Mothering the Mother
by Dana Scarano
Throughout history in most countries of the world, women in childbirth have been cared for by other women. One anthropological study of 128 non-industrialized hunting-gathering and agricultural societies concluded that all but one offered mothers the continuous support of other women during labor and delivery. Artistic representations of birth usually depict a woman giving birth surrounded by two or more women: One woman is the midwife, responsible for the delivery of the baby; the other woman or women stand beside the mother and hold, comfort, and support her. Those women are her doulas.
The word doula is derived from the Greek word meaning "caregiver of the mother." In the ancient Greek household, it was a woman who helped another woman through childbirth. As time went on childbirth became less common at home, more common in hospitals, and the use of doulas lessened.
Nowadays, a doula is a trained professional who is an experienced childbirth assistant. She provides continuous physical, emotional, and informational support to a woman and her partner throughout pregnancy and birth. Most women have normal pregnancies and labors. The medical world has scared women into thinking that their pregnancies and deliveries "may" go wrong and that an emergency "may" arise, instead of instilling in women the reassurance they deserve when they are going to give birth. A doula provides such reassurance and encouragement to the couple. She also brings a calm, focused energy into the delivery room, which can help a mother feel more grounded and centered.
A trained doula is knowledgeable in pregnancy, birth, labor and delivery. She does not however diagnose, give medical advice or perform clinical tasks. She supports the mother's decisions, explains procedures, and provides information about the progress of the labor. She encourages the couple to gain as much education as possible prior to the actual birth, so that they can make informed decisions. She stays by the side of the mother for the entire duration of labor, regardless of how long it takes. A good doula also acts as a facilitator of communication between the laboring woman, her partner, their doctor or midwife, and the hospital staff.
Doctors and hospitals often have their own priorities when it comes to the treatment of patients; it is important for a couple to have the support of someone else who will make sure their wishes are heard and carried out. We are fortunate to have the kind of medical technology that we do in this country and it is often put to use in positive ways. Sometimes, however, intervention with drugs and technology can complicate childbirth... say for example Pitocin—a synthetic form of the body's natural hormone Oxytocin—is used to induce labor, causing very intense and painful contractions. The woman may be given an epidural for the pain, which numbs her from the waist down. She then must be catheterized and hooked up to an electronic fetal monitor to measure the baby's heart rate. As a result, she is restricted to the hospital bed and not able to let gravity do its job to bring the baby down the birth canal. Labor can slow down and even stop, resulting in a cesarean section.
A doula can help avoid this scenario by working with the mother before she chooses the epidural. She can suggest comfort measures that relieve pain, such as a warm shower or bath that relaxes the body's muscles. She may suggest moving into different positions, or using a birth ball, or start a process of massage and touch to relieve muscle tension, along with guided imagery and breathing techniques.
In the late 1970s, Drs. John Kennell and Marshal Klaus did numerous studies to measure the effects of a doula's continuous support during labor. The results of these studies showed that doula-attended births had significantly better outcomes than the births where no doula was present. Among the benefits: reduced length of labor, less chance of Cesarean, less use of forceps and vacuum extraction, less need for pain medication during labor, increased self-image and self-esteem of the mother after labor, higher satisfaction with partners, improved maternal-infant bonding, and better overall outcomes for the babies.
The relationship between the mother and doula is one of extreme trust and honesty. It can start at any stage during the pregnancy, but an early start with your doula allows you to get to know one another and form a rapport. A doula will typically meet with a couple at their home a few times prior to the birth to formulate a "birth plan"—a list of the couple's goals and expectations for the birth.
I suggest that my clients take the time to come up with such a plan, since it encourages couples to think about what is important to them in the birth of their child and can be an important tool to use in any birth setting, whether at home or in the hospital. A birth plan stimulates communication between mother and partner as well as mother and doctor and encourages a mother to be more in charge of her and her baby's care. I always remind my moms that the birth plan is not set in stone and can change at any time, including during labor.
The doula is part of a team; her role is not to "take over" or replace the women's partner but rather to assist him or her. In the 1960s, when fathers started becoming more involved in childbirth, an expectation sometimes arose that they become the mother's support system—and the decision makers. This expectation turned out to be unrealistic, because most fathers had no prior knowledge of birth or medical procedures and did not feel confident enough to question the medical staff. Having a doula present during birthing can take pressure off the partner, allowing him or her to better enjoy the experience. When the partner needs a break—a breath of fresh air, food or a cup of coffee, he/she can leave and know that the mother will not be left alone. Partners who want to be more actively involved can also use some guidance from a doula in how to be more supportive of the mom before and during labor. I may suggest certain things a couple can do together, like taking a walk, breathing together, or slow dancing to some calm music (the rocking back and forth motion helps bring the baby down.)
A doula is available by phone throughout a mother's pregnancy to answer any questions or concerns the couple may have or to suggest books to read or videos to watch prior to the birth. When the due date is near she remains on call and keeps in close phone contact with the mother until her presence is requested. The doula meets the couple at their home or the hospital and stays with them until the baby is born and the couple and baby are united as a family.
In cases where a cesarean section might be necessary or if the baby needs to be transferred to the Neonatal Intensive Care Unit or NICU, the doula may go with the baby so that the father can stay with the mother, or vice versa. I was once at a birth where this happened, and the baby was crying and irritated. At the parents' request I followed the nurses and baby to the NICU and was able to do light, therapeutic touch on the baby to calm her. After 15 minutes of lightly stroking and talking to her, she stopped crying, settled down and eventually fell asleep. I then was able to bring the mother to join her baby in the NICU to begin breastfeeding.
Doulas understand that the birth of a child is an important experience which a couple will remember for the rest of their lives. The manner in which a child comes into this world is equally profound for her or him. Doulas encourage a mother to birth her baby naturally, with the least amount of intervention. She urges the mother to trust that her body was made to perform this amazing event, that she has the ability and power to carry it out, and reminds her to listen to what her body instinctively tells her. Doulas do not make decisions for their clients and should not project their own values and goals. The only goal is to help the couple have a safe and satisfying, memorable birth experience.
Dana Scarano is a Certified Birth Doula and New York State Licensed Massage Therapist in the Hudson Valley. She has over ten years of experience specializing in prenatal & postpartum massage. For more information call 845-258-7143.
