What is a doula?

A professional birth doula offers a woman and her partner continuous support throughout labor and delivery. They essentially mother the mother, as well as offering reassurance and support to the partner. Birth doulas provide a set of skilled and experienced hands for both mother and partner in various forms. They provide emotional support, physical comfort measures and remind parents of their personal birth preferences. The birth doula strives to be a calm non-judgmental presence, fostering self-confidence and a nurturing environment. Doulas support all types of birth, that could mean un-medicated, medicated, induction, cesarean birth, VBAC, or high risk. Many families find the experience of having a birth doula fosters closer bonds between the woman, her partner and their baby.

The benefits of doula support are not limited to the mother, but also support her birth partner and family.  When both mothers and birth partners feel valued, their choices are taken into consideration, they are active participants in the process, and their relationship and experience are enhanced.  The purpose behind providing doula support is helping couples feel safe, informed, and satisfied with their birthing experience.

The needs of the laboring and birthing mother are very complex and women deserve the continual support of a person specifically trained in labor support.  When a doula performs her duties to her client with the earnest intent of providing the best care possible, it helps women build confidence in their ability to birth. When a woman gives birth and feels safe, informed, and satisfied, she is not only more likely to have a healthier newborn and postpartum period, but she is also more likely to look back and remember her experience with joy and fondness.  This is a beautiful way to begin life as a parent, and something everyone should have the opportunity to experience.

What does the research say?

The most recent and largest systematic review of continuous labor support summarizes the experiences of over 15,000 women who participated in 21 randomized controlled trials. The authors conclude: Continuous support during labor has clinically meaningful benefits for women and infants and no known harm. All women should have support throughout labor and birth. (Hodnett and colleagues 2013)

What are the benefits of continuous labor support shown by current research?

The review found that, in comparison with women who had continuous support, women who labored without continuous support had longer labors and were less likely to have a spontaneous birth. Women without support were more likely to:

  • Be dissatisfied with or negatively rate their childbirth experience o Use any type of pain medication (including narcotics)

  • Give birth by cesarean birth

  • Give birth with vacuum extraction or forceps

  • Give birth to a baby with a low Apgar score at 5 minutes

 

Does it matter who provides continuous support in labor?

The review also looked closely at how effects of labor support varied by type of person providing labor support. Effects were strongest when the person was neither a member of the hospital staff, nor a person in the woman’s social network, and was present solely to provide one-to-one supportive care. Compared with women who had no continuous support, women with companions (such as a doula) who were neither on the hospital staff nor in the woman’s social network were:

  • 28% less likely to have a cesarean birth

  • 31% less likely to use synthetic oxytocin to speed up labor o 9% less likely to use any pain medication

  • 34% less likely to rate their childbirth experience negatively.

 

Support provided by a person that the woman selected from her social network increased her satisfaction but did not seem to impact the use of obstetric interventions. Support provided by a member of the hospital staff did not seem to impact a woman’s likelihood of having a cesarean or her satisfaction.

 

What does ACOG say about doula support?

From the joint Obstetric Care Consensus “Safe Prevention of the Primary Cesarean Delivery” issued by The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine in 2014:

Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula. A Cochrane meta-analysis of 21 trials and more than 15,000 women demonstrated that the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery. Given that there are no associated measurable harms, this resource is probably underutilized.

 

 

References

Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD003766

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