wHAT IS ADOULA?
A birth doula is a supportive companion professionally trained to provide physical and emotional support during pregnancy, labor and birth.
A doula provides continuous support, beginning during early or active labor, through birth, and for approximately couple hours following the birth. The doula offers help and advice on comfort measures such as breathing, relaxation, movement, positioning, and massage. She also assists families with gathering information about the course of labor and their options. The doula's most critical role is providing continuous emotional reassurance and comfort.
Doulas attend home births and hospital births; medicated births and unmedicated births, with women whose care is being overseen by doctors or midwives. Doulas may be the only support person for the mother, or may be part of a labor support team including mother's partner, friend(s), and/or family members.
Doulas specialize in non-medical skills, and do not perform clinical tasks, or diagnose medical conditions.
Doulas do not make decisions for their clientes nor speak for them. Their goal is to provide the support and information needed to help the birthing mother have a safe and satisfying birth as the mother defines it.
Many people think a doula is only responsible for assisting with delivery. However a doula can offer help and support during your prenatal care period. They can also be an essential postpartum support person.
Why hire a doula?
Many studies for the past three decades have shown significant benefits of hiring a doula. A Swedish study investigated midwives' experiences of doula support. The study showed that doulas are a facilitator for the midwives.
"Doulas provide support by enhancing the degree of peace and security and improving communication with the women in childbirth. Doulas also provide increased opportunities for transcultural care. They may increase childbearing women's confidence and satisfaction, help meet the diverse needs of childbearing women and improve care quality."
(Midwifery: 2011, Jan 12)
Another recent U.S. study confirmed the benefits of postpartum doulas, who help new parents with the transition to life with their new infant. This is not something that the doctors and midwives usually do at all after the mother's discharge from hospital.
Take a look at these benefits of a doula to make an educated choice whether to hire one or not.
THE EVIDENCE IN USING A DOULA
"There have been at least 26 randomized, controlled trials that tested the effects of continuous labor support on more than 15,000 people total. These studies were included in a Cochrane Review published in 2017. People in these studies were randomly assigned to either receive one-to-one continuous support from someone or “usual care.” The type of support provided could be from a member of the hospital staff, a doula, a childbirth educator, a retired nurse, or a family member or friend.
The researchers found that, overall, people who received continuous support during labor – meaning that someone never leaves their side – experienced a 25% decrease in the risk of having a Cesarean. The largest decrease in the risk of Cesarean was seen with a doula; using a doula lowered the risk of Cesarean by 39%. Continuous support led to an 8% increase in the likelihood of a spontaneous vaginal birth. Again, the largest effect was seen with doulas; using a doula increased the chance of a spontaneous vaginal birth by 15%.
Having continuous support during childbirth was also linked to a 31% decrease in the risk of being dissatisfied with your childbirth experience. Mothers’ risk of being dissatisfied with their experience was decreased if they received continuous support from a family member, friend or a doula, but not if they received continuous support from hospital staff. With continuous support, they also found a 10% decrease in the use of any pain medications during labor, shorter labors by about 41 minutes on average, and a 38% decrease in the risk of your baby having a low Apgar score. Researchers did not find any difference between groups with the rates of Pitocin augmentation or special care nursery admissions.
There is one new randomized, controlled trial that was published in 2017 and was too new to be included in the Cochrane Review. In this study that took place in Iran, researchers conducted a randomized, controlled trial to test the effects of doulas on pain and anxiety levels in first-time mothers who were giving birth. The mothers were assigned randomly to either have a doula or to not have a doula. They used standardized questionnaires to measure anxiety and pain. They found that, on average, the mothers who had doula support experienced less anxiety during labor and less pain. The authors concluded that the doula’s presence has a clinically meaningful impact on both pain and anxiety during labor." evidencebasedbirth.com
Benefits of having a doula
Benefits of hiring a doula that you may personally notice during and after childbirth:
- Someone who really has been there, done that before, which can reduce stress;
- Help you and your partner understand what is happening and how to get informed;
- Help you let go of the control, and simply let your body guide you through childbirth;
- Keep everyone calm during childbirth and be your advocate;
- Provide massage, breathing techniques, positions and so on during labor as well as teach these techniques to your partner;
- Help provide any emotional or physical support you need;
- Answer your questions about baby care;
- Answer your questions about your post-pregnancy body and emotions;
- Answer questions about breastfeeding;
- Can offer nutrition guidelines and information designed specifically for you and your personal needs;
- Can also offer you with guidance when it comes to rest, nutrition, exercise and offer support.