The following essay was written for my DONA Birth Doula Certification Packet
Sarah Sirianni – 2012


The Good News About Doulas

            When I tell people I’m a doula, a common response I receive is, “A what?” accompanied by a confused look and a tilted ear toward me to make sure they are hearing me right. Of course I’m delighted when I receive a look of recognition, but even then the rest of the conversation will reveal whether they believe a doula is another word for midwife, or that doulas are hippies who only attend home births. Thankfully, times are changing, and more and more people have heard of doulas, know someone who hired a doula, or have hired a doula for their own births. But I’m still excited to receive the questioning and confused looks because it means another opportunity for me to spread the good news about what I do and about the doula profession – who we are, what we’re there for, how we impact women & families and their births.

The Doula’s Role & Responsibilities
            The word “doula” comes from a Greek term for “woman servant.” She serves the mother and partner in a number of ways. First, she provides mental and emotional support and encouragement, and a continuous reassuring presence – she gets in tune with the mother and is sensitive to her mental and emotional needs during labor. Second, she provides physical support and comfort measures, helping with breathing techniques, labor positions, comforting touch, etc., working together with the birth partner at his or her comfort level to make the mother as comfortable as possible during labor. Third, she assists the mother’s birth partner in participating as much as he/she would like to in providing hands on support and encouragement to the mother, as well as providing reassurance to partner’s and what they are experiencing. Fourth, a doula aids the parents in gathering information and understanding options (most likely meeting together prenatally to go over their wishes, goals, and concerns) so that they can make informed choices about their birth. She does not make decisions for the mother, rather she supports whatever choices the mother makes, aiming to help her to have her best birth, however she defines it. If the mother chooses to use pain medications, as is stated in a DONA International Position Paper entitled The Birth Doula’s Contribution to Modern Maternity Care, “Doulas can help maximize the benefits of pain medications while minimizing their undesirable side effects. The comfort and reassurance offered by the doula are beneficial regardless of the use of pain medications.” Doulas do not perform any clinical tasks such as monitoring fetal heart tones or maternal blood pressure, or checking the cervix. Her duties are reserved for the emotional and physical well-being of the mother, the areas in which she is appropriately trained, experienced, and certified (see DONA International’s Standards of Practice for Birth Doulas). Finally, the doula sets forth to abide by a code of ethics in her practice, which includes propriety, competency, and integrity, and a commitment to the wellbeing of her clients and to the advancement of “the values, ethics, knowledge and mission of the profession” (DONA International Code of Ethics for Birth Doulas).

The Purpose and Value of Labor Support
            So, why go to all of this trouble? In my opinion it would be enough just on an individual basis to be able to improve a mother’s (and father/partner’s) experience of her birth so that it can be a positive memory that she will cherish. But in addition to helping mothers have more comfortable births and births that they feel good about, doulas also help mothers have safer births. A meta-analysis of 15 trials from North America, Europe, and Africa that explored the difference between women cared for by doulas versus women receiving usual care found the following results: 26% less cesarean births, 41% less births with vacuum or forceps assistance, 28% less use of analgesia/anesthesia, and 33% less dissatisfaction or negative ratings of birth experience (Hodnett, et al). Similar findings are shown across other studies, including three North American trials that included over 8,000 women which compared continuous labor support provided by nurses versus intermittent support/usual care. In addition, mothers who experience safer births and births that they feel good about have improved breastfeeding rates and maternal-infant bonding (information adapted from DONA’s position paper, The Birth Doula’s Contribution to Modern Maternity Care). The constant presence of a doula (or any knowledgeable support person such as a midwife or nurse who remains attentive to the mom at all times during birth) seems to be one of the most impacting factors for more positive outcomes, for comfort, enjoyment, and safety during labor, for lower  interventions and lower costs, and for the health of the mother and baby, and therefore – the health of the community. In short, doulas make a positive difference.

            When someone asks me what a doula is, I get to tell them about what I do and why, with all of the benefits outlined above. Someday perhaps we will see the word “doula” become as common of a word associated with childbirth as the word “epidural.” I’m doing my best to spread the good news about doulas.

 


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