When my Grandmother was pregnant with my mother in the early 1950s, childbirth was a pretty scary event. Her experiences giving birth to my mother, and later, my uncle were very typical of the day-lonely, cold, and terrifying.
But with the birth of my aunt, my Grandmother experienced something different. Though the birth itself was similar to her other birthing experiences, my Grandmother remembers this birth more fondly thanks to a visit she had from a young nurse when my aunt was barely a day old. My Grandmother vividly remembers that this woman brushed the newborn's silky hair, winding it into a beautiful kiss curl on her forehead. These few moments of kindness transformed what had been a typical birth into something special, and created a memory to be treasured throughout my Grandmother's entire life. Whether she knew it or not, this kindly woman was a doula.
The title "doula" originally comes from an ancient Greek word that means "a woman who serves other women." Today the term is used to describe a woman who helps couples go through the process of childbirth. Unlike the woman in my Grandmother's experience, doulas are rarely nurses, and in fact, are usually lay women who feel a calling to help women in childbirth. But similar to the woman in my Grandmother's story, doulas bring a kind and nurturing touch to the birthing experience whether it be in the hospital or the home.
Typically, doulas visit with the mother and her partner a few times before the birth of the child. These visits allow the couple and the doula to get to know one another and plan for the birth ahead. By the time the woman goes into labour, she knows her doula well, and her doula is familiar with the woman's hopes and wishes for the birth, as well as her fears.
When labour starts, doulas are available day or night. Doulas offer suggestions about how to speed labour and ease pain. As well, a doula provides an extra pair of hands, ready to do what needs to be done, from refilling a water glass to parking the car. Most of all, a doula's quiet presence communicates support, encouragement, and reassurance-the "mothering" many labouring women crave.
For hospital-birthing couples, doulas are on hand to de-mystify terminology, procedures, and machines that can seem quite intimidating to parents. Doulas also make sure the couple receives all the information they need when faced with unexpected situations.
The support a doula offers is not limited to the mother; in fact one of the key aspects of a doula's role is to support the mother's partner. Whispers of "Why don't you try rubbing her back right here" or "She looks like she might like some more water" are common at doula-attended births, after which women will often marvel at how her partner mysteriously knew exactly what she needed.
After the birth, doulas return for one or two more visits to help with breastfeeding, process the birth experience, and refer to other community resources if necessary.
The results of this type of continuous care are impressive. A landmark 1993 study by Klaus, Kennel, and Klaus found a 50% reduction in cesarean births, a 25% reduction in length of labour, and a 60% reduction in epidural requests among women supported by doulas.1
Although doulas and midwives generally share a view of birth as a natural family event, they differ in that doulas do not perform any clinical skills or assessments. They are also different in that a doula's responsibility peaks during active labour when contractions are the strongest, whereas a midwife's responsibility peaks at the time of birth. This means that doulas can spend the bulk of their energy helping women from one contraction to the next, without having to save energy to monitor the delivery.
As well, doulas work with women that midwives generally do not work with, such as women who are classified as 'high-risk,' women who plan to undergo an epidural or a cesarean, or in parts of Canada where midwifery is not yet legalized, with women who plan a hospital birth. A doula wants her client to have the most satisfying birth possible, however the woman defines it.
Training programs for doulas are varied; however, like the training offered by the 4,600-member organization Doulas of North America (DONA), many begin with an intensive three-day workshop focusing on the physical and emotional aspects of childbirth and pain-coping techniques.
Doulas usually work in private practice, charging anywhere from $250-$800. Nevertheless, most doulas are committed to DONA's vision of "a doula for every woman who wants one," and offer their services on a sliding scale or on a volunteer basis.
Although the scope of the role played by the woman who had such an effect on my Grandmother's birth is far more limited than today's standards for doula care, the impact this woman had is what today's doulas strive for. Kindness, support, and recognition of the significance of childbirth are hallmarks of doula care, because, as in my Grandmother's experience, these were the factors that created a lifetime of positive births memories.
For more information, see our online article
Written by: Julia Allen
Doula
Birth Roots Doula Collective
2002
Notes
1 Klaus, Marshall H., John Kennel and Phyllis Klaus. Mothering the Mother: How a Doula Can Help You Have a Shorter, Easier, and Healthier Birth. Reading, Massachusetts: Addison-Wesley Publishing House, 1993.
