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By Melissa Tennen, HealthAtoZ writer
Once upon a time, women helped other women give birth. They pressed cool cloths on fiery foreheads. They grasped hands. They murmured encouragement.
But somewhere this whispering presence was left behind as modern medicine advanced.
"In the beginning of the 20th century, when women were taken out of the home and put into the hospital, that aspect was taken away, that encouragement, that support, that sharing of information," says Nicette Jukelevics, M.A., ICCE, a childbirth educator, speaker and author on cesarean birth and vaginal birth after cesarean.
Enter the doula
Doulas are trained assistants who support women, their partners and their families in having the births they want whether it's using epidurals or having home births. Doulas work in homes, hospitals and birth centers simply to give emotional, physical and informational support while prenatal care is left in the hands of a midwife, OB/gyn or family practitioner.
Couples or mothers using doulas (the name is take from a Greek word meaning "to serve") consider them a part of the team of nurses, doctors, family and friends helping a woman with birth.
But there is one big difference that makes doulas stand out.
"They never leave the mother," Jukelevics says. "There is no other care provider in that team that never leaves the mother."
No matter if the birth is a few hours or a few days, the doula stays at the woman's side. For longer births, a doula may be temporarily relieved by colleagues. But it is that same doula that stays with the mother from beginning to end, no matter how long that labor takes.
A recent survey called "Listening to Mothers," sponsored by the Maternity Center Association, says a small number of women are using doulas (5 percent). But "this type of caregiver was rated highest in terms of quality of supportive care during labor," according to the survey.
The use of doulas in this country is on the rise. The nonprofit organization Doulas of North America (DONA) has seen its membership grow from 750 doulas in 1995 to nearly 5,000 in 2003.
With families scattered across the country, mothers may not have a female relative nearby to support her during labor. Or mothers just feel more comfortable with someone trained in the emotional support of giving birth. Also, partners may be too nervous and unsure themselves.
Research suggests having a doula might help improve the experience of birth, such as a 50 percent reduction in cesarean rates, 25 percent shorter labor, 60 percent reduction in epidural requests, 30 percent reduction in analgesia use and 40 percent reduction in forceps delivery, according to researchers Marshall Klaus, M.D., director of academic affairs at Children's Hospital in Oakland, Calif., and John H. Kennell, M.D., a professor or pediatrics at the Case Western Reserve School of Medicine in Cleveland, Ohio.
For instance, squatting during labor may help deliver a baby faster, Jukelevics says.
"In the 21st century, that knowledge is not shared in medical school," she says.
But what also helps is the security of knowing someone is there to hold hands, explain what's happening and just to be there, according to Kirsten Gerrish, a midwife and former doula in Alaska.
"You know that she is going to be there," Gerrish says.
Many organizations such as the World Health Organization and the American College of Obstetricians and Gynecologists agree that trained and experienced doulas can help improve the outcomes of birth.
"Doulas aren't there to say, 'Oh no. You don't need that epidural.' They are there to be an advocate for what the couple wants," says Jennifer Nunn, president of DONA.
A doula might suggest walking to help relieve the pain or discomfort. A doula might also massage a woman to help her feel better.
Because a doula meets with the woman before the due date, a doula knows what the woman's birth plan is: Does she want an epidural? Does she want soft music? Does she want her partner in the room? But doulas listen to their clients when they change their minds about wanting an epidural, for instance.
"We look at ourselves as the guardians of the birth experience, there to assist our clients with their wishes to make it the best possible event for them and their newborn," Nunn says.
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External Sources
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MaternityWise: How do I get the labor support I need?
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Doulas of North America
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This article was reviewed and updated June 2007.
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