by Debbie Partrick
I had been a nurse in obstetrics for 30 years, and I had never heard of doulas until I moved to Brattleboro five years ago. At first I thought it doesn’t make any sense. In Lamaze classes, you’re taught that you have a labor support person, which is usually your partner. But the doula is more. They are a breath of fresh air not only to the mom that is laboring, but to the family and to the staff.
What really opened my eyes was witnessing a birth with one of BMH’s midwives where a doula was present. It was so different from what I was used to seeing. So much calmer. So much quieter. You’ve heard stories of women screaming in labor. There was none of that. It was total focus and it opened my eyes to how much they can do and how much they can offer the woman in labor and make things easier.
Doula is an ancient Greek word simply meaning “woman who serves” but it has become an occupational title for women providing non-medical support to pregnant women. DONA International is the largest organization providing doula training and certification, and they currently count more than 7,000 members worldwide. DONA offers separate training for labor and postpartum support to new mothers and their families. Where a birth doula provides continuous physical, emotional and informational support before, during and just after childbirth, a postpartum doula could spend anywhere from a few days to 2-3 months helping a mother enjoy and care for her new baby. This includes working with the partner and other children to assist with making sure the mother gets enough rest and nourishment to nurse the new family member.
The fact that doulas are non-medical personnel is an important distinction for their role during the labor process. What they provide is very complimentary to the duties of an attending nurse. When a woman is in labor at the BMH Birthing Center, a nurse is assigned to work with her, one-on-one, and does not leave them. She is monitoring the baby’s heart rate and mother’s contraction patterns, among other things. Meanwhile, a doula can explain what the nurse is doing and why it is happening. The constant reinforcement that what is happening is normal is critical for a mother as they reach a point of physical and emotional exhaustion from labor. The doula can also coach the mother and partner, saying “you’re almost there; you’re doing a good job.” Physically, they help with positioning, walking with her or rubbing her back and shoulders. It might be something little but it might be just the trick to help her deliver.
Research into doula-assisted births shows tremendous benefits. The Cochrane Review published a report indicating that women were less like to require pain medication or have a cesarean birth when a doula was present, and that the mother’s perception of the birth experience was rated more positive. Other studies have shown that having a doula as part of the birth team decreases the overall cesarean rate by 50 percent and shortens the length of labor by 25 percent. Use of the medication oxytocin is lowered by 40 percent and requests for epidurals drop by 60 percent.
Those kinds of results really compelled BMH to revive its doula program. Carol Schnabel, the program coordinator, helped recruit and train the thirteen women who are now participating in the program. All the doulas at BMH are volunteers doing it for the love of the birthing process. They have other jobs, but they make themselves available to women 24 hours a day, seven days a week should they need support during their pregnancy. With approximately 350 births per year at BMH, having 20 doulas would be an ideal number. We are offering another training class in March and already have a couple people interested in training and taking part in the program. That would enable us to have one out of every three births at BMH attended by a doula, which is in line with the national number for active doula programs at large hospitals.
As an expecting mother makes her birth plan, usually around the seventh or eighth month of pregnancy, she can include having a doula work with her. The Vermont Birth Network website is one resource where women can find and hire a doula, but the BMH Volunteer Doula Network is completely free for patients. They and their partner can meet with a doula at a birthing class or by appointment to find a woman they are comfortable with, and then that doula is assigned to that particular family the whole time. The American Pregnancy Association web site offers the following quote from Doulas Making A Difference: “My husband (partner) is my left hand and my doula is my right.” When it comes to a successful and positive birth experience, many hands make light work.
Debbie Partrick is the nurse manager for the Brattleboro Memorial Hospital Birthing Center.