Why do we need labor support?

The evolutionary process has supported heightened emotional needs in childbirth, which has driven women to seek out companionship. Therefore, a woman’s desire to be surrounded by familiar “others” has deep roots in our human lineage. Today, modern hospital birthing practices are not conducive to the deeply rooted needs of women for continuous emotional support in childbirth. The role of a doula has developed in response to a woman’s need for continuous assistance and emotional support throughout her labor.

The Beauty of Old Age” by Vinoth Chandar is licensed under CC BY 2.0

Today, women often deliver in the presence of strangers, and it is far from routine for women to receive continuous emotional support as they labor.Many studies and reports have looked at the dehumanization of women’s birth experiences, caused by a lack of continuous support for laboring mothers. From the perspective of evolutionary medicine, the emotions of childbirth are the human adaptations of the obstetric dilemma posed by bipedalism and encephalization. Incorporation of an individual whose sole responsibility is to attend to the emotional needs of the mother recognizes this deeply rooted human need. Social birthing practices are as deep as our human lineage, and the social context with which the human neonate enters the world continues for the rest of her life history.

Today, women who receive emotional support throughout labor – in addition to attendance by a midwife or obstetrician – experience significantly fewer birthing complications relative to women who do not receive continuous emotional support, including:

  • (28%) less likely to have a cesarean section
  • 31% less likely to use synthetic oxytocin to induce or speed up labor
  • 9% less likely to ask for pain medication
  • 34% less likely to rate their birth experience negatively

Unlike a midwife or other birth attendant, a doula does not diagnose medical conditions or give medical advice to the mother. Under DONA’s code of ethics, a doula encourages the mother to speak with her provider or other nurses, midwives, or doctors when she has questions regarding her health or is looking for recommendations. If a doula gives a recommendation to the mother, it is under the condition that the mother check with her caregiver before acting on the suggestion. Furthermore, a doula does not make decisions for her client. She doesn’t project her own hopes and values onto the laboring mother, and support the mother regardless of any choice. A doula does not administer any pharmaceutical or homeopathy medications to the mother.

Rather, a doula provides emotional support for the mother in her labor and delivery. A doula works to cultivate the mother’s breath, focus her energy, find comfortable positions, and relax her through massage, words, and other comfort measures. Throughout history, women have been nourished, cared for, and supported in their deliveries by other women. In artistic representations of laboring women, she is depicted next to two women: the first is a midwife, responsible for the safe passage of the baby, as well as the health of the mother. The second woman by her side comforts the mother, addresses her fears and anxieties, and provides emotional support. Today’s doula is the embodiment of the second woman. She soothes, she mothers the mother.

Image by Trocaire is licensed under CC BY 2.0

Today, women often deliver in the presence of strangers, and it is far from routine for women to receive continuous emotional support as they labor. Many studies and reports have looked at the dehumanization of women’s birth experiences, caused by a lack of continuous support for laboring mothers. Compared to historic birthing practices where women deliver in the presence of familiar faces, this can produce anxiety and stress for the women which complicates or delays her labor’s progress (see Ina May’s Sphincter Law for more information). From the perspective of evolutionary medicine, the emotions of childbirth are the human adaptations of the obstetric dilemma posed by bipedalism and encephalization. Incorporation of an individual whose sole responsibility is to attend to the emotional needs of the mother recognizes this deeply rooted human need.Reports addressing the dehumanization of this birthing model have found that the role of a doula – someone who’s only role is to support and nourish the mother – provides numerous benefits to the mother and baby.

This doesn’t mean that partners and other caregivers are less effective in providing continuous emotional support. Unlike the partner or other caregiver, a doula doesn’t have the same intimate knowledge and unique awareness of the mother. A doula is able to relieve some of the pressure often felt by the partner, and allow the partner and other caregiver to support the mother according to their own comfort level. Ideally, a doula and partner use their complementing strengths to support the mother in a richer, more complete way than if either were to support her individually.

A doula’s role developed in response to our evolved need for labor support. She provides unique, positive benefits for the care of the laboring woman. Doula work focuses on the art of labor support, and she cultivates skills to comfort, soothe, nourish, and empower the mother. By attending to a woman’s emotional needs, the mother’s obstetric outcomes are improved. When a mother receives continuous emotional support, she is less tense, stressed, and experiences less pain in her labor. Women report more positive birth experiences when supported by a doula, and early mother-infant relationships as well as breastfeeding are enhanced. A doula’s continuous emotional support throughout labor has clinically meaningful benefits for the mother and baby.

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