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What does a birth doula do?

As part of the DONA International Birth Doula certification process, we have to write an essay that explains in our own words the purpose and value of having a designated labour support person, or doula :). I am sharing what I wrote here with you so that you can have a clear idea of what I view my job description to be and why I believe this work is important.

The Purpose and Value of Labor Support

By: Hannah Dwyer

Supporting birthing people is vitally important to the health and wellbeing of our society as a whole, not just because giving birth is a major event (some say the major event) in a woman or parent’s life, but because being born is an incredibly important event for all of us. The way we come into the world matters. Our first moments outside of the womb can set the tone for how we feel about life on earth as infants, toddlers, children and adults. Do we generally feel that the world is a safe place? That we are able to get what we need from it? That it is a place where we are seen and heard and loved? The way that we birth matters. A parent who feels that they were able to bring their child into the world on their terms, that they were supported enough to meet challenges with grace, that they birthed in strength and sovereignty, will be at an excellent starting point for raising their child. The world needs children who are well adjusted, emotionally and spiritually nourished, and connected to the things that really matter in life. Parents must be well supported and have their own needs met in order to best be able to raise such children.

Birth doulas work with a variety of tools and practices to help create the optimal birthing experience for families, as defined by the families themselves. By providing information, physical and emotional support, and practical ideas for working within a given family’s circumstances, doulas work with birthing people to help them make informed decisions about their desires, bring those wishes to fruition, and manage disappointments when outcomes are beyond anyone’s control. Even when a birth does not go as planned, the results are usually much easier to handle when the families know that they always had good information and made the best decisions they could with the information they had at the time. That way, with the supportive witnessing of their doula, they can try to avoid being haunted by “what ifs”. Doulas can help families achieve their goals and desires within the parameters of the reality that they are dealing with. Sure, skin to skin contact during the golden hour would be ideal, but if that didn’t happen, how can we nurse that disappointment while also doing everything possible to facilitate bonding and adjustment now, in the existing circumstances?

During labour and birth, a doula provides continuous, non-medical support to a birthing person and their family[1]. The practical expertise of the doula regarding comfort measures, position changes, and strategies for managing different situations can relieve birthing families from the stress of trying to remember tips from books and classes and offer suggestions to help them enjoy and fully be with the experience. They can also fill important knowledge gaps about how to support and facilitate normal physiologic birth in the hospital setting, where many of the care providers may be trained only in pathology and intervention. The doula’s presence should ease, rather than raise tensions in the relationships between families and care providers, the doula assumes responsibility for maintaining good relations and modeling good communication strategies. A doula’s primary responsibility is to their client, and they will not be weighing their client’s best interests against any other priorities[2]. The same cannot be said for all care providers, who often have diffuse professional responsibilities, to co-workers, higher ups, logistical concerns, and certifying boards.

The doula does not speak for their client, but they provide their clients with the information and support necessary to make them strong self-advocates[3]. While this limitation can sometimes be difficult to manage because we care deeply and want to stand up for birthing families who are being mistreated, the simple presence of a doula can make a huge difference in how things go for a family. Research has shown that having a doula significantly decreases the incidence of cesarean section, mothers choosing to have epidurals, length of labour, use of synthetic oxytocin, babies staying in the hospital for more than 2 days, and maternal fever[4]. The reduction in the use of interventions listed above is considered to be a positive thing, not because doulas have an ideological bias towards “natural” birth, but because they are empirically known to increase risk of harm to mother and baby. While many doulas are knowledgeable and passionate about the wonders of physiologic birth, we strongly believe that mothers and birthing people must make their own informed decisions about what is best for them, and we are prepared to support families no matter what they choose. The benefits of doula support extend beyond the birthing day. Studies have found that doula supported births led to improved breastfeeding outcomes, maternal caregiving behavior, maternal mental health, relationship satisfaction between parents, and maternal perceptions of their babies and themselves[5].

Respectful, non-judgmental, and empathetic support from a doula can make a huge difference in the lives of a family no matter how the birth unfolds. Their assistance in preparing for the birth and in debriefing and integrating the experience are just as important as their support on the big day (or days!). The relationship between a family and their birth doula, while often brief, is a very special thing. It is an honour to be trusted to witness, hold, and care for such an incredible time in people’s lives. Doulas strive in every aspect of their personal and professional lives to be people worthy of such trust, and uphold values of kindness, collaboration, respect, body sovereignty, and justice.

[1] Simkin, P. “Position Paper: The Birth Doula’s Contribution to Modern Maternity Care”. DONA International [2] DONA International. “Code of Ethics”. [3] DONA International. “Standards of Practice: Birth Doula”. [4] Klaus, M., Kennell, J., Klaus, P.. The Doula Book. Lifelong Books, 2012. [5] Klaus, M., Kennell, J., Klaus, P.. The Doula Book. Lifelong Books, 2012.

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