The support of a continuous labor support person.
As human beings, we fare better, especially in new or stressful situations, when we are surrounded by those we have a trusted and loving relationship with. Historically, labor and birth support persons were friends and family members who had gone through childbirth themselves, mothers, grandmothers, aunts, sisters. Since most births occurred at home with a local midwife, who was well known in the community and often has been the midwife to many others in the community, the laboring person was surrounded by support and comfort. The shift from home to hospital and the geographic spread of families has decentralized our support systems.
As the majority of births moved out of homes and into hospitals, the tradition of having a friend and/or familial support was lost as a result of space limitations, hospital policies, and the widespread use of anesthesia. Further, more recently, the role of primary support person has been placed upon the partner, whom many times has no personal experience with childbirth and often times feels underprepared for taking on this role.
I'm trying to stay on topic here and keep this post about how this support was left behind when birth moved into the hospital and not go on about the benefits of a doula so I am going to refer you on to the 2017 Cochrane Review and this great Evidence Based Birth (TM) article to read further on the research around doula support. For the purpose of this post, I will summarize that review found that women who received continuous labor support had the following positive outcomes: more spontaneous vaginal births, fewer cesarean surgeries or instrumental vaginal births, less use of epidurals and other pain medications, slightly shorter labors, and greater satisfaction with their birth experiences. Babies born with doula support were less likely to have low Apgar scores at birth. They conclude that all birthing people should have continuous support during labor, and further state that the services of a person, such as a doula, with some training, who is experienced in providing labor support, is the most beneficial.
What makes a good continuous support person?
I would argue that above all, love weighs pretty heavily in what makes a good continuous support person, which is why partners, if applicable, are so important in labor support. But, who is there to support the partner, if there is one? Does the loving support of a partner replace that of knowledgeable and professional support of a doula? As a doula, I argue that there is NO WAY I could replace a partner. So, let's talk about what makes a good support person and what people value in support.
I recently polled a group of 19,000+ women about what they felt was the most important trait of a professional support person. Here were the results:
"first-hand knowledge and experience" was the most selected answer, followed closely by "non-judgemental support." The third most important thing to the poll participants was "emotional presence and investment in your experience." Now, the geek in me was really super interested in these results because my perspective as a professional doula is much different than those of the clients I serve and, while I ask this question in different ways at different meetings with my clients, I have never gotten this many answers in one sitting (yay for polls!).
Interestingly, most partners are not able to provide ALL of the aspects above, even though they are invaluable support when involved or applicable. Many partners don't have first-hand experience in childbirth. It is difficult for partners to separate themselves from their emotional investment in their partner and baby to the point that they are able to truly provide non-judgemental support without an agenda. Many first time parents have the expectation that their nurse or care provider will act as a physical and emotional support person and fulfill many of the roles that they consider to be so important in a support person. In reality, it is difficult for staff to offer the continuous support that you need during labor and birth because their primary focus is on charting, documentation, and clinical tasks. According to the Journal of Obstetric, Gynecologic, and Neonatal Nursing (Volume 18, Issue 6), the patient expectation is that labor nurses will spend about 50% of their time providing information, comfort, and support; but in reality, only 6-12 percent of a nurse's time is spent doing those things because of their other responsibilities.
How common is doula support?
I was once surprised to learn, through The Listening to Mothers Survey, that only about 6% of births nationwide include the support of a professional birth doula. According to the survey: "three out of four pregnant persons (75%) who did not receive care from a doula had heard about this type of caregiver and care, including a majority (59%) who said that they had had a clear understanding the role and function of a doula. The survey also asked mothers who did not use a doula in their recent birth and who had a clear understanding of this type of caregiver and care if they would have liked to have had the care of a doula, and one in four (27%) indicated she would have liked to have had doula care, a figure that was comparable for mothers who had a vaginal or cesarean birth."
So, why if 27% of people want a doula, are only 6% hiring one? Part of this low number is due to the limits on the number of support people permitted in L&D units. In most of the Boston area hospitals, the limit is 3 support people; but every hospital has their own policies around visitors. I think that another factor in the low doula support rates stem from the idea that doulas only support a certain kind of birth and/or that there is tension between doulas and care providers. This could not be further from the truth. In my experience, nurses, who are the ones with the largest time investment in your birth, really WISH they could spend time doing continuous emotional and physical support; but, they are so busy with charting and clinical tasks that they are thrilled to have the support of a doula. Any doula that has your own best interests at heart will not have any preconceived notion of how your birth should go and what choices you should make in your birth. While I hope that through our prenatal meetings, we have addressed a lot of the fear and anxiety and gotten to a place where my clients feel like they can be in the moment and listen to what is right for them and their body, I also 100% support you. I don't work for the hospital and this isn't my birth. The choices that you make for yourself, your baby, and your body are yours to make. I am there to make you feel supported, safe, and like you have the information you need to make an informed decision!