The word Doula (doo-lah) comes from Greek and means “mothering the mother” or “woman’s personal servant”. If we look back in ancient times, women with experience in birthing have always attended other women during their labour and births. To give birth with a Doula is, in that way, connected way back through history.
In our modern world a Doula refers to a woman with experience in birth work, not as a medical person but as a person who understands the process of birth both physically and emotionally. She is trained in supporting and empowering women and their partners during pregnancy, labour, birth and early parenting and she provides that much needed continuity of care and support.A doula’s primary and very unique role is to increase the mother’s confidence and feeling of safety.
A doula’s primary and very unique role is to increase the mother’s confidence and feeling of safety. By standing by the mother no-matter how the birth journey unfolds and which decision the birthing woman might make, she can significantly help reduce fear and tension and create a calmer and more settled environment.
Physicians and midwives are responsible for monitoring labour, assessing the medical condition of the mother and baby, and treating complications when they arise. But childbirth is also an emotional and spiritual experience with long-term impact on a woman’s personal well being. A doula is constantly aware of the mother and her needs, emotionally, physically and practically. Helping her make the birth space her own and communicating effectively with other carers.
Many couples come to a hospital expecting a midwife to attend them during the labour. Unfortunately that is rarely the circumstance these days. A midwife will generally have to look after many women at a time. This, apart from the fact that midwives work on shifts, means that birthing women and their partner often spend long periods of time on their own, and often see two even three midwives and doctors during their labour and birth.
So why hire a doula?
Many studies have been conducted regarding the continuous support of a trained doula during labour and birth and how it enhances the experience for the woman and affects the outcome of birth. These studies shows that women who brought along a doula, whom they had built a relationship with during pregnancy, and who stayed with the woman until a few hours after baby was born, as a group had:
- Reduced chances of getting a C-section (1-7)
- Reduced epidural or other painkiller use (1-4,7,8)
- Reduced use of oxytocin (Pitocin) (1,2,4,6,7)
- Reduced duration of labour (1-6)
- Reduced use of forceps and vacuum extractions (1,2,4,5)
- Reduced chances of health complications and hospitalisations of baby (2,3)
- Reduced chances of maternal fever and infection (2)
- Reduced maternal bleeding following birth (5)
- Increased chances of successful breastfeeding (4,9-12)
- Reduced incidence of post-partum depression (4,10)
- Reduced levels of anxiety (4)
- Result in a more positive birth experience (4,8,13)
- Mothers feel more in control (9,13)
- Increased chance of spontaneous vaginal birth (6)
- Mothers have higher regard and increased sensitivity towards babies (4,10)
- Mothers feel more secure (14)
(Source: The Australian Doula College)
In the USA and the UK doulas have been used for decades now, and research there shows that having a Doula significantly increases the woman’s feeling of satisfaction with her experience. (www.dona.org)
The benefits of doula care have been recognized worldwide. The Medical Leadership Council of Washington, D.C, the Society of Obstetricians and Gynaecologists of Canada and the World Health Organization are among the many healthcare organizations that value the benefits that doulas provide to women in labour.
It helped that when we ran out of things to help cope with the pain Pernille suggested other options – options within our plan – stuff we’d forgotten. I was very keen for a drug free birth if possible. My baby was posterior and I can say for a fact that had Pernille not been there, helping me to stay mobile and suggesting positions for helping to turn the baby and helping to cope with the pain, I would have had an epidural. For sure. That would not have been a negative outcome for us, however I am so very proud of myself and of my husband for doing the whole thing using only a bit of gas. It was our ideal scenario and Pernille allowed us to achieve that. Also once we’d had Eloise, Pernille was able to support my husband when he held Eloise for the first time while I was busy. My husband and I had some time to ourselves once it was all over to get refreshed since Pernille looked after Eloise.”
Rebecca, 1st time MumHaving a doula meant that both me and my husband felt empowered and supported. It really felt like at any point during the labour and birth we had answers if we wanted them, and options. We felt comfortable at the hospital, something I don’t think would have been the case if we hadn’t had a doula. We knew Pernille had been there plenty of times and knew the nurses and carers it made things easier. Like we weren’t going through it alone.
It helped that when we ran out of things to help cope with the pain Pernille suggested other options – options within our plan – stuff we’d forgotten.
I was very keen for a drug free birth if possible. My baby was posterior and I can say for a fact that had Pernille not been there, helping me to stay mobile and suggesting positions for helping to turn the baby and helping to cope with the pain, I would have had an epidural. For sure. That would not have been a negative outcome for us, however I am so very proud of myself and of my husband for doing the whole thing using only a bit of gas. It was our ideal scenario and Pernille allowed us to achieve that.
Also once we’d had Eloise, Pernille was able to support my husband when he held Eloise for the first time while I was busy. My husband and I had some time to ourselves once it was all over to get refreshed since Pernille looked after Eloise.”
- offers continuous support at the birth of your child.
- brings a skilled set of hands ‘holding the space’ for you at home and/or in hospital.
- offers nurturing and caring energy.
- believes in your capacity to give birth.
- has an excellent understanding of the normal birth process.
- can reduce the risk of unnecessary interventions.
- supports you in any decisions you make.
- does not try to influence you in any way.
- enhances the birthing woman’s own strength and creative capacity to give birth.
- is aware of her own capabilities and limitations.
Doulas and Midwives
The differences between a doula and a midwife is sometimes a bit confused but are really quite profound. A doula is not a medical person like a midwife, she does not have responsibility of the physical wellbeing of the baby and mother, but is there primarily to support the mother emotionally, practically, with nurture, care, ideas, inspiration, information and communication. Her focus is on the mother and at times her partner, all the way through labour and birth. A doula is not a medical person like a midwife
She stays with the woman, where a midwife employed in the system will be working in shifts regardless of where you are in your birth process. A midwife is also a caring mother centered person but has many other duties as well. She will be busy at the other end when baby emerges for instance. She will also be busy taking your blood pressure and checking the progress in whatever way she uses. A midwife is also the person who checks in on babies heart rate, and who decides when and if a doctor needs to be consulted.
Limitations of Doula service
A Doula does not:
- replace the midwife or any other medical staff
- take blood pressure
- monitor the baby
- give vaginal examinations
- take temperature
- give medical advice
- make decisions for you (she can however help you interpret the information provided by medical staff and help the couple gather enough information to make informed choice)
- do any clinical or medical tasks
- Scott KD, Berkowitz G, Klaus M. A comparison of intermittent and continuous support during labour: a meta- analysis. Am J Obstet Gynecol 1999 May 180:5 1054-9.Kennell J, Klaus M, McGrath S, Robertson S, Hinkley C. Continuous emotional support during labour in a US
- hospital. A randomized controlled trial. JAMA 1991 May 1 265:17 2197-201Scott KD, Klaus PH, Klaus MH. The obstetrical and postpartum benefits of continuous support during
- childbirth. J Womens Health Gend Based Med 1999 Dec;8:1257-64.Keenan P. Benefits of massage therapy and use of a doula during labour and childbirth. Altern Ther Health Med
- 2000 Jan;6:66-74.Wang D, Mao X, Qian S. Clinical observation on doula delivery. Chung Hua Fu Chan Ko Tsa Chih 1997 Nov
- 32:11 659-61.Zhang J, Bernasko JW, Leybovich E, Fahs M, Hatch MC. Continuous labour support from labour attendant for
- primiparous women: a meta-analysis. Obstet Gynecol 1996 Oct 88:4 Pt 2 739-44Nolan M. Supporting women in labour: the doula’s role. Mod Midwife 1995 Mar 5:3 12-5.Gordon N P, Walton D, McAdam E, Derman J, Gallitero G, Garrett L. Effects of providing hospital-based
- doulas in health maintenance organisation hospitals. Obstet Gynecol 1999 Mar 93:3 422-6.Langer A, Campero L, Garcia C, Reynoso S. Effects of psychosocial support during labour and childbirth on
- breastfeeding, medical interventions, and mothers’ wellbeing in a Mexican public hospital: a randomised clinical trial. Br J Obstet Gynaecol 1998 Oct 105:10 1056-63.Klaus MH, Kennell JH. The doula: an essential ingredient of childbirth rediscovered. Acta Paediatr 1997 Oct
- 86:10 1034-6.Raphael D. Support and variation, the needs of the breast-feeding woman. Acta Paediatr Jpn 1989 Aug 31:4
- 369-72.Barron SP, Lane HW, Hannan TE, Struempler B, Williams JC. Factors influencing duration of breast feeding
- among low-income women. J Am Diet Assoc 1988 Dec 88:12 1557-61.Campero L, García C, Díaz C, Ortiz O, Reynoso S, Langer A. ”Alone, I wouldn’t have known what to do”: a
- qualitative study on social support during labour and delivery in Mexico. Soc Sci Med 1998 Aug 47:3 395- 403.Manning-Orenstein G. A birth intervention: the therapeutic effects of doula support versus Lamaze preparation
- on first-time mothers’ working models of caregiving. Altern Ther Health Med 1998 Jul 4:4 73-81