The Role of the Doula

The Doula
The doula is quite new to some places like Australia but is flourishing in other western countries such as the USA and UK. The success of the doula lies in women’s increased feelings of satisfaction during the birth of their babies and reduction in the need for interventions.

The Doula's Role
Doulas develop a relationship with the woman during pregnancy and help her to conceptualise her ideal birth and to develop her birth plan. During labor the doula supports the mother emotionally and physically, as well as helping to maintain the birthing environment that the woman wants. The overall aim of the doula is to help the woman to achieve the best birth experience for her, whether this is a spontaneous vaginal delivery, a vacuum delivery or a caesarean section. The focus of the doula is on the woman’s needs and the woman’s perspectives. This means that the doula does not impose her own ideal of childbirth on the woman but supports the woman’s ideal. The majority of doulas work in the hospital labor ward with women who choose medical care during labor. This means that the doula works with the woman to help her to follow the advice of the midwives and doctors who are responsible for her clinical care. For this reason the doula has become a valued member of the care team on labor wards around the world.

The Value of a Positive Birth Experienc
It is recognised that the women who report negative experiences during the birth event, and their babies, are at increased risk of morbidity in both the short and long term (Scott, Klaus & Klaus, 1999; Odent, 1984). Despite the fact that interventions during labor are known to lead to negative feelings, the use of interventions in childbirth continues to increase dramatically (Australian Institute of Health and Welfare, 2002; Gilliland, 2002). It has long been known that reducing fear by supporting the birthing event in as natural manner as possible reduces the need for interventions and enhances the outcomes (Kofinas, 1985; Lederman, et al., 1978: Levinson, Gershon & Shnider, 1979; Odent, 1984; Balaskas, 1992; Sauls, 2002). It therefore stands to reason that supporting the birth event in a way that reduces fear can only assist the woman in achieving a positive birth experience.

Evidence for the Doula
A systematic review of evidence by the Cochrane library, which reviewed fourteen trials, involving more than 5000 women provides the most supportive argument for the use of doula care in labor (Hodnett, 2003). This review found that:
The continuous presence of a support person reduced the likelihood of medication for pain relief, operative vaginal delivery, caesarean delivery, and a 5-minute Apgar score less than 7. Continuous support was also associated with a slight reduction in the length of labor. Six trials evaluated the effects of support on mothers' views of their childbirth experiences; while the trials used different measures….in each trial the results favoured the group who had received continuous support.
Earlier research show similar findings.

Following their review of this evidence Klaus, Kennell and Klaus (1993) itemised the positive effects of doula care as:

• 50% reduction on cesarean rates,
• 25% shorter labor,
• 60% reduction in epidural requests,
• 40% reduction in syntocinon use,
• 30% reduction in analgesia use,
• 40% reduction in forceps delivery.