Imagine you’re in the most vulnerable, intense, emotional, and possibly painful moment in your life. How do you cope? Some turn to drugs, some turn to doctors, but some turn to a doula (pronounced Doo-La).
Childbirth is often that moment of physical and mental truth for women. In the twentieth century natural childbirth declined in the United States with the advent of technology and the medicalization of maternal (and all) healthcare. Birth was approached pathologically, assuming birth was dangerous and therefore only focused on managing problems and complications. The medical model treated all women the same with routine, technology-dependent interventions (e.g., Pitocin augmentation, induction, cesarean birth, epidural anesthesia, fetal heart rate monitoring, intravenous fluids, artificial rupture of membranes, etc.) in order to preempt any and all complications.
“Twentieth-century developments led to the almost complete demise of midwifery practice in the United States, thus taking birth away from the control of the individual woman and her close, matriarchal support system, and placing it in the hands of the patriarchal world of medicine and the institutions (i.e., hospitals)… Most births went from being normal, home-based events to becoming illness-oriented, hospital-based procedures.”
Contrary to the medical male approach, midwives used to become embedded in the life of each woman they served and were naturally attune to the emotional wellbeing of each of their clients. Physicians, however, began pointedly ignoring the emotional state of the woman, refusing to make decisions based on the laboring person’s informed consent, but rather based on quantitative averages. The standardized care model also gave physicians the hope of scheduling and managing each birth to fit a timetable (i.e., physicians didn’t stay with the laboring woman during contractions to help them cope with the pain and foreignness of dilation; they only came to catch the finale). Therefore countless laboring women in the USA were left alone—quite literally—to toil and agonize through one of the most intense, vulnerable, frightening, and painful moments in their lives.
Enter the doula.
Gaining footholds in the maternity care system in the 1990’s thanks to DONA International, doulas began to give voice and choice back to laboring women in hospital settings. Doulas are trained in the physiology of birth, but also in the emotional needs of the individual. A doula offers continuous support to the mother because she understands that birth is an experience the woman will remember for the rest of her life and the experience could – let’s face it, will – profoundly change her. In practice doula services include:
- Staying with the mother through the entirety of labor so that the woman is never, ever alone;
- Providing emotional and physical relief through comfort measures (e.g., massage, visualization guidance, TENS, Rebozo, hot/cold packs, birth ball, music and movement, baths, etc.) to help ensure that while the woman might feel pain during a contraction, she is never, ever suffering;
- Providing informational and referral support for anything the mother might need before, during, or after birth so the she has the tools to make informed decisions;
- Providing emotional support by giving a nonjudgmental, objective, and educated viewpoint;
- Facilitating communication and strengthening relationships between the expectant family and the medical provider;
- Giving guidance and support to the partner so they can participate at their own comfort level;
- Nurturing and protecting the mother’s experience and memory of the birth.
Women who work with doulas are more likely to feel safe during pregnancy which allows wonderful labor hormones, such as oxytocin, to flow freely and aid in a healthy delivery. Statistically, doula support has shown to decrease the use of anesthesia or other pain-control medications, birth by cesarean, the use of forceps or vacuum extraction, and low 5-minute APGAR scores. Furthermore, continuous doula support increased the likelihood of spontaneous birth and shorter labor.
Doulas are the missing link between natural birth and current medical practices. As an intermediary between the physiologic and emotional boundaries of birth, doulas are the unique agents of change that can decrease trauma associated with birth that can easily poison and disrupt bonding between the mother-baby dyad and the family as a whole. Doula support empowers women to take an active role in their pregnancy, labor, and birth in order to decrease their fear of childbirth and prepare them to be attentive, caring, and responsive mothers.
Ultimately, the goal of a doula is to support the laboring women so completely they in turn have enough emotional reserves to care for themselves and their new baby. Through unconditional and ever-present support doulas have finally started to return the power of childbirth to the mother.
Imagine a world full of women who are strong and powerful, who advocate for themselves and their families without compromise or apology. That is what doulas teach and work towards. That is why doulas save the world, one birth at a time.
Medical maternity care, Creative Commons
Doula providing comfort with a rebozo, Creative Commons