The Importance of Being a Doula

In DONA International’s position paper “The Birth Doula’s Role in Maternity Care,” the word doula is described as a “Greek word meaning a woman who serves.” But what does that service entail? What does a doula do? For that matter, what does a doula not do? Let’s dive a little deeper.

What does a doula do? Short answer? According to DONA International’s website a doula is “a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible.” Let’s break that down into pieces: physical support, emotional support and informational support.

Physical support can be exactly what it sounds like: physically and literally holding up a laboring person as they dangle between the doula’s knees or as they lean over the doula’s shoulders during an epidural, head buried in the doula's neck. Physical support means massage and soothing touch whether that’s five hours of counter-pressure to relieve back labor or stroking back a laboring person’s sweaty hair as they push out their baby. But physical support can be more subtle than that. A doula can be that quiet presence in the background bringing food and water or adjusting the lights. The vast majority of doula work can simply be holding washcloths and filling up water bottles. This physical support extends to partners and other support people as well. A doula might be those strong arms that take over double hip squeezes when a partner gets tired or that rub some of the stress from a partner’s shoulders. They might be the gentle reminder to the partner to drink a little water or the offer of a chair while they hold their laboring partner. Physical support can be very active and literal, but it can also be unseen. The physical support required of a doula changes for each family that she serves. However, physical support does not include medical care or medical advice. A doula is not a health care provider and so cannot diagnose or treat a medical problem. Suggestions for comfort measures or exercises should be qualified with directions to confirm with the client’s care provider.

The second form of support is emotional. Pregnancy, labor, birth and even the postpartum period can be emotionally intense, for both the pregnant person and the supportive partner. To help cope with and process the emotions that may come up, a doula can provide tools and resources to make that process a little smoother. A doula can share relaxation exercises or guided meditations and visualizations to help the pregnant family prepare for the stress and pain of labor. During labor, the doula can remind the family of these exercises and guide them through. A doula can also stay alert to signs of perinatal mood disorders in either parent and encourage them to get professional help and support. Perhaps she would suggest a support group or even a therapist who specializes in PMAD. But above all, throughout the whole process, the doula is a validating, non-judgmental presence. She should be a shoulder to cry on or a listening ear or an encouraging voice. A doula’s simple, continued presence is invaluable. With that validation and support comes a responsibility for the doula to leave behind her own beliefs about what birth should be. It is not the doula’s role to judge or criticize a client for the choices they make. “The healthiest, most satisfying experience possible” can be defined in so many different ways. It’s different for every family

The last form of support, but certainly not the least, is informational support. In my opinion, it’s often the most important form of support. I want to give my clients the right tools to make their own decisions, to advocate for themselves and to clarify their values. A doula can be present for a family, but ultimately, the approach to their birth experience is up to them. A doula cannot make decisions for her clients or speak for her clients. The advocacy provided by the doula, according to DONA’s Standards of Practice, “enhances the communication between client and care provider.” It does not replace it. This communication-building can happen both prenatally and in the delivery room or OR. Before labor begins it’s important to discuss what to expect and what options are available depending on their provider, birthplace and pregnancy status. It’s also important to discuss what is important to them when it comes to their birth experience, regardless of how their actual labor plays out. How involved do they want to be in their birth process? What is their partner or support person’s role? How can we make this happen in different possible circumstances? Often this means discussing questions they need to bring to their provider. Creating space for the family to get their questions and concerns addressed is vital during the labor process.

So what are the tangible benefits of the types of support that a doula provides? The support of a doula can shorten labor by reducing the effects of stress hormones on the body’s ability to give birth. As per DONA’s position paper “The Birth Doula’s Role in Maternity Care” a doula can also support a more satisfying birth experience and less medical intervention. This includes C-sections, the use of pain medication and the use of pharmacological augmentation of labor. The paper also notes that the support of a doula is especially effective for pregnant people who cannot have loved ones present. The doula can provide that sensitive, continuous support when family or friends cannot.

Although the doula is neither a member of the birthing family nor a member of the medical team, she still has an important, distinct role in her client’s birth process. By maintaining objectivity and a non-judgmental mindset, a doula can bring her knowledge of birth and her dedication to the family and birthing person to the birthplace. In this unique way, the doula can be that continuous, validating presence as her clients grow their family.