Why a Doula

First of all, what is a "doula?" I had never even heard the word until about 4 years ago. It sounded foreign and unfamiliar. The word "doula" can trace its roots back to Ancient Greece, where the word meant "female slave" or "female servant." Currently, today, the word is most closely associated with a woman whose role is to support another woman during the labor and delivery process. The role of a doula is actually wider than just that, however, and also encompasses the emotional support of a woman and her family in the weeks prior to and following delivery, as well as through times of loss and grieving.

This post specifically looks at birth doulas and their role in the birth process.

Birth doulas work in many different settings. There is a stereotype and misconception that doulas only work in birth centers and at home deliveries. Nothing is further from the truth. Doulas are not only often found in the hospital setting - it is the place where (I believe) they are most needed! Women considering a hospital birth may find that they benefit more from having a doula than women in a birth center or at home. Because a doula's role is to be a constant companion for the laboring woman, they offer women in the hospital something that they would not have otherwise: a supportive female always at their side. Nurses and doctors will be in and out of a patient's room - but a doula will constantly be at your side, giving her support wherever it is needed. At home and in the birth center, a midwife will often (though not always) play the role of constant female companion. Still, however, women considering a home or birth center birth may want the consistency and reassurance of a doula who may arrive earlier and stay longer than even a midwife will.

So what does a birth doula do? In short, she supports the laboring woman. This may mean a back rub. It may mean running a bath, standing with her in a shower, suggesting different sitting, squatting, or standing positions. It may mean words of support ("You're doing great. Your body is doing exactly what it is supposed to be doing. Great job on that last contraction!"). It may mean humming a tune, singing a quiet song, panting and moaning with her during a contraction. It may also mean heating up food for a hungry husband, or simply letting him know it's okay to lay down and take a nap. The role of a birth doula is multi-faceted and without any true definition. She is there to serve the woman in labor, in whatever way is most appropriate.

And the amazing thing is: it works. Intuitively, this makes sense. It seems like common sense that having a woman provide emotional and physical support for a woman in labor would help the labor progress better. Research, though, is finally proving what women have intuitively known for thousands of years.

McGrath and Kennell (2008) conducted a randomized control trial that showed very positive results for laboring women with doulas in the hospital setting. Epidural use was decreased from 76% to 64.7%. More importantly, however, cesarean rates dropped from 25% (our current national average is 30%) to 13.4%. That is huge. Cesarean sections have become so common that we often forgot what major surgery it is. It poses some major risks for not only mother, but also baby. And this is not the only study that has shown these wonderful results. A 1999 meta analysis done by Scott, Berkowitz, and Klaus looked at 11 clinical trials that involved doula care during labor. They found that continuous doula support (when compared to intermittent support) was "significantly associated with shorter labors, decreased need for the use of any analgesia, oxytocin, forceps, and cesarean sections." The World Health Organization (WHO) states that no region in the world is justified in having a cesarean rate greater than 10 to 15 percent. Read that again. No region in the world is justified in having a cesarean rate greater than 10 to 15 perfect. Yet here we are, in a first world country with excellent prenatal care with cesarean rates hovering 2-3 times what is justified. Having a doula helps to bring those numbers down to a justifiable rate.

The findings of studies like the ones above are huge. And there are more out there. Why studies like these came out years ago, yet no changes in the care of laboring women in the hospital setting have been made, speaks volumes about the priorities of our medical culture. The incentives for doctors and medical institutions (financially) to perform cesarean sections far outweighs the incentives for them to find ways to support women in vaginal deliveries. For the women, however, the incentives to have a healthy vaginal delivery are many. Not only are you paying much less to the hospital and insurance companies, the recovery for you and your baby is much quicker and without as much risk.

Studies like the ones above help prove the importance of doula-work in the labor and delivery room. Why doctors and hospitals are not actively seeking out doulas can only be explained (in my opinion) by the financial gains these organizations are not willing to give up. Taking charge of our own bodies, our own labor process, and our own babies (yes, our babies ARE affected by these choices) is the only answer at this time. We must educate ourselves, look at the research based evidence, and choose accordingly. At this time, the evidence clearly shows that choosing a doula can help reduce the needs for medical interventions in birth.

Share this information with those around you. Support a daughter or friend by offering to be their doula (weekend workshops are available throughout the US), or to help pay the fee for one (doula fees typically run between $400-$800). Do a little research to find out if anyone is working to become a doula in your area, in which case you may receive services for free. My hope is that by the time Little Bear is thinking about starting her own family, the word "doula" is as commonly heard as "OBGYN" and "midwife" - and that insurance companies are helping to pay for their services. My hope is that the word "doula" becomes a part of every woman's birth story ... just as it was before, for thousands of years. Just as it continues to be now, in many other parts of the world.