So… What exactly is a doula?
What is a doula?
A doula is a non-clinical, trained special companion who supports you during pregnancy, labor, and birth (Morton & Clift 2014). Doulas are trained to provide continuous, personal care, physical support, and emotional support during labor. Doulas also provide information and support to families before and/or during birth, and into the postpartum period. Doulas will help for pregnant women to advocate for themselves and their births to ensure that their needs and preferences are heard and met (within limits of emergencies).
What do doulas do?
Doulas support women and their families during pregnancy, labor, birth, and the postpartum period. Doulas are non-clinical supporters that often have a non-medical approach that focuses on providing emotional and physical support, providing, sharing and explaining information, and helping to prepare mom and family before the birth.
Birth doulas can help moms and families prepare for birth using birth plans or birth maps and providing support and information as the pregnancy progresses. Should any concerns arise, doulas are available and ready to provide information and discuss such concerns so that informed decisions can be made. Once in labor, doulas provide non-medicated pain relief options, pain relief strategies and guidance to assist in labor progressing. While medical staff may not stay with women laboring and will only do brief check-ins, doulas stay by the laboring woman’s side as a constant presence of love and support. All labor support will be based off of the preferences and decisions of the laboring woman and how involved she chooses to have her labor team support her.
Doulas work beyond just building trust with you and your family. A doula’s essential role is to ensure you are able to make informed-decisions and support you through labor and birth regardless of what decisions you make or how you choose to give birth.
What types of pain relief options can a doula provide?
Feeling physically and emotionally safe during childbirth is important to ensure the best outcomes (Kozhimannil et al. 2016). Physical support is crucial during labor because it can provide relief or distraction from pain and helps maintain a sense of control, comfort, and and confidence. Feeling safe also helps your nerves and body to stay in a more laxed state allowing labor to progress. Some examples of physical support that doulas can provide include:
Soothing touch with massage, counter pressure or acupressure.
Creating a calm environment.
Assisting with water therapy (shower, tub).
Applying warm or cold packs.
Holding hands and making eye contact.
Teaching breathing and visualization techniques.
Guiding you with positions, movement, swaying, pelvic rocking, or using a birth ball or peanut ball.
Assisting you in walking to and from the bathroom or changing clothes.
Giving ice chips, food, and drinks. (Evidence-Based Birth)
Utilizing non-medicated tools such as TENS machines.
Ok, this all sounds good, but what is evidence on doulas?
In 2017, Bohren et al. published an updated Cochrane review on continuous support in childbirth. They combined the results of 26 trials with more than 15,000 people across 17 countries including North America, South America, Europe, the Middle East, Africa, Asia, and Oceania, in both high-income and middle-income settings.
In this review, continuous support was provided either by hospital staff, such as a midwife or nurse (nine studies), doulas who were not part of the family social network and not part of hospital staff (doula, eight studies; childbirth educators, one study, retired nurses, one study), or a companion from the family’s social network, such as a female relative or a partner (seven studies). In 15 studies, the partner was not allowed to be present at birth, and so continuous support was compared to no support at all. In all the other 11 studies, the partner was allowed to be present in addition to the person providing continuous labor support.
Overall, pregnant women who received continuous support were more likely to have spontaneous vaginal births and less likely to have any pain medication, epidurals, negative feelings about childbirth, vacuum or forceps-assisted births, and Cesareans. In addition, their labors were shorter by about 40 minutes on average, and their babies were less likely to have low Apgar scores at birth (an Apgar score is a measure of a baby’s immediate health at birth). There was some evidence that doula support in labor lowered rates of postpartum depression. There was no evidence that there are any negative effects of doula support.
The results of this study mean that continuous support, including support from a doula, is a safe and beneficial way to increase the likelihood of better outcomes for the birthing person and the baby.
The researchers found that overall, continuous support during birth leads to a:
25% decrease in the risk of Cesarean; the largest effect was seen with a doula at 39% decrease
8% increase in the likelihood of a spontaneous vaginal birth; the largest effect was seen with a doula at 15% increase
10% decrease in the use of any medications for pain relief; the type of person providing continuous support did not make a difference
Shorter labors by 41 minutes on average; there is no data on if the type of person providing continuous support makes a difference
38% decrease in the baby’s risk of a low five-minute Apgar score; there is no data on if the type of person providing continuous support makes a difference
31% decrease in the risk of being dissatisfied with the birth experience; this risk was reduced with continuous support provided by a doula or someone in their social network (family or friend), but not hospital staff
**If you would like to read more on this, please visit Evidence Based Birth - The Evidence on Doulas.
