What is labor support?

Labor support is when there is someone with you during childbirth whose role is to help you stay comfortable, move through your birthing process, remind you that what’s happening is normal and healthy and give you information about your care. This “labor support specialist” or “doula” may also help you move around during labor. She will usually support your spouse or partner and others in the room as well.

Who can give me support during labor and birth?

Research says that having support from a doula or other labor support specialist who is present solely to provide continuous support has the most benefits. Others who may be important sources of support are your partner, your clinical caregivers and friends or family members.

You may want to have one or more of the following people on hand to aid you throughout labor and birth:

• Trained labor support specialist or doula: The most common name for such a person is doula (pronounced DOO-lah), a Greek word meaning “woman who serves.” Other common names include labor companion, labor support professional, labor support specialist, labor assistant and birth assistant. This type of labor support specialist offers the greatest benefits for your health and safety during labor and birth.
• Your spouse or partner: While many partners are worried about accompanying a woman during labor, most find that providing help and comfort in labor is very rewarding and that being present at the birth of their child is one of life’s highlights.
• Clinical caregiver: In most cases, this would be a nurse, midwife or doctor.
• 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 or he should be a warm, relaxed and calm person who views labor and birth as healthy, normal events in a woman’s life.

What is it like to work with a doula?

A doula stays with you throughout labor. A doula usually meets with you before labor to learn your personal preferences, priorities or concerns, and stays with you until an hour or so after the birth of your baby to help get breastfeeding started.

Most doulas are also available before labor and in the days after the birth of your baby to provide information, reassurance, nonmedical advice and, when appropriate, referrals. The Working with a Labor Support Specialist/Doula section of this website provides more details and information, but here are some benefits of working with a doula:

• According to your wishes, she may be close to you, often with physical contact, nearly all of the time.
• She offers comfort measures such as cool cloths, massage and handholding.
• She gives emotional support, including reassurance, encouragement and honest praise.
• She can suggest ways to improve labor progress or ease discomfort.
• She can explain what is happening or interpret what hospital personnel have said.
• She can help you communicate your needs to hospital staff and support decisions that you and your partner have made.
• She supports your spouse/partner as well, acting as a resource and guide and making sure his or her needs are met.
• Contrary to some people’s concerns that a doula might disturb the privacy and intimacy of birth, a doula can actually help to protect privacy and create an intimate atmosphere in a busy, institutional setting.

Can’t I get enough support just from my spouse/partner?

While this is an exciting time for you and your partner, it’s a big ask to give your partner primary responsibility for supporting you through labor. Here are a few reasons it might be good to have another person in the room:

• The labor process can put pressure on your partner, who may have little or no prior familiarity with birth.
• Your spouse or partner might have strong emotional needs of his or her own during the experience. Having someone with more experience there can give loved ones practical ideas for helping with your comfort, reassure them and address their needs.
• Your spouse or partner may not be well suited to this physically and emotionally nurturing role.
• The lack of privacy and the impersonal atmosphere in the hospital may inhibit that nurturing.
• Having an additional person in the room allows your loved one to take a needed break and relieves pressure to meet your every labor support need.
• If your labor is intense, you might enjoy 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 another so that you always have someone relatively refreshed working with you.

How can my spouse/partner help?

If you have a spouse or partner, of course you want to help him or her prepare to support you in labor and birth, whether or not you will have additional support in the room. Here are some things you can do to prepare:

• Talk about each of your hopes, expectations and fears.
• Encourage your partner to learn as much about labor and birth as possible by reading, watching videos, coming to prenatal visits or attending childbirth education classes with you. (The Labor Support Resources page points you to an entire book for helping your partner, friend or relative support you in labor.)
• Practice relaxation techniques and comforting touch before labor begins.
• Make a plan for support and household help after the birth so you’ll be able to get the rest and care you need to recover from birth, get to know the new member of your family and get off to a good start with breastfeeding.

Can I rely on nurses, midwives and doctors to offer labor support?

Hospital-based providers may have difficulty giving you the best possible 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 demand that their attention focus elsewhere. Many nursing tasks (such as monitoring/adjusting equipment, helping doctors with procedures and completing paperwork) do not involve direct patient care. If you have an epidural, your nurse’s attention will be on related technology, like intravenous (IV) lines and electronic fetal monitoring (EFM). In addition, many hospitals are short-staffed, which is even harder on nurses.
• Shift structure: Nurses work in shifts, so nurses might come and go throughout your labor. Doctors and midwives often rotate being “on call,” which means a new person may 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. Read more about how birth settings differ here.

Can a relative or friend support me?

The essence of labor support is to “mother the mother.” 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.

However, it’s important to understand the challenges associated with inviting a friend or relative to serve as your labor support. When all or most births took place in homes, it was a normal part of life for women to learn about birth and care for other women while they gave birth. 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 the best position to support a woman giving birth, even if they have given birth themselves, for several reasons:

• Inexperience with supportive care: If your loved one had a typical hospital birth, she might not have received adequate supportive care and therefore won’t have knowledge of comfort measures.
• Uncertainty about physiological processes of labor and birth: Many women who give birth today experience inappropriate overuse of procedures, drugs and restrictions. Your friend or relative may not have experienced a normal labor that began on its own and was supported to proceed at its own pace, making it tough for her to support you in that process.
• Impact of the media: Media images rarely include direct supportive care and often sensationalize childbirth. Even though most women who give birth in the United States are healthy, the media often shows birth as a crisis that must be managed with many procedures and drugs. It might be hard for your loved one to get past those assumptions.

Research has found that having labor support from a well-selected friend or relative is likely to improve your childbirth experience. However, if you seek other established benefits of labor support, such as increased likelihood of vaginal birth and shorter labor, research suggests that you should find a doula.

If you decide to invite a specific friend or family member to provide labor support, be sure to ask yourself:

• Are her or his thoughts and feelings about birth similar to mine?
• Can I be myself around this person without worrying what she or he may think?
• Would I feel comfortable having her or him present during the intimate time of labor and birth? Does my partner feel the same way?
• Is she or he able to commit to being available whenever I go into labor, and staying with me until I give birth?
• Is she or he interested in learning more about ways to support women in labor?

Do I need a labor support specialist if I’m planning to use pain medication/an epidural?

Even if you plan to use pain medication or get an epidural, having a labor support specialist can still be helpful because:

• Women and their partners need information and emotional support. After all, even if pain is removed, you might have other questions and concerns.
• Even with pain medications, few women are completely pain-free during labor so they still benefit from comfort measures and strategies to help ease their pain.
• If you use an epidural, you might not experience some of the feelings and sensations in your pelvis that help you push your baby out, and your labor support specialist can help you push effectively.
• Epidurals involve or increase the likelihood of using many other interventions to monitor, prevent or treat adverse effects during labor. A labor support specialist can help you cope with those experiences.
• If you want, your labor support specialist can also help you avoid or delay medication, or use a smaller amount, which may help you avoid or limit some potential adverse effects.

How can I choose a caregiver and birth setting that value labor support?

So you’ve decided you want to have labor support when you give birth. Great! Here are some questions to ask as you are choosing your maternity care provider and birth setting:

• Your maternity care provider:
  • Would the care provider be able to stay with you through labor and provide supportive care?
  • What are the care provider’s experiences with and attitudes toward working with doulas?
• Nursing resources during labor:
  • How many laboring women does each nurse care for (nurse-to-patient ratio)?
  • Will a nurse stay with you throughout labor?
  • Do the nurses have any special training, skills or commitment to providing supportive care to laboring women?
• Institutional policies:
  • Are there any institutional policies about who or how many people may be with you?
  • What are the staff’s experience with and attitudes toward doulas?
  • Are there any circumstances in which your doula would not be permitted to be present?
  • Does the facility have its own program for making doulas available?
• Institutional resources:
  • Apart from pain medications, what is available to provide comfort during labor? (Examples might include tubs, showers, birth balls, hot and cold packs, rocking chairs, options for moving about and more.)
  • Are there enough of these resources (tubs, for example) for all the women giving birth at a given time?
  • Does the staff have training in non-drug ways of relieving labor pain?
  • If so, does the birth setting encourage women to use these resources?

You can read much more about ways to cope with labor pain here.