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Labor Support CheckList: Epidural, Pitocin, Doula (checked)Misconception about doulas #1: Women laboring with an epidural do not need a doula.

Reality: Doulas can give help through labor, birth and postpartum.  This includes providing information, emotional care, and physical comfort. Even though they experience less pain, fear and anxiety are possible.  Thus, women receiving epidurals often need these support systems in place   In fact, women reported that they still suffered with an epidural.  The support they received was a greater predictor of satisfaction than the level of pain they experienced.

Benefits of having a doula with an epidural

  1. A doula can help the laboring woman with coping skills until the anesthesiologist administers the medication.  In addition, she helps with breakthrough pain and any other discomforts (including pressure, nausea, or the shakes) that may come even with the epidural.
  2. A doula has knowledge of the causes of anxiety and fear and understands how to assess the woman’s needs.  She applies this information during labor, as the anesthesiologist gives the epidural, and after the mother receives the epidural.
  3. A doula helps her client come to terms with the new birth plan and discusses decisions her client needs to make.
  4. A doula can help promote physiologic principles to promote safe and effective labor.   This includes such things as positioning, assisting with sitting upright or squatting, helping the laboring mother rest, keeping the mother in the moment,  providing care that decreases fears and anxieties, creating a birthing environment that promotes physiologic labor, and helps her feel safe and comforted.

Misconception about doulas #2: Women who have supportive partners do not need doulas.

Reality: Having a supportive companion is wonderful and provides a positive experience for both people involved. Women come away from birth more satisfied if they have a partner that supports them and their choices, and it helps to strengthen their relationship. Nothing replaces that interaction for a birthing mother.

So what makes doulas useful?  They receive training and experience in labor support.  According to a national survey of women, Listening to Mothers, doulas ranked above partners for quality care by providing benefits that help decrease the chance of medical problems.  A recent Cochrane Review showed these advantages: women who used doulas were less likely to need a c-section or forceps, had shorter labors, and the infants had higher apgar scores.

The doula acts as a role model for the father.  In fact, it helps to have someone trained to show you how to help when you are at the birth. It allows the father to take breaks without feeling as if they are abandoning their partners, and a doula can verify the normalcy of the mother’s actions or what is happening in labor. The doula provides support for both the partner and the mother.

Misconception about doulas #3: Nurses already give support to birthing women.

Reality: Many nurses give good support, but they have to spend time on lots of other tasks.  This makes it difficult to give the laboring woman the attention they need. Tasks that nurses do include giving and monitoring medications, overseeing the health of mother and baby, documentation, consulting with the doctor or other medical professionals, and working with technology such as IVs, electronic fetal monitor, and epidurals. They work shifts which can interrupt the relationship with the birthing mother. In reality, nurses only spend between 6.1%-31.5% of their time giving labor support.

Doulas stay by the mom from the beginning until after the baby is born. They offer the one-on-one contact that the mother needs while in labor the whole time and allow rest periods for other support people. Because of these factors, and others that researchers have not studied yet, the use of doulas lower c-section rates, while being supported by just a nurse does not.

Additional resources you may enjoy:

blog: What is a doula?

handout: Doulas in the labor and delivery room

kits: Birth doula starter kit



Wuitchik M,  et al.  (1990)  Relationships between pain, cognitive activity, and epidural analgesia in labor.  Pain 41:136-142.

Balen, L. E., & Fulcher, A. J. (2006). Nurses and doulas: complementary roles to provide optimal maternity care. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 35, 304-311.

Hodnett, E. D., Gates, S., Hofmeyr, G. J., & Sakala, C., Weston J. (2011). Continuous support for women during childbirth. Cochrane Databaseof Systematic Reviews, Issue 2. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub3.

Follow Rachel Leavitt:

Rachel has worked as a register nurse (BSN from University of Utah) since 2004 with a work history in Labor and Delivery, NICU and Postpartum Care. She is also the founder of New Beginnings Doula Training which she organized in 2011. When she's not busy being a mother and grandmother, she can be found reading research papers related to some aspect of childbirth.

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