Blog: Doulas help mothers through a labor of love

Last weekend, I attended a birth doula workshop in the beautiful Kalihi Valley. Located on a 100 acre piece of land with vegetable gardens and medicinal Hawaiian plants, the three-day workshop was attended by approximately 12 women and one man, all with different reasons and inspirations for being there: bad experiences with epidurals, highly enjoyable births, the desire to incorporate men into the birth process, and the intent to mix traditional Hawaiian birthing methods with modern, natural birthing methods. The teacher was a neonatal nurse and doula for 30 years, and a very knowledgeable woman whose goal was to lessen the amount of unnecessary medical interventions during labor. 

So what is a doula? The Doulas of North America (DONA), the largest doula association in the world, says that the word “doula” comes from ancient Greek meaning “a woman who serves,” and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during, and just after birth. Doulas are often confused with midwives, but they provide different services. While the doula supports and cares for the laboring mother, the midwife provides medical care and delivery—she catches the baby and the doula does not.

DONA states that a birth doula:

- Recognizes birth as a key experience the mother will remember all her life.
- Understands the physiology of birth and the emotional needs of a woman in labor.
- Assists the woman in preparing for and carrying out her plans for birth.
- Stays with the woman throughout the labor, provides emotional support.
- Physical comfort measures and an objective viewpoint.
- Helps the woman get the information she needs to make informed decisions.
- Facilitates communication between the laboring woman, her partner, and her clinical care providers.
- Perceives her role as nurturing and protecting the woman’s memory of the birth experience.
- Allows the woman’s partner to participate at his/her comfort level.

I’ve heard women wonder if doulas really help or make a difference. A friend of mine was told by her doctor that she didn’t need a doula because she had a doctor. But doulas do make a difference. Numerous studies have shown that when doulas attend births, labors are around 25 percent shorter, cesarians are reduced by around 50 percent, epidural requests by 60 percent, 30 percent reduction in analgesia use, and a 40 percent reduction in forceps delivery. Women experience fewer overall complications, babies are healthier and they breastfeed more easily. The attendance of a doula at birth is also known to reduce negative feelings about the childbirth experience and reduces the need for labor induction.

Of course, all of these things can serve their purpose and be of help when they are needed, but unfortunately, many of these are performed when they are far from necessary. A doula who has attended births on Oahu for 20 years told me recently, “They are done for the money. The hospitals make a lot more money when a woman has a C-section, or is doped up on drugs. Any medical makes money for the hospital while natural birthing techniques, whether it be physical or mental, is free.”

This doula could be right. According to Penny Simkin, leading doula, cesarians are the most commonly performed surgery in the United States and the rate is about 1 in 3, or about 1.3 million cesarian births each year. However, the World Health Organization (WHO) states that no region in the world is justified in having a cesarean rate greater than 10 to 15 percent. If doulas can reduce the rate of these by around half naturally, having a doula sounds pretty helpful.

To help a mother have a minimal intervention birth, a doula’s bag of tricks include a birthing ball, a rebozo (a piece of fabric used for positioning and pain relief for the mother), a TENS unit, massage techniques, and good ol’ positive thinking, among other things. “I love it. It’s not a profession that is going to make me rich, but I love each and every birth. I couldn’t imagine a more exciting and fulfilling job,” the long time Oahu doula told me.

The rate of doula use is growing. A doula told me over the weekend that the Oahu doula referral line is “ringing off the hook with calls of women looking for doulas.” If you’re interested in more information, check out Hawaiichildbirthprofessionals.com.