To Doula or Not to Doula

Feb. 19, 2001 -- They don't call it 'labor' for nothing. Giving birth is hard work, and it pushes most women to the point of exhaustion. But there are ways to make the entire process more comfortable for mom and her partner and perhaps promote mother-infant interaction even months after delivery.

Surprisingly, most women in this country do not make use of a labor aide known as a doula. While the name may sound funny, the functions the doula can perform for a woman in labor are no laughing matter.

"A doula never does anything clinical, but what she does do is give a lot of physical and emotional support," explains Kristi Ridd-Young, who has worked as a doula for the past 16 years.

In most cases, the doula meets with the pregnant woman and her partner a few times before the birth.

"As soon as the woman goes into labor, the doula arrives at the birthplace and starts doing any kind of comfort measures that are appealing to the woman for her particular pain during labor," says Ridd-Young, the administrative director of Doulas of North America (DONA).

Comfort measures may include cold and hot packs applied to different parts of the body, massage, and acupressure techniques. One popular acupressure technique involves applying pressure to the leg below the kneecap to relieve pain from uterine contractions.

Although dads or other partners of the pregnant woman can provide comfort and reassurance, the doula's experience is her key advantage. For example, she can suggest frequent changes in position to allow labor to progress and reduce the pain of contractions.

"Doulas suggest a lot of movement during labor that a father might be frightened to suggest," Ridd-Young says.

Although the medical community hasn't exactly embraced the use of doulas, they are starting to see the potential of these so-called 'female supportive companions.'

"We were just astounded at how impressive the benefits were when a mother had a doula," says John H. Kennell, MD, who presented findings from a new study of doulas on Feb. 16 at a meeting of the American Association for the Advancement of Science in San Francisco.

Kennell, a professor of pediatrics at Case Western Reserve University School of Medicine in Cleveland, has found that compared with women who didn't use a doula, those who did had 50% fewer cesarean deliveries, 40% fewer deliveries requiring use of forceps, 60% fewer requests for epidurals, a 30% reduction in need for pain killers, and a 25% decrease in the time actually spent in labor.

Another important recent finding, says Kennell, is that mothers who use doulas seem to smile at, talk to, and stroke their babies more after delivery than mothers who do not use doulas.

"It's very powerful in what it does for the mother's confidence and self-esteem," he says. "She seems to have less anxiety and less depression in the weeks after the baby is born. The way they interact with their baby is more positive and more responsive and more sensitive."

Kennell says he hopes that larger studies can be done with women in the U.S. to further document the benefits of doulas so that more women will be encouraged to use them.

Fees for doula services vary in different regions of the country, but Kennell says a typical fee is about $250. While there are no firm statistics on how many practicing doulas there are in the U.S., about 3,700 are members of DONA.