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What is a doula?
by Lauri Smit, CCE

A doula, also referred to as a labor assistant or monitrice, is a woman trained in labor and birth. She joins a woman early in labor and assists her with pain management including massage, visualization, relaxation, and aromatherapy. She provides encouragement and constant support throughout the entire labor and delivery to both mother AND father. A doula arms the parents with information about medical interventions, including risks and benefits, and allows them to make an informed decision.

There are several benefits of having a doula at your birth. These women have been shown, in published studies, to provide:

  • A 50% reduction in your chance of having a cesarean (1, 2, 3, 4, 12, 13, 14)
  • A 60% reduction in the use of epidural anesthesia and 30% reduction in the use of narcotics (1, 2, 4, 10, 13, 14)
  • A 40% reduction in the use of Pitocin (the synthetic version of oxytocin (1, 4, 12, 13, 14)
  • A 25% reduction in the time of labor (1, 2, 3, 4, 13, 14)
  • A 40% reduction in the use of forceps and vacuum extraction (4)

There is also evidence of:

  • Reduced chances of health complications and hospitalizations of baby (1, 2)
  • Reduced chances of maternal fever and infection (1)
  • Reduced maternal bleeding following birth (3)
  • Increased chances of successful breastfeeding (4, 5, 6, 7, 8)
  • Reduced incidence of post-partum depression (4, 6)
  • Reduced levels of anxiety (4)
  • Found to be superior to Lamaze (9)
  • Result in a more positive birth experience (4, 10, 11)
  • Mothers feel more in control (5, 11)
  • Increased chance of spontaneous vaginal birth (12)
  • Mothers have higher regard and increased sensitivity towards babies (4, 6)
  • Mothers feel more secure (9)

Why should I use a doula?

In order to have a positive birth experience, most women need continuous labor support. Although obstetrical nurses are experienced in dealing with a laboring woman's emotional and physical needs, they can seldom guarantee the support they provide will last throughout the labor - especially in hospital settings where shift changes, coffee breaks, heavy paperwork and busy nights regularly occur. Some OB nurses handle up to six laboring couples at a time. Midwives may be able to offer more labor support, but they too have clinical duties to which they must attend.

The father or partner may be better able to provide continuous support but has little actual experience in dealing with the forces of labor. Even fathers who have had intensive preparation are often surprised at the amount of work involved (more than enough for two people). Even more important, many fathers experience the birth as an emotional journey of their own and find it hard to be objective in such a situation.

Why aren't doulas more widely used?

According to Doulas of North America, one of the biggest obstacles of doulas becoming more of an integral part of the childbirth process, is simply the lack of education among the general population, healthcare professionals, and insurance companies. As people become more aware of the differences that doulas can make, their role will become more and more prominent.

Can I afford a doula?
The cost of a doula can range anywhere from $200 to $800, depending on location. However, price should not be an obstacle. According to Doulas of North America, several insurance companies are already reimbursing for doula services. If your insurance does not cover this service, don't give up there. Make sure that you pursue the matter and bring all of the benefits to their attention. Many of these benefits can save them a significant amount of money.

How can I find a doula?
Doulas of North America (DONA) is an international association of over 3,000 doulas who are trained to provide the highest quality labor support to birthing women and their families. DONA doulas are specially trained and certified by the organization, in order to help insure the quality of the services that their members provide.

To obtain a complete list of doulas in your area, send an e-mail to Referrals@dona.org. For more information about doulas or maybe even becoming one yourself, contact DONA at http://www.dona.org or (801)756-7331

1. Kennell J, Klaus M, McGrath S, Robertson S, Hinkley C. Continuous emotional support during labor in a US hospital. A randomized controlled trial. JAMA May 1, 1991 265:17 2197-201
2. Scott, K.D., Klaus P.H., Klaus M.H. The obstetrical and postpartum benefits of continuous support during childbirth. J Women's Health Gend Based Med, December 8, 1999 1257-64.
3. Wang, D, Mao X, Qian S. Clinical observation on Doula delivery. Chung Hua Fu Chan Ko Tsa Chih November 1997 32:11 659-61.
4. Keenan P. Benefits of massage therapy and use of a doula during labor and childbirth. Altern Ther Health Med Jan 6, 2000 6:66-74.
5. Langer A., Campero L., Garcia C., Reynoso S. Effects of psychosocial support during labor and childbirth on breastfeeding, medical interventions, and mother's wellbeing in a Mexican public hospital: a randomized clinical trial. Br J Obstet Gynaecol Oct 1998 105:10 1056-63.
6. Klaus, M.H., Kennell, J.H. The doula: an essential ingredient of childbirth rediscovered. Acta Paediatr Oct 1997 86:10 1034-6.
7. Raphael, D. Support and variation, the needs of the breastfeeding woman. Acta Paediatr Aug 1989 31:4 369-72.
8. Barron, S.P., Lane H.W. Hannan T.E., Struempler B., Williams J.C. Factors influencing duration of breastfeeding among low-income women. J Am Diet Assoc Dec 1988 88:12 1557-61.
9. Manning-Orenstein G. A birth interventions: the therapeutic effects of Doula support versus Lamaze preparation on first-time mothers' working models of caregiving. Altern Ther Health Med Jul 1998 4:4 73-81.
10. 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 Mar 1999 93:3 422-6.
11. Campero, L, GarcAa C., Daaz 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 Aug 1998 47:3 395-403.
12. Zhang J, Bernasko JW, Leybovich E, Fahs M, Hatch MC. Continuous labor support from labor attendant from primiparous women:a meta analysis. Obstet Gynecol Oct 1996 88:4 pt 2 739-44.
13. Scott KD, Berkowitz G, Klaus M. A comparison of intermittent and continuous support during labor: a meta-analysis. Am J Obstet Gynecol May 1999 180:5 1054-9.
14. Nolan M. Supporting women in labor: the doula's role. Mod Midwife Mar 1995 5:3 12-5.

Lauri Smit is a certified childbirth educator and doula. She lives in Michigan with her husband Jake and 3 young children.

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