A Doula Makes the Difference!

Karen Nugent
Issue 87, March/April 1998

We couldn't have done it without our doula!

Despite difficulties encountered during an arduous 96-hour labor, my husband Paul and I cherish the birth day of our first child.

We were fortunate to have a doula who provided continuous emotional and physical support, and worked as our advocate to complement the midwife's medical expertise. This personalized labor assistance enabled us to achieve our childbirth goals, which included birth without medication or other unnecessary medical intervention. We couldn't have labored alone as successfully.

The doula made the difference.

Doula is a greek word meaning "woman helping woman." Dana Raphael first coined the term in her book The Tender Gift, which underscores the fact that women need women to assist in childbirth and to provide continued emotional support and guidance throughout the joyous and turbulent postpartum time. A doula, by definition, is present to serve. She helps a woman integrate the day she will never forget.

"Labor support is Centuries old, but its advantages have now been validated in six controlled studies, and its positive benefits should not be overlooked," says neonatologist Marshall H. Klaus, MD, adjunct professor of pediatrics at the University of California and director of academic affairs at Children's Hospital in Oakland.

According to research conducted by Klaus and his partner, John H. Kennell, MD, professor of pediatrics at Case Western Reserve University School of Medicine, the presence of a doula during the laboring process reduces the need for a cesarean by 50 percent, length of labor by 25 percent, use of oxytocin by 40 percent, use of pain medication by 30 percent, the need for forceps by 40 percent, and requests for epidurals by 60 percent. Comparable research studies on the effect of doula support have been analyzed by precise statistical methods and published in the Journal of the American Medical Association and the New England Journal of Medicine.

Along with the psychological and physical benefits of labor support, there are significant financial advantages. Klaus and Kennell report that births assisted by doulas could mean a $3,500 savings for individual families, and therefore reflect a $2 billion annual reduction in national medical care costs associated with labor and delivery. And no one can put a price on a woman's birth memories.

In recounting the success of our doula-assisted birth with family and friends, we discovered that few people truly understand the affirming advantages associated with a doula's services. Many wonder how a doula enhances the laboring woman's process when she already has a partner present who has attended childbirth education classes and a midwife or doctor attending the birth. Some fear that the doula will interfere with the couple's intimate experience or conflict with medical assistance.

However, more frequently than not, adequate emotional nurturing for the laboring woman is not routinely provided by mainstream medical caregivers. Doctors have separate concerns requiring medical expertise that take precedence over providing constant emotional support. As a result, women are too often encouraged to accept induction of labor, epidural pain relief, episiotomy, or other unnecessary medical intervention "to speed labor along," rather than offered encouragement to value their own inherent process and power to give birth naturally.

We located our doula, Lori, through a birthing center. I was aware of Doulas of North America and found out that she is a member, so I telephoned her to see if we were "a match" before Paul and I met with her in person. From our first conversation, I knew that she would be the one to help us through our big event. She provided us with specific information regarding her services, along with a portfolio containing a job description and a contract outlining our agreement for services and fees. The contract included unlimited prenatal consultations, early labor and delivery support, transportation to the birth site, continuous care until two hours postbirth, lactation assistance, and postpartum care. The orientation packet also contained information on nonmedical support techniques for labor and birth, inducing exercise, acupressure, massage, aromatherapy, herbal therapy, color therapy, and use of a birthing ball--a large gymnastic ball for sitting or rocking. This was my favorite birthing tool, as it helped immensely with the incredible back labor I endured.

A three-hour consultation with Lori and her partner followed this first meeting. We discussed my needs for labor support and began to formulate a birth plan that, when complete, would be duplicated and distributed to any medical personnel we would potentially come in contact with at the birth. Having this plan in hand would enable us to focus on the birth, rather than having to be concerned about conveying our wishes to people we hadn't met. This became one of our most beneficial exercises, especially when we unexpectedly found ourselves in the hospital on the night before the birth.