A Birth Doulas role, in the most basic explanation is to provide continuous labor support for the pregnant person. However, a Birth Doulas role of support for the family begins well before the caregiver has their first contraction and continues after the baby has arrived.
In the beginning, around week 37 of pregnancy, a Doula will be on call for the pregnant person. Phone calls, text messages and pictures are common ways of communicating questions and concerns. Mainly these will come from the birthing person, but on occasion a partner will also reach out. It is not a Doulas role to diagnose or verify anything during this time, (i.e. start of contractions, rupture of membranes, high blood pressure) but would have the client contact their provider and then follow back up with their Doula. It is within the Doulas role to provide emotional support in these few weeks before labor, and also serve as a referral source for services that the family may want or need during this time, as well as after the birth. It is in these weeks that a birth plan is discussed and alternative circumstances are also brought to light.
It is important for a birthing person to understand that while in labor in a hospital, there are multiple Labor and Delivery staff that will be caring for them, none of whom really know their birth plan. Their primary role is on the medical side, not to assist in labor positions or comfort measures. A Doula can make a very big difference in assisting with these comfort measures, helping the family advocate their wants and needs, and helping the family understand medical terms and options.
Once checked into a hospital, there are many scenarios that may play out. For example; If it is felt that the birthing person is not progressing fast enough, or if the water has broken but there are no contractions, or in the event of an induction, there is often a great deal of information given and possibly quickly depending on how busy the Labor and delivery floor is. Having a Doula present can first advocate for some time for the laboring person and family (if applicable) to think about what next step they would like to take. A Doula will also help explain in easier to understand terms what the doctors and nurses are saying/suggesting. In some hospitals a Doula will have to work very hard to help advocate for the rights of the laboring person to make their own choices (baring medical necessity), and in some hospitals they are more open to allowing the laboring person to make decisions. It is overwhelming and a lot of caregivers simply rely on the L&D staff for their opinions. If these opinions do not line up with the laboring persons views, they may not know how to change that and could end up in a laboring situation that they did not want. This cannot only cause discomfort; it can also slow progression and possibly end in a C-section. Having a Doula also means the laboring person is never alone.
In the U.S. about 32% of deliveries are by Cesarean. According to ICEA (international Childbirth Education Association), having a Doula present at birth has shown a 50% reduction in C-sections, shorter labor, reduction of epidural requests as well as less use of Pitocin. In addition, 34% of birthing caregivers who have a Doula at birth are less likely to rate their birth experience in a negative way.
It is often thought that if a home birth is chosen that a doula is not necessary. It is important to understand the role of the midwife in a homebirth and how, when working together this team creates a strong and positive birth environment. It is common for laboring person to believe that midwives and doulas play similar roles but a midwifes role is focused on the medical side of the labor. A midwife may also not arrive until the birthing person is further along in the labor process. A Doula at a home birth can assure that the laboring person is never alone, that the midwife can take a break if needed and that the family is supported throughout the entire labor. In this instance their may be another child(ren) involved in the labor process, and it is an important role of a doula to help anyone involved in labor support to be part of the childbirth experience. While there is no need to educate and advocate in a home birth concerning epidurals or induction methods, the scientific evidence that shows that having shorter and less painful labors with a Doula hold true for both hospital and home births.
After the baby is born, a birth Doula will also have one or two post-natal home visits. If there is a struggle breastfeeding a Doula can be of assistance as well as give other resources. It is also during these first few days at home that a new caregiver is typically exhausted and feeling very unsure of their new role as a parent. A birth Doula can identify these emotional struggles and help a new parent and family find their confidence as caregivers. A Doula in the postpartum phase may give a list of local resources for most situations that can arise during this time. If the parent does not want, or cannot talk about what they are struggling with, or it is beyond the scope of practice of a doula the new parent now has a guide of local support people they can reach out to.
The purpose and value of labor support can make the entire birth experience from pre-labor through postpartum more successful and one with more positivity. It also builds self-confidence in the laboring person, which can be of great importance in grappling with her new found parental role.