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The Role of a Birth Doula

Why a birth doula is such a valuable addition to your birth team.

 
 

A big part of what makes doula work so invaluable is that it values simple truths that women have known for countless generations: that reliable emotional and physical support throughout pregnancy, birth and early postpartum can have a huge impact on the new mother’s physical and mental wellbeing. A doula can help parents feel empowered by the information and support they have been given, which allows them to experience and remember the birth of their child through a lens of pride and control, rather than fear and powerlessness.

Fortunately for all the nerds out there (myself included), there is also lots of scientific evidence on the benefits of doulas, especially birth doulas. There is also lots of evidence on how certain characteristics of today’s healthcare system may not be ideal for all new and growing families. 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.

A few prime examples of this phenomenon are:

  • High rate of caesarian births: rates in North America have been near 30% for many years, whereas the World Health Organization states that an ideal rate would be closer to 10-15%.

  • Common use of synthetic oxytocin to augment labor: it is used in about 1/3 labors, but its routine use is not supported by evidence.

  • Fasting once you are admitted: not supported by evidence.

  • Laboring in bed: not supported by evidence.

  • Giving birth on your back: not supported by evidence.

The reasons behind all of these practices are at times understandable, at others completely baffling. The bright side of all this is that 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.

So 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:

This simply means that the doula will remain with the laboring person throughout their entire labor. In fact, studies have 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. In addition, the likelihood of a Caesarian birth was decreased by 25% – 39% when the continuous support was provided by a doula.

Unfortunately, it is uncommon for hospital staff to provide continuous care. Nurses, midwives and doctors often 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, doulas and loved ones are usually not tied to a specific schedule and will only touch a laboring person in a way that is comforting and requested.

Physical support:

Doulas provide physical support in any way that feels good for the laboring person. 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 medical side-effects.

Many natural coping techniques can also be used in tandem with medical options provided by a hospital or birth center. Tools such as positioning, counterpressure, massage, showers, baths, rebozos and peanut balls can help shorten labor, empower moms and partners and reduce the use of pain medication, allowing you to perhaps use the hospital’s options more strategically.

Informational support:

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.

Emotional support:

Doulas provide emotional support by being a calm, encouraging and knowledgeable presence in the room. 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!

Studies have found that women who received continuous support from the same person during their labor 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 throughout 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 all 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.

Advocacy:

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.

Final thoughts

I have learned and seen first-hand the gaps in care that laboring people and their families experience in the healthcare system as it is today. I have 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 have had the immense joy of providing a calm, knowledgeable and supportive presence to many a birth team and have seen what a significant difference this kind of support can have on the experience of pregnancy, labor and early parenthood.

Indeed, 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 North America.