The word doula is a Greek word that means "Woman'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. Based on a particular doula's training and background, the doula may offer support during prenatal
care, during childbirth and/or during the postpartum period. A birth doula is a care provider for labor. Thus a
labor doula may attend a home birth or might attend the parturient woman during labor at home and continue
while in transport and then complete supporting the birth at a hospital or a birth center.
A doula is a childbirth professional who understands the natural process of having a baby. The doula
accompanies the woman in labor, provides emotional and physical support, suggests comfort measures, and
provides support and suggestions for the partner to create the most positive, healthy, and enjoyable
experience possible. Whenever possible, the doula provides antepartum and postpartum emotional support,
including explanation and discussion of practices and procedures, needed.
A doula does not perform clinical or medical tasks such as taking blood pressure or temperature, fetal heart
tone checks, vaginal examinations, or postpartum clinical care. A doula advocates for her client's wishes as
expressed in their birth plan, in prenatal conversations, and intrapartum discussion. She helps the mother
incorporate changes in plans if and when the need arises, and enhances communication between client and
caregiver. A doula does not speak for or make decisions for the client. The advocacy role is best described as
support, information, and mediation or negotiation.
Why should you use a Doula?
Numerous studies have revealed the benefits to having a doula present during labor. 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 experience. Not only does a doula benefit the mother but
newborns as well. Newborns in supported births have lower rates of fetal distress and fewer are admitted to
neonatal intensive care units.* One study found doula support without childbirth classes to be more helpful
than childbirth classes alone, as measured by levels of emotional distress and self-esteem evaluated at an
interview 4 months after birth. In particular, it was noted that women in the doula-supported group reported
their infants as less fussy than the group attending childbirth class without any doula support.**
At least thirteen scientific studies evaluating the effectiveness of doulas have shown that having a doula
present at your birth can have the following results:
•
Shorter labor by 25% (average two hours less for first time mothers)
•
Reduced need for pain medication
•
Fewer episiotomies
•
40% reduction in the use of forceps
•
40% reduction in the use of Pitocin
•
50% reduction in cesarean rate
•
60% reduction in the request of epidurals
•
Greater satisfaction with the birth
•
Better mother infant interaction
•
Improved neonatal outcomes
•
Increased breastfeeding success
*From M.H. Klaus, J.H. Kennell, "The doula: an essential ingredient of childbirth rediscovered." Acta Paediatr. 1997 Oct;86(10):1034-6.
**From Manning-Orenstein, Grace, "A birth intervention: the thereapeutic effects of doula support versus Lamaze preparation on first-time
mothers' working models of caregiving." Alternative Therapies, July 1998, Vol. 4, No. 4, pp. 73-81.
Should I Get My Doctors "OK"
I am sometimes asked if it is important to have a doula who has worked successfully with or is recommended
by your doctor or midwife. The answer to this is yes, and no. If your chosen caregive recommends a particular
doula, it is probably because they have worked together well in the past and have similar philosophies of care.
However, not having worked with a caregiver in the past should not exclude a doula from your list because
you cannot make judgements based on the inexperience.
One thing to be wary of is a caregiver who has an overall distrust of doulas without being able to explain why
from personal experience. Doulas are still relatively new in some parts of the country, and not all caregivers
have had the opportunity to work with one. As with anything else that is "new," the popularity of doulas has
come with an abundance of myths and imaginary doulas whose "stories" everyone knows, but no one actually
experienced. If you find that your chosen caregiver is nervous about doulas, you may want to interview other
caregivers in your area to see if someone else has a more positive attitude.
What about a father's role when using a doula?
The role of the doula is never to take the place of the husband or partner in labor, but to compliment and
enhance their experience. Today, many husbands are taking a more active role in the birth process, but 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 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 partner emotionally during labor and
birth and also enjoy it himself without the pressure to remember everything he learned in childbirth class.
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 alongside medication by helping mom deal with
possible side effects 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.
