Hi, everyone. My name is Rebecca Dekker. I’m a nurse with my Ph.D. and the founder of evidencebasedbirth.com. I’ve written extensively about the evidence on doulas and the research supporting their use. You can find that info at ebbirth.com/doulas, but, in today’s video, I want to focus in on using a doula for pain relief during labor and childbirth.

What is a birth doula?

For those of you who don’t know, a birth doula is a companion who provides people with continuous support during labor and birth.

How do doulas provide pain relief during childbirth?

There are four different ways that doulas can affect pain management. These include physical support, emotional support, childbirth preparation/information, and advocacy.

Physical Support

Doulas are trained to provide physical support through the use of soothing touch and massage. They make sure that the laboring person is as comfortable as possible. This might include the use of movement and positioning, which we talked about in a different video, which is a very effective pain management technique. Physical support may also include the use of pressure on your back during contractions (called the counter-pressure), and helping to keep you nourished with ice chips, food and drinks. Other comfort measures may include fanning you if you get hot, giving you a cold, wet washcloth if you feel nauseous, providing you with pillows, ChapStick, music – anything you need to keep you comfortable.

Emotional Support

Doulas also provide emotional support, which helps the mother to manage pain during childbirth. Doulas work to create a calm birth environment. As we discussed in our video about painless birth and pain perception, the hospital birth environment today can cause stress, which can increase your perception of pain. Doulas work to help decrease that stress in the birth room. They give you encouragement and praise and remind you that you are safe and supported.

Doulas work with the birth partner (e.g., spouse, boyfriend, girlfriend, family member or friend) to help that birth partner better support you. Researchers have found that when people feel capable, confident and cared for, they feel less pain during labor. They perceive their pain as more manageable and they’re better able to cope.

Doulas also help mothers to interpret labor in a positive way, by reminding them that the sensations they’re feeling are productive and purposeful and that each wave or contraction is helping to bring the baby down and out. Research shows that when mothers view their contractions in this way, they’re more likely to perceive them as less painful.

There’s a researcher in Sweden named Kerstin Uvnäs Moberg, who’s an expert in oxytocin, which is the hormone that most of us know about that causes contractions. It’s also known as the “love” hormone. She writes that doulas facilitate oxytocin release, which decreases your stress, fear or anxiety and increases the effectiveness of your contractions. In addition, the calming effect of the doula’s presence increases the mother’s own natural pain-relieving hormones, also known as endorphins. All together, these things make labor feel less painful.

Childbirth Preparation and Providing Information

Childbirth preparation is another way that doulas can help to decrease pain. Doulas help pregnant people and their partners prepare for childbirth through education, information, practicing coping skills and counseling at prenatal visits. They help them talk through their fears and suggest coping techniques that they can use such as breathing, relaxation, movement and changing positions.

Researchers have found that both childbirth classes and support from a doula help lower pain perception during labor. This mechanism of pain relief is called Central Nervous System Control, and we talk about it in detail in our overview video all about pain management during labor. Central Nervous System Control causes the mother to perceive pain as less unpleasant by activating the parts of the brain responsible for memory, emotions and reaction to pain.

Advocacy

Finally, advocacy is another way that doulas can help decrease pain. Doulas typically don’t speak up for you, rather, they encourage you to speak up for what you want. This advocacy technique may be helpful in relieving your pain. For example, if a mother is coping well in an upright mobile position and the care provider insists that she get back in bed even though things are progressing normally, the doula could facilitate communication between the woman and the care provider by asking the woman which position she prefers.

What’s the evidence on using a doula for pain relief?

There have been at least 26 randomized, controlled trials that tested the effects of continuous labor support on more than 15,000 people total. These studies were included in a Cochrane Review published in 2017. People in these studies were randomly assigned to either receive one-to-one continuous support from someone or “usual care.” The type of support provided could be from a member of the hospital staff, a doula, a childbirth educator, a retired nurse, or a family member or friend.

The researchers found that, overall, people who received continuous support during labor – meaning that someone never leaves their side – experienced a 25% decrease in the risk of having a Cesarean. The largest decrease in the risk of Cesarean was seen with a doula; using a doula lowered the risk of Cesarean by 39%. Continuous support led to an 8% increase in the likelihood of a spontaneous vaginal birth. Again, the largest effect was seen with doulas; using a doula increased the chance of a spontaneous vaginal birth by 15%.

Having continuous support during childbirth was also linked to a 31% decrease in the risk of being dissatisfied with your childbirth experience. Mothers’ risk of being dissatisfied with their experience was decreased if they received continuous support from a family member, friend or a doula, but not if they received continuous support from hospital staff. With continuous support, they also found a 10% decrease in the use of any pain medications during labor, shorter labors by about 41 minutes on average, and a 38% decrease in the risk of your baby having a low Apgar score. Researchers did not find any difference between groups with the rates of Pitocin augmentation or special care nursery admissions.

There is one new randomized, controlled trial that was published in 2017 and was too new to be included in the Cochrane Review. In this study that took place in Iran, researchers conducted a randomized, controlled trial to test the effects of doulas on pain and anxiety levels in first-time mothers who were giving birth. The mothers were assigned randomly to either have a doula or to not have a doula. They used standardized questionnaires to measure anxiety and pain. They found that, on average, the mothers who had doula support experienced less anxiety during labor and less pain. The authors concluded that the doula’s presence has a clinically meaningful impact on both pain and anxiety during labor. They recommended that all hospitals and maternity care centers in their country provide access to doulas, since they believe that having a safe and calm delivery is a human right.

How do you find a doula?

In the resources section below, I will provide a link to Childbirth Connection, which has a great list of questions you can ask if you’re interviewing a doula. Even if you’re not sure if using a doula for pain relief is right for you, sometimes it helps to interview several and just see if you find someone who really clicks with you.

Also, doulamatch.net is a great way to find a doula. Doulas upload their availability to that website on a regular basis, so you can find if there is somebody in your area who’s available for the time around your due date.

Conclusion

In summary, out of all of the possible ways that we can help people manage pain during labor and childbirth, using a doula for pain relief seems like one of the most important. Doulas provide physical support, emotional support, childbirth preparation and advocacy – all of which can help decrease pain.

Providing doula support to birthing people is a risk-free endeavor, and it’s highly effective for improving  health outcomes such as decreasing your risk for Cesarean or forceps or vacuum delivery. People who use a doula report experiencing less pain and anxiety during labor. They’re also much more likely to be highly satisfied with their birth experience.

In one study that looked at giving couples a doula, they found that all of the partners rated their experience with a doula as positive or extremely positive. So, typically, both the birthing people and their partners are highly satisfied with the help they got from their doula.

The bottom line is that using a doula for pain relief should be an option for all birthing people since doulas are a valuable, evidence-based member of the birth care team.

That’s it for this video. Thanks and bye!

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