"Cynthya was our doula for the birth of our third child in April 2016. As this was my third birth, and I had been attended to by a doula at the first two, I knew that finding the right doula was crucial to a successful and satisfying birth." - Winter Wheeler-Young
When Childbirth Moved Into Hospitals Labor Support Was Left Behind
The 2013 Cochrane Review concluded that all women should have continuous support during labor, and further state that the services of a person, such as a doula, with some training, who is experienced in providing labor support, is the most beneficial.
Part 4 of 7, written by Christina Thomson, Certified Birth Doula and Lamaze Childbirth Educator
Healthy Birth Practice #3: Bring a loved one, friend, or Doula for continuous support.
As humans, we do better when we’re surrounded by those we love and trust, with people who are positive and encouraging. Historically, women were helping other women as they labored and gave birth. Since most births were happening in the home with a local midwife delivering the baby, the laboring mother took comfort and support from her female relatives or close friends.
As we moved away from home births and into hospitals, this tradition wasn't as common. Your support person became your doctor or nurse. In modern hospitals, however, it is difficult for staff to offer the continuous support that you need during labor and delivery. According to the Journal of Obstetric, Gynecologic, and Neonatal Nursing, women expect their labor nurses to provide information, comfort, and support, but research shows less than 5 percent of a nurse's time is spent doing that.
Credit Lamaze International
What does good labor support look like?
According to The Official Lamaze Guide, it's “making sure you are not disturbed, respecting the time that labor takes, and reminding you that you know how to birth your baby.” Your support person “should spin a cocoon around you while you're in labor – create a space where you feel safe and secure and do the hard work of labor without worry.” Good labor support might include: helping you change positions or move around, offering words of encouragement, reminding you to eat or drink, and offering you cold cloths if you are hot. “Good labor support tries to respond to all your physical and emotional needs throughout labor.”
The 2013 Cochrane Review finds that women who received continuous labor support had the following positive outcomes: more spontaneous vaginal births, fewer cesarean surgeries or instrumental vaginal births, less use of epidurals and other pain medications, slightly shorter labors, and greater satisfaction with their birth experiences. Babies of these mothers were less likely to have low Apgar scores at birth. They conclude that all women should have continuous support during labor, and further state that the services of a person, such as a doula, with some training, who is experienced in providing labor support, is the most beneficial.
“The doula’s presence allows your birth partner to participate in the birth in a way that is meaningful to them.”
In Penny Simkin's book, The Birth Partner, a birth doula “guides and supports women and their partners continuously through labor and birth.” According to Lamaze International, a doula is “trained to provide continuous physical, emotional, and informational support to a mother before, during, and just after she gives birth.” A doula isn't going to replace your birth partner.
In fact, the doula’s presence allows your birth partner to participate in the birth in a way that is meaningful to them. If your partner wants to be more active in supporting you, your doula can gently remind them about techniques they learned in your childbirth class, assist them in physically supporting you, and model ways to provide emotional support. If partners prefer to let the doula be the primary support person, the doula can take the lead and help partners to participate in the birth to their level of comfort, while ensuring that the mother’s needs are met. The doula may even give the partner a break to go to the bathroom or to get something to eat.
The true value of having a doula is that a doula knows birth. She brings a quiet confidence in the process of birth, which allows you and your support team to relax and find strength as you do the hard work of meeting your baby. Research has shown doulas to be so effective that neonatologist and researcher John Kennell says, “If a doula were a drug, it would be unethical not to use it.”
Continuous labor support is an essential component of safe, healthy care during labor and birth. All women should be allowed and encouraged to bring a loved one, friend, or doula to their birth.
In both Atlanta and Tampa, we teach an "intensive" preparation for childbirth - the 3 Hour Labor Lesson. You can schedule a private prenatal lesson here. Registration includes weekly follow-up emails to further learning, and access to our online Learning Center where you may watch videos, review current evidence, and download sample birth plans. This is an excellent opportunity for you and your birth partner to gain knowledge on healthy birth practices to help you have the safest birth for you and your baby.
This post is part 4 of a 7 part series written by our team of Lamaze Childbirth Educators. Stay tuned for upcoming posts in our series, How To Alleviate Fears and Manage Labor Pain.
Read part 2, Hormones and the Waiting Game
Read part 3, Make Labor Productive
Read part 4, When Childbirth Moved Into Hospitals
Read part 5, Avoid Routine Medical Interventions
Read part 6, Benefits of Upright and Spontaneous Pushing
Read part 7, Keep Parent and Baby Together
Related posts:
How Taking a Childbirth Class May Prevent Birth Trauma
5 Reasons to Hire a Birth Doula
6 Points For Birth Partners to Consider When Hiring a Labor Doula
5 Reasons Your Labor Nurse Cannot Be Your Doula
Is Waterbirth Safe? What are the benefits and risks for mothers and babies?
Our team has seen the beneficial effect of hydrotherapy use for labor and when clients give birth in the tub. The warmth of the water, the added buoyancy, with the addition of pouring water down the back or tummy, always adds a measure of comfort throughout labor and birth.
How To Have An Easy and Relaxed Labor
As labor doulas, we have seen the beneficial effect of hydrotherapy use during labor and while giving birth in a tub. We often suggest to clients that they take a long, warm bath in early labor to slow down contractions and relax the uterus enough so that sleep becomes possible. Once a strong pattern of contractions has been established, typically, a bath will not slow labor but allow for complete relaxation of the muscles between contractions.
The warmth and buoyancy of the water provides a measure of comfort throughout labor and birth. Slowly pouring water down the back or tummy is also helpful. Hydrotherapy and underwater birth is safe and reduces the need for pain medications while lowering your risk of a c-section due to the ability to move into and maintain open-pelvic positions for easier rotation and descent of the baby.
“A 2012 Cochrane review found no harm to the baby in 12 randomized controlled trials of water labor or birth involving 3,243 women, and less use of epidural anesthesia.”
The evidence shows that babies born in the water have similar health outcomes compared to babies born on land. The bottom line is that waterbirth is a reasonable option for low-risk birthing people.
An excerpt by Dr. Rebecca Dekker of Evidence Based Birth from her article titled Water Immersion During Labor for Pain Relief:
"The bottom line is that researchers have found that water immersion during labor poses no extra risks to the baby. They’ve overwhelmingly found that it lowers the need for pain medications and it makes people feel more satisfied with their pain relief. Hydrotherapy’s effectiveness on pain appears to be less effective than an epidural or spinal, but more effective than using IV opioid drugs. The good thing about water immersion during labor is that there doesn’t seem to be any side effects. Also, evidence shows that water immersion during labor increases people’s satisfaction with their childbirth and their sense of privacy and comfort. Mothers who labor and give birth in water tend to remember their experiences as being more positive and less painful." Read full article here.
We encourage you to explore for yourself all that underwater birth can offer you. Seek out medical facilities and care providers offering inflatable tubs or birth pools for labor and delivery (not just water "labor" or immersion). For further reading on water birth, checkout NPR's Shots article from March 2014.
