Options: Labor Support

Who can give me support during labor and birth?

• trained labor support specialist: The most common name for such a person is doula (pronounced DOO-lah), a Greek word meaning "woman who serves." Other names that are sometimes used include: labor companion, labor support professional, labor support specialist, labor assistant, and birth assistant. (This section does not discuss "postpartum doulas," who help women at home in the days and weeks after birth.)
  
  

  Walking with a Doula click to enlarge

• your partner: Many partners feel some concern about accompanying a woman during labor. In the end, most find that providing help and comfort in labor is enormously rewarding, and that being present at the birth of their child is one of life's peak experiences.
• clinical caregiver: In most cases, this would be a nurse, midwife, or doctor.
• invited relative or friend: You can choose someone in your social network with whom you (and your partner, if you have one) feel comfortable sharing this important and intimate time. She should be a warm, relaxed, and calm person who views labor and birth as healthy, normal events in a woman's life.

How do my options for labor support compare?

How can I find a doula?

• get information and recommendations from area childbirth educators, maternity nurses, midwives, doctors, breastfeeding counselors, and others who may be familiar with doulas and women who have worked them
• contact a doula trainer in your area
• talk with new moms in your area who may have worked with doulas
• look in the Yellow Pages, under "Childbirth" or "Pregnancy"
• check with local hospitals -- a small and growing number offer doula services.




Can I get supportive care from my partner alone?

Making your partner responsible for supporting you through labor puts pressure on someone who may have little or no prior familiarity with birth, and who may have strong emotional needs of his or her own during the experience. Some partners may not have temperaments suited to this physically and emotionally nurturing role. The lack of privacy and the impersonal atmosphere in the hospital may inhibit others.

Partners can benefit by having someone with more experience mentor them through, provide a practical fund of ideas for helping with your comfort, reassure them, and look after their needs. Having an additional person allows partners to take a needed break and relieves pressure to meet your every labor support need. If labor is intense, you may welcome having more than one person to help you. For example, you may want one person in front of you talking you through each contraction while the other is behind you pressing on your lower back. If labor is long, members of your support team can relieve one other so that you always have someone relatively refreshed working with you.




Can I rely on nurses, midwives, and doctors to meet my need for supportive care in labor?

Hospital-based practitioners and staff may have difficulty providing optimal labor support for several reasons:
• background and education: Doctors' education focuses on diagnosing and treating problems and performing surgery. Nurses trained and working in hospitals where most women have epidurals may have limited experience supporting women who want to avoid or delay this form of pain relief. Midwifery education includes labor support, but hospital-based midwives may have difficulty providing it (see next two points).
• responsibility to others, and care that doesn't involve support: Your caregivers may also need to attend to other laboring women, office appointments, or scheduled procedures. Hospital or employer policies may focus their attention away from direct supportive care. Many nursing tasks (such as monitoring/adjusting equipment, helping doctors with procedures, and completing paperwork) do not involve direct patient care. Where epidurals are common, much nursing attention is drawn to technology used with epidurals, such as intravenous (IV) lines and electronic fetal monitoring (EFM). In addition, many hospitals are short-staffed, which makes demands on nurses that much greater.
• organization of work: Nurses work shifts, which means the same nurse may not be on site throughout your labor. Doctors and midwives often rotate being "on call," which means you may not know well or may not ever have met the person who will attend your birth. It is unlikely that you will have met the nurses.
For these reasons, clinical caregivers in hospitals are rarely able to offer the direct continuous personalized labor support that has been shown to be so beneficial for laboring women.

These factors are less likely to be a problem at out-of-hospital ("freestanding") birth centers. They would rarely have an impact on home birth care.



Can a relative or friend meet my need for supportive care in labor?

When all or most births took place in homes, women learned about birth and cared for other laboring women as a central part of family and community life. This knowledge was lost when birth moved into the hospital and women were isolated from their loved ones during childbirth. Few women today are in an optimal position to assist a laboring woman, even if they have given birth themselves, for several reasons:
• inexperience with supportive care: If they had a typical hospital birth, they, themselves, may not have received adequate supportive care. Thus, they may have no model to follow, including knowledge of comfort measures.
• uncertainty about physiological processes of labor and birth: Many birthing women today experience overuse and inappropriate use of procedures, drugs, and restrictions. Many have not experienced a normal labor that has been allowed to begin on its own and supported to proceed at its own pace.
• impact of the media: Media images rarely include direct supportive care and often sensationalize this topic. Although the great majority of childbearing women in the U.S. are well and healthy, images of birth as a crisis that must be managed with many procedures and drugs are common.
• challenges of providing supportive care in hospitals: Unlike homes and free-standing birth centers, those in hospitals who don't "know the ropes" or come prepared can have difficulty obtaining and using comfort measures.



Given these challenges, does it make sense to consider inviting a friend or relative to provide labor support?

The essence of labor support is to "mother the mother." A calm, nurturing person with a basic understanding and respect for birthing processes can provide helpful labor support. A friend or relative who takes on this role can offer a special gift to you, and can experience the great privilege of participating in this important event in your life.


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Best Evidence: Labor Support