Before going into the many, varied reasons you should hire a doula, I feel I should explain just what a doula is. Of course, it’s not as easy as just pinning down what a doula “is” because honestly I could fill out 20 A4 pages and the list would still be non-exhaustive. But at their cores, doulas are birth experts who can offer you, your birthing partners and your immediate families emotional and physical support before, during and after birth. Doulas are not medical professionals, nor do they perform medical procedures, rather they are there to inform, advocate for, and protect birthing people and their space. They are non-judgemental allies to all birthing people who believe in you at all costs and make it their mission to best educate themselves on your wants, your needs and your rights.
As aforementioned, doulas can work antenatally and/or postnatally and may specialise in prenatal care, birth care, postnatal care, miscarriage and baby loss care or abortion care, some even work in end of life care. Each doula differs and may work across the full spectrum or just one or two areas, if you are just looking for postnatal care then it could be wise to look out for doulas who wholly offer postnatal support, likewise if you are looking for someone to go through the whole journey with you it would be preferable to get somebody with experience of each intersection of doula work. There truly is a doula that’s the right fit for everyone and you should be encouraged to interview as many as you need to until you find the one you click with.
So why hire a doula? They just sound like a glorified birth partner, right? Wrong! Doulas offer so much more than just being a birth partner. Here are some stats. A 2015 peer reviewed study entitled “Doula support compared with standard care; Doula support compared with standard care Meta-analysis of the effects on the rate of medical interventions during labour for low-risk women delivering at term” [Jacqueline H. Fortier, 2015] found that the presence of a trained doula appears to have a significant effect on rates of instrumental vaginal deliveries and caesarean sections (significantly lower) and also resulted in a slightly shorter duration of labour. One part of the study looked at nulliparous birthing people attempting vaginal delivery of uncomplicated pregnancy across 4 hospitals, the exact percentages which ended in instrumental delivery was much lower when a trained doula was present in all except for Mexico City where the rate was exactly the same;
In Oakland, California
Trained doula present – 19.2%
Standard care – 28.8%
In Toronto, Ontario
Trained doula present – 18.1%
Standard care – 24.7%
In Houston, Texas
Trained Doula present – 7.5%
Standard care – 21.6%
In Mexico City, Mexico
Trained doula present – 3.4%
Standard care – 3.4%
A link to the full study can be found in the references at the bottom of the post, it’s a great read.
So we’ve established that they can lower the risk of birth interventions but why else should you hire a doula? Well let’s look at the antenatal period to begin with, antenatal doula care generally consists of a few appointments getting to know you, listening to your birth preferences to help work out a birth plan, signposting to further information, studies or services to help you make informed decisions about anything which may have come up in your pregnancy (or just stuff you want to know more about!), attending antenatal appointments with you if you so wish and proving ongoing phone or email support.
A 2013 peer reviewed study by Lamaze International which looked at women who received antenatal doula support vs. women who received none found that “Expectant mothers matched with a doula had better birth outcomes. Doula-assisted mothers were four times less likely to have a low birth weight (LBW) baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding. Communication with and encouragement from a doula throughout the pregnancy may have increased the mother’s self-efficacy regarding her ability to impact her own pregnancy outcomes.” (Gruber, Cupito and Dobson, 2013)
During birth a doula builds on the relationship they have created with you antenatally to ensure you are fully supported and that your needs and wants are adhered too, if you plan to birth at home a doula can help set up the pool and the birth environment while you and your birth partner focus on getting into the zone, or if you plan to transfer to a hospital or a MLU the doula can ensure you are left undisturbed by the midwives and communicate your preferences for you as soon as you arrive acting as an advocate and protecting your space. Doula’s will stay with you until your baby is born and you feel settled enough to be left alone, no matter how long that takes, the whole time providing continuous care, support and reassurance whatever comes up during labour. They can also support your birth partner to feel involved and not just like a spare part, while giving them space to take short breaks if the labour is long or they are overwhelmed. The book “Why Oxytocin Maters” summises “The presence of a supportive woman stimulates the release of oxytocin into the circulation and into the brain… When the birthing woman feels calm and without fear, the oxytocin system operates at a maximal capacity and so does the parasympathetic nervous system. In addition, the stress-reducing effects of touch and warm hands will be optimised. So the doula can be thought of as enhancing the power of the birthing mother’s oxytocin system.” (Uvnas Moberg, K. 2019) *
*Oxytocin in the powerful hormone that drives labour forward. “The two main actions of oxytocin in the body are contraction of the womb (uterus) during childbirth and lactation. Oxytocin stimulates the uterine muscles to contract and also increases production of prostaglandins, which increase the contractions further.” (yourhoromones.info, 2015)*
Many doulas who have supported you throughout pregnancy and birth will continue to work with you postnatally, or some birthing people may want to hire a doula specifically just for the postnatal period, and if that’s what works for you then there are a whole range of amazing postnatal doulas out there ready to make the transition to parenthood as smooth as possible. They can start as soon as baby is born, or join you and your family later in your parenthood journey. They may only visit you for a couple of sessions or they may work with you for the full first year! Doulas roles postnatally vary greatly depending on your needs and your family’s needs however they will always continue to provide emotional support, advocate for you, and signpost to other relevant services if needed, ensuring that your fourth trimester is a time for bonding and connection with your new baby and family. Many doulas are also trained in other areas such as babywearing, breast/chestfeeding, gentle sleep techniques, attachment parenting or other spectrums of the parenting wheel so make sure you take into consideration what you may want support with once baby is here (however anything doulas don’t feel able to support you with personally, they will always pass on to another trusted and well informed agency).
Postnatal doulas each bring a different set of skills however it is generally accepted that they will prepare and bring over nourishing food for you and your family, do light housework, look after the baby while you rest, shower or just take some time out, help with other children if required such as a school pick up or just playing with them while you feed, give feeding support and just being there for a chat if you need to get anything off your chest or want to talk through your birth experience. Some may also provide massages or offer ceremonies such as “closing the bones”, a three step rewind or placenta encapsulation, all which can have profoundly healing effects on the birther, providing they are done in a culturally sensitive and respectful way.
So why hire a doula? I think this quote from the summary of the 2017 Cochrane Review on the use of continuous support for women during childbirth just about sums up everything we’ve discussed above, “Overall, people who received continuous support were more likely to have spontaneous vaginal births and less likely to have any pain medication, epidurals, negative feelings about childbirth, vacuum or forceps-assisted births, and Cesareans. In addition, their labours were shorter by about 40 minutes and their babies were less likely to have low Apgar scores at birth. There is a smaller amount of evidence that doula support in labour can lower postpartum depression in mothers. There is no evidence for negative consequences to continuous support.” (Bohren, M. 2017) A doula is an investment in yourself, a guarantee that somebody is by your side and on your side during one of the most important times in your life, a listening ear, an advocate and a proven way to ensure you have best outcomes possible for you and your family as you travel through pregnancy, birth and the fourth trimester.
References:
Bohren, M., 2017. Continuous support for women during childbirth. [online] Doi.org. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003766.pub6/full [Accessed 24 January 2021]
Gruber, K., Cupito, S. and Dobson, C., 2013. Impact Of Doulas On Healthy Birth Outcomes. [online] PubMed Central (PMC). Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647727/> [Accessed 12 January 2021].
Jacqueline H. Fortier, M., 2015. Doula Support Compared With Standard Care: Meta-Analysis Of The Effects On The Rate Of Medical Interventions During Labour For Low-Risk Women Delivering At Term. [online] PubMed Central (PMC). Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463913/> [Accessed 12 January 2021].
Uvnas Moberg, K. 2019. Why Oxytocin Matters. 1st Edn. Pinter & Martin. Brixton, London.
Yourhormones.info. 2015. Oxytocin | You and Your Hormones from the Society for Endocrinology. [online] Available at: https://www.yourhormones.info/hormones/oxytocin/. [Accessed 24 January 2021].
Apologies for the gendered language in the quote from “Why Oxytocin Matters” and the studies used throughout this blog post, direct quotes must be copied word for word.
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