A doula is a woman experienced in childbirth who provides continuous support to a mother before, during, and after birth. Doula, (pronounced Doo-la) comes from a Greek word that means “a woman who serves” or “handmaiden.” Doulas “mother the mother.” While performing her role, a doula:
Helps a mother become informed about various birth choices
Protects your birthing environment
Supports your partner enabling them to participate more comfortably and confidently.
It’s also important for you to understand what doulas do NOT do. Doulas are NOT medical professionals. They do not perform clinical tasks. They do not give medical advice or diagnose conditions. They do not judge you for decisions that you make. They do not let their personal values or biases get in the way of caring for you. They do not take over the role of your partner. They do not deliver the baby. They do not change shifts. For more information on doulas you can look at Doula UK.
How is the Doula’s role different from a birth partner’s role?
A doula’s role is very different from that of your birth partner, instantly dispelling the myth that doulas replace or push aside the partner. Birth partners come in many varieties. Husband, boyfriend, wife, girlfriend, mum, auntie, sister or friend and sometimes no birth partner at all. They may have little or no knowledge about birth, medical procedures, or what goes on in a hospital. Asking your partner to be your sole provider of emotional, practical and physical support during labour and birth is like asking them to be your sole tour guide in Timbuktu, even though they have never been there before and don’t speak the language. Doulas work alongside your partner providing support for them too, reassuring them along the way. Doulas can look after the practical side of things freeing the birth partners up to concentrate on the birthing woman and offer support. Think of it as building your “dream team”. Support, encouragement, strength, knowledge and love from all sides, all working to help you to achieve a positive birth experience. “I didn’t really understand or see the need for a doula, I felt I would be pushed out but my wife was very keen so I went along with it, after all she was the one giving birth not me. Now I can’t understand why you wouldn’t have a doula. We had meet a few times before the birth for antenatal sessions which where such a great insight to the whole birth process, these could be arranged around my busy work schedule which was a bonus, taking place in the comfort of your own home gave it a really relaxed feel. By the time the labour started it felt like we knew Siobhan well enough to feel comfortable and at ease with her. She kept my wife and I calm all throughout the labour, I know we would have arrived at the hospital far to early if I was left to solely support my wife, she helped us understand any medical terms that where being used and enabling me to grab 5 mins fresh air when I needed it, she even had loose change for the car park and remembered to grab the camera and chargers. It was great to be able to share the responsibility of caring for my wife with someone I had grown to know and trust. I am sure we would not have had such a positive experience without Siobhan’s support. We are now expecting our second baby and I was the one who called Siobhan to book her!” Joseph, Belsize Park, Hampstead NW3 North London.
So what is the evidence for doulas?
In 2011, Hodnett et al. published an updated Cochrane review on the use of continuous support for women during childbirth. They pooled the results of 21 trials that included more than 15,000 women. These women were randomised to receive continuous one-on-one support during labour.
The results? Overall, women who received continuous support were more likely to have spontaneous vaginal births and less likely to have any pain medication, negative feelings about childbirth, assisted births or Caesarean births. In addition, their labours were shorter by about 1 hour and their babies were less likely to have low Apgar scores at birth.
The researchers also looked to see if the type of support made a difference. They wanted to know—does it matter who you choose for your continuous support? Does it matter if you have a midwife, doula, or partner for your continuous support?
They were able to look at this question for 6 outcomes: use of any pain medication, use of Pitocin (artificial oxytocin) during labour, spontaneous vaginal birth, Caesarean birth, admission to special care nursery after birth, and negative ratings of birth experience. For 4 of these 6 outcomes the best results occurred when woman had continuous labour support from a Doula – someone who was NOT a staff member at the hospital and who was NOT part of the woman’s social network.
When continuous labour support was provided by a Doula, there was a 40% decrease in the use of Pitocin, a 12% increase in the likelihood of a spontaneous vaginal birth, a 28% decrease in the risk of C-section, and 34% decrease in dissatisfaction with the birth experience. These outcomes were better than all the other types of continuous support that were studied.
In the words of Dr Kennell “If a doula were a drug, it would be unethical not to use it.”