The purpose and value of labour support
Updated: Jul 18, 2019
Throughout time, childbirth has always been women’s business. Giving birth was something that would happen in the presence of a midwife, your own mother or sister, an aunt. Knowledge was passed along generations and women felt surrounded by a support network to guide them through the process. They were supported by these women both physically and emotionally (Steel, Frawley, & Adams, 2014). Around the 19th century, childbirth moved from the home experience to the hospital. Midwifes disappeared from the scene, and doctors, more often than not male ones, became part of the experience. Birth became a medicalized fact (Feldhusen, A.E., 2000). During this same period in time, the medical world developed at a fast pace. Methods of intervention that could save both mother and child in distress were introduced and childbirth became more safe. However, somewhere along the way, we lost track of the normal, natural process that is childbirth. Interventions and procedures became the norm instead of the exception. Birth companions got pushed further and further away. Giving birth became lonely.
Luckily, as women are becoming more and more vocal and empowered, there has been a slow and steady rise in the usage of midwifes, doula’s and other birth companions. Women are once again looking at alternatives to the standardized care they so often receive. And with good reason.
Benefits of Labour Support
Having continuous support during labor may have numerous benefits for both mother and child. (Bohren, Hofmeyr, Sakala, Fukuzawa, & Cuthbert, 2017). This support can be in the form of hospital staff, such as a midwife or nurse, or by women who were not employed by the hospital but rather chosen by the mother. Hospitals don’t always have the staff to provide a laboring woman with continuous support, so some women choose to employ a doula to accompany them during their labor. Other women brought support in the form of their partner or a family member. The benefits Bohren et al (2017) listed conclude of:
· Increased spontaneous vaginal birth
· Shorter duration of labor
· Decreased cesarean birth
· Decreased instrumental vaginal birth
· Decreased use of any analgesia
· Decreased low Apgar score after five minutes
· Decreased negative feelings about childbirth
No evidence of harm from continuous labor support has been found.
Why do we Want Women to Feel Supported During Labor?
Pregnancy and childbirth have a great effect on women. The process of labor and childbirth can have a variety of effects on women. The World Health Organization (2018) has published their recommendation on companionship during labor and childbirth. Other than the benefits listed above, having a support person present during labor can help with non-pharmacological pain relief (such as massage or holding hands), and adopt alternative positions to help relieve pain.
The review by WHO (2018) also found that women value feeling in control during their labor. A support person can help build self-confidence, ensure a higher self-esteem, and make sure women are aware of their choices. All these findings contribute to a better birth experience, which will lead to a better postpartum experience.
The Doula’s Role in the Birth Story
The word douladerives from the Greek word for ‘woman caregiver’. A doula is a caring, experienced woman that accompanies the birthing couple throughout labor and childbirth with continuous mental, spiritual, and physical support (Klaus, Kennel, & Klaus, 2012). She will not take over the role of the father or partner present, but will be an addition to the mother’s support team. She is a calm, reassuring presence and her support is supplementary to the support provided by the partner. By not being emotionally involved, the doula is able to stay calm and reassuring. She offers help and advice with comfort measures and can assist in positions to alleviate pain. The pressure on the father decreases with the presence of a doula, rendering him more able to provide the laboring mother with love and intimacy.
The Doula’s Responsibilities
As stated in the DONA position paper, a doula is not a medically trained person. Therefore, she will not perform any medical tasks. She will not make any diagnoses regarding medical conditions. She does not give second opinions or medical advice, and a doula will not impose her own beliefs or opinions onto the laboring couple. The doula’s primary responsibility is her client. She advocates for the client’s wishes by offering information and encouraging them to ask questions.
A doula will usually meet up with the pregnant couple to get acquainted and establish a deep understanding of what kind of birth the couple desires. She will work through their fears, concerns and questions and offer information and guidance. During labor, she engages herself to offer continuous labor support in whatever form the mother deems needed. She will devote her time to the couple as soon as labor starts, and will usually stay with them until after birth. Whenever possible, a doula often will offer postpartum care where she can assist with breastfeeding, mental support and other issues that may arise during the postpartum period. She can refer clients if they have needs that extend her expertise.
Everyone deserves a good birth; however this may be defined by the birthing couple. It is the doula’s responsibility to provide them with adequate care and support that can translate into the birth experience this couple longs for.
THE PURPOSE AND VALUE OF LABOR SUPPORT
Bohren, M.A., Hofmeyr, G.J., Sakala, C., Fukuzawa, R.K., Cuthbert, A. (2017). Continuous support for women during childbirth.
Code of ethics: birth doula (2017). DONA International.
Feldhusen, A.E. (2000). The History of Midwifery and Childbirth in America: A Time Line
Klaus, M.H., Kennel, J.H., Klaus, P.H. (2012). The Doula Book: How a Trained Labor Companion Can Help You Have a Shorter, Easier, and Healthier Birth (A Merloyd Lawrence Book)
Simkin, P. (2012). Position paper: the birth doula’s role in maternity care.
Steel, A., Frawley, J., Adams, J. (2014). Trained or professional doulas in the support and care of pregnant and birthing women: a critical integrative review.
WHO Reproductive Health Library (2018). WHO recommendation on companionship during labour and childbirth. Retrieved from https://extranet.who.int/rhl