Doulas: Steering the Way to Improve Birth Outcomes

Doulas, people with a special place in their heart to serve and hold space for birthing families, have been aiding in the childbirth process for many generations dating to the beginning of time. The mere presence of a doula, or someone entrusted as a birthing assistant, brings a peace and comforting ambience to a life-changing moment such as giving birth. Doulas have seen the ever changing landscape – from birthing at home to being moved to medical institutions, whether in a hospital or birthing center. Here in America, doulas have witnessed the transition from the midwifery model of care to physicians and now slowly integrating back to home birth with midwives. From the cascade of highly medicated labors with serious side effects, to increased cesareans and now VBAC policies and bans, doulas have witnessed just about every birthing situation one can think of. And for every negative story or outcome, there are many positive experiences as well.

Just as each birth is miraculous and all babies have their own individual birth story, every doula is different and brings their own special gifts of nurturing and compassion to the births they attend. Along with their wealth of knowledge in resources, comfort measures, and words of encouragement, doulas hold space with their patience, gentleness, and self-control under intense situations. Whether a baby arrives by a natural, no hands-on approach, or by a quick emergency cesarean rescue, babies are entering this new world on a daily basis and doulas are helping to improve birth outcomes one birth at a time.

Doulas are available to offer emotional, physical, informational, and advocacy support throughout pregnancy, labor, birth, and into the postpartum transition. Evidence Based Birth states a doula’s “essential role is to provide continuous labor support to the mother, no matter what decisions the mother makes or how she gives birth.” When a birthing person is supported and is receiving continuous encouragement from someone other than a member of the hospital staff or from her own personal social network, they have a better chance of experiencing a decrease in the use of pitocin, the risk of cesarean, use of any pain medications for relief, their newborns being admitted to a special care nursery, and feelings of dissatisfaction with their birth experience. Birthing people also have an increase in spontaneous vaginal birth (Evidence Based Birth) with a doula. Overall, doulas are an asset to improving birth outcomes.

But even with these improvements in birth outcomes, why are there still drastically high numbers of maternal deaths and unnecessary cesareans taking place in our country? Doulas have been working hard to improve birth outcomes in communities large and small, not only offering their services but by providing educational programs, resources of beneficial information, meeting with providers to change and enhance their standard of practice, and advocating in hospitals and state legislative meetings for a change – a change for better policies and procedures for birthing families. A change to improve maternal and birth outcomes here in America.

According to the national organization ImprovingBirth, African-American women and their babies are dying in large numbers — four times that of white women regardless of their socioeconomic status. One in three births are being performed by cesarean. In many communities there are VBAC bans and many of these women don’t have any other options for a birthing alternative. More than 40% of hospitals have a mandatory surgery policy in place for women who have previously had a cesarean even though many current national and health guidelines state otherwise. A staggering 70% of labors are being induced or sped up for non-medical reasons, which does not have an improved outcome for the infants. A change in these areas must take place to improve birth outcomes for those giving birth now and for future generations. (ImprovingBirth)

So what happens 25 years from now when a family is getting ready to welcome their newborn home? What will the birthing culture look like? What will be the growing trends of childbirth? Will home births with midwives be the normal routine? Are VBAC’s going to be permitted in hospitals or completely banned all together? Will medical providers be trained on how to safely catch a baby born breech? What are we doing as a society to help improve the birth outcomes for the next generation to come?

Doulas are continuously advocating for the rights of the birthing person to be heard and following the guidelines of informed consent and refusal. They hear and witness the negative traumas and positive experiences taking place in birthing rooms all over their communities. They are often times the go-to person when non-medical questions arise or when a birthing person is feeling unsure or even frightened about their birthing situation. As advocates, doulas are trusted confidants and knowledgeable resources time and time again for birthing families. Evidence Based Birth gives the suggestion for the definition of advocacy pertaining to doula support as, “Advocacy is defined as supporting the birthing person in their right to make decisions about their own body and baby.” Doulas are a great asset of improving birth outcomes and more families are realizing their importance and gaining from their expertise and knowledge.

This Labor Day, ImprovingBirth rallies will take place all over the United States and other locations across the world to advocate for safer birth options and improved maternal care. Their “mission is to inform, support, engage, and empower consumers, community leaders and providers with the tools to improve birth. [They] believe that when people have the tools to inspire change, that they will take action.” (ImprovingBirth) We all can be change agents for better maternal and infant outcomes. We can continue to advocate for improved policies and procedures for birthing families. If you are unsure of the maternity culture in your area, contact local doulas who can help to educate and inform you. Great information and resources on the evidence, facts, and rights in maternal care can be found at You can stand along with great doulas who are supporting, educating, advocating, and continuing in steering the way to improve birth outcomes!

Dekker, Rebecca. “Evidence on: Doulas – Evidence Based Birth®.” Evidence Based Birth®. N.p, 14 August 2017. Web. 23 August 2017.

“Home.” Improving Birth. N.p., n.d. Web. 23 August 2017.

“Resources.” Improving Birth. N.p., n.d. Web. 23 August 2017.

Chanté Perryman is a doula, maternity coach, childbirth educator and birth advocate at Baby Dreams Maternity Concierge. She specializes in encouraging and supporting families during their pregnancies, births and postpartum transition. She believes in birth choices along with respectful care and evidence based education.

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