Designing Your Ideal Delivery with a Doula

LABOR. The single word is enough to cast a pallor of trepidation, if not outright fear, over first-time expectant moms like me.  How amazing that, for something women have been doing for thousands of years, in environments ranging from the most technologically advanced hospital delivery room to an isolated home in the remote reaches of, oh, let’s say Mongolia, labor still isn’t anywhere close to a “meh” type of event. Labor gets all up in your face. Labor demands respect.

I was acutely intrigued recently while emailing back and forth with a colleague of mine while he was at the hospital, bone-tired but obviously happy, after his participation in the labor and delivery of his first son. I congratulated him and jokingly suggested, if his wife had any tips for getting through labor, I was taking recommendations. My own labor will be upon me probably within the next 7-9 weeks, and I’ll readily admit I’ve turned into a sponge for other people’s labor stories. Within 15 minutes, he’d written back a lovely note full of detail and helpful information (I anticipate his wife may have been dictating some of it to him from their hospital room, bless her heart). But the overarching message in his missive to me? Hire a doula.

I’ll admit, before a few weeks ago, I’d hear “doula” and my thoughts would go all crunchy. I’d start seeing Earth Mother-type women in diaphanous skirts, smelling of patchouli and advising laboring moms to breathe happiness into their cervixes and tap into the powers of the universe while sweating and grimacing through contractions. That is, of course, a completely incorrect and wholly unfair stereotype. I know that now. Now, when I hear “doula,” I’m more likely to think “rock star,” and I’ll explain why.

The word “doula” is from ancient Greek, and can be interpreted anywhere from “woman servant” to “female slave.” These days, a doula is neither a servant nor a slave, but a person who provides non-medical antepartum, labor and delivery, and/or postpartum support to families. They’re an educator, a labor coach, an objective third party and a communicator. They’re someone who can draw upon their training and attendance at previous births to enable and reassure you and your partner through what can be a pretty intense experience, helping you make informed decisions and have the birth experience you want, without interfering at all with the clinical aspects of your care.

And, from what I hear, they are worth their weight in gold, for both moms and dads or other birth partners. Despite what you might expect, the presence of a doula seems to enhance and focus the contributions of dads or birth partners rather than marginalize them. They’re a living, breathing “cheat sheet” for nervous birth partners to be able to do and say the right things, the productive things, the “whatever I have to do so she doesn’t yell at me during a contraction because I look at her wrong” things. The more I researched the use of doulas, the more I ran across sentiments like, “I don’t know why anyone would ever give birth without a doula.” And my attempts to find negative feedback were pretty fruitless.

So, okay, that’s nice warm-fuzzy information, but how about quantifying the awesomeness? DONA International, a preeminent doula organization, points to clinical studies that indicate having a doula present at birth:

  • tends to result in shorter labors with fewer complications
  • reduces negative feelings about one’s childbirth experience
  • reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans
  • reduces the mother’s request for pain medication and/or epidurals

A systematic review of the effects of continuous labor support by doulas or other caregivers was published in The Cochrane Library in 2011, issue 2. It summarized results of 21 randomized controlled trials involving 15,061 women. The goals of the study were to assess the effects, on mothers and babies, of continuous one-on-one support during labor and delivery, compared with solely clinical care, regardless of setting. The results showed the following:

Women allocated to continuous support were more likely to have a spontaneous vaginal birth (RR 1.08, 95% CI 1.04 to 1.12) and less likely to have intrapartum analgesia (RR 0.90, 95% CI 0.84 to 0.97) or to report dissatisfaction (RR 0.69, 95% CI 0.59 to 0.79). In addition their labours were shorter (mean difference -0.58 hours, 95% CI -0.86 to -0.30), they were less likely to have a cesarean (RR 0.79, 95% CI 0.67 to 0.92) or instrumental vaginal birth (fixed-effect, RR 0.90, 95% CI 0.84 to 0.96), regional analgesia (RR 0.93, 95% CI 0.88 to 0.99), or a baby with a low 5-minute Apgar score (fixed-effect, RR 0.70, 95% CI 0.50 to 0.96). There was no apparent impact on other intrapartum interventions, maternal or neonatal complications, or on breastfeeding. Subgroup analyses suggested that continuous support was most effective when provided by a woman who was neither part of the hospital staff nor the woman’s social network, and in settings in which epidural analgesia was not routinely available.

Reading all this, I realized: you’re telling me having a doula in the room while I’m laboring can increase my chances of a spontaneous vaginal birth, causing no harm to me, help my husband, my baby AND me all get through this entirely new and alien process and increase our satisfaction with the whole experience? I want all those things! I don’t want a cesarean. I don’t really want drugs. I don’t want to yell mercilessly at my husband because he can’t intuit exactly what I need through hours and hours of exhausting labor. Bring on the doula! Sign me up!

So yes, we have an initial appointment with a doula next week. She’s the same one my colleague and his wife hired, actually. I have to laugh, because I am looking forward to meeting her with the anticipation of someone who is going to meet a really good friend they don’t quite have yet. I’m hoping it’s the start of a beautiful relationship, one that will culminate with a healthy, squalling infant in a birthing suite at our hospital sometime in July if all goes to plan. I’ll let you know how it goes.

How about you, Mom and Dad readers out there? Did you use a doula for labor and delivery? What did you think? I’d love to hear whether your experience supports or refutes the research and anecdotal evidence.

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Caroline Sober

Senior Software Developer at Promega Corporation
Caroline is a senior software developer at Promega. She’s not a scientist, so if you hear her talking about DNA purification or pipetting or current issues in bioprivacy, she’s totally faking it and you should tell her to hush. She is, however, passionate about building useful software, the interactions between people and technology in general, and how social media is changing the conversation between companies and customers. She lives in Madison with her husband, daughter, and 110-pound dog.

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