Doula is a Greek word loosely translated to mean ‘a woman caring for women’ The word now refers to a professional who has been trained to understand childbirth and to provide continuous care for a mother before, during, and just after birth.
The Wendy Effect
Pediatrician Marshall Klaus discovered the importance of doula support in the 70’s, as an incidental finding during a research study in Guatemala on the effect of ‘rooming-in’ on breastfeeding. This was actually the discovery of the power of the doula. The study took place in a large hospital, where every day dozens of women were giving birth. These were mainly poor women, who gave birth in a room filled with other women in labor.
Wendy, one of the medical students who conducted the research, spoke fluent Spanish and was friendly. She stayed with the women during labour, encouraging them, telling them they were doing well, and holding their hand. These women delivered faster than the others, with fewer complications and more satisfaction.
Dr. Klaus realized something special was going on. Wendy’s presence at the birth had made a difference. this is now referred to as “The Wendy effect”.
The modern day role of a doula
The role of a doula is to prepare a mother (and her family) for her birth in anyway she is able, getting to know her needs, wishes and fears.
She will help a mother to become informed about her birth choices.
She provides emotional support by using various techniques, encouraging a positive attitude, guiding a mother through rough moments and reassuring and encouraging her partner.
She will provide informational support by describing common interventions and procedures, explaining the birth process to the family and support team and facilitating communication between the mother (and partner) and her medical care team where necessary.
A doulas responsibilities
Confidentiality and privacy. Non-judgmental support. Reliability. Support of clients right to informed choice. Professionalism with clients, colleagues and caregivers. No clinical responsibilities.
What does a doula not do?
Doulas are NOT medical professionals, they do not perform clinical tasks such as vaginal exams or provide fetal heart monitoring. They do not give medical advice or diagnoses. They do not judge a birthing woman. They do not let their personal values or biases get in the way of caring for women. They do not take over the role of the partner unless specifically hired in for this purpose. They do not catch the baby. They do not change shifts (continuity of care).
Cochrane review on continuous support
In 2012, Hodnett et al. published an updated Cochrane review on the use of continuous support for women during childbirth. They pooled the results of 22 trials that included more than 15,000 women. These women were randomized to either receive continuous, one-on-one support during labor or “usual care.” The quality of the studies were good.
Continuous support was provided either by:
- a member of the hospital staff, such as a midwife or nurse
- a doula who was not part of the woman’s social network and not part of hospital staff
- childbirth educators
- retired nurses
- a companion of the woman’s social network such as a female relative or the woman’s partner
The best results occurred when woman had continuous labor support from a doula– someone who was NOT a staff member at the hospital and who was NOT part of the woman’s social network.