What is a Doula?

It is natural for a pregnant woman to feel fear and apprehension when she thinks about the impending experience of childbirth, especially if she’s a first time mom. Ina Mae Gaskin, author of the classic book “Spiritual Midwifery” had a point when she said, “Women are far more afraid of childbirth than they were 25 years ago. We are just one more generation away from the days when a girl grew up on a farm watching the sheep and pigs give birth. Anyone who saw that year after year knew that giving birth was a natural process, a process that could be trusted.” She went on to say, “Women don’t seem to know today that a woman’s body knows how to work. We rely on drugs as if our bodies couldn’t get along without them.” It’s true that in our Aspirin, Tums, and Pepto-Bismol culture, women are encouraged to take something for PMS, something for menstrual cramps, and are told later in life that they can’t go into menopause without Estrogen. In childbirth a woman often is given oxytocin to speed things, Demerol “to take the edge off” (which slows things down) and then an Epidural to numb things out. No one should be expected to go through agony just to have a “natural” childbirth, but how much of the pain is fear and tension based? How much comes from our pain-free culture?” Again, studies show that women who are more relaxed and in a mental and emotional framework of excitement and involvement feel less pain and “forget” to ask for drugs. I think Ina Mae is right. The body can be trusted. And, generally, when it is trusted, women have an easier and more memorable birth experience.

The word “Doula,” comes from the Greek word for the most important female slave or servant in an ancient Greek household, the woman who probably helped the lady of the house through her childbearing. The word has come to refer to “a woman experienced in childbirth who provides continuous physical, emotional, and informational support to the mother before, during and just after childbirth.” (Klaus, Kennell and Klaus, Mothering the Mother).

A 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 side of the laboring woman throughout the entire labor...
  • Provides emotional support, physical comfort measures, an objective viewpoint and assistance to the woman in getting the information she needs to make good decisions...
  • Facilitates communication between the laboring woman, her partner and clinical care providers...
  • Perceives her role as one who nurtures and protects the woman’s memory of her birth experience.

    A Doula provides all this and more. “A Doula offers emotional and physical support to the laboring woman, is an advocate for the mother’s birth wishes, and helps women to achieve a healthier, happier and more fulfilling birth experience, thereby, leaving them better prepared to cope with the challenges of motherhood.”

Statistics: It has been reported by Drs. Marshall Klauss and John Kennell, and published in the
Journal of American Medical Association (JAMA) May 1, 1991, that women attended by doulas have improved outcomes such as:

reduction in overall cesarean rate by 50%
reduction in length of labor by 25%
reduction in use of Pitocin by 40%
reduction in use of pain medications by 30%
reduction in Epidural requests by 60%
reduction in use of forceps by 40%

It has also been reported that women attended by doulas have a reduction in secondary complications such as maternal infection, maternal fever, newborn problems and post-partum depression.

One can use the assistance of a Doula whether she is birthing in the hospital with a doctor, or birthing with a midwife. The Doula is simply a helper and WONDERFUL support. “A Doula is not just a nice woman to have around to rub your shoulders or back and fetch you juice. She does a lot more. She is an anchor offering emotional support to the laboring mother as well as praise, pep talks, empowerment. She helps you keep your birth wishes in perspective if complications set in and difficult compromises and decisions need to be made. She affirms and works through joyous accomplishments and disappointments in the post-partum period. This special person is also a teacher, instructing the mother in labor-saving techniques, answering questions, explaining labor events as they occur, and preparing the couple for what is ahead. The anticipatory guidance she provides can alleviate most of the fear of the unknown. The Doula is also a diplomat, the mother’s advocate, acting as a liaison between parents and medical staff, conveying the couple’s wishes and seeing that they are honored whenever possible. She makes no medical decisions but helps interpret the suggestions of the medical attendants to the parents. She assists the parents in asking the right questions so that they are informed enough to take an active part in decisions. She helps to see that interventions are avoided or at least decided on mutually. She has a sensitive presence, knowing when to actively assist the laboring mother and when to retreat quietly into the shadows and leave the couple alone so that they don’t feel watched or judged. Best of all, she is a comforter, touching and tuning in to the mother during contractions, helping her relax, and assisting her in using her natural resources to ease her discomfort and steady the progress of labor. And when the mother’s strength seems almost gone, her own strength is offered to the woman, encouraging her beyond her perceived limits to meet the goal of birthing her baby.”

An excerpt from The Birth Book, co-written by Dr. William Sears and wife, Martha Sears, RN.
Using a Doula is another example of simple, appropriate technology which can save money. It has been estimated that if every woman in the United States had a supportive woman with her continuously throughout labor, the reduction in interventions such as cesarean sections and Epidural would reduce maternity care costs by more than two billion dollars (Klaus et al.1992).

As a childbirth educator and Doula, it is my responsibility, and my delight, to help frightened, unsure, apprehensive pregnant moms find their own inner strength and confidence before they go into labor. This is accomplished through childbirth classes and much one-on-one attention, helping to replace fears of the unknown by confidence and understanding. Then, childbirth is an experience of a lifetime, for mom and dad, and for the baby too.

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