BENEFITS OF CONTINUOUS DOULA SUPPORT IN LABOR

Data From Meta-Analyses of Twelve Trials

Reduction in analgesia by 35%

Reduction in oxytocin augmentation by 71%

Reduction in use of forceps by 57%

Reduction in cesarean sections by 51%

Reduction in length of labor (by an average of 98 minutes) 

Reduction in epidural use by 16%

Reduction in forceps and vacuum extractor deliveries by 32%

Reduction in cesarean deliveries by 21% 

Doula: A woman trained and experienced in childbirth who provides continuous physical, emotional, and

Effects on Birth Outcomes: Eleven studies showed the following effects of doula support:

DONA-Doulas of North America: A non-profit organization incorporated in l992,

which trains and certifies doulas according to ethical standards. 

Dads and Doulas: Key Players on Mother's Labor Support Team

There was a time when expectant fathers were portrayed as anxious, floor-pacing, cigar-smoking men who were tolerated in hospital corridors until the long-awaited moment when a nurse or doctor would announce they were the proud father of a daughter or a son. Today's expectant fathers are different.
When it comes to pregnancy, birth, and parenting, today's father wants to share everything with his partner. He wants to be actively involved; ease his partner’s labor pain, welcome his baby at the moment of birth and help care for his newborn at home. A labor doula can help a father experience this special time with confidence.

The word "doula" which comes from ancient Greek, today refers to a woman trained and experienced in childbirth. A doula provides continuous physical, emotional, and informational support to the expectant mother and her partner during labor, delivery and in the immediate postpartum period. The wisdom and emotional support of experienced women at birth is an ancient tradition.

Studies show that when doulas are present at birth, women have shorter labors, fewer medical interventions, fewer cesareans and healthier babies. Recent evidence also suggests that when a doula provides labor support, women are more satisfied with their experience and the mother-infant interaction is enhanced as long as two months after the birth. With doula support, fathers tend to stay more involved with their partner rather than pull away in times of stress.
Today, a father's participation in birth preparation classes or his presence at prenatal visits and in the delivery suite is a familiar occurrence. Yet, we sometimes forget that the expectations of his role as a "labor coach" may be difficult to fulfill. Sometimes it is also culturally inappropriate for an expectant father to be so intimately involved in the process of labor and birth.
The father-to-be is expected among other things to become familiar with the process and language of birth, to understand medical procedures and hospital protocols and advocate for his partner in an environment and culture he is usually unfamiliar with. A doula can provide the information to help parents make appropriate decisions and facilitate communication between the laboring woman, her partner and medical care providers.
At times a father may not understand a woman’s instinctive behavior during childbirth and may react anxiously to what a doula knows to be the normal process of birth. He may witness his partner in pain and understandably become distressed. The doula can be reassuring and skillfully help the mother to cope with labor pain in her unique way. The father-to-be may need to accompany his partner during surgery should a cesarean become necessary. Not all fathers can realistically be expected to "coach" at this intense level.
Many fathers are eager to be involved during labor and birth. Others, no less loving or committed to their partner's well-being find it difficult to navigate in uncharted waters. With a doula, a father can share in the birth at a level he feels most comfortable with. The doula’s skills and knowledge can help him to feel more relaxed. If the father wants to provide physical comfort such as back massage, change of positions, and help his partner to stay focused during contractions, the doula can provide that guidance and make suggestions for what may work best.
Physicians, midwives and nurses are responsible for monitoring labor, assessing the medical condition of the mother and baby, and treating complications when they arise. But childbirth is also an emotional and spiritual experience with long-term impact on a woman's personal well-being. A doula is constantly aware that the mother and her partner will remember this experience throughout their lives. By "mothering the mother" during childbirth the doula supports the parents in having a positive and memorable birth experience.

The benefits of doula care has been recognized world wide. The Medical Leadership Council of Washington, D.C, the Society of Obstetricians and Gynaecologists of Canada and the World Health Organization are among the many healthcare organizations that value the benefits that doulas provide to women in labor.
The father's presence and loving support in childbirth is comforting and reassuring. The love he shares with the mother and his child, his need to nurture and protect his family are priceless gifts that only he can provide. With her partner and a doula at her birth, a mother can have the best of both worlds - her partner’s loving care and attention and the doula's expertise and guidance in childbirth.

Role of the Doula

In nearly every culture throughout history, women have been surrounded and cared for by other women during childbirth. (Ref 12) Artistic representations of birth throughout the world usually include at least two other women, surrounding and supporting the birthing woman. One of these women is the midwife, who is responsible for the safe passage of the mother and baby; the other woman or women are behind or beside the mother, holding and comforting her. The modern doula is a manifestation of the woman beside the mother.

Doulas are trained and experienced in childbirth, although they may or may not have given birth themselves. The doula's role is to provide physical, emotional, and informational support to women and their partners during labor and birth. The doula offers help and advice on comfort measures such as breathing, relaxation, movement and positioning. She also assists families to gather information about the course of their labor and their options. Perhaps the most crucial role of the doula is providing continuous emotional reassurance and comfort.

Doulas specialize in non-medical skills and do not perform clinical tasks, such as vaginal exams or fetal heart rate monitoring. Doulas do not diagnose medical conditions, offer second opinions, or give medical advice. Most importantly, doulas do not make decisions for their clients; they do not project their own values and goals onto the laboring woman. (Ref 13)

The doula's goal is to help the woman have a safe and satisfying childbirth as the woman defines it. When a doula is present, some women feel less need for pain medications, or may postpone them until later in labor; however, many women choose or need pharmacological pain relief. It is not the role of the doula to discourage the mother from her choices. The doula helps her become informed about various options, including the risks, benefits and accompanying precautions or interventions for safety. Doulas can help maximize the benefits of pain medications while minimizing their undesirable side effects. The comfort and reassurance offered by the doula are beneficial regardless of the use of pain medications

13. Doulas of North America, Code of Ethics and Standards of Practice, DONA, Seattle, WA, 1992