What’s a doula?

“Doula” means servant. A doula is an old word for a new concept: a woman specially trained in supporting women and their families before, during and after labour and delivery.

Doulas and midwives bridge our birthing history

In her American-based practice, the well-known midwife, Ina May Gaskin, has a C-section rate of 1.4%. That’s around 20 times less than the going rate at many Canadian hospitals where you will have approximately a 1 in 3 chance of a Cesarean birth. That says one thing to me: medical practitioners are ignoring important historical knowledge on how to make birth physically and emotionally manageable, safe and natural.

The impact of doulas has been widely researched

Two studies of labouring women in Houston^1,2, whose results have been widely repeated in other studies, showed the following results when a doula was present:

• 21% shorter labour, 9.9 hours vs. 7.8 hours on average
• 460% more natural deliveries (vaginally without oxytocin, forceps or medication)
• 330% reduction in forceps delivery
• 125% reduction in cesarean section
• 1000% reduction in maternal fever
• 240% reduction in infants being kept more than two days in hospital

Studies have also been done on the longer-term effects of having a doula. One study by Woolman et al.³ published in the American Journal of Obstetrics and Gynecology found when a doula was present at the birth six weeks later there was a:

• 30% reduction in anxiety
• 230% reduction in depression
• 21% increase in self-esteem
• 35% increase in the woman’s satisfaction with her partner

Additionally, the study showed mothers saw their babies as more beautiful, clever, easy to manage and that she or he cries less than other babies.

Imagine a world where every woman has access to a doula!

A doula’s approach

Each doula is different, but the general approach is similar. Doulas support families during pregnancy with information and help women and their partners define and prepare for their ideal birth. This might mean supplying a family with information, teaching her husband or other birth partner constructive ways to help during labour (different positions, massage, etc.), or guiding them to develop a birth plan.

Doula techniques

During labour, doulas have knowledge of a variety of techniques to speed things along, lessen pain and reduce the need for medical intervention. In the early hours after delivery, a doula will support mothers to a good start breastfeeding and caring for their newborn. A doula might also write a birth story and take photographs during labour and of the newborn. A specialized, post-partum doula will support a family in the days and weeks after birth in whatever way they need: chores, child care, breastfeeding support, infant care, etc.

What a doula doesn’t do

A doula is not a midwife. Anyone can hang a shingle that they are a doula. At best, certification programs offer a course, essay, required readings and assign a number of clients that a doula must take for free to develop their clinical knowledge. In contrast, a midwife goes to school for four years to specialize in birth.

However, with the shortage of midwives globally, doulas are filling an important role. They can bring many of the management techniques used by midwifes during labour. Doulas can’t, however, diagnose or treat their clients. Though a doula may use forms of healing touch such as pressure to relieve back labour, suggest positions to adjust the baby or speed up labour, and massage to lessen overall pain, a doula, should never perform a physical exam of any kind on her clients.

References

1)    Kennell, J.H., Klaus, M., McGrath, S.K., et al Continuous emotional support during labour in a U.S. hospital. Journal of the American Medical Association, 265: 2197-2201, 1991.
2)    Mcgrath, S.K., Kennell, J.H., Suresh, M. et al. Doula support vs. epidural analgesia: Impact on cesarean rates. Pediatric Research, 45: 16A, 1999.
3)    Wolman, W.L., Chalmers, B., Hofmeyr, G.J. et al. Post-partum depression and companionship in the clinical birth environment: a randomized, controlled study. American Journal of Obstetrics and Gynecology. 168: 1380-1393. 1993.