Options: Labor Support

Who can give me support during labor and birth?

How do my options for labor support compare?

What kind of care can I expect if I choose a doula?

Can I get supportive care from my partner alone?

Can I rely on nurses, midwives, and doctors to meet my need for supportive care in labor?

Can a relative or friend meet my need for supportive care in labor?

Given these challenges, does it make sense to consider inviting a friend or relative to provide labor support?

Who can give me support during labor and birth?

You may want to have one or more of the following people on hand to aid you throughout labor and birth:
  • trained labor support specialist: The most common name for such a person is doula (pronounced DOO-lah), a Greek word meaning "woman who serves." Other names that are sometimes used include: labor companion, labor support professional, labor support specialist, labor assistant, and birth assistant. (This section does not discuss "postpartum doulas," who help women at home in the days and weeks after birth.) This type of labor support companion has the strongest impact on your health and safety during labor and birth (see Best Evidence: Labor Support page).

  • your partner: Many partners feel some concern about accompanying a woman during labor. In the end, most find that providing help and comfort in labor is very rewarding, and that being present at the birth of their child is one of life's peak experiences.
  • clinical caregiver: In most cases, this would be a nurse, midwife, or doctor.
  • invited relative or friend: You can choose someone in your social network with whom you (and your partner, if you have one) feel comfortable sharing this important and intimate time. She should be a warm, relaxed, and calm person who views labor and birth as healthy, normal events in a woman's life.

How do my options for labor support compare?

The table below can help you think through your options for labor support. It shows which types of personnel are most likely to be able to offer specific aspects of supportive care. Although the ratings are generally accurate, there will always be exceptions.

Aspects of Supportive Care Support Person
Doula Partner Hospital Nurse Hospital Midwife Hospital MD Out-of-
Relative/ Friend
Is free to be continuously present + + - ? - + +
Gives priority to warm, nurturing, encouraging behavior + ? ? ? ? + +
You already know and feel comfortable with this person + + - ? ? + +
Knows your preferences, concerns, priorities + + - ? ? + +
Facilitates communication with caregiver + ? + n.a n.a. n.a. ?
Enhances partner's participation; looks after partner's needs + n.a. - - - ? ?
Understands and works to enhance emotional aspects of labor + ? ? + ? + ?
Knows and uses comfort measures and strategies to promote progress + ? ? + ? + ?
Has much experience with laboring women + - + + + + -
Is able to remain calm, objective + - + + + + -
Is responsible only to you + + - - - - +
Involves no added cost for support services ? + + + + + +

Key: + generally provides this component

- generally cannot or does not provide this component

? varies, and may be impossible to know in advance

n.a. not applicable

Table adapted with permission from the ICEA Position Statement: The Role and Scope of the Doula, (1999) published by International Childbirth Education Association (ICEA), PO Box 20048, Minneapolis, Minnesota 55420 USA 952/854-8660. Original table by Penny Simkin, PT, CD (DONA).

A growing body of better quality research is clarifying that the impact of labor support companions varies, by type of companion. To learn about effects of a person from the woman's social network versus a member of the hospital staff versus someone such as a doula who is present solely to provide labor support, see the Best Evidence page.

What kind of care can I expect if I choose a doula?

As is clear from the table above, a trained labor support specialist is likely to to be your best option for optimal labor support. A doula stays with you throughout labor. According to your wishes, she may be close to you, if not in actual physical contact, nearly all of the time. She offers comfort measures such as cool cloths, massage, and handholding. She gives emotional support, including reassurance, encouragement, and honest praise. She can suggest ways to improve progress or ease discomfort. She can explain what is happening or interpret what hospital personnel have said. She can also help you communicate your needs to hospital staff and support decisions that you and your partner have made.

A doula looks after your partner as well, acting as a resource and guide and making sure your partner's needs are met. Some couples wonder if having a doula will disturb the privacy and intimacy of labor and birth; in fact, a doula can help to protect privacy and create an intimate atmosphere in a busy, institutional setting.

A doula usually meets with you before labor to learn your personal preferences, priorities, or concerns, and stays with you until an hour or so after the birth of your baby to help get breastfeeding started. Most doulas are also available before labor and in the days after the birth of your baby to provide information, reassurance, nonmedical advice, and, when appropriate, referrals.

Can I get supportive care from my partner alone?

Giving your partner responsibility for supporting you through labor puts pressure on someone who may have little or no prior familiarity with birth, and who may have strong emotional needs of his or her own during the experience. Some partners do not have temperaments suited to this physically and emotionally nurturing role. The lack of privacy and the impersonal atmosphere in the hospital may inhibit others.

Partners can benefit by having someone with more experience mentor them through, offer practical ideas for helping with your comfort, reassure them, and look after their needs. Having an additional person allows partners to take a needed break and relieves pressure to meet your every labor support need. If labor is intense, you may welcome having more than one person to help you. For example, you may want one person in front of you talking you through each contraction while the other is behind you pressing on your lower back. If labor is long, members of your support team can relieve one another so that you always have someone relatively refreshed working with you.

The Tips & Tools: Labor Support page offers ideas to help your partner prepare to support you in labor.

Can I rely on nurses, midwives, and doctors to meet my need for supportive care in labor?

Hospital-based practitioners and staff may have difficulty providing optimal labor support for several reasons:
  • background and education: Doctors' education focuses on diagnosing and treating problems and performing surgery. Nurses trained and working in hospitals where most women have epidurals may have limited experience supporting women who want to avoid or delay this form of pain relief. Midwifery education includes labor support, but hospital-based midwives may have difficulty providing it (see next two points).
  • responsibility to others, and care that doesn't involve support: Your caregivers may also need to attend to other laboring women, office appointments, or scheduled procedures. Hospital or employer policies may focus their attention away from direct supportive care. Many nursing tasks (such as monitoring/adjusting equipment, helping doctors with procedures, and completing paperwork) do not involve direct patient care. If you have an epidural, your nurse's attention is drawn to technology used with epidurals, such as intravenous (IV) lines and electronic fetal monitoring (EFM). In addition, many hospitals are short-staffed, which makes demands on nurses that much greater.
  • organization of shifts: Nurses work shifts, which means the same nurse may not be on site throughout your labor. Doctors and midwives often rotate being "on call," which means you may not know well or may never have met the person who will attend your birth. It is unlikely that you will have met the nurses.
For these reasons, clinical caregivers in hospitals are rarely able to offer the direct continuous personalized labor support that has been shown to be so beneficial for laboring women. The Tips & Tools: Labor Support page of this section offers some help assessing the quality of labor support available in your birth setting.

These factors are less likely to be a problem at out-of-hospital ("freestanding") birth centers. They would rarely have an impact on home birth care.

Can a relative or friend meet my need for supportive care in labor?

When all or most births took place in homes, women learned about birth and cared for other laboring women as a central part of family and community life. This knowledge was lost when birth moved into the hospital and women were isolated from their loved ones during childbirth. Few women today are in an optimal position to assist a laboring woman, even if they have given birth themselves, for several reasons:
  • inexperience with supportive care: If they had a typical hospital birth, they, themselves, may not have received adequate supportive care. Thus, they may have no model to follow, including knowledge of comfort measures.
  • uncertainty about physiological processes of labor and birth: Many birthing women today experience inappropriate overuse of procedures, drugs, and restrictions. Many have not experienced a normal labor that has been allowed to begin on its own and supported to proceed at its own pace.
  • impact of the media: Media images rarely include direct supportive care and often sensationalize childbirth. Although the great majority of childbearing women in the U.S. are well and healthy, images of birth as a crisis that must be managed with many procedures and drugs are common.
  • challenges of providing supportive care in hospitals: Unlike homes and free-standing birth centers, those in hospitals who don't "know the ropes" or come prepared can have difficulty obtaining and using comfort measures.

Given these challenges, does it make sense to consider inviting a friend or relative to provide labor support?

The essence of labor support is to "mother the mother." A calm, nurturing person with a basic understanding and respect for birthing processes can provide helpful labor support. A friend or relative who takes on this role can offer a special gift to you, and can experience the great privilege of participating in this important event in your life. The Tips & Tools page in this section offers help choosing a family member or friend to provide labor support. The Resources page offers books and videos to help your labor support companion prepare for your birth.

Next >
Best Evidence: Labor Support

Most recent page update: 11/16/2012

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