Labor and delivery

Doulas make sense

By Jennifer Vanderlaan

It's four in the morning and the contractions you have been feeling for the last eight hours no longer let you sleep. You are tired, working hard and just want reassurance that everything is going well. Who will help you find a comfortable position? Who will rub your back? Who will place a refreshing cloth on the back of your neck? Who will get you up to walk to the bathroom? Who will wait with you through contractions and offer you praise when they ebb away?

If your first thought was your doctor, think again. Unless your physician is the rare one-in-a-million, her assessment of your labor is likely to be done through phone conversations with the hospital nurse. She will join you if there is a problem that requires her attention or when the nurse alerts her that you are pushing. If she is in the hospital with another patient she may stop in to see how you are doing, but will not stay to labor with you.

If you assume the hospital nurse will labor with you, you will be disappointed. Most hospitals require nurses to provide care for several patients. That care includes assessment and documentation, consultation with doctors, and administering any medications ordered. Include a few minutes for lunch that must be worked into her busy shift. After the tasks and paperwork, nurses have less than 10% of their time left to provide support for laboring patients.

If you bring a friend or family member to support you, be sure they are trained and willing to provide labor comfort techniques. Some loved ones perceive their supportive role as being present in the room with you. Others are well intentioned but find providing support while you are in pain more difficult than they expected. While some may be people you dearly love, their demeanor does not lend itself well to providing support during labor. Many try to offer support but are limited because of a lack of experience and training in helpful techniques.

If you want true supportive care during your labor you need to hire a doula. A doula is trained in labor support techniques and comfort measures. She has the necessary experience to increase her support as your labor intensifies. She understands the normal process of labor, and is able to provide reassurance when you start to feel overwhelmed.

Because your doula works for you, she is not limited by hospital scheduling policies. She begins her support when you call her and does not stop until your baby has been born. She spends time getting to know you before labor begins so she understands what type of support you need and what type of labor you want.

Contrary to what you might have heard, doulas provide support for women who choose epidurals, inductions, cesareans or natural births. Your doula will not make decisions for you. Instead she works with you to ensure the decisions you have made are respected. If necessary she can help you gather information to make decisions, and can offer insight into the birth planning process.

Instead of taking over for loved ones, doulas actually improve the quality of support they are able to provide. Your doula is able to demonstrate helpful techniques nd offer suggestions to your less experienced family support. She encourages those you have chosen to labor with you to be as involved as they are comfortable, and helps them to be comfortable beyond their expectations.

All this support translates to a better birth experience for you. Mothers who hire doulas are more satisfied with their labor experience, regardless of the circumstances of their labor. Women who use doulas are less likely to need a cesarean surgery or other labor intervention. They are more likely to be successful with breastfeeding and their babies have fewer health problems six weeks after birth. Interestingly, women who use doulas are also more likely to be satisfied with their partners after the baby is born even though there is no difference in partner satisfaction before or during pregnancy.

The benefits of a doula have led one leading researcher to comment that if a doula were a drug, it would be unethical not to use it during labor. Regardless of the type of labor you are planning, having the continuous support of a professional doula makes sense.