Why Use a Doula?

What's the point?  I hear this question a lot.   With a nurse on hand, a doctor/midwife, and a spouse, partner, or loved one at the ready, what is the point of hiring a doula?  Do they really have anything more to offer?   Great question.   During my training at Bastyr University, Penny Simkin, author and one of, if not the foremost childbirth educators and doulas in the country, handed out a comparison chart that she created to help answer that very question.    I will attempt to summarize her findings here...

First, she defines the roles of each person present at a birth.

• Physician: responsible for clinical well-being of the mother and baby; present only occasionally during labor
• Midwife: responsible for clinical care; gives intermittent support and comfort; present whenever possible during active labor
• Nurse: responsible for clinical care as dictated by the caregiver's order and hospital policies; intermittent support and comfort; keeps caregiver apprised of situation
• Baby's Father/Loved One: continuous or intermittent presense, 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

Next she created a chart to compare each person's ability to furnish emotional care to the laboring woman.    Here is what she found for the following 11 categories:

1. Continuous Uninterrupted Presence: Baby's Father/Loved One, Doula (possibly the Midwife)
2. Knowledge/Understanding of Woman: Baby's Father/Loved One (possibly the Midwife and Doula)
3. Love for Mother & Baby: Baby's Father/Loved One
4. Knowledge/Understanding of Emotions and Physiology of Labor: Midwife, Nurse, Doula (possibly the MD and Doula)
5. Experience with Other Laboring Women: MD, Midwife, Nurse, Doula
6. Ability to Remain Calm/Objective: MD, Midwife, Nurse, Doula
7. Knowledge of MD, Midwife, Hospital Policies: MD, Midwife, Nurse, (possibly the Doula)
8. Perspective on Problems/Options: MDd, Midwife, Nurse, Doula
9. Advocacy of Mother's Wishes & Goals: Midwife, Baby's Father/Loved One, Doula
10. Freedom from Other Obligations, Other Patients, Tasks, Clinical Management, Hospital/MD Policies: Baby's Father/Loved One, Doula
11. Knowledge of Comfort Measures: Midwife, Doula (Possibly the MD, Nurse and Baby's Father/Loved One)

So here's a quick look at the tally of points (not including the "Possibly..." sections)

MD: 4
Midwife: 7
Nurse: 5
Baby's Father/Loved One: 5
Doula: 8

These numbers helped convince me back when I was the one asking this question.  Simkin's chart showed me how valuable the presence of a doula can be during birth, where so much is unpredictable and unknown.  Even in the very best of circumstances, with the very best care, it's so important for the laboring woman and her partner to have uninterrupted care and support from a knowledgeable, compassionate person.