Pregnant women have unending decisions to make and choices to contemplate during their pregnancy; from what should I be eating to best support my growing baby, to why am I still so nauseous and where will I give birth, all the way to how the heck will I be able to breastfeed for an entire year as recommended! Choosing a doula is often a decision pregnant women do not even know is available to them, yet if they did know it could quite possibly make all of the other decisions and choices related to pregnancy and birth that much easier and less stressful.
A birth doula is defined as a support person for pregnant people. Our job is to provide education and support pregnant people both physically and emotionally before, during and after the birth of their baby(s). The word “doula” comes from ancient Greek meaning “a woman who serves”. For generations women have been supporting other women during labor. It just makes sense. Yet, with the evolution of modern medicine, many traditional means of supporting women during birth went to the wayside. Modern medicine took control of the birthing process in an effort to make it more predictable and safer. In this effort, whether you view it as well intentioned or misguided, the role of women supporting women in labor moved to the wayside. In the 1970s the natural birth movement shifted the focus back to supporting women through labor with the view that childbirth is not a medical procedure but rather a completely natural process. With this movement the role of a doula became a professional, paid and valued service. Whether giving birth in a hospital, birth center or home setting, doulas filled the role that traditionally female family members did, providing continuous support during labor.
When in labor in a hospital, where the majority of births still occur, there are stretches of time where there may be no in person medical support and there is never continuous 1:1 support from any hospital staff. The OB/GYN typically arrives only a short time before pushing occurs in the second stage of labor. Nurses are available but are typically helping several patients at the same time. Many women do not understand this reality and have unrealistic expectations of the kind of physical and emotional support that will be available to them from a professional.
On top of the physical and emotional support, comes the necessity in many cases to make tough decisions regarding medical procedures and options while in labor. An unprepared birthing woman may agree to something that she ultimately regrets due not having the knowledge and support to make the most informed decision when the options are presented to her.
With a doula on the care team, the birthing woman has guaranteed continuous 1:1 emotional and physical support. She will also begin labor with more knowledge regarding the potential choices she may encounter while in labor. This is because birth doulas work with their client’s prenatally to educate, plan and prepare for labor and delivery. There is a relationship that is developed during the prenatal visits that builds trust and confidence between the doula and birthing mother. This relationship establishes a framework for working as a team during labor. There is no need to spend time figuring each other out between a contraction, which often is the case with the labor and delivery nurse assigned to the birthing mother. The doula knows the birthing mothers birth preferences and/or plan as well as comfort strategies that are best received by the mother, because all of this has been discussed and often practiced before labor begins.
By having a doula present at your birth, evidence has shown that the birthing mother is more likely to reflect on her birth as a positive experience. She is less likely to have a cesarean delivery and to require an epidural or pain medication. It has also been shown that pain perception is less with doula support and the duration of labor is reduced. Some of these outcomes have more statistical significance than others but all stack the cards more in your favor for a positive birthing experience than if you did not have a doula on your care team.
Finally, imagine a birth where you are with only your partner for up to 30-60min at a time while you go through countless contractions, you have no idea how to make yourself more comfortable and feel out of control because you don’t know what to expect or what to ask. Now imagine a birth where from the moment you thought you were in labor you had support from a trained birth professional, your doula. In early labor she will coach you over the phone on what to do to rest, relax and be comfortable. She will help you make an informed decision on when to go to the hospital. Once you arrive at the hospital your doula is by your side the entire time. She is providing you with suggestions on positioning, relaxation and breathing, while supporting you physically in any position that gives you a sense of relief, rest or comfort. When and if things go not as planned, she is prepared with evidence based information to base your decision on. She is by your side every step of the way, serving your needs and yours alone. Which birth would you prefer?
I would be remiss if I did not comment on how birth doula support may look in the context of the current COVID-19 pandemic. The benefits of birth doula support are unchanged but the process may look different due to certain restrictions placed by organizations including hospitals and the CDC. To begin prenatal visits are likely to occur over a video platform such as Zoom. These visits are likely to be longer due to the need for the doula to provide more upfront education to prepare the birthing mother (or couple) on how to perform many of the physical support strategies that the doula would typically do at the birth. This is a because there is a higher possibility of the doula not being physically present during the birth due to hospital support person guidelines during the pandemic.
If the doula is unable to be present during the birth, she will be available for intermittent phone or video based check ins throughout the labor stages. This will look different for each client due to the vast variability of labor progress and presentation, as well as differing individual needs for each birthing mother. However, a typical pattern would be to check in when things change, for example when transitioning from the first to second stage of labor. During the check in the doula is available for educational and emotional support, intended to boost the mothers morale and help provide evidence-based information for any decisions she needs to make. The doula will also provide suggestions for physical support strategies that the birthing partner or nurse may be able to provide to help progress labor or provide more comfort during and between contractions.
Despite the uncertainty of today, a birth doula’s value has not changed. How we deliver services, just like the way we shop for groceries and socialize with friends, has changed. Fortunately, doula’s are masters of flexibility, rolling with the punches, remaining clear headed, calm, nurturing and last but not least supportive.
If you or someone you know may be interested in birth doula support during this exceptionally unpredictable time, please contact Windward Maternal Wellness at firstname.lastname@example.org. We are currently accepting clients for January, February and March 2021.
Hilary Valentine, Owner of Windward Maternal Wellness
I was born and raised in Massachusetts but I have called Oahu my home for the past 14 years. I live with my family in Kailua, including my husband, Jason, my daughters, Victoria and Gwendolyn and my parents, Nanette and Geoff. This blog is intended to shine light on both my work as a women's health occupational therapist and postpartum doula, my personal views on lifestyle topics such as parenting and women's health as well as a resource for education on topics relevant to the clients I serve. I welcome any and all comments and feedback! Mahalo!