Purpose and Value of Labor Support
by Sarah Klein
I once heard a tape of a lecture given at a DONA conference (August 1-4, 2002) by Kathy McGrath called “Finding the Path”. There was something she said that struck a chord, and helped me to start putting my feelings about being a doula into words. She discussed the difference between pain and suffering. I have since used this differentiation with my clients, and they, too, understand its wisdom. She said, “Pain is the very real, unavoidable part of labor which has a physiological basis. Suffering is the result of not being respected, listened to, or not having needs met. ....it's possible to be in a lot of pain and not suffer, and to suffer with very little pain. No woman in labor should suffer..."
As I thought about McGrath's words further, I found that while her insight forms the basis for a large part of what doulas practice, getting a woman through her labor pains without suffering is in itself a means to a far greater end. I deeply believe that the crux of the work we do as birth doulas is to facilitate experiencing the miracle of birth. I am here to help alleviate the chance of any suffering in order to make it possible for a birthing mother to have this wonderful, miraculous experience. Labor support helps a woman work with her pain, not against it, and understand the information that pain is there to show us. McGrath goes on to say that the value is in the quality of the process, not just the outcome.
I, as a birth doula, am there to help that process, so the birthing mother is able to fully partake in process as well as the outcome. My purpose is to help her shape and implement her goals, and feel strong, courageous, content and peaceful at the end. And all along the way, throughout her whole labor, lending my knowledge, experience, physical and emotional support and advice to help ease her pain, and avoid suffering. After the birth, I am also available to give support for breastfeeding, and general baby care.
There are many statistics that show the positive results of having a doula throughout the birth. If a woman is helped by a doula through her labor, she has more support, strength, and understanding to either delay having an epidural, or not request one at all. There is a study that shows that delaying an epidural, so that the medication exposure was less than one hour, was beneficial in that the newborns had less trouble breastfeeding (Crowell, Hill, Humenick, Journal of Nurse Midwifery,39, no. 3, 1994). Also, another study showed that women were less likely to request an epidural (Kenell, Klaus, McGrath, Robertson, & Hinkley, Journal of the American Medical association, 265, 1991) if they had continuous emotional and physical support to handle the pain.
In the book, “The Doula Advantage” by Rachel Gurevich, there is a “meta-analysis” of several doula studies, synopsized into one neat table (page 35). It shows a 36% reduction in use of pain medications, 51% reduction in Cesarean births, 71% reduction in use of oxytocin, and 57% reduction in forceps and vacuum deliveries, and an average of 1 hour and 38 minutes shorter labor (Scott, Berkowitz, & Klaus, American Journal of Obstetrics and Gynecology 180. no.5, 1999). These statistics help to demonstrate that there is a clear value to having a doula attend a birth.
Doulas are also there to help be a liaison while in the hospital. There is a lot of hospital terminology that can confuse people, and that confusion leads to fear and mistrust. Using knowledge and experience, the doula helps the couple (or woman, depending on the situation) navigate their way through the hospital jargon, and helps them feel secure in any decisions that have to be made.
After a woman gives birth, a whole new reality sets in as she learns how to breastfeed her baby and take proper care of him. The doula lends support and encouragement to help ease the transition of this new baby into the family.
There are many situations that a birthing mother faces during the course of her labor, and beyond. Whether it be trying to understand what is happening in her body, trying to find relief from the intensity of the pain, communicating and working together with her husband, having her needs and goals met while in the hospital, or learning to feed and care for her baby, having a doula present alleviates the pressure that these situations can cause. When she feels secure and confident, and when fear and pressures are eased, she is free to give birth without suffering, and be a witness to the miracle of birth, the miracle of life. This is the purpose, and intrinsic value, of labor support.