Giving Childbirth Back to Women through the Support of a Doula

by Jenny Shapiro
–USA–

During my three years at International Planned Parenthood Federation, Western Hemisphere Region (IPPF/WHR), I have been fortunate—and humbled—to work with incredible colleagues whose dedication to securing sexual and reproductive health and rights for all is unsurpassed.

As Project Design Coordinator, I know my work is vitally important, particularly at a time when several large global health donors have withdrawn from Latin America and the Caribbean. The United States Agency for International Development (USAID) has “graduated” the majority of countries in our region, despite the inequalities that persist, as has the UK Department for International Development, USAID’s counterpart in the United Kingdom. The Netherlands, one of the region’s significant donors, is currently phasing out its final project in Colombia, and the Danish government will be pulling out of Nicaragua, a country it has supported for many years.

Despite this trend, last year IPPF/WHR Member Associations provided nearly 29 million vital health services and worked to promote the sexual rights of every woman, man and young person. But sometimes, working on these issues from behind a computer screen is not enough. For many of us, our mission is more than our 9 to 5. We live and breathe the commitment constantly, both in and out of the office. We march for reproductive rights in the United States, spread the word, and continue to seek opportunities to expand our knowledge of the field.

While we are often challenged to defend the right of all women and girls to decide if, when, and with whom to have children, the equally important right to choose the way in which a woman brings her baby into the world often does not receive the attention it deserves. Rich or poor, childbirth is a defining moment in a woman’s life—whether the experience is positive or not, it is one that she never forgets.

When I realized I wanted to play a role in that defining moment by helping to give birthing back to women, it was a “light bulb” moment. I realized my desire was to help women give birth in the setting of their choosing with a compassionate, skilled birth attendant who is sensitive to their desires and the importance of the overall experience. It was in that moment that I decided to become a doula.

A doula is a Greek word that means ‘a woman who serves.’ Today, the term is used to describe a woman who provides information and physical and emotional support to a pregnant woman and her family members and/or friends before, during, and immediately after the birth of her baby. The doula’s role is to help the mother achieve the birth experience she desires by providing her with the accurate, non-judgmental information she needs to make her own informed decisions about labor. Once the baby is born, a doula helps establish breastfeeding and then conducts a postpartum follow-up visit within the first month to help the mother reflect on the birth and refer her to additional resources as necessary.

Most importantly, a doula must possess the knowledge and understanding needed to help the mother feel more comfortable, even when she is unable to vocalize her feelings and needs. This means knowing when to get a cool cloth for her head, discovering where she may be holding tension and suggesting ways to release it, as well as when to recommend a different position or how to encourage her when she is fatigued or at a loss for how to go on. The doula reminds the mother that the intensity she is feeling is normal and is bringing her closer to meeting this beautiful little human she has created. You would be surprised how often women forget they are having a baby!

According to the position paper published by DONA International, the oldest and largest doula association in the world, Drs. John Kennell and Marshall Klaus, in the late 1970s, found, almost accidentally, that introducing a doula into the labor room not only improved the bond between mother and infant, but also seemed to decrease the incidence of complications.

Since their original studies, published in 1980 and 1986, numerous scientific trials have been conducted in many countries comparing usual care with usual care plus a doula. According to a recent review of 21 randomized controlled trials in the Cochrane Database of Systematic Reviews, women who received continuous support were less likely than women who did not to have any anesthesia, give birth with vacuum extraction or forceps, give birth by cesarean, have a baby with a low 5-minute Apgar score (an exam conducted at one and five minutes post-birth to assess the baby’s health and responsiveness), or report dissatisfaction or a negative rating of their experience. Women who had continuous support also were found to have shorter labors.

The reviewers concluded, “Continuous support during labour should be the norm, rather than the exception. Policy makers should consider making continuous labor support a covered service, and hospitals should implement programs to offer continuous labor support. In present maternity care environments, benefits of continuous support are likely to be greater with companions who are not hospital staff members than with members of the hospital staff.”

Because the initial research that led to the “birth” of the modern doula is relatively recent, the official profession has not been around very long. To this day, I still sometimes get a perplexed look and the subsequent, “What is that?” when I tell people I am a doula. However, the word is getting out little by little. In fact, there is currently a movement in New York State called “Doulas for All,” working to get the state’s Medicare Redesign Team (MRT) to recommend to Governor Andrew Cuomo that doulas are covered under New York State Medicare.

My first birth was for a woman I deeply respect and admire, and a colleague at that. Before her labor, I met with Maria Antonieta, her husband Amando, and her parents to discuss their desires for the birth and how I could support all three of them in achieving the birth she desired. We practiced positions and the breathing techniques that I would offer in labor and clarified what they could expect from me before, during, and after labor.

On “labor day,” June 9, 2011, I met Maria Antonieta and her family at the hospital at 5pm. Because her contractions were erratic, we strolled up and down the labor and delivery floor until they achieved textbook regularity. I brought her ice chips and FrozeFruits to keep her hydrated and maintain her energy. Her mother, her husband, and I worked together as a seamless, well-oiled machine. When contractions got more intense, our focus turned to taking them one at a time, letting each one go forever as the wave receded. Amando held one hand, her mother held the other, and I pressed on her knees coaching her on her breath and helping her to focus as the intensity returned. I was astounded how time stood still. Ten hours flew by and I never left her side, not even to go to the bathroom. It was beautiful to see how Maria Antonieta’s whole body calmed at the gentle touch and soft whisper of her husband, reminding her that their baby would be in her arms soon. She was born in the early morning hours on June 10, 2011.

Their adorable daughter Sabina is now nearly six months old and continues to thrive. Maria Antonieta and Amando could not be happier with the new addition to their family. I returned to my 9 to 5 job with a refreshed love for the work I do and a renewed commitment to supporting women and families in whatever way I can—whether that is in birth or avoiding an unwanted pregnancy. Thanks to becoming a doula, it is in more ways than one.

About the author:
Jenny Shapiro is the Project Design Coordinator at International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR). She holds a Master’s in Nonprofit Management from Milano, The New School for Management and Urban Policy and a B.A. in American Studies and Spanish from Brandeis University. Jenny is a trained birth doula who works to give the birth process back to women and empower them as they make the transition to motherhood.