The Purpose and Value of Labor Support

The birthing woman surely is a force to be reckoned with. The experience of birth is no less than a body, heart, mind, and soul exerting marathon. And the doula is much like the coach, running on the sidelines after months of preparing and conditioning the athlete; the water boy, dishing out cups of nourishment at stations and check in points; she is the crowd, cheering with inexhaustible lungs along the route; and she is the adoring family and friends, to cry with and exult in the victory at the finish line. A contradiction of sorts, birth exposes the woman in labor in all her vulnerability and neediness, incidentally, where she is at her weakest is when she shines in all her courage and strength. Birth is the final stage of her preparation for motherhood. The doula is a companion who champions this woman’s journey of becoming. 

In incredibly practical ways, the doula’s purpose is one of servanthood. Trained in the art of self-sacrifice, the doula avails herself to the expectant mother. As stated in the DONA International Standard of Practices, “The doula accompanies the woman in labor, provides emotional and physical support, suggests comfort measures, and provides support and suggestions for the partner.” Practically speaking, the Birth Doula helps to prepare the birthing woman and her partner for the birth experience. She informs clients of typical occurrences and procedures which to expect during labor, birth and postpartum, and she equips them with knowledge of comfort measures, relaxation and breathing techniques, and labor positions. She is hands on as much as is necessary throughout the entire birth process. The doula guides the woman's mind to submit to what her body instinctively knows how to do. The doula offers endless comfort and praise with words and touch, and at times, even silence. The doula also prepares the mother for postpartum with basic lactation education, infant care, and self care. She also assists with breastfeeding and refers the family to community resources when necessary.

It is said that, “doulas are knowledgeable allies of expectant mothers.” This is unequivocally true.  Oftentimes a woman in labor cannot articulate what she wants or needs—the doula is intuitive—somehow knowing what to do to care for the woman at any given moment, or knowing when, what, and how to ask with laser precision—to find out what would best meet her needs.  Any offensive word or tone that could come her way in the beautiful messiness that is labor, the doula let's roll off her back as it is often, not a personal attack on her. 

Since the welfare of the client is of utmost importance, the doula is mindful of personality dynamics during client interviews—making sure that the client/doula partnership is the best fit for the client. Since the doula and clients meet prenatally in the comfort of the clients’ home, the doula builds a rapport with each client, one that develops trust and sets the tone for healthy and clear communication. The doula’s every interaction with the expectant mother must be of respect and honor, one that reminds her how powerful and courageous she is, one that calls her to surrender and embrace the birth process.

In a bodyguard-like way, the doula protects the birth environment as much as possible from invasion of stress-inducing factors such as bright lights, loud and talkative bystanders, controlling mother-in-laws, etc. As a guard of the birthing space, the doula seeks to maintain a sense of privacy, intimacy, and emotional and mental serenity for the birthing woman.

Having a birth doula can also alleviate some of the stress that the partner can feel, especially when it is their first time supporting their partner in labor. There is a sense of safety that comes with knowing that there is a professional— who feels closer than the hospital staff—and who is committed to continuous labor support from begin to end, guidance and nurturing, and whose number one focus is the mind and heart of his beloved partner.

A doula is not a medical professional in the sense that it is not in her scope of practice to provide any clinical procedures for the client. Referring to the DONA International Standards of Practice, “The DONA certified or member doula does not perform clinical or medical tasks, such as taking blood pressure or temperature, fetal heart tone checks, vaginal examinations or postpartum clinical care.”

The doula does not take the place of a partner. She must always be sensitive to respecting the expressed preferences of both the client and her partner as it relates to his or her involvement. In most cases it means that the doula is aware of where the partner is—emotionally and physically—and inspires them, influences them, and encourages the partner to participate, supporting them in ways that he or she can support the birthing woman. This of course, orients the prioritization of the family unit, as the partner’s participation and inclusion does in fact shape a positive experience for the mother.

The doula does not impose her own desires or preferences on the birthing woman’s decisions, nor does the doula treat the client differently based upon the client’s decisions before, during, and after birth. The most important factor that influences the doula’s every interaction with the client is doing what supports the client’s expressed desires. If the doula is unsure in a given circumstance, her role is, learn it and support it. DONA International calls this, Primacy of Client Interests. 

A doula is a protector and cheerleader of the laboring woman’s preferences. 

The doula is responsible to guide her with prenatal interactions that help to set a groundwork for confident, self-advocacy. This prepares the clients to speak for themselves. According to the DONA International Birth Doula Code of Ethics, “The doula should make every effort to foster maximum self-determination on the part of his/her client.” For example, if during a hospital birth, labor stalls at 5cm for several hours, and the attending physician suggests an induction against the preference of the birthing woman, the doula has already prepared the client with a list of informed consent questions that the client can then employ to better understand why they are suggesting an induction. The client can also be prepared with a response of, “can we have some time to discuss and consider in private?” At this point the doula can inform the client with any missing information and or statistics and then be a bouncing board for the client to process her decision. Finally, the doula can champion her for whatever decision she makes and inspire her to speak up for herself with confidence. 

In recent years, research results have become available that speak to the benefits of doula care.  According to Americanpregnancy.org, studies have shown that, “having a doula as a member of the birth team decreases the overall cesarean rate by 50%, the length of labor by 25%, the use of oxytocin by 40%, and requests for an epidural by 60%.” Additionally, according to Evidence Based Birth, “when a doula was present and provided continuous delivery support, mothers experienced: a 31% decrease in the use of Pitocin, 28% decrease in the risk of C-section, 12% increase in the likelihood of a spontaneous vaginal birth, 9% decrease in the use of any medications for pain relief, 14% decrease in the risk of newborns being admitted to a special care nursery, 34% decrease in the risk of being dissatisfied with the birth experience.” As evidence supports, favorable outcomes in births increase with the care and tending of a doula. In all truth, the doula does not do anything that deserves credit for birthing a baby by any standard, her involvement is more like clearing the path and setting the atmosphere, so that the birthing woman is free to inhabit a space where she can tap into the powerful woman within.