I’m planning on having my mom/sister/friend/partner as my doula. What’s the difference between hiring a paid professional to be my support?
A calm, nurturing person with a basic understanding and respect for the birthing process can offer great support. A friend or relative who takes on this role can offer a special gift to you and experience the great privilege of participating in this important event in your life. While having labor support from a well-selected friend or relative is likely to improve your childbirth experience, if you seek other established benefits of labor support, such as increased likelihood of vaginal birth, shorter labor, minimal/minimized interventions, research suggests that you should find a doula. The research available on the benefits of doula support is a 2017 Cochrane review of 26 studies from 17 countries. The review found that women with companions who were not on the hospital staff and were not the woman’s partner, friend or relative, experienced the greatest – and quite impressive – benefits of doula support. Compared with women with no labor support, those with a labor companion were:
- 39 percent less likely to have a cesarean birth
- 35 percent less likely to rate their childbirth experience negatively
- 15 percent more likely to have a “spontaneous” vaginal birth (no forceps or vacuum extraction)
The review also found that women with labor support from someone in the doula role were notably less likely to:
- use synthetic oxytocin to speed up labor,
- use any pain medication while giving birth, and
- have their babies admitted to a special care nursery.
In comparison with women who had no labor support, women who got support from a partner, spouse, other family member or friend were also less likely to rate their birth experience poorly. However, their likelihood of experiencing interventions (cesarean birth, etc.) was not different from women with usual care.
Support provided by a member of the hospital staff (such as a nurse) did not seem to affect women’s likelihood of having a cesarean birth, their use of synthetic oxytocin or their ratings of their birth experience. Birthing people with “staff” support were slightly more likely to have a spontaneous vaginal birth, and slightly less likely to use pain medications. Study authors Bohren, Hofmeyr, Sakala, Fukuzawa, and Cuthbert noted that hospital employees may have other duties or be limited in their ability to offer labor support by hospital policies.
If you decide to invite a specific friend or family member to provide labor support, be sure to ask yourself:
- Are their thoughts and feelings about birth similar to ours?
- Can we be ourselves around this person without worrying what they may think?
- Would I feel comfortable having them present during the intimate time of labor and birth?
- Does my support partner feel the same way?
- Are they able to commit to being available whenever I go into labor, and staying with me until I give birth?
- Will we prefer if they are there for some parts of the labor and not others?
- Are they interested in learning more about ways to support birthing people in labor?
Bohren, M.A., Hofmeyr, G., Sakala, C., et al. (2017). “Continuous support for women during childbirth.” Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD003766.
Why isn’t my doctor, midwife or nurse able to provide continuous labor support?
Hospital-based providers may have difficulty giving you continuous labor support for several reasons:
Background & Education
Doctors’ education focuses on diagnosing, treating problems and performing surgery. Nurses trained and working in hospitals where most birthing people use epidurals may have limited experience supporting those who want to avoid or delay this form of pain relief. When they do have the knowledge and experience, they may have difficulty providing continuous support (see next two points). Midwifery education includes labor support, but hospital-based midwives may have difficulty providing it (see next two points).
Your caregivers may also need to attend to other laboring people, office appointments or scheduled procedures. The many responsibilities of midwives and nurses (such as monitoring, administering medications, and completing documentation), both in the home and hospital setting, do not allow time for continuous labor support.
Most nurses, doctors and midwives work in 12 hour shifts. The average first time labor is about 24 hours. This means there could be two to three shift changes, and two to three different nurses caring for you during that time.
For these reasons, clinical caregivers in hospitals are rarely able to offer the direct, continuous and personalized labor support that has been shown to be so beneficial for laboring people. These factors are less likely to occur in an out-of-hospital birth center or at a home birth with a midwife.
A collaborative piece, written for PDX Birth with the doulas of Brave Birth Doula Care.