For those expecting parents who decide to go drug-free during childbirth, there are many options for pain relief and coping.
The Bradley Method is a coaching, breathing and relaxation method that centers on the father (or another family member) providing the main comfort during labor and birth. Some parents use acupuncture, some use hypnosis and some learn the Lamaze breathing technique to get them through the delivery. Among all these no-drug options, there's an old word that's making a resurgence: doula.
According to the professional organization DONA (Doulas of North America), doula is a Greek word that can be loosely translated as "woman's servant" or "minister to the woman." In modern medical practice, a doula provides companionship, advocacy and emotional support to a woman and her partner before, during and after childbirth. Unlike a midwife, a doula does not perform clinical services, such as vaginal exams or blood pressure monitoring; rather, the doula's role is to support the mother's emotional well-being during labor and to protect the mother's memories of the birth.
"A doula's job is to provide whatever a person needs to be as comfortable as possible during labor," says Tami Roloff, a doula from Spokane who has also trained to be a midwife. She says doulas have to be skilled at both verbal and non-verbal communication. "Early on, we talk between contractions. I'll ask, 'How did that feel? Did this help?' But as labor progresses, I ask fewer questions."
Because of her training and the high number of births she has attended, Roloff has far more experience with the process of childbirth than most parents. She knows what normal childbirth looks like and her calmness can ease the fears of mother, father and family during delivery.
"I'm there to give informational support as well," she explains. "I can remind them where they are in the labor process and how well things are progressing. For instance, if they're in transition, I can reassure them that although transition is the hardest labor, the most intense, things move quickly from that point forward."
Spokane architect Juliet Sinisterra and her husband Matt Melcher hired Roloff during her last pregnancy, and Sinisterra says it was the best thing she's ever done. "We met once or twice before the birth," she explains. "She was interested in our goals for the birth experience. She's there for both you and your husband. My husband was thrilled to have her there because she was a very calming presence. Her presence helped me."
Part of that informational support is translating the information being presented by medical personnel during delivery.
"At each point along the way, I try to explain, 'These are your options.' I don't come in with preconceived idea of how the woman should choose to do it," says Roloff. "Sure, I have my biases, but I lay them on the table ahead of time. During labor, the point is to help the woman get what she needs. The word 'empowered' gets overused, but I can think of no better way to say it -- I'm there to help them come through the process empowered, to realize that they've done birth now, so they can do anything."
For example, while there's great debate over whether to use drugs such as an epidural during childbirth, Roloff says she's there to make sure the woman's wishes and needs are respected -- not to make the woman do or not do certain things.
Recent studies show that the presence of a doula or other female labor-support person does help both mother and child. The October 1, 2002 issue of American Family Physician, the peer-reviewed journal of the American Academy of Family Physicians, reported that the presence of an experienced female caregiver, whether clinical (such as a nurse, midwife or childbirth educator) or non-clinical (friend or family member who had given birth before or a doula), provided medical and psychosocial benefits.
A study of more than 5,000 women showed that the continuous presence of a support person reduced the likelihood of medication for pain relief, operative vaginal delivery (the use of forceps or suction) , Caesarean delivery and a five-minute Apgar score of less than seven. The Apgar score is a measurement of the newborn's vital signs; if it's less than seven, the baby needs immediate medical attention.
Continuous support also was associated with a slight reduction in the length of labor and an increase in reported satisfaction with the birth experience. The report states: "Few interventions in medicine provide such impressive benefits at such low cost and risk," and it recommends that family physicians discuss the services of a female labor-support person with the expectant mother as a part of routine prenatal care.
Publication date: 02/13/03