The Evolution of the Modern-Day Doula
The practice of women helping women give birth is by no means a new idea. Before the evolution of the medical profession and hospitals, it was the norm for relatives, neighbors, friends and traditional midwives assist a woman to give birth in the home. Their role was to strengthen and encourage the birthing mother. They gave emotional and physical support to sustain the mother to bring a new life into the world. This was the norm for the 19th and early part of 20th centuries. In the early 1900’s, as the social classes was at a greater distance, there was a change in the way women gave birth. As doctors became more and more respected, the model of childbirth changed from that of a home based event to that of an illness based hospital event. The female support unit was taken away, fathers were kept in waiting rooms and birth changed to an illness based model. The practice of midwifery all but disappeared. Women (especially in the upper classes) began to give birth in a hospital with the aid of primarily male, physicians. These changes hugely benefitted women who were considered to have a “high risk” pregnancy. On the other hand it began to subject “low risk” pregnancies to a cascade of interventions that could result into (what would have been a routine home delivery) into a complicated labor and delivery. In the 1920’s the “routine” use of forceps was actually promoted for a births, especially first time mothers. By 1940, anesthesia was commonly used and by 1950 it was commonplace for a woman to be anesthetized to the point of unconsciousness (has anybody watched the BBC show “Call the midwife”?). Nitrous Oxide (laughing gas) was given to put the mom in an un-alert state. Later in the 1950’s continuous caudal anesthesia (a localized anesthesia……a regional block, saddle block…etc) was being developed and used. In the 1960’s continuous lumbar anesthesia was introduced. By 1970 continuous lumbar epidural anesthesia and continuous fetal monitoring was common. With continuous epidurals, the evolution of labor became a bed-ridden event. Walking during labor was a thing of the past. As hospital births increased the Cesarean Section (C-Section) rate, in the United States, has steadily risen. We are now at an all time high of 33% in 2011. Here are the current C-Section rates for some other countries: Italy 40%, China around 50% and Brazil has a rate around 85% and in some private facilities the rate in Brazil it is approaching 99%…..Check it out, it’s easy to find the statistics on the World Health Organization (WHO) and other websites. The WHO states that there is no reason for a countries’ C-Section rate to exceed 15%. As C-Section rates rise you can alos see the mortality rates rise. It’s not all bad….worldwide I mean…..some Nordic countries have a C-Section rates around 14%. So, it can be done!!!!
The modern-day Doula (Greek for “woman who serves”) started to reappear in the 1970’s. Marshall Klaus and John Kennell began to study the effects of a woman being supported during labor. In 1971, Ina May Gaskin founded “The Farm Midwifery Center” in Summertown TN. The Farm was one of the first out-of-hospital birth centers founded in the United States. Ina May and the farm Midwives returned to the family centered home based birth model (Ina May has recently released a documentary based on her experience on the farm…..a DVD I highly recommend you watch).
Doulas began to increase in popularity in the 1980’s in response to the dramatically rising C-Section rates. Women like Ina May Gaskin and Penny Simkin and Dr. Klaus and Dr. Kennel revolutionized the role of the Doula. Drs. Marshall Klaus and John Kennell, Phyllis Klaus C.S.W., M.F.C.C., Penny Simkin, PT, and Annie Kennedy, all renowned experts in childbirth and newborns, founded DONA International (formerly known as Doulas of North America) in 1992. Their goal was to promote doula care: continuous emotional and physical support for women during labor and early postpartum. DONA registered 750 certified doulas in 1994 (their first Doula was certified in 1994), increasing to 2,000 in 2002. Between 1994 and 2004, DONA has provided training to approximately 25,000 people and as of 2012 has 8,500 certified Doulas in 50 countries. Doulas use techniques such as imagry, massage, acupressure and patterned breathing to help reduce a woman’s pain during labor. The Doula is not there to replace the healthcare team; she is there to enhance it. Studies have shown the MULTIPLE benefits of having a Doula (refer to my earlier entries about the benefits of hiring a Doula). Now fast forward to 2012 the University of Minnesota published a study in the American Journal of Public Health about Doula support during labor. The study showed that women who were supported by a trained Doula were 40% less likely to have a C-Section. That bears repeating……40% LESS likely to have a C-Section!!!!! The study was conducted among pregnant women with Medicaid. Check it out, it is pretty interesting!!! http://www.minnpost.com/second-opinion/2013/02/doula-support-linked-lower-c-section-rate-among-medicaid-moms-u-study-finds The study shows that in the hospitals involved the study, the average cost of a vaginal delivery was around $9000.00 and the cost of a C-Section was around $13,000.00. Hopefully more and more hospitals will start to recognize the benefits of a Doula or at least do the math!! Other studies have shown the patient satisfaction surveys are improved by the presence of a Doula. Hospital based Doula programs are on the rise.
When all is said and done, the modern-day Doula is here to stay!!!
Idoula4u 
Written
on May 12, 2013