Doulas in the Delivery Room: How much of a difference can they make?

 As we know, in the United States, we have one of the highest rates of maternal death out of all the developed countries. There are, unfortunately, many factors that play a role in this, but one of importance, that could help prevent maternal death, is having a doula in the room, especially for women of color (particularly Black women) and those who have low socioeconomic status; these populations are specifically effected due to the institutionalized racism in hospitals as well as insurance and health literacy status. There are a lot of people, especially those with more conservative views, that feel doulas are a more “hippie” approach to childbirth and you just need to “listen to the doctor”, my parents being one of these types of people, unfortunately. However, there has been data showing how much doulas can affect the maternal outcomes after birth, including preventing unnecessary or unwanted procedures to occur. For example, one study showed that women who had a doula had 52.9% lower odds of having a C-section, where doulas weren’t even hired throughout the entire pregnancy. Also, doulas helped reduce the odds of postpartum anxiety or depression by 64.7% by just being hired for the part of labor and delivery. These numbers just show how important doulas can be in the labor and delivery room, but what do they have to do to get doctors to listen to them?

               More recently, doctors/OBGYNs have been a little bit more receptive to doulas being in the labor and delivery room, however, most OBGYNs are still not. Sometimes, doctors feel they are doing what is easiest/safest for the patient to give birth, but instead it can sometime just be the OBGYN doing what is convenient for them or what they were trained to do (even though it might not be correct). For example, a simple way to help prevent episiotomies and further complications is by having the mother walk around and do a standing birth, in order to use gravity to help push the baby out. However, it has almost been ingrained that women have to be laying down to give birth, which is not true at all; this instead is more convenient for the doctor and actually puts the mother and baby at risk for complications due to the baby getting forced (by gravity) to go down into the hips and then out instead of a more streamlined way of getting out. Now you might say, why don’t mothers always do this then? Sometimes the mother is in so much pain, they can’t voice their opinion as much and just follow the doctor, even though it might be in their birth plan to not be laying down (or whatever their request is). This is where a doula comes in, to help voice that plan and stick to the plan. But, as shown in a different study about doula perspectives, they have to come at it from a passive aggressive or subtle angle in order for the doctor to not get mad (really get their ego bruised). For example, some doulas mentioned that they would let the patient know what the doctor was doing and ask if they were okay with that, such as grabbing scissors (for an episiotomy), in order to not call out/ask the doctor directly where they could get offensive. Another example is some doulas mentioned when doctors thought to induce (when not absolutely necessary), doulas asked the patient if they would like to just wait one more hour, as long as it wasn’t going to be detrimental to their health. Apparently, some doctors still get annoyed and irritated by doulas communicating what is going on to the patients body, even with this subtle approach, but it can help make it so the patient can consent or not consent, which (generally) legally makes the doctor stop if they do not consent; unfortunately this doesn’t always happen, but legally they are supposed to stop. Some doctors think that family can help in the delivery room, but doulas are needed as they understand what is happening and communicate it; this is why doctors are generally okay with family being there rather than doulas.

               Now, doulas are not always a “burden” to doctors in the delivery room, with one example being where the doctor deferred to the doula on the plan in the delivery room and who should catch the baby (to make the patient most comfortable).  Another example was when the patient wanted to do a natural and/or water birth, and the doctors did not know what to do in these situations, so turned to the doula for help. From here, the doula mentioned they have done in a lot and can help walk them through it; doulas felt when they are open to the doulas opinions, they open their eyes to different kinds of birth and kind of allow the patient and doula to take control while they are there to help if needed. I feel this is the way it should be handled in the delivery room, where the patients wishes are communicated and respected, and letting the professional in that type of birth (doctor or doula) to take control; however, the doctor should always be there in case of emergency, or if they notice they need to take a new approach due to actual medical concern.

               Overall, doulas play a major role in childbirth, especially in preventing unnecessary procedures and voicing patient concerns/wants. Unfortunately, they are not always accepted in the delivery room from doctors (and patients who don’t believe in them), but they help significantly, especially when a mother is in so much pain and can’t voice her opinions, and must just listen to the doctor or turn to someone else for help. I personally think everyone should have a doula, especially in the labor and delivery room, because, I mean, the numbers speak for themselves. As we have seen, just a simple change in position of giving birth can significantly change the outcome to the patient and the baby. There likely needs to be training and education that starts at home, but especially in medical schools that encourages the collaboration with doulas instead of getting annoyed or wanting to remove them from the room. As we have learned, interprofessional communication is necessary for successful health outcomes, and this should include doulas.

https://www-sciencedirect-com.proxy.lib.umich.edu/science/article/pii/S0277953621006286?via%3Dihub

https://pmc.ncbi.nlm.nih.gov/articles/PMC9257331/#:~:text=Evidence%20collectively%20suggests%20that%20doulas,for%20maternal%20morbidity%20and%20mortality.

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