Doula-Supported Birth: A Modern Adaptation of an Ancient Tradition
by Erika Harding, certified Doula and Childbirth Educator
When she heard of my most recent change of profession, my mother asked me, “You’re becoming a What-a?” One of the ObGyn doctors at UNM Hospital laughingly called us “boula-boulas” the first time she heard the term. My favorite was when the Tennessee mother of one of my clients, after hearing her daughter’s positive birth story, asked about how women go about hiring a “Do-er.” Some women doing this work use the term “professional labor support person,” but the most common name for it these days is Doula, Greek for “servant to women.” The terminology may be unfamiliar, but the function of a Doula is as old as time.
What do Doulas do? We attend and support women in labor and birth. We are women who are very familiar and comfortable with this process, being mothers ourselves, and have assisted in many births. We provide strength (physical, emotional, sometimes spiritual) from which women draw during this most difficult and powerful experience. We support the entire family, helping fathers participate in the birth of their child and showing all family members present how they can help the birthing mother.
In ancient times, women were familiar with birth; its pain and exhilaration, its noises, smells and rituals; the way it is intended to proceed and available interventions when things didn’t go smoothly. Women were familiar with birth because it took place among them, in the homes and compounds of the community. Children heard the sounds of birthing women and accepted them as normal. Women birthed in the presence of other women who encouraged them, brought them food and drink, massaged them, bathed them in cool baths or applied hot compresses, and who supported them with their arms and shoulders while they walked or pushed out their babies.
Until about a century ago, the vast majority of American women birthed at home, with a midwife or doctor to help deliver the baby and an experienced woman (sister, mother, neighbor, servant…)with them to provide undivided attention throughout hard labor. Nowadays, few women birth at home with a familiar midwife to attend them throughout their labor. As birth has moved into the hospital, fewer women have had the opportunity to witness a birth before they deliver their first child. Thus expectant women and couples attend birthing classes and read endless books and articles, trying to figure out what it will be like and how best to cope with the frightening and exciting challenge. Yet, despite this childbirth education process, most women go into labor with many unanswered questions, and unresolved concerns or insecurities. Some first-time mothers are deeply fearful of the birthing process itself, which seems mysterious and foreign. Others have specific fears related to their health or that of their baby, the birth environment, or the nurses, doctors or midwives who might attend them during their birth. A substantial number of women having their second or subsequent baby carry fears resulting from a previous birth trauma.
In addition to making childbearing a mysterious and somewhat fearful process, the switch from home to hospital has isolated mothers and fathers from the kind of support they need during this vulnerable time. Hospitals have long-standing policies which discourage “visitors” to the labor ward. Even fathers were excluded from the birth until the last thirty years, and many hospitals continue to restrict the number of people who can attend a mother during labor and delivery. In support of these hospital policies, childbirth classes in recent decades have pushed fathers into the role of labor “coach,” placing the full burden of the labor on one, usually inexperienced and highly nervous, male.
Now that so few women witness a birth before they deliver their own babies, a romanticized vision of birth has proliferated in our culture. In accordance with this vision, many women believe that birth should be a private event (if possible, set in a room filled with candles, flowers and whale music) shared between a woman and her partner, and that no one else is needed or wanted. I shared this romantic image of birth as I approached the due date for my first child. Despite my fears and questions about the birth process (and about my own ability to handle it), I didn’t see any middle ground between “going it alone” (with my husband’s encouragement) and “getting the help I might need” (drugs). Furthermore, when a Doula was first suggested to me, I felt she would be an intrusion, and would potentially make my husband feel unnecessary or unwanted.
Thanks to my husband’s insistence that a Doula would be useful, I soon discovered what every woman who has given birth knows: that if you want to be an active participant in your birth and have as little medical intervention as possible, it is very important to have the continuous support of someone who has experience with birth. Women need the calming presence of another woman in the room, even if she is just a quiet and reassuring guide who takes little or no active role. It is best if this person can answer questions, and has a broad range of birth experiences (someone who is comfortable with a variety of birth environments and attendants, who has witnessed many different birth interventions and outcomes, and who has also attended many normal and unmedicated births).
Under the current hospital model, neither doctors, nurses nor midwives are available to fill the role of birth support person. Even if they have the inclination and patience to “labor-sit” with a woman through her contractions until the birth, hospital staff have too many demands on their time to stay long periods with a birthing mother. Many of the nurses and midwives mourn the loss of this prolonged and intimate contact with laboring women, but that is the reality of our contemporary medical system.
In some cases, women can turn to their mothers or other family members for the information, advocacy, support, protection and reassurance they need during labor and birth. However, many of our mothers never experienced natural childbirth and don’t know how to support a woman trying to accomplish it. Many women who gave birth in hospitals in the 1940s through the 1960s and even into the 1970s were not allowed to be active participants in their births, even if they went without pain medication.
I am not trying to discourage fathers or grandmothers from participating. On the contrary, unless you are laboring in bed with an epidural, you generally need at least two pairs of hands available. In addition to the logistical difficulties of a single birth attendant (what do you do when he or she needs to pee, eat or sleep?), having an experienced support person present allows fathers and other family members to participate more fully, since without having to shoulder the full burden they can relax a bit and be more available and loving to their partners and more present for the birth experience.
In addition to making good sense in our society, the ancient tradition of Doula work has been clinically studied and found to be effective. In six international studies documented in Mothering The Mother by Marshall H. Klaus, John H. Kennell and Phyllis Klaus (originally published in the New England Journal of Medicine, British Medical Journal, British Journal of Obstetrics and Gynaecology, and the Journal of the American Medical Association), Doulas were found to have a profound impact on the length of labor, the use of pain medications and artificial labor inducers, and the number of forceps and cesarean deliveries.
Specifically, the studies indicated that through the presence of a Doula:
* the average length of labor was reduced by slightly more than 50%;
* the use of epidural anesthesia went from 55% to 8% of mothers;
* the number of women giving birth vaginally without the use of pain medications quadrupled;
* the need for artificial labor inducers (pitocin, etc.) was reduced by more than half;
* the use of forceps was reduced from 26% to 8% of the births studied;
* and the number of cesarean births was cut in half.
According to these same studies, the use of a Doula also improved mother’s satisfaction with the birth experience, and had a positive impact on post-partum pain, breastfeeding and infant health. This is dramatic evidence to support a return to a supported model of birth for modern mothers, particularly those birthing in a hospital environment.