In the current situation of Covid-19, doulas are switching to supporting their clients remotely instead of in-person. This switch from physical aid does not negate the validity of providing emotional support for laboring women by doulas. Emotional support is a form of pain relief.
“Pain is a good example of a mind-body connection. When the body feels pain, one’s thoughts and emotions are influenced by how much pain is felt. Depression and anxiety make pain worse, yet pain causes depression and anxiety. Stress makes pain worse, yet pain causes stress. Treatment for pain is education, helping patients to gain skills to manage a very trying problem.” (1)According to the Cleveland Clinic on Pain Psychological Treatment
Pain can have numerous of effects on how a mother feels, as well as detrimental consequences on the labor itself. Pain can also lead to increased stress and anxiety, which in turn can lead to a whole host of other problems.
“Fear tends to increase feelings of pain, which in turn increases feelings of fear and anxiety. This is believed to happen because the area of the brain that regulates emotional reactions is also stimulated when pain is felt. It also affects our hormones, that then tightens the uterine muscles. Fear is created in many ways during childbirth. Things like hospital routines, unfamiliar environments, strange people around you, and being confined can all lead to feelings of fear or that something is wrong.” (2)According to New Beginnings Doula Training material
The fear-tension-pain theory by Dr. Grantly Dick-Read, co-author of Childbirth without Fear, explains that pain during labor is caused by fear. Fear can cause the sympathetic nervous system to be stimulated. This in turn causes the circular muscles of the uterus to contract, which opposes the normal action of the uterus and results in oxygen deprivation and more pain.
Doula Actions to Help
Fears about pain before labor can be alleviated by discussing the birth plan. Showing and explaining ways that they can help work with their contractions as well as telling them what you plan to do as a part of their care team.
Visualization is a technique that can be used to decrease the flight or fight response and help the mother feel in control.
Deep breathing is very useful to help with feelings of anxiety. It helps decrease the flight or fight response that increases pain, decreases oxygen to the uterus, and may slow down labor. When used properly deep breathing can help to improve concentration, help give a greater sense of connected-ness, and increase the relaxation response.
Progressive relaxation works by helping to decrease the bodies flight or fight response and increase relaxation. It also helps the laboring mother and support person pay attention to when she is tensing up. This has been called the roving body check by other labor support professionals and can be used to help release tension during labor.
Additional Doula Actions
- Birth Affirmations (More information about birth affirmations can be found here: https://www.trainingdoulas.com/general/using-affirmations-during-labor/ )
According to a recent study conducted in China (3), fear and anxiety can result in adverse effects on the course of labor. The study concluded that women who did not receive continuous support during labor had 2.03 times the labor duration of women with supportive care. Continuous support should be a part of labor care.
Emotional support during labor is a form of pain relief to decrease fear, anxiety, stress and depression. During Covid-19, emotional aid can alleviate adverse effects during labor. Doulas can employ virtual support to assist the mind-body connection during labor and provide continuous emotional help for laboring mothers.