The Purpose and Value of Doulas in Modern Births

By Carolee Abbott, Certified DONA Doula


                Women have been helping women through the process of childbirth since ancient times. Mothers-to-be have turned to their grandmothers, mothers, sisters, aunts, and trusted friends to assist them through the profoundly significant physical and emotional experience of childbirth. The modern practice of having a birth doula continuously present throughout labor and delivery is increasing in its popularity for many reasons.  

                The main function of the doula is to provide the mother and her husband continuous emotional support, physical comfort and assistance in obtaining information before, during, and just after childbirth. She does not make medical diagnosis, or give medical advice or perform clinical tasks such as fetal monitoring or vaginal exams. She recognizes birth as a key life event that will be imprinted in the mother's memory for the rest of her life and strives to enable the mother to have a satisfying birth experience birth as the mother defines it. It is important for the doula not to project her own values and goals in the process. She facilitates good communication between the mother, the husband, and the medical providers; however, she does not make decisions for her clients or talk to medical staff in their place. She helps with various positions throughout labor and delivery, encourages good breathing techniques, provides diverse comfort measures such as massage, warm/cold therapy, and counterpressure, and seeks to increase the mother's security and confidence during the birth process by providing necessary information and a listening ear throughout the process.

                 Many people think doulas are only helpful for those choosing natural childbirth but mothers choosing epidural pain relief also benefit. Labor must be managed until the time for the epidural has arrived and at times there are side effects of the epidural that must also be dealt with including partial pain relief, fever, and inability to push effectively.The woman's controlled physical pain does not automatically relieve all other emotional distress and anxiety.   

                It is Important to understand at the onset that a doula (a Greek word meaning woman caregiver) does not take away from the importance of the presence of the husband during birth. The main advantage the man has is his deep emotional involvement with both the mother and the baby, which enables him to support her in a unique, loving  way. However that same emotional involvement also can become a disadvantage at some point during the process, making it difficult for him to remain calm and objective when he is needed to be.  Labor is usually more like a  strenuous marathon than a sprint, and the husband can often be more relaxed and successful in his supportive role if he does not carry the entire role of support for the mom on his shoulders alone. The doula's purpose is to provide emotional and physical support for BOTH parents so they can experience the type of birth they desire. 

                Study after study demonstrate many medical benefits to those women who choose to be attended by a doula. The average length of labor is shortened, pain is reported as better controlled, the cesarean rate is lowered, the occurrences of interventions such as pitocin and episiotomies are lowered, and incidence of maternal fever is lessened.   Most of these can be directly traced to the increased calm and security of the mom who is continuously attended throughout labor and delivery with both emotional and physical support.   It is also found that those mothers who have doulas recount a more positive birth experience overall and describe less postpartum anxiety as well as more enjoyment in their parenting afterward, due in part to their confidence gained during the birth process.     

                A typical birth doula meets with her client twice before labor begins. The first visit helps to establish rapport and build a relationship. The role of the doula is clarified and what she can and cannot do is discussed. Various aspects of the birth including pain management, activity in labor, fetal monitoring, and immediate postpartum care are discussed and the couple has the opportunity to voice their wishes, fears, and concerns. The pregnancy and any complications are reviewed as well as the setting of the impending birth  including home, hospital, or birth center. The second visit might include specific teaching regarding breathing, positioning, comfort measures to consider, and relaxation techniques.  Also considered are the signs of pre- labor and when to contact the doula when labor does start.  Most doulas are available by phone for support during early labor as long as the mother is demonstrating good coping mechanisms and her physical presence begins when labor progresses to the active stage. From then on, the doula is present continuously until birth occurs and she generally stays for at least one hour afterward to help take pictures and help establish breastfeeding.  A follow up visit occurs a couple of weeks after birth to allow the parents to review and process the birth experience. A myriad of postpartum issues including healing, feeding and sleep adjustments, breastfeeding, and sibling concerns may also be discussed.

                Overall, the benefits of a birth doula are many and have been known by many cultures throughout history. Today's woman needs the same level of support and encouragement and often finds herself more isolated from family than in times past. For many reasons, the use of a birth doula should be considered by today's expectant couples.  For more information regarding doulas in general, please visit the website of DONA, Doulas of North America, the largest doula organization which provides teaching and training for doulas worldwide,