The Birth Doula's Contribution to Modern Maternity Care
A DONA International Position Paper
The birth of each baby has a long lasting impact on the physical and mental health of mother, baby and family. In the twentieth century, we have witnessed vast improvements in the safety of childbirth, and now efforts to improve psychosocial outcomes are receiving greater attention.
The importance of fostering relationships between parents and infants cannot be overemphasized, since these early relationships largely determine the future of each family, and also of society as a whole. The quality of emotional care received by the mother during labor, birth and immediately afterwards is one vital factor that can strengthen or weaken the emotional ties between mother and child. Furthermore, when women receive continuous emotional support and physical comfort throughout childbirth, their obstetric outcomes may improve.
Women have complex needs during childbirth. In addition to the safety of modern obstetrical care, and the love and companionship provided by their partners, women need consistent, continuous reassurance, comfort, encouragement and respect. They need individualized care based on their circumstances and preferences. The role of the birth doula encompasses the non-clinical aspects of care during childbirth.
Role of the Doula
In nearly every culture throughout history, women have been surrounded and cared for by other women during childbirth. Artistic representations of birth throughout the world usually include at least two other women surrounding and supporting the birthing woman. One of these women is the midwife, who is responsible for the safe passage of the mother and baby; the other woman or women are behind or beside the mother, holding and comforting her. The modern birth doula is a manifestation of the woman beside the mother.
Birth doulas are trained and experienced in childbirth, although they may or may not have given birth themselves. The doula's role is to provide physical and emotional support and assistance in gathering information for women and their partners during labor and birth. The doula offers help and advice on comfort measures such as breathing, relaxation movement, and positioning. She also assists the woman and her partner to become informed about the course of their labor and their options. Perhaps the most crucial role of the doula is providing continuous emotional reassurance and comfort.
Doulas specialize in non-medical skills and do not perform clinical tasks, such as vaginal exams or fetal heart rate monitoring. Doulas do not diagnose medical conditions, offer second opinions, or give medical advice. Most importantly, doulas do not make decisions for their clients; they do not project their own values and goals onto the laboring woman.
The doula's goal is to help the woman have a safe and satisfying childbirth as the woman defines it. When a doula is present, some women feel less need for pain medications, or may postpone them until later in labor; however, many women choose or need pharmacological pain relief. It is not the role of the doula to discourage the mother from her choices. The doula helps her become informed about various options, including the risks, benefits and accompanying precautions or interventions for safety. Doulas can help maximize the benefits of pain medications while minimizing their undesirable side effects. The comfort and reassurance offered by the doula are beneficial regardless of the use of pain medications.
The importance of fostering relationships between parents and infants cannot be overemphasized, since these early relationships largely determine the future of each family, and also of society as a whole. The quality of emotional care received by the mother during labor, birth and immediately afterwards is one vital factor that can strengthen or weaken the emotional ties between mother and child. Furthermore, when women receive continuous emotional support and physical comfort throughout childbirth, their obstetric outcomes may improve.
Women have complex needs during childbirth. In addition to the safety of modern obstetrical care, and the love and companionship provided by their partners, women need consistent, continuous reassurance, comfort, encouragement and respect. They need individualized care based on their circumstances and preferences. The role of the birth doula encompasses the non-clinical aspects of care during childbirth.
Role of the Doula
In nearly every culture throughout history, women have been surrounded and cared for by other women during childbirth. Artistic representations of birth throughout the world usually include at least two other women surrounding and supporting the birthing woman. One of these women is the midwife, who is responsible for the safe passage of the mother and baby; the other woman or women are behind or beside the mother, holding and comforting her. The modern birth doula is a manifestation of the woman beside the mother.
Birth doulas are trained and experienced in childbirth, although they may or may not have given birth themselves. The doula's role is to provide physical and emotional support and assistance in gathering information for women and their partners during labor and birth. The doula offers help and advice on comfort measures such as breathing, relaxation movement, and positioning. She also assists the woman and her partner to become informed about the course of their labor and their options. Perhaps the most crucial role of the doula is providing continuous emotional reassurance and comfort.
Doulas specialize in non-medical skills and do not perform clinical tasks, such as vaginal exams or fetal heart rate monitoring. Doulas do not diagnose medical conditions, offer second opinions, or give medical advice. Most importantly, doulas do not make decisions for their clients; they do not project their own values and goals onto the laboring woman.
The doula's goal is to help the woman have a safe and satisfying childbirth as the woman defines it. When a doula is present, some women feel less need for pain medications, or may postpone them until later in labor; however, many women choose or need pharmacological pain relief. It is not the role of the doula to discourage the mother from her choices. The doula helps her become informed about various options, including the risks, benefits and accompanying precautions or interventions for safety. Doulas can help maximize the benefits of pain medications while minimizing their undesirable side effects. The comfort and reassurance offered by the doula are beneficial regardless of the use of pain medications.
The Doula and the Partner Work Together
The woman's partner (the baby's father or another loved one) is essential in providing support for the woman. A doula cannot make some of the unique contributions that the partner makes, such as a long-term commitment, intimate knowledge of the woman and love for her and her child. The doula is there in addition to, not instead of, the partner. Ideally, the doula and the partner make the perfect support team for the woman, complementing each other's strengths.
In the 1960s, the earliest days of fathers' involvement in childbirth, the expectation was that they would be intimately involved as advisors, coaches and decision-makers for the women. This turned out to be an unrealistic expectation for most men because they had little prior knowledge of birth or medical procedures and little confidence or desire to ask questions of medical staff. In addition, some men felt helpless and distressed over the women's pain and were not able to provide the constant reassurance and nurturing that women needed. With a doula present, the pressure on the father is decreased and he can participate at his own comfort level. Fathers often feel relieved when they can rely on a doula for help; they enjoy the experience more. For those fathers who want to play an active support role, the doula assists and guides them in effective ways to help their loved ones in labor. Partners other than fathers (lovers, friends, family members) also appreciate the doula's support, reassurance and assistance.
The woman's partner (the baby's father or another loved one) is essential in providing support for the woman. A doula cannot make some of the unique contributions that the partner makes, such as a long-term commitment, intimate knowledge of the woman and love for her and her child. The doula is there in addition to, not instead of, the partner. Ideally, the doula and the partner make the perfect support team for the woman, complementing each other's strengths.
In the 1960s, the earliest days of fathers' involvement in childbirth, the expectation was that they would be intimately involved as advisors, coaches and decision-makers for the women. This turned out to be an unrealistic expectation for most men because they had little prior knowledge of birth or medical procedures and little confidence or desire to ask questions of medical staff. In addition, some men felt helpless and distressed over the women's pain and were not able to provide the constant reassurance and nurturing that women needed. With a doula present, the pressure on the father is decreased and he can participate at his own comfort level. Fathers often feel relieved when they can rely on a doula for help; they enjoy the experience more. For those fathers who want to play an active support role, the doula assists and guides them in effective ways to help their loved ones in labor. Partners other than fathers (lovers, friends, family members) also appreciate the doula's support, reassurance and assistance.
Doulas as Members of the Maternity Care Team
Each person involved in the care of the laboring woman contributes to her emotional well-being. However, doctors, nurses and midwives are primarily responsible for the health and well-being of the mother and baby. Medical care providers must assess the condition of the mother and fetus, diagnose and treat complications as they arise, and focus on a safe delivery of the baby. These priorities rightly take precedence over the non-medical psychosocial needs of laboring women. The doula helps ensure that these needs are met while enhancing communication and understanding between the woman or couple and the staff. Many doctors, midwives and nurses appreciate the extra attention given to their patients and the greater satisfaction expressed by women who were assisted by a doula.
Each person involved in the care of the laboring woman contributes to her emotional well-being. However, doctors, nurses and midwives are primarily responsible for the health and well-being of the mother and baby. Medical care providers must assess the condition of the mother and fetus, diagnose and treat complications as they arise, and focus on a safe delivery of the baby. These priorities rightly take precedence over the non-medical psychosocial needs of laboring women. The doula helps ensure that these needs are met while enhancing communication and understanding between the woman or couple and the staff. Many doctors, midwives and nurses appreciate the extra attention given to their patients and the greater satisfaction expressed by women who were assisted by a doula.
Training and Certification
Doula training focuses on the emotional needs of women in labor and non-medical physical and emotional comfort measures. The programs require that participants have some prior knowledge, training and experience relating to childbirth, and consists of an intensive two or three day seminar, including hands-on practice of such skills as relaxation, breathing, positioning and movements to reduce pain and enhance labor progress, touch, and other comfort measures.
For certification, the doula must have a background of work and education in the maternity field, or she must observe a series of childbirth classes or equivalent. She must also complete the following: a doula workshop course offered by a DONA Approved Doula Trainer; required reading; and an essay that demonstrates understanding of the integral concepts of labor support. Lastly, she provides positive evaluations from clients, doctors or midwives and nurses along with detailed observations from a minimum number of births.
Doula training focuses on the emotional needs of women in labor and non-medical physical and emotional comfort measures. The programs require that participants have some prior knowledge, training and experience relating to childbirth, and consists of an intensive two or three day seminar, including hands-on practice of such skills as relaxation, breathing, positioning and movements to reduce pain and enhance labor progress, touch, and other comfort measures.
For certification, the doula must have a background of work and education in the maternity field, or she must observe a series of childbirth classes or equivalent. She must also complete the following: a doula workshop course offered by a DONA Approved Doula Trainer; required reading; and an essay that demonstrates understanding of the integral concepts of labor support. Lastly, she provides positive evaluations from clients, doctors or midwives and nurses along with detailed observations from a minimum number of births.
Summary and Conclusion
In summary, the doula is emerging as a positive contribution to the care of women in labor. By attending to the women's emotional needs, some obstetric outcomes are improved. Just as importantly, early mother-infant relationships and breastfeeding are enhanced. Women's satisfaction with their birth experiences and even their self-esteem appears to improve when a doula has assisted them through childbirth.
Analysis of the numerous scientific trials of labor support led the prestigious scientific group, The Cochrane Collaboration's Pregnancy and Childbirth Group in Oxford, England to state: "Given the clear benefits and no known risks associated with intrapartum support, every effort should be made to ensure that all labouring women receive support, not only from those close to them but also from specially trained caregivers. This support should include continuous presence, the provision of hands-on comfort, and encouragement."
In summary, the doula is emerging as a positive contribution to the care of women in labor. By attending to the women's emotional needs, some obstetric outcomes are improved. Just as importantly, early mother-infant relationships and breastfeeding are enhanced. Women's satisfaction with their birth experiences and even their self-esteem appears to improve when a doula has assisted them through childbirth.
Analysis of the numerous scientific trials of labor support led the prestigious scientific group, The Cochrane Collaboration's Pregnancy and Childbirth Group in Oxford, England to state: "Given the clear benefits and no known risks associated with intrapartum support, every effort should be made to ensure that all labouring women receive support, not only from those close to them but also from specially trained caregivers. This support should include continuous presence, the provision of hands-on comfort, and encouragement."
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