Labor Support by Doulas, Midwives, Nurses, Physicians and Loved Ones

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A laboring woman is cared for by a variety of people, each of whom has a defined role to play. Clinical or medical aspects of care are the top priority of physicians, nurses, and midwives. Doulas, fathers and loved ones focus on psychosocial or non-medical aspects of care. The baby’s father and loved ones also have a great emotional investment in both the woman and baby and may need emotional support and guidance at times during labor. Below is a brief description of the roles played by each member of the team:

 Physician: responsible for clinical well-being of mother and baby; present occasionally during labor
› Midwife: responsible for clinical care; gives intermittent support and comfort; present when possible 
in active labor
› Nurse: clinical care as dictated by caregiver’s orders and hospital policies; intermittent support and comfort; 
keeps caregiver apprised of situation
› Baby’s father/loved one: continuous or intermittent presence, varying amounts of support and comfort, 
witnesses and shares birth with the woman
› Doula: continuous presence for emotional support, physical comfort, non-clinical advice, guidance for partner

Does it matter who provides continuous support in labor?
The most recent systematic review looked closely at how effects of labor support varied by type of person providing labor support, and offers new knowledge.
Effects were strongest when the person was neither a member of the hospital staff nor a person in the woman’s social network, and was present solely to provide one-to-one supportive care. Compared with women who had no continuous support, women with companions (such as a doula) who were neither on the hospital staff nor in the woman’s social network were:

 28% less likely to have a cesarean section
› 31% less likely to use synthetic oxytocin to speed up labor › 9% less likely to use any pain medication
› 34% less likely to rate their childbirth experience negatively 28% less likely to have a cesarean section
› 31% less likely to use synthetic oxytocin to speed up labor › 9% less likely to use any pain medication
› 34% less likely to rate their childbirth experience negatively

Support provided by a person that the woman selected from her social network (for example, her partner, husband, other family member, or friend) increased her satisfaction, but did not seem to impact her use of obstetric interventions

*As quoted by Dona international 

​ONA International Birth Doula Manual/2017©