To be a doula, one must serve. After all the word doula is Greek for “woman who serves”. The doula serves pregnant, birthing, and postpartum families in many ways. They provide knowledge that can be used to achieve desired birth results. They provide unconditional support through the hardest parts of this often uncharted journey for the family. The challenges, the unforeseen, the misunderstood, and the pain in all of its possible forms do not have to be faced alone. The doula is in your corner every step of the way. That is what labor support is. Doulas want to make the birthing and postpartum families experience as joyful and perfect as possible. Doulas want to do whatever it takes, ethically and responsibly, to help these families achieve their goals, and play the necessary roles to get them there. A doula gives birthing families the freedom to trust their instincts and inner wisdom, and to birth without fear.
If we look back through time we can see that women have gathered in support of a woman and her family during the time of labor, delivery and postpartum. These close knit groups have the ability to serve one another with the true meaning of agape and joy for the new life. According to DONA’s Position Paper: The Birth Doula’s Contribution to Modern Maternity Care, the element of emotional support provided to the mother during labor, birth and right after the birth is a significant component to the emotional bond between the mother and the baby. Additionally, women who are able to receive that kind of emotional care and physical comfort throughout the birthing process have a tendency to improve their obstetric outcomes. When a doula is able to meet a woman and her family where they are throughout the birth process, outcomes of negative feelings can be turned into positive ones. In the Science Daily article, Doula Support during Labor Reduces Cesarean Rates and Epidurals,a survey was performed with women who had continuous support from a doula measuring the benefits, specifically with middle and upper class women. The support the ladies received from a doula during the study were: physical closeness; touching; eye contact with the laboring mom; guiding; reassuring and encouraging the mom and her significant other during the birth. Over a five year period they took 420 pregnant women in their 3rd trimester and provided a doula to accompany 224 of the pregnant moms, while 196 women did not get such support. They found that, with the mothers who received doula support, the rate for cesarean deliveries were lowered by 12%, women getting an epidural dropped by 11%, and the women that were induced had a 46% decrease for a cesarean birth when compared to the women who did not have a doula. The article also mentioned that the 196 “did not receive this intervention” indicating that there can be a positive side to the word “intervention”. The purpose behind providing labor support is to improve the outcome throughout the birth process. The doula is able to provide professional knowledge about the birth process, thus being able to provide educational information that will further help a laboring mother to make informed decisions about the care she is receiving during labor and delivery.
The doula’s responsibilities should be the driving force for the doula to provide the best care to a woman and her family. In the DONA Position Paper it is stated that the way the doula and partner work together is a very important part of the doula’s responsibility allowing for optimal care of the mother. The doula should be a helper to the partner and not overshadow the couple’s birth experience. In the Position Paper the doula is a member of the maternity care team and they should help provide the nonmedical needs of the woman. They should help with communication between the couple and the staff. The DONA Code of Ethics gives the doula a clear picture of what the responsibilities are to the Clients, Colleagues, Birth Doula Profession and Society. The client is the primary responsibility of the doula. The doula should help provide the self-assurance the client needs through labor and delivery. It is important to create a safe place for the client to be able to share things in confidence. As the meaning of the word doula means “to serve”, we need to provide any woman looking for labor support with appropriate referrals if we are unable to serve them. Doulas need to make sure that they fulfill any commitments made with a client or have appropriate backup depending on the situation. When fees are being setup they need to be fair, reasonable and considerate for any potential clients. The doula needs to be clear on their fee and what services will be provided to the client for that fee. It is important to treat our peers with respect, kindness fairness and good faith. The doula’s responsibility to the Labor Support Profession should show the mission of the profession by maintaining the values and ethics of the group. Keeping in mind that the DONA International vision is “A Doula For Every Woman Who Wants One”, one way to achieve this is to provide low cost or no cost services, when able, to families who want a doula but are unable to afford one. Above all, the doula’s responsibility is to encourage in favor of health for moms, their babies, their family and friends.
The doula’s role is to provide comfort, care, and encouragement throughout the labor, birth, and after the birth. DONA’s Standards of Practice outline the services to be provided by the doula. The doula stays with the laboring mother and will try relaxation, help with moving and positioning her body during labor, provide comfort measures, and use touch while the mother is in labor. The doula provides a calming presence to the laboring mom, partner, and other support. The doula should provide presence and knowledge to the woman and her partner both before and after the baby is born. Utilizing the knowledge the doula has in regards to childbirth should empower the mom and her partner to make informed, practical decisions about the birth. One very important role as a doula is to inform the parents of their choices but it is their responsibility to never make the decisions for or prescribe medical treatment to the client. The doula’s role should never include anything that is out of the scope of practice defined by the Limits to Practice in the Standards of Practice. This would include vaginal exams, blood pressure checks, fetal heart tones and postpartum clinical care, as well as any other practice normally performed by a health care professional. The doula should continue to provide emotional and physical support throughout the pregnancy, labor, delivery, and postpartum. The doula should support the client’s wishes expressed in her birth plan. The doula should discuss with the mom her desires for the birth and educate her on achieving those desires, including making her aware of any risks and/or hurdles involved. The doula will encourage the mother and her partner to speak with her health care provider in regards to the client’s desires prior to birth. While the doula is an advocate for the mom she should not make decisions for the couple or speak in place of the woman or her partner. The doula should provide a quiet presence, allowing for birth to work in its most natural form.
In closing, the benefits of labor support to the mother and her family are an important part of the way that a mom is left feeling after the birth of her baby and the special bond that is formed during that time. The purpose behind providing labor support to the laboring mom and her partner is that it helps provide them the knowledge and empowerment they need to successfully complete the journey of labor and delivery and increases the likelihood of a positive birth experience. The doula’s responsibilities encompass the true meaning of the word doula. It is a woman who serves a family by sharing words of encouragement, concern for the woman and her partner and compassion towards a couple embarking on a great journey. The role of a doula can improve the medical outcomes when the needs of the mother are met throughout labor and delivery. A doula gives birthing families the freedom to trust their instincts and inner wisdom, and to birth without fear.
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