When I told my family and friends that I decided to become a doula, I was surprised at how many of them said… “Wow, cool., Wait…what is a doula?” It occurred to me that though I’ve lived and breathed in the world of childbirth for the past seven years as a labour and delivery nurse, there are a lot of people out there who might not know exactly what a doula is, what they do, and just how important they can be in helping you have a positive birth experience.
If you found my blog and are reading this post, chances are you have heard of a doula. You might have thought that doulas are all the rage right now (just google “celebrities” and “doulas” and you’ll see what I mean). Perhaps you may have even considered a doula for your own pregnancy and birth, but for whatever reason decided not to have one. So, I thought I’d clarify the role of a doula and share about what the evidence says on how they substantially improve birth outcomes.
History of Doula Support
Despite their current pop-culture trendy status, doulas, as traditional birth attendants, have been around for centuries. Anthropologists have studied cultures from all over the world, and have found that humans have very similar patterns of providing support around a birthing woman. In a precursor to his landmark research on doulas, Dr John Kennell, one of the founders of DONA (Doulas of North America) International, investigated records between the 1960’s-1970s[1] and found that in 127 industrialized nations, it was considered normal for a mother, a grandmother, or close a female friend to be with a woman during her labour and birth. The Greek origin of the word “doula” literally translates to “a woman who serves” however in its modern sense, the term was coined by Dr. Dana Raphael, a medical anthropologist in the 1970s, who described a doula as “one or more individuals, usually female, who give psychological encouragement and physical assistance to the newly delivered mother”[2].
The Role of a Doula
While not a medical care provider, a professional doula is someone trained in the field of birth, that provides continuous emotional and physical support during your labour, when you may feel at your most scared and vulnerable. Prenatally, they can also prepare you for your birthing journey by guiding you through childbirth basics and helping you identify what is important to you in your birth. Doulas can help you develop mental fortitude and emotional resilience when the events of birth take a different turn from what you had planned. They do not (or should not) give medical advice or recommendations or perform any clinical assessments or duties.
Rather, doulas provide knowledge about all of the care options, and help you prepare questions for discussion with your midwife or obstetrician to see how those options relate to you. Most importantly, going back to the greek roots, the heart of a doula's role is a commitment to service. A doula puts the birthing parent’s needs, desires, and concerns above all others, and does what is necessary to “hold space” for the woman in whatever way that she needs her to, so that the woman feels safe and empowered in the birth of her child. A doula also provides steadfast support for the woman's partner and can keep a calm presence for when the emotion and intensity of birth builds up.
The Benefits of Doulas – What the Evidence Says
There is a plethora of evidence about the benefits of continuous labour support, particularly by birth doulas. A Cochrane Review, originally published in 2013, and then updated in 2017, included more than 26 research trials conducted in 17 different countries, of over 15,000 participants giving birth[3]. Despite the technical quality of some of the evidence being rated low (since the participants could not be blinded in the studies’ design), the evidence demonstrates the following benefits of continuous labour support with a doula (that is, someone who was not a hospital staff member or a member of the woman’s social network).
In studies that had continuous labour support by a doula[4]
- 15% increase in likelihood of having a vaginal birth
- 39% decreased risk of having a Caesarean birth
- 31% decreased risk of being dissatisfied with their birth experience
This last point is NOT to be understated. How important is it to you to LOVE your birth experience? Aside from a universal human desire we all have to create positive and beautiful life memories, research by Goodman, Mackey, and Tavakoli[5] has shown that having a positive birth experience can lead to “increased self-esteem, self-efficacy, skills, maternal and infant attachment, and better acceptance of the maternal role.” Furthermore, Goodman et al found that having a not-so-positive birth experience or perhaps even a traumatic one could contribute to postpartum depression and post-traumatic stress disorder (PTSD). The World Health Organisation (WHO)[6] “insists that a positive childbirth experience should meet a woman’s personal and sociocultural beliefs and expectations in every setting.”
More broadly, continuous labour support in a general sense is absolutely essential. The Cochrane Review reports that those participants who received continuous one-on-one labour support (from either partner, family member, midwife, or doula) were more likely to have[7]:
- a spontaneous vaginal birth
- less utilization of an epidural or any analgesia for pain relief
- shorter labours (by an average of 40 minutes)
- less instrumental (ventouse and forceps) births
- less caesarean births
- less risk of the babies having a low 5-minute Apgar score
Overall, there was no evidence that having continuous one-on-one labour support was harmful or caused negative outcomes. For an even better, in-depth analysis of the Cochrane Review, check out Evidence Based Birth. For a cool infographic that summarizes the Cochrane Review and other clinical research results nicely, see the DONA graphic below[8].
In Summary
Look, the reality is that you don’t “need” a doula, per se. You are perfectly capable of birthing your baby all on your own. It is up to you to decide how you want to have that experience and the type of support you want in the room. In the same way that an Olympic marathoner does not “need” a coach or trainer to actually run that epic race, having one might significantly improve their experience and athletic performance. A doula, in essence, is your birth coach, attendant, and guidance counsellor all in one. They can improve your satisfaction in your birth because you will be informed, protected, encouraged and loved.
I hope I’ve clarified the role of a doula and the advantages of being supported by one continuously in labour. I invite you consider all the benefits that doulas can provide: you are more likely to having a vaginal birth, have less risk of unplanned caesarean birth, and are more likely to have a positive birth experience (or at least not a negative one). Give yourself the best chance at having the birth you want with less intervention, less complications and better outcomes for you and your baby. Give yourself that gift because your birth experience is sacred and will be a day that will stay with you for the rest of your life. Do everything you can to make your birth story a positive one. Hire a doula today!
I leave you with the famous quote by Dr. John Kennell, “If a doula were a drug, it would be unethical not to use it.”
References: [1] Olness, K. & Meyers, C. (2015). Keeping Mothers and babies together: The story of Dr. John Kennell, Amarillo, TX: Praeclarus Press [2] Jones, M. (2016, December 21). The Lives They Lived. The New York Times. Retrieved from https://www.nytimes.com/interactive/2016/12/21/magazine/the-lives-they-lived-dana-raphael.html [3] Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, Issue 7. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub6. Accessed 28 June 2023 [4] Dekker, R. (2019). Evidence Based Birth. Evidence on: Doulas. Retrieved June 28, 2023 from https://evidencebasedbirth.com/the-evidence-for-doulas/ [5] Goodman P, Mackey MC, Tavakoli AS. Factors related to childbirth satisfaction. Journal of advanced nursing. 2004;46(2):212-9 DOI:10.1111/j.1365-2648.2003.02981.x. Accessed 28 June 2023 [6] World Health Organization (2023). Making childbirth a positive experience. https://www.who.int/activities/making-childbirth-a-positive-experience. Accessed 29 June 2023. [7] Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, Issue 7. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub6. Accessed 28 June 2023 [8] DONA International (2016) https://www.dona.org/wp-content/uploads/2016/12/DONA_infographic-3.pdf Accessed 29 June 2023
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