When a woman goes into labor, a new chapter of her life begins. Though she may not realize
it at the time, her life as she knows it will never be the same again.
In our modern Western society, most of us are accustomed to the assembly-line style healthcare system in place. That is to say; we are shuffled from one procedure, doctor, and/or facility to the next, given generalized care, and often overlooked when serious concerns arise. There are deeply-rooted issues at play here, which aren’t the subject of this essay. However, it is important to acknowledge this system, because hospitals account for 98.4 percent of births in the United States, with 90.6 percent of those births being attended by physicians (MacDorman and Declercq). This means that nearly every mother in the U.S. goes to a hospital to give birth as a part of her labor experience. Because of the wide array of provider types, practices, and hospital policies, there is extreme variation in a woman’s birthing experience from one hospital to the next. Furthermore, maternity care in the United States is complex by nature, making the experience of navigating the system itself difficult and strenuous, which can then lead to consequences in health outcomes (Backes and Scrimshaw).
So, what does a woman actually experience during labor and birth? Well, in my experience, there is a flood of emotions and physical sensations when labor starts. This is true for both spontaneous and induced labor. While each woman will have her own unique journey through labor, the hormonal changes are pretty universal; oxytocin levels rise when labor begins, causing regular contractions. Oxytocin is considered the “love hormone” because along with contracting her uterus, it also helps create feelings of calmness and safety, and helps the laboring woman to get into a focused mental “zone”. This is all part of the body’s way of facilitating the smoothest labor possible (Buckley).
Essentially, a woman’s production of oxytocin is crucial for labor to progress. And in order to maintain the flow of oxytocin, she has to continue to feel safe in her environment. Perhaps this is due to an evolutionary need for humans to know they are protected from environmental harm when giving birth.
But what happens when a woman is in a space where she doesn’t feel completely safe? In the aforementioned healthcare system we operate in, a woman likely enters a hospital to give birth and is often ushered into a room that isn’t designed to feel comforting or safe. If biology has anything to say about this circumstance, it will have a negative effect on her birthing experience. In other words; as women, our bodies are programmed through evolution to take environmental cues to ensure that we won’t be ambushed or attacked during the vulnerable time of labor. If her body senses her environment isn’t safe, it will subsequently react by releasing stress hormones, which can inhibit oxytocin. When oxytocin lowers, contractions slow or even stop, making labor take longer. This can lead to a higher likelihood of unplanned medical interventions, often leading to negative experiences. The domino effect then continues as this scenario results in a higher chance of postpartum depression, anxiety, and other mood disorders (Waller et al.).
This outcome affects not only the mother but also her baby, who is dependent on a woman who is ultimately suffering. This in turn can cause guilt in the mother, piling onto the symptoms of perinatal mood disorders. This vicious cycle can continue and even escalate long-term if not treated by a professional. In short: the results of a mother feeling unsupported, uncomfortable, and emotionally stressed during labor can be catastrophic. I should mention I know this to be true because I experienced it first-hand.
These important variables in labor seem to present a conundrum: A laboring woman needs to feel safe in her environment, but there is no guarantee that the hospital (the most likely of birthing locations) will provide such an environment to her because of the inherent nature of our healthcare system. So then comes the inevitable question: What can be done to help a woman feel safe in a place that isn’t designed for her emotional comfort?
She can be supported by someone who is trained to do so.
A doula is well-versed in the importance of oxytocin and knows that it is well within the scope of her job to help facilitate a positive environment for the birthing mother. A doula is also trained in the ways of providing emotional support, educational guidance, and physical comfort measures, all of which help to create this crucial sense of safety and security. While a doula doesn’t have control over the external factors involved (i.e. the hospital room decor, the doctor’s temperament, the stressful sounds outside the door, unforeseen circumstances, or the birth outcome itself), she can provide one-on-one support to the laboring woman. A doula can be the guide needed through the whole experience. The results of this kind of support have been studied, and proven to be profound.
The research is clear: Trained doulas positively impact maternal outcomes and experiences. This support is shown to reduce stress, anxiety, and pain, by promoting self-efficacy and confidence in the laboring woman. Studies continue to show that this positive effect is seen throughout pregnancy and delivery. Furthermore, the evidence suggests that infants benefit too; including higher rates of breastfeeding initiation postpartum, which has an array of health benefits for baby (Knocke, et al.). When we look even closer at the well-documented racial/ethnic disparities in maternal and infant health outcomes, amazingly, studies have also identified doula care as an effective strategy in reducing these discrepancies, helping to bridge this problematic gap between care. (Marshall).
In a practical sense, this goes beyond studies and research. Every day women are giving birth within a system that has no inherent procedures to ensure emotional comfort. And yet, we know that comfort is essential to produce the most important labor hormone. While it seems clear on paper, it isn’t implemented by design. A woman’s emotional well-being isn’t considered by the system, instead, it must be advocated for, and typically it is up to the laboring woman to figure that out, often in the moment.
When a woman proactively decides to use a doula, she is engaging in a form of self-care. She is showing up for herself, and advocating for her own wellbeing. She is deciding that in one of the most delicate experiences of her life, she shouldn’t have stress about trying to learn methods to increase emotional and physical comfort. She is delegating the importance of that type of support to someone else. A doula is there to give the pregnant woman the ease of knowing she is not alone, an assurance that she has someone fully in her corner, (as opposed to that of the healthcare system or any other interests). A doula can’t make guarantee of a perfect birth, nor that a mother will have any type of specific experience or outcome. But the studies show that statistically, doulas do make a positive difference, they do matter.
I am passionate about this field because in my three birthing experiences, I didn’t have this support. I had my loving and wonderful husband by my side, who despite his best efforts, could never fully empathize with my experience. I had a good care team, who by design, was focused on checking off the necessary boxes for a successful birth. I had wonderful nurses, but their jobs involved managing multiple births simultaneously. After a while they would inevitably go home, making me feel in some ways, like I was starting a new and crucial relationship every shift change.
I didn’t have a doula when I gave birth, but I wish I had. I wish there could’ve been a trained person beside me to guide and nurture me through birth, and support me at home when the sense of new motherhood fear kicked in. I would have cherished someone qualified to be in my corner when I developed postpartum depression and anxiety. If I had that type of support, maybe my own outcomes could’ve been different. Research seems to suggest that’s likely.
I wish I had a doula, so I decided to become one. This choice was made after learning the incredible job doulas take on; the way they support, how crucial it is, and what a profound difference their work makes. This is true in the testaments of women who experienced doula support, and the extensive research done on outcomes. I don’t think it’s a reach to say that doulas change the world. A doula’s support is proven time and time again to help mothers achieve better outcomes in labor, birth, and postpartum. That outcome creates a new chapter of her life that is rooted in positivity, which in turn gives the baby a well-supported beginning to their life.
I can’t imagine a more beautiful purpose than to help give the best possible experience to brand new humans entering this world, and to the powerful women who birth them.
You can learn more about Sondra and her amazing Doula practice at her website, thelovelymother.com.
References
Backes, Emily P., and Susan Scrimshaw. “Birth Settings in America: Outcomes, Quality,
Access, and Choice.” The National Academies Press, 2020.
Buckley, Sarah J. “Hormonal Physiology of Childbearing: Evidence and Implications for
Women, Babies, and Maternity care.” Washington DC: Childbirth Connection Programs, National Partnership for Women & Families, 2015
MacDorman, Marian F., and Eugene Declercq. “Trends and State Variations in Out‐of‐hospital
Births in the United States, 2004‐2017.” Birth, vol. 46, no. 2, 2018.
Knocke, Kathleen, et al. “Doula Care and Maternal Health: An Evidence Review.” ASPE, 2022,
aspe.hhs.gov/reports/doula-care.
Marshall, Cassondra. “Partnering with Community Doulas to Improve Maternal and Infant
Health Equity in California.” PCORI, 12 July 2023.
Waller, Rebecca, et al. “Clinician-Reported Childbirth Outcomes, Patient-Reported Childbirth
Trauma, and Risk for Postpartum Depression.” Archives of Women’s Mental Health, vol.
25, no. 5, 2022, pp. 985–993, doi:10.1007/s00737-022-01263-3