How Doulas Work

Why Use a Doula?

doula, patient doula, patient
A doula comforts her emotional pregnant client as she lays in the operating theatre during a Caesarean section. Petri Oeschger/Getty Images

Traditionally, women relied on female relatives and friends to help them though the birthing process. But as births move into hospitals in the 20th century, many of these functions were handed over to nurses. As electronic monitoring became prevalent, nurses didn't have to stay with one patient and usually had several to attend to at one time. This often left the mother feeling lonely and unsupported. Even if she had her husband, partner or a friend in the birthing room with her, they may not know the best way to assist her [source: Papagni]. Enter the need for a doula.

Doulas might not be technically necessary to the childbirth process, but many parents consider them essential nonetheless. Science appears to be backing that sentiment, too. A recent review of studies looked at the birth results of more than 15,000 people. Some of the birthing mothers had continuous support, like doulas, nurses or friends/family members. Other women had no continuous support at all. Outcomes for women with continuous support were better than those without. Their labors were shorter, on average, by 40 minutes and their babies tended to have higher Apgar scores (scores used to assess the baby's health at birth). They experienced fewer negative feelings about childbirth and required less pain medication, forceps or vacuum-assisted interventions and C-sections. No disadvantages to continuous support were found whatsoever [source: Bohren et al.]

The researchers then looked specifically at care by a doula to see how it compared with other types of continuous care. Women who used a doula were 31 percent less likely to use Pitocin and 28 percent less likely to have a C-section. They were also 12 percent more likely to have a spontaneous vaginal delivery and their infants enjoyed 14 percent less risk of needing to be admitted to a special care nursery. In many of these categories, doulas outperformed other types of continuous care providers [source: Dekker].

If you're wondering why/how doulas are able to achieve these statistical feats, consider how Bennett likens them to "professional nurturers," insisting that they serve to complement the typical group of nurses, doctors, midwives and other medical professionals. "I've run across some very compassionate doctors, midwives and nurses in my day, the more compassion around you the better, but they need to reserve a lot of mental capacity for their medical roles," she explains. "They have very demanding jobs and so doulas are there to lessen that burden by comforting our clients and helping them to have a positive experience."

This is in line with the harsh environment theory, which holds that the many sights, sounds and experiences of the hospital setting make it more difficult for laboring mothers to have great outcomes. The severe lighting, procedures and presence of virtual strangers causes lagging self-confidence (pretty important when in the midst of a difficult feat) and can even slow labor. So, the presence of a knowledgeable advocate can lessen the harshness of the experience. The constant support and supplication of pain management techniques can also effectively reduce pain levels, essentially turning the doula herself into a powerful, human pain-reliever.