For most of human history, pregnancy and childbirth were highly communal events. Groups of women would attend other women in labor—they would have various techniques and traditions (some more effective than others) passed down through generations for coping with the discomforts of childbirth.
Though modern living blesses us with many wonderful advances, one result of this is that pregnancy and delivery have become much more private. We no longer flock to our neighbors’ homes when they go into labor. Many of our previously widely-known traditions for comforting a laboring woman are now unknown to most people. Modern women often have a very different (and often more vague/less practical) understanding of the pregnancy and birth process than our pre-modern ancestors.
Enter the labor coach (sometimes referred to as a birth doula). A birth doula is a layperson without formal medical training—usually a woman—whose role is to support the pregnant/laboring patient. Usually this person has participated in many births (and may have a certification from a professional organization attesting to completion of course work or other requirements). She may also provide antenatal and postpartum support.
A birth doula is a member of the care team in addition to the traditional medical team (physician, midwife, RN). She knows many techniques for coping with the discomforts of labor. This may include massage, essential oil use, body manipulation/positioning, breathing methods, distraction or pain gating techniques, and beyond. Usually, an interested patient contacts a doula privately (usually outside of her relationship with her physician) to provide counseling and support for specific time frames (before, during and/or after childbirth). Doulas may offer different pricing for different services—services that are often not covered by insurance (but may be reimbursed via a health or flexible spending account).
When interviewing a labor coach, specific services can be discussed to ensure that everyone is on the same page. Is the patient looking for antenatal services? Labor coaching only? Postpartum/nursing support?
There is medical evidence that having a labor coach or birth doula present for labor improves vaginal delivery rates and maternal health outcomes. Moms who use birth doulas are less likely to request medications (either epidural or intravenous medication) for analgesia in labor. However, even if a mom plans to have pain medications in labor, patients report greater satisfaction with their experiences if a doula is present during their labor.
One of the most important roles that a doula plays is that of advocate. So often, physicians and midwives communicate in ways that aren’t completely clear to patients. A laboring patient is in a vulnerable state—the birth doula can ensure that clear and proper communication occurs.
So why doesn’t everyone use a doula? Labor coaches can be expensive. They can be hard to find. People might prefer a more private birth experience. And sometimes, people have no idea they exist.
How do doctors and midwives feel about doulas? For the most part, we absolutely love them! Physicians want their patients to be as comfortable and safe as possible, and anything that helps achieve that goal is a welcome addition to the care team. Yes, occasionally a doula will have her own agenda or beliefs that may contradict evidence-based medicine. This is rare, but when it happens, it is an opportunity for discussion, a moment to review goals of care and the thinking and evidence underlying medical recommendations.
Overwhelmingly, labor coaches bring another layer of care and advocacy for patients. Ultimately, everyone on the team has the same goal: a healthy, happy mommy and a healthy, happy baby.
Amanda Resnikoff, MD is a skilled, determined, and compassionate OB/GYN who grew up in the Hudson Valley. She attended Columbia University and graduated with a bachelor’s degree in neuroscience. Dr. Resnikoff then earned her medical degree from Sackler School of Medicine and later completed her residency at Rutgers NJMS (formerly UMDNJ). Dr. Resnikoff worked as an OB/GYN at Hackensack University Medical Center for five years before joining the team at Maternal Resources in 2017.
