The Value and Purpose of Labor Support
by Cristin Tighe

How is labor support (i.e. having a doula) valuable? 

Labor support is valuable to a woman because there is someone with the woman, during the process, who assures that she is empowered, self-expressed and supported.  This support begins during the pregnancy and continues during labor, birth and beyond. The most significant support that a birth doula provides is “…to foster maximum self-determination” for the pregnant woman.  There are at least four main areas where this can happen: (1) knowledge/experience, (2) emotional support, (3) advocacy and (4) physical support.

First, doulas have knowledge and experience to share with the mother.  A doula can work with her to help her understand the changes she is going through, what is happening with the baby, what her options are to give birth, what to expect during labor, potential complications, and how to make the birth process more manageable.  A mother, working with a doula, knows she can have answers to her questions when she wants support in a specific area.  Often, a doula will assist with creating a birth plan.  A doula’s knowledge and experience bring wisdom, which translates into someone always being present and calm for the mother.  Knowing an intelligent, able woman is watching out for a new mother, provides assurance for the woman through an amazingly transformative, but also potentially overwhelming time.

Secondly, doulas offer women emotional support through the process. A birth doula provides companionship and encouragement with positive thoughts and kind words to support the woman.  In some ways, the doula is like a cheerleader, always encouraging the best for the woman and looking out for her as the end of her pregnancy progresses into the labor and during the labor, even if something unanticipated emerges. Beyond that, doulas also can increase the woman’s self-confidence during pregnancy and birth. When women know they have someone who will be with them and will be looking out first for their needs above those of anyone else, it is comforting.  Also, evidence-based research shows that having a supportive woman present consistently during birth shortens labor.

The doula/mother relationship also allows the doula to play a more important role -- as an advocate.  The doula’s support can be simply just listening to a woman’s concerns and thoughts, but more importantly, she can make sure some action is taken to assure the woman’s needs and hopes are met. Often in a hospital setting, liability issues, time pressure and technological interventions are prioritized over the mother’s wishes.  A doula is especially important if a woman’s partner or family have differing perspectives than the woman. At times, caregivers and family may be more focused on the baby. There is great value for the woman in being able to express her wishes, thoughts and concerns, and knowing someone will listen and take action to assure they are heard and fulfilled.  Also, during labor if the woman is tired and an urgent issue requires quick decisions, the woman knows someone understands her hopes for birth plan changes. The doula -- in prenatal discussions, during the intrapartum process, or during the birth -- can facilitate and mediate between the woman and her caretakers, her family and her partner as needed.

Last, but not the least important, doulas provide physical support and comfort measures for the pregnant women.  During pregnancy, this could mean teaching them how to sleep comfortably, exercises to elongate the back, and what to do to strengthen the abdominals and pelvic floor.  During labor preparation, the doula can help mothers practice different positions for labor and teach the birth partner massage techniques to ease pain.  Doula support during labor is essential -- positive stimuli, such as finding more comfort in new positions and counter pressure to ease contraction pain, can help so much. Women who are supported to move freely in labor, often have shorter and easier labors, and less need for interventions. Also, a doula can help with breathing exercises and relaxation and visualization techniques.  Women who can focus on their breathing during each contraction are able to stay present to get through it, so will not become fearful or overwhelmed.  Finally, a doula’s touch, holding a hand, a hug, or putting cool cloths on the forehead during labor all keep the women more content.

A birth doula’s purpose is to support and advocate for the mother during pregnancy and birth. Often, the doula is the only one looking out first and only for the mother. The implications of this are important, since a supported, empowered woman is more likely to be calm during her pregnancy.  If women are relaxed and confident, when going into labor, it has been shown to make a positive difference in their birth experience and birth outcomes.  This means a happier mother, easier time breastfeeding, bonding successfully with the baby early on, a more rested mom and baby, and a happier family.  A birth that is less stressful helps the woman feel confident moving into her new role as a mother… which is great, since she has no time to rest once the baby is born!

Bibliography
•    DONA International Birth Doula FAQs
•    DONA International Birth Doula’s Contribution to Modern Maternity Care
•    DONA International Birth Doula Position Paper
•    DONA International Standards of Practice for Birth Doulas
•    DONA International Code of Ethics: Birth Doulas

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