Purpose of Labor Support: The Birth Doula

The Purpose and Value of Labor Support

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By Gina Conley, CD(DONA)

            The purpose of labor support is to enhance a mother’s childbirth experience with respect to her birthing desires, allows her to be involved in the decision-making choices of her birth, improves the outcome and increases her satisfaction with her childbirth experience.  The value of continuous labor support is that a woman’s childbirth experience can influence the bonding with her baby, likelihood of breastfeeding success, and postpartum recovery.  Furthermore, the childbirth experience extends into the postpartum, and can have either positive or negative implications following birth.  

            The American birth experience generally consists of at least two components of a mother’s labor support team:  the partner, such as her spouse, mother, sister, or close friend, and the medical support team at the birthing unit, such as the doctors, midwives, and nurses.  While many mothers have successful birth experiences under the aforementioned model, continuous support during labor from a trained doula has been shown to improve the outcome and experience for women and infants.   Incorporating this third component, the doula, to the mother’s labor support team, increases the likelihood of spontaneous vaginal delivery, increased positive feelings about the overall birth experience, decreases the occurrence of cesarean birth and medical interventions during labor and delivery, and decreased likelihood to use pain medication.

            The doula’s knowledge and educational background in labor support compliments the partner’s intimate relationship with the mother by guiding the partner to better physically and emotionally support the mother during labor.  The doula can provide reassurance to the partner during a mother’s labor that her behavior is normal in addition to providing emotional support for the partner.  The doula’s presence allows the partner to relax and focus on supporting the laboring mother’s needs, without feeling overwhelmed by the lack of knowledge of birth or medical procedures.  The doula can help give the partner confidence to ask questions and advocate for the laboring mother’s birthing desires.

            The doula compliments the mother’s medical support team by ensuring a mother’s non-medical needs are met, such as her emotional needs, and assists in facilitating clear communication between the mother, her partner, and the medical staff.  However, it should be made clear that doulas do not perform clinical tasks, such as vaginal exams, or provide medical advice; every family is still responsible for making their own decisions, and a doula cannot make decisions for them or provide second opinions.

            Continuous support from a birth doula incorporates information, advocacy, and a combination of physical and emotional comfort measures.  Physical support includes: massage, counterpressure techniques, and allowing the mother to physically lean on the doula or partner.  Emotional support includes: rhythmic breathing and relaxation techniques, encouragement and reassurance, and patience and confidence in the mother.  Both physical and emotional support provides comfort measures for the mother during labor and helps to enhance her experience by relieving tension, improve comfort in labor, and enhance labor progression.

            Continuous support in the form of information involves validating and normalizing a mother’s prenatal and childbirth experience.  Doulas can provide non-clinical information and advice, such as changing a laboring positions or comfort techniques that a partner can utilize during labor to comfort the mother.  A doula’s knowledge of labor and medical procedures can help a mother and her partner gain a better understanding of the stages of labor and possible complications during pregnancy or birth.  Additionally, a doula should have an understanding of the resources available in their area and should be able to refer the family to various local resources, such as a lactation consultant, massage therapist, or pelvic floor physical therapist.

            Continuous support in the form of advocacy involves facilitating clear communication between the mother and the medical staff.  When a woman is involved in the decision-making about her care, and clearly understands her options, there is an increased satisfaction in her childbirth experience. 

            Doulas advocate for their clients by encouraging them to ask questions and understand the risk and benefits of procedures so that the family may make an informed decision about their medical care.   It is important to remember that doulas cannot make decisions for the mother, nor does the doula speak for the mother to the medical staff; however, doulas can remind the mother or partner to ask questions.   Additionally, the doula should not express biased information in an effort to sway a mother or her partner to make a decision that aligns with a doula’s personal opinion. 

            The purpose of labor support is to enhance a mother’s childbirth experience by respecting her birthing desires and enabling her to be an active member of the decision-making process in her birth experience.  The value of labor support is that there is: an improved outcome in birth; an increased birth satisfaction; a positive birth experience; as well as a decrease in cesareans and medical interventions.  The improved birth outcome heavily influences the mother’s postpartum experience.  The consolidation of the intimate relationship to the mother from the partner, the responsibility of the medical team for the health and well-being of the mother and baby, and the continuous labor support of the doula all contribute towards the emotional well-being of the mother.  

 

References:

1.       Bohren, M., Hofmeyr, G., & Sakala, C. (2017).  How does continuous support affect outcomes for pregnant women during childbirth? Cochrane Database of Systematic Reviews, (7).

2.       DONA International. (2017). Code of Ethics: Birth Doula.

3.       DONA International. (2017). Standards of Practice: Birth Doula.

4.       Dekker, R., PhD, RN, APRN. (2017). Evidence on: Doulas. Evidence Based Birth. Retrieved from https://evidencebasedbirth.com/the-evidence-for-doulas/.

5.       Simkin, P. (2013). The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and Other Labor Companions. Beverly, MA: The Harvard Common Press.

6.       Simkin, P. (2012). Position Paper: The Birth Doula's Role in Maternity Care. DONA International.