LABOR SUPPORT FOR A BLISSFUL BIRTH
Tay Smith Halas, Professional Doula 

When I first heard the term doula, I did not know whether it was an adjective, a verb or a noun.  Since becoming a doula, I have come to realize that I experience doula as all three. Even though it is only a noun according to the dictionary, I find that illustrating what a doula does is more complete with a “creative” approach grammatically.  

The Greek word doula is descriptive of a woman (and sometimes, a man) who, according to the Cochran Review (www.cochran.org), offers an indispensible service.  “…women who had continuous intrapartum support were less likely to have intrapartum analgesia, operative birth, or to report dissatisfaction with their childbirth experiences.”  These results occurred when, “…the provider was not a member of the hospital staff, when it began early in labor and in settings in which epidural analgesia was not routinely available.”  Studies have shown that when doulas attend a birth, labors are shorter with fewer complications, and babies are healthier (APGARs 7 +) and breastfeed more easily.  Doula, adj. = beneficial.

Birth doulas show action and are in agreement with their subjects.  They fulfill the role of protecting a pregnant woman’s memory of childbirth as a positive experience, one she will remember all her life.  Some doulas have strong clinical skills – they check blood pressure, do cervical exams and diagnose problems during labor – but are not primary care providers.  Most doulas, however, offer their expertise in the form of continuous emotional reassurance and comfort, physical support, and current information and statistics on the birthing process. They know what position changes, acupressure points or breathing techniques work and when to use them.  They offer facts about the risks and benefits of labor options that the medical staff doesn’t always have time to explain.  A doula encourages the laboring woman and her partner or coach to participate to the fullest, helping everyone focus during the most intense part of labor.  Research shows that the level of satisfaction of both the mother and her partner increases when a doula is present.  After the delivery, postpartum doulas offer care for the mother and infant at home.  These doulas assist with the newborn, sibling adjustment, breastfeeding tips, physical recovery from birth, coping skills for new parents, meal preparation and light housekeeping.  Studies provide evidence that a postpartum doula can reduce the risk of mood disorders in postpartum mothers.  They help the new parents adjust and develop a healthy routine.  Doula, v. = support.

Birth is a normal, natural process.  Unfortunately, due to fear and lack of knowledge, many women unnecessarily undergo a less than natural birth experience.  Induction of labor in the US was 9.5% in 1990, according to Jennifer Block in her landmark book Pushed.  As of 2004, that number had increased to 21.2%.  (She believes these numbers were underreported by at least 5%.)  Pitocin, a drug that mimics the naturally occurring hormone oxytocin, is used as one form of induction.  It is impossible to describe to the uninitiated the difference between natural contractions and those amplified by this drug.  A doula and coach have a much greater chance of comforting a woman whose labor is not complicated by the increased intensity, duration and occurrence of pitocin contractions. Block says that the mismanagement of the drug is the leading cause of obstetric liability suits and damage awards in the US and that pitocin-induced births are two to three times more likely to end in C-section.  Henci Goer, in her book Obstetric Myths Vs. Research Realities states that a C-section can carry four to five times the mortality risk of vaginal birth – at a rate of 30 per 100,000 births versus 6 per 100,000.  To put these numbers in perspective, she noted that in 1985, only 20 per 100,000 women aged 15-34 died in a car accident.  The cesarean section rate in the United States has climbed to an all-time high of approximately 33%!

A birth doula is a person, who comes to a place, with lots of things:  rebozos, massage tools, stress balls (or cows, in my case), comfy socks, birth balls, combs, music, herbs and teas, books, videos, essential oils, cushions, knowledge and encouragement.  She is there to help her client(s) discover concerns and preferences about childbirth and create a birth plan that reflects those things.  She supports their choices completely.  The doula will help navigate the unpredictable twists and turns of the birth experience with dignity and empowerment.  Most women are capable of the miracle of birth with nothing more than loving and confident support in place around them.  In rare instances, when there is a complication in labor that requires medical intervention, we fortunately have options available.  A doula can help a discontented couple make peace with a sudden change in plans.  Lamaze International (www.lamaze.org) believes that the following care practices, adopted from the World Health Organization, promote, support, and protect nature’s plan for birth:

1. Allow labor to begin on its own 
2. Promote freedom of movement/position change 
3. Have continuous labor support
4. Eliminate routine interventions 
5. Get upright for birth – squatting, hands and knees, etc. and follow natural urges to push
6. Keep baby with you after birth

Ina May Gaskin, a well-known midwife and author (www.inamay.com), gave a talk in December 2009 at Duke University where she recommended laughing during labor because it opens the cervix.  A doula with a fine sense of humor might soften the rough spots.  Ina May also told the audience that the prostaglandin in semen helps bring on labor.  Doulas can’t help with that, but they can offer a reminder of this interesting fact, especially if an obstetrician has you scheduled for an induction at 41 weeks.  Let’s keep it natural!  Doula, n. = guide.

Tay Smith Halas is a professional doula and student of   midwifery.  You can reach her at 336-601-2814 or email: ntrknktd@bellsouth.net.  For more information on doulas in the Triad visit http://www.padanc.org, website for Piedmont Area Doulas Association. Give the gift of a doula!