The United States has seen many great advances for birth in the last 20 years which are undoubtedly saving lives, and yet, we are also seeing an increase in the deaths of mothers and their babies. In 2013, researchers estimated 18.5 U.S. mothers died for every 100,000 births, “That is more than double the maternal mortality rate in Saudi Arabia and Canada, and more than triple the rate in the United Kingdom” (Maternal Deaths in Childbirth Rise in the U.S., The Washington Post). In 2010, the CDC found the U.S. infant mortality rate was in the lead compared to 25 other participating countries, many of those following the same western medicine techniques as used in the United States (International Comparisons of Infant Mortality and Related Factors: United States and Europe). Yes, there are unforeseen complications and poor health amongst mothers which factors in the demise at birth, but there is clearly an increase of maternal death rates alongside the use of unnecessary interventions. However, there is a way to protect birth, create better outcomes, and improve the quality of care mothers are receiving.
The word doula (doo-lah) is of Greek origin, meaning “a woman who serves”, and in the last 30 years has been adapted as the word to describe a trained and experienced professional with knowledge in labor and birth. The doula does not perform any clinical tasks (Position Paper: The Birth Doula’s Contribution to Modern Maternity Care, DONA International). With many of the lifesaving medical interventions, skilled doctors and midwives, why is it important to have a person there who doesn’t even so much as check your temperature? Is it even worth having a doula? Yes. John H. Kennell, MD, tells us, "If a doula were a drug, it would be unethical not to offer it to every laboring mother."
Doulas make birth better by encouraging advocacy, as well as providing educational, mental, emotional, and physical support to a mother and her birth partner (Kyndal May, MFA, LMP, CD/BDT(DONA), LCCE). The doula provides these services throughout pregnancy, labor, birth, and postpartum. Doulas are not a replacement of the doctor, midwife, nurse, or birth partner; they share their knowledge with the expecting parent(s), making them aware of their options (DONA International's Standard of Practice). Doulas work alongside and respect the mother’s healthcare providers (Position Paper: The Birth Doula’s Contribution to Modern Maternity Care; Doulas as Members of the Maternity Care Team, DONA International).
Another term birth professionals use to describe a doula is speed bump. Just as a speed bump reminds you to use caution and slow down, the doula reminds the laboring mother to question the risks and benefits of augmenting her labor. This advantage helps a mom make educated rather than fear based decisions.
In June of 2015, Lamaze International published a quick educational video on the benefits of having professional birth support, such as, a 28% decrease in cesarean births, Epidurals reduced by 9%, and the use of Pitocin (the drug which causes contractions to last longer and be stronger) reduced by 31%. As with any intervention there are risks, but when we can lower the rate at which these interventions are used, we lower the risk of harm and death to our nation’s mothers and babies. So, how does the doula help create these positive outcomes?
The doula knows a variety of techniques to create better results without having to jump straight to the drugs and/or surgery. Of course, there are moms who feel better about having, or need a drug assisted birth and doulas can be of great benefit to these mothers as well. Let’s say a mother wants an epidural for her birth. The epidural is administered through a catheter in her back and within about 30 minutes she has felt the full effects of the epidural kick in. Her pain receptors are blocked by the medicine flowing into her spine, which also immobilizes her. The doula, having been with the mother from the beginning of labor, can then help the mom adjust into optimal positions and even manipulate mom’s legs to keep the pelvis open and in motion which helps the baby descend. These actions prevent the labor from slowing down or stalling, and can even speed up labor.
“The birth of each baby has a long lasting impact on the physical and mental health of mother, baby and family.” (Position Paper: The Birth Doula’s Contribution to Modern Maternity Care, DONA International). It is important for the mother to feel at peace and respected during her labor. When a mom is made to feel insecure or fearful in her labor, the birth will have a negative impact on her and she will have a hard time bonding with the baby. Some mothers are so traumatized after birth that they can’t bear to hold their newborn infants.
Birth is a sacred moment that we must protect. Moms need to have good birth experiences. They need to feel safe and in control. With doulas honoring a code of ethics, (DONA International's Code of Ethics) they can make a positive difference in families lives by respectfully working alongside medical professionals.