Tuesday, April 24, 2007

Why you really do want a doula...

When I gave birth for the first time, I didn’t know what a doula was, but I recently realized that the care and support of a “doula” is what actually carried me through that birth.

Her name was Eve. She was the labor and delivery nurse assigned to me when I entered the hospital for my oldest daughter’s birth. She was gentle, unassuming, and kind. When I told her that I was hoping to “go natural,” she mentioned that she could offer positions to try and techniques to cope with the pain of labor. She said she had given birth without drugs before, and knowing she was supportive and experienced gave me courage.

As labor progressed, Eve showed my husband how to provide counter-pressure to ease the discomfort of contractions. She pulled out the rarely-used, water-proof telemetry monitor so my husband could spray my back with hot water in the shower. When I got out of the shower, she brought in a birth ball and helped me to sit and rock on it. Later, she coached me to keep my vocalizing low, deep, and relaxed instead of high-pitched and tense. When I doubted myself and contemplated drugs as I struggled through the hardest contractions, she said, “Why don’t I check you first—you might be almost fully dilated.” Sure enough, I was only a couple of centimeters from the end. She told me that, in her experience, it felt good once you could push (and she was right). She rubbed my feet and sat by my side through those last intense contractions, encouraging me with her reassuring words. Although her shift ended before the pushing started, she chose to stay with me until after the birth. Ultimately, I did it! Giving birth for the first time without complications or drugs was one of the most empowering experiences of my life.

At the time I didn’t realize it was rare to find such a supportive, encouraging labor and delivery nurse. But, after my daughter was born, all I could do was mumble over and over to Eve, “Thank you, thank you, thank you.” I knew that if it hadn’t been for Eve’s patience and support I would not have had such a wonderful, satisfying birth.

Maybe you’re still thinking… what’s a doula? Doula is a Greek term—“a woman who serves another woman.” The tradition of women helping other women through childbirth is centuries old. The practice of hiring professionals to fill that role is fairly new. A modern birth doula is a hired labor support professional who provides comfort and advice but does no clinical tasks. According to the Doulas of North America (DONA) website, “The doula offers help and advice on comfort measures such as breathing, relaxation, movement, and positioning. . . . Perhaps the most crucial role of the doula is providing continuous emotional reassurance and comfort” (see DONA). Eve was a hospital nurse, not necessarily a trained “doula,” but she filled the doula role in my case. Based on my personal experience, I can attest that every laboring woman ought to have a doula’s aid.

Research supports my belief. Gathering and analyzing the results of 15 studies, a team of researchers found that, compared to women laboring without a doula, women who labored with a doula were:
• 26% less likely to have a cesarean section
• 41% less likely to have a vacuum extractor or forceps delivery
• 28% less likely to use pain medication or epidurals
• 33% less likely to rate their birth experience negatively
(Hodnett E, Gates S, Hofmeyr G, Sakala C. Continuous support for women during childbirth. The Cochrane Database of Systematic Reviews 2003. Issue 3. See DONA).

Another study showed that women who were supported by doulas were more likely to have success with breastfeeding as reported in a questionanaire at six weeks postpartum—exclusively breastfeeding on a flexible schedule with few problems (see Hofmeyr, Nikodem, Wolman, Chalmers, and Kramer; 1991, South Africa. British Journal of Obstetrics and Gynaecology 98 (1991):756-764).

With such significant benefits, it’s no surprise that doulas are the most highly rated providers of labor support according to the “Listening to Mothers” survey published by Childbirth Connection (formerly the Maternity Center Association, see website). Despite such rave reviews, few women are even aware of doulas. Fortunately, now you are one of them.

So, how do you find a doula, and how much does it cost to hire one? It’s really quite simple to find a trained doula. You can search on the DONA website (and other doula association websites) for lists of doulas in your area. Once you have a list of names, it’s a good idea to interview each one to find the right “fit.” Cost varies depending on training and experience, but most doulas have packages ranging from $200-$800 which generally cover one or two pre-birth visits, labor support, and one or two postpartum visits. Doulas typically espouse the philosophy that cost should never be a roadblock, so most will work with clients to barter, create payment plans, or even volunteer their services. Ultimately, the cost is insignificant considering a doula’s ability to help reduce complications and costly medical interventions, not to mention improve your overall birth experience.

DONA wishes to provide “A Doula For Every Woman Who Wants One,” and I’m convinced that most women, if educated about their benefits, would want one. Few women are lucky enough to have a supportive and attentive labor and delivery nurse like Eve. Birth has been given a bad rap over the years largely because women haven’t had the support they need to navigate labor’s journey with confidence, and society has, for the most part, lost faith in women’s bodies and the beautifully orchestrated process of birth. Birth can be a beautiful, satisfying, empowering experience—it has been for me. It could be that way for all women, and doulas are taking huge strides toward making that happen.


Brooke said...

Well, you have me convinced! When I have my first baby, I will be looking for a doula!

I have heard some of the same stories and different ones - about the way birthing is in hospitals (UNBELIEVEABLE things, I must say, which left me scared to really even THINK about having a child).

I must say, Lani... your story is not only inspiring to me - but comforting. I was beginning to get scared about the whole thing. Thank you for easing my thoughts about it and getting me excited about the birthing process & potential. :)

You are awesome. Love you!

Brooke said...

Lani! I love all of your information! One of your links led me to read this article and I loved it so I thought I would share it with you: http://pregnancy.about.com/cs/doulas/a/douladiary.htm

Thanks for being you!!

Love ya!