Your advocate and your comforter

If you have never had a doula before, you may wonder what a doula actually does. The best way I can describe it is that a doula is like your lawyer and your comforter wrapped into one. As your advocate, I learn your birth wishes ahead of time and help you and your husband ask the right questions, so every decision in labor is an informed one made in peace instead of pressure.

As your comforter, I never leave your side. Nurses change shifts, and your doctor or midwife may only be in the room now and then, but your doula stays with you from the first strong contractions until your baby is in your arms. I bring position changes, counter pressure, a cool washcloth, encouragement, and prayer, so you and your husband never walk through labor alone.

What the research shows

God designed birth to work, and the research backs this up beautifully. A Cochrane review of 26 studies with more than 15,000 mothers found that women with continuous labor support, especially from a doula, had better outcomes across the board:

• 39% fewer cesarean births when the support person was a doula ^[1]
• 15% more spontaneous vaginal births with a doula ^[1]
• 10% less pain medication of any kind ^[1]
• Labors 41 minutes shorter on average ^[1]
• 38% fewer babies with a low five-minute Apgar score ^[1]
• 31% fewer mothers dissatisfied with their birth experience ^[1]

Other studies tell the same story. In a randomized trial, couples supported by a doula had a cesarean rate of 13.4% compared to 25% for those without, along with fewer epidurals ^[2]. In a large study of mothers on Medicaid, those with doula care had a cesarean rate of 22.3% compared to 31.5% for similar mothers without ^[3]. Dr. Klaus and Dr. Kennell, the doctors whose research began the modern doula movement, found across their studies that having a doula cut the use of Pitocin by about 40%, requests for an epidural by about 60%, the need for forceps by about 40%, and the length of labor by about 25% ^[4].

The American College of Obstetricians and Gynecologists agrees. In their official guidance on safely preventing cesareans, they describe the continuous presence of support personnel such as a doula as “one of the most effective tools to improve labor and delivery outcomes” ^[5].

A shorter labor and a faster recovery

Every intervention has its place, and when one is truly needed it is a blessing. But each one also adds to your recovery. A cesarean is major surgery with weeks of healing. An epidural brings an IV, a catheter, and laboring in bed. Pitocin makes contractions stronger than your body intended, which often leads to more medication to cope with them. When interventions are avoided, recovery is gentler. Mothers are up and walking sooner, nursing tends to get off to an easier start, and you spend those first precious days soaking in your baby instead of healing from surgery.

I lived this difference myself. With my daughter, my labor was almost half as long as my first, I had no tearing, and I was resting in my own bed with her that very night. That is the kind of birth and recovery I pray over every mother I serve.

Laboring at home until it is time

One of the greatest gifts a doula gives is helping you stay home until labor is truly active. The hospital tends to put you on a clock the moment you are admitted, and research shows that mothers admitted in early labor are more likely to receive Pitocin and more likely to have a cesarean than mothers admitted in active labor ^[6]. ACOG likewise supports waiting for active labor before being admitted when mother and baby are doing well ^[7].

A doula knows the signs that things are picking up. I help you labor peacefully at home, resting, eating, praying, and changing positions, and then we head to your birth place when your body shows us it is close. With my first son, the hospital was ready to induce me when my labor slowed. My doula encouraged me to go home, and I labored there in peace until it was time to return. When we came back, Paxton was born unmedicated and healthy.

Sources

1. Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous Support for Women During Childbirth. Cochrane Database of Systematic Reviews, 2017. Read the review
2. McGrath SK, Kennell JH. A Randomized Controlled Trial of Continuous Labor Support for Middle-Class Couples: Effect on Cesarean Delivery Rates. Birth, 2008. Read the study
3. Kozhimannil KB, Hardeman RR, Attanasio LB, Blauer-Peterson C, O'Brien M. Doula Care, Birth Outcomes, and Costs Among Medicaid Beneficiaries. American Journal of Public Health, 2013. Read the study
4. Klaus MH, Kennell JH, Klaus PH. The Doula Book: How a Trained Labor Companion Can Help You Have a Shorter, Easier, and Healthier Birth. 3rd edition, 2012.
5. American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Safe Prevention of the Primary Cesarean Delivery. Obstetric Care Consensus No. 1, 2014. Read the guidance
6. Neal JL, Lamp JM, Buck JS, Lowe NK, Gillespie SL, Ryan SL. Outcomes of Nulliparous Women with Spontaneous Labor Onset Admitted to Hospitals in Preactive Versus Active Labor. Journal of Midwifery & Women's Health, 2014. Read the study
7. American College of Obstetricians and Gynecologists. Approaches to Limit Intervention During Labor and Birth. Committee Opinion No. 766, 2019. Read the guidance