Your birth plan, your advocate, your doula

By Candice Briggie
It is difficult to deny that a womans pregnancy and birth, especially her first, may be the
most exquisite and joyful time of her life. It may also be very stressful, trying, and confusing.
There are innumerable decisions to make, so much to prepare for, so many questions, and so
little time. So, whats a doula got to do with it?
Doula is a Greek word that means woman servant, or woman care-giver. Today, a
birth doula refers to a trained and experienced woman who provides emotional support, physical
comfort, and informational assistance to the expectant mother and partner before, during, and
shortly after childbirth. An experienced birth doula knows that birth is a key life experience that
the mother will always remember, and hopefully cherish and look back on as positive and
transformative. She understands the physiology of birth and recognizes that there are vast
emotional needs of a woman in labor, and stays by the side of the laboring mother throughout her
labor while assisting the mother and her partner in preparing for and carrying out their birth
plan.
Due to the growing evidence of doulas important roles and contributions to improved
physical outcomes and emotional well-being of mothers and infants, doula care is becoming
rapidly more acceptable in maternity care today.
Chelsea Day, 28, recently gave birth to her first son, and was determined to try for a
natural birth with no medical interventions, i.e. breaking of membranes, induction, use of
Pitocin, epidural, cesarean section.

I dont know what would have happened if my doula had not been there, Day recalled,
the nurses were in and out, bustling around, but she was with us the entire time. She helped me
breathe through my entire labor, helped me shower, reminded me of my natural birth plan,
helped me focus on my baby. Dragan [Days partner] and I would have been really afraid if
Brooke hadnt been in the room with us that whole time.
Day gave birth at the Med, and apparently there are very few natural births to be seen at
that hospital.
By the time he was crowning, there were 13 people in that room, Day said, its a
student hospital, and none of them had ever seen someone give birth without an epidural, or at
least some kind of pain medication.
Indeed studies show that women who have continuous labor support are far less likely to
use any type of pain medication, including narcotics, give birth by vacuum extraction or forceps
(which can and often do, put undo strain on the infants neck, resulting in trying times when it
comes to breastfeeding for several weeks following birth, not to mention a very fussy newborn),
and less likely to give birth by cesarean section.
Does it matter who provides this continuous support? According to a 2011 study,
Continuous Support for Women in Labor Review, conducted by Hodnett and colleagues, these
positive effects were strongest when the person providing support was neither in the social circle
of the laboring mother, nor a member of the hospital staff. While it was important for the mother
to have someone close to her in her social circle like her mother or sister, their presence affected
the laboring mother positively, but they had virtually no effect on the use of interventions such as
epidurals or cesarean sections.

So, what does a doula do during childbirth? Tammy Ryan, director of southwest chapter
of DONA International, the oldest and most widely recognized doula certification organizations,
said, The role of the doula is to help ensure that the womans and couples agenda is
acknowledged and followed as closely as possible. The doula helps with decision-making by
asking questions that will ensure that the right information is given to the woman or couple so
that they can make an informed decision. When a woman is in the throes of labor, it is very easy
to become intimidated and accept procedures and interventions offered by the care givers that
she may not really want or need.
As far as pain management goes, the doula typically coaches the laboring mother with
relaxation and tension release techniques, massages and uses pressure points, changing of
positions, hand and foot rubs, holding, hugging and resting touch during contractions. The doula
may apply warm or cold packs to low abdomen, low back, and perineum before and after birth.
I cant imagine giving birth again and not having a doula with me, Day said, I mean I
was up walking around twenty minutes after I gave birth, I didnt tear, I didnt need an
episiotomy, it was incredibly empowering to me to know that I am capable of this, and that, I
mean, this is what I was built for. If I could do it again tomorrow I would.
So how can more women gain access to this option? Leslie Salama, University of
Memphis medical anthropology graduate candidate and founder of Choices, Full Spectrum
Doula Collective, is working on just that.
It is part of a doulas vision to make sure that every woman who wants a doula can have
one, Salama said, for a doula individually who is self-employed, this may mean fee
adjustment, etc. but here at CFSDC, we are trying to build a team of doulas that is purely

volunteer-based, a team that can reach out to underprivileged women and couples here in
Memphis.
Salama recognizes that Memphis has an outlandishly high infant mortality rate, and much
of this disturbing fact has to do with a lack of education throughout pregnancy.
A lot of women here in Memphis often dont even see their doctor until their second
trimester, which means, theyre not getting the vital information about nutrition, healthy habits
and self-care that would usually ensure a healthy pregnancy.
The team at CFSDC also wishes to widen the scope of a doula and offer services not only
to women who are expecting, but also to women and couples who choose abortion, who may
have experienced perinatal loss, miscarriage, as well as couples dealing with infertility.
We are facing many challenges, Salama said, A lot of midwives and doulas, even,
dont like seeing doula and abortion in the same sentence. But our mission is to be a group of
women who support women, no matter their life choices or birth plan.
Salama went on to explain that while, yes, many and perhaps the majority of women who
seek a doula during pregnancy wish to try for a natural birth, but not all do, and there is still a
place for a doula when a woman has an epidural.
There is a lot of anxiety associated with the use of an epidural. The mother may feel
paralyzed, have a dead feeling in her legs, and this is all the more reason she will need acute
instruction in pushing and breathing. Salama said.
While sometimes it is difficult to decide whether or not to seek or hire a doula, Ryan
thinks the evidence speaks for itself.

In the grand scheme of things, women have not been giving birth in hospitals on drugs
for that long. It is not a doulas job to criticize women who choose to use modern interventions,
but to empower mothers and make sure they know what is possible for their birth and what they
are capable of. We help women make truly informed decisions about their birth experience.
There is a lot of scientific evidence showing that the presence of a doula improves the birth
experience of the couple and the health of the infant, and there is virtually no evidence that
shows any harmful effects.