What a good bloody question- isn’t that for rich folk and hippies who want to free birth?
Absofuckinglutely NOT!
Let’s clarify a few things straight away…
1. Doulas are for everyone.
2. Doulas are for all births.
3. Doulas are not a replacement for the birth partner.
4. Doulas can be an expensive investment- BUT the presence can be HUGELY advantageous.
So, what is a doula?
A doula is a person who supports women and birthing people through pregnancy, labour, and birth, and/or after the baby is born. They are trained, non-medical professionals to promote the most positive birth experience possible.
A birth doula will:
meet the pregnant persons, spend time getting to know them and support them in their birth preferences
provide one-to-one support during labour, physically, emotionally and practically.
A postnatal doula will:
care for the birthing person and family after the birth
help the new parents look after the baby (rather than looking after the baby for them).
So now we kind of know what a doula is, let’s look at why you might hire one.
Firstly, let’s look sat some statistics as how a doula might help you have a more physiological birth. Research ("Mothering the Mother" Klaus, Kennell & Klaus, 1993) has showed us that having a doula present during birth has the following impacts:
· 50% reduction of caesarean
· 25% shorter labour
· 60% reduction in epidural request
· 30% reduction in analgesia used
· 40% reduction in forceps delivery
The World Health Organisation recommends continuous support for women and birthing people however many Western practices promote more health-based facilities and don’t respect this level of support. A study published in the Cochrane review (Hodnett ED, Gates S, Hofmeyr G, Sakala C.) found that the presence of a doula improved several health outcomes for both the mother/birthing person and the baby, including lower APGAR scores. Showing that the support of a doula isn’t solely about the benefits to the birthing person, but the holistic benefits to all, including the postnatal period.
Sometimes during birth, the birthing person may need to speak up, to share their preferences, however this can disturb the physiological process of birth, and therefore the use of a doula can help increase advocacy for the woman/birthing person. This can mean that the decision is still kept by the birthing person and therefore reduces any unwanted procedures, increasing feelings of satisfaction for their labour and birth. Which is one of the primary outcomes of a positive birth experience. I must add, doulas do not speak on the birthing persons behalf, they only support them in their right to make their informed choice when advocating. This needs clearly noting.
Now, I don’t know about you, but for me, birth wasn’t just a physiological process, it was a mental one too. I knew I needed to get in the right headspace, remain calm and in control, not anxious. Ravangard et al. 2017 found that ‘doulas presence has clinically meaningful impact on anxiety and pain relief in birth.’ This calming effect is so important to help the birthing person feel comfort, comfort in birth is so important. So how do you help someone feel more comfortable? Yes physically, but also emotionally, Gilland (2010b) states that ‘One of the doula’s primary goals is to care for the mother’s emotional health and enhance her ability to have positive birth memories’ but how is this actually done?
Continuous presence
Reassurance
Encouragement
Praise
Helping the birthing person see themselves or their situation more positively
Keeping company
Showing a caring attitude
Mirroring—calmly describing what the birthing person is experiencing and echoing back the same feelings and intensity
Helping the birthing person and partner work through fears and self-doubt
Debriefing after the birth—listening to the mother with empathy
As well as this mental/emotional support, you might wonder what doulas actually can do to physically support you, this is not dissimilar to a birth partner, but imagine HOW supported you feel during your birth if you have someone who can also do the following.
· Soothing with touch through the use of massage or counter pressure
· 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
· Giving ice chips, food, and drinks
We also know that attachment has a significant impact on our hormones, specifically our oxytocin levels. Oxytocin, being a shy, love hormone, can often be inhibited during birth, due to the environment, interruption, anxiety etc, so a doula can really help provide a calming effect on the birthing person and therefore raise oxytocin to help the birth process. Things like massage, encouragement and breathing will help encourage, topped with the love and support of a birthing partner, birth is gonna rock! Increased oxytocin also helps to reduce the pain the birthing person feels (Hofmeyr, 1991) by increasing endorphin levels, so many benefits! (now are the statistics at the start starting to make more sense?)
Being the ultimate pillar of support.
You might ask “but I can get support like this from my HCP and my birth partner/family members so why would a doula be necessary?”, and that’s a really, good question… In 2017, Bohren et al. published an updated Cochrane review on the use of ‘continuous support for women during childbirth’. For two of the outcomes studied, the best results occurred when a birthing person had continuous labour support from a doula– someone who was NOT a staff member at the hospital and who was NOT part of their social network.
Overall, this diagram helps to visually outline the support that doulas provide.
It is fair to say that ‘doulas should be viewed by both parents and providers as a valuable, evidence-based member of the birth care team’ and the value of them isn’t explicitly measurable, there are many ways that positive birthing outcomes can be improved and having continuous support from a doula is risk free and effective, and this is WHY YOU SHOULD HIRE A DOULA.
And of course, hire one because you want to.
References:
Mothering the Mother" Klaus, Kennell & Klaus, 1993
Hodnett ED, Gates S, Hofmeyr G, Sakala C. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub5 and Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub6)
https://amygilliland.com/research-0 - Personal communication, Dr. Amy Gilliland, July 2015