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A doula is a non-medical assistant in prenatal care, childbirth and during the postpartum period.
Etymology and history of usage
The word doula comes from Greek, and refers to a woman who personally serves another woman. In Greece, the word has some negative connotations, denoting "slave" or "servant of God," as some doulas have inadvertently discovered through their international social networks. For this reason, some women performing professional labor support choose to call themselves labor assistants. Anthropologist Dana Raphael first used this term to refer to experienced mothers who assisted new mothers in breastfeeding and newborn care in the Philippines. Thus the term arose initially with reference to the postpartum context, and is still used in that domain. Medical researchers Marshall Klaus and John Kennell, who conducted the first of several randomized clinical trials on the medical outcomes of doula attended births, adopted the term to refer to labor support as well as prenatal and postpartum support.
Types of doulas
Labor support doulas are trained and experienced labor support persons who attend to the emotional and physical comfort needs of laboring women to smooth the labor process. They do not perform clinical tasks such as heart rate checks, or vaginal exams but rather use massage, aromatherapy, positioning suggestions, etc., to help labor progress as well as possible. A labor support doula joins a laboring woman either at her home or in hospital or birth center and remains with her until a few hours after the birth. In addition to emotional support, doulas work as advocates of their client’s wishes and may assist in communicating with medical staff to obtain information for the client to make informed decisions regarding medical procedures.
Postpartum doulas are trained to offer families evidence-based information and support on infant feeding, emotional and physical recovery from childbirth, infant soothing and coping skills for new parents. They may also help with light housework, fix a meal and help incorporate an older child into this new experience.
Community doulas play an important role for women at risk for complications, and those facing barriers to prenatal care. These doulas will combine the roles of labor support and postpartum doulas to offer continuous encouragement and reassurance to pregnant women with little social support. In order to form strong, trusting relationships in a social support network, it often benefits a pregnant teen to participate in both group discussions and receive individual attention. In this way, community doulas can encourage self-advocacy, teach parenting skills and motivate a teen to feel in control of her pregnancy. Goals of social support models like the Community-based Doula Initiative, include preventing subsequent pregnancy and increasing the quality of the mother-infant bond directly after birth in order to increase the chances of secure mother-infant attachment throughout early childhood.
Doulas in North America
In the United States and Canada, doulas are not required to be certified, however certification is available through several different organizations *. A doula provides:
- Explanations of medical procedures and interventions;
- Emotional support;
- Advice during pregnancy;
- Exercise and physical suggestions to make pregnancy and childbirth more comfortable;
- Help with preparation of a birth plan;
- Facilitation of communication between members of laboring woman's birth team;
- Massage and other non-pharmacological pain relief measures, aromatherapy, any other non-medical comfort techniques she may be trained in;
- Positioning suggestions during labor and birth;
- Support the partner so that s/he can provide support and encouragement to the laboring woman;
- Help to avoid unnecessary interventions;
- Help with breastfeeding preparation and beginning;
- Some doulas offer a written record of the birth (birth story);
- Is present during entire labor and afterwards as long as is needed by parent(s).
Women supported by a doula during labor have been shown to have:
- 50% reduction in cesarean rate
- 25% shorter labor
- 60% reduction in epidural requests
- 30% reduction in analgesic use
- 40% reduction in forceps delivery
6 weeks after birth, mothers who had doulas were:
- Less anxious and depressed
- Had more confidence with baby
- More satisfied with partner (71% vs 30%)
- More likely to be breastfeeding (52% vs. 29%)
These statistics appear in “A Doula Makes the Difference” by Nugent in Mothering Magazine, March-April 1998. For detailed results from multiple studies, see: http://www.dona.org/positionpapers.html
For more information on the study of the effectiveness of doula support, please see http://maternitywise.org/pdfs/continuous_support.pdf
For more information on the Community-based Doula Initiative, please see http://www.chicagohealthconnection.org/our_work/doula/
External links
- http://www.alace.org
- http://www.doula.org.uk/
- http://www.cappa.net
- http://www.globalbirth.org
- http://www.positivebirth.org/
- http://www.midwiferytoday.com/friends/motherlove/
- http://www.bellywomen.net
- http://www.dona.org
"Doula"