How does having an attendant or doula in birth positively impact a families experience? And why are doulas SO effective?
Labour & birth is an intense and emotional experience for birthing persons and their families. It is also a time of great vulnerability and that can be tough. Strong support during this special time can drastically affect a families perspective of their experience, greatly improving the chances of having a positive one. But what is a positive birth experience really? It can be very different for every person. One woman’s cesarean birth and another’s natural vaginal birth can both be equally positive, empowering and satisfying experiences, depending on the life experiences they brought to the birth and more importantly how supported, respected and cared for they felt they were by their birth teams. A birth experience can also be traumatic to a person regardless of the type of birth it is, especially if the birthing person feels they were disrepected, discluded, unheard or mistreated. Continuous support is one of the most important and most basic needs of birthing persons. If a woman is continuously supported, both the mother and the baby are more likely to have better outcomes in their own minds and much research has indicated just that.
The Purpose of Support
The purpose of labour support and having attendants in birth is to nurture the birthing person and the partner, creating a safe space and to uphold a mother’s choices and vision for her birth and the birthing process. It is also to promote the physical and mental health of a mother and her loved ones.
This is the role of a doula. What is a doula anyway? The word ‘doula’ is a greek word meaning ‘woman servant or caregiver’. A doula is a companion who supports a birthing person before, during and after labour & birth. She provides continuous one-on-one care as well as information, physical support and emotional support. The role of a birth doula encompasses the non-clinical aspects of care in childbirth and the variety of needs women have during this time, including consistent and continuous reassurance, comfort, privacy, encouragement and respect.
A partner is most of the time the very best person to support a mother in labour. Truth! A father, partner or incredibly supportive loved one is invested and they know the mother or birthing person better than anyone else in the room. They will be in the best position to read her reactions and to communicate her needs and their presence is so important for the birthing person’s well being & sense of safety. This important role carries with it a lot of pressure and emotion as well. Partners & fathers will often benefit greatly from professional birth support themselves.
There is much to be said for having a person trained and experienced in birth support accompany a birthing couple on their journey as they navigate their way. A doula is a calm and reassuring presence and she works to reduce fear and anxiety, promote the couple’s vision and preferences, maintain a conducive labouring environment and provide physical and emotional support. She gently guides the partner’s support efforts to ensure they are effective, softly suggesting, demonstrating and supporting position changes and various comfort measures. She will keep the lights dim and the door closed. She ensures the birth team is fed and hydrated and that processes are explained and questions are answered. She is an extra set of hands with a lot of wisdom and a warm heart.
As someone trained and experienced in birth support, a doula is intuitive as to what a labouring mother needs. Things the nurse or midwife may not have time for or that a partner might not pick up on or know how to tackle. The doula’s primary responsibility is to her clients and according to the DONA International Birth Doula Code of Ethics ‘she should promote the general health of women and their babies, and whenever possible, that of family and friends as well’. A doula leaves her own opinions at the door and fully embraces the agenda of the birthing woman and her family.
The Value of a Doula’s Support
In 2017, Bohren et al. published an updated Cochrane Review on the continuous support of women during childbirth. They combined the results of 26 trials that included more than 15,000 people. According to this review, people who received continuous support were more likely to have spontaneous vaginal births and were less likely to have any pain medication, epidurals, negative feelings about childbirth, vacuum or forcep-assisted births and cesareans. In addition, their labours were shorter by about 40 minutes and their babies were less likely to have lower Apgar scores at birth. The review also reported that for most of these outcomes, the best results occurred when a birthing person also had continuous support from a doula – someone who was NOT a staff member at the hospital and NOT part of their social network . When continuous support was provided by a doula, women experienced a;
- 31% decrease in the use of Pitocin
- 28% decrease in the use of Cesarean
- 12% increase in the likelihood of a spontaneous vaginal birth
- 9% decrease in the use of any medication 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
It is difficult to dispute that continuous labour support results in a reduction in the use of interventions and an overall more positive perspective of birth by birthing families. There is a massive benefit to having attendants support birthing persons in labour emotionally, physically, in terms of making decisions and also for the partner.
The Impact of Emotional Support
Given the long-term emotional effects births can have on mothers, their partners and their babies, a doula is a very valuable asset to any birthing team. Her continuous presence, reassurance, affirmation, encouragement, praise, positive perspective and validation through the tough stuff is invaluable. Emotional support helps a birthing person to feel cared for and contributes to a sense of pride and empowerment following the birth and these feelings can easily continue on into the postpartum period as well. A doula helps families to work through fears and anxiety and creates a space where the labour hormones can do their work and this builds a couple’s confidence.
The Impact of Physical Support
Doulas are well versed in natural pain management. Rebozo, massage, counter-pressure, breathing techniques, hydrotherapy, warmth & cold, position changes, movement, visualization and relaxation techniques and ensuring mothers are hydrated and nourished and much more. The addition of physical support allows the birthing person to maintain a sense of control, confidence and adds comfort. It is a welcomed distraction from the intensity of the contractions and birth.
The Impact of Support on Accessing Great Care
Doulas are trained to help families connect with evidence based resources so they can ask questions and make informed decisions about their birth. A doula does not make decisions for or speak for a client, however she works to keep a birthing couple informed about the events of their labour and provides access to information about their birth options. She also creates the space and time to ask questions and facilitates communication between families and birth teams. A doula’s informational support contributes greatly to more individualized care for the birthing couple and a more positive experience on the quality of care by the couple.
The Impact on the Partner
In a McGrath & McKennel study, the women and their partners who had a doula overwhelmingly rated their support as positive, with 93% rating their experience with doulas as very positive and 7% as positive. Partners & fathers feel a doula’s support complemented and reinforced their own support. With the complexities of supporting a birthing partner as well as the major life event in the birth of a child, fathers and partners appreciate having their questions answered and their work and efforts guided as they have their own journey they are taking as well. There is a big weight that is lifted from them in being the only person relied on to help their wife or partner through.
Why Are Doulas SO Effective?
A doula’s support is continuous regardless of how the birth goes or what decisions are made and she fully embraces the wishes and vision of the birthing couple without judgement. Having a familiar face present who is there to support and care may enhance the physiology of labour & birth and also contributes much to a woman’s sense of control and confidence in her ability to give birth.
Doulas are also a form of pain relief. With touch, massage, counter-pressure, water, position changes and more a doula works to relieve as much of a mother’s discomfort as possible. Reducing fears and anxieties works to release tension and lessen the perception of the pain that the birthing person is experiencing as well. By relieving some discomfort in a variety of ways, a doula promotes the efficiency and progress of the labour. Her ability to help a mother feel more calm, relaxed and in control enhances oxytocin production, promotes natural endorphin release and so reduces pain.
A doula can help to maintain the right birthing conditions. Although the hospital is the right place to birth for many mothers it is not the ideal place for labour hormones to do their work. Routines, needles, interventions, unfamiliar staff, people coming and going, other birthing families, bright lights and hospital gowns can all be quite intimidating, especially in such a vulnerable state. These things can slow labour. Doulas act as a bit of a buffer between the birthing person and these more harsh and less ideal conditions by providing continuous care and working to minimize their impact. Some music, dim lights, a lit candle or a warm robe to cover up with are all little things that can go a long way in giving a birthing person confidence and comfort.
The Big Picture
The impact of continuous labour support has proven to be extremely beneficial both emotionally & physically and in making informed decisions about birth options for birthing persons and their families.
It’s Heart & Hands.
A heart full of compassion and the drive to care for birthing people and the ones they love most so they have the best chance of having a positive story to tell. That they can say they were supported and cared for, affirmed, nurtured and respected, made to feel comfortable, encouraged, communicated with and heard. And hands to hip squeeze, to massage a sore back, grab a sandwich at the cafeteria and hug them when it’s over.
Have you had an experience with a doula? How do you feel it impacted your birth experience? Leave your comments, we would love to know.
- Dona Birth Doula Code of Ethics