What is a Doula?

If a doula were a drug, it would be unethical not to use it.” ~ Dr. John Kennell

The word "doula" is Greek for "trusted servant".  A birth doula is a skilled and experienced woman who provides professional and continuous labor support for the mother and partner during the entire birth process.  The doula is knowledgeable about the needs of women during labor and birth, and understands the intense transitions a woman endures.  Knowing how to plan, prepare, and cope with the changes that take place during labor are essential to having the birth experience that you deserve.  The use of a birth doula has proven to decrease the need for pain medication, medical interventions, and cesarean sections (click on the following numbers to see some of the proof 12345).

Continuous emotional support during labor in a US hospital. A randomized controlled trial.
Kennell J, Klaus M, McGrath S, Robertson S, Hinkley C.
JAMA 1991 May 1;265(17):2197-201

50% Reduction in the cesarean rate
25% Shorter labor
60% Reduction in epidural requests
40% Reduction in oxytocin use
30% Reduction in analgesia use
40% Reduction in forceps delivery 

According to DONA International :
Numerous clinical studies have found that a doula’s presence at birth
    • tends to result in shorter labors with fewer complications
    • reduces negative feelings about one’s childbirth experience
    • reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans
    • reduces the mother’s request for pain medication and/or epidurals

Research shows parents who receive support can:

    • Feel more secure and cared for
    • Are more successful in adapting to new family dynamics
    • Have greater success with breastfeeding
    • Have greater self-confidence
    • Have less postpartum depression
    • Have lower incidence of abuse
Your doula acts as an advocate and a liaison for you and your partner with the health care staff at the hospital.  A doula is able to explain the medical jargon and information that is often hastily presented to patients before major health care decisions are to be made.  Doula's are knowledgeable about normal birth and the complications that can arise.  The doula helps you to better understand your choices and supports your decisions unconditionally.       

The continuous presence of a doula during your time of vulnerability (and incredible strength!!) is invaluable.  As an insider, let me inform you that the well meaning hospital staff will be not be able to adequately support you during your labor.  The nurses, midwives, and physicians often have multiple patients to care for.  Many women are left to labor alone and face difficult decisions that they do not understand alone.  Additionally, there will most likely be numerous shift changes and new faces/personalities throughout your labor.  The hospital health care providers are unable to provide the comfort, care, and continuous therapeutic presence that a doula does because they have many other responsibilities to juggle.  The sole responsibility and goal of the doula is to be with YOU and support YOU and your partner.  

The birth doula does not take the place of the father.  A good doula will incorporate the father (as much or a little as you both prefer) and help him to support his loved ones through the hard work of labor and birth.  

The doula is there to support fathers too!!  

The Realities of the Hospital Labor & Birth Experience: 
    Care Provider Roles in the Hospital Setting

                Nurse (RN):  Your nurse will be the hospital personnel you will have the most contact and support from.  Some nurses may be less supportive than others.  Most nurses are heaven                            sent angels with hearts of gold and will stay with you as much as possible.  However, even these angels have a bad day occasionally or can be overworked, stressed,                                           or pulled by numerous duties during her shift which is usually 8-12 hours long.  Many nurses juggle several patients at a time plus carry administrative duties.  At the                                        end of her shift you will have a new nurse come on for the next 8-12 hours.  The nurse's duties are to follow the doctor or midwife's medical orders, ensure patient                                           safety, and provide basic support to the patient and family such as getting blankets, food, water, assistance to the bathroom, administering medications, and minimal                                           emotional support/encouragement.  The nurse is not obliged to massage, back rub, labor sit for hours, or provide above minimum comfort.  The nurses that do this                                             are purely providing a charity of love for the patient as a person.  
                Certified Nurse Midwife (CNM):  Your midwife will have every intention of providing you with the best care possible.  However, the duties of the CNM are very intense                                       physically, mentally, and psychosocially.  The Midwife must care for all laboring patients that walk through the door, meticulously monitor, evaluate, and  medically                                       manage each mother and baby's course of care.  Each pregnant woman equals two patients.  She also answers all after hours phone calls, triage visits, admissions,                                               postpartum rounds, and discharges.  The CNM must communicate with the RN and consult with the MD, NICU team, and Pediatrician, keeping everyone abreast of                                           the cases and situations as they develop.  The midwife must often deal with bitter nurses that are unfriendly, unprofessional, and sometimes mean.  The CNM must also                                   cope with doctors that are sometimes very mean, abusive, or unsupportive of midwifery.  She toes a tight rope of trying to please everyone during her typically 12 hour                                   shift.  The midwife desires to labor sit, rub backs, comfort, encourage, and support but often can't because she is the Ringmaster and must tend to the circus that is sometimes                            L&D.  Even if you are the only patient the midwife has, she must eat, sleep, and care for herself in order to preserve her energy for any disaster that might arrive at any hour                            of the night.  She also assists with cesarean sections when ordered by the doctor.  Additionally, she most likely has administrative duties piling up that must be completed                               such as reviewing clinic labs, messages, ultrasounds, prenatal records, and charting.  The CNM is not obliged to provide above minimal support during your labor.  Her                                   main duty is ensuring patient safety and medical management of the labor course and birth.    
                Doctor (MD, DO):  The doctor is like the executive director of the team unit.  The doctor is usually not "in house" meaning, physically at the hospital.  They must be available by                             phone and ready to get to the hospital rapidly in the event of an emergency.  During labor, the doctor is usually involved in the care by phone consultation with the nurse or the                          midwife.  The doctor is typically called to notify them of an admission, occasional status updates, consultations, management questions, or if there is an emergency.  The                                 doctor specializes in surgery not natural birth and always has cesarean birth as a close option.  Usually, the doctor will recommend cesarean section as a last resort and works                             with the midwife, RN, and patient to avoid it first.  Sometimes, the doctor is able to come in to evaluate the patient and perform a technique that facilitates a vaginal, natural                             birth.  The doctor doesn't provide support beyond informed consent and basic human empathy.  This is understandable given the heavy mental and psychological burden the                             doctor carries and how packed their 24-48 hour shift is.  The doctor usually is tending to the OB/GYN urgent matters coming into the ER, answers all calls from nurses,                                     midwives, and sometimes patients.  Performs emergency and many scheduled surgeries, etc.