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Compiled and Written by
Mélissa Cowl, CD/DT (DONA)
With help from the files of
Doulas of North America

The birth of each baby has a long lasting impact on the physical and mental health of mother, baby and family. In the twentieth century, we have witnessed vast improvements in the safety of childbirth, and now efforts to improve psychosocial outcomes are receiving greater attention. 

The importance of fostering relationships between parents and infants cannot be overemphasized, since these early relationships largely determine the future of each family, and also of society as a whole. The quality of emotional care received by the mother during labour, birth, and immediately afterwards is one vital factor that can strengthen or weaken the emotional ties between mother and child. Furthermore, when women receive continuous emotional support and physical comfort throughout childbirth, their obstetric outcomes may improve.

Women have complex needs during childbirth. In addition to the safety of modem obstetrical care, and the love and companionship provided by their partners, women need consistent, continuous reassurance, comfort, encouragement and respect. They need individualized care based on their circumstances and preferences. The role of the Doula encompasses the non-clinical aspects of care during childbirth.

In nearly every culture throughout history, women have been surrounded and
cared for by other women during childbirth. Artistic representations of birth throughout the world usually include at least two other women, surrounding and supporting the birthing woman. One of these women is the midwife, who is responsible for the safe passage of the mother and baby; the other woman or women are behind or beside the mother, holding and comforting her. The modern Doula is a manifestation of the woman beside the mother.

Doulas are trained and experienced in childbirth, although they may or may not have given birth themselves. The Doula's role is to provide physical, emotional, and informational support to women and their partners during labour and birth. The Doula offers help and advice on comfort measures such as breathing, relaxation, movement and positioning. She also assists families to gather information about the course of their labour and their options. Perhaps the most crucial role of the Doula is providing continuous emotional reassurance and comfort.

Doulas specialize in non-medical skills and do not perform clinical tasks, such as vaginal exams or fetal heart rate monitoring. Doulas do not diagnose medical conditions, offer second opinions, or give medical advice. Most importantly, Doulas do not make decisions for their clients; they do not project their own values and goals onto the labouring woman.

The Doula's goal is to help the woman have a safe and satisfying childbirth as the woman defines it. When a Doula is present, some women feel less need for pain medications, or may postpone them until later in labour; however, many women choose or need pharmacological pain relief. It is not the role of the Doula to discourage the mother from her choices. The Doula helps her become informed about various options, including the risks, benefits and accompanying precautions or interventions for safety. Doulas can help maximize the benefits of pain medications while minimizing their undesirable side effects. The comfort and reassurance offered by the Doula are beneficial regardless of the use of pain medications.

"Doula" also refers to lay women who are trained or experienced in providing postpartum care (mother and newborn care, breastfeeding support and advice, cooking, child care, errands, and light cleaning) for the new family. To distinguish between the two types of Doulas, one may refer to "birth Doulas"and "postpartum Doulas."

The Doula and the Partner Work Together:

The woman's partner (the baby's father or another loved one) plays an essential role in providing support for the woman. A Doula cannot make some of the unique contributions that the partner makes, such as intimate knowledge of the woman and love for her and her child. The Doula is there in addition to, not instead of, the partner. Ideally, the Doula and the partner make the perfect support team for the woman, complementing each other's strengths.

In the 1960's, the earliest days of fathers' involvement in childbirth, the expectation was that they would be intimately involved as advisors, coaches and decision- makers for the woman. This turned out to be an unrealistic expectation for most men because they had little prior knowledge of birth or medical procedures and little confidence or desire to ask questions of medical staff. In addition, some men felt helpless and distressed over the women's pain and were not able to provide the constant reassurance and nurturing that women need. With a Doula present, the pressure on the father is decreased and he can participate at his own comfort level. Fathers often feel relieved when they can rely on a Doula for help; they enjoy the experience more. For those fathers who want to play an active support role, the Doula assists and guides them in effective ways to help their loved ones in labour. Partners other than fathers (lovers, friends, family members) also appreciate the Doula's support, reassurance and assistance.

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