With Prince Harry and Meghan Markle’s baby due very soon, speculation is mounting about their choices for the birth, including talk of Meghan hiring a doula. If she has, when she goes into labour, someone who knows her birth plan and has built up a rapport with her during pregnancy will arrive at her chosen place for the birth to support her through labour and childbirth - quicker than you can say “Brexit baby”. This, in a nutshell, is the role of doulas, who are trained non-medical professionals.
Women have traditionally been supported by a companion of their choice during childbirth, and this has many benefits for both the woman and baby. We know this from the best available research evidence on the effects of continuous support in labour, brought together in a Cochrane Review.
Now there is new evidence providing insights into the ways in which women are supported during childbirth, that could help ensure that more women benefit.
Research involving over 15,000 women has shown that continuous support during labour may improve health outcomes for both the woman and baby, whether it is provided by a woman’s partner, family member, or friend; hospital staff (student midwives) or a doula, and no risks have been identified. Women who receive continuous support may be more likely to give birth ‘spontaneously’, (ie vaginally with neither caesarean nor forceps nor vacuum extraction), have shorter labours and be satisfied with their birth experience. What’s more, they may be less likely to use pain medications, and their babies may be less likely to have low five-minute Apgar scores (the score used to assess babies’ health and wellbeing at birth and shortly afterwards).
Our new research has shown that labour companions (including doulas, partners, and family members), support women in four key ways. Firstly, through providing information, they bridge communication gaps between health workers and the woman, keep her informed about the process of childbirth and facilitate use of non-pharmacological pain relief (such as meditation). Labour companions advocate for the woman, speaking up in support of her and her preferences. They also give practical support, including encouraging the woman to move around, providing massage, and holding her hand. Finally, companions give emotional support, helping the woman to feel in control and confident by praising and reassuring, and providing a continuous physical presence.
So having a trusted companion through labour and childbirth is a Good Thing and it doesn’t have to be a doula. But if you think doulas are just for royalty and the rich, think again. Hiring their services can be expensive; in the UK, doula services range from £800-£2000 depending on the doula’s experience and offered services. But doula services may be provided free-of-charge for low-income individuals and families. The Doula Access Fund Charity is being established to provide doula care to those in financial, practical or emotional hardship, who would otherwise be alone through pregnancy and childbirth.
Something the research highlights is that providing community-based doula care for migrant, refugee and other foreign-born women in high-income countries may be an important way for them to receive culturally-competent care and improve equity. When migrant women receive care from community-based doulas, who are from the same ethnic, linguistic, and/or religious background, they may feel more confident and less like “outsiders” in their new communities. In Sweden and the United States, research has demonstrated that foreign-born women supported by a community-based doula were more satisfied with their birth experiences, and doulas themselves felt empowered.
So labour companionship and doula support may increase equity directly through improved women’s empowerment and provision of culturally-responsive care, and indirectly by reducing medicalization of childbirth. Supporting all women to have a labour companion of her choice during childbirth is an effective way to improve health outcomes, and is an important component of respectful maternity care.
Whatever Meghan’s birth choices turn out to be, we hope she will be supported by someone she trusts throughout her labour and childbirth, and that’s something every woman and baby should be able to benefit from.
For more information about doula services and hiring a doula: Doula UK
Meghan Bohren will be returning to the post on 25th March at 9am to answer your questions.
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Guest Post: “Continuous support during labour may improve health outcomes for both the woman and baby”
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MumsnetGuestPosts · 22/03/2019 14:22
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