No Epidural? Pain management alternatives and tips – Part 4: Using a Doula

Using A Doula

You are probably thinking – How can a person be pain relief?!? But the concept of doulas has been around for centuries.

The desire to have our mothers, sisters or female friends with us in labour is a primal and instinctual example of women’s abilities to act on intuition. For centuries women have given birth with the support and understanding of elder women who have the life experience to guide the labouring woman through her birth. It makes absolute sense that women would chose to labour with their mother or sister in addition to their husband or partner. Women are naturally empathetic, supportive and strong. Many have the experience of having birthed themselves, which can add another dimension to support.

Research has shown that the use of a doulas 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 either in a family member, friend or through hiring a doula.

Photo credit: Jessica Rockwell Photography

Photo credit: Jessica Rockwell Photography

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.

“If a doula were a drug, it would be unethical not to use it.” ~ John H. Kennell, MD

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 wellbeing 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 that women labouring with a doula may prosper from a range of benefits.

Evidenced Based Benefits

Research shows that:
· 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%

A doula does not replace your partner but rather encourages him or her to be as involved as his/her comfort level allows.

“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 (DONA)

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

What Women Say:

“on my first labour I felt quite alone. The midwife was busy writing notes and my husband tried but just didn’t quite know what to do. He felt stressed with the pressure and was emotionally involved himself. On my next baby we decided to hire a doula. I met with her over my pregnancy so we really felt comfortable with her by the time I went into labour. In labour, it was brilliant, she was relaxed and it rubbed off on me. Her experience really shown through and her suggestions really helped get me through.”

And:

“After I had my own babies I decided to train as a doula. It is such an honour to support a woman through her labour.”

And:

“I always loved the idea of having a friend or a doula with me in labour but I am quiet self conscious and worried about having someone seeing me undressed or being vocal. I had a talk about it with my friend, who has been a doula before, and we came up with a plan and the promise that if I changed my mind at any time it was OK, no hard feelings. In the end, I was so happy she was there. I felt so loved and cared for – by my husband and my doula. It was a beautiful birth. “

Photo credit: TLP photography

Photo credit: TLP photography

How do I find a doula?

You can find a doula in Ireland through the following website. A word of mouth recommendation is also another good option. It’s a good idea to speak or meet with a number of doulas so that you can find the right one for you.

Irish Doula Directory

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 relaxed their policy on the attendance of doulas at births. 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.

References:

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

Madi, B.C., Sandall, J., Bennett, R., & MacLeod, C. (1999). Effects of female relative support in labor: A randomized controlled trial. Birth, 26 (1), 4.8.

AIMS Ireland: The Great Birthing Partner Debate, 2007

Related Links:

No Epidural? Pain management alternatives and tips – Part 1

No Epidural? Pain management alternatives and tips – Part 2: TENS machine

No Epidural? Pain management alternatives and tips – Part 3: Water therapy, water immersion and water birth

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3 thoughts on “No Epidural? Pain management alternatives and tips – Part 4: Using a Doula

  1. Pingback: No Epidural? Pain management alternatives and tips – Part 1 | 42 weeks

  2. Pingback: No Epidural? Pain management alternatives and tips – Part 2: TENS Machine | 42 weeks

  3. Pingback: No Epidural? Pain management alternatives and tips – Part 3: Water Therapy, Water Immersion and Water Birth | 42 weeks

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