Why Hire a Doula?

By now you know what a doula is and a little bit about the history of doulas. Now you're wondering whether hiring a doula for the birth of your child is the right choice for you. There have been many reports on the benefits of having a doula present for a birth, which will hopefully aid you in deciding whether or not you want to hire a doula.

Numerous clinical studies have found that a doula’s presence at birth:1

  - tends to result in shorter labors with fewer complications
  - reduces negative feelings about one’s childbirth experience
  - reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans
  - reduces the mother’s request for pain medication and/or epidurals

Research shows parents who receive support can:2

  - Feel more secure and cared for
  - Are more successful in adapting to new family dynamics
  - Have greater success with breastfeeding
  - Have greater self-confidence
  - Have less postpartum depression
  - Have lower incidence of abuse


Percentage of women who used an epidural or other pain medication during labour3

With Doula 7.8%
Without Doula 55.3%

Results of feeding questionnaire taken at 6 weeks postpartum4

With Doula Without Doula
Exclusively breastfeeding 51.4% 29.3%
On food other than milk 17.6% 53.3%
Has had feeding problems 16.2% 62.7%
Feeding on a flexible schedule 81.1% 46.7%

Meta-analysis of several doula studies5

  - 36% reduction in use of pain medications
  - 51% reduction in c-sections
  - 71% reduction in use of oxytocin
  - 57% reduction in forceps deliveries
  - an average of 1 hour and 38 minutes shorter labour

Labour support persons and effectiveness of support6

Take a look at the following study. The first table shows what percentage of labouring women used which type of support person; you can see that a doula is a rare blessing at a birth. The second table shows the effectiveness rating that these labouring women gave their support person. Despite the fact that they aren't so widely used, doulas rank very high on the effectiveness scale! The numbers below may surprise you.

Type of Person Providing Labor Support Proportion Receiving Care from this Source
Partner/husband 92%
Nursing staff 83%
Doctor 53%
Another Family Member or Friend 50%
Midwife 11%
Doula/trained labor assistant 5%
Some other person 2%
Received no support 1%

Type of Person Providing Labor Support Proportion Receiving "Excellent" Ratings
Doula/trained labor assistant 71%
Midwife 66%
Another Family Member or Friend 60%
Partner/husband 59%
Doctor 52%
Nursing Staff 48%

In Support of Doulas...7

"Given the clear benefits and no known risks associated with intrapartum support, every effort should be made to ensure all labouring women receive support, not only from those close to them but also from specially trained caregivers. This support should include continuous presence, the provision of hands-on comfort, and encouragement."
Hodnett, E.D. Support from caregivers during childbirth (Cochrane Review) in Cochrane Library, Issue 2. Oxford Update Software, 1998. Updated Quarterly.

"A doula provides support consisting of praise, reassurance, measures to improve the comfort of the mother, physical contact such as rubbing the mother’s back and holding her hands, explanation of what is going on during labour and delivery and a constant friendly presence. Such tasks can also be fulfilled by a nurse or midwife, but they often need to perform technical/medical procedures that can distract their attention from the mother."

Care in Normal Birth: a Practical Guide. Report of a Technical Working Group. World Health Organization, 1996.

"Facing unprecedented pressures to reduce expenses, many hospitals are targeting the largest single budget item - labor costs... (An) unintended consequence of nursing cutbacks may be an increased cesarean rate; the inability of pared down nursing staff to provide continuous coverage to laboring mothers (has been) shown to increase the chance of a cesarean... Doulas clearly improve clinical and service quality; they provide an absolutely safe way to reduce cesareans and other invasive birthing interventions."

Coming to Term: Innovations in Safely Reducing Cesarean Rates. Medical Leadership Council, Washington D.C. 1996

"Professionals have paid much attention to innovative technology and the many new options for monitoring and managing labor. While the technology is important, it can become so prominent that clinicians ignore both the natural aspects of labor and the non-technical needs of women in labor... Changes that support the patient in labor and reinforce the natural, physiologic process... Includes providing one-to-one psychological support for patients using nursing staff or doulas."

Reducing the Cesarean Section Rates while Maintaining Maternal and Infant Outcomes. Bruce L. Flamm et al. Institute for Healthcare Improvement, Boston, 1997

"The continuous availability of a caregiver to provide psychological support and comfort should be a key component of all intrapartum care programs, which should be designed for the effective prevention, and treatment of dystocia (non-progressive labor)." Guidelines on Dystocia. Society of Obstetricians and Gynaecologists of Canada, 1995.

References

1 - DONA International - Why use a doula?

2 - DONA International - Why use a doula?

3 - Kennell, J., M. Klaus, S. McGrath, S. Robertson, & C. Hinkley. Continuous emotional support during labor in a U.S. hospital: A randomized controlled trial. Journal of the American Medical Association, 265 (1991): 2197-2201.

4 - Hofmeyr, G.J., V.C. Nikodem, W. Wolman, B.E. Chalmers, & T. Kramer: Companionship to modify the clinical birth environment: Effects on progress and perceptions of labour and breastfeeding. British Journal of Obstetrics and Gynaecology 98 (1001): 756-764.

5 - Scott, K., G. Berkowitz, & M. Klaus. A comparison of intermittent and continuous support during labor: A meta-analysis. American Journal of Obstetrics and Gynecology 180, No. 5 (1999): 1054-1059.

6 - Continuous Support for Women During Childbirth, new Cochrane Review through the Maternity Center Association, July 2003.

7 - DONA International - Research