The Value of Labor Support / Doula Care

By Liza Morgan

Throughout history and across cultures, women have supported each other throughout labor. With the advent of modern medicine, doctors have replaced these wise women and have medicalized the birth process. In an effort to bring this emotional and physical support back to the birthing process, doulas are becoming a popular addition to the labor support team.

The purpose of a doula is to provide pregnant women with prenatal education, labor preparation, labor support and some postnatal care.  Through 1-3 prenatal visits, a doula helps educate her client on her medical choices, the risks and benefits of medical intervention and possible unexpected events.  Often times mothers don’t realize that they have choices, let alone what those choices are. Creating a birth plan helps to facilitate communication between the mother, partner and doctor/midwife, so that the mother is informed about her medical choices and can make educated decisions about them before the ‘heat of the moment’.  Discussing the birth plan assures that the father knows what her medical preferences are so that he can advocate for her.  Reviewing the birth plan with the mother’s doctor informs the doctor of the mother’s wishes and also alerts the mother to change doctors if they do not see eye-to-eye.  Talking about the ‘what ifs’ helps the parents feel prepared for whatever happens and reminds them that the birth may not go exactly as ‘planned’.  Doulas also teach comfort measures such as massage, positioning, visualization, breathing and relaxation techniques to help the mother discover what works for her and to make these things familiar to her in labor.  Mothers can also look to their doula for quality resources and referrals.

Possibly most importantly, a doula provides continuous support throughout labor, delivery, and immediate post-partum.  A doula, in combination with the partner and possibly other family members, provides what the mother’s emotional side needs most: constant reassurance and encouragement.  The presence of continuous support helps a mother feel safe and cared for.  With a doula, the mother knows she will never be alone, that she can be herself, and that her doula knows what her medical preferences are.  Because other support people like the father and family members will flock to the baby after he/she is born, the doula stays by the mother’s side to support her through the delivery of the placenta and any stitches.  A doula can also help with establishing breastfeeding.

Doulas are also beneficial in the weeks following birth. Most doulas offer a post-partum visit to check-in and talk about the birth. It is helpful for the new mom to discuss how the birth went, delighting in the joys as well as expressing any disappointments.  This helps her process the intense feelings associated with childbirth and become clearer on the details of the birth. Many doulas offer the gift of a ‘birth story’, a priceless keepsake remembering the birth.  At the post-partum visit, a doula can also look for signs of post-natal depression or trouble with breastfeeding and refer her for help if necessary.  Ultimately, a doula is just trying to help the mother have a good birth experience because as stated in DONA’s position paper; “The birth of each baby has a long lasting impact on the physical and mental health of mother, baby and family.”

Possibly the most noticeable benefits of doula care are the effects it can have on obstetrical outcomes.  As researched and documented by John Kennell and Marshall Klaus, the benefits of continuous labor support include: shorter labor, lower cesarean-section rates, less use of Pitocin to speed delivery, less need for pain medication, less need for forceps or vacuum to aid delivery, and a lower rate of complications overall.  These are all beneficial to mother, baby, hospital and doctor/midwife.

In addition to these obstetrical benefits, more mothers report the birth experience as a positive one.  Also, fathers tend to enjoy the birth experience more with the presence of a doula. When they aren’t pressured to be the mother’s only support system, they can participate as much or as little as they feel comfortable.  A doula can also give the father ideas on how to help comfort his partner.  Continuous labor supports helps foster a strong bond between mother and baby, benefiting the whole family.  Often times, because of the extra encouragement and support, breastfeeding is more successful with the presence of a doula.  Doula care has also been shown to improve the mother’s self-esteem.

An essential responsibility of a doula is to respect the mother’s choices.  A doula should present educational information in an unbiased way and be careful not to push her values on her clients.  All a doula can do is present the information and trust that any decision the mother makes is what’s right for her.  A doula is responsible for being available to the mother when she goes into labor and providing a back-up doula if for some reason she cannot make it.  It is important for a doula not to take over and give the husband and family a chance to show their support (if that’s what the mother wants). A doula is also responsible for advocating for the mother, without making decisions for her. Giving midwives, doctors and nurses the same respect we expect is another vital piece of being a doula.  Because doulas provide non-medical support, it is key that they practice within their scope.  DONA’s ‘Code of Ethics’ and ‘Standards of Practice’ outline these guidelines in detail.

The reintegration of continuous physical and emotional support in the birth process is shown to have great benefits.  The benefits for mother, baby, family, doctor/midwife, hospital and society as a whole, prove that doula care is in the best interest of all people. Together we can bring DONA’s vision to fruition: “ A Doula For Every Woman Who Wants One.”