doula

A doula is an assistant who provides various forms of non-medical and non-midwifery support (physical and emotional) in the childbirth process. Based on a particular doula's training and background, the doula may offer support during prenatal care, during childbirth and/or during the postpartum period. A birth doula provides support during labor. Thus a labor doula may attend a home birth or might attend the parturient woman during labor at home and continue while in transport and then complete supporting the birth at a hospital or a birth center. A postpartum doula typically begins providing care in the home after the birth. Such care might include cooking for the mother, breastfeeding support, newborn care assistance, errands, light housekeeping, etc. Such care is provided from the day after the birth, providing services through the first six weeks postpartum. In some cases, doula care can last several months or even to a year postpartum - especially in cases when mothers are suffering from postpartum depression, children with special needs require longer care, or there are multiple infants.

Etymology and history of usage

The word doula comes from Ancient Greek δούλη (doulē), and refers to a woman of service as slave. In Ancient Greece, the word had negative connotations, denoting "slave." For this reason, Greek women performing professional labor support choose to call themselves labor companions or birthworkers. Anthropologist Dana Raphael first used the term doula to refer to experienced mothers who assisted new mothers in breastfeeding and newborn care in the book Tender Gift: Breastfeeding (1973).^{[citation needed]} 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.^[1]

Types of doulas

Labor/birth support doulas are 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, nor do they provide advice. Rather, they use massage, positioning suggestions, etc., to help labor to progress as well as possible. A labor/birth support doula joins a laboring woman either at her home, birth center, or hospital and remains with her until a few hours after the birth. Some doulas also offer several prenatal visits, phone support, and one postpartum meeting to ensure the mother is well informed and supported. The terms of a labor/birth doula's responsibilities are decided between the doula and the family. In addition to emotional, physical and informational 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 hired to support the woman after birth, usually in the family's home. They are skilled in offering families evidence-based information and support on breastfeeding, emotional and physical recovery from childbirth, infant soothing, mother-baby bonding, and coping skills for new parents. They may also help with light housework, coordinate freshly made nutritious meals for the mother, and help incorporate older children. The terms of a postpartum doula's responsibilities are decided between the doula and the family.

Some hospitals and foundations offer programs for volunteer community doulas.^[2] Volunteer doulas play an important role for women at risk for complications and those facing financial barriers to additional labor support. All doulas offer continuous encouragement and reassurance to laboring women. Volunteer doulas can encourage mother-based birth advocacy and motivate a woman to feel in control of her pregnancy.

The doula is an ally and occasional mentor for the father or partner. Their respective roles are similar, but the differences are crucial. The father or partner typically has little actual experience in dealing with the often-subtle forces of the labor process, and may receive enormous benefit from the presence of a doula, who is familiar with the process of birth. Even more important, many fathers experience the birth as an emotional journey of their own and find it hard to be objective in such a situation, and a doula facilitates the family process. Studies have shown that fathers usually participate more actively during labor with the presence of a doula than without one.^{[citation needed]} A responsible doula supports and encourages the father in his support style rather than replaces him.

Labour/Birth doulas in the UK

In the UK doulas are not required to be certified. However, doula preparation courses are available through several different organisations. The main organisation for doulas run by doulas is Doula UK (http://www.doula.org.uk/) They have a recognition process, a Code of Conduct, a philosophy and a complaints procedure. Doula UK also has a hardship fund to ensure that all parents who require the support of a doula have access to one.

Some steps are being made in the UK by governmental bodies to integrate doulas into more mainstream maternity services (see the Goodwin Project (http://goodwindoulas.org/). Many UK working doulas believe that much of the 'doula effect' is due to the doula's independence from Health Services and that the parents choose their own doula.

Doula UK is working to enable local health services to benefit from doulas, whilst maintaining the independence of individual doulas.

Labor/birth doulas in the US and Canada

In the United States and Canada, labor/birth doulas are not required to be certified. However, certification is available through several different organizations, such as Aviva Institute (http://avivainstitute.org), CAPPA (Childbirth And Postpartum Professionals Association), A.L.A.C.E. (now called toLabor[5] ), Cornerstone Doula Trainings www.cornerstonedoulatrainings.com, Birth Wisdom, D.O.N.A. (Doulas of North America)^[3], Birth Arts International, International Childbirth Education Association and I.C.T.C. (International Center for Traditional Childbearing). Their course, study, and practical requirements vary.

A labor doula provides:

• Continuous physical, emotional, and informational support during pregnancy, labor, and childbirth.
• Support from a person who understands and trusts the process of birth, and who helps facilitate the birth experience for the parents, baby, and primary care providers.
• Emotional support;
• 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 - though most doula certification programs discourage doulas from talking directly with caregivers for the mother/partners;
• Massage and other non-pharmacological pain relief measures;
• 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).

Postpartum doulas in the US and Canada

In the United States and Canada, postpartum doulas are not required to be certified, however certification is available through several different organizations. A postpartum doula provides:

• Assistance with breastfeeding education and offers tips and informational support
• In-home support for the mother, baby and family, anywhere from a couple days postpartum to several months.
• Informed and helpful newborn care help and assistance.
• Support for the partner so that s/he can support and nurture the mother, and the newborn baby.
• Evidence-based information.
• May also offer help in the following areas: household care, help with childcare/sibling care, meal preparation, errand running, and other tasks that may be requested.

Labour/Birth doulas in Australia

In Australia, the doula industry is not regulated and certification is not compulsory. Thus, anyone can be a doula. The course requirements are not regulated, so courses range from weekend courses to online courses, to year-long courses. Registration is not available. It is illegal for doulas to practice elements of midwifery as this is seen to be practicing midwifery without a license. Hence, doulas may not provide clinical care such as listening to the baby's heart rate, checking the blood pressure and so on. They also may not give clinical advice or provide opinion on the advice of professional care providers.

Benefits

Studies have found that birth companions, of which doulas are one type, offer numerous benefits both to the mother and child. Women with support have a reduction in the duration of labor, less use of pain relief medications, lower rates of operative vaginal delivery, and, in many studies, a reduction in caesarian deliveries. Newborns in supported births have lower rates of fetal distress and fewer are admitted to neonatal intensive care units. In addition, one study found that 6 weeks after delivery, a greater proportion of doula-supported women, compared to a control group, were breastfeeding, and these women reported greater self-esteem, less depression, and a higher regard for their babies and their ability to care for them.^[4][5] These results are similar to findings that support from a female relative during childbirth has similar effects.^[6]

One study found doula support without childbirth classes to be more helpful than childbirth classes alone, as measured by levels of emotional distress and self-esteem evaluated at an interview four months after birth. In particular, it was noted that women in the doula-supported group reported their infants as less fussy than the group attending childbirth class without any doula support.^[7]

References