I was recently interviewed for a magazine article on the role of doulas in reducing the maternal mortality rate in the US and the reporter asked why, in the absence of significant amounts of research, there is a growing understanding that doulas can play a role in improving maternal health outcomes during pregnancy, birth, and the postpartum transition.
I had to pause for a moment on that one. When you are a doula and you’re in the birth community it’s fairly easy to see the value in your own work, but if we really have to break it down and qualify it, what specifically, does a doula do, that helps improve a mother’s chances of surviving the birth of her child?
After a moment, the answer was clear to me though.
Doulas provide personalized, accessible, on-going prenatal education:
The only way to truly know that something is wrong is to know what right looks like. The majority of women in the United States have little to no experience with birth before giving birth themselves, and experience with birth doesn’t always equate with knowledge of normal physiologic birth. Culturally, we believe that birth is painful, scary and something to just “get through”. So, it stands to reason that if you are in labor and start feeling intense pain, for example, but have no education surrounding what typical labor pain feels like or what a typical labor pattern looks like you may not know to speak up and alert your medical providers to a possible problem. The education that a doula provides is also personalized to the situation of the client and allows the family to plan ahead and prepare for the possible decisions that they may be faced with during the labor and delivery process which decreases anxiety and uncertainty and allows the client to better advocate for herself and her baby. How is this different than attending a childbirth education class? It's more accessible, this is personalized childbirth prep right there in your living room. That’s not to say that childbirth education classes aren’t necessary or useful- they provide an opportunity to meet other expectant parents, they are a great bonding and practice opportunity for couples and they offer more variety in learning techniques and activities than you will get in a doula prenatal visit. However, having that one-on-one prep time with a doula in the comfort of your home allows the information to really sink in, gives you time to ask questions and can lead to further research and conversation which in turn leads to more confidence and proper self-advocacy during and after birth.
Doulas are the on-call sounding board you need:
Moms, in general, are notorious for downplaying their needs and discomforts. We don’t have time to be down for long so we try to brush things off and just keep moving. During pregnancy, it becomes especially easy to brunch off potentially dangerous symptoms as normal pregnancy complaints. Have a headache? Maybe it's just because you’re not sleeping or you’re dehydrated… or maybe your blood pressure is too high. Throwing up in your third trimester? Maybe its hormones or maybe it's HELLP syndrome. Pass a clot that seems a little too large on your first day home from the hospital? It may be normal or it may not be. Unfortunately though, compounding our desire to minimize discomfort is the legitimate challenge of navigating the healthcare system. If it’s the weekend and the office is closed, do you go to the hospital? Did you leave a voicemail but never get a callback? Is this really worth tracking down the midwife for? But a doula is someone you know. Someone who is on-call for you and is one text message away at all times. Doulas aren’t medical providers by any means but we’re often the sounding board that is needed to convince a mom that her complaint is worth a call to the doctor, even if it feels inconvenient.
Doulas help reduce the risk of cesarean birth:
One area of research on this topic that is fairly clear is the role doulas play in birth outcomes. Depending on the study or review, doulas have been shown to reduce cesareans by anywhere from 28 percent (Hodnett et al., 2012) to 56 percent (Kozhimannil et al., 2016) for full-term births. Why does that matter? A French study done in 2006 found that the risk of postpartum death was three times more likely following a c-section than a vaginal delivery due mostly to blood clots, infections, and complications from anesthesia. This is compounded by the fact that once a woman has one C-section she is more likely to have another with future children. Obviously, sometimes a c-section is absolutely necessary and in-itself life saving, but it is major surgery that should not be entered into unless necessary- and the best way to be sure that your c-section was necessary is to have the support needed to avoid an unnecessary c-section.
So it seems that there is not one singular thing that a doula does that account for a decrease in the risk of maternal mortality, but rather doulas fill in the various gaps that have been created in our current culture and healthcare system. With that in mind, we need to continue to strive towards creating models of affordable and accessible doula care and doing away with the system that reserves education, support, and care for only those that can afford to pay a premium for it.
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