The Benefits Of Hiring A Doula For Your Birth

by Katharina Bishop

Doula (pronounced doola) is a term which is used to describe a woman experienced in childbirth who provides continuous physical, emotional, and informational support to the mother before, during, and immediately after child birth. Originally from the Greek word for slave, the term doula was used by Dana Raphael in her book, The Tender Gift, as a “title for those individuals who surround, interact with and aid the mother at any time within the perinatal period.” Nowadays, the term ‘doula’ is routinely used in this context. 

In their book, Mothering The Mother: How a Doula Can Help You Have a Shorter, Easier, and Healthier Birth, Marshall Klaus, John Kennell and Phyllis Klaus summarize scientific studies which have been carried out on the advantages of doula-assisted births. The evidence cited is drawn from six randomized, controlled studies. Two studies were carried out in Guatemala, the first one with 136 women, and the second with 465 women. One study took place in Houston (Texas) in the United States with 416 women. A further study involving 192 women was carried out in Johannesburg, South Africa. The fifth and sixth studies were done in Helsinki, Finland and in Canada. 

All participants were primiparas (a medical term used to describe women who are giving birth to their first child). All participants were in good overall health and had had uneventful pregnancies. They were invited to participate when they were admitted into the hospital in labor. The Guatemalan doulas were trained in a 3 week course. In the South African study the women were untrained lay-women. The doulas were asked to stay with the laboring women constantly. They were instructed to use touch and verbal communication focusing on three primary factors: comfort, reassurance and praise. All of the doulas in the study had experienced regular labors and vaginal births. 

In all the above studies, the doulas used soothing words, touch and encouragement. They explained the procedures as they occurred and translated medical terms into laymen’s terms. The results of the studies were as follows:

• Reduced the overall cesarean rate by 50%
• Reduced the length of labor by 25%
• Reduced oxytocin use by 40%
• Reduced the use of pain medication by 30%
• Reduced forceps deliveries by 40%
• Reduced requests for epidural pain medication by 60%
• Reduced incidences of maternal fever
• Reduced the number of days newborns spent in NICU (neo-natal infant care unit)
• Reduced the amount of septic workups performed on newborns
• Resulted in higher rates of breastfeeding
• Resulted in more positive maternal assessments of maternal confidence
• Resulted in more positive maternal assessments of maternal and newborn health
• Resulted in decreased rates of postpartum depression

Klaus and Kennel speculate that the mere presence of a doula had a beneficial effect on the emotional state of the mother, resulting in a decrease in catecholamines (adrenaline). This relaxed state allows uterine contractions to be more effective and reduces the occurrence of compromised uterine blood flow. 

Insurance companies are taking note of the proven benefits of doula-assisted births. As a result, some providers have started to reimburse for doula care. If your company health care plan covers in-home care, nursing care, lactation consulting, or similar fields, doula care is most likely covered as well. 

How To Find A Doula 

Contact one of the following certification groups:

• Doula UK
• Doulas of North America (DONA)
• Birthworks
• Association of Labor Assistants and Childbirth Educators (ALACE)
• International Childbirth Education Association (ICEA)
• Ask your midwife or obstetrician
• Call local birth centers
• Go to a La Leche League meeting and ask members for referrals

Questions To Ask A Doula 

When you are interviewing a potential doula, the following list of questions may be a useful reference. A personal rapport with your doula is important, since she will assist you during an emotionally and physically intense process.

• Are you certified? By what organization? What kind of training have you had?
• How long have you been working as a doula? How many births have you attended?
• How many home births have you attended? Have you attended hospital births?
• Tell me a little bit about the births you have attended.
• What is your child birth philosophy? How do you support women and their partners throughout labour?
• Do you work with one or more backup doulas (for times when you are not available)? May I meet them?
• What is your fee? Is any part of your fee refundable if, for some unexpected reason, you do not attend the birth?
• Can you provide references?

Recommended Reading: 

Mothering the Mother: How a Doula Can Help You Have a Shorter, Easier, and Healthier Birth by Marshall H. Klaus, John H. Kennell, Phyllis H. Klaus 

The Tender Gift by Dana Raphael