In nearly every culture throughout history, women have been surrounded and cared for by other women during childbirth. Artistic representations of birth throughout the world usually include at least two other women surrounding and supporting the birthing woman. One of these women is the midwife, who is responsible for the safe passage of the mother and baby; the other woman or women are behind or beside the mother, holding and comforting her. The modern birth doula is a manifestation of the woman beside the mother.
Birth doulas are trained and experienced in childbirth, although they may or may not have given birth themselves. The doula’s role is to provide physical and emotional support and assistance in gathering information for women and their partners during labor and birth. The doula offers help and advice on comfort measures such as breathing, relaxation, movement, and positioning. She also assists the woman and her partner to become informed about the course of her labor and their options. Perhaps the most crucial role of the doula is providing continuous emotional reassurance and comfort.
Doulas specialize in non-medical skills and do not perform clinical tasks, such as vaginal exams or fetal heart rate monitoring. Doulas do not diagnose medical conditions, offer second opinions, or give medical advice. Most importantly, doulas do not make decisions for their clients; they do not project their own values and goals onto the laboring woman.
The doula’s goal is to help the woman have a safe and satisfying childbirth as the woman defines it. When a doula is present, some women feel less need for pain medications, or may postpone them until later in labor; however, many women choose or need pharmacological pain relief. It is not the role of the doula to discourage the mother from her choices. The doula helps her become informed about various options, including the risks, benefits and accompanying precautions or interventions for safety. Doulas can help maximize the benefits of pain medications while minimizing their undesirable side effects. The comfort and reassurance offered by the doula are beneficial regardless of the use of pain medications.
Studies have shown that when doulas attend birth, labors are shorter with fewer complications, babies are healthier and they breastfeed more easily.
A Birth Doula:
- Recognizes birth as a key experience the mother will remember all her life
- Understands the physiology of birth and the emotional needs of a woman in labor
- Assists the woman in preparing for and carrying out her plans for birth
- Stays with the woman throughout the labor
- Provides emotional support, physical comfort measures and an objective viewpoint, as well as helping the woman get the information she needs to make informed decision
- Facilitates communication between the laboring woman, her partner and her clinical care providers
- Perceives her role as nurturing and protecting the woman's memory of the birth experience
- Allows the woman's partner to participate at his/her comfort level
Doula FAQs
1. What is a birth doula?
A birth doula is a person trained and experienced in childbirth who provides continuous physical, emotional and informational support to the mother before, during and just after childbirth.
2. Where does the word “doula” come from?
The word “doula” comes from ancient Greek, meaning “Woman’s servant.” Throughout history and in much of the world today, a cadre of women support a woman through labor and birth, giving back rubs and providing continuous emotional support. Like their historical counterparts, DONA International birth doulas know how to help a woman in labor feel better. However, today’s doulas are much more diverse than their predecessors. DONA International membership includes men and women from a wide range of ages and cultural backgrounds.
3. What effects does the presence of a doula have on birth outcomes?
Numerous clinical studies have found that a doula’s presence at birth:- tends to result in shorter labors with fewer complications
- reduces negative feelings about one’s childbirth experience
- reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction
- reduces the requests for pain medication and epidurals, as well as the incidence of cesareans
When a doula is present during and after childbirth, women report greater satisfaction with their birth experience, make more positive assessments of their babies, have fewer cesareans and requests for medical intervention, and less postpartum depression.
5. What effects do the presence of doulas have on babies?
Studies have shown that babies born with doulas present tend to have shorter hospital stays with fewer admissions to special care nurseries, breastfeed more easily and have more affectionate mothers in the postpartum period.
6. How do doulas practice?
Doulas practice in three ways: privately hired directly by clients, as hospital employees, and as volunteers in community or hospital programs.
7. Does a doula replace nursing staff?
No. Doulas do not replace nurses or other medical staff. Doulas do not perform clinical or medical tasks such as taking blood pressure or temperature, monitoring fetal heart rate, doing vaginal examinations or providing postpartum clinical care. They are there to comfort and support the mother and to enhance communication between the mother and medical professionals.
8. Does a doula make decisions on my behalf?
A doula does not make decisions for clients or intervene in their clinical care. She provides informational and emotional support, while respecting a woman’s decisions.
9. Will a doula make my partner feel unnecessary?
No, a doula is supportive to both the mother and her partner, and plays a crucial role in helping a partner become involved in the birth to the extent he/she feels comfortable.
Why use a doula?
Doulas mother the mother.
Women have complex needs during childbirth and the weeks that follow. In addition to medical care and the love and companionship provided by their partners, women need consistent, continuous reassurance, comfort, encouragement and respect. They need individualized care based on their circumstances and preferences. Doulas are educated and experienced in childbirth and the postpartum period. We are prepared to provide physical (non-medical), emotional and informational support to women and their partners during labor and birth, as well as to families in the weeks following childbirth. We offer a loving touch, positioning and comfort measures that make childbearing women and families feel nurtured and cared for.
- tends to result in shorter labors with fewer complications
- reduces negative feelings about one’s childbirth experience
- reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans
- reduces the mother’s request for pain medication and/or epidurals
Research shows parents who receive support can:
- Feel more secure and cared for
- Are more successful in adapting to new family dynamics
- Have greater success with breastfeeding
- Have greater self-confidence
- Have less postpartum depression
- Have lower incidence of abuse
Dads and Doulas: Key Players on Mother's Labor Support Team
There was a time when expectant fathers were portrayed as anxious, floor-pacing, cigar smoking men who were tolerated in hospital corridors until the long-awaited moment when a nurse or doctor would announce they were the proud father of a daughter or a son. Today's expectant fathers are different.
When it comes to pregnancy, birth, and parenting, today's father may want to share everything with his partner. He may want to be actively involved; ease his partner’s labor pain, welcome his baby at the moment of birth and help care for his newborn at home. A birth doula can help a father experience this special time with confidence.
Studies show that when doulas are present at birth, women have shorter labors, fewer medical interventions, fewer cesareans and healthier babies. Recent evidence also suggests that when a doula provides labor support, women are more satisfied with their experience and the mother-infant interaction is enhanced as long as two months after the birth. With doula support, fathers tend to stay more involved with their partner rather than pull away in times of stress.
Today, a father's participation in birth preparation classes or his presence at prenatal visits and in the birth suite is a familiar occurrence. Yet, we sometimes forget that the expectations of his role as a labor coach may be difficult to fulfill. Sometimes it is also culturally inappropriate for an expectant father to be so intimately involved in the process of labor and birth.
The father-to-be is expected, among other things, to become familiar with the process and language of birth, to understand medical procedures and hospital protocols and to advocate for his partner in an environment and culture he may be unfamiliar with. A doula can provide the information to help parents make appropriate decisions and facilitate communication between the birthing woman, her partner and medical care providers.
At times a father may not understand a woman’s instinctive behavior during birth and may react anxiously to what a doula knows to be the normal process of birth. He may witness his partner in pain and understandably become distressed. The doula can be reassuring and skillfully help the mother to cope with labor pain in her unique way. The father-to-be may be asked to accompany his partner during surgery should a cesarean become necessary. Not all fathers can realistically be expected to coach at this intense level.
Many fathers are eager to be involved during labor and birth. Others, no less loving or committed to their partners' well being, find it difficult to navigate in uncharted waters. With a doula, a father can share in the birth at level at which he feels most comfortable. The doula’s skills and knowledge can help him to feel more relaxed. If the father wants to provide physical comfort, such as back massage and change of positions, and help his partner to stay focused during contractions, the doula can provide that guidance and make suggestions for what may work best.
Physicians, midwives and nurses are responsible for monitoring labor, assessing the medical condition of the mother and baby and treating complications when they arise; but birth is also an emotional and spiritual experience with long-term impact on a woman's personal well being. A doula is constantly aware that the mother and her partner will remember this experience throughout their lives. By mothering the mother during birth, the doula supports the parents in having a positive and memorable birth experience.
The benefits of doula care have been recognized worldwide. The Medical Leadership Council of Washington, D.C, the Society of Obstetricians and Gynaecologists of Canada and the World Health Organization are among the many healthcare organizations that value the benefits that doulas provide to women in labor.
The father's presence and loving support in birth is comforting and reassuring. The love he shares with the mother and his child and his need to nurture and protect his family are priceless gifts that only he can provide. With her partner and a doula at birth, a mother can have the best of both worlds - her partner’s loving care and attention and the doula's expertise and guidance in birth.
source: DONA international, www.DONA.org
