The Special Role of the Doula

Whereas the midwife, ob-gyn physician and/or nurse, must focus on facilitating a healthy birth, the doula’s main concern is to promote the mother’s comfort, well-being, and parental readiness. Nurturing and competent female caregiving has been scientifically shown to offset labor time, level of pain, attachment problems, postpartum depression, and family tension. Continuing studies indicate that rates of birth complications, and a baby’s failure to thrive, may also be ameliorated. 

A maternal caregiver is there to provide physical and practical help to the new mother. In addition, the doula often provides the mother subtle emotional and psychological support that can’t be easily quantified and is non-formulaic. Like the best teachers, therapists, and parents, the doula optimally is a person with social and emotional intelligence and maturity, empathy, compassion, and warmth; who is personable and self aware, and open to being needed by a person who is in an extremely vulnerable situation. 

During late pregnancy, labor and the postnatal period, trained caregivers provide the safety, nurturing, responsiveness and respect to the mother, enabling her to more fully surrender to the biological process and enter states of alert receptivity, internal focus and vulnerability needed to cope with intense waves of physiological (and emotional) change.

A parent who has been supported may be more prepared to recognize the subtle signals of their young child can be responsive in appropriate ways. The child feels safe and nurtured and is prepared for gaining more autonomy. This lays the groundwork for self-regulation.

Preparing For Labor
Practical Ways Doulas Can Help 

The Doula is a Knowledge Resource
A birth doula needs to have accurate, up-to-date, and in-depth knowledge about all facets of labor, birth and the immediate postpartum period, so that she can provide ongoing education to the parents.

The birth-giver is educated and included in all decisions
Prior to labor, the doula makes sure that the mother and her partner are adequately informed about all options related to birth, pain management, and postpartum care. They should be made aware of the phases and experience of labor, including the range of normal emotional, physical, and interpersonal changes that might occur. 

Helping to reassure and provide perspective
The doula can also help the mother who has unrealistic expectations, is self-critical, and perfectionistic, to recognize the realities of motherhood, and to accept that daily life will significantly change with a new baby.
The doula patiently answers questions as often as needed; and may have to answer the same inquiry many times.

Working Effectively with Medical Providers
The doula advocates for the mother’s needs with medical and hospital officials
Doulas should not interfere with procedures conducted by medical management (physicians, nurses, or midwives) outside her realm of expertise. However, doulas can act as liaisons to ensure the birth-giver’s wishes, concerns, and needs are fully respected and considered by medical staff.

Doulas can respectfully ask the medical professionals if she can try out a particular technique before an intervention is used: such as a change in position to help turn a baby or a non-pharmacological pain relief method. (Optimally, having these options available is arranged before labor begins.)

Creating a positive birth experience. How a Doula Can Help

A variety of factors can enhance a woman’s birth experience
Doulas have acquired many skills from their training and their own experience to help laboring women. Whereas the midwife, ob-gyn physician and/or nurse, must focus on facilitating a healthy birth, the doula’s main concern is to promote the mother’s comfort, well-being, and parental readiness. Nurturing and competent female caregiving has been scientifically shown to offset labor time, pain, attachment problems, postpartum depression, and family tension. Continuing studies indicate that rates of birth complications, and a baby’s failure to thrive, may also be ameliorated.
A positive birth experience requires far more than handholding
A birth-giver needs to be secure that the person helping is competent and responsive, is “on top” of everything that is actually happening, and has knowledge about what to do to help. She needs to know that her caregiver won’t leave her, will help her through every contraction, will work with her through the pain, will guide her as needed, will help her understand and express her own feelings, fears, needs, worries, convey her wishes to the medical caregivers, will not confront or be in conflict with the other caregivers, but help her express herself, and as appropriate ask respectfully if a particular method might be used before a medical intervention is done.
Informing and Educating
At each stage of labor, the birth-giver is kept abreast of what is occurring. She is given updates every step along the way, briefed about any new developments and the thinking of the staff and their recommendations, potential decisions to be made, etc.

Comfort and Sensitivity
The mother’s body should be treated in a gentle, sensitive and careful manner. 

She feels secure that her body won’t be injured, that an epidural will be administered in a way to not hurt her joints, and will not be given any unnecessary invasive procedures, such as episiotomy, etc. She is helped to work with her body and to manage the pain with a variety of methods.

The doula is always available and near at hand
During first-stage labor, if the mother is comfortable, stable, and doing well, she may specifically request an interval of privacy. For example, parents with past childbirth under their belt may want some time to themselves. The doula can step back into an unobtrusive role, sit quietly in the room, or in the next room, to be called when needed. She should remain alert.

Running interference
The doula provides a “firewall” against stressful encounters, undue pressure, and distractions. She makes sure that the woman’s privacy is respected—that she is not intruded upon. Doulas can model appropriately respectful behavior for others on the birth team. She makes sure that everyone speaks calmly and gently and does not convey anxiety to birth-giver. No one walks in or out of the birth-giver’s room without explaining what she or he is doing, checking, learning, and the reasons for it (except during states of absorption, when she is not to be disturbed).

Nurturing and Doting
The birth-giver feels cared about, totally supported, and valued, her wishes known and respected. She feels accepted and should never feel judged or be seen as inadequate. The doula consistently reassures and comforts mother, and allows her to utterly relax and be “cared for.” The doula is unconditionally accepting and sensitive to changing states of mind and moods—and comfortable with any bodily responses: messiness, awkwardness, fluids, etc. 

Autonomy
The birth-giver is free to change her mind or her choices. She is regularly asked if a method, an action, or a technique is still working for her.