What Is A Doula and What Do Doulas Do?

(article from Bellybelly.com.au. For the original article, click here)

The word ‘doula’ (pronounced ‘doo-la’) is a Greek word meaning ‘woman servant or caregiver’. More recently, it refers to someone who offers emotional and physical support to a woman and her partner before, during and after childbirth. A doula (also known as a birth attendant) believes in ‘mothering the mother’, enabling a woman to have the most satisfying experience that she can, from pregnancy and into motherhood. This type of support allows the whole family to relax and enjoy the experience too.

Despite doulas being fairly unheard of in Australia, they have been actively supporting women for a very long time and are fast growing in popularity, as a result of positive word of mouth and the need for increased support. In fact looking at google statistics recently, searches on the word ‘doula’ are at its highest yet from 2004 to 2011.

Doulas are trained and experienced in childbirth and are usually mothers themselves. They have a good knowledge and awareness of female physiology, but a Doula does not support the mother in a medical role – that is the job of the midwife or doctor. She works on the basis of keeping birth normal and empowering, and should the birth become complicated and require medical assistance, a doula will still remain by your side and help in any way she can. She also does not make decisions for those she supports, but she assists them through the decision making process and provides balanced information so the couple can make their own choices.

Many women consider doulas to be a must for those giving birth in a hospital, due to the modern medicalisation of birth – unnecessary inductions are skyrocketing and 1 in 3 babies are now born by caesarean section (and yes, one of those interventions readily results in the other – its no coincidence). In Australia, some hospitals have caesarean section rates as high as 50% or more. This is a terribly high statistic, well above World Health Organisation recommendations of 10-15% – which makes us amongst the highest in the world. Given the long term emotional and physical effects this can have on the mother, her partner and baby, a doula to me is like an ‘insurance policy’ – which can help protect you from a disempowering experience. With a doula, you know that someone is always on YOUR team, holding the space for you and your family.

A doula works in birth centres, private and public hospitals and at homebirths in conjunction with midwives – but never as the sole carer at birth. Birthing without a midwife or doctor present is known as free-birthing however BellyBelly recommends birth with at a qualified midwife or doctor.

There are two types of doulas, birth doulas and post-natal doulas, with many doulas performing both roles. The difference is that the role of the post-natal doula is to nurture the mother at home after childbirth. This may include further breastfeeding support, light home duties, massage, emotional and physical support for the mother and so on. Post-natal doulas are particularly in demand as support for new mothers has reduced in modern society. Needless to say, studies show that post-natal doulas make a huge impact on the well-being of mothers.

The Promise Of A Doula

1. You cannot hurt my feelings in labour
2. I won’t lie to you in labour
3. I will do everything in my power so you do not suffer
4. I will help you to feel safe
5. I cannot speak for you; but I will make sure that you have a voice and I will make sure you are heard

What Are The Proven Benefits Of A Doula?

A recent review of many studies from around the world have concluded that a doula’s support is more effective than hospital staff, friends or family. You can read the review here.

Studies consistently demonstrate very impressive benefits for the mother, father and baby, including:

  • 50% less caesarean sections
  • Reduction in the use of forceps by 40%
  • 60% less requests for epidurals
  • 40% reduction in the use of synthetic oxytocin for inductions or augmentations
  • 30% reduction in use of pain medication
  • 25% reduction in labour length
  • Increased rates of breastfeeding at 6 weeks post-partum (51% vs 29%)
  • Higher self-esteem (74% vs 59%), less anxiety (28% vs 40%) and less depression (10% vs 23%) at 6 weeks post-partum

These are not misprints! The benefits are significant. Most of the women in the studies were accompanied by male partners, however study results show that women who had the support of a male partner and a doula fared best, for example, the caesarean rate of women supported by both a male partner and a doula was significantly lower (15.4%) than the caesarean rate for women supported only by their partners (24.4%). The studies also clearly show the positive benefits of doula support occur regardless of a woman’s economic status or whether or not they were privately insured. Its simply about having the right support with you at birth.

What About The Woman’s Partner – Does a Doula Replace Them?

According to the studies (and from personal observations in births I have attended) rather than reducing a partner’s participation in the birth process, a doula’s support complements and reinforces their role. Partners feel more enthusiastic and that their contribution to the labour and birth was meaningful and helpful. I often find when partners have a visual on how to support a woman i.e. watching me support her, they feel more confident and relaxing having seen some ideas to try themselves. In the studies, not only did partners report higher levels of satisfaction after the birth, but mothers reported feeling more satisfied with their partners role at birth too.

What Will My Ob/Hospital/Midwife Say If I Have a Doula?

More obstetricians and midwives are becoming aware of the doula as they become more popular; most are very supportive or are not bothered by a doula – in fact obstetricians and doulas rarely cross paths. If they do, it’s often for a very short time, during the birth.

In a recent birth I attended, a student midwife told me that they were currently doing a unit on birth support in her studies, and she was very impressed about the benefits and outcomes achieved with women who have doulas.

There is the occasional story I hear about some obstetricians not wanting a woman to have a doula present, however ultimately it is your own choice and decision as to the level of care you receive. An obstetrician is not present for you throughout most of the labour, only if you need intervention or to catch the baby (if they make it!). So continuous support from a known carer is crucial while you labour – because what happens during the labour can affect the outcome. It also is very telling about the sort of care you may receive at the birth if your Obstetrician is not open to you looking for ways to help reduce your chances of interventions. If your doctor is not supportive of you making choices, decisions and avoiding intervention, you may end up feel unsupported and disempowered in labour.

What Training Do Doulas Receive?

In Australia, there are several ways a Doula can train, through courses conducted by very experienced Doulas – some of which are also midwives, doctors and educators. Again, this is not medical training – doulas are trained in professional birth support. As part of a doula’s training, she may be required to read certain materials, attend several births (as an unpaid trainee), write assignments/reports, attend birth education classes and other requirements. If you are interested in becoming a Doula, see our BellyBelly article, Doula Training In Australia. (Doulahanani: In Singapore, you can train as a doula with Foutrimesters or Parentlink)

What Do Couples Think of Doulas?

Check out this short video on YouTube featuring couples talking about doulas:

Here are a few short testimonials from Australian couples who have used professional birth support:

“A very special thank-you… You made such a difference at the birth for us both, encouraging me when it all seemed too hard and helped me achieve the birth that has given our little girl the best start in life. Thanks for sharing this special time with us. I hope our paths cross again. You are a beautiful person with much to give the world.” — Catherine & Jason

“Thank-you for helping us achieve a wonderful birth experience. I felt safe and far more relaxed knowing I had the right support. Everything went exactly as I wished for with minimum intervention and stress¦ I feel sooooo grateful that we had such a great outcome. I am sure it is even helping me get through these difficult first months. I now know I CAN get through anything with determination, knowledge and support! — Meredith & Chris

“Wow I’m still in shock when I think about that long labour and the fantastic result – it was sooo worth it. I truly know that I couldn’t have done it without you – that is a fact. You are amazing and are truly made for the job – I really can’t thank you enough.” — Bronte & Michael – 2006

References and Recommended Reading

1. Klaus M, Kennell J, Berkowitz G, Klaus P. Maternal assistance in support and labor: Father, nurse, midwife, or doula. Clin Cons Obstet and Gyn 1992; 4:211-17.

2. The Doula Advantage, Rachel Gurevich, Prima Publishing 2003

3. The Doula Book, Marshall H. Klaus, M.D., John H. Kennell, M.D., and Phyllis H. Klaus, C.S.W., M.F.T. Da Capo Press, 2002

4. Sosa R, Kennell J, Klaus M, Robertson S, Urrutia J. The effect of a supportive companion on perinatal problems, length of labor, and mother-infant interaction. N Engl J Med 1980; 303(11):597-600.

Kelly Winder is a birth attendant (aka doula), the creator of BellyBelly and mum to two beautiful children. Become a fan of BellyBelly on Facebook or add Kelly as a friend (frequently adding articles and stories). You can also follow BellyBelly on Twitter.

Disclaimer: Doulahanani did not write this article. This article is from bellybelly.com.au

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