Have you ever heard someone refer to a doula as an advocate? I have. It usually sounds something like this:
“We hired a doula because we want someone to advocate for us if the doctor tries to force us to have an induction/epidural/Cesarean.”
You may have read statistics linking doula support to certain birth outcomes: decreased use of Pitocin, decreased likelihood of Cesarean birth, increased likelihood of spontaneous vaginal birth, and decreased use of pain medication. In fact, many doulas feature those exact statistics prominently on their websites.
Those statistics are drawn from a reliable source: a recent Cochrane systematic review, which is an analysis of all the available evidence on health care interventions, held to the highest academic standard. I’m pretty familiar with systematic reviews and I can tell you that this is certainly not pseudoscience. Here’s the problem: when these numbers are used to sell doula services, there’s a risk of misleading clients (you!). Specifically, presenting the numbers in this way confuses correlation with causation. The statistical tests used in the studies included in the Cochrane review calculate the correlation between variables. They do not imply causation; that is, the statistics do not tell us that doulas actively prevent unwanted interventions. Doula support is not correlated with happy and healthy births because of advocacy. The relationship between doula support and “better” birth outcomes is more nuanced than that.
So. How to explain it?
A doula can positively impact your birth experience no matter what type of birth you have. This is not because the doula will fight for you, challenging your care providers and convincing you to make decisions to support a certain agenda. Rather, it’s because with a doula on your team, you and your partner will feel calm and confident. You’ll be comforted in every way. You will never be alone. When you feel calm and confident, happy hormones will help you to relax and enjoy the journey. They may even allow you to cope better with the sensations of labour and delivery. Relaxation and happiness can actually help you to cope with pain! With the help of a birth doula you’ll feel good about yourself no matter what happens.
It’s not my job to make sure you get to check off every item on your plan. I’m not an advocate. My job is to support you every step of the way. As your doula I’ll slow down time for you, so to speak, when you need to make a decision. I’ll encourage you and help prepare you to ask your questions. If things aren’t going according to plan I’ll help you to accept, to adapt, to process, and to revise your plan. All the while, I’ll help you to maintain those calm and confident feelings.
I don’t consider it a success when you have a “natural birth”; I consider it a success when you look back on your birth with fond memories. I want you to feel like you handled it like a boss, made your own choices, spoke up for yourself. I want you to look back at your birth and know that you were strong. That’s what doulas do, and it’s not something *those* statistics can capture.