This is my position paper for DONA Birth Doula certification.
*Please feel free to leave feedback in the comments section.*
The Purpose and Value of Labor Support
By Lisa Hart
Doula is a Greek word meaning “woman who serves.” The notion of a doula has been around for millennia, as women have been assisting other women in labor and birth for thousands of years. Birth is a highly important experience in that where and how a woman births will have an impact on her for the rest of her life. Giving birth requires the energies of the body, mind, heart, and spirit, and as such, will have a lasting effect on all. Birth is a physical act that primes the mother for bonding and a lifetime relationship with her baby. As birth is most often a family affair, it is also important that the entire family, in addition to the mother, feel supported. A doula can be a support person for a mom as much as for a dad. A doula’s role shifts to accommodate the unique dynamics of the birth she attends: sometimes it is one-on-one intimate support with the mother, other times it is “coaching” Dad as he takes the primary place as the woman’s support person. Either way, there is a delicate balance that comes to fruition at every birth and it is the doula’s role to recognize, honor, and support it.
It has been said that a woman who is treated well in labor will carry that nurturing with her to the care of her baby. The love and support a woman receives in labor sets the stage for that mother’s future relationship with her child. According to recent statistics, women who birth with a doula in attendance are 34% less likely to experience dissatisfaction in their birth experience. This is critical in reducing the incidence of post-birth trauma and overall well-being.
Additional statistics of birth with a doula include:
31% decrease in the use of Pitocin
28% decrease in the risk of cesarean section
12% increase in the likelihood of spontaneous vaginal birth
9% decrease in the use of any medication for pain relief
14% decrease in the risk of newborns being admitted to the NICU
Many have said that having a doula in attendance allows the woman’s partner and other family members to relax and enjoy the birth experience. Help persons can aid as much or little as they are comfortable. With the coming of a new age where fathers are expected to be not only present at the birth but labor “coaches,” many feel the pressure of having to be the sole support person, sometimes with little or no experience with labor or birth. This can be anxiety-provoking and detract from the experience. With a skilled and knowledgeable doula present, the father feels supported in his role supporting the woman, and is also freed-up to eat, take small breaks if necessary, and look to his own welfare.
The doula provides comfort techniques such as massage, use of essential oils, heat and cold packs, hydrotherapy if available, position changes, visualization, vocalization, and breathing. Her techniques will vary with each birth she attends, as she strives to match the energy and rhythm of the birthing woman. She ensures the mother stays hydrated, nourished, and comfortable. Lighting and temperature changes may be necessary. She is sensitive to and creates a safe and comfortable atmosphere in the room and may even provide pictures, music, battery-powered candles, and aromatherapy diffusers if permitted. Each doula is unique in what she brings to a birth, but a basic “birth bag” should be toted with a few staples of birth comfort and relaxation. It is often said a doula’s best tools are her hands and her heart.
The doula has a responsibility to act in accordance with the DONA International Code of Ethics, which outlines her responsibilities to clients, colleagues, and society. Namely, she is there to provide physical and emotional support to the birthing mother. She is an advocate for the mother’s wishes, and adheres to the written or unwritten “birth plan.” She does not speak on the mother’s behalf. Rather, she educates the woman and her partner, if applicable, to empower them to make their own decisions. She acts as a buffer between the woman and birthing staff, aiding in communication, explaining terminology where necessary, and facilitating the woman’s wishes. She does not offer medical advice. Clinical tasks, such as vaginal exams, blood pressure readings, and assessing fetal heart tones are outside the scope of the role of a doula.
Quite often a doula will provide prenatal and postpartum education and support, referring her client(s) to reading lists, websites, and resources that will aid in the woman’s journey through pregnancy, birth, and the postpartum period. She should maintain a current list of resources in the community, and refer out when necessary. A doula may maintain a “lending library” of books and resources for her clients. She is also available for phone and email support. A doula makes visits to the home and should be able to help with breastfeeding and basic newborn care, and recognize any symptoms that would be cause to refer out. A doula provides continuity of care in that she arranges back-up during busy times and is able to refer a mother on if she is for any reason unable to provide service. She generally makes herself available during the “childbearing year,” from pregnancy, through birth, and beyond.
A doula is an invaluable tool in helping a woman to achieve the birth she so desires. From being a resource to providing education and empowering the woman to make informed decisions, then being there to see them through, doulas have been heralded as those who “hold space” for beautiful, even sacred, birth.
DONA International Code of Ethics
DONA International Standards of Practice
DONA International Position Paper: The Birth Doula’s Contribution to Modern Maternity Care
Simkin: The Birth Partner