A Labor Support Doula
Recognizes birth as a key life experience that the mother will remember all her life.
Understands the physiology of birth and the emotional needs of a woman in labor.
Assists the woman and her partner in preparing for and carrying out their plans for the birth.
Stays by the site of the laboring woman throughout her entire labor.
Provides emotional support, physical comfort and an objective viewpoint.
Provides assistance to the woman in getting the information she needs to make good decisions.
Facilitates communication between the laboring woman, her partner and her careprovider(s).
Perceives her role as one who nurtures and protects the woman's memory of her birth experience.
Practices confidentiality.
HISTORY
Doula, from the Greek, meaning slave, is a woman experienced in childbirth who provides continuous physical, emotional, and informational support to the mother before, during, and just after childbirth. Dana Raphael, in the book, The Tender Gift described Doula as a "title for those individuals who surround, interact with and aid the mother at any time within the perinatal period." And it was from that book that the word became used in the context in which we are using it today.
It is now widely recognized that having a female labor support doula assisting the birthing woman or couple can decrease the length of labor, decrease the severity of perceived pain, decrease the need for anesthesia or analgesia, and can help prevent cesarean section. A good birth experience will enhance the post-partum period by speeding recovery, easing breastfeeding and securing the satisfaction of the mother and father with each other and themselves.
RESEARCH
In Mothering the Mother Marshall Klaus, John Kennell, and Phyllis Klaus; the wonderful group of doctors that made the concept of 'bonding' a household term, (Addison Wesley Publishing Company, 1993 Pages 33-51) describe the crucial evidence that supports the use of doulas.
It was from six randomized, controlled studies; two in Guatemala, one with 136 women, another with 465 women; a study in Houston Texas with 416 women and one with 192 women in Joahannesburg, South Africa. The fifth and sixth studies were done in Helsinki Finland and in Canada. All participants were primiparas women, they were all healthy and had had uneventful pregnancies. They were invited to participate when they were admitted into the hospital in labor.
The Guatamalen doulas were trained in a 3 week course, but in the South African study the women were untrained lay-women, they were all asked to remain with the laboring women constantly and use touch and verbal communication focusing on three primary factors: comfort, reassurance and praise. All of the doulas in the study had experienced normal labors and vaginal births.
Soothing words, touch, encouragement, explaining procedures and what could be expected to happen next, They also translated medical terms into laymens terms and did some very minimal charting - such as noting the number of staff contacts that the mother had and any interventions.
STATISTICS
The results showed a
* 50% decrease in cesarean sections
* 25% decrease in the length of labor
* 30% decrease in use of forceps
* 40% decrease in use of oxytocin
* 60% decrease in use of epidruals
*30% decrease in use of pain medications (narcotics)
In addition, long term benefits of labor support include:
*Improved Breastfeeding
*Decreased Postpartum Depression
*Greater Maternal Satisfaction
*Better Mother-Infant Interaction
Not only was there a doula group and an unobserved group, but there was an observed group. In this group there was significant benefits shown and the doula merely sat in the corner with a clipboard charting staff contact and other events. Klaus and Kennel speculate that it was merely her presence that made a difference. The decrease in catecholamines (adrenaline) will make a woman feel safer, and her uterine contractions and the uterine blood flow will not be compromised, but will be allowed to work as normal.
Not only were these results fairly amazing, but they also reduced costs. Now, to many of us involved in the birth world that is not as significant as the good outcomes. But when the cost of anesthesia, sepsis workups on babies resulting from epidural induced fevers, and the cost of cesarean surgery and extra time spent in hospitals is decreased, insurance companies and hospitals sit up and take notice.
John Kennell's next research project idea is to study the long-term effects of well-bonded and attached children on their social and emotional lives; this would also involve the long-term effects of the doula! Needless to say doing this work has major social, economical, emotional and spiritual impact not only on the mother's we work with, but for society as a whole.
Klaus & Kennell said that there are no controlled studies done to date on the male partner's affect on labor. However, studies have shown that doulas touch a woman 95% of the time while a man tends to use touch only 20% of the time. His time in the room with his woman is lower than the continuous presence of the doula. His presence has been shown to decrease the use of medication, however the decrease in the length of labor forceps, cesareans and pitocin induction or augmentation that has been shown in the doula studies has not been shown with male partners.
