A Labor Companion for the Modern Age
Dou·la \ˈdü-lə\ noun
Etymology: Modern Greek, female helper, maidservant,
from Greek doulē female servant
A woman experienced in childbirth who acts as an advocate
and provides information, emotional support, and physical comfort
to a family before, during, and just after childbirth
The practice of women helping other women through childbirth is an ancient one. Until the early 1930’s American childbirth practices adhered to the social childbirth philosophy. Women gave birth at home with the aid of a knowledgeable birth attendant who would stay in close contact with the mother before, during and immediately after the birth. However, advances in modern medicine in the early part of the twentieth century triggered a shift in the way Americans viewed childbirth. The natural process of childbirth became an illness, and a backdrop on which primarily male physicians were able to demonstrate the marvelous technological advances being made in the medical field. This phenomenon was satirized in the opening sequence of the Monty Python movie, The Meaning of Life. Obstetricians preparing for a birth fill the room with a myriad of high-tech equipment and command “Get the machine that goes ping!” The poor forgotten mother, who is shoved off into a corner asks, “What do I do?” and the doctor responds, “Nothing dear. You’re not qualified!” (Python, 1983). Many of these advances in the obstetric field were immensely helpful to high-risk mothers and babies, and resulted in fewer cases of maternal death. However, their overuse by physicians subjected the majority of women, who were perfectly capable of having a natural labor, to unnecessary and often harmful interventions. The routine use of forceps, anesthesia, and electronic fetal monitoring were all commonplace by the early 1970’s, despite empirical evidence that showed such interventions were counterproductive to a normal healthy labor.
Today, the occurrence of interventions in childbirth is at an all time high. The national rate for cesarean sections is over 30[% (Childbirth Connection, 2010). Although family members are welcome in most hospitals to support women in childbirth, they often have very little experience with the birth process or are emotionally invested, making it difficult for them to remain focused on what the mother needs. Likewise, maternity nurses have the experience but lack the time and resources to provide continuous emotional support to birthing mothers. However, the tradition of women assisting women through childbirth is slowly gaining momentum again. More women are choosing to have a doula, an experienced and knowledgeable woman trained in the practice of natural pain management and emotional support, present at their births. Doulas are the missing element in modern maternity care. They can play a vital role in reversing many of its negative effects on mothers and babies by helping women to manage labor pain, enhancing the communication between the woman and her medical caregiver, and assisting mother and baby with establishing healthy breastfeeding.
In contrast to midwives, doulas do not provide medical care. Rather, a major part of the doula’s role in the birth process is to advocate for what the mother wants, and to help the mother manage pain naturally. Visualization exercises and self-hypnosis are introduced to pregnant women in the weeks before labor as a means to encourage relaxation. The doula understands that “when able to greet labor…in a relaxed state, the mother can cooperate with her body to bring her baby into the world rather than fight against [it]” (Klaus, 2002, p. 212). When employing visualization exercises, the doula encourages the mother to imagine her own personal refuge that she can associate with comfort, relaxation, and security. When used in combination with various labor positions, the exercises are extremely effective for decreasing the pain of contractions.
Many people would argue that managing pain in a laboring mother may seem secondary to just having a healthy baby. However, a mother’s stress and pain level during labor are closely connected to a baby’s immediate health after birth. Newborn complications, such as low Apgar scores (a test designed to quickly evaluate a newborn’s condition), breathing difficulties, jaundice, and a higher probability of being admitted to the Newborn Intensive Care Unit (NICU) have all been tied to the spiral of interventions that begins with receiving an epidural. A mother overwhelmed and in pain that opts for an epidural believes that with less pain, she will have a quicker and easier labor. However, epidurals slow the progress of a normal labor, which prompts most obstetricians to give Pitocin, a drug used to stimulate stronger contractions. A woman’s body releases a natural form of Pitocin, oxytocin, during labor along with endorphins to help counteract the effects of stronger contractions, but the synthetic Pitocin does not have the same properties. Pitocin increases the intensity and frequency of contractions without the benefits of endorphins, and leads to “higher episiotomy rates, forceps… and cesarean rates” (Goer, 1999, p. 132). However, studies have shown that women who labor with a doula present are 10 to 60 percent less likely to request an epidural, and have lower rates for induction, episiotomies, and forceps delivery (Klaus, 2002, p. 98). Therefore, mothers and babies both stand to benefit from the pain management techniques utilized by doulas.
Along with learning ways to manage pain, part of a doula’s training is to thoroughly understand the normal progression of labor, the effects of common interventions used by medical professionals, and signs that could indicate a labor complication. Because of their knowledge of the birth process, doulas can help parents make informed decisions and are an excellent buffer between laboring women and their medical care providers. During pregnancy many women create a birth plan in order to outline their wishes and preferences for the birth and immediately postpartum. A woman hoping for a natural birth would not include an epidural in her plan. But when labor is in full swing, an offer of medication from a well meaning care provider can often undermine a woman’s original plan. Having a trained labor companion who can help voice an opinion or bolster the laboring mother’s convictions can often make for a shorter, more satisfying labor. A woman who perceives her birth experience as positive is much more likely to avoid postpartum baby blues and will likely bond more easily with her newborn in the first weeks, which in turn influences the very foundation the mother-child relationship. For that reason, a doula’s role in facilitating a positive birth experience has far reaching implications on the family as a whole.
Another essential role the doula plays is to aid the mother and baby to establish breastfeeding in the post-partum period. Although breastfeeding is a natural process, it is not always a simple one. Doulas are trained to identify issues that can interfere with the early stages of breastfeeding, such as thrush, a common yeast infection of the infant’s mouth. They may also suggest different positions for nursing that can help the newborn maintain a proper latch, which will prevent or minimize the experience of pain for the mother. Mothers who feel confident with breastfeeding from the beginning are more likely to nurse their babies for a longer period of time which benefits the health of mother and baby.
Increasing interest in natural childbirth signals a shift in the way women and their caregivers are thinking about the process of labor and childbirth. Moving away from the virtual “solitary confinement” that labor became in the middle of the twentieth century, our society is slowly beginning to recognize the importance of experienced women providing continuous support to mothers during labor. However, the atmosphere of modern maternity care is frequently still a minefield of medical interventions that a woman hoping to have a natural birth must brave. But women who choose to have a doula will often have a shorter, easier, and healthier labor. The modern doula is at once an advocate, a gentle guide, and a source of strength for the laboring woman. Birth is the place we all begin. It would behoove us to ensure the experience is a positive one.
Childbirth Connection. (2010 йил 10-February). Childbirth Connection. Retrieved 2010 йил 2-March from http://www.childbirthconnection.org/article.asp?ck=10456
Goer. (1999). The Thinking Woman’s Guide to a Better Birth. New York: The Berkley Publishing Group.
Klaus, K. K. (2002). The Doula Book. Cambridge: Perseus Books Group.
Jones, T. (Director). (1983). The Meaning of Life [Motion Picture].
Lindsay Schneider is a doula serving Tucson and surrounding areas. She offers birth support and placenta encapsulation. Her journey toward birth work started in 2009, after the natural birth of her second child at the Birth Center. Since then, she has supported dozens of families in a variety of settings, from hospitals to home births. Lindsay has experience supporting mothers of multiples, VBAC clients, breech babies, mothers on bed rest, high-risk pregnancies, special needs babies, single parents, and planned cesarean births. She lives in northwest Tucson with her husband, three children, and one wild dog. A former chef, Lindsay still loves to cook for her family and her postpartum clients. www.swelldoula.com