What Is a Doula

The Purpose and Value of Labour Support

I’ve watched now, several times, a home video that a couple took whilst on honeymoon to Ulusaba – a private game reserve in South Africa. It is a video of a mother elephant giving birth in the wild to her baby. In a word, it was spectacular. Amazing. Mind-blowing. Breath-taking and unbelievably…. human. I was most impressed by the number of other (presumably) female elephants with their young; all the aunties, sisters, grandmothers, “DOULAS” supporting this new mother in her efforts. As the mother was preparing for her baby to come, she moved, swayed, back and forth, back and forth, walking and swinging her hips, tossing her head. The other elephants wrapped their trunks around her trunk, sweeping their trunks across her brow, stroking her shoulders. It was incredible. It was, in a perfect image, the embodiment of what we, as human doulas, do for our clients, mentors and friends.

When I am asked by potential clients, friends, family what I do, and what the benefits are of what I do, I often pause and reflect upon the image of the elephants. What is the purpose of what we, as birth doulas do? What is the value?

If we were in a different time, place, culture, we as doulas would be the sisters, mothers, aunties, and friends of the labouring woman – we would be the women of experience, the women to whom the labouring woman could turn to for continuous emotional, physical, informational and spiritual support as she transitions from maiden to mother. We would encourage her with words of support, gentle or strong caresses, help her to move, to sway, to rock, moan and breathe through each swelling and vibration as her body surrenders to the intensity of the journey into motherhood. We would do then what we do now.

Doulas provide an opportunity for the mother and her partner to experience birth as a ceremony, something to be celebrated, honoured and at the very least, an active participant in. Doulas provide a service that is tailored to meet the needs of each individual couple, and in so doing, support each couple to give birth their way. A doula’s role is one of continuous support that is far reaching: she provides informational support, emotional support, physical support and spiritual support when required and/or requested. She does not provide clinical support or perform clinical duties such as internal exams, fetal heart checks or blood pressure monitoring.

Doulas provide a woman and her partner (if she has one) the opportunity to experience birth as a ceremony – something to be celebrated, honoured and actively participated in. Each parent-to-be is unique in their preferences and needs surrounding their birthing, It is the Doula’s role to offer support that is tailored to those needs, so birth may unfold as a personal experience.

A doula provides continuous informational, emotional, physical, and spiritual support. She does not provide clinical support or perform medical duties.

A doula provides the best information possible so a birthing woman / couple can make informed decisions around the course of their baby’s birth. A doula doesn’t speak on behalf of her clients but rather provides them with questions they may wish to ask their primary caregivers regarding interventions or courses of action.

A doula assists in building confidence in the birthing family so that their birth is one of ownership and empowerment – she is a wise woman in the art of childbirth.

However informational and educational a doula’s support is, her true light shines in the form of emotional and physical support throughout the birth process. A doula becomes that auntie, the wise woman who understands birth energy, who is familiar and knowledgeable about birth and the birth process. She is the calm hand on a shoulder, a caress on a sweaty forehead, providing continuous encouragement and reassurance throughout the entire experience. Doulas may offer positional changes and movement techniques that aid in the management of pain and assist a woman to cope with the swellings of her body as her baby moves through her. She offers nourishment and suggestions for breathing, toning, swaying, and hydrotherapy. She may offer massage or hypnosis or aromatherapy, depending on her specific additional trainings.

A doula supports not only the birthing woman, but her partner as well, providing him/her with a trusted friend to turn to when s/he may be having difficulty understanding the process and what his/her love is experiencing. She works with partners to provide them with additional tools to help the birthing woman locate their inner resources and when necessary help them to focus and remain on track. She is the guide, but can never replace a partner’s role, for she can never love the woman in the same way, and understand her nuances and intimacies. A doula works with the partner to provide a solid, continuous support team for the birthing woman, whilst also offering the partner the chance to take a break when necessary. Thus the birthing woman is never left feeling alone or unattended in labour; she always has someone to support her throughout her journey.

The effect on births attended by a doula is astounding: less interventions, shorter, more manageable labour, less caesareans, increased satisfaction with the birthing experience, and more successful and extensive breastfeeding. In a recent study conducted by Marshall H. Klaus, M.D. and associates, “continuous labour support from a doula in…ten studies reduced the odds of receiving analgesia by 31 percent, decreased the use of Oxytocin to stimulate labour by 50 percent, forceps deliveries by 34 percent and caesarean sections by 45 percent.” Statistics are important, but the true benefit rests still with the family – how any particular family feels about the birth of their child; are they satisfied? Did their child enter into the world in the way in which their parents had hoped? Did the birthing woman experience the birth she most desired? There is obviously no way to ensure that everything every family desires is always possible. However, the doula’s role is to instil confidence and trust in the birthing process and the birthing couple so that even if special circumstances arise, they will feel supported and guided; held in care during this, their most intimate, life-changing and special time of their lives.

In addition to providing prenatal care and continuous birthing support, most birth doulas provide some degree of post-partum care. She comes to the home (or hospital if necessary) of the family and assists with breastfeeding support, helps during the adjustment period of expectations around a newborn, assists with newborn care concerns/questions, can provide light housekeeping or meal preparation and is generally available to answer questions and support during the transition to family life with a new baby.

Whatever role a doula takes, it is always with the family’s best interests at heart and with the understanding that no information that a doula provides is intended to replace the recommendations or care of the family’s primary caregiver.

Thinking back now to the birthing elephant I am again struck by the similarities in what I witnessed and what it is we do. It is wise to take a moment and contemplate just how closely connected we are with our mammal cousins; how birth in nature is not associated with pain, or fear or the need for a surgical removal of the young. Perhaps not only is there a connection to be acknowledged, but also some lessons yet to be learned.

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