The Benefits of Birth Doulas
I became a doula because I wanted to help people. I know, I know, it’s not a very original reason. In fact, growing up, this was one of the common themes in all the jobs I pictured myself having as a grown-up. However, when college came around, I chose to become a translator. After all, I love language and writing, and translating helps more people have access to a text. I also figured I could find some more concrete way to help people in other spheres of my life. I would figure that all out later.
Luckily for me, my first job out of college was as the in-house translator for a nurses’ union in Montreal. I became quickly immersed in the world of health care from the perspective of nurses who, in addition to their day jobs, also spent a considerable amount of their time and energy defending the rights of their patients and their coworkers. I heard countless stories about how budget cuts, understaffing and antiquated workplace mores affect the care that patients receive, as well as the medical staff’s ability to provide the kind of quality care they strive for.
I have since learned that there are often hierarchical pressures to provide services in a specific way for reasons that are not always evidence-based. In fact, for reasons ranging from cultural biases, economic issues, limited research and even plain old resistance to change, it takes an average of about 17 years for evidence-based research to become standard care. I also learned the value of emotional wellbeing from these nurses, and how this kind of support is not contrary to scientific medical care, and that it therefore shouldn’t be dismissed so quickly.
All of these issues lingered with me when I moved to San Francisco in 2016 and was fortunate enough to be able to take some time to re-evaluate my career path. Without quite being able to articulate it, I wanted a career in health care that would allow me to support women and that would take into account the emotional gaps in care that are suffered by far too many medical professionals and patients.
I then came across an article about doulas and, upon researching exactly what a birth doula is, I somewhat spontaneously decided to sign up for a workshop to get some hands-on knowledge from an experienced certified doula trainer. I was instantly hooked! I had, for some time, had an interest in pregnancy and birth, but there was SO MUCH I didn’t know! Since then, I have learned so much more about the hyper-medicalization of labor and the antiquated practices imposed on birthing people in most hospitals today.
Prime examples that come to mind are the high rate of caesarian births (32%) and the common use of synthetic oxytocin to augment labor (31%), whose routine use is not supported by evidence. There are also many non-pharmacological practices that affect birthing people, such as fasting once they are admitted (80%), laboring in bed (57%) and giving birth on their backs (68%), which are also not supported by evidence.
The reasons behind all of these practices are far too complex for me to dive into within the scope of a single article! The bright side of all this is what I learned about how birth doulas can help birthing people avoid some of these sometimes unnecessary procedures, as well as help empower them to stand up for the birth they want. I also discovered the ways in which a doula can be a valuable asset to the medical staff.
How exactly can a doula help laboring people and their partners?
The role of a birth doula, as described in my DONA-approved training, is to provide continuous physical, informational and emotional support and advocacy to the laboring person and their partner/s.
Continuous support simply means that the doula will remain with the laboring person through labor and birth. This mostly differs from the care provided by nurses or other medical staff, because they tend to come and go because they have other responsibilities or work on a shift-based schedule. Doulas provide physical support in any way that feels good for the laboring person, whether it is by helping them in and out of certain positions, by applying counterpressure, giving massages, using a rebozo, using a peanut ball, etc.
Ideally, a lot of the informational support comes before the birth itself during prenatal appointments. Doulas can provide their clients with information about natural options that they were perhaps not aware of so that they can make informed decisions about their preferences. Because of their experience, they can also help families navigate the various choices they may have to make if giving birth in a hospital setting, for example. Doulas may even bring up topics that parents may not have thought to ask their doctor.
Doulas provide emotional support by being a calm, encouraging and knowledgeable presence. They can remind the laboring person that this is their labor, not anybody else’s. A doula may remind them of their own agency and reassure them that they are doing wonderfully. Doulas can also help laboring people and their partners reframe the way they think of pain – it is pain that serves a purpose and it is a pain that will end. It is pain that they can get through!
The special way in which doulas can advocate for their clients is, in fact, by not advocating for them per se, but by holding space. This, to me, means lending your calmness and confidence to someone who needs it through your presence and support. Often, this means reminding laboring people that they always have the final say when it comes to their body and that they can request additional information about a recommended course of action and refuse it if they want to.
Evidence-based reasons to hire a doula
A significant aspect of what a doula can offer in terms of evidence-based care is their knowledge about the benefits of natural pain management techniques, many of which have been shown to be as effective or sometimes more effective than some pharmacological methods, as well as not causing any negative medical side-effects. For example, upright positions and movement during labor can reduce the length of both the first and second stage, reduce the use of epidurals (thus eliminating their associated side-effects or downsides), decrease the likelihood of caesarians, increase maternal satisfaction and reduce pain. Hydrotherapy, such as showering or taking a bath at various points during labor, has been shown to pose virtually no risk, and it can help mothers use less pain medication, have higher satisfaction with their birth and increase their sense of privacy and comfort.
Another aspect of doula care is the fact that it is continuous, which could of course also be provided by a loved one. In fact, research has shown that women who receive continuous support during labor and birth are 8% more likely to have spontaneous vaginal births – 15% when using a doula. They are also less likely to use pain medication, their labors were found to be shorter on average and their babies were less likely to have low Apgar scores at birth. In addition, the likelihood of a Caesarian birth was decreased by 25% –39% when the continuous support was provided by a doula. These studies also found that women who received continuous support were 31% less likely to be dissatisfied with their birth. I believe this is because there is a lot of value in a pregnant person choosing people they trust to be by their side and to support them through their labor. However, partners are going through an emotional journey of their own, which is another reason why doulas offer a special kind of support for any expectant parents. They are of course there to help the laboring person, but they can also facilitate partner involvement and make sure that they are also getting the rest, food, information and support they need.
Unfortunately, it is uncommon for hospital staff to provide continuous care. Nurses, midwives and doctors usually work on a shift-based schedule and have many other responsibilities, including other patients to take care of. Most of their time spent in a laboring person’s room will be dedicated to clinical duties, such as a cervical exam, adjusting the fetal monitor, measuring blood pressure, taking a blood sample, etc. It may be more difficult for laboring people to see these medical professionals as emotionally comforting when most of their interactions with them include a medical intervention – the necessity and frequency of which vary greatly depending on the person’s labor and their care provider. In contrast, a doula is usually not tied to a specific schedule and will only touch a laboring person in a way that is comforting and requested.
Some final thoughts
In essence, I have learned and seen first-hand the gaps in care experienced by laboring people in the health care system as it is today. I have also maintained a deep respect for medical staff, nurses in particular, who often find themselves in positions with immense responsibility, but who are not always able to provide the kind of care their patients are requesting. I believe that doulas can help alleviate some of this stress by providing a continuous, knowledgeable presence for the laboring person and by facilitating communication between them and their medical team.
So, yes, doulas can indeed be essential tools for families wanting a more natural birth. However, my goal as a doula is to help my clients be informed of all their options, medical and non-medical. I want to empower expectant parents to feel confident in their choices and to voice their concerns clearly and without fear to their medical team. I also want to help them be kind to themselves if they end up deviating from their initial plan, and to have true agency when it comes to the decisions they make during that process. Bottom line is, regardless of how medical or natural your birth is, I want you to feel like you remained informed and in control of your body throughout the entire experience.
Note: The use of feminine terms and pronouns in this text is meant to reflect the majority of people who give birth, and the totality of people participating in some of the cited studies. It is not meant to exclude laboring and birthing people who do not identify as female. All statistics are from the USA.
Journal of the Royal Society of Medicine https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3241518/
World Health Organization http://www.who.int/reproductivehealth/intrapartum-care/en/
Evidence Based Birth https://evidencebasedbirth.com/the-evidence-for-doulas/
EBB Podcast episode 3 “Why it’s so hard to get evidence based care” Jan 11, 2018.
DONA International Position Paper: the Birth Doula’s Role in Maternity Care https://www.dona.org/wp-content/uploads/2018/03/DONA-Birth-Position-Paper-FINAL.pdf