Is a doula really necessary?

Yes, a doula is needed at births–unmedicated births, epidural births, caesarean births, and anything in between.

She constantly stays with the mother and enhances her experience–acknowledging her struggle, encouraging and reassuring her of progress, seeing to her comfort, and reducing mother’s fear. Did you know babies can feel the anxiety and stress hormones from their mothers? Having a doula helps prevent these hormones of anxiety and stress from interrupting the mother’s birth and from reaching the baby, too. However, for mothers desiring an drug-free natural birth, having a doula is absolutely essential!

Time and time again, we have seen several moms who completely commit to a natural birth but will choose not to hire a doula (probably for financial reasons, but don’t let this stop you!). They read the books, watch the documentaries, comment on the Facebook groups, and psych themselves up for achieving a drug-free birth. They do not know or do not remember that they are facing these obstacles:

  1. Our hospitals have some of the worst c-section rates in Alabama;
  2. Alabama has one of the worst c-section rates in America;
  3. America has an appalling c-section rate and an astonishingly high maternal mortality rate;
  4. Most likely, these determined mothers have never seen a trained woman give birth without medication;
  5. Their husbands are way out of their element even while trying their hardest to help;
  6. Their nurses are also caring for 2 other patients, see 50 epidural births for every one unmedicated birth, have never been trained how to help an unmedicated mom, mean well by denying moms food or drink, and would really rather you stay in this position so their monitors can easily pick up Baby’s heartbeat;
  7. Their physicians are trained surgeons who treat every patient the same to save them from what “may happen”, who constantly fear a lawsuit, and who are always trying to prove that they are not negligent. No, our doctors are very much not negligent when they keep checking your cervix every hour or so to see what’s going on in there.

With all of these disadvantages, mothers proceed into the unfamiliarity of a physical process that is chemically and hormonally designed to be an overwhelming experience. All of the mom’s “learning” cannot help prevent that!

Ask any labor and delivery nurse at the hospital of your choice, “What is the success rate of women who come in here attempting natural or unmedicated birth without a doula?” They will all say the same thing! Lots of women come in “trying” for a natural or unmedicated birth, but almost no one can do it unless they have a doula!


Why isn’t “learning” enough?

Well, here’s what happens during labor.  While she is very busy focusing on herself and relaxing her body through contractions, the mother’s prefrontal cortex (her rational or “higher thinking” brain) goes silent and her instinctual “middle brain” begins to influence her emotions and behavior. Literally, birthing mothers stop “thinking” and start “feeling” how to behave.

Mom’s middle brain floods her system with oxytocin, beta-endorphin, and prolactin. Oxytocin causes the mother to love, to trust, and to “give herself over” to what is happening; beta-endorphin is a natural opiate similar to morphine and heroin that activates dopamine receptors and also produces euphoria and pleasure; and prolactin (which prepares breasts for lactation) is a mood-altering hormone that influences a person into submission and surrender.  These hormones are working together to put the mom in a “happy place” to help her manage the pain and to keep her responsive to her body’s instincts.  This is sometimes called the “birth high”, and it’s similar to being high on drugs or alcohol.

This process is important for labor.  As the rational brain to go silent, the mother’s instincts influence her to respond to her labor’s needs–changing position, eating or drinking, moving, or groaning as she feels the urge to do so.  Mother’s body is beautifully designed to work this way! If her baby needs more space in the pelvis, she’ll suddenly only feel comfortable if she gets on her hands and knees–letting gravity pull her pubic bone out of the way.  If her baby needs to shift to get through her boney hips, the mother will want to start walking or raise one leg higher than the other.  And almost all mothers who are left alone in labor will have an urge to stand upright or to squat aright before the baby’s birth, easily letting the baby slide down and out.  All this can only happen if the mom is in “another place” where her brain can just “give in” to what her body needs. The more a person resists “giving in” or “giving over” to the dopey feeling of the natural birth hormones, the more painful her birth will be and the less her body will be able to listen to its own suggestions.

Can’t a mom just prepare for birth and then give in to her instincts?

if you are being left alone to listen to your body in labor, then you probably don’t need a doula. However most women in the Wiregrass will not be birthing undisturbed; most will be birthing in a hospital with doctors and nurses interrupting the process by asking you to think, respond, and behave rationally. They explain procedures and make you sign consent forms; they tell you how they’ve “always done it” and why it’s not a good idea to do something listed on your birth plan.  They try to get you to “understand” and agree with their reasons to lie on your back, push when they say push, pull your knees like this, only eat ice chips instead of drinking water, do this, do that, blah blah blah…  At a hospital, you will be interrupted, transported, admitted, gowned, poked, asked, instructed, and denied. What in the world?!?! There’s no way your body can tell you to do what it needs you to do if you are trying to pay attention to a friendly looking nurse asking you about your blood-type, a power of attorney, living will, any piercings or tattoos, any allergies, do you have a car seat to take baby home in, and other ridiculous nonsense like “What’s your favorite learning style? Do you prefer me to talk to you, show you, or do something with you?” (EEEK! There shouldn’t be ANY “learning” going on when you’re giving birth to a baby! You should just be left alone!) Knowingly or not, the hospital staff keeps “waking you back up”.  All the while, your body is trying to “put you back under” in a quiet, relaxed submissive other-worldly state. 

There are several ways a doula helps fight all of the stress and interruptions of hospital births. A doula can help minimize distractions and can help you get back “in the zone” after interruptions.  A doula will encourage you to do what you feel is most comfortable, instead of staying in the bed because that’s where they put you.  A doula can massage or give you encouraging touches, which is very convenient since the body produces more oxytocin when a person is touched. A doula will remember all the stuff from your childbirth class, and will have the state of mind to recall facts and information if they apply to your birth.

Birth hormones also make moms far more susceptible to a perceived authority figure’s “suggestion” or scare tactics–like maybe you need a C-section because “you seem tired” (when you’re really just fine, or when you are so very close to the end) or because “you’ve been laboring too long” (when there’s no such thing as laboring too long as long as the baby looks find on the monitor).  If you don’t have a doula there, then you won’t have a rational brain in your corner who isn’t susceptible to authority figure’s pressure to comply, who knows what the latest birth evidence really says, who knows your rights and that no one can “make you” do anything, who remembers what you’ve discussed before the birth, who’s seen all this drama before, and who can help you respond. Or if you do need an intervention, a doula can provide the pros and cons, the alternatives, and any suggestions to make the intervention more comfortable for you.

So, that’s why I think a doula is absolutely mandatory for achieving a natural birth. In birth, you will forget what you’ve learned, and you will need an experienced person in your corner who understands what labor feels like, who knows how to help the natural birth process along, who will be there to support your choices, and who will provide every physical comfort to help you achieve them.  And 100% of my clients and their spouses agree; yes, you need a doula!

In the words of one new dad giving birth advice to another expecting father,