Why Might Doulas Make a Difference?
Last week, the Cochrane Library released an updated systematic review of continuous support during labor.
After examining 21 trials involving over 15,000 women, the review authors found that women who received continuous support during labor:
- were more likely to have a spontaneous vaginal birth
- were less likely to have intrapartum analgesia (i.e. an epidural)
- were less likely to report dissatisfaction with their labors
- had shorter labors
- were more likely to give birth without cesarean, vacuum, or forceps
- were less likely to have regional analgesia
- were less likely to have babies with a low 5-minute Apgar score
In addition to these welcome and exciting findings–many of which appeared in the previous Cochrane Review of continuous support during labor–the new review adds the following information:
Continuous support from a person who is present solely to provide support, is not a member of the woman’s social network, is experienced in providing labor support, and has at least a modest amount of training, appears to be most beneficial.
What do I think we can infer from this statement?
DOULA SUPPORT MAKES A DIFFERENCE!
In light of this news, I’ve been pondering why doula support in particular provides these unique benefits.
Why does it matter if a labor support person is not a member of the hospital staff? Why does it make a difference if s/he is not a friend or family member of the woman in labor?
Here are a few of my sneaking suspicions:
Emotional Distance/Emotional Closeness
Promoting the unique benefits of doula support is not meant to detract from the support that friends, family, and caregivers can offer to a woman during labor. In fact, the new Cochrane review found that women were often more satisfied with their birth experience when they received continuous support from a chosen family member of friend.
But doulas don’t typically have the same sort of emotional closeness that a woman’s friends and family have, and this difference can be beneficial during labor.
It’s not that doulas don’t care for their clients. I care deeply for my clients and now consider many of them to be my friends! But this care is different from the emotional investment that a woman’s friends and family have, especially during labor. A doula’s “emotional distance” can help a her to maintain a relatively objective standpoint so that she can continuously support her clients regardless of whether they and their other support people are confident or scared, sailing through an easy birth or facing a challenging labor, experiencing their ideal birth or encountering unexpected circumstances. (And, for what it’s worth, providing continuous support can be difficult for a family member or friend to do during scary, challenging, or unexpected circumstances.)
On the other hand, as much as some hospital staff members would love to provide continuous support during a woman’s labor, few are able to because of their other responsibilities and duties on the job. In this respect, the emotional closeness and commitment that a doula does have with her client can help her to maintain a continuity of care throughout a woman’s labor.
Knowledge is Power
Good books and internet resources, a childbirth education class, and even past experience with birth can all help to prepare a woman’s friends and family to support her during her labor. I would even go so far as to describe this sort of preparation as being “essential” for any person who wants to accompany a woman during her labor!
But despite all of this preparation, a trained or experienced doula probably has more in-depth knowledge or familiarity with:
- hospital and/or care provider policies and protocols
- non-pharmaceutical comfort measures (such as massage, heat and cold, position changes, aromatherapy, etc.)
- position changes that help to enhance labor progress and/or relieve discomfort
- questions that a woman can ask to help her make informed decisions before and/or during labor
- understanding about the behavior that is “normal” during labor (even when it might not look or sound “normal”)
- community resources related to prenatal care, childbirth preparation, breastfeeding, and infant care
On the one hand, by keeping this knowledge “in play” during labor, a doula can help a woman to navigate the hospital system more confidently, to avoid pain medication for as long as possible, and to generally avoid various medical interventions that are associated with additional complications or negative side effects.
On the other, a doula can also use this knowledge to help the rest of a woman’s support team to better support her. In other words, any doula worth her salt (or worth her lavender oil!) won’t be out to replace a woman’s partner, or her mother, or her best friend, or whoever else is in the room. A doula’s role is to “fill in the gaps”–and sometimes, this means helping everyone else in the room to become even better support people!
Confidence, Compassion, and Respect
The effect that confidence, compassion, and respect have on a woman’s labor is difficult, if not entirely impossible, to quantify.
But when a doula can help to bring each of these into the laboring woman’s space–when a doula is giving continuous encouragement to her client, when she is treating her with compassion, when she is modeling what it means to treat a laboring woman with respect–I think that it can do wonders for that woman’s birth.
I’ve seen it do wonders for women’s births.
Why do you think that doula support offers such unique benefits to laboring women? Why does doula support seem to make such a difference?
And don’t forget to check out Childbirth Connection’s new (and fabulous) resource on Labor Support!