The Purpose and Value of Labor Support

May 23, 2009 at 2:46 pm (Comfort Measures, Doula, Informed Consent) (, , , , , )

Labor support is not a new concept.  Traditionally, a birthing mother’s female relatives and friends would gather to assist her through labor, birth and the postpartum, with or without the added assistance of a trained birth attendant.  Now, with an increasing number of extended families living great distances from one another, and with the demands and pressures of modern life and careers, that traditional support has been interrupted.  Women labor in the unfamiliar environment of hospitals, alone or with the support of a husband or partner who may have no prior experience with childbirth.  The creation of the professional doula’s role serves to address that lack of experienced, usually female, support that women used to provide for one another.

The birth doula’s role is to provide nonmedical support to mothers, families, and/or their friends throughout labor, birth, and the immediate postpartum. This support may take the form of physical comfort measures such as gentle massage, hand holding, positional support and recommendations, as well as many other techniques gleaned from modern and traditional sources.  Doulas also nurture their clients emotionally, providing encouragement and acceptance throughout the intense experience of labor.   Another part of the doula’s role is her advocacy for her clients.  Doulas meet with their clients prenatally and listen to their needs, values, and plans for their birth.  They assist their clients in gathering information about aspects of labor and birth that are important or of concern to the client.  During labor, a doula can help to facilitate communication with medical caregivers, and she can remind the mother of aspects of her birth plan or prenatal conversations.  This advocacy does not extend to speaking for the client, or to making decisions for her.  Doulas must be careful to shed all of their own values and standards of what constitutes a good birth, choosing instead to serve as a recorder and reminder of the mother’s decisions and needs.

The birth doula has responsibilities to the women and families she works with, her colleagues, the labor support profession and society in general.  “The doula’s primary responsibility is to her clients.” (DONA Code of Ethics)  She allows and encourages her clients to make their own decisions regarding their care.  She maintains their privacy and confidentiality, and does not spread information she has heard in client meetings to anyone else.  The doula strives to assist each mother who is seeking labor support in finding a doula.  She makes sure she is available to provide the care she has agreed to provide, and if she is unavailable, she makes sure to have a backup doula who can serve the client in her place.  She maintains reasonable fees which she clearly communicates to her clients, as well as the services provided for those fees.  With respect to her colleagues, the doula maintains a fair, reasonable, respectful relationship with them, and treats their clients with courtesy.  Doulas support their profession by maintaining its “values, ethics, knowledge and mission.” (ibid.)  When possible, she provides some clients with free or reduced cost services, to continue the “vision of ‘A Doula For Every Woman Who Wants One’” (ibid).  Finally, a doula commits to advocating for the health of women and children across society.

When birth doulas act according to their roles and responsibilities, the rewards to mothers and children are obvious and encouraging.  According to the findings of Hodnett’s et al meta analysis of 15 trials from North America, Europe and Africa, “Women cared for during labor by a birth doula, compared to those receiving usual care were

Cesarean sections have documented risks for mothers “including infections, hemorrhage, transfusion, injury to other organs, anesthesia complications, psychological complications, and a maternal mortality two to four times greater than that for a vaginal birth,” (http://www.childbirth.org/section/CSFact.html), and risks for babies, including “increas(ing) the risk to the infant of premature birth and respiratory distress syndrome, both of which are associated with multiple complications, intensive care and burdensome financial costs. Even for mature babies, the absence of labor increases the risk of breathing problems and other complications.” (ibid)  The decrease in cesarean birth for women accompanied by a doula in turn decreases the risks of these negative outcomes, and so therefore doula care has a positive effect on the health and wellbeing of laboring women and their newborns.

 An equally important consideration is the mother’s satisfaction with her birth experience.  Since mothers who have the help of a doula are less likely to remember their birth as a negative or traumatic event, they may be less likely to succumb to certain postpartum mood disorders, such as postpartum depression and post-traumatic stress disorder. 

These scientifically verified outcomes of labor assisted by a doula are encouraging in a country whose maternal and neonatal mortality rates rank among the worst in the developed world. “American babies are three times more likely to die in their first month as children born in Japan, and newborn mortality is 2.5 times higher in the United States than in Finland, Iceland or Norway, Save the Children researchers found.”  (http://www.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/)  Doulas, with their information gathering and nurturing support, are well-placed to assist families in achieving a healthy, positive, and powerful birth, and therefore the best possible start for their life together as a family.

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