All Mothers need support DONA Position Paper: The Doula's Contribution to Modern Maternity Care
The birth of each baby has a long lasting impact on the physical and mental health of mother, baby and family.
In the twentieth century, we have witnessed vast improvements in the safety of childbirth, and now efforts to
improve psychosocial outcomes are receiving greater attention.
The importance of fostering relationships between parents and infants cannot be overemphasized, since these early
relationships largely determine the future of each family, and also of society as a whole. The quality of emotional
care received by the mother during labor, birth, and immediately afterwards is one vital factor that can
strengthen or weaken the emotional ties between mother and child. (1-5) Furthermore, when women receive
continuous emotional support and physical comfort throughout childbirth, their obstetric outcomes may
improve. (6-11)
Women have complex needs during childbirth. In addition to the safety of modern obstetrical care, and the love and
companionship provided by their partners, women need consistent, continuous reassurance, comfort,
encouragement and respect. They need individualized care based on their circumstances and preferences. The role of
the doula encompasses the non-clinical aspects of care during childbirth.
This paper presents the position of DONA on the desirability of the presence of a doula at childbirth, with
references to the medical and social sciences literature. It also explains the role of the doula in relation to the
woman's partner, the nurse, and medical care providers. This paper does not discuss the postpartum doula, who
provides practical help, advice, and support to families in the weeks following childbirth.
Role of the Doula In nearly every culture throughout history, women have been surrounded and cared for by other women during childbirth. (12) Artistic representations of birth throughout the world usually include at least two other women,
surrounding and supporting the birthing woman. One of these women is the midwife, who is responsible for the
safe passage of the mother and baby; the other woman or women are behind or beside the mother, holding and
comforting her. The modern doula is a manifestation of the woman beside the mother.
Doulas are trained and experienced in childbirth, although they may or may not have given birth themselves. The
doula's role is to provide physical, emotional, and informational support to women and their partners during
labor and birth. The doula offers help and advice on comfort measures such as breathing, relaxation, movement
and positioning. She also assists families to gather information about the course of their labor and their
options. Perhaps the most crucial role of the doula is providing continuous emotional reassurance and comfort.
Doulas specialize in non-medical skills and do not perform clinical tasks, such as vaginal exams or fetal heart rate
monitoring. Doulas do not diagnose medical conditions, offer second opinions, or give medical advice. Most
importantly, doulas do not make decisions for their clients; they do not project their own values and goals onto the
laboring woman. (13) The doula's goal is to help the woman have a safe and satisfying childbirth as the woman defines it. When a doula is present, some women feel less need for pain medications, or may postpone them until later in labor;
however, many women choose or need pharmacological pain relief. It is not the role of the doula to discourage the
mother from her choices. The doula helps her become informed about various options, including the risks and
