What is a doula? And what can she do for me?


            A doula is a trained childbirth companion. She is informed, respectful, and kind. A mother and a doula have the most intimate relationship two people can form in 8 hours. But this relationship begins months before a woman’s first contraction. By spending time with a woman and learning everything she can about her, the doula becomes an extension of the woman’s needs. She can guide the woman through the decisions she faces in childbirth by using the woman’s own words and thoughts. She can limit the interventions needed in her labor, facilitate the mother-partner interaction in labor, and potentially affect the new family for life.


            In the course of a normal hospital birth, approximately 12 hours in the hospital before baby is born, the nurses have as little as 10 minutes per hour to spend with a laboring couple and the doctor or midwife will only be called when the birth of the baby is imminent and will remain for the repair of a woman's perineum. That means that a couple spends the vast majority the time completely alone in a hospital room with machines that make noise and with a labor that changes from minute to minute during normal progress. It is then that a doula serves a couple best. A doula is a coach, a coach's coach, a space-keeper, a light dimmer, a water fetcher, a sleep encourager, a masseur, a clock-watcher, a patience creator, a walking talking self-indexed birth book, and a mirror of your pre-labor self. During delivery the doula is again a coach, an encourager, and a space-maker.


            Being attended by a doula has been shown to reduce the use of medical interventions in labor. The use of a doula during labor and delivery can result in a 50% reduction in the cesarean rate, 25% shorter labor, 40% reduction of forceps or vacuum delivery, 40% reduction of pitocin use, and a 50% decrease in epidural requests. But there is something that a doula does that is even more amazing and lasting than all of that. A doula has been shown to improve the mother’s and her partner’s satisfaction with the birth experience and this has been shown to improve initial bonding and care of the infant. Mothers who reported satisfaction with their birth experience also described their infants as smarter, calmer and more attractive. These mothers were more attentive to their infants’ needs. They were more confident in their own ability to care for their infant.


            So how does a doula improve birth outcomes when she cannot perform vaginal examinations, check blood pressure, temperature, or fetal heart tone? She is present. From early in labor through those precious early hours, the doula is present, watchful and reassuring. She encourages activity in early labor, she helps the mother communicate her needs to her partner and her care providers, she offers positions and massage as the labor intensifies. And when things get really tough, just her calm presence is often enough to allow the new parents-to-be space to be calm too. As choices are offered, the doula can be the mother’s reminder of her goal and her plan. She can also be the permission to veer when a mother is overwhelmed.


            When I first started out as a doula, I spent a lot of time planning what I would carry in my birth bag. I made lists, I researched what other doulas carried; I felt that the value of my presence was inextricably linked to the tools I had at hand. Here I am, years into my work as a doula and the greatest lesson I’ve learned is that my value in the birth room is me, not my tools. I have attended births where my bag comes in, finds a corner, and is not touched again until I’m gathering my things to leave the new family in peace, and I feel no less of a doula for it. The purpose of a doula is not to have the latest massage roller or clever heating sock. The value of a doula has nothing to do with how many peanut butter sandwiches she packed before heading out the door. The value and purpose of a doula is in her arms and in her heart.