Doulas: Why Every Pregnant Women Deserves One

Doulas: Why Every Pregnant Women Deserves One

by Susan Ross


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Imagine birthing your baby exactly the way you would like -- quietly and peacefully in a dimly lit room in absolute control of your labour and birth, feeling safe and supported. A doula can help you achieve this. Doulas are trained to look after you, both emotionally and physically, during pregnancy, labour and birthing.

They empower you to negotiate the best care for you and your baby. They act as your advocate, steering you and your partner through the sometimes daunting hospital system. Or if you have chosen to have your baby at a birth center or at home, your doula will be with you and your partner providing support, reassurance and encouragement. An Australian book to educate you on what a Doula is, why a pregnant woman needs one and what to look out for when selecting one.

Product Details

ISBN-13: 9781921295300
Publisher: Rockpool Publishing
Publication date: 09/01/2012
Pages: 200
Product dimensions: 6.60(w) x 8.20(h) x 2.20(d)

About the Author

Susan has been a midwife for over 30 years, working in both the public and private sector, and community health in Australia. Susan is a childbirth educator, HypnoBirthing® Practitioner, a Trainer, author of the book Birth Right, published by Random House Australia. She is the founder and Director of her own company, Birth Right, providing information, education, counselling, support to pregnant women and their partners.

Read an Excerpt


Why Every Pregnant Woman Deserves One

By Susan Ross, Kathryn Lamberton

Rockpool Publishing Pty Ltd

Copyright © 2011 Susan Ross
All rights reserved.
ISBN: 978-1-921878-90-9


Why choose a doula?

Choosing a doula is one of the most important decisions you will make during pregnancy. This decision should ideally be made early on, so you have the opportunity to really get to know your doula and work with her, taking advantage of all her knowledge and wisdom.

Doula is a Greek word, meaning 'to serve'. A popular interpretation is 'mothering the mother' — although my Greek builder assures me that if he called his 'wife' a doula she would certainly react violently! He says the word means 'slave' and he would never dare use it in reference to his wife!

Doulas are not medically trained and do not provide medical advice; they provide much, much more. They are women supporting women. They are trained to look after you emotionally and physically during pregnancy, labour, birthing and postnatally. Your doula will provide information about choices — how to shop around and choose the caregivers, birth place and prenatal education that is best for you. She will support and guide you during pregnancy. She will be a familiar face that you can turn to and rely on, without judgement. During labour and birthing she will stay with you, wherever you are, at home or in hospital, nurturing you and protecting you. A doula will be your advocate, should you need one. She will most likely provide your only true 'continuity of care', because this care is very different from what you receive from other caregivers, such as an obstetrician or a midwife.


Women helping women give birth is an ancient practice. According to anthropological data reviewed for 128 non-industrialised hunting — gathering and agricultural societies, all but one offered women continual support during pregnancy, labour and birthing.

When childbirth moved from home to hospital, this all-important support virtually disappeared.

In many countries, more women are now giving birth in hospital than at home, and continuous support during labour has become the exception rather than the norm. This raises concern about the resultant dehumanisation of women's birth experiences. Modern obstetric care frequently subjects women to institutional routines, which may have adverse effects on labour progressing normally. The type of support you receive from a doula will enhance normal labour, as well as your feelings of control and competence, thus reducing the need for obstetric intervention. A review of studies by Hodnett et al. (2007), including 16 trials from 11 countries, involving over 13 000 women in a wide range of settings and circumstances, stated:

Women who received continuous labour support were more likely to give birth spontaneously, i.e. give birth with neither caesarean nor vacuum nor forceps. In addition, women were less likely to use pain medications, were more likely to be satisfied, and had slightly shorter labours. In general, labour support appeared to be more effective when it was provided by women who were not part of the hospital staff.

Doulas are very popular and have been around for some decades in the USA and Europe. Studies by Klaus et al. (1986), Campbell et al. (2006) and Hodnett et al. (2007) show the enormous difference a doula can make to labour and birth. Doulas have emerged over the years as a response to the cry of many women for more support and continuity of care.

Anthropologist Dana Raphael first used the term 'doula' in her book, The Tender Gift: Breastfeeding (1973), to refer to experienced mothers who assisted new mothers in breastfeeding and newborn care.


In their book, Mothering the Mother: How a Doula Can Help You Have a Shorter, Easier, and Healthier Birth (1993), Marshall Klaus, John Kennell and Phyllis Klaus summarise the scientific studies that have been carried out on the advantages of doula-assisted births. The evidence cited is drawn from six randomised, controlled studies. Two studies were carried out in Guatemala (Central America), the first with 136 women, and the second with 465 women.

One study took place in Houston (Texas) in the USA with 416 women. A further study involving 192 women was carried out in Johannesburg, South Africa. The fifth and sixth studies were done in Helsinki (Finland) and Canada. All participants were primiparas (a medical term used to describe women who are giving birth to their first child). All participants were in good overall health and had had uneventful pregnancies. They were invited to participate when they were admitted to hospital in labour. The Guatemalan doulas were trained in a three-week course. In the South African study the women were untrained laywomen. The doulas were asked to stay with the labouring women constantly. They were instructed to use touch and verbal communication, focusing on three primary factors: comfort, reassurance and praise. All of the doulas in the studies had experienced regular labours and vaginal births.

In all of the above studies, the doulas used soothing words, touch and encouragement. They explained the procedures as they occurred and translated medical terms into layperson's terms. The results of these studies were as follows:

» reduced the overall caesarean rate by 50%

» reduced the length of labour by 25%

» reduced oxytocin use by 40%

» reduced the use of pain medication by 30%

» reduced forceps deliveries by 40%

» reduced requests for epidural pain medication by 60%

» reduced incidences of maternal fever

» reduced the number of days newborns spent in NICU (neo-natal infant care unit)

» reduced the amount of septic workups performed on newborns

» resulted in higher rates of breastfeeding

» resulted in more positive maternal assessments of maternal confidence

» resulted in more positive maternal assessments of maternal and newborn health

» resulted in decreased rates of post-partum depression.

Klaus, Kennell and Klaus (2002) speculate that the mere presence of a doula has a beneficial effect on the emotional state of the mother, resulting in a decrease in catecholamines (adrenaline). This relaxed state allows uterine contractions to be more effective and reduces the occurrence of compromised uterine blood flow.

You might be asking, at this point, why not just have your partner, your mother, your sister or your best friend at the birth of your baby?

Should we really expect partners to take on this role? What a huge ask! They are about to become a dad; they should be able to relax, feel supported and enjoy the birthing experience. I don't believe that attendance at a prenatal class and reading — maybe — a book or two qualifies fathers in any way to provide support. A partner should not have to feel that pressure. In expecting dads to be the main support, our society may have created a very difficult expectation of them. I encourage all couples to have ongoing discussion, throughout pregnancy, about what role Dad would like to play. Ongoing, because it may well change as he gains more education in and understanding of the process!

It is not so long ago that men were not 'allowed' to be present at the birth of their baby. When I was working in a hospital in the early 1970s, men who wanted to be present were required to present written permission from their wife's doctor, which they had to give to the midwife on arrival at the labour ward. If they did not have written permission, the rule was: No Letter; No Admission. They were sent to the 'Father's Room', which was a smoke-filled room, with lots of very nervous men pacing up and down and swapping 'wife' stories! We have certainly come a long way in a relatively short time — but have we really? The majority of men are not asked what their feelings are about being at the birth, or how they feel about taking on the important role of advocate and support.

During the 1980s and 1990s, when there was a global shortage of midwives, it emerged as not a bad thing to have Dad at the birth. Women could be left alone for longer periods because her partner was present. And so it became the norm. Like so many processes in the health system, once something has been accepted, it stays — forever, and without question. Women also began to assume that their partner would be at the birth, and so it became an unwritten law that no self-respecting male would dare question it. They agreed to be at the birth, they went, and many of them were terrified. They had no knowledge, no understanding, no benchmarks for what was normal, and for a number of years sat in the corner of the labour room in a state of panic, without any avenue for expressing their feelings. As one woman remarked, 'I want the doula there for reassurance and to comfort me, and I want my partner there for emotional support'.

Partners and others, including mothers, aunts and best friends, are not only too emotionally attached to you, but do not have the knowledge of birthing to be able to provide appropriate support. Very often, these well- meaning friends or relatives are offering advice based on their own personal experience of birth. A doula, on the other hand, has sound knowledge of the hospital system and the people who work in it, and good negotiating skills.

It is not uncommon for a couple, especially the dad, to be concerned that a doula will take over the birth and therefore erode his role. A doula is very aware that the couple will carry the memory of this experience throughout their lives. She is there to make sure they have the birthing experience they want. On the birthing day, her presence allows the father to play the role that is most comfortable for him. The doula gives a level of support to the woman that is different from the support given by her partner. These two kinds of support complement each other.

The World Health Organization (1985) recommends that the caesarean section rate should not be higher than 15%. Rates lower than 15% have been reported for Holland, Sweden, Austria and Norway. However, Laws, Li and Sullivan (2010) in a publication published by the Australian Institute of Health and Welfare show that in 2008 Australia had a very high medical intervention rate of 31.1%. Other research reported by Sufang et al. (2007) in the Bulletin of the World Health Organization indicates increasing caesarean section rates in countries such as France, Germany, Italy, North America and the United Kingdom, with similar trends in low-income countries such as Brazil, China and India, especially for births in private hospitals.

We know that by engaging the services of a doula these horrific statistics can be reduced. Every pregnant woman deserves a doula — a person who provides compassionate, experienced and unbiased support throughout pregnancy, labour and birthing. With this support, couples can enjoy the unique experience of a natural birth, which lays the foundation for strong attachment as the new family grows.

Thank goodness for our wonderful doula! Without her, I am sure our experience of Lily's birth would have been far less satisfactory than it eventually was.

I had a normal, healthy pregnancy and was excited and happy to be expecting my first baby. At 35 weeks or so, Lily was found to be lying breech. We tried everything under the sun to get her to turn head down, but none of it worked. It looked as though it was going to be difficult to create the kind of natural birth we wanted. Luckily there were voices other than those of a mainstream hospital. Our doula encouraged me to read and think for myself about what I wanted, and to ask for it. In full knowledge of the realities and risks, I decided to attempt a vaginal breech delivery instead of accepting the elective caesarean recommended by the hospital.

My labour was long and irregular, with lots of stops and starts, and Lily was slightly distressed right from the beginning. It was nothing like what I had imagined! Our doula valiantly came and went from the hospital as we needed her, encouraged me, held my hand, massaged me, gave Andrew much needed breaks, talked things through and helped us to make decisions about the labour. Most importantly, she helped me to understand that I had choices and to act on them for the sake and safety of my baby and myself — particularly once it became obvious that we needed an emergency caesarean.

Although I was frightened, and dependent on the hospital staff, I never truly felt like I had lost control of the labour, of my baby's wellbeing, of my story, my body and my self. And for that reason, when I look back at Lily's birth, I feel entirely satisfied with our decisions and the outcomes.

Thank you to our doula for helping us to deliver our beautiful, bright, healthy baby girl, and for facilitating a difficult birth in such a practical, empowered and spiritually satisfying way.



It is very important to know what services, support and advice a doula can provide for you. A doula understands and trusts birth. She will not provide medical advice, but you can rely on her to:

» be an amazing listener

» trust in you and your ability to birth

» empower you to negotiate the best care for you and your baby

» find out what you want and respect your choices

» acknowledge the power of birth

» understand that birth is not a medical event

» understand the importance of good prenatal education

» respect the birthing environment and 'your space' during labour and birthing

» know the importance of birthing in a quiet, dimly lit room, with no unnecessary interruptions

» provide continuous support, reassurance and encouragement during labour and birthing, whether at home or in hospital

» provide invaluable support and reassurance for your partner

» respect your birthright to labour and birth your baby in your own time and in your own way.

The wisdom and understanding that doulas bring to the birthing environment provide a protective bubble for you, allowing you to feel safe to enter into 'the zone' of birthing your baby without fear. This, in turn, allows your partner to relax and enjoy becoming a dad.

Robyn had been in pre-labour for over a week. She had a 'birth show' a week before, and was in and out of labour, mainly at night, for the remainder of that week. Very frustrating! There were a number of nights when she phoned me, her doula, saying that the surges were now regular and she felt like this was it! As the dawn arrived, the surges would slow, she would get some sleep and have a relatively normal day. I could sense that Derek, her partner, was getting tired as well. I gave them lots of reassurance over the phone, which was what they needed. There were a couple of nights when I suggested that I come over but they wanted to wait and see.

Exactly one week later, it was decided that they should go into the birth centre, as her membranes had released about 36 hours previously, and there was a small amount of meconium (baby's first poo). Some surges were evident, but were not regular. Following an assessment at the birth centre, Robyn was transferred to the delivery suite, due to the presence of meconium. It was suggested that she should have Syntocinon (synthetic oxytocin) to regulate the contractions. Syntocinon can be very rugged on the birthing body and so many of these births lead to an epidural and the beginning of a cascade of medical intervention. This was certainly not on Robyn's birth agenda. Robyn understood that Syntocinon could lead to other medical interventions and, while she was disappointed, she accepted that this was the best course of action, given that she had been pre-labouring for a week and her membranes had released 36 hours ago, and there were not many surges and quite a lot of meconium.

This is a challenging time for a woman. Robyn was amazing. She continued to use her HypnoBirthing® breathing, remaining incredibly calm and relaxed. The Syntocinon drip was started, which also involved continuous foetal monitoring. Having a drip in and being attached to a monitor can be enough of a distraction for a woman to lose focus. Various midwives were continually fidgeting with the two monitor belts around her belly (which can be very irritating). Even with so-called 'mobile' monitoring, it is difficult to maintain a good connection and therefore, from a medical point of view, to get an accurate picture about how the baby is managing with the Syntocinon. Many babies don't like Syntocinon.

This is a challenging time for a woman. Robyn was amazing. She continued to use her HypnoBirthing® breathing, remaining incredibly calm and relaxed. The Syntocinon drip was started, which also involved continuous foetal monitoring. Having a drip in and being attached to a monitor can be enough of a distraction for a woman to lose focus. Various midwives were continually fidgeting with the two monitor belts around her belly (which can be very irritating). Even with so-called 'mobile' monitoring, it is difficult to maintain a good connection and therefore, from a medical point of view, to get an accurate picture about how the baby is managing with the Syntocinon. Many babies don't like Syntocinon.


Excerpted from Doulas by Susan Ross, Kathryn Lamberton. Copyright © 2011 Susan Ross. Excerpted by permission of Rockpool Publishing Pty Ltd.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Table of Contents

Acknowledgements iv

Introduction Every pregnant woman deserves a doula 1

Chapter 1 Why choose a doula? 9

Chapter 2 About pregnancy and choices 23

Chapter 3 Fear - and how it relates to birthing 53

Chapter 4 Hormones - let them flow! 71

Chapter 5 The role of the doula in your labour and birth 93

Chapter 6 Breastfeeding 137

Chapter 7 Helpful support during pregnancy 149

Bibliography 165

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