Have you ever seen, “The Price is Right.” on TV? Imagine, a curtain opens revealing a quiet bedroom with dim lights and a laboring woman bent over a bed. Her husband stands with his hand on her shoulder, while her doula applies counter pressure to her hips and soft music plays. Can you guess what the price tag should read? More importantly, can you comprehend the value of labor support?
It’s no secret that childbirth is a profitable industry. From the moment you buy your first pregnancy test, the dollars start stacking. Prenatal visits with an obstetrician or a midwife, maternity clothing, and furnishing a nursery are just the beginning of 18 years worth of investing into your child as they grow into an adult. You may not remember many things, like the baby clothes you purchase, or the amount of money you spend on diapers. What you will remember, for the rest of your life is your experience welcoming your child from your womb earthside.
It’s hard to put a price on a moment that you will remember for a lifetime. Pregnancy, birth, and that short-sweet-difficult postpartum period are truly priceless, precious moments to be treasured and enjoyed. The value of support during pregnancy, labor, and postpartum is so much deeper than money and the impact of good support lasts a literal lifetime. In this paper, I will discuss what labor support looks like, and the benefits of having professional support during labor.
Labor support is defined as the therapeutic presence of another person, in which human-to human interaction with caring behaviors is practiced (Jordan,2013). During labor you may have several different facets of support, and different support persons present. You may have your partner, a close friend or relative present alongside members of your birth team. Your birth team usually consists of a midwife or obstetrician, and their medically trained partners who will help with the delivery of the baby, care for you during labor and postpartum, and assess and care for your newborn. You may also decide to hire some non-medically trained professionals to help with your birth and postpartum periods such as a doula, or a birth photographer. Then, there are the people who you don’t hire: your significant other, family members, or close friends who are there to cheer you on and support you throughout labor and life. Everyone’s role in the birthing room is different but important.
The Doulas role is to provide physical, emotional, and informational support throughout pregnancy, during labor, and postpartum. A big benefit of having a doula present at your birth is they work for you as a part of your birth team. They do not work for your medical provider, and you are their primary responsibility. Another benefit is that your doula will also support your birth partner, and help them to support you better.
Having a doula attend your birth, and receiving continuous support increases your likelihood of having a spontaneous vaginal birth and your overall satisfaction with your birth experience. You will also decrease your likelihood of having any pain medications, vacuum or forceps assistance, unplanned caesareans, and negative feelings about your birth. Births attended by a doula are on average 40 minutes shorter, and babies are more likely to score better on their APGAR (newborn) testing.
If you’re into numbers, here are some exact statistics from Evidence Based Birth that outline some of the benefits of having a doula during birth; 39% decrease in the risk of Cesarean 15% increase in the likelihood of a spontaneous vaginal birth 10% decrease in the use of any medications for pain relief Shorter labors by 41 minutes on average 38% decrease in the baby’s risk of a low five minute Apgar score 31% decrease in the risk of being dissatisfied with the birth experience
So, now you know the numbers. Let’s break down what these numbers mean: financially and emotionally.
In the United States, the average cost of an epidural is $2,133 and the average cost of a cesarean is $3,382. If you were to get both an epidural and to have a cesarean that would bring your total for just delivery up to $5,515 on average. Compared to the average cost of an unmedicated, uncomplicated, spontaneous vaginal birth ringing in at $3,035. That means there is an average price difference of $2,460 just for the differences in delivery prices! These numbers don’t include things like prenatal care, or the actual fee for staying at the hospital, and they are just averages. The average cost for a doula is between $800-$2,500 depending on where you’re located, the doulas experience, and what kind of services your doula provides. Even the higher-end doulas would financially cost about the same as a complicated, birth. Keep in mind that hiring a doula doesn’t mean you for sure won’t need an epidural, or a cesarean it just lowers your likelihood.
Let’s talk about Anne and Betty. Anne and Betty are both first-time mothers, in Average Town, USA. Anne hired a doula to support her birth, but Betty didn’t. They see the same providers and have uncomplicated pregnancies, and are planning unmedicated, vaginal births, and want to exclusively breastfeed for a year. Here are their hypothetical stories.
Anne hired her doula during her first trimester. She and her birth partner decided to attend childbirth classes and a breastfeeding class at the recommendation of their doula. Anne also had two prenatal visits with her doula to discuss her birth preferences. During these prenatal visits, they discussed normal labor progression, pain management measures, and created a code word for if Anne did decide to have medication. Months pass, and Anne is 39 weeks pregnant. She and her doula already discussed her options of induction or waiting. Using the B.R.A.I.N. Method, and with the approval of her, provider Anne decides to wait.
Anne naturally goes into labor at 41 weeks. She calls her doula and her doula virtually supports her until she arrives at Anne’s house to offer in-person support. Anne labors at home with the support of her doula and birth partner for several hours. When things begin to pick up, and Anne’s contractions are very consistent and close together they all head to the hospital. At the hospital, Anne is in a lot of pain and requests to labor in the tub. When she gets out, her doula applies counter pressure. She uses a peanut ball and changes positions frequently from standing to sitting to side-lying. When it comes a time, Anne pushes in a squatted position that is comfortable for her. She delivers her baby and is proud of herself, and is happy with her birth outcome. Her baby is able to latch, Anne and her birth partner are transferred into their postpartum room and their doula helps them settle in before heading out for the night. Anne is relieved, and looking forward to her first postpartum visit in two days where her Doula will warm up a meal that they prepped together before the baby’s birth. Anne feels empowered, and that she was well prepared for her birthing experience. She feels supported, and that her beginnings into parenthood are off to a great start.
Betty does not hire a Doula. She and her birth partner go to their prenatal appointments regularly and follow their doctor’s advice. She reads many books about birth and breastfeeding. She feels prepared. Months pass, and Betty is 39 weeks pregnant. Her doctor suggests that Betty is scheduled for induction at 40 weeks. Betty doesn’t realize that this is an option, so she schedules her induction and arrives at the hospital a week later, on Monday evening.
She is checked in and fills out paperwork. She has had some Braxton Hicks contractions but hasn’t experienced any very painful contractions. Betty has not written a birth plan. When her nurse asks for her birth preferences Betty explains that she wants an unmedicated, vaginal birth and that she plans to breastfeed. As the induction process begins, Betty is given medication to soften her cervix and told that she can sleep. Her nurse comes in to check her dilation and vitals regularly. Outside of the comfort of her own home Betty is uncomfortable and has a hard time sleeping. Her birth partner lays on a narrow couch across the room and they chat throughout the night. Neither of them is able to rest. The next morning, Betty’s doctor checks her progress and tells her that she has only dilated one centimeter and that they want to break her water. Betty is nervous but agrees to have her water broken. The process is painless. Hours pass after her water is broken and she is still slowly progressing. Betty’s doctor tells her that he wants to give her Pitocin. When Betty asks, “What is Pitocin?” Her doctor replies, “Medication that we put in your IV to help speed things up.” He does not mention that it will make Betty’s contractions stronger and last longer. Betty agrees to the Pitocin. As time passes, her contractions become noticeable, and then painful. Her husband is nervous seeing her in pain. He holds her hand. When Betty’s doctor returns ro check her cervix, he tells her that little progress has been made and she needs more Pitocin. Betty becomes emotional, and asks her doctor, “Why are you trying to rush my baby out?” And her doctor explains that the risk of infection is higher after having her water broken. At this point Betty is distraught, her husband has tears in his eyes from watching his wife in so much pain. A few more hours pass and Betty decides to get an epidural to help with the intense pain caused by the Pitocin. After Betty gets the epidural she is able to sleep. A few hours pass and her doctor comes into the room and tells her that it’s time to practice pushing. Betty has no urges to push but pushes when coached by her doctor resulting in tears to her perineum. Her baby is stuck in her birth canal, and they use a vacuum to assist the baby’s head out. Betty is happy when her baby is placed on her chest, and she is stitched up. Betty is able to latch her baby. She is not confident in her body and feels like she did something wrong by not having the birth she had dreamed of.
The truth is, with or without a doula your birth will not go exactly as you plan it. There is one certainty about birth, and that it is uncertain. The emotional value of labor support is clear. When you’re given support, and confidence in yourself and your body’s ability to birth your outcomes are generally positive. In case of an emergency, or a change in plans having support during labor can allow you to feel more satisfied with your choices and the changes in your plans.
Having great labor support benefits your wallet, but more importantly, it can affect how you feel about the birth of your child, and the beginning of your new life as a parent.