Doulas and the labouring woman

The role of the doula becomes apparent during labour. A doula will be an invaluable source of support whether the mother-to-be wants a hospital birth or a home birth. Even with elective Caesarean sections, a doula may be required to act as a support for the mother, the partner and other family members. There is no birth where a doula is unneeded!

A doula is not a trained professional and, as such, remains present during labour and birth to support the mother (and partner). Her presence is continuous and may be invaluable in a hospital setting where midwives work in shifts and labour crosses many shift changes and tea breaks. Both in hospital and at home, a doula will begin by ‘preparing’ the room / labour space. Lights may dimmed, beds moved, ‘nests’ made and music and/or candles started. All of these details will have been discussed before the birth and the doula will remember these details when birth starts and all else gets forgotten. Her role is to create a safe environment in which the mother feels at ease, safe and relaxed.

The element of safety is incredibly important during labour, and some research has linked this to hormonal reactions within the body. Hormones such as adrenaline, which are produced if the mother is stressed, can stall labour in the same way it would stall an animal’s labour in the wild.

Although not a trained professional, a doula is able to help with non-medicating pain-relief methods. Some labouring women want the doula to remain in the room as a ‘presence’ with no hands-on support; whilst others benefit from a hands-on approach and will use the doula to provide pain relief, or to guide their partners in the use of non-medication methods. These methods may include massage, touching and/or stroking – light pressure on the small of the back can be incredibly relieving during a contraction; the use of hot and/or cold towels on the back, shoulders, neck and head; or just gentle words of encouragement. “You’re doing really well” and “You can do this, you ARE doing this” can make a huge difference when a woman is tired and feeling like she can’t cope any more. The doula can also guide the mother into new positions to help with labour pain. This is illustrated in excellent detail in an article by Penny Simkin, Comfort in Labor (2007).

A doula can also help with breathing techniques to cope with the pain of labour. Focusing on breathing is a very powerful pain relief technique which can be easily forgotten by labouring women and their partners when contractions become intense. Doulas will remain calm and remind them of the techniques which may have been practised over the past few weeks and months. This brings the focus back to the couple and allows them to properly explore the options available to them with an informed choice (something not always available in the hospital setting).

The role of the doula is to support the labouring women AND her partner during this time. It is essential for the partner (if present) to feel engaged in the labour and birth of their new baby and a doula will facilitate his or her interaction and subsequent bonding with the baby. A doula’s role is not a replacement to a partner and many partners report positively to the presence of the doula at their partner’s birth.

The progress of a woman’s labour can take many paths depending on what her wishes are beforehand. Most women want to experience an easy labour with no intervention and no induction but as the medicalised system has taken over from routine pregnancy care, the chances of induction and intervention are highly increased.

References:

Berg, M. and A. Terstad, Swedish women's experiences of doula support during childbirth. Midwifery, 2006. 22(4): p. 330-8.

Buckley, S.J., Gentle Birth, Gentle Mothering. 2009, Berkeley: Celestial Arts. 348.

Kaufman, T., Evolution of the birth plan. J Perinat Educ, 2007. 16(3): p. 47-52.

Keenan, P., Benefits of massage therapy and use of a doula during labor and childbirth. Altern Ther Health Med, 2000. 6(1): p. 66-74.

McGrath, S.K. and J.H. Kennell, A randomized controlled trial of continuous labor support for middle-class couples: effect on cesarean delivery rates. Birth, 2008. 35(2): p. 92-7.

Simkin, P., Comfort in Labor: How You Can Help Yourself To A Normal Satisfying Childbirth, in http://www.childbirthconnection.org. 2007.

Stockton, A., Birth Space, Safe Place: Emotional Well-Being through Pregnancy and Birth. 2009, Scotland, UK: Findhorn Press. 102.