The idea of doulas is at once very old and very new. The word “doula” comes from the Greek, meaning “female servant or slave”. It’s modern usage conveys the idea of a trained or experienced woman (friend, relative, or health worker) who supports a birthing woman and her family physically, emotionally, and informationally throughout the childbearing year. Women have been helping women give birth perhaps since the very beginning. Whales, coyotes and pygmy chimpanzees are just a few examples from the animal world whose female members help one another during birth. In some current cultures, birth is a community event which all the women attend to celebrate and support the laboring mother. One of my favorite examples of this is an anecdote told by the oriental dancer Morocco, who was able to witness a birth in a traditional community in the country of Morocco. She describes a tent containing a circle of women dancing around the birthing mother, whose only signs of being in labor were sweat on her forehead and the occasional grunt while pushing. The women were dancing to remind the mother to move to help the baby out, to remind her of her own birth, to initiate the mother into motherhood.
The evolution of our collective birth culture is very interesting to evaluate. Not so long ago, the majority of the world’s births took place at home. The majority of those births were attended by trained or untrained midwives and other female supporters. Very quickly—at lightening speed in fact—birth at home has become the anomaly and hospital birth the standard entrance into the world for most children, especially in developed countries. Hospital birth has helped save the lives of many babies and mothers who would otherwise have been injured or worse in the home situation, and for this we must be grateful. However, because the primary function of a hospital is to treat illness and save lives, pregnancy and childbirth in the hospital has come to be regarded as a sickness rather than a natural physiologic event. It can sometimes happen even in normally progressing pregnancies, that pregnancy and birth are seen as a highly dangerous processes requiring many routine tests and interventions to be safe. This intention often brings with it an aura of fear or urgency into the experience of pregnancy and birth, sometimes even making it difficult for women to give birth under their own power. Why is this? The answer lies in our magnificently orchestrated hormones.
At the onset of labor, the hormone oxytocin is released, telling the uterus to contract and open the cervix. Oxytocin is also called the “hormone of love”, because it is also present in large quantities when eating a good meal, during breastfeeding, and most importantly, during orgasm. This gives us a clue as to why, for some women, birth is not frightening or painful, but joyful and ecstatic—under the right circumstances.
It is still not entirely understood exactly how the body receives the signal to release oxytocin, but it has recently been discovered that a hormone released by the mature baby’s lungs passes through the placenta, setting labor into motion. Along with the hormone oxytocin, endorphins are also released. These two hormones increase in relation to one another, and to signals in the body, in a juicy hormonal dance. As oxytocin increases, the sensation of the contractions increases, and the body produces more endorphins to help the woman tolerate the rising intensity. Not only tolerate, but actually move into an altered state—into “laborland”. For those who have seen women in labor, the entrance into laborland is easily recognizeable. The laboring woman is deeply focused inward, has difficulty answering logical questions, and moves and makes noise instinctively.
Let’s consider an ancient woman, thousands and thousands of years ago, before doctors, before midwives even. How did that ancient woman know what to do and how to do it?
Using her instincts, what kind of location do you imagine this ancient woman would have chosen to give birth? Warm or cold? Dim or brightly lit? Crowded or quiet? Open or protected? What would happen to that ancient woman’s labor if she senses a threat, perhaps a vicious predator prowling about? What is happening in your body now just thinking about this scenario? Perhaps you’ve noticed a tensing of muscles, a surge of adrenaline, the urge to flee—fight or flight from the dangerous situation.
Now imagine for a moment the conditions under which oxytocin is present in large quantities. Imagine the environments in which the most oxytocin will be released. Under what conditions do you most enjoy a good meal, breastfeeding, or lovemaking? Now consider the typical hospital birth environment. How do the two birth environments compare, when looking from the perspective of optimal oxytocin release? Now we begin to understand why so many modern women have difficulty birthing their babies under their own power in the typical hosptial delivery room—everything in their environment is telling their bodies to flee, even when their minds have the best of intentions.
So what does all of this have to do with the doula? Doulas can help women to reclaim their birth spaces, even in the hospital. Many women expect that the nurse or midwife or their doctor will support them and guide them in birth, but the reality is that due to modern medical practices, most caregivers do not have the time to give women the attention they need during labor. Nurses and hospital midwives unfortunately have many women to care for at one time, as well as a lot of paperwork to attend to, often preventing them from doing much more than regular checks on baby and mom’s well-being. Because the doula is not concerned with the medical aspects of the birth process, she is free to give her love and attention soley to the birthing mother and her family. Doulas can make suggestions for transforming the birth space, making it more oxytocin-friendly. Doulas offer ideas for positions, remind mothers and fathers of useful breathing practices and massage techniques, and encourage mothers to move around. Doulas help redirect mother’s and father’s attention away from the “machine that goes ping” and back onto her body, her labor, their baby. Doulas can help protect the birth space, reducing the number of uncessary interruptions and interventions.
Some couples are concerned that a doula may usurp the father’s role at the birth, but it is actually quite the opposite. The father’s job is to provide the love and presence only he can give to the mother, while being witness to the birth of his child. Many fathers have difficulty helping their wives throught the tough parts of labor, simply because they have no experience in this arena. Doulas protect the father’s birth experience by aiding him in supporting the mother, relieving him of the intense pressure having to remember everything learned in labor class. Doulas encourage the mother and father throughout the labor, empowering them to birth their child in their own way, whatever that may be. As studies by Drs. Kennell and Klaus have shown, the simple presence of a caring, relaxed person in the labor room can have a dramatic impact on the energy and mood of the labor room. It has actually been shown in multiple studies that when doulas are present at a birth, there are fewer epidurals, fewer cesarean births, and on average 2-3 hour shorter labors. The statistics are so convincing that some insurance companies in the US have begun compensating for doula fees!
The beneficial impact of doulas continues into bonding and breastfeeding, the early postpartum period, and in marital satisfaction in the years following birth. Many families report less problematic breastfeeding experiences and more extended breastfeeding relationships than women who receive no such support during and after labor. Parents’ positive relationship with and understanding of their babies’ needs also increases. Because doulas support and normalize mothers’ postpartum experiences, incidences of postpartum blues and depression are fewer. A good doula actually fosters greater closeness and understanding between mother and father, and reports of increased marital satisfaction after birth are higher with families who are assisted by a doula.
Here in Turkey, and in much of Europe, the concept of a doula in the hospital is a new idea. However, there are doctors who are open to this very beneficial addition to the birth room. Hopefully the coming years will see a vast increase in support for birthing families, bringing into greater awareness what birth can be, what mothers and babies are capable of, and a joyous respect for the sanctity of the birth place.
Mothering the Mother: How a Doula Can Help You Have a Shorter, Easier and Healthier Birth, Marshall H. Klaus, M.D., John H. Kennell, M.D., and Phyllis H. Klaus, M.Ed., C.S.W.
The Birth Partner: Everything You Need to Know to Help a Woman Through Childbirth, Penny Simkin, P.T.
The Thinking Woman’s Guide to a Better Birth, Henci Goer