The website Evidence Based Birth recently published an informative and research-based article on Doulas; what we do, what we don't do and why you should consider hiring one for your birth. I've summarised the core points of the article for you in this blog post.
A doula can provide labor support via the four pillars of labor support. In the textbook Best Practices in Midwifery, the author describes three pillars of labor support as emotional support, physical support, and advocacy. In the book Optimal Care in Childbirth, informational support is also listed as a pillar of support.
Physical support is important because it helps the birthing person maintain a sense of control, comfort, and confidence. Aspects of physical support provided by a doula may include:
Soothing with touch through the use of massage, counter pressure, or a rebozo
Helping to create a calm environment, like dimming lights and arranging curtains
Assisting with water therapy (shower, tub)
Applying warmth or cold
Assisting the birthing person in walking to and from the bathroom
Giving ice chips, food, and drinks
Emotional support helps the birthing person feel cared for and feel a sense of pride and empowerment after birth. One of the doula’s primary goals is to care for the mother’s emotional health and enhance her ability to have positive birth memories (Gilland, 2010b). Doulas may provide the following types of emotional support to the birthing person and their partner:
Helping the birthing person see themselves or their situation more positively
Showing a caring attitude
Mirroring—calmly describing what the birthing person is experiencing and echoing back the same feelings and intensity
Accepting what the birthing person wants
Helping the birthing person and partner work through fears and self-doubt
Debriefing after the birth—listening to the mother with empathy
Informational support helps keep the birthing person and their partner informed about what’s going on with the course of labor, as well as provides them with access to evidence-based information about birth options. Aspects of informational support include:
Guiding the birthing person and their partner through labor
Suggesting techniques in labor, such as breathing, relaxation techniques, movement, and positioning (positioning is important both with and without epidurals)
Helping them find evidence-based information about different options in pregnancy and childbirth
Helping explain medical procedures before or as they occur
Helping the partner understand what’s going on with their loved one’s labor (for example, interpreting the different sounds the birthing person makes)
Advocacy is a pillar of support that is considered controversial by some for two reasons: first, the word advocacy has several meanings and definitions, and second, doulas differ on their beliefs about whether or not advocacy is part of their role.
So what is the bottom line?
Of all the ways birth outcomes could be improved, continuous labor support seems like one of the most important and basic needs for birthing people. Providing labor support to birthing people is both risk-free and highly effective. Evidence shows that continuous support can significantly decrease the risk of Cesareans, NICU admissions, Pitocin, and medications for pain relief. Labor support also increases satisfaction and the chance of a spontaneous vaginal birth. Although continuous support can also be offered by birth partners, midwives, nurses, or even some physicians, research has shown that with some outcomes, doulas have a stronger effect than other types of support persons. As such, doulas should be viewed by both parents and providers as a valuable, evidence-based member of the birth care team.