The Value of Labor Support
Women have been supporting other women through birth since the dawn of our species. This support is essential to positive outcomes and positive experiences for mothers and babies. Historically, support could come in the form of mothers, mothers-in-law, sisters, aunts, or other trusted women. Today, professional doulas are another option for unbiased support. Doulas Provide five facets of support including physical, emotional, informational, advocacy, and partner reinforcement. Within each facet, many layers of value can be found.
1. Physical
Doulas increase physical satisfaction and outcomes in birth both in terms of pain management and interventions.
Doulas are trained in providing comfort measures such as massage, acupressure, soothing touch, calming words, and visualization which help to relieve the body of pain during both through physical manipulation and reduction in stress hormones linked to pain responses.
Another pain relief that works exceptionally well is reframing the feelings of birth from a perspective of pain to one of sensation, waves, or pressure.
These techniques combined work so well that birthing people who utilize doula support have
14% less use of epidurals (McGrath and Kennel, 2008)
31% less use of Pitocin (Hodnett et al., 2003)
41% less forceps delivery (Hodnett et al., 2003)
2. Emotional
Doulas help birthing people navigate the complex feelings that arise during the deeply intimate and life-changing experience of birth.
Birthing people who have doula support experience a 34% decrease in negative feelings and recollections after birth (Hodnett et al., 2003).
There are two aspects to the emotional support doulas provide.
They are the only person there solely to support the birthing person. The medical provider is tasked with caring for the medical needs of the birthing person and the baby. The birth partner is concerned with the outcomes of the birthing person and the baby. The doula, however, is only there to make sure the birthing person feels supported.
Continuity of care. Most people will birth in hospitals where doctors and midwives have shifts, vacations, and other patients. They cannot be continuously available to the birthing person in labor, nor is it guaranteed that their provider will be available for their birth. Meaning, they could have a complete stranger in the room with them during the most vulnerable moment of their lives. The doula provides a comforting familiar face whom they trust.
3. Partner Reinforcement
Doulas help partners to rest, nourish themselves, and take care of their basic needs so that they can give 100% of themselves in support of the birthing person.
The Doula Book by Klaus et al. drafts the perfect analogy for first time birth partners: “it’s like asking the father to play a professional football game without practice after watching a few lectures”. First time birth partners are untrained and totally new to being a support person in this way. They are also highly emotionally invested in the situation. Expecting them to be the sole support is extremely high pressure and has been known to trigger feelings of fear, loneliness, or past trauma (Klaus et al., 2002).
In addition, they may not always know about the hospital policies or procedures to be able to provide full informational support. In fact, most partners feel grateful to have had the support and relief of the doula during labor and birth (Klaus et al., 2002).
4. Informational
Doulas educate the birthing person on the processes of pregnancy, labor, postpartum, breastfeeding, and infant care.
Research shows that the more birthing people are educated on what to expect during birth, the more comfortable and prepared they feel. This leads to more confidence in birthing and decision making.
5. Self-Advocacy
Doulas also use this informational support to teach birthing people how to stand firm in their decisions and advocate for themselves. This creates an important piece of the positive birth experience puzzle: informed consent.
Informed consent is when the birthing person is informed on all options, benefits and risks, can ask questions, makes a decision, and the decision is respected. Informed consent then leads to more power and less feelings of vulnerability in birth. Ultimately, when the birthing person feels respected, their birth has a better outcome.
These outcomes include:
25% shorter labor (McGrath and Kennel, 2008)
22% less chance of preterm birth (Kozhimmanil et al., 2016)
28% reduction in cesarean birth (McGrath and Kennel, 2008; Kozhimmanil et al., 2016)
Higher birth weight, less time in the hospital, and higher rates of breastfeeding (Hodnett et al., 2003)
References
Hodnett , E D. , Gates, S , Hofmeyr , G J. , & Sakala ,C . ( 2013 ). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews , Issue 7. Art. No.: CD003766. Pub 5.
Kozhimannil KB, Hardeman RR, Alarid-Escudero F, Vogelsang CA, Blauer-Peterson C, Howell EA. (2016). Modeling the Cost-Effectiveness of Doula Care Associated with Reductions in Preterm Birth and Cesarean Delivery. Birth 43(1):20-7.
Klaus, M.H.; Kennell, J.H.; Klaus, P.H. (2002). Mothering the Mother: How a doula can help you have a shorter, easier and healthier birth. Addison Wesley Publishing Company.
McGrath, S.K. and Kennell, J. (2008). A Randomized Controlled Trial of Continuous Labor Support for Middle-Class Couples: Effect on Cesarean Delivery Rates. Birth, 35 (2):92-7.
