What is a doula?

by Leigh Jansen

Introduction

The word comes from the Greek word doulē which used to refer to a female slave, but now refers to a woman who helps other woman through the childbirth process, often from before the birth, through the labour and birth process, right through to the days and weeks immediately after the birth.

The term 'childbirth companion' can also be used, she is usually someone who has some kind of training or accreditation who is hired by the expectant couple to help through the childbirth process. The term can also be used to describe someone hired by the hospital to help women through the labour and birth of their child, or can refer to a layperson assisting at the birth as well, although I am not covering that type of labour support here.

You may also be interested in:

Types of Birth Support
Birth Partner's Guide

Usually a woman will become a doula because she really is passionate about helping families to have positive, safe and healthy birthing experiences. Whether or not she has had children of her own she will be attuned to the emotional needs of a woman in labour, and should have an excellent understanding of the physiology of birth. Her role is to nurture the family and provide guidance through the birth process as one of life's most sacred and intense experiences.

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Why is it helpful to have one?

Having a childbirth companion is especially helpful with your first child, because usually neither you nor your partner will know what to expect. Even if you are having your second or third child, if you are feeling anxious in any way it may be helpful to have one around. Having said that, every pregnancy and every labour and birth are different, so it's probably a great idea to have one for your second, third (and fourth?) births as well.

For some statistics on the benefits of having a doula, keep reading!

A birth doula will help you in your preparation for the birth by helping you find information relevant to your circumstances and desires. This makes sense because it can be so difficult to get all the information you need to make informed decisions, it is helpful to have an objective party who can point you in the direction of relevant information!

She can also give your partner some ideas and guidelines as to how to support you...

A labour support team consisting of both a doula and your birth partner is probably ideal, as she can support your partner as well as yourself. She can also give your partner some ideas and guidelines as to how to support you, which can be very helpful as it is easy for your partner to feel anxious and helpless when seeing you in pain.

Having a childbirth companion definitely has an effect on your birth outcome as her presence can help you feel more secure and relaxed which means that your body will release endorphins more easily, which in turn will increase your pain threshold and decrease the pain you experience. If you are stressed while in labour, even sub-consciously, your body will produce adrenalin at the wrong time which will hinder the release of endorphins and possibly cause distress on the part of the baby.

...she can make that journey a little easier.

Having a childbirth companion is also very helpful if your partner is absent, by choice or by circumstance, and even if you have someone else that you trust to walk with you through the process, she can make that journey a little easier.

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What does she do?

There are actually at least two different types of doulas, although some individuals fulfill all the various roles. The one you are probably most familiar with is the birth doula. If you are having a hospital birth, she may come to your house when you go into labour and support you at home until it is time to go to the hospital, and then stay with you until some hours after the birth. If you are having a homebirth, you just skip the going to hospital part, and she may help you decide when to call the midwife.

You also get postpartum doulas that help you and your family adjust to life with a baby in the house. As I said before, some women provide both services.

...she provides individual, continuous, uninterrupted support...

The whole idea is that she provides individual, continuous, uninterrupted support, rather than the general, intermittent support you would generally receive from maternity nurses at the hospital. Furthermore, you usually meet her some time before the birth so you can get to know and trust each other, and so that she knows what your expectations of the birth are. This would not usually be the case with a maternity nurse, or even someone hired by the hospital to fulfill the role of a childbirth companion.

In South Africa particularly I don't know of any private hospitals that provide a doula service and most childbirth companions are privately hired by the moms themselves. Some, or at least one that I know of, volunteer their services at public hospitals to gain experience and just to help out as many of the women giving birth at government hospitals have little understanding of what is happening to them and are usually there alone.

...she takes care of the non-clinical or non-medical aspects of your care...

Essentially a birth doula takes care of the non-clinical or non-medical aspects of your care. She can provide encouragement and reassurance and can help bring comfort, mentally, emotionally, and of course, physically.

On the physical side, a childbirth companion usually has training and experience in the effective use of various natural comfort measures to manage pain (or the perception of pain) such as changing positions, breathing and relaxation techniques, movement, and massage.

...she empowers the mother (and her partner if present) to make informed choices...

A doula can also act as an advocate for you in a hospital situation by facilitating communication between you and the hospital or medical staff, and can help explain and discuss some of the more mysterious practices and procedures. The idea is that she empowers the mother (and her partner if present) to make informed choices, in line with her desires and expectations of the birth, rather than making decisions for them.

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What does she not do?

A childbirth companion will not (or should not):

  • Make decisions for you
  • Bring her own agenda to the birth process
  • Make a diagnosis or give medical advice (information perhaps, but not advice)
  • Do any of the medical stuff - monitoring blood pressure or doing vaginal exams etc
  • Replace your birth partner - the doula is there to serve you both, not to replace your partner

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Benefits - The Evidence

Having a doula as part of your birth support team brings many benefits. In one study involving over 1500 the presence of a childbirth companion resulted in a:

  • 50% reduction in the cesarean rate
  • 25% shorter labor
  • 60% reduction in epidural requests
  • 40% reduction in oxytocin use
  • 30% reduction in analgesia use
  • 40% reduction in forceps delivery

Reference: Mothering the Mother: How a Doula Can Help You Have a Shorter Easier and Healthier Birth, M Klaus, J Kennell, and P Klaus (1993).(Or see the more updated version by the same authors: The Doula Book: How a Trained Labor Companion Can Help You Have a Shorter, Easier, and Healthier Birth (2002))

Other research shows that the presence of a childbirth companion resulted in better bonding between mom and baby and reduced rates of past partum depression. Couples who were assisted by doulas at the birth also reported having a much more positive experience than those who did not have assistance.

Now that I've convinced you how important it is to have one, here is a page on finding, choosing and hiring a doula

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