Doulas – Pros and Cons

Taking the doula attitude a step further


I was e-chatting with Sarah, a colleague of mine who works for CARE. I'm preparing to go the National CARE Convention in Washington DC next week, where I'll be moderating a panel discussion on global maternal health issues. We had a laundry list of details to discuss. All we really wanted to talk about though was "doulas."

Sarah's expecting her first baby and is going through her own laundry list of preparations for her delivery. She wanted to know what I thought of doulas. Are they necessary if you have a good nurse and a supportive partner? Do they help or hinder? How do you pick out a good one? I've blogged about doulas before and though the information and my opinion are essentially the same; I think the doula's role has become more important lately.
In just the couple years since I wrote that blog, things have changed a bit in the American birth industry. It's up for debate whether they've changed for better or worse. Our C-section rate is climbing higher and higher, in large part because we do more interventions than ever and have less tolerance for allowing labor to play out naturally. In 2006 (our most current statistics) 31.1% of all deliveries wound up as a C-section. If this resulted in saving more lives, then I'd say our higher C-section rate is justified. The problem is that we're not. Some studies show an increase in maternal deaths concurrent with more C-sections and we may actually be causing more problems in women's health in years following her surgery (or surgeries if she chooses to have other children).
So why are doulas more important? Because women who are dedicated to having a vaginal birth may need all the advocates they can get. They need support to utilize skills and tools that lead to normal vaginal deliveries. If their husband, partner, friends or family aren't able to be that advocate, then a doula is the woman for the job.
I still think that the best support is the baby's father or Mom's partner. Dad's presence during labor and birth is an important bonding moment and sometimes, the first real-life on-the-ground connection he has with the baby. It's been "real" for Mom since she missed that first period. It's been more of an abstract idea for dad until he sees labor in action. Please read my earlier blog about my concerns about doulas stepping into Dad's role (not a good idea) and displacing him and on how to pick a good one. Bottom line, make sure someone is there to support, guide and advocate for mom during her time of need and that that someone is also able to support Dad and the rest of the family.
Sarah's and my discussion got me to thinking about the roles we all play in supporting the mothers of the world. While I think it is ideal if all mothers' needs are met by her partner, family and community; in reality, that doesn't always happen. 500,000 women still die every year in childbirth and from pregnancy-related causes. The reasons why are complicated. I can analogize that some of the reasons why I'm committed to CARE and excited to attend the conference next week is because they act as doulas at large to women of the world. CARE is committed to supporting, advocating and guiding communities, countries and health care facilities to take the best possible care of mothers.
Each of you can help the world be a better place for mothers and children. If you're pregnant, allow people to support you. Let your partner, husband, family and friends "doula" you in positive, non-medically oriented ways. People love to help and by allowing them to support your pregnancy, you're providing them a gift: the opportunity to be kind, compassionate and part of your village.
If your loved one, friend or family member is the pregnant one, shower them with support without displacing her key players. Mom is #1, but Dad is #2. He needs to be supported to be the best father he can be, starting with pregnancy, labor and birth. Don't step on his toes or step in front of him. Stand behind him and give him a helping hand.
Please don't share your horror stories. Nothing valuable ever comes after the statement: "You think your pregnancy's bad? Well let me tell you about bad... ." It's not about you. It's about Mom and Dad-to-be. They need help, hope and reassurance. Instead, offer positive, loving statements like: "How can I help you feel more comfortable? What can I do to make your load lighter?"
You can take this "doula" attitude out to a broader platform by supporting community, state and governmental actions and initiatives that help mothers and families. Log on to websites like and learn more about how helping mothers helps the world be a better place. Nothing's more optimistic than a new life and now, more than ever before, is a good time for optimism.
Got a question for Jeanne? Email it to: and it may be answered in a future blog post.
This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.