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By Julia Johannsen.
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Among future parents, the “doula” – a Greek word that means “servant woman” or “women’s servant” – is increasingly popular. Who are doulas and what accounts for their popularity? A doula is someone who provides the support and understanding necessary to make childbirth an enriching and personalized experience. In many countries doulas meet a need that traditional maternity services cannot.
Not surprisingly, for Margarita Anderson, this is “the most incredible and gratifying profession in the world.” And to be a doula is something to be taken seriously: their training certifies them to accompany deliveries and trains them to provide appropriate information during pregnancy, delivery, and following childbirth. In addition, the doula provides physical and emotional support during all these stages, both to mothers as well as their families. Although doulas are not specifically health professionals and are neither trained nor authorized to make medical decisions or conduct clinical procedures, their role complements that of health personnel during the delivery and has undeniable benefits for mothers and their babies.
Popularizing New Trends or Rediscovering Old Practices?
Historically, women have given birth in the company of other experienced women in the family or the community. This custom, handled by what are called midwives or traditional birth attendants, continues to be common among many indigenous populations in Latin America and other parts of the world. High rates of maternal and neonatal mortality that persist among these populations have sometimes been attributed to what is considered the informal support provided by these persons. In reality, those rates are generally due to economic and social exclusion, the absence of adequate sanitary conditions and nearby medical personnel, or lack of access to emergency services that can prevent or mitigate possible complications.
In those countries where women give birth in hospitals, health centers, maternity hospitals, or in their own homes but with emergency services nearby, continuous support is provided by nurse auxiliaries, licensed obstetricians, doulas, or even traditional midwives. Doulas and traditional midwives, in contrast to nurse auxiliaries and licensed obstetricians, are neither physicians nor specialists, but they are trained in deliveries. And in all cases, they use their experience and skills to carry out their mission to calm and reassure the expecting mother in order to ensure the best possible experience along the path to childbirth.
The practice of turning to doulas started in the United States and has extended into Latin America, primarily in response to the need for continuous support – not necessarily medical support, but support from someone experienced. This is due to the fact that basic clinical care in countries like Ecuador and Bolivia is handled by nursing professionals, while deliveries in general are handled by medical specialists who have barely been present during the phases prior to the moment of delivery.
The situation is different in the European Union and in some Latin American countries such as Chile or Peru, where the public health system designates midwives as the main source of care for vaginal births without complications, given the credentials of these midwives as health professionals who specialize in pregnancy, birth and post-partum care, reproductive health, and neonatal care. Medical specialists, such as obstetrician-gynecologists or perinatologists, only intervene in the event of complications or when there is a need for a Caesarian section.
The Fundamental Role of Doulas
During pregnancies, doulas provide pertinent information, help clarify the role of the woman’s partner in the delivery, try to reduce fear about the physical pain involved in delivery and share nonmedical techniques to mitigate it, and address logistical questions as basic as what women should have in their suitcase when it’s time to go to the hospital. During labor and delivery, they provide emotional support through their constant presence and encouragement, in addition to offering concrete information about what is happening and what is going to happen next.
Doulas also alleviate women’s physical pain using such techniques as massages and hot baths, indicating positions that are more comfortable, and promoting mobility. After the birth, they frequently facilitate the bonding process between parents and newborns, help with the initiation of breastfeeding, and offer practical recommendations and advice about care for the baby upon returning to the home. Their role can thus have significant effects in contributing to a healthy birth, without replacing other aspects of the process that ensure a safe birth.
Is It a Feasible Option?
In most of the region, the service of a doula is considered a private expense and hospitals, public or private, can choose not to allow the presence of a doula. In Ecuador, where Margarita works, doulas can earn $50 per pre-natal and post-natal session and up to $250 during the delivery itself, for a total of $500. In the United States, these services are generally not included in hospital packages and the costs can range between $500 and $3,500.
The lack of social and legislative support in some countries stands in contrast to scientific evidence that demonstrates the beneficial effects of continuous support from a doula, which include a greater tendency for spontaneous births, that is, vaginal births without a need for induction, forceps, or Caesarian section. In addition, women who receive continuous support tend to take less medication, have deliveries that take less time, and have a more positive view of their childbirth experience.
Also in these cases, the women’s babies generally have a lower propensity to have low five-minute Apgar test scores, and the quality and results of care as well as the overall care experience for such a unique event improves. Although every case is different and it is important to use a doula who is properly qualified, it is worth considering this option as an element of continuous support on the path toward maternity.
Would you consider using a doula to accompany your delivery? What has been your experience with companions during pregnancy and delivery? Is this an option in your country? Tell us in the comments section below or by mentioning @BIDgente on Twitter.
Julia Johannsen is a Social Protection Specialist with the Inter-American Development Banks’s Division of Social Protection and Health in Ecuador.