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Labor Support CheckList: Epidural, Pitocin, Doula (checked)

Nowadays, most people have at least heard about doulas. But there are still many misunderstandings about what they actually do when serving a laboring family. Here are some of the top misconceptions we have heard.

Misconception about doulas #1: Laboring with an epidural takes away the need for a doula.

Reality: Doulas help through labor, birth and postpartum.  This includes providing educational information, emotional care, and physical comfort. Even though clients with epidurals typically experience less pain, fear and anxiety are still possible, even likely.  Thus, women receiving epidurals often still need support systems in place   Reports show that many of them still suffer with an epidural. The support they receive is a greater predictor of satisfaction than the level of pain they experience.

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

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

Reality: Having a supportive companion is wonderful and provides a positive experience for both people involved. Everyone comes away from birth more satisfied if they have a partner who supports them and their choices. It helps to strengthen their relationship. Nothing replaces that intimate interaction.

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

The doula acts as a role model for the partner.  It helps to have someone trained to show you how to help when you are at the birth. The partner can take breaks without feeling as if they are abandoning anybody, especially since a doula can verify the normalcy of what is happening in labor. These assurances mean that a doula provides support for the whole birthing family.

Misconception about doulas #3: Nurses already give all the support needed at birth.

Reality: Many nurses give good support, but they have to spend time on several other tasks.  This makes it difficult for them to give the laboring family focused attention. They also work shifts which have defined beginnings and endings. This can interrupt crucial relationship bonding. Common tasks that nurses do include: giving and monitoring medications, overseeing the health of parent and baby, documenting the events and proceedings, consulting with the doctor or other medical professionals, and working with technology such as IVs, electronic fetal monitor, and epidurals. All that taken into consideration, nurses only spend between 6.1%-31.5% of their time giving labor support.

In contrast, doulas stay from the beginning of labor until after the baby is born. They offer one-on-one contact the whole time and allow rest periods for other support people. Because of these factors, (and others that researchers have not studied yet,) doula involvement lowers c-section rates. Whereas being supported by only a nurse does not.


Additional resources you may benefit from:

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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