Value & Purpose of Labour Support

I am a Birth Doula certified by Doula Of North America (DONA) International. This is the essay that I wrote at the time of my certification. It's a little lengthy, but if you're interested at all in what I believe the Value and Purpose of Labour Support it's well worth a read. I've included the resources I used for the essay as well. Please, if you are hoping to be certified by DONA International write your own essay, and put yourself into it, don't steal mine. Enjoy!

Purpose & Value of Labour Support

            Throughout history women have supported one another during childbirth. With the inception of preventative interventions, however, these valuable supports were left to wait outside of the delivery room during this emotionally and physically exhausting time and mothers and their partners were left to make decisions based on little information. Thankfully, in the last half a century fathers became welcomed into the birth room allowing the couple to be together for childbirth (Klaus, Kennell and Klaus, 2002). This led to the realization that although fathers provided a familiar face and a loving relationship they were often not prepared to provide the support a labouring woman needed during childbirth (Klaus et al. 2002). The rebirth of continuous support provided by a caring, experienced woman, now termed “Doula”, filled this void and drastically improved the obstetric outcomes.

Studies have found that the beneficial effects of continuous labour support vary by type of provider but there was a decrease in operative birth and an increase in spontaneous birth when women were cared for by women whose training, role or identity focused on labour support and was not part of the hospital staff (Hodnett, Gates, Hofmeyr & Sakala, 2007, p.10). Similarly, another review by Hodnett, Gates, Hofmeyr, Sakala & Weston (p.13, 2011) found that women who were allocated to continuous one-to-one support were more likely to have spontaneous vaginal births, their labours were shorter, and they were less likely to have intrapartum analgesia,  caesarean or instrumental births, regional analgesia or a baby with a low five-minute Apgar score. A doula’s presence has proven to be highly beneficial in the childbirth environment.

            Similarly, DONA International’s Position Paper: The Birth Doula’s Contribution to Modern Maternity Care (2008), discusses the benefits of having continuous support during childbirth. The emotional, physical and informational support a doula provides is, however, more than just support: it is confidence in the ability to birth, to make decisions and to be a good parent; it is reassurance that parents will not be alone.  In The Birth Partner (2008, p.309), Penny Simkin states that:

“Studies have found lower rates of cesarean and fewer interventions among doula-attended births… by instilling greater confidence in the parents to choose options that include fewer un-necessary interventions and improve the chances for a normal labour.”

Continuous labour support also promotes long term benefits such as increased bonding between parents and infants, better breastfeeding relationships and an increased self confidence and satisfaction as parents leading to better long term attachment as a family unit. Fostering relationships is of utmost importance. A doula can give the emotional support necessary to ensure that the first few hours together as a family start off in the best possible way. It is a physically and emotionally sensitive time and the care she and her infant receive during this time can have a beneficial long-term effect on a woman’s self-concept, her relationships with the father, their care and image of their infant and their own emotional well-being (Klaus et al., 2002 p. 101). The benefits of having continuous labour support are evident in the positive effect that it has on obstetrical outcomes and the emotional and psychological well-being of the mother, all of which directly contribute to the overall well-being of the family unit.

            By providing informational, emotional and physical support a doula hopes to enable a mother and her partner to have a safe and satisfying birth as they define it. To help attain this goal a doula can help partners feel more confident in their ability to support the woman, allowing him to participate at his own comfort level and become more involved and subsequently contributing to a positive birth experience (Hodnett et al. 2011). Also, a time comes when questions arise during labour. Having a trained and experienced birth partner such as a doula can help to keep the woman at ease by answering questions or through reassurance. As discussed by Klaus et al. (2002). A doula can provide an objective perspective, a calm presence and removed, to some degree, from the mother’s discomfort. Finally, families that have information make informed decisions and are more likely to advocate for themselves when faced with a choice. A doula serves exactly this purpose. She advocates for the family by encouraging her client to gather information, ask questions and express concerns. The purpose of continuous labour support is, through empowerment, to ensure that a mother and her partner have a positive birthing experience.

            A mother’s well-being is the most crucial aspect of her care because it impacts so many parts of her life. The medical team has extensive training in the clinical well-being of the mother and plays a very important role in ensuring that she is taken care of. A doula also has a very important role; the non-clinical care of the labouring mother. The non-clinical aspects of doula care include: physical, emotional and informational support; pain relief through the use of comfort measures and relaxation techniques; and emotional reassurance. A doula can provide exactly this because she has taken the time to learn what a couple expects and wants during labour and is able to read  a mother and know what is and isn’t working; above everything else, she provides assurance that her support will be continuous (Klaus et al., 2002). Because a doula is not responsible for the medical well-being of a labouring mother, she can provide continuous and personalized care by focusing on the mother’s emotional and physical needs throughout labour and childbirth.

            Along with her non-clinical role, a doula also has ethical responsibilities that she, like many other professionals, must conform to and respect. First and foremost she has responsibilities to her clients. These ensure that a client is treated fairly and with the highest respect and professionalism. They include primacy; rights and prerogatives of clients, confidentiality, privacy, and finally a doula must both be reliable and set fair and well-stated fees (DONA International Code of Ethics, 2006). In order to ensure that a doula acts in accordance with the highest standards of professional integrity, she must treat her colleagues with respect, fairness and courtesy and when dealing with a colleague’s clients she should relate to them with full professional consideration (DONA International Code of Ethics, 2006). The doula must also strive to maintain the integrity of the labour support profession and to assist the DONA vision of “A Doula for Every Woman Who Wants One” by reducing or eliminating cost of her support services whenever possible (DONA International Code of Ethics, 2006). Finally, the doula has an ethical responsibility to society; promoting maternal and child welfare by promoting the general health of women and their babies (DONA International Code of Ethics, 2006). In order to uphold the integrity and professionalism of trained and certified doulas it is most important for doulas to respect and fulfill her ethical responsibilities.

            Although doulas have essentially been around for centuries it is only in recent history that they have been recognized as a truly valuable resource. Many studies have shown that interventions and complications are reduced when a mother receives continuous labour support and positive psychological and emotional outcomes have increased. Fathers and partners are more involved and families as a whole benefit from having a doula present. This non-clinical care and support that a doula provides has proven to have long-term benefits for both parents and infants and should not be overlooked. While the purpose of a doula is to ensure that a mother and her partner have a positive experience and memory of their child’s birth it is also the doula’s responsibility to maintain the integrity of the labour support profession by fulfilling her ethical responsibilities. All of which are an honour to be a part of.

References

DONA International. Code of Ethics: Birth Doula.

DONA International. (2008). Position Paper: The birth doula’s contribution to modern

maternity care. Simkin, P. & Way, K..

DONA International. Standards of Practice: Birth Doula.

Hodnett, E.D., Gates, S., Hofmeyr, G.J. & Sakala, C. (2007). Continuous support for women

during childbirth (review). The Cochrane Collaboration, (3), 1-68. Retrieved from www.childbirthconnection.org

Hodnett, E.D., Gates, S., Hofmeyr, G.J.,  Sakala, C., & Weston, J. (2011). Continuous support

for women during childbirth (review). The Cochrane Collaboration, (2), 1-100. Retrieved

from www.childbirthconnection.org

Kitzinger, S. (2004). The Complete Book of Pregnancy and Childbirth (4^th Ed.). New York:

Knopf.

Klaus, M.H., Kennell, J.H., Klaus, P.H. (2002). The Doula Book. (2^nd Ed.). Cambridge, (MA):

Da Capo Press.

Simkin, P. (2008). The Birth Partner (3^rd Ed.). Boston (MA): The Harvard Common Press.

Simkin, P., Whalley, J., Keppler, A. (2001). Pregnancy Childbirth and the Newborn the

Complete Guide. Minnetonka, (MA): Meadowbrook Press.