Advantages of Having a Doula

In an article in the Pediatrics: A Journal of the American Academy of Pediatrics, it is stated that "At the present time, the demands on labor and delivery nurses are so great that they can spend less that 10% of their time providing supportive services.  By adding continuous doula support in six random, controlled trials , there were reductions in cesarean deliveries by 50%, use of forceps by 40%, and requests for epidural analgesia by 60%, and a 25% decrease in labor length.  This study showed the value of doula support for all mothers whether laboring alone or with a partner." 

Interestingly enough, in the same study, having a doula provided a significant positive impact on the mother-child bond.

     The long-term advantages of doula support during labor may be even greater for the baby, as 

demonstrated in 2 studies that examined changes in mother-infant interaction following doula support. Investigators in Johannesburg observed the psychological health of the women and infants in both the control and supported groups 6 weeks after delivery.1,10 There were favorable effects of doula support on the subsequent psychological health of the women and infants. At 6 weeks there were impressive postpartum behavioral differences: a significantly greater proportion of doula-group women were breastfeeding (51% compared with 29%), and the doula-group women were significantly less anxious, had lower scores on a test of depression, and had higher levels of self-esteem. These maternal qualities would be favorable for the development of the infants. Not only did the supported mothers show more positive behaviors with their babies, but they more often rated their babies as better than a standard baby, more beautiful, more clever, and easier to manage than did the control mothers, who perceived their babies as slightly less beautiful and clever than a standard infant.

"Many women are aware of the improved clinical outcomes for both mother and baby associated with doula care during labor and delivery (Table 1)." (Ann Fulcher, CLE, CD)

TABLE 1. Benefits of Doula Care

Randomized, controlled trials assessing the role of the doula demonstrate benefits in the following outcome

measures:

• Shorter labors
• Reduced need for pain medication
• Fewer episiotomies
• Fewer operative vaginal deliveries
• Fewer cesarean sections
• Improved neonatal outcomes
• Better mother-infant interaction
• Improved breastfeeding rates
• Greater maternal satisfaction

After reading this article, as well as hearing it in my training and experiencing it first hand, it's interesting for me to know the reason for a doula.  A doula is there for one reason and one reason only...to provide continuous support for the mother.  Whether or not another woman is present (i.e. sister, mother, friend, partner), the doula generally has the ability to remain calm and neutral.  The doula should not take it personally when the laboring woman is shouting at or cruel to her.  The doula will know that it is what the momma needs to do at that moment to deal with what she is experiencing. 

A client told me today, "I felt like I could get angry at you or at [my husband] without fear that it would be taken personally.  I knew that [my husband] would have you as support, to give knowing glances.  I could focus on my labor and not worry about how I was being toward anyone."