Value & Purpose of the Doula - One Perspective
With every birth, there is a wide range of birthing persons, circumstances, and outcomes to the birth process. The impact of that birth remains long after the birth itself is past. The experience of birth for all involved - the birthing person, the baby, and the partner - has great meaning and value.
Labour support from a birth doula can help the birther recall their experience in a positive light. We know, from studies that have been done on the recall memory of birth, that women remember their births in detail and with clarity for many years. They remember how they felt, if they felt heard and if they felt to be a part of the decision making process. Birthing persons who gave birth with the physical and emotional support provided by a doula felt the greatest levels of satisfaction. This is the value of a doula.
Birth doulas are no cure-all. We cannot make births go a certain way, and are not responsible for outcomes. Continuous labour support from anyone is of benefit to birthing persons. Yet, the doula has a place. Doulas are trained, knowledgeable experts in supporting births. A doula can look at a birthing person and reassure them with, ‘you’ve got this, you are doing amazing’ and because of their established relationship, can help them believe it of themselves. A doula will stand with a birthing person as she leans on her partner, providing physical comfort in the form of counter pressure during contractions to help them stay focused and relaxed for hours on end, if necessary. A doula will confidently reassure the birthing person that what they are experiencing is valid, providing reassurance and comfort. Doulas can also reassure the partner, suggesting a variety of comfort measures to provide relief and taking pressure off of the partner to know everything. This allows the partner to be the person who knows the woman the best, while the doula calmly suggests strategies to relieve discomfort, or reminds them both to eat, drink, and save their strength. A doula supports the birthing person and her partner by seeing that they have space emotionally to process, reminding them of their established birth preferences, and encouraging them to ask their care providers questions. In this way doulas help facilitate open communication between client and care provider. And when things don’t go according to plan, a doula can hold space for the birthing person to process the change, and help them move forward. Doulas occupy a unique position where they can gently guide the new parents to be empowered advocates for themselves, giving them the tools they need. A doula will accompany a birthing person for labour, but also provides emotional support both prenatally and in the immediate postpartum period.
A birth doula is not, does not, and cannot take the place of a primary medical care provider, such as a doctor, obstetrician, or midwife. That provider is responsible for the pregnant persons medical care, and for the health of the birther and baby. The provider handles the medical side of birth, such as ultrasounds and fetal heart tones, and it is the medical professionals’ responsibility for the physical side of birth, from vaginal exams, to catching the baby, providing pharmaceutical pain relief, and cesarean surgery. A doula does not provide medical or clinical tasks. Doulas do not diagnose or treat.
Doulas also do not practice outside their scope as physical and emotional support during labour without additional specialized training. A good example of this is aromatherapy. Doulas are not aromatherapists. While we may have knowledge that scents can provide benefits during the labour process (Peppermint being one that is helpful for nausea), a doula is not an aromatherapist and cannot provide peppermint oil to a client to treat nausea. If the doula is an aromatherapist as well as a doula, they must make it clear that her recommendation to use peppermint oil comes from her training as an aromatherapist, and not from her training as a doula. The same goes for other services a doula may provide - childbirth education, massage therapy, etc. Those services are outside a doulas scope, and can only be provided separately.
Ethically, a doula has several responsibilities. A doula must always maintain confidentiality for their clients, ensuring that their needs are met first, and should make every effort to foster maximum self-determination for the client. Once contracted, the doula must ensure a client has support either personally or through referral or backup. If possible, a doula should promote the value of ‘A doula for every person who wants one’ by providing services at reduced cost or referring appropriately to others. To do this, the doula ensures fees are reasonable, while valuing herself and the profession. To maintain reasonable value, a doula needs to broaden her knowledge and continually educate herself. She must also always be professional while conducting her duties.
The science is clear. The Cochrane review of the evidence on doulas outlines that having a doula provides measurable benefits to women. There is a link to lowering risk of Cesarean surgery, an increase in the likelihood of spontaneous vaginal birth, a decrease in risk of dissatisfaction with birth, decrease in the overall use of pain medications, and on average, shorter labours. Women with a doula are shown to have lower pain and anxiety levels than women who do not.
The value of a doula isn’t monetary. The purpose of a doula in providing support to pregnant persons and their partners makes a difference. A doula provides so much value, knowledge, training and support to a birthing person during a very vulnerable and transformative time. This time where a birthing person becomes something more remains deep within our memory and we deserve to have positive feelings around that transformation. A doulas purpose is for that vulnerable moment to be positively impacted. While costs for doulas may vary widely, the value in having a doula is immeasurable.