What Does A Birth Doula Do?
It’s a straightforward question, but one that often provokes some misunderstanding, so let’s clear a few things up before we begin. A professional birth doula has been trained to support expectant parents in the period before, during, and just after the birth of their baby. It’s a role that is common in many cultures, and is sometimes described as mothering the mother. It’s often said that it’s not just a baby that is born in the birth space, a family is too - and it’s a doula’s role to support the transition from woman to mother, from couple to family.
They do this in several key ways. Firstly, the doula will help the expectant parents prepare for the birth, both practically and emotionally. Usually during one or more pre-birth preparation sessions, the doula will work with the parents to illuminate and alleviate any fears that they may have; provide information about the options that are open to them; educate them about the process of physiological birth; and teach comfort measures for labour. The doula will also inform the parents of their rights and furnish them with the skills to look critically at any options and choices that may arise during the birth, enabling them to calmly advocate for themselves at a time when emotions may be running high.
Then, during the birth itself, the doula will provide emotional and physical support for both the birthing person and the birth partner - helping them work as a team towards the birth preferences they established together. Some doulas are trained in additional complementary therapies - from massage and aromatherapy to acupressure and rebozo - while some lend support and give encouragement in other ways. The doula will provide physical support through touch and verbal reassurance, offer ideas for new positions and comfort measures, and take care of physical needs - from gentle pressure on an aching lower back, to a cool cloth on a warm brow - all while making you feel like she was never really there. Like a birth space Mary Poppins, your doula will help you remember everything you have learned, and support you at every step of the birth, but somehow at the end she will disappear and you’ll find yourself as a family feeling satisfied and empowered by all that you have achieved.
The theory is lovely - who doesn't want support when they need it most - but is it just a leap of faith or is there any evidence to support the use of a doula for childbirth?
Dr Rebecca Dekker - founder of Evidence Based Birth - is a leading authority on all aspects of childbirth, and provides both birth professionals and expectant parents with robust information on a range of subjects. She takes a concept - from complementary therapies to drugs and other interventions - and looks at all recent studies that have been carried out into that subject, producing a robust overview of its efficacy in birth. Her study into the effectiveness of having a birth doula refers to the 2017 Cochrane report which takes into account 26 studies involving more than 15,000 birthing women.
The studies all looked at continuous support in labour - that is, the birthing person being accompanied by someone who was there and focused on them throughout the birth versus what the study calls “usual care” - that is a group of midwives or doctors who are simultaneously tending to several women and who may change shifts during the labour. For these studies, some of the continuous support people were doulas, some were members of hospital staff (a midwife or nurse), some were a friend or female relative, and some were a companion who was not from the birthing person’s social circle or from the hospital - like a childbirth educator or a retired nurse. It’s a difficult study to conduct since it’s not possible to blind test any participants - in that, a person knows if they have a continuous companion or not - and so the findings are not considered as high quality as they would be if a blind control was possible.
That being said, the studies found that people who received continuous support were more likely to have spontaneous vaginal births and less likely to have to use pain medication, epidurals, vacuum or forceps-assisted births, and cesareans. They were also - and perhaps most importantly - less likely to have any negative feelings about their birth experience. In addition to this, those who received continuous support experienced labours that were shorter by an average of 40 minutes - and their babies were less likely to have low Apgar scores at birth. The study found no evidence for any negative consequences to continuous labour support. In short, the study found that “if a birthing person has continuous labour support, both mothers and babies are statistically more likely to have better outcomes,” Dekker asserts. But does it matter who that continuous support person is? Is a doula any better than having your friend or mother there with you?
The researchers assessed six outcomes for the births of the surveys’ 15,000 participants: use of any pain medication, use of Pitocin during labor, spontaneous vaginal birth, caesarean, admission to special care nursery after birth, and negative birth experiences. Within those categories, in four of the six doulas fared just as well as retired nurses, midwives, or members of the birthing person’s close circle - and in two areas doulas fared better than any of the other support people, meaning that doulas were the most effective continuous support of all. Continuous support throughout labour (vs “usual care” from the medical team) resulted in:
25% decrease in caesarean; the largest effect was seen with a doula (39% decrease)
8% increase in the likelihood of a spontaneous vaginal birth; the largest effect was seen with a doula (15% increase)
10% decrease in the use of any medications for pain relief
Shorter labors by 41 minutes on average
38% decrease in the baby’s risk of a low five minute Apgar score
31% decrease in the risk of being dissatisfied with the birth experience
In addition to these findings, there was also a smaller amount of evidence that doula support in labour can lower postpartum depression in mothers. So, the short answer is, yes. Anecdotally it’s nice to have someone support you, help you, and tell you you’re doing a great job - and statistically your birth is more likely to proceed without intervention and leave you satisfied afterwards if a doula supports you. Now, all you need to do is find one you like and who you feel you connect with, and start getting ready to meet your baby.
