A birth doula is a woman who provides support to expectant women and their families during childbirth to facilitate a positive, and sometimes healing, birth experience while potentially improving the emotional and physical outcomes of both mother and baby through continuous physical, emotional, and educational labor support. Many women are surprised to find that the role of a doula is not a new concept, rather, her place has been at the side of laboring women for centuries. Studies found in The Doula Book by Klaus, Kennell, and Klaus, reveal that the impact that a doula can have on the physical, as well as emotional, outcome of the mother and family is strongly positive, including shorter labor times, fewer requests for pain medication, an astounding reduction in the number of cesarean sections performed, and a significant decrease in other medical interventions, such as assisted delivery by use of forceps and vacuum extraction. Included in these studies are the findings that the presence of a labor support person increased the mother's positive feelings towards her partner and newborn(s), increased confidence in herself as a woman and mother, and reduced the occurrence of post partum depression.
Whether a mother chooses to birth at home, in a hospital, or in a birthing center, families can take comfort in knowing that their doula will remain with them throughout the entire labor and birth, providing continuous support. Practitioners are rarely able to be with laboring women continuously because of occupational restraints, such as tending to multiple laboring women at a time, caring for clinical needs of the mother and her unborn baby, and other variables, such as required paper work and even shift-changes in settings such as a hospital. Though their intentions are to care for the mother to the absolute best of their abilities, these restraints make it nearly impossible for practitioners to devote their undivided attention to laboring women and their families throughout the entirety of their birth experience. Having a doula present ensures that women will have someone with them constantly to aid them in any need they may have, giving them peace of mind that they are not alone in this life-changing event. The doula can also help mothers and their families communicate more efficiently with staff to ensure that there is open, honest, and respectful communication between the laboring woman and her support persons and the staff tending to her clinical needs.
Because every labor and birth is a unique experience, the doula's role will change in some way to fit the needs of each birth she attends. Some women require more physical support than emotional, desiring a wide range of comfort measures, such as massage, counter pressure, ambulation, and other touch therapy, while other women may need intense emotional support, such as in the case of previous abuse or loss. The purpose of providing labor support to all women is to ensure to the best of her ability that the doula is thorough and consistent in her care for the mother and family. She must also protect the birthing space, acting as a shield to guard against negative comments or emotions that others may bring into the birth space that may interfere with the mother's potential for a positive labor and birth. Deflecting negativity may be as simple as offering positive affirmations to the mother regarding the way she is laboring, or could be as involved as delicately conveying to visitors that conversations should be positive and encouraging, or even that silent support would be most helpful to the mother and family at this point. Though the doula may need to help the laboring woman's needs be known to visitors, it is never the place of the doula to speak for the woman or her partner to medical or health practitioners. The doula should be an advocate, helping the mother find her own voice in order to speak for herself, or else helps her loved ones be her voice at times when she is unable to speak. Helping the expectant family construct a working birth plan before the onset of labor can be a helpful way to ensure that staff and visiting family and friends, as well as the doula, are aware of the mother's desires for her labor and birth so that direct questions regarding care can be kept to a minimum since a birth plan will have answered the majority of this manner of inquisition.
When a doula takes on a client, it is her moral, and even contractual, duty to carry out her role as doula to the highest level possible. A DONA-International affiliated doula should also abide by the Code of Ethics and Standard of Practice that have been outlined by her certifying organization. A doula's responsibilities to her client include, but are not limited to, full disclosure of the doula's service agreement or contract, one or more prenatal meetings with the expectant family to educate the mother and her spouse or other labor support person(s), as well as to gain knowledge of the mother's desires for her baby's birth, continuous, uninterrupted labor support from the time the mother and her family call on their doula until after the birth of the baby, immediate post partum support, including aiding with the initiation of breastfeeding, answering questions the family may have regarding their birth experience or, and ensuring that the new family is settled and comfortable before leaving them to bond, as well as some type of post partum contact within the first few days or weeks of the birth, preferably in the form of a post partum home visit to ensure that the family is coping well with the addition of it's new member and to answer any questions or concerns they may have.
It is also imperative that the doula let her client know that she will not share personal information with anyone without consent. Expectant mothers should be able to feel completely safe with their doula and trust that she has their absolute best interest at heart. It can sometimes be difficult to put our own opinions aside when supporting an expectant mother and family that may have different opinions than our own. However, it is never appropriate for a doula to pass judgment or make a woman feel badly in any way for religious or cultural views, personal decisions, opinions, or rituals she may hold dear. If ever a doula feels that she may not be comfortable supporting a woman and her family for any reason, she has a moral obligation to respectfully decline her services and do her very best to secure other labor support arrangements for the family. After all, it is a beautiful thing to assist women in a way that allows every woman the opportunity to have a doula.