A doula is a woman, experienced in childbirth, who provides unconditional emotional, physical and informational support to women and their partners during labour and birth.
Support in Labour – why is it important?
One-to-one constant support throughout labour has been shown to not only provide a woman with emotional support, so that she is relaxed, but also to have a strong positive effect on the physiology and outcomes of labour. Research over the last 25 years has shown that the constant presence of a supportive birth companion is one of the most effective forms of care that women can receive during childbirth.
What is support in labour?
Women in labour have a profound need for companionship, empathy and physical comfort. Support in labour has been described as having four dimensions:
Emotional support: encouragement, praise, reassurance, listening, continuous physical presence; Informational support: explanations and information; Physical support: comfort measures such as massage, cool/heat packs, relaxation exercises; Advocacy: representing the woman’s wishes to others and acting on her behalf, when requested.
A Cochrane systematic review of 15 RCT’s revealed that women who had continuous labour support from a doula:
- Had 26% fewer caesarean births; Had 41% fewer instrumental vaginal deliveries; Were 28% less likely to use any analgesia or anaesthesia; Were 33% less likely to be dissatisfied or to rate their birth experience negatively;
- Postpartum benefits found in a review of 12 trials show that women are:
- More likely to be fully breastfeeding at four to six weeks post birth; More likely to display more positive mother-baby interaction at eight weeks post birth; More likely to have good self-esteem; More likely to find mothering easy and to feel that they were managing well; Less likely to experience anxiety and postnatal depression.
The Midwife – the reality.
Hospital midwives usually have to divide care between different women, cope with administration and work along others in the multidisciplinary team. As a result, they may be unable to give constant emotional, informational or physical support.
What do Doula’s do?
The doula’s role is to provide individualized, physical and emotional support and assistance in gathering information for women and their partners both prior to and during labour and birth. The doula offers help and advice on comfort measures such as breathing, relaxation, movement and positioning. Perhaps the most crucial role is providing unconditional continuous emotional reassurance and comfort. It is important to stress that the doula and the woman’s partner work together, she does not and should not, be seen as a replacement for the partner. A doula cannot make some of the unique contributions that the partner makes, such as commitment, intimate knowledge of the woman and love for her and her child so the doula should be there in addition to, not instead of, the partner. Furthermore, the presence of a doula can enhance the role of the partner by reducing his anxiety and freeing him to offer more emotional support and operate at his own comfort level.
Doula’s do not perform clinical tasks, such as vaginal exams or fetal heart rate monitoring. Doula’s do not diagnose medical conditions, offer second opinions or give medical advice. Most importantly, doula’s do not make decisions for their clients and they do not project their own values and goals onto the labouring woman.
What I offer as your Doula?
As a doula my goal is to help you have a safe and satisfying birth as you define it and to support your partner at the level which he requires. I have supported women who have chosen no medical pain relief, those who choose pain medication including epidurals, women who are hoping for a VBAC (vaginal birth after c-section) and those who have emergency c-sections.
Typically I would meet you once or twice in your own home before the birth, where we would discuss your hopes for the birth, how you see my role in helping you achieve that and go over your birth plan. If you have not attended the Birth Matters Workshops, then we would also spend some time exploring some of the research based evidence for enabling your birth to proceed as smoothly as possible.
I am on-call for you, from the moment you book me as your doula. In an effort to ensure that all my clients are assured continuity of care, I work with a network of other local experienced doulas who will be my back up in the event that I am unable to attend your labour and/or birth due to: sickness, family emergencies, previous commitments that we would have discussed (ie Birth Matters workshops) and/or other unforeseen circumstances.
We will have email or telephone contact on a more regular basis as your pregnancy advances. Once in labour I can give encouragement over the telephone, or visit with you in your home until time to go to the hospital, or if your labour is progressing well I can meet you at the hospital, where I will remain with you until your baby is born. I usually visit twice after the birth, once the day after the birth in the hospital and then again, when you are settled at home. Although, not a breasfeeding counsellor, I am an experienced breastfeeding supporter and can also offer information on newborn care and other postnatal issues.
Cost: $1,200.00 – for VBAC and first births and $900 for subsequent births. This is based on ability to pay and payment plans or alternative recompense is negotiable.
Some people have mentioned they are concerned about the relationship between doulas and the doctors and hospital. If you are worried about this, please do telephone the maternity ward and mention it at your doctor’s visit to find out how they feel about your having me as your doula