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What is a Doula? The Value and Purpose of Labor and Birth Support

DONA International Position Paper - Cherilynn Whitten

The value and purpose of having labor support are immensely vast, relational, helpful, and rewarding. The word doula is translated as ‘helper’ in Greek, which very well describes a doula's role as a support person for women in labor. A doula helps women in labor by preparing them mentally, being present emotionally, and giving tools to prepare them physically to know the best labor positions for managing pain. Women who are on the journey of childbirth need support to feel safe, comforted, empowered, and well prepared to have a good birth experience and a doula helps them achieve that goal!

A doula is also considered the laboring woman’s ‘Advocate’, meaning that the doula is the one who actively and publicly supports the mom's birth choices, while recommending a particular cause or policy to help her make an informed decision. This is most helpful when a particular protocol at the hospital is the standard of care, yet not necessarily required. The woman in labor can ask the doula for advice and information to help her choose between another option or choose what is considered the hospital’s standard of care. For example, mom might be getting into the active labor stage cuffing in between 4-6cm for multiple hours at the hospital. She is not quite dilating as fast as the hospital would like her to according to their timeline, so the nurse suggests she start a dose of Pitocin to help progress labor and dilatation. Mom wants an unmedicated birth and is feeling the pressure to side with the nurse's standard of care to augment labor. The doula can inform the mom about the risks and benefits of Pitocin while encouraging her to stick to her plan, follow her intuition, and ask the nurse questions about the procedure. The doula can also advocate for the mom’s choice in having an unmedicated birth by simply reminding the nurse about the mom’s birth goals and desires. With the help of the doula’s advocacy role, the mom will make the final decision on what the next steps will be.

The duties and responsibilities of a doula are extremely beneficial for any woman preparing for childbirth. A doula provides mental, emotional, and physical support, which are called ‘comfort measures’ and ‘pain management’. The doula is trained in useful tools to support the birth mom to naturally cope during labor with things such as breathing techniques, visualizations, messages, guiding the birth mom to find her rhythm, counter pressure points, position changes, hydrotherapy, and utilizing TENS. Applying these comfort measures and utilizing the pain management tools with intentionality, most often than not, benefits the birth mom by having a natural vaginal unmedicated birth. It also brings her a sense of community support during labor as the doula and husband/partner apply these comfort measures during the active labor phase.

A doula helps prepare the birth mom mentally by informing her what to expect in labor and the process of being admitted to the hospital. The doula can also help birth moms cope with the pain of unavoidable contractions through mental visualizations and breath work. These specific comfort measures actually benefit them to work through contractions by not thinking about the pain of the contraction, but visualizing a picture that brings them comfort and breathing to relax as each contraction goes by. Breathing and visualizing focuses the birth mom’s attention on something other than the pain, which then initiates the rhythm and ritual during labor that will help guide them through every contraction.

A valuable strategy is using verbal and mental affirmations, mantras, and encouragements that are personable to the birth mom to meditate/speak over herself during or in between a contraction. The doula also uses these verbal and mental affirmations, mantras, etc, to encourage the mom to help her cope with the pain of the contractions. This then decreases the need for medicated pain management like epidural, nitrous oxide, and narcotics. On the flip side, if the need for medication arises, stress naturally will decrease as the progression of labor continues with these mental strategies and comfort measures applied. The outcome of this kind of support brings about steadiness, inner focus, comfort, and better execution to follow the birth mom's goals and desires, whether medicated or unmedicated.

The responsibility of a doula consists of physical comfort measures like positions and movement to decrease the level of pain in labor. These movements and changing positions can also help get the baby in a prime position for entering the birth canal. For example, a woman in labor will benefit from a good hip squeeze from the doula, while being on her hands and knees eliminating lower back pain and opening up the pelvic floor for the baby to reposition. After a few contractions have passed, changing positions to birth mom leaning on her husband or partner for a swaying slow dance works with gravity, helping baby drop and giving mom a good dose of natural oxytocin to strengthen contractions, which in turn, progresses labor naturally. The doula’s facilitation and assistance of these positions and movements with the combination of emotional and mental support actually increase the birth mom’s chance of not having an emergency c-section and decrease the possibility of birth complications. Not to mention, it also decreases the percentage of medical interventions to augment labor.

In terms of what a doula is ‘not’ is as follows. The role of a doula only supports the birth mom emotionally, mentally, and physically in ways that do not pertain to medical care. With that being said, a doula is not a medical provider nor can the doula give medical advice or prescribe medication. The doula cannot perform medical tasks such as cervical checks, monitoring, testing blood pressure, catching the baby, stitching, etc. Although the doula can give recommendations, references, and information regarding birth, so that the birth mom is well informed when she talks to her care provider about options. As a birth advocate, the doula is not allowed to make the decisions and speak for the birth mom.

The role of a doula does not replace the birth mom’s medical care provider nor does it replace the husband or partner. The doula is simply an additive help to the birth team and serves her own role to support the birth mom. The doula is also there to coach the husband/partner to be a more proactive and involved team member for the birth mom. As the doula serves the birth mom and husband/partner by bringing the skills, education, and experience to the table. This helps the birth experience to be more of a safe, comforting and empowering environment for the team and for the baby.

The doula brings an unmistakable value to the table dramatically increasing the possibility that a positive birth experience will be had by the birth mom. The doula provides the non-medical care and nurturing that is needed to help a birth mom cope in labor, feel championed and remain empowered every step of the way. It provides more of the possibility for a vaginal unmedicated birth with very few complications for the baby and the birth mom. Doula’s help the soon-to-be or current birth mom during their major transitional stage of life. In the end, the reward of having a great labor and support person, such as a doula, brings about significantly better and healthier birth experiences for birth moms across the globe.

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