The word doula is a Greek word that means "Women's Servant." Women have been serving other women in childbirth for centuries and have proven that this support from another woman has positive effects on the labor process.
"My husband (partner) is my left hand and my doula is my right." ~~from Doulas Making a Difference
What is a Doula?
A doula is a professional trained in childbirth who provides emotional, physical and informational support to the woman who is expecting, in labor or has recently given birth. The doula's role is help women have a safe, memorable and empowering birthing experience.
Most often the word "doula" is referring to the birth doula, or labor support companion, but there is also the Antepartum Doula and the Postpartum Doula. For the following information, the word "doula" will be referring to the Labor Doula. Doulas can also be called labor companions, labor support specialist, labor support professional, birth assistants or labor assistants.
What Does a Doula Do?
Most doula and client relationships begin a few months before the baby is due. During this time they establish a relationship that gives the mother complete freedom to ask questions, express fears and concerns, and take an active role in creating a birth plan. Most doulas make themselves available to the mother by phone to answer questions or explain any developments that may arise in pregnancy. Doulas do not provide any type of medical care. However, they are knowledgeable in the medical aspect of labor and delivery so they can help their clients get a better understanding of procedures and complications that may arise in late pregnancy or during delivery.
During delivery, doulas are in constant close proximity to the mothers at all times. They can provide comfort through pain relief techniques, such as breathing, relaxing, massage and laboring positions. Doulas also encourage participation from the partner and offer reassurance. A doula acts as a silent advocate for the mother, encouraging her in her desires for her birth. The goal of a doula is to help the mother have a positive and safe birth experience, whether the mother wants an un-medicated birth or is having a planned cesarean birth.
After the birth, many labor doulas will spend a short time helping mothers begin the breastfeeding process and enoucourage bonding between the new baby and family members.
What are the benefits to having a doula?
Numerous studies have revealed the benefits to having a doula present during labor. A recent Cochrane Review, Continuous Support for Women During Childbirth, revealed a very high number of positive birth outcomes when a doula was used. When a doula was present, women were less likely to have pain relief medications administered, less likely to have a cesarean birth, and reported having a more positive childbirth experience1.
Other studies have shown that having a doula as part of the birth team decreases the overall cesarean rate by 50%, the length of labor by 25%, the use of oxytocin by 40% and the request for an epidural by 60%2.
Doula's often use the power of touch and massage to reduce stress and anxiety during labor. According to physicians Marshal Klaus and John Kennell, massage helps stimulate the production of natural oxytocin. The pituitary gland secretes natural oxytocin to the bloodstream which causes uterine contractions and also secretes it to the brain, which results in a feeling of well being, drowsiness and a raised pain threshold. Synthetic IV oxytocin can not cross into the blood stream and brain, so it increases contractions without the positive psychological effects of natural oxytocin.
The Father's Role when Using a Doula
The role of the doula is never to take the place of the father or partner in labor, but to compliment and enhance their experience. Today many more fathers are taking a more active role in the birth process, but still some partners feel that this is a huge expectation, and would rather be able to enjoy the delivery without having to stand in as labor coach. With a doula as a part of the birth team, a father can do whatever he feels comfortable with at each moment. Doulas can encourage the father when to use comfort measures, and can step in when he needs a break. Having a doula allows the father to be able to support his wife emotionally during this process and also enjoy it himself without the pressure of having to remember everything learned in the birthing classes!
Are Doulas Only Useful If Planning an Un-medicated Birth?
The presence of a doula can be beneficial no matter what type of birth you are planning. Many women do report needing fewer interventions when they have a doula, but the role of the doula is to help you have a safe and pleasant birth, not to choose your type of birth. For women who know they want a medicated birth, the doula still provides emotional support, informational support and comfort measures to help the women through labor and the administration of medications. Doulas can work along side medication by helping mom deal with possible side affects and filling in the gap that medication may not cover; rarely does medication take all discomfort away.
For a mother who faces a cesarean, a doula can be helpful by providing constant support and encouragement. Often a cesarean is an unexpected situation and moms are left feeling unprepared, disappointed and lonely. A doula can be with the mother at all times throughout a cesarean, explaining what is going on throughout the procedure while the partner is able to attend to the baby and accompany the newborn to the nursery if problems arise.
What About Other Types of Doulas?
There are three types of doulas: the Antepartum Doula, the Labor Doula and the Postpartum Doula:
- Antepartum Doulas provide help and support to the mom who has been put on bed rest or is experiencing a high risk pregnancy. They provide informational, emotional, physical and practical support in a situation that is often stressful, confusing and emotionally draining.
- Postpartum Doulas are there to support you in your first weeks of being a mom. They provide informational support on feeding and care for the baby. They provide physical support by cleaning, cooking meals and filling in when mom needs a break, and they provide emotional support by encouraging a mom during those times when she feels overwhelmed.
- Some doulas are trained in more than one area and can provide service as more than one type of doula.
Finding a Doula
The most important thing in deciding on a doula, is finding someone you feel comfortable with and confident in. Most doulas do not charge for a free initial consultation and interview, so take the time to interview a couple until you find the one that meets your needs.
Questions to Ask a Potential Doula:
- What training have you had?
- What services do you provide?
- What are your fees?
- Are you available for my due date?
- What made you become a doula?
- What is your philosophy on childbirth?
- Could you meet with me at home before the birth to discuss my birth plan?
- What happens if you are not available at the time of my birth?
Resources on Doulas
- Mothering the Mother: How a Doula can help you have a shorter, easier and healthier Birth by Marshall H. Klaus, Phyllis H. Klaus, and John Kennell.
- The Doula Book by Marshall H. Klaus, John Kennell, and Phyllis H. Klaus.
- The Doula Advantage by Rachel Gurevich.
- Doulas of North America (DONA)
- Childbirth and Postpartum Professional Association (CAPPA)
1Hodnett ED. Gates S Hofmeyr GJ. Sakala C. Continuous Support for women during childbirth. Cochrane Databse of Systematic Reveiws.(3) CD003766, 2003.
2Klaus, M., Kennell, J., Klaus, P. Mothering the Mother.: Addison-Wesley Publishing Company, 1993.
Reprinted with permission from American Pregnancy Association