What is a doula

Here is what a doula does, and does not do. I am sorry it is so long, but I can’t seem to condense it without leaving out important information.

A doula is a professional trained in childbirth who provides emotional, physical, and educational support to a birthing person who is expecting, is experiencing labor, or has recently given birth. The doula’s purpose is to help the birthing person have a safe, memorable, and empowering birthing experience. Doula comes from a Greek word that means “a woman who serves” or “handmaiden.” However, I disagree with a few things here, one, I don't agree with saying "a woman who serves", it should say "a person who serves" because there are other people that doula as well. This is just the original meaning.

Most often the term doula refers to the birth doula, or labor support companion. However, there are also antepartum (prenatal) doulas and postpartum doulas. Most of the following information relates to the labor doula. Doulas can also be referred to as labor companions, labor support specialists, labor support professionals, birth assistants, or labor assistants.

What does a doula do?

Most doula-client relationships begin a few months before the baby is due. During this period, they develop a relationship in which the client feels free to ask questions, express her fears and concerns, and take an active role in creating a birth plan.

Most doulas make themselves available to the client by phone in order to respond to the clients’ questions or address any concerns that might arise during the course of the pregnancy. Doulas do not provide any type of medical care. However, they are knowledgeable in many medical aspects of labor and delivery.

As such, they can help their clients gain a better understanding of the procedures and possible complications in late pregnancy or delivery.

During delivery, doulas are in constant and close proximity to the mother. They have the ability to provide comfort with pain-relief techniques including breathing techniques, relaxation techniques, massage, and laboring positions. Doulas also encourage participation from the partner and offer reassurance.

A doula encourages and helps the client fulfill specific desires she might have for the birth. The goal of a doula is to help the client experience a positive and safe birth, whether a non-medicated birth or a cesarean. A doula also looks after your partner as well, this can be your mother, your partner, your friend, etc. (gives them bathroom breaks!), but their primary responsibility is to the client.

After the birth, many labor doulas will spend time helping the client begin the breastfeeding process and encouraging bonding between the new baby and other family members. A doula does not leave your side as soon as they arrive. To read a husband’s perspective on hiring a doula, read this article from Bloom in Spokane, Washington.

What doesn't a doula do?

Doulas are NOT medical professionals
They do not perform clinical tasks such as vaginal exams or fetal heart monitoring
They do not give medical advice or diagnose conditions
They do not judge you for decisions that you make
They do not let their personal values or biases get in the way of caring for you (for example, they should not pressure you into making any decisions just because that’s what they prefer)
They do not take over the role of your husband or partner
They do not deliver the baby
They do not change shifts

What are the benefits of having a doula?

Numerous studies have documented the benefits of having a doula present during labor. A recent Cochrane Review, Continuous Support for Women During Childbirth, showed a very high number of positive birth outcomes when a doula was present. With the support of a doula, the birthing person was less likely to have pain-relief medications administered and less likely to have a cesarean birth. Women also reported having a more positive childbirth experience.

How is a doula different from a labor and delivery nurse or partner/spouse?

The most important thing a client needs during labor is continuous support. This means that you have someone by your side continuously from start to finish. A doula never leaves your side. Nurses have many other responsibilities other than you. Aside from helping care for you, the nurse is communicating with your care provider, taking care of other patients, documenting care, taking breaks, and taking care of other responsibilities. A nurse’s support ends when their shift does. The doula only has one obligation the whole time and that is with you.

Sometimes people think that they don’t need a doula because their partner will be with them continuously throughout labor. Your partner is an essential support person for you to have by your side. However, your partner will need to eat and use the bathroom at times. Also, most partners have limited knowledge about birth, medical procedures, or what goes on in a hospital. Doulas and partners can work together to make up a labor support team.

So what is the evidence for doulas?

In 2012, Hodnett et al. published an updated Cochrane review on the use of continuous support for the birthing person during childbirth. They pooled the results of 22 trials that included more than 15,000 birthing people. These birthing people were randomized to either receive continuous, one-on-one support during labor or “usual care.” The quality of the studies was good.

Continuous support was provided either by a member of the hospital staff, such as a midwife or nurse (9 studies), women who were not part of the woman’s social network and not part of hospital staff (doula 5 studies; childbirth educators 1 study, retired nurses 1 study), or a companion of the birthing person's social network such as a female relative or the woman’s partner (6 studies). In 11 studies, the husband/partner was not allowed to be present at birth, and so continuous support was compared to no support at all. In all the other studies, the husband or partner was allowed to be present in addition to the person providing continuous labor support.

Overall, birthing people who received continuous support were more likely to have spontaneous vaginal births and less likely to have any pain medication, epidurals, negative feelings about childbirth, vacuum or forceps-assisted births, and C-sections. In addition, their labors were shorter by about 40 minutes and their babies were less likely to have low Apgar scores at birth.

What does this mean?

It means that if you have continuous labor support (that is, someone who never leaves your side), you are statistically more likely to have better outcomes and your baby is more likely to have better outcomes!

How did doulas compare to the other types of continuous support?

The researchers also looked to see if the type of support made a difference. They wanted to know—does it matter who you choose for your continuous support? Does it matter if you choose a midwife, doula, or partner for your continuous support? They were able to look at this question for 6 outcomes: use of any pain medication, use of Pitocin during labor, spontaneous vaginal birth, C-section, admission to special care nursery after birth, and negative ratings of birth experience.

For most of these outcomes,* the best results occurred when the birthing person had continuous labor support from a doula— someone who was NOT a staff member at the hospital and who was NOT part of the birthing persons social network. When continuous labor support was provided by a doula, the birthing person experienced a:

31% decrease in the use of Pitocin*
28% decrease in the risk of C-section*
12% increase in the likelihood of a spontaneous vaginal birth*
9% decrease in the use of any medications for pain relief
14% decrease in the risk of newborns being admitted to a special care nursery
34% decrease in the risk of being dissatisfied with the birth experience*

For four of these outcomes,* results with a doula were better than all the other types of continuous support that were studied. For the other outcomes, there was no difference between types of continuous support.

Why are doulas so effective?

A doula can act as a buffer in a harsh environment.

There are 2 main reasons why we think doulas are so effective.

The first reason is the “harsh environment” theory. In most developed countries, ever since birth moved out of the home and into the hospital, the birthing person have been giving birth in conditions that can often be described as harsh. In the hospital, laboring birthing people are frequently submitted to institutional routines, high intervention rates, personnel who are strangers, lack of privacy, bright lighting, and needles. Most of us would have a hard time dealing with these conditions when we’re feeling our best. But the birthing people in labor to deal with these harsh conditions when they are in their most vulnerable state. These harsh conditions may slow down a birthing person's labor and decrease the birthing person's self-confidence. It is thought that a doula “buffers” this harsh environment by providing continuous support and companionship which promotes the birthing person's self-esteem (Hofmeyr, Nikodem et al. 1991).

A dad says: “My experience has shown me that whether you’re giving birth in the hospital, birth center, or at home, your impact and ability to connect and support your partner during the birth process is both supported and maximized by having a doula there on your team.”

The second reason that doulas are effective is because doulas are a form of pain relief (Hofmeyr, 1991). With continuous support, birthing people are less likely to request epidurals or pain medication (Hodnett, 2011). Why are women with doulas less likely to request pain medications? Well, birthing people are less likely to request pain medications when they have a doula because they just don’t need an epidural as much! Birthing people who have a doula are statistically more likely to feel less pain when a doula is present. Furthermore, by avoiding epidural anesthesia, birthing people may avoid many medical interventions that often go along with an epidural, including Pitocin augmentation and continuous electronic fetal monitoring (Caton, Corry et al. 2002).

So what is the bottom line?

Evidence shows that the most important thing is for birthing people to have continuous labor support from someone– whether that person is a nurse, midwife, partner, or doula. However, with several birth outcomes, doulas have a stronger effect than other types of support persons.

Reference :Evidence Based Birth

Top Ten Myths about Doulas

1. Myth: A Doula won't let a laboring woman take any pain relief drugs.

Truth: A Doula is there to help support a laboring woman so the woman has a safe and satisfying childbirth as the woman defines it.

2. Myth: A Doula will interfere with medical advice.
Truth: A Doula will not interfere with medical advice. They facilitate communication between all involved and encourages their client to ask relevant questions so the birthing person can make informed choices. Doulas do not make decisions for their clients, medical or otherwise.

3. Myth: A Doula will "take over."
Truth: A Doula is there to facilitate and enhance the relationships between the hospital staff, the laboring woman's partner, and any others present. Often times the partner will become more involved with a Doula present.

4. Myth: A Doula will take away "the best part of a nurse's job."
Truth: A laboring person can never have too much support. A Doula strives to work as a team with the nursing staff and welcomes any suggestions and physical support that the nurse may provide.

5. Myth: A Doula has negative opinions about a hospital setting.
Truth: A Doula has the utmost respect for the lifesaving technology available for unexpected circumstances in a hospital. Additionally doulas should always respect and value the setting their clients choose to give birth in.

6. Myth: Doulas are not necessary because the nurse (partner, family member, friend, and fill in the blank) is there.
Truth: A Doula does not have to perform clinical skills and therefore can offer the uninterrupted support that nurses are not always able to provide. A Doula is not emotionally involved with the laboring person as are other family members and close friends so the Doula knows what to expect and doesn't panic when they see the laboring person in pain.

7. Myth: A Doula will leave if the mother gets an epidural.

Truth: There seems to be an urban legend of sorts about the Doula who left as soon as the birthing person got an epidural. This is not usual, and I have actually never heard a real story of this myself or seen it. A Doula is there to support the laboring person with any decisions she makes. The birthing person still needs continuous support even with an epidural. The Doula can give the partner a break to go get something to eat or to take a nap if it's been a particularly long labor. The doula can take pictures, get ice-chips, do hand massage or just sit quietly while the birthing person rests.

8. Myth: Doulas secretly want to catch the baby.

Truth: A Doula does not have the clinical skills or the knowledge to want to receive the baby on their own. Trying to deliver the baby on their own is an irrational notion. Doulas are not at a birth to deliver babies; they are present to serve the needs of the birthing person.

9. Myth: Doulas only attend home births. Truth: Doulas attend births at home, at the hospital, and at birth centers. She will labor at home with the birthing person until it is time to go to the hospital/birth center (where applicable)

Reference: Birth Arts International

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