Thursday, November 19, 2009

Bring a loved one, friend, or Doula for continuous support

All images Courtesy: Google Images

This is the second time Aruban Breastfeeding Mamas is participating in Lamaze International's Healthy Birth Blog Carnival. These "Blog Carnivals" are based on Lamaze International's - The six Lamaze healthy birth practices. The third healthy birth practice is

Bring a loved one, friend, or Doula for continuous support

Having emotional, physical,comforting and informational support during labor can be empowering and can prove to be a blessing to the laboring woman. We will answer the following questions throughout the course of this blog, ; What are the benefits of having someone there to support me during labor? Why should I consider childbirth education classes and encourage my labor partner to attend with me? What is a Doula, and why should I consider hiring one? When meeting with a prospective labor Doula, what questions should I ask?

Benefits of having your partner/loved one/best friend there with you
 When a woman has an informed, caring and experienced labor support team/person there during childbirth it helps the mother to feel safer, more comfortable and relaxed during labor. Research supports that when a woman is calm, positive and assured about her labor, it increases the body's production of  hormones that ease the pain of contractions and help a mother to cope better.Women who are fully supported physically as well as emotionally, report feeling better and more satisfied about their birthing experience.

Why should I consider childbirth education classes and encourage my labor partner to attend with me?
Childbirth Education classes is a wonderful resource that can provide you and your labor partner with knowledge of pregnancy and childbirth, and can be a place to go to find support during pregnancy and get to know other pregnant couples/women. Childbirth Education classes offer a variety of benefits to you as well as your partner, even in subsequent pregnancies. If you have any questions and you need trust-worthy and current information, you can turn to your Childbirth Educator to provide the answers for you or will guide you to websites or books that contain the answer. In CBE (childbirth education) classes you will be taught the normal physiology and progression of pregnancy and childbirth and breastfeeding basics. Also included are coping strategies for pain and/or anxiety during labor. It's important that you as well as the person supporting you during labor (be it your partner, mother, sister or best friend) attend these classes together. Many a women report 'forgetting' what they learned in their class once labor begun. In such instances, a well educated and well informed labor partner can help the laboring mother to recall and implement all that she has learned.

What is a Doula, and why should I consider hiring one?

The word "doula" comes from the ancient Greek meaning "a woman who serves" and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.

A Birth Doula
  • Recognizes birth as a key experience the mother will remember all her life
  • Understands the physiology of birth and the emotional needs of a woman in labor
  • Assists the woman in preparing for and carrying out her plans for birth
  • Stays with the woman throughout the labor
  • Provides emotional support, physical comfort measures and an objective viewpoint, as well as helping the woman get the information she needs to make informed decision
  • Facilitates communication between the laboring woman, her partner and her clinical care providers
  • Perceives her role as nurturing and protecting the woman's memory of the birth experience
  • Allows the woman's partner to participate at his/her comfort level

Study findings indicate that, compared to women who do not receive continuous labor support, women who receive continuous, one-to-one support are less likely to:
  • have cesarean surgery;
  • give birth with vacuum extraction or forceps;
  • have regional analgesia (e.g., an epidural);
  • have the need for any analgesia (pain medication); and
  • report dissatisfaction with or negative feelings about their childbirth experience (Hodnett et al., 2007).
Two previous reviews of the research on continuous labor support had similar findings (Leslie & Storton, 2007; Simkin & O’Hara, 2002). The authors of all three reviews found that, compared to care from hospital staff nurses or midwives, continuous labor support is more effective when the person providing labor support is not a member of the hospital staff (Hodnett et al., 2007; Leslie & Storton, 2007; Simkin & O’Hara, 2002). In one review, increased benefits were found when continuous support started early in labor (Hodnett et al., 2007).
Research findings suggest that the benefit of labor support has no economic or cultural boundaries. In one study, continuous support reduced pain for low-income women who would have labored alone if they had not had a doula present (Simkin & O’Hara, 2002). Another study found that fewer cesarean surgeries and less need for epidural analgesia occurred when middle-class, laboring women and their male partner had the support of a doula (McGrath & Kennell, 2008). The same study also found that women and their partners were more satisfied with their birth experience when a doula provided support. Higher rates of early initiation of breastfeeding were found in an urban, multicultural setting when a doula was present (Mottl-Santiago et al., 2008).

My husband is worried that our Doula will take over his role
The doula is also responsive to the needs of the father and respects his level of involvement. First-time fathers are usually inexperienced in understanding and reacting to the normal behavior of a woman during labor and they appreciate the reassurance the doula offers. An experienced father may also appreciate a doula. While he cares for the mother, the doula performs peripheral tasks such as getting ice, juice, or blankets for the mother. She also fills in for the father if he needs a break, gives him an occasional back rub, and supplies supportive information. Since each labor presents its own unique challenges, even experienced birthing couples benefit from the services of a doula. A doula may also provide these kinds of support for others who support a mother in labor, such as friends or other family members.
The doula's calm presence and commitment to the mother's well-being helps counteract the effects of stress hormones (adrenaline and noradrenaline) which are released when a woman in labor becomes anxious, fearful, or insecure. Elevated stress hormones cause labor to slow down or stop while heightening the perception of pain. A trusting, relaxed mother continues to produce oxytocin (the hormone that causes the uterus to contract). She has more effective contractions, but with less tension in her body, she feels less pain. With quiet reassurance, the doula helps the laboring mother and her partner to draw on their own unique talents and strengths.

A good doula takes her cues from the labor partner. If your partner is sitting close to you, holding your hand, and providing eye-to-eye contact and supportive words, the doula will not interfere. Instead, she will support and encourage both of you.

When meeting with a prospective Birth Doula, what questions should I ask?
  • What training have you had? (If a doula is certified, you might consider checking with the organization.)
  • Do you have one or more backup doulas for times when you are not available? May we meet her/them?
  • What is your fee, what does it include and what are your refund policies?
When interviewing a birth doula
  • Tell me about your experience as a birth doula.
  • What is your philosophy about birth and supporting women and their partners through labor?
  • May we meet to discuss our birth plans and the role you will play in supporting me through birth?
  • May we call you with questions or concerns before and after the birth?
  • When do you try to join women in labor? Do you come to our home or meet us at the place of birth?
  • Do you meet with us after the birth to review the labor and answer questions?

It is a good idea for both you and your partner to meet doula candidates to decide if they are compatible with your family. Are they kind, warm and enthusiastic? Are they knowledgeable? Do they communicate well? Are they good listeners? Are they comfortable with your choices or do they seem to have their own agenda? Do you feel at ease with them?
The way that you feel with a doula is more important than the number of births that they have attended or how many new families they have nurtured. You may want to interview more than one doula and make comparisons before choosing your doula.

How do we do it here in Aruba?
The concept of a Doula is fairly new in Aruba. The lady who was my childbirth educator offers Doula services, and as far as I'm concerned, I think she's the only one. She focuses more on CBE classes though and keeps her work as a doula at a minimum. There are two women who are interested and are in the course of persuing doula training to be able to offer these services exclusively.  

Not using a Doula? Depending on your husband/partner, mother/sister or best friend for labor support? No worries! Here is Lamaze International's Birth partner cheat sheet., showing some guide lines and principles of how your labor partner can best support you and your choices. Remember, it's not always possible to be ready for any twist or turn that may pop up in labor, but by having the fundamental principles, your labor partner can assist you, come what may!

Healthy Birth Practice #3. Lamaze International and Injoy bring you the Lamaze Healthy Birth Practices on video. For more information, visit:



Hodnett, E. D., Gates, S., Hofmeyr, G. J., & Sakala, C. (2007). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub2 (This review is available at no charge on the Childbirth Connection Web site at
Leslie, M. S., & Storton, S. (2007). The Coalition for Improving Maternity Services: Evidence basis for the ten steps of mother-friendly care. Step 1: Offers all birthing mothers unrestricted access to birth companions, labor support, professional midwifery care. The Journal of Perinatal Education,16(Suppl. 1), 10S–19S.

Simkin, P., & O’Hara, M. (2002). Nonpharmacologic relief of pain during labor: Systematic reviews of five methods. American Journal of Obstetrics and Gynecology, 186(Suppl. 5), S131–S159.

McGrath, S. K., & Kennell, J. H. (2008). A randomized controlled trial of continuous labor support for middle-class couples: Effect on cesarean delivery rates. Birth, 35(2), 92–97.

Mottl-Santiago, J., Walker, C., Ewan, J., Vragovic, O., Winder, S., & Stubblefield, P. (2008). A hospital-based doula program and childbirth outcomes in an urban, multicultural setting. Maternal and Child Health Journal, 12(3), 372–377.


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