What is a doula?

The work of a doula is the resumption of an ancient tradition which dates back to when it was the custom for womxn* to be continuously and intimately accompanied and supported before, during, and after birth by birth-experienced womxn. Outside of what we know as ‘the West’ this kind of work continues to be practiced in many countries. The name ‘doula’ is derived from the ancient Greek word ‘douleia’ and means ‘to serve the woman’ / ‘servant of the woman’.

Doulas inform, strengthen self-competence, and instil trust by reminding you of your natural intuition and strength. While doing so, they accompany you along every path that the birthing person choose, always focusing on the wishes and needs of the expectant mother*. As the confidant of the pregnant woman, a doula passes on her needs to the team of obstetricians. To enable this intimate relationship, pregnant women and Doula get to know each other well before the date of birth. 

Doula work before, during, and after birth can be divided into informational, emotional, and physical support.

Doula offerings cover the following:

  • Upholding the birthing person’s primacy of interest. In other words, a doula’s primary responsibility is to the birthing person—not to a hospital administrator, nurse, midwife, or doctor.
  • Supporting the birthing person in their right to make decisions about their own body and baby.
  • Providing evidence-based information about pregnancy and birth options, infant care, postpartum recovery
  • Supporting the birthing person with the preparation of their birth preferences
  • Talking through emotional concerns which you or your partner may have (this includes talking and coming to terms with previous pregnancy and birth experiences)
  • Supporting the birthing person with the preparation of their fourth trimester (the time between birth and 12 weeks postpartum)
  • Guiding the birthing person (and their partner) through the course of labour (e.g. helping explain medical procedures before or as they occur, helping the partner understand what’s going on with their loved one’s labour)
  • Suggesting techniques in labour, such as breathing, relaxation techniques, movement, and positioning (positioning is important both with and without epidurals)
  • Facilitating communication between the parents and care providers
  • Soothing with touch through the use of massage, counter pressure, or a rebozo
  • Helping to create a calm environment, like dimming lights and arranging curtains
  • Assisting with water therapy (shower, tub)
  • Applying warmth or cold
  • Assisting the birthing person in walking to and from the bathroom
  • Providing food and drinks
  • Helping the birthing person and partner work through fears and self-doubt
  • Debriefing after the birth—listening to the mother with empathy
  • Continuous presence and company
  • Reassurance, encouragement, and praise
  • Helping the birthing person see themselves or their situation more positively
  • Supporting your partner which allows them to participate at his/her/their own comfort level during the labour.

The benefits of doula support:

  • A 26% lower risk of giving birth by Caesarean section
  • 15% increase in the likelihood of a spontaneous vaginal birth
  • Significantly higher AGPAR scores ​​of new-borns
  • A 41% lower risk of using a suction cup or pliers
  • 39% less administration of labour-promoting agents
  • 10% decrease in the use of any medications for pain relief
  • A significantly shorter overall time spent in labour
  • More babies are fully breastfed
  • Parents have more confidence when handling their baby
  • A 31% decrease in the risk of being dissatisfied with the birth experience; mothers’ risk of being dissatisfied with the birth experience was reduced with continuous support provided by a doula
  • Birthing persons who are supported by a doula develop postpartum depression much less frequently

Doulas do not:

  • Perform clinical tasks such as vaginal exams or foetal heart monitoring
  • Give medical advice or diagnose conditions
  • Make decisions (medical or otherwise) for you, your partner, or your baby
  • Pressure the birthing person into certain choices just because that’s what they prefer
  • Take over the role of your partner
  • Assist in the delivery of the baby (they are not midwives or doctors) or ‘catch the baby’
  • Change shifts (although some doulas may call in their back-up after 12-24 hours)

What about my partner?

Not all expectant mothers have a partner who can support them continuously throughout labour. If you have a partner, he or she will be an essential and irreplaceable source of support. A doula will never take over the role of your partner who will always know you better and love you and your child like no one else does. However, it is important to point out that the expectations towards partners are often rather high. Childbirth is an intense and transformational experience and event, it is demanding, unpredictable and it can last for anywhere from a few hours to 24 and more. Even if your partner is well prepared, it might be difficult to apply what you have learned in conventional birth preparation classes. Moreover, partners also need reassurance advice, and help. They usually do not have much experience in supporting a birthing person. Their knowledge about birth, birth work, and medical procedures also tends to be limited.

Doulas have knowledge and experience about all of these things while also having experienced birth themselves. They have a network of other birth workers and usually know their way around different birth environments including hospitals, birth centres, and home births. Ideally, doulas and partners can complement each other in order to make up a birth team that works together with other birth workers such as midwives and doctors. It is important to emphasise that doulas do not only support birthing persons but also their families, including their partners as they might need a break to eat, use the bathroom, sleep, or check on other children. More importantly, partners become parents, too, during birth and they are going through their own emotional journey that requires support. A doula can encourage your partner to become an active part of your birth journey and advise about how to support you and baby best.

*womxn as it is used here includes nonbinary and queer identities, transgender womxn, womxn of colour, womxn from Third World countries, and every self-identifying womxn out there.

 

Sources:

Bohren, M. A., Hofmeyr, G.J., Sakala, C., Fukuzawa, R.K., A. Cuthbert (2017) ‘Continuous support for women during childbirth’, Cochrane Database Syst Rev, 7: 7.

Dekker, Rebecca (2019) ‘Evidence on Doulas’, Evidence Based Birth, (accessed August 2020).

Klaus, M. H., Kennell, J. H., and P.H. Klaus (1993) Mothering the Mother: How a Doula can help you have a shorter, easier, and healthier birth, Persues Books: Reading, Massachusetts.

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