The Role of a Doula

by Wanda Sundermann

Most pregnant women today will at some time be asked if they are planning to have a doula at her birth. For many this will be the first time she has ever heard the word “doula”, a Greek word meaning “woman who serves”.  In today’s birth culture, a doula is a birth attendant who gives physical and emotional support to a woman in labor and her partner. The doula is most often a woman, so I will use the pronoun “she” but recognize that there are a few male doulas out there in the world.  There is no licensure or required training for doulas. Most of them learn their craft by attending workshops and many births. Some doulas are just getting started and some have attended hundreds of births.

When considering whether to have a doula at your birth it is important to understand what a doula’s role would be.

A doula will usually meet with a woman and her partner at least once before the birth. The doula is available for consultation by phone or in person to answer questions or concerns that the mother may have about her pregnancy and care. The doula does not give medical advice, but can often explain conditions or procedures that the woman may not understand. 

When the woman thinks she might be in labor, the doula will talk with her on the phone to offer suggestions of what the couple can do in the very early stage of labor to either move labor along or rest and prepare for it.  When the couple is ready for more support the doula will come to their home and help them stay at home as long as possible. This is a key component in a plan for natural childbirth. In the early stage of labor the woman is very susceptible to disruptions that can slow labor. She is the most comfortable in her own home and will make more progress there.

When the doula arrives at the couple’s home she will assess the situation. Doulas do not do clinical assessments such as cervical checks, listen to fetal heart tones or take vital signs. Rather she will observe how frequent and strong the contractions are, how the mother is handling them and ask the mother how the baby is moving. Depending on what is happening, they may stay at the home for minutes or several hours. Having a doula there will usually give the couple the confidence to stay at home longer than they normally would by reassuring them that what is happening is normal and that there is still plenty of time.

While at home the doula will suggest comfortable positions for the mother and help her find ways to progress the labor. She will also remind the mother to eat, drink and empty her bladder, and offer suggestions on how to get some rest if she has been in labor a long time. The doula may use massage, give soft soothing affirmations and encouragement, perhaps suggest a bath or shower, and remind the mother to stay focused on her breathing. If the couple has been laboring a long time already, the doula may need to give the woman’s partner a break to get some food and rest. The doula will also be helpful with the logistics of transition from home to hospital or birth center.

The transition from home to hospital or birth center can be difficult for women and the doula can be a bridge for that. A doula, who has worked in that particular birthing facility can help the couple settle in, knowing what to ask for from the staff to smoothly transition to the new setting. At the hospital or birth center the doula will continue to offer the comfort measures used at home. She is also a guide and advocate for the woman and her partner. Because she works for them and not the institution her only agenda is to serve their needs. She can help them navigate the unknown territory of labor and birth.  She can give them both the reassurance that what is happening is normal and good, or in situations when labor takes a turn from normal she can help them sort through the information they are being giving by their care provider. The doula is there to help the parents get the information they need to make the decision that is right for them and their baby given the labor they have on that day.

The doula is also support for the partner, giving ideas and guidance on how to support the mother. Having a doula at the birth takes the pressure off of the partner to remember and properly implement everything he/she read in books or learned in childbirth class and frees him/her to experience the process without having to be the sole support.  In most situations the partners actually feel more involved in the birth with a doula there giving suggestions on how to support the mother.

In most cases the doula will stay with the family throughout the labor process, for the birth of the baby and usually for an hour or two after the birth. And then the doula will do at least one follow up visit with the family after they get home.

An article summarizing the study Continuous Support For Women During Childbirth review  from Cochrane Library in 2011, issue 2, www.ChildbirthConnections.com reported that overall, women who received continuous support during labor were less likely than women who did not to:

-have any analgesia/anesthesia,

-give birth with vacuum extraction or forceps,

-give birth by cesarean,

-have a baby with a low 5-minute Apgar score,

-or report dissatisfaction or a negative rating of their experience.

And women receiving continuous support were more likely than those who did not to give birth spontaneously (that is, with neither cesarean nor vacuum extraction nor forceps) and have a shorter labor.

The decision to have a doula at your birth is a big one. It involves inviting someone you have just met to be involved in a very intimate and transformative time in your life. It is important that you feel good about that person. To find a doula in your area, ask friends, midwives, childbirth educators and other health care providers for recommendations. Talk with her on the phone, ask lots of questions. A dear friend or family member or a doula in training can also fill the role. Although they will not have the experience, they can be a huge support if you are unable to secure a professional doula.

Wanda Sundermann NCMBT #713, is a professional doula with 23 years of experience helping moms, dads, and babies in the triangle area. She is also a licensed massage therapist specializing in prenatal and postnatal massage and a childbirth educator teaching classes at the Women’s Birth and Wellness Center in Chapel Hill.  She is the mother of two fine young men.

For information go to www.wandaswork.com .

This article was originally written for

www.chapelhillmothersclub.org 

Wanda Sundermann offers a four-week, Saturday morning childbirth education class, 9:00 to 1:00 at the WBWC. The classes cover massage for moms, the normal birth process, common complications, labor support techniques for partners, deep relaxation, breastfeeding, adjusting to life with a newborn and newborn massage, among other things.

If you would like to learn more about these classes please contact Wanda at wandasund@gmail.com or www.wandaswork.com

Upcoming classes are:

March 23, 30, April 6 and 13

June 1, 8, 15 and 22

August 3. 10, 17 and 24