Why Hire A Doula?

Why should I hire a Doula? This is one of the questions I asked myself when I was pregnant with my son in 2017. At the time, we were planning our wedding and had just moved in to our first home together. Money was in no way floating about the place waiting for us to spend it. Looking back now, I can see that I was very naïve to the real impact Doulas can have. I knew about Doulas, I daydreamed of being one, but I did not really understand how hiring a Doula could translate to better outcomes for me and my baby. With this lack of knowledge and pretty prams filling my Pinterest board, the cost of a Doula just did not seem essential and so it promptly slipped down my priority list.

It was not until after I gave birth to my son that I understood many of the subtle ways that a person may need support during this time. His birth sparked something in me, and I desperately began searching for ways that my birth could be different next time; more gentle, more supported, and much more informed. I quickly fell down the rabbit hole in to ‘douladom’. I read everything I could get my hands on and devoured all of the juicy evidence out there that shows how Doulas, whilst often seen as a ‘nice-to-have’, can also make a bloody big tangible difference to someone’s birth experience.

Having suffered from symptoms of PTSD and Postnatal Anxiety after the birth of my little boy, this evidence was music to my ears. Maybe my next birth did not have to go the same way. So, what did I find?

Doula’s have been around forever. For as long as people have been birthing babies, Doulas have been there in one form or another, although it was not until the 1960s that they became more popular and well-known. Over the years, people began to realise that women and birthing people who had access to a Doula were achieving different and often better outcomes than those who birthed without. This became interesting to researchers across psychology and health arenas and spurred them on to investigate.

Continuous Support

In general, we understand that birthing people do better when they have access to continuous support (Bohren et al., 2017). It is part of the reason ‘continuity of carer’ is being pushed for by many both outside of and within our health care system today. It makes sense that seeing the same people and having the time to establish a trusting relationship with them is conducive to a person feeling safer and in turn having better birth outcomes. Not everyone has access to this kind of continuity of care and anecdotally, having the same care provider throughout your pregnancy, birth and postpartum journey can be quite rare. This is where Doulas come in.

Doulas can provide you with a person who is able to be with you throughout your entire journey. Some people employ Doulas and work with them throughout their pregnancy, during their birth and right the way through to a few weeks after their baby is born. Research by Bohren et al. (2017) showed that when someone has this kind of continuous support they experience:

• 25% decrease in the risk of Cesarean;*

• 8% increase in the likelihood of a spontaneous vaginal birth;*

• 10% decrease in the use of any medications for pain relief;

• Shorter labors by 41 minutes on average;

• 38% decrease in the baby’s risk of a low five minute Apgar score;

• 31% decrease in the risk of being dissatisfied with the birth experience;

Amazing right?! Even more amazing when you realise, that for points 1 and 2, the largest effects were seen for people who had a Doula; a 39% decrease in risk of caesarean and a 15% increase in the likelihood of spontaneous birth retrospectively. Furthermore, the evidence also showed how the mothers’ risk of being dissatisfied with their birth experience was reduced with continuous support provided by a Doula or someone in their social network (family or friend), but not if the support was provided just by hospital staff. This demonstrates how important it can be for some people to have a support person that is separate from the person providing their clinical care.

Helping you to feel calmer

So now I knew having continuous support from someone like a Doula could reduce my labour by 41 minutes on average, I was pretty much like…sign. Me. Up. But it got even more interesting from there. During my labour, I tried my best to make the hospital room a ‘home-from-home’ but I still found it very difficult to switch off and feel relaxed. I found that the bright lights, sterile environment, and the strange bed threw me for a loop, and it took me a while to get into my groove.

This is something that researchers refer to as ‘the harsh environment theory.’ Basically, when labouring in hospital we are often confronted with an unfamiliar environment, unfamiliar people, and unfamiliar processes. Some people can experience a lack of privacy, a high turnover in staff and high intervention rates. All of this can leave a woman or birthing person feeling extremely off kilter. So much so, the environment has even been shown to slow labour down and add to feelings of vulnerability. Research by Hofmeyr, Nikodem et al. (1991) found that having a Doula in this situation can be very helpful as they seem to act as ‘buffers’ to this type of environment. They can help the labouring person feel safe and provide them with some familiarity which soothes them and increases their self-esteem. When you have had a chance to build a relationship with someone and in turn build trust in them, it can really help to have them nearby during a time when you may feel worried or vulnerable such as during labour.

The attachment formed between a Doula and their client has also been shown to have a physiological effect on the body, reducing stress hormones and allowing for the all-important hormone oxytocin to surge (Personal communication, Dr. Amy Gilliland, July 2015). We know that Oxytocin is in many ways the magic hormone of labour, helping you to not only feel calmer but to also increase the effectiveness of your contractions, potentially making labour shorter and getting your baby in to your arms sooner.

A form of Pain Relief

I know what your thinking, “This all sounds pretty good Danielle, but it’s not like a Doula can actually make labour less painful, is it?” If you were not thinking that, I bet you are now. And I am happy to tell you that the evidence shows that yes, they can! Our bodies are complex, clever things, and the hormonal dance that happens during labour is a delicate one. We have something inside us called beta-endorphins and these are known as our natural pain relievers. Having ways to encourage these in labour can be key and may reduce the need for alternative pain relief. The good news is, if you hire a Doula, their presence is proven to encourage you to release more of these natural pain coping hormones into your body and can actually help labour to be less painful (Uvnas Moberg, 2014). This is probably why other studies show how, on average, mothers who had doulas present at their birth had lower average pain scores during their labour than those that did not (Ravangard et al. 2017). The effect of Doulas shown here was so much so that the researchers concluded that having a Doula had a “clinically meaningful impact”, not just on pain levels but also, and some would say more importantly on levels of anxiety in first time mothers.

Better outcomes for Black Birthing People

So, so far, we know that Doulas are capable of supporting some pretty good outcomes. It is also important to note though, that positive birth outcomes are not a given for everyone. Birthing people who are not straight, white or cis gendered can experience many prejudices and obstacles that lead to worse birth outcomes for them and their babies.

Currently, in the UK, black women are four times more likely to die in childbirth than white women (MBRACE, 2020). This evidence is unfortunately nothing new and is backed up by other studies such as Thomas et al. (2017) who found that Black women experience higher rates of poor birth outcomes, including higher rates of Caesarean, preterm birth, low birth weight, and infant death. Research shows that health and social factors alone do not explain the higher rates of poor birth outcomes among Black birthing people and in fact, research from the US shows that the individual, institutional, and other forms of racism that black people experience throughout their lives are a likely source of poorer pregnancy outcomes within this community (Giscombé and Lobel, 2005).

Doula support has been shown to reduce some of these negative outcomes and research by Kozhimannil et al. (2016) identified five main ways Doula’s may be able to do this;

• By supporting pregnant people’s agency by helping them to understand their options and communicate with health care professionals.

• By supporting birthing people to feel safer by having access to a comforting and reassuring presence.

• By helping to facilitate greater respect and autonomy in decision-making.

• By ensuring knowledge about the pregnancy and birth process from care providers is properly received and understood by the birthing person.

• By helping black birthing people to feel connected and less socially isolated by having access to a doula with similar life experiences and someone who shares their culture and background.

In 2010, Healthy Start Brooklyn demonstrated how this could work in practice by formalising a programme which set to reduce the negative outcomes for non-Latina Black women – the group which had the highest infant-mortality rate in the program area. Between 2010 and 2015, the programme provided doula support to over 500 black birthing people and saw significantly lower rates of preterm birth and low birth weight, demonstrating how Doulas can support black women and birthing people to have better outcomes for themselves and their babies.

So, why hire a Doula?

Each woman and birthing person has their own specific history, challenges and experiences that they bring to birth. Finding a doula that is well educated, that you feel safe with and that has values that match your own can make a real difference to how you experience your pregnancy, birth and postnatal period. Not only do doulas provide you with a person of continuous support, but they are also proven to help you to feel calmer, provide a form of pain relief and support you so that you may experience better birth outcomes overall.

If those alone are not enough reasons to hire a Doula, I do not know what would be!

Knowing what I know now I cannot imagine ever heading into birth again without a Doula by my side (note: I may or may not have already chosen my Doula even though I am not even pregnant yet, ha!). I truly believe in the power of Doulas as a positive force for change and any woman or birthing person who wants to have access to a doula should do which is part of the reason the Belly Beautiful was born.

So, in conclusion and in answer to the question of this article, “Why hire a doula?” Because they are fricken amazing, they make a difference and you bloody deserve to be loved and held and supported throughout your baby journey in whatever way is best for you.

If you have any questions on anything at all, please send me a little message. As you can tell, I love to talk Doula.