BC Council for Families

by Carolyn M. Usher

The newest participants in childbirth have a long history

Doula is a Greek work meaning “women's servant.”

In labour support terminology, doula refers to a supportive companion (not a loved one) with the labouring women. She may be professionally trained to provide labour support but provides no medical care.

Doulas, the newest participants in the childbirth scenario, have deep roots in the history of birthing babies. They are the mothers, sisters and friends of times past who provided the emotional supports and comforts that labouring mothers depended on to see them through the difficult hours.

Doulas were there to rub backs, brew tea, encourage and provide the continuous, empathetic emotional support through labour that all women need.
All women need this, but in these modern times, few labouring women get what they need.

Birth has never changed. The female body goes through the same physiological process it always has. It is how we care for our labouring mothers that has changed.

Childbirth was women's work

In the past, childbirth was women's work. Women took care of each other, encouraged each other and helped bring each other's babies into the world. A body of knowledge about this process evolved and was added to with each new birth. This knowledge, and the wisdom that applied it, was passed from mother to daughter, women to women. While women who showed particular aptitude for the birthing of babies were called on as midwives, the knowledge and the empathetic process of bringing a women through labour was not confined to midwives.

People wonder what is the difference between doulas and midwives. It is very clear. An attending midwife's primary responsibility is the clinical care of the mother and the newborn. Certainly, midwives are aware of the critical ramifications of the mother's stress level and emotional state and do everything in their power to ensure that the climactic conditions most conducive to an unhurried, safe and peaceful birth prevail. At times however, the medical status and care of both the mother and the infant must take priority with her.

The doula, while knowledgeable about birth, does not concern herself with the medical care of the mother or infant. “This is something I am very clear about,” says Lorena Battistel, a Coquitlam childbirth educator and certified doula. “I'm not the medical practitioner. I assist the women and her partner by preparing for and carrying out their plans for the birth, I advocate on their behalf and I facilitate the communication between the labouring women, her partner and the medical team. I stay by their side until the birth is completed and provide comfort, support, encouragement and when decisions need to be made, I offer an explanation of what their options are. I am there for both the women and her partner. I've often found that when labour gets into its more trying hours or when an unexpected outcome like Caesarean birth occurs, it is the husbands who need me as much as the labouring women.”

Labour support research

The value of effective labour support has been extensively studied by medical researchers who discovered that significantly fewer complications arose in women who were supported in labour. In studies by M. Klaus, J.H. Kennell, S.S. Robertson and R. Sosa, significant differences were noted between a group of women (giving birth for the first time) who were randomly allocated to either a group constantly supported by a lay, labour-support women or to an unsupported control group. Both received the same routine care from the hospital.

The findings suggested that not only is the labour shortened and less complicated by constant human support during labour, but that some important medical outcomes are positively affected. This is believed to be so because a kind, supportive companion through labour decreases perinatal problems by reducing emotional stress. Stress hormones such as adrenaline prolong labour and reduce fetal oxygenation. By reducing stress hormones, the accompanying labour problems may be reduced.

Birth moved into hospitals

Historically, when women were enticed into hospital birthing by promises of pain-free labour, the traditional role of women at birth (including the role of the labouring women herself) was eliminated. In an article titled The Labour Support Person, Penny Simkin states, “Pain medication...rendered them (labouring women) either groggy and unconscious or agitated and out of control.” The role of “kind, helpful women” became that of professional nurse whose task became to “...safely manage the medical and surgical procedure that birth had become.” With an increasingly lengthy list of procedures and clinical assessments to complete, there was precious little time left for nurses to fill anything approximating the role of doula.

At first, the medical establishment did not tolerate, let alone welcome the presence of husbands and fathers, but as western culture evolved and the 1960s brought a return to nature and family togetherness, husbands were brought onto the scene as labour coaches. “He” was now responsible for ensuring that his labouring wife stayed calm and focused, “breathed” appropriately for the strength of each contraction and laboured drug free.

Couples were encouraged to develop birth plans that specified their wishes around the procedures that would and wouldn't be done and the husband was charged with protecting his wife and child from unnecessary technological invasions. It was a pretty big order.

Husbands had been appointed to a role that, until relatively recent history, had belonged to women. It was a role for which men had no inherent or instinctual knowledge; were given very little training for; and in many cases genuinely felt inadequate and coerced into. As Penny Simkin states: “Perhaps it was too much to expect of men—to witness their loved one's pain, to nurture and encourage her in managing her pain, to act as her advocate and to maintain perspective and confidence in a strange environment filled with busy, authoritative, professional people. For most men, keeping out of the way, cooperating with staff and letting the staff do what they feel is best, has seemed to be the most suitable role.”

The coaching and advocacy role thrust on men sometimes created a wedge between the couple. Lorena Battistel recalls one such couple. The labour had resulted in a Caesarean birth and when some years later they finally explored their feelings about that birth, the wife expressed anger that her husband had not prevented the Caesarean. “It was your job to do that! You were supposed to protect us. You were supposed to know what to do!” He replied with tears in his eyes, “I thought you were going to die.”

What role, then, for husband?

Is there a role for partners at the birth of their children? Emphatically, yes. It's the role that has always been theirs alone, that of companion in this greatest of all adventures and witness to the birth of their child.

At the time this article was
written, Carolyn M. Usher was Director, Affiliate Operations, for the BC Council for Families and an author on family life issues.
This article first appeared in Family Connections (Winter 1993/94), published by the BC Council for Families.