The use of doulas in maternity
care has grown with the recognition of their important contribution
to the well-being of mothers and infants. Hospitals worldwide are
striving to provide comprehensive and individualized maternity care,
and doula programs are becoming an important element in this care.
The word "doula" is a Greek
word for a woman who sit beside women in pregnancy and help them
through their birth experience. They provide informational and emotional
support during pregnancy, and "mother the mother" continously
during labor, and provide support during the initial postpartum
period. A doula provides a nurturing birth environment that supports
and encourages women and their partners. Without making decisions
for a birthing woman, a doula offers information so birthing women
can make informed choices.
certified doula receives professional training in the physiology
of birth and the emotional needs of a woman in labor. A doula is
a non-medical professional working in the company of medical professionals.
Her purpose is to provide continous emotional support to help a
woman come as close as she can to the birth she desires, and to
leave her with the best possible feelings about herself and her
Doulas can suggest certain labor positions
and massage techniques to faciliate labor. She can facilitate communication
between the laboring woman, her partner and her clinical care providers.
Doulas can also teach self-hypnosis techniques and also guide women
in hypnosis to help them move away from a "fear-tension-pain"
cycle and to maximize feelings of well-being, safety, and trust
during her birth experience. When this happens, her body and baby
can do the work of labor most efficiently.
A doula works with a woman's
partner during birth. She helps build confidence in the partner
and helps the partner to be as involved in the birth experience
as s/he feels comfortable. And, sometimes, a doula does nothing
at all! In all of our efforts to support women, sometimes all that
is needed the presence of another woman who is compassionate and
encouraging. Simply being with a woman and her partner sounds
so simple, but is something that, more often than not, is left out
of the birthing environment.
Women have complex needs during childbirth and the weeks that follow.
In addition to medical care and the love and companionship provided
by their partners, women need consistent, continuous reassurance,
comfort, encouragement and respect. They need individualized care
based on their circumstances and preferences.
Numerous clinical studies have found that a doulas
presence at birth:
- tends to result in shorter labors with fewer complications
- reduces negative feelings about one's childibrth
- reduces the need for pitocin (a labor-inducing
drug), forceps or vacuum extraction and cesareans
- reduces the mother's request for pain medication
- increases breastfeeding success
- increases partner confidence and maternal satisfaction
The benefits of providing laboring women with continuous
emotional support, physical comfort, and encouragement has been
Given the clear benefits and no known risks associated
with intrapartum support, every effort should be made to ensure
all labouring women receive support, not only from those close
to them but also from specially trained caregivers. This support
should include continuous presence, the provision of hands-on
comfort, and encouragement. Hodnett, E.D. Support from caregivers
during childbirth (Cochrane Review in Cochrane Library, Issue
2. Oxford Update Software, 1998. Updated Quarterly.)
A doula provides support consisting of praise, reassurance,
measures to improve the comfort of the mother, physical contact
such as rubbing the mothers back and holding her hands,
explanation of what is going on during labour and delivery and
a constant friendly presence. Such tasks can also be fulfilled
by a nurse or midwife, but they often need to perform technical/medical
procedures that can distract their attention from the mother (Care
in Normal Birth: a Practical Guide. Report of a Technical Working
Group. World Health Organization, 1996.)