How Doulas Could Save Birth {A Nurse’s Manifesto}


{Image via Dooce}

~ The country that rates 50th in the world terms of maternal mortality.

~ 34,000 women who nearly die each year from pregnancy-related complications.

~ A 32% Cesarean Rate.

~ 21%: the increase in the maternal mortality rate in areas with a C-Section rate higher than 33%.

Am I talking about a third world country? No. I’m talking about the United States.

I have been an L&D nurse for almost eight years. I am proud to be an L&D Nurse. After working in other parts of the world, including places where there are no doctors, I am grateful for the medical care in this country. I am grateful for the advances in obstetric medicine that save mothers’ and babies’ lives every day. I am grateful for safe and skillful surgery when necessary, for innovative neonatal-intensive care units and initiatives to enhance the effectiveness of treatment for postpartum hemorrhage.

But we’ve got to do better.

Instead of treating catastrophic obstetric events after they happen, what if we could prevent them in the first place?


{Art by Judy Saidman}

Six months ago, I embarked on the development of a simple project with a simple question: How as L&D Nurses can we work to enhance a woman’s birth experience? My thought was that I would do research on positioning, massage, hypnotherapy and other non-pharmacologic pain relief skills, then train my fellow nurses in the best techniques. After all, L&D Nurses are rarely trained in basic labor support skills, even though they spend more time with laboring women than any other care provider.

What I discovered in my research blew my mind.

“If a doula were a drug, it would be unethical not to use it.”

~ John H. Kennell, MD

I discovered that the most effective labor support technique was not a technique at all, but a person: a skilled, non-medically trained labor support professional known as a Doula.

DOULA: A woman who serves. A specially trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth.

The most recent review of studies about the effectiveness of continuous labor support (Cochrane Review, 2013) included 23 trials (22 providing data), from 16 countries, involving more than 15,000 women in a wide range of settings and circumstances.

  • Women who received continuous labor support by doulas were more likely to give birth spontaneously, requiring neither Cesarean nor vacuum nor forceps-assisted delivery.
  • Women supported by doulas were less likely to require pain medications or epidurals, were more likely to be satisfied, and had slightly shorter labors.
  • Women supported by doulas gave birth to babies that were less likely to have low five-minute Apgar scores.
  • No adverse effects were identified.

 There are more studies about the benefits of using a doula for labor than all the other comfort measures (hydrotherapy, acupressure, massage, music, hypnosis, aromatherapy) combined. The research shows that using a doula for childbirth has a more positive benefit, with less risk or negative side effect, compared to any other form of pain relief in labor. 



If we have any hope of improving the safety of birth is this country, (and the quality of birth in this country), then WE NEED MORE DOULAS.

Every Woman deserves a doula. Not just women of a certain socioeconomic class, or women with the financial means, or women that desire un-medicated or out-of-hospital birth. But all women.


  • All women that are insured by Medicaid in this country should be provided with a certified, independent doula for labor support. The doula should be reimbursed by Medicaid for the majority of her fee (experienced labor support doulas typically charge $1000 per birth as a living wage).
  • All health insurance plans providing maternity coverage should be required to reimburse the fees of a certified, independent labor support doula for the full amount of her fee (see above).
  • All L&D Nurses should receive training as part of their required annual competencies in the importance of labor support, as well as communication and collaboration with independent certified birth doulas. For an example of this kind of training, please learn more about our evidence-based workshop titled Labor Support for Busy Nurses.


{Image via Fine Art America}

Whether a woman gives birth without any medication or by C-Section, a doula can improve a woman’s birth experience. Regardless of when, where or how a woman gives birth, a doula is a loving, familiar presence that will keep a woman calm, reduce her pain and enhance her ability to bond with her baby. Doulas not only make birth better, but they also make birth SAFER.

So what are we waiting for?

One thought on “How Doulas Could Save Birth {A Nurse’s Manifesto}

  1. Pingback: Save the Cheerleader…..Save birth? | Culture of Life Doula

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