Rachel assisting at the birth of Jackie's second child

The Purpose and Value of Labor Support

As part of my birth doula accreditation process with DONA International (almost done! I should have the packet in the mail this week!!!!!), I am required to write an essay on “The Purpose and Value of Labor Support.” I share it here.

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The birth of a child is a challenging and transformative time. “The moment a child is born, the mother is also born. She never existed before. The woman existed, but the mother, never. A mother is something absolutely new,” wrote Bhagwan Shree Rajneesh. This is true for every mother, with every birth. It is in the interest of the mother, the child, and the whole family—indeed of society at large!—that this “absolutely new” mother-being should be as physically, emotionally, and spiritually healthy as possible. The physical well-being of mother and baby are widely acknowledged, and are the purview of the mother (and her partner if she has one) and the medical team. The mother’s emotional/spiritual well-being, however, are too often overlooked in the bustle. This is where professional labor support—a birth doula—can be of most service.

A doula’s responsibilities span the prenatal to early postpartum period. They begin, typically, during pregnancy. The doula assists her clients in acquiring and understanding information related to their own and their newborns’ health care. This may mean helping the mother find childbirth education and breastfeeding classes; sharing and discussing books, websites, or scholarly articles; helping the mother prioritize birth preferences and compose a document to share with her care provider; and working through feelings and anxieties related to childbearing. Postpartum, a birth doula should remain in touch with her client for a period of a few days or weeks, ideally with at least one in-person visit to offer breastfeeding support, give the mother a chance to reflect on her birth experience, and observe mom for signs of postpartum depression or other referral needs.

The birth doula’s main duties, of course, are executed during labor and delivery. From the first suspicion that labor may be imminent, a doula is available for support and encouragement, though in early labor telephone support is appropriate and (to prevent doula exhaustion and help mom remain calm and restful) generally preferred. As labor progresses, the doula joins her client and provides continuous, calm emotional and physical support as needed. In some parts of some labors, this involves much rubbing of backs and supporting of squats; at other times it may involve speaking to a mom with an epidural and reminding her that she is, in fact, in labor. It may mean going for a walk, or sitting down to breakfast, or chanting with a mother to help her maintain her rhythm when contractions become strong, or subtly encouraging mom’s partner to take a walk or a nap so he/she has the energy to be supportive later on. It will almost certainly involve continued discussion of the laboring mother’s preferences for her care, as the situation evolves, and helping her keep up a constructive and mutually satisfactory dialogue with her medical team.

None of this is necessarily easy (well, except sitting down to breakfast!), but it can benefit everyone involved, from mom to baby to partner to medical professionals, in the short and long term. The presence of a doula is statistically associated with shorter labors and with decreased use of analgesia/anesthesia, vacuum extraction or forceps, cesarean birth, babies with low 5-minute Apgar score, and dissatisfaction or a negative rating of the birth experience. It eases the burden on the laboring woman’s partner (or other social support), as such loved ones are typically relatively unfamiliar with childbirth and can benefit from a doula’s knowledge. Moreover, labor support drawn from a mother’s social network is, by definition, intimately emotionally involved with her and may find it hard to remain calm and professional even when they are extremely knowledgable; a professional doula can provide both breaks and an aura of calm that can benefit everyone involved. A doula can even make doctors’, nurses’, and midwives’ jobs easier: the doula’s physical and emotional support of the laboring woman lighten medical staff’s load and give them more freedom to focus on medical care.

A doula does not replace any of the more traditional roles in the birthing room, but having a doula present allows everyone else there to focus more completely on their own tasks. Mom can focus on laboring and birthing her baby, her loved ones can focus on loving her, medical staff can focus on mom and baby’s physical well-being. The doula watches, and steps in where needed, to help the laboring woman feel empowered and, so far as possible, physically comfortable. A doula cannot ensure that any given client will have the physical outcomes she desires, or even always the emotional ones, but she can help to make the process of birth one in which the laboring woman feels heard and valued, which can only have positive effects on her parenting and self-identity, and therethrough on how she, and her child, live in the world.

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