whydoula

The Clinical Benefits of Doula's

"If a doula were a drug, it would be unethical not to use one." John Kennell, Mothering the Mother

Potential Health Benefits of Using a Doula

~ 60% reduction in epidural requests

~ 40% reduction in pitocin use

~ 50% reduction in cesarean section

~ 25% reduction in labor time

~ 30% reduction in additional pain drug use

~ Reduced chances of maternal fever and infection

~ Reduced maternal blessing following birth

~ Reduced incidence of postpartum depression

~ Parents have higher regard and increased sensitivity towards

babies

~ Greater parental satisfaction with the birth

~ Decreased risk of postpartum depression

~ Increased breastfeeding success

"The father-to-be' s presence during labor and delivery is important to the mother and father, but it is the presence of the doula that results in significant benefits in outcome." (10)

More Benefits to the Father and Mother

~ The doula is trained and knew comfort measures (nurses,

midwives, and OB's may or may not)

~ The doula is there only for the mother and her partner, no other

responsibilities (like monitoring, charting, helping another

nurse, health of mother and baby, servicing the machines, etc)

~ Will notify you if there is a deviation from your plans, wishes

~ Helps keep the birth atmosphere clam, peaceful, and sacred

~ The doula is familiar with terminology, so can help the mother

and partner understand what is being said, if caregivers

become too technical/medical in their explanations

~ If something does go differently than expected, all the

caregivers will be very busy doing what they are supposed to

do, and the busier they are the less time they will have for

explanations and reassurances, the doula can give a running

commentary, and still just hold a hand, provide emotional

support, which may be more important now than before

~ It allows the partner to participate to his (her) comfort level,

without feeling nervous about the aspects he/she may not be

so comfortable about

~ No change of shift for the doula, while nurses will most likely

change at least once during mom's stay in L&D

~ Continuous presence, getting used to the voice, settling into a

team with partner

~ Taking turns doing the harder parts of physical support, just

offering an extra set of hands and another heart and brain

~ Allows brief breaks and breathers without deserting mom

1. Scott KD, Berkowitz G, Klaus M. A comparison of intermittent and continuous support during labor: a meta-analysis. Am J Obstet Gynecol 1999 May 180:5 1054-9.

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

3. Scott KD, Klaus PH, Klaus MH. The obstetrical and postpartum benefits of continuous support during childbirth. J Womens Health Gend Based Med 1999 Dec;8:1257-64.

4. Keenan P. Benefits of massage therapy and use of a doula during labor and childbirth. Altern Ther Health Med 2000 Jan;6:66-74.

5. Wang D, Mao X, Qian S. Clinical observation on Doula delivery. Chung Hua Fu Chan Ko Tsa Chih 1997 Nov 32:11 659-61.

6. Zhang J, Bernasko JW, Leybovich E, Fahs M, Hatch MC. Continuous labor support from labor attendant for primiparous women: a meta-analysis. Obstet Gynecol 1996 Oct 88:4 Pt 2 739-44

7. Nolan M. Supporting women in labour: the doula's role. Mod Midwife 1995 Mar 5:3 12-5.

8. Gordon NP, Walton D, McAdam E, Derman J, Gallitero G, Garrett L. Effects of providing hospital-based doulas in health maintenance organization hospitals. Obstet Gynecol 1999 Mar 93:3 422-6.

9. Langer A, Campero L, Garcia C, Reynoso S. Effects of psychosocial support during labour and childbirth on breastfeeding, medical interventions, and mothers' wellbeing in a Mexican public hospital: a randomised clinical trial. Br J Obstet Gynaecol 1998 Oct 105:10 1056-63.

10. Klaus MH, Kennell JH. The doula: an essential ingredient of childbirth rediscovered. Acta Paediatr 1997 Oct 86:10 1034-6.

11. Raphael D. Support and variation, the needs of the breast-feeding woman. Acta Paediatr Jpn 1989 Aug 31:4 369-72.

12. Barron SP, Lane HW, Hannan TE, Struempler B, Williams JC. Factors influencing duration of breast feeding among low-income women. J Am Diet Assoc 1988 Dec 88:12 1557-61.

13. Campero L, García C, Díaz C, Ortiz O, Reynoso S, Langer A. ''Alone, I wouldn't have known what to do'': a qualitative study on social support during labor and delivery in Mexico. Soc Sci Med 1998 Aug 47:3 395-403.

14. Manning-Orenstein G. A birth intervention: the therapeutic effects of Doula support versus Lamaze preparation on first-time mothers' working models of caregiving. Altern Ther Health Med 1998 Jul 4:4 73-81.

Why hire a doula?

An Interview with Penny Simkin,

Founder of Doulas of North America

by Jillian Hanson

Why hire a doula? Simkin has devoted a good deal of her professional life to working as a doula and training others to be doulas. She has attended approximately 300 births, "which," she contends, "is not a lot." She explained the advantages of having a doula present, even when the laboring woman is surrounded by friends, family, her partner, and midwives or nurses.

"In comparing a doula to a best friend or the woman's mother or sister, the difference is the experience and the perspective of the doula, and her hands-on knowledge. Doulas have had training in a variety of situations, such as when labor slows down, or if the mother becomes discouraged, or if she's having back pain. And someone who truly cares for the woman may offer love and stay with her, but may not have ideas of things to try. Having that well-rounded knowledge and experience with many laboring women means the doula offers benefits that a friend couldn't have. Comparing a doula with a partner, I think the partner brings things that no one else can bring. He or she loves the woman more than anybody else, he or she knows her better than anybody else, which are wonderful things.

"But one of the disadvantages is that it's awfully hard sometimes to watch the person you love in pain, or frustrated or discouraged with a lack of progress. And there's a tendency to want to rescue her from that. Partners do not have the objective, calm perspective and experience that a woman needs and a doula has. Sometimes the woman doesn't need to be pitied, or rescued. What she needs is someone to say, 'you're OK, this is all right, you're going to get through this, let me help you.' But she also needs someone with a perspective on when to throw in the towel, and to recognize that this is not going normally, or that we need some interventions here. Furthermore, sometimes the doula can speak with the [hospital] staff, in a liaison capacity, with a little more confidence than the partner can.

"And finally, when compared to nurses and midwives who have clinical responsibilities that have to take priority over the mother's emotional needs, the doula can always remain beside the woman as a continuing source of nurturing encouragement and reassurance. Also, nurses and even some midwives are often not skilled in some of these hands-on comfort measures used by doulas."

Simkin says she is heartened by what she sees as an increase in the popularity of doulas. "Doulas are the most positive innovation I've seen. And that's because they fit in anywhere: at home, at the hospital, at birth centers. Doulas appeal to many women and their partners -- the idea of having someone there just for them, who has no other obligations, no shift changes -- even fathers who want to play the primary support role are relieved to know there's going to be someone there reminding them and helping out and giving them a break if necessary and offering perspective. The doula is the most significant change that's taking place on in the direction of woman-centered childbirth." "Doulas are the most positive innovation I've seen. And that's because they fit in anywhere: at home, at the hospital, at birth centers."

- Penny Simkin

DONA provides a referral service for expectant parents looking for a doula. "We have enough doulas now in North America that if someone calls our referral number they are very likely to find someone in their area. DONA also gives some guidelines on how to select a doula," says Simkin. "And we have a video called 'Introducing the Doula,' that we make available to our members, so that they have something to show clients, and also to hospitals, to show what a doula is and what a doula does."

Penny Simkin is a physical therapist, childbirth educator, author, and doula. She is highly regarded both nationally and internationally in the field of childbirth and labor support and has published several books for expectant parents and childbirth professionals promoting woman-centered childbirth. Simkin, an unassuming woman, is humble about her success and passionate about her work. She is also a one-woman force for woman-centered labor and childbirth practices. In 1992, Simkin founded Doulas of North America (DONA), an international organization that certifies doulas (trained labor support people) and provides its members with support and continuing education. At "almost 60," she is still going strong: writing, teaching, traveling, lecturing, and counseling expectant mothers who are survivors of sexual abuse and women who have had disappointing birth experiences.

About the Author: Jillian Hanson is a freelance writer and mother living in western Massachusetts.