Wednesday, April 19, 2017

Doulas and Birth Outcomes

When I first became a doula six years ago, I thought my job was to help improve birth outcomes. 

Everything I read about doulas boasted the same stats:

  • 50% reduction in cesarean rate
  • 25% shorter labor
  • 60% reduction in epidural requests
  • 30% reduction in pain medication use
  • 40% reduction in forceps delivery
  • 40% reduction in oxytocin (pitocin) use
These stats come from the book Mothering the Mother by Marshall Klaus, John Kennell, & Phyllis Klaus and were listed on most of the material about doulas I could get my hands on at the time. 

As a new doula, I thought my job was to help people have natural births. 

After all, one of the first bits of advice people receive after proclaiming they want a natural childbirth is, "Hire a doula!"  People were coming to me because they wanted natural births, and, by golly, I wanted to help them have natural births!

Early on, I started to notice something. Not everyone who said they wanted to have a natural childbirth during our interview ended up wanting one once they were in labor. At first, I took this as a personal failure. I thought, maybe if I were a better doula, maybe if I had more experience, maybe if I had said that one thing or tried that one position, they would have had their natural birth. I started to learn that wanting a natural birth is not always enough, and that sometimes, birth does not go how we hope or plan despite our best efforts to do "everything right."

Then I took my Birth Boot Camp DOULA training and learned something that would forever change the way I thought about what it means to be a doula.

I learned during my training that doulas are not responsible for birth outcomes.

I breathed out a huge sigh of relief - one that I had been holding in for years. Something clicked for me. I realized that I was actually doing a good job as a supportive doula even though my clients were having all kinds of births, not just natural births. I am ashamed to admit that I couldn't understand why they were so happy when I often didn't help them achieve the natural births they said they wanted.

They seemed to understand something that I didn't.

So what are doulas for if they don't help improve birth outcomes?

Support. Unconditional, non-judgmental support.

Doulas help you remember your options when others are telling you what decisions they think you should make.

Doulas help you gather as much information as you want or need when others give unsolicited advice. Or not enough advice.

Doulas stand by your side no matter what you decide when others tell you they would "never do that."

Doulas understand the art of holding space when others want to take up space.

Doulas know who the awesome and supportive care providers are. 

Doulas have a unique point of view because they often attend births in hospitals, birth centers, and homes.

Doulas encourage your partner to participate to their own level of comfort when everyone else forgets they exist. Or expects them to do everything.

Doulas won't mind if you burp, yell, make tons of noise, make no noise, forget to say "excuse me," or "thank you."

Doulas are the ones who give you a foot massage or a scalp rub or offer kind words as you prepare for your Cesarean birth.

Doulas are the ones who offer a cool breeze or take a quick picture or offer an encouraging word as you push your baby into the world.

Doulas know when to be quiet, when to talk, when to touch, when to step back, when to suggest, when to listen, when to offer....

Doulas remind you how amazing you are when others may forget this is a once in a lifetime experience for you.

Doulas ask, "How would YOU like to do this? What would work for YOU?"

Doulas instill confidence when others instill fear.

Doulas remind you that you CAN when others say you CAN'T.

Doulas are a great addition to your birth team, but can't guarantee any certain birth outcome. Doulas are there for informational, physical, emotional, and relational support. While doulas can't determine birth outcomes, they can and do help make the birth experience more satisfying and enjoyable. In short, they help make your birth experience better.