An experienced and trained doula understands that her doula role is limited to emotional and physical support only (1). Whereas medical care providers will have a trained eye on the safe and healthy labor and delivery for mother and infant, a doula is a constant presence, ‘mothering’ the mother through labor. This mothering can include affirmation and encouragement, suggesting and offering comfort measures, and encouraging the couple to ask questions and communicate with care providers regarding their personal labor and delivery preferences.
The doula role with pain relief
Fear and tension can be a laboring mother’s worst enemies, working against the natural progression of labor on both muscular and chemical levels. Consequently, the ability to relax is perhaps the most important gift for a laboring mother. An effective doula will be knowledgeable in techniques such as varied positioning, use of heat and cold, massage, rhythm and ritual that can be used by the mother, partner and doula to enhance relaxation. By using these tools, a doula can help the mother remain calm, focused and able to tolerate the physical pain and discomfort of labor to the best of her ability. These techniques can also contribute to more efficient labor progression.
Doula advocacy and responsibility
The goal of the doula is “to help the mother have a satisfying birth as she defines it.” (2) A professional and ethical doula will ignore her own vision of what labor should look like and focus on the preferences and needs of the mother and partner. Knowing and understanding her clients allows a doula to better support the birth experience and guide the mother and partner appropriately. To this end, doulas will typically meet with the couple prenatally to better understand what is important to them, as well as address their questions and concerns. With this background, she can help the mother advocate for her care. A doula should not make decisions for the mother; rather she will help the couple ask appropriate questions and express their preferences to their care providers.
A doula's primary responsibility is to her client. In addition to following their birthing preferences, the ethical doula understands that it is her obligation to follow through with a birth responsibly. As described in the DONA Code of Ethics, this includes having a backup plan (which may include offering a backup or referred doula), being present through active labor and immediate postpartum and charging reasonable fees for services provided. (3) Responsibility also includes maintaining levels of training and childbirth knowledge that allows the doula to serve to the best of her abilities.
1 DONA International Standards of Practice (2008)
2 Simkin,”The Birth Partner,” 2008
3 DONA International Code of Ethics, 2008