'Labour support is centuries old, but its advantages have now been validated in six controlled studies and its positive benefits should not be overlooked.' John Kennell, Marshall Klaus, Et Al Journal of the American Medical Association 1991
A doula is a woman caregiver. I love the term coined by Dana Raphael, a medical anthropologist, in her 1973 book, 'The Tender Gift - Breastfeeding', and used by Doctors Klaus and Kennel, in their book. 'Mothering the Mother', The kind of support you would want from your own mother; protective, non-judgemental, calm, experienced, warm and knowledgeable. These pioneers can be seen on this video produced by DONA International, the doula training organisation they founded. DONA video
'Doula' has come to mean a woman who gives emotional and practical support to a labouring woman, and who remains with her through birth, and if required, enables her to have the most stress-free environment in which to bond with her baby for up to six weeks after birth. Here is a short preview of an English film about doulas, featuring two local doulas who happen to be my wonderful mentors!
A doula is not a nurse, or a midwife, although, like me, many have been trained as such. The doula's training means that she will be familiar with the process of labour and birth, and with the complications and medical interventions that can accompany it. She is not there to make any medical diagnosis or decisions.
The doula protects and maintains a safe emotional and physical space for the mother and her partner. Her reassuring presence enables mum to let go and surrender herself to the birthing process, safe in the knowledge that she and her partner are protected by a nurturing female companion. By supporting the birthing woman in surrendering herself to her natural hormonal processes in this way, the presence of a doula can make a profound difference to the birth.
The care a doula gives is totally individual; mum and partner if she has one, will meet up with the doula in the weeks before birth to get to know one another. This is a safe space for mum-to-be to share her feelings about the birth, and maybe about previous births - what she wants to do, doesn't want to do, and what she may be fearing. When labour starts the doula can be called as soon as the mum-to-be wants her, and the doula will stay with her for as long as needed.
In the postnatal period, the doula's most useful role is to free the new mother from her daily household tasks so that she may spend precious bonding time with her new baby. This may involve doing everyday jobs such as housework, shopping, cooking, dog-walking, maybe looking after the older children. The doula may mind the baby so that mum can get some much-needed sleep or enjoy a relaxing bath. The doula's training and experience makes her a good listener and she is available if the new mum needs to talk about how the birth was for her, or needs support with breastfeeding.
"All over the world there exists in every society a small group of women who feel themselves strongly attracted to giving care to other women during pregnancy and childbirth. Failure to make use of this group of highly motivated people is regrettable and a sin against the principle of subsidiary." ~ Dr. Kloosterman, Chief of OB/GYN, Univ. of Amsterdam, Holland
Doulaing is not new; women have had female companionship during labour throughout recorded history. The benefits for the mother and baby of having a doula at the birth cannot be over-estimated.
'I've run a number of marathons. I've done a lot of hiking with a heavy backpack, and I've worked for forty hours straight on-call; but going through labour with my wife was more strenuous and exhausting than any of these experiences. We could never have done it without the doula. She was crucial for us.' ~A father.
Below is some of the latest research about doulas
|Cochrane Database Syst Rev. 2011 Feb 16;2:CD003766.Continuous support for women during childbirth.Hodnett ED, Gates S, Hofmeyr GJ, Sakala C, Weston J.|
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario, Canada, M5T 1P8.
BACKGROUND: Historically, women have been attended and supported by other women during labour. However in hospitals worldwide, continuous support during labour has become the exception rather than the routine.
OBJECTIVES: Primary: to assess the effects of continuous, one-to-one intrapartum support compared with usual care. Secondary: to determine whether the effects of continuous support are influenced by: (1) routine practices and policies; (2) the provider's relationship to the hospital and to the woman; and (3) timing of onset.
SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2010).
SELECTION CRITERIA: All published and unpublished randomized controlled trials comparing continuous support during labour with usual care.
DATA COLLECTION AND ANALYSIS: We used standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group. Two authors independently evaluated methodological quality and extracted the data. We sought additional information from the trial authors. We used random-effects analyses for comparisons in which high heterogeneity was present, and we reported results using the risk ratio for categorical data and mean difference for continuous data.
MAIN RESULTS: Twenty-one trials involving 15061 women met inclusion criteria and provided usable outcome data. Results are of random-effects analyses, unless otherwise noted. Women allocated to continuous support were more likely to have a spontaneous vaginal birth (RR 1.08, 95% CI 1.04 to 1.12) and less likely to have intrapartum analgesia (RR 0.90, 95% CI 0.84 to 0.97) or to report dissatisfaction (RR 0.69, 95% CI 0.59 to 0.79). In addition their labours were shorter (mean difference -0.58 hours, 95% CI -0.86 to -0.30), they were less likely to have a caesarean (RR 0.79, 95% CI 0.67 to 0.92) or [COLOR="#ff8c00"]instrumental vaginal birth[/color] (fixed-effect, RR 0.90, 95% CI 0.84 to 0.96), [COLOR="#ff8c00"]regional analgesia[/color] (RR 0.93, 95% CI 0.88 to 0.99), or a baby with a low 5-minute Apgar score (fixed-effect, RR 0.70, 95% CI 0.50 to 0.96). There was no apparent impact on other intrapartum interventions, maternal or neonatal complications, or on breastfeeding. Subgroup analyses suggested that continuous support was most effective when provided by a woman who was neither part of the hospital staffnor the woman's social network, and in settings in which epidural analgesia was not routinely available. No conclusions could be drawn about the timing of onset of continuous support.l women should have support throughout labour and birth.
The power and intensity of your contractions cannot be stronger than you, because it is you.~ Unknown