote as part of my birth doula certification through DONA International.
Historically, it has been the norm for birthing women to have the gift of another woman’s presence all throughout her labor, birth, and immediate postpartum. This labor companion may have been a mother, aunt, grandmother, sister, friend, or combination of these. A pregnant woman could expect the presence of an experienced woman to comfort her, encourage her, help with pain relief, instruct her how to breastfeed, and help her care for a newborn. However, this gracious transition into motherhood was lost when North American birth moved to the hospital in the 1930’s and women were disallowed their husbands or other support with them in labor.
In the decades that followed, husbands or other support people were eventually allowed to be present in the birthing room. Yet by then, birth had come to be viewed as a medical emergency fraught with micromanagement, staunch protocol, and standard medical interventions. As a result, most women had little understanding of the value of labor support or even how to articulate what they needed in labor. Not surprisingly, partners or other support were ill-equipped to comfort, support, and advocate for the birthing woman.
Today, the birth doula steps in to re-establish this healthy support network of female labor companions. A birth doula is a trained labor professional. Ideally, she has sought certification through a credible organization, a process that includes birth-related reading, in-person workshop attendance, breastfeeding education, labor support experience, childbirth education, and obtaining positive references from her clients and their caregivers.
A doula’s scope of practice involves prenatal communication, education, emotional and physical support during labor, suggesting comfort measures, support for the partner, and advocacy for her clients choices and rights. She does not perform any kind of clinical or medical tasks such as vaginal exams, taking vital signs, or prescribing treatment for her clients. Additionally, if a doula has other certifications or qualifications, those skills must be practiced separately from her role as a doula.
Prenatally, a doula can educate mothers on how hormones work in labor and birth – and how pain relief drugs can interfere with them, potentially making labor longer and more painful. She is supporter of the woman’s choice in labor and birth, but ensures that she factually presents both the benefits and risks of these choices and preferences. For example, if a woman knows that she wants an epidural as soon as possible in labor, the doula can help make that happen by facilitating communication with the mother’s caregivers. She can also educate the mother on ways to encourage the production of birth hormones as much as is possible with an epidural. In labor, the doula is a protector of those wonderful birth hormones – whether guarding mom’s privacy, advocating for her choices, coaching her through contractions, using a rebozo to relieve back pain, or encouraging skin-to-skin contact with baby.
A doula supports not only the mother, but her partner, as well. The kind of support she provides enables the partner to be fully focused on the needs of the mother. Her support of the partner might include showing him how apply counter-pressure on the mother’s lower back, suggesting a position change, grabbing water and ice chips, reminding him to eat a quick snack, or trading places for a bit if he needs a breather or short nap.
A doula may be the sole female support person at a birth, or she may guide the laboring woman’s own mother or sister as they support the mother. Regardless of how many support people the mother has, a doula has a commitment to provide continuous support to the mother. Over the hours of labor and throughout hospital shift changes, she does not leave except for short, necessary breaks to keep herself refreshed and nourished. After the birth, a doula ensures that breastfeeding is off to a good start and that her clients are comfortable, settled, and ready for some quiet enjoyment of their new baby.
As a trained labor professional, a doula understands that emotional support during labor and birth is as important as physical support because a woman needs to feel safe and nurtured in order for her labor to progress normally. When high levels of fear and anxiety are present in a laboring woman, oxytocin flow is reduced, often resulting in slow or stalled labor progress. Providing emotional support for a laboring woman will often look like giving undivided attention, expressing belief in her ability to birth, helping her focus and establish ritual, and giving verbal reassurance and reminders.
Current research has shown that the continuous presence of a labor support person – such as a doula – can lower shorten a woman’s labor, reduce her need for pain medication, lessen her risk for an instrumental vaginal birth, increase her chances of a spontaneous vaginal birth, and lower her risk of a cesarean birth. (Bohren, Hofmeyr, Sakala, Fukuzawa, & Cuthbert, 2017). Women who have given birth with the presence and support of a doula also report having a more positive view of their birth than did women without a doula. Additionally, the American College of Obstetricians and Gynecologists have continued to equate the presence of a doula with better birth outcomes, noting that births with doula support result in shorter labor, few cesarean births, less pain medication, and more satisfaction with the birth experience (American College of Obstetricians and Gynecologists [ACOG], 2019).
From prelabor to pushing, the doula is a positive, reliable support to mother and partner, sharing in the miraculous journey of birth. Her support during pregnancy, birth, and immediate postpartum helps usher a woman into confident motherhood, whether it is her first baby or fourth. Capable, confident mothers contribute to the making of strong, healthy families. Healthy families in turn undergird the health and well-being of society – and this is why labor support matters.
REFERENCES
Cochrane Library (2017). Continuous support for women during childbirth. Retrieved from www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003766.pub6/full
American College of Obstetricians and Gynecologists. (2019). Approaches to Limit Intervention in Labor and Birth. Retrieved from www.acog.org/-/media/Committee-Opinions/Committee-on-Obstetric-Practice/co766.pdf?dmc=1&ts=20190204T2356061672
