This is my personal statement on the purpose and value of labor support-- submitted along with other required materials for my Doulas of North America certification application.
The Purpose and Value of Labor Support
by Gaylen Alexander
Labor is an intense period in a woman’s life. Whether it is exhilarating, uncertain, uncomfortable, or all of the above, birth is both emotionally and physically demanding. Doulas help to make these demands more bearable by carrying some of the burden. This could be as literal as the doula holding a mother through contractions, or more indirect; even the presence of a doula can alleviate some of the stress felt by a woman and her family.
Doulas are in a unique position to provide emotional and physical support for a woman during a very intimate occasion. They are trained and knowledgeable about this point in a woman’s life, and have experience to draw from. However, it is crucial to understand the limitations of their knowledge, training, and responsibility. The role of the doula is cut short at medical support: among any other medical procedures, they cannot perform exams, take temperature or blood pressure, or provide other clinical care. These boundaries are crucial for upholding the goal of the doula: to promote the welfare of the mother, her child and any other companions present by providing emotional and physical care that complements the care of her medical providers.
Beyond a family’s evident appreciation for their doula following a birth, tangible benefits of doulas have been recorded in medically recognized studies. According to one randomized study in Houston, the average length of labor for a woman without a doula was 9.4 hours, and 7.4 hours for women with a doula (Klaus 83). This is marked as a highly significant difference, and is just one set of results among many that illustrates the obstetrical benefits of having a doula present. Klaus, Kennell and Klaus also mention how the period around birth is a “formative developmental stage” for mothers (Klaus 101); the benefits of a doula are not only seen during the labor and delivery itself. A randomized, controlled study that was published in the American Journal of Obstetrics and Gynecology shows that at six weeks postpartum, women with a doula had lower rates of anxiety and depression, and higher self esteem (Wolman, qtd. in Klaus 106). Again, these results were seen as highly significant. The companionship, reassurance, and comfort that a doula provides do have a very clear effect, and results have been published in medical literature.
A doula’s role is to help a mother and her family have a satisfying experience despite the unpredictability of birth. To achieve this goal, a doula must always focus on the mother in labor. Building a strong relationship with her is crucial. Even if this must happen during the labor itself, the doula must respect the woman and her choices, be flexible with her needs, which may change moment to moment, and try to read any cues she may give, regardless of how subtle they are. A mother’s needs are always first and foremost in the doula’s eyes. This could even mean that the doula does not directly support the mother. Helping a partner feel at ease in an unfamiliar environment and giving space for them to comfort the mother and bond with her could be the most beneficial for both. When given in an unbiased and conscientious way, labor support crosses cultural, socioeconomic, and language barriers, and is a valuable experience for both the family and doula.
Klaus, Marshall H., John H. Kennell, and Phyllis H. Klaus. The Doula Book: How a Trained Labor Companion Can Help You Have a Shorter, Easier, and Healthier Birth. Cambridge, MA: Perseus Pub., 2002.
Wolman, W. L., B. Chalmers, and G. J. Hofmeyer. "Postpartum Depression and Companionship in the Clinical Environment: A Randomized, Controlled Study." American Journal of Obstetrics and Gynecology 168(1993): 1388-393.