Doula care provides the laboring woman with emotional support and direction as well as education. Recent studies show that the presence of the doula at a birth provides the following benefits: decreases length of labor by up to 25 percent, decreases overall cesarean rate by up to 50 percent, decreases request for pain medication by up to 30 percent, decreases various interventions by up to 40 percent and decreases postpartum depression.

These statistics translate into a more positive birth experience for the mother. By providing continuous care, the doula helps the mother to feel secure and in control. Mothers who work with a doula tend to have increased sensitivity and higher regard for their newborns. This, no doubt, contributes to higher rates of successful breastfeeding for those mothers who use doulas during their labors.

The certified doula has completed an extensive educational process that covers training in childbirth education and labor support. Many organizations require that students work with a preceptor before becoming certified.

DONA, Doulas of North America, is one of the largest most recognized training and certifying associations. Members of DONA must agree to adhere to the clearly defined standards of practice that outline the services rendered by a doula as well as practice limitations. Doulas do not perform clinical or medical tasks. They provide emotional and physical support, while acting as an advocate for the laboring woman, providing information and in some cases mediation or negotiation. Women certified through DONA must maintain data collection and documentation of each client encounter. Re-certification takes place after a three-year period.

The doula mindset centers on the concept that every birth is a unique experience for each woman and her family. Her goal is to facilitate positive communication between the laboring woman, her partner and the health-care providers. Emphasis is placed upon education and informed consent. Doulas encourage women to trust their bodies and to have confidence in the natural process of birth.

The doula may go to the home of the laboring woman and stay with her until they transition to the hospital or birth center. She labor sits, providing helpful advice and reassurance. Women, who have experienced doula care, believe that having their doula with them, in their home, provided an atmosphere of encouragement and calm. In the absence of fear, they felt confident and eager for their labor to progress. The doula will remain with the woman throughout her labor, including one to two hours after the birth in order to help the mother establish breastfeeding with her newborn.

Positive outcomes associated with the use of a doula not only impact the laboring woman and her family. The benefits to society in terms of cost savings to our health-care system are substantial. It has been estimated that if every woman in the United States had a supportive woman with her continuously throughout labor, the reduction in interventions such as caesareans sections and epidurals would reduce maternity care cost by more than $2 billion a year (Klaus et al. 1992)

- References: “Pursuing the Birth Machine,” Marsden Wagner, MD; “A Guide to Effective Care in Pregnancy and Childbirth,” Murray Enkin, MD, Ellen Hodnett RN, PHD, G. Justus Hofmeyr, MBBCH, MRCOG, Marc Keirse, MD, Crowther, MD, James Neilson, BSC, MD; Hospital Physician 2/2001, “Social Support by Doulas During Labor and the Early Postpartum Period,” Bruce Meyer, MD, MBA, Jane Arnold, CNM, MSN, Debra Pascali-Bonaro, BEd, CCE, CD, CPD; DONA - Doulas of North America at www.dona.org

Andrea Branagan, MA, CNMI, is a childbirth educator and health care advocate. She is an associate with Choice's West, A Center for Women's Health, and the director of education for “Gentle Birth Choices.” To learn more, visit www.gentlebirthchoices.net