THE BENEFITS OF HAVING A BIRTHKEEPER
There have been several studies done throughout the world acknowledging the multiple benefits for both the mother and baby, when a doula is present throughout the pregnancy, labor and birth.
When a doula is able to help cultivate a calming and grounding energy that slows down the pace of the room and creates safety, you are able to be with how you feel and listen to what your body needs from you as each moment unfolds. Parents have more capacity to make informed and instinctual decisions that go a long way in ensuring better experiences and health outcomes.
A doula provides support during pregnancy, labor and birth through emotional, informational and physical support. I also incorporate spiritual support within my services through mindfulness practices, meditations, somatic education and tools as well as rituals and ceremonies.
Informational support
⦁ Sharing topics, resources, and what you need to know.
⦁ Keeping you informed about what is going on throughout each milestone.
⦁ Informing you about the different topics that can be brought up during prenatal appointments with your providers and give you all important information around these topics.
⦁ Understanding the phases and stages of labor.
⦁ Help you to find evidence-based information about different options in pregnancy and childbirth.
Emotional support
⦁ Making sure you feel cared for by being a calming and grounding, continuous presence.
⦁ Reassurance and encouragement
⦁ Helping you see yourself and your situation more positively.
⦁ Showing a caring, empathetic attitude and holding a non-judgmental and safe space. Support in empowering you.
⦁ Accepting what you desire without bias.
⦁ Helping you to work through any fears and self-doubt you and your partner may hold.
⦁ Debriefing after the birth to process what happened, holding space and actively listening.
Physical support
⦁ Using soothing touch as well as other techniques such as massage, counter pressure and acupressure throughout pregnancy, labor and birth.
⦁ Assisting with getting a TENS machine if you are interested.
⦁ Helping to create a calm environment, such as dimming the lights, arranging curtains and utilizing music.
⦁ Assisting with water therapy (shower, tub)
⦁ Applying warmth, cold washcloths or fanning.
⦁ Assisting the birthing person in walking during labor.
⦁ Assisting with your chosen, instinctual positions throughout labor and birth.
⦁ Giving ice chips and making sure the birthing person is very well hydrated and nourished.
Rituals will be weaved into sessions with the birthing parent such as a relaxing flower and herbal birth
So what is the evidence around doula support? A scoping review that was published in 2023 concluded that being guided by a doula in perinatal care was associated with positive delivery outcomes such as reduced cesareans and premature deliveries. Furthermore, the length of labor was shown to be statistically shorter, there was a decreased need for an epidural and other pain medication with increased confidence and autonomy. Babies were also more likely to have higher Apgar scores.
The review also showed that the emotional support provided was seen to reduce anxiety and stress with lower rates of postpartum depression. With regards to low-income women, doula support was shown to improve breastfeeding success with quicker initiation and continued breastfeeding weeks after childbirth. Mothers had better birth outcomes when compared to those without doula support in regard to low birth weight and complications experienced during birth and delivery. Women were also more likely to attend prenatal education courses. All women and their partners had positive opinions regarding the presence of a doula during labor and delivery.
In 2017, Bohren et al. published an updated Cochrane review on continuous support in childbirth. They combined the results of 26 trials with more than 15,000 people across 17 countries including North and South America, Europe, Middle East, Africa, Asia and Oceania within high and low income settings. Overall, birthing people who received continuous support were more likely to have spontaneous vaginal births and less likely to also have any pain medication, epidurals, negative feelings about childbirth, vacuum or forceps-assisted births, cesareans, long labors, and their babies were less likely to have low Apgar scores at birth.
Again there was some evidence that also showed lowered rates of postpartum depression. Below there is further statistical evidence showing that continuous support either from doula or someone else you trust is a safe and beneficial way to increase the likelihood of better outcomes for the birthing person and baby.
25% decrease in the risk of Cesarean
8% increase in the likelihood of a spontaneous vaginal birth
10% decrease in the use of any medications for pain relief
Shorter labors by 41 minutes on average
38% decrease in the baby’s risk of a low five-minute Apgar score
31% decrease in the risk of being dissatisfied with the birth experience
There could be so many reasons to these statistics. One reason includes ever since birth has moved out of the home and into hospital settings, people in labor are submitted to institutional routines, high intervention rates, staff who are strangers, lack of privacy, bright lighting and needles. Having a doula buffers this type of environment. Helping you to regain clarity and focus, providing encouragement and trust and promoting empowerment. Additionally, doulas are considered to be pain relievers themselves. When doulas are present, who are calm and grounded themselves, slowing the pace of the room right down, that is likely to prevent a cascade of medical interventions including an epidural and Pitocin (which is a synthetic oxytocin). Soothing touch may also help a birthing person’s body to feel safe and more relaxed, contributing to a smoother delivery. A baby will struggle to come out of a tense body. Lastly, having a doula present can lead to a natural release in oxytocin, a hormone promoting labor contractions. Swedish oxytocin researcher Kristin Uvnas Moberg writes that the doula enhances oxytocin release, decreasing stress reactions, fear, and anxiety, and increases contraction strength and effectiveness. The calming effect of the doula’s presence increases the release of natural pain coping hormones (beta-endorphins), making labor feel less painful.
A study that was taken place in Iran, compared first time parent’s anxiety and pain levels with doula support to those without doula support (Ravangard et al. 2017). They randomly assigned 150 first time births to either doula support or no support and used standard questionnaires to measure anxiety and pain levels. They found that on average, those who did receive support had less anxiety and lower average pain scores during labor. They recommend that all hospitals in Iran provide access to doulas since having a safe and calm delivery is considered a human right.
I am currently located in Brazil, where it has one of the highest rates of cesarean births in the world with 56%. A 2016 study found that cesarean births accounted for all deaths from anesthesia complications, and was associated with a significant increase in death due to postpartum hemorrhage. To improve the quality of the birth experience, Brazil enacted a national law in 2005 to ensure that birthing parents have the right to have and choose a companion to be present throughout their labor and birth. A survey in 2012 showed only 18% of women had continuous companionship whereas in 2017 it had increased to 163%. Women who attended the Senses of Birth health education intervention and received doula support (26%) during childbirth, were more likely to have a vaginal birth, have freedom of mobility throughout labor, receive midwife care, use non-pharmacological pain-relief methods, deliver in a non-lithotomy position, deliver in a public hospital and have higher knowledge of evidence based practice. What is interesting is that women who had doula support were more likely to be within the low and mid-level income bracket in comparison to high income women who were more likely to deliver in private hospitals where interventions take place more commonly. The results supports the hypothesis that doula support decreases the frequency of unnecessary medical use of cesareans. The study also suggests that education may change the norms and normalize birth in a country that normalizes cesarean birth.
Investing in yourself and your family is the best gift that you can provide for yourself. Your physical and emotional wellbeing are high priorities. You gain so much wisdom and value when you invest in education, mentors, coaches, support and resources. You will never regret investing in a doula or any other support for that matter, unless they are not aligned with you. I saw a post recently that stated people spend so much money on a wedding, why not invest a small amount of money for a supportive doula. Pregnancy and birth is more important than a wedding. Heck its probably the most important thing that you will ever experience in your life.
References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10292163/
https://evidencebasedbirth.com/the-evidence-for-doulas/
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-05069-0
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00261-9/fulltext#seccesectitle0014