This essay was written as part of my application for doula certification through DONA International.
The Purpose and Value of Labor Support
by Heidi Kruckenberg
Over the past few months as I’ve read, trained, and experienced childbirth from a doula’s perspective I have begun to understand the purpose and value of labor support. The required reading offered a multitude of evidence on the positive medical outcomes of having a doula present at birth. DONA International’s Position Paper: The Birth Doula’s Contribution to Modern Maternity Care provides an overview of seven North American Trials of Labor Support, which concluded that “women cared for during labor by a birth doula, compared to those receiving usual care were 26% less likely to give birth by cesarean section, 41% less likely to give birth with a vacuum extractor or forceps, 28% less likely to use an analgesia or anesthesia.” It is interesting that the presence of a doula affects medical outcomes so positively despite the fact that doulas provide absolutely no medical support to the woman in labor. These improvements in obstetric outcomes are striking, but perhaps the most valuable thing about labor support is the emotional and psychological mark it leaves on the mother. The overview of the trials also notes that women who received care by a doula were “33% less likely to be dissatisfied or negatively rate their birth experience.” Doulas help women process the birth experience at the post-partum visit by listening to the mother share her feelings and answer questions.
The purpose of labor support as performed by a birth doula is to provide continuous physical, emotional, and informational support to the woman and her partner in labor and childbirth and immediately postpartum. I’ve learned from personal experience as a mother in labor and as a doula that continuous support is priceless. Nurses, midwives, and doctors are likely to come and go in the course of labor and delivery, but a doula remains by the woman’s side regardless of the length of labor. This continuous support allows the partner a chance to rest and eat during labor without having to leave the mother alone. A doula eases the pressure off the partner, who may be experiencing childbirth for the first time. Rather than having the sole responsibility of coaching and comforting, the partner can look to the doula for guidance on coaching and how to best provide comfort. Then the partner can fulfill the role he/she is best at: loving the mother. The doula does not take the place of the partner during birth, but helps him/her to participate at the level he/she feels most comfortable. The doula understands that childbirth is a monumental event in a couple’s life and does not try to claim it as her own accomplishment. The doula remains with the couple after delivery to ensure that breastfeeding is established.
Doulas are trained in drug-free pain management such as positions and movements to aid in pain relief and to assist in easier birth. They know how to use massage, visualization, relaxation, and breathing to manage labor pain. A doula’s understanding of the stages of labor enable her to remind mothers about the course of labor, which may help her labor longer at home before going to the hospital or birth center. Women are often able to manage pain and labor more efficiently in the familiar environment of their homes, thereby cutting down the amount of time they labor at the hospital or birth center, which may reduce the use of interventions during labor and speed the labor’s progress. A doula advocates for her client by encouraging her client to ask questions of her caregiver at prenatal visits and during labor. The doula does not make decisions for the client or speak to the caregiver on the client’s behalf. She can help the couple formulate their birth plan at a prenatal visit and remind them of it during labor.
As I begin to more fully understand the purpose and value of labor support through reading and experience I’m inclined to think of a doula as a wise guide for the laboring woman. The doula is wise because she understands and has witnessed labor and birth. She believes that childbirth can be a cardinal event of empowerment for a woman. The doula’s wisdom helps her understand what the mother is feeling and how best to comfort, encourage, and empower her. She expects the mother to listen first to her own body and mind to learn how to manage labor, but is ready to guide the mother with her wisdom and kindness when asked. As she applauds and reassures the mother, the doula imparts her wisdom and empowers the mother as she begins her journey through motherhood.