Doula Care

Research has shown that the presence of a doula is extremely beneficial for the labouring woman. According to some research, midwives and nurses are only able to give 10% of their time in ‘supportive roles’ in labour and birth. It is not surprising then that women feel the need to find additional emotional support through hiring a doula.

What’s a doula?

Doula (Greek) is a woman experienced in childbirth who provides continuous emotional support to the labouring mother and her partner. A doula’s primary role is to the mother. Their sole focus is on the emotional well-being of the woman in labour. Unlike a midwife who may be assigned several labouring women and whose focus in on physiological/medical birth issues, the doula’s primary focus is on one woman and is undivided emotional support. This support is reflected in the doula ideology and doula promises.

Research has shown that due to the individual emotional support provided, women labouring with a doula may prosper from a range of benefits.

Evidenced-based benefits

Research has found that women who laboured and birthed with a female partner experienced extensive benefits to those who did not. Women had more spontaneous vaginal deliveries (91% to 71%), less analgesia use during labour (53% to 73%), less synthetic oxytocin (13% to 30%), fewer amniotomies (waters broken) to augment labour (30% to 54%), fewer vacuum extractions (4% to 16%) and fewer Caesarean sections (6% to 13%) compared to the control group. The support of a female relative while in labour is shown to have fewer interventions and increased frequency of normal vaginal deliveries.

Research has shown:

  • women using a doula have a 50% reduction rate in caesarean section
  • women using a doula have a 40% reduction in the rate of forceps deliveries
  • women using a doula have a 60% reduction in request for the epidural
  • women who used a doula had a decrease in labour length by 25%*

*(Klaus, Kennell and Klaus, Mothering the Mother, 1993)

Doulas in Ireland work independently. Some doulas are members of the Doula Association of Ireland, but not all. Doulas in Ireland, are trained via a variety of different courses, notably DONA, Childbirth International, Paramama, Birthing From Within and Birth Know How amongst others. Some doulas in Ireland work only as birth doulas, whilst others offer postpartum doula services as well. A few offer miscarriage support and support for still birth. An up to date list of all doulas currently practising in Ireland can be found in the on-line Irish Doula Directory.

What about Dad, will he not feel left out?

A doula does not replace the partner but rather encourages the partner to be as involved as his comfort level allows. As one mum describes, “My husband wasn’t initially sure about using a doula but on the day he found it a great relief to have her there. It meant he could go through this with me—he could have his own experience knowing that my doula would provide all the emotional support I needed. It took the pressure off of him—he was really worried about how he would perform on the day.”

Promises of a doula

  • You cannot hurt my feelings in labour
  • I won’t lie to you in labour
  • I will do everything in my power so you do not suffer
  • I will help you feel safe
  • I cannot speak for you but I will make sure that you have a voice and I will make sure you are heard

Roles of a doula

Doulas in Ireland offer a wide range of services including antenatal classes, birth plans, labour and birth attendant, and postnatal care. Due to restrictions in some Irish maternity units, any woman desiring a doula to attend her labour and birth should discuss plans with her care providers and her doula to ensure permissions on the day.

What is the policy in Irish hospitals when you have a doula – I’ve heard they’re not allowed in with your birth partner?

Policies differ from unit to unit. Often maternity hospitals state that only one birth partner is allowed to be present with a labouring woman. However, the vast majority of hospitals are happy to approve the presence of both your birth partner and your doula if you communicate in writing with them in advance. A letter to the director of midwifery and occasionally a meeting in person will usually ensure that your doula has permission to attend your birth. The Coombe maternity hospital in Dublin recently released a position paper on doulas in labour. More information on that can be found here. Women who plan to have a doula when attending the Coombe simply need to have it noted in their file at one of their antenatal appointments.

More information on doulas practising  in Ireland:

www.irishdouladirectory.com

Reference: John H Kennell, MD; PEDIATRICS Vol. 114 No. 5 November 2004, pp. 1488-1491 (doi:10.1542/peds.2004-1721R)